Shipman method 'claimed patients within minutes'

The final moments of serial killer Harold Shipman's victims were outlined in detail yesterday as a hospital drugs expert explained the effect of the doctor's favourite method of murder.

Harold Shipman, convicted in January last year of murdering 15 elderly women, always killed by lethal injection of diamorphine.

Yesterday the public inquiry chaired by Dame Janet Smith into the deaths of the former Hyde GP's known victims and a possible 444 others heard that they would all have been dead within minutes.

Dr Henry McQuay, professor of pain relief at Churchill Hospital, Oxford, said the diamorphine would take effect swiftly, causing the person to stop breathing.

"If you do not breathe for three minutes then your brain will be starved of oxygen and you will die," the professor explained. "Breathing would become very slow and then stop within two minutes of the end of the injection. Lips would then go blue and then fingers and toes would go blue. Skin colour would become pallid, and death would follow," he added in a report prepared for the second day of the inquiry in Manchester.

A small dose administered intravenously would prove lethal to a fit person who had not previously used the drug, he explained. A patient injected with 30mg or more over a period of five minutes would be dead in less than double that time. And the effects of the diamorphine would be worse on the elderly, the very patients Shipman targeted, as kidney function is reduced.

The professor told lead counsel to the inquiry, Caroline Swift QC, that the standard dose used to deal with acute pain relief in an adult would be 10mg of morphine or 5mg of diamorphine repeated every four hours.

"The greatest amount I have ever administered is 15mg of diamorphine over about five minutes to a large Swedish man who had been out cross-country skiing and had broken his femur [thigh bone]," he explained.

Professor McQuay continued: "If someone has a horrid pain such as a broken thigh bone they would be given morphine bit by bit, then a bit more depending on how the pain was being managed.

"When there is pain there it is relatively safe to administer morphine. But if the person is not in pain there is no opposition to the potential for morphine to stop the breathing. It comes up against no barriers. Morphine travels in the bloodstream after injection until it reaches special receptors in the nervous system in both the brain and the spinal cord. When morphine reaches the pain receptors it binds to them causing any pain messages to be dampened down. It also depresses the rate at which we breathe and can cause constipation. This action is more apparent if the morphine is given to someone who is not in pain.

"A doctor should determine the appropriate dosage by a 'suck it and see' method. They would start using painkillers such as paracetamol and Nurofen to give them some idea what was needed. Injections of morphine and diamorphine are most commonly given in hospital emergency rooms, operating rooms, coronary care wards and intensive care.

"The amount of injections that a GP gives has gone down partly because of the use of paramedics," he said.

Yesterday a coroner criticised by families of suspected victims on the opening day said he was "saddened" by their comments. John Pollard came under criticism for the way he opened and adjourned 228 inquests without notifying relatives. Richard Lissack QC, speaking on behalf of the Tameside Family Support Group, said his clients had been "outraged" when they discovered the procedure had been dealt with in private.

Mr Pollard said: "I don't think it is in anyone's interests to involve ourselves in public recriminations and sparring. However, I have been saddened by what has been said. Throughout the Shipman inquiry I have tried at all times to, wherever possible, ensure the families' needs have been catered for."

The inquiry is also seeking information on a further 152 cases, though Dame Janet stressed some may not have been suspicious.

The hearing was adjourned until today when Dr John Grenville, an expert on GPs, is due to give evidence.