The doctor who conducted Jeffrey Epstein's autopsy explains why she hesitated to declare his death a suicide

• The doctor who conducted Jeffrey Epstein's autopsy initially didn't conclude he killed himself.
• She later did, after a doctor hired by his brother said the death looked like homicide.
• In an interview contained in the Epstein files, she explains why she decided Epstein hanged himself.

In the seven-year debate over Jeffrey Epstein's death, one important voice has been missing: the doctor who performed his autopsy.

Epstein was found dead in his Manhattan jail cell the morning of August 10, 2019, while awaiting trial on explosive sex-trafficking charges.

On August 11, his autopsy was performed by Kristin Roman, a doctor and New York City medical examiner. It was observed by Michael Baden, a forensic pathologist hired by Epstein's estate and brother, Mark Epstein.

After examining Jeffrey Epstein's corpse, Baden was convinced he died by homicide.

Roman was less sure. On Epstein's death certificate, she did not check the boxes for "homicide" or "suicide" and instead checked the box for "pending studies."

Five days later, Barbara Sampson, the chief medical examiner of New York City and Roman's boss, ruled that Epstein died by suicide after what she said was a "careful review of all investigative information." Sampson, who did not attend Epstein's autopsy, did not elaborate on the findings.

Roman's initially ambiguous classification of Epstein's death, combined with Baden's frequent media interviews, helped fuel conspiracy theories that Epstein, a financier with ties to elite figures in politics and business, was murdered as part of a cover-up.

The world did not learn that Roman agreed with her office's findings until nearly four years later, when the Justice Department inspector general's office released its report into Epstein's death. Even then, the reasoning behind her ruling — and the delay — was not made clear.

Until now.

A transcript of Roman's interview for the Justice Department investigation was made public this year under the Epstein Files Transparency Act.

In it, Roman said she was just "being thorough" by waiting to formally determine Epstein's death was a suicide.

"If he had been a less high-profile person who there weren't people wanting to kill, I would have probably called it a hanging on the day of autopsy," Roman said.

'It was pretty clear cut'

Baden told Business Insider Friday he still believes Epstein died by homicide after reviewing the transcript of Roman's interview, citing three fractures in his neck that he said are more consistent with strangulation than hanging. Epstein's brother, many of his former lawyers, his sex-trafficking co-conspirator Ghislaine Maxwell, and numerous victims have all said they do not believe he died by suicide and often point to Baden's findings.

Roman said in her interview, conducted under oath in May 2022, that she was certain Epstein hanged himself.

"It was pretty clear cut," she said.

Roman told investigators she wanted to see Epstein's cell and speak to the employee at the Manhattan Correctional Center who found his body before finalizing her findings.

"Was he fully hanging? Where was he hanging? That kind of stuff," Roman said, in explaining her requests for more information.

Roman said she was not permitted to speak to correctional officers or look at Epstein's cell, but she was shown photographs of the room. She said those limitations did not affect her conclusion that Epstein killed himself.

"It would have been more for completeness rather than a big factor in making the determination," she said.

In Roman's interview, she pointed to the same fractures in Epstein's neck that Baden said were inconsistent with a hanging.

She said the hyoid bone was fractured on "the tip" where it would have pressed up against his spine, rather than near the joints, where one would expect fractures "if somebody squeezes your neck in a homicidal fashion with un-sustained pressure."

According to Roman, the thyroid cartilage was fractured in the places where the hyoid bone pressed against it, which is also consistent with hanging. She said "manual strangulation" would have fractured it "unevenly."

Baden told Business Insider he has never seen three fractures in a suicidal hanging while working as a New York City medical examiner for 25 years, nor while serving for decades on a New York state commission that oversees prison deaths.

"That doesn't mean it can never happen, but it sure as hell is very rare if it happens," Baden said.

The missing noose

When Epstein's body arrived at the medical examiner's office, it was accompanied by a noose, found by jail officers, fashioned out of a bedsheet, Roman said in the interview. Baden told Business Insider that he did not see the noose during the autopsy, but later saw pictures of it, as well as photos of other nooses on the floor of Epstein's cell. He said the ligature marks on Epstein's neck did not resemble what he would expect to see if Epstein used those nooses to hang himself.

Roman said she was "not as convinced as I would like to be" about which noose was used, but that it didn't affect her conclusion that Epstein hanged himself.

In another part of the interview, investigators showed her photos of two possible nooses made from torn bedsheets and found in Epstein's cell that could have been used for the hanging. Roman said she hadn't seen them before and that they looked like they would match the injuries on Epstein's neck.

"Either one of these, in terms of its shape, could have caused the markings on Mr. Epstein," she said. "But this one, this second one that you're showing me that was never brought to me, looks like a more likely candidate."

Business Insider has been unable to determine if the photos shown to Roman are among the Epstein files released by the Justice Department.

Roman and Sampson did not respond to Business Insider's requests for comment. (In her interview with the Justice Department, Roman said she has done "a lot of ducking of the media.") Representatives for the New York City Office of the Chief Medical Examiner didn't respond to a request for comment.

After reviewing the transcript of Roman's interview, Mark Epstein told Business Insider he continues to think his brother was murdered.

"They're either lying, they're incompetent, or they're wrong," he said.