The deadly doctor
By tony leather, 23rd Mar 2011 | Follow this author
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Posted in WikinutGuidesHistory
He was one of those people that the generally public instinctively and regularly entrust with thier lives, yet his abuse of that tendency was deadly for some unfortunate patients
history
Somehow there is a gut feeling in people that the doctor is someone they can trust but for hundreds of patients at one practice in Hyde, England this was a fatal assumption. The question that begs to be asked is why Dr Harold Shipman ever reached the point where he could sentence and execute patients at will. He was a ‘former’ drug addict himself, after all.
He had only been working as a GP at a practice in Todmorden for one year when, in 1975, one of the reception staff noticed discrepancies in the dangerous drugs register at a local pharmacy. She told the senior partners in the practice. They knew Shipman as a confrontational and rude man but put this down to the epilepsy they thought him to suffer because of repeated blackouts.
Investigations proved that Shipman had been prescribing large amounts of pethadine – a morphine-like analgesic - that had not been given to patients as recorded but self administered by him. He was forced into a drugs clinic and dismissed from the practice. He was an addict. On release he was hired by the National Coal Board at Doncaster though a Home Office investigation continued into his numerous instances of prescription forgery.
In February 1976 Shipman pleaded guilty to eight specimen charges, with over sixty other charges being taken into consideration. Unbelievably, he was only fined six hundred pounds and ordered to pay compensation. The General Medical Council held that no lasting harm had been caused and because Shipman had been declared cured following his detoxification, he need not be struck off.
He declared his intention, at that time, never to carry controlled drugs again yet within two years was practicing in Hyde as if nothing had happened. It may seem startling, but he was able on one occasion in 1996 to obtain, in the name of a dying patient, enough diamorphine to kill 360 people.
If his patients knew that their own doctor had, in the course of his career issued over two and a half times as many death certificates as any other GP in the area they might feel a little uneasy about it, but it didn’t stop them staying loyal to him. The majority of those deaths involved elderly people because, after all, and old people are sort of expected to pop off at any time.
It’s both an amazing and sad fact that most people place implicit faith in their doctors, unaware that the system under which those GPs operate in the UK is in some respects so antiquated that it really does offer them an almost unlimited licence to kill, with little real chance of being found out.
Take the law on death certification as a prime example. This came onto the statute books in 1927 and is still in use today in its original form. Is it really any wonder that a man like Harold Shipman could act as judge and executioner for so many years when the rules governing his conduct were so lax?
When someone dies suddenly the doctor called out will be their own GP in most cases, though a deputy who has no knowledge of the deceased’s medical history can be used. The doctor confirms death and then has to certify the cause, putting a ring around one or more of the following on the death certificate
a. The certified cause of death takes account of information obtained from post-mortem.
b. Information from post-mortem may be available later.
c. Post-mortem not being held
d. I have reported this death to the coroner for further action
e. Seen after death by me
f. Seen after death by another medical practitioner but not me.
g. Not seen after death by a medical practitioner.
Shipman almost always ringed c and e, so that the coroner would not be involved. He could, as ridiculous as it seems, put ‘old age’ as a cause of death and indeed did so on 49 occasions. He should then – according to the 1953 registration act – ‘deliver the certificate to the registrar’ but in practice this is normally handed in a sealed envelope to a relative or the person making funeral arrangements.
The flaw in the system here is simply that, provided the doctor testifies to having attended the deceased in the previous fourteen days and provides an acceptable cause of death the registrar will see no need to refer the case to the coroner. They will accept that the doctor is telling the truth and process the document without question. Shipman therefore, like any other doctor, was free to make a mockery of the system by saying what he liked.
It is both frightening and fascinating to note that among his patients death tended to occur most often in the afternoon, was normally certified as heart conditions, stroke or old age and that Shipman himself was often present. Doctors are normally rarely resent at the deaths of patients yet he was the exception to the rule. Odd too that most of the deceased were cremated, but this did prevent the possibility of post-mortems.
Again, Shipman was playing the system here because it suited his evil purposes. Four forms need to be filled in. Form A by a relative – application to cremate – form B (certificate of medical attendant) by the certifying doctor – form C (confirmatory certificate) by another doctor. Here again standard practice falls down.
Most doctors will sign form C as a matter of formality without ever actually seeing the deceased. They simply don’t have the time but since they receive a standard fee of forty-five pounds sterling for their signature it’s easy to see why they would be prepared to take the certifying doctor’s word for the cause of death after phoning them for conformation of the details.
In Shipman’s case the form C doctor was almost always the late Dr Stella Brown, whom it later transpired never contacted any of the relatives of deceased persons as she by law ‘required’ to do. Most relatives had no idea that any doctor other than Shipman was involved and this same ignorance is the general rule.
Form F (Authority to cremate) is issued by the medical referee at the crematorium to be used. Normally a retired GP this person also receives a fee for each form they sign and it is rare indeed for them to refuse. These forms and checks are meant to be a safeguard but in reality provide no genuine protection at all.
Complaints procedures don’t really address the problem either because they are so time-consuming. Even with the new fast-track systems introduced in April of 2002 it can still take many weeks to get satisfaction, if ever and in the meantime doctors carry on regardless.
If you have a complaint you register it with your local area Heath Authority who will investigate it within six months of receiving the details. In theory the first step is a ‘local resolution’ which should occur within four weeks of the initial complaint. If this does not satisfy you then the case goes to an independent review board, which can also take many weeks to be set up and reach conclusions.
Three months might have elapsed before you find out that this board didn’t satisfy your questions so you then get referred to the Health Service Commissioner (Ombudsman) and they will take even more time to investigate. It’s easy to see how tangled in red tape you can become without ever getting an answer to your original query.
If you want to complain about a doctor you can go to he General Medical Council, although they do not investigate complaints of medical negligence or incompetence. For those you need to see the police or a solicitor. It seems that mountains of administrative obstacles need to be climbed any time you want to be heard and there is no sign that anyone wants to make any easier in real terms.
Shipman had, at the time of his discovery already been investigated by the police once. Staff at Massey’s undertakers became concerned, in 1997, about the seemingly large number of old ladies funerals they were performing connected with his medical practice. Doctors at the Brooke surgery – near to his – were also alarmed at the high death rates.
Shipman refused, citing doctor/patient confidentiality, to talk to the police in depth and they decided in the end that his patient mortality rate seemed ‘not unusual for the Manchester area’ and dropped the case, having nothing solid to go on. His killing spree went on unabated and he might never have been caught had he not made the basic mistake of becoming greedy for money. Forgetting his earlier convictions for forgery when he used his office machine to re-type the will of Kathleen Grundy was his undoing.
Even though this monster is now safely behind bars, serving fifteen life sentences for murder plus four years for forgery you can’t help but wonder if he is indeed unique, as a doctor, in his godlike attitude in his treatment of patients. Current thinking has it that he may well have disposed of as many as 1000 people over 24 years in practice.
It makes you shudder to think that, in England anyway, doctors are so over-burdened with work that nobody ever stops them to ask telling questions about the power they wield and how they use it. Shipman was only found out because he made a basic mistake that had nothing to do with his practising medicine. How many more might never be discovered? The system needs a major overhaul. Let’s just hope it comes in time.
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