Merged Concerns over baby killer ignored? / Nurse Lucy Letby killed babies in her care

[Planigale]

Whilst I don't doubt Letby is guilty, I think there are some very interesting aspects to this unique case. Six of the cases had post mortem which found a natural cause, these had to be over turned to present them as unnatural deaths. Contrary to what TV programmes would make you think, post mortem are as dubious as any other process.

however the claims of death by air embolism are novel and somewhat dubious in themselves, they may be correct but the evidence is minimal*. The poorest evidence is the recalled 'mottling' at time of resuscitation. I have been at enough cardiac arrests to know my immediate recall when trying to write up an arrest is vague. Mottled skin is not that unusual in a sick child, would my recall of this years later in one case be reliable? Is mottled skin a real diagnostic feature of air embolism? This is far more debatable than the evidence around shaken baby syndrome.

*I have personal experience of killing by air embolism; many rats and a few rabbits have been killed by me in this way. So I have no doubt this is a rapidly effective and painless way of dispatching small creatures. I have seen one or two adult humans inadvertently die (not at my hands) in this manner.

 

[FatherLukeduke]

It is not about 'demonizing the administrators'. The average salary of a Hospital Administrator in the UK is £267,000 pa.

No it isn't, that is way out. The head of the entire NHS is on £255K, so that might give you a little context.

As someone else has pointed out there is no such post as "Hospital Administrator" in the UK and I'm not even sure what you are referring to by that title. There is a class of jobs referred to as "admins", however these are among the lowest paid jobs in the NHS. For middle management we have post titles like "General manager" or "Service manager" or "Matron" in nursing. The most senior hospital posts are the CEO, Medical Director (a doctor), Director of Nursing (a nurse), Chief Nurse (a nurse) and then all the usual ones such as Director of HR, Director of Operations etc.

The CEO in the Letby case, Tony Chambers (a former nurse), was on £160k - which is typical for a CEO. The highest paid CEO in the NHS is on a package (including pension contributions) of £295K, but he heads up a one of the biggest hospital groups in Europe with a budget of £1.5 billion and 13,500 employees.

 

[Vixen]

Whilst I don't doubt Letby is guilty, I think there are some very interesting aspects to this unique case. Six of the cases had post mortem which found a natural cause, these had to be over turned to present them as unnatural deaths. Contrary to what TV programmes would make you think, post mortem are as dubious as any other process.

however the claims of death by air embolism are novel and somewhat dubious in themselves, they may be correct but the evidence is minimal*. The poorest evidence is the recalled 'mottling' at time of resuscitation. I have been at enough cardiac arrests to know my immediate recall when trying to write up an arrest is vague. Mottled skin is not that unusual in a sick child, would my recall of this years later in one case be reliable? Is mottled skin a real diagnostic feature of air embolism? This is far more debatable than the evidence around shaken baby syndrome.

*I have personal experience of killing by air embolism; many rats and a few rabbits have been killed by me in this way. So I have no doubt this is a rapidly effective and painless way of dispatching small creatures. I have seen one or two adult humans inadvertently die (not at my hands) in this manner.

Lucy Letby was first to mention mottling to the police, without any prompting. Mottling is not unusual in babies, especially f they are born post mature but of course, they soon rally to a healthy colour.


With Baby A (who may or may not be Letby's homicide #1) a strange discoloration was noted by the medics. The post mortem showed a line of what looked like air bubbles, parallel to Baby A's spine. the pathologist testified that whilst it was not unusual to see air bubbles in the brain or the heart after, say, a car accident, he had never seen one like that, except in one other case. That other case was...Baby B. The nurse who was on duty with Letby said she noticed the same dramatic discoloration of Baby B's skin as with Baby A and actually said, oh no, not again. The pathologist said the line of bubble seen per X-ray were consistent with but not diagnostic of the introduction of an air embolism. One of the fathers of another baby also mentioned stark mottling before baby's collapse. The line of bubbles appear to follow the line of a feed tube. Baby B had also had the lines end points at the nostrils blocked. The introduction of air, as you say, is very easy for a malevolent practitioner to inflict: it could be by syringe, the IV lines or the naso-gastric tube.

But proving it was Lucy Letby and not just some fluke of coincidence or somebody else, meant that Cheshire police had to be very careful how they investigated (see their documentary Operation Hummingbird) because the CPS and a court jury aren't going to accept a suspect-centric case based on statistics and coincidence. To this end, the detectives assigned each individual case to a separate individual team of detectives to work on, each completely independently and Chinese-Walled from the other teams. The CPS expected proper evidence, not just 'this person was there on each occasion'.

IMV Letby simply utilised whatever nearby weapons she had, whether it be the naso-gastric tubes, the insulin in the fridge, the introduction of potentially lethal air bubbles, which could be via a syringe, tube or an IV line together with the case of overfeeding one neonate with milk so much so its stomach was distended. She went home knowing that by the time the little mite began to collapse she was not around. This is one way she skillfully covered her tracks. To underline her duplicity, she would send text messages claiming to be so sad and having had a **** day, etc., as another cunning subterfuge.

 

[Vixen]

No it isn't, that is way out. The head of the entire NHS is on £255K, so that might give you a little context.

As someone else has pointed out there is no such post as "Hospital Administrator" in the UK and I'm not even sure what you are referring to by that title. There is a class of jobs referred to as "admins", however these are among the lowest paid jobs in the NHS. For middle management we have post titles like "General manager" or "Service manager" or "Matron" in nursing. The most senior hospital posts are the CEO, Medical Director (a doctor), Director of Nursing (a nurse), Chief Nurse (a nurse) and then all the usual ones such as Director of HR, Director of Operations etc.

The CEO in the Letby case, Tony Chambers (a former nurse), was on £160k - which is typical for a CEO. The highest paid CEO in the NHS is on a package (including pension contributions) of £295K, but he heads up a one of the biggest hospital groups in Europe with a budget of £1.5 billion and 13,500 employees.

It is sweet of you to point this out. However, the term CEO is quite a recent Americanism. My work colleague wanted to be a Hospital Administrator because her father was one. When I worked at Brompton Hospital, we were all called 'Officers'. For example, I started as a 'Higher Technical Officer'. Sure, all the office staff did administrative type work but their job title then wasn't 'administrator'. It was 'XX Officer'.

Hospital Administrator vs. CEO: What Are the Differences?
Learn about the two careers and review some of the similarities and differences between them.


Job Search Insights
Published Oct 5, 2022
A hospital administrator is responsible for the overall management of a hospital, while a CEO oversees the entire operation of a company. Both positions require excellent leadership skills, but there are several key differences between the two. In this article, we compare the job titles of hospital administrator and CEO, and we discuss the skills and experience needed for each role.

What is a Hospital Administrator?
A Hospital Administrator is responsible for the overall management of a hospital or healthcare facility. They develop and implement policies and procedures to ensure that the hospital runs smoothly and efficiently. Hospital Administrators also develop budgets and allocate resources to various departments and projects. They oversee the hiring and training of hospital staff and work with other healthcare professionals to develop and implement patient care plans. Hospital Administrators also work with the Board of Directors to develop long-term strategic plans for the hospital.

https://climbtheladder.com/hospital-administrator-vs-ceo/

Caveat: the above might be American as in the US you can take a degree in it.

--

Apropos of this, it is truly astonishing that whilst nursing and medical staff are regulated and indeed Drs. Brearey and Jayaram tried very hard to get the attention of the 'Director' Ian Harvey and the 'CEO' Tony Chambers, they were able to report the former to the General Medical Council because he was still on their register as an orthopeadic surgeon at the time. The GMC did nothing after four years, so that was in vain. But the point is, the guy at the top, an NHS Director of Health or Whatever is completely unregulated, as are all the leadership management non-medic Trust appointees. Tony Chambers who crossed the line IMV (NB however, I have only heard Brearey and Jayaram's version of events) by not just being incompetent and idiotic - as is the cause of most managerial cockups* - Mr. Chambers appears to have actively and one could say corruptly tried to cover up a potential serious crime scene and danger to neonatal safety - left CoCH shortly after Letby's arrest on an NDA (non-disclosure agreement with usually a handsome settlement) plus £1m to his pension fund and onto other similar posts. He is answerable to no regulatory body at all. At least Alison Kelly was suspended until she is investigated by her nursing body. With his NDA he doesn't have to give any account of himself at all. Just utter a few mealy-mouthed stock phrases of sympathy.

The first five murders happened between June and October 2015 and the final two were in June 2016.

It was several months before police were called. Some doctors have claimed that babies’ lives could have been saved if managers had responded to concerns.

Asked if he would like to see regulation of hospital administrators, Dr Brearey told BBC Radio 4’s Today programme: “Absolutely. Because doctors and nurses all have their regulatory bodies that we have to answer to.

“And quite often, we’ll see senior managers who have no apparent accountability for what they do in our trusts, and they move to other trusts, and you worry about their future actions.

Independent



*(and I would put Nursing Director moron Alison Kelly in this category as she said in a recent interview she didn't take any action because 'I wasn't given any information' er, it's your job to information gather _DER.)

 

[zooterkin]

Letby has applied to appeal her conviction.
https://www.theguardian.com/uk-news/2023/sep/15/lucy-letby-appeal-conviction

 

[Carrot Flower King]

https://www.theguardian.com/uk-news...y-must-examine-nhs-cover-up-culture-ombudsman

In related news, Rob Behrens, the Health Ombudsman, has finally noticed that there is a problem with NHS managers' behaviour towards those who raise safety concerns and more broadly with whistleblowers.

Where the **** has this wazzock been since - just to pick the year I began working in the NHS - 1984? We've known this was a problem at least since then - my late parents would have suggested it goes back a lot further.

It's no wonder we have protracted issues when the sodding Ombudsman seems to have no grasp on what happens nor for how long.

 

[Darat]

Letby has applied to appeal her conviction.
https://www.theguardian.com/uk-news/2023/sep/15/lucy-letby-appeal-conviction

What a bloody useless article, not one word about on what grounds she is appealing. It seems even journalists believe that you can simply appeal if you don't like the verdict.

 

[Nessie]

All the news about Letby's appeal have yet to say what the appeal we be about.

 

[Darat]

All the news about Letby's appeal have yet to say what the appeal we be about.

Yet the information has to be there, it's simply lazy and bad reporting not to report the grounds, doesn't need to be more than a couple of sentences. I think it annoys me as folk seem to have a distorted view of what an appeal is.

 

[Vixen]

Personally, I can't see on what grounds there should be an appeal as the UK press meticulously avoided prejudicing the trial in any way. The judge bent over backwards for the defendant, allowing her to enter the dock in a sealed off court room before allowing everybody else in. It is rare in England for an appeal to be allowed a hearing unless there is some kind of procedural error, such the Judge's summing up to the jury being amiss, or a point of law, which is very specific, or it is to do with sentencing being 'too harsh'.

A tabloid hints that the US crowdfunder re Science in medicine (see earlier in thread) were critical of the statistics used, i.e., the spreadsheet details showing that only Letby was on duty for each of the selected crimes. Whilst indeed this could be seen to be suspect-centric (the halo effect of shoehorning your results to fit your premis) in itself, it was just one small part of the evidence and of course an increase in deaths has to be statistically analysed for the increase to become apparent. It was faulty flagging that failed in alerting hospital chiefs that deaths were abnormally high.

If the defence believed the statistics against Letby were flawed, the trial hearing was the correct time to bring in an expert medical statistician or epidemiologist to challenge them. Even if some parts of the evidence were relatively trivial and subject to disputable motive, the sum of all the evidence has to be looked at as a whole, not piecemeal by piecemeal, rejecting each small part one by one.

Instead Letby and her defence seem to have relied on her claim that she was just a downtrodden nurse victimized for being conscientious by nasty doctors looking to shift blame. It is telling that she really thought she could play the grievance card but maybe she had got away with it for so long with her parents' strong backing and that of the Nursing Chief, the Unit Chief and the NHS Trust Chief (Tony Chambers) that she really believed the jury would sympathize with her 'poor victim' demeanour, clutching her comfort blankets and special treatment. If the defence offered was poor or non-existent that is not grounds for appeal.

Public interest - is a vague term that covers miscarriage of justice or something that is a principle of the constitution that should be clarified by the Supreme Court.


I couldn't see the judge, Justice James Goss put a foot wrong, so I cannot see how Letby could be granted an appeal and certainly not a retrial. Given this first trial lasted nine months that would really be taking the proverbial.

 

[pipelineaudio]

Wow, "The Cumulative Case for Christ"...right here at the JREF

 

[catsmate]

What a bloody useless article, not one word about on what grounds she is appealing. It seems even journalists believe that you can simply appeal if you don't like the verdict.

All the news about Letby's appeal have yet to say what the appeal we be about.

Doesn't the initial notice of intent to file an appeal merely give notice, without the detailed filing?

 

[Planigale]

There are legitimate concerns about the case.

Inequality of arms; the police had hundreds of people on the case for years, there are likely tens of thousands of documents. Her lawyer would not have had the resources to properly check the accuracy of the prosecutions case. One prosecution tool for defeating the defence is overwhelming with documents in discovery. The defence may have had very little idea of the case against Letterby until the case was presented by the prosecution.

Expert opinion: the prosecution expert who analysed the cause of death is a paediatrician who has been retired for ten years and functions as an expert for hire. He touted himself to the police at the beginning of the case. He has never worked as a neonatologist. So he is not an expert. (To be fair he avoided claiming to be an expert, but that would have been the way he came over to the jury.) The defence had no expert of their own to challenge the evidence, that may have been because they could not afford one to go through the huge number of documents , or because the case was poisonous and no one wished to be involved, which might be why the prosecution could not get an expert witness. Since in most cases the initial post mortem findings and clinical diagnosis of sepsis had to be re-interpreted there is a serious question about this being done by someone who is not an expert. Indeed the witness had been previously criticised in the evidence given by appeal court judges.

Deaths when Letterby was not present; were these interpreted blindly? Were cases presented to the expert knowing which occurred when Letterby was present and which weren't?

One ground for appeal may be an inadequate defence. Another might be the prosecution's witness. In theory the witnesses act for the court not for the prosecution or the defence. The fact that the witness was a professional witness (being retired from clinical practice, and working solely as a medical witness), who touted his services to the prosecution and being paid over may years by the prosecution could be used to claim he was not truly independent his continued employment was dependent on giving the police the answers they wanted.

 

[smartcooky]

Deaths when Letterby was not present; were these interpreted blindly? Were cases presented to the expert knowing which occurred when Letterby was present and which weren't?

She wouldn't necessarily need to be present at the time of death to be the cause. One of the two methods she used to murder babies was overdosing them with insulin. She would be able to inject insulin into them, or into an IV (if being used) and be at the other end of the country when the baby died.


In reality, there is little doubt that she did what she was found guilty of... How else can you explain why -

1. The unexpected illnesses (6) and infant deaths (7) started happening shortly after she started working at the children's ICU?

2. She was always on duty when each incident took place?

3. When she was removed from duties in June 2016, the suspicious incidents and deaths stopped?

She was also caught in the act, or shortly after, several times by parents and colleagues.

 

[Vixen]

There are legitimate concerns about the case.

Inequality of arms; the police had hundreds of people on the case for years, there are likely tens of thousands of documents. Her lawyer would not have had the resources to properly check the accuracy of the prosecutions case. One prosecution tool for defeating the defence is overwhelming with documents in discovery. The defence may have had very little idea of the case against Letterby until the case was presented by the prosecution.

Expert opinion: the prosecution expert who analysed the cause of death is a paediatrician who has been retired for ten years and functions as an expert for hire. He touted himself to the police at the beginning of the case. He has never worked as a neonatologist. So he is not an expert. (To be fair he avoided claiming to be an expert, but that would have been the way he came over to the jury.) The defence had no expert of their own to challenge the evidence, that may have been because they could not afford one to go through the huge number of documents , or because the case was poisonous and no one wished to be involved, which might be why the prosecution could not get an expert witness. Since in most cases the initial post mortem findings and clinical diagnosis of sepsis had to be re-interpreted there is a serious question about this being done by someone who is not an expert. Indeed the witness had been previously criticised in the evidence given by appeal court judges.

Deaths when Letterby was not present; were these interpreted blindly? Were cases presented to the expert knowing which occurred when Letterby was present and which weren't?

One ground for appeal may be an inadequate defence. Another might be the prosecution's witness. In theory the witnesses act for the court not for the prosecution or the defence. The fact that the witness was a professional witness (being retired from clinical practice, and working solely as a medical witness), who touted his services to the prosecution and being paid over may years by the prosecution could be used to claim he was not truly independent his continued employment was dependent on giving the police the answers they wanted.

By court rules, Letby's defence counsel had to be on a par with that of the prosecutor's. Thus we had silks Nick Johnson for the Crown and Ben Myers for the Defence. Myers is a top drawer KC. Has got many of his clients off.

Letby was first arrested 2018 and then twice more. In all that time she could have built up a defence. Before the trial there would have been many Case Management and Directions prehearings. These would include allowing the other party full discovery of the evidence and documents. In addition, it would have been agreed what the 'issues' were. These refer to points of contention. There is no point bringing up issues everybody is in agreement with. Letby was equally allowed to bring her own expert witnesses and to know what the other expert witnesses for the prosecution was going to say. Letby did have expert witnesses but in the event Myers for Letby and her lawyers either decided it was too risky for them to testify and be cross-examined or even that the expert witness agree with the Crown expert witnesses! The other possibility is that Justice James Goss, the judge, refused to allow them on the grounds of irrelevance or trivia. For example, they might have been arguing the obvious (this might be an appeal point) regarding the use of spreadsheet statistics.

With respect to cause of death, had the neonatal unit and the executive management bothered to read the death certificate reports and final toxicology results, it would have found seriously suspicious high levels of synthetic insulin in the blood of at least one of the babies. This was where Dr. Brearey and the Chester Polcie had their 'Eureka Moment' breakthrough.

Dr Dewi Evans is the 'gun for hire', as described scathingly by silk Myers in his summing up. So the jury were quite free to prefer not to accept Dr Evans' testimony. Dr Sandie Bohin, the other expert witness, gave testimony that was utterly bloodchilling, about how incredibly painful the babies' deaths must have been with unnatural screaming. She testified that neonatals just do not scream.

Justice Goss told the jury that the expert witnesses were for the court, not advocates for the prosecution. He directed that they could determine by looking at a pattern, i.e., if they found Letby guilty on one, they could take the view the same applied to others. (This could be a point of appeal.). However, we saw the jury take over 100 days to reach verdicts and they were undecided on six of the charges, so they clearly weighed up each case on their individual merits. The only defence witness called was the plumber, whose testimony wasn't even related to a day when a death or assault took place. Unfortunately, Letby's whole attitude was 'prove it' - 'you can't prove it', believing that the jury would see her as just being picked on to cover the doctors' own backs. After all, she had been the poster girl for the new neonatal unit fundraiser. She knew she had fooled people into thinking she was a kindly nurse who loved babies.

 

[Vixen]

She wouldn't necessarily need to be present at the time of death to be the cause. One of the two methods she used to murder babies was overdosing them with insulin. She would be able to inject insulin into them, or into an IV (if being used) and be at the other end of the country when the baby died.


In reality, there is little doubt that she did what she was found guilty of... How else can you explain why -

1. The unexpected illnesses (6) and infant deaths (7) started happening shortly after she started working at the children's ICU?

2. She was always on duty when each incident took place?

3. When she was removed from duties in June 2016, the suspicious incidents and deaths stopped?

She was also caught in the act, or shortly after, several times by parents and colleagues.

Likewise, when she worked nights the deaths/assaults went up. When she worked days, ditto.

 

[Darat]

Doesn't the initial notice of intent to file an appeal merely give notice, without the detailed filing?

It has to give the legal reason why they will be appealing, does not have to give the entire appeal details.

 

[smartcooky]

By court rules, Letby's defence counsel had to be on a par with that of the prosecutor's. Thus we had silks Nick Johnson for the Crown and Ben Myers for the Defence. Myers is a top drawer KC. Has got many of his clients off.

Letby was first arrested 2018 and then twice more. In all that time she could have built up a defence. Before the trial there would have been many Case Management and Directions prehearings. These would include allowing the other party full discovery of the evidence and documents. In addition, it would have been agreed what the 'issues' were. These refer to points of contention. There is no point bringing up issues everybody is in agreement with. Letby was equally allowed to bring her own expert witnesses and to know what the other expert witnesses for the prosecution was going to say. Letby did have expert witnesses but in the event Myers for Letby and her lawyers either decided it was too risky for them to testify and be cross-examined or even that the expert witness agree with the Crown expert witnesses! The other possibility is that Justice James Goss, the judge, refused to allow them on the grounds of irrelevance or trivia. For example, they might have been arguing the obvious (this might be an appeal point) regarding the use of spreadsheet statistics.

With respect to cause of death, had the neonatal unit and the executive management bothered to read the death certificate reports and final toxicology results, it would have found seriously suspicious high levels of synthetic insulin in the blood of at least one of the babies. This was where Dr. Brearey and the Chester Polcie had their 'Eureka Moment' breakthrough.

Dr Dewi Evans is the 'gun for hire', as described scathingly by silk Myers in his summing up. So the jury were quite free to prefer not to accept Dr Evans' testimony. Dr Sandie Bohin, the other expert witness, gave testimony that was utterly bloodchilling, about how incredibly painful the babies' deaths must have been with unnatural screaming. She testified that neonatals just do not scream.

Justice Goss told the jury that the expert witnesses were for the court, not advocates for the prosecution. He directed that they could determine by looking at a pattern, i.e., if they found Letby guilty on one, they could take the view the same applied to others. (This could be a point of appeal.). However, we saw the jury take over 100 days to reach verdicts and they were undecided on six of the charges, so they clearly weighed up each case on their individual merits. The only defence witness called was the plumber, whose testimony wasn't even related to a day when a death or assault took place. Unfortunately, Letby's whole attitude was 'prove it' - 'you can't prove it', believing that the jury would see her as just being picked on to cover the doctors' own backs. After all, she had been the poster girl for the new neonatal unit fundraiser. She knew she had fooled people into thinking she was a kindly nurse who loved babies.

Agree. These babies did not die of natural causes, their deaths were caused by human intervention.

- Babies do not get air into their bloodstream unless someone injects them with air.
- Babies do not suffer insulin overdoses unless someone injects them with insulin.
- Babies diaphragms are not crushed unless a person crushes them.

Same for those babies who became very ill but did not die. If Letby didn't do it, then another person must have - a person who was on the same shift as Letby for every one of the deaths and assaults during the period 8 June 2015 to 24 June 2016. The problem with that idea is the ward manager established that no staff member other than Letby was on the shift at the time every death and assault took place.

There is one case that is particularly chilling. The case of Child G on 7 September 2015. The child, a girl, collapsed and did so again on two other occasions in the following three weeks. She was taken to another hospital, but five days after she came back, she collapsed again, 15 minutes after Letby had been feeding her. She survived, but is now severely disabled as a result of what happened to her. The child was witnessed projectile vomiting massively. The doctor said that he could not find a natural cause for the drastic vomiting. Later, at trial, an expert witness doctor concluded that the only viable explanation was that the baby was force fed too much milk down. It was later discovered that Letby had deliberately altered the baby's temperature on her observation chart to make it seem like it was already unwell before it collapsed, and she also falsified the time of the baby's collapse to make it seem like it coincided with when a colleague gave the baby a milk feed.

This shows shew knew exactly what she was doing. Letby must have known she was coming under suspicion, and tried to point the finger at a colleague.

It is not just beyond any reasonable doubt that Letby murdered these babies, it is an absolute cold-blooded certainty!

 

[Gulliver Foyle]

She wouldn't necessarily need to be present at the time of death to be the cause. One of the two methods she used to murder babies was overdosing them with insulin. She would be able to inject insulin into them, or into an IV (if being used) and be at the other end of the country when the baby died.


In reality, there is little doubt that she did what she was found guilty of... How else can you explain why -

1. The unexpected illnesses (6) and infant deaths (7) started happening shortly after she started working at the children's ICU?

2. She was always on duty when each incident took place?

3. When she was removed from duties in June 2016, the suspicious incidents and deaths stopped?

She was also caught in the act, or shortly after, several times by parents and colleagues.

1-3) All those things were said about Lucia de Berk for years before it was funally realised that she couldn't have caused the deaths she was convictrd of.

And on your last paragraph, what direct evidence was there in this case. From following it all the evidence was either circumstantial or Roy Meadows level misuse of statistics.

 

[Planigale]

There are lots of people ascerting things that are simply untrue. I'll try and respond to them in turn.

Pointing out some concerns about the judicial process is not the same as claiming that Letterby is innocent.