Tooth infection and dental disease have been cited as the cause of death for a Haitian man who died in ICE custody this spring, according to the Maricopa County Medical Examiner’s Office.

Emmanuel Damas, 56, died on March 2 in a hospital in Scottsdale, Arizona. ICE said he was transported to the hospital on Feb. 19 after complaining of shortness of breath while at the Florence Detention Center in Florence, Arizona. Damas was taken into custody in September and remained detained until his death.

The Maricopa County medical examiner’s website now lists Damas’ primary cause of death as “Complications of Necrotizing Mediastinitis with Neck and Retropharyngeal Abcess in the setting of Severe Dental Caries and Peridontal Disease.”

The report also lists the “manner of death” as “natural.”

An operator at the medical examiner’s office said Friday that a preliminary report had not yet been issued and that reports are not released for 90 days. The medical examiner did not immediately return a message seeking comment Friday afternoon.

The Department of Homeland Security responded on Sunday saying in a statement to NBC News that Damas, “On January 8, Emanuel Cleeford Damas, a criminal illegal alien from Haiti that was facing criminal charges for assault and battery, REFUSED dental extraction and claimed his tooth did not hurt anymore.”

The statement went on to say Damas was seen again on February 12 by dental for bleeding gums and loose front teeth. “Two teeth were recommended for extraction, and he REFUSED again.”

“It is a longstanding practice to provide comprehensive medical care from the moment an individual enters ICE custody,” the statement said. “This includes medical, dental, and mental health services, access to medical appointments, and 24-hour emergency care. Many individuals receive healthcare in ICE custody that exceeds what they have previously experienced.”

In a statement on March 6, ICE described in detail Damas’ medical treatment, stating that he was tested at the hospital and had been in the hospital’s intensive care unit throughout his stay. It did not include discussion of and concerns Damas may have raised about his teeth or whether he made requests for dental treatment.

Days after his death, Damas’ brother told The Associated Press that Damas died from an untreated tooth infection.

An attorney for Damas’ brother did not respond to request for comment Friday afternoon.

Damas’ brother Presly Nelson has previously said his brother was fine before he was detained. Nelson said Damas had periodically undergone routine dental care but did not have serious issues. Nelson said the last week he spoke to his brother, Damas was complaining about a toothache.

Nelson said a person who had befriended Damas while they were both detained called him to tell him Damas was not doing well and that he had been taken to the hospital. Nelson said the friend said Damas had been complaining of a toothache and received ibuprofen from a nurse at the detention facility.

“At no point did we think this would happen. The last time I spoke to him, had I known that would have been the last time, I would have made it a more meaningful conversation,” Nelson said previously.

Rep. Adelita Grijalva, an Arizona Democrat, said the medical examiner’s preliminary findings raise more questions about Damas’ medical treatment while in custody.

She said she had formally requested Damas’ medical records, records of complaints to staff and a “full accounting of the circumstances leading to his death.” She said in a statement that her office has not received “the full records, transparency or accountability that his family deserves.”

The medical examiner’s final report is scheduled to be issued later this month.