Warning: This article is about suicide and may be distressing for some readers.

The body of disgraced billionaire paedophile Jeffrey Epstein, who was found dead in his Manhattan prison cell in August, bore telltale signs of homicide despite an official suicide ruling, a former New York City medical examiner has claimed.

Dr Michael Baden raised concerns on Wednesday on Fox News about the New York City medical examiner's findings that ruled Epstein's death a suicide. The autopsy report appeared to put much speculation about the 66-year-old financier's death to rest.

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New York City Chief Medical Examiner Dr Barbara Sampson said she stands "firmly" behind her findings.

Sampson said no conclusions should be drawn from a lone injury or piece of evidence.

"In forensics, it's a general principle that all information from all aspects of an investigation must be considered together," Sampson said. "Everything must be consistent and nothing can be inconsistent, and no one finding can be taken in isolation. You can't draw a conclusion from one finding. Everything about the case has to be considered."

Baden told Fox News the findings of the autopsy were more consistent with homicidal strangulation.

Epstein, 66, had two fractures on the left and right sides of his Adam's apple, as well as one fracture above the Adam's apple, said Dr Baden, who has examined more than 20,000 bodies.

"Those three fractures are extremely unusual in suicidal hangings and could occur much more commonly in homicidal strangulation," he said, adding that the three fractures were "rare".

Dr Baden, who probed cases involving OJ Simpson, President John F. Kennedy, Martin Luther King and record producer Phil Spector in his career, said: "I've not seen in 50 years where that occurred."

He explained that if a person weighed 120 pounds (55kg) and their head weighed 10 pounds (4.5kg), there would be 110 pounds of pressure on the neck at the jaw. But, if someone put a hand around a person's neck and squeezed, that could double or even triple the pressure on the neck.

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Baden says Epstein's injuries included fractures to the larynx and hyoid bone. He says he hasn't seen that in a suicide in 50 years of death investigations, but cautioned that his observations were not conclusive.

Pathologist Dr. Michael Baden speaks during a news conference in 2014. Photo / AP
Pathologist Dr. Michael Baden speaks during a news conference in 2014. Photo / AP

There were also haemorrhages in Epstein's eyes that were common in homicidal strangulation and uncommon, though not unheard of, in suicides, the forensic pathologist said.

"The prominent haemorrhage in the soft tissues of the neck next to the fractures is evidence of a fresh neck compression that could have caused the death," Dr Baden said.

Epstein was found dead in his cell at the Metropolitan Correctional Centre on August 10. He'd been held there since his July 6 arrest on sex trafficking charges.

On the day Epstein was found dead, the prison security had experienced a "total breakdown" in procedure, according to Dr Baden.

"It was determined that the two guards who were supposed to be working in that area of the prison had allegedly fallen asleep and hadn't made their 30-minute rounds for more than three hours," he said.

Security cameras that were supposed to be recording the cell and the hallway outside, to see who went in and out, both apparently malfunctioned.

Through his five decades of experience, Epstein's death is not straightforward, Dr Baden said.

"It doesn't give you the answer," he said. "It's not a typical case."

WHERE TO GET HELP:

If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.

OR IF YOU NEED TO TALK TO SOMEONE ELSE:

0800 543 354 (0800 LIFELINE) or free text 4357 (HELP) (available 24/7)
https://www.lifeline.org.nz/services/suicide-crisis-helpline
YOUTHLINE: 0800 376 633
• NEED TO TALK? Free call or text 1737 (available 24/7)
KIDSLINE: 0800 543 754 (available 24/7)
WHATSUP: 0800 942 8787 (1pm to 11pm)
• DEPRESSION HELPLINE: 0800 111 757 or TEXT 4202