Editorial: A British nurse quietly murdered newborns. There are lessons for US hospitals.

The case of Lucy Letby, a serial killer masquerading as a nice neonatal nurse at Countess of Chester Hospital in Northern England, is so horrific as to beggar belief.

On Aug. 18, the 33-year-old Letby was convicted of murdering seven babies and attempting to murder six others between June 2015 and June 2016. Over the past few days, the British media has also reported on other mysterious infant deaths when Letby was present, suggesting that the total number of murders from a woman who has become known as the worst serial killer of children in British history was not fully accounted for in a country already wracked with anguish.

British media have followed the case very closely, knowing it plays into so many of the deepest fears of parents who must trust medical professionals with their precious newborns. Following Letby’s conviction and her sentence to life imprisonment without the possibility of parole, the chief prosecutor in the case put out a gut-wrenching statement.

“Lucy Letby was entrusted to protect some of the most vulnerable babies,” Pascale Jones said. “Little did those working alongside her know that there was a murderer in their midst. She did her utmost to conceal her crimes, by varying the ways in which she repeatedly harmed babies in her care. She sought to deceive her colleagues and pass off the harm she caused as nothing more than a worsening of each baby’s existing vulnerability. In her hands, innocuous substances like air, milk, fluids, or medication like insulin would become lethal. She perverted her learning and weaponised her craft to inflict harm, grief and death.”

Perhaps the closest equivalent to this United Kingdom case came some years before and dealt with a similarly vulnerable population but one at the other end of life’s journey.

A primary care physician based outside Manchester, Harold Shipman, was found guilty in 2000 of murdering at least 15 patients under his care. Shipman’s victims were elderly people who, of course, trusted him, as most of us would trust our doctors. But Shipman was a killer, not a healer, quietly murdering his victims either by dispensing a lethal dose of drugs or prescribing familiar medicine in quantities that led to a fatal overdose. Shipman, who became known as “Dr. Death,” later hanged himself in prison.

But while the medical profession in both cases went to considerable lengths to obscure what they really were doing, both were able to profit from a kind of built-in bias. Not every newborn survives, even in good hospitals, and we’re conditioned to think that there sometimes might be an air of mystery about their fate. Similarly, we are conditioned to believe that old people can die suddenly. As a consequence of those pervasive lines of thoughts, Shipman and Letby evaded discovery for enough time to kill more people.

In both cases, family members have demanded answers as to why it took so long. There is no question that part of the problem was that those who had misgivings about the sudden rise in deaths had to overcome the general assumption that medical professionals are to be trusted.

In the Letby case, in which the wounds are fresh and open, parents have focused on the nurse’s former boss, director of nursing Alison Kelly, who has been accused of ignoring concerns. Kelly is being investigated on “fitness to practice” concerns. Also under longtime scrutiny is hospital medical director Dr. Ian Harvey, who has been accused of ignoring concerns raised by doctors early in Letby’s killing spree. Some staffers have said he was protective of Letby and, in British parlance, fobbed off complaints from concerned colleagues.

Incredibly, Letby was the only staffer present in June 2015 when three premature babies died at the hospital. Reportedly, it was the equivalent of an average year’s worth of deaths at the hospital occurring in just two weeks. By the end of that October, Letby had been alone in the room even as seven premature babies had died.

Premature babies die, it was deemed at the time, and Letby was merely unlucky to be the nurse standing there. But with hindsight, it is stunning that no one dug deeper early on, given what Letby was actually doing, including poisoning the babies with insulin. Had they done so, many more babies would be alive now.

What are the lessons here on this side of the Atlantic?

For one, effective medical teamwork requires looking out for malevolent colleagues. However rare they may be, the Shipman and Letby cases prove they do exist. For another, family members deserve, and should always demand, full disclosure about what happened to their loved ones who die while medical professionals are present. While death is sometimes shrouded in the unknown, that truth must not be allowed to prevent families being sure they are comfortable that what transpired was inevitable. And, for a third, medical directors and other hospital administrators must cultivate open door policies so that whistleblowers are willing to come forward with any misgivings.

Much of that requires often harried medical professionals to build in more redundancies, as well as peer checks and balances. Nobody wants to be under the constant scrutiny of their peers, but these were life-or-death matters, and a normal human reluctance to consider the worst, enabled the loss of innocent life and unspeakable anguish.

This happened in a well-respected hospital. Pride must be swallowed and systems rebuilt and maintained so it never happens again. Anywhere.

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