UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #4

[Charlot123]

This talk of a high number of neonatal deaths MUST be put into context. The numbers are far from statistically overwhelming.

The notion that there were 'loads' of additional deaths at CoCH in 2015 and 2016 is just NOT the case.

The Countess of Chester Hospital delivered 3043 babies in 2015.
The Countess of Chester Hospital delivered 2980 babies in 2016.

A neonatal death IS a liveborn baby (born at 20+ weeks gestational age or later, or with a birthweight of 400g or more where an accurate estimate of gestation is not available), who died before 28 completed days after birth

In 2015 overall neonatal mortality was 1.91 per 1000 live births. Hospitals with similar numbers of births had an average neonatal mortality rate of 1.27 per 1000 births.

For some additional context the UK neonatal mortality rate in 2015 was 2.6 per 1000 births. In 2016 it was 2.7 per 1000 births. Therefore, the CoCH had a significantly lower neonatal mortality rate that the UK average in both of these years.

The extended perinatal births and extended perinatal mortality include stillbirth, which we do not need to consider in this instance.

The CoCH neonatal mortality rate declined in 2016, as shown on the graph.

The CoCH had the highest neonatal mortality rate in 2015, when compared to NHS hospitals with a similar number of births. In 2016 The CoCH still featured as one of the highest, compared with hospitals with a similar number of births.


View attachment 373413

Countess of Chester Hospital: Woman held in baby deaths probe

A healthcare professional is being held over the deaths of eight babies at a Cheshire hospital.

www.bbc.co.uk

Indicator 3.2.2 - Neonatal mortality rate - U.K. Indicators For The Sustainable Development Goals

sdgdata.gov.uk

Thank you for this interesting statistics.
Is there any statistics for neonatal deaths at COCH, year-by-year, from 2010 to 2018?

I think I am battling with not knowing the full story.

We are told that the statistics was off at that NICU, and after everything was controlled, there still was no explanation for the higher deaths, and then police was called in and they paid attention to LL (source: Wikipedia).

I wonder if there was already some suspicion about LL, but they don’t want it to be known as to who, and why, raised it. The situation might have sounded unalarming if told to the public, but very suspicious to the staff of NICU. Sometimes “intuition” is more convincing than “statistics”.

 

[Whitehall 1212]

which, for me, puts LL in an even more precarious position.

How so?

 

[Tortoise]

One thing I am interested in is the charge that was struck off. Will the defence be able to mention this?

I wonder what the original evidence was to say it was murder and then what changed to decide they couldn't include it in the charges. Does this not indicate that there is certainly a possibility for doubt within the cases. However I do think the defence will need some excellent experts to get the jury on board with them, because I don't believe they will take the risk of putting LL up there

I have a feeling it could be baby K, who was transferred to a different hospital and died there two days later. LL is charged with her attempted murder but not murder. I could be wrong on this of course.

 

[Marantz4250b]

I dont have information on this case but there are many possible reasons for striking cases. Insufficient evidence could be one. There are myriads of possibilities. It is unlikely to affect the actual prosecutions which are going ahead because the evidence meets the bar for a murder charge.

It wasn't "struck out", as such. The prosecution offered no evidence so the court directed a formal not guilty verdict.

 

[Marantz4250b]

I have a feeling it could be the baby who was transferred to a different hospital and died there three days later. LL is charged with her attempted murder but not murder. I could be wrong on this of course.

Yes, it was that one. The original charge was murder with attempted murder as an alternative. The murder charge is the one for which no evidence has been offered and, hence, a not guilty verdict has been directed.

 

[Dcflag]

One thing I am interested in is the charge that was struck off. Will the defence be able to mention this?

I wonder what the original evidence was to say it was murder and then what changed to decide they couldn't include it in the charges. Does this not indicate that there is certainly a possibility for doubt within the cases. However I do think the defence will need some excellent experts to get the jury on board with them, because I don't believe they will take the risk of putting LL up there

My guess would be that there wasn’t enough for them to be confident in a conviction, jeopardising the rest of the charges.

 

[Dcflag]

Thank you for this interesting statistics.
Is there any statistics for neonatal deaths at COCH, year-by-year, from 2010 to 2018?

I think I am battling with not knowing the full story.

We are told that the statistics was off at that NICU, and after everything was controlled, there still was no explanation for the higher deaths, and then police was called in and they paid attention to LL (source: Wikipedia).

I wonder if there was already some suspicion about LL, but they don’t want it to be known as to who, and why, raised it. The situation might have sounded unalarming if told to the public, but very suspicious to the staff of NICU. Sometimes “intuition” is more convincing than “statistics”.

There was an explanation for the higher neonate deaths. There was an independent review by the RCPCH that came to the conclusion that there was significant gaps in nurses rotas, insufficient senior cover and poor decision making. However despite offering this conclusion, the decision was made based off their findings to involve the police with a suspicion on the deaths of 15 babies. 7 of which form todays charges. I would say the findings of the review found LL was involved and on shift with a significant amount of the neonate deaths, coupled with whatever concerns had her put on both the day shift and then admin duties.

Dr Jayaram was one of those initially concerned clinicians as stated in the prosecution opening. He observed concerning behaviour. The opening prosecution statement also suggests there was a clinician (perhaps the same one, but the person is not named) who questioned a nurse following a baby’s death, and it is said LL was concerned she was perhaps going to be in trouble or had done something wrong.

After the initial independent review it was made public knowledge not just the findings, but that the police were investigating 15 neonate deaths and 6 collapses. This was in 2018.

 

[Marantz4250b]

My guess would be that there wasn’t enough for them to be confident in a conviction, jeopardising the rest of the charges.

How could it possibly jeopardise the other charges? Each charge stands or falls on its own facts.

The prosecution decided that it simply did not have the evidence available to prove a murder case. The most likely reason for that is that the baby in question was extremely ill to begin with and they did not think that they could prove that what they allege LL did constituted a "substantial and operating" cause of the death - which is the legal threshold for murder. Essentially, it was too difficult to differentiate between the pre-existing illness and the effects of her alleged actions.

For the attempted murder charge they only need to show that she tried to kill the victim. The attempt may, in reality, have had absolutely no effect what-so-ever but as long as the act was carried out with the intention of causing death then that is sufficient.

 

[Charlot123]

This talk of a high number of neonatal deaths MUST be put into context. The numbers are far from statistically overwhelming.

The notion that there were 'loads' of additional deaths at CoCH in 2015 and 2016 is just NOT the case.

The Countess of Chester Hospital delivered 3043 babies in 2015.
The Countess of Chester Hospital delivered 2980 babies in 2016.

A neonatal death IS a liveborn baby (born at 20+ weeks gestational age or later, or with a birthweight of 400g or more where an accurate estimate of gestation is not available), who died before 28 completed days after birth

In 2015 overall neonatal mortality was 1.91 per 1000 live births. Hospitals with similar numbers of births had an average neonatal mortality rate of 1.27 per 1000 births.

For some additional context the UK neonatal mortality rate in 2015 was 2.6 per 1000 births. In 2016 it was 2.7 per 1000 births. Therefore, the CoCH had a significantly lower neonatal mortality rate that the UK average in both of these years.

The extended perinatal births and extended perinatal mortality include stillbirth, which we do not need to consider in this instance.

The CoCH neonatal mortality rate declined in 2016, as shown on the graph.

The CoCH had the highest neonatal mortality rate in 2015, when compared to NHS hospitals with a similar number of births. In 2016 The CoCH still featured as one of the highest, compared with hospitals with a similar number of births.


View attachment 373413

Countess of Chester Hospital: Woman held in baby deaths probe

A healthcare professional is being held over the deaths of eight babies at a Cheshire hospital.

www.bbc.co.uk

Indicator 3.2.2 - Neonatal mortality rate - U.K. Indicators For The Sustainable Development Goals

sdgdata.gov.uk

Here, thank you so much again.

It seems that 2013 was the year of lowest neonatal mortality in England; 2015-2016 was “up” everywhere.

But if you look up “Northwest”, where Chester is, the dynamic is even more interesting. There is an unexpected rise above the National average in the whole area. And it slowly goes down. But even in 2018 it is elevated.

The R one is NW region, where according to Google Chester is.

No one alone, no seven babies could have contributed. It was a sharp rise from 2.6 equal to National average, to 3.6 in 2015.

Why? New people settling there? Economy of the region? More IVFs in that area? Some external factor as it was obviously true for the region.

 

[Whitehall 1212]

Here, thank you so much again.

It seems that 2013 was the year of lowest neonatal mortality in England; 2015-2016 was “up” everywhere.

But if you look up “Northwest”, where Chester is, the dynamic is even more interesting. There is an unexpected rise above the National average in the whole area. And it slowly goes down. But even in 2018 it is elevated.

The R one is NW region, where according to Google Chester is.

No one alone, no seven babies could have contributed. It was a sharp rise from 2.6 equal to National average, to 3.6 in 2015.

Why? New people settling there? Economy of the region? More IVFs in that area? Some external factor as it was obviously true for the region.

The most comprehensive data from 2013-2020 is at the MBRRACE-UK website (Mothers and Babies - Reducing Risk through Audits and Confidential Enquiries across the UK.

Reports | MBRRACE-UK | NPEU

The National Perinatal Epidemiology Unit (NPEU) is a multidisciplinary research unit based at the University of Oxford. Our work involves running randomised con

www.npeu.ox.ac.uk

In the 2020 report go to the interactive map and home in on the CoCH for the birth and mortality rates. You can toggle in the left-hand pane to also see 2017, 2018 and 2019 statistics.

For 2013-2016, inclusive go back to the 2020 report box. Look below for the hyperlink 'Perinatal Mortality Surveillance' and click. Scroll down for each years 'full report'. Towards the end of each report, after the UK maps, there are lists of hospitals by birth rate ranges. CoCH falls in the 2000-3999 birth range.

CoCH Births and Neonatal Mortality (SOURCE: MBRRACE-UK)​

Year​	Births​	Neonatal Mortality per 1000 births​
2013​	3576​	1.84​
2014​	3026​	1.28​
2015​	3047​	1.91​
2016​	3057​	1.49​
2017​	2936​	1.08​
2018​	2482​	0.93​
2019​	2458​	1.09​
2020​	2390​	0.8​

Note how the number of births drop significantly in 2018, after:

a) The downgrading to level 1 (SBU) in mid-late 2016.
b) Publicity of the police investigation in mid 2017

Mums to be were probably going elsewhere. due to their concerns of unnecessary additional risk.

Neonatal mortality drops significantly in 2017. Likely due to:

a) downgrading to level 1 unit, with more poorly neonates going elsewhere
b) Birth rates decrease significantly, then so does the neonatal mortality rate
c) Issues within the unit being addressed

As an example:

Liverpool Womens NHS Foundation Trust for 2020. 7411 births. Neonatal mortality rate of 3.62. Well above CoCH at ANY time. LW is a level 1 (NICU) though, therefore is treats the most poorly neonates, with the greatest risk of mortality.

The question was CoCH in 2015 and 2016 just a statistical outlier, possibly because they were a failing unit or did LL bear any criminal responsibility?

 

[Whitehall 1212]

But if you look up “Northwest”, where Chester is, the dynamic is even more interesting. There is an unexpected rise above the National average in the whole area. And it slowly goes down. But even in 2018 it is elevated.

The R one is NW region, where according to Google Chester is.

No one alone, no seven babies could have contributed. It was a sharp rise from 2.6 equal to National average, to 3.6 in 2015.

Why? New people settling there? Economy of the region? More IVFs in that area? Some external factor as it was obviously true for the region.

Thank you @Charlot123

Very interesting spike for the NW in 2015-2017.

There are many possible factors. Maybe a combination of socio-economics and NN unit performance. Drugs and alcohol misuse in the region may also be a factor. Without proper exploration it is impossible to say for sure.

 

[merrypason]

The question was CoCH in 2015 and 2016 just a statistical outlier, possibly because they were a failing unit or did LL bear any criminal responsibility

Could be both as well that caused CoCH to be a statistical outlier? A failing unit AND LL bore criminal responsibility in those specific cases. Probably why the investigation has taken this long and is so complex, as it must have been difficult to pick out what was a result of mismanagement/failings (that everyone was aware of with the RCPCH report) v criminal intent. This is why I'm very interested in the evidence they present.

It has also made me wonder if other colleagues, patient's families raised any concerns ever to the Consultants about LL, that made them take notice. Rather than it being they just noticed her presence at the incidents themselves. The prosecution did focus on LL's version of events being different to the mum's and with all this focus on FB searches and photos taken, cards sent - am wondering if maybe it wasn't just stats that played a part in investigating LL but other complaints or comments. Her notes trying to understand who had made allegations, and what evidence they had makes me think there were a few people she thought were involved, not just 1-2 consultants.

I don't think the defence mentioned anything in opening about LL's general performance being exemplary as a nurse (just that she had a clean record and was dedicated to babies) - but am unsure if this means there were no reprimands, complaints or other performance concerns in the 4 years she was there which displayed a sinister pattern as well. A failing unit that is understaffed could also mean that nurses with bad performance are promoted/retained as there's no other option.

All to be revealed of course as this trial progresses.

All MOO.

 

[ConcernedThirdParty]

I think she was moved from the night shift after the doctor and possibly others noticed a pattern.

Letby was allegedly 'present for all 24 incidents;' the unexpected collapses and deaths, between 2015- 2016.

According to Johnson, 'when she was moved to the day shift, the rate of collapses shifted to day.'

Surprisingly, she did not seem to recall many of the victims or what they went through.

When she was interviewed she claimed she wasn't present for one incident, but the cellphone data placed her in the room. For child F, she told police she had no recollection of the incident, or any involvement in administering the IV bag, but confirmed her signature on the TPN form. This was the interview in which she asked police 'if they had access to the bag she connected.'

She also didn't remember child L, who was reportedly doing well before Letby started caring for her, the prosecutor said. Out of nowhere the baby started projectile vomiting, had difficulty breathing and 'critical desaturation levels.' The prosecutor stated LL had no recollection of this, apparently, although this is the family she got a sympathy card for and took a picture of.

For baby G, someone allegedly switched off the monitor when the baby collapsed, which was discovered by LL. She denied switching it off. She also didn't remember doing a FB search of the parents. I'm not sure if she admitted to any of the searches, but I find it hard to believe she'd forget after they had suffered such a tragic loss.

For child B and C, she was not the designated nurse, but instead for a baby boy. The designated nurse tried to 'reinforce her assignment," but allegedly LL 'was ignoring her.'
Hopefully we will hear in more detail how she ended up caring for them.
I believe it was Baby B that she kept the handover sheet for?

I haven't heard anything about which deaths were outside their scope or how it would relate to the case.

Finally, as soon as the victims were taken to the other hospital, they all made a speedy or remarkable recovery.

In what way is the evidence 'tainted?' I got the impression investigators have been meticulous. And yes, it will likely be
presented in much further detail during the trial.

I hope the families will see justice served in the end. They have been waiting a very long time.

Ah he said about the being moved shifts at the beginning which just sounded odd, the detail must have come once he reached those cases chronologically - you don't move someone to the day shift if you suspect they're at best incompetent and at worst a murderer, you move them off the ward and investigate, that's crazy.

She claimed she wasn't present but a text she sent arguably placed her in the room iirc - cell phone location data is not so precise.

It is hard to know if what she does or doesn't remember is significant. I would not expect her to remember a specific time she changed an IV on a specific shift 2 - 3 years previously given that it's the sort of thing she would do multiple times in a shift every shift. We really need to know what questions were being asked - as many have pointed out, there's a big difference between "do you remember searching for X?" and "do you remember searching for X on June 15th?".

Some of the 22 incidents she is charged with causing happened after her shifts, so she was clearly not literally present at all of them. You said 24, were there 2 more she wasn't charged with? But of course if she worked a normal shift pattern, then about half of all incidents that year would have occurred during or in the hours following her being on shift by chance. There were 7 other deaths so that's at least 29 incidents, were there not other non-fatal collapses? It would strain credulity if she was the cause of every bad thing that year, or even every bad thing on her shift - so there certainly must have been more than 24 incidents.

I say much of the non-statistical evidence is tainted in the sense nearly all of it appears to have been gathered long after the fact and gathered after they identified her as the suspect. People aren't just remembering what happened, they're looking for any memories of LL and particularly any of her doing anything odd.

 

[merrypason]

Ah he said about the being moved shifts at the beginning which just sounded odd, the detail must have come once he reached those cases chronologically - you don't move someone to the day shift if you suspect they're at best incompetent and at worst a murderer, you move them off the ward and investigate, that's crazy.

She claimed she wasn't present but a text she sent arguably placed her in the room iirc - cell phone location data is not so precise.

It is hard to know if what she does or doesn't remember is significant. I would not expect her to remember a specific time she changed an IV on a specific shift 2 - 3 years previously given that it's the sort of thing she would do multiple times in a shift every shift. We really need to know what questions were being asked - as many have pointed out, there's a big difference between "do you remember searching for X?" and "do you remember searching for X on June 15th?".

Some of the 22 incidents she is charged with causing happened after her shifts, so she was clearly not literally present at all of them. You said 24, were there 2 more she wasn't charged with? But of course if she worked a normal shift pattern, then about half of all incidents that year would have occurred during or in the hours following her being on shift by chance. There were 7 other deaths so that's at least 29 incidents, were there not other non-fatal collapses? It would strain credulity if she was the cause of every bad thing that year, or even every bad thing on her shift - so there certainly must have been more than 24 incidents.

I say much of the non-statistical evidence is tainted in the sense nearly all of it appears to have been gathered long after the fact and gathered after they identified her as the suspect. People aren't just remembering what happened, they're looking for any memories of LL and particularly any of her doing anything odd.

Serial killer or serial rapist evidence is normally gathered years after the fact, because of the nature of it - multiple victims and trying to figure out who they were, when they happened. If that evidence was considered 'tainted', no one would ever able to get a case through the courts or a conviction on anything that was charged years after the fact.

Also we don't know when the non statistical evidence was collected, that hasn't been shared. There might have been comments and complaints made at the time. A few of these cases did have post mortems at the time too. Non statistical evidence is also the digital footprint confirming where someone was and whose account may be correct. That's how they corroborated for one of the babies, the mother's version was correct and not LL's notes - based on phone pings, calls made, electronic access etc. There have been also been text messages from the time that she sent, and no doubt emails and other electronic communication. She has a diary and notes. Others may have had electronic communications and notes from that time too. In any case 1-3 years past the event is not a long time for people to remember details surrounding unusual medical incidents involving people dying or almost dying on a ward as small as this one.

 

[Whitehall 1212]

Serial killer or serial rapist evidence is normally gathered years after the fact, because of the nature of it - multiple victims and trying to figure out who they were, when they happened. If that evidence was considered 'tainted', no one would ever able to get a case through the courts or a conviction on anything that was charged years after the fact.

Traditional serial killings and stranger rape investigations secure valuable primary and forensic evidence. This enables suspects arrested years later. to be interviewed, charged and prosecuted with compelling evidence against them.

The prosecution statement in relation to the actual deaths and collapses and LL's implication in them, is based entirely on circumstantial evidence....no primary or forensic evidence was mentioned.

Whatever Mr Johnson KC said in his opening address has not been presented to court by the witnesses. Neither has it been cross-examined.

<modsnip: rude / unnecessary>

 

[Charlot123]

Thank you @Charlot123

Very interesting spike for the NW in 2015-2017.

There are many possible factors. Maybe a combination of socio-economics and NN unit performance. Drugs and alcohol misuse in the region may also be a factor. Without proper exploration it is impossible to say for sure.

I wonder if it was some environmental factor, and it went unnoticed. Unless they did a fantastic job in improving all NICUs in the area by 2019.

Still wonder if some zoonotic infection (akin to Zika virus), or even an unusual flu, hit the area in 2014-2015, and its effect was gone by 2019? It is the “above natural average” element that bothers me.

Whatever factor was there, its effect is gone in 2019, so it could have been some exposure in 2014-2015.

 

[catgreen]

The most comprehensive data from 2013-2020 is at the MBRRACE-UK website (Mothers and Babies - Reducing Risk through Audits and Confidential Enquiries across the UK.

Reports | MBRRACE-UK | NPEU

The National Perinatal Epidemiology Unit (NPEU) is a multidisciplinary research unit based at the University of Oxford. Our work involves running randomised con

www.npeu.ox.ac.uk

In the 2020 report go to the interactive map and home in on the CoCH for the birth and mortality rates. You can toggle in the left-hand pane to also see 2017, 2018 and 2019 statistics.

For 2013-2016, inclusive go back to the 2020 report box. Look below for the hyperlink 'Perinatal Mortality Surveillance' and click. Scroll down for each years 'full report'. Towards the end of each report, after the UK maps, there are lists of hospitals by birth rate ranges. CoCH falls in the 2000-3999 birth range.

CoCH Births and Neonatal Mortality (SOURCE: MBRRACE-UK)​

Year​	Births​	Neonatal Mortality per 1000 births​
2013​	3576​	1.84​
2014​	3026​	1.28​
2015​	3047​	1.91​
2016​	3057​	1.49​
2017​	2936​	1.08​
2018​	2482​	0.93​
2019​	2458​	1.09​
2020​	2390​	0.8​

Note how the number of births drop significantly in 2018, after:

a) The downgrading to level 1 (SBU) in mid-late 2016.
b) Publicity of the police investigation in mid 2017

Mums to be were probably going elsewhere. due to their concerns of unnecessary additional risk.

Neonatal mortality drops significantly in 2017. Likely due to:

a) downgrading to level 1 unit, with more poorly neonates going elsewhere
b) Birth rates decrease significantly, then so does the neonatal mortality rate
c) Issues within the unit being addressed

As an example:

Liverpool Womens NHS Foundation Trust for 2020. 7411 births. Neonatal mortality rate of 3.62. Well above CoCH at ANY time. LW is a level 1 (NICU) though, therefore is treats the most poorly neonates, with the greatest risk of mortality.

The question was CoCH in 2015 and 2016 just a statistical outlier, possibly because they were a failing unit or did LL bear any criminal responsibility?

But presumably you also have to see the distributions these deaths across the calendar year to see clusters/spikes and other patterns that might indicate an unnatural cause?

 

[Charlot123]

Interesting, the hospital CEO resigned in 2018 when LL was first arrested and let out on bail. It is not spectacular news, probably, but one wonders how many irregularities were there in the hospital.

Chester hospital chief executive resigns amid baby deaths inquiry - BBC News

Countess of Chester Hospital has been at the centre of an investigation into a series of baby deaths.

www.bbc.com

P.S. a little bit more about prior biography.

Search | Nuffield Trust

www.nuffieldtrust.org.uk

I also found annual report for Countess of Cheshire foundation trust for 2019-2020. I wonder if such report for 2015-16 should be available, to compare hospital challenges.

https://www.coch.nhs.uk/media/178139/combined-annual-report-and-accounts-2019-20-coch-pdf.pdf

Here is report for 2015-2016

https://www.coch.nhs.uk/media/133225/abdb_3091_coch-annual-report-2015-16-min-1-.pdf

2016-2017

https://www.coch.nhs.uk/media/145316/rjr_chester_annual_report_and_accounts_2016-17_wit.pdf

2017-2018

https://www.england.nhs.uk/wp-content/uploads/2019/09/Countess_of_Chester_Hospital_NHS_Foundation_Trust_Annual_Report_and_Accounts_2017-18.pdf

So far, it seems that the risks in 2019-20 are assessed as higher. More transparency, perhaps?

 

[Music2022]

I think this case will rely a lot on testimonies of her co workers. Unlike what we have come to expect from tv shows not all cases have clear cut evidence like dna or cctv or an electronic trail etc.. this case might resemble older cases, or he said she said rape cases - who is more credible.

 

[Music2022]

Interesting, the hospital CEO resigned in 2018 when LL was first arrested and let out on bail. It is not spectacular news, probably, but one wonders how many irregularities were there in the hospital.

Chester hospital chief executive resigns amid baby deaths inquiry - BBC News

Countess of Chester Hospital has been at the centre of an investigation into a series of baby deaths.

www.bbc.com

Could’ve also decided to quickly quit because he worried not only that he ran a low quality care hospital but also allowed an alleged serial killer to work there. Would be enough for any manager to panic I imagine.