Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: |5 Date: 07/27/2019 07:14 Provider: —— Focus of Session He was seen by writer while he was on Psych Observation. | Subjective/Objective Presentation The "Eating/Shower Chart” indicated yesterday he ate dinner, drank liquids, and took a shower when offered. The Psych Observation Log noted he brushed his teeth, went to a Legal visit, talked about business and investing to an Inmate Companion, ate, and slept. When interviewed, he stated he still cannot remember what happened in SHU that caused the marks on his neck. He stated that for the 5 days before that he had only slept about 30 minutes each night because of noise in SHU. He stated he is anxious about going back to SHU because he stated he is going back to a place where he had gotten marks on his neck and he does not know why it happened. | He said he has an appetite and is eating. He said he is waking up every 1 1/2 hours. He stated he feels because he is not drinking enough water because he stated he feels he is not given enough bathroom breaks while with his Attorney. Medical was e-mailed with his complaint of feeling dehydrated. He said his Lawyers and fri emotionally supportive. Current Mental Status: He exhibited a neutral mood with a full range of affect. His speech was logical and no loosening of associations or tangential, circumstantial or irrelevant speech. Auditory and visual hall denied, and delusions were not elicited. He did not engage in any bizarre or inappropriate behavior. He den ied current suicidal or self harm ideation. He stated “I'm a coward." He added he does not like pain and even does not like when he has to give blood. He agreed to immediately tell staff and Inmate Companions if he starts to have suici harm thoughts. He was future oriented. He does not appear to be an immediate danger to self. He denied hurting others and he agreed to tell staff and Inmate Companions if he has these thoughts. Intervention(s) Supportive and educative interventions were provided. Turning Points handouts on stress management, , and building a routine in SHU were placed on his cell door to be given to him when his food slot is opened. He stated he wants it noted in his chart that he is being given a pamphlet on sleep, but that is not going to help because of the noise in SHU that prevents him from sleeping. Progress/Plan He will remain on Psych Observation in an abundance of caution and pending housing arrangements to be made on Monday. While on Psych Observation, he will be seen daily by Psychology. Completed by i: 07/28/2019 09:19 Generated 07/28/2019 09:19 by Bureau of Prisons - NYM Page 1 of 1 EFTA00032162

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Bureau of Prisons “SENSITIVE BUT UNCLASSIFIED“ Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 7631 8-054 Date of Birth: 01/20/1953 © NYM Unit Team: | 5 Date: | 07/28/2019 08:33 Provider: He was seen by writer while he was on Psych Observation. Subjective/Objective Presentation The "Eating/Shower Chart” noted that yesterday he ate breakfast He is not in the Psych Observation cell for about 12 hours per day because of being in Attorney Conference with his Attorneys, so the "Eating/Shower Chart" may not reflect all of his meals. He stated he was served one meal in Attorney Conference yesterday. He stated he drinks a lot water at night. The Psych Observation log noted he talked about life in general population and he slept. Earlier he had complained that his right arm was numb and hanging. Nurse Columbo from Medical had n him for this. | When this writer was interviewing him, he said his right arm still feels somewhat numb and he said he cann\ make a fist wh tet hand He also said he has numbness on his neck. This writer notified Nurse J sn ogg He said in the movie "Rain Man," the person with Autism had an aversion to noise. He stated he is also really good with numbers. hallucinations were denied, and delusions were not elicited. He did not engage in any bizarre or inappropriate behavior. He ied current suicidal or self harm ideation and he agreed to immediately tell staff and Inmate Companions if he starts to have suicidal or self harm thoughts. He was future oriented. He does not appear to be an imm: self. He denied thoughts of hurting others and he agreed to tell staff and Inmate Companions if he has Supportive and educative interventions were again provided. He had not been given the Tuming Point hi yesterday that were on his cell door, so they were handed to him by staff today. Exemention He will remain on Psych Observation in an abundance of caution and pending housing arrangements to be made on Monday. While on Psych Observation, he will be seen daily by Psychology. Completed by ED on 07/28/2019 09:24 Generated 07/28/2019 09:24 by J’ Bureau of Prisons - NYM Page 1 of 1 ~ EFTA00032163

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Bureau of Prisons **SENSITIVE BUT| UNCLASSIFIED Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN, JEFFREY EDWARD Reg#: | 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team} 5 Date: | 07/29/2019 10:01 Provider: —— Inmate Epstein was seen while on psychological observation today in the hospital area. Subjective/Objective Presentation Same presentation today, but he said he thinks his memory for the incident (injury to his neck) may be impaired because of his sleep apnea. He is supposed to get his CPAP machine today. He is aware he will be ling to SHU, but said he is feeling unwell due to his inability to sleep and numbness in his arm. He requested to have good night of sleep with his CPAP and will retum to SHU with a cellmate tomorrow. He then asked if he could remain/ down here where it is “safe” for the entire week. | told him he can stay down one more night to receive his CPAP anda good night's sleep, but that he would be returned to SHU tomorrow. It was explained that there is no mental health issues precluding him from returning to SHU tomorrow and that we could not house him in the SW/Hospital area ise he felt safe or more comfortable for him. \t was explained to him that he would be placed in a safe situation in the SHU. ing to his log book and eating/shower chart, he has been eating and drinking when not in his legal visits. He has also been writing and attending his legal visits. Intervention(s) Inmate EPSTEIN was provided with brief supportive interventions and psychoeducation regarding additional coping strategies. Inmate EPSTEIN was somewhat receptive to these interventions, but appears more co about getting his various needs in the prison (phone calls, recreation, housing placement concems, etc.) Progress/Plan He will remain on psychological observation today and will transition to the SHU tomorrow. He will be sect by psychology daily to assess his mental status and psychological functioning. Comet , mre Generated 07/29/2019 10:26 » iii Bureau of Prisons - NYM Page 1 of 1 EFTA00032164

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Bureau of Prisons “SENSITIVE BUT|UNCLASSIFIED™* Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPST EIN, JEFFREY EDWARD Reg # 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team; 5 Date: | 07/30/2019 12:01 Provider: He was seen by writer while he was on Psych Observation. Sublective/Objective Presentation able to start using it tonight. He discussed how he does not think he will able to sleep in SHU and how he does not like He stated he hasn't slept weil at MCC-NY because he hasn't had his cpap machine. He stated it is here he will be SHU because of the noise. He discussed issues on not getting some medication with Medical today. offered and so far today it noted he ate breakfast and drank liquids. The Psych Observation Log note: lept, drank The "Eating/Shower Chart" indicated yesterday he ate breakfast and dinner, drank liquids, and took a snob when id he water, went to legal, and talked to an Inmate Companion about investments. Current Mental Status: He exhibited a neutral mood with a full range of affect. His speech was logical and coherent, with no loosening of associations or tangential, circumstantial or irrelevant speech. Auditory and visual halluci denied, and delusions were not elicited. He did not engage in any bizarre or inappropriate behavior. There: indication of disturbed thought process or content. intellectual ability appeared to be above average. P have suicidal or self harm thoughts. He was future oriented. He does not appear to be an immediate dai denied thoughts of hurting others and he agreed to tell staff if he has these thoughts. Intervention(s) Si ive and educative interventions were provided. When asked about the Turning Point handouts for|coping in SHU, he stated he already knows these strategies before he read the handouts and had tried them when he was in SHU the last time. He stated with the noise in SHU, he said the strategies will not work. He was encouraged tq try them. Progress/Plan The Chief Psychologist was consulted. Psych Observation will be discontinued. Mr. Epstein was edu about both routine and emergency procedures for contacting Psychology staff. He will be seen in follow up by Psychology tomorrow to monitor his mental status and to provide further intervention if needed and he was informed that he will be seen by Psychology tomorrow. In the meantime, he was encouraged to self-refer to Psychology if needed to which he agreed and seems capable of doing. If he remains in SHU, he will be seen by Psychology in SHU Rounds and in SHU Reviews The SHU Lt. was informed that Mr. Epstein needs to be housed with an appropriate cellmate. Completed » 07/30/2019 13:54 Generates 0730/2010 13:54 by Bureau of Prisons - NYM Page 1 of 1 EFTA00032165

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| Psychology Services | Institution Disciplinary Process Report Inmate Name: EPSTEIN, JEFFREY EDWARD Reg#: | 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team; 5 Date: | 07/30/2019 12:01 Provider: —* Inmate Epstein was referred by Unit Manager Proto for an evaluation of competency to proceed with the disciplinary process for actions resulting in an incident report. On 7/23/19, inmate Epstein was charged with code 228 (Tattooing or Self-Mutilation). These infractions were assigned incident report number 3282555. Background Information According to a Suicide Risk Assessment dated 7/09/19 by IEEE, "Inmate Epstein denied any history of mental health treatment, either on an inpatient or outpatient basis. Inmate Epstein denied any treatment in the past or present with psychotropic medication. He also denied any acute mental health symptoms at this time." | | According to a Suicide Risk Assessment dated 7/09/19 by [INE “inmate Epstein denied any past or present suicidal ideation, intention or plan. He denied ever engaging in any suicide attempts or self-injurious behavior in the Accor ing to this writer's Suicide Risk Assessment dated 7/23/19, "It is unclear at this time if he had placedithe string around his neck or if someone else did." Clinical interview and Mental Status Exam inmate Epstein still does not remember how he obtained the marks around his neck. Current Mental Status: He exhibited a neutral mood with a full range of affect. His speech was logical and no loosening of associations or tangential, circumstantial or irrelevant speech. Auditory and visual hallucinations were denied, and delusions were not elicited. He did not engage in any bizarre or inappropriate behavior. There was no indication of disturbed thought process or content. Intellectual ability appeared to be above average. P: was adequate. He denied current suicidal or self harm ideation and he agreed to immediately tell staff if he| starts to have suicidal or self harm thoughts. He was future oriented. He does not appear to be an immediate denied thoughts of hurting others and he agreed to tell staff if he has these thoughts. Clinical Impression care” to his last Diagnostic and Care Level Formulation Note dated 7/09/19 by ma: Diag Cu Eindings The determination of whether an inmate is competent to proceed with the disciplinary process is based on 4 clinical assessment of the inmate's (1) ability to understand the nature of the proceedings, and (2) their ability to own di . Depending on the outcome of the assessment, one of three findings can be made: (1) the innjate is rest to competence with treatment; or (3) the inmate is NOT COMPETENT and is unlikely to become Recommendations Regarding Sanctions In the case of inmate Epstein, after a review of available psychological and psychiatric records as well as pertaining to the offense conduct, it is determined that this inmate is: (X) COMPETENT to proceed with the disciplinary process. () NOT PRESENTLY COMPETENT, but could become competent with treatment; it is recommended that an updated competency assessment in 30 days. () NOT COMPETENT and not likely to become competent. inmate for | Page 1 of 2 Generated 07/30/2019 12:33 vy Bureau of Prisons - NYM EFTA00032166

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Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team:| 5 Date. | 07/90/2019 12:01 ——— Completed by NY on 07/30/2019 12:33 Generated 07/30/2019 12:33 iii Bureau of Prisons - NYM Page 2 of 2 EFTA00032167

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Bureau of Prisons **SENSITIVE BUT UNCLASSIFIED* Psychology Services General Administrative Note Inmate Name: EPST EIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team:| 5 Date: 07/30/2018 12:01 Provider: Comments Psych Observation Discontinuation Note: Please see "Clinical Contact" dated today. Completed by NIN on 07/30/2019 12:33 Generated 07/30/2019 12:33 by Bureau of Prisons - NYM Page 1 of 1 EFTA00032168

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lame oo | Psychology Services | Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN, JEFFREY EDWARD Reg# | 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team:| 5 Date: 07/31/2019 10:35 Provider: Focus of Session Mr. EPSTEIN was seen today by this writer for a follow up appointment after he was removed from Psycho} Observation yesterday. Subjective/Objective Presentation Mr. EPST EIN presented in a pleasant mood and reported he is generally doing well. He stated, "I could be acknowledged he is doing as well as can be expected given his circumstances. He reported he is going to staff while he is in SHU, if needed. Current Mental Status: Mr. EPSTEIN was alert and oriented. He was polite, calm, and cooperative in d eating ihabits. Mr. EPSTEIN explicitly denied recent and current suicidal ideation, planning, and intent. He future- oriented and expressed a commitment to life and safety, agreeing to contact staff immediately should he e suicidal ideation or psychological distress. He also denied thoughts of harming others. all interventions. Progress/Plan Mr. EPSTEIN was educated about both routine and emergency procedures for contacting psychology. appears to be no need for follow-up at this time and he expressed willingness to self refer to psychology staff if needed. He will continue to be seen during routine SHU rounds and SHU reviews while he is housed in SHU. He was e' raged to reach out for PRN services should he experience any psychological distress. | | Supportive interventions and cognitive behavioral therapeutic techniques were utilized. Mr. EPSTEIN was rere to Completed by SMIIIIEC on 07/31/2019 10:56 Generated 07/31/2018 10:56 by Bureau of Prisons - NYM Page 1 of 1 EFTA00032169

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Bureau of Prisons “SENSITIVE BUT UNCLASSIFIED" Psychology Services Suicide Risk Assessment Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M __ Facility: NYM Unit Team: 5 Date: 08/01/2019 13:28 _—Provider: Type of Housing: SHU- Administrative Segregation Cell Accommodation: Double-Cell This as: ent and the resulting recommendations are based on the following sources of information: Clinical Interview, Medical Record, Psychology Data System, Sentry R & D staff reported to this writer this morning at about 8:30 AM on 8/01/19 that yesterday when Mr. Epstein was brought back from court the US Marshals asked him to sign a form that noted Mr. Epstein has "suicidal solduneten Mr. Epstein was seen for a Suicide Risk Assessment at about 1:00 PM on 8/01/19 in Attomey Conference. | This note is being entered at about 4:20 PM on 8/01/19. According to a Suicide Risk Assessment dated 7/09/19 by EEF. "Inmate Epstein denied any history gf mental health treatment, either on an inpatient or outpatient basis. Inmate Epstein denied any treatment in the or present with jsychotropic medication. He also denied any acute mental health symptoms at this time." Self-Harm History According to a Suicide Risk Assessment dated 7/09/19 by IEF. "inmate Epstein denied any past or present suicidal ideation, intention or plan. He denied ever engaging in any suicide attempts or self-injurious behavior in the According to this writer's Suicide Risk Assessment dated 7/23/19, "It is unclear at this time if he had my the string nil his neck or if someone else did." R& } staff reported to this writer this morning at about 8:30 AM on 8/01/19 that yesterday when Mr. bro Hels de tothe nlont a aItG. bate ene euton crater Suite Epstein has “suicidal Mr. Ehetetn seemed surprised that there was a form noting suicidal tendencies. He denied stating he He said he saw the DHO today and he said his incident report for the marks on his neck was expunged. th he has his cpap machine now, he said his celimate talks at night and he stated this keeps him up! This writer to talk to the SHU Lt. to have him housed with a different cellmate, but he stated he wants to givelit 3 to 4 days > if he wants a different cellmate. He complained about the noise in SHU. Current Mental Status Level of Consciousness: Alert and Oriented Psychomotor Activity: Normal General Appearance: Normal Behavior: Cooperative Mood: Appropriate to Content Thought Process: Goal Directed Thought Content: Normal Current Mental Status: He exhibited a neutral mood with a mildly restricted range of affect. His speech was logical and Generated 8101/2019 16:21 by Bureau of Prisons - NYM Page 1 of 3 -EFTA00032170

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Inmate Name: EPSTEIN, JEFFREY EDWARD Reg# 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 08/01/2019 13:29 Provider: coherent, with no loosening of associations or tangential, circumstantial or irrelevant speech. Auditory and visi hallucinations were denied, and delusions were not elicited. He did not engage in any bizarre or inappropriate denied current suicidal or self harm ideation and he agreed to immediately tell staff if he starts to have suicidal or self harm thoughts. He was future oriented. He does not appear to be an immediate danger to self. He denied thoughts of hurting suicide, | The following STATIC risk factors were assessed to be present and increase the inmate's risk for engaging ins behaviors: High Profile Crime, Lack of family connections, Sex offender status relationships, View of death as negative, Willingness to engage in treatment Risk Factors: He was found by staff in his cell in SHU on 7/23/19 with a string loosely tied around his neck, whi stated he did not remember anything about. It is still unclear at this time if Mr. Epstein had placed the string ¢ Protective Factors: He denied current suicidal or self harm thoughts and agreed to tell staff if he starts to have these thoughts. He had denied a history of self harm and suicide attempts. He had denied a family history of suicidal and self ha attempts. He had denied having any chronic medical conditions. He denied feeling hopeless. He had denied a history of cl iidhood abuse. He denied ing for his safety at this time. He denied feeling like a burden to anyone. He stated he lives for and plans case and to go back to his normal life. He said his friends and Lawyers are emotionally supportive. He said he said in his religion suicide is against the religion. | Overall, his current protective factors override his risk factors for suicidality. He is currently psychologically stable. He denied feeling hopeless. He is reporting positive future plans and reasons to live for. He said he has social supports in the community and his Lawyers visit him often. He denied any current suicidal or self harm ideation, intention or plan. Suicide|Watch is not indicated at this time. DIAGNOS 1S: No Diagnosis, No Dx - Current The Overall Acute Suicide Risk for this Inmate is: Low Overall Chronic Suicide Risk for this Inmate is: Absent RECOMMENDATIONS 1. Suicide Watch is not indicated at this time. 2. Supportive and educative interventions were provided. 3. He was educated about both routine and emergency procedures for contacting Psychology staff. 4. He will be seen in follow up by Psychology next week to monitor his mental status and to provide further intervention if needed. 5. In the meantime, he was encouraged to self-refer to Psychology if needed to which he agreed and seems le of doing. 6. Ifhe remains in SHU, he will be seen by Psychology in SHU Rounds and in SHU Reviews. Suicide Watch: A suicide watch Is not warranted at this time | | | { Generated 08/01/2019 16:21 by Bureau of Prisons - NYM Page 2 of 3 | ee en EFTA00032171

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Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: | 08/01/2019 13:29 Provider: Reg # 76318-054 Unit Team: 5 Completed by on 08/01/2019 16:21 Generated 08/01/2019 16:21 by | Bureau of Prisons - NYM Page 3 of 3 EFTA00032172

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=~ ~ Bureau of Prisons “SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN, JEFFREY EDWARD : 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team:| 5 Date: 08/08/2019 10:02 Provider Focus of Session Inmate Epstein was seen today for a follow-up session in SHU. Subjective/Objective Presentation Inmate Epstein stated he is feeling okay and has been eating his meals. He reported his sleep as “fair” would like to go the general population. He denied any mental health symptoms at this time and denied any feelings of depression and/or anxiety. Inmate Epstein denied any suicidal ideation, intention, or plan. He currently has a cellmate appears to interact with him. Inmate Epstein continues to spend his days and evening with his attorney's in the att conference room. He told this writer he received his PAC number to make phone calls. Inmate Epstein i ited he has only had a couple of phone calls over the speaker phone and wondered "if that counted" as his monthly phone contact. He also reported he his missing some books he was reading in the suicide watch area prior to ing to the SHU. | Other} than complaints about the prison and concems regarding his housing, he had no mental health concerns today. He did not appear to be in any distress and the SHU Staff have not reported any unusual behaviors on his ppt Intervention(s) Inmate EPSTEIN was provided with brief supportive interventions and psychoeducation regarding additional coping strategies. Inmate EPSTEIN was receptive to these interventions. Progress/Plan Inmate EPSTEIN was educated about both routine and emergency procedures for contacting Psychology staff. He was reminded of the self-help books and audiotapes available through the Psychology department. There appeats to be no need i follow up at this time. He will be seen in weekly rounds and monthly for SHU reviews. eid Bureau of Prisons -NYM | Page tof 1 EFTA00032173