The Lucy Letby Trial & Some Of The Strange Things That Happen In Hospitals

Anyone who has worked in a hospital for a period of time, has seen some strange and unexpected things. Fortunately most of the health care workers are ethical, and worry more about harming a patient accidentally, as opposed to contriving diabolical and murderous schemes.

It is not unusual to see mistakes being made, for to err is human, and many health care workers are working long hours, often on little sleep. Mistakes get made when people are tired, burnt out, distracted, or lack experience in a certain area. Often mistakes are made because the proper systems are not in place to prevent errors.

Those who work in hospitals become aware of staff conflicts, affairs, petty grievances, and bizarre events with psych patients, or unruly admissions at 3 am in the emergency departments. It is all part of the job.

But those poor people who worked at the hospital in the UK alongside Lucy Letby, had far more to be concerned about. What happened there takes things to a whole new level of stress for those involved.

Of all the patients a doctor or nurse ever encounters, the most vulnerable, and the tiniest, most innocent, of all human beings, are the premature babies. When I worked in LDR, the greatest fear was having to resuscitate a one and half, to two pound premature baby. Oftentimes your two hands are almost as big as they are.

Everything about them is miniature. Their stomachs are hardly bigger than a walnut to begin with. Their lungs are tiny. Their veins are the size of dental floss. They have monitors, central lines, ventilators, nasogastric tubes, and heat regulated incubators, all of which have to be watched like a hawk.

Yet, like any other infant, they need ordinary care and gentle human touch. They need to be changed, washed, fed, and have close contact with their parents, and caregivers. Many of them are incredibly resilient, and spunky in spite of it all. If they can be stabilized, they can thrive and catch up.

I knew a nurse whose grandmother was one of a set of triplets. All three were girls. Two of them were identical twins, yet to look at pictures of them, they all looked identical. They looked like perfect clones of each other.

They were born in Scotland in the late 1800’s, and each was said to have weighed about two pounds. At the time, they were handled with common sense, because they did not go to a NICU. They were put on the bun warmer of a wood burning stove, and fed with an eyedropper to begin with.

All three lived to their late 90’s, and the house they grew up in became known for decades to follow, as the triplet house. Apparently, no one could tell them apart.

In one of the hospitals I worked at, there was one naturally born set of triplets born there in the 1950’s. The picture of the happy family was displayed on the wall in the LDR for many years.

As it turned out, those triplets on the wall, also had their babies at the same hospital years later. It was quite a thrill to see them grown up, since their picture had been on the wall, and only the oldest nurses who worked there remembered the background story, and details of their birth.

Twins are fairly common, but in the absence of fertility treatments, triplets are really quite rare. Many midwives, nurses, and doctors who work in LDR can go through their entire careers without seeing a set of triplets come through.

The jury is out following a lengthy murder trial involving Lucy Letby, a neonatal intensive care nurse in the UK. She was a fairly new grad when it all began. She is now thirty-three years old, but the initial suspicions, and police investigation began several years ago, when she was in her mid-twenties. 

She took a post basic certification in neonatal intensive care nursing, which gave her a higher band level in the hierarchy of the nursing profession. It qualified her to work with the sickest babies. The hospital did have some basic protocols regarding what they could and could not handle there, so they shipped babies who were very sick or premature to a more advanced tertiary care centre. From the exchanges of texts with her co-workers, she seemed to think this certification made her vastly superior when it came to the assignments she expected. She made frequent reference to the incompetency of others. 

It did not come up in the court transcripts that there had been a significant change in the number of high acuity beds in the hospital she worked at. Nor was there any clear evidence the hospital changed its policies, and kept babies they previously shipped out. So in spite of claims about the acuity being higher, the years in question, with the huge spike in deaths and adverse events, was not related to any significant change in hospital protocols for that particular NICU. 

As far as staffing levels, as it is with most hospitals, they were busy, with a lot of available overtime. However, if one nurse works extra shifts, it does not explain how she can be the common denominator in all of the adverse events. There are many full time staff members on a busy ward, and it is common for some of them to pick up extra shifts. 

The babies who were targeted were triplets, twins, and single births. Most were premature, but one of them was near term, and was admitted because of an infection. One of them was a hundred days old, and the parents were looking forward to finally taking the baby home.

So, it’s not as if all the victims were so precarious, they could collapse at any moment. Some of them were quite stable. Their sudden demise was a devastating shock, with no explanation or forewarning.

The time frame of the large increase in baby deaths, and unexpected collapses on that particular unit, happened in 2015 – 2016. After the police investigation was launched, she was arrested twice, then got out on bail. The third time she was arrested, they did not let her out, so she has been incarcerated for a couple of years at least, maybe more.

I don’t think many people are envying the job of the jury. They listened to months and months of evidence from doctors, co-workers, police interviews, communications between Letby and co-workers via text, and social media such as WhatsApp. They heard the agonizing testimonies of parents of the babies who had been under her care, and the details of what happened to them. 

There was a couple thousand FaceBook searches to evaluate. They also had to wade through pages and pages of notes, patient charts, lab work, and hospital handover sheets, as well as the diary and distorted, haphazard notes Letby wrote, that were piled up in her own residence.

She wrote post it notes, creating a collage, and jumble of sinister words. To many, they were interpreted as a confession. Yet there was also a mixture of denial, and confusion expressed as well, so how does anyone interpret the meaning of those words? Regardless of whether the admissions are taken seriously or not, one thing for certain, is they demonstrated a jumble of disjointed, and distressing thought processes. 

You would think such distortions of thought processes, would have been evident in the charting she did at work, but the days of narrative nurses notes are long gone. Most of what is charted in modern day nursing, is simply signatures for medication administration, fluid balance sheets, graphs to chart vital signs, and any significant observations etc. Therefore, in the absence of writing any kind of cohesive narrative in the nurses notes, it would be much more difficult to pick up on distorted thought processes.

Writing is a reflection of thought processes. In addition to speech, it is how we communicate. If it does not make sense, it should be a red flag, when it comes to those assigned to roles involving complex care of children, and neonates. Even the many text messages she exchanged were more like fishing expeditions. Fishing for sympathy, fishing for attention, fishing for compliments, as well as an attempt to control the narrative. 

The hospital notes, and handover sheets are supposed to be left at the hospital for shredding after each shift, but for unknown reasons, she took hundreds of pages of random papers home with her.

It is absolutely mind boggling. After listening to many of the court transcripts, in my opinion, it is clear that someone was causing intentional harm on the ward. There is no way insulin could get put into a TPN bag accidentally.

It is also highly unlikely that infants who are stable, thriving, and in some cases, ready for discharge, would suddenly go into respiratory or cardiac arrest. Things do not happen out of the blue, without an explanation. Perhaps she was too naive, and inexperienced as a nurse to know that much. You can’t just chalk everything up to bad luck, when you are dealing with human lives. 

If you are standing at the bedside, or monitoring and observing a sick patient for hours on end, you will notice if there is a problem, long before they go into a cardiac arrest. Even if there is a rapid deterioration, there are warning signs. So for two babies of a set of triplets, and a set of twins to die suddenly, and without warning, begs an explanation.

There were also cases where another nurse went on her break, leaving Letby to watch over a stable infant for an hour, or even as little as fifteen minutes. They would return from the break, or the errand, to find the previously stable infant in a catastrophic collapse.

Initially when I heard the various podcasters make claims about Letby having an affair with a doctor, I thought it was irrelevant. But – it appears it was relevant. Because they introduced it as evidence, and also as a motive, because the prosecution believed she was keen to summon the doctor to her side,  so they could “work together”. It was believed she orchestrated the crisis to get close to the doctor, on at least some of the occasions.

Afterwards, she would share long texts back and forth with the doctor, seeking reassurance, and sympathy for what she had to deal with. Now I can’t help but wonder what has happened to his life, in the aftermath of it all? What a chaotic mess it has brought to the reputation of the married doctor, the other doctors, nurses, admin, and the ward in general.

She also had other friends among her co-workers who she texted back and forth with, socialized with, and carried on about all the drama on the ward. She worked full time, worked a ton of overtime, and when she was off, was constantly texting, and meddling in all the affairs of the ward. When she said her job was her life, she wasn’t kidding.

The number of lives impacted cannot even be measured. Whatever the outcome, there is no going back to normal for any of the people involved. The trust in the system, the trust in the nursing staff and hospital, and the stress upon the doctors and nurses who testified, must be astronomical. Some of those babies whose lives were nearly snuffed out during the NICU ward reign of terror, are now seven years old.

One of the things that really stood out to me, was some of the language she used. Or at least it was language that was read out during the trial, when the various text messages between co-workers were divulged.

I realize language, especially slang terminology, differs from country to country. But I can honestly say in all of the years I worked in hospitals, I never heard a nurse or doctor describe a patient as looking like “rubbish”.

In Canadian terms, it would be more likely to be “garbage”. While listening to the trial, I heard the term rubbish used several times, and if I heard it correctly, and in the context it was presented, it confirms in my mind, how those who abuse power will dehumanize their victims. 

In hospitals, there is definitely some dark humour, bad language, and things not meant to be repeated. So I guess this trial, will be a lesson for today’s technological world, in that what is put into a text, WhatsApp, emails, etc. does not simply go up in vapour, as private conversations do. 

However, as far as describing a patient’s condition, I have heard patients described as looking very ill, limp, pale, non-responsive, gasping, anxious, demanding, combative, and various other adjectives. Sometimes difficult patients were called manipulative, but even that was frowned upon.

I never once heard of a patient, or a ward referred to as garbage. I suppose the closest thing to it would be when there are a lot of management problems, and conflicts, causing people to refer to it as a toxic workplace. But toxic refers to a poisoned environment, and is understood to be related to the culture, such as a culture of bullying. It is still not garbage, in the sense most of us think of garbage. Garbage has no value. It’s to be disposed of. 

The period of time for all of the allegations, was concentrated over a time span of about two years. Ten of the babies lived through the ordeals, and at least one of them ended up with severe brain damage and lifelong disabilities. Who knows what the long term effects on all of them might be?

If what was presented during the trial is true, with many of the babies attacked more than once, it is almost like a case of torture. The concept of force feeding large amounts of milk and air through a nasogastric tube, or injecting boluses of air intravenously, or putting a person into insulin shock, as well as using an instrument to cause bleeding in the throat, are things we cannot fathom being done to an adult, much less a tiny neonate. 

If those allegations are true, I can honestly say, we have no hope of ever understanding why anyone would do such things. Some of her own handwritten post-it notes, touched upon her own mindset. Once the trial and verdict is all over with, there will be laser focus on some of the evidence that was presented. Because when all the speculation is over and done with, the nitty gritty bits of raw truth will rise to the surface. 

The trauma for the families, as they sat through the trial, must have been heart wrenching. Many of them had to testify as to the events leading up to the attacks, and near misses on their child. Others did not get to take their child home, and sat through the trial, listening to the evidence, and what was believed to have taken place.

In Eastern Canada many years ago, there was a huge investigation over four baby deaths on one ward. The nurse in question was ultimately exonerated. Initially they believed infants had been poisoned with digoxin. However it was later established that there were other explanations for the high levels of digoxin in their blood. That case garnered one of the biggest murder investigations in Canadian history.

However, in the Letby case, there were far more adverse events, with more victims, and more than just one mechanism of injury. The two cases are not even comparable, even though both cases led to protracted murder investigations, with a nurse as the primary suspect.

I do recall reading about a case in the US, where a respiratory technician was intentionally giving patients boluses of air. He was eventually charged and convicted. He killed a number of adults who had the misfortune of crossing paths with him.

Part of the difficulty in making the diagnosis, is that air embolus through an IV tubing is quite rare, especially in a NICU, so it is not something the neonatologists would normally see.

The IV tubing for all high acuity patients, is run through a pump that is very sensitive to even tiny air bubbles, and will sound an alarm if there is air in the line. If a central line is being put in, the tubing is always primed first, so all precautions are in place, when it comes to air in IV tubing.

In the case of adults, a few bubbles of air would be quickly absorbed, and would be of little consequence. In the case of a tiny premature infant, it would not take that much air to cause a stroke, heart attack or respiratory arrest. But the big question is, how could it happen?

How could insulin get added to IV bags? No one would ever do that, unless they were intentionally out to harm a patient. It is sabotage of the worst kind.

When you think of the fact a nurse in the US was charged with homicide for making a medication error that killed a patient, she was not even in the same orbit of wrongdoing; not even close, compared to someone who would intentionally tamper with IV bags, and intentionally cause air emboli.

In the case of the nurse who made the medication error, even the family had sympathy for her, as she was overwhelmed with remorse. She made a mistake, and even though she bypassed some basic safety checks, she did not intend to harm the patient. She was in a rush, distracted, and did an over ride on the medication system, which was apparently something many nurses did where she worked.

Who knows what the outcome will be on the NICU trial? But whatever the outcome, there will be a loss of trust for a long time. How does a facility screen for disordered individuals? How could they have screened her out, when she was a young, keen, fresh faced new grad? No one would have dreamt that hiring her would have led to murder.

According to evidence given during the trial, doctors raised concerns with the Director of Nursing months before anything was done. They then took it to a higher level of administration, and never got a reply for another three months. 

The first action taken was to remove her from night shift, because there was a spike in adverse events during the nights shifts when she was working. There is less supervision on night shift, and fewer people around to respond to the collapses as they are called in the UK. In Canada they are called Codes. 

The next action taken, when the high rate of adverse events continued to be linked to her conduct at work, they removed her from the ward, and gave her an assignment involving clerical duties. She was not happy about the reassignment and filed a grievance. It is difficult to understand why she did not clue in to the gravity of her situation. 

Many people surmise based on what developed there, followed by the trial with a global audience, will lead to changes. They suggest there will be CTV cameras put up at every bedside. But the trouble is that if a person cannot be trusted, they should not be there.

Nurses are always flushing IV’s, adding medications to IV bags, and tubing, and do many tasks that cannot easily be monitored or even seen. If someone really wants to do harm, they can surreptitiously add a drug, without charting it. How easy is it to see on a camera, whether or not there is saline in a syringe – or air?

One of the key lessons from the entire saga, will likely be the recognition of the need for a protocol of some sort to follow, as soon as suspicions arise. There were four doctors who expressed concerns for months, before Lucy Letby was taken out of the NICU, and no longer given access to vulnerable babies. The hospital administration was initially reluctant to do an investigation. In my opinion, one of the central issues, was the reluctance to investigate.

How many people in a hospital setting believe they should be trained in investigative police work? How many even know when the line has been crossed? It is probably something people should be educated about, because otherwise the denial is so prevalent and ingrained, it places more and more patients at risk. More harm is done, even though the red flags have been setting off alarm bells for months, and sometimes for years.

One of the main issues, is that people do not recognize abnormal psychology. We tend to assume other people think the way we do. Most nurses are caring, and ethical, therefore it is easy to assume all nurses must be trustworthy and caring. In reality, many nurses are highly ethical, others are just there for the job, and a small minority could care less. 

The truth of the matter is that all professions have the occasional rogue. The higher the stress levels, or the more opportunities there are, for the aberrant characters to get through the system, the longer it goes on. It has been know to happen in police forces, and within the educational system as well. Churches too. I think most of these situations progress through a series of steps.

The first steps, with all destructive behaviours, is when the person who wields power, abuses power. They do so because they place their own interests, whether it is financial gain, attention, self exaltation, or control and dominance – over and above all else. They use the victims as a means to advance a selfish agenda. They do not comprehend the boundaries crossed, when they have a conflict of self interest that leads to an abuse of power. 

The following steps, involve a high level of deception and manipulation. A person who abuses power is self exalted, and deluded about their own importance. They play God, but in the most pathetic way imaginable. They have too much pride to recognize the error of their ways. They view cunning and deviousness, as being brilliant and clever.

Another symptom of those who seek to harm and abuse others, is that they will target a certain individual, or a certain type of individual. They are like sharks, and to them, vulnerability is like blood in the water. It draws them. They get excited, because they know they can overcome their victim. 

When you think about it, in the case of all predators, they will single out a certain person who is vulnerable. They may feign caring, or pretend the victim is special. They may have delusions about their relationship to the victim. They want to create some kind of bond. I believe it is the reason so many of them take souvenirs, or make claims of deeply caring about the victim. They fabricate a warped attachment, for very strange reasons. In reality, they only care about themselves. The victim is an object, to serve the ego of an apex predator. 

Their superiority allows them to pull strings, and make things happen, according to their own hidden agenda. Not all these behaviours lead to murder. But they do lead to victimization, and damages to the professions, or institutions they work for.

Of all places for harmful actions toward others, one is least likely to be suspicious of a baby nurse. After all, she is not carrying a gun, or doing raids on crack houses. She is not in a high ranking corporate or political role. In fact, traditionally, she is supposed to follow orders, and work within a tightly constrained, task oriented role.  

The worry for many who work in hospitals, if they see questionable conduct, is in making a false accusation, or worse yet, becoming the target of one. Plus all people with a grain of humility recognize they too, can make mistakes. Competency is more of an issue, because criminal conduct is not the norm, therefore denial can cause people to overlook what is atypical behaviour. 

There is a need to avoid falling into the practice of witch hunts, and finding scapegoats for squabbles, staffing issues, and oddball personality types. So it is easier to deny and avoid going down all such rabbit holes, than it is to confront a problematic staff member, and seek an in-depth enquiry.

The spike in adverse events and deaths without a plausible explanation, understandably started to raise alarms. When they put two and two together, and found they were linked to a certain individual, it raised suspicions even more. And there was more, so much more…

In my opinion, anytime a person who is in a professional role, and takes an abnormal interest in a certain assignment involving a child, a vulnerable person, or their family – it is a big red flag. If they seek contact outside of their professional role, it is a also a red flag.

If they try to create a long term bond, or “special” relationship, it is another big red flag. They are setting the stage for victimization. They are in a conflict of interest. If a professional is violating boundaries, it is one of the first clues authorities should be aware of, and should be addressed immediately. If a predatory person gets away with pushing past boundaries, they will go to the next step. A person who will not respect boundaries, can become quite dangerous. Once they have a foot in the door, there are no limits. 

Just as professionals are not supposed to seek romantic or sexual relationships with patients or students, they should also be bound by standards of professional conduct, not to seek any kind of “delusional relationship”.

They do not “love” their patient or student. They are not in a “special” relationship with a patient or student. If they think so, they are likely victimizing the person, and are also delusional as to the parameters, or truth of the relationship they contrive. 

If there is a special relationship, the victim should be given every opportunity to tell their side of the story. Oftentimes, the abuse of power entraps the victim, and no one will listen to them or support them. There should never be an assumption of blind trust, just because someone holds a professional title.

If they are trusted regardless of all the red flags, it means the victim or victims have no recourse. They get intimidated, threatened, dehumanized, and punished for telling the truth of how the relationship came to be what it is. It enables a facade and extension of the initial victimization to go on and on. Therefore, a long term victimization is possible, with countless re-victimizations, scapegoating and victim blaming. All organizations overseeing children, have an obligation to protect those children. 

All professionals should maintain boundaries, and treat all patients, students, etc. in an unbiased, neutral way. They may like some of their clients or subjects more than others, but they should be professional enough to deliver the service in a non-prejudicial manner. So for all professions, one of the first warning signs is when someone in a professional role has an unexplained interest, obsession with, or desire to make connections outside their workplace. 

For all those who abuse power, and seem to think a professional designation or title, or money, or status, can cover a litany of wrongdoing, they are living in a delusional and warped reality. Deception is not sustainable.

When self becomes the monument, self becomes the destroyer of self. Monuments are made of stone, concrete, metal or wood. They have no heart. Many monuments are created as gravesite markers. Therefore, any person who turns their own selfishness, into an object of exaltation and worship, is actually destroying their own soul. 

Hospital staff throughout the UK must be waiting for the verdict with bated breath. The jury must be exhausted. I don’t know if any of them have medical backgrounds, but regardless, the number of cases, and adverse events, is more than any trial I have ever heard about in my lifetime.  It is especially gripping when it is a trial involving a professional in a hospital environment. The jury has a monumental job to do. In most murder trials, they just have one victim to seek justice for. 

Let’s hope they find the wisdom and clarity to be able to follow it through, untangle the web, and figure it out. When this is over, they all deserve a vacation, and some lengthy spa treatments. No doubt they got immersed in a hospital education that surpasses what most people can even imagine.

When health care, and medicine cross over into an incredible and convoluted legal challenge, few things could be more dizzyingly complicated.

How many hours will they end up deliberating? It is anyone’s guess. I am going to take a wild guess and say 108 hours. The reason I am making this guess is because I think they would deliberate for about three weeks, in order to cover seventeen cases. So if a work week is generally 36 hours, three weeks would be 108 hours. 

Like all people who have followed this case, I hope and pray the jury comes through with the right decision. Perhaps when the dust settles, the polices can be put into place to help protect the innocent, and above all, the healing can begin, for those who were directly affected by the stress of it all.

Copyright Valerie J. Hayes and Quiet West (2023). Unauthorized use and/or duplication of this material without express and written permission from this blog’s author/owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Valerie J. Hayes and Quiet West with appropriate and specific direction to the original content.