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.

The village of Hyde Greater Manchester has a dark history in the 1960s, a pair of serial killers terrorized local teenagers. Five young residents were tortured, assaulted and murdered, their bodies abandoned on the nearby moors.

When Ian Brady and Myra Hindley were arrested in 1965, the citizens of Hyde thought they could return to normal. But 40 years later, Hyde fell victim to a second serial killer.

The teens who'd lost friends now watched as their parents fell prey. This time, the murders were less graphic, the victims were too old to fight or run away, and instead of being murdered on the moors, these patients were killed in their own homes. No one expects a small town to hide multiple serial killers, but defying expectations was Dr. Fred Shipman's specialty.

This is Medical Murders, a podcast original. Every year, thousands of medical students take 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.

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 chose 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 Alastair Murden and I'm joined by Dr. David Kipa, M.D.. Hi, everyone. I'm very happy to be back and continue to dive into the details with Alastair about Dr. Shipmen.

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 second episode on Dr. Fred Shipman, the UK's most prolific serial killer. Between 1974 and 1998, Shipman killed at least 218 people, but some estimates suggest he may have killed over 400. He intentionally overdosed his patients with opiates like morphine, giving them a painless, peaceful death.

Today, we'll examine how Shipman used his One-Man practice to escalate his crimes and how the subsequent inquiry into Dr Death forever changed the British medical field. All this and more coming up.

Stay with us.

Renata Overton thought she was dying as she weaves through her asthma attack. Her daughter Sharon called the doctor. Within 30 minutes, Dr. Shipman arrived nebuliser in hand. He was always available for his patients. That's why they loved him. February 18th, 1994, was no exception. Sharon retreated upstairs, leaving her suffering mother in the doctors caring hands. Once he was alone with Renata, Dr. Shipman lightly poked a needle into her veins. A look of peace washed over her face.

Then she collapsed, struggling even harder to breathe. Shipmen waited a moment to ensure the drug either diamorphine or morphine had taken full effect, then banged on the house's banister. He shouted for Sharon. Her mother was having a heart attack. Sharon rushed downstairs to find her mother. Gasping on the living room floor, Dr. Shipman instructed Sharon to perform CPR while he administered a cardiac massage. After a few moments, Renata seemed to be recovering. Shipman injected her again with the drug he promised would ease her breathing as he instructed Sharon to call an ambulance.

Renata's heart stopped when the ambulance arrived.

Seven minutes later, Renata Overton was ostensibly dead, but the paramedics had one last gambit.

They produced a defibrillator, attempting to shock Renata's heart back into rhythm. After the intravenous administration of adrenaline, they succeeded. Her heart restarted. However, she was still struggling to breathe. Dr. Shipman said Renata was likely brain dead, they couldn't save her, but that determined paramedics ignored this, rushing Renata to the hospital. When asked how he treated Renata's so far, Shipman recalled the nebulizer. Then he said he'd injected 10 milligrams of diamorphine after she had collapsed, complaining of chest pain.

He knew he could have given her less, but he claims that that was the only dosage he had in his bag. After all, Renata didn't have a prescription for diamorphine.

Diamorphine says strong opiate, which normally is given for post surgery pain and to manage pain in cancer patients. Doctors try to avoid giving opiates to asthmatic because these drugs are respiratory depressants. So doctors must be very vigilant to carefully monitor seniors taking these narcotics by giving Renata a bolus injection of diamorphine, which is just a large and rapid IV push of the medication. Shipman was probably surprised that she clung to life. This is because of bolus injection of this medicine delivers an intense and faster acting effect of a drug that can stop someone's breathing.

If Dr. Shipman were actually treating her asthma, he would be giving her medicines that actually opened up her airways, not close them like the morphine. I think that Renata survived this bolus injection because simply the dose wasn't high enough to shut down her respiratory center. It seems odd that Shipman would even admit doing this. So the first responders as it reeks of malpractice, but it was ultimately helpful. This information would have enabled the hospital to possibly revive or not.

With Narcan, a drug given for overdoses since nineteen seventy one, it works by displacing the opiates from their receptors and immediately reverses respiratory failure, which is exactly what kills people during an overdose.

The hospital was able to save Renata, but she remains comatose, everyone believed Dr. Shipman's tale that the heart attack was random. It was extremely lucky he happened to be at the house to save her and he'd done everything in his power to help. The only person who knew differently was in a coma. When Renata Overton died 14 months later, she became Shipman's ninety third victim. And just like the previous 92 times he'd gotten away with murder, no one could catch Dr.

Death. Ever since he'd opened his solo practice on Hydes Market Street and May 1992, everything had gone precisely to plan. When Shipman's set up shop around, 2000 patients followed him from his previous Stonybrook practice. Before long, he'd added another thousand to the roster. Shipman's patients said they'd won the lottery getting care from the best doctor in Hyde because he always had time for visits. Shipman was widely popular and soon had a waiting list for new patients. In the Shipman inquiry, the official investigation into Shipman's crimes, Dame Janet Smith wrote.

He would make much of them and sometimes tease them gently. They liked it. He made them feel that he was a real friend as well as their doctor. The scale and manner of his business impressed the people of Hyde, but the medical community may have had a different perspective. One issue with having a very large practice is losing focus on the patients that you have. If, for instance, a doctor that has a large practice encounters a period where people are getting sick at the same time, it's going to be impossible for that doctor to provide the best care.

People also subconsciously assume their doctors are always up to date competent and truly care about them. We don't want to consider the alternatives. Most doctors aren't killers, and we don't expect them to be trust in your doctor is built into the fabric of society, and every time we're treated or cured, that belief is reinforced. That's part of why shipmen was so dangerous. Every ecstatic patient reinforced his image, luring more unwitting elderly people into his trap. By the end of 1994, after two years in private practice, he'd killed over a hundred patients with each murder, Shipman grew more cavalier.

After examining one patient, he told the man's son. I wouldn't buy him any Easter eggs. That patient had cancer, so Shipman's glib remark came across as dark humor until Shipman killed him the next week.

As time went on, it seems Shipman's urge to kill overtook his carefulness and paranoia, he grew reckless. Each unsign murder, further burnishing his ego and pushing him to take bigger, bolder risks.

On March six, 1995, shipments stopped by 81 year old Maria West's house. It was a scheduled visit.

He'd recently prescribed her pethidine tablets for arthritic pain. And Maria felt it wasn't helping. She wanted to change her prescription. Dr. Shipman found Marina alone in her living room.

They spoke for a few moments and then Shipman attacked.

He likely injected her with an overdose of pethidine or morphine. And within minutes, Maria was passed out in her chair dead. She looks tranquil. Her arthritis pain gone for good. Shipman decided to call Maria's son and inform him personally, he went to the phone and he bumped into Maria's friend, Mary Ann Hatfield.

Mrs. Hatfield had been visiting and was in the bathroom when Shipman arrived, she heard distant voices and waited for a few minutes to give Maria and her doctor some privacy. She had no idea she was in the middle of a crime scene. Shipman quickly explained that he turned around to access his bag, and when he looked up, Maria had collapsed and died. Naturally, Mrs. Hatfield wondered why Shipman did not try to resuscitate her friend, Shipman said there was no point, even if it worked, she'd come back as a vegetable.

Still, he made a show of checking Maria's non-existent pulse, then pushing open her closed eyelids and pointing out her dilated pupils, notably dilated pupils, are a sign of brain death. Shipman said all of these were clear signs. She was dead. There was no saving Maria. He wouldn't even call an ambulance. This was typical for Shipman and often accompanied by another step to prove a patient had died. He'd make a point of feeling the back of a patient's head and neck, supposedly checking for brain stem activity.

Shipman was appropriate in checking Maria's pulse and noting her dilated pupils, the lack of pulse and dilated pupils are the most common indicators of death. If you come across a patient that you assume is dead, the first thing you do is check to see if they're breathing. So you can do this by putting your ear to their mouth, putting your hand to their mouth. You also check at the same time for a pulse. And we typically check the carotid artery, which is that artery in the neck because it's the biggest artery and will give us the quickest and easiest information and feeling the back of the head and neck for brainstem activity was just theater.

The only way to examine brain stem activity would be through testing reflexes and not by touching the body in the general area of the brain stem. It's as if he pilfered his performance right out of a Hollywood movie.

Those weren't his only performances. On more than one occasion, Shipman claimed he had called an ambulance, but then said he'd cancelled it once it became apparent that the patient was beyond saving. Other times he pretended to call an ambulance but merely spoke to a dead phone line. The longer Shipman's killing spree went on, the more he pushed the bounds of trust with Maria West he'd killed almost immediately after arriving at her home. And when he lied about how Maria died, Mrs Hatfield, who was in the house when it happened, believed him.

At her death in 1995, Maria West became his 100th and fourth victim. Shipman must have felt unstoppable, Renata Overton's survived his attack and he still walked free. Marion Hatfield was in the house as he killed and he remained unsuspected. Within eight months, Shipman killed four neighbors as if he was trying to empty out the neighborhood. The surviving neighbors remained unaware. He took 30 lives in 1995. He killed another 30 in 1996, 37 in 1997. At 200, his victim count hit a number hard for most people to truly fathom the skyrocketing numbers.

Leave us with the question why it seems beyond addiction spiraling out of hand. Psychiatrist consulted during the Shipman inquiry suggested Shipman sought to control a common motive for serial killers. He may have feared death or been perturbed by it. If so, perhaps he felt the only way to fight death was to cause it. That would explain in part why Shipman killed so many elderly and ill patients. Another possibility is he saw death as the best prescription for his patients maladies, the only cure for their physical pain.

And with so many victims in fairly good health, he may have seen it as a cure for emotional pain to ship and sometimes attacked a group of friends or a couple one after another, and passed it off as the colloquial died of a broken heart. Shipman seemed to have a good relationship with his wife and perhaps he didn't like seeing long married spouses separated. He may have seen himself as a psychological healer, ending victim's grief as well as their physical pain.

This likely happened in the case of Mavis pick up in 1997. Dr. Shipman's patient, Kenneth Pickup, died naturally, leaving behind a grieving widow of 50 years.

Mavis Shipman assured the family that he would always be there for Mavis whether the support she needed was medical or emotional. Mavis and her family were so enamored with Shipman's personal touch, Mavis decided to leave him some money in her will.

He killed her three weeks later.

And though he likely killed Mavis to end her grief, it may have led Shipman to a new motive killing for financial gain, though he didn't act on it immediately. It stayed in the back of his mind.

After Mavis's body was discovered, Dr. Shipman was called to the pick up house to certify Mavis's cause of death. He brought his son along in the car and offered to show him the dead body. Shipman's son said, no, thank you. He stayed in the car watching as his father walked inside to cover up a murder.

But he wasn't the only one watching the pick ups. Neighbor Shirley Harrison had grown suspicious. She'd seen Shipman enter the house mere hours before Mavis died, and he he was back again. Shipman had been present when Shirley's aunt died the year before and something about him didn't sit right with her.

Shirley Harrison was right to be suspicious, but there was one thing she feared more than a possible serial killer being wrong. Coming up, Hyde locals grow more suspicious, but hesitate to challenge Dr. Shipman's impenetrable reputation. Now back to the story.

In the year 1997, Dr. Fred Shipman murdered 37 patients, the most he ever killed in a calendar year, though his victims were usually elderly and often ill. Some locals harbored suspicions about the so-called best doctor in Hyde. Shirley Harrison grew suspicious when both of her neighbors, the Pick-Ups, died within a month of each other. It had been less than two years since her aunt died and all three of them were Shipman's patients. But when Shirley thought about how to bring her concerns to light, she realized it might be more difficult than she'd anticipated.

Fred Shipman was extremely well liked, and any false accusations could make her a pariah in her small town. Shirley figured she was probably overthinking it and kept quiet. However, she wasn't the only one stifling doubts. Frank Massey and Son Funeral Home had served hyd for nearly a century when Deborah Massey Bamburgh and her husband took over as funeral directors in 1996. It wasn't long before Deborah noticed the high number of elderly women who had died of apparently peaceful heart attacks while home alone.

Deborah wasn't sure what was going on, but she knew it was not right. However, Deborah's father, Alan Massey, the former funeral director, trusted Shipman and brushed off Deborah's concern. They'd known Shippen for years and liked him. He was even Deborah's personal doctor. So Deborah kept quiet until February 1998 when she shared her suspicions with Dr. Susan Buth, Deborah's suspicions worried. Dr. Buth Boose worked at Brook Medical Practice across the street from Shipman's offices.

She was actually at the funeral home to complete a form C for cremation on Shipman's behalf in the U.K., Form C is an independent doctors verification of a cause of death and needs to be filled out in lieu of an autopsy before a person can be cremated in this country. In order to have a patient cremated, we go through the same exact steps. We have to document on a death certificate what the cause of death was, what secondary and tertiary causes of death were.

So there's really no difference between the paperwork involved and someone that's being cremated versus someone that's being buried. This exact same documentation and record keeping have become exaggerated over the years because malpractice oversight from insurance companies continues at full throttle. Doctors probably spend 25 percent of their day doing paperwork. The oversight issue is really there to protect patients as much as it is doctors.

So I think the more oversight, the better. And I don't think that we are too encumbered with this. I think there's a very real need for this primarily to protect the patients. In regard to Doctor Booth's, I'd hope she would gather evidence and secondary testimony, then contact the medical board.

Luckily for Dr. Buth, her associate, Dr. Linda Reynolds, had grown suspicious, too.

She'd begun keeping track of the cremation forms that practice verified for shipment between January and March of 1998. The Brook practice, which counted more than 9000 patients between all of its doctors, had just 14 deaths. Shipman, a sole practitioner, certified 16 cremations. When Shipman asked Dr. Reynolds to fill out another form C on March 17th, she couldn't sit on it any longer. Dr. Reynolds, after a discussion with the other physicians at her practice, brought her worries to the local coroner who took it to the Manchester police.

However, the police apparently considered it minor and appointed a single detective to investigate.

When former funeral director Alan Massey heard the police were investigating, he paid the good doctor a visit at his Market Street office. It appears that Massey felt Shipman had a right to know. Shipman appeared cool and unconcerned, keeping up a friendly conversation as Massey told him what people were saying. Massey conveniently avoided mentioning that people were his own family. In response, Shipman referred to his book of death certificates. He noted that anyone was welcome to the records and that nothing would appear out of the ordinary.

Massey left satisfied he wasn't involved in anything unscrupulous and business could proceed as usual. Shipman, on the other hand, did not proceed as usual.

From March 24th to May 11th, 1998, Shipman didn't kill once. Self-preservation was more important than feeding his addiction. Perhaps because of this, the detective couldn't find anything noteworthy, and the police investigation was closed due to lack of evidence. After only a few weeks on April 17th, it was closed too soon. On May 11th, Dr. Shipman killed Winifred Mella, perhaps seeing it as a lapse after attempting to quit cold turkey.

But when he murdered Joan Melior a month later on June 12th, Shipman's so he couldn't ever truly kick the habit.

All addictions can manifest themselves as behavioral addictions, and these can range from gambling addictions, sex addictions and even murder, like all mental health disorders, shipments was rooted in a chemical imbalance in his brain. The two chemical culprits that create these disorders are serotonin and dopamine, and they're imbalances are the root cause of all addictions. Addiction is a disease that takes many forms and murders. Unfortunately, no exception. Among a host of other catalyst shipments, insatiable addiction to killing was fueled by his insufficient dopamine levels, which manifested as an intense need for adrenaline.

The adrenaline rush shipment got from killing caused the release of dopamine in his brain, giving him a strong feeling of pleasure. And over time, he became hooked on that dopamine, which was reinforced by the adrenaline rush he felt for murdering his victims. Without that dopamine surge, Shipman felt immense stress and anger. Quitting would have been impossible for him for two reasons. One, he was getting away with it, and two, his underlying chemical imbalance remained untreated.

Decades earlier, shipments seemingly substituted his pethidine addiction with overdosing patients. But there was no bigger thrill, no riskier behavior to substitute for murder.

Or perhaps there was. For his next crime, he wouldn't only kill his victim, he'd rob her blind and he do it so blatantly, even the most NuVasive gumshoes would have to catch on. He took such great risk. Some of the psychiatrists consulted during the Shipman inquiry suggested the doctor wanted to be caught. The same paranoia that dogged him as he carefully concealed 23 years of murder may have finally bit he'd lost control of the situation. It's possible he couldn't stop himself from killing.

He must have known he would be stopped eventually. But he didn't know when or how. He could only take charge by being caught on purpose. So he decided to see how far he could push the bounds of the law. Around June 1998, Dr. Shipman began planning to kill a well-off widow and not just any wealthy widow. Her husband was once the mayor of Hyde. She was a woman well-liked and known throughout the community, a woman just as popular as Shipman himself, if not more so Kathleen Grundy.

And after he killed Kathleen Shipman, would steal everything she had, including multiple properties, investments and cash. Shipman may have planned for this to go one of two ways. Either he'd be caught and apprehended or he'd run away with the money knowing he was untouchable. Either outcome would assuage his paranoia. In early June, Shipman concocted a fake study on aging being done at Manchester University and asked Kathleen Grundy to take part in it. He just named her signature and some blood samples.

Kathleen had been going to Dr. Shipman for years and was more than happy to participate. On June 9th, Kathleen signed a form consenting to the study witnessed by two fellow patients who also signed the form. Little did they know they just provided signatures that Shipman would use to forge a brand new will, leaving all my estate, money and house to my doctor. My family are not in need and I want to reward him for all the care he has given to me and the people of Hyde, his schemes sealed with a narcissistic flourish.

Shipman's sent a copy of the will and accompanying cover letter to the Hamilton Ward law firm on June 22nd. It was addressed to no one in particular. No one at Hamilton Ward had ever worked with Kathleen Grundy. It was typed out on Shipman's personal typewriter and full of errors. Even more glaring, Shipman knew Kathleen's daughter Angela, was a lawyer who would certainly question it. Still, he killed Kathleen Grundy the morning of June 24th, 1998. At 4pm, he logged into his computer system and backdated false records.

This way, even if a toxicology reports came back positive, Shipman could point to symptoms of an opioid addiction in Kathleen's medical history. Despite that, he told her friends and daughter Angela, that she died of a heart attack and wrote on her death certificate that Kathleen died of old age.

Four days later, he sent a letter to Hamilton Ward claiming to be a John Smith, informing them of Kathleen's passing. It was time to execute the forged will. This alerted Angela's suspicion. She contacted the Greater Manchester police and a second investigation was launched.

Meanwhile, Shipman kept working, even obtaining more diamorphine. He could kill again at any moment when news of the investigation spread, no one in hide wanted to believe it. Most of Shipman's patients kept seeing him, and he operated business as usual for over a month. Kathleen's body was finally exhumed on August 1st, 1998, while they waited for results on the toxicology reports, the police searched Shipman's office and dug into his past. They found Kathleen's fake medical records, the typewriter.

The second will was typed on, and most damningly they found out that Shipman had passed convictions for drug abuse and forgery. And after Kathleen's toxicology reports determined she died of a morphine overdose, they had enough evidence to arrest. Shipman was taken into custody on September 7th, 1998, keeping in line with his earlier behavior, he directed his wife, Primrose, to answer the practices phones and inform everyone he'd be back to work soon. But this was just the latest lie.

Kathleen Grundy was his last murder. Shipman's cry for help had been heard, and he was finally forcibly stopped. However, as the police examined the case more carefully, they realised to their horror that Fred Shipman was responsible for more than one murder over the next few years. The authorities uncovered over 200 hidden crimes. Up next, the path to unmasking Britain's most prolific serial killer. Now back to the story.

When serial killer Fred Shipman was arrested in 1998, it wasn't because he'd killed hundreds of people, it was partly because he'd forged a will. It was the first and last will he forged had Shipman killed Kathleen Grundy. Like all his prior victims, he may have never been caught before this incident. There was virtually no way for victims families to catch him or stop him from killing again. So the ensuing investigation into Kathleen Grundy's death pulled the first threads in unraveling a string of murders within a month, the Greater Manchester police were investigating 28 suspicious deaths.

The trouble was, in most cases, there weren't bodies to exhume. They'd been cremated and their main suspect wasn't talking. Even when he was arrested in September 1998, Shipman held onto his cover, according to the Shipman inquiry. The doctor was patronizing and arrogant in police interviews. He maintained this veneer through October. Even then, he wouldn't confess. He simply refused to talk at all.

By December 1998, the authorities had exhumed eight more of Shipman's suspected victims and each tested positive for a narcotic overdose. Shipman was charged with all eight homicides, as well as seven counts where the victim had been cremated. In response, he shook his head, sobbing and gave no comment. On October 5th, 1999, Fred Shipman stood trial for 15 counts of murder and one count of forgery. Despite his not guilty plea, Shipman was convicted on all counts and sentenced to what amounted to life in prison.

In his sentencing, Justice Forbes said, none of your victims realize that yours was not a healing touch. None of your victims realized that you brought her death. Death, which was disguised as the caring attention of a good doctor. The realization of the monster Fred Shipman was a long time coming, but when it arrived, it was a tsunami. While he was on trial for the initial 15 cases, the police were already examining 23 more possible murders.

Unlike many criminal cases, Shipman was apprehended and imprisoned fairly early on in the investigation. The evidence for the 15 murders led to a quick conviction, but the revelations of his crimes were only beginning when Shipman was locked away in Franklin jail. Many who had kept their suspicions quiet came forward all over Hyde. Citizens questioned debts they previously accepted. Had Shipman killed their mother, too. How about Grandma? While most suspected one or two deaths, local cabbie John Shaw had a documented 21.

Shaw made a large part of his living chauffeuring the elderly around Hyde. In the mid 90s, an increasing number of Shaw's customers died unexpectedly. Shaw began recording the details of their deaths in his customer tracking system. The rising number was so unnerving, Shaw worried he was the real problem. He said, I couldn't believe what my suspicions were. My suspicions were so fantastic that I just couldn't I couldn't grasp what was going on. In my own mind, it was unthinkable.

But 19 of Shaw's 21 deceased customers were confirmed to be shipmen victims. A year after Shipman's conviction, the count of confirmed murders had risen to 192. The press dubbed shipmen Dr. Death. He was already behind bars for life, but with each new revelation, his once stellar reputation plummeted further. Still, Dr. Death refused to confess, but his silence didn't stall the investigation.

The police and Todmorden, where Shipman spent the first few years of his career, started digging to. They quickly turned up another 20 odd suspicious deaths. With hundreds of cases coming out of the woodwork, Shipman's case grew too large for the Greater Manchester police to handle. It was a case for the crown. In January 2001, parliament passed a resolution for a public inquiry into Shipman's career and crimes. Typically, public inquiries are used to investigate mass deaths and determine how to prevent them in the future.

They review events like plane crashes, natural disasters or acts of terrorism. And though they're funded by taxpayers, they operate independently of the government. This speaks to the scope of the pain Shipman caused his crime stretch beyond the police or medical boards straight to the top of the British government. It was a medical investigation on a massive scale in this country.

Almost all cases of investigations for medical malpractice are done through the state medical boards. It's very unusual, as in Shipman's case, to have these investigations reach the federal level. Medical investigations are set into motion when someone reports a doctor's misconduct to the state medical board. If the complaint gets approved, the board will assign an investigator to the case. After this, medical records may be collected, experts and witnesses can be interviewed, and even search warrants might be conducted depending on the allegations.

There have also been cases that required investigators to go under cover when the investigation is finished. The case is reviewed by the supervising investigator, who then recommends a course of action to the board. If homicide is suspected or alleged, the case is considered high priority and gets turned over to the police. As disturbing as these investigations are, the silver lining is that they become lessons for us. They also can shift policy, giving us the ability to prevent similar occurrences moving forward.

They really are grim learning experiences.

The Shipman inquiry found they had a lot to learn from the doctors hidden history, spearheaded by Dame Janet Smith. The Shipman inquiry spanned from February 2001 to January 2005. Their eventual findings were published in six different volumes, with hundreds of pages each. The statements collected during the hearing and Dame Smith's findings were extremely valuable resources for these episodes. The inquiry scoured Shipman's patient records and investigated those who had died while in his care. All in all, the inquiry considered eight hundred and eighty eight deaths and gave decisions and 494 of those cases.

By the end, they were positive. Shipman was guilty of two hundred and eighteen. However, many deaths were suspicious but lacked evidence. It's believed Shipman killed closer to 250 people. Unlike most serial killers, it was easy to pinpoint Shipman's possible victims. They were all documented in his patient records. This allowed a level of thoroughness most investigations don't have, in addition to examining patient deaths. The inquiry investigated how Shipman covered up his crimes, how he accessed large quantities of narcotics, and how the UK's General Medical Council failed the people of Todmorden and hide.

While the inquiry marched forward digging into Shipman's crimes and releasing their findings periodically, Shipman remained in the news. He was living what may have been his worst nightmare when he began killing. So he did everything he could to maintain control from his jail cell. He kept his mouth shut and formed a secret scheme. He may not have had access to drugs, but there was one final way to alleviate the pain he'd caused himself and his family. As a former doctor, Shipman was entitled to a hefty pension, the kind that would pass to his wife, Primrose, once he died.

If he passed away before turning 60, Primrose would receive a one time payout of 100000 pounds, followed by ten thousand pounds a year after. On January 13th, 2004, the morning before his fiftieth birthday, Fred Shipman was found hanging in his cell. It's actually not uncommon to see suicides and suicide attempts in prisons for obvious reasons, it's also not uncommon to see doctors take their own lives.

A 2013 study found that three to 400 doctors in the United States kill themselves each year. This alarming suicide rate is more than two times the rate of the general population. This is likely due to many reasons, including the stress that comes with being a doctor and the costs and interfacing with death. As a listener.

If you or someone you know is struggling with thoughts of suicide, know that there's always help available. The suicide prevention hotline number is one 800 273 8255. So if you suspect a friend or family member is considering suicide, please reach out as quickly as possible to either a health care professional or to that person directly. So they may get the help in time to save their life.

When news spread that Dr. Death had died, many victims were outraged. The details of his crimes were still coming to light, and he was supposed to spend years rotting in prison. Instead, he secured a large sum of money for his family and took any hope for answers to his grave. Even worse, after Shipman died, one cellmate alleged that the doctor confessed to 508 murders. That's over twice as many as the Shipman inquiry found. And if it's true, it's a devastating miscarriage of justice.

Even more devastating is the fact that he could have been stopped. The inquiry found that if Shipman had lost his license when he was investigated for drugs in 1975, he may have only taken a single victim even if he'd been put on probation as a result of the first investigation in March 1998, three lives could have been saved. When I think about Dr. Shipman's case, my first thought is feeling sorry for this man who did not get the appropriate mental health treatment that he needed.

With that, we would have saved hundreds of lives, including Dr. Shipman's shipments. Crimes demonstrate that regulation and oversight in the medical field need to be constantly scrutinized and doctors should necessarily be given the benefit of the doubt. Essentially, Shipman took the phrase, trust me, I'm a doctor and gave it a lethal injection. The case serves as a reminder to speak out against any form of malpractice as soon as you see it. It could very well end up saving lives.

From 2004 on, a variety of changes began to be made within the UK's medical community, new methods of submitting anonymous complaints about doctors were established, as well as new sanctions for doctors who failed to meet standards of care. The inquiry also recommended a change in culture to encourage doctors to report unsavoury behaviour when they witnessed it, something that had been in place in theory, but not in practice. In the years since shipmen was caught, the field did change.

The British Medical Journal opened its obituary for Shipman, with few doctors have had as great an impact on British medicine as Fred Shipman. But shipmen left us with another lesson that evil can work within protective boundaries and hide in paperwork and plain sight, you may think your town is free of serial killers even as they attack your family. Criminals always find ways to skirt the laws.

And like Shipman, some may even believe they're helping us.

Thanks for listening to medical murders and thanks again to Dr. Kipa for joining me today. Alastair, thank you so much for having me. And I'm really looking forward to next week's episode.

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.

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Medical murders was created by Max Cutler and his podcast Studio's Original. 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 Kepa and Alistair Murden.