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

[WaxLyrical]

So on Friday we were told that junior doctors were to blame for being unable to interpret and fully appreciate the results of the insulin blood test. But today we’re told that the lab actually telephoned the results to the hospital because the levels were so high.

So they completely missed two seemingly clear cut cases of insulin poisoning, even when alerted to one of them by the lab. Whether Letby is guilty or not, this hospital has some serious questions to answer. JMO.

 

[Dotta]

Well I have to agree with Gottleib here. Alarms are a tool. Alarms are loud to get my attention so that I can come and assess the situation, but they are actually irritating to the baby, and to small babies can even disturb them so much that it causes negative physiological changes. I silence alarms so I can do my job. When I come to check on the baby, I always silence the alarm and then I assess, which might look like "doing nothing" because I am reading the ventilator wave forms, observing for color, respiratory movement (chest rise) and so on so that I can make the correct interventions. Jumping in and doing without thinking just leads to doing the wrong thing. I am eager to hear the testimony on baby K (K, the one who was on paralytic but somehow self extubated?). When I first read of that episode, as a nurse I didn't immediately think LL was criminal or incompetent. But, having followed all the testimony so far, mostly the technical stuff rather than the social behavior, I understand why there have been concerns and a trial.

JMO.

I understand.
But didn't we read on this thread that alarm did not sound in emergency b/c it was silenced/turned off on purpose - and the baby was on the brink of death???

I, as a patient, would be very worried if sth like this happened to me.

JMO

 

[JosieJo]

do we know if there was a stock level of insulin kept in the fridge? or Was it something used and then disposed of and then ordered as per need? it seems with what is a limited supply the opportunity for it to be misused would be much reduced. Say we know child e was given a dose of it the day before child f so would that vial have been disposed of ?

No they are multi use

 

[marynnu]

I

Now, I am not totally sure, but it sounds to me like the undiluted insulin (humalog? 100 u/1mL), given at a rate of 0.56 mL/hour (or roughly 50 units per hour), would give this change in blood sugar. Presumably the insulin was added into a bag of fluid. I don't know the standard size of fluid bags on NHS unit, but on ours, the bags are 500 mL. But the rate of TPN doesn't need to change. Take the whole 10 mL vial of humalog, which I believe is 100 units of insulin per mL. So 1000 units of insulin per 10 mL. Now you add this to the 500 mL bag of TPN. Now your TPN has a concentration of 1000 units insulin / 510 mL of TPN. To deliver 50 units per hour, you'd have to run the TPN at around 25 mL/hr. If you added two vials, the TPN would have to run at 13 mL/hr. Add 4 vials and the rate of infusion could be even slower. Etc. I don't remember how big this baby was but depending on size and where they were on feeds, any of these numbers is plausible to me.

JMO.

EDIT - hold on, this doesn't pass my common sense test. 50 units of insulin sounds like an awful lot for an infant. Let me rethink. Leaving post up for transparency.

I calculated the amount, but not a registered expert (the process too complex for me) so my post was deleted - I do understand of course, but can't help feeling frustrated!

 

[JosieJo]

So on Friday we were told that junior doctors were to blame for being unable to interpret and fully appreciate the results of the insulin blood test. But today we’re told that the lab actually telephoned the results to the hospital because the levels were so high.

So they completely missed two seemingly clear cut cases of insulin poisoning, even when alerted to one of them by the lab. Whether Letby is guilty or not, this hospital has some serious questions to answer. JMO.

It may have been the junior Dr who took the call from the lab ...often when a lab finds a very high or low reading that's extraordinary or dangerous ..aswell as going down the normal route of putting the result on the computer system for the Doctors to read when they check ...they phone it through by bleeping the doctor on call

 

[magikarpmagikarp]

I understand.
But didn't we read on this thread that alarm did not sound in emergency b/c it was silenced/turned off on purpose - and the baby was on the brink of death???

I, as a patient, would be very worried if sth like this happened to me.

JMO

I would be worried too! Others on the unit were worried as well, which suggests that whatever was happening was perhaps out of the ordinary.

 

[marynnu]

I think that the defence is arguing for a lot of the cases that sub optimal care was the cause of the collapse, not some criminal interference by a third-party. So by highlighting examples from the report which show sub optimal care at COCH which aren’t related to these cases, the defence can build a stronger argument that suboptimal care is the cause.

In particular, if the defence can show that sub optimal care was behind the other excess deaths during the period for which LL is not charged, or that sub optimal care was behind other non-fatal collapses for which LL is not charged, then the defence would appear to be in a stronger position.

There is a big problem with this in my opinion. Firstly, the detailed medical/nursing investigation - which had many recommendations for improvement - could not account for the rise in deaths & collapses. And I feel that just repeating 'suboptimal care' just won't cut it without specifying exactly what was or wasn't done to cause these babies harm.

 

[WaxLyrical]

It may have been the junior Dr who took the call from the lab ...often when a lab finds a very high or low reading that's extraordinary or dangerous ..aswell as going down the normal route of putting the result on the computer system for the Doctors to read when they check ...they phone it through by bleeping the doctor on call

Understood. I suppose it just wasn’t made clear that the result was actually flagged as being concerning, and so the fact it was still dismissed is very worrying. Especially on a ward where concerns had already been raised, and a nurse had been shifted to days because of unusual happenings. Just feels like there should have been a higher degree of vigilance in general, but it seems there was the opposite. JMO.

 

[Tortoise]

So on Friday we were told that junior doctors were to blame for being unable to interpret and fully appreciate the results of the insulin blood test. But today we’re told that the lab actually telephoned the results to the hospital because the levels were so high.

So they completely missed two seemingly clear cut cases of insulin poisoning, even when alerted to one of them by the lab. Whether Letby is guilty or not, this hospital has some serious questions to answer. JMO.

I agree, I think it's shocking. Probably different doctors who recorded the results from the separate incidents I would think. It's really hard to imagine a doctor would write it off twice.

According to the BBC's write-up, the results weren't phoned through for five days. Test sent to the lab on the 9th. Not that that's any excuse, but I suspect his stabilisation might have had something to do with it.

"The results were later communicated by phone to the Countess of Chester's biochemistry lab on 14 April."
Lucy Letby trial told of battle to save air-injected baby


further quote from police interview -

"She said to her knowledge neither she nor a nursing colleague had accidentally administered the substance, which had not been prescribed, adding she could not believe such a mistake would have been made."

 

[ColourPurple]

That with the alarms f.i. I remember reading on previous threads how people are commenting on the silent alarms - I silent my alarms 15 times a day because they are not relevant. Alarms not sounding are not the equivalent of murderous intentions.

Or her wanting to go back into the room with the most complicated cases - I have done the same several times too. Nursing is a mix of theoretical and practical skills. Practical skills can only get better through - guess what - practice. Even today if I have a bad experience like an unsiccessful reanimation or a rapidly deteriorating patient, my reaction is that I want to take the next such case because I want to manage such situations better, and the only way to get better at nursing is to do it. I am bad at administration duty so I asked for an extra administration shift. Because I want to get better at it. Not because some sick reason.
But I read in previous threads how people interpret her asking to go back into the same room as a sure sign of her guilt ("reliving her sin for pleasure" or so) or her looking for opportunity to kill more babies.
For me, it is a completely normal reaction to a high stress situation. I did and still often do the same. And I am not murdering anyone

Keeping handover notes at her home was also interpreted as sinister. I do keep handover notes, because I forget about them and bring them home in my pocket. If police would search my home there would be several handover notes with names of patients I have no recollections of anymore. It is suboptimal but we are humans that get very tired at the end of a long, exhaustinh shift. Such things happen.

So these are things I completely understand as a nurse but are mentioned here as red flags and signs of her being guilty.

We all do this - silencing alarms, wanting to practice situations that were less than ideal, or taking home handover notes. These are not red flags, these are just normal things every nurse does. That's what people who are not in health care do not understand and misinterpret.

But as I have told, I did not read all the threads and do not follow closely.

I would be deeply hurt though if my desire to practice a skill to be better at it would be misinterpreted as a desire to kill or relive some terrible scenario.

ETA: this is a personal opinion and not a medical opinion (my previous post was also no medical opinion but my own) but please delete if against tos

Re baby B, she didnt ask to go back in room 1 to improve her skill. She said she wanted to go back in there the next night after Baby A's death, to see a healthy baby in there after Baby A died in there. Baby B, Baby A's twin was in there that night. LL was designated nurse for two other babies in room 3.

She was refused permission to work in room 1 that night, went in there anyway, several times, got involved in baby B's care and then allegedly attempted to murder her. The handover sheet was then found at LL's home.

 

[ColourPurple]

Well I have to agree with Gottleib here. Alarms are a tool. Alarms are loud to get my attention so that I can come and assess the situation, but they are actually irritating to the baby, and to small babies can even disturb them so much that it causes negative physiological changes. I silence alarms so I can do my job. When I come to check on the baby, I always silence the alarm and then I assess, which might look like "doing nothing" because I am reading the ventilator wave forms, observing for color, respiratory movement (chest rise) and so on so that I can make the correct interventions. Jumping in and doing without thinking just leads to doing the wrong thing. I am eager to hear the testimony on baby K (K, the one who was on paralytic but somehow self extubated?). When I first read of that episode, as a nurse I didn't immediately think LL was criminal or incompetent. But, having followed all the testimony so far, mostly the technical stuff rather than the social behavior, I understand why there have been concerns and a trial.

JMO.

They did explain that the pause option is there so it can be silenced if it's causing a distraction whilst a nurse/doctor is already attending to a baby and carrying out a procedure but LL is accused of allegedly pausing it whilst the monitor showed a baby's oxygen levels were dropping and she was allegedly standing there watching but doing nothing. We're yet to hear the full details of that case though.

 

[Gottlieb]

So what is the use of alarms if they are silenced by staff as "not relevant"?

As for handover notes with patients' sensitive info - shouldn't they be brought back to place of work as soon as possible?
I wouldn't be happy if the details of my treatment and my name were lying in somebody's home

As for returning immediately to perform some previously done unsuccessful procedures on patients - maybe it is better to "cool off" and observe them when others perform them well?

JMO

I explained why I often silence alarms in my previous post zhat got deleted. Long story short - monitor is a machine. It can not decide if the amount of O2 in your blood is low or your finger is cold. It can not decide if you are having a ventricular tachycardia or are just brushing your teeth. It can not decide if your blood pressure is low or you just have changed your position and the transducer is not at the right level anymore. It only senses that something is wrong and alarms. 90% of the time it is a false alarm and the patient is fine. Hence the silencing.

You are right with the handover sheets, it is not optimal but it happens. I bet you too have made more than one mistake in the course of your life I put it in the shredder when I find them.

Nobody says immediately. It's not like we're running from one code to the other. There are sometimes days even weeks between two resuscitations. But your advice to cool off and observe is exactly what I'm speaking about - you clearly have no idea how it works irl but still form a strong and sadly inadequate opinion. You imagine a situation but it has nothing to do with reality. This is not how it works. Resuscitation can be unsuccessful even when the whole staff is superb and everybody is doing their best. It does not need a mistake or a bad performance to die. People die because they are severely sick or injured. You cannot fix everything. A patient dying does not mean staff was not performing well and has to cool off. Life just ends and often there is nothing you can do about it.

This is exactly what I commented on in my first, now deleted post - a lot of people have no idea how these things work but still judge and form opinions about them even without any relevant knowledge or insight.

No offence to you personally

I do not know if LL is guilty or not. I'm just not seeing red flags in everything she does or not does.
Mods please delete if too medical. I have no interest in becoming a verified professional at the moment. I might change my mind later

 

[Gottlieb]

DBM because of doublette

 

[GoodDayToYouSir]

Which report has examples of other cases? Dr Evans reports?

The defence hasn't mentioned, in its opening speech, any other cases she isn't charged with.

JMO

I meant the CQC report which resulted in the downgrading .

 

[ColourPurple]

I explained why I often silence alarms in my previous post zhat got deleted. Long story short - monitor is a machine. It can not decide if the amount of O2 in your blood is low or your finger is cold. It can not decide if you are having a ventricular tachycardia or are just brushing your teeth. It can not decide if your blood pressure is low or you just have changed your position and the transducer is not at the right level anymore. It only senses that something is wrong and alarms. 90% of the time it is a false alarm and the patient is fine. Hence the silencing.

You are right with the handover sheets, it is not optimal but it happens. I bet you too have made more than one mistake in the course of your life I put it in the shredder when I find them.

Nobody says immediately. It's not like we're running from one code to the other. There are sometimes days even weeks between two resuscitations. But your advice to cool off and observe is exactly what I'm speaking about - you clearly have no idea how it works irl but still form a strong and sadly inadequate opinion. You imagine a situation but it has nothing to do with reality. This is not how it works. Resuscitation can be unsuccessful even when the whole staff is superb and everybody is doing their best. It does not need a mistake or a bad performance to die. People die because they are severely sick or injured. You cannot fix everything. A patient dying does not mean staff was not performing well and has to cool off. Life just ends and often there is nothing you can do about it.

This is exactly what I commented on in my first, now deleted post - a lot of people have no idea how these things work but still judge and form opinions about them even without any relevant knowledge or insight.

No offence to you personally

I do not know if LL is guilty or not. I'm just not seeing red flags in everything she does or not does.
Mods please delete if too medical. I have no interest in becoming a verified professional at the moment. I might change my mind later

I don't think anybody does think that somebody must be at fault if a resuscitation is unsuccessful or a patient dies, or that any monitor being paused is automatically suspicious. You're missing a lot of detail.

 

[Tortoise]

I meant the CQC report which resulted in the downgrading .

That report wouldn't have attributed causes to collapses and deaths.

 

[Gottlieb]

I don't think anybody does think that somebody must be at fault if a resuscitation is unsuccessful or a patient dies, or that any monitor being paused is automatically suspicious. You're missing a lot of detail.

I replied specifically to the poster who advised to cool off and observe somebody who does it better I wasn't referring to LL.

You are right, I do miss a lot of details, because I do not read all the threads and just dip in when I have some time. I do not follow the case closely and have no opinion about LL. I am a nurse though and so I am interested in this case even when I do miss a lot of details

 

[JosieJo]

"Jurors were also told that three vials of insulin were issued to the neo-natal unit in 2014, six vials in 2015 and two vials in 2016."

I can stop thinking about the 6 vials in 2015

Even if one was ordered late in 2015 and not opened till 2016 ..its still high.

I cannot see how so much extra could have been used .. imo its a strong possibility vials were put in a pocket

Lucy Letby trial told of battle to save air-injected baby - BBC News

Murder-accused Lucy Letby is alleged to have injected a baby with air and his twin with insulin.

www.bbc.co.uk

 

[Marantz4250b]

"Jurors were also told that three vials of insulin were issued to the neo-natal unit in 2014, six vials in 2015 and two vials in 2016."

I can stop thinking about the 6 vials in 2015

Even if one was ordered late in 2015 and not opened till 2016 ..its still high.

I cannot see how so much extra could have been used .. imo its a strong possibility vials were put in a pocket

Lucy Letby trial told of battle to save air-injected baby - BBC News

Murder-accused Lucy Letby is alleged to have injected a baby with air and his twin with insulin.

www.bbc.co.uk

Like so many other things about this case - how on earth was this sort of stuff not picked up on? Surely a hospital has systems in place to flag unusually high requests for dangerous drugs and equipment? Even if it's only to pick up on staff abusing it for their own purposes - Shipman was a Herion addict, after all!

The incompetence and "couldn't give a toss attitude" seems overwhelming at this place!

On your last point, I wonder whether that extremely detailed search of her house was looking for stuff like this?

 

[Dotta]

I replied specifically to the poster who advised to cool off and observe somebody who does it better I wasn't referring to LL.

You are right, I do miss a lot of details, because I do not read all the threads and just dip in when I have some time. I do not follow the case closely and have no opinion about LL. I am a nurse though and so I am interested in this case even when I do miss a lot of details

And I was talking about LL, not you (as this thread is about the specific British nurse - a defendant).
But it seems what I consider red flags you think are common things happening in hospitals.

If they are really that common - well, it does not sound optimistic for patients.
As is this case

JMO