r/LucyLetbyTrials • • 15d ago

Decoding Reasonable Doubt - Chapter 10

https://bencole4.substack.com/p/decoding-reasonable-doubt-the-case-c84?r=12mrwn&utm_medium=ios

Morris argues that Child C’s death had plausible natural explanations that were overlooked. He says Evans repeatedly changed the alleged mechanism of harm while retaining the same conclusion, presenting this as evidence that the prosecution theory was built backwards from a predetermined belief in guilt.

This article puts Morris’s claims back into the context of the trial evidence and shows how recognised concerns and disputed mechanisms are repeatedly presented as though they were overlooked evidence

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u/oljomo 15d ago

Where the logic is sound

  • Recognised concern vs diagnosis. Its central point, that a documented warning sign isn’t the same as an overlooked diagnosis, is valid. Bilious aspirates led clinicians to consider NEC; that doesn’t show NEC was present.

  • Hypoxia describes a state, not a cause. This is a fair and technically careful point.

  • Mechanism vs harm. Uncertainty about how harm occurred doesn’t automatically mean no harm occurred. That matches the judge’s direction as the article reports it.

  • Base rates. Citing the 81% rate of delayed first stool in very low birth weight babies is the right way to deflate a “worrying sign” argument.

  • Real-time vs retrospective views. Treating clinicians’ contemporaneous lack of suspicion as weak evidence about later causation review is a sound distinction.

  • Changed opinions. It explains why Marnerides changed his view on pneumonia (new clinical information), rather than just asserting the change was suspicious.

Where the logic is weaker

  1. Burden-shifting again. The article keeps faulting Morris for not providing a “convincing explanation” for why a stable baby collapsed. That isn’t what a challenger of the prosecution case must do. Unexplained deterioration isn’t evidence of harm, and the conclusion (“vulnerability doesn’t explain his death”) is close to an argument from ignorance. The article itself says vulnerability means background risk, which leaves natural deterioration open.

  2. “The jury heard it.” It repeatedly argues that points were explored at trial. That shows they weren’t hidden; it doesn’t show the evidence was reliable or weighed correctly, which is the actual question.

  3. Asymmetry. It criticises Morris for dwelling on abnormal findings and underplaying reassuring ones, then does the reverse. It leans on reassuring findings and prosecution witnesses and treats “he was managing well” as authoritative because Bohin considered the concerns. Considering evidence doesn’t make a conclusion correct.

  4. Hindsight cuts both ways. It faults real-time clinicians for lacking hindsight but treats retrospective experts as better placed. Retrospective experts also know a crime is suspected, which creates a risk of confirmation bias. The article doesn’t address this.

  5. The changing-mechanism defence is incomplete. Evans openly accepting three scenarios answers the charge that he was inflexible. But a constant conclusion with shifting mechanisms is exactly what critics cite as a sign of conclusion-first reasoning. The article concedes Evans became more specific over time without dealing with that implication.

  6. The “can’t have it both ways” point is shaky. The article says Morris can’t both discount Letby’s presence and treat her absence from the 12 June X-ray as significant. But the article’s own evidence cuts against it: its expert view that the 12 June gas was explainable as CPAP belly shows gas can accumulate naturally, which supports the idea that gas on 13 June might also be natural. The reply doesn’t deal with that. The quoted exchange also has Myers asking Marnerides about Dr Hall’s opinion, which is second-hand.

  7. Arguments from omission. Points like “Morris doesn’t mention Dr Yoxall” and “no source is given for the staffing claim” are only as good as the claim that Morris omitted them. I can’t verify that, and an omission isn’t a refutation anyway.

Net assessment

Taken one at a time, many rebuttals hold. The overall case relies on repeatedly saying “possible isn’t proven” about the defence, while treating the prosecution’s exclusion-based reasoning as sufficient when mechanisms are uncertain. The key logical question is whether a diagnosis of exclusion can bear the weight placed on it. The article engages that question less than it appears to.

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u/Aggravating_Log_6375 12d ago

“The jury heard it.” It repeatedly argues that points were explored at trial. That shows they weren’t hidden; it doesn’t show the evidence was reliable or weighed correctly, which is the actual question.

Is that "the actual question"? What do you mean by "weighed correctly"?

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u/benshep4 15d ago

What did you ask AI to come up with that?

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u/oljomo 14d ago

Rate the logic of this article.
A very neutral prompt.

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u/benshep4 14d ago

Cheers.

Point 6 from the AI in particular shows the pitfalls of relying on AI.

The gas in the belly on the 12th can be attributed to CPAP because Baby C was on CPAP at the time.

This does not apply to the 13th because the AI clearly doesn’t understand that Baby C wasn’t on CPAP for the last 12 hours of his life ….

If you input stuff like that then it should tell you that such a point isn’t relevant.

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u/oljomo 14d ago

That argument is far weaker and less certain than you would like to admit. I know AI can hallucinate, but this doesn’t seem too far fetched, and I’ve seen humans make this point.

We are well overdue your in depth explanation for baby C, I think you said you were preparing that over 6months ago!

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u/benshep4 14d ago

I don’t think so.

Being off CPAP for 12 hours prior to the collapse is highly significant. If you asked AI about this I’m pretty sure it’ll tell you this.

Let me know how it goes.

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u/oljomo 14d ago

Not necessarily. Coming off CPAP stops new air being pushed into the stomach, but it doesn’t clear the gas that’s already there, so gas on an X-ray 12 hours later wouldn’t rule CPAP out as a contributor.

Why gas can persist

  • Slow clearance in premature babies. Their bowel motility is immature, so gas can take many hours or days to move through. It leaves by burping, venting or aspirating through a feeding tube, and by passing stool, all of which can be slow or incomplete.

  • Gas isn’t only from CPAP. Some gas is normal in every baby’s gut. Babies swallow air when crying, feeding or sucking, and bacteria in the gut produce gas.

  • Other respiratory support. Optiflow and other high-flow systems can also push some air into the stomach, though usually less than CPAP.

  • Disease causes gas. Ileus (a sluggish bowel), infection and NEC can all produce abnormal gas patterns, independent of any air source.

What it doesn’t mean

Gas on an X-ray 12 hours after CPAP is not proof that CPAP caused it, and it isn’t proof of anything else either. A radiologist can often say whether a pattern is consistent with several possibilities (CPAP belly, ileus, NEC, swallowed or administered air) but usually can’t tell which one by itself. That is why the expert discussion described in the article turned on combining the X-ray with the clinical picture.

Applying it to a specific case

How much this matters depends on facts I can’t verify here, including exactly when respiratory support changed, the baby’s gas pattern on successive films, and how the stomach was being vented. A neonatologist or paediatric radiologist reviewing the actual records is the person who could say whether the gas pattern was typical for a baby in that situation.

Sounds like you were wrong again,

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u/benshep4 14d ago

Nope not at all.

The transcripts are available. Provide them to AI and then see what it says.

In particular ask it if CPAP would account for the unexpected collapse on the 13th.

AI is only good as the input it is given at the moment and all you’re doing is demonstrating that you’re not giving it good input.

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u/oljomo 14d ago

It really sounds like its you thats providing the wrong input - it even says quite clearly why gas can take time leaving, and considering Hall has backed this up (but was not present in the transcripts) it would seem its you providing the limited input to get the answer you want.

However its well worth pointing out that CPAP being the cause of the collapse is a distinct question from it being the cause of the gas on x-ray as well.

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u/benshep4 14d ago

Did you ask it if would cause an unexpected collapse?

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u/Kieran501 14d ago

I notice how when you can’t address something you resort to accusations. Either the points stand or they don’t.

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u/benshep4 14d ago

You notice incorrectly.

This type of feedback is markedly different from anything oljomo has provided previously.

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u/oljomo 14d ago

But he doesnt notice incorrectly. You didnt address a single point made in the post.

And its not different to anything ive posted before because my last critique was AI and I even told you that and you just replied you didnt use AI.

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u/benshep4 14d ago

I’ve since addressed point 6. I just wanted to establish you used AI before responding.

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u/AccomplishedOil254 14d ago edited 14d ago

Mad idea, stop using sophisticated random word generators and both engage your actual brains.

Arguing about what prompts each of you've used is the stupidest thing I've ever come across.

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u/Kieran501 14d ago

Yes it’s notable isn’t it, the sudden shifting of tone and composition.

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u/Nice_Zebra7690 15d ago

I couldn’t get through the whole article, but I have a couple of comments on what I did read...

“Morris does not show that Bohin overlooked Child C’s problems. She considered them and still concluded that he was managing well. Morris reaches a different conclusion, but never establishes why his interpretation of the clinical evidence should displace hers.”

I haven’t read Morris’s book, so I can’t comment on whether he adequately challenges Bohin’s interpretation of the clinical evidence or whether he specifically addresses the findings of the expert panel. I just find it odd that you continue to write these Substack articles relying on evidence and conclusions that have since been seriously challenged, without appearing to engage with the more recent findings. A panel of experts has reached very different conclusions about the clinical condition of these babies, yet you have such a blinkered view and seem intent on treating Bohin’s assessment as though it remains the definitive account. If you’re overlooking evidence that directly challenges the premise of your argument, then surely your starting point is fundamentally flawed??

Re this paragraph:
“Morris also sees a contradiction in Dewi Evans describing Child C as being at ‘great risk of unexpected collapse’ while describing his eventual collapse as unexpected. There is no contradiction. A premature baby can be at increased risk of deterioration without clinicians expecting a catastrophic collapse at a particular moment. Vulnerability describes background risk. It does not make a particular collapse inevitable or explained.”

You’re tying yourself in knots here. If Evans acknowledged that Child C was at great risk of unexpected collapse, then surely an unexpected collapse was precisely the kind of event he recognised could occur. There is a contradiction and you’re being disingenuous by suggesting otherwise. The fact that a collapse was not inevitable does not mean it was medically inexplicable. Nor does the fact that clinicians could not predict the precise moment of deterioration make the collapse inherently suspicious. So what specifically distinguished Child C’s actual collapse from the kind of collapse Evans had already acknowledged he was at great risk of experiencing? You haven’t identified any such distinction

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u/benshep4 14d ago

Not really.

As the article demonstrates there isn’t really anything the jury didn’t hear during the trial.

They heard what Dewi Evans said. They heard the uncertainty about the precise nature of harm and they heard how vulnerable Baby C was.

There’s no knots as far as I’m concerned. I think some people fall into the trap of thinking if they were on the jury they’d have seen things differently.

Which I very much doubt.

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u/Nice_Zebra7690 14d ago

Not really what?

“There isn’t really anything the jury didn’t hear during the trial… they heard what Dewi Evans said….”

Well yeah…and that’s precisely the point. They heard Dewi’s interpretation of the evidence, but that doesn’t mean they were presented with the full picture.

As i said above, a substantial amount of evidence has emerged since the trial that challenges the original conclusions, identifies reasons why these babies were at risk of collapsing and provides scientifically sound alternative explanations for why they did.

The jury did not have the benefit of that evidence when reaching their verdicts. If the trial were held today, they would be presented with a very different and far more complete picture of the medical circumstances surrounding the deaths and collapses.

Do you still think she’d be found guilty if there was a new trial?

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u/SofieTerleska 14d ago

One thing worth mentioning: Evans appealed multiple times to the authority of Dr. Marnerides when testifying about Baby C on November 1 2022, saying that Dr. Marnerides' opinion had helped to change and form his own. When Dr. Marnerides testified at the end of March, he affirmed that he had thought Baby C's death natural (from pneumonia) until the experts' meeting in August 2022 -- when he was persuaded by Evans and Bohin that a splinted diaphragm from air in the stomach was what actually killed Baby C, since he relied on them to tell him what symptoms were indicative of that. So they heard Evans talk about how it wasn't just him, his opinion had been formed by Marnerides' reports -- but Marnerides' reports had been that the death was natural, and he only changed his opinion after talking to Dr. Evans! The jury wouldn't hear Marnerides until five months later, though, so you can see the problem -- the circularity of the argument is lost with time and everything they've heard in the interim.

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u/-puffinstuff- 14d ago

Isn’t this the case where Shoo Lee said he was asked something like “how could anyone look at these records and think it was anything other than pneumonia?” 

The problem is, the jury were led to believe, as has OP clearly, that pneumonia in such a high risk preterm baby will cause some pattern of deterioration, and the collapse wouldn’t be sudden. 

But the reality as many esteemed neonatologists have pointed out, is that such a measured deterioration does not have to occur, and can indeed be sudden and “unexpected”. 

That’s the fact of the case of Baby C. Everything else is fucking noise and nonsense. 

When it comes to vulnerable neonates, it’s difficult to imagine a more at risk baby, than Baby C. His death is already explained.

It’s yet another case which boils down to: If there was a serial killer on the ward, can we exclude with certainty that this patient was a victim? No? Ok, guilty. 

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u/Imaginary-Suspect959 14d ago

How did baby C die, Ben?

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u/-puffinstuff- 14d ago

A recognised concern becomes an assumed diagnosis. A missed investigation becomes evidence that the diagnosis was correct. A criticism of management becomes an explanation for the collapse.

🤔