Serial killer Peter Tobin was suffering from dementia, vascular disease and prostate cancer and had contracted pneumonia when he died in 2022, a fatal accident inquiry has heard.
Tobin was serving three life sentences for the murders of Vicky Hamilton, Dinah McNicol and Angelika Kluk when he sustained a broken leg during a fall in his cell at HMP Edinburgh on 8 September 2022.
He was taken to hospital the following evening, but died a month later on 8 October at Edinburgh Royal Infirmary aged 76.
His ashes were scattered at sea after no-one came forward to claim his remains.
Tobin had been receiving palliative care before his death due to worsening health.
He was monitored by officers from custody service firm GeoAmey at all times while he was in hospital.
The Crown Office and Procurator Fiscal Service (COPFS) ordered the fatal accident inquiry, which is mandatory for any prisoners who die while in custody, in April.
Its findings revealed he had multiple health issues, including previously undisclosed vascular dementia.
Tobin was diagnosed with suspected prostate cancer in 2016 but was unwilling to undergo further testing.
In December 2020, Tobin was found to have vascular dementia.
He had also suffered strokes and mini-strokes, chest pain and general confusion, and used a wheelchair and walking stick because of mobility issues.
On 8 September 2022, Tobin was leaving his cell to get medication when a prison officer pointed out he wasn’t using his walking stick.
Tobin went back into his cell and fell on to his side.
He contracted pneumonia in the hospital after undergoing surgery, where tests confirmed he had prostate cancer which was progressing.
He was also suffering from delirium, linked to his dementia.
Principal procurator fiscal Stuart Brown told the inquiry that a palliative care team took over his care.
“Efforts were made to make his condition comfortable,” he said.
“Mr Tobin was informed that his general condition was declining and it was unlikely he would be discharged from hospital.”
A “do not attempt resuscitation” order was put in place.
A month after his admission, GeoAmey security officers who were monitoring Tobin alerted medical staff when his breathing stopped.
He was pronounced dead and the police were informed.
The cause of death was determined as pneumonia in a man suffering from a fractured femur, generalised vascular disease and prostate cancer.
None of the evidence led by the inquiry was disputed and no recommendations for changes to prison or hospital procedures were made.
Sheriff Matthew Auchincloss will issue his findings in writing at a later date.
Killer unmasked
Tobin was only revealed to have been a serial killer after the remains of his final victim, Ms Kluk, were found under the floor of a church in Glasgow in 2006.
He was later convicted of raping and murdering the 23-year-old.
A UK-wide investigation later tied him to the killings of 15-year-old Vicky Hamilton and 16-year-old Dinah McNicol, who both disappeared in 1991.
The two teenagers’ remains were found in the garden of a home previously belonging to Tobin in Kent.
He is suspected of having been been involved in the murders of several other women.
Investigations into his background revealed he had lived under more than 40 aliases and owned more than 150 cars.
Police Scotland said unsuccessful attempts had been made to prompt Tobin into revealing information about other suspected victims towards the end of his life.