UK - Lucy Letby Trial - Media, Maps & Timeline *NO DISCUSSION*

[Tortoise]

Thursday October 20th 2022 - Live updates from the trial

Day 5 of Evidence - Cross-Examination of Dr David Harkness - Re: Child A

2:35pm

Dr Harkness is now being asked questions by the defence.
Mr Myers says what happened was "a tragic event".
He said "You have given us a description of skin evidence which was unusual."
Dr Harkness agrees the skin patches of purple, blue, red and white were "very striking", but adds he was not forensically analysing the skin at the time.
Mr Myers refers to notes retrospectively written at 9.20pm-9.30pm and attributed to Dr Harkness, which does not refer to skin condition.
"You could have put anything you wanted in these notes?
"Nowhere do you make reference to skin colour."
Dr Harkness said the "significance" of the skin colour changes was noted later, following conversations and the non-fatal collapse of Child B.
The defence asks Dr Harkness if he had been "influenced" in his recollections, that had led him to form the impression of the skin pattern in Child A.
He said at the time it was an "emotional" time, as it was "one of the first" neonatal deaths he had seen in his experience, and he had fond it "greatly upsetting".
He added that at that time his documentation may not have been as detailed.
The defence say the skin patterns are also not referenced in Child A's inquest report from October 2016, but "pale and poor peripheral perfusion".
Dr Harkness admits it's "not clearly documented" but he would still have been in an emotional state.
Mr Myers asks that by the time of the police statement, his impression had been formed.
Dr Harkness says his statement of observations in the cases of Child E and F had jogged his memory for Child A's skin patterns.

2:39pm

Dr Harkness says "there was no evidence" for the long line to have moved in Child A.
"This has been proved on the post-mortem."
Mr Myers says would the long line have still been in there at the time of the post-mortem?
Dr Harkness: "No, and there was no damage [found] there [where the long line had been]."
Dr Harkness said the long line was removed at 8.27pm as a "theoretical" concern "based on no evidence at the time". He said the last new thing, as far as he could know, was the addition of the long line at the time of the collapse.
He adds: "The logical thing was to remove it."

2:41pm

Mr Myers: "There are dangers with a long line too close to the heart?"
Dr Harkness: "Yes...that was my concern at the time. There was no evidence at the time or subsequently that that long line did any damage."

2:45pm

Mr Myers refers to the x-ray review from 7.09pm, and the position of the long line at that point.
Dr Harkness noted it was "to be pulled back."
He explained the review took plce at 7.10pm - it would have been reviewed during the procedure I was doing."
He said his view the long line was to be pulled back was made 'with his experience and knowledge at the time'.
"It was not a danger then and it's not a danger now. With my experience and knowledge then, that was my assumption. The guidelines and subsequent experience say...it was fine. It's ideal."
Dr Harkness said he likely inserted the long line 'between 6pm and 7pm'.

2:48pm

Dr Harkness explains the x-ray dept takes 15-30 minutes to come to the department with a portable x-ray.
"You wouldn't expect to report these in 30 minutes. An hour would be more likely."
Mr Myers: "Surely if the long line was in the wrong position, you would want to know immediately?"
Dr Harkness says "In an ideal world" the x-ray would have been made available immediately, but "in reality" it was "impossible".
He agrees the x-ray result could have been available more quickly with extra staff and if he had not been treating another patient at the time.
The decision to administer the 10% dextrose was because it was "safe" for all over the body.

[My note: Redirect - Prosecution]

2:53pm

Dr Harkness said he was able to review the x-ray as soon as the image was made available from radiology, and fluids were able to be administered at that point, as he wanted to check for the x-ray first.
He says there would be "reluctance" from nurses to administer fluids without having seen an x-ray first.
He says, from his experience, medical staff are "much more keen" to administer the fluids, while nurses would want to see the x-ray result first.
Dr Harkness says the long line was in the right position, and the use of it was appropriate.
The prosecution ask one more qeustion about the "striking discolouration".
Dr Harkness: "Categorically, yes, there was discolouration."
That concludes Dr Harkness giving evidence for Child A.

LIVE: Lucy Letby trial, Thursday, October 20

 

[Tortoise]

Thursday October 20th 2022 - Live updates from the trial

Day 5 of Evidence - Agreed Evidence - Witness Statements - Re: Child A

3:07pm

More 'agreed evidence' - evidence which is agreed by both the prosecution and defence - is being read out, via a statement.
The next statement is from a junior doctor, Dr Christopher Wood, who assisted Dr Harkness in the long line procedure by preparing sterile equipment.

3:12pm

He said he did not remember hearing a 'crash bleep' at the time of Child A's collapse, but he was very close by at the time.
Swipe data suggests Dr Wood had previously entered the neonatal unit at 7.40pm.

3:16pm

He said that he was "the least experienced person there", so "took a step back" and began scribing.
All the times on the record had come from a fob watch Dr Wood had, and said scribing was "an important role".
He documented what fluids were administered, as said by Dr Harkness, and which staff members were present, and the events which followed.

3:21pm

He added he left the room at the conclusion of the resuscitation attempts to give the family of Child A some space and privacy.
He added it was "only natural" doctors would look back and wonder if they could have done anything differently.
He added: "The death came as a shock," saying there had been no concerns "flagged" at the start of the shift for Child A.

3:35pm

Countess of Chester Hospital neonatal nurse assistant Lisa Walker said, in her agreed evidence statement, she was not working in the neonatal room 1, but knew it was "very busy" that night.
She said she could "recall the sadness in the atmosphere in the unit" that night.
She added she could recall an increase in the number of neonatal unit deaths at the time, and prior to that, in her 10 years, "there was only news of a couple of deaths".
She added: "I remember thinking, 'what on earth is happening?'" in relation to the increased number of neonatal unit deaths.
The witness concludes, in her statement, that she had a lot of interaction with Child B as she recovered in the weeks following her non-fatal collapse and subsequent relocation to nursery room 4, and was in contact with the mother.

3:42pm

Further 'agreed evidence' statements are being read out by the prosecution, made by Countess of Chester Hospital staff.

3:53pm

Joanne Williams explains she was the designated neonatal unit nurse for Child B, who was in room 1.
The shift on June 9 was not "unusually busy", but they were "always busy".
The screens were put up for the family following the loss of Child A the previous night.
She assisted the mum with skin-to-skin contact, and taking "lots of photos". Child B became tired so was placed back in the incubator.
Throughout the shift, Child B was "stable" and "nothing significant happened". She was "breathing for herself".
Ms Williams said she tried to keep the atmosphere "calm and relaxed" for the family.
"Although I had no dealing with [Child A], [the death] had come as a shock."
She adds: "Throughout the shift, [Child B] was progressing well," with a slight rise in her breathing rate, which she put down to Child B being tied after being taken out of the incubator.
Child B was "doing relatively well". Although she said nurses "can never become complacent", there were "no obvious signs that caused any concern" when she went off the shift that night.
When she arrived for her next shift, the reventilation of Child B "came as a bit of a shock".
She added that babies "can deteriorate quickly".

3:55pm

That concludes the evidence for today.
The trial will resume tomorrow (Friday, October 21). We will continue to bring updates throughout the day.

 

[Tortoise]

Friday October 21st 2022 - Live updates from the trial

Day 6 of Prosecution Case - Evidence of Prof. Owen Arthurs, Consultant Paediatric Radiologist GOSH - Re: Child A & Child B

10:07am

The trial is due to resume at 10.30am, with the prosecution calling further witnesses to give evidence in the cases of Child A and B.

10:35am

There has been a short delay in starting, but the trial is expected to resume imminently.

10:42am

A legal discussion has resulted in a delay to the start of today's hearing. The trial is now expected to start at 11.15am.

11:34am

The trial is now resuming, with the next witness, Prof Owen Arthurs, consultant paediatric radiologist at Great Ormond Street Hospital, giving evidence.

11:34am

The court hears he has reviewed "many of the children in this case", and will be asked questions about Child A and Child B.

11:43am

Prof Arthurs is asked about a post-mortem x-ray for Child A.
He comments "unusual findings" in gas and air found in the baby boy, including "a line of gas just in front of the spine".

11:44am

He said such a finding is not found in cases of 'natural causes' death in babies.

11:47am

Trapped air such as this, Prof Arthurs explains, could be found in cases such as road traffic accidents, or infection such as sepsis - overwhelming infection in the organs of the body, or "very occasionally" outside of hospital in 'sudden unexpected death in infants'.

11:52am

Prosecution: Have you seen this much gas in a baby before?
Prof Arthurs: "Only in one other case, which I think we'll explain later on [another of the children in the Letby case]."
Prosecution: "What was your final opinion?"
Prof Arthurs: "This was an unusual appearance. In the absence of any other explanation...this is consistent with...air being administered."


[My note : Cross-Examination]


11:57am

Ben Myers KC is now questioning Dr Arthurs.
He asks questions about 'air in the body' and analysis of them.
Mr Myers: "Radiographic evidence of air embolus is rare, isn't it?"
Prof Arthurs: "Yes."
"On post-mortem imaging, the presence of air may also be the result of medical procedures or placement?"
"Yes."

12:00pm

Mr Myers asks if the presence of a UVC or long line for some time could lead to air in the system. Dr Arthurs agrees.
Prof Arthurs says the "assumption that an image is needed to prove an air embolus is wrong".

12:05pm

Prof Arthurs says his review of the cases involved him, to give a conclusion of 'unusual', having to look through a number of past cases.
Mr Myers says that translated to similar findings in 25% of the total number of past cases he had gone through.

12:14pm

Mr Myers says Prof Arthurs looked at 500 cases at Great Ormond Street Hospital, which after narrowing down the criteria, amounted to 38 babies aged under two months, and of those, eight had gases in the greater vessels.
Prof Arthurs said there were "no unexplained cases" of gases in that location. The causes found included trauma, a road traffic accident, sudden unexpected death in infants or congential heart disease.
Mr Myers said that does not include many cases of babies in similar circumstances of death of babies aged under four days old.
He says there are "many variables" in such a study.

12:17pm

Prof Arthurs says air can be 'distributed' in the system during CPR.

12:20pm

For Child A, Mr Myers says "one possibility" of the air seen on the image is air administration.
He says others can be through resuscitation or post-mortem changes.
Prof Arthurs: "Yes."

12:28pm

For Child B, the radiograph image shown from June 10, about 40 minutes after the time of the non-fatal collapse.
Mr Myers: "On that image, there are no features which support an air embolus diagnosis?"
Prof Arthurs: "Yes."

[My note: Prosecution Re-direct]

He clarifies from a question by the prosecution that it could not be concluded either way.
Prof Arthurs says his observational study was from "a large body of evidence".


[My note: Question from the judge]

The judge, Mr Justice Goss, asks about the study as the jury has not seen it.
Prof Arthurs said the study was carried out for children (up to 18 years old) in 2015 and looked at 35 cases, with 10 having some gas in the larger vessels. The study was published, peer-reviewed and available in literature.
He tells the court "probably none" were of premature babies.
The study was performed independently of the trial, the court hears, and was prior to Prof Arthurs' own review, for babies, carried out later at Great Ormond Street Hospital, involving hundreds of cases.


12:32pm

The court is now adjourning for an early lunch break.

Recap: Lucy Letby trial, Friday, October 21

 

[Tortoise]

Friday October 21st 2022 - Live updates from the trial

Day 6 of Prosecution Case - Evidence of Senior Neonatal Practitioner Caroline Bennion - Re: Child A & Child B


1:43pm

The trial is now resuming.

1:47pm

The next witness to give evidence is senior neonatal practitioner Caroline Bennion, who was present for the delivery of Child A and Child B in June 2015.

1:49pm

She recalls that Child B required assistance at birth, and that support was given for her. She explains more support was required for her than Child A.

1:53pm

Child B "recovered well" and, after review, she was tried off the ventilator as she was "vigorous" and was breathing by herself.

2:04pm

She is now being asked about "the significant event" for Child A on the evening of June 8. Child A suffered a collapse and died during that evening.
She says she was in the room when that collapse happened. She knew that she had taken the handover - a "comprehensive update" from the day-time shift staff - from 7.30pm, and carried out equipment checks.

2:07pm

She said, from reading her statement, she was "next to [Child B]" and "still doing" her checks and completing observations and safety checks at the time.
She said she "wouldn't have left" Child B.
She said she remembered Lucy Letby asking for help on Child A.
"When it became more obvious she needed assistance and [Child B] was safe, I went over to help."
She said she did not have a recollection whether the alarm went off.

2:08pm

She said it was a "busy evening" with babies having long lines put in, and the nursery was "quite full" with the cross-over of day and night staff.
She also said Dr Harkness was in at the time.

2:09pm

She recalled she helped Lucy Letby give some ventilation breaths via the Neopuff device.

2:10pm

She said there was no crash call put out as the doctors were already in attendance.

2:12pm

The nurse recalls drawing up the emergency drugs required during Child A's emergency treatment.
Child A passed away following a series of resuscitation attempts.
The nurse said she then returned to treatment of Child B.

2:17pm

The court is shown the nurse continued to take hourly observations for Child B.
She confirms "nothing unusual" was noted during the rest of that night shift for her.


[My note: Cross-Examination]


2:21pm

Questioned by the defence's Ben Myers KC, the nurse says she had many years of experience in neonatal care.
She is asked about if there were challenges in staffing levels.
The nurse replies: "We were always very fortunate to have a lot of senior staff."
"There were occasions where we had busier periods, but that is the nature of a neonatal unit."

2:24pm

The nurse agrees the babies were "vulnerable" and "could deteriorate very rapidly".
She agrees 'it was known' a deterioration could happen when a baby was almost ready to go home.

2:28pm

Ms Bennion is asked about medication that is given to babies who would 'otherwise be at risk of infection'.
For Child A, she is asked about such a prescription, and a 'clinical indication' is for 'suspected sepsis' on June 7 at 10pm.
The administration of the dose is dated at June 7, 10.46pm.

2:38pm

Ms Bennion is being asked about blood gas records for Child A. The blood gas machine was "on the unit" in the next room, taking about 3-4 minutes, providing an automatic read-out to be attached to the chart.

2:47pm

Ms Bennion is shown a copy of the neonatal record chart, about how some of the tasks and times are shown taking place on the hour, when they might be around that time.
My Myers says that as some tasks take some time, it could give the impression a member of staff was 'in two places at once'. The nurse agrees.

2:52pm

Ms Bennion is now being asked about Child A's collapse, and that Lucy Letby had called for assistance.
She said: "We have an emergency buzzer which could be pulled, but there were so many staff that a nurse can call for assistance.
Mr Myers: "That would be appropriate?"
"Yes."

2:54pm

Ms Bennion is asked if there was any 'formal support' for nurses, particularly for dealing with incidents such as when an infant died.
She said there was no formal support, but said of the nursing team: "We were very supportive of each other."

2:56pm

She said there was "no formal procedure or form for everyone to fill in."
She added: "Under the direction of the medical staff, a debrief would always be offered. We have a supportive management team and...in the network of our close unit [if a nurse did not want to return to room 1 for the following shift following a traumatic event the previous shift], that can be provided."
"Even after a tragic event, you have to remain professional in the care you give."


[My note: Prosecution re-direct]


3:00pm

Ms Bennion adds, from a follow-up quesion from the prosecution, that simultaneous observation of two babies would not happen, even if the documentation would appear as simultaneous on the records.
She is asked about the "speed of the deterioration" of Child A. Ms Bennion said it was "very rapid, very sudden".
"It's like a jigsaw, you're putting in observations, but there was nothing to say [Child A was going to collapse].
"However it has happened, and it can happen."

Recap: Lucy Letby trial, Friday, October 21

 

[Tortoise]

Friday October 21st 2022 - Live updates from the trial

Day 6 of Prosecution Case - Evidence of Neonatal Nurse/Night-Shift Leader on June 8th 2015 - Re: Child A

3:17pm

The next witness is someone who was also working at the Countess of Chester Hospital, as a neonatal nurse in June 2015.
She describes, on staffing levels: "There were definitely periods when we were short-staffed, periods when we were ok."
For shifts when they were 'short on numbers', they would look to bring staff and swap on the rota, or if anyone could do an extra shift.
Agency or bank nurses were a possibility, but didn't happen very often.

3:28pm

The nurse was the shift leader at the neonatal unit on the night-shift for June 8. Lucy Letby was one of the designated nurses.

3:35pm

The nurse remembers walking by the neonatal unit room 1 and seeing Dr Harkness in there at the incubator for Child A.
Swipe data showed her coming into the neonatal unit at 8.20pm.
She said: "I was like, something has happened.
"With my experience, I was thinking he was having a sort of 'episode' that babies can have."
She believed it was down to one of a number of medical conditions.
She recalls seeing who else was in the room.

3:37pm

She recalls the Neopuff device was being used to give Child A breaths, as he had "stopped breathing".
She recalled being told it had happened "suddenly".

3:40pm

She recalled being involved in the resuscitation attempts, and was physically holding Child A at the time.

3:43pm

She recalled she had "never seen a baby look that way before", with a skin discolouration on a pattern she had "never seen before".
Asked to describe the discolouration, she said he was "white with purple blotches", with a bit of "blue", and it had "come on very suddenly".
"Just very unusual, it was," she added.

3:54pm

The nurse will continue to give evidence next Monday.
The court is now adjourning for today.
We will continue to provide live updates next week.

Recap: Lucy Letby trial, Friday, October 21

 

[Tortoise]

"The shift leader at the Countess of Chester Hospital, who cannot be named for legal reasons, was carrying out CPR on Baby A after he suddenly deteriorated in the neonatal unit.

In order to give the infant CPR, she was reaching in through a flap at the back of his incubator. Her hands were around the tiny infant's chest, her thumbs near his sternum.

All the time she was holding him, nurses and doctors were crowded around the incubator in the final attempts to revive him.

[...]

'I've never seen a baby look that way before,' she told Simon Driver, prosecuting. 'He looked very ill. He had a discolouration pattern I've never seen before.

'He was white with sort of purply blotches. He looked cyanotic. It was these purple blotches with white that I'd not seen before, all over his body'.

[...]

Dr Owen Arthurs, professor of radiology at Great Ormond Street Hospital, guided the jury through an image displayed on a screen at Manchester Crown Court.

He showed them pockets of gas in the infant's stomach and heart. Both were normal.

But the doctor then pointed out a third accumulation of gas – in a line just in front of the spine, running from the stomach to just beyond the heart.

'That is an unusual find,' said Dr Arthurs.

His conclusion after carrying out a review of cases of infant mortality was that the line of gas was consistent with 'air being administered' to Baby A."

[...]

More at link

Lucy Letby trial: Emotional nurse felt final heartbeat of newborn twin 'murdered', court hears

 

[Tortoise]

"A line of gas in front of the spine was an "unusual finding" on the post-mortem X-ray of a baby allegedly murdered by nurse Lucy Letby, her trial has heard.

Paediatric radiologist Dr Owen Arthurs said its appearance was "consistent with, but not diagnostic, of air having been administered".

[...]

Dr Arthurs said he could not say from the image alone that an air embolism, a gas bubble which enters a blood vessel, was the cause of Child A's death."

[...]

Lucy Letby trial: Unusual finding in baby's X-ray, court hears

A doctor tells a court of his findings after examining a baby allegedly murdered by nurse Lucy Letby.

www.bbc.co.uk

 

[Tortoise]

An additional report in the Independent, re. evidence of Dr David Harkness (note they've got the day wrong - Dr Harkness took the stand on Thursday, not Wednesday):


“There was very unusual patchiness on his skin which I had not seen before. There were patches of blue/purple colour, patches of red and of white that didn’t fit.

“This was bright red patches… that means you have blood going round your body.”

He said the patches were all over the body and were “there from shortly after the event started”.

[...]

Mr Myers said: “I am going to suggest that you have been influenced in that recollection by conversations that have taken place about skin colours?”

“No,” said the medic. “This was worth mentioning because it was a pattern recognition.

[...]

Mr Myers said: “I am going to suggest there is a possibility that by this point the discussions had set in your mind about this colour when it really had not been there at all.”

Dr Harkness replied: “No.” "

Dead baby had ‘extraordinary’ discoloured patches on skin, Lucy Letby trial told

The newborn twin died at the Countess of Chester Hospital just over 24 hours after his premature birth.

www.independent.co.uk

 

[Tortoise]

Monday October 24th 2022 (no live blog today)

Day 7 of Prosecution Case











@MrDanDonoghue

BBC Journalist.


10.40
I'm back at Manchester Crown Court this morning for the trial of Lucy Letby. Jurors currently hearing from a nurse, who cannot be named for legal reasons, who was on shift the evening Child B fell ill. She recalls that there was no concerns for her health when she began her shift
11.12
The nurse is telling the jury how Child B stopped breathing around 12.30am on a night in June 2015. The baby, which survived, broke out in similar 'whitey purple blotchy' patches to Child A. 'I just thought no, not again', the nurse told the jury
11.22
Notes from that night show how an emergency call went out to doctors. Child B was placed on an infant resuscitator and medicines administered. Within about 10/15mins Child B began to 'improve almost as quickly as she had deteriorated'
11.29
Lucy Letby's defence barrister Ben Myers KC is now questioning the witness. He asks her if there were times when the Countess of Chester, during the period June 2015-June 2016, was 'just too short staffed' 'Yes', the nurse replies.
11.44
Mr Myers is now asking the nurse about the circumstances of Child A's death. He asks whether she had been made aware, when starting her shift, that Child A had been without fluids and medicines for several hours due to various tubes being out of position. 'Possibly', she said
12.18
Circling back to the nurse's description of 'white and purple' patches, Mr Myers points the jury to past statements made by the witness - to police in 2018 - which make no mention of such patches. Asked to explain why they're mentioned now, but not then the nurse cannot explain
12.18
Mr Myers puts it to the witness that these descriptions of patches have come from subsequent discussions with other staff, rather than what was actually seen on Child A
2.06 pm
We're back after a break. Jury is now hearing evidence from paediatric registrar Dr Rachel Lambie, who was on duty the night Child A died. Dr Lambie is talking the court through the emergency 'crash' call she got after Child A fell ill
2.12 pm
Dr Lambie recalls arriving in the neonatal intensive care unit as medics were attempting to resuscitate Child A. After 30-40mintutes the decision was taken to stop.
2.16 pm
Dr Lambie was also on shift the evening Child B fell ill, she recalls 'patches of purple and red flitting around her body...they lasted 10 seconds, disappeared and moved…as we treated her, they subsided and went away'
3.30 pm
Paediatric consultant Dr Ravi Jayaram is now giving evidence. He is taking the jury through his recollection of the evening Child A died...he says the baby's deterioration 'didn't fit to me with any disease process that I have seen, learned or read about'
4.41 pm
Dr Jayaram told the court that when he raised initial concerns about Ms Letby he was told 'not to make a fuss' by senior managers, he said he 'wished' he had been 'more courageous' in reporting his concerns. The case has been adjourned until tomorrow

 

[Tortoise]

Monday October 24th 2022 (no live blog today)

Day 7 of Prosecution Case

"She went on: 'She suddenly looked very ill. She looked very like her brother had done the night before. She was pale, white, with this purple, blotchy discolouration.

'I just remember thinking 'Oh no, not again'. I'd not seen anything like that before. To see his sister with the same appearance…'

[...]

A medical note of the incident read: 'Shut down, limp, apnoeic…Colour changed rapidly to purple blotchiness with white patches. Started to become bradycardic (slow heart rate)."

see link for more - per 10% copyright rule

Lucy Letby trial: Nurse thought 'Oh no, not again' when baby collapsed​

A nurse caring for a baby girl at the Countess of Chester Hospital thought 'Oh no, not again' when the infant collapse 28 hours after her twin brother's death, Lucy Letby's murder trial heard today

www.dailymail.co.uk

 

[Tortoise]

Monday October 24th 2022 (no live blog today)

Day 7 of Prosecution Case

"Giving evidence at Manchester Crown Court on Monday, a nursing colleague of Letby recalled she was preparing medicines when the monitor alarm sounded at Child B’s incubator.

[...]

She told Ben Myers KC, defending, that people on the unit were talking at the time about rashes but she was not influenced by anything somebody said.

The nurse told the jury she could not remember who administered intravenous fluids to Child A shortly before his collapse but accepted she told police that another nursing colleague had “pressed start” in the process and Letby assisted with checks."

see link for more - per 10% copyright rule

Nurse thought ‘not again’ when baby suddenly collapsed, murder trial told

Lucy Letby denies the murders of seven babies and the attempted murders of 10 others while she worked at Countess of Chester Hospital’s neonatal unit.

www.standard.co.uk

 

[Tortoise]

"Dr Jayaram told the jury of eight women and four men the situation he faced was “unusual” as [Child A's] the youngster’s observations were stable up to the point of collapse.

Giving evidence at Manchester Crown Court on Monday, he said: “(Child A) was pale. What I did not give any clinical significance to at the time was unusual patches of discolouration. I didn’t actually record it in the notes.

“Pink patches, mainly on the torso, which seemed to appear and disappear and flit around.

“I had never seen anything like it before but my focus at the time was on ABC, airway, breathing, circulation.”

[...]

Dr Jayaram agreed with Ben Myers KC, defending, that he did not reference unusual discoloration in his clinical notes recorded less than three hours after Child A died.

[...]

Mr Myers also asked why the consultant had not mentioned any discolouration in a July 2015 statement to the coroner presiding over the inquest of Child A. [...]

Dr Jayaram said there were similar discussions following the death of Child D on June 22 2015, who is also said to have been murdered by the defendant using the same method.

He said that some time after Child D’s death he “alighted” on a research paper entitled Pulmonary Vascular Air Embolism In The Newborn.

The medic said it described a series of accidental events of air embolism – where a blockage in the passage of blood occurs – and a similar pattern of discolouration.

"I remember reading this paper for the very first time and feeling really quite cold and worried. It is a matter of regret for me I didn’t mention it to the coroner at the time"

In his first interview with police in July 2017 the doctor spoke of the “bright pinkness of patches against a bluey/grey background” on Child A, the court heard.

[...]

Asked again by Mr Myers, whether his description of skin discolouration had been influenced by the research paper, the doctor said: No, absolutely, categorically not.”

Consultant tells trial skin marks ‘didn’t fit with anything he’d seen’

Nurse Lucy Letby denies the murders of seven babies and the attempted murders of 10 others.

www.expressandstar.com

and

Lucy Letby trial hears TV doctor and his colleagues 'raised concerns'

The neonatal nurse, 32, is standing trial charged with killing seven babies and the attempted murder of a further 10 at the Countess of Chester Hospital between between June 2015 and June 2016.

www.dailymail.co.uk

 

[Tortoise]

Tuesday October 25th 2022 - Live updates from the trial

Day 8 of Prosecution Case

[My note - Evidence of Consultant Paediatrician on-call June 10th 2015 - Re: Child B]

10:34am

The trial is now resuming, with someone who was a consultant paediatrician at the time of June 2015, giving evidence in court in relation to Child A and Child B.

10:37am

She said she "cannot recall" the events for Child B's collapse at 12.30am on June 10, as it was seven years ago, and her recollection would be based on the statement she had given to police.

10:40am

The court is shown clinical notes made by her, written retrospectively at 2.40am on June 10, 2015.
She was called at home at 12.36am, and arrived at the neonatal unit at 12.50am.
She recorded Child B "went apnoeic [stopped breathing]", followed by "suddenly purple blotching of body all over, with slowing of heart rate."

10:41am

The consultant says the 'purple blotching' would have been the registrar's account of events, relayed to her.

10:44am

The registrar also relayed Child B was bagged and tubed, and the heart rate went up, with adrenaline "not required".
The consultant noted, for her observation: "Upon my arrival purple blotching right mid-abdomen and right hand." The baby was "pink and active".

10:44am

The prosecution asks: "Do you have any independent recollection of that now?"
The consultant replies: "No."

10:51am

The consultant relays the various medical observations that were recorded at the time, including blood gases, protein levels, and heart rate.

10:57am

The consultant tells the court discussions had been ongoing since the evening of June 9, in light of Child B's twin brother dying, on whether Child A and/or Child B had been affected by the mum's blood condition.
Consultants at Great Ormond Street Hospital had said they "did not feel" the mother's condition would affect the baby "in any way", while consultants at Alder Hey Hospital suggested further blood tests being carried.
Following Child B's collapse, the blood observations taken were 'good', the court heard, and meant the requested extra tests were "held off".

10:58am

Child B was restarted on antibiotics "as a precaution".
There was still concern her circulation had to return to normal, so the consultant noted more fluid was administered to help with that.

11:04am

The consultant's notes add: "Spoke to parents.
"Purple discolouration almost resolved.
"?? cause."
The consultant says, from looking at her notes, she was "quite puzzled" by that as there were two question marks.
The notes add: "Stabilised at present.
"[Continued antibiotics].
"[Nil by mouth].
"Repeat gas and wean as tolerated."

11:05am

The notes conclude for further tests to be repeated at 7.30am, at the end of the night shift.

11:06am

Ben Myers KC, for Letby's defence, asks about "one area" on the clinical notes talked about.

11:14am

Mr Myers asks about the purple discolouration, and that by the time the consultant had arrived, she had noted what she had seen at 12.50am, and had 'almost resolved' by the time of the note at 2.40am.
She tells the court: "I think this was something I was puzzled about, and wondering what it would be."
She says other causes were ruled out as such a rash had "come out of nowhere" and had "almost completely gone" a couple of hours later.
She added she was "a little bit confused" and was "trying to put in place all the safe things" she could do to treat Child B.

Recap: Lucy Letby trial, Tuesday, October 25

THE trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

https://twitter.com/MrDanDonoghue

I'm once again at Manchester Crown Court for the trial of Lucy Letby. Jurors are today hearing from a doctor, who can't be named for legal reasons, who worked at the Countess of Chester in 2015

The doctor is currently running through her notes made in June 2015 when she received an emergency call to attend to Child B. They state: 'Baby suddenly stopped breathing. Purple blotching of body all over with slowing of heart rate'

The doctor tells the court that in light of Child B's twin brother dying 24 hours before, advice was sought from various medics across the country on whether Child A and/or Child B had been affected by the mum's antiphospholipid syndrome

Medics at Great Ormond Street Hospital said the condition would not effect the babies and no further investigation was needed. Experts from Alder Hey suggested doing a full blood count. Given Child B's good health when the doctor started her shift tests were held off

Child B took ill that evening and after she was stabilised she was put on antibiotics as a precaution. Subsequent blood observations taken were 'good' and no more tests were ordered

The doctor says she was 'puzzled' by Child B's deterioration. Describing the 'rash' that covered her, she said: 'It was so florid, it came out of nowhere. One and a half hour's later it is completely gone'

 

[Tortoise]

Tuesday October 25th 2022 - Live updates from the trial

Day 8 of Prosecution Case

[My note - Evidence of Expert Witness Dr Dewi Evans - Re: Child A]

11:25am

Independent medical expert Dr Dewi Evans has returned to give evidence in respect of Child A.
He confirms he has written four separate statements in respect of Child A, the latter two being clarification on technicalities.
The first report was written in November 2017, the second in May 2018.

11:31am

Dr Evans said he became involved in the case in July 2017 by the National Crime Agency.
He visited Cheshire Police where they had concerns about a number of deaths in the Countess of Chester Hospital which were "unusual" and "far more deaths than they would expect".

11:33am

The deaths had "followed collapses in babies" which were "otherwise quite stable" and involved collapses where resuscitation attempts were not successful.
He said: "I thought I could help, advise review case notes and form an opinion that led to the collapses of [Child A and Child B]."


11:35am

He said "despite the prompt resuscitation in [A's] case", Child A had died despite doing "very well".
He said his job was to look at the "clinical evidence".
He added that Child A was the first case he looked at, and subsequent reviews of other children had reinforced his opinions for the conclusions of Child A and B.

11:37am

He said "a pattern became apparent in the cases", which he described as "quite disturbing and quite unusual."

11:39am

For Child A, Dr Evans confirms he had received clinical records for the baby boy to review, and had received statements from Countess of Chester Hospital medical staff for the case.

11:47am

Dr Evans explains to the court certain medical procedures such as cannulas, UVC and long lines.

11:53am

Dr Evans said there is a connection between the insertion of a long line and 'cardiac tamponade', where fluid obstructs the heart and is a "deadly serious condition".
He added that, "sadly", he was aware of a case which happened in Swansea where a baby had died as a result of that.
He said such cases are where a long line has been in place "for several days".
Diagnosing such a condition post-mortem would also be "relatively straightforward" as fluid would be detected outside the heart.
For Child A, he had not come to the conclusion that cardiac tamponade was the likely cause of death.

11:54am

Dr Evans says, from looking at Dr Harkness's clinical notes at the time, the efforts to save Child A were "very good standard resuscitation procedures."
He added: "[It is] what you would expect in any neonatal unit in 2015."

12:01pm

Dr Evans said, just before Child A's collapse, he was "in a stable condition". In his report he had described his condition as "perfectly satisfactory."
He added: "He was as well as could be expected. All the markers of well-being were very satisfactory. He was in air, not needing additional oxygen, heart rate in normal limits, oxygen saturation normal - it had been in the 90s...respiratory rate slightly above normal rate but that was the only marker outside normal rate."

12:06pm

He said Child A "had survived the most dangerous journey of his life" and, although he needed care for feeding himself, he "was doing really, really well" and "everyone one the unit would have been really pleased with how he was."

12:17pm

Dr Evans said he had not been presented with evidence of the discolouration, as the court has heard through this trial, for Child A.
He said it was not noted in the evidence he had received.
He adds: "I think the rash in [Child A's] collapse fits together and fits a significant diagnosis...of air embolous [injection of air into the circulation]."

12:18pm

"Somehow air had got into the circulation...I found this opinion without knowing about the rash and without anybody suggesting expressing concern of air embolus."

12:21pm

He rules out other conditions such as sepsis, a lack of fluids or hypoxia as causes, or contributing factors to the collapse.
He said he had "only one" conclusion, that Child A had received an air embolus, "through an IV line".
He said with the systems in place, and the medical equipment, and medical staff being "obsessive" about making sure patients are not injected with air, "there was no way this could have been done by accident".

12:24pm

Dr Evans will be cross-examined by the defence after giving evidence for Child B.

LIVE: Lucy Letby trial, Tuesday, October 25

https://twitter.com/MrDanDonoghue

The court is now hearing from medical expert Dr Dewi Evans on the death of Child A. Dr Evans was approached by the National Crime Agency in 2017 to assist police in their investigation

Dr Evans said: 'The concern was that there had been a number of deaths in the Countess that had been unusual, there were far more deaths than they would expect. Collapses in babies that were otherwise quite stable, but in many of the cases resuscitation was not successful'

Dr Evans said he found the cases 'quite disturbing and quite unusual' and soon 'a pattern became apparent'

In the last week there's been examination of the 'abnormal' position of a long line (used to deliver fluids) to Child A. Dr Evans is asked if he has seen any evidence to suggest the positioning of this line was a cause of death. 'none at all', he says

Dr Evans says the cause of death with Child A is an air embolism (bubble)..he explains: 'It interferes with the blood supply to the heart and lungs, mechanism is the same as a clot that goes into the lungs'

 

[Tortoise]

Tuesday October 25th 2022 - Live updates from the trial

Day 8 of Prosecution Case

[My note - Evidence of Expert Witness Dr Sandie Bohin - Re: Child A]

12:24pm

Dr Evans will be cross-examined by the defence after giving evidence for Child B.
Before that, independent medical expert Dr Sandie Bohin has now been called in to give evidence for Child A. She is detailing to the court her medical and professional background.

12:27pm

Dr Bohin says she was asked to peer review Dr Evans's reports and was to find whether she agreed with them, disagreed with them, or had additional findings to present.
She has also considered other findings from other independent experts in the case.

12:28pm

The prosecution ask Dr Bohin to clarify whether she had also seen a post-mortem report for Child A, and the reports of Countess medical staff. She confirms that was the case.

12:31pm

Dr Bohin explains Child A was, for a baby born 10 weeks premature, a "stable baby", on breathing support via CPAP but not requiring oxygen ventilation, and was doing "so well" that medical staff decided to start giving him some feeds.
"If he was unstable in any way they would[n't] have done so," she tells the court.

12:33pm

The UVC placement and long line placement did not have any contribution to Child A's death, Dr Bohin tells the court.

12:39pm

Was the stopping of breathing for Child A caused by his prematurity, the prosecution asks.
Dr Bohin said it could be ruled out as there were no previous episodes, and caffeine had already been administered to counteract it as a precaution.

12:45pm

The discolouration seen, while seen in collapses in other infants, "did not explain" the pink blotching that came and went in Child A, Dr Bohin tells the court.

12:45pm

She says the "only plausible explanation" for Child A's collapse is an air embolus.

12:48pm

Dr Bohin said doctors and nurses are "absolutely meticilous" in making sure even "the tiniest air bubble" is not injected by accident into a patient's circulation.
She adds that even if air was accidentally administered, there is an electronic pump system which would detect the air and stop the administration.
Dr Bohin explains to the court that could be bypassed further down the line by administering the air embolus via a connector normally used for administering drugs.

1:02pm

Dr Bohin is asked how much of an air embolus would be considered fatal to a child of Child A's size?
She says that 3-5ml of air per kilogram of body weight "could be fatal".
She explains Child A weighed 1.6kg [about 3.5lb].
"A teaspoon of air?" Nicholas Johnson KC, prosecuting, asks.
"Well, that is 5ml of air, so yes," replies Dr Bohin.

1:02pm

Mr Johnson: "What, in your opinion, killed [Child A]?"
Dr Bohin: "[Child A] was killed by an air embolus."

LIVE: Lucy Letby trial, Tuesday, October 25

https://twitter.com/MrDanDonoghue

Independent medical expert Dr Sandie Bohin, who peer reviewed Dr Evans' findings, came to the same conclusion - that Child A died from an air embolism

 

[Tortoise]

Tuesday October 25th 2022 - Live updates from the trial

Day 8 of Prosecution Case

[My note - Evidence of Expert Witness Dr Dewi Evans - Re: Child B]


1:08pm

Dr Evans is recalled to give evidence for Child B's non-fatal collapse.
He said the collapse was "not really" likely as "all the markers were satisfactory" and the medical staff had elt comfortable enough to allow the baby girl to be out of the incubator for a short time so she could be handled by the mum.
He said that was "not something you would do" if the child was not stable.

1:10pm

He said the two conclusions he had for Child B's collapse were "smothering" or an "air embolus".
He said the discolouration was a "striking feature" which had been seen in Child A arrived and went "very quick".
He said if the rash was associated with other conditions, it "tends to stay".

1:17pm

Dr Evans tells the court the collapse was "very similar" to that of Child A, but what happened was "less severe".
He said "either the volume of air [injected] was less, or the volume of air in the circulation got there more slowly, or a combination of the two."
Asked by Mr Johnson if there were any other possibilities to the cause of the collapse, Dr Evans replies: "I could not think of anything else.
"The doctors did a really good job in saving her.
"There was no evidence of sepsis, problems with the lungs, nothing unusual about the chest x-rays, lungs were full of air...nothing else to explain this collapse which again was sudden and unexpected."
He added: "We have heard numerous doctors saying they have never seen this before. I feel I can say the same. It's very unusual."

1:54pm

The court has adjourned for the lunch break, with the trial resuming at 2.10pm.
Dr Evans will be cross-examined by the defence this afternoon in relation to the collapses of Child A and Child B.

LIVE: Lucy Letby trial, Tuesday, October 25

https://twitter.com/MrDanDonoghue

Dr Evans is now back in the witness box, he's discussing Child B's case. He says the cause of her collapse - like her brother Child A - was an air embolism, 'there was nothing else to explain this collapse, which was so sudden and unexpected', he said

 

[Tortoise]

Tuesday October 25th 2022 - Live updates from the trial

Day 8 of Prosecution Case

[My note - Cross-Examination of Expert Witness Dr Dewi Evans - Re: Child A]


2:16pm

The trial has resumed.
Ben Myers KC, defending, says Dr Evans has prepared a "large number of reports" over the years, and air emboluses feature in "a number of them" - "literally dozens". Dr Evans agrees.
Dr Evans is asked to explain the features of an air embolus.
He adds: "An air embolus will lead to a sudden and unexpected collapse. A patient, otherwise stable, collapses. And by collapse, I mean change of colour, stops breathing...reduced heart rate, and death. This occurs all of a sudden.
"There are additional features - you don't get all the features in all the cases. The two main associated features are unusual skin discolouration and the presence of air in 'great vessels' - various parts of the body. Those are the compounding features which lead to a diagnosis of air embolus.
"This occurs when there is no other explanation...which fits the collapse, and when resuscitation is unsuccessful.
"Resuscitating patients [for doctors] is part of our bread and butter, so resuscitating is well known. When that is unsuccessful, it adds to the confirmation [of an air embolus diagnosis]."

2:20pm

Dr Evans relays one case of a baby who had died in Swansea from an air embolus, from what "should have been a regular surgical procedure", when recalling it was "absolutely awful" and led to a criminal trial.
He said he had not been involved in the report so was unaware of any discolouration in that baby.
He says he has never come across such skin discolouration in a collapse in 'hands-on experience'.
"That is something I am relieved and pleased about, actually."

2:21pm

Mr Myers said the diagnosis is 'one of exclusion' - ruling out alternatives until there is one explanation left.
Dr Evans said there is more to the case than that. He said his original conclusion was without knowing about the skin discolouration in Child A.
He adds that if you discover additional information, that "simply firms up your diagnosis".

2:26pm

Dr Evans states that air embolus cases are difficult as there are "isolated" case reports, and the systems are put in place in modern times so the conditions are not repeated - "that is not a criticism, that is a compliment", hence there is "very little new research".
He adds that doctors may be reluctant to "spread news" of mistakes in cases where there may have been an air embolus.

2:40pm

Dr Evans said he was tasked with investigating a "clinical condition", not a "crime", when he became aware of the Countess of Chester Hospital case, when tasked by the National Crime Agency.
He said the scenarios added up to a "constellation of worries" on what went on between June 2015 and June 2016.
He adds that in past cases, he has been brought in by police and the conclusion was accidental, so the case was closed with no further police involvement.
He is asked about his 'state of mind' in his approach to the cases.
"My state of mind was very clear - let's find a diagnosis. Nothing to do with crime. Let's identify any specific collapse, and see if I can explain it.
"There were occasions where I couldn't explain it, and occasions where I found something deeply suspicious.
"There were incidents I found disturbing."
He was asked to investigate 33 cases in total, with two insulin cases later.
He said there were two babies were born in unsurvivable conditions, with obvious medical diagnoses.
He said: "The name Lucy Letby meant nothing to me. I didn't know the staff.
"I was the easiest physician and the most difficult. I was a blank sheet of paper. I had no idea and relied entirely on the evidence I could see from the clinical notes and applying my clinical experience and forming an opinion to the cause."

2:42pm

He said he asked to have one case file to have "an idea" of what he was dealing with.
Mr Myers: "Was the phrase 'air embolus' used at all?"
Dr Evans: "No. The first person to use air embolus, as far as I was concerned, was me.
"I need to give the NCA a compliment, they never gave me a steer. They are good, professional people."

2:48pm

Mr Myers turns to the case of Child A.
He asks that pre-term babies such as Child A are 'prone to complications'?
Dr Evans: "That is why we have neonatal units."
He adds that the care he received meant he had overcome the most difficult parts of his life and was "stable" prior to his deterioration.

2:50pm

Mr Myers asks if Child A was "perfectly satisfactory" prior to the collapse, as according to Dr Evans's notes.
Dr Evans says he does not want to engage in semantics, but adds that, for a pre-term baby in the position he was in, Child A was "satisfactory" and "really good".

2:53pm

A clinical note is presented to the court, with a number of 'problems' listed.
Dr Evans: "I would call them issues, not problems.
"This is what any competent junior doctor would list as the issues present.
"We have got to deal with the fact he is pre-term, he has breathing support, we need to establish feeds, there are concerns over suspected sepsis.
"Any doctor would write this things down."

2:55pm

An x-ray review is presented, with the note 'RDS [respiratory distress syndrome] type picture'.
Dr Evans is asked about that comment. He says: "I have seen the report, it's not too bad actually. This is why we put babies on CPAP."

2:59pm

A blood gas record showing a 'high' number for lactate (2.6 - outside the range up to 2) is shown.
Dr Evans explains he wouldn't be "particularly" concerned at such a reading, in the "whole picture", as he says one or two readings would be outside the normal range.
He describes the reading as "marginal", with all the other readings "normal", and Child A was "handling well".
He said he would not interpret an oxygen reading from a capilliary sample from a 'heel prick'.
He says if he saw such readings, knowing if the baby was "in air", he would not be "rushing to stick needles in him" unless there was a change in condition in the baby.

3:07pm

A NICU observation chart is presented for Child A, including the respiratory rate.
Mr Myers says the readings are "not stable."
Dr Evans disagrees, saying the readings are "within range".
The 'increase' in the respiratory rate readings were down to the insertion of the long line and UVC, handling of the baby and a heel prick procedure which caused the baby discomfort.
Dr Evans said he would expect the heart rate to go up with an increased respiratory rate, which would be a concern. But as the heart rate had remained stable, he said he would "not be concerned" and Child A "was not even requiring oxygen", with saturation levels at about 97-99 per cent, "was about as good as it gets".

3:10pm

Dr Evans says "it happens" that children on neonatal units can go without fluids for four hours.
He said it was not ideal, and "unfortunate", but it did not make a "clinical difference" in this case.
He said a child which had missed out on that level of fluids for that time would not have subsequently collapsed and died.

3:12pm

Dr Evans reiterates that the context of other readings had "all the markers" of a stable baby.
"This was a baby who was stable prior to him collapsing," he said, referring to the words other doctors had made in evidence.

3:18pm

Dr Evans dismisses alternatives put forward by the defence, including 'infection', saying such evidence would appear on a post-mortem examination.
He dismisses a suggestion of a 'rapidly spreading infection' in the baby as "ridiculous", as he said such evidence would again be found post-mortem by a pathologist.

3:22pm

Dr Evans said his conclusion of an air embolus was based on a baby "suddenly crashing" and, "more significantly", followed by "resuscitation which was unsuccessful".
He adds the subsequent x-ray and skin discolouration reports had firmed his opinion.

3:24pm

"A collapse of this speed in a baby unit, with full medical care, is very unusual these days."

3:27pm

He adds that Child A, given all the factors, is normal, and in "the safest place on the planet" for their needs.
"Neonatal unit care is as good as it gets.
"It has come on leaps and bounds [over the years]."

3:29pm

Mr Myers says skin discolouration can be a sign of illness, or due to underlying circulation problems, or infection, or blood pressure issues (secondary to something else).
Dr Evans agrees.
Mr Myers asks if it would be "flawed" to diagnose skin discolouration as an air embolus.
Dr Evans: "Discolouration is a general term, noting there is something present on the skin, as noted by a doctor or nurse. You can't say it is due to a specific condition."

3:34pm

Mr Myers refers to a 1989 study which showed, following 50 cases involving an air embolism, only '11 per cent' involved skin discolouration.
Dr Evans said he had come to his initial conclusion of an air embolus for Child A before becoming aware of the skin discolouration.

3:41pm

The judge rephrases a question of Mr Myers to ask that "failure of resuscitation", of itself and in isolation, is not a consequence of an air embolus.
Dr Evans agrees. He says in combination with all factors already presented - including air in the great vessels, sudden collapse and skin discolouration, the conclusion is that of an air embolus.
He says an air embolus is not "common", but is rare and unusual.

3:48pm

Dr Evans said in 14 of the 17 cases he had completed his preliminary reports by November 2017, and was unaware of any medical staff member being a suspect.
He became aware of the name 'Lucy Letby' for the first time upon her arrest in July 2018 when he read her name in the press.
He said he was the first to come up with a diagnosis of an air embolus, and this had been agreed by a peer review by Dr Sandie Bohin, plus by a medical expert who began to peer review his reports but sadly, before completing the review, became seriously unwell and died.

LIVE: Lucy Letby trial, Tuesday, October 25

https://twitter.com/MrDanDonoghue

We're back after a break. Lucy Letby's defence barrister Ben Myers KC is now questioning expert Dr Dewi Evans

Mr Myers says 'It's important not to hurry to a conclusion of deliberate harm if there is no direct evidence?' Dr Evans responds: 'You never hurry with a diagnosis which has such serious consequences'

Mr Myers is asking whether there was any suggestion of deliberate harm when the NCA first contacted Dr Evans. He tells the court 'no' and sets out that there was a 'constellation of worries' around what had happened at the Countess of Chester

'This was a hospital where three or four babies died a year on average, but somehow, over a very short period, the hospital had loads of deaths', he said

Dr Evans tells the court that he originally examined 33 baby deaths

Dr Evans has been going back and forth with Mr Myers about the health of Child A. Dr Evans has reiterated several times that Child A was a stable baby. He says but for an air embolism, Child A would have lived

Dr Evans said the collapse of this speed (seen in Child A) in neonatal unit with full monitoring and care is 'pretty unusual these days...babies don’t go from normal heart rate to stopping breathing'

Jury now being taken through a research paper from 1989, which Dr Evans used when reviewing this case to determine air embolism. The paper brings together 50 case studies on the phenomena https://adc.bmj.com/content/archdischild/64/4_Spec_No/507.full.pdf

 

[Tortoise]

Tuesday October 25th 2022 - Live updates from the trial

Day 8 of Prosecution Case

[My note - Cross-Examination of Expert Witness Dr Dewi Evans - Re: Child B]


3:54pm

Mr Myers asks about the non-fatal collapse of Child B, who needed breathing support at birth, as a clinical note shown to the court shows.
An x-ray review has the note 'RDS type picture', as also shown for Child A.
Dr Evans agrees with Mr Myers that a child such as Child B is 'prone to desaturations'.

4:03pm

Mr Myers presents a clinical note to the court from June 19, 12 days after Child B was born, noting there were desaturations recorded - if not on the same scale as those recorded during the non-fatal the collapse - and on June 20 when "the apnoea alarm went off" on three occasions, with oxygen saturation "down to 70-80% each occasion".
A paediatric asessment dated July 14 for Child B is presented to the court, in which 'breathing problems' are noted along with 'mottling'.
Mr Myers: "There are some respiratory issues associated with her health?"
Dr Evans: "Nothing compared to what we would call the 'index event' (the collapse). She needed resuscitating."

4:07pm

Mr Myers asks about the differential diagnosis for Child B, concluding there was either an air embolus, suffocation, or someone had removed the prongs on purpose.
Dr Evans said, in his opinion, he was "on the ball from the start" in considering an air embolus.
He said his opinion was reinforced by colour changes "every 10 seconds" as mentioned by a Countess staff member in court.

4:09pm

The theory of removing the CPAP prongs on purpose is discussed.
He says it's possible for a baby to move them by accident.
He is asked if smothering is a possibility, to which Dr Evans says he has since discounted.

4:16pm

Mr Myers said it is a 'key aspect' that the inability to successfully resuscitate Child A had led to an air embolus. He adds that child B recovered, and that is "inconsistent" and "contradicts the air embolus theory".
Dr Evans: "No it does not. We cannot do studies where we inject air into babies and see what happens."
He adds that the volume and speed at which air is injected, along with the skill of the resuscitation attempts, can make a difference as to whether the baby survives or dies.

4:19pm

Dr Evans says, under questioning by Mr Myers, he would be happy to hear of an alternative explanation from a medical perspective for Child B, but he is happy with the conclusion he has made for Child B, that she had had an air embolus.



Prosecution Re-Direct



4:24pm

The prosecution refers to the clinical note from June 20, following the desaturations recorded. The note adds Child B 'self-corrected'.
Dr Evans: "It's a bit frightening, but she self-corrected. These things happen in babies."
He reiterates that those events noted on June 20 are a long way from what happened when Child B suffered a non-fatal collapse.

5:02pm

The trial has been adjourned for today.
Our live coverage will continue tomorrow (Wednesday, October 26), with updates throughout the day.

LIVE: Lucy Letby trial, Tuesday, October 25

 

[Tortoise]

Jurors earlier heard from a doctor, who cannot be named for legal reasons, who was on shift the night Child B fell ill.
Reading her notes from that night, the doctor told the court: "Baby suddenly stopped breathing. Purple blotching of body all over with slowing of heart rate."
[...] the doctor remained "puzzled" over the purple rash.
She said: "It was so florid, it came out of nowhere. One-and-a-half hours later it was completely gone."

[...]

He [Dr Evans] added: "The name Lucy Letby meant nothing to me. I didn't know the staff.
"I was a blank sheet of paper. I had no idea and relied entirely on the evidence I could see from the clinical notes and applying my clinical experience and forming an opinion to the cause."

[...]

Fellow expert Dr Sandie Bohin said [...]
"The lines and the connecting points are filled with saline so even the tiniest of air bubbles could not get in. It is ingrained in nursing staff."
She said the amount of air likely to be fatal in an infant such as Child A, who weighed just 3lb 5oz (1.6kg) at birth, was a "teaspoon of air".
Child A's mother wept in the public gallery as Dr Bohin said she was left with only one "plausible explanation" for her son's collapse and death, which was an air embolism.

Lucy Letby: Disturbing pattern in baby deaths, nurse's trial told

A medical expert gives evidence in the cases of babies allegedly murdered by nurse Lucy Letby.

www.bbc.co.uk

 

[Tortoise]

Wednesday October 26th 2022 - Live updates from the trial

Day 9 of Prosecution Case

Evidence of Expert Witness Dr Sandie Bohin - re Child B

10:32am

Dr Sandie Bohin is now giving evidence in respect of Child B.

10:34am

She confirms she has examined medical records, case notes and photographs for Child B, and peer-reviewed Dr Dewi Evans's report for her non-fatal collapse in June 2015.

10:36am

Child B collapsed at 12.33am on June 10, 2015, at the neonatal unit. She later recovered and, four weeks later, was discharged from the Countess of Chester Hospital.

10:38am

Dr Bohin says Child B was "compromised" at birth, and required respiratory support, which was "not that unusual" for someone of her prematurity.
"She stabilised very quickly," Dr Bohin added, and was "in air" with "normal" blood gases, and "stable enough" to have skin to skin contact with her mother and for feeds to be started.

10:41am

Dr Bohin said the circumstances of Child B's collapse were not normal, but "very concerning".
She said: "Despite being on CPAP, she was otherwise normal."
If such babies deteriorate, there is normally "prior warning", but there was "nothing to suggest she was going to collapse in this way".

10:43am

The prosecution refer to an event where the nasal prongs were dislodged, prior to the collapse.
Dr Bohin said the prongs can be "misplaced", and the babies are "probably quite uncomfortable", and if left for a prolonged period of time, there would be a desaturation, with prior warning.
She added: "It was noted, the prongs were replaced, and everything went back to normal".
Dr Bohin replies to the question if the misplaced prongs had anything to do with the subsequent collapse: "No, none at all".

10:44am

Dr Bohin said other factors, such as infection or cardiac arrhythmia, could be discounted, and the only conclusion left was "air embolus".

10:45am

She refers to the skin colour changes seen on Child B, and how "florid and different it was from anything they had seen before".
"It just didn't fit with any other potential different causes".

10:45am

Dr Bohin said she looked at Child B's case "on its own merit", as with any other, when coming to a conclusion.

Recap: Lucy Letby trial, Wednesday, October 26