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

[Tortoise]

https://twitter.com/MrDanDonoghue

Medical expert Dr Sandie Bohin, who reviewed Dr Evans' findings, is now in the witness box

 

[Tortoise]

Whilst I have no idea whether this lady is guilty or not, the defence are not really swaying me.
Will be interesting when it is their turn to present evidence.

One thing that has stuck out to me is LL texting her colleague that she was "bored" that day. I wonder, JMO, if she is guilty, I wonder if she was creating chaos for an adrenaline high rather than with the direct intention to kill.

I don't think that theory really holds water once a few babies have actually died.

 

[GoodDayToYouSir]

One thing that is certain IMO is that this was no error. The fluids were changed by LL and the designated nurse to no effect, but the change overnight resolved the problem. Either way, someone administered a large dose of insulin to this child. The only question is who.

I might be able to see a medical error if for example, the baby in the next cot was on insulin. You could maybe see that and overworked, exhausted nurse injected insulin into the wrong baby. But that wasn’t the case with baby F as IIRC, no other babies on the unit at that time were on insulin. I don’t know whether that’s true for baby L as well.

 

[LadyEdgeworth]

I don't think that theory really holds water once a few babies have actually died.

Plus, some babies were (allegedly) attacked multiple times until they died, if you just wanted adrenaline from the drama of a collapse or whatever it's risky to keep attacking the same baby until they pass away rather than just move on and cause another collapse for thrills.

 

[WaxLyrical]

I can’t stop thinking about the testimony yesterday from Dr J, about discussing stopping resuscitation efforts with Baby M’s parents, before M made a sudden and miraculous recovery.

Imagine being the parents of the other babies, who agreed to stopping resuscitation, and listening to this. They will forever be haunted, thinking “what if I just said no, would my baby still be here”. It’s unfathomable.

There’s probably no worse pain that a human could endure.

Also, I note the neurologist and LL’s notes suggested M had sustained brain damage. But both parents seem to suggest there was no lasting damage? Do we know either way for sure? I’m really hoping that any damage was so minimal that it’s left no obvious mark on that little boy.

 

[Tortoise]

https://twitter.com/MrDanDonoghue

Dr Bohin says 'there are very few things that can cause a baby to collapse in this way', she says it doesn't fit with infection or issues with feeds (as he was nil by mouth at the time). She also says there was no issues with his heart, 'this was completely unexpected'

 

[Sweeper2000]

I can’t stop thinking about the testimony yesterday from Dr J, about discussing stopping resuscitation efforts with Baby M’s parents, before M made a sudden and miraculous recovery.

Imagine being the parents of the other babies, who agreed to stopping resuscitation, and listening to this. They will forever be haunted, thinking “what if I just said no, would my baby still be here”. It’s unfathomable.

There’s probably no worse pain that a human could endure.

Also, I note the neurologist and LL’s notes suggested M had sustained brain damage. But both parents seem to suggest there was no lasting damage? Do we know either way for sure? I’m really hoping that any damage was so minimal that it’s left no obvious mark on that little boy.

That’s what I’m wondering as well. 30 minutes of blood not going to the brain I would have thought would leave anyone with severe brain damage. There mau be a way that oxygen could still get there though?

 

[Tortoise]

https://twitter.com/MrDanDonoghue

Nick Johnson KC asks Dr Bohin if she believes air was administered with 'malevolent intention' - she says 'yes'

 

[Tortoise]

https://twitter.com/MrDanDonoghue

Mr Myers is now questioning Dr Bohin, he puts it to her that there is 'not much' to support her conclusions. She says that the infant suffered a cardiac arrest, 'something caused that, the baby almost died...for me air embolus fitted with that'

 

[Tortoise]

https://twitter.com/MrDanDonoghue

Prosecutor Nick Johnson KC has just read a summary of Ms Letby's police interview in relation to Child M. Earlier this week the court heard how after Ms Letby was arrested in 2018, police recovered a blood gas report of Child M under a bed at her home

She told police that there was 'no reason why she had kept it' and that it was an 'error on her part' perhaps not emptying pockets before she left work. She denied taking it to 'remind her of an attack' on Child M

 

[FoxyLoxy1]

Plus, some babies were (allegedly) attacked multiple times until they died, if you just wanted adrenaline from the drama of a collapse or whatever it's risky to keep attacking the same baby until they pass away rather than just move on and cause another collapse for thrills.

The entire thing is risky. Continuing to attack certain babies over and over again rather than a wider attack would suggest to me LL (if guilty) had a personal reason or motivation. So far none have been suggested

 

[WaxLyrical]

The entire thing is risky. Continuing to attack certain babies over and over again rather than a wider attack would suggest to me LL (if guilty) had a personal reason or motivation. So far none have been suggested

I don’t think there’s any clear pattern. Some babies were allegedly attacked several times, others allegedly attacked once and then never again (eg L & M currently who remained on the ward for a further month). Some were allegedly attacked soon after birth, and others just as they were about to go home.

 

[marynnu]

I might be able to see a medical error if for example, the baby in the next cot was on insulin. You could maybe see that and overworked, exhausted nurse injected insulin into the wrong baby. But that wasn’t the case with baby F as IIRC, no other babies on the unit at that time were on insulin. I don’t know whether that’s true for baby L as well.

This is all IMO:

Even if another baby were on insulin, this just wouldn't happen. Firstly insulin is never injected into neonates. And two nurses check absolutely everything - the prescription, the vial, the name & number of the baby and the rate of infusion. Not only that, no way could an unprescribed infusion be in place and go unnoticed!

 

[Dotta]

"Baby given noxious substance"

Lucy Letby: Baby boy given 'noxious substance', nurse trial hears

A baby boy's heart stopped after he was given a "noxious substance" or injected with air, jury told.

www.bbc.com

 

[GoodDayToYouSir]

This is all IMO:

Even if another baby were on insulin, this just wouldn't happen. Firstly insulin is never injected into neonates. And two nurses check absolutely everything - the prescription, the vial, the name & number of the baby and the rate of infusion. Not only that, no way could an unprescribed infusion be in place and go unnoticed!

That’s very helpful inside information , thank you.

In terms of negligent nursing care though, do you think would be it possible for a less conscientious nurse who didn’t check as carefully to make a mistake like this (assuming there was a baby in the next cot who was on insulin)?

As I said, I know it makes no difference for baby F because nobody else on the ward required insulin, but I’m just curious to hear what you think, given we have heard quite a bit about the poor standard of care at COCH and generally poor awareness and alertness to things which you would normally expect to be picked up (e.g. reading blood test coming back showing raised levels and not realising that the results were showing synthetic insulin had been injected).

 

[magikarpmagikarp]

@marynnu, this question is for you. When we have a baby on insulin, we don't usually routinely send c-peptide. However, when we have a baby who has chronic/intractable hypoglycemia, we'll often send a whole panel of blood tests, which I believe includes c-peptide. The intention is not that our neonatologists will interpret it immediately, but that it will be later read by the endocrinologist. It's not sent as an acute test to solve the hypoglycemia. The treatment for acute hypoglycemia remains the same. For babies with chronic/recurrent hypoglycemia due to hyperinsulinemia, the endocrinologist sometimes treats with diazoxide. Our unit doctors don't do any of this. I'm just wondering - in your opinion - if it might be similar in the NHS.

 

[magikarpmagikarp]

I guess what I am wondering is, was c-peptide sent because it was part of a panel of tests usually ordered for intractable or recurrent hypoglycemia, or was it sent because someone suspected poisoning? Has this been discussed in the trial?

 

[marynnu]

That’s very helpful inside information , thank you.

In terms of negligent nursing care though, do you think would be it possible for a less conscientious nurse who didn’t check as carefully to make a mistake like this (assuming there was a baby in the next cot who was on insulin)?

As I said, I know it makes no difference for baby F because nobody else on the ward required insulin, but I’m just curious to hear what you think, given we have heard quite a bit about the poor standard of care at COCH and generally poor awareness and alertness to things which you would normally expect to be picked up (e.g. reading blood test coming back showing raised levels and not realising that the results were showing synthetic insulin had been injected).

I really don't see it happening accidentally. Not only do 2 nurses check everything but they start the infusion together too, making sure it's going at the correct rate. Both nurses would have to mess up in exactly the same way. I've gone to the wrong cot once or twice, but as soon as you shout out the unit number to the other checker you realise your mistake. This is why you have such stringent checking policies because we're all human! This is just basic stuff for neonatal nurses.

 

[marynnu]

@marynnu, this question is for you. When we have a baby on insulin, we don't usually routinely send c-peptide. However, when we have a baby who has chronic/intractable hypoglycemia, we'll often send a whole panel of blood tests, which I believe includes c-peptide. The intention is not that our neonatologists will interpret it immediately, but that it will be later read by the endocrinologist. It's not sent as an acute test to solve the hypoglycemia. The treatment for acute hypoglycemia remains the same. For babies with chronic/recurrent hypoglycemia due to hyperinsulinemia, the endocrinologist sometimes treats with diazoxide. Our unit doctors don't do any of this. I'm just wondering - in your opinion - if it might be similar in the NHS.

I'm aware of the tests being sent where I worked, though very rarely, but we never had a baby with a metabolic condition as far as I recall. And I have no recollection of a case of insulin poisoning either!! So not much help to you.

 

[ColourPurple]

I guess what I am wondering is, was c-peptide sent because it was part of a panel of tests usually ordered for intractable or recurrent hypoglycemia, or was it sent because someone suspected poisoning? Has this been discussed in the trial?

From what we've heard in the trial the tests were just requested because of the hypoglycemia and not because anybody suspected insulin poisoning.