Lucy Letby Case #16

[Faith61]

A couple of things re last few pages of chat..

We all die of cardiac arrest. Death certificates have to qualify what led to that. A ‘failure’ such as respiratory failure, heart failure etc is not allowed, it must be qualified by something that caused it.
Having a post Mortem wouldn’t have necessarily stopped things. Firstly, from reporting to the coroner to the time of inquest is usually up to a year. Secondly, the consultant did speak to the coroners office. When someone dies it’s either expected or unexpected. If expected, certificates can be issued without hesitation to the best knowledge of the doctor - it should be to the knowledge of the overseeing consultant despite usually completed by the junior. If unexpected then it is presented to the coroners office with a timeline of events and what the likely cause of death is despite it being unknown. The doctor has to say whether they can reasonably determine to the best of their knowledge that that’s what the cause is. This is then ‘run past’ the coroner and if the story sounds reasonable with a cause of death that sounds reasonable, and if the next of kin has given no concern to the coroners office, then it will be ‘ok for doctor to issue certificate’. So it has been discussed to an extent, no further knowledge could have been gained unless a pm was done.
Lastly, it’s not a finger pointing exercise.
The pathologist may have seen no signs of NEC on pm but that would have then meant the inquest was based on going through the notes and calling relevant staff to inquest. By relevant staff, I mean those who have documented and been active at significant treatment times ie the consultant who ran the cardiac arrest. I doubt LL would have been called up as a witness at inquest but if so it would just be to go through her version of the deterioration under her care, and then they would likely have focussed on what medical causes could have led to death to get a verdict in order to close the case. I need to point out here that she was so horribly evil that most methods of torture were so subtle anyway, and at the point of likely inquest I think she had been suspended re other deaths.
My last point really is related to this and I find difficult to explain the extent of it. I am an experienced frontline worker and never - despite the sickest patients I have encountered - have I ever wondered if their health could have been sabotaged by a colleague. It’s just not something that’s ever considered. It’s never in the ‘list’ of causes of a problem. Yes we might not meet a standard of care each and every time, but 99.999999% are working their absolute hardest to provide the care, and working as a team, and these failings per se are more reflective of the numbers of staff rather than their abilities.

I also have worked in NHS for many many years and understand and respect all that you've said...I just can't get beyond...the consultant saying openly today that she didn't think the events fitted with NEC, but still put this as cause of death anyway...I'm not saying it points to LL's innocence.
We never think we will be in the unfortunate position she and the other members of staff involved are in right now, giving evidence in such a horrific case as this, but they are and she is now having to explain her decisions and apologise to those poor parents.

 

[struggs123]

What was also interesting is that there was some talk of how long it took her to get to the neonatal unit when she was being called, and how she was in the resident block.

Do you have a link to this? I haven't seen anything about that, but if she was on call it wouldn't be unusual to be in the resident block?

 

[avabella]

Yes it was. It’s either that or she’s very unlucky to have had yet another baby die in an extremely sudden and rare way after seemingly doing very well before. So which one is it, lucky or unlucky

If she takes to the stand on a different baby and says actually looking at the X-ray I can see that I HAVE missed an obstruction and I think that means the cause of death was NEC- would you question it as suspicious then? If a doctor later was able to say yes actually it was this natural cause and it benefited Letby’s case - would it be suspicious? Or is it suspicious because it works against her?

Well you tell me, because can she be both? If she has murdered all those babies so far, and this one escalated but the Consultant missed it and put it down as NEC then by God she was incredibly lucky.

Whatever she says now on the stand will be tainted for me unfortunately. There must have been a massive chain of command to ascertain a death and to not stand up and say something if you knew the picture didn't fit, just doesn't sit right with me.

Do you have a link to this? I haven't seen anything about that, but if she was on call it wouldn't be unusual to be in the resident block?

I'm just heading out but can you ping me to remind me please? I'll find it, it was on Twitter somewhere.

Do you have a link to this? I haven't seen anything about that, but if she was on call it wouldn't be unusual to be in the resident block?

The inference I got from this was that she took too long to get there.

Also, for a trial based on babies crashing ‘unexpectedly’, this consultant said in a police interview that it was to be expected. Nothing is making sense.

 

[OldBlondie]

I need to point out here that she was so horribly evil that most methods of torture were so subtle anyway, and at the point of likely inquest I think she had been suspended re other deaths.

Thank you so much for taking the time to explain the whole coroner/inquest process. I found it really interesting, and cleared up a few points that I’d been wondering about. You have also mentioned that suspecting a colleague of harming a patient, is the last thing you’d imagine. So could see how this could be part of the reason it took so long for LL’s colleagues to have any real firm suspicions of her. The part of your post that I have quoted is the very chilling to think about. A few people, including myself have had posts were we had wondered if there were more babies before A, and in between the ones involved in the trial, that she had been hurting in minor ways. Such as removing nasal prongs temporarily, or slightly moving tubes, maybe making babies wait slightly longer for feeds that kind of thing. I feel there’s something very sadistic to her, and I feel that when we get to E there’s a shift in LL, in being more devious but also in how sadistic her methods of hurting babies becomes. This is just in my opinion after reading about the methods, and the inclusion of finding blood, and over feeding, and multiple attempts on the same baby, and beginning to inflict a lot of more obvious pain on some of the babies from E onwards

 

[MmmB777]

Well you tell me, because can she be both? If she has murdered all those babies so far, and this one escalated but the Consultant missed it and put it down as NEC then by God she was incredibly lucky.

Whatever she says now on the stand will be tainted for me unfortunately. There must have been a massive chain of command to ascertain a death and to not stand up and say something if you knew the picture didn't fit, just doesn't sit right with me.


I'm just heading out but can you ping me to remind me please? I'll find it, it was on Twitter somewhere.

I have missed your point I’m afraid? What escalated? So the consultant should have spotted that somebody had murdered the baby but at the same time you don’t think anyone murdered the baby? She would not have known or believed somebody to have given this baby internal trauma to cause blood loss, at any point. She hasn’t said that she thought it was murder but went for NEC - she has said it didn’t fit NEC (more proof that it IS sabotage imo) but that she came to that conclusion with the coroner. That was a mistake because of course now we know it very well could have shown something but as @docmum and @Haveyouanywool it’s quite possible it wouldn’t have changed much immediately anyway. I’m struggling to link up the outrage at the docs decision whilst also believing nobody murdered the babies.

I will stop replying so I don’t get in trouble but will just say this point
Charles Cullen is predicted to have killed 400+ people. 400! On every single one of their death certificates it will have said something. It will not have said ‘poisoned by a nurse’. It will have said the opinion of the doctor at that time. And they would all have been wrong. And the reason they were wrong is because they did not know a nurse was poisoning patients and sabotaging their care in a way that even a court of law and police would find hard to prove.

 

[friedeggontoast]

Additionally if LL didn’t murder the babies then she’s just an exceptionally bad nurse and should be punished for death by medical negligence.

 

[struggs123]

Well you tell me, because can she be both? If she has murdered all those babies so far, and this one escalated but the Consultant missed it and put it down as NEC then by God she was incredibly lucky.

Whatever she says now on the stand will be tainted for me unfortunately. There must have been a massive chain of command to ascertain a death and to not stand up and say something if you knew the picture didn't fit, just doesn't sit right with me.


I'm just heading out but can you ping me to remind me please? I'll find it, it was on Twitter somewhere.


The inference I got from this was that she took too long to get there.

Also, for a trial based on babies crashing ‘unexpectedly’, this consultant said in a police interview that it was to be expected. Nothing is making sense.

Thanks, I hadn't seen that reported. I don't think it suggests much for me, perhaps she was on another call and didn't effectively prioritise, perhaps she had been non stop and was taking a break, maybe she was on the toilet- they're human as well. Both can be the case, yes babies can unexpectedly deteriorate but it's not completely out of the blue if they're poorly, but it can also be unusual and unexpected for babies who were previously stable to die and in such numbers.

 

[docmum]

I also have worked in NHS for many many years and understand and respect all that you've said...I just can't get beyond...the consultant saying openly today that she didn't think the events fitted with NEC, but still put this as cause of death anyway...I'm not saying it points to LL's innocence.
We never think we will be in the unfortunate position she and the other members of staff involved are in right now, giving evidence in such a horrific case as this, but they are and she is now having to explain her decisions and apologise to those poor parents.

reading between the lines, the consultant felt to the best of their knowledge that it was the most reasonable cause of death, not completely unreasonable to occur in a patient of this background and would be the most reasonable cause to give to avoid post mortem. I expect the reason why they’re saying they don’t think it was the right thing on reflection is because they want to convict the utter evil being in the dock and because with new information, there is a more clear ‘beyond all doubt’ cause of death. It would be taking a huge amount out of those doctors and the wider trust to say that, which if you know the nhs then you probably understand what I mean when I say that there is no ‘not guilty’ possible in this case to those who have been through the notes and seen/lived the pattern of event over LLs spree. People may see that there are failings, which undoubtedly there were, but I can say that the sheer balls it takes to stand up there and say ‘we were wrong’ to testify against LL, each member of staff is contributing to a life saved in future by ensuring she never does see the light of day again.

Additionally if LL didn’t murder the babies then she’s just an exceptionally bad nurse and should be punished for death by medical negligence.

yes; I did mention this on an earlier thread that with insulin etc, it would be manslaughter to be negligent to that extent for sure.

 

[IGiveUp22]

See I actually aren’t seeing the RD for all the babies we’ve heard at the moment but maybe that’s because we haven’t heard the full defence side yet…or maybe LL should be glad I aren’t on the jury
I’m also astounded that the consultant did what she did. As I mentioned yesterday, you have such a level of trust of doctors/nurses etc in these professional settings that you take their word for things. Doesn’t mean they don’t make mistakes I guess. Likewise, it would be useful to have know the conversation with the coroner was it a case of “baby passed, there was blood, this is usually NEC so we’ll go with that” or was it a “I’m confused, I wasn’t expecting this baby to decline, there was blood but no other symptom of NEC but I don’t know what else it could have been & asked if a Pm would help & coroner had said won’t offer much, NEC is what we’ll say”
I still wouldn’t wanna sign off on that personally but she did unfortunately. Could be a huge combination of everything - bad hospital, sub-par care, arrogance, stressful situation, emotional parents, lots of unexpected deaths in short succession so arse covering, and also a murderer…

 

[docmum]

See I actually aren’t seeing the RD for all the babies we’ve heard at the moment but maybe that’s because we haven’t heard the full defence side yet…or maybe LL should be glad I aren’t on the jury
I’m also astounded that the consultant did what she did. As I mentioned yesterday, you have such a level of trust of doctors/nurses etc in these professional settings that you take their word for things. Doesn’t mean they don’t make mistakes I guess. Likewise, it would be useful to have know the conversation with the coroner was it a case of “baby passed, there was blood, this is usually NEC so we’ll go with that” or was it a “I’m confused, I wasn’t expecting this baby to decline, there was blood but no other symptom of NEC but I don’t know what else it could have been & asked if a Pm would help & coroner had said won’t offer much, NEC is what we’ll say”
I still wouldn’t wanna sign off on that personally but she did unfortunately. Could be a huge combination of everything - bad hospital, sub-par care, arrogance, stressful situation, emotional parents, lots of unexpected deaths in short succession so arse covering, and also a murderer…

sadly medicine is about as far from ‘black and white’ as you can get. It’s about evidence gathering, examination of patients, looking at numbers and trends, looking st responses to treatment or trends over time, and fitting these to a reasonable pattern to make a judgement call. I can only emphasise that medics and the wider team are trusted for their actions and opinions ‘to the best of their knowledge’.

 

[avabella]

I have missed your point I’m afraid? What escalated? So the consultant should have spotted that somebody had murdered the baby but at the same time you don’t think anyone murdered the baby? She would not have known or believed somebody to have given this baby internal trauma to cause blood loss, at any point. She hasn’t said that she thought it was murder but went for NEC - she has said it didn’t fit NEC (more proof that it IS sabotage imo) but that she came to that conclusion with the coroner. That was a mistake because of course now we know it very well could have shown something but as @docmum and @Haveyouanywool it’s quite possible it wouldn’t have changed much immediately anyway. I’m struggling to link up the outrage at the docs decision whilst also believing nobody murdered the babies.

I will stop replying so I don’t get in trouble but will just say this point
Charles Cullen is predicted to have killed 400+ people. 400! On every single one of their death certificates it will have said something. It will not have said ‘poisoned by a nurse’. It will have said the opinion of the doctor at that time. And they would all have been wrong. And the reason they were wrong is because they did not know a nurse was poisoning patients and sabotaging their care in a way that even a court of law and police would find hard to prove.

If we are assuming LL is guilty, then her method of harming the babies could be said to have escalated by this point.

Of course it wouldn't have been in the Consultant, or anyones mind, but at the time they said it wasn't to be unexpected as the babies were poorly, they have committed to a Cause of Death on a certificate, and declined a PM. Now they're saying the crashes were totally unexpected, that wasn't the cause of death, and they should have done a PM? It feels very disingenuous to me - and how do we know what is credible and/or the truth then?

I understand you're coming at it from the viewpoint that LL absolutely *did* murder the babies and therefore everything else is inconsequential, but it is a trial, and it's not proven yet. So incidents like this play a massive part in the whole story, imo.

 

[Deeznutslol]

There is no doubt there were many faults in that unit, but I still think the doctor not doing a PM (terrible decision) does not change how E died, yes it may have changed other things, but no PM makes no difference to E’s death happening.

I disagree, I think the fact there was no PM is huge considering the lack of hard evidence in this case and it’s the exact reason why Letby could get off even if she’s guilty.
Regardless of whether letby killed them or not, these babies have been failed massively by the hospital and staff. I appreciate that they’re not on trial here but they should hang their heads in bleeping shame, I’m honestly appalled by it all

 

[docmum]

One last point to note. Assuming some of these babies were cremated, apologies if I’m wrong. For a burial then only the original death certificate is required to register and complete the funeral process. However, for cremation the same doctor who did the death certificate has to do the cremation form initially, and then two completely independent doctors who can never have met or treated the patient have to also review the form. They each separately read what the doctor wrote as the series of events leading up to death and the named cause/s of death. They have to contact a further named person involved in care (usually another medic) usually as well as a family member to ask if they have any concerns regarding the death and if they agree with the cause of death as certified. Once three doctors have independently signed it off, then a patient can be cremated and it is for these exact reasons why it’s required - obviously with a burial, some details are still salvageable on exhumation.

 

[OldBlondie]

I don’t see how it changes anything at all to do with Letby’s innocence but I see Myers has been successful in making people think that it does.

Think a few have been caught up in the doctor not asking for PM, rather than that this is still an unexplained death (especially as it now looks like it’s wasn’t nec afterall, so what actually was it). And at that time if pm had happened probably wouldn’t have changed much in outcome of realising, or anything changing, that it was actually LL (if G). Regardless of PM sadly E still would have died. In fact it would probably have helped the prosecution now, more than the defence, as rest of evidence on E seems stronger and pm could have backed up prosecutions version of events. So BM has obviously done his job well today afterall. Some more have more doubts again. Not for one minute am I excusing doctor, or trying to say that it was ok to give the wrong cause that didn’t actually fit. I wonder is it worse to think your baby died from a natural complication such as nec, rather than was murdered by the nurse you wholly trusted and even thanked. Either way it’s beyond heartbreaking for those poor parents that shouldn’t have lost their little boy, and I feel for these parents so much, they have suffered so much already and then it will be F up next

 

[Tofino]

Would there be little other explanation for the bleeding other than something extremely rare or deliberate harm though, the latter I imagine did not cross her mind at all. In the Chester round up- it does sound like she doubted at the time and that the parents were upset so she didn’t push for a PM. It’s a huge mistake either way. I thought BM did his job well today however, I was intrigued by some of his questions written in more detail in the Chester.

Ben Myers KC, defending, said: “This is precisely the type of situation where a post-mortem would have been very helpful, isn’t it?” - If he’s going to state and have experts that will say baby E did indeed die from NEC why would he say that really.

Mr Myers said: “But at the time you were questioning NEC and at the time you didn’t have an obvious explanation?” - does it help defence case to point out there isn’t an obvious explanation to the baby’s death?! I would have thought he will later say that baby E obviously did indeed have NEC but perhaps not if this is how he is questioning.
So if not NEC then what will it be from defence? Is it another relying on ‘we cannot know what we don’t know’ thing..so just no PM so no answer. I personally think Dr. Evans will make easy work of disputing NEC. Will definitely be interested to hear the medical experts from both sides.

I think you are right he won’t go for NEC as he can’t prove it either (the lack of PM also does not help Lucy!). I think he will just say you have a consultant who has changed her mind, no PM so how can you be certain how this baby died? And if you have any doubt how the baby died then you can’t convict Lucy.

However, I think it will come down to what the medical experts say again (plus whatever defence say at a later date). We have PMs for the earlier babies and they did not conclude suspicious circumstances anyway so its not a massively different situation. We do have an X-ray from one hour before the baby died and all the other information from the medical records plus yet another baby with the same pattern as the others.
Whilst a PM might have helped, it also might not have been conclusive so I don’t think it all hinges on that.

Sorry I missed the first part of your last message, trying to multitask and as usual, failing at life!

I guess in this scenario, the method/scenario in which LL is accused of harming this baby wasn't particularly subtle - the baby apparently lost what, 25% of its blood volume? If this was something the Dr's had very rarely seen and were so confused by it, why did they put down a cause of death that has a very typical lead up and deterioration point?

If she stood on that stand today and said she stood by her NEC diagnosis, it would have been ripped apart, because apparently there was no lead up and it didn't show on x-ray. So she had no other choice today but to admit it was wrong and apologise for it. That is what is shifty. The fact that she knew back then, but still didn't pursue to find out the actual cause of death.

What was also interesting is that there was some talk of how long it took her to get to the neonatal unit when she was being called, and how she was in the resident block.

If she still stood by the NEC diagnosis then she would not be a prosecution witness but a defence one so wouldn’t have been on the stand today. But of course if she was a defence witness and cross examined by prosecution then they may have asked her about why she decided NEC as cause of death.

I know there was some discussion of confirmation bias earlier today and my thoughts are that the bias actually took place at the hospital on 2015/2016. Not sure what type of bias (unconscious?) but as so many people on this thread have said you just wouldn’t suspect a colleague of deliberate harm. The babies never left hospital so even those that did have a PM, did the pathologist ever consider deliberate harm might have been a factor?
If they knew now there were some suspicious circumstances, would they still come to the same conclusion for cause of death?

So it’s not surprising to me that some staff members might see things differently now they know there’s a possibility of deliberate harm. I don’t see that as confirmation bias, particularly when it makes no difference to them whether Lucy is guilty or not guilty. We’ve had posters say how arrogant doctors can be and most will do anything to not admit they’ve made a mistake yet now we do have one actually admitting they made a mistake and the consultant gains nothing at all from admitting that. In fact she might have more to lose. So I find this witness credible.

 

[avabella]

One last point to note. Assuming some of these babies were cremated, apologies if I’m wrong. For a burial then only the original death certificate is required to register and complete the funeral process. However, for cremation the same doctor who did the death certificate has to do the cremation form initially, and then two completely independent doctors who can never have met or treated the patient have to also review the form. They each separately read what the doctor wrote as the series of events leading up to death and the named cause/s of death. They have to contact a further named person involved in care (usually another medic) usually as well as a family member to ask if they have any concerns regarding the death and if they agree with the cause of death as certified. Once three doctors have independently signed it off, then a patient can be cremated and it is for these exact reasons why it’s required - obviously with a burial, some details are still salvageable on exhumation.

Woah that is really interesting thank you.

 

[OldBlondie]

I disagree, I think the fact there was no PM is huge considering the lack of hard evidence in this case and it’s the exact reason why Letby could get off even if she’s guilty.
Regardless of whether letby killed them or not, these babies have been failed massively by the hospital and staff. I appreciate that they’re not on trial here but they should hang their heads in bleeping shame, I’m honestly appalled by it all

Yes there have been loads of problems at the hospital, and I understand that some very questionable decisions were made. But I still don’t think the lack of PM made any difference to Baby E dying, he died regardless of PM afterwards. But do understand what you are saying that if a PM had been carried out, it may have had an outcome on what happens to LL in this trial. The fact the Dr regrets it and has apologised to parents, to me shows she has realised that she now feels she made the wrong decision at the time

 

[docmum]

Thank you so much for taking the time to explain the whole coroner/inquest process. I found it really interesting, and cleared up a few points that I’d been wondering about. You have also mentioned that suspecting a colleague of harming a patient, is the last thing you’d imagine. So could see how this could be part of the reason it took so long for LL’s colleagues to have any real firm suspicions of her. The part of your post that I have quoted is the very chilling to think about. A few people, including myself have had posts were we had wondered if there were more babies before A, and in between the ones involved in the trial, that she had been hurting in minor ways. Such as removing nasal prongs temporarily, or slightly moving tubes, maybe making babies wait slightly longer for feeds that kind of thing. I feel there’s something very sadistic to her, and I feel that when we get to E there’s a shift in LL, in being more devious but also in how sadistic her methods of hurting babies becomes. This is just in my opinion after reading about the methods, and the inclusion of finding blood, and over feeding, and multiple attempts on the same baby, and beginning to inflict a lot of more obvious pain on some of the babies from E onwards

i think (obviously if it is beyond reasonable doubt she is guilty) that these are the only cases that would be able to stand up in court with sufficient evidence as documented in the notes to get a conviction. I don’t know the case whatsoever personally, but I could strongly suspect that there are many many more cases of her cruelty where there wasn’t enough to convince a jury, and the cps wouldn’t want to negatively influence a jury where doubt over one baby’s harm could be cast. I truly believe a few sets of notes had to be put in to the pile where there was another possible explainable cause of death or where evidence wasn’t available to prove any more (ie no exhumation, no PM). This also does reference what’s just been mentioned about bias and I think that will play a huge part in the defences argument eg the description of the unusual rash. But I really do think this rash (just as an example) may have been noted by other medics or staff on other occasions but not documented as such since it didn’t fit a known pattern of illness. In retrospect it is fitting with her. At the time it was part of an emergency situation where the sick baby took precedent. I have no doubt in my mind that the amount it has taken to produce the evidence they have got that she is guilty and likely guilty of more twisted things we’ll thankfully never know the extent of, and I think that whoever blew the whistle to initially voice their concerns over her must have been in mental anguish then and ever since.

 

[Daisydunn15]

Yes there have been loads of problems at the hospital, and I understand that some very questionable decisions were made. But I still don’t think the lack of PM made any difference to Baby E dying, he died regardless of PM afterwards. But do understand what you are saying that if a PM had been carried out, it may have had an outcome on what happens to LL in this trial. The fact the Dr regrets it and has apologised to parents, to me shows she has realised that she now feels she made the wrong decision at the time

I don't think the lack of PM would have made a difference with this baby, I mean it couldn't since he had already passed by the time that decision was reached. I do however think its just another example of the standard of care not being good enough and maybe that could have made a difference to whether he lived or died (if NG).

 

[candyland_]

To go back to the 'luck of the draw' then, wouldn't it be incredibly lucky for LL to have a Consultant write a death off as something other than suspicious? She must have been wringing her hands at her good luck with that one.

This could be why she kept going. She knew she was getting away with it.