The authors consider and systematize the methods currently in use for the purpose of operational management of the state forensic medical expert activity (FMA) in Russia throughout the entire historical period since the establishment and development of the forensic medical expertise service in this country as well as the prospects for its further improvement. The importance of the problem arises from the fact that the legal status of the forensic medical expertise in the Russian Federation remains a matter of scientific discussions. On the one hand, some experts consider it necessary to set up on a broader basis forensic medical facilities of a new type as an alternative to the existing governmental bodies. On the other hand, such structures are being de facto established by the state law-enforcement agencies. The organizational restructuring keeps abreast with the better understanding of the its theoretical principles, forms of and approaches to the operational management of the state forensic medical expert activity. Under these conditions, the historical analysis of the current forensic medical activities at different stages of their development and their operational management as well as prospects for their further improvement appears to be both highly justified and useful.