13.5 Organizational issues of forensic psychiatric expertise in civil matters

According to the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens, a forensic psychiatric examination is carried out in the state or municipal health care institutions intended for this purpose. Note that in accordance with Art. 11 of the Law on Forensic Expertise, the organization and production of forensic psychiatric examinations can only be carried out in medical institutions or their units that are not under the jurisdiction of the federal executive body in the field of health.

However, the name "forensic psychiatric expert institution" is somewhat tentative. There are no independent institutions whose sole function is to conduct forensic examinations. The functions of state forensic institutions are performed by forensic psychiatric expert commissions and forensic psychiatric expert departments organized at general psychiatric institutions - psychiatric hospitals and mental hospitals. Expert commissions and expert departments produce forensic psychiatric examinations on a regular basis according to the rules for conducting forensic examinations in expert institutions.

Forensic psychiatric expert commissions are divided into outpatient and inpatient. The personal composition of the commission (at least three specialists) is approved annually by the health authority of the subject of the Russian Federation. Some commissions are competent to conduct both outpatient and inpatient examinations. For the production of inpatient forensic psychiatric examination in civil cases, the subject experts are placed in specialized (besstratny) forensic psychiatric departments, as well as in general (non-expert) departments and chambers of the psychiatric institution under which the commission operates. Outpatient forensic psychiatric examinations, including correspondence and post-mortem, are conducted by commissions that operate at psychiatric or psycho-neurological institutions.

The personal composition of the forensic psychiatric commission of experts is annually approved by the local health authorities according to the subordination of the psychiatric institution in which this expert commission is organized.

The work of forensic psychiatric expert institutions is organized according to the zonal-territorial principle, i.e. The expert institution serves the bodies of preliminary investigation and the courts of a certain territory. Regional commissions serve the territory of the subject of the Russian Federation, whose health care authorities organized this expert institution. Interregional commissions conduct forensic psychiatric examinations on behalf of law enforcement agencies not only in their own field, but also in other (usually neighboring) areas. According to the principle of interregional, expert institutions of the city, region, territory, republic are part of the Russian Federation. The list of territories that are served by interregional expert institutions is approved by Roszdravnadzor by prior agreement with the federal law enforcement agencies and taking into account the views of representatives of the respective territories.

Scientific and methodological functions assigned to the regional centers of forensic psychiatry. The organizational and methodological management of psychiatric and psycho-neurological institutions, including forensic psychiatric expert commissions, is entrusted to the chief psychiatrist of the health authority of the subject of the Russian Federation. The scientific and methodological management of the activities of forensic psychiatrists in Russia is assigned to the State Scientific Center for Social and Forensic Psychiatry. V.P. Serbsky (Moscow), which also produces the most complex examinations for judicial and investigative bodies of the Russian Federation.

In particular, the order of the Ministry of Health of Russia dated 07.04.1999 No. 113 "On measures but improving forensic psychiatric examination" in order to monitor the quality of forensic psychiatric examination and standardization of diagnostic and expert approaches to provide heads of health authorities of subjects of the Russian Federation to ensure timely direction to the address State Scientific Center for Social and Forensic Psychiatry. V.P. Serbian of copies of forensic psychiatric examinations for analysis and submission to the Ministry of Health of Russia (now - the Ministry of Health and Social Development of Russia) references with proposals for the further organization of expert work. It is also prescribed for the submitted analysis to annually develop for the health authorities of the constituent entities of the Russian Federation a draft information letter of the Ministry of Health proposing measures aimed at improving the quality of forensic psychiatric examination, send copies of the findings of the repeated inpatient forensic psychiatric examination to forensic psychiatric commissions that previously conducted the examination.

To streamline the form and content of the expert opinion of the state forensic psychiatrist, the Ministry of Health of Russia since 2004 introduced forms of sectoral accounting and reporting medical documentation on forensic psychiatric examination (order of the Ministry of Health of Russia dated 12.08.2003 No. 401 "On approval of sectoral accounting and reporting medical documentation on forensic psychiatric examination ").

The three-tier system of organizing a forensic psychiatric service in the Russian Federation does not mean its instance. If in one civil case several forensic psychiatric expert opinions were received with different conclusions, then according to the principle of free assessment of evidence established by procedural legislation by persons conducting court proceedings, no evidence for a court or prosecutor has “pre-determined strength”. In accordance with this principle, each expert opinion is evaluated from the point of view of its scientific validity, internal consistency of expert conclusions, their compliance with other evidence, etc. And only based on the results of such an assessment, the court is entitled to reject some expert conclusions and recognize others as reliable.

According to the procedural legislation, a forensic examination is appointed in cases where special knowledge is required during civil proceedings. A forensic psychiatric examination in a civil case is appointed due to doubts about the mental usefulness of a civil plaintiff or defendant. Its production is mandatory in all cases of recognition of a citizen as incapable.

To become the basis for the appointment of a forensic psychiatric examination, the doubt in the mental usefulness must be precisely justified, i.e. caused by the factual circumstances that were actually revealed during the proceedings, which may be:

- data on the examination of the face by a psychiatrist in the past and the establishment of a psychiatric diagnosis;

- information that the person was registered with a psychiatrist, was hospitalized and treated in a psychiatric hospital;

- the person was recognized for mental illness unfit for military service;

- The person was declared irresponsible in a criminal case and was sent for compulsory treatment.

Also important circumstances that determine the need for a forensic psychiatric examination, are data on inappropriate behavior, absurd statements and unmotivated actions, which are obtained from the words of witnesses.

The legal basis for conducting a forensic psychiatric examination is a decision (determination) on its appointment issued by the court. The decision (definition) must specify: the date and place of its preparation; the name of the person or body that appointed the examination; the number of the civil case in which she is assigned; passport details of a citizen to whom an examination is scheduled; his procedural position; the grounds for the examination (circumstances causing doubts in the mental usefulness); experts or expert institution entrusted with the examination; questions posed for resolution by experts; materials submitted to experts; type of examination (outpatient, inpatient, extramural, post-mortem, etc.). When formulating experts for an expert assignment, the questions should be clear, do not allow ambiguous interpretation, and comply with the law, the provisions of psychiatric science and the subject matter of this civil case.

The beginning of the examination should be considered the moment it becomes available to the experts or to the expert institution of the decision (definition) on its purpose and materials (objects) necessary for the study. The expert should be considered completed when the conclusion, fully signed and executed by experts, is sent to the body on whose instructions it was conducted.

The term of outpatient examination should not exceed 20 days from the date of receipt by the expert commission of the decision (determination) on its appointment with all necessary materials until the day of sending the written expert opinion (examination certificate) and case materials to the investigator and the court. During this period, experts should study the materials of the case, conduct a forensic psychiatric examination of the person, draw up a written conclusion. The time required for the provision of additional materials to the experts, the late arrival (delivery) of the person, and other temporary costs incurred through no fault of experts or an expert institution are not included in the period of outpatient expertise.

The legislation does not define the dates for the absentee and post-mortem examinations. It is believed that they should not exceed the deadline for outpatient examination, i.e. 20 days.

Inpatient forensic psychiatric examination begins from the moment of delivery to the expert institution of the decision (definition) on its appointment, the materials of the civil case and the arrival of the person being examined in the hospital. The time of his stay in the hospital should not exceed 30 days, but if necessary, this period can be extended, but not more than 90 days (Art. 30 of the Law on Forensic Expertise). A frequent reason for the extension of a person’s time for examination is the complexity of the expert case and the absence of all the necessary case materials. If the first circumstance is objective, then in the second case it is usually a question of shortcomings in the work of judges. After the experts arrived at the final conclusions, the examiner is subject to discharge from the hospital, however, the examination period does not end there, since, as a rule, the written expert opinion is not ready yet.

Often, due to the extraordinary workload in expert institutions, a queue of civilian cases awaiting examination is formed. Waiting times can vary from several days to several weeks and months. The waiting time of the examination is not included in the period of its production.

Each appointed forensic psychiatric examination must be carefully prepared by the court. The completeness and comprehensiveness of expert research, the reliability of expert conclusions depend largely on the quality of this preparatory work. The materials of the civil case submitted to the experts should include not only all the testimonies concerning expertly significant situations, but also all available medical records or extracts from them, outpatient cards of treatment-and-prophylactic institutions where the subject was treated or registered.

The opinion of a forensic psychiatrist is one of the evidence in a civil case. Like any evidence, it is subject to evaluation by a court. In assessing the expert opinion, its internal structure is analyzed, the compliance of the expert’s conclusions with other evidence gathered in the case. In assessing the expert opinion, the court must:

- check the observance of the procedural-legal procedure for the preparation, appointment and conduct of the examination;

- check whether the professional qualifications of experts are sufficient to answer the questions put to them and whether the experts, when formulating their opinion, have not gone beyond their special knowledge;

make sure the completeness of expert studies and expert opinion;

- to assess the scientific validity of the applied method of expert studies and expert conclusions made;

- to evaluate the evidence contained in the report in terms of their relevance, admissibility and place in the system of other evidence.

After evaluating the expert opinion, the court either accepts its findings to be complete and reliable, or appoints a second examination. If there are several forensic psychiatric opinions in a civil case that contain different conclusions on the same issues, the court should give an assessment of each of them in combination with other evidence in the case. A judgment rendered by a court on the subject of a civil dispute must be based on an analysis of all forensic psychiatric expert opinions, which are evidence in the case, in their comparison with other materials of a civil case. In its decision on the subject of a civil dispute, the court is obliged to provide the argument for the issuance of a decision.

In a number of cases, assessing the expert opinion and eliminating any doubts that arose during his assessment helps the interrogation of an expert psychiatrist, which should be limited to the subject matter of the expert opinion. Based on the results of the expert opinion assessment, a repeated or additional forensic psychiatric examination may also be appointed. The question of the validity or correctness of the conclusions of the previous examination before the experts is not within the competence of the experts. The answer to this question is possible only in assessing the totality of the evidence available in the case, and not just the subject-specific side of the former conclusion. Therefore, this question is authorized only to solve the persons in whose proceedings this civil case is located.