The Experts

Summary

Podcast Summary: "The Experts" (Doubt: The Case of Lucy Letby)

Hosted by Amanda Knox
Episode 9, Released April 21, 2026
Podcast by iHeartPodcasts

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Overview of Episode

This episode investigates the findings of an International Expert Panel on the conviction of Lucy Letby, a neonatal nurse in the UK found guilty of murdering and attempting to murder premature babies under her care. Host Amanda Knox—herself a survivor of wrongful conviction and intense media scrutiny—explores whether Letby’s conviction is truly beyond reasonable doubt. The episode centers on a press conference where Dr. Xu Li, a leading neonatologist, and other panel experts present their in-depth review of the medical evidence used to convict Letby, raising the possibility of wrongful conviction due to flawed medical interpretations and systemic failures.

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Key Discussion Points & Insights

1. Introduction to the Panel and Their Mission

• Amanda Knox opens by emphasizing the difficulty and sensitivity of exploring infant deaths and ongoing public outrage against Letby.
  “The truth..., when it comes to Lucy Letby, is not an easy place to land.” (04:39, Amanda Knox)
• Dr. Xu Li and 13 other highly-credentialed international experts volunteered to review the case, seeking only to clarify the truth, not to exonerate or condemn.
  “Our work is not meant to cause more distress. Rather, it is meant to give them comfort and assurance in knowing the truth about what really happened.” (03:54, Dr. Shu Li)

2. Dr. Xu Li’s Involvement and Motivation

• Dr. Li was initially contacted because the prosecution cited an old paper of his to support the air embolism theory. Shocked by what he saw as a misapplication of his work, Li agreed to review the evidence—and later formed the expert panel.
  “I realized that...what they had interpreted wasn’t what I wrote about.” (10:17, Dr. Xu Li)
• His testimony refuting the prosecution’s use of his research was disallowed in appeal due to UK legal technicalities.

3. Panel Methodology

• Each of the 17 cases tried was independently reviewed by two experts from different subspecialties (including neonatology, pediatrics, infectious disease, nursing, and surgery).
  “They were asked to look at the medical records without referring to the prosecution witnesses or court transcripts... so they weren’t biased.” (13:27, Dr. Xu Li)
• If reviewers disagreed, a third expert adjudicated.
  “If there was a disagreement…, then a consensus was achieved.” (17:55, Dr. Xu Li)
• After months of work, the unanimous finding was: no malfeasance—all deaths and injuries had plausible natural or iatrogenic explanations.

4. Key Case Example: "Baby A"

• The prosecution claimed Baby A died from a deliberate air embolism—citing Dr. Li’s own published research (“Li sign”) as proof. “They seemed to be migrating and moving, and therefore this was diagnostic of air embolism. Unfortunately, that’s not correct.” (23:49, Dr. Xu Li)
• Dr. Li explained that the specific sign seen in true air embolisms (the “Li sign”) was not present, and that the skin changes could easily be attributed to other factors. He also detailed how Baby A’s risk of clotting was heightened by clinical missteps and medical conditions, offering an alternative, medical (not malicious) explanation for the collapse. “In the cases where air was injected into the veins, there were no cases of patchy skin discolorations ever described in the literature.” (25:43, Dr. Shu Li)

5. Systemic Failures Identified

• The panel highlighted a catalog of grave problems in the neonatal unit:
  • Incomplete medical histories and ignored risk factors
  • Diagnostic failures and mismanagement of common neonatal conditions
  • Inadequate staffing, lack of training and resources
  • Poor communication and teamwork “There was disregard for… warnings about bacterial colonization… poor skills at resuscitation and intubation… and poor supervision of junior doctors… There was failure to protect infants who were at risk.” (31:28, Dr. Shu Li)
• Most crucially:
  “We did not find any murders. In all cases, death or injury were due to natural causes or just bad medical care.” (33:45, Dr. Shu Li)

6. Challenging the Prosecution’s Main Evidence

• The prosecution relied heavily on Dr. Dowie Evans’s testimony, which the panel criticized as selective, biased, and not medically sound.
  • Dr. Evans’s expertise and previous track record were called into question by both senior judges and expert witnesses. “[Dr. Evans’s] report… was, quote, worthless and makes no effort to provide a balanced opinion.” (40:23, Journalist quoting Lord Justice Jackson)
• The prosecution’s use of a statistical chart showing Letby on shift for all deaths was described as a logical fallacy (“Texas Sharpshooter Fallacy”), ignoring other possible explanations and not including all staff members for comparison. “There were other deaths on that ward when Lucy was not on shift. None of these were represented on that chart.” (49:03, Amanda Knox)

7. Panel’s Public Presentation and its Impact

• Dr. Li and the panel presented their findings publicly in London, faced with skepticism and hostility in a country convinced of Letby’s guilt.
  • Their presentation was a turning point, shifting some public and media perspectives and prompting renewed scrutiny. “You could hear a pin drop. I think it was a moment of clarity for many people who thought all along that she was guilty.” (34:15, Dr. Xu Li)
• MP David Davis, Letby’s lawyer Mark McDonald, and eminent neonatologists have since called for a comprehensive review, emphasizing the seriousness of a possible miscarriage of justice.

8. Broader Reflections on Justice and Expertise

• The episode parallels Amanda Knox’s own experience, noting how narratives can shift only with independent, rigorous review of evidence.
• The panel’s work raises major questions about expert witness standards, bias in police investigations, and the dangers of public opinion driving criminal justice. “Can we actually trust the legal process?” (43:43, Dr. Nina Modi)

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Memorable Quotes & Moments (with Timestamps)

• On Motivation:
  “If in fact this woman is innocent... I think it would be all worth it and I’m prepared to pay that price.” (07:29, Dr. Xu Li)
• On Panel Method:
  “Each case was then assigned to two members of the team randomly... without consulting each other initially.” (13:27, Dr. Xu Li)
• Medical Explanation:
  “These were very sick babies... There was evidence, medical and laboratory evidence, that these babies were actually deteriorating and they were not picked up and not treated.” (29:43, Dr. Xu Li)
• Panel’s Conclusion:
  “We did not find any murders. In all cases, death or injury were due to natural causes or just bad medical care.” (33:45, Dr. Shu Li)
• On Expert Testimony:
  “How is it that Dr. Evans found none [of the failings in care the panel identified]?... Was he just callous or was it deliberate?” (38:42, Dr. Shu Li)
• Legal Warning Ignored:
  “[Dr. Evans’s] report… was, quote, worthless and makes no effort to provide a balanced opinion.” (40:23, Journalist quoting Lord Justice Jackson)
• On Changing the Narrative:
  “You don’t start by assuming that there’s murder when you have no evidence.” (46:50, Prof. Jane Hutton)
• Dangers of Miscarriage of Justice:
  “Can you just imagine yourself in her shoes?... That would be a terrible, terrible injustice.” (50:11, Dr. Xu Li)

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Important Segment Timestamps

• [04:39-05:16] – Public certainty of Letby’s guilt and surfacing doubts
• [07:29-12:09] – Dr. Xu Li’s motivation and expert panel formation
• [13:19-14:04] – Rigorous, blinded review process explained
• [17:55-18:35] – Panel reaches consensus: No evidence of murder
• [19:22-20:06] – Explanation of medical categories analyzed
• [23:49-26:42] – Dr. Li rebuts prosecution’s medical evidence and “Li sign”
• [31:28-33:03] – Systemic care failures detailed
• [34:15] – Moment the press conference changed perceptions
• [38:42-40:23] – Direct criticisms of Dr. Evans’s testimony and legal warnings
• [42:27-44:44] – Dr. Modi and expert critique of police and legal process
• [49:03] – Flawed use of statistical evidence

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Final Reflections

"The Experts" is a powerful episode dissecting the weaknesses of the prosecution's case against Lucy Letby, led by some of the most reputable figures in neonatal medicine. Through methodical review, the panel found no medical evidence of murder—only tragic outcomes and systemic shortcomings. Their findings go beyond Letby’s case, questioning forensic, legal, and statistical standards in high-profile criminal justice.

As Amanda Knox and several experts contend, the true story of the case may be more complicated, and the system's failures far-reaching, than the public has been led to believe. The episode ends with a call for renewed scrutiny and justice—not just for Lucy Letby, but for all who might face conviction without true expert analysis.

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Transcript

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[Amanda Knox (Host/Narrator)]

begin, please be aware this episode contains discussions around infant deaths and other difficult topics. Please take care while listening.

[Journalist/Interviewer]

Now, you all presumably know the background of the Lucy Letby issue, the miscarriage as I view it.

[Amanda Knox (Host/Narrator)]

Member of Parliament David Davis is sitting behind a rectangular table. Beside him to his right is Lucy Letby's current lawyer, Mark McDonald, to his left, one of the world's most distinguished neonatal experts.

[Journalist/Interviewer]

And today what we're here to do is to present a report which is the idea, the genesis, the creation of Dr. Xu Lee, who's sitting next to

[Amanda Knox (Host/Narrator)]

me in front of the panel waiting anxiously to hear this report are a gaggle of media, newspapers, TV broadcasters, and in keeping with the times, a number of podcasters, all their microphones and cameras squarely focused on the group of people sitting before them.

[Dr. Shu Li (Neonatologist, Panel Member)]

Thank you, Sir David. My name is Shu Li and I'm here to share with you the findings of the International Expert Panel on the Lucy Labby case. But before I start, I'd like to share the synchronies and condolences of members of the International Expert Panel with families of the affected infants. We understand their stress and their anguish and our work is not meant to cause more distress. Rather, it is meant to give them comfort and assurance in knowing the truth about what really happened. We know that they want to know the truth and that is why we are here to tell the truth.

[Amanda Knox (Host/Narrator)]

The truth. When it comes to Lucy Letby, the truth is not an easy place to land. There are some who are sure they know the court for one has sent her away for the rest of her life. In the mind of the judge, the jury and the prosecutor, she is one of the worst serial killers in UK history. But as more and more information beyond what the juries have heard comes out, more and more people are starting to wonder if the truth might actually be one of a wrongful conviction.

[Mark McDonald (Lucy Letby's Lawyer)]

There is overwhelming evidence that the conviction is unsafe and if Dr. Shu Lee and the panel are correct, no crime was committed. If no crime was committed, that means that a 34 year old woman is currently sitting in prison for the rest of her life for a crime that just never happened.

[Amanda Knox (Host/Narrator)]

I'm Amanda Knox and from Vespucci and Iheart podcasts, this Is doubt. The Case of lucy letby episode 9 the Experts. On the surface, Lucy has run out of options. Nearly every level available to her in the UK court system has turned down the opportunity to rehear her case. But Lucy's lawyer, Mark McDonald, is hopeful that the UK's criminal case review Commission will consider a new review.

[Mark McDonald (Lucy Letby's Lawyer)]

What I do know is that the CCRC are taking this very seriously. They've already got a team in place, they're ready to go, They've watched this conference, I've made sure they've had a link to this, they've watched the presentation, they've got this report. They're going to get the final report that they've seen what you've all seen. I'm hoping they're going to take this very seriously and deal with it very quickly. And we will be back in the Court of Appeal very soon.

[Dr. Shu Li (Neonatologist, Panel Member)]

The panel comprises 14 very experienced and well known experts from highly prestigious institutions in six countries around the world, including Canada, United States of America, Japan, Germany, Sweden and the United kingdom. They include 10 new natologists, one pediatric surgeon, one pediatric infectious disease specialist, one senior neonatal intensive care nurse and one other pediatric specialist.

[Amanda Knox (Host/Narrator)]

These experts were not paid for their time. In fact, Dr. Xu Li, a veteran neonatologist who lives in Canada, paid for his own trip to the UK to be part of this press conference.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

I decided that it was necessary to do this even though there would be a cost to pay for me personally. I also recognized that there was going to be a lot of pressure because this was such a high profile case in the sense that there would be public backlash, there would be people on both sides, arguments, and I'll be open to attacks, etc. But if in fact this woman is innocent of the crimes that she's accused, I think it would be all worth it and I'm prepared to pay that price.

[Amanda Knox (Host/Narrator)]

Now retired doctor Shu Li spends his days farming on his spot of land in Alberta, Canada. When he talks about farming, it sounds like something he's been doing all his life.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

Last year was wheat, the year before that was canola and we're actually bringing cattle onto the farm this year. I enjoy being a farmer. I love to see things grow, just like I love to see my babies grow.

[Amanda Knox (Host/Narrator)]

But it's when the conversation turns to neonatology that you see his expertise really come alive. Calm, warm and precise, he carries decades of knowledge with him. And when it comes to the Lucy Letby case, he knows the details almost by heart. I asked him how he first became involved.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

I got an email from a lawyer in the UK asking me if I would look at a case. And I was busy during harvest, and I ignored it initially because how often does one get an email from a lawyer in the uk? But then two weeks later, after my harvest, it was there again. And so I decided to answer it out of curiosity. And I realized that in fact this was genuine. What a lawyer told me was that they had used a paper that I had written in 1989 to convict her. And that stirred my attention because I don't normally do medical legal cases.

[Dr. Shu Li (Neonatologist, Panel Member)]

The.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

But in this case, because they used my paper, I was curious about what they actually said. So I agreed to look at the case without committing to actually participating in the process.

[Amanda Knox (Host/Narrator)]

You may remember earlier in this series, we heard how the prosecution's medical expert, Dr. Dowie Evans, relied on a research paper Dr. Lee published in 1989. In court, it was cited as evidence suggesting that unusual skin discoloration seen on some of the babies and could indicate air embolism. For Dr. Lee, that was the moment this case stopped being distant news. If his research had been used to support that conclusion, he needed to understand exactly how.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

So they asked me to look specifically at the skin discolorations and whether the interpretation of the prosecution doctors were accurate.

[Dr. Shu Li (Neonatologist, Panel Member)]

And when I looked at it, I

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

realized that it wasn't because what they had interpreted wasn't what I wrote about. And so I appeared at the appeal and I explained that to the judges. And unfortunately, my testimony was disallowed because in the British legal system, you can only present evidence at appeal that could not have been presented at the original trial. And at the original trial, since they did not call me, they. They lost their chance and therefore my evidence was inadmissible. So her appeal was rejected. And I was a little concerned because as far as I was concerned, the evidence that was used to convict her on the air embolism and skin discoloration was inaccurate. So potentially this was an unsafe conviction.

[Amanda Knox (Host/Narrator)]

With his evidence dismissed by the court, his work might have ended there. But it didn't sit easily with him. If the medical conclusions presented at trial were wrong in this one case, what about the others? Dr. Li felt he had a responsibility to find out.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

On the one hand, I could be selfish and say, well, this is not my problem anymore. I did my part. On the other hand, I felt compelled to do it because if in fact this was wrong, a young woman would be in jail for the rest of her life without possibility of appeal or parole, which means she has to die in prison. That is a horrible consequence to contemplate. And I think I would lack humanity if I didn't find out whether or not that conviction based on the medical evidence was correct. I would do this only on condition that we would publish our results and make it public, regardless of whether we felt she was innocent or guilty. I just wanted to get the truth.

[Amanda Knox (Host/Narrator)]

So he agreed to look at the rest of the medical evidence in the case. But what that meant in practice was an enormous undertaking.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

So for each case, because some of the cases were very long and baby stayed in the hospital for months, it's hundreds and hundreds of pages of material, and then hundreds and hundreds of pages of laboratory results and medical charting by nurses in the unit and the heart rate, blood pressure, all that kind of stuff. So it was a great deal of material.

[Amanda Knox (Host/Narrator)]

Dr. Lee knew this wasn't something one person should be reviewing alone to get through the mountain of evidence and to do it properly. He turned to the panel we mentioned earlier, bringing together those 14 medical experts from around the world to examine the case alongside him.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

And we not only had neonatologists, we also had one infectious disease expert, and we had a pediatric surgeon because some of the cases involved trauma. And so we wanted to be sure that we covered all the basis of a multidisciplinary team that had forensic experience, that had pathological experience, surgical, obstetric, and neonatal. So that was the team.

[Amanda Knox (Host/Narrator)]

The panel divided the work between them, assigning each baby's case to two experts to review independently.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

Each case was then assigned to two members of the team randomly, and they were asked to look at the cases independently without consulting each other initially. And we asked them to look at the medical records without referring to the prosecution witnesses or to the court transcripts. In other words, just take the chart and tell us what you think was the cause of injury or death in this baby so that they weren't biased by other opinions.

[Amanda Knox (Host/Narrator)]

Only after they had reached their own conclusions independently were they asked to review the evidence presented at trial.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

They were then asked to look at the prosecution witnesses reports to see whether or not it would change their minds. And if it did not, then they completed their report. Even though we divided up the work among 14 people, it still took us four months to get through all that material. It was a lot of work. Nobody paid us to do any of this. You know, I think it was Dr. Zawi Evans who said that within a few minutes he had decided that one of the cases was murder. And I'm impressed that he was able to do that.

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[Amanda Knox (Host/Narrator)]

after months of work and with more than a dozen medical experts reviewing the evidence, the reports finally came back. The panel compared their conclusions for each baby, but even then there was still more work to do in verifying the conclusions.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

If the two reports on each baby agreed with each other, then that was accepted as the final result. If there was a disagreement between the two reports, then a third member was brought in and then a consensus was achieved. We found that there was unanimous opinion that there was no malfeasance. In other words, there was good reasons why each of the babies either died or suffered injury. There's a logical explanation for what happened to each baby. In other words, you don't have to invoke murder to understand why the baby died.

[Amanda Knox (Host/Narrator)]

But by this point, there was no clear way to put those findings back before a court. So Instead, along with MP David Davies and Lucy's current lawyer Mark McDonald, the panel decided to make their conclusions public. A press conference was organized in London and Dr. Lee traveled to the UK to present the report.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

When I went to the UK, there was an additional burden in that I was actually coming to the uk, where the majority of the opinion now was cut at that time was that she was guilty. So therefore, to step into the arena and say she is not and here's why we think she is not is a huge task, right? So it was unclear to me what the public reaction would be, but I felt that it needed to be done.

[Amanda Knox (Host/Narrator)]

In a room packed with journalists in London, Dr. Lee stepped up to present the panel's findings. He began by laying out how the team had grouped the cases, placing the deaths and injuries into six medical categories.

[Dr. Shu Li (Neonatologist, Panel Member)]

First Air embolism caused by injection of air into the intravenous system two Splinting of diaphragm caused by injection of air into the nasogastric tube, three, dislodged nasogastric endotracheal tube, causing collapse. Four, hypoglycemia caused by injection of insulin, five, trauma to the abdomen or gastrointestinal tract, and six, overfeeding.

[Amanda Knox (Host/Narrator)]

Dr. Lee did not go over every case the panel had examined.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

Mark McDonald's lawyer said, why don't we focus on the fatalities, because those are the most important cases. Second, there were some cases that were, shall we say, very obvious in terms of the causes of death or egregious in terms of the accusations that we felt that they needed to be highlighted. So Those were the two conditions.

[Amanda Knox (Host/Narrator)]

The first case Dr. Lee brought up was Baby A, or as he called him, Baby Baby one, citing the cause of death argued by the prosecution.

[Dr. Shu Li (Neonatologist, Panel Member)]

Baby 1 died from injection of air into the intravenous line, causing air embolism.

[Amanda Knox (Host/Narrator)]

This case in particular had already drawn Dr. Lee's attention. It was the prosecution's conclusion in that death and the way his research had been used to support it that had first led him to speak at the appeal.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

And so, on the day of the collapse, actually, Baby A had two central catheters, and these are lines that are placed into the large veins for a venous excess. Now, normally, when you put in central catheters like this, we would infuse the lines together with anticoagulants to prevent them from clotting, because central lines are notorious for clotting and causing thrombus. Right.

[Amanda Knox (Host/Narrator)]

A thrombus is simply a blood clot that forms inside a blood vessel or medical line blocking the normal flow of blood, something doctors work carefully to prevent in fragile newborns.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

Now, in Baby A, the risk of thrombosis was further increased because the mother had something called antiphospholipid syndrome, which is a condition in which the immune system mistakenly creates antibodies that attack tissues in the mother's body that can trigger blood clots to form in the arteries and veins.

[Amanda Knox (Host/Narrator)]

You see, although Baby A didn't have antiphospholipid syndrome, antibodies from the mother can cross the placenta and enter the baby's bloodstream, increasing the risk of dangerous blood clots. In Baby A's case, that risk may have been compounded by the fact that the catheter lines had been left in place without infusion for an extended period of time.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

The lines were left uninfused for four hours. Clot forms very quickly. You don't need four hours to form a clot, all right? It forms in minutes. And if you leave a line, there for four hours, you're almost begging the thrombus to form. On top of that, you did not anticoagulate the line and you did not infuse it. So after four hours, you are going to get a thrombus. I mean, there's no question about it. And then after that, somebody started the infusion. And shortly, very shortly after the infusion was started, the baby collapsed.

[Amanda Knox (Host/Narrator)]

According to Dr. Li, on top of the risk factors already present, allowing blood to sit in an unmaintained catheter line creates the conditions for a clot to form. Once the line is flushed or infusion restarts, that clot can break free.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

And when the thrombus breaks off, it can go to an artery supplying a critical structure in the brain, for example, or in the heart that causes sudden collapse and death.

[Amanda Knox (Host/Narrator)]

Dr. Lee also pointed to findings in the post mortem that suggested a recent clotting event. Evidence he says, is consistent with a thrombus traveling through the bloodstream shortly before death. But the detail that first drew him into this case, the one tied to his own research, was something else entirely. The unusual skin discoloration seen on the baby.

[Dr. Shu Li (Neonatologist, Panel Member)]

Now, then there's this matter of these

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

patchy skin discolorations, because a lot of it was made about it during the trial, saying that these were very unusual skin discolorations. They were consistent with what I had written in 1989, and they seemed to be migrating and moving, and therefore this was diagnostic of air embolism. Unfortunately, that's not correct. The only skin discoloration that is diagnostic of air embolism is something called the Lee side.

[Amanda Knox (Host/Narrator)]

You heard that, right? The Li sign, as in Dr. Xu Li, the clinical sign, was literally named after him. And in the case of Baby A, it sits right at the center of the debate over what happened. Dr. Li first identified what would become known as the lee sign in 1980 after observing a dramatic and previously undocumented pattern of skin discoloration on a newborn.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

Basically, the arteries appear on the skin, and it's like a tree that fans out, and it starts proximally and then moves distally so you can see like a Christmas tree lighting up on a dark baby.

[Amanda Knox (Host/Narrator)]

That discovery eventually led to the 1989 paper, the paper Dr. Dowie Evans cited at trial. But according to Dr. Lee, what was described in his research was something very specific. The marks discussed in court were patchy. The Lee sign, he says, looks nothing like that.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

Nothing patchy about it at all. These are very clear vessels. You can see the blood vessels very clearly. Superimposed on the dark background.

[Amanda Knox (Host/Narrator)]

So at the press conference, Dr. Lee, in no uncertain terms, revealed that Dr. Evans had misunderstood his research.

[Dr. Shu Li (Neonatologist, Panel Member)]

The prosecution, in part, based their allegation on a paper that I had written in 1989, where I described 57 cases that about 10% of them had skin

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

discolorations of different kinds.

[Dr. Shu Li (Neonatologist, Panel Member)]

At that time, I did not distinguish between arterial and venous air embolism. And in this particular case, the allegation is that she injected air into the venous system, into the veins. And in the new paper that I published in December of 2024 in the American Journal of Perinatology, we actually separated the cases with arterial venous air embolism from the cases with venous air embolism. And what we found was that in the cases where air was injected into the veins, there were no cases of patchy skin discolorations ever described in the literature. So the notion that these babies can be diagnosed with air embolism because they collapsed and had these skin discolorations has no evidence. In fact, none of this actually has ever been described.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

If this is true, it will be

[Dr. Shu Li (Neonatologist, Panel Member)]

the first case ever described, but it's never been.

[Amanda Knox (Host/Narrator)]

We, of course, wanted to ask Dr. Evans about this and so much more, but he has repeatedly turned down our requests to for an interview. In other media, we know that Dr. Evans is aware of Dr. Lee's response. In fact, in one documentary called Conviction, we can see Dr. Evans watching the press conference. Despite the author of the papers explaining the issues with Dr. Evans diagnosis, Dr. Evans refuses to accept that he is wrong. Now, in court, prosecutors pointed to one clear pattern in the collapses, that Lucy Letby happened to be on shift. But when Dr. Lee looked at the cases, he noticed another pattern, one that had received far less attention. Many of the babies involved weren't isolated cases at all. They were part of multiple births.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

Now, Baby A had a twin called Baby Baby. Now, this twin suffered the same thing in the sense that the baby also had sudden collapse within the first two days of life, but the baby survived. So there was no pathology, etc. But there are common things. Number one, the baby had a similar catheter. Number two, they had the same mother. And as I said earlier, the mother has antiphospholipid syndrome. And so I think that there's a commonality why these multiple babies just, you know, twins, triplets, had problems because they had a similar pathology or something underlying it. In other words, that in fact created the conditions for these things to happen. And so if it happened to one baby it was more likely actually to happen to another because it's the same condition that's affecting the babies.

[Amanda Knox (Host/Narrator)]

So after laying out the medical evidence surrounding baby A, the obvious question followed, if not air embolism, then what actually caused the baby's sudden collapse? Dr. Li brings up a few possibilities from the high risk of thrombosis, as we heard earlier, to malpractice. A postmortem on the baby showed that there was in fact a thrombic event and an IV had been inserted into the baby in order to infuse medicine. But that IV had penetrated the vein and had come out into the tissues.

[Dr. Shu Li (Neonatologist, Panel Member)]

And so the infusion was not going into the circulation, was going into tissues. And so the air was getting swollen because the infusion was coming out. And so because of this, they removed the IV and replaced it with an umbilical venous catheter. But the first insertion was mal positioned and so they had to replace it again.

[Amanda Knox (Host/Narrator)]

Dr. Li never says that he is sure that how baby A died, but he is sure it wasn't from an air embolism. But baby A was not the only baby that this cause of death was given to.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

It was especially concerning because in many of these babies, Dr. Evans contended that the babies were stable and then they suddenly collapsed and died. And therefore it can be nothing but air embolism because the babies were stable, they were doing well, so why did they collapse and die? There was no reason for that. And yet when we looked at the case, we found that was not the case. These were very sick babies who had certain conditions. And not only that, in many of these babies, they were actually getting worse every day. There was evidence, medical and laboratory evidence, that these babies were actually deteriorating and they were not picked up and not treated. In some cases, they had pneumonia or infection or haemorrhage from a particular lesion, etc. And they were just not picked up. So that is very concerning to us that the experts in this case did not pick up on the fact that these babies had pre existing conditions and they were worsening and who were actually in danger of dying because of these conditions and not because they were stable. They were not stable.

[Amanda Knox (Host/Narrator)]

The important part of this report isn't that the panel members were able to determine 100% why these babies died. We may never have definitive answers to those questions. What is important is that these experts offered a plausible explanation other than murder. Had the jury in Lucy's first trial been able to hear another possibility, would they have been able to find her guilty? Or would the weight of reasonable doubt have changed things for more than an hour? Dr. Li went on to discuss a number of the other cases they looked at.

[Dr. Shu Li (Neonatologist, Panel Member)]

We found that the medical histories were incomplete. It was a failure to consider the obstetric history. There was disregard for surveillance, warnings about bacterial colonization. There was misdiagnosis of diseases in these babies. They were caring for babies that were probably beyond their expected ability or designated level of care. There were unsafe delays in diagnosis and treatment of acutely ill patients. There were poor skills at resuscitation and intubation. There was poor supervision of junior doctors in procedures like intubation. There were poor skills in basic medical procedures like insertion of chest tubes. There was lack of understanding about basic things like respiratory physiology and how to mechanically ventilate a baby. There was poor management of common neonatal conditions like hypoglycemia. There was a lack of knowledge about commonly used equipment in the nicu. There was failure to protect infants who were at risk, for example, haemophilia from trauma during intubation. There was a lack of teamwork and trust between the health professions. There were also statements given by many witnesses which point to serious resource and infrastructure deficiencies. And these specific concerns that were expressed by individuals include inadequate numbers of appropriately trained personnel in the unit, lack of training for assigned nursing roles, inadequate staffing and workload overload, poor plumbing and drainage resulting in the need for intensive cleaning in the unit. There was poor environmental temperature control in the facility. There was difficulty in finding the doctor when the need arose. Some high risk infants should have been born and cared for at higher level institution institutions, but were born and cared for in this hospital. And there were delays in transfer of sick infants to higher level facilities when the need arose. So these are not things that we invented. These are statements given by people who work in the unit. Our conclusions of this panel, therefore, was that there was no medical evidence to support malfeasance causing death or injury in any of the 17 cases in the trial. In summary, ladies and gentlemen, we did not find any murders. In all cases, death or injury were due to natural causes or just bad medical care. Lucy was charged with seven murders and seven attempted murders. In our opinion, the medical opinion, the medical evidence doesn't support murder in any of these babies.

[Amanda Knox (Host/Narrator)]

It was a striking moment. After months of analysis, the panel had delivered a clear conclusion, one that challenged the central claim of the prosecution's case.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

The room was extremely attentive and one of the reporters said to me afterwards, you could hear a pin drop. I think it was a moment of clarity for many people who thought all along that she was guilty. And suddenly a lot of reporters and other people in the room were saying, wait a minute, maybe we got it wrong.

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[Amanda Knox (Host/Narrator)]

Pets age 0 to 10 Following Dr. Lee's comments, the panel is opened for the media to ask their questions. In a country where the story of Lucy Letby and her sensational crimes have dominated the news cycle for years, this news conference was well attended.

[Journalist/Interviewer]

I'll start. I'll go right across from right to left.

[Amanda Knox (Host/Narrator)]

Sir, you Many of the questions asked concerned Dr. Dowie Evans, especially prescient considering he used Dr. Lee's research to help convict Letby.

[Dr. Shu Li (Neonatologist, Panel Member)]

When it comes to Dr. Evans testimony and his opinions, I would ask you to ask three questions. First of all, the first question would be if our panel found so many problems with the medical care provided by this team at this hospital, how is it that Dr. Evidence found none? The second question I would ask is this. He seemed to be rather selective in his use of information. So if he wasn't selective, if all the information was used, in fact, he would come to a very different conclusion than what he came to. So was he just callous or was it deliberate? The next question I would ask is even when there's an obvious cause of death, why did he go around looking for malfeasance?

[Amanda Knox (Host/Narrator)]

Dr. Lee wasn't the first to raise questions about Dr. Evans. Many people were concerned with the retired pediatrician's lack of expertise, the speed in which he found wrongdoing, the quality of his assessments. Amazingly, some of those concerns were actually raised during Lucy Letby's first trial by another judge.

[Journalist/Interviewer]

Three months into the murder trial, Letby's defense team applied for evidence from Dowie Evans to be excluded due to an adverse judgment from a judge in a previous case.

[Amanda Knox (Host/Narrator)]

MP David Davis brought this up in Parliament. How Lord Justice Jackson of the Court of Appeal took the extraordinary step of writing to Lucy's trial judge to warn him about Dr. Evans. Justice Jackson wanted Judge Goss to know that in another case, A report by Dr. Evans was, quote, worthless and makes

[Journalist/Interviewer]

no effort to provide a balanced opinion. In an extraordinary and, as far as I can see, unprecedented intervention, that very judge, Lord Justice Jackson actually wrote the trial judge with his judgment on Dr. Evans attached, clearly indicating how unsuitable Evans was.

[Amanda Knox (Host/Narrator)]

That warning seemed to fall on deaf ears.

[Professor Jane Hutton (Statistician)]

I think it's quite clear with hindsight that there were holes throughout this entire process and holes lead to a flawed set of evidence and an incomplete set of evidence being presented to the jury and therefore called into question whether the jury was sufficiently well informed to enable them to reach a reliable verdict.

[Amanda Knox (Host/Narrator)]

Dr. Nina Modi was one of the members of Dr. Xu Li's expert panel.

[Dr. Shu Li (Neonatologist, Panel Member)]

Professor Nina Modi is one of the most senior neonatologists here in the uk. She is the professor of Neonatal Medicine and Vice Dean International at Imperial College London, Honorary Consultant to the Chelsea and Westminster NHS Foundation Trust and President of the European association of Perinatal Medicine and a former President of the Royal College of Pediatrics and Child Health here in the uk.

[Amanda Knox (Host/Narrator)]

One of the big questions she has is how the court system in the UK defines an expert.

[Professor Jane Hutton (Statistician)]

So the law looks at your qualifications, but it doesn't necessarily address the issue of how experienced you are and how recent your experience is. So, you know, I am qualified in paediatrics, but I'm a neonatologist. I haven't worked in big children's paediatrics for a very, very, very long time. It would be, even though my qualifications state I am a paediatrician, it would be completely inappropriate for me to be commenting on a paediatric case because I'm not experienced.

[Amanda Knox (Host/Narrator)]

Dr. Modi believes that Dr. Evans lack of experience impacted the investigation into Lucy Letby right from the start.

[Professor Jane Hutton (Statistician)]

There were then flaws in the police investigation, for example, not looking at the obstetric Notes not speaking to obstetricians. That was then amplified by what happened in court with the prosecution, none of the prosecution's expert witnesses drawing attention to some obvious features and facts that were present in the medical notes and which would have led to different conclusions regarding the causes of the baby's deaths. And then there was failure on the part of the defence to mount an adequate challenge to the prosecution. Tragedies like this, of course, are going to be emotional, but a court, to my best knowledge, should not be a place where emotion holds sway, but where facts and evidence hold sway. And that's, I think, even more pertinent point when one considers the anguish of these families who are being told, we don't know what's caused your baby's death to. We do know what's caused your baby's death to. Again, actually, a lot of people saying, we don't think that the right conclusions would be reached. I mean, what an agonizing roller coaster that must be for them. What's also emotional and deeply worrying is the possibility of a miscarriage of justice on this scale. Can we actually trust the legal process? And as my nursing colleagues fear, you know, will I be next? Prior to the press conference, the headlines on the papers in relation to Lucy Letby's trial had all been along the lines of, here is the worst serial killer Dinke has ever seen. Here is an evil person. But after that press conference, there were more and more and more questions that seemed to be raised in various parts of the press. So, with hindsight, it does look as though that press conference changed the perception of the public.

[Amanda Knox (Host/Narrator)]

It's hard to pinpoint the moment that a narrative shifts. It happens in stages. My family started to notice a shift in the American media. About halfway through my first trial, TV pundits and journalists were finally asking, where's all this evidence we were promised? But only during my appeals trial, when independent experts were finally appointed to review the DNA, did I sense a shift in the courtroom.

[Journalist/Interviewer]

Lucy Letby was convicted of murdering seven infants and attempting to murder seven more. She received multiple concurrent full life sentences. The case horrified the nation. It seemed clear a nurse had turned into a serial killer. Now, I initially accepted the tabloid characterization of Letby as an equality, evil monster.

[Amanda Knox (Host/Narrator)]

As we've heard throughout this series, that characterization of Lucy Letby, it ran deep. Years of blaring headlines, guilty verdicts and denied appeals reinforced that image. And press blackouts prevented competing narratives from taking hold. But slowly, as journalists and experts and politicians like David Davis began to ask critical questions, the Story started to change.

[Journalist/Interviewer]

But then I was approached by many experts, leading statisticians, neonatal specialists, forensic scientists, people who are more knowledgeable than the purported experts whose evidence convicted. Let me they were all concerned about what they perceived as false analyses and diagnoses used to persuade a lay jury to convict Letby.

[Amanda Knox (Host/Narrator)]

Experts like Jane Hutton. You may recall Jane from earlier in the podcast. Her experience with the Cheshire Police during their investigation cemented the idea that detectives were looking for evidence that fit their theory.

[Professor Jane Hutton (Statistician)]

You don't start by assuming that there's murder when you have no evidence.

[Amanda Knox (Host/Narrator)]

Professor Hutton had been approached by the Cheshire Police before Lucy Letby was arrested to help legitimize the infamous ledger that showed Lucy Letby was in the hospital and on duty for every single death.

[Journalist/Interviewer]

Now, from the start of the case, Cheshire Police picked up on the doctor's statistical argument, supposedly pointing to Letby. In April 2018, an officer on the investigation approached a leading satellite statistician, Professor Jane Hutton, and asked her to put a figure on the likelihood of a nurse being on duty. Quotes during all the deaths and collapses in the unit. Of course, this is a false proposition, as Letby was not on duty for anything like all the deaths. But that was glossed over at the trial. That notwithstanding, Professor Hutton informed the police that any proper statistical inquiry should not concentrate on one member from the outset. Instead, it required full, proper research into all possible explanations for any increase in babies collapsing, including their medical conditions and prematurity, as well as the broader performance of the unit. You'd think that would be common sense, really. Cheshire Police then signed a consultancy agreement with Professor Hunt. But then, in 2021, after Letby had been charged, the police wrote an email to Professor Hutton and I quote it in terms. We have had a further meeting this afternoon where we have informed the prosecutors we were looking into the validity of the statistical evidence in this case. The prosecutor has instructed, instructed us not to pursue this avenue any further at present. Now, this appears to be in direct contravention of the Code for Crown Prosecutors. Specifically part three, decimal three of the Code. Prosecutors cannot direct the police or any other investigators. Again, the jury was never informed of Professor Hutton's explicit advice to the police that their statistical approach was flawed.

[Amanda Knox (Host/Narrator)]

The jury and Lucy's trial were never told about any of this. What they saw was a chart that had Lucy on shift for every death, a chart that many experts say was deeply flawed. Not only was it based on bad statistics, firstly in the fact that they did not include all the staff that were working, but also There were other deaths on that ward when Lucy was not on shift. None of these were represented on that chart. This is actually a known logical error called the Texas sharpshooter fallacy. A man fires a hundred bullets at the side of a barn. Then he walks up and draws a bullseye around the tightest cluster and says, see, look how accurate I am. But despite those flaws, David Davis says it became very powerful evidence. Evidence that Dr. Xu Li believes has led to a wrongful conviction and an innocent woman in prison for a crime she didn't commit. A crime that many believe didn't actually happen.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

Can you just imagine yourself in her shoes? If she was innocent and in jail and told that she's going to stay there until she dies, that would be a terrible, terrible injustice. I cannot imagine how anyone could survive that.

[Amanda Knox (Host/Narrator)]

Next time on Doubt the Case of Lucy Letby.

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It ruptured like my sense of identity. I knew that I wasn't responsible for hurting a child. But I'm bad because this is happening and I have to go away and accept this.

[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

Somehow this is turns out to be wrong.

[Amanda Knox (Host/Narrator)]

Every single level of the British establishment will be torn to shreds.

[Mark McDonald (Lucy Letby's Lawyer)]

Lucy, let me will be freed. These convictions will be overturned. The only question is when.

[Amanda Knox (Host/Narrator)]

Doubt the Case of Lucy Letby is brought to you by Vespucci I Heart Podcasts and Knox Robinson Productions. I've been your host, Amanda Knox. This is this episode was written by Kathleen Goldhar and Natalia Rodriguez. Senior producer is Natalia Rodriguez. The co producer was Lucy Ditchment. The assistant producer was Ami Gill. The sound designer is 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.

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[Dr. Xu Li (Lead Neonatologist, Panel Leader)]

This is an iHeart podcast.

[Amanda Knox (Host/Narrator)]

Guaranteed Human.