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

[Marantz4250b]

I don't understand the assumption that this case was formed because Letby was present for every collapse. The staff working with her didn't even seem to know someone was deliberately harming babies at first.

The prosecution has said that her presence at every event is the basis of their case - "constant malevolent presence" is the phase I think they used. If Dr J is to be believed then he had his suspicions of her when she was still working there. She was moved to day shift to "test" the theory that she was harming patients. Then she was put on admin duties. It is inconceivable that this wasn't all communicated to the police the minute they were called in, I think.

From the way the prosecution is presenting its case, I think it's quite obvious that Lucy Letby was the main person of interest right from the off.

 

[merrypason]

The prosecution has said that her presence at every event is the basis of their case - "constant malevolent presence" is the phase I think they used. If Dr J is to be believed then he had his suspicions of her when she was still working there. She was moved to day shift to "test" the theory that she was harming patients. Then she was put on admin duties. It is inconceivable that this wasn't all communicated to the police the minute they were called in, I think.

From the way the prosecution is presenting its case, I think it's quite obvious that Lucy Letby was the main person of interest right from the off.

Yes she was a person of interest. That's how any performance management system would have kicked in - if any one person has a larger than expected set of adverse outcomes, they need to be investigated. Surely, we can't be expecting management to ignore it, they have a duty of care to patients. Even if it wasn't murder, they might have realised she's just incompetent as a result of it.

So the RCPCH were brought in who said the unexplained deaths needed further review. Then the police were brought in who brought in the NCA, who brought in two external experts. And if there wasn't anything suspicious in the notes or investigation, and every death could be explained away from medical causes or negligence or equipment failure, she wouldn't be on trial. Even if the experts knew it was a criminal investigation, they didn't know who was suspected - it could have been a doctor, janitor, anyone. They reviewed 33 cases and only some of them have been charged - that means there were plenty they ruled out as murder/attempted murder.

As I've said previously, a lot of the cases she wasn't even the designated nurse. They weren't technically her patients. So the only way to have uncovered every case she was present at was to review all the cases with unexplained deaths or collapses to see where she signed for something or a note was made.

This is why the defence are fighting the charges on medical evidence, not statistics. Because statistics may be what created suspicion but the medical reviews, expert testimony, evidence from her colleagues, messages are what have led to her being on trial.

 

[MsBetsy]

A summary from the defence. Lucy Letby trial: 'Sub-optimal care at Countess hospital' a factor in baby collapses, defence say

Includes direct reference to “Mr Myers addressed the issue of Letby being present at all the apparent collapses and deaths.

He said: “We say there are many occasions when Lucy Letby was simply not there when she had to be present if she was doing the deliberate harm alleged.

“She was a young woman with no immediate family commitments and someone who built her life around her work in a neonatal unit.

“Someone in that position is more than likely to be looking after the more clinically challenged babies and more likely to be there when deterioration happened, but it doesn’t mean she made it happen.”

I don't remember which specific incidents the defense claimed she wasn't there for. Even when LL could not recall being in the room for some, she later admitted she was, at least from what we've heard so far.

 

[Tortoise]

The prosecution has said that her presence at every event is the basis of their case - "constant malevolent presence" is the phase I think they used. If Dr J is to be believed then he had his suspicions of her when she was still working there. She was moved to day shift to "test" the theory that she was harming patients. Then she was put on admin duties. It is inconceivable that this wasn't all communicated to the police the minute they were called in, I think.

From the way the prosecution is presenting its case, I think it's quite obvious that Lucy Letby was the main person of interest right from the off.

I think that's misconstruing the words of the prosecution. Yes they used the words malevolent presence and reinforced it at every event, but not "that is the basis of our case", that would be to ignore all of the evidence which they intend to prove.

Perhaps you are thinking of statements like - "We also say that you are entitled to look at the evidence of what happened to [Child A and B] in the context of one, what Lucy Letby did to other children and two, most starkly, her having poisoned [two other children] with insulin."

That isn't the same as what you are saying though. That is allowing the evidence to inform them of proclivity, if they are satisfied that A & B are proven beyond reasonable doubt.

MOO

 

[Tortoise]

I don't remember which specific incidents the defense claimed she wasn't there for. Even when LL could not recall being in the room for some, she later admitted she was, at least from what we've heard so far.

I remember one of the insulin cases is that they are alleging the contaminated nutrition prescription feed bag was hung by her and then she went off duty.

 

[Sweeper2000]

The factors that led to LL being on trial is the cases being forwarded to a pathologist who noticed the symptoms that pointed at air embolism. That’s after all investigations and after LL was put on clerical duties due to suspicion. Dr Ravi stated only pattern is presence of LL, defence has stated that as a issue. If defence is contesting that after seeing the prosecution’s evidence what else do the prosecution have to offer that isn’t already known to the defence?

 

[annpats]

Well, hasn't the prosecution already established she was there for all 22 incidents? Why would the trial take five more months if that's all there is to it?

Because just being there, even for all 22 incidents, is 'circumstancial evidence'.....and it actually has to be proven as to how she killed/attempted to kill all the babies. The prosecution need to have forensic evidence, and not just say 'Well, she was there!'

 

[merrypason]

The factors that led to LL being on trial is the cases being forwarded to a pathologist who noticed the symptoms that pointed at air embolism. That’s after all investigations and after LL was put on clerical duties due to suspicion. Dr Ravi stated only pattern is presence of LL, defence has stated that as a issue. If defence is contesting that after seeing the prosecution’s evidence what else do the prosecution have to offer that isn’t already known to the defence?

Not sure what you are saying here? LL is on trial for more charges than an air embolism? There were no investigations before she was put on clerical duty?

Dr Ravi is not the reason she's on trial. He and other clinicians like Dr G raised suspicions to management, and eventually they decided to put her on clerical duties while this was being investigated.

From the opening statement:

All the children involved in the case were in the neonatal unit and, Mr Johnson said, Letby "was either responsible for their care or got involved with them."

Mr Johnson: "Following those events, the consultants suspected that the deaths and life-threatening collapses of these 17 children were not medically explicable and were the result of the actions of Lucy Letby.

"No doubt they were acutely aware that making such an allegation against a nurse was as serious as it gets.

"They, at the time, did not have the benefit of the evidence that you will hear and the decision was taken by the hospital took the decision to remove Lucy Letby from a hands-on role. She was moved to clerical duties where she would not come into contact with children.

"The police were contacted and began a very lengthy and complex enquiry.

"This involved the police contacting independent paediatricians and other specialists to review many cases which had passed through the NNU at the CoCH. Following that review, the decision was taken to arrest Lucy Letby – the first arrest came in July 2018.

 

[MsBetsy]

Because just being there, even for all 22 incidents, is 'circumstancial evidence'.....and it actually has to be proven as to how she killed/attempted to kill all the babies. The prosecution need to have forensic evidence, and not just say 'Well, she was there!'

Yes, and forensic evidence is circumstantial as well.

But yeah, simply proving that a person was there for every incident is not proof unless it is backed up by other evidence. I just don't think investigators built their case based on her presence alone.

 

[MsBetsy]

I remember one of the insulin cases is that they are alleging the contaminated nutrition prescription feed bag was hung by her and then she went off duty.

Thank you. I thought there was one case where she was either out of the room or away from the hospital but I couldn't remember which one.

 

[Sweeper2000]

Yes, and forensic evidence is circumstantial as well.

But yeah, simply proving that a person was there for every incident is not proof unless it is backed up by other evidence. I just don't think investigators built their case based on her presence alone.

Just out of curiosity. Do you think we have been informed of the worst that the prosecution has to offer in way of incriminating personal evidence like the note and fb searches? I think we have. We all knew about dr Ravi and LL being by the cot before we knew anything else.

 

[JosieJo]

Albeit the Mail ...this link gives a decent run down of the lengthy exchange between Dr Evans znd Myers.


"Ben Myers KC, defending Letby, suggested Dr Evans had changed his mind about Baby C's cause of death after subsequently reading the reports of other experts, including pathologist Andreas Marnerides, who carried out a post-mortem following his death."

I'm having a mind blank day today ...have we heard this pathologists report yet ?

Baby 'suffocated when Lucy Letby injected air into his stomach': trial

The child, Baby C, had pneumonia and needed some respiratory support but was considered stable by doctors at the Countess of Chester Hospital, in Cheshire.

www.dailymail.co.uk

 

[merrypason]

Albeit the Mail ...this link gives a decent run down of the lengthy exchange between Dr Evans znd Myers.


"Ben Myers KC, defending Letby, suggested Dr Evans had changed his mind about Baby C's cause of death after subsequently reading the reports of other experts, including pathologist Andreas Marnerides, who carried out a post-mortem following his death."

I'm having a mind blank day today ...have we heard this pathologists report yet ?

Baby 'suffocated when Lucy Letby injected air into his stomach': trial

The child, Baby C, had pneumonia and needed some respiratory support but was considered stable by doctors at the Countess of Chester Hospital, in Cheshire.

www.dailymail.co.uk

Nope! Pathologist and radiologist still to testify.

 

[MsBetsy]

In my opinion the circumstantial evidence is very strong in this case.

I have seen people who have been convicted in the UK, with less circumstantial evidence than we have seen in this case.

Some people seem to think that this kind of evidence can't be good or reliable. I'm sorry but it's very effective at securing a conviction. We shall see won't we.

And those cases were without the amount of experts we have in this case. Which the defence has not really disproven in any effective manner to be honest.

Obviously each case is separate and on its own merit.

Yes, Circumstantial 'no body' cases have an 86% rate of conviction in the US. I don't know about the UK, but in this case, they have autopsy reports on several babies, as well.

Usually it is the strongest circumstantial cases that are brought to trial because the prosecution needs to ensure a conviction.

 

[Supernovae]

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?

From my lay understanding I think there may be an error in the way the journalist is reporting it in that I suspect it's actually supposed to be "splinted" rather than "splintered" diaphragm. As I understand it it's not being suggested that there was lasting damage to the diaphragm (or what would have been lasting had the baby lived). The suggested mechanism is that the presence of large amounts of air in stomach and the pressure resulting from that prevents the diaphragm being able to expand as it would need to to breathe effectively. That's what the word "splinting" means.

Splint (medicine) - Wikipedia

en.wikipedia.org

 

[JosieJo]

Nope! Pathologist and radiologist still to testify.

Thanks thought I was losing the plot but their exchange makes sense now

 

[JosieJo]

From my lay understanding I think there may be an error in the way the journalist is reporting it in that I suspect it's actually supposed to be "splinted" rather than "splintered" diaphragm. As I understand it it's not being suggested that there was lasting damage to the diaphragm (or what would have been lasting had the baby lived). The suggested mechanism is that the presence of large amounts of air in stomach and the pressure resulting from that prevents the diaphragm being able to expand as it would need to to breathe effectively. That's what the word "splinting" means.

Splint (medicine) - Wikipedia

en.wikipedia.org

Makes sense ! ... I couldn't understand how he hadn't known previously about an injury

 

[Supernovae]

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?

This is absolutely key to me in terms of what his medical testimony adds, or doesn't, to the other prevailing evidence. He's not getting these proposed mechanisms from direct physical evidence, he's come to the conclusion that there must be foul play because of the lack of a clear natural mechanism, because of the unusual clinical course, the weight of cases, or some combination of the above. He's then gone back and postulated biologically plausible mechanisms, after the fact.

 

[Supernovae]

4:09pm

Dr Bohin says babies on CPAP can have CPAP belly, and in order to minimise that, they would aspirate the NGT.
"It is usual practice to note down the volumes of air aspirated to give colleagues an idea [of how much air is coming out of the baby]."
"I couldn't find any evidence of that [in the notes]."
She adds that, for babies not fed, the nursing staff would put the tube on free drainage so air could come out on its own, as well as actively aspirate every four hours or so. She says there was only 'fleeting mention' of free drainage.
If neither of those things happen, Dr Bohin said that would lead to gas accumulation in the stomach.

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

4:11pm

Dr Bohin said it was not clear from the notes how long the 'free drainage' was in place.
She said one conclusion for Child C's collapse was CPAP accumulation of air, the other being deliberate injection of air.
She said the doctors did not appear to have a concern as they had noted the abdomen to be "soft".

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

Now this is interesting. Could it indicate a practice issue within the unit?

 

[Music2022]

With regards to the numbers aspect. The issue wasn’t just a higher number of deaths. It’s the nature of the deaths and collapses that was strange to the consultants. Sudden, unexpected and from unclear causes. Maybe if the same number of children died from regular and expected reasons there wouldn’t have been such suspicion.