How did Jeffrey Epstein die?

At the very southern tip of Manhattan a gray building squeezes into New York’s skyline. The Metropolitan Correctional Center – currently at least temporarily closed – was once considered the Guantánamo of New York: harsh conditions for inmates, rats, rough handling.

There, in Cell 220 on Block L‑Tier, one of the biggest legal scandals of recent U.S. history is said to have taken place on the night of August 10, 2019, that's at least what the murmurs of numerous supporters of Donald Trump’s Make America Great Again movement say, as well as large parts of the conspiracy internet. That night, multimillionaire Jeffrey Epstein, charged among other things with sex trafficking of minors, was found dead in his cell.

According to official accounts, he died by suicide. But many people doubt the version put forward by the U.S. Department of Justice; according to surveys, only a minority of Americans believe it was suicide. And on the online platform Reddit, users have been discussing Epstein’s death tirelessly for years. A popular claim: too many powerful men around the perpetrator had an interest in silencing him.

Perhaps all of this is just conspiracy narratives. But one person who does not see it that way is Michael Baden, one of the most prominent forensic pathologists in the United States. He was involved in investigations into the deaths of John F. Kennedy, Martin Luther King Jr., and George Floyd, and he also took part in the examination of Epstein’s body: Jeffrey Epstein’s brother Mark had commissioned him to review the autopsy on the morning after the night of Epstein’s death. He says in an interview with Süddeutsche Zeitung: “Based solely on the findings of the autopsy, more points to homicide than to suicide.”

At the beginning of the year, the U.S. Department of Justice released millions of documents, emails, and thousands of photos related to Epstein, including investigative files. To follow up on Baden’s hypothesis of third‑party involvement, Süddeutsche Zeitung evaluated numerous documents from the Epstein files and other sources and spoke with several experts. Some irregularities can be explained, others not so easily: ten points concerning the night of Epstein’s death, for which questions remain unanswered.

1: Unclear events on the night of his death

In the investigation protocols published by the U.S. Department of Justice after the inquiry into the night of his death, there is mention of a technical defect on July 29 that allegedly led to footage from four of the five cameras being transmitted live but not stored on the servers. The problem was discovered only on August 8 and was remedied after Epstein’s death.

The official investigation report later states that this was supposedly one of the female guards, who around 10:40 p.m. carried bed linen or prison clothing into the tier.

2: Suicide risk – and yet cables in the cell?

Several weeks before his death, Epstein is said to have  attempted hanging himself. According to the investigative files, his cellmate stated that he had woken up to find Epstein with a ligature around his neck. Epstein denied any suicide attempt in an interrogation, instead accusing his cellmate of attacking him. Despite an investigation, the incident could not be solved.
In photos said to have been taken after that night, one could interpret faint ligature marks on his neck, but the quality is too poor for any definitive statement. Afterwards, Epstein was classified as suicidal and closely monitored. A few days before his death, however, this status was lifted according to the investigative files. On the night of his death, the files state that Epstein was alone in his cell.

The two guards on duty should have known that Epstein was actually supposed to have a cellmate according to the files, but they failed to assign one to his cell. Later they stated that during the night they did not carry out the required rounds, though checks were mandated every 30 minutes. The investigation by the Department of Justice notes that between 1 a.m. and 3 a.m., the two guards “sat motionless at their post” and “appeared to be sleeping.”

“It is at least strange that these items were in the cell of an inmate at risk of suicide,” says Stefanie Ritz, forensic pathologist at the University of Düsseldorf and president of the German Society for Forensic Medicine. Ostensibly, using the available power cable to hang oneself would have been easier than using a bed sheet, which Epstein apparently tied into several nooses to find a suitable one. Forensic pathologist Baden notes, however, that Epstein would have had to cut the cable because it was plugged into an outlet outside the cell. Photos from the tier confirm this.

Striking as well is that Epstein had a lot of fabric at his disposal – and was apparently able to tear it with his bare hands. Often, prison clothing is sewn in such a way that simple tearing is at least difficult. The final report of the investigation also does not clearly state from which bed sheet or garment the nooses were ultimately made. A query into this point from Süddeutsche Zeitung to the Federal Bureau of Prisons went unanswered.

3: The unclear death scene

According to the report by the U.S. Department of Justice, Epstein was found in an “almost seated position” in front of the bunk bed, his buttocks hovering about three centimeters above the floor “and his legs stretched out straight in front of him on the floor.” The guard who says he found Epstein first stated in an interrogation that he immediately tore the orange ligature from the bunk bed. It remains unclear how a single guard could tear a fabric ligature with his bare hands, that was strong enough to support Epstein’s body weight. A detailed description or photos of the body recovery scene were not made – or not released.

For forensic pathologist Stefanie Ritz key details about the death scene are also missing. In forensic medicine it is very important to interpret the injuries present on the body in light of the findings at the scene, says Ritz. Only then can one assess whether a hypothesis about the cause of death is plausible. Accurate documentation of the death scene would have been one of the crucial puzzle pieces – but it is missing.

4: Remarkable fractures of hyoid bone and larynx?

The autopsy report states...

Microscopic images of the fractures show vital hemorrhaging, that is, hemorrhage consistent with vital reaction – meaning the fractures must have occurred while he was alive, because only a living body has an active blood circulation. In his interview with Süddeutsche Zeitung, forensic pathologist Baden notes that in his view, the three unusual fractures in Epstein’s neck suggest a killing – “for example, when the neck is encircled with a hand or with a ligature used as a garrote. Not solely by the weight of the body acting on the structures of the neck,” he says. In the 50 years he has been reviewing deaths of inmates in prisons, he says he has never seen a suicide by hanging with three fractures of the laryngeal skeleton. He regards this as a key indication that it could be homicide.

Independent experts, however, disagree: "There's no scientific evidence to support that", says Florian Fischer, head of forensic radiology at the Institute of Forensic Medicine at the University of Munich. There are numerous publications that describe such injuries in hangings, including multiple fractures. According to Fischer this literature is plausible, because the weight of the body alone can exert considerable force on the larynx and hyoid bone, pressing them against the spine and causing them to break.

While the combination of a fracture of the hyoid bone and of the thyroid cartilage is in fact rarer in hangings, it does occur, says Benjamin Ondruschka, director of forensic medicine at the University Medical Center Hamburg‑Eppendorf. This assessment is also confirmed by a meta‑analysis that examined more than 8,500 deaths by strangulation for fractures of the larynx and hyoid bone. “In that case, I would trust the systematic analysis more than personal experience,” says forensic pathologist Ritz.

5: Striking ligatur marks on the neck

Süddeutsche Zeitung has photos of Epstein’s body that are not included in the files. They show a ligature mark on the neck. Baden argues that this ligature mark is more typical of manual strangulation than hanging, as it runs too straight across the neck. Typically, one would expect that, given the described death scene, the ligature mark would rise toward the ears if the suspension point was behind and, above all, above the head.
Ritz agrees with her U.S. colleague Baden to the extent that, given the roughly described death scene, “one would indeed initially expect a ligature mark rising toward the back.” However, she warns against drawing false conclusions: to interpret the injuries properly, one would have to see the body in detail; it is hard to judge from just a few photos.
The forensic pathologist who performed the autopsy on Epstein speaks in her interrogation of a “ligature mark that does indeed reach a high point.” The autopsy protocol describes this accordingly:

According to Baden, “there may have been a shadow on the right side.” In any case, he says he does not recall a second, ascending mark. This detail raises questions. If there had actually been a double ligature mark, it would be possible that the noose had slid under upward tension at that point. Or that Epstein was strangled before being hanged. What exactly this drawing of the “furrow” is meant to represent remains unclear.

The forensic pathologist who conducted the autopsy could perhaps explain this. Her name is partially redacted in the files, but it is known to Süddeutsche Zeitung. She has so far not responded to an inquiry. Süddeutsche Zeitung sent a list of questions to the City of New York, her employer. The press office replied that the city continues to assume suicide – and would not comment further on details.

6: A conspicuous suspension point

There were several possible places in Epstein’s cell where a ligature could have been fastened. The most obvious idea is to choose a point of attachment that is as high as possible. Epstein may have thought this as well, since photos from his cell show pieces of fabric on the window grille and on the ladder of the bunk bed.

7: Which ligature did Epstein use?

The ligature used also raises questions: In photos from the cell included in the files, a total of three nooses can be identified. Two of these are intact; the third is hard to make out – it appears to be torn.

The protocol with the forensic pathologist records her puzzling over the ligature used and also coming to the conclusion that the smooth ends cannot match the piece of fabric at the bed. Michael Baden likewise doubts that the ligatures shown were the ligature used. In his view, parts of the ligature marks on Epstein’s neck do not match the fabric of the nooses.

She also states that she was denied permission to inspect the cell herself and had to rely solely on photos in her work. It remains unclear who exactly issued these instructions. A query from Süddeutsche Zeitung to the U.S. Department of Justice went unanswered.

The forensic pathologist’s statements suggest that, when drafting her report – and when determining the cause of death – she had no precise knowledge of the death scene and of the ligature used. For interpreting the findings, that would have been crucial, says Ritz. “Yet the colleague insists on suicidal hanging, apparently meaning that self‑hanging is proven. With such a thin body of information, that is at the very least bold.”

Wolfgang Eisenmenger, former long‑time director of the Institute of Forensic Medicine at LMU Munich, shares this assessment: “The failure to examine the cell and the hands for fiber traces compatible with the ligature used does not correspond to the standards of forensic autopsies commonly applied in Germany.”

The forensic pathologist who performed the autopsy justifies her conclusion that Epstein must have died by suicide in part by stating that she found no defensive injuries on the body. Such findings could have pointed to homicide. It remains unclear, however, whether the body was examined during the autopsy for bruising or grip marks consistent with being lifted or carried, for example under the armpits.

8: Missing drug screenings?

The mere absence of defensive injuries is not enough to rule out homicide. The possibility that Epstein may have been sedated before his death must also be explored. To investigate a potential sedation, one would expect a broad toxicological examination, says forensic pathologist Ritz. According to the autopsy report, there was screening for sleeping pills and anti‑epileptic drugs as well as for alcohol, barbiturates, methadone, cannabis, fentanyl, and synthetic cannabinoids – all with no notable findings.

9: A conspicuous hematoma on the neck?

Further photos show Epstein’s body as he was presumably brought to the forensic institute. He is still wearing a so‑called stiff‑neck collar, which is used during rescue operations to prevent injured structures in the neck from being further damaged by vibration and repositioning. Another photo shows the nape of the neck without the collar. A red spot can be seen. It is unclear where this injury came from. It cannot be ruled out that it was caused by placement of the stiff‑neck collar; however, another photo shows that the collar was correctly applied and thus covered precisely the area of the neck where the redness appears.

If the mark had occurred before the collar was applied, that “would have had to be regarded as conspicuous,” says Ritz. Yet the autopsy report contains no indication that these injuries were examined more closely; there is also no discussion or interpretation of this injury. Michael Baden likewise cannot recall that this mark was a subject of discussion during the autopsy.

10: Unclear time of death?

It is still unclear when exactly Epstein died. Yet this piece of information would be another important puzzle piece that is missing. Baden assumes that Epstein had been dead for several hours before he was found around 6:30 a.m. Photographs of the rescue effort provide clues: they seem to show livor mortis – although the poor resolution makes them difficult to see clearly. Baden considers the fact that the body was moved at all to be perhaps the most serious mistake. 

“Normally, when someone is found dead in a cell and it is obvious they are deceased, the body is left there, then the police come and investigate the case,” he says.

Conclusion

Malfunctioning cameras, poor forensic evidence collection and crime scene preservation, an unclear time of death, and a forensic pathologist who apparently knew neither the death scene nor the ligature used – many aspects of this case at least point to massive sloppiness. For Michael Baden, one thing is certain: Epstein’s death must be re‑investigated.

Forensic radiologist Fischer says that of course "the data situation could be better." To rule out third‑party involvement with certainty, there would need to be more detailed reports, findings, and examinations. But he also says: “In view of the details known so far, one has to say that none of this points to third‑party involvement.” Wolfgang Eisenmenger adds: “The image material presented to me can readily be reconciled with hanging.” The documents, he says, do not support the conclusion that there was one ligature strangulation by another person in the form of garroting and then a separate hanging.

Forensic pathologist Ritz agrees with this assessment: nothing in the documents “suggests that Epstein was strangled.” But it also cannot currently be ruled out beyond doubt. “On the basis of this inadequate information, we would in any case not have stated with such clarity: ‘This was a suicide. Period.’”

Note from the authors: This article discusses details of a possible suicide. If you are having thoughts about taking your own life, please contact the German telephone counseling service immediately, anonymously and free of charge at +49 800 111 0 111 or +49 800 111 0 222. Online counseling is also available at www.telefonseelsorge.de. A list of nationwide support centers is provided on the website of the German Association for Suicide Prevention (Deutsche Gesellschaft für Suizidprävention).