As a physician who has worked with prisoners as well as suicidal patients, I was shocked by the strange circumstances surrounding sexual offender Jeffrey Epstein’s death by apparent hanging in his cell. We may never know for sure all the details of what happened, though I expect further review of the autopsy results to determine once and for all whether this death was self-inflicted.
Earlier in my career, I worked on both a psychiatric ward and a prison ward. In both places, the regular surveillance was sufficient (at least every 15 minutes on the psych ward) so that suicide was almost impossible. For someone who, like Epstein, had apparently made a suicide attempt less than three weeks before, it is almost inconceivable to me that he could possibly be without diligent, frequent observation and without surveillance cameras constantly monitoring him.
How could he be placed in a cell, according to the New York Post's unnamed source, with a bunk bed to hang himself on and a strong enough bed sheet to do it with? If one cellmate was transferred, as sources told The New York Times, why wasn’t he immediately replaced with another?
'Serious irregularities' raise eyebrows
It's true that suicide is the leading cause of death in jails and, in 2014, hit a 15-year high in federal and state prisons, according to the Bureau of Justice Statistics. But although accused sexual offenders are particularly at risk for both suicides and homicides, the Metropolitan Correctional Center where Epstein was imprisoned has had only one reported suicide over the past 40 years, the gangster Louis Turra, 21 years ago.
Despite its reputation for squalor and overcrowding, the corrections center is not known for suicide.
What is most disturbing to me, as a physician, is the way Epstein went from being on suicide watch starting July 23 to going for long periods without being observed just six days later, sources told The Times. Having treated depression for many years, I know suicidal ideation doesn’t turn on and off like a switch. A person does not want to end it all one day — staring down news as bleak as Epstein faced — and then six days later you are suddenly stable and out of danger. Whoever took Epstein off this watch made a very poor judgment at the very least. And the latest reports by sources of The Times that guards fell asleep for possibly hours while on watch and then falsified records is simply inexcusable.
I am not a conspiracy theorist, though it is conceivable to me that the “serious irregularities” Attorney General William Barr is concerned about could possibly turn out to reveal that Epstein’s was not a simple suicide, that there were other actors in this tragedy. Time, along with the final autopsy report, will tell. It is clear that there were many victims in Epstein's life who loathed him for legitimate reasons, and many others who stood to lose more by his survival than by his death.
Doctors try to save everyone
But no matter what happened inside Epstein’s cell, both the medical personnel and the prison authorities who were involved had the obligation to bring him to a safer place, whether that meant more enhanced psychiatric observation inside the prison, or transferring him with enhanced security to an inpatient psychiatric facility. There was plenty of warning that this could happen.
Children deserve more than we give them: I lost a student to sex trafficking and murder. We woefully fail to protect our children.
After all, we don’t judge our patients, no matter how repulsive their actions or the allegations against them are. Doctors and nurses are simply assigned to try to keep them alive. I have taken care of a perpetrator of assault chained to a stretcher in the emergency room right next to his victim suffering from a gunshot wound, and I have had to do my best to save both without hesitation.
The prison officials who took Jeffrey Epstein off his suicide watch prematurely, relegating him to almost certain death, did not do the prison system and how it handles mental health emergencies any favors.
Marc Siegel, a member of USA TODAY's Board of Contributors and a Fox News medical correspondent, is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. Follow him on Twitter: @DrMarcSiegel
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This article originally appeared on USA TODAY: Jeffrey Epstein death: Suicidal prisoners deserve better treatment