Merged: Concerns over baby killer ignored? / Nurse Lucy Letby killed babies in her care

[Planigale]

Whilst I don't doubt Letby is guilty, I think there are some very interesting aspects to this unique case. Six of the cases had post mortem which found a natural cause, these had to be over turned to present them as unnatural deaths. Contrary to what TV programmes would make you think, post mortem are as dubious as any other process.

however the claims of death by air embolism are novel and somewhat dubious in themselves, they may be correct but the evidence is minimal*. The poorest evidence is the recalled 'mottling' at time of resuscitation. I have been at enough cardiac arrests to know my immediate recall when trying to write up an arrest is vague. Mottled skin is not that unusual in a sick child, would my recall of this years later in one case be reliable? Is mottled skin a real diagnostic feature of air embolism? This is far more debatable than the evidence around shaken baby syndrome.

*I have personal experience of killing by air embolism; many rats and a few rabbits have been killed by me in this way. So I have no doubt this is a rapidly effective and painless way of dispatching small creatures. I have seen one or two adult humans inadvertently die (not at my hands) in this manner.

[FatherLukeduke]

Originally Posted by Vixen

It is not about 'demonizing the administrators'. The average salary of a Hospital Administrator in the UK is £267,000 pa.

No it isn't, that is way out. The head of the entire NHS is on £255K, so that might give you a little context.

As someone else has pointed out there is no such post as "Hospital Administrator" in the UK and I'm not even sure what you are referring to by that title. There is a class of jobs referred to as "admins", however these are among the lowest paid jobs in the NHS. For middle management we have post titles like "General manager" or "Service manager" or "Matron" in nursing. The most senior hospital posts are the CEO, Medical Director (a doctor), Director of Nursing (a nurse), Chief Nurse (a nurse) and then all the usual ones such as Director of HR, Director of Operations etc.

The CEO in the Letby case, Tony Chambers (a former nurse), was on £160k - which is typical for a CEO. The highest paid CEO in the NHS is on a package (including pension contributions) of £295K, but he heads up a one of the biggest hospital groups in Europe with a budget of £1.5 billion and 13,500 employees.

[Vixen]

Originally Posted by Planigale

Whilst I don't doubt Letby is guilty, I think there are some very interesting aspects to this unique case. Six of the cases had post mortem which found a natural cause, these had to be over turned to present them as unnatural deaths. Contrary to what TV programmes would make you think, post mortem are as dubious as any other process.

however the claims of death by air embolism are novel and somewhat dubious in themselves, they may be correct but the evidence is minimal*. The poorest evidence is the recalled 'mottling' at time of resuscitation. I have been at enough cardiac arrests to know my immediate recall when trying to write up an arrest is vague. Mottled skin is not that unusual in a sick child, would my recall of this years later in one case be reliable? Is mottled skin a real diagnostic feature of air embolism? This is far more debatable than the evidence around shaken baby syndrome.

*I have personal experience of killing by air embolism; many rats and a few rabbits have been killed by me in this way. So I have no doubt this is a rapidly effective and painless way of dispatching small creatures. I have seen one or two adult humans inadvertently die (not at my hands) in this manner.

Lucy Letby was first to mention mottling to the police, without any prompting. Mottling is not unusual in babies, especially f they are born post mature but of course, they soon rally to a healthy colour.


With Baby A (who may or may not be Letby's homicide #1) a strange discoloration was noted by the medics. The post mortem showed a line of what looked like air bubbles, parallel to Baby A's spine. the pathologist testified that whilst it was not unusual to see air bubbles in the brain or the heart after, say, a car accident, he had never seen one like that, except in one other case. That other case was...Baby B. The nurse who was on duty with Letby said she noticed the same dramatic discoloration of Baby B's skin as with Baby A and actually said, oh no, not again. The pathologist said the line of bubble seen per X-ray were consistent with but not diagnostic of the introduction of an air embolism. One of the fathers of another baby also mentioned stark mottling before baby's collapse. The line of bubbles appear to follow the line of a feed tube. Baby B had also had the lines end points at the nostrils blocked. The introduction of air, as you say, is very easy for a malevolent practitioner to inflict: it could be by syringe, the IV lines or the naso-gastric tube.

But proving it was Lucy Letby and not just some fluke of coincidence or somebody else, meant that Cheshire police had to be very careful how they investigated (see their documentary Operation Hummingbird) because the CPS and a court jury aren't going to accept a suspect-centric case based on statistics and coincidence. To this end, the detectives assigned each individual case to a separate individual team of detectives to work on, each completely independently and Chinese-Walled from the other teams. The CPS expected proper evidence, not just 'this person was there on each occasion'.

IMV Letby simply utilised whatever nearby weapons she had, whether it be the naso-gastric tubes, the insulin in the fridge, the introduction of potentially lethal air bubbles, which could be via a syringe, tube or an IV line together with the case of overfeeding one neonate with milk so much so its stomach was distended. She went home knowing that by the time the little mite began to collapse she was not around. This is one way she skillfully covered her tracks. To underline her duplicity, she would send text messages claiming to be so sad and having had a **** day, etc., as another cunning subterfuge.

[Vixen]

Originally Posted by FatherLukeduke

No it isn't, that is way out. The head of the entire NHS is on £255K, so that might give you a little context.

As someone else has pointed out there is no such post as "Hospital Administrator" in the UK and I'm not even sure what you are referring to by that title. There is a class of jobs referred to as "admins", however these are among the lowest paid jobs in the NHS. For middle management we have post titles like "General manager" or "Service manager" or "Matron" in nursing. The most senior hospital posts are the CEO, Medical Director (a doctor), Director of Nursing (a nurse), Chief Nurse (a nurse) and then all the usual ones such as Director of HR, Director of Operations etc.

The CEO in the Letby case, Tony Chambers (a former nurse), was on £160k - which is typical for a CEO. The highest paid CEO in the NHS is on a package (including pension contributions) of £295K, but he heads up a one of the biggest hospital groups in Europe with a budget of £1.5 billion and 13,500 employees.

It is sweet of you to point this out. However, the term CEO is quite a recent Americanism. My work colleague wanted to be a Hospital Administrator because her father was one. When I worked at Brompton Hospital, we were all called 'Officers'. For example, I started as a 'Higher Technical Officer'. Sure, all the office staff did administrative type work but their job title then wasn't 'administrator'. It was 'XX Officer'.

Quote:

Hospital Administrator vs. CEO: What Are the Differences?
Learn about the two careers and review some of the similarities and differences between them.


Job Search Insights
Published Oct 5, 2022
A hospital administrator is responsible for the overall management of a hospital, while a CEO oversees the entire operation of a company. Both positions require excellent leadership skills, but there are several key differences between the two. In this article, we compare the job titles of hospital administrator and CEO, and we discuss the skills and experience needed for each role.

What is a Hospital Administrator?
A Hospital Administrator is responsible for the overall management of a hospital or healthcare facility. They develop and implement policies and procedures to ensure that the hospital runs smoothly and efficiently. Hospital Administrators also develop budgets and allocate resources to various departments and projects. They oversee the hiring and training of hospital staff and work with other healthcare professionals to develop and implement patient care plans. Hospital Administrators also work with the Board of Directors to develop long-term strategic plans for the hospital.

https://climbtheladder.com/hospital-...trator-vs-ceo/

Caveat: the above might be American as in the US you can take a degree in it.

--

Apropos of this, it is truly astonishing that whilst nursing and medical staff are regulated and indeed Drs. Brearey and Jayaram tried very hard to get the attention of the 'Director' Ian Harvey and the 'CEO' Tony Chambers, they were able to report the former to the General Medical Council because he was still on their register as an orthopeadic surgeon at the time. The GMC did nothing after four years, so that was in vain. But the point is, the guy at the top, an NHS Director of Health or Whatever is completely unregulated, as are all the leadership management non-medic Trust appointees. Tony Chambers who crossed the line IMV (NB however, I have only heard Brearey and Jayaram's version of events) by not just being incompetent and idiotic - as is the cause of most managerial cockups* - Mr. Chambers appears to have actively and one could say corruptly tried to cover up a potential serious crime scene and danger to neonatal safety - left CoCH shortly after Letby's arrest on an NDA (non-disclosure agreement with usually a handsome settlement) plus £1m to his pension fund and onto other similar posts. He is answerable to no regulatory body at all. At least Alison Kelly was suspended until she is investigated by her nursing body. With his NDA he doesn't have to give any account of himself at all. Just utter a few mealy-mouthed stock phrases of sympathy.

Quote:

The first five murders happened between June and October 2015 and the final two were in June 2016.

It was several months before police were called. Some doctors have claimed that babies’ lives could have been saved if managers had responded to concerns.

Asked if he would like to see regulation of hospital administrators, Dr Brearey told BBC Radio 4’s Today programme: “Absolutely. Because doctors and nurses all have their regulatory bodies that we have to answer to.

“And quite often, we’ll see senior managers who have no apparent accountability for what they do in our trusts, and they move to other trusts, and you worry about their future actions.

Independent



*(and I would put Nursing Director moron Alison Kelly in this category as she said in a recent interview she didn't take any action because 'I wasn't given any information' er, it's your job to information gather _DER.)

[zooterkin]

Letby has applied to appeal her conviction.
https://www.theguardian.com/uk-news/...eal-conviction

[Carrot Flower King]

https://www.theguardian.com/uk-news/...ture-ombudsman

In related news, Rob Behrens, the Health Ombudsman, has finally noticed that there is a problem with NHS managers' behaviour towards those who raise safety concerns and more broadly with whistleblowers.

Where the **** has this wazzock been since - just to pick the year I began working in the NHS - 1984? We've known this was a problem at least since then - my late parents would have suggested it goes back a lot further.

It's no wonder we have protracted issues when the sodding Ombudsman seems to have no grasp on what happens nor for how long.

[Darat]

Originally Posted by zooterkin

Letby has applied to appeal her conviction.
https://www.theguardian.com/uk-news/...eal-conviction

What a bloody useless article, not one word about on what grounds she is appealing. It seems even journalists believe that you can simply appeal if you don't like the verdict.

[Nessie]

All the news about Letby's appeal have yet to say what the appeal we be about.

[Darat]

Originally Posted by Nessie

All the news about Letby's appeal have yet to say what the appeal we be about.

Yet the information has to be there, it's simply lazy and bad reporting not to report the grounds, doesn't need to be more than a couple of sentences. I think it annoys me as folk seem to have a distorted view of what an appeal is.

[Vixen]

Personally, I can't see on what grounds there should be an appeal as the UK press meticulously avoided prejudicing the trial in any way. The judge bent over backwards for the defendant, allowing her to enter the dock in a sealed off court room before allowing everybody else in. It is rare in England for an appeal to be allowed a hearing unless there is some kind of procedural error, such the Judge's summing up to the jury being amiss, or a point of law, which is very specific, or it is to do with sentencing being 'too harsh'.

A tabloid hints that the US crowdfunder re Science in medicine (see earlier in thread) were critical of the statistics used, i.e., the spreadsheet details showing that only Letby was on duty for each of the selected crimes. Whilst indeed this could be seen to be suspect-centric (the halo effect of shoehorning your results to fit your premis) in itself, it was just one small part of the evidence and of course an increase in deaths has to be statistically analysed for the increase to become apparent. It was faulty flagging that failed in alerting hospital chiefs that deaths were abnormally high.

If the defence believed the statistics against Letby were flawed, the trial hearing was the correct time to bring in an expert medical statistician or epidemiologist to challenge them. Even if some parts of the evidence were relatively trivial and subject to disputable motive, the sum of all the evidence has to be looked at as a whole, not piecemeal by piecemeal, rejecting each small part one by one.

Instead Letby and her defence seem to have relied on her claim that she was just a downtrodden nurse victimized for being conscientious by nasty doctors looking to shift blame. It is telling that she really thought she could play the grievance card but maybe she had got away with it for so long with her parents' strong backing and that of the Nursing Chief, the Unit Chief and the NHS Trust Chief (Tony Chambers) that she really believed the jury would sympathize with her 'poor victim' demeanour, clutching her comfort blankets and special treatment. If the defence offered was poor or non-existent that is not grounds for appeal.

Public interest - is a vague term that covers miscarriage of justice or something that is a principle of the constitution that should be clarified by the Supreme Court.


I couldn't see the judge, Justice James Goss put a foot wrong, so I cannot see how Letby could be granted an appeal and certainly not a retrial. Given this first trial lasted nine months that would really be taking the proverbial.

[pipelineaudio]

Wow, "The Cumulative Case for Christ"...right here at the JREF

[catsmate]

Originally Posted by Darat

What a bloody useless article, not one word about on what grounds she is appealing. It seems even journalists believe that you can simply appeal if you don't like the verdict.

Originally Posted by Nessie

All the news about Letby's appeal have yet to say what the appeal we be about.

Doesn't the initial notice of intent to file an appeal merely give notice, without the detailed filing?

[Planigale]

There are legitimate concerns about the case.

Inequality of arms; the police had hundreds of people on the case for years, there are likely tens of thousands of documents. Her lawyer would not have had the resources to properly check the accuracy of the prosecutions case. One prosecution tool for defeating the defence is overwhelming with documents in discovery. The defence may have had very little idea of the case against Letterby until the case was presented by the prosecution.

Expert opinion: the prosecution expert who analysed the cause of death is a paediatrician who has been retired for ten years and functions as an expert for hire. He touted himself to the police at the beginning of the case. He has never worked as a neonatologist. So he is not an expert. (To be fair he avoided claiming to be an expert, but that would have been the way he came over to the jury.) The defence had no expert of their own to challenge the evidence, that may have been because they could not afford one to go through the huge number of documents , or because the case was poisonous and no one wished to be involved, which might be why the prosecution could not get an expert witness. Since in most cases the initial post mortem findings and clinical diagnosis of sepsis had to be re-interpreted there is a serious question about this being done by someone who is not an expert. Indeed the witness had been previously criticised in the evidence given by appeal court judges.

Deaths when Letterby was not present; were these interpreted blindly? Were cases presented to the expert knowing which occurred when Letterby was present and which weren't?

One ground for appeal may be an inadequate defence. Another might be the prosecution's witness. In theory the witnesses act for the court not for the prosecution or the defence. The fact that the witness was a professional witness (being retired from clinical practice, and working solely as a medical witness), who touted his services to the prosecution and being paid over may years by the prosecution could be used to claim he was not truly independent his continued employment was dependent on giving the police the answers they wanted.

[smartcooky]

Originally Posted by Planigale

Deaths when Letterby was not present; were these interpreted blindly? Were cases presented to the expert knowing which occurred when Letterby was present and which weren't?

She wouldn't necessarily need to be present at the time of death to be the cause. One of the two methods she used to murder babies was overdosing them with insulin. She would be able to inject insulin into them, or into an IV (if being used) and be at the other end of the country when the baby died.


In reality, there is little doubt that she did what she was found guilty of... How else can you explain why -

1. The unexpected illnesses (6) and infant deaths (7) started happening shortly after she started working at the children's ICU?

2. She was always on duty when each incident took place?

3. When she was removed from duties in June 2016, the suspicious incidents and deaths stopped?

She was also caught in the act, or shortly after, several times by parents and colleagues.

[Vixen]

Originally Posted by Planigale

There are legitimate concerns about the case.

Inequality of arms; the police had hundreds of people on the case for years, there are likely tens of thousands of documents. Her lawyer would not have had the resources to properly check the accuracy of the prosecutions case. One prosecution tool for defeating the defence is overwhelming with documents in discovery. The defence may have had very little idea of the case against Letterby until the case was presented by the prosecution.

Expert opinion: the prosecution expert who analysed the cause of death is a paediatrician who has been retired for ten years and functions as an expert for hire. He touted himself to the police at the beginning of the case. He has never worked as a neonatologist. So he is not an expert. (To be fair he avoided claiming to be an expert, but that would have been the way he came over to the jury.) The defence had no expert of their own to challenge the evidence, that may have been because they could not afford one to go through the huge number of documents , or because the case was poisonous and no one wished to be involved, which might be why the prosecution could not get an expert witness. Since in most cases the initial post mortem findings and clinical diagnosis of sepsis had to be re-interpreted there is a serious question about this being done by someone who is not an expert. Indeed the witness had been previously criticised in the evidence given by appeal court judges.

Deaths when Letterby was not present; were these interpreted blindly? Were cases presented to the expert knowing which occurred when Letterby was present and which weren't?

One ground for appeal may be an inadequate defence. Another might be the prosecution's witness. In theory the witnesses act for the court not for the prosecution or the defence. The fact that the witness was a professional witness (being retired from clinical practice, and working solely as a medical witness), who touted his services to the prosecution and being paid over may years by the prosecution could be used to claim he was not truly independent his continued employment was dependent on giving the police the answers they wanted.

By court rules, Letby's defence counsel had to be on a par with that of the prosecutor's. Thus we had silks Nick Johnson for the Crown and Ben Myers for the Defence. Myers is a top drawer KC. Has got many of his clients off.

Letby was first arrested 2018 and then twice more. In all that time she could have built up a defence. Before the trial there would have been many Case Management and Directions prehearings. These would include allowing the other party full discovery of the evidence and documents. In addition, it would have been agreed what the 'issues' were. These refer to points of contention. There is no point bringing up issues everybody is in agreement with. Letby was equally allowed to bring her own expert witnesses and to know what the other expert witnesses for the prosecution was going to say. Letby did have expert witnesses but in the event Myers for Letby and her lawyers either decided it was too risky for them to testify and be cross-examined or even that the expert witness agree with the Crown expert witnesses! The other possibility is that Justice James Goss, the judge, refused to allow them on the grounds of irrelevance or trivia. For example, they might have been arguing the obvious (this might be an appeal point) regarding the use of spreadsheet statistics.

With respect to cause of death, had the neonatal unit and the executive management bothered to read the death certificate reports and final toxicology results, it would have found seriously suspicious high levels of synthetic insulin in the blood of at least one of the babies. This was where Dr. Brearey and the Chester Polcie had their 'Eureka Moment' breakthrough.

Dr Dewi Evans is the 'gun for hire', as described scathingly by silk Myers in his summing up. So the jury were quite free to prefer not to accept Dr Evans' testimony. Dr Sandie Bohin, the other expert witness, gave testimony that was utterly bloodchilling, about how incredibly painful the babies' deaths must have been with unnatural screaming. She testified that neonatals just do not scream.

Justice Goss told the jury that the expert witnesses were for the court, not advocates for the prosecution. He directed that they could determine by looking at a pattern, i.e., if they found Letby guilty on one, they could take the view the same applied to others. (This could be a point of appeal.). However, we saw the jury take over 100 days to reach verdicts and they were undecided on six of the charges, so they clearly weighed up each case on their individual merits. The only defence witness called was the plumber, whose testimony wasn't even related to a day when a death or assault took place. Unfortunately, Letby's whole attitude was 'prove it' - 'you can't prove it', believing that the jury would see her as just being picked on to cover the doctors' own backs. After all, she had been the poster girl for the new neonatal unit fundraiser. She knew she had fooled people into thinking she was a kindly nurse who loved babies.

[Vixen]

Originally Posted by smartcooky

She wouldn't necessarily need to be present at the time of death to be the cause. One of the two methods she used to murder babies was overdosing them with insulin. She would be able to inject insulin into them, or into an IV (if being used) and be at the other end of the country when the baby died.


In reality, there is little doubt that she did what she was found guilty of... How else can you explain why -

1. The unexpected illnesses (6) and infant deaths (7) started happening shortly after she started working at the children's ICU?

2. She was always on duty when each incident took place?

3. When she was removed from duties in June 2016, the suspicious incidents and deaths stopped?

She was also caught in the act, or shortly after, several times by parents and colleagues.

Likewise, when she worked nights the deaths/assaults went up. When she worked days, ditto.

[Darat]

Originally Posted by catsmate

Doesn't the initial notice of intent to file an appeal merely give notice, without the detailed filing?

It has to give the legal reason why they will be appealing, does not have to give the entire appeal details.

[smartcooky]

Originally Posted by Vixen

By court rules, Letby's defence counsel had to be on a par with that of the prosecutor's. Thus we had silks Nick Johnson for the Crown and Ben Myers for the Defence. Myers is a top drawer KC. Has got many of his clients off.

Letby was first arrested 2018 and then twice more. In all that time she could have built up a defence. Before the trial there would have been many Case Management and Directions prehearings. These would include allowing the other party full discovery of the evidence and documents. In addition, it would have been agreed what the 'issues' were. These refer to points of contention. There is no point bringing up issues everybody is in agreement with. Letby was equally allowed to bring her own expert witnesses and to know what the other expert witnesses for the prosecution was going to say. Letby did have expert witnesses but in the event Myers for Letby and her lawyers either decided it was too risky for them to testify and be cross-examined or even that the expert witness agree with the Crown expert witnesses! The other possibility is that Justice James Goss, the judge, refused to allow them on the grounds of irrelevance or trivia. For example, they might have been arguing the obvious (this might be an appeal point) regarding the use of spreadsheet statistics.

With respect to cause of death, had the neonatal unit and the executive management bothered to read the death certificate reports and final toxicology results, it would have found seriously suspicious high levels of synthetic insulin in the blood of at least one of the babies. This was where Dr. Brearey and the Chester Polcie had their 'Eureka Moment' breakthrough.

Dr Dewi Evans is the 'gun for hire', as described scathingly by silk Myers in his summing up. So the jury were quite free to prefer not to accept Dr Evans' testimony. Dr Sandie Bohin, the other expert witness, gave testimony that was utterly bloodchilling, about how incredibly painful the babies' deaths must have been with unnatural screaming. She testified that neonatals just do not scream.

Justice Goss told the jury that the expert witnesses were for the court, not advocates for the prosecution. He directed that they could determine by looking at a pattern, i.e., if they found Letby guilty on one, they could take the view the same applied to others. (This could be a point of appeal.). However, we saw the jury take over 100 days to reach verdicts and they were undecided on six of the charges, so they clearly weighed up each case on their individual merits. The only defence witness called was the plumber, whose testimony wasn't even related to a day when a death or assault took place. Unfortunately, Letby's whole attitude was 'prove it' - 'you can't prove it', believing that the jury would see her as just being picked on to cover the doctors' own backs. After all, she had been the poster girl for the new neonatal unit fundraiser. She knew she had fooled people into thinking she was a kindly nurse who loved babies.

Agree. These babies did not die of natural causes, their deaths were caused by human intervention.

- Babies do not get air into their bloodstream unless someone injects them with air.
- Babies do not suffer insulin overdoses unless someone injects them with insulin.
- Babies diaphragms are not crushed unless a person crushes them.

Same for those babies who became very ill but did not die. If Letby didn't do it, then another person must have - a person who was on the same shift as Letby for every one of the deaths and assaults during the period 8 June 2015 to 24 June 2016. The problem with that idea is the ward manager established that no staff member other than Letby was on the shift at the time every death and assault took place.

There is one case that is particularly chilling. The case of Child G on 7 September 2015. The child, a girl, collapsed and did so again on two other occasions in the following three weeks. She was taken to another hospital, but five days after she came back, she collapsed again, 15 minutes after Letby had been feeding her. She survived, but is now severely disabled as a result of what happened to her. The child was witnessed projectile vomiting massively. The doctor said that he could not find a natural cause for the drastic vomiting. Later, at trial, an expert witness doctor concluded that the only viable explanation was that the baby was force fed too much milk down. It was later discovered that Letby had deliberately altered the baby's temperature on her observation chart to make it seem like it was already unwell before it collapsed, and she also falsified the time of the baby's collapse to make it seem like it coincided with when a colleague gave the baby a milk feed.

This shows shew knew exactly what she was doing. Letby must have known she was coming under suspicion, and tried to point the finger at a colleague.

It is not just beyond any reasonable doubt that Letby murdered these babies, it is an absolute cold-blooded certainty!

[Gulliver Foyle]

Originally Posted by smartcooky

She wouldn't necessarily need to be present at the time of death to be the cause. One of the two methods she used to murder babies was overdosing them with insulin. She would be able to inject insulin into them, or into an IV (if being used) and be at the other end of the country when the baby died.


In reality, there is little doubt that she did what she was found guilty of... How else can you explain why -

1. The unexpected illnesses (6) and infant deaths (7) started happening shortly after she started working at the children's ICU?

2. She was always on duty when each incident took place?

3. When she was removed from duties in June 2016, the suspicious incidents and deaths stopped?

She was also caught in the act, or shortly after, several times by parents and colleagues.

1-3) All those things were said about Lucia de Berk for years before it was funally realised that she couldn't have caused the deaths she was convictrd of.

And on your last paragraph, what direct evidence was there in this case. From following it all the evidence was either circumstantial or Roy Meadows level misuse of statistics.

[Planigale]

There are lots of people ascerting things that are simply untrue. I'll try and respond to them in turn.

Pointing out some concerns about the judicial process is not the same as claiming that Letterby is innocent.

[Matthew Best]

Letterby is definitely innocent!

[Planigale]

Originally Posted by smartcooky

She wouldn't necessarily need to be present at the time of death to be the cause. One of the two methods she used to murder babies was overdosing them with insulin. She would be able to inject insulin into them, or into an IV (if being used) and be at the other end of the country when the baby died.


In reality, there is little doubt that she did what she was found guilty of... How else can you explain why -

1. The unexpected illnesses (6) and infant deaths (7) started happening shortly after she started working at the children's ICU?

2. She was always on duty when each incident took place?

3. When she was removed from duties in June 2016, the suspicious incidents and deaths stopped?

She was also caught in the act, or shortly after, several times by parents and colleagues.

This is simply untrue. Intravenous insulin in a neonate would act very quickly; wihin minutes. Indeed almost certainly the psychpathology is Letby wanted to be involved in the excitement of dealing with a suddenly sick child. I don't think she was interested in killing them, she just wanted to make them sick. I suspect she was a sociopath with no empathy who didn't care about whether the children lived or died. Not being present would defeat the whole object of her activities.

Neither of the infants given exogenous insulin died. It is unusual for this type of serial murderer to change technique. It is said that there were two nurses on duty on both occasions Letby and one other. No one observed Letby giving any unauthorised injections and no contaminated syringes etc. were recovered. One criticism of the unit would be that they got back the results showing the babies had been given exogenous insulin and didn't notice them.

[Planigale]

Originally Posted by smartcooky

She wouldn't necessarily need to be present at the time of death to be the cause. One of the two methods she used to murder babies was overdosing them with insulin. She would be able to inject insulin into them, or into an IV (if being used) and be at the other end of the country when the baby died.


In reality, there is little doubt that she did what she was found guilty of... How else can you explain why -

1. The unexpected illnesses (6) and infant deaths (7) started happening shortly after she started working at the children's ICU?

2. She was always on duty when each incident took place?

3. When she was removed from duties in June 2016, the suspicious incidents and deaths stopped?

She was also caught in the act, or shortly after, several times by parents and colleagues.

The problem is that you define the unexpected illnesses and deaths by her presence. Deaths occurred before she started, when she was not on duty, and after she stopped working. A key problem in forensic science is suspect centred interpretation. The question I asked, and an appeal might be asking is whether all deaths on the unit were analysed with the analyser blind to the presence of Letby. If only those deaths when Letby was present were analysed, we cannot conclude whether the only suspicious deaths occurred when Letby was present. Remeber all these deaths including those that had undergone post mortems were initially viewed as natural deaths.

There is no suggestion trhat at the time the parents viewed what Letby was doing as suspicious, they did not raise concerns at the time. One problem is that no one saw Letby in the act. Certainly if you then ask the parents 'we think Letby killed your child did you see anything of concern', then it is not surprising that they subsequntly view actions as being suspicious. But some of what they describe as being suspicious could not have been the acts that killed the child.

Letby stopping working coincide with the unit changing from a level 2 unit (looking after premmy's and non-surgical sick neonates) to a level 1 unit - a SCBU essentially not allowed to look after sick babies. Since the population changed to a much less at risk poulation at the same time that Letby moved it is almost impossible to attribute the drop in deaths to Letby.

https://www.childrenscolorado.org/do...s/nicu-levels/
A US reference but UK definitions are similar.

[Planigale]

Originally Posted by Vixen

By court rules, Letby's defence counsel had to be on a par with that of the prosecutor's. Thus we had silks Nick Johnson for the Crown and Ben Myers for the Defence. Myers is a top drawer KC. Has got many of his clients off.

Letby was first arrested 2018 and then twice more. In all that time she could have built up a defence. Before the trial there would have been many Case Management and Directions prehearings. These would include allowing the other party full discovery of the evidence and documents. In addition, it would have been agreed what the 'issues' were. These refer to points of contention. There is no point bringing up issues everybody is in agreement with. Letby was equally allowed to bring her own expert witnesses and to know what the other expert witnesses for the prosecution was going to say. Letby did have expert witnesses but in the event Myers for Letby and her lawyers either decided it was too risky for them to testify and be cross-examined or even that the expert witness agree with the Crown expert witnesses! The other possibility is that Justice James Goss, the judge, refused to allow them on the grounds of irrelevance or trivia. For example, they might have been arguing the obvious (this might be an appeal point) regarding the use of spreadsheet statistics.

With respect to cause of death, had the neonatal unit and the executive management bothered to read the death certificate reports and final toxicology results, it would have found seriously suspicious high levels of synthetic insulin in the blood of at least one of the babies. This was where Dr. Brearey and the Chester Polcie had their 'Eureka Moment' breakthrough.

Dr Dewi Evans is the 'gun for hire', as described scathingly by silk Myers in his summing up. So the jury were quite free to prefer not to accept Dr Evans' testimony. Dr Sandie Bohin, the other expert witness, gave testimony that was utterly bloodchilling, about how incredibly painful the babies' deaths must have been with unnatural screaming. She testified that neonatals just do not scream.

Justice Goss told the jury that the expert witnesses were for the court, not advocates for the prosecution. He directed that they could determine by looking at a pattern, i.e., if they found Letby guilty on one, they could take the view the same applied to others. (This could be a point of appeal.). However, we saw the jury take over 100 days to reach verdicts and they were undecided on six of the charges, so they clearly weighed up each case on their individual merits. The only defence witness called was the plumber, whose testimony wasn't even related to a day when a death or assault took place. Unfortunately, Letby's whole attitude was 'prove it' - 'you can't prove it', believing that the jury would see her as just being picked on to cover the doctors' own backs. After all, she had been the poster girl for the new neonatal unit fundraiser. She knew she had fooled people into thinking she was a kindly nurse who loved babies.

The advocates only present the case in court. It is the solicitor that would have to do all the reviewing of paperwork, organising second opinions etc. It is the inequality between a prosecution service with a police investigatory service and a local solicitor that is the issue. The huge quanity of documents would have been a challenge to any but the largest of law firms. You would probably have needed a company with both criminal defence specialists and medical negigence specialists to properly manage the case. It is unclear the defence had the funding to employ expert witnesses to examine the cases (nor as I alluded to that they would have been available - one problem is that since expert witnesses such as Meadows have been denigrated experts are increasingly unwilling to appear in court). The use of Sandie Bohin is a good example. The prosecution had to get a paediatrician from Guernsey (which has no NICU), to give an expert opinion. She has worked in neonates, but not since 2008, and currently does mainly general paeds.

I think it is difficult to entirely tcall these either exoert witnesses or neutral, even if the intention are that they should be. Given that they were approached by the police to find something suspicious, and only later would they become expert witnesses effectively validating their previous work as reviewers for the police. The expert witnesses should not have been the same as the professionals employed by the police to review the medical records.

ETA As mentioned previously neither of the infants with insulin poisoning died. so your comment about death certificates and insulin is in error.

[Planigale]

Originally Posted by smartcooky

Agree. These babies did not die of natural causes, their deaths were caused by human intervention.

- Babies do not get air into their bloodstream unless someone injects them with air.
- Babies do not suffer insulin overdoses unless someone injects them with insulin.
- Babies diaphragms are not crushed unless a person crushes them.

Same for those babies who became very ill but did not die. If Letby didn't do it, then another person must have - a person who was on the same shift as Letby for every one of the deaths and assaults during the period 8 June 2015 to 24 June 2016. The problem with that idea is the ward manager established that no staff member other than Letby was on the shift at the time every death and assault took place.

There is one case that is particularly chilling. The case of Child G on 7 September 2015. The child, a girl, collapsed and did so again on two other occasions in the following three weeks. She was taken to another hospital, but five days after she came back, she collapsed again, 15 minutes after Letby had been feeding her. She survived, but is now severely disabled as a result of what happened to her. The child was witnessed projectile vomiting massively. The doctor said that he could not find a natural cause for the drastic vomiting. Later, at trial, an expert witness doctor concluded that the only viable explanation was that the baby was force fed too much milk down. It was later discovered that Letby had deliberately altered the baby's temperature on her observation chart to make it seem like it was already unwell before it collapsed, and she also falsified the time of the baby's collapse to make it seem like it coincided with when a colleague gave the baby a milk feed.

This shows shew knew exactly what she was doing. Letby must have known she was coming under suspicion, and tried to point the finger at a colleague.

It is not just beyond any reasonable doubt that Letby murdered these babies, it is an absolute cold-blooded certainty!

There are lots of ways to get air into the blood stream. One way is certainly through vascular access devices. It does not require air to be actively injected, a disconnect with low venous presures can result in air being sucked in, a well known phenomenon. Drug pumps can suffer disconnects or leaks and pump air into the blood, which is why they are supposed to have bubble detectors, but there is always the chance someone just muted an alarm by accident. Another way is mistaking the NG feeding tube and an iv tube and flushing the iv line with air instead of the feeding line.

Over ventilation and resuscitation may result in alveolar rupture or lung trauma with air entering the circulation.

Air embolism is well known to occur through misadventure, it does not only occur with deliberate injection of air into the circulation. It should be noted that post morem examination which is the most reliable way to diagnose air embolism failed to do so in any of the cases. all the cases of air embolism were post hoc diagnoses by the police 'expert' reviewers. One of the key peices of evidence was their interpretation of x-rays. Normally interpretation of x-rays would be done by a paediatric radiologist, not by persons out of clinical practice for many years.

https://www.scienceontrial.com/post/...ity-of-experts
For further comment. I do not agree with all that is said but references to relevant research are given.

Babies diaphragm's are crushed unintentionally. They are notoriously easy to crush. Sometimes they are born crushed. It is very easy to overfeed a premmy and splint the diaphragm causing a respiratory arrest. It would certainly be very easy to kill or cause acute respiratory disturbance in a neonate that way. The problem is that this is essentially a retropective conclusion. Assuming Letby killed the child, how could she do so without leaving evidence - by over feeding.

The porosecution have avoided directly using statistics, but have implicitly used them. There was an excess of deaths so lets find ways these could have been unnatural. the issue of overfeeding and splinting a diaphragm is well know, it can be manged by aspirating the NG tubeto empty the stomach. This does not appear to have been done and the diagnosis was not made at the time.

In part this is why unlike other cases of homicidal serial killer nurses Letby is accused of using so many different ways of killing, bacause a method has to be constructed retrospectively to fit the facts on the assumption that she killed every child who died on her shift. At least statistically there should be some entirely natural deaths!

There is no evidence that Letby falsified records. The prosecution claimed that she did so, and it is necessary to their case that she did so, otherwise events would have been incompatible with their hypothesis. One example of falsified records given was Letby not recording on an observation chart something that she did record in the written nursing record. That is not falsifying a record. It is poor record keeping. Equally it is clear other nurses filled in records after events, timing the as if contemporaneous, which was falsifying records. Letby may well have falsified records, but there is no evidence she did so.

[Planigale]

Originally Posted by Matthew Best

Letterby is definitely innocent!

Personally I think she is an attention seeking sociopath who definitely intentionally harmed children. I think some of those children died as a result. I don't think her intention was to kill or hurt the child, she just didn't care about them or their parents.

I do however think that this very unique case has some interesting aspects to discuss if we can do so in a civilised manner without personalising comments.

[Matthew Best]

Originally Posted by Matthew Best

Letterby is definitely innocent!

Sorry, that was just me being my normal spelling Nazi.

[Planigale]

mods can we move to trials and errors?

[Planigale]

Originally Posted by Matthew Best

Sorry, that was just me being my normal spelling Nazi.

Blame spellcheck, I do!

[smartcooky]

Originally Posted by Planigale

There are lots of ways to get air into the blood stream. One way is certainly through vascular access devices. It does not require air to be actively injected, a disconnect with low venous presures can result in air being sucked in, a well known phenomenon. Drug pumps can suffer disconnects or leaks and pump air into the blood, which is why they are supposed to have bubble detectors, but there is always the chance someone just muted an alarm by accident. Another way is mistaking the NG feeding tube and an iv tube and flushing the iv line with air instead of the feeding line.

Over ventilation and resuscitation may result in alveolar rupture or lung trauma with air entering the circulation.

Air embolism is well known to occur through misadventure, it does not only occur with deliberate injection of air into the circulation. It should be noted that post morem examination which is the most reliable way to diagnose air embolism failed to do so in any of the cases. all the cases of air embolism were post hoc diagnoses by the police 'expert' reviewers. One of the key peices of evidence was their interpretation of x-rays. Normally interpretation of x-rays would be done by a paediatric radiologist, not by persons out of clinical practice for many years.

https://www.scienceontrial.com/post/...ity-of-experts
For further comment. I do not agree with all that is said but references to relevant research are given.

Babies diaphragm's are crushed unintentionally. They are notoriously easy to crush. Sometimes they are born crushed. It is very easy to overfeed a premmy and splint the diaphragm causing a respiratory arrest. It would certainly be very easy to kill or cause acute respiratory disturbance in a neonate that way. The problem is that this is essentially a retropective conclusion. Assuming Letby killed the child, how could she do so without leaving evidence - by over feeding.

The porosecution have avoided directly using statistics, but have implicitly used them. There was an excess of deaths so lets find ways these could have been unnatural. the issue of overfeeding and splinting a diaphragm is well know, it can be manged by aspirating the NG tubeto empty the stomach. This does not appear to have been done and the diagnosis was not made at the time.

In part this is why unlike other cases of homicidal serial killer nurses Letby is accused of using so many different ways of killing, bacause a method has to be constructed retrospectively to fit the facts on the assumption that she killed every child who died on her shift. At least statistically there should be some entirely natural deaths!

There is no evidence that Letby falsified records. The prosecution claimed that she did so, and it is necessary to their case that she did so, otherwise events would have been incompatible with their hypothesis. One example of falsified records given was Letby not recording on an observation chart something that she did record in the written nursing record. That is not falsifying a record. It is poor record keeping. Equally it is clear other nurses filled in records after events, timing the as if contemporaneous, which was falsifying records. Letby may well have falsified records, but there is no evidence she did so.

https://www.cps.gov.uk/mersey-cheshi...y-baby-murders

The prosecution was able to present evidence of Letby using various methods to attack babies, including: the injection of air and insulin into their bloodstream; the infusion of air into their gastrointestinal tract; force feeding an overdose of milk or fluids; impact-type trauma. Her intention was to kill the babies while deceiving her colleagues into believing there was a natural cause.

Key evidence in the prosecution case

Medical records – these were crucial to establish the condition of the babies when they were attacked. When some babies recovered, the speed of their recovery was too sudden to be seen as a natural occurrence. Several medical documents featured falsified notes made by Letby to hide her involvement. She amended timings on several documents in an attempt to distance herself from incidents where babies had suddenly become severely unwell.

Text messages and social media activity – these were an important part of the case as they coincided with the attacks happening on the neonatal Unit. They were dated and timed, sometimes they were similar to a live blogging of events. They also explained how Letby deceived her colleagues into believing that these inexplicable collapses were simply a natural worsening of children’s underlying conditions. They also revealed an intrusive curiosity about the parents of babies she had harmed.

Staff rotas – we were able to show the jury that Letby was the one common denominator in the series of deaths and sudden collapses on the neonatal unit. We were also able to show the jury that many of the earlier incidents occurred overnight, but when Letby was put onto day shifts, the collapses and deaths began occurring in the day. We were able to corroborate this further using Letby’s personal diary in which she had noted her shift patterns.

Handwritten notes and diaries – many handwritten notes were discovered by police during their investigation. They included phrases such as: “I killed them on purpose because I’m not good enough to care for them”; “I am evil I did this”; and “today is your birthday and you are not here and I am so sorry for that”. These notes gave an insight into her mindset following her attacks.

Your defending of this serial killer of babies and children is noted!!

[Vixen]

Originally Posted by Planigale

This is simply untrue. Intravenous insulin in a neonate would act very quickly; wihin minutes. Indeed almost certainly the psychpathology is Letby wanted to be involved in the excitement of dealing with a suddenly sick child. I don't think she was interested in killing them, she just wanted to make them sick. I suspect she was a sociopath with no empathy who didn't care about whether the children lived or died. Not being present would defeat the whole object of her activities.

Neither of the infants given exogenous insulin died. It is unusual for this type of serial murderer to change technique. It is said that there were two nurses on duty on both occasions Letby and one other. No one observed Letby giving any unauthorised injections and no contaminated syringes etc. were recovered. One criticism of the unit would be that they got back the results showing the babies had been given exogenous insulin and didn't notice them.

Child F and Child L didn't die, simply by dint of the skilled medical staff saving their lives! Given Child L was given twice the dose of insulin as Child F, it doesn't look as though 'she just wanted to make them sick'. Why would a neonatal nurse inject synthetic insulin into a baby when it hasn't been prescribed? That is extremely dangerous. Letby tried to make out that it must have been added to the Baby's feedbag by the pharamcists, but the pharmacists do not put anything in the feedbag that is not nutricional. The insulin was kept elsewhere in a fridge. Letby, having agreed under cross-examination, that someone must have illicitly added the insulin to the feedbag, then tried to claim it must have been the other nurse, and even named her. Of course no-one observed Letby adding the insulin. Letby seemed to thrive on stealthiness.

[Vixen]

Originally Posted by Gulliver Foyle

1-3) All those things were said about Lucia de Berk for years before it was funally realised that she couldn't have caused the deaths she was convictrd of.

And on your last paragraph, what direct evidence was there in this case. From following it all the evidence was either circumstantial or Roy Meadows level misuse of statistics.

De Berk's conviction was found to be unsafe because Richard Gill, professor in Statistics found that there was an error in how some of the statistics had been calculated. Letby's conviction didn't centre around statistics. The Chester Police made in it clear in their programme Operation Hummingbird that each individual baby had their own individual discrete team of detectives, who were all china-walled from each other. Thus the case were build up individually n their own merits. If there was an issue with 'statistics' then the Defence had every opportunity during the trial to challenge them. Circumstantial evidence is just as powerful as prima facie evidence. Perfectly acceptable in criminal law. Unfortunately, there is a perception amongst people that 'circumstantial' = 'guesswork'. No. One of the strongest tools of a lawyer/barrister is the timeline or chronology. That is circumstantial but shows a clear logical sequence, whether it be for a defendant alibi or for the prosecution. An FBI authority (forget the name) said the most important part to solving a crime is working out what happened immediately before.



Roy Meadows, in the Sally Clarke case was reprimanded and disciplined for going beyond his remit (later reinstated). This is because in calculating the probability of two children both dying of Sudden Infant Death Syndrome (SIDS) made the ridiculously stupid error of assuming the two boys (Clarke's sons) were each random members of a population. For example, if there is a 50% chance of a baby being a girl or a boy, then say you have a girl (50%) and then another girl, then you can say the probability of this happening is .50 x .50 = 0.25 or 25%. What Meadows failed to factor in is the genetic element in that two close relatives often have the same predisposition to a medical condition. For example, say there is a 1% chance of any one random member of the population having, say Huntingdon's Chorea, it would be quite improper to apply that to two close relatives, if one of them as Huntingdon's, because if your close relative has Huntingdon's then your chance of developing it rockets extortionately to near 50%.

But the Letby case wasn't based on probability theory, other than to illustrate to the jury how the trends of babies suddenly collapsing or dying, correlated very strongly to Letby's presence. But that would not be sufficient for a jury to convict and it would not be reasonable to disallow these statistics from the trial.

Each case has to be judged on its own individual merits. Sally Clarke was a mother of the two sons. Completely different from a nurse randomly selecting neonatals that came in her path.

[Vixen]

Originally Posted by Planigale

The problem is that you define the unexpected illnesses and deaths by her presence. Deaths occurred before she started, when she was not on duty, and after she stopped working. A key problem in forensic science is suspect centred interpretation. The question I asked, and an appeal might be asking is whether all deaths on the unit were analysed with the analyser blind to the presence of Letby. If only those deaths when Letby was present were analysed, we cannot conclude whether the only suspicious deaths occurred when Letby was present. Remeber all these deaths including those that had undergone post mortems were initially viewed as natural deaths.

There is no suggestion trhat at the time the parents viewed what Letby was doing as suspicious, they did not raise concerns at the time. One problem is that no one saw Letby in the act. Certainly if you then ask the parents 'we think Letby killed your child did you see anything of concern', then it is not surprising that they subsequntly view actions as being suspicious. But some of what they describe as being suspicious could not have been the acts that killed the child.

Letby stopping working coincide with the unit changing from a level 2 unit (looking after premmy's and non-surgical sick neonates) to a level 1 unit - a SCBU essentially not allowed to look after sick babies. Since the population changed to a much less at risk poulation at the same time that Letby moved it is almost impossible to attribute the drop in deaths to Letby.

https://www.childrenscolorado.org/do...s/nicu-levels/
A US reference but UK definitions are similar.

The Chester Police bent over backwards to ensure there were no issues with confirmation bias or halo effect. They sifted through all of the records during the time frame, identified all of the collapses and deaths and came to the breath-stopping conclusion, as one senior detective put it, that 'No matter how much we tried to explain it away we could only come to one conclusion'.

[Vixen]

Originally Posted by Planigale

The advocates only present the case in court. It is the solicitor that would have to do all the reviewing of paperwork, organising second opinions etc. It is the inequality between a prosecution service with a police investigatory service and a local solicitor that is the issue. The huge quanity of documents would have been a challenge to any but the largest of law firms. You would probably have needed a company with both criminal defence specialists and medical negigence specialists to properly manage the case. It is unclear the defence had the funding to employ expert witnesses to examine the cases (nor as I alluded to that they would have been available - one problem is that since expert witnesses such as Meadows have been denigrated experts are increasingly unwilling to appear in court). The use of Sandie Bohin is a good example. The prosecution had to get a paediatrician from Guernsey (which has no NICU), to give an expert opinion. She has worked in neonates, but not since 2008, and currently does mainly general paeds.

I think it is difficult to entirely tcall these either exoert witnesses or neutral, even if the intention are that they should be. Given that they were approached by the police to find something suspicious, and only later would they become expert witnesses effectively validating their previous work as reviewers for the police. The expert witnesses should not have been the same as the professionals employed by the police to review the medical records.

ETA As mentioned previously neither of the infants with insulin poisoning died. so your comment about death certificates and insulin is in error.

Letby had her powerful trade union behind her. They succeeded in helping her win her grievance case (but thankfully, she never set foot in a neonatal ward again). She had the Neonatal Unit manager backing her, as well as the Nursing Chief, together with the Ian Harvey chap, to whom Letby was the golden fundraiser girl. In addition, she had the backing of Tony Chambers, who threatened seven doctors who expressed reservations about Letby's presence on the ward, with being reported to the GMC, with all the stress that entails. Trades Unions are incredibly strong with some of the best legal teams around (for example, Thompsons). They have no shortage of funds. Letby will have been well-represented, that is for sure.

The prosecution and the police are not allowed to hide or withhold evidence. She will have got a dossier of the entire case well in advance.

[Vixen]

Originally Posted by Planigale

There are lots of ways to get air into the blood stream. One way is certainly through vascular access devices. It does not require air to be actively injected, a disconnect with low venous presures can result in air being sucked in, a well known phenomenon. Drug pumps can suffer disconnects or leaks and pump air into the blood, which is why they are supposed to have bubble detectors, but there is always the chance someone just muted an alarm by accident. Another way is mistaking the NG feeding tube and an iv tube and flushing the iv line with air instead of the feeding line.

Over ventilation and resuscitation may result in alveolar rupture or lung trauma with air entering the circulation.

Air embolism is well known to occur through misadventure, it does not only occur with deliberate injection of air into the circulation. It should be noted that post morem examination which is the most reliable way to diagnose air embolism failed to do so in any of the cases. all the cases of air embolism were post hoc diagnoses by the police 'expert' reviewers. One of the key peices of evidence was their interpretation of x-rays. Normally interpretation of x-rays would be done by a paediatric radiologist, not by persons out of clinical practice for many years.

https://www.scienceontrial.com/post/...ity-of-experts
For further comment. I do not agree with all that is said but references to relevant research are given.

Babies diaphragm's are crushed unintentionally. They are notoriously easy to crush. Sometimes they are born crushed. It is very easy to overfeed a premmy and splint the diaphragm causing a respiratory arrest. It would certainly be very easy to kill or cause acute respiratory disturbance in a neonate that way. The problem is that this is essentially a retropective conclusion. Assuming Letby killed the child, how could she do so without leaving evidence - by over feeding.

The porosecution have avoided directly using statistics, but have implicitly used them. There was an excess of deaths so lets find ways these could have been unnatural. the issue of overfeeding and splinting a diaphragm is well know, it can be manged by aspirating the NG tubeto empty the stomach. This does not appear to have been done and the diagnosis was not made at the time.

In part this is why unlike other cases of homicidal serial killer nurses Letby is accused of using so many different ways of killing, bacause a method has to be constructed retrospectively to fit the facts on the assumption that she killed every child who died on her shift. At least statistically there should be some entirely natural deaths!

There is no evidence that Letby falsified records. The prosecution claimed that she did so, and it is necessary to their case that she did so, otherwise events would have been incompatible with their hypothesis. One example of falsified records given was Letby not recording on an observation chart something that she did record in the written nursing record. That is not falsifying a record. It is poor record keeping. Equally it is clear other nurses filled in records after events, timing the as if contemporaneous, which was falsifying records. Letby may well have falsified records, but there is no evidence she did so.

Dr. Arthurs, a radiologist, who gave expert witness, took X-Rays of Child A and Child B. He said whilst it was normal to see air int he bowels, he said it was totally unnatural to see the embolisms lined up parallel to the babies' spines. He had never seen that before.

The doctor who examined the crushed abdomen said it was of the same severity of someone who had been crushed in a car accident at great speed. She did falsify records. For example, coming in early but then only signing in later, is just one instance, when she claimed she could not have been present as the signing in record showed her arrival as being 15 minutes later.

Neither synthetic insulin administration or air bubble injection are accidental.

Whilst most of us have no idea of what either of these feel like, we can all imagine how incredibly painful being overfed on milk for someone with a tiny stomach must have been. Letby precluded this by telling the changeover nurse that the baby had had an extended stomach to make it seem as if it was something that developed gradually and that she would be well away from the hospital when the baby finally died.

[Planigale]

Originally Posted by Vixen

Dr. Arthurs, a radiologist, who gave expert witness, took X-Rays of Child A and Child B. He said whilst it was normal to see air int he bowels, he said it was totally unnatural to see the embolisms lined up parallel to the babies' spines. He had never seen that before.

The doctor who examined the crushed abdomen said it was of the same severity of someone who had been crushed in a car accident at great speed. She did falsify records. For example, coming in early but then only signing in later, is just one instance, when she claimed she could not have been present as the signing in record showed her arrival as being 15 minutes later.

Neither synthetic insulin administration or air bubble injection are accidental.

Whilst most of us have no idea of what either of these feel like, we can all imagine how incredibly painful being overfed on milk for someone with a tiny stomach must have been. Letby precluded this by telling the changeover nurse that the baby had had an extended stomach to make it seem as if it was something that developed gradually and that she would be well away from the hospital when the baby finally died.

I have no pretensions as to to knowing the subjective suffering of the victims. i am only trying to objectively discuss this unusual case. To be clear Dr Arthurs did not take any x-rays he reviewed x-rays previously taken. What he actually said was "consistent with, but not diagnostic of, air administration". So what I ask is whether 'consistent with' is sufficient for a murder conviction.

I have flagged that in one case a senior nurse on the unit entered notes the next day for events the previous day. Signing in 15 minutes after you actually arrived does not seem to be falsifying records when senior nurses enter records many hours later. FWIW I frequently see medical records entered in retrospect particularly around medical emergencies. Surprisingly doctors and nurses have better things to do than entering records when dealing with an acutely ill person. Letby may have falsified records, but I have seen no hard evidence she did so, just claims by the prosecution she did so.

I can both believe the accused is guilty and think the prosecution case is weak. A poor prosecution case can result in a guilty person gong free, just as it can cause an innocent person being convicted.

[Planigale]

Originally Posted by Vixen

Letby had her powerful trade union behind her. They succeeded in helping her win her grievance case (but thankfully, she never set foot in a neonatal ward again). She had the Neonatal Unit manager backing her, as well as the Nursing Chief, together with the Ian Harvey chap, to whom Letby was the golden fundraiser girl. In addition, she had the backing of Tony Chambers, who threatened seven doctors who expressed reservations about Letby's presence on the ward, with being reported to the GMC, with all the stress that entails. Trades Unions are incredibly strong with some of the best legal teams around (for example, Thompsons). They have no shortage of funds. Letby will have been well-represented, that is for sure.

The prosecution and the police are not allowed to hide or withhold evidence. She will have got a dossier of the entire case well in advance.

I am not sure that most of this is relevant to the trial. Thompson's are medical negligence lawyers who sue doctors and nurses. Letby would not have had her defence funded by the RCN (her union). The RCN would support civil cases but not criminal cases.

[Planigale]

Originally Posted by Vixen

De Berk's conviction was found to be unsafe because Richard Gill, professor in Statistics found that there was an error in how some of the statistics had been calculated. Letby's conviction didn't centre around statistics. The Chester Police made in it clear in their programme Operation Hummingbird that each individual baby had their own individual discrete team of detectives, who were all china-walled from each other. Thus the case were build up individually n their own merits. If there was an issue with 'statistics' then the Defence had every opportunity during the trial to challenge them. Circumstantial evidence is just as powerful as prima facie evidence. Perfectly acceptable in criminal law. Unfortunately, there is a perception amongst people that 'circumstantial' = 'guesswork'. No. One of the strongest tools of a lawyer/barrister is the timeline or chronology. That is circumstantial but shows a clear logical sequence, whether it be for a defendant alibi or for the prosecution. An FBI authority (forget the name) said the most important part to solving a crime is working out what happened immediately before.



Roy Meadows, in the Sally Clarke case was reprimanded and disciplined for going beyond his remit (later reinstated). This is because in calculating the probability of two children both dying of Sudden Infant Death Syndrome (SIDS) made the ridiculously stupid error of assuming the two boys (Clarke's sons) were each random members of a population. For example, if there is a 50% chance of a baby being a girl or a boy, then say you have a girl (50%) and then another girl, then you can say the probability of this happening is .50 x .50 = 0.25 or 25%. What Meadows failed to factor in is the genetic element in that two close relatives often have the same predisposition to a medical condition. For example, say there is a 1% chance of any one random member of the population having, say Huntingdon's Chorea, it would be quite improper to apply that to two close relatives, if one of them as Huntingdon's, because if your close relative has Huntingdon's then your chance of developing it rockets extortionately to near 50%.

But the Letby case wasn't based on probability theory, other than to illustrate to the jury how the trends of babies suddenly collapsing or dying, correlated very strongly to Letby's presence. But that would not be sufficient for a jury to convict and it would not be reasonable to disallow these statistics from the trial.

Each case has to be judged on its own individual merits. Sally Clarke was a mother of the two sons. Completely different from a nurse randomly selecting neonatals that came in her path.

This is an example of how people who are not experts fail to realise Meadows was actually correct. The question was about SIDS, by definition SIDS excludes a familial genetic component, so Meadows was actually correct in his response to the question asked. The problem was the question asked was inappropriate to the case under trial.

More broadly, speaking to friends who are paediatricians, after Meadows they are unwilling to appear as expert witnesses. This is why the prosecution expert witnesses are a doctor who has been retired for ten years and never worked as a neonatologist, and a doctor who has not done neonatology for several years and works in Guernsey (for those unfamiliar this means that there are about ten children (slight exaggeration) per paediatrician on the island). Both of whom are professional medico-legal opinions - experts for hire.

Almost certainly it was impossible for the defence to get an independent professional review.

[smartcooky]

Originally Posted by Vixen

Letby had her powerful trade union behind her. They succeeded in helping her win her grievance case (but thankfully, she never set foot in a neonatal ward again). She had the Neonatal Unit manager backing her, as well as the Nursing Chief, together with the Ian Harvey chap, to whom Letby was the golden fundraiser girl. In addition, she had the backing of Tony Chambers, who threatened seven doctors who expressed reservations about Letby's presence on the ward, with being reported to the GMC, with all the stress that entails. Trades Unions are incredibly strong with some of the best legal teams around (for example, Thompsons). They have no shortage of funds. Letby will have been well-represented, that is for sure.

The prosecution and the police are not allowed to hide or withhold evidence. She will have got a dossier of the entire case well in advance.

The parents of the victims, especially the later ones, might have a strong case to sue Chambers for negligence. When several doctors come to you and state that they believe something suspicious is going on in your hospital, threatening them for bringing this to your attention is not what you are supposed to do.

[Vixen]

Originally Posted by Planigale

This is an example of how people who are not experts fail to realise Meadows was actually correct. The question was about SIDS, by definition SIDS excludes a familial genetic component, so Meadows was actually correct in his response to the question asked. The problem was the question asked was inappropriate to the case under trial.

More broadly, speaking to friends who are paediatricians, after Meadows they are unwilling to appear as expert witnesses. This is why the prosecution expert witnesses are a doctor who has been retired for ten years and never worked as a neonatologist, and a doctor who has not done neonatology for several years and works in Guernsey (for those unfamiliar this means that there are about ten children (slight exaggeration) per paediatrician on the island). Both of whom are professional medico-legal opinions - experts for hire.

Almost certainly it was impossible for the defence to get an independent professional review.

Whether Sally Clarke killed her own babies in a state of hormone-induced post-natal psychosis imbalance or whether they were genuine SIDS (and it is not unusual for babies to be found dead - it happened to a friend of my family) then we can feel great pity for her either way. She drank herself to death in the end, so was punished whether guilty or innocent.

Letby is a completely different kettle of fish. Giving birth to a baby and the relief of a successful live birth after a traumatic premature delivery is a time of great emotion for parents. For a cold-blooded smiling nurse to take that joy away from you is the cruelest crime. Especially if that same smiling nurse is intruding on your grief and stalking you on FaceBook to voyeuristically watch you. Letby in particular targeted two sets of twins and a set of triplets. The triplets had been naturally conceived and the parents and the hospital were greatly anticipating their safe arrival...only to have Letby maliciously take two of the triplets away and permanently cripple and brain damage the surviving triplet, who needs 24 hour care, likewise another of her victims.

We all know how bullies work, they enjoy the game of cat and mouse. Letby maliciously waited until a mother went to pick up her kids from school, smilingly telling her that her baby was in her trusting good care, only to assault and kill the poor little mite as soon as the mother's back was turned.

Letby seems to have built up her repertoire over the years, using any instrument within her reach: removing babies' naso-gastric tubes, or ramming same down their throat, removing breathing masks, applying air via the gastric tubes or via injection, applying synthetic insulin via same, stuffing the new-born with milk via the naso-gastric tube, which the baby had n defences against...Letby enjoyed being 'one-up' on the parents and her colleagues. The Victorians had a word for her which is old-fashioned but apposite: Letby's crimes were wicked.

Completely not on a par with whatever crime Clarke may or may not have committed and Clark's conviction was found to be unsafe.