UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #4

[JTS101]

Hello, Sorry I have been out of the loop for a few hours, but catching up. On a scientific point about machines introducing air, anything that moves liquids (e.g. syringe pumps etc) may be prone to introducing air if they become leaky (due to pressure changes) and thus need to be checked on (sometimes) a frequent basis. I wonder if such checks were done (and documented, as they have to be). even syringes can introduce air through either poor technique, or defective syringes. I appreciate that many medical devices are single use only, but the possibility exists that they can be not 100% (although I expect the single use scenario to be extremely rare). I would appreciate any thoughts on this.

 

[Legal]

Perhaps they will bring in a forensic linguist to analyse the note written by LL. I find this such a fascinating field - I had a university place to study forensic linguistics many years ago and regretfully didn't pursue it. However, it would be interesting to hear their interpretation.

 

[arrogantcat]

I think if I was on this jury, so far it is the insulin related deaths that I would be the most concerned over. Whether or not it is deemed believable, the milk and air deaths I presume will be argued by mistakes/negligence mixed with possible other medical conditions/events being responsible for the deaths. The insulin deaths being framed as deliberate tampering with the bags is IMO a harder thing to argue away, other than maybe the bags being contaminated prior to the ward getting them.

Have we actually heard what evidence they plan to show for this? I don’t think there’s anything as concrete as tampered bags etc to back up this claim.

Like the milk and air deaths, the (alleged) insulin deaths were originally considered natural and did not raise any alarms. Medical notes will be able to show blood glucose value changes, but not the precise cause. That will come down to expert interpretations, I assume.

 

[Dotta]

Perhaps they will bring in a forensic linguist to analyse the note written by LL. I find this such a fascinating field - I had a university place to study forensic linguistics many years ago and regretfully didn't pursue it. However, it would be interesting to hear their interpretation.

As I understood, there is a whole diary that might be analysed.

 

[29 Acacia Road]

Have we actually heard what evidence they plan to show for this? I don’t think there’s anything as concrete as tampered bags etc to back up this claim.

Like the milk and air deaths, the insulin deaths were cases that were originally considered natural and did not raise any alarms. Medical notes will be able to show blood glucose value changes, but not the precise cause. That will come down to expert interpretations, I assume.

I may be misremembering then, but I thought as part of the prosecutions opening statement they had said at least one bag had been deliberately tampered with so that insulin was added.

 

[29 Acacia Road]

Lucy Letby trial: Countess of Chester Hospital nurse 'tried to poison new-born twin with insulin'

THE trial of Lucy Letby has heard the Countess of Chester Hospital neonatal unit nurse tried to poison a new-born twin with insulin.

www.leaderlive.co.uk

 

[Marantz4250b]

Hello, Sorry I have been out of the loop for a few hours, but catching up. On a scientific point about machines introducing air, anything that moves liquids (e.g. syringe pumps etc) may be prone to introducing air if they become leaky (due to pressure changes) and thus need to be checked on (sometimes) a frequent basis. I wonder if such checks were done (and documented, as they have to be). even syringes can introduce air through either poor technique, or defective syringes. I appreciate that many medical devices are single use only, but the possibility exists that they can be not 100% (although I expect the single use scenario to be extremely rare). I would appreciate any thoughts on this.

I'm sure it was stated in documentation produced by the manufacturer that the introduction of air was something which was to be expected from time to time. It was a natural and expected result of using the machine.

The impression given previously was that there was no rational/likely explanation for the introduction of air other than by the intention of some person to do so. Clearly the manufacturer says differently!

If such an explanation is expected then it hugely undermines the prosecution argument that it was intentional.

 

[Marantz4250b]

I may be misremembering then, but I thought as part of the prosecutions opening statement they had said at least one bag had been deliberately tampered with so that insulin was added.

On the first day it was said that a bag could have been tampered with. That's a rather "thin" statement to my mind.

 

[MachinaCollecta]

I think if I was on this jury, so far it is the insulin related deaths that I would be the most concerned over. Whether or not it is deemed believable, the milk and air deaths I presume will be argued by mistakes/negligence mixed with possible other medical conditions/events being responsible for the deaths. The insulin deaths being framed as deliberate tampering with the bags is IMO a harder thing to argue away, other than maybe the bags being contaminated prior to the ward getting them.

I’m not sure how easy it is to accidentally dose someone with too much insulin, as a diabetic who injects it myself. I’d be interested to know from a nurse who maybe posts here about their process, as insulin is typically very carefully managed. It’s pretty difficult (from my perspective) to inject more than you’d need, but perhaps the process is different for babies.

 

[JTS101]

I'm sure it was stated in documentation produced by the manufacturer that the introduction of air was something which was to be expected from time to time. It was a natural and expected result of using the machine.

The impression given previously was that there was no rational/likely explanation for the introduction of air other than by the intention of some person to do so. Clearly the manufacturer says differently!

If such an explanation is expected then it hugely undermines the prosecution argument that it was intentional.

Thank you, Marantz4250b to add to this, I have personally seen a few defective plastic syringes in my time which drew up air due to imperfect seals. I shudder to think if any of those were used in a very busy clinical setting.

 

[Marantz4250b]

I’m not sure how easy it is to accidentally dose someone with too much insulin, as a diabetic who injects it myself. I’d be interested to know from a nurse who maybe posts here about their process, as insulin is typically very carefully managed. It’s pretty difficult (from my perspective) to inject more than you’d need, but perhaps the process is different for babies.

I have no experience but, from reading the reports on these babies, we're talking about tiny amounts everything. Volumes of 1ml of milk have been mentioned in some cases. I doubt it would take much insulin over the prescribed dose to kill a person who weighs 800gms.

 

[29 Acacia Road]

On the first day it was said that a bag could have been tampered with. That's a rather "thin" statement to my mind.

Lucy Letby trial: Countess of Chester Hospital nurse 'tried to poison new-born twin with insulin' from here;

The day after allegedly murdering child E in August 2015, Lucy Letby allegedly used insulin for the first time to poison a baby, the court heard, in trying to murder child F.

Child F was prescribed a TPN (total parenteral nutrition) bag of fluids and later suffered an unexpected drop in his blood sugar levels and surge in heart rate. Checks on his insulin levels were carried out which showed, “conclusive evidence” someone had given child F insulin to poison him.

Mr Johnson said no other baby on the neo-natal unit was prescribed insulin so child F could not have received the drug intended for some other child by negligence.

Mr Johnson said the prosecution allege Letby had injected insulin into the TPN bag before it was hung up to give to the child.

He added: “You know who was in the room and you know from the records, who hung the bag.

“It can’t have been an accident.”

(my bold) - That was what had stuck in my mind, obviously we are yet to here the evidence for it and any explanation from the defence, but I was just thinking out loud that if I was on the jury, that probably would have sounded worse (at this point) compared to the air/milk deaths.

 

[Music2022]

I'm sure it was stated in documentation produced by the manufacturer that the introduction of air was something which was to be expected from time to time. It was a natural and expected result of using the machine.

The impression given previously was that there was no rational/likely explanation for the introduction of air other than by the intention of some person to do so. Clearly the manufacturer says differently!

If such an explanation is expected then it hugely undermines the prosecution argument that it was intentional.

I wonder if the amount of air that was found was above what would’ve been expected as result of the machine? Would be strange if the machine had a common side effect of introducing enough air to cause babies a splint diaphragm.

 

[Gardenista]

The Dr. Evans testimony is a perfect example of why it is so hard to figure out what is going on in a trial we can't watch.

In the Dr Husel trial, there was an expert whose testimony was portrayed in media reports (both on direct and cross) as extremely damning to the defendant. In reality, those of us who were watching, saw an expert whose responses showed he was arrogant jerk who would not give an inch even when it was obvious the defense was correct on points they were making.

The media did this throughout the trial with witnesses from experts to family members. This is why people who did not watch the trial were outraged over all of the NG verdicts. The vast majority of those who watched every minute of the trial agreed with the NG verdicts.

 

[JTS101]

I’m not sure how easy it is to accidentally dose someone with too much insulin, as a diabetic who injects it myself. I’d be interested to know from a nurse who maybe posts here about their process, as insulin is typically very carefully managed. It’s pretty difficult (from my perspective) to inject more than you’d need, but perhaps the process is different for babies.

Thank you for your insights MachinaCollecta, Hyperglyceamia and Hypoglycaemia (high and low blood sugar) is a very complex situation and can have many causes, not always related to insulin (e.g. mother having gestational diabetes, some medications, infections, other medical conditions). If there was, for example, insulin resistance in the neonate (I do not know how rare this is), then that would make titration of blood glucose with insulin more challenging. On a note of concern was the low c-peptide levels previously reported. Insulin is made by the body together with c-peptide in equal amounts so a low c-peptide with high insulin indicates that insulin was introduced from the outside (insulin starts to disappear from the circulation within minutes, but c-peptide remains much longer). Also, I do not know if the blood samples were taken pre- or post mortem. Post mortem readings would have very little value.

 

[arrogantcat]

Lucy Letby trial: Countess of Chester Hospital nurse 'tried to poison new-born twin with insulin'

THE trial of Lucy Letby has heard the Countess of Chester Hospital neonatal unit nurse tried to poison a new-born twin with insulin.

www.leaderlive.co.uk

Ah interesting! Thanks for finding and sharing that.

I always find it interesting to read between the lines of what the legal teams do and don’t say in assertions like this.

If they were so certain at the time that insulin had been erroneously or maliciously administered then there would have been a significant investigation with detailed reports and blame apportioned accordingly.
But if that happened, they’d be saying so, right? They’d be saying, “a contemporaneous investigation already established her guilt” or similar. And they’re not.

It’s not my area of expertise but to my knowledge, you can measure blood insulin but there’s no way to test what is synthetic vs natural insulin, and lots of natural things can cause blood insulin levels to spike. My prediction is that these insulin cases will be equally ambiguous and difficult to prove either way. It’s what is going to make this case so difficult.

JMO and interpretation though. Hopefully things will become clearer in due course!

 

[JTS101]

Ah interesting! Thanks for finding and sharing that.

I always find it interesting to read between the lines of what the legal teams do and don’t say in assertions like this.

If they were so certain at the time that insulin had been erroneously or maliciously administered then there would have been a significant investigation with detailed reports and blame apportioned accordingly.
But if that happened, they’d be saying so, right? They’d be saying, “a contemporaneous investigation already established her guilt” or similar. And they’re not.

It’s not my area of expertise but to my knowledge, you can measure blood insulin but there’s no way to test what is synthetic vs natural insulin, and lots of natural things can cause blood insulin levels to spike. My prediction is that these insulin cases will be equally ambiguous and difficult to prove either way. It’s what is going to make this case so difficult.

JMO and interpretation though. Hopefully things will become clearer in due course!

arrogantcat, just to clarify my previous post (I apologise if the details were not clear) you can distinguish between body-produced insulin and externally produced insulin by measuring c-peptide levels.

 

[annpats]

One has to have nerves of steel to follow this trial.

If I was on the jury, I'd have had a severe migraine by now.

Five days would be more than enough.

The thought of sitting in that court every day for potentially 6 months would induce panic.

 

[arrogantcat]

I have no experience but, from reading the reports on these babies, we're talking about tiny amounts everything. Volumes of 1ml of milk have been mentioned in some cases. I doubt it would take much insulin over the prescribed dose to kill a person who weighs 800gms.

This is key. I really think the jury might benefit from visiting a neonatal or SCBU ward to see some infants of a similar age to those in this case to contextualise this (if that were remotely possible). We’re talking about incredibly tiny, fragile infants. Babies whose skin is so delicate that the wrong type of bandage can tear it. Babies who can fit in the palm of your hand. Babies whose organs haven’t all finished developing yet.

It’s an incredibly delicate and complex area of healthcare. The margins for error are especially fine in this patient group.

 

[arrogantcat]

arrogantcat, just to clarify my previous post (I apologise if the details were not clear) you can distinguish between body-produced insulin and externally produced insulin by measuring c-peptide levels.

Ah thank you! I stand corrected! It will be very interesting to hear about these results in due course, then!