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

[JosieJo]

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.

Was this the CPAP machine? Regarding air in the stomach? Were the "air in stomach" patients on CPAP?

 

[annpats]

Re: faulty equipment.

How many of the deaths and attempted deaths are the defence team going for potentially faulty equipment with?

Surely the chances of that much faulty equipment is slim. And I also wonder how many other staff nurses/doctors had trouble with alarms not going off, or sensors becoming dislodged etc....?

It would be interesting to see if it was ever reported by others and how often.

MOO.

 

[arrogantcat]

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.

This is all very interesting and informative! Thank you for sharing!

I can only imagine the complex and delicate art of balancing individual insulin needs alongside varying types of feeds - expressed colostrum and milk, specialist formula, medications and hydration fluids, etc. All on a careful timetable, balanced with other patients and emergencies arising constsntly.

Would the speed of gastric emptying have any impact on blood sugars, do you think? Eg in the cases of children with large quantities of intestinal gas and delayed digestion?

None of this is to say that the accused is innocent, of course (or guilty for that matter!).

 

[arrogantcat]

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

I always imagine the typical jury might look a bit like the spread of Websleuth commenters. A few very for, a few very against, the majority very committed to due process and following the system, and then a couple of wildcards who have google-diagnosed the accused with multiple rare mental illnesses and suspect the involvement of an evil twin

Migraine territory for sure!

 

[annpats]

I always imagine the typical jury might look a bit like the spread of Websleuth commenters. A few very for, a few very against, the majority very committed to due process and following the system, and then a couple of wildcards who have google-diagnosed the accused with multiple rare mental illnesses and suspect the involvement of an evil twin

Migraine territory for sure!

That gave me a chuckle.

The migraine and panic would come from the fear of having to give such mental strength and energy to listening so intently to such detailed knife-edge evidence for 6 hours every day. I would dread it.

Although we don't know the actual reasons why, I'm not surprised 2 jury members have dropped out already.

I presume the jury are being housed in a hotel somewhere? Or are they all going home every night?

What a difficult thing to do, voluntarily done, and with no extra remuneration than what your usual job pays.

 

[Dotta]

What is really terrifying - is that these "medical murders" are so difficult to prove - especially with so tiny babies, where little amount of substances can decide between life and death.

And the death can be written off as an accident or faulty equipment, etc.

The general public is usually oblivious of medical matters and can only rely on experts.

I guess it emboldens some twisted people who get caught only when they finally go too far and even laymen start getting suspicious.

But the arrogance, entitlement and sheer madness are their downfall.

I trust that Prosecution have enough evidence and can bring Justice to those "little guys" robbed of lives and also to their poor parents.

I'm glad that medical experts will help.

I might seem biased to some of you - but I always follow my intuition (and so far it has never failed me.
OK - nearly never).

But, of course, I might be surprised at the end of this trial.

Who knows?

 

[JTS101]

Re: faulty equipment.

How many of the deaths and attempted deaths are the defence team going for potentially faulty equipment with?

Surely the chances of that much faulty equipment is slim. And I also wonder how many other staff nurses/doctors had trouble with alarms not going off, or sensors becoming dislodged etc....?

It would be interesting to see if it was ever reported by others and how often.

MOO.

Very good point annpats, some equipment, like a syringe pump, for example may be used for more than one patient as they are expensive and have no direct contact with the patient, thus it is imperative that they are checked (and the checks documented) that they are working and accurate. Machines like this can lose their accuracy, or develop faults over time. There is a possibility that due to pressure of work in a busy department, checks and recalibrations can be overlooked.

 

[JTS101]

What is really terrifying - is that these "medical murders" are so difficult to prove - especially with so tiny babies, where little amount of substances can decide between life and death.

And the death can be written of as an accident or faulty equipment, etc.

The general public is usually oblivious of medical matters and can only rely on experts.

I guess it emboldens some twisted people who get caught only when they finally go too far and even laymen start getting suspicious.

But the arrogance, entitlement and sheer madness are their downfall.

I trust that Prosecution have enough evidence and can bring Justice to those "little guys" robbed of lives and also to their poor parents.

I'm glad that medical experts will help.

I might be biased to some of you - but I always follow my intuition (and so far it has never failed me).

But, of course, I might be surprised at the end of this trial.

Who knows?

Dotta, if a person is innocent, that may be equally difficult to prove. The best justice for the poor victims is for an accurate and truthful outcome, whatever that may be.

 

[Music2022]

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.

With child L the blood was taken when alive, does it mean it’s definitely not natural insulin?

Bolded by me -

In the hours that followed, Child L's glucose levels fell abnormally low. He was given additional doses of glucose, but they proved ineffective.

The answers to these levels were found after a lab sample sent to the Royal Liverpool Teaching Hospital laboratory came back with results some time later.

The results of the test were "grossly abnormal", but nothing was done about it as Child L had, by the time the results came back, returned to normal.

The reading was "at the very top of the scale" the equipment could measure, the court hears.

There was no correspondingly high level of C-peptide: it was within the normal range. The only explanation for this anomaly is that what was being measured was synthetic insulin, which had not been prescribed to Child L but was stored and readily available in the neonatal unit.

Recap: Prosecution continues opening of Lucy Letby trial

The prosecution continues its opening in the trial of Lucy Letby, accused of multiple baby murders at the Countess of Chester Hospital.

www.chesterstandard.co.uk

 

[JTS101]

This is all very interesting and informative! Thank you for sharing!

I can only imagine the complex and delicate art of balancing individual insulin needs alongside varying types of feeds - expressed colostrum and milk, specialist formula, medications and hydration fluids, etc. All on a careful timetable, balanced with other patients and emergencies arising constsntly.

Would the speed of gastric emptying have any impact on blood sugars, do you think? Eg in the cases of children with large quantities of intestinal gas and delayed digestion?

None of this is to say that the accused is innocent, of course (or guilty for that matter!).

The speed of gastric emptying would indeed have an impact on sugar absorption and this is one of many complicating factors in balancing medications. Intestinal gas is usually expelled rather quickly (unless there is a blockage further down) delayed gastric emptying is more likely due to reduced gastric motility - an automatic reaction of the stomach and intestines to propel food along.

 

[JTS101]

With child L the blood was taken when alive, does it mean it’s definitely not natural insulin?

Bolded by me -

In the hours that followed, Child L's glucose levels fell abnormally low. He was given additional doses of glucose, but they proved ineffective.

The answers to these levels were found after a lab sample sent to the Royal Liverpool Teaching Hospital laboratory came back with results some time later.

The results of the test were "grossly abnormal", but nothing was done about it as Child L had, by the time the results came back, returned to normal.

The reading was "at the very top of the scale" the equipment could measure, the court hears.

There was no correspondingly high level of C-peptide: it was within the normal range. The only explanation for this anomaly is that what was being measured was synthetic insulin, which had not been prescribed to Child L but was stored and readily available in the neonatal unit.

Recap: Prosecution continues opening of Lucy Letby trial

The prosecution continues its opening in the trial of Lucy Letby, accused of multiple baby murders at the Countess of Chester Hospital.

www.chesterstandard.co.uk

Thank you Music2022 That was a concern of mine also. One possibility is that if the usual amount of insulin did not have the desired effect (for example, due to insulin resistance), then additional insulin may have been administered to correct that. but managing blood glucose, especially in neonates is extremely challenging at best.

 

[JTS101]

What also concerns me is that it was not correctable by addition of glucose. In relation to this case, there have been instances of much higher insulin doses been given when have corrected the low glucose.

 

[Music2022]

Thank you Music2022 That was a concern of mine also. One possibility is that if the usual amount of insulin did not have the desired effect (for example, due to insulin resistance), then additional insulin may have been administered to correct that. but managing blood glucose, especially in neonates is extremely challenging at best.

If the baby had insulin resistance he would’ve had more episodes and would’ve been diagnosed later I imagine? Or that’s not how it works?

 

[JTS101]

If the baby had insulin resistance he would’ve had more episodes and would’ve been diagnosed later I imagine? Or that’s not how it works?

Very good point Music2022, these were neonates so they would not have such a diagnosis, this may be the fist time it was spotted.

 

[Music2022]

Another thing that crossed my mind. I could be wrong but is it true that with insulin resistance the body still releases the insulin so it would also release the c peptide. The resistance is the cells ignore the insulin.
If that’s true then insulin resistance won’t explain the low c peptide.

 

[JTS101]

Another thing that crossed my mind. I could be wrong but is it true that with insulin resistance the body still releases the insulin so it would also release the c peptide. The resistance is the cells ignore the insulin.
If that’s true then insulin resistance won’t explain the low c peptide.

The body will still release insulin, but a lot more insulin from external sources may need to be added to correct that. if blood glucose was raised by some other mechanism, that also may need exogenous insulin. what concerns me is that the levels seen were very high. Is there a quote for c-peptide (and more importantly its units, normally ng/ml) the units are important because is you measure insulin in units per ml and c-peptide in ng/ml, you may introduce an artificial erroneous interpretation. it is never enough to quote just numbers (the units have to match)

 

[Tortoise]

"Dr Evans also gave explanations to the jury of medical terms which have been heard during the start of the trial and he commented on a series of short videos demonstrating neonatal medical equipment and procedures.

Evidence directly related to the 17 children allegedly harmed by Ms Letby, originally from Hereford, will be heard later in the trial, with Dr Evans being an expert witness."

Jury hear from medical expert in Lucy Letby trial

 

[Music2022]

The body will still release insulin, but a lot more insulin from external sources may need to be added to correct that. if blood glucose was raised by some other mechanism, that also may need exogenous insulin. what concerns me is that the levels seen were very high. Is there a quote for c-peptide (and more importantly its units, normally ng/ml) the units are important because is you measure insulin in units per ml and c-peptide in ng/ml, you may introduce an artificial erroneous interpretation. it is never enough to quote just numbers (the units have to match)

They said c peptide was in normal range so I guess not elevated as it would’ve been with release of natural insulin. I think with that baby LL agreed the insulin was external.

“
In police interview, Letby said she was aware of Child L's low blood sugar levels and knew the insulin was kept in a locked fridge, with a variety of other drugs. Keys were passed around nursing staff and there was no record of who held the keys at any time.

She agreed the insulin could not have been administered accidentally, but denied being responsible.

Her explanation was it must have been in one of the bags already being received.

The prosecution say that is not a credible possibility.”

Recap: Prosecution continues opening of Lucy Letby trial

The prosecution continues its opening in the trial of Lucy Letby, accused of multiple baby murders at the Countess of Chester Hospital.

www.chesterstandard.co.uk

 

[Tortoise]

A really good summary of the charges here, outlining each baby with medical details

Who are the children alleged to have been murdered by Lucy Letby? | ITV News

I'll add it to the trial media thread so it can be found again more easily

UK - Lucy Letby Trial - Media, Maps & Timeline *NO DISCUSSION*

 

[JTS101]

They said c peptide was in normal range so I guess not elevated as it would’ve been with release of natural insulin. I think with that baby LL agreed the insulin was external.

“
In police interview, Letby said she was aware of Child L's low blood sugar levels and knew the insulin was kept in a locked fridge, with a variety of other drugs. Keys were passed around nursing staff and there was no record of who held the keys at any time.

She agreed the insulin could not have been administered accidentally, but denied being responsible.

Her explanation was it must have been in one of the bags already being received.

The prosecution say that is not a credible possibility.”

Recap: Prosecution continues opening of Lucy Letby trial

The prosecution continues its opening in the trial of Lucy Letby, accused of multiple baby murders at the Countess of Chester Hospital.

www.chesterstandard.co.uk

There is also the possibility of dosing/dilution error (I think insulin administered to neonates has to be diluted)