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Legal Medicine in Spain

There are eight university institutes of legal medicine in Spain (University of Barcelona; Faculty of Medicine, Cadiz, Granada; Complutense University, Madrid; University of Salamanca; University of Santiago de Compostela; University of Valladolid; University of Zaragoza; and University of Valencia).

Each of these institutes is headed by a professor. About fifty doctors are employed in these university departments. With only a few exceptions, all the departments are financed by their universities. (The Faculty of Toxi- cology in Valencia, is partly financed by the Department of Social Security and the Faculty of Toxicology in Madrid receives some aid from the Ministry of Justice.)

The institutes deal with most medico-legal subjects, i.e., forensic pathology, toxicology, serology (biology) forensic psychiatry, compensation for injury examination, clinical examination for drunkenness, sex offences, etc., road traffic alcohol analysis, criminology, forensic anthropology and jurisprudence and medical rights. The institutes provide forensic science services, e.g., ballistics, fiber examination, etc.

There is also a state medico-legal service (the National Body of Forensic Medicine, which has its own establishments: Institute of Forensic Anatomy and Clinics of Legal Medicine).

The university institutes are teaching undergraduate medical students, and forensic medicine is compulsory in the final course. The students have to pass both an oral and a written examination. The duration of the course is nine months with classes on alternate days and practical instruction every afternoon. The ratio of time devoted to theory and to practical instruction is 2:l. Autopsy instruction is compulsory, and tuition is given both in medical ethics and physicians’ relations with the state and its laws and foren- sic pathology. Also clinical instruction is given. Approximately 8% of the time of the medical staff is used for teaching.

Postgraduate instruction is given in (a) legal and forensic medicine and (b) occupational medicine. The duration of each course is two years, and after the course the doctor can use the title of specialist; a certificate is issued by the Ministry of Education and Sciences. To become a member of the Na- tional Body of Forensic Medicine it is necessary to pass and additional exami- nation.

The medico-legal specialists receive their salaries from the universities. All the examinations are paid for by the Administration of Justice or by the party that requests the examination. The facilities of the institutes are con- fined to the police or the public prosecutor, but in cases of doubt or contra- diction, expert opinion may be obtained from the institute by the legal representative of the accused.

The state also maintains criminalistic laboratories organized by the police. These laboratories are not handling medical problems.

In Spain there are two professional societies: Asociacicin de Medicos Forenses. Goya 99. Madrid-g. Sociedad Esptiola de Medicina Legal y Social. Escuela de Medicina Legal. Facultad de Medicina, Ciudad Universitaria. Madrid-3.

The first mentioned is a professional society, the second one is a scientific society. Membership of the association is a legal requirement before a doctor can practise as a medico-legal expert. The society safeguards the standards of practice and the standards of membership of medical-legal experts, organizes scientific meetings, and negotiates salaries, etc.

Asociacion de Medicos Forenses publishes Revista Espaiiola de Medicina Legal.

To be able to certify a death a physician must be registered at the college of medicine of the province. A physician is not allowed to issue a certificate in the case of a violent death or when there is a suspicion of criminality. It is not practice to report the death to the Institute of Forensic Medicine. The investigation is performed by a medico-legal expert appointed by the court (the judge). All violent deaths or deaths suspected to be the result of a criminal act are examined externally and internally according to the decision of the judge. All of the recorded cases are autopsied.

The following types of death must be reported to the authorities: homicide, suicide, traffic accidents, industrial accidents, domestic accidents, other acci- dents, sudden unexpected deaths, infant deaths (with no medical certificate), anaesthetic and other deaths associated with medical treatment, deaths in prison or custody, deaths in mental hospitals (the last two groups if there exist any doubt about their aetiology), industrial diseases, and deaths not certified by the doctor treating the patient. The death will also be reported if rumours suggest that the death was violent.

In Spain there is no public inquiry comparable to the “coroner’s inquest”. A documentary report by the forensic pathologist is accepted, but he may be called upon to testify at any stage during the court proceedings. He can also be questioned out of court by the legal representative of the accused in civil cases and even the accused may be present at the autopsy or he may appoint a specialist to be present and ask questions. The accused may also appoint the doctor to treat the victim if the victim is not dead.

The system in Spain is, in general, satisfactory; it is sufficiently economical and rapid, but it could be improved.

Today legal medicine depends on the Ministries of Justice, of Employment, of Government, of Education and Science. It would be better to unify the departments under one body. Regional institutes could be created, and more incentive and reward should be given. Finally, the teaching and the practice of legal medicine should be integrated. Now they are generally not associated. Financial support is totally insufficient and should be augmented.

The available medical manpower is insufficient; legal medicine is not a popular career because of the lack of economic and moral stimulation in the face of the number of difficulties.

The autopsy rate in Spain is high. In Spain numerous organizations concerned with legal medicine and foren-

sic science exist. (a) Universities: these are charged with the teaching of the medical

students and with research in this field. (b) “La Forense”: constituted by the National Body of Forensic Medicine.

A judge may use the service of organs such as: (1) the Institute of Forensic Anatomy, (2) the Medical Forensic Clinic, (3) The National Institute of Toxicology.

(c) National Medical Body of the Civil Register: charged with developing the functions connected to the Civil Code (births, deaths, sex, etc.)

(d) Medical Body of Prisons: charged with giving assistance to the prisons in criminologic processes and the rehabilitation for reinsertion into society.

(e) Labour Organizations: who work with their own doctors in all their activities.

(f) Central Laboratories of Identification under the Director General of Security: charged with the majority of the problems of identification, and also those of criminalistic nature.

(g) Laboratory of the Special Academy of the Civil Guard: with the same goals as (f) and which is now beginning to function.