The organization of Legal and Forensic Medicine in Spain has undergone important structural and functional changes. Social, legislative, and technological progress has determined an evolution in the form of access, scope of action, organizational dependence, functions, specialisation, provision of resources, extrajudicial activities, and relations with other institutions. The figure of the forensic doctor attached to a court, isolated, polyvalent, with no teaching or research activity is now a thing of the past. The figure of the Institutes already provided for in Organic Law 6/1985 of 1 July 1985 on the Judiciary promoted unity of action, teamwork, specialisation and training, teaching, and research. The enactment of Royal Decree 144/2023, of 28 February, approving the Regulations of the Institutes of Legal Medicine and Forensic Sciences has allowed these technical bodies to adapt to the process of modernisation of justice and to the necessary social and health projection of forensic sciences. We must look to the future and adapt the organizational structure, the functioning of the institutes, and the regulations for their creation and entry into operation to the new changes.
La organización de la Medicina Legal y Forense en España ha asistido a cambios estructurales y funcionales importantes. La progresión social, legislativa y tecnológica ha determinado una evolución en la forma de acceso al cuerpo de médicos forenses, ámbito de actuación, dependencia orgánica, funciones, especialización, dotación de medios, actividades extrajudiciales y relaciones con otras instituciones. La figura del médico forense adscrito a un juzgado, aislado, polivalente, sin actividad docente e investigadora ha quedado atrás. La figura de los Institutos de Medicina Legal prevista ya en la Ley Orgánica 6/1985, de 1 de julio, del Poder Judicial promovió la unidad de la actuación, el trabajo en equipo, la especialización y la formación, docencia e investigación. La promulgación del Real Decreto 144/2023, de 28 de febrero, por el que se aprueba el Reglamento de los Institutos de Medicina Legal y Ciencias Forenses ha permitido adaptar estos órganos técnicos al proceso de modernización de la justicia y a la necesaria proyección social y sanitaria de las ciencias forenses. Debemos mirar hacia el futuro y adaptar a los nuevos cambios la estructura organizativa, la normativa de creación y entrada en funcionamiento, la especialización, así como a la necesaria trasformación digital y mejora de la calidad que debe acompañar todo este proceso.
Forensic and legal medicine (MLYF) arose from the needs of the administration of justice to establish itself as a bridge between medicine and law.1 It is now also considered a medical specialty that aims to use medical, legal, administrative, ethical, and related scientific knowledge for the application, development, and improvement of law, healthcare, and the medical profession.
In Spain, the organization of forensic medicine has undergone a major change in the last 25 years, moving from an atomised and dispersed model to a new organizational model represented by the Institutes of Legal Medicine and Forensic Sciences (IMLCFs), with territorial and functional structures and a multidisciplinary vision of forensic science. Social progression has meant that the classical organizational concept, training, and its purpose have evolved, without losing its main mission of supporting the administration of justice.
In addition to this organizational change, a new regulation of the specialty of legal and forensic medicine (EMLYF)2 has been developed in parallel, which will converge and have an impact on the medical professionals who, in the short and medium term, will form the corps of forensic doctors and will be included, together with other professionals and staff, in the IMLCFs.
In this changing context and from a historical perspective, assessing the present and the lines of the future, the aim of this article is to describe the evolution and analyse the current organization of forensic and legal medicine, including a view of the main actors involved.
The specialty of legal and forensic medicineThe speciality of legal and forensic medicine (EMLYF) in Spain dates back to 1843 when Pedro Mata included it as an independent discipline in medicine and surgery studies. The Law of 20 July 1955 on teaching, qualification, and practice of medical specialties recognised EMLYF as one of the medical specialities.3
Royal Decree 127/1984 of 11 January 1984, which regulates specialist medical training and the awarding of the qualification of specialist doctor, later differentiated between 3 groups of specialities: those essentially requiring hospital training, those not essentially requiring hospital training, and those not requiring hospital training but in professional medical specialisation schools or university departments. The EMLYF was included in this third group, known as the student regime, and its access was the same as for the rest of the specialties.4
However, the 2003 regulations on the organization of the health professions and their subsequent update in 2008 declared some student-based specialist degrees, including the EMLYF, were to be made “extinct”, which occurred in 2014, since, from the 2015 call for selective tests for access to specialist health training (FSE) places in 2016, no student-based training places would be offered. Although practically all training was linked to the university colleges of the medical faculties of Catalonia (with the collaboration of the IMLCF), Granada, Madrid, Murcia, Seville, and Valladolid, the IMLCF of Valencia also trained its first residents through the college system, between 2009 and 2014 (Table 1).
Calls for applicants to the MIR in the specialty of legal and forensic medicine under the student regime 1992–2014 (Source: Compiled by the authors).
| CALL | AC Andalusia | AC Catalonia IML Catalonia | Region of Murcia Univ. Murcia | AC Madrid Univ. UCM | AC Valencia IMLValencia | AC Castila León Univ. Vallad | Total | |
|---|---|---|---|---|---|---|---|---|
| Univ. Seville | Univ. Granada | |||||||
| 1992–1993 (BOE (Official State Gazette) 09/07/92) | 5 | 0 | 0 | 0 | 0 | 0 | 0 | 5 |
| 1993–1994 (BOE 30/07/93) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 1994–1995 (BOE 27/07/94) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 1995–1996 (BOE 05/10/95) | 7 | 15 | 0 | 0 | 15 | 0 | 0 | 37 |
| 1996–1997 (BOE 11/10/96) | 4 | 4 | 0 | 0 | 15 | 0 | 4 | 27 |
| 1997–1998 (BOE 25/11/97) | 5 | 0 | 0 | 0 | 15 | 0 | 0 | 20 |
| 1998–1999 (BOE 31/12/98) | 5 | 0 | 0 | 0 | 15 | 0 | 0 | 20 |
| 1999–2000 (BOE 28/12/99) | 5 | 0 | 0 | 0 | 6 | 0 | 0 | 11 |
| 2000–2001 (BOE 22/12/00) | 5 | 0 | 0 | 0 | 10 | 0 | 0 | 15 |
| 2001–2002 (BOE 09/11/01) | 3 | 0 | 0 | 0 | 12 | 0 | 0 | 15 |
| 2002–2003 (BOE 02/11/02) | 5 | 0 | 0 | 0 | 12 | 0 | 0 | 17 |
| 2003–2004 (BOE 17/10/03) | 5 | 3 | 0 | 0 | 12 | 0 | 0 | 20 |
| 2004–2005 (BOE 01/10/04) | 5 | 5 | 0 | 0 | 12 | 0 | 0 | 22 |
| 2005–2006 (BOE 22/09/05) | 5 | 5 | 4 | 2 | 15 | 0 | 0 | 31 |
| 2006–2007 (BOE 22/09/06) | 5 | 5 | 4 | 2 | 15 | 0 | 0 | 31 |
| 2007–2008 (BOE 19/09/07) | 5 | 0 | 5 | 3 | 10 | 0 | 0 | 23 |
| 2008–2009 (BOE 19/09/08) | 5 | 0 | 5 | 3 | 10 | 0 | 0 | 23 |
| 2009–2010 (BOE 22/09/09) | 5 | 0 | 5 | 3 | 10 | 1 | 0 | 24 |
| 2010–2011 (BOE 22/09/10) | 2 | 0 | 5 | 3 | 10 | 0 | 0 | 20 |
| 2011–2012 (BOE 26/09/11) | 5 | 0 | 5 | 3 | 10 | 1 | 0 | 24 |
| 2012–2013 (BOE 18/09/12) | 5 | 0 | 5 | 3 | 10 | 1 | 0 | 24 |
| 2013–2014 (BOE 23/09/13) | 5 | 0 | 5 | 2 | 10 | 1 | 0 | 23 |
| 2014–2015 (BOE 23/09/14) | 5 | 0 | 5 | 2 | 10 | 1 | 0 | 23 |
| CALLS 1992–2014 | 101 | 37 | 48 | 26 | 234 | 5 | 4 | 455 |
In this context, the Ministry of Justice had taken an interest in the subject, and this was made clear in Organic Law 7/2015, of 21 July, amending Organic Law 6/1985, of 1 July, on the Judiciary (LOPJ), which introduced amendments to book VI, including the incorporation of the requirement of a specialisation in forensic medicine for entry into the CMF (Forensic Medical Council).5 This established a vacatio legis as it will come into effect when the Ministry determines that the first classes that have obtained a place through the residency system, through the corresponding annual call for selective examinations for access to positions in FSE have completed their training. Another action by the Ministry was to request a report from the Scientific-Technical Committee of the Forensic Medical Council,6 constituted in 2014, on the specialty, and which concluded on the importance of developing a quality specialty that would facilitate the entry of future members of the CMF.
Finally, Royal Decree 704/2020, of 28 July, was issued, establishing access to the qualification of legal and forensic specialist doctor through the residency system,7 which included the specialty in the catalogue of health science specialties and configured the IMLCFs in teaching units. In parallel, the National Commission for the Speciality was renewed on 12 March 2020 and then Order PCM/997/2022 of 18 October was issued, approving and publishing the training programme for the specialty of legal and forensic medicine, the assessment criteria for specialists in training, and the accreditation requirements for teaching units.8
Through this route, the Ministry of Health has accredited some IMLCFs as teaching units and places have been offered since the 2021–2022 call for applications. Table 2 shows the current situation of IMLCFs accredited as teaching units in legal and forensic medicine and the number of places offered to date.
Current situation of IMLCF accredited as legal and forensic medicine teaching units and the places offered to date.
| Area | IMLCF teaching unit | Call 2021/2022 | Call 2022/2023 | Call 2023/2024 | Call 2024/2025 | TOTAL |
|---|---|---|---|---|---|---|
| Aragon | Zaragoza | 1 | 1 | 1 | 1 | 4 |
| Canary Islands | Las Palmas | – | – | 1 | 1 | 2 |
| Catalonia | Barcelona | 1 | 1 | 2 | 4 | 8 |
| Valencian Community | Alicante | – | – | 1 | 1 | 2 |
| Valencia | 1 | 1 | 1 | 1 | 4 | |
| Ministry | Albacete | 1 | 1 | 1 | 1 | 22 |
| Badajoz | – | – | 1 | 1 | ||
| Burgos | 1 | 1 | 1 | 1 | ||
| Cáceres | 1 | 1 | 1 | 1 | ||
| León | – | – | – | 1 | ||
| Murcia | 1 | 1 | 1 | 1 | ||
| Mallorca | – | – | – | 1 | ||
| Valladolid | – | – | 1 | 1 | ||
| Basque Country | Bilbao | 1 | 1 | – | 1 | 3 |
| TOTAL | 8 | 8 | 12 | 17 | 45 | |
Source: Compiled by the authors.
Initially, professional career opportunities were oriented towards private expertise, the university (full professor, associate professor, or professor) or the private expert field, and later extended to the health field (public and private sector) to address problems arising from the functioning of health systems and the ethical, legal, and health implications of clinical care service provision. The requirement to hold the qualification of legal and forensic specialist doctor in order to join the Corps of Forensic Doctors will soon constitute a new professional opportunity and will improve professionalism and expert quality, while promoting the social and health projection of forensic sciences.
In any case, it will be necessary to pay attention to potential changes in the MIR system, 40 years after its consolidation. Particularly, in a context in which the priorities of students in certain fields have changed from an initial “essentially vocational” phase, through an intermediate “essentially technological” phase, to the current phase, described by Pujol Farriols as “essentially beneficial”.9
From the Corps of Forensic Doctors to the Institutes of Forensic Medicine and Forensic SciencesThe Corps of Forensic Doctors, attached to the courts of first instance and instruction, was created in 1862 after the Health Act established the figure of the forensic doctor in 1855. In 1882, the Criminal Procedure Act (LECrim) recognised the functions and role of the forensic doctor, which have remained the same to this day, despite the reforms made and the projects for the new LECrim that have been undertaken.
Admission to the corps has taken place through various systems, from personal appointment, through the merit-based competition system, previous professional experience, and the competitive examination system, with the requirement of the EMLYF being taken into account when the ministry so provides, as we have already mentioned. It has also undergone changes in assignment, firstly to the courts of first instance and instruction, then to forensic science groups, forensic anatomy institutes, and forensic medicine clinics (in the provincial capitals where they existed) and, since the end of the 20th century and the beginning of the 21st century, to forensic medicine institutes (IML), structured territorially and organized by service.
The evolution of the organization of forensic medicine can be divided into 3 phases.
Organization of forensic services between 1855 and 1996The courts often had to support their judgements with the opinion of experts, and doctors were among those most frequently offering them the support of their scientific knowledge. However, for various reasons, their cooperation was sometimes lacking. With the Royal Decree of 28 August 1855 (Gaceta of 14 September), the first 8 forensic doctors were appointed to the Madrid courts. The Health Act of 28 November 1855 ordered the organization of the forensic medical services, which was established by Royal Decree of 13 May 1862, which also provided for the creation of a corps to deliver any forensic service entrusted to it by judges and courts, and for a regulation to regulate the internal organization of the corps. In 1882, with the promulgation of the LECrim, the figure and function of the forensic doctor were recognised in our procedural laws.
The figure of the forensic doctor assigned to a court, isolated, polyvalent, with the complexity of medical knowledge and without teaching and research activities, made it necessary to rethink the organization of the forensic services of the Ministry of Justice into institutes.
The new organization provided for in Organic Law 6/1985, of 1 July, on the Judiciary (LOPJ) was the only way to carry out forensic medicine in an effective and scientifically rigorous manner, in line with the scientific development of medicine. The entry into force of the LOPJ on 3 July 1985 necessitated organizational changes. The regional and provincial institutes of forensic medicine were created and the need for cooperation with the university was stressed. The White Paper on Forensic Medicine (1988)10 was born with the idea of undertaking this reform. It envisaged the need to improve the training of forensic doctors, to centralise it in institutes and to promote their specialisation and training in specific areas, to extend their scope of action to other jurisdictions (labour, disputes, minors) and to participate in the improvement of legislation, to promote scientific and research aspects, and to improve their material means with their own suitable spaces and premises.
The institutes were set up as technical bodies, centralising the functions of the anatomical forensic institutes and forensic medicine clinics and providing expert medical, thanatological, clinical, and laboratory services.
Organization of forensic services between 1996 and 2023Royal Decree 386/1996, of 1 March 1996, approving the Regulations of the Institutes of Forensic Medicine, defines them as technical bodies whose mission is to assist courts, tribunals, public prosecutors' offices, and civil registry offices by carrying out expert medical, thanatological, clinical, and laboratory examinations, and to carry out teaching and research activities related to forensic medicine.
The regulations established the rules of creation, organizational structure, governing bodies (director, board of directors) and their functions, services (pathology, clinical, laboratory, and others) and their competences, staff, administrative services, and the creation of the Teaching and Research Commission and collaboration with universities and other institutions. The forensic doctors previously assigned to the courts were integrated into the institutes.
At the same time, competences in the area of justice were transferred to the autonomous communities (ACs): the Basque Country (1988), Catalonia (1990), Galicia (1995), the Canary Islands (1996), Valencia (1996), Andalusia (1997), Navarre (1999), Madrid (2003), Asturias (2006), Aragon (2008), Cantabria (2008), and La Rioja (2011). The Autonomous Regions of Castilla-La Mancha, Castilla-León, Extremadura, Balearic Islands, Region of Murcia, and the Autonomous Cities of Ceuta and Melilla were attached to the Ministry of Justice.
The institutes were successively created (Table 3) in: Valencian Community (1998), the Basque Country (1998), Navarre (2000), Catalonia (2001), La Rioja (2002), Aragon (2002), Andalusia (2002), Canary Islands (2002 Tenerife 2007 Gran Canaria), Asturias (2002), Cantabria (2003), Galicia (2005), Madrid (2006), Murcia (2002), Castilla-León (2002), Castilla-La Mancha (2002), Extremadura (2003), Balearic Islands (2003), State Jurisdiction Bodies -OJE- (2011), and Ceuta and Melilla (2017). Their organization, operation, and technical resources depend either on the Ministry or on the corresponding Regional Ministry of Justice.
Creation and entry into operation of the IMLCFs and the regulations that currently govern them.
| Autonomous Community | Regional scope | Year of creation | Current regulations |
| ANDALUSIA | Almeria | 2002 | Decreto 69/2012, de 20 de marzo, que aprueba el Reglamento de Organización y Funcionamiento de los Institutos de Medicina Legal de la Comunidad Autónoma de Andalucía, del Consejo Andaluz de Medicina Legal y Forense y de la Comisión de Coordinación de los Institutos de Medicina Legal |
| Cadiz | |||
| Cordoba | |||
| Granada | |||
| Huelva | Decreto 90/2018, de 15 de mayo, por el que se modifica el Reglamento de Organización y Funcionamiento de los Institutos de Medicina Legal de la Comunidad Autónoma de Andalucía, del Consejo Andaluz de Medicina Legal y Forense y de la Comisión de Coordinación de los Institutos de Medicina Legal, aprobado por el Decreto 69/2012, de 20 de marzo | ||
| Jaén | |||
| Malaga | |||
| Seville | |||
| ARAGON | Aragon | 2002 | ORDEN JUS/331/2002, de 31 de enero, por la que se dispone la creación del Instituto de Medicina Legal de Aragón (BOE de 21.02.2002) |
| ASTURIAS | Asturias | 2002 | Orden JUS/2948/2002, de 31 de octubre, por la que se dispone la creación del Instituto de Medicina Legal de Asturias (B.O.E. de 22 de noviembre de 2002) |
| RESOLUCIÓN de 30 de junio de 2003, de la Secretaría de Estado de Justicia, por la que se dispone la entrada en funcionamiento (BOE de 21 de julio de 2003) | |||
| CANARY ISLANDS | Las Palmas | 2007 | Decreto 83/2007, 23 abril, por el que se crea el Instituto de Medicina Legal de Las Palmas |
| Santa Cruz de Tenerife | 2002 | Decreto 198/2002, 20 diciembre, por el que se crea el Instituto de Medicina Legal de Santa Cruz de Tenerife | |
| Resolución, 4 nov 2003, de la Dirección General de Relaciones con la Administración de Justicia de la Consejería de Presidencia y Justicia, por la que se dispone la entrada en funcionamiento del Instituto de Medicina Legal de Santa Cruz de Tenerife | |||
| CANTABRIA | Cantabria | 2003 | Orden JUS/1897/2003, de 26 de junio, por la que se dispone la creación del Instituto de Medicina Legal de Cantabria (BOE nº 163, 9-Jul-2003) |
| Resolución de 1 de julio de 2004, de la Secretaría de Estado de Justicia, por la que se dispone la entrada en funcionamiento del Instituto de Medicina Legal de Cantabria (BOE de 29 de julio de 2004) | |||
| CASTILLA LA MANCHA | Albacete, Cuenca, and Guadalajara | 2002 | ORDEN JUS/3345/2002, de 20 diciembre, por la que se dispone la creación del Instituto de Medicina Legal de Castilla-La Mancha (derogat per Orden JUS/1516/2004) |
| Orden JUS/1516/2004, de 17 de mayo, por la que se dispone la creación del Instituto de Medicina Legal de Albacete, Cuenca y Guadalajara y el de Ciudad Real y Toledo. (BOE de 29 de mayo de 2004) | |||
| Resolución de 12 de abril de 2005, de la Secretaría de Estado de Justicia, por la que se dispone la entrada en funcionamiento del Instituto de Medicina Legal de Albacete, Cuenca y Guadalajara y del de Ciudad Real y Toledo. (BOE de 5 de mayo de 2005) | |||
| Ciudad Real and Toledo | 2004 | Real Decreto 326/2004, de 27 de febrero, por el que se determina el ámbito territorial del Instituto de Medicina Legal de Ciudad Real y Toledo. | |
| Orden JUS/1516/2004, de 17 de mayo, por la que se dispone la creación del Instituto de Medicina Legal de Albacete, Cuenca y Guadalajara y el de Ciudad Real y Toledo. (BOE de 29 de mayo de 2004) | |||
| Resolución de 12 de abril de 2005, de la Secretaría de Estado de Justicia, por la que se dispone la entrada en funcionamiento del Instituto de Medicina Legal de Albacete, Cuenca y Guadalajara y del de Ciudad Real y Toledo. (BOE de 5 de mayo de 2005) | |||
| CASTILLA Y LEÓN | León and Zamora | 2002 | Real Decreto 1109/2002, de 25 de octubre, por el que se determina el ámbito territorial del Instituto de Medicina Legal de León |
| ORDEN JUS/3346/2002, de 20 de diciembre, por la que se dispone la creación del Instituto de Medicina Legal de León y Zamora. | |||
| Resolución de 5 de noviembre de 2003, de la Secretaría de Estado de Justicia, por la que se dispone la entrada en funcionamiento del Instituto de Medicina Legal de León y Zamora (BOE de 9 de diciembre de 2003) | |||
| Palencia, Salamanca, and Valladolid | 2002 | Orden JUS/2968/2002, de 18 de noviembre, por la que se dispone la creación del Instituto de Medicina Legal de Palencia, Salamanca y Valladolid. (BOE nº 283, 26-Nov-2002) | |
| Resolución de 5 de noviembre de 2003, de la Secretaría de Estado de Justicia, por la que se dispone la entrada en funcionamiento del Instituto de Medicina Legal de Palencia, Salamanca y Valladolid. (BOE de 9 de diciembre de 2003) | |||
| Avila, Burgos, Segovia, and Soria | 2002 | Orden JUS/3344/2002, de 20 diciembre, por la que se dispone la creación del Instituto de Medicina Legal de Ávila, Burgos, Segovia y Soria. (BOE nº 3, 3-Ene-2003) | |
| Resolución de 5 de noviembre de 2003, de la Secretaría de Estado de Justicia, por la que se dispone la entrada en funcionamiento del Instituto de Medicina Legal de Ávila, Burgos, Segovia y Soria. (BOE de 9 de diciembre de 2003) | |||
| CATALONIA | Catalonia | 2001 | DECRETO 114/2024, de 18 de junio, por el que se aprueba el Reglamento del Instituto de Medicina Legal y Ciencias Forenses de Cataluña |
| CEUTA | Ceuta | 2016 | Orden JUS/607/2016, de 22 de abril, por la que se crean los Institutos de Medicina Legal y Ciencias Forenses de Ceuta y Melilla |
| Resolución de 4 de abril de 2017, de la Secretaría de Estado de Justicia, por la que se dispone la entrada en funcionamiento de los Institutos de Medicina Legal y Ciencias Forenses de Ceuta y Melilla | |||
| VALENCIAN COMMUNITY | Alicante | 1998 | DECRET 60/2007, de 20 d'abril, del Consell, pel qual s'aprova el Reglament d'Organització i Funcionament de l'Institut de Medicina Legal d'Alacant. (DOGV núm. 5498, de 25.04.2007) |
| Castellón de la Plana | 1998 | DECRET 61/2007, de 20 d'abril, del Consell, pel qual s'aprova el Reglament d'Organització i Funcionament de l'Institut de Medicina Legal de Castelló. (DOGV núm. 5498, de 25.04.2007) | |
| Valencia | 1998 | Decret 62/2007, de 20 d'abril, del Consell, pel qual s'aprova el Reglament d'Organització i Funcionament de l'Institut de Medicina Legal de València (DOGV núm 5498, de 25.04.2007) | |
| GALICIA | Galicia | 2005 | Real Decreto 1704/2004, de 16 de julio, por el que se determina la sede del Instituto de Medicina Legal de Galicia. (BOE de 30 de julio de 2004) |
| Decreto 119/2005, de 6 de mayo, por lo que se crea el Instituto de Medicina Legal de Galicia.(DOG de 18 de mayo de 2005) | |||
| EXTREMADURA | Badajoz | 2003 | Orden JUS/511/2003, de 26 de febrero, por la que se dispone la creación del Instituto de Medicina Legal de Badajoz. |
| Resolución de 22 de diciembre de 2003, de la Secretaría de Estado de Justicia, por la que se dispone la entrada en funcionamiento del Instituto de Medicina Legal de Badajoz BOE de 27 de enero de 2004) | |||
| Cáceres | 2003 | ORDEN JUS/512/2003, de 26 de febrero, por la que se dispone la creación del Instituto de Medicina Legal de Cáceres (BOE de 11.03.2003) | |
| Resolución de 22 de diciembre de 2003, de la Secretaría de Estado de Justicia, por la que se dispone la entrada en funcionamiento del Instituto de Medicina Legal de Cáceres. (BOE de 27 de enero de 2004) | |||
| BALEARIC ISLANDS | Mallorca, Menorca, Ibiza | 2003 | Orden JUS/1898/2003, de 26 de junio, por la que se dispone la creación del Instituto de Medicina Legal de las Illes Balears (BOE de 09.07.2003) |
| Resolución de 1 de julio de 2004, de la Secretaría de Estado de Justicia, por la que se dispone la entrada en funcionamiento del Instituto de Medicina Legal de las Illes Balears. (BOE de 29 de julio de 2004) | |||
| LA RIOJA | La Rioja | 2002 | Orden JUS/2949/2002, de 31 de octubre, por la que se dispone la creación del Instituto de Medicina Legal de La Rioja (B.O.E. de 22 de noviembre de 2002) |
| RESOLUCIÓN de 30 de junio de 2003, de la Secretaría de Estado de Justicia, por la que se dispone la entrada en funcionamiento | |||
| MADRID | Madrid | 2006 | Decreto 37/2006, de 4 de mayo, del Consejo de Gobierno, por el que se crea el Instituto de Medicina Legal de la Comunidad de Madrid y se aprueba su Reglamento (BOCM de 9 de Mayo de 2006) Versió consolidada |
| Decreto 50/2015, de 21 de mayo, del Consejo de Gobierno, por el que se modifica el Decreto 37/2006, de 4 de mayo, del Consejo de Gobierno, por el que se crea el Instituto de Medicina Legal de la Comunidad de Madrid y se aprueba su Reglamento (BOCAM de 22 | |||
| ORDEN 123/2019, de 27 de septiembre, de la Consejería de Justicia, Interior y Víctimas, por la que se publica la relación de puestos de trabajo del Instituto de Medicina Legal y Ciencias Forenses de la Comunidad de Madrid. | |||
| Orden 12/2020, de 21 de enero, de la Consejería de Justicia, Interior y Víctimas, por la que se dispone la entrada en funcionamiento del Instituto de Medicina Legal y Ciencias Forenses de la Comunidad de Madrid. | |||
| MELILLA | Melilla | 2016 | Orden JUS/607/2016, de 22 de abril, por la que se crean los Institutos de Medicina Legal y Ciencias Forenses de Ceuta y Melilla |
| Resolución de 4 de abril de 2017, de la Secretaría de Estado de Justicia, por la que se dispone la entrada en funcionamiento de los Institutos de Medicina Legal y Ciencias Forenses de Ceuta y Melilla | |||
| MURCIA | Murcia | 2002 | ORDEN JUS/332/2002, de 31 de enero, por la que se dispone la creación del Instituto de Medicina Legal de Murcia. (BOE de 21.02.2002) |
| Resolución de 10 de febrero de 2003, de la Secretaría de Estado de Justicia, por la que se dispone la entrada en funcionamiento del Instituto de Medicina Legal de Murcia (BOE núm 51, de 28.02.2003) | |||
| NAVARRE | Navarre | 2000 | DECRETO FORAL 355/2000, de 13 de noviembre, por el que se crea el Instituto Navarro de Medicina Legal y se aprueba su Reglamento de funcionamiento. |
| Orden Foral 147/2002, de 06.09, del Consejero de Presidencia, Justicia e Interior, por la que se declara la entrada en funcionamiento del INML con efectos desde el 15.09.2002 | |||
| BASQUE COUNTRY | Basque Country | 2001 | Decreto 236/2012, de 21 de noviembre, por el que se regula el Instituto Vasco de Medicina Legal |
| DECRETO 160/2016, de 22 de noviembre, de modificación del Decreto por el que se regula el Instituto Vasco de Medicina Legal | |||
| BODIES UNDER STATE JURISDICTION | 2011 | Real Decreto 448/2010, de 16 de abril, por el que se determina el ámbito territorial y material del Instituto de Medicina Legal de Órganos con Jurisdicción Estatal. | |
| Orden JUS/1216/2011, de 4 de mayo, por la que se crea el Instituto de Medicina Legal de órganos con jurisdicción estatal. | |||
| Resolución de 1 de junio de 2012, de la Secretaría de Estado de Justicia, por la que se dispone la entrada en funcionamiento del Instituto de Medicina Legal de órganos con jurisdicción estatal. | |||
Source: Compiled by the authors.
The territorial model varies from region to region. In the uniprovincial models, the institute covers the entire territory of the autonomous community (Asturias, Cantabria, La Rioja, Navarre, Murcia). In the pluriprovincial models, the model could be territorial, covering the entire autonomous community, with sub-directorates in each province, as in the case of Catalonia, Galicia, the Basque Country, and Aragon, or provincial, with an address in each province, as in the case of the Canary Islands, Andalusia, Extremadura, and Valencia, or with 2 or 3 offices, as in the case of Castilla-La Mancha and Castilla-León. The OJE are responsible for the whole of Spain, while the Ceuta and Melilla institutes are responsible for the autonomous cities.
The advantages of this new organization were the unity of action, maintaining objectivity and independence, teamwork, specialisation, and the need to promote training, teaching, and research. The disadvantages were the heterogeneous provision of resources, organization of work, lack of uniformity (training, quality, coordination between IMLCFs), the different development of the laboratories and the resistance to change of some of its professionals.
The creation and regulation of the Forensic Medical Council by Royal Decree 355/2014 of 16 May, already foreseen in the White Paper on Forensic Medicine, established the appropriate coordination between all the institutes.
The process of incorporating technical teams in the Department of Justice (psychology and social work professionals and, in the field of minors, social educators) took place progressively in different jurisdictional family courts (1983), juvenile courts (1992), some also in the criminal jurisdiction, penitentiary surveillance, or in the clerk's office. The incorporation of psychology and social work professionals in the institutes took place with the enactment of Organic Law 1/2004, of 28 December, on Comprehensive Protection Measures against Gender-based Violence, which established the integrated forensic evaluation units.
Organic Law 7/2015 of 21 July 2015, which amends Organic Law 6/1985 of 1 July 1985 on the Judiciary, brought about a major reform in the organization of forensic medicine institutes, introducing the term “Forensic Sciences” and broadened their professional profiles. Until then, the IMLs (forensic medical institutes) were essentially made up of forensic medicine professionals. Likewise, the LOPJ provides that the institutes may include the rest of the technical teams that provide services to the Department of Justice, as well as civil servants from the medical corps, specialist technicians, and laboratory assistants from the National Institute of Toxicology and Forensic Sciences (INTCF), among others, who have become part of the organization chart of the IMLCFs.
In all this time, in addition to the experience gained, there have been many changes in the Department of Justice, in society and in the forensic sciences themselves. In addition, there have been numerous legislative changes, which made it necessary to amend the 1996 Regulation.
Organization of forensic services from 2023 onwards. Forecast and futureRoyal Decree 144/2023, of 28 February, approving the Regulation of the IMLCFs was issued with the following objectives:
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To comply with the provision of Article 479 of the LOPJ, adapting the regulations of the institutes to the changes that have occurred in the Department of Justice, society, forensic sciences, and regulatory changes.
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To make its structure more flexible, allowing it to respond to everyone, regardless of their size.
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To regulate the integrated forensic evaluation units and allow the creation of new units (anthropology, trafficking, childhood and adolescence, sudden death, etc.).
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To promote the implementation of quality in processes and expertise, putting the victim at the centre.
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To promote the social and health projection of the IMLCFs, beyond the Department of Justice, including extrajudicial functions.
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To be accredited as teaching units for specialist health training.
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To promote the professional career of their staff by creating new positions such as institute coordinators and area managers, as well as directors of studies and tutors.
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To strengthen participation and collaboration in the digital transformation of justice by improving and digitising processes, as well as promoting, as far as possible, digital immediacy in order to provide a better service to citizens.
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To reflect and strengthen the multidisciplinary nature of the IMLCFs.
The institutes have become training centres with very positive results. Undergraduate students (in medicine, psychology, social work, law, criminology) and graduate students (in cytodiagnosis and pathological anatomy), specialists in MLYF and in other medical specialties such as psychiatry and pathological anatomy are trained, as well as those who have passed the theoretical and practical phase of the entrance examination to the corps of forensic doctors can complete their initial training in the IMLCFs. In recent academic years, professionals with other medical specialities have joined the corps of forensic doctors.
However, training in legal and forensic medicine for healthcare professionals is currently inadequate to deal with medico-legal conflicts in healthcare activity. Very few hospitals in the healthcare field have forensic medicine services, although their importance has long been recognised.11 The incorporation of MLYF MIR interns in hospital centres has facilitated synergies, as has the fact that the specialty programme includes hospital forensic medicine as part of the knowledge and skills to be acquired by specialists in training.
We still have work to do. Actions need to be protocolised, specific units need to be created, adequate resources need to be made available, available specialists need to be strengthened, specific training needs to be promoted, collaboration agreements need to be established with public and private bodies, the activity of the training and research committees needs to be promoted and their collaboration with the activities of the official training centres needs to be promoted, continuous training of professionals needs to be ensured, lines of research need to be defined, research working groups need to be created, and relations with other bodies at national and international level need to be established.
We can be sure that there is a general awareness of the need to take on new challenges. We must carry out appropriate planning that will allow us to define strategic lines of action, identify needs, medium and long-term objectives, and adapt the organizational structure, the requirements and functions of job descriptions, the functioning of the institutes and their regulations for creation and entry into operation to the new changes, as well as advance in the digital transformation that must accompany this whole process.
ConclusionThe organization of legal and forensic medicine in Spain has undergone important structural changes that have allowed it to modernise and improve the public service it provides. The foundations have been laid and we can affirm that we are entering a favourable phase in which professionalism, training, and research will be combined. However, strategies must be promoted to provide a highly qualified, high quality, technologically advanced professional service with a health and social projection.
FundingThe authors declare that they have not received any funding.
Please cite this article as: Grijalba M, Barbería E, Montero JM, Bañón R, Pastor M, Marcos RA, Santiago-Sáez A. Organization of legal and forensic medicine in Spain. Revista Española de Medicina Legal. 2024. https://doi.org/10.1016/j.remle.2024.11.003.