LAKE TOXAWAY, N.C. (AP) — A 12-year-old boy who was enrolled in a wilderness therapy program for troubled youths in North Carolina died in February from an inability to breathe in the mostly plastic tentlike structure he was sleeping in, according to an autopsy report.

The 8-page report released Monday by North Carolina’s chief medical examiner’s office focused on the damaged bivy, or small camping enclosure, and determined the adolescent died of asphyxia.

The bivy’s internal mesh door was torn, while a weather-resistant door was used instead to secure the opening, the report stated. Medical examiners noted that bivy products often warn against fully securing the weather resistant opening because it may lead to “breathing restriction.”

“Asphyxia due to smothering refers to death due to the inability to breath in oxygen, in this case due to covering the nose and mouth with a non-breathable material,” the medical examiners wrote.

The autopsy report is the fullest accounting so far of the boy’s death, which occurred in the care of Trails Carolina. The organization has described itself as a nature-based therapy program that helps 10-to-17-year-olds “work through behavioral or emotional difficulties.”

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Trails Carolina did not immediately respond to an email sent through its website seeking comment. The program is in Lake Toxaway, in mountains about 120 miles (190 kilometers) west of Charlotte.

Two weeks after the boy died, the North Carolina Department of Health and Human Services said it was removing all children from the program’s care for two months “to ensure the health and safety of the children.”

Trails Carolina said in a February news release that “everything points to an accidental death.”

“We grieve with the family of the student who tragically passed and have promised to do everything we can to determine what happened,” the release said.

The boy had history of anxiety, attention deficit hyperactivity disorder and migraines, the autopsy report stated. He was brought from his home in New York to the Trails Carolina wilderness program at the request of his family. He died less than 24 hours after arriving.

A counselor told detectives from the Transylvania County Sheriff’s Office that the boy refused to eat dinner and was “loud and irate,” but later calmed down and ate snacks, according to an affidavit filed with a search warrant that was released in February. The boy slept on the bunkhouse floor in a sleeping bag inside a bivy that had an alarm on its zipper triggered when someone tries to exit.

The counselor said the boy had a panic attack around midnight and was checked on at 3 a.m. and 6 a.m., the affidavit stated. He was stiff and cold to the touch when he was found dead at 7:45 a.m.

According to the autopsy report, the bivies the campers slept in were placed on top of a thick plastic sheet that was folded up the sides in the form of a “canoe.” Because the boy’s mesh door was torn, the weather-resistant door was secured with the alarm.

Counselors checked on the boy during the night but couldn’t actually see him because of the “outer, opaque layer” of the bivy being closed, the autopsy report stated.

When the boy was found dead, his body was turned 180 degrees from the entrance and his feet were near the opening, “which would have allowed the waterproof material to fall onto his head and face,” the report stated.

“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,” medical examiners wrote. “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.”