'Months to find' virtual Shipman

Shipman is thought to have killed 236 patients over 24 years

A hospital would have taken eight months to uncover a "virtual" murdering ex-GP Harold Shipman, a study suggests.

A fake increase in death rates was slotted into the records of an anaesthetist and a surgeon dating back to April 2000 at a Cambridge hospital.

The study in the journal Anaesthesia found Papworth Hospital would have rung alarm bells at eight months for the surgeon and 10 for the anaesthetist.

Shipman was convicted of 15 murders but is thought to have killed 236 patients.

If you look at the Beverley Allitt case - it was about converting people's suspicious into actions that was the key thing

An official UK government inquiry found the GP from Hyde, Greater Manchester, committed the murders over a 24-year period but it is unknown when he killed first.

The Papworth Hospital team analysed the pattern of murders committed by Shipman.

They then chose an anaesthetist in the cardiothoracic department and a heart surgeon who had been working at the hospital for more than six years and had performance figures closest to the average for all staff at the hospital.

They inserted a similar pattern of unexplained deaths, as seen in the Shipman case, into their records.

This worked out at about 12 excess deaths over a period of 12 months at a rate of one a month.

Surgery quality

Information from these records are analysed by the clinical audit team on a monthly basis and results from the previous 12 months are scrutinised in detail.

The study found that once the death rates fell outside the tolerance zone for each, they would have been picked up by hospital monitoring systems.

This was at eight months for the heart surgeon and 10 months for the anaesthetist.

By this time a virtual Shipman surgeon would have killed eight patients and the anaesthetist 10 patients.

The hospital said it carried out the study to test the theory that what had happened at Shipman's single-handed GP's practice could not happen in a large and accountable hospital.

Co-author surgeon Sam Nashef said: "The system wasn't specifically designed to detect serial murders, but to assure the quality of our surgery service was maintained.

"Papworth has established targets for patient survival after heart surgery, based on patient profiles and the operations performed.

"It's these targets that would have been breached if the extra deaths had actually occurred."

'Angel of Death'

Hence the study does not separate excess death due to malicious intent from human error.

Consultant cardiothoracic anaesthetist Dr Joe Arrowsmith said the excess deaths were picked up in a shorter time than expected and that suspicions would have been raised long before.

"Had the surgeon been focussing on high risk patients it would have been longer.

"It's about the time it takes to identify that there's a problem not necessarily who is responsible for it.

"If you look at the Beverley Allitt case - it was about converting people's suspicious into actions that was the key thing."

Disappointment

The nurse nicknamed the Angel of Death killed four children while she worked as a nurse at Grantham Hospital.

The inquiry into the Shipman murders, headed by High Court Judge Dame Janet Smith, recommended a national system for monitoring mortality rates at GP surgeries.

It suggested primary care trusts should review dead patients' medical records.

But recently Dame Janet told a Royal Society of Medicine conference that she was disappointed by the lack of progress over drug controls and checks on doctors' competence.

'Not realistic'

The Department of Health said the NHS used more than just death rates to monitor staff.

A spokeswoman said it was only possible to detect medical incompetence or deliberate harm by looking at different sources of information - not just death rates.

"This is not a realistic trial as it only refers to mortality rates, which are only one form of data that can be used to monitor situations like this.

"Small increases in mortality rates need several months before they become statistically relevant," she added.

Solicitor Ann Alexander who represented over 200 families of the victims of Harold Shipman and a number of families of the victims of Beverly Allitt said the study showed hospitals are still not picking up patterns of serious concern until it is too late.

"It is completely unacceptable that doctors and nurses who are intentionally harming patients are not being noticed until it's too late."