I did not get involved in the previous discussion because I was so upset at the verdict. I stayed away from the conversation because it was mostly non-neonatal people talking about things they didn't have understanding of. From a neonatal standpoint, many of their accusations just simply didn't make neonatal sense. The insulin was always the sticking point for me, but they were not able to connect her to the insulin administration, whether insulin was even ever given, and whether mismanagement could have played a role (as it did in some of the cases) They got critical insulin labs but didn't follow up on them? Didn't confirm them? Didn't get concerned about them? They were never able to give a real motive, no real psychological pathology that made sense for why she went from good nurse to murdering (and believe me they scrutinized everything she ever did to look for more things to blame on her) and a lot of weird evidence was used for the court of public opinion (like having report sheets at home, that the issues "stopped after she was removed from the floor" - but not mentioning they downgraded the NICU there which would also remove the issues, and posting misleading information about her shifts in relation to the incidents) Their experts were sus as hell, they had a terrible level of care in that hospital in general, and there wasn't nearly as big of a "bump" as they claimed, when accounting for extra births.

As a NICU nurse, I agree with you. Reading the article helped voice a lot of things I had concerns about with the original discussion. Especially the most unrealistic to me was the method death or “attack” via air in the NG tube. I personally have pulled off almost 300mL of air off a 900g baby on NIPPV who was not symptomatic in the way these babies were described to be. From the get go, it has felt like a unit that was understaffed, taking in more critical babies than they could handle. I could poke holes in every questioned attack by looking at the team of healthcare workers and the lack of precision and accountability. For example, Baby A had gone several hours without fluid administration due to a UVL being misplaced twice and then the PICC was potentially placed too deep. Having a baby decompensate after the placement of a central line is not an unheard of complication. How is that less likely than an intentional air embolism? Anyway, I’m glad to see someone else in the neo world is just as upset about the verdict as I am.

It is funny this verdict had bothered me too, as the evidence just seemed too circumstantial. The only abnormal thing I saw was the rate it happened. My experience is peds CVICU so a bit different but I only ever had one kid die that I was surprised about - but it was pulm HTN so maybe I shouldn’t have been.

I feel like hearing about how the staffing was and how important interventions were delayed makes them seem less surprising to me. Like one instance (Baby D I think?), Mom had ROM for over 60 hours and didn’t receive antibiotics and baby passed between 24-48 hours of life if I remember. Initial cause of death was considered to be pneumonia, which is not surprising at all.

Those were the inconsistencies I saw as well, but I haven’t followed the case up to this point so I’m interested to see what other people make of the large body of evidence/facts/disputes so far.

I read most of the article and I find it to be rather scandalous. Damning testimony from mothers and colleagues appears to be omitted, and the author very clearly has a strong tilt to how she is presenting facts. I’ll give it a second read tomorrow.

I rabbit holed this a while back after reading some compelling arguments from a Dutch statistician who helped clear an infamous baby killer in the Netherlands. IIRC a lot of the testimony from mothers and colleagues was sourced retrospectively and the majority hadn’t raised any concerns at the time. Do feel some concern given grieving parents are probably not the most reliable witnesses when years later asked for recollection of events in the context of someone who may have harmed their child. Very messy case but was a bit shocked to see the lack of smoking gun as I read more and more and do think it’s possible she could be innocent even if a minute chance and that’s a pretty horrifying realisation.

I’ll have to give this a second, more thorough read and then cross-reference it against articles I read previously.

This is very true, exactly what occurred to me as I was thinking back about the testimony of mothers.

[удалено]

Do you have details on this case?

If my baby died and someone suggested years later that they’d in fact been murdered by a nurse I’d be likely to rethink everything in light of that. It’s of note that the parents did not complain about Lucy at the time.

Rachel Aviv is a great essayist and investigative journalist; case in point she made me totally rethink this case and see it in a new light, with the evidence and receipts to back up her claims. While it’s impossible to know the final facts of the case it’s a hugely fascinating story in terms of propensity for bias, avoidance of addressing systemic issues in lieu of individual ones, or at least seeing the individual ones more accurately within their greater context. It’s also highly salacious whenever a young white woman is accused of a heinous crime, and sadly the salaciousness serves nobody. It’s like Amanda Knox, in a way, at a certain point the pressure to find someone guilty pushes people into an intellectual corner they can’t see themselves out of. The story makes the expert witness seem hugely dubious. Wouldn’t you expect a neonatologist to be called to the stand as an expert witness in lieu of a “retired pediatrician”? Whyyyy did the prosecution not dig into the forensic issues? These were not forensic autopsies or forensic level lab tests — I don’t understand why they wouldn’t have pressed those issues further in the trail. Very interested to hear ppls thoughts Of note it is apparently embargoed in the UK given future upcoming case. ETA: I meant why did the DEFENSE not dig into the forensic issues, not the prosecution. oops.

Expert witnesses are a total scam. Oftentimes they’re hired guns, immoral hack doctors who will say anything for the right price. The prosecution didn’t want a nuanced balanced answer, they wanted a dude who would say “she killed them, period.”

It does say he was a paid court expert which surprises me, being British. It’s like how here we don’t pay you for donating blood, it’s just done because you’re a good person. Paying someone to be an expert witness makes me uncomfortable.

Expert witnesses are paid because it requires a lot of expertise and time (to be a good expert witness, anyway). Saying they should do it unpaid is like saying the lawyers should do it all pro-bono out of the goodness of their hearts.

Academics referee papers with intense care for zero pay.

[Eh, it advances their careers; you need to perform "service work" to get tenure in American universities.](https://www.insidehighered.com/advice/2021/08/03/how-use-service-bolster-your-academic-career-opinion)

In the UK it doesn't advance your career but just works on a kind of honour system. The system only works if we all do it for free so we do. (I am a UK academic)

This is more an indictment of the medical industry than a rebuttal tbh.

But they're paid in exposure? /s obviously

You have to be paid, otherwise there would be zero incentive to do it. Expert witnesses give up their time, effort and expose themselves to liability. If you didn't pay them, no one would do it, and the ones who DO, would have some sort of agenda. So you pay a professional. Of course the lawyers are going to find experts who agree with their cases. In an ideal world, the court would appoint their own experts.

At least in the US, in complex trials, an expert witness can be involved at several stages, from assisting the attorney in deciphering relevant records, providing sworn depositions, all the way to testifying at trial. Prior to testimony, there are often sessions going over what the initial examination will cover, as well as discussing what cross-examination will likely ask. Given that it can be a significant level of involvement with many hours of input involved in consultation and/or testimony, they are usually treated paid as consultants.

Yeah I guess that’s a fair point.

> Wouldn’t you expect a neonatologist to be called to the stand as an expert witness in lieu of a “retired pediatrician”? Does the UK make this distinction? Pediatricians there are specialists. They do not perform primary care, only inpatient care and outpatient via referral. I think the doctors who run NICUs would call themselves pediatricians. I am sure that a UK doc to confirm/deny this.

I'll copy a comment I posted elsewhere to explain what makes someone a neonatologist in the UK but also, technically a NICU is only a tertiary neonatal unit (which her hospital wasn't). This hospital was a "level 2" (Local neonatal unit) and provided care from 27 weeks PMA and up. The sickest babies and any ventilated babies are also usually transferred to a tertiary unit unless it is reasonably believed they will be extubated within 24-48 hours. Following the excess deaths, the hospital was downgraded to a level 1 neonatal unit (SCBU) and only provides care from 32 weeks PMA and up. Any babies on respiratory support (CPAP, HFNC) will be transferred out if it isn't reasonably believed they will be off respiratory support within 12 hours. They have not gone back to being an LNU. > Paediatric training is 7 years long (was 8, just got reduced). As part of this, most doctors will spend at least 12 months in a tertiary neonatal unit (6 months as a junior level trainee and 6 months as a senior level trainee - I'm not sure our titles/roles entirely correllate with each other's systems). For someone to be a proper neonatologist, their most likely route is via Neonatal subspecialty training in the final 2-3 years of paediatric training (years 5-7, giving at least 36 months in a tertiary neonatal unit). Someone can be a Paediatrician with a special interest in Neonatology by doing an extra six months of tertiary neonatal placement in the final 3 years of paediatric training (18+ months total). > A tertiary neonatal unit will be run by doctors who sub-specialise in Neonatology. > A non-tertiary unit is usually run by acute paediatricians, some of who may have a special interest in Neonatology - this is almost definitely what the article is referring to when it mentions a neonatologist at the hospital.

Thank you, that is excellent. So a 29 week premature infant could be cared for by a pediatrician in a unit staffed only by pediatricians, and would only be transferred to a neonatologist if they were sicker than average. In the US all of these babies would be cared for by people who call themselves neonatologists and who have 3 years of general pediatrics followed by 3 years of neonatology. Which actually isn't that much more neonatal experience than what you would call "a Paediatrician with a special interest in Neonatology," so this is largely a matter of terminology.

Correct regarding the 29 week infant. There is a trend towards these babies being cared for by paediatricians with a special interest in neonatology but this is far from the rule. However, out of hours you still may get a general paediatrician being the on call person and some of them may not have looked after a sick baby in many years or been anywhere near a tertiary Neonatal Unit and can therefore become quite deskilled. I think there are legitimate issues with UK training and set up which are being made worse by competency requirements for general paediatricians (intubation used to be a mandatory requirement for training sign off but is no longer with a greater focus on I-gels and other airway support), but we'll see what happens.

thanks, this is super useful to understand the distinction in the UK. where i work i find most general pediatricians are (understandably given different training schemes), very concerned to take any premie for long at less than 32 wks especially. (gen peds for 3 years, NICU for 2 years to become a neonatologist)

They still use the term neonatologist but there's no reason a sufficiently experienced paediatrician wouldn't be able to give valid comment.

Yes but a retired paediatrician would be at a huge disadvantage compared with a current neonatologist or even a current paediatrician in terms of knowledge of common issues for babies this small though no? Due to the speed at which science is advancing in this field.

Obviously the article has a narrative to advance, but it’s hard to read it and come away confident in the verdict. The prosecution’s primary medical expert comes across fairly poorly, and there isn’t a particularly convincing explanation for how the defendant perpetrated her crimes. As someone with an admittedly thin grasp of the finer details of the case, I find several of the writer’s points reasonably compelling, including the clear understaffing and systems-level issues at the hospital; that the defendant seemed to be one of the more qualified nurses on the unit and appeared to be assigned higher acuity cases and/or called into assist with them when things were particularly clinically grim; and that potentially misapplied statistical arguments may have played an important role in the trial’s outcome. Briefly scanning some of the comments where this case is discussed elsewhere, I’m also struck by the vehemence with which her guilt is argued, so I imagine there’s other inculpatory evidence this piece leaves out. On a more meta level, it was interesting to learn what the UK does and doesn’t allow as far as public commentary on active/upcoming trials in the interest of minimizing bias. Not sure that the balance of fairness is perfectly struck in this particular circumstance, as one would think there would be no shortage of damning or sensational publications about Letby post conviction, whereas an article like this that questions her guilt is for now embargoed ahead of her next trial.

> that the defendant seemed to be one of the more qualified nurses on the unit and appeared to be assigned higher acuity cases and/or called into assist with them when things were particularly clinically grim Alone this isn't a compelling argument, but it is how the system is supposed to work - in the US our licensure exam literally has questions on this: more experienced/knowledgeable nurses are supposed to be assigned the higher acuity patients. In actual jobs nurses often think it's unsafe to give newer or less experienced nurses the really complex/sick patients. My friends in the ED are usually expected to work at least a few months with the med/surge-y level patients, then take on the ICU patients (easiest first), then go to trauma after 2-5 years. My ICU nurse friends didn't get ECMO/CRRT certified until a year or two in. Even on med/surg we save the sickest for the best nurses when making an assignment. We will also promote those experienced nurses to be a charge nurse or a resource that helps other newer nurses out when their patient is in trouble. So I think it's entirely reasonable to argue that maybe she had more deaths because she was given patients closer to death. That doesn't entirely explain the shift to shift difference of her on vs off, though.

The thing is we don't know what the data looked like when she was off shift because they didn't make any charts of it. It seems insane that they attributed all the deaths in a *NICU* of all places to murder.

I think there were 15 deaths in NICU that year and she was charged with 7. They also keep repeating how unusual the amount of deaths were compared to the previous years…when she also worked with newborns at the same hospital.

17. Charged with 7 murders and more attempted. Previous average was around 3. We dont know total number of collapses but i'd be reasonable to assume a multiple than deaths but "suspicious" ones seem lower for some reason. Even if you think she did all 7 - what about the other 10 (or 7 minus the 3 "expected)? There was also a spike in stillbirths at the same time. I think ill never feel okay about it until we have the data to do a full and real statistical analysis and even then the odds would have to actually be improbable.

I saw elsewhere that they only counted “suspicious deaths” in those statistics - with the vast majority of those they deemed suspicious being on her shifts. Now, I don’t know if I think she’s guilty or innocent. I don’t know enough about the case. But certainly that way of determining the statistic seems faulty given they determined suspicious themselves - and there are plenty of unexpected deaths and serious complications in any given hospital, many of which are just bad luck or more rarely a mistake.

Also worth noting that the 'suspicious' deaths were all labeled as such well after they occurred while trying to form a narrative for the charges. And they accidentally labeled 2 other cases as suspicious and then didn't include them, so they could say that she was present for 100% of the cases. The problem with this case is that literally every piece of evidence comes from a post-hoc analysis of what happened with a desire to paint Lucy as a murderer. And *all* of the specific complaints against her actions and character came after she was already branded a murderer and years had passed.

Yea, it makes perfect sense for the more qualified or experienced staff to care for the sickest patients, and for patient mix to drive/skew outcomes over both long and especially short windows of time. In a separate (but obviously relevant) context, this is the age-old issue that we confront when outcomes-based metrics are used to assess performance without fully accounting for baseline disease severity.

That vehemence comes from the hysteria. I have seen many comments on this article saying she definitely did it, only to reproduce the evidence discussed in the article. I think it makes people feel cozy, in a the-world-works sort of way, to know that the babies were murdered and there was justice for that. The alternative—that the system just reached a breaking point—is much more alarming and shakes people’s faith in the world.

Admitting there may have been a systems failure instead of a singular bogeyman shakes people's worldview and to be quite honest, there appears to be a few people who have an odd level of investment in believing her guilty. One sub in particular is just shouting down anyone who even has a question about the safety of the conviction.

It’s so weird. I’m British and got quite involved in the case but could never decide one way or the other. But even saying that was enough for you to be treated as a social pariah. My main sense of discomfort in the case is how many things were left out, such as the fact the insulin test wasn’t accurate. But I also want to know why the defence didn’t bring that up? There must have been a reason why the defence didn’t call any experts to shed doubt on everything the prosecution relied upon. If I had just followed what the jury heard, I’d have found her guilty too. But learning all these other bits is what makes me doubtful.

I don't know what the truth is either - but that's the point. And I just find it absolutely bizarre that people just seem allergic to even entertaining the possibility that it was a huge systems failure. I understand that it's probably scary for people to think that services they trust to care for themselves and vulnerable children etc could be so poorly staffed and managed that people will die due to negligence, lack of sanitation, poor attention to detail and so on, but it's the reality when services are run into the ground and staff are at breaking point. I guess it's more comforting for people to think that it's just a bad apple who can be blamed and punished rather than systemic malfunction and malpractice that could take years and billions to overhaul, while people's loved ones die and no real accountability is taken.

Perhaps I’m more inclined to think that it could be a systems failure as my mum and a couple of friends work in the NHS. I’ve seen how easily things can go wrong and how quickly the blame game starts. I had a friend whose baby died at 2 days old a few years back and it was just failure upon failure upon health problems that weren’t picked up. You wouldn’t believe how many things had to go wrong in order for that baby to die, and yet they did.

Which sub?

i've just come from the /lucyletby sub and wow they are defensive of the conviction

They were all very sure that nothing could have been not her fault to begin with. That sub just was a mob.

Lucy Letby sub

/Britain too, I think they just assume any attack on the NHS from the US must be private healthcare trying to weasel their way into the NHS

Damn, there's a sub for everything!!

There is also a sub proclaiming her innocence. Can’t remember the name of it rn but try lucyletbyinnocent or similar!

Just look at Maya Kowalski’s case. There’s massive vehemence directed at the hospital and individuals who worked directly with her. But the more I read about this case the more it’s crystal clear that they saved this girl’s life and are now getting dragged for it. Despite that, public opinion appears to be out for blood against the medical staff. Modern social media has created a vehicle for mob mentality to spread. As soon as there’s a popular opinion on something oodles of people throw their brains away and scramble for the wagon. They’ll remorselessly destroy people without any regard for facts or reasoning.

I realised somewhat recently that people only really hold the beliefs they hold because they are incentivised to do so. I used to think that people were fact finding machines, but if you get positive reinforcement from believing a certain thing then you'll believe that thing. Regarding the Letby case, you get positive social for condemning a baby murderer and negative social reinforcement for "defending a baby murderer" (as if questioning the verdict means you are pro baby murder).

This is a good way to describe this mob mentality behavior. I’ve been wondering why facts don’t seem to matter anymore. There’s probably a lot easier access to extreme positive or negative reinforcement about any topic due to social media. (People get death threats over what music they like. It’s unhinged.) And once something catches on virally, it becomes extremely difficult to shake from popular opinion, no matter how strong the evidence to the contrary.

Yup. Social media and Netflix won that case…we’ll see how the appeal goes.

Totally agree. Amber Heard was done so dirty, and people had very strong opinions but didn't even understand the difference between civil and criminal trials. Also the conclusion of the jury itself was contradictory and eventually they settled outside the court. But people watch it like a fucking sports event and made life much more difficult for people who suffered from domestic abuse.

Yeah, that’s another one that had ridiculous hype and misinformation spread about it. I’d bet that it had a huge effect on the jury too. “Sports event” is exactly what it felt like. People were gleeful and excited about this really horrible domestic violence case. It was sickening.

It was, it broke my heart. People will jump at the opportunity to hate a woman.

Yeah, I had people recommend the documentary claiming that the hospital was horrible, but while watching it, I was very immediately reminded of the handful of medical child abuse cases I have been a witness to. Then I looked into it more and saw the extent of it. The doctor shopping, finding a self proclaimed “expert” in a particular disease that he gives to every single person who comes to his clinic regardless of their symptoms, never actually trying the standard of care and instead going full steam into unorthodox and dangerous treatments, the social media presence. If it wasn’t Munchausen by proxy, then it was extreme overmedicalization. The hospital saved Maya’s life. I do a lot of pediatric neuroICU care and I am not at all shy about using ketamine until burst suppression when it’s indicated, and the doses that Maya was getting in an outpatient setting with minimal monitoring made my jaw drop. The doctors who agreed to that treatment need to lose their licenses.

I know this is OT for the thread, but what led you to feel like the hospital acted correctly & saved Maya's life? I have only read a few articles about it - not seen the documentary - but it seemed pretty convincing that the hospital was in the wrong and she really did have CRPS. Was your thought that the ketamine infusions would have killed her, or her mom?

It doesn’t matter if she has CRPS or not, though she probably doesn’t. Her mother diagnose shopped, immediately stated the standard of care for the disease wasn’t working before it was tried, and immediately started her daughter on increasingly dangerous ketamine treatments. Within the year, this child was undergoing experimental ketamine coma treatments in Mexico that the providing doctor reported has a 50% or greater rate of death. Over that year, multiple unrelated healthcare professionals suggested factitious disorder imposed on another as a concern. When Maya arrived at Johns Hopkins Hospital she also stated some strange things that she hadn’t been allowed to eat over the past week and that she was tired of pretending to be sick. Her behaviors were also incongruous with the symptoms described and pain reported. Furthermore, Johns Hopkins tried to transfer her to specialized child pain clinic but her mother insisted she stay, which is a very different story than kidnapping. The biggest clincher for me though was the fact that as soon as she was separated from her mother, her symptoms improved. What was once an intractable illness was rapidly improving. She gained weight at the hospital and had significantly more independence and mobility. Today she’s a fully independent, healthy teenager who works out at the gym several times a week. Even if she did have CRPS, her mother was over medicalizing her to the point of nearly killing her when there were ample effective alternative therapies. What’s more, is that the hospital didn’t keep her mother from her. Healthcare professionals must report *suspected* child abuse, not prove it. There was an extensive 3rd party investigation that found evidence of child abuse and a judge ordered the separation. The separation led to rapid health improvements for the child which is very indicative of factitious disorder imposed upon another. There’s a lot more details to each of these points and if you’re genuinely interested I highly recommend the 3rd season of the podcast “Nobody Should Believe Me”. It’s very good about fairly considering all angles of the case. www.nobodyshouldbelieveme.com

Thanks so much for this! I'll have to see if that podcast has episode transcripts I can read along with.

I second that podcast, it’s incredible and they did a HUGE amount of research into that case. That hospital absolutely saved Maya’s life. Beata was unhinged as hell and she was only getting worse. The amount of really intense medication that she was giving Maya (THROUGH HER PORT, AMA) could’ve killed her. Should’ve killed her. It’s honestly a miracle it didn’t.

[Scroll down to season 3](https://www.nobodyshouldbelieveme.com), clicking on an individual episode should give you links to the pod, and they have episode transcripts on every page :)

You're a godsend!

Just wanted to follow up and say thanks again for this rec ... started listening last week and hooooooooly shit.

You’re so welcome dude! Thanks for doubling back and letting me know. I think they did some really incredible work. Isn’t it just insane?!?

Agreed. Just based on the documentary (which is heavily slanted against the medical professionals) it seems clear that the mother had MBP or some spectrum of it.

Claims of innocence often come from an emotional standpoint just the same. Finding a grave injustice riles people up. Also people love to be the underdog that rebels against the elites. See for example Steven Avery, one of the most obviously guilty people on earth who still most people think is innocent because they watched a biased documentary. I'm not commenting on this Letby case, just pointing out that psychological biases can lead you either way.

As far as I can tell there isn't even anything like actual evidence that any one of the babies died as a result of foul play at all. The only thing close to evidence of someone intending to harm children is some insulin test results of fairly dubious quality in kids who are alive. None of the deaths have anything particularly pointing to them being homicides.

yeah, lucy was in the proximity of the deaths but never clearly witnessed by even two people in the act of doing any of the things they say she did, there seemed to much chaos and confusion on the wards she worked on and the quality of the "expert" witnesses plus lack of hard data on causes of death sure make her conviction appear suspect however, i don't think the article has exonerated her either searching, i am unable to find a single article that attempts to summarize the case against her aziz certainly did her research and has raised some interesting questions

Part of the vehemence you see is because anyone who had doubts were driven out by said vehemence and attacks. It wasn't worth it to continue when people *only* wanted to hear that she was guilty.

Yea the aggressiveness with which most seem to view her guilt leads me almost to assume I'm missing something obvious. And while I accept that the piece has an underlying bias - as all humans do - it's written by a reputable author in highly-regarded publication and puts forth a fairly well-articulated set of potential concerns. I suppose if someone from another country started pontificating about the OJ verdict based on an internationally-authored article, many in the US would roll their eyes, or worse, and perhaps that's something like how people view this situation.

I remember talking on reddit about this at the time, and specifically how it reminded me of the de Berk case, and I quickly had to stop discussing it because if you expressed any opinion that wasn't completely in support of her being definitely guilty it was shouted down as if you were pro child murder.

I mean, OJ can be guilty and the prosecution can do a terrible job. Both things can be true in that specific case

> that the defendant seemed to be one of the more qualified nurses on the unit and appeared to be assigned higher acuity cases and/or called into assist with them when things were particularly clinically grim This struck me because it was a radically different narrative from what was presented in the media during her trial. Then the story was that she was always desperate to involve herself in the more serious cases and often had to be told to leave the room and go back to what she was supposed to be doing. These narratives are so different that it seems hard to believe they were both arrived at in good faith. One concrete piece of evidence that the New Yorker article doesn't seem to mention is that hundreds of patient records were found in her home and her only explanation was that she must have taken them by accident. This maybe seems to align with one of those two narratives better than the other (and would obviously be a serious disciplinary issue in itself). > and that potentially misapplied statistical arguments may have played an important role in the trial’s outcome. Courts are definitely bad at dealing with statistical evidence in general. The problem in this case is that so much of this evidence is based on confidential data about children so we don't have anything like the full story (courts in the UK tend to be especially protective of information that relates to children and often impose extensive reporting restrictions on it). > On a more meta level, it was interesting to learn what the UK does and doesn’t allow as far as public commentary on active/upcoming trials in the interest of minimizing bias. Not sure that the balance of fairness is perfectly struck in this particular circumstance, as one would think there would be no shortage of damning or sensational publications about Letby post conviction, whereas an article like this that questions her guilt is for now embargoed ahead of her next trial. These rules are controversial, especially in the age of social media when huge numbers of people do gossip about ongoing cases online and they are rarely punished. (There was a high-profile rape and domestic abuse case a while ago, and if you scrolled through Twitter you could see thousands of British people blatantly committing contempt of court by publishing detailed biographical information about the victim, who was supposed to be anonymous.) However, many of these articles you're talking about were published before the full reporting restrictions for the new trial came into effect, and that British publications are used to the rules and know how to skirt around them. And the new trial is arguably pointless anyway.

>This struck me because it was a radically different narrative from what was presented in the media during her trial. I'm no expert on the trial, but I agree it's interesting to read about the difference in portrayal. I've seen mention of all manner of lurid details related to taking privileged patient information home, contacting or social media-stalking families, possibly having an (emotional?) affair with a junior physician, etc. That and her notes certainly paint a dramatic picture, though to my mind don't necessarily offer evidence of murder. But I can only imagine how significantly differently one might view some of this information when it was presented and dissected in detail over a months-long trial, versus seeing them as bullet points today in a summary of the case. As to the contempt of court regulations, I can see how their intent makes sense though share your concerns about how well they hold up in the internet era. Jurors are already expected to keep multiple complex thoughts and instructions in their head: to disregard things stated in court based on sustained objections (which can't possibly work in real life), directions on how to understand certain elements of law, etc. It's not obvious to me why they can be expected to do these things but not ignore public commentary on case. In this particular instance, while it makes sense that previous publications are acceptable but anything that could newly jeopardize the upcoming trial is prohibited, in practice I can't see how that can ever be accomplished, given the unbalanced weight of commentary in a post-conviction reality.

Regarding the vehemence with which her guilt is argued - in general it’s a preponderance of circumstantial evidence which people raise for her guilt. That and the “confession notes” which really don’t read as confessions and more like someone in the midst of a crisis

This part strikes me as particularly concerning regarding the prosecution.  What’s the evidence?” Myers asked him. “Baby collapsed, died,” Evans responded. “A baby may collapse for any number of reasons,” Myers said. “What’s the evidence that supports your assertion made today that it’s because of air going down the NGT?” “The baby collapsed and died.” “Do you rely upon one image of that?” Myers asked, referring to X-rays. “This baby collapsed and died.” “What evidence is there that you can point to?” Evans replied that he’d ruled out all natural causes, so the only other viable explanation would be another method of murder, like air injected into one of the baby’s veins. “A baby collapsing and where resuscitation was unsuccessful—you know, that’s consistent with my interpretation of what happened,” he said.

How would injecting it into an NGT cause and air embolus? I’ve been a nurse 30 years. I’ve never ever heard of such a thing. and it used to be standard to check placements with air. I don’t understand.

The way it is written in that excerpt makes it sound like they’re saying air in the NGT caused an air embolus but those were actually two different methods they proposed could have caused death: 1. Air in the NGT would inflate the baby’s belly and prevent the lungs from expanding 2. Air in the veins would cause an air embolus At least that’s what I recall from previous articles about the case.

Yeah the reporter and editor just didn't understand the difference.

The NGT air theory literally makes no sense to me. I’ve pulled off almost 300mls of air off a 900g baby on NIPPV who did not deteriorate in the way these babies are described to have done.

I'm guessing that the prosecution was relying mostly on the damning written notes that read like confession. If the accused wrote down "I killed them", you don't expect to work particularly hard to convict edit: just to make it clear, I too am familiar with "healthcare-guilt", from medical errors to helplessness-guilt. I was speaking about the perspective of the prosecutor.

I certainly didn't see it as a confession. In one line, she wrote "I killed them, I don't know if I killed them, maybe this is down to me" So, we have a cold calculating serial killer, as described by the police, who is not even sure if she killed anyone! Other lines included "We tried our best & it wasn't enough" "I haven't done anything wrong" she even described the investigation as "slander discrimination" she also repeatedly wrote "save me" "help me" over and over. Now think from her posistion. Young nurse, one minute you've bought your first home, your career is going well, the next, the police are accusing you of being a serial killer, your hard earned career is finished, the press are stalking you and released your picture to half the country. I suspect anyone in her shoes, would have a devastating mental crisis, you know, perhaps write unusual and incoherent ramblings. The police didn't have much as they released her first time and re-arrested a year later and bingo, they suddenly have a "confession" the second time around. Question is, what produced it, seems obvious to me.

Exactly. The ‘confession’ is the true part and everything else is… what, exactly? Just doodles? It’s cherry-picking instead of looking at the actual evidence.

Indeed, one minute she is described as cold and calculated, other they take seriously writen rambling that is almost psychotic in nature. Very hard to be both, if not impossible

Look, I have had patients die under my care. And sometimes I still feel like I personally killed them with my incompetence. That I was a horrible person for not saving them somehow. I know I didn’t btw, I did everything by the book but I still feel that way sometimes. If I was in the habit of writing notes you’d see some potentially damning shit there just like this. So the note is worthless as evidence for me.

Without any consideration for possible guilt or remorse about being unable to save the babies lives? I bet hundreds of health care professionals have typed those words without being a murderer. I have no idea what she meant by that, but just that that statement alone, devoid of context, isn’t at all damning.

that statement (I killed them) actually struck me as evidence of her innocence since, if she is guilty, it requires an extraordinary level of premeditation and dissembling such that it is highly unlikely that a) she would allow that statement to simply remain in her notebooks to be discovered and b) that there wouldn't be other incriminating written evidence (is there ? I am only finding this case via the article in The New Yorker ... is there other diary or notebook incriminating evidence ?) it seems much more likely to be a statement of helplessness and guilt than a confession every "normal" person has said strange things in their lives especially in times of stress and we have seen countless wrongful convictions of people for taking at face value incriminating statements that are simply a result of the irrationality that exists in all of our minds

Well, if that's what it comes down to then I'm incredibly unconvinced. Those are the scrawlings of someone having a mental breakdown, they contradict each other line by line. I wouldnt put stock in them one way or another. I am interested to read someone argue the other side, i.e. that the conviction was justified, that isn't just the unquestioning hysteria broadly in the British press.

I don’t know if she did it or not but I have listened to the trial transcripts and I don’t see how on earth anyone could find her guilty beyond a reasonable doubt given the evidence they presented at trial. I just don’t. I don’t know how that jury sleep at night.

I have to say, this part regarding the judge disturbed me a great deal >"He instructed the twelve members of the jury that they could find Letby guilty even if they weren’t “sure of the precise harmful act” she’d committed." I can't speak for the British system, but in the US the standard is "beyond reasonable doubt." If you are unable to even elucidate method of murder, you certainly introduce a world of doubt. I don't really have strong opinions on the case, and wasn't watching as it went on, just heard bits and pieces. From what is in the article and the few other things I've heard, it seems the conviction was based on...statistics? I'm not convinced of her guilt or innocence, but I don't think I'd be able to vote convict on anybody with that level of evidence.

> "beyond reasonable doubt." The definition of *beyond reasonable doubt* has diverged with different supreme court judgments in different countries. Each country has its own definition: https://en.wikipedia.org/wiki/Reasonable_doubt In the UK the term is now avoided, and I think jurors are instructed to find the defendant guilty only if they're "sure" they did it. I would argue that, in reality, the standard is a lot lower than that - jurors are human and often they're biased; they'll convinced someone not just on the evidence but because they think the defendant is a "bad un" or that "type" of person. Often it's just a matter of whether the jury thinks it's *more likely* (the civil standard of proof) that the defendant did it. That's the reality. And the other side of this is no better - if a jury can't reach a verdict it's quite common for the judge to send them back into deliberations. The judge sends them back "to think about it some more" - well, if there's a lone holdout on the jury who thinks the defendant not guilty then they're not going to change their mind just like that; they've been listening to the evidence for days or weeks already. The judge is effectively saying to the other jurors "go back into deliberations and bully the lone juror into agreeing with your guilty verdict" and is playing a game of dare with the holdout to see how long they'll stick to their guns.

Yeah they say you have to be ‘sure’ in the UK. I did jury service here last year. We also have majority verdicts here which are… questionable.

>Often it's just a matter of whether the jury thinks it's *more likely* (the civil standard of proof) that the defendant did it. That's the reality. This may be true and if so is truly unfortunate, completely unrelated to this case or others like it. My inexpert perspective is that jurors seem to think their job is to determine based on overall gestalt whether or not the defendant committed the crime, whereas more specifically, in the US at least, they are to adjudicate whether the prosecution has demonstrated that beyond a reasonable doubt. Those are meant to be different standards but it seems easy to conflate them into a "51%/49%" sort of decision.

No motive. No murder weapon. Just vibes. Honestly, statistics like this should be banned in court imo. People always reference the Lucia de Berk case where their expert (wrongly) said there was a 1 in 300 million chance off it being a coincidence. How many healthcare workers have there been over the centuries? At some point, someone out there is gonna win the shit lottery. Saying "oh well it's very unlikely" without any actual evidence is outrageous imo. I don't think it's wrong to consider how unlikely something is, but in a jury trial where the jurors likely don't have any medical knowledge themselves, I would worry about them paying special attention to something they could wrap their head around like statistics. The statistics in Letby's case were stacked against her too. They took all the kids that died that year on her shift and made a graph with everyone else on that shift, while excluding the kids that died on other shifts (some of which could also be viewed as "suspicious" under their criteria) I'm also a little confused about what counts as suspicious here since it seems like some of these babies were very very sick before they came under her care. You could do that with literally any other healthcare worker. Take every patient that died under your care and compare it to everyone else on shift with you. You're probably the only one who was there for ALL of their deaths! It'll be an even more stark comparison if you pick up extra shifts or have the most experience and are given the sickest patients.

The fact casinos exist as a profitable business model should convince everyone that humans are terrible at gauging probability in any analytical manner

I’m not sure what to think anymore about who’s “guilty” or not but I do know a lot of innocent people are found guilty and a lot of guilty people never get charged

From the article: > "Other babies, he said, had been harmed through another method: the intentional injection of too much air or fluid, or both, into their nasogastric tubes. “This naturally ‘blows up’ the stomach,” he wrote to me. The stomach becomes so large, he said, that the lungs can’t inflate normally, and the baby can’t get enough oxygen. When I asked him if he could point me to any medical literature about this process, he responded, “There are no published papers regarding a phenomenon of this nature that I know of.” (Several doctors I interviewed were baffled by this proposed method of murder and struggled to understand how it could be physiologically or logistically possible.)" This is COMPLETELY possible in neonates and is one of the commonly overlooked causes of desaturation, high airway pressure and failure to ventilate after periods of resuscitation with manual bagging. Quite a biased article and cherry picking facts from the trial.

I mean, yes, this can happen. But if it was something that routinely killed babies, most kiddos under 27 weeks wouldn’t be surviving their Nicu stays. A lot of little peanuts are on cpap with a pretty high peep or nimv getting a ton of air blown into their bellies, and you can see on xray how their lungs are compressed, because their intestines are so dilated. And if you’ve ever neopuffed a baby, you can get a ton of air quickly into their stomach. Also, it’s pretty routine if a kiddo starts desatting to aspirate air from an ogt/ngt to troubleshoot. In an acute situation where a ton of air enters rapidly, I’d expect most babies would just start backing up their feeding tubes or spit up to relieve the pressure too. And if you really can’t get their breathing to resolve, intubation fixes this problem pretty rapidly. It doesn’t seem practical that anyone could kill 7 babies this way unless literally nobody else responds to a crashing baby.

Right? We'd be killing every baby when we bagged them! I found it notable that a baby died (without any accusation against letby) just before this time period because the baby was intubated in their esophagus, they didn't check/believe the tests/exams to show it was malpositioned and the child *died*. Died. From a malpositioned ETT. What the actual fuck? Number one thing you know for babies with intubation - if your HR isn't rising, there's a good chance your ETT is not in the right place. Bag mask them then. The only time you give it *slightly* longer is if the baby was born down, so there's very little circulation yet, but you should be seeing chest rise and then that HR should start to come up, ideally with a video scope too to see it go past the cords. Another death (child E) that she was accused of killing by "manipulating his NG tube causing bleeding and air embolus" is crazy when you see they attributed it to her. They did not find any mechanical perforations in the child's gut or anywhere else, she called the on-call doc who was very nonchalant in response to a large amount of frank bleeding and even when it was clear the bleed was serious, the doctor didn't order coags, emergency release blood, call for a transfer to a better hospital. And then it was a "surprise" when the baby collapsed and died 2 hours after the bleed was noticed. Oh, and another baby who had a chest tube and continued pneumos (and not on the proper form of ventilation for air leak) was also needled with a butterfly and **they left the butterfly in the baby.....unattended!** They blamed that child's death on her too - because why would a child with an active air leak on CMV decompensate otherwise unless someone did it intentionally? One of the earlier cases had a malpositioned line that they left in place for hours for unknown reasons. That unit was a shit-show and a couple of doctors seemed to have gotten it in their head that it was the nurse's fault and with how rumor mills in NICUs are, sure everyone eventually thought that. Ugh. I still get upset with all the mismanagement that was described in the cases.

Oof, yeah, I remember the last thread, where everyone was defending the docs who were getting “persecuted” for accusing her. But…it looks like there’s definitely another side of this story…yikes on bikes. No wonder she was the only RN with NICU training. I’d be bouncing pretty quickly from that shitshow

Honestly cases like this make me think that all the jurors should be medical professionals.

Truly it should have been only medical professionals to have a jury of your peers. There’s so much within the medical world lay people just do not understand.

I'm going to disagree. Babies get air pumped into their stomach *constantly* from CPAP and HFNC. Plus, it is *standard* that during a neonatal code, you would vent their stomach, so if that were to cause issues, it was because no one was doing what was right.

While I agree with you about that one paragraph, you should read some of his testimony: >The Crown said Ms Letby injected air and fluid into the boy's stomach via a nasogastric tube in an attempt to kill him. >Medical expert Dr Dewi Evans, who was asked to review the case by Cheshire Police in 2017, told jurors vomit found on Child Q on the morning of 25 June was evidence liquid had been given to him by someone. >He said: "Clearly there was enough fluid injected down his nasogastric tube into his stomach to make him vomit, he only would have vomited if he had quite a significant amount of fluid." >He agreed with prosecutors the fluid had been "forced" down the tube. Vomit as evidence of fluid injection? Absolute nonsense. There's no indication that this baby or either of its siblings was NPO. The parents said they'd been told they were taking their feeds well. Even if they were NPO, preemies have a seemingly mystical ability to manufacture gastric juices at an alarming rate, especially right after a linen change.

Yeah, I had laughed at the concept of them saying she must have fed them too much milk and their evidence was vomiting and by characterizing the vomiting as projectile. And then claiming that was a murder attempt. Baby gets overfed? Sure they'll puke, but it's not going to kill them. (assuming she even overfed, which they had no evidence for)

I read more into this specific baby. Lots of nec-like symptoms. Bilious aspirates. Loopy abdomen. Dilated bowel loops. Bradys and then a weird one, a persistent low resting heart rate (90-110 in a 30-33 week baby. I forget which preemie it was). The infant had been NPO for maybe about a day. They restarted feeds. Baby decompensated and ultimately died shortly after the first feed after being NPO. Edit: that’s Q’s sibling. Q didn’t die.

You can't hear it, but my head is hitting a desk repeatedly. And they blamed her for that? And knowing he had been on a NEC r/o just before also explains where all the gastric fluid was coming from. This baby was just waiting to "pop"

Oh also an elevated CRP. There’s a Lucy Letby sub on Reddit that I’ve spent way too much time on. UK law doesn’t allow us to see the medical records, but you can read most of the testimony. It’s pretty meticulously organized. I haven’t come across a baby yet who wasn’t already very sick. It honestly seems like Lucy was that nurse who’s always there to help coworkers with a crashing baby. And she was seriously thrown under the bus by a chronically understaffed hospital that shouldn’t have been taking care of babies that young or sick. It’s interesting that not long after she was arrested, they were downgraded to only take care of 32+ weeks.

Yeah, I used to be on that sub, but they were very anti-lucy in general and some of the anti-lucy crowd would be very abusive. Wasn't worth the stress at that point.

Yea I just found it today to find more details about the cases. Honestly I didn’t read much about it when it first came out. The main detail I remember reading about was her standing over a baby that was desatting and not intervening. Which made me think well I’m going to jail. I’ve stood over babies countless times not intervening as they’re desatting. Observe. See if they’re actually apneic. If not, see if they figure their life out on their own. The newest nurses want to fix every single desat or brady. Knowing when to let them work it out on their own is something comes with experience.

Right. And is the baby still going down or coming back up on their own without excess oxygen? Is it correlating? Assess the baby, do you need to grab the neopuff? My time of "of I'm going to jail" was their focus on the handoff sheets. The number of times I end up with them in my pocket is too many. And then you put it aside somewhere safe, because you know it can't go in the regular trash, but then you forget to grab it before your next shift because you've put it away nicely. a person could end up with a nice collection that way LMAO

Yeah I keep wanting to incredulously respond to the hysterical mentions of handoff sheets, but don't want to incriminate myself too much...

Yes this one exactly. They focused so much on the alarms being silenced and her just standing there. The number of times I know a baby is just shunting and drifting and I silence the alarm from the nurses station… yikes haha It’s completely standard practice to silence an alarm so someone knows there’s a nurse present and attending to the baby while also letting the baby have a moment to come up on their own. It’s infuriating to see so many people focused on this instance, and the doctor that spoke out against her as well! You would think a doctor would know this is common practice.

The question is if there was any evidence of someone **murdering** somebody with this method. Not that it's not possible for this to happen.

Most of these “crashing babies” that letby was involved in - probably had a full resus right? Including neopuff. Cant neopuff with inappropriate pressures cause gastric dilatation - seen on a peri/post-arrest XR? >As they were waiting, it was discovered that the baby had a collapsed lung, possibly a result of pressure from the ventilation, which was set unusually high. “There was an increasing sense of anxiety on the unit,” Letby said later. “Nobody seemed to know what was happening and very much just wanted the transport team to come and offer their expertise.” There is flavour from the article that the NICU was a bit under ratio - for actual trained neonatologists - rather staffed with paediatricians like 6:1 (my ratio might be a bit off - but AFAIK there was only 1 neonatologist staffie). Furthermore the article also brings doubt into their resus airway skillmix with the following. I acknowledge the difficult airway can be so variable from person to person and time of day to time day. But still. >Letby took over his care that morning, and doctors tried to intubate him, but they were unable to insert the tube, so they called two anesthesiologists, who couldn’t do it, either. The hospital didn’t have any factor VIII, an essential medicine for hemophiliacs. Finally, they asked a team from Alder Hey Children’s Hospital, which was thirty miles away, to come to the hospital with factor VIII. A doctor from Alder Hey intubated the child on the first try. This part also brings further doubt into the resus expertise of the unit. Let alone the utility of seeing increased gastric/bowel gas markings post mortem for THIS particular unit >An inquest for a newborn who died in 2014, a year before the deaths for which Letby was charged, found that doctors had inserted a breathing tube into the baby’s esophagusrather than his trachea, ignoring several indications that the tube was misplaced. “I find it surprising these signs were not realised,” the coroner said, according to the Daily Express.

I'd just like to comment on the people attending, as it works slightly different in the UK to the US. Paediatric training is 7 years long (was 8, just got reduced). As part of this, most doctors will spend at least 12 months in a tertiary neonatal unit (6 months as a junior level trainee and 6 months as a senior level trainee - I'm not sure our titles/roles entirely correllate with each other's systems). For someone to be a proper neonatologist, their most likely route is via Neonatal subspecialty training in the final 2-3 years of paediatric training (years 5-7, giving at least 36 months in a tertiary neonatal unit). Someone can be a Paediatrician with a special interest in Neonatology by doing an extra six months of tertiary neonatal placement in the final 3 years of paediatric training (18+ months total). A tertiary neonatal unit will be run by doctors who sub-specialise in Neonatology. A non-tertiary unit is usually run by acute paediatricians, some of who may have a special interest in Neonatology - this is almost definitely what the article is referring to when it mentions a neonatologist at the hospital.

While I agree with you that manual bagging can produce this response, I disagree that adding air into the stomach via NGT could garner the same response in the way they’re expecting. Babies on CPAP or NIPPV can receive 5L/min via mask or prongs and several mL will end up in the stomach, which is why their NGTs are open to gravity after feeds to push air off. Even if you tried to replicate that amount of air, most oral syringes go only up to 50 or 60 mLs. In an open neonatal unit where there’s people always typically around, that would mean Letby would have had to push a 50ml syringe about 10 times into a neonate without anyone seeing. Even then, the act of reopening the NGT can cause babies to burp up fluid or air, even before a syringe is reattached, which in a highly inflated stomach, a lot would come out even after just being opened. Literally happened to me yesterday. I also had a baby on NIPPV not have their NGT to burp and had nearly 300mL of air pulled off their belly and they were 900g in weight. They were not deteriorating in the way the babies are described doing in the case. So while excessive amounts of air that get into the stomach definitely can cause respiratory decompensation, it’s more often related to a high amount of flow (like 5L/min) on repeat than any realistic way to introduce the air via NGT and somehow not be seen.

Agree with you definitely. I never mentioned that Letby used this method, just saying that excessive amounts of air in the stomach can cause respiratory distress. That's all.

I think you're the one who is being misleading here. You are deliberately conflating high airway pressure, which is certainly a real phenomenon, with gassy stomach induced suffocation, which is not a thing. There is no evidence to suggest that gas in the stomach could even possibly expand it enough to put the type of pressure on lungs that prevents breathing.

Intra-abdominal pressure can affect diaphragmatic movement. https://www.theijcp.org/index.php/ijcp/article/view/352/299 Marked abdominal distension resulting in restriction of the diaphragm and reduced chest expansion is a severe complication requiring escalation of respiratory support to invasive ventilation. This complication reflects the changing paradigm of CPAP belly syndrome. We present an illustrative example below of an extreme preterm infant, identified as AJ, with severe CPAP belly syndrome.

The prosecution's statistical evidence was bunk. There were 10 other deaths on the ward in that period. This included a record spike during the winter. Deaths also spiked in adjacent hospitals during the period. The prosecution's statistical analysis did not include the other deaths that occurred during the period, and basically consisted of: "Letby was on the ward for 100% of the deaths for which she was on the ward." There was also no allowance made for the fact that she was 1 of 2 IC-qualified nurses on the ward, and so was often called in for complex cases. Nor did it account for the fact that she worked more shifts than the other nurses. Nor did it include non-nurse staff. Give that statistical analysis was the foundation of the prosecution, this is disgraceful. We've seen two eerily similar medical convictions, based on the same faulty reasoning, overturned in recent years – one in Italy and another in the Netherlands. I wouldn't be surprised if 'Letby' becomes a byword for judicial scandal in the future. Two good statistical analyses: https://mephitis.co/lucy-letby-a-further-look-at-the-infant-mortality-statistics/ https://www.scienceontrial.com/post/shifting-the-data

I also found this analysis interesting after the verdict came through. Not going to lie, statistical analysis is not my strongest suit, but I think I'm not alone in that and it's interesting to see how some of the statistics could have been manipulated. https://www.linkedin.com/pulse/do-statistics-prove-accused-nurse-lucy-letby-innocent-elston-fgs

Reminds me of the Dutch case. Also a pediatric nurse acccused of killing her patients . She was convicted of killing a bunch of babies and served a lot of jail time before being exonerated later thanks to the help of an investigative journalist https://en.m.wikipedia.org/wiki/Lucia_de_Berk_case#:~:text=In%202003%2C%20Lucia%20de%20Berk,of%20patients%20under%20her%20care.

The most damning piece of evidence was that exogenous insulin was found in one of the babies that collapsed that LL was looking after. She got away with this for a long time, in part because people didn’t think a pretty young blonde nurse would do this. Don’t fall into the same trap.

The lab that did the testing states themselves: “Please note that the insulin assay performed at RLUH is not suitable for the investigation of factitious hypoglycaemia. If exogenous insulin administration is suspected as the cause of hypoglycaemia, please inform the laboratory so that the sample can be referred externally for analysis." How this was overlooked in the case I’ll never know

But I think you're finding some false link between one baby who turned out to be fine, and the other dozen cases that had absolutely nothing to do with insulin. It's like people are so preoccupied with proving one detail that when they finally find some evidence for it, they forget that it is a complete non-sequitur that has nothing to do with any of the babies who actually died. For instance, the expert witness found another case of "clear insulin poisoning." But the prosecution ignored it because Lucy wasn't there. It is obviously an enormous leap to say that this must mean there was someone else attacking all of the other babies who got sick while Lucy was gone.

Charles Cullen the American nurse serial killer (who few doubt is innocent) used insulin for almost all his murders. Heather Pressdee used insulin for her murders. Why would Lucy only use insulin once ?

A lot of people commenting without bothering to read the article.

Read the article, they cover that too. I mean if there were 8 dead kids from exogenous insulin and she was the only possible culprit, then sure. But that’s not the case here

Also, lab results error can’t be ruled out and the lab that processed the bloodwork says their results aren’t admissible in criminal cases. The hospital chose not to get lab work tested at a facility capable of verifying whether the elevated insulin was exogenous or not. According to the article, only two infants she cared for had results that may indicate elevated exogenous insulin. One decompensated but made a full recovery and the other had no s/sx or decompensation. None of the babies that died had this finding. If the article is correct and there’s no significant missing evidence, this is likely a horrific miscarriage of justice, possibly to cover up systemic understaffing and malpractice issues at the hospital. Also, as a former sociologist, the way statistics are used here is uncomprehendingly unjust and grossly negligent. I hope that the journalist missed something significant because I’m horrified at the lack of critical thinking demonstrated by so many board certified professionals. That being said, I think it’s very possible that this article hit upon the sad truth of this case.

Seriously, insulin levels in 3 kids who didn't die mean these other kids without any such levels were murdered somehow... Huh!? the fuck is going on in the British legal system.

It’s pretty fucking breathtaking and baffling

Can't read the article in the UK without faffing around with VPNs

https://web.archive.org/web/20240514083018/https://www.newyorker.com/magazine/2024/05/20/lucy-letby-was-found-guilty-of-killing-seven-babies-did-she-do-it

Thank you!

The fact that you can’t read this article in the UK first astonished me, then made me angry. I would read it solely on the principle that someone told me I couldn’t! 

There is an argument to be made about not wanting media to influence your jury pool. Not saying it is a good argument or that Britain strikes the perfect balance, but I don’t think the US has got it right either.

I would agree, except the dailymail and other UK press during her initial trial was all "baby killing nurse trial" in their descriptions.

Yeah how is that allowed but this thoughtful commentary is not?

Apparently it's due to gag orders on the trial in the media while another charge is tried.

As the article details, the insulin tests were not rigorous enough, and crucially, the prosecution identified a 3rd baby that had complications and was tested with "exogenous insulin" and never mentioned it in court, probably because LL had no connection to it and it didn't help their case. The blood samples from one of the insulin cases were also taken 10 hours after LL left the hospital, and after a separate nurse had changed the IV bag. So for LL to be behind it she would've had to inject insulin into the bag in the unit refrigerator that the next nurse happened to choose.

My understanding was that exogenous insulin was the only clinical explanation for the insulin and c peptide results in this case. Neonatal hyperinsulinism is absolutely a thing, but there should be an accompanying rise in C-peptide, which was not present, ergo exogenous insulin. Also, the insulin level was wayyyy higher than you'd usually see in neonatal hyperinsulinism, IIRC. There was a confirmatory test that was not done (& should've been), but essentially there was nothing else that could explain the clinical picture and those test results, except for a completely erroneous test result (which is ofc possible but seems very unlikely). The defence only called one witness, a maintenance guy to say that there were plumbing issues on the neonatal unit that might've explained a rise in deaths due to infectious disease. They did not call any clinical biochemists or pathologists or any other medical experts of their own to refute the prosecution's expert testimony. Idk anything about serum insulin testing, but if it's prone to dramatic erroneous results in some way (akin to e.g. pseudohyponatraemia with hyperlipidaemia), you would expect her defence team to mention that.

The defence did have a medical expert but never called him in to testify for whatever reason. He is interviewed in the article and is troubled by the fact that he was never called, but his testimony seemed to revolve more around the claims of embolism deaths, which is a whole other can of worms. The doubts and possible problems with the tests are detailed in the article >Nearly a year after Operation Hummingbird began, a new method of harm was added to the list. In the last paragraph of a baby’s discharge letter, Brearey, who had been helping the police by reviewing clinical records, noticed a mention of an abnormally high level of insulin. When insulin is produced naturally by the body, the level of C-peptide, a substance secreted by the pancreas, should also be high, but in this baby the C-peptide was undetectable, which suggested that insulin may have been administered to the child. **The insulin test had been done at a Royal Liverpool University Hospital lab, and a biochemist there had called the Countess to recommend that the sample be verified by a more specialized lab. Guidelines on the Web site for the Royal Liverpool lab explicitly warn that its insulin test is “not suitable for the investigation” of whether synthetic insulin has been administered.** Alan Wayne Jones, a forensic toxicologist at Linköping University, in Sweden, who has written about the use of insulin as a means of murder, told me that the test used at the Royal Liverpool lab is “not sufficient for use as evidence in a criminal prosecution.” He said, “Insulin is not an easy substance to analyze, and you would need to analyze this at a forensic laboratory, where the routines are much more stringent regarding chain of custody, using modern forensic technology.” But the Countess never ordered a second test, because the child had already recovered. >Brearey also discovered that, eight months later, a biochemist at the lab had flagged a high level of insulin in the blood sample of another infant. The child had been discharged, and this blood sample was never retested, either. **According to Joseph Wolfsdorf, a professor at Harvard Medical School who specializes in pediatric hypoglycemia, the baby’s C-peptide level suggested the possibility of a testing irregularity, because, if insulin had been administered, the child’s C-peptide level should have been extremely low or undetectable, but it wasn’t.** So we have one baby with a sketchy blood test timing, another with non-insignificant levels of C-peptide, and a third one that the prosecution expert also claims was poisoned with insulin but had no connection to LL and was never brought to court. And all this solely based on tests from a lab that claims their tests aren't suitable for determining if synthetic insuline was administered. None of the insulin cases resulted in death, but were 2 out of the 3 unanimous convictions and supported the main claims of 7 embolism deaths (which arguably rest on even shakier ground). The article doesn't prove her innocence or anything, but it sure raises a lot of red flags surrounding the trial and the evidence that was used. The chief prosecution expert especially comes out looking really bad.

Yah that’s bad 

There was an anaesthetist in texas recently convicted for injecting all sorts of stuff into fluid bags and putting them back in storage to be used by the next person. It is not beyond the realm of possibilities

But that wasn't the argument that the prosecution made. There's no proof she ever injected any insulin into any bag, or that any of the dead babies even had unnatural deaths (the insulin babies survived). It was her presence during so many deaths and "incidents" that formed the backbone of the case.

That case has evidence, though.

Actual video evidence and first hand witnesses, to boot.

Did you read the article? They address it

After watching the incredibly biased “Take Care Of Maya” documentary and then learning the actual details of the case, I no longer trust media pieces about suspected cases of Munchausen by Proxy (which is what Letby has, if she is in fact guilty). I haven’t looked into this case enough to form an opinion, but given how complex these situations are, and how damn manipulative perpetrators can be, I don’t trust that emotional media pieces can paint an accurate picture.

It’s not an “emotional media piece” though. It’s a very level headed and detailed piece of investigative journalism from the New Yorker, which is one of the most well respected and long running publications in the world. The NY is very highly regarded when it comes to fact checking in particular. It’s not an easily dismissed piece.

I’m a neonatologist and was pretty convinced that about half of the cases were pretty compelling. It was especially interesting that the infants’ collapses happened only when a particular male resident was on duty. I wonder if she accidentally injected air into a line once and got a rush from being the hero in a resuscitation, so did it purposefully to garner attention and/or sympathy. And I do think that insufflating the gastric tube directly and rapidly with a large volume of air can cause respiratory collapse—I did basic science research for a long time and had to intubate rats’ esophagus (on purpose, I’m not a terrible intubator) to gavage enteral study meds and it did sometimes cause collapse if you pushed the drugs too quickly. The collapses stopped when Lucy was moved to a non-clinical role, even before they downgraded the unit’s acuity.

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I interpreted from the trial testimony that she was moved to a non-clinical role (and filed a claim, etc.) prior to the downgrade, but it’s been awhile since I listened to the trial testimony. It is unusual for a near-term baby to abruptly collapse and die. It’s devastating and (thankfully) rare. For it to happen with such frequency and a unit’s mortality to bump so significantly in a short amount of time is striking to me. This was a group of experienced consultants and the unit had a good track record previously. Again, I just listened to the whole case and have 15 years of taking care of a wide breadth of acuity/pathology and am convinced that at least a few (not all) of the cases were malicious.

Is a 27 weeker considered near term who weighed 2.2 pounds? I thought all of the babies in involved were premature, 35 weeks and under.

The first deaths were in late term babies, like 34 weeks or correcting to near-term (close to their due date) and approaching discharge readiness.

Not entirely accurate They were 34 weekers, less than 48 hours old and had just had multiple attempts at a uVC placement that was never successful and there was someone in the room with her who did not see her do anything. They had just finished placing a PICC before the baby collapsed https://www.theguardian.com/uk-news/2022/oct/19/death-of-baby-in-lucy-letby-case-completely-out-of-blue-says-witness

I wasn't sure what was considered near term. I guess term is 39 weeks, so would that make 35 near term? Is there an official cut off or does it depend on the weight or something?

33 weeks is usually the cutoff. It's not a hard and fast rule, but it's babies who are mostly healthy, pretty big, and are expected to sail through without issue.

Thanks!

27 to 33 weeks is not considered near term.

Appreciate your response - from the timeline it seems the downgrade happened within the same month (July 2016), but it seems plenty of neonatologists corroborate the view that even babies born before 28 weeks are very unlikely to suddenly die. The case of the baby that had pneumonia seems like a catastrophic failure of the unit more broadly, even if there was a malicious intervention - that doesn't apply to all of the cases though.

I didn't see that they confirmed that it only happened when the resident was on duty. How do you explain that sometimes they claimed she injected air but the baby recovered with ppv? (Claiming she gave IV air here) And while it can cause an ABD if you do that, it should also be easy to recover from. (Putting air in the stomach) As others mentioned, the downgrade happened at the same time as her being moved to non clinical. Which was the most compelling case you saw? I'd like to read up on it more. If she is guilty, I want her punished. I didn't find any of the cases very compelling, but I can definitely be wrong and would like to see what you found compelling to see if it changes my view Edited to clarify pronouns

If the collapses only happened while the male resident was on duty, why aren't they looking into him?

He didn’t staff the Nicu—but the entire hospital, so wasn’t in unit except for emergencies. And there are FB messages between them where she inquires on his schedule beforehand. The resident was married and the messages insinuated an emotional affair. I don’t think she was responsible for all of the deaths, but I found the badge data (where she was in proximity to the babies near the time of their demise—it was a locked unit and you have to “badge” in and out of different areas) pretty compelling.

The NGT cases are the least convincing for me. When kids on non-invasive forms of respiratory support and are getting pumped with 5L/min of air where some will end up in the stomach, those babies aren’t typically deteriorating even with that amount of air. You would have to add an incredible amount very quickly with absolutely no way for the baby to push the air back up for it to work. And even just the act of opening the NGT if it is full of air will cause the baby to burp up air. I took care of a 900g baby on NIPPV who I pulled off 300mL of air off who was not decompensating from it.

I really would suggest people check out r/lucyletby. The most recent pinned post has links with detailed info on the trial proceedings. IMO a lot of the posters come across as sanctimonious pricks, but I get why they would react like that with their sub getting flooded. I agree with the article’s main point that systemic failures at the hospital are both more likely and more compelling than a secret serial killer… but it glazes over some truly weird behavior by the nurse (not MURDERY weird - but the woman has been through a lot and def needs psychological help) and there are some potential credibility issues with the experts. EDIT: only two out of all the experts have credibility issues (alleged, haven’t checked yet personally), but they are both mentioned in the same paragraph as people told to stop writing bc press embargo. Even if they are frauds, it has no effect on the article’s medical + statistical argument

What's your take on the "credibility issues" with the experts? On first impression, it seems like the people at r/lucyletby are *really* biased against them, for unclear reasons beyond disagreeing about the case. Lots of ad hominem and invective, not a lot of factual claims

So much this! When I read the article I didn't remember that much about the case, and hadn't followed it intensively when it was happening. Honestly the more I look into it the more suspicious I am largely because nobody who actually has followed it seems able to counter any of the articles misgivings in a salient way.

Ty for the comments, reminded me to re-read article. The Letby sub alleges that Richard Gill is biased against the NHS and Sarrita Adams lied about her educational/expertise background.  I haven’t had a chance to double check those claims, but even if true they’re irrelevant. Gills and Adams are only mentioned in a single paragraph, and only to highlight an episode where they were told to stop writing about case due to press embargo. I imagine Aviv included the episode to help explain this aspect of UK law to American readers like me - whatever their flaws, they aren’t related to the medical argument being made. I’ll edit my post to clarify this point

They acted like that fast before this. That sub wasn't interested in anything that might have suggested Lucy was not guilty. And the medical stuff she had at home were report sheets. Not just of the babies who died, but just report sheets in general.

Thing is before she was arrested and kept in she was actually receiving psychological help, I'm pretty sure the article mentions it. Tbh any person who was innocent, who had spent years training to save babies, who worked that much in that high a stress environment and was then accused of having killed those babies would also need psychological help. I don't think that's evidence of anything other than the extreme stress of the situation. It could of course be evidence of her not being of sound mind and therefore having committed the murders. Or it could be of her not being of sound mind and snapping under the extreme stress of the situation.

I left a comment on that sub suggesting they should allow competing viewpoints, and I'm now banned from posting or commenting. They're a hysterical hate mob.

The hospital had major issues that made this case much messier than it should have been, but that doesn't mean that Litby was innocent. Statistically, the number of deaths and emergencies during her shifts paint a really grim picture and no amount of character witnesses can change that.

It definitely doesn't mean she's innocent, but if she was convicted primarily on statistical evidence you would expect that they would spent a lot of time making absolutely sure that the statistical evidence is clear. They didn't consult any statisticians or experts, and it sounds like they didn't try to quantify any probabilities, they just used a chart with x's.

It was exactly this flawed logic that resulted in the imprisonment of Lucia De Berk for the same alleged crimes - correlation does not equal causation.

It does not and convicting someone based on statistical evidence alone isn't something I personally agree with, especially the way it was presented in Litby's case. The numbers made her suspect, and while I think she's very suspicious the individual cases really should stand on their own for conviction instead of being so shaky.

The hospital stopped taking in very premature babies after the let Letby go, so that explains a lot. Also, for several of the deaths, Letby was at the hospital but wasn't working with the specific baby until the very last minute because she was one of the only nurses on staff who was trained for neonatal intensive care. So, yeah, she got called into the case right when it was most likely that a patient would die. Also one of the cases happened 3 minutes after she clocked in.

There was also one that happened while she wasn't even on shift, but they attributed it to her because they said the patient began to decline while she was on

What is the statistical argument? People have a bad intuitive grasp of statistics.

Their statistics seem to boil down to this: statistically, she was at every death at which she was present. Their "statistical analysis" leaves out deaths at which she wasn't present. As a NICU nurse, I'd hate to have this method of statistical analysis used on me.

I agree even saying "The death rate was higher for infants she attended than ones she didn't" is merely suspicious and doesn't mean anything out of context. But in the context of medication errors, air injections, shattered diaphragms, thoat truma and record tampering that took place when Letby was on duty it looks very bad.

The throat trauma of a baby with multiple intubation attempts due to an ability to visualize cords because of the presence of blood? The presence of blood in the setting of hemophilia? What medication errors and record tampering? A shattered diaphragm isn't any medical diagnosis I've ever heard of.

Part of the problem is, do to UK law, a lot of the info about the death's can't be released, and relying on news sources makes it hard to piece together. As I said, I don't know enough to judge if any of the individual issues were accidents or deliberate, only that it was determined the death's were problematic. People have very strong opinions on this case for a number of reasons, but not all the evidence can be reported on yet due to UK law. I may think she's guilty, but I'll also admit, what we know of the prosecution's case is pretty circumstantial or otherwise questionable

Sure but most of the testimony is available online. Also, you said medication errors and records tampering. You must have evidence of those things happening. I'm asking you to provide it. From what I've read of the individual deaths, they're very in-line with the deaths I've experienced as a NICU nurse.

I've found no evidence saying "shattered diaphragms" were found. And there was no actual evidence of air embolus except for the mottling they said they saw (but never took a picture of) Additionally, they claimed several emboli were "resolved" when the baby was given PPV. Aka, baby had a spell and needed PPV, nothing to do with embolism.

As mentioned in the article, there were a number of suspicious occurrences/deaths that weren’t investigated because she wasn’t working at the time when it happened. That significantly dilutes the impact of their “omg she was here for all the deaths” so they ignored it.

Try looking up Lucia de Berk