 In her sixth and final report, issued on 24 January 2005, Smith reported that she believed that Shipman had killed three patients, and she had serious suspicions about four further deaths, including that of a four-year-old girl, during the early stage of his medical career at Pontefract General Infirmary.In total, 459 people died while under his care between 1971 and 1998, but it is uncertain how many of those were murder victims, as he was often the only doctor to certify a death.Smith's estimate of Shipman's total victim count over that 27-year period was 250.