Page 1182 BP-A0563 JUN 10 MUL Tl-LEVEL MORTALITY REVIEW U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Date: To: From: Subject: Inst: 09/09/2019 Office of Quality Management MCC New York Health Services Mortality Review for Inmate Epstein #76318-054 MCC-NY Name: Epstein, Jeffrey Reg. #: 76318-054 DOD : 08/10/2019 DOB: 01/20/1953 Age: -~66 __ Sex: Male Place of Death: _ Inst. :L Community Hospital _ OTHER Name of community hospital: New York Presbyterian Lower Manhattan Hospital Nature 1:>f Death: _ Natural (chronic) _ Natural (Acute) _ Accidental: _______________ _ _ Homicide .L Suicide (Method) Hangjng Cause(s) of Death: Ax h iation NARRATIVE SUMMARY: (Should include components below) Date of admission to the 07/06/2019 Race: ..L.New commit __ Transfer from ______ _ Holdover Status: __ Inpatient at: __ Inst. __ Community Hospital __ Outpatient AdmlttinR 1. Sleep Apnea 2. Hypertriglyceridemia 3. L4 - LS Lumbar Stenosis 4. --------------------------------- (Pis. continue on supplementary page if necessary) Past diaRnosls: 1. Sleep Apnea 2. HyPertriglyceridemia 3. L4 - LS Lumbar Stenosis 4. --------------------------------- (PI s. continue on supplementary page if necessary) Significant mental health __ (Yes) _L(No) _ (NA) Include specific information as relevant to death: PDF Presaibed by P6013 White

Page 1183 Name: ____ E ... ps=te...,in""', J.,.e,..ffre~y ___ _ Reg.#: ___ ___:7.:.63:;.:1..::.8-.:.0.::..S4:...... __ _ DOB: 01/20/1953 Admitting dlagnosis:(continue) Past diagnosis: (Continue) PDF Prescribed by P6013

Page 1184 Description of course of illness (past and present) and cause of the death in sufficient detail to indicate circumstances of death, including treatment, medications, diagnostic testing, etc. Give findings of diagnostic exams. Insert pages in this section as required. Intake Screeninq History and Physical present? Date of most recent History and Physical Timeliness of Diaqnostic and Treatment reqimes? Discharge summary from Attending M.D. on chart Institution Community Hospital Autopsy Toxicology Death Certificate Available INSTITUTION MEDICAL CARE REVIEW: Severity of illness at time of admission to hospital / Health Services Unit Proqnosis on admission to hospital / health Services Unit Were diagnostic procedures appropriate and timely _:/_Yes 07/09/2019 .-LYes __ Yes __ Yes __ Yes __ Yes __ Yes -- Critical . _L __ Poor _L _LYes _:/_Yes _____No _NA _No _.NA _L_No _NA _L_No _NA _LNo _NA LNo -----NA _L_No _NA Stable Unknown Good NA __ No __ No Was treatment appropriate to diagnosis and instituted timely Proqnosis with treatment - - Poor _L_ Good __ Unknown Any complications adversely affecting outcome: Describe briefly Asphvxiation Secondary to Hanging. Was treatment appropriate to complication Surgical Procedures (list) Appropriate pre-operative evaluation completed, including lab, physical exam, updated history Complications related to surgical procedures (describe) _____________________ _ Prognosis following surgical procedure Patient compliant with treatment / medications PDF Prescribed by P6013 __ Yes _LYes __ Yes __ Yes __ Yes __ Poor __ Yes ...L_No __ No __ No __ No __ No ...:L_NA Good ....L... Unknown __ No _:{_NA 3

Page 1185 Discussion with patient or patient's family regarding prognosis DNRorder Advance Directive / Living Will LOCAL COMMUNITY HOSPITAUZA TIONS ONLY: __ Yes __ Yes __ Yes Date _No ...L...NA .L.No LNA Type of admission __Routine 1-.Emergent __ Other Method of transportation appropriate to patient condition Severitv of condition at time of admission to local hospital ProAnosis on admission to local hospital Were diagnostic procedures appropriate and timely Was treatment appropriate to diagnosis and instituted timely ProAnosis with treatment Any complications adversely affecting outcome: (describe briefly) Asphyxiation Secondary to Hangjng. Was treatment appropriate to complication _..:f.._Yes _:{__ Critical _L__ Poor .LYes _:/_Yes _:I_ Poor LYes Surgical Procedures (list) ________________ _ L Yes __ Yes Appropriate pre-operative evaluation completed, including lab, physical exam, updated history Complications related to surgical procedures Describe ------------------------ __ Yes __ Yes _No -- Stable -- Good _No _No -- Good _No _No _:L_).Jo Prognosis following surgical procedure -- Poor __ Good Patient compliant with treatment / medications Discussion with patient or patient's family regarding patient prognosis PDF Prescribed by P6013 __ Yes __ Yes _No __ No _NA -- Unknown --Unknown -- Unknown _L Unknown ...LJ.JA LNA 4

Page 1186 DNRorder Advance Directive / Living Will REVIEW OF EMERGENCY MEDICAL CARE: Was death related to a medical emergency Response to medical emerQencv notification timely Physician Physician Assistant Nurse Practitioner Nurse(s) EmerQencv Medical Techs Others CPR ACLS List protocol (s) used (if appropriate) B 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: __ Yes __ Yes ....:f.._Yes ....:f.._Yes _L_Yes ....:f_yes __ Yes __ Yes __ Yes ....:f.._Yes ....L_Yes __ Yes ....:L._ves Date Date ....i.....No ...L.No _No _No _NA _No _NA __No __:l___NA _No ...LM _No _NA _No ...:L.J.JA __No _NA _No _NA ....L_No __No _NA Inmate Jeffery Edward Epstein #73618-054 a 66 year old male with a history of Obstructive Sleep Apnea on CPAP a;:..t ""ni:.i:=h"-=-=~<-='-----~ H rtri I ceridemia treated with Vasce a, no ast Mental Health Histo rior to incarceration and U-LS Stenosis b)(7)(A) Cb)i7HA> n 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 I 0, 2019, at 6:33 a.m. Special Housing Unit Staff found inmate Epstein unresponsive in his cell and attempted to wake him. Thefb:C71(Ei! (b)(?)(E) as activated in SHU and the Control Center announced a medical emergency. CPR was initiated by Special Housing Unit Staff. At 6:35 a.m. m 1cal 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 5 PDF Prescribed by P6013

Page 1187 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: _:/_Yes _No __NA ....LYes _No __NA I. 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. 6 PDF Prescribed by P6013

Page 1188 28. Attachments: 1. Medical Record __ 2. Narrative Summary __ 3. Death Certificate __ 4. Autopsy Report __ 5. Other Documents as appropriate (list) ALL INFORMATION CONTAINED IN THIS REPORT IS EXEMPT AND TO BE CONSIDERED FOR REVIEWNIEWING ON A NEED TO KNOW BASIS ONLY. 'b)(6); (b)(7)(C) PDF REVIEW COMMITTEE: A-W, (M) , HSA DofN (b)(6); (b)(7)(C) Prescribed by P6013 PA 7

Page 1189 OFFICE OF THE REGIONAL DIRECTOR Comments: - Agree with Institution MRC _ Disagree with Inst. MRC Recommendations or Action taken: Regional HSA Date Regional Director Date 8 PDF Prescribed by P6013

Page 1190 OFFICE OF QUALITY MANAGEMENT Comments: Signature of Review Committee Member 9 PDF Prescribed by P6013

Page 1191 Re: Inmate Epstein, J. 76318054 - Notify Psychology ASAP when he returns from court From (b)(6); {b)(7)(C) To Date Subject: Re: Inmate Epstein, J. 76318054 - Notify Psychology ASAP when he returns from court Attachments: TEXT.htm I got his psiqjust so you know r )(6); (b)(7)(C) U.S. Department of Justice Federal Bureau of Prisons Disturbance Control Team Instructor/Operator Firearms Instructor MCCNewYork 150 Park Row New York, NY 10007 ] -646-83 :g;;;;(C) > > r )(6); (b)(7)(C) r/8/201910:SOAM >>> I just got off the phone with Central Office and they are recommending we conduct a suicide risk assessment with this inmate when he returns from court. Should he return from court and psychology is gone for the day, he is to go on PSYCHOLOGICAL OBSERVATION unless, of course, he reports he is suicidal. In that case, he is to go on Suicide Watch. Inmate Epstein will likely be receiving bad news in court today and has multiple risk factors for suicidality as identified by BOP statistics. Let's be proactive. "This writer consulted wit~(b)l 6>;<bi(l)(c) ~entral Office, regarding inmate Epstein. Inmate Epstein has various risk factors for suicidality including a high profile case with media attention, sex offense charges, pre- trial status, and a court proceeding today which could potentially be giving him bad news regarding his legal situation. As such, when inmate Epstein returns from court, R&D staff as well as Lieutenant's have been informed to immediately notify the psychology department. If he returns after duty hours, the aforementioned staff were instructed to notify the on-call psychologist and to place inmate Epstein on a watch status until psychology can conduct a thorough suicide risk assessment." Thank you{b~6>; (b,(7)(C) r 6): (b)(7)(C) IPsy .D. Chief Psychologist U.S. Department of Justice/ Federal Bureau of Prisons Metropolitan Correctional Center 150 Park Row New York, New York 10007 Office: (646) 83 (b>C5>;<b>c7>cc> Fax: (646) 836-7712 E-mail: j'b>c61; (b)(7)(c> p>bop.gov Page 3108