EFTA00138954.pdf

Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Suicide Risk Assessment Inmate Name: EPSTEIN JEFFREY EDWARD Reg #: 76318-054 Date of Birth: Sex: M Facilit : NYM Unit Team: A&O Date: 07/09/2019 08:41 Provider: 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 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, pre-trial status, and he had a court o ing yesterday which could have given him bad news regarding his legal situation. As such, this writer instruc &D staff s well as the Lieutenant's Office, to immediately notify the psychology department when he returned fro Inmate Epstein returned from court after duty hours and denied suicidality. The aforementioned staff notifi -call psychologist and inmate Epstein was placed on a precautionary psychological observation status until psycho terview him this morning to conduct a suicide risk assessment. Developmental History Inmate Epstein denied any history of being the victim . . . - .etrator of physical or sexual abuse. Educational History/Cognitive Impairment Inmate Epstein reported he obtained his high school diplom- d 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' apse 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 inpat CI tient basis. Inmate Epstein denied any treatment in the past or present with psychotropic medication. He also d i 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 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 SDNY 00017317 Generated 07/09/2019 10:36 by PhD/Chief Bureau of Prisons - NYM - Page 1 of 3 Page 274 EFTA00138954 Inmate Name: EPSTEIN. JEFFREY EDWARD Reg #: 76318-054 Date of Birth: Sex: M F ili : NYM Unit Team: A&O Date: 07/09/2019 08:41 Provider: 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. EP IN was alert and oriented. He was polite, calm, and cooperative in demeanor. He exhibited a neutral affect with appropri e. Eye contact and hygiene were appropriate. The inmate spoke with normal rate, tone, and volume. His thoughts nized and coherent, with no loosening of associations or tangential, circumstantial, or irrelevant content. There ce of perceptual disturbance, delusional ideation, or a formal thought disorder. He did not engage in any bizarre or ina e behavior. He noted having normal sleeping and eating habits. Mr. EPSTEIN explicitly denied recent and curre eation, planning, and intent. He was future-oriented and expressed a commitment to life and safety, agree' tact staff immediately should he experience suicidal ideation. This writer screened the inmate for a variety of validated factors commonly associated with risk for self-harm and suicide. The following STATIC risk factors were assessed t and increase the inmate's risk for engaging in suicide related behaviors: High Profile Crime, Lack of family connect' ender status Of the DYNAMIC risk factors assessed, none were foun RS nt. The following PROTECTIVE factors were assessed to be pres m y decrease the inmate's risk of suicide:Able to identify reasons to live, Adequate problem solving skills, Denial of suici ention/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 PVr k factors for suicidality at this time including a high profile case with extensive media attention, sex offenseitr c rges, pre-trial status, and he had a court proceeding yesterday which may have given him bad news regarding his leg i Inmate Epstein also informed this writer that his only family at this time is his brother, with whom he does not hav cl tionship with. Despite these risk factors, inmate Epstein possesses a number of protective factors a Inmate Epstein adamantly denied any suicidal ideation, intention or plan. He was very future oriented and requeste all, to meet with his attorney, to take a shower, and to brush his teeth. He was eating his cereal when this writ r 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 g t sed from jail. Inmate Epstein reported he is a Banker and has a "big business" in the community and that "bei fun." 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 SDNV 00017318 Generated 07/09/2019 10:36 by PhD/Chief Bureau of Prisons - NYM — Page 2 of 3 Page 275 EFTA00138955 Inmate Name: EPSTEIN. JEFFREY EDWARD Reg #: 76318-054 Date of Birth: Sex: M Facilit : NYM Unit Team: A&O Date: 07/09/2019 08:41 Provider: PhD/Chief Psychologist RECOMMENDATIONS 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 PhD/Chief Psychologist on 07/09/2019 10:36 060 oto,6) oet SDNY 00017319 Generated 07109/2019 10:36 by PhD/Chief Bureau of Prisons - NYM — Page 3 of 3 Page 276 EFTA00138956  Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED** Psychology Services General Administrative Note Inmate Name: EPSTEIN JEFFREY EDWARD Reg #: 76318-054 Date of Birth: Sex: M Facility: NYM Unit Team: A&O Date: 07/08/2019 10:41 Provider: PhD/Chief Comments This writer consulted with Dr. , 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 PhD/Chief Psychologist on 07/08/2019 10:49 SDNY_00017320 Generated 07/08/2019 10:49 by PhD/Chief Bureau of Prisons - NYM Fape 1 of 1 Page 277 EFTA00138957  Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Risk of Sexual Abusiveness Inmate Name: EPSTEIN JEFFREY EDWARD Reg #: 76318-054 Date of Birth: Sex: M Facility: NYM Unit Team: A&O Date: 07/08/2019 09:35 Provider: PsyD/PhD Comments 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 victimization 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) ( ) Hypermasculinity ( ) 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 sexual abusiveness, an unforeseen change in risk factors may significantly alter his risk level.). Programming recommendations included sex offender treatment. Inmate Epstein declined programming recommendations.The 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 Psychology staff's recommendation that he not be housed in a cell with any inmates identified as at increased risk for sexual victimization. Psychology also recommends a greater level of supervision regarding his work and education assignments. Programming recommendations include XXXXX. 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. SDNY_00017321 Generated 07/08/2019 09:41 by PsyD/PhD Bureau of Prisons - NYM Page 1 of 2 Page 278 EFTA00138958 Inmate Name: EP T JEFFREY EDWARD Reg #: 76318-054 Date of Birth: Sex: M F ility: NYM Unit Team: A&O Date: 07/08/2019 09:35 Provider: PsyD/PhD Completed by PsyD/PhD on 07/08/2019 09:41 SDNY_00017322 Generated 07/08/2019 09:41 by PsyD/PhD Bureau of Prisons - NYM Page 2 of 2 Page 279 EFTA00138959  Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Intake Screening Inmate Name: EPSTEIN JEFFREY EDWARD Reg #: 76318-054 Date of Birth: Sex: M Facilit : NYM Unit Team: A&O Date: 07/08/2019 09:24 Provider: . PsyD/PhD 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 mental 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 f or prostitution. Inmate Epstein stated he is single and does not have any children. He revealed he was living in New York. He stated he completed high school. He stated he was employed in banking work prior to his incarceration. 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 trafficking and has previously been charged with prostitution. He was informed of the programs offered by MCC-NY as well as the Bureau of Prisons. Additionally, he was informed of this institutions self-help program. Inmate Epstein reported he 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 short-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 or 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 SDNY_00017323 Generated 07/08/2019 09:30 by PsyD/PhD Bureau of Prisons - NYM Page 1 of 2 Page 280 EFTA00138960 Inmate Name: EPSTEIN JEFFREY EDWARD Reg #: 76318-054 Date of Birth: Sex: M F tli : NYM Unit Team: A&O Date: 07/08/201909:24 Provider: PsyD/PhD Inmate EPSTEIN denied any history of mental health symptoms or treatment. He denied any current mental 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 about 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 PsyD/PhD on 07/08/2019 09:30 SDNY_00017324 Generated 07/08/2019 09:30 by PsyD/PhD Bureau of Prisons - NYM Page 2 of 2 Page Vat EFTA00138961  Federal U.S. Medical Center for Federal Prisons Bureau of 1900 W. Sunshine Street Prisons Springfield, MO 65807 417-874-1621 - *Sensitive But Unclassified*** Name EPSTEIN, JEFFREY Facility MCC New York Collected 07/09/2019 13:34 Reg # 76318-054 Order Unit E06-547U Received 07/10/2019 10:44 DOB Provider MD Reported 07/10/2019 14:46 Sex M LIS ID 188191004 CHEMISTRY Sodium 137 137-148 mmol/L Potassium 4.7 3.5.5.0 mmol/L Chloride 99 99.114 mmol/L CO2 27 22-30 mmol/L BUN 17 7-22 mg/dL Creatinine 1.05 0.66.1.25 mg/dL eGFR (IDMS) >60 GFR units measured as mUmin/1.73 m^2. If African American multiply by 1.210. A calculated GFR <60 suggests chronic kidney disease if found over a 3 month period. Calcium 9.8 8.5-10.9 mg/dL Glucose 102 70-110 mg/dL AST H 57 11.55 U/L ALT 62 11-66 U/L Alkaline Phosphatase 64 41.133 U/L Bilirubin, Total 1.1 0.2.1.3 mg/dL Total Protein 7.3 6.0-8.2 g/dL Albumin 4.4 3.6.5.1 g/dL Globulin 2.9 2.0.3.7 g/dL Alb/Glob Ratio 1.50 1.00-2.30 Anion Gap 10.2 9.0.19.0 BUN/Creat Ratio 16.1 5.0.30.0 Cholesterol H 216 <200 mg/dL Triglycerides H 413 10-150 mg/dL Calculation of LDL is not appropriate for samples with a triglyceride greater than 400 mg/dL. Therefore the LDL is not calculated. HDL Cholesterol L 31 40.60 mg/dL Chol/HDL Ratio H 6.9 0.0.4.0 HEMATOLOGY WBC 7.6 4.3-11.1 K/uL NRBC% 0.0 c/O RBC 5.42 4.46-5.78 M/uL Hemoglobin 15.6 13.6-17.6 g/dL Hematocrit 47.8 40.2-51.4 MCV 88.2 82.5-96.5 fL MCH 28.8 27.1-34.9 Pg MCHC L 32.6 33.0-37.0 g/dL ROW-CV 12.8 12.0-14.0 Platelet 338 130-374 K/uL FLAG LEGEND L=Low L!=Low Critical H=High H!=High Critical A=Abnormal A! =Abnormal Critical Page 1 of 3 SDNV_00017325 Page 282 EFTA00138962  Federal U.S. Medical Center for Federal Prisons Bureau of 1900 W. Sunshine Street Prisons Springfield, MO 65807 417-874-1621 - *Sensitive But Unclassified *** Name EPSTEIN, JEFFREY Facility MCC New York Collected 07/09/2019 13:34 Reg # 76318-054 Order Unit E06-547U Received 07/10/2019 10:44 DOB Provider MD Reported 07/10/2019 14:46 Sex M LIS ID 188191004 HEMATOLOGY MPV 10.4 6.9-10.5 fL Neutrophils °A) 58.7 Therapeutic decision making should be based on absolute values, rather than percentages Lymphocytes % 25.0 Monocytes 11.1 Eosinophils % 4.1 Basophils 0.8 Immature Granulocytes % 0.3 0.0-5.0 Neutrophils # 4.4 1.9.6.7 K/uL Lymphocytes # 1.9 1.3.3.7 K/uL Monocytes # 0.8 0.3-1.1 K/uL Eosinophils # 0.3 0.0.0.5 K/uL Basophils # 0.1 0.0.0.1 K/uL Immature Granulocytes # 0.02 0.00-0.50 10A3/uL HEMOGLOBIN Al C Hemoglobin A I C H 6.3 <5.7 5.7 - 6.4 Increased Risk > 6.4 Diabetes SEROLOGY RPR Non-Reactive Non-Reactive Results may be affected in patients with severely advanced immunosuppression. FLAG LEGEND L=Low L!=Low Critical H=High H!=High Critical A=Abnormal A! =Abnormal Critical Page 2 of 3 SDNV_00017326 Page 283 EFTA00138963  Federal U.S. Medical Center for Federal Prisons Bureau of 1900 W. Sunshine Street Prisons Springfield, MO 65807 417-874-1621 - *Sensitive But Unclassified — Name EPSTEIN, JEFFREY Facility MCC New York Collected 07/09/2019 13:34 Reg # 76318-054 Order Unit E06-547U Received 07/10/2019 10:44 DOB Provider MD Reported 07/10/2019 14:46 Sex M LIS ID 188191004 HIV HIV 1/2 Negative Negative Screening test • See confirmatory testing for Reactive results FLAG LEGEND L=Low L!=Low Critical H=High H!=High Critical A=Abnormal A! =Abnormal Critical Page 3 of 3 SDNY_00017327 Page 284 EFTA00138964  Bureau of Prisons Health Services Cosign/Review Inmate Name: EPSTEIN JEFFREY EDWARD Reg #: 76318-054 Date of Birth: Sex: M Race: WHITE Encounter Date: 07/10/2019 16:58 Provider: Lab Result Receive Facility: NYM Cosigned by MD on 07/14/2019 18:12. SDNY_00017328 Bureau of Prisons - NYM Page 285 EFTA00138965  BP-S358.06 SEP05 0 MEDICAL TREATMENT REFUSAL CDFRM U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-24.2019 Date I, JEFFREY EPSTEIN 76318-054 refuse treatment recommended by the Federal Bureau of Prisons Medical staff for the following condition(s): DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY: EYE DOCTOR EVALUATION. The following treatment(s) was/were recommended: EYE DOCTOR EVALUATION. Federal Bureau of Prisons Medical staff members have carefully explained to me that the following possible consequences and/or complications may result because of my refusal to accept treatment: INABILITY TO DIAGNOSE CURRENT OPTHALMOLOGIC DISEASES. I understand the possible consequences and/or complications, listed above, and still refuse recommended treatment I hereby assume all responsibility for my physical and/or mental condition, and release the Bureau of Prisons and its employees from any and all liability for respecting and following my expressed wishes and directions. Counseled by MD 7-24-2019 Date IN Patient's Sign Date Signature of VVitneis Date NYM-NEWYORKMCC f/r<ci SDNY_00017329 Page 204 EFTA00138966 BP-A0618 A&O DENTAL. EXAMINATION JUN 16 (Initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Occlusion: ; I 1 2 3 4 5 8 7 8 9 10 11 12 13 14 15 113 cc — 32 31 30 29 28 27 28 26 24 23 22 21 20 19 • 18 17 Head & Neck ! Soft Tissue: 2- Classification: (51\ D. #11 F: /9 Dental Prostheses at Intake: Coma/ 4O Ots elfl Yes No rn )3 pica Type: Age: it 62 SS / on 012Strut • 2-4."—k-e- C-N. -Sell or Ceen.g...inc O.199-filled Condition: Intra-oral Photos Taken: Radiographs Taken: (Document findings on MO encounter) Yes Yes 0 9 Instructed how to obtain urgent and non-urgent dental care: Yes: i No: Treatment Priorities: None: Non-urgent Urgent Referred to Sick Call: non-urgent Radiographs authorized: Prophylaxis authorized: Yes i No PM: (Approval valid 18 months from examination date) BWs: Panorex: Prafient Name: Dentist Si nature: .... s S ni ""3"--e_clcity E I>DS 44' r r Number. Institution: / Date: Signature Block/Stamp: 7‘31iczt 0cm MCC NEW YORK 7- 04 -19. aDS. let Uental Umcer MCC New York PDF Prescribed by P6400 Replaces BP-A0618 of JUN 10 S0N1100017330 Page 287 EFTA00138967 BP-5358.060 MEDICAL TREATMENT REFUSAL CDFRM SEP 05 U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-24-2019 Date I, JEFFREY EPSTEIN 76318-054 refuse treatment recommended by the Federal Bureau of Prisons Medical staff for the following condition(s): DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY: EYE DOCTOR EVALUATION. The following treatment(s) was/were recommended: EYE DOCTOR EVALUATION. Federal Bureau of Prisons Medical staff members have carefully explained to me that the following possible consequences and/or complications may result because of my refusal to accept treatment: INABILITY TO DIAGNOSE CURRENT OPTHALMOLOGIC DISEASES. I understand the possible consequences and/or complications, listed above, and still refuse recommended treatment I hereby assume all responsibility for my physical and/or mental condition, and release the Bureau of Prisons and its employees from any and all liability for respecting and following my expressed wishes and directions. MD 7-24-2019 Counseled by Date NYM-NEW YORK MCC SDNY_00017331 Page 2i34 EFTA00138968 BP-5358.060 MEDICAL TREATMENT REFUSAL CDFRM SEP 05 U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-10-2019 Date I JEFFREY EPSTEIN 76318-054 , refuse treatment recommended by the Federal Bureau of Prisons Medical staff for the following condition(s): DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY: 66 YR OLD MALE WITH NO PMHX , REFERRED FOR ROUITNE CXR. The following treatment(s) was/were recommended: CHEST X-M Federal Bureau of Prisons Medical staff members have carefully explained to me that the following possible consequences and/or complications may result because of my refusal to accept treatment: WORSENING THE CONDITION IF THERE IS ANY FINDINGS I understand the possible consequences and/or complications, listed above, and still refuse recommended treatment. I hereby assume all responsibility for my physical and/or mental condition, and release the Bureau of Prisons and its employees from any and all liability for respecting and following my expressed wishes and directions. X 7-10-2019 Counseled by Date Patien Signature Date - /Of NYM-NEW YORK MCC Signature of Witness Date SDNY_000i 7332 Page 289 EFTA00138969  Medical Records request for Inmate Jeffrey Epstein, Reg. No. 76318-054 07/01/19 - 07/24/19 From To Date 2019/07/24 10:38 Medical Records request for Inmate Jeffrey Epstein, Reg. No. 76318- Subject: 054 07/01/19 - 07/24/19 Attachments: TEXT.htm, PrintChartGetRcport.faces.pdf Please see attached. Thank You!! Legal Assistant CLC New York Metropolitan Correctional Center 150 Park Row New York, NY 10007 (P) (F) SON\100017333 Page 16115 Page 290 EFTA00138970  Bureau of Prisons Health Services Clinical Encounter Inmate Name: _EPSTEINi. JEFFREY EDWARD Reg #: 76318-054 Date of Birth: Sex: M Race: WHITE Facility: NYM Encounter Date: 07/23/2019 06:20 Provider: MLP Unit: H01 Injury Assessment - Non-work related encounter performed at Health Services. SUBJECTIVE: INJURY 1 Provider: MLP Date of Injury: 07/23/2019 01:27 Date Reported for Treatment: 07/23/2019 08:25 Work Related: No Work Assignment: UNASSG Pain Location: Pain Scale: 0 Pain Qualities: Where Did Injury Happen (Be specific as to location): Special Housing Unit Z05-Cell 124 L Cause of Injury (Inmate's Statement of how injury occurred): "I do not know. Just went to drink a little water and wake up snorting". Symptoms (as reported by inmate): None OBJECTIVE: Temperature: Date Time Fahrenheit Celsius Location Provider 07/23/2019 06:30 NYM 97.5 36.4 Oral MLP Pulse: Data Time Rate Per Minute Location Rhythm Provider 07/23/2019 06:30 92 Via Machine Regular . MLP Respirations: Data Time Rate Per Minute Provider 07/23/2019 06:30 NYM 16 MLP Blood Pressure: Date Ikea Value Location Position Cuff Size Provider 07/23/2019 06:30 NYM 140/85 Right Arm Sitting Adult-regular MLP SaO2: Date Time Value(%) Air Provider 07/23/2019 06:30 NYM 96 Room Air MLP Exam: General Affect Yes: Cooperative Appearance Yes: Appears Well, Alert and Oriented x 3 No: Appears Distressed, Lethargic, Dyspneic, Appears in Pain, Pallor, Cyanotic, Diaphoretic, Disheveled, Generated 07/23/2019 09:05 by MLP Bureau of Prisons - NYM SDNY_0001:701 of 2 Page 291 EFTA00138971 Inmate Name: EP TEIN JEFFREY EDWARD Reg #: 76318-054 Date of Birth: Sex: M R : WHITE Facility: NYM Encounter Date: 07/23/2019 06:20 Provider: . MLP Unit: H01 Exam: Acutely III Pulmonary Auscultation Yes: Clear to Auscultation, Vesicular Breath Sounds Bilaterally No: Crackles, Rhonchi, Wheezi