UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #5

[arrogantcat]

<modsnip - quoted post was removed>

<modsnip> we also have to acknowledge that these findings of ‘unnatural deaths’ were only discovered because the statistical data pattern had been identified. Ie, without that human interpretation of that data, the deaths would have stayed ‘natural causes’ as signed on most of the death certificates.

We can’t really know how many other ‘natural cause’ deaths might be found to be something else on external review. It’s possible that the statistics-led focus created biased results in this way, as only the suspected cases were reviewed.

Just the reviewing doctor knowing that he was looking at a cluster of cases creates a degree of bias. Even if he’s told nothing about the case, doesn’t know there’s a suspicion of intentional killing, the minute you’re given multiple files instead of one, the human brain makes certain assumptions and wants to look for patterns.

The earliest foundations of this case come from data and statistics, so everything is built onto those assumptions. It’s impossible to extract the statistics from the case as they are woven into every subsequent discovery and decision.

 

[MsBetsy]

We know it has happened before, so it’s certainly not impossible.

Lucia de Berk case - Wikipedia

en.wikipedia.org

Well, we already know there is much more evidence to be presented than the presence of one person, nurses notes and hospital records.

Also, in that link it says that for both children, it was not clear how de Berk could have delivered the poison and the moment of the 2 poisonings, that de Berk was not with the patients at all, the specialist and his assistant were present.

 

[Sweeper2000]

Based on the snippets we are hearing I'm struggling to understand how he has only just come to the conclusion of the damaged diaphragm being his conclusion?
I can understand that none of the existing factors might cause collapse but are we missing what new piece of evidence allowed him to come to a conclusion? Or am I misunderstanding?

That’s why the defence is stating he is choosing info that suits a “to cause harm” diagnosis. evidence of bias.

 

[Legally Bland]

3:09pm

Dr Evans: "You can't exclude infection from [Child C]'s general status.
"He's got an infection, but it's under control."
Mr Myers refers to another of Dr Evans's reports, from 2019, referring to infection being 'probable' as a significant cause in Child C's collapse.
Dr Evans says if he receives additional evidence, then he will change his mind.
Mr Myers says Dr Evans has not received any new evidence on Child C's infection since.

3:17pm

Mr Myers says the 2019 report said Dr Evans raised a possibility of deliberate injection of air from June 12 via the naso-gastric tube.
Dr Evans, reflecting on that report, said: "Can't rule it out".
Mr Myers refers to a 'massive gastric dilation' was 'most likely' due to an injection of air on June 12.
Dr Evans: "That was a possibility, yes."
Mr Myers says in that report, there was no suggestion the diaphragm had been splintered since, and if he wanted to say so in that report, he could have done so.
"If it wasn't said, it wasn't said."
Dr Evans said what was being discussed, on June 12, there was a "distinct possibility" Child C had excess air in the stomach from CPAP belly.
He was "still stable" from a respiratory point of view.
He tell the court: "However the air went in, it would have been insufficient to splinter the diaphragm on the 12th, as he would've collapsed and died on the 12th."
The air which had gone in was 'insufficient' to cause a collapse. There was 'nothing to suggest' the excess air was enough on June 12.
He says the two events on June 12 and 13 "are quite different" in the way they happened.
Mr Myers said that it was Dr Evans's view, a couple of months ago, there was deliberate harm on June 12.
"That was a possibility, yes it was."

3:19pm

Mr Myers: "What you have done today in your evidence is introduce something supporting the allegation."
Dr Evans: "That is incorrect."
He adds that in coming to his conclusion for this case he is not relying solely on his opinions, but taking in other clinical evidence and reports.
"That is what doctors do, we do it all the time." in what Dr Evans says is a "complicated case".

Recap: Lucy Letby trial, Tuesday, November 1

THE trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[Tortoise]

<modsnip> we also have to acknowledge that these findings of ‘unnatural deaths’ were only discovered because the statistical data pattern had been identified. Ie, without that human interpretation of that data, the deaths would have stayed ‘natural causes’ as signed on most of the death certificates.

We can’t really know how many other ‘natural cause’ deaths might be found to be something else on external review. It’s possible that the statistics-led focus created biased results in this way, as only the suspected cases were reviewed.

Just the reviewing doctor knowing that he was looking at a cluster of cases creates a degree of bias. Even if he’s told nothing about the case, doesn’t know there’s a suspicion of intentional killing, the minute you’re given multiple files instead of one, the human brain makes certain assumptions and wants to look for patterns.

The earliest foundations of this case come from data and statistics, so everything is built onto those assumptions. It’s impossible to extract the statistics from the case as they are woven into every subsequent discovery and decision.

How do you know only the suspected cases were reviewed?

Dr Evans reviewed 33 cases and there are not 33 charges.

 

[MsBetsy]

It’s just that in a case of largely circumstantial evidence it will be statistics that give you an indication as to guilt.



Yeh that’s my thinking as well. The prosecution will undoubtedly have allot of stuff that points at LL but if it was bias that made them look that way?

Think the AE theory will have the most weight as it seems to be difficult to treat and also makes resuscitation efforts “difficult” which is in addition to LL being present.

You mentioned upthread a possibility that power and control may be possible motivations. It’s very true as far as I know that in previous SK that’s nearly always a motive. Most violence done by psychopaths is for money etc but in serial killers power and control feature so often, IMO . The emotional high is the reward and that fits this case if she is guilty but what’s your theory and how did you get there?

Most evidence is circumstantial. I have never heard of a case using mainly statistics to prove guilt.

Aren't juries in the UK directed to examine all of the evidence combined to determine guilt or innocence?

 

[Legally Bland]

3:28pm

Mr Myers has gone back to the case of Child B to discuss the legibility of a nursing note concerning blotchiness of Child B's skin.
The discussion goes on for several minutes.
Dr Evans adds: "This is just making a meal out of something."
Mr Myers: "You're not independent, as a witness, are you, Dr Evans?"
Dr Evans: "I am completely independent. I am not here for the prosecution, I am not here for the defence, I am here...to assist the jury."
The judge interjects to clarify the meaning of the note, before the case resumes on Child C.

Recap: Lucy Letby trial, Tuesday, November 1

THE trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[Legally Bland]

3:31pm

Mr Myers asks about the bile aspirates, and asks if the dark colour was additional concern.
Dr Evans says it could be discoloured blood, and the presence of vomit once would be a concern, but would need to be put in context of the baby's condition.
"You can't choose out something that supports your case - you need to look at the big picture."

 

[kittythehare]

Based on the snippets we are hearing I'm struggling to understand how he has only just come to the conclusion of the damaged diaphragm being his conclusion?
I can understand that none of the existing factors might cause collapse but are we missing what new piece of evidence allowed him to come to a conclusion? Or am I misunderstanding?

Confused too but this followed which I think covers it sans diaphragmatic rupture
C/p
Mr Myers says the 2019 report said Dr Evans raised a possibility of deliberate injection of air from June 12 via the naso-gastric tube.

Dr Evans, reflecting on that report, said: "Can't rule it out".

Mr Myers refers to a 'massive gastric dilation' was 'most likely' due to an injection of air on June 12.

Dr Evans: "That was a possibility, yes."

Mr Myers says in that report, there was no suggestion the diaphragm had been splintered since, and if he wanted to say so in that report, he could have done so.

"If it wasn't said, it wasn't said."

Dr Evans said what was being discussed, on June 12, there was a "distinct possibility" Child C had excess air in the stomach from CPAP belly.

 

[arrogantcat]

I’m surprised to see some here feel they have already got enough info to make a firm conclusion of guilt in this case. To my mind, we’re still a long way off having a clear picture of anything.

It’s not illegal to send a couple of text messages to your colleagues
It’s not illegal to search for your patients on Facebook.
It’s not illegal to be on a shift at the same time as a baby dies.
It’s not illegal to go into the family room to talk to the parents
It’s not illegal to keep a handover sheet in your home
It’s not illegal to sound rude or abrupt to parents
It’s not illegal to brain-dump all of your thoughts onto a post it note.
It’s not illegal to watch a BBC documentary related to your work.

Etc etc.

It might “look bad” or “feel odd”, but those are just thoughts and perceptions.

The prosecution is doing a compelling job so far in proving that these children were illegally killed (although we still have the Defence’s rebuttal of this to come), but so far they’ve shared nothing to prove that LL is responsible other than her presence and that her shift patterns align.

The burden of proof is much much higher, and rightly so. That’s why this is a six month trial, after all. If the Prosecution thought they could prove it all with what they’ve shared so far they’d presumably be dusting their hands off and heading to the pub - not gearing up for a gruelling long slog!

 

[Legally Bland]

3:38pm

Mr Myers says the x-ray from June 12 had helped form Dr Evans's initial view that there had been an air injection into the stomach.
"That was an opinion I have expressed, yes."
Mr Myers asks Dr Evans what evidence there is to support that air had been injected into the stomach on June 13.
Dr Evans: "The baby collapsed and died."
Asked to explain further, Dr Evans says it was part of a differential diagnosis.
He said there were three clinical scenarios - injecting air into the stomach that interfered with his breathing, or that air was injected intraveneously, or from a combination of the two, which Dr Evans says "sounds awful".
Dr Evans says, from his perspective, from an academic point of view, he would not be able to rule out any one of those three scenarios.

Recap: Lucy Letby trial, Tuesday, November 1

THE trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[arrogantcat]

How do you know only the suspected cases were reviewed?

Dr Evans reviewed 33 cases and there are not 33 charges.

I believe somebody earlier in the thread identified that there were initially 33 cases being investigated by the hospital/police from an earlier news article. We can only presume these are the same 33 cases that were sent to Dr Evans.

There has been no suggestion that he was also asked to review any additional cases that were not under suspicion, as far as I know?

So, I guess my point is - how do you know there were? We can’t. We don’t. But we do know that such cases are not routinely reviewed after a cause of death has already been identified. We do know that these cases were specifically reviewed. We do know that the decision to do so was data-lead.

I’m curious to know what harm there could possibly be in interrogating this data? If she is guilty it will be provable regardless, and we all benefit from rigorous expectations and exploration in science and justice

 

[Legally Bland]

3:42pm

Dr Evans says none of the normal processes described why a baby collapsed.
He adds, for further medical information, he would prefer to defer the matter to the radiologist and pathologist.
He said he objects to being accused by Mr Myers of making things up, and says he is putting forward the information in this case as a result of his own opinion and that of other people's reports.

Recap: Lucy Letby trial, Tuesday, November 1

THE trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[kittythehare]

I wonder how the jury are responding!

The irony!
Mr Myers suggests that Dr Evans has just made up information as he has gone along.

"You keep saying that, and I keep disagreeing."

"And you're not an independent witness at all, are you?"

"And again, that is just being insulting."

 

[Tortoise]

I believe somebody earlier in the thread identified that there were initially 33 cases being investigated by the hospital/police from an earlier news article. We can only presume these are the same 33 cases that were sent to Dr Evans.

There has been no suggestion that he was also asked to review any additional cases that were not under suspicion, as far as I know?

So, I guess my point is - how do you know there were? We can’t. We don’t. But we do know that such cases are not routinely reviewed after a cause of death has already been identified. We do know that these cases were specifically reviewed. We do know that the decision to do so was data-lead.

Child C does not appear to have been a suspected case.

"At the time, the consultant pathologist gave the cause of death as "widespread hypoxic/ischaemic damage to the heart/myocardium due to lung disease". UK - Lucy Letby Trial - Media, Maps & Timeline *NO DISCUSSION*

Case was reviewed by Dr Evans.

 

[JosieJo]

I’m surprised to see some here feel they have already got enough info to make a firm conclusion of guilt in this case. To my mind, we’re still a long way off having a clear picture of anything.

It’s not illegal to send a couple of text messages to your colleagues
It’s not illegal to search for your patients on Facebook.
It’s not illegal to be on a shift at the same time as a baby dies.
It’s not illegal to go into the family room to talk to the parents
It’s not illegal to keep a handover sheet in your home
It’s not illegal to sound rude or abrupt to parents
It’s not illegal to brain-dump all of your thoughts onto a post it note.
It’s not illegal to watch a BBC documentary related to your work.

Etc etc.

It might “look bad” or “feel odd”, but those are just thoughts and perceptions.

The prosecution is doing a compelling job so far in proving that these children were illegally killed (although we still have the Defence’s rebuttal of this to come), but so far they’ve shared nothing to prove that LL is responsible other than her presence and that her shift patterns align.

The burden of proof is much much higher, and rightly so. That’s why this is a six month trial, after all. If the Prosecution thought they could prove it all with what they’ve shared so far they’d presumably be dusting their hands off and heading to the pub - not gearing up for a gruelling long slog!

Surely no one can have any opinion on guilt either way yet ?

 

[arrogantcat]

Well, we already know there is much more evidence to be presented than the presence of one person, nurses notes and hospital records.

Also, in that link it says that for both children, it was not clear how de Berk could have delivered the poison and the moment of the 2 poisonings, that de Berk was not with the patients at all, the specialist and his assistant were present.

I’m not really familiar enough with the whole case to be able to compare. I do know there was a lot more circumstantial evidence involved, including details about her private life and childhood and hobbies.

Of course with hindsight it is now easy to read about the obvious failings in the case like the fact that no route of poisoning was identified. It would be interesting to see what the page said before her conviction was overturned, and how different the focus was!
Clearly, the court found the evidence shared sufficient and compelling enough to convict at the time.

 

[arrogantcat]

Child C does not appear to have been a suspected case.

"At the time, the consultant pathologist gave the cause of death as "widespread hypoxic/ischaemic damage to the heart/myocardium due to lung disease". UK - Lucy Letby Trial - Media, Maps & Timeline *NO DISCUSSION*

Case was reviewed by Dr Evans.

I’m not sure I understand. Weren’t most of the cases put down to ‘natural causes’ at the time? Most had a death certificate issues and things continued as normal.

It was only later, once the pattern had been identified, that the suspected cases were sent to Dr Evans for review. (Or have I totally misunderstood?)

 

[Tortoise]

I’m not sure I understand. Weren’t most of the cases put down to ‘natural causes’ at the time? Most had a death certificate issues and things continued as normal.

It was only later, once the pattern had been identified, that the suspected cases were sent to Dr Evans for review. (Or have I totally misunderstood?)

I was responding to your factual assertion that "only the suspected cases were reviewed".

It might appear that all cases were reviewed.

 

[Legally Bland]

3:46pm

Mr Myers says 'never once' is an air embolus mentioned in Dr Evans's reports.
Dr Evans agrees.
Mr Myers suggests that Dr Evans has just made up information as he has gone along.
"You keep saying that, and I keep disagreeing."
"And you're not an independent witness at all, are you?"
"And again, that is just being insulting."

3:50pm

Independent medical expert Dr Sandie Bohin has returned to court to give evidence, this time for Child C.

3:52pm

Dr Bohin confirms, after being asked by Mr Johnson, she has received and reviewed all the case evidence, including from doctors' witness statements.

3:55pm

Dr Bohin says her role was not to 'rubber-stamp' anything, but to come to her own conclusions and see whether they agreed with that of Dr Evans.
She said she set out what she thought were the improtant facts for Child C. They include an x-ray taken on June 12 following the insertion of a long line.
She noted the long line was in a "low position", but in a "usable position". The stomach looked swollen and had a distended bowel.
She said initially she could not see a naso-gastric tube on the x-ray image on her laptop, but from viewing the x-ray image shown in court in higher resolution, she could detect it was present, 'very high', in 'not an ideal position'.

4:01pm

Dr Bohin is asked about her conclusions regarding Child C.
She said it was known Child C was premature, growth restricted at birth, and 'potentially at risk of complications', but 'managed very well indeed' in his early days, improving to being put on Optiflow. He had 'clearly not liked' being on CPAP, and had been put on skin-to-skin contact with his parents, without CPAP for a couple of hours, and had done well during those times.
"This was not a baby who was ill, this was a baby who was improving."
Dr Bohin noted Child C "clearly" had an infection, which was "an alerting feature" and for which the medical team treated him with antibiotics and did an x-ray confirming left lung pneumonia.
Despite that, Child C had appeared to respond to treatment due to the lessening of respiratory support.

4:03pm

Dr Bohin said it was "very clear" Child C had pneumonia, but a baby with pneumonia will "often survive", but a sign of that will be that they would slowly deteriorate, going from CPAP to ventilator support, increased heart and breathing rate.
Child C's breathing rate was "very stable", despite "effectively breathing with one lung".
Dr Bohin's conclusion was that he had pneumonia, but that did not cause the collapse or kill him.

4:04pm

Dr Bohin said pneumonia would be a factor in the difficulties in response to resuscitation.
She tells the court there would be a sign something was "amiss" prior to the collapse, and a sudden unexpected collapse would be uncommon in babies.

Recap: Lucy Letby trial, Tuesday, November 1

THE trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk