Lady Thirwall presides over the Countess of Chester Hospital Inquiry on the presumption of Lucy Letby’s guilt, as she must. With less need, she began by admonishing those of us who question this guilt or – at least – question that it was proven beyond reasonable doubt.
We should hold our tongues, we’re told, to respect the bereaved.
But the doubts and doubters grow louder, with articles across the spectrum from the Telegraph to the Guardian, along with very detailed critiques by Dr. Phillip Hammond in Private Eye.
We must and do have sympathy for the parents. They have suffered grievous loss, and ongoing argument must add hurt. But this is insufficient to imprison a young woman in perpetuity if her ‘guilt’ is a mirage, confected from bad luck and poor practice in a unit that was an accident waiting to happen, along with contradictory jottings, scribbled down at the behest of a therapist.
The Countess of Chester had an exceptionally high stillbirth rate too, on a maternity unit unconnected to Letby. It wasn’t a wise place to have your baby, as Nadine Dorries learnt from experience.
Doubts have seeped even into the BBC, just as foul water leaks oozed into the Chester Unit. Its File on Four highlights Baby C. Dr Dewi Evans, the prosecution’s principal expert, gave a detailed, if unusual, explanation for this infant’s demise: injection of air into the stomach. This, he said, caused the baby’s stomach to expand, rupturing the diaphragm and crushing the lungs. The BBC now reminds us that the critical X-ray was taken after three days when Lucy Letby hadn’t been on duty. This has led Dr. Evans to rethink, recalling that Baby C was “always the most difficult case”. He has discarded ‘injection to the stomach’ but remains confident that Lucy dunnit, by later injecting air to the baby’s bloodstream. That’s quite a jump, given the previous detail.
Nor does the inquiry evidence help the good Lady’s demands that we shut up. Late in 2016, after Letby had been moved to a desk job, the Royal College of Paediatrics and Child Health (RCPCH) reviewed the Neonatal Unit deaths, concluding that the unit was under-resourced, lacked a specialist neonatologist and had insufficient consultant ward-rounds. What has now emerged is a confidential addendum, addressing the consultants’ concerns about Letby, and concluding that these were based solely on correlation and were “quite subjective“. This led hospital management – who disbelieved the consultants’ allegations – to demand that they apologise to Letby and that she return to clinical work. The consultants then involved the police, igniting the powder trail…
This week, medics who were the unit juniors in 2015-16 took their turns on the witness stand. At the time several thought that the frequent deaths and collapses were likely due to bacterial infection, just as I do today. Sewage leaks, and taps contaminated with the opportunist pathogen Pseudomonas aeruginosa, do not mix well with very premature infants. These have incomplete immune systems and, if born before 29 weeks’ gestation, largely lack the benefit of maternal antibodies, which later transfer across the placenta. Very premature babies can ‘go off’ very quickly, often without the typical signs and symptoms of infection.
The one piece of new evidence to emerge against Letby was that her two training periods at the Liverpool Women’s Hospital allegedly coincided with 40% rates of dislodged endotracheal tubes, compared with expected rates below 1%. But this has been swiftly challenged. Neonatologists point to product problems in the period and to dislodgement rates between 1% and 80%. In any event, Letby was a trainee. If she had a problem with intubation, did no one correct her?
Lady Thirwall’s task increasingly resembles that of a 17th century justice instructed to find ways to prevent witches wreaking havoc. Outside the courthouse, people clamour that witches aren’t real, or lack the malign powers attributed to them They didn’t cause the laming of John Law, a pedlar, for which 10 women hanged at Lancaster in 1612. Law quite possibly had a stroke soon after being cursed by Alizon Device. Perhaps Alizon scared or enraged him, but she didn’t cause his stroke by witchcraft.
And, all too plausibly, Letby’s ‘crime’ was to be fool enough to remain in a badly-run and contaminated unit, working far beyond its competency. Even less wise, she accepted every shift she could because she was saving to buy a house.
Which brings me to a plug for Lucy Letby, the New Evidence airing on Channel 5 tomorrow (October 6th) at 9pm. This pulls together the doubts swirling around these convictions from statistical, medical and legal standpoints.
I’m talking about the likelihood of infection, as outlined above. Dr. John Ashton, formerly Director of Public Health in Northwest England, discusses systems failures and how multiple deficiencies were piled together to cause catastrophes. Among Chester’s deficiencies was the erosion of nurse staffing, a topic expanded by Michele Worden, who was Neonatal Nurse Practitioner at the Countess until redundancy in 2007. She talks of the many senior nurses who were ‘let go’, leaving qualified but inexperienced staff, such as Lucy, to care for the sickest infants. Drs. Svilena Dimitrova, Phil Hammond and Alan Wayne Jones discuss the bizarre methods of murder claimed by the prosecution, as in the same producer’s earlier documentary. They make the good point that, until Dr. Evans, a paediatrician, came along, these deaths were recorded, by experienced pathologists as ‘Natural Causes’.
Mark McDonald speaks of the challenges he faces in taking over as Lucy Letby’s barrister, seeking to bring her case to the Criminal Cases Review Board, and of the worthlessness of her ‘confession’ notes. Linked to this, Dr. Waney Squire, an Oxford neuropathologist, explains the difficulty of being an expert defence witness in emotive cases. She found herself in serious trouble with the GMC for standing up in court to challenge accepted ‘wisdom’ on Shaken Baby Syndrome. If expert witnesses won’t appear for fear of professional defenestration, justice can’t be attained.
Lastly, or rather first in the film’s running order, Sir David Davis MP speaks on why he is raising questions about Lucy Letby in the Commons and why he will continue to look into this case, concerned that it very well may be a major miscarriage of justice.
Do watch.
Dr. David Livermore is a retired Professor of Medical Microbiology at the University of East Anglia.
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Sally Clark, God Bless, all over again.
Aren’t experts wonderful.
The State isn’t performing well, is it.
The prospect of Lucy Letby successfully appealing against her conviction is such an appalling vista that every sensible person would say, ‘It cannot be right that these actions should go any further’.
That’s what the highly respected Lord Denning said in regard to the Birmingham Six in 1980:
“Just consider the course of events if their action were to proceed to trial… If the six men failed it would mean that much time and money and worry would have been expended by many people to no good purpose. If they won, it would mean that the police were guilty of perjury; that they were guilty of violence and threats; that the confessions were involuntary and improperly admitted in evidence; and that the convictions were erroneous… That was such an appalling vista that every sensible person would say, ‘It cannot be right that these actions should go any further’.”
It wasn’t until 11 years later that the Birmingham Six were released and their convictions were declared unsafe and unsatisfactory and quashed by the Court of Appeal in 1991.
This is what Lucy Letby is up against.
At the very least, there appear to be serious questions emerging regarding the possibility of a miscarriage of justice in this case.
One might have thought that the British establishment, after the crisis of trust so recently generated over the varied aspects of management of the Pandemic and the Post Office Horizon scandal, that its representatives might at least publicly attempt to hide their contempt for the British people.
I have read elsewhere that as a result of the case, registered nurses are leaving this high dependency area of care, and that recruitment and training in this field has dropped. Having worked in a related, but not quite so regularly intense, field of health care, I can see with absolute clarity why registered nurses would now think twice before committing themselves to such a high risk specialty.
Thank you Professor Livermore for highlighting this case, and pointing out the Channel 5 program. And thanks to Sir David Davis for raising the issue in the HoC.
I’ve been skeptical about her guilt from the moment things started coming out, never underestimate the amount of time, effort and obstacles “the state” will use to defend itself when it’s made a mistake.
I have 3 main hopes for if (when?) she is found innocent,
1. The compensation bill will be so high it will ensure she never has to work again (even though it will be us paying it).
2. Much like the case of the rapist (who wasn’t guilty) Andy Malkin with news coming out people involved are facing criminal investigations that the same will happen here starting with the health secretary who’s VERY keen for there not to be another trial and the matter closed.
3. There is a specific law introduced so that in the event of something like this happening and others attempting to cover it the automatically get the prison sentence the scapegoat would’ve received
I am becoming very unhappy with the way the law seems to be working in this Country. It appears that “hard” evidence is no longer required to convict unfortunate people of serious crimes. The PO scandal, Letby, Belfield, the “rioters” are examples which seem to me have been lacking in any proper evidence of serious wrongdoing. Is this because the Jury system is broken, because Judges are incapable of understanding the difference between supposition and fact, or something much more serious? Fully disinterested Juries are now impossible to find due to social media, poor reporting by media and other factors. What is up with politicised Judges? How can a PM say come down hard on someone and it actually happens? Why are courts accepting opinion as hard provable fact? Statistics say that some of the population are seriously criminal, some are liars, and some cannot be trusted. Does that mean we are all guilty?
No we are not all guilty, it is just that the some of us who are seriously criminal, liars and cannot be trusted seem to find safe employment in Parliament and media.
Professor Livermore makes many pertinent points as it becomes clear that shining the light of peer review on the ‘evidence’ given by Evans and Bohin is unsustainable in the real world of neonatology unless of course they are going to re-write the neonatal textbooks with their pseudo-science.
What is now so worrying is that the judicial system appears to be willfully and deliberately deaf to the real science needed to uncover the truth of what happened at Chester. The concept of there only being one (of several ridiculous) causes for each of these deaths as expounded by these two doctors is laid bare by the sudden statement by Evans that he was wrong in the case of Baby C when the ‘only’ (ridiculous) cause can suddenly be traded for another ‘only’ (ridiculous) possible cause. Are we wrong to wonder if the opinion of Professor Morley and eminent world class neonatologist should be trumped by a long retired paediatrician with no clinical experience since at least 2009 and another paediatrician working in a hospital which has 600 births a year.
This all highlights the bizarre legal system that allows certain doctors as well as other professionals to claim that they are ‘experts’ and to be judged as so by a motley collection police, National Crime Agency personnel, judges and prosecutor’s none of whom will have had a clue about neonatal Medicine.
The farce and the tragedy of the Lucy Letby case is that the lead medical ‘investigator’ appears to have been essentially self-appointed. It’s ‘my kind of a case’ piped up Dr Evans who made a living from expounding his views in various courts, when he approached the NCA. Having built a ridiculous case how then could he possibly have been allowed to give evidence in the trial itself as he could never had admitted he was mistaken at that moment.
What we as doctors do know from experience, and I am sure other professionals as well is that many of the people who are addicted to pushing their ‘expert’ opinions in court are frequently rigid type A personalities who are always totally certain of their knowledge, who often show little personal insight and usually have left a trail of discord and controversy amongst their patients and colleagues over many years and even in the Courts (Lord Justice Jackson, Guernsey parents Group).
It is extremely urgent that there should be an total review of how so-called expert evidence is gathered and used in court so that it cannot be given outside the realm of serious and qualified peer review and so that that evidence cannot be used as it was in the theatrical manner that it was abused by the prosecution counsel in the case of Lucy Letby. after all Courts are supposed to be for finding the truth rather than being as theatre for bigots and frustrated actors.
The justice system is full of wrongful convictions. The more evil the crime the higher the pressure is on the system to find a culprit. Too much of circumstantial evidence is a result of excessive immagination. This whole case needs to be thrown out.
Rent-a-witness Dewi Evans should take over Lucy’s sentence.
‘… until Dr. Evans, a paediatrician, came along, these deaths were recorded, by experienced pathologists as ‘Natural Causes’.
Not only that, but according to Professor Norman Fenton, and his Bayesian statistical study of neonatal deaths at 14 ‘comparator’ hospitals in England during 2014 to 2017, there was nothing exceptional, in terms of statistical significance, about the rate of neonatal deaths at County of Chester NHS Hospital during 2015 and 2016, the years Nurse Letby was convicted of carrying out murders in.
Prof Fenton has calculated that the probability of at least 9 deaths in one year followed by at least 8 in the next year (the CoCH figures for 2015 and 2016), is 14%. A figure below 5% is normally required for statistical significance; ie to call in question a ‘null hypothesis’ of no exceptional rate of death.
Averaged over the 14 comparator hospitals, the rate of neonatal death in the years 2014-17 was just under 2 deaths per thousand live births. In 2015 the rate at County of Chester NHS Hospital rose briefly to a peak of just under 3 deaths per thousand live births.
At Sherwood Forest NHS in 2014 the rate was 3.8.
So, when the County of Chester consultants became alarmed about an apparent spike in neonatal deaths at County of Chester in 2015-16, they would, if they’d had Prof Fenton’s analysis before them, probably have been reassured and not written to the police.