of May 20, 2010 No. 368
About approval of the Instruction on the organization and production of forensic medical examination
According to article 20 of the Law of the Republic of Kazakhstan "About judicial and expert activities", PRIKAZYVAYU:
1. Approve enclosed Instructions on the organization and production of forensic medical examination.
2. To provide to committee of control of medical and pharmaceutical activities of the Ministry of Health of the Republic of Kazakhstan state registration of this order in the Ministry of Justice of the Republic of Kazakhstan.
3. To department of administrative and legal work of the Ministry of Health of the Republic of Kazakhstan (Bismildin F. B.) after state registration of this order to provide in the procedure established by the legislation its official publication in mass media.
4. Declare invalid the order of the Minister of Health of the Republic of Kazakhstan of December 20, 2004 No. 875/1 "About approval of Rules of the organization and production of forensic medical examination" (registered in the Register of state registration of regulatory legal acts at No. 3375, No. 9-13) published in the Yuridicheskaya Gazeta newspaper of January 24, 2005.
5. To impose control of execution of this order on the vice-Minister of Health of the Republic of Kazakhstan Kairbekova of Page Z.
6. This order becomes effective after ten days after day of its first official publication.
Minister Zh. Doskaliyev
Minister of Internal Affairs
Republic of Kazakhstan
________________ S. Baymagambetov
May 21, 2010
Approved by the order of the Minister of Health of the Republic of Kazakhstan of May 20, 2010 No. 368
1. This Instruction disaggregates the organization and production of forensic medical examination in the Republic of Kazakhstan (further the Instruction).
2. Production of forensic medical examination (daleeekspertiz) is performed by the forensic scientist whose competence enters:
1) examination of corpse in cases of violent death;
2) examination of corpse in case of suspicion on use of violence or under the circumstances causing need of research of corpse for medicolegal procedure;
3) examination of the victims, persons accused and other persons for determination of nature and weight of harm to health, age, sexual conditions and permission of other questions requiring knowledge of the field of forensic medicine;
4) examination of physical evidences using laboratory methods of research;
5) examination on materials of investigation verification, criminal, administrative and civil cases, and also for private prosecution.
3. The forensic scientist is involved as the specialist in the field of forensic medicine in participation in initial and following investigative actions:
1) to survey of corpse on the place of its detection (incident);
2) to exhumation, withdrawal of samples for comparative research;
3) to carrying out investigative experiment.
Also the forensic scientist is attracted for conducting examination and giving explanation on earlier medicolegal researches conducted by it in judicial session.
4. Purpose of examination is made according to the legislation of the Republic of Kazakhstan.
5. Examination is subdivided on individual, additional, repeated, commission, and complex.
Examination is made by one or several experts depending on type and complexity of examination.
Commission examination is appointed in cases of need of production of difficult judicial and expert researches and is carried out by at least than two experts of one specialty.
The resolution, determination of body (person) who appointed commission judicial examination are obligatory for the head of body of judicial examination. The head of body of judicial examination can make also independently the decision on carrying out on the materials of commission examination provided according to the resolution, determination on purpose of judicial examination and to organize its production.
The chairman of medicolegal commission of experts is the head of body of forensic medical examination, in its otsutstviyezamestitel on expert work.
1) bears responsibility for work of the commission;
2) studies case papers;
3) is determined by structure of the commission if it is not provided by the resolution on production of examination and time of its meeting;
4) directs the commission and participates in its work.
For coordination of activities of the court experts who are part of the commission, the head of body of judicial examination or the body (person) which appointed commission judicial examination appoints the leading expert.
The leading expert performs development of the general plan of judicial and expert researches, determines terms of carrying out separate researches within aggregate term of production of judicial examination and controls their observance, performs communication with body (person) who appointed judicial examination, directs meeting of court experts.
In need of attraction in members of the commission of the specialist who is not the employee of body of judicial examination, the head of body of judicial examination makes the written offer to person (body) which appointed examination about attraction as members of commission of experts of specialists of the medical organization and higher educational institutions.
In case of production of examination on cases on criminal prosecution of health workers for inadequate accomplishment of professional obligations protocols of kliniko-anatomic and clinical conferences, documents of the commissions of the organizations of health care are represented.
Members of commission of experts:
carry out orders of the chairman;
perform preparation of materials for commission session;
timely get acquainted with case papers;
take part in work of the commission;
constitute together with the chairman of the conclusion and correctly draw up them;
hand over in office of body of judicial examination of the conclusion and the arrived materials.
In case of production of commission judicial examination each of court experts independently and independently conducts researches in full.
In case of disagreement between experts each of them or part of experts draws the separate conclusion or the expert whose opinion disperses from conclusions of other members of the commission formulates it in the conclusion separately.
Complex examination is appointed when researches on the basis of different industries of knowledge are necessary for establishment of the circumstance important for case, and is carried out by court experts of various specialties within their competence.
The production organization of the complex examination charged to body of judicial examination is assigned to his head. The head of body of judicial examination has the right to make also independently the decision on carrying out on the materials of complex examination provided according to the resolution, determination on purpose of judicial examination and to organize its production.
In case of production of complex judicial examination each of court experts conducts researches within the special scientific knowledge.
In the conclusion of complex judicial examination it is specified what researches in what amount each court expert carried out and to what conclusions it came. Each court expert signs the conclusion in the part reflecting the research conducted by it.
On the basis of results of the researches conducted by each of court experts they formulate general conclusion (conclusions) about circumstance for which establishment judicial examination was appointed. General conclusion (conclusions) is formulated and only the experts competent of assessment of the received results sign. If the basis of final conclusion of the commission or part it are the facts determined by one of court experts (certain court experts), then about it it is specified in the conclusion.
In case of disagreement between experts each of them or part of experts draws the separate conclusion or the expert whose opinion disperses from conclusions of other members of the commission formulates it in the conclusion separately.
Additional examination is appointed in case of insufficient clarity or completeness of the conclusion, and also emergence of need of the solution of the additional questions connected with the previous research. Production of additional examination is entrusted to the same, and in case of its absence, to other expert.
Repeated examination is appointed for research of the same objects and the solution of the same questions in cases:
insufficiently reasonable previous expert opinion;
doubts in correctness of the expert opinion;
violations of procedural rules of appointment and production of examination.
Disagreement reasons with results of the previous examination are given in the resolution, determination on purpose of repeated examination. Production of repeated examination is entrusted to the commission of experts. The experts who were carrying out the previous expertize can be present at production of repeated examination and give the commissions of the explanation, they do not participate in expert research and creation of the conclusion.
If second or subsequent on the account judicial examination is appointed on several bases, one of which treat additional examination, and others - to repeated, such examination is made by rules of repeated examination.
Participation of several experts (commission of experts) is obligatory in case of production (carrying out) of primary and additional examinations in the following cases:
for attraction to the criminal and administrative responsibility of health workers for professional offenses;
determinations of age;
determinations of the state of health;
the cases connected with termination of pregnancy;
other complex cases.
6. In case of production of examination out of body of judicial examination heads of the medical organizations provide forensic scientists with accommodation for examination production (morgue, medical office in polyclinic) and give necessary assistance.
7. Bodies (person who appointed examination) render assistance in transfer of the taken objects to laboratory divisions of body of judicial examination.
8. Bodies (person who appointed examination) by the forensic scientist's challenge for participation in initial and other investigative actions, provide it the vehicle.
9. The forensic scientist performs the functions within the served territory. In cases of spontaneous and technogenic catastrophes, other extraordinary events by order of the head of RGKP "Center of Forensic Medicine" of the Ministry of Health of the Republic of Kazakhstan (further - the Center), the forensic scientist is temporarily sent out of limits of the served territory.
Heads of branches of the Center in regions establish interchangeability of forensic scientists for their leave or disease.
Examinations in the Center are made after conducting primary and commission examinations in branches of the Center.
In the absence of profile specialists and in case of motivated removal of forensic scientists of branches in the Center primary expertizes can be carried out.
10. In case of complexity of examination and need of the solution of the questions requiring special knowledge, the forensic scientist declares the petition in the face of (body), appointed examination, need of participation in it of the corresponding doctors and (or) specialists having special knowledge.
11. In case of need productions in the course of conducting examination, medicolegal laboratory researches for permission of the questions raised before the forensic scientist or which arose at it personally based on the resolution of bodies of inquiry, the investigator, the prosecutor or court which is available for it, he sends objects to the relevant laboratory division of body of judicial examination with the direction on carrying out research.
Content of the direction is constituted by the short facts of the case, objective data revealed in case of examination, the purpose of laboratory research.
After receipt of results of laboratory research the expert opinion is drawn up.
12. In case of need of consultation of person subjected to examination, inspection at the specialist doctor working in other organization of health care person (body) who appointed examination who provides its carrying out, with the subsequent provision to the expert of results of inspection without delay is in writing informed of it.
13. In case of identification in the course of conducting examination of objects which are physical evidences and objects of separate medicolegal, criminalistic or other examination they are subject to the description in the expert opinion and subsequent their transfer on receipt to person (body) which appointed examination.
14. Objects for expert researches, including physical evidences, are subject to strict accounting and storage. The expert provides their unavailability from strangers.
15. When conducting examination in court, the forensic scientist constitutes the conclusion in writing. The copy of the conclusion attach to the documents of examination which are in archive of expert organization.
16. In case of the wrong interpretation by participants of legal procedure of the conclusion drawn by the expert, the forensic scientist declares it in the course of judicial session.
17. Results of examination are drawn up according to requirements of the Law of the Republic of Kazakhstan "About judicial and expert activities in the Republic of Kazakhstan".
18. The expert represents the conclusion on state or Russian.
19. The conclusion consists of the following Sections: the prolog including summary of the facts of the case, research part and conclusions.
20. In the prolog of the conclusion are specified:
time and production site of examination;
the examination conditions of production important for expert research (lighting, air temperature);
the resolution based on which examination is made; surname, name, expert's middle name, post, education, specialty and length of service in the specialty, in the presence: qualification category, academic degree, academic status;
in case of examination of corpse - surname, name, middle name, age of the dead (if it is known);
in case of examination of the victims, persons accused and other persons - surname, name, middle name, age, residence, the identity document;
in case of examination according to case papers and administrative cases of examinations of physical evidences - the name and number of criminal, administrative or civil case, quantity of volumes, sheets of case, the list of the objects and samples which arrived for examination;
surnames, name, middle name of persons which are present at examination production;
the signature of the forensic scientist about its procedural law, obligations and about the warning of criminal liability for making obviously false conclusion;
the list of the questions raised on permission of examination;
the facts of the case stated in edition of person (body) which appointed examination.
21. Research part contains the detailed description of process of research of all provided objects of expert research and actual data found at the same time. In research part the applied research methods are stated, and objective registration is used (pictures, planimetric schemes with designation of damages).
The structure of research part is determined by type of the carried-out expertize.
In research part are specified:
in case of examination of corpse - the description of clothes and data of external research of corpse, the internal research of cavities, bodies and fabrics, the list of the withdrawn objects transferred to the investigator for carrying out other types of examinations or directed to laboratory research, results of the conducted laboratory researches with indication of dates of their carrying out and receipt of researches by the expert of results in the form of the expert opinion, the medicolegal diagnosis;
in case of examination of the victims, persons accused and other persons - the detailed description of all objective medical data revealed in the course of expert inspection (specifying about the direction by the expert surveyed to doctors of other specialties, on radiological and other researches, and also results of these inspections and researches), the description of clothes (if it was researched), availability of damages and imposings on it, the list of the objects directed to laboratory research, results of these researches is noted date of additional inspections and researches, receipts of their results by the expert, forming of conclusions in the conclusion;
in case of examination of physical evidences - the detailed description of physical evidences and the traces which are available on them, statement of the applied methods of research and the received results on each type of research, with indication of the used reagents, the equipment and the equipment, process of the analysis, the description of research of samples for comparison;
in case of examination on materials of criminal, administrative and civil cases - detailed statement of the actual data necessary for the subsequent expert analysis;
in case of examination on cases on professional activity of health workers - the data received when studying originals of the medical and other documents important for case (in the absence of originals of documents, expertize is carried out based on the copy of the documents certified by body (person) who appointed examination).
22. The prolog, research part and conclusions constitute the protocol of the expert opinion.
Depending on type and complexity of examination the protocol is signed by one or several experts making examination.
23. Conclusions in the conclusion are the scientifically based opinion of the expert formulated based on the results received by it and their objective analysis. Conclusions should be stated clearly, specifically, without allowing their various interpretation. Combination of answers to faithful questions or change of their sequence is allowed. Expert judgment on each conclusion shall be motivated and proved by the actual and scientific data.
The formulation of conclusions begins with statement of the bases (preamble) based on which all subsequent facts are determined and comes to the end with statement of conclusions.
In conclusions are specified:
answers of the forensic scientist to the questions confronted (body) which appointed examination after receipt of all results of laboratory and additional expert researches with formulation of conclusions;
expert evaluation of the objective data revealed in the course of the research which, according to the expert, matter for case, are stated clearly, specifically, avoiding, whenever possible, special medical terms;
expert judgment on each conclusion shall be motivated, proved by actual data.
In cases of impossibility of provision of answers to the questions posed which are going beyond special knowledge, or the provided materials are not suitable or insufficient for making the conclusion, the expert constitutes the motivated message on it and sends it to the body or person who appointed examination.
24. The conclusion is constituted in duplicate, one of which is given to person (body) which appointed examination, and another remains stored in archive of body of judicial examination.
25. The conclusion on completion, is transferred to office for registration and issue to body (person) who appointed examination.
26. The conclusion is not substituted for various references and statements, and also the approved forms and forms of biographical type are applied to creation of the above-stated medicolegal documents, examination is not made on external examination of corpse or not its complete research.
27. Terms of production of examinations are determined by their type, amount and nature of expert researches. Duration of completion date of examinations depends on types of the conducted various laboratory researches.
Duration of production of examination shall not exceed 30 days from the date of obtaining from bodies of inquiry, the investigator, prosecutor or court of all required materials.
28. Production of examinations is performed in the following terms:
in case of examination of corpses - up to 30 days, taking into account terms of production of laboratory methods of research, but no more than in 3 days, without days off and holidays, after receipt of the last result of additional methods of laboratory researches;
in case of examination of the living persons requiring additional researches and (or) medical documentation - up to 30 days;
in case of examination of living persons, for the simplified pre-judicial legal proceedings, not requiring additional researches and medical documentation - up to 3 days without days off and holidays.
29. In cases, impossibility of completion of production of examination at the scheduled time, before its expiration the forensic scientist through the head of body of judicial examination in writing warns about it person (body) who appointed examination, having specified the reason and approximate term of its completion.
Prolongation of term of production of judicial examination is performed by body (person) who appointed judicial examination for the motivated petition of the head of body of judicial examination.
Suspension of production of judicial examination is made before elimination of the circumstances which were the basis for suspension, but no more than for ten days. If the circumstances which were the basis for suspension of production of judicial examination are not eliminated during the specified term, to body (person) who appointed judicial examination the message on impossibility to draw the conclusion goes.
Court expert's report or the message on impossibility to draw the conclusion goes to body (person) who appointed judicial examination within three days after their creation.
30. According to medical signs (criteria) of harm to health provided by the penal legislation of the Republic of Kazakhstan, the expert when conducting examination establishes weight of damage suffered to health.
For establishment of weight of damage suffered to health one of signs of this harm suffices.
In the presence of several qualifying signs weight of damage suffered to health is established on that sign which corresponds to bigger weight of harm to health.
(Injuries), either the diseases or pathological conditions which resulted from impact of various factors of external environment understand violation of anatomic integrity of bodies (fabrics) or their physiological functions as harm to health: mechanical, physical, chemical, biological, psychogenic.
It is necessary to understand condition of organism in case of which clinically expressed painful changes of local and (or) general nature caused by specific injury or disease come to light as disorder of health - when there is violation of anatomic integrity or physiological function of bodies.
The percent of permanent loss of general working capacity, owing to various injuries, is established according to the table of percent of permanent loss of general working capacity as a result of various injuries, according to Appendix 1 to this Instruction.
It is necessary to understand set of the congenital and acquired capabilities of the person to the action directed to receipt of socially important result in the form of certain product, product or service as general working capacity.
It is necessary to understand capability to work in the profession as professional working capacity or another equal to it on payment and on qualification of activities.
31. The qualifying signs (criteria) of severe harm to health are:
1) danger to human life;
2) not the life-threatening damages which entailed severe harm to health on consequence after any impacts: loss of sight, speech, hearing or any body, or loss of its functions by body; indelible disfiguration of person; the disorder of health connected to considerable permanent loss of general working capacity on one third at least (33% and above); complete loss of professional working capacity; termination of pregnancy; mental disturbance (mental disease); disease of drug addiction or toxicomania.
32. Life-threatening harm to health should be considered both bodily harms, and the pathological conditions which resulted from impact of various external factors which can threaten the victim's life.
Prevention of the death caused by delivery of health care, self-help or mutual assistance and also confluence of accidental circumstances, shall not be taken into account in case of assessment of danger to life.
33. To harm to health, life-threatening, belong:
1) the getting skull wounds, including without injury of brain;
2) the opened and closed fractures of bones of the code and the basis of skull, the cracks only of external plate of the code of skull and fractures of the bones of facial skeleton which are not part of brain skull, changes of parts of the trellised, wedge-shaped bones participating in forming of brain skull except for isolated;
3) bruise of brain of heavy degree, bruise of brain of average degree in the presence of symptoms of defeat of stem department of brain;
4) epiduralny, subduralny, subarakhnoidalny, intracerebral and intra ventricular hemorrhage in the presence of life-endangering conditions;
5) the wounds getting into the vertebral canal including without injury of spinal cord;
6) fractures dislocations or fractures of bodies, or bilateral changes of arches of cervical vertebras, and also unilateral changes of arches of the first and second cervical vertebras, including without dysfunction of spinal cord;
7) dislocations of cervical vertebras; the incomplete dislocations of cervical vertebras which are followed by life-endangering conditions or dysfunction of spinal cord;
8) the closed injuries of spinal cord to cervical department which are followed by life-endangering condition and dysfunction of spinal cord;
9) fracture or fracture dislocation of one or several chest or lumbar vertebras with dysfunction of spinal cord or with availability of clinically established shock of heavy degree and other life-endangering conditions;
10) the closed damages of chest, lumbar and sacral segments of spinal cord which are followed by heavy spinal shock or malfunction of pelvic bodies;
11) the wounds getting into gleam of throat, gullet, throat, trachea, and also open damages of thyroid and vilochkovy glands;
12) the fractures of hypoglossal bone opened and the closed fractures of cartilages of throat and trachea which are followed by life-endangering conditions;
13) the thorax wounds getting into pleural cavity, cavity of pericardium or cellulose of sredosteniye including without internal injury (hypodermic emphysema cannot be considered as sign of the getting wound, in the absence of the haemo-pheumothorax phenomena);
14) the stomach wounds getting into abdominal cavity (cavity of peritoneum and zabryushinny space) including without internal injury;
15) the wounds getting into cavity of bladder, the upper and average departments of rectum, and also extensive open damages of all layers of the lower department of rectum;
16) the opened and closed wound (gap) of internal body of chest or belly cavities, or zabryushinny space (kidneys, adrenal glands, pancreas), either diaphragm, or prostate gland, or mochetochnik, or webby part of urethra;
17) bilateral changes of back half ring of basin with gap of podvzdoshno-sacral joint and violation of continuity of pelvic ring, or double changes of pelvic ring in forward and back parts with violation of its continuity;
18) open fractures of long tubular bones in diafizarny part (humeral, femoral, tibial, both bones of forearm).
The open change should be considered change which is reported with external environment, i.e. in projection of change are available the violation of integrity of surrounding soft fabrics, skin caused by direct impact of the injuring subject or as a result of damage of soft fabrics and skin by the ends of bone otlomk from within;
19) in case of open fractures of beam, elbow and low-tibial bones, in case of the closed fractures of humeral, femoral and tibial bones, and also the closed injuries of large joints (humeral, elbow, luchezapyastny, coxofemoral, knee, talocrural) damage suffered degree to health is established depending on the danger to life, frustration duration caused by them to health, or on the basis of permanent disability;
20) injury of large blood vessel: aortas, sleepy (general, internal, external), subclavial, axillary (podkryltsovy), humeral, podvzdoshny, femoral, popliteal arteries or veins accompanying them, with penetration into their gleam;
21) damage of peripheral vessels (the head, person, neck, forearm, brush, shin, foot) is qualified depending on the specific danger to life caused by them (for example, massive blood loss, shock of heavy degree and others);
22) the damages which entailed life-endangering conditions: shock of heavy degree (III, IV degree), coma of various etiology; the massive blood loss which caused collapse, sharp heart or vascular failure, collapse, heavy extent of violation of brain blood circulation sharp kidney or acute liver failure, sharp respiratory insufficiency of heavy degree, it is purulent - septic conditions, the disorders of regional or organ blood circulation which led to heart attack of internals, gangrene of extremities, embolism (gas or fatty) vessels of brain, easy and other bodies, thrombembolia, combination of life-endangering conditions;
23) thermal burns of the third, fourth degree with the area of defeat exceeding 15% of surface of body, burns of the third degree with area of defeat of the surface of body exceeding 20%, burns of the second degree with area of defeat of the surface of body exceeding 30%, and also burns of the smaller area which are followed by life-endangering conditions (consequences of burns shall be estimated without plastic and recovery surgeries), burns of airways with the phenomena of hypostasis and narrowing of glottis;
24) chemical burns (the concentrated acids, caustic alkalis, other toxic agents) which caused in addition to local, all-toxic action, life-endangering;
25) poisonings with chemicals (poisons) or pathological conditions caused by biological agents and which entailed life-endangering conditions;
26) the sdavleniye of bodies of neck and other types of mechanical asphyxia which are followed by the expressed signs of the life-endangering phenomena (disorder of brain blood circulation, consciousness loss, amnesia and others) if it is established by objective data;
27) open injuries of coxofemoral and knee joints;
28) damages from action of low temperature (general chilling of organism, freezing injury), in the presence of life-endangering conditions.
34. Not the life-threatening damages relating to severe harm to health on outcome and consequences are loss of sight, the speech, hearing, any body, or loss of its functions by body:
1) it is necessary to understand total persistent blindness on both eyes or decrease in visual acuity to 0,04 as loss of sight below (the account of fingers at distance of 2 meters and to svetooshchushcheniye); loss of sight on the single eye;
2) loss of sight on one eye involves loss of its function by body and belongs to severe harm to health, loss of one healthy (sighted person) eyeball is loss of body and also belongs to severe harm to health;
3) the injury of blind eye which demanded its removal is estimated depending on duration of disorder of health, with obligatory specifying about indelibility of damage;
4) it is necessary to understand loss of capability as loss of the speech to express the thoughts the articulate sounds clear for people around, or as a result of loss of voice;
5) it is necessary to understand complete deafness or such irreversible condition when the victim does not hear informal conversation at distance of 3-5 cm from auricle as loss of hearing, loss of hearing on one ear is estimated as loss of its function by body and belongs to severe harm to health;
6) should be understood as loss of any body, or loss of its functions by body: loss of hand, leg, (their department from trunk or loss of functions by them owing to paralysis or other condition excluding their activities should be understood as anatomic loss of hand or leg as department from trunk of all hand or leg, and brush and foot), the loss of productive capability consisting in loss of capability to copulation or loss of capability to fertilization, conception, pregnancy incubation, child-bearing, loss of one small egg regarded as loss of body;
7) in case of injuries of face the expert establishes their weight according to the signs containing in this Instruction, is also determined whether damage is izgladimy, or indelible (it is necessary to understand considerable reduction or possibility of disappearance of visible consequences of injury as izgladimost - expressivenesses of hems, deformations, violations of mimicry and others, eventually or under the influence of conservative (not surgical) treatment if their elimination requires surgery (cosmetic or plastic surgery), then damages on face are considered indelible, in case of indelibility establishment the expert in the conclusion notes that if such consequences are acknowledged as court or the investigator disfiguring face, damages should be estimated as led to severe harm to health);
8) considerable permanent loss of general working capacity more than on one third (more than 33%): the amount of considerable permanent loss of general working capacity in case of damages is established after the defined injury outcome (according to the table of percent of disability as a result of various injuries according to appendix 1 to this Instruction);
9) at children disability is determined, proceeding from the general provisions established by this Instruction; at disabled people considerable permanent loss of general working capacity in connection with the received injury is determined as at almost healthy people, irrespective of disability and its group;
10) when losing professional working capacity - determination is made by medico-social commissions of experts of extent of loss of professional working capacity;
11) termination of pregnancy, irrespective of its term, is severe harm to health if it is not connected with specific features of organism, and costs in direct causal relationship with damage;
12) diagnostics of mental disturbance (mental disease), drug addiction, toxicomania is performed by psychiatric, narcological examination, but their communication with traumatized, and also assessment of weight of harm to health owing to sincere disease, drug addiction and toxicomania is made by the commission of forensic scientists, as necessary with participation of specialists, psychiatrists, narcologists, toxicologists (it is necessary to understand mental disease (mental disease) as mental disturbance, the group of mental diseases does not join the jet conditions (psychoses, neurosises) connected with damage of nervous system; damage is qualified as severe harm to health if it entailed development of mental disease, regardless of duration of its current and degree of curability).
35. The qualifying signs (criteria) of harm to health of average weight are:
1) long disorder of health - for the term of over 3 weeks (more than 21 day), consequences in the form of disease or malfunction of any body, lasting over three weeks (more than 21 day), directly connected with damnification to health belong to long disorder of health;
2) considerable permanent loss of general working capacity (10-33% inclusive).
36. The qualifying signs (criteria) of little harm to health are:
1) short-term disorder of health - not over 3 weeks - no more than 21 day;
2) insignificant permanent loss of general working capacity - less than 10%.
37. Medicolegal assessment of weight of damage suffered to health is carried out by the forensic scientist by physical examination of the victim based on the resolution of judicial investigating bodies.
38. Expertize of weight of damage suffered to health can be also carried out according to medical documents (the card of the inpatient, the card of the outpatient and other medical documents) in the presence of complete document package, containing exhaustive data on nature of damage, its clinical current.
39. In cases of establishment of consequences or outcome of injuries, when conducting examination according to medical documents when medicolegal assessment of weight of harm to health causes difficulties in connection with contradictory data of medical documents on nature, consequences, disease duration, at the request of the expert the criminal prosecution authority or court provides the victim's appearance for conducting examination.
40. The forensic scientist identifies the personality of the witnessed person, under the identity document (in case of its absence the identity of witnessed is proved personally by person who appointed examination), finds out from the witnessed person of circumstance of causing damages; claims and, if necessary, other data; studies case papers and medical documents. All obtained data are fixed in the expert opinion.
41. If necessary medical documents and other case papers are not provided to the expert, he within a day from the moment of emergence of need for it, declares to person or body which appointed examination, the petition for provision of missing materials.
42. When conducting examination, the expert uses only originals of medical documents, in the absence of authentic documents, the expert assumes as a basis copies of the medical documents certified by body (person who appointed examination) uses data of the additional researches conducted with involvement of profile specialists.
In these cases in the expert opinion it is specified where when also whom osvidetelstvuyemy person what facts at the same time are determined in addition was examined and to what conclusions the specialist came. The conclusion is constituted by the expert taking into account results of this inspection.
43. Duration of disorder of health is determined taking into account the data containing in medical documents. Estimating nature and duration of disease or violation of the functions connected with damage suffered to health the expert proceeds from the objective data including established in the course of conducting examination.
44. The forensic scientist estimates data of medical documents critically as duration of treatment of the victim can be not proved by nature of injury, its clinical manifestation, the refusal of the victim of leaf of disability and premature appearance at work at personal desire can also take place.
In all specified cases the forensic scientist estimates duration of disease and its weight, proceeding from objective clinical data.
Duration of disorder of health, duration of treatment and temporary disability are various concepts and not always match on terms.
45. In case of assessment of weight of the harm to health done to person having any disease only consequences of the caused injury are considered.
The expert also determines influence of injury on disease (exacerbation of disease, its transition to more severe form).
If necessary determination of influence of injury on disease is solved the commission of experts with participation of specialists of clinical profile.
46. In cases when multiple damages mutually burden each other, make cumulative assessment of weight of harm to health.
In case of different prescription of origin or the mechanism of formation of damages assessment of weight of each of them is made separately.
47. In case of damage of healthy pair part of body or pair body only consequences of the caused injury, without earlier broken function of the pair part of the same name of body or other pair body of the same name are subject to assessment.
In case of damage of part of body with fully or partially earlier lost function consider only injury consequences.
48. In case of detection, in case of survey of the victim, signs of various origin of harm to health, the expert establishes, than each of them is caused.
In case of detection, in case of survey of the victim, signs of harm to health of various prescription, not momentariness of their drawing is noted and terms of causing and weight of each of them separately are specified.
49. The complications which arose in case of production of transactions or application of methods of diagnostics are qualified as harm to health if they were consequence of defects in case of the specified medical interventions.
The harm to health caused by such complications is determined according to provisions of this Instruction.
Expertize of the complications specified in this Item is carried out by the commission of court experts.
The complications which are consequence of the reasons of the transactions which are not connected with production and methods of diagnostics (weight of condition of the patient, unforeseen features of reaction of organism and others), are subject to the description with indication of lack of causal relationship between them and damages.
50. Exacerbations of prior diseases after damnification to health, and also other consequences which arose owing to accidental circumstances, specific features of organism are not the basis for change of weight of harm to health.
In the specified cases the forensic scientist specifies in the conclusion nature of the occurred deterioration or complication and in what causal relationship it is with this injury.
51. In cases of approach of death reasons for cause of death, availability or lack of causal relationship between damages and death are specified and are given.
Assessment of weight of harm to health in cases of approach of death is carried out based on this Instruction.
52. In case of examination of weight of harm to health in the conclusion are reflected:
1) objective signs of harm to health from the medical point of view (graze, bruise, wound, fracture of bone and others), their localization and properties;
2) the characteristic of sledoobrazuyushchy part of the injuring subject (objects);
4) prescription (term) of causing;
5) harm to health with indication of the qualifying sign.
53. The expert opinion shall conform to requirements of Chapter 3 of Section 1 of this Instruction.
54. In establishment cases according to objective medical data of signs of danger to life, the forensic scientist can determine weight of harm to health, without expecting injury outcome.
55. Preliminary conclusions with presumable judgment of weight of harm to health are not constituted.
56. The forensic scientist does not estimate weight of harm to health in cases:
1) ambiguities of clinical picture or insufficient clinical and laboratory inspection of the victim;
2) harm to health, not determined outcome harmless for life;
3) refusal of the victim of additional inspection or absence on repeated survey if it deprives of the expert of opportunity correctly to estimate nature of injury, its clinical current and outcome;
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