‘You wake up and you receive a phone call – Shipman’s topped himself. You have got to think for a minute: is it too early to open a bottle?’
David Blunkett MP
SUCH WERE THE comments of the Home Secretary, on hearing that the most prolific mass-murderer in British history, Dr Harold Shipman, had hanged himself in his prison cell in the early hours of Tuesday, 13 January 2004.
For the relatives of Shipman’s victims, the news was not so welcome, for while many were happy to see Shipman rot in hell, any explanation of why he had killed and exactly whom, would go to the grave with him. He had, in the words of Jayne Gaskill, whose mother, 68-year-old Bertha Moss was among Shipman’s victims, ‘taken the easy way out’.
Shipman had been jailed for life in January 2000 at Preston Crown Court for the murder of 15 of his patients by morphine injection. In 2002 Mr Blunkett decreed that Dr Shipman would spend the rest of his life behind bars. Nevertheless, Shipman never accepted his guilt and he had lodged an appeal. The fourteenth of January 2004 was to be his 58th birthday yet the previous day he had fashioned a noose out of bed sheets which he then tied to the window bars of his cell and then strangled himself. Shipman was found unconscious at 6.20am. Resuscitation attempts failed and he was pronounced dead at 8.12am.
Professor Ian Stephen, one of Britain’s leading forensic psychologists, speculated that the murderer died because he realised the futility of carrying on, only to face further court appearances and more anguished and angry relatives of his victims. ‘Shipman has played god again, this time defying a justice system that put him away. He was manipulative, controlling and saw himself as beyond criticism. He would have considered taking his own life preferable to facing another court telling him he is guilty’. As a doctor Shipman would know how to hide the signs and symptoms prison staff look out for in potentially suicidal prisoners.
To the end, Shipman showed no remorse and made no confession. At his former surgery, the word ‘justice’ was daubed 12 times across the metal shutters. The picture the world has of Dr Shipman was one of a bespectacled, bearded, middle-aged man of medium build with slicked-back, greying, brown hair, usually seen photographed next to his battered old maroon Renault Espace. It was because he was seen as the epitome of ordinariness that makes his appalling crimes seem even more horrific.
It was on a cold night in the early hours of 1 August 1998. A digger struck at the hard-packed soil in Hyde Cemetery as the body of 81-year-old Kathleen Grundy was exhumed. An autopsy revealed morphine in her muscle tissue. A former mayoress of Hyde, known for her dedication to helping the elderly and numerous charitable causes, Mrs Grundy was lively, well known and much loved. She was visited by Shipman at 8.30am on 24 June 1998, just a week before her 82nd birthday, supposedly on the pretext of taking a blood sample. On arrival, he gave Mrs Grundy a lethal injection of morphine instead. He then scurried back to his dingy surgery and altered her medical records to imply she was a codeine addict who regularly overdosed. His undoing, if not his motive, was greed. Her friends, John Green and Ronald Pickford, found Mrs Grundy dead on the settee at 11.55am.
Apparently, Shipman had never before tried to make financial gain from his victims. This time it was different. He crudely and stupidly forged Mrs Grundy’s will on his surgery typewriter to read, ‘I leave all my estate, money and house to my doctor. My family are not in need and I want to reward Dr Shipman for all the care he has given to me and the people of Hyde’. He then forged her signature. Why did he risk exposure at this juncture? Perhaps the £386,402 left in Mrs Grundy’s will offered the chance of an escape from his mundane life and high-risk hobby and so he could not pass up the possibility. In the event, it was a stupid mistake.
Unfortunately for Shipman, Mrs Grundy’s daughter, Mrs Angela Woodruff, was an experienced solicitor of 25 years standing and doggedly refused to believe that the shoddy will, typed in upper case, was conceived and signed by her mother. To Mrs Woodruff it was ‘inconceivable’,that this could have happened or that her mother would leave her worldly possessions to her GP. She began an investigation into her mother’s untimely death.
Mrs Grundy had a prior will that left all her money to her only child, Mrs Woodruff. A new will had been drafted and signed on 9 June, only a fortnight before her death, using a different firm of solicitors, Hamilton Ward. Mrs Woodruff nervously visited the ‘witnesses’ to her mother’s will, Mrs Claire Hutchinson and Mr Paul Spencer. Both, as they later confirmed to the police and at Shipman’s trial, had been asked to sign an innocuous ‘document’ while at Shipman’s surgery. They were unaware of what they had attested to. Mrs Grundy’s own diary, meticulously detailed, would reveal that she had not known either, believing she was signing up to a ‘survey’ Shipman was conducting on behalf of Manchester University. No such survey existed. Mrs Woodruff was now faced with the realisation that her mother had been murdered by her GP for personal gain.
On 24 July Mrs Woodruff went to the police and Shipman’s world began to crumble. Mrs Grundy would be the last of his numerous victims.
Shipman was born on 14 January 1946 to a respectable working-class family in Nottingham. His father had been called Frederick but changed his name to Harold, as his wife did not like it. Nonetheless, Harold junior was given Frederick as his own middle name and known as ‘Fred’ throughout his life. A clever but unexceptional pupil, Fred passed his 11 plus and entered the distinguished High Pavement Grammar School. While sitting his A-levels, Shipman’s devoted mother Vera died of lung cancer after a long and painful illness on 21 June 1963. She was only 42 and the only relief she obtained from her suffering was from the daily injections of diamorphine administered by her GP. It can be no coincidence that her son chose this very drug to dispatch his own victims. Fred was absolutely devastated at his mother’s death. He bottled up his grief and few were to know the heartbreak he felt at losing his mother. Grief at the premature death of a loved one is an emotion Shipman would make sure was felt by hundreds of others in the years ahead.
It was a proud moment for the Shipman family when Fred won a place at Leeds University to study medicine. He originally had no interest in becoming a doctor. Vera’s death suddenly thrust on him a desire to make medicine his vocation. His studies began in 1965, at a time when only 7% of school students went on to university, an even smaller proportion from Shipman’s modest background. Nevertheless, as a student Shipman was fairly ordinary and had to spend almost every waking minute studying, as he struggled to pass his exams. A keen rugby player as a boy, sport and a social life were neglected in favour of medicine. Until his future wife emerged on the scene.
The joy of university life, such as it was, was cut short for Fred when he met 17-year-old uneducated window-dresser Primrose Oxtoby, the daughter of the landlady at his student digs in Wetherby. Soon she was pregnant. In those days the proper thing to do was marry and on Guy Fawkes Night, November 1966, 20-year-old Shipman and his young bride tied the knot. It was a low-key registry office wedding witnessed only by the new Mrs Shipman’s mother Edna and Fred’s dad. Not a single photograph of the event has ever come to light. Sarah, the first of their four children, was born four months later on St Valentine’s Day. Fred now had a young family to cope with as well as the burden of relentless study and he suffered frequently from exhaustion. Former colleagues from Leeds University Medical School have since suggested that Shipman had a macabre fascination for dead bodies at this time. Perhaps death was already permanently etched on his mind. Possibly he felt calm, or more alive, in the presence of people who had ceased to be.
The Shipmans had another child, Christopher, on 21 April 1971 and Fred graduated soon after. Upon qualifying, he began work as a house officer at Pontefract General Hospital and registered as a doctor on 4 August 1971. He took a Diploma in Child Health and a Royal College Diploma in Obstetrics and Gynaecology. After three years, Shipman decided hospital medicine was not for him. A career in general practice beckoned.
Accepting the offer of a job in Todmorden, a Yorkshire market town of 15,000 souls, Shipman started work as a junior GP on 1 March 1974. In Todmorden he appeared to blossom. The group practice run by Dr Michael Grieve was impressed by his hard work, dedication and enthusiasm. He also became a pillar of the community, helping to clean out Rochdale canal at weekends in the company of Primrose and some local volunteers, who were greatly impressed that a doctor would dirty his hands on their humble venture. In only a month he was promoted from assistant to principal GP. Shipman seemed destined for great things, with his flair for new ideas and growing reputation as an excellent administrator. He was popular too with partners and patients alike, rapidly developing quite a following.
Yet there can be no doubt that even as a young doctor, Shipman was a haunted man. He may have appeared to others as a dynamic, self-confident go-getter but the reality was different. To deal with his inadequacies, fears and miseries, he began to self-inject the synthetic opioid painkiller pethidine hydrochloride. Used as an analgesic primarily in childbirth, the short-lasting euphoria it gave Fred allowed him an escape from the stresses of everyday life.
To cover up his addiction, Shipman wrote prescriptions in the name of patients who never received the drug and were unaware it had been prescribed for them. He topped up his supply by ‘recycling’ pethidine left over through deliberate over prescribing, from those who had actually taken it. He was taking 6-700 mg daily, injecting upwards of a dozen times a day.
The signs that something was amiss became apparent when Fred began to suffer blackouts and falls. His devoted wife, who worshipped her husband, took to driving Shipman to house calls. His partners worried but Fred lied that he suffered from epilepsy. He was soon caught out.
In Todmorden village, the local chemist was worried at Shipman’s pethidine use. Rather than raise the issue directly, he deliberately left the ‘drug book’ open when a receptionist came to collect some dressings. The receptionist was horrified to read pages and pages of entries in Shipman’s name, all for pethidine ampoules, a drug seldom used in general practice. A partner, Dr John Dacre, was informed and after checking the book himself, he and his colleague Dr Brenda Lewin decided to confront Shipman directly. Without informing Dr Grieve, they spoke to Shipman on Monday 29 September 1975, at the end of his weekend shift.
Shipman flew into a fury. His partners were taken utterly aback. They had never witnessed such behaviour in their colleague who denied nothing, said he would stop and demanded another chance. Eventually, Shipman stormed out saying he had resigned. Dr Grieve was shattered that his young protégé was a junkie. An hour later, Primrose barged into the surgery and told the partners that her husband would never resign. They would have to sack him. Sack him they did but it took six long weeks while he stayed at home on full pay. The grounds he was dismissed on were, ‘Breaking practice rules through misuse of drugs’.
Shipman admitted to police that he had taken pethidine for six months prior to the discovery and blamed depression caused by overwork. He was prosecuted at Halifax Magistrates’ Court the following year and pleaded guilty to eight charges of obtaining drugs by deception, asking for 67 similar offences and seven counts of forgery to be taken into consideration. Fined £600 by the GP Magistrate, Dr Maurice Goldin, Shipman also had to reimburse the NHS £57.78 for the cost of drugs taken illegally. Sent to The Retreat psychiatric unit in York, he never worked in Todmorden again.
The recommendation Dr Goldin gave to Fred was to ‘Get better and get out of medicine’. He also recommended that Shipman ‘never have access to drugs again’. Sound advice, though sadly for Shipman’s victims, it was not taken. He kicked his habit and voluntarily resigned from the Controlled Drug Register, which would have left him open to checks on how he stored morphine, pethidine and other controlled substances. Shipman was never again allowed to retain or carry in his medical bag controlled drugs. He did of course. For their part, the General Medical Council (GMC) took no action and Shipman was not struck off.
Moving with his family to a new council house on the Burnhill Estate, Newton Aycliffe, County Durham, and seemingly out of medicine, Shipman, with Primrose right behind him, was determined to bounce back. There was a feeling in the medical profession that Shipman ‘deserved another chance’. He took it and became a children’s clinical medical officer for the South-west Durham Health Authority. Just 18 days later, on 12 September 1977, he began working again as a GP, this time with the Donneybrook House group practice in Hyde, a former mill town and close-knit community in Greater Manchester of 22,000. The Shipmans rented a pretty semi-detached house in Lord Derby Road. Two years later they bought their final home, another semi in Roe Cross Green, in the quiet suburb of Mottram. On the 20 March that year, their son David was born and on 4 April 1982 their family was complete with the arrival of Sam. On 5 January 1985, Shipman’s father died aged 70, of a heart attack. Although not close to his father, who believed his son’s marriage to Primrose had brought scandal on the family, Shipman was deeply upset at his father’s demise, barely avoiding a nervous breakdown. He became even more detached and aloof, retreating further into his own private world of resentment, anger and frustration.
Shipman was very strict with his children, a control freak, just as he was at work. On one occasion, when his two younger sons were six and nine, Primrose phoned Fred to inform him the children were at the table ready to eat. He instructed her not to feed them until he returned. When he did so, hours later, his boys had fallen asleep hungry at the table. It was even alleged that he struck his sons on occasion.
The GPs in the seven-strong Donneybrook House practice were aware of Shipman’s past. Through hard work he gained their trust but became equally well known for his aggression and violent mood swings. He brooked little opposition from colleagues at practice meetings, snapped at the staff and would go pale with fury when he did not get his own way but he rarely raised his voice or lost his cool. The apparent internalising of their co-employer’s rage would sometimes unnerve the staff. On other occasions he would shout and bully receptionists and the atmosphere in the practice soon deteriorated. The practice manager, Vivien Langfield, who had over 25 years experience there, soon clashed with him, noticing his obsequiousness to other doctors and aloofness and arrogance towards employees. He was, she recalls, ‘a divisive, despicable man’. If he took a dislike to a staff member, he would demand the practice manager sack that person, as he was too cowardly to do it himself. Shipman used his qualifications to belittle those he considered beneath him. If one queried his methods he would retort: ‘I am a good doctor, I qualified at Leeds Medical School and passed my exams’.
Shipman became involved in a number of organisations, ranging from the Local Medical Council and Parent Teacher Association to the St John Ambulance Brigade, becoming their Area Commissioner, Divisional and Area Surgeon. Abruptly and for no apparent reason, he would leave these organisations after years of commitment and never return.
In November 1989, the GMC received a formal complaint from the Family Health Services Appeal Unit. Shipman had prescribed the wrong dose of epilepsy treatment, epilim, to his patient, Derek Webb. Mr Webb suffered brain damage as a result and never fully recovered. His family sued Shipman who accepted his error and was found to be in breach of his terms of service. The case rumbled on for a further decade. The GMC did not check Shipman’s record.
February 1992 saw Shipman fined by the GMC for failing to visit a patient who had suffered a stroke. Upon investigating such professional misconduct, his previous record was again ignored.
In August 1992, after 15 years at Donneybrook, Shipman struck out alone and began to work from his own solus practice in Market Street, opposite the Age Concern charity shop, ironically the one Kathleen Grundy often helped at. He took 2,300 of his loyal Donneybrook patients, three receptionists and a district nurse with him. He said the reason for leaving was that his old-fashioned approach to medicine was at odds with colleagues’ plans to computerise their records. When he moved, Shipman did just that. The real motive for relocating was to create his own fiefdom. In Market Street he had no medical colleagues or senior partners, no one looking over his shoulder, leaving him free to carry out his cold-blooded killings, confident of avoiding discovery.
His partners had no inkling that Shipman would move out. Deviously, he found a loophole in his contract that enabled him to take his patient list. His partners had always behaved honourably towards him and were aghast when he refused to pay £30,000 towards the tax bill as his share of the previous year’s profits. As the practice was a company, they could not claim it from him. Former colleagues were also embittered that they were left to pay his £20,000 a year share of staff and ancillary costs and buy out his £23,000 share in the building. As he had taken his patient list, they could not even replace him. A sense of bitterness and betrayal festered between Donneybrook and Shipman from this point onwards.
Shipman was considered at this time by many to be ‘the best doctor in Hyde’. He seemingly could not do enough for his flock, making impromptu visits to the elderly, being kind and patient with them. He had an outstanding bedside manner and also made sure his patients received the best of medicines. Frequently he was over budget with the local prescribing adviser, fighting his corner tenaciously to defend his prescribing habits. Rather than refer patients to hospital, Shipman insisted on treating them himself whenever possible. Long hours were the norm and, until the enormity of his crimes became evident, he was highly spoken of. He nursed two neighbours and patients, Alan and Jane Smith, through nervous breakdowns, insisting that rest not medication would help them recover and when Jane became distressed at the death of her father Stanley, both Primrose and Fred insisted on running her to Tameside Hospital. ‘He is absolutely marvellous; I can’t speak well enough of him’, she said after Shipman’s arrest. Other patients took the opposite view. Lorraine Leighton remarked that: ‘He gave me the creeps’.
Some patients disliked the often brusque and condescending way Shipman spoke to them, others revered him. Soon, Shipman had a waiting list of admirers wishing to join his practice, a list eventually swollen to 3,100, two-thirds of whom remained on it six months after his conviction. He was unlike other GPs, who would write a prescription almost as soon as a patient arrived. Shipman would listen intently, inform the patient of his diagnosis and explain why he would embark on a particular course of treatment. As a result of such consideration, when he was accused, many of Dr Shipman’s patients simply refused to believe it. Cards, letters and floral tributes from well-wishers flooded into the surgery, telling him to ‘keep his chin up’ and the like. Comments to reporters were made such as, ‘He ensured I got the life-saving heart surgery I needed, I owe my life to the man’, or ‘he was a saint, nothing was too much trouble’ and ‘he was kind, reassuring and so dedicated’. Others had a different view.
On 19 September 1997, 55-year-old Jim King visited his doctor’s surgery. An unusually ebullient Shipman greeted him with the words, ‘Congratulations, you’ve won the lottery’. Mr King was told he did not have the cancer Shipman diagnosed eight months earlier. He had never had it. Relieved and upset, having endured three months of painful chemotherapy and eight months of injecting morphine, he blamed the hospital. Yet, his GP was told on 22 November the previous year that King was free of cancer and probably had kidney disease. Perhaps for his own sadistic pleasure, he had nevertheless informed King that he had only 18 months to live. In the meantime, he became addicted to morphine and his family life deteriorated. His father, also Jim King, was angry at Shipman and wanted to find another GP. He never got the chance. On Christmas Eve, Shipman called at 2.30pm to give the 83-year-old a flu jab. Mr King was found dead half-an-hour later. Shipman called it ‘old age’, even though King snr had been as fit as a fiddle, walked five miles a day and had just redecorated his home. Possibly he was murdered with morphine ‘harvested’ after being prescribed for his son. Jim King’s aunt, Irene Berry, was to die in similar circumstances, as had another aunt, Molly Dudley, in 1997.
It was soon discovered that while Shipman was highly regarded by many, he also had the nickname of ‘Dr Death’. Elderly women were heard to say, ‘He is a good doctor but you don’t last. Lots of old ladies have died with him’. Made almost in cheery innocence, such comments are somewhat chilling in that if rumours about Shipman were abroad in the community, why were the authorities unaware of what was going on until, for so many, it was too late? As the Shipman case unfolded on television, millions watched incredulous that such a seemingly bland individual was such a prolific killer.
Mrs Woodruff had taken her concerns to her local police station in Warwickshire, who passed them on to Stalybridge CID Detective Inspector Stan Egerton. Detective Superintendent Bernard Postles was placed in charge of the investigation and Shipman’s subsequent interrogation. He checked the details given to him by Mrs Woodruff and was convinced she had been murdered. To prove it, an exhumation order was required. Coroner John Pollard provided it. Forensic pathologist Dr John Rutherford examined the body of the late Mrs Grundy. Liver and muscle tissue samples were taken and sent for examination to Dr Julie Evans, forensic toxicologist, in Chorley and Professor Hans Sachs of the University of Munster, Germany.
Detective Superintendent Postles set up an incident room on 21 August in Ashton-under-Lyme station. He was 46, had 27 years on the force and served 22 of those in the CID. Some 59 officers were part of the team, working night and day, under the leadership of Postles and his subordinates detective inspectors Mike Williams and Stan Egerton, who instigated much of the hard work that brought Shipman to justice.
On 2 September 1998, Dr Julie Evans confirmed that large doses of morphine existed in the body of Kathleen Grundy. Five days later Shipman was arrested at 9.18am at Ashton-under-Lyne police station. The police had been in no rush. Shipman wasn’t going anywhere and they did not want to start a commotion. A locum doctor took Shipman’s place at the surgery he had continued to work in almost to the moment of his arrest. Shipman was charged not only with the murder of Mrs Grundy, but with theft by deception and three counts of forgery.
To investigating officers, Dr Shipman was cold, arrogant and displayed an air of intellectual superiority and calculated indifference towards them. He scoffed at their lack of medical knowledge, ‘You don’t understand medical matters, you are only plods’, he said to the police. He was contemptuous of their incredulity at his insistence that Mrs Grundy was a drug addict at the ripe old age of 81.
Shipman’s arrogance was partly based on ignorance. He had no idea that his computer would betray the times and dates he input data, changing the medical histories of patients he had recently murdered. He therefore readily admitted that he and he alone had access to patients’ computer records. Unfortunately for him, the police were able to show a direct correlation between the deaths of patients and the retrospective altering of their records hours or even minutes later. They were also able to prove that, on at least one occasion when Shipman claimed to be ‘treating’ Mrs Grundy, she was miles away with her daughter. When this was revealed to him, his aloof demeanour cracked. Detectives questioning him also proved he had altered the medical records of other victims to make it look as if their deaths were due to natural causes. At this juncture he seemed to break down completely and fell weeping and gibbering to the floor. Perhaps at that moment, when his world came crashing down, he knew he was finished. Subsequently, Shipman never said a word. In interviews he turned his back to the police and closed his eyes when shown victims’ photographs.
Checking the number of deaths among Shipman’s patients soon convinced the police, to their horror, that they were dealing with someone who had killed many times before. The police had so many potential victims they did not have the resources to investigate them all. Sixty of the most likely were investigated, with the police developing a five-point methodology for choosing which ones to progress. Firstly they would ascertain if a body was cremated or buried, the latter giving the opportunity for an exhumation and examination to find traces of morphine, scoring one point if the deceased had been interred. Secondly, they would then check if the family of the deceased had any suspicions regarding the death of their loved one, awarding another point for ‘yes’. Thirdly, another would be scored if the cause of death was inconsistent with the medical history of the deceased. Fourthly, a point was given if the medical records of the departed had been tampered with and, lastly, an extra point was scored to those cases that had a total of four points from the above categories, making them top priorities for investigation. By scrupulously sticking to their formula, the police were able to fully investigate 15 cases that they would be able to take to court including Mrs Grundy. Gruesomely, another 11 exhumations would be ordered in the coming weeks and months, all of them carried out in the dead of night. The deceased were then quietly reburied a day or so later, usually after a short, dignified religious service.
Not all the families of the dead wanted to assist the police. It was too distressing for them. Much time had to be spent and a great deal of sensitivity shown by the police. Counselling of family members helped. Such was the adverse emotional impact of the case that soon a number of stressed officers availed themselves of the service too. Shipman’s victims were often those one would least expect to die suddenly. Not all were old and many vigorous and in fairly robust health.
Elizabeth ‘Lizzie’ Adams was killed on 28 February 1997. She had just turned 77. A former dance teacher who had retired only the previous year, she still took to the floor with regular partner Bill Catlow several times a week, was fit and full of vitality. Lizzie was in high spirits when she told her daughters, Sonia and Doreen, that Dr Shipman would call and give her some antibiotics for a ‘bug’ caught on a recent holiday to Malta. When Mr Catlow came to her home at 2.00pm he was surprised to see Dr Shipman looking at her dance trophies while Lizzie lay slumped in a chair. Examining her, Bill found a pulse. ‘It’s your own’, said Shipman coldly, explaining that Mrs Adams had ‘gone’. Her iron was on and a meal was cooking on the stove. She had succumbed, said her doctor, to pneumonia.
Joan Melia was an independent and spirited woman of 73 when slain by Shipman, his second to last victim, only 12 days before Mrs Grundy. A divorcee, she remained close to her ex-husband and six nephews and nieces. Found dead in a chair by her fiancé, Derek Steele, she was another active pensioner, all hustle and bustle, who died after a visit from her GP. Her engagement ring, which she never removed, disappeared the day of her death.
Mother of five Winifred Mellor was Shipman’s third to last victim. Although aged 73, on occasion she played football with her grandsons. On the day she died, Mrs Mellor had been shopping and chatted to friends on the phone. That fateful day, 11 May 1998, Shipman had also called on her friend, Mrs Gloria Ellis, after supposedly finding Winifred dead in an armchair. According to him, she had suffered from angina for months and refused admission to hospital. It did not ring true. Nevertheless, family and friends had no reason to doubt a doctor whom they knew and trusted.
Only 49 when Shipman poisoned her, on 10 December 1997, Bianka Pomfret was one of his youngest victims. Having suffered from manic depression over many years, she placed great faith in her doctor. Quiet and religious, Bianka was probably killed because Shipman considered her dependence on him and frequent visits to his surgery a ‘nuisance’. In the summer of 1997 she promised to leave her worldly possessions, £100,000 in money and property, to her GP. After a fierce argument, when Shipman realised he was not the only person of importance in her life, Bianka threatened to cut him out. Shipman tried to give her a ‘sedative’. She refused the injection, temporarily saving her life. In the days that followed Mrs Pomfret changed her will, leaving everything to her son and grandchildren.
Maureen Ward was 57 when killed by Dr Shipman on 18 February 1997. Only two years previously he had killed her mother Muriel at the same address. Whilst Muriel’s death was supposedly caused by ‘heart failure’, her daughter’s demise was brought about by a ‘brain tumour’, which does not kill quickly. Muriel Ward had been cremated so police did not have enough evidence to charge him with that murder. They did with Maureen, a retired college lecturer who had only recently fought off cancer.
Marie West was 81 when she met her death on 6 March 1995. She was not alone with her murderer at the time. Her friend, Mrs Marion Hadfield, was in the next room. Of this, Shipman was unaware. He was startled to see Mrs Hadfield emerge from the kitchen where she had enjoyed a cup of tea. ‘She collapsed on me’, he stammered. ‘Can’t you do something?’ Her friend pleaded. Lifting her eyelid, Shipman retorted, ‘See, no life there!’ A widow, Mrs West had lost her daughter to cancer eight years previously. Grandchildren were her life and she doted on them. Marie was a character, always in good spirits and seemingly excellent health until the assassin came to her home.
The people of Hyde, most of whom had only the highest regard for Shipman, often rationalised his actions by considering the doctor an advocate of euthanasia, nothing more. He had killed perhaps, but only to put some frail, terminally sick persons out of their misery. Such attitudes made the job of the authorities difficult as many locals shunned their investigations.
Dr Shipman was placed on remand after appearing before Tameside Magistrates Court on 7 October, breaking down in the dock when new charges of murdering Joan Melia, Winnie Mellor and Bianka Pomfret were read out. Initially he was placed in Walton Prison, Liverpool, 50 miles from Hyde, for fear of attack by relatives of his victims among both prisoners and staff if he was incarcerated in Manchester Strangeways. Eventually he was moved to Manchester Prison (as Strangeways is officially known) after his solicitor, Ann Ball appealed that Walton was too far away for Primrose and the children to visit. As a ‘first timer’ he was placed on ‘suicide watch’. The authorities feared he might kill himself, as the other Fred – Fred West – a confessed serial killer, had done in Birmingham before he could be tried.
Although 12 women were exhumed, the police did not proceed in the cases of Sarah Ashworth, Alice Kitchen and Elizabeth Mellor. Morphine was found in all of them and Shipman was almost certainly their killer, but the state of decomposition could allow the defence to challenge police findings. On the other hand, cases involving six cremated victims where the police had phone and computer records, plus strong eyewitness testimony, were progressed to show the indiscriminate nature of the murderer.
Shipman was brought to trial at Preston Crown Court, 35 miles from Hyde, as it was believed Manchester could not provide an impartial jury. It was a fitting venue for such an important trial as it was architecturally similar to the Old Bailey in London with Victorian fixtures and fittings. Media interest was intense and 38 seats were set aside for press use. Outside the court, the streets thronged with reporters and television crews buzzing with anticipation.
The trial of Dr Harold Frederick Shipman began on Monday 11 October 1999 before Mr Justice Thayne Forbes, renowned for being scrupulously fair. For the Crown was Richard Henriques QC, the most respected and senior barrister in north-west England, assisted by Peter Wright QC. Defending was Nicola Davies QC, a specialist in medical cases from Wales, assisted by Mr Ian Winter.
Shipman faced 16 charges, from 136 cases investigated back to 1984. One count of forging Mrs Grundy’s will and the murders of fifteen women: Elizabeth Adams, Muriel Grimshaw, Kathleen Grundy, Pamela Hillier, Jean Lilley, Ivy Lomas, Joan Melia, Winifred Mellor, Norah Nuttall, Bianka Pomfret, Marie Quinn, Irene Turner, Kathleen Wagstaff, Maureen Ward and Marie West.
Mr Henriques’ opening remarks lasted over eight hours. He at once asked the jury to discount any thought of euthanasia. None of the victims had been prescribed morphine or its derivatives prior to being ‘executed’ by the doctor they knew and trusted. The doctor had killed not to relieve pain but for his own twisted pleasure.
Angela Woodruff was the first witness heard. Despite her legal training she found the experience an ordeal. Nevertheless, she gave a vivid and emotive account of her mother’s life and death that impacted immediately on the jury. Scores of other witnesses followed over 25 days of prosecution evidence. The decent, dignified and plain-spoken people of Hyde came first, including Mrs Grundy’s best friend, 91-year-old Mary Clark, detailing the rich and fulfilling lives led by the victims with friends and loved ones until cruelly and mercilessly cut short by their family doctor. Occasionally, the defence tried to swoop on an elderly witness who muddled times and dates. The witness seldom yielded and attempts to discredit their evidence lost Shipman ground with the jury.
Damning testimony came from the defendant’s district nurse, Marion Gilchrist, who told the court that Dr Shipman had said to her just before his arrest, ‘I read thrillers and on the evidence they have, I would find me guilty’. In the dock, Shipman looked crushed.
The Crown’s experts followed the citizenry in giving evidence. They included pathologist Dr John Rutherford, who described his examination of the exhumed bodies. Dr Hans Sachs from Munster, (the home town of Bianka Pomfret), explained the result of morphine overdose. Dr Julie Evans, detailing her analysis of the exhumed bodies, was asked by the defence if it was not true that morphine existed in some non-prescription medicines such as codeine or kaolin and morphine diarrhoea treatments. Her client was not helped by the retort that over a litre-and-a-half would have to be consumed to attain the body levels found in Shipman’s dead patients.
Mr Ian Borthwick, fingerprint expert, explained that while none of Mrs Grundy’s prints were on the document that purported to be her last will and testament, a Shipman fingerprint was.
Professor Henry McQuay of Oxford University described the effect of morphine on the body and Dr Steven Karch of Stamford University explained that the hair of the victims showed no trace of morphine, showing that they were not regular users, seriously undermining statements by Shipman that Mrs Grundy was.
Three pharmacists from Hyde specified the morphine Shipman prescribed for 28 patients, many of whom were still alive. Shipman had callously used the morphine ostensibly for some patients to kill others. This showed the cruel, calculating and premeditated nature of the accused. Close family members of patients who had died in agony told how their nearest and dearest received no morphine, despite being named on prescriptions. Mrs Ann Brown, daughter of Muriel Grimshaw, told the court that her late husband had actually been prescribed morphine for cancer. When he died, Dr Shipman arrived soon after and removed unused boxes of diamorphine. The jury was left with the distinct impression that it was deliberately stockpiled by Shipman to kill others, including Mrs Brown’s own mother, who died four years later, possibly from morphine harvested from another terminally ill patient.
On 8 November, an inebriate sneaked into the public gallery. ‘Murderer!’ he yelled at Shipman, who alone did not look up as the man continued yelling before being dragged away. Further excitement was added on day 22 when a bomb scare emptied the court.
Shipman had informed the police that he retained no morphine at home, yet 93 tablets of morphine and four ampoules of diamorphine were found when it was searched. An examination of Shipman’s prescribing habits revealed that he had prescribed 22,000mg of morphine in his six years as a solus GP. A fatal dose can be anything up to 100mg, depending on the age, health and weight of the patient. 50-60mg is normally deadly.
Despite the damning testimony presented, the defendant remained stoic throughout. To many rather grey and small, Shipman thought himself a superior intellect in a drama with himself in the starring role, as he betrayed in letters to former patients with whom he corresponded. Nicola Davies fought valiantly on his behalf. Prior to its commencement, she even tried to have the trial stopped as it ‘Could not be fair’, given the ‘unremitting, extensive, inaccurate and misleading’ reports on the case. Mr Henriques explained that the publicity was ‘reasonable, given the enormity of the crimes being investigated and the huge number of suspected victims’.
When Shipman took the stand on Thursday 25 November, it was day 26 of the trial. The courtroom was silent and tense with a sense of expectation that the defendant’s testimony, under oath, would be the most crucial yet heard. He outlined his life and career as Primrose, short, plain and obese, sat loyally with her children in the gallery, giving him their full support.
Shipman seemed out of place, giving off the air of a quiet academic rather than a ruthless serial killer. But looks can be deceptive. He spoke quietly at first, apologising for slurring his words. Looking for sympathy, he said it was because of the tablets he was taking for his nerves. Gradually he spoke more authoritatively but with a curious mixture of homespun accents perhaps intended to give him the air of a simple, hard-working and innocent local GP. Davies built up a solid picture of vocational dedication and family life. Unfortunately for Shipman, the humble posture was a difficult one for him to maintain and his true, arrogant self was made apparent to press, public and most importantly, the jury.
It was revealed by the police that the ‘will’ supposedly written by Mrs Kathleen Grundy had been typed in Shipman’s surgery. His feeble and incredulous account of how Mrs Grundy ‘frequently borrowed’ his typewriter was believed by no one. That he had committed fraud was a certainty. Soon murder would be proven beyond doubt too.
Shipman did not help his case by describing his former patients in less than glowing terms. He coldly stated that a smoker with heart disease, like Bianka Pomfret, ‘is silly and looking to die’. He hinted at patients ‘going downhill’ and that, if resuscitated, he was afraid of ‘what we would end up with’. Why did the victims need to be revived in the first place? Shipman had difficulty explaining, especially after he admitted he had simply ‘cold called’ on some of the elderly victims in passing and that few had even requested his attendance. That most of the 15 had died in front of him, or within minutes of his call, struck the jury as more than coincidence. That he changed all of their records, backdating them to the time he said the patient had first noticed her symptoms, was also considered strange. Asked directly on 15 occasions if he had killed a specific patient named in the charges against him, in every instance he simply replied, ‘No’, or ‘no I did not’.
In the case of Ivy Lomas, who died in his surgery, ostensibly from ‘heart disease’, Shipman was forced to accept that the toxicology report made it clear she had died of a massive overdose of morphine within five to ten minutes of it being ingested. How this could happen if self-administered, Shipman simply could not say. ‘I have no explanation’, he muttered. No one else was present and he had ‘no idea how it got into her body’. Weakly, he denied any responsibility.
With regard to Norah Nuttall, Shipman admitted he had not called on her in eight years, yet within minutes of his cold call she was dead. Mr Henriques tore into him, accusing the beleaguered doctor of failing to call an ambulance, admit a patient to hospital or allow an autopsy in the instance of anyone he was accused of killing. Why? Because he had murdered them.
On day 40 of the trial, Monday 13 December, with all the evidence heard the court was recessed until 5 January 2000. On that date Mr Henriques delivered his closing speech, reminding them that more than 120 witnesses had spoken for the Crown, each adding to the mountain of proof that Shipman was a heartless slayer of defenceless, trusting, harmless old women who had placed their faith in him until their untimely end. The accused was also manipulative, duplicitous and determined. There was no limit to his evil and he would cajole, comfort and bamboozle relatives into cremating or burying their relatives without the ‘trauma’ of a postmortem. Ambulances and hospitals were strenuously avoided as travelling along that road lay the certainty of detection. Such was the weight of evidence against Shipman that Henriques was on his feet all day and resumed again the following, finishing only at lunchtime. Nicola Davies now had to address the jury on behalf of her client.
Shipman was portrayed as old-fashioned, eccentric, dedicated and caring. He loved his patients and cared little for record-keeping and other ‘modern’ bureaucratic niceties that kept him from his calling. To those who found him cold and unsympathetic, this was an expression of his ‘calm, professional attitude’. No motive was unearthed by the prosecution and his stockpiling of morphine was simply ‘routine’, medical practice. He simply carried with him a medicine that could prove ‘useful at any time’. The toxicology report said Ms Davies, was, ‘inherently unreliable’, the evidence having been gathered using new scientific techniques. As for the forged letter, it was dismissed as being ‘obviously’ from someone who was not a skilled letter writer, like her client.
In his summing up, Mr Justice Forbes asked the jury to consider each of the murders separately, to look at the case dispassionately and he outlined in detail all the evidence before the jury, taking four days to do so. Eventually, the jury retired on 24 January to deliberate. It took a long, long week before they were ready with their verdicts, asking even then for a further ten minutes. Finally, at 4.33pm on Monday 31 January 2000, the jury foreman stood up, announced that the verdicts were unanimous and, to each charge, pronounced the defendant guilty.
Shipman remained emotionless. The gallery, packed to the gunnels with journalists and victims’ relatives, was shocked when the judge informed the court of Shipman’s previous convictions for forging prescriptions 25 years earlier. He then read out the sentence, expressing his horror at the wickedness of a doctor who betrayed the trust of so many vulnerable people who had put their faith in him. Shipman received 15 life sentences, one for each murder and four years for forgery. A recommendation was made that, ‘Life must mean life’, and Shipman spend his remaining days behind bars.
The police announced after Shipman’s conviction that he would be tried with 23 more murders. Bearded, ordinary, respectable, Shipman was a silent killer both in methodology and in his obstinate refusal to say anything about the number or identity of his victims. He claimed innocence, even to the ‘old lags’ who became his new ‘patients’ after he was sent to Frankland Prison, County Durham. Primrose and the family believed in him still and moved to Whitby, North Yorkshire, to make visiting easier. On 10 February 2000, the GMC finally struck Shipman off the Medical Register.
In prison, Shipman began to exert some influence on fellow inmates and was moved to the sex offender’s wing, in the prison hospital, which deeply offended him. He translated Harry Potter into Braille, was put in solitary confinement ‘for his own safety’ and placed on suicide watch. Shipman was adamant he would not take his own life. He was ‘determined’ to prove his innocence. He had a funny way of doing it, refusing to co-operate in any enquiries.
In January 2001 the Baker Report, commissioned by the Department of Health and chaired by Professor Richard Baker OBE of Leicester University, was published, detailing Shipman’s career in murder. It would be swiftly followed by Dame Janet Smith’s DBE’s public inquiry. Meanwhile Shipman became more and more despondent in jail, with rumours of suicide attempts emerging as his health deteriorated. He became increasingly frail, suffering from eye problems and depression.
His first proven victim was Marie West who died on 6 March 1995, the last, Kathleen Grundy on 24 June 1998. The first ‘officially’ suspected victim from Hyde was Sarah Hannah Marsland, who died on 7 August 1978, aged 86. A widow living alone, Mrs Marsland was found by her granddaughter, Mrs Celia Anne Saxton, after her grandmother had ostensibly died of ‘coronary thrombosis. Mrs Marsland was in good health until Shipman appeared, ‘to see if she was alright’. Mrs Saxton’s aunt, Mrs Celia Chapman, was also to die at the hands of her doctor.
However, much more was to follow. Two days after Shipman committed suicide, Mrs Sandra Whitehead, a student nurse at Pontefract General Hospital from October 1971 to October 1974, contacted the public inquiry stating that she believed he was killing patients even then. A number of suspicious deaths had occurred on Shipman’s watch when he was a young house officer at PGI between August 1970 and March 1974.
Dame Janet Smith’s inquiry investigated 137 deaths at PGI involving Shipman. In 133 cases he signed the death certificate and was present at four more deaths. An appeal for evidence in the local Pontefract and Castleford Express newspaper resulted in a number of other witnesses coming forward. Unfortunately, medical records at the hospital were lost or destroyed during four major management restructurings and hospital expansion in the intervening decades. Only 28 records, whole or in part, still existed. Many witnesses were dead and the full extent of Shipman’s guilt was almost impossible to prove, if indeed he was a murderer so early in his career. At best, guilt could be surmised ‘statistically’ ie if the number of death certificates signed by Shipman significantly exceeded that of other doctors dealing with similar patients over an equivalent time period. Obviously, this was wholly unsatisfactory and distressing for the relatives of potential victims and, it can be argued, served little purpose other than further inflating the scale of crimes committed by Shipman. It should be recalled that many, if not all, of those among the 137 were seriously ill and would have died even without the attentions of the murderous doctor, even if one assumes not all their deaths were natural. In fact the inquiry rejected this approach. After looking at the records available and interviewing witnesses, they became convinced that Shipman killed at least three patients, all male, at PGI.
The first PGI victim was Thomas Cullumbine, 54, who died on 12 April 1972. In his notes, Shipman showed himself ‘hostile’ to Mr Cullumbine, a smoker who suffered from emphysema yet still craved cigarettes. On the night his patient died, Shipman acted suspiciously. Drug notes were altered to delete a 10mg shot of morphine administered, prior to which Shipman had dissuaded the Cullumbine family from carrying out a night vigil by Thomas’ bed, as they had done on the previous night. The doctor was alone when Mr Cullumbine died and Shipman lied about prescribing aminophylline to his patient. He had not. He also said his patient ‘fell asleep’, which was unlikely given the man’s condition. Mr Cullumbine ‘officially’ died of ‘ventricular failure due to emphysema’.
Shipman’s other ‘confirmed’ PGI murders were of Mr John Brewster on 28 April and Mr James Rhodes on 22 May that same year. In total the inquiry considered there were 21 further cases where there was ‘cause for suspicion’, 45 where there was ‘insufficient evidence’ and in 68 instances the patients died naturally.
The first person Shipman was suspected of killing was 62-year-old Wilfred Arnold Sanderson on 18 March 1971. His family are adamant Mr Sanderson died naturally. Dr Julian Boon, a leading criminal profiler who has examined the Shipman case, believes Shipman’s compulsion to kill would have begun to ‘build up’ while unsupervised and with vulnerable patients in his care. It would then be his choice who in his care lived or died. On entering general practice, he would have had to proceed with much more caution. In Todmorden, Shipman’s first victim was Eva Lyons. She suffered from cancer of the oesophagus and was killed on, 17 March 1975, the day before her 71st birthday.
Incompetence may have led to further deaths among Shipman’s patients. During his brief stint in Todmorden, he signed 22 death certificates, more than double that of any other local GP. Included was one for prematurely born Christian Orlinski. Shipman, probably high on pethidine at the time, visited the baby’s parents, Mark and Susan, took a cursory look at the newborn and said the child was okay. He did not suggest any routine check-ups or that the little boy should be taken for observation to hospital. Sadly, he died the next day. Shipman described the death as being from ‘Sudden Infant Death Syndrome’ on the death certificate. Had he done his job, Christian Orlinski might still be alive today.
Ten months after he began his career as a GP, on 21 January 1975, three of Shipman’s patients, Lily Crossley, Robert Lingard and Elizabeth Pearce died suddenly that same day. All expired within minutes of him visiting, all were ill to varying degrees, although none were previously considered at risk of an abrupt end. Did Shipman kill them? It seems probable. Without more evidence than the inquiry had available, no one will ever know for sure.
Shipman’s modus operandi followed a set pattern. The victims, the vast majority of them elderly women living alone, would be visited at home. He would betray the trust of his patient by examining him/her and then advising that an injection was required to treat some malady or other. The patients sleeve would then be rolled up, the fatal dose administered and soon the victim would calmly drift into a drugged sleep, their breathing becoming shallower and more depressed until it stopped altogether a few minutes later. Shipman then rearranged the body to suit him, often leaving them propped up in an armchair. Before leaving for his surgery to alter his victim’s medical records, he took ‘trophies’, no doubt to later remind him of the ‘thrill’ just experienced. Usually nothing too valuable was taken, just trinkets, rings, and odds and ends. Primrose found them stashed in a cardboard box, accepting her husband’s plausible explanation that they were gifts from grateful patients.
As time went on, Shipman no longer needed to be with a dying patient. He could save time by leaving them to die while driving away, enjoying in his mind the scene of death that was soon to follow – a scene he had arranged so many times.
What drove Shipman to murder on such a massive and, ultimately, reckless scale? Sexual or physical abuse suffered as a child are often precursors to a life as a serial killer but there is no evidence that such abuse was ever suffered by him. He was socially inadequate though. In his youth, prior to meeting Primrose, he was unable to cultivate friends or girlfriends. In his childhood he felt powerlessness and developed an inadequacy that remained in adulthood. This undoubtedly helped form his cold and calculating personality, yet the most decisive moment in shaping his murderous destiny could only have been the agonising death of his mother. Why had she been taken when so many ‘inferior’ beings continued to walk the Earth? Shipman decided he would play God. Who would live, who would die would be his choice and his alone. A warped form of altruism may have gripped him. After all, did his victims not endure a death much less painful than his beloved mother?
Of course, as a true psychopath, Shipman had no empathy whatsoever for his victims or their families. They were there to provide an outlet for his own manipulative psychosis. He undoubtedly gained pleasure not only from ending the lives of others but from ‘getting away with it’ too. Whereas his early crimes were usually committed several months apart, his need to kill became greater and greater as time passed. The high obtained from each murder gradually wore off more and more quickly. In 1997, the last full year of his killing spree, he killed 37 people, as he became more and more convinced he was ‘untouchable’ and needed ever increasing numbers of victims to satisfy his craving for death. In the first half of 1998 a further 18 patients were dispatched. So focussed was he on killing that the rest of his life was a shambles. His house was a squalid tip and his practice was deteriorating. He suffered from anxiety and insomnia, believing himself to be infallible, while at the same time fearing imminent discovery. Near the end, he took such risks that perhaps part of him wanted to be caught, to end the charade his life had become. For what other reason did he stupidly forge Mrs Grundy’s will?
Why were certain patients chosen rather than others? It has been suggested that ‘difficult’ patients, such as Ms Pomfret, were prioritised for death. He could often be irritable and intolerant of other people, especially if he considered himself at the fringes of their thoughts rather than the centre of their universe. Shipman was also embittered that his medical ‘genius’ remained unrecognised as he failed to win enough respect and admiration from colleagues, community and patients. Certainly his patients did like him but they were considered too insignificant to massage his fragile ego. In the end, he regarded his victims as less than people with lives, hopes and fears; they were merely objects for his warped gratification.
Opportunity was a factor in selecting a victim. Called out on a house visit to a vulnerable patient, he sometimes could not resist the chance to kill. He even murdered six patients in his own surgery. Perhaps Shipman gained even more euphoria from these ‘in your face’ murders than the others.
What astonished so many of those who looked into the Shipman case was how he got away with it for so long. The nearby Brooke clinic had three times the numbers on Shipman’s patient list with only one-tenth of the sudden death rate, yet GPs from this practice continued to countersign their colleague’s death certificates. A new partner in the practice, Dr Linda Reynolds did become suspicious. She was to pass away from cancer on 6 March 2000 but not before she had initiated action. Alan Massey and his daughter Debbie, Hyde funeral directors, grew concerned at the number of bodies they were called to that were found alone in exactly the same position. Mr Massey visited the doctor, who seemed so unfazed that his suspicions were temporarily allayed. Local pharmacists noted the huge quantities of diamorphine used by Shipman. Even taxi driver John Shaw noted the number of his customers who had died on Shipman’s list. For seven years Mr Shaw kept a list of people he believed had died suspiciously. One of them, Joan Harding, had actually died after he had delivered her to Shipman’s surgery. Mr Shaw told the police the 24 names on his list after the doctor was in custody. To do so before, he believed, could have led to his accusations being ridiculed. As a doctor, trained, employed and supposedly dedicated to saving lives for many Shipman was above suspicion. As one former patient said, ‘You don’t expect Santa Claus to steal your presents do you?’
For years nothing was done. Eventually, on 24 March 1998, the police, following a complaint by Dr Reynolds to Coroner John Pollard, carried out an investigation. Dr Reynolds had only been at her current practice for three years, yet noticed the unusually high amount of ‘ash cash’ generated by her partners for cosigning death certificates of Shipman’s cremated patients. She talked to members of the community, associates of Shipman and checked death rates for his practice compared to that of other local doctors. In doing so she knew her career could be destroyed if her assumptions proved false.
The police despatched only one officer, Detective Inspector David Smith, to investigate. The investigation was to be subtle, giving no clue to Shipman that he was being probed, or who had complained about him. DI Smith interviewed doctors, including Linda Reynolds and undertakers such as the Masseys. Medical records were checked, although at the time the police were unaware they had been literally ‘doctored’. Nothing was found to incriminate Dr Shipman and there was no apparent motive as to why he would harm his patients. Inspector Smith asked for copies of death certificates of Shipman’s patients for the previous six months. He received 19. Unbeknown to him, there were 11 more. No check was made on whether Shipman had a criminal record, his prescribing habits or if he was ever called out with police officers, routinely, to investigate sudden deaths.
The investigation was carried out half-heartedly. It was no surprise then when no discrepancies were found between patient’s medical histories and their death certificates. Without sufficient evidence, no exhumation of possible victims could be carried out. After several weeks, the investigation was terminated. Dr Reynolds asked for autopsies on the bodies of two more of Shipman patients at Massey’s funeral parlour. The police did not act. Shipman continued as before, killing a further three women before his arrest: Winnie Mellor, Joan Melia and Kathleen Grundy. The investigation was not in vain however, as without it, Mrs Grundy might not have been exhumed, because when Mrs Woodruff came forward, the police were much more ready to take complaints about Shipman seriously.
What lessons could be learned to prevent another ‘Shipman?’ In future prescription drugs will be much more tightly monitored, including the disposal of those that are unused. GP death rates will be cross-checked and solus doctors subject to greater scrutiny. It will now no longer be considered ‘unthinkable’ that a doctor systematically and methodically might kill his/her patients.
At the time of Shipman’s death he was not on suicide watch. He had even spoken to Primrose the night before. Perhaps he knew how to hide his suicidal feelings just as he hid so many other emotions for so long. Possibly the enormity of his crimes dawned on and overwhelmed him. This is unlikely. He never displayed a hint of remorse for what he did. The relatives of former patients who had died under his ‘care’ wrote to the doctor in prison. He never replied to a single one. His death was a final act of control, a last hurrah.
Dame Janet Smith’s inquiry produced six detailed reports, the first on 17 July 2002 and the last on 27 January 2005, the inquiry being wound up that Easter. Looking into so many unexplained deaths over so many years from so many witnesses had been a difficult, harrowing and gruesome task. No one will ever know the exact number of Shipman’s victims. Over 24 years in general practice, in Todmorden and Hyde, 526 patients died sudden deaths. Of these, 174 were considered ‘natural’, 60 ‘probably natural’, 43 appear to be ‘probable’ victims, 212 ‘definite’ and in 37 instances there was ‘insufficient evidence’ one way or the other. Including PGI, Shipman killed a minimum of 215 people. There were almost certainly more.