Michael Baden’s Review of Jeffrey Epstein’s Autopsy: The Fractures, Ligatures, and Disputed Findings
Snapshot
Forensic pathologist Michael Baden observed Jeffrey Epstein’s autopsy on August 11, 2019, at the request of Epstein’s family. Kristin Roman, a New York City medical examiner, performed the examination. The available records establish one physical autopsy, followed by Baden’s independent interpretation of its findings. They do not establish that Baden performed a separate second examination of the body.
The signed medical examiner file, EFTA00063517 gives the cause of death as hanging and the manner as suicide. Baden has argued that the three documented neck fractures and questions about the cloth ligature and death scene point more strongly toward homicide. Roman explained her contrary assessment in a sworn interview, EFTA00063459.
The disagreement has two parts. Both pathologists acknowledge the neck fractures. They differ over what the complete pattern means. They also differ over how confidently the material brought to the autopsy can be matched to the mark on Epstein’s neck.
Key Takeaways
• Baden observed the city autopsy. Calling his work a “second autopsy” suggests another physical examination that the identified records do not establish.
• The three fractures were recorded by the city. They involved the left greater horn of the hyoid bone and both superior horns of the thyroid cartilage. They were not fractures of the cervical vertebrae.
• Baden considered the combination unusual for suicide. Roman considered the locations of the breaks, along with the other findings, consistent with hanging.
• The ligature question is more specific than a simple mismatch. Roman later said she could not be certain which of multiple cloth pieces in the cell was used. When investigators showed her two candidate nooses, she said the second one, which had not been brought to her, looked more likely to have caused the mark.
• Roman initially waited before finalizing the manner of death. Her later sworn account says she wanted scene information and was being thorough because of the case’s circumstances. She affirmed that her final determination was her own medical judgment.
• Baden continued to disagree in 2026. His later comments followed the release of Roman’s interview. No separate completed physical autopsy has been established by those comments.
Baden’s Role at the August 2019 Examination
The medical examiner’s scene report and case notes record that Epstein’s brother Mark requested an independent forensic pathologist as an observer. The office agreed under stated conditions. A case entry records Baden’s arrival for the examination.
Roman began the autopsy at 9:21 a.m. on August 11, 2019, in the Manhattan Mortuary. She performed the examination and authored the official report. The report was reviewed within the Office of Chief Medical Examiner and electronically signed on August 27.
Baden’s presence gave him firsthand access to the examination. It did not make him the author of the city’s report or create a second official death certification. A separate written Baden report has been described in public accounts, but the medical examiner packet and the identified EFTA interview records are not that report.
What the Official Autopsy Documented
The signed report and forensic anthropology pages establish the findings central to Baden’s objections.
| Finding | Official documentation |
|---|---|
| Hyoid bone | Fracture of the left greater horn |
| Thyroid cartilage | Fractures of both superior horns |
| Tissue near the fractures | Accompanying soft tissue hemorrhage |
| Cervical vertebrae | No fractures identified |
| Neck surface | A ligature furrow that did not completely circle the neck and rose on both sides |
| Face and eyes | Congestion and small hemorrhages above the furrow |
| Head | No skull fracture or bleeding around the brain |
| Other injuries | Forearm abrasions, faint wrist contusions, and left deltoid hemorrhage |
| Resuscitation findings | Rib fractures near the breastbone and a liver laceration attributed to chest compressions |
The specialist anthropology examination within EFTA00063517 identifies the break in the left hyoid greater horn and breaks in the right and left superior thyroid cartilage horns. It reports no cricoid cartilage fracture and describes substantial ossification of the thyroid cartilage.
The dispute is therefore not whether the three fractures existed. The city documented them. The dispute is how to interpret them in the context of the entire death investigation.
Baden’s Interpretation of the Fractures
In his January 2020 60 Minutes interview, Baden said he considered the combination of three neck fractures exceptionally unusual in a suicidal hanging. He viewed the available findings as more consistent with homicidal strangulation.
Baden drew on his experience with custodial deaths. His experience is relevant, but it is not a published case specific statistical test showing that three fractures cannot occur in a hanging. The exact location of each break, surrounding tissue injury, degree of cartilage ossification, and circumstances of neck compression also matter.
In a March 2026 interview following release of Roman’s sworn account, Baden maintained his homicide interpretation. He acknowledged that a three fracture pattern in a hanging was not impossible while saying he regarded it as very rare.
Roman’s Contrary Interpretation
Roman explained her reasoning in a recorded, sworn May 2022 interview, EFTA00063459. She said the fractures occurred toward the ends of the hyoid and superior thyroid cartilage horns. She considered that pattern consistent with sustained pressure during hanging, rather than the pattern she expected from manual compression.
Roman did not rely solely on the breaks. She also cited the upward course of the ligature furrow, facial congestion, small hemorrhages above the neck, and the absence of other injuries she would expect from a struggle. The Justice Department inspector general’s report recounts her view that the combined findings supported hanging.
The difference between the two opinions cannot be reduced to “three fractures versus no fractures.” Both discuss the same three fractures. Baden assigns greater significance to their combined number and his experience. Roman assigns greater significance to their locations and the full pattern of findings.
What Forensic Studies Say About Neck Fractures
A published review of fracture patterns in suicidal hanging found that interpretation must account for factors including age and the method of examination. A prospective autopsy study and review also examined fractures of the hyoid and laryngeal structures in hangings.
The reported frequency varies substantially by study. A prospective study of 40 suicidal hangings identified fractures of neck structures in 19 cases. A study of 557 suicidal hangings reported hyoid or laryngeal fractures in more than half.
These studies establish that such fractures can occur in suicidal hanging. They do not establish the probability of either manner of death in Epstein’s individual case. Nor does a population average, by itself, settle Baden and Roman’s disagreement about the precise three fracture pattern.
Baden’s Objection to the Neck Mark and Cloth
The autopsy report describes a neck furrow that did not form a complete circle. It rose on both sides, more sharply on the right, and branched near the right ear.
Baden told 60 Minutes that the cloth noose presented in photographs did not appear to match the furrow. He thought the mark lay lower on the neck than he would expect from hanging. He also questioned the relationship between the photographed cloth and the surface injuries.
Roman told inspector general investigators that the furrow’s upward course supported hanging and that cloth material from the cell could account for the injuries. She said the furrow was too broad to have been made by the electrical cord of Epstein’s medical device.
Those statements describe a genuine disagreement about the mark. A photograph alone cannot establish the identity of the material that made it. The original cloth, its condition and shape under tension, scene photographs, and evidence handling history are relevant.
The Important Distinction Between the Candidate Nooses
The medical examiner scene investigation describes strips of orange cloth and bedding in cell 220. It records collection of material presented as the ligature. The autopsy says a ligature and clothing were separately received, examined, photographed, and submitted to evidence.
Roman’s sworn interview, EFTA00063459, adds a crucial qualification. She was not certain which piece of cloth had actually been used. Investigators later showed her photographs of two possible nooses from the cell. She said either could have produced the markings, but the second item looked more likely to her. According to her account, that second item had not been brought to her for the original examination.
This distinction changes how Baden’s mismatch argument should be presented. His comparison concerned a particular photographed noose. Roman’s later assessment indicates that the material brought to the autopsy may not have been the strongest visual candidate among the photographed cloth pieces. That uncertainty deserves a place in the record. It does not, without further evidence, determine whether the death was homicide or suicide.
The October 2022 evidence request, EFTA00035810, sought the remaining medical examiner ligature evidence and chain of custody paperwork. A request identifies what investigators sought. The full collection and transfer history must be examined separately to establish what happened to each cloth item.
The Initial Pending Classification
The medical examiner case materials show that the manner of death was not immediately finalized at the autopsy. Contemporary correspondence, EFTA00023982, says the office was awaiting toxicology and investigative information.
Roman said in her sworn interview that she wanted more detail about the cell and the position in which Epstein was found. In the March 2026 account of that interview, she explained the delay as thoroughness in a high profile case. She said she had seen scene photographs, although she had not personally examined the cell or interviewed the officer who discovered him. She affirmed the final hanging and suicide determination.
An initial pending entry is a temporary classification while information is gathered. It is neither an initial homicide ruling nor evidence that Roman ultimately disagreed with the signed determination.
Baden’s Questions About the Death Scene
Baden told 60 Minutes that he wanted clearer evidence of Epstein’s original position and the cloth used. He noted the absence of a photograph showing the body as first discovered in the cell. He questioned the movement of the body during the emergency response and offered an estimate that Epstein had died before he was found.
That time estimate is Baden’s opinion, not a documented time of death established by a scene photograph. Emergency personnel attempted resuscitation, and hospital staff pronounced Epstein dead at 7:36 a.m. The medical examiner investigator’s report and inspector general review provide the hospital and discovery accounts.
The available video did not show the inside of Epstein’s cell or directly record his cell door. The inspector general reviewed the surviving camera evidence and the security procedures, but its conclusion should not be described as though a camera captured the death itself.
Other Findings Baden and Roman Weighed Differently
The signed autopsy records hemorrhages in the eyes, face, mouth, tongue, and tissue near the broken neck structures. It reports no hemorrhage in the anterior strap muscles, while documenting one hemorrhage in a deep left posterior neck muscle.
Roman said in her inspector general interview that she found no broken nails, debris beneath them, knuckle contusions, or broader injury pattern indicating a struggle. She considered the combined pattern more consistent with hanging.
The autopsy also records wrist contusions, forearm abrasions, and hemorrhage in the left shoulder muscle. Those findings should not be omitted when discussing the absence of defensive injuries. The narrower point is that Roman did not interpret them as evidence of a fight. The report separately attributes certain rib fractures and a liver laceration to resuscitative chest compressions.
The Official Response and Later Review
New York City Chief Medical Examiner Barbara Sampson publicly rejected Baden’s homicide interpretation and stood behind the hanging and suicide ruling. A contemporaneous account of her response reports her position that hyoid and cartilage fractures can occur in suicides as well as homicides.
The Justice Department inspector general’s investigation documented serious failures at the prison, including missed required rounds, falsified records, and failure to assign a replacement cellmate. It reported that its investigation did not uncover evidence contradicting the FBI’s determination about the absence of criminality in how Epstein died.
That review did not create a second autopsy. It assessed prison conduct and other evidence, interviewed Roman, and reported its findings. The prison failures remain documented even though the medical examiner and inspector general did not adopt Baden’s homicide interpretation.
Evidence Appearances
| Record | Relevance |
|---|---|
| EFTA00063517 | Official autopsy, anthropology report, toxicology, scene investigation, observer record, and case notes |
| EFTA00063459 | Roman’s sworn interview, including her fracture analysis and discussion of candidate ligatures |
| EFTA00063395 | Inspector general interview memorandum and list of photographs discussed |
| EFTA00023982 | Contemporary correspondence about awaiting toxicology and investigative information |
| EFTA00035810 | Request for remaining ligature evidence and custody paperwork |
| EFTA00109981 | Postmortem cervical spine radiograph bearing the medical examiner case number |
| EFTA00130065 | Another medical examiner production and a receipt listing the autopsy report and two photo discs |
| EFTA00137978 | Additional production of overlapping medical examiner records |
| EFTA00039025 | Released copy of the inspector general review |
The medical examiner interview memorandum lists selected cell and ligature photographs used during Roman’s interview. The receipt for two photo discs establishes that discs were transferred. Neither record alone publishes or identifies every image on those discs.
Questions the Evidence Leaves Open
• Was a second physical autopsy performed? The identified case records establish Baden as an observer and independent reviewer. They do not establish a second physical autopsy.
• Were the fractures hidden by the city? No. The official autopsy and anthropology examination document all three.
• Can fractures occur in suicidal hangings? Yes. Forensic studies document them. Their presence alone does not decide this case.
• Was the exact cloth piece that made the neck mark established by Roman’s examination? No. In her later sworn interview, she expressed uncertainty about which candidate noose was used and considered a different photographed piece more likely than the item originally brought to her.
• Did the initial pending classification mean Roman found homicide? No. She later affirmed hanging as the cause and suicide as the manner and explained why she had awaited more information.
• Did Baden retract his view after Roman’s interview became public? No. In March 2026 he continued to argue that the injuries favored homicide.
• Did the inspector general find no problems at the prison? No. It documented serious failures while reporting that it found no evidence contradicting the FBI’s conclusion concerning criminality in how Epstein died.
Sources
• New York City Office of Chief Medical Examiner case file, EFTA00063517.
• Kristin Roman sworn interview, EFTA00063459.
• Inspector general medical examiner interview memorandum, EFTA00063395.
• Contemporary autopsy correspondence, EFTA00023982.
• Request for transfer of ligature evidence, EFTA00035810.
• Postmortem cervical spine radiograph, EFTA00109981.
• Additional medical examiner production, EFTA00130065.
• Additional medical examiner production, EFTA00137978.
• Inspector general review in the EFTA production, EFTA00039025.
• Official Justice Department inspector general report.
• 60 Minutes interview with Baden and scene investigation.
• March 2026 account of Roman’s interview and Baden’s continuing disagreement.
• Published review of fractures in suicidal hanging.
• Study of hyoid and laryngeal fractures in suicidal hanging.