'Whenever I go into a house, I will go to help the sick and never with the intention of doing harm or injury. If, therefore, I observe this Oath and do not violate it, may I prosper both in my life and in my profession, earning good repute among all men for my time. If I transgress and forswear this Oath, may my lot be otherwise.'
– From The Hippocratic Oath.

To the outside world, Harold 'Fred' Shipman was a caring, well-respected GP¹. In fact he was an arrogant psychopathic drug addict who was obsessed with death. His epitaph is that he is the world's most prolific multiple murderer²; with 236 unlawful killings (between 1971 and 1998) being the estimate of the Department of Health. He took the truth to his grave when he hanged himself in prison in January, 2004.

Early Life

The middle one of three children, 'Fred' was his mother Vera's favourite. She was quite dominant and over-protective, but Fred was devoted to her. When she fell ill with lung cancer, Fred became her primary carer while his father was at work. The family GP injected Vera with morphine for pain relief. Vera Shipman died aged 43 in June 1963, when Fred was just 17 years old. On the night she died, he went for a 20-mile run in the pouring rain³.

Medical Training

Shipman's first job was as a hospital intern, after he had completed a degree course in medicine at Leeds University medical school. He had not been an ordinary student: he never mixed socially, preferring his own company to the other students' bawdy games and nightlife. Instead he met a 'homely' girl named Primrose (the daughter of his landlord) who was three years his junior. Before long she was pregnant with their first child. A wedding soon followed and they settled into family life.

The Doctor

Shipman took up his first GP's position in the small Pennine town of Todmorden in 1974. He was one GP in a group practice, and when large quantities of pethidine⁴ were found to have been prescribed for patients (who had never previously been prescribed it nor had any need for it) by Shipman, he was reported to the senior GP and asked to account for it. Shipman confessed he had been taking the pethidine himself, but said he could give up his addiction if he was given another chance. The practice refused and Shipman ended up in a drug rehabilitation unit. He was fined £600 for forgery and prescription fraud but, tragically, he was allowed to continue practising as soon as he was discharged, supposedly cured of his addiction.

In 1977, he was taken on as a GP in a group practice, the Donneybrook Medical Centre in Hyde, Manchester. The trusted and respected doctor visited patients in their own homes, and they thought him attentive and wonderful; he was 'an old-fashioned doctor with the personal touch.' In 1993, after he fell out with his partners, he set up his own single-handed practice in the same town, boasting a patient list of approximately 3,000. His wife Primrose worked for him as a part-time receptionist. Shipman served on local committees, helped organise charity collections and donated prizes to the local rugby club.

When news of Shipman's arrest spread it came as a shock to many of his patients who had believed him to be an excellent GP. This was why those in the community didn't notice anything amiss for so long (until a GP in a neighbouring practice pointed out the rather odd death rates under his direct care).

Suspicions

The Last Victim, Her Daughter and the Will.

Kathleen Grundy, a former Mayor of Hyde, died aged 81 on 24 June, 1998. Shipman talked Mrs Grundy's only daughter, Mrs Angela Woodruff, out of requesting a post-mortem examination as he had seen her just before she died when he 'took blood samples'. He tried to persuade her to have her mother cremated but she refused and Kathleen was buried in the town's cemetery. Her body was the first to be exhumed⁵.

Mrs Grundy had left a will of £386,000 to one beneficiary: 'My doctor' — Harold Shipman. Mrs Woodruff, a solicitor, was convinced the doctor had forged the will (which was typewritten⁶) and murdered her mother to gain financially. Stored at her own law firm was her mother's previous will, written in 1986. Mrs Grundy had been a devoted grandmother and she would not have disinherited her grandsons.

Mrs Woodruff showed the suspected forged document to the police. There were spelling errors and bad grammar in the will, which was not consistent with the well-educated and articulate Mrs Grundy. An investigation was launched in secrecy, as Shipman was well-liked and a respected member of the community. This was when the taxi driver came forward with his list.

The Taxi Driver

During the 20 years that Shipman was a GP in Hyde, a local taxi driver, John Shaw, noticed that he was losing a lot of regular customers, and they were all patients of Harold Shipman. This worried him so much, he started making a note of all the deaths.

He took one customer to the surgery for an appointment with the doctor. This apparently healthy lady died in Shipman's surgery, straight after he'd dropped her off. When the taxi driver heard this shocking news, he showed his list to his brother-in-law, a local policeman. Shipman was already being investigated for another matter⁷, but the list came in very handy for the subsequent police investigation.

Mr Shaw had not voiced his suspicions publicly because he thought nobody would believe him. Also his wife warned him that if he spoke out and were to be proved wrong, he could be sued for libel.

The Undertaker

A female undertaker became alarmed at her colleagues' references to the phrase 'another one of Shipman's'. The doctor's patients seemed to have a certain modus operandi in that they were all found in the same way. They were all dressed, relatively healthy, and death was sudden and unexpected. When she voiced her concerns to her peers they were ignored and she was warned not to go public for fear of liability.

Arrest, the Trial and Outcome

The Police

We discovered that he had altered medical records, but he failed to take into account the fact that there was an audit trail in there [his computer], which our experts actually found.
– Detective Chief Inspector Mike Williams

The Coroner

In a Coroner's job, we have to order exhumations maybe once a year. They are quite rare things. During the investigation I had to order twelve exhumations in a year. It was quite unheard of.
– Dr John Pollard

Shipman was arrested for the murder of Kathleen Grundy on 7 September, 1998. The trial started at Preston Crown Court on 5 October, 1999, where he was accused of killing 15 patients. The jury convicted Shipman on 15 counts of murder on 31 January, 2000 and he was sentenced to life in prison.

The next day, the Health Secretary, Alan Milburn, launched an inquiry into the case. The inquiry opened in Manchester in June 2001, chaired by High Court judge Dame Janet Smith DBE. The first part concluded that Shipman killed at least 215 of his patients, both men and women, ranging in age from 41 years to 93 years. There was quite serious suspicion about the death of Susan Garfitt, who was aged only four years. Possibly his youngest victim, Susan was in hospital and her mother had expressed a wish [to Shipman] that she hoped her daughter wouldn't suffer. When the mother returned from having a cup of tea, the child had died.

Shipman was found to have murdered three people on consecutive days. At the time of his arrest, he had been killing, on average, one person a week. Dr John Pollard, a local coroner, estimated 1,000 patients had been murdered by the doctor during his 30-year career. He showed no remorse for his actions, in fact he had taken morbid pleasure in comforting the bereaved families.

The way in which Shipman could kill, face the relatives and walk away unsuspected would have been dismissed as fanciful if it had been described in a work of fiction.

Each of your victims was your patient. You murdered each and every one of your victims by a calculating and cold-blooded perversion of your medical skills. For your own evil and wicked purpose, you took advantage and grossly abused the trust each of your victims put in you. I have little doubt each of your victims smiled and thanked you as she submitted to your deadly administrations. None of your victims realised that yours was not a healing touch.

Why Did Shipman Commit Suicide?

Harold Frederick Shipman hanged himself in his prison cell on the eve of his 58th birthday. His motive for suicide is not known for sure, although he knew he was incarcerated for the rest of his life with no hope of parole. He had been stripped of his NHS pension but knew that his wife, Primrose, would be entitled to a lump sum (reportedly £100,000) and a pension for life, should he die before the age of sixty. An inquest jury concluded, after reviewing all the evidence, that Shipman had killed himself because he could not cope with spending his remaining days behind bars.

Shipman was an arrogant man used to having control over life and death. He had been a respected member of society enjoying a powerful position of authority. Although he never admitted his guilt and did not co-operate with the police investigation, he knew he was at risk of revenge attacks from other prisoners. This restrictive environment was something he couldn't control, the only thing left was his own destiny. In taking his own life, the ultimate act of control, he was escaping from the confinement he found himself in, and rewarding his wife for her loyalty.

Primrose Shipman

The mother of four steadfastly believed her husband to be innocent, and stood by him throughout the investigation, trial and verdict. She visited him in jail, did not co-operate with the police and adamantly refused to be interviewed by the media. Shepherded by her son to and from the court, she gave evidence at the inquiry, but her answers were those of a hostile witness, such as I don't know and I don't remember.

On at least two occasions, Mrs Shipman gave her husband a lift to visit patients (at their own homes) who subsequently died. She was also present (in her working capacity as receptionist) when one patient died⁸ in the doctor's surgery.

After the investigation ended, Mrs Shipman unsuccessfully appealed for the return of jewellery⁹ which had been removed from her home as evidence. Some of the items have since been claimed by relatives of Shipman's victims, and an Asset Recovery Agency are trying to reunite the rest with their rightful owners.

After his death, Mrs Shipman wanted to bury her husband, but the police wouldn't allow this due to the obvious risk of desecration. Due to her stubborn refusal to have him cremated, Shipman's body remained in the morgue for over a year, at a cost (to British taxpayers) of over £1,000 a week. He was finally cremated on 19 March, 2005.

Mrs Shipman was the sole beneficiary of her husband's will. He left around £24,000. She now lives as a virtual recluse in relative comfort due to the generosity of the widow's pension.

The Shipman Effect

Although medical schools have fallen short of actual psychological profiling of students (which wouldn't reveal much other than that medical students are a little bit more obsessive-compulsive, and more icky in the 'clinical distance' sense, than the other students), all medical students starting from the new academic year will have had to submit a Criminal Record Check to the medical school (again, more of an illusion of security, as the vast majority will not have a criminal record), along with their Hepatitis B status¹⁰.

In New Zealand, one direct result has been the (shortly to be introduced) Peer Review System for GPs, where each year ten patients and six professional associates will be asked by an independent body to fill out a questionnaire about every GP's competency, manner and so on. One of the stated reasons was that Harold Shipman's fellow GPs and medical staff were suspicious of him, but never acted.