The Guardian today on the safety of the Lucy Letby convictions

[Kittybythelighthouse]

This article was apparently months in the making but it was delayed by the reporting restrictions https://www.theguardian.com/uk-news/article/2024/jul/09/lucy-letby-evidence-experts-question

“A Guardian investigation has interviewed dozens of these experts and seen further evidence from emails and documents. Those raising concerns include several leading consultant neonatologists, some with current or recent leadership roles, and several senior neonatal nurses. Others are public health professionals, GPs, biochemists, a leading government microbiologist, and lawyers. Several of those still working in the NHS have asked to remain anonymous, fearing the impact if they are named.

These experts said they were acutely aware of the suffering of the families involved and did not want to reopen their trauma, but were so troubled they felt compelled to become involved”

Intusive thoughts

But you seem to make a number of massive and very important assumptions:

• a very large number of deaths occurred in Lucy's absence (up to 9, in and on of themselves that would be around 3x the basic annual mortality rate for the unit)

• this was concealed from the jury

• LL's defence team didn't bother to point this out to the jury in her defence

I find these assumptions to be absolutely astonishing, implausible and groundless.

I'm not debating the accuracy of the FOI data - it is accurate. But it refers to babies who died after being born at the Countess of Chester NNU, not babies who died at the Countess of Chester NNU. So it gives us incomplete information which you (and others) have chosen to interpret in a manner which is as favourable to LL and your conspiracy theories about her defence, as possible. Theres an irony to that I think!

You seem to think that because (an undefined number of) deaths for which LL was not charged have been omitted from a table used by the prosecution - that they must exonerate LL in some way that the prosecution was trying to conceal. But if that were the case, her defence would have pointed them out to the jury as they had every opportunity to do so. It does not take a statistician to say "hang on a minute, what about the enormous increase in deaths taking place at the same time that LL could not have possibly been involved with".

Whereas I am proposing the alternative explanation, that as the prosecution were not making a statistical argument, but an argument related to means and opportunity for those deaths and events in which LL was being charged - those were the events included in the table. And that the reason her defence did not make a reference to other excess deaths on the unit that occured in her absence, it was because there weren't any and that highlighting that would have further harmed her case.

In either case - the legal teams had full access to the information pertinent to this case and it's obvious that the public critiquing them do not answer and are having to rely on their own assumptions/ fabrications.

Like this isn't a "Schroedinger's cat" situation with equally likely possibilities.

We have on the one hand the claim that a miscarriage of justice has occurred and on the other, no such claim. It is the claim that needs to prove itself.

But the reasoning I'm seeing in support of this claim, regarding the presentation of LL's involvement in deaths on the NNU, is as follows:

• We (the public) don't have clearly established facts, lacking clarity even on the basic questions of how many deaths took place (13, 15, or 17) and for how many of these LL was present

• So let's make the unfounded assumption that the missing information exonerates LL as far as is it would be possible to do so (17 deaths and she was only present for 8 of these) - ignoring the difficulties with this assumption as follows:

• It requires that no babies were transferred to other locations where they later died, even though that would be routine for level 2 unit and we know was the the case at least for baby K

• It requires a remarkable and unprecedented increase in deaths unrelated to LL which has not been explained and resolved as abruptly as it began

• It requires LL's defence inexplicably failing in the very simple task of bringing these alleged exonerating figures to the jury

@Mollypolly45

"if we only look at times of collapse/death when she was not on shift, we only see Letby as innocent"

With respect, this is the key point made by those claiming that LL's convictions are unsafe, but as far as I can tell, it appears to be fabricated by them.

Can you substantiate this claim beyond other people (/conspiracy theorists) also making this claim? In particular, what deaths when LL was not on shift? What is your source for this?

I think it's quite clear that the prosecution did use the table to show guilt. From one of the articles linked:

She was the “one common denominator,” the “constant malevolent presence when things took a turn for the worse,” one of the prosecutors, Nick Johnson, told the jury in his opening statement. “If you look at the table overall the picture is, we suggest, self-evidently obvious. It’s a process of elimination.”

But neither exclusively nor mainly.

The prosecution will construct a narrative of her guilt as is their job. LL absolutely was the common denominator in every instance where expert consensus was that babies had been intentionally harmed - the only person with opportunity and means.

If up to a dozen deaths took place in her absence, as has been claimed, can anyone explain why the defence would have missed this open goal?

One thing that troubles me is are the deaths/collapses stated to be due to large injections of air into the NG tubes. It seems that the idea that this would prevent the lungs inflating and cause respiratory collapse is controversial and there are no cases of this reported in the medical literature. Apparently a number of experts don't believe this would result. So how did Lucy Letby know to do it in order to cause harm?

In fairness (I can't weigh in on the controversy as I lack the relevant expertise) you couldn't expect cases of deliberately injecting large volumes of air into the stomach to see what happens to make it into the medical literature. I don't think it's a stretch that someone willing to kill babies would be willing to experiment on them.

I agree, but it doesn't sound like other experts are convinced that it would even cause respiratory collapse, they argued that the babies would simply burp it out. I've seen (accidental) oesophageal intubation a number of times in adults where quite large volumes of gas are injected and it does tend to just come straight out again.

Fair

So the main misunderstanding here is HOW the case was investigated:

1. Police are contacted and work to establish which of the collapses were suspicious. They do this by giving the medical records to Dewi Evans who combs through each patient’s medical records.

2. Once it is establish that a collapse couldn’t be natural, the families involved are each assigned an investigation team that is responsible for collecting information on that case alone. They are told to look at all factors and draw their own conclusions in an open manner

3. Investigation Teams spend months interviewing and collecting data. They then present their conclusions at a case conference. Each team independently returns with the conclusion that Lucy Letby was present at the collapse and is the most likely culprit. How do these teams come up with this independently when none of the families even knew they suspected Lucy at this point.

FYI- this is also the point that she writes those diary entries. An expert in serial killers suggests this is her being manipulative again to gain sympathy and make sure she can play the victim when arrested, which she does.

4. Investigation now focuses on Letby and evidence gathering about her begins, including time sheets and interviewing consultants.

So you see- the timesheets and the consultants come very much AFTER they have established that she is the common factor. The police were scrupulously fair to her. Yet somehow people have got the whole thing arse over tip.

Sure - the author of the Telegraph article states the following:

“Yet experts say there are major problems in this approach. To begin with, it is unsurprising that Letby is present on all these occasions given that these are the cases for which she is under investigation.

The chart excludes deaths and collapses which occurred at the neonatal unit when she was either not present or where there was little evidence to suggest she was responsible.”

Now, neither you, nor I, nor, it seems, the prosecution, defence, judge and jury have the full data set of all shifts when a baby collapsed or died.

The shift table also doesn’t specify whether a collapse or death occurred on that shift.

I’ve read back through previous articles and can confirm that Dr Brearey (Neonatal Consultant at CoC) was the person who compiled that shift table data set.

I strongly suspect his motivation for doing so was to identify whether there was a colleague whose presence on the ward correlated with increased collapses or deaths.

In short - it’s likely he sat down at an Excel spreadsheet with the hypothesis “A staff member may be responsible for these events. Who is the most likely candidate?”.

Secondly, let’s assume Dr Brearey DID include every single episode of collapse/death… and every time, Letby was there.

25 such events over a 13 month period (June 2015 - June 2016) would be a VERY small number of adverse events for an understaffed, poorly equipped ward admitting:

• Seriously premature infants

• Seriously underweight infants

• Infants requiring ventilation

• Infants with complex illness (e.g. necrotising enterocolitis)

In addition, the Telegraph article also acknowledges instances of adverse medical accidents in the care of some of the babies, such as the incorrect placement of umbilical venous catheters (UVCs) by doctors, which can lead to blood clots.

In fact, the 2016 RCPHC review recommended the Trust revise procedures around UVC placement. In 2021, NICE guidelines were given a huge overhaul to acknowledge that incorrect UVC placement was dangerous and advice on correct placement methods was updated to improve safety.

In another infant, doctors tried multiple times to insert a breathing tube. In the end, they had to request a doctor attend from a neighbouring hospital to attempt intubation. That doctor successfully intubated the baby on first attempt. That baby had a long wait for proper ventilation and it raises questions about the skills of the doctors on the unit.

My point is - NICU is a ward in which adverse events or collapse are likely to be high.

It is therefore highly unlikely that the 25 instances Dr Brearey submitted on the shift table were the only episodes in which adverse events or collapse occurred, irrespective of death.

In short, the data only includes instances of collapse/death in which Letby is the common factor.

It could be that Dr Brearey initially compiled a massive table of data with every event detailed.

It could be that he saw slightly more crosses for Letby’s column.

It could be that he then filtered the data to show only Letby’s shifts…

… and bingo! You have the nurse caught red handed!

… or do you have the nurse working a lot of shifts who looked after the majority of very poorly babies more likely to die of natural causes?

We just don’t know.

I sincerely hope the defence requests all of the data and arranges a statistical analysis by a professional so that it can be submitted as new evidence to the Criminal Cases Review Commission.

I agree the following points:

• The shift table does not indicate deaths vs collapse

• The shift table does not indicate if all the babies included (A-Q) died with Letby present

• The shift table does not indicate all additional adverse events/ collapses/deaths that occurred when Letby was not on duty

Once again, we cannot conclude that Letby was the common denominator when collapse/death occurred, because:

1. The data set is incomplete

1. It does not factor in very important variables such as whether Letby looked after the most poorly babies (with the highest probability of natural death due to premature Illness) for the largest number of shifts compared to other nurses on the unit

I cannot say either way if Dr Brearey was well intentioned or conscious of his own bias.

Doctors generally have a decent grasp of complex statistic - for example, a lot of medical research studies will use statistics to calculate something called a p value. If it’s less than <0.005, it tells you that the treatment (e.g. a drug) works. It rules out that the patient didn’t just get better by pure chance alone. This is known as calculating statistical significance.

In short, doctors know exactly how to make sure their data is statistically significant!

In fact… making that statement makes me flabbergasted all the more…

Why didn’t Dr Brearey enter his shift data into a simple statistical calculation tool to determine if Letby was involved in more cases simply by chance or not?!

If she had a statistically significant p value of >0.005, perhaps we wouldn’t be sitting here debating whether a miscarriage of justice has taken place or not...

@Mollypolly45 But that’s not how the police came to their conclusions. However the doctors drew conclusions does not count because the police didn’t use their methodology. Anyone with the least knowledge of the case knows that.

It's usually p<0.05 that is taken to indicate statistical significance but I do otherwise agree with you. I'd be really interested to know what the actual statistical likelihood of any individual being present at all events is purely by chance when taking into account all the adverse events over the time period and the number of shifts they worked.

I would also add that doctors do have an advanced knowledge of statistics but IME are as prone to everyone else at seeing patterns where it could just as easily be random

It is clear and I think as a PP stated, the effect of that simple image (if badly incorrect) on the jury vs days and days on each point of complex medical detail is clear too. More than that, it was also on the front page of every tabloid newspaper, totally convincing masses of people that she was definitely guilty. As we see in any conversation about this topic, including this one, the stats will come up again and again.

Very few people understand statistics, outside of statisticians, but it’s the kind of thing that seems to make “common sense” even when it is wildly off base.

Thank you for the clarification 👍

Well I think your post was misleading as it took a snapshot of a limited part of the process. Glad you understand, I just wanted to clarify.

If you think the minutiae of how criminal trials work isn't relevant I wonder why you didn't raise that in your support of the post that originally brought it up. Your bias is showing.

I understand as per this article that the ward was chronically understaffed. However as a nurse I have to say I have never ever worked on a ward that wasn’t chronically understaffed (unfortunately). It is awful for nurses and doctors out there working in these environments. However i don’t think it explains the amount of sudden unexpected deaths which occurred in this unit.

But if the babies were without much doubt killed (highly unlikely they spontaneously collapsed and died), then the ONLY person who could’ve done this would be the ONLY person present at each event. There are ‘adverse events’ ie unlikely but they do happen and can be confirmed, then suspicious deaths where there is no cause for the collapse and it basically never happens that way. They haven’t taken a bunch of rare-but-it-does-happen events and deduced she was present at all and therefore she must be a killer. The babies collapse was completely unexpected and unexplainable so surely the only person present at all is likely to be the suspect?

God this maddening. All of you talking about the way stats were used. But they weren’t. The doctors investigation and the police investigation are separate. The one did not inform the other. What is so hard to understand about that?

The police, being very aware of the flaws in the Beverley Allet case, did not build from the hospital investigation. Anyone suggesting that they did and that everything hangs on the time sheets is wrong.

You entire analysis (and that of the article you have cited) is flawed because this simply is not how the case against LL was built nor prosecuted. Likewise the telegraph here is referring to these presumed deaths when LL was not present but at no point clearly establishes that they occurred(!!!). That LL was absent from these deaths appears to be a presumption based on nothing more than their absence from the table - a presumption which has gained traction in the press only because of how many times it has been repeated.

You are very successfully deconstructing a strawman. I believe that you're doing so in good faith and I'm not trying to be unpleasant but this isn't something I can constructively engage with.

But that presupposes that all the babies were murdered and some experts seem to be casting doubt on that. Initially none of the deaths were thought to be suspicious by the pathologists doing the post mortems.

What's not clear to me is a) whether the notes of all babies who had collapses during the time LL was working there were examined by the prosecution medical expert and b) whether these notes were anonymised so the person reviewing these notes did not know who the staff in question involved were.

According to one of the articles linked, iirc LL wasn't actually on shift in one case, so it was argued that she must have injected a TPN bag with insulin. But nobody saw her do it and the analysis used to determine that the baby had been given insulin is not considered forensically robust.

Personally I'm not convinced either way of her guilt or innocence. The idea of someone murdering vulnerable babies is horrific but so is the idea of an innocent woman spending the rest of her life in prison.

There are some really helpful points being made here and I, too, am pleased that, while we don’t all agree, we haven’t resorted to trolling.

It’s a really interesting case and we are all essentially speculating on an incomplete set of data.

Some of us are speculating in favour of guilt.

Some of us are speculating in favour of poor evidence.

I’ve worked in acute services for 16 years and currently work in adult ITU/HDU.

I’ve worked within four different NHS Trusts and witnessed change since the recession of 2008.

With concerns highlighted by medical professionals and statisticians publicised by the Telegraph, Guardian and New Yorker, from a legal perspective, I feel very strongly that the evidence used in prosecution is extremely weak.

Without a weapon, motive or direct witnesses of harm occurring, I do not believe it can be proved beyond reasonable doubt that Letby is guilty.

That does not mean I am convinced of absolute innocence - anything is possible.

However, what comes to mind is the principle that often the most straightforward, boring cause of a phenomenon is usually the culprit.

Instead of UFOs causing crop circles, it’s probably a rogue cow or artistic farmer.

In a neonatal unit acknowledged to be…

• Understaffed

• Poorly attended by consultants

• Staffed by few well trained nurses

• Suffering from equipment shortages

• Experiencing building failure from sewage backing up into ward sinks

• Having ongoing concerns about poor leadership

… the most likely cause for increased adverse event and deaths is that these infants and their parents received inadequate care in a year where more stillbirths also occurred in maternity.

It is far, far less likely that a nurse whom Psychologists agree doesn’t fit the profile of a sociopath or psychopath, suddenly started taking repeated shifts to kill babies.

I’ve seen the NHS decline over the years.

I’ve witnessed grossly unsafe staffing levels daily.

I’ve seen patients sitting in their own faeces with bodily fluids dripping down dressed legs full of pressure wounds.

I’ve seen medication errors, documentation error, preventable accidents… everything.

The most likely factor in increasing incidents in any ward environment is not “a new angel of death” nurse or doctor.

It’s less exciting to accept, but the culprit is much more likely to be inadequate proper care due to an understaffed, undertrained, overworked workforce.

The spike in deaths on the CoC Neonatal ward are most likely just another sad case of failures in care of mother and babies similar to Nottingham or Staffordshire.

The only difference here is that a doctor made a shift spreadsheet and then went to the police about it.

It literally does not bare thinking about if Letby is innocent.

• A dedicated nurse will have gone to jail, lost her career and had her life ruined.

• Many parents will have gone through the trauma of being told their baby didn’t die of natural causes, but was murdered.

• Alison Kelly (the former CoC Nurse Manager) was removed from her job and suspected from practice for failing to report Letby.

• Several other senior colleagues at CoC have had their competence questioned.

It’s horrifying to think about.

@Mollypolly45

"In fact, the 2016 RCPHC review recommended the Trust revise procedures around UVC placement. In 2021, NICE guidelines were given a huge overhaul to acknowledge that incorrect UVC placement was dangerous and advice on correct placement methods was updated to improve safety"

This would be relevant if many of the infants had died as a consequence of poorly executed UVC placement. They did not. Their deaths could not be explained. So it isn't relevant.

"Neither you, nor I, nor, it seems, the prosecution, defence, judge and jury have the full data set of all shifts when a baby collapsed or died"

This is a rather bizarre assumption which you appear to have made up. Why wouldn't this information be available to the prosecution and the defence, and why wouldn't the defence use it if it would assist their client?

"25 such events over a 13 month period (June 2015 - June 2016) would be a VERY small number of adverse events for an understaffed, poorly equipped ward admitting: ..."

You've made this up. You don't work in neonatal care and you have no idea how many clinical events (considered to be unusual / significant) or deaths could be expected in this environment within a 13 month period, do you? You also seem to have a level 2 unit confused with a level 3 unit. Only level 3 units, which Countess of Chester is not and never was, routinely care for the very sickest patients requiring intensive care. You forget that Countess of Chester admitted approximately 400 infants per year of whom only 2-3 died within a typical year.