UK - Healthcare worker arrested on suspicion of murder/attempted murder of a number of babies, 2018

[Whitehall 1212]

I entirely agree. Given the extreme severity of the result of a conviction there needs to be very, very good evidence in the hands of the prosecution! Anything which essentially amounts to Well, she was there at the time or similar just should not make the grade. I'm highly sceptical of them having much more than that though. Highly sceptical.

The thing is that health care workers have been convicted on just that in the past. Statistical analysis has been used as evidence on the probability of a health care worker coincidentally being present at the material times. Expert witnesses in the form of statisticians have bamboozled juries and probably barristers and judges with their pronouncements and their degree of certainty.

The mortality rate at Countess of Chester Hospital for 2015.

Authors of the MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) report looked at stillbirths and neonatal deaths around the UK in 2015.

They found the Countess of Chester Hospital NHS Foundation Trust had a neonatal death rate of 1.91 for every 1,000 live births that year.

This was the highest out of the 43 trusts of a similar size it was compared with, which had an average of 1.27 neonatal deaths for every 1,000 live births.

There were also 5.42 extended perinatal deaths - deaths within four weeks - for every 1,000 births, including stillbirths. The average for similar sized maternity units was 4.73 deaths per 1,000 births.

The rate declined in 2016 but was still among the highest in the group.

Source: Countess of Chester Hospital: Woman held in baby deaths probe

I am no statistician but this increased mortality rate does not seem particularly compelling of a serial killer operating in a specific area! The percentage increase is significant but it would be when the average mortality rate in similar sized maternity units was so low. These figures amount to significantly less than one additional death per thousand births. Maybe I am missing something!

I share many of your concerns.

There are lies, damned lies and statistics (Mark Twain)

 

[Tortoise]

Without checking back through the whole thread does anyone know offhand if we already have a prepared timeline of all the relevant events for this case?

I think it would be helpful and I'm more than happy to do one but wanted to make sure first that I'm not duplicating efforts.

 

[Whitehall 1212]

Most drugs are in locked cupboards that any registered nurse would have access to ..there are certain drugs classed as "controlled drugs" where they are logged in a book and 2 nurses or a nurse and a dr have to sign out (using the book)
Most drugs aren't "controlled" so would be very easy to remove from the cupboard unnoticed
Obviously it would depend on what drugs were involved.
Prescription is by a Dr or Advanced nurse practitioner but in theory any nurse could remove drugs from a cupboard and administer them undetected

Thanks for the clarification. However, I recall investigating instances of controlled drugs being signed out and administered by a single member of hospital junior nursing staff on night duty where there were staff shortages and the second and supervisory member of staff was not immediately available.

Those of us who have worked in the emergency of health care sector know we 'make it work' and sometimes operate outside our area of expertise or qualification when the situation is pressing and lives may depend on it. I bet every rookie copper with a one day driving assessment under their belt has exceeded the limits of their driving grade to get to a colleague calling for 'urgent assistance'. The alternative is to say "sorry I can't do that, I'm not authorised to do so. You'll need to see my supervisor".

Maybe it was that LL was put in situation that was beyond her remit but there was no one else to support her or provide guidance. Maybe the stress of the responsibility was affecting her judgement and decision making and she felt totally isolated. Maybe she did something, when to do nothing would have been to neglect her patient. Maybe she made mistakes in titrating the doses of muscle relaxants or other medication when an incorrect dose can have life threatening consequences.

Who knows, but every case of alleged criminal conduct, clinical accident or reportable incident that I investigated in the NHS was often heavily influenced by poor management practices. Many clinical managers in the NHS have no management experience or training, they are promoted though seniority and whilst they may have excellent nursing skills this does not make them excellent managers.

 

[Marantz4250b]

If any thing was found during the search of her house,garden or anywhere else that was searched she would of been charged

Charged with what though? Just because they found "something" isn't evidence of murder necessarily. If they had found illegal drugs which may be linked to the murder investigation I'm not sure they would have charged straight away.

 

[JosieJo]

Although NMC registration also includes indemnity insurance for the member. If there is cover elsewhere in addition to the employers liability then NHS Resolution will be looking to reduce or even nullify their payout.

A civil action against LL by the Countess of Chester Hospital following a criminal conviction may result in the NMC insurers paying out for Countess Chester Hopsital losses from compensation claims, reputational damage and other losses etc.

If the cause was purely down to systemic failures, staff shortages, poor reporting and clinical investigation then NHS Resolution will most likely be the sole payee.

NMC registration does not include indemnity cover ?? You have to state you have indemnity cover when registering with the nmc ...the NHS Trust provides indemnity

 

[Whitehall 1212]

Cheers, all excellent points.

NMC registration does not include indemnity cover ?? You have to state you have indemnity cover when registering with the nmc ...the NHS Trust provides indemnity

Apologies JosieJo, I meant the RCN (too many abbreviations everywhere) and obviously membership is optional but advisable.

 

[JosieJo]

Thanks for the clarification. However, I recall investigating instances of controlled drugs being signed out and administered by a single member of hospital junior nursing staff on night duty where there were staff shortages and the second and supervisory member of staff was not immediately available.

Those of us who have worked in the emergency of health care sector know we 'make it work' and sometimes operate outside our area of expertise or qualification when the situation is pressing and lives may depend on it. I bet every rookie copper with a one day driving assessment under their belt has exceeded the limits of their driving grade to get to a colleague calling for 'urgent assistance'. The alternative is to say "sorry I can't do that, I'm not authorised to do so. You'll need to see my supervisor".

Maybe it was that LL was put in situationa that was beyond her remit but there was no one else to support her or provide guidance. Maybe the stress of the responsibility was affecting her judgement and decision making and she felt totally isolated. Maybe she did something, when to do nothing would have been to neglect her patient. Maybe she made mistakes in titrating the doses of muscle relaxants or other medication when an incorrect dose can have life threatening consequences.

Who knows, but every case of alleged criminal conduct, clinical accident or reportable incident that I investigated in the NHS was often heavily influenced by poor management practices. Many clinical managers in the NHS have no management experience or training, they are promoted though seniority and whilst they may have excellent nursing skills this does not make them excellent managers.

I must admit ..I have never known anyone cut corners with the signing out of controlled drugs ..they are checked at handover of each shift and weekly by pharmacy...but if people were not carrying out that procedure I can understand why you may have investigated that.

To be fair many IV drugs that would be deadly would be readily available without using controlled drugs.
Usually if there are controlled drug irregularities it would be for a person's personal habit rather than killing

 

[JosieJo]

Apologies JosieJo, I meant the RCN (too many abbreviations everywhere) and obviously membership is optional but advisable.

Yes I see ...unison would also have some cover

 

[Whitehall 1212]

If any thing was found during the search of her house,garden or anywhere else that was searched she would of been charged

Absolutely not so. Criminal investigation is somewhat more nuanced than that.

I can recommend the Criminal Procedure and Investigations Act 1996 and the Police and Criminal Evidence Act 1984 as a good place to understand how a criminal investigation works and the powers of the police in England and Wales, to support such investigations.

 

[Marantz4250b]

The thing is that health care workers have been convicted on just that in the past. Statistical analysis has been used as evidence on the probability of a health care worker coincidentally being present at the material times. Expert witnesses in the form of statisticians have bamboozled juries and probably barristers and judges with their pronouncements and their degree of certainty.

The mortality rate at Countess of Chester Hospital for 2015.

Authors of the MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) report looked at stillbirths and neonatal deaths around the UK in 2015.

They found the Countess of Chester Hospital NHS Foundation Trust had a neonatal death rate of 1.91 for every 1,000 live births that year.

This was the highest out of the 43 trusts of a similar size it was compared with, which had an average of 1.27 neonatal deaths for every 1,000 live births.

There were also 5.42 extended perinatal deaths - deaths within four weeks - for every 1,000 births, including stillbirths. The average for similar sized maternity units was 4.73 deaths per 1,000 births.

The rate declined in 2016 but was still among the highest in the group.

Source: Countess of Chester Hospital: Woman held in baby deaths probe

I am no statistician but this increased mortality rate does not seem particularly compelling of a serial killer operating in a specific area! The percentage increase is significant but it would be when the average mortality rate in similar sized maternity units was so low. These figures amount to significantly less than one additional death per thousand births. Maybe I am missing something!

I share many of your concerns.

There are lies, damned lies and statistics (Mark Twain)

I share your concerns too. These seem rather small numbers to me. Also, I'm not sure that being able to demonstrate that that particular unit (or hospital) having that level of higher death rate is indicative of anything at all without taking many other factors into account; were there other factors at play here such as particular local conditions (such as infections) which could have contributed to it?; was it the case that the hospital was receiving more babies of an especially critical nature for some reason?; one might even ask about potential lifestyle factors of the mothers in it's catchment area - was there a particular problem with mothers who were addicts or obese or had some other underlying health problems more than in other areas?; was another hospital having particular issues with very ill babies which resulted in them being sent to the Countess? The biggie, obviously, is that the place was already a failing unit and failing units would tend to have worse patient outcomes than perfectly run ones.

I'm not sure what relevance it is but I read the other day, in a New York Post article I think, that this unit looked after around 400 patients a year. I'm certainly no expert but that sounds like an awful lot of premature or very sick babies for somewhere like Chester.

 

[Bakers]

Charged with what though? Just because they found "something" isn't evidence of murder necessarily. If they had found illegal drugs which may be linked to the murder investigation I'm not sure they would have charged straight away.

Absolutely not so. Criminal investigation is somewhat more nuanced than that.

I can recommend the Criminal Procedure and Investigations Act 1996 and the Police and Criminal Evidence Act 1984 as a good place to understand how a criminal investigation works and the powers of the police in England and Wales, to support such investigations.

Absolutely not so. Criminal investigation is somewhat more nuanced than that.

I can recommend the Criminal Procedure and Investigations Act 1996 and the Police and Criminal Evidence Act 1984 as a good place to understand how a criminal investigation works and the powers of the police in England and Wales, to support such investigations.

They were already holding her on suspicion of murder she wasn't arrested helping police with there inquiries from the off she was arrested on suspicion of 8 murders.so anything found in her home or anywhere else a charge of some sort I'm sure would off followed.

 

[Whitehall 1212]

I must admit ..I have never known anyone cut corners with the signing out of controlled drugs ..they are checked at handover of each shift and weekly by pharmacy...but if people were not carrying out that procedure I can understand why you may have investigated that.

To be fair many IV drugs that would be deadly would be readily available without using controlled drugs.
Usually if there are controlled drug irregularities it would be for a person's personal habit rather than killing

Absolutely, sad cases of opiate addiction stemming from an initial clinically necessary prescription. I have dealt with many such cases and there is need for some compassion and empathy, although it was not for me to do anything else other than be impartial in applying the criminal investigation process. Mitigation is for the courts.

I think procedures have since been tightened since, but the number of morphine ampoules missing from ambulance secure lockers that had apparently been dropped and broken ruled staff out from ever fielding in the slips at friendly cricket matches!

 

[MsBetsy]

Without checking back through the whole thread does anyone know offhand if we already have a prepared timeline of all the relevant events for this case?

I think it would be helpful and I'm more than happy to do one but wanted to make sure first that I'm not duplicating efforts.

I've not seen one but I think that would be great! I've had to check the documents to find when each event occurred but if we have it right here on the thread it would definitely help.

 

[Marantz4250b]

They were already holding her on suspicion of murder she wasn't arrested helping police with there inquiries from the off she was arrested on suspicion of 8 murders.so anything found in her home or anywhere else a charge of some sort I'm sure would off followed.

Well, as Whitehall 1212 (who seems to have far more experience of serious criminal investigations than anyone here, especially suspicious hospital deaths) has said, that is not necessarily the case!

Being arrested, even on very serious charges, is not always necessarily very strong evidence of guilt. It merely means that the police have enough evidence/suspicion to arrest you. Indeed, it is not always a bad thing for the arrestee as certain protective statutes (such as PACE, bail provisions, etc) become immediately relevant. A now retired cop who was old enough the remember the situation pre-PACE was very adamant in telling me that if the police ever tried to call you in for a private chat about a serious crime then make sure that arrest you first. It also protects their investigation - wasn't there a recent case of a murder prosecution falling apart because the cop in charged spoke to the suspect before he should have done or while he wasn't arrested or something?

 

[Tortoise]

Well, as Whitehall 1212 (who seems to have far more experience of serious criminal investigations than anyone here, especially suspicious hospital deaths) has said, that is not necessarily the case!

Being arrested, even on very serious charges, is not always necessarily very strong evidence of guilt. It merely means that the police have enough evidence/suspicion to arrest you. Indeed, it is not always a bad thing for the arrestee as certain protective statutes (such as PACE, bail provisions, etc) become immediately relevant. A now retired cop who was old enough the remember the situation pre-PACE was very adamant in telling me that if the police ever tried to call you in for a private chat about a serious crime then make sure that arrest you first. It also protects their investigation - wasn't there a recent case of a murder prosecution falling apart because the cop in charged spoke to the suspect before he should have done or while he wasn't arrested or something?

This one I think
How detective was disgraced catching a double killer

 

[Tortoise]

I've not seen one but I think that would be great! I've had to check the documents to find when each event occurred but if we have it right here on the thread it would definitely help.

I'll start working on one.

 

[Marantz4250b]

This one I think
How detective was disgraced catching a double killer

Yes, that was the one.

 

[Marantz4250b]

This one I think
How detective was disgraced catching a double killer

Yes, that was the one.

I'll start working on one.

I'm sure the Chester Standard had a basic timeline on one of it's stories. Might have been one of the other papers though.

 

[Whitehall 1212]

They were already holding her on suspicion of murder she wasn't arrested helping police with there inquiries from the off she was arrested on suspicion of 8 murders.so anything found in her home or anywhere else a charge of some sort I'm sure would off followed.

As I implied before, you are exceptionally wide of the mark.

Firstly, the level of suspicion required to arrest someone for any criminal offence falls way lower than the evidence required for charge, let alone conviction.

Following arrest police can use various powers of search to support different objectives, one being if they believe there is evidence relating to that offence for which they have been arrested or another offence. Once again the benchmark for 'belief' is low.

Just because police find an article during a house search that is possibly incriminating does not mean instant charge. We are talking about a criminal investigation here not Cleudo!

What is the item?

Where did it come from?

How did it get there?

Where exactly was it found....a kitchen in a shared house or the suspects bedroom?

Who else has access to the premises?

Where does it possibly fit into the alleged offences?

Does is have fingerprints, DNA or other forensic marks to directly link it to the suspect?

How does the suspect account for it in interview - rational explanation that can be corroborated or not? Etc, etc!

If you don't understand please ask. Many people on Websleuths are happy to explain.

 

[Whitehall 1212]

DBM