The sudden death of accused sex trafficker Jeffrey Epstein in a Manhattan detention center has been ruled a suicide by hanging, according to New York's chief medical examiner.

The much anticipated determination, issued by Dr. Barbara Sampson, refutes a wave of conspiracy theories that have been building since the disgraced financier was found unresponsive at Manhattan's Metropolitan Correctional Center last week.

"After careful review of all investigative information, including complete autopsy findings, the determination on the death of Jeffrey Epstein" is that he committed suicide by hanging, Sampson wrote.

At the time of his death, Epstein, 66, was awaiting trial following last month's indictment on charges of sex trafficking and sex-trafficking conspiracy.

Federal prosecutors alleged that Epstein "sexually exploited and abused dozens of minor girls at his homes" in Manhattan and Palm Beach, Florida, and at other locations from 2002-2005.

He was found "unresponsive in his cell" early Saturday at the federal detention in Manhattan and transported to nearby New York Presbyterian-Lower Manhattan Hospital, where he was pronounced dead.

Lawyers for Epstein issued a statement Friday saying they were dissatisfied with the medical examiner’s conclusions.

Attorneys Martin Weinberg, Reid Weingarten and Michael Miller said it is “indisputable that the authorities violated their own protocols” and they plan conduct their own independent investigation.

Epstein's death is now the subject of at least three federal investigations, involving the FBI, the Justice Department's inspector general and the Bureau of Prisons.

Among the areas of focus, authorities have been examining whether guards assigned to Epstein's unit may have slept through checks on the prisoner's cell in the hours before he was found dead, a person familiar with the matter said.

The review of the guards' conduct also will include whether they appropriately accounted for their time on duty, said the person who is not authorized to comment publicly.

Prison union officials have long warned that officer fatigue, caused by staffing deficits and frequent overtime duties, compromised security at the Manhattan facility. Serene Gregg, local president of the prison workers' union, has said that there are more than 30 staffing vacancies at the facility and that prison officials have regularly deployed civilian staffers to work guard duty to plug unfilled officer positions.

Ten of 18 staffers who reported for duty Saturday on the midnight-to-8 a.m. shift, were working overtime, according to the Justice official, relating information provided by federal prison authorities. The official spoke on condition of anonymity. Guards discovered an unresponsive Epstein shortly after 6:30 a.m.

On the previous shift, Friday's 4 p.m.-to-midnight rotation, six of the 20 staffers were working overtime.

Earlier this week, Attorney General William Barr temporarily reassigned the warden at the New York detention center, and prison officials placed two staffers on administrative leave. One of those staffers, according to the person familiar with the investigation, had worked multiple overtime shifts before reporting to duty on Epstein's unit.

Epstein's death set off a wave of recriminations from his accusers, lawmakers and the attorney general who referred to the discovery of "serious irregularities" at the federal detention center.

"We will get to the bottom of what happened, and there will be accountability," Barr said. “Let me assure you that this case will continue on against anyone who was complicit with Epstein."

After the Washington Post reported Thursday that the autopsy found multiple broken bones in Epstein's neck, speculation accelerated that the fractures may indicate that Epstein could have died by strangulation.

Just three weeks before he died, Epstein had been found in his jail cell semiconscious with bruises on his neck that prompted authorities to put him on suicide watch. His removal from suicide monitoring just days later also has drawn investigative interest.

A Justice official said Friday that investigators also have encountered difficulties assembling a timeline leading to Epstein death, citing limited access to prison workers officials who have retained counsel.

At the time of his death, Epstein was being held in the same lower Manhattan jail that previously held infamous criminals such as Joaquín "El Chapo" Guzman.

Multiple jail suicide experts have told USA TODAY that an inmate can only be removed from suicide watch if a licensed mental health professional finds them to no longer be at risk for attempting suicide.

“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," said Lisa Boesky, a clinical psychologist and jail suicide expert from San Diego, California.

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.”