In a neonatal unit in the UK, a controversy arose in the management of a baby born at 25 weeks. The baby died three days after being transferred to a more specialised hospital. A 34-year-old nurse, Lucy Letby, was convicted of attempting to murder the baby by dislodging her breathing tube.
Prosecution observed that Letby had turned off the alarm on the incubator and deliberately dislodged the breathing tube of the baby and falsely claimed that the baby was repeatedly dislodging the tube itself. An independent team of medical experts who investigated the death of the baby, concluded that the baby collapsed because of poor medical care.
Doctors made several traumatic attempts to insert a breathing tube in the baby’s airways, which tube was even too small for the baby. The tube had not been dislodged as alleged, but was in the wrong place and an allegation that Letby had deliberately turned off the alarm, which was on the incubator, was contradicted by another nurse.
There was a large air leak, which meant that the baby was not getting enough oxygen to breath. A doctor who attempted to resuscitate the baby used an incorrect equipment during the procedure. Another case involved a set of identical triplets whose birth by caesarean-section was reported as normal.
One of the babies, who was stable, suddenly collapsed and died. A postmortem examination showed multiple sites of damage to his liver and internal bleeding. There was no suggestion at the trial of the Letby, who had been accused of murdering the baby that the liver damage happened during birth.
A professor of pathology told court that it was extremely unlikely that the damage was caused by a needle because there was no evidence of a perforation injury. The professor further said that he had only ever seen such injuries in children involved in road traffic accidents or other accidents.
The baby had an unusual rash observed during resuscitation and an amount of air in a blood vessel in his heart. Court was told that this pointed to air embolus- meaning that the baby had been deliberately injected with air. An independent team of experts announced that the baby died of liver injury caused during a rapid, traumatic Caesarean-section delivery, which caused internal bleeding and shock.
Doctors had failed to diagnose this liver injury and the wrong techniques had been used to resuscitate the baby. The head of the unit, a doctor, blindly inserted a needle into the baby’s abdomen during resuscitation, making the injury even more worse. Letby was convicted of the murder of seven infants and attempted murders of seven others. The incidences complained of are reported to have happened between June 2015 and June 2016.
What sparked investigations was the death in June 2015, of three infants in a unit that typically saw only two or three deaths a year. Letby was accused of deliberately injecting some of the infants with air or insulin or overfeeding them, methods that could not be easily detected afterwards. All the 61 cases of sudden infant collapse were investigated in the hospital but this was narrowed to a total of 22 counts during the trial.
The prosecution presented the jury with a a chart showing Letby as the only nurse on duty for 25 incidents and then told the jury that by a process of simple elimination, she must have been responsible for the incidents. When she was removed from duty and the unit stopped admitting infants requiring intensive care or those born before 32 weeks of gestation, unexpected deaths stopped.
Letby’s conviction was mainly based on circumstantial evidence- that many of the babies who collapsed or died, were doing quite well, but suddenly deteriorated without any medical reason to explain such sharp turns and increase in neonatal deaths.
Investigations pointed to deliberate acts, although these could not be proved beyond reasonable doubt. It was also most unfortunate that Letby was a common factor in all the cases. In January 2024, she applied to the Court of Appeal for permission to appeal her convictions, but a judge rejected the appeal.
She renewed her application and put forward four grounds of appeal, one of which was that the evidence of the prosecution’s lead witness was dogmatic, biased and lacked impartiality. Another ground was that the medical evidence that Lucy injected air into the bloodstream of her patient’s was simply very weak.
During the initial trial, the judge had directed the jury to convict Letby even if they were unsure of the precise method used to murder or attempt to murder the infants. This directive was contested during the appeal.
Investigations pointed to deliberate acts, although these could not be proved beyond reasonable doubt. It was also most unfortunate that Letby was a common factor in all the cases. In January 2024, she applied to the Court of Appeal for permission to appeal her convictions, but a judge rejected the appeal. She renewed her application and put forward four grounds of appeal, one of which was that the evidence of the prosecution’s lead witness was dogmatic, biased and lacked impartiality.
Another ground was that the medical evidence that Lucy injected air into the bloodstream of her patient’s was simply very weak. During the initial trial, the judge had directed the jury to convict Letby even if they were unsure of the precise method used to murder or attempt to murder the infants. This directive was contested during the appeal.
The final ground of appeal was that the trial judge had failed to investigate the impartiality of one of the members of the jury. In May 2024, three judges of the Court of Appeal denied Letby the permission to appeal.
The judges ruled that the prosecution’s lead witness was well qualified to give an opinion and did not lack impartiality and it was up to the jury to assess the quality of his evidence. The judges also ruled that the initial trial had been thoughtful, fair, comprehensive and correct and none of the legal challenges advanced by Letby were arguable and that the criteria for admission of fresh evidence had not been met.
On February 4, 2025, Letby’s team applied for her case to be reviewed as a potential miscarriage of justice. Coinciding with this application, findings from an independent panel of medical experts was released.
