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

[Charlot123]

I have a question.

Medcabs
Automated medication dispensing systems

Medcab Delivers Exceptional Care While Lowering Risk

The medcab is one of the best investments a hospital can make in giving nurses more time with patients while reducing their stress and the risk for errors.

www.taloncontrols.com

https://snscourseware.org/snscphs/files/1610066894.pdf

My question is not only LL’s culpability, but also, how the heck could a nurse draw unaccounted for insulin in the NICU part of the hospital?

What hospital system allows the nurse to draw insulin: 1) without a doctor’s prescription?
2) without any trace in the dispensing system?

It is insulin! And if I remember correctly, she was also accused of adding morphine? A controlled drug? How can a nurse gain access to a controlled drug without any trace? And if she can, that means, anyone can steal morphine from a hospital, and none the wiser?

Maybe Lucy was wrong, but I see a huge system error. If insulin is kept in the refrigerator and the key is passed around, unaccounted for, it is an error on behalf of the hospital. If by the end and beginning of the shift, there is no counting of the insulin vials, it is an error. No comments about LL, specifically, but human factor is a tricky thing. And what if someone decides to take insulin home to take care of the ailing relatives?

About postcards. Personal example. I once knew a lady who was buying amazing postcards made by a local crafter and reselling them at $6 per card. When I found the crafter, I found out that they cost $ 5 from her. So I bought a lot, for b-days and for the coming NY.

Then I started using them. If anyone compares my behavior when I “saved” on postcards with my regular pattern (“who cares about postcards”?), there is a major difference. I have no doubt it can be tied up to malice, if someone wants to. IRL, the explanation is different. There would be an additional peak before the NY, as “2022” is not reusable.

In short, the postcards are not a proof to me. No way. Likewise, some explanations for human behaviors would be unusual, but not necessarily, malicious.

No matter how the trial ends, Chestershire hospital HAS to invest into a better drug distribution system. It is cheaper than dealing with the trial now.

 

[Whitehall 1212]

“conclusive evidence” someone had given child F insulin to poison him.

This implies that the evidence is not open to legal challenge.....that there can be no other explanation! However, even if it shows causality, it doesn't of itself prove a guilty act or even that LL administered it with the required intent....both necessary elements to prove the offence

Lucy Letby had injected insulin into the TPN bag before it was hung up to give to the child.

Weren't the TPN bags prepared in the pharmacy? If so, this creates doubt in the assertion that LL contaminated the TPN bag. Additionally, without the remains of the bag it can never be proven that it was contaminated.

Of course, we need to hear the evidence proper for Child F, to make an informed judgement, but what had been said so far, about the mechanics of Child F's raised insulin levels causing their collapse, is entirely circumstantial.

 

[Music2022]

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

That baby wasn’t prescribed any insulin though, he should’ve had zero extra insulin. So LL agrees the bags had insulin in them but I guess thinks it was the pharmacist who made the bags and put it there by mistake?

 

[JTS101]

I have a question.

Medcabs
Automated medication dispensing systems

Medcab Delivers Exceptional Care While Lowering Risk

The medcab is one of the best investments a hospital can make in giving nurses more time with patients while reducing their stress and the risk for errors.

www.taloncontrols.com

https://snscourseware.org/snscphs/files/1610066894.pdf

My question is not only LL’s culpability, but also, how the heck could a nurse draw unaccounted for insulin in the NICU part of the hospital?

What hospital system allows the nurse to draw insulin: 1) without a doctor’s prescription?
2) without any trace in the dispensing system?

It is insulin! And if I remember correctly, she was also accused of adding morphine? A controlled drug? How can a nurse gain access to a controlled drug without any trace? And if she can, that means, anyone can steal morphine from a hospital, and none the wiser?

Excellent questions, Charlot123 I don't know the answers to those questions

 

[notsure]

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*

It is very interesting, but it seems that foul play was not suspected at all at the time, despite all those facts that make everything so suspicious retrospectively.

 

[JTS101]

That baby wasn’t prescribed any insulin though, he should’ve had zero extra insulin. So LL agrees the bags had insulin in them but I guess thinks it was the pharmacist who made the bags and put it there by mistake?

There is always a risk of error in any clinical setting and checks and balances are there to reduce that risk to a minimum. In a busy clinical setting, the risk of error may be increased to reduced checks.

 

[Whitehall 1212]

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.

I understand that Child F was a collapse, not a death, so hopefully the blood insulin/c-peptide readings were accurate.

 

[Music2022]

My question is not only LL’s culpability, but also, how the heck could a nurse draw unaccounted for insulin in the NICU part of the hospital?

Looks like it was just some floating keys and a fridge, nothing super secure.

“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.”

 

[Music2022]

There is always a risk of error in any clinical setting and checks and balances are there to reduce that risk to a minimum. In a busy clinical setting, the risk of error may be increased to reduced checks.

True. But it happening to two separate babies with the same drug? Not sure I can believe it. Who knows.

 

[JTS101]

True. But it happening to two separate babies with the same drug? Not sure I can believe it. Who knows.

I shall await the reported evidence and explanations on that one

 

[kittythehare]

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.

Imagine if the other 11 were from opposite end of all you held dear?
Does that ever happen?

 

[Whitehall 1212]

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.

Would it be likely then that blood taken to help identify the reason for collapse would only be tested, in the heat of the moment, for raised insulin rather than both insulin and c-peptide levels?

If the sample is not tested for c-peptide at the time, then it would not be suspected that the insulin had been administered? Would this be an accurate assertion?

If insulin is raised significantly is dextrose or a similar glucose product administered via IV, in an effort to stabilise the patient?

Thanks @JTS101

 

[squish]

LL probably only needs to be convicted of a single murder to receive a whole life tariff.

Wayne Couzens, the cop who murdered Sarah Everard, received a whole life tariff, because he abused his position of trust and power as a police officer to abduct her. He was seen on CCTV flashing his badge at her to convince her to get in his car. Normally, for committing one murder, it would not legally warrant a whole life sentence.

Lucy Letby is in a similar situation, because she is accused of abusing her position of power and trust as a nurse, in order to commit murder. Only one murder conviction will put her away for life.

Even a single attempted murder conviction would carry a much long sentence than usual, in her case.

 

[cuecard]

It is very interesting, but it seems that foul play was not suspected at all at the time, despite all those facts that make everything so suspicious retrospectively.

I think you have to take into consideration that hospitals are manic places. New patients, shift changes, nurse changes, births, deaths, different conditions, medications etc. I could see why a situation like this could go under the radar for a period of time before anyone started to think something was off/wrong.

 

[JTS101]

Would it be likely then that blood taken to help identify the reason for collapse would only be tested, in the heat of the moment, for raised insulin rather than both insulin and c-peptide levels?

If the sample is not tested for c-peptide at the time, then it would not be suspected that the insulin had been administered? Would that be an accurate assertion?

If insulin is raised significantly is dextrose or similar glucose product administered via IV, in an effort to stabilise the patient?

Thanks @JTS101

c-peptide is not a common measurement in terms of diabetes, but greater clinical value is being placed on it as insulin has a very short biological half life (a few minutes) so c-peptide levels may give a better indication of whether anything was affecting insulin production

 

[Gardenista]

I have a question.

Medcabs
Automated medication dispensing systems

Medcab Delivers Exceptional Care While Lowering Risk

The medcab is one of the best investments a hospital can make in giving nurses more time with patients while reducing their stress and the risk for errors.

www.taloncontrols.com

https://snscourseware.org/snscphs/files/1610066894.pdf

My question is not only LL’s culpability, but also, how the heck could a nurse draw unaccounted for insulin in the NICU part of the hospital?

What hospital system allows the nurse to draw insulin: 1) without a doctor’s prescription?
2) without any trace in the dispensing system?

It is insulin! And if I remember correctly, she was also accused of adding morphine? A controlled drug? How can a nurse gain access to a controlled drug without any trace? And if she can, that means, anyone can steal morphine from a hospital, and none the wiser?

I wondered about this. I'm sorry to keep bringing up Dr Husel's case, but there are so many commonalities.

The defense proved in the Husel case that the hospital was ignoring the rules for dispensing medication from the machines. This allowed medical personnel to override the safeguards built into the system. These safeguards are required by governmental agencies if the hospital wanted to get paid.

Husel worked at a hospital in a very low income area and the majority of the patients had Medicaid or Medicare ie: government pays the patients medical bills.

When it came to light that the hospital was not following the rules about dispensing medications, the hospital executives came up with a plan and made Dr Husel the scapegoat to keep themselves from losing their contract with the government. I believe it was a $200 million contract they stood to lose and the hospital is a for profit hospital.

Luckily, the defense was accidentally given the PR documents about the plan to scapegoat Husel which I believe helped him get acquitted.

 

[JTS101]

Also I would hope that c-peptide would be measured at the same time in the sample (I don't know if it was).

 

[Whitehall 1212]

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!

 

[norealnameshere]

This implies that the evidence is not open to legal challenge.....that there can be no other explanation! However, even if it shows causality, it doesn't of itself prove a guilty act or even that LL administered it with the required intent....both necessary elements to prove the offence



Weren't the TPN bags prepared in the pharmacy? If so, this creates doubt in the assertion that LL contaminated the TPN bag. Additionally, without the remains of the bag it can never be proven that it was contaminated.

Of course, we need to hear the evidence proper for Child F, to make an informed judgement, but what had been said so far, about the mechanics of Child F's raised insulin levels causing their collapse, is entirely circumstantial.

This needs to be clarified. It's been years since I was involved with this but we didn't used to make up TPN except on very rare occasions. We used to buy them ready made and send them up to the ward, sometimes with a syringe of extra vitamins to be added to the bag on the ward.

That said, I've never been involved with babies that unwell. There are vastly more qualified people out there, probably some reading this thread.

 

[arrogantcat]

Medcabs
Automated medication dispensing systems

Medcab Delivers Exceptional Care While Lowering Risk

The medcab is one of the best investments a hospital can make in giving nurses more time with patients while reducing their stress and the risk for errors.

www.taloncontrols.com

https://snscourseware.org/snscphs/files/1610066894.pdf

My question is not only LL’s culpability, but also, how the heck could a nurse draw unaccounted for insulin in the NICU part of the hospital?

What hospital system allows the nurse to draw insulin: 1) without a doctor’s prescription?
2) without any trace in the dispensing system?

It is insulin! And if I remember correctly, she was also accused of adding morphine? A controlled drug? How can a nurse gain access to a controlled drug without any trace? And if she can, that means, anyone can steal morphine from a hospital, and none the wiser?

Maybe Lucy was wrong, but I see a huge system error. If insulin is kept in the refrigerator and the key is passed around, unaccounted for, it is an error on behalf of the hospital. If by the end and beginning of the shift, there is no counting of the insulin vials, it is an error. No comments about LL, specifically, but human factor is a tricky thing. And what if someone decides to take insulin home to take care of the ailing relatives?

About postcards. Personal example. I once knew a lady who was buying amazing postcards made by a local crafter and reselling them at $6 per card. When I found the crafter, I found out that they cost $ 5 from her. So I bought a lot, for b-days and for the coming NY.

Then I started using them. If anyone compares my behavior when I “saved” on postcards with my regular pattern (“who cares about postcards”?), there is a major difference. I have no doubt it can be tied up to malice, if someone wants to. IRL, the explanation is different. There would be an additional peak before the NY, as “2022” is not reusable.

In short, the postcards are not a proof to me. No way. Likewise, some explanations for human behaviors would be unusual, but not necessarily, malicious.

No matter how the trial ends, Chestershire hospital HAS to invest into a better drug distribution system. It is cheaper than dealing with the trial now

Insulin is a POM (prescription only medication) but not a Controlled Drug in the UK, so not subject to higher level checks IIRC. Additionally some qualified senior nurses can issue prescriptions for commonly used drugs in a clinical setting - not sure if this applies to LL’s status or not.

Insulin is at a low risk for theft as it’s very affordable here and no fun for recreational abuse.

Systems like this are generally trust-wide, and often nation-wide, so the hospital may not be directly culpable for this policy (if the policy was being followed in this case).

Morphine, however, is a controlled drug nationally and would require a doctor’s prescription and a paper trail.