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Medicolegal System in Lithuania

Romas Raudys
Director of the State Forensic
Medicine Service, MD, PhD

The State Forensic Medicine Service (SFMS) is a personal health care budgetary institution of the Lithuanian national health system, administered by the Ministry of Health of the Republic of Lithuania, established under provisions of the Government of the Republic of Lithuania Resolution No. 547 of 18 June 2014 "On Changing the Name and Subordination of The State Forensic Medicine Service Under the Ministry of Justice of the Republic of Lithuania”.

The main purpose of SFMS operational activities is to provide quality forensic medical services by performing forensic medical expertise and examinations by the court, public prosecutor or pre-trial investigation institutions officers’ orders and other individuals and legal entities’ requests.

The key operational objectives of SFMS
  • To provide forensic services;
  • To ensure training and skills development of forensic medicine experts of their field, organize provision of their qualifications and training of forensic doctors;
  • To collaborate with institutions of higher education.

The main functions of structural units in their working areas are set out in the Regulations of the State Forensic Medicine Service approved by the Minister of Health Resolution No. V-3 of 6 January 2015 "On Approval of the State Forensic Medicine Service Regulations“.

SFMS expert units are located in 5 major cities of Lithuania - Vilnius, Kaunas, Klaip?da, ?iauliai and Panev??ys and 5 regional centers - Alytus, Jurbarkas, Marijampol?, Taurag? and Utena. Forensic laboratory tests are performed at Didlaukio Str. 86E, Vilnius.? This is a center of modern Toxicology, Serology and DNA, Forensic Medical Criminalistics and Histology laboratories, compliant with scientific and technological standards.

Human Resources
  • In 2014 SFMS staff consisted of 250 employees, including: 12 senior forensic medical experts and 32 forensic medical experts who perform examinations of living persons and the deceased. In total - 44 forensic medical experts.
  • Laboratory examinations are performed by 6 senior forensic medical experts and 27 forensic medical experts in SFMS Toxicology, Medical Criminalistics, Histology, Serology and DNA laboratories. In total - 33 forensic medical experts.
  • The staff also includes a doctor radiologist, senior forensic medical technicians, 42 forensic medical technicians. In total - 50 forensic medical technicians, 1 radiology technician, 24 medical registrars, 3 autopsy technologists, 59 other employees.
SFMS provides the following forensic medical examinations and expertise (1)
  • Of the deceased persons:
  • Determination of the cause and time of death, injuries, injury-making mechanism, manner and time;
  • Determination of the health impairment scale;
  • Determination of the age of the deceased, etc.
SFMS provides the following forensic medical examinations and expertise (2)
  • Of the living persons:
  • Determination of injuries, injury-making mechanism, manner and time;
  • Determination of the health impairment scale;
  • Examination and expertise of sexual canditions - rape, abuse, sex, former pregnancies, former birth abortion;
  • Determination of age, the general capacity for work, health status, etc.
  • Deontological:
  • Determination of diagnosis, assessment of the medical treatment tactics, etc.
SFMS provides the following forensic medical examinations and expertise (3)
  • Toxicological:
  • Determination of ethyl alcohol in blood, urine and other biological samples;
  • Determination of alcohol surrogates and other volatile poisons (methyl, propyl, butyl and amylin alcohols, acetone, ethylene glycol, etc.) in biological samples;
  • Determination of drugs and psychotropic substances in biological samples;
  • Determination of medicinal substances in biological samples;
  • Determination of acids, alkalis, organic phosphorus compounds and other chemical agents in biological samples of the deceased;
  • Determination of carboxyhemoglobin and methemoglobin in the blood of the deceased persons.
SFMS provides the following forensic medical examinations and expertise (4)
  • Serological:
  • Determination of blood, semen, saliva, sweat;
  • Blood type dependence;
  • Blood group dependence;
  • Morphological examination of hair.
  • Cytological:
  • Regional dependence of cells;
  • Gender dependence of cells.
SFMS provides the following forensic medical examinations and expertise (5)
  • DNA:
  • Blood, secretions, hair, tissue identity (coincidence of the examined object’s DNA structure with DNA structures of specific individuals, and the examined object dependency to the identifiable person);
  • Disputed paternity, maternity, children's substitution, family relation.
SFMS provides the following forensic medical examinations and expertise (6)
  • Osteological:
  • Determination of gender, biological age, body length, and the other group and individual identification characteristics in skeletons, bone residues affected by high temperature or highly active substances;
  • Determination of the time of the bones staying in the ground;
  • Personal indentification by skull by applying the video matching method;
SFMS provides the following forensic medical examinations and expertise (7)
  • Medical criminalistics:
  • Determination of injuries and the injury-making mechanism in objects provided for examination;
  • Determination of a group dependency of the tool of crime, identification of the tool by examining injuries in objects provided for examination;
  • Examination of gunshot injuries - determination of the bullet entrance and exit wounds (holes), the projectile diameter, projectile type, presence of additional shooting factors or determining traces of their affect, determination of the shooting distance.
SFMS provides the following forensic medical examinations and expertise (8)
  • Determination of metal concentration in biological objects.
  • Determination of plankton diatomies in biological objects and water from the water pool.
  • Determination of the quantity of glucose in the deceased person‘s blood plasma.
  • Determination of the quantity of glycogen in biological objects.
SFMS provides the following forensic medical examinations and expertise (9)
  • Histological:
  • Determination of the microscopic structure of biological objects and their dependancy to a specific organ;
  • Determination of compulsive changes, injury time and nature of injury;
  • Determination of characteristics indicating the period of changes by using special staining techniques.
Autopsies are generally performed in the following cases:
  • If the evidence suggests that the person could have been killed (homicide),
  • In cases of a sudden unexpected death,
  • If the evidence suggests violation of human rights, or the person has been tortured or otherwise severely treated before death,
  • In cases of suicide or suspected suicide,
  • In cases of a suspected inadequate provision of medical assistance,
  • In cases of accidents at work, transport or domestic accidents,
  • In cases of occupational diseases and deaths related to occupational risks and hazards,
  • In cases of deaths caused by natural disasters, disasters of natural or technogenic origin,
  • If a person dies in police custody or detention,
  • In other cases when the deceased is unknown or the dead body is skeletonized,
  • In other cases ordered by a pre-trial investigation officer, prosecutor or judge.
Examination of living persons is performed in the following cases:
  • In cases of personal injury (for determining the tool(s) of crime, manner and time of injury, estimating residual scars after injury, health impairment scale, the loss of general capacity for work level);
  • In cases of sexual offence and sexual conditions (for determining the former forced sexual intercourse, molestation of minors, virginity, pregnancy, a former childbirth, abortion, the fetus development time);
  • In other cases (for determining the age, sex, personal identification, assessing health status, considering deontological issues).
KEY STATISTICS (from SFMS report of 2014) (1)
  • Examination of living persons - 18 370. Including: 74% - slight health impairment, 22% - non-severe health impairment, and 4% - severe health impairment determined.
  • Autopsies - 6 329. Including violent death determined in 48% of cases. The structure of violent deaths: 4% - homicides, 32% - suicides, 60% - accidents, 4% - undetermined.
  • Attending the crime scene - 545.
  • Attending the court proceedings - 653.
KEY STATISTICS (from SFMS report of 2014) (2)
  • Toxicological examinations: Determination of ethanol - 11 299 (including 5 744 - in blood of the deceased), examination of internal organs of the corpses - 598, analyses for CO (carbon monoxide) - 188, drugs (in blood and urine) - 3 507, examination of the stomach contents and other samples - 31. The total number of toxicological examinations performed - 15 623.
  • The Serology and DNA Laboratory performed 444 family relationship (paternity) testings in civil cases and 373 DNA testings in criminal cases, 161 semen detection testings.
KEY STATISTICS (from SFMS report of 2014) (3)
  • Examinations performed in the Medical Criminalistics Laboratory:
  • 115 - identification of the tool of crime,
  • 116 - skeletal (osteological) examinations for determining the age and sex,
  • 57 - diatomic plankton examinations,
  • 151 - biochemical (glucose, glycogen) examinations.
  • Sufficiently good forensic experts’ knowledge and skills gained during residency studies and practice. Large workloads offer a possibility to faster gain great experience.
  • Under the current legal regulation, the law enforcement authorities’ demand for forensic medical services is constant and extensive.
  • SFMS status at the national level ensures a regular funding from the state budget, thus eliminating the need to worry about maintenance of the institution and staff - this is a public concern.
  • Recently the number of doctors in forensic medicine residency studies is sufficient, thus, within the next few years issues on the lack of forensic medical doctors might be solved.
  • SFMS has a Medical Criminalistics Laboratory whose main objective is identification of the tool of crime by examining traces left in bodily injuries. Such type of laboratories is rare in Europe.
  • SFMS has a specialist who has acquired forensic medical doctor‘s and radiologist‘s speciality and regularly provides consultations to all SFMS experts on radiology related issues.
  • Good professional relations established with the judiciary, prosecution and police authorities ensure a smooth solution of systemic problems, including initiatives related to the amendment of laws or other legal acts.
  • SFMS is the main institution in Lithuania whose conclusions regarding the adequacy of medical treatment applied are considered by courts. Such type of expertise involves professionals of other medical fields of expertise, thus offering SFMS experts an excellent opportunity, through practical activity, to improve their knowledge of other clinical disciplines.
  • SFMS is a monopolistic institution in the state (there are just a few private experts), so there are good conditions for the development of general expertise rules and methodologies and their uniform use. The domination of one (monopolistic) institution ensures SFMS’ continuous involvement in the preparation and development of laws and regulations related to forensic expertise and a possibility to express the institution's position on expert activity related issues.
  • Large workloads, although enabling faster accumulation of expert experience, create preconditions for errors and inaccuracies, and the law enforcement authorities request faster terms of providing expert conclusions. Also, due to the large workload, not much time is left for research activities.
  • The institution financing from the state budget is stable, however often insufficient for the acquisition and modernization of new technologies (devices), acquisition of standards (reference materials) required for toxicological detection of specific substances, as well as for the improvement of specialists’ qualifications abroad.
  • The persistent lack of specialists is related to relatively low salaries (the average doctor’s monthly salary before taxes in SFMS - 1141 euro), therefore young specialists are looking for better paid jobs.
  • The institution’s monopolistic position in the state and the relative lack of specialists eliminates competition, so some specialists are not concerned about professional improvement.
  • The expertise performed at SFMS for law enforcement authorities in criminal proceedings is conducted from the institution's budget; therefore they are not concerned about saving SFMS financial resources. However, this is also an advantage, because there is no need to save the law enforcement authorities’ (police) financial resources assigned for crime detection, so the police request to get answers to as many questions as possible.

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