I would recommend everyone interested in the Lucy Letby case to carefully study the 58 page appeal judgement – a board of three judges refused Lucy’s application to appeal. It is only 58 pages, it is well written and carefully argued… It is just built on heaps of false assumptions. What it says about the insulin evidence is particularly significant.
Three points specifically concern the insulin babies, babies F and L: points 14, 30 and 104 [and another on the evidence of Prof Hindmarsh, which I won’t go into right now.] Here they are in italics; my underlining.
14. A proposed ground 4 (that the jury were wrongly directed on evidence relating to the persistence of insulin in the bloodstream) was withdrawn following the refusal of leave to appeal by the single judge.
30. At trial, the integrity of the blood samples and reliability of the biochemical testing was challenged by Mr Myers. However, in her evidence at trial, the applicant [Lucy Letby!] admitted that both babies had been poisoned by insulin, but denied that she was the poisoner. The prosecution relied upon the unlikelihood of there being two poisoners at work on the unit. As the judge expressed it shortly before the jury retired to consider their verdicts: “If you are sure that two of the babies…had Actrapid, manufactured insulin, inserted into the infusion bag that were set up for them 8 months apart in August 2015 and April 2016 respectively, and you are sure that that was done deliberately, you then have to consider whether that may have been a coincidence, two different people independently acting in that way or were they the acts of the one person and, if so, who.”
104. The prosecution made some general points to rebut the allegations of bias and unreliability, including that almost every opinion given by Dr Evans was corroborated by another expert. In addition, it was pointed out that Dr Evans was the person who had identified that two of the babies had been poisoned by insulin (Baby F and Baby L). This was a matter which had eluded the treating medics and went to prove that someone was committing serious offences against babies in the unit; and it was particularly important independent evidence, bolstering Dr Evans’ credibility and reliability. Further, when Dr Evans reached his conclusions, he did so without knowing about other circumstantial evidence relied on by the prosecution in establishing guilt, including the applicant’s Facebook searches, the shift pattern evidence, and the “confession” in the note recovered from the applicant’s home on 3 July 2018
Richard’s comment on point 30: the applicant was told during the trial that it had been proven that two babies had been poisoned. Her reply was not that she admitted this fact, it was more like “well if you say it is proven it must be true. But I didn’t do it”. Notice that for the prosecution, six experts all say that this was true: Evans, Bohin, Hindmarsh, Milan, Wark; the hospital doctors had concurred (Gibbs, in particular). The defence had apparently not even looked for an expert on the insulin matter. They had raised problems about the reliability of the tests but these are ignored because Lucy herself agrees that the babies were poisoned with hospital insulin.
How can a young nurse agree or disagree with a deduction made by half a dozen senior medics that the immunoassay results proved deliberate insulin poisoning? All doctors and nurses have been taught in doctors’ or nurses’ school something about insulin metabolism and know that the ratio of insulin to C-peptide (after someone has been fasting for three hours) should be about 1 to 6. They are not taught anything about the forensic determination of deliberate insulin poisoning, which tells us that an anomalous ratio is a warning sign for something that might have been happened but it should be followed up with completely different tests which exclude a numerous sets of artefacts which can each also cause an anomalous ratio of immunoassays’ numbers. The test result comes back from the lab with a warning note printed in red with exactly this information. It was ignored by hospital doctors. The specialists weren’t called in and never told about it. The babies were nicely recovering from their hypoglycaemia and were rapidly transferred elsewhere.
Note that according to point 14 the defence had submitted and withdrawn a “ground for appeal” concerning the insulin. [I don’t know what it was, someone should find out!]. Note that the insulin is seen by all concerned as proof of presence of a murderer on the unit. The court of appeal sees it as ludicrous to suggest there are two murderers on the unit! They believe that the other evidence (air embolism etc etc) proves Lucy is a murderer. The insulin evidence shows someone tried to murder babies F and L. There can’t be two murderers. Therefore Lucy also tried to murder babies F and L.
The logic of the argument is impeccable. Just the premises of the argument are wrong.
These points do show the utter incompetence of the defence team.
One of the prosecution experts (Gwen Wark) has even published a paper Marks and Wark (2013) with a concluding list of recommendations which state that the immunoassay only suggests a possibility; in order to prove it other tests must be done. https://pubmed.ncbi.nlm.nih.gov/23751444/ They were not done. No sample was saved so they never can be done. Both babies F and L are alive and well to this day though one has cerebral palsy … linked to problems experienced during birth.
At the trial Dr. Wark confirmed the other experts’ claim that insulin poisoning had been proven. How could she? What had she written in any written testimony provided pre trial to police or CPS? Richard Thomas (Lucy’s solicitor) says that the defence team can’t say whether or not any documents exist and whether or not they saw them. The jury is not shown any such documents.
People say “the jury was given so much more, information…”. That is quite simply not true. The jury in a UK criminal trial hears what is said and it observes the body language. That’s all. It does not receive copies of written testimony of scientific experts. (This is a consequence of “open justice” with a trial by a jury of your peers).
What was the fifth ground in the original application for an appeal? The one which a single judge scrapped and the defence team then scrapped too?
Maybe some journalist should chase after that. I’m afraid the defence team is unlikely to tell us. They are not obliged to, and they can only do it if Lucy instructs them to do so. And nobody is able to talk to her.
These are things I read.
Blood for the insulin-test was not taken from a vein, but from a line also used to administer medications. This can lead to valse readings. It was not transported as required for a forensic sample (timely, guarded conditions). The test-results came back with a disclaimer: Not Suitable for Forensic Purposes.
A technician from the lab stated later, that the measured value was the limit of the equipment. That could indicate a valse reading.
The hospital was informed of the value by phone. The lab advised that a different test was needed. But by then the babies had recovered. No more testing was done.
No one thought of foul play. These were premature babies who can have insuline levels spikes, also the mother had diabetes. No more research was done in what had triggered the events.
Dr. Brearey was given access to medical notes, patient information, etc. at Chester PD. Where he discovered the test results, included in the files of the babies. He thought the levels were high. As said, different re-testing was not done and, as the blood was discarded, no longer possible.
Dr. Brearey is not an endocrinologist. And neither is Dr. Evans.
Lucy attached a bag for one baby. When the (second) bag for the second baby was chosen, attached, Lucy was not on the ward. A third baby had apparently similar issues with insulin levels, also recovered.
If I am wrong somehow, somewhere, please let me know.
I think you are right, Antoinette
By the way, both Brearey and Evans claim to be the ones who discovered the immunoassay results. Both Jayaram and Evans claim to be the ones who cane up with the air embolism explanation of the curious rashes / mottling based on the same old paper of Lee and Tanswell. The Welsh paediatricians met in 2016 in Chester and several CoCH paediatricians presented papers. What a lot of coincidences!
Is it possible to predict/ describe how a vulnerable baby with Congenital Hyperinsulinism (CH) would react if the child’s condition was exacerbated by a severe infection? I understand that Alder Hey identify CH., as having ” persistently low blood glucose levels.
At the risk of exposing my lack of information, it seems to me that , even if the question that I have raised above, has never been researched it might be possible to comment on possible effects/reactions given experience of serious infection of children/babies/ older people who suffered from other undesirable physical illness. I am wondering whether the symptoms of infection ( eg., fever) could seriously interfere with test results?
I’ve been around for over 80 years and always heard ‘beyond reasonable doubt’. I have been a juror on three occasions and always found the jury room debate sensible and robust, but these were ‘ordinary’ crimes with real evidence. In one case we found a man not guilty of intending threatening behaviour because he had a kitchen knife in his car – not beyond reasonable doubt because his girlfriend gave an explanation. In another case the court usher made an inappropriate comment about the previously abandoned trial that we ignored and decided the defendant was guilty of only one minor offense out of five. I didn’t follow the Letby trial and looked into what went on only after a post by @lawhealthandtech that also mentioned you. I have not done clinical medicine but have done R&D with a great interest in science, my background. It seems to me that an ordinary jury would struggle in the case just as they would in cases of financial fraud. Did the jurors know that these babies were not just smaller versions of normal term babies but hot fully formed in many ways, especially having no effective immune system? To me the evidence suggested the Lucy was a dedicated, caring nurse who was distressed by the deaths and always felt she had not done enough. My worry goes beyond this case. I note that a man who was imprisoned for decades on a rape charge was found to be innocent. I did follow the Julian Assange case that was a total inversion of justice. The appeal process has to be less technically circumscribed. Proper justice is expensive and we should collectively accept that lest we sometime get caught in a false prosecution.
I have read a good amount of your report which raised a few points for me as follows :-
(1) Air Embolism. About a year ago I learned that a relevant doctor had never seen a rash anything like one that he had observed on a baby in his care in Chester. Despite this unusual experience . no notes were made and it appears that there was no further reference to it until an “academic paper” was produced on the subject some time later.
(2) The plumber was the only expert witness for the defence. I gather that he confirmed reports of a small number of leakages in the CoCH NICU and it is known that serious micro organisms arise from such problems ( and did). However, it would be interesting to learn what action to sanitise the unit was taken. I have not discovered any mention of it during this last year. A professional or Industrial cleanse should have been considered given the nature of the patients etc., I doubt whether this happened as it would probably would have been necessary to close the unit. If thorough, deep cleaning did not occur, bacteria in taps, sinks, crevices in floors and fittings etc., would have a good environment for increased development.
(3) While it is clear that air embolism can kill, there is no evidence that Lucy L., was involved in any way in such action. The support fot the opinion of Dr Dewi Evans came from another doctor who arrived at the conclusion that air embolism must have been an issue because everything else on the list of possibilities could be ruled out. Were there any other possibilities either known or unresearched ?
(4) The trial was based on mainly circumstantial evidence and some of that was unsound. It did not adequately consider the suggestion of infection ( or the facts) in the unit ( although I believe that one parent referred to an incident in the NICU) which might have led to a question of whether any murders had been committed). The court was only required to find the defendant guilty or not guilty when there was an alternative explanation.
More to read.
The unit was demolished and a new one was built – if I understood correctly.
Whilst I knew that it’s status changed and was no longer considered suitable for very vulnerable and premature babies I did not know that it had been rebuilt. That would suggest that the problems with the fabric of the building were considered to be .serious
Then-Prime Minister Gordon Brown announced plans in September 2007 for every NHS hospital to be deep-cleaned in a bid to tackle infections like MRSA and Clostridium difficile.
Health Secretary Alan Johnson said in early 2008 he expected all 169 hospital trusts in England to have said cleaning finished later that year. Even though official responses suggested almost one in ten would miss the deadline.
CoCH had an expensive deep cleaning costing £ 325,000, in 2008. Almost immediately afterwards it had a C.Diff outbreak on a surgical ward – over 26 people got ill.
It was later stated by some, that the method used for the deep-cleaning was an incorrect one.
CoCH decided to promote more and better handwashing.
According to statements from cleaners, the cleaning time at CoCH was brought down by the hospital around 2015, in efforts to economize.
CoCH stated it spends more than £2 million a year on cleaning.
How big the plumbing problems were is a bit unclear. Apparently there were back-ups, one made waste water flow back into the hand-washbasin(s). Another made pipes leak on the ward above the neonatal unit, causing spills to come in. According to the plumber there was a time he had to come in quite frequently. Some of the waste water should have gone to the sewer (containing human waste) apparently.
The prosecutor – a professional at using and twisting words – was no match of course for blue-collar Mr. Mansutti. He managed to make the plumber agree that the problem “was mainly in adjacent rooms”.
How on earth can a jury believe in 2024 that pathogens obey boundaries. Because by now we know how a viruses escaping a laboratory in Wuhan, China, traveled all over then world in just a few weeks time, and killed millions of people.
How Lucy’s defense missed bringing in an epidemiologist, a micro-biologist after Mr. Mansutti, is one of the big mysteries of this trial.
This is the problem with the adversarial legal system we have here in England. The prosecutor wasn’t interested in arriving at the truth, he was only interested in winning his case. Being at home in a court of law, as opposed to Mr Mansutti not feeling at all at home, the prosecutor was able to minimise his evidence, if not demolish it completely. Another example of the adversarial system during the Lucy Letby case. The Cheshire Standard reported one day that the prosecution team were celebrating like premier league footballers when Mr Johnson made LL cry during cross examination.
According to newspaper articles, the new unit will be officially opened next year (2025).
How many column inches are going to be written about Lucy Letby before things are settled. It is all so unedifying, so tasteless. Sorry to say it but it is not just the Letby is as guilty as hell crowd, it is also the Lucy Letby supporters. With Mark McDonald now Lucy Letby’s official barrister (giving his services for free by the way) I think that people should work from behind the scenes and with Mark McDonald. A little (a lot of) silence would be appropriate I think.
Mark McDonald knows very well that an application to CCRC is not enough. There must be a campaign at the same time to win hearts and minds of the public, including people in the worlds of medicine, law, and government. Otherwise the CCRC will do its best to do nothing. There are excellent contacts between members of Mark McDonald’s core team and people who are working with documentary film makers, talking to journalists, taking action in parliament and government. I’m a statistician and because of my public activities I can never be accepted as a court expert. I don’t want that role. There are plenty of statistical experts who can take that role. And plenty who will be prepared to.
You not only have the expertise of being a statistician, you have the experience of the Lucia de Berk case, I guess I should defer to you. That Mark McDonalds team is in contact with suitable people is good to hear, my problem is that others elsewhere are working independently of Mark McDonald. Some of them can undermine the cause. And some of them are ego driven. I am calling for collaboration and a worked out plan of action fronted by Mark.
I believe that the majority ( if not all) contributors to this site want a fair trial / justice for Lucy and the opportunity to , hopefully, convey to her ( plus her parents and friends) that there are many people who are far from being
convinced of any guilt.
Justice for Lucy will also be justice for the bereaved parents. Let us hope that it is not delayed.
We are all familiar with the statistics used as evidence in the trials of Lucy L., I have heard far less regarding infections at CoCH NICU. Have any relevant comparisons been made between CoCH and other similar units during the same period ? Was the incidence of infection the same as or above./ below the “norm”. Were the number of tests being carried out what might be expected ? Are these sort of statistics ever subject to audit ?
There seems to have been a preference for ruling out a cause of problems in the CoCH NICU – for which some evidence might exist – in favour of an alternative for which there is little evidence and that is circumstantial.
Just testing
I firmly believe that the majority of supporters of this site ( if not all) wish for a fair hearing for Lucy Letby (LL) based on clear and uncontroversial evidence. This would be in the interests of the bereaved parents, LL., and the UK’s justice system.
At the moment I gather that (a) no one saw LL., engaging in any “malpractice”; (b) she was well regarded by her colleagues before the environment at CoCH changed It has emerged that the unit was less than ideal for the care of very premature and vulnerable infants owing to lack of space and staff shortages etc., No doubt there was a wider shortage of suitable provision for these children which created problems for tertiary referral ..
I doubt whether anyone would doubt the levels of stress prevailing in the unit. And , it seems to me that all, the evidence regarding (a) and (b) above is also undisputed. Any controversy is about everything else.
From The Guardian today (10/10/24) “They argue that the chart represents a classic example of the “prosecutor’s fallacy”, in which an investigation starts with only a suspicion, and a case is built to support it, rather than all possible evidence and explanations having been rigorously explored.” This is precisely how the system works, the system being all elements – H. M. Constabulary, Crown Prosecution Services, and the courts themselves – of the criminal justice system. One only has to have limited knowledge of the police to recognise that they are invested in finding crime, they are not even handed. Similar story with CPS, and of course our courts are merely there to rubber stamp the police’s and CPS’s work. I leave the clever stuff to Richard and others, my contributions are based on believed insights into the nature of the human beings who collectively form our criminal justice system. They are, all of them, not fit for purpose.
Very possibly , finding the post-it notes was the “light bulb moment ” when no further investigation was considered to be necessary
This is so infuriating. Why did no one who knew exonerating facts speak up ?
– The therapist who advised her to write the notes.
– The people who knew there was a report about contamination on the ward (that was suppressed).
– The statistician who was almost hired by Chester PD.
– The people in the lab that did the insulin assay.
Read the testimonies of the mothers given in the Thirwall inquiry. Bad care before the birth, during the birth, after the birth. Bad care for the prematurely born children. The parents saw it happening. They asked the hospital for answers and were rebuffed. Many of them hired a lawyer. Then, a deus ex machina ! Lucy Letby, serial killer nurse.
Fear ? At some point in 2023 I read that no one ( presumably in the hospital) expected LL., to be arrested or charged with anything. However, once the ball was set in motion , intervention would have been very difficult .
Lucy was arrested three time, put in prison, the trial lasted ten months, then there was a second trial. There was time enough to intervene for those who had exonerating knowledge. At least Gill tried. Others should have taken his example. There is strength in numbers.
Dr. Evans evidence did not add up – overfeeding, insulin poisoning, air through a gastric tube. It could all have been proven incorrect with the available facts.
Dr. Brohin talked about children screaming because they had heart attacks – how did Lucy accomplish that ? Anyone ever ask her ? Myers KC did not.
What amazes me is the UK media. None of them asking hard questions, none of them doing proper research into what happened, none of them poking holes in Dr. Evans c.s. testimony. All regurgitating the official account. All going for cheap emotions. They are supposed to be the fleas in the fur ! Instead they are blogging and vlogging and podcasting.
I share your opinion and , as someone who is very unconvinced of Lucy L.s (LL.,) guilt , I am appalled at the gross injustice and the horror of her situation. I am also mindful of the bereaved parents who, believing that their vulnerable children died from natural causes, were some time later informed by the police that deliberate harm was involved.
I have faith in those who are doing good work to reveal fresh insights into the events at CoCH and of course this includes Richard Gill I hope that their work will produce the irresistible evidence that will secure an outcome of true and unquestionable justice for LL., . However, those involved are unlikely to move forward unscathed by the events during recent years
ON THE SUBJECT OF STATISTICS
An order that I placed with a well known firm has been duplicated and I am in discussion regarding the solution. However, as I am a very regular purchaser it might possibly be decided that I caused the error. However, I know that I ordered one item only. A weak argument and there are alternative possible reasons which could , , sensibly, be considered , However I thought of the statistical evidence in the case of Lucy Letby (LL) and wondered about the degree of confidence that could be expressed regarding this measure if applied to each of the methods used by LL., to physically harm vulnerable infants at CoCH as determined by the EW for the prosecution. I have probably not read every report but I have seen no figures in this connection. . It might be useful to suggest a reasonable and professional confidence level in the case of Insulin poisoning; air embolism etc., as it could apply to this case and if this measure is not already apparent.
PS.,
I should have added Confidence Level in EW., decisions compared with other explanations .
There were no “insulin poisonings”. The test that was used had a disclaimer “Not Suitable for Forensic Purposes”. The number the test gave was so high that the lab called CoCH to arn something was done incorrectly; re-testing using another method was advised. But the babies had recovered (although one has lasting damage ?) so more tests did not happen.
Overfeeding – has been debunked from day 1 by neonatal experts.
Air through the nasogastric tube – Dr. Evans himself has already walked back that idea.
Air embolisms. A theory based on a “talking paper” from 1986.
Have you read the statements from the mothers given in the Thirwall inquiry ? Read them and weep. Bad care before the birth, during the birth, after the birth. Bad care for the premature babies. In a cramped ward with a shortage of experiences nurses, doctors. Desperate parents in search of an answer why their child died, rebuffed by CoCH management. Many hired an attorney. Then, one day at six a.m., Chester PD rang doorbells to deliver the message: we found a serial killer nurse !
So many question, so few answers. E.g. when babies died, worrying CoCH, why were placentas not kept ? Why was no toxicology done during the autopsies of the dead babies ? Why was no blood/tissue kept for more testing ? How was sepsis “excluded” ?
The situation is riddled with questions and there was, in addition, faulty monitoring equipment in the unit which ( depending on the fault) could have led to some staff over/underestimating the condition of their very young and vulnerable patients.
Almost no one wished for the calamitous, catastrophic fiasco that has occurred with its life changing consequences.
I also ponder on the testing regime and how it was possible to eliminate “Infection” from the possible causes of death. The answer could depend on how deaths were reported to the Coroner. but there are other explanations.
Regarding my earlier comments, I wonder whether expressing the diagnosis of the EW., in terms of confidence levels compared with the alternative cause of death possibilities ( such as an infection but not exclusively) might be useful. I would expect to find that the confidence level in connection with air embolism plus others would be considerably lower than other possibilities that did not depend on the presence of malign motivation.
I hope for an indication of better news soon.
Nothing is quite as it seems. And, a bit like ” The King.s Magic suit of Clothes”, it is unmentionable. Added to that the “EW” , on his own admission was not an expert in the specialty.
Autopsies were done, NEC an/or pneumonia were detected and for five children the death was attributed to this, for a sixth baby the cause of death was “uncertain”. The coroner accepted these findings and the verdict was death by natural causes.
During the Letby trial Dr. Marnerides pushed these results aside, stating the babies did not die FROM pneumonia, but WITH pneumonia – while being killed by nurse Letby. Why none of the original pathologists came on to defend the original autopsies, one of the many things I fail to understand.
One of the reasons parents were angry, was the lack of testing for toxins, etc. That would have been done had the babies died in their home, but was seen as not-needed when they died in the hospital.
There are many ways (some) air can get in a vein/a body during medical interventions, of which the babies had many in their short lives. But it means doctors, nurses are not careful enough.
There are many possible explanations why the babies died, but with no placentas/blood/tissue saved, these are hard to prove.
And yes, the fact that Dr. Evans was a pediatrician, not a neonatologist, could be the reason he saw no issue with the fact that a just-born premature child was left for four (4 !) hours without antibiotics, glucose, other needed medication.
Recently I spoke a gentleman who told me he once worked on a farm where male turkeys were “milked” (I leave this to your imagination). They had several sheds with animals. If he wanted to go from one building into the next, he first had to shower, wash his hair, put on a complete set of clean clothing/shoes.
Compare that with CoCH – where one consultant went back and forth between a clinic with CF patients and the neonatal ward. Where parents were allowed in without hand-washing/ disinfecting, without PPE. Where a nurse sneezed in her hands and then picked up a baby. Where a nurse came in with a nose full of snot – she had the problem all week, she said.
My father would say that” there is nothing between us”. Thank you for sharing your thoughts etc.,
“Oh what a tangled web” ….” springs to mind.