EFTA00137978.pdf

M-19-019432 JEFFREY EDWARD EPSTEIN Page 5 similar, % x W, faint, red contusion. Internally, there is a deep muscle hemorrhage of the left deltoid muscle. INTERNAL EXAMINATION: HEAD: The scalp is without contusion or laceration. The skull is without fracture. There is no epidural, subdural or subarachnoid hemorrhage. The brain weighs 1520 gm. The brain, spinal cord, and dura mater are submitted for neuropathologic evaluation. NECK: See "Injuries." BODY HABITUS: The abdominal pannus is 1-1/4" thick. The body mass index is 27. BODY CAVITIES: The pleural and pericardial cavities are free of abnormal fluid accumulations or adhesions. See also "Therapeutic Procedures." CARDIOVASCULAR SYSTEM: The heart weighs 440 gm and has a normal distribution of right dominant coronary arteries with slight atherosclerosis (left main and left circumflex arteries, no stenoses; left anterior descending artery, multiple, focal, less than 50% stenoses; right coronary artery, multiple, focal, less than 50 to 60% stenoses). The myocardium is brown and diffusely fibrous. There is no focal fibrosis, hemorrhage, or pallor. The free wall of the left ventricle and the interventricular septum are each 1.9 cm thick, and the free wall of the right ventricle is 0.5 cm thick. The four valves and endocardial surfaces are unremarkable. The pulmonary vessels and the venae cavae are free of thrombus and embolus. The aorta has moderate atherosclerosis. RESPIRATORY SYSTEM: The right lung weighs 560 gm and the left weighs 510 gm. Both lungs have spongy, maroon and pink parenchyma that is free of masses. The distribution of bronchi and vasculature are unremarkable. The bronchi are empty. LIVER, GALLBLADDER, PANCREAS: The liver weighs 2480 gm and has soft, brown parenchyma. The gallbladder is unremarkable and contains approximately 30 ml of brown bile without stones. The pancreas is tan, lobular, and free of hemorrhage and mineralization. HEMIC AND LYMPHATIC SYSTEMS: The spleen weighs 270 gm and has an intact, purple capsule and an unremarkable distribution of red and white pulp. There are multiple, enlarged, cervical lymph nodes, measuring up to 1.5 cm in greatest dimension. The remainder of the lymph nodes is unremarkable. There is no thymus. The bone marrow is unremarkable. GENITOURINARY SYSTEM: The right kidney weighs 180 gm and the left weighs 160 gm. Both kidneys have granular, brown surfaces and otherwise unremarkable architecture and vasculature. The ureters maintain uniform caliber into an unremarkable SONY 000 EFTA00137978 M-19-019432 JEFFREY EDWARD EPSTEIN Page 6 bladder that contains approximately 5 ml of cloudy, yellow urine. The prostate is slightly and diffusely enlarged, with marked enlargement of the verumontanum. The testes are unremarkable. ENDOCRINE SYSTEM: The pituitary, thyroid, and adrenal glands are unremarkable. DIGESTIVE SYSTEM: The esophagus and gastroesophageal junction are unremarkable. The stomach contains approximately 5 ml of opaque, brown fluid without recognizable food or pills. The gastric mucosa is unremarkable. The small intestine and large intestines and rectum are unremarkable. The vermiform appendix is surgically absent. MUSCULOSKELETAL SYSTEM: See "Therapeutic Procedures." On the anterior, inner surface of the right, first rib is a slightly displaced, healed, fracture callus. The vertebrae, clavicles, remainder of ribs, and pelvis are without fracture. The musculature is well developed and normally distributed. MICROSCOPIC DESCRIPTIONS: Tissue or Organ x # of fragments and/or levels (#= slide ID number) Histology # HT19-003396 HEART x 2 (#2): Myocardial and perivascular fibrosis. Slightly hypertrophied myocytes. LUNG x 5 (#3,4): Slight patchy emphysema. LIVER x 1 (#1): Steatosis involving approximately 50% of hepatic parenchyma. Slight periportal fibrosis. Marked congestion. KIDNEY x 1 (#1): Arteriolar sclerosis. Congestion. TESTES x 2 (#5,6): No pathologic abnormality. TONGUE x 1 (#7): Intramuscular and fascial hemorrhages consisting of intact erythrocytes. MUSCLE ADJACENT TO HYOID BONE x 1 (#8): Intramuscular and fascial hemorrhages consisting of intact erythrocytes. LEFT POSTERIOR NECK MUSCLE x 1 #9 • Intramuscular and fascial hemorrhages consisting of intact erythrocytes. SONY 00014091 EFTA00137979 M-19-019432 JEFFREY EDWARD EPSTEIN Page 7 LEFT DELTOID MUSCLE x 1 (#10): Intramuscular and fascial hemorrhages consisting of intact erythrocytes. TOXICOLOGY: Specimens are submitted for toxicologic analysis. A separate report will be issued. FORENSIC BIOLOGY: Blood spot card, clippings from right and left fingernails, and swabs of the back and front of neck and right and left hands are submitted. NEUROPATHOLOGY: A separate report will be issued. ANTHROPOLOGY: A separate report will be issued. EVIDENCE: Received separately are a ligature and clothing. The items are examined, photographed, and submitted to Evidence. See also "Additional Autopsy Notes". RADIOGRAPHY: Post-mortem radiographs are taken. PHOTOGRAPHY: Autopsy photos are taken. This report is reviewed by Dr. Jason K. Graham, First Deputy Chief Medical Examiner. The information provide ' and correct to the best of my knowledge and belief Electronically signed by on Aug 27, 2019 07:38:00 AM SDNY 000'4092 EFTA00137980  FORENSIC TOXICOLOGY LABORATORY THE CITY OF NEW YORK OFFICE OF CHIEF MEDICAL EXAMINER 520 FIRST AVE NEW YORK NY 10016 Decedent Name : Jeffrey Edward Epstein Laboratory No : FT19-03508 Medical Examiner: IME Casa No: M-19-019432 Examination Date: 8/11/2019 Specimen Type : Blood(Femoral): FT19-03508-001, Blood(Fetnoral): FT19-03508-002, Blood Femoral): F719-03508-003, Blood(Hoart): F719-03508-004, Blood(Heart): FT19-03508-005, Biood(Heart): F719-03508-0OB, Bile: F719-03508-007, Urine: F719-03508-008, Gastric Contents: FT19-03508-009, Brain: F1-19-03508-010, Liver: FT19-03508.011, Vitreous: F719-03508-012 Received By : I Date Received : 08/12/2019 Results Blood(Fainoral) : F719-03508-001 Ethanol Not Detected HSGC Benzoyiecg onino, barbiturates, oxycodone, opiates, amphetamines, Not Detected IA benzodiazepines, methadone, cannabinoids, fentany( Gabapen tin, pregabalin Not Detected LC- TOF/MS Basic Drugs Not Detected GC/MS Blood(Femoral) : F119-03508-002 Synthetic cannabinoids Pending Report NMS Vitreous : F1-19-03508-012 Ethanol Not Detected HSGC THS Report Ms topftsoclatod FoatosteTomfotow came* Cones STOX_MsfoSoano.nycgor / you non Gumbos rata Dornilona of pxme used roporl con be looted at Cs option/ Ms moot MiNfowalnyc.brovistlelocralobnicoblotobgtioct nical-rnetuttpopo Signed : ogAr7 Dr. Gail Cgd6er BSc (Nona) M s PhD CChem RSC FHEA Director of Forens Toxicology Date: 8/142019 Page 1 of 1 SDNY_00014093 Page 0(s-F. EFTA00137981  NMS Labs CONFIDENTIAL NMS LABS 200 Welsh Road, Horsham, PA 19044-2208 Phone: (215) 6574900 Fax (215) 657-2972 ornagnmstabs.com Robert A. likldieberg, PhD, Fair; DABCC-TC, Laboratory lIrecior Toxicology Report Patient Name FT19-03508 M19-019432 Patient ID NP Report issued 08/22/2019 17:09 Chain 19244749 Age Not Given DOB Not Given Gender Not Given To: 10074 New York Office of Chief Medical Examiner Workorder 19244749 Attn: Department of Toxicology 520 First Avenue New York, NY 10016 Pago 1 of 2 Positive Findings: None Detected See Detailed Findings section for additional information Testing Requested: Analysis Code Description 95808 Synthetic Cannabinoids Screen (2019 Scope), Blood Specimens Received: ID Tube/Container Volume/ Collection Matrix Source Miscellaneous Mass DaterrIme Information 001 Gray Top Tube 4.25 mL Not Given Femora, Blood All sample volumes weights are approximations. Specimens received on 08/1472019. NMS v.18.0 SDNY_00014094 EFTA00137982  CONFIDENTIAL Workorder 19244749 NMS LABS Chain Patient ID 19244749 NP Page 2 of 2 Detailed Findings: Examination of the specimen(s) submitted did not reveal any positive findings of toxicological significance by procedures outlined In the accompanying Analysis Summary. Unless alternate arrangements are made by you, the remainder of the submitted specimens will be discarded one (1) year from the date of this report; and generated data will be discarded five (5) years from the date the analyses were performed. CERTIFICATION: Pursuant to New York Criminal Procedure Law Section 190.30(2), I certify that this report was made by me or is a true copy thereof for testing conducted at NMS Laboratories. I further certify that I am authorized by NMS Laboratories to make this certification. Workorder 19244749 was electronically signed on 08/22/2019 16:36 by: Sherri L. Kacinko, Ph.D., F-ABFT Forensic Toxicologist Analysis Summary and Reporting Limits: All of the following tests were performed for this case. For each test, the compounds listed were included in the scope. The Reporting Limit fisted for each compound represents the lowest concentration of the compound that will be reported as being positive. If the compound is Wad as None Detected, it is not present above the Reporting Limit. Please refer to the Positive Findings section of the report for those compounds that were identified as being present Acode 9560B - Synthetic Cernabinoids Screen (2019 Scope), Blood - Femoral Blood -Analysis by High Performance Liquld Chromatography/Tandem Mass Spectrometry CITFtAP (LC-MS/MS QTRAP) for Comnnmstd Rot Limit C.omoounil HOLUOlit 4-cyano-CUMYL-BINACA 0.10 ng/mL AMB-FUBINACA 1.0 ng/mL 4-fluoro-MOMB-BINACA 0.10 ng/mL CUMYL-THPINACA 0.10 ng/mL 5-fluoro-EDNIB-PINACA 0.10 ng/mL MDMB-CHMCZCA 0.10 ng/mL 5-fluoro-MOMB-PICA 0.10 ng/mL MDMB-CHMICA 0.10 ng/mL 5-fluoro-MDMB-PINACA 5-fluoro- 0.20 ng/mL MDMB-CHMINAC 0.10 ng/mL EMB-PINACA MOMB-FUBICA 0.10 ng/mL 5-fluoro-MMB-PINACA 0.050 ng/rra. MDMB-FUBINACA / EMB- 0.10 ng/mL 5-fluoro-NA-PIC 0.10 ng/mL FUBINACA 5-fluoro-QU-PINAC 0.10 ng/mL MMB-CHMICA 0.10 ng/mL ADAMANTYL-FUBINACA 0.20 ng/mL MMB-CHMINACA 0.20 ng/mL ADMB-CHMINACA 0.10 ng/mL MMB-FUBICA 10 ng/mL ADMB-FUBICA 1.0 ng/mL MMB-FUBINACA 0.10 ng/mL ADMB-FUBINACA 1.0 ng/mL NA-FUBIC 1.0 ng/mL AMB-CHMINACA 1.0 ng/mL NA-FUBIM 0.20 ng/mL NMS v.18.0 SDNY_00014095 Page 070 EFTA00137983  THE CITY OF NEW YORK OFFICE OF CHIEF MEDICAL EXAMINER NEUROPATHOLOGY REPORT CASE NUMBER: M-19-019432 NAME OF DECEDENT: EPSTEIN, JEFFREY EDWARD (AUTOPSY PERFORMED BY DR. ON 811112019) MACROSCOPIC EXAMINATION (PERFORMED BY DR. WITH DR. IN ATTENDANCE, ON 8/20/2019): The unfixed brain weighs 1520g (expected, 1200-15009). Examination of the fixed brain (minus the left occipital pole, removed at the time of autopsy for possible toxicology) shows normal leptomeninges. No contusions, stigmata of hemiation, or other surface abnormalities are seen. External brainstem landmarks and cranial nerves are normal. Vessels at the base are distributed normally, and have no atherosclerosis. The cerebellum is normal. Coronet sections of the cerebral hemispheres reveal normal cortical ribbon, white matter, and deep gray nuclei. There is no midline shift. Hippocampi are symmetrical and of normal volume. Ventricles are normal in size and appearance. Axial sections of the brainstem and cerebellum en bloc show the substantia nigra and locus ceruleus to be well-pigmented. The aqueduct and fourth ventricle are normal. Cerebellar cortex, white matter, and dentate are normal. Cranial dura from the convexities, tentorium, and base shows falcine ossification (comment common age-related finding). The venous sinuses and tributary (bridging) veins are patent. Spinal cord and dura from upper cervical to cauda equine levels show no abnormality, externally or on midsagittal section. PHOTOGRAPHS: YES MICROSCOPIC EXAMINATION: NO FINAL NEUROPATHOLOGIC DIAGNOSIS: I. NORMAL BRAIN AND SPINAL CORD fl Cr The information provided above is true and correct to the best of my knowledge and belief. Electronically signed by on Aug 20, 2019 05:41:27 PM SDNY_00014096 Page 0/ EFTA00137984  OFFICE OF CHIEF MEDICAL EXAMINER 520 First Avenue, New York, NY 10016 Barbara A. Sampson, MD-Ph.D., Chief Medical Examiner Department of Forensic Pathology Forensic Anthropology Unit M-19-19432 (212)447-2763 ANTHROPOLOGY [email protected] BACKGROUND: On 12 August 2019. the Forensic Anthropology Unit received a hyoid and larynx that were removed by Dr. during the autopsy of a 66-year-old male and submitted for a trauma analysis. The hyoid was cleaned in warm water and a combination of sodium bicarbonate and enzyme detergent. The larynx was placed in formalin and the soft tissues of the thyroid and cricoid were manually removed to facilitate examination. The specimens were examined radiographically. macroscopically and microscopically. Hyoid Thyroid Cricoid Figure I. Diagram of the submitted hyoid and larynx (anterior view) showing the approximate fracture locations (red lines). FINDINGS: Hyoid The greater horns of the hyoid arc bilaterally fused to the hyoid body. There is a fracture of the left greater horn (Figures I and 2). The Forensic Anthropology Unit is accredited in Forensic Inspection under ISO/IEC 17020 issued by ANSI National Accreditation Board. Refer to certificate and scope ofaccreditation FI-0014. SDNY_00014097 Page on EFTA00137985  M-I9-19432 Larynx The thyroid cartilage is almost entirely ossified and the cricoid cartilage is partially ossified. The thyroid exhibits two fractures: one to the left superior horn and one to the right superior horn (Figures I and 3). The fractures to both the left and right superior horns occur just superior to the junction with the lamina. The cricoid does not exhibit any fractures. Figure 3. Microscopic (10x) posterior views of fractures (white circles) to the left and right superior horns of the thyroid. SUMMARY: The hyoid bone exhibits a fracture of the left greater horn. The thyroid exhibits two fractures: one to the right superior horn and one to the left superior horn. Date: 2I August 2019 Forensic Anthropologist Page 2 of 2 SDNY_00014098 Page 01 EFTA00137986 =MRS'. WNW 11MI• ,O hi.imaS•••• . • m•• afl na a AS --- inaa 7 . Laaa OBSERVATION STARTED: PLEASE RETURN LOG TO PSYCHOLOGY AFTER THE OBSERVATION HAS ENDED. THANK YOU. Regular Clothes Safety Toothbrush Newspaper/Magazine Books (softcover only) Safety Pen and Paper Toilet Paper Legal Mail Other SW Blanket & SW Mattress must be used even on Psych Observations. If nothing is checked with a silver marker, only a Suicide Smock and Suicide Blanket are allowed. ra u 4 EFTA00137987 Name of inmate On Suicide Watch or Psych Observation: Registration #: -163)X-()5ti EATING/SHOWER CHART 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. ri Thank you. SDNy DUD 4 IL:. 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INANE YOU. gams ALLOWED: ' or' Regular Clothes — 7- 1\ / Safety Toothbrush _ 1.J Newspaper/Magazine 1, V_Bouks (softcover ID only)/it, Ll r Safety Pen and Paper / • C• of Toilet Paper .1 Legal Mail Other SW BianItet & SW Matttess must he used even on Psych Observations. If nothing is checked with a silver marker, only a Suicide Stnock and Suicide Blanket are allowed. EFTA00138000  79.a.--6-1-0:7 Name of inmate On Suicide Watch or Psych Observation: &.'... Registration ft: rq-6 7/ff —Ur-le EAT NG/SHOWER CHART DATE BREAKFAST LUNCH DINNER LIQUIDS OFFERED RECEIVED SHOWER SHOWER 1 . c)- I Z '7 v--- t7/a7 q fcli • '741̀111 1/ v, -7,/ciact V - • • ., .., ..••• — 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. 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