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, an inquiry has heard.

Tobin, who hid the remains of two girls at his Margate home, died aged 76 on October 8, 2022, in Edinburgh Royal Infirmary, a month after a fall in his jail cell in HMP Edinburgh.

His 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 Patrick’s Church in Glasgow, where convicted sex offender Tobin worked as a handyman.

In July 2007, Tobin was further charged with murdering Vicky Hamilton, 15, who vanished in 1991.

Her remains were found under the patio of his former home in Margate in November of 2007.

Also found in the same location were the remains of Dinah McNicol, 18, a hitchhiker who disappeared in 1991 after leaving a rave in the Home Counties.

A fatal accident inquiry (FAI) into the death in custody, heard that Tobin 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 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.

Tobin was warned he was unlikely to survive and he died less than a month after the operation, the hearing was told.

GeoAmey staff reported that he was speaking incoherently shortly before his death which was confirmed at 5.45am on October 8, 2022.

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.

His post-mortem examination confirmed the cause of death as “bronchial pneumonia in a man with a fractured right neck of femur, generalised vascular disease and prostate cancer”.

The review was carried out to see if areas of “learning” could be established.

A determination will be given “as soon as possible”.