The Ongoing Trial Of UK’s Neonatal Intensive Care Unit Nurse Lucy Letby & Baby Deaths

This case is probably one of the most excruciatingly horrific abuses of power, and betrayal of trust carried out in a modern day hospital setting. The trial is ongoing, but if the allegations are true, it is incomprehensible as to why anyone would intentionally cause harm to the most helpless and vulnerable people in a neonatal care unit. 

Lucy Letby is a former NICU nurse who is being held without bail or in remand for the duration of her trial, which has been going on for months. She is accused of murdering at least seven babies, as well the attempted murder of at least ten more babies, who were under her care, or in close proximity, so she had some involvement in their care.

It is not clear if the neonatal deaths dropped back to previous levels after she was taken out of the loop, but it is consistently reported that the neonatal deaths increased dramatically for a period of time in 2015 and 2016, and in most, or all of the cases, she was present. 

Initially most of the sudden collapses as they are called in the UK, or crashes as they are called in North America occurred during the night shift, with some of them happening on the day shift. This is because on the night shift there is less staff in general, and hospital administration does not work during the night.

It appears there was enough concern about her at one point to take her off night shift, and only allow her to work days. This was long after there were suspicions raised by doctors, and a few other nurses, noting that she was always the common denominator in so many of the unexpected collapses that would happen to infants under her care.

Although the trial is ongoing, and she has not been convicted yet, my guess is that she will be convicted, based on what I have read and heard about so far. It will be a very difficult case for the jury to process, partially due to all the medical terminology, and also because there can be an argument made for reasonable doubt in several of the cases. After all, these were premature babies, with complications and hardships most people cannot even fathom.

However if there is a conviction for one of the deaths, it does increase the probability that she was responsible for other deaths. I do think she will be convicted for at least one of them beyond a reasonable doubt.

It has been determined that the methods she used to kill the babies involved the introduction of a bolus of air into the bloodstream through an IV line, or through the nasogastric tube.

The IV lines are used to administer medication and fluid. The tubing is always run through a pump with a closed and clamped door, with the various settings on the outside of the pump. The settings limit the amount of IV fluid to a certain hourly amount, and are very accurate. In the old days nurses had to stand and count the drops per minute, and calculate the timing, being sure not to overload the patient, especially a neonate, with fluids. For all acutely ill patients, fluid balance is a vital component of managing care.

The IV pumps also detect any accidental air that may pass through the IV tubing. Air can get into the tubing when the IV is initially set up and primed. If there is even a small bubble of air in the tubing, it will not get past the alarm system on the infusion pump. It there is an air alarm, the IV has to be turned off, and the tubing removed from the pump so the air can be manually removed with a syringe. At least that’s the way it used to be, and I can’t really imagine how else the air would be removed. Perhaps there is now a better system to make sure no air gets into the line in the first place. But regardless, an accidental bolus of air in a neonatal ICU would be next to impossible.

I suppose it might be possible for air to be introduced during the insertion of an umbilical catheter, but it seems unlikely, because after the catheter is inserted it is hooked up like any other IV line. However those with more experience working in NICU might have plausible explanations. 

There was another true crime case I watched where a nurse was convicted of killing adults in an acute care setting by giving boluses of air into the blood stream intravenously. The reason it is so deadly is because it causes an embolus to travel to the lungs or major arteries, and will cause respiratory or cardiac arrest, or in some cases a stroke.

The amount of air required to cause death is fairly significant. It is not a matter of allowing a few bubbles of air to pass through the tubing. In those cases the air is absorbed fairly quickly and is of little consequence. The introduction of enough air to cause serious harm or death, is a significant and intentional amount. In the case of the infants, it was determined to be at least 5ml IV and much more when administered into the stomach via the NG tube.

When you consider the size and weight of a premature baby, a 5ml bolus of air is a large amount. In addition to being accused of giving boluses of air into the IV tubing, it is also reported that she did a similar thing, adding excess amounts of air into the nasogastric tube. It is an absolutely horrific and sadistic thing to do, if she did in fact do that. A premature infant has a very tiny stomach and undeveloped digestive system. One can only imagine the pain and duress it would cause to distend the stomach with 45ml of air, on top of whatever the baby was being fed. These infants were described by other nurses, as well as the parents as being in extreme distress when these incidents happened.

This is not the first case of a nurse murdering patients, but it certainly highlights the absolute helplessness, and innocence of the victims, if they are placed under the care of a deranged killer.

In recent years the hospitals have tightened controls to prevent the diversion of drugs, or the easy access to anesthetic drugs, and various other drugs that can kill or harm patients. The systems now have multiple controls, with the access granted through various assigned codes, and will not permit access to drugs that are not ordered. They also must be signed out for a specific patient and documented. There are ways to override such a system, but if a drug is accessed and administered, it is much easier to track if there is an investigation. Drugs such as succinylcholine, which is an anesthetic drug that paralyzes the muscles of the diaphragm so a person cannot breathe, have been stolen from hospitals and used in murders.

Other drugs like potassium chloride and insulin have also been used to kill people. So I suppose in the mind of a warped killer nurse, the use of air must seem like a brilliant idea, as it cannot be tracked in the same way that drugs can be tracked within the system.

In my opinion, the case most likely to lead to a conviction, is the one where insulin was used, and is reported to have been added to a TPN IV bag. TPN stands for total parenteral nutrition, which is a bag of specially made up nutrients that are administered intravenously, as opposed to through the GI tract. The TPN bags were kept in the medication room fridge, which is also where the insulin was kept.

Insulin in addition to being kept in a fridge, typically has a rubber stopper on top, and is not a single use vial. The amount ordered is withdrawn into a 1ml syringe, and is never put into a TPN bag because it sticks to the bag and IV tubing, which makes it impossible to give an accurate dose.

Lucy Letby is the one who removed the TPN bag from the fridge, and documented administering it at a certain time. When the baby became suddenly ill, the blood sugars were checked, along with other lab work. The baby had very low blood sugars, and even with glucose, could not be stabilized.

There are many reasons a newborns blood sugar can drop. In fact any external stressors can cause the blood sugar to drop, and if it drops too low, can cause seizures, brain damage, and death.

Fortunately they did C-peptide tests on this infant, and were able to determine that the cause of the low blood sugar was due to insulin, introduced externally into the system, as opposed to an acute stress reaction that triggered a release of insulin internally. Therefore, I believe this is the one case that can convict her beyond a reasonable doubt.

The difficulty and complexity of all these different cases, as well as the sheer volume of harm done to so many infants, and often to one infant several times, makes it a very convoluted act to follow. The fact air was used as a primary source of injury also makes it more difficult to be sure of the cause. However there already has been precedent setting legal cases on the introduction of air emboli to cause death. It has already been proven in previous cases, so hopefully they can come up with enough compelling evidence to help the jury understand what happened.

Since the intentional introduction of a bolus of air into an IV is not a common practice, does not happen accidentally, and is very rare, it means the outcomes are not well known. Apparently it has been tested on rabbits and mice, where it is recognized it can cause sudden death. In some cases the large bubble of air will travel directly to the heart and cause immediate cardiac arrest. In other cases it may travel to the lungs. There would be different factors such as the amount, how fast it was injected, and how much of it was absorbed prior to entering a major organ or vessel. 

What makes things so much more difficult, is that premature infants are so compromised, and have an uphill battle to overcome, just to get to a point of stability, followed by weight gain. There are many things that can go wrong, such as respiratory distress, infections, bowel problems etc. It is really quite remarkable how resilient so many of them are, and how well they respond to love and care. The parents are beside themselves with worry and exhaustion, yet their love is powerful enough to be shared and conveyed to the baby, and in turn, the baby responds and thrives. Such survivals in spite of so many odds, often does seem like one of the most enlightening miracles of God, because some of them only weigh a pound or two at birth.

Almost all things are directional. If a premature baby does make it past the first weeks of life without dying, each and every day is a step toward recovery, and thriving. As they become stronger, and respond to care and nutrition, they have a much better chance of doing well, and eventually catching up with other children.

It is not common for a baby to be doing well, off the ventilator and supplemental oxygen, gaining weight, and then to have a sudden collapse. Yet in the case against Lucy Letby, several of those babies were well on their way to a full life ahead of them, and being discharged into the care of a loving family. I can see why the alarm bells started going off for the administration, doctors and people she worked with, when babies who had been doing well, took a sudden and catastrophic turn for the worse while under her care.

There are far too many coincidences to overlook. She also left post it notes in her house admitting to it, and did a number of other questionable and unprofessional things. She repeatedly looked up the parents of the babies she had harmed on FaceBook. She took photos, and sent a long winded sympathy card to one of the parents. She hovered, and chatted with grieving parents to the point she was told to leave them alone.

What could have been going on in her psyche though? She is charged with murders that occurred between 2015 and 2016. Chillingly there might have been earlier cases, but perhaps she was not as bold or frequent in her assaults, and went undetected. Or she may have only targeted those with the least chance of survival initially, so it would be ruled a natural cause.

Or it is possible she went through some kind of crisis in her personal life that precipitated the onset of her rampage. She may have been rejected by a boyfriend. She may have been jealous of the family unit, and parents of the infants. She may have had an accidental pregnancy followed by an abortion or miscarriage. She may have had some kind of warped religious ideologies.

One of the true crime podcasts claimed she is an only child, and was doted on by her parents, who have been married long term, and raised her in a nice upper middle class neighbourhood. Another possibility crossed my mind, and is pure speculation, but I wondered if she was adopted. It was reported that her father is a business man, however there is very little information about the family background. Just that they published a lengthy amount of praise for their daughter when she graduated from nursing, citing her many qualities, along with a picture of her in the local newspaper.

If it is true, it does sound a bit over the top to put a list of her exceptional qualities in the newspaper. After all, most people are expected to grow up and get a job. Maybe she was in need of constant praise and attention, and was accustomed to being the centre of attention. Whatever the background, her parents must be going through anguish as the trial unfolds. It does sound like she has a good lawyer, who is refuting, and defending every single charge against her.

If she was adopted, it could help to explain a sense of rage, or abandonment she might harbour deep within her psyche. If her birth mother rejected her, and did not want her, maybe she developed anger toward birth parents who did want their children. It’s just a guess as to how she might have become so messed up. Most adopted children adapt just fine, but some struggle throughout their lives, and always wonder about their birth parents, and why they were put up for adoption.

In other cases, adopted children carry a genetic predisposition for certain behaviours, even if they never met their birth parents. There are cases where they grow up in a loving stable environment, yet end up in jail just as a birth parent did. It is uncanny how genetic factors can play a role in later behaviours, even if the child had no exposure to the biological parent. Yet there are many examples. 

If she did in fact commit these crimes, she was a grand puppet master. She would have to be sadistic to the core. Not only did she inflict harm on the tiny babies, but she would have relished in her ability to get the entire ward ramped up, and rushing to the bedside to administer aid. They could not figure out what was going on, but secretly, she knew full well what happened. It may have aided her sense of superiority and control over the entire ward.

She would have seen the parents brimming with worry, the visits with expressed breast milk from the exhausted mothers, and seen their hope growing with every tiny sign and flicker of progress. She had the power to take it all away. She had the power to watch the rippling effect of her actions, all the while posing as a sweet, caring nurse.

She wrote on one of her post it notes that she was pure evil. Just as she knew the diagnosis of the infants she harmed, she also may have diagnosed herself with complete accuracy. All it took was a post it note. A psychiatrist could not be anywhere near as succinct, as she was about herself.

As this trial unfolds and comes to a conclusion, all we can hope for is that there will be justice, and safeguards put in place to prevent such atrocities. One of the biggest concerns is that she was still working long after the alarm bells started going off. Doctors took their concerns to the hospital administration, and were stifled.

One of the things we must always keep in mind, is what happened during the Nazi regime inside the walls of hospitals and institutions. There are many people who somehow convince themselves they are doing mercy killings with some kind of twisted justification. In Germany over 100,000 people were killed because they were disabled, weak or sick. Instead of helping people, they killed them, and took pride in how merciful they were.

During that time frame, most of the nurses involved in the death programs were never charged. A few were, and even among those who were not charged, some of them, remarkably admitted to not even having a guilty conscience.

Much as we might try to understand such aberrations of human logic, it is impossible to get inside the mind of those who kill. I do not believe in mercy killings. I think it is an abhorrent concept, and goes against the will and laws of God. I do not even believe in capital punishment, because God’s judgment is far beyond our comprehension or abilities.

Whatever her reasons were, and whatever the outcome of the trial, her life as she once knew it, is changed forever. The onset of and bulk of her crimes, or at least what she is standing trial for, began just four years after she graduated from nursing. She seemed to think she was an advanced super nurse, according to all the reports about her attitudes toward other nurses, yet she was barely wet behind the ears. Four years is not that much experience when you consider there are many nurses who work twenty, thirty, or forty years. They tend to be far more humble than this nurse was.

Multiple reports describe how Letby viewed herself as being vastly superior. Overall it seems like she had a great deal of insecurity, or she would not have tried to pretend to be a super nurse. Apparently in the UK there are band levels in nursing. A five band level is a general duty nurse, and a six band level is one with some additional training and experience. It seems to create a caste system of sorts.

The thing about neonatal ICU and severely compromised premature infants is that many nurses are afraid to be responsible for such a tiny helpless human being. They are afraid, because they are mortified at the thought of accidentally causing harm. So the nurses who were considered to be beneath her, were probably more cognizant of the level of responsibility involved, and therefore proceeded with much more caution and care.

Every profession has its power abusing rogues. From police officers, to teachers, lawyers, doctors and nurses, there is no shortage of examples of those will use their positions to harm, exploit, and even murder innocent victims. Pity them when judgement day arrives.

There is no doubt they will be held accountable for every last thing they did to betray trust, violate boundaries, and harm some of the most vulnerable and helpless people in all of God’s creation. It is really too bad they cannot screen out those who are likely to abuse power over others ahead of time. Such is the power of deception, and until it is all exposed, there may be no real way of knowing who harbours such dark and devious inclinations. 

To an extent, the systems have to assume the education and motives of their employees is consistent with what is expected and conveyed. Some people are so good at deception, they go undetected, and are in fact protected by the very system that is supposed to protect the vulnerable populations they serve.

In addition, it takes a long time before hospital administration will resort to a police investigation. It means there will be public exposure, and a great deal of talk among the people who work there. It is devastating from a public relations perspective. It makes it even sadder, because in the meantime, more deaths occur. If Letby was investigated sooner, it may have saved several lives. In cases where she caused the dramatic collapses, and the child lived, some of them will have profound lifelong neurological deficits as a result of what she did.

The rippling effects of her actions are immeasurable. I cannot imagine what it must be like for the parents to follow the trial, knowing what was inflicted upon their child, and the horror of such a person being in charge of them without anyone to intervene. The parents would feel guilty because they were unable to protect their baby. Yet how could they? Who would ever expect such atrocities to occur in a NICU?

And even if they were there watching over their newborn, they still had to take bathroom breaks, go and eat, and possibly take care of other children. It would have taken a matter of seconds for Letby to give a bolus of air. Given the fact that nurses are always giving infusions, flushing tubing, giving medications, adjusting monitors, etc. How could anyone, even another nurse who was five feet away know what she was up to?

These were covert actions done very surreptitiously, and would have been easy to hide, because in such a busy environment, each person has enough of their own workload to concentrate on. It might explain why she thinks there is no evidence or actual witnesses. Few crimes if any, are done without leaving evidence. Let’s hope this one has the irrefutable evidence to either convict or exonerate, without leaving a gaping grey zone.

In addition to the parents, I can imagine the shock felt by the nurses she worked with, especially those who socialized with her, and listened to her many complaints. They must be reeling with the unfolding of all the evidence, text messages, and accusations. Some of them must be feeling very fragile.

One person’s actions can shake a nation, and even the entire world, as the scope of it all unfolds. I just hope and pray the concept of killing helpless human beings is seen for what it really is – a monstrous act of depravity and cruelty.

It is most certainly not mercy or fate, as those with a flawed sense of morality seem to think. Some people who are truly depraved and mentally ill, go unnoticed, and unfortunately, they live and work among us. 

Copyright Valerie J. Hayes and Quiet West (2023). Unauthorised 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.