Reports > The Fourth Report > SUMMARY >
Shipman's Use of Pethidine in the 1970s
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In March 1974, Shipman entered practice as a GP in Todmorden, West Yorkshire. Within a short time, he began obtaining large quantities of pethidine from Boots the Chemists (Boots) by presenting requisitions or signed orders for the drug. He told the pharmacist that the drugs were required for use in the practice. He also began to issue NHS prescriptions for pethidine in the name of an elderly patient who lived on the outskirts of Todmorden. Shipman presented these prescriptions and collected the drugs, saying that he would deliver them to the patient. In fact he kept the pethidine, or most of it, for himself. In early 1975, inspectors from the Northern Regional Office of the HODI, examining the records of a wholesale supplier, noticed unusually large deliveries of pethidine to Boots, Todmorden. The Boots CDR showed to whom it was being supplied. In July 1975, two HODI inspectors and an officer of the West Yorkshire Police (WYP) interviewed Shipman and inspected the practice's controlled drugs stock and CDR. There was no pethidine in stock. It was found that Shipman had entered the amounts of pethidine obtained into the CDR but had made no entries in the 'drugs supplied' pages and had not, therefore, accounted for the removal of the drug from stock. Shipman claimed that he did not know that this was required. The HODI inspectors advised Shipman as to his duties and resolved to keep watch on his activities. Shipman continued to obtain pethidine on requisition and by collecting supplies dispensed against prescriptions issued by him in the names of patients. After a short while, his partners were informed; Shipman admitted that he had been using the pethidine himself. It emerged that, since the visit of the HODI inspectors in July, he had not made any entries at all in the practice CDR. |
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Shipman left the practice and, shortly afterwards, was admitted to a private hospital for treatment for addiction. While there, he was interviewed by a HODI inspector and the police. He admitted obtaining pethidine on requisition and by the improper use of prescriptions. He said that the patients for whom he had prescribed pethidine had received small amounts of the drug but that he had kept most of it himself. In fact, during a period of about 18 months, he had used over 83,000mg of pethidine. There is no evidence that Shipman used pethidine to kill patients, and I think it highly improbable that he did. In the First Report, I found that, while working in Todmorden, Shipman had killed one patient, probably using a strong opiate such as morphine or diamorphine. I was suspicious that he might have caused the deaths of six others. |
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At the end of 1975, Shipman left hospital and early the following year found employment with the Durham Area Health Authority (AHA) in the field of child development. In February 1976, he pleaded guilty at the Halifax Magistrates' Court to eight offences of unlawful possession of pethidine, obtaining pethidine by deception, and forgery. He asked to have 74 similar offences taken into consideration. He relied on two psychiatric reports from doctors who had treated him. These said that he had undergone treatment for addiction to pethidine and had responded well. He was fined and ordered to pay compensation and costs. |
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Shipman's convictions were notified to the General Medical Council (GMC), the doctors' regulatory body, so that it could consider disciplinary proceedings. The procedure at that time was for the circumstances to be considered by the Penal Cases Committee, which would decide whether the case warranted referral to the Disciplinary Committee on a charge of serious professional misconduct. If Shipman were to be found guilty of such misconduct, the GMC had the power to erase him from the register of medical practitioners or to suspend him for a period of up to a year. It had no power to impose conditions on his registration. The GMC obtained information about Shipman from the HODI and the WYP. Shipman's solicitors supplied copies of the two psychiatric reports prepared for the Magistrates' Court and an up to date report describing his recent progress. This expressed the view that it would be 'catastrophic' if Shipman were not allowed to continue in practice. A letter from the Area Medical Officer of the Durham AHA reported that Shipman was doing well in his new post. On 28th April 1976, the Penal Cases Committee of the GMC decided not to refer his case to the Disciplinary Committee but concluded it with a warning to him against any repetition of his conduct. So far as the GMC was concerned, Shipman was free to practise medicine unrestricted. I shall consider the appropriateness of the GMC's decision in the Fifth Report. |
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Under section 12 of the MDA 1971, the Home Secretary had (and, in theory, still has) the power to make a direction restricting the right of any doctor convicted of offences under the Act to possess, prescribe, supply or administer any controlled drug. Until 1976, this power was regularly used in cases such as Shipman's. Before deciding whether to invite the Home Secretary to make a direction, Home Office officials would consult with the GMC and with the Department of Health and Social Security (DHSS). They did so in Shipman's case. It is not clear whether the DHSS responded; if it did, its response has been lost. The GMC responded by telling the Home Office that Shipman's case had been concluded. |
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At about this time, it appears that there had been a change in policy within the Home Office as to the type of circumstances in which a direction under section 12 might be made. Previously, directions had been made in cases, such as Shipman's, where the doctor was addicted to a drug and had committed offences in the course of obtaining supplies for self-administration. For reasons that are now obscure, in about May or June 1976, it was decided that the Home Secretary would be invited to make a direction only where a doctor's offences involved supplying a controlled drug to someone else or allowing it to be so supplied. Shipman may have been the first doctor to benefit from this new policy. On 1st July 1976, Home Office officials decided not to invite the Home Secretary to consider making a decision in Shipman's case. His file was closed and he was free to practise medicine without restriction or supervision. I have concluded that no criticism should attach to the Home Office officials for this decision, which was made in accordance with the policy of the day. That policy did, however, leave a lacuna in the power of the authorities to protect patients from a drug-abusing doctor. |
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Pethidine and Diamorphine
