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

[Tortoise]

Was there mention of a cold cot or cuddle cot?

Simon Rothwell, a founder of CuddleCot and former policeman, started the company after previously working on cooling devices for deceased obese people and then visiting children’s hospices where bodies tended to be kept in cold rooms along with the parents who would stay for days with a deceased child, while being extremely cold themselves.

In hospitals, the Cuddlecot might allow the parents to spend a night with the baby. However, if the mother has had a traumatic labour and has been unable to see their baby for a few days this might be longer. Mr Rothwell says how long the baby can be kept in the Cuddlecot depends on a number of variables including when the baby died and how often it has been taken out of the cot. He is aware of a family who kept their baby for a few weeks over Christmas because they did not want to be apart from it at that time of year.

The cot which gives parents of stillborn babies more time with them

For many grieving parents, a Cuddlecot can mean spending a few more days with the baby they carried for nine months

www.independent.co.uk

I had no idea! Yes there was mention of a cooling moses basket in one of the tweets. Thanks for that.

 

[Tortoise]

"The social media chat includes a series of messages between her and a consultant registrar that one nursing colleague had earlier suggested she was 'flirting' with.

In one conversation she simply writes: 'Boo'.

He replies with a winky emoji.

In other messages the paediatrician and nurse joke about reporting in sick so they can go home.

[...]

Later, the two colleagues find themselves working side by side as a team of medics work frantically to save first Baby O and later his brother.

[...]

The same registrar was there, along with a female paediatrician and Letby. 'O's cot was now flat and the team were around him. I sat outside in my wheelchair. Lucy was running around sorting out stuff for the doctors. She was going into the room marked 'Sterile'."

Nurse Lucy Letby 'murdered two triplets immediately after holiday'

 

[GoodDayToYouSir]

Accuracy is really important when one is making any implication of impropriety.

He didn't change his opinion on the stand as regards an injection of air on the 12th.

The court report said -

"Mr Myers says the 2019 report said Dr Evans raised a possibility of deliberate injection of air from June 12 via the naso-gastric tube.
Dr Evans, reflecting on that report, said: "Can't rule it out".
Mr Myers refers to a 'massive gastric dilation' was 'most likely' due to an injection of air on June 12.
Dr Evans: "That was a possibility, yes."
Dr Evans said what was being discussed, on June 12, there was a "distinct possibility" Child C had excess air in the stomach from CPAP belly.
He was "still stable" from a respiratory point of view.
He tell the court: "However the air went in, it would have been insufficient to splinter the diaphragm on the 12th, as he would've collapsed and died on the 12th."
The air which had gone in was 'insufficient' to cause a collapse. There was 'nothing to suggest' the excess air was enough on June 12.
He says the two events on June 12 and 13 "are quite different" in the way they happened.
Mr Myers said that it was Dr Evans's view, a couple of months ago, there was deliberate harm on June 12.
"That was a possibility, yes it was."

Mr Myers says the x-ray from June 12 had helped form Dr Evans's initial view that there had been an air injection into the stomach.
"That was an opinion I have expressed, yes."
Mr Myers asks Dr Evans what evidence there is to support that air had been injected into the stomach on June 13.
Dr Evans: "The baby collapsed and died."


If anything it shows he was not honing in on a suspect as some here seem to think. He didn't ever opine that one explanation for air in child C's stomach on the 12th being deliberate, the other being CPAP belly, killed him a day later.

Dr Evans didn't admit there was no new evidence since his earlier reports to make him change his opinion. He said the exact opposite.

The court report said -

"Mr Myers suggests that Dr Evans's opinion alone would not have reached this conclusion.
Dr Evans said the death could not be explained from the usual causes babies get. He said, taking into account all the other evidence and information from experienced medical people's reports, and reading the pathology report, the splintering of the diaphragm was now his conclusion.
He said he was functioning as a clinician.

He adds that in coming to his conclusion for this case he is not relying solely on his opinions, but taking in other clinical evidence and reports.
"That is what doctors do, we do it all the time." in what Dr Evans says is a "complicated case".

Dr Evans tells the court the process in accumulating information in reaching his conclusions.

Dr Evans says if he receives additional evidence, then he will change his mind

He adds, for further medical information, he would prefer to defer the matter to the radiologist and pathologist.
He said he objects to being accused by Mr Myers of making things up, and says he is putting forward the information in this case as a result of his own opinion and that of other people's reports.

Mr Myers suggests that Dr Evans has just made up information as he has gone along.
"You keep saying that, and I keep disagreeing."


Dr Sandie Bohin came to the same conclusion.

Recap: Lucy Letby trial, Tuesday, November 1

JMO

ETA This is in relation to child C

- He’s introduced injection of air on 13 June for the first time and IMO, based on his careful choice of words, has changed his conclusion that there was an injection of air on 12 June.

Look at his words. “That was a possibility , yes.” “That was an opinion I have expressed .”

IMO , his careful choice of words is revealing.

- in relation to 13 June, dr evans said this on the stand:

“Mr Myers asks Dr Evans what evidence there is to support that air had been injected into the stomach on June 13.

Dr Evans: "The baby collapsed and died."

“Asked to explain further, Dr Evans says it was part of a differential diagnosis.

He said there were three clinical scenarios - injecting air into the stomach that interfered with his breathing, or that air was injected intraveneously, or from a combination of the two, which Dr Evans says "sounds awful".

Dr Evans says, from his perspective, from an academic point of view, he would not be able to rule out any one of those three scenarios.” “

- I don’t think Dr bohin did come to the same conclusion about this:

“Dr Bohin said it was not clear from the notes how long the 'free drainage' was in place.

She said one conclusion for Child C's collapse was CPAP accumulation of air, the other being deliberate injection of air.”

I don’t think dr evans was writing these reports with a particular suspect in mind. But once the prosecution noticed that dr evans’ report was saying there was a deliberate injection of air on a day when LL couldn’t have done it, it is IMO naive to think there weren’t conversations between the prosecution and dr evans regarding his conclusions about 12 June.

 

[Parker Knoll]

It might not be so simple in a case with multiple experts aligning.

JMO

Oh agreed - it would be near on impossible.

 

[WaxLyrical]

Re Baby O’s, I understand they are alleging air embolus, but are they saying that LL also caused the liver injury? It sounds like abdominal issues were presenting themselves before LL came on shift?

 

[Parker Knoll]

Dr Andreas Marnerides, the reviewing pathologist, thought that the liver injuries were most likely the result of impact type trauma and not the result of CPR.

He thought that the excess air via the NGT was likely to have led to stimulation of the vagal nerve which has an effect on heart rate and would have compromised Child O's breathing.

He could not say whether it was either of these factors in isolation or in combination which caused Child O's death.

He certified the cause of death to be “Inflicted traumatic injury to the liver and profound gastric and intestinal distension following acute excessive injection or infusion of air via a naso-gastric tube” and air embolus.

​

 

[esther43]

What I can't understand is how she brought the two brothers to the parents, because they died a day apart. Sounds horrible to say, but did she retrieve baby O from the mortuary, or have I completely misunderstood?

Hmm, I suppose baby O could have been placed in a cool crib and they could have had some time with him, then perhaps after child P they put them together so they could be together as a family..

 

[Tortoise]

- He’s introduced injection of air on 13 June for the first time and IMO, based on his careful choice of words, has changed his conclusion that there was an injection of air on 12 June.

Look at his words. “That was a possibility , yes.” “That was an opinion I have expressed .”

IMO , his careful choice of words is revealing.

- in relation to 13 June, dr evans said this on the stand:

“Mr Myers asks Dr Evans what evidence there is to support that air had been injected into the stomach on June 13.

Dr Evans: "The baby collapsed and died."

“Asked to explain further, Dr Evans says it was part of a differential diagnosis.

He said there were three clinical scenarios - injecting air into the stomach that interfered with his breathing, or that air was injected intraveneously, or from a combination of the two, which Dr Evans says "sounds awful".

Dr Evans says, from his perspective, from an academic point of view, he would not be able to rule out any one of those three scenarios.” “

- I don’t think Dr bohin did come to the same conclusion about this:

“Dr Bohin said it was not clear from the notes how long the 'free drainage' was in place.

She said one conclusion for Child C's collapse was CPAP accumulation of air, the other being deliberate injection of air.”

I don’t think dr evans was writing these reports with a particular suspect in mind. But once the prosecution noticed that dr evans’ report was saying there was a deliberate injection of air on a day when LL couldn’t have done it, it is IMO naive to think there weren’t conversations between the prosecution and dr evans regarding his conclusions about 12 June.

He hasn't once said he's changed his opinion about June 12th. Considering it was an allegation of harm on 12th, and not murder (on 13th), it wouldn't be reflected in the charges even if it was his opinion. He said "can't rule it out". Other things like the insulin happened when LL was off shift. It is what it is, and you are suggesting that the experts are manipulating this case to shore up a prosecution.

He said he updated his opinion based on the reports of other medics, the radiologist and pathologist, opinions he wouldn't have had at the time of his reports, which as he says, is what clinicians do when additional information becomes available.

There is zero evidence that there were conversations between Dr Evans and the prosecution regarding his opinions about 12th June, which were not material to the charges. Please quote the part of his testimony where he says he changed his opinion. There would be no point, knowing that the defence would have copies of all of his reports.

With regard to Dr Bohin she added to the part you have quoted -

She said one conclusion for Child C's collapse was CPAP accumulation of air, the other being deliberate injection of air.
She said the doctors did not appear to have a concern as they had noted the abdomen to be "soft".

Recap: Lucy Letby trial, Tuesday, November 1


Another expert paediatrician, Dr Sandie Bohin, said she believed the only plausible explanation for Baby C's collapse was an introduction of air into his system.

Baby 'suffocated when Lucy Letby injected air into his stomach': trial

 

[esther43]

The testimony from dr evans re: baby c :

Recap: Lucy Letby trial, Tuesday, November 1

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

And LL shift patterns mentioned at entry at 12:10pm:

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

So had a good read through. I'm trying to get with your train of thought. You say you distrust Evans but we don't know the reason behind his changing the testimony. He refers to drawing upon particular sources of knowledge to redefine the emerging picture, this included peer reviewing Bohen's reports which were fairly impartial. If something new comes to the table then that changes things. that doesn't have to be new evidence, it can include new knowledge too.
It's worth remembering (or at least hoping!) That air embolism in vulnerable newborns is incredibly rare. I'm imagining that it would be more peculiar to not change a view point throughout a learning process.

 

[magikarpmagikarp]

Esther I agree. It's my understanding is that doctors take both subjective and objective information (symptoms and signs) as well as history, in formulating their diagnoses. Even outside of a situation like this, it's completely normal for doctors to revise their diagnosis when new information, signs, symptoms, or history becomes available. Additionally, a diagnosis has to be coherent with all the information. It's very common for doctors to revise a diagnosis when more information becomes available, either retrospectively or through the passage of time.

JMO.

 

[GoodDayToYouSir]

He hasn't once said he's changed his opinion about June 12th. Considering it was an allegation of harm on 12th, and not murder (on 13th), it wouldn't be reflected in the charges even if it was his opinion. He said "can't rule it out". Other things like the insulin happened when LL was off shift. It is what it is, and you are suggesting that the experts are manipulating this case to shore up a prosecution.

He said he updated his opinion based on the reports of other medics, the radiologist and pathologist, opinions he wouldn't have had at the time of his reports, which as he says, is what clinicians do when additional information becomes available.

There is zero evidence that there were conversations between Dr Evans and the prosecution regarding his opinions about 12th June, which were not material to the charges. Please quote the part of his testimony where he says he changed his opinion. There would be no point, knowing that the defence would have copies of all of his reports.

With regard to Dr Bohin she added to the part you have quoted -

She said one conclusion for Child C's collapse was CPAP accumulation of air, the other being deliberate injection of air.
She said the doctors did not appear to have a concern as they had noted the abdomen to be "soft".

Recap: Lucy Letby trial, Tuesday, November 1


Another expert paediatrician, Dr Sandie Bohin, said she believed the only plausible explanation for Baby C's collapse was an introduction of air into his system.

Baby 'suffocated when Lucy Letby injected air into his stomach': trial

When asked about the opinions he wrote in his reports regarding 12 June, dr Evans says “that WAS a possibility “ and “ that WAS an opinion I have expressed .” He doesn’t say “that IS a possibility “. IMO, he is saying “was “ to indicate that it is no longer his view.

I’m not suggesting that the experts are manipulating the evidence to shore up the prosecution’s case. I have said many times that I think Dr Bohin is very credible and persuasive, as are the other specialists we’ve heard from.

With dr Evans, the defence has said that he changes his opinions in order to fit the evidence. The judges in the Court of Appeal said the exact same thing about Dr Evans. I am saying that for me, those arguments have landed.

However, as I have also said before , that doesn’t mean I would find LL not guilty of all charges. I would not have a problem with concluding that a murder or AM has taken place based solely on Dr Bohin’s opinions because I think she is very credible (subject of course to anything the defence puts forward to debunk her evidence).

 

[GoodDayToYouSir]

He hasn't once said he's changed his opinion about June 12th. Considering it was an allegation of harm on 12th, and not murder (on 13th), it wouldn't be reflected in the charges even if it was his opinion. He said "can't rule it out". Other things like the insulin happened when LL was off shift. It is what it is, and you are suggesting that the experts are manipulating this case to shore up a prosecution.

He said he updated his opinion based on the reports of other medics, the radiologist and pathologist, opinions he wouldn't have had at the time of his reports, which as he says, is what clinicians do when additional information becomes available.

There is zero evidence that there were conversations between Dr Evans and the prosecution regarding his opinions about 12th June, which were not material to the charges. Please quote the part of his testimony where he says he changed his opinion. There would be no point, knowing that the defence would have copies of all of his reports.

With regard to Dr Bohin she added to the part you have quoted -

She said one conclusion for Child C's collapse was CPAP accumulation of air, the other being deliberate injection of air.
She said the doctors did not appear to have a concern as they had noted the abdomen to be "soft".

Recap: Lucy Letby trial, Tuesday, November 1


Another expert paediatrician, Dr Sandie Bohin, said she believed the only plausible explanation for Baby C's collapse was an introduction of air into his system.

Baby 'suffocated when Lucy Letby injected air into his stomach': trial

One more thing.

The original murder charge for baby C was that LL murdered him between 12 and 15 June 2015.

 

[esther43]

Esther I agree. It's my understanding is that doctors take both subjective and objective information (symptoms and signs) as well as history, in formulating their diagnoses. Even outside of a situation like this, it's completely normal for doctors to revise their diagnosis when new information, signs, symptoms, or history becomes available. Additionally, a diagnosis has to be coherent with all the information. It's very common for doctors to revise a diagnosis when more information becomes available, either retrospectively or through the passage of time.

JMO.

Yes, a really good example of objectivity was in Bohen's review of the same case referenced in the above thread (child C) She observed that there was a not enough information recorded to categorically rule out the possibility that the air inside the baby C's abdomen was a result of the NG tube not being put on free drainage.
So in this case she offered a 50/50 guess at what might have caused the diaphragm to split.
It's notable that in other cases, she has not been able to display this objectivity.

 

[Tortoise]

When asked about the opinions he wrote in his reports regarding 12 June, dr Evans says “that WAS a possibility “ and “ that WAS an opinion I have expressed .” He doesn’t say “that IS a possibility “. IMO, he is saying “was “ to indicate that it is no longer his view.

I’m not suggesting that the experts are manipulating the evidence to shore up the prosecution’s case. I have said many times that I think Dr Bohin is very credible and persuasive, as are the other specialists we’ve heard from.

With dr Evans, the defence has said that he changes his opinions in order to fit the evidence. The judges in the Court of Appeal said the exact same thing about Dr Evans. I am saying that for me, those arguments have landed.

However, as I have also said before , that doesn’t mean I would find LL not guilty of all charges. I would not have a problem with concluding that a murder or AM has taken place based solely on Dr Bohin’s opinions because I think she is very credible (subject of course to anything the defence puts forward to debunk her evidence).

I don't think you'll find that quote in anything the Court of Appeal said about him.

However, yes that is exactly what he is saying - he changes his opinions to fit the evidence. New information he saw after he wrote his reports.

It is correct to use the word WAS when talking about a report written 2 years ago, and also an opinion which the prosecution didn't pursue in its case. He also said 'can't rule it out' which puts it firmly in the present. What he doesn't say anywhere is that is no longer my view.

Dr Evans and Dr Bohin came to the same conclusion over the cause of his death. It makes no sense to me to hold one expert in higher esteem when they concur.

JMO

 

[Tortoise]

One more thing.

The original murder charge for baby C was that LL murdered him between 12 and 15 June 2015.

He died on 14th June.

How does that range of dates prove that he no longer thinks what he did about the possibility of harm on the 12th?

 

[GoodDayToYouSir]

He died on 14th June.

How does that range of dates prove that he no longer thinks what he did about the possibility of harm on the 12th?

You said in your previous post “Considering it was an allegation of harm on 12th, and not murder (on 13th), it wouldn't be reflected in the charges even if it was his opinion.”

My point is that the charges did originally reflect Dr Evans’ report about harm being caused by LL on 12 June.

 

[Tortoise]

You said in your previous post “Considering it was an allegation of harm on 12th, and not murder (on 13th), it wouldn't be reflected in the charges even if it was his opinion.”

My point is that the charges did originally reflect Dr Evans’ report about harm being caused by LL on 12 June.

It's quite common for indictments to be drafted between a range of dates initially, just as baby I's was.

The 13th, close to midnight, is the date that LL is alleged to have injected air into baby C, and she died just before 6am on the 14th. I used the date that Myers and Evans used in his cross-examination.

"He says the two events on June 12 and 13 "are quite different" in the way they happened."
"Mr Myers asks Dr Evans what evidence there is to support that air had been injected into the stomach on June 13."

There is no way for you to know that the charges initially reflected Dr Evans' opinion about the 12th. The prosecution had other expert reports and they are not forced to allege any harm they don't feel passes the threshhold. This demonstrates nothing as regards Dr Evans' opinions.

MOO

 

[GoodDayToYouSir]

I don't think you'll find that quote in anything the Court of Appeal said about him.

However, yes that is exactly what he is saying - he changes his opinions to fit the evidence. New information he saw after he wrote his reports.

It is correct to use the word WAS when talking about a report written 2 years ago, and also an opinion which the prosecution didn't pursue in its case. He also said 'can't rule it out' which puts it firmly in the present. What he doesn't say anywhere is that is no longer my view.

Dr Evans and Dr Bohin came to the same conclusion over the cause of his death. It makes no sense to me to hold one expert in higher esteem when they concur.

JMO

The exact quote was “Instead the report has the hallmarks of an exercise in ‘working out an explanation’ that exculpates the applicants” and also describes Dr Evans’ report as “worthless”. Which is about as bad as you can get.

So the allegation from the defence (backed up by the court of appeal in that particular case) is that he moulds his “expert” opinions on the evidence to fit with a desired conclusion.

Bohin and Evans may well come to the same conclusions in cases. But what I am saying is that we are hearing the defence launch various attacks against the experts and just like everything else, we have to consider whether those attacks are valid in our opinions or not. For me, there have been several things about dr evans which have hit the mark, to the extent that I don’t really rate his evidence now. Similar attacks against dr bohin and her credibility have , in contrast, not landed IMO .

So it doesn’t matter to me whether dr evans agrees with dr bohin in a particular case. What I would be basing my decisions on would be Dr Bohin’s opinions , for the reasons I’ve said.

 

[Tortoise]

The exact quote was “Instead the report has the hallmarks of an exercise in ‘working out an explanation’ that exculpates the applicants” and also describes Dr Evans’ report as “worthless”. Which is about as bad as you can get.

So the allegation from the defence (backed up by the court of appeal in that particular case) is that he moulds his “expert” opinions on the evidence to fit with a desired conclusion.

Bohin and Evans may well come to the same conclusions in cases. But what I am saying is that we are hearing the defence launch various attacks against the experts and just like everything else, we have to consider whether those attacks are valid in our opinions or not. For me, there have been several things about dr evans which have hit the mark, to the extent that I don’t really rate his evidence now. Similar attacks against dr bohin and her credibility have , in contrast, not landed IMO .

So it doesn’t matter to me whether dr evans agrees with dr bohin in a particular case. What I would be basing my decisions on would be Dr Bohin’s opinions , for the reasons I’ve said.

The Court of Appeal judgement didn't say he changed his opinion to fit the evidence. We don't know whether he initially held a different opinion in that case.

This looks to me exactly like mud slinging, unsupported by the evidence he gave.

He explained to the court why he revised his final conclusions, that is all.

And I will leave it at that.

 

[Sundial]

Sorry I don't know how this is going to land but I've had a real shitter of a day and a lot of this is extremely triggering. My heart breaks for these families.

The more I read anything from the doctors along the lines of 'it would never have occurred to me that a nurse would be attacking babies', the angrier I get. That's why we have safeguarding, right? If you provide care for vulnerable people - in this case poorly babies - then you have a duty of care to prevent them coming to harm.

When it is clear to you that the babies in your care are coming to harm, it is your job to consider all the possibilities - including staff negligence or malice. That isn't to say they are your only options, but you need to be open to considering them, right? Otherwise that is such an obvious way a child is going to come to harm?

Surely it's the same with teachers? Ideally, a teacher would never need to suspect another of harming a child but we all know we do not live in that world.

I understand that the Trust aren't the ones on trial here, and should the jury find LL guilty then none of this mitigates what she has done, but I feel so angry that the safety and wellbeing of these babies is being so readily dismissed. I hope this features somewhere in Myres closing statement. When RJ and his colleagues had their discussions, what was actually said? Where are the emails that were sent to the Head of Nursing and then... was it the Medical Director? I can't remember.

And why only the Head of Nursing in the first instance? I assume because their suspicions either were that it was a problem with LL either negligently or perhaps within the wider nursing staff? It's really difficult to work out what LL's colleagues made of her - it seems like she did have a close knit group of friends who regularly checked in on each other and used each other for emotional support (LL mostly on the receiving end), and sometimes we might think she's seen as driven, competent and capable through some of her interactions with the drs praising her, but then other times we hear that there are some that feel she might be out of her depth and seem worried about the care she is giving to the sicker babies (this is just my inference).

Again, I think we need to see exactly what RJ said to the Head of Nursing, and what she said 'probably not, let's see' to. Because is that actually what she said? When babies were dying? Let's see. (I will edit if I have misrememberd). I could go on and on but my heart is so broken. I have no idea if LL is guilty. But I do believe that if I am to believe what the prosecution say, then yes she is guilty of something I will never, ever be able to comprehend - but we are also here because so many people failed to protect those babies and their families.

JMO - mods delete if too aggy - sorry everyone x

I feel this same kind of heartbreak for these families, and what they must have gone through and continue to go through; I’m sorry you’ve not had a great day too. It’s a heartbreaking trial and I agree with everything you have said.