In a case that also shocks the UK, a 34-year-old former neonatal nurse named Lucy Letby was convicted final yr of murdering seven infants in a hospital within the northeast English metropolis of Chester and attempting to homicide six extra.

Within the six years, two trials and two attraction functions since her arrest, opinion stays fractured on whether or not Letby truly dedicated the crimes on the Countess of Chester Hospital from 2015 to 2016 that she is serving uncommon 15 whole-life sentences for.

The case has led to large on-line hypothesis that the conviction was not based mostly on dependable proof and is a miscarriage of justice. This has precipitated nice upset for the households of the infants she was convicted of harming.

Within the meantime, an ongoing public inquiry into the deaths of the infants has began listening to proof from dad and mom and witnesses, a few of whom mentioned the hospital was woefully mismanaged.

On Thursday, the daddy of two triplet infants whom Letby was discovered responsible of murdering instructed the inquiry he had witnessed a physician use a display “to search for easy methods to carry out the chest drain and the place the incisions and tubes ought to go. It seemed as if they had been following a tutorial and never as in the event that they actually knew what they had been doing.”

This week, guide paediatrician Elizabeth Newby instructed the general public inquiry that workers within the neonatal clinic didn’t come ahead to boost issues in regards to the deaths and deterioration of infants on the ward as a result of hospital administration was too “indifferent” and “impersonal”.

Right here’s why the Letby case has divided opinion in Britain:

What occurred within the Letby case?

• Dr Stephen Brearey, the medical director of the hospital’s neonatal unit, raised issues about Letby in 2015 as a result of Letby was on shift when a number of deaths or collapses of infants occurred. The hospital administration dismissed these issues initially, deeming them a coincidence as a result of the causes of the deaths had been completely different.
• In July 2016, Letby was faraway from the neonatal unit and positioned within the hospital’s threat and affected person security workplace.
• In 2017, police launched an investigation into the excessive toddler mortality charge on the hospital. It’s unknown how the hospital’s mortality charge in contrast with different hospitals with related caring services.
• On July 3, 2018, when she was 28, Letby was first arrested at her dwelling in Chester on suspicion of murdering eight infants and making an attempt to homicide six others. She was not charged and was launched on bail three days later pending additional inquiries.
• Letby was arrested once more on June 10, 2019, on the identical prices and was once more granted bail on June 13, pending additional inquiries.
• In November 2020, she was arrested a 3rd time, denied bail and remanded into custody. She was charged with murdering 5 boys and three women from June 2015 to June 2016.
• Letby’s trial in Manchester Crown Courtroom started in October 2022. She was discovered responsible in August 2023.
• In January, Letby utilized to the Courtroom of Enchantment. After initially being denied the best to attraction, she was allowed a three-day listening to to use for permission to attraction in April. Nevertheless, in Might, that courtroom additionally refused her permission to attraction.
• In June, one other trial started, on the finish of which Letby was discovered responsible of making an attempt to homicide one other child. She was handed one other whole-life sentence on July 5.
• In her 2023 conviction, Letby was discovered to have attacked newborns utilizing strategies that included insulin poisoning, overfeeding via nasogastric tubes and air embolism, a blockage of blood vessels brought on by air coming into the circulatory system via intravenous traces or feeding tubes.

She has been jailed on the high-security Low Newton Jail in Durham. Solely about 70 persons are at the moment serving whole-life sentences within the UK.

Why is there an ongoing public inquiry?

After Letby’s conviction, a public inquiry was established to research the circumstances surrounding the deaths of the infants on the Countess of Chester Hospital. Girl Justice Kathryn Thirlwall of the Courtroom of Enchantment was appointed to go the inquiry in September 2023.

The hearings started on September 10 this yr. Hearings of proof by the inquiry will run for 4 weeks, in accordance with a timetable printed on the inquiry’s web site.

The inquiry is contemplating components together with the experiences of the victims’ dad and mom, the behaviour of hospital workers in direction of Letby whereas she was working within the hospital and the effectiveness of Nationwide Well being Service administration.

Who doubts the judgement towards Letby?

One one who has attracted a variety of consideration is Richard Gill, a statistician and retired arithmetic professor, who instructed Al Jazeera: “I feel it’s 1,000,000 to 1 that she’s harmless.”

In 2006, Gill turned concerned within the Lucia de Berk case. De Berk, a paediatric nurse who had labored at three hospitals in The Hague, Netherlands, was arrested in 2001 on suspicion of killing infants, toddlers and aged sufferers by growing doses of medication. She was sentenced to life in jail in 2003. In 2008, nevertheless, the case was reopened, and in 2009, the courtroom accepted that the deaths had been pure and de Berk was harmless.

Gill mentioned the Letby case is “horribly the identical” as de Berk’s. “From the start of the Lucy Letby case, I had the impression that ‘Oh, my God! Right here it goes once more.’ It was simply the identical,” he mentioned. He sees parallels within the instances as a result of in each cases, an argument was made that the nurse was current when suspicious occasions occurred, not factoring in incidents that occurred within the nurse’s absence.

Why do some individuals consider Letby is harmless?

In brief, they query the validity of a few of the proof that was used to convict Letby, together with:

The statistics

The jury was proven a spreadsheet itemizing deaths and collapses that occurred in infants named in courtroom as Little one A via Little one Q. The column beneath Letby’s identify was totally marked with crosses, exhibiting she was on shift each time that the collapses or deaths occurred. Columns beneath different nurses’ names had been sporadically marked, exhibiting that no different nurse was current each time.

Statistical proof was misused within the Lucy Letby case too, see the well-known spreadsheet which @cheshirepolice are so pleased with pic.twitter.com/N3E9Uht6X5

— Richard Gill (@gill1109) September 10, 2023

Gill argues that there is no such thing as a transparency about whether or not there have been different incidents that occurred when Letby was not on shift. Gill instructed Al Jazeera: “The lie is that Lucy is there each time a suspicious occasion happens. Why are these occasions known as suspicious occasions? As a result of she’s there.”

Peter Inexperienced, a professor of statistics and a former president of the Royal Statistical Society (RSS), additionally took subject with the chart. “The chart seems to be very convincing, however there are a selection of points with it,” he was reported by the BBC as saying. “A giant factor is that it solely describes 25 of the unhealthy occasions which occurred on this interval. It doesn’t embody any of the occasions that occurred when Lucy was not on responsibility.” Actually, there have been at the very least six deaths and collapses of infants that weren’t included within the chart, in accordance with UK media experiences.

Moreover, Inexperienced mentioned, Letby was working further shifts throughout this era and, due to this fact, was extra prone to seem in any chart exhibiting staff’ shifts.

The Guardian reported {that a} senior guide paediatrician, Dr John Gibbs, who was a witness in each the 2022-2023 trial and the 2024 trial wrote in a July 2016 e-mail to his co-workers that was later leaked: “The rise in neonatal mortality that now we have skilled during the last 18 months is likely to be inside ‘anticipated’ statistical variance (however I’m unsure as a result of my stats isn’t adequate). You may really feel that this have to be unsuitable, but it surely’s all to do with the statistics of small numbers.” Those that doubt Letby’s guilt say the e-mail exhibits medical consultants believed the numbers might be inside statistical norms.

The RSS launched a report in 2022 detailing the challenges of utilizing statistics in authorized instances associated to medical settings. In a September 2023 letter to Thirlwall, the RSS wrote: “It’s removed from easy to attract conclusions from suspicious clusters of deaths in a hospital setting.”

Insulin check outcomes

Letby was discovered responsible of giving two infants artificial insulin, inflicting their blood sugar ranges to drop to harmful ranges. Each infants survived.

Medical experiences for these two infants indicated excessive ranges of insulin and low ranges of the hormone C-peptide. They had been the one empirical scientific proof introduced within the case proceedings.

These check experiences “strongly instructed” that the insulin had been administered as medication relatively than naturally produced by the physique, Gibbs was quoted as saying in a BBC article in 2022.

However consultants, together with forensic toxicology scientist Alan Wayne, have contested using such checks as the idea for felony convictions and have known as for extra particular checks that end in binding proof.

“That check can’t differentiate between artificial insulin and insulin produced by the pancreas,” Wayne instructed the BBC in August.

“The issue is that the strategy of study used [in these two cases] was most likely completely good from a medical perspective however not a forensic toxicology perspective,” he mentioned.

Letby’s defence didn’t query whether or not the check cited was the correct of check to show insulin poisoning.

Analysis cited within the air embolism allegation

The prosecution mentioned Letby injected a few of her victims with air or launched air into their our bodies via feeding tubes, which might trigger air bubbles to dam veins and arteries. Lead prosecution witness and retired paediatrician Dr Dewi Evans concluded this based mostly on indicators together with the discolouration, or mottling, that appeared on the pores and skin of the affected infants.

He supported this by citing a analysis paper from 1989 written by Dr Shoo Lee and Ok Tanswell from the Lawson Analysis Institute at Canada’s St Joseph’s Well being Centre, which concluded that such mottling was indicative of an air embolism brought on by high-pressure air flow.

Letby’s defence didn’t name Lee, the surviving creator of the analysis article, to provide proof on the authentic trial. Nevertheless, he did testify throughout her attraction and gave his opinion that the discolouration described by the prosecution was not the identical as what he wrote about in his analysis. Nevertheless, his testimony was not deemed admissible by the appeals courtroom, which concluded the defence may have known as him through the trial however had not carried out so.

A key piece of proof utilized in Letby’s trial referring to the collapse and dying of an toddler known as Child C was an X-ray exhibiting a swollen abdomen taken the day earlier than the infant collapsed.

The prosecution alleged that the swollen abdomen was “probably attributable to deliberate” pumping of air into his feeding tube. However consultants have solid doubt on this proof.

Dr Michael Corridor, a neonatologist who was consulted by the defence however was not known as to provide proof, instructed the BBC: “There are a variety of potential explanations for there being extra gasoline there.” He mentioned the probably clarification was that the swelling had been brought on by the respiratory assist the infant was receiving and likewise mentioned the X-ray confirmed a potential bowel obstruction.

Crucially, Letby was not engaged on the day the X-ray was taken and had not been on shift since earlier than the infant was born. Whereas this info was given to the jury within the first trial, the choose didn’t remind it that Letby had not been on shift. However Letby’s former barrister Ben Myers highlighted these particulars in his closing argument.

The rationale the variety of deaths dropped after Letby’s elimination

It was alleged within the case towards her that after Letby was faraway from the neonatal unit in 2016, the variety of deaths dropped.

Nevertheless, about the identical time, the hospital downgraded its neonatal unit and stopped taking very untimely infants who had been at excessive threat of dying.

A Telegraph article from September 6 cited new evaluation by the RSS that discovered the spike in deaths from 2015 to 2016 was not statistically uncommon.

Letby’s handwritten notes

Police searches of Letby’s home and belongings after her first arrest in July 2018 uncovered a number of adhesive notes believed to have been handwritten by Letby. These notes contained messages akin to: “I AM EVIL, I DID THIS,” “I killed them on objective as a result of I’m not adequate,” “HATE” and “WHY ME? I haven’t carried out something unsuitable.”

These notes had been publicly launched in April 2023.

The prosecution additionally confirmed photographs of Letby’s private diary from 2016 by which, it claimed, the initials of her victims had been recorded on dates akin to the times they had been born, once they had been attacked or once they died.

Nevertheless, Letby has by no means formally confessed to homicide or tried homicide. Her defence as a substitute argued that the notes didn’t replicate her guilt however her anguished way of thinking.

The Guardian reported that sources near the case revealed that the Countess of Chester Hospital’s head of occupational well being and wellbeing, Kathryn de Beger, had inspired Letby to jot down down her ideas.

Moreover, David Wilson, a professor of criminology at Birmingham Metropolis College who specialises in serial killers, instructed the newspaper that these notes are “meaningless”.

“Many individuals will say issues when they’re beneath stress and feeling bereft that appear to indicate one factor however imply nothing in any respect, apart from reflecting the underlying stress,” he was quoted by The Guardian as saying.

Did all the Lucy Letby followers all of a sudden resolve to disregard the act of contrition in her diaries? The medical paperwork of kids that weren’t even her sufferers? Their initials in her diary on their day of dying?

— Avi (@AviSipsTea) Might 13, 2024

How have the hospital and households reacted to those doubts?

Thirlwall has remarked that this questioning of the validity of Letby’s convictions is inflicting “huge extra misery to the dad and mom” of the affected infants.

“Our household is deeply shocked by the continued hypothesis surrounding what’s being known as a miscarriage of justice,” the dad and mom of dual infants – considered one of whom died and the opposite discovered to have been poisoned with insulin – instructed The Occasions newspaper in September.

“Sure items of proof being mentioned within the media are grossly out of context and misrepresented. Misinformation is being circulated about what transpired in courtroom. Having attended the trial ourselves, we’re totally conscious of what was mentioned,” the dad and mom of infants referred to within the trial as Infants E and F mentioned.

A spokesperson from the Countess of Chester Hospital declined to touch upon the case to Al Jazeera, citing the continued public inquiry and investigations.

Al Jazeera additionally reached out to the lead prosecutor of Letby’s first trial, Nick Johnson, however didn’t obtain a response.

On Thursday, barrister Richard Baker, who represents the victims’ households, revealed to the Thirlwall inquiry that an audit of incidents at Liverpool Ladies’s Hospital, one other hospital that Letby labored at as a trainee nurse from October to December 2012 and from January to February 2015, confirmed infants had their respiration tubes dislodged throughout 40 % of Letby’s shifts.

The inquiry heard that dislodgements usually occurred throughout lower than 1 % of different nurses’ shifts.

“All people who recklessly promotes conspiracy theories or who parrots with out questioning the identical drained misconceptions about this case needs to be ashamed of themselves,” Baker mentioned.

What else may clarify the deaths of the infants?

Letby herself mentioned throughout her trial in 2023 that the deaths had been the results of understaffing and poor hygiene on the hospital.

Gill instructed Al Jazeera that he additionally believes that is what precipitated the excessive toddler mortality charge.

Can Letby file additional appeals?

Serving 15 whole-of-life sentences, Letby is just not eligible for parole.

Nevertheless, she will be able to attraction her whole-life sentences by way of the Felony Circumstances Evaluation Fee (CCRC). Her new defence workforce, headed by barrister Mark McDonald, is already doing this.

McDonald, who specialises in appeals instances and miscarriages of justice, must discover recent proof and persuade the CCRC that Letby’s convictions are unsound.

He instructed UK media this month that he’s in touch with “consultants in neonatology, anaesthetists, pathology, statistics which have come ahead and have recognized flaws within the trial that now need to give proof for her”.

McDonald added that new medical proof that contradicts the proof introduced by the prosecution has additionally been introduced ahead.

The CCRC investigates instances by which there are suspected miscarriages of justice.

The CCRC solely accepts instances which have already been the topic of a courtroom attraction listening to, and it solely considers instances for which there are new grounds for a brand new attraction. After assessing proof, if the CCRC decides the conviction was unsound, it’s despatched again to the courtroom as an everyday felony attraction.

Relying on the complexity of a case, it may take from a couple of weeks to a number of years for the CCRC to succeed in a choice as soon as it begins a evaluate – which itself could not start for as much as 12 months.