This week opined that Jeffrey Epstein, who died in a New York City jail while awaiting trial for sex trafficking, had injuries to his neck that were "unusual for suicidal hanging and more consistent with ligature homicidal strangulation." Baden also shared with a website called Law & Crime a photograph and diagram, which he claims is from the Epstein postmortem investigation, showing the location of these fractures at the left hyoid greater cornu and bilateral thyroid cartilage cornua.
Baden, a Fox News analyst, said he was making himself available to these press outlets because Mark Epstein, Jeffrey Epstein's brother and Baden's client, does not believe that the New York City Office of Chief Medical Examiner, which determined the manner of death to be suicide, had performed a thorough-enough investigation. Mark Epstein wants to know what information prompted the medical examiner to conclude that the manner was suicide after it had been, first, "pending further study." Baden told his Fox News colleagues that he believes that the FBI needs to conduct DNA testing on the torn bedsheet that was used as the ligature.
So, how likely are fractures of the hyoid and thyroid in cases of hangings?
A retrospective study of 175 cases of suicidal hangings over a five-year period found that fractures of the hyoid bone and associated cartilages -- the injuries the medical examiner found in Jeffrey Epstein's throat -- were detected in 68% of cases, and that the proportion of fractures increased with the . A prospective study of 40 cases of suicidal hangings over a three-year period found fractures of neck structures in 19 cases (47.5%), more commonly in the study's older men. Six of those decedents (15%) had . In the most recently published series, fractures of the neck skeleton were present in . The data revealed in the peer-reviewed scientific literature does not support Baden's statement that "hanging does not cause these broken bones, and homicide does."
How does a medical examiner distinguish between a hanging and ligature strangulation?
At autopsy, a typical hanging furrow elevates either to the back of the head or to the side, and unless the ligature is very tight, there will be a gap where it is not pressed against the skin. In contrast, a strangulation furrow is horizontal, generally encircling the neck, and there is often traumatic injury to the back of the neck where the tightening force was applied. The direction of the furrow on the decedent's neck can help the examining physician determine whether the cause of death was a hanging or a strangulation -- but it doesn't tell you the manner of death. Most hangings are suicides, but homicidal hangings, usually called lynchings, do occur. Conversely, most strangulations are homicides, but there are also decedents who have died by suicide after having .
The hyoid bone and thyroid cartilages can get broken in both hangings and strangulations. It's not, as Baden asserts in his interview on Fox News, the location or number of fractures that matter -- it's the location of the ligature relative to the fracture in the context of the death scene and other autopsy findings of injury that tells the investigating forensic pathologist what happened. If the neck fractures are nowhere near the ligature furrow and there are injuries elsewhere on the body indicating a struggle, then the case is more consistent with a homicide that is being covered up as a suicidal hanging. If there are no other injuries to the body and the fractures do correspond to the location of the furrow, then those bony structures have likely been broken in the course of a hanging suicide. Bones become brittle and cartilage calcifies with age, and both will break easily in older people like Epstein, who was 66 when he died.
Would the FBI performing DNA tests on the ligature make a difference?
Not really. , but it can only really tell you which individuals may have touched something. It can answer the "who" question, but not necessarily the when, where, why, and how questions that are critical to any death investigation. Testing the ligature may reveal DNA from the guard or prisoner who handled the sheets during distribution, or even the factory worker who made them. The sheets might have picked up old DNA from that cell's bunk, useless evidence pointing to someone who left the facility weeks or months before Epstein arrived. Having the DNA of another person on the ligature does not mean that person was involved in Epstein's death. DNA, in an in-custody death investigation like this one, can illuminate very little.
How does the medical examiner distinguish between a homicide and a suicide?
This is where the death scene investigation comes into play. How could such a high-profile prisoner go unsupervised? It has been reported that jail guards failed in their duty to check on , and were suspected of falsifying log entries, to pretend that they had. When New York City's chief medical examiner, Barbara Sampson, , she said, "I stand firmly behind our determination of the cause and manner of death for Mr. Epstein. The cause is hanging, the manner is suicide." This was after a review of "all investigative information."
What is that information? I know what I would have asked for, if I were examining this case: the toxicology report, police reports, interviews with the guards and other inmates, and video or electronic records of the jail doors that documented whether and when anyone came in or out of the decedent's cell. It is not unusual to list the manner of death as "pending further study," as the investigating doctor did in the Epstein case, until all this investigative information shows up on your desk and you have examined it. Baden and his client have not been given access to these investigative records because of the ongoing inquiry into the guards' behavior. That's why they're applying pressure, through the press, on the New York City medical examiner.
Baden's allegations are broad, unfounded in science, and conspiratorial. He might have a point, though. It might be time for the investigative agencies to open up, to both the family and the wider public, about everything they have found in determining that Jeffrey Epstein died by suicide while he was alone, in his cell, incarcerated and awaiting his fate in the courts.
, is a forensic pathologist and CEO of PathologyExpert, Inc. Her New York Times bestselling memoir, co-authored with her husband, writer T.J. Mitchell, is . They've also embarked on a medical-examiner detective novel series with , now available from Hanover Square Press.