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If we want to stop errors happening and to do so we require candour.
I don't disagree, but "We appear to have employed a serial killer" category error seems so wildly outside the normal operational decisions that any Trust senior executives are qualified to make, do we really need to broaden the definition of the corporate manslaughter rules that members of the Trust's executive are being investigated under now? If it gets to trail they'll be required to swear on oath anyway.
If people are afraid of being blamed and criminal sanctions then we will not get candour
Agreed ish - but if people behaved we wouldnt need prisons. Also in other places in this thread, the NHS doesnt allow people to raise concerns unfortunately is culturally systemic in the NHS to not allow people to raise issues of safety
Way outside my sphere of knowledge, but if an organisations fails to correct Health & Safety stuff in the workplace, can they not get criminally prosecuted ?
Is this any different? The management did put due process in place/follow it to prevent patient harm ?
serial killer
@nickc and that's the key point. Most healthy safety cultures use a test of reasonableness or what other trained a competent people might do.
She is an outlier because she was malevolent. The danger in this situations is people either assume malice across the entire spectrum of the incident, or in this case infer that others had the same level of malice.
It's emotive because it's babies, understandably so. But it's the emotions that run the whole thing off the tracks.
The point about criminality, excluding Letby for now in a more general POV, unless it is glaringly obvious or evidence has been presented of clear criminality then there's little purpose in using it as a threat at the outset. It's been proven to harm the quality of investigations outside of the CJS.
Most investigations I've seen in the NHS thus far aren't truly independent, allowing the facts to inform the outcome. They have been trying to prove the accusation or failing, to gather evidence to support the "problem".
Case in point, evey person I spoke to in a recent piece of work (55) at the outset of an investigation had been presented a document outlining the process of the investigation and disciplinary process, along with the sanction guidance (which is policy).
No facts have been gathered, nothing has been proven or disproven, but we're subjecting individuals to a CPS-lite procedure from the outset and wondering why the culture is poor? It's a culture based on fear of subjective judgement and punishment.
A just and blame free investigation and culture does not mean no accountability or sanctions, it means impartiality until the facts are gathered and an evidence led outcome is decided. That outcome might be referral for criminal proceedings.
The fact that there is pushback against this sort of approach and complaints about the blame/cover-up culture in the same breath would be hilarious if it wasn't tragic and somewhat ridiculous.
"Do what you've always done, get what you've always got" springs to mind.
Also I don't hold the NHS fully to blame for this. The CIPD and HR culture and training have a lot to answer for. They're the biggest threat to culture change within this complex organisation in this regard.
It's not really a case of 'I told you so' but I've always had my doubts about the Lucy Letby trial, and her guilt. As much (if not all) the evidence against her was circumstantial. Private Eye have conducted an investigation, and published their findings - after over turning a court application to stop publication.
I haven't read a lot of the detail but two things come to mind. 1) some of the evidence against Letby is flawed to say thew least
2) I still believe she did it. Her behaviour was so weird and the weight of evidence even without the dubious stuff so strong
and the weight of evidence even without the dubious stuff so strong
Read the P-E stuff and see if you still think that. I've (like you) always assumed that there must be more to it than the flimsy circumstantial evidence, but it turns out that the defence didn't call any of its expert witnesses who have told a quite different story to the one heard at trial. While obviously its up to the prosecution to prove guilt, not for the defence to prove innocence, it does mean that the jury essentially got hear just one side.
It’s possible she did something but also appears undeniable that the case was horribly flawed and there has been a gross miscarriage of justice along the lines of the cot death fiasco a while back.
David Allen Green has misgivings on how the trial was conducted. No answers to an awful lot of questions here
It seems to imply a lack of statistics knowledge by the legal system in general.
Just read the Private Eye report. Holy shit. I had no idea that it was a conscious choice on the part of her defence not to introduce experts to cast doubt on the clinical evidence the prosecution was putting forward. I just thought it was because no rational counter-argument could be made along those lines. Presented like that, the case looks paper-thin.
The parallels with the Bristol Heart Baby case, which I know well, are very clear. Obviously in that case the surgeons involved made the case that there were other similar reasons for the increase in their mortality rates - sicker babies, etc, but were struck off mainly because in their overseeing capacity they should have stopped operating sooner once the spike became apparent.
Not so much the physical evidence as her behaviour. If I had seen her behaviour as a nurse I would have been very suspicious indeed and would have reported her. some of the things she did are so far from acceptable in nursing its not true. Some of them are instant dismissal offences
The way the Eye presents it almost makes it look as if they've tried to retrofit murder to explain a spike in infant mortality at the unit. When there are many complex alternative reasons why a particular unit might be performing so badly. I must admit I didn't follow the published trial evidence closely, found it a bit too distressing at the time.
There are plenty of nurses out there who are bad at their jobs and perhaps even should be dismissed/struck off for their behaviour. I'm now left very uneasy about the weight of the evidence taking her from being incompetent or weird/inappropriate to being a remorseless, calculating and precise serial killer.
I have never seen a nurse behave as bizarrely as she did. I have met inadequate nurses and weird ones but never anyone who did stuff like she did. Taking photos of babies? Instant dismissal and totally bizzare. Taking notes home? Instant dismissal etc etc.
She is not a calculating and precise serial killer. She is mentally severely unwell. Her actions cannot be explained in any rational way.
this was not just a spike in deaths - someone was killing these babies.
Not so much the physical evidence as her behaviour.
Doesn't make her guilty though does it? I mean sure you might be suspicious, but the only evidence is the excel with her name on it, there was no investigation at the trial about how accurate it was, or where the data had come from. One statistical expert has called it "Evidence that Letby was on duty when she was on duty"
his was not just a spike in deaths – someone was killing these babies.
Several paediatric experts (some of them defence expert witnesses who weren't called ) disagree with that assumption. These babies were often presented to the jury as 'well' when they were in fact very far from being well.
I haven't had a chance to read everything properly yet (and honestly, most likely I won't) but is there any explanation given about why the defense didn't call their expert witnesses?
The spike in deaths: And that is what the statisticians have since identified as misleading. The statistics presented to show bias to those who do not understand them.
She deserves another trial where all evidence is clearly scrutinised - its horrendous if she is innocent - as is its horrendous if she is guilty. Those babies and their families deserve to know the truth .. not just have a scapegoat.
He defense team appear to be shite for sure.
there is a lot more good evidence than that nickc. Like the consultant that walked in on her with a baby thats breathing tube was dislodged and the alarms turned off and letby just standing there watching the baby die. that has no innocent explanation. It is inconceivable she did not know what was hapening
Whether there is enough good evidence to convict I am not sure. However I am sure she killed those babies
but is there any explanation given about why the defense didn’t call their expert witnesses?
From the private Eye investigation report:
Letby and her barrister Ben Myers KC did not call their single expert witness to give evidence, secure in the knowledge that the evidence against her was largely circumstantial, and perhaps mindful that the prosecution had six expert witnesses and seven consultant paediatricians who were united in believing her to be guilty because it seemed the most plausible explanation for the spate of sudden and unexplained collapses.
However I am sure she killed those babies
I'm not sure she did, but I think it's pretty certain that either way, the jury did not get to hear the full scientific or statistical evidence.
It’s possible she killed and harmed some, but wholly implausible that she did all of them. Ergo, miscarriage of justice.
And being weird and worthy of instant dismissal isn’t the same thing as being a mass baby murderer.
Else where are Liz Truss’ victims hidden (etc etc)?
Whether there is enough good evidence to convict I am not sure. However I am sure she killed those babies
There was enough evidence to convict, and the jurors were sufficiently sure to do it. Whether the prosecution evidence was sufficiently challenged in court - and whether her trial was unfair as a result - is the question here.
If a fresh jury are presented with the same evidence - and perhaps a more robust defence involving expert witnesses pointing out some of its flaws and inconsistencies - and they still choose to convict, so be it.
Whether there is enough good evidence to convict I am not sure.
Not very well put. Sorry. Of course I meant was the evidence robust enough to convict given a competent defense which Letby did not appear to get
. I must admit I didn’t follow the published trial evidence closely, found it a bit too distressing at the time.
I followed it reasonably closely at the time. I was called for jury service at Manchester CC and swerved serving on the Letby case by inches, I had to explain to the judge that I worked with a potential witness who was a Doctor on a general ward who'd worked with Letby before she transferred to neo-natal. If called she was going to say that Letby was OK, just a nice normal nurse, a bit slow, never really outstanding, but reasonably competent and capable.
but reasonably competent and capable.
Which makes the doing nothing with a baby dying from a dislodged ET tube and with the alarms turned of even more damning. there is just no way on earth that is not malicious
The fact is, we are now being given a barrage of defence 'evidence' which hasn't been tested in court. Personally I'm going to stick to the opinion that she received a fair trial and a jury, which was presented with all the evidence the defence thought appropriate, convicted her. I'm saying 'Guilty as charged'. I'll wait until the outcome of any subsequent legal process before posibly changing my mind.
Also, from the BBC:
Barrister Tim Owen KC has spent 40 years as a defence lawyer, and worked on many cases which he successfully referred back to the Court of Appeal and the Criminal Cases Review Commission.
He also co-hosts a legal podcast, Double Jeopardy, which has examined the Letby debate.
Much has been made of the fact that the Letby case relied on circumstantial evidence and no-one definitively saw her harming any of the babies.
Mr Owen said this point is far less relevant than many might think.
"Some people believe that circumstantial evidence isn’t really evidence," he said.
"That’s simply not true.
"A circumstantial case can be a powerful case but in order to understand it, you have to look at the totality.
"You can’t just pick one little bit and say, 'Oh look at that, that’s unreliable,' or 'That doesn’t prove anything'."
there is just no way on earth that is not malicious
Unless she's stood there thinking "oh no, how can this be happening again"
I dunno, I wasn't there. Neither was anyone else.
There were other excess baby deaths when she was not on shift that were batted away as irrelevant. It looks dodgy.
I assumed she was a monster, having read the PE series it's not so clear cut.
Boomerlives - as someone who has been in an ITU with a patient going off there is no way at all that can be so. Its simply not credible to not notice or not take any action. the alarms do not get turned off accidentally - someone did that deliberately. Breathing tubes do not dislodge on their own either done deliberatly or accidentaqlly when moving the baby but in the latter case you check.. the baby would have been in obvious distress - basically going blue!
The idea that she did not notice or was paralyzed into not taking action is just not credible
Barrister Tim Owen KC....co-hosts a legal podcast, Double Jeopardy, which has examined the Letby debate.
Just having a listen, and it's very interesting. Recommended.
It's worth noting in the case of Baby K - the dislodged breathing tube that @tjagain is describing, the original jury couldn't reach a decision - and was the only death that they couldn't. This individual case had to go to a retrial
It's not exactly the same but in my last job I was involved in a complaint of sexual impropriety by a staffmember against a student. We reacted pretty much exactly as you'd hope, contacted the authorities, etc etc, he ended up getting done for it.
But during the trial it turned out that he'd been reported for the exact same thing at the previous 2 institutions he'd worked at and they'd circled the wagons "to protect the institution" and he'd been allowed to quietly resign and move on elsewhere. It was eventually reported he'd been kicked out of catholic seminary for sexual impropriety, which I'm surprised is even mathematically possible. And he'd floated around a couple of other jobs in the sector which look suspiciously like it was the exact same thing.
I wasn't shocked that it can happen once or that a few people can handle something like that wrongly but this was over and over for literally his entire career. And honestly I think it could still have happened with us if things had been just a little different, except that the dude was universally disliked.
Anyway thing is, in the end we got 100% of all the shit for it. "City university embroiled in sex abuse scandal". So it turns out they were in a horrible way right. There was next to no backlash against the other places because that was all boring and historic and what little there was, got painted over with "that was a different time, things were different" (the 2010s ffs), and just astonishingly little of "this place discovered the problem and made sure the guy got nailed for it". I can absolutely promise you that some people involved in the process were left thinking "well that was all a terrible mistake" and a whole bunch of people involved in the coverup at other places feel completely vindicated.
Alarms get turned off/silenced all the time because they go off very frequently when there's not really anything to worry about. A breathing tube could be accidentally dislodged by a baby, some of them are surprisingly active.
I tend to agree with TJ in feeling that she's probably guilty although I'm far from convinced that the was sufficient evidence to prove beyond reasonable doubt.
Alarms get turned off/silenced all the time because they go off very frequently when there’s not really anything to worry about.
Depends which alarms but basically when I worked in ITU we did not do this ever. You might turn the alarms off while carrying out a procedure, you would ALWAYS turn them back on afterwards. The equipment in the ITU I used you could put alarms on mute for a short period and they would come back on again. Its not clear to me which alarms were turned off but its in general a huge NO to turning them off.
A breathing tube could be accidentally dislodged by a baby, some of them are surprisingly active.
Very very unlikely as if it is ventilated as it will be sedated and paralyzed thus unable to move
A formal analysis of the odds of babies dying whilst she was on shift versus not on shift is needed, you can’t disregard other cases that died whilst she was not working. I have no idea whether she is guilty or not, but I understand relative risk and the notion of statistical significance. Comparison with reference data from other units should also be included - and other covariates - did she work on particularly challenging cases? What was the average patient staff ratio? Lots of areas where further analysis is needed.
I had previously presumed that there was more than circumstantial evidence. That there was not is troubling. Shipman was identified based on his practice being a very significant outlier. For that work David Spiegelhater should be thanked. I imagine he will be all over this data too.
A formal analysis of the odds of babies dying whilst she was on shift versus not on shift is needed,
IIRC this was done and the numbers pointed very firmly at her. Lots of statistical work to identify suspects. there is more than circumstantial evidence -There is also the consultant that saw her in a room with a baby with a dislodged breathing tube and no alarms. Most of the case is circumstantial however - as is normal in cases like this.
doesnt seem to have been done by actual statistics experts
Indeed. Ask Sally Clark how that worked out. Except you can’t. :-(. The Royal Statistical Society doesn’t weigh in lightly on legal issues.
Fair enough
Very late to this discussion, but lots of it seems to centre around clinical questions, but evidence was found at her home reflecting her state of mind - I understand that this isn’t evidence as such, but it is a clear indication of her state of mind. To be fair, it is desperately sad that any individual could be in such a dark place.
I cannot understand her defense team at all tho - they seem to be complete rubbish.
Here's the thing about her defence - if expert medical witneses could have supported her case, they'd have called them. Instead, they called a plumber to the stand. Note too that she used the same team for the appeal, so she doesn't think a different team would do anything better.
There are stats experts who would testify the methodology is suspect. Some of the actual medical evidence is just wrong ie the idea that injecting air into a feeding tube could cause an embolus. .Unless something has got lost or confused there. Injecting air into an IV line can cause an embolus, injecting air into a feeding line does not cause an embolus. It would be no problem to get someone to testify to that.
I think there was a hunt for "evidence" that stretches the bounds of credibility in the attempt to make a strong case. Thats does not exonerate her but it does make the conviction dodgy
Why none of this was challenged is beyond me
The use of statistics and probability in criminal trials of this magnitude needs to be carefully regulated. There are a lot of worrying aspects to this, both in terms of the medical evidence and the way the numbers were presented to a lay jury.
Doesn't mean she's innocent, but frankly, the NHS employs a lot of people in patient facing roles whose personality defects and weird private lives might raise eyebrows if scrutinised in such circumstances.
Here’s the thing about her defence – if expert medical witneses could have supported her case, they’d have called them
This is provably wrong. She was accused of murdering several of the children via an air embolism based partially on a old research paper. One of the authors wasnt called in the case but were in the appeal and they were clear they didnt agree with the prosecutions use of the paper.
The appeal court dismissed that evidence since it wasnt "new" but that just raises the question mark about the competence of her defence lawyers vs her guilt or not.
but frankly, the NHS employs a lot of people in patient facing roles whose personality defects and weird private lives might raise eyebrows if scrutinised in such circumstances.
Who me? Not guilty yer honour!
A lot of it is institutional negligence.
I know as my late father successfully sued the NHS for 50k.. It didn't bring his wife or my step mum back, and the consultant who was mostly to blame was simply moved sideways rather than struck off.
It makes me wonder how much of the NHS bill on the tax payer is paying out for clinical negligence cases.