Members Council

Norway / Norge (NO)

Autor: Professor Sidsel Rogde
Institute of Forensic Medicine, University of Oslo

Introduction
In the following a brief description /overview of the “Norwegian experience“ in the field of forensic medicine will be given. Forensic pathology/clinical forensic medicine in Norway is not yet recognised as a medical speciality, but efforts are being made.

History
Forensic medicine has been taught to medical students since the first Norwegian university was established in 1813 in Oslo. The first Norwegian textbook was published in 1838.
The Institute of Forensic Medicine in Oslo was established in 1938; prior to that, forensic pathology was taken care of by university and hospital pathologists. Later, the universities in the cities Bergen, Trondheim and Tromsø were founded. All the centres now have chairs in forensic medicine.
In Bergen, medicolegal autopsies were performed by hospital pathologists, and in 1912, the institute of pathology (Gades institutt) was founded. Medicolegal autopsies were performed at this institute thereafter. In 1965, a university position dedicated to forensic medicine was established. As for Trondheim and Tromsø, further information is given under the heading “key personalities”.
In 1900, the Norwegian Board of Forensic Medicine (Den rettsmedisinske kommisjon, in The Criminal Procedure Act named The commission for Forensic Medicine) was established: (http://www.justissekretariatene.no/en-gb/Innhold/). The Criminal Procedure Act (see later) is the legal basis for this board. It provides external quality control of all medicolegal documents. The board is now divided into four groups: forensic psychiatry, forensic toxicology, forensic genetics and forensic pathology/clinical forensic medicine. The expert who elaborates a medicolegal report is obliged by law to submit a copy of the entire report to this board. Medical evidence used in civil cases is however not subjected to this type of external quality control. The board members are ought to be (according to the act and its provisions) the foremost experts in their respective fields with ample experience from giving evidence in court. They should also be academically active.
In principle, Norway does not have an adversarial juridical system, which means that the expert witness in most cases is engaged by the court itself, not by any of the two parties.
Previously, all medical practitioners employed by the state (e.g. district surgeons) and specialists in pathology, surgery and gynaecology as well as university teachers in forensic medicine were considered potential expert witnesses who could be asked to give an expert opinion or perform a medicolegal autopsy. This has now changed. At present, it is not your position, but rather your personal qualifications that is the background for your function as an expert witness.

Current structure
The Institute of Forensic Medicine in Oslo has national functions in forensic genetics, organised in two departments: paternity cases (funded by The Ministry of Children, Equality and Social Inclusion), and forensic science/biology in criminal cases (funded by The Ministry of Justice), both based at The University of Oslo.
Forensic psychiatry is performed by clinically active psychiatrists who have been specifically educated in this discipline. The National Board of Forensic Medicine has a list of names of persons qualified in forensic psychiatry. There are no positions solely dedicated to forensic psychiatry.
Forensic toxicology is mainly taken care of within the Norwegian Institute of Public Health, Division of Forensic Toxicology and Drug Abuse. They perform all the analyses and interpretation in road traffic related cases, the vast majority of cases from medicolegal autopsies and analyses requested by prison authorities and child welfare authorities.
Clinical forensic medicine: Suspected child abuse cases (including sexual molestation) are normally dealt with within hospital paediatric departments/out patient clinics. These departments function partly as self referral centres but the social services as well as the police may contact the paediatric departments in order to obtain an expert opinion.
Sexual assaults against adults are dealt with within self referral centres localised in out patient clinics. This service is organised as a part of the local community emergence centres. The victims do not have to decide in the acute phase whether to report to the police – documentation and relevant sampling will be performed in the acute phase regardless of police involvement.
Examination of a victim will only be performed provided the consent of the victim and reporting to the police is likewise left to the victim.
The number of clinical forensic examinations performed by forensic pathologists is increasing. Such examinations will only be performed when requested by police (or in rare instances the court). Offenders as well as victims are examined by forensic pathologists.

Forensic pathology
Forensic pathology is university based. There are chairs in forensic medicine in the cities Oslo, Bergen, Trondheim and Tromsø. In Oslo and Bergen, the medicolegal autopsies are performed by university employed forensic pathologists. In Trondheim and Tromsø, some of the hospital pathologists also participate in the medicolegal work in cooperation with the professors of forensic medicine.
Furthermore, at Stavanger University Hospital, two hospital pathologists currently practice in the field. These pathologists have received special training in forensic medicine.

Forensic pathology/clinical forensic medicine is not yet recognised as a medical speciality. However, the Norwegian Association of Forensic Medicine has formulated rules and requisitions for certification of forensic pathologists. Representatives from this association is now in dialogue with the Norwegian Medical Association (the body who recognises specialists and specialities on behalf of the Ministry of Health), and hopefully, a speciality will also be a reality in Norway some day soon.

As there is still no medical speciality in forensic pathology/clinical forensic medicine, the education of forensic pathologists is mainly based on educating research fellows in forensic medicine as well as in scientific work. Only one position in the whole of the country (and located in Oslo) is dedicated to this kind of education. Hence, forensic pathologists have obtained skills in forensic pathology/clinical forensic medicine via scholarships (from various scientific funds) dedicated to research, while learning forensic medicine at the same time. In this way, the only road into a career in forensic medicine is by means of scientific work combined with casework. The majority of the practitioners of forensic pathology have a background as surgical pathologists.

The legal basis for forensic medicine
All relevant acts and provisions can be found in Norwegian at the following website: http://www.lovdata.no/
The Criminal Procedure Act (Straffeprosessloven) chapter 11 deals with expert witnesses and The Board of Forensic Medicine (in the English translation of the act named as Commission for Forensic Medicine. Furthermore, sections 227 and 228 deal with medicolegal autopsies, when they are compulsory and when they are optional ( http://www.ub.uio.no/cgi-bin/ujur/ulov/sok.cgi. ) “Påtaleinstruksen”, chapter 13, gives further provisions (there is no official English translation of these provisions). Basically, in all deaths which may have been caused by a punishable act and all cases where the deceased’s identity is unknown, a medicolegal examination is compulsory. Other unnatural deaths ought to be subjected to such an examination. These include suicides, accidents, possible medical mishaps, sudden unexpected deaths as well as industrial deaths and all deaths in custody.
The deaths should have been reported to the police by the attending doctor, according to the Health Personnel Act section 36 and its provisions: http://www.regjeringen.no/nb/dep/hod/dok/lover_regler/reglement/2002/act-of-2-july-1999-no-64-relating-to-hea.html?id=107079 The provisions give a definition of “unnatural death” which is basically in accordance with the abovementioned provisions in “Påtaleinstruksen” but which also specifically includes drug related deaths as unnatural. The police shall always be notified about these deaths. It is the police who decide whether a medicolegal autopsy will be performed or not.

Teaching of forensic medicine
Undergraduate teaching of forensic medicine is given at all four medical faculties. At the Institute of Forensic Medicine in Oslo, a 3-day compulsory course of forensic medicine is given to candidates specialising in surgical pathology every three years.
There is no formalised teaching of post graduate forensic medicine, but the candidates are given ample supervision by the senior forensic pathologists.
However, the National Board of Forensic Medicine gives a course in criminal procedure and law for expert witnesses. This course is meant for all expert witnesses within the medico/ biological field (forensic pathology, clinical forensic medicine, forensic genetics, forensic toxicology, forensic psychiatry and psychology).

Key personalities
Francis Harbitz (1867-1950) was professor of pathology and forensic medicine in Oslo 1900-1937. In addition to this, he was a member of the National Board of Forensic Medicine from its foundation and chairman 1912- 1946. After his retirement (1937), the chair in pathology and forensic medicine was divided. Harbitz’ textbook in forensic medicine was first published in 1915, its seventh and last edition being in 1957. Harbitz was scientifically active within many fields within pathology and forensic pathology. He is most known for describing Müller-Harbitz' disease, familial hypercholesterolaemia.
Georg Frederik Waaler (1885-1983) was the first professor of forensic medicine (i.e. not shared with pathology) in the period 1938-1965. His scientific interest was mainly within forensic genetics. During his time, a department of toxicology was founded within the Institute of Forensic Medicine in order to investigate toxicology related deaths. From 1946-1965 Waaler chaired The National Board of Forensic Medicine. Georg Waaler and Erik Waaler (see below) were brothers.
Jon Lundevall (1919-1991) was professor of forensic medicine from 1965 – 1989. His main scientific interest was also within forensic genetics. He also chaired the National Board of Forensic Medicine from 1965 - 1987. He authored a new textbook of forensic medicine, first edition in 1966, and 6th edition in 1989. This book has later been edited by Torleiv Ole Rognum (se below).

Bjørnar Olaisen (born 1943) was professor and head of the Institute of Forensic Medicine in Oslo after Jon Lundevall. His main scientific interest was also forensic genetics. He has also been president of The International Society for Forensic Haemogenetics. He left the institute in 1997 but continued in the National Board of Forensic Medicine until 2006. Thereafter, the most profiled forensic pathologist in Oslo has been professor Torleiv Ole Rognum (born 1948), with main scientific interest in SIDS and time of death determination. Rognum has since 2009 chaired the division of forensic pathology and clinical forensic medicine within the National Board of Forensic Medicine. From 1997 on Rognum has edited the nationally used textbook of forensic medicine; the 3rd edition of the book being published in 2010. In Bergen Erik Waaler (1903-1997) (Georg’s brother) was professor of pathology and forensic medicine from 1948 until 1971. However, Johan Christopher Giertsen (1923 - 2007) was associate professor of forensic medicine since 1965, and from 1972 he was professor of forensic medicine until his retirement in 1993, whereafter Inge Morild (born 1951) took over. In 1978, Giertsen authored a textbook of forensic medicine. Erik Waaler’s name is most known for the test for rheumatoid factor, Waaler-Rose’s test.

In Trondheim, the hospital pathologists took care of forensic medicine. In 1987, Olav Anton Haugen (born 1934) was appointed professor of forensic medicine until he retired in 2007. Until April 2009 he chaired the division of forensic pathology and clinical forensic medicine within the National Board of Forensic Medicine. Forensic medicine has been taught in Trondheim for as long as medicine has been taught there – originally in cooperation with forensic pathologists from Oslo, but from 1987 the teaching has been performed by the professor in Trondheim.
In Tromsø, hospital pathologists have also taken care of forensic pathology. From 1992 there has been a professor – the first one being Leif Jørgensen (born 1926). He had previously held a position as professor of pathology in Tromsø from 1971.
In forensic genetics, in addition to Waaler, Lundevall and Olaisen, Halldis Lie (1929-2001)was a central person during the era of protein typing (1969-1994), mainly as a means of paternity testing, even though AB0 and PGM also were used in criminal cases. After the DNA techniques were introduced, the field has expanded vastly. Bente Mevåg has now since 1997 been the head of the division of forensic science while Margurethe Stenersen is the head of the division of family genetics.

Major books and journals
a) Books

Francis Harbitz: Retsmedicin
Jon Lundevall: Rettsmedisin
Torleiv Ole Rognum (red): Lundevalls rettsmedisin
b) Journals
Scandinavian Journal of Forensic Science, ed. in chief Torleiv Ole Rognum was first published in 1995 under the name of “Nordisk rettsmedisin”. The journal is a joint venture between the Danish, Norwegian and Swedish Medicolegal Associations.

National scientific society
Norsk rettsmedisinsk forening – The Norwegian Association of Forensic Medicine (forensic science) was founded in 1993, the first chairman being Torleiv Ole Rognum. The association has scientific meetings on a yearly basis as well as a general assembly. The present chairman is Arne Stray-Pedersen. The association has been instrumental in defining the rules for certification of forensic pathologists.

Periodic scientific meetings
As stated above, there are scientific meetings on an annual basis, many of the meetings being held in English for the benefit of international participants. Information about the meetings is given in the Scandinavian Journal of forensic Science.
Furthermore, there is a triennial Nordic meeting; the most recent one took place in Bergen (Norway) in June 2009. The next meeting will take place in Århus, Denmark in 2012. Previously, these meetings were mainly held in Scandinavian language (Norwegians, Swedes and Danes can readily understand each other’s language and communicate freely), but the most recent meetings have been held in English.

Cooperation nationally/internationally
The international cooperation is not based on institutions. University professors of forensic medicine participate in a host of national and international bodies. One of the forensic pathologists is a member of an international expert group on documenting torture in collaboration with the IRCT and The Institute of Forensic Medicine in Copenhagen. Various Norwegian forensic pathologists have participated in UN organised work on the Balkans, and some have been active working for organizations like Amnesty International. Furthermore, Norwegian forensic pathologists participate actively in international scientific boards etc. However, everything mentioned here is based on personal achievements and interests.

Contact details
Rettsmedisinsk institutt, Rikshospitalet, Postboks 4950 Nydalen, NO- 0424 Oslo
exp-rmi@medisin.uio.no , telephone: +47 22841440
Gades institutt, Avdeling for rettsmedisin, Postboks 7804, NO- 5020 Bergen inge.morild@gades.uib.no , telephone: +47 55 97 25 59
Ivar Nordrum, Laboratoriesentret, Medisinsk teknisk forskningssenter (MTFS)
NO- 7489 Trondheim. ivar.nordrum@ntnu.no, Telephone: +47 72 57 32 05
Lars Uhlin-Hansen, Institutt for medisinsk biologi, Det helsevitenskaplige fakultet, Universitetet i Tromsø, NO-9037 Tromsø. lars.uhlin-hansen@uit.no , telephone: +47 776 27207
Den rettsmedisinske kommisjon, Postboks 8027 Dep, NO-0030 Oslo. drk@sivilrett.no, telephone: +47 22 99 13 63
Police website: https://www.politi.no/ Norsk rettsmedisinsk forening (The Norwegian Association of Forensic Medicine)

Future prospects
We are hoping for a medical speciality in forensic pathology and clinical forensic medicine. Furthermore, the age distribution among forensic pathologists is a challenge. It is necessary to recruit young colleagues into forensic medicine. The authorities will have to take their responsibility finding financial means so that the appropriate persons can be recruited into this field. It is important to introduce these young people to research as well – especially as experience in research is an important factor in learning to have the necessary critical view.