Ep 62-Lucy Letby (Part One) and a Swiss Cheese Smuggler

A neonatal unit is supposed to be the safest room in a hospital and yet this story begins with a run of collapses that staff couldn’t make sense of. We’re finally digging into Part 1 of the Lucy Letby case, starting where so many explanations actually begin: an ordinary life, a conventional nursing path, and a workplace where sudden deterioration is terrifyingly possible even when nobody is doing anything wrong. Trigger warnings apply for infant deaths, neonatal medical crises, murder allegations, and hospital failures. 

If you want Part 2 with the arrests, trial, and the newer evidence that could challenge assumptions, make sure you’re subscribed, share this with a friend who loves true crime and medicine, and leave a review so more listeners can find the show.

Resources:  

The book: Unmasking Lucy Letby — Jonathan Coffey and Judith Moritz 

R -v- Letby Final Judgment - 02.07.24

C-Peptide Test: MedlinePlus Medical Test

 Terms of reference | The Thirlwall Inquiry

The Thirlwall Inquiry | Examining the events at the Countess of Chester Hospital and their implications following the trial, and subsequent convictions, of former neonatal nurse Lucy Letby of murder and attempted murder of babies at the hospital.

Transcript

Cold Open And Life Updates

SPEAKER_01 0:54

A man Hi Jenna area.

SPEAKER_00 1:06

That um intro cheering makes me wish that I was at like some dingy divy like comedy bar.

SPEAKER_03 1:16

Mm-hmm. Yeah. Full of people who appreciate true crime like we do. Yeah. But cheering us on and giving us the energy.

SPEAKER_02 1:32

So what's new with you?

SPEAKER_00 1:35

Uh nothing. Well, I'm still I'm still doing the same thing every day. What's new with you?

SPEAKER_02 1:42

I was like, I happen to know that you gave our baby Ellie cat a bath just now.

SPEAKER_04 1:46

Oh yeah. Um so that's cute. And he's squeaky clean. Got a queen, baby Ellie cat. Does he like baths or does he get upset? Okay. Took him a bit.

SPEAKER_00 1:58

When he was just a wee widow young star, he was like, so cool. But now he kind of seems like like he wants to play a little bit.

SPEAKER_02 2:12

Oh, that's so cute.

SPEAKER_00 2:13

Yeah.

SPEAKER_03 2:14

Well, I listen, y'all are lucky because I came back from Mexico with a little something, some kind of hijacker bug. And so I got over this last weekend, I had full-on laryngitis, like no voice at all. And then when it did come back, yeah, when it did come back, it was like, I don't know, something evil was coming out of my throat. Oh my god. And to the point where my corgi got scared and shivered and howled and hid under the bed. So I must have sounded like a demon from hell. So I was off work yesterday, but yeah, we're back. I was like, are you kidding me? We can't get I'm finally ready for Lucy freaking let me and I can't do it because I don't have a voice, but I didn't even tell you because I was like, we'll just pray a little time pass, and here we are. So you're welcome, everyone. Might be a little hacking here and there, but we're good.

SPEAKER_02 3:11

But she backed up. There's no punishment like someone who's just been on vacation. You get back to work, it's like overtime, like double time, boom, boom, boom. Punish, punish, punish. And then you know, usually the universe is like strike down, strike down.

SPEAKER_03 3:26

I mean, I sat I sat an extra four hours on the plane breathing uncirculated air because the air conditioning didn't work. So I mean, it was bound to get something out of 300 people huffing and puffing uh for eight hours on a plane.

SPEAKER_04 3:42

So gross.

SPEAKER_02 3:46

You know, when you put it like that, I know. Did you did I tell did I talk about this last time or was it just to you personally? Uh no. So neither, actually.

Cancun Flight From Hell

SPEAKER_03 3:55

Okay, so Delta is a great airline, love them, but I'm a little concerned about their flights to Cancun because on the way there, we were on the tarmac and they were like faffing around on the on the jetway. We were like, what's going on? What's going on? Finally, this announcement came on.

SPEAKER_02 4:12

Well, you know, something's not working. We're just gonna turn the plane off and turn it on again.

SPEAKER_00 4:18

Oh my god. It's like you called the help desk and they're like, Did you try?

SPEAKER_02 4:23

So they turned the plane off, turned it on again, and whatever it was that wasn't working is working now, honestly. So we took off. So on the way, I'd be like, Are we confident?

SPEAKER_03 4:35

So on the way back, we're sitting on the tarmac, it's 90 degrees and humid outside, and the air conditioning isn't working. And they're like, folks, the air conditioning is not working. Um, we appreciate your patience with us, and uh, as Delta. Like, we can't afford to not be patient. We're strapped in here in tin can with you know 300 other sweaty people. So we sat on the tarmac for two hours, and then the announcement came over the intercom. Passengers, we thank you for your you know patience with us, brah brah brah. We've decided to turn the airplane off and on again.

SPEAKER_02 5:15

God, so it took them that long to do what we had done on the way. Why didn't we do this after 12 minutes? Okay, so they turned the plane off, and after an agonizing 20 minutes, they turned it back on again. Because at least at least a fan with hot air is a fan, but like so they turn it back on again.

SPEAKER_03 5:37

And guess what? After half an hour, we realized nothing had changed, and then they took off anyway. Oh my god, all it's colder in Minnesota.

SPEAKER_02 5:48

So right before we were landing, the pilot was so dejected and self-defeated.

SPEAKER_03 5:54

He was like, Well, you realize this has been our very uncomfortable and in fact, really awful uh flight. We hope you just give us a second chance and that your next Delta experience will be hopefully 100% better.

SPEAKER_04 6:11

He's like, Well, the bar's in the basement, so it can't get much worse.

SPEAKER_03 6:18

Bless his heart. I didn't care. I was watching a movie. I got to watch three movies when I should have only been on the plane for four hours. So there you go. But I did spend$24 on a so-called fruit plate because you know, we hadn't eaten because we thought we were gonna be just a short amount of time. So I ordered the last, I got the last fruit plate, because of course we're in the back of the plane, and a fruit plate constituted for$24, couple, a couple of mushy apple slices, four grapes total, and two melted pieces of Swiss cheese. Are you guys not keeping your fruit plates in the fridge? Because I know there wasn't any air conditioning, but didn't you have a fridge? I don't know.

SPEAKER_04 6:56

It's like hello, knock, knock, knock. Um, Delta, are you listening? Hello. So I hate Swiss cheese, so I was trying to put it aside.

SPEAKER_03 7:03

It's like I love cheese, cheese until I die. If I pick one food that I have to live on forever, it's some sort of cheese, except for Swiss. So this sweaty Swiss cheese. I was trying to move it to the side so I could get to my four grapes and two dried apricots. I want to get my money's worth, you know. And the cheese fell to the floor. And I thought, well, what the hell? I'm in the middle seat, of course. I can't bend over and pick up the cheese. So we finally, by the time we finally get back to America, we're going through customs and I feel this like under my left foot, like this flap and then step my right foot, flap on my left foot, step on my right foot, flap, flap, flap.

SPEAKER_02 7:46

And I lift up my shoe and it's like, you're next, passport, you know, you have to be ready. And I look down and there's a piece of Swiss cheese just flapping on my left shoe.

SPEAKER_03 7:57

But I didn't have time to like remove the said cheese because we were going through customs and security, and it looked really sus. So that cheese and I made it to customs to the security area. And then somewhere in between, he part of it came off. So I only had the residue that was ground into my tennis shoe cleats, you know, not the cleats, but you know, the little grooves. So I mean it was just adventure. It was a learning experience. Anyway, uh, I don't know how I got there, but here we are. I'm glad we're all okay. Yes. Most importantly, and guess what we're talking about today?

SPEAKER_04 8:40

La la la la la Lucy. Finally.

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Sources And Trigger Warnings

Letby’s Early Life And Persona

SPEAKER_03 8:45

Yeah. Whether she likes it or not, it's time. But before we start, do we have a correction section? I don't think so. I was gonna go into our first sponsor, and then I was like, wait. Okay. So our first sponsor, it's like having a facial in a bottle. Amroutini, luminosity dewdrops from Love Indus is a serum that deeply hydrates and strengthens your skin, leaving it visibly firm, more supple, and truly radiant. It's been featured in Vogue, Forbes, InStyle, L, Birdie, Harper's Bazaar, and many more. And it frequently sells out on QVC thanks to its rare ingredients and the visible improvements that you'll see in your skin's firmness, texture, and radiance. At the core is muga silk, a prized golden silk from India, known for its strength and longevity. It's combined with silver tips tea for antioxidant protection. We all know tea has antioxidants. And ashwagonda, a calming botanical that helps skin bounce back from stress and fatigue. If you use it every day, this serum helps your skin feel stronger, look plumper, and glow with real radiance. I plan to get a bottle today. What about you? If you want visibly smoother, stronger, and glowing skin, go to loveindus.com and get 21% off using our promo code Stay Suspicious. So the resources for this show, this episode show, I'm kind of really glamorizing this me. So the resources for this show are mainly from a book called Unmasking Lucy Let Be, and then information from the Thurwall Incur Inquiry, a Criminal Cases Review Commission, and the Crown Prosecution Search Service, the Court of Appeal judgment in R versus Let Bee, and reporting from the BMJ, which I would say is the British Medical Journal. Trigger warnings, there is going to be discussion of infant deaths, neonatal medical crises, murder allegations, and hospital failures. So let's get started. On January 4th, 1990, in Hereford, England, baby Lucy Letby was welcomed to the world by her loving and doting parents, John and Susan Letby. It was a difficult birth, and when John and Susan were likely overjoyed that after a long, traumatic journey, their family was complete. Lucy was their only child, and they provided her with a nurturing and conservative upbringing which placed value on education. John worked as a furniture salesman and Susan worked in accounting. Reports suggest they lived a comfortable middle class life. Lucy attended St. James Church of England primary school and then Aylstone School and later Hereford Sixth Form College. She was an average student, but keen on studying pediatric nursing. A friend later remarked that this may have been motivated by Lucy's own difficult birth. Lucy's mother must have told her how much the nurses who cared for her during that traumatic time meant to her, and this obviously inspired Lucy. Accounts of her early life generally describe her as quiet, ordinary, studious, and socially unremarkable rather than an especially charismatic person or troubled childhood. In the book Unmasking Lucy Letby, the authors frame her story as tracing Letby from primary school to prison, drawing on interviews with people who knew her before the case made her infamous. This was a perfectly ordinary young woman with an innocuous upbringing. No McDonald triad factors that we know of, you know, arson, cruelty to animals, wetting the bed. She liked to party with her friends and go drinking and dancing. As an adult, she had a whimsical girly bedroom with fairy lights, ruffles, and stuffed animals to cuddle. Her ordinary row house sat in a cul-de-sac with a carefully tended flower garden in the backyard. How is this person, this girl next door, in her powder blue hoodie, a serial killer? Perhaps even worse, a killer of those most fragile and vulnerable of all, newborn babies in the NICU. Lucy was deeply attached to a Yorkshire terrier named Whiskey, a detail that adds to the picture of a young woman whose life, at least on the surface, looked gentle and familiar. She was also said to be especially close to her best friend Dawn, suggesting that even if her social life wasn't broad, it wasn't isolated, though. Nothing in that early biography reads like the beginning of a notorious criminal case. It reads like the life of a girl who did well in school, stayed close to home, loved animals, maintained close relationships, and moved steadily towards a career in nursing. Lucy Lepbe did not move through school as one of the popular girls. According to her longtime friend Dawn, she and Lepby were part of a small friendship group made up of the more studious, less socially dominant kids. The ones who were focused on schoolwork and not especially interested in competing for status. Dawn described them as the geeky ones, a tight little circle that existed somewhat apart from the popular crowd. Outside that group, she said, Letby came across as shy, reserved, serious, and level-headed. But inside the group, she was different. She was silly. She was more relaxed and openly funny. In Dawn's telling, there was a split between the public version of Lepbee, the controlled, quiet, and self-contained person, and the private person that her friends knew, someone more playful who could let her guard down and make them laugh. On August 14th, 2008, when A-level results came out, Lucy Letby got what she'd been working for for years. For as long as she could remember, she'd wanted to become a neonatal nurse, and now that ambition was turning into a real path. She had the grades, she had a university place, and she was leaving Hereford for Chester to study child nursing. For her parents, John and Sue, it was a milestone. Neither of them had been a university, and Lepby was the first in the family to go. In Hereford, a professional future usually meant moving away, and that was true for Lucy as well. While some of her year chose larger and louder cities, Letby picked Chester. Chester suited the version of Lucy Lepbee people already knew from Hereford. It was smaller, quieter, and more restrained than the bigger university cities that some of her classmates chose. A place of Roman walls, tutor facades, and cathedral stone. The kind of city that feels orderly even when it's crowded. But moving there was still a rupture. According to the book, Lepby struggled at first with homesickness and returned to Hereford whenever she could, slipping back into her old friendships and the familiarity of home. She met up with the same school friends she'd grown up with, and when they were together, the old dynamic seemed to reappear easily. One video filmed before the start of her second year showed Lepby and her friend Dawn after a heavy night out, arms linked, stumbling around and collapsing into fits of laughter. It's one of the glimpses the book gives of her at her least guarded. Not the composed, careful version of Lepbee that so many people later describe, but a young woman loose, tipsy, and fully inside the safety of an old friendship. Over time, though, she settled into Chester as well. She found a new group of friends, and the photographs from that period suggest the same kind of slightly awkward, wholesome social life she had in Hereford. Fancy dress parties, group nights out, playful faces for the camera. Even then, she didn't seem to fit the stereotype of the reckless university student. The book describes her as someone who kept the same basic habits she'd always had. Studious, self-controlled, and usually the first to leave after a night out. One peer remembered her as a quote, plain girl and quote. Sorry, cow, who mostly avoided the chaos and excesses of university life. She came in, did her work, and went home. I mean, I don't who wants to be described as a plain girl? That was just rude, right?

SPEAKER_00 17:02

I I'm living the life of a plain girl right now. I I just go to work and I go home.

SPEAKER_02 17:07

It's not something to be ashamed of.

SPEAKER_00 17:09

I love my boy and plain girl life.

SPEAKER_02 17:14

Yeah. No, you appreciate it now.

SPEAKER_00 17:16

Hey, we knew I would never have been described as the plain girl.

Training And The Chester NICU

SPEAKER_03 17:20

Chester was not a dramatic break from the life Lucy Ludby had known in Hereford. In some ways, it looked like an continuation of it. Another small, historic English city full of old stone, Roman remains, tutor fronts, and the kind of postcard beauty that feels almost self-consciously calm. As university life settled into something more familiar, one thing did not seem to fall into place as easily for Lucy Levy as it did for some of the people around her. Friends coupled off, relationships began. That part of student life appeared to come more naturally to others than it did to her. In the book's telling, romance remained elusive for Levy, although there is no indication that she made much of it publicly. If it bothered her, she didn't seem to advertise it. Even to close friends, she appears to have presented as steady, good natured, and fundamentally easy to like. That impression lingered long after university. One of the friends that the authors contacted described as one of Letby's closest at university, declined a full interview, but did give them a short statement, saying that Lucy had been her closest friend, that she'd been a wonderful student nurse, and that she believed she was innocent of all the charges. Another former classmate was similarly skeptical, saying that she trusted her own judgment of character and could not reconcile the woman that she knew with the crimes for which Lepby was later convicted. Well, that doesn't alter the legal record, it does show how strongly the ordinary version of Lucy Lepbee survived in the minds of some people who knew her best before the case. Like other students, she attended lectures and seminars, but nursing was never a course that existed only in classrooms. It was practical from the start. And for Lepbee, that meant hospital placements, real wards, real patients, and real experience. For her, that practical training could begin close to campus because Chester had its own hospital with a neonatal unit that welcomed student nurses. The Countess of Chester Hospital was smaller than many of the big regional hospitals in the Northwest. It didn't have the feel of a sprawling campus with endless buildings, long corridors, and whole departments hidden behind layers of walkways. It felt more modest than that, compact enough that the place could almost seem closer in scale to a large secondary school than to a major hospital. Even the neonatal unit was small. Most mothers, if a birth goes to plan, will never see a neonatal ward. These are the rooms where premature and sick babies are taken when they need specialist care before they're well enough to leave with their families. At Chester, the neonatal unit was made up of four small rooms called nurseries, filled with incubators, ventilators, monitors, and the machinery needed to keep very fragile babies stable. The largest room could take four babies at once. The others held two each. It was not a large ward. It was a small, enclosed, tightly run space, the sort of place where you might assume people would notice everything. Letby worked on the neonatal unit at the Countess of Chester Hospital from January 2012 until July 2016. It was a ward built around intensive monitoring, fragile patients, and the kind of routine vigilance that defines neonatal care. Babies on the unit were often premature or medically unstable. Deterioration was not unknown. Staff were used to pressure, uncertainty, and the reality that outcomes could change quickly. That background's important to the early part of this case because the first signs of trouble did not emerge in a setting where every collapse immediately looked suspicious. They emerged in a world where bad outcomes could happen, where the margin between stability and crisis was already narrow, and where consultants initially had to work out whether they were seeing tragic coincidence, clinical failure, or something else. Neonatal medicine is full of fragile patients and uncertain outcomes, but the unit wasn't built for the most extreme cases. Chester was what clinicians called an A-level unit, meaning that the sickest babies, the ones that need the most complex intensive care, were usually sent somewhere else, to tertiary centers like Arrow Park or Liverpool Women's Hospital. Most of the babies that were treated in Chester still have the possibility of a good outcome. When Lepbe first started there, the Rota included around 25 to 30 nurses, plus another 15 junior nurses. She was assigned a mentor, an older senior nurse who had worked on the unit for years. And over time the two became close. That's one of the details that sharpens the later story. Lepbee wasn't entering the unit as a drifter or an outsider. She was absorbed into its routines, guided by experienced staff, and folded into the close relationships that make a small ward function. On January 4th, 2011, just before she qualified as a nurse, Lucy Lepby turned 21. Around that time, a birthday message appeared in the local paper from her godchildren, Thomas and Matthew, wishing her a happy birthday. Next to it was a childhood photograph. Lepbe sitting upright, smiling, her long, blonde hair tied back with a dark bow. It's a very Local, very ordinary kind of image, the sort of family detail that places someone firmly inside a recognizable life of birthdays, relatives, and community rituals. In itself, it tells you nothing dramatic, but it does add to the picture the book keeps building of Ludby's early life as stable, familiar, and outwardly unremarkable. By September 2011, Lucy Ludby had done what she'd been working towards for years. She finished her degree and qualified as a nurse with a Bachelor's of Science in Child Nursing. In Hereford, her parents celebrated the moment with another message in the local paper, this time alongside a photograph from her graduation. The note was simple and direct. They were proud of her, proud of the work that she'd put in, proud that she'd reached the point she'd aimed for. It was one more small piece of the early biography that the book builds, a life moving in a recognizable direction with family pride, local approval, and the sense of a young woman becoming exactly what she intended to become. The placements that she'd completed at the Countess of Chester Hospital during her training had done what good placements are supposed to do. They opened a door. As soon as she graduated, she was offered a job in the hospital's neonatal unit, the area of nursing she'd wanted for years. It was not a dramatic leap into the unknown. It was a seamless step from university into working life. By then, Leppy already knew the wards, she knew the rhythms of the hospital, and knew many of the peoples that she'd be working with. And they knew her too. And she wasn't the only new nurse arriving there from her course. One of her fellow students also landed a job in the same unit. Taken together, it meant that Leppy wasn't entering a professional life as an outsider. She was moving into a place that already felt familiar and achievable, and already looked like the beginning of the career she'd always wanted. Melanie Taylor was the other nurse that had studied alongside her that got a job there, and for the next four years, the two women worked closely together. At the time, it would have looked like a straightforward continuation of university life into working life. Two former classmates beginning their careers on the same ward. Years after those shifts together, Melanie Taylor would find herself in a courtroom, giving evidence against the woman she'd once known as a fellow student nurse. And yet, in the early years, Lepby doesn't seem to have made a particularly vivid impression on many of the doctors around her. The descriptions that later surfaced were striking for how flat they were. She was described as very nice, one doctor said, but also a bit bland. Rude. Another remembered their conversations as bland and superficial. What is wrong with these people? I'm so sorry, but she may be bland and a person may be bland, but do you do you need to say that?

SPEAKER_00 25:36

Also, maybe you're the problem because sometimes when people gray rock a conversation with you, it's because they don't want you to. You know what I mean?

SPEAKER_04 25:45

It's like I'm gray rocking you on purpose. I'm not bland.

Red Flags And A Failed Placement

Deaths Begin To Cluster

Insulin And C Peptide Explained

Baby Cases That Build Suspicion

Consultants Clash With Management

From Ward Removal To Police

Part Two Tease And Doubt

SPEAKER_03 25:49

And also bland isn't a crime, so like or a characteristic of your ability to do your work. So stop bringing it up. Honestly. Red. And it was a bunch of white men giving these comments, so just saying. All right. Well, anyway, um the picture that emerged wasn't that she was particularly charismatic or volatile, but she seemed ordinary. The unit's most senior doctor, Dr. Steve Breary, later described Lucy Leppy in notably untraumatic terms. He said that she didn't strike him as very different from most of the nurses working there at the time. She wasn't especially extroverted and she wasn't especially introverted. In his recollection, she simply looked like what she was supposed to be. A normal neonatal nurse on a busy ward. That kind of memory matters because of how ordinary it is. Before the collapses, before the investigation and the trial, Leppy seems to have blended into the professional life of the unit rather than dominating it. To one of the most senior doctors there, she wasn't memorable at all, just another nurse. There is, however, one early warning sign in Lepby's training record that sits awkwardly besides the otherwise steady picture of her route into nursing. In July 2011, during her final student placement at the Countess of Chester Hospital, she failed the placement. The assessor, deputy ward manager Nicola Lightfoot, wrote that Lepby needed far more support, prompting, and supervision than would normally be expected at that stage for someone about to qualify. Lightfoot's criticism wasn't limited to technical performance. She said Lepby didn't seem to have the overall characteristics that she would expect in a successful registered nurse. Later descriptions attributed to Lightfoot were even sharper. She recalled Lepby as quite cold and said she didn't see the natural warmth that she expected from a children's nurse. She also raised concerns about Lepby's clinical knowledge, including problems retaining information about medication dosages. In the context of the later case, that failed placement stands out, not because it predicts what came next in any way, but because it introduces a discord into an early biography that otherwise looks smooth and conventional. Conventionable? Conventional. Convent your vegetables. It's been a long day. All right. One nursing colleague would later remember something Lepbee allegedly said on her first day at the neonatal unit in January of 2012. According to that account, Lepbee made a comment along the lines of, I can't wait for my first death to get it out of the way. The nurse said the remark caught her off guard. On a neonatal ward, everyone knows that death is a possibility, and everyone working there will eventually have to confront it. But in her recollection, it was not the kind of thing people normally say on their first day. It was like she was making a list, and that was an experience to be checked off rather than dread. So this comment stayed with her, not because it seemed definitive on its own, but it just sounded out of step with how most people talked about that part of the job. The difficulty with stories like this is that memory doesn't stay still. Once someone becomes nationally infamous, old moments began to look different and it began to look different. It could be hard to tell which impressions truly existed at the time and which ones were sharpened by everything that came later. That same colleague also remembered Lepbee seeming excited after an unexpected resuscitation and said that she didn't appear upset or traumatized in the way that the nurse might have expected after such an event. So those recollections have to be handled carefully because they come filtered through everything that happened later. But they do form part of the later portrait that some colleagues gave of Lepby. Not dramatic, not obviously alarming in the moment, but occasionally reacting in ways that, viewed after the fact, seemed out of step with the rest of the ward. There was at least one serious clinical error in Lepbe's early years on the unit. In 2013, roughly 18 months into the job, she and another junior nurse gave a baby 10 times the prescribed dose of a painkiller. The baby almost died. I know. Jeez. According to the book, and the thing is, with 10 times, you think, is it a decimal point? Like at some point, is it a dosing error because of a decimal point? Anyway, according to the book, the other nurse was so shaken by what had happened that she thought about resigning altogether, but Lepbee seems to have processed it differently. In messages quoted by the authors, she told a friend that Erin Powell, her boss, believed that the incident had been escalated more than it needed to be. Lepbee wrote that she just needed more training on the pumps and that Powell had been very supportive, and that the task now was to learn to live with it and get her confidence back. She admitted still feeling vulnerable and replaying the what if, but the overall tone wasn't of collapse. It was the tone of someone trying to absorb a serious mistake and continue. Which I don't falter. I mean, everybody reacts to these things differently. But trouble began during 2015 and 2016, when a series of collapses and deaths on the unit started to concern consultants. In retrospect, the public story can make that period look linear, as if the pattern was instantly clear and everyone around it simply failed to act. But the later record is more complicated. Concern appears to have formed gradually. Individual events may initially have looked like they were severe but natural neonatal crises. Over time, some consultants began to feel that the overall pattern did not fit what they would normally expect to see. And as those incidents accumulated, Lepbee's presence during a number of them began to stand out. In the summer of 2015, the first cases that later formed the backbone of the Lepbee prosecution began to unfold on the neonatal unit at the Countess of Chester Hospital. So because they are minors, the names of the victims were not able to be released, understandably. So these babies are named after letters of the alphabet. So it can get kind of confusing, but bear with me. So the first was baby A, a premature twin boy that died on June 8th, 2015, after basically he was a day old. By the time his case reached court, the prosecution's position was that he'd been stable beforehand and that his collapse was sudden and medically inexplicable by the ordinary problems that doctors had been considering. In the Court of Appeal summary, the expert evidence described no convincing sign of infection, no clear oxygen deprivation, no benign clinical explanation that accounted for how abruptly he deteriorated. Baby A's death became important not only because he was the first baby in the indictment, but because it was later treated as the beginning of a pattern. A baby that wasn't expected to collapse, who did so catastrophically and without what the prosecution said was an adequate, natural explanation. Then there was Baby B, baby A's twin sister. During the night of the 9th to 10th June 2015, she survived, but her collapse was later treated as one of the earliest moments in which staff encountered something they considered deeply unusual. According to the Court of Appeal judgment, nurses and doctors described sudden deterioration accompanied by striking skin discoloration, purple blotches with pale patches that seemed to move or shift across her body. One nurse said she'd never ever seen anything like it. A registrar described an unusual combination of gray-white coloring and red-purple discoloration that appeared and disappeared. In the later prosecution case, those visual features became part of the alleged air embolus theory. What mattered in real time was that this wasn't simply another medically fragile baby becoming unwell. To those present, the pattern of collapse appeared strange enough to be memorable. A few days later, on June 14, 2015, there was Baby C, a premature baby boy. His case became one of the early deaths later put before the jury. Public reporting on the trial said the prosecution alleged that air had been forced into his stomach through a nasogastric tube and that Ledby had been near his monitor when the alarm sounded. The Court of Appeal judgment itself doesn't retell BBC's case in as much scene detail as it does for some of the other babies, but his death was one of the June 2015 events later grouped together when consultants started looking for common threads. That grouping is important because the concern did not arise from one single dramatic case. It arose from several severe events arriving close together. Baby D was different from some of the earlier babies because she was much closer to full term. She'd been born at 37 weeks gestation and died at about 36 hours old on June 22nd, 2015. By the time her case reached the courts, the prosecution said she'd been stable before a sequence of sudden collapses in the early hours of the morning. The Court of Appeals summary describes three separate events that night. She was checked again about 10 minutes later and was still satisfactory. Then the alarm sounded. Staff found her desaturating with a failing heart rate. She was resuscitated. A second collapse followed around 3 a.m. and she was brought back. And then at 3 45 a.m. she collapsed for a third time and could not be revived. What stayed with staff, according to later evidence, wasn't only the repetition but the visual features of the collapse. Doctors described unusual skin discoloration, dark, mottled, reddish-brown changes that one witness said he'd never seen before or since. Later imaging also showed unusual quantities of gas in one of the major vessels, something the prosecution experts said he had not encountered in that form without another clear explanation like trauma or sepsis. And in the midst of this disturbing content, we are going to break for a chart note. Welcome to the chart note segment where we learn about what's happening in medicine and healthcare. This is a short medical sidebar to help make sense of one of the stranger pieces of evidence in this case. Insulin and C peptide. So here's the basic idea. When the human body makes its own insulin, it doesn't make insulin by itself. The pancreas first produces a larger molecule called pro insulin and then splits it into insulin and C peptide and releases them together into the bloodstream. So that means when someone's body is naturally producing insulin, you expect insulin and C peptide to rise together. C peptide is useful because it acts like a biological tag. It tells doctors that the insulin in the blood came from the pancreas. In other words, that it was endogenous, that it came and was made inside the body. Medline Plus describes C. peptide as something the pancreas makes in the process of making insulin, and the test is commonly used to help figure out how much insulin the body's producing on its own. But if someone is given manufactured insulin from outside the body, what doctors call exogenous insulin, then that changes the pattern. The insulin level in the blood can go up, but C peptide doesn't rise along with it because the pancreas didn't make it. It wasn't the source of that insulin. So if a lab result shows high insulin was suppressed or unexpectedly low C peptide levels, that can suggest that the insulin was administered rather than naturally produced. So that relationship is why insulin and C peptide are often interpreted together instead of separately, because a high insulin level by itself doesn't tell the whole story. The key question is whether the matching C peptide signal is there too. If they're both elevated, that points towards insulin being produced by the body. If insulin is high and C peptide is not, that raises the possibility that the insulin came from an external source. So in plain English, natural insulin comes with C peptide. Injected insulin does not. And that's why those two numbers taken together become such an important forensic clue. So back to the story. Where we left off June 2015, within just two weeks, the unit had already seen the bet death of baby A, the collapse of baby B, the death of baby C, and now the death of baby D. That doesn't mean consultants instantly concluded that they were looking at deliberate harm, but it does mean that the raw material for suspicion was starting to accumulate very quickly. These weren't events spread over several quiet years. They were arriving close together, and some of them were being remembered because the collapses had looked odd before anyone had a theory for why. And I'm not sure if I say this later, hopefully I do, but I mean they were typically used to three, two or three deaths a year. So this has happened, you know, as a unit. Because remember, they're not super high intensive care, they're kind of intermediate intensive care. So it, you know, it was concerning. It was a lot for this little hospital. The next major turn in the chronology came in August 2015 with the twin boys later known in court as Baby E and Baby F. Baby E died in the early hours of August 4th. He'd been born at 29 weeks and five days. Gestation. According to the court summary, Lepbee was his designated nurse that night. At the trial, Baby E's mother said she came into the room and saw blood around his mouth. And Lucy Lepbe told her that the bleeding was from a tube irritating the back of his throat and told her to go back to the postnatal ward. Reporting on the trial says that the mother testified that Lepbee reassured her and that she trusted Lepbe completely. At 9:30 p.m., a doctor was called after bloody aspirate was seen. When the doctor was there, baby E vomited a large amount of fresh blood. Medical notes later recorded further gastrointestinal blood loss. For a time, despite that, his blood pressure and heart rate were said to be holding and he still had respiratory effort. Then shortly before midnight, he deteriorated sharply while staff were preparing to intubate him. Doctors later described an unusual purple discoloration across his abdomen. During CPR, a large amount of blood came from his nose and mouth. Something one of the doctors said he'd never previously seen in a neonate. Baby E briefly regained a spontaneous heart rate and then collapsed again and died. In the later prosecution case, this wasn't treated as a difficult resuscitation, but as one of the most medically extraordinary deaths on the unit. His twin, Baby F, survived, but his case became important for a different reason. Baby F later formed part of the insulin evidence in the prosecution case. The full scene-by-scale of his collapse is less fully summarized in the appeal judgment than some of the other deaths, but what mattered to the later case was that his deterioration was linked to an insulin insulin reading pattern that the prosecution said could not be explained naturally. By this point, the sequence was broadening. The concerns on the unit were no longer only about a sudden collapse and visual oddities during resuscitation, but also about unexplained biochemical evidence in a baby who survived. Then in the autumn of 2015, there was Baby Eye, whose case became one of the most important in the prosecution's narrative because it involved a series rather than a single abrupt collapse. Baby I had been born at 27 weeks gestation. By late September 2015, she'd been doing well enough that concerns about her diminished. Then September 30th, when Letby was her designated nurse, a crash call was issued after Baby I vomited. Her heart rate dropped and she struggled to breathe. Later, X-rays showed very large amounts of gas in her stomach and bowels. Staff aspirated air and milk through the nasogastric tube and she recovered. Then, October 13th, while her designated nurse briefly stepped away, the nurse returned to find Leppi present and reporting that Baby Eye looked unwell. Later, the prosecution questioned Lepby about this because she'd actually remarked to the other nurse in the room that she thought baby I looked pale, but she was standing in the doorway and it was dark in the room. So she was far away from the child. So how would she have known she was pale? And another x-ray showed major gaseous distension, and a similar event followed the next night. And then just before midnight, on October 22nd, Baby Eye became unsettled, collapsed again, and this time required compressions. She was resuscitated, seemed to recover briefly, and then collapsed once more an hour later. She died in the early hours of October 23rd. By this stage, consultants were no longer dealing with one or two disturbing events. They were carrying in their heads a growing internal list: babies that collapsed, babies with strange skin discoloration, and unexplained gastrointestinal findings, and now cases where the same infant went through multiple episodes that the doctors said didn't fit what they would normally expect. This was the point in the timeline where the story stopped being a run of isolated bad outcomes and started becoming, for some clinicians, a pattern that demanded explanation. The next major cluster came in June 2016 with the triplets. Baby O, one of three triplet boys, was born June 21st, 2016, at 33 weeks and two days gestation. According to the Court of Appeal judgment, he'd been born in good condition and was making good progress. Lepby just returned from holiday and was his designated nurse on the 23rd of June. Earlier that day, a doctor examined him and recorded no concerns. Shortly after 2 39 in the afternoon, he collapsed. A nurse responding to the alarm found Lepby alone with him. He was resuscitated and then he collapsed again about 3 49 p.m. and then again at 4 15. He could not be revived. Staff later described unusual skin changes and postmortem exams, found free blood in the abdomen and multiple liver injuries that reviewing pathology could not explain by virtue of CPR. So sometimes CPR can cause damage. And it was not in the right area for that to be considered a cause. And then came baby P, one of the triplets, another one of the triplets, who died the next day on the 24th. The appeal judgment doesn't retell his death in the same narrative detail as baby O, but the timing alone made it impossible to ignore. There were two babies from the same set of triplets that died within 24 hours of each other. By then, this wasn't a matter of the consultants looking back at their notes and wondering, oh gosh, did we have bad luck? They were watching events unfold in very close succession. They're trying to understand what was going on. And that's the chronology that eventually fed suspicion. Not one death, not an unexplainable collapse, a run of babies in more than over, just slightly over a year. A, B, C, D, E, F, I, O, N P, and others later that were included in a broader indictment. Some died suddenly after appearing stable. Some collapsed with discoloration or abdominal findings that were strange and unprecedented. Some survived and became part of the prosecution's insulin or attempted murder evidence. And over time, the same nurse's presence kept recurring often enough that some consultants began to feel they could no longer treat it as a coincidence. That didn't amount to a criminal criminal accusation yet. At that stage, it meant that some people, clinicians, were starting to compare their cases and start to ask questions. And what those early cases seemed to have done was change how the consultants were reading the unit. So by the time the ward gone through the deaths of baby A, C, D, E, B, and F, and then the crises that involved baby I, they started to compare cases against each other and noticed how the collapses were described as sudden, the visual details were unusual, and Lucy Leppy's name seemed to always appear in the background. And they kept saying, why does this keep happening like this? How does a baby that seems stable collapse without the kind of warning that they would expect? And how would the same nurse be present off enough that, you know, it wasn't more than a coincidence? So later, evidence from the Thurwall inquiry showed that some consultants believe they had seen enough to justify urgent action well before the hospital moved decisively. So the Thurwall inquiry is an investigation into these cases. And the word Thurwall is because the judge who was in charge of that inquiry, that was her last name. So the next phase of the story wasn't criminal, it was institutional. Consultants raised their concerns. And unfortunately, those concerns did not produce any reaction or escalation from leadership. Instead, it started a conflict between consultants and hospital management over what was happening on the ward and what should be done. Later evidence heard by the Thurwall Inquiry and later reporting made clear that some doctors believed the situation required much more urgent action than management was taking at the time. Consultant pediatrician Dr. Ravi G. later told the inquiry that he and his colleagues should have gone to the police much sooner than waiting for hospital management to move. But that evidence didn't describe a lack of concern. It described concern that had not translated quickly enough into outside intervention. This is one of the central features of the part one episode that it's not simply that doctors were worried, it's that the hospital didn't move in the straight line that people might imagine in hindsight. I mean, these doctors kept pushing and pushing that something needed to be done. And instead, management would bring them in the room and it eventually told them because her nurse, I forget what her name is now, but the nurse that was her mentor was in charge of the unit and was really supportive of Leppi and saying that they she was being victimized by these physicians and so on and so forth. And management bought that for one reason or another, and actually brought these head consultants in, told them off and told them if they did anything else, they'd be gone. They were to no longer complain about Lepbee. And in fact, they needed to issue a formal apology to her. So they had to write her a letter apologizing for you know presenting their concerns about her. Yeah. Wow. But Lepbee was eventually removed from the unit in July of 2016, and she was moved basically to a desk job. And even so, her nursing supervisor wrote emails to everyone so that Lucy's colleagues, her nursing colleagues, didn't even realize that this was a a downgrade or a punishment or a concern. It was just like, oh, she she's she gets an administrative position. But Lucy knew she was being pulled off the ward, which is where she wanted to be, and she knew why. So in September 2016, she was fully pissed off that she got taken off the ward, felt like she was being bullied, and so she filed a grievance, and then that's when they all had these meetings between leadership and the consultants, where the consultants were told to apologize. So that sequence shows how differently people inside the same institution were reading the situation. The timeline after Lepbee's removal is one of the most revealing parts of this case. She was removed from the ward in 2016. Police didn't begin investigating until May 2017, after the hospital referred the deaths. Lepbee was first arrested in July 2018. That means there was nearly a year between her removal from the ward and the start of the police investigation, and roughly two years between her removal and her first arrest. Those intervals shaped the later institutional story. The case didn't move directly from bedside concern to law enforcement. It moved through a much slower sequence, repeated collapses, consultants' concerns, complaints, filing concerns, internal conflict, managerial hesitation, removal from the ward, continued dispute, and then finally the police involvement. The Thurwall Inquiry was set up in part to examine exactly that sequence. Its terms of reference ask whether suspicions should have been raised earlier, whether Leppy should have been suspended or removed sooner, and whether police and external bodies should have been informed earlier and whether the hospital's governance and culture contributed to failures in protecting babies on the unit. The Thurwall Inquiry is the official public inquiry into what happened at the Countess of Chester Hospital after Lucy Leppy's convictions. And like I said, it's called the Thurwall Inquiry because it's chaired by Lady Justice Thurwall. By the time the case left the hospital and entered the criminal justice system, the meaning of it had changed. Lucy Leppy was no longer simply a nurse whose name appeared too often during a series of unexplained collapses. She'd become the focus of a police investigation into baby deaths at the Countess of Chester Hospital. From that point forward, the question was no longer whether the unit had suffered an appalling run of tragedy. It was whether someone on the unit was causing it. And that's where part one ends. A nurse has been taken off the ward, consultants have spent months trying to get management to move faster. An institution failed to act with a clarity some of its own doctors later said that the moment demanded, and police have now entered the picture. In part two, we'll get into the arrests, the trial, and everything that followed, including some surprising new evidence that may or may not change your mind about whether or not Lucy Leppy was actually guilty.

SPEAKER_00 52:53

Ooh. I guess I wasn't aware that we might think she wasn't guilty. So I'll look forward to hearing about that. But because my mind right now is like a dirty scoundrel. How could you? These little babies. I mean, they're probably like one pound. I mean, some of the really, really early ones, like the triplet. Well, actually, those triplets were further in gestation than I thought. They would be for triplets, but that's not the point of this.

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SPEAKER_03 53:23

Yeah, obviously these it was tragic, and these parents does deserve justice, but I'll just say, just sort of a point for thought, is that evidence is circumstantial. These babies were fragile, and Lucy was the only nurse on the unit that was trained in at-risk neonatal like NICU population. So she was scheduled for to be looking after the most vulnerable. And after she was taken off the unit, they downgraded the unit to a lesser severe unit. Yeah. So that's tough to think about. Yeah. Yeah. Do you want to do the second sponsor? Because my voice is on the fry.

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Medical Mishap The Portal Ate It

SPEAKER_03 55:17

First of all, I love the dub dub dub. And second of all, thank you for singing that. That just made my day. You're on fire, girl.

SPEAKER_00 55:25

Medical mishap is titled The Portal That Ate My Appointment. Oh wow. It says, Hi Jenna and Amanda with a musical note emoji. So I'm guessing that's supposed to mimic Jenna at the intro. I'm not sure. Just listen to your lobotomy episode, and my skin is still crawling. I can't believe they used to do that to people and to so many people. I had no idea. Thanks for bringing such an insanely crazy, weird, and often useful information each week.

SPEAKER_01 56:03

You're welcome.

SPEAKER_00 56:05

Here's a quick mishap of my own. I needed to go to my primary care provider for a general wellness check. No biggie, your girls got a portal. No need to even have to make a dreaded phone call. I'm all about that texting life. Same. I log in, find a spot that works. And I honestly, I'm sorry, I gotta back up. When someone texts me and they're like basically want to schedule a phone call. I'm like, you're already talking to me. Can we just can you just tell me what you want? I hate phone calls. Just call me. Either call call me. I'll answer if I can. I hate phone calls. I don't know. That is so bizarre. Like to schedule a phone call. Okay, anyway, sorry. Yeah. Yes. Ah. Okay. So this person goes on to say, I log in, find a spot that works for me, get approval from my supervisor to take time off work, and check schedule appointment for annual exam off my to-do list. So I show up to my appointment on time, check in, sit down, and wait. And wait. And wait. At 45 minutes, I politely ask the front desk if they're running behind. The receptionist asks for my name and birth date, clicks and clacks around on the computer for a while, and then looks at me like I'm a ghost and says, Oh, you're not on the schedule. Oh. Then how the F did you get checked in? I pull up the confirmation email, the reminder text, the calendar invite. I'm basically producing a documentary at this point. She clicks around for another minute and goes, huh. Looks like you requested an appointment, but it never became an appointment. So apparently the patient portal has a phase where your healthcare is in a situation ship.

SPEAKER_04 57:58

They offer to squeeze me in.

SPEAKER_00 58:04

They offer to squeeze me in three weeks from now. Me. Quote. So I took off work, drove here, paid for parking, and the portal just ate it. End quote. Her quote. It happens. End quote. It happens. Anyway, if you no. If anyone needs me, I'll be refreshing the portal like it's Ticketmaster. Love you, ladies. Stay safe and stay suspicious of your patient portal.

SPEAKER_02 58:35

Oh my god.

SPEAKER_00 58:36

Reagan.

SPEAKER_03 58:37

That's so frustrating. I can feel the frustration. It's so hard to get off work and take the time and get there. And then, you know, it's just some ridiculous reason.

Subscribe And Closing Notes

SPEAKER_00 58:49

I hope they gave you a parking pass. I hope so too. Oh, it's the least they could do. Oh, we can offer to squeeze you in and throw a wigs. Yeah. Oh, oh, goody. Uh, can I get in sooner for a virtual appointment, please? Okay, Doki, Alley Cats. Well, we'll be next. Or we'll be next. We will be back next week with part two of this horrific story about Lucy Letby. But meanwhile, do not miss a beat. Subscribe or follow Doctoring the Truth wherever you enjoy your podcasts for stories that shock, intrigue, and educate. Trust, after all, is a delicate thing. You can text us directly on our website at DoctoringTheTruth at BuzzSprout.com. Email us your own story ideas, medical mishaps, and comments at DoctoringTheTruth at Gmail. And be sure to follow us on Instagram at DoctoringTheTruth Podcast and Facebook at DoctoringTheTruth. Ey-Oh, we're also on TikTok at DoctoringTheTruth and ed odd pod. That's E D A U D P O D. Don't forget to download, rate, and review so we can be sure to bring you all this horrific content next week and the one after that and the one after that. And until then, stay safe and stay so I just love all your musicality today. Are we counting down? Oh wow. Zing zang z boom boom. Okay, wait, do we push stop? Oh, okay, bye.