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[00:00:00]

Listener discretion is advised, this episode features discussions of murder, medical malpractice, mental health conditions, addiction and prescription drug abuse that may be upsetting. We advise extreme caution for listeners under 13. At a certain point in life, we accept death is inevitable. We even come to expect it in certain cases when we lose someone elderly or very sick. We grieve, but we aren't surprised. We've prepared for the pain, anticipated the event. When a grandmother dies of old age, no one questions it when her aging friend down the road dies from cancer.

[00:00:47]

It's not a shock. And when over 200 elderly citizens of Hyde, England, died within a 20 year span, no one imagined that they were the victims of the UK's most prolific serial killer. This is Medical Murders, a podcast original for decades, thousands of medical students have taken the Hippocratic Oath. It boils down to do no harm. But a closer look reveals a phrase much more interesting. I must not play at God.

[00:01:33]

However, some doctors break that oath, choosing to play God with their patients, deciding who lives and who dies each week on medical murders. We'll investigate those who decided to kill. We'll explore the specifics of how they operate not just on their patients, but within their own minds, examining the psychology and neurology behind heartless medical killers. I'm Alistair Madden and I'm joined by Dr. David Kipa, M.D..

[00:02:07]

Hi, everyone. It's a pleasure to be here to assist Allaster by providing medical information and insight into the killer's modus operandi. I've been in practice for over three decades specializing in internal and addiction medicine, and I'm really thrilled to be part of this program because I'm a huge fan of crime stories. And for me, as a doctor, solving a murder is much like solving a difficult diagnosis.

[00:02:31]

You can find episodes of medical murders and all other podcast originals for free on Spotify or wherever you listen to podcasts to stream medical murders for free on Spotify, just open the app and type medical murders in the search bar. This is our first episode on Dr. Harold Fredrick Shipman, otherwise known as Fred, the UK's most prolific serial killer. Between 1974 and 1998, Shipman killed at least 218 people. Every one of them was a patient who had entrusted the doctor with their care.

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Each victim's family believes they died of natural causes until the dark truth was revealed today. We'll look at Shipman's disturbing modus operandi, his early murders and likely motivations.

[00:03:24]

Next time, we'll examine how Shipman escalated his crimes within his private practice and how the subsequent inquiry into Dr Death forever changed the British medical field. All this and more coming up. Stay with us. Kathleen Grundy was late still. It was only a few minutes into her scheduled 11 a.m. volunteer shift, her friend John Green figured she was merely distracted. But after 45 minutes, Greene and his friend Ron Pickford grew concerned. It wasn't like Kathleen to be late, though.

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She was 81. She stayed active, volunteering five days a week. Still, she was 81. So Green and Pickford went to check on their friend around noon on June 24th, 1998.

[00:04:22]

They found her back door unlocked. It wasn't uncommon for Hydes elderly citizens to leave their doors open, but it still gave green pause. He shouted hello with no response. Further inside, he found Kathleen lying peacefully on the settee, fully dressed as if she'd fallen asleep with her shoes on. He tried to wake her, but her skin was gray and her body was cold. Green called in Pickford, who called Cathleen's Dr. Fred Shipman, 20 minutes later, Dr.

[00:05:03]

Shipman arrived, checked Kathleen for a pulse and promptly declared she died of a heart attack. Greene asked about Kathleen's doctor's appointment that morning, had she been sick, Shipman replied that he'd stopped by only for a talk.

[00:05:22]

Later that day, Kathleen's daughter, Angela, called Shipman to inquire about her mother, Shipman told her what he told Green and Peckford that her mother had died of cardiac arrest. In fact, she'd complained of chest pains at her appointment that morning. However, when he filed the death certificate with the coroner, Dr. Shipman wrote that Kathleen Grundy had died of old age, not a heart attack.

[00:05:51]

Old age means that you have lived to a point where some of your illnesses and some of the chronic things that have gone on with you starting to catch up with you. So we don't really think about aging until we start feeling the effects of these chronic illnesses. Old age is sort of the nondescript answer and can be very misleading to the coroner. Families rarely review a death certificate, but the coroner is very careful about what's written. These are legal documents and actually have life insurance implications and also reflect exactly in case people do have to go back for family reasons to know what their genetic history is.

[00:06:31]

They'd like to be able to refer back to these death certificates to see if they're in trouble for anything that may be in their in their genetics.

[00:06:41]

Kathleen's daughter, Angela, did question the death certificate. She was a solicitor. And to her, it was clear the listed cause of death did not line up with the facts.

[00:06:53]

When Angela approached Dr. Shipman, he claims the fib was a favor to save for the stress of a post-mortem exam and ID. He was helping her. Angela knew her mum loved Dr. Shipman and that his private practice was extremely popular with the citizens of Hyde. So she trusted him until things grew more suspicious.

[00:07:19]

A law firm reached out to Angela saying they had her mother's will, but that couldn't be possible. Angela already had her mother's will, even stranger. This second will left nothing to Angela and requested Kathleen be cremated, despite the fact that she'd expressly told Angela to bury her. Not to mention the will was typed in all caps with words, missing letters the law firms set. Their point of contact was John Smith, which Angela guessed was a fake name.

[00:07:54]

This will was a forgery and a lazy one.

[00:07:59]

She wouldn't stand for it. Angela began an investigation, starting with the law firm and then the police. Before long, Kathleen Grundy's body was exhumed and an autopsy revealed that she hadn't died of a heart attack or old age. She'd been murdered, injected with a lethal dose of morphine. The evidence pointed straight to the Wills beneficiary and perhaps the last person to see Kathleen Grundy alive, Dr. Fred Shipman. Angela didn't know it, but her mother was an Shipman's first victim.

[00:08:39]

She was, at the very least, his 218 of his murders spanned 23 years with his first confirmed killed back in 1975. But his crime story began 12 years before that in 1963, the first time Fred Shipman saw a sick woman dying.

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When he was a teenager, Shipman's mother, Veera, was diagnosed with lung cancer. This news was made more devastating by reports that Fred was his mother's favorite. According to some accounts, she spoiled him rotten, always telling him he was better than the other boys.

[00:09:23]

Though they were working class, she pushed him to apply for a scholarship to an elite private school. Shipman's soon learns that perception was everything. He lauded his tie in uniform over his family and the neighborhood kids, displaying an early sense of arrogance on and off the playground.

[00:09:43]

But he had no more time for that. In 1963, after his mother's diagnosis, he'd raced home from school to comfort Veera as she waned away from cancer. At the time, it was routine for doctors to make house calls to check on patients and administer drugs like morphine. Sometimes doctors drop by unannounced just to say hello or have a cup of tea. Fred Shipman got to know his mother's doctor and his work.

[00:10:12]

Well, Fred recalled watching his mother struggle for breath, then grow calm and peaceful as the doctor injected morphine into her veins.

[00:10:22]

Morphine works in the brain by slowing down those reflexes in the brain to control breathing and heart rate. So as morphine comes into the brain, those centers that normally regulate these functions start to slow down. More interesting, Alistar doctors prescribe morphine not just for pain management, but we also use this at the end of someone's life in order to give them a very peaceful and calm exit.

[00:10:48]

Veera passed away in 1963. It seems Shipmen dedicated much of his life to reliving his last year with her. To that point, by the age of 17, he had decided to become a doctor and in 1970 he graduated from Leeds University Medical School. Later that year, 24 year old shipmen began working as a preregistration house officer at Pontefract General Infirmary. In retrospect, Shipman's killing career may have started alongside his medical one, so some people attempt to process their traumas by reliving that trauma.

[00:11:27]

This is not uncommon and is used constantly in therapeutic sessions. And this is called exposure therapy. Exposure therapy.

[00:11:35]

However, in someone that is murdering people is probably not such a good therapy. The trouble with investigating Dr Shipman is that every one of his murders was initially documented as a natural death, meaning that the hard evidence was lost to time and the truth buried with the victims. Not much is known about his training, but the accounts we do have are concerning. One nurse, Sandra Whitehead, recalled that the Infirmaries women's ward once saw three deaths in a single day that Shipman worked, and she often found empty injection packs left in deceased patients rooms.

[00:12:16]

She presumes they were used to administer intravenous drugs like morphine. If any of these deaths were murders, they lined up with Shipman's later ammo. And it wasn't just Sandra. The Infirmaries records show a higher than usual death rate during Shipman's training period, perhaps because we're conditioned to trust our doctors. No one suspected Shipman of anything at the time. Nurse Sandra Whitehead only came forward decades later after she heard about the government investigation into Shipman. It's also possible some of these deaths weren't premeditated murders, but accidental overdoses.

[00:12:58]

Shipman may have hoped to relieve a patient's pain, remembering the miraculous relief morphine gave his suffering mother and overdone it.

[00:13:07]

If so, this period may have contained Shipman's second moments of revelation. Morphine had the power to take away pain, but it also had the power to kill without consequence.

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Coming up, shipmen experiments with his murder weapon. Now back to the story.

[00:13:32]

After watching his mother die at age 17, Fred Shipman seemingly became obsessed with the event. He trained to become a doctor and developed a strong interest in morphine, the same painkiller he'd seen his mother's doctor administer on her deathbed. In his 20s, shipmen tried morphine himself and claimed he didn't care for it, but that didn't stop him from experimenting with opioids even as he began to treat his first patients at Pontefract General Infirmary by the early 1970s. Dr. Shipman had developed a pethidine addiction.

[00:14:08]

Pethidine effects are similar to those of morphine, which is derived from opium poppies.

[00:14:14]

The source of heroin pethidine is used primarily in labor and delivery for pain management. Shipmen obviously became addicted to the drug and after a certain point, as we discussed, with receptors being dumbed down and the patient needing more and more drug in order to get the same effect, this is called tolerance, by the way.

[00:14:36]

At a certain point, people start taking their opiate drug not for the pleasure that they used to get, but in order to prevent a withdrawal, because after a certain point, those pleasurable symptoms from an opiate become less and less pleasurable and the withdrawal effects are more and more uncomfortable. So that's how these drugs maintain their their addictive quality. So addiction is really a problem of mental health. So the signs that you look for are mental health issues.

[00:15:06]

So if people are depressed or anxious, bipolar, have any other mental health issue that is untreated, those are the people that are more likely to self medicate. And since self medicating is fairly easy these days, they often turn to these substances that are not prescribed and not monitored.

[00:15:26]

Access to narcotics was certainly on Shipman's mind. Once he began working in 1974, he went out of his way to handle them. That year, Shipman was hired as an assistant general practitioner at the Abraham Ormerod Center in Todmorden. He quickly jumped into two undesirable tasks reorganizing the records and disposing of outdated pharmaceuticals, including pethidine. On the outside, it seemed like a move to earn goodwill among his new co-workers. But secretly, Shipman abused his responsibilities. He learned all about how records were kept, who monitored them and how to forge medical documents.

[00:16:11]

And once he confirmed no one was keeping tabs on the trash, he stopped disposing of the pethidine legally. Instead, he injected the drug into his own body.

[00:16:25]

When he'd made his way through the practices drugs, Shipman began overprescribing pethidine to his patients. This way, there were always leftovers to be disposed of. He was essentially stealing drugs from his patients and he was getting away with it. Over the next year, Shipman's painkiller addiction only grew more dangerous, according to the Shipman inquiry. The official investigation into Shipman's crimes a normal dose of pethidine to relieve pain is 100 milligrams. And for someone with no tolerance, a lethal dose is around 500 milligrams.

[00:17:07]

In 1975, shipmen was using 600 to 700 milligrams of pethidine a day, his patients and his colleagues were clueless, according to the Shipman inquiry. He was viewed as keen and hard working around the practice, and his patients felt he was their friend as well as their doctor in hiding his addiction. Shipman was extremely thorough. He put all the prescriptions he used in his patients names, and some patients didn't even know they had an open pethidine prescription. Shipman would pick up the medicine on a patient's behalf and never tell them about it.

[00:17:50]

But he couldn't keep his secret forever.

[00:17:54]

In June 1975, a pharmaceutical company noted the absurd amount of pethidine they were supplying, Todd Martens Boots Pharmacy and contacted the UK's federal law enforcement known as the Home Office. The investigation led to Shipman, and in July, officers interviewed him about his prescription practices. All signs pointed to pharmaceutical abuse. It should have been a quick arrest. However, the Home Office couldn't verify if the amount of pethidine supplied stacked up to the amount actually used by Shipman's patients.

[00:18:33]

Shipman hadn't kept a record of it, and because it was his job to organize the practice records, no one had noticed. As we said, Shipman always covered his bases and then he covered them again. When the Home Office pressed him, Shipman claimed he wasn't aware he was legally required to keep those specific records with no recourse. They let Shipman off with a warning. After that, Shipman stopped keeping records of his pethidine prescriptions.

[00:19:08]

All together, he became increasingly unhinged. Shipman began experiencing blackouts and seizures. He'd suddenly convulse and lose consciousness at home, in the car and even at the medical practice in front of patients. One seizure even caused Shipman to fall in the bathroom. At his home, he hit his head, resulting in a bad concussion. In August 1975, Shipman was diagnosed with idiopathic epilepsy or unexplained seizures. Eventually, the seizures forced him to stop driving. But despite all of this, Dr Shipman continued to practice medicine, including intravenous injections, a skill that certainly requires a clear head and a steady hand.

[00:20:01]

Someone that had one epileptic attack would not be dangerous because that would more likely be treated if someone had multiple episodes of epilepsy. It would mean either that they weren't being treated or that their form of epilepsy was resistant to treatment. So doctors will often try to mask any kind of subtle or minor problem that they're having with their health. If a doctor recognises that they are no longer capable of performing, they are obligated to step away for reasons that doctors might not step away is that they might not recognise or admit that they are incapable or they are compromised.

[00:20:42]

Capable or not, Shipman would not be stopped from seeing his patients.

[00:20:48]

He kept his symptoms hidden and his old fashioned manner and charming housecalls continued to gain him favor. He would do anything to help them recover from their pain and suffering.

[00:21:00]

When he stopped driving, his wife Primrose chauffeured him to appointments around Todmorden. Primrose often helped her husband throughout his career and had no idea she was actually putting Shipman's patients lives in danger.

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And by this time they were in danger.

[00:21:21]

In 1975, 29 year old Shipman committed his first confirmed murder, 71 year old Ava Lyons. Shipman visited Ava at her home on the night before her 71st birthday. Seeing her suffering, Shipman said he'd give Ava something to ease the pain. Ava suffered from cancer and a dose of painkillers wasn't unexpected. Sitting beside Ava's husband, Shipman pierced his needle into the back of Ava's hand. Opiates take effect quickly, and caregivers are sometimes able to stop the dose when it's clear the patient is no longer suffering.

[00:22:05]

Shipman likely saw that Ava had enough. But kept pressing the syringe, intentionally overdosing her. When he did stop the injection, Shipman acted as if everything had gone normally, Ava's husband even invited Shipman to have a cup of coffee downstairs. Eventually, Shipman went back into the bedroom to check on Ava when he returned, he told her husband she's dead.

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Ava's husband was upset but not surprised. Shipman left shortly after. Later, he certified Ava's death without an autopsy. Everyone believed it was natural, caused by her struggle with cancer, not any medication. Later, Ava's husband told his granddaughter Shipman was a nice bloke. He didn't suspect a thing. The doctor had perfected his forgery skills and could now quite literally get away with murder.

[00:23:21]

However, it didn't make Shipman's behavior less paranoid, and he had every reason to be near the end of September 1975, Shipman's colleagues at Todmorden confronted him. They believed him guilty of theft, forgery and drug abuse. Shipman admitted it. He'd abused pharmaceuticals, but then he made a request. Would they help him cover it up?

[00:23:49]

If his colleagues overprescribed pethidine as well, he could avoid further suspicion from the Home Office and keep working at the practice.

[00:23:58]

But the doctors wouldn't be fooled again. They forced Shipman to resign and check into rehab. Then they alerted the authorities.

[00:24:10]

The Home Office sent officers by Keating and Macintosh to interrogate Shipman at the rehab hospital. At first, Shipman declined to speak with them, but he soon change tack and began confessing. He spoke about how he acquired pethidine, how he forged prescriptions, falsified records and abused the drug. There was only one detail they doubted, Shipman said. He began abusing pethidine in 1974, but Detective Marketing noted all his veins had collapsed, something I would have expected to see on an addict of at least five years standing, making me suspect that his habit was longer than he admitted.

[00:24:53]

Even if he may have been lying about when he started using pethidine, Shipman disclosed enough crimes in enough detail that authorities believed they had the full story. They didn't press him further. He was charged with 82 criminal counts solely around unlawful drug possession and prescription forgery. He pled guilty to eight and was fined a sum worth around 7000 U.S. dollars. Today, the convictions were sent to Britain's General Medical Council, which had the power to begin proceedings to revoke Shipman's license if they found him incompetent.

[00:25:32]

But they, too, were thwarted by Shipman's careful cover ups, even though he confessed to possession and forgery, those crimes were considered lower level. There was no evidence his patients had suffered due to Shipman's drug abuse. On top of that, shipmen seem to have made a full recovery after three months in rehab and vowed to never abuse drugs again, he perfectly played the role of an upstanding citizen who'd made a mistake. So the General Medical Council gave him the benefit of the doubt.

[00:26:09]

By May 1976, Shipman's case was fully closed. He was cleared to resume medical practice. Given this fresh start, he'd learned one important lesson he would no longer abuse drugs on himself. He'd abuse them on other people and much like opioids, overdosing patients proved all too habit-forming for Dr. Shipmen.

[00:26:43]

Up next, Shippen replaces one addiction with another. Now back to the story.

[00:26:51]

Dr. Fred Shipman left his first job with one confirmed murder and a series of suspicious deaths in his wake, but he was a medical con artist, a master of deceit. He passed his first murder off as a natural death. And it was only a matter of time before he killed again in October 1977, 31 year old ship and landed a job as a general practitioner at Donnybrook Medical Center in Hyde, a village just southeast of Manchester, England. At Donnybrook, Shipman was open with his new colleagues about his checkered past.

[00:27:29]

Just as he'd been with the police, he used a partial admission of the truth to gain his new colleagues trust. For the next year, he played it safe, creating a fresh facade. Shipmen charmed his new patients, joined the PTA and ran a rugby club. He bought a nice suburban house for his family, which now included Primrose and four children from a distance. Dr Shipman was an upstanding citizen. Before long, his new patients were raving that he was the best doctor in Hyde, and he clearly agreed.

[00:28:07]

Shipman was confident and proud of his work. Arrogant, even the sole remaining consequence of his crimes in Todmorden was that Shipman was not legally allowed to carry controlled substances on his person. This was intended to ensure he didn't abuse any more opioids. But that ruling didn't keep Shipman from encountering controlled substances, he continued to treat elderly and terminally ill patients prescribing and administering painkillers, as any doctor would. In the Shipman inquiry, Dame Janet Smith proposed that Shipman was able to steal opioids left behind by his terminally ill patients after their deaths through 1977 and 1978.

[00:28:56]

He could have easily stockpiled morphine, diamorphine, pethidine and chlorpromazine. He certainly had the knowledge and experience to do so, and he had a plan to use the drugs.

[00:29:10]

About 10 months after starting work at Donnybrook, Shipman overdosed another patient, his second confirmed murder. On August 7th, 1978, 54 year old Irene Chapman paid her mother Sarah marsland a visit. It was just across the neighborhood. Both lived in a small village of Hyde. Irene's sister Cecily had just died, and Irene knew her mother was feeling low. Sarah had lived alone since she was widowed, so Irene was shocked to find a man leaning over her eighty six year old mother's bed.

[00:29:48]

The shock turned to agony as she realised her mother was dead. Then it turned to confusion as she processed that the man was the family doctor, Fred Shipman. Shipman had a story. Immediately, he'd stopped by for an unplanned check in on Sarah, who'd complained of physical pain, says she grieved. Shipman helped her move from the chair to the bed, hoping to make her more comfortable. But moments later, she died. Shipman attempted to revive Sarah but couldn't save her.

[00:30:24]

In her extreme shock and grief, Irene accepted the story. Shipman listed Sarah Maslin's cause of death as coronary thrombosis. In reality, Shipman likely injected Sarah with an overdose of opiates.

[00:30:42]

Dubbing a murder coronary thrombosis became a pattern for Shipman, though he also frequently documented his patients as dying of pneumonia, respiratory failure and myocardial infarction, which is a heart attack. So I think that Shipman picked this cause of death in a way to throw off the coroner. And also, as families rarely question a death certificate, he knew that he would not be scrutinized. But people that die of a heart attack die in a very uncomfortable manner. People that die of an opiate overdose die very peacefully.

[00:31:16]

So the way people die is different in these two events. So there is a tremendous abuse of power in this. And it really is comes down to that question of are doctors allowed to make that decision about who's going to die?

[00:31:29]

And when Shipman's pattern of forgery continued, he weaseled his way out of his second murder unnoticed. But that wasn't the last Shipman would see of Sarah's daughter, Irene Chapman. Irene remained his patient for the next 20 years. In that time, her daughter in law, Carol Chapman, was even hired as Shipman's receptionist. Irene never suspected that her doctor may have killed her mother. She continued to see Shipman for routine care until 1998. That year, Dr. Shipman killed her too.

[00:32:14]

From Sarah, marsland through Irene Chapman shipmen followed a distinct modus operandi visit a patient at home, inject them with narcotics to stop their pain and suffering, stay for a few minutes as they die, ensure the death looks natural and peaceful. Each murder brought him back to his last days with his mother watching the morphine wipe the pain away after he killed them. He usually turns on the fireplace and this actually makes a lot of sense. Alster A lit fireplace would increase the temperature in the room, speeding up the body's decomposition.

[00:32:54]

This could create complications when it comes to establishing a time of death. Increased heat also speed the onset of rigor mortis, which is a biochemical change in the body that causes stiffening of the skeletal muscles and usually happens a few hours after we die. Increase temperatures, hasten the arrival of rigor mortis, creating a more productive environment for the bacteria to do their damage side from stiffening the skeletal muscles. Rigor mortis changes the composition of the tissues, making them more difficult to examine in an autopsy.

[00:33:28]

This degraded tissue would make identifying the morphine levels of corpse all the more difficult. These combined effects likely made it even harder to connect Shipman to his crimes. Even decades later, the British government was only able to tie Shippen to four murders in 1978, just three weeks after killing Sarah marsland Shipman murdered Mary Ellen Jordan the same way before Christmas, he killed Harold Bramwell and Annie Campbell. No one suspected a thing. There was virtually no way to stop him.

[00:34:06]

Shipman made sure of it. He continued overdosing patients through 1979 with two confirmed murders toward the end of the year. Still, he was careful there were no confirmed killings in 1980 and only two in 1981. And he apparently cooled off in 1982 before killing twice more in 1983. But it's extremely likely Shipman killed more during this era because we know he took nine victims in 1984. And from 1985 to 1991, Fred Shipman killed a confirmed 52 people.

[00:34:54]

Psychologists consulted during the Shipman inquiry, observed the doctor as obsessive with a need for control, clearly evidenced in the way he covered up his crimes.

[00:35:05]

First, he was careful about his selection. Most victims were terminally ill and patients he treated for some time. He'd built up trust as the family doctor before acting, and he built up medical records of their illness.

[00:35:20]

Their life expectancy wasn't guaranteed. It was whatever their doctor estimated. For Dr. Shipman's patients, their life expectancy was only as long as he waited to kill them. Some victims weren't even ill, take Moira Fox. She was 77 and in generally good health. On June 27, 1983, Shipman wrote in his appointment book that she was getting blood drawn. The next day, there seemed to be his code for administering a fatal dose of morphine. Dame Janet Smith suggested a blood sample was a clever ploy for the doctor to access veins while the victim wasn't looking, and that's likely what he did to Moira Fox.

[00:36:08]

He asked her to lay in bed while he drew a blood sample. Minutes later, she was dead. Shipman updated his appointment book again the next day, merely writing Miss Fox Blood's Dead.

[00:36:27]

However, Shipmen told Mr Ounsworth, Moira's retirement community caretaker, a very different tale, shipmen claimed Moire called him on the 20th, complaining that she didn't feel well. This was no shock to Ounsworth. Moire often complained about her aches and pains, though he believed she was more of a hypochondriac, Shipman continued his story. He'd arrived to find moire dead on the floor out of respect.

[00:36:55]

He moved her to the bed. But he didn't just inform the caretaker.

[00:37:00]

Shipman insisted.

[00:37:01]

Mr Ounsworth come look at Moira. Ounsworth wasn't sure why Shipman required this, but he was a doctor and must have had some medical reason.

[00:37:13]

Shipman had several patients in the retirement community, and Ounsworth hadn't heard a bad word about him. So he examined Moira and confirmed she was dead. He noted that she looked peaceful as if she'd had a painless death.

[00:37:29]

With this charade, Shipman was essentially creating a second witness, solidifying his cover up. That cover up continued when Shipman documented Moira's death as coronary thrombosis, when he killed a healthy patient like this, Shipman often backdated his records, falsifying evidence of a lingering disease, often months of heart problems. He also invented tales like the one he told the caretaker where a patient complained of an ailment they never had. Shipman relied on the fact that almost all of his victims were over 60 and most of them were over 80.

[00:38:10]

A peaceful death at home wasn't shocking.

[00:38:14]

Like Moira Fox, most of Shipman's victims were found in the same tranquil state, sitting in an armchair or lying in bed. They were always fully dressed as if they were taking a nice midday nap for a single death. This wouldn't raise eyebrows, but looking at over 200 deaths together, it's extremely odd. Because they were overdosed with painkillers, Shipman's victims were never found struggling to reach the phone, collapsed in the kitchen or groaning on the toilet. They were never partway through tying their shoes or in the midst of cooking dinner.

[00:38:56]

There was no blood, no gore or bruising when they were found.

[00:39:02]

Shipman's patients never looked like one imagines a murder victim.

[00:39:06]

Most causes of death are not peaceful because what's happening inside the body is that some part of that body is shutting down, starving the brain and the lungs and the heart from their oxygen. And the body reacts in very uncomfortable ways. When somebody dies, they exhibit a very unusual breathing pattern. It's called chains stokes breathing. If somebody observes their loved one going through a chain stokes breathing pattern, it's very uncomfortable and it appears that person is struggling. If somebody sees somebody that acutely dies of an overdose of morphine, they go very peacefully.

[00:39:46]

They don't have that same reflex. When someone dies of a sudden death, they are usually found in an awkward or compromising position. You can find somebody that has died on a treadmill. You can find somebody that has died on the toilet seat. These are people that when they die, suddenly they fall, they land on the ground and they don't look like they're in a peaceful place to actually post these patients. Before he injected the morphine. And he did this because he used a blood draw to hide the fact that he was actually not taking blood, but injecting morphine.

[00:40:23]

If someone gets a rapid injection of morphine, they can die within a minute. It's very sudden. So his victims, who are already in a peaceful place, they were already in a peaceful position lying down. And so when they were found dead, they looked very much like they had died in their sleep. Shipman's victims families saw what they wanted to see, their parents and grandparents were calm in their final moments. Their death wasn't painful or drawn out.

[00:40:53]

It's what we all wish for, our loved ones, an end to their suffering. But even that cover wasn't enough for Dr. Shipman, he remained fastidious in a racing evidence, the final key to his years of undetected murder was hidden in plain sight cremation.

[00:41:18]

He recommended all of his patients be cremated and many of them were. When the bodies burned, so did all the evidence of an overdose, unlike many serial killers. There was no need for Shipman to dispose of his victims bodies. Their families did it for him. Shipman himself is reported to have said you can't exhume ashes.

[00:41:45]

Dr. Fred Shipman's actions paint the picture of a man obsessive and paranoid, a killer who more than anything feared being caught. He maintains a charming, trusted face with his colleagues, his patients and the people of Hyde.

[00:42:02]

Anyone who saw the true shipmen only glimpsed him in their final moments. Dr. Shipman made every effort to ensure his victims never saw justice for years it worked, but by 1992, his tolerance for murder had risen. He'd taken on more and more patients serving much of the town of Hyde. He gave them his version of care, but his fear of being caught wore on him. He couldn't escape his paranoia as long as he worked at Donnybrook Medical Center to feed his addiction.

[00:42:43]

Shipman needed more secrecy and more power. He needed to escape the oversight of his colleagues.

[00:42:52]

He needed a one man practice. Next time on medical murders, Dr. Fred Shipman launches his own practice. He remains a pillar of the community despite killing the parents, grandparents or friends of almost every resident of hide. His murders are so horrifying and so numerous. The British government's reaction hits the scope and scale of a natural disaster.

[00:43:28]

Thanks for listening to medical murders and thanks again to Dr. Kipa for joining me today.

[00:43:33]

Thanks for having me. I really look forward to the next episode.

[00:43:37]

For more information on Fred Shipman, among the many sources we used, we found the six volumes of the United Kingdom's shipmen inquiry compiled by Dame Janet Smith. Extremely helpful to our research.

[00:43:49]

You can find all episodes of medical murders and all other podcast originals for free on Spotify, not only to Spotify, already have all of your favorite music, but now Spotify is making it easy for you to enjoy all of your favorite podcast originals like medical murders for free from your phone, desktop or smart speaker to stream medical murders on Spotify. Just open the app and type medical murders in the search bar. We'll see you next time. Medical murders was created by Max Cutler and as a podcast Studios' Original.

[00:44:22]

It is executive produced by Max Cutler, Sound Design by Ron Shapiro with production assistance by Carly Madden, Kristen Acevedo, Jonathan Cohen and Jonathan Ratliff. This episode of Medical Murders was written by Maggie Admi with writing assistants by Drew Cole and stars David Kipa and Alistair Murden.