Introduction

Mrs Sarah Adkinson died at her home, 16 Strines Court, Hyde on Thursday, 2^nd August 1979 at the age of 76. She was a patient of Shipman and thought very highly of him. He certified that the cause of her death was carcinomatosis due to carcinoma of the stomach.

The Inquiry has taken a statement from Mrs Anne Ottridge, Mrs Adkinson's niece, and has also had access to Shipman's visits book for 1979, the copy entry in the register of deaths ('death certificate') and the counterfoil to the Medical Certificate of Cause of Death (MCCD). Mrs Adkinson's medical records have not survived.

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

Personal Background

Mrs Adkinson was a widow who, at the time of her death, was living alone in her first floor flat. She had been a very fit woman, with a wiry build. According to her niece, she enjoyed very good health until shortly before her death. Not long before her death, probably in 1978, she spent six months in Australia. She was not well on her return and was referred to Tameside General Hospital. She told her niece that she had been diagnosed as suffering from a bleeding ulcer. In view of the cause of death which Shipman was later to certify, it is possible that she was found to have cancer of the stomach. It may be that she was not told the true diagnosis or it is possible that she was, but chose not to pass on the information to her niece.

In the early summer of 1979, Mrs Adkinson spent two weeks with Mrs Ottridge and her husband at their home in Buckinghamshire. She seemed well during that visit and had a good appetite. Following that visit, Mrs Ottridge did not see her aunt for some time, but they spoke regularly on the telephone. Mrs Adkinson did not mention any health problems, but Mrs Ottridge says that she might well have denied having a problem even if she had one.

In July 1979, about three weeks before she died, Mrs Adkinson travelled to Buckinghamshire by train to visit Mrs Ottridge. Unfortunately, Mrs Adkinson did not have the strength to open the carriage door when the train arrived at Watford Junction station where she was due to disembark. The train left Watford with Mrs Adkinson still on board and took her to Euston station. Mrs Adkinson was there put on a northbound train and eventually arrived in Watford. Mrs Ottridge recalls that her aunt looked 'terrible'. She had lost a lot of weight since the early summer and she was very frail and required assistance with washing and dressing. Although she was able to walk, she could not climb the stairs unaided. During her three day stay with her niece, Mrs Adkinson did not eat, which was in complete contrast to her previous visit. Mrs Adkinson had brought with her a letter from Shipman addressed to Mrs Ottridge's general practitioner. Mrs Ottridge passed this letter to her doctor who put the letter in the bin and instructed Mrs Ottridge to take Mrs Adkinson back to Hyde as soon as possible. Mrs Ottridge did as she was told. No explanation was apparently requested or given.

The Events Leading up to Death

Mrs Adkinson's name appears in Shipman's visits book for 24^th July, 30^th July and 31^st July. This suggests that Mrs Adkinson's health was deteriorating.

A few days before her aunt's death, Mrs Ottridge received a telephone call from her sister, Mrs Irene Porter, who lived in Hyde. Mrs Porter told her that Mrs Adkinson was ill. Mrs Ottridge travelled to Hyde on 1^st August and arrived at Mrs Adkinson's flat during the afternoon. She found her aunt lying in bed, unconscious.

Mrs Porter told her sister that, when she had arrived at the flat that morning, one of Mrs Adkinson's neighbours told her that the doctor had been. Mrs Porter found her aunt sitting in a chair, obviously very ill. Mrs Adkinson was still well enough to tell Mrs Porter that the doctor had called. She said nothing about being given an injection. Mrs Porter put her aunt to bed and shortly afterwards Mrs Adkinson lapsed into unconsciousness.

The evidence that Shipman called to see Mrs Adkinson on the morning of 1^st August is not supported by the available documentary evidence. Mrs Adkinson's name does not appear in Shipman's visits book. However, that does not mean that the visit did not take place. I have the impression that Shipman used his visits book as an aide-memoire to remind him of the patients he had to see on his regular rounds. If he was called out in an emergency, the patient's name might well not appear.

That night, Mrs Porter slept in her aunt's room whilst Mrs Ottridge slept on the settee in the sitting room. When Mrs Ottridge awoke at about 7.30am, she found that her aunt had died. On her evidence, her aunt must have died during the night because otherwise her sister, and quite possibly Mrs Ottridge herself, would have noticed that Mrs Adkinson was already dead when they prepared to settle down for the night. It is evident that Shipman had not visited during the time that Mrs Ottridge was with her aunt.

Shipman was contacted soon after the death was discovered. He came to the flat and confirmed that Mrs Adkinson had died. Mrs Ottridge told Shipman that she felt that Mrs Adkinson had waited for her to arrive in Hyde before she died. Shipman replied rather abruptly, 'I think not. People don't know when they are going to die'.

Certification

Shipman must have completed the MCCD. Although the certificate itself has not survived, its counterfoil has been found. On this, Shipman recorded that Mrs Adkinson died on 2^nd August 1979. The death was caused by carcinomatosis, which was due to carcinoma of the stomach. He said that he had last seen Mrs Adkinson alive on 1^st August, which accords with the witness evidence.

Conclusion

I am satisfied that Mrs Adkinson died of natural causes, almost certainly as certified by Shipman.

Although the medical records are not available, the history described by Mrs Ottridge is entirely consistent with the onset of cancer of the stomach, which later spread to other organs and led quite quickly to death. The visits book suggests that Shipman saw Mrs Adkinson three times in the week before her death. We do not know what treatment she was receiving from him, but it is likely that she was receiving some medication for pain relief. However, as Shipman was not apparently visiting daily and as Mrs Adkinson was not confined to bed, it seems unlikely that she was receiving regular injections of a strong opiate.

Although her name does not appear in his visits book for 1^st August, from the witness evidence it seems likely that Shipman visited Mrs Adkinson that morning. We do not know at what time he visited, except that it was before Mrs Porter arrived. He might have been called out by the neighbour who spoke to Mrs Porter, possibly because Mrs Adkinson was in severe pain. He might well have given her an additional dose of pain-relieving medication. This might have been morphine or diamorphine. It is quite possible that he did this, even though Mrs Adkinson did not mention it to her nieces. However, the important feature of the evidence is that Shipman did not see Mrs Adkinson for at least ten hours before the death and probably rather more. I say that because it appears that Shipman visited on the morning of 1^st August (which I take to be before noon) and Mrs Adkinson was still alive when her nieces went to sleep, which I take to be at about 10pm. That being so, I can say with confidence that any injection which Shipman might have given Mrs Adkinson on the morning of 1^st August cannot have directly caused her death. The fact that she was conscious after his departure and made no mention of any injection, makes me sure that she was not given any injection that might even have contributed to her death.