Lucy Letby

[kkloo]

New thread as the last one has filled up.

There will be experts on here who are as or better qualified than him

Something I think you're still failing to understand is that even if she is guilty the investigation and the case put forward had serious issues. While it may not be possible for there to be a consensus among every expert, it is extremely concerning to have a case where so many experts express doubts on so many aspects of the evidence. That shouldn't happen.

You seem to believe that if there's a retrial then the prosecution will obliterate the defence, I believe that that is highly unlikely, I don't think they'll be able to get together a decent panel of experts for a start, but let's say for arguments sake that that does happen, that's not a loss for the unsafe conviction side, a fair trial with robust and tested evidence is what many people want, regardless of the verdict.

It seems you think it is exceptional police work to profile someone and decide the case is solved, despite not even investigating the other options, like it suggests that they (and you) have some kind of superior intelligence because you didn't need to look at the other things, and managed to catch a murderer because of the likes of the handover sheets. While there may be some cases that a police force would get right with that approach it's highly risky, it risks more miscarriages of justice, and it also risks more guilty people going free because the police and prosecution put an amateur case together that wasn't robust enough and they then missed their one chance to put them away.

The law commission 2011 report regarding expert evidence in criminal proceedings in England and Wales recommended that there be a Statutory reliability test to ensure expert opinion evidence is sufficiently reliable to be admitted in court, but unfortunately they didn't implement that or other recommendations.

I think that regardless of the outcome that due to all of this that police forces and CPS (at least some of them) will be far more careful with cases such as these and that there will be some changes, and that can only be a good thing for the justice system.

Sure, I expect there are plenty. Just a reminder, from the CoA Judgment:

Dr Evans qualified as a medical practitioner in 1971. He trained in paediatrics in Swansea, then in Cardiff and Liverpool. Each phase of that training involved specific training in neonatology and working in a neonatal unit. He was appointed a full-time clinical consultant paediatrician in Swansea in 1980, a position he held until 2009. During the 1980s he
became involved in the development of the newborn services and intensive care services for babies. He was responsible for setting up, supervising and leading a neonatal intensive care service in Swansea from his appointment, developing intensive care services “from scratch.” His experience was, he said, “very much hands-on.” In 1990, in Swansea, the health board built a new children’s department, which included a new neonatal unit which he helped to design. His operational and managerial roles
involved serving as clinical director of paediatrics and neonatology in Swansa between
1992 and 1997, and between 2004 to 2008. In his evidence he said that Swansea was
one of the bigger units in South Wales and it covered the area of the whole of the south
west of Wales over time. He had training in neonatology. When he arrived, there was
no specialist neonatology services at that hospital, and it was just a question of getting on with it. His team had to deal with all the babies in the catchment area. The only babies who were sent elsewhere, were those requiring surgery, who went to Cardiff, or those requiring cardiac care, who went to Bristol. So all of the “tiny babies who required intensive care were under my care and the care of my colleagues in Swansea from 1980 onwards.”

How many peer-reviewed research papers has he authored? Have you looked at the qualifications and experience of the experts worried about the safety of Letby's convictions? (FYI - it is not just Lee and his panel who have spoken out).

No one has claimed they are more qualified than Evans in medicine; what we are saying is that a lot of people who are vastly more qualified and experienced than Evans have questioned the quality of the evidence he gave in court. Due to the sheer number of experts speaking out with concerns, the medical research available that backs up their opinions vs the lack of it backing Evans' and their combined expertise compared to Evans ', we feel more comfortable putting our trust in those experts than we do in Evans and Bohin.

Survival rates for extremely premature babies have almost doubled since Evans retired from clinical practice, and that’s because of advances in neonatal intensive care.

His CV also tells us nothing about his character, we rely on his multitude of inappropriate interviews for that.

Unfortunately, the standard of his evidence fell short of his qualifications. Dr Dimitrova, one of the UK experts who has been instructed by Lucy Letby's defence and examined the files, has stated that the medical reports seem to have written with no sense that they might ever be scrutinised by peers. We know that Evans qualified as a pediatrician and worked in neonatology as well as pediatrics. But how can that justify the kind of logic he uses in an article like this - and his performance in court wasn't free of such rhetoric either
https://www.theguardian.com/uk-news/2024/dec/20/my-kind-of-case-intense-focus-falls-on-lucy-letby-trial-expert-witness

Perhaps Evans approached things more scientifically in his clinical career than at court. But what really suggests to me that he and Bohin were making the facts fit a predetermined conclusion is their lack of action since the trial.

You've discovered a murder method. It involves a mechanism (air in stomach) that affects hundreds of babies in the UK daily - air in the stomach. Fortunately, through your hard work and rare skills, you've worked out how to tell the difference. Which scans show enough air to kill an infant. How much air will kill an infant. What signs do clinicians need to watch for? How do we tell this air from the effects of CPAP? From wind?

And ... crickets. No sign of a publication, a presentation, a letter to the British Medical Journal. No wish to share this important information for their peers to critique. It's almost as if, at some level, they know the science hasn't been tested and won't stand up.

Scientific issues are generally solved with research, experimentation and discussion. They’re not solved in court by non-scientists for obvious reasons.

Whether x is a good treatment for dementia cannot be resolved by barristers and a vote from some random lay people.

Likewise cases of medical murder - in the absence of any supporting forensic or circumstantial evidence - the only people who can determine intentional harm are medics and scientists.

Survival rates for extremely premature babies have almost doubled since Evans retired from clinical practice, and that’s because of advances in neonatal intensive care.

By that logic a clinician of his generation would be expecting more babies to collapse and die from natural causes than one who is still practicing.

And I’m not sure babies have changed a great deal in the last 20 years or so (although no doubt oftenaddled will be along soon to correct me on that).

And I’m not sure babies have changed a great deal in the last 20 years or so (although no doubt oftenaddled will be along soon to correct me on that

What an utterly vacuous comment. On a par with Evans arguing that statisticians don’t work in neonatal intensive care units. Puerile.

And I’m not sure babies have changed a great deal in the last 20 years or so (although no doubt oftenaddled will be along soon to correct me on that).
Maybe not but younger and younger babies are given a chance, so his experience will be with babies born at a higher gestation with different difficulties and outcomes to some of the very prem babies the NICU sees today

Medicine moves rapidly so 20 years is a very big difference in how Dr's work

That comment is pertinent to this discussion if you are suggesting that Dewi Evans’s expertise is nullified as a result of time passed since he last practiced.

No, that isn’t what she’s saying. She is saying that medicine has moved on, what we thought we knew, we don’t and advances have been made.

If someone has worked as a teacher for forty years but not for the last decade and thus has never delivered the most recent curriculum, it doesn’t nullify their experience as a teacher but it does mean that their opinions may be based on things that are no longer relevant.

We’re back to my point that on that basis, a clinician of Evans’s generation would be less surprised to see babies collapsing and dying of natural causes within a unit comparable to the CoCH.

Would you mind just asking me a question, if you'd like me to comment?

@fosterma has answered your question. The babies being treated have changed - smaller, sicker children survive into the first days of life. Older, less healthy women sustain pregnancies. Treatments and equipment have changed. It's not impossible for Dr Evans to have kept abreast of changes but his expertise can't be derived from his career history alone at this stage.

Can you tell me what the things were that Evans got wrong because of outdated knowledge? (Not the insulin cases, because he deferred to the endocrinologist on those)

The real issue is that Evans retired 20 or so years ago, so his direct clinical experience predates 20 years of progress in keeping extremely premature babies alive.

When my DSD was born at 25 weeks, over 30 years ago, most babies born at that gestation died. Nowadays most of them survive but they are in complex, unstable in-between states. It is a different clinical picture from 20+ years ago. He doesn’t have direct hands-on familiarity with today’s borderline-viable survivors.

Extremely premature babies often don’t have the underlying health issues that he would likely have encountered with older premature babies. They are dealing with birth trauma, prematurity itself and the side effects of the treatment they have to keep them alive.

For example, far fewer premature babies now develop retinopathy of prematurity. I worked on a surfactant trial in the 1990s which drastically cut rates of the oxygen-induced blindness that used to be so common. My DSD was born before this and nearly went blind. She has severe myopia now among other issues caused by the treatment, not her condition.

No, I don’t have the expertise to. Others will, though.

I was explaining what the poster meant as you didn’t appear to know the difference between babies changing in twenty years and advances in medical knowledge relating to neonates in twenty years.

😂

I can’t comment on what he got wrong as a result of outdated knowledge. What I can say is his experience would have been with babies nearer term than babies are now. So babies in the NICU in his experience who were stable would be more likely to survive and go home.

Nowadays the really premature babies may look stable but can collapse suddenly because they need much more intensive support for a longer time. And even if they last to 30+ weeks the fact of their prematurity means they are more vulnerable even at a later age because their organ systems are still so immature, not necessarily a sign that something was done to them.

No idea if outdated but he has no knowledge of NG tube feeding

You can flush the NG with air to clear any residue left in tube - before feeding you need to test PH to check the tube is in the stomach, sometime you can't get enough stomach contents up to test. The tube can also settle against the stomach wall, so pushing air down the tube can move it into a better postion.

There were other similar cases on the unit that were not investigated beyond the point at which they realised they couldn’t have pinned it on her. It was at best a failing unit taking babies it wasn’t equipped to care for and at worst negligent.

By that logic a clinician of his generation would be expecting more babies to collapse and die from natural causes than one who is still practicing.

But it’s clear that he wasn’t using that logic at all.

By his own account, he decided the outcome of the investigations - ‘foul play’ before he’d even been hired by the investigators. He prided himself on never ‘losing’ a case. The cases weren’t his to win or lose, he was just supposed to provide an objective medical opinion.

He wasn’t interested in the maternity and birth notes that might have given an alternative explanation for the collapse or death even though there was only 2 days between birth and death for some babies.

It really comes across from his interviews that he just made up his mind that it was murder and tailored the ‘facts’ accordingly.

Nobody can explain exactly why Evans got any point wrong. However:

He missed the significance of Baby I's s maltophilia colonisation, a pathogen which has become much more of a problem at hospitals over the last decade or so, with alerts and descriptions in the literature.

He worked before better testing methods revealed higher than suspected incidence of enterovirus, particularly in infants. Enterovirus is the explanation the expert panel proposes for Band G's deterioration.

He was unaware until after the trial, by his own admission, that there were separate, forensic tests to detect exogenous insulin.

He retired just around the time when there was sweeping revision to guidance for recognizing and treating neonatal sepsis, which would have corroborated, for example, Mike Hall's concerns about Baby O's treatment and could have prompted concerns about Baby I's treatment with broad spectrum antibiotics.

He seems to have been unfamiliar with the respiratory monitors used at Chester, suggesting that they could have been switched off unnoticed when in fact they would show a countdown before restarting. I suspect such monitors were rarer in time.

Not insuperable obstacles with research and investment of energy, but this sort of thing, mixed with the different demographics and treatments others have discussed, mean that a lot of his knowledge and experience from before 2001 would not have been directly transferable.

Out of the 17 babies on the indictments, only five were born earlier than 30 weeks (and two of those five were born at 29 weeks).

Out of the 17 babies on the indictments, only five were born earlier than 30 weeks (and two of those five were born at 29 weeks).

But the treatment for those babies will have changed in 20 years, medicine moves rapidly. Babies that definitely would have died 20 years ago can survive now. His knowledge would be dated