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”

I live in a similar jurisdiction to UK and the disclose obligations are as follows. Note that they won't be identical in the UK, but I believe very similar:

Prosecutors are under a continuing obligation to fully disclose to the accused all material known to them in a timely manner that on their sensible appraisal:

is relevant or possibly relevant to an issue in the case
raises or possibly raises a new issue that is not apparent from the evidence the prosecution proposes to rely on
holds out a real as opposed to fanciful prospect of providing a lead to evidence that goes to either of the previous two situations.
The prosecution’s duty of disclosure continues after trial and the conclusion of any appeal.

The defence also has obligations to disclose. They must disclose reports commissioned by expert witnesses they will call to give evidence. So if they commission a report and it's damaging, no you don't have to disclose if you don't intend on calling the writer. This is because you don't have an obligation to build an alternate theory (though many do, as it helps) but instead your most primary task is to demonstrate that the prosecution has not proven their case "beyond reasonable doubt".

Both sides have an obligation to not make an argument you know is false. Very few lawyers would do this because the sanctions are significant and no client or case is worth risking your career over. For us it's our day job and while obviously by being criminal lawyers we are passionate about helping our clients, personal success is demonstrating diligence and professionalism. Next week will be a new case.

This isn't to diminish our commitment to advocacy but rather to say our commitment to upholding the system comes first; not out of a higher moral standard but just out of personal and professional interest.

The easiest example of not making an argument you know to be false is if you are defending someone who instructs to you that they committed the offence but are pleading not guilty, you cannot argue for them "they didn't do it" but you can argue "the prosecution has not made the case that the evidence proves their guilt beyond reasonable doubt" and it is up to the jury to decide whether they agree.

I write this whole essay because while I agree with other posters that there is enormous room for improvement in the justice system, some posts have veered into almost conspiracy about the court covering up the truth. Just wanted to keep it a little more tethered to reality.

I don't personally think anyone is trying to cover up the truth deliberately just that mistakes can be made and have been made in just this kind of case before.

Exactly this.

I also think that it is the limitations of the legal / justice system that makes it look like a cover up. It simply hasn't evolved to keep up with cases as complex as these, which is why it might be useful to enlist specialist juries - ie. selected from a pool of people who have at least basic knowledge of medical / scientific evidence or a separate form of assessment altogether. In this case in particular the big question is whether murder has actually been committed at all. Of course the argument is that of course it has based on the big picture evidence. It wouldn't have come to court if it hadn't.

However, there are such worrying aspects to the medical evidence. For example much has been made of the fact that Lucy Letby agreed that insulin poisoning had occurred, but said she didn't do it. The thing is, it was stated as an established fact that she was not in position to deny without appearing delusional. Now there are questions about the reliability of the test results which cast doubt on the certainty.

This is why I was banging on about things like how much insulin was readily available on the ward, accessibility to it, discrepancies in inventory etc. And how much insulin would be required to produce the test results / symptoms observed.

Similarly the issue of air being injected via the NG tube - what volume of air would be needed to achieve the reported damage? How long would it take?

The impact injury to the liver sounds dreadful indeed. Which us why I googled to get an idea of size, scale and location of the liver in a neo-nate. Plus how CPR is administered. Because the impression given is that Lucy Letby did something really violent leaving no external sign. The feasibility of that needs to be explored.

Am I a psychopath to want to examine this further? Or am I just doing what I had to do for myself in similar circumstances because I'm trying to make sense of it all in my own head? And what does it matter?

It matters if an innocent person is convicted on dubious evidence. It matters because the truth matters. It matters because while no system is perfect, when issues are identified we have to try and address them. It matters that we have trust in the institutions that have such great control and influence in our lives, and that they are seen to be as fair and transparent as possible.

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I've just been listening to this cross examination of her. I found it quite sad and somewhat alarming actually. Most of what she did I've done myself - handover notes, writing up notes afterwards, visiting the unit during time off etc. keeping notes of obs on random pieces of paper. Checking on patients and how they're doing. I found handover notes in old work bags from a couple of years previously. I've photographed cards too. Her answers are perfectly reasonable and understandable in the context of her daily life as a nurse. I feel a bit upset about it tbh. I'm really hoping she's guilty, but a big part of me just tells me she was over involved and a bit obsessive about her job, but just didn't kill anyone.

I have really bad feelings about all this. I'm still waiting for the gotcha moment. Everything I'm hearing can be explained and no, I'm not clutching at straws. I really believed she was guilty when she was arrested and went to trial.

In case anyone is interested there's a podcast called 'We need to talk about Lucy Letby' where a retired doctor and a guy with an interest in statistics discuss the case. I think it's fair to say that they are very much on the side of LL (the Dr is so effusive about her I think he'd nominate her for sainthood if he could!) but it is interesting to hear some of the background and arguments that the defence might have used.

In the first episode they allege that the lead expert for the prosecution (Dr. Evans) got involved by emailing someone he knew at the national crime agency, saying that he's heard about the case and would like to be involved. They suggest that this is a highly irregular way of becoming an expert witness in a particular case.

I certainly think that it would be interesting to know whether Dr. Evans was aware that LL was under suspicion and about the infamous chart produced by one of the consultants before he reviewed the cases.

but a big part of me just tells me she was over involved and a bit obsessive about her job, but just didn't kill anyone.

I think if you view this through the lens of the pressures nurses are facing , the explanation of writing notes is far more likely than collection of " trophies"
No she should not have taken notes home but the fear of getting something wrong haunts most nurses.
The words " lose your PIN" are drummed into nurses from the day they start training

We have on one hand a dedicated, diligent nurse, with no former issues or disciplinary concerns and on the other a medical team who have been proven as incompetent with one preventable death and one severely brain damaged baby, sadly proven at inquest.

DARVO is an interesting and well known concept

Yes, I've actually kept notes before in order to prove I've done something at the time. I've kept them in order to write something up privately at home in the event a relative kicks off and I needed to make a statement as well. I forgot about these things.

Another thing that troubles me is RJ and his watching her do nothing with the alarms switched off and only reporting this 18 months later

Is anyone familiar with resus guidelines ABCDE?
Assessing Airway -
Breathing
Circulation
Disability
Exposure

If LL was assessing breathing I would expect her to have turned off the alarm, assess air entry and then breathing
Record Resp rate, over 1 full minute , check depth, sound, chest rise and fall is bilateral, -this is all done by observing.

It strikes me she is doing exactly what I would expect her to do, what we are all trained to do and what I would have done.

It's also exactly what wasn't done in the case of the baby incorrectly intubated.
The Doctor relied on the monitor instead of checking the baby and the baby died.

I think her defence team have let her down and I think expert juries should be mandatory.

Absolutely. Doctors are not aware of nursing practices and can misinterpret things because they don't have nursing knowledge. Nurses aren't just doctors handmaid's, they have their own education, knowledge base, practices and culture.

The doctors on the unit sound awful to be honest. Are they being tried for the deaths their negligence caused?

That is a very, very good post.

I've just listened to what @lawnseed posted and what struck me is how so many things could get twisted and turned against someone.

Such a big thing was made of the shredder. I bought one once. Turned out it was a real faff to use, you could only shred 1 sheet at a time and the tub would be full after 3 or 4 and need emptying. Ended up never using it. I may have got rid of it, it may be shoved in a cupboard somewhere. I just don't know.

Taking notes home, I change handbags a lot (they're a weakness of mine). I've gone to use a bag and found work notes in there. Which I've then sometimes shoved elsewhere to deal with at some random point. I too have a lot of paperwork I don't need around the house. The more you have, the bigger job it is to sort through it all and you just put it off.

Equally having to take stuff home to write up the next day, has happened a lot in my job. I might then shove the notes back in my bag without thinking. I do also still have documents from my training days.

People can appear professional and competent at work (I do). But not be on top of things at home (I'm certainly not!).

If the police arrested me this very second, I can immediately think of half a dozen things that might look "odd" in my home if the goal was to make me look bad.

Heh, go through my flat and my storage unit you would be convinced I was a serial killer or one in the making. You could find "evidence" of Satanism, for a start, never mind the taxidermy and bone collection. My bad for being a "lifestyle Goth". My tarot cards might suggest I'm prone to irrational and Magickal thinking - bonus points as my deck is part of a collaborative effort with Aleister Crowley.

I'm slightly over invested in keeping my nearest and dearest alive, safe and happy to be honest - but would a profile based on my environment and interests suggest otherwise?

I’m a bit of a goth too, so I’ve no doubt the Daily Mail would have a field day with photos of my house if I was accused of something like this. There’s a cast of a human skull sitting on my desk right now 😬

“It's also exactly what wasn't done in the case of the baby incorrectly intubated.
The Doctor relied on the monitor instead of checking the baby and the baby died.”

Quite! Dr Harkness directly caused the death of one baby in this way and left another permanently disabled. He also left it far far too long before ordering a transfusion for Baby E. Imagine if there had been anything as direct in relation to Letby. Nobody accused Harkness of murder. The doctors weren’t even included on the infamous staff rota.

(I don’t think Harkness is a murderer by the way. I’m just pointing out the wild double standards).

“It matters if an innocent person is convicted on dubious evidence. It matters because the truth matters. It matters because while no system is perfect, when issues are identified we have to try and address them. It matters that we have trust in the institutions that have such great control and influence in our lives, and that they are seen to be as fair and transparent as possible.”

That’s exactly the point and very well put. I would not want to be a nurse if the wobbly evidence used to secure this conviction remains unchallenged. We cannot have a situation where innocent people can be locked away for life because procedure is valued more than justice. That’s something that affects all of us.

This is the thing - "profiling" is an inexact science. Someone in a previous post on one of the two Lucy Letby threads said something, I think, that it has largely been debunked as pseudoscience. But the study and analysis on human behaviour has been going on forever. We wouldn't have "nudge" units employed by the government to help inform public policy if it didn't have merit in official eyes.

Another comment that made me stop and think was someone referring to "watching too many crime dramas" which may be influencing their thinking and expectations around the legal system.

Which is why it's good to have the perspectives of those working in the fields of medicine and law chiming in because we are fed a constant diet of fiction often inspired by real life events that suggests complicated scenarios can be wrapped up in 45 minutes due to the blinding insight of either a singular hero or a dedicated team of them.

While we may be able to distinguish reality from fiction, everything in the world influences everything else in some way, and no-one is immune from that entirely.

Think of simple marketing, it depends on pushing our buttons to part us from our money, often dressed up as "helping us" or "solving problems" - some of which we don't realise are problems until we see an advert or several news articles etc - and our exposure to media is so great that even if you try to actively avoid it, it's there in every Internet search.

I find it fascinating and slightly terrifying at the same time.

I think this is why the medical evidence in Lucy Letbys case should be officially investigated as a matter of priority and in isolation from the other aspects of the case. Of course we're now in a situation where most experts are aware of the case and are essentially compromised to a degree. Is complete impartiality ever truly possible?

I think the closest we have to that point is the original post mortem results. Even though the evidence of murder was there in plain sight, it wasn't picked up on and therefore it should be investigated why not.

Regarding the evidence of murder being in "plain sight" I missed out the word allegedly, just to be clear of my argument.

Yes, I've actually kept notes before in order to prove I've done something at the time
I would have thought that what was deemed non standard practice was not the taking a few note pages found in different places but the sheer number of pages, found organised, in one place, hidden, and moved as such through a house move.

Yes, I agree that this is more than just taking a few home in your bag and as such it does need proper explanation.
I find the trophies theory far fetched but what she did is still extreme.

Yes, I agree the note storage was excessive, but that still doesn't mean it makes someone a serial killer.

Only a very small number of the documents that were found in her house related to children she was convicted of harming though. And not all of the children either, only about half iirc.

I do agree think that at the very least she was overinvested in her job and the families.

Just been doing a quick Google on the subject and the arguments are very much that holding onto the handover sheets in such a quantity is a huge no no from a data protection perspective at the very least, then it all escalates into "trophies".

I really don't know what to make of this as evidence as such tbh. Logic dictates that if she knew she was under suspicion and was interviewed by police what 3 ? times at least, holding onto such damning evidence doesn't really fit with her characterisation of being calculating. Either there is genuinely nothing of note about them in themselves, so why should she even think about them or she's a bit thick or what? We're back to pretty much anything being interpreted as sinister in the light of her charges and subsequent convictions.

I keep seeing references to 4000 cases being investigated right back to the beginning of her nursing career and honestly it really doesn't bear thinking about if she is guilty nor if she is innocent. It's making me feel really nauseous to be honest.

https://www.theguardian.com/uk-news/article/2024/jul/15/the-lucy-letby-trial-and-the-limits-of-expert-opinion

This has just been posted on the AIBU thread.

Of special note - the "whoosh" test.....

The more even cursory googling I do using terms from the medical evidence the more I turn up suggesting that pretty much all the episodes that Lucy Letby is accused of nefarious involvement in, could have a natural explanation. I'm not talking about anything with a reference to the case, I'm talking journals and papers in medical publications from years prioe or since.

The prosecutions claim is that these babies were otherwise stable and doing well, but their histories were replete with crises. Prematurity, needing ventilation, possible infections etc. All in an environment where while it is standard to avoid unnecessary procedures by definition they needed far more intervention than a full term healthy baby, and every intervention elevates risk factors.

Simple things like getting an idea of size and scale of both premature babies and the equipment and procedures likely going on in the unit is very enlightening.

I recently re-read the Sky news article regarding the baby with the "unexplained" bleeding from the court reporting. Contradictory doesn't begin to cover it.