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

[marynnu]

I wonder who was doing the calculations, would that be a doctor? or is that similar to the evidence we heard in an earlier case where a chart was missing and the designated nurse did the calculations.

JMO

I

I really hope not. Nurses check calculations, they shouldn't be doing this independently.
This evidently refers to the infusion, not the bolus doses, as Dr. Bohin mentions 'rate'.

 

[Imogenia]

I keep coming back to the below text, in particular the bolded part. I don't know why but I have this niggling feeling it fits what prosecution believe is her MO. There's been several references to her parents and childhood. Thinking out loud is all.

Letby replied: “Cockington is gorgeous!! We always go there for afternoon tea. Dad was offered a job in Paignton many moons ago, could have been a very different childhood growing up by the sea. Looking forward to going back.

Lucy Letby told colleague she ‘wanted to cry’ after baby collapsed

MURDER-ACCUSED nurse Lucy Letby told a colleague she “wanted to cry” after a baby in her care had collapsed, her trial has heard.

www.chesterstandard.co.uk

I think that we all look back to childhood, maybe romanticising it: there’s a piece of prose that talks of ‘that far-off land called childhood, where nobody really dies ...’.

 

[Kemug]

I do wonder if "management" was a mostly female group, and "senior consultants" were mostly male. Then it could be possible that some persons in "management" were not about to be dictated to by "senior consultants". Just a thought.

 

[ColourPurple]

I

I really hope not. Nurses check calculations, they shouldn't be doing this independently.
This evidently refers to the infusion, not the bolus doses, as Dr. Bohin mentions 'rate'.

So is this like the TPN bag where two nurses would have signed it off? Who would have calculated the dose?

I can't work out if the infusion would've been done during the resus or after?

 

[marynnu]

So is this like the TPN bag where two nurses would have signed it off? Who would have calculated the dose?

I can't work out if the infusion would've been done during the resus or after?

The constituents & rate of TPN are prescribed by a doctor (or advanced nurse practitioner) using a computer program. The nurses double-check the rate is correct based on the baby's fluid requirements.
I've never seen an infusion of adrenaline. But it would be prescribed by a doctor, as everything is, and based on a formula.

 

[marynnu]

I like Dr. Bohin. She doesn't pull her punches when it comes to pointing out shortcomings, but at the same time points out whether they're of significance or not.

 

[Imogenia]

I do wonder if "management" was a mostly female group, and "senior consultants" were mostly male. Then it could be possible that some persons in "management" were not about to be dictated to by "senior consultants". Just a thought.

I think that gender roles do have something to do with this, in a complicated way.

So does the power assigned to those who wear suits (in management).

So does the inability of management to believe that evil acts are allegedly being carried out by a respected nurse, and that such acts would likely (even if irrationally) continue if she were placed back on the unit.

Was Occupational Health asked to provide any input at all into any of this?

I think that Occupational Health are usually informed about attendance at A&E for needle stick injuries (for instance).

MOO

 

[Penny68]

I am not medically trained in any way at all.

Just thinking if I was a juror I would be totally out of my depth when hearing all the medical references etc.

I wonder how on earth those Jurors, if in similar mind to me, are coping with all this medical evidence.

 

[notsure]

12:24pm

The court is resuming after a short break.
Mr Johnson has one more point to raise with Dr Bohin.
He asks her about the adrenaline dose rates being double what they should be, and if that was beyond a safe limit.
Dr Bohin explains the limits, in accordance with guidance, would have been within limits, but the higher the rate, the more the risk of side-effects.
Higher doses would be administered in extreme circumstances, on guidance from a consultant.
Side effects would be rising blood pressure, rising heart rates, irregular heart rates, and, in very high doses, and constricting of blood vessels.

12:26pm

Mr Myers is now asking Dr Bohin questions.
He asks about the need for an x-ray to have been taken sooner. Dr Bohin said that would have been needed when looking for the cause of a collapse.
Mr Myers says Dr Bohin had, in her report, identified a particular issue with the adrenaline, which she had recorded as a "high starting dose".

12:30pm

Mr Myers says the ventilator settings were also 'high'. Dr Bohin agrees the settings did not need to be as high as the oxygen requirement was not so high.

12:32pm

Dr Bohin says the pneumothorax could have contributed to the collapse, but would not have caused it.

Recap: Lucy Letby trial, Thursday, March 23

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

 

[notsure]

12:39pm

Mr Myers says the care offered to Child P was, in Dr Bohin's words, 'muddled' and 'unusual' following the baby boy's collapse.
Dr Bohin said 'questions need to be answered' about the ventilatory strategy and the high doses of adrenaline, but the latter issue had been raised and answered by doctors in court.
She adds that neither of those issues had caused the initial collapse of Child P.

12:41pm

Mr Myers asks about the rate of adrenaline administration. Dr Bohin says the starting rate depends on what the child has, their condition, and what they have been administered before.
Dr Bohin says doctors wanted to give a 'large dose to kick-start the heart', as Child P had suffered a cardiac arrest. Even at this rate, the dose was ineffective, Dr Bohin adds.

12:52pm

Mr Myers asks about a "very high" lactate reading Child P had at 10.46am on June 24. Dr Bohin says it is "impossible" to quantify, to what degree, the effect adrenaline doses would have had on the lactate levels, particuarly on Child P, who had previously had a cardiac arrest which would have raised lactate levels in any case.

12:58pm

Mr Myers moves on to question about the cause of Child P's collapse.
He says it is not mentioned in Dr Bohin's reports about any additional administrations of air that morning. Dr Bohin says there is not.
He says the only evidence of abdominal distention is from 4am. Dr Bohin says it was identified then, it went away, then it is noted as appearing 'distended and loopy' again in the morning.
Mr Myers asks if Dr Bohin says the splinting of the diaphragm is from air administered the night before. Dr Bohin disagrees.

1:05pm

Dr Bohin says the collapse was 'unexpected and completely unexplained'.
The collapse happened 10 minutes after Dr Anthony Ukoh examined Child P and found the abdomen 'moderately distended / bloated'.
Dr Bohin says an issue she has had in the course of the trial is there does not seem to be consistent practie among nursing staff in the aspirations of feeding tubes, but in this case, when there was 25mls of air aspirated early on June 24, that was "normal".

Recap: Lucy Letby trial, Thursday, March 23

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

 

[Marie Bell]

I am not medically trained in any way at all.

Just thinking if I was a juror I would be totally out of my depth when hearing all the medical references etc.

I wonder how on earth those Jurors, if in similar mind to me, are coping with all this medical evidence.

I think that in court everything we're getting in just short tweet summary form will be much lengthier, and carefully explained to judge and jury. They also have the advantage of being able to see the demeanour of these witnesses, and whether they seem hesitant, or confident, when they are describing events, facts, and their findings etc. The summary makes each sentence uttered read as though everything said is concise and fluent. They don't capture any 'erm's or long pauses for instance.

 

[notsure]

2:05pm

The trial is resuming following its lunch break.

2:18pm

Benjamin Myers KC continues to ask Dr Sandie Bohin questions.
He refers to the case of Child G, in reference to milk and pH levels, where a pH level from the aspirates was recorded as '4' on September 7, 2015, at 2am.
Dr Bohin had said a pH level of 4 was 'very acidic', and there was not milk in the tummy, as the milk would 'buffer' the pH level and 'neutralise it'.
For Child P, the feeding chart on June 23, 2016 at 8pm records 14ml of milk aspirated and a pH level of 3.
Mr Myers says 20mls of milk is aspirated several hours later, with a pH level of 3.
Mr Myers says that it can mean milk could have been present in the stomach for Child G, even with a pH level of 4.
Dr Bohin said milk would 'buffer' the pH level. She adds the trial has moved through so many babies since Child G, she would need to know the clinical context for Child G.
Mr Johnson asks to clarify the meaning of 'buffer'.
Dr Bohin said it would effectively neutralise it.

Recap: Lucy Letby trial, Thursday, March 23

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

 

[notsure]

2:20pm

Nicholas Johnson rises to clarify pulmonary hypertension as a possible diagnosis.
Dr Bohin says it can affect blood flow and blood pressure. In neonates, its an attempt for them to return to the conditions where they were in their mummy's tummy, but staff don't want that in terms of making sure a baby is clinically stable.
"It's a very difficult thing to treat," Dr Bohin adds.
Dr Bohin adds one of the treatments is making sure the blood pressure in the body, not the lungs, is high, through treatment.

2:21pm

That concludes Dr Bohin's evidence for Child P.

Recap: Lucy Letby trial, Thursday, March 23

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

 

[notsure]

2:25pm

The judge, Mr Justice James Goss, is informing the jury they will not be required on Friday.
It remains unknown whether they will be required for next Monday. If not, their next day of evidence will be on Tuesday, March 28.

Recap: Lucy Letby trial, Thursday, March 23

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

 

[notsure]

2:28pm

The jury is told the case of Child Q will begin next week, and evidence will take place over three days.
Child Q is the last of the 17 babies, chronologically, in the case.

Recap: Lucy Letby trial, Thursday, March 23

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

 

[JerseyGirl]

Lucy Letby: Nurse found guilty of murdering seven babies

Letby, 33, described as a 'calculated opportunist', used several ways to inflict harm on the children including by injecting air intravenously and administering air and/or milk into their stomachs.

uk.news.yahoo.com

Lucy Letby: Senior doctors wanted CCTV if nurse returned to neonatal unit, court hears​

As the trial continues, Yahoo News UK sets out who Letby is, her background and what she has been charged with.​

 

[notsure]

2:33pm

Work is ongoing between the prosecution and defence to have an agreed version and length of Lucy Letby's interviews with police to be shown to the jury, the court hears.
Those will be played, it is intended, before the Easter break, which begins on Good Friday (April 7) and the jury will return on April 17 at noon.
The court hears the jury will also not be sitting on April 18.

Recap: Lucy Letby trial, Thursday, March 23

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

 

[Penny68]

I think that in court everything we're getting in just short tweet summary form will be much lengthier, and carefully explained to judge and jury. They also have the advantage of being able to see the demeanour of these witnesses, and whether they seem hesitant, or confident, when they are describing events, facts, and their findings etc. The summary makes each sentence uttered read as though everything said is concise and fluent. They don't capture any 'erm's or long pauses for instance.

Thank you so much for this explanation.

 

[Phoenix Lazarus]

I've just seen that evidence for the final alleged victim, child Q, will be given over three days next week.

 

[JosieJo]

So no trial from 10th to 19th April?