U.S. DEPARTMENT OF JUSTICE JUN 10 MULTI-LEVEL MORTALITY REVIEW FEDERAL BUREAU OF Date: 09/09/2019 To: f Quality M: it From: MCC New York Health Services Subject: Mortality Review for Inmate Epstein #76318-054 Inst: MCC-NY Name: Epstein, Jeffrey Reg. # 76318-054 OD: __ 08/10/2019 DOB: __ 01/20/1953 Age: 66 Sex: Male Race: __ White Place of Death: Inst. | ¥ Community Hospital OTHER Name of community hospital: __New York Presbyterian Lower Manhattan Hospital — Nature of Death: — Natural (chronic) — Natural (Acute) — Accidental: — Homicide w Suicide (Method) _____Hanging -___ Cause(s) of Death: NARRATIVE SUMMARY: (Should include components below) Date of admission to the 07/06/2019 _¥_Newcommit Transfer from 20 Hider Status: __inpatient at: ____ Inst. ____ Community Hospital ___Outpatient Admitting 1. Sleep Apnea (Pls. continue on supplementary page if necessary) Significant mental health (Yes) —HNo) __(NA) include specific information as relevant to death PDF Prescribed by P6013 EFTA00040930

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Name: _____Epstein Jeffrey Reg 7318-054 DOB: __ 01/20/1953 Admitting diagnosis: (continue) Past diagnosis: (Continue) PDF Prescribed by P6013 EFTA00040931

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Description of course of iliness (past and present) and cause of the death in sufficient detail to indicate circumstances of death, including treatment, medications, diagnostic testing, e tc. Give findings of diagnostic exams. Insert pages in this section as required. PDF Prescribed by P6013 Intake Screening History and Physical present? _¥_Yes ——No —NA Date of most recent History and Physical 07/09/2019 Timeliness of Diagnostic and Treatment regimes? “Yes ——No —N Discharge summary from Attending M.D. on chart Institution —_—Yes ~No —_NA Community Hospital ——Yes _~No NA Autopsy __Yes _¥_No NA Toxicology __Yes Y~No —_NA Death Certificate Available —_—Yes “No __NA INSTITUTION MEDICAL CARE REVIEW: Severity of illness at time of admission to hospital / Health Services Unit _— Critical _Y Stable — Unknown Prognosis on admission to hospital / health Services Unit _ Poor -“— Good —— NA Were diagnostic procedures appropriate and timely —_¥_Yes ——No Was treatment appropriate to diagnosis and instituted timely _v_Yes ——No Prognosis with treatment — Poor —% Good —_ Unknown Any complications adversely affecting outcome: ___Yes _~_No Describe briefly Asphyxiation Secondary to Hanging. Was treatment appropriate to complication _v¥_Yes ——No Surgical Procedures (list) ___Yes __No _¥_NA ' Appropriate pre-operative evaluation completed, __Yes —_No _¥_NA including lab, physical exam, updated history Complications related to surgical procedures __Yes No _¥_NA (describe) Prognosis following surgical procedure —— Poor —— Good _yv_ Unknown Patient compliant with treatment / medications ___Yes ——_No _¥_NA EFTA00040932

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Discussion with patient or patient's family regarding prognosis —yYes ——No DNR order —_—Yes Date Advance Directive / Living Will ——Yes ——No LOCAL COMMUNITY HOSPITALIZATIONS ONLY: PDF Prescribed by P6013 Type of admission — Routine _# Emergent — Other Method of transportation appropriate to patient condition —_v_Yes ——No —— NA Severity of condition at time of admission to local hospital _v_ Critical — Stable —— Unknown Prognosis on admission to local hospital —“ Poor — Good = —— Unknown Were diagnostic procedures appropriate and timely _v_Yes ——No Was treatment appropriate to diagnosis and instituted timely —_¥_Yes ____No Prognosis with treatment _¥_ Poor —— Good —— Unknown Any complications adversely affecting outcome: _v_Yes ——No (describe briefly) _Asphyxiation Secondary to Hanging Was treatment appropriate to complication _v_Yes ——No Surgical Procedures (list) 00 vg _v_No Appropriate pre-operative evaluation completed, __Yes _¥_No including lab, physical exam, updated history Complications related to surgical procedures ——Yes No Describe Prognosis following surgical procedure — Poor —— Good —¥_ Unknown Patient compliant with treatment / medications —__Yes ——No —¥_NA Discussion with patient or patient's family regarding —__Yes —___No —_¥_NA patient prognosis EFTA00040933

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ONR order Advance Directive / Living Will REVIEW OF EMERGENCY MEDICAL CARE: Was death related to a medical emergency Response to medical emergency notification timely Physician Physician Assistant Nurse Practitioner Nurse(s) Emergency Medical Techs Others CPR ACLS List protocol (s) used (if appropriate) By EMS. \ Problems encountered during medical emergency, e.g., equipment, communications, transportation. Describe briefly: Providers responding maintain current certification / credentials in BCLS, ACLS (if required) SUMMARY REVIEW: 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 Date —— Yes Date _¥_Yes _v_Yes —v_Yes _¥_Yes _v¥_Yes _v_Yes PLESEE OEE 5 | 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 Prescribed by P6013 EFTA00040934

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Documentation in medical record reviewed by Mortality Review Committee and found to be within acceptable limits. If no, describe Did patient receive appropriate and adequate health care, consistent with community standards, during his incarceration in the Federal Bureau of Prisons? If no, explain State any strengths and weaknesses that existed: _w_Yes _¥_Yes —No ——NA ——_No W—_NA 1. The Mortality Review Committee reviewed the Medical Record. The patient received timely and appropriate medical and psychological care. 27. Recommendation(s) if any. The Mortality Review Committee reviewed the Medical Record. No recommendations at this time. POF Prescribed by P6013 EFTA00040935

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28. Attachments: 1, Medical Record 3. Death Certificate 2. Narrative Summary 4. Autopsy Report 5, Other Documents as appropriate (list) ALL INFORMATION CONTAINED IN THIS REPORT IS EXEMPT AND TO BE CONSIDERED FOR REVIEW/VIEWING ON A NEED TO KNOW BASIS ONLY. REVIEW COMMITTEE: A-W, (M HSA DofN Prescribed by P6013 EFTA00040936

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OFFICE OF THE REGIONAL DIRECTOR Comments: — __ agree with Institution MRC ___ Disagree with Inst. MRC Recommendations or Action taken: Regional HSA Regional Director PDF Prescribed by P6013 Date Date EFTA00040937

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OFFICE OF QUALITY MANAGEMENT Comments: Signature of Review Committee Member PDF Prescribed by P6013 EFTA00040938