25 Comments

Unfortunately, everything you have prepared and written, points to a very badly executed defence strategy, if there was any, other than the plumber.

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Excellent work Scott, keep going.

Looking at the LNU Criteria for treatment ie greater than 800gms and 48 hours time limit, otherwise transfer.

Child A is indeterminate borderline for the 48 hrs. Time of birth not given.

Child C breaches the criteria on both counts. 800gms at birth with a post birth reduction predicted.

Child E breaches 48hrs criteria - estimated 6 days in LNU

Is the system failing ie transfers not possible or are the doctors exceeding their competence?

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And with 1 fighting the respirator so extubated at midnight & died and one having ett 'fall' out was sedation adequate?

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Nothing about the trial seems right. It's like the trials of witches in the 17th century. Once accused there is no way to prove innocence. There must be another agenda behind this.

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Absolutely, it was assumption of guilt by association rather than proof of guilt through evidence. Normally their is an assumption of innocence and the prosecution must to prove guilt, rather than the defence must prove innocence. Clearly this trial wasn’t normal.

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Hard to see it any other way. The defence seems to be subservient to the prosecution. What's going on?

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Robert,

17thCentury witch trials - my thoughts precisely. Another agenda? The Unit was failing and it would reflect on the Consultants, if they can lay the blame at LL or another it saves their professional ego. Management wouldn't buy moving LL to save Consultants ego . I suspect the Consultants thought the Police would take a light touch and force management's hands - no way with this career defining case, some have got promotions for their work, they never going to say move on nothing to see here.

And then the Jury - 12 'men' randomly picked basically off the street. The Closing Statements and Judge's Summing up were 5 days each ie 15 days of complex conflicting information and then make a decision on 22 ? charges can't see what job or life experience can prepare you for that challenge. Add in the intense media coverage and the Jury must have confirmatory bias as a survival mechanism ie lean towards the Prosecution and media viewpoint, in fear of being criticised, they will live locally. Perhaps a Jury should not be used in complex cases such as this.

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Typo in 2nd paragraph? 57 birthz not deaths.

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Corrected. Thanks!

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I have seen such numbers reported elsewhere so the data here doesn't surprise. Of course in using statistics we cannot rely on the average alone. It would be interesting to see the detail, so the dispersion around that average was understood.

Unless I missed it, are you saying that the upgrade from Special care baby unit to Locale neonate unit was made early 2015? I saw that it dropped to SCBU in 2016, according to the RCPCH report.

Was that the CoCH NHS Trust's only experience in running a LNU?

Curious how the categories of baby deaths in the FOI response are defined?

The whole investigation was started based on the identification of a cluster of deaths that were unusual. The RCPCH reports "13-14 (1 excluded)" as the size of cluster, which obviously grew when the police got involved.

The jury had to decide if they were convinced someone was harming babies, which had to be based on the definition of unexpected and unexplained. Besides the fact that the RCPCH report highlights a long list of deficiencies, it also gave the impression that a definition of what constitutes an unexpected death was lacking. What defines unexpected at that, or any other neonatal unit, is key to the case.

One of the first things I would be doing as defence is not just looking at the detail in the CoCH but other units/Trusts too. But there is also a lack of lab test results reported in the media.

There isn't enough information in the public domain to assess this case, nor did it appear at trial as far as I am aware. But to have a MEDICAL unexplained factor that was common across so many deaths is quite incredible. And all this against a backdrop of not having an established clear definition for reporting and engaging with outside parties, a failure to adhere to proper practice by engaging with the right players and external bodies when such a death occurred, and by the 1-2 Sept 2016 not having conducted a proper root cause review of deaths, as well as a unit of questionable LNU experience,

Ouch.

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IN the FOI they provide separate columns for stillbirth, early neonate, late neonate and post neonate deaths... so we at least have defined classes to work from. As best as I can tell in 2014 (one of their NHS Trust reports confirmed this) they were a SCBU, in 2015 they were magically an LNU, and then in mid-2016 they voluntarily downgraded back to a SCBU.

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I saw that and wondered how early, late and post were defined, and how it correlates with birth weight data etc.

You would know more about this, but I would have thought there would be prerequisites for that grading. When the RCPCH report highlights staffing issues it seems unlikely they would have met the basics.

Sadly a feature of the dilapidated NHS.

Interesting that the consultants described themselves "as victims of their own success", while managing only two ward rounds per week for an area that was most susceptible to deaths.

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Why did the defence fail to make these points? Something is very wrong about this trial.

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Has a group to innocent Ms. Letby been started? If yes, would you know where to direct me?

If not, would you join such group?

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No conclusion of guilt or innocence can be arrived at from a scientific perspective in the absence of so much data. And we have no idea what the defence counsel were aware of, but could not use at trial.

What seems clear to many on here is that, at a minimum, this was not a fair trial.

Science and the law occupy very different realms. Scientists deal with, and have to be comfortable with uncertainty every day. Lawyers want black and white if at all possible, and don't want anything that might sully that like statistics or complex science or medicine.

Scienceontrial.com is not about LL's innocence, but about the questionable use of science, or the lack there of at this trial. In a field where data, whether attribute or variable should be plentiful, it was so lacking that this had all the semblance of a witch hunt.

Two other factors impact on public perception also. One is we know a lot less about anything than the hype and spin in the media would leave you to believe. Neonatal medicine is not the exception - a lot of it is very hit and miss and we don't know why things happen, when they happen. Secondly pre-term babies are nothing like normal. Sorry if the women on here bristle at the thought, but a preterm birth has not been a successful pregnancy. These babies always have deficits even if they survive to be discharged home.

I don't "believe in" her innocence or guilt. Show me the evidence.

I still could accept that she is probably guilty, based on the evidence. But I have not seen enough evidence, and based on what we have heard it looks like the jury has not either.

Given the way things work in England I cannot see any chance of her getting out of prison in the next decade, at which point this thread will be long forgotten - and this is my last comment on this substack.

The government have already made a mess with the potential conflict between an appeals process and a statutory inquiry, not to mention a plan to assess LL's involvement with 4000 other babies. You just could not make this stuff up, not even in Hollywood.

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Once being put into a position of power that it matters life or death; Instincts prevails reasoning. The instinctive feeling that there is an unpredictable threat or a gruesome person (e.g., a peadophile, a calculatus mass -murder or -rapist or a psychopath otherwise), as by a stress reaction, it kill reasoning; even in a judge or defence barrister.

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Doesn't the 6.4% refer to the number of births less than 2.5kg? The figure of 63% mortality is only for those baby's born between 22 and 26 weeks. The unit would have a wide range of gestational ages, so I don't think you can apply a 63% mortality to all the admissions over an 18 month period.

Rick

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My mistake in this post was to try and use what I thourhg for readers would be easy to digest pre-packaged numbers from other websites - rather than simply doing the hard yards and trying to explain all the math steps along the way. I have done a complete update to this post in the next article (https://lawhealthandtech.substack.com/p/ll-part-15-basic-math-part-2) wherein I actually find that there were either still no excess deaths (when we factor in missing term and post-term deaths), or potentially 4-5 excess deaths for the period.

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I'm thinking you may not have counted all the deaths that occurred on the unit because the data you have acquired is not accurate. Is it possible to check the numbers from an independent source? It's hard to believe that everybody involved overlooked the low rate that you report.

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The numbers I use as the absolute minimum were those disclosed in an FOI by the CoCH hospital management. As I stated in LL Part 10, I believe the true number (once accounting for babies discharged that died at home and babies transferred to other units) is closer to 30-31. BUT, in order to not be called out for making the numbers up from wholecloth, I used the hospital's own public disclosure numbers in this math.

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Clearly the hospital FoI is not accurate - otherwise the Drs would not be complaining about excessive deaths in the Unit. For the Drs to be complaining the deaths must have been greater than the average.

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Funny. I have just been having a private conversation with a very experienced senior consultant on this exact issue. He agreed with me that CoCH may have acted to the letter of the FOI (babies that died in CoCH Neonatal unit) and not the spirit - and therefore left out babies that died in other parts of the hospital (delivery suite, postnatal ward, A&E), babies that died within 24-48 hours of discharge, and babies that were transferred to other higher acuity facilities and subsequently died. I am hopig that a new FOI asking for those data is submitted very soon.

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CoCH is likely only to hold their Unit's deaths so a new FoI is unlikely to help. I don't have knowledge of death certificates/registration, other may well have this.

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I'm liking your blog but I think here you've conflated things. There is a rate of 6.4% for premature and underweight babies out of all births. But not all of these need level 2 care. Premature just means under 37 weeks. Therefore, not all the 57 premature babies would have gone to level 2, so the expected deaths would have been considerably lower than what you calculated.

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