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Anyway, clearly I'm wrong again so I'll leave you all to it. 😉
her being present every time there was a unexpected or suspicious death is hugely relevant, surely.
Except, there were also unexpected deaths at which she was not present. The medical evidence that these were 'otherwise stable babies' has been challenged, and air can be introduced into the stomach as part of a resuscitation attempt. The whole air in the stomach thing is controversial, and the mechanism proposed by the prosecution has also been challenged.
These were all babies considered sick enough to be in PICU. Sure, you wouldn't expect them to be dying en masse, but they are all at increased risk of collapse and sudden death. That's why they're there. And there are lots of factors in their quality of care which can influence their recovery, positively or negatively.
these were otherwise stable babies
According to the expert witness that her defence team decided not to call, many of the babies that the prosecution described as well, were in fact not very well at all. As others have said, we can't decide guilt or otherwise, but it's pretty clear from the post trial investigations that the jury heard just one side of the story, and that story was founded on - it turns out, at least highly contestable evidence.
What if those nine deaths were neither suspicious nor unexplained?
Well then that's quite an increase from their usual 3-4 per year.
The problem with only including the suspicious deaths was that the alarm was first raised about Letby in July 2015:
For every death after that (and possibly from even earlier) if Letby is present then it is going to be suspicious. Her presence automatically makes people suspicious. And then you make a chart showing that she was the only common factor in the suspicious deaths.
Of course she was.
Like I said, this proves nothing one way or the other. As far as I know there was more evidence than just the 'one common factor' chart.
However, we're thankfully at a stage now where any sign of manipulating numbers in these type of cases makes people immediately suspicious. It could be she's still very guilty but drawing a line under it is not the best way forward until all the extra deaths can be plausibly explained.
“ But you can guarantee that, if she was off-shift for every unexpected death during that period, she would not now be in prison.”
She was off shift for about half of them, so they decided that this half was just bad luck and the half that happened when she was there were all murders, every single one of them. They could have done exactly the same for any staff member and come up with a spreadsheet that looked just the same.
She regularly did overtime as she was saving for a house, the unit was always short-staffed so plenty of work available.
You may find this interesting, from the blog of Norman Fenton, Professor of Risk.
A lot of babies in neonatal care aren't necessarily "sick", they have been born prematurely and need support to get them in a condition to be allowed home. The three main things they need is to be able to feed, breathe and retain heat. They might be in neonatal care due to being underweight and needing to effectively fatten up. A baby is pretty much fully developed way before being full term and spends a long time just putting weight on to make them more resilient at birth. The unit she worked on wasn't for the most sick babies so I don't think it would be normal for there to be a lot of deaths.
if expert medical witneses could have supported her case, they’d have called them.
Only if they were prepared to testify on her behalf. If not then once summons they would just no comment everything. The real problem is if it wasn’t her then what were the patients consultants doing and the consultant heading the unit? That bit seems to have been ignored with her conviction and I imagine the consultants don’t want looking at too closely. The reason everyone has a named consultant is because they are the one legally responsible for their patients care.
Puts rather a different spin on the notes she wrote:
These were all babies considered sick enough to be in PICU.
A friend of mine worked as a nurse in special care baby unit. I asked her how she coped with the death of babies. Her response was that you celebrate the ones that get to go home because if your in that unit the odds are stacked against you in the first place
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
So coz it's against training and your experience, the only other explanation is baby murder? That's a bit of a leap.
It's rigid thinking like that, that can scapegoat someone for the failings of an entire department rather than looking further. Maybe that's the NHS way.
I’m not a statistician so I’m sure the answer is statistics
There is always a naive presumption that events are independent. So two rare events occurring in the same individual is simply related to the probability of each event squared. For some events, that are truly random, like winning the lottery, that premise is true. In the case of cot deaths the events may not be independent, and as mentioned, some underlying but unidentified risk factor may be present in both newborns that predispose. An analysis suggested that the true rate could be as high as 1/200 for two deaths when one had died already. For Sally Clark, it was not disclosed that the first child had a bacterial infection that may have hastened death. And hence the second death could have simply been chance. That rare events occur at all is simply the result of the huge number of trials (statistical term not legal event) - someone wins the lottery most weeks, despite the low individual probability.
For a paediatric ICU, one can calculate the risk of being on watch for any proportion of deaths, presuming they are independent. The closed form solution will be challenging, but the simulation shown in the link I provided shows that it is very easy to generate data that was used to convict. That "evidence" should be disregarded completely. In the dutch case discussed by the RSS, the miscarriage of justice was that no offence had been committed, the mortality rare for that unit at that time was an outlier.
Presume that the mortality rate for any shift is 10%, and there are 20 beds in the ICU. The probability that at least one baby dies in any shift is 1 - (1-0.1)^20 = 0.87 or 87%. And that is per shift. Without any wrongdoing. If shifts are staffed evenly, one can expect a distribution in number of shifts worked with a death. And it is possible that one poor nurse will be present for more than others. If you don't adjusts for number of shifts worked, this is even more likely.
It's not really a question of stats in this case. They had decided a few years previous to fit her up so along with a whispering campaign to undermine her confidence (hence the counselling!), they treated any incident while she was present as suspicious, while sweeping other events under the carpet. N years later, of course it looks like a bit more than coincidence.
The whole idea that she killed babies by pumping air into their stomachs is just nonsense. What an absurd suggestion.
So coz it’s against training and your experience, the only other explanation is baby murder? That’s a bit of a leap.
Its not a leap at all. There is no other explanation for this one. 3 dif6fert things that can only be deliberate acts. One could be innocent mistake? 3 together. Not a chance.
Its really basic stuff.
The whole idea that she killed babies by pumping air into their stomachs is just nonsense. What an absurd suggestion.
Why?
its really basic stuff
What is basic is that hospitals exist to help people get better. Given that, it's surprising how often they make people get a whole lot worse/dead.
The Bristol scandal might have looked a whole lot different if one doctor, or one nurse could be shown to have been on shift for 50% of the deaths.
It may have been 'The Butcher Of Bristol' and the rest of the failings could have been quietly dealt with.
What about the other 50%? They'll just be ignored as outliers, like in this case.
Being married to a social worker during the old "shaken baby syndrome" I'm more open minded on this.
But we need to be very aware in our online bubble that some families have been through hell and this isn't about us having fun with our theories.
The Bristol scandal might have looked a whole lot different if one doctor, or one nurse could be shown to have been on shift for 50% of the deaths.
The Bristol case was an excellent example of how taking a blinkered view of your own clinical outcomes can contribute to disaster. It's almost the reverse of this situation, but in favour of the clinicians involved. They looked at their cases of babies who died, and there was always a 'reason' why - the babies were sicker, had more complex heart defects etc - and they ploughed on because they thought it was just a spike and results would improve as they overcame the natural 'learning curve' for the new procedure. In many ways this was true for UK paediatric heart surgery at the time - too many small units all trying new stuff at the same time. Other units also had poor results, but Bristol was the clear outlier and had a whistleblower prepared to say so.
The key thing there was at what point they should have put aside the ego, stopped, and asked for help. And at what point management should have intervened.
What it teaches you is that humans have a habit of looking for the answer that suits their situation, either hiding behind complexity, or ignoring it in favour of a more convenient answer.
It doesn't mean that Letby is innocent, simply that we have to look harder for counter-arguments to the position we've taken, and guard against the temptation to squeeze evidence until it fits that position, or discard it if it clearly doesn't.
Because it’s just a completely stupid way of trying to kill a baby and there was no meaningfully valid diagnosis or evidence in most of the cases.
Ah, well - if I'd known you were going to be so scientific about it, I wouldn't have got involved!
I know I said I was going to step away (and I will) but this is me just repeating something I've already said, which doesn't count. 🙂 For most of the babies she was accused of killing through injecting air, air was found in them where air shouldn't be.
https://www.theguardian.com/uk-news/article/2024/jul/09/lucy-letby-evidence-experts-question
This is along the same lines as the Private Eye articles.
Air being found 'where it shouldn't be' is obviously a nice, neat way of presenting all that to a jury, but where there is no consensus, and even an element of conjecture as to how that air got there, we need to make sure that any alternative expert views are also put to the jury. Then we can look back a few years later and see that a fair trial has taken place, prosecution evidence has been robustly challenged, and we can be confident in the verdict.
It's not helpful when idiots like David Davis are advocating on your behalf. Standing up in Parliament and declaring her innocent is equally wrong-headed.
Air being found ‘where it shouldn’t be’...
I'm kind of summarising from the appeal's 58 page judgement there. 🙂
... is obviously a nice, neat way of presenting all that to a jury, but where there is no consensus, and even an element of conjecture as to how that air got there, we need to make sure that any alternative expert views are also put to the jury.
PResumption is a dangerous thing, but I presume the defence would have done that were there credible alternatives?
PResumption is a dangerous thing, but I presume the defence would have done that were there credible alternatives?
Indeed it is (presumption). There can be many reasons why a defense might not present an expert witnesses. You can't just assume it's because they didn't have anything to say that might have helped their case:
There can be many reasons why a defense might not present an expert witnesses.
Such as?
You know you could just read the link I posted but OK, fine, let me paste the most relevant bits although I really think you should read the whole thing.
One possible good reason for there not being expert evidence put in by the defence has been identified by the experienced criminal barrister Adam King in a strong piece setting out why there may be a miscarriage of justice in this case:
“One reason the defence might have chosen not to call Dr Hall (and I am speculating here) is if they felt they had so thoroughly undermined Dr Evans that they were better off leaving it at that. That would be a big tactical call, but covering your own back is not always consistent with protecting your client’s interests.
“So, for example: if your own expert would contradict much, but not all, of the Crown’s expert’s conclusions, and you believe the credibility of the Crown’s expert has been totally destroyed, you might judge it prudent not to put your own expert in the witness box. Avoiding the potential for future criticism and hindsight regret by putting your client in what you believe will be a worse position — by calling your own expert — is not a boss move. This is all speculation, but I guarantee that careful thought went into the decision not to call Dr Hall. None of this, though, would mean the conviction is safe.”
*
Another possible reason not to call expert evidence is that your client’s case is that the relevant area of knowledge is such that no actual expertise is possible. This may be because of the lack of reliable data, or because it is a novel or developing area.
If so, calling an expert on that point would contradict that position.
We do know that Letby’s defence lawyers put in a detailed submission at the end of the prosecution case in the first trial that the prosecution had shown no case to answer and that prosecution expert evidence should be ruled inadmissible. It may have been that calling expert evidence would have undermined the prospects of what may have been a successful application.
We don’t know.
Oh, I read it, but you said "many" - again, dangerous to presume but I presumed you had more than the two you outlined above.
But again, I'll leave you to it.
Well, just let us know when you come up with a number you would find acceptable.
Anyway, the piece linked in the original piece which is also worth a read:
https://unherd.com/2024/07/the-questions-haunting-the-lucy-letby-trial/
Ok, cool.
Human rights and criminal defence Barrister Mark McDonald states, “It is almost impossible to get defence experts in the UK to give evidence in cases involving children, they are too scared. You have to go overseas, usually to the US.”
That’s one interpretation, but another interpretation would be that US “experts” are much more willing to say what the defence want to hear in return for cash, and UK experts understand their responsibility is to the court and not directly to the party that pays them so will give more nuanced (and less “useful”) evidence!
Only if they were prepared to testify on her behalf. If not then once summons they would just no comment everything.
that’s not how being a witness works in court - you can’t say “no comment” when you are in the witness box. And expert witnesses don’t give evidence on behalf of the defence or the prosecution, they may be instructed or called by one party but they are not (supposed to) have any allegiance to that party or miss out / gloss over details to help that side. In a perfect world all experts would agree so you only need one (on each topic). In many cases that IS the way it works. Of course a defence team are very unlikely to call/summons an expert who they have not had lots of discussion with before hand - rule 1 is never ask a witness a question you don’t already know the answer to! But I think it is very unlikely that any esteemed expert would be unwilling to engage because the alleged crime is heinous, most experts completely understand the implications of being falsely accused of such a crime.
So, one of the issues for the defence is they have their own expert report. It agrees with the prosecution expert report on a lot of content - but differs on some key facts. Do you call your witness and have him say “yes most of what the prosecution witness said is true BUT…” and risk the jury remembering the bits where they agreed. Or do you try through robust cross examination to get the prosecution expert to admit that there are some holes in their version. It does not follow that if there are holes that the person is not guilty - only if together with all the other evidence there is reasonable doubt. The defence don’t have to decide that until after they’ve examined the prosecution witnesses so a calculated decision will have been taken that it was at least no worse for their case not to call a witness.
as a passive observer of the media stories, the “post it notes” probably had more weight on my impression than the “stats”. If it is true that they were from counselling I don’t think that was explained in court. Presumably she could even have called the counsellor and waived any rights to confidentiality - but of course that is not without risks either!
the jury did see her give evidence in her defence, they would have been told that if they found her to be a credible witness she should be acquitted, so not only did they believe enough of the crown case, they didn’t believe her. That doesn’t mean there were no mistakes in the crown case - but did they result in a miscarriage of justice is a different question. It’s one of the problems with our jury system - there’s no record of what weight they put on any individual aspect and therefore we second guess what might have happened if slightly different evidence was presented.
That’s one interpretation, but another interpretation would be that US “experts” are much more willing to say what the defence want to hear in return for cash, and UK experts understand their responsibility is to the court and not directly to the party that pays them so will give more nuanced (and less “useful”) evidence!
From the link I posted above:
Also very unusual is the fact that Dr Evans “pitched” his services to the police, when he heard about the investigation in the media. This is not the way experts are normally selected. The defence argued it indicated pro-prosecution bias. The Court of Appeal disagreed.
Also interesting was the comments on Evans from a judge in an unrelated case:
One way of achieving this is to look at whether the experts have been wrong before. In the case of the lead expert in Letby’s case, Dr Evans, the defence discovered halfway through the trial that he had been utterly excoriated in a ruling by a Court of Appeal judge in a different case. “No effort to provide a balanced opinion… No attempt made to engage with the powerful contradictory indicators… The report has the hallmarks of an exercise ‘working out an explanation’ that exculpates the applicants… tendentious and partisan expressions of opinion that are outside [his] professional competence.” That level of criticism from a senior judge is not made lightly: they know it can be career-ending. And if the Crown had known of it in advance, I suspect they would have looked for a different expert.
David Davis has an interesting history of taking up unpopular causes. Of course he's also got a history of being spectacularly wrong on occasion too!
Bristol - They looked at their cases of babies who died,
It wasn't just babies that were dying in Bristol, they used the data for babies to prove a point, Wisheart (the cardiac surgeon) had an appalling cardiac surgical record, nearby hospitals knew this and would send their patients to cardiac units further away. I was on the ward back in the 70s, made friends with the other patients and watched them die, found one dead on the bathroom floor - quite something for a 13 year old......................
Bit of an update here. Seems a panel of experts have found there was no evidence of murder being committed.
Reasons given appear to have been echoed in this thread.
Saw that. I wonder if those poo-pooing my comments (and those of others) from a few weeks back have yet accepted that it has been terrible miscarriage of justice.
There are some proper big hitters in that panel, people who do not have an agenda but do have serious credentials. It will be hard to ignore their voice, so long as judicial process allows for it to be heard.
I still can't get my head around how or why her defence team did not call any expert defence witnesses. If or when she appeals, I hope she has a new legal team that will do a better job of offering a fair defence.
The expert witness has form and would be interested to know whether Mark McDonald has been made aware of it. It's horrific by the way.
Form for what?
Ah, bad choice of words. Not done a good job on an occasion much much earlier than this.
Be jaysus it's hard work getting any intel out of you! Could you possibly give some details of this failing?
Could you possibly give some details of this failing?
Careful, STW don't want to be a respondent in a libel case.
Exactly Sandwich, am very mindful of that.