Serial killer Peter Tobin was suffering from cancer at the time of his death, which had gone undiagnosed for years as he refused medical tests, a fatal accident inquiry heard.
Tobin, 76, died on October 8 2022 in Edinburgh Royal Infirmary, a month after a fall in his jail cell in HMP Edinburgh where he was serving three life sentences for the murders of young women who vanished between 1991 and 2006.
The death occurred 16 years and a day after his first appearance in Glasgow Sheriff Court on October 9 2006, for the murder of Polish student Angelika Kluk, 23, whose body was hidden under St Patricks Church in Glasgow, where convicted sex offended Tobin worked as a handyman.
Tobin was also convicted of the murders of 15-year-old Vicky Hamilton and 18-year-old Dinah McNicol, whose remains were found under the patio of his former home in Margate, Kent, in November of 2007.
Miss Hamilton was last seen on 10 February 1991 as she waited for a bus home to Redding, near Falkirk, from Bathgate, West Lothian.
Serial killer Peter Tobin was suffering from cancer at the time of his death, an inquiry found
Tobins confirmed victims were (left to right) Angelika Kluk, Vicky Hamilton and Dinah McNicol
Tobin, 76, died on October 8 2022 in Edinburgh Royal Infirmary, a month after a fall in his jail cell in HMP Edinburgh (pictured)
Miss McNicol disappeared in 1991 after leaving a rave in the Home Counties.
A fatal accident inquiry (FAI) into Tobins death in custody, heard that he was diagnosed with dementia in December 2020, and suffered from a litany of health problems, including strokes, dizziness and chest pains. He used a walking stick and wheelchair.
The court heard that cancer had been suggested as long ago as 2016 but Tobin was unwilling to undergo testing.
Procurator fiscal depute Richard Brown said: On September 8 2022, Mr Tobin was being held in HMP Edinburgh, his cell was opened by a prison officer to allow him to collect medication.
Mr Tobin had taken steps without a walking stick, he was reminded he didnt have a walking stick, and he fell and landed on his side.
The prison officer reported he was in pain but okay, and a nurse and prison officer helped him onto his bed.
Tobin was admitted to the Edinburgh Royal Infirmary and, the following day, underwent surgery for a fractured right hip.
Tests also established he was suffering from metastatic prostate cancer and delirium, as well as hospital-acquired pneumonia.
Peter Tobin is taken from Dundee High Court on December 2, 2008 in Dundee, Scotland
A knife found buried with Vicky Hamiltons remains, which was vital forensic evidence at trial
Tobin was admitted to the Edinburgh Royal Infirmary and underwent surgery for a fractured right hip
Tobin was warned he was unlikely to survive and died less than a month after the operation.
GeoAmey staff reported that he was speaking incoherently shortly before his death which was confirmed at 5.45am on October 8.
Mr Brown said: Mr Tobin was seen by the palliative care team and effort was made to make his condition comfortable.
Mr Tobin was told it was unlikely he would be discharged from hospital.
He had a Do Not Resuscitate Order which meant medical staff could not restart his heart.
He was monitored at all times by officers from GeoAmey.
He added: Mr Tobin was in bed and was described as breathing heavily in the early hours. He was speaking incoherently.
An officer guarding Tobin went to alert a nurse due to concerns at about 4.35am and death was confirmed an hour later.
On October 12 2022, a post-mortem examination confirmed the cause of death as bronchial pneumonia in a man with a fractured right neck of femur (surgically treated on September 9 2022), generalised vascular disease and prostate cancer.
A review was carried out to see if areas of learning could be established.
Sheriff Matthew Auchincloss said: I will be issuing my determination as soon as possible.