UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #13

[Sundial]

Possibly but from what we know I don't get that impression of her. From what I recall reading ages ago it was mentioned by people who knew her that being a nurse is what she wanted to do since so was a child so it's unlikely that she was influenced in that by a TV show.

Also, she's been a nurse for several years - and there was also several years of study and training - so she would have had a pretty good idea of what life as a nurse would be like, I think.

All MOO, obviously.

But, it doesn’t mean she couldn’t have become influenced by it at a later stage (for whatever reason). Perhaps the role wasn’t what she thought it would be. From qualifying in 2011 (I think it was?) to the reported cases between 2014-2015, if guilty, it does make you wonder how things panned out the way they have.
JMO.
All very sad and heartbreaking awful trial regardless of the outcome. I can’t imagine how the parents must feel and the jury having to hear such detailed heartache. It must be agony.

 

[GoodDayToYouSir]

Timeline for O

June 21 LL is on holiday

2.24pm weighing 4lb 7oz O born via c section at 33+5 weeks. Born well and needed just a little oxygen support

June 22

10.45 CBG carried out

13.00 donor milk feeds commenced

6.29pm nurse O'brien notes: 'No signs of increased work of breathing...CBG carried out this AM at 1045, good result....respiratory rate remains stable. Baby nursed in incubator...temp within normal limits.' Fluid requirements checked and correct...10% dextrose infusing via cannula in left hand, site became puffy throughout day....feeds of donor EBM also commenced at 1300hr, currently having 4mls 2 hr...'

7.30pm night shift begins. Nurse Elllis designated nurse for O, P.

11pm ECG dots removed

June 23

Nurse Ellis tells court the oxygen saturation readings were recorded as 'very good - what we would like', at 97% and above. Child O was recorded as not requiring additional oxygen, and was on Optiflow.

2.19am nurse Ellis notes '[incubator] temperature reduced due to temperature of 37.3C - to check hourly as appropriate. All other observations stable. Pink, warm and well perfused....abdo full but soft.'

Nurse Ellis tells court Child O was reviewed towards the end of that night shift as he had "quite a full abdomen".

5.30am cannula removed as no longer needed.

6.30am optiflow weaned down as O coping well

6.41am unknown notes PN nutrition bag stopped as Child O had reached full feeds of donor expressed breast milk, and was 'tolerating well'.

6.41 antibiotics stopped as no longer required

7.30am LL day shift begins, designated nurse for O, P and unknown baby in nursery room 2

7.32am nurse Ellis? notes 'Abdomen looks full slightly loopy. Appeared uncomfortable after feed. Reg Mayberry reviewed. Abdo soft, does not appear in any discomfort on examination. Has had bowels open. To continue to feed but to monitor'

12.10pm Dr records brain scan for Child O noting normal observations.

12.30pm LL records a fluid chart with 'trace aspirates'.

13.15pm A doctor's notes 'vomits and has distended abdomen. 'Trace aspirate...no bile 1x vomit post feed No blood'. 'Unlikely NEC, most likely distention secondary to PMec.'

13.15pm Letby notes: Child O had vomitted [undigested milk], tachycardiac and abdomen distended. NG tube placed on free drainage...blood gas poor as charted...saline bolus given as prescribed with antibiotics. Placed nil by mouth and abdominal x-ray performed. Observations returned to normal'

Prior to 2.40pm x-ray report of 'possible onset of sepsis' by a consultant radiologist said Child O's appearance had improved on a subsequent image. 'NEC or mid gut volvulus cannot be excluded'.

2.40pm A doctor notes: 'Called to see [Child O] at [about] 1440. Desaturation, bradycardia and mottled. Bagged up and transferred to Nursery 1. Neopuff requirement in 100% oxygen...'

2.40pm Letby notes: 'Approx 1440 [Child O] had a profound desaturation to 30s followed by bradycardia. Mottled++ and abdomen red and distended...'

2.46pm shift leader Melanie Taylor enters NICU

3pm Consultant writes 'Child O intubated about 3pm when [doctor colleague's] fast bleep went off. Arrived to find [Child O] was being bagged. Desat to 35...'

3.03-3.08 The doctor records Child O was intubated 'at first attempt'.

3.49pm bleep data shows crash call made

3.51pm LL notes Drs crash called due to desaturation to 30s with bradycardia, minimal chest movement and air entry observed. Reintubated...'

Morphine administered around this time, no exact time given.

4.15pm A doctor records a further collapse and chest compressions commence.

4.19pm LL notes retrospectively CPR commenced 16:19 and medications/fluids given as documented...IV fluids 10% glucose...morphine...'

4.26pm Adrenaline given as well as a prescription for sodium bicarbonate.

4.30pm Dr Brearey records he is called back

5pmish LL notes: 'Placed back on to ventilator. Dopamine commenced....Flecks of blood from NG tube. Discolouration to abdomen. Unable to obtain heel prick...due to poor perfusion.'

5.47pm O dies After 30 mins of resus Dr Brearey notes

LL does incident report 30 June to say resources not available on unit' to deal with resus and that 'staff obtained equipment from children's ward' and that there was a 'delay in this happening due to staff being needed for infant care needs'

Based on
Recap: Lucy Letby trial, Wednesday, March 8


And https://twitter.com/MrDanDonoghue

So the abdomen was already “quite full” before LL had even returned from holiday. And the reporting doesn’t indicate that the full abdomen had been resolved by the time LL started her shift. Indeed, another nurse is saying that it still appears full and “loopy” 2 minutes after LL has started her shift.

Not sure how the experts are going to make the case that a further injection of air took place while LL was on duty , which allegedly caused the death.

 

[GoodDayToYouSir]

Yes a doctor told the family there would be according to today's report.

From the prosecution opening statements on baby O:

“A post-mortem examination found free un-clotted blood in the peritoneal (abdominal)space from a liver injury. There was damage in multiple locations on and in the liver. The blood was found in the peritoneal cavity. He certified death on the basis of natural causes and intra-abdominal bleeding.

He observed that the cause of this bleeding could have been asphyxia, trauma or vigorous resuscitation.”

 

[GoodDayToYouSir]

Just my non expert view, but I would have thought that a post mortem would have identified signs of AE if they had been present.

I am also interested to see/hear how people respond to cases where the pathologist (who literally sees dead bodies for a living every day) comes to different conclusions regarding cause of death compared to Dr Evans and Bohin, who aren’t there for the autopsy or conducting it, and are going off of notes and reports .

 

[GoodDayToYouSir]

Sorry, a deluge of posts! But from the prosecution opening :

“Dr Dewi Evans concluded Child O's death was the result of a combination of intravenous air embolus and trauma. The liver injury was not in his view consistent with vigorous CPR. His view was that the liver damage would have occurred before the collapse and contributed to it and was probably the reason for his symptoms through the morning. As for the air in the bowel loops, Dr Evans concluded that that was consistent with excessive air going down via the NGT.”



“A post-mortem examination found free un-clotted blood in the peritoneal (abdominal)space from a liver injury. There was damage in multiple locations on and in the liver. The blood was found in the peritoneal cavity. He certified death on the basis of natural causes and intra-abdominal bleeding.

He observed that the cause of this bleeding could have been asphyxia, trauma or vigorous resuscitation.”

Surely the fact that the post mortem found “free unclotted blood” from a liver injury supports the pathologist’s opinion that the trauma was as a result of CPR?

Because if the bleeding had been caused much earlier (dr evans says it was caused earlier and probably the reason for the baby’s symptoms during the course of the morning), there would surely be evidence of clotting? The fact that there was free unclotted blood suggests it happened just before death (ie during CPR) so that the body didn’t have time to start the clotting process before death occurred?

(Just the thoughts of a completely non medical person, as always).

 

[Sundial]

So the abdomen was already “quite full” before LL had even returned from holiday. And the reporting doesn’t indicate that the full abdomen had been resolved by the time LL started her shift. Indeed, another nurse is saying that it still appears full and “loopy” 2 minutes after LL has started her shift.

Not sure how the experts are going to make the case that a further injection of air took place while LL was on duty , which allegedly caused the death.

It’s also the x-ray report; can’t exclude certain factors and another that wasn’t time-stamped etc. Considering parents have previously also mentioned *handwashing* and this whole hand hygiene thing makes a grim read imo. I wouldn’t be surprised if there was gastroenteritis on the ward somewhere either tbh. Didn’t baby Ns mother say she felt unwell? I wonder what that was.

Either way just from what I’ve heard recently; I certainly wouldn’t want my baby being cared for if staff aren’t washing their hands properly. Infection control could have a field day here.

ETA: my own opinion of course

 

[Parker Knoll]

I would be absolutely staggered if the defence do not call their own experts.
It would be madness not to.

 

[ColourPurple]

So the abdomen was already “quite full” before LL had even returned from holiday. And the reporting doesn’t indicate that the full abdomen had been resolved by the time LL started her shift. Indeed, another nurse is saying that it still appears full and “loopy” 2 minutes after LL has started her shift.

Not sure how the experts are going to make the case that a further injection of air took place while LL was on duty , which allegedly caused the death.

It's not clear who wrote the 7.32am note, as LL was on shift from 7.30am but there's a big difference between a baby's stomach being described as full but soft, and it being so swollen, he looked like ET.

 

[JerseyGirl]

Lucy Letby: parents begged for baby to be moved to different hospital, trial hears

Nurse is accused of murdering triplet’s baby brothers in 24 hours at Countess of Chester hospital in 2016

www.theguardian.com

 

[marynnu]

What do you folks make of this thing about LL being in "floods of tears" after Baby P died?

 

[Tortoise]

his quote about dr evans and the thirty minutes resus looked informed. He mentions the nitrogen in air and the likelihood of it disappearing. I don’t think that’s something a non informed individual would say about AE.

I think this might have arisen during the course of Professor Kinsey's cross-examination earlier in the trial.

2:59pm

Prof Kinsey's report, dated November 1, 2022, is referred to.
Mr Myers says Prof Kinsey was asked to give further consideration as to how an air embolism worked.
She says she was asked to give further explanation on the features of an air embolism. She said she was not an expert in such mechanisms, but has provided an explanation.
Mr Myers says the report notes there is very little medical literature in relation to air emboli.
Mr Myers: "You have used your knowledge of blood and circulation to assist this?"
Prof Kinsey: "Yes."
Mr Myers says part of the limited medical literature relates to decompression in deep-sea divers, colloquially known as 'the bends', and that in those circumstances, nitrogen bubbles would be in the circulation longer than oxygen bubbles. He asks Prof Kinsey if that is the case.
Prof Kinsey: "I don't know the answer to that question."

3:04pm

Mr Myers says the research paper in question [for 'the bends'] dealt with four overweight deep-sea diving adults.
Prof Kinsey: "Yes, there were many limitations to their findings."
Mr Myers said the results were "very specific based to the people [in that study]."
Mr Myers asks if the symptoms of decompression sickness would always result in skin discolouration. Prof Kinsey said it would not.
Mr Myers asks if that can be applied to babies - if an air embolus could always lead to skin discolouration observations. Prof Kinsey said it would not.

3:07pm

Prof Kinsey says the problem with decompression syndrome, in comparison to air embolus in infants, is the bubbles get larger as the deep-sea diver returns to the surface.
Mr Myers says that is another limitation of the available medical literature for air emboli.
Prof Kinsey says the reason that study was used in her report was that skin discolouration had been an observation in that study, as it had been in cases of air embolus.

3:08pm

Prof Kinsey says the scale of the air embolus problem would depend on the size of the air bubble and the type of vessel that it is in.

3:10pm

Upon a question from the judge, Prof Kinsey says she has never encountered any discussion about nitrogen bubbles in the system, other than in deep-sea divers.
She says the biggest factors for any air embolus would be the size of the air bubble and the vessel that it is in.
What was not a factor in her discussions was the quantities that made up the air [ie what amount was nitrogen, what amount was oxygen, carbon dioxide, etc].

LIVE: Lucy Letby trial, Tuesday, November 29

 

[Anxala]

IMHO having read some info on Mr Myers and the past cases he has been involved in, he is too experienced to attack Dr Evans without good reason.

Yes, the side-eyeing of BM and his approach is disconcerting and has to be coming from a place of not being at all familiar with him and his professional history. This is really not someone who comes in unprepared. Added to which we're only getting a % of the picture of what's actually been said in court, so judging him on the basis of what we get to hear/know is as 'fruitful' imo as what we get to hear/know about his client.

I posted a link to his profile on an earlier thread and I'm posting it again now just as a reminder that this is so not some out-of-his-depth Johnny come lately, looking to eg. up his media profile for likes on SM.

Benjamin Myers KC - Criminal CV | Exchange Chambers

Ben specialises in serious crime. He is instructed consistently in cases of murder, manslaughter, high value fraud, money laundering, multimillion-pound confiscation under POCA, drug trafficking, national and international organised crime, rape, historic sexual abuse and armed robbery.

www.exchangechambers.co.uk

And this:

Benjamin Myers QC | King's Counsel Appointments

We met at Benjamin Myers’ rooms in Exchange Chambers in Manchester. Ben is one of the 100 Silks appointed in 2014 and one of 20 of the new QCs who were based outside of London. Called to the Bar in 1994, Ben specialises in serious crime. As well as appearing regularly for the defence, he is a...

kcappointments.org

 

[ColourPurple]

What do you folks make of this thing about LL being in "floods of tears" after Baby P died?

Sounds a bit out of character tbh compared to her lack of reaction at other times (other than when she was crying over it always being her babies, and crying at the mention of Dr Nice Guy's name in court)

What was different this time? It says a doctor was in tears too. Was the doctor, Dr NiceGuy? It sounds like he may have been working day shifts that week? Was he present at the deaths? His text messages have shown he's great believer in the benefits of having a good cry.

 

[Tortoise]

Sorry, a deluge of posts! But from the prosecution opening :

“Dr Dewi Evans concluded Child O's death was the result of a combination of intravenous air embolus and trauma. The liver injury was not in his view consistent with vigorous CPR. His view was that the liver damage would have occurred before the collapse and contributed to it and was probably the reason for his symptoms through the morning. As for the air in the bowel loops, Dr Evans concluded that that was consistent with excessive air going down via the NGT.”



“A post-mortem examination found free un-clotted blood in the peritoneal (abdominal)space from a liver injury. There was damage in multiple locations on and in the liver. The blood was found in the peritoneal cavity. He certified death on the basis of natural causes and intra-abdominal bleeding.

He observed that the cause of this bleeding could have been asphyxia, trauma or vigorous resuscitation.”

Surely the fact that the post mortem found “free unclotted blood” from a liver injury supports the pathologist’s opinion that the trauma was as a result of CPR?

Because if the bleeding had been caused much earlier (dr evans says it was caused earlier and probably the reason for the baby’s symptoms during the course of the morning), there would surely be evidence of clotting? The fact that there was free unclotted blood suggests it happened just before death (ie during CPR) so that the body didn’t have time to start the clotting process before death occurred?

(Just the thoughts of a completely non medical person, as always).

On quoting in a separate post above from the evidence of Professor Kinsey I happened to notice this line about blood clotting -

"For the haematology, he asks for Child E, whether it is a general point that such a child would not develop the levels of blood clotting as you would see in a more developed child or adult. Prof Kinsey agrees."

Recap: Lucy Letby trial, Tuesday, November 29

 

[Tortoise]

I would be absolutely staggered if the defence do not call their own experts.
It would be madness not to.

That has to depend on the conclusions reached, surely

 

[Cardgame]

Presumably the pathologist makes notes of observations, from which they draw their overall conclusions.

So the same observations can lead to different conclusions.

The first report says 'could have been caused by' but doesn't list 'malicious intent infliction of injury' because at that time, insofar as that person knew, that couldn't be an option.

If a different child dies at home, away from doctors, with similar internal bleeding, perhaps a malicious cause would be considered.

There is always context to the post mortem IMO. They needed to try and explain the medical cause. Once they established there could be a non medical cause, the same set of observations led to different conclusions.

JMO. Might be totally wrong!

 

[esther43]

Just because someone doesn't think of EVERY possibility the first round of an investigation, that does not make them incompetent. Even a very experienced doctor may not think of every single possibility if that one possibility was very rare and seemed, to them, unlikely.

Even as a very experienced doctor, I am sure he has NEVER encountered a nurse maliciously attacking newborns with various deadly methods. Why would he consider that as an initial possibility?


It may not have occurred to him until he began seeing the weird patterns, like babies considered well enough to go home, to suddenly have unexplained collapses, needing 20 to 30 shots of adrenaline. That was a sudden pattern, the need for many adrenaline shots, that was unusual and reoccurring.

I don't see it necessarily as sub-conscious confirmation bias----I think it might be more of slow epiphany or evolving revelation, after watching various patterns unfold. JMO

I agree and remembering that it took 2 years or more to bring it to trial. I'm so confused why people criticize Evans for changing his reports based on emerging evidence.
This would seem to me to be the logical thing to do rather than an example of a corrupt process.
How on earth would the police make sense of the medical data without medical guidance? How would they even be competent in investigation were it not for for medical guidance?

 

[Cardgame]

What do you folks make of this thing about LL being in "floods of tears" after Baby P died?

Pretty odd IMO.

Maybe inevitable to feel creeped out by the idea of her weeping and dressing them and making a memory box, given the accusations she faces.

But the grief belongs to the parents.

 

[LorriB]

So the abdomen was already “quite full” before LL had even returned from holiday. And the reporting doesn’t indicate that the full abdomen had been resolved by the time LL started her shift. Indeed, another nurse is saying that it still appears full and “loopy” 2 minutes after LL has started her shift.

Not sure how the experts are going to make the case that a further injection of air took place while LL was on duty , which allegedly caused the death.

That's right and nurse Ellis confirmed this in court. There was already something different going on medically with the baby after an otherwise uneventful 2 days.

"Nurse Ellis says this was something notable for Child O, hence the need for a second opinion. It was not a concern in intself, taking into context other observations, but it was "one to keep an eye on".

I noticed that around the time he seems to start showing signs of his stomach swelling, antibiotics have stopped. Could well be coincidental.

 

[esther43]

That has to depend on the conclusions reached, surely

You know what they say... You can't drink from an empty cup! - that's me just being cynical, I agree they'd be mad not to try.
This 'medical expert' role is an interesting one to unpick. The guiding values of the nhs and the justice system seem streets apart. ..