A NURSE who cared for a patient allegedly murdered by his doctor told a court yesterday of her shock at his death.

District nurse Lesley Roberts said she visited Frank Moss at his County Durham home twice in the hours before he died, but he did not appear to be suffering from pain.

At Teesside Crown Court yesterday, she told the jury that Mr Moss, who had lung cancer, had not deteriorated in health since her visit the week before.

She visited his home in New Row, Eldon, Bishop Auckland, at about 10.30am and 1.30pm on March 13, 2003, but was surprised to be told the next day that he had died in the early hours.

The nurse said: "I was very shocked. I was expecting to visit him the next day and possibly for another couple of weeks.

"He did not appear to be suffering from any pain. He made no complaint."

Dr Howard Martin is accused of killing 59-year-old Mr Moss, Stanley Weldon, 74, of Coundon Grange, and Harry Gittins, 74, of Newton Aycliffe, between March 2003 and January last year, by administering lethal doses of morphine. He denies the charges.

At the time of the alleged offences, the 71-year-old was a GP and partner in the Jubilee Medical Group, which had surgeries in Newton Aycliffe, Bishop Auckland and Shildon.

Ms Roberts, who qualified as a staff nurse more than 20 years ago, said that on the day before he died, Mr Moss had been visited by Dr Martin, his GP.

She said: "I did not know he had been intending to visit. He said Mr Moss wanted to die at home."

The court previously heard that Dr Martin had visited twice that day and administered two injections of morphine, one while Mr Moss was unconscious. He died hours later.

Medical experts for the prosecution said it was very unlikely Mr Moss would have died from his lung cancer that day, and that the large doses of morphine given to him were inexplicable.

The court was told the doctor had injected all three men with doses of 60mg, or more, of morphine - about five or six times the recommended level. He did not stay with the men after he had given the injections, it was claimed.

Dr Peter Robson, a palliative care specialist at St Benedict's Hospice, in Sunderland, said doses of 60mg should only be used "in extremis".

The prosecution claims Dr Martin, now of Gwynedd, North Wales, deliberately injected the men with the high doses, to end their lives.

Dr Robson also said that the method Dr Martin used to administer morphine - with an intra-muscular injection - was old-fashioned.

He said that if the drug could not be taken orally, the preferred option was for an injection under the skin because it was less painful and dangerous for the patient.

The prosecution claims that Dr Martin visited Mr Moss at 11pm on the night before his death, with a prepared syringe to administer a top-up injection.

Dr John Grenville, a GP advisor who assists major investigations into general practice, said: "I would regard that very poor and dangerous practice. I have never seen it done before."

He said the dose required to control pain could not be calculated before the patient was seen, so there would be a risk of accidentally giving more than necessary.

Dr Robson and Dr Grenville both told the jury it was usual to start administering opiate drugs such as morphine in small doses, then to increase them until they controlled the patient's pain.

The trial continues.