UK - Nurse Lucy Letby, Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #19

[Dotta]

Make peace and kiss MUAH How nice!

 

[Sweeper2000]

This article is interesting reading. Baby n.

Lucy Letby: ‘Unusual’ presence of blood in throat of baby

AN “unusual” presence of blood and swelling was seen in the throat of a baby allegedly attacked by nurse Lucy Letby, a jury heard.

www.chesterstandard.co.uk

multiple medical experts failed to insert the breathing tube each having more than one attempt, only took one attempt by a medical expert from alder hay and he saw no swelling, injury or bleeding. That’s a very poor reflection on the doctors and other specialists at coch. It’s also a poor reflection of who ever said the swelling was likely caused by traumatic inflicted injury. Presumably dr evans. Out of all these med experts whom do you place greater faith in, the doctors who couldn’t intubate, dr evans diagnosing from afar or the doc who incubated on first attempt? In this case I know who my money is on.

baby n also had further episodes of breathing difficulties after discharge and there was no reason found for it. Apparently medical anomalies do happen. In this case as well it is a cardiac collapose that is Under question. This baby seemed to have issues even after discharge that really does weaken the prosecutions case IMO for baby n.

I mention this as in a case built around the unlikelihood of these events being coincidental with every case that’s knocked off the list the chances decrease overall that ll was responsible.

 

[Becky53]

This article is interesting reading. Baby n.

Lucy Letby: ‘Unusual’ presence of blood in throat of baby

AN “unusual” presence of blood and swelling was seen in the throat of a baby allegedly attacked by nurse Lucy Letby, a jury heard.

www.chesterstandard.co.uk

multiple medical experts failed to insert the breathing tube each having more than one attempt, only took one attempt by a medical expert from alder hay and he saw no swelling, injury or bleeding. That’s a very poor reflection on the doctors and other specialists at coch. It’s also a poor reflection of who ever said the swelling was likely caused by traumatic inflicted injury. Presumably dr evans. Out of all these med experts whom do you place greater faith in, the doctors who couldn’t intubate, dr evans diagnosing from afar or the doc who incubated on first attempt? In this case I know who my money is on.

baby n also had further episodes of breathing difficulties after discharge and there was no reason found for it. Apparently medical anomalies do happen. In this case as well it is a cardiac collapose that is Under question. This baby seemed to have issues even after discharge that really does weaken the prosecutions case IMO for baby n.

Dr Gibbs said the “serious life-threatening deterioration” only improved after a consultant anaesthetist, called from Liverpool’s Alder Hey Children’s Hospital, managed to intubate at his first attempt.

He told the court he “couldn’t understand” why two consultants, two registrars and two anaesthetists had failed previously to intubate Child N throughout the day, but said the adrenaline may have helped reduce the swelling.

‘Unusual’ presence of blood in throat of baby ‘attacked by nurse’

Lucy Letby is accused of attempting three times to kill the infant at the Countess of Chester Hospital’s neonatal unit.

news.stv.tv

 

[Tortoise]

I haven’t seen anyone do a 180. People have been waiting for context around the fb searches and handover notes, despite them being ancillary to the main evidence, and so it’s nice to have some new information to discuss that isn’t simply discussing the words ‘on purpose’ for eternity.

For me, the key bit of information to come out of yesterday was the assertion from Letby that NG tubes are not routinely aspirated in the way it was suggested at the start of the case. I’m surprised that’s not being discussed more, since it’s been used to support several allegations that air must’ve been forced down the NG tubes. However, I do recognise that many people will have made up their minds now and are therefore less likely to want to discuss the specifics of the evidence, or might view these sorts of questions as people protesting Letby’s innocence. JMO.

right, what I could find

"Mr Myers asks about feeding babies at the neonatal unit.

Lucy Letby explains the process of administering milk, saying you would "aspirate the NG Tube first" and testing the acidity of the contents of the stomach.

Asked if that is a process done every time, Letby responds: "No.""

Recap: Lucy Letby trial, Tuesday, May 2 - defence begins


Baby G

Dr Evans -

Mr Myers refers to Dr Evans, in his report, referring to Child G being treated "inappropriately" at 2am on September 7, 2015.
Mr Myers says that is worked on the basis that Child G's tummy would have been empty or almost empty at the time, as the nurse responsible would have aspirated Child G's stomach of all milk.
Mr Myers says 'we now know' the stomach was not aspirated prior to 2am.
Dr Evans says that was not the case, as the nurse had aspirated to get a pH reading.
Mr Myers says the nurse had not aspirated the milk, as she would not have done so in a baby as young as Child G as a matter of procedure.
Dr Evans: "No, this is too simple." He says milk is a neutral pH, so if the reading is '4', then that sample was indicative of acid in the stomach.
Dr Evans says after the projectile vomiting, over three areas of a nursery, there was an aspiration of 45mls of milk.
"There has to have been a significant amount of additional milk plus air to explain what happened to the little baby at two o'clock in the morning."
Mr Myers refers to the report, saying a nurse empties the stomach contents through aspirates.
Dr Evans: "The pH was 4 [in the stomach], 4 is acid."
Mr Myers says Dr Evans is basing what he says upon having her stomach aspirated before the 2am feed.
Dr Evans says there would have been no milk in Child G's stomach prior to the 2am feed, as the stomach was checked for pH.
Dr Evans says he is "totally satisfied" with his opinion that Child G's stomach was empty prior to the 2am feed.
The amount of vomit plus aspirate was "massive" and only had one explanation - "she had a huge amount of milk plus air".
Mr Myers asks if Dr Evans is basing his opinion on Child G's stomach being emptied of milk just before the 2am feed. Dr Evans says he is.
He says the nurse said she would not normally aspirate all the milk from a stomach [as in completely remove all trace].

Mr Johnson asks about the pH aspirate the nurse would have obtained, if the previous milk feed had not been digested/aspirated.
Dr Evans said the aspirate would have looked like undigested milk and the pH reading would have been neutral - around 7.

Dr Bohin -

Mr Johnson asks if there is an 'innocent explanation' which could have explained the projectile vomiting.
Dr Bohin says "no", as the stomach was empty, with a pH reading of 4. If there was milk in the stomach, it would have 'neutralised' the stomach and the pH reading would have been higher.
"I think the stomach was empty, and she was given excess milk and possibly air...which distended the stomach."
Dr Bohin is asked by police about Lucy Letby saying babies can 'take on a lot of air when vomiting'.
Dr Bohin was asked if that was correct or not.
Dr Bohin tells the court: "That's not correct. Babies do not take on air when they vomit."

Recap: Lucy Letby trial, Monday, December 12

Baby O

Benjamin Myers KC, for Letby's defence, is now asking Sophie Ellis questions. [...]
Mr Myers asks if it is usual for babies to have aspirates of under half their feeds.
The nurse replies that reading would suggest Child O was tolerating his feeds that night.
The nurse says she wouldn't always record a full aspirate for every feed, but would do so if there was a concern for the baby.

Recap: Lucy Letby trial, Wednesday, March 8


Cross-examination of Dr Bohin during baby P's evidence -

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

Baby C

Dr Bohin says babies on CPAP can have CPAP belly, and in order to minimise that, they would aspirate the NGT.
"It is usual practice to note down the volumes of air aspirated to give colleagues an idea [of how much air is coming out of the baby]."
"I couldn't find any evidence of that [in the notes]."
She adds that, for babies not fed, the nursing staff would put the tube on free drainage so air could come out on its own, as well as actively aspirate every four hours or so. She says there was only 'fleeting mention' of free drainage.
If neither of those things happen, Dr Bohin said that would lead to gas accumulation in the stomach.
Dr Bohin said it was not clear from the notes how long the 'free drainage' was in place.

Recap: Lucy Letby trial, Tuesday, November 1

 

[Sweeper2000]

Dr Gibbs said the “serious life-threatening deterioration” only improved after a consultant anaesthetist, called from Liverpool’s Alder Hey Children’s Hospital, managed to intubate at his first attempt.

He told the court he “couldn’t understand” why two consultants, two registrars and two anaesthetists had failed previously to intubate Child N throughout the day, but said the adrenaline may have helped reduce the swelling.

‘Unusual’ presence of blood in throat of baby ‘attacked by nurse’

Lucy Letby is accused of attempting three times to kill the infant at the Countess of Chester Hospital’s neonatal unit.

news.stv.tv

Helped reduce the swelling does not mean it leaves no trace of it or indeed of the alleged injury. Swelling doesn’t magically disappear or injury inflicted. Is there a possibility here of an allergic reaction to something, like meds?

 

[marynnu]

Helped reduce the swelling does not mean it leaves no trace of it or indeed of the alleged injury. Swelling doesn’t magically disappear or injury inflicted. Is there a possibility here of an allergic reaction to something, like meds?

Newborns do not have allergies to medications.

 

[WaxLyrical]

right, what I could find

"Mr Myers asks about feeding babies at the neonatal unit.

Lucy Letby explains the process of administering milk, saying you would "aspirate the NG Tube first" and testing the acidity of the contents of the stomach.

Asked if that is a process done every time, Letby responds: "No.""

Recap: Lucy Letby trial, Tuesday, May 2 - defence begins


Baby G

Dr Evans -

Mr Myers refers to Dr Evans, in his report, referring to Child G being treated "inappropriately" at 2am on September 7, 2015.
Mr Myers says that is worked on the basis that Child G's tummy would have been empty or almost empty at the time, as the nurse responsible would have aspirated Child G's stomach of all milk.
Mr Myers says 'we now know' the stomach was not aspirated prior to 2am.
Dr Evans says that was not the case, as the nurse had aspirated to get a pH reading.
Mr Myers says the nurse had not aspirated the milk, as she would not have done so in a baby as young as Child G as a matter of procedure.
Dr Evans: "No, this is too simple." He says milk is a neutral pH, so if the reading is '4', then that sample was indicative of acid in the stomach.
Dr Evans says after the projectile vomiting, over three areas of a nursery, there was an aspiration of 45mls of milk.
"There has to have been a significant amount of additional milk plus air to explain what happened to the little baby at two o'clock in the morning."
Mr Myers refers to the report, saying a nurse empties the stomach contents through aspirates.
Dr Evans: "The pH was 4 [in the stomach], 4 is acid."
Mr Myers says Dr Evans is basing what he says upon having her stomach aspirated before the 2am feed.
Dr Evans says there would have been no milk in Child G's stomach prior to the 2am feed, as the stomach was checked for pH.
Dr Evans says he is "totally satisfied" with his opinion that Child G's stomach was empty prior to the 2am feed.
The amount of vomit plus aspirate was "massive" and only had one explanation - "she had a huge amount of milk plus air".
Mr Myers asks if Dr Evans is basing his opinion on Child G's stomach being emptied of milk just before the 2am feed. Dr Evans says he is.
He says the nurse said she would not normally aspirate all the milk from a stomach [as in completely remove all trace].

Mr Johnson asks about the pH aspirate the nurse would have obtained, if the previous milk feed had not been digested/aspirated.
Dr Evans said the aspirate would have looked like undigested milk and the pH reading would have been neutral - around 7.

Dr Bohin -

Mr Johnson asks if there is an 'innocent explanation' which could have explained the projectile vomiting.
Dr Bohin says "no", as the stomach was empty, with a pH reading of 4. If there was milk in the stomach, it would have 'neutralised' the stomach and the pH reading would have been higher.
"I think the stomach was empty, and she was given excess milk and possibly air...which distended the stomach."
Dr Bohin is asked by police about Lucy Letby saying babies can 'take on a lot of air when vomiting'.
Dr Bohin was asked if that was correct or not.
Dr Bohin tells the court: "That's not correct. Babies do not take on air when they vomit."

Recap: Lucy Letby trial, Monday, December 12

Baby O

Benjamin Myers KC, for Letby's defence, is now asking Sophie Ellis questions. [...]
Mr Myers asks if it is usual for babies to have aspirates of under half their feeds.
The nurse replies that reading would suggest Child O was tolerating his feeds that night.
The nurse says she wouldn't always record a full aspirate for every feed, but would do so if there was a concern for the baby.

Recap: Lucy Letby trial, Wednesday, March 8


Cross-examination of Dr Bohin during baby P's evidence -

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

Baby C

Dr Bohin says babies on CPAP can have CPAP belly, and in order to minimise that, they would aspirate the NGT.
"It is usual practice to note down the volumes of air aspirated to give colleagues an idea [of how much air is coming out of the baby]."
"I couldn't find any evidence of that [in the notes]."
She adds that, for babies not fed, the nursing staff would put the tube on free drainage so air could come out on its own, as well as actively aspirate every four hours or so. She says there was only 'fleeting mention' of free drainage.
If neither of those things happen, Dr Bohin said that would lead to gas accumulation in the stomach.
Dr Bohin said it was not clear from the notes how long the 'free drainage' was in place.

Recap: Lucy Letby trial, Tuesday, November 1

Thank you for this, it’s incredibly helpful.

It does make me wonder whether Myers is going to call someone re the aspirates.

Edit: at the least I think they will need to revisit Baby P, I cannot get my head around Bohin’s explanation as to why the milk didn’t neutralise the ph in that case.

 

[Sweeper2000]

Newborns do not have allergies to medications.

Food ? The equipment used? Etc. I was just thinking if there was swelling and it literally disappeared, did it disappear after the aggravating factor had been removed? Would explain the reoccurring apnoea and swelling even after leaving the unit. there has also been no further problems after reentry On the unit, could that be because o changes in the immune system later on Down the line?

 

[Dotta]

"At times her mother, Susan, 62, wiped away tears as her only child gave evidence. She and her husband, John, 76, have attended every day of the trial."

Dad of 'killer nurse' Lucy Letby made her bed after she was arrested

The 33-year-old nurse is accused of murdering five boys and two girls and trying to kill 10 others at the Countess of Chester Hospital from June 2015 to June 2016.

www.dailymail.co.uk

 

[marynnu]

Food ? The equipment used? Etc. I was just thinking if there was swelling and it literally disappeared, did it disappear after the aggravating factor had been removed? Would explain the reoccurring apnoea and swelling even after leaving the unit. there has also been no further problems after reentry On the unit, could that be because o changes in the immune system later on Down the line?

No, the only thing you'd get is a milk intolerance which would be picked up.

 

[Becky53]

Helped reduce the swelling does not mean it leaves no trace of it or indeed of the alleged injury. Swelling doesn’t magically disappear or injury inflicted. Is there a possibility here of an allergic reaction to something, like meds?

I’m no expert, I was just giving the explanation that was given by Dr. Gibbs as to how the consultant anaesthetist from Liverpool’s AHCH, managed to intubate at his first attempt compared to the other attempts by COCH staff.

Swelling must eventually disappear otherwise I’d still be walking around with a cartoon like bump on my head

 

[Sweeper2000]

I’m no expert, I was just giving the explanation that was given by Dr. Gibbs as to how the consultant anaesthetist from Liverpool’s AHCH, managed to intubate at his first attempt compared to the other attempts by COCH staff.

Swelling must eventually disappear otherwise I’d still be walking around with a cartoon like bump on my head

It’s the laco of any swelling at all or visible injury that concerns me. Much more like it was never there The alleged injury that is.

No, the only thing you'd get is a milk intolerance which would be picked up.

Do you know if we use meropenem in the uk Mary thankyou?
interesting reading that neonates don’t have the immune response to allergens that causes anaphylaxis.

 

[JosieJo]

I might be misremembering but I recall one of the experts, SB possibly, saying that staff at the COCH were notoriously bad at record keeping when it came to NG tubes. Which is not helpful if there turns out to be a dispute around how the nurses handle NG tubes. JMO.

Yes I remember that ..I think some but not sure how many..had had aspirates recorded

 

[Dotta]

Radio interview with Dan
Lovely voice

Lucy Letby trial: Nurse accused of murdering babies gives evidence

Dan O’Donoghue, BBC journalist

www.rte.ie

 

[Becky53]

It’s the laco of any swelling at all or visible injury that concerns me. Much more like it was never there The alleged injury that is.

rsbm

So imo you are basically saying that the 6 people who tried to intubate child N at the COCH are in cahoots and have made this injury up and 3ml of blood wasn’t withdrawn from his nasogastric tube.

 

[Sweeper2000]

rsbm

So imo you are basically saying that the 6 people who tried to intubate child N at the COCH are in cahoots and have made this injury up and 3ml of blood wasn’t withdrawn from his nasogastric tube.

No I’m saying the doctor from alder hay who had no difficulty in intubation saw no swelling, no injury and nothing remarkable about baby n at all. as I say swelling doesn’t reduce to nothing magically. The alleged injury not being present after inspection from ah doc might suggest that it was never there. The injury presumably would be visible after this swelling had gone, completely and magically. Also this child’s further episodes of apnoea might suggest some other cause and may play a role in the cardiac collapse. Did the coch docs miss something?

 

[Jazmania]

Why is it a minor point? The strength of this case relies heavily on the sheer breadth of the charges. If Myers has someone waiting in the wings to show how failure to aspirate could result in what’s being described here as air being forced into the tummy, then it would be a bit of a blow to the case as a whole. IMO.

I don't think that is the point. I don't think that anyone is saying that failure to aspirate could cause any of the symptoms seen. I think the reason it is key relates to the cases where babies have allegedly been fed way too much milk. For example in one case a baby was been fed tiny amounts, and each time before a feed they are supposed to aspirate to empty the stomach. Yet this baby vomited huge amounts (more than was fed), and when they aspirated they found milk still present in the stomach. So if this baby's stomach actually wasn't aspirated before feeds, then perhaps the defence could argue that milk built up in the stomach over time.

 

[Sweeper2000]

Also why if swelling is visible would multiple further, ultimately futile and potentially harmful attempts at intubation be continued rather than a difference in approach be thought of.

 

[marynnu]

Also why if swelling is visible would multiple further, ultimately futile and potentially harmful attempts at intubation be continued rather than a difference in approach be thought of.

Like what? I'm sure the doctors, consultants and anaesthetist knew more about intubation than any of us.

 

[Sweeper2000]

Like what? I'm sure the doctors, consultants and anaesthetist knew more about intubation than any of us.

Tracheotomy? I believe that’s standard when the normal approach isn’t viable And is vital. Looks like it wasn’t vital to me But who knows.