EFTA00113109.pdf

LIMITED OFFICIAL USE 1 2 3 4 DIGITALLY RECORDED 5 SWORN STATEMENT 6 OF 7 8 9 OIG CASE #: 10 2019-010614 11 12 13 14 15 16 17 18 DEPARTMENT OF JUSTICE 19 OFFICE OF THE INSPECTOR GENERAL 20 MAY 31, 2022 21 22 23 24 25 RESOLUTE DOCUMENTATION SERVICES 28632 Roadside Dr., Suite 285 Agoura Hills, CA 91301 Phone: (818) 431-5800 LIMITED OFFICIAL USE EFTA00113109  LIMITED OFFICIAL USE 1 APPEARANCES: 2 3 OFFICE OF THE INSPECTOR GENERAL 4 BY: 5 BY: 6 7 8 WITNESS: 9 10 11 12 OTHER APPEARANCES: 13 14 15 16 17 18 19 20 21 22 23 24 25 LIMITED OFFICIAL USE EFTA00113110  LIMITED OFFICIAL USE 1 MR. : This is Special Agent 2 . Today is May 313', 2022. The time is 3 3:33 p.m., and the recording is now on. 4 My name is . I am a Special 5 Agent with the U.S. Department of Justice, 6 Office of the Inspector General, New York Field 7 Office, and these are my credentials. You 8 should be able to see. This interview with New 9 York City Medical Examiner Dr. • 10 Did I say that right? 11 MS. : Yes. 12 MR. : Is being conducted as part of 13 an official U.S. Department of Justice, Office 14 of the Inspector General investigation. 15 Today's date is May 31st, 2022. The time is 16 3:34 p.m. This interview is being conducted 17 via Microsoft Teams Video Conferencing. Also 18 present is DOJ/OIG Special Agent-in-Charge 19 , and Office of Chief Medical Examiner 20 General Counsel, . For this 21 interview be recorded by me, Special Agent 22 Could everyone please identify 23 themselves for the record and spell your last 24 name? To start, again, I am DOJ/OIG Special 25 Agent , and that's spelled LIMITED OFFICIAL USE EFTA00113111  LIMITED OFFICIAL USE 4 1 ? You're on mute. Sorry. 2 MR. My name is 3 I'm e—the Special Agent-in-Charge for the 4 New York Field Office. 5 MR. : Ms. 6 MS. : Oh, 7 General Counsel from the New York City 8 Office of Chief Medical Examiner. 9 MR. : Dr. 10 MS. : I'm 11 And I'm a city medical examiner at Office of 12 the Chief Medical Examiner in New York. 13 MR. : Thank you, everyone. This is 14 an official DOJ/OIG investigation into the 15 events surrounding the death of inmate Jeffrey 16 Epstein. And you are being asked to 17 voluntarily provide answers to our questions. 18 Will you agree to a voluntary interview with 19 the DOJ/OIG? 20 MS. : Yes. 21 MR. : Before starting the 22 interview, I would like to place you under 23 oath. Dr. , can you please raise your 24 right hand? Do you swear to tell the truth and 25 nothing but the truth during this interview? LIMITED OFFICIAL USE EFTA00113112  LIMITED OFFICIAL USE 1 MS. : I swear. 2 MR. : Thank you. Please let me 3 know if you don't understand any questions that 4 I ask. I'll try to repeat it or try to 5 rephrase it for you. 6 MS. : Okay. 7 MR. : We're going to start with 8 your background, and then get into the details 9 of the autopsy itself. Can you provide us with 10 a summary of your college level education, 11 starting with your bachelor's degree? 12 MS. : Sure. My bachelor's degree is 13 in Fine Art, and I completed that at Cooper 14 Union School of Art (Phonctic Sp. *00:02:15). 15 I then went back to school for pre-medical 16 studies only, to Columbia University School of 17 Graduate Studies, and completed the requisites, 18 the pre-requisite courses for applying to 19 medical school. 20 I then went to medical school at SUNY 21 Ddownstate in Brooklyn, completed that, and I 22 earned an MD. I did a year of residency 23 training in obstetrics and gynecology. Found 24 that that wasn't the right field for me, so I 25 switched. LIMITED OFFICIAL USE EFTA00113113  LIMITED OFFICIAL USE 1 I did three years of training in 2 pathology. And then, I did a final year of 3 fellowship training in forensic pathology. All 4 of my residency training was done at King's 5 County Hospital in Brooklyn, and the fellowship 6 training was done here at the Office of the 7 Chief Medical Examiner. 8 MR. : Okay. And the three years in 9 pathology, that was done at the Office of Chief 10 Medical Examiner? 11 MS. : No. That was also done at 12 King's County, and not Brooklyn. 13 MR. : Okay. Now, once you do the 14 three years in pathology, and you come over. 15 Did you start with the Office of Chief Medical 16 Examiner right after that? 17 MS. : After completing the 18 fellowship year, yes. 19 MR. : Okay. And then, once you 20 started at the Office of Chief Medical 21 Examiner, is there specialized training that 22 they sent you in for also, or -? 23 MS. : We do, to maintain our 24 licenses, we do training on a weekly basis. 25 And in order to be board certified, you have to LIMITED OFFICIAL USE EFTA00113114  LIMITED OFFICIAL USE 1 recertify every ten years, and every year, show 2 that you've done a certain amount of credits of 3 training. So, I've been undergoing 4 supplementary training my entire life since 5 coming to the Office of the Chief Medical 6 Examiner. 7 MR. : Okay. And what year did you 8 earn your doctor? Did you become a doctor? 9 MS. : It was 1999 when I graduated 10 from medical school. 11 MR. : Okay. And your three years 12 in pathology? When did you complete that? 13 MS. : So, I did, from '99 to 2001 14 was OB. And then, from 2001 to 2003 was the 15 pathology training. And then, '03 to '04 was 16 the fellowship training. 17 MR. '03 to '04. So, you've been 18 with the Medical Examiner's Officer for almost 19 20 years now? 20 MS. : Yes. I did leave for one year 21 briefly. I took a job elsewhere to be second 22 in command. Didn't like it. Came back. So, 23 there has been a year break in service. 24 MR. : Was that recently, or going 25 back a while? LIMITED OFFICIAL USE EFTA00113115  LIMITED OFFICIAL USE 1 MS. : 2013 to 2014. 2 MR. : Okay. Where did you go? 3 MS. : I went to Madison, Wisconsin 4 to work at the Dane County Medical Examiner's 5 Officer. 6 MR. : That's a big jump from New 7 York City to Madison. 8 MS. : Oh, you aren't kidding. It's 9 very different. 10 MR. : SAC , do you have any 11 questions about background? 12 MR. : Nothing from me. Thanks. 13 MR. : No problem. Prior to 14 conducting -. So, are you familiar with MCC 15 inmate - the Metropolitan Correctional Center 16 in New York - inmate Jeffrey Epstein? 17 MS. : After his death, yes. 18 MR. : So, prior to conducting -. 19 Did you conduct his autopsy? 20 MS. : I did. 21 MR. : Okay. Prior to conducting 22 Jeffrey Epstein's autopsy, how many autopsies 23 had you conducted? If you can give me a rough 24 estimate. 25 MS. : Oh. I don't know exactly. It LIMITED OFFICIAL USE EFTA00113116  LIMITED OFFICIAL USE 1 was a couple thousand. 2 MR. : Oh, okay. And do you know 3 how many -? An estimate of how many of those 4 autopsies resulted in the conclusion of 5 suicide? 6 MS. : Again, I don't have an exact 7 number, but I will say that there were an awful 8 lot of suicides in Staten Island where I 9 worked, and in Dane County. So, I've done 10 plenty. Certainly more than a hundred, 11 probably several hundred. 12 MR. : Wow. Okay. And did you ever 13 deal with any prisoner deaths that you 14 conducted autopsies for, prior to Mr. Epstein? 15 MS. : Oh, yes. 16 MR. : Okay. And how many of those 17 autopsies, if you can give an estimate, 18 resulted in the determination of cause of death 19 by suicide? 20 MS. : So, I can remember a couple 21 actually. Maybe two or three. 22 MR. : Okay. I'll come back to 23 that. Anything else, SAC , on that? 24 MR. : No. And now, doctor, these 25 were deaths at the MDC, Metropolitan Detention LIMITED OFFICIAL USE EFTA00113117  LIMITED OFFICIAL USE 10 1 Center, or was this the MCC, or what facility 2 were these autopsies conducted in reference to 3 their deaths? 4 MS. : I honestly don't remember. 5 I'd have to look that up. 6 MR. : But they were local here in 7 New York? 8 MS. : They were New York cases. 9 Yes. 10 MR. : Okay. 11 MS. : I didn't do any custody cases 12 at all when I was in Dane County. 13 MR. : Thanks. 14 MS. : Just to clarify, it is 15 (Indiscernible *00:07:30) City Department of 16 Correction -- 17 MR. : Okay. 18 MS. : -- you're asking about 19 federal deaths. 20 MR. : Yes, we are. 21 MR. : Okay. So, yeah. 22 MR. : Thank you for that. Dr. 23 , do you recall when and where you 24 conducted the autopsy of Jeffrey Epstein? 25 MS. : I did the autopsy on the 11th LIMITED OFFICIAL USE EFTA00113118  LIMITED OFFICIAL USE 11 1 of August, 2019, and I actually have my notes 2 in front of me, so I will check the -- 3 MR. : Okay. 4 MS. : -- time, if you'd bear with 5 me. Oh, let's see. I mean, actually, maybe I 6 don't have that particular note. I don't 7 remember exactly, but I know he was my only 8 case that day. So, I started in the morning, 9 and worked steadily through the day on him. 10 MR. : Okay. So, that was the only 11 case for the day. 12 MS. : Yes. 13 MR. : And when did you become aware 14 of his death? 15 MS. : We were made aware of the 16 death the day prior, and we were expecting him 17 to arrive the day prior, actually, on the 10th. 18 MR. : Okay. How do you get 19 assigned to do Mr. Epstein's autopsy? Is that 20 like a rotation? Or was it assigned to you by 21 somebody? 22 MS. : It was assigned to me by 23 somebody. We had initially thought he would 24 come in on the 10th, and I wasn't the person 25 assigned, but that person wasn't working on the LIMITED OFFICIAL USE EFTA00113119  LIMITED OFFICIAL USE 12 1 11th, and I was chosen to do the autopsy on the 2 11th. 3 MR. : Okay. Do you know who it was 4 that was chosen initially? 5 MS. : Yes. 6 MR. : Do you know the name? 7 MS. : Sure. It was Dr. 8 (Phonetic Sp. *00:09:00). 9 MR. • . Okay. No problem. 10 MS. : Yup. 11 MR. : Did anyone else assist you 12 with the autopsy? 13 MS. : Yes. I had morgue technicians 14 and photographers assisting me with the 15 autopsy. 16 MR. : Do you know the names off 17 hand? 18 MS. : I remember the photographer is 19 (Phonetic Sp. *00:09:17). And there 20 were a couple of morgue techs, but the one that 21 I recall is Gosh, what's her last 22 name? It's blanking. I'm blanking on 23 last name. But 24 MR. : Okay. No problem. And you 25 said -- LIMITED OFFICIAL USE EFTA00113120  LIMITED OFFICIAL USE 13 1 MS. : Yeah. 2 MR. : -- there's , and there's 3 one other person. Right? 4 MS. : Yeah. And there was another 5 morgue tech who sort of rotated in and out, and 6 I don't remember which one that was. 7 MR. : Okay. 8 MS. : We usually don't keep track of 9 that. 10 MR. : No problem. 11 MS. . That's her last name. 12 . I know a couple of 13 (Indioccrniblc *00:09:49), and she . Mm- 14 hmm. 15 MR. : Thank you. Based on your 16 recollection of the autopsy, is there anything 17 that stood out in your mind, based on your 18 examination? 19 MS. : Yeah. Definitely. 20 MR. : Do -? 21 MS. : Do you want me to -- 22 MR. : Yes. 23 MS. : -- recount it for you? 24 MR. : Yes, please. 25 MS. : So, he had a really marked LIMITED OFFICIAL USE EFTA00113121  LIMITED OFFICIAL USE 14 1 (Phonctic Sp. *00:10:07) _and obvious ligature 2 furrow (Phonetic Sp. *00:10:10)„ very 3 consistent with what I typically see in a 4 hanging. And he, above the furrow, had fluride 5 (Phonetic Sp. *00:10:16) petechial hemorrhages 6 of his facial skin, his conjunctiva, and in his 7 mouth, all things that I see very frequently in 8 hangings. 9 MR. : I'm going to ask you a favor. 10 So, some of the terminology is going to go 11 right over my head. So, and especially for 12 reporting everything. Is it possible -? I 13 don't know if you can, how do I say? To dumb it 14 down. 15 MS. : Say it in English? 16 MR. : Yes. 17 MS. : I could do that. I'm pretty 18 sure you know what ligature furrow -- 19 MR. : Yes. 20 MS. : -- means. 21 MR. : I do. 22 MS. : It's just a deep -- 23 MR. : Yes. 24 MS. : -- abraded sort of abrasion of 25 the skin. The petechiae that I'm referring to, LIMITED OFFICIAL USE EFTA00113122  LIMITED OFFICIAL USE 1 and the plethora. So, plethora is purple 2 discoloration of the skin from back up of 3 circulation. Petechiae are pinpoint 4 hemorrhages that occur with a similar 5 mechanism. If the blood is cut off, and the 6 small capillaries burst, you get petechial 7 hemorrhages, which, they're just like pinpoint 8 bleeds in the skin. So, he had them in his 9 skin, in his eyes, and in his mouth. 10 MR. : Okay. 11 MS. : Yeah. 12 MR. : And is that consistent with 13 suicides? 14 MS. : It's consistent with a suicide 15 by hanging. Yes. 16 MR. : Right. Hanging. Can that 17 also be associated with anything else, like 18 strangulation, anything like that? 19 MS. : So, the petechiae can be. The 20 plethora, usually not. 21 MR. : Okay. And why not the 22 plethora? 23 MS. : Because the plethora really 24 involves having a sustained steady pressure, 25 and you usually don't get that in a LIMITED OFFICIAL USE EFTA00113123  LIMITED OFFICIAL USE 16 1 strangulation because very rarely is a person 2 going to be still for that, or submit to it, 3 without struggling. So, with a struggle, the 4 pressure is not even, and you really don't get 5 the plethora, and the petechiae aren't quite 6 distributed like his were. His were, like, 7 just all the way from the neck up, he had 8 petechiae. In strangulations, it's usually 9 just the eyes and mouth, not all of the skin. 10 So, even though they can be seen in homicidal 11 strangulations, they usually have a different 12 pattern then I saw in Mr. Epstein. 13 MR. : Got it. Thank you. So, what 14 made you come to the conclusion that Jeffrey 15 Epstein's death was a suicide? Can you walk us 16 through that? I know you mentioned the 17 plethora, the petechiae, and also the ligature 18 itself. What ,all else did you see that made 19 you come to the conclusion as suicide? Sorry. 20 MS. : So, the autopsy didn't show 21 really any signs of a struggle. And every 22 single strangulation case I've had, even people 23 who were really impaired by intoxicants, they 24 struggled. So, he didn't have any marks on his 25 hands. He had one abrasion on his arm, which LIMITED OFFICIAL USE EFTA00113124  LIMITED OFFICIAL USE 1 probably was from convulsing when being 2 hanging. But nothing that suggested a 3 struggle. No broken fingernails. No other 4 bruising anywhere. 5 He was pretty much pristine, other than 6 the neck and face findings. He also internally 7 didn't have strap muscle hemorrhages of the 8 neck. That's bleeding in the lung muscles, in 9 the front of your neck. Nor did he have 10 hemorrhaging in the muscles of the back of his 11 neck. That you see when it's been an 12 incomplete compression, not a sustained 13 compression like a hanging. So, when I don't 14 see those, I'm more likely to think hanging 15 than manual strangulation, or even ligature 16 strangulation. 17 And then, lastly, he did have fractures of 18 his thyroid cartilage and one side of his hyoid 19 bone. These are structures inside your neck. 20 Then the pattern of these fractures was 21 consistent with a hanging. You see a very 22 different pattern of fracturing if there has 23 been a manual compression of the neck versus a 24 sustained pressure of a hanging. And the 25 pattern of his fractures was that of a hanging. LIMITED OFFICIAL USE EFTA00113125  LIMITED OFFICIAL USE 16 1 So, even without an investigation, and 2 although I wanted one, just because of the 3 nature of the case, even without an 4 investigation, this case, autopsy wise, looked 5 like a very clear-cut hanging. 6 MR. : Okay. I'm going to break 7 that down just a little bit. The hyoid -- 8 MS. : Sure. 9 MR. -- the hyoid bone. What is 10 that? 11 MS. : So there's It's a little 12 waerm in my office, sorry - it's a U-shaped 13 bone that sits between your tongue and your 14 larynx. Sort of horseshoed like this, shaped 15 like this, right here. And its function is to 16 aid in swallowing and phonation, speaking. 17 Because it's almost like a little 18 wishbone, when somebody squeezes your neck, it 19 snaps. And if somebody squeezes your neck in a 20 homicidal fashion with un-sustained pressure, 21 it'll snap near the joints where it was 22 centrally. If your hyoid bone is pressed 23 against your spine by hanging, it fractures at 24 the tips. Maybe one. Maybe both. His is 25 fractured on the tip, on the left. So, that's LIMITED OFFICIAL USE EFTA00113126  LIMITED OFFICIAL USE 19 1 why I think his hyoid bone is fractured from 2 hanging and not manual strangulation. 3 MR. : Okay. And what about the 4 thyroid -? What is the thyroid? 5 MS. : So, the thyroid cartilage, I 6 think that's what you mean -- 7 MR. : Yes. 8 MS. : -- is what we refer to as, 9 like, the larynx, or the voice box. And it's 10 sort of a -. It's almost shaped like a 11 butterfly inside of your throat. And it has 12 two horns at the top, which be almost like the 13 tops of butterfly wings. And those sit next to 14 the end points of the hyoid bone. 15 MR. : Okay. 16 MS. : So, that structure also gets 17 pressed against the spine when you hang, and 18 the tips break, and that's exactly where his 19 thyroid cartilage is fractured, on both of the 20 tips. 21 MR. : Okay. 22 MS. : And if it's fractured during a 23 manual strangulation, whether it's a bar type 24 or a pincher type, it usually fractures, again, 25 centrally or unevenly, not in this even LIMITED OFFICIAL USE EFTA00113127  LIMITED OFFICIAL USE 1 fashion. 2 MR. : And because there was 3 consistent - you're saying - because there was 4 consistent pressure 5 MS. : Yes. 6 MR. : -- pressure on the neck, it's 7 a different type of damage that happens to the 8 hyoid bone, and also the thyroid cartilage 9 itself, and that's what you saw in Epstein - 10 Jeffrey Epstein 11 MS. : Yes. 12 MR. : -- and that's why you came to 13 the determination of suicide? 14 MS. : Yes. All of these things 15 combined, lack of other trauma, beautiful 16 ligature furrow that actually peaked. You 17 know, if it's a ligature strangulation, they 18 usually don't peak upward. They're either 19 straight across, or they peak downward. His 20 peak is upward slightly. He's got the 21 plethora, the petechiae, the patterns of 22 fracturing, and no other trauma. So, all of 23 that together made this autopsy very, very 24 consistent with a suicidal hanging. 25 MR. : When you say peak, you mean LIMITED OFFICIAL USE EFTA00113128  LIMITED OFFICIAL USE 21 1 the back of the actual ligature itself, on the 2 back of the neck, going up? 3 MS. : Yeah. I can -. Let me see. 4 I'm going to use my phone cord to show you. 5 When you hang yourself, it hangs, and it 6 actually will sometimes make like a peak at the 7 back, right? And sometimes it isn't fully 8 circumferential. That's really classic for 9 hanging. So, Mr. Epstein had a peak, it was 10 sort of to the right and behind the ear, and it 11 was not fully circumferential. Totally 12 consistent with a hanging. 13 MR. : And if it was circumstantial, 14 that means someone strangled him? 15 MS. : It can, or it can mean that if 16 he has - if you are really good, if what they 17 showed me was his ligature, he didn't tie a 18 good slip knot, i.e., he didn't tie a good 19 hangman's knot. If you tie a good hangman's 20 knot, it will sometimes be circumferential just 21 because it tightens with your weight. If you 22 don't, if you have a fixed knot, you slump into 23 the ligature, and it doesn't -. It isn't 24 circumferential. So, it depends on the 25 ligature. I have a feeling he wasn't well LIMITED OFFICIAL USE EFTA00113129  LIMITED OFFICIAL USE 22 1 versed in the tying of hangman's knots or good 2 slip knots, and that's why his isn't 3 circumferential. 4 MR. : So, what type of knot did you 5 see on the noose? 6 MS. : So, they showed me a noose 7 with what looked like a fixed sort of granny 8 knot. And I'm not convinced that's even a 9 noose because they told me they thought this 10 was the ligature, but there was a lot of 11 confusion about what the ligature - which thing 12 was actually the ligature. And there was a lot 13 of stuff in that room. But the thing that they 14 said, this is the ligature, it had a fixed 15 knot. Not a slip knot. 16 MR. : Okay. I kind of jumped, but 17 I'll come back to the noose part. That's later 18 on in the interview. You said there was no 19 defensive wounds. So, if someone was to - if 20 there was possibly an attack - me just putting 21 it out there - if it was an attack, there would 22 have been defensive wounds. Where else? Where 23 would you have seen the defensive wounds? 24 MS. : So, what I tend to see in 25 victims of strangulation is they have lots of LIMITED OFFICIAL USE EFTA00113130  LIMITED OFFICIAL USE 23 1 debris under their fingernails from fighting, 2 and from trying to pull the strangling person 3 off their own neck. So, you'll see a bunch of 4 linear abrasions usually on the neck itself, 5 and chin, and you'll see a lot of debris under 6 the nails. He didn't have either of those 7 things. Those are usually women. 8 Being that he's a man, I would have also 9 expected more of sort of the pugilistic type of 10 injuries, because I can't imagine somebody 11 strangling a man easily without him trying to 12 punch them out. So, I would think there would 13 be some, you know, punch-type things, too, or 14 sort of contusions on the knuckles and stuff. 15 But he didn't have any of that. None of that 16 stuff. 17 MR. : Is it possible, I mean, in 18 cases of suicide, like, once someone tries to 19 hang themselves, do they just sit there? I 20 mean, is it possible that they -? Normally 21 with a person trying, you know, last second, 22 change their mind, and try to dig in, and try 23 to stop themselves from dying? 24 MS. : Well, that really rarely 25 happens. I've yet to see that happen. I've LIMITED OFFICIAL USE EFTA00113131  LIMITED OFFICIAL USE 1 seen hangings where people simply tie a 2 ligature and slump forward in a chair. It 3 happens pretty quickly. You lose consciousness 4 in, like, less than a minute. And then, at 5 that point, there's really no intentional 6 activity, and you start to seize pretty 7 quickly. 8 So, there is a very small sort of envelope 9 of time, and most people are able to not fight 10 that. I mean, I rarely -. I actually can't 11 think of any case where I've seen the clawing 12 things in a hanging, even a non-complete 13 suspension hanging, which I suspect this is. 14 MR. : No problem. SAC , any 15 questions on that? 16 MR. : Yes, doctor. So, the broken 17 hyoid bone and the fractured thyroid. Was 18 there any indication that these bones were 19 damaged -- 20 MS. : Mm-hmm. 21 MR. : -- before the possible - well, 22 I guess the break, right? - but could you be 23 able to tell if there was some kind of damage 24 to those bones before you actually conducted 25 your atop autopsy? LIMITED OFFICIAL USE EFTA00113132  LIMITED OFFICIAL USE 25 1 MS. : So, I had an anthropologist 2 look at those to determine exactly that, if 3 they were fractured superimposed on old trauma, 4 or if they were just recent fractures. And 5 their opinion was that they were recent 6 fractures. It was no superimposed trauma. 7 MR. : So, I'm guessing you were 8 familiar with the July 23rd incident where Mr. 9 Epstein tried to take his life initially? 10 MS. : Yes. I was. 11 MR. : And there was a noose found 12 around his neck. We were just trying to get an 13 idea if it's possible that he sustained 14 injuries during that attempt, that could have 15 also assisted, or made things, you know, the 16 broken hyoid and the thyroid cartilage could 17 have also been because of the fact of the 18 initial attempt? Could it have been broken 19 because of the damage already caused by the 20 July 23rd incident? 21 MS. : I think probably not, just 22 based on how they appeared. They don't 23 describe any - the anthropologist - doesn't 24 describe any healing. So, there would have 25 been, if thrcc there is a refracture from LIMITED OFFICIAL USE EFTA00113133  LIMITED OFFICIAL USE 26 1 prior fracture, there probably would have been 2 some healing visible, and they didn't see that. 3 Also, if he had sustained that kind of 4 trauma the first time, he would have had 5 symptoms. He would have, you know, had 6 difficulty talking and swallowing, and they 7 probably would have noted that clinically. So, 8 that might be a question you direct the people 9 who took care of him after the first attempt. 10 MR. : Okay. 11 MR. : And just a follow up, doctor. 12 You said that people lose consciousness within 13 a minute. Is that pretty standard, you know, 14 when they attempt to hang themselves? Is that, 15 in your practice, a pretty standard time frame? 16 MS. : So, where I'm getting that 17 information from isn't so much my practice as 18 there is a woman in Canada who researched this 19 extensively, and actually had a collection of 20 films of people hanging themselves. 21 They were judicial hangings. They were 22 in-custody hangings where there were actual 23 cameras on prisoners who had managed to hang 24 themselves. And there were people who actually 25 filmed their own hangings. LIMITED OFFICIAL USE EFTA00113134  LIMITED OFFICIAL USE 2. 1 And on those films, there is a really 2 consistent pattern of they hang, in about a 3 minute or less, they become limp, and then they 4 start to seize violently. And it's almost a 5 hundred percent reproducible. So, it's based 6 on sort of evidence that other people have 7 gathered as opposed to anything I've done or 8 researched on my own. 9 MR. : Sure. Okay. No. Thank you. 10 MR. : Is there anything else you 11 observed during the autopsy examination that 12 you thought might seem suspicious or out of 13 place? Like bruising, cuts, things like that? 14 MS. : Nothing at all. 15 MR. : I'm going to show you -. I'm 16 going to share a picture with you. This is 17 part of your -. Bear with me. Can you see 18 this? 19 MS. : Yes. 20 MR. : Do you see the cut above the 21 lip? 22 MS. : Yeah. 23 MR. : On him. 24 MS. : Yeah. I do. 25 MR. : Do you know where -? Do you LIMITED OFFICIAL USE EFTA00113135  LIMITED OFFICIAL USE 1 know what the cause of that? Is that something 2 from the resuscitation, or was that -? 3 MS. : So, there were other photos 4 that will also show cuts on the other side of 5 the lip, inside, and I think that these are 6 from resuscitative efforts. They're pretty 7 commonly seen when there is a mixture of 8 different types of resuscitation, particularly 9 if they've used a mask, or if it's somebody who 10 is - if there was any bystander resuscitation, 11 as well. So, these, to me, appeared 12 resuscitative. 13 Also, there is no, like, real bruising 14 under these. If I had thought these were from 15 some kind of impact to his face, there would be 16 bruising, and if you look at the rest of the 17 autopsy, I have the inside of his mouth 18 photographed really well, and all you see are 19 the petechiae. There is no big bruising. So, 20 these aren't impacts. These are consistent 21 with him probably being already dead when they 22 were trying to resuscitate him. 23 MR. : Okay. And this is, this 24 picture is labeled, "Photos, I.D., Visual 001". 25 This is the picture that was taken by your LIMITED OFFICIAL USE EFTA00113136  LIMITED OFFICIAL USE 1 office. Right? 2 MS. : Yes. It's taken by the 3 mortuary technicians for the purpose of showing 4 it to a family so they can identify the 5 deceased formally for us. 6 MR. : Okay. (Indiscernible 7 *00:25:21). 8 MS.-: In the next picture, you car. 9 see the petechiae really well on his face, 10 actually. 11 MR. : Yeah. Doctor, that was going 12 to be my question. Is this a good depiction of 13 the petechiae, was you described earlier to us? 14 The blonchyness (Phonetic Sp. *00:25:29) red in 15 his face. Is that what you typically see? The 16 petechiae. 17 MS. : Yeah. 18 MR. : Okay. 19 MS. : Yeah. You can see it's 20 blotchy, and almost sort of -. It looks almost 21 like a measles rash, but it's small pinpoint 22 hemorrhages. Yeah. 23 MR. : Okay. 24 MR. : And you mentioned that's from 25 sustained pressure on the neck. LIMITED OFFICIAL USE EFTA00113137  LIMITED OFFICIAL USE Ju 1 MS. : Yes. 2 MR. : All right. I'm going to show 3 you a couple other pictures from the same 4 Tell me if you recognize this picture. It was 5 also labeled, "INV scene 004." It was provided 6 by your office. Do you recognize this? 7 MS. : I do. 8 MR. : Okay. So, just to give an 9 explanation. Did you have a chance to go by 10 the cell, see the cell itself? 11 MS. : No. They wouldn't let me go 12 in and see the cell itself. I had to rely on 13 photographs. 14 MR. : Yeah. So, it's a little 15 tough. So, just to give an explanation. Where 16 the picture, the person's point of view, 17 whoever is standing there, that's where the 18 door is, the cell door is. Now, if you look 19 in, there is a little window on the door. So, 20 when we got a chance to interview the 21 correctional officer who found Mr. Epstein, he 22 was basically doing feeding, just to give you 23 an understanding, he was coming there early 24 morning, he was doing the feeding time, and he 25 knocked on the cell, and you see the mattress LIMITED OFFICIAL USE EFTA00113138  LIMITED OFFICIAL USE 1 on the floor? 2 MS. : Yes. 3 MR. : Mr. Epstein's legs were 4 sticking out. So, he was actually - and not, 5 like, to (Indiscernible *00:26:53) - I mean, 6 the mattress sticking out. Mr. Epstein was to 7 the right itself. So, he couldn't see anything 8 to the right. He called out to Mr. Epstein. 9 He didn't answer. So, he walked in. 10 And when he walked in, he couldn't explain 11 it for us, a mess like this, he explained there 12 was a lot of linens, a lot of different stuff, 13 but the mattress was there. And when he found 14 Mr. Epstein - and I'm going to show you another 15 picture - Mr. Epstein was to the right, the 16 part that we can't see in the initial picture. 17 MS. : Yup. 18 MR. : And he was hanging from the 19 corner over here. So, you see then, he 20 mentioned that's part of the noose. And he was 21 hanging low with his bottom, with his buttocks 22 off the ground. So, his feet was out, and his 23 buttocks was off the ground. So -- 24 MS. : Okay. 25 MR. : -- that's how he found him. LIMITED OFFICIAL USE EFTA00113139  LIMITED OFFICIAL USE 1 So, basically, he didn't use a cutter. He 2 actually pulled. So, I think he used all his 3 might, he panicked, so the C.O. kind of pulled 4 the noose, and the noose broke, and Mr. Epstein 5 fell to the ground, and then he wrapped his 6 arms around Mr. Epstein and dragged him out to 7 the outer area. I don't know if I have a 8 picture. Let me go back. He dragged him out 9 here. Can you see where my mouse is? 10 MS. : Yup. 11 MR. : He dragged him out here so he 12 could perform CPR on it, or on Mr. Epstein. 13 MS. : Can I ask you a question 14 quickly? 15 MR. : Yeah. 16 MS. : So, I see that piece of stuff 17 hanging in the corner there. That is not what 18 they brought to me and called the ligature. 19 When this correction officer pulled Jeffrey 20 Epstein out to start CPR, did something remain 21 around his neck? 22 MR. : So, he doesn't recall. He 23 thinks he took it 24 MS. : Ah. 25 MR. : -- took it off. He was not a LIMITED OFFICIAL USE EFTA00113140  LIMITED OFFICIAL USE 33 1 hundred percent sure. Everything happened in 2 the moment in time. One of the questions we 3 were going to ask you is, who provided you with 4 that noose? 5 MS. : I believe -. So, I think that 6 it was given to the investigators by the EMS 7 crew who took over the -. Yeah, that's the 8 picture of how it came to us. It was in the 9 bag. And this is what they brought me. 10 MR. : So, this is labeled, "Path 11 evidence 006." And the picture prior to this 12 was, "INV scene 009." So, this is what they 13 provided to you. And you said this didn't seem 14 -. This was like a -. You didn't think this 15 was the piece that cost - that was the noose 16 around his neck? 17 MS. : Well, I'm asking because in 18 the photo you showed me a piece of stuff 19 hanging, and you tell me that the correction 20 officer pulled and ripped. This thing that 21 they gave me isn't ripped at all like it would 22 be ripped off of something. It's ripped to 23 create the strip, but it's not ripped off. So 24 25 MR. : Okay. LIMITED OFFICIAL USE EFTA00113141  LIMITED OFFICIAL USE 1 MS. : I'm -. 2 MR. : That's the same question we 3 had. 4 MS. : It's making me wonder if this 5 is even the ligature that they gave me. 6 MR. : All right. So, I'm going to 7 show you another picture. This is in the same 8 set of pictures that you had to -. Sorry. 9 (Indiscernible *00:29:50). 10 MS. : Oh, no, don't do that. 11 MR. : This is labeled "INV scene 12 055." Right? And this is when you -. Let me 13 show you the initial picture again. You 14 notice, there's the entrance when we walk in. 15 This is the little table, stool area right 16 there. 17 MS. : Yes. 18 MR. : This is INV picture 005. 19 There is a toilet here. There is a stool 20 there. Now, we're going to go back to the 21 other picture. You'll notice this to the left 22 of the stool. You see that? 23 MS. : Yes. 24 MR. : You see that little noose 25 laying there? LIMITED OFFICIAL USE EFTA00113142  LIMITED OFFICIAL USE 1 MS. : Yeah. 2 MR. : Now I'm going to give you a 3 close up over here. This is INV scene 015. 4 This seems like there was another noose that 5 was laying at the scene. I don't know if you 6 can see that a little bit better. 7 MS. : Yeah. 8 MR. : And this seems to have a 9 tear. 10 MS. : It does. 11 MR. : And if you compare it to the 12 other picture that we saw, if he pulled, if 13 this was around Mr. Epstein's neck, to me, it 14 seems like there should have been more 15 Like, it should have been tight, tightened up a 16 lot more. Like, he should have been more 17 wrinkled up because it was wrapped around his 18 neck. Right? As a noose. But it doesn't seem 19 like there was much. It looks like Can you 20 explain the difference? By looking at it, what 21 do you think? 22 MS. : Well, what it looks like to me 23 is that it's too tidy. And if you tell me that 24 somebody tore him off of the corner -. Like, 25 when you look at that thing that they showed LIMITED OFFICIAL USE EFTA00113143  LIMITED OFFICIAL USE 36 1 me, it was never clear to me how that suspended 2 him from anything. All right? I could see him 3 putting the looped part around his neck, but I 4 can't see how this suspended him from anything. 5 There is no knot hanging anywhere or anything 6 like this. 7 And then, that other thing you showed me 8 that's by the desk apparatus, that is torn, it 9 makes more sense to me because that's got the 10 tearing that the correction officer remembers. 11 Either one of these, in terms of its shape, 12 could have caused the markings on Mr. Epstein, 13 but this one, this second one that you're 14 showing me that was never brought to me, looks 15 like a more likely candidate. 16 MR. : Okay. Do you recall -? Do 17 you know if the initial noose that was brought 18 to you, was there any DNA testing, or any kind 19 of testing done on that noose? 20 MS. : I didn't swab it or anything. 21 We're instructed not to do that just to submit 22 it. So, I am not sure what happened to it 23 after I bagged it up and gave it to evidence. 24 MR. : When you say submit it, what 25 does that mean? LIMITED OFFICIAL USE EFTA00113144  LIMITED OFFICIAL USE 1 MS. : It means that I bag it up 2 again, and submit it as evidence, and then 3 whoever is investigating, the cops, you guys, 4 whoever it is, they decide whether or not to do 5 DNA testing. I don't actually order that. 6 MR. : Okay. 7 MS. : Because it's irrelevant to me, 8 really. 9 MR. : SAC , do you have any 10 questions on the pictures before -? 11 MR. : Yes. I do. Just a follow up. 12 And I think you said this earlier. You said 13 this cloth material could have caused those 14 marks. So, regardless of what noose was used 15 here, we have several in the pictures, but what 16 you're saying is that, this type of material 17 could have caused the marks consistent of what 18 you noticed in your autopsy? 19 MS. : Correct. 20 MR. : Okay. 21 MR. : And your office doesn't have 22 the second noose, you said. Right? 23 MS. : I don't think I ever received 24 this piece of stuff that you're showing me. 25 No. LIMITED OFFICIAL USE EFTA00113145  LIMITED OFFICIAL USE ic 1 MR. : Okay. And this knot. I 2 know, since you mentioned hangman's noose, and 3 different nooses, do you 4 MS. : Mm-hmm. 5