Introduction

Mrs Irene Aitken died at her home, 19 Burkitt Street, Hyde on Monday, 31^st July 1995 at the age of 65. She had been a patient of Shipman since his arrival in Hyde in 1977 and had followed him when he moved to the Market Street Surgery. She thought very highly of him. He certified that the cause of her death was cerebrovascular accident due to hypertension.

In February 2000, following the publicity surrounding Shipman's convictions for murder, members of Mrs Aitken's family expressed concern to the Greater Manchester Police about the circumstances of Mrs Aitken's death. The police investigated the death and took statements from Mrs Mary Aitken, Mrs Aitken's sister-in-law and from Mrs Margaret May Freeman, a friend and neighbour.

Shipman was not prosecuted for causing Mrs Aitken's death but an inquest was opened and adjourned by the South Manchester Coroner on 18^th May 2001.

The Inquiry has taken statements from Mrs Freeman and Mr Edwin Aitken, Mrs Mary Aitken's son. Mrs Mary Aitken has died since making her police statement. The Inquiry has also had access to Mrs Aitken's general practitioner records and to appointments sheets, visits books and other practice documents for the relevant period. In addition, the district nurse diary for 1995 has been considered.

This decision has been written following consideration of the papers and without an oral hearing.

Personal Background

Mrs Aitken had a history of chronic hypertension dating back more than a decade prior to her death. In 1984, she suffered from a heart attack. In 1990, Mrs Aitken suffered a stroke, which left her with weakness on the left side. Her medical records show that she had high blood pressure on many occasions in the ensuing years. In April 1994, she was admitted to Tameside General Hospital suffering from progressive weakness of the left side and associated dizziness. She was also suffering from a chronic duodenal ulcer, thought to be related to her medication. After her discharge, she seemed to make quite good progress. Her speech and mobility improved. She had a course of physiotherapy at Tameside General Hospital, which was completed in December 1994. In that month, Mrs Aitken's husband died and thereafter she lived alone.

In February 1995, on outpatient review, she was walking with a stick but said she was 'fine'. Apart from raised blood pressure, there were no adverse clinical findings. She was to be seen again in four months' time. She continued to be well and, following review in June 1995, she was discharged back to Shipman's care. A few days later she fell and fractured her femur. She was admitted to Tameside General Hospital and made an uneventful recovery. She was discharged on 27^th July 1995, four days before her death.

The Events of the Days Leading up to Death

Mrs Aitken's name appears in the visits book for Friday, 28^th July and the entry records as follows:

According to the computerised medical records, Shipman visited Mrs Aitken on that day. The entry reads as follows:

A second entry for the same day records as follows:

Mrs Mary Aitken visited her sister-in-law on Saturday, 29^th July and Sunday, 30^th July 1995. She remembers that Mrs Aitken seemed well, considering that she had just been discharged from hospital. Her bed had been moved downstairs and her mobility was very restricted. Mrs Freeman also saw Mrs Aitken that Sunday evening and remembers that although she was weak, she was also mentally alert and generally quite well. Mrs Aitken was apparently happy to be home and was looking forward to regaining her strength and being able to go shopping again. The two ladies had dinner together. Mrs Freeman remembers Mrs Aitken saying that she had an appointment to see Shipman either on the Tuesday or the Thursday of the following week.

The Day of the Death

Mrs Mary Aitken told the police that she and her husband visited Mrs Aitken on the morning of Monday, 31^st July. She thought that they left at about lunchtime and that Mrs Aitken appeared to be well.

Mrs Freeman called at Mrs Aitken's house at around 11.30am to see if she wanted any shopping. She remembers that as she arrived, Mrs Mary Aitken and her husband, as well as an old friend of Mrs Aitken from Derbyshire, were leaving. Mrs Freeman had a cup of tea with Mrs Aitken and at about midday Mrs Freeman left to go shopping. She remembers that Mrs Aitken was weak from her stay in hospital but still very alert. Mrs Aitken asked Mrs Freeman to leave the front door open as it was a very hot day and she wanted air to circulate in the house.

When Mrs Freeman returned from shopping between one and one and a half hours later, she noticed that Mrs Aitken's front door was closed. This struck her as odd as Mrs Aitken had specifically asked her to leave the front door open and it was still a very hot day. Mrs Freeman went over to the house to investigate and through the window saw someone, whom she initially suspected to be a burglar. As she went to put her key in the front door, a man opened the door and seemed somewhat surprised to see her. He asked who she was and Mrs Freeman replied that she was a neighbour and asked Shipman what he was doing at the house. He introduced himself and said that, as it was lunchtime, he had thought he would call in to see how Mrs Aitken was.

From the front door, Mrs Freeman could see Mrs Aitken sitting in an armchair just as she had left her. She was still wearing the same day clothes and her eyes were open. When she spoke to the police in March 2000, Mrs Freeman said that she called out to her friend, who did not respond. Mrs Freeman tried to approach Mrs Aitken but Shipman stopped her and said, 'She's taken a turn for the worse' and then something like, 'She has just gone' or, 'She's on her way out'. He then walked over to Mrs Aitken, lifted her wrist and took her pulse. Shipman said, 'She's gone'. Mrs Freeman was very shocked. Mrs Aitken did not look as though she were dead. Mrs Freeman asked Shipman if he was sure. Shipman told her that he must telephone the coroner. She heard him speaking about Mrs Aitken on the telephone. He asked her questions about Mrs Aitken's age and the identity of her relatives. Shipman also telephoned Mrs Mary Aitken and her husband, who both came to the house soon afterwards.

In her Inquiry statement, made in September 2001, Mrs Freeman gave a very slightly different account of her meeting with Shipman. However, the essentials are the same and the differences are no more than I would expect where a witness tries to remember a very shocking event some years later. On this occasion, Mrs Freeman recalled that Shipman was very 'matter of fact' and showed no sympathy or other emotion.

Mrs Mary Aitken remembered that soon after she and her husband had arrived home, there was a telephone call from Shipman. He did not immediately tell her that Mrs Aitken was dead but that she was 'taking a turn for the worse'. The Aitkens went straight over to the house where they found Shipman and Mrs Freeman. Mrs Mary Aitken remembered Shipman saying, 'I'm sorry there was nothing I could do. She had a final stroke'. He went on to say that he had been passing Mrs Aitken's home, thought he would call in and see her and she had suffered a stroke whilst he was there.

Mr Edwin Aitken has given an account of these events, based on what he was told by his father, which is broadly consistent with the account given by Mrs Mary Aitken. He remembers that his parents were pleased that someone had been with Mrs Aitken when she died.

Although the telephone billing records are available for the relevant period, only calls costing more than 40 pence are itemised so it cannot be confirmed at what time Shipman called the coroner or Mrs Aitken's brother and sister-in-law. The records show that at 2.04pm, a telephone call lasting 8 minutes 37seconds was made to a number in Tyneside. At 3.49pm, a call was made to a number in Stoke-on-Trent, lasting 7 minutes 11 seconds. At 5.27pm, the number in Tyneside was called again, this time for 5 minutes 14 seconds. Mr Edwin Aitken cannot remember to whom these calls were made.

The final entry in the computerised medical records is dated 31^st July 1995 and records as follows:

I interpret this to indicate that Shipman attended at Mrs Aitken's house and found, on examination, that she was dead. He seems to suggest that a neighbour had found the body at 3.30pm. He attributed the death to a stroke due to hypertension.

Certification

Shipman completed the Medical Certificate of Cause of Death (MCCD), saying that he had last seen Mrs Aitken alive on the day of her death. He said that a post-mortem examination would not be held and that he had seen the body after death. The cause of death was certified as cerebrovascular accident and the approximate interval between onset and death was said to be two hours. The stroke had been due to hypertension, from which Mrs Aitken had suffered for 11 years.

Shipman also completed cremation Form B. The time of death is said to have been '15.30hrs', which is later than suggested by the witnesses or the telephone record. Shipman said that he had attended Mrs Aitken for 30 minutes during her last illness. He said that he had last seen her alive immediately before death and had seen and examined her body immediately after death. The cause of death was as stated on the MCCD and the mode of death was said to be collapse lasting 'no more than 2 hours'. When asked to what extent his answers relating to the cause and mode of death were based on his own observations or on statements made by others, he did not answer the question but wrote: 'neighbours/self'. Shipman claimed that both he and a neighbour were present at the moment of death.

Shipman correctly stated that within the last 12 months Mrs Aitken had undergone an operation at Tameside General Hospital for pinning of the left femur. In response to question 16, as to whether there was any reason to suspect that the death of Mrs Aitken was due directly or indirectly to violence, poison, privation or neglect, Shipman answered in the negative and then added:

The Expert Evidence

Professor Richard Baker concluded that the death of Mrs Aitken was highly suspicious both on the basis of his consideration of the medical records and his separate consideration of the cremation forms. He commented with regard to the medical records:

Conclusion

There are several suspicious circumstances surrounding this death. The first and most obvious is that it took place in Shipman's presence. Dr John Grenville, in his generic evidence, has advised that it is extremely unusual for a patient to die during a routine visit of a general practitioner, where the patient is not terminally ill and the doctor has not been called out in an emergency, following the onset of acute symptoms indicating, for example, a heart attack or stroke. Mrs Aitken was not suffering from a terminal illness. Nor did Mrs Aitken need to see a doctor on account of any symptoms. Shipman was not called out to her at all that day. He made a wholly unsolicited visit. It would be too much of a coincidence that Mrs Aitken should have begun to suffer a stroke shortly before Shipman happened to visit, so that he was in time to see her die. This single factor is enough to persuade me that Shipman probably killed Mrs Aitken.

Mrs Aitken had a history of strokes and was certainly at risk of suffering another, possibly fatal, episode. A fatal stroke can occur without any warning. However, Shipman did not claim that Mrs Aitken had had a sudden fatal stroke. He claimed that her stroke had begun about two hours before death and progressed to death, following a period in a coma. However, the timing of other events do not fit with Shipman's claims. Mrs Aitken was observed by a number of people to have been well on the day of her death. Mrs Freeman last saw her at about midday and although she was weak following her spell in hospital, she was mentally alert and did not complain of any specific illness. Shipman claimed that he was with Mrs Freeman for about half an hour before Mrs Aitken's death, which he said occurred at 3.30pm. Mrs Freeman believes that the death occurred between 1pm and 1.30pm. Mrs Aitken thought that she received news of the death just after lunchtime. The first of the long telephone calls took place at 2.04pm. I think it highly likely that this telephone call was made to break the news of the death to a friend or member of the family. On Shipman's account, Mrs Aitken would have been lying alive but comatose in her house. I am satisfied that Shipman has pretended that the death occurred later than it did, probably because either Mrs Freeman or Mr Aitken and Mrs Mary Aitken told him when they had last seen Mrs Aitken alive and well.

Shipman's conduct that day does not accord with what any reasonable and competent general practitioner would have done if he had found his patient suffering from a stroke. In his generic evidence to the Inquiry, Dr Grenville said that where a stroke due to subarachnoid haemorrhage is suspected, the patient should be admitted to hospital for possible neurosurgical intervention. As to an occlusive or haemorrhagic stroke, Dr Grenville said that the decision to admit a patient to hospital depends on the severity of the stroke and the wishes of the patient or those close to her. As Shipman claimed that Mrs Aitken was in a state of collapse, she would not have been able to give any instructions as to whether she wished to be admitted to hospital. It would, in any event be very difficult to diagnose a cerebrovascular accident in a patient in a state of collapse. However, it must be accepted that if Shipman had found Mrs Aitken collapsed, it would be reasonable to assume she had probably had another stroke. In any event, Shipman should not have done nothing for half an hour. He should either have summoned an ambulance or have tried to contact a friend or relative. There is no evidence that he did either.

On Form B, Shipman claimed that Mrs Freeman was present at the moment of death. It is possible that she was, in that Mrs Aitken might still have been just alive when Mrs Freeman arrived. However, Shipman's statement on Form B is clearly misleading as it gives the impression that Mrs Freeman was present during the process of death and was able to give Shipman relevant information about the mode of death. I am quite sure that Shipman wished to create the impression that he was not alone with Mrs Aitken throughout her death, as was in fact the case.

Mrs Aitken's position and appearance in death were not typical of those seen following a death due to a stroke. On the other hand, they are entirely typical of the position and appearance of many of Shipman's victims who had been killed by lethal injection of opiate.

This case has Shipman's hallmark on it. All the evidence suggests that Shipman killed Mrs Aitken. I am sure that he did, almost certainly by administering a lethal injection of opiate, under the guise of taking a blood sample or giving some therapeutic treatment.