<![CDATA[Chimp Investor]]>https://www.chimpinvestor.com/postsRSS for NodeThu, 29 Feb 2024 02:51:15 GMT<![CDATA[Inaccessibility of Trial Transcripts]]>https://www.chimpinvestor.com/post/inaccessibility-of-trial-transcripts65bd0fb8f2dc1fc37d8e8184Fri, 02 Feb 2024 16:13:42 GMTPeter ElstonObstacles faced by those wishing to see trial transcripts fly in the face of the UK's principle of Open Justice

Today I wrote a letter to senior law/government officers about the poor access to trial transcripts, given my own experience. I thought blog members would be interested to see it (below). I have included email addresses so would encourage anyone whose has a little bit of time to use them to send your own thoughts on the matter. Feel free to simply copy and paste the below in its entirety and append a covering message along the lines of "I concur with the below and wish to express my support for the recommendations contained therein". Or to write something more substantial. You may also want to look up your MP's email address and include that too.

I will post any responses I receive either in a new blog post or by adding to this post.

Also, if you wish to comment on this post you can do so on the Forum.

To:

The Attorney General, correspondence@attorneygeneral.gov.uk

The Solicitor General, correspondence@attorneygeneral.gov.uk

The Lord Chief Justice of England and Wales, justicecom@parliament.uk

The Lord Chancellor/Secretary of State for Justice, constitution@parliament.uk

The Parliamentary Under-Secretary of State for Courts and Legal Services, mike.freer.mp@parliament.uk

The Parliamentary Under-Secretary of State for Justice, contactholmember@parliament.uk

The Permanent Secretary and Clerk of the Crown in Chancery, permanent.secretary@justice.gov.uk

The Second Permanent Secretary and Clerk of the Crown in Chancery, secondpermanentsecretary@justice.gov.uk

CC:

Crown Office Team Leader, Manchester Crown Court, McrCrownoffice@justice.gov.uk

Opus 2 (Transcripts), criminal@opus2.digital

Marten Walsh Cherer Ltd (Transcripts), crown@martenwalshcherer.com

Sirs/Madams,

I wish to inform you about the obstacles that I have faced in trying to obtain a trial transcript. These obstacles fly in the face of the principle of Open Justice that the UK apparently adheres to (https://www.barcouncil.org.uk/resource/open-justice-court-reporting-and-the-rule-of-law.html). Perhaps my experience and observations may help with respect to any effort to improve the process, to make it more “open”.

I am a retired finance professional, a fellow of the Royal Statistical Society, and a fellow of The Geological Society, and now write a blog (www.chimpinvestor.com) that is broadly about the justice system (and in many respects specifically about the Lucy Letby case). When Letby was found guilty last August, I applied to receive a copy of the trial transcript which I knew would help me to better serve my blog members.

I completed Form EX 107 which I know was received by Manchester Crown Court on 22 August. Five weeks later, which seemed like an inordinate amount of time, I received an email saying that my EX 107 had been approved but that the full transcript was likely to cost in the region of £100,000 [on 4 Oct I was given an update by the Court that the cost would be be "substantially more than £100,000"]. Although I understood that the one off transcription cost would be high, given the length of the trial, I did not understand why the one off cost should be borne by one person (me).

As you might imagine, the cost of £100,000 was prohibitively high. I was aware that I could apply to see transcripts of specific days, the cost of which would naturally have been lower, but the cost of the days that at a minimum I wanted to see would still have run into the thousands of pounds so I did not pursue that option.

Recently, I revisited applying to see the transcript either in full or in part. I thought that it was possible that someone else may have paid the one off cost to see the transcript and therefore that the cost to those subsequently applying to see it may have fallen. It became clear this was not the case, though I don’t know whether this was because nobody else had paid for the transcript in the intervening four or so months or because the one off cost was being charged to everyone. Regardless, what I have encountered recently in terms of communication with Opus2, the assigned transcription company, has been appalling.

On 17 January I wrote to Manchester Crown Court saying that I had heard that two people had received the transcript and wondered if the cost may have fallen. I received a very swift response saying that the Court could not assist with the pricing structure as that was entirely within the remit of the assigned transcription company, Marten Walsh Cherer. I contacted Marten Walsh Cherer who informed me that they were no longer the assigned transcription company and that I should contact the newly assigned company, OPUS2 (I was also informed of this by the Court when it too realised there had been a change). I then wrote to OPUS2, who informed me that Marten Walsh Cherer was the assigned transcription company. After informing OPUS2 what I had been told by both the Court and by Marten Walsh Cherer, OPUS apologised (on 18 Jan) for the misunderstanding and that its team that handled transcription would be reaching out to me soon. I responded to say ’thank you’.

By 23 Jan I had heard nothing so contacted OPUS2 again to ask if there was any update. I received no response and as of today I have still not had a response.

Provision of trial transcripts is contracted out to private companies which of course happens, understandably so, in respect of much government business. However, having made this decision, the relevant government body has a responsibility to ensure that the system works well and achieves its aims, namely that trial transcripts are accessible to members of the public and to (media) companies (accepting that there should be restrictions with respect to certain Courts and certain types of trial). I would suggest that the aims are not being met which is unacceptable, particularly given the amounts of money involved and the importance of transcripts being accessible.

My observations and recommendations are as follows:

1. It is unacceptable that there was confusion as to who was the assigned transcription company.

2. It is unacceptable that, despite chasing, I never received the promised communication from OPUS2, the assigned transcription company (I checked my junk folders).

3. If everyone who applies to see a transcript is charged for the one off transcription costs, this is wrong. The one off transcription cost should be spread across those who apply to see it.

4. Regardless of whether it is correct that everyone who applies to see a transcript is charged for the one off transcription costs, by charging the full one off costs to the first person/company that applies to see it, particularly in relation to lengthy trials where the one off cost is high, there is the very real possibility (certainly this may well have been the case with the Letby trial transcript) that nobody sees it since nobody is able to afford the huge cost. In other words, the system as it stands at the moment does not promote the principle of Open Justice.

5. While I understand that it makes sense to contract out transcription to private companies, these companies, in order to enjoy the rewards on offer, must also bear risk (this after all is the basis for private enterprise). My suggestion therefore would be to force transcription companies to charge a much lower amount. By doing so, transcription would be loss making in respect of the first transcription (and perhaps one or two more) but with a much lower cost, transcription would be much more accessible and therefore demand would increase. The result of this would be that provision of transcription service would eventually be profitable once enough transcript applications have been received. And, importantly, that Open Justice is achieved. (My understanding is that media companies generally run on tight budgets and thus often are not prepared to pay for the high cost of transcription service but may well do if the cost was much lower. This I believe would also go for interested members of the public, other bloggers, etc).

6. If private companies are not prepared to bear the risks involved, perhaps some sort of government underwriting should be considered. If the system was designed well, the cost to the taxpayer of such underwriting provision would likely be negligible.

By setting out my experience, I do hope that this email gives you a better understanding of how the transcription system works (or rather doesn’t) in practice.

Yours faithfully,

Peter Elston

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<![CDATA[Lucy Letby: The North Wales Conundrum ]]>https://www.chimpinvestor.com/post/lucy-letby-the-north-wales-conundrum6548b9d052571ad944f89a71Wed, 08 Nov 2023 19:55:12 GMTPeter ElstonIf you enjoy reading this blog please leave a star rating on WealthTender. Thank you!

The spike in deaths in 2015/6 at The Countess may have been related to the temporary closure of the North Wales neonatal unit at Glan Clwyd hospital in late 2014/early 2015

If you would like to post comments and replies about this post, please do so on the Forum by clicking one of the thread links below (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

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,Update on reporting restrictions: I have not sought legal advice about what the reimposition of reporting restrictions means for what I can write in relation to Lucy's case but I have spoken to someone who knows about these things. The test is whether a published report poses a "substantial risk of serious prejudice." The trial to which the reporting restrictions pertain is a year or so away (it hasn't even started!) This blog post is not about Baby K (the case being retried) but is an objective appraisal of the publicly available, official data from key sources.

After I published my recent post Lucy Letby: A Further Look at the Infant Mortality Statistics, I was made aware of key differences between MBRRACE and ONS data in relation to definitions. MBBRACE collects data at a Trust level, so births and deaths data pertain to place (specific hospital) of birth/death. The ONS does not collect data at a Trust level but births and deaths registered via the General Register Office (i.e. postcode of home address of mother/baby). So, a baby born to a mother from, say, Wales (or who died) at CoCH would not be in the ONS's Chester/Cheshire West data.

As you will see, Venn Diagrams are perfect for visualising this. But first, the key chart showing the MBRRACE and ONS data and some maps.

Figure 1: Neonatal deaths at CoCH (MBRRACE) and "in" Chester/Cheshire West

Source: MBRRACE, ONS (note that MBRRACE number of neonatal deaths are derived from the number of births multiplied by the rates of neonatal deaths per 1,000 births). Mortality data from the FOI request, MBRRACE, and the ONS can be found in this shared folder - https://1drv.ms/f/s!AiV2u7y3BGn0jJMsd8sIs_1A7WtoLw?e=c5axt5 ).

Figure 1 above illustrates how in 2015 and 2016 there were more deaths at CoCH than there were in Chester/Cheshire West. Since CoCH is within the Chester/Cheshire West region, this at first seems impossible, until one understands that the Chester/Cheshire West data is based on home postcode not place (hospital) where a baby died.

Figure 2: Chester and Cheshire West

Source: Google Maps

Figure 3: Location of The Countess of Chester

Source: Neonatal unit guide, https://www.infantjournal.co.uk/nicu_list.html (Infant Journal)

Figure 4A: First of two maps showing location of key neonatal units in the region

Source: Neonatal Data Analysis Unit, https://ndau-maps.github.io/UnitMap2020/ (Imperial College, London)

Figure 4B: Second of two maps showing location of key neonatal units in the region

Source: Neonatal unit guide, https://www.infantjournal.co.uk/nicu_list.html (Infant Journal)

Discrepacies/points of interest:

  • Alder Hey Children's Hospital on NDAU map but not on Infant Journal map
  • CoCH listed as an LNU on NDAU but as NICU on Infant Journal
  • CoCH was downgraded (from a Level 2 LNU to a Level 1 SCBU) in July 2016 so it looks like it was upgraded (to a Level 2 LNU or Level 3 NICU) at some point since then
  • Glan Clwyd listed as LNU on NDAU but as NICU on Infant Journal
  • Wrexham ODN listed as SCBU on NDAU but as NICU on Infant Journal

The above should of course be investigated further by anyone carrying out a more robust analysis in the future.

Now, the maths......

Figure 5: Generalised Venn Diagram

Figure 6: Introducing generalised CoCH data (MBRRACE) and Chester/Cheshire West data (ONS) to the Venn Diagram

Figure 7: Introducing specific (for year 2015) CoCH data (MBRRACE) and Chester/Cheshire West data (ONS) to the Venn Diagram

Figure 7 above shows that in 2015, ?1, ?2 and ?3 can take the values (9,6,0), (8,5,1).....or (3,0,6). The question is, what should be considered reasonable values for ?1, ?2 and ?3 for each of the years from 2015 to 2020 (the years where there is data from both MBRRACE and the ONS)? We must make assumptions.

The aim of the exercise is to make assumptions that are reasonable and ultimately to see what the implications are for the number deaths at CoCH of babies registered at a postcode outside Chester/Cheshire West (North Wales, for example).

So, let's start off with what we know. I have set out three scenarios for reasons that will become clear. In the tables below, I have made three sets of assumptions (explained below). The assumptions are highlighted in light yellow.

Step 1:

It seems clear from Figure 1 (chart) and Step 1 (table) above that:

  • the number of deaths of babies registered to a home address in Chester/Cheshire West (ONS data) was fairly stable
  • the number of deaths at CoCH (MBRRACE data) was materially elevated in 2015 and 2016

It is not clear why, despite CoCH being the main neonatal unit within Chester/Cheshire West, the number of deaths of babies registered to Chester/Cheshire West postcodes did not fall in 2017 (as did number of deaths at CoCH). Perhaps it was because many babies registered to postcodes in Chester/Cheshire West were sent to the three units in Liverpool (Arrowe Park, Liverpool Women's, Alder Hey). Or perhaps it related to News item #8 below ('Babies forced to travel more than 28 miles during labour more at risk from neonatal death, says study') such that the rise in deaths at CoCH related to babies sent to CoCH from North Wales as a result of the temporary closure of Glan Clwyd which would not have affected babies closer to CoCH. And perhaps if doctors knew that because of the closure of Glan Clwyd and the transfer to CoCH, they instead sent babies who otherwise would have gone to CoCH to one of the Liverpool hospitals. I have also been told that within the region, the neonatal unit at CoCH had a pretty awful reputation, supported by News Item # 1 below.

Regardless, let's assume that the ONS data was stable outside of 2015 to 2020 and therefore that the number of deaths in 2014 and 2021 was equal to the average for 2015 to 2020.

Assumption #1: ONS data for 2014 and 2021 are based on the average of 2015 to 2020

Step 2: Accounting for Assumption #1

Given that the two years of unusually high neonatal deaths at CoCH were 2015 and 2016, let's assume that deaths at CoCH outside these years of babies registered at postcodes outside Chester/Cheshire West were stable. This means either 0 per year, 1 per year, or 2 per year (it will become clear why there is no need to consider 3 per year).

Assumption #2: Non-Chester/Cheshire West neonatal deaths at CoCH outside of 2015 and 2016 of either 0, 1 or 2.

Step 3: Accounting for Assumption #2

We can now calculate number of neonatal deaths at CoCH outside of 2015 and 2016 of babies registered at postcodes in Chester/Cheshire West, as in Step 4 below.

Step 4:

We can then calculate number of neonatal deaths outside of CoCH of babies registered at postcodes within Chester/Cheshire West, as in Step 5 below.

Step 5:

Let's now assume that neonatal deaths of babies at CoCH registered at postcodes within Chester/Cheshire West was stable and that such deaths in 2015 and 2016 equaled the average of 2014 and 2017 to 2021, as in Step 6 below.

Step 6:

We can now calculate the number of deaths at CoCH of babies registered at postcodes within Chester/Cheshire West, as in Step 7 below.

Step 7:

Since a negative number in Scenario 3 is absurd, we can discount that scenario, as in Step 8 below.

Step 8:

We can now calculate the number of neonatal deaths at CoCH of babies registered at postcodes outside of Chester/Cheshire West, as in Step 9 below.

Step 9:

You can check if the numbers in the Step 9 table above are consistent by adding ?1 and ?3 (to get X) and ?2 and ?3 (to get Y).

The rather astonishing conclusion (and I welcome feedback on where my analysis may have been wrong or my assumptions unreasonable) is that most of the elevated number of deaths at CoCH in 2015 and 2016 were of babies registered at postcodes outside of Chester/Cheshire West. This makes sense given News Item #8 below and does not discount the possibility that there was some sort of outbreak of a water-borne virus at CoCH in 2015 that would have made babies travelling a long distance even more vulnerable.

I will let you peruse the 27 news items below. Suffice to say that they tell a story of pressure being put on CoCH in 2015 and 2016 as a result of what was going on at neonatal units in North Wales.

I have also included below as an Appendix an email I received from the ONS is response to a query I made about the differences/discrepancies between ONS and MBRRACE data. I don;t believe there is anything in it that renders my analysis in this post obsolete but, again, I welcome thoughts.

News item #1

December 2003

One of the most MRSA infected in the country

THE Countess of Chester Hospital has been named and shamed as one of Britain's worst hospitals where patients are most at risk of catching one of the most feared superbugs.

https://www.cheshire-live.co.uk/news/chester-cheshire-news/one-most-mrsa-infected-country-5303430

News item #2

January 2013

Health minister must step in over North Wales hospital and baby care cuts

HEALTH Minister Lesley Griffiths must intervene in a health board’s decision to transfer intensive care services for the most at-risk newborns to England and controversial plan to axe hospitals and services.

https://www.dailypost.co.uk/news/north-wales-news/health-minister-must-step-over-2642179

News item #3

April 2013

Wrexham Maelor Hospital could lose special care baby unit

Intensive care neo-natal units could be shut at either Wrexham Maelor Hospital or Ysbyty Glan Clwyd, Bodelwyddan

https://www.dailypost.co.uk/news/north-wales-news/wrexham-maelor-hospital-could-lose-2820293#

News item #4

May 2014

Glan Clwyd hospital to house North Wales neonatal intensive care centre

Region's sick babies to be cared for at Bodelwyddan after First Minister chooses it ahead of Wrexham Maelor

https://www.dailypost.co.uk/news/north-wales-news/glan-clwyd-hospital-wins-race-7114553

News item #5

May 2014

Glan Clwyd to be new neonatal care site, minister says

Intensive care services for babies in north Wales are to be centralised at Ysbyty Glan Clwyd, Bodelwyddan, the Welsh government has decided.

https://www.bbc.co.uk/news/uk-wales-27397146

News item #6

February 2015

Maternity services at Ysbyty Glan Clwyd set to be downgraded as doctor led care withdrawn

Bodelwyddan hospital will offer midwife-led care only to expectant mums from April for at least 12 months, if the controversial proposal is approved

https://www.walesonline.co.uk/news/health/maternity-services-ysbyty-glan-clwyd-8616697

News item #7

February 2015

Outrage as maternity services at Ysbyty Glan Clwyd to be downgraded

Health board chairman says they have 18 months to resolve issues and axed services must be returned ahead of neonatal intensive care centre opening

https://www.dailypost.co.uk/news/north-wales-news/outrage-maternity-services-ysbyty-glan-8616227

News item #8

March 2015

Babies forced to travel more than 28 miles during labour more at risk from neonatal death, says study

Politicians argue that the evidence proves the health board’s plans to downgrade maternity services at Glan Clwyd will put more lives in danger

https://www.dailypost.co.uk/news/north-wales-news/babies-forced-travel-more-28-8839436

News item #9

May 2015

Ysbyty Glan Clwyd judicial review over maternity downgrade set to start

Two day hearing at Mold County Court will examine how the Betsi Cadwaladr board reached its controversial decision to remove doctor-led care from Bodelwyddan

https://www.dailypost.co.uk/news/north-wales-news/ysbyty-glan-clwyd-judicial-review-9193260

News item #10

July 2015

Health board U-turn over Ysbyty Glan Clwyd maternity plans

A health board has performed a U-turn over plans to contest a judicial review into downgrading maternity services at a Denbighshire hospital.

https://www.bbc.co.uk/news/uk-wales-north-east-wales-33367737

News item #11

December 2015

Betsi Cadwaladr health board baby care U-turn confirmed

Plans to suspend consultant-led maternity care at one of north Wales' main hospitals have been scrapped, the health board has confirmed.

https://www.bbc.co.uk/news/uk-wales-35038164

News item #12

March 2016

Glan Clwyd Hospital plan for neo-natal care unit agreed

Plans to develop a new neo-natal baby care unit in north Wales have been approved by the Welsh Government.

https://www.bbc.co.uk/news/uk-wales-35800710

News item #13

May 2017

Campaigners call for 'best' neonatal services in wake of Countess of Chester baby deaths probe

Of the 7,000 births in the Besti Cadwaladr University Health Board area a year around 600 North Wales babies are delivered in Chester

https://www.dailypost.co.uk/news/north-wales-news/campaigners-call-best-neonatal-services-13057169

News item #14

August 2017

Family of 16-week premature baby test new neonatal ICU kit

Baby Jude weighed just 1lb 12oz when he was born 16 weeks prematurely.

https://www.bbc.co.uk/news/uk-wales-north-east-wales-40904152

News item #15

February 2018

'Sick and premature babies will receive best possible start in life' Infants now receiving care at new look neonatal unit

The Sub-Regional Neonatal Intensive Care Centre will look after newborn infants from across North Wales with significant needs

https://www.dailypost.co.uk/news/north-wales-news/sick-premature-babies-receive-best-14257993

News item #16

February 2018

Glan Clwyd neonatal unit: First babies treated at £18m facility

An £18m neonatal intensive care unit in Denbighshire has begun treating its first sick and premature babies.

https://www.bbc.co.uk/news/uk-wales-north-east-wales-42950451

News item #17

September 2018

Wrexham baby might have stood a better chance of survival if born at Wirral hospital, inquest told

A PREMATURE baby who died at Wrexham Maelor Hospital might have faced a better chance of survival had he been born at a specialist regional centre, an inquest was told.

https://www.leaderlive.co.uk/news/16886945.wrexham-baby-might-stood-better-chance-survival-born-wirral-hospital-inquest-told/

News item #18

November 2018

‘It would be nice if parents were able to look back’

Inspired by her own experiences, Lisa Jones designed a diary to enable families to keep track of their baby’s progress in the neonatal unit, Madeleine Scott reports

https://www.nursingtimes.net/careers/career-inspiration/it-would-be-nice-if-parents-were-able-to-look-back-09-11-2018/

News item #19

April 2019

Health minister apologises after 27 baby deaths at two Welsh NHS maternity units as they are placed into special measures after investigation finds staff are under 'extreme pressure'

https://www.dailymail.co.uk/health/article-6976101/NHS-trust-launches-investigation-43-incidents-including-baby-deaths-stillbirths.html

News item #20

June 2019

Prestatyn Dental holds open day in support of Glan Clwyd Hospital's special baby care unit

A PRESTATYN dental surgery will say thank you for its warm welcome to the town by giving up the proceeds of a day's worth of trade to the area's special care baby unit.

https://www.rhyljournal.co.uk/news/17722114.prestatyn-dental-holds-open-day-support-glan-clwyd-hospitals-special-baby-care-unit/

News item #21

March 2020

Important update for anyone with relatives in any North Wales hospital

The decision to all but ban all visits has come in a bit to help prevent the spread of Covid-19

https://www.dailypost.co.uk/news/north-wales-news/full-list-strict-new-north-17984636

News item #22

June 2020

FUNDRAISING HELPS PURCHASE SPECIALIST EQUIPMENT FOR NEONATAL UNIT

Thousands of pounds have helped towards paying for new equipment at Ysbyty Gwynedd’s Neonatal Unit by the family of a boy who was given lifesaving treatment as a newborn.

https://www.thebangoraye.com/fundraising-helps-purchase-specialist-equipment-for-neonatal-unit/

News item #23

September 2021

How couple left 'broken' by tragic loss of son found help and support in their darkest hours

Antonia Demia Lewis and Aaron Houlston are backing a campaign by SANDS to light up landmarks

https://www.dailypost.co.uk/news/north-wales-news/how-couple-left-broken-tragic-21668385

News item #24

October 2021

'Our baby was born at 24 weeks weighing just 1lb 10oz'

Claire Stones has relived giving birth to baby Erin who was so premature that her vital organs had not been formed properly meaning the tot couldn't breathe independently and needed heart surgery aged just nine weeks

https://www.walesonline.co.uk/news/health/our-baby-born-24-weeks-21861151

News item #25

August 2023

Lucy Letby: When did BCUHB learn of concerns over baby deaths, MS asks

AN MS HAS questioned when Betsi Cadwaladr University Health Board (BCUHB) were made aware of concerns over the high number of baby deaths at the Countess of Chester Hospital.

https://www.northwalespioneer.co.uk/news/23739572.lucy-letby-bcuhb-learn-concerns-baby-deaths-ms-asks/

News item #26

September 2023

Five of the babies in killer nurse Lucy Letby's trial were from Wales

The Welsh cases will be considered in a statutory inquiry into Letby's murder and attempted murder of babies in an NHS hospital

https://www.walesonline.co.uk/news/wales-news/five-babies-killer-nurse-lucy-27653002

News item #27

September 2023

Lucy Letby inquiry to consider experiences of Welsh patients

The inquiry into the Lucy Letby case will consider the experience of babies from Wales using services in England, it has been confirmed.

https://www.bbc.co.uk/news/uk-wales-66713671

Appendix 1: Email from ONS in relation to differences between ONS and MBRRACE definitions

Hi Peter,

The Office for National Statistics’s (ONS’s) figures on perinatal mortality are based on all births and deaths registered via the General Register Office regardless of gestational age, and all stillbirths registered at 24 weeks or more gestation in line with the Stillbirth (Definition) Act 1992.

Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) figures on stillbirth and neonatal mortality rates exclude births below 24 weeks gestational age and births that resulted in a death following termination of pregnancy.

Reasons for these exclusions

  • Using this definition is consistent with the gestational age cut-off for stillbirths; MBRRACE-UK’s main focus is reporting on extended perinatal deaths (stillbirth and neonatal death), so it seems logical to use the same gestational age threshold used to legally define stillbirths in the UK for early neonatal deaths, which is 24 weeks.
  • As babies born showing no signs of life before 24 weeks (late fetal losses) are not legally required to be registered in the UK, MBRRACE-UK cannot validate ascertainment using registration data that the ONS shares with them.
  • Historically, there has been wide variation in whether NHS trusts and health boards report births before 24 weeks as late fetal losses (that will not be reflected in ONS birth or death registrations) or as live births resulting in neonatal deaths (registered as both a birth and a death); this variation in registration practice resulted in MBRRACE-UK’s decision to focus on births at 24 weeks gestational age or above, which has been the case since their first Perinatal Surveillance Report detailing deaths in 2013 (PDF, 22.0MB).
  • MBRRACE-UK mortality rates exclude stillbirths and neonatal deaths following termination of pregnancy to minimise the impact of policy differences in the provision and timing of antenatal screening and population differences in the uptake of Termination of Pregnancy because of Fetal Anomaly (TOPFA) between organisations.

Kind regards,

If you would like to post comments and replies about this post, please do so on the Forum by clicking one of the thread links below (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

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The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

© Chimp Investor Ltd

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<![CDATA[Lucy Letby: A Further Look at the Infant Mortality Statistics]]>https://www.chimpinvestor.com/post/a-reappraisal-of-the-infant-mortality-statistics6534469c40cce3e43f1fe8cdTue, 31 Oct 2023 12:04:04 GMTPeter ElstonIf you enjoy reading this blog please leave a star rating on WealthTender. Thank you!

Comparing hospital (FOI), MBRRRACE, and ONS data raises more questions

If you would like to post comments and replies about this post, please do so on the Forum by clicking one of the thread links below (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

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Update on reporting restrictions: I have not sought legal advice about what the reimposition of reporting restrictions means for what I can write in relation to Lucy's case but I have spoken to someone who knows about these things. The test is whether a published report poses a "substantial risk of serious prejudice." The trial to which the reporting restrictions pertain is a year or so away (it hasn't even started!) This blog post is not about Baby K (the case being retried) but is an objective appraisal of the publicly available, official data from key sources.

Analysis update: I have been made aware that the ONS does "not hold data on NHS trusts. ONS mortality data are published in line with the National Statistics Postcode Lookup which is based on the area of usual residence of the deceased" and also that the families of five of the seventeen babies in Lucy's case were from Wales (https://www.walesonline.co.uk/news/wales-news/five-babies-killer-nurse-lucy-27653002# ). Even if all five babies were babies who died, this would still not account for the six 'negative deaths' in 2015 and 2016 discussed below, particularly given the number of 'positive deaths' in 2017, 2018, 2019, and 2020. Rather than amending this post, I have published a new post addressing the specific issue, Lucy Letby: The North Wales Conundrum.

Intro/background

In June I wrote a blog post titled Do Statistics Prove Accused Nurse Lucy Letby Innocent? It was a detailed assessment of data in the public domain at that time, notably infant mortality data from The Countess of Chester (CoCH) that was obtained through an FOI (freedom of information) request. It also highlighted the many and relevant parts of the RCPCH service review about issues with UVC insertion, understaffing, high activity, poor reporting, etc, as well as other irregularities.

Following my June blog post, I became more aware of infant mortality statistics provided by MBRRACE -UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) and the ONS (Office of National Statistics) that collect data from trusts across the country (then publish trust level data as well as numerous aggregates).

It has taken me a while but I have finally got round to doing a detailed side-by-side appraisal of the three datasets. In short, there are discrepancies between each of them which raise important questions about what was actually going on at CoCH.

This blog post is quite technical but I hope can be followed by a broad audience. It should also in time provide more serious statisticians than myself with a decent appraisal of the mortality data that they could use to do a truly formal analysis. And it I hope will be useful as a reference for anyone wishing to see infant mortality statistics that relate to Lucy's case.

The datasets

In the research that I conducted for this blog post I used six datasets, one from CoCH itself (the dataset obtained via the FOI request), three from MBRRACE, and two from the ONS. Four of the datasets pertained to CoCH itself, either directly (the FOI dataset and two of the MBRRACE datasets, crude and stabilised/adjusted, pertain directly to CoCH) or indirectly (one of the ONS dataset pertains to Chester and Cheshire West, c. 80% of which is CoCH). The other two datasets (one each from MBRRACE and the ONS) pertain to England. These latter two are useful when comparing mortality rates (deaths per 1,000 births) between England and CoCH/Chester and Cheshire West. You can see my spreadsheet in which I have collected and processed data here (Infant mortality data.xlsx) and a folder containing all the downloaded data here (Infant mortality data).

The URLs of the three datasets (or where datasets can be found) are below.

CoCH (FOI): https://www.whatdotheyknow.com/request/neonatal_deaths_and_fois#incoming-1255373

MBRRACE-UK: https://timms.le.ac.uk/mbrrace-uk-perinatal-mortality/

ONS: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/childhoodinfantandperinatalmortalityinenglandandwales/2021/relateddata

User guides can be found as below.

MBRRACE: https://timms.le.ac.uk/mbrrace-uk-perinatal-mortality/surveillance/technical-manual.html

ONS: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/methodologies/userguidetochildmortalitystatistics

The hospital (FOI) information is the actual number of deaths, and can be converted into a mortality rate (deaths per 1,000 births) using the number of births (live and total) from MBRRACE. This allows data from the three sources to be compared with each other, as well as to be compared with rates across England as a whole provided by MBRRACE and the ONS.

MBRRACE provides mortality data for each hospital trust (including CoCH) as well as by region (England, England and Wales, UK etc). Furthermore, it provides data on a 'crude' basis as well as on a 'stabilised and adjusted' basis. 'Crude' simply means the actual number of deaths in various categories during the period (year) in question. The 'Stabilised and adjusted' mortality rate "takes into account the effects of chance variation and also allows for key factors known to increase the risk of perinatal mortality". It is described in more detail below (taken from the MBRRACE-UK Perinatal Mortality Surveillance Technical Manual Version 1.2)

For service delivery organisations, some organisations have a higher proportion than others of women at high risk of experiencing a stillbirth or neonatal death: for example, they provide a national or regional specialist service or serve areas of high socioeconomic deprivation. Thus the case-mix of the service users can influence mortality rates even when high quality maternity and neonatal care is provided. The mortality rates for service delivery organisations are, therefore, also adjusted to account for key factors which are known to increase the risk of perinatal mortality: i.e. stabilised & adjusted mortality rates. The extent of the adjustment is limited to those factors that are collected for all births across the whole of the UK: mother’s age; socio-economic deprivation based on the mother’s residence; baby’s ethnicity; baby’s sex; whether they are from a multiple birth; and gestational age at birth (neonatal deaths only). Therefore, some factors that might be associated with poor perinatal outcomes could not be taken into account in the adjustment because they are not universally collected on all births; for example, maternal smoking and body mass index (BMI). As for stabilised rates, the stabilised & adjusted mortality rate will also tend to be closer to the average mortality rate than will the crude mortality rate, especially for organisations with a small number of births.

The ONS provides infant mortality data for local regions (in Lucy's case, the local region that is relevant is 'Chester and Cheshire West', c. 80% of which is accounted for by the Countess) as well as for England, UK, etc.

In terms of categories, the ONS breaks down its data into 'stillbirths', 'neonatal' and 'perinatal', allowing one to derive 'early neonatal', 'late neonatal', and 'extended perinatal' (see below definitions).

Note that the datasets do not overlap neatly, whether in terms of period covered or categories of death presented. The FOI data spans the period from January 2014 to October 2018 but has the most exhaustive number of mortality categories. MBRRACE data for CoCH covers 2014 to 2021 but only for two categories, stillbirths and neonatal deaths (and 'crude' data in 2016 and 2018 is not provided since numbers were low which increased possibility of identification of individuals). MBRRACE data for England and ONS data for England and Chester/Cheshire West have similar issues.

Nevertheless, where there is overlap, comparisons can be made that are useful. Despite differences with respect to period covered, all charts presenting annual data cover 2013 to 2021 inclusive so that they all correspond with each other, making visual comparison easier (I have added "n/a"s above the x-axis (years) where there is no data). Charts that present the monthly (FOI) data are based on the entire period from Jan 2013 to Oct 2018 (other than one which presents winter deaths where I have estimated deaths in December 2012 using the average of all December data, other than December 2015 which was during the Lucy's alleged killing spree, in order to be able to use the Jan to Mar 2013 data and thus to increase the sample size and make the statistical analysis more robust).

Definitions relating to category of death (from MBBRACE)

Late fetal [foetal] loss - A baby delivered between 22 and 23 completed weeks’ gestational age showing no signs of life, irrespective of when the death occurred.

Stillbirth - A baby delivered at or after 24 completed weeks’ gestational age showing no signs of life, irrespective of when the death occurred.

Early neonatal death - A liveborn baby (born at 20 completed weeks’ gestational age or later, or with a birthweight of 400g or more where an accurate estimate of gestation is not available) who died before 7 completed days after birth.

Late neonatal death - A liveborn baby (born at 20 completed weeks’ gestational age or later, or with a birthweight of 400g or more where an accurate estimate of gestation is not available) who died after 7 completed days but before 28 completed days after birth.

Postneonatal death - A death of a live born baby (born at 20+0 weeks gestation of pregnancy or later or 400g where an accurate estimate of gestation is not available) occurring after 29 or more completed days after birth.

Neonatal death - An early or late neonatal death (see above)

Perinatal death - A stillbirth or early neonatal death (see above)

Extended perinatal death - A stillbirth or neonatal death (see above)

Infant death - A neonatal or postneonatal death (see above)

The hospital data obtained via the FOI request

The data from the hospital was monthly, spanned the period from January 2013 to October 2018 inclusive, and presented the number of deaths in five categories (late fetal loss, stillbirths, early neonatal deaths, late neonatal deaths, and post neonatal deaths). See chart below.

In my June post I noted that there were no deaths recorded in the FOI data in August or October 2015 when the deaths of Babies E and I occurred, respectively.

According to the Court records, Baby E died on 4 August so one supposition is that this was the July early neonatal death in the FOI data (or possibly one of the three July stillbirths). However, I would argue this is unlikely. First, a neonatal death is not a stillbirth. The two categories are clearly defined and mutually exclusive. Second, the hospital might have recorded the death a few days late (which would itself be poor) but a few days early? 4 August 2015 was a Tuesday. Could it really have been recorded as having happened in July i.e. on or before the previous Friday? I somehow doubt it.

Baby I died on 22 October. Given that this is 9 days from the end of the month it is unlikely to be the late neonatal death recorded in November and almost certainly neither of the two early neonatal deaths in September. And anyway, Baby I died aged 76 days so would have been recorded as a postneonatal death. 76 days is well after the threshold for a postneonatal death (more than 28 days) so there is little chance of it being wrongly recorded as a late neonatal death. Also, there were no post neonatal deaths recorded in either September or November.

So, I think it can be assumed that the hospital did not record the deaths of the two babies, supported by the RCPCH service review that found:

"Two of the cluster of deaths were not reported; the current policy indicates that not all deaths need to be submitted as DATIX, if they are "expected deaths", and in 2015-6 only 10 of the 13 deaths were reported as incidents on the neonatal incidents summary. The definition of 'expected' was not available but presumed to be that used in safeguarding/child death panels and it was not clear who is responsible for DATIX entry. Other areas in the hospital report well but the neonatal unit have for some time apparently been less systematic in reporting." (RCPCH clause 4.4.5)

Adding the two deaths to the FOI data means that there were 17 infant deaths during the 13 month period from June 2015 to June 2016, the period during which Lucy was alleged to have murdered 7 babies. In other words, there were 10 deaths that she wasn't charged for (see charts below). Now, the monthly average infant deaths at CoCH outside of the 13 month period was 0.32 (sample size 57 months) which equates to a 13 month average of 4.1. The probability of 10 (or more) deaths occurring during a 13 month period if chance (natural variation) is the explanation is just 0.34% or 1 in 290.

Furthermore, 6 of these 10 deaths that Lucy was not charged with occurred in the period from December 2015 to March 2016 (winter) which is a particularly high number (see chart below). The average number of deaths for these particular four months outside of the four months in question was 1.4 (in order to increase the sample size number of periods from four to five, I have estimated the number of infant deaths in Dec 2012 using the average for December in each of 2013, 2014, 2016, and 2017) and I have calculated that the probability of six (or more) deaths occurring if chance (natural variation) is the explanation is just 0.06% or 1 in 1,607. If one uses only the winters of '12/'13, '13/'14 and '14/'15 to calculate the average to take account of the possible effect of the downgrade on the unit in July 2016, the probability rises to 1.01% or 1 in 99 but this is still very low.

In summary, although the probabilities are a little higher than in my June post they are still very low; my calculations are now based on infant deaths not just early neonatal deaths and I am also now not including the death of Child K as having occurred at CoCH, even though it seems the baby should have been transferred sooner and thus the death may have been inevitable and thus in some respects could be deemed to have occurred at CoCH. This all means that since the prosecution did not associate Lucy with any of the other ten deaths, it is arguing, effectively, that along with a baby murderer, there was some other factor causing the spike in deaths. This is an extraordinary coincidence, though of course we know from true crime shows that police detectives never believe in coincidences. Er....

There is also some specific and unknown factor that caused the spike in deaths in the winter of 2015/6. There must be a good reason why Lucy was not charged with any of them. And why there were many more than in other winters. One answer would be that they related to seasonal flu, exacerbated perhaps by the issues highlighted in the RCPCH report. The former might explain why there were no unusual rashes that Evans and Co. could get their teeth into, the latter why there were more than in other winters. Just a hypothesis.

There is another discrepancy in the CoCH (FOI) data, one I had not spotted when I wrote my June post. There were a very small number of stillbirths recorded (just two) in 2016 (this is not a typo in the annual number since the aggregate of the monthly data is also two) compared with 8, 9, 12, 11, and 6 in 2013, 2014, 2015, 2017 and 2018 respectively (see chart below). Since the 6 in 2018 were the ten months up to and including October, this can be annualised to 7, giving a mean outside of 2016 of 9.4.

The probability of there being 2 (or fewer) stillbirths if chance was the explanation is 0.44% or 1 in 229. In other words, there was some new factor that was causing the unusually low number of stillbirths in 2016. It has been suggested that there was recategorisation issue, supported by the Telegraph article NHS logging baby deaths as stillbirths ‘to avoid scrutiny’. However, if this suggestion is correct, the number of stillbirths would have been higher not lower. Some hospitals might have thought they could get away with recategorising live births as stillbirths, per the article, but surely not the other way round. And anyway, why would hospitals want more scrutiny?

Enter MBRRACE

For individual trusts, MBRRACE publishes data on rates (per 1,000 births) of stillbirths, neonatal deaths, and extended perinatal deaths. Given that it also publishes the total number births, one can calculate live births by subtracting stillbirths from total births. One can then use the five data items to calculate the number of stillbirths, neonatal deaths, and extended perinatal deaths (number of deaths equals number of births times rate of deaths per 1,000 births divided by 1,000).

Where the number of stillbirths or neonatal deaths is low, rates are not published given the greater possibility of identification. If only one (of stillbirths or neonatal deaths) is low, the other is not published given that it could be used, along with extended perinatal deaths data, to calculate the low item and thus potentially identify individuals.

MBRRACE did not publish stillbirth or neonatal death data for CoCH in 2016 or 2018. However, we have the FOI data for those years and, indeed, one of the item (stillbirths or neonatal deaths) in each year was low (there were just 2 stillbirths in 2016, while in 2018, there were just 2 neonatal deaths). Data was also suppressed in 2020 and since the FOI data did not cover that period, the number of stillbirths and neonatal deaths that year have been estimated by applying a general ratio between the two (6 extended perinatal deaths => 4 stillbirths and 2 neonatal deaths). This does not seem unreasonable, as you will see.

The charts below show the crude/actual number of stillbirths and neonatal deaths data for CoCH from both the FOI request and MBRRACE.

In sum, the crude MBRRACE data for CoCH (for stillbirths and neonatal deaths) appear to correspond with the hospital (FOI) data, if at times only roughly.

As for the MBRRACE stabilised and adjusted data in relation to CoCH, what can be learned from them? As mentioned above, the crude data are stabilised and adjusted to "take into account the effects of chance variation and also allow for key factors known to increase the risk of perinatal mortality". MBRRACE goes on to say that "the stabilised & adjusted mortality rate will also tend to be closer to the average mortality rate than will the crude mortality rate, especially for organisations with a small number of births".

MBRRACE's methodology with respect to stabilised and adjusted data can be found in Appendix 1 below. The calculations are complex but, in short, the aim is to smooth/dampen the crude data in order to produce more meaningful data series.

The two charts below show, respectively, the crude and stabilised/adjusted data for stillbirths and neonatal deaths. The effects of the stabilisation and adjustment can be clearly seen.

The three charts below present the data in a slightly different way. They show the crude and stabilised/adjusted data for stillbirths and neonatal deaths, and the size of the adjustment (the stabilised/adjusted data minus the crude data). Although MBRRACE did not publish stillbirth and neonatal death data in 2016 and 2018 because of the "small number of deaths", I have substituted FOI data which shows a low number in 2016 (just two stillbirths) and a low number in 2018 (just two neonatal deaths).

It is hard to know how to interpret the three charts above, particularly the third one. Stillbirths appear routinely to be stabilised/adjusted upwards, while neonatal deaths were stabilised/adjusted downwards substantially in 2015 and 2016, the years of Lucy's alleged killings. The charts below show neonatal deaths only, before and after stabilisation/adjustment. After stabilisation/adjustment, there is still clearly a high number of neonatal deaths in 2015. However, 2016 is essentially indistinguishable from 2014, while the low numbers from 2017 onwards are almost certainly related to the unit being downgraded in July 2016.

There is one more discrepancy in the MBRRACE data for CoCH. The below two screenshots are of two excerpts from the MBRRACE data. In the first, 2.51 deaths per 1,000 births pertains to extended perinatal deaths. In the second, 2.51 pertains to perinatal deaths. This is not coincidence; the same goes for other years. I have asked the ONS (rather than MBRRACE) about this - it may be less defensive given ONS uses MBRRACE data and I'm sure would want to resolve the matter.

ONS data for Chester/Cheshire West

The ONS publishes data not at trust level but on a local area basis. The local area in which CoCH sits is the unitary authority Cheshire West and Chester. The chart below shows total births data for both CoCH (from MBRRACE) and Chester/Cheshire West (from ONS). There is clear correspondence. Births at both CoCH and within Chester/Cheshire West fall from 2016 to 2018, following the downgrade of CoCH's neonatal unit from Level 2 HDU to Level 1 SCBU. They do not fall as much in Chester/Cheshire West, suggesting that some but not all of the more serious cases were transferred to other units in the area.

Despite the correspondence in total births data, there are some apparent discrepancies in the deaths data. The two charts below show data for CoCH and Chester/Cheshire West for respectively, stillbirths and neonatal deaths. One would expect, given that CoCH is within Chester/Cheshire West, that numbers would be higher for the latter than for the former. This is indeed the case for stillbirths but not for neonatal deaths.

The chart below subtracts CoCH numbers from Chester/Cheshire West to get the implied numbers of stillbirths and neonatal deaths in Chester/Cheshire West outside of CoCH.

An obvious discrepancy is that in 2015 and 2016 there were a negative number of neonatal deaths in Chester/Cheshire West outside of CoCH (if it not obvious, a negative death is absurd), the two years in which Lucy was on her alleged killing spree. This is a disturbing discrepancy that Lucy's team should certainly investigate.

Introducing national data from MBRRACE and the ONS

The fifth and sixth datasets that I looked at relate to national data (for England) from MBRRACE and the ONS. While not relating directly to CoCH, there is a clear discrepancy in early neonatal deaths between MBRRACE and the ONS. Late neonatal deaths on the other hand correspond quite closely (see chart below).

Finally, one can put rates of neonatal deaths (per 1,000 live births) from all six datasets in one chart, as below. The difference in the rate for England between MBRRACE and the ONS is noticeable, as is the increase in the rate in Chester/Cheshire West in 2018 and 2019. Indeed, in relation to the latter, one can also derive a rate for Chester/Cheshire West excl CoCH which is included in the second chart below.

Conclusion

There are numerous discrepancies in the infant mortality statistics from the three data providers that should be investigated. I have contacted the ONS about some of them and will post its response when I receive it.

Of course, this blog post has looked only at discrepancies in the infant mortality statistics. There are certainly discrepancies elsewhere, notably with respect to the roster data table created by Cheshire Constabulary, shown to the jury, and referred to by Judge Goss in his summing up. This should be the subject of another blog post, though I would make the below points here.

  1. If the ten deaths (in the FOI data) during the period in question (June 2015 to June 2016) which which Lucy was not charged were included, the uninterrupted line of X's would disappear.
  2. If all other collapses during the period (of which there must have been many) with which Lucy was not charged were included, then more gaps in the X's would appear.
  3. Adjustment should be made for Lucy being single and saving up for a house, and thus doing more shifts.
  4. Adjustment should be made for Lucy being a Band 5 (more senior) nurse, and thus being assigned more serious cases as well as being more broadly responsible.
  5. Adjustment should be made for Lucy having an additional intensive care qualification, and thus being assigned even more serious cases.
  6. It is not clear that an 'X' means an event actually happened during one of Lucy's shifts or near/adjacent to one of her shifts.
  7. Adjustment should be made for the fact that Lucy was was a good nurse, always willing to do extra shifts when asked.
  8. Adjustment should be made for the fact that Lucy was a good nurse and therefore was more attentive. If so, she would have been more likely to be present when events occurred.
  9. Adjustment should be made for the fact that Lucy was was a good nurse, perhaps more willing to do night shifts (where incident rates may have been higher and staffing lower) that others did not want to do
  10. Adjustment should be made for the fact that Lucy was a good nurse, perhaps arriving well before the start of her shifts and leaving well after.
  11. Neonatal head Erian Powell testified at trial that Lucy was a good nurse and filed reports about incidents particularly diligently. If this was the case, Lucy would have been associated with more incidents than a nurse who was not as good at reporting incidents.

If you would like to post comments and replies about this post, please do so on the Forum by clicking one of the thread links below (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

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Appendix 1: MBRRACE calculation methodology in relation to stabilised and adjusted data (from MBRRACE-UK Perinatal Mortality Surveillance Technical Manual Version 1.2)

If you would like to post comments and replies about this post, please do so on the Forum by clicking one of the thread links below (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

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The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

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<![CDATA[Thirlwall Inquiry Q: Why was Letby not stopped sooner? A: Er, she never started M'lady]]>https://www.chimpinvestor.com/post/thirlwall-inquiry-q-why-was-letby-not-stopped-sooner-a-er-she-never-started-m-lady65321add895916f7149499baFri, 20 Oct 2023 06:59:36 GMTPeter ElstonIf you enjoy reading this blog, please leave a star rating on WealthTender. Thank you!

The government has published the public inquiry's terms of reference. Will they allow the the truth to be revealed?

If you would like to post comments and replies about this post, please do so on the Forum by clicking here (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

Update on reporting restrictions: I have not sought legal advice about what the reimposition of reporting restrictions means for what I can write in relation to Lucy's case but I have spoken to someone who knows about these things. The test is whether a published report poses a "substantial risk of serious prejudice." The trial to which the reporting restrictions pertain is a year or so away (it hasn't even started!) Also, this article is about Prof Sally Kinsey whose testimony had nothing to do with Child K (the case being retried).

The terms of reference (the framework for the inquiry) were published yesterday and are below in full. Is it really possible that the truth will remain hidden? Questions 11 to 27 in Section B look most interesting. Below are my answers to a couple of them. They may provide hope that discrepancies will quickly emerge.

11. What was known and what should have been known about Letby’s previous work as a nurse when she began employment at the Countess of Chester Hospital?

That she was a good nurse.

12. What concerns were raised and when about the conduct of Letby? By whom were they raised? What was done?

Er, late June 2015. No, early July. Or was in October? Or perhaps it was February.

13. Should concerns, including about hospital or clinical data, have been raised earlier than they were? When? What should have been done then?

We weren't allowed to contact the GMC. Er, yes you were. We weren't allowed to contact the NMC. Er, yes you were. We weren't allowed to contact the police. Er, yes you were. We weren't allowed to tell the coroner about our suspicions. WTF???

16. Whether systems, including security systems relating to the monitoring of access to drugs and babies in neonatal units, would have prevented deliberate harm being caused?

They would not have prevented deliberate harm being caused because there wasn't any (they might have helped people realise no crimes were being committed though).

The Royal Statistical Society wrote a letter (see the two links below) to Lady Justice Thirlwall proposing that she "consider including a point in the terms of reference for the inquiry on the appropriate use of statistical evidence in this type of case. Statistical evidence is one type of evidence that NHS trusts might use to identify criminal activity and it is important that the right lessons are learned and that it is used appropriately". Question 13 may allow the inquiry to look at the data (whether deaths were being recategorised from stillbirths to neonatal deaths, whether there was a spike, etc).

https://rss.org.uk/news-publication/news-publications/2023/general-news/the-rss-writes-to-the-chair-of-the-lucy-letby-inqu/

https://rss.org.uk/RSS/media/File-library/News/Press%20release/Letter_to_Lady_Justice_Thirlwall_re_Lucy_Letby_Inquiry_29_September_2023.pdf

Thirlwall Inquiry: terms of reference

Published 19 October 2023

From: https://www.gov.uk/government/publications/thirlwall-inquiry-terms-of-reference/thirlwall-inquiry-terms-of-reference

Introduction

On 21 August 2023, after a trial at Manchester Crown Court, Lucy Letby was sentenced to life imprisonment and a whole life order on each of 7 counts of murder and 7 counts of attempted murder. The offences took place at the Countess of Chester Hospital, part of the Countess of Chester Hospital NHS Foundation Trust.

Terms of reference

The inquiry will investigate 3 broad areas:

A. The experiences of the Countess of Chester Hospital and other relevant NHS services, of all the parents of the babies named in the indictment.

B. The conduct of those working at the Countess of Chester Hospital, including the board, managers, doctors, nurses and midwives with regard to the actions of Lucy Letby while she was employed there as a neonatal nurse and subsequently, including:

(i) whether suspicions should have been raised earlier, whether Lucy Letby should have been suspended earlier and whether the police and other external bodies should have been informed sooner of suspicions about her

(ii) the responses to concerns raised about Lucy Letby from those with management responsibilities within the trust

(iii) whether the trust’s culture, management and governance structures and processes contributed to the failure to protect babies from Lucy Letby

C. The effectiveness of NHS management and governance structures and processes, external scrutiny and professional regulation in keeping babies in hospital safe and well looked after, whether changes are necessary and, if so, what they should be, including how accountability of senior managers should be strengthened. This section will include a consideration of NHS culture.

A non-exhaustive list of questions arising out of the terms of reference is set out in the annex.

Procedure

The inquiry will operate within the legal framework of the Inquiries Act 2005. The procedure and conduct of the inquiry will be directed by the inquiry chair. The terms of reference are decided by the Secretary of State after consultation with the chair.

The order in which the issues are to be considered has not yet been decided. The priority is to conduct a thorough inquiry as swiftly as possible. The length and timing of the hearings and where they take place will depend on the extent and nature of the live evidence that is required and upon the actions of the police and Crown Prosecution Service.

Report and recommendations

The inquiry chair will provide a final report (and if appropriate, interim reports) to the Secretary of State as soon as is practically possible. She will make recommendations as she considers appropriate.

Annex: questions

This is a non-exhaustive list of questions which the inquiry intends to seek answers to. This annex does not form part of the terms of reference.

A. The experiences of all the parents whose babies were named on the indictment at the criminal trial

1. During their involvement with the Countess of Chester Hospital and elsewhere what were the parents of each child told when and by whom about the condition of their baby, what was being done to treat them and what the prognosis was?

2. How and when were deteriorations (sudden or otherwise) in their babies’ conditions explained to them?

3. Where parents raised concerns about the condition and/or care of their babies, what was done and what were the parents told?

4. When were they given access to their babies’ medical records?

5. What information were the parents given by the hospital regarding concerns about Letby’s conduct and when? What were they told was being done about the concerns?

6. What were the parents of each child told about the likely cause of death or injuries? When and by whom?

7. When were the parents of each child told that Letby was suspected of causing the death or injury to their child? Was the trust sufficiently candid with the parents throughout?

8. What are the views of the parents of each child as to the adequacy of the information they were given at each stage?

9. What was the parents’ experience of the Patient Advice and Liaison Service (PALS)?

10. What are their suggestions for keeping babies safe on the neonatal unit?

B. The conduct of those working at the Countess of Chester Hospital including the board, managers, doctors, nurses and midwives during the period from the arrival of Lucy Letby at the hospital on 4 January 2012 to date

11. What was known and what should have been known about Letby’s previous work as a nurse when she began employment at the Countess of Chester Hospital?

12. What concerns were raised and when about the conduct of Letby? By whom were they raised? What was done?

13. Should concerns, including about hospital or clinical data, have been raised earlier than they were? When? What should have been done then?

14. Were existing processes and procedures for raising concerns used, including whistleblowing and freedom to speak up guardians? Were they adequate?

15. What was the culture within the hospital? To what extent did it influence the effectiveness of the processes and procedures at question 14?

16. Whether systems, including security systems relating to the monitoring of access to drugs and babies in neonatal units, would have prevented deliberate harm being caused?

17. Were existing processes used for reporting concerns to external scrutiny bodies where appropriate? If so, when and what happened? Such bodies may include NHS England (and its regional bodies), local commissioners, Monitor, NHS Improvement, child death overview panels, the Care Quality Commission, the police and the successor of any of these organisations.

18. When was consideration given to reporting Letby to the police? When was she in fact reported to the police and by whom?

19. What information about each of the deaths was provided to the coroner? Was the trust’s provision of information to the coroner appropriate?

20. Did the relationship between clinicians and managers, nurses, midwives and managers and between medical professionals (doctors, nurses, midwives and others) at the Countess of Chester Hospital contribute to any failure to protect babies on the neonatal unit from the actions of Letby? How did professional relationships affect the management and governance of the hospital?

21. Did the structures and processes for the management and governance of the hospital contribute to a failure to protect the babies on the neonatal unit from the actions of Letby? Is the management structure and governance typical of neonatal settings in other hospitals?

22. What was the board’s involvement in the way concerns about Letby were dealt with by the hospital?

23. What was the board’s oversight of clinical and corporate governance?

24. How was Letby managed once concerns were raised about her?

25. Was Letby reported to the Nursing and Midwifery Council (NMC)? When? What information, if any, was provided to the NMC, royal colleges and any other external scrutiny bodies? What was done by the bodies to whom the actions were referred? What happened as a result?

26. What information, if any, was provided to the General Medical Council (GMC) and what information was requested by the GMC? What was the result of any referral or discussions with the GMC?

27. What happened to those who raised concerns about Letby?

C. Wider NHS

28. Whether recommendations to address culture and governance issues made by previous inquiries into the NHS have been implemented into wider NHS practice? To what effect?

29. What concerns are there about the effectiveness of the current culture, governance management structures and processes, regulation and other external scrutiny in keeping babies in hospital safe and ensuring the quality of their care? What further changes, if any, should be made to the current structures, culture or professional regulation to improve the quality of care and safety of babies? How should accountability of senior managers be strengthened?

30. Would any concerns with the conduct of the board, managers, doctors, nurses and midwives at the Countess of Chester Hospital have been addressed through changes in NHS culture, management and governance structures and professional regulation?

If you would like to post comments and replies about this post, please do so on the Forum by clicking here (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

© Chimp Investor Ltd

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<![CDATA[Doctor's Letter to BMJ: Lucy's "conviction seems to be unsafe"]]>https://www.chimpinvestor.com/post/doctor-s-letter-to-bmj-lucy-s-conviction-seems-to-be-unsafe652bf78bdd0f7e7ecf9ecb99Sun, 15 Oct 2023 14:51:25 GMTPeter ElstonIf you enjoy reading this blog, please leave a star rating on WealthTender. Thank you!

On the two month anniversary of the announcement of Lucy's guilty verdicts, a doctor goes on the record. Others should follow. The tide may be turning.

If you would like to post comments and replies about this post, please do so on the Forum by clicking here (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

Update on reporting restrictions: I have not sought legal advice about what the reimposition of reporting restrictions means for what I can write in relation to Lucy's case but I have spoken to someone who knows about these things. The test is whether a published report poses a "substantial risk of serious prejudice." The trial to which the reporting restrictions pertain is a year or so away (it hasn't even started!) Also, this article is about Prof Sally Kinsey whose testimony had nothing to do with Child K (the case being retried).

On 10 October, the BMJ published a letter (https://www.bmj.com/content/383/bmj.p2305) from retired general practitioner Glyn Phillips titled Letby case: why did no-one contact the police earlier?

Today, Dr Phillips sent the below letter to the BMJ.

Letter to BMJ editor by Glyn Phillips, retired GP

https://www.bmj.com/content/382/bmj.p2197/rapid-responses

Glasgow

Dear Editor

Given the recurring pattern of gross legal injustices in the UK, we should remind ourselves that a verdict of guilty in court is not an absolute. Unfortunately, once the verdict is announced the widespread court of public opinion forms a fixed view of certainty that justice has been done. Many will have already done so before and during the trial. We form opinion based on the reporting of the matter on TV, radio and in the press. We do not see or hear all the evidence. We should remind ourselves of the possibility that, in fact, an injustice may have occurred.

Convictions can be, and are, overturned although that usually follows a lengthy uphill struggle. Whilst appealing, the person is incarcerated and subject to all sorts of vilification and possible violence.

Accused persons are sometimes wrongly found guilty by jurors because, amongst many possible scenarios, they are presented with flawed and inaccurate evidence (1), some potential exculpatory evidence may be improperly withheld (2), defence lawyers may underperform, and judges may give inappropriate misdirection to jurors. All such events can also occur in cases where the accused did actually commit the crime.

Since recently making a comment in the BMJ regarding the consultants not directly informing the police (3), I have been contacted by experienced statisticians who are convinced that Letby did not receive a fair trial (4). My rapid response, formulated into a letter, was not intended as a comment on Letby’s guilt or innocence. I was commenting on the misuse of control over registered clinicians by management.

I do not know if she is guilty or innocent. The court justice system found her guilty. However, I am increasingly concerned that she did not receive an entirely fair trial. In that case her conviction seems to be unsafe.

1 https://www.inference.org.uk/sallyclark/NLJ.html 2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC546106/ 3 https://www.bmj.com/content/383/bmj.p2305 4 Elston P. The Travesty of the Lucy Letby Verdicts. Chimp Investor blog 18 August 2023.

Competing interests: No competing interests

15 October 2023

Glyn Phillips

retired GP

If you would like to post comments and replies about this post, please do so on the Forum by clicking here (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

© Chimp Investor Ltd

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<![CDATA[GMC guidance: Consultants could and should have gone to the police in Summer 2015]]>https://www.chimpinvestor.com/post/gmc-guidance-consultants-should-have-gone-public-with-concerns-in-summer-20156528edd8ed5b4b69000c716aFri, 13 Oct 2023 14:32:58 GMTPeter ElstonIf you enjoy reading this blog, please leave a star rating on WealthTender. Thank you!

Formal complaints against the four COCH consultants may be warranted on the basis that by ignoring GMC guidance pertaining to concerns about patient safety they did not do what they were empowered and encouraged to do to help prevent four deaths and seventeen near deaths

If you would like to post comments and replies about this post, please do so on the Forum by clicking here (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

Update on reporting restrictions: I have not sought legal advice about what the reimposition of reporting restrictions means for what I can write in relation to Lucy's case but I have spoken to someone who knows about these things. The test is whether a published report poses a "substantial risk of serious prejudice." The trial to which the reporting restrictions pertain is a year or so away (it hasn't even started!) Also, this article is about the General Medical Council (GMC, see note 1) and the behaviour of consultants at the Countess of Chester, not Child K (the case being retried).

On 10 October, the BMJ published a letter (https://www.bmj.com/content/383/bmj.p2305) from retired general practitioner Glyn Phillips titled Letby case: why did no-one contact the police earlier? The letter is reproduced below (note 2) but Dr Phillip's message is that GMC guidelines are restrictive when it comes to its members reporting suspected criminality at a hospital to the police. This restriction, Dr Phillips suggests, is the reason the four consultants did not report their concerns that they had about Letby as early as June 2015 following the deaths of three babies that month (a particularly high number compared to the average of around 2 per year) to Cheshire Constabulary.

Instead, it was left to the hospital authorities to report the consultants' concerns to the police nearly two years later, during which time Letby allegedly murdered a further four babies and attempted to murder a further nine on fourteen occasions (seventeen including the three attempts on the baby Letby eventually succeeded in murdering). Can it really be correct that the consultants could not have sought to prevent these deaths and near deaths by going to the police when they first associated Letby with the incidents, and indeed had identified injection of air as her modus operandi, in June 2015?

Let's take a look at the GMC code of conduct, Good Medical Practice, to which Dr Phillips refers in his letter, as well as to another GMC document, Raising and acting on concerns about patient safety. The relevant clauses are included in full in Note 3 below.

It is clear from the two documents that the consultants could and should have gone to the police with their concerns about Letby. It is clearly stated that doctors should:

contact a regulatory body such as the General Medical Council (GMC) or another body with authority to investigate the issue (such as those listed at the end of this guidance) in the following circumstances.

a If you cannot raise the issue with the responsible person or body locally because you believe them to be part of the problem.

b If you have raised your concern through local channels but are not satisfied that the responsible person or body has taken adequate action.

c If there is an immediate serious risk to patients, and a regulator or other external body has responsibility to act or intervene.

'The police' is not in the list of possible "bodies with authority to investigate" referred to but it is not an exhaustive list (note the use of the words 'such as'). Surely if multiple murder is suspected, which it was (consultant Brearey noted an association between the three deaths in June and Letby in late June/early July 2015 while consultant Jayaram identified injection of air as Letby's modus operandi around the same time) and the three criteria above were satisfied, which they were (see note 4 for details of the various television interviews with consultants that were broadcast in the wake of the verdicts being announced on 15 August in which they clearly laid the blame at the feet of the hospital management for ignoring their concerns), the obvious "body with authority to investigate" was the police.

(Jayaram also appears to not remember when he found the paper Pulmonary Vascular Air Embolism In The Newborn that he realised explained Letby's modus operandi. On 24 October 2022 he testified that it was in June 2015 . On 22 February this year he testified it was in June 2016 . Which is it, Ravi? See Note 5 for more detail of Jayaram's inconsistent testimony).

It is also clear that the doctors could have gone public with their concerns too:

You can consider making your concerns public if you:

a have done all you can to deal with any concern by raising it within the organisation in which you work or which you have a contract with, or with the appropriate external body, and

b have good reason to believe that patients are still at risk of harm, and

c do not breach patient confidentiality.

It is clear that the consultants were empowered and, in the circumstances, encouraged by the guidelines to contact both the GMC and bodies with authority to investigate which would have included the police.

One other way in which they could have conveyed concerns about Letby, one which would not have involved first speaking to hospital management, was to raise their suspicions with the coroner, Nicholas Rheinberg. There is no reference in any of the hundreds of media reports on the trial of them having done this. Indeed, according to The Times article Damning email told of ‘chaos’ on Lucy Letby ward:

Letby also managed to slip through the gaps in the coronial system. Hospital managers asked the Cheshire coroner, Dr Nicholas Rheinberg, to investigate the seven baby deaths in February 2017. The coroner declined, according to sources, telling the trust he was not a “quality-assurance service” for the NHS. Rheinberg retired that year.

Finally, insulin. The alleged poisoning by Letby with insulin of Babies F and L took place, respectively, in August 2015 and April 2016. The first of these was two months after Brearey had noticed an association between Letby and the three deaths in June, and Jayaram had "alighted" upon her modus operandi, injection with air. By the second poisoning, Brearey had had an email exchange in October about his suspicions about Letby with neonatal unit manager Eirian Powell and in February 2016 had convened a half-day thematic review into the deaths and collapses with the help of Consultant Neonatologist at Liverpool Women’s NHS Foundation Trust, Dr Nimish Subhedar.

The test for insulin that the two babies underwent was this one, http://pathlabs.rlbuht.nhs.uk/insulin.pdf, which clearly states, "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" (red in document, not mine).

Given a) the consultants' concerns that their hospital harboured a serial killer, b) the insulin assay could not be used to test for exogenous insulin (possible poisoning), and c) the clear guidance to inform the lab "if exogenous insulin administration is suspected as the cause of hypoglycaemia" so the samples could be "referred externally for analysis", one would have expected the consultants to follow the assay's guidance. They didn't.

If suspected murder and attempted murder are not reasons to go to the GMC, the police, other bodies with "authority to investigate", the coroner, another laboratory, what are?

Despite their concerns that a nurse was killing babies under their care, their experience, their expertise, and the very fact that one of them in June 2015 had "alighted" on the method Letby had used to kill three babies, the four consultants were somehow not able to provide the hospital management with a single piece of medical evidence of Letby's criminality. This contrasts, strangely, with the reams and reams of medical evidence presented at trial by the seven prosecution medical experts.

Although Lucy's conviction relied firstly upon the consultants' alleged suspicions and secondly upon the later formal endorsement of them by the prosecution experts, this article is not about the latter. It is about why the four consultants did not follow GMC guidance nor report their suspicions to the coroner, action that might well have prevented four deaths and seventeen near deaths (Brearey could also not remember whether it was late June or early July 2015 when he raised concerns about Lucy's apparent link to the three deaths in June. So, he obviously did not keep a record, another breach of GMC guidelines that tell doctors to "keep a record of your concern" per Part 1, 15 below).

If I was a parent of one of the thirteen babies that died or nearly died as a result of the consultants' lack of action, I would be very angry. If I was a doctor, I would feel a duty to speak up and denounce the consultants' lack of action. There are 374,850 doctors in the UK registered with the GMC. Let's see how many of them are prepared to do so.

Notes

Note 1: The General Medical Council (from https://en.wikipedia.org/wiki/General_Medical_Council)

The General Medical Council (GMC) is "a public body that maintains the official register of medical practitioners within the United Kingdom. Its chief responsibility is to "protect, promote and maintain the health and safety of the public" by controlling entry to the register, and suspending or removing members when necessary".

Note 2: Letter from retired general practitioner Glyn Phillips titled Letby case: why did no-one contact the police earlier? published in BMJ, 10 October 2023 (from https://www.bmj.com/content/383/bmj.p2305)

A 10 year journey “to reform organisational culture so managers and clinicians work more symbiotically” is neither necessary nor acceptable. At least one of the four consultants in the Lucy Letby case has stated that in retrospect he wishes they had bypassed management. He agreed in court with the point made by Letby’s defence barrister that they were all grown adults who could have gone straight to the police. An investigation of the matter by suitably experienced officers could have prevented some deaths.

In hindsight it seems astonishing that an earlier referral to the police did not occur. Why did four experienced consultants not feel able to contact the police? Why did nursing colleagues of Letby not feel they could raise concerns with the police directly? It seems likely that the consultants were being bullied into “drawing a line under the matter.” The threat of their being referred to the General Medical Council was weaponised. This is possible because many doctors do not trust GMC processes or its ability to come to correct decisions. While management sought to protect the reputation of the trust, the doctors probably wanted to protect their own professional reputations.

It’s also possible because the option (responsibility) to go directly to the police is not available in the GMC code of conduct, Good Medical Practice. The only mention of the word “police” is in relation to a doctor being obliged to inform the GMC should they receive a police caution. The word “police” is not mentioned anywhere in the Nursing and Midwifery Council code of professional standards.

This perceived restriction on reporting unanswered concerns directly to the police should be remedied by the GMC and the NMC. A simple explanatory clause could easily be included stating that when serious concerns of criminal activity exist, obstructed by management inactivity, then the registered practitioner “must” report the matter to the police.

Note 3: Relevant clauses in Good Medical Practice and Raising and acting on concerns about patient safety pertaining to reporting of concerns about patient safety.

From Good Medical Practice:

24.c: If you have concerns that a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from a colleague, your defence body or us. If you are still concerned you must report this, in line with our guidance and your workplace policy, and make a record of the steps you have taken.

From Raising and acting on concerns about patient safety:

Part 1: Raising a concern

Duty to raise concerns

7 All doctors have a duty to raise concerns where they believe that patient safety or care is being compromised by the practice of colleagues or the systems, policies and procedures in the organisations in which they work. They must also encourage and support a culture in which staff can raise concerns openly and safely.

8 You must not enter into contracts or agreements with your employing or contracting body that seek to prevent you from or restrict you in raising concerns about patient safety. Contracts or agreements are void if they intend to stop an employee from making a protected disclosure.

Overcoming obstacles to reporting

9 You may be reluctant to report a concern for a number of reasons. Fo example, because you fear that nothing will be done or that raising your concern may cause problems for colleagues; have a negative effect on working relationships; have a negative effect on your career; or result in a complaint about you.

10 If you are hesitating about reporting a concern for these reasons, you should bear the following in mind.

a You have a duty to put patients’ interests first and act to protect them, which overrides personal and professional loyalties.

b The law provides legal protection against victimisation or dismissal for individuals who reveal information to raise genuine concerns and expose malpractice in the workplace.

c You do not need to wait for proof – you will be able to justify raising a concern if you do so honestly, on the basis of reasonable belief and through appropriate channels, even if you are mistaken.

Steps to raise a concern

11 You must follow the procedure where you work for reporting adverse incidents and near misses. This is because routinely identifying adverse incidents or near misses at an early stage, can allow issues to be tackled, problems to be put right and lessons to be learnt.

12 If you have reason to believe that patients are, or may be, at risk of death or serious harm for any reason, you should report your concern to the appropriate person or organisation immediately. Do not delay doing so because you yourself are not in a position to put the matter right.

13 Wherever possible, you should first raise your concern with your manager or an appropriate officer of the organisation you have a contract with or which employs you – such as the consultant in charge of the team, the clinical or medical director or a practice partner. If your concern is about a partner, it may be appropriate to raise it outside the practice – for example, with the medical director or clinical governance lead responsible for your organisation. If you are a doctor in training, it may be appropriate to raise your concerns with a named person in the deanery – for example, the postgraduate dean or director of postgraduate general practice education.

14 You must be clear, honest and objective about the reason for your concern. You should acknowledge any personal grievance that may arise from the situation, but focus on the issue of patient safety.

15 You should also keep a record of your concern and any steps that you have taken to deal with it.

Raising a concern with a regulator

16 You should contact a regulatory body such as the General Medical Council (GMC) or another body with authority to investigate the issue (such as those listed at the end of this guidance) in the following circumstances.

a If you cannot raise the issue with the responsible person or body locally because you believe them to be part of the problem.

b If you have raised your concern through local channels but are not satisfied that the responsible person or body has taken adequate action.

c If there is an immediate serious risk to patients, and a regulator or other external body has responsibility to act or intervene.

Making a concern public

17 You can consider making your concerns public if you:

a have done all you can to deal with any concern by raising it within the organisation in which you work or which you have a contract with, or with the appropriate external body, and

b have good reason to believe that patients are still at risk of harm, and

c do not breach patient confidentiality.

But, you should get advice (see Help and Advice below) before making a decision of this kind.

Help and advice

18 If you are not sure whether, or how, to raise your concern, you should get advice from:

a a senior member of staff or other impartial colleague

b the GMC’s Confidential Helpline

c your medical defence body, your royal college or a professional association such as the British Medical Association (BMA)

d the appropriate regulatory body listed at the end of this guidance if your concern relates to a colleague in another profession, or other relevant systems regulators if your concern relates to systems or organisations rather than individuals

e Public Concern at Work – a charity which provides free, confidential legal advice to people who are concerned about wrongdoing at work and are not sure whether, or how, to raise their concern.

Note 4: TV interviews with the COCH consultants in the wake of the verdicts being announced on 15 August (interviews with Evans, Bohin, and Rees as well as Cheshire Police's Operation Hummingbird documentary added to the list):

Dr Stephen Brearey BBC Interview (Clips): https://www.youtube.com/watch?v=Txw2Cj8GJQQ (Brearey, BBC)

Warnings about Lucy Letby weren’t acted on - says doctor who worked with serial killer nurse: https://www.channel4.com/news/warnings-about-lucy-letby-werent-acted-on-says-doctor-colleague-in-first-interview & https://www.youtube.com/watch?v=2HsWAZYUNEU (Gibbs, Channel 4)

Lucy Letby: Hospital doctor criticises management: https://news.sky.com/story/lucy-letby-case-whistleblowing-doctor-accuses-hospital-management-of-potentially-facilitating-a-mass-murderer-12942418 & https://www.youtube.com/watch?v=GJYUK1wdHJI (Gibbs, Sky News)

'Babies could've been saved': Doctor who helped catch Lucy Letby blames hospital | ITV News: https://www.itv.com/news/2023-08-18/babies-couldve-been-saved-doctor-who-helped-catch-lucy-letby-blames-hospital & https://www.youtube.com/watch?v=2jnDr5EIpmY (Jayaram, ITV)

Doctor who helped catch Lucy Letby calls for full public inquiry: https://www.itv.com/news/2023-08-21/doctor-who-helped-catch-lucy-letby-calls-for-full-public-inquiry# & https://www.youtube.com/watch?v=VsB3_9H3ksA (Jayaram, ITV)

BBC Panorama - Lucy Letby: The Nurse Who Killed: https://www.bbc.co.uk/iplayer/episode/m001q7dl/panorama-lucy-letby-the-nurse-who-killed & https://www.youtube.com/watch?v=yo13E3YwvBg (Brearey, police et al)

The Man Who Took Down Evil: https://talk.tv/news/26246/lucy-letby-angel-of-death-was-an-extremely-clever-criminal (Evans, TalkTV)

Lucy Letby - the untold story from the key prosecution expert witness - Dr Dewi Evans talks to Dr Raj Persaud: https://rajpersaud.libsyn.com/lucy-letby-the-untold-story-from-the-key-prosecution-expert-witness-dr-dewie-evans-talks-to-dr-raj-persaud (Evans, Raj Persaud podcasts)

Lucy Letby: Paediatrician who gave evidence in child killer's trial joins calls for public inquiry: https://www.itv.com/news/channel/2023-08-22/paediatrician-who-gave-evidence-in-letby-trial-joins-calls-for-public-inquiry & https://www.youtube.com/watch?v=2VHSpCaR4YY (Bohin, ITV)

Ex-nursing boss speaks out on claims she refused to remove Lucy Letby from neonatal unit: https://www.itv.com/news/granada/2023-08-22/ex-nursing-boss-wasnt-given-enough-information-to-remove-lucy-letby & https://www.youtube.com/watch?v=BWtMEGesEIs (Rees, ITV)

Cheshire Police - Operation Hummingbird documentary (no longer available on YouTube): https://1drv.ms/v/s!AiV2u7y3BGn0jJId6DfVKhwW2zsRzw?e=eUt9qo

Note 5: Jayaram's inconsistent testimony

From Consultant tells trial skin marks ‘didn’t fit with anything he’d seen’ (The Independent, 24 October 2022):

He [Jayaram] said that some time after Child D’s death [22 June 2015] he “alighted” on a research paper entitled Pulmonary Vascular Air Embolism In The Newborn [1989].The medic said it described a series of accidental events of air embolism – where a blockage in the passage of blood occurs – and a similar pattern of discolouration.....The consultant said that around the time of Child A’s inquest a group of clinicians had begun to raise concerns to hospital bosses about the “association we had seen with an individual being present in those situations and, how do I say diplomatically, being told we really should not really be saying such things and not to make a fuss”.

From Lucy Letby: Dr had 'physical chill' over baby events, trial told (BBC, 22 February 2023):

"On 29 June 2016, after a number of further unusual, unexpected and inexplicable events on the neonatal unit, the whole consultant body sat down and thought we have to work out what's going on here. One of the things that came up in discussion was could this be air embolism, I can't remember who suggested it." Dr Jayaram said after the meeting he went home and did a searched for literature on the subject, eventually finding a research paper from 1989. He said: "I remember sitting on my sofa at home with my iPad, researching. I remember the physical chill that went down my spine when I read that, because it fitted with what we were seeing."

Other links:

NHS: Post-mortem

https://www.nhs.uk/conditions/post-mortem/

NHS England: The national medical examiner system

https://www.england.nhs.uk/establishing-medical-examiner-system-nhs/

Implementing the medical examiner system: National Medical Examiner’s good practice guidelines

https://www.england.nhs.uk/wp-content/uploads/2020/08/National_Medical_Examiner_-_good_practice_guidelines.pdf

When a death is reported to a coroner

https://www.gov.uk/after-a-death/when-a-death-is-reported-to-a-coroner

NI Direct Government Services: Coroners, post-mortems and inquests

https://www.nidirect.gov.uk/articles/coroners-post-mortems-and-inquests

The Coroners’ Society of England & Wales (CSEW): FAQs

https://www.coronersociety.org.uk/faqs/

The Coroners’ Society of England & Wales (CSEW): Links

https://www.coronersociety.org.uk/links/

The Timeline of the Conspiracy

https://gill1109.com/2023/10/12/the-timeline-of-the-conspiracy/

Is the NHS ready for PSIRF? A blog by Chris Elston

https://www.pslhub.org/learn/investigations-risk-management-and-legal-issues/investigations-and-complaints/methodology-and-guidance-how-to-do-an-investigation/patient-safety-incident-response-framework-psirf/is-the-nhs-ready-for-psirf-a-blog-by-chris-elston-r10184/

If you would like to post comments and replies about this post, please do so on the Forum by clicking here (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

© Chimp Investor Ltd

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<![CDATA[Why Did Prof Sally Kinsey Testify That Babies Did Not Have Antiphospholipid Syndrome?]]>https://www.chimpinvestor.com/post/did-professor-sally-kinsey-commit-perjury65251b017671987daa807f61Tue, 10 Oct 2023 20:53:28 GMTPeter ElstonIf you enjoy reading this blog, please leave a star rating on WealthTender. Thank you!

The babies' clinical notes say they did (antiphospholipid syndrome would have explained the babies' symptoms, rashes, etc)

If you would like to post comments and replies about this post, please do so on the Forum by clicking here (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

Update on reporting restrictions: I have not sought legal advice about what the reimposition of reporting restrictions means for what I can write in relation to Lucy's case but I have spoken to someone who knows about these things. The test is whether a published report poses a "substantial risk of serious prejudice." The trial to which the reporting restrictions pertain is a year or so away (it hasn't even started!) Also, this article is about Prof Sally Kinsey whose testimony had nothing to do with Child K (the case being retried).

Professor Sally Kinsey was one of seven prosecution medical experts in Lucy's trial. She is a paediatric haematologist and practices at Leeds Teaching Hospitals NHS Trust (https://www.leedsth.nhs.uk/a-z-of-services/leeds-cancer-centre/services/childrens-and-adolescent-oncology-and-haematology/services/haematology/ ).

Professor Sally Kinsey testified in relation to Children (twins) A and B (https://tattle.life/wiki/lucy_letby_case_2/#prof-sally-kinsey-child-a-and-b ), E (https://tattle.life/wiki/lucy-letby-case-5/#prof-sally-kinsey ), F (https://tattle.life/wiki/lucy-letby-case-6/#professor-sally-kinsey ), and N (https://tattle.life/wiki/lucy-letby-case-10/#professor-sally-kinsey-child-n ). The Chester Standard article about her 29 November testimony in relation to Children A, B and E, "BLOOD abnormalities were not the cause of the collapse of three babies allegedly attacked by nurse Lucy Letby, a court has heard", can be found here: https://www.chesterstandard.co.uk/news/23158439.lucy-letby-trial-blood-abnormalities-not-cause-babies-collapse/ .

Professor Sally Kinsey testified in relation to Children A and B that the mother's antiphospholipid syndrome, an autoimmune disease, had not passed to either of her children (see below).

Professor Sally Kinsey appears to have dismissed clinical notes that said both Child A and Child B had antiphospholipid syndrome (see below).

Below are extracts from mainstream media articles about Prof Kinsey's testimony, information about antiphospholipid syndrome, and information about Prof Kinsey herself that is in the public domain. The parts that pertain specifically to antiphospholipid syndrome are in red (and underlined). Other parts that may be of relevance are underlined. Make of it what you will. Suffice to say that there appear to be questions as to why Prof Kinsey's testimony was contrary to the clinical notes, why she testified about air embolus when she she was not qualified to do so, and why issues such as the long line inserted by Dr Harkness being too close to the heart, lack of fluids for several hours, possible sepsis (sepsis was ruled out by Dr Dewi Evans), effects of resuscitation, etc, were discounted/not considered relevant.

As a general point about expert witnesses, they are there to guide jurors in matters beyond their understanding. They are supposed to be independent, with an attempt made before the trial to reach agreement between prosecution and defence experts. It appears that in Lucy's case, none of the prosecution's experts' written testimony was rebutted by the defence team's medical expert, Michael Hall. As a neonatologist he would not have been qualified to rebut the evidence of the prosecution's radiologist, endocrinologist, biochemist, haematologist, and pathologist but it is not clear why he did not do a better job of rebutting the testimony of the two paediatricians (perhaps it was because their testimony in relation to air embolism, rashes, collapses etc was endorsed by the other experts). So, given that a) the only experts the jurors heard from were the prosecution's experts and b) they are in no position to dispute it, it is no wonder they found Lucy guilty on 14 counts. What is perhaps surprising is that in the other seven counts where there was prosecution expert testimony (there was no expert testimony in relation to count 14/Child K), jurors either returned not guilty verdicts (two counts) or were not able to return verdicts (five counts). There is no clear pattern between these seven counts and the experts involved. Perhaps others can discern patterns in relation to other witnesses, agreed facts?

Child A testimony by Prof Sally Kinsey

Her first report is dated March 4, 2020, relating to Child A. The court hears the conditions that Child A and Child B's mother had before her birth, and the decision to deliver the twins by C-section in June 2015. The events of Child A's treatment at the Countess of Chester Hospital neonatal unit, subsequent collapse and death, are relayed in court. Child A's blood count was considered 'normal' for his age. She said she had considered whether Child A's mother's auto-immune disease could have been a significant factor in the death of Child A. Said auto-immune disease was a rare condition (affecting about 50 in 100,000 people) which affected the mother, which can cause increased blood clotting. It is "well recognised" that pregnancy can cause issues, which can cause nutritional problems for babies in the womb, and a C-section can be required "to save the life of the mother and the child". The court hears it can cause premature birth and blood clotting for the mother. Nicholas Johnson KC, for the prosecution, asks: "Did the...syndrome pass on to [Child A or Child B]?" Professor Kinsey: "No, that is not the case."

Mr Johnson says there was concern the condition had passed from mother to son, but says Professor Kinsey is sure it did not. "It didn't," Professor Kinsey replies. Prof Kinsey says, for the conclusion of air embolus for Child A, the doctors' descriptions of skin discolourations on the baby had "cemented" her concerns. She adds it is very "rare" and has not seen it in her experience, but she says she has read it from literature, and the skin discolourations are a "stark" feature. Prof Kinsey says she is sure the cause of Child A's death does not have a haematological origin.

Child B testimony by Prof Sally Kinsey

The case of Child B, a baby girl, is now being discussed. The events of Child B's treatment at the neonatal unit and her collapse are relayed to the court. The jury is being shown clinical records which have previously been shown as part of the sequence of events and from doctor/nurse witnesses. Prof Kinsey confirms she had noted what was written for Child B's skin discolouration on June 10 - the 'purple blotching'. For all the blood results Prof Kinsey had seen, she said they were 'normal' for her age and the time the tests were taken. There was, like Child A, no passing on of the mother's auto-immune disease to Child B, she adds. The question of air embolus is raised. She said she had made similar observations to Child A. The professor says there was no haematological evidence that could have caused Child B's collapse, and wanted to draw attention to the skin discolouration in the area around the chin, which she said was most likely a 'rash' caused when medical staff were trying to administer air.

Cross Examination of Prof Sally Kinsey by Ben Myers KC

Ben Myers KC, for Letby's defence, is now asking Prof Kinsey questions. He says his questions are more concerned on the nature of an air embolus. Mr Myers asks about the principle of experts giving evidence, and their areas of expertise. He refers to Prof Kinsey's expertise in haematology and certain paediatric specialisms, and her reports. They include focus on cancers and blood disorders. Mr Myers: "Air embolus does not feature in your expertise, does it?" Prof Kinsey: "No." Mr Myers refers to the diagrams of gas exchange, which are 'standard images' in the way gas exchange works in the body. Mr Myers: "In no way are they designed to explain an air embolus." Prof Kinsey: "They were produced to explain the gas exchange and circulation." Mr Myers: "What you are doing in your evidence is to take that understanding of circulation and gas exchange and use it to explain how an air embolus is displayed." Prof Kinsey: "Yes." Mr Myers says Prof Kinsey has, at times, commented on the issue of air embolus in her reports for Childs A, B and E. Prof Kinsey: "Only in the changes to the colour of the skin, very impactful." Mr Myers refers to the summary/opinion for Child A, and whether there was any haematological significance for Child A. He says that is not in dispute. He refers to the conclusion, which he says relies on comment from [medical experts] Dr Dewi Evans and Dr Sandie Bohin, and the description from [Countess of Chester Hospital consultant] Dr Ravi Jayaram of the skin discolouration for Child A. Mr Myers refers to the 1989 medical journal review: "mentioning a particular case - 'blanching and migrating areas of cutaneous pallor were noted in several cases and, in one of our own cases, we noted bright pink vessels against a generally cyanosed...background." Prof Kinsey confirms she is drawing a parallel between the 1989 journal review and what had been observed by doctors and nurses. She tells the court she was "shocked" by Dr Jayaram's description of skin discolouration for Child A, which she said came before she had considered the possibility of air embolus. She said she knew this is what air embolus was like, and knew from her own education, before seeing that description matched what was said in the 1989 medical journal review. Mr Myers says Dr Jayaram's clinical note - 'legs noted to look very white and pale before cardiac arrest' does not contain the full details from her report. Dr Jayaram did not add anything further to the skin discolouration observation in the report to the coroner, Mr Myers adds. Mr Myers: "The description you read came from his statement [to police] two and a half years later." Prof Kinsey agrees. Mr Myers refers to the case of Child B, and the summary/opinion Prof Kinsey made in her report. He says, for air embolus, Prof Kinsey again draws parallels between the 1989 medical journal and the skin discoluration observations seen for Child B. The clinical note of 'widespread purple discolouration with white patches' for Child B, made at the time, is shown to the court, along with a subsequent 'improvement in skin perfusion'. A doctor's note on June 10, shown to the court: 'suddenly purple blotching of body all over...upon my arrival purple blotching...[later] purple discolouration almost resolved'. Lucy Letby's note on June 10 is also shown to the court: 'Cyanosed in appearance...colour changed rapidly to purple blotchiness with white patches'. Mr Myers: "In none of those is there any description of a bright pink or red feature?" Prof Kinsey: "No." Prof Kinsey's report, dated November 1, 2022, is referred to. Mr Myers says Prof Kinsey was asked to give further consideration as to how an air embolism worked. She says she was asked to give further explanation on the features of an air embolism. She said she was not an expert in such mechanisms, but has provided an explanation. Mr Myers says the report notes there is very little medical literature in relation to air emboli. Mr Myers: "You have used your knowledge of blood and circulation to assist this?" Prof Kinsey: "Yes." Mr Myers says part of the limited medical literature relates to decompression in deep-sea divers, colloquially known as 'the bends', and that in those circumstances, nitrogen bubbles would be in the circulation longer than oxygen bubbles. He asks Prof Kinsey if that is the case. Prof Kinsey: "I don't know the answer to that question." Mr Myers says the research paper in question [for 'the bends'] dealt with four overweight deep-sea diving adults. Prof Kinsey: "Yes, there were many limitations to their findings. Mr Myers said the results were "very specific based to the people [in that study]." Mr Myers asks if the symptoms of decompression sickness would always result in skin discolouration. Prof Kinsey said it would not. Mr Myers asks if that can be applied to babies - if an air embolus could always lead to skin discolouration observations. Prof Kinsey said it would not. Prof Kinsey says the problem with decompression syndrome, in comparison to air embolus in infants, is the bubbles get larger as the deep-sea diver returns to the surface. Mr Myers says that is another limitation of the available medical literature for air emboli. Prof Kinsey says the reason that study was used in her report was that skin discolouration had been an observation in that study, as it had been in cases of air embolus. Prof Kinsey says the scale of the air embolus problem would depend on the size of the air bubble and the type of vessel that it is in. Upon a question from the judge, Prof Kinsey says she has never encountered any discussion about nitrogen bubbles in the system, other than in deep-sea divers. She says the biggest factors for any air embolus would be the size of the air bubble and the vessel that it is in. What was not a factor in her discussions was the quantities that made up the air [ie what amount was nitrogen, what amount was oxygen, carbon dioxide, etc].

Child A witness box testimony by Lucy on 5th May 2023 (https://www.chesterstandard.co.uk/news/23502385.recap-lucy-letby-trial-friday-may-5---defence-continues/)

The focus turns to the case of Child A, born on June, 7, 2015, twin of Child B. Child A died the following day. Mr Myers is retelling the notes for Child A's birth. Child A, a baby boy, was born with antiphospholipid syndrome. He died the following day. Mr Myers refers to nursing notes, referring to the UVC line being in the wrong position on June 8 for Child A. It was reinserted but was still in the wrong position. A long line was inserted. Care was handed over to Lucy Letby at 8pm. Mr Myers refers to retrospective nursing notes written by Lucy Letby on the morning of June 9. The notes include: 'Instructed line not to be used by registrar. [Child A] noted to be jittery, was due to have blood gas and blood sugar taken. 'At 20.20 [Child A's] hands and feets noted to be white. Centrally pale and poor perfusion. [Child A] became apnoeic. Reg in the nursery. [Child A] making nil respiratory effort...' Child A later died. Lucy Letby says that, around the time of this taking place, she had moved to Ash House in June 2015. She said she was "still in the process of moving an unpacking" at the time of Child A's events. She says she had received a text message that morning asking her to work that night's shift. A text message from Yvonne Griffiths from 9.21am on June 8, 2015 is shown to the court asking Lucy Letby to work that night. Letby tells the court she was "frequently" asked to come in and cover neonatal unit shifts at short notice, saying she was very "flexible". Letby tells the court the first she knew she was going to be caring for Child A, in nursery room 1 was when she arrived for the handover at 7.30pm. She recalls there was "a lot of activity" in the nursery, with Dr David Harkness doing a line procedure and nurse Melanie Taylor sorting fluids for Child A. She explained Child A had been without fluids for a few hours. An intensive care chart is shown for Child A - after 4pm on June 9, the 'cannula tissued' which meant Child A's fluids had stopped, the court is told. A clinical note is shown to the court about the UVC and long line insertions. Letby says she was told by Dr Harkness and nurse Taylor the long line was suitable for use to administer 10% glucose. A collective handover had taken place prior to Letby arriving at the nursery, lasting about 20 minutes. Letby tells the court when fluids are administered via a long line, one of the two nurses present has to be sterilised, and in this case that was nurse Melanie Taylor, handling the bag, cleaning the long line, attaching the bag to the long line 'port' on Child A's left arm and making sure the line was 'flushed'. Letby was, she says, the 'dirty nurse' (ie unsterilised) for this procedure. Letby say she turned her attention to hanging the bag on to the drip stand cotside and programming the pump. Letby says the "usual practice" is for the line to be flushed with sodium chloride prior to fluid administration. She says she did not observe if that took place. The 10% dextrose solution is shown from a fluid prescription chart as beginning at 8.05pm. Letby says Melanie Taylor went over to a computer to start writing up notes. Letby said she was doing some checks - on cotside equipment, suction points, emergency equipment. She says Dr Harkness at this point was doing a procedure on twin Child B at this point. Letby says she observed Child A to be "jittery". Letby says "jittery" was an abnormal finding for Child A. It was "an involuntary jerking of the limbs". She says she remembered it was "noticeable". Child A's monitor sounded and his "colour changed". Letby says the alarm sounded, but she did not know what it indicated at the time. She says she noted Child A' "hands and feet were white". She went over to Child A, who was not breathing, so they went to Neopuff him. Letby and nurse Taylor disconnected the 10% dextrose, on Dr Harkness's advice. Referring to 'centrally pale', Letby says that refers to Child A being pale in the abdomen and torso. Child A was apnoeic - "not breathing". Nurse Caroline Bennion was also in nursery room 1, and had been during handover, the court hears. Letby says she began the 'usual procedure' of administering Neopuff to Child A. Child A's heart stopped and a 'crash call' was put out. Letby says that is an emergency line for doctors to arrive urgently. Dr Ravi Jayaram arrived immediately and another nurse arrived shortly afterwards. Letby says she cannot recall the resuscitation efforts, and says it was "an unexpected, huge shock", saying she had just gone through the doors and "then this was happening". Child A died shortly before 9pm. Letby says she, as designated nurse, arranged hand and foot prints for Child A as part of the hospital's 'bereavement checklist' which the court heard about on Tuesday. A nursing colleague helped assist in the hand and footprints, as that was a two-staff procedure. A baptism was offered to Child A during resuscitation, and Child A and Child B were baptised together. The court hears this was part of the practice. Letby said she felt after Child A, the bag of fluids and the long line "should be retained". She says she labelled the bag as "at the time...we should be checking everything in relation to the line and fluids" as it could be "tested" afterwards. She says she did not know what happened to the bag afterwards. Letby said, in reaction to Child A's death, she was "stunned, in complete shock...it felt like we had walked through the door into this awful situation - that was the first time I met [Child A] and [Child A's] parents". A nursing colleague messaged Letby on June 9, praising her for how she handled the sitation with Child A: "...You did fab." Letby responded: "...Appreciate you saying that & Thanks for letting me do it but supporting me so well x" Letby says the network of support among colleagues in messaging each other outside of work was "something we all did". Mr Myers asks why Letby searched for the mum of Child A on June 9 at 9.58am. Letby says "it was just curiosity" that she wanted to see the people behind that "awful" event, and the parents "were on my mind". She says it was a "pattern of behaviour" she had, as she searched the name as part of a "quick succession" of name searches in a short period of time. Letby says there was a debrief after Child A had died, a few days later, led by Dr Jayaram, which discussed if there was anything to learn from the event. Letby said it was "more clinically based" rather than emotional support. She said the event "affected her" emotionally, and denies causing Child A any deliberate harm. Letby says, of that night: "You never forget something like that".

Child A cross examination of Lucy Letby on 18th May 2023 (https://www.chesterstandard.co.uk/news/23530215.recap-lucy-letby-trial-may-18---prosecution-cross-examines-letby/)

Mr Johnson asks about the case of Child A. Letby says she did have independent memory of Child A. "Before [Child A], had you ever known a child to die unexpectedly within 24 hours of birth?" LL: "I can't recall - I'm not sure." Letby says she can recall "two or three" baby deaths prior at the Countess of Chester Hospital, and "several" at her placement in Liverpool Women's Hospital. Mr Johnson says Letby had previously told police it was "two" at Liverpool. Letby says her memory would have been clearer back then. Letby says it was discussed at the time Child A's antiphospholipid syndrome could have been a contributing factor at the time. Letby tells the court "in part", staffing levels were a contributing part in Child A's death, due to a lack of fluids for four hours and issues with the UVC line. She says they were "contributing factors", and put Child A "at increased risk of collapse". "I can't tell you how [Child A] died, but there were contributing factors that were missed." Letby says the issues with Child A's lines "made him more vulnerable", with one of the lines "not being connected to anything". Letby is asked why she didn't record this on a 'Datix form'. LL: "It was discussed amongst staff at the time...I didn't feel the need to do a Datix, it had been raised verbally with two senior staff, one Dr Jayaram, one a senior nursing staff." She adds: "I don't know why [Child A] died." Letby says if the cause of death was established as air embolous, then it would have come from the person connecting the fluids, "which wasn't me". Mr Johnson: "Do you accept you were by [Child A] at the time he collapsed?" LL: "I accept that I was in his cot space, checking equipment, yes...I was in his close vicinity." NJ: "Could you reach out and touch him?" LL: "I could touch his incubator - the incubator was closed." NJ: "Could you touch his lines?" LL: "No." Letby says "there's no way of knowing" from the signatures, who administered the medication between the two nurses, Letby or nurse Melanie Taylor. Dr David Harkness recalled to the court: "There was a very unusual patchiness of the skin, which I have never seen before, and only seen since in cases at the Countess of Chester Hospital." Letby disagrees with that skin colour description for Child A. She agrees with Dr Harkness that Child A had "mottling", with "purple and white patches". Letby says she cannot recall any blotchiness. "I didn't see it - if he says he saw it...that's for him to justify. "It's not something I saw. "I was present and I did not see those." Dr Ravi Jayaram said Child A was "pale, very pale", and referred to "unusual patches of discolouration." Letby: "I don't agree with the description of discolouration, I agree he was pale." Letby disagrees with the description of Child A being blue, with pink patches 'flitting around'. An 'experienced nurse of 20 years', who the court hears was a friend of Letby, said: "I've never seen a baby look that way before - he looked very ill." Letby agrees Child A looked ill. She disagrees with the nurse's statement of the discolouration, or the blotchiness on Child A's skin. "I agree he was white with what looked like purple markings." Letby agrees with the statement that the colouring "came on very suddenly". Mr Johnson refers to Letby's police interview, in which Letby was asked to interpret what she had seen on Child A. Letby explained to police mottling was 'blotchy, red markings on the skin' "Like, reddy-purple". Child A was "centrally pale". In police interview, Letby was asked about what she saw on Child A. She said: "I think from memory it [the mottling] was more on the side the line was in...I think it was his left." Letby tells the court she felt Child A was "more pale than mottled". She says it was "unusual" for Child A to be pale and to have discolouration on the side", but there was "nothing unusual" about the type of discolouration itself. Mr Johnson asks about the bag being kept for testing. Letby says she cannot recall if she followed it up if the bag was tested. She had handed it over to the shift leader. Letby is asked if she accepts Child A did not have a normal respiratory problem. Letby agrees. Mr Johnson asks if Letby has ever seen an arrhythmia in a neonate. Letby: "No, I don't think so, no." Mr Johnson says air bubbles were found in Child A afterwards. "Did you inject [Child A] with air?" "No." Mr Johnson asks if Letby was "keen" to get back to room 1 after this event. Letby says from her experience at Liverpool Women's, she was taught to get back and carry on as soon as possible. Letby had been asked what the dangers of air embolus were, and she had not known. "Were you playing daft?" "No - every nurse knows the dangers." Letby said she did not know how an air embolous would progress, but knew the ultimate risk was death. The trial is now resuming. Nicholas Johnson KC says there is one thing he overlooked from the morning's evidence. He asks Lucy Letby why she said "blotchiness" rather than "mottling" in part of her police statement. "I think they are interchangeable," Letby tells the court.

Child B witness box testimony by Lucy on 5th May 2023 (https://www.chesterstandard.co.uk/news/23502385.recap-lucy-letby-trial-friday-may-5---defence-continues/ )

Mr Myers turns to the case of Child B, Child A's twin sister. Child B was born on June 7, 2015, weighing 1,669g. Mr Myers says Child B was born with antiphospholipid syndrome, as noted on a clinical note. Mr Myers notes that, at birth, Child B was 'blue and floppy, poor tone, HR approx 50.' Resuscitation efforts were required, with a series of inflation breaths. Intubation was successful after a couple of attempts, and Child B stabilised on the evening of June 7. Mr Myers refers to nursing notes written retrospectively on the morning June 10. Child B had desaturated to 75% 'shortly before midnight', with Child B's CPAP prongs pushed out of nose. 'Prongs and head reposition. Took a little while and O2 to recover. HR remained stable.' '0030. Sudden desaturation to 50%. Cyanosed in appearance. Centrally shut down, limp, apnoeic. CMV via Neopuff commenced and chest movement seen...' 'Became bradycardiac to 80s. Successfully intuinated...and HR improved quickly. 0.9% saline bolus given and colour started to improve almost as quickly as it had deteriorated. Started to breathe for self...' Lucy Letby says she does not have much recollection of the night shift for June 9-10, in respect of Child B. A diagram shows Letby was in nursery room 3 for that night shift, looking after two babies. Letby says without that diagram, she would not have recalled who was doing what from that night. Mr Myers asks how Letby would know if a nurse needed assistance in a non-emergency situation. Letby says they would come and ask. Letby says CPAP prongs can be dislodged "very easily" and it happened "frequently" in babies. Before 12.30am, Letby says she believed she carried out a blood gas test on Child B, at about 12.15am. A fluid chart is shown to the court. She says at 10pm on June 9, lipids were administered. A blood gas chart is shown with a reading at 12.16am, with Lucy Letby's signature initials. She says it was "usual practice" that two nurses would be involved in the blood gas test, and she says she had no other involvement with Child B in the run-up to her deterioration. Letby is asked about a morphine bolus administered to Child B, as referred to in police interviews, when establishing contact with the baby. Mr Myers says, to be clear about the timing of this morphine bolus, a prescription is shown to the court, with the 'time started' being 1.10am. The court hears this is 40 minutes after the collapse. Letby says she cannot recall, "with any clarity", events in the build-up to Child B's collapse. She says she knows there was a deterioration "fairly soon" after the blood gas test. She said both she and a nursing colleague were in nursery 1 when Child B's colour changed - "becoming quite mottled", "dark", "all over". She says the nursing colleague alerted her to the deterioration. Letby is asked if she had seen that mottling before. Letby said it was not unusual but it was a concern, in light of Child A's death the night before. Child A was "pale" but Child B had "purple mottling". She says she and the nursing colleague were joined by a doctor at that point. Letby said she was asked to get the unit camera from the manager's office to take a picture of the mottling. She says on her return, Child B had stabilised and returned to normal colouring, and there was no mottling to photograph. She said she had the camera with her, and she had returned to the nursery "very quickly". Letby says she believes she administered some of the prescribed drugs for Child B after the collapse. A blood gas test taken at 12.51am is signed by Letby. She says as it is a two-nurse procedure, the signature does not indicate whether that was also the nurse who took the initial blood sample. Letby says following Child B's collapse, other doctors came to the nursery room, but she cannot recall who. She says presumably the designated nurse would have communicated with the family following the collapse. An observation chart shows Letby took observations for child B at 1am. She says this was "not unusual" for nurses to do this, especially if the designated nurse was busy elsewhere. The court hears this could be if that designated nurse is speaking with the parents.

Child A defence closing on 27 June (https://www.chesterstandard.co.uk/news/23615797.recap-lucy-letby-trial-june-27---defence-closing-speech/ )

The respiration rate chart for Child A is shown, with what Mr Myers says is "escalating up to the point of collapse", and is in a yellow bracket (ie elevated above normal). He says [medical expert] Dr Sandie Bohin would not accept that, saying it was stable. Mr Myers says the defence wonder how much attention was paid to Child A, with Melanie Taylor looking after two babies. Mr Myers says Child A received no fluids for four hours, and Dr Bohin agrees it was "sub-optimal". He says the long line was "in the wrong place" for Child A. He said the records show it was not correctly sited. He refers to an x-ray review on June 8: 'Long line...to be pulled back'. Dr David Harkness put in 9.20pm he was unable to move the long line as he had been called to another patient. Mr Myers says Dr Harkness had a review with colleagues the following day and they agreed it was in a 'perfect place'. Mr Myers cross-examined Dr Bohin on the long line position, which she reported was 'not in the best position'. He says Dr Bohin didn't mention it in her evidence. Mr Myers says the line 'was too close to the heart', and fluids were put down it, and Child A had a fatal collapse within 20 minutes of that. He says Dr Harkness removed the line as soon as the collapse happened.

Antiphospholipid Syndrome (https://www.rileychildrens.org/health-info/antiphospholipid-syndrome )

Antiphospholipid syndrome occurs when the immune system mistakenly attacks some of the normal proteins in the blood, causing abnormal clotting. This condition is quite rare; most family doctors will never see anyone with this condition. Therefore, it is vitally important for your child to be immediately assessed by a pediatric rheumatologist if it is suspected that he or she might have antiphospholipid syndrome. Antiphospholipid syndrome can cause blood clots to form in the arteries or veins of the fingers, toes, legs, kidneys, lungs or brain. Blood clots in the brain can cause stroke, which is a serious symptom of this condition. A heart attack, lung clot or pulmonary embolism (PE) may also be caused by this condition. Other less common symptoms of antiphospholipid syndrome include:

  • Neurological effects. This condition can cause restricted blood flow to the brain, which can lead to chronic headaches, migraines, dementia and seizures.
  • Rash. A red rash with a lacy, net-like pattern—called livedo reticularis—can develop.
  • Cardiovascular disease. Clotting caused by this condition can damage the heart valves.
  • Bleeding. In some children with the condition, the blood platelet count is low.

Diagnosis of Antiphospholipid Syndrome

If your child’s rheumatologist suspects that he or she may have antiphospholipid syndrome, a series of blood tests will be conducted over the course of several weeks. The doctor will analyze your child’s blood for the presence of at least one of the following antibodies:

  • Lupus anticoagulant
  • Anti-cardiolipin
  • Beta-2 glycoprotein I

In order to make a definitive diagnosis of antiphospholipid syndrome, at least one of these antibodies must be present in your child’s blood in at least two separate blood tests conducted 12 weeks apart. Your child’s doctor will begin to treat the condition as soon as it is recognized, which is sometimes before the definitive diagnosis at 12 weeks.

​Treatments

There is no cure for this condition, but your child’s doctor will use various medicines in order to reduce the risk of blood clots. The medicines used may include:

  • Heparin. Usually, the doctor will give your child an injection of the blood thinner heparin combined with a pill that also thins the blood, such as warfarin. Blood thinners—also known as anticoagulants—reduce the chance of clotting.
  • Warfarin. After your child takes blood thinners in both injection and pill form for several days, the doctor may discontinue the heparin and continue the warfarin, potentially for the rest of your child's life.
  • Aspirin. In some cases, the doctor may recommend your child also take a low-dose aspirin each day.
  • Immunosuppressants. Your child’s doctor may prescribe immunosuppressant medications in order to reduce the body’s production of the harmful autoantibodies.

If your child is taking anticoagulants, there are some safety measures that he or she can take to reduce the chance of bleeding. It is recommended that he or she:

  • Avoid contact sports or other activities that could lead to bodily trauma or bruising
  • Use a soft toothbrush and waxed floss
  • Take extra care when using knives, scissors and other sharp objects

Blood clots related to this condition will be greatly reduced if your child takes the prescribed medicines and follows the lifestyle modifications recommended by the doctor.

Key Points to Remember

  • Antiphospholipid syndrome is a clotting disorder that is caused by an overactive immune system.
  • Left untreated, the condition can cause blood clots in major organs or structures that can lead to tissue damage like stroke or pulmonary embolus.
  • Your child’s doctor will run a series of blood tests over a 12-week time period in order to accurately diagnose the condition.
  • There is no cure for antiphospholipid syndrome, but the related blood clotting can be controlled with blood thinners and immunosuppressant medicines.

Antiphospholipid Syndrome (https://rarediseases.org/rare-diseases/antiphospholipid-syndrome/ )

Disease Overview

Antiphospholipid syndrome (APS) is a rare autoimmune disorder characterized by recurring blood clots (thromboses). Blood clots can form in any blood vessel of the body. The specific symptoms and severity of APS vary greatly from person to person depending upon the exact location of a blood clot and the organ system affected. APS may occur as an isolated disorder (primary antiphospholipid syndrome) or may occur along with another autoimmune disorder such as systemic lupus erythematosus (secondary antiphospholipid syndrome). APS is characterized by the presence of antiphospholipid antibodies in the body. Antibodies are specialized proteins produced by the body’s immune system to fight infection. In individuals with APS, certain antibodies mistakenly attack healthy tissue. In APS, antibodies mistakenly attack certain proteins that bind to phospholipids, which are fat molecules that are involved in the proper function of cell membranes. Phospholipids are found throughout the body. The reason these antibodies attack these proteins and the process by which they cause blood clots to form is not known.

Signs & Symptoms

The specific symptoms associated with antiphospholipid syndrome are related to the presence and location of blood clots. Blood clots can form in any blood vessel of the body. Clots are twice as likely to form in vessels that carry blood to the heart (veins) as in vessels that carry blood away from the heart (arteries). Any organ system of the body can become involved. The lower limbs, lungs and brain are affected most often. APS also causes significant complications during pregnancy. The severity of APS varies, ranging from minor blood clots that cause few problems to an extremely rare form (catastrophic APS) in which multiple clots form throughout the body. However, in most cases, blood clots will only develop at one site. When blood clots affect the flow of blood to the brain a variety of issues can development including serious complications such as stroke or stroke-like episodes known as transient ischemic attacks. Less frequently, seizures or unusual shaking or involuntary muscle movements (chorea) may occur. Blood clots in large, deep veins are referred to as deep vein thrombosis (DVT). The most common site of DVT is the legs, which can become painful and swollen. In some cases, a piece of the blood clot may break off, travel in the bloodstream, and become lodged in the lungs. This is referred to as pulmonary embolism. Pulmonary embolism may cause breathlessness, a sudden pain the chest, exhaustion, high blood pressure of the pulmonary arteries, or sudden death. Skin rashes and other skin diseases may occur in people with APS. These include blotchy reddish patches of discolored skin, a condition known as livedo reticularis. In some cases, sores (ulcers) may form on the legs. Lack of blood flow to the extremities can cause loss of living tissue (necrotic gangrene), especially in the fingers or toes. Additional abnormalities that may occur in individuals with APS include clot-like deposits on the valves of the heart (valvular heart disease) which can permanently damage the valves. For example, a potential complication is mitral valve regurgitation (MVR). In MVR, the mitral valve does not shut properly allowing blood to flow backward into the heart. Affected individuals may also experience chest pain (angina) and the possibility of a heart attack (myocardial infarction) at an early age but these problems are not thought to be related to valvular heart disease. Some affected individuals can develop low levels of blood platelets (thrombocytopenia). Thrombocytopenia associated with antiphospholipid antibodies is usually mild and only rarely causes easy or excessive bruising and prolong bleeding episodes. Affected individuals are also at risk for autoimmune hemolytic anemia, a condition characterized by the premature destruction of red blood cells by the immune system. Some individuals have reported symptoms that resemble multiple sclerosis including numbness or a sensation of pins and needles, vision abnormalities such as double vision, and difficulty walking, but it is not known if these problems are related to APS. Some data show an association of APS with cognitive dysfunction, but the mechanism is not known. In women, APS can cause complications during pregnancy including repeated miscarriages, fetal growth delays (intrauterine growth retardation), and preeclampsia. Preeclampsia is a condition characterized by high blood pressure, swelling and protein in the urine. Symptoms associated with preeclampsia vary greatly, but may include headaches, changes in vision, abdominal pain, nausea and vomiting.

CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME (CAPS)

Catastrophic antiphospholipid syndrome, also known as CAPS or Asherson’s syndrome, is an extremely rare variant of APS in which multiple blood clots affect various organ systems of the body potentially causing life-threatening multi-organ failure. The specific presentation, progression and organs involved vary from person to person. CAPS may develop in a person with primary or secondary APS or in individuals without a previous diagnosis of APS. In some cases, infection, trauma, or surgery appears to trigger the condition.

Causes

Antiphospholipid syndrome is an autoimmune disorder of unknown cause. Autoimmune disorders are caused when the body natural defenses (antibodies, lymphocytes, etc.) against invading organisms attack perfectly healthy tissue. Researchers believe that multiple factors including genetic and environmental factors play a role in the development of APS. In rare cases, APS has run in families suggesting that a genetic predisposition to developing the disorder may exist. The antibodies that are present in APS are known as antiphospholipid antibodies. These antibodies were originally thought to attack phospholipids, fatty molecules that are a normal part of cell membranes found throughout the body. However, researchers now know that these antibodies mostly target certain blood proteins that bind to phospholipids. The two most common proteins affected are beta-2-glycoprotein I and prothrombin. The exact mechanism by which these antiphospholipid antibodies eventually lead to the development of blood clots is not known.

Affected populations

APS affects males and females, but a large percentage of primary APS patients are women with recurrent pregnancy loss. Some estimates suggest that 1 in 5 cases of recurrent miscarriages or deep vein thromboses are due to APS. As many as one-third of cases of stroke in people under 50 years of age may be due to APS. Secondary APS occurs mainly in lupus, and about 90% of lupus patients are female.

Disorders with Similar Symptoms

Symptoms of the following disorders can be similar to those of antiphospholipid syndrome. Comparisons may be useful for a differential diagnosis. Several rare genetic disorders are characterized by the formation of blood clots (thromboses). These disorders may be collectively referred as the thrombophilias and include protein C deficiency, protein S deficiency, antithrombin III deficiency, and factor V Leiden. (For more information on these disorders, contact the National Alliance for Thrombosis and Thrombophilia.) Some individuals with APS may be misdiagnosed as having multiple sclerosis (MS) because of the development of similar neurological symptoms. Multiple sclerosis is a chronic disease of the brain and spinal cord (central nervous system) that may be progressive, relapsing and remitting, or stable. The pathology of MS consists of small lesions called plaques that may form randomly throughout the brain and spinal cord. These patches prevent proper transmission of nervous system signals and thus result in a variety of symptoms including eye abnormalities, impairment of speech, and numbness or tingling sensation in the limbs and difficulty walking. The exact cause of multiple sclerosis is unknown. (For more information on this disorder choose “Multiple Sclerosis” as your search term in the Rare Disease Database.) Lupus (systemic lupus erythematosus) is a chronic, inflammatory autoimmune disorder that can affect various organ systems. In autoimmune disorders, the body’s own immune system mistakenly attacks healthy cells and tissues causing inflammation and malfunction of various organ systems. In lupus, the organ systems most often involved include the skin, kidneys, blood and joints. Many different symptoms are associated with lupus, and most affected individuals do not experience all of the symptoms. The initial symptoms may include arthritis, skin rashes, fatigue, fever, pleurisy, and weight loss. In some cases, lupus may be a mild disorder affecting only a few organ systems. In other cases, it may result in serious complications.

Diagnosis

A diagnosis of antiphospholipid syndrome is made based upon a thorough clinical evaluation, a detailed patient history, identification of characteristic physical findings (at least one blood clot or clinical finding), and a variety of tests including simple blood tests. The most common blood tests used to detect antiphospholipid antibodies are anticardiolipin antibody immunoassays (which, despite the name, detect mainly antibodies to beta-2-glycoprotein I), anti-beta-2-glycoprotein antibody immunoassays, and lupus anticoagulant tests (coagulation assays that detect subsets of anti-beta-2-glycoprotein I antibodies and anti-prothrombin antibodies). Positive tests should be repeated because antiphospholipid antibodies can be present in short intervals (transiently) due to other reasons such as infection or drug use. Borderline negative tests may need to be repeated because individuals with APS have initially tested negative for the antiphospholipid antibodies.

Standard Therapies - Treatment

Individuals with APS who do not have symptoms may not require treatment. Some individuals may undergo preventative (prophylaxis) therapy to avoid blood clots from forming. For many individuals, daily treatment with aspirin (which thin the bloods and prevents blood clots) may be all that is needed. Individuals with a history of thrombosis may be treated with drugs that preventing clotting by thinning the blood. These drugs are often referred to as anticoagulants and may include heparin and warfarin (Coumadin). New oral blood thinners (dabigatran, rivaroxaban, and apixaban) have recently been approved to treat other blood clotting conditions. Studies are needed to determine whether these drugs are appropriate for preventing recurrent blood clots in patients with APS. Individuals with repeated thrombotic events may require lifelong anticoagulant therapy. Importantly, affected individuals are strongly encouraged to avoid or reduce risk factors that increase the risk of a blood clot forming. Such risks include smoking, the use of oral contraceptives, high blood pressure (hypertension), or diabetes. During pregnancy, women at a high risk for pregnancy loss are treated with heparin, sometimes in combination with low dose aspirin. In some cases, heart valve damage may be severe and require surgical replacement.

Sally Kinsey's Companies House entry (https://find-and-update.company-information.service.gov.uk/officers/1ISYj1j4Z_mZZCswLHHUcowe32Y/appointments )

Sally Elizabeth KINSEY

Total number of appointments 3

Date of birth: November 1958

THE CANDLELIGHTERS TRUST (03020552) Company status: Active

Correspondence address: 8 Woodhouse Square, Leeds, England, LS3 1AD Role: RESIGNED Director

Appointed on: 10 February 1995

Resigned on: 10 January 2018 Nationality: British

Country of residence: England

Occupation: Paediatric Haematologist

Candlelighters Trust: https://www.candlelighters.org.uk and https://register-of-charities.charitycommission.gov.uk/charity-search/-/charity-details/1045077

Prof Kinsey's resignation coincides with the start of her involvement in the Letby investigation.

BSH ENTERPRISES LIMITED (02677826) Company status: Active

Correspondence address: Sea Moor Farm, Brown Bank Lane Silsden, Keighley, West Yorkshire, BD20 0NN Role: RESIGNED Director

Appointed on: 19 September 2000

Resigned on: 22 January 2002 Nationality: British

Occupation: Physician

British Society for Haematology: https://b-s-h.org.uk/about-us/committees/bsh-enterprises

THE KINSEY PARTNERSHIP LIMITED (04850975) Company status: Active

Correspondence address: 21 Victoria Avenue, Apartment 1, Harrogate, England, HG1 5RD Role: ACTIVE Secretary

Appointed on: 30 July 2003 Nationality: British

According to https://www.linkedin.com/in/ben-gray-b28a7179/?originalSubdomain=uk , "Kinsey are specialist providers of high performance quality brands to the most prestigious golf establishments worldwide and corporate clients".

From https://thestrayferret.co.uk/harrogate-business-sets-up-irish-company-as-brexit-contingency/ :

A Harrogate business has set up a company in Ireland ahead of Brexit in case trade talks “go horribly wrong”. David Kinsey, owner of The Kinsey Partnership which distributes golf clothing and headwear worldwide, said he was confident his business will survive any outcome of Brexit. It comes as today is the last day of crunch talks between the UK and European Union over a post-Brexit trade deal. Mr Kinsey said he felt the outcome of the talks were “up the air”, but added that he would want to see a deal reached. He said: “I would like to see a smooth, easy transition like most would. I personally think everybody wants us to get a deal. I am sure all the nations in Europe want us to get a trade deal.” The Kinsey Partnership imports and exports golf goods to shops and golf resorts in countries like Ireland, Sweden and the United Arab Emirates. Mr Kinsey said, while he cannot plan ahead due to the uncertainty of the trade talks, he had set up a company in Ireland as a contingency. “I’m in a position where I have set up a company in Ireland, just in case that is something we need in case things go horribly wrong and we can ship and import into Ireland if we have to.” While the Brexit talks has caused uncertainty for trade, Mr Kinsey said coronavirus has caused the company bigger problems due to a shutdown on people playing golf. He said the virus has been a “much bigger issue” on stock and trade.

If you would like to post comments and replies about this post, please do so on the Forum by clicking here (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

© Chimp Investor Ltd

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<![CDATA[Prof Peter Hindmarsh, King of Insulin]]>https://www.chimpinvestor.com/post/dr-peter-hindmarsh-king-of-insulin651bd551b5f014bc75a55169Tue, 03 Oct 2023 11:50:09 GMTPeter ElstonIf you enjoy reading this blog, please leave a star rating on WealthTender. Thank you!

The doctor is being investigated by the GMC

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Update on reporting restrictions: I have not sought legal advice about what the reimposition of reporting restrictions means for what I can write in relation to Lucy's case but I have spoken to someone who knows about these things. The test is whether a published report poses a "substantial risk of serious prejudice." The trial to which the reporting restrictions pertain is a year or so away (it hasn't even started!) Also, this article is about Peter Hindmarsh and insulin, which had nothing to do with Child K (the case being retried).

Prof Peter Hindmarsh is a paediatric endocrinologist at UCLH.

Prof Peter Hindmarsh testified at Lucy's trial in November last year that, in relation to Child F's blood test result, "the insulin reading should be in proportion to the insulin C-Peptide reading" and the fact that it wasn't (insulin to c-peptide ratio was very high) meant exogenous insulin had been administered. He said this despite the guidance from Royal Liverpool University Hospital (RLUH) that conducted the test (http://pathlabs.rlbuht.nhs.uk/insulin.pdf)clearly stating, "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." (red in document not mine). The reason is that the RLUH test picks up non-poisonous insulin analogues such as proinsulin and insulin antibodies, not just insulin. The further test, that it seems was not conducted, is more sensitive and would have measured the amount of insulin and thus the correct insulin to c-peptide ratio.

Prof Peter Hindmarsh testified at Lucy's trial in February this year in relation to Child L's blood test result. According to https://tattle.life/wiki/lucy-letby-case-10/ , Hindmarsh, said "the results of a blood sample taken some time on the afternoon of April 9 meant he was “quite certain” that non-natural insulin was present in his system." This despite RLUH's guidance (http://pathlabs.rlbuht.nhs.uk/insulin.pdf) clearly stating the assay should not be used to test for exogenous insulin. Other expert testimony (https://tattle.life/wiki/lucy-letby-case-10/#dr-anna-milan-child-l, copied below) was provided by clinical biochemist Dr Anna Milan (Dr Gwen Wark, head of the Guildford lab that performs more detailed analysis, also testified). It seems that Milan as well as Hindmarsh incorrectly testified that the RLUH's test result showing a high insulin to c-peptide ratio (it didn't, it showed a high insulin plus proinsulin plus insulin antibodies to c-peptide ratio) meant that exogenous insulin had been administered. Milan had testified in November in the relation to Child F (https://tattle.life/wiki/lucy-letby-case-6/#dr-anna-milan , copied below) that "Guildford has a specialist, separate laboratory for such analysis in insulin, although the advice given to send the sample is not usually taken up by hospitals. Dr Milan said that advice would be there as an option for the Countess of Chester Hospital to take up. Dr Milan (co-author of https://pubmed.ncbi.nlm.nih.gov/23751444/ , Forensic aspects of insulin) said she was 'very confident' in the accuracy of the blood test analysis produced for Child F's sample." It is certainly not clear from the brief report of Wark's testimony that the two blood samples were sent to Guildford.

Prof Peter Hindmarsh is, as of 21 April this year, the subject of a General Medical Council investigation (big shout out to the member of this blog that put me onto it) that as of today is still ongoing (https://www.gmc-uk.org/doctors/2459998, details copied below).

Conclusions

1. You'd have thought that by April 2016 (collapse of Child L), eight months after senior consultant Dr Brearey (said he had) first noticed an association of events with Lucy, the doctors would have been keen to send the blood sample for additional analysis. Even Child F's collapse in August was a couple of months after Brearey's supposed observation and thus should have warranted further analysis.

2. The two insulin cases were the first to be decided upon by the jury (both unanimous 11-0 guilty verdicts). It may have been easier for jurors thereafter to believe Lucy guilty of committing other crimes. In other words, if the insulin cases can get thrown out because Hindmarsh's testimony gets thrown out, that should have ramifications for the other verdicts (legally, it may not, but we here are in the business of influencing public opinion too).

Following publication of my article, one of my blog members posted the below insightful comment:

Interesting comment, Peter, in your conclusion to The King of Insulin -- regarding the ramifications for the other convictions if F and L are overturned.

In the Judge's summing up he said to the jurors, [my parenthesis and bold highlights]:

"If you are satisfied so that you are sure in the case of any baby [eg F and L] that they were deliberately harmed by the defendant ,then you are entitled, to consider how likely it is that other babies in the case who suffered unexpected collapses did so as a result of some unexplained or natural cause rather than as a consequence of some deliberate harmful act by someone.

“If you conclude that this is unlikely then ,you could, if you think it right,, ,treat the evidence of that event and any others,, if any, which you find were a consequence of a deliberate harmful act, ,as supporting evidence in the cases of other babies and that the defendant was the person responsible,."

The Judge wouldn't use the word 'entitled' lightly, it seems to be a point of law he is referring to. As you say, the verdicts in F and L were the first ones the jury decided on.

It does indeed then look like they used those decisions for F and L as justification against Lucy for all the remaining ones she was convicted upon. However we'll never know, what goes on in the jury room remains in the jury room.

But given the judge's remarks it looks very like the right path to pursue to bring down this whole house of cards --starting just as soon as word gets out how shoddy the police and scientific investigation has really been regarding the inappropriate insulin investigation.

I then noted the similarity to Colin Norris ("insulin killer nurse") and the referral of his case by the CCRC (nearly two years ago!) to the CoA:

Somewhat similar to CCRC's referral of Colin Norris' case to CoA. From https://ccrc.gov.uk/news/commission-refers-the-murder-and-attempted-murder-convictions-of-colin-norris-to-the-court-of-appeal/: "As regards the murder of Mrs Hall, the CCRC considers that this conviction depends upon support from the other 4 cases and the prosecution’s assertion that no-one other than Mr Norris could have been responsible. In light of the new expert evidence, the CCRC is satisfied that this assertion is now less secure and that, as a result, there is a real possibility that the Court of Appeal will quash this conviction too." It is of course also shocking that this was written nearly two years ago and still nothing from CoA.

Testimonies of Dr Anna Milan and Dr Gwen Wark:

Dr Anna Milan (child F)

The court is hearing from Anna Milan, a clinical biochemist, how insulin and insulin c-peptide tests were taken for analysis. Child F's blood sample, which was dated August 5, 2015, was taken at 5.56pm. The court is shown a screenshot of Child F's blood sample results. Child F is referred to as 'twin 2' - Child E, the other twin boy, had died at the Countess of Chester Hospital on August 4. Dr Milan says Child F's insulin c-peptide level reading of 'less than 169' means it was not accurately detectable by the system. The insulin reading of '4,657' is recorded. A call log information is made noting the logged telephone call made by the biochemist to the Countess of Chester Hospital, with a comment made - 'low C-Peptide to insulin'. The note adds '?Exogenous' - ie query whether it was insulin administered. The note added 'Suggest send sample to Guildford for exogenous insulin.' The court hears Guildford has a specialist, separate laboratory for such analysis in insulin, although the advice given to send the sample is not usually taken up by hospitals. Dr Milan said that advice would be there as an option for the Countess of Chester Hospital to take up. Dr Milan said she was 'very confident' in the accuracy of the blood test analysis produced for Child F's sample.

Cross Examination

Ben Myers, for Letby's defence, asks about the risk of the sample deteriorating if it is not frozen. Dr Milan said the sample arrived frozen. If it wasn't frozen, it would be accepted in 12-24 hours. She said the laboratory knew it arrived within 24 hours, and adds Chester has its own system in place to store the blood sample before transport. Mr Myers said the Child F blood sample would have been stored for seven days [in Liverpool], then disposed of. Dr Milan agrees. On a query from the judge, Mr Justice James Goss, Dr Milan explains how the blood sample is frozen and kept frozen for transport. She said the sample would not have been taken out of the freezer in Chester until it was ready to be transported.

Dr Anna Milan (child L)

From Dan O’Donohue Twitter (20/02/2023)

Anna Milan, a clinical biochemist, is giving evidence about a blood sample analysis that was carried out for Child L. The analysis was to test for insulin. Court is being shown blood analysis results for Child L (they were collected on 9 April 2016). Ms Milan said the 'only way you get a pattern like that is if insulin has been given to a patient'

Cross Examination

Ben Myers KC, defending, is now questing Dr Milan on the process for analysing blood - from ward to lab. She says 'ideally' blood will be taken and cooled within 30minutes to preserve it. Mr Myers asks if blood is left for hours, will it cause issues - 'it can do yes'. Mr Myers asks if a sample hasn't been handled correctly, will it affect the relatability of the findings - and specifically in this case. Dr Milan says it can effect findings, but it 'wouldn't create insulin in this sample' Dr Milan repeats, that the only explanation for the readings in this sample is external administration

Dr Gwen Wark (child L)

From Dan O’Donohue Twitter (20/02/2023)

Dr Gwen Wark is now in the witness box. She is the director of the Guildford RSCH Peptide Hormone Laboratory. Her evidence again focuses on the blood analysis of Child L. Dr Wark's evidence relates to the veracity of the blood test results. She confirms Child L's reports met all required standards

From Prof Peter Hindmarsh's GMC entry (https://www.gmc-uk.org/doctors/2459998):

Hearings (since 20 October 2005): 21 Apr 2023 Interim Orders Tribunal

Conditions on the doctor's registration (From 21 Apr 2023):

1. He must personally ensure that the GMC is notified of the following information within seven calendar days of the date these conditions become effective: a of the details of his current post, including: i his job title ii his job location iii his responsible officer (or their nominated deputy) b the contact details for his employer and any contracting body, including his direct line manager c of any organisation where he has practising privileges and/or admitting rights d of any training programmes he is in e of the contact details of any locum agency or out-of-hours service he is registered with.

Glossary V16

2. He must personally ensure the GMC is notified: a of any post he accepts, before starting it b that all relevant people have been notified of his conditions, in accordance with condition 7 c if any formal disciplinary proceedings against him are started by his employer and/or contracting body, within seven calendar days of being formally notified of such proceedings d if any of his posts, practising privileges or admitting rights have been suspended or terminated by his employer before the agreed date within seven calendar days of being notified of the termination e if he applies for a post outside the UK.

Glossary V16

3. He must allow the GMC to exchange information with his employer and/or any contracting body for which he provides medical services.

Glossary V16

4. When undertaking patient facing clinical work, he must only do so at University College of London Hospitals NHS Trust.

Glossary V16

5. He must notify any instructing organisation when acting or accepting instructions as an expert witness as to this and any ongoing GMC investigation.

Glossary V16

6. a He must be directly supervised in all of his posts by a clinical supervisor, as defined in the Glossary for undertakings and conditions. His clinical supervisor must be appointed by his responsible officer (or their nominated deputy). b He must not work until: i his responsible officer (or their nominated deputy) has appointed his clinical supervisor and approved his supervision arrangements ii he has personally ensured that the GMC has been notified of these arrangements. c He must provide a report from his clinical supervisor in advance of or at his next IOT review hearing.

Glossary V16

7. He must personally ensure that the following persons are notified of the conditions listed at 1 to 6: a his responsible officer (or their nominated deputy) b the responsible officer of the following organisations i his place(s) of work and any prospective place of work (at the time of application) ii all his contracting bodies and any prospective contracting body (prior to entering a contract) iii any organisation where he has, or has applied for, practising privileges and/or admitting rights (at the time of application) iv any locum agency or out-of-hours service he is registered with v if any organisation listed at (i to iv) does not have a responsible officer, he must notify the person with responsibility for overall clinical governance within the organisation. If he is unable to identify this person, he must contact the GMC for advice before working for that organisation. c the approval lead of his regional Section 12 approval tribunal (if applicable) - or Scottish equivalent d his immediate line manager and senior clinician (where there is one) at his place of work, at least 24 hours before starting work (for current and new posts, including locum posts).

Glossary V16

If you would like to post comments and replies about this post, please do so on the Forum by clicking here (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

© Chimp Investor Ltd

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<![CDATA[I've Got A Little List]]>https://www.chimpinvestor.com/post/i-ve-got-a-little-list650431867bb0c3fcc49fd014Thu, 28 Sep 2023 09:12:09 GMTPeter ElstonIf you enjoy reading this blog, please leave a star rating on WealthTender. Thank you!

A list of useful/interesting organisations and individuals in relation to Lucy's case that I shall add to/keep current (please contact me with suggestions)

If you would like to post comments and replies about this post, please do so on the Forum by clicking here (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

Links to interesting organisations:

The View Magazine

The only publication by and for women in the justice system

www https://theviewmag.org.uk

email admin@theviewmagazine.org

tel 07591 185 151

The Criminal Cases Review Commission - The CCRC looks into criminal cases where people believe they have been wrongly convicted or wrongly sentenced. These cases are for those who have already lost their appeal. If we do find something wrong with a conviction or sentence, we can send the case back to the Court of Appeal. To launch a fresh appeal, we need something important like strong new evidence or an argument that makes the case look different now. https://ccrc.gov.uk

Appeal: a charity and law practice that fights miscarriages of justice and demands reform

https://appeal.org.uk

Manchester Innocence Project: paving the way to freedom for victims of a miscarriage of justice

https://www.manchester.ac.uk/discover/magazine/features/manchester-innocence-project/

https://www.socialsciences.manchester.ac.uk/connect/making-a-difference/justice-hub/manchester-innocence-project/

The Innocence Project London: aims to undertake thorough and objective investigations into alleged wrongful convictions of individuals who maintain their innocence and have exhausted the criminal appeals process

https://blogs.gre.ac.uk/innocence-project-london/

Innocence Project London is a member of the Innocence Network. Find out more about us at https://IPLondon.org

Cardiff University Innocence Project - conducts casework, research, and advocacy on the topic of miscarriages of justice and is the only university Innocence Project in the UK to have helped overturn cases at the Court of Appeal

https://www.cardiff.ac.uk/pro-bono/cardiff-university-innocence-project

Inside Justice - an award winning charity that conducts casework investigations on behalf of people who claim they’ve been wrongly convicted

https://www.insidejustice.co.uk

The Justice Gap - A magazine about law and justice and the difference between the two

https://www.thejusticegap.com

Centre for Justice Innovation (seeks to build a justice system which everyone believes is fair and effective)

https://justiceinnovation.org/aboutcji

Miscarriages of Justice Review Centre, University of Sheffield - provides Sheffield law students with a unique opportunity to investigate cases of people convicted of serious crimes who are maintaining their innocence

https://www.sheffield.ac.uk/law/undergraduate/probono/miscarriages-justice-review-centre

Miscarriages of Justice Awareness Society

https://www.facebook.com/groups/MOJASUoS/

Miscarriages of Justice Registry, Exeter University (an interdisciplinary research group specialising in behavioural and data science research, and applying this research to the legal system and in legal arguments)

https://evidencebasedjustice.exeter.ac.uk/miscarriages-of-justice-registry/

The British False Memory Society (formed in 1993 to deal with issues relating to false memory)

https://bfms.org.uk

bfms@bfms.org.uk

Justice - A law reform and human rights charity, working to reform the UK justice system with a focus on the most vulnerable and marginalised in society

https://justice.org.uk

Innocence Network UK (INUK) - Educating to overturn and prevent the wrongful conviction of innocent people (no longer operating but some useful info)

http://www.innocencenetwork.org.uk

Innocence Project London School of Law University of Greenwich Old Royal Naval College, Greenwich London SE10 9LS Tel 020 8331 9461 https://www.iplondon.org/ Email: Louise.Hewitt@greenwich.ac.uk Retired Supreme court judges contact info: https://www.supremecourt.uk/about/former-justices.html The Supreme Court For general enquiries, please contact us at: The Supreme Court Parliament Square London SW1P 3BD Switchboard: 020 7960 1500 or 1900 DX 157230 Parliament Sq 4 Text Relay: Callers with a text phone can talk through Text Relay by calling 18001 followed by our main numbers 0207 960 1900 or 0207 960 1500. Email for general public enquiries only. We recommend that you check our 'Frequently Asked Questions' page before emailing us with queries - we have worked hard to ensure the list is as comprehensive as possible. Instant & free solicitor answers legal questions:

Links to influential people:

Your MP

https://members.parliament.uk/FindYourMP https://www.scienceontrial.com/forum/letter-writing/my-letter-to-my-mp

Max Hill KC, Director of Public Prosecutions:

https://www.iap-association.org/getattachment/IAP-General-Meeting-Forum/26th-General-Meeting/Max-Hill-QC-biography.pdf.aspx?lang=en-US

The Rt Hon Victoria Prentis KC MP, Attorney General

https://www.gov.uk/government/ministers/attorney-general

Michael Tomlinson KC, Solicitor General

https://www.gov.uk/government/news/michael-tomlinson-reappointed-as-solicitor-general

The Rt Hon Alex Chalk KC MP, Lord Chancellor and Secretary of State for Justice

https://www.gov.uk/government/people/alex-chalk

The Rt Hon Suella Braverman KC MP, Secretary of State for the Home Department

https://www.gov.uk/government/ministers/secretary-of-state-for-the-home-department

The Rt Hon Steve Barclay MP, Secretary of State for Health and Social Care

https://www.gov.uk/government/people/stephen-barclay

Jon Robins, The Justice Gap

jon@thejusticegap.com

Toby Young, British social commentator

https://www.spectator.co.uk/writer/toby-young/

Jesse Norman MP (MP for Hereford and South Herefordshire, Lucy's home constituency)

https://www.jesse4hereford.com

Chris Mullin ex MP - miscarriage of justice campaigner

https://www.chrismullinexmp.com/speeches/miscarriages-of-justice

Andrew Malkinson - wrongfully convicted and jailed in 2003 for the rape of a 33-year-old woman in Salford, Greater Manchester

https://en.wikipedia.org/wiki/Wrongful_conviction_of_Andrew_Malkinson

Michael O’Brien, miscarriages of justice campaigner (wrongly convicted together with two other men of the 1987 murder of Cardiff newsagent Phillip Saunders. They spent 11 years in prison before their convictions were quashed)

Liam Allan, miscarriages of justice campaigner (faced a lengthy prison sentence after police failed to disclose vital evidence proving a false rape allegation)

Eddie Gilfoyle, miscarriages of justice campaigner (spent 18 years in prison for the murder of his wife)

The family of Ben Geen, a former nurse who was convicted of murdering two patients and causing grievous bodily harm to 15 others

Annie Brodie-Akers, co-founder of Centre for Justice Innovation

Phil Bowen, Director, Centre for Justice Innovation (Phil Bowen leads the organisation, setting and overseeing the implementation of its overarching strategy. Prior to being Director, Phil spent the majority of his career in the British civil service, working for the Home Office, Ministry of Justice, and as a delivery adviser to the Prime Minister on criminal justice reform.)

pbowen@justiceinnovation.org

07816 967361

Twitter: @PhillipBowen45

Suzanne Smith, Senior Innovative Practice Officer, Centre for Justice Innovation (Suzanne leads the Centre's practice work on women in justice and court reform, including procedural fairness and criminal problem-solving courts.)

ssmith@justiceinnovation.org

Stephen Whitehead, Head of Evidence and Data, Centre for Justice Innovation (As head of Evidence and Data, Stephen leads our research team, ensuring that our work is rigorous and provides insights that can have a real impact on the criminal justice system.)

swhitehead@justiceinnovation.org

Michael Naughton

Michael's PhD thesis was on the routine nature of miscarriages of justice as evidenced by successful appeals against criminal conviction and the extensive forms of harm that are caused by such miscarriages of justice to victims, their families and society as a whole from a zemiological perspective.

http://michaeljnaughton.com/?page_id=15

Dr Louise Hewitt, Associate Professor in Law, National Teaching Fellow 2021

Director Innocence Project London, Director IICE Undergraduate Research Hub, Faculty of Liberal Arts and Sciences, School of Law and Criminology, University of Greenwich

"Talk to me about: law of evidence, wrongful convictions, innocence projects, undergraduate research and disability hate crime"

Email: Louise.hewitt@greenwich.ac.uk

T: 0208 8331 9461 (Direct)

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The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

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<![CDATA[The Maleficent Seven]]>https://www.chimpinvestor.com/post/the-maleficent-seven650b15e3da01881ff32400f3Mon, 25 Sep 2023 18:14:45 GMTPeter ElstonIf you enjoy reading this blog, please leave a star rating on WealthTender. Thank you!

In the 1960 movie The Magnificent Seven, Cajun gunslinger Chris Adams (played by Yul Brynner) and his six fellow gunmen were good guys, hired to protect a small village in Mexico from a group of marauding bandits. The seven prosecution medical experts in Lucy's trial were not "good guys". They were The Maleficient Seven.

maleficent [ muh-lef-uh-suhnt ] adjective

doing evil or harm; harmfully malicious: maleficent destroyers of reputations

https://www.dictionary.com/browse/maleficent

If you would like to post comments and replies about this post, please do so on the Forum by clicking here (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

It has been suggested that 'incompetent counsel' should be grounds for Lucy's appeal - many have wondered why the defence did not do a better job of rebutting the arguably flawed testimony of the seven prosecution medical experts (see www.rexvlucyletby2023.com) or allowed Lucy during police questioning to be asked if she thought someone had poisoned one of the babies with insulin (she was not qualified to answer that so the solicitor should have immediately nipped that in the bud but didn't).

It also seems that another grounds might be the judge's decision during the trial to rule as a Contempt of Court the www.rexvlucyletby2023.com site which robustly set out the science that supported non-malevolent interpretations of the exhibits (X-rays, blood tests) and professional witness testimony (strange rashes, collapses etc). Statistician and miscarriage campaigner Richard Gill, who had published links to the website, received a warning letter on 7 July from Cheshire Constabulary, as detailed on his own website (see https://gill1109.com/2023/09/20/contempt-of-court/ ). A second letter he received on 17 July noted that Cheshire Police had also heard from the author of the www.rexvlucyletby2023.com so it seems they were also contacted.

My question would be, how did Judge Goss determine that the www.rexvlucyletby2023.com site was a Contempt of Court? He is not a scientist, so would have had to consult those qualified to determine whether or not it represented robust science (it certainly looked like it did) and therefore whether it was a Contempt of Court and thus inadmissible. The only experts on hand qualified to judge the science in relation to the X-rays (a radiologist and a pathologist) and the blood tests (a haematologist, an endocrinologist, and a biochemist,) were the prosecution experts (the defence expert was a neonatologist). Did he consult experts elsewhere? If he did, who were they and on what basis did they discount the science? If it was the prosecution experts he consulted (the radiologist, the haematologist, the the pathologist, the endocrinologist, and the biochemist) that is a clear conflict of interest. And if the judge did not consult any experts, that seems to be a dereliction of duty. We shall see.

According to https://www.gov.uk/contempt-of-court ,

‘Contempt of court’ happens when someone risks unfairly influencing a court case. It may stop somebody from getting a fair trial and can affect a trial’s outcome.

Contempt of court includes:

  • disobeying or ignoring a court order
  • taking photos or shouting out in court
  • refusing to answer the court’s questions if you’re called as a witness
  • publicly commenting on a court case, for example on social media or online news articles

It seems clear that the judge can only have considered the rexv website to be a Contempt of Court of the basis of it having publicly commented on the case. Below is what the gov.uk website has to say on that.

Publicly commenting on a court case

You might be in contempt of court if you speak publicly or post on social media.

For example, you should not:

  • say whether you think a person is guilty or innocent
  • refer to someone’s previous convictions
  • name someone the judge has allowed to be anonymous, even if you did not know this
  • name victims, witnesses and offenders under 18
  • name sex crime victims
  • share any evidence or facts about a case that the judge has said cannot be made public

The rexv website did none of the above.

As for the 5 July letter received by Richard Gill, I am wondering how the rexv website could have been a "flagrant and serious contempt of court" if none of the above applied. Also, the hearing involved the judge, the defence and the defendant, not the prosecution. Might it have been possible that the defence thought the rexv site was a threat to Lucy and thus argued to the judge that it was a Contempt of Court? In which case the judge could simply have agreed. If the defence wanted the rexv site to be admitted as evidence, surely that would have involved the prosecution. Or, more likely, it was the defence that received the information about the rexv site, they showed it to the judge who immediately deemed it a Contempt of Court and thus inadmissible, and this would not have required the involvement of the prosecution.

In relation to 'incompetent counsel', putting aside the fact that it is not listed as one of the three specific grounds of appeal in https://www.judiciary.uk/wp-content/uploads/2021/07/Blue-guide-July-2021-Final-1.pdf (see A5 below) and that reference to complaint about conduct of trial representatives is only noted in relation to fresh legal representatives (see A4 below), might it be possible that it was not so much the defence counsel that was incompetent but the defence team's medical expert, neonatologist Michael Hall? And even then, incompetence may only have played a minor role.

During pretrial discussions between the two teams of experts (at which the lawyers would not have been present) Michael Hall would have been faced with the bank of seven prosecution experts, many of whose testimony he would not have been qualified to rebut. The seven prosecution experts comprised two paediatricians, an endocrinologist, a biochemist, a haematologist, a radiologist, and a pathologist. Michael Hall, a neonatologist, would not have been qualified to rebut anything other than the testimony of the two paediatricians. The issue may thus have been a lack of funding to pay for more defence experts, rather than the incompetence of the one expert the defence team could afford. And clearly legal aid would have been insufficient to engage the required experts.

A4. Applications by fresh legal representatives (CPD IX 39C)

A4-1. (ii) If these queries result in privileged information being included within, or as an attachment, to the grounds of appeal (including but not limited to, explicit or implied complaints about the conduct of trial representatives), then a signed waiver of privilege must also be lodged with the grounds of appeal.

A5. Specific grounds of appeal

A5-1. Applications to call fresh evidence

A5-2. Insufficient weight given to assistance to prosecution authorities

A5-3. Applications based on a change in law

Per Experts and pretenders - examining possible responses to misconduct by experts in criminal trials in england (2020) Freer, in relation to when to call an expert, "the only general requirement is that the expert’s evidence is on matters likely outside of jurors’ knowledge". In other words, if the only expert testimony the jurors in Lucy's case heard was from the prosecution side saying that crimes had been committed, probably by Lucy, and that since the testimony was on matters beyond their understanding so they had no choice but to accept it, is it really any wonder that they found Lucy guilty? Perhaps the surprise is that they only found Lucy guilty in relation to 14 of the 22 counts.

Now, in relation to A5-1 above, I understand that new expert testimony that debunks original expert testimony can be deemed fresh evidence and thus grounds for appeal. Might the appeal court judge argue that such experts were available at the time of trial? I'm not enough of an expert to know the answer to that. I do know that the Court of Appeal sets the bar very high. I also know there is precedent in relation to appeals being granted on the basis of new expert testimony.

For example:

Wrongly imprisoned (in 2003 for four murders and three attempted murders of patients under her care) Dutch nurse Lucia de Berk was eventually exonerated (according to statistician Richard Gill who campaigned for her innocence) because the original expert toxicologist, faced with the correct interpretation of the data by a second toxicologist, withdrew their incorrect testimony (they blamed the the public prosecutor and the Court for withholding critical information from them).

As for the UK, in 1997, Anthony O'Doherty was convicted of murder but later cleared by the Court of Appeal (https://www.belfasttelegraph.co.uk/news/ex-supergrass-is-cleared-of-attack/28081422.html). His case and exoneration are described in Court Scrutiny of Expert Evidence (2003):

O’Doherty was convicted in 1997 of aggravated burglary and causing grievous bodily harm with intent, based in part on expert testimony that it was highly probable that his voice was the voice heard on the tape of a 999 call made at the time of the burglary. The expert in question, Mrs. McClelland, used only auditory techniques (essentially, careful listening and comparisons of specific sounds and words) in making her comparisons between the voice of the defendant and the voice on the tape, despite the fact that the vast majority of experts in the field place greater reliance on acoustic techniques (that is, techniques involving spectral and other quantitative analysis by machines of the respective sources). This was the same fact pattern as Robb, in which the Court of Appeal for England and Wales held that the witness was permitted to offer similar testimony. The other evidence against the defendant included the testimony of a policeman familiar with his voice that the voice on the tape was his, the jury’s own comparison of the voice on the tape with that of the defendant, and a series of calls on the victim’s mobile phone to the defendant’s house shortly after the burglary.

Following a referral of the case by the Criminal Cases Review Commission, the Court of Appeal for Northern Ireland, in a judgment by Nicolson, LJ, granted the defendant’s application for the reception of fresh evidence, consisting of testimony from three defence experts and two prosecution experts. The defence experts attacked the technique of relying solely on auditory evidence in voice identification, and also presented their own acoustic analysis which they asserted established that the voice on the tape was not that of the defendant. Although Mrs. McClelland largely supported her trial testimony, the other prosecution expert, Dr. French, could assert no more than that it was “rather more likely than not” that the voice on the tape was that of the defendant, and largely agreed with the defence experts that carrying out both auditory and acoustic analysis was “best practice.” Indeed, Mrs. McClelland herself, despite expressing scepticism about acoustic analysis, now regularly performs such analysis.

Back to witnesses...

There are three types of witness: members of the public, professionals, and experts.

The first two of these witness types attest to their memory of events ("I saw him at the bus stop", "he was wearing a green jacket", "I saw a strange rash", "I was called to repair a sewerage leak") though professionals can also provide opinion ("I believed the strange rash meant...").

The third type of witness, the expert, provides their opinion about facts (a blood test or an X-ray) within their area of expertise or about evidence (the testimony of a doctor acting as a professional witness saying they saw a strange rash). Generally speaking, facts are objective (blood tests/X-rays) while evidence, although pertaining to facts (a strange rash) can be subjective ("I saw a strange rash", "I did not see a strange rash").

In Lucy's case, there were two types of witnesses: professional and expert (although the plumber was not a medic, as were almost all the other "non-expert" witnesses, he was still a professional).

The professional witnesses were mostly doctors and nurses who attested to things like who was where, what they saw, what was happening to the babies, etc (the doctors also opined as to their interpretation of what they saw in relation to the babies - the strange rashes, sudden collapses, etc.)

The seven prosecution medical experts (two paediatricians, an endocrinologist, a biochemist, a haematologist, a radiologist, and a pathologist) provided their interpretation (opinion) of the facts/evidence that was relevant to them and their area of expertise (the radiologist would have considered the X-rays, the endocrinologist, the haematologist and the biochemist would have considered the blood tests, the paediatricians would have considered the doctors' testimony about the strange rashes and sudden collapses, etc).

According to the Crown Prosecution Service:

"Medical evidence" means the evidence of medically qualified persons, including psychiatrists, which is admissible to furnish the court with information outside the knowledge of a judge, bench or jury. Evidence given by a suitably qualified doctor that simply reports the injuries sustained by a victim to an assault is not evidence of opinion and is rarely likely to be disputed...Prosecutors need to be aware that where a doctor expresses a view as to the cause or likely cause of an injury, this is opinion and is subject to CrimPR19, unless an admission can be obtained from the Defence, or the medical evidence is not otherwise disputed (https://www.cps.gov.uk/legal-guidance/expert-evidence).

CrimPR19 refers to Part 19 of https://www.legislation.gov.uk/uksi/2020/759/pdfs/uksi_20200759_en.pdf, "Expert Evidence".

In relation to expert witnesses, according to Wikipedia (underlining mine):

In England and Wales, under the Civil Procedure Rules (CPR), an expert witness is required to be independent and address his or her expert report to the court. A witness may be jointly instructed by both sides if the parties agree to this, especially in cases where the liability is relatively small. Under the CPR, expert witnesses may be instructed to produce a joint statement detailing points of agreement and disagreement to assist the court or tribunal. The meeting is held quite independently of instructing lawyers, and often assists in resolution of a case, especially if the experts review and modify their opinions. When this happens, substantial trial costs can be saved when the parties to a dispute agree to a settlement. In most systems, the trial (or the procedure) can be suspended in order to allow the experts to study the case and produce their results. More frequently, meetings of experts occur before trial. Experts charge a professional fee which is paid by the party commissioning the report (both parties for joint instructions) although the report is addressed to the court. The fee must not be contingent on the outcome of the case. Expert witnesses may be subpoenaed (issued with a witness summons), although this is normally a formality to avoid court date clashes.[26] From: https://en.wikipedia.org/wiki/Expert_witness

According to Court Scrutiny of Expert Evidence (2003):

Although English law imposes some limits on the subject matters of expert evidence, it has traditionally imposed very few limits on the methodology or reliability of expert testimony. This position stands in marked contrast to the law of the United States, where this issue has been prominent both in the case law and in scholarly commentary, and where court scrutiny of expert testimony is more exacting.

Experts and pretenders - examining possible responses to misconduct by experts in criminal trials in england (2020) Freer has this to say about "rogue experts":

Therefore a more desirable solution would be to uncover rogue experts before they get as far as giving evidence. To achieve this I would suggest a peer-review college, where acknowledged academic and practitioner experts in the relevant area were used to peer-review the work of the expert whom a party hoped to instruct. Once that individual had been peer-reviewed that process would not need to be carried out again unless the expert asked for it, on the basis that they had assimilated further or different knowledge since their previous assessment. Any assessment could set out the topics on which an expert would be suitably experienced and knowledgeable about to give advice and/or evidence, on the basis of peer review of their published work and practical experience.

Two other interesting papers about expert evidence are Explaining and trusting expert evidence - what is a sufficiently reliable scientific basis (2020) Ward and Scientific disciplines and the admissibility of expert evidence in courts (2022) O'Brien et al.

The paper Variability in the analysis of a single neuroimaging dataset by many teams also describes how experts' interpretations of the same data can vary, something Lucy's defence may be faced with if it gets a chance to rebut the prosecution's experts' testimony.

In Lucy's trial, it seemed that little weight was given to the original postmortems that found no evidence of harm (why the consultants did not alert the pathologist to their suspicions about Lucy when they fist had them in late June/early July 2015 is another question entirely).

Below are all the references in the Chester Standard reports of the trial to the key individuals relating to pathologists, namely the coroner Nicholas Rheinberg, the original pathologist George Kokai, and the prosecution's expert pathologist Andreas Marnerides.

What I think comes across clearly is how little mention there was at trial of Rheinberg and Kokai, and how the prosecution's expert pathologist Marnerides disputed everything in the original postmortems.

Title: Mr

First name: Nicholas

Last name: Rheinberg

Gender: M

Group: Legal

Subgroup: Crown

Role/job: Coroner

Employer/association: HM Coroners, Cheshire

Recording a verdict of misadventure, coroner Nicholas Rheinberg told the inquest in Chester in February 2015: ‘There were very considerable signs [the tube was incorrectly positioned] and I find it surprising these signs were not realised.’ https://www.dailymail.co.uk/news/article-4518212/Baby-deaths-Countess-Chester-Hospital-probed.html

Letby also managed to slip through the gaps in the coronial system. Hospital managers asked the Cheshire coroner, Dr Nicholas Rheinberg, to investigate the seven baby deaths in February 2017. The coroner declined, according to sources, telling the trust he was not a “quality-assurance service” for the NHS. Rheinberg retired that year. https://www.thetimes.co.uk/article/damning-email-told-of-chaos-on-lucy-letby-ward-kd9s28k5f

Title: Dr

First name: George

Last name: Kokai

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Pathologist

Employer/association: Alder Hey

Child C

Mr Myers says, for the case of Child C, he looks at the post-mortem evidence of whether there was a gastrointestinal blockage. He refers to the agreed evidence by the pathologist, Dr Kokai, who conducted the post-mortem examination, who recorded a 'distended colon' for Child C, which was not normal. He says Dr Marnerides refused to accept this evidence, who said the bowel was 'normal'. https://www.chesterstandard.co.uk/news/23615797.recap-lucy-letby-trial-june-27---defence-closing-speech/

Dr George Kokai carried out a post-mortem examination for Child C. He noted a distended colon, which Dr Marnerides said was "not an abnormality". He said the potential complication was a twisted colon that would lead to "obvious" symptoms of pain. There was evidence of "acute pneumonia". Dr Marnerides said one could die of pneumonia or with penumonia. He said the former was plausible, but upon hearing further clinical evidence, he reviewed his opinion. He said babies dying of penumonia experience gradual deterioration, which was not the case here. He said he revisited the cause of death, viewing images of a distended stomach, and no evidence of NEC. Prof Arthurs said the small bowel was dilated. Dr Marnerides observed a dilated stomach and bowel, and noted Child C had been off CPAP for over 12 hours. No air had been obtained from aspirates before the collapse. He had never known CPAP belly being the cause of an arrest in a baby in his years of experience. He said, in his opinion, the cause of Child C's collapse was of excessive air administered into the stomach via the naso-gastric tube. https://www.chesterstandard.co.uk/news/23628455.recap-lucy-letby-trial-july-3---judges-summing/

Child I

Dr George Kokai carried out a post-mortem examination of Child I. Dr Andreas Marnerides was dependent on the report. Dr Marnerides said Child I did not have NEC. He was "very sceptical" that Child I died of natural causes. He said the collapses were more likely to be excessive air administered to the stomach, via the NGT. The defence say a similar event happened for Child I on August 23, a day when Letby was not on duty. https://www.chesterstandard.co.uk/news/23634101.recap-lucy-letby-trial-july-5---judges-summing/

Child O

Dr George Kokai carried out a post-mortem examination [of Child O]. Dr Andreas Marnerides reviewed, and said injuries to the liver were the result of impact trauma. He said during treatment, small bruises could be caused to the surface of the liver, and would not be extensive. He says the liver is not in an area where CPR is applied. He has only seen this kind of injury to the liver before in children, not babies, from accidents involving bicycles. He did not think CPR could produce this extensive injury to the liver, and has never heard of this sort being accepted as such. He also found internal gastric distention, and concluded there had been an air embolus. Prof Arthurs also referred to radiograph images, taken post-mortem. He said the gases were an 'unusual finding'. https://www.chesterstandard.co.uk/news/23636819.recap-lucy-letby-trial-july-6---judges-summing/

Title: Dr

First name: Andreas

Last name: Marnerides

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Patholigist (paediatric)

Employer/association: Guy's and St Thomas' NHS Foundation Trust (https://www.guysandstthomas.nhs.uk/our-consultants/andreas-marnerides)

General reference

He [Myers] says of Dr Andreas Marnerides, a pathologist, "is not a clinician, is not a paediatrician or a neonatologist", which "puts some limits [on his expertise]". He says his expertise is on what happens following a death, not in life. He says Dr Marnerides is "reliant" on the evidence of others, something which he agreed. He says he made a lot of reference to Dr Dewi Evans, and it is "too late in the day" to "insinuate" it is someone else. https://www.chesterstandard.co.uk/news/23613176.recap-lucy-letby-trial-june-26---defence-closing-speech/

Child A

[A Original pathology: The case was referred to the coroner and the cause of Child A's death was 'unascertained' at the time.]

Dr Marnerides said it appeared Child A, a twin boy, died as a result of an injection of air into his bloodstream. https://www.chesterstandard.co.uk/news/23422288.lucy-letby-baby-suffered-liver-injury-akin-road-traffic-collision/

The judge refers to expert witness Dr Andreas Marnerides' evidence. His expertise, the court is told, is on the pathology of conditions on those who had died. He said there was "no evidence of infection" or "any other abnormalities". He said he could see, from his study, "empty structures" of fat or air in Child A - after testing, he ruled out the former. He said he could see evidence of air in the brain when the baby was alive. The findings "could not be taken as absolute proof of air embolus". He said there was "no evidence of any natural cause of death", or any of natural disease. He took the view that Child A's death was of air embolus via injection. https://www.chesterstandard.co.uk/news/23628455.recap-lucy-letby-trial-july-3---judges-summing/

Child C

[C Original pathology: The cause of death was ‘widespread hypoxic/ischaemic damage to the heart/myocardium’ due to lung disease, with maternal vascular under perfusion as a contributory factor.]

The note recorded bile on a blanket and black-stained fluid for Child C. He says nurse Yvonne Griffiths hasn't signed for a 9am reading on June 12, and something was entered for noon and not signed. He says bile on a blanket and black fluid is recorded in the nursing note at 6.30pm, but is not noted on the fluid chart.He says a radiograph was taken at 12.36pm. Dr Evans, Dr Bohin and Dr Andreas Marnerides had all regarded the image as a 'suspicious event' of harm. He says Letby was not on duty. Dr Anne Boothroyd recorded 'marked gaseous distention of the stomach'.Mr Myers says the jury should take this as "proof" the experts can "get it wrong".He says if this event happened when Letby was on duty, Letby would be accused of causing it.....He refers to the agreed evidence by the pathologist, Dr Kokai, who conducted the post-mortem examination, who recorded a 'distended colon' for Child C, which was not normal. He says Dr Marnerides refused to accept this evidence, who said the bowel was 'normal'. https://www.chesterstandard.co.uk/news/23615797.recap-lucy-letby-trial-june-27---defence-closing-speech/

Child C, a boy, was subjected to an excessive infusion/injection of air into his nasogastric tube, he [,Dr Marnerides,] said. https://www.chesterstandard.co.uk/news/23422288.lucy-letby-baby-suffered-liver-injury-akin-road-traffic-collision/

Mr Johnson says the jury know, as a fact, from Dr Andreas Marnerides, that Child C did not have a problem with his gut, as there was no sign of infection or sepsis. There was no evidence of Child C having had an obstruction in his bowel....Dr Marnerides said there was "nothing unusual" about Child C's bowel. He concluded Child C died "with pneumonia not from pneumonia" and the gas in the bowel could not be explained by infection or an abonormality in the bowel. He said "air must have been injected into the nasogastric tube", splinting the diaphragm, which would have compromised Child C's breathing and killed him. He added: "I have never in the past 10 years, come across even a suggestion that 'CPAP belly' would lead to the deterioration of a baby, let alone this gastric distention that would lead to [a baby's death]." https://www.chesterstandard.co.uk/news/23603440.recap-lucy-letby-trial-june-21--prosecution-closing-speech/

Dr George Kokai carried out a post-mortem examination for Child C. He noted a distended colon, which Dr Marnerides said was "not an abnormality". He said the potential complication was a twisted colon that would lead to "obvious" symptoms of pain. There was evidence of "acute pneumonia". Dr Marnerides said one could die of pneumonia or with penumonia. He said the former was plausible, but upon hearing further clinical evidence, he reviewed his opinion. He said babies dying of penumonia experience gradual deterioration, which was not the case here. He said he revisited the cause of death, viewing images of a distended stomach, and no evidence of NEC. Prof Arthurs said the small bowel was dilated. Dr Marnerides observed a dilated stomach and bowel, and noted Child C had been off CPAP for over 12 hours. No air had been obtained from aspirates before the collapse. He had never known CPAP belly being the cause of an arrest in a baby in his years of experience. He said, in his opinion, the cause of Child C's collapse was of excessive air administered into the stomach via the naso-gastric tube. https://www.chesterstandard.co.uk/news/23628455.recap-lucy-letby-trial-july-3---judges-summing/

The judge refers to the case of Child C. He says medical experts found it difficult to conclude the cause of death, but Dr Marnerides said it was air administered into his stomach via the naso-gastric tube. Letby said she did nothing harmful to Child C, and a cause such as a gastrointestinal blockage cannot be excluded, that Child C should have been treated at a tertiary unit, and there was a failure to react to bile aspirates, vomiting, and an overall lack of care. https://www.chesterstandard.co.uk/news/23628455.recap-lucy-letby-trial-july-3---judges-summing/

Child D

[D Original pathology: The coroner gave the cause of death as "pneumonia with acute lung injury."]

The “likely explanation” for the death of Child D, a girl, was an air embolism into her circulation. [Dr Marnerides] https://www.chesterstandard.co.uk/news/23422288.lucy-letby-baby-suffered-liver-injury-akin-road-traffic-collision/

Another medical expert, Dr Marnerides, had ruled out sepsis, and concluded Child D was killed by an air embolus.  https://www.chesterstandard.co.uk/news/23603440.recap-lucy-letby-trial-june-21--prosecution-closing-speech/

Mr Myers refers to the pathologist's report for Child D, recording damaged lungs, "continuing respiratory problems". Presence of infection is "not ruled out" following negative microbiology tests, as Child D had been on antibiotics. Mr Myers said despite that, Dr Marnerides "preferred" air embolus as a conclusion. He said he had taken into account clinicians' views of how well Child D was doing. Mr Myers says Child D was not doing well on respiration. https://www.chesterstandard.co.uk/news/23615797.recap-lucy-letby-trial-june-27---defence-closing-speech/

Dr Andreas Marnerides said pneumonia was likely to be present at birth for Child D. Professor Arthurs talked of a 'black line' in front of the spine indicating gas in the great vessels, which was "unusual" in children who had died without an explanation. It was present in "two other children", one of whom was Child A. There was "more air" in Child D than Child A. One explanation was someone was injecting air into the child, and the radiograph images were consistent with, but not diagnostic of, externally administered air to Child D. Dr Marnerides said the presence of air in such a vessel was "significant". He said from a pathology point of view, air embolus could not be proved. He said there was "no other natural disease" that could explain Child D's death. He said in his opinion, Child D died with, not from, pneumonia. He concluded the 'likely explanation' was air embolus. https://www.chesterstandard.co.uk/news/23631372.recap-lucy-letby-trial-july-4---judges-summing/

Child E

[No postmortem]

He [Dr Marnerides] told the court he could no offer no opinion on the death of Child E, a twin boy, because no post-mortem examination took place. https://www.chesterstandard.co.uk/news/23422288.lucy-letby-baby-suffered-liver-injury-akin-road-traffic-collision/

Child I

[I Original pathology: The cause of death was given by the coroner as Hypoxic ischaemic damage of brain and chronic lung due to prematurity and 1b. Extreme prematurity.]

Another girl, Child I, received an excessive injection of air into her stomach, he [Dr Marnerides] said. https://www.chesterstandard.co.uk/news/23422288.lucy-letby-baby-suffered-liver-injury-akin-road-traffic-collision/

Dr Marnerides said at the time of Child I's death, she had no acute illnesses or abnormalities in the bowel, other than presence of air. The presence of gas had "no pathological cause". He said the collapses were air administered from the NG Tube. https://www.chesterstandard.co.uk/news/23606159.recap-lucy-letby-trial-june-22--prosecution-closing-speech/

Dr Marnerides said Child I did not have NEC. He was "very sceptical" that Child I died of natural causes. He said the collapses were more likely to be excessive air administered to the stomach, via the NGT.  https://www.chesterstandard.co.uk/news/23634101.recap-lucy-letby-trial-july-5---judges-summing/

Child O

[O Original pathology: A post-mortem examination found free un-clotted blood in the peritoneal (abdominal)space from a liver injury. There was damage in multiple locations on and in the liver. The blood was found in the peritoneal cavity. He certified death on the basis of natural causes and intra-abdominal bleeding. He observed that the cause of this bleeding could have been asphyxia, trauma or vigorous resuscitation.]

Dr Andreas Marnerides, the reviewing pathologist, thought that the liver injuries were most likely the result of impact type trauma and not the result of CPR….He certified the cause of death to be “Inflicted traumatic injury to the liver and profound gastric and intestinal distension following acute excessive injection or infusion of air via a naso-gastric tube” and air embolus. https://www.chesterstandard.co.uk/news/23035356.recap-prosecution-opens-trial-lucy-letby-accused-countess-chester-hospital-baby-murders/

Paediatric pathology expert Dr Andreas Marnerides had told jurors he concluded Child O died because of “inflicted traumatic injury” to the liver, as well as receiving fatal injections of air into the stomach and bloodstream....“I have never seen this type of injury in the context of CPR so I would say the force required would be of the magnitude of that generated by a baby jumping on a trampoline and falling.” He agreed that smaller internal bruising to the liver sustained by Child O’s triplet brother Child P – who Letby is alleged to have murdered the next day – could be capable of being caused by CPR. But asked if “rigorous” chest compressions could be the cause of the internal bruising in Child O’s case, Dr Marnerides said: “I don’t think so, no." “This is a huge area of bruising for a liver of this size. This is not something you see in CPR.” Mr Myers said: “So you don’t accept the proposition that forceful CPR could cause this injury in general terms, do you agree it cannot be categorically excluded as a possibility?” Dr Marnerides replied: “We are not discussing possibilities here, we are discussing probabilities. “When you refer to possibilities, I am thinking for example of somebody walking in the middle of the Sahara desert found dead with a pot and head trauma. “It is possible the pot fell from the air from a helicopter. The question is ‘is it probable?’ and I don’t think we can say it is probable.” Mr Myers asked: “Is it possible in your opinion for at least some of what we see in the damage to the liver arising from the insertion of a cannula?” The consultant said: “I would consider it extremely unlikely. I would expect some kind of perforation injury.” https://www.chesterstandard.co.uk/news/23424649.letby-trial-forceful-cpr-not-cause-babys-liver-damage/

Jurors were shown post-mortem examination photographs which showed two separate sites of bruising, as well as areas of a blood clot. Prosecutor Nick Johnson KC asked the consultant: “How does that injury come to be in a child of (Child O’s) age?”...Mr Johnson said: “Looking at this sequence of photographs, can you rule out the possibility that these injuries were caused by CPR?” Dr Marnerides said: “I cannot convince myself that in the setting of a neonatal unit this would be a reasonable proposition to explain this. I don’t think CPR can produce this extensive injury to a liver.”....Dr Marnerides said: “In my view, the cause of death was inflicted traumatic injury to the liver, profound gastric and intestinal distension following acute excessive injection/infusion of air via a naso-gastric tube and air embolism due to administration into a venous line.” https://www.chesterstandard.co.uk/news/23422288.lucy-letby-baby-suffered-liver-injury-akin-road-traffic-collision/

During Child O's resuscitation in his final collapse, a doctor had said efforts were made to decompress Child O's abdomen. In cross-examination it had been suggested this was the cause of the liver injury. Dr Brearey and Dr Marnerides had rejected this, Mr Johnson tells the court. https://www.chesterstandard.co.uk/news/23600333.recap-lucy-letby-trial-june-20--prosecution-closing-speech/

Dr George Kokai carried out a post-mortem examination. Dr Andreas Marnerides reviewed, and said injuries to the liver were the result of impact trauma. He said during treatment, small bruises could be caused to the surface of the liver, and would not be extensive. He says the liver is not in an area where CPR is applied. He has only seen this kind of injury to the liver before in children, not babies, from accidents involving bicycles. He did not think CPR could produce this extensive injury to the liver, and has never heard of this sort being accepted as such. He also found internal gastric distention, and concluded there had been an air embolus. https://www.chesterstandard.co.uk/news/23636819.recap-lucy-letby-trial-july-6---judges-summing/

Earlier, Dr Marnerides said the most likely explanation for the death of Child P was excessive air injected via a nasogastric tube into his stomach. https://www.chesterstandard.co.uk/news/23424649.letby-trial-forceful-cpr-not-cause-babys-liver-damage/

Child P

[P Original pathology: A post-mortem examination had the coroner concluding Child P died from Sudden Unexpected Postnatal Collapse but he was unable to identify the underlying cause. He certified the cause of death as “prematurity”.]

Dr Marnerides said he had no evidence to indicate a natural disease that would account for Child P's death. He thought small haematomas to the liver were potentially the result of CPR, or as a result of prematurity, and did not have enough to say it was an impact injury. He said there was no clinical evidence for a natural cause. He said having considered other accounts, he concluded there was gastric distention caused by excessive air injected into the stomach. https://www.chesterstandard.co.uk/news/23636819.recap-lucy-letby-trial-july-6---judges-summing/

If you would like to post comments and replies about this post, please do so on the Forum by clicking here (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

© Chimp Investor Ltd

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<![CDATA[Independent Experts? Yeah Right.]]>https://www.chimpinvestor.com/post/independent-experts-yeah-right6509c406260af323b10aea08Tue, 19 Sep 2023 16:22:56 GMTPeter ElstonIf you enjoy reading this blog, please leave a star rating on WealthTender. Thank you!

The notion that the prosecution's experts in Lucy's case were independent as they were legally obliged to be is laughable

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The prosecution in Lucy's case engaged seven medical specialists to provide expert (opinion based) testimony. Of the seven listed at the bottom of this post, it appears that only Evans and Bohin advertised their commercial expert witness services in the public domain. This however does not mean that the other five were not registered somewhere as willing to provide expert witness testimony, just that they registered this interest privately with an expert witness company that acted as their agent.

If you tell one of these companies/agents that you want a paediatric radiologist, they will then contact the paediatric radiologists on their books. For example, this document (https://www.judiciary.uk/wp-content/uploads/2022/03/Newsletter-Spring-2022.pdf) lists Dr Owen Arthurs (the prosecution's expert radiologist in Lucy's case) as being contactable on ExpertsLondon@ejudiciary.net even though you will not find him listed on https://www.ewi.org.uk/directory (referred to at the bottom of the document) or anywhere else. And here he is talking about being an expert witness: https://www.youtube.com/watch?v=Qvl1ZqoZqsc.

Also, the notion that the prosecution's experts were independent is laughable. If an expert does not support the prosecution's case of guilt they will not get selected. And if they are not selected they will not get paid. This is, frankly, the mother of all conflicts of interest. This issue is particularly heinous in in Dewi Evans' case since it was he who touted for the work, as jurors heard on 6 March:

From: https://www.chesterstandard.co.uk/news/23370074.medic-denies-touting-job-helping-lucy-letby-police-probe/:

On Tuesday, March 6, jurors were read an email sent by Dr Evans to the National Crime Agency (NCA) in May 2017, ahead of his involvement with Cheshire Police. In his message to “Nick” at the NCA’s national injuries database, Dr Evans wrote: “Incidentally I’ve read about the high rate of babies in Chester and that the police are investigating. “Do they have a paediatric/neonatal contact? I was involved in neonatal medicine for 30 years including leading the intensive care set-up in Swansea. I’ve also prepared numerous neonatal cases where clinical negligence was alleged. “If the Chester police had no-one in mind I’d be interested to help. Sounds like my kind of case. “I understand that the Royal College (of Paediatrics and Child Health) has been involved but from my experience the police are far better at investigating this sort of problem.”

Fieldfisher sets out the role of the expert witness and the test of an expert's independence in https://www.fieldfisher.com/en/insights/expert-witnesses-the-independence-factor:

As an expert’s role is to assist the court, independence is key. Experts must be ‘uninfluenced by the pressures of litigation’ (CPR Practice Direction (PD) 35 (2.1)), and are duty-bound to provide ‘objective, unbiased opinions on matters within their expertise’ to resolve the proceedings, not assuming the role of an advocate. An expert’s duty to the court ‘overrides any obligation to the person from whom experts have received instructions or by whom they are paid’ (CPR 35.3 (2)). A useful test of ‘independence’ is that the expert would form and provide the same opinion had the instructions been provided by the opposing party in the proceedings.

(For those who wish to know more, the rules on expert witnesses in the courts of England and Wales are governed by Civil Procedure Rules (CPR) r.35. See https://www.justice.gov.uk/courts/procedure-rules/civil/rules/part35).

As if touting for work was not bad enough, it was Evans himself who in December 2017 determined that crimes had been committed which meant the case would go to court and he would get paid.

From : https://news.sky.com/story/how-the-police-caught-lucy-letby-12933640

The force began to examine the deaths of 17 babies and the non-fatal collapses of 16 more, some of whom have been left with life-changing injuries. Tens of thousands of medical files were prepared for a neonatologist - an expert in young infants - found via the National Crime Agency.Then in December 2017, their expert came back with his response. These deaths were not the result of natural causes. Operation Hummingbird had begun.

The more of the 33 events Cheshire Police was examining that Evans could deem murders/attempted murders, the longer the trial would take, the more testimony he would have to provide, and the more he would get paid. Unfortunately (for him) he could only deem eight of the deaths as murders and six of the collapses as attempted murders.

From: http://www.chesterstandard.co.uk/news/16332233.home-searched-after-baby-murder-arrest-belongs-to-chester-childrens-nurse/

Cheshire Police announced yesterday that an unnamed healthcare worker was being questioned in relation to the murder of eight babies and the attempted murder of a further six. It comes after police launched an investigation in May last year into the deaths of 17 babies and 15 non-fatal collapses at the Countess of Chester Hospital between March 2015 and July 2016.

Anyway, Dr E, you must have been furious that you couldn't deem 19 of the events as crimes. Still, 14 is not a bad day's work. You were still going to get paid a tidy sum.

By the way, Dr E, why did Sky News write that you were a neonatologist? Did you tell the police that's what you were? Also, it wrote "neonatologist" not "retired neonatologist". If you did not tell the police that you were a retired paediatrician which is what you were, that's naughty.

The list of shame:

Title: Dr

First name: Dewi

Last name: Evans

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Consultant paediatrician (rtd)

Employer/association: Dewi Evans Paediatric Consulting Ltd (no website - https://find-and-update.company-information.service.gov.uk/company/07341254)

Commercial expert site: https://www.expertwitness.co.uk/expert/5763c7f0ca2f3af2228b5f41

Title: Dr

First name: Sandie

Last name: Bohin

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Consultant paediatrician

Employer/association: The Medical Specialist Group LLP (https://www.msg.gg/clinical-team/consultants/dr-sandie-bohin/)

Commercial expert site: https://paediatricexpert.com

Title: Prof

First name: Peter

Last name: Hindmarsh

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Endocrinologist (paediatric)

Employer/association: University College London Hospital (https://www.uclh.nhs.uk/our-services/find-consultant/professor-peter-hindmarsh )

Title: Dr

First name: Anna

Last name: Milan

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Clinical biochemist

Employer/association: Royal Liverpool and Broadgreen University Hospital NHS Trust (http://pathlabs.rlbuht.nhs.uk/ccfram.htm)

Title: Prof

First name: Sally

Last name: Kinsey

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Haematologist (paediatric)

Employer/association: Leeds Teaching Hospitals NHS Trust (https://www.leedsth.nhs.uk/a-z-of-services/leeds-cancer-centre/services/childrens-and-adolescent-oncology-and-haematology/services/haematology/) and St. James University Hospital (https://severe-chronic-neutropenia.org/en/partners/uk)

Title: Prof

First name: Owen

Last name: Arthurs

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Radiologist (paediatric)

Employer/association: Great Ormond Street Hospital (https://www.gosh.nhs.uk/our-people/staff-z/owen-arthurs/)

Title: Dr

First name: Andreas

Last name: Marnerides

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Patholigist (paediatric)

Employer/association: Guy's and St Thomas' NHS Foundation Trust (https://www.guysandstthomas.nhs.uk/our-consultants/andreas-marnerides)

If you would like to post comments and replies about this post, please do so on the Forum by clicking here (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

© Chimp Investor Ltd

]]>
<![CDATA[Lucy Letby: The Cast List]]>https://www.chimpinvestor.com/post/lucy-letby-the-cast-list-165098b57ede85ab1fbe1f52cTue, 19 Sep 2023 11:57:05 GMTPeter ElstonIf you enjoy reading this blog, please leave a star rating on WealthTender. Thank you!

The cast list of people involved with Lucy's case as derived from every single Chester Standard report on the case and the trial

If you would like to post comments and replies about this post, please do so on the Forum by clicking here (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

I have spent rather a long time compiling this list from Chester Standard articles and others but I think it will prove very useful. What I will do next is start to add notes underneath each individual summarising the key aspects of their testimony (or, if they did not testify, the key aspects of their involvement in Lucy's case).

Detail from David and Goliath, a colour lithograph by Osmar Schindler (c. 1888)

Source: https://en.wikipedia.org/wiki/Goliath

There are over 100 individuals on the list. There may be others I should add. Please let me know if I have missed any out. Also, please let me know if there is something specific you think I should mention in relation to (a) specific individual(s). It should be something factual i.e. something that is from a credible source.

Judges

Title: Mr

First name: James

Last name: Goss

Gender: M

Group: Legal

Subgroup: Crown

Role/job: Judge

Employer/association: Manchester Crown Court

Title: Mr

First name: Ian

Last name: Dove

Gender: M

Group: Legal

Subgroup: Crown

Role/job: Judge

Employer/association: Liverpool Crown Court

Defence side

Title: Ms

First name: Lucy

Last name: Letby

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Defendant

Employer/association: CoCH

Title: Mr

First name: Benjamin

Last name: Myers

Gender: M

Group: Legal

Subgroup: Defence team

Role/job: Defence (barrister)

Employer/association: Exchange Chambers

Title: Mr

First name: Richard

Last name: Thomas

Gender: M

Group: Legal

Subgroup: Defence team

Role/job: Defence (solicitor)

Employer/association: Russell & Russell

Title: Mr

First name: Lorenzo

Last name: Mansutti

Gender: M

Group: Tradesman

Subgroup: Tradesman

Role/job: Plumber

Employer/association: CoCH

Title: Mr

First name: John

Last name: Letby

Gender: M

Group: Family and friends

Subgroup: Family and friends

Role/job: Father

Employer/association: Family and friends

Title: Ms

First name: Susan

Last name: Letby

Gender: F

Group: Family and friends

Subgroup: Family and friends

Role/job: Mother

Employer/association: Family and friends

Title: Mr

First name: Charles

Last name: Letby

Gender: M

Group: Family and friends

Subgroup: Family and friends

Role/job: Uncle (John Letby's brother)

Employer/association: Family and friends

Title: Ms

First name: Janet

Last name: Cox

Gender: F

Group: Family and friends

Subgroup: Family and friends

Role/job: Lucy's friend

Employer/association: Family and friends

Title: Ms

First name: Dawn

Gender: F

Group: Family and friends

Subgroup: Family and friends

Role/job: Lucy's childhood friend (very bravely and helpfully did BBC interview expressing, in absence of a true confession by Lucy, 100% belief in her innocence)

Employer/association: Family and friends

Title: Dr

First name: Michael

Last name: Hall

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Expert (neonatologist)

Employer/association: Expert (neonatologist)

Note: Dr Hall was never called to testify by the defence. Why was this? Was it because his opinion (no crimes were committed) differed so much from that of the prosecution's experts (22 crimes had been committed) that he was unable to present it?

Title: Dr

First name: Marie

Last name: Oldfield

Gender: F

Group: Scientist

Subgroup: Doctor

Role/job: AI and Ethics Expert

Employer/association: Expert (statistics/risk)

Note: My belief is that Dr Oldfield was engaged by the defence to analyse/counter the evidence presented by prosecution witness Claire Hocknell who was engaged by Cheshire Police as an intelligence analyst but I have been unable to confirm this.

Individuals who do not appear to have been believed by the prosecution side

Title: Mr

First name: Nicholas

Last name: Rheinberg

Gender: M

Group: Legal

Subgroup: Crown

Role/job: Coroner

Employer/association: HM Coroners, Cheshire

Recording a verdict of misadventure, coroner Nicholas Rheinberg told the inquest in Chester in February 2015: ‘There were very considerable signs [the tube was incorrectly positioned] and I find it surprising these signs were not realised.’ https://www.dailymail.co.uk/news/article-4518212/Baby-deaths-Countess-Chester-Hospital-probed.html

Letby also managed to slip through the gaps in the coronial system. Hospital managers asked the Cheshire coroner, Dr Nicholas Rheinberg, to investigate the seven baby deaths in February 2017. The coroner declined, according to sources, telling the trust he was not a “quality-assurance service” for the NHS. Rheinberg retired that year. https://www.thetimes.co.uk/article/damning-email-told-of-chaos-on-lucy-letby-ward-kd9s28k5f

Title: Dr

First name: George

Last name: Kokai

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Pathologist

Employer/association: Alder Hey

Mr Myers says, for the case of Child C, he looks at the post-mortem evidence of whether there was a gastrointestinal blockage. He refers to the agreed evidence by the pathologist, Dr Kokai, who conducted the post-mortem examination, who recorded a 'distended colon' for Child C, which was not normal. He says Dr Marnerides refused to accept this evidence, who said the bowel was 'normal'. https://www.chesterstandard.co.uk/news/23615797.recap-lucy-letby-trial-june-27---defence-closing-speech/

Dr George Kokai carried out a post-mortem examination for Child C. He noted a distended colon, which Dr Marnerides said was "not an abnormality". He said the potential complication was a twisted colon that would lead to "obvious" symptoms of pain. There was evidence of "acute pneumonia". Dr Marnerides said one could die of pneumonia or with penumonia. He said the former was plausible, but upon hearing further clinical evidence, he reviewed his opinion. He said babies dying of penumonia experience gradual deterioration, which was not the case here. He said he revisited the cause of death, viewing images of a distended stomach, and no evidence of NEC. Prof Arthurs said the small bowel was dilated. Dr Marnerides observed a dilated stomach and bowel, and noted Child C had been off CPAP for over 12 hours. No air had been obtained from aspirates before the collapse. He had never known CPAP belly being the cause of an arrest in a baby in his years of experience. He said, in his opinion, the cause of Child C's collapse was of excessive air administered into the stomach via the naso-gastric tube. https://www.chesterstandard.co.uk/news/23628455.recap-lucy-letby-trial-july-3---judges-summing/

Dr George Kokai carried out a post-mortem examination of Child I. Dr Andreas Marnerides was dependent on the report. Dr Marnerides said Child I did not have NEC. He was "very sceptical" that Child I died of natural causes. He said the collapses were more likely to be excessive air administered to the stomach, via the NGT. The defence say a similar event happened for Child I on August 23, a day when Letby was not on duty. https://www.chesterstandard.co.uk/news/23634101.recap-lucy-letby-trial-july-5---judges-summing/

Dr George Kokai carried out a post-mortem examination [of Child O]. Dr Andreas Marnerides reviewed, and said injuries to the liver were the result of impact trauma. He said during treatment, small bruises could be caused to the surface of the liver, and would not be extensive. He says the liver is not in an area where CPR is applied. He has only seen this kind of injury to the liver before in children, not babies, from accidents involving bicycles. He did not think CPR could produce this extensive injury to the liver, and has never heard of this sort being accepted as such. He also found internal gastric distention, and concluded there had been an air embolus. Prof Arthurs also referred to radiograph images, taken post-mortem. He said the gases were an 'unusual finding'.  https://www.chesterstandard.co.uk/news/23636819.recap-lucy-letby-trial-july-6---judges-summing/

Title: Dr

First name: Francis

Last name: Potter

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Consultant anaesthetist

Employer/association: Alder Hey

A registrar doctor, who cannot be identified for legal reasons, told Manchester Crown Court on Monday, March 6, how he was asked to review Child N from about 7.30am on June 15….Giving evidence on Monday, the doctor said: “I saw blood at the back of the throat … that prevented me from seeing where the entry to his airway was.”. He said he also noticed “a degree of swelling”. Prosecutor Simon Driver asked: “ What did you notice first?” The doctor replied: “I think I will have seen the blood first because that is such an unusual thing to see at the time of intubation.” He said he could not see where the blood was coming from or what had caused the swelling....Another doctor told the court he too could not intubate Child N following a further sudden deterioration in the afternoon, after 3ml of blood was withdrawn from his nasogastric tube. Dr Huw Mayberry said: “I could see the vocal cords but I was unable to get a very clear view because there was substantial swelling within the airway. “The swelling was unlike anything I had encountered previously. It looked quite large and reddy-pink in colour.”...Dr Gibbs said the “serious life-threatening deterioration” only improved after a consultant anaesthetist [Dr Potter], called from Liverpool’s Alder Hey Children’s Hospital, managed to intubate at his first attempt. He told the court he “couldn’t understand” why two consultants, two registrars and two anaesthetists had failed previously to intubate Child N throughout the day, but said the adrenaline may have helped reduce the swelling....Alder Hey anaesthetist Dr Francis Potter told jurors that he did not see blood or swelling in Child N’s throat when he successfully inserted the breathing tube. Following his transfer to Alder Hey, Dr Potter said Child N’s stay was “fairly uneventful”, although there were episodes of “apnoea” in which he would temporarily stop breathing. Dr Potter said apnoea could simply be a sign a child was unwell or it could have a more specific reason. https://www.chesterstandard.co.uk/news/23366941.lucy-letby-unusual-presence-blood-throat-baby/

Alder Hey consultant anaesthetist Dr Francis Potter was asked to give evidence. Mr Myers said he had told the court his interest was paediatric intensive care, and he had experience with airway problem resolution. He said the intubation was managed with 'relative ease'. He said Dr Potter had been "surprised" there had been difficulties in intubating Child N as he said the Countess of Chester Hospital team was "pretty competent". He says Dr Bohin "comes to the rescue [of the prosecution]" by not agreeing with the opinion of Dr Potter. He said Dr Bohin said the drugs given to Child N would have reduced the swelling. He said it was a disagreement between the two prosecution witnesses. https://www.chesterstandard.co.uk/news/23621368.recap-lucy-letby-trial-june-29---defence-closing-speech/

Title: Mr

First name: Tony

Last name: Chambers

Gender: M

Group: Exec

Subgroup: Director

Role/job: Chief Executive

Employer/association: CoCH

Title: Ms

First name: Alison

Last name: Kelly

Gender: F

Group: Exec

Subgroup: Director

Role/job: Director of nursing/Deputy chief executive

Employer/association: CoCH

Title: Mr

First name: Stephen

Last name: Cross

Gender: M

Group: Exec

Subgroup: Director

Role/job: Director, Corporate affairs & legal services

Employer/association: CoCH

Prosecution side

Title: Mr

First name: Nick

Last name: Johnson

Gender: M

Group: Legal

Subgroup: Crown

Role/job: Prosecutor

Employer/association: Number 7 Harrington Street Chambers

Title: Mr

First name: Simon

Last name: Driver

Gender: M

Group: Legal

Subgroup: Crown

Role/job: Prosecutor

Employer/association: Number 7 Harrington Street Chambers

Title: Mr

First name: Philip

Last name: Astbury

Gender: M

Group: Legal

Subgroup: Crown

Role/job: Prosecutor

Employer/association: St Johns Buildings

Prosecution's "independent" expert witnesses

The prosecution in Lucy's case engaged seven medical specialists to provide expert (opinion based) testimony. For further discussion, see my latest post, https://www.chimpinvestor.com/post/independent-experts-yeah-right.

Title: Dr

First name: Dewi

Last name: Evans

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Consultant paediatrician (rtd)

Employer/association: Dewi Evans Paediatric Consulting Ltd (no website - https://find-and-update.company-information.service.gov.uk/company/07341254)

Commercial expert site: https://www.expertwitness.co.uk/expert/5763c7f0ca2f3af2228b5f41

Title: Dr

First name: Sandie

Last name: Bohin

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Consultant paediatrician

Employer/association: The Medical Specialist Group LLP (https://www.msg.gg/clinical-team/consultants/dr-sandie-bohin/)

Commercial expert site: https://paediatricexpert.com

Title: Prof

First name: Peter

Last name: Hindmarsh

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Endocrinologist (paediatric)

Employer/association: University College London Hospital (https://www.uclh.nhs.uk/our-services/find-consultant/professor-peter-hindmarsh )

Title: Dr

First name: Anna

Last name: Milan

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Clinical biochemist

Employer/association: Royal Liverpool and Broadgreen University Hospital NHS Trust (http://pathlabs.rlbuht.nhs.uk/ccfram.htm)

Title: Prof

First name: Sally

Last name: Kinsey

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Haematologist (paediatric)

Employer/association: Leeds Teaching Hospitals NHS Trust (https://www.leedsth.nhs.uk/a-z-of-services/leeds-cancer-centre/services/childrens-and-adolescent-oncology-and-haematology/services/haematology/) and St. James University Hospital (https://severe-chronic-neutropenia.org/en/partners/uk)

Title: Prof

First name: Owen

Last name: Arthurs

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Radiologist (paediatric)

Employer/association: Great Ormond Street Hospital (https://www.gosh.nhs.uk/our-people/staff-z/owen-arthurs/)

Title: Dr

First name: Andreas

Last name: Marnerides

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Patholigist (paediatric)

Employer/association: Guy's and St Thomas' NHS Foundation Trust (https://www.guysandstthomas.nhs.uk/our-consultants/andreas-marnerides)

General reference

He [Myers] says of Dr Andreas Marnerides, a pathologist, "is not a clinician, is not a paediatrician or a neonatologist", which "puts some limits [on his expertise]". He says his expertise is on what happens following a death, not in life. He says Dr Marnerides is "reliant" on the evidence of others, something which he agreed. He says he made a lot of reference to Dr Dewi Evans, and it is "too late in the day" to "insinuate" it is someone else. https://www.chesterstandard.co.uk/news/23613176.recap-lucy-letby-trial-june-26---defence-closing-speech/

Child A

Dr Marnerides said it appeared Child A, a twin boy, died as a result of an injection of air into his bloodstream. https://www.chesterstandard.co.uk/news/23422288.lucy-letby-baby-suffered-liver-injury-akin-road-traffic-collision/

The judge refers to expert witness Dr Andreas Marnerides' evidence. His expertise, the court is told, is on the pathology of conditions on those who had died. He said there was "no evidence of infection" or "any other abnormalities". He said he could see, from his study, "empty structures" of fat or air in Child A - after testing, he ruled out the former. He said he could see evidence of air in the brain when the baby was alive. The findings "could not be taken as absolute proof of air embolus". He said there was "no evidence of any natural cause of death", or any of natural disease. He took the view that Child A's death was of air embolus via injection. https://www.chesterstandard.co.uk/news/23628455.recap-lucy-letby-trial-july-3---judges-summing/

Child C

The note recorded bile on a blanket and black-stained fluid for Child C. He says nurse Yvonne Griffiths hasn't signed for a 9am reading on June 12, and something was entered for noon and not signed. He says bile on a blanket and black fluid is recorded in the nursing note at 6.30pm, but is not noted on the fluid chart.He says a radiograph was taken at 12.36pm. Dr Evans, Dr Bohin and Dr Andreas Marnerides had all regarded the image as a 'suspicious event' of harm. He says Letby was not on duty. Dr Anne Boothroyd recorded 'marked gaseous distention of the stomach'.Mr Myers says the jury should take this as "proof" the experts can "get it wrong".He says if this event happened when Letby was on duty, Letby would be accused of causing it.....He refers to the agreed evidence by the pathologist, Dr Kokai, who conducted the post-mortem examination, who recorded a 'distended colon' for Child C, which was not normal. He says Dr Marnerides refused to accept this evidence, who said the bowel was 'normal'. https://www.chesterstandard.co.uk/news/23615797.recap-lucy-letby-trial-june-27---defence-closing-speech/

Child C, a boy, was subjected to an excessive infusion/injection of air into his nasogastric tube, he [,Dr Marnerides,] said. https://www.chesterstandard.co.uk/news/23422288.lucy-letby-baby-suffered-liver-injury-akin-road-traffic-collision/

Mr Johnson says the jury know, as a fact, from Dr Andreas Marnerides, that Child C did not have a problem with his gut, as there was no sign of infection or sepsis. There was no evidence of Child C having had an obstruction in his bowel....Dr Marnerides said there was "nothing unusual" about Child C's bowel. He concluded Child C died "with pneumonia not from pneumonia" and the gas in the bowel could not be explained by infection or an abonormality in the bowel. He said "air must have been injected into the nasogastric tube", splinting the diaphragm, which would have compromised Child C's breathing and killed him. He added: "I have never in the past 10 years, come across even a suggestion that 'CPAP belly' would lead to the deterioration of a baby, let alone this gastric distention that would lead to [a baby's death]." https://www.chesterstandard.co.uk/news/23603440.recap-lucy-letby-trial-june-21--prosecution-closing-speech/

Dr George Kokai carried out a post-mortem examination for Child C. He noted a distended colon, which Dr Marnerides said was "not an abnormality". He said the potential complication was a twisted colon that would lead to "obvious" symptoms of pain. There was evidence of "acute pneumonia". Dr Marnerides said one could die of pneumonia or with penumonia. He said the former was plausible, but upon hearing further clinical evidence, he reviewed his opinion. He said babies dying of penumonia experience gradual deterioration, which was not the case here. He said he revisited the cause of death, viewing images of a distended stomach, and no evidence of NEC. Prof Arthurs said the small bowel was dilated. Dr Marnerides observed a dilated stomach and bowel, and noted Child C had been off CPAP for over 12 hours. No air had been obtained from aspirates before the collapse. He had never known CPAP belly being the cause of an arrest in a baby in his years of experience. He said, in his opinion, the cause of Child C's collapse was of excessive air administered into the stomach via the naso-gastric tube. https://www.chesterstandard.co.uk/news/23628455.recap-lucy-letby-trial-july-3---judges-summing/

The judge refers to the case of Child C. He says medical experts found it difficult to conclude the cause of death, but Dr Marnerides said it was air administered into his stomach via the naso-gastric tube. Letby said she did nothing harmful to Child C, and a cause such as a gastrointestinal blockage cannot be excluded, that Child C should have been treated at a tertiary unit, and there was a failure to react to bile aspirates, vomiting, and an overall lack of care. https://www.chesterstandard.co.uk/news/23628455.recap-lucy-letby-trial-july-3---judges-summing/

Child D

The “likely explanation” for the death of Child D, a girl, was an air embolism into her circulation. [Dr Marnerides] https://www.chesterstandard.co.uk/news/23422288.lucy-letby-baby-suffered-liver-injury-akin-road-traffic-collision/

Another medical expert, Dr Marnerides, had ruled out sepsis, and concluded Child D was killed by an air embolus.  https://www.chesterstandard.co.uk/news/23603440.recap-lucy-letby-trial-june-21--prosecution-closing-speech/

Mr Myers refers to the pathologist's report for Child D, recording damaged lungs, "continuing respiratory problems". Presence of infection is "not ruled out" following negative microbiology tests, as Child D had been on antibiotics. Mr Myers said despite that, Dr Marnerides "preferred" air embolus as a conclusion. He said he had taken into account clinicians' views of how well Child D was doing. Mr Myers says Child D was not doing well on respiration. https://www.chesterstandard.co.uk/news/23615797.recap-lucy-letby-trial-june-27---defence-closing-speech/

Dr Andreas Marnerides said pneumonia was likely to be present at birth for Child D. Professor Arthurs talked of a 'black line' in front of the spine indicating gas in the great vessels, which was "unusual" in children who had died without an explanation. It was present in "two other children", one of whom was Child A. There was "more air" in Child D than Child A. One explanation was someone was injecting air into the child, and the radiograph images were consistent with, but not diagnostic of, externally administered air to Child D. Dr Marnerides said the presence of air in such a vessel was "significant". He said from a pathology point of view, air embolus could not be proved. He said there was "no other natural disease" that could explain Child D's death. He said in his opinion, Child D died with, not from, pneumonia. He concluded the 'likely explanation' was air embolus. https://www.chesterstandard.co.uk/news/23631372.recap-lucy-letby-trial-july-4---judges-summing/

Child E

He [Dr Marnerides] told the court he could no offer no opinion on the death of Child E, a twin boy, because no post-mortem examination took place. https://www.chesterstandard.co.uk/news/23422288.lucy-letby-baby-suffered-liver-injury-akin-road-traffic-collision/

Child I

Another girl, Child I, received an excessive injection of air into her stomach, he [Dr Marnerides] said. https://www.chesterstandard.co.uk/news/23422288.lucy-letby-baby-suffered-liver-injury-akin-road-traffic-collision/

Dr Marnerides said at the time of Child I's death, she had no acute illnesses or abnormalities in the bowel, other than presence of air. The presence of gas had "no pathological cause". He said the collapses were air administered from the NG Tube. https://www.chesterstandard.co.uk/news/23606159.recap-lucy-letby-trial-june-22--prosecution-closing-speech/

Dr Marnerides said Child I did not have NEC. He was "very sceptical" that Child I died of natural causes. He said the collapses were more likely to be excessive air administered to the stomach, via the NGT.  https://www.chesterstandard.co.uk/news/23634101.recap-lucy-letby-trial-july-5---judges-summing/

Child O

Dr Andreas Marnerides, the reviewing pathologist, thought that the liver injuries were most likely the result of impact type trauma and not the result of CPR….He certified the cause of death to be “Inflicted traumatic injury to the liver and profound gastric and intestinal distension following acute excessive injection or infusion of air via a naso-gastric tube” and air embolus. https://www.chesterstandard.co.uk/news/23035356.recap-prosecution-opens-trial-lucy-letby-accused-countess-chester-hospital-baby-murders/

Paediatric pathology expert Dr Andreas Marnerides had told jurors he concluded Child O died because of “inflicted traumatic injury” to the liver, as well as receiving fatal injections of air into the stomach and bloodstream....“I have never seen this type of injury in the context of CPR so I would say the force required would be of the magnitude of that generated by a baby jumping on a trampoline and falling.” He agreed that smaller internal bruising to the liver sustained by Child O’s triplet brother Child P – who Letby is alleged to have murdered the next day – could be capable of being caused by CPR. But asked if “rigorous” chest compressions could be the cause of the internal bruising in Child O’s case, Dr Marnerides said: “I don’t think so, no." “This is a huge area of bruising for a liver of this size. This is not something you see in CPR.” Mr Myers said: “So you don’t accept the proposition that forceful CPR could cause this injury in general terms, do you agree it cannot be categorically excluded as a possibility?” Dr Marnerides replied: “We are not discussing possibilities here, we are discussing probabilities. “When you refer to possibilities, I am thinking for example of somebody walking in the middle of the Sahara desert found dead with a pot and head trauma. “It is possible the pot fell from the air from a helicopter. The question is ‘is it probable?’ and I don’t think we can say it is probable.” Mr Myers asked: “Is it possible in your opinion for at least some of what we see in the damage to the liver arising from the insertion of a cannula?” The consultant said: “I would consider it extremely unlikely. I would expect some kind of perforation injury.” https://www.chesterstandard.co.uk/news/23424649.letby-trial-forceful-cpr-not-cause-babys-liver-damage/

Jurors were shown post-mortem examination photographs which showed two separate sites of bruising, as well as areas of a blood clot. Prosecutor Nick Johnson KC asked the consultant: “How does that injury come to be in a child of (Child O’s) age?”...Mr Johnson said: “Looking at this sequence of photographs, can you rule out the possibility that these injuries were caused by CPR?” Dr Marnerides said: “I cannot convince myself that in the setting of a neonatal unit this would be a reasonable proposition to explain this. I don’t think CPR can produce this extensive injury to a liver.”....Dr Marnerides said: “In my view, the cause of death was inflicted traumatic injury to the liver, profound gastric and intestinal distension following acute excessive injection/infusion of air via a naso-gastric tube and air embolism due to administration into a venous line.” https://www.chesterstandard.co.uk/news/23422288.lucy-letby-baby-suffered-liver-injury-akin-road-traffic-collision/

During Child O's resuscitation in his final collapse, a doctor had said efforts were made to decompress Child O's abdomen. In cross-examination it had been suggested this was the cause of the liver injury. Dr Brearey and Dr Marnerides had rejected this, Mr Johnson tells the court. https://www.chesterstandard.co.uk/news/23600333.recap-lucy-letby-trial-june-20--prosecution-closing-speech/

Dr George Kokai carried out a post-mortem examination. Dr Andreas Marnerides reviewed, and said injuries to the liver were the result of impact trauma. He said during treatment, small bruises could be caused to the surface of the liver, and would not be extensive. He says the liver is not in an area where CPR is applied. He has only seen this kind of injury to the liver before in children, not babies, from accidents involving bicycles. He did not think CPR could produce this extensive injury to the liver, and has never heard of this sort being accepted as such. He also found internal gastric distention, and concluded there had been an air embolus. https://www.chesterstandard.co.uk/news/23636819.recap-lucy-letby-trial-july-6---judges-summing/

Earlier, Dr Marnerides said the most likely explanation for the death of Child P was excessive air injected via a nasogastric tube into his stomach. https://www.chesterstandard.co.uk/news/23424649.letby-trial-forceful-cpr-not-cause-babys-liver-damage/

Child P

Dr Marnerides said he had no evidence to indicate a natural disease that would account for Child P's death. He thought small haematomas to the liver were potentially the result of CPR, or as a result of prematurity, and did not have enough to say it was an impact injury. He said there was no clinical evidence for a natural cause. He said having considered other accounts, he concluded there was gastric distention caused by excessive air injected into the stomach. https://www.chesterstandard.co.uk/news/23636819.recap-lucy-letby-trial-july-6---judges-summing/

CoCH's medical directors

Title: Dr

First name: Ian

Last name: Harvey

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Medical Director

Employer/association: CoCH

Title: Dr

First name: Nigel

Last name: Scawn

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Executive medical director

Employer/association: CoCH

CoCH's consultant paediatricians

Title: Dr

First name: Stephen

Last name: Brearey

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Consultant paediatrician

Employer/association: CoCH

Title: Dr

First name: John

Last name: Gibbs

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Consultant paediatrician

Employer/association: CoCH

Title: Dr

First name: Ravi

Last name: Jayaram

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Consultant paediatrician

Employer/association: CoCH

Title: Dr (cannot be named for legal reasons)

First name:

Last name: B

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Consultant paediatrician

Employer/association: CoCH

Title: Dr

First name: Satyanarayana

Last name: Saladi

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Consultant paediatrician

Employer/association: CoCH

Title: Dr

First name: Sudeshna

Last name: Bhowmik

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Consultant paediatrician

Employer/association: CoCH

Title: Dr

First name: Elizabeth

Last name: Newby

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Consultant paediatrician

Employer/association: CoCH

CoCH's radiologists

Title: Dr

First name: Amer

Last name: Rehman

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Consultant radiologist

Employer/association: CoCH

Title: Dr

First name: Ann

Last name: Boothroyd

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Radiologist (paediatric)

Employer/association: CoCH

Title: Dr

First name: Stavros

Last name: Stivaros

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Radiologist (paediatric neuroradiologist)

Employer/association: CoCH

CoCH's paediatric registrars

Title: Dr (cannot be named for legal reasons)

First name:

Last name: A

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Registrar

Employer/association: CoCH

Title: Dr

First name: Gail

Last name: Beech

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Registrar

Employer/association: CoCH

Title: Dr

First name: Andrew

Last name: Brunton

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Registrar (specialist trainee)

Employer/association: CoCH

Title: Dr

First name: Rachel

Last name: Chang

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Registrar (paediatric)

Employer/association: CoCH

Title: Dr

First name: Katarzyna

Last name: Cooke

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Registrar

Employer/association: CoCH

Title: Dr

First name: Katherine

Last name: Davis

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Registrar (paediatric)

Employer/association: CoCH

Title: Dr

First name: Peter

Last name: Fielding

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Registrar (paediatric)

Employer/association: CoCH

Title: Dr

First name: Jonathan

Last name: Ford

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Registrar

Employer/association: CoCH

Title: Dr

First name: David

Last name: Harkness

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Registrar

Employer/association: CoCH

Title: Dr

First name: Rachel

Last name: Lambie

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Registrar

Employer/association: CoCH

Title: Dr

First name: Jennifer

Last name: Loughnane

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Registrar

Employer/association: CoCH

Title: Dr

First name: Huw

Last name: Mayberry

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Registrar (paediatric)

Employer/association: CoCH

Title: Dr

First name: Matthew

Last name: Neame

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Registrar

Employer/association: CoCH

Title: Dr

First name: Sally

Last name: Ogden

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Registrar (paediatric)

Employer/association: CoCH

Title: Dr

First name: Sarah

Last name: Rylance

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Registrar

Employer/association: CoCH

Title: Dr

First name: James

Last name: Smith

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Registrar (specialist)

Employer/association: CoCH

Title: Dr

First name: Anthony

Last name: Ukoh

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Registrar

Employer/association: CoCH

Title: Dr

First name: Alison

Last name: Ventress

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Registrar

Employer/association: CoCH

CoCH's junior doctors

Title: Dr

First name: Lucy

Last name: Beebe

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Junior doctor

Employer/association: CoCH

Title: Dr

First name: Jessica

Last name: Burke

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Junior doctor

Employer/association: CoCH

Title: Dr

First name: Emily

Last name: Thomas

Gender: F

Group: Medical

Subgroup: Doctor

Role/job: Junior doctor

Employer/association: CoCH

Title: Dr

First name: Christopher

Last name: Wood

Gender: M

Group: Medical

Subgroup: Doctor

Role/job: Junior doctor

Employer/association: CoCH

Other medical/scientific

Title: Mr

First name: Ian

Last name: Allen

Gender: M

Group: Medical

Subgroup: Pharmacist

Role/job: Pharmacist

Employer/association: CoCH

Title: Dr

First name: Gwen

Last name: Wark

Gender: F

Group: Medical

Subgroup: Biochemist

Role/job: Director

Employer/association: Guildford RSCH Peptide Hormone Laboratory

Senior nursing staff

Title: Ms

First name: Karen

Last name: Rees

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nursing chief

Employer/association: CoCH

Title: Ms

First name: Karen

Last name: Townsend

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nursing chief

Employer/association: CoCH

Title: Ms

First name: Eirian

Last name: Lloyd Powell

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Neonatal Unit Manager

Employer/association: CoCH

Title: Ms

First name: Susan

Last name: Brooks

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Midwife

Employer/association: CoCH

Nurses

An undetermined number of nurses who were granted anonymity in order to secure their appearance and testimony at trial

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Caroline

Last name: Bennion

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Kate

Last name: Bissell

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Vicky

Last name: Blamire

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Mr

First name: Christopher

Last name: Booth

Gender: M

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Bernadette

Last name: Butterworth

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Amy

Last name: Davies

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Nicola

Last name: Dennison

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Tanya

Last name: Downes

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Laura

Last name: Eagles

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Sophie

Last name: Ellis

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Mary

Last name: Griffiths

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Yvonne

Last name: Griffiths

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Ashleigh

Last name: Hudson

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Tracey

Last name: Jones

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Jennifer

Last name: Jones-Key

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Minna

Last name: Lappalainen

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Elizabeth

Last name: Marshall

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Elizabeth

Last name: Morgan

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Rebecca

Last name: Morgan

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Samantha

Last name: O'Brien

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Caroline

Last name: Oakley

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Kathryn

Last name: Percival-Ward/Percival-Calderbank

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Belinda

Last name: Simcock

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Melanie

Last name: Taylor

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Valerie

Last name: Thomas

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Shelley

Last name: Tomlins

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Lisa

Last name: Walker

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Joanne

Last name: Williams

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Title: Ms

First name: Belinda

Last name: Williamson

Gender: F

Group: Medical

Subgroup: Nurse

Role/job: Nurse

Employer/association: CoCH

Police

Title: Mr

First name: David

Last name: Keane

Gender: M

Group: Legal

Subgroup: Police

Role/job: Police and crime commissioner, Cheshire

Employer/association: Cheshire Police

Title: Mr

First name: Nigel

Last name: Wenham

Gender: M

Group: Legal

Subgroup: Police

Role/job: DCS

Employer/association: Cheshire Police

Title: Mr

First name: Paul

Last name: Hughes

Gender: M

Group: Legal

Subgroup: Police

Role/job: DS

Employer/association: Cheshire Police

Title: Ms

First name: Lucy

Last name: Kennedy

Gender: F

Group: Legal

Subgroup: Police

Role/job: DS

Employer/association: Cheshire Police

Title: Ms

First name: Nicola

Last name: Evans

Gender: F

Group: Legal

Subgroup: Police

Role/job: DCI

Employer/association: Cheshire Police

Title: Ms

First name: Claire

Last name: Hocknell

Gender: F

Group: Legal

Subgroup: Police

Role/job: Intelligence analyst

Employer/association: Cheshire Police

Title: Mr

First name: Darren

Last name: Riley

Gender: M

Group: Legal

Subgroup: Police

Role/job: Civilain Investigator

Employer/association: Cheshire Police

Other CoCH executive

Title: Dr

First name: Susan

Last name: Gilby

Gender: F

Group: Exec

Subgroup: Exec

Role/job: Chief Executive (2018 - 2022)

Employer/association: CoCH

If you would like to post comments and replies about this post, please do so on the Forum by clicking here (opens in new window so this blog post page stays open for you to view). The Forum is visible only to members which makes it preferable to the Blog for members’ conversations.

The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

© Chimp Investor Ltd

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<![CDATA[Great News! The Court of Appeal has confirmed that an appeal was lodged by Lucy’s team today]]>https://www.chimpinvestor.com/post/great-news-the-court-of-appeal-has-confirmed-that-an-appeal-was-lodged-by-letby-s-team-today65047b882a86b5e6941f65f5Fri, 15 Sep 2023 15:44:59 GMTPeter ElstonSee:

https://twitter.com/PaulBrandITV/status/1702707099354939527

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<![CDATA[Things the UK is Good At #1: Banging Up Innocent People]]>https://www.chimpinvestor.com/post/other-miscarriages-and-suspected-miscarriages-in-the-uk650168d8e3f91ff899e243bbWed, 13 Sep 2023 08:09:30 GMTPeter ElstonIf you enjoy reading this blog, please leave a star rating on WealthTender. Thank you!

Background on a selection of the hundreds of wrongful convictions in the UK over the years

In Wix there are two types of posts: Blog posts and Forum posts (this is a Blog post). I will disable comments on Blog posts, but you can still post comments and replies to comments on a specially created post in the Forum (moreover, comments and replies in Forum posts are only visible to members). To post comments and join the conversation about this post or Lucy's case in general, please click here to go to the Forum (opens in new window so this blog post page stays open for you to view).

Firstly, if you are someone who was or is wrongly convicted (or a family member thereof) and your case is not mentioned in this blog post, I apologise. It would have been impossible to write about all the hundreds of wrongful convictions (and I may not know about all cases of suspected wrongful conviction). If you would like your case to be included in this post please email me on peter@chimpinvestor.com.

This blog post is more for reference than it is an article (I will be writing a proper article soon about miscarriages and what the future path for Lucy might be based on other cases). However, if you read through the cases you should get a sense of how big a problem wrongful conviction is and has been in this country. You might also get a sense that although we are good at banging people up who are innocent, we do (eventually) exonerate many or perhaps even most of them. This latter process however it seems could do with improving (many/most is not good enough) and speeding up, and obviously there are poor practices that lead to people being wrongfully accused or convicted in the first place.

One fabulous resource I came across is The Miscarriages of Justice Registry at the University of Exeter. The registry is "an interdisciplinary research group specialising in behavioural and data science research, and applying this research to the legal system and in legal arguments." It contains details of over 300 people who have been acquitted following successful appeals and can be found here: https://evidencebasedjustice.exeter.ac.uk/miscarriages-of-justice-registry/the-cases/case-search/.

In addition to the database, it has many other great resources. The four "issues wikis" below are particularly interesting.

Issue Wiki: False confession

https://evidencebasedjustice.exeter.ac.uk/miscarriages-of-justice-registry/the-issues/false-confession/

Issue Wiki: Witness evidence

https://evidencebasedjustice.exeter.ac.uk/miscarriages-of-justice-registry/the-issues/eyewitness-id/

Issue Wiki: Disclosure

https://evidencebasedjustice.exeter.ac.uk/miscarriages-of-justice-registry/the-issues/misconduct-disclosure/

Issue Wiki: Forensic evidence

https://evidencebasedjustice.exeter.ac.uk/miscarriages-of-justice-registry/the-issues/forensic-evidence/

Actual wrongful convictions/accusations (notable)

Sally Clark

"Clark was convicted in November 1999. The convictions were upheld on appeal in October 2000, but overturned in a second appeal in January 2003, after it emerged that Alan Williams, the prosecution forensic pathologist who examined both babies, had failed to disclose microbiological reports that suggested the second of her sons had died of natural causes." (from https://en.wikipedia.org/wiki/Sally_Clark)

Also: https://www.manchestereveningnews.co.uk/news/greater-manchester-news/sally-clark-child-death-case-1111844

Donna Anthony

"Following the overturning of Angela Cannings's conviction, twenty-eight cases, including that of Donna Anthony, were referred to the Criminal Cases Review Commission (CCRC), and Anthony was freed in April 2005." (from https://en.wikipedia.org/wiki/Donna_Anthony)

Also: http://news.bbc.co.uk/1/hi/england/somerset/4431851.stm

Victor Nealon

"The wrongful imprisonment of Victor Nealon occurred in 1996 when the British postman Victor Nealon was mistakenly convicted of attempted rape. He was released in 2013 after spending 17 years in jail, 10 years more than his recommended tariff, because he continued to protest his innocence." (from https://en.wikipedia.org/wiki/Victor_Nealon)

Siôn Jenkins

"Billie-Jo Margaret Jenkins (29 March 1983 – 15 February 1997) was an English girl who was murdered in Hastings, East Sussex in February 1997. The case gained widespread media attention and remains unsolved. Her foster father, Siôn Jenkins, was originally convicted for the crime, but after two retrials in which the jury was unable to reach a verdict he was formally acquitted. He has been denied compensation on the grounds that there is no evidence to prove his innocence." (from https://en.wikipedia.org/wiki/Murder_of_Billie-Jo_Jenkins)

Angela Cannings

"Angela Cannings was wrongfully convicted and sentenced to life imprisonment in the UK in 2002 for the murder of her seven-week-old son, Jason, who died in 1991, and of her 18-week-old son Matthew, who died in 1999. Her first child, Gemma, died of Sudden Infant Death Syndrome (SIDS) in 1989 at the age of 13 weeks, although she was never charged in connection with Gemma's death. Her conviction was based on claims that she had smothered the children, but was overturned as unsafe by the Court of Appeal on 10 December 2003. Cannings was convicted after the involvement in her case of Professor Sir Roy Meadow, a paediatrician who was later struck off, then reinstated, by the General Medical Council." (from https://en.wikipedia.org/wiki/Angela_Cannings)

John Corcoran

"A few days after Gorrie's murder, unemployed 21-year-old John Anthony Mark Corcoran of Warren Park, Havant, was questioned about the murder....Corcoran, of Plumley Walk in Havant, was tried and found guilty of Gorrie's murder in December 1999....In January 2003, Corcoran had his conviction for the murder overturned on appeal. The grounds were that the judge had misdirected the jury in his summing up." (from https://en.wikipedia.org/wiki/Murder_of_Helen_Gorrie)

An unknown or unpublished number of sub-postmasters

"The British Post Office scandal is a miscarriage of justice involving the wrongful civil and criminal prosecutions of an unknown or unpublished number of sub-postmasters (SPMs) for theft, false accounting and/or fraud. The cases constitute the most widespread miscarriage of justice in British legal history, spanning a period of over twenty years; aspects of the scandal remain unresolved." (from https://en.wikipedia.org/wiki/British_Post_Office_scandal)

Barry George

"Barry Michael George (born 15 April 1960) is an Englishman who was found guilty of the murder of English television presenter Jill Dando and whose conviction was overturned on appeal." (from https://en.wikipedia.org/wiki/Barry_George)

Sam Hallam

"Sam Hallam (born 1987), from Hoxton, London, is one of the youngest victims of a UK miscarriage of justice after an appeal court quashed his murder conviction in 2012." (from https://en.wikipedia.org/wiki/Sam_Hallam)

Ched Evans

"R v Evans and McDonald was the prosecution of two footballers, Ched Evans and Clayton McDonald, who were accused of the rape of a woman. On 20 April 2012, Evans was convicted and sentenced to five years imprisonment. McDonald was acquitted. Several people were later fined after naming the woman on Twitter and other social media websites." (from https://en.wikipedia.org/wiki/R_v_Evans_and_McDonald)

Also: https://www.bbc.co.uk/news/uk-wales-36099522

Andrew Malkinson

"Andrew Malkinson (born 23 January 1966) is a British man who was wrongfully convicted and jailed in 2003 for the rape of a 33-year-old woman in Salford, Greater Manchester...Malkinson made another application to the CCRC in 2021, and, in 2022, a man was arrested in connection with the original crime. The CCRC referred the case for appeal, and the conviction was quashed by the Court of Appeal in July 2023, using evidence from the 2007 re-testing of samples, which identified a man who had subsequently been placed in the National DNA Database." (from https://en.wikipedia.org/wiki/Wrongful_conviction_of_Andrew_Malkinson)

Barri White and Keith Hyatt

"Barri White and Keith Hyatt were jailed in 2002 [for the murder of Rachel Manning] and had their convictions quashed in 2007." (from https://www.bbc.co.uk/news/uk-england-beds-bucks-herts-24284921)

John Kamara

"John Kamara was convicted of the brutal 1981 murder of betting shop manager John Suffield, who was tied to a chair and stabbed 19 times in a botched robbery on Lodge Lane, Toxteth. However in 2001, he was freed by the Court of Appeal after the conviction was declared unsafe." (from https://www.liverpoolecho.co.uk/news/liverpool-news/innocent-man-imprisoned-20-years-27505577)

Patryk Pachecka and Grzegorz Szal

"Patryk Pachecka and Grzegorz Szal, have been unanimously acquitted of Murder and Manslaughter after a trial at the Central Criminal Court...Both men were convicted of Murder in December 2017 and sentenced to life imprisonment with a minimum term of 18 years, while the killer escaped responsibility. Their convictions were overturned in January 2021." (from https://www.libertaschambers.com/media-hub/murder-conviction-quashed-for-patrtk-pachecka/ )

Trupti Patel (wrongly accused/acquitted)

"Trupti Patel is a qualified pharmacist from Maidenhead in Berkshire, England, who was acquitted in 2003 of murdering three of her children, Amar (5 September 1997 – 10 December 1997), Jamie (21 June 1999 – 6 July 1999), and Mia (14 May 2001 – 5 June 2001)." (from https://en.wikipedia.org/wiki/Trupti_Patel)

Other notable

Suzanne Holdsworth

Winston Silcott

Judith Ward

Derek Bentley

Stephen Downing

Stefan Kiszko

(from https://www.theguardian.com/uk/2009/mar/18/miscarriages-justice-history)

The Bridgewater Four

The Birmingham Six

The Stockwell Six

The Guildford Four and Maguire Seven

(from https://www.crimeandinvestigation.co.uk/shows/british-injustice-with-raphael-rowe/innocent-men-four-wrongful-convictions-from-the-uk )

Suspected wrongful convictions in UK (those who remain incarcerated)

Colin Norris

"Colin was a nurse in Leeds when a non-diabetic patient fell into a hypoglycaemic coma. As one of the staff on duty that night, Colin was questioned and eventually convicted on four counts of murder and one of attempted murder, of elderly hospital patients. Inside Justice first became involved with this case when the highly experienced investigative journalist Bob Woffinden brought Colin to the attention of our Advisory Panel. His case has been with the CCRC since 2011. In collaboration with the BBC, a documentary was made which you can view here BBC Panorama: The Innocent Serial Killer. You can also listen to a Radio Leeds interview with Paul May." (from https://www.insidejustice.co.uk/about-us/our-cases.php)

Also: https://www.theguardian.com/law/2021/feb/12/colin-norris-serial-killer-nurse-conviction-court-of-appeal

Roger Kearney

"Roger was convicted of murdering his lover Paula Poolton after her body was found in the boot of her car in 2010. The prosecution described a high level of interaction between victim and attacker yet no forensic evidence was found to incriminate Roger. In 2016 the Advisory Panel of Inside Justice, investigating Roger’s case, was filmed by the BBC,. The resulting two-part documentary Conviction: Murder at the Station can be viewed here and here. Today, cutting edge forensic techniques could be used to identify the killer in this case but Hampshire Constabulary has lost, destroyed and contaminated key exhibits contrary to statutory guidance. Doing so has denied Roger Kearney the chance to prove his innocence.

CCTV footage, which still exists, could be subjected to new analysis which could form the basis of a new appeal but Hampshire Constabulary has repeatedly refused Inside Justice access to this material." (from https://www.insidejustice.co.uk/about-us/our-cases.php)

Kevin Nunn

"Kevin was convicted of the murder of his girlfriend Dawn Walker in 2006 and sentenced to life imprisonment with a minimum tariff of 22 years. Although the crime scene was rich in forensic opportunity, nothing implicated Kevin. He maintains his innocence and has taken his case to the Court of Appeal, the High Court, the Supreme Court and the CCRC. Kevin came to us in 2014 for help in the final lead-up to the Supreme Court. Efforts to persuade the CCRC to finish the forensic investigation of Kevin’s case continue and Inside Justice is working with others to develop a national protocol for post-conviction disclosure of evidence. This, in the interests of justice, is vital." (from https://www.insidejustice.co.uk/about-us/our-cases.php)

David Reece

"Convicted by a 10-2 majority in March 2018 as part of a conspiracy to import and supply Class A drugs, David Reece has consistently maintained his innocence....We have made a short film about David’s day in court. Our belief remains firm that there is something wholly wrong with David's conviction and we must now do everything we possibly can, with all the expertise Inside Justice has, to find that one thing that could get us back to the Court of Appeal, but we need your help." (from https://www.insidejustice.co.uk/about-us/our-cases.php)

Also: Read the Judgment handed down by the Court of Appeal (Criminal Division) and Inside Time article, February 3rd 2020

Michael Stone

"Michael Stone (born Michael John Goodban in 1960) is a British man who was convicted of the 1996 murders of Lin and Megan Russell and the attempted murder of Josie Russell, and who is a suspected serial killer. He was sentenced to three life sentences with a tariff of 25 years for the Russell killings. Stone maintains his innocence and continues to contest his conviction. His legal team argues that the serial killer Levi Bellfield could possibly be the true perpetrator of the attack." (from https://en.wikipedia.org/wiki/Michael_Stone_(criminal))

Also: https://www.bbc.co.uk/news/uk-wales-42144445

Ben Geen

"Fresh evidence has emerged that it is claimed undermines the conviction of a nurse jailed for life 17 years ago for murdering two of his patients and poisoning 15 others. Benjamin Geen, then 25, was given a minimum 30-year sentence in 2006 largely on the basis that he had been on shift at the time of an “unusual” number of cases of respiratory arrest in the emergency ward of Horton general hospital in Banbury, Oxfordshire." (from https://www.theguardian.com/law/2023/jul/31/new-evidence-claimed-to-undermine-nurse-benjamin-geen-conviction-for-killing-patients)

Also: https://bengeen.wordpress.com

Omar Benguit

"On Friday 12 July 2002, at around 2:50 am, 26-year-old Jong-Ok Shin was murdered on Malmesbury Park Road, Richmond Park, Bournemouth...Omar Benguit was arrested on 22 August, almost six weeks after the murder, after being named as the killer by a police informant. Beverly Brown, a heroin addict and prostitute, claimed that she was with Benguit and two other male heroin addicts on the night of the murder...It was also argued by the defence that an Italian man, Danilo Restivo, convicted of two other murders who was living in the area at the time, was a more likely suspect for the crime. It was suggested that the murder of Shin resembled similarities between Restivo's other murders." (from https://en.wikipedia.org/wiki/Murder_of_Jong-Ok_Shin)

Also: http://www.omarbenguit.co.uk

Matthew Hamlen

"Justice in Jeopardy: The Matthew Hamlen Case - A six part series examining the Double Jeopardy conviction of Matthew Hamlen for the murder of Mrs Georgina Edmonds. A murder investigation that got it badly wrong not once, but twice. Seriously flawed forensics, deliberate non disclosure to the defence, other suspects ignored ... a litany of failures that culminated in the conviction of an innocent man." (from https://hi.player.fm/series/justice-in-jeopardy-the-matthew-hamlen-case)

Luke Mitchell

The murder of Jodi Jones is a Scottish murder case from June 2003 in which a 14-year-old schoolgirl was murdered in woodland in Dalkeith, Scotland. Her semi-nude body was discovered behind a wall by her 14-year-old boyfriend Luke Mitchell’s dog Mia, hours after her death...Mitchell rapidly became a prime suspect in Jones' murder. He was arrested on 14 April 2004, convicted of her murder on 11 January 2005 at age 16, and sentenced to serve a minimum of 20 years' imprisonment. Mitchell continues to protest his innocence, and several attempts to overturn his conviction have failed...In May 2007, a BBC ScotlandFrontline Scotland documentary examined a theory that the murder might have been committed by a student who was alleged to have handed in an essay about killing a girl in the woods a few weeks before the murder. A friend of this suspect saw him soon after the murder and claimed that he had scratches on his face. The documentary also challenged the theory that Mitchell was an obsessive Marilyn Manson fan and had a keen interest in the Black Dahlia murder, stating that there is no evidence that Mitchell knew of the Dahlia case until after the murder. (from https://en.wikipedia.org/wiki/Murder_of_Jodi_Jones)

Also: http://news.bbc.co.uk/1/hi/scotland/6634611.stm

Philip Peace

Philip Peace was found guilty in February 2021 of murdering his five-month old baby daughter, Summer. "The collapse of a five-month-old girl was not caused as a result of pneumonia according to an expert, a trial heard. Dr Dewi Evans, a consultant paediatrician, told jurors that Summer Peace had developed the condition after her collapse. Dr Evans told Birmingham Crown Court there was no evidence of Summer having pre-existing pneumonia prior to her collapse. He said he would expect a baby to show “clinical features” – a number of symptoms – which he hadn’t found, jurors were told....The professional said the collapse would not have been caused by pneumonia and concluded, in his opinion, that it was caused by head trauma, a judge heard. Mr Michael Turner QC, defending Summer’s father Philip Peace in the trial, questioned Dr Evans to see if it was possible the condition could be pre-existing. Mr Turner cited sounds heard by paramedics, described as noisy and bubbling, when they listened to Summer’s chest as possibly being evidence of the condition. Dr Evans, in response to the cross-examination, said it could be explained through transmitted noises – noises from the throat – due to the baby’s size. He added it could also be – in conjunction with the first explanation – could be food or liquid being aspirated into her lungs which causes aspiration pneumonia." (from https://www.expressandstar.com/news/crime/2021/02/04/dudley-baby-death-trial-collapse-of-five-month-old-summer-not-due-to-pneumonia-expert-tells-court/#:~:text=Trauma,condition%20could%20be%20pre%2Dexisting)

Also: https://www.bbc.co.uk/news/uk-england-birmingham-56198043

Lucy Letby

"Colleagues of killer nurse Lucy Letby continue to insist that she is innocent - even after the baby murderer was jailed for life earlier this week. Nurses who worked alongside Letby, 33, at the Countess of Chester hospital and remain there now are reportedly struggling to accept that she murdered seven babies and tried to kill another six. (from https://www.dailymail.co.uk/news/article-12440411/Nursing-colleagues-Lucy-Letby-insist-innocent-working-hospitals-baby-unit.html)

Also: https://www.mirror.co.uk/news/uk-news/lucy-letbys-friend-explains-convinced-30776086 and https://www.chimpinvestor.com/post/do-statistics-prove-accused-nurse-lucy-letby-innocent and https://rexvlucyletby2023.com and https://www.scienceontrial.com

In Wix there are two types of posts: Blog posts and Forum posts (this is a Blog post). I will disable comments on Blog posts, but you can still post comments and replies to comments on a specially created post in the Forum (moreover, comments and replies in Forum posts are only visible to members). To post comments and join the conversation about this post or Lucy's case in general, please click here to go to the Forum (opens in new window so this blog post page stays open for you to view).

gillgage This is a very interesting read and gives us increasing cause for hope. Thanks to Peter for collating all this relevant information.

The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

© Chimp Investor Ltd

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<![CDATA[A Message Board For Those Who Wish To Express Support For Lucy, Her Parents, Her Family, Her Friends]]>https://www.chimpinvestor.com/post/lucychat-messages-of-support-for-lucy-her-parents-her-family-her-friends64fc633ec1395929fef92d0cSat, 09 Sep 2023 12:23:38 GMTPeter ElstonIf you enjoy reading this blog, please leave a star rating on WealthTender. Thank you!

This blog post is not to facilitate member discussion. It is to leave messages of support for Lucy, her parents, her family and her friends at this difficult time.

Please feel free to post messages of support on SOT (see below), on this blog post, or on the forum section of this website. They will reach Dawn. Comments on this blog post and on the forum will be monitored closely and anything inappropriate will be deleted. Please also post only messages of support here and on the forum section. Any comments or questions about messages of support can be posted on the general discussion blog post.

Also, if you want to be anonymous, I suggest you use a 'display name' that does not identify you (you can change this in your profile section). You might prefer this, whether in relation to leaving messages of support or generally.

The below is on SOT.

Polardaisy2203Polardaisy2203Polardaisy2203Polardaisy2203Sep 01

POST MESSAGES OF SUPPORT TO LUCY HERE

in Letter Writing

Hi all, as most of you know I have been in touch with Lucy's friend Dawn and asked about how to contact her with messages of support. I now have an update! And some reassurance. Dawn and Lucy's parents are fully aware of the (growing) support. They are, of course, relaying the message to Lucy. But, given the circumstances, it's not straightforward so we will have to wait patiently for any news of an appeal. Dawn told me that she will be informed of news on this site so please, IF YOU HAVE ANY WORDS OF SUPPORT FOR LUCY POST IT HERE in the comments and Dawn will be informed and compile them to be handed to Lucy at an appropriate time. Thank you ❤️

....................................

The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

© Chimp Investor Ltd

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<![CDATA[Sepsis and Scapegoating in Lucy Letby Case]]>https://www.chimpinvestor.com/post/sepsis-and-scapegoating-in-lucy-letby-case64fac2c2c5db7c788654d688Fri, 08 Sep 2023 07:11:58 GMTPeter ElstonIf you enjoy reading this blog, please leave a star rating on WealthTender. Thank you!

One fabulous article on scienceLucyLetby subreddit about sepsis and a snippet of trial testimony that might explain why Lucy was scapegoated

Below is a snippet of the testimony on 26 April of CoCH neonatal unit manager Eirian Lloyd Powell.

"Ms Powell said Letby made mistakes, as everyone did, but was "good at reporting mistakes", and would report mistakes that other nurse practitioners or medical staff had made, regardless of seniority."

26 April 2023 (http://www.chesterstandard.co.uk/news/23484044.recap-lucy-letby-trial-thursday-april-27/)

We have five useful bits of information here:

  1. We know that Lucy was "good at reporting mistakes".
  2. We know she had no qualms about reporting senior doctors.
  3. Given that Powell specifically mentioned that Lucy would "report mistakes, regardless of seniority, I think we can infer that this may have been unusual and that other nurses feared the consequences of reporting senior doctors (after all, this would make sense).
  4. If Lucy made reports, these should be in the hospital's computer system.
  5. When Powell made this comment she was being questioned by prosecution barrister Nicholas Johnson KC. He would not have wanted the Court to hear that Lucy reported senior doctors. So, I think we can infer that Powell went out of her way to make this remark and that therefore she was a supporter of Lucy (did not believe she was a killer).

If it was indeed usual for nurses to not report senior doctors, I wonder how the likes of Drs Gibbs, Brearey and Jayaram felt when Lucy reported them as she probably did.

The below article (https://www.reddit.com/r/scienceLucyLetby/comments/16cga3g/i_found_a_confirmed_case_of_a_newborn_developing/) was posted on the scienceLucyLetby subreddit (https://www.reddit.com/r/scienceLucyLetby/) yesterday. It is brilliant research. Thank you Nessie In The Loch (https://www.reddit.com/user/nessieintheloch/) for doing such fabulous work and for letting me reproduce it on this site.

I found a confirmed case of a newborn developing sepsis at the Countess of Chester neonatal unit in June 2015—the same month babies A, C and D died, and baby B had an 'unexpected collapse.' In fact, this confirmed case of sepsis likely overlapped with the events related to babies A-C.

First, some context: In 2013, The Chester Standard teamed up with the Countess of Chester Hospital for a charity campaign dubbed 'Babygrow Appeal'. The goal was to raise £3 million to build a new neonatal unit for the hospital, to replace the old, cramped one where Lucy Letby supposedly killed and harmed over a dozen infants.

If the name 'Babygrow Appeal' sounds familiar, it's because much has been made in the press about Letby's involvement with the campaign. Mind you, she was not the only familiar face to take part—Stephen Brearey and John Gibbs did as well—to name just two.

As part of the partnership, The Chester Standard ran weekly stories about parents' and babies' experiences at the neonatal unit.

One of those stories highlighted the "emotional rollercoaster" a couple went through when their son, whom I'll refer to as "James," was born eight weeks premature. While the article is meant to be a feel-good piece, what it reveals could shed new light on the accusations against Lucy Letby.

June 2015: Sepsis in the Neonatal Unit

Baby James was born on June 6, 2015, eight weeks ahead of his due date. He was taken to the neonatal unit straight away, and placed in intensive care.

He eventually recovered enough to be taken out of intensive care. But his relatively stable condition was short-lived: when James was eight days old, according to his mom, "he became very poorly with septicaemia, and his arms, leg and tummy all swelled up."

Septicaemia and sepsis are not necessarily synonymous—there are medical distinctions between the two. But when it comes to communicating with laypeople, the NHS uses the terms interchangeably.

Going by his mother's account, James's septicaemia diagnosis came on or around June 14, 2015. In short order, he was transferred to Liverpool Women's Hospital—where, according to his mom, "he recovered quite quickly."

After a four-day stay at the hospital in Liverpool, James was transferred back to the Countess of Chester. There, he began to deteriorate again. In his mother's words,

Just as things started to look up, a lump appeared on James's chest which got bigger and turned out to be an abscess.

The MRI scan showed he also had abscesses on his elbow and ankle as well, and he underwent a bone scan to check on an infection in his hip area. He was taken back to Liverpool Women’s as doctors thought he might need an operation.

In short, a baby boy at the neonatal unit in June 2015 developed an infection so severe that it led to sepsis—possibly twice. The unit, in turn, was so ill-equipped to treat him that it twice had to transfer him to another hospital.

Possible Overlap with Babies A-C

To recap:

  • June 6: Baby James is born at the Countess of Chester. He is sent straight away to the neonatal unit, where he initially spends time in the intensive care nursery.
  • ~June 14: James is diagnosed with septicaemia. He is transferred to Liverpool Women's Hospital for emergency treatment.
  • ~June 18: James is back at the Countess, where he soon develops a noticeable lump on his chest that turns out to be an abscess. Further scans reveal additional abscesses in his elbow and ankle, and a bone infection in his hip area. His condition is so grave that he is at risk for surgery. He is once again transferred to the hospital in Liverpool.

Compare that to the timeline for babies A to D:

  • June 8: Baby A, a boy, dies. The previous evening, he had been given medication for "suspected sepsis." He was being treated in the intensive care nursery, in a cot right next to that of his twin sister. During this period, it emerged at trial, a third baby had also been staying in the intensive care room, alongside the twins. And while, to my knowledge, the third baby's identity was not revealed at trial, it could have been James, considering the overlap in dates.
  • June 10: Baby B, who is Baby A's twin sister, collapses but survives. Lucy Letby will later be convicted of trying to murder Baby B on this occasion.
  • June 14: Baby C, a boy, dies. A day earlier, his doctor had written "suspected sepsis" under "problems." He was also being treated for pneumonia. Even prosecution witness Dewi Evans, in a 2019 report, wrote that, "infection may be a significant factor in his collapse." In an earlier report, from 2017, Evans had written, "One may never know the cause of (his) collapse. He was at great risk of unexpected collapse."
  • June 22: Baby D, a girl, is pronounced dead. A post-mortem examination conducted shortly after her death would identify the cause as "pneumonia with acute lung injury." Before these results had come in, though, Baby D's doctors had had no idea she'd even had pneumonia. And though they'd suspected she had had an infection, they had started her on antibiotics a full four hourslater than they should have. The delay had been inexcusable, but was characteristic of the hospital's sub-optimal standards: A nationwide investigation had revealed the Countess of Chester to have been the fifth worst-performing hospital in the NHS when it came to treating sepsis in a timely manner. The investigation found that only 33% of the hospital's patients who needed treatment for sepsis were given antibiotics within the appropriate timeframe.

Conclusion

The deaths of three babies and collapse of a fourth in a single month—June 2015—caught the attention of Stephen Brearey, the lead consultant in the neonatal unit at the Countess of Chester Hospital. After ascertaining that Lucy Letby had been on shift for the four events, he began to suspect her of murder.

But there could have been a simpler explanation: babies in the neonatal unit during the month of June 2015 could have been at an especially high risk of serious infection—a risk that could have been exacerbated by the cramped premises. The unit, in turn, had been demonstrably ill-equipped to provide these newsborns with the care they needed.

It's a hypothesis that should not have seemed so outlandish to Brearey himself. When profiled by The Chester Standard in 2013, as part of the Babygrow Appeal charity drive, Brearey gave the following explanation for why the hospital was in dire need of a new neonatal unit:

The nurses on the unit do wonderful work and are very professional despite the lack of space around the incubators. Neonatal intensive care has improved in recent years but requires more equipment which we have very little space for. In addition, the risks of infection for the babies is greater, the closer they are to each other.

Update

The baby whom I've been referring to as "James," as well as his mother, were pictured with none other than Lucy Letby—as well as John Gibbs—in a Chester Standard article published on August 6, 2015.

A quick closing note, and something for all of us (myself included) to keep in mind: While I strongly believe that the details of this baby's experience in the neonatal unit provides important context to the accusations against Lucy Letby, the family featured in these articles deserves privacy. I've tried to shield them by referring to the baby with a pseudonym, though I realize it's not enough to anonymize them completely. Let's just all remember that the family itself has nothing to answer for—and, though unlikely, may not even realize their experience is relevant to the Lucy Letby case in any way.

The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

© Chimp Investor Ltd

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<![CDATA[When Talking About Lucy Letby Turns To Action]]>https://www.chimpinvestor.com/post/when-talking-about-lucy-letby-turns-to-action64f97147e15760fd5842edcdThu, 07 Sep 2023 20:43:00 GMTPeter ElstonIf you enjoy reading this blog, please leave a star rating on WealthTender. Thank you!

Here are your suggestions in response to my "Calling All Chimps!" post, posted on the blog or sent privately, about what we can do, over and above posting comments and responses on the blog, to help Lucy

There have been some great suggestions as to how we can collaborate more, how we can work together more, how we can be more active. I have zero experience in this sort of thing, other than blog writing, so if any of you can step up, please do.

First, some background.

My rather limited understanding about the work required to get an individual a fair trial* is that it essentially involves two main strands, which can be described as "inside the Courtroom" and "outside the Courtroom". In relation to Lucy, the former will involve her legal team (solicitor/barrister who will be in close contact with Lucy and her parents), the solicitor firm's research resources, and the various experts called upon (medical/scientific) to debunk (this time effectively) the prosecution's evidence presented at the first trial.

That first strand is not where we sit, though of course if you are an expert who is qualified to provide a different (correct!) interpretation of the two blood tests (haematologist? endocrinologist?), the X-rays (radiologist?), the Post-It note, the hoarding of handover sheets, text messages, Facebook searches (psychiatrist/psychologist?), the roster data (statistician?), etc, then please contact Lucy's defence team when we know who they will be (she will have one whether or not she applies for leave for appeal, though I'm sure we all feel/hope she will apply, we just don't know if she will).

So, we are involved with the latter strand (i.e. the work that goes on outside the Courtroom) and the main thrust of that relates to reaching out to two groups: a) the general public and, b) those in some sort of position of power who can have a positive influence in some way over Lucy's case. Both will involve a good understanding of the various issues relating to the case. If we are to persuade people we must educate ourselves about all aspects of the case (what the prosecution evidence was in the first trial, what the correct interpretation looks like, the public inquiry, the ongoing police investigation, etc.

We also need to know whom to contact, whether politicians, lawyers, scientists, celebrities, journalists, other advocacy groups, etc to tell them about the case and to ask them to do what they can.

Rather than going away as individuals to learn more detail about the case, we should probably pool resources to help each other achieve this, and indeed also have regular groups calls on which we can discuss the case (see suggestions below). Also, rather than each of us building a list of those we should contact, we should as a group build a database of those to contact, including keeping a record of all contact (see suggestions below). And please, if you have experience in these things, shout!

It feels odd that there may be other groups out there thinking similarly about what can be done to help Lucy. It feels odd to be thinking about how to help Lucy without having got her endorsement or that of her parents. I suspect Lucy and her parents are very busy right now, and anyway the trauma of the verdicts is still raw. The situation is very fluid. There may come a time when there is an "official" campaign, endorsed by Lucy and her parents, which of course would be great. Until then, if we as members of this blog want to come together and work together, support each other, great.

Before I list the various suggestions, one thing that I believe would help with all of them is to have somewhere to meet physically, whether to chat together or to work together. My flat is a ten minute walk from Euston Station, London. I have a decent sized area/room that is currently unused (I've been thinking for ages about what to do with it!) where I could set up a square table with eight chairs or so. The room also has a big empty wall which could be used as a notice board. I could get a large whiteboard too. And there's a pub right across the road!

I have thought long and hard about this as it would be a commitment that I would want to be able to follow through on, but I would be delighted to open up that space (and the fridge and biscuit tin!) to anyone who would like to drop by, whether to chat or to work on the case (yes, there will be work to be done).

Security would be paramount so there would have to be a way of vetting those who would like to drop by. Many of you have already proven without doubt by way of your comments, responses, private messages etc, that your credentials and motivations are gold-plated. However, there would probably need to be something more secure and systematic in place. Perhaps a two step process. The first step would be to put you on a list, having provided sufficient details to be verified. The second step would be to have some sort of booking system, including issuance of a number that you can shout into the intercom. This all sounds very covert but I have been told by a number of people that we have to be very very careful. After all, the ramifications of what we are doing could be serious (let's hope they are).

I will have a think about this and contact you by email.

So, below are various suggestions that you have made.

Letter/email writing/sending

One of you copied me in on a great letter they sent to their MP and a couple of cabinet ministers, together with an attachment laying out the key issues as they saw them. They have said we are welcome to use both the content of the letter and the document. I will put them into some sort of template form and provide further details in another blog in the very near future. The idea would be that all you need to do is some simple copying and pasting, then either press send or put in envelopes.

Creating various databases (of people to write to for example, names, addresses, email addresses etc) that can be stored in a secure shared drive for everyone to access.

There are various steps here:

1. Set up a secure shared drive. If any of you is an IT expert and has ideas on this front, please let me know.

2. Decide what sort of databases we need. Are there off the shelf options?

3. Decide who should be responsible for maintaining these databases.

Very clear fact sheets about unjust trial, stats etc simply written, easily printed, easily distributed. Sent to whomever, wherever. Maximizing potential, possibly, of far away weak ties not just strong localized ones.

I understand that a team at Science on Trial is doing exactly this. Please do join SoT if you haven't already and see what they have on that front. I will continue to write, and I think my future blogs could well focus on specific aspects and therefore constitute material that could easily be converted into "fact sheets". If you like writing, speak up and we can coordinate (I'm not precious about being the only author on this blog, though I do think it would be good to keep it well organised etc.)

Other documents/papers in the public domain that are of interest?

I have loads of PDFs saved off that I can start putting in individual blog posts, whether academic papers, articles about forensic science, articles about previous miscarriages etc.

Never underestimate word of mouth, people frequently make this error in the world of social media. Just talk to people, colleagues, family, friends, etc, and be honest with them about how you see the case. Continue with the social media, just remember it’s ephemeral and people are busy and distracted. Don’t shout at them and move on if they’re not receptive, it will may have planted some doubt in the recess of their mind and then when they see a social media post …… Convincing just one person is enough (although more than one is better, of course), they will then convince others and on it goes. It really does work. I’ve convinced 5 people in a week and they are forwarding on material that I send them. What you’re looking to do is to counter the MSM propaganda, which is what we are all bombarded with everyday when we watch, listen or read any MSM. You’ll feel a lot better psychologically if you ban it all!

Totally totally agree

While I greatly appreciate the platform you have provided and all the work you seem to have done, it’s a little deflating reading an article basically saying ‘sooo… now what?’. There‘s no plan then? No fund or anything? Or is that somewhere else?

There will be a way to fund Lucy's legal team directly at some point. If we do things that need funding, I'm sure we will find the right way to do that.

I would really like to see pieces from the likes of Scott Mclachlan, Norman Fenton, Mark McDonald, and others who are not sold on Lucy's guilt. Any chance of that, Peter? Particularly valuable would be pieces from medical professionals who can seriously challenge the expert medical evidence. The reality is that the serious work is being done over at SOT. Our contribution here at Chimp? Simply communicating to all and sundry our disquiet over Lucy's conviction. All and sundry includes friends, acquaintances, news media, those columnists who need challenging/converting. Everyone and anyone. Always remember to be civil and balanced.

I think that "communicating to all and sundry our disquiet over Lucy's conviction" is not a simple matter. Nor is it secondary to other work - it is hugely important. Also, it will involve a lot of work and a lot of coordination (see earlier). I think the idea of linking blogs to the work of others involved in this is a great idea, perhaps with summaries of some sort. If anyone sees anything that they think should be on this blog, please say.

Yes to this. And a legal voice as conductor.

It would be great to have an authoritative legal voice who can provide credible and useful insights into where things go from here, what the legal issues are etc. If that person could be you, please say and I will set you up as an author.

Yes, the stuff on SOT is beyond my understanding, but it is the really important stuff that is going on now. SOT will overturn Lucy's conviction, Chimp can help in that regard. We are better than a talking shop, we can influence public opinion and change the mood from "Lucy the serial killer of babies" to perhaps not, and eventually to something better still.

Yes. As you say, we can influence public opinion. This blog is not about putting together the science that will be useful to Lucy's legal team. It is as you say about influencing public opinion. And writing to influential people. And putting stuff on this site that journalists will read (and that we can actively send to journalists).

Hi Peter - There will be people who have invested a significant amount of time already in campaign support who will understandably be a little confused and wonder what's happened to lead to this. It strikes me that the previous collaboration made sense and appeared to be making progress but multiple strands has the potential for confusion and blurring of vision. Are you able to expand at all and explain how this will fit with other activities towards a common goal?

This blog is very different to what SoT is doing. I suspect the four entities (SoT, Richard Gill, LawHealthAnd Tech, Chimp, and the various others too who have posted videos for example) could be considered members of a football team, each doing something different but important. SoT may be the equivalent of Erling Haaland but the others are doing something useful too. As mentioned in another response, the science is critical but the Court of Appeal will drag their heels if there is no public pressure on them. I think this is where other parties can help. And there is absolutely nothing to stop the various parties collaborating.

Peter.you ask for suggestions on how we can go forward . In late June I was in London and whilst wandering around Westminster, I took the opportunity to observe the Supreme Court at work. The public can do that, which is as it should be, and that open access impressed me greatly. A lot of what was said was legalese and went over my heard, but what has remained with me is the demeanour of the learned , articulate and well meaning judges who I saw at work that day. I just know in my heart that they and their counterparts are committed to justice. So how on earth has this unprecedented injustice come about?? And why was the presiding judge in LLs trial so vitriolic in his condemnation of her? He was anything but impartial, unlike any other judges I’ve observed. I am still very disturbed by the whole thing.

I wonder If we could get a Supreme Court judge to at least read this blog- or even a list of the main bullet points of the flaws in the prosecution- they may agree to help? Am I being naive? I believe we do need a figure with a National profile to help here. A politician? I’ve always admired Gordon Brown. Or a NHS Consultant? As we know there of the latter who believe in this cause. Another Q. Has LL decided to appeal? Time is going on isn’t it? I worry that she is not going to bother. She must be mentally wrung out, poor vulnerable girl.

Finally, whilst out hillwalking yesterday I met a nurse and we fell into conversation. She told me that she has doubts about this conviction, as so many of her colleagues do. Another resource which could be harnessed? Please keep up the good work. Sorry if I have rambled on. Thank you.

What a super message. I certainly think we can send the aforementioned letters/emails to Supreme Court judges (past and present) and to the various other parties mentioned. And really lovely to hear about the nurse who has doubts about the conviction. As mentioned previously, although Lucy is at the centre of this, her case is about more than just her. It is about reforming the NHS. It is about reforming the justice system.

Hi, I think the work you (Peter and others) have done exposing issues with the evidence, and bringing people together to question whether this was a fair trial is admirable. However this blog talks about supporting Lucy and campaigning for her release. I personally think the focus should be on scrutiny of the facts and establishing the truth - not just for her (if she is indeed innocent) but also: a) for the sake of the families so they know what happened, b) to protect future babies by identifying if there were any other causes eg. Infection, poor hygiene, poor medical practice etc, c) to hold power to account within the NHS and justice system

Great message. I agree, and think that future blogs can focus on specific aspects of the case, scrutiny of the facts, establishing the truth, understanding how we got here etc. And, as you say, for the families, for future babies and their parents, and to help build a better NHS and a better justice system.

What are the various aspects of Lucy's case that we should be thinking about?

In no particular order, below is a list of things that I know in my case I want to really understand well and focus on.

1. The public inquiry: is there any way it can consider the possibility that Lucy is not a killer but that there were other explanations for the spike in deaths and collapses?

2. Operation Hummingbird: what is the ongoing investigation about?

3. The various legal routes for Lucy going forward (the Court of Appeal, CCRC, Supreme Court).

4. The grounds for appeal: a) the judge's appalling summing up, b) incompetent councel, c) the Cheshire Police Youtube video (is that new evidence?), d) new scientific interpretation of the medical evidence.

5. What was the evidence that convicted Lucy and how can it be countered.

6. Previous miscarriages/exonerations (Sally Clark, sub postmasters, Barry George, Daniela Poggiali, Lucia de Berk, Angela Cannings, and many more).

7. Other suspected cases of wrongful conviction (Colin Norris, Ben Geen, Omar Benguit, Roger Kearney, Michael Stone, and many more).

8. Looking after ourselves and each other. I suspect we are all getting rather stressed out about the thought of this young person locked in a cell 23 hours a day, thinking they will be there forever, and thinking they did not get a fair trial, that the system let them down.

Finally, the above is essentially a brain dump. Mine and yours! I am not an expert. I have not done this before. Some of you may have read the above and thought, oh, he's missed that, or not touched on that. If that is the case, please let me know and I can add to this post. This is not like a newspaper. Articles can be added to, improved. Importantly, while I enjoy writing and have put what I think is an ok blog site together, the next steps that are needed, the action that you have suggested/asked for will be a team effort.

* Several of you have said that we will be seen as far more credible by the media, politicians, opponents even, if our stance is that Lucy deserves a fair trail rather than that she is innocent which makes sense. Lawyers uses the phrase "unsafe conviction" and we should do likewise. We do not want to seen as a bunch of "crazies" but as a group of thoughtful, rational specialists and nonspecialists who have an abhorrence of injustice. Yes? No?

The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

© Chimp Investor Ltd

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<![CDATA[When Science Kills]]>https://www.chimpinvestor.com/post/when-science-kills6367513addf45b7399fe658dThu, 07 Sep 2023 04:25:51 GMTPeter ElstonIf you enjoy reading this blog, please leave a star rating on WealthTender. Thank you!

More must be done to improve the use of science in the courtroom

"Most lawyers are terrified of science. So are judges. So are jurors." - M. Chris Fabricant, Director of Strategic Litigation, The Innocence Project

“No matter how many times Bayesian statisticians try to explain to me what the prosecutors fallacy is I still do not understand it and nor do I understand why there is a fallacy” - one of the UK’s most eminent judges (from https://www.eecs.qmul.ac.uk/~norman/papers/bayes_and_the_law_revised_FINAL.pdf)

"You've seen one dead girl with bites on 'em, you've seen 'em all" - Michael West, disgraced forensic dentist

"It is quite clear therefore that outside the field of DNA (and possibly other areas where there is a firm statistical base), this court has made it clear that Bayes theorem and likelihood ratios should not be used." http://www.bailii.org/ew/cases/EWCA/Crim/2010/2439.pdf

"Sometimes the "balance of probability" standard is expressed mathematically as "50 + % probability", but this can carry with it a danger of pseudo-mathematics, as the argument in this case demonstrated. When judging whether a case for believing that an event was caused in a particular way is stronger that the case for not so believing, the process is not scientific (although it may obviously include evaluation of scientific evidence) and to express the probability of some event having happened in percentage terms is illusory. " http://www.bailii.org/ew/cases/EWCA/Civ/2013/15.html

"The chances of something happening in the future may be expressed in terms of percentage. Epidemiological evidence may enable doctors to say that on average smokers increase their risk of lung cancer by X%. But you cannot properly say that there is a 25 per cent chance that something has happened: Hotson v East Berkshire Health Authority [1987] AC 750. Either it has or it has not." http://www.bailii.org/ew/cases/EWCA/Civ/2013/15.html

"Imagine being in jail where everyone thinks you are the scum of the earth, the lowest human being that walks the earth. The thick end of it is that she lost five to six years of her life in what was state-sponsored torture." John Batt, a solicitor and writer who was a member of Mrs Clark's defence team, https://www.theguardian.com/society/2007/mar/17/childrensservices.uknews

"Sally Clark, the solicitor wrongly convicted of murdering her two baby sons, was found dead by her family at her home yesterday" https://www.theguardian.com/society/2007/mar/17/childrensservices.uknews

"I think justice can be served without a statistician"

"Exactly. A statistician in a case like this is purely white noise"

- a Websleuths conversation https://www.websleuths.com/forums/threads/uk-nurse-lucy-letby-faces-22-charges-7-murder-15-attempted-murder-of-babies-5.641465/page-36#post-17863003

"Proper use of probabilistic reasoning has the potential to improve the efficiency, transparency and fairness of criminal trials by enabling the relevance of evidence – especially forensic evidence – to be meaningfully evaluated and communicated. If more widely and effectively used, it could lead to fewer cases being revisited by the Court of Appeal." https://www.eecs.qmul.ac.uk/~norman/papers/stats_courtroom_webdraft.pdf

"..when you have eliminated the impossible, whatever remains, however improbable, must be the truth" (Sherlock Holmes in The Sign of the Four, ch. 6, 1890)

"To change people's hearts and minds about criminal justice, people really have to care more about accuracy and reliability than about retribution" - Peter Neufeld, Co-Founder, The Innocence Project

Court of Appeal bans Bayesian probability (and Sherlock Holmes)

https://understandinguncertainty.org/court-appeal-bans-bayesian-probability-and-sherlock-holmes

Keith Harward (exonerated through DNA). DNA excluded Harwood. Next step was to do CODIS (Combined DNA Index System) search. Ran the profile through the data bank and got a hit - Jerry Crotty. Dana Delger; Keith Harward; John Prante.

https://abcnews.go.com/US/sailor-declared-innocent-murder-rape-spending-33-years/story?id=38249082

How a Bogus Bite Mark Sent Charles McCrory to Prison. Bite-mark analysis was key to Charles McCrory's 1985 conviction. The science has since been debunked — so why is McCrory still in prison?

https://theintercept.com/2022/03/12/bite-mark-evidence-charles-mccrory/ and https://www.theguardian.com/us-news/2022/apr/28/forensics-bite-mark-junk-science-charles-mccrory-chris-fabricant

The American Board of Forensic Odontology (ABFO) developed a study. First step. 100 cases where there had been bite mark evidence. Sent to board certified diplomates who were asked whether the bite mark was human, not human, or suggestive of human. Tried to look at level of agreement among diplomates. President (Dr Freeman) thought study would prove the first step i.e. that there was a high level of agreement. Result? Some of the cases one third each! After the study, Dr Freeman decided he was no longer going to do bite mark analysis for the prosecution.

The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

© Chimp Investor Ltd

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<![CDATA[Calling All Chimps!]]>https://www.chimpinvestor.com/post/calling-all-chimps64f57dbe7c9286309e44e85fMon, 04 Sep 2023 07:59:43 GMTPeter ElstonIf you enjoy reading this blog, please leave a star rating on WealthTender. Thank you!

Many of you have asked how we can come together more actively

I have received so many messages of thanks the last few weeks for my articles and for providing a place where you can feel connected with others who want to support Lucy. Quite a few of you have asked how we can become more active, so this post is really asking you for any suggestions you might have.

You may first be interested to know where the name 'Chimp Investor' came from. My profession was financial services and there is an anecdote about a chimpanzee throwing darts at a list of investments, and performing better than most professional fund managers! (My approach to investing is very statistically- rather than narrative-driven. This interest in statistics led me to so-called cluster cases like Lucy's which can be appraised statistically, and indeed to a range of other topics.)

Also, for anyone interested, I completed a geology degree recently at Birkbeck College, London, and did my dissertation on human evolution in Africa (understanding human evolution and evolution generally involves a lot of geology). So, I Iearned a lot about our cousin the chimpanzee as well as about our ancestors (other Homo species such as habilis and other genera such as Australopithecus and Ardipithecus).

Also, using a 'cute' animal in one's branding can be effective!

Now, chimpanzees are our closest relatives (genetically, they are closer to humans than they are to gorillas). They are intelligent. And the idea of a group of chimps rising up to challenge the justice system is simply delicious!

So, Chimps, we have a mission.

The mission is Lucy.

The mission is to help protect NHS health workers in future who could be subjected to false accusations and possible imprisonment (a nurse in Birmingham has just been arrested on suspicion of 'poisoning' - in fact, the related 'surge in fatalities' could well be a summer virus which is very possibly the case with Lucy. I also wonder if the 'poison' referred to is insulin).

The mission is to help improve the justice system, the system that anyone of us could become a target of.

You have been posting fabulous comments on my posts and having some fabulous conversations with each other (also, many comments have included information that is very useful and could well end up helping Lucy's effort to be exonerated).

There are now more than 400 of you who have become a Chimp in the last four weeks. That number is growing quickly. Some of you have asked what more we could do. This is likely to be a long fight so we might as well start thinking now.

So, please, if you have ideas, share them in the comments box, have conversations via the comments feature. I'm sure 400 intelligent creatures should come up with some great ideas! I will collate them and put them together in a new post, perhaps toward the end of this week.

I know that many of you will also be members of Science on Trial. Sarrita did incredible work putting the Rex v Lucy Letby website together and she along with members is doing incredible things with the SoT site.

This is not a competition. This is about the mission at hand. There will be overlap (which is good). I'm sure we can work together.

So, I very much look forward to seeing your suggestions.

By the way, the collective noun for a group of chimpanzees is a whoop.

Onward, Chimps!

Whoop whoop!

The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

© Chimp Investor Ltd

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<![CDATA[Did Dr Evans Break The Rules?]]>https://www.chimpinvestor.com/post/did-dr-evans-break-the-rules64f482dcb6086fb3c6d7e7daSun, 03 Sep 2023 14:27:51 GMTPeter ElstonIf you enjoy reading this blog, please leave a star rating on WealthTender. Thank you!

The retired paediatrician testified as an expert in a case in 2018 when he was not licensed to practice by the GMC

In November 2018, Dr Dewi Evans testified in the case of a six-week-old baby. It is possible that in doing so he broke rules.

Figure 1 below sets out the guidance from the Academy of Medical Royal Colleges for healthcare professionals giving expert testimony. It states that, in order to demonstrate legitimacy,:

Healthcare professionals giving expert evidence must hold the appropriate licence to practise/registration and be in, or sufficiently recently in, practice. This is essential if producing a report from direct assessment and/or examination of the patient.

If there are circumstances where this is not the case the healthcare professional must be able to demonstrate why it is appropriate for them to still act as a witness and that they have maintained the appropriate expertise.

If the case relates to historical events the healthcare professional should ideally have been in practice at the time of the events in question or be able to demonstrate understanding of the standards applicable at the time and the context of the incident.

Figure 2 below is the General Medical Council record for Dr David Richard Evans (https://www.gmc-uk.org/doctors/1503009). It states that Evans was 'Registered without a licence to practise' from 26 Aug 2015 to 16 Jul 2019.

Figure 3 below is an extract from Dr Evans' LinkedIn profile (https://www.linkedin.com/in/dewi-evans-211194a3/?originalSubdomain=uk). It states that Evans was a consultant paediatrician until July 2009, and thereafter (from September 2010 to the present) a Director of Dewi Evans Paediatric Consulting.

Figure 4 below is the December 2018 article in The Southern Daily Echo about the case of the six-week-old (https://www.dailyecho.co.uk/news/17269039.doctor-claims-bite-baby-death-intentional/ ). It states that, "Winchester Crown heard from consultant paediatrician Dr Dewi Evans". It appears that Dr Evans is testifying as an expert rather than as the child's paediatrician. This is supported by the fact that Dr Evans lived in Carmarthen in 2018 (see LinkedIn profile) while the trial was being held in Winchester. He's also referred to as a 'consultant paediatrician' rather than a 'retired consultant paediatrician'.

The article also states that, "Dr Evans told the jury he thought the defendants’ accounts of either the baby being dropped or falling from a sofa didn’t explain the injuries, which included a fractured femur, rib fractures, and the bite to the nose". This also sounds like the testimony of an expert considering the injuries rather than the child's paediatrician testifying about that relationship.

So....

Do any of you (with experience in these matters or otherwise) think that Evans broke the rules? If yes, was the offence a serious one? And if yes, what might the ramifications be in relation to his testimony at Lucy's trial?

Figure 1: Guidance from the Academy of Medical Royal Colleges for healthcare professionals giving expert testimony (from https://www.aomrc.org.uk/wp-content/uploads/2019/05/Expert_witness_0519-1.pdf)

Figure 2: General Medical Council record for Dr David Richard Evans (https://www.gmc-uk.org/doctors/1503009)

Figure 3: Extract from Dr Dewi Evans' LinkedIn profile (https://www.linkedin.com/in/dewi-evans-211194a3/?originalSubdomain=uk)

Figure 4: Article in The Southern Daily Echo (https://www.dailyecho.co.uk/news/17269039.doctor-claims-bite-baby-death-intentional/ )

Doctor claims bite to baby before his death was ‘intentional’

1st December 2018

A DOCTOR told a murder trial he thought a six-week-old baby had been “hurled by the leg” and his head “smashed against a hard surface” shortly before dying.

Winchester Crown heard from consultant paediatrician Dr Dewi Evans who also said the baby, who died on February 11, suffered an “intentional” bite to the nose.

It comes as the boy’s 17-year-old father stands trial for murder, while the 19-year-old mother is accused of neglect. Neither can be identified for legal reasons.

Dr Evans told the jury he thought the defendants’ accounts of either the baby being dropped or falling from a sofa didn’t explain the injuries, which included a fractured femur, rib fractures, and the bite to the nose.

The court previously heard from a teenage witness, who also cannot be named, that she was smoking with the mother outside her flat when they heard a “thud”. They went back inside where she said the father was picking up the baby.

Later, she said the father had been playing with the baby when he “managed to bite his nose”, although she admitted she did not directly see either incident.

However, the court today heard that was disputed by the mother, who said in a police interview she was inside crying when she heard the incident, and that she also didn’t see it.

She said they had been arguing and was not aware of the full extent of the baby’s injuries, some of which are alleged to have been caused before that night.

The mother added: “I really, truly wish I had broken up with him in October when I was pregnant,” after saying he had been “violent” towards her. During the police interview, she also described him as “very controlling”, but said she had never known him to hurt the baby.

When questioned why she didn’t call police over the father’s behaviour on the night the baby died, she responded: “I don’t know.” She was then accused of “allowing this to happen through your own inaction”, which she denied.

Both deny the charges. The trial continues.

The views expressed in this communication are those of Peter Elston at the time of writing and are subject to change without notice. They do not constitute investment advice and whilst all reasonable efforts have been used to ensure the accuracy of the information contained in this communication, the reliability, completeness or accuracy of the content cannot be guaranteed. This communication provides information for professional use only and should not be relied upon by retail investors as the sole basis for investment.

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