 The
fourth report of the Shipman Inquiry into the drug induced
multiple murders of a Manchester area GP was released
in Britain in mid summer. It suggested ways to improve
the system even though, as Judge Dame Janet Smith said,
"There is no easy way to prevent a doctor who is determined
to obtain illicit supplies of a controlled drug from doing
so." The report recommended that a multidisciplinary inspectorate
be set up to monitor and audit the prescription, storage,
distribution and disposal of controlled drugs.
Dr Harold Shipman killed more than
200 of his patients over a span of 20 years. Could this
gruesome scenario play out here, in our own backyard?
"Following the case where Nurse Susan Nelles was wrongfully
accused of killing four sick babies at Toronto's Hospital
for Sick Children in 1981, documentation of controlled
drug use was tightened up," says Dr Eric Wooltorton,
a GP in Kemptville, Ontario who makes home visits to
palliative care patients. "For example, in hospitals,
nurses have to witness and document the amount of a
controlled drug that's being 'wasted.' The rules for
monitoring these drugs vary from province to province.
There are limits to the amounts of a controlled substance
that a physician can possess and reorder. When palliative
care patients choose to die at home, morphine might
be used to treat them, but there's a loose monitoring
system in place. Physicians who self-prescribe are reported
and disciplined." Still, the cautionary tale of Dr Death's
extensive killing spree begs the question: Is this enough?
The arrest of Dr Shipman was long
in coming. Only when, 81-year-old Kathleen Grundy of
Hyde, Greater Manchester, died in 1998, leaving $750,000
to her physician, did Mrs Grundy's daughter, lawyer
Angela Woodruff, sense that something didn't quite add
up. For one, the death certificate simply listed the
cause as "old age." Further digging revealed a forged
signature on the crudely typed will. Her persistence
and keen eye for detail led to the arrest of the UK's
most prolific mass murderer � the 'good' Dr Shipman
aka Dr Death.
At the trial, the prosecution revealed
that Dr Shipman had visited Mrs Grundy, a healthy former
mayor, to take a blood test, but instead administered
a lethal dose of diamorphine. The doctor had murdered
15 other patients in a similar manner. Most victims
were elderly women, living alone. After sentencing him
to 15 life sentences, Justice Thayne Forbes said, "You
brought them death disguised by the attentiveness of
a good doctor." Impassive, Dr Death denied all charges.
Later, on January 13, 2004, the eve of his 58th birthday,
he hanged himself in his cell.
The Shipman Inquiry was headed
by high court judge Dame Janet Smith. The first report
concluded that he killed at least 171 women and 44 men,
aged 41 to 93, over a period of 23 years. The next two
reports criticized missed opportunities by police detectives
and advocated 'radical reform' of the coroner's system
where so many suspicious deaths by so-called 'natural
causes' were ignored.
Born in 1946 into a working class
family, Harold Shipman was 17 when he observed doctors
administering morphine to his dying mother � an incident
that may have inspired his infamous modus operandi.
Young Harold wanted to be a physician and was later
accepted into Leeds University medical school. At age
20, he married his then pregnant girlfriend. After graduating,
he worked briefly as a GP before moving to a group practice
in Todmorden, West Yorkshire. In 1975, he killed his
first victim without arousing suspicion. His practice
partners did discover, however, that he was addicted
to meperidine, which he obtained by using patient prescriptions.
He was fined, fired from the practice and sent for treatment.
In 1977, this 'Dr Jekyll' reemerged in Hyde as a GP
in a group practice, where over the next 16 years he
killed 71 patients. In 1993, he set up a private practice
in town, and by 1998 had murdered 143 more victims.
KILLING
ME SOFTLY
Shipman stockpiled diamorphine by overprescribing to
terminally ill patients and offering to remove the surplus
when they died. He retrospectively altered medical notes
of healthy patients so that they appeared to have had
serious medical problems.
The local undertaker, wondering
why so many of Shipman's patients died wearing street
clothes, had alerted the coroner. Physicians in a nearby
group practice, who had been called on to countersign
an unusually large number of cremation certificates,
had notified the police. Only when the forged will was
presented, however, were any warnings heeded.
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