‘In summary, ladies and gentlemen, we did not find any murders.’ That was the bold proclamation of retired Canadian neonatologist Dr Shoo Lee during an extraordinary press conference with Lucy Letby’s defence team last week.
He told assembled journalists that none of the 17 babies who featured in the former neonatal nurse’s ten-month trial had been attacked or killed.
In reality, Dr Lee said, they were victims of poor medical treatment at an understaffed unit, where doctors didn’t know how to work equipment or properly look after the vulnerable premature infants entrusted to their care.
A group of 14 international experts, invited to analyse the babies’ medical notes, had found ‘new’ natural causes for their sudden collapses and deaths, the doctor claimed.
Letby’s barrister Mark McDonald described these findings as a ‘gamechanger’ and has submitted a report to the Criminal Cases Review Commission (CCRC), the body which examines potential miscarriages of justice.
But just how much of this evidence is new? And can it really persuade the CCRC that Britain’s most prolific child serial killer is really an innocent woman who has been wrongly convicted of murdering seven infants, attempting to kill seven more and condemned to spend the rest of her life in jail?
I sat through almost every day of Letby’s two trials at Manchester Crown Court – and subsequent appeals – and admit I was initially impressed by the fanfare from the apparently eminent panel.
But I’ve spent the days since taking a closer look at the initially bamboozling medical evidence discussed at the press conference, going back over my trial notes and talking to those intimately involved in the case, and my conclusions are that there is not much new here after all.
Lucy Letby has already been questioned in jail about more child murders
Possible medical explanations for the collapses and deaths of the children were all discussed and robustly challenged by Letby’s barrister Ben Myers KC at her original trial.
The jury was told that most of the murdered babies had post-mortems that initially concluded they died of natural causes, and the paediatricians working at the Countess of Chester Hospital have admitted at the public inquiry that the possibility of natural explanations delayed them from ‘thinking the unthinkable’ – that a staff member was causing deliberate harm.
A pathologist has also since told Lady Justice Thirlwall, who is overseeing the inquiry, that injecting air into a baby’s bloodstream – Letby’s favoured method of killing – can leave no trace or be ‘completely undetectable at autopsy’.
So is it really a surprise Dr Lee’s experts found no evidence of any deliberate harm?
And if, as the ‘new’ evidence suggests, the unit was so understaffed and the medical care so poor, why were there only two or three deaths a year in each of the five years before Letby’s 2015 and 2016 killing spree?
The same doctors and nurses worked on the unit, in the same cramped, unsuitable building with its intermittent drainage problems, a fact also made clear in court.
Detectives in Cheshire Police, who continue to investigate Letby, have already confirmed she has been questioned in jail about more child murders and collapses, including at Liverpool Women’s Hospital, where she trained.
If, as I anticipate, she is charged with crimes at a second hospital, is poor care at both units really a plausible explanation for babies regularly falling ill while she was on duty?
Letby’s team opted not to call any experts in her defence at her original trial and it will now be up to the CCRC to decide whether her new defence team has fresh evidence that warrants her case being looked at by the Court of Appeal a third time.
But while there’s no doubt the medical evidence was important in Letby’s conviction, it was by no means the sum total of the evidence against her.
In his closing speech, prosecutor Nick Johnson KC stressed that ‘context’ was everything. He urged the jury not to look at pieces of evidence in isolation, but to think about the whole picture, when considering her guilt.
He asked them why she’d written the ‘I am evil, I did this’ note. Why she’d taken home more than 250 nursing handover sheets found hidden under her bed relating to some of the babies who collapsed or died.
Why she’d written the initials of triplets in her diary on the day they died. Why the babies seemed to die or collapse on significant milestones, such as Father’s Day, or their due date, or on the day they were supposed to be going home.
Why children always fell ill when Letby was alone with them because their parents had nipped away from their cot for food or because their designated nurse was on a break, and why she’d searched for parents on Facebook weeks, months and even years after their babies died.
The jury also listened to the testimony of scores of Letby’s colleagues. While some described her as a competent, diligent nurse, others also recounted how she behaved oddly or made inappropriate comments when infants collapsed. And, crucially, both juries also heard Letby give evidence.
At her original trial, the eight men and four women had 14 days – around 60 hours – to watch and listen to her in the witness box and make up their own minds about whether it really was an ‘innocent coincidence’ that she was there every time a baby became ill.
At the press conference last week, Dr Lee selected seven of the 17 babies in the case – covering six different methods of harm – to demonstrate why the expert panel says all collapsed or died of natural causes. Here I compare what the panel said with what the juries heard at her trials…
Baby A – Air embolism
The first of Letby’s victims, a twin boy, was murdered with an injection of air into his bloodstream on June 8, 2015. His sister, Baby B, was attacked the following night but survived.
What the panel said: Baby A ‘most likely’ died of a blood clot. The prosecution was wrong to rely on Dr Lee’s 1989 research into air embolism, which described an unusual rash as evidence Letby injected air into his bloodstream, causing an air bubble to block bloodflow to his heart. Dr Lee said he had recently changed his mind and now believes no skin discolouration occurs when air is injected into veins.
Baby A’s mother had an immune condition known to trigger blood clots that could have been passed on to her son.
A four-hour delay in administering fluids, via a tiny long line or catheter, had caused a clot to form on the tip which was dislodged when the infusion began. It travelled to Baby A’s brain, causing him to collapse and die.
What the trial heard: Experts from Alder Hey Hospital in Liverpool, and Great Ormond Street in London, told the jury Baby A’s mother’s disorder could not be passed on to him and was irrelevant. The suddenness of his collapse, failure to respond to resuscitation and distinctive rash were evidence of air embolism. Professor Owen Arthurs, a paediatric radiologist from Great Ormond Street, found an ‘unusual line of gas’ in a blood vessel close to Baby A’s spine on an X-ray taken after his death which was ‘consistent but not diagnostic’ of air being administered into his blood.
Baby D – Air embolism
Last week’s press conference delivered very little we haven’t already heard
The only full-term baby in the case, her mother’s waters had broken 60 hours prior to her birth and she was pale and floppy when she was admitted to the neo-natal unit. She was murdered by Letby with an injection of air, on Father’s Day, on June 22, 2015.
What the panel said: Baby D died from systemic sepsis, pneumonia and a serious blood clotting condition.
A failure to administer antibiotics to Baby D’s mother after her waters broke was significant.
The baby was born with pneumonia and there was a four-hour delay in recognising her breathing difficulties and administering antibiotics.
She also had an unusual rash that was not due to air embolism, but occurred because she had an ‘out of control’ infection that triggered a clotting problem with her blood.
What the trial heard: The failure to administer antibiotics to Baby D’s mother when her waters broke, the fact the baby was born with pneumonia and the delay in treatment were all rigorously examined in court. Baby D’s post-mortem showed no evidence of sepsis, and blood tests suggested her lung infection was improving in the hours before she collapsed and died.
The suddenness of her collapse, failure to respond to resuscitation and distinctive rash was evidence of air embolism, the court heard. An unusual line of gas was also discovered in a blood vessel close to her spine by Prof Arthurs when he examined X-rays taken after her death.
Baby F – Insulin poisoning
He was the first of two twin boys who Letby was convicted of poisoning with insulin on August 5, 2015. Letby was found guilty of his attempted murder by tampering with bags of feed being given to him via a drip. She was also convicted of the murder of his brother, Baby E, the day before.
What the panel said: Baby F had prolonged low blood sugar because he had sepsis, problems related to his prematurity and doctors failed to manage his care effectively.
Dr Lee’s insulin expert, engineer and academic Professor Geoff Chase, said the blood test which the prosecution claimed showed high levels of exogenous insulin – insulin not produced by his own body – was misinterpreted. His insulin was within a normal range for premature infants.
What the trial heard: Professor Peter Hindmarsh, one of the country’s foremost experts in paediatric endocrinology at University College London, said the blood test proved Baby F had been poisoned by exogenous insulin.
Letby admitted in the witness box that Baby F had been poisoned, but said that she was not responsible.
Baby G – Overfeeding milk and air in tummy
Born in a hospital lavatory when her mother went into labour at just 23 weeks, Baby G had many issues because of her extreme prematurity but had made it to her 100th day of life when Letby first tried to murder her. She was convicted of two counts of attempted murder, on September 7 and 21, 2015.
What the panel said: Baby G collapsed because of a ‘probable’ viral infection. Although she projectile vomited, she had watery stools which are inconsistent with overfeeding. Air seen in her bowel on X-rays was due to resuscitation.
What the trial heard: The issue of whether Baby G developed an infection before or after her collapse was discussed at length. Mr Myers suggested blood tests showed the infection had begun before she deteriorated and caused her to be sick. But the prosecution’s expert medic Dr Dewi Evans disagreed, saying the infection only developed after a ‘massive’ amount of milk and air had been forced down her feeding tube.
Baby I – Overfeeding milk, air in the tummy and air embolism
Also a very premature little girl, she was born at 27 weeks in the summer of 2015. Letby attacked her by pumping air into her tummy via her feeding tube three times before she murdered her with an injection of air into her bloodstream on the fourth attempt, when she was aged 11 weeks, on October 23, 2015.
What the panel said: Baby I died from respiratory distress syndrome and chronic lung disease, linked to her prematurity. An antibiotic-resistant bacterial infection was found in her breathing tube, which doctors failed to treat. She also ‘likely’ had sepsis or an intolerance to milk which caused her tummy to swell. Air seen in X-rays of her abdomen was due to resuscitation. Her death was preventable.
What the trial heard: The issue of whether Baby I had a bowel infection common in premature infants before she died was discussed in detail and dismissed by doctors who treated her and expert forensic pathologist, Professor Andreas Marnerides, of Guy’s and St Thomas’s Hospital in London, who examined her post-mortem.
The sudden nature of her collapse, coupled with unusual relentless crying and a failure to respond to resuscitation, was evidence of air embolism.
Baby K – Dislodged breathing tube
Retired medic Dr Shoo Lee said: ‘In summary… we did not find any murders’
Born at just 25 weeks, she died aged three days after being transferred to a more specialist hospital.
Letby was convicted of attempting to murder her by dislodging her breathing tube on February 17, 2016 following a retrial.
What the panel said: Baby K collapsed because of poor care. Doctors took ‘several traumatic attempts’ to insert a breathing tube, which was too small.
There was a large air leak, which meant she wasn’t getting enough oxygen to breathe. The tube hadn’t been dislodged but was in the wrong place and consultant Dr Ravi Jayaram used incorrect equipment to resuscitate her. An allegation Letby had deliberately turned off the alarm on her incubator was contradicted by another nurse.
What the trial heard: Both juries were told about the air leak and that, ideally, a bigger tube should have been inserted first time around. They heard the conflicting evidence about the alarm and about Baby K’s breathing tube being moved, but accepted the prosecution’s case that Letby had suspended the alarm and deliberately moved the tube because she’d been caught ‘virtually red-handed’ by Dr Jayaram, and wanted to make it look like Baby K was repeatedly dislodging it herself in order to cover her tracks.
Baby O – Air embolism and traumatic liver injury
One of a set of identical triplet brothers, he was murdered by Letby on June 23, 2016. His brother, Baby P, was also murdered on the following day.
What the panel said: Baby O died of a liver injury caused during a rapid, traumatic Caesarean-section delivery, which caused internal bleeding and shock.
Doctors had failed to diagnose this liver injury and the wrong techniques had been used to resuscitate him. Dr Stephen Brearey, the head of the unit, ‘blindly inserted’ a needle into Baby O’s abdomen during resuscitation, making the injury worse.
What the trial heard: The triplets had an unremarkable birth and Baby O was stable until he suddenly collapsed and died two days later. A post-mortem showed multiple sites of damage to his liver and internal bleeding.
There was no suggestion at the trial that the liver damage was caused at birth. Expert pathologist Professor Marnerides said it was ‘extremely unlikely’ that the damage was caused by a needle because there was no evidence of a perforation injury.
He said he’d only ever seen such injury in cases where children had been involved in road traffic accidents or fallen off trampolines.
Baby O had an unusual rash during resuscitation and Professor Arthurs also found an unusual amount of gas in a blood vessel in his heart on X-rays, both of which pointed to air embolus.
My verdict
On first impressions, the press conference promised much. But it actually delivered very little we haven’t already heard.
While it generated the ‘Letby did not murder babies’ headlines her defence team and campaigners desired, it is much easier to persuade a room full of journalists than convince the CCRC and the Court of Appeal that two juries and four senior appeal court judges got it wrong.
My view is that, unless her barrister Mark McDonald has something else extraordinary up his sleeve, loud public proclamations that amount to little more than a regurgitation of the trial evidence will not be enough to set Lucy Letby free.
