BP-A0563 JUN 10 MULTI-LEVEL MORTALITY REVIEW U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Date: 09/09/2019 To: Office of Quality Management From: MCC New York Health Services Subject: Mortality Review for Inmate Epstein #76318-054 Inst: MCC-NY

Name:

Epstein, Jeffrey

Reg. #:

76318-054

| DOD : | 08/10/2019 | DOB: | 01/20/1953 | Age: | 66 | Sex: | Male | Race: White | | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | Place of Death: __ Inst. ✓ Community Hospital __ OTHER Name of community hospital: New York Presbyterian Lower Manhattan Hospital Nature of Death: __ Natural (chronic) __ Natural (Acute) ___ Accidental: ___ ___ Homicide | ✓ Suicide | (Method) | Hanging | | :--- | :--- | :--- | Cause(s) of Death: Axphyxiation NARRATIVE SUMMARY: (Should include components below)

Date of admission to the

07/06/2019

✓ New commit __ Transfer from ___ __ Holdover **Status:** ___Inpatient at: ___Inst. ___Community Hospital ___Outpatient ## Admitting 1. Sleep Apnea 2. Hypertriglyceridemia 3. L4 - L5 Lumbar Stenosis 4. ___ - (PIs. continue on supplementary page if necessary) ## Past diagnosis: 1. Sleep Apnea 2. Hypertriglyceridemia 3. L4 - L5 Lumbar Stenosis 4. ___ (PIs. continue on supplementary page if necessary) Significant mental health ___(Yes) ✓___(No) ___(NA) Include specific information as relevant to death: ___ ___ ___ PDF Prescribed by P6013 EFTA00040930 Name: Epstein, Jeffrey Reg. #: 76318-054 DOB: 01/20/1953 Admitting diagnosis:(continue) Past diagnosis: (Continue) PDF Prescribed by P6013 EFTA00040931 Description of course of illness (past and present) and cause of the death in sufficient detail to indicate circumstances of death, including treatment, medications, diagnostic testing, e tc. Give findings of diagnostic exams. Insert pages in this section as required.

Intake Screening History and Physical present?	√Yes	No	NA
Date of most recent History and Physical	07/09/2019
Timeliness of Diagnostic and Treatment regimes?	√Yes	No	NA
Discharge summary from Attending M.D. on chart
Institution	Yes	√No	NA
Community Hospital	Yes	√No	NA
Autopsy	Yes	√No	NA
Toxicology	Yes	√No	NA
Death Certificate Available	Yes	√No	NA

## INSTITUTION MEDICAL CARE REVIEW: Severity of illness at time of admission to hospital / Health Services Unit ___ Critical. ✓ Stable ___ Unknown Prognosis on admission to hospital / health Services Unit ___ Poor ✓ Good NA Were diagnostic procedures appropriate and timely ✓Yes ___No Was treatment appropriate to diagnosis and instituted timely Yes ___

Was treatment appropriate to complication	√Yes	No
Surgical Procedures(list)	Yes	No	√NA

Appropriate pre-operative evaluation completed, including lab, physical exam, updated history

Yes

Patient compliant with treatment / medications

Poor	Good	Unknown
Yes	No	NA

3 PDF Prescribed by P6013 EFTA00040932 Discussion with patient or patient's family regarding prognosis ___Yes___No___NA

DNR order

___Yes

___Date

✓No

Advance Directive / Living Will

Yes

## LOCAL COMMUNITY HOSPITALIZATIONS ONLY: Type of admission ___Routine ✓Emergent ___Other Method of transportation appropriate to patient condition ☑ Yes ___ No ___ NA Severity of condition at time of admission to local hospital ✓ Critical Stable Unknown Prognosis on admission to local hospital Poor Good Unknown Were diagnostic procedures appropriate and timely Yes No

Was treatment appropriate to diagnosis and instituted timely	√ Yes	No
Prognosis with treatment	√ Poor	Good	Unknown

Any complications adversely affecting outcome: (describe briefly) Asphyxiation Secondary to Hanging.

Was treatment appropriate to complication	√Yes	No
Surgical Procedures(list)	Yes	√No

Appropriate pre-operative evaluation completed, including lab, physical exam, updated history

Yes

Complications related to surgical procedures	Yes	No
Describe

Prognosis following surgical procedure

Poor

Good

Unknown

Patient compliant with treatment / medications	Yes	No	NA
Discussion with patient or patient's family regarding patient prognosis	Yes	No	NA

PDF 4 Prescribed by P6013 EFTA00040933

DNR order	Yes	Date	No
Advance Directive / Living Will	Yes	Date	No
REVIEW OF EMERGENCY MEDICAL CARE:
Was death related to a medical emergency	Yes	No
Response to medical emergency notification timely	Yes	No	NA
Physician	Yes	No	NA
Physician Assistant		No	NA
Nurse Practitioner		No	NA
Nurse(s)	Yes	No	NA
Emergency Medical Techs	Yes	No	NA
Others	Yes
Others	Yes
CPR	Yes	No	NA
ACLS List protocol(s) used(if appropriate)By EMS.	Yes	No	NA
Problems encountered during medical emergency,e.g.,equipment, communications, transportation.Describe briefly:	Yes	No	NA
Providers responding maintain current certification/credentials inSIC/LIC/ICP/ICPIM	Yes	No	NA

## SUMMARY REVIEW: Inmate Jeffery Edward Epstein #73618-054 a 66 year old male with a history of Obstructive Sleep Apnea on CPAP at night, a history of Hypertriglyceridemia treated with Vascepa, no past Mental Health History prior to incarceration and L4-L5 Stenosis. On July 23, 2019, at 2:00 a.m. he was placed on Suicide Watch for 31 hours and 5 minutes due to abrasion located on the lower anterior surface of his neck area. On July 24,2019 he was taken off Suicide Watch and was placed on Psychological Observation. On July 30,2019, he was removed from Psychological Observation and was placed in the Special Housing Unit where he was housed with a cell mate. On August 8, 2019, he was seen by Psychology Services and denied suicidal ideation, intention or plan. On August 10, 2019, at 6:33 a.m. Special Housing Unit Staff found inmate Epstein unresponsive in his cell and attempted to wake him. The body alarm was activated in SHU and the Control Center announced a medical emergency. CPR was initiated by Special Housing Unit Staff. At 6:35 a.m. medical staff responded and continued CPR and the AED was applied. The Control Center called for an ambulance. The EMS arrived at 6:45 a.m. and the paramedics continued CPR. Inmate Epstein remained unresponsive. Inmate Epstein was intubated, and the ACLS Protocol was initiated by the EMS. No pulse found, no shock was advised and the inmate was prepared for transport to local hospital while continuing CPR. At 7:10 a.m. the EMS departed institution en route to New York Presbyterian Lower Manhattan Hospital. At 7:36 a.m. the inmate was pronounced dead by the ER Physician PDF 5 Prescribed by P6013 EFTA00040934

Documentation in medical record reviewed by Mortality Review Committee and found to be within acceptable limits. If no, describe	√Yes	No	NA
Did patient receive appropriate and adequate health care, consistent with community standards, during his incarceration in the Federal Bureau of Prisons? If no, explain	√Yes	No	NA

State any strengths and weaknesses that existed: 1. The Mortality Review Committee reviewed the Medical Record. The patient received timely and appropriate medical and psychological care. 27. Recommendation(s) if any. The Mortality Review Committee reviewed the Medical Record. No recommendations at this time. 6 PDF Prescribed by P6013 EFTA00040935 ## 28. Attachments: ___1. Medical Record ___3. Death Certificate 2. Narrative Summary ___4. Autopsy Report 5. Other Documents as appropriate (list) ___ ALL INFORMATION CONTAINED IN THIS REPORT IS EXEMPT AND TO BE CONSIDERED FOR REVIEW/VIEWING ON A NEED TO KNOW BASIS ONLY. PDF 7 Prescribed by P6013 EFTA00040936 # OFFICE OF THE REGIONAL DIRECTOR Comments: Agree with Institution MRC ___ Disagree with Inst. MRC Recommendations or Action taken:

Regional HSA

Regional Director

PDF 8 Prescribed by P6013 EFTA00040937 # OFFICE OF QUALITY MANAGEMENT Comments: Signature of Review Committee Member PDF 9 Prescribed by P6013 EFTA00040938