UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #10

[Tortoise]

We're back after a break for lunch. Ben Myers KC, defending, is now questioning Dr Arthurs

He's asking Dr Arthurs about Child H and the positioning of her chest drains. Mr Myers asks if he is aware of guidelines on where chest drain should be inserted, in terms of the intercostal space

Dr Arthurs says that the guidance, to which Mr Myers is referring, 'refers to where they go in terms of the chest wall, not where they are inside chest'

Dr Arthurs accepts that a neonatologist is better placed to comment on positioning of drains and clinical impact

https://twitter.com/MrDanDonoghue

 

[esther43]

Baby I was a girl.

She was born at 27 weeks, had gained 90g 10 days after birth, and was tolerating feeds well.

At six weeks she looked like a full term baby. (gestational age 33 weeks)

At eight weeks she was still gaining weight and feeding normally.

Then at eight weeks, LL fed her, she vomited, and there was enough air in her bowel to splint the diaphragm. So they stopped feeds, but restarted them 24 hours later, and she was fine on breast milk again for the next two weeks.

At 10 weeks, LL was watching her while her nurse popped out of the room for 15 minutes and she stopped breathing for the second time in her life, with air in her bowel. The following night in LL's care she stopped breathing again with sufficient air in bowel to splint the diaphragm. Doctors stopped her feeds and sent her to Arrowe where she became stable again. At that point, 10 days before her death, she was referred for a bowel investigation and put on TPN.

She returned to Countess 5 days before her death, awaiting a bowel investigation, but still gaining weight.

She was only off breast milk for the last 10 days of her 11 week life because doctors wanted to check her bowel. There never was a problem found with her bowel, and therefore it wasn't that she didn't tolerate her feeds it was that she didn't tolerate excess air in her gut squashing her lungs. How that air got there is what this trial is seeking to establish, but it wasn't a lack of diagnosis of a non-existent bowel problem that caused her collapses or her death.

Her last (fatal) collapse, while she was not receiving milk feeds, but receiving TPN, is when the experts say her IV lines were used to administer air into her bloodstream.

JMO

Apologies over the sex, I try to get it right but it's so easy to get muddled.
I did specify in my original post the evidence that led me to believe that there was a history of ongoing unresolved feeding issues throughout child I's life but it was clipped.
To further elaborate the events that led up to the first alleged incident on 30th Sept
27th Sept- LL not working
28th Sept- LL not working
29th Sept- LL not working. Shelley Tomlins was the nurse.
Note recorded by nurse Shelley Tomlins ' Baby I 'remains pale but managing to complete bottles (slow to feed as windy).' The overnight shift nurse, Jennifer Jones-Key, said Baby I continued to be fed regularly, with her tummy 'full but soft'.
Then the next day there is a 'sudden' deterioration when LL is there.

 

[bbsaz]

Apologies over the sex, I try to get it right but it's so easy to get muddled.
I did specify in my original post the evidence that led me to believe that there was a history of ongoing unresolved feeding issues throughout child I's life but it was clipped.
To further elaborate the events that led up to the first alleged incident on 30th Sept
27th Sept- LL not working
28th Sept- LL not working
29th Sept- LL not working. Shelley Tomlins was the nurse.
Note recorded by nurse Shelley Tomlins ' Baby I 'remains pale but managing to complete bottles (slow to feed as windy).' The overnight shift nurse, Jennifer Jones-Key, said Baby I continued to be fed regularly, with her tummy 'full but soft'.
Then the next day there is a 'sudden' deterioration when LL is there.

This shows that she feeds normally when LL isnt there. Slow to feed and windy is basically every newborn. The fact she was bottle fed and not continually peg or ngt fed, shows to me that she was a good feeder. Many prem babies struggle to bottle or breast feed as it takes alot of muscle movement and coordination, yet she could.

She is only taken off feeds as a precaution to what the doctors suspect is NEC. When in fact it isnt nec, it is air in her system. When noone puts air into her system, her bowels and feeding are fine imo

 

[Tortoise]

Apologies over the sex, I try to get it right but it's so easy to get muddled.
I did specify in my original post the evidence that led me to believe that there was a history of ongoing unresolved feeding issues throughout child I's life but it was clipped.
To further elaborate the events that led up to the first alleged incident on 30th Sept
27th Sept- LL not working
28th Sept- LL not working
29th Sept- LL not working. Shelley Tomlins was the nurse.
Note recorded by nurse Shelley Tomlins ' Baby I 'remains pale but managing to complete bottles (slow to feed as windy).' The overnight shift nurse, Jennifer Jones-Key, said Baby I continued to be fed regularly, with her tummy 'full but soft'.
Then the next day there is a 'sudden' deterioration when LL is there.

A history of feeding issues isn't an incident of "slow to feed as windy" after 8 weeks of feeding and gaining weight, followed by a night with no problems feeding and a consultant ward round next morning with no concerns noted.

That describes every baby at some time or another. JMO

 

[Tortoise]

Mr Myers is now moving on to Child I. He put it to Dr Arthurs that from X-rays alone it was "not possible to establish a precise cause" of the air being present, Dr Arthurs agreed

Registrar Dr Rachel Chang, who was on shift the night Child I died, is next in the witness box

Dr Chang is being asked about the events of midnight, 22 October 2015. She tells the court she 'cannot remember' how she was alerted to Child I's crash, but she is reading out her notes from that night

Dr Chang said when she was bleeped she would have perceived that as a 'medical emergency'. Her notes show that when she arrived Child I was being manually ventilated

Dr Chang said Child I 'was in cardiac arrest' when she arrived. The infant was stabilised and an X-ray was taken shortly after (she says this is routine for baby like Child I)

The medic is now recalling events from around 1am on 23 October. Again she does not have a recollection of events and is reading out her notes. Child I again needed chest compressions and ventilation

Slight pause as Dr Chang breaks down in tears while recalling the desperate hour long battle to save Child I. Between 1:16am and 2:10am on 23 October the infant was given numerous rounds of CPR and eight doses of adrenaline, to no avail

Reflecting on Child I's death, Dr Chang said: 'I've never been able to truly explain it, it was awful. 'I knew we’d done everything, I trusted everyone around me'

Prosecution are now reading statements of agreed evidence. First one is from nurse Caroline Oakley - Ms Oakley was on day shifts and wasn't there when Child I died. She described Child I as a 'lovely beautiful but problematic baby'

Another statement from nurse Christopher Booth is being read, he said the events of 23 October were 'very, very distressing for parents' he said the whole team was 'heartbroken' after the death of Child I

Court has now adjourned, back Monday.

https://twitter.com/MrDanDonoghue

 

[esther43]

A history of feeding issues isn't an incident of "slow to feed as windy" after 8 weeks of feeding and gaining weight, followed by a night with no problems feeding and a consultant ward round next morning with no concerns noted.

That describes every baby at some time or another. JMO

Apologies, I was referring more to the 'pale' comment. Can you point me to the source that suggests 8 weeks of consistent feeding please?

 

[JosieJo]

You just have to feel for the staff having to go through all of this and how stressful and upsetting it must be. Of course as well as the families
If the defendant is guilty and putting so many people through this trial it truly will be awful

 

[Tortoise]

Birth

Child I was born at a gestational age of 27 weeks at 8.47pm on August 7, 2015.
She was transferred to the Countess of Chester Hospital on August 18, being cared from 8.30pm.
She was transferred back to Liverpool on September 6, before going back to Chester on September 13, at 11pm.
Recap: Lucy Letby trial, Wednesday, January 25

A statement from a consultant neonatalogist at Liverpool Women's Hospital is being read out.

Feeds were commenced, using expressed breast milk, on August 8 and Child I continued to be 'very stable, in spite of having an infection'.

A programme of five days of antibiotics began, and after a short gap in feeds, Child I continued to be fed.

Recap: Lucy Letby trial, Wednesday, January 25

She was born at 27 weeks, had gained 90g 10 days after birth, and was tolerating feeds well.

10 days

"On August 18, Child I was stable on CPAP, having four hours off it. She was tolerating feeds "very well". She had "normal tone, posture and movement".

The team at Liverpool had to wait until a bed became available at Chester before transfer was authorised on 'day 11', when Child I weighed 90g more than her birth weight, which "was good", as it was expected that babies would drop in weight in the days after birth.
"We expected [Child I] would continue to improve at Chester"."

Recap: Lucy Letby trial, Wednesday, January 25

4 weeks

September 6th - Transfer Countess to Liverpool
"Upon Child I's return to Liverpool Women's Hospital, her blood gases and heart rate were "normal".
It was thought that Child I had suspected sepsis rather than NEC, and a course of antibiotics began to cover for both possibilities.
Child I was kept nil by mouth but was "stable" on the night of September 6.
Feeds were gradually increased and the course of antibiotics ended after five days.
Child I continued to tolerate and build up feeds, which was a sign the baby girl did not have NEC."

Recap: Lucy Letby trial, Wednesday, January 25

At eight weeks she was still gaining weight and feeding normally.

6 weeks (18 September) -

"In a statement read to the court, Child I's mother said her daughter was about six weeks old when she thought she might be well enough to go home.
"I started to notice that she was looking different," she said.
"She was looking around the room now, taking it all in.
"I was able to sit her on my knee. I remember looking at her and thinking 'We are going home'.
"She looked like a full-term baby, she didn't look frail or small."

Lucy Letby: Nurse murdered baby on fourth attempt, court told

7.5 weeks

"By September 29, the infant was eight weeks old and the clinical concerns about her had diminished. She had no breathing problems, was 'in air', gaining weight and being fed both by bottles and a tube."

Lucy Letby 'tried to kill baby girl four times before succeeding'

September 30th-
Consultant paediatrician Dr Elizabeth Newby records, as part of an inspection for Child I as part of a 'grand round', for feeds to continue.
Feeds are continued for Child I during the day at 10am, 1pm and 4pm, of 35mls expressed breast milk and fortifier.

Recap: Lucy Letby trial, Wednesday, January 25

Then at eight weeks, LL fed her, she vomited, and there was enough air in her bowel to splint the diaphragm. So they stopped feeds, but restarted them 24 hours later, and she was fine on breast milk again for the next two weeks.

8 weeks

1st October -
"The sequence of events goes to the end of October 1, with Ashleigh Hudson recording at 7.48pm:
Review by Paeds SHO...abdomen is softer and less distended, ? start cautiously feeding...' Both parents were updated on the plan of care."

Recap: Lucy Letby trial, Wednesday, January 25

8 to 10 weeks

1st to 13th October -
The prosecution say "removed from the orbit of Lucy Letby," Child I's condition improved. Child I continued to improve and was in nursery room 2 on the night of October 12 by a designated nurse different to Letby.


10 weeks

13th October -
Child I was being bottle fed every 4 hours, and at 1.30am took a 55ml bottle of breast milk.
Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders

Apologies, I was referring more to the 'pale' comment. Can you point me to the source that suggests 8 weeks of consistent feeding please?

nb. infections are not feeding or milk tolerance/bowel issues.

 

[Anxala]

Although I feel the sending of the card is "unusual" ...what I find more concerning is taking a photo of the words you wrote

Leaving the innocent or guilty aside here, she does come across as a bit of an oddball. And very socially awkward in her dealings with/reading of people.

Objectively, she comes across at times as having an unsettling lack of empathy, a lack of understanding of what's appropriate in particular circumstances. But is it coming from an actual lack of empathy on her part, or just her inability to express herself/read the room? That's what we don't know.

And it's why it's imo impossible to assign motivation here because we still don't know anything significant about her as a person that would allow us, with any credibility, to do so.

 

[esther43]

Birth

Child I was born at a gestational age of 27 weeks at 8.47pm on August 7, 2015.
She was transferred to the Countess of Chester Hospital on August 18, being cared from 8.30pm.
She was transferred back to Liverpool on September 6, before going back to Chester on September 13, at 11pm.
Recap: Lucy Letby trial, Wednesday, January 25

A statement from a consultant neonatalogist at Liverpool Women's Hospital is being read out.

Feeds were commenced, using expressed breast milk, on August 8 and Child I continued to be 'very stable, in spite of having an infection'.

A programme of five days of antibiotics began, and after a short gap in feeds, Child I continued to be fed.

Recap: Lucy Letby trial, Wednesday, January 25


10 days

"On August 18, Child I was stable on CPAP, having four hours off it. She was tolerating feeds "very well". She had "normal tone, posture and movement".

The team at Liverpool had to wait until a bed became available at Chester before transfer was authorised on 'day 11', when Child I weighed 90g more than her birth weight, which "was good", as it was expected that babies would drop in weight in the days after birth.
"We expected [Child I] would continue to improve at Chester"."

Recap: Lucy Letby trial, Wednesday, January 25

4 weeks

September 6th - Transfer Countess to Liverpool
"Upon Child I's return to Liverpool Women's Hospital, her blood gases and heart rate were "normal".
It was thought that Child I had suspected sepsis rather than NEC, and a course of antibiotics began to cover for both possibilities.
Child I was kept nil by mouth but was "stable" on the night of September 6.
Feeds were gradually increased and the course of antibiotics ended after five days.
Child I continued to tolerate and build up feeds, which was a sign the baby girl did not have NEC."

Recap: Lucy Letby trial, Wednesday, January 25



6 weeks (18 September) -

"In a statement read to the court, Child I's mother said her daughter was about six weeks old when she thought she might be well enough to go home.
"I started to notice that she was looking different," she said.
"She was looking around the room now, taking it all in.
"I was able to sit her on my knee. I remember looking at her and thinking 'We are going home'.
"She looked like a full-term baby, she didn't look frail or small."

Lucy Letby: Nurse murdered baby on fourth attempt, court told

7.5 weeks

"By September 29, the infant was eight weeks old and the clinical concerns about her had diminished. She had no breathing problems, was 'in air', gaining weight and being fed both by bottles and a tube."

Lucy Letby 'tried to kill baby girl four times before succeeding'

September 30th-
Consultant paediatrician Dr Elizabeth Newby records, as part of an inspection for Child I as part of a 'grand round', for feeds to continue.
Feeds are continued for Child I during the day at 10am, 1pm and 4pm, of 35mls expressed breast milk and fortifier.

Recap: Lucy Letby trial, Wednesday, January 25



8 weeks

1st October -
"The sequence of events goes to the end of October 1, with Ashleigh Hudson recording at 7.48pm:
Review by Paeds SHO...abdomen is softer and less distended, ? start cautiously feeding...' Both parents were updated on the plan of care."

Recap: Lucy Letby trial, Wednesday, January 25

8 to 10 weeks

1st to 13th October -
The prosecution say "removed from the orbit of Lucy Letby," Child I's condition improved. Child I continued to improve and was in nursery room 2 on the night of October 12 by a designated nurse different to Letby.


10 weeks

13th October -
Child I was being bottle fed every 4 hours, and at 1.30am took a 55ml bottle of breast milk.
Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders


nb. infections are not feeding or milk tolerance/bowel issues.

6th Sept
Staff at the Countess suspected Baby I had NEC as her stomach had swelled.

On 7th September child I was prescribed antibiotics, a five day course ending on 12th.
At the point of being prescribed these child I had an elevated white blood count.

Liverpool Children's 'thought' it was sepsis.

Regarding your comments concerning feeding intolerance and NEC. Pretty sure these two conditions are intertwined with the former leading to the latter if left untreated by AB's.

Waver: Lived experience expert. Not clinically trained.

 

[JosieJo]

Leaving the innocent or guilty aside here, she does come across as a bit of an oddball. And very socially awkward in her dealings with/reading of people.

Objectively, she comes across at times as having an unsettling lack of empathy, a lack of understanding of what's appropriate in particular circumstances. But is it coming from an actual lack of empathy on her part, or just her inability to express herself/read the room? That's what we don't know.

And it's why it's imo impossible to assign motivation here because we still don't know anything significant about her as a person that would allow us, with any credibility, to do so.

I agree on the whole ..but taking photos of the words she wrote in the card ..are so different to actually sending the card which could be put down to not reading the room etc

 

[Tortoise]

6th Sept
Staff at the Countess suspected Baby I had NEC as her stomach had swelled.

On 7th September child I was prescribed antibiotics, a five day course ending on 12th.
At the point of being prescribed these child I had an elevated white blood count.

Liverpool Children's 'thought' it was sepsis.

Regarding your comments concerning feeding intolerance and NEC. Pretty sure these two conditions are intertwined with the former leading to the latter if left untreated by AB's.

Waver: Lived experience expert. Not clinically trained.

I don't understand what point you are making.

They suspected NEC but she didn't have it, at any point. That is also just a 5 day period in 11 weeks of life, during which time she was still tolerating milk.

You asked me to provide her history of tolerating feeds and it's there.

 

[sapphireminds]

I don't think anybody does think that LL talking about patients is evidence of her being a murderer.

Not directly, but I'm talking about the comments of how chilling her comments are etc. "if guilty".

Feeding tolerance and illness are directly related.

 

[Tortoise]

Feeding tolerance and illness are directly related.

And she did tolerate her feeds, very well.

 

[Tortoise]

We're back after a break for lunch. Ben Myers KC, defending, is now questioning Dr Arthurs
He's asking Dr Arthurs about Child H and the positioning of her chest drains. Mr Myers asks if he is aware of guidelines on where chest drain should be inserted, in terms of the intercostal space
Dr Arthurs says that the guidance, to which Mr Myers is referring, 'refers to where they go in terms of the chest wall, not where they are inside chest'
Dr Arthurs accepts that a neonatologist is better placed to comment on positioning of drains and clinical impact

https://twitter.com/MrDanDonoghue

This amused me.

He asked Prof Arthurs about the positioning of the chest drains and then more or less told him he wasn't the best person to ask.

JMO

 

[Tortoise]

I wonder how LL delivered the condolence card.

She photographed it on the day of the funeral at about 7 in the morning, just before clocking off work.

I don't know if "thinking of you today" means she intended them to receive it that day, and hand deliver it.

It seems strange to me for a nurse to look up a patient's address, unless of course she was handing it to someone who was going to be there.

 

[JosieJo]

I wonder how LL delivered the condolence card.

She photographed it on the day of the funeral at about 7 in the morning, just before clocking off work.

I don't know if "thinking of you today" means she intended them to receive it that day, and hand deliver it.

It seems strange to me for a nurse to look up a patient's address, unless of course she was handing it to someone who was going to be there.

I did wonder.. but jmo if she gave it to a member of staff coming on the day shift who was going to attend the funeral.

 

[ColourPurple]

I don't think anybody does think that LL talking about patients is evidence of her being a murderer.

Not directly, but I'm talking about the comments of how chilling her comments are etc. "if guilty".

Feeding tolerance and illness are directly related.

I was replying specifically to the poster who said that LL texting about patients wasn't evidence that she was a murderer.

Although I'd also say there's a difference between somebody saying they think her comments are chilling if she's guilty, and somebody saying they think she's guilty because of her comments.

 

[Tortoise]

LL's message to a colleague on 23 Oct, the day baby I died -

"Court is also shown messages between Ms Letby and another colleague, who cannot be named for legal reasons. In these messages she says she spoke to a manger about certain staff 'not pulling their weight' at the hospital
Ms Letby said in that conversation that she was told Drs at the hospital 'speak very highly of her' and that she needs to be 'confident' in her role and not feel the need to prove herself"

https://twitter.com/MrDanDonoghue


I wonder if this was true about doctors speaking highly of her. Hopefully we get the full text when the Mail Podcast comes out.

The comments about LL's confidence could have come from the text conversation LL had with the deputy manager on 26 Sep, after collapse of baby H -

Deputy manager Yvonne Griffiths messaged LL: Hope you have a good sleep. I just want to commend you for all your hard work these last few nights. You composed yourself very well during a stressful situation. It’s nice to see your confidence grow as you advance through your career. x”

LL to YG: “Thank you. That’s really nice to hear as I gather you are aware of some of the not so positive comments that have been made recently regarding my role which I have found quite upsetting. Our job is a pleasure to do and just hope I do the best for the babies and their family. Thank you to you & [another colleague] for your support x.”

 

[Dotta]

LL's message to a colleague on 23 Oct, the day baby I died -

"Court is also shown messages between Ms Letby and another colleague, who cannot be named for legal reasons. In these messages she says she spoke to a manger about certain staff 'not pulling their weight' at the hospital
Ms Letby said in that conversation that she was told Drs at the hospital 'speak very highly of her' and that she needs to be 'confident' in her role and not feel the need to prove herself"

https://twitter.com/MrDanDonoghue


I wonder if this was true about doctors speaking highly of her. Hopefully we get the full text when the Mail Podcast comes out.

The comments about LL's confidence could have come from the text conversation LL had with the deputy manager on 26 Sep, after collapse of baby H -

Deputy manager Yvonne Griffiths messaged LL: Hope you have a good sleep. I just want to commend you for all your hard work these last few nights. You composed yourself very well during a stressful situation. It’s nice to see your confidence grow as you advance through your career. x”

LL to YG: “Thank you. That’s really nice to hear as I gather you are aware of some of the not so positive comments that have been made recently regarding my role which I have found quite upsetting. Our job is a pleasure to do and just hope I do the best for the babies and their family. Thank you to you & [another colleague] for your support x.”

Hmm...
I see the Deputy Manager's praise of LL as a "positive encouragement".

It is usually offered by psychologist to boost somebody's confidence.
I see it often when a school's psychologist says such words to troubled sudents to motivate them.

But I might be wrong.

Although it was the first thing I thought about while reading these carefully chosen words of Deputy M.

JMO