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

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.

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:

The Lucy Letby case: some thoughts and observations: what should happen when a defence does not put in their own expert evidence (for good reason or bad)?

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.