Letter to the BMJ

Rapid response to:

John Launer: Thinking the unthinkable on Lucy Letby

BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p2197, published 26 September 2023, cite as: BMJ 2023;382:p2197

Dear Editor

I am a coauthor of the report of the Royal Statistical Society https://rss.org.uk/news-publication/news-publications/2022/section-group-reports/rss-publishes-report-on-dealing-with-uncertainty-i/. It is deeply distressing that the police investigation into the case of Lucy Letby and the subsequent trial made all of the mistakes in our book. The jury was never told how the police investigation arrived at that list of “suspicious” events and how it was further narrowed down to the list of charges. This is a case in which a target was painted around a suspect by investigators. We call it confirmation bias, in statistics. It is also often referred to as the Texas sharpshooter paradox.

Thanks to amateurs who report their work on Twitter and YouTube, we now know how the list of charges in the Lucy Letby case evolved. It is utterly scandalous that this history was not revealed to the court. Here is the broad picture. 

Doctors reported Lucy to the police, against the wishes of the hospital board.

They told the police the exact period she had been on the ward and gave them the files on all deaths in that period and on some of the incidents: namely, exactly and only those “arrests” at which Lucy had been present.

What qualifies as an incident, what is an arrest?

There is no medical category “arrest, resuscitation” under which such events are logged in hospital administration. Probably there were about five times as many such events when Lucy was not on duty, but nobody has ever looked. There is no medical definition of such an event. No formal criteria.

“Unexpected, unexplained, sudden” are also not defined in any formal way. Nor is “stable”.

Next the absolutely unqualified, long retired, paediatrician Dewi Evans, who has a business helping out in civil child custody cases, went through those medical files looking for anomalies about which he could fantasise a murder or murder attack. His ideas that milk was injected into the stomach or air into the veins were far fetched, and later not confirmed by any other evidence. On the contrary, the actual evidence certainly contradicts the idea that Lucy Letby actually attacked any child. He never gave alternative medical explanations, as would have been the obligation of a forensic scientist. All the deaths had had a post-mortem and a coroner’s report. Every single event on the charge sheet has absolutely normal explanation. Lucy was never seen doing anything wrong.

The medical experts for the prosecution merely confirmed Evans’ diagnosis, they also did not do the job of a forensic scientist.

The defence had no experts. They had brought in one paediatrician. But at the pre-trial hearing he said he wasn’t qualified in endocrinology, toxicology, etc etc etc. 

This was Texas sharpshooter, big time. Plus utterly incompetent defence. 

Richard Gill

Member of Royal Dutch Academy of Sciences

Past president of Dutch statistical society.

13 thoughts on “Letter to the BMJ”

  1. Hi, it’s Mycroft On X here.

    Good letter clear coverage.

    I’m also going to write directly to the BMJ courtesy of the link given me earlier this evening.

    I’m going to come at the issue from a different angle but I would also like to reference this letter if I may (I will credit you obvs) as I can utilise some of what you have done in this matter.

    I think we have a strong combination punch available to us and I am not averse to using it.

    Regards, Chris.

  2. Dear Richard,

    Do you think it would help if you sent a copy of your letter to the BMJ , onto the British prime minister?

  3. Hi again Richard,

    I thought I wouldn’t write much more on this blog. But I am afraid it has got to me. My mind is working like mad. 
    During nurse training you attend many study days,  read lots of research and books,  you produce many assignments, attend many lectures take exams and spend a lot of time on hospital wards. You are assigned a trained nurse as a mentor on every placement,  and he or she  will pass on skills and knowledge.

     When your mentor thinks that you are ready they  will let you draw up and give injections . Plus many other nursing procedures. This will be  under  strict supervision of the qualified nurse  and also with permission from the patient.

    I am sorry if this sounds patronising. I don’t mean it to be and will get to the point… you will probably guess where I am going with this.

    During  all this time the student nurse will have learnt that to inject air into a patients veins is very dangerous. Everyone of reasonable intelligence can summon up an image of a nurse drawing up liquid into a syringe. The famous image of the nurse flicking the syringe to work the air bubbles out  well, it is most likely etched on many peoples memory.

    I am now reading more about Dr Dewi Evans. I felt hurt and angry yesterday  when I read the following. He worked out that Lucy started  injecting air after she had been on her intravenous course.  Does he think nurses are a bit slow. I am sorry, but what’s he on about ? Lucy is a very intelligent young woman. She would have known long before attending that course about this danger. Does he really think that after being qualified for four years  and working alongside senior staff , that she wouldn’t know about the dangers of air in a syringe  being used wrongly.

    I bet you could ask any Nurse tutor or trained nurse if they teach this to student nurses. I would certainly have taught the students who passed  through my hands. 
    So how did the expert Dr Dewi work this out. Was it an assumption?  Or what?

    Also,  he has said it would be good for them to get him back for the next trial.  He wants a few hundred more files to study. Why, when he already is saying on podcasts and interviews to the media that he thinks Lucy has been responsible for many more attacks. Is he allowed to be biased then.?

    Are the rules different for an expert?


  4. I just want to say a quick word in reply to HUMAN BEING on here Richard. I totally understand where they are coming from. 
    They have my utmost respect for speaking out.
    I know this is not the place for us whistle blowers to moan. But in my heart of hearts,  I so wish that a whistle blower would come forward to help Lucy Letby. If you are reading this and thinking about it. then can you please, please look into your conscience and mostly your heart.

    I hope  and pray that the proposed inquiry will bring  a good person out  from somewhere. 

    I am telling everyone I know and find it amazing that people are listening and saying how shocked they are that  Lucy could have been convicted wrongly., Or that ,she maybe didn’t have a fair trial.
    They have asked me where to sign the petition for Lucy . However, I don’t want anyone to sign because they are my friend or know me. I am encouraging people to read your work Richard and that of the other scientists and  the people on here. Then make their own mind up. 


  5. Ann, There was an ANNP (those initials mean something to you, but not me) who worked on the same ward, and alongside Lucy. She posted a very supportive comment on Facebook, but then deleted it. And has been contacted since and said she doesn’t want to go public. The NHS is well known in coming down hard on whistleblowers, it asks a lot of anyone to go public. I have, on my PC, a copy of the comment from Facebook.

    1. Hi dem359,

      Sorry, I meant to reply earlier. I am not ANNP and do not know that person. My only claim to the countess of Chester hospital is that once I attended a training course there. So many years ago, I can’t even remember what it was about. I am just an old retired nurse . I love children but would never have been able to care for very ill newborns. I would have been too affected. I get upset at seeing children ill or hurt. Better for me to have worked where people get well quickly and go home. I guess that we are all different.

      It takes a very special person to work in a neonatal care unit as you are most likely aware. Sometimes , and after becoming a mother, a neonatal nurse has been known to give it up. This is because they identify too much .

      I got interested in all this about Lucy Letby and thought , why are such eminent people saying that Lucy did not appear to get a fair trial. Professor Gill has vast experience and knowledge He was instrumental in helping a Dutch nurse who had been wrongly convicted. He sees similarities with the Lucy Letby case..Why is he not respected more?
      I just find it shocking that the nurses who followed into the profession after me may be at risk of such a thing happening again.
      It also shocks me that people are now arguing and treating Professor Gill so badly. He is a super intelligent guy who believes strongly in justice. He knows that science might not have been used properly in the case.

      Yes, again I say that I am biased in that I have a nursing background. But surely all the things that Professor Gill, SOT, Dr Scott, Norman Fenton and many, many others are pointing out needs investigation
      .Why can’t it be brought to the highest judge in the land? Or why can’t we get a team in from another country to investigate and maybe help an appeal. I just don’t know what to think now.

      I have seen poor care and standards myself , and yes I have reported it. And to be honest the management have acted and put into place measure’s to address it quickly sometimes.

      However, you are completely right in suggesting that whistle blowers are not liked or treated well. Often by their peer group.
      I remember a whistle blowing nurse many years ago. .At the time many of my friends and colleagues seemed to be saying he was wrong to speak out.
      I think this is changing slowly, or so we are led to believe. Let us hope that the government enquiry will uncover some grains of truth. I wish more nurses would speak out , but it is an extremely hard thing to do, not just for the ripples it causes in an organisation , but for your own mental health.

  6. Hi
    I got interested in this via The Daily Mail podcast that somehow dropped in my feed. As a doctor who has give evidence in many homicide trials I was not surprised at what came across as an assumption of guilt but the lack of expert evidence ( doctors yes but experts in the detail, certainly not) and lack of any meaningful defence but throwing the accused under the bus. They asked her medical questions way outside her expertise, experience yes expertises no.

    My questioning what I heard led me here

    No to my question. Your letter to BMJ has “ been removed for legal reasons” can you elaborate


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