Tortoise
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Wednesday October 26th 2022 - Live updates from the trial
Day 9 of Prosecution Case
Cross-Examination of Expert Witness Dr Sandie Bohin - re Child A and Child B
10:52am
Ben Myers KC, for Letby's defence, is now asking questions to Dr Bohin.
Mr Myers asks if it is important that medical experts have current day-to-day experience in a medical environment.
Dr Bohin: "Not necessarily no - what you can't do is dispel the exerience they have had over many years."
She adds it is not "crucial" they have on-the-job current day-to-day experience. After further questions, she said such experience would be "advantageous".
10:56am
Mr Myers refers to GMC guidance in giving evidence as an expert witness, and asks if someone who retired from clinical practice is still in the same position to give evidence for events which happened in 2015.
Dr Bohin says comeone does not lose their knowledge after retiring from on-the-job clinical practice, but if they keep up to date with clinical practice, they are not at a disadvantage.
10:58am
Dr Bohin said the first time she had contact with other medical expert Dr Evans was earlier this year, to discuss one of the cases in the trial, via a telephone conversation, as there had been a difference of opinion.
11:01am
Dr Bohin said she had previously seen one example of an air embolus, and it was in a neonatal case, but was "very long ago". She said she could not recall the specifics of the case, but the air bubbles seen in the imagery were "very striking".
She said she had formed her views after excluding other possibilities.
11:04am
Dr Bohin said she is unaware of any genetic condition which would cause a baby to collapse and die within 24 hours.
She said genetic screening would only be done if staff had a suspicion the baby had a genetic condition.
Child A
11:07am
Mr Myers says Dr Bohin said Child A was "extremely stable" prior to collapse.
She said there was "nothing which was cause for concern".
11:09am
The blood gas record for Child A is shown, and Dr Bohin says the lactate number of 2.6-2.7 is 'slightly elevated' (a normal reading at the Countess was '2'), but has to be taken in context with other parameters which were normal.
11:11am
The NICU Observation Chart is shown to the court for Child A.
Mr Myers says the respiration rate is "not stable".
Dr Bohin says it's above the normal rate, but "is stable". She said the range is 60-80 breaths, which is outside the normal range, but with CPAP breathing support, and 'in air'.
She said during the afternoon there would have been interventions which would have caused the respiration rate to rise.
11:13am
She said the respiratory rate, in conjunction with other factors, would have been something staff "would have been aware of".
Mr Myers: "Would you say this was an alert?"
Dr Bohin: "Yes, but there was nothing else that needed to be done. He wasn't having a lot of desaturations.
"The next step would have been to ventilate him...and he didn't require that."
11:15am
Dr Bohin: "Handling in a baby with respiration support can make the respiration go up."
Mr Myers asks if the heart rate would also go up.
Dr Bohin: "It can do...but not necessarily."
11:22am
Mr Myers refers to the insertion of the UVC and long lines.
Dr Bohin said the long line was not in the "best" position, but was in a "fine" position that was "safe" and would not cause problems with the heart.
11:27am
Dr Bohin said a long line can move if left in "for two weeks or more".
She said the long line would not have moved in the space of a day, and the recommendation is not to x-ray every day.
11:28am
Mr Myers refers to Child A's lack of fluids for four hours.
Dr Bohin says it was "not ok", and "would not be optimal care", but he had "no IV access" and the doctors had to prioritise other matters on duty, and adds "it wouldn't cause a sudden collapse like with [Child A]."
"The only deterioration he could possibly have would be to drop his blood sugar."
11:31am
Mr Myers: "Would you agree the whole situation is sub-optimal at that moment?"
Dr Bohin: "No."
Mr Myers asks if the lack of fluids means the whole situation is sub-optimal for Child A.
Dr Bohin: "No."
11:32am
Mr Myers refers to the skin discolouration.
Dr Bohin explains there is a difference between a rash, such as chickenpox, and changes to colour in the skin, where it can go blue, or pale, or mottled.
11:38am
Mr Myers refers to a paper published by the International Journal of Critical Illness and Injury Services on air embolisms, which reports air can enter via the UVC during negative pressure in the vessel systems.
Dr Bohin says she knows this sort of thing can happen, but in adults, and is not aware of any neonatal cases.
Child B
11:42am
Mr Myers now refers to the case of Child B.
He says the UVC procedure had to be repeated with her. He asks if that was "sub-optimal". Dr Bohin replies: "No. Ideally you would want it in first time."
11:44am
A clinical note refers to Child B not getting fluids "for a couple of hours".
He asks if that was "sub-optimal".
Dr Bohin agrees.
11:49am
Mr Myers refers to a clinical note showing it took five attempts to insert a long line for Child B, and asks if that was sub-optimal.
Dr Bohin: "Five attempts is what it took - it's incredibly difficult to site these - they are a millimetre wide. At times it just won't thread for you.
"If it won't thread for you...you are very aware you are handling this baby and the easier thing is to take it out and reinsert it," she adds, rather than "fiddling about with it" in the baby's body.
11:50am
Mr Myers: "[Five attempts to insert the long line] This is standard, is it, in practice?"
Dr Bohin: "Yes, it is."
11:53am
Referring to treatment, Dr Bohin said "nothing can ever be done immediately" in the hospital, but the size of the neonatal unit care was standard for a unit of that size.
12:02pm
Dr Bohin agrees there were breathing problems for Child B at birth.
Mr Myers: "Do you agree that Child B could deteriorate without deliberate harm?"
Dr Bohin: "It is a possibility."
Mr Myers: "Air embolus is usually fatal, isn't it?"
Dr Bohin agrees there is a risk.
Dr Bohin says a small quantity of air could create an air embolus. She said it is the volume and speed which are the factors.
Mr Myers says it is "almost always" fatal.
Dr Bohin replies that can be the case with adults [to which there have been medical reports published].
12:08pm
A clinical note refers to the "purple blotching...pink and active" for Child B, and is shown to the court.
Mr Myers asks if 'pink and active' refers to the baby.
Dr Bohin: "Yes."
Recap: Lucy Letby trial, Wednesday, October 26
Day 9 of Prosecution Case
Cross-Examination of Expert Witness Dr Sandie Bohin - re Child A and Child B
10:52am
Ben Myers KC, for Letby's defence, is now asking questions to Dr Bohin.
Mr Myers asks if it is important that medical experts have current day-to-day experience in a medical environment.
Dr Bohin: "Not necessarily no - what you can't do is dispel the exerience they have had over many years."
She adds it is not "crucial" they have on-the-job current day-to-day experience. After further questions, she said such experience would be "advantageous".
10:56am
Mr Myers refers to GMC guidance in giving evidence as an expert witness, and asks if someone who retired from clinical practice is still in the same position to give evidence for events which happened in 2015.
Dr Bohin says comeone does not lose their knowledge after retiring from on-the-job clinical practice, but if they keep up to date with clinical practice, they are not at a disadvantage.
10:58am
Dr Bohin said the first time she had contact with other medical expert Dr Evans was earlier this year, to discuss one of the cases in the trial, via a telephone conversation, as there had been a difference of opinion.
11:01am
Dr Bohin said she had previously seen one example of an air embolus, and it was in a neonatal case, but was "very long ago". She said she could not recall the specifics of the case, but the air bubbles seen in the imagery were "very striking".
She said she had formed her views after excluding other possibilities.
11:04am
Dr Bohin said she is unaware of any genetic condition which would cause a baby to collapse and die within 24 hours.
She said genetic screening would only be done if staff had a suspicion the baby had a genetic condition.
Child A
11:07am
Mr Myers says Dr Bohin said Child A was "extremely stable" prior to collapse.
She said there was "nothing which was cause for concern".
11:09am
The blood gas record for Child A is shown, and Dr Bohin says the lactate number of 2.6-2.7 is 'slightly elevated' (a normal reading at the Countess was '2'), but has to be taken in context with other parameters which were normal.
11:11am
The NICU Observation Chart is shown to the court for Child A.
Mr Myers says the respiration rate is "not stable".
Dr Bohin says it's above the normal rate, but "is stable". She said the range is 60-80 breaths, which is outside the normal range, but with CPAP breathing support, and 'in air'.
She said during the afternoon there would have been interventions which would have caused the respiration rate to rise.
11:13am
She said the respiratory rate, in conjunction with other factors, would have been something staff "would have been aware of".
Mr Myers: "Would you say this was an alert?"
Dr Bohin: "Yes, but there was nothing else that needed to be done. He wasn't having a lot of desaturations.
"The next step would have been to ventilate him...and he didn't require that."
11:15am
Dr Bohin: "Handling in a baby with respiration support can make the respiration go up."
Mr Myers asks if the heart rate would also go up.
Dr Bohin: "It can do...but not necessarily."
11:22am
Mr Myers refers to the insertion of the UVC and long lines.
Dr Bohin said the long line was not in the "best" position, but was in a "fine" position that was "safe" and would not cause problems with the heart.
11:27am
Dr Bohin said a long line can move if left in "for two weeks or more".
She said the long line would not have moved in the space of a day, and the recommendation is not to x-ray every day.
11:28am
Mr Myers refers to Child A's lack of fluids for four hours.
Dr Bohin says it was "not ok", and "would not be optimal care", but he had "no IV access" and the doctors had to prioritise other matters on duty, and adds "it wouldn't cause a sudden collapse like with [Child A]."
"The only deterioration he could possibly have would be to drop his blood sugar."
11:31am
Mr Myers: "Would you agree the whole situation is sub-optimal at that moment?"
Dr Bohin: "No."
Mr Myers asks if the lack of fluids means the whole situation is sub-optimal for Child A.
Dr Bohin: "No."
11:32am
Mr Myers refers to the skin discolouration.
Dr Bohin explains there is a difference between a rash, such as chickenpox, and changes to colour in the skin, where it can go blue, or pale, or mottled.
11:38am
Mr Myers refers to a paper published by the International Journal of Critical Illness and Injury Services on air embolisms, which reports air can enter via the UVC during negative pressure in the vessel systems.
Dr Bohin says she knows this sort of thing can happen, but in adults, and is not aware of any neonatal cases.
Child B
11:42am
Mr Myers now refers to the case of Child B.
He says the UVC procedure had to be repeated with her. He asks if that was "sub-optimal". Dr Bohin replies: "No. Ideally you would want it in first time."
11:44am
A clinical note refers to Child B not getting fluids "for a couple of hours".
He asks if that was "sub-optimal".
Dr Bohin agrees.
11:49am
Mr Myers refers to a clinical note showing it took five attempts to insert a long line for Child B, and asks if that was sub-optimal.
Dr Bohin: "Five attempts is what it took - it's incredibly difficult to site these - they are a millimetre wide. At times it just won't thread for you.
"If it won't thread for you...you are very aware you are handling this baby and the easier thing is to take it out and reinsert it," she adds, rather than "fiddling about with it" in the baby's body.
11:50am
Mr Myers: "[Five attempts to insert the long line] This is standard, is it, in practice?"
Dr Bohin: "Yes, it is."
11:53am
Referring to treatment, Dr Bohin said "nothing can ever be done immediately" in the hospital, but the size of the neonatal unit care was standard for a unit of that size.
12:02pm
Dr Bohin agrees there were breathing problems for Child B at birth.
Mr Myers: "Do you agree that Child B could deteriorate without deliberate harm?"
Dr Bohin: "It is a possibility."
Mr Myers: "Air embolus is usually fatal, isn't it?"
Dr Bohin agrees there is a risk.
Dr Bohin says a small quantity of air could create an air embolus. She said it is the volume and speed which are the factors.
Mr Myers says it is "almost always" fatal.
Dr Bohin replies that can be the case with adults [to which there have been medical reports published].
12:08pm
A clinical note refers to the "purple blotching...pink and active" for Child B, and is shown to the court.
Mr Myers asks if 'pink and active' refers to the baby.
Dr Bohin: "Yes."
Recap: Lucy Letby trial, Wednesday, October 26