Among the witnesses who lined up to accuse Lucy Letby of killing babies in her care during her first trial last year, few were as influential as the group of consultants who had worked alongside the nurse in the neonatal unit at the Countess of Chester Hospital.
Indeed, they were so formidable that they became known as the ‘Gang of Four’. Thanks, in large part, to their testimony, Letby is now serving 15 whole-life terms for seven murders and eight attempted murders – even though no one ever saw her harm a baby.
All the evidence against Letby is circumstantial and, as the science behind it has come under question, attention has sharply shifted from the accused to the accusers.
And that includes the ‘Gang of Four’: Ravi Jayaram, Stephen Brearey, John Gibbs and another medic known only as ‘Dr B’.
Dr B has been less easy to pin down than the others for the simple reason that she was the only one to enjoy anonymity as a result of a court order.
I understand that astoundingly, given that her evidence helped send a young woman to prison for the rest of her days, Dr B was granted this status because she had been the consultant in charge when a baby died at the hospital in 2014. A subsequent inquest recorded a verdict of ‘death by misadventure’, pointing to a litany of failings that took place on her watch.
Faced with a premature baby desperately in need of oxygen, Dr B negligently inserted a breathing tube down the poor baby’s gullet instead of his windpipe. No fewer than five warning signs that she and her team had made a fatal mistake were ignored and, because of their lack of proper care, Noah Robinson, who had been born three months prematurely, died.
Worse still, this information was withheld from the jury that convicted Letby in her first trial. For unknown reasons it has also not been raised at the ongoing Thirlwall public inquiry into the tragic series of deaths at the hospital, which began in September.
Lucy Letby was sentenced to murder and attempted murder. She is serving 15 whole-life terms
I believe this to be an insult to open justice.
And this omission is all the more significant because Dr B’s evidence in Letby’s trial was described by one reporter covering the proceedings as ‘a defining moment’.
‘Even though her face was hidden by a screen and her voice a harrowed whisper, those in court could sense that this was a defining point in the Lucy Letby trial,’ he wrote.
‘Dr B was describing the moment a newborn triplet had died in agony – and entirely without reason – just 24 hours after his brother. As she watched the boys’ father lying crumpled on the floor, the paediatrician silently backed his desperate plea to have his one surviving son taken away from the Countess of Chester Hospital.
‘Because in that moment she saw that, despite her own skill, dedication and professionalism, she was powerless against the ‘mortal danger’ posed by the murderous nurse she was unwittingly standing next to. ‘Even though I didn’t beg,’ she told the court, ‘in my heart I just wanted the baby to leave because I knew that was the only way he was going to live.’
But at the time Letby was working in the neonatal unit at the Countess of Chester Hospital, it was a highly dysfunctional environment. A supposedly sterile intensive care unit had killer bacteria in its taps and sinks and was run by consultants who conducted just two scheduled ward rounds per week rather than two per day.
As we shall see, they made mistake after mistake inside a failing and broken NHS.
Yes, Letby has been found guilty by two juries. But is it possible that this very unhappy ship, not its most hard-working nurse, was the real serial killer?
To help answer that question, let’s look in detail at the track record of Dr B.
In 2014 – a year before Letby started her alleged killing spree – Noah Robinson, whose parents lived in Upton, Chester, was delivered by Caesarean section on March 20 after his mother Melanie developed potentially fatal pre-eclampsia. He weighed just 1 lb 7 oz. While Noah was very premature, he would have had a good chance of living had he been treated properly, according to an inquest held the following year.
Dr Ravi Jayaram was part of the ‘Gang of Four’ that accused Letby
Senior consultant Dr John Gibbs was another member of the ‘Gang of Four’
Dr Stephen Brearey also gave evidence against Letby in court
An expert paediatrician told the hearing: ‘Taking all things into consideration, I would have been hopeful for his survival.’
Two doctors were responsible for baby Noah’s care: a junior registrar and the consultant, Dr B. Junior doctors are responsible for the bulk of the day-to-day medical care but the consultant is, of course, the boss.
Noah’s problems began when the registrar mistakenly inserted the breathing tube down his gullet, or oesophagus, rather than his trachea.
When the baby showed little sign of improving, Dr B decided to reinsert the breathing tube herself but made the same error as her underling. She placed it not in Noah’s windpipe but in his oesophagus.
Instead of channelling life-giving oxygen to the baby’s lungs, the tube was put in a passageway that led to the stomach.
For a variety of reasons, five warning signs were then ignored after this error.
X-rays showed the tube was in the wrong place but doctors failed to notice this and take the appropriate action.
Noah’s tummy was swollen owing to the insertion of the breathing tube – but no one questioned why.
An alarm on the ventilator machine sounded but, instead of establishing what had triggered it, staff assumed it was faulty.
When a capnograph, a machine that measures the amount of carbon dioxide in a patient’s exhaled air, detected nothing, it, too, was wrongly assumed to be faulty.
Finally, a ‘flow-loop’ on the ventilator that recorded oxygen going in and carbon dioxide coming out was not logged – but no action was taken.
Cheshire coroner Nicholas Rheinberg soberly told the inquest: ‘There were considerable signs [the breathing tube was in the wrong place] and I find it surprising these signs were not realised.’
The coroner was especially critical of Dr B for having assumed that the carbon dioxide monitor, the capnograph, was somehow faulty.
‘That seems to be an extraordinary assumption,’ he said. ‘Shouldn’t the first assumption be the tube is in the wrong place or that’s a strong possibility? It’s like flying an aeroplane and seeing the oil gauge come on and you assume the gauge must be wrong, rather than the oil pressure is low.’
The coroner recorded a verdict of death by misadventure, ‘the unintended consequences of an intended event’, primarily oesophageal intubation.
In plain English: putting the breathing tube down the gullet, not the trachea.
After the inquest, Noah’s mother Melanie said: ‘We put our trust in the doctors to look after Noah, but they didn’t do what they were supposed to. We feel terribly let down by the NHS. It is good that there is a police investigation and the hospital has gone to them voluntarily.’
However, that police investigation came to nothing. My colleague Edward Abel Smith and I have been crowdfunding a podcast series, Was There Ever A Crime? The Trials Of Lucy Letby. And we have been joined by Cleuci de Oliveira, who was a researcher for a brilliantly forensic, 13,000-word New Yorker article on Letby’s case that was published in May.
The tragic death of Baby Noah is outlined in episode two of our podcast, The Deluded, named after the rock band led by Dr B’s fellow consultant, Dr Ravi Jayaram.
We had received a tip that the consultant involved in the death of Baby Noah had been Dr B but we had no proof.
So, last month we wrote to the four consultants, the Countess of Chester Hospital, Cheshire Police and the Crown Prosecution Service (CPS) asking them if they agreed that it was in the public interest to know if one of the doctors involved in the death of Baby Noah had herself gone on to accuse Letby of murder.
None of the doctors replied, while the Countess of Chester Hospital, Cheshire Police and the CPS sent us formulaic responses saying that Letby had been convicted by two juries but made no attempt to answer our question.
At the time Letby was working in the neonatal unit at the Countess of Chester Hospital, it was a highly dysfunctional environment, writes John Sweeney
Cheshire Police certainly knew that one of the doctors had been involved, of course, because that was the force that had conducted the investigation into the death of Baby Noah. And so did the consultants. And so did the hospital.
When Lucy Letby was first accused by the ‘Gang of Four’ of being a baby killer in 2016, before she was charged by the police, she launched a grievance procedure against some of her accusers.
During that process, hospital managers interviewed Eirian Powell, the neonatal unit’s manager.
I have obtained a transcript of that interview. One telling passage reads as follows: ‘Powell: ‘Doctor B accidentally killed a baby once. Insulation [sic – I believe this is a typo and the word actually used was ‘intubation’] is very difficult. Nursing staff were supportive. There was evidence in that case but yet Dr B was not suspended. And now, SB [Dr Stephen Brearey] has ‘gut instinct’ and wants LL suspended.”
What is striking is that the Dr B ‘killed a baby’ note has never seen the light of day until now.
Astonishingly, at no point was it brought up by either the prosecution or the defence during Letby’s two trials.
Meanwhile, the Thirlwall Inquiry, set up to examine the circumstances surrounding the Letby case, published pages one, two and four of the Powell interview – but, crucially, not page three, which contained the bombshell reference to Dr B killing a baby.
I think we deserve to know why. The missing page in the sequence gives the impression that the Thirlwall Inquiry itself is part of the cover-up. If so, it is a shameful waste of public money.
A spokesman said yesterday: ‘The Inquiry only publishes material which has been shown on screen to a witness when they are giving evidence.’
Dr B was also the consultant in charge of the cases of Babies O and P, two of a set of triplets, who were found at Letby’s first trial to be two of her seven murder victims.
The jury was told that the triplets were born ‘in good condition’. In fact, the triplets shared the same placenta during their mother’s pregnancy: they were ‘monochorionic’, which made them five times more likely to die than a typical baby.
Babies O and P were also being treated in the Countess of Chester, which had raw sewage in its sinks.
On Day 85 of Letby’s first trial, the jury heard a statement from the mother of Babies O and P, which included one particularly disturbing observation: ‘Dr B was coughing and spluttering into her hands, then going outside for a smoke. I never saw her wash her hands, which I thought was unacceptable.’
After any baby’s death, it is good practice for the NHS to draw up a ‘Root Cause Analysis’ setting out what went wrong.
We have obtained the Root Cause Analysis for Baby O’s death, which raised the following highly serious contributory factors in relation to Dr B: ‘Members of the paediatric medical team omitted to keep contemporaneous records or indeed, in some instances, any form of documentation whatsoever. No documentation of the request for commencement of antibiotic therapy.
‘Consultant assistance with intubation not documented. On call team not present on neonatal unit despite infant requiring intensive care, resulting in delay in commencement of neonatal care at immediate deterioration. Consultant not present on unit until 39 minutes following crash call for assistance, despite events occurring in daytime hours.’
Dr B’s apparent failure to respond promptly to this crash call appears to have been symptomatic of a more general malaise. When, the next day, Baby P also started to deteriorate, Dr B’s response disturbed her colleagues. This emerged when Letby was asked by her barrister at her first trial how Dr B was coping with a second baby fading on her watch:
‘Letby: ‘She was becoming increasingly agitated and quite stressed about things. She was regularly leaving the unit to go and have a cigarette, which she often does when she’s stressed.’
‘Q: So she’d go outside the building and then come back in?’
‘A: Yes.’
‘Q: You are saying she was stressed, how are you feeling?’
‘A: The same: we were all very anxious, particularly in view of what had happened to [Baby O] the day before.’
‘Q: And I don’t mean to be indelicate, but what were you anxious about?’
‘A: That there didn’t seem to be any clear plan from the doctors. Nobody seemed to know what was happening and very much just wanted the transport team to come and offer their expertise.’
Edward and I have written to Dr B asking her effectively if it is true that, while looking after seriously ill babies, she neglected her own personal hygiene, missed a crash call and may have contributed to the death of a baby through a lack of proper care. We have received no reply.
Letby’s great failing, perhaps, was to put her trust in the original legal team at her first trial, who called just one defence witness: a plumber.
He was the hospital maintenance man, Lorenzo Mansutti, who spoke about tackling ‘foul water’ – including human faeces – in the Chester hospital’s maternity wing and adjoining neonatal unit on a weekly basis.
The plumber was a good witness but he did not explain to the jury the significance of the raw sewage in the taps in the unit in the way that, say, a professor of public health would have done.
It later turned out that the plumbing was riddled with the killer bacteria pseudomonas, which only underlines the hospital’s dysfunctionality.
In addition to the Countess of Chester consultants, the prosecution fielded no fewer than six doctors, who all gave evidence pointing to Letby as a serial killer.
Its star witness was Dr Dewi Evans, a retired paediatrician who has come under fire in the wake of the trial – often from people far better qualified than him to assess Letby’s guilt or innocence.
Professor Colin Morley, who believes Letby is the victim of a monstrous miscarriage of justice, has written more than 300 papers on neonatology, a medical speciality that focuses on the care of newborn infants, especially those who are premature or sick. Dr Evans has published none at all.
I have served as a juror. I remember being worried about sending someone to prison by mistake. But doctors suggesting that there was a killer nurse at work? That would have impressed me.
If I were one of the jurors who found Lucy Letby guilty again and again, only then to discover that one of the doctors who accused her had been involved in the death of a baby in controversial circumstances and whose gross incompetence had been covered up: that would make me feel sick to the bottom of my heart.
Was There Ever A Crime? The Trials Of Lucy Letby is reported by John Sweeney and Edward Abel Smith and is available wherever you get your podcasts.