Lucy Letby thread

[Words]

Starting this as don’t think we have a new one.

The pharmacist explained that the stock bags in the unit's fridge would be unmodified ones: "we would not manipulate those bags, they are just off the shelf from the manufacturer, sent to the neonatal unit, and placed into the fridge". Fuller transcript, from https://www.reddit.com/r/LucyLetbyTrials/comments/1tf8mjl/crossexamination_and_judges_questions_of_mr_ian/ :

IA: So they would have a stock level on the neonatal unit of a certain amount of bags. As they became low, because they've been used up, they would request some from the pharmacy and we would send them more as stock. So we would not manipulate those bags, they are just off the shelf from the manufacturer, sent to the neonatal unit, and placed into the fridge.
Mr Justice Goss: You just store them until they request them basically?
IA: Yes, we are simply kind of an intermediary: we receive them from the manufacturer, we have a big fridge to store them in, the bulk of the stock. Then we send them up in small amounts to the smaller fridge in the neonatal unit.

And the in-court demo says that to add anything to the bag, you first remove "a tamper-evident safety cap which is made of preformed plastic which you snap away":

(Video playing continued)
SD: Pausing there. So the narrator said she was removing the safety cap from which port?
IA: The additive port. So the additive port is a tamper-evident safety cap which is made of preformed plastic which you snap away. That then allows the person to add additions to the bag via that port.
SD: So the safety cap having been snapped away, what lies below?
IA: It is a bung or a septum, which you can insert a needle through. Once you push the needle through you can add to the bag, but then as you pull off that bung will self-seal over so the bag doesn't leak and the container is again closed.
SD: So that central port is the additive port?
IA: That's correct.

So if you snap it away while the bag is still in its cellophane wrap, won't the snapped-away cap still be rattling freely inside the cellophane wrap, and fall to the floor when the cellophane wrap is removed? Won't the nurse hanging the bag notice that, or the fact that the tamper-evident safety cap (which she is used to seeing on bags) is not on the port?

I just don't understand how the basic mechanics of this could even theoretically work.

Yes so she probably did bin it. But even if Letby didn't hang around after her shift to fish it out the bin-why did she have it?

She had it because she had written some figures on it, which, presumably, is why it wasn't placed on the bin. Presumably she asked or grabbed for something to scribble on. (I was pretty disturbed, when I was in hospital at a few months ago, at how many nurses and other bedside staff wrote notes on their hands while dealing with me. I'd rather they'd grabbed some scrap paper!)

My understanding is that they’ve never been able to say where Letby was able to get the insulin from (that she supposedly injected into a tiny diameter tube with nobody ever seeing her do it, multiple times). The hospital audits of insulin stocks didn’t find any unexplained shortages.

That’s before you get into the science of whether the insulin levels could ‘only’ be explained by tampering / deliberate injections and/or whether the measurements (of abnormally high insulin) were in any way accurate.

I agree with a PP’s comment up thread that in one breath Letby is alleged to be the most sophisticated and smart serial killer ever, whilst in the next would have to be the dumbest / most naive ever recorded.

Even Fred West (semi literate, with an IQ circling the drain) was better at covering his tracks than Letby apparently was. That can’t all have been down to Rose, either.

So if you snap it away while the bag is still in its cellophane wrap, won't the snapped-away cap still be rattling freely inside the cellophane wrap, and fall to the floor when the cellophane wrap is removed? Won't the nurse hanging the bag notice that, or the fact that the tamper-evident safety cap (which she is used to seeing on bags) is not on the port?

Basically, yes. But the snap-off bit is quite small - from memory, maybe 10mm in length and 3mm diameter, and translucent white - so it could possibly have been missed. Its absence should have been noted, though, when the nurse inspected the bag for leaks before hanging it.

I agree, the question of insulin availability has never been explained. But I do not believe there has been an “audit” of the insulin, because all there would be is records of issue or dispensing of multi-dose vials by pharmacy, and records of administration of individual doses on the ward. There is (or would not have then been) any record of disposal of part used vials, or the quantity left in them.

So it’s possible for a small amount to have been removed, possibly from more than one vial, and not noticed.

However… I have not been able to find anywhere how much insulin would have had to have been in the bags to cause the elevated levels (adjusted for adsorption onto the bag material), so we don’t know how much insulin would have had to have been taken. I have seen it said that there would need to have been several mL per bag, which seems… unachievable.

Also, the preservative in insulin smells. When someone has been handling insulin there’s a characteristic transient whiff, which makes the whole theft-from-a-not-very-secluded fridge enterprise tricky.

On another note, you say: “…she supposedly injected into a tiny diameter tube with nobody ever seeing her do it, multiple times”. I’ve heard this phrase used several times before, here and elsewhere, and I don’t know what it refers to despite knowing exactly what these bags look (and feel) like, how they are made and how they are administered. Could you explain what this refers to please?

For the avoidance of doubt, I think evidence for the deaths and collapses being murders and deliberate harm have not been established, and that this is most likely a MoJ, but “our” talking points need to be accurate even if the pro-conviction side’s aren’t 🙂.

These are fair points. There is a little discussion of applying engineering principles to the insulin quantities on the BBCs 2024 File on Four on this topic, but it's not a straightforward account of the numbers involved.. And, as you say, we don't know how much insulin was used, only a possible upper limit. For me the main point of this discussion is that it exposes the prosecution's use of guesswork instead of scientific principles:

SHANNON: There are a number of areas of the insulin cases which require mathematics. Now, one of the areas is how much insulin would be required in order
to achieve an insulin dosage in the bodies of these tiny neonates. On the hypothesis that the insulin level was accurate and the insulin level was due to exogenous insulin, we thought,well, let’s just apply engineering principles and see how our results compare.
HEGARTY: For Baby F, their model suggested that Letby would have needed much more insulin than the prosecution claimed
SHANNON: The range of answers that we get vary from about five times the amount to about twenty times the amount. There is huge variability. But that is more typical than not for these types of calculations.
HEGARTY: For the second baby - Baby L - the prosecution said only 1% of a vial of insulin would have been needed.
SHANNON: The calculations performed by Geoff and myself ranged from 20% to 80% of a vial.
HEGARTY: That’s quite different to 1%. So twenty times or eighty times the amount that the prosecution’s expert witness said in court was needed.
SHANNON: Compared with 1%, yes, indeed. Yes.

https://downloads.bbc.co.uk/rmhttp/fileon4/01_10_2024_Lucy_Letby.pdf page 18

I suppose the port had a relatively small diameter but I have usually seen the concerns around injecting into a tiny diameter tube with reference to the theory of air in the nasogastric tube.

As well as insulin having a scent, I've seen the suggestion that the variety used in Chester would have tinged the contents of the bag yellow. I have no idea whether this is true. You'd think it could be checked fairly easily

I suppose it is never possible to rule such carelessness out absolutely, but it's also worth noting that the prosecution didn't argue that this happened. They were keen to present the ward as efficient and well functioning, so this kind of speculation wouldn't have done them many favours.

It's also a very different proposition to ask the jury to accept, rather than telling them the demonstration they have seen covers the eventualities. So it does look to me as if the jury was misled on this point, and perhaps with significant consequences

I’d really like to see these calculations set out. I presume they include insulin adsorption and the fact that the insulin would have been diluted and infused over a long period of time. Maybe all this has been fully modelled and tested and we’ll get to know eventually.

I think you’re probably right that the NG tube - or maybe even the long line - are what have been referred to as to as tiny diameter tubes. Certainly injecting air of any significant volume into them would have taken some time and couldn’t have been done instantaneously. The bag ports are small, but I would not describe them as having a tiny diameter - they are specifically there to permit injection of additions to the bags.

I have also seen the claim about insulin colouring the PN, but it wasn’t explained. The amino acid component of PN is yellowish anyway, so this doesn’t seem relevant. I’ll have a dig about.

The thing that really undermines the TPN insulin stuff for me is the second bag theory. Tampering with one bag - ok, mildly plausible. Given that these bags weren't individually allocated to specific infants as I recall, it's an incredibly hit and miss method - if the second bag had gone to a different baby, and the same symptoms etc were observed, it surely would have raised suspicions at the time. At the risk of "statistical thinking" accusations, a sudden outbreak of symptoms associated with insulin poisoning over multiple babies would surely cause suspicion and alarm - it still wouldn't rule out accidental contamination or mistake down the line.

I really think this is the most "twisted to fit" theory you could possibly come up with. They needed to explain why the symptoms continued over a period of time, even after Lucy Letby had gone off shift. What I don't get is how it all meets the evidence standards as it is just a theory. It almost has dependence on psychic vibes. No bags to examine, no clear data on cause and effect via the proposed method, no missing insulin, no witness to tampering. All there was was anomalous test results, and of course Lucy Letby was there. I keep harping on about it, but it's the definition of reasonable doubt. I don't think unchecked and unverified test results that come to light well after an event like this even fully merit the "circumstantial" label.

Same goes for the liver damage.

A proficient psychopathic serial killer, we are given to believe, takes delight in their accomplishments, and believes they are superior to investigators, so how would such a character be able to resist letting something slip about how they did it, in the quest to one up the investigators? Rather than just sitting there going "if you say so, but it wasn't me". And looking like a very weary bunny in the headlights.

Following as I found another article on her the other day.

Thanks, good to have input from someone with domain knowledge.

it could possibly have been missed

But could Letby have reasonably expected that it will be?

The pharmacist described it as "tamper-evident". That seems to be the definition of "hard to miss if it's been tampered with"?

Its absence should have been noted, though, when the nurse inspected the bag for leaks before hanging it

If failure to inspect was rare, it's unlikely that it occurred on a given occasion.
If failure to inspect was common, that would be an unusually large disregard of safety rules. It would be generally known, and there'd be testimony about it (like there was about consultants doing rounds 2x/week instead of 2x/day); it would also be one of the things fixed in the overhaul they did when they downgraded the unit. So it's hard to accept that it was common without any of that.

@Firefly1987

when I think if you look at the other stuff and actually properly consider it you might actually come to another conclusion. If she IS a killer then all the stuff she did makes sense doesn't it?

I think we all have considered it and we didn't reach another conclusion. I personally wouldn't be comfortable even locking someone up for a year based on that level of evidence, let alone locking someone up for their whole life cos 'all the stuff' she did could easily have been said or done by an innocent person.

I always thought it was interesting how they tried to make out no insulin had been ordered for any baby on the ward at the time of the alleged poisoning of baby F. Baby E had been on it the entire time hadn't he? and had died the day before.
Can anyone clarify what was the last date that baby E received insulin? I can look it up myself if not, perhaps it is clearer in some of the transcripts that are out now, I just remember from the Chester standard that a nurse agreed it had been a 'feature' of baby Es treatment when Myers asked.

I also think it was very interesting how Judge Goss made them clarify that they meant no baby was being prescribed it on the 4th and 5th of August, and not just no baby had been prescribed it the entire time baby F was there.

It doesn't seem like Judge Goss normally cared if the prosecution were ever saying anything potentially misleading so to me it was very interesting that he did force clarification on that point.

The snap off bit is tamper-evident because it can’t be reattached.

The bags that I think will have been being used around that time have the tamper evident replacement cap (the one that the pharmacist showed wasn’t really tamper evident) on a little short plastic strap so they are ready to be used (think children’s gloves on a string).

So theoretically someone could snap off the t/e cap, inject through the wrapper and into the bag, then put the replacement cap over where the snap off cap had been. For the pharmacy-made bags they would have to use a different approach and wrestle off the not-very-tamper-evident replacement cap, inject, and then replace it all without tearing the wrapper.

Could they do all this without drawing attention to themselves and tearing the wrapper? I don’t think so.

Bear in mind too that nurses going to the fridge for a stock bag would surely avoid a bag that looked as if the pharmacy had added something to it, which is the only reason the replacement cap would be on. That would be more alarming, if anything, than a replacement cap that appeared to have worked its way loose on a prescription bag.

Well you would hope so, but I don’t expect the nurses know how the bags are made, so don’t really have the condition of the additive port on their radar. They (assuming the bags are the ones I think they are) look fairly similar with the cap or replacement cap in place.

It’s just the whole idea of doing it that seems so far fetched, convoluted and risky.

I agree. It’s the incredibly high level of convolution, the amount of time and inconsistency of methods that gets me. Surely she would find a single easy method and use that.

On top of that, why didn’t she betray herself during the police interviews? A killer either knows the game is up, or enjoys taunting them that they’ll never find out.

Well of course some people think she did by asking things like did they have the TPN bags even though that's a perfectly normal question to ask, and I'd imagine most would ask it.

Of course the police acted like they were complete simpletons in the netflix documentary saying that Letby could answer some things easily (procedural knowledge) while sometimes she couldn't remember particular incidents and that was highly suspicious apparently...

Highly suspicious?? 🤔Was it their first day? Have they had no training? Have they learned nothing about memory?

That's worth considering, though of course it only accounts for the stock bags at most (and the more complicated consideration for them was which baby they'd end up with).

I haven't seen anything so detailed about the possibility of poisoning 5 dextrose bags for baby L. I don't know if the court ever looked at that.

The new book is getting torn to absolute shreds on the LL reddit. And I see any comments criticising the book are being swiftly removed on youtube (and he invited only the Letby army to his book launch) if that's the quality you get after someone has read everything about this case over nearly 3 years and the book is that much of a disaster it says it all.

@Oftenaddled you should give writing a book on her a go you might have more luck.

Thank you!

I find the book pretty useful, but it helps that I know the case well already because it does jump right in. I've certainly seen some typos and some text that appeared in two different places. I think I've only picked up on three significant errors though - one a bit of loose phrasing, one a typo, one that looks like a confusion between two terms. It's about a 7/10 for me.

The amazon reviews seem pretty favourable, which is probably a better guide than either the restricted subreddit or the author's own YouTube channel. The book isn't as polished as Moritz and Coffey's. In general it relies on authority so if for example readers don't think Shoo Lee's opinion matters, they're not going to be convinced.

I think the author's real selling point is that he has done so many interviews with people like Jane Hutton and Mike Hall. It reflects the development of the case though - he has more from people involved before Lee's press conference than afterwards.

I don't know if I would have written a better book but I do know I haven't done anything like that amount of original research. And I suppose it's not that likely I'd have the courage to put myself out there with it. It's so much easier on these anonymous sites. I don't think the book's perfect but I do think it's an achievement and pretty useful.

tamper evident replacement cap (the one that the pharmacist showed wasn’t really tamper evident) on a little short plastic strap so they are ready to be used (think children’s gloves on a string)

Wouldn’t the absence of the normally-present replacement cap on a short strap be noticeable? People who have seen something many times tend to notice when something is different.

Very good point.

You'd also hope they'd have been taught what signs of tampering to look for in different bags, though I accept they may not have been.

@Oftenaddled apparently he kept calling baby A a girl, if he can't get such basics as that right what hope can you have for the rest of the book?

They also seem to think he took half the stuff in his book from the other reddit sub. And lack of sources and editing. He's not a writer he's just got a thing for Lucy Letby as far as I can tell.

No one on the side of her guilt is really going to buy it realistically-except to just point out all the errors for the rest of us. So all the reviews come from completely biased people, some of whom don't appear to have even read it before rating!

I don't know if I would have written a better book but I do know I haven't done anything like that amount of original research. And I suppose it's not that likely I'd have the courage to put myself out there with it. It's so much easier on these anonymous sites. I don't think the book's perfect but I do think it's an achievement and pretty useful.

I don't think you could do worse. You obviously know a hell of a lot about this case. Problem is getting the interviews with experts but then they all seem quite willing to speak out (then again I have no idea what kind of connections Chris Morris has) noticeably he didn't interview anyone who thought she was guilty(!) if you wrote a book that was at least an attempt to be balanced-I'd buy it!