To think that Lucy Letby will get a new trial?

There still isn't any evidence for a birth injury. None. What is there to support that theory? Neena Modi floated it so it must be true because she's part of the "expert" panel?

I think the pathologist would know whether it was due to sepsis or not. He's said it was so extensive it was like that found in a road traffic accident. And he also ruled out CPR. Which I'm sure you already know.

He had never seen liver damage of that magnitude in a neonatal clinical context.

although there is some evidence to suggest an injury may have been accidentally inflicted by a doctor.

Doesn't want to believe Lucy did anything but will blame someone else if at all possible. The doctor was responding to the emergency and trying to save the baby who had collapsed unexpectedly. It's so wrong to try and pin this on a doctor. That panel have come up with the wildest theories, my only question is why anyone with any sense is actually buying them.

I don't think she'll get a retrial until Dr Dewi Evans has died. It would be too damaging/ embarrassing for everyone involved, which it will be anyway, but the government/ court system will be aiming for damage limitation where they can.

Actually there are significant concerns about the insulin evidence.

https://www.thejusticegap.com/lucy-letby-bullied-by-doctors-whose-suspicions-were-fuelled-by-gut-feel/

Unfortunately, yet more relevant information the jury weren't given access to during the trial.

This is another example of why the adversarial model doesn't work well in cases like this. The prosecution and defence both prioritise, as the system tells them to, putting their own cases as strongly as possible within the parameters of what they're allowed to do. That doesn't have to mean providing the court with as much relevant information as possible. Sometimes there's a conflict between the two aims.

Which is no criticism of the prosecution either. Those preparing and presenting the case did their jobs.

In any case the issue here is not how rare birth injury is, but how rare haematoma is in premature neonates - which is not that rare. Prem neonates form 90% of the cases and the prevalence on autopsy is between 2.8% and 15% depending on the study.

As has been covered previously - birth injury is only one possible cause, there are a variety - they can just occur spontaneously, as the hepatic capsule is fragile, from uvc lines, coagulopathy, sepsis, cpr etc.

Either way, the most experienced and most highly qualified doctors to analyse the medical notes - have concluded that in this instance birth trauma is the most likely cause.

And that is a more plausible and evidence-based conclusion than air from a nasogastric tube changed to air embolism + a massive whack on the liver so hard as to make it haemorrhage.

One could say Evans invents implausible methods of murder to fit around medical notes. But there is no evidence at all in the data to support either air via nasogastric tube or intravenously, & no evidence to indicate the liver bleed was intentionally inflicted, although there is some evidence to suggest an injury may have been accidentally inflicted by a doctor.

They certainly shouldn't be speculating like that during a trial without even attempting to explain what she could possibly have done.

If there was a trial or investigation relating to birth injuries then they wouldn't just say oh the doctor caused that birth injury and leave it at that, they'd have to say what they think the doctor had actually done to cause the injury.

That's how they generally do it yes, when I've heard injuries described in caregiver cases they say what the injuries are consistent with.

Do I want graphic details? No. Would I expect them in a trial like this where they're trying to claim she inflicted these injuries without being noticed? Yes absolutely.

We don't have stats for the rarity on the insulin results; we don't know how many babies were at Liverpool when there were dislodgements during four shifts, and we don't know the risk factors (skill of incubator, infant anatomy, age, handling, relevant conditions); only one of each set of twins collapsed in the sense of apnoea and cardiac arrest - the other two had hypoglycemia, which is common in babies. Whether the vomiting should be described as projectile or not is contested.

But anyway, you should expect some rare events among 3000 babies born in Chester in a year. You just shouldn't expect to be able to predict which particular rare events. But if you go looking for rare events in a population that size, you will find some.

As if birth injury was more rare than a serial killing nurse with random makeshift methods, that not a single person saw on a busy neonate unit.

@Oftenaddled the insulin tests were rare if natural, the tube dislodgements at Liverpool were rare, twins collapsing from totally different conditions was rare. A baby projectile vomiting across the room was rare.

You really don't need to scour the internet to find cases of birth injury by Caesarean. The studies pointing to the lower rates put it around 1%, so there are lots of case studies out there and you would expect about 10 cases a year at Chester if their unit achieved average results and about 1/3 of women had Caesareans And this was a triplet pregnancy.

It's worth remembering that both Child O and his brother Child P had liver hematomas, according to the pathologist who saw the bodies. They can be caused by birth injury, hypoxia or spontaneous development.

So while the defence case doesn't need to prove birth injury, it's not remarkable that they would look into it.

It's worth remembering that Dr Lee's panel, unlike the prosecution expert witnesses, had the evidence from the Thirlwall from the parents of the triplets on the delivery. Having read that, I am sure any responsible medic would want to see the obstetric notes and check for any connection with the children's condition

https://thirlwall.public-inquiry.uk/wp-content/uploads/2024/09/Thirlwall-Inquiry-25-September-2024.pdf

Did so many of the children in Lucy Letby's indictment have rare conditions? Most of what the panel pointed to were relatively commonplace issues. But you would expect some rare problems with 3000 births a year at Chester anyway.

Yes, caesarean sections (C-sections) can cause liver birth injuries in babies, though it is very rare. These injuries typically occur during emergency C-sections and are usually related to the physical extraction of the baby or complications arising during the surgical delivery

When people have to scour every bit of medical literature for those very rare occurrences over and over again to defend this woman, you know she's guilty as hell.

Nobody is assuming it is birth injury. They are saying it is a plausible cause of the child's liver hematoma and they are asking to see the obstetric records.

There are other possible causes too. In that sense it doesn't really matter whether it is birth injury or not. But it is absurd to claim you have ruled out all possible natural causes of neonatal death without looking at obstetric files, so it's to be hoped the CCRC will obtain them for the defence as requested

I think Neena Modi is a little better qualified in the treatment and diagnosis of neonates than Judith Moritz and Jonathan Coffey of Panorama, so she may well double down.

They repeat a claim in their book about Lucy Letby too that Caesareans cannot cause birth injury in babies. A few seconds research would show them this is wrong. They really shouldn't write about this topic unless they are prepared to do that much.

So it's wrong to speculate on what she might've done to the liver but we can just assume it was a birth injury with absolutely zero evidence? Okay then.

If that's the only plausible explanation for what happened, yes. If the pathologist has seen that type of injury in caregiver abuse then it's very possible. Why hadn't the pathologist seen it in natural causes before? Do you want people to spell out the graphic details of what she could've done?

Caesarians can cause birth trauma. Premature babies can develop haematomas even without birth injury. Without the obstetric notes, nobody knows. What can be said for sure though is that Evans’ theory of cause of death is ludicrous.

@aluna the baby was born by caesarean, there was no birth injury. Panorama pointed that out to Neena Modhi and she just doubled down that it was possible. Even Mike Hall knows there was no birth injury!

Sorry what?

That wasn’t covered in court because a. The prosecution chose not to use obstetric notes, b. The prosecution chose not to use the orginal pathology report. c. The police had chose to put all their faith in a provincial paediatrician, 15 years out of the game, who made a living as an expert witness producing opinions to order (in the opinion of another trial judge not me.)

Do you understand anything at all about the medical process that Professor Lee’s team undertook? And the processes Evans and police signally failed to follow?

Lucy Letby posted datixes throughout the indictment period in 2015-16, so it's not surprising or sinister that she did so in June 2016 and reported the three problems - specialist needle not on ward, resuscitation meds not on ward, bung left open - which needed attention. Which of these three should she not have reported?

Access may or may not have been lost. The point of the datix was that the doctors needed alternative access, which is verified, and that the needle they could have used to obtain this more easily wasn't on the ward. There was no point in trying to use lost access as an excuse after the point when the child had collapsed - any air embolism would have to have been inflicted earlier.

It's not going to be possible to say whether or not the baby had a birth injury without access to his obstetric records.

Lee's panel has said the likely cause of death is rupture of a liver hematoma, and that the likely cause of the hematoma is birth injury. They haven't stated that birth injury is the definitive cause. Other causes (prematurity, hypoxia, spontaneous development) would all be possible too.

But since both baby O and baby P had hematomas and the parents reported a painful and difficult caesarean delivery, unusually rapid, without the consultant they'd been seeing, it certainly seems sensible to consult the obstetric records.

Yet you've no issue in believing that LL managed to inflict an injury equivalent to the impact of a car crash without anyone noticing anything and with no theory even put forward about what she could have done.

Totally agree - it's hugely difficult isn't it?