Financial Crime: Exclusive: Bernie Madoff’s harrowing final days: hallucinations, dire medical conditions, and waiting for the end to come

The nurse told him to stop yelling as he was disturbing other inmates, to which the man behind the biggest Ponzi scheme in history replied: “F**k them!” 

The nurse told him to stop cursing and asked what was going on. The confused and agitated Madoff apologized and said: “I gave them a pass and no one is respecting me or doing anything! I can’t believe they are doing this to me!”

He couldn’t explain who he was talking about. Then he stopped answering questions altogether. He refused to lie down or turn off the light and resumed sitting silently on the edge of the bed with his face buried in his hands.

Eight days later, he would be dead at the age of 82.

The story of Madoff’s erratic behavior, and details of his long-failing health inside the federal prison where he lived for nearly the last 11 years of his life are based on more than 4,000 pages of medical records released to MarketWatch by the Bureau of Prisons in response to a freedom of information act request.

A grim and rapid decline

They describe a grim decline in Madoff’s physical and cognitive abilities as he spent the last 17 months of his life in hospice care at the prison hospital, waiting to die of kidney failure. 

Madoff also suffered from severe coronary artery disease which left him gasping for air just walking across a room, the records showed. In 2020, he developed gangrene in the fourth toe of his left foot — something not uncommon for people with end-stage renal failure. He would eventually have that toe and the one next to it amputated to prevent the gangrene from spreading.

For much of his last year, Madoff relied on a wheelchair and oxygen tanks to get around. He underwent dialysis three times a week, although he often cut treatment short or refused it outright because he found it too debilitating. He was placed on low doses of methadone for pain, as other prescription pain killers were deemed unsuitable given his kidney issues, the records showed. Madoff was considered a “high fall risk” and had lost eight of his teeth.

Because of his perilous health situation, Madoff was among the first people in the country to be inoculated against COVID-19, getting his first shot of the Pfizer-BioNTech vaccine on Dec. 18, 2020, just a week after it had been approved for emergency use by the FDA. Madoff received his second shot on Jan. 9, the records showed. 

A spokesman for the Bureau of Prisons declined to comment on any aspect of Madoff’s treatment behind bars. 

In mid-2019, Madoff began applying for an early release from his 150-year sentence, given that he was terminally ill. Madoff told prison officials that he planned to move to Baltimore to live with someone whose name was redacted in the file, and undergo treatment at Johns Hopkins Hospital, the records showed.

He told a prison social worker that the cost to hire help for his care wouldn’t be an issue as “he has several people [redacted] that can assist and some who are “indebted” to him,” according to the files.

The records showed that Madoff’s application was blocked more than once by the prison warden and general counsel, on the grounds that Madoff’s offense had been so great and that he had declined to undergo dialysis as recommended by staff.

Medical personnel eventually stated that Madoff met the criteria for compassionate release and the warden agreed to submit the request to the judge in Madoff’s case, even though he recommended against it. In June 2020, Judge Denny Chin denied Madoff’s request, stating that he believed, “Mr. Madoff was never truly remorseful, and that he was only sorry that his life as he knew it was collapsing around him.”  

When Madoff was first arrested it was estimated that the loses related to his scam were as high as $65 billion. That figure was later substantially lowered to around $18 billion when phony paper profits were deducted from the total. At the time of Madoff’s death, investigators said they had managed to recover $14.4 billion of it.

Last January, Madoff appealed once more to the warden in a handwritten note, declaring that he was at high risk due to the COVID-19 outbreak and that he was in danger of losing his foot to gangrene. The warden again rejected the request, according to a letter contained in the file. 

Brandon Sample, the attorney who handled Madoff’s early release petition, said the details of his client’s declining health were well known to the officials reviewing his case.

“It was well documented that Mr. Madoff was aged and sick. The BOP, the government, and Madoff’s sentencing judge were all aware of the same. Nonetheless, his declining health was insufficient for the judge to show Madoff a bit of mercy. That remains the real story here. There is no point to compassionate release if there is no compassion,” Sample said in a statement.

A long history of ailments

Madoff’s medical records also detailed the extensive treatment he received during his more than a decade behind bars. He was 71 years old when he entered prison in 2009 after pleading guilty to securities fraud, money laundering and perjury, and his kidney and heart issues were already known. Upon arrival, Madoff’s condition was regularly monitored — his medical records showed he underwent hundreds of doctor’s appointments and tests during his incarceration from cardiologists, nephrologists, psychiatrists, dentists and eye doctors.

Madoff proved a difficult patient, regularly refusing treatment for various ailments, skipping appointments and stopping and starting his medications at will, the records showed. Madoff for years declined to start undergoing kidney dialysis against the urging of doctors, and only began treatments after his case had been deemed terminal in 2019. At one point, it was suggested he seek a kidney transplant, but Madoff refused.   

Upon entering prison — given the notoriety of his case — he underwent regular mental-health counseling and was put on Prozac and later Celexa for depression and anxiety, the records showed.

Years later, Madoff was placed on trazadone to help him with his anxiety and to sleep, the records showed. “I never sleep and am always tired,” Madoff was quoted as telling a doctor.

In late 2009, just a few months after being transferred to the minimum security prison in Butner, N.C., Madoff fainted while returning from the bathroom and struck his head on a water fountain, leaving him with a broken nose, a fractured rib, a cut above his eye that required seven stitches and intracranial bleeding. Prison guards, who found him lying in a pool of blood and unable to explain what had happened, initially thought he had been attacked. But Madoff later explained that he had gotten dizzy after he stopped taking his blood pressure medication because he believed it made him feel itchy, the records showed.

In 2013, Madoff was rushed to Duke Regional Hospital with chest pains. Doctors determined he had suffered a small heart attack and he underwent an angioplasty and had a stent inserted. He would undergo another angioplasty in 2020.

In 2014, he underwent surgery to remove part of his prostate, which was enlarged and had caused him trouble with urinating.

Reaching the ‘terminal cliff’

In his final weeks, Madoff began experiencing hallucinations as his mental state declined, the records stated. Just before he was sent to Duke University Hospital on March 23 to have his toes removed, he reported to prison medical staff that he was seeing people in his room at night. Madoff was also scheduled to undergo a heart valve replacement that day, but surgeons didn’t think he would survive the operation so opted against it.

When Madoff returned to prison from the hospital, he told a corrections officer he saw a bird in the officer’s jacket pocket. Madoff admitted “feeling crazy” to doctors and said that nothing mattered anymore, the records showed. He said the methadone he was taking left him feeling cloudy headed.

In the days that followed, Madoff grew increasingly agitated and confused, unable to say what day it was or remember things that had just happened. His speech became increasingly incoherent.

On the morning of April 12, just two days before his death, Madoff was found on the floor of his cell, having fallen out of bed, according to the medical file. He was able to respond to his name but nothing else. Doctors noted in the records that Madoff appeared to have reached the “terminal cliff.”

Later that day, the prison rabbi was called to see Madoff, who had signed a do-not-resuscitate order, and whose breath was becoming increasingly labored. Doctors then switched Madoff to a morphine drip and moved him to a room closer to the nurse’s station. He never opened his eyes again. 

On April 13, doctors attempted to contact Madoff’s emergency contact, whose name was redacted in the records, but were unable to reach them on the two numbers contained in the files.

At 3:10 a.m. on the morning of April 14, Madoff was found dead in room 5308, according to the doctor’s notes. He was declared dead at 3:29 a.m. — the cause: end-stage renal failure.