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

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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.”
"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"

Hmm my thoughts...

I wonder which staff she thought were not pulling their weight and if she meant during the resus or in general?

I wonder what her manager felt LL had been doing to try to "prove herself"?
 
"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"

Hmm my thoughts...

I wonder which staff she thought were not pulling their weight and if she meant during the resus or in general?

I wonder what her manager felt LL had been doing to try to "prove herself"?
Maybe they wanted her to stop roaming into other rooms without being asked?
 
"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"

Hmm my thoughts...

I wonder which staff she thought were not pulling their weight and if she meant during the resus or in general?

I wonder what her manager felt LL had been doing to try to "prove herself"?
It’s a hell of a day to have that conversation too given I imagine many of the staff members were affected by the death of baby I. Unless of course her complaints related directly to that shift I can’t see why she chose that day.
 
This is from yesterdays' testimony about child H:





Consultant paediatric radiologist Owen Arthurs is first up in the witness box this morning. He's giving expert evidence on CT scans, X-rays and other images in this case

https://twitter.com/MrDanDonoghue


Dr Arthurs published a study in 2015 on the prevalence of air, post mortem, in infants. That study looked at 48 children. Of the 48, six were comparable to this case - but in each of those cases there were clear explanations for the presence of air in vessels

He agreed with prosecutor Nick Johnson that it is 'very rare' to find air vessels without an obvious explanation

...snipped....

Dr Arthurs says 'there isn’t anything specific' to suggest Child G was suffering from sepsis/NEC or any other infection. He said 'there's nothing on the X-rays that would really provide a diagnosis' for Child G's condition


We're now moving on to Child H. Ms Letby is accused of trying to kill the infant on two occasions in September 2015. The prosecution claim she first attacked Child H in the early hours of 26 September and then again the following morning

Jurors previously heard Child H, who was born six weeks premature, needed treatment for a pneumothorax, which occurs when air leaks into the space between the lung and chest wall.

On the evening of 24 September 2015, Dr Alison Ventress inserted a pigtail chest drain to prevent any accumulation of air within the chest. However, in the early hours of 25 September more air had accumulated a second drain was inserted

Ms Letby's defence counsel Ben Myers KC previously claimed that Dr Ravi Jayaram inserted the second drain in the "wrong place". Dr Arthurs is now going over the X-rays of Child H which show the drains

Dr Arthurs notes that the position of the drains have moved, but he says that the 'precise location isn’t really critical if it’s having the desired effect if it’s draining the pneumothorax' - essentially supporting what Dr Jayaram has previously said here
=================================
 
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.
It was stated in evidence recently that the parents did actually visit the ward (I believe) after baby I died (if I’ve read correctly).

I wonder if they told the unit when the funeral would be and she gave them the card the day before?
If they were indeed visiting the uni after her death, perhaps it was common knowledge on the unit *when* the funeral was happening. We haven’t heard much more about this this really, did the unit buy flowers, who attended the funeral etc (especially if as heard In evidence how upset the team was).
I wonder (even with the parents going back after the death) if it was general knowledge amongst staff that were not hearing more of.

That said; I agree we’re not hearing *how* this was given to them (or it is was posted) by LL, or even if the other nurse gave them a card too.

Moo
 
And she did tolerate her feeds, very well.
I don't want to labour the point but there are several staff who have testified that child I was particularly tricky to 'mature' describing her as 'problematic but beautiful baby'
There are snippets where doctors have commented that baby I was doing great with feeds at particular points. However, these comments follow gaps in feeds and IMO are relevant to the overall context that feeding had been a longterm issue.
The pattern I see in child I is a child who responds to antibiotics for a period but once the course finishes and feeds build back up she struggles again. IMO this was why they wanted to explore further via the contrast study.
I'm not suggesting that these known medical issues means that baby I did not receive an air embolism, just that her overall health history, together with the fact she was still in HDU @ 36weeks suggests that baby I was not an 'otherwise healthy' baby, her health status was still under investigation and therefore remained something of a mystery up until the time she passed.
 
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'd just say feeding intolerance is a symptom of NEC, rather than the other way round. IMO.
 
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.”
I have to admit I find it very strange that having a conversation about staff not pulling their weight, doctors having confidence in LL etc. on the day Baby I died rather strange. I wonder what triggered it. Obviously there's a lot we don't see!
 
I don't want to labour the point but there are several staff who have testified that child I was particularly tricky to 'mature' describing her as 'problematic but beautiful baby'
There are snippets where doctors have commented that baby I was doing great with feeds at particular points. However, these comments follow gaps in feeds and IMO are relevant to the overall context that feeding had been a longterm issue.
The pattern I see in child I is a child who responds to antibiotics for a period but once the course finishes and feeds build back up she struggles again. IMO this was why they wanted to explore further via the contrast study.
I'm not suggesting that these known medical issues means that baby I did not receive an air embolism, just that her overall health history, together with the fact she was still in HDU @ 36weeks suggests that baby I was not an 'otherwise healthy' baby, her health status was still under investigation and therefore remained something of a mystery up until the time she passed.


I feel the "problematic " times were the episodes after the "attacks" ..making it seem like they were problematic...as in they thought they were having feeding difficulties but wasn't
 
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"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
A snitch? That's not the way to do things in the workplace, that doesn't make for good relations. MOO
 
I feel the "problematic " times were the episodes after the "attacks" ..making it seem like they were problematic...as in they thought they was having feeding difficulties but she wasn't
I agree it's looking like there could have been an 'if opportunity knocks' scenario. IMO.
But in the earlier alleged attempt on 30th sept, LL had been off duty for three days prior and the nurse caring for baby I noted her to be 'pale'.
In any event, baby I's clinical condition at the point of collapse is in some ways irrelevant because it's been pointed out in the post mortem that there was no evidence of severe infection that could justify a sudden death. (From my understanding)
But yes, who knows what lengths a person might go to to cover their tracks.
MOO
 
I don't want to labour the point but there are several staff who have testified that child I was particularly tricky to 'mature' describing her as 'problematic but beautiful baby'
I do want to labour the point - your point - that milk had been a long term issue for baby I. It's not supported by the evidence. IMO

Baby I had a lot of problems, when she was at the Countess.

She had an infection at 4 weeks which was treated at Liverpool Women's with 5 days of antibiotics. It was not NEC because she continued to improve when put back on milk, and remained on milk for the next 4 weeks without any issues. It is not possible that this was caused by milk intolerance.

She vomited and had a collapse at 8 weeks, with her diaphragm splinted by air in her bowel, and doctors thought it could be NEC but her CRP was less than 1 and feeds were only interrupted for 24 hours. She was put back on milk and stayed on it without any issues for the next 2 weeks. Medical experts say that she collapsed because of air pumped into her stomach through the NGT. There is no evidence that it was NEC, particularly with feeds being reinstated without issue for the next 2 weeks. Professor Arthurs testified yesterday she had a "normal bowel" as evidenced on subsequent x-rays taken while LL was absent from the unit, after baby's return from Arrowe. It is not therefore possible that this collapse was caused by milk intolerance.

She had two cardiac arrests at 10 weeks, within 24 hours, in LL's care, with her diaphragm splinted by air in her bowel. Doctors again suspected NEC and sent her to Arrowe where she stabilised and was put on TPN and doctors scheduled tests on her bowel, which hadn't happened by the time of her death. The post mortem showed that she did not have NEC or any bowel problem. It is not therefore possible that this was caused by milk intolerance. Medical experts say that she collapsed because of air injected into her.

I think it's entirely expected that nurses would say that she was a problematic baby, with three cardiac arrests before the night of her death, without knowing that the problems which began at 8 weeks were allegedly caused by air pumped into her.

There are snippets where doctors have commented that baby I was doing great with feeds at particular points. However, these comments follow gaps in feeds and IMO are relevant to the overall context that feeding had been a longterm issue.

As shown in the timeline there were two gaps in milk feeding, both lasting a matter of days, which were not milk tolerance related issues, and then one other gap of 24 hours after the first alleged attempted murder, again not milk related.

She was receiving milk at all other times, until she was put on TPN a week before her death. I haven't seen you provide any sources for saying there were long term feeding issues, or effectively, that there was no demonstrable consistency with feeding between weeks 4 and 10 of her life.

I'm not suggesting that these known medical issues means that baby I did not receive an air embolism, just that her overall health history, together with the fact she was still in HDU @ 36weeks suggests that baby I was not an 'otherwise healthy' baby, her health status was still under investigation and therefore remained something of a mystery up until the time she passed.

At 10 weeks, the night of the second alleged attempted murder, when Ashleigh Hudson left baby with LL in the darkened nursery, she testified:

"Child I was in a "good clinical condition" when she left the nursery and there had been discussions regarding her discharge from the hospital in the coming weeks.” Lucy Letby: Murder-accused nurse cried over baby collapses, court told

Please provide a source for "she was not an 'otherwise healthy' baby, her health status was still under investigation" when she was in "HDU @ 36weeks", before she deteriorated (at 10 weeks of age) with air squashing her lungs and compromising her breathing.

JMO
 
i'd just say feeding intolerance is a symptom of NEC, rather than the other way round. IMO.
<modsnip - quoted posts removed>

So basically "feeding issues" can both cause and be a symptom of NEC. However after her death they found no sign of NEC and the expert believes that it "stands to reason" that somebody injected air into Baby I's stomach... which presumably would also cause feeding issues.
 
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As shown in the timeline there were two gaps in milk feeding, both lasting a matter of days, which were not milk tolerance related issues, and then one other gap of 24 hours after the first alleged attempted murder, again not milk related.

Do you know why there was a gap in feeds?
 
So basically "feeding issues" can both cause and be a symptom of NEC. However after her death they found no sign of NEC and the expert believes that it "stands to reason" that somebody injected air into Baby I's stomach... which presumably would also cause feeding issues.
I think we've interpreted "feeding issues" slightly differently, as it's such a vague term! I would use it for problems with the baby rather than the care - not absorbing feeds, not sucking etc. So we probably don't disagree.
 
I've already provided very detailed replies to your requests, with links, yesterday
I have read your links but IMO a lack of explanation for stopping feeds is not the same as providing evidence that the feeds were not stopped due to intolerance.
As I've mentioned on previous threads this does not negate the idea of embolism, just highlights weaknesses in the prosecution's case that baby I was as well as one might hope or anticipate for a baby of her gestational age.
As others have suggested it is possible that these ongoing historical issues (which may not of been wholly elaborated on) created an opportunity for LL.
 
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