May 2026: Thirlwall Inquiry report delayed to at least September 2026 · six-baby inquests relisted to 2027 · CCRC review active · Shoo Lee Panel: no medical evidence of deliberate harm.
Blood samples from two infants — Children F and L — returned results suggesting raised insulin with low C-peptide. Normally insulin and C-peptide are released together by the pancreas. A high-insulin-low-C-peptide pattern, the prosecution argued, is only explicable by insulin administered from outside the body. The jury was told this was proof of deliberate poisoning.
The Roche Cobas immunoassay used is a screening test. Its own manufacturer's guidance requires confirmation by mass spectrometry before a result can be treated as diagnostic of exogenous insulin. That confirmation was never done. Independent endocrinologists (including Adel Ismail and contributors to science4justice.nl) have shown the assay is prone to false positives in neonates because of interfering antibodies and cross-reactivity. The Shoo Lee Panel went further than the assay critique. It found that the insulin/C-peptide ratios in Children F and L were within the range normal for preterm infants — a pattern that does not prove exogenous insulin at all — and it attributed the babies' hypoglycaemia to natural and iatrogenic causes: for Child F, sepsis, prematurity, intrauterine growth restriction, a tissued long line and poor management; for Child L, preterm birth and severe intrauterine growth restriction, inadequately managed.
A screening immunoassay was never designed for forensic use. In every other British criminal case involving insulin, confirmatory mass spectrometry is performed. That did not happen here.
Biochemists from the Royal Liverpool laboratory described the Roche immunoassay results as showing an insulin level inconsistent with endogenous pancreatic release. The Crown's witnesses told the jury the pattern left no explanation other than exogenous insulin in the TPN bag.
The Panel concludes that the insulin/C-peptide ratios in Children F and L were within the range normal for preterm infants and do not prove exogenous insulin. It attributes Child F's prolonged hypoglycaemia to sepsis, prematurity, intrauterine growth restriction, a tissued long line and poor management, and Child L's to preterm birth and severe intrauterine growth restriction, inadequately managed. Separately, the screening result was never confirmed by the mass spectrometry the assay manufacturer recommends for forensic use — without which a result cannot reliably discriminate exogenous insulin from interference.