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

Trauma's well known to mess with your memory. How it affects you in particular isn't relevant. Alarms going off happens all the time in NICU so even subsequent trauma won't mean you experience an alarm going off or raising an alarm as traumatic in itself anyway.

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.

Ok, it seems like you're saying that we should accept that there are legal reasons for the retraction that aren't known to the general public but that the people involved who do know all the details obviously know what they're doing, so we should trust the legal process. That seems fair enough.

No, I'm just saying it can't possibly be a result of the appeal judgement (timing), there are no disproved facts there so no grounds for correction, and legal reasons (threat of contempt of court action) would explain it.

The whole article is about how British justice may have slipped up. They've no reason to remove a half paragraph where a source states a fact and a medical opinion even if that didn't fit in with the appeal judgement. The "concerns" would be legal or nothing would have happened. If they had facts to correct, they'd correct them.

There’s a concise and compelling article in the Times today about the evidence against Letby which included a fact I had hitherto been unaware of regarding the contentious chard evidence:

“This piece of evidence has come under criticism from statisticians, who note that the table did not include six other deaths during that period for which Letby was not charged. It has therefore been likened to the statistical illusion known as the “Texas Sharpshooter Fallacy”, an analogy of repeatedly firing a gun at a barn and drawing a ring around the densest group of holes to make it look, misleadingly, as if a target was hit.
However, the table only included cases that were deemed suspicious by the expert witness engaged by the police to look at the case, who was not aware at that point that Letby was a suspect”.

If this level of ignorance is the basis for sending people to prison for the rest of their life then everyone should be terrified.

But thank you for confirming that you have no expertise whatsoever in psychology or neuroscience informing your comments about how memory works.

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?

Yes. That is literally how trauma affects memory. If you knew the first thing about the topics you are holding yourself out as competent to opine on, then you would know that.

It is completely normal to have no recollection of traumatic experiences or periods. It is also completely normal to have patchy memories of recent events, let alone 8 years ago.

Even without trauma, memory is malleable and unreliable. Our memories are reconstructed every time we recall them, which means they change every time we recall them. That is the case for all humans.

There is a huge body of scientific research and evidence on this subject. Clearly you are not familiar with any of it.

I think it was more to do with the fact that she seemed able to remember all the stuff she felt was helpful to her case whilst having serious memory lapses when recalling events might have been more detrimental to her.

Yes that’s what I meant. And I’d expect a nurse to remember a patient collapse. I wouldn’t expect a close family member to remember precise details, as the trauma would be much greater to them and their mind might block it out. But I would expect a staff member to remember a memorable event like that. And Lucy did remember many work events but never the ones where she was being accused of being somewhere she wasn’t supposed to be. It was all extremely self-serving.

Also, her case wasn’t “I can’t remember this stuff because I blocked it out as I was so upset”. It was literally “I don’t remember”. I think not remembering if you were the one who raised the alarm (where others say you were) was particularly odd.

I am enjoying (or finding interesting and thoughtful, perhaps a better description) your contributions here. But I find it difficult to see how you think this quote supports a 'diagnosis of exclusion' finding.

He states the diagnosis was:

1. supported by the features of the collapse, being sudden and unexpected; and
2. supported by radiology evidence; and
3. supported by the skin discolouration noted by local medics.

He also states that the diagnosis
4) must have occurred intentionally; and
5) could not be attributed to any other condition.

You might disagree- and I am sure that many disagree with (3) and (5) in particular. But as the court of appeal found, this is a positive diagnosis, not a diagnosis of exclusion.

To the extent that it could be argued to be a diagnosis of exclusion, so is any ordinary diagnosis, where a doctor begins from the most likely diagnosis and rules out the potential diagnoses to locate the one that fits the set of symptoms and findings the most accurately.

It's the bit where he says the other features 2 and 3 aren't essential to the diagnosis, Yazzi. I would say that he is using a diagnosis of exclusion, since sudden collapse doesn't have only one cause, as he acknowledged, and he claimed to have eliminated the otger options. But it's vaguely expressed despite his confidence, like many of his statements.

But either way, the New Yorker would not need to edit an opinion Lee offered on the diagnosis of air embolism and its pitfalls just because of a court ruling on this case. If they had to follow the court line the article wouldn't exist to start with. So their editing a paragraph is not proof that they have their facts wrong or have changed perspective. It's much more likely to be a legal issue.

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

I haven't read the whole thread so I don't know if anyone has said this already, but I see some medical experts have questioned this, saying that there is extensive scientific literature showing that a dislodgement rate of up to 80% is normal.

Separately, I see BBC File on 4 is going to broadcast interviews with experts who question the medical evidence presented in the trials. If they are right, there are serious questions about this case. However, it will be difficult for Letby to overturn the verdicts even if she is innocent (and I offer no opinion on that either way). The Court of Appeal has improved, but it is still resistant to overturning the verdicts in criminal cases, particularly high profile cases such as this. The Court still seems to believe that maintaining public confidence in the justice system (which they think will be shaken if verdicts are overturned) is more important than ensuring that justice is done.

A further problem Letby faces is seen in the appeal that has already been rejected. There, her lawyers sought to introduce evidence from one of the world's leading experts on air embolism in infants. This expert disagrees with Dr Evans' evidence and does not believe the babies died of air embolism. The Court of Appeal ruled that Letby's lawyers could have called this expert to give evidence at the original trial (notwithstanding the fact they had not had any contact with him at that stage) and therefore this was not new evidence, so was inadmissible. The Court is likely to take the same approach to any of the experts now saying that the evidence presented by the prosecution was wrong.

For me, regardless of Letby's guilt or innocence, this raises real questions about how the courts handle complex expert evidence. Judges and juries are not equipped to handle such evidence, and yet they are expected to decide on it. This has been a long standing problem. We see it in the Post Office Horizon cases where, in those cases where subpostmasters fought Post Office and pleaded not guilty, judges showed a basic lack of understanding of the technology involved, making rulings that any software engineer would tell you were nonsensical. Going back a few decades, we see people convicted of IRA bombings in part on the basis of expert evidence claiming that a test showed they had handled explosives. When evidence emerged showing that the test produced a positive reaction to other substances, the judge wrongly ruled that this was not relevant. I'm not sure what a better approach to such evidence would look like, but I strongly believe we need one.