The public inquiry into the mass murderer Harold Shipman will last for two years, but it took little more than an hour yesterday to plunge his victims' families back into the familiar, unsparing details of his modus operandi.
In one of the more awful moments of his murder trial last year, the families saw Shipman, who always killed by lethal injection of diamorphine, use his own arm to indicate where he tended to place the needle.
Eighteen months on, at the inquiry which will examine 459 possible Shipman murders, 40 family members were told the precise measurements of powdered diamorphine that the GP would have added to sterile water before packing phials of the drug in his doctor's bag and setting off to kill. Thirty milligrams could finish a victim within five minutes, suggested Caroline Swift QC, counsel to the inquiry.
The detail was designed to illustrate Shipman's murderous proficiency. Just one of the 12,000mg diamorphine ampoules, which remained unaccounted for after he procured it in June 1996, could have killed 400 people alone.
Yet Shipman's almost charmed capacity to evade police, the Home Office and medical authorities and stockpile drugs in the 1970s the most prominent theme of the inquiry's opening day at Manchester town hall provided miserable proof that he should probably have never even made it to Hyde, Greater Manchester, where he killed at will.
The inquiry's preliminary investigative work has drawn up evidence from Home Office and General Medical Council files establishing that Shipman had at least five complete let-offs, having stockpiled the painkiller pethidine to feed an addiction in the Seventies. Decades later, a six-week Greater Manchester Police investigation in 1998 failed to detect his killing.
The 55-year-old former GP who will remain in Frankland Prison, Durham, where he is serving 15 life sentences, throughout the inquiry had been in general practice for less than a year at Todmorden, West Yorkshire, before attracting the attention of the Huddersfield drug squad and Home Office inspectors in 1975 by his practice of obtaining pethidine.
A West Yorkshire Police detective investigated but found no evidence of drug abuse. "It would appear Dr Shipman is held in some esteem by [pharmacists] and is described as efficient and confident," he concluded.
The next escape came within months, said Miss Swift, when a local pharmaceutical company found itself supplying abnormally large amounts of pethidine to branches of Boots to meet orders from Shipman. Two Home Office inspectors and detectives saw him and found him "relaxed with a confident manner [and] no impression of being concerned about being questioned."
Shipman could not provide a register of the patients he prescribed pethidine for, but escaped with advice on how he was required to do so, despite the fact that the Home Office inspector was "not entirely satisfied" with his story, the Home Office files show.
It took further invoices from Boots, showing more unregistered pethidine, before Shipman was confronted by colleagues, resigned and sought psychiatric help from The Retreat, a clinic at York.
At first, he refused to speak to a West Yorkshire Police detective sergeant at the clinic but later admitted taking the drug intravenously from September 1974 to overcome depression attributable to "difficulties" with his partners. He bared his arms to show his collapsed veins.
After admitting that he had been taking up to 700mg of pethidine a day and had forged the signatures of nursing home staff to acquire it, Shipman gave a written undertaking that he had "no future intention to return to general practice or work in a situation where I could obtain a supply".
He faced six specimen criminal charges in 1976, asked Halifax magistrates to take 74 more into consideration, and was fined £600.
The evidence of the 74 charges has all been destroyed or lost, forcing the Shipman inquiry team to rely on local press cuttings to draw evidence on the case.
The General Medical Council drew instead on the testimonies of psychologists and Durham health authority, for whom Shipman had started work as a clinical officer, when deciding whether to strike him from its register. Both reports were positive. The psychologists even warned against Shipman being barred from general practice. "It would be to his advantage if he was allowed to continue in practice and clearly it would be catastrophic if he was not ... allowed to continue," they concluded in a report which hindsight imbues with grim ironies.
This bought him two more "escapes". The GMC decided not to discipline Shipman, and the Home Secretary, who could have prevented him prescribing, administering or dealing with drugs, decided to take no further action either.
"Shipman was therefore free to practice wherever and in whatever manner he chose, and almost exactly two years after indicating he had no intention of doing so, he chose to return to general practice," Miss Swift told the inquiry.
It was a sequence of events that left Shipman destined for Hyde, where in October 1977 he joined the Donneybrook group practice, becoming respected for his "honesty" and hard work and so popular with his patients that he took most with him to the one-man practice he set up in nearby Market Street, 14 years later (much to the annoyance of Donneybrook).
A letter from him demanding more money from an NHS Appeals Tribunal in August 1998 demonstrated how infinitely sure of his own power base he was by then.
"[I run] a flagship practice," he said. "The health authority can always compare this practice to any other and ask why the other practice is underperforming."
It was that kind of self-confidence that commanded the respect of ordinary people like Elsie Cheetham, her husband and her neighbour, who had been brought up to respect the doctor and were all probable recipients of Shipman's powdered diamorphine.
Elsie lived at 17 Garden Street in Newton, Hyde, with her husband of more than 50 years, Thomas.
At number 15 lived Sidney Smith and his brother Kenneth.
Sidney died unexpectedly, aged 76, after an unannounced visit from Shipman in August 1996. The death had distinct Shipman hallmarks. No previous sign of illness; the victim was able to shop on the morning of his death, but perished during the five minutes his brother Kenneth was away in the kitchen, giving Sidney and his GP some privacy.
Elsie cared for Kenneth after Sidney's death, often bringing him meals, before her own husband also in good health died after a visit from Shipman made in the short time she was out delivering Kenneth's lunch and playing bingo.
With two of those close to her dead, Elsie felt ill and called Shipman, who insisted on visiting her. She was dead within the day. An inquest into her death has concluded she was killed unlawfully.
The cases, detailed for the first time yesterday, demonstrated what Richard Lissack QC, the barrister representing the families at the inquiry, described as Shipman's "organised murder" as he "moved unchecked through families, streets and bit-by-bit murdered the heart of a community".
Shipman's "callous, matter-of-fact" style was typified in his surgery visits book, said Mr Lissack. "Elsie Cheetham funny do," it read.
It was probably just another familiar story to those families who heard it in the public gallery. But quite how many of them have the stomach for all the painful details in an inquiry that they fought for 18 months to have staged in public remains uncertain.
In Hyde public library, a video link has been provided from the inquiry for those locals who cannot face the media glare and do not wish to travel to Manchester. Only eight people materialised there yesterday. One was a solicitor and one a voluntary worker providing victim support.
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