Lady Thirwall presides over the Countess of Chester Hospital Inquiry on the presumption of Lucy Letby’s guilt, as she must. With less need, she began by admonishing those of us who question this guilt or – at least – question that it was proven beyond reasonable doubt.
We should hold our tongues, we’re told, to respect the bereaved.
But the doubts and doubters grow louder, with articles across the spectrum from the Telegraph to the Guardian, along with very detailed critiques by Dr. Phillip Hammond in Private Eye.
We must and do have sympathy for the parents. They have suffered grievous loss, and ongoing argument must add hurt. But this is insufficient to imprison a young woman in perpetuity if her ‘guilt’ is a mirage, confected from bad luck and poor practice in a unit that was an accident waiting to happen, along with contradictory jottings, scribbled down at the behest of a therapist.
The Countess of Chester had an exceptionally high stillbirth rate too, on a maternity unit unconnected to Letby. It wasn’t a wise place to have your baby, as Nadine Dorries learnt from experience.
Doubts have seeped even into the BBC, just as foul water leaks oozed into the Chester Unit. Its File on Four highlights Baby C. Dr Dewi Evans, the prosecution’s principal expert, gave a detailed, if unusual, explanation for this infant’s demise: injection of air into the stomach. This, he said, caused the baby’s stomach to expand, rupturing the diaphragm and crushing the lungs. The BBC now reminds us that the critical X-ray was taken after three days when Lucy Letby hadn’t been on duty. This has led Dr. Evans to rethink, recalling that Baby C was “always the most difficult case”. He has discarded ‘injection to the stomach’ but remains confident that Lucy dunnit, by later injecting air to the baby’s bloodstream. That’s quite a jump, given the previous detail.
Nor does the inquiry evidence help the good Lady’s demands that we shut up. Late in 2016, after Letby had been moved to a desk job, the Royal College of Paediatrics and Child Health (RCPCH) reviewed the Neonatal Unit deaths, concluding that the unit was under-resourced, lacked a specialist neonatologist and had insufficient consultant ward-rounds. What has now emerged is a confidential addendum, addressing the consultants’ concerns about Letby, and concluding that these were based solely on correlation and were “quite subjective“. This led hospital management – who disbelieved the consultants’ allegations – to demand that they apologise to Letby and that she return to clinical work. The consultants then involved the police, igniting the powder trail…
This week, medics who were the unit juniors in 2015-16 took their turns on the witness stand. At the time several thought that the frequent deaths and collapses were likely due to bacterial infection, just as I do today. Sewage leaks, and taps contaminated with the opportunist pathogen Pseudomonas aeruginosa, do not mix well with very premature infants. These have incomplete immune systems and, if born before 29 weeks’ gestation, largely lack the benefit of maternal antibodies, which later transfer across the placenta. Very premature babies can ‘go off’ very quickly, often without the typical signs and symptoms of infection.
The one piece of new evidence to emerge against Letby was that her two training periods at the Liverpool Women’s Hospital allegedly coincided with 40% rates of dislodged endotracheal tubes, compared with expected rates below 1%. But this has been swiftly challenged. Neonatologists point to product problems in the period and to dislodgement rates between 1 and 80%. In any event, Letby was a trainee. If she had a problem intubation, did no one correct her?
Lady Thirwall’s task increasingly resembles that of a 17th century justice instructed to find ways to prevent witches wreaking havoc. Outside the courthouse, people clamour that witches aren’t real, or lack the malign powers attributed to them They didn’t cause the laming of John Law, a pedlar, for which 10 women hanged at Lancaster in 1612. Law quite possibly had a stroke soon after being cursed by Alizon Device. Perhaps Alizon scared or enraged him, but she didn’t cause his stroke by witchcraft.
And, all too plausibly, Letby’s ‘crime’ was to be fool enough to remain in a badly-run and contaminated unit, working far beyond its competency. Even less wise, she accepted every shift she could because she was saving to buy a house.
Which brings me to a plug for Lucy Letby, the New Evidence airing on Channel 5 tomorrow (October 6th) at 9pm. This pulls together the doubts swirling around these convictions from statistical, medical and legal standpoints.
I’m talking about the likelihood of infection, as outlined above. Dr. John Ashton, formerly Director of Public Health in Northwest England, discusses systems failures and how multiple deficiencies were piled together to cause catastrophes. Among Chester’s deficiencies was the erosion of nurse staffing, a topic expanded by Michele Worden, who was Neonatal Nurse Practitioner at the Countess until redundancy in 2007. She talks of the many senior nurses who were ‘let go’, leaving qualified but inexperienced staff, such as Lucy, to care for the sickest infants. Drs. Svilena Dimitrova, Phil Hammond and Alan Wayne Jones discuss the bizarre methods of murder claimed by the prosecution, as in the same producer’s earlier documentary. They make the good point that, until Dr. Evans, a paediatrician, came along, these deaths were recorded, by experienced pathologists as ‘Natural Causes’.
Mark MacDonald speaks of the challenges he faces in taking over as Lucy Letby’s barrister, seeking to bring her case to the Criminal Cases Review Board, and of the worthlessness of her ‘confession’ notes. Linked to this, Dr. Waney Squire, an Oxford neuropathologist, explains the difficulty of being an expert defence witness in emotive cases. She found herself in serious trouble with the GMC for standing up in court to challenge accepted ‘wisdom’ on Shaken Baby Syndrome. If expert witnesses won’t appear for fear of professional defenestration, justice can’t be attained.
Lastly, or rather first in the film’s running order, Sir David Davis MP speaks on why he is raising questions about Lucy Letby in the Commons and why he will continue to look into this case, concerned that it very well may be a major miscarriage of justice.
Do watch.
Dr. David Livermore is a retired Professor of Medical Microbiology at the University of East Anglia.
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