UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #11

[JosieJo]

This is just my opinion..but..if she was officially moved to days then I feel that would have to have been part of a formal process ... there has been no mention of that as I can remember.
The consultant who said he had raised concerns said they were brushed aside by senior management.
It's possible that the consultant mentioned something less formally to the unit manager. They made have said something like no one else has mention concerns..she seems conciensous etc ..I'll put her on days for a while just too keep an eye on her performance.

Could it coincide with the time that LL sent texts about some staff not feeling she was not doing her job properly?

 

[Tortoise]

I’m of the opposite opinion. I can’t see how the cross-examination isn’t being guided by expert opinion.

Given this case is all about the medical evidence, it goes without saying that the defence will have obtained their own expert evidence to see if there are any holes in the prosecution’s case. Otherwise, Ben Myers would be negligent in his duties to his client, and he is far too experienced and well regarded to make such a fundamental error.

So assuming therefore that expert opinions were obtained, the question is how the defence is using them.

Looking at the suggestions being made by the defence through its cross-examination, it is disputing the conclusions of dr evans and dr Bohin on many counts so far.

All barristers have an overriding duty to the court, which means that they cannot lie to the court and they cannot recklessly mislead the court.

If the defence’s experts had said that they agree with the prosecution and that there was no possibility of an alternate cause, then Myers couldn’t have made some of the suggestions he has because he would be lying to the court IMO.
And even if, for some unknown reason , the defence didn’t get its own expert evidence, then by making some of the suggestions that he has, Myers would again be recklessly misleading the court by presenting as credible alternative causes things which he hasn’t actually asked an expert about. JMO

It is not lying to the court to choose not to advance the opinions of an expert consulted, but instead to rely on explanations found elsewhere. There is nothing found in the defence arguments that can't be found in the doctors' medical notes, or in the original post-mortems, or in theories given some consideration but discounted by the prosecution experts.

JMO

 

[marynnu]

This is just my opinion..but..if she was officially moved to days then I feel that would have to have been part of a formal process ... there has been no mention of that as I can remember.
The consultant who said he had raised concerns said they were brushed aside by senior management.
It's possible that the consultant mentioned something less formally to the unit manager. They made have said something like no one else has mention concerns..she seems conciensous etc ..I'll put her on days for a while just too keep an eye on her performance.

Could it coincide with the time that LL sent texts about some staff not feeling she was not doing her job properly?

I hear what you're saying. My confusion is that I can't see that she was restricted to days at all, given what info we currently have. But hopefully all will become clear as time goes on.

 

[Tortoise]

All the following reflects my personal opinon only.
Do you think the reporting that she was moved to day shifts is accurate at all? I ask because I thought it was prior to the case of Baby L April 2016, but evidently that can't be right as during this event she is asked to work an extra night, and in her response agrees to be on call for days or nights. One summary (a different site) has her working a night on June 2nd. And as lots of us have observed, it seems a strange decision on the part of management.
I do ask myself if somehow this has got confused with her being moved to clerical duties.

Yes there's that text on 10 Apr asking if she could do some nights, a text from JJ-K saying LL hasn't got many nights coming up on the rota, and a night shift on 2nd Jun when she is accused of attempting to murder baby N.

All other allegations are for day-shifts

15 Jun - N
23 Jun - O
24 Jun - P
25 Jun - Q

I have a feeling they asked her to do nights when they were desperately short-staffed.

 

[marynnu]

Yes there's that text on 10 Apr asking if she could do some nights, a text from JJ-K saying LL hasn't got many nights coming up on the rota, and a night shift on 2nd Jun when she is accused of attempting to murder baby N.

All other allegations are for day-shifts

15 Jun - N
23 Jun - O
24 Jun - P
25 Jun - Q

I have a feeling they asked her to do nights when they were desperately short-staffed.

Thanks for that - good to know I'm not imagining things! It will be very interesting to find out the facts surrounding this day/night thing.

 

[ColourPurple]

RE working day shifts. Here's a direct quote (the part in bold) of how the prosecution worded it:

"On April 9, 2016 Letby is said to have given an unauthorised dose of insulin to child L and while that attack was underway, turned her attention to child M by administering air into his circulation.

Nicholas Johnson KC, prosecuting, said: “By this time Lucy Letby was supposed only to be working day shifts because the consultants were concerned about the correlation between her presence and unexpected deaths and life-threatening episodes on the night shifts.”

The Crown say the defendant volunteered to work an extra shift on April 9 after she noted child L’s low glucose levels shortly after his birth the previous day."

Lucy Letby: what has the court heard so far in trial of Hereford nurse?

A HEREFORD nurse was allegedly interrupted by the mother of a victim as she attacked the baby in the neo-natal unit of the hospital where she worked.

www.herefordtimes.com

 

[marynnu]

RE working day shifts. Here's a direct quote (the part in bold) of how the prosecution worded it:

"On April 9, 2016 Letby is said to have given an unauthorised dose of insulin to child L and while that attack was underway, turned her attention to child M by administering air into his circulation.

Nicholas Johnson KC, prosecuting, said: “By this time Lucy Letby was supposed only to be working day shifts because the consultants were concerned about the correlation between her presence and unexpected deaths and life-threatening episodes on the night shifts.”

The Crown say the defendant volunteered to work an extra shift on April 9 after she noted child L’s low glucose levels shortly after his birth the previous day."

Lucy Letby: what has the court heard so far in trial of Hereford nurse?

A HEREFORD nurse was allegedly interrupted by the mother of a victim as she attacked the baby in the neo-natal unit of the hospital where she worked.

www.herefordtimes.com

Thanks for that info, which I had missed. I'd love to know how the "supposed only to be working day shifts" was implemented (or not!) and how it was explained to her.

 

[Supernovae]

Thanks for that info, which I had missed. I'd love to know how the "supposed only to be working day shifts" was implemented (or not!) and how it was explained to her.

It does point to another important issue (I feel), which is the prosecution overstating their quasi-statistical case. If you look at only the deaths the whole "pattern of excess deaths following the shift change" thing seems to be wholly based on the death of the two triplets in June. And the rate of deaths and collapses, while it may have been concerning, weren't nearly frequent enough to be making any claims about death rates going up or down based on her being on holiday for a couple of weeks at most.

 

[marynnu]

It does point to another important issue (I feel), which is the prosecution overstating their quasi-statistical case. If you look at only the deaths the whole "pattern of excess deaths following the shift change" thing seems to be wholly based on the death of the two triplets in June. And the rate of deaths and collapses, while it may have been concerning, weren't nearly frequent enough to be making any claims about death rates going up or down based on her being on holiday for a couple of weeks at most.

One big problem IMO is that we're only seeing a certain number of collapses/deaths, so interpreting anything statistically is very difficult. And we have no idea if the consultants' concerns were based only on the cases we know about or if there were other events which raised their suspicions.

 

[katydid23]

It does point to another important issue (I feel), which is the prosecution overstating their quasi-statistical case. If you look at only the deaths the whole "pattern of excess deaths following the shift change" thing seems to be wholly based on the death of the two triplets in June. And the rate of deaths and collapses, while it may have been concerning, weren't nearly frequent enough to be making any claims about death rates going up or down based on her being on holiday for a couple of weeks at most.

But why look at only the deaths when it is such a small number ? Unexplained collapses are also very important in this case. How does that statistical case look when taking 22 incidents into account as opposed to 7?

 

[katydid23]

We've been discussing what we think the defense will do when they get their chance to present their case. Whatever they do will probably have been highlighted in their opening. So here are some of their opening statements:

Lucy Letby trial: 'Sub-optimal care at Countess hospital' a factor in baby collapses, defence say

'SUB-OPTIMAL' care at the Countess of Chester Hospital's neonatal unit was a factor which led to many of the baby collapses, the defence barrister…

www.chesterstandard.co.uk

Ben Myers KC, giving the defence outline case at Manchester Crown Court on Thursday, October 13, told the jury there were problems with the way the neonatal unit was run at that time.He suggested it was overstretched and understaffed, adding: “This whole case is complicated. Sat in that dock is a young woman who says this is not her fault, so we need to look at the evidence."

The defence barrister said the prosecution referred to how babies improved rapidly when moved to a tertiary unit, such as Arrowe Park or Liverpool Women's Hospital, "when moved away from Lucy Letby".

Mr Myers said the improvement could be because they had been "moved away from the Countess of Chester Hospital", adding it was evidence the neonatal unit "did not always deliver the level of care that it should have provided" and to blame Letby "is unfair and inaccurate".

Each case was disputed by the defence, with Mr Myers saying "sub-optimal care" was a factor in the cases of Child A; Child C, who should have been taken to a specialist hospital; Child D, who should have been given antibiotics hours before she was treated; Child H; Child J, where the Countess of Chester Hospital was "well out of its depth" in knowing how to treat her; Child K, who Mr Myers said 'should not have been in the Countess of Chester Hospital in the first place'; and Child N.


[So his first argument will be surrounding sub-optimal care.
I am pretty sure he will bring in people who will testify about their horrid experiences, either as former patients/families, or as ex-staff members, who have anecdotes about poor medical care due to understaffing and unskilled workers, etc

But I do think he would need a health care expert to bolster his specific claims about subpar care-----for example, an expert to say that child D shouldx have been given antibiotics much earlier and how it would have been the cause of her collapse, and the same with the accusations with A, C, H, J, K and N. ]




Mr Myers said the evidence outlined by the prosecution was disputed, in particular allegations of air being injected into babies.

[ IMO, he will need an expert to actually dispute that claim. ] ]



He said the defendant is “adamant” she did nothing to harm children.

“Anyone who approaches this as some kind of a done deal has got this very badly wrong,” Mr Myers said.

“She loved her job. She cared deeply about the babies and also cared for their families.”

[Maybe they will try and bring in character witnesses and former co-workers to support her innocence.]

 

[katydid23]

Lucy Letby trial: 'Sub-optimal care at Countess hospital' a factor in baby collapses, defence say

'SUB-OPTIMAL' care at the Countess of Chester Hospital's neonatal unit was a factor which led to many of the baby collapses, the defence barrister…

www.chesterstandard.co.uk

Each case was disputed by the defence, with Mr Myers saying "sub-optimal care" was a factor in the cases of Child A; Child C, who should have been taken to a specialist hospital; Child D, who should have been given antibiotics hours before she was treated; Child H; Child J, where the Countess of Chester Hospital was "well out of its depth" in knowing how to treat her; Child K, who Mr Myers said 'should not have been in the Countess of Chester Hospital in the first place'; and Child N.

Recap: Lucy Letby trial, Thursday, November 3

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

The first evidence shown to the court is Lucy Letby's shift patterns for June 2015.

It shows which days Letby was on 'long day' shifts, and 'night' shifts.

She worked long day shifts on June 2, 4, 17, 19, 27 and 28.

She worked night shifts on June 8, 9, 13, 14, 21, 22 and 23.

Child A died on the night of June 8-9, and Child B had a non-fatal collapse on June 9-10.

Child C died on the night of June 13-14.

Child D died on the night of June 21-22.




During the prosecution opening statement, the jury has heard Child D, a baby girl, died following three collapses in the early hours of June 22, 2015.



A text message sent from Lucy Letby, 3 or 4 hours after Baby girl D died, to a colleague said, at 8.36am: "We had such a rubbish night.

"Our job is just far too sad sometimes."

The colleague replied: "No what happened?"

Letby: "We lost [Child D]."

The colleague: "What!!!! But she was improving. What happened?

"Wanna chat? I can't believe you were on again. You are having such a tough time."

Letby refers to Child D being "messed about a couple of times" and refers to a rash that "looked like overwheming sepsis".

She adds that two members of staff said the circumstances "would be investigated".

The colelague replies: "Dad was very anxious all day." and adds, in relation to the investigation, "What the delay in treatment?"

Letby replies: "Just overall looking into the case.

"And reviewing what antibiotics she was on if sepsis."

The colleague says Child D "was behaving septic".

She adds, to Letby: "Oh hun, you need a break."

Letby said, in her response: "But it's part of the job and it's hard for everyone."

The colleague responds: "Yes but you have had it all recently."

Letby, in her response, says: "Hmm well it's happened and that is it, got to carry on..." before referring to her planned time off.

The conversation then discusses staffing arrangements, and the difficulties of the job, before noting an instance of a happier occasion on the unit.

Letby says: "How do such sick babies get through and others get to [die] so unexpectedly?"

Her colleague, in her response, says: "We just don't have magic wands..."

The colleague refers to what Child D looked like in their care.

Letby replies: "I think there is an element of fate involved. There is a reason for everything."

The colleague adds: "It's important to remember that a death is not a failure," and says Letby is "an excellent nurse."

Letby, in her response, accepts the need to take positives from the job, but it's "just so sad to watch what families go through."

Further messages are echanged between Letby and her colleague the following evening.

The colleague asks: "How you doing?"

Letby replies: "I'm ok - trying not to think about it. Work busy but at least we have 6 tonight."

The colleague enquires about Child D and whether anything had been said about not "bringing her through sooner on Saturday".

Letby replies: "I don't think so", before adding there was a theory Child D may have had meningitis.

The colleague responds: "I'm worried I missed something."

Letby: "I don't think any of us did and she [Child D] was on the right antibiotics."

The colleague replies: "Yeah, just would treatment sooner have made a difference."

Letby asks her colleague if Child D had a lumbar puncture.

The colleague replies she was not sure it ever got done, given that the baby girl was ill and had been on CPAP.

She adds her gas reading was "appalling" when she first came through to the unit.

Letby, in her response, says: "I think we did what we could."

She then refers to the condition of the mother of Child D.

The court hears at 9.51pm on June 25, Letby searched for both the parents' names of Child D on Facebook.


Towards the end of June, Letby sent a message to a colleague: "Work has been awful."

The colleague responds: "Oh dear. Staffing probe?"

Letby, in her response, says: "We have had three unexpected deaths," adding the unit is "full".

She adds: "What I have seen has really hit me tonight."

The colleague asks: "Have you worked today?"

Letby: "No, been off since Wednesday morning and now it has all hit me."

The colleague asks if Letby tries "talking to a proper counsellor".

Letby replies that she does not think she can.

The colleague: "Why not?"

Letby: "I can't talk about it now...I can't stop crying...I just need to get it out of my system."

The colleague advises Letby to think carefully what to do, before adding: "Maybe you need to take time off."

Letby: "Work is always my priority," adding she had not cried about the incidents until then.

 

[marynnu]

We've been discussing what we think the defense will do when they get their chance to present their case. Whatever they do will probably have been highlighted in their opening. So here are some of their opening statements:

Lucy Letby trial: 'Sub-optimal care at Countess hospital' a factor in baby collapses, defence say

'SUB-OPTIMAL' care at the Countess of Chester Hospital's neonatal unit was a factor which led to many of the baby collapses, the defence barrister…

www.chesterstandard.co.uk

Ben Myers KC, giving the defence outline case at Manchester Crown Court on Thursday, October 13, told the jury there were problems with the way the neonatal unit was run at that time.He suggested it was overstretched and understaffed, adding: “This whole case is complicated. Sat in that dock is a young woman who says this is not her fault, so we need to look at the evidence."

The defence barrister said the prosecution referred to how babies improved rapidly when moved to a tertiary unit, such as Arrowe Park or Liverpool Women's Hospital, "when moved away from Lucy Letby".

Mr Myers said the improvement could be because they had been "moved away from the Countess of Chester Hospital", adding it was evidence the neonatal unit "did not always deliver the level of care that it should have provided" and to blame Letby "is unfair and inaccurate".

Each case was disputed by the defence, with Mr Myers saying "sub-optimal care" was a factor in the cases of Child A; Child C, who should have been taken to a specialist hospital; Child D, who should have been given antibiotics hours before she was treated; Child H; Child J, where the Countess of Chester Hospital was "well out of its depth" in knowing how to treat her; Child K, who Mr Myers said 'should not have been in the Countess of Chester Hospital in the first place'; and Child N.


[So his first argument will be surrounding sub-optimal care.
I am pretty sure he will bring in people who will testify about their horrid experiences, either as former patients/families, or as ex-staff members, who have anecdotes about poor medical care due to understaffing and unskilled workers, etc

But I do think he would need a health care expert to bolster his specific claims about subpar care-----for example, an expert to say that child D shouldx have been given antibiotics much earlier and how it would have been the cause of her collapse, and the same with the accusations with A, C, H, J, K and N. ]




Mr Myers said the evidence outlined by the prosecution was disputed, in particular allegations of air being injected into babies.

[ IMO, he will need an expert to actually dispute that claim. ] ]



He said the defendant is “adamant” she did nothing to harm children.

“Anyone who approaches this as some kind of a done deal has got this very badly wrong,” Mr Myers said.

“She loved her job. She cared deeply about the babies and also cared for their families.”

[Maybe they will try and bring in character witnesses and former co-workers to support her innocence.]

IMO There has to be more to it than this. It won't be much of a defence if all they have is understaffing, suboptimal care & being 'out of their depth', for at least 2 reasons. Firstly, none of that, even if true, would account for the dramatic rise in serious incidents in 2015 - the unit seems to have been pretty average re. death rate in the years before. And even if the response to some of the emergencies can be criticised, none of those things could account for why these babies collapsed or were overdosed with insulin in the first place, as far as I can see. JMO

 

[Tortoise]

It does point to another important issue (I feel), which is the prosecution overstating their quasi-statistical case. If you look at only the deaths the whole "pattern of excess deaths following the shift change" thing seems to be wholly based on the death of the two triplets in June. And the rate of deaths and collapses, while it may have been concerning, weren't nearly frequent enough to be making any claims about death rates going up or down based on her being on holiday for a couple of weeks at most.

It's not a prosecution overstatement if you have to change what they said. The prosecution didn't say "pattern of excess deaths following the shift change" thing.

Here's what was reported

"12:55pm

There were between 25-30 nurses and 15-20 nursery unit nurses in that part of the hospital, working day/night shifts. More would work on the day than the night shifts, typically.
Parents tended to visit their sick children during the day, Mr Johnson added.
Many of the events occurred "during the night shifts".
When Letby was moved to the day shifts, the rate of collapses "shifted to the day shift pattern"."

Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders

These are the allegations against her, which are more than the "deaths of the two triplets in June"

9 Apr 2016 - L - attempted murder - day – room 1 – not designated – LL room 1
9 Apr 2016 - M - attempted murder - day – room 1 – not designated – LL room 1
3 Jun 2016 - N - attempted murder - night – room ? - not designated – LL room 4
15 Jun 2016 - N - 2 x attempted murder - day – room 3 - designated
23 Jun 2016 - O - murder - day – room 2 - designated
24 Jun 2016 - P - murder - day – room 2 - designated – but care transferred – not-designated
25 Jun 2016 - Q - attempted murder - day – room 2- designated

 

[GoodDayToYouSir]

We've been discussing what we think the defense will do when they get their chance to present their case. Whatever they do will probably have been highlighted in their opening. So here are some of their opening statements:

Lucy Letby trial: 'Sub-optimal care at Countess hospital' a factor in baby collapses, defence say

'SUB-OPTIMAL' care at the Countess of Chester Hospital's neonatal unit was a factor which led to many of the baby collapses, the defence barrister…

www.chesterstandard.co.uk

Ben Myers KC, giving the defence outline case at Manchester Crown Court on Thursday, October 13, told the jury there were problems with the way the neonatal unit was run at that time.He suggested it was overstretched and understaffed, adding: “This whole case is complicated. Sat in that dock is a young woman who says this is not her fault, so we need to look at the evidence."

The defence barrister said the prosecution referred to how babies improved rapidly when moved to a tertiary unit, such as Arrowe Park or Liverpool Women's Hospital, "when moved away from Lucy Letby".

Mr Myers said the improvement could be because they had been "moved away from the Countess of Chester Hospital", adding it was evidence the neonatal unit "did not always deliver the level of care that it should have provided" and to blame Letby "is unfair and inaccurate".

Each case was disputed by the defence, with Mr Myers saying "sub-optimal care" was a factor in the cases of Child A; Child C, who should have been taken to a specialist hospital; Child D, who should have been given antibiotics hours before she was treated; Child H; Child J, where the Countess of Chester Hospital was "well out of its depth" in knowing how to treat her; Child K, who Mr Myers said 'should not have been in the Countess of Chester Hospital in the first place'; and Child N.


[So his first argument will be surrounding sub-optimal care.
I am pretty sure he will bring in people who will testify about their horrid experiences, either as former patients/families, or as ex-staff members, who have anecdotes about poor medical care due to understaffing and unskilled workers, etc

But I do think he would need a health care expert to bolster his specific claims about subpar care-----for example, an expert to say that child D shouldx have been given antibiotics much earlier and how it would have been the cause of her collapse, and the same with the accusations with A, C, H, J, K and N. ]




Mr Myers said the evidence outlined by the prosecution was disputed, in particular allegations of air being injected into babies.

[ IMO, he will need an expert to actually dispute that claim. ] ]



He said the defendant is “adamant” she did nothing to harm children.

“Anyone who approaches this as some kind of a done deal has got this very badly wrong,” Mr Myers said.

“She loved her job. She cared deeply about the babies and also cared for their families.”

[Maybe they will try and bring in character witnesses and former co-workers to support her innocence.]

And maybe some expert who can speak to the report into COCH which resulted in it being downgraded in 2019 . Perhaps a former care quality inspector, or maybe even one of the inspectors who actually conducted the investigation leading to the downgrading.

 

[Tortoise]

But why look at only the deaths when it is such a small number ? Unexplained collapses are also very important in this case. How does that statistical case look when taking 22 incidents into account as opposed to 7?

It's 25 incidents when you add in the three alleged attempted murders of baby I between 30 Sep and 14 Oct which weren't charged because there is one count of murder on 23 Oct.

 

[Tortoise]

And maybe some expert who can speak to the report into COCH which resulted in it being downgraded in 2019 . Perhaps a former care quality inspector, or maybe even one of the inspectors who actually conducted the investigation leading to the downgrading.

How will they link this to collapses that only occurred on LL's shifts?

 

[marynnu]

And maybe some expert who can speak to the report into COCH which resulted in it being downgraded in 2019 . Perhaps a former care quality inspector, or maybe even one of the inspectors who actually conducted the investigation leading to the downgrading.

Is that relevant though? I would guess this unit was nothing out of the ordinary having both good & bad points, as highlighted in the medical/nursing investigation. The professionals who carried that out found nothing to explain the spike in setious incidents as far as I recall. JMO

 

[Kemug]

I really don’t like hospital gowns either

"I just love hospital gowns", said no-one ever.

 

[JosieJo]

I do think Myers will push sub optimal care as much as possible..I'm just not sure at all it's going to have much effect because they would have to link these specific deaths and collapses to something done that was suboptimal.