The flaws in medical evidence on all sides of the Lucy Letby case

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In terms of the Lucy Letby case, there are two parallel universes. In a single, the query of her guilt is settled. She is a monster who murdered seven infants and tried to homicide seven extra whereas she was a nurse on the Countess of Chester Hospital between 2015 and 2016.

Within the different universe, Letby is the sufferer of a flawed legal justice system through which unreliable medical proof was used to sentence and imprison an harmless lady.

That is what Letby’s barrister Mark McDonald argues. He says he has the backing of a panel of the most effective specialists on this planet who say there isn’t a proof any infants have been intentionally harmed.

These extremes are each disturbing and bewildering. Certainly one of them is incorrect – however which? Who ought to we consider?

The households of the infants say there isn’t a doubt. Letby was convicted after a 10-month trial by a jury that had thought of an unlimited vary of proof. They are saying Letby’s defenders are selecting on small bits of proof out of context and that the fixed questioning of her guilt is deeply distressing.

I’ve spent virtually three years investigating the Letby case – in that point I’ve made three Panorama documentaries and cowritten a guide on the topic with my colleague Judith Moritz. But, if true, the brand new proof, offered by Mark McDonald in a collection of high-profile press conferences and media releases, is stunning.

In response to his specialists, the prosecution knowledgeable medical case is unreliable.

Mark McDonald has not launched the panel’s full experiences, that are at present with the Legal Instances Evaluate Fee (CCRC), the physique he wants to steer to reopen Letby’s case, however he has launched summaries of the panel’s findings.

Letby was discovered responsible of 15 counts of homicide and tried homicide, and the jury in her authentic trial reached unanimous verdicts on three of these circumstances. That could be a good indication of the place the strongest medical proof may lie.

To get a way of the imperfections woven by each the prosecution and the defence arguments, it is price taking a look at a type of circumstances through which the responsible verdict was unanimous: that of Child O.

Child O was born in June 2016, one in every of triplet brothers. At Letby’s trial, the jury was advised that his dying was partially the results of liver accidents, which the prosecution pathologist described as impact-type accidents – just like these in a automotive accident.

As in different circumstances for which Letby was convicted, the prosecution stated circumstantial proof additionally tied her to the crime.

Nevertheless, a paediatric pathologist who was not concerned within the case however has seen Child O’s autopsy report, says it was “unlikely” Child O’s liver accidents have been attributable to impression – because the prosecution claims.

“You may’t utterly rule out the chance,” says the pathologist, who doesn’t wish to be recognized. “However for my part, the situation of the accidents and the situation of the liver tissue itself do not match with that clarification.”

Which raises the apparent query – if the prosecution have been incorrect about Child O’s liver accidents, then why did he die?

Letby was accused of injecting air into the blood of Child O in addition to that of different infants. This, the prosecution stated, precipitated an air bubble and a blockage within the circulation often known as air embolism.

Throughout the trial the prosecution pointed to a number of items of proof to make their case, together with a 1989 tutorial examine of air embolism in new child infants, which famous pores and skin discolouration as one doable function of it.

Prosecutors argued that these similar pores and skin color modifications have been noticed in a number of infants within the Letby case.

Nevertheless, Dr Shoo Lee, a Canadian neonatologist and one of many authors of that 1989 examine, is now a part of Letby’s staff of defence specialists working with Mark McDonald. He argues that his examine was misused.

He says pores and skin discolouration has not featured in any reported circumstances of air embolism in infants the place the air has entered the circulation by way of a vein – which is what the prosecution alleged occurred within the Letby case.

In different phrases, the prosecution was incorrect to make use of pores and skin discolouration as proof of air embolism.

It sounds important. However is it sufficient to defeat the air embolism allegations?

As with many features of the Letby case, the reply isn’t clear-cut.

The prosecution didn’t depend on pores and skin discolouration alone to make their case for air embolism. And though there haven’t been any reported circumstances of pores and skin discolouration in infants the place air has entered the circulation by way of a vein, some critics have argued that the variety of reported air embolism circumstances is small and that the speculation continues to be doable.

To muddy the waters additional, one other of Mark McDonald’s panel of specialists has stated that actually there was autopsy proof of air embolism within the infants.

“We all know these infants suffered air embolism due to the autopsy imaging in a few of them,” says Neena Modi, a professor of neonatal medication.

She believes that is extremely more likely to have occurred throughout resuscitation, and that there are way more believable explanations for the collapses and deaths of the infants within the Letby case than air embolism.

The air embolism idea, she stated, was “extremely speculative”. However her remarks present the controversy is much from settled.

There was one other clarification for Child O’s dying.

In December 2024, Mark McDonald referred to as a press convention through which one in every of his specialists, Dr Richard Taylor, claimed that a health care provider had unintentionally pierced the infant’s liver with a needle throughout resuscitation. This, he argued, had led to the infant’s dying.

Dr Taylor added: “I believe the physician is aware of who they’re. I’ve to say from a private perspective that if this had occurred to me, I might be unable to sleep at night time figuring out that what I had achieved had led to the dying of a child, and now there’s a nurse in jail, convicted of homicide.”

The physician accused of inflicting the infant’s dying was subsequently recognized as Stephen Brearey – one in every of Letby’s principal accusers on the Countess of Chester Hospital.

Mr Brearey says: “Given the continuing investigations and inquiries, and to respect the confidentiality of these concerned, I cannot be making any additional remark at the moment.”

It was a bombshell declare. However does the proof assist it?

One indication that the needle idea is perhaps shaky was that Dr Taylor, by his personal admission, had not seen Child O’s medical notes and was counting on a report that had been written by two different specialists.

One other apparent downside with the needle idea is that it had already been examined at size throughout Letby’s trial.

The prosecution pathologist concluded that there was no proof {that a} needle had pierced Child O’s liver whereas he was alive and the paediatric pathologist we spoke to agrees.

They advised us: “These accidents weren’t attributable to a needle. They have been in numerous elements of the liver and there was no signal of any needle harm on the liver.”

Even when the needle had penetrated the infant’s liver, it can not clarify why Child O collapsed within the first place or why he died – the needle was inserted after the infant’s closing and deadly collapse in direction of the tip of the resuscitation.

When requested if he nonetheless stood by his feedback concerning the physician’s needle, Dr Taylor advised us that whereas the needle could not have been the first reason behind dying, his “opinion has not considerably modified”.

He stated the “needle most likely penetrated the liver” of Child O, and “most likely accelerated his demise”.

The query of the place this leaves the case offered by Mark McDonald’s panel of specialists relating to the needle idea is a tough one to reply.

It will seem that among the many specialists working with Letby’s defence, there may be not consensus.

Guide neonatologist Dr Neil Aiton is likely one of the authors of the unique report on which Dr Taylor primarily based his feedback. Dr Aiton says that he has examined the proof independently and has concluded that Child O’s liver accidents have been attributable to inappropriate resuscitation makes an attempt, together with hyperinflation of the infant’s lungs.

Nevertheless, he additionally says it was “fairly clear” a needle had punctured the liver throughout resuscitation.

When Dr Aiton was advised that different specialists, together with the paediatric pathologist who spoke to the BBC, have examined the case of Child O and stated that it’s implausible to conclude this occurred, he stated that there have been two prospects. Both the liver ruptured due to a needle or it ruptured spontaneously.

Dr Aiton’s place seems to be that poor resuscitation precipitated the infant’s liver accidents and whether or not the rupturing was attributable to a needle or not is “not vital”.

That could be a distinction from what Dr Taylor stated in that December press convention. And critics say Dr Aiton’s account nonetheless doesn’t clarify why Child O collapsed within the first place and why he wanted such determined resuscitation.

A abstract report from Letby’s knowledgeable panel seems to again additional away from the needle idea. It says a needle “could have” punctured the liver.

Different specialists, together with the paediatric pathologist, stated that Dr Aiton’s statement of hyper-inflated lungs wouldn’t clarify Child O’s liver accidents.

As soon as once more, the case illustrates how tough it’s to differentiate between believable and implausible claims.

Since that press convention, different specialists working for Letby’s defence staff have put ahead one other idea for Child O’s dying. They are saying his liver accidents have been the results of traumatic supply on the time of start.

Professor Modi says this was a “extremely believable trigger”.

However that has been contested from a stunning route. Dr Mike Corridor, a neonatologist, was Lucy Letby’s authentic defence knowledgeable and attended courtroom all through her trial.

He has been a staunch critic of her conviction, arguing her trial wasn’t honest and that there isn’t a definitive medical proof that infants have been intentionally harmed.

Nevertheless, Dr Corridor’s view is that proof for the start trauma idea is solely not there. He notes that Child O was born in good situation by caesarean part and there’s no report of a traumatic supply within the child’s medical notes.

“There’s nonetheless no proof that anybody did something intentionally to hurt Child O,” he provides. “Nevertheless, one thing was occurring with Child O, which we have not defined.

“We do not know what the reason for that is. However that does not imply that we subsequently need to fake that we all know.”

For the jury, Child O was one of many clearest circumstances that proved Letby was a killer. And but there seems to be flawed knowledgeable proof on either side.

There have been two different circumstances the place the jury returned unanimous verdicts – the circumstances of Infants F and L.

The prosecution argued that each infants had been poisoned with insulin and highlighted blood assessments that it stated have been clear proof of this. For the prosecution, the insulin circumstances proved that somebody on the Countess of Chester Hospital was harming infants.

Letby’s defence have, in the meantime, marshalled quite a few arguments in opposition to the insulin idea. One is that the blood take a look at used – an immunoassay – is inaccurate and may have been verified. However even Letby’s specialists settle for the take a look at is correct round 98% of the time.

One other argument is that untimely infants can course of insulin in a different way and that the blood take a look at outcomes are “inside the anticipated vary for pre-term infants”. However the medical specialists we have spoken to are baffled by this declare and say it goes in opposition to mainstream scientific understanding.

In fact, mainstream opinion will be incorrect. However it’s tough to inform as a result of Letby’s defence staff haven’t shared the scientific proof.

One of many specialists behind the report – a mechanical engineer who carries out biomedical analysis – clarified that his evaluation says the blood take a look at outcomes have been “not unusual”. Nevertheless, Letby’s defence declined to indicate the BBC the revealed research that assist this declare.

As soon as once more, the claims of each the prosecution and defence are usually not clear-cut.

Finally, the query of whether or not Letby’s case needs to be re-examined by the Court docket of Attraction now lies with CCRC. They’ve the duty of finding out Mark McDonald’s knowledgeable experiences.

If he’s profitable and Lucy Letby’s case is referred again to the Court docket of Attraction – that’s in the end the place the knowledgeable proof on either side will face a real reckoning.

Lead picture credit score: Cheshire Constabulary, PA

Clarification 19 August: This text was amended to clarify that in mentioning Letby’s defenders we have been referring to these specialists working together with her defence staff. We have additionally added some context to our reporting of Dr Aiton’s place concerning whether or not a needle performed any half within the child’s liver accidents.