Thirlwall Inquiry/Lucy Letby

[PrettyFlyforaMaiTai]

Is anyone following? There have been so astonishing revelations about how Letby was able to harm/murder babies for so long without being stopped.

Some interesting details so far:

• They have discovered through an audit that whilst on placements in Liverpool Women’s Hospital (Oct-Dec 12/Jan-Feb 15) dislodgement of endotracheal tubes occurred in 40% of shifts she worked. Usually it is found in less than 1% of shifts
• The Doctor she was allegedly involved with took her on supervised visits to Alder Hey Children’s Hospital during investigation
• She returned to the Unit at least once during the investigation (Feb 2017)
• Junior Doctors referred to her as Nurse Death at the time
• Letby sent an email to all staff on the neonatal unit saying she had been exonerated from accusations from medical staff. However, no one involved emailed to correct her that she hadn’t even been investigated yet, never mind exonerated
• Doctors who continued with their concerns were threatened with disciplinary action and were made to understand that mediation was compulsory. When one Doctor stated he felt uncomfortable the mediator stated that it was actually voluntary

40% does not equal 40 times more likely 🙄.

if the statistics were presented in a meaningful way then I would look at it. As it’s been said 1% (of what? Babies per day? Babies that have tubes for how many days?) there is not enough info to even use this data. It’s rubbish. My issue is the way the stats are being used.

People have said that she is innocent, have called this the worst miscarriage of justice in history, have accused people of lacking empathy towards her.

I imagine she didn’t destroy the notes because she is so arrogant that she thought she was untouchable.

And of course she’s mentally ill, she’s a psychopath. I mean no-one who murders someone is mentally normal.

I have no doubt this issue will be revisited at some point over the next few months of the enquiry and I expect there will be more details for the Save LL statisticians to chew on and spit out. How many more times likely was it then? Maths is admittedly not my strong point though I’m pretty sure an increase from 1% to 40% is a pretty notable increase in likelihood.

Depends how many babies were intubated on the ward and how frequent extubations were per infant on that hospital.

Even after that, some babies extubate more often than others, and more as time goes on, so a nurse on placement would only have to coincide with one of them to get an above average reading.

So yes I hope we will get enough information to put this data in context.

This. And it looks like they might be trying to do the same again with this 1%/40% stat already coming out in the opening statement....

No and for the millionth time she was not convicted based on coincidence. She was convicted based on expert evidence that the babies died unnatural deaths (even if many armchair-medics disagree with their opinions). She was also convicted on the basis of various other evidence, which included being there for every event, hoarding medical notes at home, behaving oddly, falsifying notes, insisting on being in particular rooms with sick babies when assigned elsewhere etc.

I think it's reasonable to assume that she was also likely convicted on the basis of her own testimony on cross-examination. The jury heard her version of events from her own mouth.

Several of the things she said on the stand (most notably, belatedly disputing several agreed facts and conceding previously disputed evidence) torpedoed her own defence, IMO.

Name change for this as it’s incredibly outing.

If you're calling someone Nurse Death in the canteen but not reporting any concerns - you're just taking part in workplace bullying.

Whilst at face that sounds obvious; I have been in an odd situation here where I worked somewhere I and others believed a resident was murdering pigeons. This sounds so odd. And it is an incredible accusation. That at first you do kind of make a joke out of it or quietly jest whilst sounding others out so as not to appear completely insane. It’s partly disbelief, partly protecting yourself, partly testing your own sanity. Basically I can see this happening. 100%. No one just comes out and makes an official or serious accusation of x is killing y without sounding that out informally with anyone else.

But yes aside from the above; I saw the thread last few weeks of people saying she’s innocent. I thought how?!? Why are people saying this?!

Having just watched the channel 5 doc it is even more mind boggling. I am starting to see why some people think she is innocent.

I literally have no idea either way. But considering most of this is based on circumstantial data analysis; it’s really all down to how that data is processed and presented.

I think there a high chance she could get off with this. I don’t know what’s crazier; a serial baby murderer walking free or this being a miscarriage of justice. This whole thing is completely insane.

I can see that. We are all human. But if you're doing this at work and aren't very discreet, you're obviously at risk of being called out for bullying.

But I hope you got justice for the pigeons!

Oh yes I am sure we would have got into a lot of trouble accusing someone of being a pigeon killer! 😭

The outcome was very Letby actually. A few of us had to engineer a part naivety/ deniable yet part ‘we are on to you’ confrontation where we feigned concern about some kind of new terrifying bird flu and that we were sending the next bird we find off to RSPB for testing for confirmation and that they take clusters of dead birds very seriously. Suddenly no more dead birds.

But it could have just been a complete coincidence. Such a bizarre story.

You're wrong.

I worked in ICU for adults for 8 years and ET tubes do not just become 'unlodged'. In an adult, this would be incredibly rare - possibly during log-rolling someone, but highly unlikely.

One of the cardiothoracic units I worked on had paediatric unit attached where tiny babies were looked after post cardiac surgery.

The care taken with such ill tiny babies is extreme - sometimes even the slightest movement could cause a drop in blood pressure/heart rate/ oxygen sats. I'd be totally flabbergasted if even one ET tube became misplaced as number one priority is airway ! The tube is very well secured indeed.

All the utter nonsense on these threads re Lucy L is innocent written by people who know zilch on the topic and presented as The Truth

It's not about statistics - it's about the facts of what happened. You can pick apart numbers and that proves jackshit.

You can't really compare adults with premature infants, though, and the fact that hospitals publish their work on initiatives to try to get the rate down to 1 per 100 ventilation days at NICUs suggests this isn't that rare among these infants.

In no way can you compare an intubated baby with an intubated adult. I say that not only as an ex nurse (did 26 years, some in paeds), but also as a mum who had a tiny very prem baby who was intubated.

It looks like part of the New Yorker article has been redacted. The part about skin discolouration.

By "concerns raised by an English court", they obviously mean they've now read the appeal judgment and revised their claims accordingly.

To be fair to the New Yorker, the appeal judgment wasn't published until 2 July, six weeks after the article was published, so they probably did draft it in good faith based on the best available evidence at the time (e.g. selected court transcripts from the original trial, interview with Dr Lee, etc).

But that doesn't explain why others (especially those in the UK who would have been more aware of the publishing of the judgment and those involved in law/politics professionally) wouldn't read the May New Yorker article alongside the July judgment.

What I find odd is that people in the UK were giving interviews based on the out-of-date information in the article (and stating what it said: that Dr Lee had reviewed the babies' case files when he hadn't, and asserting Dr Lee's claim that air embolism had been diagnosed on the basis of the rashes alone, when the judgment makes it patently clear that the defence was barking up the wrong tree by claiming that) after the judgment had been published. Which means that the people quoting the New Yorker article even where it contradicted what actually happened in court chose to prioritise the findings of a foreign opinion piece over the actual court judgment.

Yes, as well as remembering some events in minute detail whereas others she claimed to have no recollection, even though it was something you’d think someone would remember. Eg with one of the deaths, her colleague said it was LL who raised the alarm. LL claimed not to recall whether she was even in the room when the baby collapsed. She sought to distance herself from events when convenient by claiming not to remember. Other times, where it did matter, she remembered precise times. Oh and some of the babies where she apparently was not around and can’t remember them, she still performs multiple searches of their parents.

The article was revised during the hearing for appeal, not after, so the "English court" can't have raised concerns based on the judgement.

Since Lee was potentially a major player if an appeal had been granted, his evidence was central to that hearing, so I would presume that paragraph was removed in response to possible contempt of court claims.

The removed text doesn't contradict anything in the judgement. It says two things - Lee reviewed information relating to the rashes reported. Lee pointed out that air embolism should not be a diagnosis of exclusion. The appeal judgement didn't dispute the first. It claimed the second was irrelevant because air embolism hadn't been used as a diagnosis of exclusion. That's the position of the court following the first trial. But those who consider that Evans did indeed use embolism as a diagnosis of exclusion (because no evidence specific to air embolism was found, and other causes were more than possible) continue to disagree.

In any case, the New Yorker has not printed anything inaccurate by quoting Lee on what appear to be two undisputed statements of fact. The fact that an appeal court later disputed their relevance is not a sign of bad journalism or anything the New Yorker would seek to cover up. This will have been removed as allegedly particularly prejudicial to proceedings - bear in mind that we still can't access that article on the New Yorker's website.

Anyone who reads the Court of Appeal's judgement will know that there is nothing in it contradicting that paragraph.

That sounds like the way memory works. I remember some work events in detail, some vaguely, some - eight years ago? - presumably not at all.

Facebook searches - the whole unit was aware that there was a review into babies' deaths. Letby was aware by September 2016 that she was accused of causing babies harm. Of course she would be curious enough to try to find out something about the infants concerned

Today we have reports that the same doctor who claimed this summer to have caught Letby "virtually red-handed" attempting to murder a baby in February 2016, told an internal inquiry in September 206 that he had never seen seen anything suspicious, the statistical pattern was the only thing associating her with incidents under investigation, and he was only concerned for her wellbeing.

Dr Jayaram said the “only concern raised about Lucy was she had been exposed to so many deaths” and there was a feeling that “it might be traumatic for her”.

When asked if he heard any suggestion that Lucy had been deliberately harming babies, Dr Jayaram said there was “no objective evidence to suggest that at all”.

He added: “The only association was Lucy’s presence on the unit at the time. Anything else is speculation.”

This is well after her last shift on the ward. His story of what happened with that child also changed between the two trials.

https://www.telegraph.co.uk/news/2024/09/13/doctor-who-helped-convict-letby-no-objective-evidence/

It is hard not to have concerns about the safety of this conviction.

The article was revised during the hearing for appeal, not after, so the "English court" can't have raised concerns based on the judgement.

If that's the case, then I suspect the issue with UK people not having seen the latest version would have likely been because they were looking at archived versions that predated the changes - the version I saw a couple of weeks ago when it became a mainstream news story in the UK certainly didn't reflect these changes.

I don't think the New Yorker is at fault for publishing the story (to the extent they complied with jurisdictional reporting restrictions), but I think that UK professionals probably should have been more mindful of the reporting restrictions when publicising the existence of the 'secret' article, and the effect that would have on the general public in England and Wales. The notion that information was being withheld from us that was common knowledge to the rest of the world obviously made it look like something was awry.

That said, it's possible (but not probable, IMO) that politicians might not have anticipated that (1) the New Yorker article might subsequently be amended and (2) that the UK public would end up accessing the original version via an archive site when raising the issue in parliament, as both of these things would have needed to occur for misinformation to spread the way it did.

However, I think such politicians were wrong to subsequently tour the UK media circuit publicising the existence of of an article subject to English and Welsh court reporting restrictions, as they knew we would either have to take their word for what it said or that we might end up accessing an outdated version.

I also think the redacted portion formed the basis of many of the medical experts who have spoken out in recent weeks, who echoed Dr Lee's now deleted quote:

He also said that air embolism should* never be a diagnosis that a doctor lands on just because other causes of sudden collapse have been ruled out “That would be very wrong—that’s a fundamental mistake of medicine.”*

Sorry - bold fail at the end there, but that whole last paragraph was from the article.

Really? So you can experience a highly traumatic event at work where your patient literally dies but you have no recollection of where exactly you were when it happened? And other colleagues do remember you raising the alarm. Because for example, I remember precisely what I was doing when I heard about Sep 11, 23 years ago. With an event involving a patient death, I’d expect a person to remember what happened years later. Especially a person who remembers whether something less significant happened at 9.30 or 10.30. It’s weird how the not remembering seems quite selective and always when it benefits her to say she doesn’t remember. I don’t think that’s how memory works.

Anyone who reads the Court of Appeal's judgement will know that there is nothing in it contradicting that paragraph.

I think that reading the two versions of the article and the appeal judgment make it quite clear as to why respected medical experts who had only read the original article (and not the judgment) felt that the courts might have erred on this one.

The impression created by Dr Lee's comments (based on the defence's appeal arguments) in the original article was that the court had overlooked an important point, whereas the reality was that it had actually considered that argument in detail during the appeal hearing and had rejected it, for the reasons set out in the judgment.

I do think that air embolism quotation is still relevant and reasonable, though. Because Evans consistently implies that he has excluded other causes, found something "consistent" with air embolism, and then can add non-specific findings that are not essential to the diagnosis (so the diagnosis stands if details of rashes and X-rays are challenged).

Here he is in this week's Private Eye

MD asked Dr Evans two questions: 1. What other causes of death or deterioration did you consider alongside deliberate harm? 2. How did you exclude them?

His responses were:

1. "In relation to the seven deaths, it was possible firstly to exclude natural causes such as haemorrhage, infection or some congenital problem. The unexpected collapses were very unusual -- and consistent with air embolus, air injected into the bloodstream. This was the most likely cause before the radiology evidence was flagged up by Owen Arthurs (air in the great vessels) and the peculiar skin discolouration noted by the local medics. These findings were not essential to the diagnosis but added to the clinical presentation already noted.

"Having made the diagnosis (the injection of air), it could have happened accidentally or intentionally. If it was accidental, the cause would have been easily spotted, as it's normal for two nurses (or a doctor and a nurse) to be present when babies are given fluids or drugs intravenously. Any deterioration would have occurred there and then. There were no reported events of this nature. The collapses occurred when the infants were in Letby's sole care."

1. "I was able to exclude other causes, such as the ones noted above, because there were no other causes. Sorry if that sounds rather odd. But that's clinical practice for you."

There is a lot to pick apart there, but there is no doubt he is treating air embolism as a diagnosis of exclusion, doing exactly what Lee describes.

The Court of Appeal could certainly state, accurately, that the jury did not rely only on one specific and certain factor to determine that there had been death by embolism. But they did rely on Evans's evidence, which does seem to have treated air embolism as a diagnosis of exclusion.

I find Evans's contributions particularly disturbing in this case.

That doesn't matter to the decision to retract information though. Journalists aren't required to update with revised opinions following new developments. And none of the facts Lee offered in that paragraph have been refuted. Retraction would be for legal reasons. Chester Police have contacted people on behalf of the court with such requests during the trials.