Introduction

Mrs Lizzie Adams died on 28^th February 1997 at the age of 77. She was a widow and lived alone.

Personal Background

She had been a professional ballroom dancer and was still keen on dancing. For her age, she was physically very fit. On 26^th February, she had returned from a holiday in Malta with a group of friends, including her dancing partner. She had a cold and a cough. On 27^th February, she spent the day shopping in Stockport with her daughter, Mrs Doreen Thorley. By the end of the day, she was tired and a little troubled by her cough. At 4pm, Mrs Thorley collected a prescription for an antibiotic (Ceporex) from Shipman's surgery, had it dispensed and took it to her mother.

The Circumstances of the Death

The following morning, Friday, 28^th February, Mrs Adams told Mrs Thorley that the antibiotic had 'nearly blown her head off'. On her daughter's advice, at 12.10pm, Mrs Adams telephoned the surgery. A note made by the receptionist on the visits request form recorded that Mrs Adams felt dizzy, sick and wobbly and wanted a visit. During that morning, Mrs Adams washed some clothes by hand and hung them out on the washing line. She also partly cooked her evening meal. When Shipman arrived at the house, in the early afternoon, the ironing board and iron were set up in the kitchen ready for use.

In the mid-afternoon, Mr William Catlow, a friend of Mrs Adams, arrived at the house. He found the door unlocked and Shipman in the front room looking into a china cabinet. Shipman told him that Mrs Adams was ill and he was sending her to hospital. When Mr Catlow reached her, he found Mrs Adams apparently asleep in her chair. He took her hand, which felt warm. He said to Shipman, 'I think she's fainted'. Shipman came over and said, 'She's gone'. He said he would cancel the ambulance. There was no medical examination.

Shipman telephoned the Thorley home and, according to Mr Thorley, said that he had ordered an ambulance to take Mrs Adams to hospital. Shipman then telephoned Mrs Thorley at work and said her mother had to go to hospital. He did not say she was dead. Mrs Thorley went quickly to her mother's home where she found her mother in her chair, with her legs crossed in a comfortable way. Shipman told her that her mother had died of pneumonia. He was very abrupt with her. He told her there was no need for a post-mortem examination, as he had been present at the death.

The Defence Case

Shipman's account, which the jury must have rejected, was that, when he arrived in the early afternoon, Mrs Adams was obviously poorly. She came to the door slowly to let him in. She led him back into the living room at the rear of the house. She said that she was breathless, she felt unwell and had a cough. On examination he found that her heart was racing. She was clammy to touch and looked pale. On listening to her chest, he heard fine crackles. Her lips were slightly blue. He thought she had bronchopneumonia in both lungs. He told her she should be in hospital. She said she had been just as ill as this on other occasions and had stayed at home. At her suggestion, he went into the front room to find a telephone to speak to Mrs Thorley. While he was there, Mr Catlow arrived. Shipman explained the situation and said that he was about to telephone the daughter, as Mrs Adams ought to be admitted to hospital. After a few seconds, Mr Catlow called him into the living room and said that Mrs Adams was not very well. He carried out a full external examination and concluded that she had died. He thought the cause was bronchopneumonia. He explained to Mr Catlow that he could not resuscitate her on account of the infection. He summoned Mrs Thorley and, when she arrived, he gave her a full explanation of what had happened and asked her if she wanted a post-mortem examination. She did not.

The following day, Mrs Sonja Jones, Mrs Adams' other daughter, went to see Shipman. He gave her an account which tallied with his evidence to the court save that she claimed that he told her he had telephoned for an ambulance and had cancelled it later after Mrs Adams had died. It was admitted at trial that no call was made from the house to the ambulance service. Shipman denied ever having said he had called for or cancelled an ambulance. Mrs Jones also claimed that she asked Shipman whether there should be a post-mortem examination in view of the suddenness of the death but he said it was not necessary. That was also disputed.

Certification

Shipman signed the Medical Certificate of Cause of Death (MCCD), saying that the cause of death was bronchopneumonia of 12 to 24 hours' duration. He completed cremation Form B saying that death had occurred at 14.50, some 50 minutes after his arrival. He said that a neighbour (Mr Catlow) was present at the death. He certified that he carried out a complete external examination. In evidence, he claimed that he undertook a modified external examination, which included looking at the pupils, the retina and listening to the heart through Mrs Adams' clothing. Mr Catlow said that no examination at all was carried out at that time.

The Expert Evidence

Dr John Grenville examined the medical records. On the visits request form, Shipman had written:

There was no reference to any proposed treatment or to calling an ambulance or to the death. The computerised records contained entries made on the day after the death. They said:

Mrs Adams' Lloyd George records were found in Shipman's garage after his arrest. They showed that Mrs Adams had suffered from a number of chronic conditions, none of which was related to the death.

Dr Grenville said that the antibiotic, Ceporex, could cause stomach upset, dizziness and nausea. In his view, Mrs Adams' deterioration on the morning of her death was probably due to an adverse reaction to the antibiotic. It was possible that her chest infection had worsened but, as she did not complain to the receptionist of breathlessness or deterioration in her cough when she telephoned the surgery, that was unlikely. He said that Shipman's note of the consultation on the visits request form was consistent with a severe chest infection but he thought it very strange that the fatal outcome had not been recorded. He said that, if Mrs Adams had been as ill as Shipman claimed she was when he arrived, he should have sat her down in the front room and examined her there. If, as he claimed, he was out of the room when Mrs Adams 'fainted', he should have summoned an ambulance and tried to resuscitate her. Her chest infection would have been treatable. This was a sudden and unexpected death which should have been reported to the coroner.

Comment

The following significant points arise in this case:

• The death took place in Mrs Adams' home and in Shipman's presence. This is a factor which gives rise to a high degree of suspicion. A natural death at home during a doctor's visit is an extremely rare event in the experience of most general practitioners. If Shipman were to be believed, natural deaths occurred frequently during his home visits.
  
  
• The death was extremely sudden. As Dr Grenville has explained, death from bronchopneumonia is not as sudden as this. The patient is very ill for at least a few hours before death. Mrs Adams had been out shopping the previous day. That morning she had done her usual household jobs.
  
  
• Shipman's treatment of the condition he claimed to have found was inappropriate, according to Dr Grenville. If Mrs Adams had been truly as ill as Shipman later claimed, he should have summoned an ambulance immediately. If she had been unwilling to go to hospital, he should have spoken to Mrs Thorley. If Mrs Adams really had collapsed, he should have tried to resuscitate her. As it was obvious that he had not made any attempt to do so, he made an untenable attempt to justify his decision. He should have made a complete and thorough note of the consultation, Mrs Adams' reluctance to go to hospital, the steps he had taken in the face of that reluctance and the events leading to the death. He did not.
  
  
• Mrs Adams was found sitting in a chair as though asleep. This position and appearance are not typical of a death following bronchopneumonia but are entirely typical of those observed at the deaths of many of Shipman's victims.
  
  
• Shipman told others that the patient had been advised she needed hospital admission but that she was reluctant to agree. This is an explanation Shipman was to give on many other occasions.
  
  
• Shipman told others he had called an ambulance and cancelled it but no such call was made. At trial, he denied having said this.
  
  
• A witness says that Shipman did not carry out any examination to diagnose death whereas Shipman claimed he did. This is a feature common to many cases.
  
  
• Shipman's claim on cremation Form B that Mr Catlow was present at the death is misleading.
  
  
• Shipman claimed that he suggested a post-mortem examination but the witnesses said that Shipman told them this was not necessary. The death was not reported to the coroner although, as Dr Grenville said, such a report was plainly called for.