Lucy Letby Court Case

[Pebble21uk]

Today has been the first day of the trial, which is expected to last for six months. One thread has already been pulled on the subject. Upon deletion MNHQ said that a thread about the case is fine but please read the rules around contempt of court before posting... these are copied and pasted here:
Publicly commenting on a court case:

You might be in contempt of court if you speak publicly or post on social media.
For example, you should not:
say whether you think a person is guilty or innocent
refer to someone’s previous convictions
name someone the judge has allowed to be anonymous, even if you did not know this
name victims, witnesses and offenders under 18
name sex crime victims
share any evidence or facts about a case that the judge has said cannot be made public

If any of the above take place then new threads will also be pulled. Let's please try and keep it going!

Pebble21UK

New Doctor rotations start in July usually, so you might have been seen by actual new doctors on their first jobs. Probably with very limited experience in cannulating real people. Hope you were OK.

Those doctors would not be working in a NICU.

Just out of curiosity, anyone on here also following the websleuths thread. I'm reading both and this is the first comment I've made on either.

I'm finding the testimony so confusing and also the commentary on it!

My twins were born extreme preterm (c 23 weeks). My daughter weighed barely 500g and was in NICU for 5 months. In that time she had dozens of long lines - they are extremely difficult to inset on very tiny and very poorly babies.

One night when my daughter was only a few days old, the consultant on shift tried two or three times to insert a long line but his attempts were unsuccessful. He then refused to try again or do anything else to treat our baby because he believed she wouldn't survive. A junior doctor offered to try. The consultant let him and the JD got the long line in on his first attempt. The nurses hailed him a hero that night because without that long line at that point, my daughter would have died and the consultant was prepared to let her.

Sadly my her twin brother passed away but my daughter is now nearly three and thriving.

It's important to note that long lines often

Sorry, hit post by accident.

It's important to note that long lines often don't last long. They can fail very easily or the baby may deteriorate which can be a sign of an infection in the long line causing them to be even more unwell. This is commonplace and NOT down to poor hygiene/lack of sterility at insertion etc. If a long line infection is suspected as a possibility, they have to remove it even if it's working well, and the baby will be treated with medication accordingly.

I'm so sorry for the loss of your little boy, I can't imagine how awful that was. I'm so glad to hear that your little girl is thriving though. It's a whirlwind of emotions all at the same time, but I thank you for your comment. It's nice to hear real life experience it really adds to the debate/thought process.

Thank you for your reply.

This case is utterly devastating - for the babies, their parents and families, for the medical staff who worked on the ward at the time, for the reputation of the hospital and the Trust and indeed for LL's family IF she is found guilty of any/all charges. I know we can't speculate on that and of course there's months of information still to come.

Whatever the outcome, babies have lost their lives - naturally or not - and devastatingly nothing will bring them back.

I know first hand how incredibly fragile and yet exceptionally strong these tiny and very sick babies are. In our many months in NICU, I heard more than one consultant say that the tiniest, sickest babies look like the most fragile little people on Earth but they're stronger than any adults because adults don't cope as well with adversity and our fight for life isn't as strong. Tiny ones don't give up easily. This adds little relevance to this case or discussion but I thought I'd mention it.

Whatever the outcome, it's one of the saddest cases I've ever heard. IF anyone is capable of deliberately harming such vulnerable babies, it defies any logic or belief in my mind that any 'reason' could be given for a person of sound mind. It just doesn't make sense to me.

I agree it's totally devastating. I have 3.5 year old twin girls who spent just 3 weeks in NICU. One of my girls has had lots of low level problems since birth, and we're constantly in hospital for appointments, regular blood tests & 1 small operation. What you learn very quickly is how the NHS works and you become an expert fairly quickly. It makes me shudder now how totally clueless I was when my girls arrived. The poor parents (regardless of how their children died) would have felt totally and utterly helpless.

If my girls were born now with all my knowledge I would be giving the Dr's hell with all my questions. You put your 100% trust in them and I agree with you that if this erodes that trust even a little bit then that is a tragedy.

It is so sad. Even if she isn't found guilty, I'm sure many of the families will continue to believe that their precious little babies were harmed by someone they put their trust in. It's terrifying. My baby was in nicu too.

If I'm reading the reports right today about Child C, the specialist said the air could have accumulated in his belly from the use of the CPAP machine, and not being adequately drained or aspirated out. That seems to be a very important piece of testimony!

Can anyone answer a question I have?

Although it seems possible that the deaths of some of these babies could be attributed to other factors, will the jury be looking at the big picture of the high number of babies dying (relative to this neonatal unit) in a short space of time, who LL was involved with?

I'm sure there will be evidence about the statistical probability of the number of recorded deaths and on the chances of them being deliberate. But that would be hugely complicated by an all around bad standard of care.

If the Crown can prove beyond reasonable doubt that certain of the infant deaths were caused deliberately by LL, then it's a lot easier for the jury to conclude that she committed murder against others too. But if they can't prove any of these deaths were deliberate AND were committed by LL purposefully beyond reasonable doubt, then I don't see how the jury could convict under the law.

Me too. A lot of the witness statements are contradicting each other too. Like the two nurses assigned to baby C. If I read the transcripts correctly both are claiming not to have been in the room when he had his fatal collapse. Both say Lucy was stood over his incubator. Yet another witness says Lucy arrived in the room after the alarm sounded? It comes across like they are all covering their own backs, and if that means throwing Lucy or another colleague under the bus then do be it. Also the nurse assigning patients, said the baby in room 3 was most needy that's why Lucy was given him to care for. Yet child c was so small he on the threshold of being sent to a tertiary unit. But yet he was given an inexperienced junior member of staff was incharge of his care. It sounds like nobody knew what they were doing.

Honestly I can't work out from what's being said if Lucy is guilty or not. All the evidence presented somare could be something or nothing. It seems to depend on context. Maybe she did have opportunities to sneak in the room, but what I'm also getting, is that these were all really sick babies and despite what's being said I don't think they were as stable as some of the witnesses are trying to make out.

Regarding the statistics question the Royal Society of Statisticians released a paper on Medical Statistics and the law in September. I'll link at the end.

I'm a statistician myself so will attempt to briefly explain but of course I haven't seen all the evidence (only what's been reported) so won't know things like some of the health conditions that have been kept out of the press for confidentiality reasons, which could be key.

With medicine it's not the same as rolling a dice or flipping a coin and clusters do happen. Especially when it's a ward with very small numbers of patients anyway.
It's also complicated by other factors, for example in this case there are twins and triplets who may share pre-existing conditions and pregnancy history.
There's also been some defence arguments about them taking babies smaller and sicker than they would usually.

The prosecution can, and seem to be, using it to suggest a pattern has been occurring though. Although after Sally Clark I hope anyone would be extremely wary of convicting on stats alone.
As I understand it they need to consider each charge separately and be convinced that the patient was murdered or attempted murder not any other cause. And that LL was the person to do it.

It's an extremely difficult case and as a previous poster said I really feel for the jury and the families.

Link to article
rss.org.uk/membership/rss-groups-and-committees/sections/statistics-law/

What do others make of this expert witness Dr Evan's? He seems to be making up new theories as he's going along.

Last week he said something along the lines of 'that he was the first person to connect or notice the signs of an air embolism' there's just something oddly self congratulating about that sort of statement. And off about the people who say that kind of things. He just comes across as quite arrogant in the transcripts and as someone who can't be wrong and doesn't like his opinion questioned.

Thank you @PearWhere . I love when we get the chance for proper statistical insight.

Even with what you say, though, I imagine it would be very difficult if not impossible to tease out the impact of a single individual with mal intent Vs the impact of a whole department with poor morale, management, and resourcing if you found that a cluster of deaths was very unlikely to be chance.

I think the cases where baby’s died due to insulin will be harder to defend

I was thinking about this and wondering is it medically possible to know of the insulin levels in a body are too high or do they just see if the blood glucose level was too low ? Because if it’s just very low blood glucose that will be tricky to prove or disprove foul play ?

@CheapAsChip I may be wrong, but I think insulin poisoning isnt like e.g. arsenic poisoning where you can be really very sure that deliberate poisoning has occurred; the body naturally produces insulin and if I recall correctly, the effects of insulin poisoning can also be produced by other things going wrong in the body.

Using a wide variety of methods is also very unusual for a killer. Shipman stuck to morphine OD; MO does change, but with stakes this high killers tend to stick to the same thing so they can refine it.

@LadyTwinkle there will naturally be contradictions from different perspectives and best recollection. Not ‘covering backs’, the other staff are not on trial.

It will rightly contribute to "reasonable doubt" in the jury, though - and though other staff aren't on trial criminally, they may be subject to workplace criticism or censure if they've done their jobs poorly. And all of us remember things in a self -serving way; that's why witness testimony is often so problematic.

Re. blood glucose & insulin, while blood sugars are often unstable in preterm babies, it's highly unusual for them to fall perilously low. And they're easy enough to correct. I imagine there will be more detail given as time goes on.
Can I also say that hospital failings of poor staffing, low morale and not enough equipment does not automatically equate to poor care in this area of work. Many, if not most, neonatal units are in the same situation & staff just have to pull together. You get very good at prioritising.

It’s been a while since I learnt this so I might have the details slightly wrong. Naturally occurring insulin has a protein called c-peptide which synthesised insulin doesn’t. So if a patient has high insulin levels and low c-peptide, it means they’ve been administered insulin rather than producing it themselves. I believe that’s been used in previous ‘angel of death’ type trials.

when a mother has GD that can happen though can’t it I suppose that would be disclosed though if had been the case

When my DC was in NICU I asked if my diabetes had caused blood sugar/insulin issues - they told me that this didn't happen 🤔

This is more what I was getting at. It is going to create a lot of doubt within the jury. If three of the witness statements are so very different then who's to know who's telling the truth or remembering correctly. One of the nurse's didn't even mention seeing Lucy Letby in her original police statement. That's a pretty important detail to have missed out.

The other staff may not be on trial, but I'm not sure it's showing them in the best light either. The social workers in the trial of Arthur Labino Hugh's murderers weren't on trial, but also showed themselves to be so woefully inadequate that it led to a review. One of the social workers forgot to bring her case notes to court and the judge postponed her giving evidence until she found them.

Yes, maternal diabetes can cause a lot of problems, especially if poorly controlled, but that is not a factor here. In any case the most difficult patients re. hypoglycaemia are full-term babies who are heavier than average, rather than little pre-term infants.