Lucy Letby, a British neonatal nurse, has been found guilty of the murder of seven newborn babies and the attempted murder of six others. The verdict, delivered by a jury at Manchester Crown Court, has shocked the nation and raised serious questions about the safety protocols in neonatal units across the UK. Letby, 34, was convicted of attempting to kill another infant, known as Child K, in February 2016 at the Countess of Chester Hospital in northwestern England. This conviction comes after a previous jury failed to reach a verdict on the case.
Letby, who has consistently denied harming any children, was accused of trying to murder the “very premature” Child K by dislodging her breathing tube in the early hours of February 17, 2016. Senior Prosecutor Nicola Wyn Williams alleged that Letby removed the baby’s breathing support and was found standing by doing nothing as the child struggled. Williams further claimed that Letby removed the breathing tube two more times over the next few hours to cover her tracks and suggest that the first dislodgment was accidental.
Dr. Ravi Jayaram, a pediatrician at the hospital, testified that he saw “no evidence” that Letby had done anything to help the baby as he walked in and saw her standing next to the newborn’s incubator. Letby, however, told the jury she had no recollection of any such event and denied harming Child K or committing any of the offenses she had been convicted of. The parents of the baby gasped and cried as the verdict was read after three and a half hours of deliberations, while Letby showed no emotion.
In August 2023, Letby was found guilty of seven murders and six other attempted murders after over three weeks of deliberation. All of the deaths took place at the Countess of Chester Hospital’s neonatal unit between June 2015 and June 2016. During the trial, Letby was accused of deliberately harming the newborn infants in various ways, including injecting air into their bloodstreams and administering air or milk into their stomachs via nasogastric tubes.
Letby is already serving a life sentence with no chance of release, the most severe punishment possible under British law, which does not allow the death penalty. Only three other women have received such a harsh sentence in the UK. Despite her conviction, Letby has launched a bid to appeal her convictions. Officials at the Court of Appeal confirmed they had received an application for permission to appeal against the convictions. Typically, such applications are considered by a judge without a hearing. If the bid is refused, the guilty parties have the right to renew their bid at a full court hearing before two or three judges.
Letby’s motives remain unclear, but the scale of her crimes pointed to intricate planning. She was accused of poisoning infants by adding insulin to intravenous feeds and interfering with breathing tubes. Judge James Goss imposed a rare “whole-life order” on Letby, stating that she acted with “malevolence bordering on sadism.” The British government launched an independent inquiry soon after the verdicts to look into the wider circumstances around what happened at the hospital, including the handling of concerns raised by staff.
The case has galvanized the British government. The Health Secretary immediately announced an inquiry to examine how Letby’s hospital had failed to protect babies. After Letby refused to attend her sentencing hearing, the Justice Secretary said he would work to change the law so that defendants would be required to go to court to be sentenced. Prime Minister Rishi Sunak stated, “It’s cowardly that people who commit such horrendous crimes do not face their victims.”
The public conversation has largely accepted Letby’s guilt, with media outlets like The Guardian calling her “one of the most notorious female murderers of the last century.” However, an incongruous aspect of the story is that Letby appeared to have been a psychologically healthy and happy person. She had many close friends, and her nursing colleagues spoke highly of her care and dedication. A detective with the Cheshire police, which led the investigation, said, “This is completely unprecedented in that there doesn’t seem to be anything to say” about why Letby would kill babies. “There isn’t really anything we have found in her background that’s anything other than normal.”
The judge in her case, James Goss, acknowledged that Letby appeared to have been a “very conscientious, hard-working, knowledgeable, confident and professional nurse.” But he also said that she had embarked on a “calculated and cynical campaign of child murder,” and he sentenced her to life, making her only the fourth woman in UK history condemned to die in prison. Although her punishment can’t be increased, she will face a second trial this June on an attempted-murder charge for which the jury could not reach a verdict.
Letby had worked on a struggling neonatal unit at the Countess of Chester Hospital, run by the National Health Service, in the West of England, near Wales. The case centered on a cluster of seven deaths between June 2015 and June 2016. All but one of the babies were premature; three of them weighed less than three pounds. No one ever saw Letby harming a child, and the coroner did not find foul play in any of the deaths.
The case against her gathered force on the basis of a single diagram shared by the police, which circulated widely in the media. On the vertical axis were twenty-four “suspicious events,” which included the deaths of the seven newborns and seventeen other instances of babies suddenly deteriorating. On the horizontal axis were the names of thirty-eight nurses who had worked on the unit during that time, with X’s next to each suspicious event that occurred when they were on shift. Letby was the only nurse with an uninterrupted line of X’s below her name. She was the “one common denominator,” the “constant malevolent presence when things took a turn for the worse,” one of the prosecutors, Nick Johnson, told the jury in his opening statement. “If you look at the table overall the picture is, we suggest, self-evidently obvious. It’s a process of elimination.”
But the chart didn’t account for any other factors influencing the mortality rate on the unit. Letby had become the country’s most reviled woman—“the unexpected face of evil,” as the British magazine Prospect put it—largely because of that unbroken line. It gave an impression of mathematical clarity and coherence, distracting from another possibility: that there had never been any crimes at all.
Since Letby was a teenager, she had wanted to be a nurse. “She’d had a difficult birth herself, and she was very grateful for being alive to the nurses that would have helped save her life,” her friend Dawn Howe told the BBC. An only child, Letby grew up in Hereford, a city north of Bristol. In high school, she had a group of close friends who called themselves the “miss-match family”: they were dorky and liked to play games such as Cranium and Twister. Howe described Letby as the “most kind, gentle, soft friend.” Another friend said that she was “joyful and peaceful.”
Letby was the first person in her family to go to college. She got a nursing degree from the University of Chester in 2011 and began working on the neonatal unit at the Countess of Chester Hospital, where she had trained as a student nurse. Chester was a hundred miles from Hereford, and her parents didn’t like her being so far away. “I feel very guilty for staying here sometimes but it’s what I want,” she told a colleague in a text message. She described the nursing team at the Countess as “like a little family.” She spent her free time with other nurses from the unit, often appearing in pictures on Facebook in flowery outfits and lip gloss, with sparkling wine in her hand and a guileless smile. She had straight blond hair, the color washing out as she aged, and she was unassumingly pretty.
The unit for newborns was built in 1974, and it was outdated and cramped. In 2012, the Countess launched a campaign to raise money to build a new one, a process that ended up taking nine years. “Neonatal intensive care has improved in recent years but requires more equipment which we have very little space for,” Stephen Brearey, the head of the unit, told the Chester Standard. “The risks of infection for the babies is greater, the closer they are to each other.” There were also problems with the drainage system: the pipes in both the neonatal ward and the maternity ward often leaked or were blocked, and sewage occasionally backed up into the toilets and sinks.
The staff were also overtaxed. Seven senior pediatricians, called consultants, did rounds on the unit, but only one was a neonatologist—a specialist in the care of newborns. An inquest for a newborn who died in 2014, a year before the deaths for which Letby was charged, found that doctors had inserted a breathing tube into the baby’s esophagus rather than his trachea, ignoring several indications that the tube was misplaced. “I find it surprising these signs were not realised,” the coroner said, according to the Daily Express. The boy’s mother told the paper that “staff shortages meant blood tests and X-rays were not assessed for seven hours and there was one doctor on duty who was splitting his time between the neonatal ward and the children’s ward.”
The NHS has a totemic status in the British psyche—it’s the “closest thing the English have to a religion,” as one politician has put it. One of the last remnants of the postwar social contract, it inspires loyalty and awe even as it has increasingly broken down, partly as a result of years of underfunding. In 2015, the infant-mortality rate in England and Wales rose for the first time in a century. A survey found that two-thirds of the country’s neonatal units did not have enough medical and nursing staff. That year, the Countess treated more babies than it had in previous years, and they had, on average, lower birth weights and more complex medical needs. Letby, who lived in staff housing on the hospital grounds, was twenty-five years old and had just finished a six-month course to become qualified in neonatal intensive care. She was one of only two junior nurses on the unit with that training. “We had massive staffing issues, where people were coming in and doing extra shifts,” a senior nurse on the unit said. “It was mainly Lucy that did a lot.” She was young, single, and saving to buy a house. That year, when a friend suggested that she take some time off, Letby texted her, “Work is always my priority.”
In June 2015, three babies died at the Countess. First, a woman with antiphospholipid syndrome, a rare disorder that can cause blood clotting, was admitted to the hospital. She was thirty-one weeks pregnant with twins and had planned to give birth in London, so that a specialist could monitor her and the babies, but her blood pressure had quickly risen, and she had to have an emergency C-section at the Countess. The next day, Letby was asked to cover a colleague’s night shift. She was assigned one of the twins, a boy, who has been called Child A. A nursing note from the day shift said that the baby had had “no fluids running for a couple of hours,” because his umbilical catheter, a tube that delivers fluids through the abdomen, had twice been placed in the wrong position, and “doctors busy.” A junior doctor eventually put in a longline, a thin tube threaded through a vein, and Letby and another nurse gave the child fluid. Twenty minutes later, Letby and a third nurse, a few feet away, noticed that his oxygen levels were dropping and that his skin was mottled. The doctor who had inserted the longline worried that he had placed it too close to the child’s heart, and he immediately took it out. But, less than ninety minutes after Letby started her shift, the baby was dead. “It was awful,” she wrote to a colleague afterward. “He died very suddenly and unexpectedly just after handover.”
A pathologist observed that the baby had “crossed pulmonary arteries,” a structural anomaly, and there was also a “strong temporal relationship” between the insertion of the longline and the collapse. The pathologist described the cause of death as “unascertained.”
Letby was on duty again the night after Child A’s death. At around midnight, she helped the nurse who had been assigned to the surviving twin, a girl, set up her I.V. bag. About twenty-five minutes later, the baby’s skin became purple and blotchy, and her heart rate dropped. She was resuscitated and recovered. Brearey, the unit’s leader, told me that at the time he wondered if the twins had been more vulnerable because of the mother’s disorder; antibodies for it can pass through the placenta.
The next day, a mother who had been diagnosed as having a dangerous placenta condition gave birth to a baby boy who weighed one pound, twelve ounces, which was on the edge of the weight threshold that the unit was certified to treat. Within four days, the baby developed acute pneumonia. Letby was not working in the intensive-care nursery, where the baby was treated, but after the child’s oxygen alarm went off she came into the room to help. Yet the staff on the unit couldn’t save the baby. A pathologist determined that he had died of natural causes.
Several days later, a woman came to the hospital after her water broke. She was sent home and told to wait. More than twenty-four hours later, she noticed that the baby was making fewer movements inside her. “I was concerned for infection because I hadn’t been given any antibiotics,” she said later. She returned to the hospital, but she still wasn’t given antibiotics. She felt “forgotten by the staff, really,” she said. Sixty hours after her water broke, she had a C-section. The baby, a girl who was dusky and limp when she was born, should have been treated with antibiotics immediately, doctors later acknowledged, but nearly four hours passed before she was given the medication. The next night, the baby’s oxygen alarm went off. “Called Staff Nurse Letby to help,” a nurse wrote. The baby continued to deteriorate throughout the night and could not be revived. A pathologist found pneumonia in the baby’s lungs and wrote that the infection was likely present at birth.
“We lost [her],” Letby texted a close friend I’ll call Margaret, a shift leader on the unit. Margaret had mentored Letby when she was a student training on the ward. “What!!!!! But she was improving,” Margaret replied. “What happened? Wanna chat? I can’t believe you were on again. You’re having such a tough time.” Letby told Margaret that the circumstances of the death might be investigated. “What, the delay in treatment?” “Just overall,” she said. “And reviewing what antibiotics she was on, etc., if it is sepsis.” Letby wrote that she was still in shock. “Feel a bit numb.” “Oh hun, you need a break,” Margaret said. Reflecting on the first of the three deaths, Margaret told her that the baby’s parents would always grieve the loss of their child but that, because of the way Letby had cared for him, they’d hopefully have no regrets about the time they spent with their son. “Just trying to help you take the positives you deserve from tough times,” Margaret wrote. “Always here. Speak later. Sleep well xxx.”
A few days later, Letby couldn’t stop crying. “It’s all hit me,” she texted another friend from the unit. She wrote that two of the deaths seemed comprehensible (one was “tiny, obviously compromised in utero,” and the other seemed septic, she wrote), but “it’s [Child A] I can’t get my head around.”
The senior pediatricians met to review the deaths, to see if there were any patterns or mistakes. “One of the problems with neonatal deaths is that preterm babies can die suddenly and you don’t always get the answer immediately,” Brearey told me. A study of about a thousand infant deaths in southeast London, published in The Journal of Maternal-Fetal & Neonatal Medicine, found that the cause of mortality was unexplained for about half the newborns who had died unexpectedly, even after an autopsy. Brearey observed that Letby was involved in each of the deaths at the Countess, but “it didn’t sound to me like the odds were that extreme of having a nurse present for three of those cases,” he said. “Nobody had any concerns about her practice.” The head of the pediatrics department, Ravi Jayaram, told me, “There was an element of ‘Thank God Lucy was on,’ because she’s really good in a crisis.” He described Letby as “very popular” among the nurses. To make sense of the events, Jayaram said, “you
Source: CBS/AP, Reuters, The Guardian, The New Yorker
