Despite warning signs, why wasn't Jeffrey Epstein on suicide watch when he died?

Joey Garrison, Kevin McCoy and Olivia Sanchez
Billionaire sex offender Epstein charged with trafficking conspiracy

Less than three weeks ago, Jeffrey Epstein was placed on suicide watch after he was found in his New York jail cell with injuries to his neck.

But the wealthy financier had already been removed from constant surveillance when he was found unresponsive in his jail cell early Saturday morning. He was rushed to a hospital and pronounced dead after an apparent suicide by hanging.

Epstein, 66, was removed from suicide watch on July 29, just six days after the self-inflicted bruising on his neck was spotted, according to the New York Times. It meant that he was returned to the special housing unit at the jail, which is separated from the rest of the facility and has extra security. 

The Federal Bureau of Prisons did not respond to a message from USA TODAY asking why Epstein was taken off suicide watch. His death, which followed the July 23 warning signs, has raised questions about whether the Metropolitan Correctional Center followed proper procedures to ensure Epstein didn't kill himself. 

"The decision to remove him appears to have been a colossal error that must be thoroughly probed," Harry Litman, former U.S. attorney and deputy assistant attorney general, wrote in a stinging column in the Washington Post. He also questioned why Epstein was given access to the tools needed for suicide. 

How Epstein died: Disgraced financier Jeffrey Epstein, awaiting sex trafficking charges, dead of apparent suicide

Federal jails and prisons are required to house at least one room for inmates on suicide watch with staff taking shifts to ensure the individual is under "constant observation." That typically means having someone watching inmates 24 hours a day.

Observers must document behavior, under federal law, and inmates can only be removed from suicide watch when they are determined to be "no longer at imminent risk for suicide" or in need of medical attention.

Who decides when inmates are taken off suicide watch?

Mental health professionals determine whether someone is placed on suicide watch, said Jeff Eiser, a corrections expert with 30 years of experience operating prisons and jails in Ohio. He said a mental health expert would decide the level of care following evaluations and determine when someone is fit to be removed. 

Lisa Boesky, a clinical psychologist and jail suicide expert from San Diego, said that if Epstein was no longer on suicide watch, it likely meant he was cleared by a licensed mental health professional.

“When removing such a high risk individual from suicide watch it would be critical to do it in a step-down fashion so that there is still some extra monitoring on the high-risk individual.”

But Boesky said Epstein was still "a high risk for suicide" because of the nature of his crimes, the humiliation he is experiencing and the recent reported suicide attempt. "This would increase his risk for suicide significantly.”

Inmates can fake improvement

Christine Tartaro, a criminal justice professor at Stockton University in New Jersey, said it’s not totally uncommon for an inmate to be removed from suicide watch after six days. 

“The length varies by individual,” Tartaro said. One person might have a fleeting moment of suicidality but then stabilize and accept their situation, whereas another might be in the depths of a depression that requires monitoring for much longer.

Experts say it's also possible Epstein pretended to be doing better to get out of suicide watch.

“Not everyone is honest with the corrections staff," Tartaro said. "If they really want to kill themselves they might say that they are fine, to act fine, to not draw attention to themselves. So there is that possibility here. The other possibility is that he was showing signs and really not doing well.”

Epstein’s celebrity status, and the crimes which he was accused of, likely have warranted some extra supervision in general, Tartaro said.

“Those who harm children are at the bottom rung and are seen as being acceptable targets for violence,” Tartaro said. 

Epstein shared a cell with Nicholas Tartaglione, a former police officer facing murder charges. Tartaglione's attorney last month denied that his client was responsible for Epstein's injuries. 

How was Epstein injured? Lawyer for Nicholas Tartaglione denies client involved in Jeffrey Epstein's jail injuries

Suicide watch isn't foolproof 

Although around-the-clock monitoring can decrease the chance of inmates killing themselves, Eiser said suicides in prisons are hard to prevent.

"One thing in the jail business unfortunately is if somebody wants to hurt themselves at some point, unless you have constant eyes on them, it's almost impossible to prevent," Eiser said.

"To point fingers now at anybody would be premature I think," he said, adding that the case needs to first be investigated to identify the facts. 

Epstein's death came within 24 hours after long-sealed documents were released by a federal court in a since-settled lawsuit against Epstein’s ex-girlfriend by Virginia Giuffre, one of Epstein’s accusers. The documents included depositions of years of alleged sex acts involving underage girls.

It was unclear before Epstein's death whether federal prosecutors were pursuing a superseding indictment that would include additional charges and defendants beyond Epstein. Epstein was know for his high-profile connections, including Bill Clinton, Donald Trump and Prince Andrew.

Questions from Congress: 'We need answers. Lots of them.': Congress calls for investigations after Jeffrey Epstein's death

U.S. Attorney General William Barr said the Department of Justice Inspector General would open an investigation in addition to the FBI investigation.

“Mr. Epstein’s death raises serious questions that must be answered," Barr said.

What is suicide watch?

According to the U.S. Justice Department, suicide is the leading cause of death in jails.

Suicide watch is a more “punitive management of an inmate,” said Lindsay Hayes, an expert on inmate suicide and prevention and a project director for the National Center on Institutions and Alternatives. It typically includes being locked in a cell without contact with other inmates, being served only finger foods, and being required to wear a “safety smock” instead of regular jail clothing, he said. 

The smock is usually heavy, quilted fabric that’s difficult to tie together or tear into strips that could be used for an attempted asphyxiation or hanging.

“Being on suicide watch is probably even worse than being harassed by other inmates,” said Hayes, who added that jail and prison inmates often try to get reclassified at a lower level of monitoring at the earliest opportunity.

For that reason, it can be “hard for a clinician to determine if the person is suicidal or not,” or simply wants to return to less restrictive treatment within a jail or prison, said Hayes.

He said federal officials should conduct a rigorous and transparent investigation of the suspected suicide by Epstein, whom he characterized as “probably the most high-profile inmate right now” in the federal correctional system.

“If there was any wrongdoing, people should be held accountable,” said Hayes.

Reach Joey Garrison on Twitter @joeygarrison.

This article originally appeared on USA TODAY: Why wasn't Jeffrey Epstein on suicide watch when he died?