UK - Nurse Lucy Letby, murder of babies, 7 Guilty of murder verdicts; 8 Guilty of attempted murder; 2 Not Guilty of attempted; 5 hung re attempted #38

[Marantz4250b]

The original discussion with the police was quite clear that the existing nursing contingent was expected to deal with many more babies who were more vulnerable than usual. Four nurses normally looking after 5-10 babies now expected to look after up to 20 babies at a time, with a trend towards lower birth weights.

https://thirlwall.public-inquiry.uk/wp-content/uploads/thirlwall-evidence/INQ0102298_3,4.pdf

This may be so but what relevance is it as to her guilt or innocence? It is nothing more than a random fact - a coincidence - and coincidence is meaningless.

 

[WaneLyrical]

This may be so but what relevance is it as to her guilt or innocence? It is nothing more than a random fact - a coincidence - and coincidence is meaningless.

It’s only meaningless if you are convinced there was an individual causing deliberate harm to patients.

If you are not convinced of that, then it becomes a core part of a wider set of circumstances whereby the unit was spread so thinly that signs were missed and actions were too often delayed or not performed to an adequate standard. Which is the fundamental argument within Shoo Lee’s assessment of the medical evidence.

 

[Marantz4250b]

It’s only meaningless if you are convinced there was an individual causing deliberate harm to patients.

If you are not convinced of that, then it becomes a core part of a wider set of circumstances whereby the unit was spread so thinly that signs were missed and actions were too often delayed or not performed to an adequate standard. Which is the fundamental argument within Shoo Lee’s assessment of the medical evidence.

With respect, no that's not correct. A simple coincidence of facts does not prove that one caused the other. It simply cannot.

In order to prove that staff shortages were relevant then you need to show how those shortages directly caused the deaths, collapses and injuries. An example might be of a patient collapsing or dying because every available person was dealing with another emergency and that that would not have been the case were there more staff present.

You need to demonstrate that no one was available at that precise moment and that the lack of available staff was the direct cause of the death. To my knowledge that has never been alleged by anyone, let alone the defence.

Also, as I have pointed out, understaffing could never be the cause of insulin being added where it shouldn't be or the infliction of traumatic injury. It just can't.

If you can't show that then any staff shortage is irrelevant as a causal factor. Two circumstances existing at the same time are meaningless - you may as well say that a lack of Cherry Coke in the vending machine was the cause were it extant at the same time as a medical event.

So, can you explain to us, precisely and specifically, how the (alleged) lack of staff was the direct cause of the various deaths and collapses?

 

[marynnu]

The original discussion with the police was quite clear that the existing nursing contingent was expected to deal with many more babies who were more vulnerable than usual. Four nurses normally looking after 5-10 babies now expected to look after up to 20 babies at a time, with a trend towards lower birth weights.

https://thirlwall.public-inquiry.uk/wp-content/uploads/thirlwall-evidence/INQ0102298_3,

dbm

 

[marynnu]

The original discussion with the police was quite clear that the existing nursing contingent was expected to deal with many more babies who were more vulnerable than usual. Four nurses normally looking after 5-10 babies now expected to look after up to 20 babies at a time, with a trend towards lower birth weights.

https://thirlwall.public-inquiry.uk/wp-content/uploads/thirlwall-evidence/INQ0102298_3,4.pdf

There were never 4 staff looking after 20 babies. This is a pointless argument as even Letby herself acknowledged that staffing was not an issue.
A poorly staffed shift leads to things like drugs or feeds being given late, staff missing breaks, phone calls unanswered, no time to talk to parents etc. (none of which appears to have been the case at Chester). Not babies collapsing/dying

 

[Ruthbullock]

With respect, no that's not correct. A simple coincidence of facts does not prove that one caused the other. It simply cannot.

Yet there is a POV that this whole thing started through a simple coincidence of facts?
You may have no interest in what the staffing figures were, it doesn’t mean they aren’t of interest to others on this post and discussions about the overall functionality of the unit. If I wanted to directly link it to specific babies and it causing their death, I wouldn’t use generalisations, I would look for specific examples relating to lack of staffing for individuals.
We read the posts saying all NNU units were understaffed so that was normal- I was curious how normal this was at the time ,and even in units that were short staffed, did that apply to all units across a region, as it did in this area.

It’s almost pointless at this point for anyone on here to argue they weren’t understaffed and stretched thinly and that didn’t have an indirect impact on identifying the cause of these collapses, as every doctor and consultant in the inquiry has used that argument to support why they didn’t take certain actions that they should have done. Even if you strongly believe in her guilt, a discussion is still to be had about why it took so long to reach the point of a referral to the police and if you have followed the inquiry, a lot of the basis for this delay was missed opportunities for reporting and escalating.

Dr G’s testimony is interesting in that he was the predecessor to Dr J taking up the lead role, he is clear that when he was in the role he attended all the weekly meetings and had a really strong relationship with management and this changed when Dr J was appointed and that he often missed meetings and the relationships weren’t as coherent. That is not all down to Dr J, but also down to how they restructured the department at the time. We often hear reference to the fact that when LL was removed from duty it coincided with the downgrading of the unit, but the unit was also downgraded when they did the restructure, prior to child A. The restructuring caused staffing issues and relationship issues across the departments and also subsequently was changed back, at the same time as the unit was downgraded even further for a second time in 24 months.

 

[katydid23]

Yet there is a POV that this whole thing started through a simple coincidence of facts?
You may have no interest in what the staffing figures were, it doesn’t mean they aren’t of interest to others on this post and discussions about the overall functionality of the unit. If I wanted to directly link it to specific babies and it causing their death, I wouldn’t use generalisations, I would look for specific examples relating to lack of staffing for individuals.
We read the posts saying all NNU units were understaffed so that was normal- I was curious how normal this was at the time ,and even in units that were short staffed, did that apply to all units across a region, as it did in this area.

It’s almost pointless at this point for anyone on here to argue they weren’t understaffed and stretched thinly and that didn’t have an indirect impact on identifying the cause of these collapses, as every doctor and consultant in the inquiry has used that argument to support why they didn’t take certain actions that they should have done. Even if you strongly believe in her guilt, a discussion is still to be had about why it took so long to reach the point of a referral to the police and if you have followed the inquiry, a lot of the basis for this delay was missed opportunities for reporting and escalating.

Dr G’s testimony is interesting in that he was the predecessor to Dr J taking up the lead role, he is clear that when he was in the role he attended all the weekly meetings and had a really strong relationship with management and this changed when Dr J was appointed and that he often missed meetings and the relationships weren’t as coherent. That is not all down to Dr J, but also down to how they restructured the department at the time. We often hear reference to the fact that when LL was removed from duty it coincided with the downgrading of the unit, but the unit was also downgraded when they did the restructure, prior to child A. The restructuring caused staffing issues and relationship issues across the departments and also subsequently was changed back, at the same time as the unit was downgraded even further for a second time in 24 months.

NONE of the above had anything to do with the 27 collapses LL was charged with. Those specific babies had designated nurses with 3 to 5 babies to look after. NEVER 20 babies.

These specific babies had observation logs filled in every 20 or so minutes by their nurse. They were not being overlooked or neglected.

So the above complaints about doctor's leadership meetings and department restructuring had ZERO relevance to these 27 unexplained collapses. Nurse Letby faked some of her observation logs, lied in court about many of her actions, lied about what time Baby E's mother arrived to the nursery and lied about what time Baby E began actively bleeding from his mouth.

Those ^^^ are the facts that are relevant to these charges.

All of your points about the failure to report these suspicions to the police are well taken and NEED to be improved and re-structured. But it is not helpful to keep trying to make Nurse Letby be an innocent, unfairly accused victim, when the evidence has clearly shown she was anything but. IMO

 

[joltz]

It’s only meaningless if you are convinced there was an individual causing deliberate harm to patients.

If you are not convinced of that, then it becomes a core part of a wider set of circumstances whereby the unit was spread so thinly that signs were missed and actions were too often delayed or not performed to an adequate standard. Which is the fundamental argument within Shoo Lee’s assessment of the medical evidence.

Going back to the trial. Staffing levels were shown not to be a contributing factor in almost every instance. The prosecution directly asked this question in every collapse. From previous posts COC was in a similar situation to most units up and down the country, and slightly above average in comparison to other units in the area. Staffing levels don't make babies have sudden unexpected cardiac arrests and lack of response to resuscitation.

 

[Ruthbullock]

NONE of the above had anything to do with the 27 collapses LL was charged with. Those specific babies had designated nurses with 3 to 5 babies to look after. NEVER 20 babies.

These specific babies had observation logs filled in every 20 or so minutes by their nurse. They were not being overlooked or neglected.

So the above complaints about doctor's leadership meetings and department restructuring had ZERO relevance to these 27 unexplained collapses. Nurse Letby faked some of her observation logs, lied in court about many of her actions, lied about what time Baby E's mother arrived to the nursery and lied about what time Baby E began actively bleeding from his mouth.

Those ^^^ are the facts that are relevant to these charges.

All of your points about the failure to report these suspicions to the police are well taken and NEED to be improved and re-structured. But it is not helpful to keep trying to make Nurse Letby be an innocent, unfairly accused victim, when the evidence has clearly shown she was anything but. IMO

I’m not trying to prove LL is innocent and you should try not to interpret my posts to imply that- I have no idea whether she is or not. I’m discussing whether the conviction could have been more secure, whether if certain things had been made apparent in court the outcome would have been the same, what lessons might be learnt through the inquiry.

 

[Ruthbullock]

The prosecution directly asked this question in every collapse.

I don’t suppose you can remember, or do we even know, which aspects of sub optimal care the prosecution did agree with from the defences opening statement?

“Examples of sub-optimal care for babies previously mentioned and conceded by the prosecution are relayed to the jury.

"There are many other examples of sub-optimal care of babies in this unit," Mr Myers.”

 

[Ruthbullock]

“Mr Myers says it was accepted by the prosecution there was sub-optimal care in the cases of Child D and Child H”

From the defences closing statement.

There are then numerous other examples given, but these were not accepted by the prosecution:
“
He says for Child A, there was a 'four-hour' "delay in fluids", and the "line was placed too close to his heart" and was 'not in the optimal place'. "There is plenty of sub-optimal care knocking about in this unit". He says some of the sub-optimal care is 'more contentious than others'. He says there is a "list" for Child H, including the second chest drain for Child H. 'Poor management of stomas' for Child J, and not moving Child K to a tertiary centre, a failure to have factor 8 ready for Child N, 'mistakes in ventilation' and 'getting the doses of adrenaline wrong' for Child P. Failure to react to 'dark bile aspirates' for Child C for 24 hours. He says Child Q was moved to a tertiary centre after three bilous aspirates. He says that is on top of 'babies not being in the right place'. He says babies like Child G and Child I were "prone to serious problems" and "not always" looked after sufficiently qualified staff. He says 'with one exception', senior consultants refused to accept anything was wrong in the 12 months, except for one doctor who failed to attend an emergency as quick as she should have been in the case of Child E.“

I don’t suppose you can remember, or do we even know, which aspects of sub optimal care the prosecution did agree with from the defences opening statement?

“Examples of sub-optimal care for babies previously mentioned and conceded by the prosecution are relayed to the jury.

"There are many other examples of sub-optimal care of babies in this unit," Mr Myers.”

 

[May72031]

I’m discussing whether the conviction could have been more secure, whether if certain things had been made apparent in court the outcome would have been the same, what lessons might be learnt through the inquiry.

Not sure why you have such a focus on staffing levels then, considering the trial showed staffing levels had no relevance to the incidents/deaths.

And it doesn't matter if Myers claimed there were examples of "sub-optimal" care, because at no point was it demonstrated that "sub-optimal" care caused any of the incidents or deaths.

The examples of sub-optimal care you - and Myers - cite(d) are common in units up and down the country. We would expect to see similar spikes in incidents and deaths if this type of "sub-optimal" care was responsible.

 

[Ruthbullock]

Not sure why you have such a focus on staffing levels then, considering the trial showed staffing levels had no relevance to the incidents/deaths.

And it doesn't matter if Myers claimed there were examples of "sub-optimal" care, because at no point was it demonstrated that "sub-optimal" care caused any of the incidents or deaths.

The examples of sub-optimal care you - and Myers - cite(d) are common in units up and down the country. We would expect to see similar spikes in incidents and deaths if this type of "sub-optimal" care was responsible.

I could ask the same question of yourself- why are you so determined to not discuss it? Even after the prosecution agreed in 2 children there was sub optimal care before the trial. My thought process may seem odd to you, but it’s logical to me when taken in relation to testimony at the inquiry. I may well end up at the same point that you already are at, it is just taking me longer to have a strong opinion and no more questions to be asked.

To counter one point you have made- you remind us that “at no point was sub optimal care the cause of any incidents or deaths”- you can’t possibly know this from the trial, it was not part of the trial, no one else was being investigated and no one else was on trial. You have willingly dismissed what the defence said about sub optimal care, and the prosecution is hardly going to destroy their own case by ever bringing up sub optimal care.
Will the inquiry find more than the 2 cases that the prosecution agreed with that involved sub optimal care, IMO they will and if more of the cases in the original trial had been put forwards with the prosecution accepting sub optimal care- do you believe that the jury would still have come to the same conclusions? Or do you believe that the inquiry won’t find further examples of sub optimal care and I’m barking up the wrong tree?

 

[Ruthbullock]

It certainly seems that this registrar agrees with my POV page 140

https://thirlwall.public-inquiry.uk/wp-content/uploads/2024/10/Thirlwall-Inquiry-2-Oct-2024.pdf

“LANGDALE: You set out at 67 a number of recommendations you think would be beneficial. Your first is a broad cultural change within the Ministry of Health and executive boards mandating that concerns of senior clinicians are listened to and that patient safety is prioritised over all else. Would you like to expand on that?
MAYBERRY: Yes, sure. I think with regard to that comment what -- maybe what I haven't said explicitly there is that the level, firstly, the level of staffing wasn't sufficient; certainly at a Registrar level and that while it seemed from my level like the Consultants were trying to improve that situation how much engagement there was further up, I am not entirely sure and that's probably a question I guess for them. Certainly the thing about locum caps and things like that it wasn't a particularly safe initiative to -- to drive down the supply of doctors looking -- looking for locums. And I think the last thing I am referring to in it is probably whether it's been broadly publicised now of Consultants raising their concerns at an earlier point in time. From what I can tell in what's been written in the media felt that that wasn't addressed in sufficient time.“

 

[Ruthbullock]

Dr ZA has a differing opinion, I wonder if this information that was originally excluded from this initial review has since been added to the analysis- not that we have eyes on it- page 57

https://thirlwall.public-inquiry.uk/wp-content/uploads/2024/10/Thirlwall-Inquiry-7-October-2024.pdf

“DE LA POER: What was the central point that you Consultants made at the meeting about the data?
DrZA: There was some data about staffing levels and the deaths, but it seemed that many of the deaths had happened on the days with better staffing levels as opposed to fewer staff. And although we had -- we had agreed that we had been busier, the nature of the deaths weren't explained by the increased acuity.

DE LA POER: Did the data take into account whether the deaths were expected or unexpected, explained or unexplained?
DrZA: No, and didn't take the gestation of the babies into consideration either when a lot of the babies who'd died were still premature babies but the less extreme prematurities where it's more unusual for children to die.”

 

[May72031]

I could ask the same question of yourself- why are you so determined to not discuss it?

Simple. The staffing levels have nothing to do with Letby's attacks on the babies. The staffing levels issue is irrelevant compared to say, the management repeatedly trying to get Letby back on duty, and blocking the concerns of the whistle-blowers.

 

[Ruthbullock]

So Dr ZA later in her testimony acknowledges they were at breaking point with staffing
“DE LA POER: If we move forward to page 5, please, please, three quarters of the way down the page, there is a line ending "PJ", being a reference to Mr Jameson.
DrZA: Yes.

DE LA POER: Do you see that?
DrZA: Yes.

DE LA POER: "PJ felt the paediatric service was almost at breaking point and needed support before it hits the point of burn out." Does that resonate with your experience at around that time?
DrZA: Yes, it does.

DE LA POER: Obviously we're not just seeking here specifically about the neonatal unit, this is the whole paediatric --
DrZA: This is the whole paediatric department.”

“DrZA: We were very busy. There weren't enough Consultants for the workloads that we were doing. We also didn't have enough junior doctors, and that meant that we -- it was relatively common that the Consultants would have to act down to cover vacant junior doctors' shifts, which was important to assure the acute safety at that particular time. But that did mean that there was less time for the non-urgent clinical tasks because everything was done to sort of a prioritise that acute safety. But it did mean partly that Lucy could hide what she was doing within people being generally busy. It also meant there was less time for the non-urgent acute things like reviewing the deaths afterwards and reviewing other incidents because we were so busy just trying to cover the acute service.”

 

[Ruthbullock]

Perhaps Dr B should have read the management review before getting all pushy over his own thematic review- I would suggest management were looking into things far more impartially than Dr B was, and who attends a meeting without reading what you have been copied into previously????

Dr B’ staff association questioning: pg 128

“LANGDALE: So you got that, you had got the Letby association with the staff association document?
BREAREY: Yes. So, I mean, essentially the Thematic Review I felt had enough information in it to take some action and the assurance document that had been created by Eirian Powell and Karen Rees essentially with a sort of counter to it, if you like, that they created the week before and it got quite heated, the meeting. I was taken a little bit surprised because I hadn't read their document beforehand and Ian Harvey and Alison Kelly were quite passive throughout the whole meeting, really and they didn't interject too much with things. I made it very clear it wasn't just my own individual view, it was the views of my -- all my colleagues, concerns about this and I was very much hoping that the Executives in the room could bring some oversight and objectivity to the discussion.”

The review/ meetingfrom the previous week by management- Dr B is noted as attending, but denies being there and his response to the minutes of the meeting are below: pg 123

“BREAREY: Well, the first sentence saying there is no evidence whatsoever other than coincidence overlooks the timing of the deaths and the sudden/unexpected nature of the deaths. The increase in numbers above anything we'd expected and the rashes that we have discussed already, although that wasn't at the forefront of my mind at the time. The second sentence says there was no performance management issues and no members of staff have complained to me about her regarding performance, we now know about the -- I didn't know at the time, about the morphine overdose or any other issues that have come to rise since then because during risk management meetings we don't identify the member of staff that have made those mistakes in the meeting. It is up for the unit manager and senior nursing staff to address that with the individual member of staff. So I wasn't aware of her name with that one. But clearly there were performance issues, so 3: "I found LL to be diligent and of excellent standards within the clinical area." Well, I couldn't really argue with her at the time which made it more worrying in a way that if there was no concerns regarding her clinical competence, what was the cause of her association with the deaths? Number 4: "Whilst our mortality rate has risen in January 15 to January 16 we have had three mortalities from January 16 to date. Two have died due to congenital abnormalities." I mean, the babies had congenital abnormalities but the point and the level of concern was that it wasn't clear from the postmortem results that those congenital abnormalities led to the sudden collapses. Dr H and Dr G is Dr Harkness and Dr Gibbs, appear to be involved in many mortalities. Well, they were involved more than some of the other doctors but it was still less than half of the episodes that Letby had been involved with. And I did explain in the meeting on May 11th regarding the fact that Consultants tend to come along towards the end of a resuscitation or certainly not at the beginning, when -- when juniors have escalated concerns to us and we are attending, so it makes it less likely that even if Dr Gibbs is there on a number of occasions he was actually there at the beginning when the collapse occurred. So that didn't seem to make any sense. Number 6: "Cheshire and Mersey Transport Service have been involved in a few of these mortalities and they may have survived if the service was running adequately." I don't think there was any evidence that a delay in a transport caused a death or led to a death; that was established with all the cases and obviously the transport service had problems to all the other neonatal units in the region who hadn't seen an increase in our mortality. 7: "Alder Hey Children's Hospital's failures in facilitating a cot also add to the complexities of these mortalities. If there been a bed sooner, the infant may not have died." I don't think there was any evidence for that in any of the cases. Number 8, "some of the issues related to midwifery problems." Well, there were some items of care that might have been improved on in terms of midwifery but certainly none that related to something that might have caused a mortality. Number 9: "Two of the babies' postmortems diagnosed congenital pneumonia." And it's attributed to transport team issue. I don't actually understand what she's trying to get at with that and the children with congenital pneumonia were improving and stable and getting better a number of days after treatment before they collapsed and died. Number 10: four babies had congenital abnormalities. It's a repeat of point 4 which I have mentioned already. Number 11 on maternal syndrome, I am assuming that was the mother of [Child A] and B., where we may have been still waiting for the Coroner's Inquest for that baby but certainly not a common theme at all. Point 12, two with possible necrotising enterocolitis. We had one without a PM with this and [Child I] must have been the other one, but we didn't have a PM result by then, well, I did not, I didn't have sight of it, although it had actually been completed in February 2016.”

As much as my initial response to the trial was that management should have done more- I now struggle to see that this was the reality. I do think management took time to investigate and get external reports done, and we can’t forget they were also the ones who went to the police, still not the consultants who by that point were so convinced- so why did they still not report it? Why did the police have to contact them and request they come in to help them decide whether to investigate criminal behaviour?

https://thirlwall.public-inquiry.uk/wp-content/uploads/2024/11/Thirlwall-Inquiry-19-November-2024.pdf

 

[joltz]

Simple. The staffing levels have nothing to do with Letby's attacks on the babies. The staffing levels issue is irrelevant compared to say, the management repeatedly trying to get Letby back on duty, and blocking the concerns of the whistle-blowers.

We don't have to worry because the people that had a legal obligation to look into this such as the prosecution, the police, the CPS etc put thousands of man-hours into finding out the causes and that is why Letby is in prison with 15 whole life orders. It doesn't really matter if random people online want to keep on talking about "staffing issues" and "sub-optimal care" imo, they are incapable of seeing anything other than Letby being innocent and will fit everything around that. It won't change anything. It's just repeating the same old things we've heard before, nothing new.

Just MHO

 

[WaneLyrical]

With respect, no that's not correct. A simple coincidence of facts does not prove that one caused the other. It simply cannot.

In order to prove that staff shortages were relevant then you need to show how those shortages directly caused the deaths, collapses and injuries. An example might be of a patient collapsing or dying because every available person was dealing with another emergency and that that would not have been the case were there more staff present.

You need to demonstrate that no one was available at that precise moment and that the lack of available staff was the direct cause of the death. To my knowledge that has never been alleged by anyone, let alone the defence.

Also, as I have pointed out, understaffing could never be the cause of insulin being added where it shouldn't be or the infliction of traumatic injury. It just can't.

If you can't show that then any staff shortage is irrelevant as a causal factor. Two circumstances existing at the same time are meaningless - you may as well say that a lack of Cherry Coke in the vending machine was the cause were it extant at the same time as a medical event.

So, can you explain to us, precisely and specifically, how the (alleged) lack of staff was the direct cause of the various deaths and collapses?

I’ve never said a lack of staff was a direct cause of various deaths and collapses.

I think it is a contributory factor to the numerous delays and mistakes with these babies. But clearly this was business as usual for the unit, as everyone points out again and again, delays and mistakes are acceptable in the NHS.