This is totally wrong in all respects.
I will quote the evidence reported, and include the evidence of the other experts so that you can see that
they all say the same thing as regards June 12th, but they do not say that baby C's collapse and death on the 13th was attributed to air seen on the 12th. Dr Evans not giving a cause for the collapse and death on 13th in his reports is
the very opposite of bias against Letby. Continuing to say there was a possibility of deliberate harm on 12th, along with all the other experts, is
the very opposite of engineering a case against Letby because she wasn't on shift. Dr Evans was criticised for
not having given an opinion that the death was unnatural until he went in the witness box and said his final opinion was based on that of the reports of the radiologist and the pathologist.
Dr Evans Cross-examination -
"He confirms his initial conclusion from 2017 was
'one may never identify the cause of his collapse'.
Mr Myers says up until the evidence of today,
he had not provided in his reports an allegation of harm.
Dr Evans says this case "will always be a challenging case" for any clinician as it is difficult to separate the pathological problems from an event where Child C "was placed in harm's way by some kind of deliberate act."
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".
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 tells 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."
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".
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."
Dr Evans says none of the normal processes described why a baby collapsed.
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.
Recap: Lucy Letby trial, Tuesday, November 1
Dr Bohin's evidence
Asked to explain a build-up of gas in Child C’s abdomen detected on a
X-ray on June 12 – the day before his fatal collapse –
Dr Bohin said air could have accumulated via respiratory support he was receiving. The alternative explanation is a deliberate introduction of air down a fitted nasogastric tube, she said.
Prosecutor Nick Johnson KC asked: “
When you looked for a reason for (Child C’s) collapse on June 13, can you find an explanation?”
Dr Bohin replied: “
No. Babies like this should not collapse. You get prior warning that something is amiss.
Lucy Letby trial: Murder-accused nurse told police she found baby’s lingering death ‘quite hard’
Professor Arthurs' evidence -
A further x-ray image is shown for Child C at
June 12 at 12.36pm, which is centred at the child's abdomen.
He says the most striking feature about this image is the dilatation of the stomach, which is 'full of gas'.
He says this is more gas in the stomach 'than you would expect for a child of this age'.
There was a 'small tube' in the stomach taking out air.
Professor Arthurs says, for his conclusion for Child C, that
the 'marked gas dilatation' in the stomach noted at June 12 had several potential causes, including CPAP belly, sepsis, NEC or exogenous administration of air by someone.
Professor Arthurs, asked by the prosecution about a bowel obstruction, says if the bowel was blocked at a particular point, it would give a 'marker' of where the obstruction was.
He says the image shows no such marker, and as bowel obstructions are a 'common clinical occurrence', it would be diagnosed and babies would go to theatre for an operation.
He says there is no evidence of a bowel obstruction on the imaging, on the clinical notes, or in an autopsy.
Referring to the possibility of a twisted bowel, which he says 'can happen in small babies' and result in a blockage. He says that is often a surgical emergency, and would be documented as such, and found post-mortem if there is such a finding.
Recap: Lucy Letby trial, Friday, November 11
Prosecution closing speech -
Mr Johnson says
Dr Dewi Evans was justifiably criticised for not giving a cause of death for Child C in written evidence, then giving a cause in the witness box.
He says if anyone was caught by surprise, he returned to give evidence on 14 more occasions.
Mr Johnson says Dr Evans's evidence can be disregarded if there had been any confusion for this case, as Dr Marnerides had given more detailed evidence on this.
Dr Bohin excluded the possibility of a bowel obstruction.
Dr Marnerides said there was "nothing unusual" about Child C's bowel. He concluded Child C died "with pneumonia not from pneumonia" and the gas in the bowel could not be explained by infection or an abnormality in the bowel.
He said "air must have been injected into the nasogastric tube", splinting the diaphragm, which would have compromised Child C's breathing and killed him.
He added: "I have never in the past 10 years, come across even a suggestion that 'CPAP belly' would lead to the deterioration of a baby, let alone this gastric distention that would lead to [a baby's death]."
Mr Johnson says Child C came off CPAP 12 hours before his collapse, and "did so well" after kangaroo care he was put on to Optiflow, a 'much less invasive method of breathing support, and his NG Tube had been aspirated shortly before his collapse, and no air was found.
Dr Marnerides described "massive" gastric distention, using the word "ballooning".
Recap: Lucy Letby trial, June 21 - prosecution closing speech
, but everyone has a mixture of good and bad characteristics, surely... IMO
