[content warning: discussions of infant death]

There are no witnesses who ever saw nurse Lucy Letby harm a baby. There is no forensic evidence that Lucy Letby ever harmed a baby. Lucy Letby never had any history of harming babies nor any apparent motive to harm them. Her colleagues saw her as a conscientious and caring healthcare worker. Yet Lucy Letby stands convicted of murdering seven babies. In the U.K., she has become “arguably the most notorious serial killer of modern times” and the country’s “most prolific child murderer.” Hers is the “biggest baby-killer case in British history.” Letby, who has maintained from the start that she is an innocent nurse wrongfully accused, is now serving life in prison, and her appeals have been rejected.

But it is abundantly clear that Letby’s guilt has never been proven beyond a reasonable doubt. As her case has been scrutinized and much of the evidence convicting her has completely fallen apart, headlines about the case have gone from lurid and certain (“POISON NURSE KILLED 7 BABIES,” October 11, 2022) to the somewhat more unsettled (“Innocent neonatal nurse or conniving angel of death?,” August 14, 2024.) But at this point it needs stating plainly and unequivocally: there is, at this point, no compelling evidence that Lucy Letby is a serial killer, and she needs to be released from prison. 

To be clear: this does not mean Letby is definitely innocent. It is possible that she murdered seven babies and attempted to murder others. I do not foreclose that possibility. But it would take more evidence to show that. We do not send people to prison for life based on what is possible or conceivable. We are only allowed to send them based on what has been convincingly proven. And nobody who examines the evidence in Letby’s case fair-mindedly and carefully, with an understanding of common statistical mistakes, biases, and logical fallacies, can possibly conclude that she is “guilty beyond a reasonable doubt.” There is not only reasonable doubt, there is overwhelming doubt. 

What’s more, it now appears possible that Lucy Letby was blamed for deaths that resulted from systemic negligent medical care in the British hospital system, which itself occurred thanks to the ongoing right-wing project of neglecting, dismantling, and privatizing the country’s famed National Health Service. It may sound too glib to say that “neoliberalism was the real killer.” But it may turn out, once Letby’s case has been fully examined, that this is not too far from the truth.

In June 2015, Lucy Letby was working as a nurse in the neonatal unit of the Countess of Chester Hospital in North West England. That month, a spike in unexplained infant deaths and collapses (sudden clinical deteriorations) began in the neonatal intensive care unit. In 2015, there were eight deaths in the unit, while there had only been between one and three per year between 2010 and 2014. The spike in deaths continued into the first half of 2016. Several doctors noticed that whenever a baby died, Letby had been present and pushed for her to be removed from duty. In June of 2016, Letby was reassigned to an administrative post in the “patient experience” team. After that time, there were no further suspicious excess deaths. Letby was investigated by the Cheshire police, charged in November 2020, and ultimately convicted of seven counts of murder and a further seven counts of attempted murder. 

At Letby’s trial, jurors heard medical experts testify as to how Letby managed to kill all the babies and cover her tracks. As the appeals court later summarized, “she did so by various means: by causing air embolus by introducing air exogenously via intravenous lines; by forcing air into the abdomen via nasogastric tubes; by force feeding milk; by poisoning through exogenous administration of artificial insulin and by physical trauma causing bleeding or internal injury.” There were no witnesses to any of these incidents, but as the appeals court later explained, her guilt “could be inferred from a raft of circumstantial evidence.” (Note the weakness of the term “inferred,” rather than “proven.”) 

What was that evidence? Well, first, medical experts testified as to why they believed the infants showed signs of having been deliberately killed and deduced causes of death for each. Then there was additional circumstantial evidence, which the appeals court summarized as follows. I’ve added numbers so that we can conveniently refer to these six pieces of evidence in considering them. 

[1] The applicant alone was present on the unit at the time of all of the deteriorations and deaths and was the common factor in all of the cases. [2] She appeared to be fixated with being involved in events in the intensive care nursery and involved herself unnecessarily with babies who had been designated to other nurses. [3] She created, it was alleged, false entries on certain documents to hide her activities, to provide her with an alibi or lay the ground for invented explanations. [4] She retained and took home a large number of handover sheets as “trophies” of her crimes. These handover sheets were confidential documents and should not have been removed from the unit. Over 200 were found hidden under the applicant’s bed. [5] After the collapse or death, she searched for the names of some of the babies on the indictment and searched out their families on Facebook. [6] Various handwritten notes were found at her home. One of those notes concluded with the words: “I am evil, I did this.” The prosecution relied upon this evidence as amounting to a confession.

From all of this, the proof of Letby’s guilt can seem at first glance to be overwhelming. But it isn’t. Apply a bit of critical scrutiny, and it all falls to pieces. Let’s see why.

The Bogus Correlation Evidence

One of the prosecution’s most compelling and dramatic points was that when babies died or suddenly deteriorated on the unit, Lucy Letby was almost always on duty. As Rachel Aviv reported in her major New Yorker investigation into the case (many facts from which I draw on here), the prosecution showed a startling visual diagram which matched nurses’ shifts to “suspicious events,” which “included the deaths of the seven newborns and seventeen other instances of babies suddenly deteriorating.” The chart looked like this: 

As you can see, Lucy Letby was the only nurse on shift for all of the events. She was, in the prosecutor’s words, the “one common denominator,” the “constant malevolent presence when things took a turn for the worse.” In his opening statement, he said: “If you look at the table overall the picture is, we suggest, self-evidently obvious. It’s a process of elimination.” Aviv writes that “Letby had become the country’s most reviled woman… largely because of that unbroken line.” The chief medical expert in the case said infant mortality was “30 times greater when Letby was on duty.” 

It was, in fact, this pattern of correlations between Letby and death that initially led two male doctors to suspect her, and one later “recalled conversations in corridors with fellow consultants about the repeated presence of Letby during sudden and unexplained deaths on the unit.” The pattern was, one later admitted, the only thing that raised suspicion, since there was “no objective evidence” of her doing anything wrong, though the other doctor said in addition to his “gut feeling” he kept a “drawer of doom” about Lucy, the contents of which he would not reveal to other staff. 

But the seemingly highly damning line doesn’t tell us much at all. We have to remember the first rule of statistics, the one everybody knows: correlation isn’t causation. If Fireman Sam is present at all of the city’s worst fires, that doesn’t make him an arsonist. We can ask: what if Letby wasn’t at the deaths because she was an evil nurse, but because she was a good one? What percent of the time was she on duty, anyway? How many shifts did Letby work relative to other nurses? 

If a teacher in a school has all the worst students, we might assume they’re the worst teacher. But that might be the opposite of the truth. They might be the most dedicated teacher, the one who takes on the toughest cases. In other words, we would predict that an especially dedicated nurse who volunteered for the sickest patients, and takes many shifts, could also be present during a disproportionate number of infant deaths. (As we’ll see shortly, there is evidence that Letby was precisely this kind of nurse, meaning that there was a “selection bias” that was not accounted for in the analysis.) 

So the same pattern of facts (Nurse X is present whenever an infant dies) can be explained in more than one way: by the presence of a serial killer nurse or by a dedicated nurse who works a lot. (And since there are far more of the latter in a hospital than the former, we should demand extraordinary evidence before we conclude it’s the former). But the non-coincidental presence of Letby at infant deaths would actually be consistent with a third possible theory. If our first is the “Good Nurse” theory, and our second is the “Serial Killer Nurse” theory, our third—one raised neither by the prosecution nor the defense—is the Bad Nurse theory. This is the theory that Letby wasn’t a serial killer, she was just not a very good nurse and made deadly mistakes. (Maybe from overwork from all those shifts!) Under the Bad Nurse theory, Letby’s presence at infant deaths wouldn’t be a coincidence, but it also wouldn’t amount to first-degree murder. Each theory must be explored, and with the knowledge that the Good Nurse Theory and the Bad Nurse Theory are typically much more likely to be correct than the Serial Killer Nurse Theory. 

Still, the string of shifts is striking. What we really need is a statistician here, because we need to know whether it is strange or not strange that every time a baby deteriorated unexpectedly, Letby was on duty. Unlikely events do happen. A coin can come up heads 20 times in a row. There’s a one in one million chance of it happening, but we must be aware of the “lottery fallacy,” which is the idea that just because an event is rare, we should conclude it didn’t happen. (If you win the lottery, I might conclude that you likely cheated, because there’s a 1 in 300 million chance of you winning. But someone’s got to win!) There are over 700,000 nurses in Britain. It may well be that every year, purely by chance, one or two of them are going to have shift patterns that coincide remarkably closely with a disproportionate number of the unexplained medical events on their unit. But if we conclude causation from the correlation, every year we would end up falsely accusing a nurse or two of murder! Because the event was unlikely in their particular case, we would forget that it’s very likely to happen somewhere. As William C. Thompson, an author of the Royal Statistical Society report, told Rachel Aviv, “One theory is that there was an unlikely coincidence. And the other theory is that someone like Lucy Letby, who was previously a fine and upstanding member of the community, suddenly decides she’s going to start killing people.” Unlikely coincidences are unlikely. But so are serial killer nurses. (Britain has had three or four other cases in the last 100 years.)

We also need to understand how the “events” were selected for the chart. How were the “suspicious events” determined to be “suspicious”? Were there any suspicious events that were not included? If so, was Letby on duty for them? “Suspicious” is a classification that requires a degree of subjectivity. What if the person deciding what to label “suspicious” already knew that Letby was a suspect and knew when Letby worked? Letby’s presence on shift might bias (unconsciously even) that person’s perception of whether a particular baby’s deterioration or death was suspicious. Dr. Dewi Evans, the prosecution’s lead medical witness who participated in compiling the chart, did not make these determinations “blind.” That is, he knew which shifts Letby was on when he was making his suspicion determinations. We might wonder whether there are other events that could have been deemed “suspicious” but weren’t because Letby wasn’t present for them. 

“We know there was a lot of cherry-picking going on” in compiling the chart, says statistics professor John O’Quigley, who has examined the case closely. He says that the implicit definition of “suspicious” for the purpose of the chart in part means “involving Lucy Letby,” so it is “something of a circular argument when you show she always seems to be there.” If you included the full class of “suspicious” events rather than only the ones with Letby present, there would be holes in the chart where Letby wasn’t there, which would be far less compelling to a jury than the seeming 100 percent correlation between suspicious goings-on and the presence of Letby. 

We might be dealing, then, with a classic example of what is called the “Texas sharpshooter fallacy,” named after a hypothetical Texan who shoots his bullets at the wall and then draws a bullseye after the fact to make himself look like a better shot than he really is.

I also rather like this cartoon although it’s less precisely analogous to the fallacy.

The fallacy occurs when we make data selection choices that give significance to things that were in fact arbitrary. If you select only the subset of events at which Letby was present, then of course Letby would be present at all of them, because those are the events you picked. It proves that “Letby was on duty when Letby was on duty.” You need to be certain that you’re looking at all events within a certain class in order to know whether anything statistically unexpected has happened. Peter Elston of the Royal Statistical Society says that actually, there were more deaths and incidents during the period of Letby’s alleged killings, not just the ones Letby was charged with. “So what was happening with these others? Was there another serial killer?” But Letby wasn’t charged over these, and they weren’t added to the chart. David James Smith, former commissioner at the UK’s Criminal Cases Review Commission, adds: 

How would the graph look if it showed the shift patterns of all the cases and not just those that had been cherry-picked by the prosecution? Clearly, Letby was not on shift for them all… There were many other incidents in the neonatal ward for which she was not present, and so could not apparently be blamed. 

I say the case needed a statistician. Incredibly, the prosecution deliberately decided to avoid using one to assess questions like “How unusual is this shift pattern for a random nurse?” or “How likely was it that said nurse was personally drawn to caring for the sickest infants? How were shifts assigned?” When hospital managers went to Cheshire police in 2017, they “explained that there was a notable high statistical relationship between Letby and babies deteriorating on the unit, but no other evidence.” (Notice that they did not have medical evidence that the babies were killed deliberately, just that they deteriorated and Letby was on duty.) “The likelihood of this occurring by chance alone is very low,” seven doctors said in a report to police. The police then called Jane Hutton, a professor of statistics at the University of Warwick, so that she could figure out whether that was true. Was it unlikely to have occurred by chance alone? (And, as I have stressed, even if it wasn’t “chance alone,” perhaps the same pattern could have been explained by the fact that Letby was either especially devoted to the sickest patients or especially inept at her job.)

Hutton told police that their premises were wrong. They just wanted to know whether “chance alone” could have explained the eerie correlation between Letby’s presence on duty and collapsing babies. But Hutton said there needed to be “full research into all possible explanations for any increase in babies collapsing including their medical conditions and prematurity, as well as the performance of the unit.” The only intelligent way to examine the case was by looking at alternative explanations as well. The police signed a consultancy agreement with Hutton but did not commission an analysis from her. They then scheduled a video call with her, which they canceled. Finally, they dropped her entirely, saying that “the prosecutor does not agree with our line of inquiry [i.e., talking to a statistician] and has instructed us not to pursue this avenue, any further, at present.” In other words, the prosecution deliberately avoided inquiring into whether the correlation does tell us anything meaningful, probably because they knew the jury would just see the line of X’s and assume Letby’s guilt. (They did not disclose information on the police’s interactions with Hutton to the defense team. This on its own is, in my judgment, prosecutorial malpractice. Here in the U.S. it would likely be a violation of the Brady rule, which requires disclosure of facts material to the guilt or innocence of the defendant.)

Statisticians have since been scathing of the prosecutor’s suggestion that Letby’s shift patterns are inherently suggestive of guilt. The Royal Statistical Society even put out a paper warning against using this kind of correlation as evidence of foul play, writing that “It is far from straightforward to draw conclusions from suspicious clusters of deaths in a hospital setting.” They noted that in multiple previous cases, other nurses had been accused of crimes on the basis of correlations between their presence and deaths. Dutch nurse Lucia de Berk, for instance, was charged with killing thirteen patients, and a criminologist testified that “the probability of so many deaths occurring [by chance] while de Berk was on duty was only 1 in 342 million.” De Berk was at first convicted, and showed even more suspicious behavior than Letby (De Berk had faked a diploma and had some bizarre, morbid diary entries), but she turned out to be completely innocent. 

Peter Green, emeritus professor of statistics at the University of Bristol, calls the use of the staff chart a “classic misuse of statistics.” (Indeed, perhaps someday it will appear in statistics textbooks to illustrate elementary reasoning errors.) Green said it was an “extraordinary revelation” that the prosecution had actually “decided not to proceed with a proper analysis by Prof Hutton.” Hutton herself says that the calculation that babies were 30 times more likely to die while Letby was working is “meaningless.” Peter Elston of the Royal Statistical Society says that statisticians have concluded that the use of statistics in the case was a “statistical abomination” and a “scientific fake.” 

But what about the evidence that this was an unusually high number of infant deaths for the unit? Okay, we might say, a mere correlation between Letby and baby deaths in any given unit might in and of itself be unhelpful to establish causes of death, but here there was an unusually high number of deaths, and they stopped when Letby was taken off duty. 

First, some important context: even though press accounts often say that these were “healthy babies” or “seemingly healthy babies,” this is false. Readers of such stories might assume we’re talking about babies of average health, or think this took place in a maternity ward. But that’s not right: This was the Neonatal Intensive Care Unit (NICU). The babies were there because they had some kind of medical issues going on. They were not healthy babies. They were sick babies. Many were born prematurely or struggling with respiratory issues or feeding. 

The public has been straightforwardly misled by being told that we’re talking about “healthy babies.” It is an outright lie that has been repeated endlessly and distorted public understanding of the case. In fact, in the trial it came out that Lucy Letby specifically did not like working with healthy babies because she found it “boring” and requested to be in intensive care to care for the sickest babies. She would “migrate" to the intensive care room to assist if “anything was going on” to the point where colleagues were worried she was taking on too much work. She was “regularly working in what was called nursery one - where the most ill children were cared for… [which] was known as the ‘hot room’... [and] would text colleagues when working in the lower-risk nurseries—two, three and four—that she was bored and wanted to work in nursery one.” This fact alone would substantially increase the chances that Letby would be present at the worst moments. She was a nurse who was not only in the NICU but sought out the most difficult cases within the unit, i.e., the babies with the lowest chances of survival, so a non-random correlation between her presence and baby deaths would be expected. In other words: while the “unbroken line” of Letby presences at deteriorations/deaths might be surprising, if it was indeed the case that she was unusually involved with the sickest infants, we should expect her presence to at least be somewhat greater than that of many other nurses. 

One of the babies Letby was accused of attempting to kill weighed only 1.17 pounds at birth (a normal weight is closer to seven pounds), and had been given a 5 percent chance of survival at birth. Letby actually made a banner to celebrate the child’s 100th day of life, because this was considered such an achievement. Letby’s text messages to colleagues on the day that the baby got sicker appear to be a model of conscientiousness and compassion:

The colleague said the girl was “improving a bit now” but noted that her leg and arm “both went white”.

 

Ms Letby replied: “Not well at all, is she. Poor parents.”

 

She later messaged: “How are parents?”

 

The colleague said: “Devastated but determined she’ll get through ‘as always’. Thought that if she got to 100 then they would feel confident she’d be fine.”

 

Ms Letby said: “Awful isn’t it. We’d all been sat at desk at start of the shift making banner.”

 

The defendant later told her colleague: “Needs to go out.”

 

The colleague replied: “Too sick to move.”

 

Ms Letby said: “Oh no. Any idea what’s caused it?”

 

The colleague said: “Nope. Just seems to be a circ (circulatory) collapse, chest seems clear.”

 

Ms Letby responded: “Hmmm. What can cause that? Is it that she’s been an extreme prem who had long term inotrope and vent dependency and now she’s older and doing more for herself and it just takes a little bug or something to tip her over as no reserves and chronic lung etc.”

 

Her fellow nurse said: “We are going with sepsis...and yes to no reserves, she looks grim.”

 

The court heard that Ms Letby visited the unit briefly later that evening. She later messaged her colleague - who had finished her shift - saying: “She looks awful doesn’t she.”

 

Her colleague replied: “Yeah. Going to APH (Arrowe Park Hospital) ...So no better. Damn. I have a bad feeling. At least they know APH.”

 

Ms Letby said: “Not looking good but yes least going to where she is known. Just hope they get here there.”

 

Her colleague said: “Hmmmmm not sure they will.”

 

Ms Letby said: “On today of all days.”

 

Her colleague replied: “Yup poor parents.”

 

Ms Letby said: “Yeah she’s declining bit by bit.”

 

Child G was transferred at 3am on 8 September to Arrowe Park, where she recovered and was moved back to the Countess of Chester more than a week later, the court heard.

Note the phrase “extreme prem” (extremely premature). 

But Countess of Chester Hospital did see an increase in deaths, and a decrease after Letby was relieved of her clinical duties. What explains that? 

First, regarding the decrease post-Letby, we can read in the BBC that once “Letby is finally taken off nursing duties and given clerical work… baby collapses and deaths stop.” Another BBC article notes that “Since Letby left the hospital's neonatal unit, there has been only one death in seven years.” But as the hospital’s chief executive said, at the same time, “the unit was downgraded, the criteria for access changed, a whole range of things to manage [the spike in deaths were implemented.]” The BBC declines to note the absolutely crucial fact that in July 2016, the hospital “downgraded its neonatal unit to a level-one special care unit,” which “limited the premature babies that it took into its care to those born at 32 weeks’ gestation or over, an age where the medical complications and risks were much lower,” and the “team found the unit more suited to that level,” stating that “staff reported feeling calmer and more confident and morale/sickness has improved.” So it no longer took babies with the same level of health issues, meaning that the correlation of decreased mortality with Letby’s absence could itself be spurious and at the very least also coincides with major changes to the unit that were specifically directed at addressing mortality. 

Regarding the initial increase, first note that Letby began working on the unit in January 2012, meaning that her presence long predated the spike in deaths. Everyone remarks on the correlation between Letby and deaths in 2015, but in 2012, 2013, and 2014, the “serial killer nurse” was working on the same unit and apparently just, I don’t know, lurking and waiting for her opportunity. But before the deaths began there had been “a sudden rise in the more complex cases [on the unit],” and as Peter Elston explains, there was good reason to think the unit had been worsening over time: 

“A report by the Royal College of Pediatric and Child Health… was commissioned by the hospital when they became aware of this cluster [of deaths]. And it was a litany of issues and failings. So [there were] issues such as there being a particular increase in admissions of low birth weights, an increase in admissions of low gestational ages, an increase in admissions for particularly high acuity, how unwell the babies were, and then you had a number of failings in relation to understaffing. There was a reluctance for doctors to escalate concerns. There were issues with certain clinical procedures. Umbilical venous catheter insertion was highlighted as a problem. There were issues with the transport network.”

Notably though, the statistics suggest that while the rising mortality in the unit was alarming, it was “not extreme enough to be considered an outlier.” It was indicative of a problem, but the numbers alone did not suggest serial murder. 

In fact, there was also a slight increase in neonatal deaths generally in England during this period. The hosts of Was There Ever a Crime?, a podcast about the Letby case, asked Evans, the lead prosecution medical expert, about this. He could have shown, if it was the case, that the increase at the Chester hospital was greater than the national increase. Instead, he simply denounced statisticians as a whole, comparing them to climate change deniers:  

WTEAC: There was a general spike, a general increase in neonatal deaths in England in this time, that's what the statisticians say.

 

EVANS: What does that mean? What does that mean? 

 

WTEAC: That more babies in neonatal units are dying across the country, and so therefore what you're looking at is nothing that actually points to a serial killer.

 

EVANS: Time and time again, the statisticians are just wrong. They're out of their depth. They do not understand what it is that leads to babies in neonatal units deteriorating, dying. They just don't understand it. Speaking to statisticians about this is a bit like speaking to a climate change denier or a Donald Trump supporter. It doesn't matter what you tell them. They don't want to know. They are welcome to their opinion. I spent 30 years on a neonatal unit developing a neonatal intensive care service from scratch in Swansea. Your professor of statistics in London, I'm sure, is a very intelligent person. I doubt whether he spent 30 minutes on a neonatal unit, unless one of his kids was a premature baby.

“I really am quite annoyed with statisticians,” Evans said elsewhere about their heavy criticism of the correlational evidence. 

The Disputed Medical Evidence

Dr. Evans, a retired pediatrician, was the prosecution’s lead medical expert at the trial and is the person who first concluded that there was medical evidence of the babies having been killed. Evans was fairly openly biased. Incredibly, Evans found his way into the case when he read about it in the local newspaper. He approached the police in 2017, offering to help by providing paid consulting services. The process for selecting him, he acknowledged, was “very, very informal.” He essentially self-selected, rather than the prosecutors looking for an independent evaluator. “Sounds like my kind of case,” he told the police. Within ten minutes of arriving at the police station to look at case notes, Evans concluded there had been foul play. Nadine Dorries notes that “prior to Dr Evans' involvement, several of the baby deaths Lucy is accused of committing… had been appraised by neonatal pathologists in Liverpool for a lot longer than ten minutes. They had found no evidence whatsoever of inflicted harm.”

Evans, whose company Dewi Evans Paediatric Consulting would ultimately allegedly be paid a seven-figure sum over the course of the investigation and trial, has boasted that he has never “lost a case,” suggesting that he doesn’t actually understand that the role of an expert witness is not to “win” cases but to prepare a neutral assessment of the facts so that the jury can decide what the truth of the matter is. Indeed, in a different case, a judge declared that Evans’ expert report made “no effort to provide a balanced opinion,” was “worthless,” “tendentious and partisan,” and a “breach of proper professional conduct” since “no attempt has been made to engage with the full range of medical information or the powerful contradictory indicators. Instead the report has the hallmarks of an exercise in 'working out an explanation.'”

Evans, as the appeal court says, “remained the lead expert throughout the investigation and trial,” although interestingly, he himself denied he was much of an expert, saying "I call myself an independent medical witness, not an expert." (His LinkedIn does say otherwise.)

Indeed, Evans’ methods of deduction have been called into question, and “many leading medical experts have spoken out and criticised, even ridiculed, the evidence presented by Evans.” He appears to have suffered from confirmation bias and even changed his mind on a baby’s cause of death after his original explanation turned out to make it impossible for Letby to have killed the child. His theories have been described by medical experts as “nonsensical or ‘rubbish,’ ‘ridiculous,’ ‘implausible’ and ‘fantastical,’” or even “bollocks.” Rachel Aviv, in her New Yorker piece, quotes a cross-examination of Evans in which concluded that a baby had died from an air embolism. 

“What’s the evidence?” Myers asked him.

 

“Baby collapsed, died,” Evans responded.

 

“A baby may collapse for any number of reasons,” Myers said. “What’s the evidence that supports your assertion made today that it’s because of air going down the NGT [nasogastric tube]?”

 

“The baby collapsed and died.”

 

“Do you rely upon one image of that?” Myers asked, referring to X-rays.

 

“This baby collapsed and died.”

 

“What evidence is there that you can point to?”

 

Evans replied that he’d ruled out all natural causes, so the only other viable explanation would be another method of murder, like air injected into one of the baby’s veins. “A baby collapsing and where resuscitation was unsuccessful—you know, that’s consistent with my interpretation of what happened,” he said.

Indeed, Evans has said elsewhere that “You should never, as a clinician, decide that you don't know the cause of death. What you should never do is to say, 'Well, this baby has died. I've no idea why he's died.’ [...] That, to me, is not clinically acceptable." This suggests he may be comfortable positing wild explanations simply because no others come to mind, out of his belief that uncertainty is unacceptable. 

But as Dr. Phil Hammond notes, “in a review of more than 1,000 cases of infant death in south-east London, ‘the cause of mortality was unexplained for about half of the newborns who had died unexpectedly, even after post-mortem examinations.’” In other words, uncertainty is tragically common, and so Dr. Evans’ stated method of mandatory certainty inevitably leads to unwarranted speculation and error. Nevertheless, he seems to be overconfident in his conclusions. Asked why he diagnosed air embolism when other experts looking at the same notes didn’t, Evans replied: “Well without being too blase about it, it’s only difficult if you don’t know the answer, OK. Once you know, you know … It’s not very good asking me why I diagnosed air embolus. I think you should be asking other people why didn’t they make the diagnosis.” The phrase “it’s only difficult if you don’t know the answer” should be an enormous red flag. He’s right, though, that it isn’t difficult to find a cause of death if your method is to come to a snap judgment and then find whatever evidence supports it. That just happens not to be science. 

In arguing that Letby killed children by injecting air into their bloodstream, Dr. Evans at one point cited a 1989 paper by Dr. Shoo Lee, one of Canada’s leading neonatologists. Evans said that a child exhibited symptoms consistent with death via an air embolism, claiming that Lee’s paper showed the symptoms the infant displayed were signs of this manner of death. But when Lee found out how his research had been cited, he was horrified. “My research was misused to convict Letby,” Lee said. In a kind of “McLuhan moment,” Lee said that Evans essentially knew nothing of his work and decided to conduct his own investigation into the deaths Letby was accused of causing. “I didn’t know whether she was innocent or guilty,” he said. “But regardless of whether you’re innocent or guilty, you cannot be convicted on wrong evidence. That’s just wrong.”

Dr. Lee sits at the very top of his profession. He “created the Canadian Neonatal Network, connecting specialists from across the country to improve outcomes for newborns,” served as pediatrician-in-chief at Mount Sinai Hospital, Toronto, and “received the Order of Canada for introducing best practices that reduced infant mortality.” He assembled a veritable supergroup of 14 neonatal experts, including “the head of neonatology at Children’s Hospital of Philadelphia, a former president of Britain’s Royal College of Pediatrics and the former director of the neonatal intensive care unit of Boston Children’s Hospital.” To reach an answer, the team spent months (as opposed to Dr. Evans’ ten minutes) reviewing every single death in the Letby case and recently produced a report on their findings. Dr. Lee said his only interest was in finding the truth and had committed to releasing the results regardless of whether they were favorable or not to Letby. 

The conclusion was unequivocal: “We did not find any murders. In all cases, death or injury were due to natural causes or just bad medical care… In our opinion… the medical evidence doesn't support murder in any of these babies.” And Dr. Lee raises the obvious follow-up question: “If there’s no malfeasance, there’s no murder. If there’s no murder, there’s no murderer… And if there’s no murderer, what is she doing in prison?”

Letby’s convictions

But if Lucy Letby didn’t murder the babies, why was there such a rise in deaths? Dr. Lee explained: 

“Dr Lee claimed there were several issues affecting the treatment the babies received at the Countess. He cited incomplete medical treatment, failure to consider medical histories, disregard for warnings about infections, misdiagnosis of babies and staff caring for very poorly babies beyond their medical competencies. The medic also spoke of delays in treatment of acutely poorly babies, poor medical skills in certain procedures, poor supervision of more junior medics, a lack of understanding of some basic procedures, poor management of common medical conditions and lack of knowledge about commonly used equipment in the hospital unit. Dr Lee also said there was evidence of inadequate numbers of staff on the unit, a lack of training and workload overload, while some poorly babies should have been treated at a ‘higher level’ unit or hospital.” 

Dr. Lee said that if the Cheshire unit had been under his supervision, he would have ordered it shut down. “You’re asking doctors in places without the expertise, without the infrastructure, to look after babies that they’re not prepared to do,” he said. “And if you do that, then you’re going to get disasters.” Indeed, there is evidence that the unit was simply not functioning. As another member of the Lee panel put it, it was a place where “the consultants and other neonatal staff were faced with having to provide care for complex neonatal cases outside their experience.” As Aviv reports, “one father [said] he had caught doctors and nurses Googling how to carry out a life-saving procedure,” and described the hospital’s operating theatre “like something out of a horror film.” Rachel Aviv reports that the unit

…was outdated and cramped. In 2012, the Countess launched a campaign to raise money to build a new one, a process that ended up taking nine years. “Neonatal intensive care has improved in recent years but requires more equipment which we have very little space for,” Stephen Brearey, the head of the unit, told the Chester Standard. “The risks of infection for the babies is greater, the closer they are to each other.”

We know now that “The year before the Letby deaths, a premature baby had died after doctors mistakenly put a breathing tube in his gullet when it should have gone into his trachea” and “several of the babies also experienced medical accidents while on the ward including four incidents where umbilical venous catheters (UVCs) were placed wrongly or fell out.” We know that staff had written to the NHS Trust with “grave concerns” about understaffing, warning that the place was an “accident waiting to happen.” We also know that “a previous review into the unit had found it was short of nursing staff and consultants were spread thinly between the paediatric ward and the neonatal unit. Junior staff reported feeling like they couldn’t call on them and, consequently, the unit was often left in the care of less experienced doctors working in a very stressful environment.” Yet as Phil Hammond comments, the “consultants themselves didn’t seem to spot that the babies could have been dying due to substandard care. […] They were convinced that [Letby] was a murderer and they led the police in the direction they had already concluded.”

For his part, Dr. Evans has denied that the Countess of Chester neonatal unit was dysfunctional, saying “There were protocols for all sorts of things, which is not something you’d get in a dysfunctional unit.” Oh, well, if there were protocols, it couldn’t possibly have been dysfunctional. 

The Worthless Behavioral Evidence 

We finally turn to what I’m calling “behavioral” evidence, items 2-6 in the appeals court summary of the evidence against Letby. This is stuff like her “confession” (“I AM EVIL I DID THIS”), her “trophies,” her text messages, etc. 

It is not an overstatement to say that all of this material is entirely worthless in adjudicating Letby’s guilt or innocence. These facts tell us nothing whatsoever except that it is very easy to make perfectly ordinary actions seem sinister and suggestive of guilt once a narrative is in place. 

To illustrate how easy it is to turn things that can easily be innocent into something sinister, consider this BBC article by the journalist Judith Moritz, who also co-authored a book on the case. Discussing Letby’s texts to colleagues, Moritz says she noticed some “interesting themes,” “interesting” here essentially meaning “sinister.” She writes that “certain messages hinted at a possible God complex.” The only example she provides (and therefore presumably one of the strongest demonstrations of this “God complex”) is this:

I confess, my reaction to Moritz’s evidence of a “God complex” was: What the fuck are you talking about? Letby’s text is precisely the kind we’d expect to find on the phone of a nurse who has seen a lot of sick babies die and struggles to process the unfairness of their fate. God complex my ass! Or how about when Moritz writes that “quite often [Letby would] text other nurses to tell them about her involvement with babies who had collapsed—it looked like she was fishing for sympathy.” Here is Letby “fishing for sympathy”: 

Heck, maybe she did even want a bit of sympathy, because her job had involved seeing a lot of sick babies struggling for life and sometimes dying. But these texts are only demonstrations of abnormal behavior once you’ve already become convinced that Letby is a sadistically evil killer nurse. If you are continuing to entertain the alternate, much more likely possibilities (Letby was a good nurse in a bad hospital, or even a bad nurse in a bad hospital), they appear entirely unremarkable.

This interpretation problem applies to much of the other behavioral evidence of Letby’s guilt. It looks damning only if you have already concluded her guilt based on other evidence. On its own, it’s nothing. As we’ve seen, the other evidence (statistical, medical) has either entirely collapsed or been brought into serious question. So the behavioral evidence is worthless.

Let me better explain what I mean. Imagine a situation where: 

• A piece of evidence (E) looks incriminating only if some other fact (F) is true.
• You assume F is true, so you interpret E as supporting guilt.
• Later, F is shown to be false.
• But you’ve already psychologically locked in E as damning.
• So you don’t revise your view of E, even though the status of E should now revert to ambiguity or innocence.

As an example: imagine, in a murder case, that there are two key pieces of evidence, a fingerprint and a text message from ten minutes after the murder saying “It’s done, I took care of it.” The text is presented as a confession. But then it turns out that the fingerprint analysis was done incorrectly. Well, a text that says “It’s done, I took care of it” is much more powerful as a piece of evidence against someone whose fingerprints were found at the murder scene than it is about a random person. 

The Letby behavioral evidence is of this character. For instance, consider the “trophies” (#4 from the appeals court’s list of circumstantial evidence), she allegedly took from her victims. The court says that “she retained and took home a large number of handover sheets as ‘trophies’ of her crimes.” News accounts said that police “discovered a 'treasure trove' of souvenirs from Lucy Letby's killing spree stashed at her home,” namely “More than 250 nursing handover sheets, a blood test result and resuscitation notes relating to some of the babies who collapsed or died.” Now, first, an important piece of missing information here is that most of the 200 handover sheets were not about the babies who died, meaning that if she collected “trophies” from her victims she also collected these “trophies” (in the form of, uh, medical forms) from a bunch of other random patients. But more importantly, here’s what one former nurse had to say about this: 

For decades in my work as a nurse I took home patient handover sheets. My colleagues would have done the same. By way of a simple explanation to others: At home, for each nursing shift, I would put on a fresh uniform (a dress with useful pockets). At the hospital, at the beginning of my shift, I would write down information verbally handed over to me by the previous shift. These notes would be made on a fresh handover sheet. The completed handover sheet would go into my left pocket and I would refer to it many times during the shift, adding any further information I wanted to be sure to pass on. At the end of my shift I would verbally hand over to the next shift using my handover sheet which would be returned to my pocket. I would go home wearing my uniform. Back at home I would undress in my bedroom emptying out my pockets (handover sheet, scissors, pens etc) before placing my uniform in the laundry and having a shower. Next shift would be a fresh uniform. Old used handover sheets would mount up in my bedroom until I had time to rip them up into shreds to properly dispose of them. Although I never received training in this matter, I obviously understood that the handover sheets contained information about patients and so they could not be just dropped into a bin without destroying them first. In addition, on the odd occasion when a member of staff contacted me at home with a query about a patient I had been looking after, it could be useful to retain the handover sheet for a while. I can easily imagine that younger nurses with busy social lives (and possibly a little less tidier than my “tidy” self) would let these handover sheets build up. In fact, if I were in a situation where I felt doctors at work were trying to apportion blame to me, I think I would have made sure I held onto these handover sheets. They served to jog one’s memory. To suggest that a nurse having handover sheets at home is odd in any way is evidence of someone having no insight into the normal everyday working day of a nurse. Yes, when I focus on this issue I can see that nurses should probably not take such notes home. But in all honesty I can say that I did so for decades, so too did my colleagues and there was never any discussion about this. In my opinion, the judge was entirely wrong to assign any sinister intent to Lucy Letby having handover sheets at home. I found his comment to be lacking any insight into normal nursing behaviour. In fact, I found his comment to be quite bizarre.

So: If you already think Lucy Letby is a killer nurse, the handover sheets become trophies. But if she’s innocent, the handover sheets are just a pile of papers she took home from work. 

The other behavioral evidence is of the same character. Take Letby’s “confession.” (#6) It appears scrawled on a sheet of paper that is clearly a stream-of-consciousness feelings dump:

If we consider the theory that Letby is an innocent nurse wrongfully accused and has become mentally unhinged because the entire country despises her and thinks she’s a child-murderer, this is precisely the sort of thing we might expect to find in her house. False confessions are actually not uncommon, and it’s easy to see how an innocent person might end up being convinced that they must in fact be evil and horrible if everyone in the country is telling them so. I mean, just look at the tabloid headlines and the kind of questioning she was subjected to when she testified in court:

PROSECUTOR: You are a very calculating woman, aren’t you, Lucy Letby?

LETBY: No. 

PROSECUTOR: The reason you tell lies is to try to get sympathy from people, isn’t it?

LETBY: No.

PROSECUTOR: You try to get attention from people, don’t you?

LETBY: No.

PROSECUTOR: In killing these children, you got quite a lot of attention, didn’t you?

LETBY: I didn’t kill the children.

But there’s more: the notes in question were actually written on the advice of therapeutic counsellors who told Letby getting her raw feelings and most troubling thoughts out would be a way to relieve the extreme stress she was going through. 

Most of the remaining behavioral evidence can also be dismissed. The appeals court judge noted that Letby “appeared to be fixated with being involved in events in the intensive care nursery and involved herself unnecessarily with babies who had been designated to other nurses.” (#2) In what way does her desire to be “involved in events” suggest she murdered babies? Or take the fact that she “searched for the names of some of the babies” online or looked up their families’ Facebook pages. (#5) Again, while this may be unprofessional, it’s not suggestive that she killed the babies, merely that she had a slightly intrusive, perhaps even macabre, curiosity about the patients who died in the hospital. The only remaining piece of evidence is the “false entries on certain documents,” (#3) but here, too, the evidence appears to be quite weak (for example, Letby wrote down that a baby vomited at 2:15 when it was closer to 2:30) and consistent with sloppy note-taking by an overworked nurse. 

Many people who knew Letby find it very puzzling that she has been convicted as a killer. Even the judge in Letby’s case described her as appearing to be a “very conscientious, hard working, knowledgeable, confident and professional nurse.” As the BBC’s Judith Moritz writes, “There is nothing obvious in Letby’s background that points to her becoming a killer. Her parents seem to have adored her, and her friendship groups in Hereford—and later in Chester—were happy and supportive.” Moritz commented, “I'm not sure what you'd expect Britain's most prolific child killer to look like. But I'm pretty sure it's not this.” 

Still, we must beware the risk of assuming that Letby doesn’t “look like” a killer because she is white and middle-class. Zuri Stevens argues that Letby got away with murdering babies because of the assumption that white ladies cannot commit heinous crimes. Martha Gill correctly warns that we may be inclined not to wish to believe Letby could be a serial killer because she doesn’t “seem” like the type of person who would be one. But actually, Gill writes, female serial killers tend “to be white, middle class, Christian, in their 20s or 30s, of average intelligence and attractiveness and in a ‘stereotypically feminine job,’ such as nursing.” 

On the other hand, one criminologist observed: “Serial killers are often loners. Until this happened she was a normal person. She’s breaking all the rules.” A friend of Letby’s says that “It is the most out of character accusation that you could ever put against Lucy. Think of your most kind, gentle, soft friend. […] She is the kindest person that I’ve ever known. She would only ever want to help people. To say that she could have harmed any baby, it’s just not in her nature.” But some of the character evidence is contradictory. She was described as “nice Lucy” by a doctor who worked with her, but as “lacking” in “warmth” by a nursing examiner who failed her. On the other hand, the head of nursing said she had seen Letby so upset so many times that she found it hard to think Letby’s emotions were an act. Faced with contradictory accounts of her character (Was she cheerful? Aloof?), the real question at issue is not how she seems, or whether she acted “normally” or “strangely” (serial killers can do both), but what evidence, if any, proves beyond a reasonable doubt that she is a murderer.

Ravi Jayaram, one of the doctors who first suspected Letby, said that the association between Letby and infant deaths was “like staring at a Magic Eye picture.”

“At first, it’s just a load of dots…But you stare at them, and all of a sudden the picture appears. And then, once you can see that picture, you see it every time you look, and you think, How the hell did I miss that?” 

Eventually he said he could not “unsee it.” 

Jayaram’s comparison may be more accurate than he realizes. I’ve written before about how humans identify spurious patterns that do not really exist, using the example of QAnon adherents who became convinced that they saw “Q” symbols all over the place. We have plenty of historical evidence from the Salem Witch Trials to sightings of Jesus in a piece of toast to show that it is very easy for humans to succumb to mass hysteria or become convinced that they see a pattern in a series of dots. 

And it might be even easier for doctors living in a region of the country that had been traumatized by a legendary medical serial killer… 

In Shipman’s Shadow

Harold Shipman was one of the most prolific serial killers in modern history. A general practitioner, he is estimated to have killed over 250 of his own patients between 1971 and 1998 by administering lethal doses of diamorphine. He then falsified medical records to make the deaths appear natural and even forged a will for one of his patients so that he would inherit the entirety of her estate. 

As Rachel Aviv notes in her New Yorker investigation, Shipman’s crimes took place about 40 miles from the hospital where Letby worked. After Shipman was finally exposed, there was self-reflection in the U.K. medical profession over the question: how could he have gotten away with it? The chair of the British Medical Association’s general practitioners committee said that one of the important lessons from the Shipman debacle was that "Everybody needs to be more vigilant and more aware of their obligations to report suspicions.” Aviv records that the “chair of a government inquiry into Shipman’s crimes said that investigators should now be trained to ‘think dirty’ about causes of death.”

But what if the traumatizing Shipman debacle created a kind of overcorrection, one especially pronounced in the region where his crimes took place? As we have discussed, serial killer nurses are vanishingly rare. “Thinking dirty” is actually not in accordance with real-world probability. The most innocent explanation is still overwhelmingly the likeliest. What if the Shipman case made people more likely to cast suspicion on innocent-seeming medical professionals? In other words, if the Shipman killings had never happened, would Lucy Letby ever have been suspected of a crime? We have already seen that in the Letby case, the “killer nurse” explanation was quickly preferred over the “bad nurse” explanation for seemingly no good reason. Perhaps the anomalous horror of the killer local doctor subtly influenced people’s interpretations of events.

Of course, if Lucy Letby is guilty, then it’s good that professionals became more vigilant after Shipman. Were it not for that heightened scrutiny, she may have gotten away with her crimes for much longer—it took a horrifyingly long time for Shipman to be found out. But we have to consider the possibility that the presence of a real-life medical monster in North West England could have increased the probability that a witch hunt would take place there. If Lucy Letby is innocent, then in one way she might have been Harold Shipman’s final victim. 

Neoliberalism: The Real Culprit? 

The British National Health Service is being destroyed. The crown jewel of the country’s social welfare state, the NHS is “the closest thing the British have to a religion.” It offers universal healthcare free at point of use, from cradle to grave. It is an incredible achievement and a model that shows another, better world is possible. 

But not everyone believes in the NHS, and Britain has suffered from over a decade of Conservative governance in which the system was overseen by people who had no interest in building a strong system of socialized medicine. Putting an institution in the care of people who would prefer to privatize it and sell it to their friends is catastrophic, and the NHS has been falling apart. As John Lister of Jacobin writes: 

In ten years from 2000, a decade of sustained investment by a New Labour government managed to repair much of the damage done to the National Health Service (NHS) by twenty-one years of underfunding. Then, in 2010, David Cameron’s government threw that into reverse with a new decade of austerity. That’s why the performance of England’s NHS is now the worst ever, with sky-high and still-rising waiting lists, huge delays in emergency services, and dwindling numbers of general practitioners (GPs) struggling to deliver increased numbers of appointments. Latest figures show fewer than 100,000 acute beds available and a record 96 percent bed occupancy.

Grace Blakeley writes that “since 2010, the NHS has undergone the longest funding squeeze in its history,” and:

The results are now clear. Waiting lists for hospital treatment rose to a record level of nearly 7.8 million in September 2023. The proportion of patients waiting more than four hours in Accident and Emergency (A&E) departments is now at 45 percent, just below the pandemic high of 50 percent in December 2022. Thousands of people are now waiting more than 12 hours for admission into A&E.  The proportion of patients waiting under 62 days for cancer treatment has fallen to 59 percent next to a target of 85 percent. And waiting times for ambulances have risen to an average of 36 minutes, compared to a target of 18 minutes. This has led to many avoidable deaths, such as the case of an East Sussex man named Martin Clark who died at age 68 from a cardiac arrest after waiting 45 minutes for an ambulance.

These austerity/underfunding issues were present in Letby’s own hospital, and Letby herself had been one of the faces of the fundraising campaign the hospital had to launch to try to raise money to replace the neonatal unit. (Nurses shouldn’t have to raise money to fund public hospitals, just as teachers shouldn’t have to raise money for school supplies.)

The resulting horrors are often used to indict socialized healthcare generally. Peter Hitchens, for instance, a supporter of Letby’s innocence, says the “establishment” are trying to “protect the sacred NHS” by refusing to look into the Letby case. But it’s precisely those who care about this precious institution who should be determined to expose how neoliberal politicians have damaged it. We should demand that they fulfill the promise of a world-class public health service that is not starved for resources while bits are sold off for parts. It may be the war on the NHS, not Lucy Letby, that was killing babies in Chester. 

Conclusion

I don’t know if Lucy Letby is innocent, but I know she deserved a “not guilty” verdict. The facts are very clear:

1. The medical evidence against Letby has been utterly vaporized by a team of the world’s leading experts on infant mortality, meaning that the “suspicious” deaths may have been anything but. Even those who still defer to the original prosecution experts must admit that serious doubt has been introduced by the expert panel. 
2. The correlational evidence was statistically worthless and manipulated, and there are innocent explanations for Letby’s presence on the unit when babies deteriorated. Statisticians were appalled at the prosecution’s sloppy invocation of correlation. Similar reasoning has been used before, in the de Berk case, to falsely accuse a nurse of being a killer. 
3. The public was misled about the case. The babies were not healthy, and the hospital was not functioning well. The head of the expert panel says the unit should have been shut down. 
4. Letby’s behavior was perfectly consistent with innocence. In fact it is remarkable just how little incriminating evidence there is in her texts or her coworkers’ accounts. 
5. Serial killer nurses are extremely rare. Bad hospitals and bad nurses are much more common. We should test every possible plausible alternate explanation before coming to the conclusion that Letby was a sadistic murderer. These alternate explanations were never rigorously investigated. 

Bad reasoning has pervaded discussion of this case, both inside the courtroom and out. During the trial, the prosecutor actually took Letby to task for not crying enough when talking about the babies, even though as a nurse who dealt with sick and dying children she would be expected to have learned to remain emotionally composed. The appeals court says that Letby “admitted that [two] babies had been poisoned by insulin, but denied that she was the poisoner,” when in fact, as Richard Gill notes, her reply was more like “well if you say it is proven it must be true. But I didn’t do it.” Lawyers for the families of the dead children, in rejecting Dr. Lee’s findings, mentioned “the fact that several of the babies had siblings who also collapsed or died unexpectedly,” suggesting that this makes it less likely the deaths were natural. (In fact, it was precisely this kind of poor reasoning that led to the false conviction of Sally Clark, whose two sons both died unexpectedly as young infants. In this case, prosecutors argued that it was very unlikely that such “cot death”—what we would call Sudden Infant Death Syndrome or SIDS in the U.S.—would happen to two children in a row, when in fact that was a poor statistical argument, because the fact that the children were siblings increased the odds that the same thing that happened to one would happen to the other. Incidentally, Clark developed severe psychiatric problems and died of alcohol poisoning at 42, and it is not unlikely that if Letby does turn out to have been falsely accused she will be damaged for life by the events.)

The question we must return to is: what is the evidence? As statistician Richard Gill reminds us, in the absence of compelling evidence, the probability of a serial killer nurse (rather than a bad hospital) is vanishingly low: 

“I have seen how these cases arise out of nothing. You can completely understand everything on the basis of the innocence hypothesis. In other words, this is what happens when things go wrong. There is a calamity and a scandal in an NHS maternity unit or neonatal unit every year. There is a serial killer nurse in England maybe once in 50 years. The probability that this is just another NHS scandal is enormous. Every single piece of evidence only makes me more certain of that.’

I agree. I cannot see how you get to “beyond a reasonable doubt” given what we now know. 

Letby’s last avenue for exoneration is Britain’s allegedly dysfunctional Criminal Cases Review Commission, which she has applied to for review. Advocates have demanded the case be looked into rapidly. At the moment, the main open inquiry to the case is based on the premise that she is guilty, and is trying to assess how she could have been stopped earlier. The former heads of the hospital have now asked that that review be suspended, given the doubts about Letby’s actual guilt. But it remains to be seen whether the CCRC will actually take up her case, whether it will accept the new evidence, and whether it will ultimately free her. (Note that the U.S. does not have an equivalent of Britain’s CCRC—a centralized, independent public body dedicated to investigating potential miscarriages of justice in criminal convictions. Once someone in the U.S. has exhausted their appeals it can be very, very difficult to get the case reviewed.)

If Lucy Letby is innocent, it would be “one of the worst miscarriages of justice we have ever seen.” If she is innocent, it would mean that British prosecutors, police, and the media ruined the life of a caring nurse, turning her into a national hate figure and obscuring systemic failures. As Phil Hammond comments, the case has cost the public tens or even hundreds of millions of pounds that could have been spent “employing neonatal nurses for these units to make them safer.” It would be another example of individual scapegoats being blamed for injustices that ultimately have political causes. It would also have been a grave disservice to the families of the dead children, who now above all deserve the full truth about what happened to their babies.