Lucy Letby - have you changed your mind thread 4

[MistressoftheDarkSide]

With thanks to the original poster @kittybythelighthouse and @Tidalwave for continuing the discussion.

So maybe she poisoned that third baby as well?

I don’t know if that would make a difference in terms of probability though. They didn’t start with the dodgy test results and then move on to having suspicions about those babies’ twins, it was the other way round (and with a long gap inbetween). The test results are concrete - ie whether they are correct or incorrect they tangibly exist and were produced outside of the unit - so either way it still seems probabilistically more complicated that it was these two babies that happened to have those results (with symptoms of severe hypoglycaemia) if they are incorrect.

And then for the third baby there is clearly some dispute about whether the result was naturally occurring (which I believe has been excluded for the other two) or potentially whether she might have harmed that baby too.

If you mean the third that had an assay come bavk with high insulin - the baby was transferred to LWH, further testing was done bevause of the unusual assay and baby Y was diagnosed with hyperinsulinism

But, moving forward, convict peopld on maybes and f’i don’t know how she did it but she was there’.

That’s what I had thought too, but other posters are saying there is some dispute about that and whether it would have caused the test result.

I don’t think that would be a great idea.

Who is saying that?

We're in very murky territory if despite a diagnosis at a different hospital, a hitherto uninvolved baby can be used to tantalise those salivating for fresh charges.

For a start, one would assume competency at this other hospital, and that they wouldn't stick to a diagnosis regardless of change or repeated tests showing different results, which would surely follow if the diagnosis was wrong. The result for that child could have a terrible impact if the diagnosis is wrong.

Equally it's incredibly worrying to think an "expert" would be so wedded to his theories that he would be so dogmatic that the child must be a further victim.

Problem is that it is all pure speculation, and smacks of "here's another baby with odd test results, Lucy Letby was there, even if it's a bona fide condition she must be somehow responsible".

If the case was picked up on during the original time period, or even during / immediately post trial, one has to ask why it took so long to pinpoint, when by then they knew what they were looking for.

Either way, I don't like the fact that it seems the "prosecution happy" are throwing this sort of speculation around when the original convictions are being challenged.

The fact it's being reported on like this strikes me as prejudicial on the legal front at the very least.

Well if Dewi disagrees….

After all, as he has said, to Moritz when she put to him that there were other professionals who disagreed with him ‘That is a question for them. Perhaps they don’t know as much as they think they know.’

There's clearly a lot of stuff to consider but I do think Frayn possibly has a point about the Evans stuff being a bit of a rabbithole/red herring in light of the insulin questions (I appreciate it's hard not to scrutinise his contributions).

From my admittedly limited knowledge of the specifics it seems to me that the big questions to answer are what natural mechanism could be responsible for a baby having insulin levels 40x the norm, and what biological factors specific to newborns would create a bodily state that could normally only be induced with exogenous insulin (in terms of the peptide levels etc)?

https://jollycontrarian.com/index.php?title=Lucy_Letby:_the_insulin_smoking_gun

Don't know if this might be of interest to anyone.

@GingerPower

All very pertinent questions which we are lead to believe have been asked and answered in slam dunk style.

But not really, as the questions of test reliability, volumes of insulin, observed outcomes and method of delivery still remain.

@kkloo said that Dewi Evans disagrees with the hyperinsulinism diagnosis (I am not saying that is their opinion!).

And @Oftenaddled said “The third case is supposed to have had a later diagnosis of congenital hyperinsulinism, but that wouldn't explain a result which allegedly showed exogenous insulin, i.e. poisoning. If that child could have such a result naturally or by lab error, so could others.”

Don’t you think that the prosecution’s star expert witness bring a bit of a rabbit hole might be worrying?

There’s a bigger question. It has two parts

How did the insulin get into two bags completely undetected, past the heat sealed wrapper and the tamper evident seals? And how did insulin get into the second correct bag for baby F when Letby wasn't even on duty?

Anyway, the point is that unless he has worked with these tests for premature neonates specifically, he's not in a position to say whether these test values are extraordinary for premature neonates, regardless of how well he knows the tests. Because he wouldn't know the other data - the insulin and antibody measures for premature infants. Therefore the extent of any testing error would be unclear.

But surely there are reference ranges for these? If he's understands the mechanics behind the tests then presumably he could just cross reference the results.

But you'd expect an Oxford professor of human metabolism to have at least a foundational understanding of a child's metabolism and how it differs from an adults.

I thought there was some doubt around the accuracy of the card swipes being used to determine which staff were on duty? Weren't they mislabelled? Perhaps there were further errors which we're not privy to. It doesn't sound completely out the question.

Ah, I see. There is the supposition that the child was poisoned and also had congenital hyperinsulinism? This seems wildly unlikely.

Or is Evans saying the third child didn’t have congenital hyperinsulinism @kkloo ?

There's a problem with foundational understanding and broad references right across medicine IMO.

Certainly you need a usual baseline for everything, but ultimately every single person's physiology is unique. Sometimes when a person doesn't "fit" the expectations of a condition, or respond to treatment as they should, there's a tendency to be dismissive or defensive in the medical profession.

Because something is rare or unusual, or falls outside what one expects to see, more investigation should be done.

However, sometimes the focus is on the psychology of the patient, or with children their parents / caregivers and becomes a fixation.

It all gets very very complex, but in this case it is notable that Dewi Evans comes from a cadre of medics who are very interested in FII etc.

There are plenty of arguments why doctors shouldn't take everything at face value, but also plenty that suggest even if something seems odd, a two pronged approach should be implemented, to see which has the most coherent results.

Just pointing at "my experience" or "the literature" without acknowledging that weird shit does happen does a grave disservice to patients and medical practice in general.

Where does the card swipe data (a) which was found to be reversed by Cheshire Police and b) it was found that the unit was accessible by at least 1 other door that was a keypad pin entry system rendering the data completely meaningless) relate to insulin magically appearing inside TPN bags that have several tamper evident devices and no one hanging the bags ever noticed that these devices had been tampered with?

The police etc seemed to think this is a minor irrelevant detail that doesn't change a thing.

But then there's that saying - the devil's in the detail.

Bit that always depends on whose detail it is....

Yes - the data for one of the doors was mislabelled in the inital trial so that out/in were the wrong way round I believe. There was also another route in that didn't involve swiping (keypad?) and it was pointed out that two people arriving together wouldn't both necessarily swipe. You'd think that that would make the door swipe data completely useless because surely it means that not only could LL be there when she's not recorded to be but so could anybody else. Apparently not though.

The point with the bags was that they are in a heat sealed wrapper and, while they do have ports for adding things, these are covered with a tamper proof cap. If something is added in the pharmacy, a different tamper proof cap is then put on. It's not normal to add insulin to these bags because insulin "sticks" to the plastic and you wouldn't know exactly what dose you were giving. Poking a random hole in the bag with a needle would make it leak and be obvious. If the tamper proof ports aren't actually tamper proof then we have bigger problems.

Well exactly. And ivd read lots of reports from other NHS workers that people swipe each other in etc all the time. We do at my work, abx if we forget our swipe cards and can be bothered to traverse the corridors of our town hall building to reception were given a generic card, not specific to us (if hope that thing wouod be tighter at a hospital but let’s face it, there was at least one door that operated on a generic pin pad so what is point of having door swipe cards specific to staff snyway?!)

I think one of the most heinous things in this trial was the judge effectively saying if the jury felt theywere sure about some of the charges, they could assume guilt in the others.

It might well be a valid legal mechanism, but surely not in a case like this.

Consensus is that the insulin cases were the foundation of the case, yet there are so many unanswered questions.

Me neither.

The swipe cards are just to keep
unauthorised people out. If you leave, you get your swipe card cancelled. They are not meant to track people.