The convictions of child serial killer Lucy Letby were today branded ‘one of the major injustices of modern times’ as a team of experts claimed the baby deaths were ‘due to natural causes or just bad medical care’, concluding: ‘We did not find any murders.’
The 35-year-old’s case will be reviewed by the Criminal Cases Review Commission (CCRC), which investigates potential miscarriages of justice, after an application made by Letby’s lawyers who continue their campaign protesting her innocence.
Letby, from Hereford, is serving 15 whole-life orders after she was convicted at Manchester Crown Court of murdering seven infants and attempting to murder seven others, with two attempts on one of her victims, between June 2015 and June 2016.
The babies were attacked by various means while Letby worked as a nurse on the neonatal unit at the Countess of Chester Hospital. One such method discussed in court was injecting air into the bloodstream which was said to have caused an air embolism that blocked the blood supply and led to sudden and unexpected collapses.
This morning, analysis conducted by a ‘blue riband committee’ of 14 neonatalogists -experts in care of newborn babies – was presented at a press conference in London.
Retired medic Dr Shoo Lee, an internationally recognised neonatal medical expert, co-authored a 1989 academic paper on air embolism in babies – which featured prominently in Letby’s ten-month trial.
Today, he chaired a panel of experts who compiled an ‘impartial evidence-based report’ and said their thoughts were with the families of the babies who died – but also claimed the prosecution misinterpreted his findings on skin discolouration.
And Dr Lee told the packed press conference: ‘Death or injury of all the affected infants were due either to natural causes or to errors in medical care. There were serious problems related to medical care of patients at this hospital.
‘There were problems related to teamwork and interdisciplinary collaboration at the Countess of Chester Neonatal Unit. In summary, ladies and gentlemen, we did not find any murders. In all cases, death or injury were due to natural causes or just bad medical care. Lucy was charged with seven murders and seven attempted murders.
(From left) Professor Neena Modi, Lucy Letby’s barrister Mark McDonald, Sir David Davis MP and retired medic Dr Shoo Lee at a press conference at 1 Great George Street in London today
Lucy Letby is serving 15 whole-life orders after she was convicted at Manchester Crown Court
Bodyworn camera footage issued by Cheshire Constabulary of Lucy Letby’s arrest in 2018
‘In our opinion, the medical opinion, the medical evidence doesn’t support murder in any of these babies, just natural causes and bad medical care. Our full report will go to Lucy’s barrister later this month and then it will be up to him and the courts to decide what next to do.’
MP Sir David Davis began the press conference by saying Dr Lee had ‘come here today, I suspect at his own expense, to put right what I think, anyway, is one of the major injustices of modern times’.
Dr Lee, who founded the Canadian Neonatal Network which includes 27 hospitals and 16 universities, opened his presentation by saying: ‘I’d like to share the sympathies and condolences of members of the international expert panel with families of the affected infants.
‘We understand their stress and their anguish, and our work is not meant to cause more distress. Rather it is meant to give them comfort and assurance in knowing the truth about what really happened.
‘We know that they want to know the truth, and that is why we are here – to tell the truth. Should they have any queries or concerns we’d be pleased to discuss them with them.’
He said the panel of experts he had convened to look at Letby’s case were all independent and none had been paid.
Dr Lee said they looked at all 17 babies Letby is accused of harming, in six different ways.
He added that he would speak about some of the babies, citing baby one, a pre-term boy who collapsed two days after being born, with skin discolouration noted and who did not respond to resuscitation.
Dr Lee said the allegation against Letby was that she injected air into his veins causing his collapse and death.
He said the prosecution in the trial used a paper he had authored in 1989, but he said he had made a distinction between air in veins and air in arteries.
Dr Lee told the press conference: ‘In the cases where air was injected in the veins there was no cases of patchy skin discolouration. So the notion that these babies can be diagnosed with air embolism because they collapsed and had these skin dis-colourations has no evidence in fact.’
He said it was more likely that the baby was pre-disposed to blood-clotting, and had died from a thrombosis after an intravenous (IV) line was inserted but no infusion started through it for four hours.
Dr Lee added: ‘Our conclusion is that baby one died from thrombosis, and there is no evidence of embolism.’
The defendant worked as a nurse on the neonatal unit at the Countess of Chester Hospital
A photo taken in July 2018 of Lucy Letby’s bedroom in Chester, which was shown in court
He also said that baby four was born full-term by emergency caesarean section, adding that prosecutors alleged during the trial that three days after the baby’s birth it suddenly collapsed.
‘The allegation is that baby four was a stable baby after the baby was born and admitted to the neonatal intensive care unit,’ Dr Lee said.
‘Then on day three of life the baby suddenly collapsed, and that this was due to injection of air through the intravenous system causing air embolism, resulting in patchy discoloration of the skin and death.
‘I would like to just repeat what I said earlier, that there is no evidence that air embolism through the veins results in patchy discussion of the skin.
‘So let’s just dismiss that, that’s not a consideration.’
Dr Lee said the birth of baby four after ‘prolonged, premature rupture of membranes’ caused an infection.
‘The mother did not receive antibiotics. Second, there were important delays in the admission, diagnosis and treatment of the baby after the baby was born,’ he said.
‘This was not a stable baby, as alleged by the prosecution witness, and in fact, this baby continued to deteriorate for the next few days until final collapse with worsening symptoms of infection as we went along.’
Dr Lee said the baby died from ‘systemic sepsis, pneumonia and disseminated intravascular coagulation’.
‘The mother should have received intrapartum antibiotics prior to delivery,’ he said.
‘There was delay in recognising respiratory distress after birth, there was delay in starting antibiotics and delay in starting treatment for the respiratory distress.
‘We did not find any evidence of clear embolism.’
Dr Lee said the panel had next looked at a baby girl identified only as baby nine.
He said her death was preventable, suggested she had been poorly cared for, adding there was no evidence of an air embolism, for which Letby has been blamed after claims she injected the child with air.
An artist’s drawing of Lucy Letby giving evidence at Manchester Crown Court in June 2024
Police investigate at Lucy Letby’s home in Chester in June 2019, with a tent erected outside
Dr Lee said the child was born severely pre-term with chronic lung disease and needed to be resuscitated.
He said Letby had been accused of injecting air into the child through a nasal-gastric tube into her stomach causing respiratory arrest, heart failure and death.
Letby was also accused of turning off a monitor alerting medics if the baby stopped breathing for longer than around 20 seconds, causing a delay in her treatment.
Dr Lee said the alarm was not switched off and the baby was ‘gasping’ for air.
He suggested the medics caring for her failed to respond timely to a bacterial infection with antibiotics, and he concluded the child died from respiratory complications, with no evidence of air embolism.
Dr Lee then told the press conference that baby 11 was born pre-term and resuscitated at birth. He said doctors took three ‘traumatic’ attempts to insert an endotracheal tube.
Dr Lee alleged the consultant who performed the procedure ‘didn’t know what he was doing’.
He said when the consultant disconnected the endotracheal tube from the ventilator to manually resuscitate the baby with a bag, their chest did not move up and down – suggesting the tube was in the wrong place.
‘The consultant therefore concluded and alleged that baby 11’s first episode of clinical deterioration was caused by deliberate dislodgement of endotracheal tube because bagging failed to move the chest and carbon dioxide was not detected on capnography.
‘He also alleged that the incubator alarms were deliberately turned off to prevent prompt rescue response because he did not hear the alarms when he entered the room.’
Dr Lee said there was a 94 per cent leak of air with only 6 per cent was going into the baby’s lungs because the wrong sized intubation tube was used: ‘That’s kind of like using a straw and blowing through a garden hose and hoping that you can inflate something at the end of the garden hose.
‘It doesn’t work and, as a result, ventilation was ineffective, because 94 per cent of the air was leaking out and only 6 per cent was entering the lung.
‘Effective gas exchange could not occur, and mechanical ventilation could not generate sufficient pressure to keep the small air spaces in the lung open. When the tipping point was reached, the baby decompensated, desaturated and collapsed.’
Dr Shoo Lee continued speaking about baby 11, saying: ‘There’s actually no proof that the tube was even dislodged. It was probably in the right place. It says that the consultant didn’t know what he was doing.
‘The consultant also stated that he did not hear the alarms but another nurse in her testimony stated in her statement: ‘That when I returned to the unit, I immediately became aware of the alarms sounding and I rushed in to help’.
‘So there is actually a statement from another nurse saying that the alarms were not off. They were actually working. Perhaps the consultant just didn’t hear them?
‘There is no evidence to support a dislodged endotracheal tube. The clinical deterioration was caused by the use of an undersized endotracheal tube, and the initial intubation was traumatic and poorly supervised.
‘The consultant did not understand the basics of resuscitation, of air leak or mechanical ventilation, and the equipment that he was using.’
Dr Lee then moved to baby six, a boy who survived after Letby injected him with insulin.
He told the press conference the child had been given the ‘wrong treatment’ and he had been medically ‘mismanaged’, adding his supposed high insulin levels due to injection by Letby had been misinterpreted.
Dr Lee told the press conference that baby 15 was a boy and the second of pre-term triplets to be born by emergency caesarean.
Dr Lee said the baby deteriorated and later died, with a post-mortem examination showing a ruptured haematoma of the liver, with prosecutors alleging at Lucy Letby’s trial that he suffered blunt trauma to the abdomen.
‘Later the accusation was then changed to say that in fact, there was deliberate injection of air into his intravenous system to cause air embolism, collapse and death,’ Dr Lee said, adding that he believed the haemorrhage was caused during birth as another triplet suffered the same issue.
‘It was highly likely that this was the result of extremely rapid delivery and this is a well-recognised cause of birth injury,’ he told the press conference.
‘One of the other triplets also had the same haematoma, although it was not this severe. The fact that two of them had the same problem again confirms that this was likely caused by birth injury.’
Baby 7 was the final case highlighted by Dr Lee during the press conference. He said the baby was born very premature and had a lot of ‘chronic problems’.
Dr Lee said that at 14 weeks old the baby suddenly became unwell and the allegation against Letby was that the baby was overfed but later recovered. He said the evidence his team had found suggested the baby was in fact suffering from a viral infection.
‘At Alder Hay Hospital she received seven days of antibiotics and she recovered after seven days, which is consistent with an infection,’ Dr Lee said.
‘In our opinion baby 7 had vomiting and clinical deterioration because of infection, possibly enterovirus infection, which can cause all these signs and symptoms. There is no evidence to support an injection into the stomach of overfeeding.’
Dr Lee, summarising his panel’s findings, cited a number of flaws in the prosecution evidence.
He cited incomplete medical treatment, failure to consider medical histories, disregard for warnings about infections, misdiagnosis of babies, caring for very poorly babies beyond their medical competencies, delays in treatment of acutely poorly babies, poor medical skills in certain procedures and poor supervision of more junior medics and a lack of understanding of some basic procedures.
He also cited poor management of common medical conditions and lack of knowledge about commonly used equipment in the hospital unit, adding: ‘There was a lack of teamwork and trust between the health professions.’
Dr Lee also said there was evidence of inadequate numbers of staff, a lack of training, workload overload, and some poorly babies should have been treated at a ‘higher level’ unit or hospital.
He added: ‘Our conclusions of this panel therefore was that there was no medical evidence to support malfeasance causing death or injury in any of the 17 cases in the trial.
‘Death or injury of all the affected infants were due either to natural causes or to errors in medical care.
‘There were serious problems related to medical care of patients at this hospital.’
It comes as Letby’s case is now set to be reviewed by a commission that investigates potential miscarriages of justice.
The Criminal Cases Review Commission (CCRC) received an application from her lawyers yesterday and said that work has already begun to assess the case, which involves ‘a significant volume of complicated evidence’.
Tory former minister Sir David, who last week used justice questions in the House of Commons to raise concerns on behalf of Letby’s legal team, chaired today’s panel and the former nurse’s barrister, Mark McDonald, was also present.
Sir David, the MP for Goole and Pocklington, wants a retrial for Letby and said he believes it will clear her of any wrongdoing.
Retired consultant paediatrician Dr Dewi Evans, the lead prosecution medical expert at Letby’s trial, has said concerns regarding his evidence were ‘unsubstantiated, unfounded, inaccurate’
A press conference by Lucy Letby’s legal team last December at the Royal Society of Medicine in London, where they announced fresh developments on the case and new evidence
Letby lost two bids last year to challenge her convictions at the Court of Appeal – in May for seven murders and seven attempted murders, and in October for the attempted murder of a baby girl which she was convicted of by a different jury at a retrial.
At the first of those appeals, a bid to admit fresh evidence from Dr Lee was also rejected as three senior judges concluded there had been no prosecution expert evidence diagnosing air embolus solely on the basis of skin discolouration.
Dr Lee has said he has recently updated his academic paper and found no cases of skin discolouration linked to air embolism by the venous system.
In December, Mr McDonald said – that separately from the CCRC application – he would also seek permission from the Court of Appeal to apply to re-open her case on the grounds that Dr Dewi Evans, the lead prosecution medical expert at her trial, was ‘not reliable’.
Retired consultant paediatrician Dr Evans said concerns regarding his evidence were ‘unsubstantiated, unfounded, inaccurate’.
A public inquiry into how Letby was able to commit her crimes began hearing evidence in September, with closing legal submissions expected in March.
The inquiry findings of Lady Justice Thirlwall are expected to be published this autumn.
Detectives from Cheshire Constabulary are continuing their review of the care of some 4,000 babies admitted to hospital while Letby worked as a neonatal nurse.
The period covers her time at the Countess of Chester Hospital from January 2012 to the end of June 2016, and includes two work placements at Liverpool Women’s Hospital in 2012 and 2015.
Letby has been interviewed at HMP Bronzefield in Ashford, Surrey, under caution in relation to the ongoing investigation into baby deaths and non-fatal collapses. She maintains her innocence.
A CCRC spokesperson said today: ‘We are aware that there has been a great deal of speculation and commentary surrounding Lucy Letby’s case, much of it from parties with only a partial view of the evidence. We ask that everyone remembers the families affected by events at the Countess of Chester Hospital between June 2015 and June 2016.
‘We have received a preliminary application in relation to Ms Letby’s case, and work has begun to assess the application. We anticipate further submissions being made to us.
‘It is not for the CCRC to determine innocence or guilt in a case, that’s a matter for the courts.
‘It is for the CCRC to find, investigate and if appropriate, refer potential miscarriages of justice to the appellate courts when new evidence or new argument means there is a real possibility that a conviction will not be upheld, or a sentence reduced.
‘At this stage it is not possible to determine how long it will take to review this application. A significant volume of complicated evidence was presented to the court in Ms Letby’s trials.
‘The CCRC is independent. We do not work for the government, courts, police, the prosecution or for anyone applying for a review of their case. This helps us investigate alleged miscarriages of justice impartially.’