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DATE NAME Signo we Tn mote Rea Tye We WS, \\#pkllawege \Poffoe [Ls Iker G6 237-OSY e:30|)°% Me |" "|" "1D. tleot er Fb 2a0- O54 |I2:35|//-¥ 74 | Sho | 7, Soft. | 1 1-47 Wie fe Fie | RK — aan C. ccitop—— Blyce -os | _ Me Sue A Zsnc-oxn |22 7-18 OTE. file Ko Kt ot per oo x TY | Gstwo —~ | 27 0s¢-_ pr We \ Abs I | LuisOrhe Cxyjo-054 ha—|_ 12_| A. 4k AML NR Scbels $3756 -0% \2—| 2h CEsb bo) | hen Ck, es ep |Z 7 L ftolk 2 we | See len i ae 7 hY | iL Fese Sa | Soe sd 8 a 0G |2” |S te haw | Leweshnd sees | 2¢ave-o87 \s* | _ This_| Gowoa | res rasy feo} Wes FI K heist iF Sir | DESIG OSH BY 20" Vee in ies FJOrqs-or, |: nf MCh | Le (ota Lean F | ¢ 13 { oe RE Bret Rilo —_| ga pir3 04/5] 1q| E- Cnorr fayerer tts | 86553-0294 | SS] ” de, D.Geschmu | Je Cen Necholuc | 86423 -O5 4/6 SI 7104 { 4 | Ce bom Ment | 2s ie-08 sa} WIA Qeereder ? CGOySOTM | TORS TOS apess 74 Calicl, [Us1p-0F9 Wal EZ STW] Rooms CCH BLYS52-054 |b: 2o\F2% r) 7A] Sitvemn | Ae ONow SCYS2OSy| C2, 4B — DNS | (Ca my LZ Sash | S Jee sso} fu is 1G) a.clan Cand o5 Vy cee G8 }o-08 fpretie emacs Std a UNI on lee Sy] oa + EFTA00137921

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DATE NAME S crete Tnmecte | 7b (Td \e OS) ” | 1424 béleh, ni Epstein Hr emosT7 SAQYS Ue Bs Wichmas WV Wie lab? IQichwan | CRO Nebo 17a \Bu SMe Deomane ira ae Eps hin |ote A/ Wr | Nk Lee is fbr A149— | Eph A422 | DColeor DPD Golecar}- Esproh | jlzz DAs _| Zo |Vizowns “Zz Pweg) *) ae oe Aintot, 6. Tali ae J. Sipe : 3 - Kiw ‘ r hon te E-rosn~ a sto 7. O)reve > Tne CiSex= t_ Ale | | Ghee | Seen W ler (NA- eke Bea _| MI Koauo0e,A ft Nk Hine Dh a ssms de 1044-05 4[0% P= B4US -ald po [°° 300-0 Be 7 WAY de A 3033-9 F (330 |] WIP 81 SPI IGS EPeersT] | ¢ PRE. See WS \7¥ | oIS-O05Y Sev aS B'S Sugiy—-osy | 8 152: 91600 oe $6357-2 ho Bek = he i <s77\~2 Sy Garson | F | 955-08 fio 69730 4| I £ EFTA00137923

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_sawate | Peg Yet Dus (Jes | VWaas : Mele, Lae 992-077 | 42s 23 fire Ys (Lon) Bol eryiet 7/4 ‘Mamner L Krceer (B44? -os’| fo V3 V7 Py bee LAL COS3 : Pye Mal FAK FI798a7 | | IBS| hdl jt | bE /c-o 07 \Y |x Anas Dane cut LQ peee | Srwd — ferme yt 3 4b) ran NY Chap oo Te3 | OSTA oe i. Vertu 277-0 we ses | , _ | Vath { | 56384. os4_ | Ago | 4.Taly J. Gakin.|263/2-0-¥. a qloz{tolon. J. Gestein 9-054] (2:00 i: 124 pooasus Liane | BS@32-07% ice Kalin ee 17 A | Bint. 3s - t Fis. en all se ‘es Ve er bes ae _e99e4-2 4 i Mime we ; | 257009 =e 20 4 i tc aa ea, oh |Sool FO ez, Iomb LC Conecia ! | B6290-2T | p30 [3:5 ¥ “| Yao OnayFur pT | 71473- 018 fod [25 ; ae Resale | Seles | BANG | BIZ { Ths Uk VD p| 2-2 S.% “ft W232, —_ Ap ali. ; i Be ROAR!) WY (3 EFTA00137929

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| a UG | Se cey le | AE Kou | Lan _ Yo Mnggedy [Che 22-28] dire | OT het te at a ee, Benjarin Wes od, est | 74 Se. |e3negyesy| | 4pler rn |BST4; 6c ey AY We q ND 2K OIF Ly. al hs Ant f- UC—.| Gontan | 2Mes b= |e Lec G.7al. 25.116 5h rye 2a Sasa diaz | 8ese-o@ wont. [Aepay lig low tact ipo CU _Moorp PUM bi5| eos | | Heme te IRL reeor Slee! soc 7a) |e MTsre [8Hewyltsa | | ae ZV | Ch 2 vA oF Lews——n| (resp Zen: vice {764-08 727] More{Qut} Poffo -oH5/2:Bo__| “Tle bie CSaundoe | 75 3) 084] 1:54 (5, Al fi of Apex |! 30ltb ) 226] f)) LL Bente ZWOSOSAL BL" Tn Nerd VWreitet® 4s Wes NI] v YP Va 4 SeHors |<a2 brah Bers huh shag ME TPES Geet cay URE Z— [rane tess as4Jfe td} 4 EFTA00137934

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1A) | KonTs Casatressare~ | (Cova vo EFTA00137936

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ASILOD BES Jo Mayo _|4(RGo> [2:30 [4 a fe a — —_ x KngaWr EFTA00137960

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a NAME Suguature | Inuate| Poge | 13° a ! Le) Gerspioe ROW GaSseR OS 5/5] 14 Coles — j q Hh 4 Lantsmarn (ann 1eb\) 84] 2°30 BE21G-~2 Bt {1D | dsp ez0 7 $414 iis Pesigere PO! Vl! Rr Ni | Albert - Salar Gr |Y-30 fojsey | kore.) nog he 67% [7 \ Pn — |9uar-Ory Fr0fpaite X75 ee ' \ferz 18 (o*. i (o . CF #3 : Outen n) Suet osbentiny 430 |f8.00 6/2 / (wavg eavee Vihar |\Hoeos | 7.34) |— y/% AS / L— |SmBr-Fisre|0r3 wt \7:-50 ¥ Moskouwt Qcm male, | Wers-csy!O | (2 €/4 MnexKow: Hila | eeoc-op fre [0 sql. Mosketot2 | Boar Tine, [Sextet] 10 | 2 | 19 Sedona §37 21-3] 1 | @/4q Cee, lb, (2a; wer | 2I2RT] Poor é le Broo | e722 wid | fares |) Spestern. 708 12-06 ‘It ib as i aa a J. Epakin 17o5/¢-ar4| 1/00 o. i (. yr Fe= sSoeeo | Sco 2| 4} I. 50 Si a Beep TWP | Grnaalec| or oy (Mpory | a “4 (Benpl/ 1B Me hozr| SURES [lpg 21s ba F-9 TBe rill Wi20F | Qrnlers | (1732.1 yap 2 | Sx |Z. Gopeymny | [pry | Levon [psses- of Dppzes | E FTA00137961

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Tie 1) tN se ature ae Trmacte Qeo tt Swe BUt0l7 12:30 One» ~csro| 9F3s- 05] 2.50 P S° a Leorte ebt3(-t4 9:35 Xi 2 {9 N ie Nye A (—~ a nat ab ZA re as oo Ae} ~~ 4S Mees [4632-0 4 he pg- = 7 l: mee ZbUZ OSH S70 | O>4 L. Benjaner gh463 054] $230 | >! Kim _|040098 CPG. reds mia Se 3[4 dete ohn Pina” aE ene —~ aa SDNY_00014075 EFTA00137963

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From: To: Date: Subject: Last contact with Epstein I visited inmate Epstein in SHU on Thursday. He was getting ready to meet with his attorneys for the day so I had gone to visit him right after the SHU meeting. He had a cell mate at the time with whom I saw him interact with. He did not report any mental health concems 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 time. 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

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Psychology 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, IDO, 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 082 EFTA00137965

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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 Observation 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

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G 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 HO1-001L — HO1-004L. 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

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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 055 EFTA00137968

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Truscope. Silverlight. Dashboard Page | of 2 NYM : 8/11/2018 = 6/11/2019 WNS83 | ASIS Contraband | AIBA ¥ 9 SOUTH SHU Ea) okcal “Highfick emate its S8e SiS Contraband Bis As Daly Adivty STG# New borates anid | Wi0/2089 | Selected Everts WAU Evert Lael Count | ‘owoeani9 (08:39 PM} 06/08/2019 08:38 PH Evening! STEVEN CHAMBERS Visual Search Inmate: 76318054 + EPSTEIN, JEFFREY. | g (07/30/2019 03:25 FM) 07/10/2089 03:24 PH Day ae Iomnate: 76318054 - EPSTEIN, JEFFREY, 7/07/2019 07:22 money pipe ie pee inmate: 76318054 - EPSTEIN, JEFFREY, | , i | Housing Unit, Spedal (SHU) Institution Property Queve SDNY_00014081 https://10,33.3.57/Dashboard.aspx 8/10/2019 Page 056 EFTA00137969

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U.S. Department of Justice Federal Bureau of Prisons MCC New York 150 Park Row NY, NY 10007 August 12, 2019 MEMORANDUM FOR JEFFERY D. ALLEN, M.D., MEDICAL DIRECTOR FROM: I ., Acting Clinical Dirgctor MCC New York ~ AN / SUBJECT: 24-hour death report Inmate Name (LN, FN) McC New York - Northeast Region Care Level Care Level-1 MH Care Level Carel-MR CSC‘ Alleged Suicide Preliminary Cause of Death Alleged Suicide Location of Death (]) institution ([/]) Community Hospital (Lj) Other: TYPE OF DEATH: | | Natural Suicide tL Accidental | Homicide EL Legal Execution CL Unknown DNR ordered (CO) ves (HZ) no Autopsy ordered (Z)) yEs (()) NO TIf£_no, reason RIS addressed (CO) ves (CL) no () n/a Anticipated death ([]) YES ([¥]) NO Please attach PP37 with this notification and submit to the BOP-HSD/Quality Management~@bop.gov mailbox within 24 hours of inmate death or next business day if weekends/holiday Cc SDNY_00014082 Page 057 EFTA00137970

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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 Centex 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 Page 058 EFTA00137971

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Co 24 Hour Death Report Page | of 1 24 Hour Death Notification Recieved Death Notification for Epstein (#76318-054) @ NYM successfully received on 2019-08-12 @ 14:30:08 (Eastern) Notification sent to Region and Central Office including the Medical Director and OQM. Submitted by: EE 20Ps2781) You may save and/or print this page for your local records. Local Date And Time of Pronounced Legal Death: 08/10/2019 07:36 Location: Community Hospital Type: Suicide Autopsy Status: Autopsy Ordered RIS: na Anticiapted 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 Sleep Apnea on CPAP at night, 4 history of Hypertriglyceridemia treated with Vascepa, no past Mente! Health Histary prior to incarceration and L4-LS 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 am. 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_00014084 https://map. bop.gow/SASStoredProcess/do?_program=%2F Projects%2FHSD%2F Web%2. .. 8/12/2019 Page 059 EFTA00137972

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From: < To: < Date: 8/12/2019 2: M 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 Region and Central Office including the Medical Director and OQM. Submitted by: {[BOP52781] 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 DNRILSO: no Preliminary Cause of Death: Alleged Suicide Narrative: Inmate Jeffery Edward Espstien #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 Menta! Health History prior to incarceration and L4-L5 Steno sis, 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 L ower Manhattan Hospital. At 7:36 a.m. the inmate was pronounced dead by the ER Physician. Use this link: https://sallyport.bop.gov/co/hsd/quality_ managemenSAS/admin_dashboard jsp to view the 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 Page 060 EFTA00137973

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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 Ul. tl. IV. Vi. Vil. Vill. IX. Xl. FINAL DIAGNOSES: HANGING: LIGATURE FURROW OF NECK PETECHIAL HEMORRHAGES OF BILATERAL PALPEBRAL CONJUNCTIVAE AND OF ORAL MUCOSA CONFLUENT HEMORRHAGES OF RIGHT BULBAR CONJUNCTIVA PLETHORA OF FACE AND HEAD WITH PETECHIAL HEMORRHAGES OF FACE FRACTURES OF BILATERAL THYROID CARTILAGE CORNUAE AND LEFT HYOID CORNUA WITH ACCOMPANYING SOFT TISSUE HEMORRHAGES 1. SEE ANTHROPOLOGY REPORT . RESUSCITATION ATTEMPTED 1. ABRASIONS OF MOUTH 2. ANTERIOR PARASTERNAL RIB FRACTURES 3. HEPATIC LACERATION WITH THIN HEMOPERITONEUM ABRASIONS OF LEFT FOREARM CUTANEOUS CONTUSIONS OF WRISTS SUBCUTANEOUS HEMORRHAGE OF LEFT DELTOID MUSCLE HYPERTENSIVE AND ATHEROSCLEROTIC CARDIOVASCULAR DISEASE A. CARDIAC HYPERTROPHY (440 GM) B. LEFT VENTRICLE HYPERTROPHY (1.9 CM) C. RENAL ARTERIOLAR SCLEROSIS 1B) E m 99 @> nan SLIGHT CORONARY ATHEROSCLEROSIS SLIGHT TO MODERATE AORTIC ATHEROSCLEROSIS HEPATIC STEATOSIS (2480 GM) CERVICAL LYMPHADENOPATHY REMOTE FRACTURE OF RIGHT FIRST RIB REMOTE APPENDECTOMY (DATE AND INDICATION UNKNOWN) SEE TOXICOLOGY REPORT SEE NEUROPATHOLOGY REPORT SDNY_00014086 age 061 P; EFTA00137974

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CAUSE OF DEATH: HANGING MANNER OF DEATH: SUICIDE (HANGED SELF) SDNY_00014087 Page 062 EFTA00137975

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OFFICE OF CHIEF MEDICAL EXAMINER CITY OF NEW YORK REPORT OF AUTOPSY CASE NO. M-19-019432 | hereby certify that |, Kristin Roman, M.D., City Medical Examiner - Il, 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 Ib 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 3", 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 SDNY_00014088 Page 063 EFTA00137976

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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, noncircurferential 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 % 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 !ower 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 media! 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 SDNY_00014089 Page 064 EFTA00137977