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The Shipman files Monday, 31 January, 2000, 16:44 GMT
How could this happen?
Shipman got away with forgery, drug abuse and murder
By social affairs editor Niall Dickson

No system of safeguards can ever guarantee success in the face of evil and cunning, and Harold Shipman had more than enough of both these qualities.

It is also fair to say that as a doctor he was trusted instinctively, not just by his patients but by colleagues and by those who were initially brought in to investigate concerns about what was going on at his practice.

Yet it is clear that for many years Harold Shipman succeeded in killing his patients with impunity and in a way which suggests serious flaws in the systems that should protect patients from unscrupulous doctors.

The first offence

It was back in the 1970s that the first clues emerged that this was no ordinary respectable GP - Shipman's partners became suspicious at the number of prescriptions he was writing for the morphine-like drug pethidine. When they confronted him he admitted he had a drug habit and that he had been writing out false prescriptions for patients who did not need the drug and then stealing it for himself.

He was asked to leave the practice and was convicted of eight charges of obtaining drugs by forgery and deception - he asked for more than 70 other offences to be taken into account. Here on the police files was evidence that Shipman was capable of falsifying medical documents and of stealing drugs.

The General Medical Council
Marie West was murdered back in 1995
His case was also sent to the General Medical Council, the body set up by parliament to keep a record on every doctor and to protect the public from wicked, incompetent or dangerous practitioners.

But the GMC took no action against Shipman - instead it sent him a stiff letter and left him to carry on practising.

Significantly, this decision meant that any employer or patient who asked about Shipman from then on would probably not have been told about his conviction. His secret was safe with the GMC.

The first investigation: March 1998

By the late 1990s, Shipman's past was forgotten and he appeared as the dedicated professional - if anything more caring than most. But then early in 1998, the local undertakes became suspicious at the number of his patients that were dying. What is more, they all seemed to be elderly women who were found sitting in their chairs, or lying fully clothed on their beds - unusual positions for people to die.

They were also concerned that Shipman appeared always to have visited the patients on the day they died.

Coincidentally, doctors at the neighbouring Brook surgery were becoming concerned at the number of cremation forms Shipman was asking them to countersign. When the undertakers voiced their worries, the doctors checked the book which lists all the cremation forms they sign. To their amazement they discovered that in 1997, 41 of Shipman's patients had died at home and were cremated - Shipman had about 3,500 patients.

The Brook practice had nearly 10,000 patients, yet had just 14 deaths at home over the same period covering both cremations and burials - in other words Shipman's death rate appeared to be nearly 10 times higher.

So concerned were the doctors that they referred the matter to the local coroner, who in turn called in Greater Manchester Police. The coroner asked the officers to be discreet because the neighbouring doctors did not wish Shipman alerted to the fact that they were suspicious. That investigation, however, failed to make even the most basic checks.

Police fail to check criminal record
Shipman was respected - here he wins an award for raising money for charity
But most amazing of all - the BBC has established - is that the officers failed to check whether Shipman had a criminal record.

Had they done so, they would have discovered that they were investigating a doctor who in the past had falsified medical documents and stolen quantities of a dangerous drug. But instead the police worked on the assumption that here was a highly respected professional who was loved by his patients.

What is more, they failed to carry out the other elementary check that anyone investigating a doctor would normally be expected to do - they did not ask the General Medical Council what was on his file. Nor did they interview all the doctors at the Brook surgery.

Neither Shipman himself nor relatives of his dead patients were contacted.

Instead the police went to the registrar of deaths and asked for details of all the recent deaths from Shipman's practice - the registrar was not able to locate all the files although the police assumed that he had.

The officers then asked the health authority to look through the medical notes of 19 patients who had died to see if there were any inconsistencies between the medical notes and the cause of death on the death certificate.

Extraordinary death rate

The health authority medical adviser who sifted through the notes did not know that the doctor whose notes he was examining had a record of forging documents - yet that is exactly what Shipman had done to cover his tracks, adding false illnesses afterwards to make the deaths seem more likely.

The health authority check did find that Shipman was not sending some patients to the coroner who should have been sent, but it did not reveal any sign of criminal wrongdoing.

But what of the extraordinary death rate? Somehow the health authority, the police and the coroner convinced themselves that this was explicable, although the truth was that they simply did not have the full information to hand.

Only after the second police inquiry which led to his trial for murder did it emerge that 85 more elderly women died in Shipman's practice in the mid 1990s than would have been expected.

Relatives of those patients who were murdered by Shipman after this first investigation will now want explanations as to why it was not more rigorous.

However, even if the police could have stopped Shipman a little earlier that still leaves the question of health authority supervision of family doctors, especially those like Shipman who practise on their own.

The local health authority

The local West Pennine Health Authority knew surprisingly little about the single handed GP in Hyde. Like its counterparts everywhere in the country it does not collect death rates by individual practice so it had no idea that something was amiss.

Nor did it know that five patients had died while actually visiting his surgery. Deaths in surgery are incredibly rare; had they known about the five deaths alarm bells would certainly have rung.

Indeed the authority did not even known about his criminal conviction - the checks made on him when he came to the area were the responsibility of his partners - when he set up on his own no further checks were made as he was an established figure in the area.

Since the health service was launched GPs have been independent contractors often left to their own devices - in that sense the supervision of Shipman or rather the lack of it was by no means unusual.

The fact that he was able to kill with impunity for so many years is an indictment of the systems that are supposed to protect patients - if confidence and trust in the medical profession is to remain, further safeguards will be essential.

Find out more about the Shipman murders

Trial and reaction

AUDIO VIDEO
See also:

31 Jan 00 | The Shipman files
31 Jan 00 | The Shipman files
31 Jan 00 | The Shipman files
31 Jan 00 | The Shipman files
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