Nurse Lucy Letby – premature baby murders or miscarriage of justice?

Niall McCrae

After her conviction for killing seven babies and attempted murder of ten others, nurse Lucy Letby is expected to spend the rest of her life in prison. The media whipped up such a public frenzy, that she would be safer inside. But as some legal commentators argue, her trial was a farce. Is Letby the fall girl for a corrupt system, in which doctors made serious errors and found a convenient scapegoat?

The crimes were committed from June 2015 to June 2016, at the neonatal unit at Countess of Chester Hospital. The impression given is that an exceptional number of babies died during this period, but there were contributory factors unrelated to nursing care, and the peak of infant mortality at the unit occurred in 2019, long after Letby had gone.

Almost everyone who knows of Letby’s case has only heard the official story of a prolific serial killer punished for unconscionable evil. But in an interview with Norman Fenton (statistician at Queen Mary University of London), Scott McLachan doubted that any justice was served. A lecturer in applied health technology at King’s College London, MvLachan has both nursing and legal qualifications. He has meticulously studied the evidence presented in court, revealing misleading use of data and omission of crucial information.

Of critical import to the guilty verdict was a chart showing which nurses were on duty at the time of baby collapses and deaths. It looks damning: in every case, Letby was there. But this was horridly misleading: other casualties occurred when Letby was off duty, but these were not considered in court. Data from a freedom of information request to the hospital showed that 31 infants died in the 12-month period of Letby’s adjudged crimes, yet 23 of these were excluded from the trial (of the eight deaths for which Letby was believed culpable, one case was dropped). In other words, Letby was implicated by circular logic: deaths happened when she was on the unit, so she must have caused them.

According to McLachan various other factors could have caused an elevation in mortality. The neonatal unit had been upgraded, enabling it to provide for premature babies who previously would have gone to a specialist unit. There was a problem with the plumbing: sewage pipes leaked, risking contamination of the water supply. McLachan suggested that bacterial infection could have been the cause of air in the bloodstream and organs of babies, rather than injection by Letby (which nobody witnessed).

The role and responsibility of doctors was strangely marginalised in the proceedings. Why weren’t they crosstabulated by infant injury? Dr Gibbs, the unit consultant, had one foot in the door of retirement at the time of the incidents, and clinical decision were increasingly taken by the registrar and junior doctors. As McLachan described, inexperienced trainees were performing skilled procedures such as umbilical venous catherisation, which should be supervised on the first three or more occasions. Sometimes a junior doctor made multiple unsuccessful insertions, raising the risk of infection.

Letby was reported to police by consultants, after a critical report about the unit by the Royal College of Paediatrics & Child Health, despite no concerns being raised by Letby’s nursing colleagues at the time. Perhaps she was a convenient target, after disagreeing with a doctor’s decision? In my mental health nursing experience many years ago, I was the subject of a witch hunt after a patient alleged that a nurse had doubted the drug regime prescribed by a consultant psychiatrist. I had merely informed the patient that antidepressants don’t work for everyone (an evidence-based statement), but that was enough to incur the wrath of the medical gods.

NHS management always blames nurses if something goes wrong. Doctors exert power without responsibility, while nurses are given responsibility without power. In the 1990s I was manager of an innovative mental health crisis service. Months were spent working on the operational policy, partly to ensure that the service (which had six beds) was used for genuine crises and not as an annex to the psychiatric ward. When I objected to consultant psychiatrists transferring patients from the acute wards as overspill, senior management sided with the doctors rather than the manager running the service to the operational policy!