UK - Nurse Lucy Letby, Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #27

[notsure]

https://twitter.com/x/status/1673638050466009088

 

[ColourPurple]

So Myers is basically saying the jury shouldn't listen to the medical experts as none of them are experts in air embolism, and instead they should listen to ...* checks notes* ... HIM... who has no medical training whatsoever.


JMO

 

[notsure]

https://twitter.com/MrDanDonoghue

Mr Myers asks 'where is there an image that looks like this in this case? There isn't'. He says the expert evidence and research evidence 'falls far short' of what is required
11:26 AM · Jun 27, 2023

He says there is 'inadequate knowledge' and that has been applied 'repeatedly' in this case
11:27 AM · Jun 27, 2023

 

[notsure]

11:26am
Mr Myers says the jury know what an air embolus looks like, from how Professor Owen Arthurs described it, and a radiograph image was supplied with the research article. He says it looks "nothing like" what was shown in this case.

He says for Child G, the image looks "nothing like", and the UVC is "misplaced" to the lower liver. A second image for Child G shows the baby 'in life', with an air embolus.

He says an air embolus can happen "by accident" in legitimate medical treatment. He says Dr Bohin "reluctantly" accepted that could be the case. He says Dr Evans refused to accept it.

Mr Myers says the scientific evidence "falls short" on air embolus in this case, with background research "poor", and the guidance has been applied "inconsistently".

He says the evidence "is so poor" it "cannot be used" to back the allegations.

Recap: Lucy Letby trial, June 27 - defence closing speech

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is…

www.chesterstandard.co.uk

 

[KathPlumber]

The way the defence has started so vehemently makes me think there might not actually be a lot of undisclosed bad stuff about LL to come out later when the trial is over (as some of us thought might happen, if found guilty). Otherwise, how could Mr. Myers go in so strong in her defence? JMO

Because it’s his job?!

 

[IDK]

DBM

 

[Jazmania]

11:15am
Mr Myers says there are many causes of discolouration to a baby, and there isn't a precise description as there is no photograph of any. He says the descriptions vary between the witnesses. He adds sometimes the descriptions have come months or years afterwards, after people have listened to other people's descriptions, and the dangers of recollection being 'contaminated or influenced are obvious'.

Mr Myers says 'unexpected collapses' can happen to neonatal babies. He says Child D had pneumonia and was at risk of collapse.

He says for 'resuscitations unsuccessful', the proportion of babies who recovered in this case "doesn't make sense".

He says the air is 78% nitrogen and "doesn't just go". He says it is "static, it is a blockage", and would be found post-mortem. He says the jury won't find air in the heart, post-mortem, in any of the cases.

Recap: Lucy Letby trial, June 27 - defence closing speech

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is…

www.chesterstandard.co.uk

I just don't get this. If it's true that air bubbles don't just go, and would be detected on post mortem scans, then why didn't Myers put up a medical expert to testify to this? As I remember, the medical experts we did hear from said that bubbles of air would only be detected on scans if they were taken within minutes of when the air embolism was administered. Is Myers allowed to offer medical opinions as facts without any supporting evidence?

 

[ColourPurple]

Mr Myers says the scientific evidence "falls short" on air embolus in this case, with background research "poor", and the guidance has been applied "inconsistently".

He says the evidence "is so poor" it "cannot be used" to back the allegations.

Recap: Lucy Letby trial, June 27 - defence closing speech

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is…

www.chesterstandard.co.uk

Yet he was not able to find a single medical expert to dispute their findings. I hope the jurors are aware that he had the option of doing that and didn't.

 

[notsure]

11:37am
Mr Myers refers back to the case of Child A.

He says there was a 'failure to read subtle signs'.

He says the "crucial" element is there is no evidence of air embolus.

He says the prosecution have gathered witness accounts from this trial of the skin discolourations. He says those recollections can change over the years. He says there is no reference to discolouration in the contemporaneous notes for Child A, which he says is "extraordinary".

He says nurses Caroline Bennion and Melanie Taylor didn't note anything remarkable.

He cross-examined Dr Harkness on the description, who was "very animated" on the "striking" discolourations and "unexpected deterioration", but did not note it at the time, or in a statement to the coroner.

He says the evidence by a nursing colleague noted, in a 2018 police interview, Child A was 'centrally pale', with limbs 'white'. Mr Myers cross-examined her on it, and asked her about 'blotchiness', and where that had come from. She agreed the description was different between police interview and evidence.

Dr Jayaram said Child A was 'pale blue', with discolouration 'flitting around'. Mr Myers says the description he gave from the interview was 'very similar' to the one from the research paper.

My Myers says the description does not appear in his clinical notes at the time, or in the "lengthy statement" to the coroner.

Mr Myers says it is a "remarkable coincidence" that two doctors did not give evidence of discolourations to the coroner in a statement, or note it at the time.

11:39am
My Myers says there is "no fair or proper basis" for an air embolus for Child A, and sub-optimal care, with the "long line in the wrong place".

Recap: Lucy Letby trial, June 27 - defence closing speech

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is…

www.chesterstandard.co.uk

 

[IDK]

I just don't get this. If it's true that air bubbles don't just go, and would be detected on post mortem scans, then why didn't Myers put up a medical expert to testify to this? As I remember, the medical experts we did hear from said that bubbles of air would only be detected on scans if they were taken within minutes of when the air embolism was administered. Is Myers allowed to offer medical opinions as facts without any supporting evidence?

I was wondering the same, but then remembered he did cross examine each medical expert though. Wouldn’t his summation be based on his cross examination? IMO, if guilty.

 

[notsure]

https://twitter.com/MrDanDonoghue

On the case of Child A and the rash reported, Mr Myers notes that nurses at the time did no report seeing this and that Dr Harkness did not include any description of a rash in his notes. He says Dr Harkness also made no mention of it to the coroner
11:38 AM · Jun 27, 2023

 

[JosieJo]

So far today this is making me very uncomfortable..the defence are putting forward medical theories, showing x rays etc that have not been backed up by any medical experts at the trial ...I'm no expert but this doesn't seem right to me.
He is stating the opposite to what the numerous medics have said with no medical expertise.

I'm no legal expert but it just doesn't seem right ?

 

[GoodDayToYouSir]

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

How is it wrong?

Dr Evans’ reports were saying that based on the X-ray on 12 June , there was a possibility of deliberate harm caused to baby C (air injection). This was his 2019 report . But then he said there was deliberate harm on 13 June

The baby didn’t collapse until 13 June. But the original murder charge (in 2020) was in relation to the period from 12 June , meaning that the prosecution believed the alleged act on 12 June was the act causing the collapse and death on 13 June. Based presumably on dr evans saying about deliberate air injection in his 2019 report taking place on 12 June.

 

[JosieJo]

I just really hope the jury can see the wood for the trees here

 

[JosieJo]

How can he put up an x Ray and say this looks nothing like baby As...radiology is a very specialised area and you would need someone to clarify that

 

[notsure]

https://twitter.com/MrDanDonoghue

Mr Myers says Dr Harkness mentioned it in his police interview, after reading the Lee and Tanswell paper.

He says that is 'no coincidence'. He tells the jury there is 'no fair or proper basis' for an allegation of air embolism
11:42 AM · Jun 27, 2023

 

[ColourPurple]

I was wondering the same, but then remembered he did cross examine each medical expert though. Wouldn’t his summation be based on his cross examination? IMO, if guilty.

What seems to be happening is that he's just repeating the same allegations that the medical experts dismissed or disagreed with when he cross examined them.

JMO

 

[Becky53]

Does he think the NHS have unlimited funding to provide 24/7 one on one care?


JMO

 

[JosieJo]

It's one thing not being fully staffed and a very different think to link deaths and collapse with staffing levels.
We have heard from the nurses and LL herself that levels were not that dangerous.
Plus we have not been shown by the defence that hourly observations, blood gases , feeds etc were not carried out due to staffing.
The vast majority of the cases cannot be linked to staffing

 

[marynnu]

Does he think the NHS have unlimited funding to provide 24/7 one on one care?


JMO

It's a joke anyway. Babies A&B didn't need 1:1, you'd spend all day twiddling your thumbs. IMO.