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- [00:00]
BJ's Wholesale Club Advertiser
Nicole hosts Easter every year. That's why she shops at BJ's Wholesale Club, stocking up on spiral ham, baked goods, fresh flowers, candy and five dozen eggs.
- [00:10]
Amanda Knox
I've got a lot of baskets to fill.
- [00:12]
BJ's Wholesale Club Advertiser
Nicole's not worried because she knows she can save big and get it all done in one trip.
- [00:16]
Amanda Knox
It's like winning the Easter egg hunt.
- [00:18]
BJ's Wholesale Club Advertiser
When you save, everyone wins. Get a $15 digital coupon when you spend $150 in one transaction. Now through April 5th. Visit BJ's.com easter coupon for details. BJ's your Easter destination.
- [00:33]
Amanda Knox
Before we begin, please be aware this episode contains discussions around infant deaths and other difficult topics. Please take care while listening.
- [00:44]
Sarah Knapton
They told me that there had been a lot more deaths in it. I think just something that's there for a lot of them. Did you have any concerns that there was a rise in mortality day? Yes. Okay, so tell me about that. What concerns did you have? I think we don't just notice until the teenagers that this was a rise compared to previous years.
- [01:12]
Amanda Knox
I'm watching a short clip from Lucy Lepe's police interrogation. It's not long, but it's hard to watch. What strikes me immediately is how small she seems in the room. She sits quietly, her shoulders rounded, her voice low. She answers questions carefully, not defensively, not forcefully, but with a kind of deference, as if she's already accepted that the people across the table control what happens next. I hesitate even to say that out loud, because I know how dangerous interpretation can be. And I also know that plenty of others convinced of Lucy Lepi's guilt have watched this video and seen a wolf in sheep's clothing. I was called that, too. And I can still remember when my own body took on that posture, that sense of being trapped inside. A process you don't fully understand, where every word feels. Feels like it could make things worse. But yeah, I mean, watching interrogation videos is not fun for me.
- [02:30]
Dr. Dewey Richard Evans
Why?
- [02:31]
Amanda Knox
You were asking why?
- [02:34]
Sarah Knapton
And I was stressed.
- [02:35]
Amanda Knox
I was scared.
- [02:36]
Sarah Knapton
It was after long hours in the
- [02:37]
Amanda Knox
beginning, middle of the night.
- [02:39]
Sarah Knapton
I was innocent. They were telling me that I was guilty.
- [02:44]
Amanda Knox
My own interrogation began much the way Lucy's did. At first, I responded the same way, carefully, dutifully, trying to cooperate, believing if I was calm, honest, if I just explained myself clearly enough, the situation would resolve itself. And then, as the pressure built, something shifted. They accused me of lying repeatedly. I became desperate to be believed. But all I could do was repeat the truth, and that never seemed to satisfy them. I'm telling you What I know. Why don't you believe me? I thought maybe it was my bad Italian, that it was my fault they were getting so angry as they gaslit me into doubting my own memories, as they threatened me with 30 years in prison, as they slapped me. I didn't know what was true or not anymore. A part of me even began to doubt myself. That's where my mind goes when I watch this video of Lucy, that feeling that the people asking me questions aren't looking for the truth, but for confirmation of a guilt they've already assumed. I spoke about Lucy's police interview with journalist Rachel Aviv, who covered the Letby case for the New Yorker. Rachel had spent several weeks reading the full transcript, and I wanted to know what she made of them.
- [04:21]
Rachel Aviv
I could see sort of the, like, disorientation of being accused of something that felt like a very alien concept and just, like, not knowing how to talk about it. It was like an incongruous thing in her life that, like, she had no language for even sort of comprehending how she had got there. And I think you could see her when she was in the police interview, just, like, not quite getting it and sort of answering, but not really defending herself, just sort of trying to be a good student, trying to be like an obedient nurse in a way, and also kind of giving the authorities the benefit of the doubt. Like, she seemed like someone who really did trust authority. And it was almost as if she was saying, like, if they think I did something wrong, maybe I. I mean,
- [05:05]
Amanda Knox
I. I deeply empathize with that.
- [05:08]
Rachel Aviv
That seemed to be the state that she was in a lot for the police interviews, at least, and even for the trial. Sort of like just a sense of grief that she was finding herself in that position.
- [05:22]
Amanda Knox
The interrogation room and the courtroom are very different spaces, but they are connected. The assumptions formed in one quietly set the terms of the other. And it was within those terms that the prosecution presented its case. So when Lucy Lepi finally took the stand, she wasn't starting from zero. She was stepping into a story that had already been written about her. And every pause, every careful answer, every attempt to explain herself was now filtered through that story. Not in the interrogation room, but in front of 12 jurors. This episode is about how that story was told. I'm Amanda Knox, and from Vespucci and iheart podcasts, this is the case of Lucy Letby. Episode four. Four the Prosecution. It's October 10, 2022. Rain drizzles over Manchester Crown Court. Inside, the air is Heavy. For the first time, Lucy Letby steps into the court. After three and a half years of investigation, thousands of interviews and mountains of evidence, police handed their case to the Crown Prosecution Service. Manchester Crown Court sits right in the city center, a working courthouse built for volume. It's not grand or ceremonial, it's practical, busy. The kind of place where life changing things happen in rooms that look almost ordinary.
- [07:25]
Kim Pilling
Manchester Crown Court is a relatively modern building, I think it is slightly decaying, I have to say. Long corridors, not particularly public friendly.
- [07:37]
Amanda Knox
That's Kim Pilling again, the journalist who was in the court at the time.
- [07:42]
Kim Pilling
There's probably, I'd say 15 courtrooms in the building. I was in court seven from my perspective as a reporter gave you a very good front row seat. The stage was all set in front of you.
- [07:59]
Amanda Knox
The public gallery is small, seats are scarce. Everyone is packed into a room waiting for a trial. That comes nearly seven years after the first alarms were raised.
- [08:12]
Kim Pilling
The public gallery was divided into two sides as you walk through the entrance, the left hand side where I sat, maybe have 15 at a push. So there was three, four seats available to the press and that was it. Letby's mum and dad, John and Sue on the right hand side and then on the other side were the families of the victims and, and we were sat in front of them on the front row of the public gallery nearest to the dock in the well of the court was the judge, Mr. Justice Goss. And then in front of us were the various lawyers, including the lead counsel for the prosecution, Nick Johnson, King's counsel and Ben Myers for the defense. BEN Myers King's COUNSEL and then behind them we had the jury of 12
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Amanda Knox
and then the defendant, a face most people there knew only through photographs printed after her arrest, frozen beneath headlines describing the charges she now faced.
- [09:25]
Kim Pilling
There was great anticipation ahead of Letby coming into this doc. You were going to see her in person. And of course there's a great curiosity as to her appearance and how she conveys herself.
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Amanda Knox
For the first time the jury of four men and eight women were able to assess this so called monster for themselves. But for Kim at least what he saw was nothing that stood out.
- [09:52]
Kim Pilling
She wasn't particularly expressive. She looked tired and strained. Yeah, it was hard to get a handle on her from the start really. She didn't fit the characterization of somebody accused of such monstrous crimes. Unfortunately, the rather banal reality is that they looked often just like anybody, any normal person that you just pass in the street without thinking.
- [10:18]
Amanda Knox
The clerk asks her name. Lucy. Letby confirms. And then the charges. Seven counts of murder, 15 counts of attempted murder, 22 times they're read out and 22 times she replies not guilty. The judge rules all 22 charges are to be tried together. That would mean after both opening statements, there would be 25 weeks of prosecution evidence before the defense could even counter. For us listeners, you may be interested to know that in British courts there are highly experienced senior lawyers who are given the title King's Counsel or often shortened to kc, with English prosecuting lawyers being part of the Crown Prosecution Service, because theoretically right at the top of the criminal judicial system in Britain is, is the King. So in every case it's always the monarch versus the defendant. And in this case it was Rex. You know, like King versus Lucy Letby.
- [11:40]
Actor Reading Court Transcript
As I have already told you, a large quantity of paperwork from the hospital was recovered.
- [11:47]
Amanda Knox
What you are hearing now is an actor reading sections from the court transcript of Nick Johnson, kc, the prosecutor in the case, giving his opening statement. Prosecutors don't just present facts, they organize them. They decide what comes first, what follows and how quickly the picture takes shape. Evidence is paced, arranged and built over time. So in that room, the prosecution aren't just presenting evidence, they are telling a story.
- [12:21]
Actor Reading Court Transcript
In addition to the paperwork relating to some of the children I have told you about and other children, they also found some other interesting items.
- [12:31]
Amanda Knox
Nick Johnson's opening ran for 94 pages. Three days in court, three days of evidence previewed, themes introduced, and a narrative laid carefully into place. And the image Johnson chose to end on, the one he left ringing in the courtroom, wasn't medical charts or expert testimony. It was a Post it note found in Lucy Letby's home.
- [13:07]
Actor Reading Court Transcript
There were some Post it notes, you know what I mean, those little yellow tabular notes with closely written words on them, some of which included the names of her colleagues. On some of the notes were phrases like why? How has this happened? What process has led to this current situation? What allegations have been made and by whom? Do they have written evidence to support their comments? In her writings she expressed frustration at the fact that she wasn't being allowed back onto the neonatal unit. And she wrote, I haven't done anything wrong and they have no evidence, so why have I had to hide away? And her notes also expressed concern for the long term effects of what she feared was being alleged against her. There are also many protestations of innocence. But I want to show you one note in particular. There's all sorts of material on this document, but just where that cross is now Just to the right of that, it says I don't deserve to live. I killed them on purpose because I'm not good enough to take care of them. I am a horrible, evil person. At the bottom, I am evil. I did this. Well, ladies and gentlemen, that in a nutshell is your task in this case. You have to decide on the evidence whether she did do these things or any of them. It is important to remember that the prosecution brings this case and therefore we, the prosecution, must prove it. And in order to prove it, we must make you sure. Thank you, my lord.
- [14:54]
Amanda Knox
Here's Kim Pilling again.
- [14:55]
Kim Pilling
The post it notes were, yeah, I'd say they were a key moment in that. I think it was purposefully done to sort of say, and finally to the jury, we've given you all this information as to why we think she's the killer on the unit and is a little bit more. So that's a very striking visual piece of evidence for the jury. So we got that very early on and of course you look at that and you think, ah, well, this could be game over already here. You know, this person's literally confessed to what she's done.
- [15:36]
Amanda Knox
By the time the prosecution finished its opening, the tone of the trial had already been set. Before the jury heard a single doctor, before a single scan or blood result was put on screen, the question of what that note meant, a confession or a fragment of despair twisted into evidence, would be argued later. But for now, this was the frame through which the jury would begin to hear months of dense medical evidence, timelines, collapses, charts and expert opinion, not in a vacuum, but under the shadow of words already hanging in the room. I am evil. I did this. Along with the handwritten notes recovered from Lucy Letby's home, the prosecution would go on to present a wide range of other evidence. They placed text messages and social media activity alongside events on the neonatal unit. Time stamped exchanges that sometimes read like real time commentary and were used to suggest how Lucy reassured her colleagues that sudden collapses were simply natural deteriorations in an attempt to deflect suspicion. One of these text messages Lucy wrote, it was the hardest thing I've ever had to do. Just a big shock for us all hard coming in tonight and seeing the parents xx. An exchange between one colleague read, we lost baby D. To which her colleague replies, what? But she was improving. What happened? Wanna chat? I can't believe you were on again. You're having such a tough time. In another exchange, a colleague wonders what's happening on the unit. There's something odd about that night and the other three that went so suddenly, Lucy replies, well, baby C was tiny, obviously compromised in utero. Baby D septic. It's baby A I can't get my head around. The jury was also shown a chart that the Crown said revealed that let be was the one constant presence across the deaths and collapses, including a shift from incidents happening overnight to happening during the day once Lucy's own shift patterns changed. But central to the case were the medical records themselves. These medical records were used to establish the baby's conditions before and after each collapse, to argue that some recoveries were too sudden to be natural, and to allege that notes and timings had been altered to distance Lucy Letby from critical moments. The prosecution then laid out the different mechanisms by which they alleged harm had been done.
- [18:47]
Sarah Knapton
There was so many different ways that they said that Letby had killed or harmed these babies, which in itself was strange to begin with.
- [18:56]
Amanda Knox
Sarah Knapton, science editor for the British newspaper the Daily Telegraph, was following the trial closely.
- [19:04]
Sarah Knapton
But they said she had, over a period of over 2015 and 2016, had been purposefully inflicting harm on babies in various ways. In some cases they said she had injected air into their bloodstream which caused blockage genitalyte. I mean they went into cardiac arrest and then some of them died. In other cases they said she injected air into the stomach which that has the effect of making the stomach enlarge and then that pushes up into the diaphragm which is controlling the lungs coming in and out so the diaphragm is constricted and can't essentially pump the lungs. Then the baby can't get its oxygen and again it collapses. In other cases they said she'd put insulin into feed bags so that the babies had too much insulin. There was another case where they said she dislodged a tube of a baby. Another case where she'd injected milk into the baby's stomach to cause it to vomit and destabilize. There was another incident where they said she smothered the baby.
- [20:05]
Amanda Knox
In most serial murder trials the prosecution points to a single consistent method or mo. Here they were asking the jury to accept seven different mechanisms of harm from insulin poisoning in two babies, air injected into the bloodstream of others, physical interference with breathing and in several cases a method they said had never before been described, forcing air into babies stomachs until they could no longer breathe. It was a theory that had no clear precedent in the medical literature and one that some doctors unconnected to the case said that they had never encountered. But the Crown's expert witnesses told the jury it was possible and that it had happened here. The jury would hear from dozens of witnesses, not just experts, but also nurses, doctors and parents. But one voice would become the spine of the medical case. And he was the first expert witness called. Here are actors reading court transcripts.
- [21:25]
Actor Reading Court Transcript
Could you please state Your full name? Dr. Evans.
- [21:28]
Dr. Dewey Richard Evans
Dr. Dewey Richard Evans.
- [21:31]
Actor Reading Court Transcript
Thank you. You are, I understand, a consultant pediatrician.
- [21:35]
Dr. Dewey Richard Evans
I am.
- [21:36]
Actor Reading Court Transcript
Could you please inform the jury when you first qualified medically?
- [21:40]
Dr. Dewey Richard Evans
I qualified from the Welsh National School of Medicine in 1971 and carried out my first pediatric post 18 months later.
- [21:52]
Amanda Knox
Now, as you may recall from earlier episodes, Dr. Evans, or the Welsh wizard, had never treated any of the babies in this case. He had never worked at the Countess of Chester Hospital. He was actually retired and had reached out to police to volunteer himself as an expert witness in this case. But his role was different. Dr. Evans was there to look backward, to read the medical notes, reconstruct collapses and tell the jury what those records meant. What, in his opinion, could explain what had happened to these babies and what could not.
- [22:35]
Actor Reading Court Transcript
Having passed through the various stages of training, could you confirm that you later became a National Health Service clinical consultant pediatrician?
- [22:44]
Dr. Dewey Richard Evans
Yes, I was appointed consultant pediatrician in Swansea in 1980.
- [22:51]
Amanda Knox
Before any individual child was discovered discussed, before any allegation was examined, the court spent hours establishing who he was, his decades in neonatology, his role building intensive care services, his long experience as an expert witness in criminal and family courts. This mattered because from this point on, much of what the jury would hear about how these babies died, whether their collapses were natural, accidental or deliberate, would be filtered through Dr. Evans conclusions. He wasn't just another witness. He was the lens. And as the prosecution made clear, they were asking the jury to trust that lens, case by case, baby by baby, as the medical foundation of everything that would follow. The prosecution began with baby A, a premature infant who collapsed and died shortly after birth. The allegation was air embolism, air entering the bloodstream.
- [24:08]
Sarah Knapton
So essentially, an air embolism is where a pocket of air, an air bubble, is injected into a vein on the body and things need to run freely, so the oxygen, the blood, can run to the heart and the lungs and everything gets oxygenated and then gets to the brain. If you have an air bubble in that system, as you can imagine, it's basically forming a little blockage and that can cause a problem with the brain, it can cause problem with the heart.
- [24:37]
Amanda Knox
Here's actors again, reading court transcripts of Dr. Evans testimony about Baby A's possible cause of death.
- [24:45]
Actor Reading Court Transcript
Yes, finally on baby A. Please, Dr. Evans, the means by which air could have been inserted into a baby's circulation, from what you know, of the way in which Baby A was being treated, what are the possibilities?
- [24:58]
Dr. Dewey Richard Evans
Well, there are only two, really. Sorry, there's only one really. The air would have gone through an intravenous line. And that can only occur in two ways, accidentally or on purpose. And that's it. Some time ago, I obtained a copy of all the intravenous bits and pieces of equipment used at the Chester Hospital, which we're all familiar with. We're all familiar with these lines from visiting people in hospital. An intravenous bag line. I won't go through the whole bit, but doctors, nurses, we're so obsessive about insurance that air does not get into the system. You know, we're absolutely obsessive about it and always have been. And it's much better now than so having rigged up the system that was used in Chester, and it's in a room in this court, in this building, so we could demonstrate it if necessary. I rigged it all up. There's no way air could have got into Baby A by accident. You know, the fail safe systems, the monitoring, the alarm setups, which have been present for, you know, a couple of decades, I suppose, ensures that this is not something that can occur accidentally.
- [26:19]
Actor Reading Court Transcript
Thank you.
- [26:22]
Amanda Knox
No ambiguity, no alternative explanation offered. The problem with air embolism is that it leaves no DNA. It's hard to prove, but here Dr. Evans was pointing to a red flag all over the baby's skin.
- [26:40]
Sarah Knapton
Dr. Dowie Evans based his conclusion of embolism on a skin rash, largely. So in many of the babies there was this splitting pink rash that is recorded in some cases and the doctors talk about it in other cases which had this mottled appearance. And it came and went and they said it was evidence of air embolism. Now, one of the papers, or pretty much the only paper they based that on, was a paper by a very, very eminent neonatologist in Canada called Dr. Shu Lee.
- [27:10]
Amanda Knox
Now, remember the name Dr. Xu Lee, because his paper and what he has to say about it will later become vitally important. But for now, Dr. Evans was very keen on emphasizing the importance of this study to the jury. Dr. Evans argues that the paper supports what the doctors at the hospital, that these types of rashes are indicative of an air embolism.
- [27:41]
Dr. Dewey Richard Evans
So therefore what we've got here is bright pink vessels against a generally cyanosed cutaneous, you know, relating to the skin. So the fact that it's bright pink, now that is remarkable. It's very unusual. It shouldn't be pink, you know. Or if it's pink, why has the baby collapsed? It doesn't make sense. Their interpretation is absolutely correct.
- [28:14]
Amanda Knox
Then there was Baby E. Baby E had died of gastrointestinal bleeding. Dr. Evans was not asked to name a precise cause. He was asked something narrower, whether there was any evidence this could have happened naturally.
- [28:33]
Dr. Dewey Richard Evans
There is no evidence at all that this was a natural phenomenon. It is not something I have ever seen in my decades of neonatology and hands on clinical practice.
- [28:44]
Amanda Knox
This again, certainty. Not unlikely, not rare, not unexplained. In Dr. Evans view, impossible to attribute to nature. This was the pattern the prosecution established case by case. Sudden collapse, no natural explanation. Expert opinion that deliberate harm was the only answer. Over the months that followed, Dr. Evans was recalled repeatedly, each time addressing a different baby and a different cause of death. If the medical evidence alone wasn't enough to convince the jury, it didn't stand on its own. Alongside the expert testimony came stories from doctors, nurses, hospital managers and parents. Accounts of moments that felt wrong, of sudden collapses, of patterns noticed only in hindsight. Of suspicions that grew quietly, then hardened. One of the most striking came from Dr. Ravi Jayram. He told the jury about the early hours of February 17, 2016, when he went to check on baby K. He said that when he entered the nursery, he saw Lucy Letby, quote, standing by the incubator and the ventilator. Dr. Jram testified that the infant's blood oxygen levels were in the 80s and. And falling, and that Ms. Letby was doing nothing to respond. It was a moment the prosecution returned to again and again. A still image frozen in time. A doctor's interpretation of inaction presented as intent, but arguably the most emotionally powerful testimony. Testimony came from the parents. The mother of baby D told Manchester Crown Court about being pushed into the neonatal unit and noticing a nurse nearby. Quote, I was pushed into the neonatal unit. She was sort of hovering around my baby, but not doing much. She had a clipboard to take notes and she was sort of looking at a machine, but I didn't understand what she was doing. When she asked if everything was okay, she said the response was calm, stating, I asked if everything was okay and she said, yes, she's fine. I would have expected her to leave us, but she just stuck around and was sort of just watching, looking over us. I wanted to tell her to go away, to Give us some privacy. That idea of hovering, of watching, was seized on by the prosecution. These moments mattered. They didn't prove how the babies died. They didn't explain mechanisms or causes. But they did something else. They gave the prosecution's case human weight. They turned timelines and charts into lived experience. And for the jury, grief did what evidence alone sometimes can't. It made the story feel real. In essence, what the jury heard was a web of circumstantial evidence, professional judgment layered on professional judgment, each account reinforcing the last. And all of it arrived in a courtroom where the jury went home every night. In the uk, juries are not sequestered. They're instructed not to read coverage, not to search the case. But they're still living inside the same media environment as everyone else. Headlines had been written, narratives had been established. By the time this trial began, Lucy Letby was already known to the public as the nurse accused of murdering babies. The prosecution didn't need to introduce that context. It was already there. And yet, for all of this, the testimony, the timelines, the suspicions, there was still a concern, conspicuous absence at the center of the case. No one ever testified to seeing Lucy Letby harm a baby. No eyewitnesses, no moment where someone could say, I saw her do this. What remained then was the authority of expertise. Because here's the thing. The prosecution didn't really rely on one expert. They called seven. Seven medical experts brought in to interpret collapses, rashes, blood results, patterns, and to tell the jury why those things were important. And the defense? They didn't call a single medical expert, not one. The only external person who testified on Lucy Letby's behalf was a hospital plumber. That's it. In a trial that lasted 10 months. We will look into why this might have been in future episodes. But for now, what's important to note is that imbalance, it mattered, not just legally, but psychologically. Because when science is complex and explanations are hard to follow, numbers can begin to stand in for certainty.
- [35:01]
Medical Expert Commentator
So there was layer upon layer of, gosh, how can she possibly be innocent? Amongst all this, seven experts appeared for the prosecution, none appeared for the defence. And seven doctors who worked at the hospital stood up and said, we think she's guilty. So there were 14 medical experts who said she was guilty of. So, purely on the numbers. You know, sometimes in a jury you're baffled by all the science and it was complicated. But if you think this is 14, zero, you got 14 experts up here, think she's guilty, zero speaking up for
- [35:28]
Amanda Knox
her next time on Doubt the Case of Lucy Letby.
- [35:33]
Actor Reading Court Transcript
No direct evidence of Lucy doing anything wrong. In fact, the opposite.
- [35:37]
Medical Expert Commentator
The thing that was a big red flag for me as a doctor about Derwi Evans, who's the lead prosecution expert, is his certainty.
- [35:43]
Sarah Knapton
He's not a liar. He shouldn't be about winning and losing. He's about giving his expert opinion. But he's never lost a case, so he's a hired gun, really, for the prosecution.
- [35:57]
Amanda Knox
The Case of Lucy Letby is brought to you by Vespucci, iHeart podcasts and Knox Robinson Productions. I've been your host, Amanda Knox. This episode was written and produced by Natalia Rodriguez. The co producer was Lucy Ditchment. The assistant producer was Ami Gill. The sound designer is Tom Biddle. The theme music was written by Tom Biddle. Voice acting by Paul Leeming and David Charles. Story editing by Kathleen Goldar. 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.
- [37:02]
BJ's Wholesale Club Advertiser
Nicole hosts Easter every year. That's why she shops at BJ's Wholesale Club, stocking up on spiral ham, baked goods, fresh flowers, candy and five dozen eggs.
- [37:12]
Amanda Knox
I've got a lot of baskets to fill.
- [37:14]
BJ's Wholesale Club Advertiser
Nicole's not worried because she knows she can save big and get it all done in one trip.
- [37:18]
Amanda Knox
It's like winning the Easter egg hunt.
- [37:20]
BJ's Wholesale Club Advertiser
When you save, everyone wins. Get a $15 digital coupon when you spend $150 in one transaction now through April 5th. Visit BJ's.com easter coupon for details. BJ's your Easter destination.