Tuesday, July 24, 2012

Dr. Harold Shipman

Raising the Dead


Harold Shipman (AP)
Harold Shipman (AP)
His patients- mainly elderly women- were living alone and vulnerable. They adored their doctor, Harold "Fred" Shipman.
Even when their contemporaries began dying in unusually high numbers, patients remained loyal to the murderous M.D.
For as long as he spared them, his victims loved their doctor to death.

No film director could plan a grislier scene.
In the dead of a black August night, relentless rains and driving winds formed the perfect backdrop for an exhumation.
But this was no psychological thriller the Manchester police were observing a real-life drama.� Experts were raising the mud-streaked coffin of wealthy Kathleen Grundy.
Interred just 5 weeks earlier in the Hyde cemetery, the 81-year-old ex-mayoress held, in death, the key to solving nearly 400 murders. This would give killer Dr. Harold Shipman the dubious distinction of being the greatest serial murderer the world has ever known.
It puts him well ahead of modern history's most prolific serial killer to date Pedro ("monster of the Andes") Lopez. Convicted of 57 murders in 1980, Lopez allegedly killed 300 young girls in Colombia.
55-year-old Shipman is already serving 15 consecutive life sentences in Frankland Prison, County Durham, plus four years for forging the will of his last victim, Kathleen Grundy.
In spite of overwhelming evidence to the contrary, he continues to maintain his innocence.
How could this prolific serial killer go undetected for so long? And what made him the monster he became? The answers lie in a story that began in earnest over fifty years ago in a government-owned red brick terrace house in the north of England.

A Killer's Childhood

Born into a working class family on June 14, 1946, Harold Frederick Shipman, called Fred or Freddy, knew a childhood far from normal. He maintained a distance between himself and his contemporaries mainly due to the influence of his mother, Vera. This distance was to manifest itself in later years.
One neighbor notes, "Vera was friendly enough, but she really did see her family as superior to the rest of us. Not only that, you could tell Harold (Freddy) was her favorite the one she saw as the most promising of her three children."
Vera decided who Harold could play with, and when. She wanted to distinguish him from the other boys he was the one who always wore a tie when the others were allowed more casual dress. His sister Pauline was seven years older, his brother Clive, four years his junior. But in his mother's eyes, Harold was the one she held the most hope for.
As a student, Shipman was comparatively bright in his early school years, but rather mediocre when he reached upper school level. Nonetheless, he was a plodder determined to succeed, even when it meant re-sitting his entrance examinations for medical school.
Strangely, he had every opportunity to be part of the group he was an accomplished athlete on the football field and the running track. In spite of this, his belief in his superiority appears to have precluded forming meaningful friendships with his contemporaries.
And there was something else that isolated him from the group. His beloved mother had terminal lung cancer. As she wasted away, Harold willingly played a major supportive role.

Watching Vera Die

Much has been made of the way young Harold Shipman dealt with his mother's final months justifiably so. Because his behavior then closely paralleled that of Shipman the serial killer. Every day after classes, he would hurry home, make Vera a cup of tea and chat with her probably about his day at school.� She counted the minutes as she waited, and found great solace in his company.
For his part, this is likely where Shipman learned the endearing bedside manner he would adopt later in his practice as a family physician. Toward the end, Vera experienced severe pain. But, because pumps to self-administer painkillers did not exist at that time, Vera's sole relief from the agony of cancer came with the family physician.
No doubt young Harold watched in fascination as his mother's distress miraculously subsided whenever the family doctor injected her with morphine. As the disease progressed, the already trim Ms. Shipman grew thinner and frailer until, on June 21st 1963, the cancer claimed her life.
Vera's death left her son with a tremendous sense of loss. After all, his mother was the one who made him feel special, above the rest. Significantly, her passing left him with an indelible image the patient with a cup of tea nearby, finding sweet relief in morphine.
Etched upon the 17-year-old's mind, it was a scene he would re-create hundreds of times in the future.
And when it happened, he would be a doctor one with no regard for human life or feeling.

Invisible Student

Two years after his mother died, Harold Shipman was finally admitted to Leeds University medical school. Getting in had been a struggle. In spite of his self-proclaimed superiority, he'd had to re-write the exams he'd flunked first time around. Nonetheless, his grades were adequate enough for him to collect a degree and serve his mandatory hospital internship.
It is surprising to learn that so many of his teachers and fellow students can barely remember Shipman. Some who do remember claim that he looked down on them and seemed bemused by the way most young men behaved. "It was as if he tolerated us. If someone told a joke he would smile patiently, but Fred never wanted to join in. It seems funny, because I later heard he'd been a good athlete, so you'd have thought he'd be more of a team player."
Most of his contemporaries especially from his earlier years simply remember him as a loner. They also remember the one place where his personality changed the football field. Here, his aggression was unleashed, his dedication to win intense.
Even so, he was more sociable in medical school than his mother had allowed him to be while living at home.
A former teacher said, "I don't think he ever had a girlfriend; in fact he took his older sister to school dances. They made a strange couple. But then, he was a bit strange a pretentious lad."
But Shipman finally found companionship in a girl and married before most of his contemporaries did. At nineteen, he met Primrose 3 years his junior.
Her background was similar to Fred's. Her mother restricted her friendships, and controlled her activities.
No poster girl, Primrose was delighted to have finally found a boyfriend. Shipman married her when she was 17 and 5 months pregnant.
By 1974 he was a father of two and had joined a medical practice in the Yorkshire town of Todmorden. In this North England setting, Fred seemed to undergo a metamorphosis; he became an outgoing, respected member of the community in the eyes of his fellow medics and patients.
But the staff in the medical offices where he worked saw a different side of the young practitioner. He was often unnecessarily rude and made some of them feel "stupid" a word he frequently used to describe anyone he didn't like. He was confrontational and combative with many people, to the point where he belittled and embarrassed them. He also had a way of getting things done his way even with the more experienced doctors in the practice.
Not yet thirty, Shipman had become a control freak.

Addiction and Attitude

Hard working, and enthusiastic, Shipman fitted well into the social matrix.
His senior partners saw him as a Godsend.� One, Dr. Michael Grieve, appreciated Fred's contribution in providing up-to-date information, as he was so recently out of medical school.
But his career in Todmorden came to a sudden halt when he began having blackouts.� His partners were devastated when he gave them the reason.� He suffered, he said, with epilepsy.� He used this inaccurate diagnosis as a cover-up.
The truth soon surfaced, when practice receptionist Marjorie Walker stumbled upon some disturbing entries in a druggist's controlled narcotics ledger. The records showed how Shipman had been prescribing large and frequent amounts of pethidine in the names of several patients.
Moreover, he'd written numerous prescriptions for the drug on behalf of the practice.� Although this was not unusual (drugs are kept on hand for emergencies and immediate treatments), the prescribed amounts were excessive.
Pethidine a morphine-like analgesic was initially thought to have no addictive properties.� Now, some sixty years after scientists first synthesized it, pethidine's non-addictive reputation is still hotly debated.�
Following the discovery of Shipman's over-prescribing, a covert investigation by the practice including Dr. John Dacre followed. To his alarm, he discovered many patients on the prescription list had neither required nor received the drug.
Dacre challenged Fred in a staff meeting, as one of his partners, Dr. Michael Grieve recalls:
"We were sat round with Fred sitting on one side and up comes John on the opposite and says, 'Now young Fred, can you explain this?'� And he puts before him evidence that he has been gleaning, showing that young Fred had been prescribing pethidine to patients and they'd never received the pethidine, and in fact the pethidine had found its way into Fred's very own veins."
Shipman's way of dealing with the problem was to provide an insight into his true personality. Realizing his career was on the line, he first begged for a second chance.�
When this was denied, he became enraged and stormed out, hurled a medical bag to the ground and threatened to resign. The partners were dumbfounded by this violent and seemingly uncharacteristic behavior.
Shortly afterwards, his wife Primrose stormed into the room where his peers were discussing the best way to dismiss him. Rudely, she informed the people at the meeting that her husband would never resign, proclaiming, "You'll have to force him out!"
She was right.� Ultimately he was forced out of the practice and into a drug re-hab center in 1975.
Two years later, his many convictions for drug offences, prescription fraud and forgery cost him a surprisingly low fine just over 600 pounds sterling. Shipman's conviction for forgery is worth noting.� First, because his skill in this area was nothing less than pathetic; second, he failed to learn that his ineptitude in this area was readily exposed.�
Yet in spite of this early warning, some 22 years later he actually believed he could get away with faking signatures on a patently counterfeit will that of his last victim, Katherine Grundy.
This lack of judgment some say arrogance set in motion the mechanism for his downfall.
As for the pethidine charges, the question remains:� Did he really self-inject the drugs (as he claimed) or had he already begun using them to kill unsuspecting patients?� This is currently under review.

Back in Business

Today, it is unlikely Harold Shipman would be allowed to handle drugs unsupervised, given his previous track record.� Nonetheless, within two years, he was back in business as a general practitioner.
He was accepted into the Donneybrook Medical Center in Hyde in the north of England.� How readily he was accepted demonstrates his absolute self-confidence and his ability to convince his peers of his sincerity.
Dr. Jeffery Moysey of the Center explained "His approach was that I have had this problem, this conviction for abuse of pethidine.� I have undergone treatment.� I am now clean. All I can ask you to do is to trust me on that issue and to watch me."
Perhaps he was not watched carefully enough.
Again, he played the role of a dedicated, hardworking and community-minded doctor. He gained his patients' absolute trust and earned his colleagues' respect.
Some of those who worked under him have told of his sarcastic and abusive nature, but he was skilled at masking his patronizing attitude in front of those he chose to impress.� As for any signs of addiction, there were no blackouts as before, and no indication of drug abuse.�
In Hyde, Harold Shipman was home free and free to kill.

Headstones of Shipman victims at Hyde Cemetery
Headstones of Shipman victims at Hyde Cemetery (TIMEPIX)
 

A Diary of Death

Because of the nature of the Shipman case, it may never be possible to document every murder he committed.
A clinical audit commissioned by the Department of Health estimates his responsibility for the deaths of at least 236 patients over a 24-year period.
This audit, by Professor Richard Baker of the University of Leicester, examined the number and pattern of deaths in Harold Shipman's practice. It then compared them with those of other practitioners. Significant differences appeared, notably that the rates of death in elderly patients were disproportionately higher.
Other variations appeared; deaths were often clustered at certain times of the day, patients' records and previous symptoms mismatched, and Shipman was usually in attendance.
Professor Liam Donaldson, Chief Medical Officer for the Department of Health, wrote that these factors "must now be investigated by the proper legal authorities."
Detective Chief Superintendent Bernard Postles, who headed the original investigations, said of the report 'many of its conclusions accord with our own findings to date.' He noted the death toll estimated in the audit was "broadly in keeping with the number of deaths investigated by Greater Manchester Police during the course of the investigation."
Even so, the final numbers are anyone's guess Coroner John Pollard once speculated "we might be looking at 1000."
But whatever the final count, there is no immediate plan to try the killer on future findings nor would it serve much purpose because he's already serving 15 concurrent life sentences.
Instead, other cases are being investigated as they come to light, with coroners' verdicts of unlawful killing continuing to mount. As they do, the question most asked is this: Why wasn't he stopped sooner?

Early Warnings

In this macabre and unfinished story, Shipman's former patients are grateful indeed he was finally stopped. The feeling "I could have been next" will always haunt them. And there is little doubt that some owe their lives to a determined and intelligent woman named Angela Woodruff.
Her dogged determination to solve a mystery helped ensure that, on Monday, January 31, 2000, the jury at Preston Crown Court found Shipman guilty of murdering 15 of his patients and forging the will of Angela's beloved mother, Katherine Grundy.
But Ms. Woodruff was not the first to realize something was dangerously wrong where Dr. Shipman was involved.
Local undertaker Alan Massey began noticing a strange pattern: not only did Shipman's patients seem to be dying at an unusually high rate; their dead bodies had a similarity when he called to collect them. "Anybody can die in a chair," he observed, "But there's no set pattern, and Dr. Shipman's always seem to be the same, or very similar.� Could be sat in a chair, could be laid on the settee, but I would say 90% was always fully clothed.� There was never anything in the house that I saw that indicated the person had been ill.� It just seems the person, where they were, had died.� There was something that didn't quite fit."
Worried enough to voice his unease, Massey decided to confront Shipman, and paid the doctor a visit.
Massey recalls, "I asked him if there was any cause for concern and he just said 'no there isn't".� He showed me his certificate book that he issues death certificates in, the cause of death in, and his remarks were 'nothing to worry about, you've nothing to worry about and anybody who wants to inspect his book can do."'
Reassured by Shipman's ease at being questioned, the undertaker took no further action.� But his daughter, Debbie Brambroffe also a funeral director was not so readily appeased.� She found an ally in Dr. Susan Booth.

Cash for Ash

From a neighboring practice, Dr. Booth had gone to the funeral directors to examine a body.� British law requires a doctor from an unrelated practice to countersign cremation forms issued by the original doctor. They are paid a fee for this service which some medics cynically call "cash for ash." Debbie told Dr. Booth she had misgivings.��
Booth explained, "She was concerned about the number of deaths of Dr. Shipman's patients that they'd attended recently.� She was also puzzled by the way in which the patients were found.� They were mostly female, living on their own, found dead sitting in a chair fully dressed, not in their nightclothes lying ill in bed."
Booth spoke to her colleagues.� One of them, Dr. Linda Reynolds contacted coroner John Pollard.� He in turn alerted the police. In a virtually covert operation, Shipman's records were examined and given a clean bill of health because the causes of death and treatments matched perfectly.
What the police did not discover was that Shipman had re-written patient records after he killed.�
The quality of that investigation has been questioned because the police failed to check for a previous criminal record.� Nor did they make inquiries with the General Medical Council. Had they done so, Shipman's past record of drug abuse and forgery might well have led to a more thorough approach.
But more intense scrutiny was about to blow the Shipman case wide open.

Angela Investigates


Kathleen Grundy, victim
Kathleen Grundy, victim (CAVENDISH PRESS/UK)
Kathleen Grundy's sudden death on June 24th 1998 came as a terrible shock to all who knew her. A singularly active 81-year-old, she was well known to the people of Hyde. A wealthy ex-mayor, she had energy to burn and was a tireless worker for local charities until the day of her death.
Her absence was noted when she failed to show at the Age Concern club. There, she helped serve meals to elderly pensioners. Because the wealthy widow was noted for her punctuality and reliability, her friends suspected something was wrong.

The Grundy home
The Grundy home (CAVENDISH PRESS/UK)
When they went to her home to check up on her, they found her lying on a sofa. She was fully dressed, and dead.
They immediately called Dr. Shipman.
He had visited the house a few hours earlier, and was the last person to see her alive. He claimed the purpose of his visit had been to take blood samples for studies on aging. Shipman pronounced her dead and the news was conveyed to her daughter, Angela Woodruff.
The doctor told the daughter a post mortem was unnecessary because he had seen her shortly before her death.
Following her mother's burial Ms. Woodruff returned to her home, where she received a troubling phone call from solicitors. They claimed to have a copy of Ms. Grundy's will.
A solicitor herself, Angela's own firm had always handled her mother's affairs - her firm held the original document lodged in 1986. The moment she saw the badly typed, poorly worded paper, Angela Woodruff knew it was a fake. It left 386,000 pounds to Dr. Shipman.
"My mother was a meticulously tidy person," she later told the Shipman trial, 'the thought of her signing a document which is so badly typed didn't make any sense. The signature looked strange, it looked too big. The concept of Mum signing a document leaving everything to her doctor was unbelievable.'
"It wasn't a case of 'Look, she's not left me anything in her will."' she later said.
Initially, she wondered if Shipman was being framed. But after interviewing witnesses to the "will," she reluctantly concluded the doctor had murdered her mother for profit.
It was then she went to her local police. Her investigation results ultimately reached Detective Superintendent Bernard Postles.
His own investigation convinced him Angela Woodruff's conclusions were accurate. Of the forged will itself, Postles was to later say, "You only have to look at it once and you start thinking it's like something off a John Bull printing press. You don't have to have twenty years as a detective to know it's a fake. Maybe he thought he was being clever an old lady, nobody around her: Look at it; it's a bit tacky. But everyone knew she was as sharp as a tack. Maybe it was his arrogance..."
Now Det. Supt Postles had the oldest motive in the world greed to justify his future actions.

The Plot Thins

To get solid proof of Kathleen Grundy's murder, a post mortem was required which, in turn, required an exhumation order from the coroner.
This is a rare occurrence for any British police force, one the Greater Manchester Police had not experienced. "We did not have one officer who had ever taken part in an exhumation.� We asked the National Crime Squad for advice." Det. Supt. Postles explained.
By the time the trial had begun, his team would be uncomfortably familiar with the process.� Of the fifteen killed, nine were buried and six cremated. Katherine Grundy's was the first grave opened.� Her body was the first of the ongoing post mortems.
Her tissue and hair samples were sent to different labs for analysis, and the wait for results began.
At the same time, police raided the doctor's home and offices. It was a low-key exercise, but timed so Shipman had no chance of learning a body had been exhumed for a post mortem Police had to be certain no evidence could be destroyed or concealed before their search. When the police arrived, Shipman registered no surprise.� Rather, his approach was one of arrogance and contempt as the search warrant was read out.
One item crucial to police investigations was the typewriter used to type the bogus will. Shipman produced an old Brother manual portable, telling an improbable tale of how Ms. Grundy sometimes borrowed it.� This unbelievable story was to work against Shipman especially when forensic scientists confirmed it was the machine used to type the counterfeit will and other fraudulent documents.�
Searching his house yielded medical records, some mysterious jewelry and a surprise.� The Shipman home was littered with filthy clothes, old newspapers and, for a doctor's home, it was nothing short of unsanitary.
But an even bigger surprise was due.

The Morphine Factor

When toxicologist Julie Evans filed her report on the cause of Ms. Grundy's death, Det. Supt. Postles was astounded.
The morphine level in the dead woman's body was the cause of death.� Not only that, her death would have occurred within three hours of having received the fatal overdose.
Postles later said Shipman's use of the drug was a serious miscalculation. A doctor would surely have known morphine is one of the few poisons that can remain in body tissue for centuries.� Postles observed, "I was surprised... I anticipated that I would have had difficulty if he gave them something in way of poison lost in background substance." He gave insulin, which the body produces naturally, as an example. "It was an unexpected bonus once I had checked that Kathleen Grundy did not take it herself."
Shipman would claim later that the stylish and conservative old lady was a junkie.� Even today psychologists speculate on the possibility that he wanted to be caught.� Otherwise, why would he hand them the typewriter and use a drug so easily traced back to him?� Others believe he saw himself as invincible, believing that, as a doctor, his word would never be questioned.
The detective realized the case went far beyond one death, and the scope of the investigation was broadened immediately.

Selecting the Dead

Just which deaths to investigate became the priority.� To decide, a scale was devised, based on patterns.�
Those who had not been cremated and had died following a Shipman "house call" took precedence. Other issues were factored in, but obviously only uncremated bodies could yield tissue samples for examination.
Slightly different criteria were applied to the next group for police investigation. All cremated, they were investigated, mainly, on the basis of known pre-existing conditions, recorded causes of death, and Shipman's presence before they died.
Whenever he could, the doctor had urged families to cremate their dead and had also stressed no further investigation was necessary. It may seem strange now that no relatives found this peculiar, but people typically trust their doctors, especially in times of great stress.�
After all, the causes of deaths Shipman presented were rational, even though bereaved families were often surprised to learn of conditions their loved ones had never mentioned.
Even if they had questioned the doctor, he had the computerized medical notes to prove patients had seen him for the very symptoms he cited as leading to causes of death. Police would later know he'd altered computer records to make everything match. Callously, Shipman made most of these changes within hours of his patients' deaths.� Often, immediately after killing, he would hurry to his office and adjust his records.
In the case of 82-year-old Kathleen Grundy, he reinforced his later statement that she was a morphine junkie by inventing and backdating several entries.
His sheer audacity in suggesting this highly respected woman had been scoring hits from drug dealers was overwhelmingly stupid.� The moment he made the statement, his credibility crumbled.

Gravestone of Shipman victim Irene Turner
Gravestone of Shipman victim Irene Turner (CAVENDISH PRESS/UK)
 

The Cybertrail

When Shipman first encountered the computer, he was technophobic. But once he reluctantly agreed to embrace the (then) new technology, he declared himself a computer expert.� This was consistent with his need to assert his superiority
But what the self-proclaimed computer wiz didn't know was that his hard drive recorded to the second every phony alteration he made to a patient's records.
A taped interview with the Greater Manchester Police demonstrates this lack of knowledge:
Police Officer:� I'll just remind you of the date of this lady's death 11th May '98.� After 3 o'clock that afternoon, you have endorsed the computer with the date of 1st October '97 which is 10 months prior, 'chest pains'.
Dr. Shipman:� I have no recollection of me putting that on the machine.
Officer:� It's your passcode; it's your name.
Shipman:� It doesn't alter the fact I can't remember doing it.
Officer:� You attended the house at 3 o'clock.� That's when you murdered this lady.� You went back to the surgery and immediately started altering this lady's medical records. You tell me why you needed to do that.
Shipman:� There's no answer.
In another recorded interview, Detective Constable Marie Snitynski also demonstrated how Shipman's computer trapped him.� Following her advising the doctor he had killed a patient (73-year-old Winnifred Mellor) with morphine overdose, then altered records to show a history of angina and chest pains, the police officer continued her interview:
Police Officer:� The levels were such that this woman actually died from toxicity of morphine, not as you wrongly diagnosed.� In plain speaking you murdered her...One feature of these statements from the family was they couldn't believe their own mother had chest pains, angina and hadn't been informed.
Harold Shipman: By, by whom?
Officer:� By her.
Shipman:� By her, thank you.
Officer:� They also found it hard to believe... Because she didn't have a history of chest complaints and heart disease and angina, did she doctor?
Shipman:� If it's written on the records then she had the history and therefore...
Officer:� The simple truth is you've fabricated a history to cover what you've done, you'd murdered her and you make up a history of angina and chest pains so you could issue a death certificate and placate this poor woman's family didn't you?
Shipman:� No.
Officer:� We've got a statement from a detective sergeant John Ashley who works in the field of computers.� He has made a thorough examination of your computer, doctor, and the medical records contained on it...what he's found is that there are a number of entries that have been incorrectly placed on this record to falsely mislead and to indicate this woman had a history of angina and chest pains.� What have you got to say about that, doctor?
Shipman: Nothing.
It should be apparent from the above exchange that Shipman was unwilling to cooperate with the police in any way.� Throughout the entire ordeal he was to be arrogant and supercilious.� This behavior earned him no friends during the ensuing trial, which commenced on a bright, sunny day in the Lancashire town of Preston on October 5th, 1999.

Preliminaries

The first week was spent with the usual courtroom minutiae.� Shipman's Defense Counsel Nicola Davies went first.
Primarily a medical lawyer, 46-year-old Ms. Davies mainly dealt with matters outside the criminal courts.
She had three applications to present.

Harold Shipman after his arrest
Harold Shipman after his arrest (AP)
First, that the trial be halted. Ms. Davies claimed that Dr. Shipman could not receive a fair trial because of the prior "inaccurate, misleading" coverage of the case. For the better part of two days, she drew attention to the range of newspaper articles reportage of nearly 150 patients' cases and financial searches, plus the extensive coverage of the exhumations.
The prosecutor Mr. Henriques countered with a statement that the reports had actually been beneficial they had helped alert other families to possible irregularities in the deaths of their loved ones.
In the Second Application, Ms. Davies wanted the court to hold three separate trials.�
She claimed the case of Kathleen Grundy should be separate it alone had any alleged motive, greed.
The second trial, she said, should involve only patients who had been buried, because this was the only group where physical evidence of cause of death morphine poisoning applied.
The third trial, she believed, should cover those cremated, as no physical evidence of death existed.
Again, the prosecutor countered with an argument that, because the cases were inter-related, trying them all together was required to present a more comprehensive picture.
Ms. Davies then presented the prosecution's third application one that stunned the court.� She wanted evidence referred to in 'volume eight' disallowed.
Essentially, volume eight detailed how Shipman had accumulated morphine from 28 patients many now deceased. It showed the doctor continued prescribing for some after they had died, and kept the drugs for his own purposes. Similarly, he had prescribed opiates for many still living patients who had never required strong painkillers, much less morphine.
After considering the defense's three applications, Mr. Justice Forbes carefully explained why he was denying each one.
The trial would proceed; it would include the sixteen charges in the indictment, and evidence in volume eight would be allowed.
Proceedings were adjourned until the following Monday, October 11th 1999. Then, the jury would be made up.�
And a torrent of damning evidence would flow.

The Trial


Richard Henriques
Richard Henriques (CAVENDISH PRESS/UK)
The trial began in earnest as Counsel for the prosecution Richard Henriques delivered his opening address. One of the top barristers in Britain, he had handled many sensitive and difficult trials, including the sensational Jamie Bulger trial, where two ten-year old boys kidnapped, tortured, then murdered two-year-old Jamie.
Addressing the case at hand, Mr. Henriques stated "None of those buried - nor indeed cremated were prescribed morphine or diamorphine.� All of them died most unexpectedly. All of them had seen Dr. Shipman on the day of their death.'
As he briefly outlined the case, Henriques dismissed euthanasia or mercy killing on the basis that none of the dead had had a terminal illness.
He claimed Shipman killed the fifteen patients because he enjoyed doing so: "He was exercising the ultimate power of controlling life and death, and repeated the act so often he must have found the drama of taking life to his taste."
His first witness was Angela Woodruff.� An accomplished solicitor, she was as striking as her mother had been in life.� Fashionably dressed in an expensive gray suit, she found it difficult to retain her usual strong demeanor.� Understandably, she appeared on the verge of breaking down throughout her long and arduous time in the witness box.
First, she explained in detail the police photographs of the house where her "mum" had lived so happily.� She then told of the harrowing phone call from the Hyde Police to inform her that her mother had died.
Seeking clarification, she later had a conversation with Dr. Shipman: "Exactly what he said was difficult to remember... It's very hazy because I was very, very upset. Dr. Shipman said he had seen (my mother) on the morning of her death.� He said he had seen her at home." She couldn't remember why the doctor claimed to have been there.
Speaking of the clumsy attempt made to fake the will leaving everything to Shipman, she told of her mother's meticulous attention to detail, how doing everything neatly was her mother's way.
This would later be apparent to anyone reading her mother's diary, where every detail of importance was meticulously recorded in perfect penmanship.� In contrast, Ms. Woodruff said how her mother viewed "...my writing; mine's appalling."
She went on to show how healthy her 81-year-old mother had been. "She was just amazing.� We would walk five miles and come in and she would say, 'Where's the ironing?'� We used to joke she was fitter than we were."
This portrait of an elderly but extremely fit woman was to be repeated frequently as other victims' families took the witness box.
In the ensuing cross-examination, Ms. Davies seemed intent on emphasizing Ms. Woodruff's wealth. She had analyzed and described the family's finances, and asked, "You are not a family in need, are you?"
Ms. Woodruff concurred it was common knowledge that she and her husband David had inherited one million pounds from her father in law. She confirmed the couple earned sizeable incomes.
A subsequent attempt by Ms. Davis to show Ms. Woodruff's relationship with her mother had been unharmonious was totally dispelled when the victim's writings and a host of witnesses were examined.
Several days later, Dr. John Rutherford a leading government pathologist appeared.� He was tactful and dignified as he led the court through the gruesome details of the post mortems carried out.�
In great detail, he explained how the procedure was performed, focusing on the importance of collecting body tissue for analysis.
The outcome of the tests was consistent.� In case after case, Dr. Rutherford said the victims had not died from old age or natural disease. Typically, morphine toxicity was the cause of death.
To analyze any fingerprints found on the will, fingerprint expert Dr. Rutherford who had worked on the Waco cult disaster was called. He explained how he had taken fingerprints from the hands of the deceased Ms. Grundy.
The defense fingerprint expert claimed the methodology was inconclusive, but Dr. Rutherford's expertise helped destroy the counter-claim. Then, Rutherford's associate told how prints on the fake will only identified three people two witnesses to the document's signing, and Dr. Shipman.

Det. Sergeant John Ashley
Det. Sergeant John Ashley (CAVENDISH PRESS/UK)
Because there were no prints matching Kathleen Grundy's, it was obvious she had never handled the "will". This observation was reinforced when calligraphy analyst Michael Allen described the signatures as "crude forgeries."
Computer Analyst Detective Sergeant John Ashley then testified how Shipman had doctored his computer records to create symptoms his dead patients never had.
Recorded interviews were beyond contest.


The Trial: Week Two


Shipman with his staff
Shipman with his staff (CAVENDISH PRESS/UK)
In the second week, Shipman's former staff and colleagues were called to bear witness.�
District nurse Marion Gilchrist took the oath and immediately burst into tears.� Regaining her composure, she told how Shipman had reacted when he realized he would be arrested any moment.
The doctor had broken down and he said, "I read thrillers and on the evidence they have I would have me guilty," But the nurse said she took it as black humor when he said, "The only thing I did wrong was not having her cremated.� If I had had her cremated I wouldn't be having all this trouble."
Another patient, whose statement was read out in court, described Shipman's feelings on the will when he told her, "If I could bring her back...I would say look at all the trouble it's caused. I was going to say I didn't want the money but because of all this trouble, I will have it."� He had claimed he would use most of the money for philanthropic causes.
The last part of the Grundy case heard evidence from GP Dr. John Grenville.�
Analyzing Shipman's medical notes, he spoke of how he would have behaved quite differently under the circumstances.
Whereas Dr. Shipman had quickly pronounced Kathleen Grundy dead, "I would examine the body carefully to ensure death had occurred...if I found no pulse at the neck, I would look for a more central point.
Grenville claimed he would have attempted to revive the patient standard medical practice.
By now, onlookers were forming a picture of a very callous, inefficient defendant this impression would only intensify in the grueling weeks ahead.

Litany of Lies

By now, the trial had gained a momentum that is characteristic, where evidence follows a set pattern over and over. Although the Kathleen Grundy case had taken over a week, those to follow would progress more quickly.
What speeded up the trial were emerging characteristics, among them the ambulance-telephone scam. Here, Shipman would pretend to call emergency services.� But when he "discovered" a patient dead, he would pick up the phone and pretend to cancel the ambulance.

Lizzie Adams, victim
Lizzie Adams, victim (CAVENDISH PRESS/UK)
One sad example of this ruse involved a vibrant 77-year-old, Lizzie Adams.
She loved dancing with her dance partner, William Catlow She played Ginger to his Fred. William dropped in to visit Lizzie the day she died.
When he arrived, he found Shipman examining her impressive collection of porcelains and crystal. In the next room, Lizzie lay dying.�
Catlow told the court, "I just burst past him...she felt warm. I said, 'I can feel her pulse.'"�
Shipman said, "No, that's yours.� I will cancel the ambulance."��
But telephone records proved Shipman never phoned the ambulance service that day.
In another case, that of Nora Nuttall, her son Anthony told how he had left his mother alone for just 20 minutes.� He returned to find Dr. Shipman leaving their house. 'I asked him what was wrong.� He said "I have rung an ambulance for her."� I ran in and... she looked like she was asleep in the chair.� I took her by the hands and shook her, saying, "Mum, Mum..."'
Shortly after, Shipman merely touched her neck and told the son, "I'm sorry, she has gone."
Tales of phone calls the doctor never made continued.
Norah Nuttall's sister went to Shipman's office to examine the dead woman's records she wanted details of her sister's death.
Annoyed, Shipman addressed his staff: "I knew it would happen, I told you it would happen."
Quickly, he fabricated a story of how Norah had called his office to say she was ill.� Shipman then claimed he'd been paged and just happened to be nearby.� When telephone records proved him wrong, Shipman quickly fabricated a new story.
But he outdid himself with the tale of the missing blood samples. His reason for visiting his last victim, Kathleen Grundy, was allegedly to collect blood samples for a study on aging. When asked what had happened to them, he initially said they had gone for analysis.
When the prosecution proved there was no study on aging, he suddenly "remembered" what happened.� He had left the samples under a pile of notes, and, as they were no longer useful he disposed of them.
With each new revelation his credibility sank.

Callous Behavior

Other witnesses told of Shipman's lack of compassion toward the bereaved.

Jean Lilly, victim
Jean Lilly, victim (CAVENDISH PRESS/UK)
Truck driver Albert Lilley broke down as he recalled the way Shipman announced the death of his wife, 59-year-old Jean Lilley.
"He said, 'I have been with your wife for quite a while now, trying to persuade her to go to the hospital, but she won't go.� I was going to come home (later) and have a word with you and your wife and I was too late.'"�
"I said, 'What do you mean too late?' He said, "You are not listening to me carefully."' Perhaps Shipman took pleasure in forcing Lilly to guess his beloved wife had died.
He repeated this tactic with Winnie Mellor, a healthy outgoing 73-year-old who still played football with her grandchildren.�
Excited about a planned trip to the Holy Land, she, too, died following a Shipman visit. When he called her daughter Kathleen, he was deliberately obtuse, forcing her to guess her mother had died:
"He said, 'Did you realize that your mother has been suffering from chest pains' and I said No."

Winnie Mellor, victim
Winnie Mellor, victim (CAVENDISH PRESS/UK)
"He said, 'She called this morning and...I came to see her and she refused treatment.'� So I says well I'll be up as soon as I can.� He said, 'No, no there's no need for that.' So I said has she gone to hospital?
"And he said, 'There's no point in sending her to hospital.'� And I just went silent then, and he didn't say anything neither.� And then I just realized what he was not saying.� And I said do you mean my mother's dead?� He says, 'I see you understand."'
Shipman's rudeness to a neighbor Gloria Ellis was consistent with his personality.� But Ms. Ellis was to play an important role in bringing him down.�
She had witnessed Shipman's visit to Winnie Mellor just hours before her death.� He was to return later, as Detective Chief Inspector Mike Williams explained:�
"A neighbor, teatime, gets a knock on the door from Dr. Shipman saying he's come to see Winifred Mellor.� He can see her sat in a chair and he thinks she's dead.� They go into the house and again they find Winifred Mellor dead in a chair.'�
When the neighbor Gloria asked, "You were here before, weren't you?" Shipman did not answer.� When she asked "Has Gloria had a stroke?" Shipman was irritated and insulted her with: "You stupid girl!"
Far from stupid, the neighbor knew to the minute the times Shipman had arrived and left. She brought a smile to the court when she claimed to have been surprised to learn he was a doctor, "I thought he was an insurance man."

Defaming the Dead

In an outrageous example of Shipman's heartless behavior, the killer ridiculed dead Ivy Lomas. Of the fifteen deaths Shipman was charged with, only Ms Lomas' occurred in his offices.

The Surgery Offices on Market Street, where Shipman worked
The Surgery Offices on Market Street, where Shipman worked (CAVENDISH PRESS/UK)
Detective Sergeant Philip Reade a constable at the time, told how he had gone to the doctor's office to locate Ivy's next of kin. He recalled his bizarre encounter with Shipman:
"He was laughing.� He said he considered her such a nuisance that he was having part of the seating area permanently reserved for Ivy with a plaque to the effect seat permanently reserved for Ivy Lomas."
Even worse, Shipman told the officer that as he left the room Ivy "could have taken her last breath."� And yet, he had made no effort to resuscitate the woman.� Instead, he left her alone while he saw other patients.
Medical expert for the defense, Dr Grenville told the court: "This was a medical emergency.� I would have given my entire attention to this particular patient."
But 63-year-old Ivy would have been past resuscitation.�
Again, Shipman had murdered with morphine.

Ivy Lomas' gravesite
Ivy Lomas' gravesite (CAVENDISH PRESS/UK)

Defending the Indefensible

Throughout the trial, Shipman's defense mainly Angela Davies, backed by junior counsel Ian Winter valiantly and professionally attempted to portray Shipman as a kind and caring human being. She painted a rosy portrait of a plain old-fashioned family doctor one prepared to go the extra mile for his patients.
His prior record of drug misuse, pethidine addiction and forgery went unmentioned.� Instead, Ms. Davies focused on his happy family life with wife Primrose and their four children.�
But the defense fought an uphill battle from the start.� On the one occasion Ms. Davies appeared to be gaining the upper hand, she suddenly lost.
She had been questioning the forensic analyst about the validity of tissue testing for drugs:
"As a scientist you have been breaking pretty new ground in this analysis?"
"That is correct," the forensic analyst replied.
Ms. Davis then asked whether finding morphine in tissue samples was proof of single or multiple doses.
"I can't say," the scientist replied.�
It was easy to see where the defense was heading. If it could be proven that the tissue samples might not have resulted from a single dose, perhaps the jury could be convinced the high levels of morphine in the bodies resulted from years of use.
It was a desperate long shot.� And it failed miserably when Dr. Karch Steven, took the stand. An American whose credentials were as impressive as his evidence, Steven explained a relatively new technique.
He described the test he had performed. It was so new, Britain's prestigious medical journal The Lancet had covered it just a year earlier.� It analyzed hair samples for ongoing drug use.
This remarkably accurate test proved conclusively that not one victim was a long-term morphine user. Clearly, any of the narcotic in murdered women's tissue samples resulted from a single, massive dose.
Finally, the trial turned to evidence revealing Shipman's devious ways of hoarding drugs to kill.

Prescription for Death

During the trial, Shipman had claimed he never carried morphine, therefore he could not have killed any of his patients. But the family of Molly Dudley (another victim) disproved this assertion.�
Although Shipman was not charged with Molly's death in the original trial, he had admitted to giving her morphine.�
Daughter-in-law Joyce Dudley received a call from Shipman telling her, "I'm afraid your mother-in-law has only got about half an hour left to live." Molly was dead when by the time her son Jeffrey and his wife arrived.� Shipman told them she had died from a heart attack.�
Joyce Dudley stated, "And this is when he said to me and Jeff that he 'gave her a shot of morphine' for the pain."
This proved Dr. Shipman did carry morphine.� Just how he amassed enough of the drug to kill so many would soon be revealed. Shipman told many outrageous stories but few as ludicrous as his morphine-related tales.� He had, he said, prescribed 2000 milligrams of morphine to patient Frank Crompton, who had prostate cancer. Although Mr. Crompton was not in pain, Shipman said he wanted to have it on hand in case pain developed later.�
He said the patient had told him he "didn't want to be a drug addict. So he broke them (the ampoules) and put them in the rubbish. We talked about it again and Mr Crompton agreed to keep them in the house. So, Shipman said, he got him another supply.� Of course, since the patient had died, it was impossible to prove Shipman had confiscated both batches.
In another example, Shipman's staff told how he had confused them regarding drug entries. He explained away some missing morphine with the excuse he was merely giving it to a colleague who had loaned him some for a prior patient emergency.
But the doctor vastly overrated the gullibility of the court with one ridiculous story:� He said a supply of diamorphine (the medical term for heroin) must have been put through a slot in his office door, because he found it lying on the office doormat when he arrived at work.
Prosecution counsel Richard Henriques sarcastically dismissed this nonsense, referring to Dr. Shipman's "magic mat" where restricted drugs could simply materialize overnight.
In most instances, Shipman got his morphine through patients who had never needed it in the first place, or he confiscated unused supplies from patients who had died. Detective Superintendent Bernard Postles explained:
"What he tended to do is overprescribe to individuals who legitimately required diamorphine, certainly in the days just prior to them dying.� What he would do then is go along to the home, offer to dispose of any excess that was left at the house, and he would take that away.
One man who narrowly escaped being an unwitting supplier is Jim King.� In 1996 he was incorrectly diagnosed as having cancer.� Shipman treated him with masive doses of morphine.� Jim King told how "he kept saying to us 'well you can take as much morphine as you wish,' because of course it didn't really matter, I was dying anyway."
When Jim's condition worsened, Shipman made a house call.� He diagnosed pneumonia and said he needed to give an injection. Jim looked at his wife, who seemed wary.� Perhaps her unease was prompted because both King's aunt and father had died following Shipman visits.�
She remembers how the doctor "asked me if I wanted him to give him an injection and I said no.� I said can we write out a prescription for him.� He kept being a little bit persistent about it and I kept telling him no, no, I don't want it.� He was a bit arrogant about it, a kind of snotty attitude towards me, a little bit"
So, King probably cheated death and the doctor out of more morphine.
The Kings learned later that Shipman had killed their relatives.

The Verdict and Sentence


Judge Justice Forbes presided in Shipman's trial
Judge Justice Forbes presided in Shipman's trial (CAVENDISH PRESS/UK)
It took the judge Mr. Justice Forbes two weeks to meticulously dissect the evidence heard by the jury.� He urged caution, noting that no witness had actually seen Shipman kill.� And he also urged the jurors to use common sense in arriving at their verdict.
In summing up, he said, in part:
"The allegations could not be more serious a doctor accused of murdering 15 patients... You will have heard evidence which may have aroused feelings of anger, strong disapproval, disgust, profound dismay or deep sympathy."
At 4:43 pm on Monday January 31st 2000, the foreman declared all the jury's verdicts were unanimous:� they found Shipman guilty on 15 counts of murder and one of forgery.
The disgraced doctor stood motionless and betrayed no sign of emotion as he heard the jurors' verdicts read.
Wearing black, Shipman's wife, Primrose, also remained impassive.� Her boys one beside her and the other seated behind looked down and seemed to diminish on hearing the results.
In the public gallery, some gasped as Shipman's previous forgeries were described.
Defense counsel, Nicola Davies, asked that sentence be passed immediately.
Mr. Justice Forbes obliged, addressing Shipman:
"You have finally been brought to justice by the verdict of this jury.� I have no doubt whatsoever that these are true verdicts.� The time has now come for me to pass sentence upon you for these wicked, wicked crimes.
"Each of your victims was your patient.� You murdered each and every one of your victims by a calculated and cold-blooded perversion of your medical skills, for your own evil and wicked purposes.
"You took advantage of, and grossly abused their trust.� You were, after all, each victim's doctor.� I have little doubt that each of your victims smiled and thanked you as she submitted to your deadly ministrations.
The judge passed fifteen life sentences for the murders and a four-year sentence for forgery.

Shipman listens to the verdict
Shipman listens to the verdict (Elizabeth Cook, REUTERS/Archive Photos)
Then he broke with the tradition that usually involves writing to the Home Secretary about his recommendations on length of the sentence:
'In the ordinary way, I would not do this in open court, but in your case I am satisfied justice demands that I make my views known at the conclusion of this trial... My recommendation will be that you spend the remainder of your days in prison.'
Fifteen murders had been dealt with and the fifty-seven day trial was over.
But the extent of the killing was yet to be revealed.
 

Murder Unlimited

British police are so convinced that Shipman's killing spree started long ago that a special helpline has been set up for those concerned about how friends and relatives died while under the killer's care.
The Baker report, noted earlier, is filled with chilling statistics.�
When he compared Shipman's patient list with those of doctors with similar lists, Professor Baker concluded that Shipman had 236 more in-home patient deaths than would normally be expected.� Most of these deaths involved women over 75.
Chief Medical Officer Professor Liam Donaldson stated: "The questions raised in the report will be distressing reading to the patients and relatives who were under Shipman's care over the years, but it is important for their sake that this work has been done and is published...'there must be serious concerns about deaths of some patients during Harold Shipman's entire career as a GP.'

Judge Dame Janet Smith
Judge Dame Janet Smith (CAVENDISH PRESS/UK)
High Court judge Dame Janet Smith heads a proposed inquiry expected to start in March 2001 and last over two years.
Initially, the government said the inquiry would be held behind closed doors, but in September 2000, concerned relatives won their battle to have it held in public.

Why?

The reason Harold Shipman killed may never be known.� As long as he professes his innocence, the mystery will remain, for this serial killer is unique.
There were no signs of violence, no sexual overtones, no known motive except for the one exception and no 'smoking gun'.�
Also, serial killers often like to toy with their victims, to reinforce their self-portrait of power, before they strike.� But Shipman's victims seem to have died peacefully, and in surroundings where they felt safe and comfortable at home.
Endless, contradictory theories abound.
Some psychoanalysts speculate he hated older women, citing comments he made about the elderly being a drain on the health system.�
Others feel he was re-creating his mother's death scene, in order to satisfy some deep masochistic need.� His belief in his own superiority makes this questionable.
That fact that he left so many indelible clues indicates, some say, that Shipman desperately wanted to be discovered and stopped; that he was fighting a compulsion he simply could not control.
But the consensus seems to be that he felt he was so superior he could do whatever he wanted with no fear of discovery.� Even this seems hard to comprehend he had already been caught red-handed forging prescriptions and stockpiling drugs when he was hooked on pethedine.�
Perhaps prosecutor Richard Henriques got it right when he said:
�"He was exercising the ultimate power of controlling life and death, and repeated the act so often he must have found the drama of taking life to his taste.'

Addicted to Killing

July 24, 2002

Harold Shipman
Harold Shipman (AP)
Until late July, 2002, Britain's worst serial killer was Victorian serial poisoner, Mary Ann Cotton, who murdered an estimated 21 people in the 1870s. Now that dubious distinction is claimed by Dr. Harold Shipman.
Officially, Dr. Harold Shipman murdered at least 215 of his patients 171 women and 44 men ranging in age from 41 to 93.� After a year-long public inquiry, the 2,000-page report into his 23-year murder spree was released by High Court Judge Dame Janet Smith.� The records of nearly 500 patients of Shipman's who died while in his care between 1978 and 1998 were scrutinized in the investigation.�
Another investigation, conducted by University of Leicester professor Richard Baker determined that the real minimum number of Shipman victims was 236. Associated Press reported that Judge Janet Smith said "the full toll may be higher, citing a 'real suspicion' that Shipman had killed 45 more people for whom there was insufficient evidence to be certain. In another 38 cases, there was too little information to form any opinion on the cause of death."
Despite overwhelming evidence of his guilt, the 56-year-old former physician maintains his innocence, continuing to shroud the motives for his extraordinary crimes.� The official report speculated that the doctor was "addicted to killing" much like he was addicted to painkillers around the time the murders started.� Like other death angels such as Dr. Michael Swango, the American doctor who killed patients in both Africa and the U.S., there was no hint of a sexual interest in his victims. Rather, as South Manchester coroner John Pollard speculated, Shipman "simply enjoyed viewing the process of dying and enjoyed feeling the control over life and death."�
A fatal fascination with death, dying and drugs is consistent with the behavior of the 17-year-old Shipman who spent hours comforting Vera, his cancer-stricken dying mother. In the young man's mind, there was a powerful emotional connection between the visit of the family doctor and the relief that his injections of morphine brought to her suffering.� Is it just a coincidence that he began abusing painkillers himself and shortly after he began practicing medicine, he used a lethal injection of pain medication to murder his first victim?
Judge Smith found Shipman's "non-violent" killing almost incredible. "The way in which Shipman could kill, face the relatives and walk away unsuspected would be dismissed as fanciful if described in a work of fiction."� Even more incredible was that his murders of so many people did not arouse suspicion for decades, even though there were supposedly safeguards in place at that time.
Clearly new safeguards are needed and a number of them are now in the works in Britain.� For example, after he murdered a victim, Dr. Shipman would often arrange for the body to be cremated if the family did not object, thereby destroying evidence of his crime. Judge Smith points out that new pre-cremation procedures are needed to prevent future abuse.� Also, the system failed tragically when Shipman, after being convicted of drug abuse in 1975, was allowed to obtain enormous quantities of painkilling drugs. For example, in the name of a dying patient, Dr. Shipman obtained enough of the painkiller diamorphine to kill 360 people.
Is Shipman a one-off monster as some have suggested? There is growing evidence that he is not as rare as one hopes him to be.� Disguised in the aura of respectability that normally surrounds medical professionals, a number of monsters like Shipman have gradually been unmasked, but only after numerous deaths have taken place. These "angels of death" are not only doctors, but nurses, therapists, hospital workers and proprietors of care facilities for the sick and the elderly.� Dr. Michael Swango killed his patients because it gave him a thrill and a feeling of power; Beverley Allitt and Genene Jones, pediatric nurses, killed their young patients to get more attention for themselves; Dr. Marcel Petiot and Dr. H.H. Holmes killed for money; Dr. Josef Mengele killed for political beliefs, and so on. The medical profession clearly needs more oversight if the world is to rid itself of this problem.

Shipman Inquiry

July 2003
Shipman Inquiry Criticizes Police and Coroner.
On July 14, 2003, BBC Online reported that officers from the Greater Manchester police department who investigated the Harold Shipman case had come under heavy criticism following the findings of an official enquiry into the case.
According to the report, Dame Janet Smith, the judge heading the inquiry, said the enquiry had found that "three of Harold Shipman's victims could have been saved if police had investigated properly."
In particular, the enquiry criticized the two Greater Manchester Police detectives who investigated the doctor calling them "inexperienced and unfit to handle the case" and indicated that their lack of experience resulted in "many missed opportunities to bring Shipman's crimes to light."
"If the police and the coroner had moved with reasonable expedition, the lives of Shipman's last three victims would probably have been saved," Judge Smith said.
Chief Superintendent David Sykes, the senior officer on the case was, according to the enquiry "unable to give effective leadership but did not do anything about it," Dame Janet said.
The junior officer, Detective Inspector David Smith, was "out of his depth and made many mistakes but did not ask for help and later lied to cover them up," Smith said.
The enquiry also found that an internal policy inquiry into the two officers' handling of the investigation was "quite inadequate."
The report stated that Sykes has since retired from the police department and a misconduct investigation has been launched against Smith.
A spokeswoman for Greater Manchester police told reporters that the department would examine the report's recommendations thoroughly. �� "We have publicly acknowledged that mistakes were made during the first police investigation into Shipman's activities and [we offer] our sincere apologies to the families of the three women who later died. We have already made a number of changes to our working practices as a result of our own reviews of the investigation. These we believe will ensure that this could never happen again."
The following day The Guardian also carried a report of the findings and paid particular attention to Judge Smith's criticism of the way in which the coroners had handled the case stating that, in future they "would be backed by a team of expert investigators to ensure that a homicidal doctor such as Shipman would not be able to exploit the system again."
The enquiry also found that the postmortem examination of victim Renate Overton, who lingered in a coma for 14 months after Shipman apparently gave her a fatal injection in 1994, were inadequate and there should have been an inquest. "Had the circumstances of her admission to hospital been fully investigated at that time, there is a real possibility that it would have been appreciated that Shipman had deliberately administered a lethal dose of morphine - it was a missed opportunity," Judge Smith said.
The enquiry also criticized Alan Banks, the medical adviser to the West Pennine health authority, saying, "his respect for Shipman closed his mind to the fact that his colleague could have harmed a patient."

The Final Betrayal
By Rachael Bell

On Tuesday, January 13, 2004 , Dr. Harold Shipman, Britain's worst serial killer, was discovered at 6 a.m. hanging in his prison cell. He apparently committed suicide in Wakefield prison, where he had been incarcerated since June of 2003 after being moved from Durham prison. The 57-year-old physician was serving 15 concurrent life sentences for his murders, beginning in January of 2000. It is estimated that he killed between 215 and 260 patients during his 23-year killing spree.

Wakefield Prison, UK
Wakefield Prison, UK
His death has opened an inquiry as to how he was able to hang himself in his cell although suicide attempts are not particularly unusual for people facing life in prison. There is no evidence that he was on a suicide watch at Wakefield, even though he had been on suicide watches at Durham.� A spokeswoman from Wakefield told BBC News that Shipman used bed sheets to hang himself from the window bars of his cell. "'He was showing no signs whatsoever of pre-suicidal behavior at all,' she said."

Harold Shipman, prison photo ID
Harold Shipman, prison photo ID
The Guardian reported that Shipman was "obnoxious and arrogant to the prison staff. Just before Christmas his enhanced status was reduced to basic. He was deprived of the television set in his cell and had to wear prison uniform rather than his own clothes."� Some of his privileges were given back to him shortly before he died.
To many of Shipman's victims his suicide is a kind of final betrayal: not only will they never know why he killed their loved ones, but he escaped his punishment of spending the rest of his natural life in prison.
Danny Mellor, whose mother was one of Shipman's victims, told Reuters that Shipman was a coward. "I always harbored the remote possibility that one day I could confront him and ask him why, Mellor said. "Now that has been taken away from me."

Dr. Richard Badcock
Dr. Richard Badcock
The closest that anyone came to understanding what motivated Shipman was Dr. Richard Badcock, psychiatrist at Rampton Special Hospital. After speaking at length with Shipman, Dr. Badcock told the Telegraph that "he believed that Shipman's choice of career might have been influenced by his developing tendencies towards necrophilia, perhaps originally triggered by the death of his mother from cancer when he was 17."� Having complete control over life and death, "that can give a sense of power and omnipotent invulnerability in itself," Dr. Badcock theorized.
Shipman's wife and four children have never accepted that he was guilty. Primrose Shipman was very devoted to her husband. His transfer to Wakefield prison made it easier for her to visit him.

Frightening New Revelations
By Katherine Ramsland

Although he used a bed sheet to commit suicide in his cell in Wakefield prison in 2004, a renewed inquiry into Dr. Harold Shipman's practice ended with a startling announcement on January 27, 2005 . While he was already credited as one of the world's most prolific serial killers with an estimated 215 to 260 victims, whom he killed with lethal injections of diamorphine, people generally settled on the lower figure as the official toll. It turns out, according to the BBC, that a British commission set up to scrutinize his entire medical career believes that the higher figure may be more accurate. While the fatal physician, about to turn 58 when he died, can no longer be punished for his crimes, more families may now receive closurealbeit painfulas to how a loved one died.
The inquiry commission, writes journalist Annabel Crabb in London, had earlier published reports in 2002 to the effect that Shipman had begun his killing career after he had joined a general practice in Todmorden in 1974, but then investigators decided to examine 137 patient deaths prior to that time for suspicious circumstances. Russell Jenkins for the timesonline.co.uk writes that this new inquiry was inspired by reports from Sandra Whitehead. She had been a student nurse in Pontefract General Hospital in West Yorkshire , a facility where Shipman had worked as a junior house officer (an interim position between leaving medical school and becoming a doctor) and where he then received his doctor's registration in 1971. He remained there nearly three years. After Shipman's suicide, Whitehead had reflected back over her three months there and recalled the high death rate, so she contacted the commission to voice her concerns. "The realization," she was quoted in several sources as saying, "was like hitting a brick wall at 60 miles an hour." She believed her colleague, who had used prescription drugs inappropriately, had been killing patients even then.

Dame Janet Smith
Dame Janet Smith
The commission, chaired by Dame Janet Smith, re-examined 137 patient deaths: 133 for which Shipman had signed a death certificate or cremation order, and four more around whom witnesses had indicated he was present. The New Zealand Herald included the information that Dame Janet found Shipman present in at least one-third of the cases he had certified, compared to an average of 1.6 percent for other doctors. That raised red flags, as did the fact that an unusually high percentage of the deaths had occurred between 6:00 P.M. and midnight.
It was initially believed that Shipman, who as a GP made house calls to the elderly (mostly women), had taken advantage of the easy pickings among such patients. But that idea has proven to be erroneous. While he certainly engaged in such behavior, it seems that he preyed on other types of patients as well. The latest report confirmed, according to several media accounts, that Shipman appeared to have killed at least fifteen patients prior to 1975, and Leeds Today added another seven. Timesonline mentions that Dame Janet was suspicious of about at least twenty-four deaths, and also indicates that she said that while there will never be definitive evidence in many cases, the actual figure could be as high as 284.
The public was angry that he'd been allowed to practice for so long without anyone noticing what he was doing, so the inquiry was launched, in part, to answer this question. Since healthcare serial killers (HCSKs) appear to have increased worldwide over the past two decades, people are demanding to know why vigilance has been so low and institutions have not been held accountable for hospital-based murders by practitioners. Given these new findings, it was clear that new procedures had to be put into place especially in light of yet another report that demanded investigation.

Preston Prison
Preston Prison
Although Shipman never publicly confessed, and in fact denied the truth of the allegations, John Harkin, an inmate at Preston Prison where Shipman was temporarily housed, said that the doctor confessed to killing as many as 508 patients. Upon investigation, there proved to be no basis for that claim's accuracy. A psychiatrist also described Shipman as a "classic necrophilliac," although there was no evidence that he had an erotic attraction to corpses. Others believed that his motive was to exercise control, but Dame Janet had her own opinion.

Deadly Details
By Katherine Ramsland

Shipman's first victim was probably Margaret Thompson, 67, who was recovering from a stroke.�� She died in March 1971, and records indicated that Shipman had been alone with her at the time. Three males were added to the murder list as well: Thomas Cullumbine, 54; John Bewster, 84, and James Rhodes, 71. Dame Janet, who included the fact that Shipman had watched his cancer-ravaged mother die within a morphine-induced coma and who had himself become addicted to pethidine, interpreted Shipman's behavior as a fascination with drugs. To BBC News, she said, "There is some evidence that he liked to test the boundaries of certain forms of treatment...It is quite likely that some of the deaths Shipman caused resulted from experimentation with drugs."
It was her opinion that many of these patients would have died anyway, perhaps within a few hours, but that Shipman had used the opportunity to experiment on them with drugs, thereby accelerating their demise. He then made unusual entries into their medical records, which included brief comments about their deaths, as well as overly elaborate comments and items crossed out. These notations were similar to those he had made with patients that he was convicted of killing. In Dame Janet's opinion, he experimented during the evening shift when fewer medical personnel would be around to observe him with patients.
Among four additional patient deaths for which the commission found suspicious circumstances when Shipman was a young doctor was a girl only four years old.�� Susan Garfitt, a cerebral palsy patient, was at Pontefract on October 11, 1972, with a bad case of pneumonia. Her mother, Ann Garfitt, remembers Dr. Shipman telling her in a soothing voice that the child was going to die and that medicating her any further would only prolong her suffering. Mrs. Garfitt asked him to be kind to her child and then stepped out for a cup of tea. When she returned, a nurse told her that Susie had died. She was shocked, and in retrospect she wondered if Shipman had taken her request as an unspoken consent to euthanize her daughter. Given the circumstances, the inquiry commission decided that Shipman had likely given the child a lethal injection.
It's not unusual for HCSK's to "predict" deaths that they themselves intend to commit. They see a defenseless patient in sufficiently bad health that few would suspect foul play if that person died, and they then prey on him or her. The elderly and the very young are the most vulnerable, especially if they're in critical condition. Few pathologists look for suspicious needle marks, because hospital autopsies, when undertaken, are fairly routine. In addition, Shipman showed another behavior common to HCSKs: ingratiating himself with authority figures, which apparently had the effect of deflecting them from his suspicious behavior.
In sum, the three definite murders, four highly suspicious deaths, plus seventeen more in which there were reasonable suspicions amounts to 24. Dame Janet Smith's report is the sixth thus far and was announced as the last one, although the Scotsman reported that as many as 45 more deaths in other places where Shipman worked might still merit investigation. Dame Janet emphasized that her figure was an estimation, not a calculation. She herself had positively identified only 218 victims.

Mind Set on Murder
Mind Set on Murder
In Leeds Today, it was reported that even a year later, there has been no funeral for Shipman and his body remains in a morgue in Sheffield. However, the Yorkshire Post says that his remains were moved to Wakefield in secret and the family is waiting for publicity to die down before they decide what to do. Apparently Shipman's wife, Primrose, wants to bury him, while a son prefers cremation. A book devoted to Shipman's crimes, Mind Set on Murder, written by Carole Peters has been published, yet it probably does not cover a recent revelation, that Shipman mocked his victims and used derogatory codes for them, such as WOW - Whining Old Woman-and FTPBI - Failed To Put Brain In. He also viewed himself as the "star" of his trial. Reportedly, the family believed he had been murdered in his cell and had tests done to make those determinations perhaps another reason that his remains are still on hold.
The General Medical Council must now respond to the results of the expensive four-year inquiry with a plan for better policing of the medical establishment.�� The pressure of lawsuits from families of Shipman's victims will ensure that measures are taken so that such a long-running killing streak by a doctor, which involved as many as 36 patients a year, never happens again. It can no longer be assumed that people who enter the healthcare industry have only the best motives. While killers like Shipman are rare, patient care demands better scrutiny.

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