The Countess

Summary

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DOUBT: The Case of Lucy Letby

Episode 2: The Countess

Host: Amanda Knox
Date: March 3, 2026
Podcast: iHeartPodcasts

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Episode Overview

This episode, “The Countess,” explores the early events at the Countess of Chester Hospital that set the stage for the Lucy Letby case. Amanda Knox takes listeners through the culture and conditions of the hospital’s neonatal unit (NICU), describes the initial cluster of tragic infant deaths that raised suspicions, and reveals how differences in staff perspectives — and persistent institutional issues — laid the groundwork for what became one of Britain's most notorious legal cases. The episode humanizes the profound trust families invest in NICU care and delicately probes how suspicion and doubt filtered through a strained, close-knit medical environment.

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Key Discussion Points and Insights

1. Amanda Knox’s Personal Reflection and Establishing Trust in the NICU

• [01:51] Amanda opens with a deeply personal account of her experience as a NICU parent, highlighting parental vulnerability and reliance on medical staff:
  • “In the NICU, trust isn't optional. It’s the air you breathe. You hand over the most precious thing in your life to people you barely know, believing they will protect what you can’t.”
• This sets a tone of empathy and underlines the emotional stakes for all involved in the Letby case.

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2. History and Condition of the Hospital

• [05:30] The Countess was built on the grounds of a former Victorian mental asylum.
  • “The hospital building itself doesn’t exactly live up to its regal name. It’s, you know, a hospital. It looks like a hospital built in the 70s. You can probably picture it: unfussy, functional, lots of concrete.” – Amanda Knox ([05:39])
• The neonatal unit suffered from chronic underfunding and problematic infrastructure, with tales of sewage leaks and makeshift repairs.
  • “The plumbing system had recycled the Victorian pipes in the foundation... maintenance crew was forced to improvise… a last ditch effort to stem the flow of literal shit from the pipes overhead.” – Amanda ([09:04])

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3. Profiles of Key Medical Staff

• Dr. Stephen Breary and Dr. Ravi Jayaram:
  • Dr. Breary characterized as soft-spoken, “pillar of the community.”
  • Dr. Jayaram, described as energetic and multifaceted:
    • “He busked on the streets of Chester as a teen, shot his shot at the Edinburgh Fringe Festival… became a mainstay of British game shows, all while coming up the ranks in medicine.” – Amanda ([11:16])
    • “I indulge in the occasional karaoke… I could do Honky Tonk Women by the Rolling Stones in tribute to you.” – Dr. Jayaram ([12:12])

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4. NICU Structure, Culture, and Patient Population

• [17:37] Explanation of NICU levels (1-3) with Jenny Harris, nurse:
  • Level 2 at Countess: “They can also take high dependency babies… premature babies up to a certain gestation and then your level 3 unit is the unit that does everything.” – Jenny ([18:15])
  • Nurse culture described as warm and homey, but staff was stretched and facilities aging.
• Typical annual baby death rates were low (2-3 per year). [19:31]

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5. The Initial Spike in Unexplained Infant Deaths

• Timeline Begins:
  • Early June 2015: Premature twins (Baby A & B) admitted. Son (Baby A) dies unexpectedly; daughter (Baby B) later collapses but survives.
    • “They just need a little more time. They’re in the best place… No promises, no guarantees, just something soft enough to hold onto.” – Amanda ([20:54])
    • “We never got to hold our little boy while he was alive.” – Victim impact statement, as read by Amanda ([22:39])
    • Lucy Letby made the memory box for the parents.
    • “What happened during those 48 hours left the nurses and doctors… in shock.” ([25:01])
• Four days later: Baby C dies.
• Eight days later: Baby D dies.
  • “Three deaths and one unexplained collapse in two weeks. Even on a unit where the babies are compromised, this was unusual.” – Amanda ([26:57])
• The phrase “why is this happening?” becomes central, as staff try to make sense of unprecedented tragedies.

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6. Staff Responses: Uncertainty, Grief, and Division

• [27:56] Dr. Rachel Lambie (via actor):
  • “It was a regular topic of conversation… almost a heart sink feeling: oh gosh, what’s going to happen today?” ([28:59])
• Emergence of Internal Conflict:
  • Registrars and nurses look to consultants (senior doctors) for answers; consultants themselves are struggling for explanations but want to project confidence. ([29:06])
• Consultants’ Internal Communications:
  • Dr. John Gibbs (email, via actor):
    • “The registrars are very concerned about the recent neonatal deaths and collapses… nurses are very worried… I think a meeting would be useful even if we have no answers.” ([30:10])

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7. The Pattern Emerges: Correlation with Lucy Letby’s Shifts

• [31:15] Dr. Breary identifies Lucy Letby as the only nurse present for all three initial deaths.
  • “Staffing analysis did identify that Lucy Letby was on shift for those three.” – Narrator ([31:19])
• Pattern hardens: “Lucy Letby was there for seven out of eight baby deaths by year’s end.” – Amanda ([32:05])

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8. Contested Interpretations and the Role of Evidence

• While Dr. Breary’s suspicions focus on this correlation, the nursing leader, Arian Powell, pushes back:
  • “It is unfortunate that she was on. However, each cause of death was different. Some were poorly prior to their arrival on the unit.” – Arian Powell ([37:43])
  • Powell argues there are multifactorial causes—birth defects, infections, and more—plus no suspicious autopsies.
• The two sides — medical and nursing — remain at odds, with reviews and meetings yielding “no other evidence or reports of clinical concerns about the nurse beyond the simple correlation.” ([43:33])

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9. The Climax: The Triplet Brothers and Aftermath

• June 2016: Identical triplets—an extremely rare case—are born. Two of the three boys die in back-to-back days under chaotic circumstances; Letby attended both.
  • “The mother, during the trial, would later describe it as deja vu… she would remember a young doctor, ‘googling what to do.’” – Amanda ([39:59])
• After this, Letby is removed from clinical duty—moved to an office role, but the unit is also downgraded to Level 1. No more high-risk admissions means, from that point, no further deaths among the babies.
  • “It’s really frustrating for me when I hear people saying, ‘Well, after they took Lucy off, there were no more deaths.’ Well, that’s true, but there were no more sick babies either.” – Dr. Ravi Jayaram ([43:22])

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10. Persisting Doubts and Disputed Investigations

• An external review dismisses the allegations as “subjective views” unsupported by hard evidence:
  • “There was no other evidence or history to link Nurse L to the deaths and her colleagues had expressed no concerns about her practice.” – Quoting final report ([44:01])
• Letby files a grievance for the manner of her removal, claims bullying/harassment, and wins; doctors are forced to apologize and are told she will return.

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11. Turning Point: Dr. Jayaram's "Horror Movie" Account

• The month Letby is due to return, Dr. Jayaram recounts an incident where he claims to have walked in on Letby standing over a baby who was gasping for air, allegedly doing nothing.
  • “That is a night that is etched onto my memory and will be in my nightmares forever.” – Dr. Jayaram ([45:51])
  • “She was just standing there.” ([46:36])
• This story finally prompts management to involve the police.

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Notable Quotes & Memorable Moments

Empathy and Parental Trust

• Amanda Knox [01:51]
  • “In the NICU, trust isn’t optional. It’s the air you breathe.”

The Shift from Correlation to Suspicion

• Staffing Pattern ([31:19])
  • “Staffing analysis did identify that Lucy Letby was on shift for those three.”

Underlying Institutional Strain

• On Funding and Facilities ([09:04])
  • “Maintenance crew was forced to improvise… last ditch effort to stem the flow of literal shit from the pipes overhead.”

Witness Sorrow and Doubt

• Dr. Breary at the Inquiry ([35:38])
  • “I’d like to speak to the families. Sorry, sorry for my part in not being able to protect your babies. I tried my best and I acknowledge that at times my best was not good enough.”
• Dr. Jayaram, The Horror Movie Scene [45:51–46:36]
  • “That is a night that is etched onto my memory and will be in my nightmares forever… She was just standing there.”

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Structurally Important Segments (Timestamps)

• [01:51] Amanda’s personal story; framing parental vulnerability
• [05:30] Historical context & hospital conditions
• [11:16] Dr. Jayaram’s background, blending medicine and media
• [17:37] NICU levels explained; understanding patient acuity
• [19:31] Introduction of Baby A & B; beginning of cluster deaths
• [26:57] Three deaths in two weeks; staff reactions
• [29:06] Onset of division: consultants vs. nurses
• [31:19] Staffing pattern emerges: Letby on shift for all deaths
• [39:59] Story of the triplets; tipping point
• [43:22] No more deaths after Letby's removal & unit downgrade
• [44:01] External review dismisses allegations
• [45:51–46:36] Dr. Jayaram’s “nightmare forever” testimony

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Tone & Language

Amanda Knox’s narration is personal, measured, and empathetic—she draws deeply on her own experience, and brings out the every-day humanity of the NICU staff. The tone in conversations ranges from matter-of-fact (describing institutional shortcomings and medical protocols) to sharply emotional (when doctors narrate traumatic moments or apology statements to grieving families). When relaying direct testimony or victim statements, the style deliberately avoids sensationalism, leaning into the gravity and ambiguity that define the early period of the Letby case.

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Conclusion

In “The Countess,” Amanda Knox sets up the complex backdrop of the Lucy Letby case, drawing listeners into both the physical and emotional world of a flawed but devoted hospital unit. The episode moves from intimate moments of hope and fear in the NICU through systemic breakdowns and into the slow, uncertain turn to suspicion. The pattern of deaths, the internal staff divisions, and the persistent lack of hard evidence all serve to lay the foundation for Amanda’s central theme: is this case as clear-cut as it seems, or is there room for reasonable doubt?

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“Regardless of where the truth ultimately lies, this is the reality these parents have been living inside.”
— Amanda Knox ([25:01])

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Transcript

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[Amanda Knox]

Before we begin, please be aware this series contains discussions around infant deaths and other difficult topics. Please take care while listening. The moment my daughter was born, the doctors noticed strange markings on her skin. Within hours, someone gently explained she might have a rare genetic disorder. I remember sitting in the postpartum room, exhausted and terrified while my fragile, beautiful baby girl had dozens of wires taped to her scalp. I couldn't help her. I couldn't hold her. Like all first time parents, I had been expecting that cinematic moment. Skin on skin. A warm little body settling into mine. The quiet breath of relief after months of Waiting. Instead, I spent the next six months in limbo, fearing she might never walk or talk, that she might go blind, that a tiny hidden defect in her heart might stop it altogether. When I became a mother, I knew I would sacrifice everything to help my child. But this was not a problem I could fix. And I was left with no choice but to trust. Trust the nurses lifting her from my arms. Trust the doctors who did test after test. Trust the specialist who spoke in a calm voice about a possibility that parts of her brain might be missing. Because in the nicu, trust isn't optional. It's the air you breathe. You hand over the most precious thing in your life to people you barely know, believing they will protect what you can't. That vulnerability defines the experience. It's overwhelming, and it's necessary. And then, finally, mercifully, the doctors told us she had tested negative. That her brain, her heart, her eyes, they were just fine. I'll never forget that feeling. The world opening up again. The gratitude so heavy it almost knocked me off my feet. Most parents with a child in the NICU get that moment. But in 2015, at the Countess of Chester Hospital, some never did. The historic heart of Chester is like a time capsule filled with everything you expect from a very old, very storied British city. Cobbled streets, pubs dating back to medieval times, an imposing stone cathedral and an honest to goodness castle tucked in one corner, all surrounded by a great big fortified wall. Right at the edge of Chester is the local hospital named after Princess Diana. It's called the Countess of Chester, which was one of the titles she got when she married King Charles. But the history of the site where the hospital was built isn't, shall we say, quite as illustrious as the stuff in the old city center.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

The Countess of Chester originally was built on the site of a Victorian mental asylum.

[Amanda Knox]

That's Michelle Warden. She used to work at the Countess of Chester as a neonatal nurse. She started a few years after Charles and Diana's royal visit. Speaking of which, the hospital building itself doesn't exactly live up to its regal name. It's, you know, a hospital. It looks like a hospital built in the 70s. You can probably picture it. Unfussy, functional, lots of concrete. But this run of the mill building and what happened inside has for the past decade been at the center of the latest building. Big chapter in the history of Chester. In fact, many believe that what happened here is one of the biggest things to have happened in the history of modern Britain. The country just hasn't settled on what that thing is History is still being written.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

They've clearly found that she's one of Britain's most notorious killers. What to do about a trial, which

[Narrator / Voice Actor]

in my view is a clear miscarriage

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

of justice by a judicial system that could not manage.

[Amanda Knox]

I'm Amanda Knox and from Vespucci and iheart podcasts, this is the case of Lucy Letby. Episode two, the Countess. Back in 2015, when you arrive at the Countess, that's how a lot of people refer to it, by the way, the Countess, one of the first things you'll see is a short, stocky building to your left. That was the Women and Children's building.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

I mean the Women and Children's Department hospital was designed for, as it says, women and children. So you've got a pediatric ward, you have a neonatal ward, you have all the maternity.

[Amanda Knox]

Michelle again. She spent so many years in this building, she could probably recite the layout in her sleep.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

You've got fetal medicine unit, antenatal postnatal gynecology, you've got operating theatres, infertility. Anything to do with women and children is within that building.

[Amanda Knox]

But a lot has changed since Michelle first started working there in many important ways, some for the better and some for the worse.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

It wasn't until the mid-1990s, with the development of a drug which helps to develop premature babies lungs, that really revolutionized the care of these sick and premature babies.

[Amanda Knox]

Though new drugs helped the infants breathe easier, the same couldn't be said for the facilities. By the time Michelle retired in 2007, the women and Children's building itself was coughing and spluttering.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

It was a lovely unit, but it was old and with any old building it had its problems, which were always going on. I went to work on the unit in 1988 and Wear and tear was beginning to show even back then, problems with the plumbing, the sinks and the taps sometimes not working properly.

[Amanda Knox]

The plumbing system had recycled the Victorian pipes in the foundation from the ground's mental asylum days. Sewage would back up into the sinks. It would also leak from the pipes overhead onto the incubators. This was a chronically underfunded unit and often the maintenance crew was forced to improvise. One maintenance worker described to the Telegraph newspaper a time he and his colleagues had to pad the ceiling tiles with diaper lining, a last ditch effort to stem the flow of literal shit from the pipes overhead. There was never enough time or money to put out all the fires. By the summer of 2015, the hospital had been begging the public for help, pleading for donations.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

She's raising money for the Countess of Chester's Baby Grow appeal. Launched to raise 3 million pounds to build a new neonatal special baby care unit to provide better facilities.

[Amanda Knox]

Everyone threw themselves into the effort. Racing rubber duckies on the River Dee, charging down the streets of Chester in Santa costumes and gamely taking part in goofy dance videos like the one with the pediatrician in charge of the unit, Dr. Stephen Breary, shaking his hips to the tune of Twist and Shout and making heart shapes with his hands. All for the cause.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

On behalf of the doctors and nurses that work in Chester on the neonatal unit.

[Amanda Knox]

That's him. Dr. Breary, I'd like to express my

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

sincerest thanks for your very kind donation. A new neonatal unit.

[Amanda Knox]

Soft spoken, self effacing, Dr. Breary had that pillar of the community vibe to him. But the real poster boy of the pediatric team was Dr. Breary's close friend, Dr. Ravi Jayaram. He was thin and sprightly with a shock of curly black hair. The local papers called him the TV doctor.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

And Dr. Ravi Jayaram is with us now because we're going to talk about this a little bit more. I'm Dr. Ravi Jayaram. I'm a consultant pediatrician and I've worked for the NHS all my career.

[Amanda Knox]

Consultant is the most senior rank of doctor in the uk. You'll be hearing that word a lot in this series. Dr. Jayarum was a consultant. And just so we're all on the same page, NHS stands for National Health Service. It's the UK system of free health care for all. Making it to consultant level took a long time and a ton of work. But through all those sleep deprived years, Dr. Jayarum never forgot to nurture his first love, showbiz. He busked on the streets of Chester as a teen, shot his shot at the Edinburgh Fringe Festival in college and became a mainstay of British game shows, all while coming up the ranks in medicine.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

And this is your third appearance?

[Amanda Knox]

It is, yes. That's him on the Weakest Link. He actually won at one point. Anything else?

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

I indulge in the occasional karaoke. Put your board down. What can you sing? I could do Honky Tonk Women by the Rolling Stones in tribute to you. Well, I doubt whether you can, but you can try. Have you started yet?

[Amanda Knox]

I met a Ginsault bar on Queen in Memphis. She tried to take me upstairs St for a ride. In his downtime, Dr. Jerum played local gigs with his band, the Deluded. Here they are at the Cavern, a live music spot in Liverpool, where the deluded were a regular attraction.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

He's actually got a good singing voice and he is both theatrical. I actually asked him why he didn't pursue a career in drama and he said, well, that's not what nice Indian boys do, is it? I mean, his father was a consultant. His brother is a very eminent consultant ophthalmologist in London.

[Amanda Knox]

But Dr. Jaram found a way to make his medical career and his rock star ambitions work for him. In the summer of 2015, he was co starring in a reality TV show called Born Naughty where he and a fellow doctor met parents of badly behaved children and decided if a medical diagnosis was the answer to their problems.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

As a pediatrician and a GP, Dr. Ravi and Dr. Dawn often meet badly behaved kids. But now they must crack some real hard nuts.

[Amanda Knox]

He spent the early part of that summer crisscrossing the country doing promo for his reality show as well as other media work. He seemed to be everywhere, except perhaps the understaffed neonatal unit at the Countess of Chester Hospital. But just as the future's looking bright, something terrible starts unfolding in the neonatal unit. It won't be long before the unit is demanding all of Dr. Jaram's attention. There will be little time left. Show business.

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[Amanda Knox]

In the UK not every NICU is the the same. Neonatal units are graded level one through three depending on what level of care they are equipped to provide. Jenny Harris, who spent years as a neonatal nurse in the nhs, helped me understand what those levels actually mean. If your hospital has a level 1

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

neonatal unit that means that you can just care for babies that just need feeding and growing, maybe a little help with respiratory support, but only like minor respiratory support, like oxygen.

[Amanda Knox]

Then you have your level two unit.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

They can also take high dependency babies. So these are babies that need say cpap, may need fluids, premature babies up to a certain gestation and then your level 3 unit is the unit that does everything. So special care, high dependency, all intensive care babies, whatever they may need and what they do is say there is a baby in a level one unit that needs to go to a level three. Then the transport team would go to that baby, stabilize the baby and take it to the hospital that's more equipped to care for that baby.

[Amanda Knox]

Jenny worked on the transport team. She spent years moving tiny patients from one hospital to another, from one level of care to the next. The Countess of Chester was a level 2 unit.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

My favorite was going to the level ones and the level twos because they were so cozy, quiet. They're all like decorated nice and, you know, got pictures on the walls and selling knitted stuff and a little trolley, like, it's just so lovely. You just go in and it's just. Yeah, it just seems more homely.

[Amanda Knox]

For the parents, the NICU is both terrifying and miraculous. It's where the smallest lives fight their biggest battles. A place of constant fear, yes, but also of hope. The unit at the countess in summer 2015, like many across the UK, is warm and cozy. It cares for premature babies, babies who struggle to breathe, to feed, to grow. And it isn't known for high death rates. From 2011 to 2014, two or three babies died there each year. On paper, it was unremarkable. It's early June and a set of twins has just been born. They're premature, tiny, but breathing. Their mother has a rare autoimmune condition which made her pregnancy risky. At seven months, her twins are born by C section and whisked away to the neonatal unit. Here's Michelle again, the nurse that worked at the Countess.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

They were supposed to be born in London and the mum had antiphospholipid syndrome, so they delivered her in Chester.

[Amanda Knox]

The twins are placed in adjoining cots, tubes for feeding, wires for monitoring. In place of their mother's heartbeat, they now hear something else. Monitors, footsteps, hushed voices. The unfamiliar rhythms of the neonatal unit take over. Unlike many American hospitals where parents can stay around the clock, UK neonatal units are often more nurse led. Parents come and go. Care continues through the night. And like so many parents in a neonatal ward, the twins parents were most likely offered gentle reassurance, the kind meant to steady you when everything feels uncertain. They just need a little more time. They're in the best place. I remember hearing a version of that myself when my daughter was in hospital. We have our best people on it. You're doing great. No promises, no guarantees, just something soft enough to hold onto. But when nothing feels certain, you hold onto hope and trust. But for the parents of these twins, that trust became Heavy. The moment the alarm sounded, Something is wrong. Their baby boy's condition has deteriorated. Suddenly, Hours later, they're holding him, but not in the way they had hoped. In a later victim impact statement, his parents would describe how, quote, we never got to hold our little boy while he was alive. Dr. Jaram was there that night. There was no clear answer he could give the parents. Years later, during his testimony, during Lucy Letby's trial, Dr. Jayarum would recall the awful conversation he had to have with the parents that night. It was a difficult situation, he'd say, when the first thing you have to tell a family is that, number one, I'm not sure what's going on, and number two, I don't think we're going to be able to bring him back. With their daughter still in intensive care, the parents were forced to do the impossible to grieve one child while hoping for the other. Baby A's nurse, Lucy Letby, makes them a memory box. A lock of hair, a footprint, a tiny knitted hat. Years later, in a court of law, these mementos would take on a very different meaning. One day later, the alarm sounds again. This time, their daughter, the surviving twin, has collapsed. Thankfully, the doctors intervene in time. Neonatal medicine is a world built on watchfulness. Doctors and nurses are used to things changing suddenly, to alarms, to emergencies, to living in a constant state of readiness because these babies are fragile, unbelievably fragile. Here's Jenny again.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

There's so many things that can go wrong with preterm babies. They're so sensitive, even changing their nappy can cause them to have a bleed in their brain. People just don't realise how sensitive these babies are. That's very rare, but it can happen.

[Amanda Knox]

Most days they manage to pull babies back from the edge and then they're the days that stay with them forever. What happened during those 48 hours left the nurses and doctors on the unit in shock. Of course, these twins had names. But because the courts ruled that none of the names of the babies in this case could ever be made public, they came to be known as Baby A and Baby B. One day, the UK justice system would officially recognize Baby A as the first known victim of a serial killer. Nurse. Now, I want to be careful here, as it's hard for me to truly grasp what these parents lived through. Although I myself have experienced what it's like to have a newborn in the hospital, to then be told that the person you trusted with your baby's life may have been the one who took it. It's unimaginable. And yet, regardless of where the truth ultimately lies, this is the reality these parents have been living inside. When I spoke to Dr. Phil Hammond, who you may remember from episode one, we discussed the power of grief, how it forces one to search for answers. And for the parents in this case,

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

the parents supported by the laws, are still absolutely convinced of her guilt because they've spent so much of their life invested in this. Imagine the emotion of the verdict of all that stuff.

[Amanda Knox]

Tragically, four days after baby B collapses, baby C dies. A boy. And eight days after that, a baby girl, baby D. Three deaths and one unexplained collapse in two weeks. Even on a unit where the babies are compromised, this was unusual. The staff tended to see three baby deaths a year. Three in two weeks was a crisis. By the end of that summer, the NICU at the Countess would be forever changed. There were more collapses, more funerals. Parents brought in balloons for milestones, only to leave with condolences. And quietly, a question began to swirl amongst the staff. Why is this happening?

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

So I remember within the hospital, within the our team at handover, it was a regular topic of conversation.

[Amanda Knox]

These are the words of Dr. Rachel Lambie, read by an actor. They are from transcripts of her testifying at a public inquiry which was set up right after Lucy Lepe's conviction. This inquiry had a very specific mandate to figure out if Letby the serial killer, could have been stopped sooner. Back in 2015, Dr. Lambe was still a doctor in training. In England, doctors in training are referred to as registrars or junior doctors. Dr. Lambie was one of the first people on the scene when baby A's alarm went off. She was there the next night too, when his twin sister, baby B, collapsed. By the time babies C and D die, everyone is on high alert. Here's an actor again reading a section of testimony from Dr. Lambi during the inquiry.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

I remember on more than one occasion, almost a heart sink feeling of oh gosh, what's going to happen today?

[Amanda Knox]

In this moment of crisis, a fissure begins to form amongst the staff. On one side are the registrars and the nurses. They're looking to the senior doctors in charge, the consultants for answers. On the other side are the consultants. There are seven of them. Together they're responsible for all of the children who pass through the building, from the most premature of babies to the 17 year old with a broken leg. Dr. Jayarum leads the pediatric department and Dr. Breary the neonatal unit. The consultants don't have any answers for the sudden spate of baby deaths. But they also don't want the rest of the staff to think they don't have this under control.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

Dear all, Rachel Lambie came to see me this morning.

[Amanda Knox]

This is how one of the consultants, Dr. John Gibbs, begins an email to the six others the day after Baby D's death. Here's an actor reading what he wrote.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

The registrars are very concerned about the recent neonatal deaths and collapses. Rachel also said that all the neonatal

[Narrator / Voice Actor]

nurses are very worried.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

They feel we ought to be doing something. Although I've mentioned we are looking into this, I'm not sure exactly how this is being done. I think a meeting would be useful even if we have no answers.

[Amanda Knox]

In an effort to put the others at ease, Dr. Breary says that he and the head of the neonatal nursing team have carefully gone over the details of the three recent deaths to see if there's anything connecting them. But as he would tell the BBC

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

years later, there was nothing in common that we could pin this three deaths on.

[Amanda Knox]

Well, maybe there is one thing. Dr. Breary has gone through the work schedule for the nurses and notices one nurse who has been on duty when all three babies died.

[Narrator / Voice Actor]

Staffing analysis did identify that Lucy Letby

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

was on shift for those three.

[Amanda Knox]

A pattern starts to emerge. In August, a fourth baby dies. Lucy Letby was his nurse in September. Lucy Letby is on duty when one of two babies die in October, another baby, Lucy Letby, is on duty again. In December, another, and again. Lucy Letby was there eight deaths by the end of the year. Lucy Letby is present for seven. For Dr. Breary, what could be dismissed at first as mere correlation is hardening into a strong basis for suspicion.

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[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

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[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

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[Narrator / Voice Actor]

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[Amanda Knox]

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[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

i'd like to speak to the families. Sorry, sorry for my part in not being able to protect your babies. I tried my best and I acknowledged that at times my best was not good enough.

[Amanda Knox]

That's an actor reading from transcripts of Dr. Breary testifying at the inquiry about a year and a half ago. He looks much older now, older perhaps than you might expect the rosy cheeked doctor in the light hearted fundraising videos to be. The toll of the last 10 years is clearly visible in his appearance. Dr. Breary was the first of the consultants to notice a correlation between Lucy Letby's work shifts and and the deaths of babies. The way he says he remembers it, it had actually been the head of the neonatal nurses, Arian Powell, who had pointed the correlation out to him and that his instinctive reaction had been to say, oh no, not Lucy, not nice Lucy. He was asked about this at the inquiry.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

Well, your mind jumped to something to say oh no, didn't it? Yes. What did it jump to? The concern that there might be somebody harming babies.

[Amanda Knox]

Yeah. As the number of deaths kept climbing and Lucy Letby kept being there when they happened, the association, as he would take to calling it, would come to dominate Dr. Breary's mind. It would also put him at loggerheads with the nursing leader who he had said had originally pointed out the association to him and who was Lucy Letby's boss. To the nursing leader, Aaron Powell, the correlation with Letby's shifts told them nothing about why these babies had died. In an email to Dr. Breary after yet another death, she wrote, it is unfortunate that she was on. However, each cause of death was different. Some were poorly prior to their arrival on the unit.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

There was no evidence there. Your evidence was dead children, was the commonality. Well, dead children, yes.

[Amanda Knox]

As more and more babies die, there are more meetings and more reviews by Breary and Powell. These discussions grow to include others. The nursing manager for the whole hospital, a neonatologist from a top hospital in Liverpool who is friends with Dr. Breary, but always with Breary and Powell arguing from opposite ends, which Powell was grilled about at the Inquiry.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

Letby was protected because she occupied an intersection between two things. She was a nurse who was being criticised by the doctors and she was a nurse who you liked and that's why she was protected, isn't it? I think you're mistaken liking with actually supporting your staff.

[Amanda Knox]

Powell points to other factors. Several of the babies had unsurvivable birth defects. Many others had serious worsening infections. By the time they died, all but one of the babies had autopsies, none of which flagged anything suspicious in those meeting rooms. Two stories kept colliding and for a long time the discussions continued. But then, in June 2016, just over a year since the death of baby A, a set of triplet brothers are born at the Countess. They've been naturally conceived and are identical, sharing the same placenta. An incredibly rare thing, the kind of thing that only happens once every 200 million births. The triplets are born at 33 weeks by C section and sent straight to the neonatal unit. Their parents are told not to worry, the babies just need some time to grow. But on the brothers second day of life, their parents are confused, confronted with a scene of total chaos. One of the triplets is having a very serious medical crisis. His stomach is swollen. His dad would later say during his testimony in court that it was like ET stomach, like a pot belly. The doctors tell the parents they don't know what's going on, but they are trying their best to save him. At one point, the dad would recall, it was like they were trying anything. The doctors aren't able to save him and the baby boy dies. The next day, the second of the triplets die in a scene so similar and chaotic to the day before that. The mother, during the trial, would later describe it as deja vu. She would remember a young doctor quote, googling what to do. In two days, two of their babies have died. The parents plead to have their surviving son transferred to a different hospital. For Dr. Breary, it was obvious what had happened. Lucy Letby had murdered both boys. She'd been on duty both days and been put in charge of both babies. Dr. Breary would later tell the police about the way Lucy Letby had smiled and said hello to him the morning before the first triplet had died. He would wonder out loud if she'd been taunting him. After these two deaths, the management knew they had to make changes. There was no more discussion to be had after this incident.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

After the deaths of O and P.

[Amanda Knox]

Yes, murders, we now know they agreed to get Letby off the unit. She shipped off to a back office in another department at the hospital and given an excuse to cover up the real reason for the move, that all the neonatal nurses would be moved out for a period of time and she was just the first one up. So the consultants get what they want. Lucy Letby off the unit. But the hospital executives aren't finished. They too are concerned about the spike in baby deaths, but think the explanation lies elsewhere. They see an overburdened unit and believe they should hit the pause button on taking in so many babies, especially ones that are so vulnerable. The managers agree to remove Letby on the condition that the unit also be downgraded.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

They downgraded the unit to a level one, which was in June 2016. A level one unit is basically just special care. So you're not taking any sick babies at all. You do, of course, always still get sick babies because you can't predict what's coming into the maternity doors.

[Amanda Knox]

But the sickest babies, and the ones who are especially premature, would now be transferred to bigger, more specialized hospitals straight after birth.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

It's really frustrating for me when I hear people saying, well, after they took Lucy off, there was no more deaths. Well, that's true, but there was no more sick babies either.

[Amanda Knox]

On top of this, management invites the medical body responsible for all pediatric care in the United Kingdom to come in and investigate. These are not easy compromises. For the doctors, Downgrading the unit would be a hit to their reputation and they worry they will lose skills. They also feel they already had an answer for why so many babies are dying in their unit. Lucy Letby was murdering them. This didn't need more medical reviews, it needed the police. Despite the consultant's allegations that Lucy Letby was on shift for each death, the review finds those beliefs to be based on gut feelings. The report states that, quote, there was no other evidence or history to link Nurse L to the deaths and her colleagues had expressed no concerns about her practice. This was a subjective view, with no other evidence or reports of clinical concerns about the nurse beyond the simple correlation. End quote. Rather than supporting the doctor's suspicions, the final report points out other issues that needed to be dealt with on the understaffed, underfunded and overwhelmed unit. For the consultants, things seem to go from bad to worse. Lucy Letby eventually finds out why she's been suddenly removed from the unit because the consultants thought she was murdering babies. She files a grievance saying the hospital has not been honest about the reason for her redeployment and that the doctors had bullied and harassed her. She wins that grievance. The doctors are forced to apologize to her. They are told that she will be coming back. That is more than they can accept. The same month that Lucy Letby is set to return, Dr. Jayram asks for a meeting with the head of HR. And in that meeting, he tells her a hair raising tale that changed everything.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

That is a night that is etched on my memory and will be in my nightmares forever.

[Amanda Knox]

This is Dr. Jerum on ITV News describing how he had once walked in on Lucy Letby trying to murder a baby.

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

Part of me was saying, you better go in and just check everything's okay because you know what's happened before when Lucy's been on duty.

[Amanda Knox]

It had happened a year earlier, but Dr. Jayram hadn't told anybody in management until now. Lucy Letby was standing over a baby and the baby was struggling to breathe. As the baby was gasping for air, Lucy Letby was doing nothing to help.

[Narrator / Voice Actor]

What was she doing then?

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

She was just standing there.

[Amanda Knox]

This scene right out of a horror movie is finally enough to get the police involved.

[Narrator / Voice Actor]

What was clear at that point was

[Dr. Ravi Jayaram / Dr. Breary / Other Medical Professionals]

that Lucy Letby was the consistent in all this. She was the thread running through the mold. Take a seat in there for me, Lucy.

[Amanda Knox]

That's next time on Doubt the Case of Lucy Letby. Doubt the Case of Lucy Letby is brought to you by Vespucci, iHeart podcasts and Knoxville Robinson Productions. I've been your host, Amanda Knox. This episode was written by Joe Meek, Clusy de Oliveira and Natalia Rodriguez. The co producers were Clusy de Oliveira and Lucy Ditchmont. Senior producer is Natalia Rodriguez. Audio mix by Tom Biddle. The theme music was written by Tom Biddle. Story editing by Kathleen Goldhar. Legal advice was provided by Jack Browning. The producers at iHeart Podcasts are Chandler Mays and Katrina Norville. The executive producers were Joe Meek, Amanda Knox, Christopher Robinson, Daniel Turkin and Johnny Galvin. Thank you for listening. Foreign.

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[Amanda Knox]

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