Seven years ago, Lucy Letby was arrested as part of an investigation into a series of unexplained deaths at the Countess of Chester hospital’s neonatal unit. She was charged in 2020, and finally convicted of murdering seven babies and attempting to kill six more in August 2023.
Since then, serious concerns have been raised about Letby’s conviction: there have been doubts about the way statistics were used during the trial, questions over standards at the neonatal unit in which she worked, and claims that too much emphasis was put on a supposed confession that Letby wrote as part of a counselling process.
But the bedrock of Letby’s conviction was the expert medical evidence from retired consultant paediatrician and prosecution witness Dr Dewi Evans, which persuaded a jury, as Evans later said, that “something must have happened”. The medical evidence is the key part of the case against Letby that was challenged yesterday.
What is the status of Letby’s case?
Letby is in prison serving 15 whole-life sentences, meaning that she will never be eligible for parole. After the guilty verdicts, she applied for permission to appeal but had that request turned down, first by a judge who considered the case documents and then after a fuller consideration of the case by the court of appeal.
She also faced a retrial on one count of attempted murder on which the jurors could not reach a verdict. She was found guilty in July last year, and again had her application for leave to appeal turned down.
Separately, the government ordered an inquiry, chaired by Lady Justice Thirlwall, examining the events leading up to the deaths at the Countess of Chester neonatal unit. Thirlwall noted that her inquiry was not a review of the convictions, and said that criticisms of the process had created a “noise that caused an enormous amount of stress” for the victims’ parents. That inquiry is still ongoing.
Letby appointed a new legal team in September last year. This week, her barrister Mark McDonald applied to the Criminal Cases Review Commission to consider her conviction, and said he would be submitting a report from an expert panel which has examined the cases over which she was convicted. The CCRC said that it will now assess the application.
The case is, naturally, incredibly sensitive, and the CCRC and the panel of experts have both said that the trauma of the babies’ families should be central to how the case is treated. This morning, the front page of the Daily Mail covers the response of one mother of a baby who Letby was convicted of trying to kill, who said: “Every aspect of what they are doing is so disrespectful … We already have the truth and this panel of so-called experts don’t speak for us.”
Who are the panel and how did they operate?
The 14-strong panel was led by Dr Shoo Lee, a retired Canadian neonatologist who wrote an academic paper in 1989 which was the basis of some of Evans’ evidence at trial.
At the press conference yesterday, he said he had heard little about the trial as it unfolded but that he had subsequently learned how his research had been used, and told a hearing during appeal proceedings that his findings had been misunderstood. Letby’s legal team then asked Lee to convene a panel to examine the evidence. He agreed to do so on the basis that their findings would be published whether or not they ultimately supported her case.
The members of the panel are eminent neonatologists and paediatricians. Lee is a former paediatrician-in-chief at Mount Sinai hospital in New York and a recipient of the distinguished neonatologist award from the Canadian Pediatric Society; he has published more than 400 peer-reviewed scientific papers. Other panellists include Neena Modi, a professor of neonatal medicine at Imperial College London and a past president of the Royal College of Paediatrics and Child Health; Prof Mikael Norman, the director of the Swedish Neonatal Quality Register; and Prof Helmut Hummler, the senior medical director of the European Foundation for Care of Newborn Infants.
The panel reviewed each of the 17 cases in the trial. Most of them knew little about the case before embarking on their work.
What were their conclusions?
After setting out the findings of the panel at the press conference yesterday, Lee said: “Our conclusion was there was no medical evidence to support malfeasance causing injury in any of the 17 cases in the trial. In summary, ladies and gentlemen, we did not find any murders.”
A full report will be submitted to the CCRC later this month. In the summary report released yesterday, the panel says that it found numerous issues with medical care at the neonatal unit. Dr Neena Modi said that “there were very plausible reasons for these babies’ deaths … a combination of babies being delivered in the wrong place, delayed diagnosis and inappropriate or absent treatment.”
Lee has also reiterated that, in his view, the research paper he published in 1989 – which examined air embolism in babies, where a vein or artery is blocked by an air bubble – was misrepresented at the trial in relation to cases where Letby was accused of injecting babies with air. As Josh Halliday explains here, Evans told the trial that “mottled” skin could be evidence of an air embolism in preterm newborn babies, but Lee said that the evidence showed that only pink blood vessels “superimposed” on a pink or blue body would point to that diagnosis.
Lee told the Sunday Times this week that the infants in the trial should not have been diagnosed with air embolism, adding that it was “a very rare and specific condition and should not be diagnosed by … concluding that it must be a case of air embolus because nothing else could be found”.
When the court of appeal considered that point, it said that “there was no prosecutorial evidence diagnosing air embolus solely on the basis of skin discoloration” and that therefore “the prosecution witnesses did not fall into the error which the proposed fresh evidence seeks to assert they made”.
What are the other criticisms of Evans and how has he responded?
Part of the criticisms of Evans’ status as the lead medical witness for the prosecution – repeated yesterday – are a matter of legal procedure: he was appointed after volunteering himself to the National Crime Agency, which did not consult a panel of experts of the kind assembled to provide the new report.
And while experts have a legal duty to provide an objective opinion, some have noted his statements since the trial that he has “lost only one case” in 35 years as an expert witness. Prof Gillian Tully of King’s College London, a former forensic science regulator, told the Guardian: “An expert should not be concerned about the outcome of a trial, only about providing independent evidence.”
A judge heard the defence’s claims that Evans was not an impartial expert at the original trial and rejected them. On the issues over air embolisms raised by Lee, Evans said at the weekend: “His paper from 1989 got a lot of publicity, but it was not a major factor in the prosecution case.” He has also denied any bias, saying: “We’re clinicians, we’re scientists, we stick to facts.”
What impact will all this have on Letby’s conviction?
The crucial question about the review is whether it is viewed as new evidence. Letby’s appeals have failed in part because judges have concluded that her defence could have called Lee or another expert witness to dispute Evans’ evidence during the trial when they had the opportunity, but did not do so. They said that as a result, such testimony would not form a proper basis for appeal.
The CCRC will be given the full report and will then be tasked with deciding whether it constitutes new evidence. If it does so, and thinks that it means that there is a real possibility that the conviction would not be upheld, it can send the case back to the court of appeal.
Even if that happens, it may take years. Yesterday, McDonald said that the review met the CCRC’s criteria and “demolished” the medical evidence against Letby. “If Dr Shoo Lee and the panel are correct, no crime was committed,” he said. “And if no crime was committed, that means a 35-year-old woman is currently sitting in prison for the rest of her life for a crime that just never happened.”
