The death of an elderly North Carolina woman who died after her oxygen-concentration device stopped working because someone shot out a power transformer, cutting power to her neighborhood, has been ruled a homicide by the state medical examiner, raising the stakes in a series of similar attacks that have been undertaken by right-wing groups nationwide.

Per the Washington Post, 87-year-old Karin Zoanelli died on December 3rd after her device stopped working when 45,000 residents of Moore County lost power. Zoanelli’s husband woke in the middle of the night to find her lying on the floor with no pulse.

At the time, police said the attack appeared deliberate, with the shooter knowing exactly what to target to knock out power to the most people. A neo-Nazi group claimed responsibility, saying it was done to prevent a drag show from performing at a nearby club.  The damage from the attack caused so much damage, internet service was cut, schools had to be closed and pharmacies had to relocate or discard refrigerated drugs. 

“While the decedent succumbed to her pre-existing natural disease, preceding failure of her oxygen concentrator as a result of a power outage precipitated her demise through exacerbation of her breathing insufficiency,” reads the August 24 report signed by an associate chief medical examiner for North Carolina. “And since the power outage involved reportedly occurred in the setting of a criminal firearm attack on the regional electrical distribution substation, the manner of death is best classified as Homicide.”