inference is far, very far, from beyond a reasonable doubt....
“One question in need of further attention is when guilt is proven beyond a reasonable doubt (BARD) in criminal trials. This article defends an inference to the best explanation (IBE)-based approach on which guilt is only established BARD if (1) the best guilt explanation in a case is substantially more plausible than any innocence explanation, and (2) “there is no good reason to presume that we have overlooked evidence or alternative explanations that could realistically have exonerated the defendant”
There is every good reason to question the evidence not led by the defence!
We have to ask WHY some of this evidence, like the insuling evidence, remained largely unchalleneged. And WHY did they advise Lucy to accept the insulin evidence without challenge? She is a nurse - she would not have been trained in insulin pharmacodynamics where it crossed firmly into pathology findings, so she can't possibly understand any of what was put to her beyond what was written on the piece of paper. Was the test conducted with due care and attention? was it the right and proper test or was the test used against protocol? what do the results really mean? As a nurse you are taught to await the doctor's assessment. Accordingly, she would likely have no idea.
It doesn’t appear to be one of Ben Myers finest hours, on the face of things, however that is me speculating, I obviously have no idea what his instructions were, or what transpired in chambers...apart from BM’s failed objection to the admittance of Evans testimony/opinion.
There is an unnerving silence from LL’s defence on the subject of appeal, which I do not comprehend at all.
There is also now the added, as I see it abuse of process, instigated by the government, with the announcement of a Judge led inquiry.....before the clarification of the possibility of any appeal. They, if there is to be an appeal, cannot run in tandem, an appeal, if any, must be heard free of any outside influences, which could taint any appeal, by suggestion or innuendo.
A quite staggering lack of legal acumen, by the government and its law officers.
This is the most serious type of criminal case, for murder. How did the defence not raise these issues? What happened to the 'beyond reasonable doubt'? We are spoilt for choice of reasonable doubts.
Don't forget that you and the journos and jury members have vastly different capabilities.
Your expectation of journalists is far too high - but we all struggle with their power of pen or pixel. The Pandemic shone a blinding light on their ineptitude.
As for the jury, "If I had been a member of the jury the prosecution would have had to prove to me" well they are nothing like you. They don't remotely think the way you do. If things were being done right you'd think she should have been judged by a group of her peers, namely medical or biomedical professionals, scientists, not just your average Jack and Jill.
And in the end the Judge essentially invited the jury, with their limited insight, to speculate:
“If you are sure that someone on the unit was deliberately harming a baby or babies, you do not have to be sure of the precise harmful act or acts. In some instances, there may have been more than one.]
[ (you) must be sure Letby deliberately did something to the child that was “more than a minimal cause” of the death.]
[ “In the case of each child, without necessarily having to determine the precise cause or causes of their death and for which no natural or known cause was said to be apparent at the time, you must be sure that the act or acts of the defendant, whatever they were, caused the child’s death in that it was more than a minimal cause."
From the Judge's perspective it wasn't necessary to know what was done, how many times it was done, or whether there were different things done. So long as you suspected whatever it was that was done, and if that (unknown) was enough to cause death, then the defendant must be guilty.
I admit that I too have an issue with judges saying (for example): Just because something was here, and now it is there, and this person passed through the area at some point but was never seen to actually move it - you, the jury, are 'free to infer' that they moved it. If you have to 'infer' then to my mind you cannot be absolutely certain - certainly not to the level of being beyond a reasonable doubt.
It seems that in many ways the jurors were expected both to act with the capability of coroners, and to ignore the findings of the coroners who did investigate the infants' deaths.
What premature babies are put through in NICU is a form of torture. How on earth any neonatologist lives with themself is simply beyond comprehension. The invasive care/treatment these newborn premature babies receive is simply a horror. I still have flashbacks from the 70’when I worked for less than one year in NICU. It was horrible.
I have family who avoided paediatrics for that very reason.
When you think that below 2.5kg is considered low birth weight, and some of these babies were "born" at 25-27 weeks gestation weighing 700 - 800 grammes. Devices are inserted and the baby scanned to confirm it is not in close proximity to the heart, you have to wonder what it is travelling through.
There is also the fact that premature and underweight babies born at a centre with a Level 3 NICU (say Arrow Park or Liverpool Womens Hospital) have a 53% chance (according to the Royal College of Paeds) of dying during their stay - with 1 in 3 that do survive to discharge having a permanent mental or physical defecit as a result of prematurity and their medical adventures.
Premature and underweight babies born in a Level 2 Local Neonatal Unit (LNU) centre like CoCH was during the 18 months of Lucy's supposed involvement have a greater chance of dying - the death rate rises to 63%.
Therefore, if we consider that 6.4% of babies in the UK are born underweight and premature, and CoCH had 600 births per year, that means around 40 underweight and premature babies per year were born there in a year, 60 in the 18 month period of Lucy's supposed death spree... and 63% would have died - therefore 38/60 should have died in the period yet only 17 such babies did.
Therefore there were not increased deaths due to Lucy or a murderer, they were actually SAVING almost twice as many of these underweight and premature babies as the national average for a Level 2 unit!
The interesting thing about this area of human development is the power/dominance of the undeveloped ventral vagus nerve, that can drive bradycardia and death in neonates, and could well have been central in the demise of babies in this trial.
You just never know when it is going to happen. The rule is expect the unexpected. Whether LL is guilty or not, it is an area fraught with challenges.
Interesting too that they attributed the incessant crying of one baby to LL interference, when such preterm babies cry unconsolably, when their autonomic nervous system has not developed properly (and cannot achieve full development having missed that opportunity in the womb). When they are discharged home parents are beside themselves on how to deal with it. These kids unfortunately are disruptive amongst their peers, don't exam well and face a future with a lot of challenges.
“...and for which no natural or known cause was said to be apparent at the time...”
Apparently 6 post-mortem examinations said death through natural causes. So it would seem therefore that for the jury to convict, for those 6 cases at least, the court would have had to bring forward evidence to refute those PM conclusions. As far as we know that didn’t happen.
Exactly. Most of the children who died either at CoCH, or who were transferred out and died elsewhere, have some form of natural causes on their death certificate... As you correctly point out there does not appear to have been a coronial inquest first to discharge the causes on the prior death certificates.
Thanks for ongoing articles, fascinating and enlightening. Out of interest- have you made/intend to make any contact with Lucy's defence team or family? Have you reached out to any of the expert witnesses for interview/comment?
The so-called 'expert' witnesses are potentially anything but (at least one of them, anyhow). They are too busy enjoying their 15 mins of fame on the telly.
I also don't feel it is my place to reach out to her family - they have got to be going through some pretty dark times at the moment and don't need all and sundry disturbing their peace. I know of at least two barristers who are trying to contact them to offer their services - one has suggested he may do it pro bono.
I have had recent experience of a COVID-19 ICU case where the lawyers involved engaged the wrong medico-legal expert - in my opinion.
While there was a query concerning whether the patient was infected while in hospital and a medical microbiologist may have been the appropriate expert to evaluate that, she certainly wasn't the expert required to assess ICU practice. Yet she reported on that ICU performance and failed to comment on the obvious administration of penicillin class antibiotic to a patient who was on record as having such an allergic response. When challenged then proceeded to trivialise the allergy diagnosis.
I sense a lot of circling the wagons. And if you think the number of cases in the LL trial is a lot, the number of cases of negligence and incompetence is a whole different order of magnitude where it comes to COVID-19. And I am not referring to nosocomial infection.
The professions and insurance industry are actively derailing work in this area.
If the handling of the contaminated blood products scandal reflects how things are likely to pan out, it does not augur to well for those concerned.
I've been waiting for more insights into the insulin issues. Thank you. I have a lingering question that I doubt will be answerable. Just who took the blood test, when and how? I'm thinking more of potential competence of a locum, unfamiliar with the busy unit and procedures, flustered, flushing a syringe with insulin rather than heparin, both kept in the fridge....if this was required to prevent samples clotting on the way to the lab?? Were both babies TPN prescription available as evidence, that would clarify if one had added insulin, if there was potential for the wrong bag to have been administered. I'm sure to a neonatal professor, like Lucy's witness who didn't give evidence, other causes would have been hilighted. .
Generally speaking the blood tests should have been taken into a pre-prepared tube. It is pretty uncommon now for anyone to be manually preparing a blood sample container. In this case one would expect it probably should have gone into two seperate tubes each for insulin and c-peptide tests:
one serum tube (gold top)
one plasma tube (green/yellow top)
and maybe
a Citrate tube (if being thorough and testing for glucose).
Thank you for another amazing and insightful piece of research.
I'm really hopeful that with people like you (well you really) fighting Lucy’s corner, she will appeal and be exonerated of this trumped up charge, and shocking miscarriage of justice.
Do you know the insulin level found in the tests and the units used?
Mr google & even articles in google scholar use confusing units. There is microIU per ml or litre, and pmol per ml or litre. I have read that pmol/litre should be used.
If the level was unusually high was the baby's clinical condition consistent with that level? If not, then what could cause that? If as high as some say > 4000 ??units the baby would surely be unconscious & not survive.
You have explained how the test itself may be inappropriate. Another possibility is that somewhere between collection & analysis, insulin got into the specimen. I assume Chester Path spun the specimen down & froze it because it was frozen when arrived at Liverpool. How many hands did it pass through. Was it sitting in a fridge at any time unobserved? We will probably never know but this 'evidence' is so tainted.
I am not saying that if 1-3 are positive then 4 must be 'true'.
What I am getting at there is that even IF they showed positive findings for 1-3, they still have to convince me that she is the only plausible remaining explanation (beyond a reasonable doubt) before I would confer a guilty verdict. This is because there is still room for it to have been a cryptic infection or some other natural causes event (the Colin Norris case is going back to the court of appeal because as we have learned more about how the body regulates glucose control, we are learning that our assumptions about things like insulin and c-peptides may be completely wrong). There is also still room for this to have been, as I suggest in the article, an accidental incident whereby insulin intended for Baby E (same surname) got unintentionally administered to Baby F (same surname)
inference is far, very far, from beyond a reasonable doubt....
“One question in need of further attention is when guilt is proven beyond a reasonable doubt (BARD) in criminal trials. This article defends an inference to the best explanation (IBE)-based approach on which guilt is only established BARD if (1) the best guilt explanation in a case is substantially more plausible than any innocence explanation, and (2) “there is no good reason to presume that we have overlooked evidence or alternative explanations that could realistically have exonerated the defendant”
There is every good reason to question the evidence not led by the defence!
I couldn't agree more.
We have to ask WHY some of this evidence, like the insuling evidence, remained largely unchalleneged. And WHY did they advise Lucy to accept the insulin evidence without challenge? She is a nurse - she would not have been trained in insulin pharmacodynamics where it crossed firmly into pathology findings, so she can't possibly understand any of what was put to her beyond what was written on the piece of paper. Was the test conducted with due care and attention? was it the right and proper test or was the test used against protocol? what do the results really mean? As a nurse you are taught to await the doctor's assessment. Accordingly, she would likely have no idea.
It doesn’t appear to be one of Ben Myers finest hours, on the face of things, however that is me speculating, I obviously have no idea what his instructions were, or what transpired in chambers...apart from BM’s failed objection to the admittance of Evans testimony/opinion.
There is an unnerving silence from LL’s defence on the subject of appeal, which I do not comprehend at all.
There is also now the added, as I see it abuse of process, instigated by the government, with the announcement of a Judge led inquiry.....before the clarification of the possibility of any appeal. They, if there is to be an appeal, cannot run in tandem, an appeal, if any, must be heard free of any outside influences, which could taint any appeal, by suggestion or innuendo.
A quite staggering lack of legal acumen, by the government and its law officers.
A quite staggering lack of legal acumen
This is the most serious type of criminal case, for murder. How did the defence not raise these issues? What happened to the 'beyond reasonable doubt'? We are spoilt for choice of reasonable doubts.
I really hope Lucy can appeal. I can't believe she was found guilty!
Don't forget that you and the journos and jury members have vastly different capabilities.
Your expectation of journalists is far too high - but we all struggle with their power of pen or pixel. The Pandemic shone a blinding light on their ineptitude.
As for the jury, "If I had been a member of the jury the prosecution would have had to prove to me" well they are nothing like you. They don't remotely think the way you do. If things were being done right you'd think she should have been judged by a group of her peers, namely medical or biomedical professionals, scientists, not just your average Jack and Jill.
And in the end the Judge essentially invited the jury, with their limited insight, to speculate:
“If you are sure that someone on the unit was deliberately harming a baby or babies, you do not have to be sure of the precise harmful act or acts. In some instances, there may have been more than one.]
[ (you) must be sure Letby deliberately did something to the child that was “more than a minimal cause” of the death.]
[ “In the case of each child, without necessarily having to determine the precise cause or causes of their death and for which no natural or known cause was said to be apparent at the time, you must be sure that the act or acts of the defendant, whatever they were, caused the child’s death in that it was more than a minimal cause."
From the Judge's perspective it wasn't necessary to know what was done, how many times it was done, or whether there were different things done. So long as you suspected whatever it was that was done, and if that (unknown) was enough to cause death, then the defendant must be guilty.
Am I reading all this right?
Is this 2023?
Am I on a different planet?
Or wtf is going on?
Can some one tell me please.
Thank you.
I admit that I too have an issue with judges saying (for example): Just because something was here, and now it is there, and this person passed through the area at some point but was never seen to actually move it - you, the jury, are 'free to infer' that they moved it. If you have to 'infer' then to my mind you cannot be absolutely certain - certainly not to the level of being beyond a reasonable doubt.
Yes, I too am totally bewildered as to how and why this case was so badly handled by the 'Justice System'.
It seems that in many ways the jurors were expected both to act with the capability of coroners, and to ignore the findings of the coroners who did investigate the infants' deaths.
It's beyond all understanding how these assertions have been left unchallenged.
What premature babies are put through in NICU is a form of torture. How on earth any neonatologist lives with themself is simply beyond comprehension. The invasive care/treatment these newborn premature babies receive is simply a horror. I still have flashbacks from the 70’when I worked for less than one year in NICU. It was horrible.
I have family who avoided paediatrics for that very reason.
When you think that below 2.5kg is considered low birth weight, and some of these babies were "born" at 25-27 weeks gestation weighing 700 - 800 grammes. Devices are inserted and the baby scanned to confirm it is not in close proximity to the heart, you have to wonder what it is travelling through.
There is also the fact that premature and underweight babies born at a centre with a Level 3 NICU (say Arrow Park or Liverpool Womens Hospital) have a 53% chance (according to the Royal College of Paeds) of dying during their stay - with 1 in 3 that do survive to discharge having a permanent mental or physical defecit as a result of prematurity and their medical adventures.
Premature and underweight babies born in a Level 2 Local Neonatal Unit (LNU) centre like CoCH was during the 18 months of Lucy's supposed involvement have a greater chance of dying - the death rate rises to 63%.
Therefore, if we consider that 6.4% of babies in the UK are born underweight and premature, and CoCH had 600 births per year, that means around 40 underweight and premature babies per year were born there in a year, 60 in the 18 month period of Lucy's supposed death spree... and 63% would have died - therefore 38/60 should have died in the period yet only 17 such babies did.
Therefore there were not increased deaths due to Lucy or a murderer, they were actually SAVING almost twice as many of these underweight and premature babies as the national average for a Level 2 unit!
The interesting thing about this area of human development is the power/dominance of the undeveloped ventral vagus nerve, that can drive bradycardia and death in neonates, and could well have been central in the demise of babies in this trial.
You just never know when it is going to happen. The rule is expect the unexpected. Whether LL is guilty or not, it is an area fraught with challenges.
Interesting too that they attributed the incessant crying of one baby to LL interference, when such preterm babies cry unconsolably, when their autonomic nervous system has not developed properly (and cannot achieve full development having missed that opportunity in the womb). When they are discharged home parents are beside themselves on how to deal with it. These kids unfortunately are disruptive amongst their peers, don't exam well and face a future with a lot of challenges.
“...and for which no natural or known cause was said to be apparent at the time...”
Apparently 6 post-mortem examinations said death through natural causes. So it would seem therefore that for the jury to convict, for those 6 cases at least, the court would have had to bring forward evidence to refute those PM conclusions. As far as we know that didn’t happen.
Exactly. Most of the children who died either at CoCH, or who were transferred out and died elsewhere, have some form of natural causes on their death certificate... As you correctly point out there does not appear to have been a coronial inquest first to discharge the causes on the prior death certificates.
Thanks for ongoing articles, fascinating and enlightening. Out of interest- have you made/intend to make any contact with Lucy's defence team or family? Have you reached out to any of the expert witnesses for interview/comment?
The so-called 'expert' witnesses are potentially anything but (at least one of them, anyhow). They are too busy enjoying their 15 mins of fame on the telly.
I also don't feel it is my place to reach out to her family - they have got to be going through some pretty dark times at the moment and don't need all and sundry disturbing their peace. I know of at least two barristers who are trying to contact them to offer their services - one has suggested he may do it pro bono.
Medical and scientific expertise from outside the UK will be required.
The sad thing was that there were experts on such things as the insulin issues (e.g. Prof Vincent Marks) who it seems were never asked. :-(
I have had recent experience of a COVID-19 ICU case where the lawyers involved engaged the wrong medico-legal expert - in my opinion.
While there was a query concerning whether the patient was infected while in hospital and a medical microbiologist may have been the appropriate expert to evaluate that, she certainly wasn't the expert required to assess ICU practice. Yet she reported on that ICU performance and failed to comment on the obvious administration of penicillin class antibiotic to a patient who was on record as having such an allergic response. When challenged then proceeded to trivialise the allergy diagnosis.
I sense a lot of circling the wagons. And if you think the number of cases in the LL trial is a lot, the number of cases of negligence and incompetence is a whole different order of magnitude where it comes to COVID-19. And I am not referring to nosocomial infection.
The professions and insurance industry are actively derailing work in this area.
If the handling of the contaminated blood products scandal reflects how things are likely to pan out, it does not augur to well for those concerned.
Yes. I have been wondering if an appeal is possible/likely. The case is horrifying
I've been waiting for more insights into the insulin issues. Thank you. I have a lingering question that I doubt will be answerable. Just who took the blood test, when and how? I'm thinking more of potential competence of a locum, unfamiliar with the busy unit and procedures, flustered, flushing a syringe with insulin rather than heparin, both kept in the fridge....if this was required to prevent samples clotting on the way to the lab?? Were both babies TPN prescription available as evidence, that would clarify if one had added insulin, if there was potential for the wrong bag to have been administered. I'm sure to a neonatal professor, like Lucy's witness who didn't give evidence, other causes would have been hilighted. .
Generally speaking the blood tests should have been taken into a pre-prepared tube. It is pretty uncommon now for anyone to be manually preparing a blood sample container. In this case one would expect it probably should have gone into two seperate tubes each for insulin and c-peptide tests:
one serum tube (gold top)
one plasma tube (green/yellow top)
and maybe
a Citrate tube (if being thorough and testing for glucose).
Thank you for another amazing and insightful piece of research.
I'm really hopeful that with people like you (well you really) fighting Lucy’s corner, she will appeal and be exonerated of this trumped up charge, and shocking miscarriage of justice.
Do you know the insulin level found in the tests and the units used?
Mr google & even articles in google scholar use confusing units. There is microIU per ml or litre, and pmol per ml or litre. I have read that pmol/litre should be used.
If the level was unusually high was the baby's clinical condition consistent with that level? If not, then what could cause that? If as high as some say > 4000 ??units the baby would surely be unconscious & not survive.
You have explained how the test itself may be inappropriate. Another possibility is that somewhere between collection & analysis, insulin got into the specimen. I assume Chester Path spun the specimen down & froze it because it was frozen when arrived at Liverpool. How many hands did it pass through. Was it sitting in a fridge at any time unobserved? We will probably never know but this 'evidence' is so tainted.
How is the info from the medical records obtained?
I am not saying that if 1-3 are positive then 4 must be 'true'.
What I am getting at there is that even IF they showed positive findings for 1-3, they still have to convince me that she is the only plausible remaining explanation (beyond a reasonable doubt) before I would confer a guilty verdict. This is because there is still room for it to have been a cryptic infection or some other natural causes event (the Colin Norris case is going back to the court of appeal because as we have learned more about how the body regulates glucose control, we are learning that our assumptions about things like insulin and c-peptides may be completely wrong). There is also still room for this to have been, as I suggest in the article, an accidental incident whereby insulin intended for Baby E (same surname) got unintentionally administered to Baby F (same surname)