Lucy Letby: We spent years overlaying the case – right here’s why consultants are nonetheless arguing about it

There are two parallel universes within the Lucy Letby story.

One will be witnessed every single day in Liverpool on the public inquiry into her case. Right here, the matter of Letby’s guilt is settled. The query for the decide is why Letby was in a position to hurt infants for thus lengthy.

Within the different universe, doubts concerning the proof used to convict her have been mounting. Main statisticians and medical consultants are arguing Letby will be the sufferer of a miscarriage of justice.

It’s a surreal state of affairs: a authorized system that has determined Letby is a serial killer – and a debate outdoors that questions her guilt.

As journalists we have now been overlaying the Lucy Letby case for years – by means of two trials, an appeals course of, an ongoing public inquiry and the rising controversy over her conviction. We’ve got written a e book collectively and made two Panorama movies concerning the case – the most recent of which airs on Monday with new info, and hears from each main critics and the prosecution consultants now beneath hearth.

Letby is formally essentially the most prolific baby killer of contemporary occasions – convicted of murdering seven infants and trying to homicide seven others. And but her case divides opinion.

Had somebody really seen her harming a child on the neonatal unit within the Countess of Chester Hospital, the case might need been extra simple, however no-one did. There was no incriminating CCTV or DNA proof both. The proof in opposition to her was circumstantial.

One of many paperwork that performed a key position in her trial was a grid, itemizing the incidents within the case with ‘X’s to indicate which members of employees had been on responsibility. Letby was the one nurse on responsibility for all of them.

However the grid has attracted scorn from statisticians. They argue that we don’t know the way the “suspicious occasions” listed on the grid have been chosen or which incidents have been excluded, so by itself the grid is little greater than a visible stunt. The jury additionally heard there have been two suspicious incidents when Letby was not at work – neither of which was included on the grid.

However is the grid actually the issue?

If there was undisputed medical proof that 24 crimes had been dedicated, then certainly the very fact Lucy Letby was current every time can be damning.

And therein lies the important thing query of the Letby case: How convincing is the medical proof that the newborn deaths and collapses have been undoubtedly crimes slightly than naturally occurring occasions?

Probably the most controversial proof involved allegations that Letby murdered infants by injecting air into their blood. That will trigger an air embolism – a blockage brought on by an air bubble within the blood circulation.

To do that, Letby must have taken a syringe and injected the air into the infants’ intravenous strains. These are usually used to manage fluids, medicine, and diet to unwell or untimely newborns.

Syringes in hospitals are thrown away and incinerated after they’ve been used. As a homicide weapon, they’re nearly untraceable.

The issue is no-one noticed Letby doing this. The allegation rested as an alternative on a “guidelines” of observations of a number of the infants who died or collapsed whereas Letby was round.

In line with the prosecution, the infants deteriorated instantly and unexpectedly. Retired guide paediatrician Dr Dewi Evans was the prosecution’s fundamental medical professional witness. He advised us: “Infants do not instantly drop useless.”

Many exhibited unusual pores and skin discolourations that medics on the unit hadn’t seen earlier than. Some infants screamed.

The infants additionally failed to reply to resuscitation as medics anticipated. Publish-mortem X-rays revealed air within the blood vessels of some.

In line with the prosecution, this guidelines was a positive option to establish air embolism. However how strong was it? Analysis on air embolism in infants may be very restricted – one thing the prosecution’s personal consultants readily admitted.

Probably the most complete research was a 1989 analysis paper by two Canadian teachers. The account within the paper appeared to assist the prosecution case – significantly its references to pores and skin color adjustments related to air embolism.

However the variety of circumstances within the research was restricted – simply 53 – and the circumstances of the infants described within the paper differed in some respects from these within the Letby case.

Lucy Letby: Unanswered Questions

Reporter Judith Moritz, who has coated the case from the beginning, investigates the questions which have been raised about Lucy Letby’s conviction.

Watch on BBC iPlayer from 06:00 on Monday 21 October – or on BBC One at 20:00 (20:30 in Wales and Northern Eire).

One of many paper’s authors, Dr Shoo Lee, later appeared as a witness in Letby’s defence, throughout her unsuccessful try to attraction her convictions in April 2024. He stated not one of the pores and skin discolourations seen on the infants within the Letby case have been proof of air embolism.

Legal professionals for the prosecution disagreed. Additionally they identified that pores and skin discolouration was only one merchandise on their air embolism guidelines and that they’d by no means argued that one specific type of pores and skin discolouration was, by itself, proof of air embolism.

A number of consultants have publicly criticised the prosecution’s air embolism idea, though hardly any have seen the entire medical proof. One professional who has is the person who suggested Letby’s defence throughout her authentic ten-month trial: retired guide neonatologist Dr Mike Corridor. Dr Corridor didn’t really give proof in court docket, however he advised us that in his view there was no proof that the air seen within the X-rays of the infants obtained there whereas they have been alive.

These are the forms of professional disputes now enjoying out over the medical proof within the Letby case – and a few of them have grow to be private.

Dr Corridor believes there have been important flaws within the prosecution’s medical proof.

He additionally believes the prosecution consultants overstated how steady the infants have been earlier than they collapsed and died.

“Phrases such because the child was actually, rather well got by the prosecution professional witnesses on a number of events for a number of of the infants,” Dr Corridor advised us.

“And it was my view and is my view that they weren’t actually, rather well, they’d indicators of serious sickness.

“I believe that what the prosecution consultants stated was deceptive for the jury. That’s not the identical factor as saying that they intentionally misled the jury.”

It’s an allegation that each of the principle prosecution consultants reject emphatically.

Dr Dewi Evans advised us: “These ideas are utterly flawed and point out both that the folks making them haven’t seen the medical proof or that they’re unaware of what constitutes well-being in a untimely child.”

Marketing consultant paediatrician Dr Sandie Bohin, the prosecution’s different fundamental professional, who’s talking concerning the controversy surrounding the case for the primary time, stated: “I gave proof beneath oath 16 occasions. I advised the reality.”

“It was my opinion and stays my opinion that these infants have been steady previous to their collapse, so I can’t agree with these those that instructed that I misrepresented the soundness of the infants and that I misled the jury.

“I believe that’s an outrageous suggestion.”

It is a sign of the toxicity and intense division of opinion within the Letby case – even among the many consultants.

One apparent query is why Dr Corridor didn’t testify in court docket. He clearly disagreed with the prosecution consultants, and the truth that he didn’t give proof meant that Letby had no medical professional witnesses in her defence.

That has prompted some to argue she didn’t have a good trial.

We requested Dr Corridor if he had been keen to testify and he stated he had.

He advised us he was anticipating to provide proof and that he was advised of the choice to not name him “proper on the final minute”- a call that left him “at odds” with Letby’s defence crew. Dr Corridor advised us he was so involved that he even thought-about writing to the decide to say he believed that the jury had not heard the entire fact.

However the final determination to not name Dr Corridor as a witness got here from Letby herself – a degree that Dr Corridor acknowledges.

Why did she not name him? It’s certainly one of many questions that solely she will be able to reply.

Letby was convicted of utilizing a wide range of strategies to hurt and homicide infants – injecting air into their stomachs, force-feeding them with milk, dislodging respiration tubes, and inflicting trauma.

As with the allegations of air embolism, the prosecution relied closely on the opinions of consultants to make their case.

However there was one a part of the prosecution’s argument that appeared to relaxation on one thing greater than particular person professional opinion: the insulin proof.

Lab exams indicated that two infants had been poisoned. The fundamental precept concerned within the check was fairly simple. When the physique produces insulin, it additionally produces one other substance known as C-peptide, so C-peptide is a dependable marker of naturally produced insulin.

Though C-peptide is produced by the physique on the similar charge as insulin, it clears way more slowly. So you’ll sometimes anticipate to see 5 to 10 occasions extra C-peptide than insulin, if the insulin is pure.

The place you discover excessive ranges of insulin, however low ranges of C-peptide, there is just one apparent conclusion: the insulin isn’t pure and has as an alternative been administered from the skin.

That’s what investigators present in two of the infants within the Letby case. One had extraordinarily excessive ranges of insulin in his blood and a C-peptide degree that was so low that it was unmeasurable.

The second child had an insulin degree greater than 4 occasions increased than the C-peptide degree, once more indicating it had not been naturally produced.

The medical situation of the infants additionally fitted with the lab outcomes. In each circumstances, the infants’ blood sugar ranges had plummeted, which is what you’ll anticipate to see with insulin poisoning. And whereas no-one noticed Letby poisoning both of the 2 infants, she was there once they began experiencing signs.

Of all of the allegations within the case, this one regarded like essentially the most strong. In court docket, Letby herself accepted the scientific proof that the infants had been given harmful portions of insulin. She simply denied being accountable. Her attorneys have been extra cautious. They didn’t settle for the insulin proof, however they didn’t say it was incorrect both.

For the prosecution, the insulin proof was elementary to your entire case. It appeared to show that somebody on the neonatal unit on the Countess of Chester Hospital was a poisoner.

If jurors might be persuaded on this level, it wouldn’t be so troublesome for them to conclude that Letby was the perpetrator.

And they also did. Of all of the allegations within the case, the jury returned unanimous verdicts of guilt on simply three – and two of those have been the insulin circumstances.

Nevertheless, since then, sceptics have questioned whether or not the lab check used to measure insulin and C-peptide within the Letby case was as strong because the prosecution had claimed. It’s known as an immunoassay check, and works by utilizing antibodies to detect and measure substances.

Critics argue there are circumstances by which the check can mistake one other substance for insulin. It’s known as interference and it might lead to a false optimistic. The critics say the one option to ensure that the substance being measured is certainly insulin is to make use of a extra exact methodology of study – equivalent to mass spectrometry.

We spent months analyzing this argument. Our conclusion, having spoken to main consultants on all sides of this debate, is that, whereas the immunoassay methodology isn’t good, it’s normally correct and the circumstances by which interference would possibly happen are extraordinarily unlikely within the context of the infants within the Letby case.

It’s much more unlikely that two lab exams carried out inside months of one another would each be flawed.

On this week’s Panorama, we reveal new proof on the insulin allegations and the query of whether or not Lucy Letby actually poisoned infants.

A permanent problem within the Letby case – and reporting on it – is the problem of seeing the massive image.

Particular person components of the proof can, and can proceed to be, criticised. However it’s not attainable to achieve a view on the case with out taking the entire proof into consideration – and a few of this goes past the opinions of the medical consultants.

Letby’s time within the witness field was revealing for individuals who have been there. Throughout her authentic trial, she spent 14 days being questioned. A number of observers famous that she appeared aloof and detached. At occasions, she squirmed, and appeared to tie herself in knots.

She claimed she couldn’t keep in mind issues – just like the demise of a child she had texted colleagues about, or looking out repeatedly for the dad and mom of useless infants on-line.

There are different particulars, not included in Letby’s trials, which might be additionally difficult for the sceptics.

A complete of 13 infants died within the neonatal unit between June 2015 and June 2016. Letby was on responsibility for 12 of them.

And but, no-one really noticed her hurt a child.

In latest weeks, a number of of Letby’s colleagues have given proof to the Thirlwall Inquiry saying that they’ve since come to grasp her guilt.

Nevertheless, when consultants started to suspect her again in 2016, a lot of her nursing colleagues remained fiercely loyal – and so they remained loyal even after her elimination from the neonatal unit in July 2016.

It’s not exhausting to grasp why. There may be nothing apparent in Letby’s background that factors to her turning into a killer. Her dad and mom appear to have adored her, and her friendship teams in Hereford – and later in Chester – have been completely satisfied and supportive. Her closest buddies in Hereford stay satisfied she is harmless.

Then there may be Letby’s personal continued protestation of innocence. In July 2024, she was convicted of an extra rely of tried homicide. After listening to the decision, earlier than being taken to the cells, she turned to the decide with outstretched palms and stated: “I’m harmless.”

Letby now has a brand new lawyer, Mark McDonald, who plans to take her case to the Felony Circumstances Evaluate Fee (CCRC). Her makes an attempt to attraction in opposition to her convictions have to this point failed.

Mr McDonald tells us he has gathered the best consultants on the planet to evaluate the prosecution’s medical and scientific proof. He says the prosecution’s case was flawed and he’s assured his crew of consultants will give him the arguments he must problem her convictions.

However the CCRC course of might take years. Within the meantime, battles over the proof will proceed. Which means extra heartbreak for the households of the infants, who say they discover the continuous questioning of Lucy Letby’s convictions “grossly offensive and distressing”.