Journalist clashes with Letby star witness over death of 10-year-old Welsh schoolboy

Martin Shipton

One of Britain’s best-known investigative journalists has challenged the star witness in the Lucy Letby murder trial over his involvement in a case where a Welsh schoolboy died as a result of medical negligence.

John Sweeney has released the final episode of a seven-part podcast series in which he raises doubts about the guilt of Letby, a nurse who has been convicted of murdering seven babies in the Countess of Chester Hospital, and of attempting to murder seven more.

Retired consultant paediatrician Dr Dewi Evans, of Carmarthen, was the main prosecution witness in Letby’s prosecution, having identified her as the only medical professional who had the opportunity to commit the murders.

In an earlier episode of the podcast series, Sweeney and fellow journalist Edward Abel Smith questioned Dr Evans about his findings in relation to Letby, suggesting there were other possible explanations for the deaths of some of the babies. Dr Evans insisted that Letby was guilty.

Robbie Powell

In the seventh and final podcast, Sweeney focusses on the death in 1990 of 10-year-old Robbie Powell, of Ystradgynlais, Powys. Robbie died of Addison’s disease, a rare illness that stops the adrenal glands pumping vital hormones. Doctors did not act on a suspicion that he had the condition and he did not receive the treatment that would have saved his life.

Six years later the NHS accepted that negligence had occurred at Morriston Hospital, Swansea.

An initial police inquiry said there was no evidence to justify criminal proceedings against doctors they coincidentally employed as police surgeons, but, after pressure from Robbie’s father Will Powell, a reinvestigation of the case by a senior detective from West Midlands Police resulted in a recommendation that 35 possible charges should be brought against five named doctors and a secretary.

Evidence had emerged of documents being tampered with, and a secretary confirmed during the inquiry that she had been asked to type a backdated medical referral note which gave a falsely positive impression of the care Robbie received.

In 2003 the Crown Prosecution Service agreed there was evidence that various doctors had been negligent or grossly negligent and/or involved in forgery and perversion of the course of justice.

Yet it concluded that none of them should be prosecuted because too much time had elapsed and that the police had effectively given them immunity from prosecution.

‘Poorly served’

Sweeney put it to Dr Evans: “You were one of the three paediatric consultants [in Swansea] at that time. Robbie was served poorly by your hospital. Addison’s was suspected by Dr Forbes and he wrote up his tentative diagnosis. Tests showed that Robbie had low sodium, low blood sugar and high potassium, classic chemical symptoms of Addison’s, along with the tell-tale abdominal pain, weight loss, vomiting, no diarrhoea and darkened skin.

“Dr Forbes, who is now dead, instructed the following info to be sent to Robbie’s GPs: Addison’s disease was suspected; he needed an ACTH test for Addison’s disease; that Robbie suffered from hormonal imbalance; that Robbie’s parents had been so informed. On December 9 1989 Robbie was sent home but the hospital did not weigh him on discharge – a schoolboy error. Dr Forbes asked the GPs [to] send Robbie back to hospital immediately if he became ill again. The test never took place; mum and dad were not told about Addison’s disease or the need for the test. But Robbie was suffering from extreme symptoms of the disease: an Addisonian crisis. The normal treatment is hypercortisone. However, according to the medical records, this was never given.

“In April 1990 Robbie fell ill again. Will Powell begged GPs at the local medical centre in Ystradgynlais to send Robbie back to hospital. He was seen by five GPs on seven separate occasions in the last 15 days of his life.

“Mr Powell pleaded with the GPs to refer his son to hospital six times, in vain. At the seventh attempt, GP Dr Nicola Flower did so but did not agree to send him by ambulance.

“On arrival, the hospital nurses and doctors found Robbie in a ‘collapsed state, could not find a pulse, sunken eyes, airway problem, desperately ill, unresponsive, eyes fixed and staring, shallow breathing, dry lips, no resistance to intubation, seriously ill child, unconscious, horrific appearance, close to death, most seriously ill child admitted’, according to a report by a second expert endocrinologist, Professor Ieuan Hughes of Cambridge University.

“At Robbie’s inquest in 2004, Dr Narendra Agarwal, one of the three consultant paediatricians, along with yourself and William Forbes, said under oath that he believed that Robbie was dead on arrival. Whether he was right or Robbie died later that night, the serial failure of the GPs to admit the boy to hospital in a timely fashion was a terrible mistake.

“A professor from Great Ormond Street Hospital in London who later reviewed the case concluded: “[Though] Addison’s disease is not common, it is clear that the diagnosis was entertained in December 1989 and January 1990. Not to have pursued it constitutes practice of an unacceptably low standard. Had the diagnosis been made, Robert Powell would not have had a further collapse in April and he would be alive to this day.”

Letter

In the podcast Sweeney refers to a letter written in 1996 by Dr Evans, who had been a consultant paediatrician at Morriston Hospital at the time of Robbie’s death, to one of the GPs involved in Robbie’s care, in which he stated that it was understandable that they missed Addison’s disease. Dr Evans stated: “One can but conclude that there are conditions in children that are virtually undiagnosable before it is too late. Certainly I cannot think of any steps that you could have taken as the GPs which could have anticipated such an event.”

Sweeney put it to Dr Evans: “Will Powell believes that your letter was a whitewash, stating: ‘When a professor of endocrinology looked at the events in relation to the GPs’ involvement in Robbie’s care in the 15 days prior to his death, he opined that four of the five GPs were medically grossly negligent and a substantial cause of Robbie’s death. How can Dr Dewi Evans or any other doctor think that the conduct of those GPs was acceptable?’

“Mr Powell notes the fact that you had informed him that you had read the Guardian article in 1994 which reported the forgeries at the GP surgery. So you absolved the GPs of any wrongdoing while knowing about the forgeries. He fears that you cannot be regarded as a reliable witness.

“Do you agree that your conduct in the Robbie Powell tragedy casts a shadow on your standing as a reliable witness in the Lucy Letby case?”

‘Cover ups’

Dr Evans responded: “I’m afraid Will Powell was the victim of one of the worst cover ups in NHS history.

“I had no involvement in Robbie’s care. Just to show how little I knew, it was only in 1994, from reading an article in the Guardian Magazine that I discovered for the first time that prior to his terminal admission over Easter 1990 he was admitted under the care of my colleague Dr Bill Forbes in December 1989. The diagnosis was gastro-enteritis. His blood sodium was VERY low (120) and potassium raised (around 6). These values are characteristic of Addison’s disease. Naturally he got better after Intravenous sodium containing fluid and was discharged.

“Bill reviewed him in January but for some reason failed to arrange the relevant tests for Addison’s, and discharged him.

“He was admitted to Morriston Hospital in a moribund state during Easter weekend (I think on Tuesday) under the care of my other consultant colleague Dr N Agarwal. He died soon after admission.

“I remember hearing about the death (Morriston Hospital was the main A& E department. Paediatrics was based in Singleton Hospital, eight miles away on Swansea Bay.)

“So, not involved, and astonished when I read of his earlier admission from the Guardian article 4 years later.

“We were a busy department, with three of us covering the whole of Swansea and surrounds – population 350,000.

“Bill Forbes retired in 1993 I think, and died around 2003 of a cerebral tumour. He never mentioned Robbie’s case with me ever and we did not maintain social contact after his retirement. No one else discussed the case with me! And as I had no idea about the earlier admission and the abnormal blood tests it never crossed my mind to ask. The delayed Easter admission was clearly negligent but I don’t think his condition was rescuable when he was admitted. If only he had been admitted 24 hours earlier.

“The GPs clearly failed him – not because they did not suspect Addison’s but because they failed to appreciate he was so seriously ill. I think his parents called them out three or four times over Easter weekend. This explains the content of my letter written on behalf of the GPs. I knew them well, and carried out regular clinics at Ystradgynlais Community Hospital. In my opinion the overall quality of their practice was very good, notwithstanding Robbie’s tragedy.

“I was never involved in any investigation but Will Powell’s comments re altered notes etc are probably correct.

“Why did Bill Forbes not discuss the case with me? I don’t know, but suspect that I would have told him to own up to the missed diagnosis! Probably rather forthrightly! But that is speculation on my part.

“Bill was a very sound clinician. He was rarely wrong with his clinical diagnosis. This was a rare error of judgment. I think that at one of the inquiries into Robbie’s death he had to admit altering some notes. As with all the events I was not involved, kept in the dark and did not have access to any disclosures.”

Pressed by Sweeney on why he had written the supportive note to the GPs, Dr Evans stated: “It’s a long time ago but I think that my comment related to the difficulties of recognising the features of a rare condition like Addison’s. I don’t think I got involved with any allegations regarding altering notes. I’d never endorse that.”

The podcast series Was There Ever a Crime? is available free of charge on all the usual channels.