Lucy Letby (born 4 January 1990) is a British serial killer and former neonatal nurse who murdered seven infants and attempted to murder six others at the Countess of Chester Hospital between 2015 and 2016. Letby was the focus of much suspicion as the outbreak of unexpected collapses and infant deaths commenced shortly after she was qualified to work with children in the hospital’s intensive care unit and was consistently on duty when each incident took place. As soon as Letby was removed from duties in June 2016, the suspicious incidents stopped.
Letby was charged in November 2020 with eight counts of
murder and ten counts of attempted murder. During her trial, which lasted from
October 2022 to August 2023, it was revealed that Letby's methods included injecting
the infants with air or insulin, overfeeding them, or physically assaulting
them. She also stole over 250 confidential documents relating to the children's
care to keep as mementos of her crimes and falsified patient records to avert
suspicion. Several parents and staff members had also walked in during, or just
after, Letby's attacks on victims. On 21 August 2023, Letby was sentenced to
life imprisonment with a whole life order. She has announced her intention to
appeal, while a retrial of one count of attempted murder is also planned.
Letby is the most prolific serial killer of children in
modern British history; the Cheshire
Constabulary now suspects that she may have claimed more victims, including
at Liverpool Women's Hospital, where two babies died while she was training
there. Management at the Countess of Chester Hospital was criticized for
ignoring warnings about Letby that could have prevented some of the killings.
The British government has since announced that an independent statutory inquiry
would be held into the circumstances surrounding the murders.
Early life and
education
Lucy Letby was born on 4 January 1990 in Hereford,
Herefordshire, the only child of a finance manager and an accounts clerk. She
was educated at Aylestone School and
Hereford Sixth Form College. She had
had a very difficult birth herself and was, according to a friend who had known her
since secondary school, "very
grateful for being alive to the nurses who would have helped save her
life". This, the friend states, had led her to want to be a nurse all
her life and that "everything that
she did was geared towards that ultimate goal of becoming a nurse". Letby
pursued her education in nursing at the University of Chester, where she also
worked as a student nurse during her three years of training, carrying out
placements at Liverpool Women's Hospital and the Countess of Chester Hospital.
Letby was the first member of her family to study at university and graduated
in September 2011. A friend described her as "quite awkward and geeky".
Career
Letby began working as a registered nurse at the neonatal
unit of the Countess of Chester Hospital in 2012. In a 2013 staff profile, she
said that she was responsible for "caring
for a wide range of babies requiring various levels of support" and
that she enjoyed "seeing them
progress and supporting their families." Letby also took part in a
campaign to raise funds for a new neonatal unit at the hospital. Parents noted
that Letby happily chatted about her life, such as telling them about how she
was single and happy being single.
Letby had two training placements at Liverpool Women's
Hospital, in late 2012 and early 2015, which came under investigation after her
conviction. In June 2016, consultants asked management to remove her from clinical
duties pending an investigation into her conduct. She had previously been moved
from night to day shifts in April 2016 by the unit's ward manager. Letby was
transferred to the patient experience team in July 2016 and later to the risk
and patient safety office, working there until her arrest in 2018.
Letby had finally qualified to work with the infants who
needed intensive care in 2015, the same year the suspicious incidents began.
Letby had told others that she found non-intensive care work "boring" and sought the action
of the intensive care unit. When she was moved to day shifts the suspicious
incidents notably moved from occurring overnight to happening in the daytime
when Letby was working.
Murders
Initial investigation
An informal review conducted in June 2015 by a consultant
and lead neonatologist at the Countess
of Chester Hospital NHS Foundation Trust revealed troubling details
regarding four unexplained collapses that occurred in the same unit. Three of
these cases resulted in deaths in the same month. It was observed that Letby
had been on shift on each occasion. The unit's consultants promptly reported
these deaths to the trust's committee responsible for addressing serious
incidents. The committee classified the deaths as "medication errors". Had they been classified as "serious incident[s] involving
unexpected deaths", an immediate investigation could have taken place
if they were grouped together. The number of unexplained collapses was
particularly abnormal: there had previously been only two or three deaths a
year in the neonatal unit. What was also particularly unusual was that the
babies did not respond to resuscitation attempts as they would be expected to.
Usually, babies that had a heartbeat back would see an improvement in their
breathing, but that did not happen in these cases, which was distinctly
unusual. A misconception of the later Senior Investigating Officer on the
case, Detective Superintendent Paul Hughes, was that sick babies in such a ward
for vulnerable patients could collapse at any moment; in fact, baby collapses
are usually expected beforehand. On the rare occasions when a collapse is not
predicted, a medical explanation can usually be found, unlike in this case.
In October 2015, a ward manager conducted her own review,
noting that Letby was the only staff member consistently present throughout
these incidents of unexplained collapses and deaths. These findings were
relayed to the lead neonatologist. Further concerns were voiced to management
by the unit's consultants that same month; concerns were either resisted by the
Trust Executives or ignored. In February 2016, the lead neonatologist, along
with other consultants, concluded a thematic review investigating five
unexplained deaths and collapses within the unit. Their investigation
determined that the only common factor in these cases was the presence of
Letby. The lead neonatologist communicated the findings via an "urgent" email to the trust's
medical director leading to an eventual meeting in May 2016. The executive team
deemed it to be coincidental and no substantial action was taken.
Reports by the Mothers and Babies: Reducing Risk through
Audits and Confidential Enquiries across the UK project (MBRRACE-UK) found a
neonatal death rate at least 10% higher than expected between June 2015 and
June 2016. Additionally, the neonatal death total in 2015 doubled that of the
previous year. The mortality rate had risen above what might be considered 'normal' rates. During a hospital visit
in February 2016, The Care Quality Commission (CQC) was informed of
difficulties in raising concerns with managers but heard no mention of an
elevated mortality rate. The CQC's report identified issues of "short-staffing" and
"skill-mix" issues within the unit, yet it praised the overall
positive culture of the trust, where "[s]taff
felt well supported, able to raise concerns and develop professionally."
On 24 June 2016, following the deaths of two triplet babies
on that day and the previous day, the lead neonatologist phoned the duty
executive demanding that Letby be removed from the unit. The duty executive
insisted that Letby was safe to work and that she was "happy to take responsibility" if anything happened to
any more babies under Letby's care. In late June 2016, the trust's executive
directors convened to address a critical decision: whether to involve law
enforcement. By this time, seven unexpected deaths had taken place within the
unit. The belief among these executives was that the indications of Letby's
involvement were largely circumstantial and they suspected certain doctors of
embarking on a misguided "witch
hunt". Moreover, they were concerned about potential harm to the
Trust's reputation resulting from a police inquiry. Ultimately, they opted
against engaging the police. The medical director and chief executive instead
organized a review through the Royal
College of Paediatrics and Child Health (RCPCH), which was initiated in
September 2016. At the same time, the unit's services were scaled back in July
2016, no longer accommodating premature births before the 32-week mark. Such
cases were redirected to other hospitals in the North West of England, such as
Alder Hey Children's Hospital.
The trust set a narrow scope for the review that excluded
investigating Letby's actions or the deaths but instead focused on the unit's
general service. The RCPCH reported its findings to the medical director and
chief executive in October 2016. They could not find a definitive explanation
for the increase in mortality rate at the unit but found some insufficient
staffing and senior cover. The report recommended a detailed case review of
each death. The medical director asked neonatologist Jane Hawdon from Great Ormond
Street Hospital to carry out the case reviews. Hawdon responded she could not
conduct a detailed review because of lack of time but could provide a summary
and did so after briefly reviewing the notes. She identified four cases that "potentially benefit from local
forensic review as to circumstances, personnel, etc". The board's chair
at the time, has said that he was misled about the scope of that review and its
findings. Despite the thorough external independent review recommended by the
RCPCH or the forensic review recommended by Hawdon, records of the hospital
board meeting show the medical director telling board members that the RCPCH and
Hawdon reviews concluded that the deaths in the neonatal unit were due to
issues with leadership and timely intervention.
In March 2017, consultants asked management to involve the
police after receiving advice from the regional neonatal lead, who suggested
further investigation was needed. They then met with Cheshire Constabulary on
27 April 2017, to raise their concerns, with Letby due to return to work on 3
May 2017. The trust publicly announced the involvement of the police in May
2017, stating this move was to "seek
assurances that enable us to rule out unnatural causes of death." The
police's investigation was called Operation Hummingbird. Senior Investigating
Officer Paul Hughes later said: "The
initial focus was around the hypotheses of what could have occurred: so generic
hypotheses of 'it could be natural-occurring deaths', 'it could be
natural-occurring collapses', 'it could be an organic reason', 'it could be a
virus', and then one of the hypotheses was that, obviously, it could be
inflicted harm."
Timeline of cases
The first suspicious case occurred on 8 June 2015. At 8 pm a
healthy baby boy – a twin – was being cared for in nursery 1 on the ward and
the designated nurse was Letby. The boy had been handed over to Letby after she
started her night shift, with the pediatric registrar having clocked off when
Letby was 30 minutes into her shift. 26 minutes later, she called a doctor with
the baby's state rapidly deteriorating. The baby died half an hour later, less
than 90 minutes into Letby's shift. The pediatric registrar later testified
that when she heard about the death of the child the next day after returning
to work it was a "big
surprise" and "completely
out of the blue and very upsetting. [He] showed no signs of any problems
throughout the day. He was handling well. I had no concerns at all for him or
his twin sister". A fellow nurse said that when the baby started
deteriorating she saw Letby standing over the infant's incubator and originally
did not intervene. However, the nurse then did when she realized he was not recovering
under Letby's care. Doctors attending the scene said that Child A developed an
unusual blue and white mottling on his skin after collapsing, which they said
they had never seen before. This symptom later occurred in other babies that
were believed to have been intentionally injected with air. The day after Child
A's death, Letby searched for his parents on Facebook.
About 28 hours after Child A's death, his twin sister, Child
B, also inexplicably collapsed and had to be resuscitated. After Child A's
death, the parents had spent the day with Child B in the nursery but
were persuaded to go and rest before the baby's sudden crash. Tests later
showed loops of gas-filled bowel in the child. As a result, it was later
concluded that the baby had been injected with air. Letby had fed the baby 25
minutes before their collapse and the child had the same unusual rash on her
skin as first seen on Child A hours earlier, indicating that they had also been
injected with air.
On 22 June 2015, baby girl Child D collapsed three times in the
early hours and died. Those who attempted to save the child noticed the girl's
skin had been discolored. A post-mortem X-ray showed a 'striking' line of gas in front of the spine, consistent with air
being injected into the bloodstream. A doctor later testified that such a
finding could not be explained by natural causes. The mother had noted Letby "hovering around" the family
hours before the baby collapsed.
On 2 July, a doctor raised his concerns over the sudden
collapses and deaths. No action was taken against Letby. The suspicious cases
stopped for a month. On 4 August 2015, a mother walked into the unit to give
her baby boy, Child E, his milk, only to find Letby apparently in the process
of attacking the child. She found the baby distressed and bleeding from the
mouth, with Letby standing nearby "faffing
around, not doing anything" and wanting "to look busy but not actually doing anything". The boy
later died after suffering a fatal bleed, which was believed to have been the
cause of death along with the injection of air. Flecks of blood were found in
his vomit. The next evening, Child E's twin brother Child F was being cared for
in nursery 2, the same room in which Letby was looking after another infant. At
1:54 am Child F suffered an unexpected drop in his blood sugar and saw a surge
in his heart rate. The child survived and a blood test later revealed that he
had been given an "extremely
high" amount of exogenous pharmaceutical insulin, which he had never
needed. No baby on the unit had been prescribed insulin at the time and so
there was no reason why this baby should be given it. The insulin was kept in a
locked fridge next to a nurses' station. Later, at trial, Letby did not contest
that the baby had been intentionally injected with insulin, suggesting someone
else must have done it. Letby searched for the parents of Child E and F on
social media in the following weeks and months.
At this point the lead consultant made his feelings known
that he was not happy with Letby working on the unit, but this was dismissed.
7 September 2015 was the 100th day of Child G being alive
and the nurses had put up banners and made a cake for her parents to mark the
day. On that same day, the child collapsed and did so again on two other
occasions in the following three weeks. After the first collapse, the baby girl
was taken to Arrowe Park Hospital,
but five days later she collapsed again, 15 minutes after Letby had been
feeding her. The child survived but is now severely disabled as a result of
what happened to her. The baby has witnessed projectile vomiting so massively
that it reached the chair next to the cot and canopy, which an attending doctor
said he had never witnessed before. Her heart rate and oxygen levels also dropped
to unusually low levels. The doctor said that he could not find a natural cause
for the drastic vomiting. Later, at trial, an expert witness doctor concluded
that the only viable explanation for the baby vomiting so extraordinarily was
if she had received far more milk than that allocated down her feeding tube and
that this could not have happened accidentally. It was later discovered that Letby had
deliberately altered the baby's temperature on her observation chart to make it
seem like she was already unwell before she collapsed, and also falsified the
time of the baby's collapse to make it seem like it coincided with when a
colleague gave the baby a milk feed. A nurse noticed when she arrived after crying for help after one of the baby girl's collapsed that the machine
connected to the baby to measure its oxygen saturation and heart rate levels
had been turned off. A colleague had also noticed that Child G's initial
collapse occurred on the day she was originally due to be born.
About six weeks after Child G's multiple collapses, on 23
October 2015, Child I died. This was the fourth time the baby girl had
collapsed. On the fourth collapse, Letby was found next to her incubator by
another nurse. Letby later sent a sympathy card to the baby girl's parents on
the day of her funeral, a card which Letby kept photos of on her phone. Letby
also wanted to go to the funeral. Twice the baby was found to have excess air
in her stomach which had affected her breathing. Before the second collapse,
Letby had said to a colleague that Child I 'looked
pale', even though it would have been hard to see from where they were
standing in a doorway looking into the darkened nursery. Then, when the
designated nurse for the child turned the light on, she saw the girl was not
breathing. The child's mother later said Letby 'smiled' as she bathed her dead
daughter and offered to take a photo of the dead child. A doctor had seen
unusual skin mottling on Child I's skin and X-rays showed the child had a
massively enlarged stomach that was consistent with her having been deliberately
injected with air. Letby later searched for Child I's mother on Facebook.
Later on 23 October, the hospital management was alerted to
the concerns of the doctors on the unit. They were told to "not make a fuss". Staff reviews were carried out which
highlighted that Letby was always on duty for the suspicious incidents and in
February 2016 a doctor requested an "urgent"
meeting with executives, but no meeting occurred until May 2016.
At 11:26 pm on Christmas Day 2015, Letby searched on
Facebook for the parents of the twins, Child E and Child F.
By April 2016, Letby had been moved to day shifts because of
the concerns about her and the suspicious collapses began occurring in the
daytime. On 9 April 2016, two twin brothers suffered sudden collapses within hours
of each other. Tests found that Child L inexplicably had insulin levels in his
blood "at the very top of the scale
that the equipment was capable of measuring". Hours later, twin
brother Child M's heart rate and breathing suddenly dropped and he nearly died.
Experts said that Child M's heart was likely caused by air being injected into
his bloodstream. Although he lived, the child suffers from brain damage. It
was noted that the collapses of Child L and M occurred in almost identical
circumstances to Child E and F. Both were twins where one was believed to have
been injected with insulin and the other with air. Child F had survived his
injection of insulin and it was noted that Child L had been injected with twice
the dose of insulin, the suggestion being that Letby had done so to ensure
death on this occasion.
A meeting about the suspicious cases took place on 11 May 2016,
but no action was taken.
A month later, Child N nearly died after suffering trauma to
the throat. Doctors saw blood and "unusual"
swelling at the back of his throat upon examination. The baby had been heard
randomly 'screaming'. Child N's
father said he then saw blood spattered around his son's mouth.
The final two cases occurred within hours of each other on
23 and 24 June 2016. The two children involved were triplets, siblings of each
other, and the cases occurred on Letby's first shift back after she had
returned from a trip abroad to Ibiza and after Letby texted a colleague saying
she would "be back with a
bang". Child O, a "perfect"
healthy baby, was due to be discharged home, but suddenly collapsed on 23 June.
When the child initially became unwell, another nurse suggested he be moved to
nursery 1 where the sickest children were treated, but Letby disagreed and the
baby subsequently collapsed less than two hours later. He recovered but
suffered two further collapses and died almost exactly three hours later. The
lead consultant noted that the child "should
have responded better" to
resuscitation. X-rays on a post-mortem showed he had an abnormal amount of gas
in his body and liver damage that an independent pathologist later ruled had
resulted from an "impact
injury" similar to what would be seen in a car crash. 13 minutes after
Child O's death, Letby was feeding his triplet brother Baby P, who also was
expected to be able to soon go home, but he collapsed after his diaphragm was
somehow shattered. Doctors attempted to recover him by preparing him to go to
another hospital and Letby then remarked "he's
not leaving here alive, is he?” The boy soon died. X-rays likewise showed
an inexplicable amount of gas inside the baby. These deaths have been described
as "exceptional" and the "tipping point" when the
consultants realized that "drastic"
action needed to be taken. A consultant allowed the surviving triplet to be
taken to a different hospital by medics who had turned up to take Baby P, who
had been expected to live. The consultant said she allowed this after her
parents begged for it, as she now felt Letby was a "mortal danger" to the surviving triplet. Before the
second triplet died, Letby had texted a doctor saying she would "be watching them both [Child P and the
surviving triplet] like a hawk" and said, "I'm OK. Just don't want to be here really. Hoping I may get the
new admissions".
Three weeks later, in July 2016, Letby was removed from duty
and the suspicious collapses stopped.
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