Kristin Roman, MD, the physician who performed Jeffrey Epstein's autopsy, initially did not rule the death a suicide and listed the manner of death as "pending".[3] An autopsy revealed multiple fractures of the neck bones, including the left and right thyroid cartilages and the left hyoid bone.[1][3][5] Injuries included bruises on both wrists, an abrasion on the left forearm, deep bleeding in the left shoulder muscle, an injury to the back of the neck, a cut on the lip, and petechiae on the face, mouth, and eyes.[3] The official conclusion of the autopsy was that the cause of death was hanging and the manner was suicide, with no drugs or illegal substances in the blood.[2][4] Doctor Roman explained that the injuries were more consistent with suicide by hanging than murder by strangulation, with no signs of a struggle such as nail material or bruises on the hands.[2][4] She later changed the classification to suicide after reviewing additional evidence, including an alleged previous suicide attempt.[3]