Jeffrey Epstein was found in his cell at the Metropolitan Correctional Center in Manhattan last week. (AP)

Multimillionaire sex offender Jeffrey Epstein died as a result of a suicide by hanging, the New York City medical examiner concluded Friday — affirming law enforcement officials’ initial assertion that the high-profile prisoner had killed himself.

Epstein, 66, was found in his cell at the Metropolitan Correctional Center in Manhattan on Saturday morning, and an official said he hanged himself with a bedsheet attached to the top of a bunk bed. Epstein was rushed to a nearby hospital, where he was pronounced dead.

Chief Medical Examiner Barbara Sampson issued a terse statement Friday announcing her conclusion: “After careful review of all investigative information, including complete autopsy findings, the determination on the death of Jeffrey Epstein is below — Cause: Hanging. Manner: Suicide.” She has shared her findings with law enforcement officials, according to people familiar with the matter, but no further details have been disclosed. They, like others, spoke on the condition of anonymity because they were not authorized to discuss the investigations.

Epstein’s lawyers said they did not accept the medical examiner’s findings.

“We are not satisfied with the conclusions,” his legal team said in a statement.

“The defense team fully intends to conduct its own independent and complete investigation into the circumstances and cause of Mr. Epstein’s death.” The lawyers, Martin G. Weinberg, Reid Weingarten and Michael Miller, said they were prepared to sue the government for access to any security video from the time of his death.

Epstein had been held at the detention facility in Lower Manhattan since his arrest July 6 on sex trafficking charges. He was accused of abusing numerous teenage girls over several years in the early 2000s and had pleaded not guilty.

The medical examiner’s findings were released amid ongoing investigations by the FBI and the Justice Department’s inspector general into how suspected missteps by Bureau of Prisons personnel may have contributed to Epstein’s death.

Epstein’s death ended the criminal case against him, but the legal fights over his conduct and his wealth will likely live on for years. His alleged victims have vowed to continue their claims against his estate, and prosecutors insist any possible co-conspirators will not escape justice just because Epstein is now dead.

People familiar with the investigations have said that Epstein was left alone in a cell and that guards failed to check on him for several hours leading up to his death, after officials had given explicit instructions for him not to be left alone and for guards to check on him every 30 minutes.

Those precautions were in place partly because of an apparent suicide attempt July 23, though the specifics of that incident have been debated and officials say it is still under examination.

After that incident, when staff at the detention center found light markings on Epstein’s neck, officials placed him on suicide watch for about a week before returning him to the special housing unit, where prisoners get more scrutiny and security.

Less than two weeks later, he was dead, leading to frenzied speculation, including from President Trump, about who might have wanted to harm Epstein, and whether he possessed compromising information about others. The jet-setting financier once boasted high-powered connections to political figures, including Trump and former president Bill Clinton.

Sampson, the medical examiner, issued a statement Sunday indicating that while Epstein’s autopsy was complete, she needed more information before reaching a conclusion about how he died. She also noted the autopsy was observed by Michael Baden, a private pathologist retained by Epstein’s lawyers.

On Wednesday, The Washington Post reported that Epstein suffered multiple bone breaks in his neck, including the hyoid bone, which in men is near the Adam’s apple. Medical experts noted that such injuries are consistent with hanging suicides, though they can be found in strangling victims. Asked about the neck injuries, Sampson said Thursday that no single factor in an autopsy can be evaluated on its own, but has to be considered in relation to other evidence.

Epstein’s death has led to a shake-up at the detention center, where the warden was reassigned and the two guards who were supposed to be checking on his cell were placed on leave. Union officials have said such a death was inevitable because of the short staffing and forced overtime that guards are working.

The Justice Department has since sent additional Bureau of Prisons lieutenants from around the country to buttress the MCC workforce, and a suicide reconstruction team is at the facility to better understand how Epstein died, according to a person familiar with the matter.

Critics of the Bureau of Prisons have said Epstein’s death, combined with other security failures such as the still-uncharged killing of Boston gangster James “Whitey” Bulger at a West Virginia prison last year, should spur reforms inside the federal prison system, which was hit with a hiring freeze in the beginning of the Trump administration. That freeze has since been lifted, but union officials say MCC and many other facilities are straining under the long-term effects of not having enough employees to operate effectively.

In a speech Monday, Attorney General William P. Barr decried what he called a “failure” of Bureau of Prisons personnel to keep Epstein secure.

Speaking to law enforcement officials in New Orleans, Barr said he “was appalled … and, frankly, angry” to learn of Epstein’s apparent suicide. “We are now learning of serious irregularities at this facility that are deeply concerning and demand a thorough investigation,” he said.

Barr also vowed that Epstein’s death would not stop the ongoing investigation of others who may have conspired with Epstein.

“Let me assure you that this case will continue on against anyone who was complicit with Epstein,” Barr said. “Any co-conspirators should not rest easy. The victims deserve justice, and they will get it.”

On Wednesday, a woman who says Epstein raped her as a teenager filed a lawsuit against his estate. It’s possible that other alleged victims could follow her example, based on a law that just went into effect in New York State giving victims of long-ago sex abuse a one-year window to file such cases.

More than a decade ago, Epstein negotiated a plea deal with prosecutors in Florida after facing similar accusations. In the years since, lawmakers and victims’ advocates have criticized the terms of that deal, saying it shows the criminal justice system is lenient to wealthy criminals. The deal was approved by Alexander Acosta, who was then the U.S. attorney in Miami and would go on to become Trump’s labor secretary — a post he resigned after Epstein was charged last month and the controversy over the previous case intensified.

Carol D. Leonnig contributed to this report.