Angels of death!

By Dr Upul Wijayawardhana

Another British nurse has just joined the ranks of ‘angels of death’, after being convicted of murdering seven newborns and the attempted murder of another six while working in the neonatal intensive care unit of Countess of Chester hospital in the Northeast of England.  On 18 August, a jury in Manchester crown court, while convicting 33-year-old Lucy Letby of the aforesaid charges, cleared her of two counts of attempted murder and was unable to reach a verdict regarding six further attempted murder charges relating to five newborns. It has sent shockwaves across the country.

Having witnessed a similar occurrence first hand, albeit from the sidelines, at the very beginning of my 20-year stint at Grantham Hospital in the Midlands of England, I never expected a repetition in my lifetime, as I thought lessons would be learned. I was wrong and, in a way, it is not surprising considering the vastness of the British NHS. However, what surprised me most was the callous indifference shown by the management of Countess of Chester hospital, which totally disregarded the concerns repeatedly raised by the consultant paediatricians running the unit.

In 1991, an internal market was introduced to the NHS at the behest of Kenneth Clarke, the then Health Secretary of Margaret Thatcher’s government, which some call ‘Clarke’s curse’, for good reasons. Clarke was of the opinion that hospitals were not sufficiently managed. Besides getting hospitals to compete with each other, he introduced a system to turn them into trusts with plenty of managers with overriding powers. It was suspected that the move was intended to reduce the power of doctors who, the Conservatives thought, were becoming too powerful. The direct result of that unwanted change was that managers overruled the concerns of doctors.

Beverly

The first nurse to be dubbed ‘the angel of death’ is Beverly Allitt, who was convicted of murdering four infants, attempting to murder three more and causing grievous bodily harm to a further six, between February and April 1991 at Grantham Hospital. In fact, I started working at Grantham Hospital on 04 February 1991 and I remember a phone call I received shortly afterwards from my good friend Dr Charitha Nanayakkara, whom I have known since our medical student days.

He was one of the two paediatricians and asked me whether a neonate could die of a heart attack. Having replied that it was possible only if the child had a congenital defect of the coronary arteries, I asked him why he asked such a question. He said a neonate under his care had died unexpectedly and as he was uneasy with the post-mortem report that the child had died of a myocardial infarction, he was appealing to the coroner to get a repeat PM done by a pathologist specialising in children. Unfortunately, his request was not granted, and perhaps Beverly Allitt could have been prevented from destroying more lives if it had been allowed.

Beverly Allitt’s modus operandi was to smother her victims or inject potassium chloride to stop their hearts or inject Insulin to lower their blood sugar to dangerous levels. A number of children had suffered cardiac arrests, and if not for the prompt actions of the two paediatricians, many more lives would have been destroyed; unfortunately, politicians attempted to scapegoat them later. On the basis of their suspicions, the hospital management called the police in, and they found that Allitt was responsible for the cardiac arrests at issue.

She was convicted in May 1993 and given 13 life sentences, but instead of being jailed, she was sent to a secure hospital on the basis that she has Munchausen Syndrome by Proxy, a condition in which a caregiver creates the appearance of health problems in another person, typically a child which may include injuring the child or altering test samples. Permanent injury or death of the victim may occur as a result of the disorder. However, many who were closely involved in the Beverly Allitt case consider her to be a cold-blooded killer. Whatever it may be, Grantham Hospital lost the paediatric department as a result, and that cost the taxpayer millions of pounds to compensate the children who had severe long-term damage.

The way the managers responded to Lucy Letby’s killings is a blot on the entire NHS. Worryingly, there seems to have been an attempt to silence the doctors who raised concerns. A team of seven paediatric consultants and about 30 trained nurses provided 24-hour care to babies born prematurely in this intensive care unit, where hundreds were treated but only two or three died each year. However, within a fortnight in June 2015 there were three deaths with the unexpected deterioration in a fourth neonate, and that made the lead paediatrician Dr Stephen Brearey suspicious. He reported that Letby may be harming patients in October 2015, when two more deaths occurred, as she was present during all those episodes. The manager of the unit opined that it was a coincidence and there was no response, at all, from the Director of Nursing!

In January 2016, another consultant Dr Ravi Jayaram caught Letby in suspicious circumstances and Dr Bearsley contacted authorities but in vain, again. Three months later, following the near-death of two more patients, he was able to meet the Medical Director and the Director of Nursing but they took no action. In June, following the deaths of two out of triplets, Dr Bearley demanded the removal of Letby but the management refused to do so. However, the following day, after the near death of another neonate, Letby was removed. The paediatricians called for a referral to police but the management refused. The Medical Director instructed the paediatricians not to send any further emails regarding Letby!

The management, instead of calling the police in, attempted to get other bodies to review, but in the meantime, Letby initiated a grievance procedure, which was successful. The Chief Executive ordered the seven consultants to send a letter of apology to Letby! Two months later, the senior management got the police involved.

Police launched “Operation Hummingbird” and were astonished by what they found. Three years after concerns were raised, Letby was arrested and after a trial lasting ten months, the longest murder trial in British judicial history and after over 100 hours of deliberation by the jury, Letby was found guilty, at last! Justice has finally been served thanks to the unfailing attempts of the seven paediatricians led by Dr Bearsley.