Lucy Letby rots in Bronzefield jail, serving 15 whole-life sentences for murder and attempted murder. Her appeals have been denied. The Thirlwall Inquiry, predicated upon her convictions, seeks to prevent future killing sprees by miscreant nurses. It listens through an earpiece that filters anyone doubting Letby’s guilt. Jeremy Hunt, Health Secretary at the time of the deaths, has just given evidence.
He began: “Insofar as lessons were not learned from previous inquiries that could have been, or the right systems were not in place… then I do bear ultimate responsibility, and I want to put on record my apology to the families for anything that didn’t happen that could potentially have prevented such an appalling crime.”
Apparently, Jeremy shelved a recommendation, from the Francis Inquiry, for medical review of all hospital deaths, including those not referred to the coroner. This is irrelevant: six of the seven deaths for which Letby was convicted were reviewed by the Chester Coroner and his pathologists, who recorded natural causes. The Coroner says that he was never told of suspicions, even though one consultant later claimed he’d caught Letby “virtually red-handed”, thus both torturing the English language and failing in his duty. For Baby D there was a specific diagnosis of pneumonia. Four deaths were re-examined by specialists at Alder Hey – the specialist Liverpool children’s hospital, which again recorded no suggestion of deliberate harm. The Royal College of Paediatrics and Child Health’s Report, reviewing the Chester Unit, found deficiencies in staffing and care, but no evidence of foul play. A confidential addendum dismissed consultants’ concerns as “subjective“. Jeremy Hunt can be blamed for many things – not least encouraging vaccination of children against COVID-19 – but he’s hardly responsible here.
Murder was only reliably diagnosed by Dr. Dewi Evans, a retired paediatrician employed to review the deaths by the Cheshire Constabulary and then – ‘marking his own homework’ – as the prosecution’s lead expert. Sometimes it took him only 10 minutes to spot murder, he confidently says, adding that babies are “simple things”.
Perhaps we, Jeremy and the inquiry should reflect here on the expert witness system. Should an expert in a criminal case, engaged by prosecution or defence, be completely partisan? Or do professionals owe a higher duty to the recognition of uncertainty? I’d take the latter view, but Dr. Evans doesn’t, boasting to Phil Hammond, Private Eye’s medic, that, over 35 years, he has lost only one serious case. During Letby’s original trial, the judge (Justice Goss) was contacted by Lord Justice Jackson, who cautioned that Evans’s evidence was “worthless”. He outlined Evans’s report in a separate case: “It ends with tendentious and partisan expressions of opinion that are outside Dr. Evans’ professional competence and have no place in a reputable expert report.”
Hunt did make one valuable point. That, annually, the NHS records around 13,500 ‘preventable deaths’, leading to payment of £4.5 billion in compensation. I am unsure where these figures come from. The ONS records six-fold higher numbers of ‘preventable’ deaths, including these as a subset of ‘avoidable’ (the latter 10-fold above Hunt’s number). It includes, in both categories, deaths that hypothetically might be prevented (or delayed) by public health measures including, curiously, for COVID-19. Perhaps 13,500 are iatrogenic deaths, for which the NHS is more directly responsible? Medical errors and hospital-acquired infections, for example? Or perhaps he’s confused with the NHS receiving 13,382 clinical negligence claims in 2023-4, 52% of them successful and 80% settled out of court, costing £5.1 billion? Maybe it’s preferable for public confidence to identify a murderous nurse than systemic failures?
Which brings us back to Letby and her new barrister, Mark McDonald, seeking to return her case directly to the Court of Appeal rather than via the infamously slow Criminal Cases Review Commission. New experts, working pro bono, are dissecting Letby’s supposed killings one by one, trying to identify what really happened. These efforts are also tunnelling beneath the inquiry’s foundation, letting water seep around the bricks.
In the case of Baby C, Dr. Evans first asserted that Letby forced air down the nasogastric tube and into the baby’s stomach. This was a novel mode of murder. Neonatologists observed that collections of stomach air were neither uncommon nor fatal in intubated infants. More succinctly, one informed Private Eye’s Dr. Phil Hammond: “It’s bollocks. Babies get too much air in the stomach all the time. All you do is take it out again.”
Such criticisms, and the fact that Letby was not even on duty on the day of a critical X-ray, led Dr. Evans to alter his homework mid-trial. He decided that Baby C’s death was by air to a vein, not to the stomach. That’s quite a swap but the prosecution barrister omitted the edit in his summing-up, reasserting that Baby C’s demise was by air to the stomach. The judge didn’t flag the point. Dr. Evans has since backed off the diagnoses of ‘air to stomach’, not only for Baby C but also for Babies I and P.
And then there is Baby O. Here, Letby was convicted of murder by blunt force trauma to the liver, together with air embolism. Doubt has been circling for months. One expert, reviewing the case blind, suggested that the ‘liver injury’ might really be a subcapsular haematoma – a rare but natural complication. Now, during case note reviews for Mark McDonald, Drs. Aiton and Dimitrova, at the University Hospitals in Brighton, have found a different and shocking story, outlined by Sir David Davis MP in Parliament. To quote directly Hansard (as I understand is legally advisable):
The doctors used excessive ventilation pressure during resuscitation, which overinflated the baby’s lungs and prevented blood from flowing back into the lungs. This caused the baby to desaturate repeatedly (i.e., caused blood oxygen to fall).
The medical team responded by increasing the pressures even more, initiating a downward spiral in the baby’s condition. The overinflation of the baby’s lungs forced the diaphragm downwards, pushing the liver into the baby’s abdominal cavity.
The consultant in charge [then] took a decision to insert a needle into the abdomen to release what they thought was gas pressure in the abdomen. However, this was wrongly inserted into the right side of the baby’s abdomen.
As a result of this error, the needle penetrated the liver, causing serious internal bleeding. This was undoubtedly a significant contributory factor in the baby’s death, if not the outright cause.
In short, concluded Davis, the death of Baby O “was avoidable and resulted from suboptimal care”. I won’t name the doctor implicated. Suffice to say he or she is among Letby’s chief accusers. Notable, too, is that this liver injury case was one where, over 10 minutes and a police station coffee, Dr. Evans could diagnose: “This baby had been put in harm’s way.” Maybe so. But by Letby? That looks less and less likely.
In the midst of this, the Daily Mail has published a ‘leak’ saying that Letby was on shift, or had recently gone off duty, at the time of five of the six further baby deaths in the same period. The newspaper implies that this increases the likelihood of Letby’s guilt. It doesn’t. As Dr. Evans told Talk, these other six infants “died for the usual problems why small babies die: haemorrhage, infection, congenital problems”. So, if we take everything at face value, Letby was present, or recently departed, at 12 deaths, seven of which she caused and five of which, even according to Dr. Evans, she didn’t. This proves that Letby worked a lot, which we knew anyway. She was saving for a house. But it doesn’t make her a murderess. If she was present for natural deaths as well as supposed murders, it weakens any statistical link to the latter.
I’d love to know what Lady Thirlwall really thinks, as the trickle around the foundation bricks grows to a stream, swelling still. Does she ponder if the structure will hold? Might it all be on sand, not on solid bricks at all? Even the Appeal Court, denying Letby’s application of her most recent conviction, on narrow grounds, acknowledged the considerable critique of medical and scientific evidence arising from the first trial.
Dr. David Livermore is a retired Professor of Medical Microbiology at the University of East Anglia.
To join in with the discussion please make a donation to The Daily Sceptic.
Profanity and abuse will be removed and may lead to a permanent ban.