I assume you may already know about the so-called Letby case, where a neonatal nurse was accused and charged for several neonatal deaths, deemed intentional by the UK courts.

A panel of neonatology experts have now reviewed the (legal) evidence and found that (medical) evidence speaks for alternative and natural causes of death.

I find it hard to fully grasp the whole situation, first of all, if someone being unguilty is declared guilty, that is disastrous at so many levels, from the imprisoned person to the society as a whole. Calling this "Epic fail" is not enough.

I wanted to share a comment by Prof Neena Moody in London, a piece to the point.

What do you think and feel around all this?

https://www.theguardian.com/commentisfree/2025/feb/12/lucy-letby-case-trial-justice

This case is hugely concerning, but we do not know the facts. All of us who take part in mortality review meetings know that we can not always explain every death; we sometimes disagree on the primary cause. We all have examples of cases where we thought one cause, but PM revealed another. What is written in the notes, or recorded, does not present the full picture. Sometimes there are 'gaps' because we were too busy to write, or forgot.

I listened with interest to the presentation from Shoo Lee; the panel seem 'clear' they have an alternate explanation (other than deliberate harm) for every case. That is quite a brave claim. I do not know the make-up of the panel members, but I would also make the point that neonatologists with strong academic credentials are not necessarily any 'better' at determining clinical management, and working out what might have happened i.e. the sequence, than 'jobbing' neonatologists. If my own baby needed resuscitating I would rather have a neonatologist with zero publications who had intubated 400 babies in the last 10 years, rather than published 400 papers but resuscitated none!

I am not saying they are wrong or right; or that Letby is likely innocent or guilty. I don't know, and opinions are cheap. It is clear the 'system' has failed on multiple levels and we need a full enquiry. To fully review a single death on a NICU takes around 2 hours and requires 4-6 (or more) experienced neonatologists; also nurses, pathologists, obstetrics; ideally with at least 1-2 external (non-conflicted) neonatologists. How much time do you all have in your job plans to undertake this activity?

Also note, this unit typically had 2 deaths per year until 2015 and 2016 where the annualised rate is closer to 8 - the probability of that happening by chance is less than 1%. Of course if you take 100 neonatal units, then a 1% chance happens to one unit every year (on average). But who in this audience would have watched 8 deaths a year and said "...oh that is bad luck" or "...we used to be very good, why are we now so bad?"

[Stefan - can you add me a legal disclaimer !!]

I hereby share a legal disclaimer to everyone participating in this thread !

Yes, you are very right one needs to be careful with opinions. Being declared guilty is a black-white decision, but like medicine, it is based on probabilities (although, if someone is shot by a person 1 meter away and holding a smoking gun, the probability is almost 100%!). And to be honest, I was not much aware of the case before it showed on my various radars about "experts", so I am not into any details.

Still, if someone is declared guilty based on reasoning and no technical evidence, then it is mind-shaking to think about all stakeholders in this case. Letby herself, parents of the diseased infants, staff members, everyone in public authorities engaged etc-etc. So many levels of impact.

My personal mind-shake is also about that I connect to similar cases in Sweden where HCPs was judged guilty in processes not living up to standards (later found out). In one legal case here, a GP and a forensic pathologist was sentenced for cutting up the body of a dead woman with drug addiction, and it all seems this legal process was just so incorrectly managed (the "da Costa case") back in the 1980s. Some pretty basic journalism, that resulted in a recent documentary, has revealed so many strange details, and it all just seems those two are completely innocent. Since that case went up to the highest court, it seems though that their sentences cannot be re-assessed in a new legal process. The other case I connect to is the "Astrid Lindgren case", this was about an anesteiolgoist accused for killing a former extremely preterm infant admitted to the PICU after discharge from the NICU, that was like a "witch process" from the mediveal times!

If there are some good public reading etc, please share some links for background etc. I tried to google but the web is so full of stuff about this, I find it hard to find good sources.

Hi Everybody

I am Nestor Vain, senior neonatologist from Argentina.

I became interested in the Letby case because currently there is an ongoing trial of a similar case in Argentina where a nurse is accused of 5 murders and 8 attempts. Many HCP are accused of delay in implementing a judicial investigation including the chief of Neonatology, the Hospital Director and up to the Minister of Health of the Province (because they were only doing internal investigations with no police involvement).

In this case the infants were all rooming in after being born at term and vigorous, in a period of 4 months, at a 5000 deliveries/year hospital.

Back to the Letby case, I also saw and heard the press conference by Sho Lee and Neena Modi. I personally now 6 of the very highly qualified professionals and them and the other 6 are extremely knowledgeable in Neonatology. I understand what Nick expresses about being in the NICU with practical activity and not only academic but I am also sure that the panel, which by the way worked pro bono was extremely careful at the analysis and they are very strong at their conclusions. They do not shoe much doubts.

Furthermore from what I understood Lucy Letby did not have a well trained neonatologist (Academic or not) expert witness in her defense. If I was the authority who now decides I would not sleep well without generating a revision or a new trial!

Thank you.

Nestor

Hi Nestor, I agree; the trial was inadequate, the 'expert witness' is not credible (not an experienced NICU consultant) and I agree the experts on Shoo's panel are experienced. But, they made some comments that I need to know more about - I don't know the cases - but I do not believe you can say all these cases are "natural" and the deaths are due to poor medical management. Of course, many of the deaths might be 'natural' = 'bad luck' but surely that does not easily explain all cases.

There were comments that "you should never use a size 2.0 ETT" - I have used very successfully in difficult cases to stabilise a baby ;

Comments that 96% leak means there is not effective ventilation - that is too simple an explanation. Has anyone else ventilated a baby with a large leak successfully? Yes. Of course we want low leak, but just because the expired gas passes out around the tube does not automatically mean you are not ventilating the baby. From what I heard (and there may be more) the conclusions seem too 'black and white' to say "there are no murders".

Pro bono is great - but we are all far more bothered by our reputation than money! But pro bono does not equal "no conflict". And confirmation bias works both ways - maybe they started out believing she was probably innocent and then reviewed.

I agree - we don't know the truth and we need a review ; but the reporting of the panel conclusions is not clear

We need a debate!

I am not a lawyer, etc. etc.

99 is a medical forum and so we of course focus on the neonatology aspects of the case, but as someone who spends a great deal of time thinking about causal inference and bias in study design, the most obnoxious part of the Letby case is the "grid" shown at trial purporting that Letby was the only person present when all the listed events took place and that, therefore she was guilty. The problem of course is that, as the panel review discussed here addresses, its not clear all (any?) of the events in the grid were crimes and, worse, it appears the events on the grid were chosen specifically to include only events Letby was present for (reverse causation).

I found a long article about the Letby case on Wikipedia, very interesting read.

I personally feel confused on a higher level… There are many suspicious circumstances. But legal conviction is about ”certainty beyond any uncertainty” and it seems there is indeed lack of technical evidence and that the court decision is based on reasoning around probabilities.

https://en.wikipedia.org/wiki/Lucy_Letby