We Need To Talk About Lucy Letby
We Need To Talk About Lucy Letby is a podcast series hosted by statistician Peter Elston and retired doctor Michael McConville. Lucy Letby was a neonatal nurse at The Countess of Chester Hospital in NW England who was convicted in August 2023 of murdering seven babies and attempting to murder a further six on seven occasions, though she was found not guilty on two counts of attempted murder and verdicts could not be reached in another six. In this series, Peter and Michael discuss the many aspects of the case and the steps over more than ten years that led to Lucy ending up in HMP Bronzefield serving 14 full life terms. But could it be the worst miscarriage of justice in British legal history?
Episodes
20. Magic Eye
Hospital management finally learns of the extent of the increased mortality over the previous year or so, thouigh why they did not know earlier is a mystery. Immediately they decide to no longer admit babies below 32 weeks gestation and to invite the RCPCH to conduct a service review. The consultants also demand that Lucy is taken off the ward on the basis of no evidence whatsoever.
30/06/24•53m 55s
19. Toytown
June 2016 proves to be a particularly frenetic month at The Circus of Chester. There is no essential medicine for a baby with haemophilia. 33 week triplets are admitted but do not receive the care promised the mother. Two of them die and the third is transferred to Liverpool Women's Hospital. The mother later says the two hospitals were "as different as night and day".
23/06/24•50m 25s
18. Occam's Razor again and again. And again. And again.
Michael and Peter continue to discuss Rachel Aviv's article in The New Yorker. They note how time and time again Countess consultants dismissed obvious explanations for deaths and honed in on Lucy. But, docs, if you thought Lucy had killed babies as you say you did from the getgo, why didn’t you order forensic autopsies? Were you worried they might find you culpable rather than a nurse?
16/06/24•52m 10s
17. Beyond baffling
Babies A, C and D die in June 2015 and hospital consultants immediately identify an association with Lucy Letby. They did not associate the deaths with the acute pneumonia, phospholipid syndrome, emergency caesarian, low birthweights, lack of antibiotics, lack of fluids, delay in transfer to neonatal unit, crossed pulmonary arteries, multiple birth issues, effect of anaesthetic, high blood pressure, problems with two long lines, dangerous placenta condition, and sepsis. The pathologist did. Why didn't you, docs?
09/06/24•50m 32s
15. New York, New York!
The New Yorker publishes a 13 thousand word article about the holes in the Lucy Letby case. In episode 15, Michael and Peter discuss various aspects of the article, such as it having been 'geoblocked' in the UK, and whether the UK's contempt laws in relation to reporting restrictions that are designed to prevent upcoming trials being prejudiced are fit for purpose. Aviv's article touches on the infamous roster data table shown to jurors, which your co-hosts discuss in detail.
07/06/24•57m 5s
16. Victorian plumbing, Victorian medical care
There is much in Rachel Aviv's New Yorker article to digest. In this episode Peter and Michael continue to discuss the piece, specifically what Aviv writes in relation to the 1970s origins of the neonatal unit at The Countess, its poor plumbing, and the cramped conditions that increased likelihood of infection spreading. They also discuss the many many medical issues faced by Baby A and wonder why jurors decided they didn't explain his death.
02/06/24•55m 28s
14. Infighting
In this episode, Michael and Peter pick up the timeline of key events in June 2016 with the deaths of the two triplets, Babies O and P. Lucy is put on admin duty and submits a grievance against the consultants. The RCPCH and Jane Hawdon are brought in. Lucy wins her grienace and the consultants are threatened with a GMC referral. They fight back, and the police are called in to investigate the high mortality.
19/05/24•42m 50s
13. Chaos
Peter and Michael go through a timeline of key events from June 2015 to May 2016. Why did lead paediatric consultant Stephen Brearey hone in on Lucy so early on? What was his October email about and who was it to? Then came the damning 'chaos' email from consultant Alison Timmis to hospital management.
12/05/24•48m 59s
12. Expected or unexpected? Which is it, docs?
In this episode, Michael and Peter complete their discussion of the RCPCH service review. They focus on a stark contradiction, namely that because deaths were expected, consultants did not report them to the Child Death Overview Panel , and yet their line later was that the deaths were unexpected.
05/05/24•44m 13s
11. Reluctance among doctors at The Countess to seek advice
Michael and Peter discuss RCPCH review findings that not only was there insufficient senior medical cover at The Countess but there was also reluctance to seek advice, whether among junior doctors or consultants. Was this because proceedures were weak or they weren't being followed? Michael cites an example from his own experience.
28/04/24•41m 0s
10. Why didn't the consultants use the Child Death Overview Panel?
The RCPCH service review determines that staffing numbers and competencies at The Countess were inappropriate for the acuity of the babies being cared for. In this episode, Michael and Peter discuss this issue and possible reasons for the increased acuity in 2015 and 2016. However, the discussion soon turns to the bigger question of why the consultants did not use the Child Death Overview Panel to report deaths as early as June 2015, and their concerns about them, as they should have done.
21/04/24•24m 26s
9. Non compliance everywhere (but let's blame a nurse)
The RCPCH reviewers consider whether The Countess' neonatal unit is compliant with current professional standards. The answer is a resounding 'no'. Is it really any wonder there was an increase in mortality and collapses? Non-compliance plus lower birthweights plus higher activity plus sewage equals....?
11/04/24•31m 46s
8. Which came first? Mottling or resuscitation?
According to the prosecution medical witnesses at trial, it was Letby injecting babies with air which caused the skin mottling and collapses, leading to resucutation being required. And yet six years earlier the consultants told the RCPCH service review team that the mottling appeared "after a few minutes of resucitation". Is this a smoking gun?
11/04/24•31m 3s
7. Marking One's Own Homework
Neonatal lead Stephen Brearey has suspected Lucy Letby for over a year when, in July 2016, he conducts further in-depth analysis into activity and acuity on the unit since June 2015. Brearey concludes that there was higher higher activity and lower admission birthweight than average during the period corresponding to the increase in mortality but does not consider it to be significant enough to explain the increase. Isn't that what he would say?
05/04/24•52m 31s
6. The Countess Consultants Are Told There Is No Link With Lucy
Paediatric consultants at The Countess have suspected Lucy Letby for nearly eight months so a broader meeting of senior doctors is convened to review 10 deaths since June 2015. A review of the nursing observations, staffing and junior doctor rotas for the 12 hours before the deaths is conducted and no link between the deaths and Lucy Letby is identified. However, a number of recommendations, such as new UVC guidance, are made.
24/03/24•29m 30s
5. The College of Paediatricians Finds No Evidence of Intentional Harm
The Royal College of Paediatric and Child Health (RCPCH) has been “invited to review the investigations of each death and the wider service, including network support and advice, protocols and transfer arrangements, to provide a view on whether there were any contributory factors in the deaths or missed opportunities to take action that could have prevented or mitigated them”. The report identifies failings on the unit and makes 22 recommendations that it said should be implemented before a reinstatement of the unit as an LNU should be considered.
24/03/24•37m 17s
4. The Many Failings On The Countess' Neonatal Unit
Following the deaths of two triplets in June 2016, The Countess invites The Royal College of Paediatrics and Child Health (RCPCH) to conduct a service review of its neonatal unit “following re-designation from level 2 Local Neonatal Unit (LNU) to level 1 Special Care Unit (SCU) in July 2016 due to concerns about increasing neonatal mortality”, a downgrade that means the unit no longer admits higher risk babies under 31 weeks gestational age. The review is published in February 2017 and presents a catalogue of failings on the unit. In this episode Michael and Peter begin to discuss the RCPCH report.
19/03/24•32m 55s
3. The Not-So-Chilling Code In Lucy's Diaries
Lucy Letby’s diaries are found during a police search of her addresses. They purport to contain a chilling code used by Letby to denote the days on which she attacked babies. However, it turns out that the letters that the police thought were “LO” are in fact “LD” which is a common acronym used by nurses that stands for “Long Day”. Post-it notes were also found on which Letby had scribbled “I am evil” and “I killed them on purpose”. Was Letby confessing to crimes or did her notes have another explanation?
19/03/24•49m 32s
2. Was Lucy Really On Duty At Every Event?
A table of roster data is presented to jurors that shows Lucy Letby was present at all 25 events. These 25 events comprised the seven alleged murders, the fifteen alleged attempted murders, and three non-fatal collapses with which Lucy Letby was not charged. However, why weren’t the other ten deaths included in the table? And there were probably many more non-fatal collapses than the eighteen in the table. Why weren’t they included?
19/03/24•45m 2s
1. Background To The Case
There is a significant rise in the number of deaths on the neonatal unit at the Countess of Chester Hospital in the summer of 2015. Between June 2015 and June 2016 there were 17 deaths compared which a normal rate of around 3 deaths per year. In November 2020 nurse Lucy Letby is charged with murder in relation to seven of them, despite there being more feasible explanations for the deaths such as the frequent sewage problems, the reported ‘chaos’ on the ward and suspected medical negligence. And what about the other ten deaths?
19/03/24•45m 49s
