Introduction

Mr Frederick Coomber died at Bowlacre, a residential home for the elderly, Stockport Road, Hyde on Sunday, 10^th February 1980 at the age of 81. He had probably been a patient of Shipman for about ten months. Shipman certified that the cause of his death was bronchopneumonia due to chronic bronchitis.

Despite extensive efforts by the Inquiry, no witnesses or relatives have been traced. Very little is known about the circumstances surrounding Mr Coomber's death.

The Inquiry has taken a statement from Mrs Sandra Holdsworth, the former manager at Bowlacre. Unfortunately, Mrs Holdsworth did not begin her employment at the home until 1982. The Inquiry has had access to the copy entry in the register of deaths ('death certificate'), the counterfoil to the Medical Certificate of Cause of Death (MCCD), the cremation forms and Shipman's visits book for 1980.

The Evidence

Shipman's visits book shows that, in the period preceding his death, he visited Mr Coomber on 31^st January and 8^th February 1980.

The death certificate shows that Mr Coomber was a retired army officer. The informant was one Peter Philip Taylor, who appears not to have been related to Mr Coomber. It seems likely, therefore, that he had no close relatives living at the time of his death.

Shipman must have completed the MCCD. Although the certificate itself has not survived, the counterfoil has been found. Shipman completed this on 11^th February and recorded that Mr Coomber had died at Bowlacre on 10^th February 1980. He stated that he had last seen Mr Coomber alive on 8^th February 1980, two days before his death. Mr Coomber's name appears in Shipman's visits book for 8^th February but not for the day of the death. The cause of death was said to be bronchopneumonia due to chronic bronchitis. Shipman also stated that there was to be no post-mortem examination and that he had seen the body after death.

Shipman also completed cremation Form B. He said that the death had occurred at 6pm on 10^th February. He said he had been Mr Coomber's ordinary medical attendant for about ten months. This may well indicate that Mr Coomber had lived at Bowlacre for about ten months and that Shipman became his doctor at the time of the move. Shipman said that he had attended Mr Coomber for seven days during his last illness. The visits book does not confirm a visit seven days before the death. Shipman said that he had last seen Mr Coomber alive on 8^th February, which is confirmed by the visits book. He gave the cause of death as on the MCCD counterfoil. He said that the mode of death was a coma lasting about 12 hours. This information concerning the cause and mode of death was said to be based on statements made by the matron of Bowlacre. The staff at Bowlacre had nursed Mr Coomber during his last illness and the matron had been present at the death.

Conclusion

Nothing is known about Mr Coomber's state of health in the period before his death. I do not know whether he had developed bronchopneumonia or indeed any chest infection. I cannot say whether Mr Coomber's death was sudden or expected.

Although the evidence would suggest that Shipman did not see Mr Coomber in the last two days of his life, the only source of information is Shipman himself. His account cannot be accepted unless corroborated by other evidence. I cannot therefore say whether Shipman had access to Mr Coomber shortly before he died.

In view of the paucity of information, I am unable to reach any conclusion about Shipman's role in this death.