12. Expected or unexpected? Which is it, docs?

Hospital management finally learns of the extent of the increased mortality over the previous year or so, thouigh why they did not know earlier is a mystery. Immediately they decide to no longer admit babies below 32 weeks gestation and to invite the RCPCH to conduct a service review. The consultants also demand that Lucy is taken off the ward on the basis of no evidence whatsoever.

June 2016 proves to be a particularly frenetic month at The Circus of Chester. There is no essential medicine for a baby with haemophilia. 33 week triplets are admitted but do not receive the care promised the mother. Two of them die and the third is transferred to Liverpool Women's Hospital. The mother later says the two hospitals were "as different as night and day".

Michael and Peter continue to discuss Rachel Aviv's article in The New Yorker. They note how time and time again Countess consultants dismissed obvious explanations for deaths and honed in on Lucy. But, docs, if you thought Lucy had killed babies as you say you did from the getgo, why didn’t you order forensic autopsies? Were you worried they might find you culpable rather than a nurse?

Babies A, C and D die in June 2015 and hospital consultants immediately identify an association with Lucy Letby. They did not associate the deaths with the acute pneumonia, phospholipid syndrome, emergency caesarian, low birthweights, lack of antibiotics, lack of fluids, delay in transfer to neonatal unit, crossed pulmonary arteries, multiple birth issues, effect of anaesthetic, high blood pressure, problems with two long lines, dangerous placenta condition, and sepsis. The pathologist did. Why didn't you, docs?

The New Yorker publishes a 13 thousand word article about the holes in the Lucy Letby case. In episode 15, Michael and Peter discuss various aspects of the article, such as it having been 'geoblocked' in the UK, and whether the UK's contempt laws in relation to reporting restrictions that are designed to prevent upcoming trials being prejudiced are fit for purpose. Aviv's article touches on the infamous roster data table shown to jurors, which your co-hosts discuss in detail.

There is much in Rachel Aviv's New Yorker article to digest. In this episode Peter and Michael continue to discuss the piece, specifically what Aviv writes in relation to the 1970s origins of the neonatal unit at The Countess, its poor plumbing, and the cramped conditions that increased likelihood of infection spreading. They also discuss the many many medical issues faced by Baby A and wonder why jurors decided they didn't explain his death.

In this episode, Michael and Peter pick up the timeline of key events in June 2016 with the deaths of the two triplets, Babies O and P. Lucy is put on admin duty and submits a grievance against the consultants. The RCPCH and Jane Hawdon are brought in. Lucy wins her grienace and the consultants are threatened with a GMC referral. They fight back, and the police are called in to investigate the high mortality.

Peter and Michael go through a timeline of key events from June 2015 to May 2016. Why did lead paediatric consultant Stephen Brearey hone in on Lucy so early on? What was his October email about and who was it to? Then came the damning 'chaos' email from consultant Alison Timmis to hospital management.

In this episode, Michael and Peter complete their discussion of the RCPCH service review. They focus on a stark contradiction, namely that because deaths were expected, consultants did not report them to the Child Death Overview Panel , and yet their line later was that the deaths were unexpected.

Michael and Peter discuss RCPCH review findings that not only was there insufficient senior medical cover at The Countess but there was also reluctance to seek advice, whether among junior doctors or consultants. Was this because proceedures were weak or they weren't being followed? Michael cites an example from his own experience.