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S_ .- - 6 :.-.. 1\ re: .04)51,eArN. . _. \ec9)_4:s2 _-:=7-L-7-2--t3 4-14"4":-HtiVole.like: eQ5\t\vs. `r•8 .---r-t--.:--_ :a i - . - e!......6±rn_.ple4e_.Q.10.5_\ eyil ._k_..Cft.txxil-e.c -5.c .....:frm.c,A_ L.Inrs,s15.1. itrAeiri O..-AA.V6iiia:No-r'ii- labia( -- .. k Iltr6\_ VCt. _. _ - - .- - - - - - - ..- -- .00 , ._...__-7,t.rt, . _ _ l ira _.0c.. .5\s,c)r. _ _. __ _ _. ,..12/Fir. — Sttf4166:4 ta4it? ._12(LitateLacifirthiulli.iffl [ ..I.-. A4 62Sthei kk? 41.114Vrafr AA&at a jo ild hr - 'NS' A Kf .. riAt?.. :..i ..:4 er7 1--L12:2 7" kaiddr.01- kv_45t_ekk zaettorp low pi_ _ 7-•_37,_,Le2c P-n-r&- kr. 4. 9./f4.---A* dijetp----•vg_ EFTA00055991 Name of Inmate On Suicide Watch or Psych Observation: Registration #: 1741/ar C)r —le EATING/SHOWER CHART BREAKFAST LUNCH DINNER LIQUIDS OFFERED SHOWER RECEIVED SHOWER (.7 Please check the appropriate box if the person on Suicide Watch/Psych Observation actually eats his meal. Do not check the box if he just received it, but did not eat it. Place a check in the "Liquids" box each time the person drinks. Thank you. EFTA00055992 ront4G+ 5 )t) d icti5 Preds14 -7/7,3-77,6 7.6.19- Epstein Arrives and is placed in GP (on a Saturday) 7.8.19- Dr. Schlessingerr Intake Screening — Monday (No endorsements on PSIQ and had just returned from court) — clear mental status, no hx of mental health treatment or symptoms, no suicide history, nothing significant noted, CC1-MH assignment. 7.8.19- Dr. Miller Consults with Central Office regarding Epstein and Risk Factors and R&D was instructed to place him on psychological observation when he returns from court pending a SRA. He is placed on psychological observation at 6:00 p.m. Log book reflects he was asking VC about how life is in GP and the crazy things he has seen as an I/C., about prison life, sleeping, pacing 7.9.19- Dr. Miller —Suicide Risk Assessment (placement on Psych 0bs after court proceeding as a precaution/precautionary SRA) — No mental health history, no substance abuse history, no suicide history, no suicidal thoughts. Clear mental status. Denies suicidality, future oriented, wants to make phone calls and speak with his lawyer, enjoys life, learning and teaching, has a business in the community, spoke about being a mathematician and about his post graduate studies, good sense of humor, no acute sxs, Was eating when I arrived (cereal) and his log book was not significant for any . symptoms. Recommended that he remain on psychological observation pending a suitable housing arrangement. (This writer spend 45 minutes interviewing him) — Log Book: he reeves for his legal visit at 8:20 am, returns at 2:00 pm and eats as well as goes to medical... leaves again around 3 pm and returns to cell around 8 pm from attorney visit. Talks to companion about the escort business, how to handle prison, about celebrities he knows, about prison food • 7.10.19 — Dr. Miller— Psychological Observation Contact (remained on psy obs pending suitable c housing placement with a cellmate) — indicated he did not like SHU because he is not comfortable there and said he wanted to be single celled. He expressed numerous needs: Colace instead of Ducolax, being able to walk around, no orange uniform, phone call, shower and towel, placement on the cadre unit, ipperpen, and property. Log book indicated he has been eating, sleeping and interacting with companions, went to his legal v' it. Looking forward to bail hearing, realizes he will be here for a couple of weeks even if he gets baiWmate Epstein is to return to SHU with a cellmate (this is documented). • 7.11.19- Dr. Miller —Psychological Observation Follow-up —Saw him in Attorney Conference area- he listed numerous concerns related to his confinement including receiving his property, feeling cold in his ye .. cell, not getting Colace, not having enough water in the attorney conference area and desire for more recreation, dislike of orange jumper and wanted brown one. This writer told him she would address in the SHU meeting. (I did not put in clinical note but It is worth noting he was kind of mocking me in the atty conference area about being placed on watch...he was smirking and said, "why would you ever think I would be suicidal, I am not suicidal arid I would never be." — he said it in front of his attorney (palm beach one)...) V 7.18.19- Dr. Miller- Attempted SHU Review but he was in legal visit. 7. 19 —Dr. Imeri —Suicide Risk Assessment— Epstein placed on SW after a string was found loosely cA ?.8. anging from around his neck. He said he does not remember what occurred that he had a drink of water, went back to bed, and then just remembers hearing himself snore. Epstein told the staff membetwattiing him early this morning that his cellmate tried to kill him, but did not tell this to Dr. elmerk He denied any mental health sym-ptorni or suicidality, denied feeir@cifecss, reported future EFTA00055993 plans including having fun, enjoying life and to learn. He wants to fight his case and go back to his normal life. At this time, it was not clear if he placed the string around his neck or whether someone else did. Remaining on SW for further observation and safekeeping. 7.24.19- Dr. DiMisa — Post Suicide Watch Report — Nature of incident unclear. Said he is fearful of returning to the cell with his previous cellmate. Recently, was denied bail. He said his cellmate was agitated and called him a pedophile and he had read a newspaper article about him. His cellmate threw away the newspaper photograph of him by crumbling it up and flushing it down the toilet. He thought it was strange he even had the article. He said he remembers his cellmate was "playing with a bed sheer and he does not remember the events thereafter. "maybe he put it there as a joke" He just remembers eating and drinking and that waking up to hear himself snore up on a stretcher. r Epstein adamantly denied suicidality, "lots to do for legal case, wonderful life, interesting people and projects in life, it would be crazy to take my life, I would not do that to myself." He did report feeling depressed and unhappy with his situation. He reported he slept well last night and was future oriented. Talked to companions about having taught math and physics and has been eating, sleeping, drinking. He wanted hygiene products and to shower. Log book: talking about jail to I/C, sleeping, brushes teeth, drinking. Goes to legal visit all morning. Discussing investment strategies, inmate safety, and prison adjustment with the I/C. He washes his face, rests, and sleeps. c te.1.25.19 — Dr. Miller — Psychological Observation Contact — Smiled "welcome back"; good spirits. He says he still does not remember how he got markings on his neck. "maybe you can give me cues." He remembers going for a drink of water and the next thing he knew he woke up to the sound of his own snoring. Reported being unhappy with SHU due to the restrictions and noise and he said his requests have not been granted for phone calls and recreation. He is unhappy that he is not taken to the bathroom enough during attorney/conference visits. Denied suicidality, stated he is too vested in case to fight it and I have a life and I want to go back living my life: No acute mental health symptoms were noted. Log Book: He had been eating, drinking, and sleeping. Also showers, brushes teeth, and goes to legal visit. Talks to I/C about business and investing, life•lessons, and tells I/C he does not want to go to SHU in lieu of GP and wants to know about the conditions of various housing units. 7.26.19 — Dr. Miller- Psychological Observation Contact- Smiling and cracking some jokes. Disappointed in writer that his various requests in the prison have not been adhered to. "I have to trust you if you want to trust me" He elucidated many complaints with legal visiting procedures, his constipation edication, and conditions of SHU confinement and prison restrictions. He stated he still does not know how he got the marks on his neck, that he did not remember if he did something or his cellmate did. He denied any symptoms of psychosis, depression, or anxiety. Denied suicidality; He stated he would never harm himself as he wants to be alive to fight his legal case and go back to live his life. He remarked he is "a coward... I am Jewish." He said he does not like pain and never attempt to harm himself. EFTA00055994 Log Book: sleeping, talks to I/C about BOP policy including phone visits and usage, Talks to I/C about business and investing, life lessons, and tells I/C he does not want to go to SHU in lieu of GP and wants to know about the conditions of various housing units. 7.27.19- Dr. Imeri — Psychological Observation Contact — reports no memory of events that caused marks on his neck; did report difficulty sleeping in SHU due to noise; anxious about returning to the SHU because he does not know how he got the marks or why it happened. He ate, drank, went to legal visit, and interacted with the inmate companions talking about business and investing topics. Reported good support from friends and lawyers, denied mental health sxs or suicidality, said he felt dehydrated and medical was notified. Provided with self-help handouts. Log boot eating, sleeping, sitting on bed, legal visit, asking for toilet tissue, talking about life in GP 7,28.19- Dr. Imeri —Psychological Observation Contact— noted he is in attorney visits 12 hours a day, logs indicate he speaks about life in general population; reported his right arm felt numb and he had been seen by medical. Flushing of the toilet in his cell was aversive; told writer maybe he has Autism because sounds/noise are aversive to him like "the Rain Man." Mildly anxious mood; provided with P' Turning point handouts and supportive interventions. Eating when in the cell, but otherwise, eating in Attorney conference. Log Book: Upset about non-stop flushing of toilet, goes to legal visit most of day, talks to I/C later about who is best cook on 11N, investments, driving a taxi in NY, sleeping. 7.29.19- Dr. Miller- Psychological Observation Contact — continues to report no memory of the event which lead up to him being placed on SW/Psych Obs. He requested to stay on psychological observation another day so that he could get a good night's sleep. NO mental health sxs or suicidality was reported or noted, he ate and has been attending legal visits. Wanted to remain on psychological observation V because it is more comfortable and not noisy like SHU. It was explained that psychological observation cannot be continued long-term for the purposes of being more comfortable and that the purpose of • psych obs is to stabilize mental health problems. His only concerns are getting his various needs met in ) the prison including more phone calls, recreation, and being placed in a comfortable and safe place. He was informed he would be housed in a safe situation in the SHU. Log Book: showers, eats, writes in note pad, drinks water, legal visit, talks to I/C about investment options, his jail appeal, sleeps. 7.30.19.- Dr. Imerl - Psychological Observation Contact and Discontinuation — waiting to go to SHU to get.cee.machine as he did not sleep well without it. Said SHU is noisy and he is concerned about sleeping well there and he said he did not get one of i i edications yet that day. He ate meals, drank liquids, showered, no mental health sxs, no suicida ty. SHU L formed inmate Epstein needs to be housed with an appropriate cellmate while in SHU. •wed up with an e-mail). Inmate remained on observation until brought to his attorney conference visit. Log book: Sleeping, eats breakfast, talks about jail life, taken off of psych obs status at 8:15 a.m., goes to his legal visit, and later to SHU. 7.31.19- Dr. Avena- Psychological Observation Follow-up Session —denied suicidality, no mental health sxs, slelpt well and was getting reading for court hearing. Reported getting along with cellmate in SKIS EFTA00055995 8.1.19- Dr. Imeri- SRA was conducted— court sent a form "suicidal tendencies" Denied any suicidality; friends and lawyers supportive; Jewish-against his religion; still denies knowing what happened to him on 7/23/19 when he was discovered with a string loosely tied around his neck. Said his incident report for self-mutilation was expunged. His cellmate is talkative but he will give it a chance. Noisy in SHU. He lives for fighting this case and going back to his normal life. 8.8.19- Dr. Miller - for a follow-up session to assess adjustment in SHU .a,cute symptoms, distress or mental health concerns; denied suicidality, some concerns with slee .Cthppy he received his PAC # to make phone calls and requested to speak with someone without it being o alPeakerphone. Wanting his books he left in the suicide watch area. Interacting and getting along with his cellmate. Getting ready of this attorney visit. 8.10.19 - Found Unresponsive and Hanging in SHU at 6:30 a.m. (10 days after his removal from a constant observation) EFTA00055996 7.6.19- Epstein Arrives and is placed in GP (on a Saturday) 7.8.19- Dr. Schlessinger — Intake Screening — Monday (No endorsements on p51O and had just returned from court) — clear mental status, no hx of mental health treatment or symptoms, no suicide history, nothing significant noted, CC1-MH assignment. 7.8.19- Dr. Miller Consults with Central Office regarding Epstein and Risk Factors and R&D was instructed to place him on psychological observation when he returns from court pending a SRA. He is placed on psychological observation at 6:00 p.m. Log book reflects he was asking I/C about how life is in GP and the crazy things he has seen as an I/C., about prison life, sleeping, pacing 7.9.19- Dr. Miller — Suicide Risk Assessment (placement on Psych Obs after court proceeding as a precaution/precautionary SRA) — No mental health history, no substance abuse history, no suicide history, no suicidal thoughts. Clear mental status. Denies suicidality, future oriented, wants to make phone calls and speak with his lawyer, enjoys life, learning and teaching, has a business in the community, spoke about being a mathematician and about his post graduate studies, good sense of humor, no acute sxs, Was eating when I arrived (cereal) and his log book was not significant for any symptoms. Recommended that he remain on psychological observation pending a suitable housing arrangement. (This writer spend 45 minutes interviewing him) — Log Book: he leaves for his legal visit at 8:20 am, returns at 2:00 pm and eats as well as goes to medical... leaves again around 3 pm and returns to cell around 8 pm from attorney visit. Talks to companion about the escort business, how to handle prison, about celebrities he knows, about prison food 7.10.19 — Dr. Miller — Psychological Observation Contact (remained on psy obs pending suitable housing placement with a cellmate) — indicated he did not like SHU because he is not comfortable there and said he wanted to be single celled. He expressed numerous needs: Colace instead of Ducolax, being able to walk around, no orange uniform, phone call, shower and towel, placement on the cadre unit, paper, pen, and property. Log book indicated he has been eating, sleeping and interacting with companions, went to his legal visit. Looking forward to bail hearing, realizes he will be here for a couple of weeks even if he gets bail. Inmate Epstein is to return to SHU with a cellmate (this is documented). 7.11.19- Dr. Miller — Psychological Observation Follow-up —Saw him in Attorney Conference area- he listed numerous concerns related to his confinement including receiving his property, feeling cold in his cell, not getting Colace, not having enough water in the attorney conference area and desire for more recreation, dislike of orange jumper and wanted brown one. This writer told him she would address in the SHU meeting. (I did not put in clinical note but It is worth noting he was kind of mocking me in the any conference area about being placed on watch...he was smirking and said, "why would you ever think I would be suicidal, I am not suicidal and I would never be." — he said it in front of his attorney (palm beach one)...) 7.18.19- Dr. Miller- Attempted SHU Review but he was in legal visit. 7.23.19 — Dr. Imeri — Suldde Risk Assessment — Epstein placed on SW after a string was found loosely hanging from around his neck. He said he does not remember what occurred that he had a drink of water, went back to bed, and then just remembers hearing himself snore. Epstein told the staff member watching him early this morning that his cellmate tried to kill him, but did not tell this to Dr. Imeri. He denied any mental health symptoms or suicidality, denied feeling hopeless, reported future EFTA00055997 plans including having fun, enjoying life and to learn. He wants to fight his case and go back to his normal life. At this time, it was not clear if he placed the string around his neck or whether someone else did. Remaining on SW for further observation and safekeeping. 7.24.19- Dr. DiMisa — Post Suicide Watch Report-Nature of incident unclear. Said he is fearful of returning to the cell with his previous cellmate. Recently, was denied bail. lie said his cellmate was agitated and called him a pedophile and he had read a newspaper article about him. His cellmate threw away the newspaper photograph of him by crumbling it up and flushing it down the toilet. He thought it was strange he even had the article. He said he remembers his cellmate was "playing with a bed sheet" and he does not remember the events thereafter. "maybe he put it there as a joke" He just remembers eating and drinking and that waking up to hear himself snore up on a stretcher. Epstein adamantly denied suicidality, "lots to do for legal case, wonderful life, interesting people and projects in life, it would be crazy to take my life, I would not do that to myself." He did report feeling depressed and unhappy with his situation. He reported he slept well last night and was future oriented. Talked to companions about having taught math and physics and has been eating, sleeping, drinking. He wanted hygiene products and to shower. Log book: talking about jail to I/C, sleeping, brushes teeth, drinking. Goes to legal visit all morning. Discussing investment strategies, inmate safety, and prison adjustment with the I/C. He washes his face, rests, and sleeps. 7.25.19 - Dr. Miller Psychological Observation Contact -Smiled "welcome back"; good spirits. He says he still does not remember how he got markings on his neck. "maybe you can give me cues." He remembers going for a drink of water and the next thing he knew he woke up to the sound of his own snoring. Reported being unhappy with SHU due to the restrictions and noise and he said his requests have not been granted for phone calls and recreation. He is unhappy that he is not taken to the bathroom enough during attorney/conference visits. Denied suicidality, stated he is too vested in case to fight it and 1 have a life and I want to go back living my life." No acute mental health symptoms were noted. Log Book: He had been eating, drinking, and sleeping. Also showers, brushes teeth, and goes to legal visit. Talks to I/C about business and investing, life lessons, and tells I/C he does not want to go to SHU in lieu of GP and wants to know about the conditions of various housing units. 7.26.19 - Dr. Miller- Psychological Observation Contact- Smiling and cracking some jokes. Disappointed in writer that his various requests in the prison have not been adhered to. "I have to trust you if you want to trust me" He elucidated many complaints with legal visiting procedures, his constipation medication, and conditions of SHU confinement and prison restrictions. He stated he still does not know how he got the marks on his neck, that he did not remember if he did something or his cellmate did. He denied any symptoms of psychosis, depression, or anxiety. Denied suicidality; He stated he would never harm himself as he wants to be alive to fight his legal case and go back to live his life. lie remarked he is "a coward... I am Jewish." lie said he does not like pain and never attempt to harm himself. EFTA00055998 Log Book: sleeping, talks to I/C about BOP policy including phone visits and usage, Talks to I/C about business and investing, life lessons, and tells I/C he does not want to go to SHU in lieu of GP and wants to know about the conditions of various housing units. 7.27.19- Dr. lined —Psychological Observation Contact— reports no memory of events that caused marks on his neck; did report difficulty sleeping in SHU due to noise; anxious about returning to the SHU because he does not know how he got the marks or why it happened. He ate, drank, went to legal visit, and interacted with the inmate companions talking about business and investing topics. Reported good support from friends and lawyers, denied mental health sxs or suicidality, said he felt dehydrated and medical was notified. Provided with self-help handouts. Log book: eating, sleeping, sitting on bed, legal visit, asking for toilet tissue, talking about life in GP 7,28.19- Dr. lined —Psychological Observation Contact— noted he is in attorney visits 12 hours a day, logs indicate he speaks about life in general population; reported his right arm felt numb and he had been seen by medical. Flushing of the toilet in his cell was aversive; told writer maybe he has Autism because sounds/noise are aversive to him like "the Rain Man." Mildly anxious mood; provided with Turning point handouts and supportive interventions. Eating when in the cell, but otherwise, eating in Attorney conference. Log Book: Upset about non-stop flushing of toilet, goes to legal visit most of day, talks to I/C later about who is best cook on UN, investments, driving a taxi in NY, sleeping. 7.29.19- Dr. Miller- Psychological Observation Contact —continues to report no memory of the event which lead up to him being placed on SW/Psych Obs. He requested to stay on psychological observation another day so that he could get a good night's sleep. NO mental health sxs or suicidality was reported or noted, he ate and has been attending legal visits. Wanted to remain on psychological observation because it is more comfortable and not noisy like SHU. It was explained that psychological observation cannot be continued long-term for the purposes of being more comfortable and that the purpose of psych obs is to stabilize mental health problems. His only concerns are getting his various needs met in the prison including more phone calls, recreation, and being placed in a comfortable and safe place. He was informed he would be housed in a safe situation in the SHU. Log Book: showers, eats, writes in note pad, drinks water, legal visit, talks to I/C about investment options, his jail appeal, sleeps. 7.30.19- Dr. lined - Psychological Observation Contact and Discontinuation — waiting to go to SHU to get CPAP machine as he did not sleep well without it. Said SHU is noisy and he is concerned about sleeping well there and he said he did not get one of his medications yet that day. He ate meals, drank liquids, showered, no mental health sxs, no suicidality. SHU Lt. informed inmate Epstein needs to be housed with an appropriate cellmate while in SHU. (Dr. Imeri followed up with an e-mail). Inmate remained on observation until brought to his attorney conference visit. Log book: Sleeping, eats breakfast, talks about jail life, taken off of psych obs status at 8:15 a.m., goes to his legal visit, and later to SHU. 7.31.19- Dr. Avena- Psychological Observation Follow-up Session— denied suicidality, no mental health sxs, slelpt well and was getting reading for court hearing. Reported getting along with cellmate in SHU. EFTA00055999 8.1.19- Dr. Imeri- SRA was conducted- Court sent a form "suicidal tendencies" Denied any suicidality; friends and lawyers supportive; Jewish-against his religion; still denies knowing what happened to him on 7/23/19 when he was discovered with a string loosely tied around his neck. Said his incident report for self-mutilation was expunged. His cellmate is talkative but he will give it a chance. Noisy in SHU. He lives for fighting this case and going back to his normal life. 8.8.19- Dr. Miller - for a follow-up session to assess adjustment in SHU. No acute symptoms, distress or mental health concerns; denied suicidality, some concerns with sleep. Happy he received his MC 4$ to make phone calls and requested to speak with someone without it being on a speakerphone. Wanting his books he left in the suicide watch area. Interacting and getting along with his cellmate. Getting ready of this attorney visit. 8.10.19 - Found Unresponsive and Hanging in SHU at 6:30 a.m. (10 days after his removal from a constant observation) EFTA00056000 Bureau of Prisons Psychology Services Intake Screening **SENSITIVE BU UNCLASSIFIED•• Inmate Name: EPSTEIN. JEFFREY EDWARD Date of Birth: 01/20/1953 Sex M Facility: NYM Date: 07/08/2019 09:24 Provider: Schlessinger, K. PsyD/PhD Reg #: 76318-054 Unit Team: MO Limits of Confidentiality Limits of confidentiality were reviewed with inmate EPSTEIN. He expressed an understanding of the limits of confidentiality and consented to be interviewed accordingly. Data Source(s) The following data sources were reviewed in conjunction with this Initial Intake Evaluation: Self-Report, SENTRY, Staff Observation. Inmate Epstein is a 66-year-old, Black male who was seen by Psychology Services due to newly arriving at MCC-NY. He denied a history of mental health treatment on his Psychology Services Intake Questionnaire. Mental Health History and Current Symptoms No history of mental health issues was noted. No history of prior menta: health treatment was noted. No current mental health symptoms were noted. No suicidal ideation, attempts. or self-harm were noted. Substance Abuse No history of substance abuse was noted. No history of substance abuse treatment was noted. Sex Offenses No sexual offense convictions were noted. No history of sexual predation in a correctional setting was noted. Relevant Psychosocial History Noteworthy psychosocial issues: Other. Inmate Epstein is currently incarcerated for a Sex Trafficking. He stated he was previously incarcerated three months for prostitution. Inmate Epstein stated he is single and does not have any children. He revealed he was liFing in New York. He stated he completed high school. He stated he was employed in banking work prior to his incarcer ion. Adjustment to Incarceration Adjustment to incarceration concerns were identified: Other. SEXUAL ABUSE HISTORY Inmate Epstein denied being the victim of physical or sexual abuse. He is currently charged with sex fficking and has previously been charged with prostitution. He was informed of the programs offered by MCC-NY as w as the Bureau of Prisons. Additionally, he was informed of this institutions self-help program. Inmate Epstein reported e was not currently interested in any treatment programs. MENTAL STATUS: Inmate Epstein appeared calm, controlled, without signs of psychomotor agitation or retardation. He was fully cooperative, maintained good eye-contact, and related in an interpersonally appropriate manner with interviewer. Speech and thought processes were organized, coherent, logical, and goal-directed. Based on informal assessment during this interview, this inmate's cognitive functioning appeared within normal limits, as reflected by adequate long and shod-term memory, good attention, and appropriate concentration during interview, as well as adequate receptive and expressive language skills. Inmate denied any current sleep disturbances and described his appetite as adequate. This inmate denied recent or present morbid thoughts, passive or active suicidal ideation, intent or plan and contracted for safety. This inmate's verbalizations were optimistic, future oriented, and without indications of helpless or hopeless thinking. Inmate Brown denied any familial history of suicide behaviors cr attempts. This inmate was provided with supportive psychotherapy, and psycho-education to strengthen coping skills and facilitate adjustment to incarceration. Findings Care Level: CARE1-MH Gencrairm 07/08/2019 09:30 by Sch!essrnger. K Psyn/Pal) Bureau of Prisons • NYM Pago 1 of 2 EFTA00056001 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: A&O Date: 07/08/2019 09:24 Provider: Schlessinger, K. PsyD/PhD Inmate EPSTEIN denied any history of mental health symptoms or treatment. He denied any current rnenta) health symptoms. He does not meet criteria for any current psychological diagnosis. He meets criteria for Mental Health Care Code 1. CARE1-MH is indicative of an inmate who shows no significant level of functional impairment associated with a mental illness and demonstrates no need for regular mental health intervention. Recommendations The following psychological services are recommended: Other. Inmate EPSTEIN was educated aboct both routine and emergency procedures for contacting Psychology staff. He does not appear to be in distress at this time. He agreed to contact psychology if he feels he needs psychology services in the future. He meets criteria for CC1 and does not require scheduled follow up at this time. Completed by Schlessinger, K. PsyD/PhD on 07/08/2019 09:30 Generated 07/08/2019 09:30 by Si:Messinger, K. PsyO/Pf10 Bureau of P0Soas - NYM Paso 2 of 2 EFTA00056002 Oa\ Bureau of Prisons Psychology Services Risk of Sexual Abusiveness "SENSITIVE BUT UNCLASSIFIED" Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team MO Date: 07/08/2019 09:35 Provider: Schlessinger, K PsyD/PhD CottMUM Risk of Sexual Abusiveness During the intake screening process, for Inmate Epstein, based on the documentation available at the time of the screening, and Inmate Epstein's self-report, he was identified as being at risk for sexual abusiveness due to previous perpetration of sexual abuse in the community or in an institutional setting, as evidenced by the following objective criteria: ( ) Having a history of prior institutional violence or sexual abuse perpetration (X ) Having a history of prior sexual abuse perpetration in the community (X ) Having prior convictions of violent offenses As required by P5324.11, Sexually Abusive Behavior Prevention and Intervention, Inmate Epstein was seen by Psychology on today's date to assess his risk factors for sexual abusiveness. At the onset of this clinical contact, the inmate was informed about the BOP requirements regarding PREA. Inmate Epstein indicated he understands the institution's policy against engaging in sexual behavior. His risk factors for sexual abusiveness were assessed and include: ( ) History of prior sexual victimizatbn in prison ( X ) History of prior prison sexual predation ( ) History of head injury with loss of consciousness ( ) History of childhood psychological, physical, sexual abuse ( ) Witnessed family violence ( ) Antisocial Personality Disorder traits of irritability/aggressiveness and recklessness ( ) Hypersexuality (defined by eight or more orgasms a week prior to prison) ( ) Hypermascutinity () Other: Based on this clinical assessment, the inmate is considered to be at: (X ) Low Risk of Abusiveness at this facility (Note: Even though this inmate is judged to be at low risk of xual abusiveness, an unforeseen change in risk (actors may significantly alter his risk level.). Programming recommendations included sex offender treatment. Inmate Epstein declined programming recomm inmate understands the procedure for contacting Psychology for routine or emergent services. ( ) Moderate Risk of Abusiveness. The Unit Team and Correctional Staff have been notified regarding Ps chology staff's recommendation that he not be housed in a cell with any inmates identified as at increased risk for xual victimization. Psychology also recommends a greater level of supervision regarding his work and education assignments. Programming recommendations Include )OOO(X. Inmate =inmateLastName is agreeable to! declined programming recommendations. ( ) High Risk of Abusiveness. It is recommended this inmate be housed in the Special Housing Unit in accordance with P5324.11 to 'keep separate those inmates at high risk of being sexually victimized from those at high risk of being sexually abusive" until Correctional Services and Correctional Programs staff can assess his appropriateness for general population at this facility. This inmate should not be housed with any inmates judged to be at an increased risk for sexual victimization. Programming recommendations Include XXXXX. Inmate =inmateLastName is agreeable to/ declined programming recommendations. Generated 07/08/2019 09:41 by Schlessinger. K. PsyD/PhD Bureau of Prison • NYM Page 1 of 2 EFTA00056003 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg 11: Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team Date: 07/08/2019 09:35 Provider Schlessinger, K. PsyD/PhD 76318-054 A&O Completed by Schlessinger, K. PsyD/PhO on 07/08/2019 09:41 Generated 07/08/2019 09:41 by Schlessinger. K PsyD/PhD Bureau of Prison - NYM Pogo 2 of 2 EFTA00056004 Bureau of Prisons Psychology Services General Administrative Note "SENSITIVE BUTILINCLASSIFIED" Inmate Name: EPSTEIN, JEFFREY EDWARD Reg ale: Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: Date: 07/08/2019 10:41 Provider: Miller, Elissa PhD/Chief 76318.054 MO Comments This writer consulted with Dr. Robert Nagle, Central Office, regarding inmate Epstein. Inmate Epstein has various risk factors for suicidality including a high profile case with media attention, sex offense charges, pre-trial status and a court proceeding today which could potentially be giving him bad news regarding his legal situation. As such, when inmate Epstein returns from court, R&D staff as well as Lieutenant's have been informed to immediately notify the psychology department. If he returns after duty hours, the aforementioned staff were instructed to notify the on-call psychologist and to place inmate Epstein on a watch status until psychology can conduct a thorough suicide risk assessment. Completed by Miller, Elissa PhD/Chief Psychologist on 07/08/2019 10:49 Gone:014d 07)001201910:49 by Miler. Etna PhOlChls1 Bureau of Prisons NYM Poplar I EFTA00056005 Bureau of Prisons Psychology Services Suicide Risk Assessment "SENSITIVE BUT UNCLASSIFIED" Inmate Name: EPSTEIN. JEFFREY EDWARD Reg #: 76318-054 Date of Birth 01/20/1953 Sex: M Facility: NYM Unit Team: A&O Date. 07/09/2019 08:41 Provider: Miller. Elissa PhD/Chief Psychologist Type of Housing: Other Psychological Observation Cell Accommodation: Single Cell FINDINGS This assessment and the resulting recommendations are based on the following sources of information: Clinical Interview, Medical Record Inmate Epstein was placed on s chological observation when he returned from court yesterday evening 7/8/19 for precautionary reasons. He i a suicide watch at this time. Reason for Referral Inmate Epstein is being seen e risk assessment today for precautionary reasons. Inmate Epstein has various risk factors for suicidality at thi ing a high profile case with media attention, sex offense/trafficking charges, l d pre-trial status, and he had a court e ittling yesterday which could have given him bad news regarding his legal situation. As such, this writer instructe-a-R&D staff, as well as the Lieutenant's Office, to immediately notify the psychology department when he returned from-cart). Inmate Epstein returned from court after duty hours and denied suicidality. The aforementioned staff notified-the.orcall psychologist and inmate Epstein was placed on a precautionary psychological observation status until psychology,coulaM A terview him this morning to conduct a suicide risk assessment. Ni ..y• Developmental History iv Inmate Epstein denied any history of being the victim<endJitfrperpetrator of physical or sexual abuse. 4„, ti-i-, EctucationatHistory/Cognitive Impairment C(1\ 1) Inmate Epstein reported he obtained his high school diplomwencite (led some graduate classes in the area of mathematics. Arrest History and Experience of Incarceration Inmate Epstein reported he has served time in Palm Beach County jail nse charges (soliciting prostitution) in the past. He is now being charged with sex trafficking, on a federal level. Mental Health History Inmate Epstein denied any history of mental health treatment, either on an inpatief o S L tient basis. Inmate Epstein denied any treatment in the past or present with psychotropic medication. He also d ' acute mental health symptoms at this time. Self-Harm History Inmate Epstein denied any past or present suicidal ideation, intention or plan. He denied ever e ging in any suicide attempts or self-injurious behavior in the past. Substance Abuse History Inmate Epstein denied any alcohol or substance abuse. He said it is well-known that he does not even drink alcohol. Medical Concerns Inmate Epstein denied any significant medical problems, other than a history of high triglycerides. He reported feeling constipated at this time. Current Problem Inmate Epstein is currently on psychological observation due to his having multiple risk factors associated with suicidality. He denies any suicidality at this time and has no mental health or suicide history. He is being seen for a suicide risk assessment in an abundance of caution. _current Mental Status Level of Consciousness: Alert and Oriented Generated 07/09/2019 10.30 by Miller. Elissa PhD/Chief Bureau of Prisons NYM Page 1 of 3 EFTA00056006 ' Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01120/1953 Sex: M Facility: NYM Unit Team: A&O Date: 07/09/2019 08:41 Provider: Miller. Elissa PhD/Chief Psychologist Psychomotor Activity: Normal General Appearance: Normal Behavior Cooperative Mood: Appropriate to Content Thought Process: Goal Directed Thought Content: Normal Inmate Epstein did not exhibit any acute psychopathology and exhibited a clear mental status. Current Mental Status: Mr. EPSTEIN was alert and oriented. He was polite, calm, and cooperative in demeanor. He exhibited a neutral affect with appropriate range. Eye contact and hygiene were appropriate. The inmate spoke with normal rate, tone. and volume. His thoughts Were organized and coherent, with no loosening of associations or tangential, circumstantial, or irrelevant content. There was no evidence of perceptual disturbance, delusional ideation, or a formal thought disorder. He did not engage in any bizarre or inappropriate behavior. He noted having normal sleeping and eating habits. Mr. EPSTEIN explicitly denied recent and currentabicid4 eation, planning, and intent. He was future-oriented and expressed a commitment to life and safety, agreein ' t tact staff immediately should he experience suicidal ideation. s t RISK AND PROTECTIVE FACTORS A SSED. This writer screened the inmate for a variety of e y validated factors commonly associated with risk for self-harm and suicide. The following STATIC risk factors were assessed tojbe,pfeCent and increase the inmate's risk for engaging in suicide related behaviors: High Profile Crime. Lack of family connections, Sex-offender status Of the DYNAMIC risk factors assessed, none were found to be present. V c / The following PROTECTIVE factors were assessed to be preser/- may decrease the inmate's risk of suiCide:Able to identify reasons to live, Adequate problem solving skills, Denial of suicidii tention/plans. Future orientation, View of death as negative, Willingness to engage in treatment As noted above. Inmate Epstein is a 66-year-old Caucasian male. He S • sk factors for suicidality at this time including a high profile case with extensive media attention, sex offense/tr arges, pre-trial status, and he had a court proceeding yesterday which may have given him bad news regarding his leg • Inmate Epstein also informed this writer that his only family at this time is his brother, with whom he does not hay r . ationship with. oe, Despite these risk factors, inmate Epstein possesses a number of protective factors at,t Inmate Epstein adamantly denied any suicidal ideation, intention or plan. He was very future oriented and requeste call, to meet with his attorney, to take a shower, and to brush his teeth. He was eating his cereal when this write d said "I have my paper spoon here." He reported he is going to have a bail hearing on Monday and believes he is go sed from jail. Inmate Epstein reported he is a Banker and has a "big business" in the community and that "be n." He also revealed he enjoys learning and teaching. He has confidence in his attorney and described him as mpetent." Inmate Epstein denied any mental health history or history of suicidality. He also reported none of his family members have mental health histories. Inmate Epstein stated he is a mathematician and took post graduate classes in this area of study. Inmate Epstein stated he has a support system in the community, including friends and other associates. Finally, inmate Epstein demonstrated a good sense of humor and did not appear dysphoric, agitated or anxious. No acute psychopathology was noted. Overall, inmate Epstein has numerous protective factors at this time that outweigh his risk factors for suicidality. He has a positive outlook regarding his legal case, demonstrates no psychiatric symptoms, has no psychiatric or suicide history, and verbalized a desire to be alive at this time and future orientation. DIAGNOSIS: No Diagnosis, No Dx - Current CONCLUSIONS The Overall Acute Suicide Risk for this Inmate is: Low Overall Chronic Suicide Risk for this Inmate is: Absent Generated 07/0912019 10.36 by Miller. Elissa PhD/Chief Bureau of Prisons - NYM Page 2 of 3 EFTA00056007 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: MO Date: 07/09/2019 08:41 Provider: Miller, Elissa PhD/Chief Psychologist REcOMMENIIATIONS Inmate Epstein is currently on psychological observation pending suitable housing placement. In light of his current sex offense charges and extensive media coverage on the television, he will need to be confined in a suitable housing unit. Inmate Epstein will be seen daily while on psychological observation and will be seen for a psychological observation follow-up session once he is released from observation. Inmate Epstein denied the need for psychological intervention, self-help materials, or follow-up. He has been classified as a CC1-MH inmate at this time. CARE1-MH is indicative of an inmate who shows no significant level of functional impairment associated with a mental illness and demonstrates no need for regular mental health intervention. Suicide Watch: A suicide watch is not warranted at this time Completed by Miller, Elissa PhD/Chief Psychologist on 07/09/2019 10:36 t e Generated 07/09/201910:36 by Miller. Eltsse PhD/Chief Bureau of Prisons - NYM Page 3 of 3 EFTA00056008 Bureau of Prisons Health Services See Amendment Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318.054 Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/09/2019 08:41 Facility: NYM Amendment made to this note by Miller, Elissa PhD/Chief Psychologist on 07/10/2019 09:20. Bureau of Prisons - NYM EFTA00056009 Bureau of Prisons Psychology Services Suicide Risk Assessment **SENSITIVE BUT UNCLASSIFIED** Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: A&O Date: 07/09/2019 08:41 Provider: Miller, Elissa PhD/Chief Psychologist Type of Housing: Other Psychological Observation Cell Accommodation: Single Cell FINDINGS This assessment and the resulting recommendations are based on the following sources of information: Medical Record, Clinical Interview Inmate Epstein was placed on psychological observation when he returned from court yesterday evening 7/8/19 for precautionary reasons. He is not on a suicide watch at this time. He was seen this morning for a psycholopical observation contact and suicide risk assessment this morning, 7/9/19, at 7:30 a.m. as it was determined he possessed some at-risk factors for suicidality. Reason for Referral Inmate Epstein is being seen for suicide risk assessment today for precautionary reasons. Inmate Epstei has various risk factors for suicidality at this time including a high profile case with media attention, sex offense/traffi ng charges, pre-trial status, and he had a court proceeding yesterday which could have given him bad news regardin his legal situation. As such, this writer instructed R&D staff, as well as the Lieutenant's Office, to immediately notify the psychology department when he returned from court. Inmate Epstein returned from court after duty hours and denied suicidality. The aforementioned staff notified the on-call psychologist and inmate Epstein was placed on a precautionary psychological observation status until psychology could interview him this morning to conduct a suicide risk assessment. Developmental History Inmate Epstein denied any history of being the victim and/or perpetrator of physical or sexual abuse. Educational History/Cognitive Imnakmen.t Inmate Epstein reported he obtained his high school diploma and attended some graduate classes in the rea of mathematics. Anreast±listoryantigeperience of Incarceration Inmate Epstein reported he has served time in Palm Beach County jail on sex offense charges (soliciting ostitution) in the past. He is now being charged with sex trafficking, on a federal level. Mental HealthillStall Inmate Epstein denied any history of mental health treatment either on an inpatient or outpatient basis. Inmate Epstein denied any treatment in the past or present with psychotropic medication. He also denied any acute mental health symptoms at this lime. Self-Harm History Inmate Epstein denied any past or present suicidal ideation, intention or plan. He denied ever engaging in any suicide attempts cr self-injurious behavior in the past. Substance Abuse History Inmate Epstein denied any alcohol or substance abuse. He said it is well-known that he does not even drink alcohol. Medical Concerns Inmate Epstein denied any significant medical problems, other than a history of high triglycerides. He •eported feeling constipated at this time. Current Problem Inmate Epstein is currently on psychological observation due to his having multiple risk factors associated with suicidality. He denies any suicidality at this time and has no mental health or suicide histcry. He is being seen for a suicide risk assessment in an abundance of caution. Current Mental Status Generated 071101201909:20 by Miner, Erssa PhD/Ch:ef Bureau or Prisons NYM Paget of 3 EFTA00056010 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg ft 76318-054 Date of Birth: 01/20/1953 Sex: M Fadkty: NYM Unit Team: A&O Date: 07/09/2019 08:41 Provider Miller, Elissa PhD/Chief Psychologist Level of Consciousness: Alert and Oriented Psychomotor Activity: Normal General Appearance: Normal Behavior: Cooperative Mood: Appropriate to Content Thought Process: Goal Directed Thought Content: Normal Inmate Epstein did not exhibit any acute psychopathology and exhibited a clear mental status. Current Mental Status: Mr. EPSTEIN was alert and oriented. He was polite, calm, and cooperative in demeartor. He exhibited a neutral affect with appropriate range. Eye contact and hygiene were appropriate. The inmate spoke with normal rate, tone, and volume. His thoughts were organized and coherent, with no loosening of associations or tangential, circumstantial, or irrelevant content There was no evidence of perceptual disturbance, delusional ideation, or a formal thought disorder. He did not engage in any bizarre or inappropriate behavior. He noted having normal sleeping and eating habits. Mt EPSTEIN explicitly denied recent and current suicidal ideation, planning, and Intent. He was future-oriented and expressed a commitment to life and safety, agreeing to contact staff immediately should he experience suicidal ideation. RISK AND PROTECTIVE FACTORS ASSESSED: This writer screened the inmate for a variety of empirically validated factors commonly associated with risk for suicide. The following STATIC risk factors were assessed to be present and increase the inmate's risk for engaging in suicide related behaviors: Sex offender status, Lack of family connections, High Profile Crime Of the DYNAMIC risk factors assessed, none were found to be present. The following PROTECTIVE factors were assessed to be present and may decrease the inmate's risk of sui e:WIllingness to engage in treatment. View of death as negative, Future orientation, Denial of suicidal ideationfintention/plans, dequate problem solving skills, Able to identify reasons to live As noted above, Inmate Epstein is a 66-year-old Caucasian male. He has various risk factors for suicidality a including a high profile case with extensive media attention, sex offense/trafficking charges, pre-trial status, ar proceeding yesterday which may have given him bad news regarding his legal situation. Inmate Epstein also writer that his only family at this time is his brother, with whom he does not have a close relationship with. f-harm and this time d he had a court formed this Despite these risk factors, inmate Epstein possesses a number of protective factors at this time. Inmate Epst adamantly denied any suicidal ideation, intention or plan. He was very future oriented and requested a phone call, to m t with his attorney, to take a shower, and to brush his teeth. He was eating his cereal when this writer arrived and said 'I have my paper spoon here? He reported he is going to have a bail hearing on Monday and believes he is going to be released from jail. Inmate Epstein reported he is a Banker and has a "big business" in the community and that "being alive is furl." He also revealed he enjoys learning and teaching. He has confidence in his attorney and described him as "compete Epstein denied any mental health history or history of suicidality. He also reported none of his family membe health histories. Inmate Epstein stated he is a mathematician and took post graduate classes in this area of Epstein stated he has a support system in the community, including friends and other associates. Finally, in demonstrated a good sense of humor and did not appear dysphoric, agitated or anxious. No acute psychopa Overall, inmate Epstein has numerous protective factors at this time that outweigh his risk factors for suicidal positive outlook regarding his legal case, demonstrates no psychiatric symptoms, has no psychiatric or suie verbalized a desire to be alive at this time and future orientation. DIAGNOSIS: No Diagnosis, No Dx - Current t." Inmate s have mental tudy. Inmate ate Epstein hology was noted. . He has a history, and Generated 07/10/201.9 09 20 by M.::er. Elissa PhD/C h.ef Bureau of Prisons - NYM Paget of 3 EFTA00056011 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: A&O Date: 07/09/2019 08:41 Provider: Miller, Elissa PhD/Chief Psychologist CONCLUSIONS The Overall Acute Suicide Risk for this Inmate is: Low Overall Chronic Suicide Risk for this Inmate is: Absent RECOMMENDATIONS, Inmate Epstein is currently on psychological observation pending suitable housing placement. In fight of his c charges and extensive media coverage on the television, he will need to be confined in a suitable housing unit wiN be seen daily while on psychological observation and will be seen for a psychological observation follow-u is released from observation. Inmate Epstein denied the need for psychological intervention, self-help materi He has been classified as a CCI-MH inmate at this time. CARE1-Mli is indicative of an inmate who shows rx of functional impairment associated with a mental illness and demonstrates no need for regular mental health Suicide Watch: A suicide watch is not warranted at this time Completed by Miller, Elissa PhD/Chief Psychologist on 07/10/2019 09:20 rrent sex offense . Inmate Epstein session once he Is, or follow-up. significant level ntervention. Generated 07/10/2019 09:20 by Miller. Elissa PhD/Chief Bureau of Pdsons - NYM Page 3 Of 3 EFTA00056012 Bureau of Prisons Psychology Services Diagnostic and Care Level Formulation **SENSITIVE BUT UNCLASSIFIED** Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/09/2019 10:13 Provider: Miller, Elissa PhD/Chief Reg #: 76318-054 Unit Team: A&O Relevant Historical Information Inmate Epstein is a 66-year-old Caucasian male, currently incarcerated on sex trafficking charges. He denied any history of mental health treatment, either on an inpatient or outpatient basis. Inmate Epstein denied any treatment in the past or present with psychotropic medication. He also denied any acute mental health symptoms at this time. Inmate Epstein denied any past or present suicidal ideation, intention or plan. He denied ever engaging in any suicide attempts or self-injurious behavior in thpast. Inmate Epstein denied any alcohol or substance abuse. He said it is well-known that he does not even drink presenting Problem/Sym Inmate Epstein was seen sk assessment today for precautionary reasons. He did not mark any mental health items or symptoms on h' ology Questionnaire (PSIQ) when he entered the institution. Nonetheless, Inmate Epstein has various risk factors including a high profile case with media attention, sex offense/trafficking charges, pre-trial status, and he had proceeding yesterday which could have given him bad news regarding his legal situation. Inmate Epstein return om court er duty hours yesterday evening and staff notified the on-call psychologist. Inmate Epstein was placed on ionary psychological observation status until psychology could interview him this morning to conduct a fo e risk assessment to determine whether he is currently at-risk for suicidality. Diagnostic Formulation Inmate Epstein has no history of mental health proble s not exhibit suicidality at this time. He has never received inpatient or outpatient mental health treatment any history of suicidality. Currently, he does not exhibit any acute psychopathology, is currently psychologi I nd is in no psychological distress. As such, he is being classified as a CC1-MH inmate at this time. CARE1-M s e of an inmate who either has no identifiable mental illness (Axis I "No Diagnosis") or is mildly ill and requires nl jvention on an as-needed basis. Care Level Formulation CARE1-MH is indicative of an inmate who shows no significant level of illness and demonstrates no need for regular mental health intervention. Diagnosis: No Diagnosis, No Dx - Current Completed by Miller, Elissa PhD/Chief Psychologist on 07/09/2019 10:32 airment associated with a mental Generated 0710912019 10:32 by Miller. Elissa PhD/Chief Bureau of Prisons - NYM Page 1 of 1 EFTA00056013 Bureau of Prisons Health Services See Amendment Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/09/201910:13 Facility: NYM Amendment made to this note by Miller, Eases PhD/Chief Psychologist on 07109/201910:40. Nureau of Prisons - NYM EFTA00056014 Bureau of Prisons Psychology Services Diagnostic and Care Level Formulation "SENSITIVE BUT UNCLASSIFIED** Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team. A&O Date: 07/09/2019 10:13 Provider. Miller, Elissa PhD/Chicf Relevant Historical Information Inmate Epstein is a 66-year-old Caucasian male, currently incarcerated on sex trafficking charges. He denied any history of mental health treatment, either on an inpatient or outpatient basis. Inmate Epstein denied any treatment in the past or present with psychotropic medication. He also denied any acute mental health symptoms at this time. Inmate Epstein denied any past or present suicidal ideation, intention or plan. He denied ever engaging in any suicide attempts or self-injurous behavior in the past. Inmate Epstein denied any alcohol or substance abuse. He said it is well-known that he does not ever drink a'cohol. Presenting Problem/Symptom Inmate Epstein was seen by this writer for suicide risk assessment today, 7/9/19 at 7:30 a.m. for precautionary reasons. He returned from court yesterday evening. He did not mark any mental health items or symptoms on his Psychology Questionnaire (PSIQ) when he entered the institution. Nonetheless, Inmate Epstein has various risk factors for suicidality including a high profile case with media attention, sex offense/trafficking charges, pre-trial status, Ind he had a court proceeding yesterday which could have given him bad news regarding his legal situation. Inmate Epstein returned from court after duty hours yesterday evening and staff notified the on-call psychologist. Inmate Epsitein was placed on a precautionary psychological observation status until psychology could interview him this morning to conduct a formal suicide risk assessment in order to determine whether he is currently at-risk for suicidality. Plagnostic Formulation Inmate Epstein has no history of !rental health problems and does not exhibit suicidally at this time. He has never received ir.patient or oJtpatiert7rental health treatment and dented any history of suicidality. Currently, he d es not exhibit any acute psychopathology, is currently psychologically stable and is in no psychological distress. such, he is being classified as a CC1-MH inmate at this time. CARE1-MH is indicative of an inmate who either has noidentifiable mental illness (Axis I "No Diagnosis") or is mildly ill and requires clinical intervention on an as-needed basis. Care Level Formulation CAREI-MH is indicative of an inmate who shows no significant level of functional impairment associated wit a mental illness and demonstrates no need for regular mental health intervention. Diagnosis: No Diagnosis, No Dx - Current Completed by Miller, Elissa PhD/Chief Psychologist on 07/09/2019 10:40 Generated 07(09/2019 10:40 by Miler. Elissa PhD/Chief threau of Prisons - NYM Pagel Of I EFTA00056015 Bureau of Prisons Psychology Services Clinical Intervention - Clinical Contact "SENSITIVE BUT UNCLASSIFIED** Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM link Team MO Dale: 07/10/2019 08:38 Provider: Miller, Elissa PhD/Chief focus of Session Inmate Epstein was seen today for a psychological observation contact in the hospital area by this writer. SUbJeatin=ittikelresentatIon Inmate Epstein appeared well and it was noted in his log hook and eating/sleeping chart that he has been e ling his meals, sleeping, interacting with the inmate companions, and pacing in his cell. Today, he presented this 'ter with numerous concerns and requests. He stated he does not want to be housed in the SHU because he is not mfortable there; he wants to be single-ceNed if he goes to the SHU; he wants Colace, not the Ducolex he received fro medical yesterday; he wants to be able to walk around and go to recreation; he does not want to wear an orange un cx-m to his legal visits because he is treated "like a punished inmate;" he wants a phone call before he leaves the psy 'cat observation area; he wants a shower and towel; he would like to be housed in the cadre (5S) unit; and would like his property, paper, and a pen. Inmate Epstein's concerns were addressed by this writer and it was explained to him he will not be single lied or placed in a housing unit for safety and security concerns. His medical concerns (constipation) were discus ed with health services as well as his desire to be placed on Colace. Inmate Epstein was provided a shower this ming. interventIonlet. Inmate Epstein was provided with supportive Intervention and coping skills strategies today. He was rece ive to interventions and was able to elucidate his various needs. He did not present with any acute psychopat gy and continues to deny any suicidal ideation, intention, or plan. He is looking forward to his bail hearing on Mon ay but stated he is aware that even if he gets bail, it will take at least two weeks to sort things out so he can leave the jail. 21991211O811 Inmate Epstein is not in any psychological distress, does not present with any mental health symptoms or mplaints, and is denying any suicidality. He appears psychologically stable at this time and can be released from th psychological observation area. Inmate Epstein wiN be housed in the 9S area with a cellmate. He will be seen again tomorrow by psychology to evaluate his mental status and psychological stability. Completed by Miler, Elissa PhD/Chief Psychologist on 07/10/2019 09:09 Generated 07/102019 09:09 by Miller, Mao PhOfCAecf Bureau of Prisons • NYM Page i of 1 EFTA00056016 Bureau of Prisons Psychology Services General Administrative Note "SENSITIVE BUT NCLASSIFIED" Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unk Team: A&O Date: 07/11/2019 14:28 Provider: Imeri, Darlene PsyD Qommenfs This writer attempted to see Mr. Epstein in the morning and then again in the afternoon for a Psych Obseni lion Follow Up, but he was in Attorney Conference. Completed by Imer, Darlene PsyD on 07/11/201915:51 Generated 07/11/2019 15.51 by Imor. Dadono osyD Bureau of Prisons - NYM Pig01 of 1 EFTA00056017 Bureau of Prisons Psychology Services Clinical Intervention - Clinical Contact "SENSITIVE BUT UNCLASSIFIED" Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date o! Birth: 01/2C/1953 Sex: M Facility: NYM Unit Team: MO Date: 07/11/2019 15:21 Provider: Miller, Elissa PhD/Chief focus of Session Inmate Epstein was seen for his psychological observation follow-up in attorney conference this aftemcon. Subjective/Objective Presentation Inmate Epstein reported he has been consulting with his attorney most of the day. He elucidated concerns bout his incarceration including not receiving his property yet in SHU, feeling cold in his cell, not receiving his Cola not having enough water in attorney conference, and a desire to recreate in SHU." Inmate Epstein was a:so upset a ut wearing an orange jumpsuit and being treated like "a bad guy' when he did not do anything wrong in the prison. C stody and security concerns were addressed with inmate Epstein including why he has to wear his orange jumpsuit ( ue to his being housed in SHU). He requested that he be placed in a brown uniform during his legal visits. He was Id his concerns would be addressed in the SHU meeting. Inmate Epstein stated he is not having any current problems with his cellmate and indicated he at bran cereal for breakfast and took a shower yesterday. He did not sleep well last night. Inmate Epstein continues to deny ny suicidal ideation, intention cr plan. He did not appear to be in any distress at this time. interventlonfs) Inmate EPSTEIN was provided with brief supportive interventions, CBT-based interventions, and psychoeducation regarding additional coping strategies. Inmate EPSTEIN was receptive to these interventions. ProgressfPIan Inmate EPSTEIN was educated about both routine and emergency procedures for contacting Psychology taff. He was reminded of the self-help books and audiotapes available through the Psychology department. He will be n next week after his bail hearing to assess his mental status and psychological stability. Completed by Miller, Elissa PhD/Chief Psychoogist on 07/12/2019 07:51 Generated 07/12/2019 07:51 by Miller, Eussa PhD/Ctdef Btl roa u of Prisons - NYM J Page 1 of 1 EFTA00056018 Bureau of Prisons Psychology Services Clinical Intervention - Clinical Contact "SENSITIVE BUT UNCLASSIFIED" Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/16/2019 12:46 Provider: Miller, Elissa PhDlChief Reg 76318-054 Unit Team: I A&O Focus of Session Inmate Epstein called for this writer in attorney conference today. The officer in attorney conference notified this writer that he was asking to be seen. 511b.le.011YegattakeiMantaillII Inmate Epstein reported he has not received a spoon or soap in SHU, nor did he receive the phone calls that were "promised to him." He told this writer we need to have mutual trust that his needs are met in the prison. This writer told inmate Epstein that she would address his concerns. On the way out, a staff member told this writer she witnessed inmate Epstein receive two phone calls from the Lt. Nonetheless, this writer informed the SHU lieutenant of his concerns and he said he would ensure that he had soap, a spoon, and his initial SHU phone call. Inmate Epstein did not have any psychological concerns today. He denied any mental health symptoms or suicidality. He has been eating as best as he can and has requested a Kosher diet. Interventionisi Inmate EPSTEIN was provided with brief supportive and psychoeducation regarding additional coping strategies. Inmate EPSTEIN was receptive to these interventions. He continued with his legal visit. progress/Plact Inmate EPSTEIN was educated about both routine and emergency procedures for contacting Psychology staff. He was reminded of the self-help books and audiotapes available through the Psychology department. There appears to be no need for follow up at this time. He will be seen in SHU for rounds and monthly SHU reviews. Completed by Miller, Elissa PhD/Chief Psychologist on 07/18/2019 13:05 Generated 07118/2013 13-.05 by Miter, Elissa PhOf(Thief Bureau of Miens - NYM Page 1 of 1 EFTA00056019 Bureau of Prisons Psychology Services SHU Review "SENSITIVE BUT UNCLASSIFIED•• Inmate Name: Date of Birth: Date: EPSTEIN, JEFFREY EDWARD 01/20/1953 Sex: M Facility NYM 07/18/2019 07:21 Provider: Miller, Elissa PhD/Chief Reg #: 763 Unit Team: 8-054 A&O Placed In SHU: Status: Basis of Review: Mental Status: 07/10/2019 ADMIN DETENTION Inmate was interviewed No significant mental health issues. Type: Threat to Self: Adjustment: Threat to Others: SHU Low Satisfactory, segregation not detrimental Low comments Monthly SHU Review Note Inmate Epstein was meeting with his legal team today and has a court hearing. He was not able to be seen f a SHU review. Another attempt to interview him for a SHU review will be done in the near future. Completed by Miller, Eissa PhD/Chief Psychologist on 07/18/2019 12:C6 Generated 07/18/2019 12.C5 by Md!cr. Elissa PhD/Chief Bureau of Prisons - NYM Page 1 of I EFTA00056020 Bureau of Prisons Psychology Services General Administrative Note "SENSITIVE BUT UNCLASSIFIED" Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318.054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/23/2019 07:56 Provider: Miller, Elissa PhD/Chief comments This On-Call Psychologist was contacted by the Operations Lt. at about 2 AM on 7/23/19 to inform Mr. Epsl= n was being placed on Suicide Watch because he was found with a string loosely hanging around his neck. Mr. Ep ein will be seen today by the duty psychologist for a Suicide Risk Assessment. Completed by Miller, Elissa PhD/Chief Psychologist on 07/24/2019 07:59 Generated 0724201907:59 by Miller, Elissa PhD/Chief Bureau of Prisons NYM Page 1 of 1 EFTA00056021 Bureau of Prisons Psychology Services Suicide Risk Assessment - SENSITIVE BUT UNCLASSIFIED** Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/23/2019 10:09 Provider: Imeri, Darlene PsyD Reg #: 76318-054 Unit Team: 5 Type of Housing: SHU- Administrative Segregation Cell Accommodation: Double-Cell FINDINGS This assessment and the resulting recommendations are based on the following sources of information: Clinical Interview, Medical Record, Psychology Data System, Sentry Fteason for Referral The On Call Psychologist, Dr. Miller, had been contacted by the Operations Lt. at about 2 AM on 7/23/19 to inform her that Mr. Epstein was being placed on Suicide Watch because he was found with a string around his neck. Mr. Epstein was seen by this writer for a Suicide Risk Assessment at about 9:10 AM cn 7/23/19. This note is being entered at about 3:35 PM on 7/23/19. Mental Health History According to a Suicide Risk Assessment dated 7/09/19 by Dr. Miller, "Inmate Epstein denied any history of erital health treatment, either on an inpatient or outpatient basis. Inmate Epstein denied any treatment in the past or present with psychotropic medication. He also denied any acute mental health symptoms at this time." Self-Harm H isturA According to a Suicide Risk Assessment dated 7/09/19 by Dr. Miller, "Inmate Epstein denied any past or p4sent suicidal ideation, intention or plan. He denied ever engaging in any suicide attempts or self-injurious behavior in the past." Substance Abuse History According to a Suicide Risk Assessment dated 7/09/19 by Dr. Miller, "Inmate Epstein denied any alcohol or Isubstance abuse. He said it is well-known that he does not even drink alcohol." Current Problem Earlier this morning Mr. Epstein was found by SHU staff in his cell with a string loosely tied around his neck, It is unclear at this time if Mr. Epstein had placed the string around his own neck. i When Mr. Epstein was asked by this writer how he ended up on Suicide Watch, he denied remembering. e stated he got a drink of water last night in his cell and went back to bed. He said the next thing he remembered is hearing himself snore. He said he wants to know why he is on Suicide Watch. He was informed that staff stated he was found in his cell with a string on his neck. According to Medical records, he had been seen by Medical for this and had I rule out of self inflicted injuries. Wnen this writer reviewed the Start Suicide Watch Log, it noted that Mr. Epstein told the staff watching him that his cellmate tried to kill him, which Mr. Epstein did not tell this writer when this writer had interviewed Mr. Epstein. This writer was net ab e to ask Mr. Epstein about this, since Mr. Epstein was now in Legal. The Captain was notified about this notation and the Captain stated they were already aware of this statement. Current Mental Status Level of Consciousness: Alert and Oriented Psychomotor Activity: Normal General Appearance: Normal Behavior: Cooperative Mood: Appropriate to Content Generated 07/23/2019 15:38 by Imen. Darlene PsyD Bureau of Prisons - Nvfil I Page 1 of 3 EFTA00056022 inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/23/2019 10:09 Provider: linen, Darlene PsyD Thought Process: Goal Directed Thought Content: Normal Current Mental Status: He exhibited a neutral mood with a full range of affect. His speech was logical and co loosening of associations or tangential, circumstantial or irrelevant speech. Auditory and visual hallucinations and delusions were not elicited. He did not engage in any bizarre or inappropriate behavior. He denied curre harm ideation and he agreed to immediately tell staff if he starts to have suicidal or self harm thoughts. He oriented. He does not appear to be an immediate danger to self. He denied thoughts of hurting others and he staff if he has these thoughts. RISK AND PROTECTIVE FACTORS ASSESSED- This writer screened the inmate for a variety of empirically validated factors commonly associated with risk for suicide. The following STATIC risk factors were assessed to be present and increase the inmate's risk for engaging in behaviors: High Profile Crime, Lack of family connections, Sex offender status The following DYNAMIC risk factors were assessed to be present and increase the inmate's risk for engaging i behaviors: Current physical pain The following PROTECTIVE factors were assessed to be present and may decrease the inmate's risk of su reasons to live, Adequate problem solving skills, Denial of suicidal ideation/intention/plans, Future orientation. negative, ViAllingness to engage in treatment Risk Factors: He was found by staff in his cell in Shill with a string loosely tied around his neck, which Mr. Epa not remember anything about. It is unclear at this time if Mr. Epstein had placed the string around his own rte else did. According to Medical, he had a circular line around the base of his neck, which he denied knowing ho He stated his throat hurts which was reported to Medical. He has a high profile sex offense case and recently When asked if he has any friends or family that are emotionally supportive, he stated he does not know what th emotional supports were explained to him and then again asked If he as any family or friends that are emotion was vague and said he has a lot of people. Reg #: 76318-054 Unit Team: 5 Protective Factors: He denied current suicidal or self harm thoughts or ever having these thoughts. He denied harm and suicide attempts. He denied a family history of suicidal and self harm attempts. He denied having an medical conditions. He denied feeling hopeless. He denied a history of childhood abuse. He denied fearing for denied feeling like a burden to anyone. He reported he is sleeping adequately. He stated he lives to have fun. to learn. He said his future plans include fighting his case and going back to his normal life. rent, with no re denied, t suicidal or self s future reed to tell f-harm and icide related suicide related Able to identify iew of death as eln stated he did or if someone he obtained. s denied bail. t means. When Ey supportive, he a history of self y chronic his safety. He o enjoy life, and Whereas, he is denying suicidal and self harm thoughts and has a lot of protective factors, he is denying that he remembers how he ended up on Suicide Watch and has marks encircling his neck. It is unclear at this time if he had placed the string around his neck or if someone else did. He wiN remain on Suicide Watch for further observation and safekeeping. DIAGNOSIS• No Diagnosis, No Dx - Current CONCLUSIONS The Overall Acute Suicide Risk for this Inmate is: Moderate Overall Chronic Suicide Risk for this Inmate Is: Absent ftCOMMENOATIONS 1. Mr. Epstein will remain on Suicide Watch for further observation and safekeeping. 2. While on Suicide Watch, he will be continuously observed by Inmate Companions. 3. While on Suicide Watch, he wilt be seen daily by Psychology. 4. Supportive and educative interventions were provided. 5. Medical was informed that he reported his throat hurts. Suicide Watch: A suicide watch was initiated by non-clinical staff and continues to be warranted Suicide Watch was initiated on: 07/23/2019 01:40 Generated 07123/2019 15:38 by Imerl, Darlene PsyO Bureau of Poisons • NYM Page 2 of 3 EFTA00056023 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Fadlity: NYM Date: 07/23/2019 10:09 Provider: Imeri, Darlene PsyD Reg #: 76318-054 Unit Team: 5 Completed by Imeri, Darlene PsyD on 07/23/2019 15:38 Generated 071!3201916:36 by lewd. Darlene PsyD Bureau SPrhons - NYM Pap 3 of 3 EFTA00056024 Bureau of Prisons Psychology Services Post Suicide Watch Report **SENSITIVE BUT UNCLASSIFIED— Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex. M Facility: NYM Unit Team: 5 Date. 0712412019 09:23 Provider: DiMisa, Samantha Ph.D. Watch Start Date: 07/23/2019 01:40 Watch Stop Date: 07/24/2019 08:45 Total Time on Watch: 31 hrs 5 minutes Watch Conducted By: Both inmates and staff Transfered to Medical Center. No Current Mental Status Level of Consciousness: Alert and Oriented Psychomotor Activity: Normal General Appearance: Normal Behavior. Cooperative Mcod: Appropriate to Content Thought Process: Goal Directed Thought Content. Normal Current Mental Status: Mr. EPSTEIN was alert and oriented. He was polite, calm, and cooperative in demeanor. He exhibited a neutral affect with appropriate range. Eye contact and hygiene were appropriate. The inmate spoke with normal rate. tone, and volume. His thoughts were organized and coherent, with no loosening of associations or tangential, circumstantial, or irrelevant content. There was no evidence of perceptual disturbance, delusional ideation, or a formal thought disorder. He did not engage in any bizarre cr inappropriate behavior. He noted having normal sleeping and eating habits. Mr. EPSTEIN explicitly denied recent and current suicidal ideation, planning, and intent. He was future-oriented and expressed a commitment to life and safety, agreeing to contact staff immediately should he experience suicidal ideation or psychological distress. He also denied thoughts of harming others. Risk Factors ASSOSSCd' This writer screened the inmate for a variety of empirical' y validated factors commonly associated with risk for selr harm. The following STATIC risk factors were assessed to be present and increase the inmate's risk for engaging in su tide related behaviors. High Profile Crime, Lack of family connections, Sex offender status The following DYNAMIC risk factors were assessed to be present and increase the inmate's risk for engaging In Suicide related behaviors. Current physical pain, Fear for own safety The following PROTECTIVE factors were assessed to be present and may decrease the inmate's risk of suicide: ble to identi5,, reasons to live, Adequate problem solving skills, Denial of suicidal ideation/intention/plans, Future orientation, View of death as negative, Willingness to engage in treatment Risk Factors: Mr. EPSTEIN has a significant scar around his neck, which is now scabbing over. He reported swelling in this area but denied experiencing any related pain. Mr. EPSTEIN continues to claim a lack of memory for the incident resulting in this scar. The story he provided was vague, such that this writer challenged him a couple of times, but he insisted he was being honest about his lapse in memory. The nature of the incident remain unclear. Mr. EPSTEIN is incarcerated for a very high prole crime with media attention. He was recently denied bail. He also reported difficulty managing his time in the SHU. He repo ed being fearful for his safety if he is to return to the cell with his previous cell mate. Protective Factors: Mr. EPSTEIN adamantly denied current suicidal ideation or intent or a history of suicide attenipts. He stated, "I have no interest in killing myself." He explained, although his situation is "not perfect" due to his being incarcerated, he noted he has 'lots to do for [his] legal case." He described having a "wonderful life," to include interactions with "interesting people and projects." He said "it would be crazy" to take his life. He furthered, "I would not do that to myself? He denied feelings of hopelessness, although did report being "depressed" and "unhappy" about his current legal situation. He previously denied a history of childhood abuse. He reported he is sleeping adequately now that he is no longer in the SHU. He appear future-oriented as he endorsed an interest in being housed in general population. Weighing of Risk and Protective Factors: Mr. EPSTEIN adamantly denied sucidality. However, in light of his vague self-reoort regarcing the incident which precipitated his placement on Suicide Watch, combined with his fear for his own safety, reported Generated 07O4/2019 12 09 by °Nish, Samantha Pt.D. Bureau o Pnsons - NYM Pap 1 of 0 EFTA00056025 "sifaN .401 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 7631 Date of Birth: 01120/1953 Sex: M Facility: NYM Unit Team: Date: 07/24/2019 09:23 Provider: DiMisa, Samantha Ph.D. difficulty managing his time in the SHU, and the high profile nature of his alleged offense, Mr. EPSTEIN will be stepped down from Suicide Watch to Psychological Observation. -054 5 Changes in Risk Factors Asserted Upon a review of the log book, it was indicated Mr. EPSTEIN has been speaking to the inmate companions about having previously taught mathematics and physics. He has been observed pacing the cell as well as steeping, eating, and drinking within normal limits. Upon interview today, Mc EPSTEIN requested he be provided a toothbrush as well as a shower His requests were made known to the lieutenants and he was provided a shower prior to attending his legal visit. This writer also provided him a toothbrush, toothpaste, and hygiene products. Asked about the alleged incident which transpired yesterday resulting in his placement on Suicide Watch, M. EPSTEIN said he is frustrated he has been placed in a "punishment cell for no reason." Specifically, Mr. EPSTEIN wa referring to his placement in the SHU. Asked to recall the events surrounding the alleged incident, Mr. EPSTEIN ' his cell mate was "playing with a bed sheet" and he claimed he does not recall the events thereafter. He said her led eating meat and drinking water and claimed the next event for which he has memory is his hearing himself snore e d waking up on a stretcher. Mr. EPSTEIN claimed he does not recall himself or his cell mate tying a string or rope around his neck. He ald he has 'been trying to remember" and "wracking his mind." Asked if he experienced any interpersonal issues with is cell mate, Mr. EPSTEIN described his cell mate as "agitated" and claimed his cell mate called him a "pedophile" for the first time yesterday. His cell mate was also reportedly reading a newspaper article about Mr. EPSTEIN, which bothered him and it was something he believed to be "strange" for their to be an article about him in his cell. Mr. EPSTEIN recalled throwing away the newspaper photograph of himself by crumpling it and flushing it down the