Safety Critical Industry – Are you different to the NHS (Lucy Letby)

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

And, to be fair, she was subsequently found guilty of that, too.

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.

IIRC this was done and the numbers pointed very firmly at her.  Lots of statistical work to identify suspects.

From PE etc it doesnt seem to have been done by actual statistics experts vs cops and moonlighting doctors. Which is problematic.

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.

https://rss.org.uk/RSS/media/File-library/News/2022/Report_Healthcare_serial_killer_or_coincidence_statistical_issues_in_investigation_of_suspected_medical_misconduct_Sept_2022_FINAL.pdf

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.

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 inference is that the defence assumed that the court officers were competent to test and verify the methodology used in the statistical analysis.

Most of us should be aware that assumption is the mother of all **** ups! They trusted but failed to verify in attempt to save court time and the conviction is now suspect as a result.

Edit: suspect and the legal profession are circling the wagons to protect themselves rather than ensuring justice is being served. (Very similar attitude to the Birmingham Six convictions).

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.

If the evidence was dismissed from the retrial as it wasn’t new, how is that proof that her lawyers weren’t competent?

The inference is that the defence assumed that the court officers were competent to test and verify the methodology used in the statistical analysis.

I don’t think she was convicted solely on the basis of the statistical analysis.

No, but take that away, and some of the medical evidence, and suddenly you start to wonder whether the case is anything like as strong.

This is a nice summary of some of the deficiencies in the statistical evidence and is worth a read https://www.scienceontrial.com/post/shifting-the-data

The data was selected by non-statisticians to support their cause (i.e., guilt). The simulation presented in the analysis above is rather damning. And relatively straightforward to conduct. There are some nice methods to look at probability of what seem like rare outcomes, and of course these were not presented in this instance. They were in the case of eventual acquittal of the Dutch nurse in similar circumstances.

No, but take that away, and some of the medical evidence, and suddenly you start to wonder whether the case is anything like as strong.

Of course, if you take ALL the evidence away, she’s not guilty in the slightest.

However, the evidence exists, and the jury convicted.

If the evidence was dismissed from the retrial as it wasn’t new, how is that proof that her lawyers weren’t competent?

Sorry not sure what you are trying to say here?

It was the appeal and dismissed since they could have called them at the trial and didnt.

So if we return to your claim that if they could have called an expert witness they would have done so and so inferring that helps show she is guilty.

Do you still stand by this and if so why?

Of course, if you take ALL the evidence away, she’s not guilty in the slightest.

I don’t think anyone is saying that. As @tjagain has said, the evidence of Baby-K is damning, a doctor essentially said he saw her just standing there doing nothing while all the alarms were going off. That’s pretty strong. On the other hand, the Excel with her name all over the shifts seems now to be largely non-evidence. There seems to be evidence that some of the other deaths on the unit were ignored becasue they didn’t involve Letby or fit any pattern, and the unit itself was understaffed, had recently seen an increase in baby deaths, was criticised by a CQC report. I think it points to an overall impression that neither trail was particularly robust.

Why none of this was challenged is beyond me

I think Letby’s defence barrister did [by all accounts] a stand up job in his cross examination of expert witnesses.  think they chose a strategy that it’s up to the prosecution to prove guilt, and their evidence was largely circumstantial. Rather than to try to prove innocence.

Re alarms on critical care monitors in healthcare settings,

If an alarm is triggered that is considered serious, it will produce an audible tone and a flashing visual signal.

This can be silenced by a button press, but has a time out, so if the alarm condition is still relevant, will alarm again once the timeout has finished.

This would give a staff member time to deal with the alarm cause without the added distraction of an annoying noise and flashing light.

To physically ‘turn off’ an alarm is a very deliberate act and would involve going into a menu system or changing a configuration, both of which may have been captured on an events  log within the monitor.

It makes me wonder how much of the NHS bill on the tax payer is paying out for clinical negligence cases.

https://blackwaterlaw.co.uk/7-stats-latest-nhs-resolution-figures/

NHS budget is about 180bn, so about 1.5%  And i think I read they are insured, but if you have standard losses every year around the same amount I can’t see why an insurer would take on at a premium below what they ‘know’ they are going to pay out, insurance is cover for the unforeseen.

Of course, if you take ALL the evidence away, she’s not guilty in the slightest.

She was convicted on the sum total of the evidence, statistical, medical and circumstantial. If a large chunk of the evidence that convinced the jury was flawed or misleading, obviously that may have an impact on the verdict. The prosecution shouldn’t just be allowed to make stuff up and present it as fact, or cherry pick circumstantial evidence, however sure they are that she is guilty.

She may have killed none, some, or all of those babies, but fishing for data which supports that premise while ignoring data that disagrees with it is a recipe for a miscarriage of justice.

As a side note, I read back through some of the court reporting, and there was testimony from a former colleague that suggested the Baby K breathing tube incident was not entirely straightforward, as the alarm had been muted (by someone), plus the baby was described as ‘active’ and could have dislodged it by themselves. Letby here certainly appears unprofessional, negligent, and incompetent, but this incident in isolation is still a long way short of proof of malice and murderous intent.

But if you take stuff like this, add in a dollop of evidence of a disordered personality, some questionable statistical and medical evidence, and suddenly things start looking much worse.

I don’t know much about this case beyond what was reported, but I’m reminded of the Cleveland child abuse scandal. Circumstances are very different, but reliance on experts was a huge problem

In February 2007, Sir Liam Donaldson, the Chief Medical Officer, who was the regional medical officer at the time of the scandal, said of the original diagnoses: “The techniques that have been used have not been reliable and it does look as if some mistakes have been made” https://en.wikipedia.org/wiki/Cleveland_child_abuse_scandal

More like the Meadows cot death scandal, where an incompetent duffer made up some totally bogus stats and no-one involved in the defence apparently had enough of a clue to challenge him. I recall at the time assuming that the reporting was sloppy as the main claim repeated in the press was so obviously wrong (in at least two important respects) that no respected expert could possibly have made such a stupid statement in court. How wrong I was.

I didn’t pay such attention to the Letby thing while the trial was ongoing and the details are different but it stinks in all the same ways. There’s simply no way she did what she was convicted of, she may have done some incompetent and/or malicious things but not all she was convicted of. The only question now really is how long she will rot in jail while the establishment tries to misdirect, delay, and otherwise evade their responsibilities.

There’s simply no way she did what she was convicted of

I’m interested to see what evidence you think unequivocally supports this statement, or is it just a belief you have?

I didn’t pay such attention to the Letby thing and the details are different

It’s obvious given that there were lots of incidents and she was accused precisely of causing the things that happened when she was there and none of the things that happened when she wasn’t there. It’s completely implausible that every single unfortunate event that happened due to chance or other people/bad performance, happened when she wasn’t there.

It’s obvious to everyone that the spreadsheet “evidence” is completely bogus and dishonest, right?

Sorry not sure what you are trying to say here?

No, I’m sorry – in the cold light of day I think I’ve tried to make a singular point based on two seperate strands. Really shouldn’t post late at night….

It was the appeal and dismissed since they could have called them at the trial and didnt.

So if we return to your claim that if they could have called an expert witness they would have done so and so inferring that helps show she is guilty.

Do you still stand by this and if so why?

I don’t think I made that claim, but if there’s a suggestion that the defence didn’t call witnesses out of incompetence, I think it’s equally valid to suggest that they WERE competent and had very valid reasons not to call expert witnesses. After all, she was happy enough to keep the same team for the appeal.

Without access to the defence’s case notes, we’re all just speculating, to be fair.

On the other hand, the Excel with her name all over the shifts seems now to be largely non-evidence. 

At the very least it puts her at the scene of the crimes.

At the very least it puts her at the scene of the crimes.

I think the main question is, are we sure crimes were committed?

It’s not like it’s a typical murder where you have a body and signs of violence so you know someone did it.  In these cases (like the 1 in 73 million cot death case) it seems so unlikely that we just assume a crime must have been committed.

The prosecution shouldn’t just be allowed to make stuff up and present it as fact, or cherry pick circumstantial evidence, however sure they are that she is guilty.

I don’t think they made anything up, but I think they absolutely do have to present the factors that indicate guilt, that’s their job just as much as it is the defence’s to present factors that indicate innocence. Whether either team believed her innocent or guilty is kind of irrelevant, both sides are there to win.