When Dr. Shoo Lee, one among Canada’s most famous neonatologists, wrote an academic paper in 1989, he by no means imagined it will in the future assist convict a British nurse of homicide.
However greater than three many years after his paper was printed, that’s what occurred.
Lucy Letby, a former nurse in a neonatal unit in northern England, was found guilty in two trials in 2023 and 2024 of the homicide or tried homicide of 14 infants in her care, and sentenced to life in jail, the place she stays at the moment.
The case rocked Britain, seeming to show a remorseless serial killer who, prosecutors mentioned, used a weird vary of strategies to kill her tiny, typically very untimely, victims: Injecting them with air, overfeeding them with milk or contaminating their feeds with insulin.
For seven of the homicide or tried homicide fees, the prosecution’s lead skilled witness relied on Dr. Lee’s 1989 paper on a uncommon complication in newborns — pulmonary vascular air embolism — to argue that Ms. Letby had deliberately injected air into their veins.
The one drawback? The skilled witness had misinterpreted his work, Dr. Lee says.
“What they have been claiming was that this child collapsed and had pores and skin discoloration, subsequently that equals air embolism,” mentioned Dr. Lee, 68, in an interview in London final month. However, he mentioned, “That isn’t what the analysis exhibits.”
That realization set Dr. Lee on an ethical mission to evaluation Ms. Letby’s case. Working professional bono, he gathered 14 specialists from world wide to evaluate the scientific proof. Final month, he revealed their explosive findings — that “there was no medical proof to assist malfeasance inflicting demise or harm” in any of the infants that Ms. Letby was charged with harming.
“If there’s no malfeasance, there’s no homicide. If there’s no homicide, there’s no assassin,” Dr. Lee mentioned, including, “And if there’s no assassin, what’s she doing in jail?”
Ms. Letby has exhausted her avenues to attraction within the courts. Her solely hope now lies with a small, unbiased physique, the Prison Instances Evaluation Fee, which is answerable for investigating potential miscarriages of justice.
‘I didn’t know whether or not she was harmless or responsible’
Dr. Lee, who retired in 2021 to a farm in rural Alberta, knew virtually nothing about Ms. Letby’s case till an e mail landed in his inbox in October 2023.
Ms. Letby had all the time maintained her innocence, and her lawyer wished Dr. Lee to evaluation the medical proof. “I assumed it was spam at first, as a result of how typically do you get an e mail like that?” Dr. Lee mentioned. After a second e mail, he realized the request was actual.
Dr. Lee had spent his complete profession centered on the youngest sufferers. After finishing medical college in his native Singapore, he moved to Canada and skilled in pediatrics earlier than endeavor a neonatal fellowship at Boston Youngsters’s Hospital and later a Ph.D. in well being coverage at Harvard.
In 1995, he created the Canadian Neonatal Community, connecting specialists from throughout the nation to enhance outcomes for newborns. He grew to become pediatrician-in-chief at Mount Sinai Hospital, Toronto, and in 2019, he received the Order of Canada for introducing finest practices that diminished toddler mortality.
As he studied Lucy Letby’s trial transcripts, Dr. Lee instantly knew his analysis had been misinterpreted. “I didn’t know whether or not she was harmless or responsible,” he remembers. “However no matter whether or not you’re harmless or responsible, you can’t be convicted on fallacious proof. That’s simply fallacious.”
He agreed to assist with Ms. Letby’s request for an attraction, writing to England’s Court docket of Attraction and later offering reside video testimony. However the courtroom in the end denied her request, saying Dr. Lee’s testimony ought to have been launched at trial.
It was then that Dr. Lee determined to assemble a crew of neonatal specialists to look into the case.
“This panel, you’re not going to discover a higher group of individuals,” he mentioned, rattling off a listing that included the top of neonatology at Youngsters’s Hospital of Philadelphia, a former president of Britain’s Royal School of Pediatrics and the previous director of the neonatal intensive care unit of Boston Youngsters’s Hospital.
The important thing caveat Dr. Lee insisted on was that the panel’s evaluation could be launched irrespective of their findings — even when they strengthened the case that Ms. Letby was responsible.
‘You’re going to get disasters’
The specialists, who all labored on a voluntary foundation, forensically assessed the reason for demise or deterioration for every of the 17 infants whom Ms. Letby was initially charged with murdering or making an attempt to homicide.
Two specialists individually examined the medical notes of every child. If their assessments differed, a 3rd skilled was introduced in. The method was painstaking and took 4 months. However the last outcomes have been clear, Dr. Lee mentioned. “In all instances, demise or harm have been because of pure causes or simply dangerous medical care,” he instructed the information convention final month.
Within the case of 1 child, for example, the prosecution argued at trial that she had been secure and had died from an injection of air into her IV line, inflicting an embolism. However the unbiased evaluation discovered, based mostly on her medical information, that she had died of sepsis and pneumonia, and that the mom, who went into labor prematurely, had not been given antibiotics to forestall an infection.
In one other case, a child born at 25 weeks was intubated utilizing the fallacious measurement of endotracheal tube. Whereas the prosecution alleged that Ms. Letby tried to homicide the toddler by dislodging the tube, the specialists discovered the newborn’s situation deteriorated due to harm attributable to intubation with a tube that was too giant, and since a physician didn’t perceive “the fundamentals of resuscitation, air leak, mechanical air flow, and the way gear that have been generally used within the unit work.”
Among the hospital employees, the panel concluded, have been caring for probably the most critically in poor health or untimely infants in a unit that was solely meant to deal with infants with lesser wants.
“You’re asking docs in locations with out the experience, with out the infrastructure, to take care of infants that they they’re not ready to do,” Dr. Lee mentioned. “And in the event you do this, then you definately’re going to get disasters.”
No one ever noticed Ms. Letby harming a child, and main questions have been first raised about her guilt in a New Yorker article in Could 2024. Within the months since, dozens of experts in medicine and statistics have voiced considerations concerning the proof.
Dr. Dewi Evans, the prosecution’s lead skilled witness, didn’t reply to requests for remark, however he has publicly criticized the panel’s work and said he stands by his testimony.
The Countess of Chester Hospital, the place the deaths came about, mentioned it was centered on an ongoing police investigation and on a public inquiry that was arrange by the federal government final yr to analyze how a serial killer may get away with such crimes for therefore lengthy. Earlier this week, the hospital’s former managers requested a halt to that inquiry, within the wake of Dr. Lee’s evaluation, however the decide refused, saying that the inquiry was by no means centered on inspecting Ms. Letby’s guilt.
Mark McDonald, Ms. Letby’s present lawyer, plans to incorporate Dr. Lee’s full skilled report in his utility to the Prison Instances Evaluation Fee, which may refer instances again to the Court docket of Attraction. The fee mentioned in a statement final month that it had “acquired a preliminary utility in relation to Ms. Letby’s case, and work has begun to evaluate the applying.”
The mother of a child whom Ms. Letby was convicted of making an attempt to homicide denounced the skilled panel’s evaluation, and a spokesman for the C.C.R.C. requested “that everybody remembers the households affected.”
Dr. Lee insisted that these households have been one among his central considerations as he analyzed the instances, after spending 4 many years caring for infants.
“I can let you know one factor: Households need to know the reality,” he mentioned. “They need to know the reality, no matter whether or not it’s painful or not painful. They need to know what actually occurred.”
