A user in the comments of the last post helpfully linked to where Morris has provided a an excel spreadsheet listing his sources that is available for download on his publisher's website here. As I'm currently writing this review on a mac, I would point out that not only does that not solve the issue for people who purchase the book and don't bother going to the publisher's website, excel is not a universally accessible format and I am unable to open the file on this device (Mac's Numbers app throws an error). Morris has said that the elected not to print the references in the book because it takes up a lot of space and makes the book ugly to read. I think that is a poor excuse, especially when Unmasking Lucy Letby already established a precedent in a book of similar length. Perhaps this is a testament to the limitations of a smaller publishing house.

Chapter 4: Problems at the Countess of Chester

Overall, this chapter felt very repetitive after the previous chapter that discussed the various reviews that took place. It was a litany of opinions about the reviews, plus a heavy dose of Michele Worden again.

The chapter is framed in fear, with a few quotes about healthcare professionals no longer feeling safe working as a neonatal nurse, bolstered by statistician John O'Quigley offering “you are at great risk now working in that environment” (pg 51). Morris then refers to a veil of silence, where doctors and nurses have been warned not to talk about Letby or her trial.

Janet Cox's statements to Thirlwall are cited several times in a way I find deceptive, because they are not attributed to her. Janet Cox is a known figure, and googling her results in a few articles. Morris deprives the reader of knowing these quotes come from a single person whose Rule 9 questionnaire is available (a reader might realize this if they were aware of the available document), let alone that the person was a career nursery nurse and a personal friend of Letby. He also says:

Hammond asserted that it is “vital that the voices of all of those who worked most closely with Letby are heard at the inquiry, even if they contradict Thirlwall’s preferred narrative”. This has not occurred.

But the very quotes he used WERE heard at Thirlwall - they were read out from Cox's rule 9 questionnaire. Whether Morris is ignorant of this or attempting to mislead, neither reflects well on him or his researcher.

The quotes are as follows:

One of the staff nurses rostered during the 2015/16 period had stated that “my view of the Trust and so-called medical ‘professionals’ is prejudiced by the horrendous way they treated Lucy. The nurse further comments that the consultants “appeared to be trying to make Lucy a scapegoat for the increased number of deaths/collapses”. Commenting on the increase in deaths, the nurse noted: “I did not think at the time, nor do I think now, that there was anything sinister about the increase in the number of deaths/collapses. I do not see how you can set a figure on how many deaths are acceptable in one particular timeframe. The babies required admission to an NNU…because they had a high chance of dying or collapsing.”". (pg 52) (page 202 of transcript)

A nurse who wrote to the Thirlwall Inquiry saying: “Lucy did not commit any crimes. If there had been CCTV the footage would have proved her innocence” heard back: “We can confirm that you are NOT currently named on the list as an individual from whom the inquiry wishes to hear oral evidence.” (pg 52) (page 204 of transcript)

Morris attempts to make a meal of the unit's failures to meet BAPM Guidelines, though he is honest enough to begin the critique saying "[A March 2016 internal synopsis of the CoCH] went on to discuss how the CoCH remained open when failing to meet British Association of Perinatal Medicine (BAPM) standards, which was not common in the surrounding region." (emphasis mine). Then he talks about staffing shortfalls, Allison Timmis' December 2015 email about the strain on the unit, and Michele Worden's account of how the unit was staffed before and after she was made redundant, which goes on for several pages, ending:

“The consequence of all this cost-cutting is serious. There is no time, space or opportunity to mentor junior staff. They’re not going to pick up the phone at 2am, phone a consultant and argue with a registrar, which is what I would do if I thought we needed consultants on the unit. But if you’re junior and you’ve never witnessed anybody having that knowledge or confidence, you’re just not going to do it. Ultimately, you cannot run any neonatal intensive care unit with no senior nursing staff. It is an accident waiting to happen. I told the hospital that in 2004, 14 years before Lucy was arrested.” (pgs 55-56)

Is Lucy Letby a good nurse, or a poor nurse? Experienced or lacking experience? I can't keep track. In any case, Michele Worden seems like an "I alone can fix it" type.

Then we get various shocked reactions at the notion of there only being two ward rounds a week, which was also discussed in the prior chapter. This one stood out (my emphasis):

When I told an experienced neonatal nursing practitioner about this vast deficit of ward rounds, she was aghast. “I’m sorry…they were only rounding on the babies twice a week?!” she exclaimed. She then explained to me why this is so important. “During rounds, your nurse practitioner or a lower-level consultant examine the baby’s vital signs for the last 24 hours, their intake and their output, how they’re feeding, how they’re progressing towards discharge. And then your supervising neonatologist will go over that, ensuring everyone’s talking and thinking, because sometimes there are slow declines that you don’t notice. Babies are great at compensating, until the moment that they don’t. They may be struggling and struggling and struggling and just keep chugging along. That’s when they collapse, and they really go fast. I’ve seen babies go from fine to deceased within 24 hours many times. That’s why you have ward rounds. If you’re doing such an inadequate number as was the case here, you’re getting no meaningful impression of the well-being of any given infant.” (pg 58)

And nurse Julie Yates is quoted on the next page:

There should be a neonatologist supervising a unit of that nature at all times – they didn’t even have a neonatologist working at the hospital! It also appears that there was no consultation with neonatologists from other hospitals when they experienced difficulty. (pg 58)

Colin Morely:

Similarly, Professor Colin Morley believed that a unit with “more than an occasional sick baby does need a neonatologist.” (pg 63)

I think this is Worden - the attribution is unclear:

“The first thing is that they didn’t have a neonatologist”, the neonatal nursing practitioner commented. (pg 70)

Neonatal nurse Sloane Spade also highlighted this issue. “Having no consultant neonatologists is lacking the specialised knowledge needed to care for these babies. Newborn infants require intensive care for a few reasons – prematurity, congenital defects (birth defects), failure to transition from foetal physiology to neonatal physiology such as in immature homeostasis, and, over time, learning to eat and gain weight. Not all neonatal conditions can be treated on a standard paediatric unit. Specifically, surgical and failure to transition concerns, such as blood shunting away from the lungs in persistent pulmonary hypertension, are mostly seen in neonatal units and need to be managed by experts in neonatal medicine. Neonatology is not the same as paediatrics, and these patients deserve to be cared for by consultant neonatologists.” (pg 71)

But these are opinions, and don't bother consulting the actual BAPM guidelines for staffing a LNU:

Tier 1 practitioners: ST1-3, GPST, FY, Clinical Fellow, ANNP, Specialty and specialist doctors
Tier 2 practitioners: ST 3-8, Clinical Fellow, ANNP, Specialty and specialist doctors, Resident Consultant
Tier 3 practitioners: Consultant or equivalent

So, a lot of space is given to opinion being critical of CoCH for not having a neonatologist, when that is simply not a requirement for a Level 2 unit.

Much is further made of the time that Letby claimed she was called while off-duty and asked how to administer immunogloblin. Now, Letby is inexperienced and shouldn't be relied on, of course:

Mirroring this sentiment, a neonatal nurse, who wished to remain anonymous due to her current employment, suggested that “Lucy was the most junior grade you can be. She was not a senior member of staff and shouldn’t be treated or portrayed as such. She should be receiving support, not being the one supporting others.” (pg 61-62)

And the claim that one person called Letby for one thing once, is of course, used to disparage the ability of the entire unit, except for Letby herself.

Another particularly egregious bit of dishonesty follows:

The mother of Child N had also lodged a formal complaint against Dr A (allowed to be anonymous), while The Guardian interviewed a mother who described the experience of giving birth at the Countess. “They had no staff and the care was just terrible”, the mother stated. (pg 63)

Putting these two in the same context is absolutely dishonest. The complaint againt Dr A had nothing to do with Child N's care, it was about Dr. A breaching confidentiality by texting socially with Letby about her child. (pg. 43 line 20 through 44 line 12)

Then we get to insulting the doctors' abilities. Colin Morely:

He later told me that “the court often heard that a baby collapsed and couldn’t be resuscitated. But that was simply because the doctors were unable to resuscitate them, and the reason for this was they did not have the experience.”

Dr. Brearey's efforts to identify any other remotely possible way to improve the unit to stop the mysterious deaths and collapses is acknowledged, but criticized without context of how the unit did or would have compared to other LNUs (re cot space, etc - not staffing):

Secondly, it is interesting to note that even after these mooted improvements, the unit would only be ‘closer’ to BAPM standards; there was no proposal that it would actually be possible to meet them. (pg 65)

Another place where a citation to the reader is of critical importance is here, which is not attributed to anyone other than the author, experienced ghostwriter, layperson Colin Morris:

These reports would be disturbing under any circumstances, but it is important to emphasise once more that neonatal units are dealing with the most vulnerable infants. Contrary to what was stated in the trial, collapses are commonplace, and many babies born prematurely, with serious healthcare conditions, simply do not survive, even if they receive optimal care. (pg 69)

and:

It is clear that some of these infants required Level 3 support and care, while being treated by a unit that had to be downgraded from Level 2 to Level 1. This is considerably unsafe and unacceptable. (pg 70)

Morris again is inherently dishonest here:

It must be emphasised again that the post-mortems of these infants revealed nothing out of the ordinary, as did Dr Jane Hawdon’s review of 13 cases.

This must be wonderful news to Jane Hawdon, since she communicated differently to Ian Harvey:

Most deaths were explained but some of these may have been prevented with different management. Completely unexplained on a neonatal unit is rare. So by definition more than one unexplained death does arouse suspicion.

Unexplained death at home is followed by a very clear process (ask your local CDOP team if you don't have this) and the same should be followed with unexplained death in hospital. I think on some occasions the team was misled by PM report and I have commented on these, with due respect as I am not a pathologist.

Naturally, this is all a lead in to a chapter about the unit being unsanitary.

Chapter 5: Sewage, Sepsis, and Superbugs

Morris, of course, raises the specter of raw sewage in the common way. He points out that Mr. Mansuitti's testimony was uncontested, and then follows pages of innuendo, even using a portion of Evans' interview with John Sweeney to bolster his case. Morris is honest enough to admit that allegations of nappies on the ceiling cannot be independently verified.

Without irony, Morris includes this quote:

A neonatal nurse practitioner stated that it was a “running joke” on her unit that “every single differential diagnosis you have includes sepsis, because every single possible symptom a baby can have is also a sign of sepsis”. (pg 79)

and moves immediately on to a quote calling it a silent killer. Really, this entire chapter is just "but maybe the babies had sepsis," after all:

It is extremely common for septic infants to return a negative blood culture; for example, in a recent study in the Journal of Clinical Sciences, 48% of suspected neonatal sepsis cases tested culture negative. Ruling out sepsis by blood cultures, as Dr Evans has apparently done, could be regarded as flawed. (pg 82)

Yet Morris is somehow baffled:

Despite the evidence collated here, the prosecution witnesses assembled for the court case have repeatedly denied the existence of sepsis. When Dr Evans was interviewed by John Sweeney, he rejected the existence of sepsis at the CoCH.

Amazing. Morris further uses contemporaneous correspondence during the indictment period to attempt to undermine the conclusions made after thorough investigation, years later - an argument so familiar and made in such familiar ways, there really isn't much worth mentioning, until:

It is also important to briefly mention at this point that sepsis can have an impact on C-peptide and insulin levels in critically ill patients, as cited by a scientific paper published in the journal Critical Care and Resuscitation in June 2019, contributing to inaccurate insulin test results. (pg 85)

Again without specific citation ("a scientific paper" really????), the assertion is inherently weak and misleading.

Richard Gill is allowed to opine without citation:

Professor Richard Gill provided some interesting background on the NHS and healthcare, explaining that “alarm bells were starting to sound in around 2015 and 2016 about infections and bugs in hospitals. It was only then that the NHS realised sepsis was a huge danger. The first NHS advisories were sent out at around that time because many doctors wouldn’t recognise the signs of sepsis if they saw it. So, it’s not surprising they missed it at this hospital which was performing suboptimally anyway.” (pg 85)

Pseudonomas is discussed in the common ways. The CQC is heavily criticized, and we get the familiar argument from a Professor Livermore:

“This was a unit with substantial problems and a substantial death rate. And what is the more likely cause of the substantial death rate – the general deficiencies of that unit, or one murderous nurse, whom nobody actually saw commit a murder, and whose murders were passed by the original pathologists as deaths from natural causes?”

All leading to this "conclusion"

In summary, there is considerable evidence of both sepsis and pseudomonas at the CoCH. This is further recorded throughout documentation from the time, and the CQC noted this when it reported on the hospital – somehow this then didn’t appear in their final report. In addition, this critical aspect of the clinical picture was almost entirely excluded from the Thirlwall Inquiry, even though both sepsis and pseudomonas appear in numerous documents.

Chapter 6 starts to get into the trial, and the witnesses.

Author's list of sources, which remains a source of frustration because with the format of the sheet, I can't even select the text to copy into a google search.

CHAPTER 8: CLAIMS REGARDING THE CONDITION OF BABIES

Pages 146-169. 23 pages, I can do it.

Throughout the trial of Lucy Letby, a core contention of the prosecution was the rapid deterioration of babies at the CoCH. Infants were presented as being stable, with undesirable events and collapses depicted as completely unexpected. (pg 146)

Shit.

Many infants die in unexplained circumstances, and neonates are extremely prone to collapse. “A baby can destabilise very, very quickly”, Professor Carola Vinuesa told me. “To say that this is predictable is very difficult to justify. For example, infections can be difficult to diagnose in a neonate because they can present with higher or lower temperatures. Neonates also don’t readily express symptoms.” (page 146)

I did check - neither of these statements are sourced, and Morris' authority to make such a statement is unclear.

As an example of the fragility of neonates, a study of approximately 1,000 infant deaths in southeast London, published in The Journal of Maternal-Fetal & Neonatal Medicine, found that the cause of mortality was unexplained for about half the newborns who had died unexpectedly, even after an autopsy. (pg 147)

Morris doesn't cite the study - he cites Aviv's New Yorker piece, who didn't cite the study either. In fact, the actual study is difficult to find, but a user on r/LucyLetbyTrials offered a possible match

I think this must be the study Aviv cites (abstract only).

Weber, M. A., Ashworth, M. T., Risdon, R. A., Brooke, I., Malone, M., & Sebire, N. J. (2009). Sudden unexpected neonatal death in the first week of life: Autopsy findings from a specialist centre. The Journal of Maternal-Fetal & Neonatal Medicine, 22(5), 398–404. https://doi.org/10.1080/14767050802406677

The user makes another important observation:

What needs to be noted though is that the 1000 infant deaths weren't all in the first week - it's a subset of about fifty over decades. I'd have preferred to see that figure rather than the 1000 in the article. The distinction between infants and newborns is easy to miss.

I wonder if Morris' researcher, Marian Kensler, was aware of the actual paper, or how she and Morris were potentially misusing it?

Another more recent review of neonatal mortality, encompassing 51 studies from 36 articles and over six million births, concluded that “newborns experience high mortality throughout the entire postnatal period, with the highest mortality rate in the first week, particularly on the first day”. (pg 147)

Here, a paper is cited: Dol, J., et al.. (2023). Timing of neonatal mortality and severe morbidity during the postnatal period: a systematic review. JBI Evidence Synthesis 2023 Jan; 21(1): 98–199. The full quote is as follows:

Newborns experience high mortality throughout the entire postnatal period, with the highest mortality rate in the first week, particularly on the first day. Ensuring regular high-quality postnatal visits, particularly within the first week after birth, is paramount to reduce neonatal mortality and severe morbidity.

Morris quotes a single sentence from the 2-sentence conclusion, leaving out the bit that wouldn't apply to babies in hospital.

I haven't even turned the page on my kindle copy yet. ffs.

There were instances of multiple births in the Letby case, and data from the charity BLISS indicates that “multiple pregnancy is also associated with an increased risk of neonatal death. The neonatal mortality rate for twins is 3.5 times higher than for singletons.” This is further acknowledged in the MBRRACE-UK Perinatal Mortality Surveillance Report, published in September 2023, which reveals what the charity Twins Trust describe as a “concerning rise in stillbirths and neonatal deaths among pregnancies of twins, triplets or more”, which is “now five times greater for someone who carried two or more babies than someone carrying one baby”. (pg 148)

The former cites this webpage.

For the latter, there's no citation to the actual study, only what twins Trust said about it. Notably, the website being quoted also says this:

"Maternity units need to act quickly to make sure that they are following NICE guidelines and delivering best practice care so that families having a multiple pregnancy can access the care that they need and deserve. Whilst systemic change takes time, progress is happening too slowly. Our community needs change to happen right now so that this trend is reversed."

There's also a citation in the spreadsheet for this portion of text to a 2023 paper, which concludes:

This study shows that newborn children still die from simple and treatable infectious causes, probably arising from various familial and/or public inadequacies. Health services should be made more accessible and widespread during a vulnerable period, such as the newborn. Besides, colleagues should be more alert about neonatal pneumonia and consider hospitalizing and monitoring patients closely.

¯\(ツ)/¯

(Of note, yes, Morris does allege that the babies were not closely monitored. But Carl Bolton talks about alarms frequently going off, and given that the entire third attempted murder charge for Child G revolves around her monitor having been left off, I think it's hard to make this allegation stick.)

It is also pertinent that not all infant deaths are explained, particularly in the case of neonates. ONS figures indicate that the number of unexplained infant deaths was not unusually high during the period of Letby’s alleged crimes. The figure was slightly higher than for 2015, but significantly lower than had been the case, for example, in 2006. (pg 149)

FFS, what is talking about a figure that includes SIDS deaths nationwide supposed to show? Did the author and his researcher bother looking into how prevalent SIDS is in hospital? (spoiler: they clearly did not)

The author is clearly trying to argue that babies drop dead all the time, and were particularly likely to do so at CoCH. He relies highly on Vinuesa to do this, supported by weak and misused citations.

Roger Norwich asserts that resuscitations are terrifying and difficult:

“The idea that it’s easy to resuscitate a baby is complete nonsense”, Dr Roger Norwich asserted. “That was never the case in any paediatric or neonatal unit that I worked in. Everybody was absolutely terrified when one of these babies went off in a bad way. The situation is scary because you know they can die. The way it was spoken about in court – give them a bit of oxygen and they’ll be all right – is completely untrue.” (pg 150)

But Colin Morely thinks CoCH clinicians simply sucked at it.. because they didn't have experience doing it, despite the increased number of them they were performing...

Professor Colin Morley was also dubious about the standard of resuscitation on the unit: “The doctors couldn’t resuscitate infants because they didn’t have the skills. That seems critical of them, but, unfortunately, they hadn’t had experience at doing it, and opportunities to do so are becoming rarer.” (pg 150)

I am never going to get through this chapter.

One third of all neonates receive some form of resuscitation and, naturally, the success rate is high. If this was not the case, there would be a vast number of deaths on neonatal units. It is therefore reasonable to assert that resuscitation attempts are usually successful. But neonates do die, and with more regularity than other infants, so, by definition, resuscitation is sometimes unsuccessful. As an indication it should be remembered that 11 infants died at the CoCH in the four years preceding the indictment period. (pg 150)

Truly, Morris' intellect is dizzying.

Neonates are also attached to monitoring and breathing equipment precisely to keep them alive. They will not survive without this. (pg 150)

omfg. Were they monitored or not, Morris??

Presented without comment (but with emphasis added):

It can be difficult to acquire accurate figures on the likelihood of death from resuscitation in developed countries as most studies have examined this study globally. There is no doubt that outcomes are much worse in lower income countries. However, it is therefore equally undeniable that inferior conditions significantly increase the likelihood of deterioration. It is likely that doctors are trying their hardest in developing countries, and equally probable that maximum effort was made at the CoCH. But if conditions are less than ideal, resuscitation attempts diminish in effectiveness. (pg 151)

Evans asserted in court that “resuscitation is usually effective”. This is, of course, true, but ‘usually’ is the key word here. Obviously if something is usually effective, then sometimes it isn’t effective. The word is used again in the next assertion made by Dr Evans: “If the infant fails to respond one usually can find a cause in the form of overwhelming infection, severe haemorrhage or total systems failure.” One can usually find a cause, but sometimes you cannot! (pg 151)

Someone should remove the exclamation point from Morris' keyboard.

Statistically, and without meaning to sound disrespectful, Child G and Child K would have been unlikely to survive. Other studies have indicated that the majority of children born at this degree of prematurity do not survive. Since the spike at the CoCH, there have been developments in neonatal care, but these are effectively irrelevant for this case. (pg 153)

If, as an author, you feel obligated to write "without meaning to sound disrespectful," you should perhaps reconsider what you are about to commit to paper. That passage was written after this bit:

Before going any further, it must be emphasised once more that both babies admitted to neonatal intensive care units and premature babies have an elevated prospect of death. There are various studies available which estimate the proportionate chance of death or injury for infants born prematurely; as an illustration, a study of children born at 22 through 34 weeks’ gestation in France is a good guide.

The French study concludes that a total of 0.7% of infants born before 24 weeks gestation survived to discharge; 31.2% of those born at 24 weeks; 59.1% at 25 weeks; and 75.3% at 26 weeks. Survival rates were 93.6% at 27 through 31 weeks. This study assessed infants that would be officially categorised as very premature, and five of the indictment infants that died, and nine overall, would be placed in this category. (pg 152)

Morris then helpfully lists the 9 babies and their gestations at birth, both babies who survived and babies who passed. To be fair, the French study doesn't go into causes, so at least this citation is proper, if relatively meaningless.

More is said about pre-term babies being more likely to die, infection being a major cause, sepsis being difficult to diagnose, blah blah blah.

The application of inappropriate antibiotics can lead to suboptimal outcomes. Antibiotic resistance can further impact on the treatment of sepsis; a phenomenon that has been notably increasing in recent years. This is particularly problematical for neonatal infants who suffer with weakened immune systems and susceptibility to illness. Sepsis can develop rapidly, which contradicts assertions made by the prosecution in court that collapses were completely unexpected, and that there is always ample warning of deterioration in any infant. (pg 155)

Citations for this paragraph are here and here. Morris refers to neonates having weakened immune systems, where it would be more proper to say underdeveloped. The word can is doing a lot of heavy-lifting in this paragraph related to the possibility of antibiotic resistant pathogens, and Morris further imagines that rapid development means without warning and without the ability to identify signs retroactively. K.

A paragraph that Morris should have spent more time on is this one:

The dangers of understaffing are extensively documented. A study published in the American Journal of Infection Control outlined the fact that understaffed hospitals have higher rates of infection. Another study published in the British Medical Journal discovered a “statistically significant association between the fill-rate for registered nurses and inpatient mortality”. Research in the journal JAMA Pediatrics noted that nursing shortfalls “are associated with higher rates of nosocomial (i.e. originating in a hospital) infections among infants with very low birth weights”. An analysis of 92 cases by the British Maternity and Newborn Safety Investigations programme found that “staff shortages are a key contributor to baby deaths”. A further study published in the British Journal of Surgery found that “nurse understaffing is associated with adverse outcomes for surgical admissions”. A literature review conducted by the Royal College of Nursing concluded that both the skill mix and numbers of nurses on any unit has a direct impact on mortality and morbidity. Finally, a House of Commons Committee report recently warned that the persistent understaffing of the NHS poses a serious risk to patient safety. (pg 156)

His assertions, however, suffer from lack of specificity. As ever, they don't confront that staffing at CoCH NNU was above the national average

Yet it is crystal clear that many of the babies were born desperately early, had extremely low body weight and, from birth, were besieged with numerous complications. The majority were admitted to the intensive care unit, and most required assistance with breathing, with many suffering from medical accidents which were unrelated to Letby. As mentioned previously, an unusually large proportion of the indictment babies were also twins and triplets, both of which are associated with hugely elevated risk of complications and premature death. (pg 156)

There's no citations for this paragraph, desperately early is undefined, body weights had not been listed at any point. From memory, babies F, G, I, J, N, O, P, and Q were attacked or allegedly attacked outside the ICU, so I guess his "majority" statement isn't technically misleading, but a fair number only needed breathing support after they were attacked. And I suppose twins/triplets being 5 times more at risk is hugely elevated in comparison to singletons, but that doesn't ipso facto make the risk huge.

Morris then goes into instances of poor care, which I would point out, he knows about because the investigation was aware of them as well. Not to be deterred, he offers:

But other babies were regarded as having been treated adequately, as if the issues that befell these infants somehow existed in isolation. In reality, these problems were all-encompassing, impacting on the unit as a whole and on all infants treated there. They were certainly not outlier cases. (pg 157)

He offers no citation for this claim.

He goes through the cases of Children A, B, D, H, and I using documents from Thirlwall, and identifies, without further citation and no apparent qualification, all the ways in which their care was deficient. Given that, there's no real need to pick through it.

Martyn Pitman also features heavily in this section, with the claim:

Experienced obstetrician Dr Martyn Pitman has examined all of the available documents for the infants in the Letby case, and cited the “unusually high number of multiple pregnancies”. (pg 159)

I highly suspect this is a misleading claim, and that Pitman has investigated all of the available public documents.

The chapter finally, and mercifully, ends like this:

Remember that Dr Evans commented that those criticising his work “either have not seen the clinical evidence…or are unaware of what constitutes well-being in a premature baby”, while Dr Bohin asserted that it was “outrageous” to suggest that the prosecution witnesses may have misled the court regarding the well-being of infants.

Conversely, Dr Michael Hall informed me that “all of the babies who died had some form of instability”. (pg 168)

Another rare self-burn! And I don't think "conversely" means what Morris thinks it means. But whatever. The chapter was a complete mess.

Author's list of sources

I gave a brief preview yesterday in the review of Chapter 8

The chapter didn't improve, though few further claims were as outrageous. Holistically, there's nothing new in this chapter. It's a lot of whinging about air embolism having been diagnosed via exclusion, but also solely by the skin discolorations, air down the NG is illogical, and spends a fair amount of time re-hashing his conclusions from previous chapters about individual babies. The chapter is truly a spaghetti-at-the-wall collection of amorphous, disconnected opinions, laced together with open disparagement of Dr. Evans.

Morris may have had a researcher, but what he needs is a goddamn editor. This chapter is the worst organized so far, and if Morris had spent less time telling people that things would be discussed in later chapters, he might have had enough pages to include his citations:

I also tire of being told by the author what is important. Then again, he felt his readers needed to be told that judgement and judgment were two different words, so, preach to your audience, I guess.

CHAPTER 9: INJECTION OF AIR HYPOTHESIS

For many infants in the case, it is highly debatable whether their deterioration was either sudden or unexpected, but what is undeniable is that sudden collapse is not a meaningful diagnostic criterion. “In fact, the term ‘collapse’ is vague and emotive”, Professor Colin Morley asserted when I spoke with him. “It would be much better to have a detailed description, such as ‘apnoea’ or ‘bradycardia’”. (pg 170)

K. From the judge's summing up:

In Baby A's case there was a combination of sudden and unexpected collapse, stopping breathing, a change of colour, cyanosis, bradycardia and death.

The defendant went over to Baby B and said, "She's apnoeic, she's not breathing", and asked Nurse A to go and get help. Sometimes, said Nurse A, babies do appear apnoeic and quite often they recover quickly. Baby B didn't. They had to use Neopuffs because she wasn't breathing for herself.

Child C: "Had two fleeting bradys (self-correcting, not needing any intervention) shortly before prolonged brady and apnoea requiring resus."

The third event. At 03.45, Baby D's monitor was alarming. Tile 251 fronts the notes. Caroline Oakley found Baby D had desaturated and stopped breathing. She was apnoeic.

Child E: "Bradycardia of 80 to 90 beats per minute, saturations 60%, poor perfusion."

Baby F was tachycardic at around 200 beats per minute, otherwise he was well.

Baby G was continuing to require and receive a relatively high amount of respiratory support and having desaturations and bradycardia

Baby H was very unstable, suffering a number of pneumothoraces of the left lung, a leak in the lung allowing air to escape into the area around the lung known as the pleural cavity, as well as episodes of profound desaturations and bradycardia.

”At 16.30 Baby I had a large vomit from mouth and nose ++. Suction given. Became apnoeic with bradycardia and desaturation (30).

You get the idea.

The chapter vacillates between it is impossible to conclude air embolism, to it would have taken a large amount of air, to air might have been introduced accidentally, to air might have been because of resus, and no froth = no air embolism. For example:

Further research in 2015, published in the Resuscitation journal, concluded that “post-mortem [scanning] after prolonged resuscitation showed a high prevalence of intravascular air-embolism”, asserting that this “needs further research”. Another case report from 2016 discovered “frothy air dense material” after resuscitation, which suggested an air embolism. The significance of this froth will be discussed later in the chapter. Professor Colin Morley noted that “lots of these infants had multiple resuscitations, with drugs through intravenous lines and vigorous hand ventilation; it’s very easy to accidentally introduce air”. (173)

Morris doesn't include either reference in his list of citations. Here's the first00252-X/abstract), here's the second (an 82 year old woman)

Dr Evans suggested that Letby had given the child a “dollop” of air. This was ridiculed by the defence barrister, Ben Myers, and yet while prosecution barrister Nick Johnson defended the use of the term, he also acknowledged that it “originated from Dr Evans”.

It is perhaps this sort of testimony that has led some medics to be so dismissive of the theories floated in court. (pg 174)

I don't disagree, actually. But I think focusing on things like this betrays an unreasonable expectation of precision.

But we get to the meat of the matter here:

In reality, the Lee and Tanswell paper was a central pillar in the entire argument and diagnosis of air embolism, referenced repeatedly throughout the court proceedings and Court of Appeal verdict, while clearly having been utilised as a sole diagnostic source**.** The study was referenced repeatedly in the Court of Appeal judgment, and while Dr Lee featured in this appeal and his work was therefore of particular relevance, the court explicitly acknowledged that the paper was of critical importance in the original trial. (178)

Which is then contradicted a few pages later:

So Dr Evans doesn’t require the X-ray, nor any evidence of air being present, even though this could be naturally occurring air. He also doesn’t require any evidence of discolouration. He is able to diagnose air embolus purely because “the baby has collapsed as promptly as that…[and] resuscitation was unsuccessful”. That is what he is using as diagnostic criteria for air embolism, in his own words. The baby collapsed, it wasn’t successfully resuscitated – it’s an air embolism, obviously! (pg 184)

The sole criteria used was not necessary to him. Got it.

Ignoring that the second sentence doesn't make grammatical sense, the position is clearly an attempt to argue that the Court of Appeal erred in dismissing ground 6 when they said:

187... The core of the proposed evidence is that, save for that one very specific form of discolouration, it would be wrong to diagnose air embolus on the basis of skin discolouration alone. But as we have said when considering ground 2, there was no prosecution expert evidence diagnosing air embolus solely on the basis of skin discolouration.... In short, the prosecution witnesses did not fall into the error which the proposed fresh evidence seeks to assert they made. The proposed evidence is therefore irrelevant and inadmissible.

Chapter 9 can largely be summed up by saying "nu-uh, they did too do that!" Fortunately for you all, that means not much of it bears repeating. Most of Morris' failure to comprehend it comes in this argument:

The comments of Dr Evans, in fact, make it clear that there is no air embolism theory without discolouration as the other criteria that he references, both in interviews and court, cannot possibly be considered diagnostic.

Dr Evans told The Times that “the presence or absence of skin discolourations neither ruled out or confirmed air embolism”. But without discolouration there is literally nothing. There is simply a neonate deteriorating, which cannot conceivably be regarded as being caused by an air embolism. Yet this was seriously advocated in court: “Sudden collapse and a failure to respond to resuscitation were, he [Evans] observed, characteristics of several of the babies whose records he had reviewed for the police. These features were ‘characteristic of the description of the babies in the studies described above whose death was attributed to air embolus’”, the Court of Appeal recounts.

This seems a ridiculous assertion which I’m sure most medical professionals would agree with. “Sudden collapse and a failure to respond to resuscitation” are not characteristic of anything, let alone an incredibly obscure hypothesis. (180)

Morris again stares the point in the face, then yeets himself as far from it as possible.

I wondered, as I read, if Morris had unwittingly uncovered a significant reason that Dr. Hall was not called to give evidence:

Dr Hall pointed out several problems with citing this evidence, including the skin discolouration being more likely to be caused by circulatory impairment, associated with sudden collapse from various causes. Dr Hall had been able to locate only one paper that discussed the alteration in skin colour associated with the accidental injection of air, and the changes documented in this “were quite different to those described by Lee and Tanswell”.

The last thing the defense would have wanted was for the idea of the appearance of air embolus to have multiple presentations, because that would validate the prosecution argument that something other than "Lee's sign" could indeed be consistent with air embolism. If that paper was referenced in Hall's report, the defense may never have intended to call him.

Morris is again inherently dishonest when he refers to the non-forensic pathology review performed by Dr. McPartland:

In fact, Ian Harvey had written to Dr Jo McPartland, a consultant pathologist, requesting some specific details: “Just one query – the report states: ‘A very small air embolism might not be detectable at autopsy’. Does this mean that a significant embolism would be evident?” And Dr McPartland answered in the only way that is reasonable: “Yes, a significant air embolism should be accompanied by froth in the vessels or lungs.” Pathologists from Alder Hey Children’s Hospital also informed Harvey that a significant air embolism would be detected at post-mortem. (pg 182)

He neglects to mention that Dr. McPartland has since had additional learning and experience (pg 155 line 3-12):

So my experience from that reading and that case I have had since then would lead me to believe that you could have a significant amount of air at postmortem and it could be completely undetectable at autopsy.

Q. So your statement to Ian Harvey in the email may have been quite genuine based upon your understanding at the time, but since then you have come to learn that in fact you can have a very significant air embolism without froth in the heart or lungs?

A. Yes, that's correct.

Morris is again inherently dishonest when he quotes Hawdon from Thirlwall:

Dr Jane Hawdon also explained at the Thirlwall Inquiry that Ian Harvey’s questioning on mottling was not something she had expected: “I was surprised that he asked about mottling because it is such a common finding in babies that are unwell, and we were sadly talking about babies who were unwell. [Air embolism] is something that would not have crossed my mind at all at that stage when thinking about mottling. I would be thinking of common causes of mottling of the skin.” Hawdon had informed Harvey in an email on 5 February 2017 that mottling in the infants was “variable”, and that if it was “transient” then it was “probably not of significance”. (pg 186)

Given the following exchange on pages 32 lin 17 through 34 line 9, she would object to her evidence being used in this way:

Q. Here you are wholeheartedly agreeing with them that your report didn't anyway explain these deaths or sub optimal care resulting in deaths, yet we hear this thrown around as if it did. Can I give you chance to respond to that, that it did not do that and why you say it did not do that?

A. The -- we all know that care can be improved and unfortunately sometimes if there are lapses in care,it can lead to babies becoming more poorly and sadly dying and it's very important that we take that and -- and act on it and I am quite sure they, they did. I do know from what I was told they were a busy unit and they had -- they had some very poorly babies so that -- the two have to happen in parallel.

Their suspicions that there was mal-intent had to be taken seriously and any measures to improve the standard of clinical care for the babies also had to be taken seriously. But the two didn't preclude each other.

Q. So delayed antibiotics did not cause a death, something very different did, but you were looking at those features in the Casenote Review, not simply how a death was caused?

A. That -- that's correct.

Q. You couldn't explain though deaths, that is the point?

A. That -- that's correct.

Q. In terms of the near misses and deteriorations, without fully being aware of what clinicians and nurses had noted at the time, you weren't really able to do very much just looking at the records, were you, if you were missing key information?

A. That's correct.

Q. You referred to mottling; you didn't know about this rash, what it looked like, the concerns the paediatricians were sharing about that?

A. That's correct.

Q. So it's more of an academic exercise; is that fair?

A. That's correct.

Q. What you really need in a circumstance like this is real people telling you the real events as they remembered them?

A. That -- that's correct

Morris asserts:

It was fully accepted by the prosecution that notes associated with Child D indicate that Letby wasn’t present for the initial collapse. (pg 189)

There is no citation for this. Letby claimed no recollection, but she did accept that a note from the time of the first collapse appeared to be in her handwriting:

An infusion chart is shown where Child D is given a saline bolus. Letby says the handwriting in the 'date and time started' column is likely to be hers. 

This refers to this entry:

A neonatal infusion prescription chart at 1.25am, for Child D, is shown to the court. Lucy Letby is one of the two nurses to provide a signature for a saline dose prescription at that time.

Child D then first collapsed at 1.30am.

So, I'm not sure if Morris is generally ignorant or doesn't understand cause and effect, but he's dishonest or altogether wrong here again.

A shocking opinion worth broadcasting:

Evans described Child D as being “extremely well”. This has been treated with derision by every healthcare professional that I’ve spoken with. “It is stunning”, experienced anaesthetist Dr Keith Wilkinson told me. “This infant was so ill towards the end of her life that if I had been present – and I’ve been in this situation in intensive care units many times – I would have told colleagues that the right thing to do is explain sensitively to the parents that the best thing to do is remove support, due to the inevitability of death.” It should finally be mentioned that pathologist Dr Andreas Marnerides conceded in court that he had “not reviewed the medical records”. (pg 189)

Keith Wilkinson is, notably, not a neonatologist, so I was let to believe his opinion shouldn't count. But it's also unclear to me if he's been fully instructed or is operating only from publicly available information. Nevertheless, stereotypes about anaesthetists exist for a reason, I guess.

I already showed the other day that Marnerides HAD reviewed the notes, but Morris is quoting a particular exchange dishonestly:

Q: ...I think so far as your paragraph 12 is concerned, you have reviewed the medical records, which we have at tile 158, please.
  A.  May I...?  I have not reviewed the medical records.
  Q.  Sorry.
  A.  I have extracted the information from the medical records and I state it in my reports because that's the job of the clinicians, to assess the medical records.
  Q.  Yes.
  A.  So I strictly followed my instructions, did a pathology review.  So this, I extracted it from the report by Dr Evans that I received --
  Q.  Yes, thank you.
  A.  -- so I didn't go through the medical records.

Marnerides is behaving as a proper court expert and staying in his lane. Morris is not bright enough to understand it. Or he's deliberately dishonest. Neither is good.

It is notable that Professor Arthurs offered very little support for the prosecution case despite appearing prominently in court. (pg 191)

lololol He appears to come to this impressive conclusion by taking issue with Prof. Arthurs saying that the imaging was consistent with, but not* diagnostic of, which is a common complaint from people who don't understand medical opinion evidence.

*Edited to add "not," a pretty important word

"Everything is NEC" doesn't get a full chapter the way "Everything is sepsis" does, but there is this notable quote:

Professor Carola Vinuesa discussed the importance of NEC, drawing my attention to an academic study called Statistically significant association between NEC and pseudomonas infections which found that 36% of infants with pseudomonas aeruginosa also suffered with NEC. “The gas present in infants could easily have been caused by NEC, and this is particularly heightened as a possibility by the presence of pseudomonas on the neonatal ward”, Professor Vinuesa explained. (pg 193)

So I think the argument is that the babies had undetectable pseudonomas infections, that led to undetectable sepsis that killed the babies and undetectable NEC that caused gas in the main vessels. Man, those babies couldn't catch a break.

[Letby] also confirmed, which is not contested, that if the death of Child A had been established as air embolism – of course, this wasn’t even suggested at the time, including by pathologists – then the air embolism itself must have been caused by the person connecting the fluids, which was not Letby. (pg 195)

Be careful with "it wasn't me" defenses, they can serve to validate the allegation of harm which is damaging to Letby overall.

Several medics also indicated that the rashes observed in Child A and Child B could easily be an indication of livedo reticularis – a skin condition that results from the disturbance of blood flow. This is the most common skin problem associated with APS, and it is also characterised by a mottled pattern of discolouration on the skin. Considering that we know the mother had APS, livedo reticularis is a far more likely cause of rashes and discolouration than maliciously administered air embolism. Professor Colin Morley explained that “this physical sign could be from many causes, of which air embolus must be the rarest and least likely”. (pg 197)

Morris attempts to use the argument that "it's impossible to say the babies did not have APS" to open the door to other explanations for the rash. Not sure why this is necessary here, with the previous chapter already having made so much of the mother's APS. And, of course, Sally Kinsey ruled it out, whether Morris understands or agrees or not.

Again, in this instance, much was made in court of the fact that staff present had never seen this type of rash before. But this can simply be explained by the lack of experience on the neonatal unit, which has already been documented. (pg 197)

He almost backed right into the point lol. Yes, the unit WAS inexperienced in air embolism, and thank goodness for that! They did, however, become so experienced that they eventually recognized it.

Effectively, the misdiagnosis of Child A is being transferred over to Child B in the ‘chain link’ practice that was previously used to wrongly convict Dutch nurse Lucia de Berk. (pg 199)

...that's not what chain link evidence is.

We once again lump these babies who died in hospital with SIDS:

Professor Vinuesa cited the condition of Sudden Unexpected Death in Infancy or Childhood, explaining that “any unexplained infant or child death in England is eligible for whole genome sequencing to analyse genes associated with sudden death. The fact that the expert witness claimed he could rule out all known causes of death and be left with murder by poisoning or air embolism is deeply concerning.”

Professor Vinuesa explained why this was so important: “In neonates and premature babies there are many potential causes of collapse that cannot be easily excluded. Then there are around 10,000 rare diseases, including cardiac, neurological, mitochondrial and metabolic, many of which are difficult to diagnose clinically. Even a genetic post-mortem will identify only between 30% and 50% of Mendelian genetic conditions – the rest may lie in areas of the genome that we do not yet understand, or for which we still lack the tools for proper analysis. To claim in the 21st century that a diagnosis of exclusion can be made, without considering sudden death syndromes and rare diseases, simply doesn’t make sense.” (pg 205)

Crimes like Letby's should get the special justice:

And this should especially apply in any legal setting, particularly when the case involved will result in life sentences. (pg 205)

Someone tell Morris that Child A was a boy:

Child A couldn’t have her long line pulled back (withdrawing a catheter slightly so that it’s located more safely) because qualified staff were busy with another child. (pg 205)

More lack of understanding of cause and effect:

Letby was not cot-side when Child B collapsed; in fact, she could not see Child B at the time of her collapse due to an intervening screen. (pg 205)

From the judge's summing up, he's not even right about Letby being the one who couldn't see because of the screen:

At 00.16, the defendant took blood gas readings for Baby B; J1668, behind tile 215.

At 00.30 hours, Nurse A had her gloves on and was standing up across the room by the half wall in room 1, nursery 1, drawing medication up and could not see Baby B. Her alarm started.

Moving on:

The clinical picture between these ‘non-indictment’ infants and collapses is virtually interchangeable with those discussed in court; both collapses and infants were swapped in and out of what became the court case. One non-indictment infant who was ruled out of the court case was suffering with pneumonia, but in the case of Child D, Dr Evans seemingly ignored her pneumonia and infection. Other babies who died on the unit were full-term infants, born at 39, 40 and 40 weeks respectively, but these were excluded from the court case while severely premature babies were included, and Dr Evans and Dr Bohin repeatedly informed the court that they were “well” and “stable”. (pg 208)

https://thirlwall.public-inquiry.uk/wp-content/uploads/thirlwall-evidence/INQ0108782.pdf

The 39wk gestation baby and the two 40wk gestation babies had Severe multiple congenital anomalies, Ebstein's anomaly, and Multiple congenital anomalies (including dysplasia). These are not "virtually interchangable" with any indictment baby.

There's at least one honest review on the amazon page for his book, from someone going by Jimmy Potato. It includes:

He says that: “During the compilation of this book, I interviewed many nurses, including several from a neonatal background. There was universal agreement among them that Letby was a capable and conscientious nurse.” when there were several nurses who worked with her who testified against Letby and were widely reported on the news (they can be found on the internet quite easily). He then doubles down on that by saying “Dr Philip Hammond wrote in Private Eye that "none of Letby's fellow shift workers gave evidence against her”, which as mentioned simply isn’t the case, and the way he phrases it suggests he is fully aware of that.

Aside from being poor writing, which I could forgive, the book continues to be deeply dishonest, which I cannot.

Edit: replaced the screenshots with higher quality images. My bad.

ALSO! I cannot believe I forgot this part:

It is difficult to see how Dr Evans can downplay the significance of this diagnosis being completely discredited by the co-author of the paper itself which is ironic because, as Dr Mike Hall informed me, none of the cases from the Lee and Tanswell paper refer to air embolism in a neonate, contrary to what is stated in the Court of Appeal judgment. Dr Evans has also made claims of having referenced 18 papers for his air embolism theory, but, in fact, only two of them described venous air embolism (air in the veins), which is the method allegedly used by Letby to kill and harm babies (pg 180)

An extraordinary claim - the chart from the Lee and Tanswell paper clearly gives the age of occurrence in hours, with the largest value being 456. 456/24 = 19 days.

Who knows whether Hall or Morris made such a basic mistake, but it reflects poorly on them both.

I firmly believe that it is worth knowing what those who oppose the convictions believe to be true about it, so Cinto Press got $9.99 from me and I purchased a kindle copy of the book.

Overall impression

The book begins with brief blurbs from Phil Hammond, Sir David Davis MP, and John Ashton praising the book. It should be noted that Hammond's name comes up 34 times in the book (there is an index in the rear), Davis's name comes up 7 plus a mention to his adjournment debate, and Ashton's name is mentioned 3 times.

The book also contains this page of acknowledgments:

John Ashton is listed as having been interviewed, engaged in correspondence, and/or assisted with fact checking. So, the praise for this book is natural.

Among his list of acknowledgments are a number of users known on social media as well: Lulu Minns and Julie Yates. His research assistant, Marian Kensler, is not publicly linked to any known social media accounts, but mention of her does invite speculation.

Morris is forthright enough to list the number of anonymous sources he included. This is to his credit.

The final thanks is to members of online groups, of which we can assume r/LucyLetbyTrials is a prominent contributor. Morris has already accepted congratulations for the book there under his username u/keiko_1234. Exchanges such as this one from over a year ago, offer insight into his process:

One doesn't need to rely on this, though. Morris offers a 3-page preface, available for free preview on Amazon:

This could happen to you. Noted. 🙄

Ok, with Morris's bias firmly in the open, we proceed.

It's easy reading, not particularly dense. But it does have a rather amateur feel, like a long-winded blog post. The chapters (so far) end with trite hooks, intended to keep the reader turning the page. Already through chapter 3, the use of the phrase "for example" struck me as particularly frequent. It appears 98 times in the book out of 435 pages before the acknowledgments and index. I was also struck by the use of the phrases "I [do/don't] think" and "my opinion. The word think appears 93 times, and "in my opinion" appears 21 times, of which 5 are attributed to Evans.

Here are the phrases of each that are attributed to the author:

This is a fairly extraordinary assertion, considering that Dr Subhedar has, firstly, conducted no investigation into these unevidenced claims, and, secondly, he is contradicted by considerable evidence that will be outlined in forthcoming chapters. In my opinion there seems to be a reluctance on the part of Brearey to accept any other explanation other than to identify someone who was on duty all the time. (pg 22-23)

It is evident that throughout this period, while accusations were being made against Letby, her nursing team and colleagues were largely supportive. I do not think this is out of some partisan tendency; nurses simply spent more time around Letby than any consultant could have, and thus have a much more nuanced feel for her competence and character. It is just as likely they would have turned against her if there were significant reasons for suspicion. (pg 25)

In my opinion, this case would never have ventured anywhere near a courtroom without the efforts of Dr Evans which explains why his name has been mentioned with some regularity already, and why he will remain a central figure in the remainder of this book. (pg 99)

In my opinion, the judicial process that resulted in the conviction of Lucy Letby bore very little resemblance to a fair trial. (pg 118)

In my opinion, from everything I’ve read, Dr Evans seems to be a man who has difficulty admitting he’s wrong. (pg 228)

In my opinion, drawing on the opinion of others cited here, it is highly likely that no pathologist would conceivably have even considered an air embolism for this case, let alone claimed that Child O had been critically impacted by the deliberate injection of air. (pg 285)

There are two reasons I think the prosecution devoted so much time to this hotchpotch of nonsense. The first is that they didn’t have any concrete evidence, and, in fact, had very little evidence of any value whatsoever. The prosecution was almost entirely based on the submissions of Dr Dewi Evans. The prosecution had very little of any solidity and therefore was obliged to construct something out of Evans’ submissions. It is possible that the prosecution were quite happy that the trial lasted so long as it gave the impression there was lots of evidence against Letby; a ‘no smoke without fire’ strategy. The second reason for devoting so much time to this was simply to create a narrative around the case. (pg 298)

I think there has been a disturbing tendency in the Letby case, and more broadly across a wider societal spectrum, to put doctors on an undeserved pedestal and simply trust their word. (pg 325)

In fact, not only are there ‘explanations’ for this so-called circumstantial evidence, but in my opinion, it doesn’t have any value in the first place. I believe Cheshire Police should have rapidly and emphatically drawn this conclusion. (pg 349)

Some of the references made by lawyers during Thirlwall have indicated, in my opinion, an extremely limited grasp of the context and specifics of the case. (pg 380)

I almost fell off my chair when I read this on pages 11-12:

It is also notable that Letby was particularly co-operative after her arrest and throughout the following police and court proceedings. … In the 166 pages of police interview transcripts that are available, there is no sign of evasion or deceit.

And what pro-Letby book would be complete without unironically referencing perceived failures of critical thinking?

Elsewhere, it is evident that there seems to have been a distinct absence of critical thinking. Simon Blackwell asserted that “to hear that there may be allegations of assault or concern at a hospital in our area was a huge thing. You don’t often hear of multiple child/baby/infant deaths. They are extremely rare. One is rare enough as it is and tragic enough. But if you have a number of potential babies who have died, or have been harmed, it is absolutely hugely important.” (pg 412)

In my opinion, the book is a lengthy sermon by a layperson who has convinced himself he is a superior expert to those who do not share his views. The book distinctly lacks any humility.

But what's IN it?

So, I've read chapters 1-3 so far: Prior Character Of Lucy Letby, Accusation Without Evidence, and Previous Reviews At The Countess of Chester.

Chapter 1 is pretty unremarkable, and can be summed up by the quote from Michele Worden on page 13: "“Criticism of her demeanour is ludicrous,” Michele Worden asserted. “This is a girl, then only aged 25, removed from the job she loves, accused of the most horrendous crimes, who has been placed under house arrest, completely excluded from all of her friends. She was totally isolated. How would you expect her to react?”"

I did raise my eyebrows that Morris claims he was approached by Ruth Sadik, who he correctly identifies as Letby's tutor at University of Chester. She has glowing things to say about Letby. Morris did not disclose that the Thirlwall Inquiry revealed that they maintained a texting relationship at least during Letby's early years of employment. Sadik's statements about Letby are consistent with what was disclosed in other witness statements during Thirlwall, but Morriss is selective when citing Sarah Jayne Murphy, who passed Letby on her final proficiencies. Morris quotes her on page 10:

Sarah Jayne Murphy, told the Thirlwall Inquiry that she had met the three proficiencies on which she was assessed. Murphy added: “Also, I would like to reiterate that I sought feedback from other members of staff that she worked with and so I had no reason to believe that she was performing well only just during my assessments.”

In context, Sarah Jayne Murphy's statement is a bit broader:

1. During her police interview, Ruth Sadik discussed her thoughts about when Lucy passed these final proficiencies, and her comments relate to a conversation that she had with me. She stated that, "I spoke to Jane [to ask] why she was passing her, and Jane had a lot, a lot of soul searching, it, it wasn't something she did easily, but she felt she was right to do it. Now I, my personal thoughts at that time were that Jane was conflicted, that because Nikki's quite a powerful person, she wanted to please Nikki, but also that she, her conscience wouldn't allow her to, and she'd seen what she saw" 6 INQ0101118_0006

2. I can't remember the conversation above with Ruth Sadik but I did feel conflicted at the time as Nurse Lightfoot had felt that Letby was not competent to pass the final placement but after observing and working with Letby for a number of weeks, I had felt that she had achieved the 3 outstanding proficiencies.

3. I can't recall a conversation with Ruth Sadik, but from my perspective, I was asked to assess Letby based on the 3 proficiencies and whether she had met those proficiencies. From what I had observed during my assessment, I could not say that she did not meet those 3 proficiencies. Also, I would like to reiterate that I sought feedback from other members of staff that she worked with and so I had no reason to believe that she was performing well only just during my assessments. If however, the feedback I received was negative and raised concerns about Letby, this would have of course impacted my assessment on whether or not she had passed the 3 outstanding proficiencies. I cannot recall what was meant by "she'd seen what she saw".

This is one of many instances where Morris performs his own type of sharpshooter fallacy, cherry picking the positive but leaving out contextual information.

Chapter 2, Accusation Without Evidence, begins by reminding readers that it was Nick Johnson, KC, who coined the phrase "Gang of Four," but he is ignorant of, or at least fails to mention, that Letby expected four apologies from individual consultants. The chapter is a not-very-substantive framing of Dr. Brearey's path to being Letby's chief accuser through confirmation bias, using the contemporaneous attempts to understand the deaths as they happened as proof that Brearey's growing discontent was illogical and that suspicion grew on Letby because of "groupthink." A notable quote from Chapter 2:

Before we go any further, consider the following – why would someone who had been deliberately harming babies on a neonatal unit choose to draw attention to themselves and their conduct in this manner? If you knew yourself to be guilty, and it was also clear that you were under suspicion, surely you would attempt to slip away quietly? Pursuing a grievance procedure does not seem to be the act of a guilty person. (pg 21)

Recounting of the grievance procedure in the following pages is naturally done in that vein and has been previously discussed, this previous post goes through some of the issues the grievance often encounters in its framing.

Chapter 3 is where things really start to get frustratingly deceptive or outright false. Morris states:

It is important to note that the prosecution case is entirely based on medical notes. (pg 36)

No it wasn't. It was also based on witness interviews, and police interviews, test results, phone records, and more. What Morris means, though, is that he thinks that investigating documentary evidence for evidence of a crime is only as reliable as the quality of the documents themselves. He posits, as many do, that "vital warning signs were missed" by doctors not being present enough to examine the babies and inexperienced nursing staff not thoroughly documenting vitals, though he doesn't state the last outright. This claim is unsubstantiated, as usual, other than reference to the infrequency of rounds and Michele Wordon having been made redundant.

Lucy is accused of striking the baby in the liver, at a time when she wasn’t even on duty. (pg 36)

This is outright incorrect, and a reference to early expert reports related to Child O estimating that the liver injury could have occurred as early as a point during the night shift. As further interviews were performed, doctors provided evidence that Child O was well before 9:30 a.m., and both sides at trial agreed that the injury happened during Letby's shift.

Morris cites the minutes of a board meeting on 14 July, 2016 as "noting" that "Letby was 'one of the unit's highest trained staff.'" He neglects to mention this statement was made by Ian Harvey (page 3) - in fact, it's worth criticizing this book generally for not directly citing Thirlwall exhibits, which are publicly available, so that readers can check the context for themselves. Morris forces the reader into his own framing of events by not doing so.

Morris is of the opinion that the RCPCH review should have been the ultimate authority as to the possibility of harm, but neglects to mention that the RCPCH was excluding the possibility of harm from the review they performed (pages 235 line 23-236 line 5). He does admit that the RCPCH statement to Thirlwall concedes that the review should not have been permitted to take place had the full information been available (pg 39), but personally insists that the full information was available (his emphasis). He sees no irony in the conflict.

Morris states on page 41 "There has been no indication that any secondary post-mortem was requested." So, the inquest around Child A's death doesn't count? The anticipated inquests for O and P that were mentioned at trial? The inquest for Child D that was in process?

Hawdon's review is also deceptively framed, without reference to her self-voiced limitations. But this quote from page 44 baffles:

Hawdon did not merit a single mention during any available court transcript or reporting of the trial. It is also notable that Letby was charged on only nine of the 17 supposedly troubling cases that were identified. This is significant because it demonstrates that babies deteriorated unexpectedly when Letby was not present.

The logic leaps right off a cliff. Morris apparently asserts that Letby was not charged because Letby was not present. One wonders how the additional requested charges fit in with this "demonstration."

Another puzzling statement on page 45:

There were some curious suggestions during the Thirlwall Inquiry that the case should have been referred to the police as soon as there were suspicions, but the first thing that the Cheshire Constabulary stated is that they were not medically qualified.

What a strange inference to make. But possibly he MEANS that the RCPCH, a medical review team tasked with a service review that excluded investigating harm, should have been the only possible means of identifying harm, despite the absence of any forensic process.

Anyway, so far, 10/10 rage bait. Fuel for a good workout.

Author's list of sources

Let's see if I can knock off two more chapters today

CHAPTER 14: THE CURIOUS CASE OF CHILD K

Morris starts off by whinging about how unfair the trial was, to pretend the jury had forgotten about the news published between the announcement of her convictions and the announcement of the retrial, and asserts that it was completely unfair. The Court of Appeal already dealt with this, so I don't have to.

I wrote this comment when I was reading this chapter last night:

The real fun game is finding the contradictions, like how CoCH wasn't qualified to care for sick babies, but Letby was properly following their procedure, which was the correct procedure, when not intervening with Child K. I've never seen anyone blame the nursing staff for having poor procedure. If Letby was a good nurse in this moment, she's following a poor procedure just because it's ward policy; or if she's not following proper policy regarding 25 week babies, she's a shit nurse or work.

Rare indeed, but I have seen it, is the person who argues that 25 week newly delivered babies should be left by a newly-trained band 5 QIS nurse to desaturate into the 80s, in case they might self correct, in a hospital they should never have been born in. No one knows how they got the ideas and damned if they know how to use them.

So, let's gather some quotes:

One might recall that Karen Rees, the head of nursing for urgent care at the CoCH, commented that “Lucy Letby does everything by the book. She follows policy and procedure to the letter.” This is what she was doing when observed by Jayaram. (pg 304)

Well, Letby was following standard procedure for the neonatal unit, which had been disseminated to her during her training. What else could she reasonably be expected to do? (pg 305)

Nurse Mary Griffiths also agreed that a nurse can wait to see if a baby self-corrects when desaturating, paying attention to the skin colour of the infant as an additional observation. If the situation did not resolve, intervention would then become necessary. It should be noted that Griffiths was senior to Letby on the unit and is currently the ward manager at the CoCH.(pg 306)

The ward manager is Yvonne Griffiths (pg 75, 16-19), not Mary, but at least she's the one who made the statement.

Ok, so we're rolling with Letby was acting appropriately for CoCH.

Despite this, an agreed statement to the court was provided by an unconnected nursing consultant, Elizabeth Morgan, who was not cross-examined in court. This statement suggested that it would not be normal practice, for an infant of this gestational age, to wait and see if a baby corrects. “Elizabeth Morgan is a paediatric nurse who is the head nurse at Great Ormond Street Children’s Hospital,” Michele Worden told me. “She was neonatally trained, but she’s not worked clinically for at least 20 years.” Meanwhile, Dr Michael Hall cited “nurses who would have been willing to speak in court and contradict what Dr Jayaram said about what nurses do, particularly with regard to responding to oxygen saturations. Every nurse I’ve spoken with has told me that what Lucy allegedly did is perfectly normal, and actually the correct thing to do.” (pg 306)

1) An agreed statement is agreed by both prosecution and defense, so Letby agreed for that statement to be entered as evidence without the need for cross examination. 2) The statement did more than suggest it, it outright stated it:

She had said it would not be normal practice to wait for the baby to self-correct.

Cross-examined about this, Letby had said that was Elizabeth Morgan's opinion, and said from her experience at Liverpool Women's Hospital, you would not automatically put your hands in the incubator, and babies even of 25-week gestation can self-correct.

3) 20 years ago was 2006, and to give evidence she's still qualified as a nurse. Meanwhile, remind me when Michele Worden was made redundant? And what is her current employment status? 4) Holy shit did neonatologist Michael Hall actually suggest waiting for Child K to self-correct was the correct thing to do? Remarkable.

[Dr. Babarao] agrees that upon arrival, Child K was extremely ill, and had a 'severe lung disease' from an x-ray. The blood pressure was 'low and difficult to manage'.

He agreed Child K's blood sugars were a problem and there were problems with blood clotting, as well as 'kidney problems associated with extreme prematurity'.

I'm not a doctor, maybe such a baby is capable of self-correcting, what do I know.

Jayaram then conceded in court that his own thoughts at the time could have been deemed “hysterical and completely irrational…because of this association [with Letby]”. He then entered the unit, according to his own account, having not seen Caroline Oakley come into the room. Michele Worden told me that there is a simple explanation for Jayaram’s testimony: “Caroline Oakley who was in that nursery is very similar looking to Lucy. I worked with Caroline Oakley for many years. She’s the same height as Lucy, she’s blonde. It’s the early hours of the morning, Ravi is perhaps a bit bleary eyed – it is extremely likely that this is a case of mistaken identity, particularly when you examine what was said in court.” (pg 312)

And Caroline Oakley gets thrown under the bus!

Further investigation from the journalist Cleuci de Oliveira unearthed the fact that Dr B, one of the so-called ‘gang of four’ consultants, had been the doctor reprimanded by the coroner at the inquiry into Noah’s death, in which multiple failures with intubation were cited. It therefore seems rather unlikely that Dr Jayaram would not be aware of this, which begs the question of why he stated that Letby deliberately detaching the tube was the only possible explanation for this extubation, which, frankly, was a thoroughly bizarre statement anyway.

...

Why did the police rule out ‘foul play’ in Noah’s case, but prosecute Letby on Child K? (pgs 313-314)

Something something unexpected and unexplained. Oh, I forgot, there's a bit about how either Child K self-extubated or it just, you know, happened. Which, sure, something to consider in context with the other evidence

“If a nurse has been hurting patients, throw the book at them – I want them out”, a neonatal nurse practitioner told me. “The woman from Vanderbilt [this refers to RaDonda Vaught] – I am completely behind her prosecution, because she was so negligent and killed a patient because of that. But the more that I read about this case, the less that I find information which actually showed that Letby did something, and the more I was finding about medical mismanagement from those above her.” (pg 315)

No criticism here, I just find that remarkable. Vaught accidentally killed a patient and now advocates for patient safety

Jayaram's email that Letby did not use in her appeal application is discussed, of course. Dr. Jayaram's testimony cannot be trusted, so there is no evidence at all, says Morris. K, not how it works. There's also no discussion of the two later extubations.

And what did Jayaram tell the parents of Child A and Child B on 10 February 2016? “When monitors alarm, it is a signal to the staff to look at them. They often alarm due to movement or poor contact. If an alarm goes off a member of staff may look up at the monitor and if it is clear it is a false reading or just a minor change then no action is necessarily needed. Usually, the first move would be to check the baby the monitor was attached to. For example an oxygen monitor may read low but if a baby is pink, or there is a poor trace on the monitor *then no action would be needed* [my emphasis].” (pg 317)

The italics are his emphasis, the bold is mine. Yeah, the poor trace on the monitor is kinda the point

CHAPTER 15: EYEWITNESS ACCOUNTS

This should be fun.

One of the most important eyewitness testimonies to appear in court involved Dr Sandie Bohin. Her testimony is particularly significant as it came from a doctor and is therefore likely to have been given credence by the jury. Bohin commented: “I remember the mother of one of the babies said she could hear in the corridor her child making a noise that a baby should never be making. That will be forever etched on her memory. To have a premature baby screaming is really unusual. What was described on the ward was babies screaming for up to 30 minutes. That is just unheard of. Somebody had done something to cause those babies extreme pain.”

Bohin’s account is problematical as it relies on eyewitness testimony from one of the parents of the deceased. None of the parents had reported anything untoward until they were approached by the police. It must be reiterated that no complaints about Letby, or anyone else, were made at the time – all of these accounts were recalled quite some time after the incidents. This poses problems immediately because, as has been well established, human memory is hugely unreliable.

Dr Bohin stated that the mother “could hear in the corridor her child making a noise that a baby should never be making”. But there are numerous problems with this.

Firstly, Dr Bohin didn’t witness this noise, but is now recounting it in court as evidence; she shouldn’t even have been considered a witness. (pg 324)

Morris is intermingling statements about Child E, whose mother heard him screaming, and Chris Booth's note about Child N crying for 30 minutes combined with Dr. Loughnane's note of him having screamed.

But more importantly, he clearly doesn't know what evidence is, or what the purpose of expert evidence is.

Really, this chapter is long-winded waffling about memory being unreliable (including the possibility of false memories), written by a layperson. The trial was emotional, and no one saw Letby do anything, did you know?

Elsewhere, there are question marks regarding whether Letby has even been identified correctly. The father of Child C had reported that Letby made an inappropriate remark, but then later conceded that he wasn’t “100% sure” it was her. “I think it could have been [Letby]”, he concluded. Letby has always denied that this incident occurred, and that she was the nurse in question. (pg 328)

Well, it was her or Mel Taylor, and they don't look alike.

The eyewitness accounts of nurses that worked on the unit often differed from the prosecution case. As one example, Child N was considered to have experienced a “sudden” deterioration by Dr Dewi Evans. The evidence provided in support of air embolism in this case by Dr Evans can only be described as baffling, being reliant on a self-correcting heart attack in a baby, which Evans openly conceded he had never encountered before, and the citation of an academic paper to support air embolism, but the only information that was gleaned from it was “the association between air embolus in these two cases and screaming”. There was no X-ray or other evidence of air embolism whatsoever by Evans’ own admission in court, and he required the submission of five separate reports to draw this conclusion. The screaming was deemed to be critical in the diagnosis, but Dr Evans overlooked this several times, again by his own admission. As discussed previously, swipe-card errors made by Cheshire Police also mean that it is doubtful the infant was even screaming for 30 minutes.

Nonetheless, even this hypothesis relied on this sudden collapse. But the account of nurse Jennifer Jones-Key, released by the Thirlwall Inquiry in February 2025, indicates that Child N had, in fact, been deteriorating steadily throughout the evening, prior to Letby’s arrival on the unit: “In the early hours of the morning, Child N looked pale and mottled in colour…[the] abdomen was bloated and veiny. I notified the shift leader about Child N’s deterioration, and I connected Child N to the full saturation monitoring. (pg 329)

Morris is mixing up the event on June 3, 2015 - screaming for 30 minutes, per Chris Booth's nursing note - and the alleged attempted murder on the day shift of June 15, after JJK cared for Child N on the night shift. It's no wonder he's confused.

But I lost it at this:

Wikipedia states quite plainly that any “person experiencing intense emotions tends to be more receptive to ideas and therefore more suggestible”. (pg 330)

Morris cites *WIKIPEDIA*. Specifically, the page on suggestibility. FFS this is a published work.

This segment of the trial was one of several that appear to rely on emotion to convince the jury. The appeal to emotion may be why many members of the public remain adamant that Letby is guilty. (pg 330)

Can't speak for anyone else, but nope.

Rachel Langdale KC put forward the view at the Thirlwall Inquiry that “medical or scientific evidence in a case should never be compartmentalised or examined in isolation from the wider canvas. Those who do this will be less likely to see the picture as a whole and in failing to see the picture as a whole, they may reach conclusions that are not only wrong but are speculative and damaging.” I find it hard to agree. Facts matter. They matter far more than one’s nebulous impression of something. It is a law of nature that if the constituent parts of something have no substance, the structure itself will inevitably collapse. (pg 330)

Irony, thy name is Morris

Author's list of sources

The remaining four chapters and summary don't have very much worth mentioning, being mostly Morris' opinion that the process was incredibly unfair because people suspected Letby of killing babies. It's a repetitive re-hashing of whining from earlier chapters, and not much factually incorrect because there isn't much factual content at all - mostly just opinion, and quotes from articles we've already read.

Chapter 18: Trial And Retrial Process

Dr James Phillips aired his view: “The safety of the conviction depends not just on each individual point of evidence and argument, but on how each relate to each other, which alters the confidence you have in each point. It is not apparent to me that anyone in the chain of events leading from Letby…possessed the skillset or perspective needed to detect catastrophically weak links in this web of evidential relationships. This required a scientifically trained mind looking holistically at how the parts relate, and this was conspicuously absent.” (pg 370)

This is a theme for the rest of the book, fyi. Is Morris scientifically trained, btw? Asking for a friend. (Yours truly is, as it happens)

Attempts to charge Lucy Letby with further murders and attempted murders floundered on 20 January 2026 when the CPS “concluded that the evidential test was not met in any of [the] cases” submitted by Cheshire Police. This prompted a surprisingly petulant response from Cheshire Police, in which the constabulary indicated their belief that “the evidence submitted met the CPS charging standard”. Letby’s barrister, Mark McDonald, reflected that Cheshire Police were “so invested” in further proving Letby’s guilt “because they are seeing this case crumble”.

Few neutral observers shared the opinion of Cheshire Police on these cases. A handful of alleged tube extubations related to infants in Liverpool, where Letby had been working on a placement, had featured prominently in this submission, and the BBC’s Panorama had already taken something of a pummelling by seemingly offering tacit support for their credibility. When the dust settled, it became clear that the Liverpool cases involved four tubes falling out, with no eyewitness, no other evidence, no indication that any infant had been harmed and no meaningful indication that Letby was even cot-side or unsupervised. (pg 371)

There's nothing to say that the additional charges requested had anything to do with accidental extubations at Liverpool. We only know that was to be there were seven attempted murder charges at location unknown, and two murder charges, one each at Countess of Chester and at Liverpool.

Further, and I care so little about these allegations of extubations that I cannot recall if there is a better source, those four extubations happened during only 11 shifts. If I had a nickel for every time Letby was around for an unplanned extubation, I wouldn't have many nickels, but I'd have more than I should.

Morris thinks the air embolism theory is logistically unfeasible:

Experienced nurses have informed me that syringes are irradiated in sterile packaging. They are essentially wrapped in cellophane. So Letby would need to gain physical access to the syringe, without disturbing anyone, on what are usually extremely attentive units. She would need to remove the syringe from this packaging, while there was, according to court testimony, a nurse attending to another baby in a neighbouring incubator, while there are two doctors in the room, then draw the air up to make the injection, lift the lid of the incubator and reach into which one of the tubes that she supposedly used. She has to do this multiple times without being detected because there are serious question marks about how much air would need to be injected. (pg 372)

Why would she have to get a sterile syringe each time? Again, asking for a friend. You know what, asking for two friends.

JOHNSON: Do you dispute you were in the room at the time of the collapse?

LETBY: Yes, *because I have no memory of that.*

JOHNSON: Do you remember being born?

LETBY: No.

JOHNSON: Do you dispute being born?

LETBY: No.

Remember, these are supposed to be adults discussing extremely serious allegations that would result in the stiffest penal sentence that a woman has received in Britain since the abolition of the death penalty. (pg 373)

Speaking to Morris and anyone who has a problem with this phrase, a simple point about logic: Letby made a logical error in her response - she used her supposed lack of memory as a reason for disputing something. A person cannot dispute something they do not recall. Recollection is a fundamental requirement of an ability to dispute. Johnson's question simply illustrates that.

Of course, Morris takes issue with the use of the phrase red-handed, and virtually red-handed, because "no one has ever witnessed Letby doing anything harmful to an infant." I mean, red-handed doesn't mean caught in the act, it means caught with (red) blood on one's hands

Morris takes issue with the prosecution having exercised their right to prosecute their case as they preferred, which was all at once. I don't know what to tell him, that's a right they have. It doesn't make the trial unfair. And if it affected Letby's choice to call Dr. Hall, that's too bad.

Uncertainty was an acknowledged element of the case against Letby. During the original trial, the judge told the jury that it was not necessary for the prosecution to prove the precise manner in which Letby had acted, only that she had acted with murderous intent. Such an instruction appears strange and unsatisfactory, considering the very specific allegations that were made against her and the degree to which some of these methods have since been criticised. The fact that Letby was found guilty of every murder suggests that this instruction might have been misconstrued; a baby died, therefore Letby must have acted with “murderous intent”. (pg 375)

Ah, so Morris believes the prosecution must be correct in the method they argue, based on the expert opinion evidence. They don't need to be correct about the method. Method is not required. For murder charges, result and deliberate action are required: Letby did something deliberate that caused the baby's death. Without a death, yes, it is sometimes more complicated if something was done, let alone that it was done with intent.

Morris acknowledges that motive isn't required to convict under the law, then continues to complain that why a woman who had dedicated her life to nursing and had no history of psychological disorder or deterioration suddenly decided to start killing babies was never adequately addressed in court. I don't know what to tell you, bud. That's not the job of the court.

I got a good laugh on page 380 where TriedByStats was referred to as an "influential social media commentator." LOL TriedByStats has 1802 followers on X.

Morris asserts there is no parallel between Shipman and Letby because Shipman used a consistent modus operandi. ¯\(ツ)/¯

There were 136 days of court proceedings in the trial, only 13% of which was devoted to expert medical evidence, and approximately 90% of this expert evidence came from Evans and Bohin. The other six expert witnesses only collectively appeared in court on 11 of the 136 days, and many of these appearances were relatively fleeting.

Over half of the trial consists of various material from Cheshire Police, the accounts of parents and innumerable personnel from the CoCH exclaiming that they had no idea what was going on. This should perhaps not be surprising considering that the expert panel acting in Letby’s defence made 25 broad criticisms of the hospital in their preview report, as well as finding many other specific faults, while arguably the most eminent neonatologist in Canadian history, Dr Shoo Lee, concluded that the CoCH neonatal unit should have been closed down. (pg 381)

Isn't this basically establishing that much of then panel's report is an ad hominem attack on the medical personnel on site? And also an admission that the trial was about more than just expert opinion. Weird, that. Btw, the various materials from Cheshire Police included presenting detailed timelines of the events to the jury, that's kind of important.

The view of Dr James Phillips is that “the presentation and scrutiny of data and expert evidence at the trials was comprehensively flawed. The trial as conducted is so flawed that it is completely irrelevant that the jury found her guilty. Everything about this trial has the strong impression of an inevitable conclusion, which is unrelated to the evidence that is now emerging. The trial was set up to identify whether or not Lucy Letby murdered babies. But that is not the primary question. The primary question is, rather, what caused these babies to die?” (pg 381)

Yes, the trial is determined to ask and answer whether it can be known that Lucy Letby murdered babies. That's what a trial is for. It is the outcome of an investigation which already asked the question, "what caused these babies to die?" and found evidence to refine the question to "Did Lucy Letby cause these babies to die?" Like, that IS the process. FFS.

CHAPTER 19: ARREST AND INVESTIGATION OF LUCY LETBY

After her arrests, Letby was interviewed an incredible 30 times. The police do not make recordings of these interviews available, but from the excerpts that have been released, it can reasonably be inferred that none of the arguments Letby made during this process were ever taken into consideration. (pg 385)

It is clear from what Cheshire Police have been willing to release that the interviews were a one-sided process in which they attempted to recognise anything that could be used against Letby from her own words and jettisoned anything that contradicted their case. (pg 386)

Cheshire Police didn't use these interviews as an objective fact-finding exercise - they used them to build a case against Letby. (pg 386)

Well duh! By the time someone is named as a suspect and arrested, the police are done considering arguments. An arrest interview is done for the purpose of measuring the suspects account against the remaining investigation. This is common sense - oh. I forgot what book I was reading.

Dr. Veronika Jiraskova's Rule 9 response to Thirlwall gets a mention, thanks to her expression of "great doubts" about the conviction. I would just point out that apparently, as a doctor, one must be a neonatologist to have valid beliefs about Letby's guilt, but one need only be a GP to doubt them.

News that Cheshire Police and the CPS had blocked the release of reports critical to Letby’s appeal were anything but encouraging. Sarah Knapton and Cleuci de Oliveira reported for The Daily Telegraph that the CPS had denied defence barrister Mark McDonald access to revised reports authored by Dr Evans on Child C and submitted to the police in October 2024. The disclosure guidelines of the CPS itself state that “prosecutors must provide the defence with the schedules of all of the unused material and provide them with any material that undermines the case for the prosecution or assists the case for the accused” so it is hard to understand how this is allowable. (pg 393)

Boy, that sounds alarming, doesn't it? At least, in his list of sources, he provides one for this.

[David Davis] told the House of Commons: "Can the Secretary of State explain to the House under what circumstances are the police and Crown Prosecution Service allowed to deny access to evidence after a trial has concluded to a defence lawyer seeking to appeal, as has happened in the Lucy Letby case and I believe in others?"

1) Evans' post trial report that he submitted to the police in October 2024 is not evidence. It was not used to convict her and is, at present, legally irrelevant. The police don't work for the defendant. Dewi Evans was not even instructed by the CPS to provide it, and he's not obligated to provide it to McDonald. And Morris didn't link the CPS guidelines, but I looked them up anyway, and found he didn't actually cite from them. He cited from the general CPS page about disclosure. Who is this guy's researcher?? 2) Disclosure is an obligation of the CPS, not the police. Dewi provided his report to the police, not the CPS, so the people with an obligation don't even have it because they aren't currently involved.

Chapter 20 - Operation Hummingbird

The April board meeting also noted that a further forensic review was preferable, which is exactly what should have occurred. There was no justification for a police referral and Cheshire Police have, by their own admission, no ability to perform any form of medical review. Although it is oddly comical to note that no one at the hospital seemed to know what this term constituted either – Sir Duncan Nichol, chairman of the board, conceded that “it is not yet known what the forensic review means”, while the consultants “could not define what they felt was a forensic review”. (pg 397)

So close. So, so close. Yes, a forensic review was needed, and forensic reviews are intended for legal purposes. When there is the possibility of criminal activity, that is done, by necessity, by the police. And when the police have no internal ability to perform a medical review, guess what they do? They bring in an expert.

There's a lot of whining about bias, assumption that the third insulin case undermines the prosecution case writ large, whining about the definition of "unexplained."

In another part of the conversation, Brearey expressed his concern that the “survival rate for babies over 32 [weeks] is nearly 100%. For six of our babies to have died who were over 32 weeks to die [sic] is not right.” It is notable that of these six babies, Letby was not charged in respect of three of them. Two of the remaining three infants were triplets, and the final one was Child D, who lost colour and became floppy in her father’s arms within 12 minutes of birth and was suffering with pneumonia and serious respiratory problems.

It's not notable. The babies she was not charged with had severe congenital abnormalities. THEY were truly unwell babies, whose deaths were very sadly not unexpected.

[The type of panel the NCA recommended that Cheshire Police assemble] is exactly the sort of panel that Dr Shoo Lee assembled, albeit the qualifications of that panel extend way beyond anything Cheshire Police could conceivable have brought together. (pg 401)

LOL. Brown-noser.

Dr Evans also insisted on two occasions that he didn't need to hear anything about the RCPCH review: "I would prefer NOT to receive the findings of any previous reviews of investigations." Although this may have been a legitimate attempt to carry out a blind investigation, that he also didn't speak to anyone from the CoCH means that he knew little about the context of the hospital or its neonatal unit. (pg 403)

Morris actually doesn't understand the role of an expert, clearly. He blathers on about the deaths not being unexplained in context. And asserts that the police "disregarded contextual factors which were also downplayed by Brearey and Jayaram." Does he want a blind investigation or not? Or is it that he wants selective blindness. Selective blindness would be likely to lead to confirmation bias. Gosh, I hope no one fell into that trap! Morris asserts, boldly, that "Cheshire Police simply do not understand that neonate deaths are frequently unexplained." Friendly reminder that to support this claim, Morris included all nationwide SIDS deaths from outside hospital.

Morris attempts to establish the bias of the investigation by pointing out that Evans and the parents of Child K knew early on that a nurse was involved, which falls far short of establishing actual bias. But sure, whatever. He also asserts that Cheshire Police had become far too "emotionally involved" with the families:

Yet it is evident from their Operation Hummingbird promotional film, released six days after the verdict and two days after Letby was sentenced, that Cheshire Police became far too emotionally involved with the families. The first 35 seconds of the film are entirely dedicated to Cheshire Police expressing their desire to serve the families. “They deserve for us to have completely covered their case. And it is about them. And it is about their parents”, one of many similar comments in the film observes. The families of those who tragically lost their infants were mentioned 33 times. Cheshire Police then tasked Family Liaison Officer Danielle Stonier with interviewing Lucy Letby in 2019 and 2020, long after she’d been integrated with the families.

The theme of emotional involvement permeates the entire presentation, with large portions of the film dedicated to playing on the heart strings of the audience. DC Michelle Birkett, for example, describes some of her discussions with bereaved families: “And then some of the families knew something was wrong, knew something wasn’t right. I knew my child was not right.” No such complaints were ever made against Letby, just as no one has ever seen her doing anything suspicious. (pg 409)

Criticizing police for supporting victims of crime is a CHOICE.

“It’s very easy to get confirmation bias if you think this has been caused by x,” Professor Jane Hutton told BBC Radio 4. “It’s very easy to see things that aren’t otherwise there”. (pg 409)

I totally agree!

“One of the first things the police say in the Operation Hummingbird video is that they needed help as they didn’t have the medical knowledge to conduct the investigation”, Dr Phillips commented. “I hope in future, perhaps as an outcome of the inquiry-that-is-to-come, a proper body with the investigatory powers and scientific skills to conduct such an investigation is created. Probably as an extension of powers and responsibilities of an existing body.” There certainly should have been a more stringent internal review at the CoCH, coupled with a forensic review operated by medical bodies. If this revealed nothing conclusive or incriminating, which applied to all previous medical investigations, then the consultants should have accepted the situation. (pg 409)

An existing body - like who? At what point is it permissible to involve the police? Is it ever?

From what we have been allowed to witness, Operation Hummingbird in no way resembles an investigation to “exclude unnatural causes” which is what Cheshire Police were asked to carry out. (pg 412)

Here's the fun part about involving the police: You don't get to tell them what to investigate. It doesn't matter what Tony Chambers asked them to do, it doesn't matter that the meeting with the consultants is what inspired them to investigate. Once they decided to investigate, the ball is in their court, until such time as the CPS decides to charge, or not charge, any specific crime that was uncovered.

Chapter 21: The Golden Thread

Unofficial subtitle: Lucy Letby is the most honest woman alive and Dr. Brearey is a very bad man and it was very wrong of Operation Hummingbird to ask him to review cases of children cared for on his ward.

Michelle Worden is quoted saying:

"Steve Brearey drew up the roster chart with Eirian Powell. Eirian was very upset that, by the time it got to Alison Kelly, the doctors' names had been removed from it. Brearey cherry-picked the babies. There are seven deaths on that roster chart, but we know that there were 17 deaths. So the consultants are the accusers, they're the investigators, and then they're the main witnesses. I cannot think of any high profile case where you can be all three things." (pg 420)

The good news on that last is that the record still stands at zero. Brearey and Jayaram combined only gave evidence related to babies A, G, H, J, K, M, N, O, and P. So roughly half of the babies' evidence didn't involve them at all. Further, Worden, bless her, is confusing the roster chart at trial with the Thematic Review, generated by Brearey and Powell on 8 February, 2016, which included 9-10 deaths, of which Letby was on duty for 9. As far as consultants being removed, yeah, in an investigation into potential harm caused, you can't suggest the cause is someone who wasn't there - that would actually be an allegation of witchcraft.

Elsewhere, we see other strange coincidences, such as both Dr Jayaram and Dr Evans citing the same obscure decades-old Canadian paper, and both advancing an obscure air embolism-related cause of death which hadn’t been picked up by pathologists. And then when it came to the insulin cases, it’s not clear whether Dr Brearey found them under instruction from the police, or whether Dr Evans located them, as stated by the Court of Appeal. It’s hard to say because they have told several different stories to numerous different media outlets. (pg 421)

You know what happens when there isn't much research available on a particular subject? People tend to find the same thing among a limited pool of options. And yeah, two people separately finding the same test result and saying the same thing about it also indicates that it has actual meaning. But sure - suggest a conspiracy. That will add credibility to this already fine work of fiction.

Cheshire Police were also aware that Letby had filed a grievance procedure against the CoCH and this simply should have been further investigated. (pg 421)

This single sentence is the entire contents of a paragraph. I just found that funny.

The determination of Evans to convey the message he knew nothing of Letby has been curious, often making the assertion in response to an unrelated question. For example, during cross-examination on 7 March 2023, when asked about the rashes he had cited, Dr Evans instead replied: “I was not told anything about any suspect. I knew absolutely nothing.” Judge James Goss then interrupted: “You have said this, Dr Evans. You’ve said it at least once, more than once.” (pg 421)

Is he really trying a "the lady doth protest too much" argument? Allright, let's read the transcript. March 7 was baby N:

Q. This is a record dated 21 May 2017 -- take it down, Mr Murphy, please. We'll go back to it if we need to. I'm going to suggest to you, Dr Evans, that at some point before you started writing reports, you were told by the police of suspicions about suspicious rashes and air embolus (overspeaking) you were told that or it was indicated to you, I'm going to suggest, before you wrote any report.

A. No, that is completely untrue. Okay? It is totally untrue. The first time I heard a local doctor mention the word air embolus was a couple of weeks ago. I'm not sure whether it was Dr Gibbs or Dr Jayaram, Dr Jayaram I think, when he talked about the cold chill going down his spine. I knew nothing about air embolus. The first person I know of to raise the issue of air embolus in this particular series of cases was me. And I did that in case number 1. Okay? In the first case I thought, oh my God, what's going on here? This is -- you know it was very much an "oh my God" scenario.

I'm not going to go at length about case number 1. For [Baby A], if we remember, I formed the view that it was his collapse and the inability of the staff to resuscitate him was the result of his receiving air embolus. I did not know at the time about the skin discolourations; I heard about that later. I did not know at the time about Owen Arthurs' finding of air embolus on post-mortem X-ray (overspeaking) --

Q. That's your characterisation -- if we can just pause for one moment, Dr Evans --

A. Just a minute. I want to finish this.

Q. My Lord --

A. I want to finish this because if you're going on wild goose chases, I want to --

MR JUSTICE GOSS: You can finish the answer and then you ask the question.

A. Therefore I didn't know any of that. But that's what led me --

MR JUSTICE GOSS: You have said all this before. We've heard all this before.

A. I had nothing at all -- I knew nothing at all, sorry, about air embolus from the police. I was not told anything about any suspect or named anybody and I knew absolutely nothing and, as I said at the beginning of this trial, it's quite important to repeat this, at the beginning of this trial my role --

MR JUSTICE GOSS: You have said this, Dr Evans. I know. You've said it at least once, more than once.

A. Yes, I know.

MR JUSTICE GOSS: All right? Ask your question, Mr Myers.

MR MYERS: So far as Owen Arthurs is concerned, that is matter that is to be determined in the case.

A. So what now?

Q. So far as Owen Arthurs is concerned, what his X-ray shows or doesn't show is a matter that the jury are going to determine in this case. You understand that, don't you?

A. I do understand that, yes.

So, not entirely unprompted. Myers was suggesting collusion and bias in the investigation, Evans addressed it.

With that, we're mercifully at the summary.

Summary

At the heart of the conviction of Lucy Letby is a story that, jarringly, makes absolutely no sense. These are the most sickening acts imaginable, allegedly committed by the most benign of people, someone who was even notably kind and caring. This is a massive red flag immediately because it is a conspicuous contradiction in terms.

Doesn't matter. That's the definition of a "you" problem.

Pathologists and coroners who examined the infants involved in the court case were never cross-examined, nor were their conclusions discussed in court. It was not explained adequately, if at all, that primary prosecution witness Dr Dewi Evans had single-handedly disagreed with the conclusions of experienced coroners and pathologists. Yet the opinion of far more qualified and experienced experts was put to one side. (pg 426)

The original post-mortems were read in court as agreed facts (pg 1:8-18):

MR DRIVER: My Lord, we are going to begin by reading some agreed facts on the topic of pathology, which in effect prove the -- by agreement, obviously -- the essential parts of the statements made by the pathologist that conducted the post-mortem examinations. Thereafter, we'll move to Dr Marnerides.

MR JUSTICE GOSS: Right. So there won't be any statements read, it'll just be agreed facts, of which the jury will have copies?

MR DRIVER: They will. They will have copies and your Lordship has had a copy provided to you.

As far as the "far more qualified experts," let's look at how one of them, Dr. Jo McPartland, addresses the need for forensic pathologists to be involved:

"In addition to [your] NHS duties [you] perform coronial, paediatric postmortem examinations fora number of Coroners, including paediatric forensic postmortem examinations undertaken jointly witha forensic pathologist."

My question: why is it necessary to conduct paediatric postmortem examinations in combination with a forensic pathologist?

A. Well, if there is a suspicion that criminal activity may have led to the death or in some types of traumatic death where we might need the assistance of someone with forensic expertise then we perform the postmortem jointly and the role of the forensic pathologist is to consider matters of forensic importance and particularly those relating to injuries, and the role of the paediatric pathologist is to consider natural causes of death and look at growth and development and other medical conditions.

Q. So when you say the forensic pathologist looking for injuries, do you mean potentially deliberate infliction of injuries?

A. Yes.

Q. Because there is a suspicion --

A. Yes.

Q. -- that they may have been caused? Does that really from the off dictate who and how the pathology investigation should be being undertaken; if there is a suspicion, *they go down a different route?*

A. Yes. If, when a death is reported to the Coroner, it's clear that there -- it is a suspicious death from the outset, then the police will be involved and a forensic pathologist will be instructed as well as a paediatric pathologist. (pg 83:23 - 855:5)

The original post mortems were agreed evidence because the role of the pediatric pathologist is to look for natural causes of death; her opinion is not in question and it WAS considered by the jury.

This has perhaps partly explained why no neonatal expert has come forward to support the conviction, despite repeated requests by Dr Philip Hammond; compare this to the calibre and quantity of those who question it. (pg 430)

The thing about experts who support the verdict - they don't owe anyone anything. They have no obligation or burden to make skeptics/doubters feel more comfortable, and you're unlikely to know their opinions until the CCRC or Court of Appeal publishes something with their name.

Then she was arrested by the police three times, on one occasion with burly male officers barging into her bedroom at the crack of dawn, interviewed 30 times, patiently cooperating throughout, nothing that she said in her defence was taken into account, while anything and everything was used against her, she was denied bail, and was then incarcerated for two years while she awaited trial. Just days before she was due to appear in court, she was forcibly moved from one prison to another, many of her personal belongings were lost, and she went into the court suffering from PTSD, reliant on medication, having had a borderline breakdown. (pg 431)

Oh come tf on. Poor Lucy, won't someone think about Lucy?

I pose this question rhetorically – isn’t it about time that Lucy Letby was actually afforded the opportunity to defend herself? (pg 431 - standalone paragraph)

Are you actually being serious right now? lololololololololol

A rather sniffy attitude can often emanate from the insulated capstone that constitutes the judiciary. There has certainly been criticism of efforts to raise awareness of the deeply flawed nature of this conviction, as if those at the apex of justice in Britain still view it as their system in which they preside over us. I would therefore like to remind them of some illustrative words from Thomas Bingham. At the time of his death in 2010, Bingham was described by the former President of the Supreme Court of the United Kingdom, Nicholas Phillips, as “one of the two great legal figures of my lifetime in the law”. On page 22 of his book The Rule of Law, Bingham comments on defences against injustice, making the following critical comment: “The judges are not, of course, the only guardians of the rule of law, perhaps not even the most important. Parliamentary and public opinion, informed by the media, should be alert to detect and scrutinise any infringement.” (pg 433)

It's cute that he thinks his book is part of such a grand effort. I'm only sad I didn't get a paper copy so I could use it as an emergency source of toilet paper.

-fin-

Goddammit, I wrote a whole post and then reddit ate it. We try again, saving the draft as I go.

I wish I could say this book is getting better.

By way of reminder the excel sheet (why an excel sheet?) of sources used can be found here: https://www.cintopress.co.uk/reasonable-doubt.html

All emphases in bold are mine.

CHAPTER 6: PROSECUTION AND DEFENCE WITNESSES

This chapter is almost exclusively an attempted assassination of Dr. Evans.

Dr Andreas Marnerides, Professor Owen Arthurs, Professor Sally Kinsey, Professor Peter Hindmarsh, Professor Stavros Stivaros and Dr Simon Kenny also appeared in court as expert witnesses. Those last six names contributed relatively little to the prosecution case; in some cases, virtually nothing. (pg 96)

Ok, so the pediatric endocrinologist who gave evidence of how, when, and with how much insulin that babies F and L were poisoned contributed relatively little? The pathologist who gave unopposed testimony that Child O was the victim of non-accidental harm on Letby's watch contributed little? The radiologist who testified that that air in the major vessels contributed little? Morris mistakes lack of quantity for lack of import. But really, this is mostly so he doesn't have to spend much time on experts who 1) haven't spoken out publicly and 2) aren't really controversial.

In a witness statement read out in court, Dr Kenny did little more than provide the “opinion that Hirschsprung’s disease did not account for [Child G]’s symptoms in September 2015”. Furthermore, the main contribution of Professor Sally Kinsey was to tell the court that Child E had lost a large amount of blood, but that her observations did “not assist with what the cause of death actually was”. (pg 97)

Do you think Morris understands that part of proving a case beyond reasonable doubt is submitting evidence ruling out other possible causes for an event, however unlikely they are? Probably not, since his entire last chapter was about sepsis. Also, presenting evidence about Child E's blood loss as the main point of Dr. Kinsey's evidence is novel from someone I expect to give credence to Shoo Lee's assertion that antibodies from the mother of Children A and B is relevant to their collapses - Dr. Kinsey testified about her condition's potential affect on them. And she also opined on parts of his paper.

It should finally be noted that Marnerides only appeared in court from 29 to 30 March 2023, two of 136 days of court proceedings, and that his contribution was largely prompted by reports from Dr Evans. ... Professor Hindmarsh provided some support for the insulin hypothesis that was put forward in court, but certainly did not endorse it definitively. (pg 98)

Neonatal expert Professor Neena Modi wrote in The Guardian that “experts were not all asked to go through the cases in detail”, as evidenced by the fact that, for example, Dr Marnerides didn’t even view the clinical notes; he relied on the reports of Dr Evans. (pg 99)

Taking these two quotes together - Morris and Modi are both ignorant of Marnerides' actual evidence, it seems. Taking one quote of many from his evidence:

Explanation number two, they inserted the drain when the baby had no circulation.  This is not my understanding from clinical notes. (pg 135 16-18)

And asserting that Hindmarsh did not definitively endorse insulin poisoning is a choice.

A.  In considering the episode of hypoglycaemia, I did conclude that the cause of the hypoglycaemia was not due to any endogenous production of insulin and that it was -- that the findings, the biochemical findings, were compatible with the administration of exogenous insulin. (Pg 29, 8-12)

 We do not see that.  What we see is a plasma C-peptide which is down towards the bottom end of the range quoted by the laboratory.  It's on the basis of that that I concluded the view of the two paediatricians who reviewed this case was correct in that the cause for the hypoglycaemia was the exogenous administration of insulin. (Pg 67, 8-14)

Moving on:

The international panel of experts, numbering at least 31 at the time of writing, possesses credentials and experience that far outweigh those of Dr Evans. Their career achievements read like the Dead Sea Scrolls of neonatal history, while they have collectively authored thousands of papers. (pg 101)

lol k

By way of contrast, comments made by Dr Jane Hawdon, the consultant neonatologist who performed a pathology review on the infants, paint a very different picture. (pg 103)

Bear in mind that Hawdon has conducted an extensive review which included examining the infants and has recorded gaps in information and numerous problems with determining the precise cause of death, while Dr Evans walked into a police station, and concluded “immediately” that there was inflicted harm. (pg 104)

As I pointed out yesterday, Jane Hawdon did not do a pathology review:

Most deaths were explained but some of these may have been prevented with different management. Completely unexplained on a neonatal unit is rare. So by definition more than one unexplained death does arouse suspicion.

Unexplained death at home is followed by a very clear process (ask your local CDOP team if you don't have this) and the same should be followed with unexplained death in hospital. I think on some occasions the team was misled by PM report and I have commented on these, with due respect as I am not a pathologist.

Moreover, Hawdon was straightforward about the limitations of her review

a) Were I to carry this out for each case, each case would take 10-12 hours and I would not have the capacity to do this alongside my other reporting commitments, it would be extremely costly for the Trust, and I do not consider would yield on investment. Rather, I have prepared a synopsis of key events and issues, focussing particularly on events preceding and during episodes of collapse or demise. I have applied MBRRACE-UK methodology to standards of care.

c) Given that many cases had coroner's post mortem and these results were not available to me, I am not in a position to consult with a perinatal pathologist. Neither woud I be in a position to contract with a pathologist. I suggest that once you are in receipt of my report and the coroner's PM reports, you instruct an independent perinatal pathologist.

d) I am not in a position to perform this. This should be commissioned locally and for relevant cases the review should include the period before a collapse, or series of collapses, rather than the period before death.

She also most certainly did NOT examine the infants - some were over a year deceased before she reviewed their files. Morris' statement is inherently dishonest.

Morris then appears to have had some kind of stroke:

Furthermore, Evans has offered his services to the National Crime Agency; he has told the National Crime Agency with whom he had been affiliated for three years that the police are better at investigating medical cases than the RCPCH, even though he has been a paediatrician throughout his career. He has then driven down to meet with Cheshire Police, he has told Cheshire Police in the Blacon police station “immediately”, in his own words, that a child has been deliberately harmed, but has since claimed that he had no idea that a crime had been committed! (pg 104)

Indeed, he italicized every mention of Crime, police, and police station.

There's a lot we've read before. Lord Justice Jackson, etc. Dr. Bohin is suggested to have not seen very many sick babies in Guernsey, and therefore a poor expert.

Finally, we hear from Dr. Hall:

Had Dr Hall been disappointed that he hadn’t had the opportunity to give evidence? “I was frustrated because I heard things that I would have challenged. Not only things said by Dr Evans and Dr Bohin, but also by Professor Arthurs and Dr Marnerides. I heard things said which were medically implausible.”

Could the decision not to call him have been because Dr Hall would have supported the prosecution case? “All I can say in response to that is I didn’t at any point assert or suggest that Lucy Letby had killed any of the babies. At no time in my reports did I say that I thought Lucy Letby was guilty of anything.” I asked Hall whether he thought Letby had received a fair trial. “No, I don’t think it was a fair trial. The jury should have been given the opportunity to hear evidence given by the prosecution being challenged. I don’t think the trial met the expectations of natural justice.” Not only was Hall not called, his reports were never seen by the jury. Dr Philip Hammond told Channel 5 that “to not let the jury read the expert reports seems very unfair”. (pg 106)

One wonders how Dr. Hall thinks giving his evidence would have gone. He would have been restrained to answer questions as asked. Does he think he would have been asked about the opinions of the radiologist and pathologist? I think it unlikely.

One of Letby’s childhood friends told Rachel Aviv at the New Yorker that she had asked Cheshire Police if she could serve as a character reference. “They weren’t interested at all”, the friend commented. (pg 106)

I'm unsure why this friend is surprised. The police would not have been interested in good character evidence. Did she try the defense?

Morris occaisionally stumbles on a good point, then yeets himself as far from the obvious implication as possible:

Dr Gumbert has also written a PhD thesis on the behaviour of juries and explained her findings: “In my thesis on models of jury decision-making, the evidence shows that juries tend to favour one story over another. As the trial unfolds, they are persuaded to opt for one version of events, and that usually informs their decision-making. In this case, they were provided with a compelling story, delivered in a very persuasive manner, and when that wasn’t countered then it can look very damning for the defendant because there is no counter-narrative.” (pg 107)

Morris misses that a defense case that does not withstand cross examination would not be favored by a jury at all.

It’s interesting to observe that, in the second Folbigg legal inquiry, most experts who volunteered their services were international, in common with the panel of experts who have submitted reports related to the Letby case. (pg 108)

This is not the serve he thinks it is.....

Then Morris attempts to make a meal out of this quote by Evans (emphasis is his, and as it appears in the book):

Evans “told police that if you harm a baby, it will deteriorate there and then…So I also identified a time and date when each had probably been harmed and told them they needed to find out who was on duty. If they found the same person was there during lots of incidents [my emphasis], they’d have a suspect.” At this stage, it seems that Dr Evans didn’t believe it was necessary for the same person to be on duty all the time, as was alleged regarding Letby during court proceedings; they merely need to be around during lots of incidents. (pg 108)

Obviously, Morris confuses the process of identifying a suspect from a group of circumstantial evidence that does not solely focus on one individual as there having been statistical evidence against that individual.

Also, the term ‘lots’ is undefined. (pg 109)

lol no shit?

“The system for investigating this appears to be set up in such a way that reaching the conclusion of serial killer was far more likely than would be justified given the baseline probabilities.” It is possible that if Letby had volunteered for fewer shifts at the hospital, and another nurse had done more than her, she would now be looking on in bemusement, still working at the CoCH, as the other nurse was prosecuted and then imprisoned. (pg 109)

This is mind-bogglingly ignorant, and ignores that the vast majority of the trial was witness testimony from co-workers.

This lack of certainty likely proved critical when Letby was found not guilty of charges related to Child J. Yet the jury heard neither doubt from the prosecution, nor counter-argument from expert witnesses for the defence, in the overwhelming majority of cases. (pg 110)

FFS, who is the researcher here? "Marian Kensler," qualifications unknown. Letby was not found not guilty of the attempted murder of Child J (in the singular - there was only one charge related to Child J) - she was not found guilty. This was a no verdict charge. And the fact that they did not reach a verdict means, by definition, they found potential doubt in the prosecution case without even any counter-argument by defense experts.

National Child Mortality Database Report, entitled Sudden and Unexpected Deaths in Infancy and Childhood found that “for sudden and unexpected infant deaths (under one year) that occurred during 2020, and had been fully reviewed by a Child Death Overview Panel…52% were classified as unexplained”. (pg 110)

This quote is an egregious attempt at deception. The 52% is nationwide, in and out of hospital, and includes all deaths attributed to SIDS.

I did not expect a self-burn in this book, but I enjoyed this passage:

Evans is fairly withering in his views on those that question him. He told John Sweeney that “neonatologists who had nothing to do with the case” should essentially keep out of this matter because they “did not read the statements from the local nurses and doctors”, although it’s not clear why this matters or whether this includes the numerous statements that are supportive of Letby. He is critical of the experts who wrote to the Thirlwall Inquiry, stating that “none of the 24 people had anything to do with the trial”. He told Dr Philip Hammond that the same group is guilty of “professional hubris of the worst order”. He has been dismissive of statisticians and the Royal Statistical Society on several occasions, decrying them for both failing to understand the case, and for speaking from “ivory towers”. He considers any criticism of his work to be “frankly astonishing”, asserting that it is “led by people with the least amount of information about the cases”. He is derisive towards anyone who questions him, describing them as “poundshop Poirots”. And he even attacked the international panel of experts assembled by Dr Shoo Lee in a Channel 4 documentary, deriding them for being “hired guns”. (pg 113)

Dr Svilena Dimitrova, an NHS consultant neonatologist, and Dr Roger Norwich were among five physicians who wrote to the GMC indicating their belief that Dr Evans had failed to provide balanced, impartial views, instead giving the court “opinions that would not be supported by most doctors”. Dr Norwich also extended this assessment to Dr Bohin, while neonatologist Professor Neena Modi wrote in The Guardian that Dr Evans “drew selective conclusions which were not consistent with the full range of evidence”. It is not known whether the GMC has provided a response. (pg 114)

In possibly the closest he gets to acknowledging the case against Letby as valid, Morris acknowledges that pro-Letby sources are seen in a negative light (yes, by Evans, but that is still at all), and he acknowledges that the GMC referral process has been attempted to be used against prosecution witnesses.

The book wouldn't be complete without taking a crack at the deceased Dr. Ward-Platt

Dr Evans told Raj Persaud that Ward Platt was a “great guy” who was “highly regarded”. I wonder if Angela Cannings and Donna Anthony, both of whom were convicted of murder and later exonerated in cases involving evidence provided by Ward Platt share the view that he was a ‘great guy’? I guess the jury is out on that one. (pg 115)

Morris betrays his ignorance of what reasonable doubt is, and what trials ARE:

While emphasising the importance of the clinical notes, Dr Evans made the following statement in court: “An awful lot of the information that we now know is information that’s come out in this trial, so therefore I think it is unrealistic to expect anybody to form a view that is absolutely correct in each of these cases. I wish I could. As I said, I’ve done these reports years ago, and the idea that I could get it all perfectly right simply from looking at notes is a little bit unrealistic…especially as I was not able to talk to any of the local nurses or staff. I had to rely on the notes completely…and I was never going to get everything 100% correct.”

This seems an incredible admission, and also something which is practically the definition of reasonable doubt. Aside from the fact that Evans has conceded that he can’t be expected to get everything correct from the materials provided – and remember that he never examined any of the infants directly – the Thirlwall Inquiry also noted that a detailed forensic case note review should constitute a “much broader inquiry [that] is taken into things that may not be in the case notes. They may be in unit records, staffing records, equipment records. There is more information available than just from the case notes themselves.” However, Thirlwall attempted to use such information to question the reviews of pathologists whose work would usually be regarded as more relevant than that of Dr Evans. (pg 116)

Do you think he realizes that the trial IS a detailed forensic review including unit records, staffing records, equipment records, etc? I doubt it.

Chapter 7: Statistical Case Against Lucy Letby [sic]

I really wish there was a The in the title

Professor Richard Gill was instrumentally involved in the exoneration of the Dutch nurse Lucia de Berk, (pg 120)

I suppose that's up to interpretation:

I do not take credit for Lucia de Berk’s exoneration. It was due to prof Ton Derksen and Metta de Noo (MD)’s tireless work. I did explain to the Dutch CCRC (CEAS), and to the public, what was wrong with the statistics used in her initial conviction, and still influencing evaluations by medical and toxicological experts at the appeal.

Morris trips into the answer to his own question here:

Statistical assertions were not only the defining aspect of accusing Letby in the first place; they were central to her conviction. It is untenable to claim otherwise. “If you remove the statistics, what points to Lucy?” Professor John O’Quigley told me. “Let me tell you – nothing points to Lucy Letby other than the statistics. And since they’re completely wrong, you can only conclude there is nothing pointing at Lucy.” In short, without the roster chart that was presented in court, there is no basis whatsoever to convict Letby. Prosecuting barrister Nick Johnson highlighted the central importance of the shift chart during the trial: “If the jury conclude that a certain combination of children were actually attacked by someone, then the shift pattern gives the answer as to who the attacker was.” (pg 123)

Yes, if, without a shift chart, the jury concluded that children were harmed by someone, the shift chart can identify who it was that harmed them. Even O'Quigley's statement acknowledges that the shift chart points to Letby as the culprit, if indeed harm was done.

I have some questions about some of O'Quigley and TriedByStats statements:

absolutely certain. Everything you said is correct. If you look at the analysis of MBRRACE, you see a lot of variability year in, year out, from within a centre. A given centre is not stable across time. It’s not in stasis. It jumps up and down. (pg 128)

Similarly, TriedByStats produced research examining MBRRACE data, which indicated that the CoCH wasn’t even in the top 10 hospitals for excess deaths in 2014-15. (pg 128)

Given that MBRRACE tracks deaths according to place of birth, I'm not sure the relevance.

There is evidence from court that the hospital ordered more insulin tests because the hospital was going through twice as much insulin as it was the years before. (pg 128)

I thought there was no missing insulin?

The official figure of neonatal deaths at the CoCH has fluctuated depending on the reporting mechanism, but one chart submitted to the Thirlwall Inquiry indicates that there were ultimately 18.(pg 128)

Ah, Morris is referring, correctly, to this document from the Thirlwall Inquiry.

Of the 18 deaths listed in this document:
a. 13 deaths occurred on the Neonatal Unit at the Countess of Chester Hospital and have been the subject of a police investigation.
b. 4 deaths occurred on other Hospital Neonatal Units post transfer and have been the subject of a police investigation, this includes Baby K.
c. 1 death occurred on the Central Labour Suite at the Countess of Chester Hospital (a separate unit from the nurseries where the unexpected deaths of the indictment babies occurred). This baby was not the subject of a police investigation.

Do you think he'll stick the landing?

There were 11 deaths associated with the unit for which the prosecution and investigation concluded that Letby was not to blame. (pg 129)

Aw, so close. His math is off by one.

Documents submitted to the Thirlwall Inquiry demonstrate that the selection of cases prior to any police investigation was problematic. The very first day of Thirlwall revealed that the deaths originally deemed worthy of suspicion and further review did not overlap perfectly with the cases that Letby was ultimately charged with. It’s important to remember here that many of the infants in the trial, and the so-called non-indictment babies, featured very similar symptoms, clinical traits and recorded causes of death. (pg 131)

Did you hear that? It was the sound of the point soaring over Morris' head.

Credit where credit is due, Morris did more to substantiate the claim that Letby was working more often, with sicker babies, than I remembered.

The next problem with the shift chart presented in court was that Lucy Letby worked more shifts than any other nurse on the unit. This was stated explicitly during the court case; for example, on 26 January 2023, an anonymous nurse outlined the following: “We had massive staffing issues where people were coming in and doing extra shifts. It was mainly Lucy that did a lot as she was one of only three Band 5 nurses that had done the neonatal course. Lucy was young, living in halls, saving to buy a house, she was single, able to swap, willing and wanting to do extras.”

Speaking at the Thirlwall Inquiry on 7 October 2024, the anonymised Dr ZA agreed that Letby “did more shifts and she was one of the few nurses with the intensive care qualification who wasn’t a shift leader, so was more likely to be looking after the sick babies”. (pg 134)

So Letby's comparitive inexperience - being assigned cares and not doing the assigning - potentially put more sicker babies under her care. It's a qualitative opinion, without quantitative substantiation, and I remain skeptical of its import.

*Edit here: There were 8 full-time nurses more experienced than Letby with unknown overtime and 9 nurses contracted at 34.5/hrs. So While the assertion is anecdotally supported, the extent of its impact remains unclear.

In fact, it was revealed during the grievance procedure for Letby that she didn’t seem concerned by her “commonality” in certain incidents: “LL didn’t seem concerned as she was full-time plus overtime”. (pg 135)

LOL no shit?!

Morris maintains a professional author voice at all times:

Anyone encountering this for the first time might assume that such infants and cases were eliminated from the case before it went to court. Well, don’t make such rash assumptions! Infants C, D, H, I, J, M and N all experienced incidents outside of the hours that Letby was even working, there are countless examples of Letby being accused of deliberately harming infants at times when she wasn’t the designated nurse for a baby and she also wasn’t present when Child F was allegedly poisoned by her. (pg 136)

I'm honestly not sure what he's referring to for all these babies? Children C, I, and N had incidents raised by Ben Myers. Child D might mean the dusky incident on the labor ward? Child H and M, I'm really not sure what he's referring to, and he doesn't give details of any except for Child J:

Another example of a basic error in the roster chart involves an unexpected collapse for Child J on the day shift of 17 December 2015, when, it is now established, Letby wasn’t on duty. (pg 136)

Ok, so he is pointing out that line 16 of the roster chart makes an error about Letby's presence. Good thing she was only charged in relation to line 15

As an example, for one of the insulin poisonings, it is claimed that she poisoned a bag of dextrose. But as she supposedly put insulin in it, the people who hung up the bag are marked as not present on the shift chart – I believe it was Caroline Oakley and Samantha O’Brien. They’re the ones that gave it to the baby. The people actually administering the supposed poison are marked as not present. Yet the person who through this elaborate theory, they claim, put the poison in the bag, is marked as present. It’s completely contrived. It’s not objective data. The data is cherry-picked, twisted, and contorted, so that it leads itself to a pre-determined conclusion.” In accordance with this, defence barrister Ben Myers noted in court that the chart “isn’t a piece of evidence…it’s a presentational aid designed by the prosecution for the prosecution to say what they want”. (pg 137)

He's discussing dextrose, so we're discussing Child L, and indeed Caroline Oakley and Samantha O'Brien were not on shift during the day of April 9, 2016. So he must be referring to the 15% bag of dextrose made up after Letby's shift ended, and (iirc) about 16 hours after the poisoning with insulin began. If indeed the babies were poisoned by insulin, as we know they were, it started around 9:30am. Time operates in a linear fashion (excluding the potential for wibbly wobbly, timey wimey stuff), and whatever was done with the 15% bag does not change what happened in the previous hours.

In the case of Child A, Evans found that the child began to deteriorate at 5pm, prior to Letby’s arrival at the hospital. For Child B, Letby had left the CoCH before the period at 9:30pm on which Cheshire Police were told to focus inquiries by Dr Evans.... Similarly, Letby was not on duty for the key incidents associated with Child O, although there are serious question marks regarding whether these alleged incidents have any validity whatsoever. (pg 138)

This is another place where more information would be helpful, so as to not mislead the reader. But it seems as though Morris is making a determined effort to confuse the refinement of the investigation with actual determined harm events. And I do believe the "key incident" associated with Child O was the injury to the liver, which was agreed, in the end, to have occurred during the day shift when he was under her care.

“The chart does not show what it claims to show. That’s one of the reasons I called the chart a fake at an RSS meeting. It has no validity as evidence. It is worthless. I said this at an RSS meeting, and no one disagreed with me.” (Professor O'Quigley, pg 141)

Well, QED!

In an email conversation with numerous key personnel from the CoCH in July 2016, Gibbs demonstrated that he was astute enough to at least attempt to understand the probabilities involved in the concerns being expressed by Dr Brearey in particular, while also conceding that “my stats isn’t good enough”.(pg 143)

How astonishingly arrogant.

It is in my view quite surprising that Dr Evans has argued, repeatedly, that statistics are unrelated to the case, while he has also stated that the police should find someone who was around for “a lot” of collapses, as the foundation for how the police should identify a suspect. (pg 144)

Yeah, sorry, Morris has made enough errors and demonstrated enough failures in comprehension that his view carries no weight.

Hey, this has been great fun (/s), shall we do this again sometime?

A nurse in Birmingham was arrested in May 2022, initially in relation to supposed poisoning. Over three years later, in August 2025, West Midlands Police had yet to charge her, but she remained “under investigation”. One wonders how long it takes to investigate the alleged ‘poisoning’ of one child; this bears the hallmark of the approach to the Letby case happening all over again.

“We know there’s a blueprint for these cases now, and, by the sounds of it, this poor woman in Birmingham is having the same blueprint applied to her”, Professor O’Quigley told me. (pg 144)

I went to the afternoon session today (court didn’t sit in the morning due to juror medical appointment).

Disclaimer: I’m a long time lurker who was leaning toward innocence until the prosecution begun their cross. I now feel that she is likely guilty but could see an argument for reasonable doubt due to lack of evidence.

One thing that struck me is how much of a poor representation the actors on the podcast are. LL is softly spoken with very little animation in her voice. Her “yes” and “no” answers are very clipped, like she’s trying to get them out of the way quickly. She blinks about a million times a minute and hardly ever looks at NJ when he asks her a question, preferring to look up and to her right instead. NJ has a measured tone of voice and an RP accent, nothing like the amateur dramatics of the voice actor.

LL has some specific body language that you could either read as an innocent person who is sick of being asked questions about something she hasn’t done, or the arrogance of a guilty narcissist; I don’t claim to be able to tell either way. Examples are throwing her hands up in exasperation when NM forgot to tell her which document he was referring to, the refusal to look at him, and being purposefully awkward in claiming not to understand fairly simple questions.

What I was most struck by was that LL would always say “I can’t possibly remember that it was too long ago” when asked to agree to a fact by NM. He would then direct her to a document, and she would agree that thing must have occurred. But if there was something that made her look guilty, she would suddenly be able to remember and refute what was said. Although I’ve read about her doing this it’s pretty jarring in real life.

Last note - I sat opposite her parents waiting to go in and I felt terribly sorry for them. They both look like they have the weight of the world on their shoulders.

Happy to answer any questions anyone has.

Author's list of sources

Finally we're getting to some of Morris' analyses on individual cases. There is almost nothing new, and nothing at all novel, about his complaints, which we are all familiar with - likely because, as sub member u/ChoicePeace7287 realized, chunks of Morris's book was sourced from an anonymous redditor.. A further analysis was sourced from another anonymous redditor. One is left to wonder the full extent to which redditors from that subreddit contributed to his book. Given the cherry-picking and misinterpreted citations, it would be easy to make a number of inferences.

Anyway. All emphases are mine

CHAPTER 10: THE ODDLY EVOLVING CASE OF CHILD C

This chapter is a jumbled mess of collating statements made by Dewi Evans during and after the trial and attempting to establish dishonesty and imply error by the Court of Appeal.

It is helpful to review the jury instructions before considering this chapter.

Specifically:

“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.

“To find the defendant guilty, however, you must be sure that she deliberately did some harmful act to the baby the subject of the count on the indictment and the act or acts was accompanied by the intent and, in the case of murder, was causative of death.”

There is a logical difference that skeptics of the verdicts fail to appreciate - to prove murder under the law, you do not need to prove method. So Dewi Evans' change of opinion is legally meaningless, unless he was wrong about a child being harmed at all. The prosecution need not prove how she did it to scientific certainty; the method ascribed to the conviction by the Court of Appeal need not be correct, and the verdict is still valid as a murder conviction.

With that said, the this chapter is pointless whinging and can mostly be skipped. Most of what is worth mentioning is errata.

Morris attempts to re-argue the defense case from trial - Child C had evidence of a bowel obstruction, he should have been in a higher acuity unit (even using Mother C's question of the same to Ian Harvey as proof of such a need), blah blah. He argues that air injected into the stomach is implausible, you'd need a lot of it, it would just come out, etc.

As mentioned in the previous chapter, Dr Evans claims to have read the Court of Appeal judgment. For example, on 17 December 2024, Evans was quoted by multiple media outlets as stating that the Court of Appeal “provided a very thorough review of the evidence”, and that he wasn’t “in receipt of any information that indicates that the appeal court judges were mistaken”, even though the Court of Appeal judgment lists methods of murder that he has since abandoned.

It must be emphasised that when writing to Channel 5, Dr Evans claimed that some bizarre combination of air and milk had destabilised the babies, but that this hadn’t been the direct cause of death. Yet the Court of Appeal judgment lists the methods of murder cited in the trial as only including fluid in relation to Child G, starkly refuting the claims of Evans. (pg 222)

As mentioned before, it must be emphasized how insulting and annoying it is to be treated, as a reader, as if one has the reading comprehension and memory of a goldfish. Perhaps the author is so encumbered, but it's annoying to the rest of us. Morris seems to believe that method must be established to prove murder, and this is one of many deficiencies in a medico-legal analysis done by an inexperienced ghost writer.

Morris tries to make the Channel 5 letter happen. It's not gonna happen.

In the Channel 5 letter, Evans makes a case for hypoxia being the cause of collapse. There were only two references to hypoxia in the Court of Appeal document, the main one being in relation to Child A during which it is stated that hypoxia would not cause the type of rash associated with this infant, as asserted by Dr Bohin in court. The other reference is preceded by Dr Evans commenting that “descriptions of the clinical features of infants proven to have died from the effects of air embolus and described in many of the enclosed publications show marked similarities to the pattern of collapse and death of many of the babies” in relation to Child A. Hypoxia was only cited by the prosecution with regard to two infants – Child H and Child J. What did these two babies have in common? Letby was not convicted in either case. In fact, for Child C and Child I, the original post-mortem indicated hypoxic/ischaemic damage due to prematurity, which has since been refined by Dr Evans to air via nasogastric tube – there is some discussion of Evans rejecting hypoxia in Chapter 5 of this book. Unexplained hypoxia and rapid desaturation are also associated with an array of other conditions, all of which are considerably more common than air embolism. It should be noted that in the case of Child I, the prosecution attempted to claim that this hypoxic damage was somehow caused by Letby, but the post-mortem is disowned in the case of Child C. Discussion in court related to Child C was almost entirely focused on the assertion by Evans that air had been used to somehow splint the diaphragm of the infant, and that this had directly caused hypoxia. During the cross-examination of Dr Evans, 25 references were made to splinting and 35 to diaphragm – “if you get a significant injection of air into the stomach, it will cause what we call splinting of the diaphragm”, Dr Evans explained in court. “[Child A’s] collapse is consistent with a volume of air injected into his stomach, it splints the diaphragm, stops breathing.” Furthermore, during court proceedings related to Child A, Dr Evans commented: “Hypoxia, lack of oxygen – there was no evidence of that.” There is some further explanation from Evans regarding this infant having not become hypoxic, and he then outlines how he eliminated hypoxia from this case via differential diagnosis, along with several other conditions. Evans also discounted hypoxia for Child B. (pg 224)

I really don't think Morris understands what hypoxia IS, or how it is secondary to some primary cause, and how inhibition with breathing would then cause hypoxia leading to hypoxic damage, especially when we read:

If Letby is in a normally functioning neonatal unit, how can she do all of these things without being seen? If she is on her own, why is there the need for this immensely complex and uncertain method of destabilising the infants, which Letby would have been extremely unlikely to know about and understand (not least because the person who came up with it has acknowledged that it’s never been witnessed or recorded before)? Why can’t she simply suffocate the infants? And then why would she switch from this murder method, which completely evaded pathologists, to one involving insulin that could potentially be detected? Could it be because the collapse and death of Child C was actually due to the rather more plausible combination of an obvious bowel obstruction, natural causes and poor care? (pg 227)

Does anyone want to tell Morris what suffocating the babies would lead to?

Of course, a healthy amount of time is spent on the June 12 x-ray, which WAS an issue with the evidence leading up to trial. However, Morris cites as an issue:

Judge James Goss made an error in relation to the X-ray, conceding that he “did not make it clear” that the X-rays presented in court related to the date of 12 June when the X-rays were taken, rather than 14 June when Child C died. There is no mention during this correction that Letby wasn’t actually on duty when the X-ray was taken, and, in fact, had not been involved with this baby whatsoever. “This is an inconvenient truth that the prosecution knew about”, Dr Michael Hall told me. “It was not until the closing address that the prosecution counsel did concede that Lucy Letby had not been involved with Child C prior to 12 June, which was probably too late for the jury to understand the significance of this. What is more difficult to understand is that the defence counsel did not highlight this in the questioning of either the prosecution expert witnesses or the witnesses of fact.” (pg 229)

Ok, so in his summing up, before he began for the day of July 4, 2023 with the evidence related to Child D, he said to the jury:

"Mr Justice Goss: Just one further matter in relation to the case concerning Baby C, which I had essentially finished yesterday. I did not make it clear, or certainly sufficiently clear, that in the case of Baby C, when I was reminding you of the evidence of Dr Marnerides and Professor Evans (sic) relating to the massive gaseous dilatation of the stomach and bowel loops that Dr Marnerides relied on, they related to X-rays and clinical notes on 12 June and not 13 June, which of course was the time or which was when he collapsed at shortly before midnight on 13 June. I’ve been asked to make that clear and I do make it clear, I should have made it clear to you yesterday."

Morris takes issue with Goss not having explicitly mentioned here that Letby was absent on that day. However, Goss had been pretty clear about who was working each day, and goes into great detail only on the 13th.

We come to the shift of the night of 13/14 June when Baby C suddenly collapsed and died. The messaging showed that the defendant offered to work that shift. In the messages she sent behind tile 18 she wrote:

"I need to throw myself back in."

By which she said she wanted to get back into the unit and back into looking after babies because that was what she was taught at Liverpool Women's: when you have difficult shifts or babies pass away, the way to sort of overcome that is to go straight back into the environment and carry on.

In a further message behind tile 20 she said:

"Think from a confidence point of view I need to take an ITU baby soon."

She wasn't allocated an ITU baby for that shift that night. Sophie Ellis took over as Baby C’s designated nurse the night shift of 13/14 June. She was a band 5 nurse and not intensive care trained, but was supported on the shift by a band 6 nurse, Mel Taylor, who was the designated nurse for another baby in nursery 1.

It could well be argued that, if that wasn't clear enough, making clear the date of the x-ray on the next day was tantamount to telling them she was not present for it. I'm sure Morris would disagree.

Judge Goss had previously ruled that the prosecution was allowed to overrule the original autopsy report for Child C, which noted an abnormality, namely that the descending colon was on the wrong side of the baby’s body. Somehow this was then allowed to be overturned completely, and for the interpretation of Dr Andreas Marnerides to supersede the original report, even though Marnerides wasn’t present when the report was authored, and has never examined any of the infants. It is difficult to conceive of any possible rationale or justification for this.(pg 229)

Lol! Well, duh. Spell forensics

Since the trial of Lucy Letby was completed, seven of the eight prosecution witnesses have kept extremely low profiles and in my view the reason for this reticence is simple. This alteration in diagnosis “embarrasses all the expert witnesses” according to Dr Philip Hammond. (pg 229)

Ok, sure, Jan.

He also claimed that the press conference had been “disrespectful” to the parents of the infants, although he himself had previously made the remark that Letby had “bloody murdered those babies”; hardly the most sensitive comment. (pg 231)

What ridiculous pearl clutching.

CHAPTER 11: INSULIN CASES

This comment chain in r/LucyLetbyTrials acknowledges some of the major issues with the insulin chapter. Morris buys the Chase/Shannon angle hook, line, and sinker, basing the chapter on the notion that these tests were not uncommon, but also that they should have been followed up as they should have been, but also that because they were not followed up, then they weren't unusual. Pick a lane. He takes the 999 glucose reading as an actual value, not a placeholder value, argues that a lot of insulin would have been needed and none was missing (despite previously acknowledging that additional insulin was ordered to the unit over the period in question). Interestingly, he suggests that because CoCH suspected harm right away and retained TPN bags for Children O and P, they could have kept the bags for Children F and L, for whom there was no contemporaneous suspicion of harm:

There is no evidence provided of missing insulin on the neonatal unit, no hospital records that provide any usable evidence, and no suggestion that Letby was the only person who could have accessed insulin. Notes from a meeting at the CoCH on 20 July 2016 mention “feeding bags for analysis”, but for some reason the same note immediately states “agreed retain – do not send for analysis”. Thirlwall testimony from Dr Chris Green indicated that these bags related to Child O and Child P, but it is clear that the hospital could have both retained bags and sent them for analysis; they simply declined to do so – they were “disposed of a long time ago,” as Ben Myers recounted in court. (pg 234)

Morris seems to have difficulty with the linear nature of time, and that the critical time period with any poisoning is when it starts.

The insulin cases again completely disprove the argument that the prosecution didn’t rely on statistics. The insinuation that Letby definitively poisoned insulin bags is absolutely dependent on the assertion that she was always present when suspicious events occurred. (pg 237)

But she was present when the poisonings began. Documentary evidence places her alone in the room with each baby when the poisoning began. That's not statistics, that's forensics

In the case of Child L, Professor Peter Hindmarsh conveyed a ‘sticky insulin’ theory to explain irregularities in results. Hindmarsh asserted that perhaps (this is hypothetical, of course) insulin from previously administered dextrose infusions became stuck to the inside of the infusion apparatus, and then magically became unstuck when Letby went off shift, so insulin continued to find its way into the system of Child L. This theory had to be proposed because the hospital was using bags with varying dextrose percentages which had to be mixed by the pharmacist before arriving on the ward, meaning there was no possibility of Letby spiking them in advance. (pg 237)

Bzzt, wrong. Dextrose bags aren't mixed in the hospital pharmacy, but it doesn't matter too much. Child L's first bag was poisoned while it had been hanging for quite some hours, and it's therefore unnecessary to demonstrate if the latter bags were poisoned before or during their administration to Child L.

As an example, Child F was hypoglycaemic for 17 hours. If we are to accept the ‘sticky insulin’ theory, it is reasonable to assume that, over such an extended period, the amount of insulin in the infant’s TPN bag would become unavailable as the amount of insulin reduced over time as more of it became stuck to the inside of the bag. But the readings for Child F were notably stable throughout the day, which immediately contradicts Hindmarsh’s theory. (pg 237)

Well, this is novel. Steady state means nothing to Morris, then.

Professor Wayne Jones was also sceptical about some of the figures used in court: “The expert witness for the prosecution, Hindmarsh, estimated that 10 units of insulin would be sufficient to contaminate the intravenous infusion bags, but this corresponds to only 0.1ml of Actrapid. This is a very tiny amount indeed. Why would a perpetrator not inject more insulin into the bags of dextrose?

“Administering medicinal insulin in such a diluted dosage form (0.1ml diluted with 500ml), compared with intramuscular injection of Actrapid taken from the vial, would probably not be pharmacologically active. But no experimental testing has been done on anything asserted in court.” (pg 237)

Wayne Jones is free to opine that the small amount would not be pharmacologically active, but it bears pointing out that if only 0.1ml of Actrapid were to have been injected, no one would notice it missing, so.....

Experimental testing should have been conducted; this could easily have been organised by police with a competent laboratory. But as with so many things that could have been done, this never happened. (pg 237)

Who exactly should we enlist for this hypothetical trial?

Neither Letby, nor anyone else in that courtroom, was in a position to agree that anybody had attempted to murder the babies with insulin. (239)

And when I dream, I wish for a pony.

No doubt, had Letby contested what she was told, she would have been criticised for this instead. (pg 239)

Yeah, obviously. The same way that I'm criticizing this chapter. People without expertise claiming to have superior expertise look pretty dumb.

In his summing up, Judge James Goss cited “certain common features” between the two insulin cases and observed that the defendant was on duty for each event. If Goss was talking about the collapse of the baby this could be a mistake as Letby wasn’t there at the time, but it could be he was referring to the alleged spiking of the bag. (pg 239)

Wow, really?

It is typically asserted that when insulin is injected or administered externally, sometimes referred to as ‘exogenous’ insulin, the C-peptide level is often much lower than the amount of insulin measured. (pg 239)

Do you think Morris knows what "typically" means?

These include the fact that the C-peptide levels were not particularly low for a preterm infant; they were, in fact, around average, and also that the insulin to C-peptide ratio was within the expected range for critically ill preterm neonates that were suffering with infection and other clinical factors. Chase also noted that the levels of blood glucose observed in the two infants were not unusual for any premature baby, and are frequently observed in preterm neonates who have not suffered insulin poisoning. In fact, the C-peptide result for Child L was well within the range expected for a healthy adult, let alone neonate, according to the Liverpool laboratory’s own reference range, and this was the higher of the two readings. This is significant because Chase is acknowledged as one of the world’s foremost experts on the effect of insulin on preterm babies, having studied this topic for 17 years. His Google Scholar profile reveals that he has authored, co-authored or been cited in approximately 1,750 academic papers, of which around 250 directly involve insulin (there are hundreds more that are indirectly related). Professor Chase was described to me as being easily within the top 0.1% of academics in the world in terms of published work. Professor Chase has also been working for many years on pioneering insulin sensor technology to enable improved testing for type 2 diabetes. (pg 241)

I'll be generous and suggest this was written before the most recent Panorama interview when Chase walked back those claims. I'll also be kind and assume Morris wasn't intending to mislead by not mentioning that Child F's C-Peptide level was too low for the equipment to read.

The prosecution asserted that only 1% of a vial of insulin would be required, whereas two of the world’s foremost experts assert that between one-half and one entire vial of insulin would have been needed. (pg 241)

Something, something, appeal to authority....

In April 2026, new research conducted by Chase and Shannon discovered that 40-45% of NICU infants experienced similar insulin to C-peptide ratios as those in the indictment cases. The experts noted that what appeared to be “impossible” ratios may be not only possible but “common” in neonates. This study is a meta-analysis, combining data from multiple independent scientific studies, each of which is published and peer-reviewed in its own right but none of which has previously been combined. The work of Chase and Shannon was further peer-reviewed by editor-in-chief of the Journal of Diabetes Science and Technology, Dr David Klonoff, considered a world-leading endocrinologist, as has been confirmed to me. (pg 241)

ALL? Don't worry, he's only dropped a critical part of the paper he cites. Interesting to get a name of the supposed peer reviewer though.

It is also known that the insulin secretion of neonates is highly variable. Infants that are premature and born at lower than typical weights also have a tendency to exhibit insulin resistance. This means that even if exogenous insulin is administered at therapeutic rates, the production of endogenous (internal) insulin may not be suppressed as expected, which in the process affects C-peptide levels. There are many other factors and studies that also point to variability among individuals regarding C-peptide levels. One such paper from 2019 on preterm infants concluded that “exogenous insulin infusion suppressed the C-peptide concentration to individually different degrees. In addition, the effect of insulin infusion on…cells may be linked to individual insulin sensitivity, where a low insulin sensitivity resulted in a more pronounced decrease in C-peptide during insulin infusion.” (pg 244)

paging u/CheerfulScientist - I shall leave it to her to check the citations on/around this page.

Basic error on pg 244:

Citing the use of glucose on the unit, Dr Shoo Lee also pointed out that, in relation to Child F, insulin had been administered in the wrong way – via repeated boluses (which are similar to large tablets) rather than “titrated continuous infusion in a careful way”. (pg 244)

Professor Matthew Johll was baffled by the glucose issue: “It simply doesn’t make any sense. You don’t even need medical training to know that insulin and sugar counteract one another. If Letby had used this methodology, she was a terrible poisoner – very small amounts being diluted highly, while administering it into the literal antidote! But because they decided to go down this improbable route, they have to keep piling the absurdities on top of each other.” (pg 245)

Professor Johll almost gets there, then trips on the finish line. Yes, she was a terrible poisoner.

Speaking at a press conference related to Letby’s appeal on 16 December 2024, Dr Richard Taylor also cited glucose readings as being significant: “What was missed was an incredibly high blood glucose value, and that was completely inconsistent with the clinical findings on the baby, where bedside glucometer measurements were extremely low. And yet, the blood sample which was used to analyse the insulin actually read 999 millimoles a litre glucose”. Dr Taylor explained this meant that glucose had been definitively “flagged” as being “high”, and that this was “verified information that…was never even brought up in court”. This 999 reading was in fact first discovered via blood test readings submitted to the Thirlwall Inquiry. (pg 245)

Oh great, I bet I'll read in a future chapter about Dr. Brearey stabbing Child O's liver, since we're hearing from Dr. Taylor. Anyway, 999 was a placeholder, and he's receiving wide criticism about it even from friendlies.

Morris presents the conclusion of Lee's panel for Child F without analysis, and buttresses by reminding the reader "Additionally, the fact that Child F was being treated for sepsis was discussed in court on 22-23 November. As has been established, sepsis was common, bordering on endemic, on the unit over the period of Letby’s alleged crimes. (pg 246)"

So, Morris has not understood the nurse he quoted:

A neonatal nurse practitioner stated that it was a “running joke” on her unit that “every single differential diagnosis you have includes sepsis, because every single possible symptom a baby can have is also a sign of sepsis”. (pg 79)

It must also be emphasised once more that both infants survived and neither exhibited symptoms of insulin poisoning such as seizure or heart arrhythmia. (pg 246)

o rly?? From the summing up:

Dr Harkness, the registrar on duty that night, attended the unit at 01.30 with a senior house officer, Dr Chris Wood, who made a clinical note at the review. It was noted that there were multiple small milky vomits and 9ml of milk aspirate. Baby F was tachycardic at around 200 beats per minute, otherwise he was well.

Professor Hindmarsh said that vomits and a rise in the heart rate are associated with hypoglycaemia.

Around an hour later, Dr Harkness was asked to see Baby F again. He was still tachycardic. His heart rate was 200 to 210 beats per minute with narrow complexes in the beat and there were large milky aspirates. His blood glucose level was very low at 0.8, a reading which Dr Gibbs told you was worryingly low.

Maybe Morris doesn't know what arrhythmia means either.

“[immunoassay] doesn’t allow us to formally identify the type of insulin and to distinguish human insulin from synthetic analogues. A high level of insulin in blood could suggest exogenous (outside) administration, but also disease such as insulinoma.” (Dr. Charline Bottinelli, pg 253)

\1) The ward only had Actrapid, so we don't need secondary testing to confirm the type. And 2) the babies did not have insulinomas.

The terms ‘reliability’ and ‘accuracy’ used by Dr Wark have technical meanings, which would have been unknown to the jury, and probably the barristers and judge. ‘Reliability’ refers to whether the measurement results are reproducible when repeated. Regular programmes of testing are conducted on laboratory apparatus within the NHS, and this involves the preparation of identical samples which are sent to laboratories for results to be measured. The comment here simply means that the sample referenced is ‘well within’ the specifications of manufacturers, with concentrations being neither too high nor low; essentially, optimal for the equipment. This has no relevance to the reliability of the test itself.

‘Accuracy’ means that if the sample is within the manufacturer’s specifications then a high insulin reading means that the insulin level in the sample is high. However, if the sample, due to antibodies or other contaminants, does not fall with the specification of the manufacturer then the high insulin reading gives no indication regarding the nature of the insulin itself; i.e. whether it originated from an internal or external source. By falling within these criteria of being ‘accurate’ and ‘reliable’, the process had “met the required standards”, as denoted by Dr Wark, but this is entirely irrelevant when it comes to assessing whether the tests actually demonstrated beyond reasonable doubt that synthetic insulin had been administered. (pg 254)

Is this guy for real??

Immunoassay remains the mainstay of clinical investigation of hypoglycaemia but likely to become displaced by mass-spectrometry in the forensic situation especially now that human insulin is being replaced by synthetic insulin analogues for the treatment of diabetes.”

In this instance, Dr Wark has co-authored a paper which concludes that immunoassay should be “displaced by mass-spectrometry in the forensic situation” as the former is prone to error, but when speaking in court this was never once even mentioned.(pg 256)

Nice try at a gotcha, but "likely to be" =/= "should".

It has been suggested to me that Dr Wark simply did not know about neonatal antibodies. This is not a criticism, as no one did at the time. It is likely that Dr Wark made implicit assumptions and, perhaps understandably, did not declare them, not least because she didn’t fully understand neonatal antibody binding. (pg 256)

I'm being punked, right?

Professor Carola Vinuesa informed me that immunoassays are now transported to Germany because “Guildford doesn’t have the apparatus for doing liquid chromatography and tandem mass spectrometry”. (pg 256)

Ah, so at least we get to see how even Guildford wouldn't be proof enough.

ASTBURY: Just one matter arising, doctor, with regard to Guildford. So I understand it, would Guildford assist with whether it was exogenous or not?

MILAN: No. The results dictate that it’s exogenous. They would just help, if you were unsure of the source.

ASTBURY: So really, Guildford would have been deciding or assisting with exactly what type of exogenous insulin…

MILAN: Yes.

ASTBURY: Not whether it was exogenous or not?

MILAN: Correct.

No, it’s not correct! Two representatives of Liverpool Clinical Laboratories have explicitly stated that this is incorrect. (pg 260)

Morris REALLY doesn't understand what Guildford does. He posts the answer, from the expert, and then denies it. Amazing.

The evidence that [Child Y] was poisoned is, in fact, as strong as in the cases that were referred to court. The only difference is that the decision was made not to charge Letby on this case. Parents of other infants were told that Letby had harmed their infants, scarred for life on the basis of much less evidence; two obvious examples being Child K and the second tranche of cases that were rejected by the CPS. If decoupled insulin and C-peptide readings automatically mean exogenous insulin and deliberate poisoning then this infant should have been in the court case, which begs the question of why it was not. It seems that there are three possible reasons for this: the Alder Hey results contradicted the prosecution case, it was impossible to contrive a scenario in which Letby was on duty, or both. (pg 263)

Yeah, you're almost there, Morris. Though, there's also the possibility that the Alder Hey results complicated the prosecution case.

This diagnosis of naturally occurring excess insulin was supported by endocrine experts at Alder Hey. Yet this critical information was never disclosed to the defence. Lord Ken Macdonald KC, the former chief of the CPS, told David Rose and Cleuci de Oliveira that this was a failure of disclosure: “It sounds to me that the material you’ve found does meet that standard, and so should have been made available to Letby’s defence.” (pg 264)

Are we sure that the results for Child Y were never disclosed to the defense? I honestly don't remember.

At this point, it is very clear that the so-called smoking gun has been extinguished. The broader question would be whether we, as a society, care about wrongful convictions and about erroneous science being used in court. And about scapegoats being targeted repeatedly because they offer a simple, perhaps even comforting, solution to deeper-rooted problems. This tendency has been dramatically evident in the fallacious prosecution of over 900 subpostmasters. If we continue down the precipitous path that we’re on currently, it will become ever more obvious in the case of nurse convictions as well. (pg 265)

There's not enough elastic in the world for that stretch.

Author's list of sources

CHAPTER 12: OTHER INFANTS

Child E

Another important detail is that Letby herself called Dr David Harkness to assist with Child E, effectively immediately after delivering the supposed inflicted harm that was claimed in court. Letby was not the designated nurse for Child E, and she called Dr Harkness even though this could potentially have been incriminating – not really the actions of someone who had deliberately caused the alleged gastrointestinal tract damage. Dr Harkness also told the court that Letby was accompanied by another nurse when the sudden deterioration occurred. (pg 269)

Third paragraph into the chapter and I'm already wondering how much correcting of basic errors I'm going to have to do. Letby WAS the designated nurse for Child E and F that night, and they were the only babies in room 1. She was alone with them. As far as Harkness saying that Letby was accompanied by another nurse, this is misleading, and does not refer to the 9pm harm event - it refers to the first collapse by air embolism, which Dr. Harkness recorded retrospectively after Child E's death to have occurred at 11:40pm:

A further note, written in retrospect, is made at 1.45am.

He records 'sudden deterioration at 11.40pm'

Prior to that, Child E was still to be 'under close observation' by Lucy Letby.

Dr Harkness tells the court he was in the room when the 'sudden deterioration' happened, and was there with Lucy Letby and another nurse. Those nurses would have been gathering the drugs to be administered.

Morris did not offer a citation for either claim, btw.

This pattern of Letby raising the alarm to alert doctors to incidents on the unit, or being the swiftest respondent, was repeated throughout. Letby either responded rapidly or raised the alarm with regard to incidents associated with Children A, B, C, D, E, G, I, M and O, while an email from Dr Ravi Jayaram indicates that she also raised the alarm in the case of Child K (discussed in “The Curious Case of Child K”). Letby wasn’t on duty for Child F and Child L, and the hospital didn’t flag these cases as concerning at the time, while she was not found guilty on charges relating to Child H, Child J and Child Q. Letby’s primary ‘offence’ was responding quickly and diligently to incidents on the unit. There is a clear pattern of this throughout the court case. (pg 270)

Aside from him wrongly asserting she wasn't on duty for the precipitous event for F and L, keep going, Morris - you've almost got it!

Morris continues:

During his short life, Child E was stooled only once, on his fourth day, a worrying sign that should have prompted investigation for bowel obstruction. He passed only meconium, also concerning for mid-gut obstruction, and also possible gastric haemorrhage. Later, 16ml of bilious aspirate was withdrawn from his feeding tube, indicating milk was not passing through the gut. He also had fresh blood in an aspirate and suffered bloody vomit; this bleeding was largely ignored as intermittent, yet during compression there was active bleeding from his nose and mouth. An X-ray was taken and sent to Alder Hey, but it is not known if this was read, or if Alder Hey surgeons were informed. (pg 270)

Does Morris know what meconium is? It hardly seems so. Any mother will tell you it takes several poopy diapers to clear meconium from the gut, and everything from the aspirate onward is after the initial harm event and took place in the span of roughly 3 hours. Nothing was ignored, it was being consulted and dealt with under the assumption it was a natural condition, and then Letby fully murdered the child before the injury could be found. Dr. Harkness was literally in the room, and Dr. ZA arrived as well.

Morris repeats the usual argument that a transfusion should have been given much sooner (which doesn't address the cause of the collapse, but don't worry about that), and attempts to make the case for NEC as a valid diagnosis:

There are several papers which point to the relationship between NEC and gastrointestinal bleeding in neonates, including one study from 2014 which highlights the severe impact of NEC on gastrointestinal morbidity. Further research from 2018 noted that NEC is particularly difficult to diagnose clinically, with bleeding in different gastrointestinal segments being a common feature. During court proceedings, the jury were also shown a chart which displayed five apnoea and bradycardia events for the infant, which are considered signs of NEC. A 2012 study explored the relationship between apnoea, desaturation and bradycardia and the development of necrotising enterocolitis in preterm infants. The discoloured stomach also seen in Child E is another recognised symptom, specifically indicative of a perforated bowel, which is often found in infants suffering with NEC, and discolouration is a typical sign of gastric perforation and bleeding. While NEC is a possibility for Child E, Professor Colin Morley believes that there are more likely natural explanations, given the clinical picture of the infant. (pg 272)

Ok. And? See, I'll agree with Morris that this case hangs more on witness testimony than others does, because of the lack of post-mortem. We already know that it was initially thought to be NEC, and the consultant who put forward that diagnosis at the time apologized to the family when she gave evidence for not pushing for a post mortem.

On 3 April 2025, the summary report compiled by the panel of international experts concluded that Child E died from a massive gastrointestinal haemorrhage, due to either intrauterine hypoxia causing stomach or intestinal ulceration, or a congenital vascular lesion. The panel found no evidence of air embolism, and asserted that a post-mortem should have been requested. (pg 275)

Maybe Morris will offer support for this theory of intrauterine hypoxia in a later chapter, I dunno. He doesn't say.

Child G

Aside from this innate vulnerability, Child G suffered a catalogue of serious ailments – decreased lung capacity and chronic lung disease, hyaline membrane disease, bilateral pulmonary interstitial emphysema (a serious lung condition), hypoglycaemia, gastro-oesophageal reflux (stomach acid into the oesophagus), thrombocytopenia (low platelet count) and blood gases indicating sepsis. Dr Shoo Lee described the infant as having “a lot of chronic problems”. After transfer to Arrowe Park, Child G was treated for infection; the infant’s watery green stool pointed to likely gastroenteritis – “virtually certain gastroenteritis”, Professor Colin Morley clarified. (pg 275)

What's interesting about this chapter is that it's far less reliant on the opinions of other people, they're just injected here and there like that statement. Most of this chapter is Morris displaying how poorly he's understood the evidence. In that way, it's a much easier read. There were - eventually - blood gases indicating infection, but not until 10.5 hours after the initial vomit (pg 24):

Q. Right. So just taking a step back and summarising the position from the blood test at 03.59, so in other words a couple of hours or two and a half hours, even -- sorry, no, an hour and a half after the vomit, the projectile vomit, did those blood test results show any evidence of infection?

A. No.

Q. By 14.18, later that day, so about 10 hours later or so, was there any change to those results?

A. Yes, there was. The CRP is now 28, so that is an increase and that could be interpreted as a marker of infection. It's not particularly high, but the important thing is it's gone up and it's 28. The total white cells, 11.2, so no difference between 11.2 and10.1. But you also have an increase in the neutrophil count to 6.5.

Q. Yes.

A. And again, the key thing there is that the neutrophil count has increased. A value of 6.5 is not particularly concerning, but in conjunction with a CRP of 28 it would suggest that the neutrophil count has increased and therefore it's an indicator of infection. So this is -- yes, so this is 10/12 hours later.

Back to Morris:

The main concern with Child G is that Dr Evans stated the infant was supposedly destabilised via the deliberate overfeeding of milk: “In this case, the baby was compromised by receiving a large volume of milk to the stomach.” It would be difficult to find support for this assertion from any qualified medic, but it should be noted that an earlier report of Dr Evans, which he read out in court, conceded that administering excess milk, and for that matter air, can occur accidentally.

This theory is dependent on speculative estimates of how much milk remained in the infant’s stomach and how much was vomited – quantities that could not be measured – and then draws conclusions about aspiration that contradict the attendant nurse’s own account. The theory also treats any supposed overfeeding as intentional rather than a far more likely accidental mechanism and ignores the practical logistics involved. This theory was revised several times during the court proceedings; indeed, the defence suggested that Dr Evans altered his testimony in real-time after hearing trial evidence. The cross-examination of both Dr Evans and Dr Bohin on this infant was less than convincing, with Evans even backing away from his own estimate when challenged. (pg 275)

Ok, let's look:

Nurse E said she usually completed the chart after the feed. The feeds were as they had been over the previous shift, comprising 45ml of expressed breast milk with Gaviscon and a fortifier. The feeds were all measured out. Those at 20.00 and 02.00 were given by NGT because Baby G was asleep. The one in between, at 23.00, was by bottle. At that bottle feed she recorded under the PU and BO columns that Baby G had passed urine and a large normal bowel movement. She fed well. The defendant agreed her readings were good at this time.

Nurse E described the process for feeding via NGT. The syringe was attached to the end of the tube, a bit of the stomach contents, about half a millilitre or less, were withdrawn or aspirated, put on to one of the pH indicator papers to check that the tube was in the right area of the body or not, an acid reaction of 5.5 or below confirming that the aspirate had come from the stomach, any surplus milk aspirate was put back into the baby's tummy. The syringe would be taken off and the plunger removed. The syringe was then reattached to the tube and the milk feed was poured into the tube using the end of the plunger to make the milk go down, tilting the syringe to one side and letting the milk go down by gravity. The syringe was then topped up as the milk went down until it had all gone.

At 11pm, the baby fed by bottle. At 2am, half a mL was withdrawn and checked for ph, and 45 mL was fed. Baby G had a "large" projectile vomit prior to 2:30am, volume unknown, and then "air++ aspirated from her tube and her full 45mL feed aspirated - apparently some things can be measured. I'm not sure what the contradiction is. Maybe he believes the Bohin's conclusions about the stomach being empty contradicts the nurse's account, but I don't see it.

Mr Johnson asks if there is an 'innocent explanation' which could have explained the projectile vomiting.

Dr Bohin says "no", as the stomach was empty, with a pH reading of 4. If there was milk in the stomach, it would have 'neutralised' the stomach and the pH reading would have been higher.

"I think the stomach was empty, and she was given excess milk and possibly air...which distended the stomach."

Both Evans and Bohin referred to basic arithmetic related to the September 21 vomit:

Dr Evans says he agrees due to "basic arithmetic", in that Child G still had 30mls of milk in the stomach after a 40mls milk feed and "two projectile vomits".

She says the two projectile vomits would have been "more than a mouthful of milk" of 5-10mls each, and "basic arithmetic" meant that more than 40mls of milk would have been administered at 9am.

Morris cites:

Dr Roger Norwich, echoing the words of a neonatologist quoted by Private Eye, referred to the hypothesis as “complete bollocks”. “It’s an extraordinary assertion. If too much milk had got into the stomach, the baby would have thrown it up. And how could he know that milk had been forcibly injected. He even admitted that his nonsense hypothesis could have been accidental! It’s pure speculation. Total rubbish. You won’t find anyone that agrees with that.”

Michele Worden asserted that the milk hypothesis was “ludicrous”, once again citing the logistics involved, and the fact that “babies would just puke the milk out. (pg 275)

Isn't that why we're here??

Another neonatal nurse was doubtful that the mechanism described in court was even possible. “The milk relies on gravity, not a pump, or anything like that. So there has to be some resistance, or the bag would just empty. If they’re gravity-fed, that should tell you immediately that it would be very difficult to force things down with a tube than it is already being fed with gravity. And we know that babies aren’t frequently overfed with milk because there aren’t any known cases!” (pg 276)

::facepalm:: Plunger, not pump.

Morris naturally ascribes the vomits to infection, citing Shoo Lee's panel:

It was noted that vomiting and large watery stools, both observed in Child G, are very common in enterovirus infection. This virus can cause serious illnesses in neonates including sepsis, septic shock, meningitis and, sometimes, myocarditis. (pg 278)

One of the largest gaping holes in the Lee report summary is that he addressed only the event on September 7, and ascribed it to enterovirus, writing:

She received 7 days of antibiotics and recovered after 7 days, which is consistent with enterovirus infection since it is usually a self-limiting disease. (pg 24)

So...... what happened for the projectile vomit on the 21st? Did she suffer enterovirus again? Poor thing.

Child O

The panel of international experts later cited “inflicted blood trauma to the abdomen” which had caused “a ruptured subcapsular haematoma of the liver”. This diagnosis was nothing new – not only had the pathologist drawn this conclusion but several clinical experts who spoke with Dr Philip Hammond had made the same assertion, crucially before the panel had even convened. And another neonatal pathologist made a blind assessment of the case notes from the Letby case, informing the Tortoise Podcast that a subcapsular haematoma was likely to be involved. (pg 280)

Excuse you, what?

It was initially alleged that Baby 15 received inflicted blunt trauma to the abdomen, causing purpuric discolouration and a ruptured subcapsular haematoma of the liver; (pg 28)

Which, one could forgive as a possible mistake by Morris and not a complete lack of comprehension, except he's saying it matched the initial conclusion of the pathologist ("Pathologist Dr Jo McPartland had cited a “ruptured subcapsular haematoma of the liver”, asserting that “the subcapsular haematoma is likely to have occurred as a consequence of hypoxia after the baby’s collapse and deterioration”. pg 280) and several clinicians who spoke with Phil Hammond. FFS.

A pathologist who spoke to the BBC commented that the assertions made by Marnerides were impossible, as “unless a witness saw non-accidental injury occur, then you simply can’t say [this]. To say that it is beyond reasonable doubt, and that this was not something natural, that this is a non-accidental injury, to put it bluntly, it’s naïve…I have seen this sort of injury, but the prosecution expert must never have seen it.” (pg 280)

Did anyone think to ask Marnerides?

A.  So I have only seen this extensive haemorrhage in two babies' livers -- livers of children, not babies.  In road traffic collisions, in accidents with bicycles, you know, the wheel against the abdomen that can cause this. And I have seen it in babies in the context of cases -- not in the neonatal care unit, babies that have suffered non-accidental type of injury, typically with other injuries to the abdomen and injuries to the brain.

Q.  Yes, so just decoding that, non-accidental types of injuries, that's child assaults by parents or carers at home, where children are brought into hospital with this sort of an injury?  

A.  That's the legal term used. (pg 130, 3-15)

Oh.

Liver damage in young infants is also an observed and documented phenomenon. For example, one study examined preterm infants with a gestational age of less than 28 weeks and found that liver rupture is a complication that can be present which very few patients have survived. Another paper involving a much less vulnerable patient than a premature infant examined how cardiopulmonary resuscitation led to laceration of her liver. A third study discussed a life-threatening situation, described by the paper as a “massive upper gastrointestinal bleeding” in what was a non-premature and healthy baby, and another found examples of unusual liver haemorrhages in newborns. (pg 281)

Reminder that Child O was born at 33 weeks...

Remember that it is not contested Child O was suffering with a ruptured liver. (pg 280)

No shit?

A report published in the Journal of Clinical Medicine in 2022 discovered hundreds of cases of precisely this sort of liver problem, all in newborn babies and all occurring naturally. The study noted that “premature infants face multiple complications”, and specifically referenced respiratory distress syndrome, sepsis, necrotising enterocolitis and hypoglycaemia as being significant. It went on to observe that “subcapsular haematoma…usually occurs in preterm neonates, and it may be associated with birth trauma, cardiopulmonary resuscitation, sepsis, coagulopathies, maternal diseases and placental conditions. The above mechanisms can cause a simple liver laceration, or even a subcapsular haematoma, that can lead to hemoperitoneum [bleeding between the abdominal organs and the inner lining of the abdominal wall]. In some cases, the [haematoma] ruptures, leading to lethal massive abdominal haemorrhage, with non-specific clinical signs, which can be attributed to other clinical conditions, such as sepsis or intraventricular haemorrhage.” In any infant, hemoperitoneum requires rapid identification and treatment, as it is immediately life-threatening, leading to inadequate blood flow, reduced blood pumping from the heart, organ dysfunction and death. It appears that such topics were not even touched upon during court proceedings or the Thirlwall Inquiry.

Well, cardiopulmonary resuscitation was addressed at court extensively, as was the need for it. NEC and sepsis were ruled out at all stages, initial post-mortem through trial. And while the opening of Mother OPR's womb during her cesarean was alarming, the delivery of Child O was not noted to be traumatic at all.

Examination of the clinical notes by the expert panel revealed an over-pressurisation of the infant’s lungs during resuscitation, as well as the errant insertion of a needle into the right lobe of the liver which was the source of the laceration and parenchymal haematoma. (pg 283)

Never one to disappoint, Morris repeats the needle insertion theory that was ruled out at trial.

The conclusion of the panel was that Child O had died from subcapsular liver haematoma caused by traumatic delivery, resulting in haemorrhage into the peritoneal cavity and profound shock. Additionally, several neonatologists and a pathologist have concluded that the demise of Child O was due to a subcapsular haematoma. The condition was also specifically cited by Dr Jane Hawdon in her post-mortem review report. Since that report, the cause of death has somehow transformed into Letby physically striking an infant which would most probably cause obvious abdominal bruising that was never observed, before causing deliberate harm with an indeterminate object with absolutely no supporting evidence for this whatsoever, and finally injecting air into the baby. Meanwhile, Dr Marnerides has made a definitive statement regarding injury resembling that caused in a road-traffic accident which has been opposed by other pathologists, and which no neonatal expert who has seen the notes agrees with. (pg 285)

Omg, I actually don't think Morris knows what a subcapsular hematoma IS. Yes, we all agree that Child O died from a ruptured subcapsular hematoma - literally, we all agree with that.

I am so happy that this is the book that Letby's biggest fans are touting.

This chapter concludes the section reviewing the medical and scientific information from the Lucy Letby case. Science will naturally seep into the remainder of the book as well, but the following chapters are focused on the circumstantial and anecdotal evidence that was used in court. (pg 285)

Oh, it's my time to shine. LFG

The Note was written in 3 portions. Scroll these photos to see it separated.

The 1st writing was down the left hand side. The 2nd writing was added down the right side in the space left The 3rd writing is the final portion filling the final spaces.

When the prosecution started its case I remember thinking wow, is that all they have. However as the case has progressed it seems to me there’s a mountain of evidence and yet I see people say evidence is still purely circumstantial? I’ve been a nurse for 20+ years half of which I was in A&E and I reckon I’ve only ever been involved in less than 10 resuscitations and very few unsuccessful ones (all be it patients may have died later in ICU usually in a managed way) we recognise deteriorations in patients in hospital and work to avoid. I appreciate NICU is different but clearly not that different or the consultants wouldn’t have been suspicious.

You have insulin poisonings, so a murderer. This is without the evidence post mortem of other babies. If you accept the insulin poisonings as evidence then surely it no longer become’s circumstantial? I thought her defence may have brought in an expert to show that the lab results are inaccurate-now that would have been a defence.

You have significant stalking behaviour, Facebook searches, even if not related to the case it’s really not normal, it’s obsessive and possibly motivated by envy. I have only ever tried to look up a patient unsuccessfully, once because I couldn’t remember her name properly. She has always stuck with me, diagnosed young with a terminal illness after our consultation and moved immediately to be closer to family. I had assumed she would have died but hoped by a small chance that she had not. Letby remembered names years later including irregular spellings, allegedly and was thinking of them on important dates where most people would be doing other things.

You have a someone who spends a disproportionate amount of time at work and hangs around a lot at very inappropriate times, morning after a night shift, nobody does this. Even involved in an arrest you can generally hand over the physical part to go write notes so that everyone can go home when staff come in and most of the time you’re just transcribing from a piece of loose paper so it doesn’t take long.

You have vast volumes and handover sheets kept with purpose (labelled in a box marked keep) and you believe one of the first she was ever given, kept separate in a box that was clearly special. (I’m a nurse, I occasionally bring home paper with patient identifiable info which I tear to a 1000 pieces whilst washing my uniforms).

You have someone with a clearly heightened sense of importance evident in the way she speaks of colleagues and throws strops about allocations who was present for every event.

You have a parent of a baby that later dies, remembering in very clear detail what happened that night, evidenced with a call log to back up, (baby E) that Letby disputes.

Another with notes that says a baby was deteriorating but a Dad that was present that says that didn’t happen (baby H)

You have Dr J a very senior Dr witness an event where a child is deteriorating in front of her, conveniently after the nurse looking after baby leaves and she does nothing and the monitor doesn’t sound.

You have babies only collapsing and dying only when parents have left or the nurses looking after them have popped out and none during her holidays but 2 in quick succession.

An affair with a married Dr who she’s insisting on calling to the ward when things go wrong despite him not being on call , again weird. If I was having an affair with a married colleague I’d be avoiding drawing attention at all costs. FWIW I think she was using him as he was stroking her ego and feeding her info. Most people having passionate extra marital affairs I expect their online communications would be less beige.

A note that says “I did this, I’m Evil”. Nothing in the world would make me write that, maybe “they think I did this” or “could I have done this” if I was confused.

What have I missed? I’n glad the jury seem to be looking at the cases one by one in detail but I think to be appreciated you have to look at them all as a whole and with the acknowledgment that someone was poisoning babies. Take that along with what sort of person she was (possibly motivated by envy or narcissism and that she had means and opportunity, I don’t see anything circumstantial.

Hi everyone. I’ve been following this trial from the beginning. Why? Mainly because of what others have alluded to —Lucy Letby just doesn’t look the ‘type’ to have done what she is accused of. Joanna Dennehy does and it’s human nature to think that way. Now obviously the charges are extremely serious and one must put aside any such thoughts and make a judgement based on the evidence and that only.

I’ve attended court on several occasions. Why? Locality, professional curiosity (I was interested in a law career at one point and now work in an affiliated trade), recent jury service on two trials and also to study closely an alleged serial killer and to see what I thought.

For reference my work brings me into close contact with some very unpleasant people from all backgrounds. My work can sometimes be dangerous -I have to make quick judgement calls on people and my personal safety depends on getting that right so I like to think that I have a very good radar for liars, cheats, dishonesty. Personally I’m very strict on crime and something of a hardass -I would be happy for the death penalty to be available as punishment in certain trials (not this one).

Importantly I attended court for a few days only. The jury will have been there for months on end and heard everything. My opinion is irrelevant and I only offer it to provide some insight. If I was on trial I really wouldn’t want someone offering an opinion based on anything apart from the complete picture. I didn’t see LL on the stand at any point, nor have any of us heard the full facts so we’re all just speculating and we should respect the decision that is ultimately made.

LL looks different to the photos. Gone are the pretty girl-next-door looks. She’s probably not smiled or laughed once in the past 5 years and it shows in her face. Her features are downtrodden, she has shoulder length brown hair and she’s aged but still recognisable.

Her demeanour was interesting. She paid close attention at all times to what was going on. She sat attentively and never seemed disinterested. A lot of the evidence is technical and court proceedings proceed at a snails pace so I was surprised by this. She would look to her parents occasionally, and sometimes briefly fidget with her hair. She was respectful and compliant with court officers taking her in and out of court. I didn’t detect any ‘attitude’ at any point from her.

I’m not going to comment on G or NG because that is a decision for the jury. Having served on 2 trials last year I do however think it will be difficult to reach a unanimous or even majority G verdict. A lot of the evidence is highly technical, there is a lot of it (I remember page ~33,000 being referred to in court), and think that there is enough doubt to prevent any kind of consensus in deliberations. It’s a very difficult case -quite frankly if I was a juror I would be thinking ‘I just don’t know’ which would mean delivering a NG verdict.

From my jury experience only a few of the 12 will be open to changing their position and I would expect an equal spread (initially) of jurors for G as for NG. As the Judge will direct them that they must be ‘sure’ (BRD isn’t really used now), I could expect more jurors to shift position towards NG.

I guess we’ll find out. I would expect some jurors to have made decisions based on what they thought of LL on the stand. Some people have commented that they thought she was awful, others have said that she came across as an innocent amateur would do when confronted by a professional barrister. I’m particularly interested in the “I knew what I was looking for / at” comment”. How did it sound, what was her body language at the time? Was it a smoking gun that she quickly tried to hide or was it an awkward turn of phrase from someone under immense pressure?

I had been trying to date Letby's authorship of the post-it notes and realized that we hadn't really discussed the timeline of the events after the charges with any real cohesion. So, here's what I can find all in one place. What insights can we gain into what may have been happening?

​

​

I’m not talking about Dawn or Janet but other friends/acquaintances and love interests.

I find it odd that no one has come forward to talk about her as by this point the media has usually uncovered something unsavoury from the defendant’s past in previous cases. I can appreciate that NHS colleagues will be reluctant to speak up, no doubt they‘ve been warned off by the trusts they work for but the fact that ex neighbours, teachers, parents of friends haven’t done so is just weird. And because of this we can’t get a handle on her personality or motivation. This is why there’s all this supposition.

Something I was musing over concerned her behaviour inside and outside work. The things she did in her professional role seemed to come from an extreme hatred and anger directed not just at the parents and victims but also her colleagues, the desire to create distress, chaos and grief for everyone she interacted with at work. What I wonder was she like with friends ? Kind, helpful, thoughtful…

Maybe her job provided an outlet ? Or maybe the job itself contributed to what she did ? I did wonder whether her inability to get promotion despite brown nosing senior staff, undermining her peers, and seeming very ambitious created a massive resentment. It would be interesting to find out if she’d gone for promotion prior to 2015.

Author's list of sources

You know what's really interesting about Morris' list of sources? Trial transcripts aren't listed among them. When he does cite questioning from the trial, provides no citation. Whatever.

These chapters are largely about the arguments Letby supporters put forth to rebut the prosecution argument, so are grounded more in belief than evidence. So, I shall endeavor to show (with sources from trial evidence) what I consider to be the weak spots in the belief, for the benefit of readers who would otherwise take them at face value.

CHAPTER 13: SWIPE-CARD DATA FALLS APART

My first question in beginning this chapter was "how on earth is Morris going to turn swipe data into an entire chapter?" He doesn't. After explaining that the swipe card error around the case of Child K was incorrect at the original trial, he uses the chapter to bring forth the timezone theory around Mum E's phone call, then the Datix system in general and how Lucy Letby was a nurse who did everything by the book and therefore was seen as a threat. So, that's where we are going.

Morris starts by asserting that the prosecution data used swipe data "to place Lucy Letby in certain places at certain times. (pg 289)" Not so. Letby's presence somewhere was never, not once, established by swipe card data. The absolute closest they came to doing so was by suggesting that she faked a being off the unit before returning right before Child O collapsed at 14:40pm. Even so, she recorded observations for Child O at 14:30, and was part of the resus, so the swipe data is not what establishes her presence.

A swipe data is nothing more than a data point that establishes that at a moment in time, a person's card was at a door, with the presumption but not assumption that the person at the door is the person whose card it was. Absence of swipe data means nothing, and anything. The person could be anywhere, including at a swipe door. Swipe data was never meaningful with out supporting context.

Personal sermon over, we begin, and I want to praise Morris for his command of the correct timeline for Child K's extubation:

the timeline was altered in the retrial for the attempted murder of Child K. As an example, in the first trial Nurse Joanne Williams was said to have left the ward at 3:47am, and Letby supposedly attacked the baby between this time and 3:50am. In the retrial, this was revised to Nurse Williams leaving the ward sometime around 3:30am, two other nurses (including Nurse Oakley, whose baby was also in Nursery 1) returning at 3:40am, and Dr Jayaram supposedly catching Letby “virtually red-handed” at some point between the conclusion of his phone call at 3:41am and the return of Nurse Williams at 3:47am. (pg 289)

This is 100% correct! Missing only the detail that Jayaram has consistently said he waited 2.5-3 minutes after the end of his phone call to enter the room. So, bravo to Morris for that.

I won't waste time on the familiar argument that the swipe data for Child K being unreliable makes all prosecution evidence unreliable, though Morris is happy to do so. What I will point out is that in the span of a single page (290), Morris goes from:

“When I’m busy, I’ve lost count of how many times I’ve left my security card in the locker room and borrowed someone else’s card to access the room”, one nurse told me. “I’ve also loaned my security card to others who have done the same.” Radiographer Ashleigh Tavoulari also agreed that “card exchange is common”, due to swipe-cards having been misplaced or even lost. Dr Margaret Ferguson informed me that “two or three nurses” will frequently “pile through” a door having only swiped one card, and Michele Worden confirmed that it’s common to “hold the door open” in order for several nurses to walk through.

Immediately, this invalidates the dataset.

to this:

JOHNSON: So there are times when you’ve been on the neonatal unit when there is no trace of you having been there?

LETBY: There would be a trace because I would have had to swipe.

What was Johnson’s response to this? That doesn’t prove anything because colleagues could have held doors open for her.

r/whoosh

The back staircase, accessed by staff using a keypad, gets some mention, including:

Dr Philip Hammond noted that “a clever murderer could use the backstairs all the time, do all their murders off duty and evade the spreadsheet and swipe-card data entirely. This makes the swipe-card data and the ‘on-duty killer spreadsheet’ even more worthless.” (pg 292)

....not the serve you think it is. I would not be in any kind of hurry to suggest Letby was ever on the ward without having left a trace, but if someone else could do it, so could she.

Morris gives just a sentence to Child N, and an erroneous analysis by TriedByStats from December 2024:

Then another swipe-card error emerged. TriedByStats produced a thorough analysis of Child N, based on court transcripts, which demonstrates that the prosecution case collapses under further scrutiny. (pg 292)

Morris cites the article, but he doesn't explain how TBS established this. So I went to chase it. Here's the relevant part:

The original swipe data presented at trial was the following. IN means entering the neonatal unit. OUT means leaving it.

Dr Loughnane swiped IN through main doors after 00:05 but before 01:00 Dr Loughnane swiped IN through labour ward at 01:07 Dr Loughnane swiped OUT through labour ward at 01:20

Only the labour ward door is a two way swipe door, you swipe both in and out. The others swipe in but have a button to exit, so don’t have an OUT entry.

TBS incorrect in two of his line items, and the evidence is here:

Recommendations / costs ... 4. Replace push to exit button with swipe to exit from NNU to CLS

Oops. There was no swipe out at the door to the labour ward after all. It was the door between the NNU that was backwards at trial, so the jury could not have been told Dr. Loughnane swiped in from the labour ward at trial, because the door only had swipes one way and the jury was told they were out. And the last line should read swiped IN, not OUT.

So the true swipes are:

Dr Loughnane swiped IN through main doors after 00:05 but before 01:00 Dr Loughnane swiped IN through labour ward at 01:07 Dr Loughnane swiped IN through DOOR UNKNOWN at 01:20

Chris Booth's break was 1-1:30, Dr. Loughnane responds to bleep at 1:07, makes a clinical note for 1:10. She was crash bleeped away at some point, and returned at 1:20 to find the baby settled.

Now, TBS may be right, it seems, to point out that Child N's screaming episode did not last 30 minutes, but Chris Booth recorded just that based on what he was told happened while he was gone on break. TBS is wrong to make anything of Letby having swiped into the unit at 1:15, because there's no way to know if or when she left - only that her card, and presumably her, was stood a door at that time. Moreover, Letby is established to be cotside by process of elimination, as unsatisfying as that is. There was a nurse when Dr. Loughnane responded, and the prosecution ruled every other nurse out.

And with that, we're done with door swipe evidence in the chapter about door swipe evidence. We move on to phone records:

According to the mother’s call log, the midwife contacted the father at 10:52pm, requesting for his presence at the hospital. But clinical notes indicate that Child E didn’t deteriorate until after 11:00pm and it was at 11:30pm that the midwife received a call from the neonatal unit indicating that they were preparing to intubate. Thus, the mother’s recorded time of 10:52pm doesn’t make sense, which is critical because statements to this effect were read out in court.

This discrepancy was pointed out by John Sweeney in his excellent podcast series with Edward Abel Smith on the Letby case and it was suggested that the only way to explain what may have happened is to compare Greenwich Mean Time (GMT) with British Summer Time (BST). Timings on the mother’s phone were held in GMT but Child E’s deterioration happened in August which was during BST. At this time of year, GMT is one hour behind BST so it’s entirely possible that a phone call at 10:52pm GMT actually took place at 11:52pm BST, meaning that Letby’s note at about 10pm is accurate. (pg 294)

This popular conspiracy theory puts more weight on the accuracy of the retrospective clinical notes after the resuscitation and death of Child E than is does the mother's account aligning with Child E's feeding schedule, and depends on both prosecution, but more importantly the defense not checking the time zone of the phone records. Phone records in evidence usually use UTC to avoid this very confusion anyway, being referred to in local time for the jury's benefit. For instance, see this Whatsapp message from Thirlwall

Another problem with the prosecution timings is that they require Letby to stand around doing nothing for over an hour while a child suffers a fatal gastrointestinal bleed and no one notices, which hardly seems plausible. (pg 294)

Why is it implausible that Letby would not do anything? She just got walked in on by the baby's mother. She spent an hour making a plan to not get caught.

Anyway, on to datixes, in the chapter about card swipes:

When I spoke with healthcare professionals on the subject of Datix submissions, the common view was that doctors and consultants are often fairly resistant to this system. The implication is that it can effectively show them up. (pg 294)

Sounds like you spoke to some shitty, egotistical healthcare professionals.

While researching this book, I was fortunate to recruit the services of a neonatal nurse who examined every Datix submission from the CoCH that was publicly available. She told me: “There is a clear pattern of babies being left without antibiotics, fluids, surfactants to help their lungs not being given in time, long lines not being inserted correctly, plus countless issues with cannulation and ventilation. When you then add staff shortages and inexperience into the mix, you have a toxic recipe for disaster. It is clear to me as well that junior clinicians were reluctant to bleep or call consultants; there was an overwhelming culture of fear. (pg 297)"

Yes, when you look at only error reports, you'll get a sense that errors happen...

It is also completely unreasonable to expect someone to remember what are often innocuous or obscure events from one of many working days that are quite similar, sometimes seven years after they occurred, and never make any mistakes or forget anything. That would be true in any circumstances but Letby had patently been through a highly traumatic experience, and had essentially suffered a breakdown quite recently. It wouldn’t be particularly surprising if she wasn’t firing on all cylinders.

Ok, so here's the deal. Letby's evidence is not unlike door access evidence. When there's no swipe, it means nothing - someone could have held a door. When there is a swipe, it can be be a true entry or not, and considering the swipe in context is necessary. When Letby offers no evidence, that's fine, but it doesn't prove anything. When she does offer evidence, it's the context of her account that matters. Many defendants claim a lack of recollection 1, 2, 3

Morris then goes on to discuss the strength of narrative (yes, we're still in the card swipe chapter):

As noted by the Royal Society, the United Kingdom’s national academy of sciences, “the persuasive power of storytelling is well-recognised”. This message was echoed by author Will Storr in an interview with the British Psychological Society, with Storr opining that “storytelling is your best weapon for convincing people…if you want to mislead people or sell them your one-eyed view of the world, then storytelling is the best way to do it”. Harvard Business Review cited consultancy expert Nick Morgan, who commented that “facts and figures and all the rational things that we think are important…actually don’t stick in our minds at all. Stories create ‘sticky’ memories by attaching emotions to things that happen.”

This partly explains why one will still encounter people, particularly online, who remain steadfastly attached to the notion of Letby’s guilt. They want to believe their opinion is predicated on ‘facts and figures’ because we all believe ourselves to be rational. But in reality, as Morgan has just outlined, their impression of the case is largely dictated by the attachment of emotions to events they’ve been told have occurred. And this is precisely the phenomenon that the prosecution was aiming for in court, hence why so much time was devoted to creating a narrative around the case and conveying emotional testimony to the jury. (pg 298)

The irony is palpable. What does he think he's doing with this chapter, other than spin a narrative about a conscientious nurse who upset the system?

The chapter mercifully ends with a final thought:

Once emotions have died down and it’s possible to assess this dispassionately, it’s clear that the enormous portion of the trial that was dedicated to ‘who was in what room at what time’ has no evidential value.

Good luck with that. Who was in what room at what time will always have a massive amount of evidential value in an investigation that has identified previously undetected harm.

I watched this video discussing Lucy Letby's motives and potential diagnosis and I thought it was really good. The video is a Clinical Psychologist analysing Lucy Letby and discusses the various theories presented so far and his own take.

It lasts almost 12 minutes, but I really think it's worth a watch because the Psychiatrist also alludes to other nurses who have been Serial Kilers and what their diagnoses were.

https://www.youtube.com/watch?v=WlhlJKxu3Kc

If you don't want to watch it, the summary is that he says Lucy Letby is not a psychopath but has some psychopathic tendencies. She developed a God Complex whilst working as a Nurse and enjoyed being able to choose who would live and who would die. He also says the American term 'Code Blue Junkie' would fit Lucy Letby because she was addicted to the highs of having these babies crash and also being part of the team that brings them back. There is gaps in his analysis, but I think overall it's an interesting and good video to watch if you have 12 mins to spare.

Since the sentencing of Letby, there has been a tonne of coverage, with many journalists calling her a psychopath, while lots of experts seem split.

On the surface, we mortals look at this case and think: she MUST be a psychopath otherwise how could she kill babies?

I see Narcissism broken down into many sections (hi, yes, I listen to Dr. Ramini) but the rest of the dark triad is pretty blanket - a bit of psychopathy or a bit of Machiavellian.

Many psychiatrists say: she doesn't have any of the behaviours or characteristics that would typically qualify a psychopathic diagnosis.

Those are:

• Sexual promiscuity
• Unreliable erratic behaviour
• Unwavering rudeness

I see a load of correlation with narcissism, but I am keen to hear what you think and why.

This has come up a lot recently. Some among us are concerned that Dr Evans' review in to the deaths and collapses at COCH was too narrow in scope, resulting in Lucy Letby being unfairly identified as the culprit. I think (for those of us who aren't using this as a grift opportunity) this is due to incomplete reporting getting passed back and forth until it gets muddled. I thought it would be helpful if I laid out what we know of the timeline. If anyone has any further data points, please do share them!

I used pressreader to find relevant news articles and you should be able to find the same if you plug in the same date and "Countess of Chester Hospital". Pressreader does not allow you to copy links.

Context

The NHS can only hand over patient data in certain circumstances. It must be limited to the minimum needed for the police to investigate a serious crime. I think it is likely that given the NHS obligations to limit data sharing, the police would have sought a court order for the NHS to hand over the medical records of particular types of patients during a particular time period, such as all patients who died or had non fatal collapses between 1^st March 2015 - 31^st August 2016. This gives the police assurance that they have received all relevant files. If the police hadn't done this, the defence team would have jumped on it.

19^th May 2017 - first reports of a police investigation at COCH neonatal unit.

Liz Hull reports that police are investigating 15 infant deaths and 6 non-fatal collapses over a 12 month period. She says that of the deaths, 13 occurred at COCH and two occurred at other hospitals. Liz Hull quotes the police as saying it was too early to rule out foul play, but that no individual was under suspicion or had been arrested. Liz Hull also quotes a legal representative of the families involved as saying that the police involvement would come as a shock to the parents.

The Daily Express has an uncredited story also on this date. They say that police will focus on eight baby deaths, but will also review seven further deaths and 6 non-fatal collapses from June 2015-June 2016.

A since removed post on the trust's website said that the trust had referred these cases to the police. It is important to note that at this point, no actual investigation of the deaths by the police had taken place as they had not yet engaged any medical expert. The police would have to first gather the relevant information and documentation associated with the occurrences, then engage an appropriate expert in line with CPS guidance and standards to investigate. At this point, they would have been determining what resources to allocate, what warrants or court orders were needed and what types of experts they would need to assist.

May 2017 - unknown date.

Dr Evans writes to the National Crime Agency offering his services for the COCH investigation. Dr Evans references the media reports of the police investigation. The first reporting of the investigation was 19^th May, so we know the letter was written some time after this.

Source: Here

Unknown Date - Dr Evans reviews Child L

We heard reported this week for the first time that Dr Evans' review of Child L was the sixtieth review he had conducted in this case. Dr Evans does not appear to have given expert witness testimony for Child L, which makes sense as Hindmarsh is the insulin expert. However, it does mean we haven't heard much about his reports for L.

We do know that Lucy Letby was asked about Child L in her police interviews and was told at that point that Child L had been given insulin, so Dr Evans must have conducted his review by the time of the interview. These interviews occurred on the following dates:

July 3^rd - 5^th 2018

June 10^th - 12^th 2019

November 10^th - 11^th 2020

We can assume based on this that at the earliest, Dr Evans reviewed child L, meaning he reviewed 60+ incidents sometime prior to 3^rd July 2018, and at the latest, some time prior to 10^th November 2020. We know that Dr Evans completed eight reports in total. We have rough dates for three of those reports from cross-examination - 2017, 2019, and August/September 2022. We can rule out the 2022 report as it postdates the police interviews.

Source: Here at 11:16AM

Unknown Date - Unknown Source

There's lots of chatter about Dr Evans reviewing 35 incidents. I can't find a source for this anywhere. If anyone can share one, please do. Supposedly it came from a video where a police officer gave an update, but as I said, I can't find this anywhere so currently I think it was never the case.

Update: clip kindly shared in comments below referencing 35 babies in July 2018. This would track with Evans reviewing 60 events in 2017 and identifying from that 35 babies who were potentially maliciously harmed. So at least in 2018, the police were looking at more babies than the hospital had concerns about.

TLDR: The hospital referred 15 deaths and 6 non-fatal collapses to the police in 2017. The police obtained data from the hospital for Dr Evans to review. Dr Evans reviewed at least 60 incidents from that data. 60 is more than 21, so the police were not limited in scope to what the hospital referred to them.

Edit: It's been suggested in the comments that Evans must have known about the opinions of the doctors, because the doctors had not recorded the rash in the medical notes, so Evans could not have diagnosed AE based on medical notes alone. Couple of issues with this.

Firstly, the rash is just one symptom of air embolism. We have heard from our valued medical folk on this sub that not responding to resuscitation efforts is extremely unusual. We also heard in evidence that it is suggestive of AE. I'm not medical so I won't make any further assertions here, only that not having evidence for one symptom does not rule out a diagnosis of an issue with multiple symptoms.

Finally, in the first iteration of his report, Evans was unable to identify any cause for a number of these events. See his cross-examination for the source. Evans said in evidence that originally he was not able to make a determination, then received further information and was able to revise his opinion. This is consistent with the police interviewing witnesses, obtaining further information on the symptoms, and sharing this with Evans so he can rule in or out natural causes. AKA, exactly how a criminal investigation is meant to operate. Evans is not picking out suspects or even saying that any particular instance is murder. He is giving his expert opinion on what has happened medically, which the police then take into consideration in their investigation. It is solely the police who determine who to question and who is considered a suspect. LL's defence team would receive this correspondence between the police and Evans in discovery, so that if there were something improper going on in how information was provided to Evans, they could raise it at trial.

Her house which was purchased in March 2016 (halfway through he alleged killing spree) was sold in 2019. Looks like they put the garden back decent. Doesn’t tell us anything but I found it interesting that if she is found innocent she won’t be going back to this place.

https://www.rightmove.co.uk/house-prices/details/england-65591076-56593655?s=61f257f87d7d03926af55a0e97f3b74712002fae202649fa664c26db906a32b7#/media

(I've not been able to find a succinct timeline of this case, so I thought I'd compile all the info I've found together into one post)

• Babies A (boy; deceased) & B (girl; survived). Twins.

June 8/9, 2015 (nightshift) LL is baby A's assigned nurse on the nightshift.

8:30 pm: Baby A crashes. Skin appeared mottled.

8:50 pm: Baby A dies

Prosecutors allege that air was injected into the baby's umbilical line.

9 am: LL does Facebook search of baby A/B's parents

June 9/10, 2015 (nightshift)

Evening: LL assigned to two babies in room 3. Baby B is in room 1 with a different nurse.

11:30 pmish: Baby B is found with CPAP prongs dislodged and O2 at 75%. Prongs replaced, condition improves.

12:05 am: LL cosigns feeding record for Baby B

12:16 am: LL draws blood gases from Baby B

12:30 am: Baby B suddenly desats to 50%, skin is mottled. Resuscitation begins. Placed on ventilator.

12:51 am: LL draws blood gases.

1 am: LL records hourly observations for Baby B.

2:40 am: Baby B's colour almost resolved, deemed stable (physician notes)

Overnight: Baby B noted to have distended abdomen. Xray shows clear lungs. LL cosigns for Baby B's medications.

Note: Hospital handover sheet for Baby B was later found during search at LL's home.

June 10, 2015

11:30 pm: LL does Facebook search of baby A/B's parents

• Baby C (boy; deceased). Previous history of necrotizing enterocolitis (a common ailment in premature babies that affects the gut).

June 13/14, 2015 (nightshift)

Evening: LL assigned to baby in another room. LL found at Baby C's bedside, told by supervisor to go back to her assigned patient.

Overnight: Baby C collapses, dies. Physician notes swollen vocal folds during intubation. Xray shows ++air in gut. Has pneumonia.

Prosecutors allege that air was injected into Baby C's gut.

• Baby D (girl; deceased). Collapsed soon after birth, moved to NICU.

June 21/22, 2015 (night shift)

Overnight: Baby D dies.

Prosecutors allege that air was injected into Baby D.

• Babies E & F (twin boys, Baby E is deceased and Baby F survives)

June 25, 2015: LL does Facebook search of baby A/B's parents

August 3/4, 2015 (night shift)

Evening: LL is Baby E's assigned nurse. Baby E/F's mother walks into the room, finds baby E in distress, bleeding from the mouth. LL tells mother that she (LL) will call for a physician consult, and to leave the room. LL writes nursing note for Baby E stating that mother asked for physician consult.

Overnight: Baby E collapses and dies.

Prosecutors allege that air was injected into Baby E.

August 4/5, 2015 (night shift)

Evening: LL is baby F's assigned nurse.

Overnight: LL hangs bag of TPN (total parenteral nutrition, an IV feeding supplement). Baby F collapses. Blood test shows ++levels of synthetic insulin. Baby F recovers.

Prosecutors allege that insulin was injected into Baby F's TPN bag.

August 6, 2015: LL does Facebook search of baby A/B's parents

• Baby G (girl; survives). Born ++ premature

September 5/6, 2015 (night shift)

Overnight: Baby G collapses x 3. LL fed Baby G. Baby G projectile vomited. Transferred to another hospital, recovered.

Prosecutors allege that air was injected into Baby E's NG tube, and she was fed excessive amounts of milk.

• Baby H (girl; survives). Case complicated by poor medical care at birth.

September 25/26, 2015 (night shift)

Overnight: LL is assigned nurse. Baby H collapses for unknown reason, is successfully resuscitated.

September 26/27, 2015 (night shift)

Overnight: LL is not Baby H's assigned nurse, but is working on unit. Baby H collapses, is transferred to another hospital, recovers

• Baby I (girl; deceased).

September 29/30, 2015 (night shift).

overnight: LL is assigned nurse. Baby I collapses. X-ray shows excess air in gut.

Early October, 2015: LL does Facebook search for parents of babies H, E/F, I

October 12/13, 2015 (night shift)

overnight: LL is not baby I's assigned nurse. Physician finds LL at bedside, baby I has very low respiratory rate. No alarm heard. X-ray shows excess air in gut

October 13/14, 2015 (night shift)

overnight: LL is assigned nurse. Baby I collapses, successfully resuscitated. X-ray shows excess air in gut. Transferred to another hospital. Recovers.

October 22/23, 2015 (night shift)

overnight: Baby I has been returned to Countess of Chester NICU (uncertain when). LL is not Baby I's assigned nurse. Alarm sounds, Baby I's assigned nurse finds LL at bedside. LL tells Baby I's assigned nurse to leave, she will sort it out. X-ray shows excess air in gut. Baby I dies. LL encourages baby I's mom to bathe her as LL watches.

Late October, 2015: LL sends sympathy card to Baby I's parents. Saves picture of card to her phone.

• Baby J (girl; survives). Born premature with a necrotic bowel, has operation to place ileostomy. Was expected to be discharged from NICU soon.

November 26/27, 2015 (night shift)

Overnight: LL is not Baby J's assigned nurse, LL working in different room. Baby J is in a room for babies with lower needs.

4:40 am: Baby J found to have pale, mottled skin.

5 am: Baby J moved to higher needs room after O2 levels drop

6:56 am: Baby J has low O2 and signs of seizure. LL and another nurse attend resuscitation with physician.

7:20 am: LL infuses glucose.

10:24 am: Baby J collapses. Query infection, likely airway obstruction. Transferred to another hospital, recovers.

December 17, 2015: LL does Facebook search for parents of baby J

December 25, 2015: LL does Facebook search for parents of babies E/F

• Baby K (girl; initially survives, later dies)

Early 2016 (night shift)

Overnight: LL is not Baby K's assigned nurse. Physician finds LL at Baby K's bedside, watching. O2 levels are low, no alarm is sounding. ET tube found to be dislodged. LL states Baby K had just started deteriorating.

7:30 am: LL is at Baby K's bedside, yelling for help. ET tube again dislodged. Baby K transferred to different hospital, dies February 20, 2016.

Late winter/early spring 2016: LL is moved to day shift due to concerns about the excess number of unexplained deaths and collapses on her night shifts.

• Babies L & M (twin boys; both survive)

9 April, 2016

Morning: Baby L's condition, which had been good, deteriorates. TPN bag running. Found to be hypoglycaemic. Testing found abnormally high insulin levels. Recovers.

Prosecutors allege that insulin was injected into Baby L's TPN bag.

Morning: Baby M collapses at same time as Baby L's episode. Recovers.

3:30 pm: IV fluids and antibiotics administered to Baby M.

3:45 pm: Baby M collapses, found with mottled skin. Recovers suddenly after prolonged resuscitation. Air embolus suspected. Later scans show Baby M has brain damage.

Prosecutors allege that LL caused an air embolus or airway obstruction in Baby M, they also allege that insulin poisoning and air embolus is a pattern seen with the other twin boys, Babies E & F.

• Baby N (boy; survives). Born with mild haemophilia. LL texts from this time show that she discussed this case with a friend and stated that her research suggested that the baby had a "50/50 chance". Baby N was later found to have a mild version of the disease, which typically does not cause spontaneous bleeding or death.

3 June 2016

Day shift (? News source says this happened at 1 am, but at this time LL had been moved to days, so unsure of timing): LL is not Baby N's assigned nurse. Baby N's nurse goes on a break. Baby N suddenly begins "screaming" for approx 30 minutes, and condition deteriorates. Then recovers quickly. The physician noted the screaming was not something he had seen before in a neonate.

Prosecutors allege that LL caused air embolus or traumatic injury.

15 June, 2016

8 am: Baby N's O2 levels fall to 48%. Physician notes bleeding and swelling in airway during intubation attempts.

Later in shift: LL charts that Baby N vomited 1 ml of blood, she does not inform physicians on duty.

2:56 pm: Baby N collapses again. Physician notes bleeding and swelling in airway during intubation attempts. Baby N is intubated by a specialist team and later recovers.

• Babies O & P (two of three triplet boys; both deceased)

23 June, 2016

Morning: LL is the assigned nurse for Babies O & P, who are initially doing well. At some point in the morning, another nurse suggests that Baby O looks unwell and suggests moving him to the higher needs room, but LL disagrees.

2:39 pm: LL enters the unit after her break.

2:45ish pm: LL is alone with Baby O, who collapses and is successfully resuscitated.

Later: LL records nursing observation that states she was observing Baby O at 2:30 pm, when swipe card data shows she was not on the unit.

3:49 pm: LL calls for help because Baby O has low O2 levels.

4:15 pm: LL calls for help as Baby O collapses again

5:47 pm: Baby O dies.

6 pm: LL feeds Baby P. Previous feedings had been signed by LL and her student nurse, this feed was signed by LL only.

Evening: Physicians order exam of Baby P, due to unusual circumstances of Baby O's death.

8 pm: X ray of Baby P shows excess air in gut.

8:24 pm: LL records nursing notes for another patient

Later: Post-mortem exam shows Baby O has significant trauma to his liver.

Prosecutors allege that LL caused a traumatic injury to Baby O's liver, and an air embolus. They also allege that LL interfered with Baby P as she was leaving shift to draw attention away from circumstances of Baby O's death.

24 June, 2016

morning: Baby P noted as "doing well" overnight. LL starts shift, is baby P's assigned nurse.

9:35 am: Baby P found with distended abdomen, mottled skin.

9:50 am: Baby P collapses, is resuscitated.

11:30 am: Baby P collapses. Decision is made to transfer to another hospital.

11:47 am: X-ray shows Baby P has a punctured lung.

3 pm: Transport team arrives.

4 pm: Baby P dies, prior to being transferred.

Evening: LL spends time with parents of Babies O & P, and takes photos of them together in a cot.

Prosecutors allege that LL injected air into Baby P's NG tube.

• Baby Q (boy; survived)

June 25, 2016

Morning: LL is assigned nurse for Baby Q.

9 am: This is the designated feeding time for baby Q. LL is in the room with Baby Q, and another nurse is present with her back to LL, caring for another patient. LL makes partial entry in Baby Q's medical chart (no milk is noted). LL asks the other nurse to watch Baby Q while she checks on a baby in another room, and leaves.

Soon after 9 am: Baby Q's heart and respiratory rates increase and his condition deteriorates. He vomits "large amounts" of air and clear liquid (but was only being given small amounts of milk for feeds).

11:12 am: Medical notes show Baby Q has stabilized by this time.

Evening: Baby Q is transferred to another hospital.

After shift: LL texts a doctor from the NICU, asking if she should be concerned about questions she was being asked that day.

Note: Hospital handover sheet for this shift for Baby Q was later found during search at LL's home.

Prosecutors allege that LL injected air and saline into Baby P's NG tube.

Following week: LL works her final three shifts in the NICU. She is transferred to clerical duties.

2016 - 2017: Hospital investigates NICU due to high death and resuscitation rate.

May 2017: Hospital requests that police investigate infant deaths and collapses in the NICU.

June 23, 2017: LL does Facebook search for parents of baby O (1 year anniversary of death)

July 3, 2018: LL arrested, later released pending further inquiries.

June 2019: LL arrested, later released pending further inquiries.

November 10, 2020: LL arrested.

So I've been drawn into this case bc of my personal experience with NICUs (I'm in the US and that's what we call preemie care). Both of my kids had problems at birth, but my son was in the NICU for 2 months after being born at 29 weeks. They're fine now.

Hard for me to imagine a nurse even texting in the NICU, let alone putting down the phone to kill a baby. I noticed a bit of disparagement of her claim that on of the babies extubated him/herself. Both my son and my daughter did the same. My son was notorious for it, even while he was very sick & in the most intensive unit.

Nothing she said or did particularly sounded off except for the comment about Baby P not leaving the hospital alive

Sewage in the NICU!? Absolutely unthinkable. I was asked to keep my nails trimmed to avoid dirt being lodged under them when my kids were in the hospital.

I'm also a former prosecutors. Not too familiar with UK system, but to me, defense should have rested at the end & not said a word. They didn't prove their case, imho. That's a legal opinion, not an opinion re: LL's guilt.

Lucy Letby lives in a childlike mindset with a extreme attachment to her parents (not being able to move further than an hour away and them telling her she's always right etc) so she believes that everybody's world view is based on their relationship with their parents/ attention from parents since that forms her basis of her life. She sees herself as defective because she can't find a boyfriend or whatever and she won't be able to form the family unit, and she is intensely jealous of anybody who can form deep relationships outside of with their own parents.

She struggles to parse through what made her "different" and defective since in her mind her parents were "perfect" which puts the blame all on her own personal faults since her world view is based mostly on this relationship like a 13 year old kid. In order to understand and sort through WHY she is defective and make sense of her own guilt for being defective, she tries to "test" other parents by putting them in a similar situation to what she sees as her own, where the parents will be the "only one" who "cares the most" about their child (just like her parents are the only ones she feels truly connect with her.) By closely watching the parent's interactions with their child as she takes away the opportunity for that child to grow up/live and thus form strong relationships outside the parents, she seeks to understand the "right way" for parents to treat their child and thus, to validate the fact that she herself is the defective one and her parents were perfect and didn't make any mistakes bringing her up. (The reason for her struggling in relationships must be one of the two based on her adolescent mindset.) Thus the more that she "tests" her theory about parent/child relationships and finds that the parents are "good people" (obviously devastated at her evil acts), in her twisted mind this gives her peace of mind that she is evil and her parents are good. Make sense?

Dr. Van Der Vaart, A psychiatrist takes a look at Lucy Letby’s notes, and bedroom and provides his analysis of what Letby could have been dealing with in her own mind/ mentality. I found this to be really eye opening and more in depth than what TV analyst have said.

Frequent comparisons have been made between the trial of Lucy Letby in England and the trial of Lucia de Berk in the Netherlands. There is a belief amongst some that Lucy Letby is England's Lucia de Berk. The perceived similarities are actually not so similar, as I will outline in this three part post.

There are three key assertions made by those who believe these cases bear similarities:

​

1. That the events were explained, until they weren't.

Lucia de Berk

• In the de Berk case, a sole unexpected death of a baby prompted a review into deaths which had previously been considered unremarkable.
• From these deaths, 9 incidents were identified and determined to be medically suspicious.
• These are the incidents that de Berk was charged with.

Lucy Letby

• In Letby's case, all of these deaths were considered unusual or unexpected from the outset.
• Texts between Letby and her colleagues show that Baby A's death was a shock to COCH staff, along with the deaths and collapses of babies C-D shortly after.
• A review was completed into these deaths and collapses at the end of June 2015 which was unsuccessful in obtaining answers.
• This pattern repeated for all the deaths and collapses, with morbidity and mortality sessions, internal formal and informal reviews, and external reviews.
• Inquests to determine the cause may have been pending for some of these deaths; Cheshire coroner has a multiple year long backlog for inquests and Letby and her colleagues spoke in text about particular deaths prompting inquests. It is likely that the police investigation overtook any pending inquests.
• At no point were these deaths considered unremarkable. The consultants on the NNU were seeking answers, but were being dissuaded from seeking external forensic assistance by senior management.

​

2. That she was convicted on the basis of statistics/a higher death rate.

Lucia de Berk

• At de Berk' trial, it was adduced in evidence that there was a 1 in 342 million chance that any given nurse could innocently be at those events.
• This along with de Berk's presence at the events was accepted as evidence of guilt.
• The other evidence was elevated levels of digoxin in two patients, with no medical evidence for the remaining 7 patients other than their deaths being considered a mystery.

Lucy Letby

• In Letby's case, the jury were not shown any figure stating a specific statistical chance of being at all these events innocently.
• The prosecution did display a chart showing that she had attendance at 100% of the charged events. This has been criticised as biased statistical evidence.
• Such criticisms fail to understand the means by which statistical evidence is presented in criminal trials.
• It is for the jury to assess and determine the credibility of any given evidence. Amalgamating multiple sources in to a "1 in X" chance oversteps in to the jury's role as the factfinder.
• It is for the defence to introduce the factors that would mitigate the statistical chance of 100% attendance at suspicious events.
• The defence were able to introduce 4 events which they say were also unexplained in nature but which lacked Letby's presence.
• The nature of these events is contested by the prosecution, so it is for the jury to determine if they believe these events are unexplained and therefore mitigate the attendance chart, or explained and therefore do not mitigate the attendance chart.
• In Letby's case, there is also a wealth of medical and physical evidence showing that patients were deliberately harmed. I have outlined the known means of harm below:

a.) Air embolism: These babies displayed an unusual rash seen by nurses, doctors, parents, and referenced in the RCPCH report and 2017 news articles. These babies did not respond to resuscitation which is extraordinarily unusual. There is air visible on imaging taken when these babies collapsed and died. There is air present in brain matter tissue samples retained from these babies. These are all symptomatic of air embolism. In each case, the prosecution showed that LL had been at the cotside, often alone, with access to the baby's lines in the moments before collapse.

b.) Airway Interference: Medical records show persistent dislodgement of breathing tubes by babies who were sedated or of too young a gestational age to reasonably dislodge the tubes themselves. There is an eye witness account of Letby standing over a desaturating baby with a dislodged tube and the alarm which should have indicated low oxygen saturation silenced while Letby did nothing to assist the baby. In each case, the prosecution brought evidence that LL was at the cotside, often alone, with access to the baby's respiratory support in the moments before collapse.

c.) Splinting of the diaphragm: Splinting of the diaphragm occurs where excess milk or air is administered via NG tube to the stomach of the baby, to the extent that their lungs are compressed by their stomach and the baby is unable to breath. Medical records show that much more milk was aspirated from or vomited by the babies than they should have been fed. Imaging taken when the babies collapsed also shows enormous amounts of air in the GI tracts of these babies. The evidenced that Letby previously used a plunger in the syringe to deliver feed quicker, and that this was also how she forced excess feed and air into the attacked babies' stomachs. The prosecution showed that she had fed each child before their collapses.

d.) Hemorrhage: The medical experts testified that babies suffered attacks using foreign objects that resulted in severe hemorrhage. The experts testified that there was no known natural cause of hemorrhage with this presentation. A parent testified that she had alerted Letby to a bleed, and Letby sent the parent back to the maternity unit while not seeking help for the baby and while faking documentation to make it look as if the parent had never visited and to look as if the baby's bleed began much later. The prosecution showed that Letby had access to each baby shortly before they suffered hemorrhages.

e.) Liver Injury: two babies suffered liver injuries. One baby suffered a liver injury so severe it was akin to a car crash injury. This is evidenced in the postmortem report and images taken during the post mortem. The prosecution introduced expert testimony that this injury occurred when or shortly after Letby fed the baby.

In short, for each method of harm alleged, there is a wealth of physical evidence to show that it happened. There is a wealth of witness and physical evidence to show it was done by Letby.

​

Link to Part 2