UK - Nurse Lucy Letby, Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #21

[Tortoise]

these are examples of what I am referring to.

Mr Myers then asked him whether vigorous CPR could be "categorically excluded" as a possibility for Child O's injuries.
Dr Marnerides compared it to the hypothetical discovery of a dead man in the desert with a pot next to him, saying it could be "possible" that a helicopter flew over and dropped the pot on his head, but that it was not "probable".

He said the "likely explanation" for the death of Child D, a girl, was an air embolism into her circulation, while another girl, Child I, received an excessive injection of air into her stomach.

Lucy Letby: Bruises on baby not caused by CPR, trial told

Nurse Lucy Letby is accused of killing the boy before also allegedly murdering his triplet brother.

www.bbc.co.uk

Dr Arthurs said he could not say from the image alone that an air embolism – a gas bubble which enters a blood vessel – was the cause of Child A’s death.

Expert in Lucy Letby trial says line of gas in baby post-mortem X-ray ‘unusual’

Letby is on trial accused of the murders of seven babies and the attempted murders of ten others at the Countess of Chester Hospital’s neo-natal unit.

www.manchestereveningnews.co.uk

took me long enough.


He agreed with Mr Myers that 'one possibility' that would explain the line of gas shown in the image would have been air administration. Other possible causes could have been attempts made at resuscitation or post-mortem changes.

Nurse felt final heartbeat of baby 'murdered' by Letby, court hears

A nurse sat crying in the witness box today after telling the trial of neonatal nurse Lucy Letby how she felt the final heartbeat of a baby she was trying to resuscitate.

www.dailymail.co.uk

it is in line with what dr bohin said when saying “no singular thing that is diagnostic of AE“.

You've quoted Dr Marnerides the pathologist and Professor Arthurs the radiologist, whose findings supplement the other medical experts' opinions and are based on their fields of expertise.

These aren't the quotes you gave in your earlier post.

Dr Bohin is saying there can be more than one symptom that is diagnostic of air embolism.

 

[Tortoise]

But wasn’t there another baby who also had an acidic ph who did have milk in their tummy, and when Myers referred back to baby G, SB didn’t have an answer as she didn’t have G’s notes in front of her? I thought that maybe called into question whether there was milk in G’s tummy for sure.

Edit: Child P, aspirated 20ml of milk with a ph of 3.

Link: Recap: Lucy Letby trial, Thursday, March 23

We don't know how that ended up, from the reporting anyway. I wonder if Mr Myers would have just left it at that or got the notes out for her, because it seems strange to just leave it unresolved for the jury. I'm hoping closing arguments will make sense of it.

Wonder if she might have said 3 has to be an error in the notes maybe?

 

[WaxLyrical]

We don't know how that ended up, from the reporting anyway. I wonder if Mr Myers would have just left it at that or got the notes out for her, because it seems strange to just leave it unresolved for the jury. I'm hoping closing arguments will make sense of it.

Wonder if she might have said 3 has to be an error in the notes maybe?

Yes, hopefully it won’t be left unresolved. And like you say, maybe they did clear it up on the day and wasn’t reported. Would be nice to know the answer though.

It’s probably unlikely to be error in the notes as it appears to have happened twice, several hours apart, both times aspirating milk with a ph of 3.

 

[Xanadu62]

He agreed with Mr Myers that 'one possibility' that would explain the line of gas shown in the image would have been air administration. Other possible causes could have been attempts made at resuscitation or post-mortem changes.

But you're cherry picking bits of the evidence instead of looking at the whole picture. For A & B Dr Evans made the diagnosis for air embolus, as did Dr Bohin. Prof Arthurs, whom you have quoted, was brought in to validate that there were air findings compatible with air embolus. But he is a radiologist - Dr Evans/Bohin were the ones making the diagnosis based on the detailed medical notes. Prof Arthurs was just backing their diagnosis up based on x-rays, not making the diagnosis conclusively himself (because he can't).

"Dr Evans said he had "only one" conclusion, that Child A had received an air embolus, "through an IV line".

"Dr Evans says, under questioning by Mr Myers, he would be happy to hear of an alternative explanation from a medical perspective for Child B, but he is happy with the conclusion he has made for Child B, that she had had an air embolus."

"Mr Johnson: "What, in your opinion, killed [Child A]?"

Dr Bohin: "[Child A] was killed by an air embolus."

"Dr Bohin said other factors, such as infection or cardiac arrhythmia, could be discounted, and the only conclusion left was "air embolus".
She refers to the skin colour changes seen on Child B, and how "florid and different it was from anything they had seen before".
"It just didn't fit with any other potential different causes".

 

[Tortoise]

Yes, hopefully it won’t be left unresolved. And like you say, maybe they did clear it up on the day and wasn’t reported. Would be nice to know the answer though.

It’s probably unlikely to be error in the notes as it appears to have happened twice, several hours apart, both times aspirating milk with a ph of 3.

oh thanks, I didn't know that. I see it is stated in the quote you provided.

 

[Supernovae]

<modsnip: no link, non verified medical source on an unamed site>

Chyme - Wikipedia

en.wikipedia.org

I've said it before but my impression is that there's been a lot of particularly pointed cross-examination on the overfeeding cases so I wouldn't be surprised if the defence has a gastroenterologist or similar to challenge this.

 

[Sweeper2000]

It’s a diagnosis it’s not actual evidence and that’s what I’m saying. they have medical notes on which the diagnosis is based but actual evidence ie x rays, post mortems, photos etc never falls into the hard Evidence category if I am correct.

 

[Xanadu62]

It’s a diagnosis it’s not actual evidence and that’s what I’m saying. they have medical notes on which the diagnosis is based but actual evidence ie x rays, post mortems, photos etc never falls into the hard Evidence category if I am correct.

Not really sure what you mean? Everything being presented by the prosecution is either agreed facts or evidence. Medical expert testimony is evidence. Either way, the jury isn't instructed to pay more attention to one type of evidence over another - if it's made it to trial it is to be considered in deliberations. Unless you think an entire jury is going to completely disregard medical expert testimony as to the cause of death of babies for some reason....? If that were the case no health care serial killers would ever be convicted as all the evidence needs a medical expert to validate and translate and diagnose - even photos, x-rays, post mortems etc.

MOO

 

[Tortoise]

Yes, hopefully it won’t be left unresolved. And like you say, maybe they did clear it up on the day and wasn’t reported. Would be nice to know the answer though.

It’s probably unlikely to be error in the notes as it appears to have happened twice, several hours apart, both times aspirating milk with a ph of 3.

I wonder if either of these babies was on medication or anything that might affect the pH.

Probably best to wait and see what comes of it as we go forward.

 

[Xanadu62]

Expert Evidence | The Crown Prosecution Service

www.cps.gov.uk

This might help with understanding role of expert evidence and the scrutiny the court applies before it can be admitted.

 

[Tortoise]

I wonder if either of these babies was on medication or anything that might affect the pH.

Probably best to wait and see what comes of it as we go forward.

Just looking back at the notes, baby G was on medications and given Gaviscon with her feed. I don't know if that affects anything at all, just an observation.

Child G was 'still a little under' her target weight by this stage, at 1.985kg, but this was "normal" for pre-term babies.
Child G was on Gaviscon medication to help with the stomach lining, and other medication to help lower oxygen support requirements.

Recap: Lucy Letby trial, Monday, December 12

At 2am on that day - when Child G was 99 days old - a feeding chart shows she was being fed with expressed breast milk, Gaviscon and a fortifier.

10:53am

The court is also shown a range of medications which were administered by Lucy Letby and another nurse, during that night, to Child G, before the handover at 7.30am.

Recap: Lucy Letby trial, Thursday, December 1

 

[Becci]

Have we heard from the original pathologist & the coroner for baby A?

Their input would be good.

 

[WaxLyrical]

Just looking back at the notes, baby G was on medications and given Gaviscon with her feed. I don't know if that affects anything at all, just an observation.

Child G was 'still a little under' her target weight by this stage, at 1.985kg, but this was "normal" for pre-term babies.
Child G was on Gaviscon medication to help with the stomach lining, and other medication to help lower oxygen support requirements.

Recap: Lucy Letby trial, Monday, December 12

At 2am on that day - when Child G was 99 days old - a feeding chart shows she was being fed with expressed breast milk, Gaviscon and a fortifier.

10:53am

The court is also shown a range of medications which were administered by Lucy Letby and another nurse, during that night, to Child G, before the handover at 7.30am.

Recap: Lucy Letby trial, Thursday, December 1

Good spot on the gaviscon. I won’t pretend to know what that would do to the ph exactly, but it feels like an important detail nonetheless.

 

[Sweeper2000]

Calcium bicarbonate lowers ph or acidity.

Our main ingredient, sodium alginate, is derived from natural seaweed which is sustainably harvested. It creates a protective barrier or raft over the irritating stomach content (which is mostly acid, but also pepsin and bile). The antacid component in the Double Action formula - calcium carbonate and sodium bicarbonate - also works to counteract acidity. Gaviscon lasts 2x longer than regular antacids* - up to 4 hours.

Learn how Gaviscon helps people feel better

Discover the history of Gaviscon and how it works to provide heartburn and indigestion relief.

www.gaviscon.co.uk

 

[Dotta]

Good morning all

New day, new testimony from the witness stand, right?

Glorious May weather here

 

[esther43]

Good spot on the gaviscon. I won’t pretend to know what that would do to the ph exactly, but it feels like an important detail nonetheless.

They give gaviscon to control reflux and fortifier to add calories so the baby gains weight quicker. Jmo

 

[WaxLyrical]

They give gaviscon to control reflux and fortifier to add calories so the baby gains weight quicker. Jmo

Haha yes sadly I’m all too aware of gaviscon

I just meant I’m not too sure of how it would influence the ph. I suppose if given alone it would raise it, not sure what happens if it’s given with a feed? Instinctively I feel like it would increase the ‘buffering’ effect of the milk, which I believe is neutral ph, and the gaviscon is presumably alkaline.

So it feels like it would make it less likely for baby G to have an acidic aspirate if there was both milk and gaviscon in the tummy.

But this is pure speculation and based on no medical knowledge whatsoever!

 

[esther43]

Haha yes sadly I’m all too aware of gaviscon

I just meant I’m not too sure of how it would influence the ph. I suppose if given alone it would raise it, not sure what happens if it’s given with a feed? Instinctively I feel like it would increase the ‘buffering’ effect of the milk, which I believe is neutral ph, and the gaviscon is presumably alkaline.

So it feels like it would make it less likely for baby G to have an acidic aspirate if there was both milk and gaviscon in the tummy.

But this is pure speculation and based on no medical knowledge whatsoever!

Yeah, I got that after I posted my even more basic knowledge ha ha

 

[esther43]

Good morning all

New day, new testimony from the witness stand, right?

Glorious May weather here

On to baby G this morning and LL's recollection of events surrounding the monitor :-/

 

[JosieJo]

For me regarding the force fed milk accusation it's more about volume. The amount of milk and air that came out couldn't reasonably just "build up" by an explainable process.

The unit Consultant, Dr Bohin , Dr Evans and the nurses who took the stand had never heard of such severe projectile vomiting in a baby that tiny.

The pressure that occurred so suddenly could not allow the baby to expand their lungs

Why was there no medical reason found such as an obstruction that would cause vomit to travel such a distance?

Why did it occur so quickly and didn't happen again?

Why wasn’t the baby sick before such a pressure built up if this built up more gradually?

Why so much air withdrawn with the milk after the vomit with no medical cause found?