UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #2

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Marantz4250b

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Is there any sort of accurate, referenced timeline floating around, do you know?
There have been several but none going into very specific details such as her holiday dates. These article below was published at the time of her arrest when police were searching her house. It mentions that she'd just come back from holiday with her parents in Torquay. It's also mentions that the hospital stated that a member of staff had been suspended a year previously. They don't say who, obviously, but it was probably her, let's face it. So, looks like she was suspended during the time she was on holiday but it was just prior to her arrest.

 
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Marantz4250b

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Chua was found guilty. That’s not to say that he was guilty. It is true that he did also confess to the crimes he was accused of, though as far as I know he didn’t provide any “perpetrator knowledge” as to how he did them. Personally I’m unsure about his case. To be honest, I have my doubts about Bev Allitt too. Both of these persons were vulnerable individuals. Both were subjected to horrendous police interrogation. By confessing, Bev Allitt was sent to a psychiatric hospital; a lot safer place for an alleged baby killer than a regular prison.

According to this early report in The Sun, the death rate at the unit was only 10% higher than expected.
I could not find the info about holiday dip in number of deaths. Will search some more, in the earliest tabloid publications.


But how was 10% calculated? If correct, it means that the real surprise would be that for a number of years there were only 2 or 3 per year. 5 or 8 would not be more than 1 above expected. These rates are extremely sensitive to changes in definitions, and to changes in hospital policy.

Lucia de Berk experienced a huge rise in deaths in her medium care unit following a secret hospital policy change on transfer of babies with serious birth defects from intensive to medium care. The hope was that more of such babies would die at home, after a short stay on medium care. This policy backfired. Doctors had told the parents of baby Amber, the trigger case, that they could take it home in a few days. They did not say why. The chief paediatrician (Chef-de-Clinique of a specialist children's hospital in The Hague) was surprised. She was working half time, doctors orders, under psychiatric treatment for depression. At Lucia’s final trial (after a 9 year ordeal) the board of judges stated that the miracle was that baby Amber was still alive, 6 months after birth. Nurses had fought valiantly and professionally to save lives in the face of numerous medical errors by the doctors in charge of their care.
I haven't looked at Chuas case in depth but I've never been in any doubt as to Allitt's guilt, to be honest.

I agree that 10% rise in deaths is not a huge number in the great scheme of things. As you say, it could be down to all manner of things such as undetected infection or a change in the types of patients being admitted from the point of view of them having differing maladies or more very early term deliveries happening purely by chance.
 

Alyce

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Whitehall 1212

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I totally agree of course they have to take action but my point was I cannot invisage a situation where a nurse would be put on adin duties "just" and only based on her being on duty for each event ..imo there must have been some other factors.
I have worked in the NHS for 34 years the last 20 years as a nurse manager.
I have seen many situations of staff misconduct of varying degrees.
Some examples

A nurse carries out a single serious drug error....they would remain on clinical duties and be re assessed in relation to drug administration

An anaesthetist was taking drugs from the theatre and collapsed ...immediately suspended

Nurses often moved to admin duties either at their own request if struggling with their physical or mental health or for same reasons instigated by the Trust.

These of course are just examples of my experiences and who knows what happened at the COCH but to me removal from from clinical duties if not voluntary cannot be instigated lightly

Have you had sight of the RCPCH report?

It outlines the initial concerns over the neonatal mortality rate from June 2015 and how the hospital reviewed a number of deaths prior to inviting the RCPCH in to review the neonatal unit in July 2016, as a further response to the mortality concerns. The final report was published in November 2016.

The extract from the RCPCH report below is of interest. In my view the 'no obvious factors' comment is one which implies a consideration of deliberate harm.

3.10 The review team agreed that there were no obvious factors which linked the deaths and that circumstances in the unit were not materially different from those which might be found in many other neonatal units within the UK.

Here is an extract from the Guardian in June 2019.

Letby, originally from Hereford, had worked at the hospital for seven years and was training to work with babies in intensive care when she was detained last July. It is understood she was suspended a year earlier and before this she had been removed from clinical duties and placed in an administrative role.



The police were originally approached by the CoCH in May 2017 and LL was first arrested in July 2018. Therefore she must have been suspended around the time the police were first contacted in May 2017.

@gill1109 mentioned previously that he recalled mention of the mortality rate abating during a period when LL was on holiday.

There were obviously huge concerns regarding the mortality, which only increased when no obvious cause could be readily identified and prompted the consideration of foul play.

If there were factors that collectively shone a light on LL then in such circumstances the hospital authorities have little choice but to act and in this case they initially moved LL to admin duties, which is effectively the least they could do.

They will have been aware of the potential for legal challenge and maybe ultimately an Employment Tribunal, but in the circumstances, if the decision making process is well documented then they will probably be seen to have acted with proportionality.

It's a case of damned if they do, damned if they don't. No doubt the merest concern about a nurse being implicated in the death of a patient will have the hospital authorities closing down the possibility of a repeat.

Suspension once suspected of a criminal offence in the workplace or one that could impact patient safeguarding/staff safety is also entirely proportionate and if they could interfere with witnesses, evidence or otherwise undermine the investigation.

I have consistently had NHS staff suspended immediately, once I am investigating them for less serious criminal offences. Of course they can appeal the decision but none ever have.
 

Whitehall 1212

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I haven't looked at Chuas case in depth but I've never been in any doubt as to Allitt's guilt, to be honest.

I agree that 10% rise in deaths is not a huge number in the great scheme of things. As you say, it could be down to all manner of things such as undetected infection or a change in the types of patients being admitted from the point of view of them having differing maladies or more very early term deliveries happening purely by chance.

With such low average neonatal deaths at CoCH prior to 2015, in the range of 1-3 a year, then an increase of 1 in a year would be a 33 - 100% increase. With such low figures and any increase having to be a positive integer then percentage increases can appear misleading.

I have no idea how the Sun managed to calculate an increase in mortality of 10% when the original mortality was 3.....probably best not to follow their finance tips.
 

gill1109

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Have you had sight of the RCPCH report?

It outlines the initial concerns over the neonatal mortality rate from June 2015 and how the hospital reviewed a number of deaths prior to inviting the RCPCH in to review the neonatal unit in July 2016, as a further response to the mortality concerns. The final report was published in November 2016.

The extract from the RCPCH report below is of interest. In my view the 'no obvious factors' comment is one which implies a consideration of deliberate harm.

3.10 The review team agreed that there were no obvious factors which linked the deaths and that circumstances in the unit were not materially different from those which might be found in many other neonatal units within the UK.

Here is an extract from the Guardian in June 2019.

Letby, originally from Hereford, had worked at the hospital for seven years and was training to work with babies in intensive care when she was detained last July. It is understood she was suspended a year earlier and before this she had been removed from clinical duties and placed in an administrative role.



The police were originally approached by the CoCH in May 2017 and LL was first arrested in July 2018. Therefore she must have been suspended around the time the police were first contacted in May 2017.

@gill1109 mentioned previously that he recalled mention of the mortality rate abating during a period when LL was on holiday.

There were obviously huge concerns regarding the mortality, which only increased when no obvious cause could be readily identified and prompted the consideration of foul play.

If there were factors that collectively shone a light on LL then in such circumstances the hospital authorities have little choice but to act and in this case they initially moved LL to admin duties, which is effectively the least they could do.

They will have been aware of the potential for legal challenge and maybe ultimately an Employment Tribunal, but in the circumstances, if the decision making process is well documented then they will probably be seen to have acted with proportionality.

It's a case of damned if they do, damned if they don't. No doubt the merest concern about a nurse being implicated in the death of a patient will have the hospital authorities closing down the possibility of a repeat.

Suspension once suspected of a criminal offence in the workplace or one that could impact patient safeguarding/staff safety is also entirely proportionate and if they could interfere with witnesses, evidence or otherwise undermine the investigation.

I have consistently had NHS staff suspended immediately, once I am investigating them for less serious criminal offences. Of course they can appeal the decision but none ever have.
I’m not saying anyone acted improperly. I’m sure all parties acted with the best of intentions and heeding legal constraints and moral responsibilities. This was also true in the case of Lucia de Berk, and also in the case of Daniela Poggiali (both found non guilty after years of imprisonment, trials and retrials), and also in the cases of Ben Geen and Colin Norris (both contested). For me the important questions are: how did suspicion fall on Lucy? Who compiled the list of cases she is now charged of contributing to, and how and when? We already know that one of the cases on the initial list was recently dropped by police. We know that police investigated the medical records of all patient ‘incidents’ in which she had early been involved in, at another hospital where she’d worked earlier. Did they also investigate the incidents at which she was not involved? Who defined what is an incident, what isn’t? These “normal procedures” led straight to a miscarriage of justice in the case of Lucia de B. It was only corrected thanks to the activities of a medical whistle blower with inside information. And that took 9 years, during which time Lucia (in jail for life and under suicide watch) had a stroke and was left unconscious on the floor of a concrete cell for 12 hours. Later she was refused physiotherapy and she’s still paralysed in her right arm (she’s right handed). Society has a visceral reaction to baby killers. That’s only natural.
 

JosieJo

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Have you had sight of the RCPCH report?

It outlines the initial concerns over the neonatal mortality rate from June 2015 and how the hospital reviewed a number of deaths prior to inviting the RCPCH in to review the neonatal unit in July 2016, as a further response to the mortality concerns. The final report was published in November 2016.

The extract from the RCPCH report below is of interest. In my view the 'no obvious factors' comment is one which implies a consideration of deliberate harm.

3.10 The review team agreed that there were no obvious factors which linked the deaths and that circumstances in the unit were not materially different from those which might be found in many other neonatal units within the UK.

Here is an extract from the Guardian in June 2019.

Letby, originally from Hereford, had worked at the hospital for seven years and was training to work with babies in intensive care when she was detained last July. It is understood she was suspended a year earlier and before this she had been removed from clinical duties and placed in an administrative role.



The police were originally approached by the CoCH in May 2017 and LL was first arrested in July 2018. Therefore she must have been suspended around the time the police were first contacted in May 2017.

@gill1109 mentioned previously that he recalled mention of the mortality rate abating during a period when LL was on holiday.

There were obviously huge concerns regarding the mortality, which only increased when no obvious cause could be readily identified and prompted the consideration of foul play.

If there were factors that collectively shone a light on LL then in such circumstances the hospital authorities have little choice but to act and in this case they initially moved LL to admin duties, which is effectively the least they could do.

They will have been aware of the potential for legal challenge and maybe ultimately an Employment Tribunal, but in the circumstances, if the decision making process is well documented then they will probably be seen to have acted with proportionality.

It's a case of damned if they do, damned if they don't. No doubt the merest concern about a nurse being implicated in the death of a patient will have the hospital authorities closing down the possibility of a repeat.

Suspension once suspected of a criminal offence in the workplace or one that could impact patient safeguarding/staff safety is also entirely proportionate and if they could interfere with witnesses, evidence or otherwise undermine the investigation.

I have consistently had NHS staff suspended immediately, once I am investigating them for less serious criminal offences. Of course they can appeal the decision but none ever have.

Yes I have read the report.

I agree her suspension coincides with the police becoming involved

The period where she was placed on admin duties is what I was referring to.

"If there were factors that collectively shone a light on LL then in such circumstances the hospital authorities have little choice but to act and in this case they initially moved LL to admin duties, which is effectively the least they could do".


Yes this was my point in that imo it is unlikely just to be due to being on duty at the times, rather "collective" factors.

The full sequence of events , how long the admin duties were in place prior to suspension and why will be interesting
 

gill1109

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With such low average neonatal deaths at CoCH prior to 2015, in the range of 1-3 a year, then an increase of 1 in a year would be a 33 - 100% increase. With such low figures and any increase having to be a positive integer then percentage increases can appear misleading.

I have no idea how the Sun managed to calculate an increase in mortality of 10% when the original mortality was 3.....probably best not to follow their finance tips.
The Sun was quoting the earlier mentioned enquiry report! That report also does not say how it got their figure.
 

Whitehall 1212

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8 at most in one year. 2016? That's not enough to be noticed over the course of a couple of weeks holiday.

It could be if the deaths occurred in clusters.

The 8 investigated deaths in 2016 were from January to July, not spread over the whole calendar year.

If there was a cluster of cases just before LL went away in patients that she'd had direct contact with not long before their demise, which suddenly stopped when LL was absent, then rightly or wrongly this could give rise to a degree of suspicion that her presence was in some way instrumental.
 

Whitehall 1212

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Yes this was my point in that imo it is unlikely just to be due to being on duty at the times, rather "collective" factors.

The full sequence of events , how long the admin duties were in place prior to suspension and why will be interesting

Absolutely! Being privy to the reasoning, decision making process and the complete timelines of the events will be very interesting.
 

Blondiexoxo

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I have been waiting so long to hear what evidence they have against LL. it’s starting to feel like we will never find out. I hope they have live reporting from the court room and not just a random article giving a general rundown of the proceedings each day. I want to hear what they uncovered, if she was putting on an act for all those who claimed she was ‘lovely’. Fingers crossed we get some good reporting next week
 

Whitehall 1212

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Did they also investigate the incidents at which she was not involved?

EXTRACT

Criminal Procedure and Investigations Act 1996

In conducting and investigation the investigator should pursue all reasonable lines of enquiry, whether these point towards or away from the suspect. What is reasonable in each case will depend on the particular circumstances. For example, where material is held on computer, it is a matter for the investigator to decide which material on the computer it is reasonable to enquire into and in what manner.

I sincerely hope that the police went the extra mile to seek evidence that pointed away from LL's involvement.

The length of time involved from the first arrest to charge gives me confidence that the police have conducted a thorough, objective and overarching investigation, seeking ALL the evidence, both supporting and pointing away from involvement.

What must be a major evidential difficulty is that none of the post mortems included tests for toxicology, blood glucose and electrolytes. The absence of medical evidence of the cause of death must be a significant hurdle when seeking a conviction.
 

Marantz4250b

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With such low average neonatal deaths at CoCH prior to 2015, in the range of 1-3 a year, then an increase of 1 in a year would be a 33 - 100% increase. With such low figures and any increase having to be a positive integer then percentage increases can appear misleading.

I have no idea how the Sun managed to calculate an increase in mortality of 10% when the original mortality was 3.....probably best not to follow their finance tips.
The Sun article I've just seen mentions that the death rate was 10% higher than other neonatal units. A figure which, of itself, is utterly meaningless.

I'm not sure that the increased death rate is the real issue which got the hospital investigating things. Maybe the real motivator was the fact that a lot of the deaths which did occur were, apparently, quite unexpected and couldn't be reasonably explained. That and an increased rate was probably the reason for the investigations.
 

Marantz4250b

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It could be if the deaths occurred in clusters.

The 8 investigated deaths in 2016 were from January to July, not spread over the whole calendar year.

If there was a cluster of cases just before LL went away in patients that she'd had direct contact with not long before their demise, which suddenly stopped when LL was absent, then rightly or wrongly this could give rise to a degree of suspicion that her presence was in some way instrumental.
The full list of charges is listed on the Cheshire Live website and was published when she first appeared at the Mags court. It contains the names of the victims so I won't post a link. The dates are all over the place so it's difficult to determine any real pattern from them. There are periods of several months where there are no charges though. Having said that, there may have been incidents in the intervening periods which did not meet the charging threshold.
 

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In regards to Victorino Chua, the trigger for the investigation at Stepping Hill wasn't purely statistical, and they did have solid evidence that someone was tampering with medications:




As someone else has said, he wasn't even the first person arrested:

 

Marantz4250b

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I have been waiting so long to hear what evidence they have against LL. it’s starting to feel like we will never find out. I hope they have live reporting from the court room and not just a random article giving a general rundown of the proceedings each day. I want to hear what they uncovered, if she was putting on an act for all those who claimed she was ‘lovely’. Fingers crossed we get some good reporting next week
There has been live reporting in pretty much each one of her court appearances so I'm sure we'll get it throughout the trial. It's looking like being a very long trial though so it may be that media outlets won't assign people to it every single day.

As to what evidence they have against her or, more specifically, what they are going to allege as to how she did it, I'm leaning more towards it being some sort of tampering with medication or equipment. If you read the list of charges, some of them span several days, the November 2015 charge spans three weeks! I cannot easily see how one unlawful act could continue for that length of time unless they are alleging that she "set on motion", for want of a better phrase, some event or chain of events which continued for that period of time.

Edit: of course, thinking about it, it could mean that they don't know when she did it but are saying whatever it was happened between those dates. It seems rather tenuous though if they can't nail it down more accurately than a three week window, though.
 
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Whitehall 1212

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Maybe the real motivator was the fact that a lot of the deaths which did occur were, apparently, quite unexpected and couldn't be reasonably explained. That and an increased rate was probably the reason for the investigations.

I have no doubt that is the case together with the doctors who reported how unusually difficult it was to resuscitate the victims and the reports of mottling, often on the limbs. This may be due to vasoconstriction of the blood vessels.

The initial processes for monitoring and review of neoantal deaths was not robust, which may have highlighted key factors sooner.

It was as a result of all the doctors experiencing a least one instance of neonatal death in the department over time that their collective experience came to the fore.

When you work in an environment where tragic, dangerous and/or extreme events become the norm then one can sometimes become desensitised and not actively consider matters of concern.
 

Whitehall 1212

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The full list of charges is listed on the Cheshire Live website and was published when she first appeared at the Mags court. It contains the names of the victims so I won't post a link. The dates are all over the place so it's difficult to determine any real pattern from them. There are periods of several months where there are no charges though. Having said that, there may have been incidents in the intervening periods which did not meet the charging threshold.

There was a cluster of three deaths over a 14 day period in June 2015. Two of the triplets died within a day of each other in June 2016.

The dates/victim's of the attempted murders are not given. These may support a clustering pattern of the alleged offences, or not.

LL's precise shift, patient allocation, duties, absence of supervision/peers present may have all contributed to a perception that the incidents occurred within a short period after LL had been in an opportune position to harm the child, as opposed to other times when then there was a greater clinical presence.

The reasonable expectation is that ALL staff were subject to the same scrutiny of their activities and were fully exonerated.
 
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