In 2020, a registered nurse, Lucy Letby, was investigated and prosecuted for murder and attempted murder of infants under her care. She came under investigation following a high number of unexpected infant deaths that occurred at the neonatal unit of a hospital in the UK, three years after she started working there.
A committee formed to review these deaths, attributed them to medication errors. However, a member of that committee was suspicious of Letby and complained to the hospital administration about her incompetence.
A neonatologist asked to review the deaths produced a report indicating that 13 of the deaths could be explained, but may have been prevented if proper care had been given. The neonatologist recommended that the remaining four deaths needed a forensic review.
In March 2017, four consultants asked the hospital management to involve the police to investigate neonatal deaths to rule out unnatural causes. The police investigations lasted one year. The investigators searched Letby’s apartment and that of her parents and found fragmentary handwritten notes with phrases such as “I do not want to do this anymore,” “I am evil, I did this” and “I killed them on purpose because I am not good enough to care for them”. The nurse herself denied that the notes were a confession, describing them as a reflection of her mental turmoil written while she was being investigated.
The nurse, in reality, wrote the notes on the advice of her personal doctor, as a healing process during the extreme stress of being investigated. On July 3, 2018, police arrested Letby and charged her with eight counts of murder and six counts of attempted murder. She denied all charges and pointed to issues of hospital hygiene and understaffing.
Her defence team argued that the notes that the investigators considered as crucial evidence, were the anguished outpouring of a young woman in fear and despair. Prosecution, however, said that the notes expressed the nurse’s frustration stemming from her removal from the neonatal unit. The notes were the closest evidence prosecution had to a confession. Sensitive medical records were also found under Letby’s bed and these included handover reports, resuscitation records, blood gas readings and some of these records included those of infants she is reported to have harmed.
In her defence, she reported that she had forgotten to remove these sheets from her pockets in the hospital and denied that she had intentions of destroying them. Meanwhile, a paper shredder was found in her home. Letby gave evidence in court in May 2023 and stated she meant no harm to the children. She said the allegations had negatively affected her mental health and made her feel as though she were incompetent and isolated from her friends in the neonatal unit.
Court proceedings show that she repeatedly contradicted herself, muddled up her story and became more and more frustrated with the prosecution’s questions, which was unlike her usual calm demeanour. Letby’s defence lawyers told court that she was a dedicated nurse in a system, which had failed and that the prosecution’s case was driven by the assumption that someone was doing deliberate harm, combined with the coincidence on certain occasions of her presence. Her lawyers also argued that there had been a massive failure of care in a busy hospital’s neonatal unit, far too great to blame on one person.
It was the defence’s case that the evidence presented by prosecution was insufficient to justify their theory of how the infants were harmed. To the lawyer, the evidence suggesting air embolism was so weak that it amounted to a no case to answer. Unfortunately, there was no medical expert who could testify on behalf of Letby in this case.
A plumber testified that sewage kept washing up into the sinks in the neonatal unit of the hospital quite frequently. He told the jury that issues like this led him to be called out almost weekly by management to deal with them. The defence argued that these hygiene issues unquestionably contribute to explaining the unit’s high mortality rate. It was later established that the water supply to the neonatal unit had a type of bacteria, known as pseudomonas, which had been responsible for several cases of pneumonia. Letby’s defence team attempted to argue a no case to answer on the following grounds;
No expertise
1. None of the experts who had given evidence on the topic of air embolus had sufficient clinical experience and expertise to do so. The research basis for air embolus as cited in the evidence, was too vague and inconsistent and failed to match the requirements of scientific evidence capable of supporting the diagnosis The prosecution experts were inconsistent in their descriptions of the characteristics required to support the diagnosis of air embolism.
The judge however ruled, using the Bolam test, that there was a sufficient body of accepted expert medical opinion that administration of air into the venous system could cause air embolism which might be fatal. In a case of murder or attempted murder, although the motive of an accused person is not one of the ingredients to be proved to convict an accused person, it may be a persuasive element.
Boredom?
The prosecution in Letby’s case suggested several theories, including boredom, thrill-seeking, and playing God as possible motives. One professor of criminology argued that healthcare killers join the profession in order to target vulnerable victims, such as the very old or the very young. Final verdicts were returned by the jury on August 18, 2023 and Letby was found guilty of seven counts of murdering seven babies, making her the most prolific child killer in modern UK history.
She was also found guilty of seven counts of attempted murder. The jury was unable to reach verdicts on six further attempted murder charges. On August 21, 2023, Letby was sentenced to life imprisonment without parole, the most severe sentence possible under English law. The judge described her as a cruel, calculated and cynical child murder. In metting out the sentence, the judge stated that there was a deep malevolence bordering on sadism and that Lucy did not show any remorse and there were no mitigating factors. Medical experts have, however, come out to question and dispute the evidence used in this case.
To be continued
Cruel, calculated and cynical child murderer?
Was it a fair verdict? Lucy Letby was sentenced to life imprisonment without pardon, the most severe sentence possible under English law. The judge described her as a cruel, calculated and cynical child murder. In metting out the sentence, the judge stated that there was a deep malevolence bordering on sadism and that she did not show any remorse and there were no mitigating factors. Medical experts have, however, come out to question and dispute the evidence used in this case.
