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religion-is-a-mental-illness · 1 year ago

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When doctors warned that she might be a killer, hospital bosses took her side — offering to support her with a master’s degree and find her a role at a top children’s hospital. This is the inside story.

By: Shaun Lintern and David Collins

Published: Aug 19, 2023

Lucy Letby sat with her parents in a meeting with senior managers at the Countess of Chester Hospital, where she worked, waiting patiently for an apology. She had prepared a statement that was read out by her parents to Tony Chambers, the hospital’s chief executive, about being bullied and victimised on the neonatal unit.

It was December 22, 2016, and for the previous 18 months, two doctors on the unit had been trying to find an answer for a series of mysterious deaths of babies. Their detective work had led them to a single common denominator: Letby. The neonatal nurse had been on shift for each of the incidents.

Rumours of a killer on the ward had spread and Letby had complained about the doctors and their finger-pointing, claiming she was being wrongly blamed.

Chambers, who had trained as a nurse, was convinced by Letby’s account, and in front of her parents, John and Susan, offered sincere apologies on behalf of the hospital trust. The doctors in question would be “dealt with’’.

Except the doctors were right. By that point Letby had secretly murdered seven babies and tried to kill six more, one of them twice.

Last week a jury sitting at Manchester crown court found her guilty following a ten-month trial. She was cleared of two attempted murders and the jury was unable to reach a conclusion over charges of attempted murder relating to four other babies.

An investigation by The Sunday Times, based on a cache of internal documents, can now reveal in detail how the hospital delayed calling the police for months and that senior management, including the board, sided with Letby against doctors after commissioning perfunctory investigations.

The files, including the outcome of a grievance case that Letby brought against the trust in September 2016, reveal that an apology from the hospital and the doctors was not all the 33-year-old got. She was also to be offered a placement at the world-famous Alder Hey Children’s Hospital in Liverpool and was to be given support for a master’s degree or advanced nurse training.

The grievance report details how consultants first raised concerns with board directors in 2015 and that doctors had been heard referring to “killing” on the ward.

One doctor was said to have described a “drawer of doom” containing links between Letby and as many as 16 unexpected deaths and collapses of babies on the neonatal unit. Another told the ward manager: “You are harbouring a murderer.”

But Ian Harvey, the medical director, told the grievance the trust wanted to “protect Lucy Letby from these allegations”. A senior nurse, Karen Rees, had told Letby “the intention was to get her back onto the neonatal unit”.

Some doctors were threatened with misconduct investigations and their attempts to escalate their worries were met with angry responses. One nurse described the consultants as conducting a “witch-hunt” against Letby.

Responding to the Sunday Times investigation, Susan Gilby, the former chief executive of the trust, said a full public inquiry was required. She said she knew within a week of arriving at the trust, in 2018, that police needed to be involved.

She said managers “had a very fixed view” and the paediatricians were “clearly psychologically in distress” when she arrived at the trust a month after Letby’s arrest.

Along with the then trust chairman Sir Duncan Nichol, Gilby commissioned an independent investigation of the trust’s handling of the Letby scandal by the consultancy firm Facere Melius. Nichol has called for it to be published and said he believes the trust board were misled by hospital executives.

First suspicions

In June 2015, Dr Stephen Brearey, a senior paediatrician and head consultant at the hospital’s neonatal unit, was trying to work out why four relatively healthy babies on his unit had “collapsed” — suffered a catastrophic and unexpected decline in their health — for no clear reason in a fortnight. Three babies had died; one had been saved. That is more than they would normally expect in a year.

Brearey, a calm, measured, clear-headed consultant, decided to open up the medical notes for each case to examine one by one their care on the ward.

He noted the doctors and nurses on duty, the times of the collapses, and the people in the room at the time. Letby was the only one at each of the four collapses.

The nurse, then 26, had a wide circle of friends at the hospital. “She was like Miss Perfect,” said a former friend. “Maybe slightly awkward, but sociable. She’d go on nights out with the hospital staff into bars and nightclubs in Chester. Her parents used to think butter wouldn’t melt in her mouth. She’s literally the last person anybody would suspect as a killer.”

She was a godmother to two children, did salsa classes, went on holiday to Ibiza with friends, and lived in a £200,000 semi-detached house close to the hospital with her two cats, Smudge and Tigger. She had grown up in Hereford, and went to Aylestone School, a state secondary, before moving to Hereford Sixth Form College. She graduated in 2011 and started at the Chester hospital in 2012.

She also had an alleged close relationship with a married registrar. He had driven her home the night one of the babies died, and it was claimed in court that many of her actions were motivated by a desire to be noticed by him. Records showed she had searched for his wife on Facebook, and had sent him heart emojis in a WhatsApp message.

Letby’s first murder was of a one-day-old boy known as Child A, on June 8, 2015. Delivered by caesarean section at 31 weeks, he had been admitted to the intensive care room at the neonatal unit, but was in good condition and breathing without help.

An hour after starting her shift, Letby called doctors to the baby’s incubator because his health had suddenly deteriorated. Both a doctor and a consultant noticed an odd discolouration on the boy’s skin — patches of pink over blue skin that appeared and disappeared — but had no idea what it could be.

Letby had injected air into the baby’s bloodstream through one of two tubes attached to his body, in what would become a tried and tested method of killing for the nurse.

Despite resuscitation attempts, Child A was pronounced dead at 8.58pm. A day later, Letby targeted Child A’s twin sister, Child B, using a similar method of air injection. She too suffered an unexpected collapse, but survived with no long-term consequences. On June 14, Letby murdered a five-day-old baby, Child C, using an injection of air through a nose tube.

Seven days later, she killed Child D, with an injection of air into the bloodstream. The baby collapsed three times in the early hours, and could not be saved.

All Brearey had was a suspicion that something was amiss. Healthy babies, no matter how premature, do not collapse and die for no reason. In neonatal units it is accepted that sudden unexplained deaths of babies is rare.

Brearey’s informal review of what had happened to Children A, B, C and D was shared with his colleague, Dr Ravi Jayaram, a consultant paediatrician in the children’s ward, who once presented Channel 4’s TV show Born Naughty?, a programme about children with behavioural problems. Brearey told Jayaram there was nothing that linked the deaths, “other than one nurse”.

The deaths were reported by consultants to the hospital trust’s committee for serious incidents, responsible for examining matters of patient safety. But the hospital classified them as “medication errors”, rather than a “serious incident involving an unexpected death”.

Had they been classified as unexpected deaths, NHS England policy would have allowed the hospital to group them together, which could have led to an immediate further investigation about what had caused them.

New ways to kill

In the early hours of August 4, Child E, a twin boy, collapsed and died. Letby had injected air into his bloodstream. The next day she used insulin to try to poison the baby’s twin brother, Child F. He survived.

Letby was becoming more prolific, and she started experimenting with her killing methods. In September, she twice tried to murder Child G, by feeding him an excessive amount of milk. The baby was left severely disabled.

On October 23, Child I died. Letby had injected a large amount of air into her stomach via a nasogastric tube. She sent a sympathy card to her parents and made Facebook searches for the family.

The same day as Child I’s collapse, Eirian Powell, a nurse and ward manager responsible for the nursing staff on the neonatal unit, conducted her own review of the cases. Like Brearey, she spotted that Letby was the only member of staff on shift for all the deaths. She emailed her findings to Brearey.

“Unfortunate that Lucy Letby was on — however each case of death is different,” she told him. By now, doctors and staff on the unit were gripped by fear and confusion. What was going wrong?

By November 2015, Ian Harvey, the hospital’s medical director and second in charge overall, was aware of the rising death rate on the neonatal unit. He felt assured, however, that the hospital had a mortality rate lower than or comparable with other similar-sized hospitals.

Joining the dots

In February 2016, Brearey, who remained suspicious of Letby, carried out a half-day thematic review into the deaths and collapses on the neonatal unit. With the help of a specialist consultant from Liverpool, he tried to join the dots.

The working group produced a report detailing complex clinical issues alongside a mortality table and an appendix. The appendix, which was reproduced in a police report, showed Letby was on shift for each of the deaths and collapses and that they had happened only between midnight and 4am.

On February 15, Brearey emailed a table of deaths, showing Letby on shift for each one, to Harvey, who as well as being medical director, had been a respected orthopaedic surgeon. Still there was no action and hospital management, believing Letby’s involvement was a coincidence, allowed her to continue her work at the neonatal unit.

Brearey continued to be concerned and emailed Jayaram. “I think we still need to talk about nurse Letby . . .”

The head nurses at the hospital were also emailing each other. On March 17 Powell, the neonatal unit’s ward manager, emailed the hospital’s chief nurse, Alison Kelly, and they discussed how Letby was a “commonality” in all the deaths. Powell asked for help.

Her plea went unanswered and she twice had to chase for a meeting, getting one 56 days later.

On April 7, Powell moved Letby from night to day shifts, telling her it was to support her “wellbeing” because she had been present for so many of the collapses. Two days after the switch, Letby attacked twin baby boys. She attempted to murder Child L using insulin and Child M was injected with air. Both survived.

These attacks would become a cornerstone of evidence in the police and prosecution’s case against her. The prosecution was able to show the jury that the deaths and collapses “followed” Letby from night shifts to day shifts.

Powell was feeling under increasing pressure. The neonatal unit was busy and understaffed. Stressed and anxious nurses were at breaking point. Internal emails from a consultant to Chambers warned of doctors working shifts of more than 20 hours. And the Letby rumours showed no sign of going away.

At the beginning of May 2016, Brearey emailed Kelly, the chief nurse, flagging Letby’s presence at the deaths and also asking for a meeting. Kelly sent it to Harvey, the medical director, expressing alarm that a doctor was implicating a nurse and told him she had been reassured there was no evidence but that a wider review might be needed.

She asked senior nurse managers to examine any staffing trend linked to the deaths, adding that it was “potentially very serious”.

After the exchange of messages, Brearey and other doctors met Kelly and Harvey to set out their concerns. They agreed to review all deaths and to keep Letby on day shifts for three months.

Doctors remained concerned. In one meeting with Powell on May 16 a senior doctor told her: “You are harbouring a murderer.”

A few weeks later, in June, Letby tried to murder Child N, a baby born at 34 weeks with mild haemophilia, a blood disorder. She injected him with air and a clear fluid into his stomach via a tube.

‘Back with a bang’

In June 2016, Letby travelled to Ibiza for a week-long holiday in the sun with two close friends. She returned to work on June 23, texting a friend the day before: “Probably be back in with a bang lol.”

Within 72 hours, she murdered two triplets Children O and P. Child O suffered “trauma” akin to a road traffic accident that damaged the liver. Both babies had air in the stomach via a nasogastric tube that would have put pressure on their diaphragm, making it difficult to breathe.

The latest unexpected deaths proved traumatic for the neonatal unit. Brearey held a staff debrief, but noticed Letby did not seem upset at all. He decided he wanted Letby off the ward.

On June 24, he called the hospital’s nursing director, Karen Rees, and expressed concerns about Letby being on duty. He wanted to stop her working.

Brearey told the trial that Rees insisted there was no evidence against Letby and said she would take responsibility for allowing the nurse to continue to work.

Claims of a witch-hunt

June’s deaths caused a flurry of emails and meetings between doctors, nurses and hospital executives. “[We need] help from outside agencies . . .” one doctor emailed. “I believe it is the police.”

Jayaram replied to the email chain, with Harvey, the hospital’s second in command, copied in: “They [the hospital directors] do not seem to see the same degree of urgency as we do.”

Harvey replied, denying a lack of action and saying concerns were being “discussed and action taken”. He told the doctors: “All emails will cease forthwith.”

At the end of June, the executive directors met and sources say they debated for the first time calling in the police, with notes from the meeting recording “all say yes to the police”. The discussion went on to consider the impact of an investigation and the arrest of Letby and the “subsequent reputational issues” and impact on the trust.

The evidence was circumstantial and directors had concerns about the unit leadership and fears the doctors were carrying out a “witch-hunt”.

Kelly, the chief nurse, contacted the Nursing and Midwifery Council for advice about Letby and whether to refer the problems to the police.

The trust did not contact the police. But the board agreed to downgrade the unit so the sickest babies were sent to neighbouring hospitals. This was designed to relieve pressure on the unit.

In late June, Harvey and Chambers, the chief executive on a salary of £160,000 plus benefits, decided to ask the Royal College of Paediatrics and Child Health (RCPCH) for an independent review. The parameters were set narrowly and did not specifically ask the experts to look at Letby’s actions or the deaths but to carry out a general review of the service.

Harvey and Chambers met the doctors and told them the trust had considered calling the police but would handle the situation “in a different way”.

Letby was called to a meeting with a senior nurse and HR manager. For the first time, she was told of her link to the baby deaths and that she would be one of several staff placed under supervision. She was visibly “upset” and “distressed”.

Staffing shortages meant she could not be supervised on the ward and in mid-July she was redeployed to an administrative role. She never returned to the unit, despite her best efforts.

On July 14, the trust board held an extraordinary meeting at which the neonatal unit was the only item of discussion. Jayaram and Brearey presented their concerns. Discussions included the link between Letby and the unexplained deaths and the possibility of involving the police. The board also discussed installing CCTV.

One source said the doctors were told that calling in the police would mean “blue tape everywhere and the end of the unit as well as the trust’s reputation”. The next day, a non-executive director, James Wilkie, went to Kelly with concerns following the board meeting. She agreed to escalate his concerns.

Letby’s grievance

At the start of September, the RCPCH arrived. Letby was one of the first to be interviewed. She hoped that engaging with the review might help her back to a frontline nursing role.

At the same time she was fighting back against the doctors she claimed were falsely blaming her for the deaths. On September 7, she raised a formal grievance against the trust for victimisation and discrimination. She said she felt she had been singled out, moved away from the job she loved, and the hospital trust had not been honest about doctors’ allegations against her.

Her Royal College of Nursing (RCN) union representative emailed hospital bosses outlining “grave concerns” about her treatment. Letby was demanding to know the grounds for an investigation into her practice.

In October, the RCPCH reported back to Chambers and Harvey. They found that what had happened “appears unusual and needs further inquiry to try to explain the cluster of deaths”. They recommended a forensic review of each death but it never happened.

The review also found that not all the deaths had been classed as serious incidents and some were not sent for post-mortem examinations, despite this being best practice. It also found gaps in staffing and poor decision-making. But it did not explain why babies had died.

Harvey contacted Dr Jane Hawdon, an expert neonatalogist at the Royal Free Hospital in north London, asking her to examine the deaths, but she told him she could offer only a summary.

Another consultant at Alder Hey told Harvey he should commission an expert review. Three separate experts had now advised him to do this.

A draft version of the RCPCH report, including a confidential section linking the baby deaths with Letby and the “subjective” concerns of the doctors, was drawn up but only a redacted version was circulated to the board, the doctors or bereaved parents.

When Letby lodged her grievance complaint in September 2016, it started a two-and-a-half-month investigation into her treatment by the hospital and, in particular, the consultants. Documents show that in particular she wanted to know what allegations were being investigated about her.

Doctors who had raised concerns about her being a baby killer, including Brearey and Jayaram, were forced to sit through interviews, along with their union reps, where an investigator grilled them about Letby’s bullying complaint.

By now, the relationship between seven senior consultants and the hospital’s management had deteriorated. The doctors felt they had not been listened to and police needed to be brought in.

In October, the executive managers met again and sources say they were told “not calling police was the right decision” and that the doctors’ evidence was “unconvincing”.

Ten hospital staff were interviewed as part of Letby’s complaint. Many of them had threatened to call the police if she was allowed back on the ward.

Not everybody agreed with them, however. One senior nurse gave evidence saying the doctors were operating “a witch-hunt”, adding: “I hope she returns to the unit . . . we would be delighted.”

Harvey is quoted as saying the doctor’s concerns felt “purely circumstantial . . . we wanted more if we were going to call the police”. He said the executive team felt strongly that if they raised concerns with the police without foundation, Letby would have been arrested which would have resulted in a “bomb-site” for the trust to manage.

As part of the grievance, investigators looked into Letby’s conduct too. The formal report found no concerns about her competence. “No red flags,” according to documents.

The grievance process had found no evidence to justify calling in the police. In fact, it found the doctors were at fault for suspecting her of murder. “This behaviour has resulted in you, a junior colleague and fellow professional, feeling isolated and vulnerable, putting your reputation in question,” the grievance inquiry told Letby. “This is unacceptable and could be viewed as victimisation.”

The report said the hospital would aid her professional development by supporting her wih a master’s degree or an advanced neonatal course. She was also offered weekly welfare meetings with a senior nurse. Documents show that hospital managers proposed offering her an observational role at Alder Hey.

On November 12, the investigation was completed, and three days later, HR and senior nurses discussed Letby’s possible return to the neonatal unit, which had not suffered a single mysterious death or collapse since her transfer more than four months earlier.

Three days before Christmas 2016, Letby and her parents arrived at the hospital. Chambers issued her with a full apology on behalf of the hospital trust, and assured her family that the troublesome doctors who had victimised her would be dealt with accordingly.

Letby had had her revenge.

Bosses back nurse

In January 2017, the hospital held an extraordinary board meeting, at which the board, chaired by Sir Duncan Nichol, was updated on the RCPCH review.

Nichol was a career hospital administrator and head of the NHS at the time of the Beverley Allitt scandal. Allitt was the serial killer nurse who injected infants with insulin and air bubbles. She was given 13 life sentences in 1993. Copies of the redacted report were handed out at the start and taken in at the end.

Harvey said that the report had found the incidents in the ward were down to “issues of leadership, escalation, timely intervention” and that it “does not highlight any single individual”. He said some case reviews were continuing but were not expected to change that finding.

The doctors were not invited to the board, and a victim impact statement from Letby’s grievance was read out. “There was an unsubstantiated explanation that there was a causal link to an individual,” Chambers, the chief executive, said. “This is not the case and the issues were around leadership and timely clinical interventions.

“As a board we did nothing wrong,” Chambers said, with Harvey adding the trust was “close to drawing a line” under their investigations.

Chambers described the behaviour of the doctors as “unprofessional” and told Nichol he was “seeking an apology from the consultants”.

By now, Brearey and Jayaram, along with five other clinicians, were being backed into a corner by management.

In January they met Chambers and Harvey and were told: “Things have been said and done that were below the values and standards of the trust.”

Managers also demanded “mediation” between Letby and the two lead doctors, Brearey and Jayaram. Harvey told them it would protect them from a referral to the General Medical Council (GMC), the doctors’ watchdog.

Their BMA union rep told them that while there were “disturbing similarities to Beverley Allitt” they should agree to write Letby an “apology letter”.

They reluctantly agreed, but behind the scenes kept trying to find an explanation for the deaths.

In late January, they wrote to Chambers asking for a full investigation: “What is the reason for the unexpected and unexplained deaths? What should we as paediatricians do now?”

On February 5, The Sunday Times reported that deaths in the baby unit at the hospital were being investigated.

In a letter to Letby dated March 1, all the paediatricians apologised. “We are sorry for the stress and upset that you have experienced in the last year,” they wrote.

On March 27, Brearey again told the hospital’s most senior managers that it was time to bring in the police. Chambers finally requested a formal investigation in a letter to the chief constable of Cheshire police on May 2, 2017. Two weeks later, after meeting the doctors, police launched Operation Hummingbird.

‘I am evil’

Letby was arrested on July 3, at her home in Chester. In her home, police discovered hospital paperwork relating to some of the babies she had murdered. They also found erratic scribbles on pieces of paper: “I don’t deserve to live. I killed them on purpose because I’m not good enough. I am a horrible evil person.” Then, in capital letters: “I AM EVIL I DID THIS.”

In November 2020 she was charged with the murders and attempted murders. Her trial began in October last year.

Her defence team always argued that she was a victim of coincidence and of a conspiracy by doctors. They said the neonatal ward was poorly run and dirty.

Inside a glass-windowed box at the back of the court, Letby showed little emotion as the prosecution and medical experts described how she murdered baby after baby on the ward. Her parents attended every day.

The attention of the police will now focus on Letby’s activities at Liverpool Women’s Hospital where she had worked briefly before Countess of Chester — Hummingbird is investigating the entire time Letby was employed as a nurse. Cheshire police are supporting an unknown number of families affected by their new inquiries, and serious questions remain for the NHS and Countess of Chester Hospital about how Letby was allowed to kill for so long.

Almost immediately after Letby’s arrest the doctors started to find justice. Trust sources say Harvey was criticised for his secrecy during a private meeting of the board, and then Chambers wrote to the doctors.

He said: “The issues were the most intellectually and emotionally challenging sequence of events I have ever had to manage in my professional career and I am sure I have been found lacking.”

In August 2018, Harvey retired from Countess of Chester. A month later Tony Chambers resigned after agreeing a non-disclosure agreement with the trust.

The Countess of Chester Hospital said it welcomed the announcement of an independent inquiry. Jane Tomkinson, the acting chief executive, said: “The trust will be supporting the ongoing investigation by Cheshire police. Due to ongoing legal considerations, it would not be appropriate for the trust to make any further comment at this time.”

Sir Duncan Nichol was head of the NHS when the serial killer nurse Beverley Allit was convicted and was tasked with writing to all hospitals following an inquiry into that case to ensure similar failings never happened again.

He said: “We were told explicitly that there was no criminal activity pointing to any one individual, when in truth the investigating neonatologist had stated that she had not had the time to complete the necessary in-depth case reviews. We were not given the full information we needed.”

In a statement Chambers said he would co-operate with the inquiry, adding: “What was shared with the board was honest and open and represented our best understanding of the outcome of the reviews at that time.”

He added: “All my thoughts are with the children at the heart of this case and their families and loved ones at this incredibly difficult time. I am truly sorry for what all the families have gone through. As chief executive, my focus was on the safety of the baby unit and the wellbeing of patients and staff. I was open and inclusive as I responded to information and guidance.”

After the trial it was reported that Harvey, who retired to France in 2018, said his comments to the board were true to the best of his knowledge. “I wanted the reviews and investigations carried out, so that we could tell the parents what had happened to their children,” he said.

He added: “These are truly terrible crimes and I am deeply sorry that this happened to them. I believe there should be an inquiry that looks at all events leading up to this trial and I will help it in whatever way I can.”

Alison Kelly, the former chief nurse who is now interim director of nursing for Salford, within the Northern Care Alliance Trust, is reported to have said: “These are truly terrible crimes and I am deeply sorry that this happened to them.”

She said lessons needed to be learned and she would co-operate with any investigation.

Karen Rees, now Moore, could not be reached for comment but is understood to dispute the account given by Dr Brearey.

[ Via: https://archive.md/a63Iq ]

This is horrific, and the fact we live in a culture where she could fabricate and successfully exploit a fake claim of victimization, where despite the justified suspicion around her, she was shielded and protected, at the cost of multiple infant lives is incredible.

#Lucy Letby #victimhood culture #serial killer #baby murderer #Countess of Chester Hospital #victimhood #baby killer #religion is a mental illness

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