caught u cataloging all ur grief

nasr a. aziz eleyan, "grandchild," 2007, oil on canvas

“We love life whenever we can”

The case galvanized the British government. The Health Secretary immediately announced an inquiry to examine how Letby’s hospital had failed to protect babies. After Letby refused to attend her sentencing hearing, the Justice Secretary said that he’d work to change the law so that defendants would be required to go to court to be sentenced. Rishi Sunak, the Prime Minister, said, “It’s cowardly that people who commit such horrendous crimes do not face their victims.”

The public conversation rushed forward without much curiosity about an incongruous aspect of the story: Letby appeared to have been a psychologically healthy and happy person. She had many close friends. Her nursing colleagues spoke highly of her care and dedication. A detective with the Cheshire police, which led the investigation, said, “This is completely unprecedented in that there doesn’t seem to be anything to say” about why Letby would kill babies. “There isn’t really anything we have found in her background that’s anything other than normal.”

The judge in her case, James Goss, acknowledged that Letby appeared to have been a “very conscientious, hard working, knowledgeable, confident and professional nurse.” But he also said that she had embarked on a “calculated and cynical campaign of child murder,” and he sentenced her to life, making her only the fourth woman in U.K. history condemned to die in prison.

[...] The N.H.S. has a totemic status in the British psyche—it’s the “closest thing the English have to a religion,” as one politician has put it. One of the last remnants of the postwar social contract, it inspires loyalty and awe even as it has increasingly broken down, partly as a result of years of underfunding. In 2015, the infant-mortality rate in England and Wales rose for the first time in a century. A survey found that two-thirds of the country’s neonatal units did not have enough medical and nursing staff.

[...] A woman came to the hospital after her water broke. She was sent home and told to wait. More than twenty-four hours later, she noticed that the baby was making fewer movements inside her. “I was concerned for infection because I hadn’t been given any antibiotics,” she said later. She returned to the hospital, but she still wasn’t given antibiotics. She felt “forgotten by the staff, really,” she said. Sixty hours after her water broke, she had a C-section. The baby, a girl who was dusky and limp when she was born, should have been treated with antibiotics immediately, doctors later acknowledged, but nearly four hours passed before she was given the medication. The next night, the baby’s oxygen alarm went off. “Called Staff Nurse Letby to help,” a nurse wrote. The baby continued to deteriorate throughout the night and could not be revived. A pathologist found pneumonia in the baby’s lungs and wrote that the infection was likely present at birth.

[...] A team from the Royal College of Paediatrics and Child Health spent two days interviewing people at the Countess [Letby's hospital]. They found that nursing- and medical-staffing levels were inadequate. They also noted that the increased mortality rate in 2015 was not restricted to the neonatal unit. Stillbirths on the maternity ward were elevated, too. [...] The Royal College could find no obvious factors linking the deaths; the report noted that the circumstances on the unit were “not materially different from those which might be found in many other neonatal units within the UK.”

[...] In September, 2022, a month before Letby’s trial began, the Royal Statistical Society published a report titled “Healthcare Serial Killer or Coincidence?” The report had been prompted in part by concerns about two recent cases, one in Italy and one in the Netherlands, in which nurses had been wrongly convicted of murder largely because of a striking association between their shift patterns and the deaths on their wards. The society sent the report to both the Letby prosecution and the defense team. It detailed the dangers of drawing causal conclusions from improbable clusters of events. In the trial of the Dutch nurse, Lucia de Berk, a criminologist had calculated that there was a one-in-three-hundred-and-forty-two-million chance that the deaths were coincidental. But his methodology was faulty; when statisticians looked at the data, they found that the chances were closer to one in fifty.

[...] “Looking for a responsible human—this is what the police are good at,” Schafer [a law professor at the University of Edinburgh who studies the intersection of law and science] told me. “What is not in the police’s remit is finding a systemic problem in an organization like the National Health Service, after decades of underfunding, where you have overworked people cutting little corners with very vulnerable babies who are already in a risk category. It is much more satisfying to say there was a bad person, there was a criminal, than to deal with the outcome of government policy.”

[...] Several months into the trial, Richard Gill, an emeritus professor of mathematics at Leiden University, in the Netherlands, began writing online about his concerns regarding the case. Gill was one of the authors of the Royal Statistical Society report, and in 2006 he had testified before a committee tasked with determining whether to reopen the case of Lucia de Berk. England has strict contempt-of-court laws that prevent the publication of any material that could prejudice legal proceedings. Gill posted a link to a Web site, created by Sarrita Adams, a scientific consultant in California, that detailed flaws in the prosecution’s medical evidence. In July, a detective with the Cheshire police sent letters to Gill and Adams ordering them to stop writing about the case. “The publication of this material puts you at risk of ‘serious consequences’ (which include a sentence of imprisonment),” the letters said. “If you come within the jurisdiction of the court, you may be liable to arrest.”

Letby is housed in a privately run prison west of London, the largest correctional facility for women in Europe. Letters to prisoners are screened, and I don’t know if several letters that I sent ever reached her. One of her lawyers, Richard Thomas, who has represented her since early in the case, said that he would tell Letby that I had been in touch with him, but he ignored my request to share a message with her, instead reminding me of the contempt-of-court order. He told me, “I cannot give any comment on why you cannot communicate” with Letby. Lawyers in England can be sanctioned for making remarks that would undermine confidence in the judicial system. I sent Myers, Letby’s barrister, several messages in the course of nine months, and he always responded with some version of an apology—“the brevity of this response is not intended to be rude in any way”—before saying that he could not talk to me.

[...] Michael Hall, the defense expert, had expected to testify at the trial—he was prepared to point to flaws in the prosecution’s theory of air embolism and to undetected signs of illness in the babies—but he was never called. He was troubled that the trial largely excluded evidence about the treatment of the babies’ mothers; their medical care is inextricably linked to the health of their babies. In the past ten years, the U.K. has had four highly publicized maternity scandals, in which failures of care and supervision led to a large number of newborn deaths.

[...] Johnson, the prosecutor, pushed her to come up with her own explanation for each baby’s deterioration. Yet she wasn’t qualified to provide them. “In general, I don’t think a lot of the babies were cared for on the unit properly,” she offered. “I’m not a medical professional to know exactly what should and shouldn’t have happened with those babies.”

“Do you agree that if certain combinations of these children were attacked then unless there was more than one person attacking them, you have to be the attacker?” Johnson asked at one point.

“No.”

“You don’t agree?”

“No. I’ve not attacked any children.”

Johnson continued, “But if the jury conclude that a certain combination of children were actually attacked by someone, then the shift pattern gives us the answer as to who the attacker was, doesn’t it?”

“No, I don’t agree.”

“You don’t agree. Why don’t you agree?”

“Because just because I was on shift doesn’t mean that I have done anything.”

[...] After a few days of cross-examination, Letby seemed to shut down; she started frequently giving one-word answers, almost whispering. “I’m finding it quite hard to concentrate,” she said.

Johnson repeatedly accused her of lying. “You are a very calculating woman, aren’t you, Lucy Letby?” he said.

“No,” she replied.

He asked, “The reason you tell lies is to try to get sympathy from people, isn’t it?”

“No.”

“You try to get attention from people, don’t you?”

“No.”

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

“I didn’t kill the children.”

[...] Toward the end of the trial, the court received an e-mail from someone who claimed to have overheard one of the jurors at a café saying that jurors had “already made up their minds about her case from the start.” Goss reviewed the complaint but ultimately allowed the juror to continue serving.

He instructed the twelve members of the jury that they could find Letby guilty even if they weren’t “sure of the precise harmful act” she’d committed. [...] The jury deliberated for thirteen days but could not reach a unanimous decision. In early August, one juror dropped out. A few days later, Goss told the jury that he would accept a 10–1 majority verdict.

[...] The public conversation about the case seemed to treat details about poor care on the unit as if they were irrelevant. In his closing statement, Johnson had accused the defense of “gaslighting” the jury by suggesting that the problem was the hospital, not Letby. Defending himself against the accusation, Myers told the jury, “It’s important I make it plain that in no way is this case about the N.H.S. in general.” He assured the jury, “We all feel strongly about the N.H.S. and we are protective of it.” It seemed easier to accept the idea of a sadistic “angel of death” than to look squarely at the fact that families who had trusted the N.H.S. had been betrayed, their faith misplaced.

Since the verdicts, there has been almost no room for critical reflection. At the end of September, a little more than a month after the trial ended, the prosecution announced that it would retry Letby on one of the attempted-murder charges, and a new round of reporting restrictions was promptly put in place. The contempt-of-court rules are intended to preserve the integrity of the legal proceedings, but they also have the effect of suppressing commentary that questions the state’s decisions. In October, The BMJ, the country’s leading medical journal, published a comment from a retired British doctor cautioning against a “fixed view of certainty that justice has been done.” In light of the new reporting restrictions, the journal removed the comment from its Web site, “for legal reasons.” At least six other editorials and comments, which did not question Letby’s guilt, remain on the site.