The death of a 12-year-old boy at a controversial wilderness therapy camp in North Carolina was ruled a homicide, according to an autopsy released by the state’s chief medical examiner.

The autopsy listed the boy’s cause of death as "asphyxia due to smothering." The boy died after being at the Lake Toxaway-based camp for less than 24 hours.

"No significant natural disease was present to have caused or contributed to death. Non-specific findings included swelling of the brain. Mild bruising was present on the left thigh and leg without significant internal injuries," the autopsy states.

The boy, who Fox News Digital will not identify due to his age, was made to sleep in a bivy bag – a bag that converts a sleeping bag into a one-person shelter. The autopsy indicated that the solid outer layer of the boy's bag was zipped because the mesh layer was torn.

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The autopsy noted that commercially available bivy products include "a common warning" indicating that the opening "should not be fully secured as it may lead to condensation and breathing restriction."

The boy's bivy bag was also closed with an audible alarm that was placed there to prevent him from being able to open the bag himself, according to the autopsy.

"It is unclear if elevated temperature (hyperthermia) may have also played a role in death since he was partially undressed and the way the sleeping area was constructed could have resulted in increased environmental temperature. He was placed into this compromised sleeping area by other(s) and did not have the ability to reasonably remove himself from the situation with the alarm securing the opening. The standard protocol was deviated from due to using a damaged bivy and securing the outer weather-resistant door instead of the inner mesh panel," the report read. "With this combination of factors, the death is best certified as homicide."

The autopsy states that counselors at the camp failed to check on the boy as they should have because they could not see through the "opaque" outer panel.

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Authorities also reviewed the boy's medication. The autopsy noted the absence of three clonidine tablets.

Clonidine is an "antihypertensive drug that lowers blood pressure and heart rate by relaxing the arteries and increasing the blood supply to the heart," according to the National Institutes of Health. However, "testing did not detect an elevated or toxic level of clonidine," the autopsy report read.

The boy was found dead on Feb. 3 in a cabin at Trails Carolina, according to the Transylvania County Sheriff's Office. 

The boy had been sent to the camp from his home in New York by his parents for reported behavioral issues.

According to an investigative report, on his first night, the boy was restless and mumbling in his sleep. A camp counselor also said the boy was "thrashing about." However, the autopsy said the boy had no known history of seizures. 

The next morning, the boy was found on his right side with his head at the foot of the bivy bag, which tapered at the end.

The autopsy states that after emergency medical personnel arrived, it was determined that the boy was already beyond life-saving measures due to rigor mortis being present, indicating he had likely been dead for several hours.

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Fox News Digital has been in contact with Trails Carolina throughout the investigation and is awaiting a statement on the autopsy results. 

The camp previously told Fox News Digital that there was "no evidence of criminal conduct or suspicious acts" and that they were complying with law enforcement in the investigation.

The Transylvania Sheriff's Office also issued a statement to Fox News Digital saying that "they will not be discussing any details of the investigation."

"As stated in the press release, we are reviewing the ME report in conjunction with the criminal investigation and will be meeting with the District Attorney," the sheriff's office said.

Following the death of the boy, Trails Carolina halted new admissions to the camp as the investigation continued.

Fox News Digital's Audrey Conklin contributed to this report.