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'Dr. Death' toll was 215 murders

Relative of Shipman
Christopher Rudol grieves for his father who was a victim of Shipman

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MANCHESTER, England (CNN) -- English family doctor Harold Shipman -- known as "Dr. Death" -- killed 215 of his patients over a 23 year period, a year-long inquiry has found.

Shipman, 56, a doctor in the town of Hyde near Manchester, is confirmed as Britain's worst serial killer -- despite continuing to deny the murders. (Priest urges Shipman to admit guilt)

According to the inquiry head, High Court Judge Dame Janet Smith, Shipman may have been "addicted to killing."

Smith's first phase report of a detailed inquiry into the case is highly critical of the way the general practioner was able to murder so many.

Relatives of patients killed by Shipman said they were "vindicated" in their fight to have a public inquiry, rather than private one as the UK government first proposed. (Families' reaction)

Shipman is serving a life term in prison for 15 murders of which he was found guilty in January 2000.

The cold killer despatched his victims -- mostly elderly women -- with large amounts of diamorphine, or heroin, from 1975 to 1998, the 2,000-page report released on Friday concluded. (Shipman: Silent slayer)

Smith looked at 887 cases of Shipman's dead patients. She immediately dismissed 394 of those cases as death from natural causes.

Of the remaining cases, she found 200 were intentionally killed by Shipman -- on top of the 15 for which he has been convicted --, 210 died from natural causes, and 45 were "suspicious." There was not enough evidence to arrive at a verdict on 38 more cases.

"He betrayed their trust in a way and to an extent that I believe is unparalleled in history"
-- Dame Janet Smith

In 1976, Shipman was convicted of drug addiction for his use of pethidine and vowed not to have access to controlled substances.

However, the inquiry found Shipman had access to large amounts of diamorphine. Once he used 12,000 milligrams of the drug to end the life of a terminally ill patient -- an amount that could kill over 300 people.

Although his motive for the killings was not entirely clear, the report concluded that Shipman began ending the lives of terminally ill patients and then moved on to patients that he found annoying or uncooperative.

The first-stage report criticises medical and legal systems that allowed Shipman to get away with it for so long. (System's 'Failures')

The second phase of the inquiry will focus on how Shipman went undetected for so long and what changes should be made to make sure it can never happen again.

The trail to Shipman's conviction began when he was found to have changed the will of his last victim Kathleen Grundy, 81, in his favour. But that was the only evidence that Shipman had acted for monetary gain, the report found.

Serial killer Shipman received 15 life sentences
Serial killer Shipman received 15 life sentences

Smith said the fact that Grundy's daughter was a solicitor, that Shipman had carried out an incompetent forgery and the way in which he arranged to have the altered will delivered to the family solicitor "made detection inevitable."

Smith said: "It is hard to resist the inference Shipman was driven by a need to draw attention to himself and his crimes."

Ann Alexander, a lawyer for many of the relatives, told CNN the families were "finding it very difficult to come to terms with the decisions made."

"It is the first time that they are actually really finding out what happened.

"And of course, if they were murdered, it was by somebody the families trusted a great deal -- their doctor."

Prime Minister Tony Blair's official spokesman the horror of the Harold Shipman affair should not "erode the bond of trust" between doctors and patients.

A Greater Manchester police spokeswoman said Shipman would not be prosecuted for any further murders because of the virtual impossibility of finding a jury unaware of his previous history.

Earlier this month, British Home Secretary David Blunkett ruled that Shipman must spend the rest of his life behind bars.

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