The New York City medical examiner and the Justice Department Inspector General ruled that Epstein's death was a suicide by hanging.

As a result of Epstein's death, all charges against him were dismissed, and ongoing sex-trafficking investigations shifted attention to his alleged associates, notably Ghislaine Maxwell, who was arrested and indicted in July 2020 and convicted on five sex trafficking-related counts on December 29, 2021.

[6] On July 6, 2019, Jeffrey Epstein was arrested in New York City on multiple charges, including sex trafficking, and held at the Metropolitan Correctional Center[note 2] in Lower Manhattan.

Under its provisions, he pleaded guilty to two state felony charges, paid restitution to three dozen victims identified by the FBI, and registered as a sex offender in both Florida and New York.

[26][27] When Epstein was placed in the Security Housing Unit (SHU), the jail informed the Justice Department that he would have a cellmate and that a guard would look into the cell every 30 minutes.

[28] The two guards assigned to check his cell overnight, Noel and Michael Thomas, fell asleep at their desk[note 4] for about three hours and later falsified related records.

[25] Baden also questioned why Epstein did not use other materials available in his cell as a ligature, such as wires and tubing from a sleep apnea machine, which were stronger and longer.

The report further attributes his suicide to lack of significant interpersonal connections, loss of status, and the idea of potentially spending the rest of his life in prison.

[42] Epstein's lawyers released a joint statement after the medical examiner's report, expressing dissatisfaction with it, challenging its conclusions and saying a more complete response was forthcoming.

[48][49][50] Three of Epstein's lawyers expressed their dissatisfaction with Sampson's conclusion, having hired forensic pathologist Michael Baden to observe the autopsy; they said they would initiate their own investigation and provide a more detailed statement in the future.

Gerald Rodts, chief of spinal surgery at Emory University Hospital, also stated that multiple broken neck bones are consistent with hanging.

[58][59] On September 5, the body was buried in an unmarked tomb next to those of his parents at the IJ Morris Star of David mausoleum in Palm Beach, Florida.

[66] Senators Kirsten Gillibrand and Rick Scott called for an investigation and expressed their dissatisfaction that Epstein's victims would not find closure in a trial.

On August 11, New York City Mayor Bill de Blasio, then campaigning for president in Iowa, said, "I'm not a conspiracy theorist, but something's way too convenient here, and we need to get down to the bottom of what happened.

"[69] The next day, the leaders of the House Judiciary Committee, Chairman Jerry Nadler and ranking member Doug Collins, sent the Federal Bureau of Prisons (BOP) 23 questions about Epstein's death.

"The apparent suicide of this high-profile and—if allegations are proven to be accurate—particularly reprehensible individual while in the federal government's custody demonstrates severe miscarriages of or deficiencies in inmate protocol and has allowed the deceased to ultimately evade facing justice", they wrote.

Geoffrey Berman, the United States Attorney for the Southern District of New York, said in a statement, "To those brave young women who have already come forward and to the many others who have yet to do so, let me reiterate that we remain committed to standing for you, and our investigation of the conduct charged in the indictment—which included a conspiracy count—remains ongoing.

[78] In November 2019, BOP director Sawyer told the Senate Judiciary Committee that the FBI was investigating whether a "criminal enterprise" was involved in Epstein's death.

[83] The United States Department of Justice's Inspector General's investigation report released on June 27, 2023, castigated jail officials for repeated "negligence, misconduct, and outright job performance failures" in connection with Epstein's incarceration and death.

According to Geoffrey Berman, the U.S. Attorney for the Southern District of New York, during that time they repeatedly signed records affirming they had performed the required checks.

[104] Because of violations of standard prison procedures and Epstein's knowledge of compromising information about famous individuals, his death spawned skepticism and multiple conspiracy theories.

[109] University of Chicago professor Eric Oliver, a conspiracy theory expert, labeled populist sentiment and a mistrust of the political system as major contributors to the widespread rejection of the official narrative.

[111] Epstein's brother, Mark, has rejected the possibility of Jeffrey's suicide, claiming, "I could see if he got a life sentence, I could then see him taking himself out, but he had a bail hearing coming up.

[113] In a press conference about two months after Epstein's death, de Blasio declined to endorse chief medical examiner Sampson's conclusions, saying, "Something doesn't fit here.

"[114] Former US Attorney and Senate Judiciary Committee counsel Brett Tolman said the death was "more than coincidental", considering Epstein's "many connections to powerful people".

[115] Immediately after his death, online conspiracy theorists falsely claimed that the images of Epstein in transport to the hospital were actually that of a body double.

[116] In October 2020, over a year after his death, similar false theories emerged that claimed that Epstein was living at Zorro Ranch, his residence in New Mexico.

The meme gained prominence as it was interjected at the end of live interviews, such as by a Navy SEAL on Fox News, or later by a University of Alabama student on MSNBC.

[122] The Associated Press noted, "[t]he phrase 'Jeffrey Epstein didn't kill himself' has taken on a life of its own—sometimes more as a pop culture catchphrase than an actual belief".

[126] In an interview with Slate, independent merchandisers indicated that the Christmas/Epstein product lines were selling comparatively well, citing the mashup's dark humor as the reason for their popularity.