Lucy Letby - Specifically those who think she is guilty…

[BEAchDays2]

I’ve just been reading massive amounts of posts of Facebook following the new doc out about LL. (Blame a long train journey!) and it got me thinking, those who still think she is guilty what are your reasons?

It does feel like the tide has turned generally. I haven’t watched the new doc yet, likewise has anyone seen it, and is it worth it?

I see posters have moved on from calling Dr Jayaram a liar and now it's Dr Evans turn.

But how did Dr Evans already know it was air embolism? Based on what symptoms of air embolism? Why should anyone believe he had got the right diagnosis?

He names a handful of issues he has ruled out in the excerpt you quoted. That doesn't amount to ruling out everything in every case - of course it doesn't.

I try to avoid calling anyone a liar in all this. But I do think recollections can be contradicted by a written record. That's not surprising, for Evans, years after the fact.

That link is absolutely damning, surprised the truthers wanted it out there. Thanks though, I was looking for all the non-indictment deaths and collapses and knew I'd seen it before somewhere.

"Truthers" is such a weird insult. What is it supposed to mean?

I find the hummingbird document very interesting (and not at all damning for Lucy Letby). Hope we get verification of its status sometime. At least Thirlwall verified Dr Jayaram's email about baby K is authentic.

@Oftenaddled whatever you want to call them. I was under the impression it was leaked by one of her supporters to make her look good and the consultants look bad but I must be wrong because it's the complete opposite.

RJ - the staffing review has looked at the notes, this has not necessarily been picked up. What has not been looked at, this baby collapsed, who was where, what were you doing at the time. As consultants, it is very rare that consultants were present at time of collapse. At the point of the collapse, the nurse was present at that time in close proximity. This has not happened to other staff. I can speak about one that did collapse, but survived, 27 weeks, was stable had breathing tube down, good ventilation, named nurse (ie nurse assigned to care for baby during that particular shift) had gone out of nursery. I went back in, the baby's oxygen levels had dropped, first thing to do disconnect baby from ventilator and bag. I noticed the breathing tube had been dislodged. The nurse (L) was present at the time.

Same thing he said in court?

RJ - there is perception that we are on campaign, this is not the case. Other (consultants & junior doctors) had come to the same view. It got to the point that when Nurse was on duty we feared something would happen.
RJ - we are not on a witch hunt, we have concerns that this nurse was present in far too many occasion Provided example of baby that was being treated for low blood sugars, very erratic pattern of sugar level which changed with shift pattern no clinical explanation, consulted with Alder Hey, who agreed was unable to explain.
SB - we have looked hard, we can’t find any explanation

I've only had a brief look and it's extremely damning.

"At the point of the collapse, the nurse was present at that time in close proximity. This has not happened to other staff."

That's quite a strong blanket statement to make, implausible on its face (none of the other staff were ever near a collapse?), and impossible to make without reviewing all collapses on the unit, which he doesn't claim to have done. How does he define "in close proximity"? In the trial there was quite a bit of uncertainty about who was where when.

@Dolphin37
I think he may be speaking in general terms, that this kept happening (not just the once) as he then goes on to speak about the one time he saw it happen as an example.

I mean you can split hairs about what he means and how hard proximity is to prove but you can see why he was worried can't you?

Well firstly, I was specifically referring to the splinting the diaphragm with air, overfeeding with milk and poisoning wrapped and tamper evident PN bags ahead of time as “fanciful”. And it seems to me that Evans himself partly agrees with that assessment since he has abandoned the milk/air down NG tube theories himself, post verdict.

But on AE, yes, it’s a fairly simple concept to understand, given a basic understanding of human anatomy and physiology. However, I don’t understand why you think ruling out a small number of conditions (possibly erroneously, but that’s another issue) rules in AE simply on the basis of collapse and inability to be resuscitated. This simply makes no sense to anyone with any medical knowledge. Evans certainly hasn’t been able to justify it scientifically.

In fact other experts have reviewed exactly the same evidence as Evans and have identified other likely causes of death and collapse. I know you don’t like those experts, but they are world renowned experts nonetheless.

And if there are other likely causes this means that there is reasonable doubt of murder, let alone whether Letby committed it.

Same thing he said in court, yes. But not the same thing he said in an email following the incident.

you can see why he was worried can't you?

Sure, but it's a long way from initially thinking you see a pattern, to proving that it's meaningful. In science, people get initial hypotheses all the time that don't pan out. So Jayaram's initial worry doesn't mean much. What would mean something is if a properly blinded review (done as explained by the Royal Statistical Society) proved that Letby's association with collapses was extremely unlikely (much more unlikely than a nurse turning out to be a serial baby killer). Such a review (including selection of records for review) would have to be done by people who have no knowledge of any suspects, so that both the determination of which collapses are suspicious, and the determination of which staff were in proximity, was done in exactly the same way for all staff. The riskiness of each staff member's shifts would need to be estimated from factors like number of babies, their prematurity level, etc. It's clear that nothing close to a proper analysis was done.

@Dolphin37 I don't get this line of thinking at all. Murder is far too serious a subject to have a statistician come in and handwave it all away. They are not doctors or investigators. What if she IS guilty and the statistician says this isn't a spike so she remains on the unit, what then? More babies die, unnecessarily. That is unforgiveable. Maybe statisticians should stick to predicting lottery odds or the risk of being struck by lightning. They can stay out of murder investigations.

Why did they decide to investigate in the first place?
An increase in the number of deaths and collapses from the expected value.

Is there a reason why there might have been more deaths and collapses than the usual value?
A statistician can help you out there.

If you wanted to, you could investigate every death or collapse as if it was deliberate harm. Post mortems are investigations into the cause of death. In most cases they found natural causes - medical reasons why the baby died (undetermined for baby A and no pm done for baby E I think).

If you want to start a police investigation every time the raw numbers go up then it's going to have an impact on whether nurses want to work with the sickest babies. Who wants additional deaths on their record when it might mean going to prison? Better not to volunteer for those night shifts where there's fewer doctors around.

So a few things that stood out to me from the link-https://lucyletbyinnocence.com/leaks/op_hummingbird_leaks.pdf

which oftenaddled thinks isn't the least bit damning to Lucy Letby. Ok then.

Here the consultants are going through their concerns (I'll just post a few)-

SB - of those 9 we reviewed initially, 6/9 collapsed between 000-0400, which was highly unusual. One of the action was to review the period prior and nothing was found (will share these reviewed) that review also noticed a significant number of collapses. SB - following on from that thematic we discussed the nurse (Lucy) but no action taken. I shared the report with IH prior to the COC inspection (Feb) at this time the nurse had been put on day shifts for mentoring reasons

Q: Confirm how many that Nurse has been present?

SB - the nurse was present in all but one of the deaths

Q: if third party involvement would you expect to see the same indicator?

SB - it is relatively easy to manipulate fluid, to administer drugs and or too block an airway

SB - there seems to be a theme with multiple births (triplets & twins) and the more stable infant being the one to collapse
SH - case of Baby [I&S] twins, 1 twin was on CPAP — but baby [I&S] (not needing any respiratory support) was the one that collapsed, from clinical perspective neither were anticipated to collapse but clinically the one on respiratory support was more vulnerable

SB- to put in perspective consultant who joined us from Crewe, he has never experienced anything like this in 5 years as consultant
RJ - we all have concerns, nothing significant changed over the years to explain the deaths e.g. the changes in patient numbers, staffing, do not explain the number of deaths or collapses.

SB - survival rate for babies over 32 is nearly 100%, for 6 of our babies to have died who were over 32 weeks, to die is not right.

There is an association with a member of staff who was present during the majority of instances when the babies unexpectedly deteriorated. When this member of staff was put onto day shifts for 3 months, no sudden collapses occurred during the night. Previous to this change in her work pattern, in 6 out of 9 deaths, the arrests occurred between 0000 and 0400. When this member of staff was no longer working on the unit (July 2016- present), there have been no neonatal deaths on the unit and no unexpected or unexplained sudden deteriorations. This member of staff was present on the unit during the deterioration of the [X] Children who died (Child A, C, D, E, I&S, I&S, Child I, I&S, I&S, Child O and Child P).

The gestation at birth of the babies who died was between 27 weeks and 40 weeks. 6 babies were >32 weeks gestation. The redesignation of the unit from July 2016 (only permitted to care for babies >32 weeks gestation) cannot therefore be the only reason why there have been no deaths or sudden unexplained deteriorations of babies on the unit since July 2016.

Then this from John Gibbs I think-

Initially, we felt Lucy was just unlucky in happening to be involved in more of these infants than other nurses but this association become steadily more worrying especially with recurrent sudden collapses at night that stopped when Lucy was moved off nights and then, on one occasion (only that I'm aware of), when Lucy covered a stable infant during a colleague's coffee break during which that infant unexpectedly collapsed.

Im a paediatric ED consultant in a different country. Ive read it all. She 100% did it.

@Bones101 absolutely. I just don't know what others aren't seeing here...

If you wanted to, you could investigate every death or collapse as if it was deliberate harm. Post mortems are investigations into the cause of death. In most cases they found natural causes - medical reasons why the baby died (undetermined for baby A and no pm done for baby E I think).

You would only need to do it for an unexpected death. If the baby followed a normal path of decline that was to be expected then it wouldn't be necessary.

If you want to start a police investigation every time the raw numbers go up then it's going to have an impact on whether nurses want to work with the sickest babies. Who wants additional deaths on their record when it might mean going to prison? Better not to volunteer for those night shifts where there's fewer doctors around.

But it's not just about the numbers going up is it? It's about the shock nature of the collapses and deaths that made zero sense from a clinical perspective. Take that out the equation and then I might agree with you that you could ask a statistician about the spike in deaths. Do you really think they'd have singled out one nurse if the deaths weren't so unusual? A spike is happening all over the country at some time or another and no one gets singled out for being a murderer because the deaths are explainable.

What is interesting about those claims is how thin they are, and indeed how selective the consultants were, accidentally or not, with the truth.

For example:

The gestation at birth of the babies who died was between 27 weeks and 40 weeks. 6 babies were >32 weeks gestation. The redesignation of the unit from July 2016 (only permitted to care for babies >32 weeks gestation) cannot therefore be the only reason why there have been no deaths or sudden unexplained deteriorations of babies on the unit since July 2016.

Except that the six babies who were >32 weeks gestation included two identical triplets, who wouldn't be born at the redesignated unit and had a heightened risk of perinatal death compared with others of this gestation, baby D, whose mother's complex labour put her at increased risk meant she wouldn't be cared for at the redesignated unit, Epstein's anomaly (kills 30% of affected newborns), Papp-Varadi syndrome (extremely rare and frequently fatal), and a sixth baby with congenital dysplasia.

If any of these last three conditions were picked up in utero, the children would likewise not have been delivered at Chester after the redesignation. Even if they weren't picked up in utero, these children had risk factors which placed their risk of dying well above the average 32 weeker's. So using them to argue either that the unit's death rate among 32 weekers was suspiciously high or that the redesignation couldn't have contributed to the fall in deaths was disingenuous, to put it mildly.

The whole thing is a great example of selecting facts to favour a particular narrative. You can see why the police were convinced there was a problem, but the consultants' narrative doesn't stand up to scrutiny at all.

There's really nothing in the consultants' internal reviews in 2016 to suggest the deaths made no sense from a clinical perspective. In fact, for three of the deaths they reported to the police there, they didn't even request post-mortems. (Nurses insisted on it for the third child in this category). Dr Brearey noted in early 2016 that there was probably no point in reviewing the deaths of babies A, C and D again.

There was no correspondence with the pathologists suggesting the deaths made no sense from a clinical perspective. Every indication is that their concerns came from the number of deaths rather than initially from their nature.

There is no reason why air in nasogastric tube, overfeeding, air embolism could not have happened by accident, so the idea that only a forensic pathologist could have spotted them seems a stretch too.

I’d be interested to know which symptoms point to air embolism rather than, say, thromboembolism, sepsis, or hypoxia e.g. from pneumothorax?

It’s ironic that statistical evidence given by an expert led to a miscarriage of justice in the case of Angela Cannings.

The statistics in this case, such as they were, went nowhere near misleading the jury in my view, and, crucially, in the view of Myers and the rest of the defence team, who did not raise the treatment of the shift table as a ground of appeal at all. It’s almost as if some of the innocence lobby, who make the same tired old points about that shift table, haven’t read the judgment. Surely not…

The shift table never purported to show anything other than the indictment incidents. It was transparent about that. It amazes me that people think the prosecution would have just said ‘look how she was present for all of them, members of the jury’, because of course she was, the prosecutor would have just been laughed at. It showed her presence relative to the presence of all the other nurses, so they can see she was the only one there for all of them and how few or how many the others were present for.

Of course it was open to the defence to point out the limitations of this eg any innocent reasons why she might be present more than the other nurses. As I say, there was not a word in the appeal to the effect that the table should not have gone before the jury or that it was misleading.

This is how I came to the view she is guilty:

What are the different possibilities that led to these deaths?
1- totally random circumstances. This is ALWAYS a possibility. Probability: very low.
2- environment factors - this was investigated and nothing was found. Probability? Low to medium low
3- someone else did it. Probability: low. This was also investigated and there has been no evidence that this could be the case.
4- Poor quality of care. Probability? The highest besides Lucy. However, poor quality of care is sadly very common in the NHS and social care settings. Does it results in higher deaths than expected ? Yes? Does it results in a large number of circumstances that points to one person's involvement? No, it only ever very very rarely does.
5- Lucy is guilty? Probability? Based on all the evidence? Very high

Could 1 to 4 be possible? Yes, but the latter is by far more likely, so that's why, without any certainty, I believe she is guilty.

How are you calculating these probabilities?

Doctors feeling free to speak up about concerns is important, safeguarding measures (such as taking a nurse off shift, moving to other less risky work) is also appropriate, and should have happened. The reason it didn't was understaffing, as far as I can tell.

However proving that a doctor's concerns translate into robust scientific proof of murder is quite another thing. Especially if there is no witness evidence and no murder was found at the original autopsy.

And if you are trying to prove this beyond reasonable doubt in a way that will stand up to scrutiny it seems not a very good idea to simply accept the expert who puts himself forward because he wants to do the job and get the money. It doesn't look like an impartial properly conducted investigation if you do.

I suspect that if you set out to prove one person was guilty of a "not uncommon" spike in deaths, you would often succeed.

The minute you allow yourself tactics like, changing your mind about what symptoms are concerning, disregarding pathologists' findings, declaring that instant causes of death can act minutes or hours later, swapping suspicious incidents in and out, you have your recipe. You have to be extremely rigorous to prove a genuine association, and there is abundant evidence what the prosecution expert witnesses were sloppy and inventive instead.