UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #3

[Legally Bland]

What can we expect once the opening prosecution statement is finished?

Can't remember which outlet, but it was reported in MSM that there'll be a defence opening statement (which they often skip). Could be a while until we start hearing the prosecution evidence.

 

[Legally Bland]

11:04am

In police interviews, Letby said the student nurse fed Child P at two-hourly intervals on June 23, and she had fed Child P alone at 6pm.
She said she had agreed to be Child P's designated nurse because the parents had asked for some continuity.
Early in the shift, around 8am, she said could see “loops” in his tummy and brought these to the attention of the doctor, and notes were made later that day.
If what she noted was true, the prosecution say, it would say when she took over the care from the previous night, he had a developing problem, but the prosecution says we know that was not the case.
A note by a nurse at 6.39am 'ran contrary' to Letby's note, as the problem 'had been resolved' during the night.
Mr Johnson: "This is another example of Lucy Letby making factually false entries in the notes to cover herself."
Letby denied deliberately causing Child P any harm.

Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement

THE prosecution in the trial of Lucy Letby, accused of murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to…

www.chesterstandard.co.uk

 

[gc105]

Added as missed:

10:57am

Child P desaturated again at 11.30am. He was given adrenaline.
His spontaneous circulation improved but he continued to deteriorate through the day.
A punctured lung was identified from an x-ray taken at 11.57am, treatment started at 12.40pm.
The transport team arrived at 3pm. Just before they arrived, Child P's blood gases were taken and were satisfactory.
A doctor was hopeful of Chils P's prospects.
The court hears Letby said to her something like:"he’s not leaving here alive is he?"

 

[merrypason]

Another question. If LL was a very experienced nurse, was there statistically an increase in neonatal mortality in the hospitals where she worked previously, as it was observed in Chester?

And did the indices of neonatal mortality go drastically down after LL left Chester?

Because the numbers of the babies LL is accused of killing should represent a definite surplus in any given time. They won’t change the statistics only if the hospital is both very big and tremendously subpar.

Let me put it so, if the expected annual mortality in NICU is 7 babies per year, then 7 plus is statistically significant. If the hospital is so poor (or maybe, so big and bad) that annual NICU mortality is 100 babies per annum, then 107 would be not significant. In the later case, malfeasance would be very difficult to prove, unless something is registered by the camera.

As I was posting it, I thought that theoretically, there might be a mix of two factors as well. Imagine LL being the killer, but, say, she killed 3 kids out of 7, and the other 4 were victims of routinely bad medical practice. Difficult…

This article sheds some light on mortality rates in NICU, and the reasons for it. Just some food for thoughts. It is almost as if two statistical models have to be made, one, the regular expected death in Chester NICU (given admissions, number of live births, gestational weight, etc), and the other model, all of these, plus additional variable, LL.

A Selected Review of the Mortality Rates of Neonatal Intensive Care Units

Newborn babies in need of critical medical attention are normally admitted to the neonatal intensive care unit (NICU). These infants tend to be preterm, have low birth weight, and/or have serious medical conditions. Neonatal survival varies, but progress ...

www.ncbi.nlm.nih.gov

The only other hospital she was at previously was during her training period, the Liverpool Teaching Hospital. They did investigate that hospital as well. It is a teaching hospital so she would have been supervised more.

A spokesperson for Liverpool Women's Hospital Trust said: "We are co-operating with police as part of their investigation which includes a routine review of patients cared for on our neonatal unit during the time of these placements.

"There is currently no suggestion that any patients at Liverpool Women's came to any harm in relation to this investigation."

Lucy Letby's training hospital helping police with baby death probe

The former University of Chester student trained at Liverpool Women's Hospital

www.cheshire-live.co.uk

She started at Countess in 2011. And got more specialised in ICU work at some point between then and 2015. Her alleged crimes started in June 2015. It's possible something happened then to trigger it, unknown. The real challenge she has is that her charges are mostly for babies she wasn't designated to, at the time. So it makes it difficult to say that her experience means she'd be more exposed to serious/at risk cases - because she wasn't supposed to be on them. She either asked to swap, or in most cases got involved when other nurses were away and sometimes leaving her own patient to do so. The trial is only for 2015-2016 so all we know is that year had an increase in deaths that was significant enough to warrant the initial RCPHC review.

For context, the neo natal unit cared for 406 patients in 2015/16 with 20 cots. There were 13-15 deaths reported in 2015/2016. Of them 10 were considered unexplained. 7-8 of them (that we know, could be more that didn't make CPS) were attended to by her only, often no one else in the room with her at time problems were initiated or started. And then the 15 attempted murder charges too.

[you can find this info in RCPHC report online].

 

[Legally Bland]

11:06am

Child Q - attempted murder allegation
Child Q was born on June 22 - the day after Child O and P. He was premature but a good weight, and on CPAP for the first 20 hours.
He was admitted to the neonatal unit as he needed breathing support, but was initially stable.
He had a catheter in place via his umbilicus for nutrition, however he was well enough to commence feeding via his NGT. Initially he was put into room 1.

11:08am

Nursing staff noted small amounts of bile when they checked his NGT on June 23-24. These were not of sufficient concern to stop him being fed milk.
A different nurse was Child Q's designated nurse on the night shift for June 24. She monitored him through the night, and fed him 0.5ml of milk every 2 hours at 3am, 5am and 7am.
The nurse was content with the condition, although the blood gases deteriorated slightly, so she referred the results to a doctor. The doctor reviewed them and was not concerned.
The day shift on June 25, Letby was on duty and was Child Q's designated nurse. Child Q had been moved into room 2.

11:10am

Letby made notes on Child Q's fluid/feeding chart at 8am. Child Q was receiving nutrition Babiven via a UVC.
Just after 9am, Letby and the nurse were together in nursery 2, and it was feeding time. The other nurse attended to another child in the room.

Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement

THE prosecution in the trial of Lucy Letby, accused of murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to…

www.chesterstandard.co.uk

 

[Dcflag]

Can't remember which outlet, but it was reported in MSM that there'll be a defence opening statement (which they often skip). Could be a while until we start hearing the prosecution evidence.

I thought that was the case about the defence opening statement but wasn’t sure where it had come from. It will certainly be interesting to get an idea of what they’re pushing for, and equally if they’re going to as in-depth as every individual charge as the prosecution have done.

 

[Legally Bland]

11:14am

According to the record, Child Q's heart and respiratory rates both increased for a short period of time.
But, the prosecution say, the feeding chart shows something 'unusual'.
That chart is shown to the court. The 9am fluid chart, in Letby's handwriting, appears unfinished, with numbers noted for fluids, but no record for the feed or Letby's signature initials at the bottom of the 9am column.
The prosecution suggests something caused Letby to leave halfway through doing this.

Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement

THE prosecution in the trial of Lucy Letby, accused of murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to…

www.chesterstandard.co.uk

 

[Legally Bland]

11:16am

Letby signed for medication for another baby at 9.04am.
The other nurse agreed to keep an eye on Child Q at 9am.
A few minutes later, Child Q's monnitor alarms activated to alert staff to a deterioration in his condition.
Mr Johnson: "We say that Lucy Letby had sabotaged [Child Q] and had injected him with air and a clear fluid into his stomach via the NGT. She was trying to kill him."

Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement

THE prosecution in the trial of Lucy Letby, accused of murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to…

www.chesterstandard.co.uk

 

[Legally Bland]

11:19am

The nurse called for help and was joined by another nurse. Child Q had been sick and nurses used a suction catheter while respiratory support was given. Lucy Letby appeared soon afterwards together with doctors who were responding to the call for help.
Medical notes indicates doctors were called to the unit at 9.17am as Child Q had "just vomited" and oxygen saturation levels were in the "low 60s".
The prosecution say medical staff gave him assistance with breathing using a Neopuff device and applied suction to clear his airways. The records indicate not only had his oxygen dropped but also his heart rate. He is described as “mottled” in appearance and, most significantly, a substantial amount of air was aspirated from his stomach via the NGT.
Mr Johnson tells the court the air had been put in there by Letby, as if the feeding chart had been followed correctly at 9am, the person feeding - Letby - would have aspirated Child Q's stomach to check there was nothing there before administering the 0.5ml milk feed.

Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement

THE prosecution in the trial of Lucy Letby, accused of murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to…

www.chesterstandard.co.uk

 

[gc105]

Pros: A doctor was supervising baby P's treatment and was optimistic of his prospects when Lucy Letby said to her something like “he’s not leaving here alive is he?”

Pros: "This was an echo of what she said when baby C collapsed. That remark surprised the doctor, but Lucy Letby’s prediction came true... (1/2)

...After all she knew what she had done and she knew what was likely to happen. It was certainly what she intended. It was something she had done to others". (2/2)

Baby P died, despite doctors' efforts to resuscitate him. Prosecution medical experts say he was killed because of having excessive air injected into his stomach.

Pros: "Lucy Letby made factually false entries in the notes to cover herself. To make it all look like this is a problem which happened on somebody else’s watch. Somebody else’s shift".

Jury told that after baby P died, she spent time with his parents and at one point took a photograph of both babies O & P together in a cot. She denied deliberately causing him any harm.

 

[Legally Bland]

From Sky:
_____

15m ago11:07

Letby took photograph of Child O and P in their cot after their deaths​

Independent medical experts concluded Child P died from "somebody injecting him with air" via his nasogastric tube into his stomach.
There was also an injury to Child P's liver, but this was probably caused by CPR rather than a "deliberate assault" - as the prosecution says was seen in his brother.
In a police interview, Letby admitted feeding Child P alone at 6pm, the day before his death.
The prosecution claims she then made "factually false" entries in Child P's medical records to cover herself - with phone records showing she was texting at the time she claimed to have been making observations.
After Child P died, she spent time with his parents and at one point took a photograph of them both together in a cot.
She denied deliberately causing Child P any harm.

Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins

Latest updates on day four of the Lucy Letby trial, with the prosecution showing the court handwritten "confessions" from the nurse in which she allegedly admitted she was "evil", and the defence saying the hospital was "well out of its depth". Letby denies all charges.

news.sky.com

 

[kittythehare]

Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins

Latest updates on day four of the Lucy Letby trial, with the prosecution showing the court handwritten "confessions" from the nurse in which she allegedly admitted she was "evil", and the defence saying the hospital was "well out of its depth". Letby denies all charges.

news.sky.com

etby took photograph of Child O and P in their cot after their deaths​

Independent medical experts concluded Child P died from "somebody injecting him with air" via his nasogastric tube into his stomach.
There was also an injury to Child P's liver, but this was probably caused by CPR rather than a "deliberate assault" - as the prosecution says was seen in his brother.
In a police interview, Letby admitted feeding Child P alone at 6pm, the day before his death.
The prosecution claims she then made "factually false" entries in Child P's medical records to cover herself - with phone records showing she was texting at the time she claimed to have been making observations.
After Child P died, she spent time with his parents and at one point took a photograph of them both together in a cot.
She denied deliberately causing Child P any harm.

 

[Legally Bland]

11:22am

Another nurse's medical note on an 'apnoea/brady/fit chart' notes: "09:10; brady 98; desat 68; fit ?; baby found to be very mucousy, clear mucous from nasopharynx oropharynx removed clear fluid +++.
"O2 via neopuff given post suctioning. Dr... emergency called to attend.
"NGT used to aspirate stomach by Nurse L Letby”
The prosecution say given that Letby was Child Q's designated nurse and she performed the aspiration of air, it might be thought surprising that she did not make the note – yet she did make notes in records of other babies’ notes at about the same time.
Mr Johnson: "We question whether this is an attempt by her to create a documentary alibi."

Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement

THE prosecution in the trial of Lucy Letby, accused of murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to…

www.chesterstandard.co.uk

 

[Legally Bland]

11:27am

Computerised nursing notes made by Letby for that morning: "“09:10hrs [Child Q] attended to by SN... – he had vomited clear fluid nasally and from mouth, desaturation and bradycardia, mottled ++. Neopuff and suction applied. [Registrar] attended. Air ++ aspirated from NG tube”.
Following the collapse, blood was taken to test for infection and other parameters. A venous blood gas test showed results suggesting that he was unwell but this had resolved by 11.12am. He was started on a course of antibiotics as a precaution.
The doctor's view recorded at the time said Child Q's collapse was a result of “presumed sepsis with jaundice”.
At that stage a chest x ray was taken which showed nothing untoward. The more detailed blood tests were recorded at 1.50pm and showed slightly abnormal results which were treated.
Child Q had made a reasonable recovery through the day and at 7.20pm was "looking tired". Doctors took the decision to intubate him because his respiratory rate was down to 19 (low)and his heart rate was between 160-200 bpm (high). At that stage his blood gas readings were good.
The proseution say Lucy Letby was "worried" when she got home that night.
She texted a doctor at 10.46pm and asked "do I need to be worried about what Dr G was asking?"
The doctor sought to put her mind at rest and told her that Dr G was only asking to make sure that the normal procedures were carried out. She replied that after Child Q had collapsed she (LL) had walked into the equipment room and Dr G had been asking the other nurse who was present in the room (when Child Q had collapsed) and how quickly someone had gone to him because she (LL) had not been there.
She continued her texts to the doctor, telling him that she had needed to go to her designated baby in room 1.

Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement

THE prosecution in the trial of Lucy Letby, accused of murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to…

www.chesterstandard.co.uk

 

[Legally Bland]

11:29am

The following day, Child Q's gases were unsatisfactory, but he had been extubated 4 hours earlier and was in air with high saturations.
Medical staff noted a 'mildly dilated loop of bowel' on Child Q's left side and raised the possibility of NEC and surgery.
Child Q was transferred to Alder Hey, where he quickly stabilised and no surgery was required.
The prosecution say this was "another child who had suffered life-threatening problems and...when out of the orbit of Lucy Letby, he made a rapid recovery."

Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement

THE prosecution in the trial of Lucy Letby, accused of murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to…

www.chesterstandard.co.uk

 

[29 Acacia Road]

I'm not sure the record of her texting is a sign she definitely falsified records, I would need to more about how many texts were sent in that period, how long they were etc. It is quite possible she had written out a text but not sent it sometime earlier, made her observations and wrote them in the records and then pressed send on her phone a few seconds before or after.

 

[Legally Bland]

11:29am

Other than three days the following week, that was the last time Lucy Letby worked in the neonatal unit at the Countess of Chester Hospital, the court is told.

Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement

THE prosecution in the trial of Lucy Letby, accused of murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to…

www.chesterstandard.co.uk

 

[gill1109]

Another question. If LL was a very experienced nurse, was there statistically an increase in neonatal mortality in the hospitals where she worked previously, as it was observed in Chester?

And did the indices of neonatal mortality go drastically down after LL left Chester?

Because the numbers of the babies LL is accused of killing should represent a definite surplus in any given time. They won’t change the statistics only if the hospital is both very big and tremendously subpar.

Let me put it so, if the expected annual mortality in NICU is 7 babies per year, then 7 plus is statistically significant. If the hospital is so poor (or maybe, so big and bad) that annual NICU mortality is 100 babies per annum, then 107 would be not significant. In the later case, malfeasance would be very difficult to prove, unless something is registered by the camera.

As I was posting it, I thought that theoretically, there might be a mix of two factors as well. Imagine LL being the killer, but, say, she killed 3 kids out of 7, and the other 4 were victims of routinely bad medical practice. Difficult…

This article sheds some light on mortality rates in NICU, and the reasons for it. Just some food for thoughts. It is almost as if two statistical models have to be made, one, the regular expected death in Chester NICU (given admissions, number of live births, gestational weight, etc), and the other model, all of these, plus additional variable, LL.

A Selected Review of the Mortality Rates of Neonatal Intensive Care Units

Newborn babies in need of critical medical attention are normally admitted to the neonatal intensive care unit (NICU). These infants tend to be preterm, have low birth weight, and/or have serious medical conditions. Neonatal survival varies, but progress ...

www.ncbi.nlm.nih.gov

"Did the indices of neonatal mortality go drastically down after LL left Chester?" The indices of neonatal mortality go down dramatically after there has been a public enquiry into scandalous looking indices, anywhere. LL was removed from the scene by the hospital around the same time. A big fall in those indices therefore does not imply anything. The whole hospital department has been shaken up, difficult looking cases are referred to other hospitals, overall attendance numbers go down and pressure goes down. This was seen in numerous other cases of accused serial killer nurses (some found guilty, some found not guilty).

7 plus is not statistically significant if 7 is the expected annual mortality. Trust me, I'm a statistician ;-).

 

[gc105]

I'm not sure the record of her texting is a sign she definitely falsified records, I would need to more about how many texts were sent in that period, how long they were etc. It is quite possible she had written out a text but not sent it sometime earlier, made her observations and wrote them in the records and then pressed send on her phone a few seconds before or after.

I think they are referring to LL documenting within other patients notes at the time she was allegedly seeing to the collapsed patients rather than the texts. So rather, LL had written documentation to ‘place’ her elsewhere/with another patient at the time of the collapses.

The prosecution say given that Letby was Child Q's designated nurse and she performed the aspiration of air, it might be thought surprising that she did not make the note – yet she did make notes in records of other babies’ notes at about the same time.

Mr Johnson: "We question whether this is an attempt by her to create a documentary alibi."

”Pros, re what Lucy Letby wrote in medical notes: "It is almost as if she was seeking to create a documentary alibi in the notes of other babies. We suggest, a cynical and fairly sophisticated way of making the notes appear as if she had nothing to do with what was going on".”

 

[1345]

"On another piece of paper, she wrote: 'I don’t deserve to live. I killed them on purpose because I’m not good enough”.

“'I am a horrible evil person' and in capital letters, 'I AM EVIL I DID THIS'.

"That, in a nutshell," Mr Johnson tells the court, "is your case."

Dropping the bombshell at the end, oof.