How careless doctors kill patients with morphine

Written by Azoma Chikwe, DAILY SUN - Nigeria

How careless doctors kill patients with morphine

On January 31, 2000, the world was served with a rude dish that changed the face of medical practice. A British medical doctor was convicted of murdering hundreds of his patients with an overdose of the narcotic analgesic, morphine. His victims were estimated to be between fifteen and two hundred and sixty, making him the most prolific killer in the world.

Almost overnight, medical doctors all over the world, once revered by their patients, turned into scary, suspicious Little Greens with murderous intent. Patients questioned medication given to them and seek clarification for prescribed procedures. Litigations sprung up everywhere and health institutions hastened to promulgate laws to safeguard their populace from killer doctors. Everyone wanted to prevent another Dr. Harold Shipman from springing up in their respective jurisdiction.

Dr. Solomon Ojehonmon is the Managing Director/Chief Executive Officer of Open Door Hospital in Egbeda, Lagos. He is also the author of "The Last Methuselah" and "The Vulcan Code." This article is extracted from his soon-to-be-published book "The Last Immigrant."

He stated: "Like the rest of the gullible world, I swallowed the story hook, line and sinker. Why shouldn't I? Before his arrest, Shipman was a respected British family physician, who ran his own practice in Hyde, Greater Manchester. His alleged victims were mainly Britons. He was arrested by the Met Police, reputed to be one of the best police forces in the world, and was convicted by an all British jury in a British court. There was therefore no question of racism, religious bigotry or social prejudice in this case. It was clear-cut: Shipman was guilty of the sin. He was sentenced to life without parole.

"Few years afterwards I travelled to Britain and worked in some NHS hospitals as a healthcare professional. Two things were immediately apparent to me. Unlike in Nigeria where doctors practically live in the wards, the doctors in Britain are mostly call-room based. The nurses and other healthcare workers take care of the patients on a day to day basis.

"The second significant observation is that the drug morphine is still much in general use and it is the drug of choice to control pain for chronically ill-patients. The most common application these days is a slow-release topical patch usually applied to the back or thigh of the patient. The drug is then absorbed through the skin to reduce pain and induce drowsiness.

"But it also has a dangerous side effect: respiratory depression. Most victims of this side effect usually drift off to sleep and onward to deep coma as their respiration is depressed and toxic substances accumulate in their cells. Without prompt, professional intervention, they often die in their sleep.

"In my first week in a hospital, I witnessed the devastating effect of this drug on two different occasions, and then several times afterwards. In the first case, a patient was discovered died in his bed. A doctor stealthily removed the morphine on his thigh patch and stalked off to write his report. Minutes later undertakers descended on the ward to wheel the corpse to the morgue.

"The second incident occured a couple of days later. Fortunately, I was the support worker directly in charge of the patient. I watched him gradually lapse into coma after a morphine patch was attached to his back. It was fruitless trying to convince the nurses that the man, who had terminal cancer, was indeed unconscious, not just sleeping or dying from his illness. Fortunately, a doctor chanced by and I approached him. The doctor removed the morphine patch and administered naloxone, the antidote to morphine toxicity, to the patient. Within minutes the patient was revived.

"Those two incidents cast the first seed of doubt in my mind about Shipman's guilt. Did the doctor administer morphine to the victims and left them to the mercy of nurses, healthcare assistants and support workers who couldn't recognize the deadly complication of the drug and thought their patients were only sleeping, until they died of respiratory depression?

It was unsurprising when, a few weeks later, a top medical doctor wrote in a daily newspaper to caution his colleagues in the NHS on the use of morphine, a warning that went largely unheeded.

"A while later, a TV station advertised a documentary on Shipman. Coincidentally (or was it deliberate?), the documentary was scheduled exactly same time Britain was playing a very important international football match, which was being aired in another station.

"As it turned out, it was probably the most boring documentary I had ever seen. I kept waiting for the big revelation, even the tiniest one, which never came. All that was told was how Shipman's mother died of morphine toxicity while suffering from lung cancer and that may have affected his psyche. A long and tedious history into Shipman's childhood followed; his health, diet, love for sport and relationship with peers, all of which added nothing to the story. Then, of course, he started killing his patients after he became a doctor. The film ended there and then.

"The next morning I expected a massive uproar on the streets of Britain; people demanding why they had been so blatantly conned but I only saw a very small article in one of the newspapers. The writer complained that the documentary did not live up to his expectation.

"The conspirators [I will call them the conspirators from this point onward] knew they were lucky; obviously saved by the football match. But there were still muted dissents among some Britons who were not wholly convinced of Shipman's guilt. The conspirators have to come out with something fast to quell the looming mutiny.

"They proposed another documentary, which they promised would be more expository. About a year later that film was also aired.

"That second documentary turned out to be an insult to human intelligence in every sense of the word. It was indeed outrageous; not even worth the dreaded slush pile. Amidst personal opinions and a lot of speculations, all of which rested on the thinnest of glasses, the central theme emerged about a cab driver who once drove Shipman to a patient's house and learnt she died afterwards. The driver then turned an unpaid sleuth, shadowing Shipman and observing that anytime he visited a patient, the person died afterwards. He did this over a decade and even kept a diary. The story was delivered with utmost hesitancy, insincerity and mediocrity, and had not a single ring of truth to it. But, more bizarrely, the story and diary were accepted as a proof of Shipman's guilt. It was unsurprisingly the only substantiate evidence [even if highly improbable]in the entire documentary. The others were mere personal opinions, speculations and deductions.

"A lady gave an account of what happened on the day she lost her mum. She said her mum had been sick of terminal cancer but on that fateful day, she knew her mother was dying. Shipman was summoned. He attended to the sick woman. Later that day her mum died. There was absolutely no suspicion of foul play then but a decade later she was told Shipman murdered her mother. Even with all the time that had elapsed, she still looked and sounded bewildered and unbelieving.

"She actually used the word "dying". What wasShipman supposed to do? Surely, nobody expected him to play God and cure the woman of her cancer and old age, or even cure the complication that was causing her death. Referral to a secondary health institution may also be out of it, especially in a culture where homecare is largely the norm and most patients prefer to be treated and even die in the familiar comfort of their homes rather than in a hospital.

"Shipman treated her with morphine as is still the practice in most hospitals in Britain today. When she was calmer, he left her to the care of her caregivers.

"Most of the other relatives narrated similar experiences. They knew their love ones were dying before Shipman was called and were perplexed decades later to learn he killed them all. Most described their late love ones as aged with chronic illnesses.

"The question however is whether Shipman deliberately administered overdose of morphine to these people or if he administered honest enough doses but the patients either died of their illnesses or succumbed to the side effect of morphine because of their already compromised state. After witnessing the havoc the drug is still causing in Britain, even with normal doses, the relatively newer and safer topical patch as opposed to intravenous formulation during Shipman's era, and on much healthier patients, I am inclined to go with the latter, especially as some people are more susceptible than others and morphine toxicity isn't entirely dose-dependant.

"Suffix to say, with the liberal way morphine is still being used in Britain, if the bodies of those who died of chronic illnesses, especially cancers, since Shipman's arrest, were exhumed and autopsied, ninety-nine percent, if not all, will show traces of morphine as it can remain in a corpse without decaying for decades.

"Shipman denied the allegations of course. A clip of the court trial was shown in that particular documentary. It presented another baffling aspect of the case. The commentator claimed Shipman did not utter a single word all through the cross examination even as allegations upon allegations were heaped on him. The reason for his silence was more than obvious. After trying in vain to proclaim his innocence and vehemently denying the charges, the doctor must have realized nothing would change the situation at that time. Of course he was bidding for time. After the euphoria had died down, when people are ready to listen, only then would he speak out.

"Shipman was sentenced to life, but the conspirators knew they were not out of the woods yet. So they coerced the doctor to confess to a script they wrote and to sign the confession. He refused of course. They became brutal towards him. Privileges were denied him, correspondence with the outside world was withdrawn, and even access to his beloved wife Primrose was halted. His life was made a living hell on earth in a desperate bid to force a false confession out of him but he refused to bulge.

"Time was fast running out and embarrassment loomed for the conspirators. They were bailed out once again in January 13, 2004, when the world was shot with the news that Shipman hung himself in prison with his bedspread, an event that was as unexpected as mother earth suddenly becoming the sun in the twinkle of an eye.

"In spite of the phony attempts of the conspirators to celebrate Shipman's death, the melancholy on the streets of Britain on that fateful day was palpable. The former Home Secretary David Blunkett aptly summarized the general mood when he said: 'You wake up and you receive a call telling you Shipman has topped himself and you think, is it too early to open a bottle? And then you discover everybody's very upset that he's done it'.

"Let us elaborate on some of the incidents that led to Shipman's arrest and salient points in the trial. One of Shipman's patients, Kathleen Grundy, a wealthy 81 years old widow, and a former mayoress, was found dead in her home. Initiate reports depicted her a very ill woman, though recent accounts [as in almost every facet of this case]countered otherwise.Anyhow, she left a huge sum of money to Shipman in her will, largely leaving out her own daughter Woodruff and her children. Woodruff shouted foul play when the will came out and reported the case to the police.

"Kathleen Grundy’s body was exhumed, and post-mortem detected traces of morphine in her system. Shipman’s home was raided, which yielded a collection of jewelry and a Brother typewriter, suspected to be the instrument used to forge Grundy’s will.

"The bodies of some of his former patients were exhumed and traces of morphine were found in them. The conspirators then simply applied the "all or none" formula, which is if Shipman is suspected of killing one patient, then he should be suspected of killing all his patients, most dating decades back, even those whose bodies were cremated, hence no evidence whatsoever that they were ever administered morphine, except that they were Shipman's patients at one stage or the other.

"So, while Dr. Harold Shipman was trying to absorb himself of the initial allegations, the deaths of all the other patients under his care during his decades of practice were slammed on him. Hundreds of them, from left, right and center; an obvious ploy to break up his resistance. Little wonder he clamped up.

"Woodruff's suspicion was fueled by the emergence of the will. Meaning if her late mother had been a poor woman with no money to bestow, Shipman would still be her darling family doctor, someone who attended to her mum and made her last moments on earth bearable. It was only when the will came out and money was left to him that Shipman suddenly became a murderer and a forger. Was this charade all about the money then, especially as the English people are mighty touchy when it comes to anything money?

"It was never confirmed that Shipman's typewriter was the actual one used to write the will. Brother typewriter is indigenous in Manchester [there was a production factory somewhere in greater Manchester]and should be in thousands of homes in the locality at that time. Does that make the other owners killers and forgers?

"The dissent became more palpable even after Shipman's death. What the conspirators next came up with made the nonbelievers took to their heels and burrowed themselves deep in the wilderness.

"They announced that a cache of jewelry was found in Shipman's home. It totaled about a hundred items and they believed the doctor stole them from his victims, in spite of Shipman's wife Primrose frantic claims that the jewelry belonged to the family.

"It was a sucker punch nobody would argue against: the ultimate irrefutable proof that Dr. Harold Shipman was not only a serial mass murderer but a forger and a thief as well. The doubters would have wondered how they got it so wrong all along.

"The conspirators went to town with their latest blitz. They challenged anyone to refute the evidence. Nobody did. They gave their backs to those who cared for a pat, and got plenty of it.

"The D-day came. The items were put on display and close relatives of Shipman's victims were invited to make their pick.

"After what must have been a very frustrating process only one of the items was returned. The other families couldn't identify the rest of the jewelry as belonging to their late relatives. Even the sole item that was returned was based on probability. A family believed their late one had a similar gem but were not absolutely sure it was the same. They were handed the jewel all the same.

"Sixty-six of the jewelry was later handed back to Mrs. Primrose Shipman while thirty-three items she wasn't absolutely sure of were given to charity.

"So that is the irrefutable evidence: a debatable one out of a hundred. In mathematics, that represents one percent. A well-love doctor was arrested, convicted, died a questionable death and his name bastardized forever based on one percent irrefutable evidence. Not even a mobile phone battery will function on one percent power. In science and mathematics, one percent is inconsequential and should never have been used to convict a man.

"And that had been the trend in every aspect of this case. Claims, counter-claims and confusion, even among the same people, reigned supreme with not even the tiniest of strands to hold on to.

"Dr. Harold Shipman is not a killer. He is a scapegoat of a flawed system that relied heavily on the use of morphine and of some romantic yo-yos hell-bent on creating a serial killer of him and making a name and some money in the sideline for themselves. The blood of this innocent man is in the hands of those who knew or suspected the truth but prefer to turn a blind eye and remained mute. Unfortunately, evil thrives where good people put a lock on their mouths. The so-called victims of Shipman will be churning ferociously in their graves at the cruel and shameful way their beloved and trusted doctor was dehumanized, and will kill sleep for the connivers and their collaborators. It is high time to right this lamentable and monumental wrong. People must speak out, and an international independent enquiry to look into the case must be set up."