A British Nurse Was Found Guilty of Killing Seven Babies. Did She Do It?

Interesting article in The New Yorker.

I’ve had to access it here via archive.ph:

Is her conviction 100% safe? No. Her conviction represents a balance-of-probabilities outcome.
Is she solely responsible for thse deaths? You could make a case that external pressures contributed, especially poor management of the hospital involved and under-resourcing of Obs & Gynae in the NHS in general, but that carries no legal weight here.
Is she morally responsible? Not sure, there is much in her case to support assertions that she was mentally unfit at the time, plus those external factors.
Was she instrumental in those deaths? Probably. As with Harold Shipman and other “Angels of Death”, there can evolve in care workers a warped moral stance allowing them to take the lives of what they see as ‘hopeless cases’ and ‘burdens on the system’ in order to focus limited resources on the more deserving. IME it’s not rare for it to be discussed behind closed doors, though it is exceedingly rare that it’s acted upon.
There is also a warped addiction to exercising the power of life and death, plus a form of ‘Munchausen’s-by-proxy’ in play.

My opinions are influenced by my time working in a large General Hospital in a clinical role. Maternity units were - and still are - odd places, and a stranger group of women than midwives and maternity nurses is hard to imagine. I knew more than 30 individuals, few had children, and many actively despised their patients. Coincidentally, cases of neglect and abuse in such units are currently making quite high profile news in the UK. While it’s as easy at it is reasonable to attribute this to under-resourcing, my own opinion is that there is an undercurrent of something ingrained and insidious at play here too.

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I’m fairly satisfied that the catalogue of circumstantial rather than direct evidence points towards her being responsible for the deaths.

What I can’t say is to what extent she was mentally compromised, with sufficient certainty to assess how consciously culpable she was.

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I followed the trial a little at the time and it did sound to me then as if a malfunctioning, understaffed & poorly resourced maternity unit (the responsibility of the healthcare trust) was being absolved with the buck being passed to one unfortunate individual. Reading this apparently well informed article reaffirms that view. It appears to me she’s been made a scapegoat for systemic failings all around her place of work. Sadly she’ll no doubt have to wait decades for the wheels of justice to turn & for this to be realised. All imho.

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The correct verdict and sentence.

Tend to agree, when all the evidence is circumstantial and also based on questionable statistics i am thankful we no longer have a death penalty. As for Trusts protecting themselves at any cost, that is a well trodden path in the NHS.

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Working my way through the article but haven’t seen the whistleblowing consultants mentioned yet - do they feature because I have to say their story of trying to raise their concerns and being shut down was something that struck me at the time as significant.

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It’s a pretty thorough article, Breary and Jayaram are namechecked often.

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Evans sounds like a decidedly unreliable expert

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We’re they the ones forced to apologise?

Yes iirc after the execs refused to agree to a police investigation they were made to apologise to Letby, and also ordered by the hospital execs to cease and desist.

The problem is i don’t know who i trust, a Trust who will only act in their best interest or a bunch of consultants who may well have been doing the same thing.

To some extent I’m basing an element of judgement from my own experience, which I recognise has limited value and application. When I’ve had the curse of being the Ops Director job at a hospital I’ve always kept an eye on the mortality reports and when something outside the lines happens, a very serious incident or a series of avoidable deaths then what I would typically do is something like this -

  • Have a walk in, informal meeting with the clincial lead consultant and head of nursing and get some background and their initial response, what kinds of things they are doing.
  • Based on this try to satisfy myself that if there is a leaky hole that it is sufficiently plugged while we try to understand more
  • If its something significant and spells very high clinical risk (and reputational) then I’d start a formal investigation and place the Med Dir and Chief Nurse in charge and make them report to the Exec team, or Board if it was appropriate
  • I’d work with those two to make sure that the lead consultant and specialty head nurse were conducting a thorough investigation and importantly that they were working together and not closing professional ranks and blaming each other etc
  • I’d typically have to rely on the medical team to give me their best explanation for the incidents/ deaths, and ensure that these reports were both of a rigorous standard and had some clinical oversight from at least the Med Dir, or a Med Dir from elsewhere
  • I’d rely on the nursing team to investigate and establish whether and to what extent nursing protocols were followed and tighten up as required.
  • If I thought the Med Dir and or Nursing Dir were either not up to this or hiding/ covering up then I’d bring in additional clinical oversight from elsewhere whether it be another centre or medical university etc

Only anecdotal but its usually a good idea to be guided in the first instance by your consultant team. They are the experts in the specific area but more importantly it’s their reputation and careers on the line so I’ve found they tend to act with a certain amount of diligence and integrity (unless they don’t but that is the exception and tbh its not too hard to spot when this is the case if you keep your ears close to the ground and spend enough time on the unit etc. Politics, affairs etc aren’t hard to surface and spot).

I can’t say what really went on in this case but I’m pretty sure the list of things from my experience didn’t happen/ weren’t followed properly. I also can’t say whether the consultant team were driven by other motives but in the face of it when your senior consultants come to you raising an issue of this kind you tend to listen, but then you also make sure all the detail and facts are established properly with some degree of independent validation.

I suppose like many others I can’t help but wonder what would have happened if the Trust had responded differently when the consultants first blew the whistle after the two initial deaths. Whether you think it was Letby who was directly responsible for the death of those babies or not, the checks and balances in place were not sufficient to prevent/ avoid the five that came afterwards.

Don’t even get me started on the fragility of clinical care and risk management in maternity services right across the board. It doesn’t take too many holes in the cheese to line up for something very tragic and avoidable to happen…

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Guilty.

Is favour making public inquiries available, they are public after all. Will this stop those who question the conviction, not in the slightest. The inquiry will try to determine how a serial killer was able to operate undetected for so long in a workplace where process and controls should prevent it. It has no choice but to start from the position of her guilt and as such will not consider other causes. The assumption is that the Court has already done that with the “beyond reasonable doubt” approach and that the Court is infalliable.

The first assumption is no doubt correct. The second not so.

Clearly the purpose of the inquiry isn’t to either try LL again, or try to unpick her conviction.

Hopefully the scope of the inquiry will be very carefully defined so that it focuses on the culpability of the Trust as a whole and the individual professional groups interacting within the unit; and the extent to which the lack of appropriate checks and balances failed to identify and take earlier action to prevent this tragedy and how it was able to go on for as long as it did.

The terms of the inquiry has been set