FILE - This March 28, 2017, file photo, provided by the New York State Sex Offender Registry shows Jeffrey Epstein. New York City’s medical examiner has ruled Epstein’s death a suicide. The medical examiner’s office said in a statement Friday, Aug. 16, 2019, that an autopsy and other evidence confirms the 66-year-old financier hanged himself in his cell at a federal jail. (New York State Sex Offender Registry via AP, File)

FILE - This March 28, 2017, file photo, provided by the New York State Sex Offender Registry shows Jeffrey Epstein. New York City’s medical examiner has ruled Epstein’s death a suicide. The medical examiner’s office said in a statement Friday, Aug. 16, 2019, that an autopsy and other evidence confirms the 66-year-old financier hanged himself in his cell at a federal jail. (New York State Sex Offender Registry via AP, File)

NEW YORK (AP) — New York City’s medical examiner ruled Jeffrey Epstein’s death a suicide Friday, confirming after nearly a week of speculation that the financier faced with sex trafficking charges hanged himself in his jail cell.

Epstein, 66, was found dead at the Metropolitan Correctional Center on Aug. 10, touching off outrage that such a high-profile prisoner could have gone unwatched at the Manhattan federal lockup where infamous inmates Mexican drug lord Joaquin “El Chapo” Guzman and Wall Street swindler Bernard Madoff came and went without incident.

Chief Medical Examiner Dr. Barbara Sampson said in a statement that she made the suicide determination “after careful review of all investigative information, including complete autopsy findings.”

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Sampson’s announcement came as a Justice Department official told The Associated Press that some prison staffers believed to have relevant information aren’t cooperating with investigators.

Epstein’s lawyers said they were “not satisfied” with Sampson’s conclusions and that they would conduct their own investigation, including seeking to obtain any video of the area around Epstein’s cell from the time leading to his death.

Epstein, arrested July 6 and jailed since, was found dead with a bedsheet around his neck less than 24 hours after more than 2,000 pages of documents were made public from a since-settled lawsuit against an ex-girlfriend alleged to be his aide-de-camp. The documents included graphic allegations against Epstein and a 2016 deposition in which he refused to answer questions to avoid incriminating himself.

At the time of Epstein’s death, the Bureau of Prisons said he had apparently killed himself. But that did not squelch conspiracy theories , including one retweeted by President Donald Trump that speculated Epstein was murdered.

What emerged in the days that followed, however, was not evidence of a sinister plot, but early signs that prison staff failed to properly secure and monitor a prisoner, leading to ferocious criticism by everyone from Attorney General William Barr to Epstein’s lawyers.

Jail guards on Epstein’s unit failed to check on him every half hour, as required, and are suspected of falsifying log entries to show they had, according to several people familiar with the matter. Both were working overtime because of staffing shortages, the people said. They spoke on condition of anonymity because they lacked authorization to publicly discuss the investigation.

Epstein, who was charged with sexually abusing numerous underage girls over several years, had been placed on suicide watch last month after he was found on his cell floor July 23 with bruises on his neck.

Multiple people familiar with operations at the jail say Epstein was taken off the watch after about a week and put back in a high-security housing unit where he was less closely monitored, but still supposed to be checked on every 30 minutes.

Barr says officials have uncovered “serious irregularities” at the jail. The FBI and the Justice Department’s inspector general are investigating.

“It is indisputable that the authorities violated their own protocols,” Epstein’s lawyers said in a statement late Friday, calling the conditions in the unit where Epstein spent his final hours, “harsh, even medieval.”

In the wake of Epstein’s death, federal prosecutors have shifted their focus to possible charges against anyone who assisted or enabled him in what authorities say was rampant sexual abuse. Barr, on Monday, warned that “any co-conspirators should not rest easy.”

Authorities are most likely turning their attention to the team of recruiters and employees who, according to police reports, knew about Epstein’s penchant for underage girls and lined up victims for him.

The Associated Press reviewed hundreds of pages of police reports , FBI records and court documents that show Epstein relied on an entire staff of associates to arrange massages that led to sex acts.

Meanwhile, the investigation into Epstein’s death is being hampered because some people, including jail staff members who are believed to have information pertinent to the probe, aren’t cooperating and have not yet been interviewed by the FBI, according to a Justice Department official.

The official said the FBI has repeatedly sought interviews with staff members but those interviews are being delayed by union representatives. The official was not authorized to discuss the investigation publicly and spoke to the AP on condition of anonymity.

One possible roadblock to further charges is the controversial plea agreement Epstein struck more than a decade ago in Florida . The non-prosecution agreement not only allowed Epstein to plead guilty in 2008 to lesser state charges and serve just 13 months behind bars, it also shielded from prosecution several Epstein associates who allegedly were paid to recruit girls for him.

The AP often does not report details of suicide methods but has made an exception because Epstein’s cause of death is pertinent to the ongoing investigations.

The Washington Post and The New York Times reported Thursday that the autopsy revealed that a bone in Epstein’s neck had been broken, leading to speculation his death was a homicide. Sampson responded that “no single finding can be evaluated in a vacuum” and experts said the bone in question often breaks in suicidal hangings.

Autopsy reports are not public records in New York, and the details of the medical examiner’s finding, or the evidence she relied upon, were not immediately available.

An office telephone number for Dr. Michael Baden, the pathologist hired by Epstein’s representatives to observe the autopsy, repeatedly rang unanswered on Friday.

Epstein was a wealth manager who hobnobbed with the rich, famous and influential, including presidents and a prince.

He owned a private island in the Caribbean, homes in Paris and New York City, a New Mexico ranch and a fleet of high-price cars. His friends had once included Britain’s Prince Andrew and Bill Clinton and Donald Trump. Clinton and Trump both said they had not seen Epstein in years when new charges were brought against him last month.

The medical examiner’s ruling that Epstein’s death was a suicide came a day after two more women sued Jeffrey Epstein’s estate, saying he sexually abused them. The suit, filed Thursday in a federal court in New York, claims the women were working as hostesses at a popular Manhattan restaurant in 2004 when they were recruited to give Epstein massages.

One was 18 at the time. The other was 20.

The lawsuit says an unidentified female recruiter offered the hostesses hundreds of dollars to provide massages to Epstein, saying he “liked young, pretty girls to massage him,” and wouldn’t engage in any unwanted touching. The women say Epstein groped them anyway.

One plaintiff now lives in Japan, the other in Baltimore. They seek $100 million in damages, citing depression, anxiety, anger and flashbacks.

Other lawsuits, filed over many years by other women, accused him of hiring girls as young as 14 or 15 to give him massages, then subjecting them to sex acts.

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Michael Balsamo reported from Washington. Associated Press writer Jim Mustian in Atlanta, Georgia, contributed to this report.