A homicidal doctor in Ireland would find it "relatively easy" to escape detection, a conference was told at the weekend.
Dr Rob Landers, consultant pathologist at Waterford Regional Hospital, said safeguards were needed to reduce the possibility of a Dr Harold Shipman-type case occurring in this State.
Shipman, Britain's worst serial killer, was convicted last year of murdering 15 female patients with lethal injections of heroin. A British government report concluded he may have murdered more than 300 people.
Dr Landers told members of the Coroners' Society of Ireland at the conference in Clonmel, Co Tipperary, that the conditions which enabled Shipman to get away with the murders for so long also existed in Ireland.
The system in both countries was similar in that it was largely dependent on doctors to certify patients' cause of death. "It would be relatively easy for a homicidal doctor to avoid detection, a la Shipman," he said.
It was extremely difficult to prevent this happening "if you have a Shipman character" working as a doctor, but steps could be taken to reduce the possibility.
A centralised registration system would allow better monitoring of death certificates and ensure that any unusual trends were detected. "Shipman was issuing over twice the average number of death certificates of any GP in his area but nobody was monitoring that at a central level and it escaped detection."
Shipman had also escaped attention by hand-picking elderly victims. He certified the deaths and, with nothing unusual apparent, autopsies were not required. The fact that he worked alone, and not in a large practice, also made detection less likely.
A centralised registration system could be set up through the existing coroners' service or a new agency "but it must be adequately resourced", said Dr Landers. A further safeguard would be to have more autopsies in cases of sudden death.
"It is up to the attending doctor in each case, but I would advocate that any doctor who is unsure about the cause of death should report the case to the local coroner and request an autopsy," he said. It was often in the interests of family members to have an autopsy carried out as it might establish that the cause of death was due to a familial or inherited condition.
Ms Mary Begley, the suicide prevention strategy co-ordinator with the Mid-Western Health Board, told the conference that families of suicide victims required more information about the role of coroners and the purpose of inquests.
The board had conducted a survey of 36 families of people who had committed suicide, and all had suffered sleepless nights in advance of the inquest, she said. "There is a tremendous sense that at the inquest they will be told something to clarify that they were to blame."
She said people bereaved as a result of suicide were 20 per cent more likely to commit suicide than other members of the population.
Support groups operated in each health board area and she would encourage families affected by suicide to contact the board in their region.
