Barnabus

@judithmoritz your colleague Jonathan Coffey does not have an X account so I address this to you. In your book, you write, “The case of Baby O is undoubtedly one of the strongest in the prosecution's armoury.” It was one of the strongest because of the bulls&*t evidence the prosecution presented, evidence you have never called out. In his BBC website article today (bbc.co.uk/news/articles/cj0y…) Mr Coffey attempts a balanced approach to Baby O, setting out both prosecution and defence arguments. I set out below what Mr Coffey missed out in his article, which I think even you will agree conveys the extraordinary level of bulls&*t presented by the prosecution in relation to Baby O. I suggest everyone keeps in mind when reading the below that Lucy Letby was not on the night shift on 22/23 June but on the day shift on 23 June which started at 8am after the 7.30-8am handover. 1. Dr Brearey writes (“written in retrospect”) in medical notes at 18:00 on 23 June 2016, "Small discoloured ? purpuric rash on right chest wall” then "Called back to NNU to assist approx. 1630”. A purpuric rash is a skin condition characterized by reddish-purple spots or patches caused by bleeding under the skin. Essentially, a purpuric rash is a bruise. 2. There is no other mention of the rash in the medical notes, whether by anyone else or of it having resolved. 3. There is no mention of the rash in Dr Kokai’s postmortem report. 4. The seven consultants, in a document they write for the police in May 2017 setting out their suspicions, note that Baby O "Had a discoloured abdomen at one stage which resolved later”. How could Dr Brearey remember nearly a year later that the rash had resolved when neither he nor anyone else had written that in the clinical notes? And when he had thought it was a bruise i.e. something which would not have resolved? 5. In July 2017, Dr Evans first meets Cheshire Police. He had asked to be given notes of one or two babies so as to get an idea of what they were looking at. He is given the notes for just one baby, Baby O, which include post mortem photographs of the baby’s abdominal haemorrhage. He later says in a podcast interview given after the trial that, having been given the notes and the photographs, he knew within 10 minutes that Baby O had been the victim of inflicted harm, a physical attack. If the evidence was so incontrovertible as Evans said it was, why had the pathologist Dr Kokai not noted any suspicions? 6. Dr Evans, in a meeting with police in October 2017, notes, "Discoloured purple rash in chest wall 18:00 23rd June”. Brearey had noted the "Small discoloured ? purpuric rash on right chest wall” before being called back at approx. 16:30, but had written the note retrospectively at 18:00. So Dr Brearey had noted the rash before 16:30 but Dr Evans mistakenly thought he had noted it at 18:00. 7. Evans also notes, at the same meeting, "5am 23rd HR climbing” (remember that Lucy Letby was not on duty on the night shift but on the day shift a few hours later). 8. In his first written statement dated 21 Nov 2017, Evans notes, "From 02.00 hr there is a significant increase in heart rate to 150 at 08.30 hr, increasing to 170 at 13.30 hr.” Then, "There is a key clinical change from around 01.00 hr on 23 June, where there is a significant increase in both his trend of heart rate and respiratory rate.” Then, "I also note the comment regarding the petechial discolouration over the right side of the chest (over the liver), noted by one of the doctors who conducted Baby O’s resuscitation. This suggests that Baby O sustained some form of trauma which initially led to his increased heart rate and increased respiratory rate from around 01.30 hr on 23 June, and which eventually led to a “tipping point” where the effects of the bleeding led to his collapse and subsequent death. Then, “Baby O’s collapse is consistent with inflicted trauma sometime during the early hours of 23 June 2016. He sustained blunt trauma to the abdomen, over the area of the liver. This caused bleeding [the subcapsular haematomas] in his liver, the blood [20 ml] found in the abdominal cavity at post mortem, and accounts for his deterioration and death. The presence of the suspected purpuric rash noted over the right chest wall is an important superficial marker noting the external site of the trauma.” 9. In a second meeting with police in March 2018, Evans notes, "Made mistake re increase in HR. Initially says 1am but chart shows 7am (handwriting not great). Now agreed 7am.” 10. He also notes, "Pathologist will need to make comment on relevance of clotted blood” (note that the blood in the abdominal cavity found on post mortem was “unclotted” not “clotted”). 11. He also writes, "Consider doing gene sequencing for [Baby O and Baby P] as per Dr Kokai suggestion” (in private correspondence with Dr Evans, I asked him, "Did you request full genome sequencing on Guthrie cards to test for genetic factors?” To which he responded, "I did not request genome sequencing. Why was that necessary?” 12. In his second written statement dated 2 June 2018, he writes, "From 02.00 hr there is a significant increase in heart rate to 150 at 08.30 hr, increasing to 170 at 13.30 hr” (this is the same as what he wrote in his first written statement). 13. He also writes, "The entry timed at 07.32 hr notes “Abdo looks full slightly loopy”” (remember Lucy was on the day shift so would not have been on duty until 8am). 14. He then repeats what he wrote in first written statement, "There is a key clinical change from around 01.00 hr on 23 June, where there is a significant increase in both his trend of heart rate and respiratory rate” then, "In my opinion the subcapsular haematoma (best seen on page 465), i.e, bleeding from the liver, caused the collapse. I also note the comment regarding the petechial discolouration over the right side of the chest (over the liver), noted by one of the doctors who conducted Baby O’s resuscitation. This suggests that Baby O sustained some form of trauma which initially led to his increased heart rate and increased respiratory rate from around 07.00 hr on 23 June, and which eventually led to a “tipping point” where the effects of the bleeding led to his collapse and subsequent death.” 15. Then, "I would value the pathology opinion regarding the cause of Baby O’s liver haematoma, and whether it’s likely to be the result of trauma. His collapse is consistent with some incident sometime during the early hours of 23 June 2016. The presence of the suspected purpuric rash noted over the right chest wall is an important superficial marker noting the external site of the trauma. He may have sustained blunt trauma to the abdomen, over the area of the liver. This caused bleeding [the subcapsular haematoma] to his liver, the blood [20 ml] found in the abdominal cavity at post mortem, and would account for his deterioration and death.” 16. And, “The air in his abdomen [noted on x-ray and clinically from the abdominal distension] is excessive, and is consistent with excess air having being infused into his stomach (via his naso-gastric tube), which tracked into his intestines, causing abdominal distension”. Remember in his second statement he had written, “The entry timed at 07.32 hr notes “Abdo looks full slightly loopy””. 17. Brearey’s only written statement in relation to Baby O is dated 23 January 2019. In it, he writes, "I did note at the time of Baby O’s intubation [c. 3pm] that he had an area of discoloured skin on the right side of his chest wall approximately 1-2cm in diameter. I was unsure of the cause for this rash but its initial appearance led me to consider it was infective in origin and probably purpuric.” 18. Then, "The purpuric looking rash on the right side of his abdomen that I had noticed earlier was no longer visible” and "The rash that I noticed on his abdomen was purpuric in its appearance which is unusual in preterm babies. The initial rash that I had observed was no longer present later when he was being resuscitated. Therefore, the rash is unlikely to have been purpura. I have not observed a transient rash like this on other term or preterm babies and was unsure of its causation.” (Note that Brearey had made no mention in the clinical notes that the rash had disappeared). 19. Two months after Brearey’s written statement, Evans, on 25 March 2019, writes his third statement. Contrary to his first two statements, he writes, "There is a key clinical change between 08.30 and 10.30 hr on 23 June. There is an increase in the trend of his heart rate. Heart rate at 07.00 hr is 145 per minute, up from 125 at 21.00 hr the previous evening, but within the normal range for a pre-term infant.” 20. Then, "The new information, from Dr Brearey’s account, is important in relation to his observations regarding the rash on Baby O’s abdomen. The information I had received previously did not include any details regarding the time of its onset. I now note that Dr Brearey noticed it at around 15.03 to 15.08 hr [on 23 June]. Baby O had a persisting rash at around 16.30 hr. It was “no longer visible” by around 17.15 hr.” 21. Then, "Given this new information I believe that Baby O’s collapse during the afternoon of 23 June 2016 was due to an air embolus. The discoloration described over his abdomen by Dr Brearey is consistent with what one find in an infant who has received a volume of air intravenously.” 22. And, "Given Dr Brearey’s description I believe it’s appropriate to note the comment from the paper by Lee & Tanswell,(page 508) in relation to colour changes: “Blanching and migrating areas of cutaneous pallor were noted in several cases and, in one of our cases we noted bright pink vessels against a generally cyanosed cutaneous background.” This description is not dissimilar to Dr Brearey’s observations regarding the discoloration he noted.” In fact, Dr Brearey had written “Small discoloured ? purpuric rash”. On which planet are these “not dissimilar”??? 23. Then, "I note the comment regarding the petechial discolouration over the right side of the chest (over the liver), noted by one of the doctors who conducted Baby O’s resuscitation. Given the recent information [24 Jan 2019] I remain of the view that Baby O may have sustained some form of trauma. This initially led to his increased heart rate and increased respiratory rate from around 07.00 hr on 23 June.” 24. He also writes, "The discoloration of the skin, described by Brearey, is similar to descriptions in other babies who collapsed suddenly and unexpectedly. I note the reports in relation to Baby A and Baby E.” Note that nowhere in the medical notes of Babies A or E is there a description of a rash that is in any way similar to that in the 1989 paper (“bright pink vessels against a generally cyanosed cutaneous background”). And we know that one of the authors of the paper has since the trial written that the rash described in his 1989 paper was not associated with venous air embolism which the prosecution had invoked. 25. Then, "In my opinion Baby O’s immediate collapse was the result of an air embolus, given shortly before his deterioration at 14.40 hr. He probably sustained earlier inflicted trauma to the right side of his chest sufficient to cause liver trauma. This would explain the earlier increased heart rate and respiratory rate.” 26. Then, "His collapse is consistent with an incident sometime from around 08.30 hr on 23 June 2016. Baby O’s immediate collapse is consistent with the effects of an air embolus occurring just before his deterioration at 14.40 hr." 27. Then, "The suspected purpuric rash faded within a few hours. This rules out its being due to any kind of bleeding. It does not rule out his having sustained blunt trauma to the abdomen, over the area of the liver. This caused bleeding [the subcapsular haematoma] to his liver, the blood [20 ml] found in the abdominal cavity at post mortem, and would have contributed to his deterioration and death.” 28. Also, "The air in his abdomen [noted on x-ray and clinically from the abdominal distension] is excessive, and is consistent with excess air having being infused into his stomach (via his naso-gastric tube), which tracked into his intestines, causing abdominal distension. (Note that Evans had previously written, "The entry timed at 07.32 hr notes “Abdo looks full slightly loopy””). 29. Then came the trial, at which the prosecution and its medical experts performed a long, convoluted verbal gymnastics show that Lucy Letby’s defence was unable to counter and which jurors would undoubtably have been unable to follow (in the end they probably relied on the two blood test results, Baby O’s bruise which wasn’t a bruise, the roster chart, and Lucy Letby’s handwritten notes, all of which could and should have been debunked by the defence). 30. After the verdicts are announced in August 2023, Evans gives two podcast interviews, with Raj Persaud and Tortoise Media. 31. In the Raj Persaud interview, he said: By 2017, I had probably carried out a couple of dozen reports for the police via the National Crime Agency on serious injuries and deaths in children. So my name was well known to the NCA. The National Crime Agency would want a copy of every report you said you prepared. And of course they would get the feedback from you going to court. And if your report stood up to scrutiny, then the perpetrators would be found guilty and there were also reports I arranged for the defence because I think that's quite important as well. There's no tide to me. I'm not the prosecutors man. I'm not the defence man. I'm my reports. So I read in the Sunday paper that there were concerns about the number of deaths of babies. And I think the report said actually in Chester and that the police had been called in. So I sent an e-mail regarding another case to the NCA and I said, by the way, I've read about this case in Chester regarding babies dying, and it was an off the cuff remark. And I said this sounds like my kind of case because of course it was. I dealt with numerous cases for the police and also I think more importantly dealt with numerous baby cases from a clinical negligence point of view and neonatal care was something that was infused in my moral really I've been involved with looking after sick babies for my mid 20s. So they came back to me and said, Where do we go next? So I said, look, I'll go up to Chester. This was in July 2017. Lovely summer's day. As it is in Wales all the time, of course. So I drove up to Chester. Met the police. And said look, I have no idea what's going on here, but get me the clinical notes of one or two babies so that I've got some sort of feel of what you're investigating. So I ride there. I met the inspector, Paul Hughes and his team. Madam Bolger, Janet Moore and I had a look at one of the cases. In fact one of the last babies who died and I was rifling through the notes and a couple of things struck me quickly. The notes were generally of good quality. There was obviously good consultant input into these case. And I found something that shouldn't be there. One of the medics had written down that he'd noticed what he thought was bruising over the area of the liver. Well, that doesn't happen. And I got the postmortem results as well. And saw some pretty horrid photographs that showed several blood areas of bleeding over the liver. In other words, trauma to the liver. And I thought, oh, my God, this is dreadful. This is inflicted injury. So right from the beginning. I said, look, this is inflicted injury. We need to investigate this and I also told them, and I think this is crucial, as far as the trial is concerned, I said if you suspect somebody or you suspect some people don't, I don't want to know. 32. To spell it out, Dr Evans in this interview is referring to bruising noted by one of the medics, saying it is suspicious because “Well, that doesn’t happen”, and inferring that it is evidence of physical attack. And yet when he gave this interview, he knew that the bruise was not a bruise so was not evidence of physical attack. 33. This was the same interview in which Evans said, “I think there was an infatuation with one of the medical staff. But hey, you know, that's not that unusual. That's something that we doctors have to put up with, nurses quite taking appeal. Medicine appears to be a profession that is very appealing to the ladies. That doesn't make nurses harm patients.” So we can add misogyny to Evans’ unenviable CV which includes support for the decriminalisation of child abuse (teapawt.org/LetbyWitchHunt/status/…). 34. In the Tortoise Media interview, there was this exchange: DE: I read about this in May 2017 and I drove up from Carmarthen to meet with them in July. I said, look, I'll just come up and talk to you, get me a couple of case notes just to give me an idea of what's going on. [They gave me] the last murder case but one actually. And this is the baby who was a triplet, who's a stable well baby, and who suddenly collapsed and died and where the postmortem showed serious problem abnormalities of the liver. Immediately, I think within 10 minutes or so of arriving and having a look at these notes and over the coffee, I felt, oh, my God, this baby is the victim of inflicted injury. Tortoise: So it took you 10 minutes to decide that this baby had been put in…. DE: Harm's way. Yes. Yes, there was evidence that this may be put in harm's way as far as I could tell straight away. A synopsis of the above might go as follows. The increase in heart rate at 1am/2am/5am/7am is evidence of physical attack, along with the bruise. Lucy Letby is not on duty at 1am/2am/5am/7am. Correction. The increase in heart rate at 8.30am is evidence of physical attack. The bruise is not a bruise so the evidence of physical attack becomes the postmortem photographs of the haematoma. And the bruise which is not a bruise becomes, out of nowhere, evidence of air embolism, despite the description not matching. And the evidence of injection of air down naso gastric tube is the full and loopy abdomen noted at 7.32am when Lucy Letby was not on duty. Oh, what a tangled web we weave. Judith, I wonder if any of the above will be in your Panorama tonight? I will send the above to you by email too, though you have never replied to my emails over the last two years, whether information with which I have provided you or polite invitations for a cup of tea (odd for a journalist don't you think?) #lucyletby @drphilhammond @DavidDavisMP @Voice4theDead @DavidRoseUK @Michelehal7344 @NeoDoc11 @sarahknapton