Alan Freeman
With a report from Reuters

p. A1.

Killer MD's betrayal of trust was 'unparalleled in history'

MANCHESTER, ENGLAND — A judicial inquiry into one of the world's worst serial killers has concluded that British doctor Harold Shipman, a small-town general practitioner, murdered at least 215 of his patients during a 23-year period.

But the judge heading the inquiry still does not know what made him kill, or why he murdered his patients calmly and methodically in a betrayal of trust "unparalleled in history."

"Only he could answer that question, and at the moment it seems very unlikely he will," Judge Janet Smith said yesterday as she released a 2,000-page report on Dr. Shipman's crimes, adding that she doubts the public ever will know why he turned from healer to killer.

In her report, the judge said psychiatrists speculate that Dr. Shipman, who is serving a life sentence for killing 15 of his patients by lethal injection, may be a psychotic who had a need to control death.

"It is possible he might have experienced a 'buzz' of pleasure from association with death," the judge wrote. "It is also possible that death might have given him a sense of relief from some intolerable pressure or anxiety. In short, Shipman may have had a need to kill."

Dr. Shipman, a 56-year-old father of four, has not admitted his crimes and consistently refused to co-operate with police and psychiatrists.

The first stage of the inquiry, which included a year of public hearings, focused on examining hundreds of cases of patients who died while under Dr. Shipman's care and identifying those he murdered. The next phase of the inquiry will look at how public-health and police authorities failed to catch him at his deadly game until June of 1998, when he made a clumsy attempt to forge a will from a wealthy female patient he killed.

Judge Smith said it is clear that systems designed to safeguard against falsifying death certificates and allowing cremations that avoid the possibility of postmortems have failed. She said she will investigate why Dr. Shipman was allowed easy access to large doses of morphine, his preferred drug of death, after he was found guilty as a young doctor of forging prescriptions and abusing painkillers himself.

Judge Smith said that even saying he killed more than 200 people "does not fully reflect the enormity of his crimes," which are "unparalleled in history."

"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," the judge said, adding that it is "deeply disturbing" that it took so long for him to be stopped.

The findings confirmed Dr. Shipman as one of recent history's worst serial killers, on a par with Pedro Alonso Lopez, dubbed the Monster of the Andes, who was convicted of 57 murders in 1980 but is suspected of killing 300 girls.

Most of Dr. Shipman's victims were from the old mill town of Hyde, near Manchester. Most were elderly women, many in excellent health, whom he killed with lethal injections of morphine during home visits. His eldest victim was 93, the youngest 41. In Hyde yesterday morning, church bells were rung 215 times in their memory.

Though 171 of his victims were women, he also killed 44 men. Judge Smith said it was purely a question of opportunity. "In general, women live longer than men, so there are more elderly women than elderly men living alone."

In addition to the 215 cases Judge Smith determined to be "unlawful killing," she said there are 45 cases in which she has a "real suspicion" the doctor may have been responsible, but she could not find sufficient evidence.

In another 38 cases, dating from his early years of practice, there is too little evidence remaining to make a determination. In a further 394 cases, Judge Smith said there was compelling evidence of natural causes.

The pace of the killings began slowly. The first victim was Eva Lyons, a terminal cancer patient who died in March of 1975, after Dr. Shipman gave her an intravenous injection at her home in Todmorden, a town in Yorkshire where he first practised.

The killings continued after he moved to Hyde, and picked up their pace, particularly in the final years before he was uncovered. He killed 11 patients in 1994, 30 in 1995, 30 in 1996 and 37 in 1997. In the first three months of 1998, he killed 15. His method of operation varied little. He would visit an elderly patient at home by responding to a call to his office or arriving unannounced, purportedly to take a blood sample.

After ensuring the patient was alone, he administered a deadly dose of morphine or diamorphine. Frequently the victim, slumped in a chair, would be found by a neighbour or family member. When filling out the death certificate, he would describe the cause as a stroke, a heart attack or simply "old age." He would discourage the family from asking for a postmortem and encouraged cremation, to eliminate any evidence.

The report describes Dr. Shipman as aggressive, arrogant, conceited and contemptuous of those he considers his inferiors. He is "an accomplished and inveterate liar;" when discovered immediately after killing a patient, he would come up with a credible explanation.

The judge said she is convinced he would have continued killing if he had not attempted his "hopelessly incompetent" forgery of 81-year-old Kathleen Grundy's will, naming himself as her heir. The will aroused the suspicion of Mrs. Grundy's daughter, a lawyer, who went to police.

Judge Smith said she is not convinced the doctor simply was looking to snare Mrs. Grundy's fortune, noting that psychiatrists have determined it is not uncommon for serial killers to be detected because they call attention to themselves.

Dr. Shipman was well respected in Hyde, and residents were stunned when he was charged with murder. Like many of the victims' relatives, Jane Ashton-Hibbert — whose 81-year-old grandmother, Hilda, was killed by him in 1996 — said that even after he was arrested, she couldn't believe that "he done anything like that to my gran.

"He was a caring, trusting doctor," said Ms. Ashton-Hibbert, a 35-year-old housewife. "He was my doctor for 20 years."

Serial killers

• Ted Bundy: One of the most-studied serial killers, he stalked and killed at least 23 women across the United States during the 1970s. Executed in a Florida prison in 1989.
• Andrei Chikatilo: The Russian "Rostov Ripper," executed in 1994 for raping, killing and cannibalizing at least 52 people during the 1980s.
• Jeffrey Dahmer: Stabbed, mutiliated and cannibalized 17 young men in Milwaukee. Beaten to death in prison in 1994.
• John Wayne Gacy: Executed in 1994 for killing at least 33 boys and young men in Chicago in the 1970s.
• Luis Garavito: A Colombian serving an 835-year sentence for murdering 189 people during a five-year period that ended in 1996.
• Donald Harvey: A Cincinnati nurse's aide, serving life in prison after his 1987 conviction for murdering at least 23 patients.
• Javed Iqbal: A Pakistani sentenced to death in March 2000 for murdering at least 100 children.
• Pedro Alonso Lopez: An Ecuadorean in jail in Colombia. Convicted in 1980 of the rape and murder of 57 children, he is suspected of killing more than 300 in Colombia, Peru and Ecuador in the late 1970s.
• Charles Ng: On death row in California for torturing and murdering at least 11 people, possibly up to 25, at a remote cabin during the 1980s.
• Clifford Olson: Sentenced to life in prison in 1982 for the sex slayings of 11 teenagers in British Columbia.
• Anatoly Onopriyenko: A Ukrainian sentenced to death in 1999 for killing 52 people, including more than 40 slain in a five-month rampage.
• Gerald Stano: Executed in Florida in 1998 after he confessed to stabbing more than 40 young prostitutes and runaways during the late 1970s and early 1980s.