Note: [20 August 2023] This post is incomplete. It needs a prequel: the history of medical investigations into two “unexplained clusters” of deaths at the neonatal ward of the Countess of Chester Hospital. It needs many sequels: statistical evidence; how the cases were selected (the Texas sharpshooter paradox) and the origin of suspicions that a particular nurse might be a serial killer; the post-it note; the alleged insulin poisonings; the trouble with sewage backflow and the evidence of the plumber; the euthanasias. For the medical material, the site to visit is the magnificent https://rexvlucyletby2023.com/.
Lucy Letby, a young nurse, has been tried at Manchester Crown Court for 7 murders and 15 murder attempts on 17 newborn children in the neonatal ward at Countess of Chester Hospital, Chester, UK, in 2015 and 2016.
She was found:– Guilty of 7 counts of murder (against 7 babies)
– Guilty of 7 counts of attempted murder (against 6 babies)
– Not guilty on 2 counts of attempted murder (against 2 of the 6 babies she *was* found guilty of attempting to murder). No decision was reached on 6 counts of attempted murder against 6 different babies. However, 2 of those 6 she was also found guilty of a different count of attempted murder. [Thanks to the commenter who corrected my numbers.]
The prosecution dropped one further murder charge just before the trial started, on the instruction of the judge. Several groups of alleged murders and murder attempts concern the same child, or twin or triplet siblings. All but one child was born pre-term. Several of them, extremely pre-term.
I’m not saying that I know that Lucy Letby is innocent. As a scientist, I am saying that this case is a major miscarriage of justice. Lucy did not have a fair trial. The similarities with the famous case of Lucia de Berk in the Netherlands are deeply disturbing.
The image below summarizes findings concerning the medical evidence. This was not my research. The graphic was given to me by a person who wishes to remain anonymous, in order to disseminate the research now fully documented on https://rexvlucyletby2023.com/, whose author and owner wishes to remain anonymous. Note that the defence has not called any expert witnesses at all (except for one person: the plumber). Possibly, they had not enough funds for this. Crowd-sourcing might be a smart way of getting the necessary work done for free, to be used at a subsequent appeal. That’s a dangerous tactic, and it seems to me that the defence has already taken a foolish step: they admitted that two babies received unauthorised doses of insulin, and their client was obliged to believe that too.
This blog post started in May 2023 as a first attempt by myself to blog about a case which I have been following for a long time. The information I report here was uncovered by others and is discussed on various internet fora. Links and sources are given below, some lead to yet more excellent sources. Everything here was communicated to the defence, but they declined to use it in court. Maybe they felt their hands were bound by pre-trial agreement between the trial parties as to what evidence would be brought to the attention of the jury, which witnesses, etc.
An extraordinary feature of UK criminal prosecution law is that if exculpatory evidence is in the possession of the defence, but not used in court, then it should not be used at a subsequent appeal, whether by the same defence team or a new one. This might explain why the defence team would not even inform their client of their knowledge of the existence of evidence which exonerated her. Even though, it is also against the law that they did not, as far as we know, disclose evidence which they had which was in her favour. The UK law on criminal court procedure is case law. New judges can always decide to depart from past judges’ rulings.
A very important issue is that the rules of use of expert evidence is that all expert evidence must be introduced before the trial starts. It is strictly forbidden to introduce new expert evidence once the trial is underway.
UK criminal trials are tightly scripted theatre. The jury is of course incommunicado, very close to its verdict, and I do not aim to influence the jury or their verdict. I aim to stimulate discussion of the case in advance of a likely appeal against a likely guilty verdict. I wish to support that small part of the UK population who are deeply concerned that this trial is going to end in an unjustified guilty verdict. Probably it will, but that will not be the end. So much information has come out in the 9 months of the trial so far, that a serious fight on behalf of Lucy Letby is now possible. Public opinion crystallised long ago against Lucy. It can be made fluid again, and maybe it can even be reversed, and this is what must happen if she is to get a fair re-trial.
As a concerned scientist who perceives a miscarriage of justice in the making, I attempted to communicate information not only to the defence but also to the prosecution, to the judge (via the clerk of the court), and to the Director of Public Prosecutions. That was a Kafkaesque experience which I will write about on another occasion. Personally, I tend to think that Lucy is innocent. That was however not my reason for attempting to contact the authorities. As a scientist, it was manifestly clear to me that she was not getting a fair trial. Science was being abused. I tried to communicate with the appropriate authorities. I failed to get any response. Therefore I had to “go public”.
Here is a short list of key medical/scientific issues, originally copied from an early version of the incredible and amazing website https://rexvlucyletby2023.com/, with occasional slight rephrasing and some small, hopefully correct, additions by myself. That site presents full scientific documentation and argumentation for all of the claims made there.
- Air embolism cannot be determined by imaging, and can only be determined soon after death, and requires the extraction of air from the circulatory system, and analysis of the composition of the air using gas chromatography.
- The coroner found a cause of death in 5 out of 7 of the alleged murder cases. Two of them appeared to be, in part, related to aggressive CPR, two appeared to be due to undiagnosed hypoxic-ischemic encephalopathy and myocarditis, one of the infants received no autopsy, and the other infant was determined to have died due to prematurity. It is highly unusual for the cause of death to be altered years after the fact and using methodology that is not supported by the coroner’s office.
- The two claims of insulin poisoning are not supported by the testing conducted, and the infants (who are still alive and well) did not have dangerously low or dangerously high blood glucose levels for any period of time. There are many physiological reasons that could explain their low blood glucose during the whole period. In one of the two cases, assumptions are being made on the basis of one test taken at a single time point, clearly inconsistent with the other medical readings, and contravening the manufacturer’s own instructions for use (see image below). The report detailing the conclusions from that single test violates the code of practice of the forensic science regulator. Moreover, it appears that some numerical error has been made in the necessary calculation, resulting in an outcome which is physiologically impossible (or the person responsible did not know about the so-called “hook effect”). The mismatch between C-peptide and insulin concentration does not prove that the excess insulin found must have been synthetic insulin. There are many other biological explanations for a mismatch. No testing was done to determine the origin of the insulin. Similarly, there are many innocent explanations for the detection of some insulin in a feeding bag.
- The air embolism hypothesis is confusing because it fails to explain why some children apparently perished and others did not, and it has not been supported by the minimal necessary measurements.
- In at least one case, Lucy is blamed with causing white matter brain injury. This claim is utterly dishonest. The infant who experienced this brain injury was born at 23 weeks gestation, and white matter brain injury is associated with such early births. Further, there is sufficient evidence that demonstrates that enterovirus and parechovirus infection has been linked to white matter brain injury in neonates, resulting in cerebral palsy.
- At the time of the collapses and deaths of the infants, enterovirus and parechovirus had been reported in other hospitals. There is a history of outbreaks of these viruses in neonatal wards in hospitals around the world. They especially harm preterm infants who do not yet have a functioning immune system. It is reported that many parents of the infants were concerned that their ward had a virus (as was Lucy) and that Dr Gibbs denied this was so. To date we have seen no evidence to show they did any viral testing, and if they did what the results were.
Then a fact pertaining to my own scientific competence.
Both prosecution and defence were warned long ago about the statistical issues in such cases. Both have responded that they are not going to use any statistics. They are also not using the services of any statistician. Seems the RSS report https://rss.org.uk/news-publication/news-publications/2022/section-group-reports/rss-publishes-report-on-dealing-with-uncertainty-i/ has had the opposite effect to that intended. Amusingly, the same thing happened in the case of Lucia de Berk. At the appeal the prosecution stopped using statistics. She was convicted solely on the grounds of “irrefutable medical scientific evidence”. (Here, I’m quoting from the words both spoken by the judges and written down on the first page of their > 100 page report of the reasons and reasoning which had led to their unshakable conviction that Lucia de Berk was guilty. The longest judge’s summing up in Dutch legal history). I was one of the five coauthors of the RSS report. We were a “task force”, formally commissioned by the “Statistics and the Law” section of the society. I consider it the most important scientific work of my career. It took us two years to put together. We started the work in 2020; we had seen the Lucy Letby trial on the horizon since 2017 when police investigations started and the suspect being investigated was already common knowledge.
The UK does not have anything like that because a jury of ordinary folk are the ones who (legally) determine guilt or innocence. This is a clever device which makes fighting a conviction very difficult; no one can know what arguments the jury had in their mind, no one knows what, if anything, was the key fact that convinced them of guilt. Ordinary people are convinced by what seems to be a smoking gun, they then see all the other evidence through a filter. This is called “confirmation bias”. In the Lucy Letby case, the smoking gun was probably the post-it note, and the insulin then seems to clinch the matter. The prosecution cross-examination convinces those who already believe Lucy is guilty that she moreover is constantly lying. More on all this in later posts, I hope.
Back to the insulin. Here are the instructions on the insulin testing kit used for the trial, taken from this website http://pathlabs.rlbuht.nhs.uk/ccfram.htm, the actual file is http://pathlabs.rlbuht.nhs.uk/insulin.pdf. Notice the warning printed in red. Yes, it was printed in red, that was not something I changed later. (All this is not my discovery; the person who uncovered these facts wishes to remain anonymous).
The toxicological evidence used in the trial violates the code of practice of the UK’s Forensic Science Regulator (see link below). It should have been deemed inadmissible. Instead, the defence has not disputed it, and thereby obliged their own client Lucy to agree that there must have been a killer on the ward. The jury are instructed to believe that two babies were given insulin without authorization, endangering their lives. (The two babies in question are still very much alive, to this day. Probably now at primary school.)
The defence stated to me that they cannot inform Lucy of the alternative analysis of the insulin question. It appears to me that this violates their own code of practice. Do they feel bound by the weird rules of UK’s criminal prosecution practice? Their client, Lucy Letby, is herself essentially merely a piece of evidence, seized by the police from what they believe is a scene of crime. No one may tamper with it during the duration of her own trial, which is lasting 10 months! I think this constitutes an appalling violation of basic human rights. The UK laws on contempt of court are meant to guarantee a fair trial. But in the case of a 10-month trial on 22 charges of murder and attempted murder, they are guaranteeing an unfair trial.
Lucy’s solicitor refused to pass on a friendly personal letter of support to Lucy or to her parents because she had not instructed him to do so. Should one laugh or cry about that excuse? I have the impression that he is not very bright and that he may have been convinced she is guilty. If so, I hope he is changing his mind. In the UK, the solicitor does all the legwork and communication between the client and the defence team. The barrister does the cross-examinations and the court theatrics, but probably never builds up a personal relationship with his client. Lucy has been all this time prison, in pre-trial detention, far from Manchester or Hereford. This might explain the extraordinarily weak defence which has been put up so far. But it might be deliberate.
One must take into account the fact that funding for legal support is meagre. The prosecution has been working on the case for 6 or so years, with unlimited resources. The defence has had a relatively very short time, with very limited resources. Probably the solicitor and the barrister already put in many more hours than they are paid for. There are no funds for expensive scientific witnesses. It is very possible that the defence team well understands that they cannot put up a serious defence during the 9 to 10 months of the trial, but that precisely this time period, with a huge number of revelations being made outside the trial, material for a serious defence during an appeal has been “crowd-sourced”. It seems to me that this mass of high-quality independent scientific work provides plenty of grounds for an appeal, in the case that the jury hands down a guilty verdict.
Some links:
Sarrita Adams’ Science on Trial website
Formerly: https://rexvlucyletby2023.com/
Scott McLachlan’s Law Health and Tech blog
LL Part 0: Scepticism in Action: Reflections on evidence presented in the Lucy Letby trial. https://lawhealthandtech.substack.com/p/scepticism-in-action
LL Part 1: Hospital Wastewater https://lawhealthandtech.substack.com/p/ll-part-1-hospital-wastewater
LL Part 2: An ‘Association’ https://lawhealthandtech.substack.com/p/ll-part-2-an-association
LL Part 3: Death already lived in the NICU Environment, https://lawhealthandtech.substack.com/p/ll-part-3-death-already-lived-in
LL Part 4: Outbreak in a New NICU: Build it and the pathogens will come…https://lawhealthandtech.substack.com/p/ll-part-4-outbreak-in-a-new-nicu
LL Part 5: The Demise of Child A https://lawhealthandtech.substack.com/p/ll-part-5-the-demise-of-child-a
LL Part 6: The Incredible Dr Dewi Evans https://lawhealthandtech.substack.com/p/ll-part-6-the-incredible-dr-dewi
LL Part 7: The Demise of Child C. https://lawhealthandtech.substack.com/p/ll-part-7-the-demise-of-child-c
LL Part 8: The Death of Child D. Had she been left or resumed on CPAP, she might still be alive today. https://lawhealthandtech.substack.com/p/ll-part-8-the-death-of-child-d
Peter Elston’s “Chimpinvestor” blog
Do Statistics Prove Accused Nurse Lucy Letby Innocent? https://www.chimpinvestor.com/post/do-statistics-prove-accused-nurse-lucy-letby-innocent This splendid and comprehensive blog post also has a large list of links to reports and data sets. Yet more data analysis can and should be done. This site gives anyone who wants to a quick-start. And after that, two more outstanding posts…
https://www.chimpinvestor.com/post/more-remarkable-statistics-in-the-lucy-letby-case
https://www.chimpinvestor.com/post/the-travesty-of-the-lucy-letby-verdicts
Data obtained from FOI requests
FOI requests provided some fantastic data sets https://www.whatdotheyknow.com/request/neonatal_deaths_and_fois#incoming-1255362 see especially https://www.whatdotheyknow.com/request/521287/response/1265224/attach/2/FOI%204568×1.xlsx?cookie_passthrough=1
How forensic science should be reported in court
Forensic Science Regulator: statutory code of practice https://www.gov.uk/government/publications/statutory-code-of-practice-for-forensic-science-activities
One of numerous enterovirus and parechovirus epidemics in neonatal wards
Cluster of human parechovirus infections as the predominant cause of sepsis in neonates and infants, Leicester, United Kingdom, 8 May to 2 August 2016 https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2016.21.34.30326
Someone commissioned a pretrial statistical and risk analysis – results not used in the trial
Lucy Letby Trial, Statistical and Risk Analysis Expert Input. Who commissioned this analysis, and what did it yield? (I can give you the answer after the verdict has come out). https://www.oldfieldconsultancy.co.uk/lucy-letby-trial-statistical-and-risk-analysis-expert-input/
The RSS (statistics and law section) report – not used in the trial
Royal Statistical Society: “Healthcare serial killer or coincidence?
Statistical issues in investigation of suspected medical misconduct” by the RSS Statistics and the Law Section, September 2022 https://rss.org.uk/news-publication/news-publications/2022/section-group-reports/rss-publishes-report-on-dealing-with-uncertainty-i/
At a pre-publication meeting of stake-holders held to gain feedback on our report, a senior West Midlands police inspector told me “we are not using statistics because they only make people confused”. Lucy’s sollicitor and barrister knew well in advance of our report, were even given names of excellent UK experts whom they could consult, but did not bother to contact one of them. No statistics in our courts please, we are British! Yet the UK has the best applied statisticians and epidemiologists in the world.
Article in “Science” about my work on serial killer nurses
Unlucky Numbers: Richard Gill is fighting the shoddy statistics that put nurses in prison for serial murder. Science, Vol 379, Issue 6629, 2022. https://www.science.org/content/article/unlucky-numbers-fighting-murder-convictions-rest-shoddy-stats
Two subreddits on the Lucy Letby case
https://www.reddit.com/r/scienceLucyLetby/ (the Lucy Letby Science subreddit)
https://www.reddit.com/r/lucyletby/ (general)
Medical Ethics
John Gibbs, recently retired Consultant Paediatrician at the Countess of Chester
Hospital, defined Medical Ethics as “Playing God with Life and Death decisions.” See article “Medical Ethics” on page 6 of The Messenger, Monthly Newsletter of St Michael’s, Plas Newton, Chester) – reporting on talk by Dr John Gibbs, retiring paediatrician at CoCH. https://stmichaelschester.com/wp-content/uploads/2019/04/Messenger-April-2020.pdf. Audio: https://stmichaelschester.com/sermons/encounter-medical-ethics/
The state of forensic science in the UK
https://www.bbc.co.uk/sounds/play/m001k7vt?partner=uk.co.bbc&origin=share-mobile “The UK’s forensic science used to be considered the gold standard, but no longer. The risk of miscarriages of justice is growing. And now a new Westminster Commission is trying to find out what went wrong. Joshua talks to its co-chair, leading forensic scientist Dr Angela Gallop CBE, and to criminal defence barrister Katy Thorne KC.”
Criminal Procedure Rules and Criminal Practice Directions
Revised rules came out earlier this year, so maybe they do not apply to a trial which started earlier. Still, they express what the Lord Chief Justice of England and Wales presently wants to promote. https://www.judiciary.uk/guidance-and-resources/message-from-lord-burnett-lord-chief-justice-of-england-and-wales-new-criminal-practice-directions-2023/ . See especially Section 7 of his “Criminal Practice Directions (2023)” https://www.judiciary.uk/wp-content/uploads/2023/04/Criminal-Practice-Directions-2023-1-3.pdf
New expert evidence cannot be admitted once a trial is in progress
“The courts have indicated that they are prepared to refuse leave to the Defence to call expert evidence where they have failed to comply with CrimPR; for example by serving reports late in the proceedings, which raise new issues (Writtle v DPP [2009] EWHC 236). See also: R v Ensor [2010] 1 Cr. App. R.18 and Reed, Reed & Garmson[2009] EWCA Crim. 2698″. This quote comes from https://www.cps.gov.uk/legal-guidance/expert-evidence. Note, a judge is always allowed to break with precedence. The rule is not actually a permanent rule, it is merely a description of current practice. Current practice evolves when and if a new judge sees fit to break with precedence. Obviously, he would have to come up with good legal reasons why he believes he has to do that. It’s his prerogative, his free choice. That’s the essence of case law, aka common law.