Another wrongful conviction? UK nurse Lucy Letby may be a scapegoat for an under-funded NHS
Dec 27, 2024
In August 2023, nurse Lucy Letby was convicted of the murder of seven babies and attempted murder of six babies in the neonatal unit of a UK National Health Service (NHS) hospital. The Australian media has reported on the current instalment of the saga (viz. a judicial inquiry into conditions at the hospital where Letby worked).
However, the possibility that this nurse may go down in history as a distressing instance of wrongful conviction has drawn scant attention here. As with Lindy Chamberlain, Sally Clark and Kathleen Folbigg, where in each case it became clear over time there was no crime, Letby’s convictions also involved the deaths of very young children. This is a relevant aspect to which we return below.
Letby’s story in brief is drawn from a fuller account published in the New Yorker magazine. She graduated in nursing in 2011 and then completed formal training in neonatal intensive care. She was described by many colleagues as competent, caring and dedicated. In 2015, Letby was working in the neonatal intensive care unit of the small Countess of Chester Hospital in the west of England. She lived at the hospital and frequently worked extra and extended shifts. From published descriptions, the unit was under-resourced, under-staffed and very busy. Many nurses and junior doctors were working 20-hour shifts to keep the unit operational. For the smallest babies in intensive care there was a policy of one nurse to one baby, but staff shortages meant that the policy was not always followed. Although the unit cared for the most premature infants, only one of its seven senior consultant paediatricians was trained in neonatology, a highly specialised area of paediatrics.
In the 12 months from June 2015, seven babies (six of whom were premature) died while Letby was on duty and was involved to a lesser or greater extent in their care. All the deaths were subject to review and all were judged to be from natural causes without any suspicious circumstances. In September 2016, the hospital management arranged for the neonatal intensive care unit to be externally reviewed by a specialist team from the Royal College of Paediatrics and Child Health. The team spoke to Letby and found her to be “an enthusiastic, capable and committed nurse” who was “passionate about her career and keen to progress”. The team criticised the medical and nursing staff levels indicating that they were inadequate. Subsequently, the unit was downgraded such that the sickest infants were sent elsewhere.
Two of the consultant paediatricians at the Countess of Chester Hospital undertook their own investigations into these deaths and created a chart that linked Letby to the seven deaths as she was on duty on the days that the neonates died. The two approached the hospital management with their suspicions and later were granted permission to show their chart to the Chester police. The police then undertook an investigation which resulted in Letby being charged with killing seven newborn babies and attempting to kill seven others. The 10-month trial began in October 2022. In August 2023, Letby was convicted on all charges other than one case of attempting to kill one baby. She was then 33 years old.
Shortly after the trial, the prosecutor announced a fresh prosecution of the single case where the jury had been unable to agree. With that announcement came a court-imposed ban on publication of any material in England that might influence a new jury. At the retrial Letby was convicted of a seventh attempted murder. An appeal against all convictions was rejected in May 2024. With the subsequent lifting of the court ban on publication, questions are now being raised in the UK about the safety of her conviction. This link is to a London newspaper report that emphasises “there may have been up to 17 infant deaths during the same period, with Letby only charged with seven”.
It seems clear that the prosecution based its case against Letby predominantly on the alleged coincidences originally compiled by the two doctors with whom she worked and on some scribbled notes she wrote that reflected her distress. The prosecution provided no evidence of motive nor direct evidence that the babies were killed. Some babies were alleged to have had air injected into veins, others had air or milk pumped into their stomachs interfering with breathing or chest expansion, and yet others were hypothesised to have had insulin overdoses.
Just before the commencement of the court case, the reliability of adverse inferences being drawn from the coincidences was criticised by the Royal Statistical Society. The report drew attention to two recent wrongful convictions (one in Italy and the other in the Netherlands) involving similar dependence on work shift patterns. The report also reminded readers of the wrongful conviction in the UK in 1999 of lawyer Sally Clark who was accused of killing her two sons; a conviction that flowed from a respected paediatrician’s misunderstanding or misuse of statistics.
Letby’s case is over for now. Her appeals are exhausted and it will take a very long time for her convictions to be overturned, if ever. As mentioned, a formal inquiry has begun into conditions at the Countess of Chester Hospital. While the inquiry has made it clear that it will not be examining Letby’s trial or the grounds for her convictions, it has provided a platform for her accusers to restate their belief in her guilt. Letby has a new legal team, whose lead barrister has recently held a press conference and has claimed that a key prosecution expert witness has changed his testimony. If a request for a new appeal is refused, there are plans to approach the Criminal Cases Review Commission.
Supposing for the moment that Letby may have been wrongly convicted, one could ask why are prosecutions such as this initiated? We suggest that in instances where very young children die in unexplained or difficult to explain circumstances (as was the case for Chamberlain, Clark and Folbigg), the answer may lie in what UK criminologist Stanley Cohen in 1972 called “moral panic”. The modern definition of moral panic is “a widespread feeling of fear that some evil person or thing threatens the values, interests, or well-being of a community or society”. An equally apt description would be society’s need (perhaps subconscious for most individual members) for a scapegoat, often in the past in the form of a witch. In Letby’s case there may be a more pressing need: viz. an understanding of the possible role played in the deaths of these premature babies by an under-resourced NHS.
Dr Kerry Breen AO is a retired physician whose career spanned roles in clinical medicine, medical ethics, regulation of the medical profession and the health of doctors. His long-term interest in medical ethics is reflected in his 2018 publication, Memoir of an Accidental Ethicist.
Stephen Cordner AM is emeritus professor of forensic medicine at Monash University and was the founding director of the Victorian Institute of Forensic Medicine. He is co-author with Kerry Breen of Good Medical Practice: Professionalism, Ethics and Law (4th ed., 2016), and Wrongful Convictions in Australia: Addressing issues in the criminal justice system (Australian Scholarly Publishing, 2023).
Contributions to Pearls and Irritations
Your contribution will fund quality independent comment and analysis in Pearls and Irritations
Contribute
