Questions raised about the conviction of nurse Lucy Letby
Recently New Yorker journalist Rachel Aviv examined whether British NICU nurse Lucy Letby should have been convicted of killing infants in her care. In a May 2024 article, Aviv showed that the evidence against Letby was weak, suggesting that she may have been a scapegoat whose prosecution diverted attention from the real plight of vulnerable neonates in a struggling healthcare system. Since then, calls for reconsideration of Letby’s convictions have grown louder.
Lucy Letby before the massive scapegoating. Does someone full of such loveliness and joy really strike people as a sociopath?
February 20, 2025 – On May 20, 2024, The New Yorker published a story by Rachel Aviv about the 2023 conviction of British nurse Lucy Letby for killing seven babies and trying to kill six more. Aviv provided ample reason to ask, as the article’s subhead did: “Did she do it?” Letby had been widely seen by her colleagues as caring and skilled, and the actual evidence against her was limited. But after a years-long campaign against her by senior physicians, she was convicted of a series of unexplained deaths of very sick neonates, amid what sounds like a kind of national hysteria about the alleged “angel of death.” U.K. legal restrictions seem to have limited public discussion of problems with the case, including Aviv’s own ability to talk to key players. But the picture that emerged from her piece was that of a vulnerable nurse who may have served as a scapegoat for tragic deaths that might more plausibly be attributed to flaws in a health system beset by understaffing, resource shortages, poor training, and low morale. For nursing, that basic picture is familiar. In recent years, some U.S. nurses have been criminally charged for errors, in a seeming effort to divert responsibility for larger problems in their healthcare systems. Perhaps the most prominent case was that of RaDonda Vaught. Aviv’s piece did not mention the U.S. cases, although it did describe European cases where nurses had been wrongly convicted of murder mainly on the basis of having merely been present when deaths occurred, as Letby was. The article also seemed to underplay the extent to which the drama around Letby involved senior physicians pushing to blame her and senior nurses trying to protect her; the physicians prevailed only after getting the police involved. Finally, the piece did not explain to readers the key healthcare roles nurses play for patients. But it did serve as advocacy for Letby and the nursing profession at a difficult time. And in recent months, there have been increasing calls to re-examine Letby’s case, including from an international panel of neonatal experts, who said they “did not find any murders.” We thank Aviv and the New Yorker.
The 33-year-old Letby was convicted of murdering seven babies and trying to kill six more, after a 10-month trial that ended in August 2023, with multiple sentences of life in prison. Aviv says the case attracted intense interest and press coverage in the U.K., where the “collective acceptance of her guilt was absolute.” Yet Aviv found there had been little serious consideration of the stark contrast between the alleged crimes and Letby’s actual history, which was that of a happy, caring, and skilled nurse with close friends. She had gotten her nursing degree from the University of Chester in 2011, and started work in what Aviv calls the “struggling neonatal unit” at the Countess of Chester Hospital, where she had trained, in the west of England, near Wales. Letby felt the nursing team there was like a family, and she spent her free time with them.
The case against Letby focused on the deaths of seven babies between June 2015 and June 2016. All but one of the babies were premature, and three of them weighed less than three pounds. Aviv reported that “no one ever saw Letby harming a child, and the coroner did not find foul play in any of the deaths.” Indeed, at least based on Aviv’s piece, there would appear to have been no physical evidence at all to suggest Letby killed the babies, and no credible motive for her to do so. In fact, Letby appeared to be very distressed by the deaths after they occurred.
At some point after the first few deaths, Aviv said, senior pediatricians at the hospital met to discuss them. It appears that the primary players in this discussion, and later in pushing for the deaths to be labeled as intentional acts by Letby, were Ravi Jayaram and Stephen Brearey. Jayaram was identified in the piece as the hospital’s head of pediatrics, and Brearey as the head of the NICU. We assume these two actually led physician staff, rather than nursing staff, but the media often misses that critical distinction in the way healthcare functions, leading to a false perception that physicians manage nurses. In any event, regarding the first deaths, Brearey himself later admitted to Aviv that the reasons for the deaths of preterm neonates are not always known. And Aviv cited a U.K. study finding that about half of unexpected newborn deaths remained unexplained even after an autopsy. Although Letby was connected in some way to each patient who died, in some cases merely by being on the clock at the time of death, it seems that neither physician initially suspected her, as she was well-regarded by her colleagues.
But after another tragic preterm death some months later, the piece said, the physicians apparently did come to suspect that Letby was somehow responsible. They shared concerns with “senior management,” and there was some review by the “neonatal-unit manager” Eirian Powell—in fact, she seems to have been a nurse manager. Powell does not appear to have not endorsed the physicians’ concerns, but she still agreed to move Letby from nights to day shifts, when more people would be around. Some months later, in June 2016, two of three preterm triplets for whom Letby had been caring died. After this, Jayaram and Brearey reportedly remained “troubled,” and soon Brearey called Karen Rees, “the head of nursing for urgent care,” to say he did not want Letby to practice there until there was an investigation. Rees, after discussing the matter with Powell, allowed Letby to continue working, later noting that “just because a senior healthcare professional requests the removal of a nurse—there has to be sound reason.”
But the physicians were not done. Brearey, Jayaram, and other pediatric consultants reportedly met to discuss the recent deaths. Jayaram apparently remembered learning in medical school about air embolisms, an extremely rare complication in which air bubbles can block a person’s blood supply, and he decided that fit with some of the cases. He and another pediatrician met with the hospital’s executive board and the medical and nursing directors, saying they were not comfortable working with Letby and suggesting calling the police. Jayaram reportedly said that the board asked them for evidence, and “we said, ‘we haven’t got evidence, but we’ve got concerns.” (Aviv notes that Jayaram was often featured on TV as a medical expert.) The board and the directors downgraded the neonatal ward, which would no longer provide intensive care, and commissioned a review by the Royal College of Paediatrics and Child Health about possible causes of the higher rate of mortality. Letby was moved to administrative duties; Aviv said Letby never returned to clinical care, despite apparent efforts by Powell, the unit manager. In September 2016, Letby filed a grievance, arguing that she had been removed from her job without sufficient explanation. She was also apparently diagnosed with depression and anxiety, reporting that she felt she had let everyone down.
Meanwhile, also in September 2016, the team from the Royal College of Paediatrics and Child Health interviewed Countess staff and completed its report. Among its findings, Aviv said, were that nursing and medical staffing levels were inadequate and that increased mortality had been present not only on the neonatal unit, but also on the maternity ward, where stillbirths had risen. The Royal College team was impressed by Letby’s professionalism, and it noted that other staff on her unit were “very upset” about her removal. The report concluded, as Aviv described it, that the senior pediatricians had made allegations based on “simple correlation” and “gut feeling,” and that they had a “subjective view with no other evidence.” 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 a public statement, the hospital acknowledged that the Royal College’s review had revealed problems with “staffing, competencies, leadership, team working and culture.”
The hospital reportedly upheld Letby’s grievance, and in January 2017 the chief executive Tony Chambers told the board that he was seeking “an apology” from the consultants and to have Letby back on the unit as soon as possible. The piece said Chambers “was formerly a nurse,” reflecting the common misconception that healthcare leaders stop being nurses when they no longer provide direct care, an assumption that is very unlikely to be applied to physicians.
Letby’s consultant colleagues go to the police
Brearey and Jayaram “felt they were being silenced by a hospital trying to protect its reputation.” For months, Aviv said, they wrote emails to hospital management, continuing to try to get Letby out of the unit. In April 2017, the hospital allowed Jayaram and another pediatrician to meet with the local police. Jayaram reported the police’s reaction: “Within ten minutes of us telling the story, the superintendent said, ‘Well, we have to investigate this. It’s a no-brainer.’” Ten minutes.
In May 2017, the police launched “Operation Hummingbird,” with Brearey and Jayaram providing what one detective called the “golden thread” of the investigation. That same month, a retired pediatrician from Wales named Dewi Evans, who Aviv said had been a “paid court expert” for more than 25 years, saw a report in his local newspaper about the investigation and injected himself into it. After driving four hours to meet with the prosecution, he eventually became the prosecution’s main expert. Evans reportedly pursued a number of theories as to how Letby might have conceivably killed the infants, mainly through causing an air embolism and injecting insulin, although the evidence for those theories seemed to be very tenuous.
In July 2018, more than a year later, Letby was arrested for multiple counts of murder and attempted murder. In her house the police reportedly found a note with the heading “NOT GOOD ENOUGH,” and phrases scrawled on it including “I can’t breathe”; “I’ll never have children or marry I’ll never know what it’s like to have a family”; “WHY ME?”; “I haven’t done anything wrong”; “I killed them on purpose because I’m not good enough to care for them”; and “I AM EVIL I DID THIS.” Not surprisingly, these phrases had a negative effect on Letby’s defense and her public image. She struggled to explain what she meant, and how these statements reflected her deteriorating mental state, which seemed to reflect self-loathing, a fear that her practice may not have been good enough to save the babies, and that others might see her as evil as a result. She denied killing the babies on purpose. and said that she had written the notes in distress after having been removed from clinical practice.
After this arrest, Aviv said, the hospital’s pediatric consultants arranged a meeting to discuss expressing no confidence in the chief executive (and nurse) Chambers, who resigned before the meeting. A physician named Susan Gilby, who supported the consultants instead of Letby, took over. The police searched Letby’s property, including digging up the back garden, and apparently found nothing incriminating. Letby was arrested again in 2019, questioned, and again released.
Letby goes to trial
In November 2020, Letby was arrested a third time, and this time she was charged with multiple counts of murder and attempted murder. She was denied bail, remaining in prison until her trial began in 2022. According to Aviv, at the start of the trial Letby’s lawyer Benjamin Myers told the court that following her several arrests, Letby had been diagnosed with post-traumatic stress disorder, and that after two years in prison, as well as a recent move to a new facility, her psychological stability had been “blown away” and she was “incoherent,” unable to “speak properly.”
Aviv said that a key part of the prosecution’s case against Letby was a diagram that was “shared by police” and appeared extensively in media coverage. On the vertical axis of this diagram were 24 “suspicious events,” the seven infant deaths and other sudden deteriorations, while on the horizontal axis were the 38 nurses who had worked on the unit during the period, with X’s marked for each event that had occurred while they were actually on the unit. The chart indicated that only Letby had been on the unit for all the events. Therefore, apparently, Letby must have intentionally caused all the events, regardless of the specifics of the events, how many shifts she was working relative to others, what she was actually doing at the time of the events, and what events had been omitted from the chart. This primitive illusion of logic “gave an impression of mathematical clarity and coherence, distracting from another possibility: that there had never been any crimes at all,” as Aviv noted.
Aviv also described problems with the trial’s expert testimony. The physician Evans apparently submitted “some eighty reports,” laying the foundation for the prosecution’s case, which also relied on five other principal experts. At one point, Letby’s lawyer Myers asked the judge to strike evidence by Evans, noting that an appellate judge had recently characterized one of his reports in another case as “worthless,” but that request was denied. The prosecution experts seemed to grow more sure of Letby’s guilt as the case, and the national media frenzy, went on. Aviv described early opinions by some, including Evans, that at least one of the babies had been at great risk apart from anything Letby might have done, with multiple possible causes of death. But at trial they seemed to have settled on air embolism. Aviv recounted a priceless exchange in which Myers repeatedly asked Evans what evidence supported that theory, and Evans simply gave variations on the response that the “baby collapsed and died.” In another case, after it emerged that a baby Evans proposed had died from air pushed through a nasogastric tube may not have had such a tube, Evans reportedly suggested that the baby had been smothered.
A physician expert named Michael Hall was expected to testify for the defense, but he was never called. Aviv said Hall was expected to point to flaws in the prosecution’s theories, particularly about air embolisms and the failure to consider the role of the care for the NICU babies’ mothers, which had apparently been a factor in other recent U.K. scandals involving high numbers of newborn deaths. Hall did not know why the defense did not call him, but wondered if it was considered risky that he would have to say he did not know why the babies died. But, he apparently told Aviv, “just because we don’t have an explanation doesn’t mean we are going to make one up.”
After the prosecution’s case, the defense sought dismissal of the case, arguing that the air embolism evidence was so unreliable it could not support a guilty verdict. The defense reportedly went on to call as witnesses only “the hospital’s plumber, who spoke about unsanitary conditions, and Letby, who testified for fourteen days.” Aviv’s account of Letby’s testimony makes for difficult reading, as the prosecutor pushed the anxious, easily startled, barely functioning witness to explain each death, accused her of lying, and tried to get her to agree that she killed the babies, which she denied. Letby did apparently manage to suggest that the hospital had systemic failures, but some of the senior pediatricians “apportioned blame on to me.” The jury deliberated for weeks, apparently struggling to reach a unanimous decision. In August 2023 it convicted Letby of 14 charges, though only three unanimously. She received 14 life sentences. Letby attempted to appeal, but this was rejected, after the New Yorker article appeared. In July 2024, Letby was convicted of attempting to murder another very premature baby; Jayaram said he saw her standing nearby when the baby’s oxygen levels dropped, as a result of a dislodged breathing tube. In October 2024, her attempt to appeal that conviction was also rejected.
Recent developments in Letby’s case
In recent months, there have been some reasons to hope that Letby’s case will be re-examined. Health experts worldwide have questioned the strength of the evidence used to convict her. And in early February 2025, an international panel of neonatal experts released a report that examined every case involved in Letby’s convictions and concluded that there was no persuasive evidence that she had intentionally caused any of the deaths. Instead, the panel found, all the deaths appeared to be the result of “natural causes or bad medical care.” Also in early February 2025, Letby’s new court lawyer Mark McDonald sought further review of the case by the U.K. Criminal Cases Review Commission, which can refer cases back to the appellate court if it finds there has been a potential miscarriage of justice.
Hear no evil
Aviv’s New Yorker story highlighted the restrictions on public discussion of the case imposed by the U.K. judicial system. This seems to have prevented Aviv from getting any information from Letby, her lawyers, or the hospitals described in the piece. It also squelched dissent by outside experts who could see how weak the prosecution’s technical case was, and it even distorted the text of the New Yorker story itself. Aviv reported that two outside experts who had publicly questioned the prosecution’s case, a Dutch professor of mathematics and a California scientific consultant, had received letters from U.K. police “ordering them to stop writing about the case” and threatening them with potential arrest. And Aviv noted that in October 2023, The BMJ, the U.K.’s leading medical journal, had “published a comment from a retired British doctor cautioning against a ‘fixed view of certainty that justice has been done.’” Aviv said the journal later removed the comment “for legal reasons,” but left up other editorials and comments that did not question Letby’s guilt. Aviv observed that “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.” Such issues are not unique to nurse defendants, of course, but they would seem to make it harder for a nurse like Letby to resist the power of legal, medical, and media establishments to dictate the prevailing narrative in their own interests.
Breaking point
The piece made clear that the clinical setting in which Letby operated was deeply flawed, and that the apparent dysfunction there was an obvious factor in the adverse health events. Aviv explained that the National Health Service (NHS) has “totemic status in the British psyche” and “inspires loyalty and awe even as it has increasingly broken down, partly as a result of years of underfunding.”
The unit for newborns where Letby worked was reportedly “outdated and cramped.” Brearey himself had told a local newspaper that neonatal intensive care “requires more equipment which we have very little space for” and that “the risks of infection for the babies is greater, the closer they are to each other.” As the hospital’s plumber testified in Letby’s defense, the plumbing was a mess, as the pipes “often leaked or were blocked, and sewage occasionally backed up into the toilets and sinks.” Sewage presents a risk of infection, especially for vulnerable premature infants. Many of the infants seem to have had symptoms suggestive of sepsis, and we can’t help but wonder if the presence of sewage in the NICU’s sinks might have been a factor. Many authorities would have shut down a unit for such an apparent failure to protect vulnerable babies.
The unit was reportedly understaffed and at times chaotic. There was only one neonatologist. Aviv said that an inquest for a newborn who died there in 2014 “found that doctors had inserted a breathing tube into the baby’s esophagus rather than his trachea, ignoring several indications that the tube was misplaced.” The infant’s mother told the Daily Express that “staff shortages meant blood tests and X-rays were not assessed for seven hours and there was one doctor on duty who was splitting his time between the neonatal ward and the children’s ward.” Aviv says that in 2015, the infant-mortality rate in England and Wales rose for the first time in a century, and two thirds of the U.K.’s neonatal units were understaffed. That year the Countess was treating more babies than in the past, and they had lower birth weights and more complex needs. Letby had just finished a six-month course to become qualified in NICU nursing; she was one of only two nurses on the unit with that training. A senior nurse on the unit reportedly told Aviv that there were “massive staffing issues, where people were coming in and doing extra shifts. It was mainly Lucy that did a lot.” (Letby’s colleagues later told us that she was saving for a house, so she worked as often as she could.) It would be only natural, then, for her to appear often on a chart showing who was working when adverse events occurred, we imagine. At one point, unit nurses reportedly called Letby when she was off-duty “because they didn’t know how to give a baby intravenous immunoglobulin treatment.” Letby texted a friend that “staffing really needs looking at,” describing the unit as “chaos” and a “madhouse.” A senior pediatrician named Alison Timmis reportedly wrote to the chief executive Chambers that unit staff were “chronically overworked,” and that in recent weeks she had “seen several medical and nursing colleagues in tears.” Physicians were working shifts longer than 20 hours, and the unit was so busy that it ran out of incubators several times. Timmis wrote that this was unsafe and “at breaking point. When things snap, the casualties will either be children’s lives or the mental and physical health of our staff.”
A nursing story
All of this makes it easy to understand why, as Aviv put 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.” Indeed, the piece provided a powerful example of the dynamics of apparent nurse scapegoating, even without the context of RaDonda Vaught and the other recent U.S. cases. The piece did discuss several striking parallel cases in Europe. It noted that in 2022 the Royal Statistical Society published a report, “Healthcare Serial Killer or Coincidence?”, that described recent cases in Italy and 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 report highlighted the “dangers of drawing causal conclusions from improbable clusters of events.” One of the report’s authors, William C. Thompson, an emeritus professor of criminology, law, and psychology at the University of California, Irvine, told Aviv that healthcare murder cases are especially prone to statistical errors because they involve a choice between two unlikely theories: that a series of unexplained deaths was just a coincidence, or else 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.” Aviv also quoted Burkhard Schafer, a law professor at the University of Edinburgh:
Looking for a responsible human—this is what the police are good at. 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.
Yet Aviv stressed that the U.K.’s “public conversation” treated the reports of the poor care on Letby’s unit as “irrelevant,” with the prosecutor telling the jury that the defense was “gaslighting” them by suggesting that the hospital was at fault. This reminds us of the 2010 case of Texas nurses Anne Mitchell and Vickilyn Galle, who were fired by their hospital and prosecuted for anonymously reporting improper medical treatment by Dr. Rolando G. Arafiles, Jr. to the Texas Medical Board. The nurses were acquitted and later won a civil suit against the physician and the sheriff responsible. In addition, Arafiles pled guilty to misuse of official information and retaliation, a felony. He was sentenced to 60 days in jail, fined $5000, and surrendered his Texas medical license. The sheriff lost his job and was sentenced to 100 days in the jail he had previously supervised.
Letby’s attorney himself assured the jury that the case was not about the NHS. At the time of the article, Aviv said, Letby’s ward remained in a downgraded status, caring only for babies who were older and less sick, and it had more consultants. Even so, it had apparently seen a rise in adverse events on the maternity unit, including unplanned hysterectomies. Aviv said an investigation by the U.K.’s Care Quality Commission
blamed a combination of factors that had been present in many of the previous maternity scandals, including staff and equipment shortages, a lack of training, a failure to follow national guidelines, poor recordkeeping, and a culture in which staff felt unsupported. It went unstated, but one can assume that there was another factor, too: a tragic string of bad luck.
It went unstated, but we assume Aviv also saw that factor in Letby’s experience. This New Yorker piece was less about the nursing profession itself than about what may have been a grave miscarriage of justice. It did not tell readers much about how U.K. nurses save babies or their mothers, or how nurses set them up for a better life. But it excelled at showing how a skilled, conscientious nurse could end up apparently taking the fall for an entire weakened health care system, or perhaps for a system that might be able to save some vulnerable patients, but not all of them. No NICU on Earth can save every premature baby. And nursing, despite recent advances, remains underpowered relative to its importance. In particular, it remains less powerful than medicine, which still has some of the classic flaws that go with excessive power and deference. The basic outline of Letby’s apparent experience might have happened to a lot of people. But being punished for adverse events because that is convenient for others —despite trying valiantly to save lives in a broken system — that is very much a nursing story.
See the report: “Healthcare Serial Killer or Coincidence?” Statistical issues in investigation of suspected medical misconduct” by the RSS Statistics and the Law Section, September 2022
See the February 2025 report by the international panel of 14 neonatologists. “The panel was convened by Canadian professor Dr Shoo Lee after he claimed the prosecution misinterpreted a 1989 paper he had written on air embolisms, which was used in evidence at Letby’s trial.” “We did not find any murders,” the experts concluded.
The Lucy Lethby case cannot e compared to the Rhonda DeVaught case. False equivalents.