Contemporaneous medical notes — what the real-time record actually says
Prosecution claim
The Crown relied on Dr Evans's retrospective interpretation of the clinical records as evidence that deliberate harm had occurred. The reasoning moved backward from collapse to alleged deliberate act, with the contemporaneous clinical notes then read through that interpretive frame.
Counter-evidence
The contemporaneous clinical notes — written in real time by the clinicians on duty during and immediately after each event — do not themselves contain findings of deliberate harm. They record: clinical signs observed, interventions performed, the patient's response, and the clinical team's impressions at the time. Where they do identify a cause of deterioration, they generally identify a natural cause: sepsis, respiratory distress, feed intolerance, NEC, prematurity-related instability. The deliberate-harm reading is a retrospective overlay applied years later by an expert working forensic-from-hypothesis. A blinded re-reading of the contemporaneous notes by the Shoo Lee Panel reaches the opposite conclusion from Dr Evans's retrospective overlay.
The contemporaneous notes record what the treating team was actually thinking at the time. They are written by people whose professional duty is to identify and treat whatever is wrong. They do not, in their own words, record deliberate harm.
What the jury heard
Contemporaneous notes were adduced in evidence but were framed through Dr Evans's retrospective interpretation. The jury was not systematically walked through a blinded reading of what the notes say in their own terms.
What the Panel says
A blinded case-by-case review of the clinical record, as conducted by the Panel, produces different conclusions from the Crown's retrospective reading. The Panel identifies natural causes sufficient to explain each deterioration.
What independent experts add
- Contemporaneous clinical notes are, in medico-legal terms, the most reliable record of what was observed at the time.
- Real-time notes are written by clinicians whose professional duty is to identify and treat what is wrong.
- A treating clinician who noticed deliberate harm would be professionally required to document and escalate it.
- The Letby contemporaneous notes generally do not contain such documentation or escalation.
- The prosecution's case depended on re-reading notes that did not say deliberate harm as evidence that deliberate harm had occurred.
- A blinded differential-diagnosis review of the same notes produces the natural-cause conclusions the Panel reaches.