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Authors: John Askill

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For three weeks the police scoured the hospital records, checked the case histories of every child who had passed through the ward and analysed every single emergency in the hospital’s ‘bad run’.

Discussions sometimes went on into the night during ‘debriefing’ sessions at the Blue Pig, the squad’s adopted pub – a sixteenth-century inn which served Whitbread bitter and an array of four real ales, Castle Eden, Flowers, Boddingtons and Websters.

There had been twenty-four separate incidents in the space of sixty days when children had suffered cardiac arrests, respiratory failures and heart attacks. The casualty ‘crash team’ hadn’t been
summoned every time but, even so, the sheer volume was astonishing when, normally, the detectives were told, the crash team might expect one call-out to the children’s ward in a year, twice at the most.

How could that be simply a ‘bad run’? The way the police saw it, this must be more than bad luck.

But suspicion was not enough and evidence was nowhere to be found.

Mr Hull produced his initial report into the nineteen cases he had examined and his conclusions were also far from encouraging. He reported that, in his view, there were no more than three incidents worthy of further investigation, and two of those might be questionable.

After three weeks they had got nowhere and every avenue had turned into a cul-de-sac. There was so little progress that they almost gave in and walked away from Ward Four, empty-handed.

There was a feeling that the case was going nowhere. Where, after all, was the evidence?

Only the persistence of Supt Clifton kept the investigation going. He was convinced that something just didn’t add up. It was the sort of instinctive feeling that detectives cannot always explain. A colleague remarked later: ‘He just wouldn’t let go. He just kept saying he knew something wasn’t right. He had a gut feeling about it.’

Supt Clifton decided to plough everything into his one and only lead – the blood tests on five-month-old Paul Crampton whose sugar level had plunged so low he had nearly died three times.

Paul had been transferred to the Queen’s Medical Centre in Nottingham where his blood had been tested. It revealed a higher than normal level of insulin, a reading of 148 milli-units per litre of blood, the calibration used to measure minute quantities. That was far, far higher than it should have been. A normal level would be between 4 and 6.

The hospital ordered a second check which showed that, by then, the level in Paul’s blood had dropped to 90. But a sample had also been taken earlier as a matter of routine at the Grantham and Kesteven General Hospital; this had been despatched to a specialist laboratory at Cardiff University for detailed analysis.

The results were totally unexpected.

Cardiff reported an insulin level ‘in excess of 500’. What was even more worrying was that the laboratory couldn’t tell Supt Clifton exactly how much higher than 500 – their equipment couldn’t measure levels beyond that.

Supt Clifton thought at first that this was the proof that Paul had been given a massive dose of insulin, enough to kill him.

But he was to find it wasn’t as simple as that.

Doctors explained that, in young children, the body sometimes produced insulin naturally in erratic and often high amounts. Big readings often indicated a tumour in the pancreas, secreting insulin into the body. Supt Clifton was told the level could sometimes soar as high as 1,000.

But was Paul suffering from such a tumour?
More tests revealed that he wasn’t, so what had caused such an enormous reading?

Another factor added to the mystery and fuelled Supt Clifton’s growing anxiety. When the body manufactures its own insulin, it also produces another substance called C-Peptide at exactly the same rate. If Paul’s sky-high insulin level had been produced naturally, tests would detect an equally high C-Peptide reading. But, in Paul’s blood, the C-Peptide was almost normal.

Supt Clifton decided to consult Britain’s leading expert on insulin to ask for an explanation. He telephoned Vincent Marks, professor of bio-chemistry at the University of Surrey, vice-president of the Royal College of Pathologists and formerly president of the Association of Clinical Bio-Chemists. Professor Marks was just about to set off from Guildford for an art exhibition in the seaside resort of Scarborough with his wife, an accomplished artist and sculptor. He agreed, however, to make a detour to Grantham and the two men arranged to meet at the Angel and Royal where they talked about the findings over a pint of best Bass bitter.

Supt Clifton outlined the case to him, explaining how children had been falling ill and dying at his local hospital. The professor listened to the unfolding story and digested the figures so far available.

By the end of the discussion Professor Marks was convinced that something untoward had been happening. He was as sure as he could be that, yes, insulin had been administered to little Paul
Crampton. There was no other possible explanation for the reading in excess of 500.

The professor offered the help of another expert at the university, Dr David Teal, who would do more tests on the Crampton blood sample, only half of which had been used at Cardiff. The remaining half of Paul’s blood was moved from Cardiff to the laboratory at Guildford which was equipped accurately to measure higher levels.

When the Guildford result came back, it was staggering.

The test showed an insulin level of an incredible
forty-three thousand
milli-units per litre of blood, a figure virtually unknown in the medical world. The only comparable reading had been found in a doctor who had deliberately injected himself with a huge overdose to commit suicide.

It was equivalent, in a baby, to having an entire 10ml syringe full of insulin pumped into the body in one dose. Even if Paul had a tumour – and the police knew he hadn’t – a level as high as 43,000 could not be explained.

Now, at last, here was the proof that the child had been overdosed on a huge scale; detectives realised just how lucky Paul had been to survive.

Insulin, first discovered in 1922 by two Canadian professors, is not a drug but a protein naturally produced by the pancreas.

Too little insulin in the blood produces the classic symptoms of diabetes – a chronic thirst, feelings of lethargy and tiredness and loss of weight. Too much brings on trembling, shaking,
sweating, fits and causes the victim painlessly to collapse, ultimately into a coma, which, if not treated with a supply of sugar, will be fatal.

Insulin at the Grantham and Kesteven General Hospital was kept, the detectives discovered, in much the same way as in hospitals all over the country. It was not a dangerous drug, to be stored with the morphine, but was kept on the ward in a locked fridge, ready for use. No accurate records were ever considered necessary because, as in most hospitals, nurses had a habit of drawing more than they required into the syringe and squirting the remainder away. It was kept and used in much the same way, and with the same security, as other everyday essential medicines.

But Supt Clifton now wanted to know whether Paul had been given an injection of insulin deliberately or could it have been an awful mistake? Suspicions grew when he discovered that the key to the fridge had gone missing. Nurse Allitt said that she had gone to open it but found that the key had vanished from the key ring. A thorough search was made but the key was never traced.

Ward manager Moira Onions had been asked by doctors to carry out an urgent review of the drug supplies to the ward. They wanted to know whether there could have been a mix-up in the labelling. Could Paul have innocently been given the wrong drug by mistake? Could there have been another child on the ward who should have been receiving insulin instead?

Supt Clifton, however, still felt that the overdose had been no accident and, if it wasn’t, then he had to know who could do such a thing. It had to be someone who had easy access, someone who was trusted enough to get close to the child, administer an overdose and not be noticed. The ‘spy’ camera was producing nothing and there had not been another single incident on Ward Four since the day the police were called in.

Detectives began questioning every nurse whose duties had taken them to the ward, asking them in minute detail what they remembered of the emergencies, where they had been and who had been with them at the time children had died or collapsed.

Still, for many of them, the reason for the police investigation was a mystery. A detective said: ‘In the end we had to call all the nurses together to a meeting and tell them exactly what we were doing and that we needed their cooperation.

‘They had all taken an oath, not to talk about patients, and as a result the word just didn’t get round for weeks on end.’

Some of the nurses suffered feelings of guilt and blamed themselves for not realising what had happened. Others were convinced they were under suspicion. Nurse Kathy Lock, who worked on the Children’s Ward, said: ‘I was there most of the time during the period that the police were investigating and yet it had never occurred to me in any way whatsoever that it could be deliberate. It was the last thing we had thought about.

‘It’s not the sort of thing you could ever imagine happening in a hospital.’

Another nurse said: ‘We realised that we were all suspects and some of us were interviewed half a dozen times. We had looked after the children at various times so I suppose at that stage we were all looking at one another, and wondering ….’

Supt Clifton and his team drew a chart, detailing each one of the emergencies, and pinned it to the wall. They were looking for a common thread – a pattern which would make sense of the events.

Armed with the detailed staff-rota lists, they drew rough graphs on the wall of the incident room. Supt Clifton wanted to know if there were any nurses who had been regularly on duty when the incidents happened.

As he ticked off each event, one name recurred time … and time … and time again.

It appeared alongside every one of the twenty-four incidents that had occurred on Ward Four during the sixty days.

The name was that of Nurse Beverley Allitt.

The newly qualified SEN, still only twenty-two, was taken under arrest at breakfast-time on the morning of Monday, 3 June – five weeks after the start of the investigation – to the grey stone Grantham police headquarters. She was questioned for two days about Paul Crampton, sleeping the night in a 10 × 11 foot cell.

She spent both days protesting her innocence, never once admitting any responsibility, totally denying she was in any way to blame. In some
instances she insisted she had not even been present when particular children had suffered unexplained relapses on her ward; it was always someone else.

Her calmness under questioning surprised Supt Clifton and his team. It was the first time in her life that the quietly spoken village girl had ever been locked up by police and they were astonished that she could remain so cool, with no sign of tears or nerves. One policeman said: ‘You would have thought she was on a Sunday School outing. There was no reaction from her. It was more a case of her saying, “Can I have something to read?”

‘You would have thought she had booked into the Ritz for a holiday.’

He added: ‘Being kept in a police cell is a very demeaning experience but she seemed to just take it in her stride.’

Nurse Beverley Gail Allitt was released on police bail the following evening and sent home on extended leave by the hospital at the suggestion of the police.

8.    Beverley – the Godmother

The joy of having surviving twin Katie back from the dead sent a welcome surge of hope into the lives of Sue and Peter Phillips. Determined to look now to a brighter future, and totally unaware of the police investigation at the hospital, they asked Nurse Beverley Allitt if she would agree to be Katie's godmother.

Peter explained: ‘We were so pleased and happy with what she'd done. We'd seen how her quick thinking probably saved Katie. We had seen her rushing from the room at the hospital, holding Katie in her arms, shouting for the ‘crash team', when she discovered she had stopped breathing. We thought that, if she hadn't have been there, Katie would have died. What she'd done was wonderful. Why shouldn't the girl, who saved her life, become her godmother?'

Sue said: ‘We asked Bev at the hospital, on Katie's first day back from Nottingham, if she would consider becoming her godmother. She said, “Yes,” without a second thought. She seemed to be overjoyed at the prospect.'

Allitt was so pleased that she went shopping for her little goddaughter and bought her a charming baby-gro.

Sue said: ‘Katie came home from hospital for the day on Friday, 10 May. I remember it because it was a glorious, sunny spring day which was so warm we were able to sit out in the garden.

‘I also remember it because it was the first time that Bev came to our house. We hadn't expected her, but she arrived about 3pm, still dressed in her blue check nurses' uniform because she had just come off duty.

‘We were all sitting out in the garden and Peter had even put up the big sun umbrella. Katie was in her buggy under the umbrella and Bev brought the present for her. Bev was fine. She was happy, smiling and we were pleased to see her. She was, after all, going to be Katie's godmother. My mum and dad were here too and, like us, they were delighted she'd made the effort to come.'

Someone made her a cup of tea and, later, she sipped a cold drink with them as she stayed for the remainder of the sunny afternoon.

Sue recalls: ‘We were still a bit nervous about Katie's condition and it felt comforting to have a nurse with us. I was constantly going up to the buggy just to make sure she was all right. She still had the Apnia Alarm fitted to her chest, that was with her all the time, but it still felt right to check.

‘I remember talking to Bev about it and she was very reassuring. She said she was sure we had nothing to worry about. Katie was going to be fine.'

Sue still couldn't manage to cope with Katie being at home permanently, so the hospital allowed her to take her baby back at night to sleep in Ward Four where she continued her stay as a part-time patient, going home whenever Sue and Peter could cope.

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