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He did not report any menial health conceals and he denied any suicidal thoughts or intention. He was asking this writer to go to general population and was making requests for various needs he had at the lime. He wanted social calls without them being on a speaker phone. He wanted a book he had left in the suicide watch area. His mood was not depressed or anxious. There were no signs of distress. He had planned on meeting with his attorneys to work on his legal situation. Sent from my iPhone SDNY_00014076 Page 051 EFTA00137964 Psvchology Epstein Reconstruction Responses 1. Single Cell Placement A system has been put in place to ensure inmates are not single celled. A single cell report is completed during each shift by the Institution Duty Officer (IDO). Psychology discusses the status of inmates who are at-risk for suicidality, their housing needs, as well as their needs for cellmates during staff meetings, department head meetings, SHU meetings, morning meetings, and close out meetings. When inmates are placed on and off suicide watch, the Warden is notified verbally, regardless of the time of day. The Warden will then determine which suicide watch area a suicidal inmate will be housed and if they will be observed with an inmate companions or a staff member. Psychology will verbally notify the Lieutenant when inmates are removed from suicide watch and indicate they will need to be placed with a cellmate (Providing direct communication and instructions). Cellmates will be recommended not only for SHU inmates being removed from suicide watch, but also for inmate returning to general population. Once an inmate is removed from suicide watch, psychology staff will send an e-mail to the Executive Staff, 113O, and Lieutenants informing them the inmate is being removed from suicide watch and can return to a cell with a roommate. The e-mail will indicate the name of the staff member whom psychology verbally spoke with. This recommendation for a cellmate and conversation with the Lieutenant will also be documented in the Post Suicide Watch Report and placed in BEMR/PDS. Psychology Services has eliminated the use of Psychological Observation to avoid any confusion as to the needs of inmates on a watch status. 3. Cellmate Assignments Inmates with serious mental illness and those at-risk for suicidality are discussed during staff meetings, department head meetings, SHU meetings, morning meetings, and close out meetings. The Captain, Associate Wardens, Warden and Psychology discuss the inmate's needs. The Staff Attorney also assists when the inmate's attorney or court are concerned. Psychology Services will be more involved in making recommendations regarding the types of cellmates that inmates at-risk for suicidality should celled with. Psychology Services will take into consideration the suicide risk factors involved with a particular inmate and share their knowledge with Executive Staff. SDNY_00014077 Page 052 EFTA00137965 4. Documentation Accuracy Psychology will consider the information from more than one source when making decisions about suicide watch placement. Clinical judgment will be used to make determinations taking into consideration each person's self-report of a situation as they may be perceived differently. The Chief Psychologist has spoken to all psychology staff members concerning proof reading all documents entered to reduce typos. Additionally, there is a second Staff Psychologist in the department now which will help reduce the workload on current psychologists, allowing for more time for documentation review. The Chief Psychologist and Drug Abuse Coordinator counseled the Drug Treatment Specialist (DTS) concerning her documentation in the suicide watch log book. There was no ill-intent on the part of the DTS as all log books were maintained, the original log book written by the officer and the one documented by the DTS. The DTS indicated a desire to assist the officer as he had written in the wrong log book; he wrote in the inmate companion log book rather than the staff log book. However, she was informed that this is not her role and she is not to document for anyone else observing an inmate on suicide watch. In the future, only the staff member watching the inmate on suicide watch will document in the suicide watch log book. Log books are now being closely monitored on a daily basis by the Chief Psychologist. The Psychology Department has eliminated Psychology Observation at MCC-NY. Both Staff and the Lieutenants will receive additional training on when they are required to complete rounds and sign Suicide Watch log books. With regard to suicide watch log books signatures, a unit officer will be rounding the suicide area hourly and signing the suicide watch log books. Additionally, Lieutenants need to be signing the book for each shift (MW, DW, EW) like they do for the regular housing units. The Unit 2 Officer will sign the books hourly in the SW area when they are doing their Unit 2 rounds. Psychology staff will check the books daily when they interview the inmates on suicide watch. If it is noted hourly rounds are not being conducted by the Unit Officer and/or the Lieutenant's are not rounding and signing the books each shift, the Captain will be notified immediately and will enforce accountability. 6. Direct (Miser% a tion The Psychology Department has eliminated Psychology Observation at MCC-NY. Inmates on Suicide Watch will not go to legal visits unless prior authorization is approved by Psychology, Lieutenants, and the Captain. Legal visits will only be provided under special circumstances when an inmate is on suicide watch precautions. When an inmate is on the legal visit, there will be continuous observation by a staff member who will record their observations in the suicide watch log book every 15 minutes. SDNY_00014078 Page 053 EFTA00137966 7. Follow Up Staff will again be trained that when they have concerns for an inmate's mental health, they need to make verbal contact with either Psychology Staff or a Lieutenant. If Psychology is not in the institution, an inmate will be placed on suicide watch, and the on-call psychologist and Warden will be notified. All Psychology Staff added a response to their incoming emails. This automatic replay states, "If you are emailing about an inmate that may be at risk for suicide or self-harm, this is an emergency situation. Please make sure that you make contact (verbally) to Psychology Staff or the on-call psychologist. Please ensure to maintain constant visual observation of the inmate until formal steps can be taken to ensure his safety pending a formal assessment by a Psychologist." The Psychology Department will use PSY ALERT codes more frequently with high profile cases and with inmates with a history or charge of a sex offense. The PSY ALERT code will be applied more immediately and not just when an inmate is about to leave the institution. If an inmate is moved in and out of our institution for court, etc., the inmate will be assessed more immediately prior to being released to a unit. R&D staff will be reminded of the Marshall and Court alert notices. Psychology Staff need to be notified immediately if there are suicidal concerns noted by the Courts. If Psychology is not in the institution, an inmate that enters the institution with an alert notice will be placed on suicide watch, and the on-call psychologist and Warden will be notified. These inmates will receive a suicide risk assessment by a psychologist before being released to the general population. 8. Inmate Accountability and Assignment Accuracy With regard to the accuracy and accountability of inmates placed on suicide watch status in the hospital area, Psychology Services now runs a daily Sentry roster of all the inmates on suicide watch in the hospital area. The roster is examined to ensure that the inmates placed on suicide watch in a suicide watch cell are keyed into SENTRY with the correct cell assignment noted. The Associate Warden, Programs, is notified if there are any inconsistencies. Moreover, the four suicide watch cells now all have Sentry Assignments of H01-001L - H01-004L. 11. Post Orders & SHU Training The Suicide Watch Post Orders will be located in the Lieutenant's Office with a quarterly sign-in sheet. All staff members assigned to a suicide watch post will be responsible for signing the post orders prior to performing the staff suicide watch. SDNY_00014079 Page 054 EFTA00137967 With regard to SHU Suicide Prevention training, this will continue to be carried out on a quarterly basis. However, the sign-in sheets for this training will be examined by the SHU Lieutenant for accuracy. If a staff member who is assigned to SHU misses the training, they will need to see the Chief Psychologist and schedule a time to receive a make-up session for the SHU Suicide Prevention Training. 12. Staffing The current Drug Abuse Coordinator position is currently a shared position. The Warden is currently working on re-establishing the Drug Abuse Coordinator position as a full-time position to provide the Psychology Department with an additional supervisory psychologist to perform critical clinical services. At the current time, the position has been approved and it has been sent to the region to formally announce. 13. Sex Offense Risk Factors The Chief Psychologist or her representative will continue to be present at all Executive Staff Meetings, Department Head Meetings, and SHU meetings. During these meetings, the Chief Psychologist will offer feedback regarding the treatment and management of sex offender inmates. Additionally, the Chief Psychologist will continue to educate all staff during IF and AT, about the sex offender specific risk factors and suicidality. SDNY_00014080 Page OSS EFTA00137968 Truscope.Silverlight.Dashboard P:1;2 c ot 01:81W1018 • 0/11/2019 AA SOPA SISOxtribrid Ask v, 9 SOUTH SHU fr:q atioi 14p1Rsc Irate Lib Ms CectreSni CM Ws Daly kin* SIG Nevarmates aleithgveri 7W2019 V1412019 I Sided Events v anent 4 Cr 4: 74 STU i 06t0012 OS:39 F14 CCM 011:38 PH en*1STAN OIMEaS lrmatt: 7631504 • EPSIEIN, IFREY. 0111012019 07:ZS 01 071102619 03:24 Pri .A. Acialii*A Watt 7631%4 • ESTI:DOERR 02270019 07:22 H1/07/0712019 07:21 P/I tretinil 0:Naa WAIS Imate: 76316054 • KI14.1FFALY. HousiN Urit, 9 SOUTH Sal Irate Search rI Irttf:n Sift Sins 1242(4 fil00 v1.12 1rep I if • ;604 SDNY_00014081 hups://10.33.3.57/Dashboard.aspx 8/10/2019 Page 05C EFTA00137969 U.S. Department of Justice Federal Bureau of Prisons MCC New York 150 Park Row NY, NY 10007 August 12, 2019 DIRECTOR MEMORANDUM FOR JEFFERY D. ALLEN, M.D., MEDICAL lrAtor , Acting Clinical D FROM: o MCC New York SUBJECT: 24-hour death report Inmate Name (LN, FN) Epstein, Jeffery Edward /6318-054 Register Number August 10, 2019 DOD DOB January 01, 1953 Sex Male White Male Race Institution/Region MCC New York - Northeast Region Care Level-1 Care Level Care l-MH MR Care Level Alleged Suicide Preliminary Cause of Death y Hospital Location of Death (p) Institution (/) Communit (CD) Other: TYPE OF DEATH: F-1 Natural Suicide aAccidental r-1 Homicide Legal Execution F-1 Unknown DNR ordered YES (E) NO YES (CI) NO If no, reason Autopsy ordered RIS addressed (0) YES (C]) NO (GU) N/A Anticipated death (0) YES (0) NO fication and submit to the Please attach PP37 with this noti mailbox within 24 hours of BOP-HSD/Quality Management-@bop.gov if weekends/holiday inmate death or next business day S0N1t00014082 EFTA00137970 r CLINICAL SYNOPSIS OF EVENTS LEADING TO DEATH: (Please provide sufficient information including a short summary of past medical history, length of hospitalization or emergency room care, and staff response to this event). Inmate Jeffery Edward Epstein #73618-054 a 66 year old male with a history of Obstructive Sleep Apnea on CPAP at night, a history of Hypertriglyceridemia treated with Vascepa, no past Mental Health History prior to incarceration and L4-L5 Stenosis. On July 23, 2019, at 2:00 a.m. he was placed on Suicide Watch for 31 hours and 5 minutes due to abrasion located on the lower anterior surface of his neck area. On July 24,2019 he was taken off Suicide Watch and was placed on Psychological Observation. On July 30,2019, he was removed from Psychological Observation and was placed in the Special Housing Unit where he was housed with a cell mate. On August 8, 2019, he was seen by Psychology Services and denied suicidal ideation, intention or plan. On August 10, 2019, at 6:33 a.m. Special Housing Unit Staff found inmate Epstein unresponsive in his cell and attempted to wake him. The body alarm was activated in SHU and the Control Center announced a medical emergency. CPR was initiated by Special Housing Unit Staff. At 6:35 a.m. medical staff responded and continued CPR and the AED was applied. The Control Center called for an ambulance. The EMS arrived at 6:45 a.m. and the paramedics continued CPR. Inmate Epstein remained unresponsive. Inmate Epstein was intubated, and the ACLS Protocol was initiated by the EMS. No pulse found, no shock was advised and the inmate was prepared for transport to local hospital while continuing CPR. At 7:10 a.m. the EMS departed institution en route to New York Presbyterian Lower Manhattan Hospital. At 7:36 a.m. the inmate was pronounced dead by the ER Physician. SDNY_00014083 0 2n nkft EFTA00137971 24 Hour Death Report Page i of 1 24 Hour Death Notification Recieved Death Notification for Epstein (#76318-054) NYM successfully received on 2019-08.12 @ 14:30:08 r (Eastern) Notification sent to Region and Central Office including the Medical Director and OQM. Submitted by: (80P527811 You may save and/or print this page for your local records. Local Date And Time of Pronounced Legal Death:08/10/201907:36 Location: Community Hospital Type: Suicide Autopsy Status: Autopsy Ordered RLS: na Anticiapted Death: no DNR/LSCE no PreWminary Cause of DeathAlleged Suicide Apnea on CPAP at night a Narrative Inmate Jeffery Edward Espstien *73618-054 a 66 year old male with a history of Obstructive Sleep and L4-15 Stenosis. On July history of Hypertriglycendemia treated with Vascepa, no past Mental Health History prior to incarceration Suicide Watch for 31 hours and 5 minutes due to abrasion located on the lower anterior surface 23, 2019. at 2:00 a.rn he was placed on taken off Suicide Watch and was placed on Psychological Observation. On July 30,2019, he was of his neck area. On July 24,2019 he was cell mate. On August removed horn Psychological Observation and was placed in the Spacial Housing Unit where he was housed with a and denied suicidal ideation, intention or plan. On August 10. 2019, at 6:33 ant Special 8, 2019, he was seen by Psychology Services The body alarm was activated in SHU and Housing Unit Staff found inmate Epstein unresponsive in his cell and attempted to wake him CPR initiated by Special Housing Unit Staff. At 6:35 a in. medical staff the Control Center announced a medical emergency. was Control Center called for an ambulance. The EMS arrived at 6:45 am. and responded and continued CPR and the MD was applied. The unresponsive. Inmate Epsten was intubated, and the ACLS Protocol was the paramedics continued CPR Inmate Epstein remained theinmate prepared for transport to local hospital while continuing initiated by the EMS. No pulse found no shock was advised and was New York Presbyterian Lower Manhattan Hospital. At 7:36 am. the inmate CPR. At 7:10 a.m. the EMS departed institution en route to was pronounced dead by the ER Physician. SDNY_00014084 https://map.bop.gov/SASStoredProcess/do?_program=%2FProjects%2FHSD%2FWeV/02... 8/12/2019 Pane MO EFTA00137972 From: Cr> r To: Data: 8/12/2019 2:30 PM Subject: 24 Hour Death Notification Death Notification for Epstein (#76318-054) @ NYM successfully received on 2019-08-12 @ 14:30:08 (Eastern) Notification sent to R ion and Central Office including the Medical Director and OQM. Submitted by: [8OP527811 Local Date And Time of Pronounced Legal Death: 08/10/2019 07:36 Location: Community Hospital Type: Suicide Autopsy Status: Autopsy Ordered RIS: na Anticipated Death: no DNR/LSO: no Preliminary Cause of Death: Alleged Suicide Narrative: Inmate Jeffery Edward Espstien #73618-054 a 66 year old male with a history of Obstructive past Mental Sleep Apnea on CPAP at night, a history of Hypertriglyceridemia treated with Vascepa, no Health History prior to incarceration and L4-L5 Steno due to sis. On July 23, 2019, at 2:00 a.m. he was placed on Suicide Watch for 31 hours and 5 minutes was taken off Suicide abrasion located on the lower anterior surface of his neck area. On July 24.2019 he Watch and was placed on Psychological Observation . On July 30.2019, he was removed from Psychological Observation and was placed in the Special Housing Unit where he was housed with a cell mate. On August 8, 2019, he was seen by Psychology Services and denied suicidal ideation, intention or plan. On in his cell August 10, 2019, at 6:33 a.m. Special Housing Unit Staff found inmate Epstein unresponsive Center announced a and attempted to wake him. The body alarm was activated in SHU and the Control medical emergency. CPR was initiated by Special Housing Unit Staff. At 6:35 a.m. medical staff responded and continued CPR and the AED was applied. The Control Center called for an ambulance. The EMS arrived at 6:45 a.m, and the paramedics continued CPR. Inmate Epstein remained unresponsive. Inmate Epstein was • intubated, and the ACLS Protocol was initiated by the EMS. No pulse found, no shock was advised and the inmate was prepared for transport to local hospital while continuing CPR. At 7:10 a.m. the EMS departed institution en route to New York Presbyterian L ower Manhattan Hospital. At 7:36 a.m. the inmate was pronounced dead by the ER Physician. the Use this link: https://sallyport.bop.gov/co/hsd/quality_managernenVSAS/admin_dashboard.jsp to view Death Report Dashboard. It will allow you to review user submitted death report data along with automatically merged SENTRY information. It may take up to several hours for newly submitted death data to appear on the dashboard. SDNY_00014085 Par. nnr. EFTA00137973 OFFICE OF CHIEF MEDICAL EXAMINER CITY OF NEW YORK REPORT OF AUTOPSY Name of Decedent: Jeffrey Edward Epstein M.E. #: M-19-019432 Autopsy Performed by: Kristin Roman, M.D. Date of Autopsy: 08/11/2019 FINAL DIAGNOSES: I. HANGING: A. LIGATURE FURROW OF NECK B. PETECHIAL HEMORRHAGES OF BILATERAL PALPEBRAL CONJUNCTIVAE AND OF ORAL MUCOSA C. CONFLUENT HEMORRHAGES OF RIGHT BULBAR CONJUNCTIVA D. PLETHORA OF FACE AND HEAD WITH PETECHIAL HEMORRHAGES OF FACE E. FRACTURES OF BILATERAL THYROID CARTILAGE CORNUAE AND LEFT HYOID CORNUA WITH ACCOMPANYING SOFT TISSUE HEMORRHAGES 1. SEE ANTHROPOLOGY REPORT F. RESUSCITATION ATTEMPTED 1. ABRASIONS OF MOUTH 2. ANTERIOR PARASTERNAL RIB FRACTURES 3. HEPATIC LACERATION WITH THIN HEMOPERITONEUM II. ABRASIONS OF LEFT FOREARM III. CUTANEOUS CONTUSIONS OF WRISTS IV. SUBCUTANEOUS HEMORRHAGE OF LEFT DELTOID MUSCLE V. HYPERTENSIVE AND ATHEROSCLEROTIC CARDIOVASCULAR DISEASE A. CARDIAC HYPERTROPHY (440 GM) B. LEFT VENTRICLE HYPERTROPHY (1.9 CM) C. RENAL ARTERIOLAR SCLEROSIS D. SLIGHT CORONARY ATHEROSCLEROSIS E. SLIGHT TO MODERATE AORTIC ATHEROSCLEROSIS VI. HEPATIC STEATOSIS (2480 GM) VII. CERVICAL LYMPHADENOPATHY VIII. REMOTE FRACTURE OF RIGHT FIRST RIB IX. REMOTE APPENDECTOMY (DATE AND INDICATION UNKNOWN) X. SEE TOXICOLOGY REPORT XI. SEE NEUROPATHOLOGY REPORT SD 14',236 EFTA00137974 CAUSE OF DEATH: HANGING MANNER OF DEATH: SUICIDE(HANGED SELF) SDNY 000'4C81 EFTA00137975 OFFICE OF CHIEF MEDICAL EXAMINER CITY OF NEW YORK REPORT OF AUTOPSY CASE NO. M-19-019432 I hereby certify that I, Kristin Roman, M.D., City Medical Examiner - ll, have performed an autopsy on the body of Jeffrey Edward Epstein, on the 11 of August 2019, commencing at 9:21 AM in the Manhattan Mortuary of the Office of Chief Medical Examiner of the City of New York. EXTERNAL EXAMINATION: The body is received in a sealed, labeled, plastic body bag (seal #152384). The body is of a well-developed, thin, muscular, light skinned, 5'10", 196 lb man whose appearance is consistent with the given age of 66 years. The scalp hair is wavy, predominantly grey with interspersed dark hairs, has slight male pattern balding, and measures up to 3". The facial hair is cleanly shaven. The eyes have light irides. The oral cavity has intact teeth in good repair. The tongue is free of natural disease. The finger and toenails are well groomed and free of polish. Striae are on the shoulders. The genitalia are atraumatic and of a normal, circumcised man. The anus is atraumatic. POSTMORTEM CHANGES: There is moderate, symmetric rigor mortis of the upper and lower extremities and the jaw. Lividity is fixed, purple, and unevenly distributed on the posterior surfaces of the body. The body is cool. SCARS: On the back of the left shoulder is an oblique, 1-1/2", well healed, linear scar. On the right lower quadrant of the abdomen is an oblique, 2", well healed, linear appendectomy scar. THERAPEUTIC PROCEDURES: An endotracheal tube is in the mouth, extending into the upper airway. On the lips are multiple, focal, red abrasions. A cervical collar encircles the neck. Electrocardiogram electrodes are on the torso. An intravascular catheter is in the left antecubital fossa. An intraosseous line is in the right shin. A blood pressure cuff encircles the upper, right arm. On the chest between the nipples is a 3" x r, irregular, yellow abrasion. Internally, there are minimally hemorrhagic, parasternal, rib fractures of right ribs #4-6 and left ribs # 5-6, approximately 60 ml of liquid blood thinly coating the serosal SU\V LIUDIC6.3 EFTA00137976 M-19-019432 JEFFREY EDWARD EPSTEIN Page 4 surfaces of the intra-abdominal organs, and an oblique, 6.5 cm laceration of the liver to the left of the falciform ligament (artifacts of resuscitative chest compressions). CLOTHING: The body is received clad in a hospital gown. INJURIES, EXTERNAL AND INTERNAL: These injuries are described in reference to standard anatomic planes. These injuries are grouped and labeled for descriptive purposes only; no sequence is implied. A. HANGING: There is a depressed, focally dried and abraded, noncircumferential ligature furrow of the neck that peaks slightly on both sides of the neck, more steeply on the right side than on the left. On the right side of the neck, the furrow bifurcates anterior to the ear, with one arm that peaks behind the right ear and one arm that extends to the right side of the back of the neck. On the back of the right side of the neck at the end of the lower arm of the furrow is a 1/2" x 1", irregular, red abrasion. The furrow ranges from 13-3/4" to 15" long (measured from both ends of the furrow on the right), and ranges from 1/8" to 1/2" wide. Anteriorly, the furrow passes over the thyroid cartilage. On the upper edge of the right side of the furrow beneath the chin is an adjacent, % x 1", inverted V-shaped, linear abrasion that ranges in width from 1/8" to 1/4". Beneath the left side of the mandible is a faint, 1/2" x 1-3/4", irregular, red abrasion with multiple, interspersed, deeper, red abrasions that measure up to /14 x 3/8". The face and head are plethoric above the furrow, with petechial hemorrhages of the face that are most marked within the eyebrows. There are multiple, petechial hemorrhages of the palpebral conjunctivae of both eyes, and confluent hemorrhages on the periphery of the right bulbar conjunctiva. There are faint petechial hemorrhages on the mucosal surfaces of the upper and lower lips. Within the parenchyma of the tongue are multiple, focal, spotty, purple hemorrhages. There is diffuse, purple hemorrhage at the base of the tongue. There are no hemorrhages of the anterior strap muscles of the neck. Posteriorly, there is a single hemorrhage in the left, deep, paraspinal muscles. Both thyroid cartilage cornuae are fractured, and the left cornua of the hyoid bone is fractured, all with accompanying soft tissue hemorrhages. See also "Anthropology Report." There are no fractures of the cervical vertebrae. B. OTHER INJURIES: On the back of the left forearm is an oblique, 1", linear, red, abrasion with an adjacent, 1/2" x 1-1/4", faint, red abrasion. On the medial aspect of the back of the right wrist is a 1/8" x 1/2", faint, red contusion, and on the medial aspect of the back of the left wrist is a SONY 000 EFTA00137977