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

[Tortoise]

Dan O'Donoghue

@MrDanDonoghue
·
9m

We're back after a break for lunch. Ms Tyndall is continuing to take the court through sequencing evidence. The evidence contains door swipe data (showing staff movements on the ward), medical charts and any social media messages incoming/outgoing from Ms Letby on April 9

Dan O'Donoghue

@MrDanDonoghue
·
3m

Notes show that at 16:02 on April 9 2016 Child M collapsed and required full resuscitation - medics administered four doses of adrenaline in just over ten minutes in a bid to stabilise the infant

Dan O'Donoghue

@MrDanDonoghue
·
40s

In all, Child M required nine doses of adrenaline and CPR for 29minutes before he stabilised on a ventilator shortly after 16:30

 

[Sweeper2000]

deleted for readers ease of use as someone got there quicker.

 

[Tortoise]

would you like to continue with the updates @Sweeper2000 ?

 

[Marantz4250b]

I had a quick look back at Professor Hindmarsh's evidence for baby F, to see if any amounts were stated :



"Professor Hindmarsh says a rate of about 0.56ml/hr of insulin would have been required to lower Child F's blood sugar levels on the TPN bag."

"Overall, the infusion [rate] has essentially stayed the same.
"I can't be absolutely sure...but it's safe to assume that the glucose infusion rate did not change, which would imply that the amount of insulin around would be similar throughout the 17-hour period - allowing for the breaks when the infusion was discontinued."

By my reckoning that is 0.56ml x 17 = 9.52mls.

Professor Hindmarsh is shown a 10ml bottle of insulin, which normally comes with an orange, self-sealing cap.
To extract the liquid from the bottle, to administer 'therapeutically', a medical professional would have to use a syringe, the court hears. Mr Johnson says by 'therapeutically', Professor Hindmarsh means 'legitimately'. Professor Hindmarsh agrees, and says the dose would have to be measured out carefully.

Recap: Lucy Letby trial, Friday, November 25

It sounds to me like virtually a whole 10ml bottle was used on baby F, unless that's not how you calculate it.

This raises an interesting question in my mind; if the rate of administration didn't change and the insulin was administered at a constant rate then does that raise questions as to when, specifically, the bag was doctored?

What I mean is, for the insulin to the administered at a constant rate it must have been thoroughly mixed/dissolved/distributed within the contents of the bag. Presumably, the inference is that it was injected into the bag by LL. If you do that, though, how does the insulin react or mix with the main contents? Would it simply drop to the bottom of the bag or clump together in some fashion? It seems unlikely that a substance injected into another would evenly distribute itself without some form of mechanical help such as shaking, heating, or perhaps being left for many hours to propagate throughout the mixture.

Have they provided any evidence to show when they allege she adulterated the bag? Unless insulin is very quick to distribute itself into other substances then this would seem to be a very critical question they should have answers to.

 

[Sweeper2000]

would you like to continue with the updates @Sweeper2000 ?

I can do if your busy tortoise ?

 

[marynnu]

Really interesting post about the 2 ml vial. I would not have guessed it would be such a minute amount of liquid. That’s like a drop. I’m wondering what would happen if someone put a larger amount than that if only 1 ml is needed. I would have thought 5 ml would show more extreme consequences and not be treatable really but that’s a guess from someone without a clue really. If it is such a small vial how was there any spare for a poisoning ? I always thought it would be a jar with plenty to spare but that doesn’t fit with it being a controlled substance.

im wondering if that creates scope for potential cross contamination. If it’s such a small amount it might be conceivable that a nurse wouldn’t even notice its presence in a syringe or something else. Despite all preventive measures.

n

All IMO.

2ml is not a drop, it's just under half a teaspoon, though thinking now 10mls is maybe more likely! A vial would absolutely be no more than that. But either way, the concentration is always the same whatever the size of the vial.
I've just done some maths and IMO a couple of mls in the bag of infusion fluid would be enough to have an impact.

I have no idea what happens to insulin if it's put into glucose though, I must say!

Insulin is not a controlled drug, by the way.

 

[marynnu]

This raises an interesting question in my mind; if the rate of administration didn't change and the insulin was administered at a constant rate then does that raise questions as to when, specifically, the bag was doctored?

What I mean is, for the insulin to the administered at a constant rate it must have been thoroughly mixed/dissolved/distributed within the contents of the bag. Presumably, the inference is that it was injected into the bag by LL. If you do that, though, how does the insulin react or mix with the main contents? Would it simply drop to the bottom of the bag or clump together in some fashion? It seems unlikely that a substance injected into another would evenly distribute itself without some form of mechanical help such as shaking, heating, or perhaps being left for many hours to propagate throughout the mixture.

Have they provided any evidence to show when they allege she adulterated the bag? Unless insulin is very quick to distribute itself into other substances then this would seem to be a very critical question they should have answers to.

Insulin is like water - it doesn't precipitate or clump. You wouldn't see it. It just needs shaking or turning of the syringe or bag to mix.
No idea whether being added to glucose has any effect as it's never done, to my knowledge.it

JMO

 

[Tortoise]

I can do if your busy tortoise ?

Thanks

I'll update the media thread instead.

 

[Sweeper2000]

Here’s a very curious happening In court today.

10 m

Judge has just called a five minute break, he remarks that prosecutor Nick Johnson KC has a rather 'flat monotone' voice....

Here’s another very interesting point, three quarters approximately through the prosecutions case folks.


We're back, continuing to go through sequencing evidence - in all there's 423 point to go through. We're on 311 at the moment

https://twitter.com/x/status/1627680731857133568

 

[Marantz4250b]

Here’s a very curious happening In court today.

10 m

Judge has just called a five minute break, he remarks that prosecutor Nick Johnson KC has a rather 'flat monotone' voice....

Here’s another very interesting point, three quarters approximately through the prosecutions case folks.


We're back, continuing to go through sequencing evidence - in all there's 423 point to go through. We're on 311 at the moment

https://twitter.com/x/status/1627680731857133568

Literally, what on earth??

Is the judge suggesting that the prosecution is not entertaining enough or something?

That is the weirdest thing to say!

 

[Sweeper2000]

My response would be “would your preference be Brian blessed presenting the case” ?

very strange.

 

[Tortoise]

Literally, what on earth??

Is the judge suggesting that the prosecution is not entertaining enough or something?

That is the weirdest thing to say!

My guess is he's probably noticing that it's sending people to sleep after lunch, and they need to stretch their legs.

 

[Marantz4250b]

My guess is he's probably noticing that it's sending people to sleep after lunch, and they need to stretch their legs.

Yeah, must be something like that.

 

[MsBetsy]

Literally, what on earth??

Is the judge suggesting that the prosecution is not entertaining enough or something?

That is the weirdest thing to say!

Maybe the judge noticed a few jurors nodding off.

 

[MsBetsy]

Yeah, must be something like that.

It's happened in other trials I've watched. Listening to the medical evidence can be interesting but also boring at times.

 

[Tortoise]

Here’s a very curious happening In court today.

10 m

Judge has just called a five minute break, he remarks that prosecutor Nick Johnson KC has a rather 'flat monotone' voice....

Here’s another very interesting point, three quarters approximately through the prosecutions case folks.


We're back, continuing to go through sequencing evidence - in all there's 423 point to go through. We're on 311 at the moment

https://twitter.com/x/status/1627680731857133568

I think he means the prosecutor has to read 423 items into evidence just for baby M, things like every staff member's door swipe, nursing notes entered on the computer, charts filled in, clinical notes, prescriptions etc. Not that he means 423 electronic items in the whole trial.

I reckon he probably speed reads through it because the jury already has it in their iPads to refer to, but it's a legal necessity to enter into evidence every document relied on in a trial.

 

[Sweeper2000]

I think he means the prosecutor has to read 423 items into evidence just for baby M, things like every staff member's door swipe, nursing notes entered on the computer, charts filled in, clinical notes, prescriptions etc. Not that he means 423 electronic items in the whole trial.

I reckon he probably speed reads through it because the jury already has it in their iPads to refer to, but it's a legal necessity to enter into evidence every document relied on in a trial.

That would make allot of sense really and totally understandable in that case how people might need a refresher including the prosecution.

 

[Tortoise]

one of these days I'd like to attend the trial, just to see what it's like. But it's a long way to travel and I'd have to stay overnight and I'm worried I wouldn't get in anyway with families deserving priority. Maybe I'll speak to a court usher and find out my chances of getting in. My son is at uni in Manchester too, but I don't think I fancy kipping down in student digs.

 

[JosieJo]

I'm not registered as an expert so please take this as my opinion

Stock insulin was usually in vials/ bottles around 10 mls .. they were multi use and had a rubber bung in the end which would self seal after a needle and syringe was used to remove the required amount..this would be a tiny amount..on a non diabetes specialist unit a vial would last months

 

[Tortoise]

Dan O'Donoghue

@MrDanDonoghue
·
35s

Court has adjourned, back at a later time of 1pm tomorrow.