Introduction

Miss Vara Penney died at her home, 8 Rowbotham Street, Hyde on Tuesday, 28^th January 1986 at the age of 86. She had been a patient of Dr Bennett but transferred to Shipman some years before she died and thought highly of him. He certified that the cause of her death was old age.

In September 2001, the Inquiry placed an advertisement in a number of newspapers, publishing a list of cases in which the Inquiry had only limited information as to the circumstances of death and in which no relatives had been traced. In response to that advertisement, Miss Penney's nephews, Mr Sam Penney and Mr Neville Grieves, contacted the Inquiry.

The Inquiry has taken statements from Mr Grieves, Mrs Nora Smythe (a neighbour of Miss Penney) and from a friend of Miss Penney who wishes to remain anonymous. The Inquiry has also had access to Shipman's visits book for 1986 and the counterfoil of the Medical Certificate of Cause of Death (MCCD). Miss Penney's medical records have not survived.

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

Personal Background

At the time of her death, Miss Penney was living alone. She had long-standing back and hip problems but remained active and independent, at least until her health began to deteriorate about 18 months before her death. Some time during the summer or autumn of 1985, Shipman told Mr Grieves' wife that Miss Penney had cancer. Shipman said that Miss Penney had refused hospital treatment and that she would not recover. Miss Penney disliked hospitals and her refusal of treatment came as no surprise to her nephew.

The Events of the Weeks Leading up to Death

Miss Penney was very ill during the last few weeks of her life. She was cared for mainly by a friend who spent virtually the whole of each day with her. Miss Penney's friend did not know the nature of her illness. Miss Penney was confined to her bed and had difficulty in eating. The district nurses visited regularly to wash her and change her clothing. It seems likely that Miss Penney was receiving morphine injections to relieve her pain. Towards the end she was in a comatose state. The district nurses kept their syringes and Miss Penney's drugs at the house.

Miss Penney's name does not appear in Shipman's visits book during the month of January 1986. However, Mr Grieves suggests that Shipman used to visit quite frequently without being called out. That seems likely in the case of a terminally ill patient.

The Day of the Death

Miss Penney's friend arrived at Miss Penney's house at about 9am on 28^th January 1986. She recalls that Miss Penney was very weak and could not communicate. She had been in the same condition on the previous few days. Miss Penney's friend recalls that the district nurses attended both in the morning and in the afternoon, as was their usual routine. She recalls that after the nurses had been she sat in a chair next to Miss Penney's bed to 'keep an eye on her'. Miss Penney's friend says that Shipman did not visit Miss Penney at all that day.

Miss Penney's friend recalls that 'sometime after teatime' while she was sitting by the bed she realised that she could not hear Miss Penney breathing. She spoke to Miss Penney but there was no response. Miss Penney's friend telephoned her son and, while she was speaking to him, heard Miss Penney make a strange noise. She recalls that her son's wife, who was a nurse, told her over the telephone that the noise was the 'death rattle' and that Miss Penney had probably just died. This proved to be the case. Miss Penney's friend recalls that Miss Penney looked very peaceful as if she were sleeping.

Certification

Shipman must have completed the MCCD. Although the certificate itself has not survived, its counterfoil has been found. Shipman recorded that he had last seen Miss Penney alive on the day of her death. I note that he certified that the death was due to 'old age' although the cause of death was probably capable of more accurate diagnosis. I do not think there is anything sinister about this. Many people of Miss Penney's generation who had cancer did not wish for others to know the nature of their illness. It seems plausible that Shipman knew that Miss Penney did not wish the nature of her illness to be known.

The copy entry in the register of deaths ('death certificate') wrongly names Miss Penney as Vera Penny.

Conclusion

It seems likely that Miss Penney died of natural causes, probably some form of cancer.

The history of gradual deterioration and increasing weakness is entirely typical of the progression of many forms of cancer. During the last two weeks of her life she was very weak, often comatose and could hardly communicate. Her death was neither sudden nor unexpected.

There is some cause for concern in this case because Shipman claimed that he had last seen Miss Penney alive on the day of the death. Miss Penney's friend does not remember him visiting that day, but she might have forgotten. If he did visit, it seems to me unlikely that the visit could have been at or shortly before the death; Miss Penney's friend would have remembered that.

My conclusion is that Miss Penney almost certainly died of natural causes.