MEMORANDUM FOR FROM: U.S. DEPARTMENT OF JUSTICE Federal Bureau of Prisons Metropolitan Correakmal Center OR Park Row VoriorkM-wnsiliar November 5, 2019 M.D., MEDICAL DIRECTOR WASHINGTON, DC Warden SUBJECT: Multi-Level Mortality Chart Review Consultant's Comments This memorandum is in response to the multi-level mortality review dated October 29, 2019, whereas, several recommendations were made concerning the Automated External Defibrillators (AEDs) at MCC New York. Please see the attachment, which addresses your recommendations. If you have any questions or concerns, please do not hesitate to contact me at EFTA00048839

MCC New York Procedures for Monitoring, Testing and Inspecting Automated External Defibrillators (AEDs) This procedural statement outlines procedures for monitoring, inspecting and testing all Automated External Defibrillators (AED) at MCC New York. 1 Every month, the Health Services Administrator (HSA) or designee will conduct an inspection and testing of all AEDs and document the findings on an inspection form. The inspection will consists of inspecting the condition of the batteries and pads and checking the expiration date, control number and location of all AEDs in the institution, to ensure they are properly functioning. All AEDs "in service and out of service" will be tested. This information will be reported to the quarterly Governing Body meeting, for one year. 2. All AEDs will be inspected and tested bi-annually by the contract biomedical company and a report will be provided by the company. 3. Back up batteries (LIFEPAK 1000) are available and are checked as per the manufacturer's recommendations, which are: a. Inspect the fuel gauge, which provides an easy way to determine the available battery capacity. b. Do not attempt to recharge. c. Do not allow electrical connection between the battery contacts. d. Use and store batteries in a location where temperatures are between 20° and 30°C (68° and 86°F). Higher temperatures accelerate the loss of charge and decrease battery life. Lower temperatures reduce battery capacity. e. Dispose of expired or depleted nonrechargeable batteries according to national, regional and local regulations for battery disposal. EFTA00048840

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AED MONTHLY CHECK MCC New York Month: November 2019 Location BATTERY (OK) EXPIRATION Date # OF AED PAD SETS PAD EXPIRATION DATE Stretcher and ALL STRAPS IN SERVICE OUT OF SERVICE Roof Control # 54149 11 Sallyport Control ft 54225 SHU Control # 54226 7 Sallyport Control # 54227 5 Sallyport Control # 54224 3 Sallyport Control # 54238 3rd floor PCU unit Control # 54145 2 Floor Sallyport Control # 54147 2nd Floor Urgent Care Room Control # 54148 1st floor Warden's Complex Area Control # 54239 Food Sally Port Control # 54205 9 Sally port 9 South Control # 54226 Name of Reviewer Date EFTA00048842

L.S. DEPARTMENT OF JUSTICE. Federal Bureau of Prisons Ikiroponnor ( 'orrniroor('ewer Office of the tl Orden In, Prot %es io.et ma' MEMORANDUM FO EGIONAL DIRECTOR FROM: . Warden SUBJECT: Request for Renewal of the SW Room Waiver We are requesting the annual renewal of the suicide watch room waiver from Pr rarr, Statement 5324.05, Suicide Prevention Program On June 18, 2018, Regional Director, approved the use of additional suicide prevention rooms based on the unique custody and security requirements of this facility. This wavier is always reviewed on a yearly basis. Furthermore, it is worth noting the cells have been renovated to meet the requirements for a suicide prevention room. The additional suicide prevention rooms we as follows: • 1 room on 9 South (Special Housing Unit) • 2 rooms on 10S Lower — (H Ter-Administrative Maximum Detention) 1 room on Unit 2 (Female Unit) 1 room on the WITSEC Unit If you have any questions or concerns, please do not hesitate to contact me, EFTA00048843

U.S. Department of Justice Federal Bureau of Prisons Office of the Warden Met titan Correctional Center November 1, 2019 MEMORANDUM FOR ASSISISTANT DIRECTOR, REENTRY SERVICES DIVISION FROM: SUBJECT: Warden, MCC New York Institution Response to Psychological Reconstruction Inmate Epstein, Jeffrey (76318-054) This is the response to the psychological reconstruction of inmate Epstein, Jeffrey (76318-054) dated September 17, 2019. I.Single Ceiling: It is recommended that all inmates be double-celled unless safety concerns or an odd number of inmates precludes this. Priority should be given to inmates with a history of mental illness, self-directed violence, recent stressors (e.g., losses, newly sentenced, etc.) It is recommended that a system of control be implemented explaining who will be notified when a Suicide Watch or Psychological Observation ends and how that communication will take place. Because this is a life safety issue, the system of control, once approved by the warden, should be reviewed in formal meetings such as staff recalls, department head meetings, and lieutenants meetings. I .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 SHU Lieutenant during Day Watch and the Operations Lieutenant during the Morning Watch and Evening Watch. Notifications are made to the Institution Duty Officer (IDO) and Executive Staff. 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. EFTA00048844

When inmates are placed on and off suicide watch, the Warden is notified verbally, regardless of the time of day. The Warden then determines 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 verbally notifies the Lieutenant when inmates are removed from suicide watch and communicates to the Lieutenant that they will need to be placed with a cellmate (Providing direct communication and instructions). Cellmates are recommended not only for SHU inmates being removed from suicide watch, but also for inmates returning to the general population setting. Once an inmate is removed from suicide watch, psychology staff sends 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 cellmate. The e-mail contains the name of the staff member whom psychology verbally spoke with. This recommendation for a cellmate and conversation with the Lieutenant is also 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. 2. Rounds: 30-minute rounds are required by P5500.14, Correctional Services Procedures Manual. 3. Cellmate Assignments: When Mr. Epstein was placed in SHU on July 7, 2019, Executive Staff decided Mr. Tartaglione would be his cellmate. As explained by input was not sought from Psychology Services and it is not clear if or how sex offender-specific needs and associated risk were incorporated into the housing plan. Mr. Tartaglione was also a high profile inmate-an ex-police officer charged in multiple murders. However, he and Mr. Epstein did not share the risk associated with being a sex offender and their pairing may have aggravated Mr. Epstein's risk for self-directed violence. In an effort to treat Mr. Epstein the same as other inmates, a statement repeated by multiple staff, Executive Staff may have inadvertently overlooked the need to consider unique risk factors associated with individuals who have been ch ed with and convicted of a sex offense. On July 25, 2019, sent an e-mail to Associate Warden explaining a consultation between and Dr. National Suicide Prevention Coordinator. In the e-mail, 3. Cellmate Assignments: The psychological reconstruction suggests MCC New York Executive Staff did not take into account Mr. Epstein's sex offender-specific needs in assigning him a cellmate in SHU. However, that is not correct. MCC New York Executive Staff considered a variety of factors in determining the most appropriate cellmate for Mr. Epstein, including but not limited to history of sex offenses, nature of the inmate, cooperation status, etc. MCC New York administrators initially housed Mr. Epstein with Mr. Tartaglione as both had high profile cases. Mr. Tartaglione is also a certified death penalty eligible inmate and, thus, based on correctional judgment, less likely to assault or otherwise try to extort Mr. Epstein. 2 EFTA00048845

Indeed, Mr. Tartaglione notified staff immediately when he realized Mr. Epstein first made a possible suicide attempt/gesture on July 23, 2019. Prior to Mr. Epstein being taken off suicide watch, MCC New York Executive Staff, with input from psychology staff, assessed all the inmates in SHU at that time and narrowed the list down to the most appropriate candidates. Mr. Tartaglione was not chosen as the investigation at the time had not yet cleared him of any wrongdoing. Most of the other inmates in SHU at the time were there for disciplinary reasons and were otherwise not appropriate to be housed with Mr. Epstein. The other notable inmate in SHU with a history of sex offenses, Mr. Hoyt, was deemed dangerous to Mr. Epstein due to his threatening nature. Accordingly, MCC New York Executive Staff narrowed the possibilities to cooperators. Specifically, Efrain Reyes, reg. no. 85993-054, was placed in SHU for claims he was being threatened and extorted on his unit, and he was confirmed as proffering with the U.S. Attorney's Office. As both he and Mr. Epstein were in SHU for safety reasons, Mr. Reyes was deemed an appropriate cellmate. Based on the above, consideration was made for Mr. Epstein's sex-offender-specific needs in choosing his cellmate in SHU. His charged crime was just one of the factors reviewed in making the determination. MCC New York Executive Staff also considered high publicity inmates with ample reasons not to hurt Mr. Epstein, and cooperators who are not only vulnerable themselves, but also had a lot to lose should they harm Mr. Epstein. 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 about an inmate's mental health. Psychology Services are involved in making recommendations regarding the types of cellmates that inmates at-risk for suicidality should celled with. Psychology Services takes into consideration the suicide risk factors involved with a particular inmate and share their knowledge with Executive Staff. Reviewed the consult and recommendation from the Psychology Services Branch, Central Office that Mr. Epstein be housed with another inmate who had also been accused of committing a sex offense. There is no evidence this information was considered beyond this e-mail, and Mr. Epstein was never housed with another inmate charged or convicted of a sexual offense. It is recommended Executive Staff and Correctional Services staff include a psychologist in decisions about cellmates as a means of incorporating expertise about suicide risk, mental health needs, and interventions for psychological stability. 4. Documentation Accuracy: On July 23, 2019, Mr. Epstein was found unresponsive in his cell. He had abrasions on his neck and knee. There are inconsistencies between documents describin the circumstances of the scene. In a General Administrative Note in PDS-BEMR. documented information received from Operations Lieutenant that Mr. E stein. "was found with a string loosely hanging around his neck." In contrast, Officer who responded to this emergency, wrote a memorandum dated July 23, 3 EFTA00048846

2019. In that memorandum, Officer wrote he saw Mr. Epstein "laying down near his bunk with what appeared to be a piece of handmade orange cloth around his neck." It is critical that all descriptions of the incident accurately reflect objective evidence. Officer wrote Mr. Epstein an incident report for Self-Mutilation on July 23, 2019, after he was found unresponsive in his cell but prior to having the necessary facts to determine whether he likely engaged in a Bureau violation. BOP Policy expects staff to write an incident report within 24 hours of having the information that an inmate likely violated BOP rules but without making a presumptive decision about guilt. A Special Investigative Services Threat Assessment was completed August 2, 2019, but results were inconclusive as to whether Mr. Epstein engaged in self- directed violence, willingly fought with his cellmate, or was assaulted by his cellmate. It is recommended that staff remain open to all reasonable explanations for a behavior and take the appropriate actions when a final determination is made. Although the incident report was later expunged, inmates frequently experience significant stress when they contemplate the potential consequences associated with findings of guilt. entered a Psychology Services Intake Screening into PDS-BEMR on July 8, 2010. The document has three typographical errors. She selected the No Sexual Offense Convictions check box when, in fact, Mr. Epstein was previously convicted of S9licitation of Prostitution and Procuring a Person Under the Age of 18 for Prostitution. Second, Mr. Epstein was erroneously identified as a Black male in this document. Finally, there is one instance where he was mistakenly referred to as Mr. Brown. 4. Documentation Accuracy Psychology considers the information from more than one source when making decisions about suicide watch placement. Clinical judgment is 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 and to improve information accuracy. Additionally, there is a second Staff Psychologist in the department which helps reduce the workload on current psychologists, allowing 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. Specifically, 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 in a log book for anyone else observing an inmate on suicide watch. In the future, only the staff member watching the inmate on suicide watch documents 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 4 EFTA00048847

Staff and the Lieutenants received additional training on when they are required to complete rounds and sign Suicide Watch log books. With regard to suicide watch log books signatures, Correctional Staff are required to perform routine rounds every hour. The 2 Sally Officer on Monday- Friday during Day Watch is required to perform rounds on suicide or observation watch inmates as prescribed by the Captain. After-hours, the Unit 2 Officer will be responsible for making rounds, feeding meals, collecting trash in the area, and performing the count with the Internal 1 or Internal 2 assisting with duties as assigned by the Captain. Additionally, Psychology staff check the suicide watch logs 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 Lieutenants are not rounding and signing the books each shift, the Associate Warden over Programs and the Captain are notified immediately and enforce accountability. completed a Risk of Sexual Abusiveness document on July 8, 2019. She marked "History of prior prison sexual predation" in the affirmative. This is not accurate. Mid-Level Practitioner, completed a History and Physical on July 9, 2019. An Intake Screening should have been conducted within 24 hours of his entry into Bureau custody which was on July 6, 2019, according to P6031.04, Patient Care. 4: Inmate Jeffery Epstein #76318-05, arrived in the Receiving and Discharge (R&D), area, on July 6, 2019, at approximately 9:24 p.m. His medical Intake Screening was conducted at approximately 9:38 p.m., by Health Services staff, Physician Assistant (PA) on July 6, 2019, the same night he arrived in R&D. On July 9, 2019, he was placed on Psychological Observation and at approximately 12:38 p.m., he was escorted from Psychological Observation to Health Services for a Medical Assessment and a History and Physical, which was performed by PA . According to P6031.04, Patient Care, a provider must perform a History and Physical within 14 days of the inmate arriving at BOP facility. The History and Physical and Intake Screening was conducted timely and in accordance to policy. behavior while on suicide watch on July 23, 2019. was responsible for observin Mr. E stein and documenting his mistakenly used a Suicide Watch Log Book intended for inmate companion documentation between Watch Log Book. 1:40 a.m. and 6:00 a.m. on Jul 23 2019, when he should have been using the Staff Suicide Dru Treatment Specialist, reportedly noticed this error and subsequently hand copied all of entries from 1:40 a.m. to 6:00 a.m. into a Staff Suicide Watch Log Book. She then initialed these entries, and this makes it appear as if she was the one conducting the watch. This information was discovered and conveyed in an e-mail from Ms. Associate Warden to with a carbon copy to Warden on August 12, 2019. Of note, did not make an entry explaining why she was making the log book changes. Additionally, then wrote entries for 6:15, 6:30, 6:45 and 7:00 a.m. in the Staff Suicide Watch Lo Book. These were not a part of the original entries made by nor was assigned to work the Suicide Watch post. Due to the inabilit to interview staff at this time, it is unknown why attempted to correct error, or made any of the subsequent log entries. It is recommended that if a staff member makes an entry error (e.g., writes in the incorrect suicide watch log book), the staff member should describe the error in the correct log book, to include indicating when they became aware of the error. The staff member should then notify the Chief Psychologist. 5 EFTA00048848

A review of Special Housing Unit Records (BP-A0292) revealed a number of incomplete entries. This document is used to monitor provision and receipt of basic services such as recreation, medical rounds, showers, meal consumption, etc. The Officer in Charge signature is missing on 10 occasions and a medical provider's signature is missing in seven instances. There are six instances in which it is not clear if Mr. Epstein ate his meal. There are nine instances in which it is not clear if Mr. Epstein took a shower. There are ten instances in which it is not clear if Mr. Epstein was offered recreation. P5500.15, Correctional Services Manual requires accurate and complete information on the BP-A0292. , A review of Psychology Observation Log Books revealed significant discrepancies from the approved Psychological Observation Procedural Memorandum, dated April 15, 2019. A Correctional Officer is required to complete hourly rounds and sign the log book; 179 out of 183 round signatures were missing. The lieutenant is required to sign the log book one time per shift and signatures were missing in 10 of 23 instances. A Physician Assistant is required to sign one time per shift and 16 of 16 instances were missing. It is recommended that a further review of Psychological Observation procedures be conducted. 5. Telephone Calls: In a PDS-BEMR note written by on July 16, 2019, she was informed by an unnamed staff member that a lieutenant facilitated two telephone calls for Mr. Epstein. It is unknown when and to whom these calls were placed and no evidence that they took place on a monitored telephone. According to a memorandum from Unit Manager on August 10, 2019, Mr. Epstein terminated his le al visit early on August 9, 2019, in order to place a telephone call to his family. (who was the Institutional Duty Officer that week) escorted Mr. Epstein to SHU around 7:00 p.m. that evening and he was placed in the shower area on G tier. While there, he was provided the telephone to make a call. Since Mr. Epstein reportedly did not have his PAC or PIN number, which is required to use the inmate telephone system, the Unit Manager placed the call, dialing a number that reportedly began with area code 347. Mr. Epstein told he was calling his mother who, according to public records, has been deceased since 2004. It is recommended that all telephone calls, other than legal calls, be made on monitored lines to be available for post-call review or on a speaker phone so staff can monitor what is discussed. 5. There is no documentation to substantiate that a Lieutenant facilitated two telephone calls to Mr. Epstein. However, there is documented evidence that Unit Manager Proto provided a call to Mr. Epstein on July 30, 2019, at 5:15 p.m., to a Karina Shaliak, friend, on a monitored telephone/speaker phone. The call was documented in a log that is maintained in the Correctional Systems Department. Mr. Epstein was provided a call because he had not been able to conduct voice recording on the inmate telephone. This is standard procedure by the Unit Team at MCC New York, to occasionally provide a call to new arrivals, when necessary. 6 EFTA00048849

6. Direct Observation: Mr. Epstein was on suicide watch from July 23, 2019, until July 24, 2019. While on suicide watch on July 23, 2019, Mr. Epstein attended an attorney visit from approximately 12:40 p.m. until 7:15 p.m. During this time, he was without "direct, continuous observation" by a dedicated BOP staff member as required by P5324.08. While on Psychological Observation, he attended attorney visits on July 24, 2019, for 11.25 hours; on July 25, 2019, for 11.25 hours; on July 26, 2019, for 9.25 hours; on July 27, 2019, for 11.33 hours; on July 28, 2019, for 10.5 hours; and on July 29, 2019, for 8 hours. On July 30, 2019, Psychology Observation was terminated. During these visits, continuous observation by a dedicated BOP staff member was not maintained as required by MCC New York's Procedural Memorandum for Psychological Observation. 6.Direct Observation: The Psychology Department has eliminated Psychology Observation at MCC-NY. Inmates on Suicide Watch are only provided legal visits under special circumstances as deemed by the Court. 7.Follow-Up: Mr. Epstein arrived at MCC New York on Saturda July 6, 2019. While conducting the 10:00 p.m. institution count that evening, Facilities Assistant reported she observed Mr. E stein in his cell. Inane-mail she sent to and and Lieutenant later that evening, she described Mr. Epstein as "distraught, sad and a little confused." She said she then asked Mr. Epstein if he was 7. Follow Up: Staff have been trained 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 is placed on suicide watch, and the on-call psychologist and Warden is 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/her safety pending a formal assessment by a Psychologist." The Psychology Department uses 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 is 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 is assessed more immediately prior to being released to a unit. R&D staff have been reminded of the Marshall and Court alert notices. Psychology Staff are 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 is placed on suicide watch, and the on-call psychologist and Warden is notified. These inmates receive a suicide risk assessment by a psychologist before being released to the general population. 7 EFTA00048850

Inmates who initially enter and/or transfer into the institution with a PSY ALERT assignment will be seen by a member from the Psychology Services Department immediately and prior to being released to the general population. R&D will review the PP44 code and Intake Screeners will utilize the PP64 to determine if inmates entering the facility have a PSY ALERT assignment. If there is not a psychologist in the building when a PSY ALERT inmate is identified and/or if it is during non-duty hours, the Operations Lieutenant will immediately be notified and will then contact the on-call psychologist. The on-call psychologist will come in after hours to screen the inmate in R&D and determine their appropriateness for general population, as well as any other pertinent housing considerations, prior to the inmate's release to general population. Inmates may also be assigned a PSY ALERT function code by a psychologist while housed at this institution. Psychologists will consider not only inmates with substantial mental health concerns for a PSY ALERT assignment, but 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 is applied more immediately and not just when an inmate is about to leave the institution. An institutional procedural memorandum will be established by Psychology Services to outline the follow-up procedures when existing PSY ALERT inmates return from trips such as court proceedings, legal hearings, and hospital trips. If any movement occurs with an existing PSY ALERT inmate, psychology must be verbally notified immediately when the inmate returns back to the institution. This would include movement from court, institutional movement, or hospital trips. The Psychology Department will also be notified of a PSY ALERT inmate's movement prior to the inmate leaving. The Psychology Department will be provided with the court lists as well as the Prisoner Schedule Report on a daily basis. These reports will be reviewed daily by a member of the psychology department to assess whether a PSY ALERT inmate is scheduled to go out to court the following day. When an existing PSY ALERT inmate who has already been initially screened by the Psychology Department returns from court with a notice from the Judge or Marshal's Office indicating imminent mental health concerns or concerns related to suicidality, the PSY ALERT inmate will be seen by a psychologist immediately and prior to their return to general population. A psychologist will determine at that time if a PSY ALERT inmate is ready to return to general population, their psychological stability, and their treatment needs. If the inmate returns after hours and there is no psychologist in the institution, the PSY ALERT inmate will be placed on suicide watch pending a suicide risk assessment by a psychologist. The Operations Lieutenant, On-Call Psychologist and Warden will be notified. When an existing PSY ALERT inmate who has already been initially screened by the Psychology Department returns from court routinely, and without a notice from the Judge or Marshal's Office, they will be screened by a member of the Psychology Department within 24 hours to assess if they are experiencing any significant distress regarding their court proceedings that may be exacerbating their mental health difficulties and/or risk factors. 8 EFTA00048851

Per guidance from Central Office Psychology Division, the Psychology Department will conduct a training with R&D staff to help train them about PSY ALERT inmates and to recognize signs of psychological distress and suicidality. okay, and he reportedly said he was. However, noted in her e-mail she was not convinced of this, adding, "He seems dazed and withdrawn." She went on to say, "So just to be on the safe side and prevent any suicidal thou hts can someone from Psychology come and talk with him." Despite the fact that Lieutenant opened the e-mail there is no evidence that he contacted the on-call s chologist as is required by P5324.08, Suicide Prevention Program. Additionally, if was concerned about suicide risk, P5324.08, Suicide Prevention Pro m, requires her to maintain direct, continuous observation of Mr. Epstein. When o ned the e-mail the following Monday morning, Mr. Epstein was evaluated by at approximately 9:30 a.m. Mr. Epstein was denied bail on Thursday, July 18, 2019. This was a significant disappointment for Mr. Epstein and likely challenged his ability and willingness to adapt to incarceration. Given the potential impact of the judge's decision, a psychologist should have assessed Mr. Epstein's mental status upon his return to the institution. The BOP developed a SENTRY assignment of PSY ALERT for purposes such as this. Specifically PSY ALERT is used "to ensure, if movement occurs, that all staff consider the special psychological and management-related risks associated with the inmate." Furthermore, P5324.07, SENTRY Psychology Alert Function states, "When a decision to move [any PSY ALERT] inmate occurs, any special psychological needs of the inmate are reviewed and considered by Psychology Services staff [and] any safety and security concerns are highlighted for non-Psychology Services staff." Psychologists should use the PSY ALERT assignment more frequently with high profile cases and with inmates who have a history or charge of sex offense. Both of these groups of inmates are susceptible to exaggerated or unrealistic fears about correctional settings and experience stress associated during movement and periods of transition (e.g., cell/unit changes, movement to and from court, institutional movement, and release of information through the media). Mr. Epstein was reportedly in court on July 31, 2019. It is unknown what time he departed or returned to MCC New York because this information was not entered in SENTRY. Regardless, upon his return, the United States Marshals Service (USMS) provided R&D staff with a Prisoner Custody Alert Notice regarding Mr. Epstein. The notice indicated Mr. Epstein had "MTL Mental Concerns Suicidal Tendencies." The USMS requested R&D staff si n the formae then departed with the signed copy. On August 1, 2019, at 8:46 a.m., sent an e-mail reporting she had just become aware of the above information. In the absence of additional information about this notation, this should have been considered a referral to Psychology Services about a potentially suicidal inmate and procedures should have been followed as outlined in P5324.08, Suicide Prevention Program. Specifically, when a staff member becomes aware an inmate may be thinking about suicide during normal working hours, that staff member must contact Psychology Services and maintain the inmate under direct,continuous observation until he is placed on Suicide Watch or seen by a psychologist. There is no evidence Mr. Epstein was monitored under these conditions from the time he returned from court until he was seen by for a suicide risk assessment 9 EFTA00048852

on August 1, 2019, at approximately 1:30 p.m. 8. Inmate Accountability and Assignment Accuracy: According to a SENTRY quarters roster generated on August 10, 2019, at 12:51 a.m., there were three inmates assigned to Mr. Epstein's SHU cell, 204-206LAD, including him, at the time of his death. However, his SHU cell was only a double occupancy cell. Inmate (#86710-054), inmate Gregory Ferrer (#79793-054), and Mr. Epstein were all assigned to the same cell. On August 13, 2019, at 12:06 p.m. and 12:08 p.m., a quarters history roster was generated for inmate Avila and Ferrer, respectively. Inmate Avila's cell assignment was 204-206LAD from August 5, 2019, until August 11, 2019, when he was moved to cell Z04-212UAD. Inmate Ferrer's cell assignment was 204-206UAD from August 1, 2019, until August I1, 2019, when he was moved to cell 2.04-207LAD. A quarters history roster was generated for Mr. Epstein on August 13, 2019, at 9:07 a.m. His cell assignment was 204-206LAD from July 29, 2019, until August 10, 2019. On Monday, August 12, 2019, photographs ofnametags on SHU cell doors and SHU locator forms were sent to the Correctional Service Department in the Northeast Region. The SHU locator form is dated August 9, 2019. It shows inmate Ferrer in cell 207L (SENTRY states he was moved to this cell on August 11, 2019), inmate Avila in cell 212U (SENTRY states he was moved to this cell on August 11, 2019), inmate Epstein in cell 220L (SENTRY never shows him in this cell) along with inmate Reyes (#85993- 054). The locator shows inmate Copper (#92299-054) and inmate Dockery (#60685-050) in cell 206. The photo sheets show the cell being 220 with inmates Epstein and Reyes' identification cards on the door. Inmate Reyes, Efrain, Reg. No. 85993-054 was in cell 206-220U from August 5, 2019 to August 9, 2019. MCC New York has four suicide watch cells and each is for single occupancy use. The suicide watch cells are located in Health Services. Each cell is abbreviated with the unit code HOI in SENTRY followed by the four-digit cell number. The doors are identified by a painted number from one to four. Two reviews were conducted. The first revealed Mr. Epstein was in H01-00IL according to SENTRY but the Suicide Watch Log Books indicate he was in cell 4. A second review was conducted on August 13, 2019, while there were four inmates on in these cells. SENTRY showed two inmates assigned to HO1-001L, one assigned to H01-002L, and the fourth inmate assigned to a general population housing unit. Through physical observation of the dedicated suicide watch cells there were four H01 cells, however a review of the BOPWARE Inmate Housing Format, only shows three cells. Inmate movement and assignments are not accurately reflected in SENTRY as required by P5500.14, Correctional Service Procedures Manual. 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 10 EFTA00048853

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. 9. Attorney Log Books: Four log books were not secured following Mr. Epstein's death. Specifically, three Attorney Log Books located in the Attorney Visiting and Front Lobby areas and an Inmate Search Log Book located in the Attorney Visiting area were not secured. All four books were still in use at the outset of the reconstruction and after the reconstruction team advised staff to secure them. P5324.08 states, "In the event of a suicide, institution staff, particularly Correctional Services staff, and other law enforcement personnel, will handle the site with the same level of protection as any crime scene in which a death has occurred." This policy further states, "All possible evidence and documentation will be preserved to provide data and support for subsequent investigators doing a psychological reconstruction." Further, a review of the attorney log books identified many errors and signify a systemic concern. For example, there were two concurrently open attorney log books in the Attorney Visiting area. Further, the different purposes of the two attorney log books, one in the Attorney Visit area and one in the Front Lobby, could not be explained. BOP staff were unable to articulate a system of control for the log books, and during the reconstruction, some of the log books could not be accounted for. Within the log books, entries were made out of chronological order, attorneys did not consistently sign in and out, significant information was illegible or missing, columns were not consistently labeled, log book opening and closing dates were inconsistent, and the cover had been torn off of several books. At the current time, these log books are not functioning as an adequate system of control and monitoring. 10. Automatic External Defibrillators: A review of available AEDs in the institution revealed that the list used for accountability and inspection purposes was inaccurate and incomplete. 10: A review of the Automatic External Defibrillators (AED) report presented by Great Lakes Biomedical Services dated July 22, 2019, revealed that all AEDS were accounted for and were placed in the correct perspective areas. The report was accurate and complete. New AEDs have been purchased and will be inspected Great Lakes Biomedical Services, upon their arrival. It must be noted that the list reviewed by the reconstruction team was an old and outdated list (January 8, 2018). 11. Post Orders & SHU Training: SHU Post Orders Sign-In Sheets were reviewed for the 3rd Quarter, spanning June 9, 2019, to September 7, 2019. Officer failed to sign post orders for SHU #3 post. Quarterly SHU Training Sign-In Sheets were reviewed. The 2019 3rd Quarter SHU Training was conducted on June 6, 2019. Three staff assigned to the 3rdQuarter SHU Roster in SHU did not attend or receive the SHU Training: Officer Officer and Officer 11. Post Orders & SHU Training The Suicide Watch Post Orders is located in the Lieutenant's Office with a quarterly sign-in sheet. All staff members assigned to a suicide watch post are responsible for signing the post orders prior to performing the staff suicide watch. 11 EFTA00048854

With regard to SHU Suicide Prevention training, this continues to be carried out on a quarterly basis. However, the sign-in sheets for this training are now be examined by the SHU Lieutenant for accuracy. If a staff member who is assigned to SHU misses the training, they see the Chief Psychologist and schedule a time to receive a make-up session for the SHU Suicide Prevention Training. 12. Staffing: The Drug Abuse Program Coordinator positon at MCC New York was abolished during Phase I of the staff realignment during fiscal year 2018. Re-establishing the Drug Abuse Program Coordinator position would provide the institution with an additional supervisory psychologist to provide critical clinical services. Staffing in the Correctional Services department is relevant to the reconstruction. However, the details about this topic are provided in an After Action Review completed separately from this report. 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 formally announced. 13. Sex Offense Risk Factors: A broad understanding of risk factors associated with sex offenders, by staff at MCC New York, did not appear to be present in all staff but was vital to his adjustment and safety in prison. A more focused management strategy is recommended, particularly in complex and high profile cases. Supplemental training on sex-offender specific risk factors is recommended for all staff and should be provided by Executive Staff and Psychology Services. 13. Sex Offense Risk Factors The Chief Psychologist or her representative continues to be present at all Executive Staff Meetings, Department Head Meetings, and SHU meetings. During these meetings, the Chief Psychologist offers feedback regarding the treatment and management of sex offender inmates. Additionally, the Chief Psychologist continues to educate all staff during Institution Familiarization (IF) and Annual Training (AT), about the sex offender specific risk factors and suicidality. 12 EFTA00048855

DOCUMENTS EXAMINED TRU-INTEL Download Report of Incident (583), 586, & Global Report TRUVIEW - Money Exchanged; Phone, Email, & Visitor Lists; Calls; Messages; Visits; Timeline TRU-SCOPE - Logs, High Risk Inmates, Inmates Lists, etc. Staff Memorandums Staff E-Mail Photographs of Scene; Deceased, Autopsy Video Showing Scene and Staff Response Sentry Documentation SIS Case File Index Psychology File PDS-BEMR Psychological Observation Procedural Memorandum Post Orders Lieutenant Logs Attorney Logs Staff Roster Medical Information/Records (BEMR) BOP Twenty-Four Hour Death Report Pre-Sentence Report Note(s) Left Behind by Deceased Time Line Autopsy Request & Report Inmate Central File Court Return Screening Form Prisoner Remand Form (If applicable) USM 129 Individual Custody/Detention Report (If applicable) Prisoner Custody Alert Notice Staff Sign-In Log 1 Week Prior to Suicide (If applicable) Detention Orders (If applicable) 30 minute SHU rounds BP 292's & 13 EFTA00048856

U.S. Department of Justice Federal Bureau of Prisons Nortkeast Regional Office MEMORANDUM FOR MCC NEW YO , WARDEN VS. Custom House - 74 Floor 2nd and Chestnut Streets Philadelphia, PA 19106 August 14, 2019 FROM: egional Director Northeast Region SUBJECT: After Action Review Team On August 14, 2019, a team of staff will arrive at MCC New York to perform an After Action Review on the apparent suicide of Inmate Jeffrey Epstein Reg. No. 76318-054. The duration of this visit will be fluid and conclude once the assessments are complete. During this visit, the teams will work largely independently, but may require your staff to perform specialized tasks or be available for interviews, etc. Please ensure your staff are responsive to the team's requests. Upon arrival, the team will begin their assessments without delay. , Regional Director, Southeast Region, and the team will meet with you to discuss the plan for the week. I am requesting you have a staff member from Computer Services available to assist with any network needs that may arise. If feasible, any videos or electronic records must be available for the team to review independently. It may be necessary to utilize external hard drives or allow team members temporary access to a local drive. Several team members will have government issued laptops for use during this review. As mentioned, ensure your staff are available and responsive. Also, advise your local union of this visit. Union representation should be quickly accessible should the need arise. EFTA00048857

The team members are: Regional Director, SER Correctional Services Administrator, SER Health Services Administrator, SER Chief Psychologist, FCI Tallahassee Correctional Programs Administrator, Correctional Programs Division, Central Office Associate Warden, FMC Carswell Captain, FCI Talladega Should you have any questions, please give me a call. EFTA00048858

Metropolitan Correctional Center New York, N.Y. Photo Sheet Special Investigative Section Type of Incident Possible Suicide Attempt Date and Time of Incident 07/23/19 — 1:27 AAI Inmate Name/Register Number Location of Incident Photograph(s) by Date and 'lime of Photo —1 Epstein. Jeffrey #76318-054 Special Housing Unit 07/23/19 -1:45 AM EFTA00048859

Lmulrrmnt NUlRrr Metropolitan Correctional Center New York, N.Y. Photo Sheet Special Investigative Section Type of Incident Possible Suicide Attempt Date and Time of Incident 07/23/19 1:27 AM Inmate Name/Register Number Epstein, Jeffrey #76318-054 Location of Incident Photograph(s) by Date and Time of Photo Special Housing Unit 07/23/19 -1:45 AM 1°) EFTA00048860

Metropolitan Correctional Center New York, N.Y. Photo Sheet Special Investigative Section Type of Incident Possible Suicide Attempt Date and Time of Incident 07/23/19 —1:27 AM Inmate Name/Register Number Epstein. Jeffrey #76318-054 Location of Incident Photograph(s) by Date and Time of Photo Special Housing Unit 07/23/19 -1:45 AM EFTA00048861

Metropolitan Correctional Center New York, N.Y. Photo Sheet Special Investigative Section Type of Incident Possible Suicide Attempt Date and Time of Incident 07/23/19 — 1:27 AM Inmate Name/Register Number Epstein, Jeffrey #76318-054 Location of Incident Photograph(s) by Date and Time of Photo Special Housing Unit 0723/19 -1:45 A Al EFTA00048862

.SO ,fi'' e .,. Lieutenant's Office Metropolitan Correctional Center New York, N.Y. Special Photo Sheet Investigative Section Type of Incident Possible Suicide Attempt Date and Time of Incident 07/23/19 — 1:27 AM ri Inmate Name/Register Number Epstein, Jeffrey #76318-054 L Location of Incident Special Housing Unit Photograph(s) by Date and Time of Photo 07/23/19 -1:45 AM i 4,, - Y . 4. . ,.1.,. ' iOj, r EFTA00048863

Metropolitan Correctional Center New York, N.Y. Photo Sheet Special Investigative Section Type of Incident Possible Suicide Attempt Dale and Time of Incident 07/23/19 - 1:27 AM Inmate Name/Register Number Location Of Incident Epstein, Jeffrey 076318-054 Special Housing Unit Photograph(s) by Date and Time of Photo (17 23:19 -1:45 AM Copy ."-tritt /a9 EFTA00048864

Metropolitan Correctional Center New York, N.Y. Photo Sheet Special Investigative Section Type of Incident Possible Suicide Attempt P Date and Time of Incident Inmate Name/Register Number 07/2349 - 1:27 AM Epstein. Jeffrey #76318-054 Location of Incident Photograph(s) by Date and Time of Photo Special Housing Unit 07,23,19 -1:45 :Of EFTA00048865

Lieutenant's Office Metropolitan Correctional Center New York, N.Y. Photo Sheet Special Investigative Section Type of Incident Possible Suicide Attempt Date and Time of Incident 07/23/19 — 1:27AM Inmate Name/Register Number Epstein, Jeffrey #76318-054 Location of Incident Photograph(s) by Date and Time of Photo Special Housing Unit 07;23/19 -1:45 A AI EFTA00048866

Metropolitan Correctional Center New York, N.Y. Photo Sheet Special Investigative Section Type of Incident Possible Suicide Attempt Date and Time of Incident 07/23/19 — 1:27 AAI Inmate Name/Register Number Location of Incident Photograph(s) by Date and 'lime of Photo —1 Epstein. Jeffrey #76318-054 Special Housing Unit 07/23/19 -1:45 AM EFTA00048867

Lmulrrmnt NUlRrr Metropolitan Correctional Center New York, N.Y. Photo Sheet Special Investigative Section Type of Incident Possible Suicide Attempt Date and Time of Incident 07/23/19 1:27 AM Inmate Name/Register Number Epstein, Jeffrey #76318-054 Location of Incident Photograph(s) by Date and Time of Photo Special Housing Unit 07/23/19 -1:45 AM 1°) EFTA00048868

Metropolitan Correctional Center New York, N.Y. Photo Sheet Special Investigative Section Type of Incident Possible Suicide Attempt Date and Time of Incident 07/23/19 —1:27 AM Inmate Name/Register Number Epstein. Jeffrey #76318-054 Location of Incident Photograph(s) by Date and Time of Photo Special Housing Unit 07/23/19 -1:45 AM EFTA00048869

Metropolitan Correctional Center New York, N.Y. Photo Sheet Special Investigative Section Type of Incident Possible Suicide Attempt Date and Time of Incident 07/23/19 — 1:27 AM Inmate Name/Register Number Epstein, Jeffrey #76318-054 Location of Incident Photograph(s) by Date and Time of Photo Special Housing Unit 0723/19 -1:45 A Al EFTA00048870

.SO ,fi'' e .,. Lieutenant's Office Metropolitan Correctional Center New York, N.Y. Special Photo Sheet Investigative Section Type of Incident Possible Suicide Attempt Date and Time of Incident 07/23/19 — 1:27 AM ri Inmate Name/Register Number Epstein, Jeffrey #76318-054 L Location of Incident Special Housing Unit Photograph(s) by Date and Time of Photo 07/23/19 -1:45 AM i 4,, - Y . 4. . ,.1.,. ' iOj, r EFTA00048871

Metropolitan Correctional Center New York, N.Y. Photo Sheet Special Investigative Section Type of Incident Possible Suicide Attempt Dale and Time of Incident 07/23/19 - 1:27 AM Inmate Name/Register Number Location Of Incident Epstein, Jeffrey 076318-054 Special Housing Unit Photograph(s) by Date and Time of Photo (17 23:19 -1:45 AM Copy ."-tritt /a9 EFTA00048872

Metropolitan Correctional Center New York, N.Y. Photo Sheet Special Investigative Section Type of Incident Possible Suicide Attempt P Date and Time of Incident Inmate Name/Register Number 07/2349 - 1:27 AM Epstein. Jeffrey #76318-054 Location of Incident Photograph(s) by Date and Time of Photo Special Housing Unit 07,23,19 -1:45 :Of EFTA00048873

Lieutenant's Office Metropolitan Correctional Center New York, N.Y. Photo Sheet Special Investigative Section Type of Incident Possible Suicide Attempt Date and Time of Incident 07/23/19 — 1:27AM Inmate Name/Register Number Epstein, Jeffrey #76318-054 Location of Incident Photograph(s) by Date and Time of Photo Special Housing Unit 07;23/19 -1:45 A AI EFTA00048874

UNITEL ,TATES GOVERNMENT Memorandum FEDERAL BUREAU OF PRISONS Metropolitan Correctional Center MEMORANDUM FOR ALL CONCERNED FROM: SUBJECT: July 23, 2019 , Material Handler Supervis Possible Suicide Attempt On July 23, 2019 at approx. 1:27 a.m., the Control Center announced a call for assistance on the Special Housing Unit. Upon my arrival to 9-South, I/M Epstein, Jeffrey #76318-054 was lying on the floor of his cell handcuffed. I assisted with carrying inmate Epstein to HA-Unit on a stretcher, where he was dressed in a suicide smock and placed on Suicide Watch observation with staff. ASensitive Limited Official Use Oita' EFTA00048875

Form 583 Report of Incident Incident #: NYM-19- Submitted By: 0076 Date/Time Of Incident: 7/23/2019 1:27 AM Section 1: General Information Staff Aware Date: 7/23/2019 1:27 AM FBI Notified: No USMS Notified: Location Level 1: SHU Type Of Incident O Assault On Inmate O Assault On Staff O Assault, Attempted On Inmate O Assault, Attempted On Staff 0 Disruptive Behavior O Escape From Non-secure Facility O Escape From Secure Facility O Escape, Attempted From Non-secure Facility O Escape. Attempted From Secure Facility O Fight O Inmate Death O Institution Disturbance O Introduction Of Contraband O Lethal Weapons Discharge Z Self Mutilation O Setting A Fire O Sexual Act, Non-consensual On Inmate O Sexual Assault On Staff O Sexual Contact, Abusive On Inmate O Sexual Harassment, Repetitive 0 Staff Homicide O Strike, Food O Strike, Work O Suicide Attempt O Use Of Force O Use Of Force/Applications Of Restraints O Use of Restraints, Pregnant/Postpartum No Indicate Where Incident Occurred: Main Facility Level 2: Housing Unit, Special (SHU) Level 3: 9 SOUTH SHU Institution Locked Down: No Method: Laceration Method: Hanging/Asphyxiation Modified Operations: No Cause Of Incident Known? No Cause Of Incident O Alcohol O Commissary O Debts O Disrespect Issue O Drugs O Ethnic Conflict O Food Issue O Geographical Conflict O Interfering with Staff duties O Property Issue O Racial Conflict O Recreation Equipment K Religious Issue O Security Threat Group Conflict O Sexual Pressure K Sporting Events o Telephone El Theft CI Visiting O Work Issue Section 2: Inmates Involved UNCLASSIFIED/LIMITED OFFICIAL USE ONLY/LAW ENFORCEMENT SENSITIVE This document is marked Unclassified/Limited Official Use Only/Law Enforcement Sensitive and may be disseminated, with proper attribution, to active Law Enforcement, DOD, or U.S. Intelligence Agencies. This document, or any segment/attachment thereof, may not be released without the approval of the Bureau of Prisons to any media sources, any non-law enforcement entity, the general public or those without a 'need to know.' It contains information that may be exempt from public release under the provisions of the Privacy Act (5 U.S.C. 552). 1 of 4 EFTA00048876

Incident #: NYM-19- 0076 Form 583 Report of Incident Submitted By: Date/Time Of Incident: 7/23/2019 1:27 AM Reg ff: 76318054 Name: EPSTEIN, JEFFREY Role: Victim Medical Attention Required: No Weapon (per inmate): No Use of Force (per inmate): No CIMS: No STG: Yes Restraints (per inmate): Escort Only Death (per inmate): No Reg #: 78514054 Name: TARTAGLIONE, NICHOLAS Role: Not Known Medical Attention Required: No Weapon (per inmate): No Use of Force (per inmate): No CIMS: Yes STG: Yes Restraints (per inmate): No Death (per inmate): No Injury Category: Minor Injury Chemical Used (per inmate): No Injury Category: No Injury Chemical Used (per inmate): No Section 3: Others Involved Name: Person Type: Staff Medical Attention Required: No Death: No Injury Category: No Injury Staff Injury by Inmate: No Sexual Assault: No Name: Person Type: Staff Medical Attention Required: No Death: No Injury Category: No Injury Staff Injury by Inmate: No Sexual Assault: No Name: Person Type: Staff Medical Attention Required: No Death: No Injury Category: No Injury Staff Injury by Inmate: No Sexual Assault: No Name: Person Type: Staff Medical Attention Required: No Death: No Injury Category: No Injury Staff Injury by Inmate: No Sexual Assault: No Name: Person Type: Staff Medical Attention Required: No Death: No Injury Category: No Injury Staff Injury by Inmate: No Sexual Assault: No Name: Person Type: Staff Medical Attention Required: No Death: No UNCLASSIFIED/LIMITED OFFICIAL USE ONLY/LAW ENFORCEMENT SENSITIVE This document is marked Unclassified/Limited Official Use Only/Law Enforcement Sensitive and may be disseminated, with proper attribution, to active Law Enforcement, DOD, or U.S. Intelligence Agencies. This document, or any segment/attachment thereof, may not be released without the approval of the Bureau of Prisons to any media sources, any non-law enforcement entity, the general public or those without a -need to know." It contains information that may be exempt from public release under the provisions of the Privacy Act (5 U.S.C. 552). 2 of 4 EFTA00048877

Form 583 Report of Incident Incident #: NYM-19- 0076 Submitted By: Date/Time Of Incident: 7/23/2019 1:27 AM Injury Category: No Injury Staff Injury by Inmate: No Sexual Assault: No Section 4: Lethal Weapon Discharge No data found. Section 5: Use of Force No data found. Section 6: Description of Incident DESCRIPTION OF INCIDENT (If Use Of Force, include details such as name of supervisor applying the chemical agent and/or restraints, reasons for use of hard restraints instead of soft restraints, etc.) Please be clear about cause(s) of the incident in your description. On July 23, 2019 at approximately 1:27 a.m., while making routine rounds inside the Special Housing Unit, staff observed inmate Epstein, Jeffrey Reg. No. 76318.054, lying in the fetal position on the floor with a homemade fashioned noose around his neck. Inmate Epstein was breathing heavily, however appeared to be responsive. Inmate Epstein was directed by staff to stand and submit to restraints. Inmate Epstein would not stand on his own and would not comply with staff directives. Staff entered the cell and placed inmate Epstein in both hand and leg restraints. Inmate Epstein was searched, metal detected, placed on a gurney and escorted from the scene without further incident. Inmate Epstein was photographed, medically examined and determined to have sustained a circular line of erythema at the base of the neck and friction marks on the front of neck, and small 2cm erthema on left knee. Inmate Epstein was placed on suicide watch with all necessary notifications made. There were no staff injuries reported. Section 7: Attachments File Date File Name Original Entered By Original Loc. Code 7/24/2019 STAFF ROSTER.pdf TF18813 NYM 7/24/2019 SOS STAFF MEMO.pdf TF18813 NYM 7/24/2019 SOS STAFF MEMO.pdf TF18813 NYM 7/24/2019 SO STAFF MEMO.pdf TF18813 NYM 7/24/2019 SO STAFF MEMO.pdf TF18813 NYM 7/24/2019 OPS LT MEMO.pdf TF18813 NYM 7/24/2019 MEDICAL ASSESSMENT.pdf TF18813 NYM 7/24/2019 MATERIAL STAFF TF18813 NYM MEMO.pdf 7/24/2019 INMATE TARTAGLIONE PHOTOS.pdf TF18813 NYM 7/24/2019 INMATE EPSTEIN PHOTOS.pdf TF18813 NYM 7/24/2019 INMATE EPSTEIN IR.pdf TF18813 NYM 7/24/2019 ADO.pdf TF18813 NYM UNCLASSIFIED/LIMITED OFFICIAL USE ONLY/LAW ENFORCEMENT SENSITIVE This document is marked Unclassified/Limited Official Use Only/Law Enforcement Sensitive and may be disseminated, with proper attribution, to active Law Enforcement, DOD, or U.S. Intelligence Agencies. This document, or any segment/attachment thereof, may not be released without the approval of the Bureau of Prisons to any media sources, any non-law enforcement entity, the general public or those without a 'need to know.' It contains information that may be exempt from public release under the provisions of the Privacy Act (5 U.S.C. 552). 3 of 4 EFTA00048878

Incident #: NYM-19- 0076 Form 583 Report of Incident Submitted By: Date/Time Of Incident: 7/23/2019 1:27 AM Approved By: SUBMITTED UNCLASSIFIED/LIMITED OFFICIAL USE ONLY/LAW ENFORCEMENT SENSITIVE This document is marked Unclassified/Limited Official Use Only/Law Enforcement Sensitive and may be disseminated, with proper attribution, to active Law Enforcement, DOD, or U.S. Intelligence Agencies. This document, or any segment/attachment thereof, may not be released without the approval of the Bureau of Prisons to any media sources, any non-law enforcement entity, the general public or those without a -need to know." It contains information that may be exempt from public release under the provisions of the Privacy Act (5 U.S.C. 552). 4 of 4 EFTA00048879

UNITE. ,TATES GOVERNMENT Memorandum FEDERAL BUREAU OF PRISONS Metropolitan Correctional Center MEMORANDUM FOR Al3CONCE NED FROM: SUBJECT: July 23, 2019 Operations Lieutenant Possible Suicide Attempt On July 23, 2019 at approx. 1:27 a.m., a call for assistance on the Special Housing Unit was announced by the Control Center. Upon my arrival I was informed that an inmate had attempted suicide and proceeded to cell, Z05-124LAD. I observed inmate Epstein, Jeffrey #76318-054 lying in the fetal position on the floor of his cell wearing a t-shirt and boxers. He was breathing heavily and was snoring. I called out to inmate Epstein and observed him flicker his eyes and continue snoring. His neck was red with no abrasions. I observed no further injuries to his person. An attempt was made to get the inmate to stand on his own with negative results. The inmate was placed in hand restraints and staff was directed to retrieve the stretcher. As inmate Epstein was being placed on the stretcher by responding staff, he would open his eyes and observe staff. When staff made eye contact with him, he would hurriedly shut his eyes. The inmate was taken to HA-Unit, dressed in the suicide smock and placed on suicide watch. While awaiting the arrival of an inmate companion, inmate Epstein sat on the edge of the bed and began moving forward as if he was attempting to fall over head first. When I looked away, he straightened up. As I turned to look at him again, he attempted the same act. I laid him down on the bed and directed him to cease his action or he would be placed in restraints for his safety. At that moment, he stated, "Okay, I won't do it again," and gave the thumbs up. Because of his unpredictable behavior, the decision was made to have a staff member observe inmate Epstein- left HA-Unit in order to make staff notifications. Moments later, I spoke with who stated that inmate Epstein was alert and had indicated that his cellmate, artaglione, Nicholas #78514-054 had attempted to kill him and had been harassing him. He stated that the inmate had indicated that he'd informed his attorney of this matter. I photographed and spoke with inmate Tartaglione, Nicholas #78514-054 who stated that he was asleep with his headphones on when he felt something hit his legs and said, "Jeff, what you're doing?" He didn't answer, so he got up, turned on the light and saw him with a string around his neck. He stated that he then called the guards and ASensitive Limited Official Use Onlyz EFTA00048880

they ran down. Upon fk...iner questioning, inmate Tartaglione ...tated that he sleeps on the bottom bunk, but gave it to inmate Epstein because he's old. He stated that he sleeps on the floor on a mattress. He stated that when he got up, he couldn't remember if he sat up or stood up to check on Epstein. He stated that Epstein was sitting on the floor leaning to the side with his eyes opened, but wasn't responding. He stated that the last time he saw him he was snoring really loud. Inmate Epstein stated that he came in from a legal visit at approx. 8:00PM and staff handed him a copy of the Daily News. "Nick" was on the floor reading the Daily News. He stated that he had given it to him. He stated that Tartaglione mentioned that he'd been in court all day in Westchester and was carrying on. At that point, inmate Tartaglione paused as if he was making the story up as he went along, and stated that Tartaglione stated, "These fucking niggers. This place is inhumane, I wish I could report it. (Officer), that nigger hobbit mother fucker." He then turned to a page in the Daily News that had his picture on it and stated that Epstein was worth seventy seven million dollars. Epstein stated that he took his picture, balled it up and threw it in the garbage. I asked inmate Epstein what happened prior to staffs arrival. He stated that at approx. 1:00 AM, he'd gotten up to get a drink of water, as he gets up every thirty minutes. He remember walking back to his bunk and waking up with staff there in his cell. I asked if he'd waken up and seen staff, why didn't he respond when we were calling out to him? He stated that he only remembered hearing himself making a noise like snoring. When asked about the allegations against his cellmate, he stated that he was told, if he hurt him, staff wouldn't care. Duty medical, was notified and briefed. It was determined no further medical attention was needed. A medical assessment was not conducted at the time of this incident, due to the fact, there was no medical staff available after 10:00 PM. 1, 111e arrival of medical staff, inmate Epstein was examined and treated by, for a circular line of erythema at the base of the neck, one section on the front with marks of friction and a small erythema on his left knee. ASensilive Limiled Official Use Oily= EFTA00048881

Metropolitan Correctional Center New York, N.Y. Photo Sheet Special Investigative Section Type of Incident Possible Suicide Attempt Date and Time of Incident 07/23/19 — 1:27 AA1 Inmate Name/Register Number Epstein, Jeffrey #76318-054 Location of Incident Photograph(s) by Date and Time of Photo Special Housing Unit 07/23/19 -1:55 AM EFTA00048882

Lieutenant's Office Metropolitan Correctional Center New York, N.Y. Photo Sheet Special Investigative Section Type of Incident Possible Suicide Attempt Date and Time of Incident 07/23/I 9 — 1:27 AM Inmate Name/Register Number Epstein, Jeffrey #76318-054 Location of Incident Special Housing Unit Photograph(s) by Date and Time of Photo 07/23/19 -1:55 AM EFTA00048883

BP-A0971 CHAIN OF CUSTODY LOG CDFRM AUG 11 U.S. DEPARTMENT OF JUSTICE FEDERAL BURPSt OF PRISONS ECN ft EPSTEIN, JEFFR Y176318-054 (Enclose with/attach to evidence) ITEM #O1.4- I CI -0016-7 CASE ID NUMBER; SUSPECT (If known) DESCRIPTION OF ITEM: ORANGE HOMEMADE ROPE DATE/TIME ITEM FOUND: JULY 23, 2019 @ 1:37 AM LOCATION:SPECIAL HOUSING UNIT SIGNATURE Or PERSON RECOVERING EVIDENCE: PRINTED NAME: LIEUTENANT EVIDENCE PLACED IN OVERNIGHT DROP SOX: DROP-BOX BY:(printed name) Date & Time- Witness:(printed name) EVIDENCE RECOVERED FROM OVERNIGHT DROP BOX BY: (printed name) Date i Time: Witness:(printed name) EVIDENCE PLACED EVIDENCE SAFE BY: (printed name) Date & Time: Witness:(printed name) DISPOSITION: ( ) Hold as evidence ( ) Return to owner Lab Analysis 1 ) Return to finder ( ) Destroy immediately FBI ( ) Other REMARKS (condition of evidence): CHAIN OF CUSTODY EVIDENCE RRIIKASE4 BY: DATE/TINE' DESTINATION: EVIDENCE OELEASED TO: 7/31/2019 fin SIS OFFICE SIS LT. Prescribed by P5S1D EFTA00048884