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

[Tortoise]

11:14am

Mr Myers asks about the purple discolouration, and that by the time the consultant had arrived, she had noted what she had seen at 12.50am, and had 'almost resolved' by the time of the note at 2.40am.
She tells the court: "I think this was something I was puzzled about, and wondering what it would be."
She says other causes were ruled out as such a rash had "come out of nowhere" and had "almost completely gone" a couple of hours later.
She added she was "a little bit confused" and was "trying to put in place all the safe things" she could do to treat Child B.

LIVE: Lucy Letby trial, Tuesday, October 25

 

[Tortoise]

10:57am

The consultant tells the court discussions had been ongoing since the evening of June 9, in light of Child B's twin brother dying, on whether Child A and/or Child B had been affected by the mum's blood condition.

LIVE: Lucy Letby trial, Tuesday, October 25

So they had linked the two incidents - I think this is further proof of the underlying causation being accepted albeit unrecorded in the notes for Child A. IMO

 

[Tortoise]

11:25am

Independent medical expert Dr Dewi Evans has returned to give evidence in respect of Child A.
He confirms he has written four separate statements in respect of Child A, the latter two being clarification on technicalities.
The first report was written in November 2017, the second in May 2018.

11:31am

Dr Evans said he became involved in the case in July 2017 by the National Crime Agency.
He visited Cheshire Police where they had concerns about a number of deaths in the Countess of Chester Hospital which were "unusual" and "far more deaths than they would expect".

LIVE: Lucy Letby trial, Tuesday, October 25

 

[JosieJo]

10:44am

The registrar also relayed Child B was bagged and tubed, and the heart rate went up, with adrenaline "not required".
The consultant noted, for her observation: "Upon my arrival purple blotching right mid-abdomen and right hand." The baby was "pink and active".

10:44am

The prosecution asks: "Do you have any independent recollection of that now?"
The consultant replies: "No."

10:51am

The consultant relays the various medical observations that were recorded at the time, including blood gases, protein levels, and heart rate.

Recap: Lucy Letby trial, Tuesday, October 25

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

www.chesterstandard.co.uk

Imo this is what is odd and "may indicate a type of embolus"

The consultant noted, for her observation: "Upon my arrival purple blotching right mid-abdomen and right hand." The baby was "pink and active".

The baby had recovered and was pink and active...with the exception of the mid abdomen and right hand .. you would expect all of the baby to return pink...just my opinion

 

[Tortoise]

11:33am

The deaths had "followed collapses in babies" which were "otherwise quite stable" and involved collapses where resuscitation attempts were not successful.
He said: "I thought I could help, advise review case notes and form an opinion that led to the collapses of [Child A and Child B]."

11:35am

He said "despite the prompt resuscitation in [A's] case", Child A had died despite doing "very well".
He said his job was to look at the "clinical evidence".
He added that Child A was the first case he looked at, and subsequent reviews of other children had reinforced his opinions for the conclusions of Child A and B.

11:37am

He said "a pattern became apparent in the cases", which he described as "quite disturbing and quite unusual."

LIVE: Lucy Letby trial, Tuesday, October 25

 

[Tortoise]

11:39am

For Child A, Dr Evans confirms he had received clinical records for the baby boy to review, and had received statements from Countess of Chester Hospital medical staff for the case.

LIVE: Lucy Letby trial, Tuesday, October 25

 

[Tortoise]

11:47am

Dr Evans explains to the court certain medical procedures such as cannulas, UVC and long lines.

LIVE: Lucy Letby trial, Tuesday, October 25

 

[bbsaz]

So, simplifying this case to the most basic level, is it a choice of 2 options for the jury:

1) Did the baby(ies) die of natural or unnatural causes?
2) If unnatural, was LL the perpetrator?

Of course, the added complication is that there are so many cases, of both M and AM. I assume she could be found guilty of some, and not all? Thoughts?

 

[Tortoise]

11:53am

Dr Evans said there is a connection between the insertion of a long line and 'cardiac tamponade', where fluid obstructs the heart and is a "deadly serious condition".
He added that, "sadly", he was aware of a case which happened in Swansea where a baby had died as a result of that.
He said such cases are where a long line has been in place "for several days".
Diagnosing such a condition post-mortem would also be "relatively straightforward" as fluid would be detected outside the heart.
For Child A, he had not come to the conclusion that cardiac tamponade was the likely cause of death.

LIVE: Lucy Letby trial, Tuesday, October 25

 

[JosieJo]

So, simplifying this case to the most basic level, is it a choice of 2 options for the jury:

1) Did the baby(ies) die of natural or unnatural causes?
2) If unnatural, was LL the perpetrator?

Of course, the added complication is that there are so many cases, of both M and AM. I assume she could be found guilty of some, and not all? Thoughts?

I agree I think at its most basic level that will be the crux of the matter

 

[Tortoise]

Just a reminder of the defence's questioning of Professor Arthurs on Friday (BBM) -

"Mr Myers asks if the presence of a UVC or long line for some time could lead to air in the system. Dr Arthurs agrees."


Although this is in relation to air, not fluids.

 

[Tortoise]

11:54am

Dr Evans says, from looking at Dr Harkness's clinical notes at the time, the efforts to save Child A were "very good standard resuscitation procedures."
He added: "[It is] what you would expect in any neonatal unit in 2015."

LIVE: Lucy Letby trial, Tuesday, October 25

 

[Tortoise]

12:01pm

Dr Evans said, just before Child A's collapse, he was "in a stable condition". In his report he had described his condition as "perfectly satisfactory."
He added: "He was as well as could be expected. All the markers of well-being were very satisfactory. He was in air, not needing additional oxygen, heart rate in normal limits, oxygen saturation normal - it had been in the 90s...respiratory rate slightly above normal rate but that was the only marker outside normal rate."

LIVE: Lucy Letby trial, Tuesday, October 25

 

[Tortoise]

12:06pm

He said Child A "had survived the most dangerous journey of his life" and, although he needed care for feeding himself, he "was doing really, really well" and "everyone one the unit would have been really pleased with how he was."

LIVE: Lucy Letby trial, Tuesday, October 25

 

[Tortoise]

12:17pm

Dr Evans said he had not been presented with evidence of the discolouration, as the court has heard through this trial, for Child A.
He said it was not noted in the evidence he had received.
He adds: "I think the rash in [Child A's] collapse fits together and fits a significant diagnosis...of air embolous [injection of air into the circulation]."

12:18pm

"Somehow air had got into the circulation...I found this opinion without knowing about the rash and without anybody suggesting expressing concern of air embolus."

12:21pm

He rules out other conditions such as sepsis, a lack of fluids or hypoxia as causes, or contributing factors to the collapse.
He said he had "only one" conclusion, that Child A had received an air embolus, "through an IV line".
He said with the systems in place, and the medical equipment, and medical staff being "obsessive" about making sure patients are not injected with air, "there was no way this could have been done by accident".

LIVE: Lucy Letby trial, Tuesday, October 25

 

[Legal]

yes but only after the spike in deaths and collapse. It was noticed that Lucy was the only consistent presence in these otherwise unexplained cases.Nothing at all to do with her character, work standards and general perception by the staff around her. He was the doctor who noticed she was working during these cases. The defence has stated “her presence“ is the only implicative pattern.

I got the impression more that he had a slow sinking feeling about what could be potentially happening. These deaths were continuing and unexplained and then by chance he read the article about embolus in newborns, which was in the testimony from yesterday and said he went cold all over. He said he had a similar feeling when he saw LL alone with the baby, following which he went to check what she was doing.

I don't think he was spuriously looking for a reason, more that the horrific possibility slowly grew on him that the fatalities could be deliberate, and her presence was a constant, though it was an idea he didn't want to contemplate.

 

[Tortoise]

12:24pm

Dr Evans will be cross-examined by the defence after giving evidence for Child B.
Before that, independent medical expert Dr Sandie Bohin has now been called in to give evidence for Child A. She is detailing to the court her medical and professional background.

LIVE: Lucy Letby trial, Tuesday, October 25

 

[Imnothere]

12:17pm

Dr Evans said he had not been presented with evidence of the discolouration, as the court has heard through this trial, for Child A.
He said it was not noted in the evidence he had received.
He adds: "I think the rash in [Child A's] collapse fits together and fits a significant diagnosis...of air embolous [injection of air into the circulation]."


Hmm I feel like this isn't good for Lucy at all. He came to this conclusion even when they never mentioned the discoloration in the evidence pack. What did Lucy say about child A? She saw the rash and though maybe there was something wrong with the fluids?

 

[Tortoise]

12:27pm

Dr Bohin says she was asked to peer review Dr Evans's reports and was to find whether she agreed with them, disagreed with them, or had additional findings to present.
She has also considered other findings from other independent experts in the case.

LIVE: Lucy Letby trial, Tuesday, October 25

 

[bbsaz]

I got the impression more that he had a slow sinking feeling about what could be potentially happening. These deaths were continuing and unexplained and then by chance he read the article about embolus in newborns, which was in the testimony from yesterday and said he went cold all over. He said he had a similar feeling when he saw LL alone with the baby, following which he went to check what she was doing.

I don't think he was spuriously looking for a reason, more that the horrific possibility slowly grew on him that the fatalities could be deliberate, and her presence was a constant, though it was an idea he didn't want to contemplate.

Totally agree. I find when people refer to him as "a TV doctor" that there is a bit of a negative slur sometimes. Like because he has been on TV (albeit for 1 show?) he could be more sensationalist/dramatic etc... when the reality is likely far from this. I imagine in reality he is a very level headed, calm, reasonable man -. traits needed in an neonatal/ITU medic imo.