UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #2

[infinit]

But it didn't take 5 years to get this evidence. They figured this out in the initial police investigation, and obviously there was unproven suspicions of her which is why she was moved to an admin role before the police started. It's taken 5 years to investigate all these cases but also cases of attempted murder, and other hospitals she trained in.

Also these are not experts employed by the hospital or instructed by the prosecution. These are external independent clinicians who have nothing to do with the hospital and did their review long before this case was even sent to the CPS. They have nothing to gain as they work in different parts of the country and frankly owe nothing to the hospital or the consultants/nurses there.

Frankly if it was a hospital cover up - they didn't need to start a police investigation. The initial RHPC report didn't speak of any criminal findings, or equipment damage and failure, or hold anyone responsible. If there was faulty apparatus, damaged bottles, surely 1 of the 2 independent reviews by external organisations would have called it out? The Trust could have avoided all this scandal and expense by just adopting the RHPC recommendations of staffing models etc. Everyone could have carried on as is because even the parents weren't demanding a post mortem. Clearly someone at the hospital, or many people were concerned there was actual foul play going on which is why they instigated this long, drawn out investigation AND moved LL to admin duties. You need to be very sure there's wrong doing, to discuss doing a post mortem on already traumatised families - it's not just standard practice.

The most important thing here is - there were multiple cases of the exact same unusual phenomenon happening, always when Lucy was in the room alone even when she wasn't supposed to be. You'd assume that after the first time or so it happened to her, she would be extra careful going forward to keep meticulous notes or flag to her superiors she thought something was wrong? They did say there was no notes found where she had requested insulin bags to be tested or IVs to be tested etc. Forget a criminal investigation, is someone's performance at work not judged by the % of errors/deaths/near misses they have compared to their peers? Given the total number of deaths at that hospital in the year, and the fact majority belonged to one nurse (so no other individual nurse could have had the same number of deaths associated with them), even from a line manager view, would you not be concerned why one nurse had much worse outcomes than all the others?

Wouldn't she herself be concerned by it and try to figure it out - instead she tells the police she can't remember the details of any of them. Obviously her leadership were concerned because they moved her off clinical duties and brought the police in. Her callousness at how many babies died in her care would be surprising to me. Unless the defence can prove instances where she raised an alarm or tried to discuss it with her superiors proactively, I think they were right to look at her performance against her peers.

MOO

I agree it's unlikely to be a hospital cover-up. But confirmation bias, which causes people to see and interpret information in a way which confirms their preexisting views is a real thing. You could have an investigation that looks potentially promising in terms of finding an answer, which then only looks and frames the information in a way which supports the initial narrative. People who are experts in their field can fall foul of confirmation bias, particularly if their day-to-day role is not investigated.

I appreciate they need to do the scene setting for each proposed victim, but I don't think we'll get to the meat and potatoes of this until it's explained how they've landed on these cases, what excluded other deaths and near-misses from being included which might not assist in the theory it was her.

So far it appears it's fairly circumstantial evidence, there is no smoking gun. It's the probability of murder vs coincidence that is going to have to be relied upon.

 

[Pinkizzy]

Was the milk fed into the babies stomach or gut?

 

[Noscrubs]

I’d be interested to know if any ‘trigger’ is indentified for the alleged murders. Perhaps something happened in Lucy’s personal life for example.

 

[JosieJo]

Quite a lot of detail in this report

"Letby took an “unusual interest” in the twins’ family, searching for them on social media two days after Baby E’s death and several times over the following months – even on Christmas Day 2015, the court heard."

"The nurse allegedly “wiped out” the mother’s visit from the medical records then falsely claimed to be in another room when Baby E collapsed. This, the prosecution alleged, was Letby trying to establish an “alibi in someone else’s medical records”.


"texted a colleague to say it would be “cathartic” to be in a room where a baby had died"


"Johnson said Letby searched for Baby C’s parents on Facebook hours after his death, adding: “The timing may suggest that it was one of the first things she did when she woke up.”

Mother walked in on nurse Lucy Letby trying to kill baby, court told

Defendant accused of murdering seven babies allegedly said ‘trust me, I’m a nurse’ when interrupted

www.theguardian.com

 

[Goldflamingo]

I’d be interested to know if any ‘trigger’ is indentified for the alleged murders. Perhaps something happened in Lucy’s personal life for example.

Also was wondering if the time of year can be linked to any kind of trigger, June of both 2015 & 2016 have charges relating to 4 separate victims where as other months have charges against no more than two victims.

 

[ChloLo]

I’ve seen “google searches” mentioned a few times about this case. Why would LL need to make any google searches? We’re talking about a qualified nurse who had the education to know exactly what she was doing.

 

[Whitehall 1212]

She also confirmed signing for a lipid syringe at 12.10am, the shift before. The prosecution say she should have had someone to co-sign for it.

I've investigated instances of risk events in the NHS when drug signing protocol has not been followed. This occurred on night duty when clinicians were under significant pressure as they were short staffed on the ward. The RCPCH review highlighted staff resourcing as an issue at CoCH.

"Interestingly, at the end of this part of the interview she asked whether the police had access to the TPN bag that she had connected," Mr Johnson added.

When any starts a statement with "interestingly" it's a sure sign there about to put some spin on something that could be interpreted to mean pretty much the opposite.....as in "that bag would prove otherwise".

Medical experts Dr Dewi Evans and Dr Sandie Bohin said the hormone levels were consistent with insulin being put into the TPN bag prior to Child F's hypoglycaemic episode.

I am waiting to learn what other circumstances such test results could be consistent with. This is likely to be a case of cherry picking?

MOO

 

[merrypason]

I agree it's unlikely to be a hospital cover-up. But confirmation bias, which causes people to see and interpret information in a way which confirms their preexisting views is a real thing. You could have an investigation that looks potentially promising in terms of finding an answer, which then only looks and frames the information in a way which supports the initial narrative. People who are experts in their field can fall foul of confirmation bias, particularly if their day-to-day role is not investigated.

I appreciate they need to do the scene setting for each proposed victim, but I don't think we'll get to the meat and potatoes of this until it's explained how they've landed on these cases, what excluded other deaths and near-misses from being included which might not assist in the theory it was her.

So far it appears it's fairly circumstantial evidence, there is no smoking gun. It's the probability of murder vs coincidence that is going to have to be relied upon.

Let's tilt the statistics on its head. And instead of approaching it by looking at cases and what is suspicious or not, how about looking at it as nurses and what is suspicious or not i.e what nurses had a higher number of deaths/near fatal incidents associated with them than average?

You have a team of 7 nurses. There's 10 total deaths in your hospital. Out of the 7 nurses, only 1 has 7 deaths associated with her. Another 3 have 1 death each. Would you not be interested in WHY this one nurse has higher worse outcomes than the others? So you investigate her. You then find that in all the deaths she's the only one present, and they're ALL under unusual, sometimes suspicious circumstances. Is that confirmation bias - or following the stats that show ONE individual has a record of more deaths than anyone else? That's why LL would have been singled out - irrespective of what's going on with her peers, her individual case history is still suspicious.

Surely not likely that any health practitioner does not get investigated for a high number of deaths. A police offer would get investigated for a single death as standard.

There's a conflation of the initial report done by the RHPC with why LL was targeted. The RHPC report which was based on understanding the high number of cases - not assessing individuals. So people have assumed that that LL was targeted based on cases and this had a bias. What we don't know is if there there was already suspicion of her owing to a large number of deaths in her care and the report was a way or ruling out other contributing factors

However you look at it, you cannot deny that any person who has a larger than average negative performance against their peers deserves investigation. A salesman who has significantly higher customer returns compared to their peers, a cashier who has always has the till 'under balanced' compared to their peers, a police officer with higher arrests of black people than their peers etc. It doesn't always mean they're guilty of wrong doing, but explains why they were chosen to be investigated. And you'd expect them to co-operate and understand the concern rather than saying they don't remember.

MOO

 

[Sarahlou]

Quite a lot of detail in this report

"Letby took an “unusual interest” in the twins’ family, searching for them on social media two days after Baby E’s death and several times over the following months – even on Christmas Day 2015, the court heard."

"The nurse allegedly “wiped out” the mother’s visit from the medical records then falsely claimed to be in another room when Baby E collapsed. This, the prosecution alleged, was Letby trying to establish an “alibi in someone else’s medical records”.


"texted a colleague to say it would be “cathartic” to be in a room where a baby had died"


"Johnson said Letby searched for Baby C’s parents on Facebook hours after his death, adding: “The timing may suggest that it was one of the first things she did when she woke up.”

Mother walked in on nurse Lucy Letby trying to kill baby, court told

Defendant accused of murdering seven babies allegedly said ‘trust me, I’m a nurse’ when interrupted

www.theguardian.com

I'd love to know what the psychiatrists/psychologists have to say about her and her actions.

 

[Music2022]

I've investigated instances of risk events in the NHS when drug signing protocol has not been followed. This occurred on night duty when clinicians were under significant pressure as they were short staffed on the ward. The RCPCH review highlighted staff resourcing as an issue at CoCH.



When any starts a statement with "interestingly" it's a sure sign there about to put some spin on something that could be interpreted to mean pretty much the opposite.....as in "that bag would prove otherwise".



I am waiting to learn what other circumstances such test results could be consistent with. This is likely to be a case of cherry picking?

MOO

I did a quick Google on dr Dewi Evans, he specialises in childhood diabetes and children endocrinology so I guess if he says the only way to get those blood insulin and hormone results is via artificial insulin this must be true?

 

[annpats]

Was the milk fed into the babies stomach or gut?

Stomach, I think, as it was vomited back up by some of them.

 

[JosieJo]

@Legally Bland thanks for the updates

 

[Jamie737]

Would there be any sensible reasons as to why a patient record sheet would be found at her home?

None. You cannot remove personal patient information from the hospital.

 

[Popcorn80]

Was thinking the defence may use the understaffed nhs/high pressure area stance, but todays talk of 7 babies to 5 nurses. That’s a good nursing ratio.

With regards to Facebook search’s it will be interesting to see if she has searched others families that she had contact through her role as a nurse as this would make it much less damming.

The insulin even very small doses would have a big effect on blood sugar levels.

 

[Cherwell]

Would there be any sensible reasons as to why a patient record sheet would be found at her home?

None. You cannot remove personal patient information from the hospital.

Did not happen. The document found at her home was a staff handover sheet, nothing to do with patient records.

 

[shadowdancer]

Did not happen. The document found at her home was a staff handover sheet, nothing to do with patient records.

If it had any information about any patient on it, then it is considered patient records. Even if the only information on there was the name of the patient. Same goes for staff details.

That is what you are taught in confidentiality training when you join the NHS.

 

[gill1109]

Let's tilt the statistics on its head. And instead of approaching it by looking at cases and what is suspicious or not, how about looking at it as nurses and what is suspicious or not i.e what nurses had a higher number of deaths/near fatal incidents associated with them than average?

You have a team of 7 nurses. There's 10 total deaths in your hospital. Out of the 7 nurses, only 1 has 7 deaths associated with her. Another 3 have 1 death each. Would you not be interested in WHY this one nurse has higher worse outcomes than the others? So you investigate her. You then find that in all the deaths she's the only one present, and they're ALL under unusual, sometimes suspicious circumstances. Is that confirmation bias - or following the stats that show ONE individual has a record of more deaths than anyone else? That's why LL would have been singled out - irrespective of what's going on with her peers, her individual case history is still suspicious.

Surely not likely that any health practitioner does not get investigated for a high number of deaths. A police offer would get investigated for a single death as standard.

There's a conflation of the initial report done by the RHPC with why LL was targeted. The RHPC report which was based on understanding the high number of cases - not assessing individuals. So people have assumed that that LL was targeted based on cases and this had a bias. What we don't know is if there there was already suspicion of her owing to a large number of deaths in her care and the report was a way or ruling out other contributing factors

However you look at it, you cannot deny that any person who has a larger than average negative performance against their peers deserves investigation. A salesman who has significantly higher customer returns compared to their peers, a cashier who has always has the till 'under balanced' compared to their peers, a police officer with higher arrests of black people than their peers etc. It doesn't always mean they're guilty of wrong doing, but explains why they were chosen to be investigated. And you'd expect them to co-operate and understand the concern rather than saying they don't remember.

Merrypason, you write "What we don't know is if there was already suspicion of her owing to a large number of deaths in her care". I understood from the story told by the prosecution on day 1 that first a large number of events in night shifts was noticed, then it was noticed that LL was connected to them, then she was moved to day shifts, then the events during day shifts started increasing. Anyway: these statistics are certainly absolutely good grounds to start thorough medical investigations into each of those events. I am looking forward to hearing how the defence deals with the accusations. The prosecution has been putting on dramatic theatre, it has given the media lots of choice snippets. Twitter is full of expressions of deep disgust and calls for the return of hanging. So far it seems to me all the evidence is circumstantial, and open to multiple interpretations. You can say "it all adds up". But of course it all adds up: the prosecution is painting a picture and putting everything they have into it. Everything they say is carefully designed to add up! We need to hear the other side of the story. I want to keep an open mind till we have heard LL's defense.

 

[Whitehall 1212]

<modsnip: Quoted post was removed>

Even though it sounds compelling, the evidence that LL looked at the victim's parents FB accounts has no bearing on the points to prove for a murder conviction.

Motive is not an element nor is obsessive behaviour, although being able to demonstrate clear motive is very beneficial.

My view so far is that the medical evidence is unconvincing, and that the Crown's case may place rather too much reliance on showing LL as a woman whose text messages to colleagues, throw away comments, getting involved with a baby not allocated to her and specific FB searches somehow demonstrate motive and hence point towards and overall picture of guilt.

I certainly hope that LL has been comprehensively medically assessed as such behaviours could be a presentation of high functioning autism or other neurodiversity.



The key points to prove for murder/attempted murder:

1. An intent to kill OR cause serious harm in the case of murder. An intent to kill for manslaughter.

2. It is also necessary to prove that LL committed the clinical acts she is alleged to have carried out.

3. It will be necessary to prove that the alleged acts were a substantial* (case law) cause of death.

It must be noted that LL has not indicated a defence of diminished responsibility when arraigned.

Any search history that is specific to the MO variations alleged, either before or after the fact, could be more troublesome as would searches regarding medical forensics. However, as she was an experienced NN nurse I very much doubt she would need to research how to harm a neonate.


* Lord Woolf MR in R v HM Coroner for Inner London ex p Douglas-Williams (1999 1 AII ER 344

See below under heading of CAUSATION

Homicide: Murder and Manslaughter | The Crown Prosecution Service -

 

[gill1109]

So LL repeatedly searched social media for Child E's parents over a period of months. Then later she searched for Child G's parents and also two other mum's of the children listed within the charges. Why? I can understand initial curisoity after a specific incident but this now clearly seems like a pattern of behaviour.

Seems to me a slightly autistic way that someone might try to deal with their own trauma from being involved in each drama. I can see myself behaving exactly like that. Yes, it is a pattern of behaviour, and obviously it is "not done". But I don't see it helps to prove guilt. It does help to prove to the jury that LL is a bit odd person, and hence it will help them believe she could have done those terrible things.

 

[merrypason]

Think the angle the prosecution are going with is - all the medical evidence points to deliberate poisoning, LL was the only one in the room at the time, therefore if the jury believe the medical evidence they must also believe LL was responsible.

A lot of this will hinge on the testimonies of all the clinicians, the police who interviewed her and what was said at the interview, her colleagues and her own account of things (if she comes forward). If all of it together can convince a jury that the medical evidence is correct and these babies were deliberately sabotaged and harmed, then they can make their case that LL is the only one who could have done it. Because it's difficult to disprove her sole presence in the room I imagine.

The defence will need enough evidence to counteract the prosecution and show there is an alternative medical explanation that is equally plausible given the circumstances.

MOO