COLUMBIA, S.C. - A patient at a state mental hospital in South Carolina died earlier this year after being at the bottom of a dogpile of several employees — something specifically prohibited in their training.

Three of the 13 employees involved in the death of 35-year-old William Avant in January had not been through training on physically restraining patients, according to The State newspaper . His death hadn’t been reported prior to Sunday.

Video of the incident showed the employees on top of Avant at a Columbia mental hospital for four minutes. His face was blue and he was unresponsive when they got up.

The State Law Enforcement Division investigated Avant’s death but did not press charges.

The newspaper reported that agents and the Department of Mental Health refused to release records. They cited patient privacy laws even though Avant died in the government’s care.

Avant’s family declined to talk to the newspaper through their attorney.

Avant had been under the Department of Mental Health’s care for a dozen years. He had Klinefelter syndrome — a rare chromosomal disorder linked with anxiety, depression, learning disabilities and behavioural problems, such as impulsivity, according to medical records obtained by the newspaper.

The incident that led to Avant’s death started Jan. 22 with him repeatedly kicking a glass window. Employees were talking to Avant, but then tackled him as he tried to push his way into a room where medicines were stored, according to video of the incident.

Several workers held Avant’s arms and others lay across his back in direct violation of policies on restraining patients. No one checked Avant’s breathing during the four minutes he was on the ground, the video shows.

The Department of Mental Health’s training manual that is supposed to be given to all employees tells workers in red capital letters to always monitor the breathing of someone being restrained and to not lie on their head, neck, back or chest because that can put pressure on their chest and keep them from breathing.

As soon as employees realized Avant wasn’t breathing, they started CPR. He died at the hospital, and Richland County Coroner Gary Watts ruled his death a homicide by suffocation.

Three of the 13 workers who helped restrain Avant had not had training in the procedure and one had gone four years without the annual classes, according to Department of Health and Environmental Control records.

Several employees were suspended and the agency was cited for regulatory violations, but no criminal charges were filed, documents obtained by the newspaper showed.

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Information from: The State, http://www.thestate.com