Page 2281 Fwd: Suicide Watch/Psych Observation Update From To Date Subject: Attachments: iay e 2019/ 08/ 10 19:13 Fwd: Suicide Watch/ Psy ch Observation Update TEXT.htm Sent from my Verizon, Samsllllg Galaxy smartphone -------- Original message -------- From:lcb>C5); (b)C7)cc> li @ bop.gov> Date: 7 / 30/ 19 12:30 PM (GMT-05:00) op.gov> r 6 ); (b)(7)(C) [email protected] @ bop.gov>' ;,.,(b;, :<6;:;);'" <b.,,. )(7;-c, )<c;;)=====~ b- o_ p_ . g- 0- v-:1:;::<b:::)<:;::: 6):::; ; (b::;:;)(7;:)c::; c);::::::==::....:::~I b)(6;; (b)(7)(C) ~ ==:,::--- =:------r=~~ :-:--=----=------'--------r:::C":"' bop.gov ,b)(6); (b)(7)(C) l.-..,---r.:-:-:,:,6)""' ; ('°'b)"'° (7)""cc"") ------------'--v::'.\bop. go~v -:::: >--.=b) ... 16.., i; -= (b)==(7=)(c"")===--======;-~ fb)(6); (b)(7)1C) 7 C bop.gov>, (i;b)(! )(6il':);(b (b)G )(71)()(C) C)~ ...,__""--__.__._.'--____.,_ls:r----f.i.bb)l)(:si6)i;(; (b)l)(7 [71):(C (C:) ) __ ..,.__,'---'---'-'----'-1-7""~ ---:---:-~b~)(6~);~(b~)(?~)(~C) ___ ...J:::......., (b)(6); (b)(7)(C) b)(6J; (b)(7)(C) (b)(6); (b)(7)(C) 'b)(6); (b)(7)(C) (b)(6); (b)(7)(C) (b)(6); (b)(7)(C) .b)(6); (b)(7)(C) (b)(6); (b)(7)(C) (b)(6); (b)(7)(C) (b)(6); (b)(7)(C) b)(6): (b\(7)(C) :b)(6); (b)(7)(C) 0 b)(6); (b)(7)(C) V> )(6); (bi(7)(Ci .b)(6) (b)i7)(C) . \ ) V> (b)(6); (b)(7)(C) 7)1C) b:(6); (b)(7)(C) 6); (b)(7)(Ci )(C) 6); (b)(7)(C) 6); lb , go (b)(6); (b)(7)(C) ov> )(6); {b)(7)(c ) ,. b' ) op. g o v> (b)(6>; (b)(7)(C) g ov ); (b:c1>cc > p. g ov> (b)(6); (b)(7)(C) bop.gov>, @ bop.gov>, bop.gov>, p. bJ<6>; cb;c7iccJ op.gov>, " V. Ski er-Scott" 0 "->--;:(b=)(:::::: 6)=; (b==)(7 ::::::)::::; (C=) ====:::!;;;~:::::.t:..:,Q:::..:.~ b > (b)(6); ,b)(7)(C) ' Page 13106

Page 2282 f b1<s >: (b)(7)cc, l(~aol.com> Subject: Suicide Watch/Psych Observation Update > ~ (b)(6); (b)(7)(C ) 107/30/2019 12:30 >>> Inmate Epstein #7 6318- 054 is being taken off of Psych Observation and needs to be housed with an appropriate cellmate. Suicide Watch None Psych Observation None Thank you, r )(6); (b)(7)(C) Page 13107

Page 2296 Re: Fwd: Inmate Epstein #76318-054 (Suicide Watch) From To Date Subject: Attachments: Thank you I""' '""". I 2019/07/24 13:33 Re: Fwd: Inmate Epstein #76318-054 (Suicide Watch) TEXT.htm, IMAGE.gif Do you have anyone in Psychological observation? Ji Please don't print this e-mail unless it's necessary r )(6); (b)(7)(C) Assistant Human Resource M anager N'lS Notary Public Training Coach Federal Bureau of Prisons Metropolitan Correctional Center 150ParkRow New York. NY l OC07 8 64&~ 646-836-7674 (fax) E-Mafb)(6); (b)(7)(C) r p,gov > * b)(6); (b)(7)(C) 17 /23/2019 10:56 AM > > > Here you go .... sorry, I was in the middle of a crazy task! f b)(6); (b){7){C) p SY .D. Chief Psychologist U.S. Department of Justice/ Federal Bureau of Prisons Metropolitan Correctional Center 150 Park Row NewYork, New York 10007 Office: (646) 83 (b)(G} (b)(7)(C) Fax: (646) 8361.-r-T-~---' E-mailr )(6); (b)(7)(C) Page 13130

Page 2304 Psych Observation 7/24-30/19 (1/M companion utili:zed) re: Epstein, Jeffrey Edward, Reg. No. 73618-054 From To Date Subject: Attachments: N'Diaye, Lamine (Charisma Edge) Lamine N'Diaye, Ray Ormond 2019/08/12 15:36 Psych Observation 7/24-30/19 (1/M companion utilized) re: Epstein, Jeffrey Edward, Reg. No. 73618-054 TEXT.htm, 2019 _08_12_15 _15 _ 46.pdf, Charisma Edge.vcf Psych Observation 7 /24-30/19 (1/M companion utilized) Page 13216

Page 2305 Psych Observation 7/24-30/19 (1/M companion utili:zed) re: Epstein, Jeffrey Edward, Reg. No. 73618-054 From To Date Subject: Attachments: N'Diaye, Lamine (Charisma Edge) Lamine N'Diaye, Ray Ormond 2019/08/12 15:56 Psych Observation 7/24-30/19 (1/M companion utilized) re: Epstein, Jeffrey Edward, Reg. No. 73618-054 TEXT.htm, Charisma Edge.vcf, Epstein Psych Observation 7-24-30- 2019.pdf Psych Observation 7 /24-30/19 (1/M companion utilized) Page 13252

Page 2308 Fwd: RE: Signed Autopsy Request Letter From r b)(6); (b)(7)(C) I To t b)(6); (b)(7)(C) 2019/09/11 07:22 Date Subj ect: Fwd: RE: Signed Autopsy Request Letter Attachments: TEXT.htm • 'b)(6); H1 :bim1c1 sorry I forgot to CC you on this e-mail. Thank you, r )(6); (b)(7)(C) > > > rb)(5); (b)(?)(C) ICME)"tb)(6}; (b)(?)(C) @ocme.nyc.gov> 9/10/2019 12:14 PM > > > Thank you; we will be in touch when we are able to fulfill your request. r )(6); (b)(7)(C) 1 General counsel Office of Chief Medical Examiner 421 E. 26th Street New York, NY 10016 Tel: 212-323 !b)(G>; lbi(?)(C> The information contained in this e-mail communication may be confidential and/or legally privileged and is for the use of the intended recipient only. If you are not the intended recipient, or an authorized employee or an agent responsible for delivering it to the intended recipient, the dissemination, distribution or reproduction of this communication or its contents (including any attachments) is prohibited. If you have received this corrmunication in error, please notify us immediately by telephone or reply e-mail and permanently delete it and any copies from your system files. From ~(b)(G);<b:cn(c> [email protected]> Sent: Tuesday, September 10, 2019 12:10 PM To:-b>(5>:(b,mcc> (OCME) (b>(5>:<b)(7,(c> ocme.nyc.gov> Cc (b)(s>;(b)(7)(C) bop.gov>f..,..'b)""'(s,..,>:(,..,.b)(.,,,;, 7x"""c,....> ----------.~ bop.gov> Subject: Fwd: Signed Autopsy Request Letter Hilrb>re>:cb)(7)(c> l per our conversation this morning I am sending you the Letter for requested information involving Mr. Jeffrey Epstein. We need the following: 1. Autopsy Report, 2. Discharge Summary Report, 3. Toxicology Report and 4. Death Certificate. We need these documents to finish our required Mortality Review and to complete our Investigation. Attached below I have included a copy of t he Certified Letter we sent to the Office of t he Chief Medical Examiner. If you have any questions you can contact myself or our Staff Attorney at: t b)(6); (b)(7)(C) Staff Attorney CLC New York Metropolitan Correctional Center 150 Park Row New York, NY 10007 p: 646-83 (b)(G); (b)(7)(C) f: 646-836- \I--• . - ---- .... -"---'· . 11 • • Page 13331

Page 2309 t b)(6); (b)(7)(C) ~ MSA, CCN, USPHS Health Services Administrator Metropolitan Correctional Center 150 Park Row, New York, New York 10007 (Office) 646-83 lb)(6): (b)(?)(c > 11b)(6); (b)(7)(C> pbop.gov > > (b)(6); (b)(7)(C; /10/2019 9:31 AM > > > Hi..,., _b)( .... '6).., ; ( ... b)(""" 7)( ... C)--..------' Please see attached, which was sent certified on August 19 or 20. Thanks, l(b)(6); (b)(7)(C) Staff Attorney CLC New York Metropolitan Correctional Center 150 Park Row New York, NY 10007 p: 646-83 b)(6); (b)(7)(C ) f: 646-83 - Page 13332

Page 2336 emergency Code EPSTEIN, JEFFREY EDWARD Reg#: 76318-054 From r b)(6); (b)(7)(C) I To Date Subject: Attachments: Respectfully, (b)(6); (b)(J)(C) linica Nurse peoa isl Department Of,Jus6ce Bureau Of Prisons MCC New York. 150 Park Row New York, NY 10007 r b)(6);(b)(7)(C) ~ BOP.Gov ,b)(6); (b)(7)(C) l(b)(6j; (b)(7)(C) I j"b)(6" (b)(J)(C) 1..,.,,.,.,.,,,..,,.=,,------------------.~ NYM/Lieutenants, i i: f b){6); (b)(7)(C) I 2019/08/10 08:12 emergency Code EPSTEIN, JEFFREY EDWARD Reg#: 76318-054 TEXT.htm, ClinicalEncounterFinalizeGetDocument.fac es.pdf Page 13442 I

Page 2337 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Encounter Date: 08/10/2019 07:25 Bureau of Prisons Health Services Clinical Encounter Sex: M Race: WHITE Provider: lcb)(S); (b)(7iCC> IRN Reg#: 76318-054 Facility: NYM Unit: Z04 Emergency Code - Resuscitation Event encounter performed at Special Housing Unit. SUBJECTIVE: Emergency Note Provider: ~f bJ_rs_u _bJ(7_ l_cc_> ---~f N Team Members: Provider ~l (b-)(6-); ,_bX7_ >_<c_> --~' RN Code Events: ~ CPR EKG/Monitor No shock advised CPR Oxygen Value Compressions Lifepak Compressions 15 L Role T earn/Code Leader Date 08/10/2019 06:35 08/10/2019 06:39 08/10/2019 06:40 08/10/2019 06:47 IV Access Peripheral IV 08/10/2019 06:48 18 g Left AC Airway Endotracheal Tube 08/10/2019 07:08 ET Tube 7.5 24CM to L Lip line Placed by Paramedics Medications Epinephrine 1 mg IV 08/10/2019 07:10 Epinephrine 3 doses and Sodium bicarb 2 doses administered by paramedics CPR Compressions 08/10/2019 07:11 Medications Sodium Bicarbonate 1 mEa/kg IV 08/10/2019 07:11 IV Fluids Normal Saline 0.9% 1000 ml 08/10/2019 07:12 Medications Epinephrine 1 mg IV 08/10/2019 07:1 3 CPR Compressions 08/10/2019 07:14 Medications Sodium Bicarbonate 1 mEa/kg IV 08/10/2019 07:14 Medications Epinephrine 1 mg IV 08/10/2019 07:16 CPR Compressions 08/10/2019 07:17 Comments: Responded to ~ biC?JCE) ~t 0635 for medical emergency on 9S, Upon arrival Inmate was received on the floor of his cell unresponsive with CPR in progress by correctional officers, Inmate was Cold, with circumferential Bruising around the neck and posterior mottling, Pupils Fixed and dilated, No Palpable pulses, Call place for EMS, CPR Continued, AED Placed No shock advised, CPR Continued, inmate transported to HSU treatment room with CPR in progress, 18g hep lock to LAC, 02 15 Lt ViA BVM, Pulse Check NO SHOCK advised. EMS and Paramedics arrived 0656, Placed on cardiac monitor asystole Resumed CPR, Inmate was intubated by Medics, 3 Rounds of Epinephrine administered, Pulse Check asystole, Inmate was transported to Local ER with CPR in progress. OBJECTIVE: Exam: General Appearance Yes: Unconscious Generated 08/1 0/2019 08:1 0 b~,:b)(S); (b)(?)CC) j RN Bureau of Prisons - NYM Page 1 of 2

Page 2338 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 08/10/2019 07:25 Provider: (b)(SJ: (bJ(?)(CJ RN Exam: ASSESSMENT: Cardiac Arrest PLAN: New Consultation Requests: Target Date Scheduled Target Date Priority Reg#: 76318-054 Facility: NYM Unit: Z04 Translator Language Consultation/Procedure Emergency Room Subtype: 08/10/2019 08/10/2019 Emergent No AMBULANCE Reason for Request: Cardiac arrest with CPR in progress Copay Required: No Telephone/Verbal Order: No Cosign Required: Yes Completed b bi(5> (bJ(7)(C J N on 08/10/2019 08:10 Requested to be cosigned by (bH6>: <b)(7)(C J D. Cosign documentation will be displayed on the following page. Generated 08/10/2019 08:1 0 b { bl(61; (b)(7)(C) Bureau of Prisons - NYM Page 2 of 2

Page 2339 DAG/USAO Tour From To l(b)(6); (b)(7)(C) I t bJ<5>: (b)(7)(c) ~ Charisma "'"E=d,.,,,g:-:-:e~:b=)( 6_>;_{b,_a)_<c,.> ~~~~-~--____JJames Petrucci, Lamine N'Diaye (b)(6> (b)(?;cc> NYM/Executive Date Subject: Attachments: Good afternoon, Stafll(b)(5>;~b)(7)(c) I Shirley V. Skipper-Scott 2019/08/14 15:04 DAG/USAO Tour TEXT.htm, U.S.Attorney, et al.tour.8.15.pdf Per the attached, representatives of the DAG's Office and the USAO SONY will be touring SHU, Inmate Epstein's cell (to the extent it does not contaminate the crime scene), and the suicide watch area on 2. Please let me know if you have any questions or concerns. Thank ou, b)(6); (b)(7)(C) r )(6); {b){7)(C) 1 Supervisory Staff Attorney CLC New York Metropolitan Correctional Center 150 Park Row New York, New York 10007 p: (646)83~ b:(6); (b)(7)(Ci I f: (646)836-7665 Page 13516

Page 2340 DA TE: August 14, 2019 TO: All Concerned UNITED STATES GOVERNMENT MEMORANDUM Metropolitan Correctional Center, New York, New York FROM: r )(6); (b)[7)(C) I Supervisory Attorney SUBJECT: Institutional Tour Please be advised that a tour for representatives of the Department of Justice and the SONY USAO will take place on: Thursday, August 15, 2019, at 10:00 a.m. The following individual(s) may be present: l .... (b-lt 5 _>:_<b_/( 7_i(c_> ___ ~I- Principal Deputy Attorney General f .... ·b-Jt 5 _J: _<b)(_ 7_lcc_>_~I Advisor at AG's office , b)(6); (b)(7)(C) 1 .... [ ______ ~ - U.S. Attorney .... r _)( 6 _); -(b)_(7_)(C_) ___ ....,I - Deputy us Attorney l (b)(5): (b)(?)(C) I Ch' f f h C • • 1 D' • • SDNY _ 1e o t e rimma 1v1s1on, :;_ r : b X::;_6::: ); ::: (b):::; (7::: )(C:::) ======~1 .... _______ ....,1Counsel to the US Attorney ' b)(6); (b)(7)(C) if"' ._[ ______ ....,1...,hief, Public Corruption Unit, SDNY l (b)(6;; (1>)(7)(C) I ..... ______ ___, Chief, Public Corruption Unit, SDNY .... r_ l(6_) _(b-X7_)~_> _____ ~1 AUSA .... r _)(6-);-'b-)(7-)(C_> __ _.....1 A USA Please inform me of their arrival so that I may greet them and take them on the tour. If you have any questions or concerns, please contact me afbXGJ; (b)f7)(Cl I

Page 2341 Re: Epstein, Jeffrey Edward, Reg. No. 73618-054_1 (Out of Office) From r b)(6); (b:(7)(C) I To Lamine N'Diaye Date 2019/08/10 14:21 Subject: Re: Epstein, Jeffrey Edward, Reg. No. 73618-054_1 (Out of Office) I will be away from the office August 9 - 19, 2019. The following staff will be acting in my capacity. Please extend them the usual courtesies. Thank you. >>> Lamine N'Diaye 08/10/19 14:21 >>> Mr. Ormond, Please see the attached updated time line. If you should have any questions please feel free to contact me. Thank you Page 13523

Page 2348 Re: Federal prison suicides rising before Jeffrey Epstein's death From To Date Subject: Attachments: (b)(6); (b)(7)(C) .___ _____ __.Hugh Hurwitz 2019/08/24 14:49 Re: Federal prison suicides rising before Jeffrey Epstein's death TEXT.htm, Suicide Data.xlsx, Annual Data Summary 1990- 2019.xlsx Page 13659

Page 2349 Hugh, 1. The attached spreadsheet has three tabs with counts on Attempts, Self Harm and Placement on Suicide Watch for all of our institutions between 2014-2018 and it was shared with IPPA. 2. This is a reporter's question sent to IPPA along with our response and my recommendation for adding more information. (4) Also, does BOP have any special initiatives under way to help reduce the numbers? What is BOP's response to the union's contention is staffing shortages is at the root of the problem? 'b)(S) 3. The second attachment is a collection of data Psychology Services does every year. 2018 and 2017 will likely have one more death added to each year. This were discovered this week, one at CAA and one at an RRC that PSB was never notified about. Please let me know if you have any questions. (b)(6); (b)(7)(C) > > > Hugh Hurwit7 l(bi<B>; inJu>ccJ ~ bop.gov> 8/23/2019 10:39 AM > > > Can I get any historical info you have? Thanks. https://www.usatoday.com/story/news/politics/2019/08/22/federal-prison-suicides-rising-before-jeffrey- epstei ns-death/2070689001 / Hugh Sent from my Verizon, Samsung Galaxy smartphone Page 13660

Page 2350 Psych Observation 7/8/19 6 pm until 7/10/19 at 9 am re: Epstein, Jeffrey Edward, Reg. No. 73618-054 From To Date Subject: Attachments: N'Diaye, Lamine (Charisma Edge) Lamine N'Diaye, Ray Ormond 2019/08/12 15:33 Psych Observation 7/8/19 6 pm until 7/10/19 at 9 amre: Epstein, Jeffrey Edward, Reg. No. 73618-054 TEXT.htm, 2019 _ 08 _ 12 _ l 5 _ 18 _ l l .pdf, Charisma Edge. vcf Psych Observation 7 /8/19 6 pm until 7 /10/19 at 9 am (1/M companion utilized) Page 13709

Page 2351 Psych Observation 7/8/19 6 pm until 7/10/19 at 9 am re: Epstein, Jeffrey Edward, Reg. No. 73618-054 From To Date Subject: Attachments: N'Diaye, Lamine (Charisma Edge) Lamine N'Diaye, Ray Ormond 2019/08/12 15:55 Psych Observation 7/8/19 6 pm until 7/10/19 at 9 amre: Epstein, Jeffrey Edward, Reg. No. 73618-054 TEXT.htm, Charisma Edge.vcf, Epstein Psych Observation 7-8-10- 2019.pdf Psych Observation 7 /8/19 6 pm until 7 /10/19 at 9 am (1/M companion utilized) Page 13730

Page 2352 Re: Fwd: Re: Interviews (Out of office reply) From To Date Subject: I"'" '".,,,c, I 2019/08/16 13:43 Re: Fwd: Re: Interviews (Out of office reply) Please be advised, I will be away from the institution as of Monday, August 12, returning on Tuesday, September 3, 2019. I will not have access to this e-mail account during that time. If this is an emergency, please contact the Lieutenant's Office at Exti~i~icc> If this matter pertains to a psychology-related issue, please contact: fb)(6); (b)(7)(C) IE (b)(6): ~- ;::::::;;;::::::::;::;:::==:::::;-,o-:=~ Xt. (b)(7)(C) r i(6); (b)(7)(C) ~Xt .b)(6); (b)(7)(C) Very respectfully, r )(6):(b)(7)1Cl ~ h.D. Forensic Psychologist LT, U.S. Public Health Service U.S. Department of Justice Federal Bureau of Prisons Metropolitan Correctional Center 150 Park Row New York, New York 10007 Office: 646.83 (b)(s> (b)(7)1C) Fax: 646.836. Email (b)(6); (b)t7)(C) If you have e-mailed to refer an inmate whom you believe may be at risk for self harm, this e- mail is not sufficient. Please maintain constant visual observation of the inmate or arrange, via the Operations Lieutenant, to initiate a Suicide Watch pending a formal Suicide Risk Assessment by a Psychologist. Please also make immediate verbal contact with a Psychologist. If it is after hours, please notify the Operations Lieutenant so that the on-call Psychologist can be contacted. "This message is intended for official use and may contain SENSITIVE information. If this message contains SENSITIVE information, it should be properly delivered, labeled, stored, and disposed of according to policy." > > r )(6); (b)(7)(C) ~8/16/19 13:43 >>> Good afternoon, Per the below, OIG would like to interview you regarding the incident last weekend involving (b)~;PSTEIN, Jeffrey, r~g. no. 76318-054. Please call Special Agentr )(B);(b)(?)(C) ~t 202-853- (b)(l)(C) t your convemence. Thank ou, b)(6); (b)(7)(C) Page 13751

Page 2353 rb)(6); (b)(7)(C) Supervisory Staff Attorney CLCNewYork Metropolitan Correctional Center 150 Park Row New York, New York 10007 p: ( 646)83l:b)(6); (b)(7)(C) I f: (646)836-7665 18/16/2019 1:41 PM>>> Per the attached OIG would like to interview the following staff members. >> b)(5);(b)(l)(C} OIG)" 8/16/2019 12:56 PM >>> b)(6); (b)(7)(C ) Sent from mobile device, please excuse typos. (b)(6); (b)(l)(C) pecia gen Office of the Inspector General 1 Battery Park Plaza, 29th floor New York, NY 10004 ell ffice r )(G); (b)(?)(C) ~ USDOJ. GO v 1.r=b)=(6i;....,,..(b= )(7)=(c,-) ----,L ; On Aug 16, 2019, at 12:34 P11 1 rote: > Medical Staff? > > >>> ~rb)-(G)-;(b-)(l-)(C-) ----~1 (OIG)" 8/16/2019 11:25 AM >>> > > We are available at all times for the medical staff interviews today, if they are willing to agree to a voluntary interview. > > Sent from mobile device, please excuse typos. > >=r )=(6)~; (b~)(7=)(C,- ) ---~ > Special Agent > Office of the Inspector General > 1 Battery Park Plaza, 29th floor > New York, NY 10004 202 853 'b)(Bi: ell > - 'b)(l)(C) > 212-908 b)(6); (b)(7)(C) ffice @USDOJ.GOV Page 13752

Page 2354 Fwd: Re: Interviews From To Date 2019/09/03 11:32 Subject: Fwd: Re: Interviews Attachments: TEXT.htm Hello all, I just spoke with Special Agentfb)(6):(b)(?)cc> !requested to meet with him for my interview on 9/6/19 at 9:00 or 10:00 a.m. He will follow-up with me to advise if this time works well. Very respectfully, rb)(6): (b)(7)(C) 1 l'b){6i; (b)(7)(C) I Ph.D. Forensic Psychologist LT, U.S. Public Health Service U.S. Department of Justice Federal Bureau of Prisons Metropolitan Correctional Center 150 Park Row New York, New York 10007 Office: 646.83 (b)(S); (b)(7)(C) Fax: 646.836.7 E-mail t >C6>: (b)(7)(c> fmbop.gov If you are emailing about an inmate that may be at risk for suicide or self-harm, this is an emergency situation. Please ensure you make verbal contact with 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. "This message is intended for official use and may contain SENSITIVE information. If this message contains SENSITIVE information, it should be properly delivered, labeled, stored, and disposed of according to policy." /16/2019 1:43 PM>>> Per the below, OIG would like to interview you regarding the incident last weekend involving EPSTEIN, Jeffrey, reg. no. 76318-054. Please call Special Agenr (6) (b)(7)(C) ~t 202-853 :g;~~;iC) t your convenience. Thank you, b)(6); (b)(7)(C) Page 13755

Page 2355 r b)(6); (b)(7)(C) 1 Supervisory Staff Attorney CLC New York Metropolitan Correctional Center 150 Park Row New York, New York 10007 p: (646)836!ib)(6;; (b)(7)(C) I f (646)836-7665 > > i b)(5); (b)(?)(C) 1/16/2019 1 :41 PM > > > Per the attached OIG would like to interview the following staff members. l (b)(6l; (b)(7)(C) L . > > i (b)(5) (b)(7)(C) 1. (OIG)" • • [email protected]> 8/16/2019 12:56 PM > > > (b)(6); (b)(7)(C) Sent from mobile device, please excuse typos. rb)(6); (b)(7)(C} Special Agent Office of the Inspector General 1 Battery Park Plaza, 29th floor New York, NY 10004 202-853 t~~c) Cell 212-908 Office b)(6); (b)(7)(C) USDOJ.GOV > On Aug 16, 2019, at 12:34 PMf~:b)-cs>-:<b_><_7 )c-c>-----~~ bop.gov> wrote: > > Medical Staff? > > > > t b)(6); (b)(7)(C) i( 01 G) .. r )(6); (b)(7)(C) pusdoj .gov> 8/16/2019 11 :25 AM > > > > > We are available at all times for the medical staff interviews today, if they are willing to agree to a voluntary interview. > > Sent from mobile device, please excuse typos. > ~b)(6); (b)(7)(C) > Special Agent > Office of the Inspector General > 1 Battery Park Plaza, 29th floor > New York, NY 10004 > 202-853- g;[~iic) Cell > 212-908- Office { b)(G) (b)(?)(C) ~ USDOJ.GOV Page 13756

Page 2356 Re: Media inquiry - due 3 pm - USA Today - re: monitoring video of suicide-risk IMs in segregated housing From Hugh Hurwitz To Date 2019/10/22 13:08 Subject: Re: Media inquiry- due 3 pm- USA Today - re: monitoring video of suicide-risk IMs in segregated housing Attachments: TEXT.htm This question is NOT about suicide watch. It should be referred to CPD. Hugh Sent from my Verizon, Samsung Galaxy smartphone -------- Original message -------- Fromr >t5>:(b;(7)cc> [email protected]> Date: 10/22/19 12:46 PM (GMT-05:00) To:fll)(S);(b)(7)(C) @bop.gov>,Hugh Hurwitzr )(S);(b)(?)(C) ~ bop.gov> Subject: Fwd: Media inquiry - due 3 pm - USA Today - re: monitoring video of suicide-risk I Ms in segregated housing > > >l(b)(S) (b)(?)(C) ' 0/22/2019 12:47 > > > FYI H h (b)(6); ug an (b)C7JiC) > > (b)(S); (ll)(?)(C) 0/22/2019 12:3 5 PM > > > (b)i6); (b}(7)(C) The reporter now says his deadline is 3 pm, so I'll need to take this to IPPA leadership as soon as you return and review this. Thanks, b.1(6); (b)(7)(C) .b)(6); ,b)(7)(C Page 13883

Page 2357 Reporter: ~[b)-(6_):(_b)[7_ )_1c_1 ---~t USA Today Question: In wake of the Epstein death, I understand that institutions across the bureau are designating specific officers to regularly monitor surveillance video in segregated housing units and other locations where inmates are at some risk for suicide. Is there someone who may be able to elaborate on this effort? Proposed Response: (b)(5) b)(5) Internal Notes: f~b)=(6)-; (b~)[7=){C~ )--~ b)(6); b)(7)(C)

Page 2358 b)(5) [ b)(6); I t bl(7l(C) [ b)(6); I fhll7lff:l Answer sent to WA Post on 8/21/2019 (finalized by IPPA leadership after consulting(bHB):<b)(?)(c) The safety of staff, inmates, and the public is the highest priority for the Bureau of Prisons (BOP). The BOP has an extensive Suicide Prevention Program that begins upon an inmate's arrival at each BOP facility, including pretrial facilities such as MCC New York. See BOP Program Statement 5324.08 "Suicide Prevention Program" here https://www.bop.gov/po)icy/progstat/5324 008,pdf and BOP Program Statement 5310.17 "Psychology Services Manual" here https://www.bop.gov/policy/progstat/5310_017.pdf. During the initial intake screening by medical staff, inmates complete a psychological questionnaire. Psychology Services staff are immediately notified if suicidal ideation is apparent from the responses. Further, any BOP staff member may place an inmate on suicide watch. The Suicide Prevention Program at each BOP facility is administered by a Suicide Prevention Program Coordinator. The Program Coordinator, who must be a doctoral-level psychologist, ensures compliance with suicide intervention and prevention policies, which include training, identification, referral, assessment, and intervention. In BOP facilities, suicide watch is typically a short-term and highly restrictive intervention measure. Every institution has one or more rooms designated specifically for housing an inmate on suicide watch. These areas are set aside as special cells, typically in the BOP's Health Services division, which allow staff to maintain a safe environment for the inmate without compromising the ability to observe and protect the inmate. This environment includes easy access to the room, privacy, unobstructed vision of the inmate at all times, and limited availability of objects, materials, or architectural features that would allow for easy self-injury. Inmates on suicide watch are evaluated daily by a psychologist and are constantly observed by either staff or inmate companions. Once an inmate is placed on suicide watch, the watch may only be terminated by a BOP psychologist following a face-to-face evaluation with the inmate. With regard to staffing levels, 15,012 correctional officers are currently working at the BOP and 1,654 correctional officer positions are vacant as of August 3, 2019. The BOP continues to work on hiring and retaining staff nationally. As you are aware, the Epstein case is currently under investigation by the Federal Bureau of Investigation and the Department of Justice's Office of the Inspector General. The BOP is also conducting an After Action Review and a Suicide Reconstruction Review. The BOP will assess any additional measures which should be taken after those processes are completed. The factors that lead an inmate from suicidal ideation to suicidal behavior are complex. Those factors include an individual's access to means (e.g., pills or razors), opportunity (e.g., privacy to implement a plan), motivation, and subjective feelings of defeat or humiliation. l(b)(6}; (b)(7)(C) I Public Information Office Federal Bureau of Prisons (202) 35~ (b)(6); (b)(7)(C) I > i (b)(G); (b)(?)(C) I 0/22/2019 11 :3 9 AM > > > Page 13885

Page 2359 r b)(6): (b)(7)(C ) The USA Today's top reporter (who's written front page stories on the BOP) is asking if BOP is "designating specific officers to regularly monitor surveillance video in segregated housing units and other locations where inmates are at some risk for suicide." (b)(S) t b)(6): (b)(7 )(C) Thanks, (b)(6): (b)(7)(C' f b}(6); (b)(7)(C) I Public Information Office Federal Bureau of Prisons (202) 353 :b)(G); (b)(7)(C) > > 1 (b)(6); (b)(7)(C) Good morning, @usatoday,com> 10/22/201910:32 AM>> In wake of the Epstein death, I understand that institutions across the bureau are designating specific officers to regularly monitor surveillance video in segregated housing units and other locat ions where inmates are at some risk for suicide. Is there someone who may be able to elaborate on this effort? Many thanks, 'b)(6); (b)(7)(C) l(b)(6); (b)(7)(C) USA TODAY ~~~~ 703-85 703-47~ --~ Page 13886

Page 2360 Fwd: Media inquiry - due 3 pm - USA Today - re: monitoring video of suicide-risk IMs in segregated housing From To Date Subject: Attachments: (b)(6); FYI Hugh and (b)(7)(c ) > > (b)(6); (b)(7i(C) (b)(6); (b;(?)(C) b)(6) (b)(7)(C) b)(6); (b)(7)(C) Hugh Hmwitz ~-----~ 2019/10/22 12:46 Fwd: Media inquiry - due 3 pm - USA Today - re: monitoring video of suicide-risk IMs in segregated housing TEXT.htm 10/22/2019 12:3 5 PM > > > The reporter now says his deadline is 3 pm, so I'll need to take this to IPPA leadership as soon as you return and review this. Here are two follow-up questions I have for you, following our call, to help finalize my draft answer below: (b)(5) Thanks, l(b)(6); (b)(7)(C) - USA Today Question: In wake of the Epstein death, I understand that institutions across the bureau are designating specific officers to regularly monitor surveillance video in segregated housing units and other locations where inmates are at some risk for suicide. Is there someone who may be able to elaborate on this effort? Proposed Response: 'b)(5)

Page 2361 'b)(5) Internal Notes: (b)(5) =1 (b)=(6),--,, ; (b..,.,, )(7,,.,.. )(C,,.,..) -----, b)(6); '.b)(?)(C) ib)(6); (b)(7)(C) Answer sent to WA Post on 8/21/2019 (finalized by IPPA leadership after consultin~-cb-)( 6 _>; 1_b>(7_)<_c> __ ~ The safety of staff, inmates, and the public is the highest priority for the Bureau of Prisons (BOP). The BOP has an extensive Suicide Prevention Program that begins upon an inmate's arrival at each BOP facility, including pretrial facilities such as MCC New York. See BOP Program Statement 5324.08 "Suicide Prevention Program" here htt.ps://www.bop.gov/po1icy/progstat/5324 008.pdf and BOP Program Statement 5310.17 "Psychology Services Manual" here https://www.bop.gov/policy/progstat/53 l O 017.pdf. During the initial intake screening by medical staff, inmates complete a psychological questionnaire. Psychology Services staff are immediately Page 13891

Page 2362 notified if suicidal ideation is apparent from the responses. Further, any BOP staff member may place an inmate on suicide watch. The Suicide Prevention Program at each BOP facility is administered by a Suicide Prevention Program Coordinator. The Program Coordinator, who must be a doctoral-level psychologist, ensures compliance with suicide intervention and prevention policies, which include training, identification, referral, assessment, and intervention. In BOP facilities, suicide watch is typically a short-term and highly restrictive intervention measure. Every institution has one or more rooms designated specifically for housing an inmate on suicide watch. These areas are set aside as special cells, typically in the BOP's Health Services division, which allow staff to maintain a safe environment for the inmate without compromising the ability to observe and protect the inmate. This environment includes easy access to the room, privacy, unobstructed vision of the inmate at all times, and limited availability of objects, materials, or architectural features that would allow for easy self-injury. Inmates on suicide watch are evaluated daily by a psychologist and are constantly observed by either staff or inmate companions. Once an inmate is placed on suicide watch, the watch may only be terminated by a BOP psychologist following a face-to-face evaluation with the inmate. With regard to staffing levels, 15,012 correctional officers are currently working at the BOP and 1,654 correctional officer positions are vacant as of August 3, 2019. The BOP continues to work on hiring and retaining staff nationally. As you are aware, the Epstein case is currently under investigation by the Federal Bureau of Investigation and the Department of Justice's Office of the Inspector General. The BOP is also conducting an After Action Review and a Suicide Reconstruction Review. The BOP will assess any additional measures which should be taken after those processes are completed. The factors that lead an inmate from suicidal ideation to suicidal behavior are complex. Those factors include an individual's access to means (e.g., pills or razors), opportunity (e.g., privacy to implement a plan), motivation, and subjective feelings of defeat or humiliation. (b)(6): (b)(7)(C) Pu ic In ormat1on Office Federal Bureau of Prisons (202) 353f b)(6); (b)(7)(C} I > > b)(6); (b)(7)(C) 1 0/22/2019 11 :3 9 AM > > > b)(6); (b)(7)(C) The USA Today's top reporter (who's written front page stories on the BOP) is asking if BOP is "designating specific officers to regularly monitor surveillance video in segregated housing units and other locations where inmates are at some risk for suicide." 'b)(5) Thanks, f b)(6); (b)(7)(C) b)(6): (b)(7)(C) 'b)(6); (b)(7)(C) b)(6); b)(7)(C) u 1c n orma 10n ffice Federal Bureau of Prisons t-in-, \ ~ C:"':> :0)(6); (b)(?)(C) b)(6); b)(7)(C: (b)(6); (b)(7)(C, Page 13892

Page 2363 (b)(6): ~LUL) .;):;J (b)(7)(C) > > t b}(6); (b)(7)(C ) Good morning, pvusatoday.com> 10/ 22/2019 10:32 AM>> In wake of the Epstein death, I understand that institutions across the bureau are designating specific officers to regularly monitor surveillance video in segregated housing units and other locations where inmates are at some risk for suicide. Is there someone who may be able to elaborate on this effort? Many thanks, b)(6); (b)(7)(C) r b)(6); (b)(7)(C) USA TODAY 703-854 (b)(6); (b)(?)(C) 703-472~-~ Page 13893

Page 2368 Mail Attachment Epstein, Jeffrey Edward, Reg. No. 73618-054 for medical mortality review.docx Page 14044

Page2369 Suicide Timeline re: Epstein, Jeffrey Edward, Reg. No. 73618-054 Saturday, August 10, 2019 6 : 33 am ~fb!_u_HE_! ____ ~lactivated in SHU. Staff fo und inmate Epstein unresponsive in cell. Staff report ed t o bedsi de of inmate and attempted t o wake him. Cont ro l a nnounced medical emergency . CPR initiated 6 : 35 am medical staff (on duty PA) on s i t e, CPR a l ready in progress medical staff cont inues CPR a nd AED appl ied on inmate . Contro l called f or ambulance 6 : 45 am EMS arr i ves , paramedi cs cont inue CPR . I nmat e Epstein remains unresponsive . I nmat e Epstein i s int ubat ed, given t hree rounds of Epinephrine , IV access started, IO initiated . No pulse found, no s hock advi sed, inmate prepared for t ransport t o l ocal hospi tal. 7 : 10 am EMS departs institution enroute to Beekman Hospital . 7 : 36 am offi c i a l t ime of death reported by ER p hys i c i an . 9 : 55 am CMC a nd I DO depart insti t ut i on wit h body enrout e t o Beekman Hospital. 10 : 00 am CMC and I DO arr i ve at Beekman Hosp i ta l , fingerprints and phot ographs taken of inmate Epstein . I nmat e c l ot hing secured and brought back to institution . 12 :1 5 pm body re l eased t o Medical Examiner (ME) for autopsy

Page 2373 Re: Suicide Watch/Psych Observation Update From To I Date 2019/08/01 08:03 Subject: Re: Suicide Watch/Psych Observation Update Attachments: TEXT.htm do you have epstein's psych obs book (b)(6); (b)[7)(C) Psy.D. C ie Psyc o ogist U.S. Department of Justice/ Federal Bureau of Prisons Metropolitan Correctional Center 150 Park Row New York, New York 10007 Office: (646) 836 b)(6): (b)[7)(c ) Fax: (646) 836-7712 E-mailfb>(6); (b)(7Jcc > ~ bop.gov > > r )( 6 ); (b)(?)(C) ~/1/2019 7:46 AM > > > Suicide Watch r )(6); (b)[7)(C) Psych Observation None Thank you, r )(6); (b)[7)(C) Page 14094

Page 2377 Fwd: MCC Visit Thursday From To Date Subject: l(b)(6); (b)(7)(C) Lamine N'Diaye 2019/08/13 14:12 Fwd: MCC Visit Thursday Attachments: TEXT.htm Page 14312

Page 2378 Warden, Can we chat about the below at your convenience? Thank you, l(b)(6); (b)(7)(C) I r:: ·: : ·: IS01 y ,ca 11 ACCOI I ll CLC New York Metropolitan Correctional Center 150 Park Row New York, ~~~....y0007 (b)(6); (b)(7)(C ) p: ( 646)83 6 '---------' f: (646)836-7665 (b'(6 ) (b) 7'(C) (USANYS)f b)(6); (b)(7)(C) b .,,..,>=>,....,,...J,,,..' .-:-- c ' ____ __, ~l ------~~ usdoj.gov> 8/13/2019 2:05 PM > > > (b)(6); (b){7)(C) The list of visitors from our office is below: (b)(6): (b)(7)(C ) As discussed, we would like to see the 2nd floor pscyh observation and suicide watch area; the 9th floor SHU, and Epstein's cell, which we understand to still be cordoned off. As discussed, we would appreciate if only MCC legal would escort us, and we will not speak to any of the guards present given the ongoing investigations. Please give me a call with any questions, and let us know what time and where we should go, and if it would be easier for us to enter via the 3rd floor bridge. Thanks, b)(6); (b)(7)(C) s Attorney Southern District of New York Tel: (212) 63 (b)(6>: <bX?xc > Page 14313

Page 2379 Epstein, Jeffrey Edward, Reg. No. 73618-054 for medical mortality review From Charisma Edge To l(b)(6); (b)(7)(C) Date 2019/08/12 10:58 Subject: Epstein, Jeffrey Edward, Reg. No. 73618-054 for medical mortality review Attachments: TEXT.htm, Epstein, Jeffrey Edward, Reg. No. 73618-054 for medical m011ality review.docx, Charisma Edge.vcf FYI.. .... Charisma Edge Associate Warden MCCNewYork 150 Park Row New York, NY 10007 ~--~ 646-836-6300 ext (b)(6); (b)(?)(C) [ b)l6);M (7)<C>@ bop.gov NYM/ A [email protected] Page 14317

Page 2382 Re: Re: Media inquiry - due 3 pm - USA Today - re: monitoring video of From Hugh Hurwitz To f b){6); (b)(7)(C) Date 2019/10/22 13:33 Subject: Re: Re: Media inquiry - due 3 pm - USA Today - re: monitoring video of Attachments: Th k L b)(6); an s. e .b)(7)<c> Hugh TEXT.htm now, since this came from usa today, I'm guessing he found out from :gmc> Sent from my Verizon, Samsung Galaxy smartphone -------- Original message -------- Frorri(b)(6>: {b}(7)(c> @bop.gov> Date: 10/22/19 1 :30 PM (GMT-05:00) To:fb)(5) (b)(7)(C) ~ bop.gov>, Hugh Hurwitz rb)(G);(b)(7)(C) ~bop.gov> Subject: Fwd: Re: Media inquiry - due 3 pm - USA Today - re: monitoring video of > > i (b)(6); (b)(7)(C) 11012212019 13:30 > > > FYI > > t )(G); (b)(7)(C) I 0/22/2019 1 :27 PM > > > Thanks to Hugh for clarifying this. Upon reflection, I agree it really is probably only about the CPD rounds issue. I'm walking down to CPD now to see if they can improve my new draft answer belowt' 5 > (b)(5) rb)(6): (b)(7)(C) 1 Public Information Office Federal Bureau of Prisons (202) 353 :~;;~t ,, ,b)(6); (b)(7)(C) >>> (b)(6): (b)(7)(C) 10/22/2019 1:24 PM > > > I'm walking down to CPD to see if I can find someone in your absence who can review my new, very rough draft answer below, which AD Hurwitz says is best answered by CPD and not RSD. Accordingly, I eliminated my prior (long) draft answer that had input from RSD. Thanks, (b)(6); (b)(7)(C) Page 14399

Page 2383 Re orter: (b)(6); (b)(7)(C) USA Today Question: In wake of the Epstein death, I understand that institutions across the bureau are designating specific officers to regularly monitor surveillance video in segregated housing units and other locations where inmates are at some risk for suicide. Is there someone who may be able to elaborate on this effort? (b)(5) Proposed Response: (b)(5) I l(b)(6); (b)(7)(C ) Page 14400

Page 2384 tb)(6); (b)(7)(C) I Public Information Office Federal Bureau of Prisons (202) 353 ~(i;~C' > >fb)(6); (b)(7)(C) I0/22/2019 1:09 PM>>> > > > Hugh Hurwitl(b)(6);(b)[7j(C) p?bop.goy> 10/22/2019 1 :08 PM > > This question is NOT about suicide watch. It should be referred to CPD. Hugh Sent from my Verizon, Samsung Galaxy smartphone > > (b:(6);(b)(?)(C) 0/22/2019 12:47 > > > FYI Hugh and (b)(6); (b)(?)cc > > >l (b)(6); (b)(7)(C) I '-· _____ __.10/22/2019 1:08 PM > > > > ,b)(6); (b)(7)(C) 0/22/201912:35 PM>>> (b)(6); (b)[7)(C) The reporter now says his deadline is 3 pm, so I'll need to take this to IPPA leadership as soon as you return and review this. Here are two follow-up questions I have for you, following our call, to help finalize my draft answer below b)(5) Thanks, 'b)(6): (b)[7)(C) Re orter: b )(6 ): (b )(7 )(C) '---------' USA Today b)(6); b)(7)(C Page 14401

Page 2385 Question: In wake of the Epstein death, I understand that institutions across the bureau are designating specific officers to regularly monitor surveillance video in segregated housing units and other locations where inmates are at some risk for suicide. Is there someone who may be able to elaborate on this effort? Proposed Response: (b)(5) > :b)(6); (b)(7)(C) /22/2019 12:35 PM >» b)(6); (b)(7)(C) The reporter now says his deadline is 3 pm, so I'll need to take this to IPPA leadership as soon as you return and review this. Here are two follow-up questions I have for you, following our call, to help finalize my draft answer below Page 14402

Page 2386 ,b)(5) Thanks, (b)(6); (b)(7)(C) Reporter: ~f b)_c 6 _>:(b- )(7_)c_c > ___ ~I USA Today Question: bi(6); b)(7XC In wake of the Epstein death, I understand that institutions across the bureau are designating specific officers to regularly monitor surveillance video in segregated housing units and other locations where inmates are at some risk for suicide. Is there someone who may be able to elaborate on this effort? Proposed Response: (b)(5)

Page 2387 Internal Notes: (b)(5) "'" lib=X6-J; ('""' b>c"'" 1x=c>----. (b)(6); 'b)(7XC) (b)(6): (b)(7)(C) (b)(6); (b)(7)(C) Answer sent to WA Post on 8/21/2019 (finalized by IPPA leadership after consulti ngl(b)(6); (bX7>cc> The safety of staff, inmates, and the public is the highest priority for the Bureau of Prisons (BOP). The BOP has an extensive Suicide Prevention Program that begins upon an inmate's arrival at each BOP facility, including pretrial facilities such as MCC New York. See BOP Program Statement 5324.08 "Suicide Prevention Program" here https://www.bop.gov/policy/progstat/5324 008.pdf and BOP Program Statement 5310.17 "Psychology Services Manual" here https://www.bop.gov/policy/progstat/5310 017.pdf. During the initial intake screening by medical staff, inmates complete a psychological questionnaire. Psychology Services staff are immediately notified if suicidal ideation is apparent from the responses. Further, any BOP staff member may place an inmate on suicide watch. The Suicide Prevention Program at each BOP facility is administered by a Suicide Prevention Program Coordinator. The Program Coordinator, who must be a doctoral-level psychologist, ensures compliance with suicide intervention and prevention policies, which include training, identification, referral, assessment, and intervention. In BOP facilities, suicide watch is typically a short-term and highly restrictive intervention measure. Every institution has one or more rooms designated specifically for housing an inmate on suicide watch. These areas are set aside as special cells, typically in the BOP's Health Services division, which allow staff to maintain a safe environment for the inmate without compromising the ability to observe and protect the inmate. This environment includes easy access to the room, privacy, unobstructed vision of the inmate at all times, and limited availability of objects, materials, or architectural features that would allow for easy self-injury. Inmates on suicide watch are evaluated daily by a psychologist and are constantly observed by either staff or inmate companions. Once an inmate is placed on suicide watch, the watch may only be terminated by a BOP psychologist following a face-to-face evaluation with the inmate. With regard to staffing levels, 15,012 correctional officers are currently working at the BOP and 1,654 correctional officer positions are vacant as of August 3, 2019. The BOP continues to work on hiring and retaining staff nationally. As you are aware, the Epstein case is currently under investigation by the Federal Bureau of Investigation and the Department of Justice's Office of the Inspector General. The BOP is also conducting an After Action Review and a Suicide Reconstruction Review. The BOP will assess any additional measures which should be taken after those processes are completed. The factors that lead an inmate from suicidal ideation to suicidal behavior are complex. Those factors include an individual's access to means (e.g., pills or razors), opportunity (e.g., privacy to implement a Page 14404

Page 2388 plan), motivation, and subjective feelings of defeat or humiliation. r b)(6): (b)(7)(C ) Public Information Office Federal Bureau of Prisons (202) 35J b)(6) (b)(7)(C) I > > t b)(G) (b)(7)(C) 11 0/22/2019 11 :3 9 AM > > > l(b)(G); (b)(7)(C) The USA Today's top reporter (who's written front page stories on the BOP) is asking if BOP is "designating specific officers to regularly monitor surveillance video in segregated housing units and other locations where inmates are at some risk for suicide." (b)(5) t b)(6); (b)(7)(C) Thanks, (b)(6); (b)(7)(C) t b)(6); (b)(7)(C) I Public Information Office Federal Bureau of Prisons '.b)(6): (202) 35 'h\17\fr,\ > i (b)(6); (b)(7)(C) Good morning, p?usatoday.com> 10/22/2019 10:32 AM > > In wake of the Epstein death, I understand that institutions across the bureau are designating specific officers to regularly monitor surveillance video in segregated housing units and other locations where inmates are at some risk for suicide. Is there someone who may be able to elaborate on this effort? Many thanks, b)(6); (b)(7)(C) r i(6); (b)(7)(C) USA TODAY r::-=,,..,,.,-=,-, 703-854 (b)(6): (b}(7)(C) 703-472 ,...._ __ _. Page 14405

Page 2389 Fwd: Re: Media inquiry - due 3 pm - USA Today - re: monitoring video of From To Date Subject: Attachments: FYI b)(6); (b)(7)(C) Hugh Hurwitz '----------' 2019/10/22 13:30 Fwd: Re: Media inquiry- due 3 pm- USA Today - re: monitoring video of TEXT.htm > { b\( 6 ); (b)(?)(C) ~ 0/22/2019 1 :27 PM > > > Thanks to Hugh for clarifying this. Upon reflection, I agree it really is probably only about the CPD rounds issue. I'm walking down to CPD now to see if they can improve my new draft answer belowt rs> (b)(S) Public Information Office Federal Bureau of Prisons (202) 353 (b)(6); (b)\7)(C! > ib)(6); (b)(7)(C) 0/22/2019 1:24 PM>>> b)(6); (b)(7 )(C) I'm walking down to CPD to see if I can find someone in your absence who can review my new, very rough draft answer below, which AD Hurwitz says is best answered by CPD and not RSD. Accordingly, I eliminated my prior (long) draft answer that had input from RSD. Thanks b)(6); (b)(7)(C' Reporter: ..... rbl_(6 >_: 1b_)(7_)(c_> ___ __.I USA Today Question: In wake of the Epstein death, I understand that institutions across the bureau are designating specific officers to regularly monitor surveillance video in segregated housing units and other locations where inmates are at some risk for suicide. Is there someone who may be able to elaborate on this effort? Prooosed Resoonse: (b)(5)

Page 2390 Pro '.b)(5) l(b)(6): (b)(7)(C) f b)(6); (b)(7)(C) Public Information Office Federal Bureau of Prisons 202 3sj ~(~1;,,, 1 [b)(G); (b)(7)(C) 1 0/22/2019 1 :09 PM > > > >>> Hugh Hurw <b>C 6 >; (b)(?)<c> bo . ov> 10 22 20191:08 PM>> This question is NOT about suicide watch. It should be referred to CPD. Hugh Sent from my Verizon, Samsung Galaxy smartphone >> bX6); (b)(7)(C) 10/22/2019 12:47 > > > FYI Hugh a t >X6\;(b)(7)cc> r 'b)(G); (b)(7)(C) h ._ ______ __,1'0/22/20191:08 PM>>> Page 14410

Page 2391 > > > l:b)(G:; (b)(7)(C) p 0/22/2019 12:3 5 PM > > > .,.., _b)=(6,-, ); (b,..,..,)(l;;, 7)(;;;,; C)= ;------' (b)(5) The reporter now says his deadline is 3 pm, so I'll need to take this to IPPA leadership as soon as you return and review this. Here are two follow-up questions I have for you, following our call, to help finalize my draft answer below Thanks, (b;(6); (b)(7)(C ' 'b)(6); (b)(7)(C) Reporter: .... r_ )(G-); (-b)(7 - )(-C) ____ _,1usA Today Question: In wake of the Epstein death, I understand that institutions across the bureau are designating specific officers to regularly monitor surveillance video in segregated housing units and other locations where inmates are at some risk for suicide. Is there someone who may be able to elaborate on this effort? Proposed Response: (b)(5)

Page 2392 'b)(5) f .b)(6), (b)(7)(C ) I ________ 10/22/2019 12:35 PM >» r )(6); (b)(7)(C) The reporter now says his deadline is 3 pm, so I'll need to take this to IPPA leadership as soon as you return and review this. Here are two follow-up questions I have for you, following our call, to help finalize my draft answer below Thanks, (bi(6); (b)(7)(C) Re orter: :b)(6); (b)(7)(C ) ~------USA Today Page 14412

Page 2393 Question: In wake of the Epstein death, I understand that institutions across the bureau are designating specific officers to regularly monitor surveillance video in segregated housing units and other locations where inmates are at some risk for suicide. Is there someone who may be able to elaborate on this effort? Proposed Response: b)(5) Internal Notes: b)(5)~-----~ l(b)(6); (b)(7)(C) :b)(6); .b)(7)(C ) (b)(6); (b)(7)(C ) (b)(6); ib)(7)(C

Page 2394 (b)(5) Answer sent to WA Post on 8/21/2019 (finalized by IPPA leadership after consultin~ .... b>_,s,_: 'b_,(7_,,_c , ___ ...., The safety of staff, inmates, and the public is the highest priority for the Bureau of Prisons (BOP). The BOP has an extensive Suicide Prevention Program that begins upon an inmate's arrival at each BOP facility, including pretrial facilities such as MCC New York. See BOP Program Statement 5324.08 "Suicide Prevention Program" here https://www.bop.gov/policy/progstat/5324 008.pdf and BOP Program Statement 5310.17 "Psychology Services Manual" here https://www.bop.gov/policy/progstat/53 l 0 017.pdf. During the initial intake screening by medical staff, inmates complete a psychological questionnaire. Psychology Services staff are immediately notified if suicidal ideation is apparent from the responses. Further, any BOP staff member may place an inmate on suicide watch. The Suicide Prevention Program at each BOP facility is administered by a Suicide Prevention Program Coordinator. The Program Coordinator, who must be a doctoral-level psychologist, ensures compliance with suicide intervention and prevention policies, which include training, identification, referral, assessment, and intervention. In BOP facilities, suicide watch is typically a short-term and highly restrictive intervention measure. Every institution has one or more rooms designated specifically for housing an inmate on suicide watch. These areas are set aside as special cells, typically in the BOP's Health Services division, which allow staff to maintain a safe environment for the inmate without compromising the ability to observe and protect the inmate. This environment includes easy access to the room, privacy, unobstructed vision of the inmate at all times, and limited availability of objects, materials, or architectural features that would allow for easy self-injury. Inmates on suicide watch are evaluated daily by a psychologist and are constantly observed by either staff or inmate companions. Once an inmate is placed on suicide watch, the watch may only be terminated by a BOP psychologist following a face-to-face evaluation with the inmate. With regard to staffing levels, 15,012 correctional officers are currently working at the BOP and 1,654 correctional officer positions are vacant as of August 3, 2019. The BOP continues to work on hiring and retaining staff nationally. As you are aware, the Epstein case is currently under investigation by the Federal Bureau of Investigation and the Department of Justice's Office of the Inspector General. The BOP is also conducting an After Action Review and a Suicide Reconstruction Review. The BOP will assess any additional measures which should be taken after those processes are completed. The factors that lead an inmate from suicidal ideation to suicidal behavior are complex. Those factors include an individual's access to means (e.g., pills or razors), opportunity (e.g., privacy to implement a plan), motivation, and subjective feelings of defeat or humiliation. r b}(6); (b}\7)(C) 1 Public Information Office Federal Bureau of Prisons (202) 353{ b)(S); (b)(7)(Ci I > (b)(5): (b)[l )(C) 10/22/201911:39AM >>> (b)(6): (b)(7)(C) The USA Today's top reporter (who's written front page stories on the BOP) is asking if BOP is "designating specific officers to regularly monitor surveillance video in segregated housing units and other locations where inmates are at some risk for suicide." (b)(6); (b)(7)(C

Page 2395 (b)(5) Thanks, (b)(6); (bK7)(C) !(b)(6); (b)(7)(C) .b)(6); (b)(7)(C) Public Information Office Fed era I Bl,1-U-................. -'--'-lsons (202) 35 (b)(6); (b)(7l(C) > i (b)(6); (b)(7)(C ) Good morning, µuusatoday.com> 10/22/2019 10:32 AM > > In wake of the Epstein death, I understand that institutions across the bureau are designating specific officers to regularly monitor surveillance video in segregated housing units and other locations where inmates are at some risk for suicide. Is there someone who may be able to elaborate on this effort? Many thanks, (b)(6); (b)(7)(C ) r )(6); (b)(7)(C) USA TODAY ......,.,..,......,..,-=-c,-----, 703-854 (b)(6); (b)•7)1C) 703-472 Page 14415

Page 2397 BP-S358.060 SEP05 MEDICAL TREATMENT REFUSAL COFRM U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-24-2019 Date I, JEFFREY EPSTEIN 76318-054 , refuse treatment recommended by the Federal Bureau of Prisons Medical staff for the following condition(s): DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY: EYE DOCTOR EVALUATION. The following treatment(s) was/were recommended: EYE DOCTOR EVALUATION. Federal Bureau of Prisons Medical staff members have carefully explained to me that the following possible consequences and/or complications may result because of my refusal to accept treatment: INABILITY TO DIAGNOSE CURRENT OPTHALMOLOGIC DISEASES. I understand the possible consequences and/or complications, listed above, and still refuse recommended treatment I hereby assume all responsibility for my physical and/or mental condition, and release the Bureau of Prisons and Its employees from any and all liability for respecting and following my expressed wishes and directions. b)/6): (b)(7)1C) 7-24-2019 Date ig~ Date (b)(6): {b)(7)(C) s NYM-NEW YORK MCC I I I l l f t ( } I .. i

Page 2398 I BP-S358.060 SEP OS MEDICAL TREATMENT REFUSAL CDFRM U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-10-2019 Date I, JEFFREY EPSTEIN 76318-054 1 refuse treatment recommended by the Federal Bureau of Prisons Medical staff for the following condition(s): 'DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY: 66 YR OLD MALE WITH NO PMHX , REFERRED FOR ROUITNE CXR. The following treatment(s) was/were recommended: CHEST X-RAY Federal Bureau of Prisons Medical staff members have carefully explained.to me that the following possible consequences and/or complications may result because of my refusal to acce~t treatment: WORSENING THE CONDITION IF THERE IS ANY FINDINGS I understand the possible consequences and/or complications, listed above, and still refuse recommended treatment. I hereby assµme all responsibility for my physical and/or mental condition, and release the Bureau of Prisons and its employees from any and all liability for respecting and following my expr~ssed wishes and directions. r )(6); (b)(7)(C) Ix-RAY 7-10-2019 Counseled by Date Patien~>- Date b)(6); (b)(?)(C) NYM-NEWYORK MCC

Page 2399 BP-S358.060 SEP 05 MEDICAL TREATMENT REFUSAL CDFRM U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-24-2019 Date I, JEFFREY EPSTEIN 76318-054 , refuse treatment recommended by the Federal Bureau of Prisons Medical staff for the following condition(s): DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY: EYE DOCTOR EVALUATION. The following treatment(s) was/were recommended: EYE DOCTOR EVALUATION. Federal Bureau of Prisons Medical staff members have carefully explained to me that the following possible consequences and/or complications may result because of my refusal to accept treatment: INABILITY TO DIAGNOSE CURRENT OPTHALMOLOGIC DISEASES. l understand the possible consequences and/or complications, listed above, and still refuse recommended treatment. I hereby assume all responsibility for my physical and/or mental condition, and release the Bureau of Prisons and its employees from any and all liability for respecting and following my expressed wishes and directions. (b)(6); (b)(7)(C) b)(6); (b\(7 )(C) MD 7-24-2019 Date ig~ Date (b)(G); (b)(7)(C ) NYM--NEW YORK MCC y . ' I I I i f I ; i

Page 2400 I BP-A0618 JUN 16 U.S. DEPARTMENT OF JUSTICE A&O DENTAL EXAMINATION (Initial Clinical Dental Findings) FEDERAL BUREAU OF PRISONS Occlusion: Oral Hygiene: Good Fair CPITN: z 3 2- Head & Neck I Soft lissue: 2 3 4 5 6 7 8 9 10 11 12 13 14. 15 16 fn 31 30 29 28 27 28 25 2423 22 21 20 19 • 18 17 ~ ------......-,,-..,.,,..---,--------- r,\l . D: Q Classification: Dental Prostheses at Intake: Yes Type: Age: Condition: G Intra.oral Photos Taken: Yes Q Instructed how to obtain urgent and non.urgent dental care: Treatment Priorities: None: Radiographs aulhorized: PAs: BWs: _____ _ Panorex: ____ _ n Institution: 7 (;, 3 I~ OS'\ MCC NEW YORK . ____ ..... M:._..__I _____. CLI F: /Y Pain Scale: /10 Radiographs Taken: (Document findings on A&O encounter) Yes Non.urgent non-urgent No: Urgent Referred to Sick Can: Prophylaxis authorized: Yes • ✓ No (Approval vafid 18 months from examination date) Date: DDS Signature Block/Stamp: teer MCC New York PDF Prescribed by P6400 Replaces BP-A0618 of JUN 10 /

Page 2401 I I BP-A0618 JUN 16 U.S. DEPARTMENT OF JUSTICE A&O DENTAL EXAMINATION (lnltlal Clinical Dental Findings) Occlusion: Oral Hygiene: CPITN: FEDERAL BUREAU OF PRISONS Good Fair 2. 3 3 2- ~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14. 15 16 l,i ~ 32 31 30 29 28 27 26 25 24 23 22 21 20 19 • 18 17 :!J t-------r-=,,.----,:,:--,.,....----------1 Head & Neck/ Soft Tissue: ... \ \ ~ Classification: (,\l.. • D: '-" Dental Prostheses at Intake: Yes Type: Age: Condition: G Intra-oral Photos Taken: Yes Q lns!JUcted how to obtain urgent and non-urgent dental care: Treatment Priorities: None: Radiographs authorized: PAs: ____ _ BWs: ____ _ Panorex: ____ _ n Institution: 7 {, 3 I~ OS'\ MCC NEW YORK ·----- M:._..._1 _____. CLI F: /Y Pain Scale: /10. Radiographs Taken: (Document findings on A&O encounter) Yes Non-urgent non-urgent No: Urgent Referred to Sick can: Prophylaxis authorized: Yes • ✓ No (Approval vafid 18 months from examination date) Dentist Signature: 'b)(6); (b)(7)(C) Date: 7-U-/9. DDS Signature Block/Stamp: 1cer MCC New York PDF Prescribed by P64CJO Replaces BP-A0616 of JUN 10 /

Page 2402 BP-S358.060 SEP OS MEDICAL TREATMENT REFUSAL C0FRM U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-24-2019 Date I, JEFFREY EPSTEIN 76318-054 , refuse treatment recommended by the Federal Bureau of Prisons Medical staff for the following condition(s): DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY: EYE DOCTOR EVALUATION. The following treatment(s) was/were recommended: EYE DOCTOR EVALUATION. Federal Bureau of Prisons Medical staff members have carefully explained to me that the following possible consequences and/or complications may result because of my refusal to accept treatment: INABILITY TO DIAGNOSE CURRENT OPTHALMOLOGIC DISEASES. I understand the possible consequences and/or complications, listed above, and still refuse recommended treatment. I hereby assume all responsibility for my physical and/or mental condition, and release the Bureau of Prisons and its employees from any and all liability for respecting and following my expressed wishes and directions. b)(6): (b)(7)(C) D 7-24-2019 Dale ig~ Date NYM- NEW YORK MCC I j I I j i l f I . : i i I t I i ' l \ I ' i j \ ; t t I I

Page 2403 • Federal B'!reau of Pnsons Name EPSTEIN, JEFFREY Reg # 76318-054 DOB 01/20/1953 Sex M HIV 1/2 U.S. Medical Center for Federal Prisons 1900 W. Sunshine Street Springfield, MO 65807 417-874-1621 Facility MCC New York Order Unit E06-547U Provider r b)(B); (b)(l)(C) I MD HIV Negative ••• Sensitive But Unclassified ... Collected 07/09/2019 13:34 Received 07/10/2019 10:44 Reported 07/10/2019 14:46 LIS ID 188191004 Negative Screening test - See confirmatory testing for Reactive results FLAG LEGEND L=Low L!=Low Critical H=High H!=High Critical A=Abnormal A! =Abnormal Critical Page 3 of 3

Page 2404 Bureau of Prisons Health Services Cosign/Review Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Encounter Date: 07/10/2019 16:58 Provider: Lab Result Receive Cosigned b~ .... (b-)(G->; (_b>C7_ >c_c > ___ ~IMD on 07/14/2019 18:12. Bureau of Prisons • NYM Reg#: Race: Facility: 76318-054 WHITE NYM

Page 2405 BP-S358.060 SEP OS MEDICAL TREATMENT REFUSAL CDFRM U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-24-2019 Date I, JEFFREY EPSTEIN 76318-054 , refuse treatment recommended by the Federal Bureau of Prisons Medical staff for the following condition(s): DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY: EYE DOCTOR EVALUATION. The following treatment(s) was/were recommended: EYE DOCTOR EVALUATION. Federal Bureau of Prisons Medical staff members have carefully explained to me that the following possible consequences and/or complications may result because of my refusal to accept treabnent: INABILITY TO DIAGNOSE CURRENT OPTHALMOLOGIC DISEASES. I understand the possible consequences and/or complications, listed above, and still refuse recommended treatmenl I hereby assume all responsibility for my physical and/or mental condition, and release the Bureau of Prisons and Its employees from any and all liability for respecting and following my expressed • ctions. (b)(6); (b)(7)(C ) b)(6); (b)(7)(C ) Counseled by (b)(6); (b)(7)(C) Si nature of Wt (b)(6); (b)(7)(C) MD 7-24-2019 Date .__ _____________ __. ig~ Date NYM- NEW YORK MCC l'/r~ ; r· I· i I i i i [ I i I f r I ( I . ,. ',

Page 2406 I BP-A0618 JUN 16 U.S. DEPARTMENT OF JUSTICE A&O DENTAL EXAMINATION (Initial Clinical Dental Findings) Occlusion: Oral Hygiene: CPITN: FEDERAL BUREAU OF PRISONS Good Fair 2- 3 2- ~ 1 2 3 4 S 8 7 8 9 10 11 12 13 14. 15 18 Iii ~ 32 31 30 29 28 27 2G 25 2U3 22 21 20 ID • 18 17 ~ 1-------,.....,....__,.,--,-----------t Head & Neck / Soft Tissue: w. r,\l. -0 Classification: ::=,== cLr ffl Dental Prostheses at Intake: Yes Type: Age: Condition: G Intra-oral Photos Taken: Yes 0 lnsltUcted how to obtain urgent and non-urgent dental care: Treatment Priorities: None: Radiographs authorized: PAs: ____ _ BWs: ____ _ Panorex: ____ _ Institution: 7 b 3 I«-:. DS'\ MCC NEW YORK F: /Y Pain Scale: /10. Radiographs Taken: (Document findings on A&O encounter) Yes Non-urgent: non-urgent No: Urgent Referred to Sick can: Prophylaxis authorized: Yes ✓ No (Approval valid 18 months from examination date) Date: 7-U-/9. l>Ds Signature Block/Stamp: lb)(6); (b)l7)(C) 1cer MCC New York PDF Prescribed by P6400 Replaces BP-A0818 of JUN 10 /

Page 2407 BP-S358.060 SEP05 MEDICAL TREATMENT REFUSAL CDFRM U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-24-2019 Date I, JEFFREY EPSTEIN 76318-054 , refuse treatment recommended by the Federal Bureau of Prisons Medical staff for the following condition(s): DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY: EYE DOCTOR EVALUATION. The following treatment(s) was/were recommended: EYE DOCTOR EVALUATION. Federal Bureau of Prisons Medical staff members have carefully explained to me that the following possible consequences and/or complications may result because of my refusal to accept treatment INABILITY TO DIAGNOSE CURRENT OPTHALMOLOGIC DISEASES. I understand the possible consequences and/or complications, listed above, and still refuse recommended treatment. I hereby assume all responsibility for my physical and/or mental condition, and release the Bureau of Prisons and its employees from any and all liability for respecting and following my expressed wishes and directions. b)(6); (b)l? )(C ) (b)(6): (b)(?)(C) MD 7-24-2019 Counseled by Date ig~ Date b)(6); (b)(?)(C) NYM-NEW YORK MCC b)(6); (b)(?)(C) f I I I I f t ! i t f l t I i i f r j i ,

Page 2408 BP-S358.060 SEP OS MEDICAL TREATMENT REFUSAL CDFRM U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-10-2019 Date I, JEFFREY EPSTEIN 76318-054 , refuse treatment recommended by the Federal Bureau of Prisons Medical staff for the following conditlon(s): DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY: 66 YR OLD MALE WITH NO PMHX, REFERRED FOR ROUITNE CXR. The following treatment(s) was/were recommended: CHEST X-RAY Federal Bureau of Prisons Medical staff members have carefully explained to me that the following possible consequences and/or complications may result because of my refusal to acce~t treatment: WORSENING THE CONDITION IF THERE IS ANY FINDINGS I understand the possible consequences and/or complications, listed above, and still refuse recommended treatment. I hereby assume all responsibility for my physical and/or mental condition, and release the Bureau of Prisons and its employees from any and alt If ability for respecting and following my expr~ssed wishes and directions. r )(6); ib)(?)(C) Counseled by Ix-RAY 7-10-2019 Date Patien~>- Date L[ "'_(6)-;(b-)(7-)(C-) _________ ,_-___ le ~ { 9( Signature of Witness Date NYM-NEWYORK MCC

Page 2409 I BP-A0618 JUN 16 U.S. DEPARTMENT OF JUSTICE A&O DENTAL EXAMINATION (lnltlal Clinical Dental Findings) FEDERAL BUREAU OF PRISONS Occlusion: Oral Hygiene: Good Fair CPITN: z 3 s 2- Head & Neck / Soft Tissue: !c ' 2 ~ 32 31 3 4 5 6 7 8 0 10 11 12 13 14. 15 16 Iii 30 29 28 27 26 25 2, 23 22 21 20 19 • 18 17 :!J --------.---,----,---------c ~l -0 Classificatiop: Dental Prostheses at Intake: Yes Type: Age: Condition: G Intra-oral Photos Taken: Yes 0 lnstn.rcted how lo obtain urgent and non-urgent dental care: Treatment Priorities: None: Radiographs authorized: PAs: _____ _ BWs: ____ _ Panorex: ___ _ n Institution: 7 <:, 3 1 ~ OS"'-\ MCC NEW YORK ::==,== CLT F: /Y Pain Scare: /10. Radiographs Taken: (Document findings on A&O encounter) Yes Non-urgent non-urgent No: Urgent Referred lo Sick Csll: Prophyla>eis authorized: Yes ✓ No (Approval vaRd 18 months from examination date) Dentist Si nature: b)(6 ); (b)(7)(C) Date: 7-24--/ 9. Signature Block/Stamp: ;b)(6); (b)(7)(C ) 1cer MCC New York PDF Prescribed by P6400 Replaces BP-A0618 of JUN 10 I

Page 2410 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Encounter Date: 08/10/2019 07:25 Bureau of Prisons Health Services Clinical Encounter Sex: M Race: WHITE Provider: b)<5>; (b>mcc > RN Reg#: 76318-054 Facility: NYM Unit: Z04 Emergency Code - Resuscitation Event encounter performed at Special Housing Unit. SUBJECTIVE: l (b)(6); (b)(?)(C) I Emergency Note Provider: ~------~RN Team Members: Provider .... ltb-)(6-): _Cbl_<1_:rc_> __ ____.I RN Code Events: bM CPR EKG/Monitor No shock advised CPR Oxygen IV Access 18 g Left AC ~ Compressions Lifepak Compressions 15 L Peripheral IV Airway Endotracheal Tube Rote Team/Code Leader ET Tube 7.5 24CM to L Lip line Placed by Paramedics Date 08/10/2019 06:35 08/10/2019 06:39 08/'10/2019 06:40 08/10/2019 06:47 08/10/2019 06:48 08/10/2019 07:08 Medications Epinephrine 1mg IV · 08/10/2019 07:10 Epinephrine 3 doses and Sodium bicarb 2 doses administered by paramedics CPR Compressions 08/10/2019 07:11 Medications Sodium Bicarbonate 1 mEa/kg IV 08/10/2019 07:11 IV Fluids Normal Saline 0.9% 1000 ml 08/10/2019 07:12 Medications CPR Medications Medications CPR Comments: Epinephrine 1 mg IV Compressions Sodium Bicarbonate 1 mEa/kg IV Epinephrine 1 mg IV Compressions 08/10/2019 07:13 08/10/2019 07:14 08/10/2019 07:14 08/10/2019 07:16 08/10/2019 07:17 Responded to a (b)(7)(E) ~t 0635 for medical emergency on 9S, Upon arrival Inmate was received on the floor of his cell unresponsive with CPR in progress by correctional officers, Inmate was Cold, with circumferential Bruising around the neck and posterior mottling, Pupils Fixed and dilated, No Palpable pulses, Call place for EMS, CPR Continued, AED Placed No shock advised, CPR Continued, inmate transported to HSU treatment room with CPR in progress, 18g hep lock to LAC, 02 15 Lt ViA BVM, Pulse Check NO SHOCK advised. EMS and Paramedics arrived 0656, Placed on cardiac monitor asystole Resumed CPR, Inmate was intubated by Medics, 3 Rounds of Epinephrine administered, Pulse Check asystole, Inmate was transported to Local ER with CPR in progress. OBJECTIVE: Exam: General Appearance Yes: Unconscious Generated 08/10/2019 08:10 ~ (bX5>; (b)(7)(C} Bureau or Prisons - NYM Page 1 of 2

Page 2411 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Encounter Date: 08/10/2019 07:25 Exam: ASSESSMENT: Cardiac Arrest PLAN: New Consultation Requests: Sex: M Race: WHITE Provider: b)(6): <b)Cncc> N Target Date Scheduled Target Date Priority Reg #: 76318-054 Facility: NYM Unit: 204 Consultation/Procedure Emergency Room Subtype: 08/10/2019 08/10/2019 Emergent Translator Language No AMBULANCE Reason for Request: Cardiac arrest with CPR in progress Copay Required: No TelephoneNerbal Order: No Cosign Required: Yes Completed b (b)(5): (bJmcc> RN on 08/10/2019 08:10 (b'i6) (b'(7)(C' Requested to be cosigned b ' • ' ' D. Cosign documentation will be displayed on the following page. Generated 08/10/2019 08:10 br )(5): (b)(7)(C) Bureau of Prisons • NYM Page 2 of 2

Page 2412 Bureau of Prisons Health Services Clinical Encounter Inmate Name: EPSTEIN, JEFFREY EDWARD Reg#: 76318-054 Facility: NYM Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/30/2019 15:58 Provider: (b)(5>; (b)f7)(C> D Chronic Care - Chronic Care Clinic encounter performed at Health Services. SUBJECTIVE: COMPLAINT 1 Provider:r bi(G); (b)(7)(C) IMO Chief Complaint: Other Problem Subjective: PATIENT WAS REFERRED BY THE WARDEN FOR EVALUATION. Unit: Z01 PATIENT REPORTS HE HAS BEEN WITHOUT HIS MEDS FOR ABOUT 1 WEEK. HE ALSO REPORTS NUMBNESS IN HIS RIGHT ARM FOR A FEW MINUTES 3 DAYS AGO. STATES THE NUMBNESS WENT AWAY ON ITS OWN, BUT WAS VERY CONCERNING. HE DENIES RIGHT SIDED WEAKNESS, DIPLOPIA, FACIAL DROOP, DIFFICULTY SPEAKING OR SWALLOWING. HE REPORTS NOCTURIA OF ABOUT 5 TIMES,. HE DENIES DYSURIA. HE REPORTS H OF KIDNEY STONES, HX OF HTN FOR WHICH HE WAS TAKING TOPROL. HE AHS A HX OF SLEEP APNEA AND STATED HE HAS NOT SLEPT FOR 3 WEEKS ISNCE HE HASB EEN HERE SINCE HE DIE NOT HAVE ACCESS THI CPAP MACHINE. I INFORME DHIM THAT WE RECEIVED HIS CPAP MACHINE AND IT WILL BE GIVEN TO HIM TONIGHT .. HE REPORT OTHER NON-MEDICAL ISSUES. STATES HE FEELS OTHERWISE FINE. Pain: Not Applicable Seen for clinic(s): Pulmonary/Respiratory, Orthopedic/Rheumatology, Endocrine/Lipid OBJECTIVE: Exam: General Affect Yes: Cooperative Appearance Yes: Appears Well, Alert and Oriented x 3 No: Appears Distressed, Dyspneic, Appears in Pain, Writhing in Pain, Pale, Pallor, Cyanotic, Diaphoretic, Disheveled, Unkempt, Acutely Ill Nutrition No: Appears Obese Pulmonary Auscultation Yes: Clear to Auscultation Cardiovascular Auscultation Yes: Regular Rate and Rhythm (RRR), Normal S1 and S2 No: M/R/G Musculoskeletal Tibia / Fibula No: Edema Neurologic Generated 07/30/2019 16:12 b t bX6); (b)(l )(C) Bureau of Prisons • NYM Page 1 of 2

Page 2413 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Encounter Date: 07/30/2019 15:58 Exam: Cranial Nerves (CN) Yes: Within Normal Limits Motor System-General Yes: Normal Exam Motor System-Strength Yes: Normal Muscular Strength ASSESSMENT: Body mass index (BMI) 27.0-27.9, adult, Z6827 - Current Constipation, unspecified, K5900 - Current Essential (primary) hypertension, 110 - Current - BY HX. Hyperlipidemia, unspecified, E785 - Current Low back pain, M545 - Current Neuralgia and neuritis, unspecified, M792 - Current Prediabetes, R7303 - Current Sleep apnea, G4730 - Current PLAN: New Medication Orders: Medication INsulin REG - Human Indication: Prediabetes Discontinued Medication Orders: &It Medication 122148-NYM Insulin Reg (10 ML) 100 UNITS/ML lnj Order Date 07/3012019 15:58 Order Date 07/30/2019 15:58 Discontinue Type: When Pharmacy Processes Discontinue Reason:new order written Indication: Copay Required: No TelephoneNerbal Order: No Cosign Required: No Completed byl'-(b)-(5_::(_nJ<_7)_cc_i -----'IMO on 07/30/2019 16:12 Generated 07/30/201916:12 b ~ (b)(6); (b)(7)(C) Bureau of Prisons - NYM D Reg#: 76318-054 Facility: NYM Unit: Z01 Prescriber Order SLIDING SCALE Subcutaneously each morning x 7 day(s) Pill Line Only Prescriber Order Inject regular insulin subcutaneously per sliding scale: twice daily ... pill line••• for 7 days Page2 of 2

Page 2414 Inmate Name: EPSTEIN, JEFFREY EDWARD Bureau of Prisons Health Services Clinical Encounter Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/30/2019 11:12 Provider: b)l6i:(b)C?)CC) MD Chronic Care - Chronic Care Clinic encounter performed at Health Services. SUBJECTIVE: COMPLAINT 1 Provider:rb)(B) (b)(l)(C) IMD Chief Complaint: Other Problem Reg #: 76318-054 Facility: NYM Unit: Z01 Subjective: PATIENT w~ REFERRED BY THE WARDEN FOR EVALUATION. PATIEN1°(~':_f_,.PRTS HE HAS BEEN WITHOUT HIS MEDS FOR ABOUT 1 WEEK. HE ALSO~,~~twS NUMBNESS IN HIS RIGHT ARM FOR A FEW MINUTES 3 DAYS AGO. STAT~i:R~~BNESS WENT AWAY ON ITS OWN, BUT WAS VERY CONCERNING. HE DENIE fflf;,>--~J SIDED WEAKNESS, DIPLOPIA, FACIAL DROOP, DIFFICULTY SPEAKING ~~il.:_OWING. HE REPORT ~0 tJRIA OF ABOUT 5 TIMES,. HE DENIES DYSURIA. HE REPORTS H ONEY STONES, HX OF HTN FOR WHICH HE WAS TAKING TOPROL. ~ HE AHS A HX OF SLEEl:,.,M> 8 AND STATED HE HAS NOT SLEPT FOR 3 WEEKS ISNCE HE HASB EEN HER~~Sfi CE HE DIE NOT HAVE ACCESS THI CPAP MACHINE. I INFORME DHIM THAT WE RE E ' HIS CPAP MACHINE AND IT WILL BE GIVEN TO HIM TONIGHT .. HE REPORT OTHER NON-ME ICA ;~~ UES. STATES HE FEELS OTHERWISE~ NI:::.. Pain: Not Applicable Q Seen for clinic(s): Endocrine/Lipid, Orthopedic/Rheumatology,iiii~\Respiratory OBJECTIVE: T ~ Pulse: Date Time Rate eer Minute Lgcation 07/30/2019 13:02 94 07/30/2019 09:40 88 Via Machine 07/30/2019 09:30 87 Via Machine Respirations: Date Time Rate Per Minute Provider 07/30/2019 09:30 NYM 12 rb)(6); (b)(7)(C) IMO Blood Pressure: Date Time Value Location Position Cuff Size 07/30/2019 13:02 NYM 114/84 Left Arm Standing 07/30/2019 09:40 NYM 125/60 Right Arm Standing 07/30/2019 09:30 NYM 108/86 Left Arm Sitting Sa02: Date Time Value(%) Air Provider erg~jggr b)(6): (b)(7)(C) Provider 'b)(6); (b)(7)(C) 07/30/2019 09:30 NYM 98 Room Air .... rb-)(6-);(-b)(7-)( _ c ) ___ _,IM□ Weight: Time .Kg_ Waist Circum. Provider Generated 07/30/2019 14:05 b~(b)(6): (b)(7)(C) Bureau of Prisons• NYM MD MD MD ~ MD MD MD Page 1 of 3

Page 2415 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/30/2019 11:12 Provider: l(blC6l: lb/(7/cc > IMO Time Kg Waist Circum . .:P=r=o=v=id=e=r;__ __ _ Reg #: 76318-054 Facility: NYM Unit: Z01 Date 07/30/2019 09:30 NYM Lbs 194.2 88 r b)(6); (b)(7)(C) I .1 _ MD Exam: General Affect Yes: Cooperative Appearance Yes: Appears Well, Alert and Oriented x 3 No: Appears Distressed, Dyspneic, Appears in Pain, Writhing in Pain, Pale, Pallor, Cyanotic, Diaphoretic, ~'.sheveled, Un~e / .~~cutely Ill Nutrition 1.·.., No: Appears 015 Pulmonary Auscultation Yes: Clear to Auscultation Auscultation Cardiovascular !$! Yes: Regular Rate and Rhythm (RRR ~o~f.81 and S2 No: M/R/G ¥ ~ Musculoskeletal Tibia / Fibula No: Edema Neurologic Cranial Nerves (CN) Yes: Within Normal Limits Motor System-General Yes: Normal Exam Motor System-Strength Yes: Normal Muscular Strength ASSESSMENT: Body mass index (BMI) 27.0-27.9, adult, Z6827 - Current Constipation, unspecified, K5900 - Current Essential (primary) hypertension, 110 - Current - BY HX. Hyperlipidemia, unspecified, E785 - Current Low back pain, M545 - Current Neuralgia and neuritis, unspecified, M792 - Current Prediabetes, R7303 - Current Sleep apnea, G4730 - Current PLAN: New Medication Orders: Rx# Medication Order Date Generated 07/30/2019 14:05 b{ b)(6); (b)(7)(C) Bureau of Prisons - NYM Prescriber Order Page 2 of 3

Page 2416 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/30/2019 11 :12 Provider: l(b)(6>: (bJ(7)(C> IMD New Medication Orders: Rx# Medication Magnesium Hydroxide Susp cone 800 MG/5ML Indication: Constipation, unspecified INsulin REG - Human Indication: Prediabetes Renew Medication Orders: Order Date 07/30/2019 11:12 07/30/2019 11:12 Rx# Medication (N\ Order Date 121836-NYM methylPR~~ls_J1Jne 4 MG Tab ( 21 count 07/30/2019 11:12 Pack) \..U Kl ~ ia and neuritis, unspecified New Laboratory Requests: ~ Reg#: 76318-054 Facility: NYM Unit: Z01 Prescriber Order 10 CC Orally - Two Times a Day PRN x 90 day(s) SLIDING SCALE Subcutaneously - Two Times a Day x 7 day(s) Pill Line Only Prescriber Order Take the tablet by mouth as directed x 6 day(s) Details \a V Frequency Lab Tests - Short List-General-CBC w/diff ne Time Due Date 08/01/2019 00:00 Priority Routine Lab Tests-P-PSA, Total Lab T ests-U-Uric Acid Lab Tests - Short List-General-Comprehensiv Metabolic Profile (CMP) Lab Tests-U-Urinalysis w/Reflex to Microscopic New Radiology Request Orders: Details Frequency ~ ;r."',)''---'r'~ Due Date General Radiology-Spine/ Cervical- One Time 08/29/2019 General Specific reason(s) for request (Complaints and findings . Priority Routine 66 YR OLD MALE WITH COMPLAITN OF RIGHT ARM NUI PLEASE PERFORM C SPINE SERIES R 2-3 MINUTES 3 DAYS AGO. Disposition: Follow-up at Sick Call as Needed Patient Education Topics: Date Initiated Format 07/30/2019 Counseling 07/30/2019 Counseling Copay Required: No TelephoneNerbal Order: No Handout/Topic Access to Care Plan of Care Cosign Required: No Completed by~r-;( 6 _); -(b)-(?-)(C_) ___ ~IMD on 07/30/2019 14:05 Generated 07/30/2019 14:05 b~(b)(6); (b)(7)(C) Bureau or Prisons - NYM b)(6); (b)(7}(C) Outcome Verbalizes Understanding Verbalizes Understanding Page 3 or 3

Page 2417 Bureau of Prisons Health Services Clinical Encounter Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Reg #: 76318-054 Facility: NYM Encounter Date: 07/30/2019 11 : 12 Provider: (b1r5>: <bl(7J(C) D Chronic Care - Chronic Care Clinic encounter performed at Health Services. SUBJECTIVE: COMPLAINT 1 Providerfbl(5l:(b)(7J(C) ~ D Chief Complaint: Other Problem Unit: Z01 Subjective: PATIENij~ REFERRED BY THE WARDEN FOR EVALUATION. PATIEN ~1?_f_pRTS HE HAS BEEN WITHOUT HIS MEDS FOR ABOUT 1 WEEK. HE ALSO~t0Ki1S NUMBNESS IN HIS RIGHT ARM FOR A FEW MINUTES 3 DAYS AGO. STATE J~~iliBNESS WENT AWAY ON ITS OWN, BUT WAS VERY CONCERNING. HE DENI SI, I· SIDED WEAKNESS, DIPLOPIA, FACIAL DROOP, OIFFICUL TY SPEAKING a._--s ALLOWING. HE REPORTS-~9.£;.tlfllA OF ABOUT 5 TIMES,. HE DENIES OYSURIA. HE REPORTS H~~DNEY STONES, HX OF HTN FOR WHICH HE WAS TAKING TOPROL. HE AHS A HX OF SLEE8,.Af> 6 AND STATED HE HAS NOT SLEPT FOR 3 WEEKS ISNCE HE HASB EEN HER sfi CE HE DIE NOT HAVE ACCESS THI CPAP MACHINE. I INFORME OHIM THAT WE RE , EIVE HIS CPAP MACHINE AND IT WILL BE GIVEN TO HIM TONIGHT .. HE REPORT OTHER NON-ME IC~ rs STATES HE FEELS OTHERWISE FfNI Pain: Not Applicable Seen for clinic(s): Endocrine/Lipid, Orthopedic/Rheumatology, OBJECTIVE: Pulse: Date Time 07/30/2019 13:02 07/30/2019 09:40 07/30/2019 09:30 Respirations: Rate Per Minute 94 88 87 Location Via Machine Via Machine Date 07/30/2019 Time Rate Per Minute Provider 09:30 NYM Blood Pressure: Date Value 07/30/2019 13:02 NYM 114/84 07/30/2019 09:40 NYM 125/60 07/30/2019 09:30 NYM 108/86 Sa02: Location Left Arm Right Arm Left Arm Date Value(%) Air 12l(b)(6); (b)(7)(C) Position Standing Standing Silting Provider b)(6): (b)(7)(C) jMD Cuff Size Provider b)(6); (b)(7)(C) Provider 07/30/2019 09:30 NYM 98 Room Air .... l(b-)(6-);-(b)-(7-)(C-) ___ _,IMO Weight: Date Lbs Kg Waist Circum. Provider Generated 07/30/2019 14:05 b~b)(6}; (b;(7)(C) Bureau of Prisons - NYM MD MD MD ~ D D D Page 1 of 3

Page 2418 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/30/2019 11: 12 Provider: bl(G): <b)mcc> D Date Time .!Sg_ Waist Circum. Provider Reg #: 76318-054 Facility: NYM Unit: Z01 07/30/2019 09:30 NYM Lbs 194.2 88.1 L..r_ )(6_,:_(b-)(7-)(C_> ___ __J~D Exam: General Affect Yes: Cooperative Appearance Yes: Appears Well, Alert and Oriented x 3 No: Appears Distres~t Dyspneic, Appears in Pain, Writhing in Pain, Pale, Pallor, Cyanotic, Diaphoretic, Disheveled, Unke 5 ~cutely Ill Nutrition No: Appears Ooes Pulmonary Auscultation Yes: Clear to Auscultation Auscultation Cardiovascular ~ Yes: Regular Rate and Rhythm (RRR ~o£a S1 and S2 No: M/R/G ~ A Musculoskeletal Tibia / Fibula No: Edema Neurologic Cranial Nerves (CN) Yes: Within Normal Limits Motor System-General Yes: Normal Exam Motor System-Strength Yes: Normal Muscular Strength ASSESSMENT: Body mass index (BMI) 27.0-27.9, adult, 26827 - Current Constipation, unspecified, K5900 - Current Essential (primary) hypertension, 110 - Current - BY HX. Hyperlipidemia, unspecified, E785 - Current Low back pain, M545 - Current Neuralgia and neuritis, unspecified, M792 • Current Prediabetes, R7303 - Current Sleep apnea, G4730 - Current PLAN: New Medication Orders: Rx# Medication Order Date Generated 07/30/2019 14:05 bf b)(Gl; !b)(7)(C) Bureau or Prisons - NYM Prescriber Order Page 2 of 3

Page 2419 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/30/2019 11:12 Provider: (bX5i; <b>c7xc > D New Medication Orders: Rx# Medication Magnesium Hydroxide Susp cone 800 MG/5ML Indication: Constipation, unspecified INsulin REG - Human Indication: Prediabetes Renew Medication Orders: Order Date 07/30/2019 11 :12 07/30/2019111:12 Rx# Medicatio~ Order Date 121836-NYM methylPR NI o ne 4 MG Tab ( 21 count 07/30/2019 11:12 Pack) Indication: ~ ia and neuritis, unspecified New Laboratory Requests: ~ Reg#: 76318-054 Facility: NYM Unit: Z01 Prescriber Order 10 CC Orally - Two Times a Day PRN x 90 day(s) SLIDING SCALE Subcutaneously - Two Times a Day x 7 day(s) Pill Line Only Prescriber Order Take the tablet by mouth as directed x 6 day(s) Details \. V Frequency Lab Tests - Short List-General-CBC w/diff ne Time Due Date 08/01/2019 00:00 Priority Routine Lab Tests-P-PSA, Total Lab Tests-U-Uric Acid Lab Tests - Short List-General-Comprehensiv Metabolic Profile (CMP) Lab Tests-U-Urinalysis w/Reflex to Microscopic New Radiology Request Orders: Details Frequency "'-...!:~~~ Due Date Priority General Radiology-Spine / Cervical- One Time 08/29/2019 Routine General Specific reason(s) for request (Complaints and findings . 66 YR OLD MALE WITH COMPLAITN OF RIGHT ARM NUI R 2-3 MINUTES 3 DAYS AGO. PLEASE PERFORM C SPINE SERIES Disposition: Follow-up at Sick Call as Needed Patient Education Topics: Date Initiated Format 07/3012019 Counseling 07/30/2019 Counseling Copay Required: No TelephoneNerbal Order: No Handout/Topic Access lo Care Plan of Care Cosign Required: No Completed bi ... :b_l<5_);-<b_)(7_>cc_> ___ ---'~ D on 07/30/2019 14:05 Generated 07/30/2019 14:05 b ~(b)(6); (b)(7)(C) Bureau of Prisons - NYM Outcome Verbalizes Understanding Verbalizes Understanding Page 3 or 3

Page 2420 Bureau of Prisons Health Services See Amendment Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Encounter Date: 07/30/2019 15:58 Amendment made to this note b ~ ._ '.b-)( 5 _); (-b)(- 7)(_c> ___ ____J~ D on 07/30/2019 16:12. Bureau of Prisons - NYM Reg#: Race: Facility: 76318-054 WHITE NYM

Page 2421 Mail Attachment Epstein BEMR pt 2.pdf Page 14869

Page 2422 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Encounter Date: 07/28/2019 20:25 Bureau of Prisons Health Services Clinical Encounter Sex: M Race: WHITE Provider: Cbl(5>; Cbl(7Jtc J RN Nursing - Follow up encounter performed at Health Services. SUBJECTIVE: COMPLAINT 1 Provider: r )(S); (b)(7)(C) IRN Chief Complaint: Neuropathy - Tingling/Numbness of Extremity(ies) Reg#: 76318-054 Facility: NYM Unit: H01 Subjective: Inmate seen for F/U after returning from attorney conference offers no new complaints or worsening S/S stats " My R hand still has pins and needles sometimes" No change in appearance from previous exam. Pain: No OBJECTIVE: Pulse: 12m I.iml. 07/28/2019 20:28 Respirations: Rate Per Minute 81 Location lliwt .Ii.mg_ Rate Per Minute Provider 07/28/2019 20:28 NYM Blood Pressure: Qi1e. I.iml. ~ 07/28/2019 20:28 NYM 157/91 Sa02: Location 12m I.iml. Value(%) Air 14 1(b)(6); (b)(7)(C) Position Rhythm Provider L.r_ )(6-); (-b)-(7)-(C-) __ _.IRN Cuff Sb:e Provider L. l(b-)(6-); -(b)-(7-){C-) __ ___.I RN Provider 07/28/2019 20:28 NYM 98 r._bJ_ce_:; (-b)(-7)-(C) ___ ......,I RN Exam: General Affect Yes: Cooperative Appearance Yes: Appears Well, Alert and Oriented x 3 Nutrition Yes: Within Normal Limits Skin General Yes: Within Normal Limits, Dry, Skin Intact ASSESSMENT: No Significant Findings/No Apparent Distress PLAN: Disposition: To be Evaluated by Provider Generated 07/28/2019 20:30 by"' [ b"'"" K5,,... >; ..,... (b)'"" (7"""' )(C,.,..) ---,I RN Bureau of Prisons • NYM Page 1 of 2

Page 2423 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Provider: r )[5): (b)(7)(C) I RN Encounter Date: 07/28/2019 20:25 Follow-up in 12-24 Hours Patient Education Topics: Date Initiated Format 07/28/2019 Counseling Copay Required: No TelephoneNerbal Order: No Handout/Topic Plan of Care Cosign Required: Yes Completed b~bJ(5) (b)(7)(C) IRN on 07/28/2019 20:30 Requested to be cosigned b~ blc5> (b~7>(C> jMD. Cosign documentation will be displayed on the following page. Generated 07/28/2019 20:30 b~(b)(5); (bP)(C) Bureau of Prisons - NYM Reg#: 76318-054 Facility: NYM Unit: H01 Provider Outcome Verbalizes Understanding Page2of 2

Page 2424 Bureau of Prisons Health Services Cosign/Review Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: ..,..a.:, M:,....,,..,.=--~ Encounter Date: 07/28/2019 20:25 Provider: ,b)(Gl (b)(7)(CJ RN Cosigned b~ .... :b-)( 5 ->; (-bJ-(7)-(c_> ___ __.F D on 07/28/2019 20:50. Bureau of Prisons - NYM Reg#: Race: Facility: 76318-054 WHITE NYM

Page 2425 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Encounter Date: 07/28/2019 06:51 Bureau of Prisons Health Services Clinical Encounter Sex: M Race: WHITE Provider: r b)(5); (b)(?)(C) IRN Nursing - Triage Note encounter performed at Health Services. SUBJECTIVE: COMPLAINT 1 ProviderjCb)CB);(b>C7)(c > ~N Chief Complaint: Neuropathy - Tingling/Numbness of Extremity(ies) Reg#: 76318-054 Facility: NYM Unit: H01 Subjective: " I woke up and I had no control over my Right arm for a few minutes it was just doing what it wanted to do" Pain: No OBJECTIVE: Pulse: ~ Time 07/28/2019 06:57 Respirations: Rate Per Minute 82 Location .Qm§ Iilillt 07/28/2019 06:57 NYM Blood Pressure: .Qgm Ii.m.e. Ya.I.wt 07/28/2019 06:57 NYM 138/80 SaO2: 12m I.im.t. Rate Per Minute Proyjder 14 f b)(6); (b)(7)(C) Location Position Rhythm Provider L.r_ )'6_:: -(b)-(7-)(C-) __ ___Ji RN Cuff Size Provider (b)(6); (b)(li(C) h RN Provider 07/28/2019 06:57 NYM Value(%) Air 98 L. r _)(6-:; (-b)-(7)-IC_) __ ____. 1 RN Exam: General Affect Yes: Cooperative Appearance Yes: Appears Well, Alert and Oriented x 3 Skin General Yes: Within Normal Limits, Dry, Skin Intact Head General Yes: Symmetry of Motor Function, Atraumatic/Normocephalic No: Facial Asymmetry, Battle's Sign, Raccoon Eyes, Deformity Eyes General Yes: PERRLA, Extraocular Movements Intact Face General Yes: Symmetric Generaled 07/28/2019 07:22 b~-,b-)(S-); (-b)(7 -, )-(C-) -~r N Bureau of Prisons - NYM Page 1 of 3

Page 2426 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/28/2019 06:51 Provider: (bl(5); (b)(?l(C) RN Exam: No: Ecchymosis, Numbness, Swelling, Periorbltal Edema Neck General Yes: Abrasion(s) Pulmonary Observation/Inspection Yes: Within Normal Limits No: Respiratory Distress, Tachypnea, Hyperventilation Cardiovascular Observation Yes: Normal Rate Musculoskeletal Shoulder Yes: Full Range of Motion R, Symmetric R No: Swelling R, Inflammation R Humerus Yes: Within Normal Limits R Elbow Yes: Normal Exam R, Full Range of Motion R, Non-Tender on Palpation R Radius I Ulna Yes: Normal Exam R, Full Range of Motion R Wrist/Hand/Fingers Yes: Full Range of Motion R, Non-Tender on Palpation R, Swelling R Reg #: 76318-054 Facility: NYM Unit: H01 No: Inflammation R, Ecchymosis R, Erythema R, Tenderness R, Laceration(s) R, Abrasion(s) R, Contusion(s) R ROS Comments Received inmate AAOX3 in no acute distress, speaking in full sentenced ambulating independently C/O Right arm numbness after waking up from "sleeping on my side" that has since subsided. inmate interviewed in psyc obs through the slot. VIS noted WNL, RR even and unlabored, no neurological deficits noted, no facial droop slurred speech or dysphagia, Inmate with Full ROM to all extremities with 4/4 strength bilaterally, slight swelling noted to right phalanges when compared to left, no edema, erythema or ecchymosis noted. Denies any pain numbness or tingling at this time. Denies any Chest pain, Headache, Dizziness, SOB or Blurred vision. Eyes PERRLA. MD on Call notified, Re-evaluate this evening or sooner if SIS persist. ASSESSMENT: Alteration in comfort PLAN: Disposition: Follow-up at Sick Call as Needed Notify Medical Duty Officer Patient Education Topics: Date Initiated format 07/28/2019 Counseling Generated 07/28/2019 07:22 bf bl(5); (b)(?)(C) Handout/Topic Plan of Care Bureau of Prisons - NYM Provider Outcome Verbalizes Understanding Page 2 of 3

Page 2427 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/28/2019 06:51 Provider: (bl(5); (b)f7J(C) RN Date Initiated Format Handout/Topic Copay Required: No Cosign Required: Yes TelephoneNerbal Order: No Completed bi b)(5);(blf?)(C) IRN on 07/28/2019 07:22 Requested to be cosigned byt-bl(5>; (blr7J(C) IMD. Cosign documentation will be displayed on the following page. Generated 07/28/2019 07:22 byfbX6): (b)(7)(C) Bureau of Prisons - NYM Reg #: 76318-054 Facility: NYM Unit: H01 Provider Outcome Page 3 or 3

Page 2428 Bureau of Prisons Health Services Cosign/Review Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Encounter Date: 07/28/2019 06:51 Sex: ..,.,:.:,: M...,,.,.,,.,.,.,,,.. __ ----. Provider: ,b)(G); (b)cncc ) RN Cosigned bYl._cb_)l5_u _bJ_(7)_cc_) ___ _.IMO on 07/28/2019 20:51 . Bureau of Prisons • NYM Reg#: Race: Facility: 76318-054 WHITE NYM

Page 2429 Bureau of Prisons Health Services Clinical Encounter - Administrative Note Inmate Name: Date of Birth: EPSTEIN, JEFFREY EDWARD 01/20/1953 Sex: M Race·WHIIE Provider: l'bl(5l: (bH7l(C> I MD Note Date: 07/26/2019 08:57 Cosign Note - Clinical Encounter Cosign encounter performed at Health Services. Administrative Notes: ADMINISTRATIVE NOTE 1 Provider: (b>(5>: (b)(7J(c> ,b)(7)(A) New Medication Orders: Medication Docusate Sodium Capsule Indication: Constipation, unspecified Copay Required: No TelephoneNerbal Order: No Cosign Required: No Completed bf .... b>_ 16 _): (-bX_ 7 >_<c_> ___ _.I MD on 07/26/2019 08:58 D Order Date 07/26/2019 08:57 Generated 07/26/2019 08:58 b~(b)i5l: Cb)(7i(C) Bureau of Prisons - NYM Reg#: Facility: Unit: 76318-054 NYM H01 Prescriber Order TAKE ONE 100 MG CAP Orally - Two nmes a Day x 180 day(s) Page 1 of 1

Page 2430 Bureau of Prisons Health Services Clinical Encounter - Administrative Note Inmate Name: Date of Birth: EPSTEIN, JEFFREY EDWARD 01/20/1953 Sex: M Race:WHITE Note Date: 07/24/2019 16:10 Provider: 1rb)(6); (b)(7)(C) jMD Cosign Note - Clinical Encounter Cosign encounter performed at Health Services. Administrative Notes: ADMINISTRATIVE NOTE 1 (b)(7){A: Copay Required: No Telephone/Verbal Order: Completed b CblC5>: <b)f?)(C) Generated 07/24/2019 16:12 bj b)(61' (b)(7)(C) Provider: (blf6): (b)(7)(C) MD Cosign Required: No IMO Bureau of Prisons - NYM Reg#: Facility: Unit: 76318-054 NYM H01 Page 1 of 1

Page 2431 Bureau of Prisons Health Services Clinical Encounter - Administrative Note Inmate Name: Date of Birth: EPSTEIN, JEFFREY EDWARD 01/20/1953 Sex: M Race: WHITE Note Date: 07/24/2019 16:10 Provider: ltblt5J; (b)(7)(C) I MD Cosign Note - Clinical Encounter Cosign encounter performed at Health Services. Administrative Notes: ADMINISTRATIVE NOTE 1 (b)(7)(A) Copay Required: No TelephoneNerbal Order: Completed b (b)IBJ: <b)(7)(c> '----------' Generated 07/24/2019 16:12 bf b;(S); (b)(7i(C) Provider: b)(5l; (bJ!7ltC) MD Cosign Required: No Bureau of Prisons - NYM Reg#: Facility: Unit: 76318-054 NYM H01 Page 1 of 1

Page 2432 Bureau of Prisons Health Services See Amendment Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Encounter Date: 07/26/2019 08:57 Amendment made to this note b~ .... '.b_lc6_):<_bl(7_l<_c> ___ ___.~ D on 07/26/2019 08:58. Bureau of Prisons • NYM Reg#: Race: Facility: 76318-054 WHITE NYM

Page 2433 Bureau of Prisons Health Services Clinical Encounter - Administrative Note Inmate Name: Date of Birth: Note Date: EPSTEIN, JEFFREY EDWARD 01/20/1953 07/24/2019 15:10 Sex: ¥, Race-WHITE Provider: r )(5); (b)(7)(C) ~ D Admin Note - General Administrative Note encounter performed at Health Services. Administrative Notes: ADMINISTRATIVE NOTE 1 Provider: j(bX5J;(blC7Kc> !MD Reg#: Facility: Unit: 76318-054 NYM H01 PATIENT WAS OFFERED TO HAVE AN OPTOMETRIST EVALUATION. HE REFUSED. REFUSAL FORM SIGNED. Copay Required: No TelephoneNerbal Order: No Cosign Required: No Completed b~ .... cb_x6_):(_b>c_7x_q ___ ..... lMD on 07/24/2019 15:17 Generated 07124/2019 15:17 byrb)(5); (b)(7)(C) Bureau of Prisons • NYM Page 1 or 1

Page 2434 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Encounter Date: 07/24/2019 13:08 Bureau of Prisons Health Services Clinical Encounter Sex: M Race: WHITE Provider: (bl(6>; Cb)(7)(C> LP Mid Level Provider - Follow up Visit encounter performed at Receiving & Discharge. SUBJECTIVE: COMPLAINT 1 Provider: ib)(G); CbJ(7)(Cl MLP Chief Complaint: Other Problem Subjective: ,b)(7)(A) Pain: No OBJECTIVE: Temperature: .D.a1!t. Iim§. Fahrenheit Celsius Location Provider Reg#: 76318-054 Facility: NYM Unit: H01 07/24/2019 13:12 NYM 97.8 36.6 Oral b)(6); (b)(7)(C ) M LP Pulse: ~ Ii.rm 07/24/2019 13:12 Rate Per Minute 83 Location Via Machine Blood Pressure: Qm .Ii!M 07/24/2019 13:12 NYM SaO2: Value 132/89 Locatjon Right Arm nm 07/24/2019 Iim§. Value(%) Air Exam: General Affect 13:12 NYM Yes: Cooperative Appearance 96 Room Air Yes: Appears Well, Alert and Oriented x 3 No: Appears Distressed, Appears in Pain Exam Comments Follow up evaluation done for inmate Epstein. He does not look in any pain or distress. ASSESSMENT: Injury, unspecified, T1490 - Current PLAN: Disposition: Position Sitting Rhythm Provider Regular tb)t5i; (b)(7)(C) MLP Cuff Size Provider Adult-regula{bX5>; (b)(7lrc> IMLP Provider (b)(6); (b)(7)(C) MLP Generated 07/24/201913:24 b (b)(G); (b)(? )(C) MLP Bureau of Prisons - NYM Page 1 of 2

Page 2435 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/24/2019 13:08 Follow-up at Sick Call as Needed Patient Education Topics: Date Initiated Format 07/24/2019 Counseling 07/24/2019 Counseling Copay Required: No TelephoneNerbal Order: No Provider: :bJC5>; Cbl<ncc> MLP Handout/Topic Access to Care Preventive Health Cosign Required: Yes Completed b~ibJi5J;tbJ(?XC> IMLP on 07/24/2019 13:24 Requested to be cosigned byfb)(G); (b)(?J<c> IMD. Cosign documentation will be displayed on the following page. Generated 07/24/2019 13:24 b~ b)(6); (b)(?)(C) ~ LP Bureau of Prisons - NYM Reg #: 76318-054 Facility: NYM Unit: H01 Provider (b)(6); (bX7){C) Outcome Verbalizes Understanding Verbalizes Understanding Page 2of 2

Page 2436 Bureau of Prisons Health Services Cosign/Review Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M ,,,..,.,.,.,...,..,.=""'""'"""""' Encounter Date: 07/24/2019 13:08 Provider: (b)<5>; (b)(7)(C) MLP Cosigned with New Encounter Note bi,_b_l( 6 _); <_bl<_ 7l(_c> ___ __,IMD on 07/24/201916:10. Bureau of Prisons • NYM Reg#: Race: Facility: 76318-054 WHITE NYM

Page 2437 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Encounter Date: 07/23/2019 06:20 Bureau of Prisons Health Services Clinical Encounter Sex: M Race: WHITE Provider: bJl5>; (b)(?)(C) LP Injury Assessment - Non-work related encounter performed at Health Services. SUBJECTIVE: INJURY 1 Provider: fb)(S); lblC7>cc> ~ LP Reg#: 76318-054 Facility: NYM Unit: H01 Date of Injury: 07/23/2019 01 :27 Date Reported for Treatment: 07/23/2019 08:25 Work Related: No Work Assignment: UNASSG Pain Location: Pain Scale: 0 Pain Qualities: Where Did Injury Happen (Be specific as to location): Special Housing Unit Z05-Cell 124 L Cause of Injury (Inmate's Statement of how injury occurred): r )(?)IA) Symptoms (as reported by inmate): None OBJECTIVE: Temperature: Time Fahrenheit Celsius Location Provider Date 07/23/2019 06:30 NYM 97.5 36.4 Oral b)(6) (b)(?)(C) MLP Pulse: Date Time 07/23/2019 06:30 Respirations: Rate Per Minute 92 Location Via Machine Date 07/23/2019 Time 06:30 NYM Rate Per Minute Provider 16 (b)(6); (b)(7)(C) Blood Pressure: Date Tjme Value 07/23/2019 06:30 NYM 140/85 Sa02: Locatjon Right Arm Date Time Value(%) Air Position Sitting LP Rhythm Regular Cuff Size Provider b)(6): /b)(?)(C) Provider Adult-regular b)ts); <blcn cc J Provider 07/23/2019 06:30 NYM 96 Room Air l(b)(6); (b)l?)(C) ~ LP Exam: General Affect Yes: Cooperative Appearance Yes: Appears Well, Alert and Oriented x 3 MLP MLP No: Appears Distressed, Lethargic, Dyspneic, Appears in Pain, Pallor, Cyanotic, Diaphoretic, Disheveled, Generated 07/23/2019 09;05 b 1 b)(6): (b)(?)(C) ~ LP Bureau of Prisons - NYM Page 1 of 2

Page 2438 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/23/2019 06:20 Exam: Acutely Ill Pulmonary Auscultation Provider: b)(5>; (b)(l)(Cl MLP Yes: Clear to Auscultation, Vesicular Breath Sounds Bilaterally No: Crackles, Rhonchi, Wheezing Exam Comments (b)(7:(A) ASSESSMENT: Injury, unspecified, T1490 - Current - RIO self inflicted injuries. PLAN: Disposition: Follow-up at Sick Call as Needed Placed on Suicide Watch Follow-up in 2-4 Hours Other: For follow up with psychology service. Patient Education Topics: Date Initiated Format 07/23/2019 Counseling 07/23/2019 Counseling Copay Required:No TelephoneNerbal Order: No HandouVJopic Access to Care Plan of Care Cosign Required: Yes Completed b~Cbl(5l:(b><7><c> I MLP on 07/23/2019 09:05 Requested to be cosigned b~tb:C6); (b)(?)(Cl ~ D. qosign documentation will be displayed on the following page. b)(6); Generated 07/23/2019 09:05 b :b)(7)(C) MLP Bureau of Prisons - NYM Reg#: 76318-054 Facility: NYM Unit: H01 Provider 'b)(6): (b)(7)(C) Outcome Verbalizes Understanding Verbalizes Understanding Page 2 of 2

Page 2439 Bureau of Prisons Health Services Cosign/Review Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M ---- Encounter Date: 07/23/2019 06:20 Provider: b)(6); (b)C7>cc > MLP Cosigned by~l'0_)l5_i; <-bi(_7ic_c > ___ __.~ o on 07/23/201915:44. Bureau or Prisons - NYM Reg#: Race: Facility: 76318-054 WHITE NYM

Page 2440 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Encounter Date: 07/14/2019 17:36 Bureau of Prisons Health Services Clinical Encounter Sex: M Race: WHITE Provider:f blC5>; (bl(7xci fAD Chronic Care - 14 Day Physician Eval encounter performed at Health Services. SUBJECTIVE: COMPLAINT 1 Provider:r )(S); (b)(7)(C) IM D Chief Complaint: ENDO/LIPl,D Subjective: 66 YR OLD WHITE MALE WITH HX OF Reg#: 76318-054 Facility: NYM Unit: Z05 HYPERTRIGLYCERIDEMIA X 5 YEARS ON VASCEPA FOR 1 YEAR. STATES TRIGL WAS 800. NOW 431. STATES HE COULD NOT TOLERATE OTHER ANTI-TRIGLYCERIDE MEDS DUE TO THEIR GI SIDE EFFECTS. HX OF OBSTRUCTUVE SLEEP APNEA X 5 YEARS FOR WHICH HE USED A CPAP MACHINE. STATES HE HAD HIS CPAP MACHINE WITH HIM WHEN HE ARRESTED. STATES THE FBI LOKEL Y HAS L4 - LS SEVERE STENOSIS CASUING NUMBNESS AND SHOOTING PAIN IN THE LOWER EXTREMITIES. SURGICAL HX: NONE MENTAL HEALTH HX: NONE Pain: Yes Pain Assessment Date: Location: Quality of Pain: Pain Scale: Intervention: Trauma DateNear: Injury: Mechanism: Onset: Duration: 07/12/2019 13:25 Back-Middle Shooting 5 MEDROL DOSE PACK 5+ Years 5+ Years Exacerbating Factors: NO EXERCISE Relieving Factors: MEDROL DOSE PACK • Reason. Not Done: Comments: Seen for clinic(s): Orthopedic/Rheumatology, Pulmonary/Respiratory, Endocrine/Lipid Added to clinlc{s): Orthopedic/Rheumatology, Pulmonary/Respiratory, Endocrine/lipid OBJECTIVE: Exam: General Appearance Yes: Appears Well, Alert and Oriented x 3 No: Appears Distressed, Dyspneic, Appears in Pain, Writhing in Pain, Pale, Pallor, Cyanotic, Diaphoretic, Disheveled, Unkempt, Acutely Ill Nutrition No: Appears Obese Generated 07/14/2019 18: 11 b~..,..lb,.,,. )(6~>; (b,.,.,)(7=)(..,..,. c)---,IMD Bureau of Prisons - NYM Page 1 of 3

Page 2441 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/14/2019 17:36 Provider: lrb)tG): tb)(7)(C) !MD Exam: Eyes General Yes: PERRLA, Extraocular Movements Intact Pulmonary Auscultation Yes: Clear to Auscultation Cardiovascular Auscultation Yes: Regular Rate and Rhythm (RRR), Normal S1 and S2 No: M/R/G Abdomen Auscultation Yes: Normo-Active Bowel Sounds Palpation Yes: Within Normal Limits Musculoskeletal Tibia / Fibula No: Edema Back Yes: Tenderness Neurologic Cranial Nerves (CN) Yes: Within Normal Limits Motor System-General Yes: Normal Exam ASSESSMENT: Constipation, unspecified, K5900 - Current Hyperlipidemia, unspecified, E785 - Current Low back pain, M545- Current Neuralgia and neuritis, unspecified, M792 - Current Sleep apnea, G4730 - Current PLAN: New Medication Orders: M Medication Omega 3 ( Vascepa) 1 GM Capsule Indication: Hyperlipidemia, unspecified New Laboratory Requests: Order Date 07/14/2019 17:36 Reg#: 76318-054 Facility: NYM Unit: Z05 Prescriber Order TAKE 2 CAPS Orally - Two Times a Day x 180 day(s)- TAKE WITH FOOD. Details Lab Tests-H-Hemoglobin A1C Lab Tests-L-Lipid Profile frequency One Time Due Date 10/10/2019 00:00 Priority Routine Additional Information: Generated 07/14/2019 18: 11 byl(b)(6): (b)(7)(C) Bureau of Prisons - NYM Page 2of 3

Page 2442 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Reg #: 76318-054 Facility: NYM Encounter Date: 07/14/2019 17:36 Provider: bJ(5>: <b)(7)(c> D Unit: 205 FASTING. Lab Tests-H-Hep B surface Ab Lab Tests-H-Hep B surface Ag Lab Tests-H-Hep C Ab Lab Tests-H-Hepatic Profile Schedule: Activity Clinical Encounter One Time 08/08/2019 00:00 Date Scheduled Scheduled Provider 07/24/2019 00:00 Optometrist 66 YR OLD MALE FOR ROUTINE SCREENING. Chronic Care Visit 01/07/2020 00:00 Mid-Level Provider 6 MONTH F/U. Chronic Care Visit 07/01/2020 00:00 Physician 01 Other: PENDING EKG AND FOBT. CXR WAS REFUSED. Patient Education Topics: Date Initiated Format 07/14/2019 Counseling Copay Required: No TelephoneNerbal Order: No Handout/Topic Diagnosis Cosign Required: No Completed by-rb)-(5-);(-b)(_7>_cc_) __ ___.IMO on 07/14/2019 18:11 Generated 07/14/2019 18:11 b~(b)(6); (b)(?)(C) Bureau of Prisons - NYM Provider Routine Outcome Verbalizes Understanding Page 3of 3

Page 2443 Mail Attachment Epstein BEMR pt 3.pdf Page 14891

Page 2444 Bureau of Prisons Health Services Clinical Encounter Inmate Name: EPSTEIN, JEFFREY EDWARD Date or Birth: o 1/20/1953 Sex: Race: WHITE Reg #: 76318-054 Facility: NYM Encounter Date: 07/12/2019 13:10 Provider: bK5>; (bK7i(C> MD Chronic Care - 14 Day Physician Eval encounter performed at Health Services. SUBJECTIVE: COMPLAINT 1 Provider: f b}CS); (b)(?)(C) IMO Chief Complaint: ENDO/LIPID Unit: 205 Subjective: 66 YR OL~ITE MALE WITH HX OF HYPERT ~ CERIDEMIA X 5 YEARS ON VASCEPA FOR 1 YEAR. STATES TRIGL WAS 800, ~:1 . STATES HE COULD NOT TOLERATE OTHER ANTI-TRIGLYCERIDE MEDS blc{iilR GI SIDE EFFECTS. HX OF O S ~- UVE SLEEP APNEA X 5 YEARS FOR WHICH HE USED A CPAP MACHINE. A,"f~~ AD HIS CPAP MACHINE WITH HIM WHEN HE ARRESTED. STATES THE FB ~ Y HAS L4 - L5 SEVERE SIS CASUING NUMBNESS AND SHOOTING PAIN IN THE LOWER EXTREMJtrt S. SURGICAL HX: NONE MENTAL HEAL TH HX: Pain: Yes Pain Assessment Date: Location: Quality of Pain: 07/12/2019 13:25 Back-Middle ~ Pain Scale: Intervention: Trauma Date/Year: Injury: Shooting ~ ~ ~EDROL DOSE PACK ..., , ~ ~~ ~, Mechanism: Onset: 5+ Years Duration: 5+ Years Exacerbating Factors: NO EXERCISE Relieving Factors: MEDROL DOSE PACK Reason Not Done: Comments: Seen for clinic(s): Endocrine/Lipid, Pulmonary/Respiratory, Orthopedic/Rheumatology Added to clinic(s): Endocrine/Lipid. Pulmonary/Respiratory, Orthopedic/Rheumatology OBJECTIVE: Exam: General Appearance Yes: Appears Well, Alert and Oriented x 3 N?: Appears Distressed, Dyspneic, Appears in Pain, Writhing in Pain, Pale, Pallor, Cyanotic, Diaphoretic, Disheveled, Unkempt, Acutely Ill Nutrition No·. J\ppears Obese Generated 07/1212019 14:20 b~r.b.,-, )l6,.,..l ..,.. •b=111='(c,...: - ---,jMo Bureau of Prisons - NYM Page 1 or 3

Page 2445 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE EncounterDate: 07/12/201913:10 Provider: (bl(5): (b)(?)(C) MD Exam: Eyes General Yes: PERRLA, Extraocular Movements Intact Pulmonary Auscultation Yes: Clear to Auscultation Cardiovascular Auscultation Yes: Regular Rat Rhythm (RRR), Normal S1 and S2 No: M/R/G Abdomen Auscultation Yes: Normo-Aclive BnUi71"~i:nfffll:l Palpation Yes: Within Normal Limits Musculoskeletal Tibia/ Fibula No: Edema Back Yes: Tenderness Neurologic Cranial Nerves (CN) Yes: Within Normal Limits Motor System-General Yes: Normal Exam ASSESSMENT: Constipation, unspecified, K5900 - Current Hyperlipidemia, unspecified, E785 - Current Low back pain, M545 - Current Neuralgia and neuritis, unspecified, M792 - Current Sleep apnea, G4730 - Current PLAN: New Medication Orders: Rx# Medication Magnesium Hydroxide Susp Indication: Constipation, unspecified MethylPREDNISolone Tab 4 MG ( Dose Pack 21 tab) Order Date 07/12/2019 13:10 07/12/2019 13:10 Indication: Neuralgia and neuritis, unspecified Disposition: Generated 07/12/2019 14:20 bf b)(6); (b)(7)(C) Bureau of Prisons - NYM Reg #: 76318-054 Facility: NYM Unit: Z05 Prescriber Order 30 CC Orally - Two Times a Day PRN x 2 day(s) AS DIRECTED Orally - daily x 6 day(s) Page 2 or 3

Page 2446 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/12/2019 13:10 Follow-up at Sick Call as Needed Other: Provider: b)(GJ; (b)(7)CCJ MD WILL CONTINUE NOTES TO ADDRESS THE NFDR AND FOLLOW-UP. Patient Education Topics: Date Initiated Format 07/12/2019 Counseling Copay Required: No TelephoneNerbal Order: Completed b b)(s>; (b)mcc J . ._ ______ .-J Generated 07/12/2019 14:20 b ~(b)(G); (b)(l)(C) Handout/Topic Diagnosis Cosign Required: No n 07/12/2019 14:20 Bureau of Prisons - NYM Reg#: 76318-054 Facility: NYM Unit: Z05 Provider r )(6); (b)(7)(C) Outcome Verbalizes Understanding Page 3 of 3

Page 2447 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Encounter Date: 07/12/2019 13:10 Bureau of Prisons Health Services Clinical Encounter Sex: M Race: WHITE Provider: .b)(si (b)(?)(C) MD Chronic Care - 14 Day Physician Eval encounter performed at Health Services. SUBJECTIVE: COMPLAINT 1 Provider:lb){SJ; (b!(7)(CJ ~ D Chief Complaint: ENDO/LIPID Reg#: 76318-054 Facility: NYM Unit: Z05 Subjective: 66 YR OL_f)ffilTE MALE WITH HX OF HYPERT~t:Glt CERIDEMIA X 5 YEARS ON VASCEPA FOR 1 YEAR. STATES TRIGL WAS 800, OOW.1\~. STATES HE COULD NOT TOLERATE OTHER ANTI-TRIGLYCERIDE MEDS'olJE,,T_9..-i:t1EIR GI SIDE EFFECTS. HX OF 01:!'ST~'f UVE SLEEP APNEA X 5 YEARS FOR WHICH HE USED A CPAP MACHINE. S...Ui IHAD HIS CPAP MACHINE WITH HIM WHEN HE ARRESTED. ST ATES THE"F V < LY HAS L4 - LS SEVERE &_1( SIS CASUING NUMBNESS AND SHOOTING PAIN IN THE LOWER EXTREMlrl S. SURGICAL HX: NONE MENTAL HEAL TH HX: Pain: Yes Pain Assessment Date: Location: Quality of Pain: Pain Scale: Intervention: Trauma Date/Year: Injury: Mechanism: Onset: Duration: 07/12/2019 13:25 Back-Middle Shooting 5 MEDROL DOSE PACK 5+ Years 5+ Years Exacerbating Factors: NO EXERCISE Relieving Factors: MEDROL DOSE PACK Reason Not Done: Comments: Seen for clinic(s): Endocrine/Lipid, Pulmonary/Respiratory, Orthopedic/Rheumatology Added to clinic(s): Endocrine/lipid, Pulmonary/Respiratory, Orthopedic/Rheumatology OBJECTIVE: Exam: General Appearance Yes: Appears Well, Alert and Oriented x 3 No: Appears Distressed, Dyspneic, Appears in Pain, Writhing in Pain, Pale, Pallor, Cyanotic, Oiaphoretic, Disheveled, Unkempt, Acutely Ill Nutrition No: Appears Obese Generated 07/ 12/2019 14:20 b}f~'b-)(6-J;i-_b;-(7-)(C-l -~!MD Bureau or Prisons - NYM Page 1 or 3