Dr Svilena Dimitrova

Lucy Letby is not innocent because her friends say she’s incapable of murder - she is innocent because the evidence shows she did not do anything wrong. There is ZERO evidence that the babies were harmed deliberately. Their deteriorations and failed resuscitations were entirely explainable by pre-existing conditions and shockingly poor standards of care. The prosecution’s case rested on the opinions of a single man with no relevant or recent neonatal experience - a self-promoting “expert” witness who claimed to have “only ever lost one case” and advanced bizarre implausible theories which brought him a generous income. Crucial evidence of systemic failings and negligent care was ignored. Several clinicians involved have since been referred to the GMC, the police, and the coroner’s court for actions or failures that may constitute gross negligence manslaughter, contempt of court, and perjury. This is NEW evidence. While experts may disagree on the specific causes of each deterioration or failed resuscitation, the public fail to understand how this is completely normal in complex medical cases (hence the concept of multiple differential diagnoses 🙄🙄) - there is clear unanimous agreement on two core aspects of the case - the standard of care these babies received was appalling. And no murders occurred. The now-infamous “post-it note” evidence was misinterpreted and used manipulatively - a deeply flawed tactic that has been heavily precedented in other “caregiver” miscarriages of justice. The “statistics” presented to the jury were laughably biased. The data was cherry picked to suit a narrative by doctors who could well have been struck off for incompetence or arrested for gross negligence manslaughter. Police refused to investigate any cause of death other than murder. Parents were misled and gaslit into believing their babies were deliberately harmed - long before the case even went to court. Judge Goss allowed this miscarriage to unfold despite warnings. He allowed the doctors who were witnesses of fact to be treated as experts and thus to mark their own substandard work as excellent in front of a jury of lay people. Media coverage was biased, sensationalist and instrumental in stoking a public witch hunt. Whistleblowers stayed silent for fear of being scapegoated. Others were actively ignored by Cheshire police and LJ Thirlwall. The legal profession oversaw a trial with no defence witnesses that was so one-sided it defied basic principles of logic, never mind justice. This case is a national disgrace. It should shame the British legal system and the NHS and turn both into a global laughingstock.

So glad this is finally public so I can comment on it openly. I have seen a fair number of HR investigations over the years. In my experience, whistleblowers are often formally investigated before they are pushed out, or as a way of “teaching a lesson” to anyone who challenges the status quo. This is actually one of the most competent internal investigation reports I have seen. What surprised me most was the outcome. Usually, management plays an active role in managing out people who raise concerns - such as Lucy, who was clearly DATIXing poor standards and practices within the neonatal unit. Dr Brearey and Dr Jayaram were in management positions at the time and therefore carried responsibility for patient safety and culture within the department. So that would have been a pretty major motivator to want her out if she was shining the spotlight on their managerial/leadership failures. Lucy Letby was never going to be safe returning to a workplace where she was clearly being bullied by a group of colleagues (most of whom were consultants and thus in a position of power over her) unless individual accountability followed. At the very least, that should have meant formal warnings, apologies to Lucy, and mediated discussions. Management could have supported her with a temporary redeployment to another clinical unit so she could continue practising while matters were resolved. Clinical work was clearly what Lucy wanted to continue doing. Some people in these situations , where redeployment is necessary during HR investigations, choose to remain in management or leadership roles instead, but that wasn't what Lucy wanted. So in essence the hospital made a strong start with doing a competent HR investigation - but by failing to follow through properly, the situation escalated to the point where consultants went to the police. What nobody seems willing to ask is this: if the consultants genuinely believed Lucy was murdering babies, why did they only go to the police after they were found to have bullied her? If you truly believed a nurse was a serial killer, is it reasonable to accept that a consultant would really think that internal Trust procedures were an appropriate way to deal with it? UK trained consultants are NOT politically naïve. Consultant appointments are highly political positions, and consultants understand very well how NHS systems actually work. It stretches credibility, and that's a generous description, to claim the consultants genuinely believed reporting concerns over a serial killer internally was what they thought was the right thing to do. If they truly thought Letby was such a prolific killer, were they not concerned she might harm children outside work as well? This entire case is a national disgrace, and I suspect it will remain in history as one of the most consequential modern witch hunts in British healthcare. Witch hunts within the NHS are unfortunately, however, very common - often carried out through internal employment procedures or GMC processes. But turning that common dynamic (whose root cause is toxic leadership practices) into the conviction of a serial killer is something else entirely. An extraordinary outcome, enabled by a broken medical "expert" system and sealed by an inadequate police investigation and criminal justice system. What a world we live in. I hope everyone involved in this MoJ - or anyone who knew what was happening and could have helped but chose not to - gets what they deserve. @LucyLetbyTrials @drphilhammond @PrivateEyeNews @NadineDorries @ClarkeMicah @peter__duffy @MartynPitman @willcpowell @DavidDavisMP @DavidRoseUK @PeterElston1 @Michelehal7344 @Voice4theDead @reasonoverfear @Oversig58651516 @Seagreen2707 @RexvsLucyLetby

@DebbieKennett @JusticeGap Thank you! I didn’t know this. ❤️

@NeoDoc11 Your brilliant article was made freely available on the @JusticeGap's website. I can, however, highly recommend purchasing Proof magazine to read all the other excellent articles. thejusticegap.com/how-to-become-…

Sarcasm is really just despair with standards. A coping mechanism for people who have looked at the state of things and decided that if they can’t fix the absurdity, they can at least phrase it properly. 🙂 Which is why working with Richard Gill has been such a pleasure. We disagree on plenty - often enthusiastically - but that’s never got in the way of a genuinely brilliant collaboration. Richard is sharp, intellectually fearless, and has been a truly exceptional partner in sarcastic crimes. @JusticeGap will hopefully be happy to share our article without a paywall after some time has passed like @PrivateEyeNews does. @drphilhammond @JusticeGap @PeterElston1 @LucyLetbyTrials @cheshirepolice @ClarkeMicah @Michelehal7344 @DavidDavisMP @parthaskar @MartynPitman @Voice4theDead @gill1109 @NadineDorries @Oversig58651516 @DavidDavisMP @DavidRoseUK

I’m not sure it’s fair to say this is due to doctor shortages, although that was certainly how it began. The gradual substitution of doctors with ANPs has been happening for around 20 years. In some places, entire tiers of staffing - SHO/middle-grade have been replaced with ANP-led models. In some countries, the decisions they make within these roles would be considered practising medicine without a licence. For more than a decade now, I have been concerned about the repercussions for ANPs who are placed in these positions when something goes wrong. The governance issues - namely - where responsibility sits, who is accountable to whom and how when things go wrong - have not been thought through at all. I suspect those conversations will only happen once serious cases of issues around accountability for decision making get reported on in the media. As things stand, there are services providing care for children and babies without a doctor on site for significant periods of time. This has been happening in some neonatal and PICU settings for quite some time. None of this is new, to be honest. I should add that I think ANPs have a valuable and important role. My concern is not with ANPs themselves, but with the way their role is currently being used (and arguably abused). @drphilhammond @parthaskar

🚨 Almost HALF of all NHS Trusts are using non-doctors to fill doctor rotas due to “shortage of doctors” FYI - 40,000 doctors applied for only 10,000 available training posts last year Doctors are unemployed Doctor substitution is real And it’s DELIBERATE

Not just the police do this. I’ve heard examples from every government institution. It depends on the people in charge rather than the system. So it would be useful to have conversations about individual accountability rather than endless conversations about system change. I hope Andrew Malkinson manages to somehow recover enough to have a peaceful life from now on. What they’ve done to him, which no doubt started off with incompetence, but definitely ended up being malicious and purposeful, is beyond disgusting.

If there was one article you want to read as a clinician? Read this Via @jenna_taglienti - an absolutely stunning write in @JAMA_current "Medicine can have extraordinary meaning. But it cannot substitute for being present in your own life. The world may need us as physicians. But the people who love us need us as ourselves. And that is the role no one else can fill." Brilliant - and much love to you 'Time is Finite" jamanetwork.com/journals/jama/…

Robbie’s story will always stay with me. I say this as a doctor who has reviewed Robbie’s medical records and documentation around what followed. Thank you for trusting me with sharing these @willcpowell and for telling me about your beautiful boy Robbie. Robbie’s death was inarguably avoidable. There were multiple opportunities to recognise deterioration, provide adequate follow-up, and multiple opportunities to take the (relatively simple) actions needed to diagnose and treat Robbie from a very easily treatable illness (albeit rare in children), of which he had every sign. Those opportunities were all missed. Poor care can and does happen, sometimes with devastating consequences. Human error is an unavoidable reality in medicine, and every doctor will make mistakes during the course of their career. In this case, several doctors made mistakes. What was far more disturbing than easily avoidable mistakes being made, however, was what followed. Instead of acknowledging these mistakes, apologising, and learning from them, several of the individuals involved lied, falsified notes, gaslit Robbie’s parents and even went on to harass them (admittedly I found this bit the hardest to get my head around!). Furthermore, the institutions that should have helped provide accountability - such as the local health regulators, the GMC, the police, and the justice system - not only didn’t help but played significant roles in the continuation of gaslighting by prolonging that harm and hiding behind procedures and tick boxes. Reading through Robbie’s case has been heartbreaking. I will never forget his story, and I will talk about it in all my future medicolegal and patient safety teaching. I feel truly honoured to have met Robbie’s dad, who is a remarkable human being. Robbie was so lucky to have a dad like you. The fact that it had to be formally established that doctors owe patients the truth still stops me in my tracks. I would have assumed honesty with patients and families was self-evident. What a world we live in.

In the interest of fairness, we should be careful before accusing anyone of lying - that does, after all, require intent. What we may be witnessing instead is a far more familiar phenomenon - information entering perfectly sensibly at one end and emerging, after a short institutional journey, as something that bears only a passing resemblance to reality. Not deception so much as interpretive storytelling - certain institutions appear to have refined this to a high art, aided and abetted by the good old “divide and rule” technique of DARVO. There are, of course, alternative explanations - differential diagnoses one may say - such as memory lapses, or difficulties with comprehension. Positions of authority are not, historically, a guaranteed safeguard against either. And, given that the quotation appears to have passed through Liz Hull - whose relationship with the truth may at best be described as flexible - there is every possibility the original correspondence has undergone a transformation. Will the NCA @NCA_UK be correcting the record where statements made by a representative of @cheshirepolice about their input into the Letby case are demonstrably inaccurate? @DavidDavisMP @PrivateEyeNews @drphilhammond @LucyLetbyTrials @PeterElston1

Interesting how the Cheshire Chief Con wrote his ranty and unsubstantiated letter where he had copied in the Cheshire MPs, just one day after the Police & Crime Commissioner received a letter of complaint about Roberts - authored by me - where I had first copied in all the Cheshire MPs. Unlike CC Roberts however, I haven’t gone running to a journalist with my letter. Instead I am respectfully waiting for a formal response from the PCC before I decide whether or not to make my 10-page letter public - which would only be for public interest purposes of course. This is a police force that is in serious trouble, with a Major Investigation Team that cannot tell the difference between a real serial killer and a fictitious one, and a Chief Constable that is bringing his own police force into disrepute by prioritising his reputation over doing the right thing. #CheshirePolice #LucyLetby #SilverKiller mol.im/a/15724565

What we see here is the inevitable result of a system that has been hijacked by individuals lacking both integrity and wisdom, diverting it from its original purpose. What was meant to uphold truth and justice now serves narrow interests and self-preservation. Those who expose its flaws and demand evidence-based accountability are punished, while incompetence is not only protected but often rewarded in the name of the “greater good.” This is not a failure of the system - it is the consequence of it being deliberately steered away from what it was meant to be. Those in charge across every level bear responsibility, with the buck ultimately stopping at our often (but not always) morally compromised judiciary. @MartynPitman @drcmday @drphilhammond

Why Lucy Letby is extremely unlikely to be granted an appeal, no matter how many experts review all the notes and trial records, and find no evidence of deliberate harm. If you couldn’t find the right defence experts first time around, it’s just bad luck. observer.co.uk/opinion-and-id…

Reframing serious, evidence-based concerns raised by genuine whistleblowers as “interpersonal conflict,” followed by the suggestion that the issue lies with the individual raising them - without directly addressing the substance of those concerns - is a common tactic in incompetent and dysfunctional institutions. Anyone who has genuinely blown the whistle and experienced negative consequences as a result can attest to this pattern. @MartynPitman @drcmday @Michelehal7344 @PrivateEyeNews @drphilhammond @guardiannews @hannahsbee @Channel4News @itvnews @LucyLetbyTrials @DavidDavisMP @MichelleWelshMP @cheshirepolice @policeconduct @ShabanaMahmood

I just watched it too. It’s worth re-reading the Chief Constable’s attack on Stephanie, after viewing. What he said, unintentionally, was: …“these cases were beyond weird, and the presentations by the Sunday Times and Mr Collins and ITV all indicate that when baffled, Cheshire Police moves rapidly to the most politically acceptable diagnoses, and then we hide behind the families till you all go away. And let’s blame the author of the explosive report, rather than think too hard about why it was explosive. Thank you for your attention in this matter. “

No surprises from @cheshirepolice. Their statement is beyond embarrassing - a textbook example of DARVO. Will anyone seriously investigate their conduct? @policeconduct Any competent investigator should welcome scrutiny, especially when concerns are raised by credible, qualified individuals about a potential miscarriage of justice. Instead, we see the familiar pattern - deny wrongdoing (whilst ignoring the evidence), reverse the dynamic, and attempt to discredit the person raising concerns. “Nothing to see here” is not a response by a competent police force. It’s shameful that this is being ignored. @DavidDavisMP @drphilhammond @PrivateEyeNews

You’re brilliant! 🙏❤️ By the way, words without action are always meaningless from people you don’t personally know and trust. In fact, people who demand trust without offering proof are a red flag - it should make you more cautious, not more trusting. Those who genuinely want to build confidence say, “Please give me the chance to show you I can do a good job and you can then hold me accountable in this and this way if I don’t,” rather than, “Just trust me.” We need to talk more about red and green flag behaviours. Individuals who consistently display abusive behaviours are often easier to identify through observation than most people realise.

🚨 UPDATE: Shaun Edwards, the CCRC's current Head of Investigations, *was* involved in the handling of Lucy Letby's appeal application up until now. A spokesperson told me he "will play no further part in it."

This has officially crossed into parody and I feel that X may well be ready to witness my other unpaid job of a wanna-be comedian - following the footsteps of the brilliant @drphilhammond So…. What have we got here from the CCRC then. “We are, of course, impeccably impartial - so impartial, in fact, that even we are occasionally surprised by our own decisions. Any missed conflicts of interest are simply charming oversights, not evidence of, well… anything awkward. As for cases dragging on for years despite obvious evidence of innocence - they are purely a testament to our commitment to thoroughness, you see… If any of our paid employees engage in activities that appear to be supporting the notion that allegations should magically be transformed into convictions without the inconvenience of examining any evidence, that’s merely an optical illusion. Rest assured, everything is functioning exactly as intended. In summary - please trust us. We’ve reviewed ourselves and are delighted to confirm we’re doing an outstanding job. So outstanding, in fact, that an excellence award surely can’t be far off. Naturally, we shall accept it with due humility, then responsibly allocate a modest budget to commemorate the occasion with a few well-deserved trinkets - funded, of course, by the taxpayer, just as @cheshirepolice did with Op Hummingbird. After all, excellence like the one displayed by us shouldn’t go unrewarded.” 🤡🤡🤡 @ccrcupdate - on a serious note - how are you not embarrassed to not even issue an apology for failing to notice this obvious conflict of interest until it was exposed by a member of the public? Is there any institution even capable of admitting they have done something wrong and owning it in this country? I shall hold my breath with hope.

Honestly, the most impressive part of all this is the sheer confidence it takes for one man to apparently speak on behalf of all his colleagues. Bold. Visionary. Telepathic? I would love a peek at the evidence behind the scenes - was there a what’s app group chat? A survey? A unanimous show of hands? Or did everyone just wake up one morning to discover they’re collectively in awe of Paul Hughes and this was telepathically transmitted to the poster? After all, why bother questioning anything when someone has already done the thinking for everyone? Saves time. Saves effort. Saves us from the inconvenience of independent thought. But hey - at least the conflicts of interest, incompetence and lack of accountability are consistent patterns. And within consistency lies comfort. And who doesn’t like being comfortable? Just look away, nothing to see here. 🤡🤡