For babies with a high probability of infection as a cause of death, rather than deliberate harm, one would expect to see more specific results for blood, aspirate and stool (although bowels had not open three days after birth).
What level of detail did you see in what you had access to?
What organisms were tested for? And what tests supported Dr Thomas' decision to discontinue antibiotics?
Given infection risk is the biggest threat to a neonate I would expect the records to be full of microbiology analysis - and not just the baby but environment, equipment and staff as well.
And now to digress from Baby E:
I would expect that the public have developed the impression that preterm babies are well and just need extra care and have no appreciation for their vulnerability and the consequences of not having full development to term in the womb that cannot be made good.
While arguably trying to reassure anxious parents medical or nursing staff using lay terms like "stable" and "very stable" don't help matters. When they are used on health records, there is obviously room for improvement.
Amazing that doctors retrospectively recall observing symptoms, that at the time were most unusual, yet never saw fit to record it in their notes. And while at the time they did not detect anything untoward, such that a post mortem was not necessary, they now with the benefit of hindsight and with the passage of six years, see the light.
I had to smile when I read Johnson KC's opening statement "It is a hospital like so many others in the UK,]". A basket case and I don't think the public know how bad that is, or maybe they do. Yet still accept it. At some point the English need to be able to answer for themselves why they take so much Sh*t.
The Countess of Chester these days is under CQC Enforcement Action and was issued with two Section 29A warning notices regarding (paraphrasing) (1) management of Post Partum Haemorrhage & hysterectomies , and (2) governance and management of incidents, complaints and PATIENT DEATH REVIEWS. So not much has changed over the years, new team players, but still scoring own goals.
Brave women going in to deliver there!
Imagine that the RCPCH were invited by the Medical Director to do a service review of the neonatal unit in June 2016, when LL had already been confined to day shifts in April. Their brief did not include an evaluation of any baby death cases. When they did their review on 1 & 2 Sept they found that there had been only one baby root cause review conducted at that stage. So Consultant paediatrician Gibbs suspected LL of murder in June of 2015, yet sixteen months on and six murders and seven attempted murders later, had not conducted more than ONE detailed review to problem solve what was going on. The families of the deceased should have a word with him.
The same Trust was shortlisted for TRUST OF THE YEAR in the Risk category while all this was going on. Further example, if it were needed of being world leading and world beating while crap at the same time. I thought they were mutually exclusive... what did I miss! lol.
I am just a lay person, but passionately believe that Lucy is innocent of any wrongdoing. Thank you for your hard work putting together a more complete critical analysis and scientific assessment of the death of Baby E.
Do we know if the PM’s were Coronial or Doctor led, if Coronial that would be a very interesting development, also which doctors signed death certificates, if any, and what cause of death was entered?
Thank you for all your hard work. I had ploughed through the trial account in the Chester Standard but was at a loss to understand what Lucy was supposed to have done in this case. I’m afraid I’m still at a loss. Is the fact that Lucy was in the room four feet away when the mother found dried blood on the baby’s face supposed to mean something?
According to the prosecution it was supposed to mean Letby had jammed the ET tube into his throat sufficient to cause it. The totality of evidence shows that he had unresolving bleeding caused by a clotting issue (in that, to put it simply, his clotting times were prolonged). The cause of that bleeding could, as Letby suggested, have been caused as a result of irritation from the tube, it might have been caused by the doctor when inserting the tube hours earlier, or it may have been caused by the infection damaging very thin and fragile tissues. Without the autopsy we will never know.
Excellent work again. Forgive me for any impertinence, but I think your particular reply here regarding how the prosecution claim Lucy killed this baby along with the other possible causes might be worth including in the main body of the text just to make that point more clear. Ta.
And what evidence there is, is actually evidence that disproves everything the doctors said. They keep sayig the babies are stable and that it can't be infection sepsis or in this case, NEC... yet everything points to it. Vomiting? hyperglycaemia? the desats? the purpura? the fact that Baby E's CRP went from 0.3 to 1.0 (a more than 300% increase that whilst still low, shows SOMETHING was happening inside him)? All these and more are common signs and symptoms of Sepsis and NEC yet apparently it was Lucy. I just don't know where to begin....
And it was made worse by the fact that the prosecution kept chopping and changing between witnesses, kept ensuring that their witnesses barely described some clinical manifestations - or, as with the blood and vomit, that these things only came out briefly or were so totally minimised that even the medically educated juror could miss them. There are things here that I had to piece together from the exhibits and testimony of two, three or even four prosecution witnesses.
And all that leaves aside how in each case the doctors (and some nurses) downplayed the actual seriousness of the condition of each neonate, and tried to uplift themselves as heroes that, but for Lucy, could have saved them all. Around 50% of neonates at the high end of prematurity (i.e. at 10-16 weks premature) will not survive to be discharged from hospital. Sadly, 25% that do leave hospital will have permanent mental or physical defecits. These are poorly babies with a low risk of survival. Show me where in the testimony the jurors were made aware of these low survivability rates?
Surely then it was for the defence to present their own medical experts to provide a reasonable doubt. Would the KC not have got some independent neonatal expert to go through the medical notes to find probable causes of death? This is the biggest mystery for me in all this
Original pathology: The case was referred to the coroner and the cause of Child A's death was 'unascertained' at the time.
Reviewing pathology (Dr Andreas Marnerides): Dr Marnerides said it appeared Child A, a twin boy, died as a result of an injection of air into his bloodstream.
He reviewed tissue samples from Child A. The medic says from his review, he found 'globules' in the veins in the lungs and brain tissue that were most likely air, he said this air 'most likely went there while this baby was alive'
Child 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.
Reviewing pathology (Dr Andreas Marnerides):
The prosecution added an independent pathologist said the skin colour changes in Child C were likely caused by prolonged unsuccessful resuscitation.
Child C had pneumonia, but the pathologist concluded Child C died as a result of having an excessive quantity of air injected into his stomach via the nasogastric tube (NGT).
Child D
Original pathology: The coroner gave the cause of death as "pneumonia with acute lung injury."
Reviewing pathology (Dr Andreas Marnerides): The “likely explanation” for the death of Child D, a girl, was an air embolism into her circulation.
Child E
The parents did not wish to have a post-mortem, the consultant did not deem one necessary, and the coroner's office agreed.
Child 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. All loops of bowel showed significantly dilated lumen due to increased air content – in layman’s terms they were expanded like a partially inflated balloon. There was no sign of NEC (bowel necrosis) or any other bowel problem.
Reviewing pathology (Dr Andreas Marnerides):
Child I, received an excessive injection of air into her stomach, he said.
Child 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.
Reviewing pathology (Dr Andreas Marnerides):
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 thought that the excess air via the NGT was likely to have led to stimulation of the vagal nerve which has an effect on heart rate and would have compromised Child O's breathing.
He could not say whether it was either of these factors in isolation or in combination which caused Child O's death.
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.
Child 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”.
Reviewing pathology (Dr Andreas Marnerides):
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.”
Thank you for bringing all this evidence together and explaining so clearly what really happened to this baby, and how evidence was presented in court in a way that was likely to mislead the jury.
Are the trial transcripts and patient notes publicly available? If so, would you mind pointing me to them, as there are a few things I would like to look at more closely too?
Jeez, this is an absolutely devastating read. I'm horrified.
Despite having a baby two years ago this month, following a series of medical emergencies and a previous birth where I nearly lost my girl (twice it's happened to me) and coming close to dying myself, I've managed to stay emotionally detached from this relatively well.
I don't believe Letby should have been convicted, I don't actually believe she's any guilty part whatsoever, but the description of that poor baby's death is horrific. That poor wee thing, the poor parents. It's absolutely heartbreaking.
Thank you for what you've done. Whether Letby is guilty or not (and obviously I do not believe she is) this has highlighted such unconscionable, hideous negligence. It's so much worse than one baddy, stalking the wards. Because we can see it's a whole culture, system, aided by overwork, understaffing, negligence, arrogance, and then a conspiracy to pin it on one woman.
I can't imagine how sociopathic you'd need to be to oversee not only this, but then the destruction of one hard working, young woman's life.
Even if the consultants were unaware of the warning signs, or the lack of fast and appropriate care, the fact they would just moan to management rather that go to the police absolutely sickens me. Who else would get away with that, while playing the clear sighted, brave whistleblower on the news?
Thank you for sharing all of this, it seems inexplicable how the defence failed to raise so many of these points... and the countless others in your other articles...
Would you be able to clarify from where you obtained the information (both in this post and others on this subject) , particularly in relation to the timelines, nursing notes etc? I've been looking for transcipts of notes, trial etc online and failed to find anything, just wondering if you may be able to point me in the right direction.... your articles seem meticulously researched, but it would be great if you could be able to provide reference to the source material... I certainly do not feel that letby has had a fair trial, and I would want to do anything within my very limited capacity to help build awareness and momentum to rectify that, though I know if I were to share blogs such as this and others similar with my immediate circle of friends etc, they'd likely reject it as soon as they fail to see any references... I can only imagine the vast amount of work and time you must put into this, and I do recognise that adding references/links to source material is a lengthy and tedious process in its own right, but feel providing that info could well persuade many people to sit up and take notice who would otherwise dismiss it out of hand.
The more I read the worse this gets, poor Lucy, no wonder she felt persecuted, because she was actually being persecuted. The plumbing that went directly though nursery one, in the suspended ceiling had micro-fractures, it was effectively spraying highly contaminated sewage water right over the incubators. It’s amazing that more babies didn’t die. I wonder how many staff had days off sick due to it??????
What a mess. Many thanks for this meticulous work.
For babies with a high probability of infection as a cause of death, rather than deliberate harm, one would expect to see more specific results for blood, aspirate and stool (although bowels had not open three days after birth).
What level of detail did you see in what you had access to?
What organisms were tested for? And what tests supported Dr Thomas' decision to discontinue antibiotics?
Given infection risk is the biggest threat to a neonate I would expect the records to be full of microbiology analysis - and not just the baby but environment, equipment and staff as well.
And now to digress from Baby E:
I would expect that the public have developed the impression that preterm babies are well and just need extra care and have no appreciation for their vulnerability and the consequences of not having full development to term in the womb that cannot be made good.
While arguably trying to reassure anxious parents medical or nursing staff using lay terms like "stable" and "very stable" don't help matters. When they are used on health records, there is obviously room for improvement.
Amazing that doctors retrospectively recall observing symptoms, that at the time were most unusual, yet never saw fit to record it in their notes. And while at the time they did not detect anything untoward, such that a post mortem was not necessary, they now with the benefit of hindsight and with the passage of six years, see the light.
I had to smile when I read Johnson KC's opening statement "It is a hospital like so many others in the UK,]". A basket case and I don't think the public know how bad that is, or maybe they do. Yet still accept it. At some point the English need to be able to answer for themselves why they take so much Sh*t.
The Countess of Chester these days is under CQC Enforcement Action and was issued with two Section 29A warning notices regarding (paraphrasing) (1) management of Post Partum Haemorrhage & hysterectomies , and (2) governance and management of incidents, complaints and PATIENT DEATH REVIEWS. So not much has changed over the years, new team players, but still scoring own goals.
Brave women going in to deliver there!
Imagine that the RCPCH were invited by the Medical Director to do a service review of the neonatal unit in June 2016, when LL had already been confined to day shifts in April. Their brief did not include an evaluation of any baby death cases. When they did their review on 1 & 2 Sept they found that there had been only one baby root cause review conducted at that stage. So Consultant paediatrician Gibbs suspected LL of murder in June of 2015, yet sixteen months on and six murders and seven attempted murders later, had not conducted more than ONE detailed review to problem solve what was going on. The families of the deceased should have a word with him.
The same Trust was shortlisted for TRUST OF THE YEAR in the Risk category while all this was going on. Further example, if it were needed of being world leading and world beating while crap at the same time. I thought they were mutually exclusive... what did I miss! lol.
I am just a lay person, but passionately believe that Lucy is innocent of any wrongdoing. Thank you for your hard work putting together a more complete critical analysis and scientific assessment of the death of Baby E.
How was Lucy Letby supposed to have caused this death? Some kind of action at a distance?
Einstein never liked Spooky Action At A Distance.
Neither do I
Do we know if the PM’s were Coronial or Doctor led, if Coronial that would be a very interesting development, also which doctors signed death certificates, if any, and what cause of death was entered?
Thank you for all your hard work. I had ploughed through the trial account in the Chester Standard but was at a loss to understand what Lucy was supposed to have done in this case. I’m afraid I’m still at a loss. Is the fact that Lucy was in the room four feet away when the mother found dried blood on the baby’s face supposed to mean something?
According to the prosecution it was supposed to mean Letby had jammed the ET tube into his throat sufficient to cause it. The totality of evidence shows that he had unresolving bleeding caused by a clotting issue (in that, to put it simply, his clotting times were prolonged). The cause of that bleeding could, as Letby suggested, have been caused as a result of irritation from the tube, it might have been caused by the doctor when inserting the tube hours earlier, or it may have been caused by the infection damaging very thin and fragile tissues. Without the autopsy we will never know.
Excellent work again. Forgive me for any impertinence, but I think your particular reply here regarding how the prosecution claim Lucy killed this baby along with the other possible causes might be worth including in the main body of the text just to make that point more clear. Ta.
I originally thought the "evidence" was circumstantial but in this case, it's pretty much entirely absent??
And what evidence there is, is actually evidence that disproves everything the doctors said. They keep sayig the babies are stable and that it can't be infection sepsis or in this case, NEC... yet everything points to it. Vomiting? hyperglycaemia? the desats? the purpura? the fact that Baby E's CRP went from 0.3 to 1.0 (a more than 300% increase that whilst still low, shows SOMETHING was happening inside him)? All these and more are common signs and symptoms of Sepsis and NEC yet apparently it was Lucy. I just don't know where to begin....
At such a difficult time your hard work, expertise and dilligance are such a breath of fresh air. Thank you!
Excellent work, your attention to detail is evident & much appreciated. Deserving of a much wider audience.
Thank you for taking time to research the science and presenting such a clear chronology of events. Hard to read but worth it.
Having read this, I can now see what an incredibly difficult job the jurors had.
Bingo!
And it was made worse by the fact that the prosecution kept chopping and changing between witnesses, kept ensuring that their witnesses barely described some clinical manifestations - or, as with the blood and vomit, that these things only came out briefly or were so totally minimised that even the medically educated juror could miss them. There are things here that I had to piece together from the exhibits and testimony of two, three or even four prosecution witnesses.
And all that leaves aside how in each case the doctors (and some nurses) downplayed the actual seriousness of the condition of each neonate, and tried to uplift themselves as heroes that, but for Lucy, could have saved them all. Around 50% of neonates at the high end of prematurity (i.e. at 10-16 weks premature) will not survive to be discharged from hospital. Sadly, 25% that do leave hospital will have permanent mental or physical defecits. These are poorly babies with a low risk of survival. Show me where in the testimony the jurors were made aware of these low survivability rates?
Surely then it was for the defence to present their own medical experts to provide a reasonable doubt. Would the KC not have got some independent neonatal expert to go through the medical notes to find probable causes of death? This is the biggest mystery for me in all this
I only wish we knew
Summary of Pathology
Child A
Original pathology: The case was referred to the coroner and the cause of Child A's death was 'unascertained' at the time.
Reviewing pathology (Dr Andreas Marnerides): Dr Marnerides said it appeared Child A, a twin boy, died as a result of an injection of air into his bloodstream.
He reviewed tissue samples from Child A. The medic says from his review, he found 'globules' in the veins in the lungs and brain tissue that were most likely air, he said this air 'most likely went there while this baby was alive'
Child 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.
Reviewing pathology (Dr Andreas Marnerides):
The prosecution added an independent pathologist said the skin colour changes in Child C were likely caused by prolonged unsuccessful resuscitation.
Child C had pneumonia, but the pathologist concluded Child C died as a result of having an excessive quantity of air injected into his stomach via the nasogastric tube (NGT).
Child D
Original pathology: The coroner gave the cause of death as "pneumonia with acute lung injury."
Reviewing pathology (Dr Andreas Marnerides): The “likely explanation” for the death of Child D, a girl, was an air embolism into her circulation.
Child E
The parents did not wish to have a post-mortem, the consultant did not deem one necessary, and the coroner's office agreed.
Child 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. All loops of bowel showed significantly dilated lumen due to increased air content – in layman’s terms they were expanded like a partially inflated balloon. There was no sign of NEC (bowel necrosis) or any other bowel problem.
Reviewing pathology (Dr Andreas Marnerides):
Child I, received an excessive injection of air into her stomach, he said.
Child 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.
Reviewing pathology (Dr Andreas Marnerides):
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 thought that the excess air via the NGT was likely to have led to stimulation of the vagal nerve which has an effect on heart rate and would have compromised Child O's breathing.
He could not say whether it was either of these factors in isolation or in combination which caused Child O's death.
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.
Child 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”.
Reviewing pathology (Dr Andreas Marnerides):
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.”
Very thorough excellent article
Look forward to the next one
Thank you for bringing all this evidence together and explaining so clearly what really happened to this baby, and how evidence was presented in court in a way that was likely to mislead the jury.
Are the trial transcripts and patient notes publicly available? If so, would you mind pointing me to them, as there are a few things I would like to look at more closely too?
Jeez, this is an absolutely devastating read. I'm horrified.
Despite having a baby two years ago this month, following a series of medical emergencies and a previous birth where I nearly lost my girl (twice it's happened to me) and coming close to dying myself, I've managed to stay emotionally detached from this relatively well.
I don't believe Letby should have been convicted, I don't actually believe she's any guilty part whatsoever, but the description of that poor baby's death is horrific. That poor wee thing, the poor parents. It's absolutely heartbreaking.
Thank you for what you've done. Whether Letby is guilty or not (and obviously I do not believe she is) this has highlighted such unconscionable, hideous negligence. It's so much worse than one baddy, stalking the wards. Because we can see it's a whole culture, system, aided by overwork, understaffing, negligence, arrogance, and then a conspiracy to pin it on one woman.
I can't imagine how sociopathic you'd need to be to oversee not only this, but then the destruction of one hard working, young woman's life.
Even if the consultants were unaware of the warning signs, or the lack of fast and appropriate care, the fact they would just moan to management rather that go to the police absolutely sickens me. Who else would get away with that, while playing the clear sighted, brave whistleblower on the news?
Thank you, so much
Thank you for sharing all of this, it seems inexplicable how the defence failed to raise so many of these points... and the countless others in your other articles...
Would you be able to clarify from where you obtained the information (both in this post and others on this subject) , particularly in relation to the timelines, nursing notes etc? I've been looking for transcipts of notes, trial etc online and failed to find anything, just wondering if you may be able to point me in the right direction.... your articles seem meticulously researched, but it would be great if you could be able to provide reference to the source material... I certainly do not feel that letby has had a fair trial, and I would want to do anything within my very limited capacity to help build awareness and momentum to rectify that, though I know if I were to share blogs such as this and others similar with my immediate circle of friends etc, they'd likely reject it as soon as they fail to see any references... I can only imagine the vast amount of work and time you must put into this, and I do recognise that adding references/links to source material is a lengthy and tedious process in its own right, but feel providing that info could well persuade many people to sit up and take notice who would otherwise dismiss it out of hand.
This is fabulous and important work, thank you
The more I read the worse this gets, poor Lucy, no wonder she felt persecuted, because she was actually being persecuted. The plumbing that went directly though nursery one, in the suspended ceiling had micro-fractures, it was effectively spraying highly contaminated sewage water right over the incubators. It’s amazing that more babies didn’t die. I wonder how many staff had days off sick due to it??????
I got this piece of info from a YouTube video: https://youtu.be/k12f_VFCbtI?si=WxZBAy7jrqHdMBMj