Lucy Letby not charged with further crimes - what does this say about her current convictions

[mids2019]

So no more charges for Lucy Letby currently.

I can't say I am surprised as the tactics the CPS used the first time to secure convictions wont wash. There have been too many questions about the 'expert' evidence in the first trial and in my opinion the CPS don't want to take the risk of trying again with a more possibly more aware jury.

The police seem to be not too happy and probably thought they had similar evidence as they had initially so were taken aback by the CPS decision. They have had to approach parents to say that their children dies either through medical incompetence or through natural causes. The poor parents will now feel distraught and confused being lef up the garden path and the police maybe telling them Lucy was guilty.

I wonder if this is paving the way for a retrial?

I had assumed that medicine in hospital wards is strictly accounted for through comprehensive audit trails, security protocols, and inventory management systems.

I didn't realise this wasn't the case

COCH carried out an extensive audit after Letby was suspected. No insulin was missing.

I don't know about COCH, but the Trust I used to work in had smart fridges for insulin and other things like that. You had to sign in with your smartcard to open, and it automatically tracked what you took out. I was in IT, not care at this point, so IDK if nurses collected it or if they ordered it and it was then sent to the ward. I do know I had a very frustrating, hour long coversation with a med tech, trying to explain it wasn't working because he had unplugged the ethernet cable to move the fridge, and the new network point he plugged it into was not on the right VNET, and he needed to move it back. No one could get in the fridge because it wasn't on the network. There was no way anyone could have tricked it into opening without a smartcard or network connection.

How could they carry out an audit if it was generally accepted that insulin was kept on the ward and its use not closely monitored or tracked as @rubbishatballet stated

Additionally the insulin cases were not even flagged as suspicious until over a year after they occurred so I can’t see how an ‘extensive audit’ would be in any way meaningful. Particularly as insulin is a non-controlled drug which, according to various witnesses’ testimony, was freely available to all staff on the unit.

So, the insulin evidence is complicated. From what I understand, the prosecution says high levels of glucose and low levels of C-peptide mean that synthetic insulin is the possible explanation, and that only small amounts of insulin would have been needed, which is why there are no discrepancies between how much insulin was ordered by the hospital and how much was recorded as being used.

All medicine used and ordered is recorded in an electronic system, and the data is kept.

Since being allowed to speak out, experts in insulin and preterm babies have said there was no evidence of insulin poisoning. The reasons given are that insulin has a different effect on neonates, and high levels of glucose with low levels of c-peptide are not unsual and there are other explanations than poisoning. Insulin poisoning has other side effects which were not present in the babies alleged to have been poisoned: heart arrhythmia, seizures, and low levels of potassium.

If we ignore all of the other evidence and carry on with the assumption that synthetic insulin was used, it would have taken 6 or 7 vials of insulin to produce the low sugar levels found in the babies, which would have been picked up in an audit.

The absence of evidence in the insulin cases also adds to reasonable doubt. On the one hand, we have Letby, who keeps stashes of compelling evidence under her bed in the midst of a murder investigation, whose internet history goes back years and shows Google searches into the family. On the other hand, we have a nurse who is stealthy enough to delete any internet searches of insulin or insulin poisoning from her search history, who can remove 7 vials of insulin from a locked fridge on a tiny ward without anyone seeing her and can then inject that into a TPN bag, in a room with no privacy, and nurses and parents wandering around, again without anyone seeing her and leaving no noticeable evidence of tampering?

They checked what they'd ordered from the pharmacy when

Since being allowed to speak out, experts in insulin and preterm babies have said there was no evidence of insulin poisoning. The reasons given are that insulin has a different effect on neonates, and high levels of glucose with low levels of c-peptide are not unsual and there are other explanations than poisoning.

I think the assertion that those relative levels of glucose and c-peptide are not unusual is still very much contested by other experts though. Including experts who were not involved with the Letby case.

If we ignore all of the other evidence and carry on with the assumption that synthetic insulin was used, it would have taken 6 or 7 vials of insulin to produce the low sugar levels found in the babies, which would have been picked up in an audit.

Is 6 or 7 vials definitely correct? Do you have a source for this @Frequency?

So not an extensive audit then. How did they account definitively for wastage etc?

Why would a qualified neonatal nurse need to google the effect of insulin overdose on a newborn?

It's referenced in this BBC article and is available in the report by Geoff Chase, which used to be online, but I can't find it right now.

https://www.bbc.co.uk/news/articles/c89l05e97vqo

Chase and Shannon's research is also referenced in Dr Lee's panel's report.

https://jollycontrarian.com/images/d/de/Shoo_Lee_Expert_Panel.pdf

Yes, other experts may dispute it (apart from Dewi et al I've not come across any experts who disagree with Lee's findings), but the point is not that it proves innocence, it's that it raises strong, reasonable doubt.

because planning to murder you'd need to know, so using the internet is a way of searching

I would also imagine that How to Poison Neonates and Not Get Caught 101 is not part of the usual curriculum for nurses.

Do you think nurses remember the dosage, side effects, and half-life of every drug in existance or do you think there is a computerised system that works all of this out for them?

They couldn't - apparently lots of insulin goes unused.

But wastage wouldn't be the point in this case, because the question is whether Lucy Letby would have had access to enough insulin to poison the children. So if you are arguing there could have been less available on the ward than an audit showed, that wouldn't matter. It would only have made the poisoning theory less viable again.

Geoff Chase said himself on one of the Panoramas that experts who thought the insulin/c-peptide ratios were extraordinary weren’t wrong, and agreed that the insulin levels were unusually high. Which contradicted the expert panel’s summary report that said the ratios were within the norm for preterm infants.

I think it is relevant that he is not medically qualified, and therefore has no real-world experience of looking after preterm babies.

I think any nurse could be fairly sure that giving insulin to preterm babies who didn’t need it would at the very least cause some kind of harm and ensuing drama. I mean, I could probably work that out and I’m not a clinician.

I don’t know why we would need to assume Letby was ever looking to be precise about any of this.

Was the wastage logged though? Because otherwise how would they know what was lost to wastage and what was potentially taken by Letby?

That wouldn't matter.

The total delivered includes the total used plus wastage, whatever proportion is used and whatever was wasted.

They looked at the total delivered for what was available to Lucy Letby, because most would expire without being used anyway. Their audit gave vials delivered that year.

No, Chase didn't say that on Panorama, about experts finding the levels extraordinary. Judith Moritz (a BBC journalist with an English literature background) is the one who said that. Reading her work, I've found she really doesn't have a grasp of science, numbers or data, unfortunately.

What Chase said was that describing the insulin results seen for these children as "within the expected range" wasn't the best choice of words, and that "not uncommon" would have been better. When Moritz asked him if it was normal, he explained to her that children this age weren't measured for insulin rates enough to establish a norm.

Probably Panorama isn't the best place to discuss what scientists mean by a norm, and normal etc, but people have certainly come up with wild and unscientific interpretations of Chase's words there.

People have made a big deal of him not being medically qualified. But these children's results have also been scrutinised by neonatologists as part of the reviews given to the CCRC. The doctor who is caring for your child is not the person who designs, conducts or interprets tests - that's where Chase's expertise comes in.

Okay, so was the assessment that there wasn’t enough available to Letby based on the 6-7 vials needed to overdose a preterm baby or a lower amount? I would be interested to read more about the findings of the audit, where have you got your info from?

From a transcript of the programme (JM = Judith Moritz, JG = Prof John Gregory, Paediatric Endocrinologist, GC = Prof Geoff Chase):

JC: For Baby F, the C-peptide is less than 169, the insulin is over 4,500. It says in this report that that is within the expected range for pre-term infants. Is that accurate?
GC: It is not the best word choice, to be direct. We would say the words ‘not uncommon’.
JC: Is it normal?
GC: There is no definition of normal for a pre-term neonate; because nobody measures these infants regularly, nobody knows what normal is.
JM (off): But the experts we've spoken to say the insulin to C-peptide ratio is extraordinary. And the babies’ dangerously low blood sugar levels is further evidence the insulin wasn't natural.
JM (talking to JG): Is there any plausible scenario in which those levels of insulin could have been naturally produced by the baby?
JG: I can't think of any plausible explanation for such high insulin levels. I think finding insulin concentrations of that order in a newborn baby is exceedingly unlikely to have arisen from naturally produced insulin. And the absence of significant C-peptide simply underlines that point.
JC (talking to GC): Pretty much everyone that we ask about this says that that ratio is extraordinary. You say that they're wrong.
GC: No, I’m actually not saying that they're wrong. What I'm saying is that it is possible. I would say that it is unusual, it’s unusually high. It is possible.

So he does say that the other experts are not wrong to say extraordinary.

And whether or not it’s true that ‘nobody measures these infants normally, nobody knows what normal is’, the neonatologists and paediatric endocrinologists who have commented on them (unconnected to the case) seem pretty comfortable about what is normal or otherwise from their own extensive experience.

Okay, I missed that last quotation - apologies.

But there it is. He sums it up exactly in the last sentence:

What I'm saying is that it is possible. I would say that it is unusual, it’s unusually high. It is possible.

Terms like normal, extraordinary etc can't be pinned down without a full dataset. But "unusual" but possible? You don't need the full dataset for that. Chase and Moritz are communicating across a subject specialist divide here.

Science isn't the sum of one's own experience. It's an organised system for collating a full range of experiences.

Individuals talking about what they personally have or haven't seen, especially regarding rarer phenomena, was one of the huge problems with this case.

That's a transcript copied and pasted from Reddit. I'm not sure it is reliable; it's also the exact opposite of what he's said in written interviews and his report. I'm not saying he didn't say that, maybe he did, but if he did, is it what he believes, or is he just not great in interviews where he feels under pressure?

Until we hear otherwise from GC, I'll stick to believing his published research. People are often far better at conveying what they mean in text where they have time to properly consider their answers.

I think it is accurate, but all he is saying at the end of the day is, it's unusual, but that doesn't make it impossible.

He can't say it's normal, abnormal or extraordinary without a fuller data set.

He's just speaking as a scientist. I don't think Panorama was a great place to do that but what he is saying supports Lucy Letby's case.

The prosecution told the court that these results were impossible without poisoning - not that they were unusual or extraordinary.

Even at Chester itself, we know there was one more case like this. That is one of the most significant things about these cases being rejected by the CPS. If that baby was definitely poisoned, why no investigation?