Shipman's morphine doses followed 'unusual pattern'

Harold Shipman administered more injections of diamorphine in a single month than most doctors dispense in their entire career, the public inquiry into his murders heard yesterday. But although pharmacy records detailed the amount of morphine that Dr Shipman was using to kill his elderly patients, his lethal prescriptions were never picked up.

Doctor John Grenville, an expert on general practice, told the inquiry that Dr Shipman had an "extremely unusual pattern" of prescribing the painkiller which should have been spotted.

Shipman was convicted in January last year of murdering 15 of his elderly female patients by injecting them with a lethal dose of diamorphine.

Chemists' records show that during one three-month period, he prescribed 30mg injections of diamorphine to 12 different patients – doses strong enough to kill a fit and healthy person.

Dr Grenville said he had given just four diamorphine injections in a 20-year career. "It is very difficult to see why he would give a single dose like that to so many people. I can't imagine any circumstances when you would prescribe that individual dose to an opiate-naive patient."

He told the hearing in Manchester that 10mg of the drug should be enough to ease pain. Most GPs carried two ampoules, or 15mg of morphine, for emergencies such as accidents, but they would not expect to use them.

Dr Grenville added that it was "extremely rare" for patients to die in front of their doctor with no one else in the room or for them to pass away just hours later. Hundreds of Shipman's patients died during or after a visit from the doctor, of Hyde, Greater Manchester, was in practice for 25 years.

Dr Grenville said he had been present at just two patients' deaths. "The vast majority of such cases are where the patient is known to be terminally ill and the doctor has been visiting the patient at home on a regular basis at the end of the patient's life."

Shipman claimed his victims had suffered heart attacks, strokes, or had died as a result of bronchopneumonia. But during his trial, witnesses revealed the dead patients were often found sitting up or lying on their beds fully clothed.

Dr Grenville told the inquiry, which is investigating the deaths of 459 of Shipman's patients, that this did not fit with the causes of death recorded by the doctor. A person who was suffering heart failure would loosen their clothes, open doors and windows and attempt to seek help, he said. They would be found lying on the floor, slumped sideways, reaching for a phone or in distress.