A British Nurse Was Found Guilty of Killing Seven Babies. Did She Do It?

New yorker Lucy Letby

In August of last year, Lucy Letby, a British nurse who was thirty-three years old, was found guilty of murdering seven newborn babies and trying to kill six more. This trial, which lasted more than ten months, was one of the longest in England and caught the attention of the entire country. The Guardian published over one hundred articles about the case and referred to Letby as one of the most infamous female murderers of the last century. Everyone was convinced of her guilt, as evidenced by statements made by the Daily Mail such as, "she has opened the door to Hell and the smell of evil overpowers us all."

The situation inspired the British government to take action. The Secretary of Health promptly declared an investigation to explore why Letby's hospital had not been able to safeguard infants. When Letby declined to attend her sentencing session, the Secretary of Justice stated that he would endeavor to alter the legislation so that convicts would have to show up in court to receive their sentence. The Prime Minister, Rishi Sunak, expressed his contempt by stating that it was cowardly for individuals who commit such dreadful offenses not to confront their sufferers.

The discussion among the public continued without paying much attention to an unusual detail in the account: Letby seemed to be a mentally sound and content individual. She had numerous intimate friends, and her nursing co-workers spoke highly of her compassionate and devoted mannerism. A detective from Cheshire police, who were in charge of the inquiry, mentioned that the situation was unparalleled because it seemed as though there was no reason as to why Letby would have murdered infants. "We haven't come across anything in her past that's not ordinary."

The judge overseeing Letby's case, James Goss, recognized that she was a diligent, diligent, well-informed, confident, and professional nurse. However, he also stated that she had intentionally and cynically murdered children, and sentenced her to life in prison, making her the fourth woman in UK history to receive a life sentence. Even though her sentence cannot be lengthened, she will be tried again in June on a charge of attempted murder that the previous jury was unable to reach a decision on.

Letby previously worked at a struggling neonatal unit within the National Health Service's Countess of Chester Hospital, located in the West of England near Wales. The case in question revolves around seven deaths between June 2015 and June 2016, with all but one of the infants being born prematurely and three of them weighing less than three pounds. However, no conclusive evidence implicating Letby was ever discovered, and the coroner found no evidence of foul play in any of the deaths. Following her arrest, Letby has refrained from making any public statements, and a court order has limited coverage of her case. To provide insight into her experiences, I relied on over 7000 pages of court transcripts that included police interviews and text messages, as well as internal hospital records that were leaked to me.

The police shared a chart with the media showing twenty-four suspicious events, such as deaths and sudden declines, that happened to babies. The chart also listed the thirty-eight nurses who worked during that time, with X's next to the names of nurses who were on duty during each suspicious event. The nurse Lucy Letby was the only one with a line of X's under her name for every event. The prosecutor argued that she was a constant presence when things went wrong and suggested that this was a clear and undeniable pattern. The prosecution believed that it was easy to eliminate all other possibilities, making it clear that Letby was the only one left.

However, the graph failed to consider any other elements that could have influenced the number of deaths in that particular ward. Due to the continuous upward trend, Letby was considered the most hated woman in the country and labeled as the "surprising representation of wickedness" by the British magazine Prospect. This was mainly due to the fact that the graph seemed mathematically logical and systematic, diverting attention away from the possibility that there may not have been any criminal activities after all.

Letby had always dreamt of becoming a nurse since she was a teenager. Her appreciation for life stemmed from her own complicated birth, and she was grateful to the nurses who had saved her. She spent her childhood in Hereford, which is located north of Bristol, and she was an only child. She had a close friend group at school, and they referred to themselves as the "miss-match family." They enjoyed playing games like Cranium and Twister and considered themselves to be a bit nerdy. Letby was known by her friends to be a kind, gentle, and peaceful person who radiated joy.

Letby achieved a significant milestone in her family by being the first to attend college. She earned a nursing degree from the University of Chester in 2011 and landed a job on the neonatal unit at the hospital where her nursing career began. She chose to work far away from home, and while she felt remorseful sometimes, it was her decision and what she wanted. She frequently spent her free time with other members of the nursing team, viewing them as a family. Letby often showed up in cheerful photographs on Facebook, wearing colorful dresses and shiny lip gloss, holding glasses filled with bubbly wine and flashing a natural smile. She was a modest but attractive woman with straight blonde hair that faded in color as she got older.

The section talks about the old unit for newborns, which was built in 1974 and was no longer suitable for the purpose it was serving. In 2012, the Countess initiated a campaign to raise funds for building a new unit, which took nine years to complete. The head of the unit, Stephen Brearey, said that neonatal intensive care has improved, but they need more equipment, and the lack of space poses a threat to the babies' health. Additionally, there were issues with the drainage system, causing leakages and blockages in both the neonatal and maternity wards, and sewage occasionally backed up into the toilets and sinks.

The hospital workers were also very busy. There were seven expert doctors in charge, but only one of them specialized in caring for newborns. This doctor is called a neonatologist. One time, a baby passed away in 2014 because the medical team put a tube in the wrong place - the esophagus instead of the trachea. Several warnings were ignored. A judge investigated the matter and said it was surprising that the signs were not recognized. The baby's mother explained to a newspaper that the staff didn't have enough people, so things like blood tests and X-rays took a long time to get done. There was only one doctor working, and he had to split his time between the neonatal ward and the children's ward.

The N.H.S. is greatly valued in the minds of the British people, with some even considering it to be their "religion," according to a politician. It is seen as a symbol of the social contract formed after the Second World War, and even though it has faced difficulties due to years of insufficient funding, it still inspires loyalty and respect. Sadly, in 2015, England and Wales saw an increase in infant mortality rates for the first time in a century, with two-thirds of neonatal units lacking sufficient medical and nursing staff. At the Countess, more babies were treated than before, and many of them had lower birth weights and medical complications, highlighting the challenges faced by the unit. Letby, a 25-year-old junior nurse who had just completed her training in neonatal intensive care, was one of two nurses on the unit with this qualification. Despite staffing issues, with people coming in for extra shifts, Letby remained dedicated, working tirelessly to save money for a house, even texting a friend to say, "Work is always my priority," when advised to take a break.

In June of 2015, three infants passed away at Countess Hospital. A woman with antiphospholipid syndrome, a rare condition that can result in blood clots, was brought to the hospital when she was thirty-one weeks pregnant with twins. Though she had initially planned to give birth in London to receive specialist care, her blood pressure spiked and she needed an emergency cesarean section at Countess Hospital. Letby was asked to cover a colleague's overnight shift and was put in charge of one of the twins, a boy known as Child A due to privacy regulations. A note from a day shift nurse said the infant had been without fluids for several hours due to an improperly placed umbilical catheter, and although the situation was urgent, the doctors were not responding. A more senior doctor eventually had to insert a longline, a narrow tube placed through a vein, while Letby and another nurse tended to the infant. Soon after, Letby and a co-worker saw that the baby's oxygen level was dropping, and it appeared as if his skin was becoming streaky. The doctor who inserted the longline removed it quickly, as it might have been too close to the baby's heart. Unfortunately, the infant passed away within 90 minutes of Letby's shift starting. She wrote a note to a colleague about how terrible it was, saying that the baby died suddenly and unexpectedly right after the handover.

The doctor who studies diseases looked at the baby's body and saw that there was something wrong with the way the arteries in the lungs were connected. They also saw that there was a clear connection between when the longline was put in and when the baby's body stopped working properly. The doctor couldn't say for sure what caused the baby's death.

Letby was working the night shift once again after the tragic death of Child A. At approximately twelve o'clock, she assisted the assigned nurse in setting up an I.V. bag for the surviving twin, who happened to be a girl. After about twenty-five minutes, the baby's skin turned purple and blotchy, and her heart rate decreased. Fortunately, medical personnel were able to resuscitate her, and she eventually made a full recovery. Brearey, the unit's leader, shared with me that during that moment, he considered if the twins were more susceptible to health complications due to the mother's disorder, which can transmit antibodies through the placenta.

"Would you like the volume at a low level where you can barely hear the speaking or at a high level where the music dominates?"

The cartoon created by Lynn Hsu depicts the importance of persistence in achieving success. In the cartoon, a person is seen digging a hole in the ground with a shovel. However, after some time they become tired and stop digging, giving up on their task. However, just a few inches of earth separate them from reaching a treasure chest, implying that if they had persisted a little longer, they would have achieved their goal. The cartoon aims to emphasize the need to persevere in the face of challenges and obstacles. It shows that it is important not to give up too soon, as success may be just around the corner. Therefore, we should all strive to develop a mindset of perseverance, especially when faced with difficulties. With determination and persistence, we can overcome any obstacle and achieve our goals, whatever they may be.

The following day, a mom with a life-threatening placental condition delivered a baby boy weighing just under two pounds, which was the smallest that the facility was equipped to handle. Shortly after, within four days, the baby was diagnosed with severe pneumonia. Although Letby was not assigned to the intensive-care nursery where the baby was admitted, she made her way into the unit after the infant's oxygen alarm went off to offer assistance. Despite the nursing team's best efforts, the tiny patient could not be saved. The autopsy revealed that the baby passed away due to natural causes.

A few days after, a lady came to the hospital when her water broke. However, the hospital sent her home and advised her to wait. After more than a day, she noticed that her baby was not moving as much, and she got worried about an infection since she was not prescribed any antibiotics. She went back to the hospital, but they still didn't give her antibiotics. She felt ignored by the staff, and finally, after sixty hours, she underwent a C-section. Following the baby's birth, the doctors confirmed that the girl needed antibiotics immediately, but unfortunately, it took almost four hours before she got the medication. The following night, the baby's oxygen alarm went off, and the nurse called for assistance from Staff Nurse Letby. The baby continued to decline throughout the evening and couldn't be resuscitated. A pathologist uncovered that there was pneumonia in the baby's lungs, which could have been present from birth.

Letby messaged Margaret, a shift leader on the unit, and informed her that they had unfortunately lost someone. Margaret had previously provided guidance to Letby when she was a ward trainee.

"Oh my goodness! I thought she was getting better," Margaret responded. "What occured? Would you like to speak about it? I'm stunned you had to go back on again. You're truly facing a lot."

Letby informed Margaret that the conditions that led to the demise could be under examination.

"Excuse me, is there a holdup in receiving medical attention?"

"In general," she expressed. "And after examining the antibiotics she had taken, among other things, to determine whether it is sepsis." Letby added that she was still taken aback. "I feel somewhat emotionally detached."

Margaret suggested that a break was necessary for her friend. When Margaret remembered the first of the three deaths, she assured her friend that although the parents of the deceased infant would always experience grief, they would not have any regrets about the time spent with their child due to the exceptional care provided by Letby. Margaret wanted to help her friend focus on the positive aspects during tough times and assured her of her support. Margaret concluded the message by wishing her friend a good night's sleep.

After a few days, Letby was unable to control her tears. She sent a text message to a friend from the unit, stating that the situation had finally sunk in. Letby revealed that she could understand why two of the children had passed away as one had a difficult start in life and the other had a severe infection, but she couldn't quite grasp why Child A didn't make it.

The senior doctors who specialize in treating children gathered to examine the deaths of infants. They wanted to check if something went wrong or if there were any patterns in the deaths. One of the main issues with these infant deaths is that premature babies can pass away unexpectedly, and there may not be an immediate explanation for why it happened. Brearey explained to me that in a study of approximately a thousand infant deaths in southeast London, half of the babies who died unexpectedly did not have an explanation for their passing, even after doctors examined their bodies. Brearey also mentioned that Letby was present for each of the deaths at the Countess, but he didn't believe that it was too unusual for her to be involved in those cases. He didn't think there were any problems with her practices.

The leader of the children's medical department, Ravi Jayaram, shared with me that Lucy was a hero during the situation. He mentioned that the nurses adored Letby. Jayaram tried to understand what happened by assuming that the baby's health might not have been as stable as they believed. He also considered the possibility that the longline went in too far and caused a heart issue. He explained that it's natural for people to want a logical explanation for events, but sometimes it's impossible to have one.

After four months, another baby passed away. This baby was born after twenty-seven weeks, which was just beyond the age limit that the unit could treat. The baby was sent to Arrowe Park, a different hospital, for more specialized care due to having an infection and a small brain bleed. However, after only two nights, the baby was returned to the Countess where its condition quickly deteriorated. The senior nursing staff blamed the neonatal unit for not being truthful and instead trying to clear up space. The baby's mother was worried that the staff at the Countess were too busy to give her daughter proper attention. She noticed that one of the nurses, Nicky, was coughing and sneezing while putting her hands in the baby's incubator. Furthermore, while Nicky was present, a doctor who was seeing another baby asked if she was full of a cold, to which Nicky replied, "Yeah, I've had it for days." The doctors were aware of Nicky's illness but failed to take any action. A survey conducted the following year showed that around two-thirds of the staff at the Countess felt pressured to come to work even when they were unwell. None of the hospitals mentioned in this article would comment due to a court order.

The workers attempted to transfer the young lady to a specific facility situated in another hospital. However, while they waited for the confirmation of the move, she started experiencing difficulty in breathing. Her assigned nurse had not received intensive care training yet, and she called out for assistance. Letby, who was attending to a separate infant, entered the room accompanied by two doctors. Despite their efforts, the baby's condition continued to worsen, and they were unable to resuscitate her.

Afterwards, Letby was seen weeping with a fellow nurse by a doctor. The doctor explained that Letby expressed how unfortunate it was that the incidents always seemed to happen under her care. The doctor noted that Letby's reaction seemed typical under the circumstances. Later on, Letby messaged Margaret, stating that she had talked to the manager of the neonatal unit, Eirian Powell. Powell had advised Letby to trust her abilities without the need to prove herself, something that Letby had been struggling with recently.

Three nurses from the ward went to the funeral of the baby. Letby presented a card to the parents, expressing her gratitude for the opportunity to care for the child. The family always prioritized the baby and did their best for her. Letby promised that the child will always have a significant place in their lives and they will never forget her. The card ended with a message of support for the family during this difficult time and always.

Jayaram, who was working at the time of the girl's passing, talked to Brearey and another pediatrician about what happened. According to him, he said, "Do you know what's interesting? It was Lucy Letby who was on duty." They all looked at each other and said, "It's always Lucy, right?"

They discussed their worries about the link with upper level management, and Powell conducted an unofficial examination. Powell informed Brearey that she had created a document to showcase the data accurately, but was sad to hear she was present. Nonetheless, the reason for each person's death differed.

The following month, Letby, who was a part of a salsa group, finished her class and noticed three unanswered phone calls: the nurses that worked with her that day reached out to her as they were not informed of how to administer intravenous immunoglobulin treatment for a baby. "I find it hard to believe that some individuals are in a position where they are unaware of what to give, the necessary equipment to use, and lacking support from their manager," Letby sent a message to Cheryl, her close friend, who is also a nurse. "The number of staff needs to be reassessed." She called the unit "disorganized" and likened it to "a chaotic situation."

Alison Timmis, a senior pediatrician, was upset about the situation at the hospital. She sent an email to the hospital's CEO, Tony Chambers, expressing her concern that the staff on the unit were working too hard and no one was listening to their concerns. She noted that many of her colleagues were very upset and had been crying. Timmis explained that the doctors were working very long shifts, some longer than 20 hours, and the unit was so busy that they had run out of important equipment, such as incubators. At one point, a midwife had to help with a resuscitation because there weren't enough trained nurses available. Timmis felt that the current situation was dangerous and unstable, and that if it continued, it would lead to either children's lives being put at risk or the health of the staff suffering.

In January 2016, the head doctors of pediatrics had a meeting with a specialist in infant care at a nearby hospital. They went over the information they had on the deaths that occurred in their ward. In 2013 and 2014, there were two and three deaths respectively. However, in 2015 there were eight. At the meeting, they discussed some things they learned from the data but nothing that was too surprising. Towards the end of the meeting, one of the doctors asked the specialist about the fact that Letby was present for every death. According to the head doctor, the specialist did not have any suggestions or ideas about this.

Jayaram and Brearey were getting more and more worried about the connection. Jayaram explained it as looking at a Magic Eye picture - at first, the dots seem random and messy. However, if you keep looking, a pattern appears, and then you see it every time you look. Jayaram said that by the spring of 2016, he couldn't stop noticing the link anymore.

Numerous fatalities happened during nighttime, thus Powell, who is in charge of the unit, decided to assign Letby to the day shift mostly. This is because there will be a greater number of individuals around who can aid her, as per her statement.

During the month of June in the year 2016, which was three months after a certain alteration had taken place, Cheryl sent a message to Letby via text before they were due to begin their shift. The message conveyed a warning, stating that it would be unwise for Letby to report for duty at that time.

"Oh, for what reason?" Letby replied.

"Five entries, one vent."

Cheryl expressed that a baby born too early with hemophilia looked terrible. The amount of oxygen in his body dropped during the night. Letby was assigned to take care of him that morning, but when doctors tried to insert a tube into his throat, they were unsuccessful. They called two anesthesiologists to help, but they could not succeed either. The hospital did not have enough factor VIII, which is an important medicine for hemophiliacs. They requested a team from Alder Hey Children's Hospital, which was 30 miles away, to come to the hospital with factor VIII. A doctor from Alder Hey quickly and easily inserted the tube. Letby shared her feelings of disappointment and sadness with her friend, a junior doctor named Taylor. She felt like she had been busy all day but had not accomplished anything positive for the baby.

Not long after, a woman became the mother of three identical baby boys at thirty-three weeks. The mother shared that she was told each newborn would have their own nurse, but Letby was given care of two of the triplets and a baby from another family. Moreover, Letby had to train a student nurse who she felt was constantly by her side. During Letby's shift, one of the triplets experienced a sudden drop in their oxygen levels and a rash developed on their chest. Letby quickly called for assistance, and despite undergoing two rounds of CPR, the baby unfortunately died.

On the following day, Letby was responsible for taking care of the two surviving triplets. She noticed that one of them had a swollen stomach which could suggest the presence of an infection. She informed Taylor about it, who then asked if there was a possibility that all the babies had gotten infected with a bug that couldn't be treated with benzylpenicillin and gentamicin. Taylor also asked if Letby was alright.

"I'm fine, but I don't really want to stay here," Letby responded. The nursing student was still present, and Letby informed Taylor that she didn't think she was mentally prepared enough to offer the proper support needed.

A medical professional arrived to examine the triplet with a swollen abdominal area, but during the doctor's visit, the infant's oxygen levels decreased. The baby was put on a machine to assist with breathing, and the hospital requested a transfer team to bring the child to Liverpool Women's Hospital. While waiting for the team to arrive, it was discovered that the baby's lung had collapsed, potentially because the ventilation had been set too high. Letby noted a growing sense of concern on the ward since there was no clear understanding of what was happening, and the team of experts was eagerly awaited to provide guidance and support. The mother of the triplets was troubled when she saw a doctor at a computer who seemed to be looking up how to do a simple medical procedure, such as inserting a chest tube. She was also dismayed that one of the doctors who was attempting to revive her son did not wash her hands despite coughing and sneezing into them. Unfortunately, shortly after the transfer team arrived, the second of the triplets passed away. The mother recalled that Letby was "completely devastated and nearly as heartbroken as we were."

The comic strip drawn by Avi Steinberg Avi Steinberg's cartoon panel

During the process of dressing the baby for his parents, which is a regular part of providing assistance to families going through grief, Letby mistakenly pierced her finger with a needle. She had not had anything to eat or taken any breaks throughout the day, and as she waited to have her finger looked at, she passed out. She explained that the intensity of the past two days had caught up with her. She found it hard to bear the thought of what the parents must have experienced while losing two of their babies.

After losing two of her triplets, the remaining baby was brought to Liverpool Women's Hospital. The mother was impressed with the level of competence and organization displayed by the clinical staff there. She noted a vast difference between the two hospitals, describing them as being like night and day.

One evening, Brearey contacted Karen Rees, who was in charge of nursing for urgent care, and expressed that he did not want Letby to come back to work until an investigation was conducted due to the consistent deaths of babies. Rees talked about the situation with Powell, who claimed that Letby always followed the protocols strictly. Rees decided to allow Letby to continue her work as there was no valid reason to immediately remove her upon the request of a senior healthcare professional.

The following day, Letby was given the duty of taking care of a male baby, referred to as Child Q, who was suffering from a digestive tract infection. At a certain point, the baby was taken to Alder Hey hospital, but he was brought back within a span of two days. Taylor sent Letby a text message saying that Alder Hey hospital was running very low on beds and could only provide space for patients who need immediate care. This was not an ideal situation for holistic care and was very disappointing for the baby's parents.

While Letby was looking after a different newborn in another room, Child Q started vomiting and his oxygen levels decreased. John Gibbs, a senior pediatrician, asked another nurse who had been present during the incident once the child had stabilized.

"Should I feel concerned about the questions asked by Dr. Gibbs?" Letby messaged Taylor following the end of her working hours.

He comforted her by saying "It's not possible for you to oversee two infants in separate nurseries simultaneously, let alone anticipate when they will fall asleep."

"I am aware that I didn't leave him alone. Both nurses inside and outside the room were informed of my departure," she explained.

"He didn't accuse you of ignoring a baby or causing any harm," he stated.

"I understand. I am concerned that I may not have completed sufficient tasks."

She stated that the loss of two babies under her care, and the current situation that occurred, have made her question whether she is qualified enough or lacking in some way.

"I understand the amount of effort you've put in these past three days, Lucy," he expressed. "If there's anyone who questions your abilities or work quality, I want you to promise me that you'll reach out to me and I'll give my contact information to back you up with a statement."

"I really hope I never have to use a statement," she stated. "Nonetheless, I appreciate it. I give you my word."

Letby had plans to work the upcoming evening, but received a sudden phone call from Powell informing her not to come in. She expressed her concern that something was awry by messaging Cheryl.

"What makes you think you're in trouble?" Cheryl retorted. "You haven't committed any wrongdoing."

"I understand, but I'm concerned they might believe I overlooked something or anything like that," expressed Letby. "Why did they wait until now to call?"

Cheryl acknowledged that it was a considerably late hour and suggested that it's possible that external sources were exerting pressure on her.

Letby expressed concern about the person, saying "She was friendly, but I have some apprehension." She went on to explain that the nature of her job can have negative effects on one's mental state.

Letby worked three more day shifts before taking two weeks off for vacation. During her absence, Brearey and Jayaram, along with a few other pediatric consultants, gathered to discuss the unexpected deaths. "We were really trying to think hard," said Brearey. An X-ray taken postmortem on one of the babies revealed the presence of gas near the skull. While the pathologist did not initially believe it to be significant, since gas is typically present after death, Jayaram recalled learning in medical school about air embolisms, a rare and potentially deadly complication where air bubbles block blood supply by entering a person's veins or arteries. That evening, he conducted research on the topic and shared a four-page paper from the Archives of Disease in Childhood with his colleagues. The paper discussed accidental air embolism and reported only fifty-three cases in the world, with all but four of the infants dying immediately. In five cases, the skin of the infants had also become discolored. "I'll never forget the shiver that went down my spine," said Jayaram. "It seemed to fit with what we were seeing."

Jayaram and another doctor who specializes in treating children went to a meeting with the important people who run the hospital. They talked to the people in charge of medicine and nursing, as well as the executive board, and told them that they didn't want to work with Letby because they had some worries. They suggested that the police should be called to help. The board members asked them for proof, but they couldn't provide any specific evidence. However, they still had concerns. To make things easier for everyone who works there, the hospital directors and board decided to make some changes. They downgraded the ward so that it wouldn't provide intensive care anymore. The hospital will also send women who are delivering their babies before 32 weeks to a different hospital. The board agreed to order a review by an important organization called the Royal College of Paediatrics and Child Health. This review will try to figure out why more babies have been dying recently.

When Letby came back from her break, she was asked to attend a meeting. During the meeting, the nursing deputy director informed her that she was the link between the group of deaths and that her ability to work as a nurse would be evaluated again. Powell, the unit manager who was also present, shared that Letby was upset and so was she. Without delay, they both headed to human resources. Powell revealed that they wanted to bring Letby back to the unit, so they had to demonstrate that the competence matter was not the cause of the problem.

However, Letby did not go back to treating patients. She was relocated to an administrative position at the hospital's risk and safety office. Jayaram referred to the office as a place where individuals with poor clinical skills or unwanted managers were sent to, describing it as an "island of lost souls."

Letby sent a text message to Cheryl after being absent from clinical work for over a month, informing her that she had spoken with her union representative. The representative warned her not to contact other staff members as they could potentially be involved in assessing her abilities. In the text, Letby expressed her frustration at feeling ignored and neglected, stating that this situation was affecting both her personal life and professional career.

Cheryl expressed that she finds everything to be extremely absurd.

"I am unable to predict the ultimate outcome."

"I'm, like, totally positive that after Christmas is done, we'll forget all about it," Cheryl comforted her.

Letby made a complaint in September 2016, stating that she was terminated from her position without a definite reason. This caused her world to come to a halt, and she later revealed that she was diagnosed with depression and anxiety and started taking medicine. The experience left her with low self-esteem and made her question everything about herself. She felt like she had let everyone down, including herself, and believed that people started to view her differently.

During that month, a group from the Royal College of Paediatrics and Child Health went to the Countess to talk to people for two days. After the conversations, they saw that there weren't enough nurses and doctors working there. They also noticed that in 2015, more people died than before and it wasn't just in the area for newborns. The number of stillbirths in the part of the hospital where moms go to have their babies was also higher.

I was given a part of a report that discussed how the staff on the unit were really unhappy about Letby being taken off of her duties. The Royal College team talked to Letby and thought she was a great nurse who cared a lot about her job. They also said that the senior pediatricians who accused Letby didn't have any real evidence and just had a feeling. The Royal College couldn't find anything that would connect the deaths together and said that the conditions on the unit were normal for other places in the UK. The hospital admitted that the review showed issues with the skills of the staff, their teamwork, leadership, and culture.

During the month of November, Jayaram was questioned by an official who was looking into Letby's complaint. It was said that some pediatricians were calling someone on the ward an "angel of death," and the discussion centered around whether or not Jayaram had voiced his concerns openly.

"It's not effective. You still resemble a unicorn."

The cartoon created by Mick Stevens is a humorous depiction of a man at a computer screen with a thought bubble showing his irrational fear of being watched through the computer's camera. This fear, commonly referred to as webcam paranoia, is a growing concern in today's digital age where privacy and security online are major issues. Mick Stevens' cartoon cleverly illustrates the absurdity of this fear by portraying the man as being watched by a large, all-seeing eye in the sky. This not only highlights the illogical nature of webcam paranoia but also provides a humorous and lighthearted take on the subject. Overall, the cartoon serves as a reminder of the importance of being mindful of online security and privacy while also offering a much-needed laugh in these uncertain times.

During the interview, the administrator inquired with Jayaram if he had received any indications that Lucy had intentionally caused harm to babies, as noted in the meeting's minutes.

Jayaram replied that there is no solid proof to indicate that. The only thing that can be connected is the fact that Lucy was present on the unit during that period.

"To make it clear, did any of the consultant team imply that Lucy intentionally caused harm to babies?"

He said that they had talked about many different options in private.

"Does that mean you're not giving a definite answer?"

Jayaram reiterated that they had thoroughly explored numerous options in private discussions.

Letby's complaint was supported by the hospital. During a meeting with the board in January 2017, Chambers, who was formerly a nurse and now serves as the hospital's chief executive, stated that they were looking for an apology from the consultants regarding their conduct. He also expressed a desire for Letby to return to the unit as soon as possible. In a letter to the consultants, Chambers expressed concern about their vulnerability to "confirmation bias," which he defined as a tendency to look for, interpret, favor, and recall information that confirms preexisting beliefs or hypotheses. Chambers was unable to comment further due to a court order.

In March of 2017, Jayaram met with Letby to discuss their issues. Jayaram is a well-known medical expert, often seen on TV discussing topics from hospital staffing to heart problems. He was even on a show called "Born Naughty?" where he helped diagnose children who had unusual behaviors. Letby had a statement prepared for the meeting, accusing Jayaram of orchestrating a campaign to get her removed and accusing her of murdering babies. Jayaram said he was not angry at Letby, but angry at the system.

Jayaram and Brearey believed that the hospital was attempting to cover up its reputation and was silencing them. Brearey mentioned an instance where he watched a documentary about the Challenger space shuttle explosion. He emphasized the story of an engineer who had tried to warn higher-ups about the shuttle's severe problems but was ignored. Brearey thought of his own experiences in the same regard, and he and Jayaram had been exchanging messages with the hospital's management for months, requesting the removal of Letby from the unit. They were convinced that their convictions and principles were well-founded, similar to those of other individuals in history who stood up for what was right.

Serial killers who happen to be healthcare professionals are an extremely rare occurrence, but they have become a popular topic in media and entertainment. However, in northwest England, these crimes have extended beyond the world of entertainment. Harold Shipman, who was one of the world's most prolific serial killers, worked as a physician for the N.H.S. just forty miles from Chester. Shipman allegedly killed around 250 patients over a period of thirty years by injecting them with lethal doses of a painkiller before being convicted in 2000. The leader of the government inquiry into Shipman's crimes suggested that investigators should be trained to consider alternative causes of death.

In April of 2017, Jayaram and another doctor who specializes in treating children met with a detective from Cheshire's police department to discuss their concerns about the Countess's leadership. The police superintendent was convinced to start an investigation within ten minutes after hearing their story. Jayaram was happy with the result.

During the month of May, the police initiated an operation named as Operation Hummingbird. One of the detectives later mentioned that Brearey and Jayaram were the primary leads in their investigation.

In that particular month, Dewi Evans, a retired physician who had previously been in charge of the neonatal and children's department at his hospital in Wales, came across a newspaper article that briefly discussed an ongoing inquiry into the sudden rise of fatalities at the Countess. Sparking his interest, he emailed the National Crime Agency, an organization that collaborates with scientific professionals and law enforcement, expressing his willingness to assist with the investigation if they had no leads. Evans declared that the investigation seemed like something he would be inclined to engage in.

During that particular summer, Evans, who had been working as a court expert for over twenty-five years and was sixty-seven years old, drove for three and a half hours to Cheshire to meet the police. After going through the records handed over to him by the police, he wrote a report stating that Child A's death could have been caused by "a noxious substance like potassium chloride or possibly an air embolus." However, when there was no supporting evidence for a noxious chemical, Evans concluded that air embolism was the most likely cause of death. "These are situations where you come to a conclusion by eliminating other possibilities," clarified Evans.

Evans had never witnessed an instance of air embolism, but his hospital had experienced one approximately two decades earlier. An anesthetist had intended to inject air into a baby's stomach but instead, mistakenly injected it into the bloodstream. This error caused the baby to collapse and die, leaving a lasting impact on all who had been involved. Evans sought to learn more about air embolisms and stumbled upon the same 1989 paper that Jayaram had found. He noted that air embolisms are extremely rare and that there haven't been many publications on the subject since then.

In other reports, Evans heavily relied on the use of documents about the Countess deaths. He claimed that many of these deaths were caused by the entry of air into the bloodstream. For other infants, the harm they faced was from an intentional injection of air or fluid, or both, into their nasogastric tubes. This action leads to the inflation of the stomach until it becomes so large that the lungs of the baby can no longer work correctly. Accordingly, the baby is not able to receive sufficient oxygen. When questioned about his findings, Evans could not point to any supporting medical literature as there were none available. Several doctors were perplexed about this proposed method of murder, finding it challenging to comprehend how it was feasible either physiologically or logistically.

A year after Operation Hummingbird began, a new way of harming people was discovered. In a baby’s discharge letter, Brearey saw a mention of high levels of insulin. Insulin is a hormone produced by the body to regulate blood sugar levels. When insulin is produced naturally, another substance called C-peptide is also produced. However, the baby’s C-peptide levels were undetectable, which suggested that insulin was given to the baby. The insulin test was done in a lab at the Royal Liverpool University Hospital. The biochemist who conducted the test had recommended that the sample be verified by a more specialized lab. However, the lab guidelines stated that their insulin test was not for investigating whether synthetic insulin was used. A forensic toxicologist from Sweden said that the test used at the Royal Liverpool lab was not sufficient for use as evidence in a criminal prosecution. He recommended analyzing the substance in a forensic laboratory with modern technology. The Countess did not order a second test since the baby had already recovered.

Brearey found out that after eight months, a biochemist working at the laboratory reported that there was a high level of insulin in the blood sample of another baby. That infant was already discharged and no further testing was done on the sample. Joseph Wolfsdorf, who is a Harvard Medical School professor and specializes in pediatric hypoglycemia, stated that the C-peptide level of the baby indicated that there might have been some problem with the testing because if the child had been given insulin, the C-peptide level would have been very low or impossible to detect. However, that was not the case.

The police spoke to a hormone specialist who said that the babies may have been given insulin through their IV bags. Evans believed that the insulin cases provided some evidence. However, there was an issue. The first baby's blood was tested ten hours after Letby left the hospital, so any insulin she gave would no longer be detectable. Additionally, the tube from the first IV bag had come loose, so a new one was given. To accuse Letby of giving insulin, one would have to think that she managed to inject insulin into a bag that another nurse had chosen randomly from the fridge. If Letby had killed by air embolism before, it would be strange for her to try the less effective method of insulin injection.

It was July of 2018 when a detective from the Cheshire police department visited Letby's home, five months after the insulin discovery. She had purchased a residence near the hospital one mile away two years prior. A tiny birdhouse adorned the entryway. Although it was only 6 a.m., she greeted the officer with a smile when he presented his badge and asked if he could come inside for a brief moment.

"Um, yeah," she replied with a frightened expression.

They informed her that she was being detained for numerous counts of homicide and attempted homicide while she was indoors. After getting out of the house, she had handcuffs on, and her skin looked nearly grey.

The authorities dedicated an entire day to comb through her residence. During this process, they stumbled upon a written message with a title labeled "NOT GOOD ENOUGH." The note contained various phrases written chaotically without any punctuations. Some of the words written on the page at odd angles include "I feel speechless," "It is hard to breathe," "Discrimination and defamation of character," "I will never know what it's like to be a parent or a spouse," "Why did this happen to me?," "I am guiltless," "I intentionally killed them because I lacked the ability to look after them," and finally, "My actions were evil."

She had a note that said "Everything is manageable" written three times, which was something her colleague had told her. At the end of the page, she expressed her desire to go back to her happy work life with a team that made her feel included. She felt like she didn't belong anywhere and was seen as a burden to those who knew her. Another note in her bag said she couldn't handle it anymore and needed help, but no one could provide it. She also acknowledged that she and others had tried their best, but it still wasn't sufficient.

Letby was questioned about why she wrote a note stating "not good enough" following a day spent in prison. A recording from the police shows Letby sitting in a room with her hands folded in her lap and her posture slumped forward. She spoke softly and with deference, almost as if she were a student faced with a tough exam. Letby explained that writing the note was simply a way for her to express her emotions on paper. It helped her process her thoughts.

The officer inquired if there was any wrongdoing on the part of the person being questioned according to their personal beliefs.

"I didn't do it on purpose, but I was concerned that they would discover that my approach wasn't satisfactory," she stated. Additionally, she shared, "I pondered if I might have overlooked something or been slow to respond."

"Can you provide us with a sample?"

In simpler terms, she suggested that she may not have fulfilled her duties in the team. She had worked during the night when there were no doctors available, and this concerned her as she may have missed calling them promptly. Additionally, she was anxious that she may have administered incorrect dosages of medicine or misused necessary equipment.

“Did you experience a sense of wickedness?”

If there was something I missed, others might see me as wicked, that's how I felt about this circumstance.

I really dislike it when they place kittens in the section designed to encourage spur-of-the-moment purchases.

The article segment in informal language using alternate vocabulary: Illustration crafted by P. C. Vey.

The investigator stated to Lucy that she wrote down she intentionally killed them.

"I didn't intentionally cause their demise."

The investigator inquired, "What is the source of the stress that has caused these emotions?"

"She expressed that her panicked reaction was due to the fear of being reassigned and all the events that followed," she shared. She had drafted the notes following her dismissal from clinical responsibilities, but after a thorough evaluation of her clinical expertise, no issues were identified. As a result, she became more assured of her competencies. She emphasized her dedication to her occupation and acknowledged that she had been overwhelmed during that time. She was unsure if anything will ever be all right again."

During a subsequent interview, a law enforcement official inquired about the purpose of a note with the word "hate" prominently displayed and encircled. "Why did you highlight that term?" was the officer's question.

She expressed feeling extremely remorseful for not meeting her own standards and disappointing those around her. Being dismissed from her beloved job, receiving criticism about her work, and being isolated from others contributed to her self-blame.

The law enforcement official repeated his question as to why she had penned down the words, "I intentionally murdered them."

She stated that was the way she was made to feel, and as her mental state declined, her thoughts became uncontrollable. She believed that if her abilities weren't up to par, and she was connected to the fatalities, then it was her responsibility.

"You're being overly critical of yourself, even though you haven't made any mistakes."

"I tend to be quite self-critical," she stated.

Letby was interviewed for more than nine hours, but she was released on bail without being charged. She went back to live with her parents in Hereford. The media reported her arrest all over the UK. A mother whose baby was treated by Letby said she was a great nurse. Another mother said Letby had supported her all the way and never left her in the dark. She had nothing negative to say about her performance. The Guardian also interviewed another mother who gave birth at the Countess. She said they had insufficient staff, which led to terrible care. Due to the negligence of a staff member, she contracted an infection, and when they complained, it was not properly dealt with.

A friend from Letby's childhood spoke to me but didn't want their name used because they've already experienced negative consequences for sticking by Letby. This friend reached out to the Cheshire police to act as a reference for Letby, but they weren't interested. The friend described Letby as appearing terrified and confused regarding the accusations against her. It was clear that Letby didn't know how to respond because it was completely foreign to her to be accused of these things.

After Letby's arrest, the hospital's pediatric consultants organized a meeting for the medical staff to discuss their lack of confidence in Chambers, the CEO, due to his mishandling of their concerns. Chambers resigned prior to the meeting. Doctor Susan Gilby was appointed in his place and supported the consultants' beliefs. When Gilby met with Jayaram for the first time, she realized he was emotionally affected by being disbelieved by the hospital's management. Jayaram described issues with sleeping and his inability to trust anyone. Gilby was shocked that Ian Harvey, the hospital's medical director, still doubted the consultants' theory about the babies' deaths. Harvey appeared more concerned about the consultants' behavior than Letby's actions. Harvey refused to comment, citing a court order.

During the time when Letby was arrested, the police searched her backyard and looked into the drains and vents. They were probably trying to find anything that would prove she was guilty. After four months passed, Letby was still out on bail and no charges had been pressed against her. People began to wonder if it was fair or even legal to keep her under suspicion of serious crimes without enough evidence to actually arrest her. Letby was arrested again in 2019 and questioned for nine hours, but then later released.

During November of 2020, Letby, who had been arrested two years prior, was charged with eight counts of murder and ten counts of attempted murder. A police officer called Gilby to provide her with this information. One of the murder charges was later dropped, but five attempted-murder charges were added. Letby was arrested again and was not granted bail, so she had to wait for her trial while in prison. Gilby called Chambers to inform him of the situation, and he expressed worry about Letby potentially being wrongfully convicted.

A report titled "Healthcare Serial Killer or Coincidence?" was released in September 2022, a month prior to Letby's trial. The report was prompted after concerns were raised about two recent cases in Italy and the Netherlands, in which nurses were wrongfully convicted of murder based on the correlation between their shift patterns and deaths on their wards. The report was submitted to both the prosecution and defense teams in Letby's trial and warned against drawing causal conclusions from improbable clusters of events. In Lucia de Berk's trial, a criminologist had claimed a one-in-three-hundred-and-forty-two-million chance of coincidence, but statistical analysis later revealed the likelihood was closer to one in fifty. This flawed methodology became the basis for collecting evidence against de Berk, who was eventually cleared of charges in 2010. Similarly, Italian nurse Daniela Poggiali was exonerated in 2021 after statisticians discovered several overlooked confounding factors in the hospital's mortality data. These cases serve as cautionary tales against jumping to conclusions based solely on correlation.

William C. Thompson, who authored the report for the Royal Statistical Society and is currently a retired professor in criminology, law, and psychology from the University of California, Irvine, has expressed that medical murder cases are likely to have errors in statistical reasoning. This is due to the fact that such cases involve deciding between two unusual theories. Professor Thompson explained that one theory is that it was merely a coincidence, while the other implies that someone who was previously a respected member of the community, like Lucy Letby, could suddenly decide to become a killer.

Mistaken mathematical thinking led to a highly publicized case of injustice in the United Kingdom. Sally Clark, a lawyer, was wrongly found guilty of murder in 1999 when her two infant sons died unexpectedly without a clear explanation. A pediatrician who testified for the prosecution prominently cited statistics, stating that there was only a 1 in 73 million chance for two sudden infant deaths to happen in the same family. However, his reasoning was flawed because he failed to consider the possibility that the same genetic or environmental factors were involved in the deaths of both babies, treating them as separate events instead.

Daniel Kahneman, a Nobel Prize winner in Economics, believes that people lack good intuition for basic statistics principles, according to his book "Thinking, Fast and Slow" (2011). He states that humans think associatively, metaphorically, and causally, but statistics requires cognizance of multiple things at once, which is not an inborn or spontaneous function. We frequently presume that outliers result from deliberate actions. This predisposition can cause significant errors in assessing the randomness of genuinely random occurrences.

According to Burkhard Schafer, a law professor at the University of Edinburgh, who explores how the law and science intersect, it seems that the prosecution in the Letby case failed to learn from previous wrongful convictions. Instead of ensuring that their statistical data was accurate, they seem to have disregarded it. As Schafer explained to me, the police are adept at identifying an individual who is responsible for a crime. However, they are not skilled at identifying systemic problems in organizations like the National Health Service. After decades of underfunding, it is likely that stressed workers may take shortcuts that could harm vulnerable patients. It is easier to blame an individual than to address the consequences of governmental policy.

According to Schafer, he became worried about the case after seeing a chart that showed suspicious events marked with X's under Letby's name. Schafer thought that the chart should have covered a longer period of time and included all of the deaths on the unit, not just the ones in question. The chart seemed to be an example of the "Texas sharpshooter fallacy," which is a common mistake in statistical reasoning. This mistake happens when researchers have a lot of data but only focus on a small part of it that supports their hypothesis. The name of the fallacy comes from a story about a marksman who shoots at the side of a barn and then draws a bull's-eye around the area with the most bullet holes.

The chart displayed that Letby was on night duty for a single infant but the information was incorrect. She actually worked during the day, and there shouldn't have been an X next to her name. During the trial, the prosecution claimed that although the infant's health had worsened overnight, the doubtful incident started three minutes after Letby arrived to start her day shift. Despite this fact, the erroneous diagram persisted in being circulated, even by the Cheshire police.

As I was speaking with Dewi Evans, a former pediatrician, he revealed to me that he was the one responsible for selecting which medical incidents were considered as "suspicious events". When I inquired about the standards he followed, he replied by saying that it had to be something unexpected, sudden or irregular - a scenario that one is not usually acquainted with. Interestingly, for a particular infant, the determination of whether the issue was suspicious or not centered around specifying what constitutes projectile vomiting.

The defense team for Letby stated that they found two other occurrences similar to the ones shown on the chart that seemed suspicious but Letby wasn't on duty during these times. Evans also found some events that may have been left out. After Letby's initial arrest, Evans reviewed a new set of medical records and notified the police of an additional 25 cases that he felt should be investigated, but it remains unclear if Letby was present for those events. These cases were not included in the chart and if they had been, the evidence against Letby may have been weaker. The Cheshire police and prosecution declined to comment due to a court order.

Evans has brought forth some new cases that he believes to be suspicious, one of which involves insulin. He claims that this case shares similarities with the other two cases, particularly in the high levels of insulin and low C-peptide. As a result, he believes that this is a clear example of poisoning. When discussing this with Michael Hall, an expert who has worked with Letby's defense, he found the news surprising and alarming. Hall offered a couple of explanations as to why this case might not have been included in the trial, such as Letby not being employed at the time or an alternate explanation for the test results. Despite this, Hall still believes that the third case is worth looking into.

In his book depicting the story of Lucia de Berk, Ton Derksen employed a train analogy. He compared the two cases of alleged poisoning to "locomotives," while the remaining eight cases, which involved sick children during de Berk's shifts, were seen as "wagons" following along due to a belief that the deaths were unlikely to be by chance.

In the Letby trial, the main focus was on the insulin cases that were deemed as attempted murders. According to Nick Johnson, the prosecutor, the two incidents where insulin was intentionally used as poison could help in determining whether the other collapses and deaths of infants in the neonatal unit were a result of deliberate harm or just unfortunate events.

However, not only were the details surrounding the poisonings uncertain, but the outcomes of the incidents were also inconclusive. If the intent was to cause harm, the desired outcomes were not achieved with either child. The first infant recuperated after twenty-four hours, and the second didn't display any symptoms and was released from care in excellent condition.

During the initial hearing, Letby's attorney, Benjamin Myers, informed the judge that Letby was unable to speak effectively as she seemed to be confused. After her arrest, she was diagnosed with post-traumatic stress disorder, which has had a significant effect on her. She was incarcerated for two years before being transferred to a new facility, but she didn't have her necessary medication there. Myers revealed that whatever progress she had made in terms of mental health had been undone due to this unavailability of medication.

Psychiatrists evaluated Letby for anxiety issues and determined that she did not have to stand up to walk from one spot to another in court. Instead, she could stay seated in the witness box before anyone else arrived. According to The Guardian, Letby appeared quite vulnerable in court, always on edge and looking nervously towards any sound that might arise, such as a cough or even the shuffling of the prison guard beside her. Throughout the trial, Letby's parents were present, often joined by a nurse who had retired from the same unit as Letby.

The media covered the case extensively and focused heavily on Letby's note where she referred to herself as "evil" and admitted to "killing them on purpose." They did not include her explanations to the police. Additionally, they highlighted a text she had sent before returning to work in which she said she would be "back in with a bang lol" and the fact that she had searched for parents whose children she was later accused of harming on Facebook 31 times. However, Letby had also searched for other people over 2,000 times during that year, including colleagues, salsa dance partners, and random encounters. She explained that these searches were out of curiosity and she did them quickly. It's important to note that her search history did not involve air embolisms.

The blog post features a cartoon created by Roz Chast.

For nearly ten years, the parents of the infants had been living in a state of uncertainty. During the trial, they recounted how their sorrow had heightened when they were informed that their babies' deaths could have been intentionally caused by an individual they trusted. "What perplexes me the most," one mother expressed, "is that Lucy presented herself as compassionate, gentle, and soft-spoken." Their belief in their own instincts had eroded. They spoke of being overwhelmed by feelings of remorse for being unable to safeguard their children.

After several months of the trial, Myers requested that Judge Goss dismiss Evans' evidence and prevent him from returning to the witness box. Unfortunately, the request was rejected. Myers came across information that a judge in a different case had labeled a medical report written by Evans as "worthless." The judge concluded that the report was not of high quality and had biases. The judge also asserted that Evans did not seem to have consulted with other professionals and that this was a violation of ethical conduct. (Evans disagreed with the judgment.)

The prosecution had built their case against Letby using Evans' medical reports, which totaled around eighty. Another specialist in pediatrics had reviewed Evans' work, and other experts in fields such as hematology, endocrinology, radiology, and pathology had also been called upon to provide their opinions. All of these experts were affiliated with the National Health Service. While Evans wasn't certain, he believed that Letby's defense team had not consulted international experts from places like North America or Australia. If he were in their position, he would have sought a nonpartisan perspective from foreign professionals.

During the five years leading up to the court trial, the opinions of several experts appeared to have changed. Evans had originally stated that one of the babies was at ri

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