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A. SHU Inmate Counts....................................................... 61
B. Staff Rounds in the SHU....................................................... 67
VI. Epstein's Death on August 10 ....................................................... 70
A. Discovery of Epstein Hanged in Cell and Emergency Response.................... 70
B. Items Found in Epstein's Cell on August 10 Following His Death.................... 76
C. Autopsy Results................................................................ 79
Chapter 6: The Availability of Limited Recorded Video Evidence Due to the Security Camera Recording System Failure....................... 81
I. Background on the Security Camera System at MCC New York....................... 81
II. Discovery of Security Camera System Recording Issues in August 2019............... 82
A. Discovery on August 8 of the DVR 2 Failure that Occurred on July 29................ 82
B. Response on August 8 and 9 to Discovery of the Recording Failure .................... 83
C. SHU Camera Locations and Operational Status on August 10........................ 84
D. FBI Forensic Analysis of the DVR System .............................................. 92
Chapter 7: Conclusions and Recommendations........................................... 94
I. Conclusions ............................................................................... 94
A. MCC New York Staff Failed to Ensure that Epstein Had a Cellmate on August 9 as Instructed by the Psychology Department on July 30 ....................... 98
B. MCC New York Staff Failed to Conduct Mandatory Rounds and Inmate Counts Resulting in Epstein Being Unobserved for Hours Before His Death ....................... 102
C. MCC New York Staff Allowed Epstein to Place an Unmonitored Telephone Call on August 9 107
D. MCC New York Staff Failed to Conduct and Document Cell Searches and Eliminate Safety Hazards in Epstein's Cell on August 9 Leaving Epstein with Excessive Linens in His Cell........... 108
E. MCC New York Staff Failed to Ensure that the Institution's Security Camera System was Fully Functional Resulting in Limited Recorded Video Evidence ....................... 109
II. Recommendations .................................................................... 110
Appendix A: The BOP's Response to the Draft Report...................................... 115
Appendix B: OIG Analysis of the BOP's Response........................................... 118