Former nurse Lucy Letby, branded Britain’s worst child serial killer, was found guilty of the murder of seven babies and the attempted murder of seven others between June 2015 and June 2016. At the time of the babies’ deaths, she was working in the neonatal unit of the Countess of Chester hospital. Letby, whose attempt to challenge her latest conviction for the attempted murder of a baby girl was dismissed in 2024, is serving 15 whole-life sentences.
The description of her by the prosecutor in her original trial as a “cold, calculated, cruel and relentless” killer echoed the phrase used by the judge who sentenced Myra Hindley. And for many, her blank expression in the photograph used in newspapers also mirrored that of the notorious child killer.
The expert medical evidence presented at the trial of the ordinary – “beige” in the words of one investigating officer – nurse was shocking. Although there were no witnesses, the prosecution successfully convinced the jury that crimes had been committed, and by a variety of horrifying means – injecting air-bubbles into the bloodstream (“air embolism”), insulin poisoning, overfeeding and/or injecting air into the stomach, tampering with a breathing tube. To pin the perpetrator to the crime scenes, the prosecution used a statistical graph that plotted 25 suspicious clinical events on one axis against shift patterns of 39 nurses on the other axis. The prosecution told the jury that Letby was “the constant malevolent presence” at all the events.
But earlier this month, a panel of 14 distinguished experts in paediatrics and neonatology from the UK, US, Germany, Sweden, Japan and Canada raised grave doubts about the evidence, following a review of the medical evidence used to convict Letby.
The panel was chaired by retired paediatrician and emeritus professor at the University of Toronto, Dr Shoo Lee, who said: “We did not find any murders. In all cases death or injury were due to natural causes or just bad medical care.” This is particularly significant because Lee is the co-author of the medical paper on air embolism used by the prosecution in building its case; there was no evidence of air embolism in any of the cases reviewed.
Clinical incident versus shift pattern graphs, like the one used in the Letby case, have previously been used in the wrongful convictions for murdering patients of Dutch nurse Lucia de Berk (in 2003) and Italian nurse Daniela Poggiali (in 2016). But those graphs were subsequently shown to be statistically nonsignificant – as many experts believe the graph in the Letby case to be.
The Criminal Case Review Commission is now preparing to examine claims by Letby’s new legal team that she has been the victim of a miscarriage of justice, after two previous applications to the Court of Appeal were rejected.
Having worked as a consultant obstetrician and gynaecologist in Ireland for more than 30 years, I am perturbed by several issues about the Letby case.
First, the increase in death rate in babies in the hospital’s neonatal unit did not happen in a vacuum. As widely reported in the media since the trial, the hospital was struggling. At the time, the neonatal unit was a Level 2 unit that accepted babies of 27 weeks and over – yet only one of its seven paediatric consultants had speciality training in neonatology. The admission rate and the level of clinical complexity had also increased at this time. Of note, six of the seven babies who died in the Letby case were premature, three weighing less than 3lb.
In September 2016, a visit by the Royal College of Paediatrics and Child Health to the hospital’s neonatal unit found that junior staff had “insufficient cover” and “a reluctance to seek advice”. It was also noted that the recent increase in deaths was not solely confined to the neonatal unit. There was an increase in stillbirths in the maternity unit also.
After Letby was removed from clinical duty, the death rate in the neonatal unit fell; however, this was coincidental with its redesignation as a Level 1 unit, accepting only babies of 32 weeks and over.
As we have seen time and time again in this country, particularly in smaller hospitals under pressure and with limited resources, when you’re flying by the seat of your pants, you may be just one step away from a disaster – or a cluster of them.
Second, there were large holes in the quality and range of expertise made available to the court. It’s unfathomable to me why the defence did not call its only medical expert witness, or a professionally qualified statistician. This tactic blew up in Letby’s face. The prosecution, on the other hand, had lined up six expert witnesses and seven consultant paediatricians, all of whom considered Letby to be guilty. Jurors (and even judges) may find it hard to weigh up the quality of expert information presented in court, particularly when it is highly technical, or to adjudicate between the arguments of independent experts fighting it out on either side. And obviously, they will have no idea about what they should have been or may not have been told.
There’s an argument to be made for courts to appoint independent expert witnesses from accredited panels to work for the court, instead of the defence and prosecution hiring them, as happens now. This, I believe, would provide greater assurance in terms of impartiality and quality.
Third, there are lessons to be learned by medical authorities in the UK, Ireland, and elsewhere in relation to investigating adverse cluster events – the need to avoid knee-jerk reactions and witch-hunts, and to seek appropriate expertise. How often have we seen individuals, hospitals or nursing homes put in the spotlight before the full facts are known and analysed? This also applies to the media, politicians and the public, particularly social media users. Once demonised as a monster in the newspapers and cyberspace and called “cowardly” by UK prime minister Rishi Sunak for refusing to attend the court for her sentencing, Letby is now the recipient of outpourings of support. As for the families affected by the Letby trial, there is no end to the anguish and suffering.
As for Letby herself, there are reasons to believe that she may be innocent; as such, her appeal needs to be accelerated. Many who look at Letby’s photos now see a very different woman.
Chris Fitzpatrick is a clinical professor in UCD’s School of Medicine and a former master of the Coombe Hospital, Dublin. He is retired from clinical practice. These are his personal views
