EFTA00122634.pdf

Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN. JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/31/2019 10:35 Provider: PsyD/DAPC Focus of Session Mr. EPSTEIN was seen today by this writer for a follow up appointment after he was removed from Psychological Observation yesterday. Subiective/Obiective Presentation Mr. EPSTEIN presented in a pleasant mood and reported he is generally doing well. He stated, "I could be better." but acknowledged he is doing as well as can be expected given his circumstances. He reported he is going to court today for a status hearing. He stated he generally slept well last night and is readjusting to being placed back in SHU. He reported getting along well with his cell mate. He was informed of appropriate procedures for contacting Psychology staff while he is in SHU, if needed. 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. He 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 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. Intervention(s) Supportive interventions and cognitive behavioral therapeutic techniques were utilized. Mr. EPSTEIN was receptive to all interventions. Rtqwessiaan Mr. EPSTEIN was educated about both routine and emergency procedures for contacting psychology. There appears to be no need for follow-up at this time and he expressed willingness to self refer to psychology staff if needed. He will continue to be seen during routine SHU rounds and SHU reviews while he is housed in SHU. He was encouraged to reach out for PRN services should he experience any psychological distress. Completed by PsyD/DAPC on 07/31/2019 10:56 Generated 07/31/2019 10:56 by PsyD/DAPC Bureau of Prisons - NYM Page 1 of 1 EFTA00122634  Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Institution Disciplinary Process Report Inmate Name: EPSTEIN. JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/30/2019 12:01 Provider: PsyD Reason for Referral and Identifying Information Inmate Epstein was referred by Unit Manager Proto for an evaluation of competency to proceed with the disciplinary process for actions resulting in an incident report. On 7/23/19, inmate Epstein was charged with code 228 (Tattooing or Self-Mutilation). These infractions were assigned incident report number 3282555. Background Information According to a Suicide Risk Assessment dated 7/09/19 by "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 time." According to a Suicide Risk Assessment dated 7/09/19 by "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 the past." According to this writer's Suicide Risk Assessment dated 7/23/19, "It is unclear at this time if he had placed the string around his neck or if someone else did." ClinicalInterview ansillent Mental Statustaro Inmate Epstein still does not remember how he obtained the marks around his neck. Current Mental Status: He exhibited a neutral mood with a full range of affect. His speech was logical and coherent, with no loosening of associations or tangential, circumstantial or irrelevant speech. Auditory and visual hallucinations were denied, and delusions were not elicited. He did not engage in any bizarre or inappropriate behavior. There was no indication of disturbed thought process or content. Intellectual ability appeared to be above average. Personal hygiene was adequate. He denied current suicidal or self harm ideation and he agreed to immediately tell staff if he starts to have suicidal or self harm thoughts. He was future oriented. He does not appear to be an immediate danger to self. He denied thoughts of hurting others and he agreed to tell staff if he has these thoughts. Clinical Impression According to his last Diagnostic and Care Level Formulation Note dated 7/09/19 by . "No Diagnosis, No Dx - Current." Findings The determination of whether an inmate is competent to proceed with the disciplinary process is based on a clinical assessment of the inmate's (1) ability to understand the nature of the proceedings, and (2) their ability to assist in their own defense. Depending on the outcome of the assessment, one of three findings can be made: (1) the inmate is COMPETENT to proceed with the disciplinary process: (2) the inmate is NOT PRESENTLY COMPETENT but could be restored to competence with treatment: or (3) the inmate is NOT COMPETENT and is unlikely to become competent. Recommendations Regarding Sanctions In the case of inmate Epstein, after a review of available psychological and psychiatric records as well as information pertaining to the offense conduct, it is determined that this inmate is: (X) COMPETENT to proceed with the disciplinary process. ( ) NOT PRESENTLY COMPETENT, but could become competent with treatment; it is recommended that the inmate for an updated competency assessment in 30 days. ( ) NOT COMPETENT and not likely to become competent. Generated 07/3012019 12:33 by PsyD Bureau of Prisons - NYM Page 1 of 2 EFTA00122635 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/30/2019 12:01 Provider: PsyD Completed by PsyD on 07/30/2019 12:33 Generated 07/30/2019 12:33 by PsyD Bureau of Prisons • NYM Page 2 of 2 EFTA00122636  Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services General Administrative Note Inmate Name: EPSTEIN. JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/30/2019 12:01 Provider: PsyD Comments Psych Observation Discontinuation Note: Please see "Clinical Contact" dated today. Completed by PsyD on 07/30/2019 12:33 Generated 07/3012019 12:33 by PsyD Bureau of Prisons - NYM Page 1 of 1 EFTA00122637  Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN. JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/30/2019 12:01 Provider: PsyD Focus of Session He was seen by writer while he was on Psych Observation. Subjective/Objective Presentation He stated he hasn't slept well at MCC-NY because he hasn't had his cpap machine. He stated it is here and he will be able to start using it tonight. He discussed how he does not think he will able to sleep in SHU and how he does not like SHU because of the noise. He discussed issues on not getting some medication with Medical today. The "Eating/Shower Chart" indicated yesterday he ate breakfast and dinner, drank liquids, and took a shower when offered and so far today it noted he ate breakfast and drank liquids. The Psych Observation Log noted he slept, drank water, went to legal, and talked to an Inmate Companion about investments. Current Mental Status: He exhibited a neutral mood with a full range of affect. His speech was logical and coherent, with no loosening of associations or tangential, circumstantial or irrelevant speech. Auditory and visual hallucinations were denied, and delusions were not elicited. He did not engage in any bizarre or inappropriate behavior. There was no indication of disturbed thought process or content. Intellectual ability appeared to be above average. Personal hygiene was adequate. He denied current suicidal or self harm ideation and he agreed to immediately tell staff if he starts to have suicidal or self harm thoughts. He was future oriented. He does not appear to be an immediate danger to self. He denied thoughts of hurting others and he agreed to tell staff if he has these thoughts. Intervention(s) Supportive and educative interventions were provided. When asked about the Turning Point handouts for coping in SHU, he stated he already knows these strategies before he read the handouts and had tried them when he was in SHU the last time. He stated with the noise in SHU, he said the strategies will not work. He was encouraged to try them. Progress/Plan The Chief Psychologist was consulted. Psych Observation will be discontinued. Mr. Epstein was educated about both routine and emergency procedures for contacting Psychology staff. He will be seen in follow up by Psychology tomorrow to monitor his mental status and to provide further intervention if needed and he was informed that he will be seen by Psychology tomorrow. In the meantime, he was encouraged to self-refer to Psychology if needed to which he agreed and seems capable of doing. If he remains in SHU, he will be seen by Psychology in SHU Rounds and in SHU Reviews. The SHU Lt. was informed that Mr. Epstein needs to be housed with an appropriate cellmate. Completed by PsyD on 07/30/2019 13:54 Generated 07/3012019 13:54 by PsyD Bureau of Prisons - NYM Page 1 of 1 EFTA00122638  Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN. JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/29/2019 10:01 Provider: PhD/Chief Focus of Session Inmate Epstein was seen while on psychological observation today in the hospital area. Subjective/Objective Presentation Same presentation today, but he said he thinks his memory for the incident (injury to his neck) may be impaired because of his sleep apnea. He is supposed to get his CPAP machine today. He is aware he will be returning to SHU, but said he is feeling unwell due to his inability to sleep and numbness in his arm. He requested to have one good night of sleep with his CPAP and will return to SHU with a cellmate tomorrow. He then asked if he could remain down here where it is "safe" for the entire week. I told him he can stay down one more night to receive his CPAP and a good night's sleep, but that he would be returned to SHU tomorrow. It was explained that there is no mental health issues precluding him from returning to SHU tomorrow and that we could not house him in the SW/Hospital area because he felt safe or more comfortable for him. It was explained to him that he would be placed in a safe situation in the SHU. According to his log book and eating/shower chart, he has been eating and drinking when not in his legal visits. He has also been writing and attending his legal visits. Intervention(s) Inmate EPSTEIN was provided with brief supportive interventions and psychoeducation regarding additional coping strategies. Inmate EPSTEIN was somewhat receptive to these interventions, but appears more concerned about getting his various needs in the prison (phone calls, recreation, housing placement concerns, etc.) Progress/Plan He will remain on psychological observation today and will transition to the SHU tomorrow. He will be seen by psychology daily to assess his mental status and psychological functioning. Completed by PhD/Chief Psychologist on 07/29/2019 10:26 Generated 07,2912019 10:26 by PhD/Chief Bureau of Prisons - NYM Page 1 of 1 EFTA00122639  Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN. JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/28/2019 08:33 Provider: PsyD Focus of Session He was seen by writer while he was on Psych Observation. Subjective/Objective Presentation The "Eating/Shower Chart" noted that yesterday he ate breakfast. He is not in the Psych Observation cell for about 12 hours per day because of being in Attorney Conference with his Attorneys, so the "Eating/Shower Chart" may not reflect all of his meals. He stated he was served one meal in Attorney Conference yesterday. He stated he drinks a lot water at night. The Psych Observation log noted he talked about life in general population and he slept. Earlier he had complained that his right arm was numb and hanging. Nurse from Medical had seen him for this. When this writer was interviewing him, he said his right arm still feels somewhat numb and he said he cannot make a fist with that hand. He also said he has numbness on his neck. This writer notified Nurse He stated last night when he flushed the toilet it kept flushing for 45 minutes. He stated he found it so aversive and upsetting that he said he sat in the corner and held his ears. He said because of this he was agitated for hours and was not able to sleep. The Lt. will be moving him to a different cell and he was informed of this. He stated the feeling he got with the noise of the toilet was similar to when he was in SHU. He said he may have something on the Autism spectrum. He said in the movie "Rain Man," the person with Autism had an aversion to noise. He stated he is also really good with numbers. Current Mental Status: He exhibited a mildly anxious mood with a full range of affect. His speech was logical and coherent, with no loosening of associations or tangential, circumstantial or irrelevant speech. Auditory and visual hallucinations were denied, and delusions were not elicited. He did not engage in any bizarre or inappropriate behavior. He denied current suicidal or self harm ideation and he agreed to immediately tell staff and Inmate Companions if he starts to have suicidal or self harm thoughts. He was future oriented. He does not appear to be an immediate danger to self. He denied thoughts of hurting others and he agreed to tell staff and Inmate Companions if he has these thoughts. Intervention(s) Supportive and educative interventions were again provided. He had not been given the Turning Point handouts yesterday that were on his cell door, so they were handed to him by staff today. Prowess/Pisa He will remain on Psych Observation in an abundance of caution and pending housing arrangements to be made on Monday. While on Psych Observation, he will be seen daily by Psychology. Completed by PsyD on 07/28/2019 09:24 Generated 07/2812019 09:24 by PsyD Bureau of Prisons - NYM Page 1 of 1 EFTA00122640  Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN. JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/27/2019 07:14 Provider: PsyD Focus of Session He was seen by writer while he was on Psych Observation. Subjective/Objective Presentation The "Eating/Shower Chart" indicated yesterday he ate dinner, drank liquids, and took a shower when offered. The Psych Observation Log noted he brushed his teeth, went to a Legal visit, talked about business and investing to an Inmate Companion, ate, and slept. When interviewed, he stated he still cannot remember what happened in SHU that caused the marks on his neck. He stated that for the 5 days before that he had only slept about 30 minutes each night because of noise in SHU. He stated he is anxious about going back to SHU because he stated he is going back to a place where he had gotten marks on his neck and he does not know why it happened. He said he has an appetite and is eating. He said he is waking up every 1 1/2 hours. He stated he feels dehydrated because he is not drinking enough water because he stated he feels he is not given enough bathroom breaks while with his Attorney. Medical was e-mailed with his complaint of feeling dehydrated. He said his Lawyers and friends are all emotionally supportive. Current Mental Status: He exhibited a neutral mood with a full range of affect. His speech was logical and coherent, with no loosening of associations or tangential, circumstantial or irrelevant speech. Auditory and visual hallucinations were denied, and delusions were not elicited. He did not engage in any bizarre or inappropriate behavior. He denied current suicidal or self harm ideation. He stated "I'm a coward." He added he does not like pain and even does not like when he has to give blood. He agreed to immediately tell staff and Inmate Companions if he starts to have suicidal or self harm thoughts. He was future oriented. He does not appear to be an immediate danger to self. He denied thoughts of hurting others and he agreed to tell staff and Inmate Companions if he has these thoughts. Intervention(s) Supportive and educative interventions were provided. Turning Points handouts on stress management, sleep, and building a routine in SHU were placed on his cell door to be given to him when his food slot is opened. He stated he wants it noted in his chart that he is being given a pamphlet on sleep, but that is not going to help because of the noise in SHU that prevents him from sleeping. Prowess/Plan He will remain on Psych Observation in an abundance of caution and pending housing arrangements to be made on Monday. While on Psych Observation, he will be seen daily by Psychology. Completed by PsyD on 07/28/2019 09:19 Generated 07/2812019 09:19 by PsyD Bureau of Prisons - NYM Page 1 of 1 EFTA00122641  Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN. JEFFREY EDWARD Reg It: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/27/2019 07:14 Provider: PsyD Focus of Session He was seen by writer while he was on Psych Observation. Subjective/Objective Presentation The "Eating/Shower Chart" indicated yesterday he ate dinner, drank liquids, and took a shower when offered. The Psych Observation Log noted he brushed his teeth, went to a Legal visit, talked about business and investing to an Inmate Companion, ate, an When interviewed, he st II cannot remember what happened in SHU that caused the marks on his neck. He stated that for the 5 days b e had only slept about 30 minutes each night because of noise in SHU. He stated he is anxious about going bac because he stated he is going back to a place where he had gotten marks on his neck and he does not know why He said he has an appetite and is eats He said is waking up every 1 1/2 hours. He stated he feels dehydrated because he is not drinking enough water bec tated he feels he is not given enough bathroom breaks while with his Attorney. Medical was e-mailed with his t gf feeling dehydrated. He said his Lawyers and friends are all emotionally supportive. Current Mental Status: He exhibited a neutral mood wr Iy full range of affect. His speech was logical and coherent, with no loosening of associations or tangential ntial or irrelevant speech. Auditory and visual hallucinations were denied, and delusions were not elicited. a engage in any bizarre or inappropriate behavior. He denied current suicidal or self harm ideation. He stated ." He added he does not like pain and even does not like when he has to give blood. He agreed to immedia t aft and Inmate Companions if he starts to have suicidal or self harm thoughts. He was future oriented. He do be an immediate danger to self. He denied thoughts of hurting others and he agreed to tell staff and Inmat s if he has these thoughts. Intervention(s) Supportive and educative interventions were provided. He was given Turnin douts on stress management, sleep, and building a routine in SHU. He stated he wants it noted in his chart th given a pamphlet on sleep, but that is not going to help because of the noise in SHU that prevents him f r1 g. Progress/Plan He will remain on Psych Observation in an abundance of caution and pending housing arr be made on Monday. While on Psych Observation, he will be seen daily by Psychology. Completed by PsyD on 07/27/2019 08:16 Generated 07/27/2019 08:16 by PsyD Bureau of Prisons - NYM Page 1 of 1 EFTA00122642  Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN. JEFFREY EDWARD Reg It: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/27/2019 07:14 Provider: PsyD Focus of Session He was seen by writer while he was on Psych Observation. Subjective/Objective Presentation The "Eating/Shower Chart" indicated yesterday he ate dinner, drank liquids, and took a shower when offered. The Psych Observation Log noted he brushed his teeth, went to a Legal visit, talked about business and investing to an Inmate Companion, ate, an When interviewed, he st II cannot remember what happened in SHU that caused the marks on his neck. He stated that for the 5 days b e had only slept about 30 minutes each night because of noise in SHU. He stated he is anxious about going bac because he stated he is going back to a place where he had gotten marks on his neck and he does not know why He said he has an appetite and is eats He said is waking up every 1 1/2 hours. He stated he feels dehydrated because he is not drinking enough water bec tated he feels he is not given enough bathroom breaks while with his Attorney. Medical was e-mailed with his t gf feeling dehydrated. He said his Lawyers and friends are all emotionally supportive. Current Mental Status: He exhibited a neutral mood wr Iy full range of affect. His speech was logical and coherent, with no loosening of associations or tangential ntial or irrelevant speech. Auditory and visual hallucinations were denied, and delusions were not elicited. a engage in any bizarre or inappropriate behavior. He denied current suicidal or self harm ideation. He stated ." He added he does not like pain and even does not like when he has to give blood. He agreed to immedia t aft and Inmate Companions if he starts to have suicidal or self harm thoughts. He was future oriented. He do be an immediate danger to self. He denied thoughts of hurting others and he agreed to tell staff and Inmat s if he has these thoughts. Intervention(s) Supportive and educative interventions were provided. He was given Turnin douts on stress management, sleep, and building a routine in SHU. He stated he wants it noted in his chart th given a pamphlet on sleep, but that is not going to help because of the noise in SHU that prevents him f r1 g. Progress/Plan He will remain on Psych Observation in an abundance of caution and pending housing arr be made on Monday. While on Psych Observation, he will be seen daily by Psychology. Completed by PsyD on 07/27/2019 08:16 Generated 07/27/2019 08:16 by PsyD Bureau of Prisons - NYM Page 1 of 1 EFTA00122643  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: 07/27/2019 07:14 Facility: NYM Amendment made to this note by PsyD on 07/28/2019 09:19. Bureau of Prisons - NYM EFTA00122644  Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN. JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/26/2019 09:09 Provider: PhD/Chief Focus of Session Inmate Epstein was seen while on psychological observation in our hospital area. Subjective/Objective Presentation Prior to this writer's contact with him, Inmate Epstein showered and dressed himself for his legal visit today. He was smiling and did crack some jokes during the interview. He did elucidate some complaints and suggested being disappointed with this writer as he wants "to trust me and for me to trust him." He stated he remains unhappy with legal visiting procedures as he cannot go to the bathroom as frequently as he would like to since he has a "weak bladder." Inmate Epstein also reported since coming to the psychological observation area, he has felt constipated and needs his Colace. He had self-carry Colace in SHU, but since coming to the observation area, he has not had his medication. This writer immediately notified medical and his pills were being processed during the interview. Inmate Epstein also continues to complain about the conditions of SHU confinement (i.e., feeling punished, smells, noise, and restrictions). With regard to the events which lead to his initial placement on suicide watch, inmate Epstein stated he has no memory of the event. He asked to speak with his old cellmate "Nick" to see if he can tell him what happened or see if his memory could be triggered. He remarked. "I am still trying to figure out how I got this (pointing to the scab around his neck)." Inmate Epstein denies remembering harming himself and/or being harmed by his cellmate. He does not exhibit symptoms of any cognitive disorder, seizure disorder, psychotic disorder, or dissociative disorder at this time or in the past. Inmate Epstein denied any current suicidal ideation, intention, or plan. He reported wanting to be alive to fight his legal case and go back and live life. He referred to himself as "a coward" and "I'm Jewish." He said he is not the type who likes pain or would ever attempt to harm himself. While on psychological observation, inmate Epstein has been eating his meals, sleeping and interacting with the inmate companions. He is in legal visiting the majority of the day and in the evenings. His log book and eating/shower chart reflect the same. He has been speaking to inmate companions about investment strategies and about prison adjustment. Correctional Staff report during his legal visits, he is interacting with his attorney, animated, laughing, and joking. Intervention(s) Inmate Epstein was provided with supportive and coping skills interventions today. He was receptive to them, but mostly wanted to express his complaints about his current prison confinement status and needs. He wanted this writer to address them. Progress/Plan Inmate Epstein will remain on psychological observation in an abundance of caution and pending housing arrangements to be made on Monday. He continues to be vague and reports memory deficits regarding the events which lead to a piece of sheet being placed loosely around his neck and marks with scabs around his neck. Completed by PhD/Chief Psychologist on 07/26/2019 10:05 Generated 07/2612019 10:05 by PhD/Chief Bureau of Prisons - NYM Page 1 of 1 EFTA00122645  Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN. JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/25/2019 10:14 Provider: PhD/Chief Focus of Session Inmate Epstein was seen by this writer this morning while on psychological observation in the hospital area of the prison. Subiective/Obiective Presentation Inmate Epstein was in good spirits today and engaged in reciprocal conversation with this writer this morning. He smiled and remarked, "welcome back" when this writer arrived. He continues to assert he does not remember how he received marks around his neck, remarking "I do not remember anything, maybe you can give me some cues." He stated he just remembers going for a drink of water and the next thing he knew he woke up to the sound of his own snoring. When this writer attempted to get a more detailed account from him, indicating that it would be rare to have such impairments in memory as he does not suffer from an acute cognitive disorder, he smiled and said he understood my position. Inmate Epstein did reveal he is unhappy with his current confinement in Special Housing (SHU) as he considers it "a punishment cell." He said he finds the restrictions up there unfair as he has not done anything wrong. Inmate Epstein stated he feels it is dangerous in the SHU, he cannot sleep well up there due to noise from the other inmates, it smells, and it is difficult for him to work on his legal case up there. He stated he has not received the phone calls he was promised nor has he been able to receive recreation. It was explained to him that he spends the entire day in the attorney conference room and it is likely that he has missed the times when staff members have attempted to give him phone calls and recreation. Inmate Epstein also reported complaints about the attorney conference room, stating they do not take him to the bathroom frequently enough. Inmate Epstein adamantly denied any suicidality at this time, stating "I am too vested in my case to fight it. I have a life and I want to go back to living my life." He denied any acute symptoms at this time. According to his log book, he has been eating, drinking, sleeping, and interacting with the inmate companions. He has also been attending his daily legal visits. Intervention(s) Inmate EPSTEIN was provided with brief supportive interventions and psychoeducation regarding additional coping strategies. Inmate EPSTEIN was mostly receptive to these interventions. He requested to be housed in general population rather than the SHU and stated he wanted to remain on psychological observation due to his concerns with being in the SHU. Progress/Plan In an abundance of caution, inmate Epstein will remain on psychological observation. He has yet to give an account of how he sustained the marks around his neck, is not revealing much about his mental status, and there are concerns about his adjustment at this time to being housed in the SHU. Inmate Epstein will be seen daily by psychology while on psychological observation. Completed by PhD/Chief Psychologist on 07/25/2019 10:43 Generated 07/2512019 10:43 by PhD/Chief Bureau of Prisons - NYM Page 1 of 1 EFTA00122646  Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Post Suicide Watch Report Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/24/2019 09:23 Provider: 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 Mood: 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 or 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 Assessed• This writer screened the inmate for a variety of empirically validated factors commonly associated with risk for self harm. The following STATIC risk factors were assessed to be present and increase the inmates risk for engaging in suicide 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 inmates 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:Able to identify 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 profile crime with media attention. He was recently denied bail. He also reported difficulty managing his time in the SHU. He reported 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 attempts. 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-report regarding the incident which precipitated his placement on Suicide Watch, combined with his fear for his own safety, reported Generated 07124,2019 12:09 by Ph.D. Bureau of Prisons NYM Page 1 of 3 EFTA00122647 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/24/2019 09:23 Provider: 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. Changes in Risk Factors Assessed 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 sleeping, eating, and drinking within normal limits. Upon interview today, Mr. 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, Mr. EPSTEIN said he is frustrated he has been placed in a "punishment cell for no reason." Specifically, Mr. EPSTEIN was referring to his placement in the SHU. Asked to recall the events surrounding the alleged incident, Mr. EPSTEIN said his cell mate was "playing with a bed sheet" and he claimed he does not recall the events thereafter. He said he recalled eating meat and drinking water and claimed the next event for which he has memory is his hearing himself snore and 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 said he has "been trying to remember" and "wracking his mind." Asked if he experienced any interpersonal issues with his 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 toilet. Asked if his cell mate ever threatened to harm him, he denied this to be the case. Asked why he told the inmate companions yesterday his cell mate tried to kill him, while also claiming no memory of the incident, Mr. EPSTEIN again said he did not recall the incident and further stated, "I don't know if he put it there as a joke." Mr. EPSTEIN explained he had been experiencing difficulty sleeping in his SHU cell due to his inmate peers banging on the cell door and window, but has not been experiencing any other acute issues other than this. Reason for Removal from Watch Mr. EPSTEIN 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." Mr. EPSTEIN did express a feeling of safety being housed on Psychological Observation rather than in the SHU. He asked if he could remain on this status for a couple of days, he was advised his housing situation will be re-evaluated on a day-to-day basis. He expressed a desire to be housed in general population rather than in the SHU and asked if there were a "safer" unit for him to be housed in comparison to the one where he was initially placed. Mr. EPSTEIN claimed there were many MS-13 gang members on the initial unit. He was advised he will be maintained on Psychological Observation in the near future, but his long-term housing situation will be revisited, as it is not ideal for one to remain in isolation on Psychological Observation for extended periods of time. Mr. EPSTEIN acknowledged this information and thanked this writer for her explanation and time. 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 Recommendations 1. Mr. EPSTEIN will be removed from Suicide Watch and stepped down to Psychological Observation. 2. While on Psychological Observation, he will be continuously observed by Inmate Companions. 3. While on Psychological Observation, he will be seen daily by Psychology. 4. Supportive and educative interventions were provided. 5. Mr. EPSTEIN was provided novels and a request was made for his legal paperwork to be provided to him on Psychological Generated 07/24/2019 12:09 by Ph.D. Bureau of Prisons NYM Page 2 of 3 EFTA00122648 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/24/2019 09:23 Provider: Ph.D. Observation. 6. This writer contacted the Pharmacy to indicate Mr. EPSTEIN has not been receiving his medication used to alleviate his constipation. 7. Mr. EPSTEIN attended a legal visit today, after having been provided a shower. 8. Mr. EPSTEIN was educated about both routine and emergency procedures for contacting psychology. 9. The inmate was encouraged to reach out for PRN services should he experience any psychological distress. Completed by Ph.D. on 07/24/2019 12:09 Generated 07/24/2019 12:09 by Ph.D. Bureau of Prisons NYM Page 3 01 3 EFTA00122649  Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Suicide Risk Assessment Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facilit : NYM Unit Team: 5 Date: 07/23/2019 10:09 Provider: PsyD Type of Housing: SHU- Administrative Segregation Cell Accommodation: Double-Cell FINDINGS This assessment and the resulting recommendations are based on the