Conclusions

As with the previous edition of the book, key areas still need to be addressed in clinical forensic medicine:

1. It needs to be recognized globally as a distinct subspecialty with its own fulltime career posts, with an understanding that it will be appropriate for those undertaking the work part-time to receive appropriate training and postgraduate education.

2. Forensic physicians and other forensic healthcare professionals must ensure that the term clinical forensic medicine is recognized as synonymous with knowledge, fairness, independence, impartiality, and the upholding of basic human rights.

3. Forensic physicians and others practicing clinical forensic medicine must be of an acceptable and measurable standard (20).

Some of these issues have been partly addressed in some countries and states, and this may be because the overlap between the pathological and clinical aspects of forensic medicine has grown. Many forensic pathologists undertake work involved in the clinical aspects of medicine, and, increasingly, forensic physicians become involved in death investigation (21). Forensic work is now truly multiprofessional, and an awareness of what other specialties can contribute is an essential part of basic forensic education, work, and continuing professional development. Those involved in the academic aspects of forensic medicine and related specialties will be aware of the relative lack of funding for research. This lack of funding research is often made worse by lack of trained or qualified personnel to undertake day-to-day service work. This contrasts more mainstream specialties (e.g., cardiology and gastroenter-ology), where the pharmaceutical industry underpins and supports research and development. However, clinical forensic medicine continues to develop to support and enhance judicial systems in the proper, safe, and impartial dispensation of justice. A worldwide upsurge in the need for and appropriate implementation of human rights policies is one of the drivers for this development, and it is to be hoped that responsible governments and other world bodies will continue to raise the profile of, invest in, and recognize the absolute necessity for independent, impartial skilled practitioners of clinical forensic medicine.

Clinical Forensic Medicine: Its Practice Around the World Questions and Responses January 2003

Question A

Response

Australia

England and Wales

Germany Hong Kong

India

Israel Malaysia

The Netherlands Nigeria Scotland Serbia

South Africa Spain

Sweden Switzerland

Is there a formal system in your country (or state) by which the police and judicial system can get immediate access to medical and/or forensic assessment of individuals detained in police custody (prisoners)?

Yes (within the state). Two-tiered system addressing general health issues and forensic medical services. Yes. Police surgeons (forensic medical examiners/forensic physicians) are contracted (but not generally employed) by both police and courts to undertake this. The Police & Criminal Evidence Act (PACE) 1984 made particular provision for this and for prisoners to request to see a doctor. Police surgeons do not necessarily have specific forensic training or qualifications.

Yes, only after a court order has been granted.

Yes. The formal and generic mechanism is for the individual to be taken to an emergency department of a nearby hospital. Rarely he or she may be sent for a specific purpose to a specialist forensic doctor.

Yes. Under a Section of the Criminal Procedure Code, a police officer can immediately bring an arrested person to a doctor for examination. If the arrested person is a female, only a female registered medical practitioner can examine her. The accused/detained person can contact the doctor and have himself or herself examined. Yes

No organized forensic clinical services available. Subjecting the detainees for examination is at the discretion of the agencies. If the need arises, usually doctors who have no training in clinical forensic medicine (CFM) undertake such examinations. In larger institutions, senior doctors and, at times, forensic pathologists may examine them. Yes

Yes (for medical reasons) dependent on the availability of the physician. Yes. Police retain services of doctors not all necessarily qualified in CFM.

Yes, via the public health system. Generally for treatment purposes. Also, if considered necessary for evidence collection (by the investigator appointed under the Criminal Procedure Act (CPA) the police will refer to prosecutor in charge seeking for his or her permission to call a forensic doctor. Yes, but not in all parts of the country.

Yes, any individual detained in police custody has the right to be examined by a doctor. In certain cases, one has the right to have a forensic assessment (by the Forensic Surgeon Corps of the Ministry of Justice).

Response

Australia

England and Wales

Germany Hong Kong

India

Israel

Malaysia

The Netherlands

Nigeria

Scotland

Serbia

South Africa Spain

Sweden Switzerland

Who examines or assesses individuals who are detained in police custody to determine whether they are medically fit to stay in police custody?

Nurses or medical practitioners who are employed or retained by police.

Police surgeons. Recent changes to statutory Codes of Practice suggest that an appropriate health care professional may be called.

Normally a police surgeon; if not, then any qualified doctor.

Currently, the duty police officer looks and asks if medical attention is required. Most duty officers are quite liberal in referring the individuals to the emergency department.

A government doctor.

Police surgeons.

Generally not unless they become ill. Any government doctor in the nearest hospital may undertake such an examination. Generally speaking: Public health officers, who are qualified in clinical forensic medicine.

Any doctor attached to prison services, the police or doctors in the local hospitals, depending on who is available.

Police surgeons—these doctors are not employees. Nursing schemes have been mooted but not yet been implemented.

If there is an obvious health problem or if they have certain diseases that need medical attention, police will take them to a public healthcare facility or, in the case of emergency, call an ambulance.

Not always; psychiatrist in some cases.

When a person is under arrest (without having being put under regulation), he asks to be examined by a doctor, he is usually transferred to the Spanish Health Public System doctors. The forensic surgeon takes part exceptionally.

So-called "police doctors," who usually are general practitioners.

The "prison doctor": either a doctor of internal medicine of university hospital or in rural regions the district physician (acute cases). A forensic doctor of the Institute of Legal Medicine of the University of Zurich (not urgent cases, "chronic cases").

Response

Australia

England and Wales

Germany Hong Kong

India

Israel

Malaysia

The Netherlands

Nigeria

Scotland

Serbia

South Africa Spain

Sweden Switzerland

If a prisoner is suspected of being under the influence of drugs or alcohol in police custody, is it usual for him or her to be examined by a doctor (or other health care professional) to determine whether they are fit to remain in custody?

Yes, but it will largely depend on any health concerns (e.g., abusive, intoxicated person—unlikely to access medical attention, but impaired conscious state—always access medical attention).

Yes, if there are associated health concerns, or if there is a specific need to determine fitness to interview when either intoxication or withdrawal may render an interview invalid. Specific guidelines are published on care of substance misuse detainees in police custody.

Yes, they will most certainly be sent to the emergency department. Registered addicts will occasionally be taken to a methadone clinic if they are suffering from withdrawal.

Not routinely.

Only when a need is established or the prisoner requests medical assistance. Profound intoxication or suspicion of head injury would be an indication for examination.

Intoxicated detainees may be requested to provide a blood or other appropriate samples for analysis. The request can be refused. Samples are arranged outside police premises, usually in the public health institutions.

Yes, but not common practice.

Yes, he or she is often examined and even blood samples are extracted (with his or her previous consent) if the prisoner is involved in some aggression, homicide or car driving, for example.

Yes. In most custody suites, a nurse is employed nurse who will call a doctor.

Yes, see previous answer to question B.

Question D Does your country/state have specific codes/laws/statutes or regulations that make provision for the welfare of individuals in police custody?

Response

Australia Yes

England and Wales Yes

Germany Yes

Hong Kong There are generic guidelines for all in custody; none specific to the police.

India The Protection of Human Rights Act 1993 stipulates detailed provisions regarding this.

Israel Yes

Malaysia Yes. Inspector General's Standing Order.

The Netherlands Yes

Nigeria Not aware of any.

Scotland Local procedures for each police force based on central guidance, but there is no statute.

Serbia No

South Africa Yes

Spain Yes, there are specific rules in Constitution and in the Penal Code.

Sweden Not known.

Switzerland Yes

Response

Australia

England and Wales Germany Hong Kong

India Israel Malaysia

The Netherlands Nigeria Scotland Serbia

South Africa

Spain

Sweden

Switzerland

Forensic medical officers.

Police surgeons or sexual offense examiners or doctors employed within specialist sexual offenses units. Either a gynecologist or a medicolegal doctor.

Forensic pathologists/doctors mainly. Accident and emergency doctors occasionally and family planning doctors. The latter when the victims do not wish to report the incident to police.

Different centers have different protocols (e.g., in this institution, gynecologists—mainly females). Forensic pathologists.

In major hospitals, there may be fixed protocols. Some forensic physicians, primary care physicians, emergency medicine physicians, and gynecologists undertake such examinations. In smaller hospitals, nonspecialist physicians do the examinations. In some cases, forensic pathologists.

Generally public health officers, qualified in clinical forensic medicine.

Primary care physicians and medical officers in local hospitals.

Usually police surgeon, some may be admitted to hospital and be examined by hospital staff.

There is no standard procedure for the examination of alleged victims of sexual assault. There are no protocols for the examination of victims, or for collection of forensic samples.

Medical practitioner.

A forensic surgeon (medico forense) and a gynecologist (if the victim is female) or a proctologist (if the victim is male).

The police are free to engage any doctor to do this. In cases of assault on adults, the examination is undertaken by specialists in FM in a small fraction of the cases. A specialist in pediatric medicine or surgery always examines children, often, but not always, with a specialist in forensic medicine.

Physicians of Institute of Legal Medicine of University of Zurich (District Physician); Physicians of University Department of Gynecology, University Hospital Zurich.

Response

Australia

England and Wales Germany Hong Kong India

Israel

Malaysia

The Netherlands

Nigeria

Scotland

Serbia

South Africa Spain Sweden Switzerland

Forensic medical officers.

Police surgeons.

Medicolegal doctor.

Forensic pathologists/doctors mainly.

Different centers have different protocols (in this institution, forensic medicine specialists). A bizarre situation, where the victim goes to the gynecology department, whereas the accused in the same case comes to us.

Forensic pathologists.

Same as for alleged victims of sexual assault. See previous answer to question E. Generally speaking, public health officers who are qualified in clinical forensic medicine. Same as for alleged victims of sexual assault. See previous answer to question E.

Police surgeon (although experienced police surgeons are not readily available in some sparsely populated areas, and the inexperienced are often reluctant to embark on such an examination).

In practical terms, rarely done although the Criminal Procedure Act allows examination of alleged perpetrators of any crime (including sexual assault) for forensic purposes even without their consent if the examination itself is not considered harmful to them.

Medical practitioner.

A forensic surgeon.

Similar to the procedures of adult victims.

Physicians of Institute of Legal Medicine of University of Zurich (District Physician).

Question G In cases of sexual assault is it always possible for victim, perpetrator, or both to be examined by a doctor of the same gender if that is requested?

Response

Australia

England and Wales Germany Hong Kong India

Israel

Malaysia

The Netherlands

Nigeria

Scotland

Serbia

South Africa Spain Sweden Switzerland

Generally, yes.

Generally, yes, but not always possible. Yes

No, there is currently only one full-time female forensic doctor able to do this.

Yes, if requested, a doctor of the same gender would be arranged. This would generally apply only to the victim (female gynecologists examine the victim anyway). The wishes of the accused are not always observed. It is highly unusual for a female to examine a male accused.

Not always.

It may be accommodated if possible. Usually but not always. No

Not always, but every effort is made to comply with an examinee's wishes.

There is no statutory provision that regulates free choice of either the victim or the perpetrator to be examined by a doctor of preferred (same) gender.

No. It depends on the doctor on duty.

Question H

Who undertakes the forensic medical examination and assessment of alleged child victims of sexual assault?

Response

Australia

England and Wales Germany Hong Kong India

Israel

Malaysia

The Netherlands

Nigeria

Scotland

Serbia

South Africa Spain Sweden Switzerland

Forensic medical officers or pediatricians.

Police surgeons and/or pediatricians. Ideally joint examinations (guidelines for the assessment have been issued). Either pediatrician gynecologist or medicolegal specialist.

Forensic pathologists/physicians, pediatricians, obstetricians, and gynecologists, sometimes jointly.

Female children—gynecologist, preferably female (which is generally the case anyway). Male children—forensic personnel of either sex.

Forensic pathologists and pediatricians.

Wherever possible, by pediatricians or gynecologists. Smaller hospitals by nonspecialist physicians. Generally speaking, public health officers qualified in clinical forensic medicine. Same as for alleged victims of sexual assault. See previous answer to question E.

In the larger centers, joint pediatric/police surgeon examinations are common. For other centers, it varies.

Physicians with forensic training are rarely involved in initial examination and assessment. Forensic physicians tend to get involved at a later stage of investigation.

Medical practitioner.

A forensic surgeon and a pediatrician.

Same as for adults. See previous answer to question E.

Younger than 16 yr: female gynecologist at University Children Hospital. Older than 16 yr: examined as adult.

Question I

Who undertakes the forensic medical examination and assessment of alleged child victims ofphysical assault?

Response

Australia

England and Wales

Germany

Hong Kong

India

Israel

Malaysia

The Netherlands

Nigeria

Scotland

Serbia

South Africa Spain Sweden Switzerland

Forensic medical officers or pediatricians. Police surgeons and/or pediatricians. Pediatrician or medicolegal specialist.

Pediatricians. Sometimes forensic pathologists/physicians. Sometimes jointly.

Forensic medicine departments.

Forensic pathologists and pediatricians.

Pediatricians in smaller hospitals by nonspecialist physicians.

Generally speaking, public health officers qualified in clinical forensic medicine.

Same as for alleged victims of sexual assault. See previous answer to question E.

Mostly pediatricians but some evidence is based on findings of family physicians.

Formerly, few forensic pathologists were involved. Situation is somewhat improved, but still poor cooperation between clinicians and forensic doctors.

Medical practitioner.

Forensic surgeon and a forensic pediatrician.

Same as for an adult. See previous answer to question E.

Younger than 16 yr: doctors at University Children Hospital (Trauma-X group). Older than 16 yr: doctors of Institute of Legal Medicine of University of Zurich (District Physician).

Is there a system in your country/state whereby individuals detained in police custody who appear to have (or do have) psychiatric disorder or mental health problems or learning disability may be assessed?

Response

Australia Yes

England and Wales Yes

Germany Yes

Hong Kong Yes. They are likely to be referred to psychiatrists or, in the case of learning disability, to social workers and/or clinical psychologists.

India Yes, in theory. This may not be strictly observed until and unless there is a court order that may need to be obtained by relatives.

Israel Yes

Malaysia Yes

The Netherlands Yes

Nigeria Yes

Scotland Variable picture. Screening by police surgeons. On-call psychiatrist or mental health team in some areas. Some courts have regular pretrial psychiatric attendance.

Serbia Not when in police custody (within 48 h after arrest). If suspect is detained on the order of the investigative judge, then may be examined by psychiatrist and/or psychologist when need.

South Africa Yes

Spain Yes. If mental health problems are apparent, case is remitted to a judge and detainee is examined by a forensic surgeon and a psychiatrist.

Sweden It's part of the "police doctors" duties, but many custodies do have access to psychiatric consultants.

Switzerland Those who have known disorders are followed by a specialized forensic psychiatric/psychological service; others are reported by the guards.

Question K

In your country/state are there specialized units or locations where victims of sexual assault are examined or assessed?

Response

Australia Yes

England and Wales Yes, but not full geographical coverage; tends to be in urban centers.

Germany No

Hong Kong There are purpose-built video interview and medical examination suites. These tend to be used only when there is a strong likelihood of prosecution. Often done in pediatric wards.

India No

Israel Yes

Malaysia Some major hospitals have "one-stop centers" with protocols for managements, both short- and long-term.

The Netherlands Sometimes, but not always.

Nigeria No

Scotland Specialized units widely available, often on police premises. Children usually in hospital.

Serbia No

South Africa Yes

Spain Victims of sexual assault are examined in gynecology or pediatric units of large hospitals.

Sweden No

Switzerland Yes, but only in some cities.

Question L

In cases of alleged assault by police, who examines the police personnel?

Response

Australia

England and Wales

Germany

Hong Kong

India

Israel

Malaysia

The Netherlands

Nigeria

Scotland

Serbia

South Africa Spain Sweden Switzerland

Forensic medical officers (report and documentation of injuries). Police medical officers (for any occupational health and safety issues).

Police surgeons.

An independent medical doctor.

The majority are examined by emergency medicine physicians. Some are examined by forensic pathologists/physicians. No experience with this. If needed, probably forensic pathologist. Forensic pathologist. Any available physician.

Generally speaking, public health officers qualified in clinical forensic medicine.

Physician attached to the police service, could be a uniformed officer.

Police surgeon (unless urgent transfer to hospital).

Physicians working for public healthcare system.

Medical practitioner.

A forensic surgeon as member of the Ministry of Justice (completely independent of the police). Advised that a specialist in forensic medicine should do it.

Physicians of Institute of Legal Medicine, University of Zurich (District Physician).

Question M

In cases of alleged assault by police, who examines the complainant?

Response

Australia

England and Wales

Germany

Hong Kong

India

Israel

Malaysia

The Netherlands

Nigeria

Scotland

Serbia

South Africa Spain Sweden Switzerland

Forensic medical officers (report and documentation of injuries). Police surgeons. An independent medical doctor.

The majority are examined by emergency medicine specialists. Some are examined by forensic pathologists/physicians. Forensic pathologist. Forensic pathologist. See answer to question L.

Generally speaking, public health officers qualified in clinical forensic medicine.

Medical officer in the local hospital; (if he is lucky to have the opportunity and guts to complain).

Police surgeon (unless urgent transfer to hospital).

See answer to question L.

Medical practitioner.

A forensic surgeon and a gynecologist or a urologist. See answer to question L.

Physicians of Institute of Legal Medicine, University of Zurich (District Physician).

Response

Australia

England and Wales

Germany Hong Kong

India

Israel

Malaysia

The Netherlands

Nigeria

Scotland

Serbia

South Africa Spain Sweden Switzerland

Yes. The Police Complaints Authority, which was replaced by the Independent Police Complaints Commission (IPCC) in 2004.

State prosecutor.

Yes. All complaints are handled by the Complaints Against Police Office (part of the police), but all cases are then reviewed by a statutory board the IPCC.

Yes. Via the police commissioner or to the magistrate. Probably rarely used. Yes

There are human rights groups. Police also conduct investigations against their own staff. Yes

A tribunal would be set up if the issue is considered to be of significant national interest.

The procurator fiscal (public prosecutor, legally qualified civil servants). Complaints must be referred by police where any criminality is alleged.

There is a Commission for Complaints within the police services as a first tier. Within the Ministry of Interior there is a second tier. Victims of police assault can also report directly to the court of law in accordance with the penal code, and Criminal Procedure Act.

Independent Complaint Directorate.

The correspondent court of first instance (the one on duty at the moment when the facts are reported).

IPCC, Independent Police Complaints Commission.

If your country has a person, body, or organization that investigates complaints against the police, (a) is it completely independent of the police? and (b) who funds it?

Response

Australia (a)

England and Wales (a)

Germany (a)

Hong Kong (a) India

Israel (a)

Malaysia (a)

The Netherlands (a)

Nigeria (a)

Scotland (a)

Serbia (a)

South Africa (a)

Sweden (a)

Switzerland (a)

Two bodies: police—Internal Investigations and government body—Ombudsman's Office. The Police Complaints Authority is independent of the police and was replaced by the IPCC.

Complaints Against Police Office—No. police establishment.

Police commissioner is from the police stream itself. Magistrates are completely independent of the police. Yes No

Yes (directly under the national prosecutor's office). No

No. Complaints are investigated by police unless criminality is suspected, when immediate report to regional PF is mandatory.

No. As part of the police and Ministry of Interior, the Commission, on both tiers, is not independent from the police. Yes (seemingly).

Yes. The police are subordinate to the Court of First Instance.

No. It's a special unit within the police. Yes

(b) Government funded, (b) The government.

(b) Judicial system.

(b) Government, (b) Ministry of Justice.

(b) There are nongovernmental organizations who back the victims and provide support. Police conducts their own investigations, (b) Ministry of Justice, (b) Government funded.

(b) Cases taken by the PF are centrally funded.

(b) Government

(b) International organizations.

(b) The judge, the judicial secretary, the district attorney, and the forensic surgeon, (b) State funded, (b) The state of Zurich.

IPCC, Independent Police Complaints Commission; PF, procurator fiscal.

In your country/state, is there person, body, or organization that investigates deaths of individuals while in police custody?

Response

Australia

England and Wales Germany Hong Kong

India

Israel

Malaysia

The Netherlands

Nigeria

Scotland

Serbia

South Africa Spain Sweden Switzerland

Yes, the Police Complaints Authority. State prosecutor and forensic legal medicine.

Yes, the coroner with a mandatory inquest held in public and with a jury. However, the investigations are conducted by the police.

Yes, the magistrate does it. Police cannot investigate such deaths. Yes

All deaths in custody are subjected to inquest by the magistrate according to Malaysian criminal procedure code. Yes

A uniformed police pathologist, rarely a hospital pathologist, and, in some cases, a medical officer.

All investigations are under the supervision of procurator fiscal; there is always a public "fatal accident inquiry" before a judge.

In the case of death in police custody, but also during the police action or allegedly as a result of police action, or while person is in penitentiary, district court that has territorial jurisdiction should order full postmortem, as well as other investigations.

Both the Independent Complaint Directorate and forensic pathologist/medical practitioner.

Yes. The Court of First Instance (of criminal investigation).

Yes, the district attorney and the Institute of Legal Medicine.

Question Q If the answer to the previous question is yes: (a) is that person, body, or organization independent of the police, and (b) who funds that organization?

Response

Australia

England and Wales

Germany

Hong Kong

India

Israel

Malaysia

The Netherlands Nigeria Scotland Serbia

South Africa Spain

Sweden Switzerland

(a) Magistrate is independent.

(a) Three bodies police—homicide squad and internal investigations, coroner's office, and Ombudsman's Office.

(b) Government.

(b) Government, (b) State, (b) The judiciary, (b) Government pays the salary, (b) Ministry of Justice.

(b) There is no full-time coroner; magistrate acts as the coroner in normal deaths, except custodial deaths, where the magistrate acts directly. Most of the deaths are investigated by the police; the coroner does not play a visible role. Inquest system needs improvement.

(a) It depends on who does the case. (b) Government funded.

All investigations are under supervision of PF; there is always a public fatal accident inquiry before a judge, (a) Yes, it is a court of law. (b) State and government,

(a) Yes (b) International organization.

(a) Yes. Doctors who assist individuals detained and prisoners are specialists totally independent of police.

(b) It is funded by health system doctors (Health Public National System), forensic surgeons (Ministry of Justice), and prison doctors (Ministry of Justice).

(a) Yes (b) The Department of Justice.

(a) Yes, the Department of Justice. (b) The state of Zurich.

Question R In your country/state are statistics published about deaths that have occurred in police custody?

Response

Australia Yes England and Wales Yes

Germany Yes

Hong Kong Yes, in the Coroners Annual Report.

India Yes, a publication called Crime Statistics, published by the Natonal Crime Records Bureau.

Israel No

Oo Malaysia Police Headquarters maintains all data.

The Netherlands Yes

Nigeria No

Scotland No

Serbia Not aware of any statistics.

South Africa Not aware of any statistics.

Spain No

Sweden No

Switzerland No

Question S If the answer to the previous question is yes, where, when, and how often are those statistics published and do they include an analysis of cause of death (e.g., self-harm, drugs, or other violence)?

Question S If the answer to the previous question is yes, where, when, and how often are those statistics published and do they include an analysis of cause of death (e.g., self-harm, drugs, or other violence)?

Response

Australia

Coroners report includes all cases. Australian Institute of Criminology publishes it annually. Complete analysis in all

cases.

England and Wales

Annual report of the Police Complaints Authority with breakdown of causes and circumstances of death.

Germany

Granzow, Puschel. Arch. Kriminol. 1998 J201:1—10. Includes an analysis of cause of death.

Hong Kong

The number of occurrences, the custodian department, and the verdicts of the inquests are summarized but no details of

death itself are presented.

India

Yearly publication. The figures may be inaccurate or incomplete.

Israel

No.

Malaysia

Not known whether it is regularly published, but data available.

The Netherlands

The prosecutor receives complete autopsy results.

Nigeria

Not applicable.

Scotland

Not applicable.

Serbia

Not applicable.

South Africa

Not applicable.

Spain

Not applicable.

Sweden

Not applicable.

Switzerland

In the state of Zurich, all cases are investigated by the Institute of Legal Medicine to establish the cause and manner of

Australia

England and Wales Germany Hong Kong

Does your country/state have a recognized (recognized by your medical professional body) specialty or subspecialty of medicine for those working in (a) clinical forensic medicine (CFM) or (b) forensic pathology (FP)?

Scotland Serbia

South Africa Spain

Sweden Switzerland

(a) No, only in some states in Germany, (a) Yes and no.

India

(a)

There

Israel

(a)

Yes

Malaysia

(a)

No

The Netherlands

(a)

No

Nigeria

(a)

(b) Yes, as part of the discipline of pathology, (b) Yes

(b) Yes. There is laid-out training for FP under the Hong Kong College of Pathologists, which includes CFM aspects. There is also statutory specialty registration but again, only in FP.

iters to both (a) CFM, as well as (b) FP. (b) Yes (b) No (b) No

(b) Yes. Recognition (by the Nigerian Medical Council and Postgraduate Medical College) is strictly as a subspecialty of pathology, (b) Yes, as part of pathology.

(b) Yes. Specialization is designated as FM, covering both issues. There are no separate specializations. The model was imported from Germany and France at the beginning of the last century when the first medical faculties were founded in the country.

(a) Yes—using a diploma or master's degree. (b) Yes, recognized registered specialty.

(a) Yes and no. Each forensic surgeon has undertaken a competitive examination in the Supreme Court-Ministry of Justice. Some also are specialists in legal and FM granted by the Ministry of Education. The Ministry of Justice has recognized both for forensic surgeons working in Institutes of Legal Medicine, (a) Yes (b) Yes

(a) Yes (b) Yes. The specialist title of Legal Medicine covers both sub specialties.

(a) As for England and Wales—only that the craft is recognized by British Medical Association, (a) Yes

FM, forensic medicine.

Can you supply the details (a) of the main organization that represents the interests of such practitioners and (b) the number of practitioners represented?

Response

Australia

England and Wales

Germany Hong Kong

India

Israel Malaysia

The Netherlands Nigeria

(a) Australian College of Pathologists.

(a) Association of Forensic Physicians (formerly the Association of Police Surgeons (approx 1000).

(a) German Society of Legal Medicine.

(a) Indian Academy of Forensic Medicine.

(a) Israel Association of Pathologists.

(a) Hospital forensic pathologists come under the Ministry of Health. Others are in the University Departments of Pathology. Forensic Unit comes under pathology. Clinical forensic medicine is mostly a neglected subject.

(a) Not available.

(a) There is no professional body that represents these few specialists.

(b) Approximately 50.

(b) British Association in Forensic Medicine (approx 300; only 40 or so full-time).

(b) Approximately 400.

(b) Hong Kong College of Pathologists, Forensic Pathology.

(b) Approximately 500 people are represented. For more information on IAFM, please visit its website at (http://www.fortunecity.com/campus/electrical/314/ iafm.html).

(b) Not available.

(b) Not available.

(b) There are two diploma of medical jurisprudence clinical graduates. There is no forensic pathologist (including the author) in Nigeria.

IAFM, Indian Academy of Forensic Medicine.

(Continued on next page)

Question U Can you supply the details (a) of the main organization that represents the interests of such practitioners and (b)

(Continued) the number of practitioners represented?

Response

Scotland

Serbia

South Africa

Spain

Sweden

Switzerland

APS and BMA for clinical forensic medicine in UK. Pathologists by BAFM and BMA—BMA has Forensic Medicine Committee. Yugoslav Association of FM. Department of Health in collaboration with international organizations

Forensic surgeons form groups in some professional associations nationwide, such as the Asociación Nacional de Médicos Forenses, Asociación Andaluza de Médicos Forenses, Asociación Estatal de Médicos Forenses, Asociación Gallega de Médicos Forenses., etc. The National Forensic Board, under the Department of Justice, is responsible for all examinations in the fields of forensic pathology (death investigations), forensic psychiatry, FM, and forensic genetics. All specialists who are active in these fields are employed by this organization. Competition in these fields is free but does not, with the exception for investigations of living victims and perpetrators, occur. Swiss Society of Legal Medicine, Website: (www.legalmed.ch).

(b) Approximately 40-50 members, (b) About 80 practitioners.

(b) About 300 forensic surgeons are represented by those associations. The number of licensed medicolegal experts in Spain is currently 450, and acting medicolegal experts about 150.

(b) There are approx 25 specialists in FM in Sweden today.

APS, Association of Forensic Physicians; BAFM, British Association in Forensic Medicine; BMA, British Medical Association; CFM, clinical forensic medicine; FM, forensic medicine.

Response

Australia

England and Wales Germany

Hong Kong India

Israel Malaysia

The Netherlands Nigeria

Scotland

Serbia

South Africa

Spain

Sweden

Switzerland

Can you give a rough estimate of (a) the population of your country/state, the number of medical practitioners working in (b) CFM, and (c) FP?

(a) Germany: 80 million/ North Rhine-Westphalia state: 16 million.

(a) Approximately 120 million.

(a) Approximately 5.25 million.

(b) Approximately 50. (b) Approximately 2000. (b) Germany: 150/state: 50.

(b) None full-time. More than 1000 in different ways.

(b) There are no data available on it. In peripheral regions, such as small towns and villages, even general duty doctors fulfill the work of CFM and FP.

(b) One trained forensic physician.

(b) Approximately 350.

(b) One part-time (a uniformed police officer).

(b) Approximately 150.

(b) Approximately 40-50.

(b) Approximately 180 (majority of them are part-time basis).

(b) Approximately 9.

(b) 35 (10 nonspecialists in training).

(c) Approximately 10. (c) Approximately 40. (c) Germany: 250/state: 50.

(c) 18; this group does most of the criminal cases relating to CFM.

(c) Approximately 20 forensic pathologists

(c) Approximately 5.

(c) Six—all currently outside Nigeria; one of the six has retired.

(c) Approximately 12 (these are mainly university staff).

(c) Approximately 40-50.

(c) Approximately 25.

(c) Approximately 9.

CFM, clinical forensic medicine; FP, forensic pathology.

Response

Australia

England and Wales Germany Hong Kong India

Israel Malaysia The Netherlands Nigeria

Scotland Serbia

South Africa Spain

Sweden Switzerland

(a) DMJ (Clin), DFM, MMJ. (a,b) Yes, but they are the same, (a) DMJ (Clin)(Lond.).

(a) Yes, 3-yr postgraduate course in forensic medicine, which can only be done by a graduate in medicine and surgery. There is an entrance test for this course, (a) No (a) No (a) Yes

(a) All trained in the United Kingdom, Germany, and United States. There are no local training programs.

(a,b) All UK qualifications, e.g., DMJ, DFM (not compulsory); pathologists MRCPath, DFM, DMJ, and one available from the RCP (Ed). (a,b) No qualifications but training program.

(a,b) There are national test (competitive examinations on supreme court-Ministry of Justice) to be admitted in the National Corps of Forensic surgeons (Cuerpo Nacional de Médicos Forenses). The professionals are the ones who conduct both CFM and FP. (a) Yes (b) Yes

(a,b) Yes, qualifications that cover both fields.

(b) DMJ (Path)(Lond.), FHKCPath, FHKAM. (b) Same as (a).

(b) Master of Pathology (Forensic)—4-yr course, (b) Yes

CFM, clinical forensic medicine; FP, forensic pathology.

Question X

Are such qualifications mandatory to practice in (a) clinical forensic medicine or (b) forensic pathology?

Response

Australia (a) Yes, in full-time practice only. (b)

India (a) No, as stated above, they are not mandatory. (b)

Although a great prestige is accorded to the report of people who have such a qualification.

Malaysia (a) Ordinary doctors undertake a large part of routine (b)

autopsies and clinical cases. Depending on the availability, difficult or complicated cases are handled by specialists.

Switzerland (a) Yes (but only at university institutes). (b)

Yes Yes Yes Yes

Not officially.

Locally trained histopathologists and medical officers unfortunately often assume this role. Yes Yes

Yes, but still unqualified are working.

Yes (but only at university institutes).

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