Jeffrey Epstein’s prison death has been ruled a suicide by hanging, the medical examiner’s office said Friday. Epstein, 66, was found dead in his cell at the Metropolitan Correctional Center in New York City on Aug. 10, touching off outrage and disbelief over how such a high-profile prisoner, known for socializing with powerful people including presidents Donald Trump and Bill Clinton, could have gone unwatched.

Jail guards on duty the night of Epstein’s death are suspected of falsifying log entries to show they were checking on inmates every half-hour as required, according to several people familiar with the matter.

A guard in Epstein’s unit was working a fifth straight day of overtime and another guard was working mandatory overtime, the people said. They spoke on condition of anonymity because the lacked authorization to publicly discuss the investigation.

The Bureau of Prisons said Epstein had apparently killed himself, but that didn’t squelch conspiracy theories about his death. 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 on July 23 with bruising on his neck.

But multiple people familiar with operations at the jail say he 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.

The warden replied that an internal investigation was completed but that he couldn’t provide information because the findings were being incorporated into investigations into Epstein’s death.

The Associated Press 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 several bones in Epstein’s neck had been broken, leading to speculation his death was a homicide.

Chief Medical Examiner Barbara Sampson issued a statement Thursday in response to those articles, saying: “In all forensic investigations, all information must be synthesized to determine the cause and manner of death. Everything must be consistent; no single finding can be evaluated in a vacuum.”The medical examiner’s ruling came a day after two more women sued Jeffrey Epstein’s estate, saying he sexually abused them.