Evidence suggests more babies have been injured in the care of a British nurse

LONDON – New findings from the BBC suggest more babies in Lucy Letby’s care were harmed – and in one case poisoned with insulin.

The former nurse was found guilty of murdering seven babies and attempting to murder seven others – including attempting to kill two with insulin in the neonatal unit at the Countess of Chester Hospital between June 2015 and June 2016.

BBC One’s Panorama has seen documents suggesting a third baby may also have been poisoned, just hours after Letby took care of the boy.

Medical records show the infant’s blood sugar levels had dropped sharply and lab results suggested insulin levels were suspiciously high.

Panorama has also found that potentially life-threatening incidents involving young children occurred in almost a third of Letby’s 33 shifts during her training at Liverpool Women’s Hospital in 2012 and 2015.

The show’s revelations follow months of criticism of the prosecution’s case in its first trial. A number of experts have questioned the medical evidence used to convict Letby and the way statistics were presented in court.

In August 2023, the 33-year-old was sentenced to life in prison without the possibility of parole. Letby was then found guilty of the attempted murder of a seventh baby in a second trial in July this year and given a 15th life sentence.

The nurse was denied permission to appeal the convictions from her first trial.

Panorama has examined the increasing questions from leading statisticians and medical experts about the security of their beliefs.

But new evidence has also emerged as part of the program that other sick and premature babies may be harmed while in Letby’s care.

We’ve been reporting on the Lucy Letby case for years – that’s why experts are still arguing about it

When the body naturally produces insulin, it also produces a substance called C-peptide. Typically, C-peptide levels are five to ten times higher than the levels of natural insulin.

Letby’s first attempt revealed that blood tests from the two babies showed high insulin levels and very low C-peptide levels.

The prosecution argued that the insulin must have been administered to them and not produced naturally.

Letby’s lawyers did not accept the insulin evidence used in court, but neither did they claim it was false. When cross-examined, Letby herself accepted that the two babies must have been poisoned, but denied that she had done it.

The new evidence, seen by Panorama, shows that a blood test from a third baby Letby cared for in November 2015 also found very high insulin levels and low C-peptide levels.

Laboratory results showed that insulin levels were over 6,945 picomoles per liter – a very high value. If the insulin had been natural, the C-peptide level would have been between 35,000 and 70,000, but the blood test showed it was only 220.

At that time, the neonatal unit consultants assumed that it must be natural insulin. Tests later revealed the baby suffered from congenital hyperinsulinism (CHI) – a condition in which the body naturally produces too much insulin.

But four experts told Panorama that CHI could not explain such an exceptionally high insulin level for the infant – partly because of the low C-peptide levels, but also because a baby with CHI would never produce that much insulin.

Medical records seen by Panorama show how quickly the boy deteriorated after Letby started duty. A blood test conducted at 6:56 a.m. revealed that the infant had a normal blood sugar level of three millimoles per liter (mmol/L).

Letby started her shift at 8 a.m. and by 1:54 p.m. his blood sugar level had dropped to 1 mmol/L – a dangerously low level and a strong sign that the baby had too much insulin.

The boy’s blood sugar levels remained low during the nurse’s shift and he did not recover until she left duty at 8 p.m.

Letby’s new lawyer, Mark McDonald, noted that the baby had a particular problem regulating his own insulin. He also disputed the claim that the baby’s condition could not explain the extremely high insulin levels found in the laboratory.

“One expert may say that, but I have other experts who have a completely contradictory view,” McDonald said. “I’m working on this case day and night. If I thought about it for a moment [Lucy Letby] was guilty, I wouldn’t do that.”

Some experts have also questioned the accuracy of the simple test used to measure insulin in all three cases, called the immunoassay method.

They point out that there is another, more precise test and that only the more advanced test can definitively determine insulin levels in the blood.

There are circumstances in which the immunoassay method may produce erroneous or misleading results, but the test is commonly used and is usually accurate.

Panorama has spoken to leading experts on all sides of this debate. The program found that circumstances in which disruption could occur were very unlikely in relation to the babies in the Letby case. It’s even less likely that three lab tests taken within a few months would all be wrong.

This is a point that Letby’s lawyer McDonald disputes: “It is accepted by all sides that there is an error assessment.” [with the test]but it is the percentage of the error score that is not accepted.”

Panorama has also found that potentially life-threatening incidents occurred in almost a third of Letby’s 33 shifts during training at Liverpool Women’s Hospital in 2012 and 2015.

In one case from November 2012, a young boy collapsed and water was subsequently discovered in his breathing tube – a highly unusual occurrence. The clinical notes confirm that the nurse who cared for him was Letby.

Additionally, a retrospective analysis found that babies’ breathing tubes became detached in 40% of Letby layers. The norm per nurse per baby was 1%.

Cheshire Police are continuing to investigate other cases they believe the nurse may have been involved in, including the incidents in Liverpool.

McDonald plans to take Letby’s case to the Criminal Cases Review Commission (CCRC) to seek a remittance to the Court of Appeal. -BBC