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

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12:28pm

The prosecution ask Dr Bohin to clarify whether she had also seen a post-mortem report for Child A, and the reports of Countess medical staff. She confirms that was the case.

12:31pm

Dr Bohin explains Child A was, for a baby born 10 weeks premature, a "stable baby", on breathing support via CPAP but not requiring oxygen ventilation, and was doing "so well" that medical staff decided to start giving him some feeds.
"If he was unstable in any way they would have done so," she tells the court.

LIVE: Lucy Letby trial, Tuesday, October 25

BBM - I'm presuming this is a typo and she said wouldn't, not would
 
12:48pm

Dr Bohin said doctors and nurses are "absolutely meticilous" in making sure even "the tiniest air bubble" is not injected by accident into a patient's circulation.
She adds that even if air was accidentally administered, there is an electronic pump system which would detect the air and stop the administration.
Dr Bohin explains to the court that could be bypassed further down the line by administering the air embolus via a connector normally used for administering drugs.

LIVE: Lucy Letby trial, Tuesday, October 25
 
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?
That’s more or less the situation. I find it interesting especially in this case that the medical paper dr Ravi says gave him an awareness of how that skin ”mottling“ is found in cases of air embolism also states that “clustering of cases prevents proper calculation of incidence”. This case is obviously a cluster Not that that means anything necessarily either way. I would like to see why the resuscitation efforts were unsuccessful and if that also is indicative of air embolism.
 
Aha, I've found a way of reading tweets without being on the writer's twitter page

This morning's Tweets from Dan O'Donoghue BBC (I can't copy the times they were tweeted by this method)

I'm once again at Manchester Crown Court for the trial of Lucy Letby. Jurors are today hearing from a doctor, who can't be named for legal reasons, who worked at the Countess of Chester in 2015

The doctor is currently running through her notes made in June 2015 when she received an emergency call to attend to Child B. They state: 'Baby suddenly stopped breathing. Purple blotching of body all over with slowing of heart rate'

The doctor tells the court that in light of Child B's twin brother dying 24 hours before, advice was sought from various medics across the country on whether Child A and/or Child B had been affected by the mum's antiphospholipid syndrome

Medics at Great Ormond Street Hospital said the condition would not effect the babies and no further investigation was needed. Experts from Alder Hey suggested doing a full blood count. Given Child B's good health when the doctor started her shift tests were held off

Child B took ill that evening and after she was stabilised she was put on antibiotics as a precaution. Subsequent blood observations taken were 'good' and no more tests were ordered

The doctor says she was 'puzzled' by Child B's deterioration. Describing the 'rash' that covered her, she said: 'It was so florid, it came out of nowhere. One and a half hour's later it is completely gone'

The court is now hearing from medical expert Dr Dewi Evans on the death of Child A. Dr Evans was approached by the National Crime Agency in 2017 to assist police in their investigation

Dr Evans said: 'The concern was that there had been a number of deaths in the Countess that had been unusual, there were far more deaths than they would expect. Collapses in babies that were otherwise quite stable, but in many of the cases resuscitation was not successful'

Dr Evans said he found the cases 'quite disturbing and quite unusual' and soon 'a pattern became apparent'

In the last week there's been examination of the 'abnormal' position of a long line (used to deliver fluids) to Child A. Dr Evans is asked if he has seen any evidence to suggest the positioning of this line was a cause of death. 'none at all', he says

Dr Evans says the cause of death with Child A is an air embolism (bubble)..he explains: 'It interferes with the blood supply to the heart and lungs, mechanism is the same as a clot that goes into the lungs'

Independent medical expert Dr Sandie Bohin, who peer reviewed Dr Evans' findings, came to the same conclusion - that Child A died from an air embolism

Dr Evans is now back in the witness box, he's discussing Child B's case. He says the cause of her collapse - like her brother Child A - was an air embolism, 'there was nothing else to explain this collapse, which was so sudden and unexpected', he said

 
1:02pm

Dr Bohin is asked how much of an air embolus would be considered fatal to a child of Child A's size?
She says that 3-5ml of air per kilogram of body weight "could be fatal".
She explains Child A weighed 1.6kg [about 3.5lb].
"A teaspoon of air?" Nicholas Johnson KC, prosecuting, asks.
"Well, that is 5ml of air, so yes," replies Dr Bohin.

1:02pm

Mr Johnson: "What, in your opinion, killed [Child A]?"
Dr Bohin: "[Child A] was killed by an air embolus."

LIVE: Lucy Letby trial, Tuesday, October 25
 
That’s more or less the situation. I find it interesting especially in this case that the medical paper dr Ravi says gave him an awareness of how that skin ”mottling“ is found in cases of air embolism also states that “clustering of cases prevents proper calculation of incidence”. This case is obviously a cluster Not that that means anything necessarily either way. I would like to see why the resuscitation efforts were unsuccessful and if that also is indicative of air embolism.
I remember in the early days of her arrest hearing the phrase "the babies were unusually difficult to resusitate"
 
I find the phrase "I killed them on purpose" much more difficult to explain

No matter how much someone says ..its my fault...I'm not good enough ..I'm evil ..the words "on purpose" do not fit with anguish
I'm just on catch-up as the past few days have been stupid busy!

That phrase stuck out to me as being strange. I know the whole note is strange of itself but the phrase, "I killed them on purpose" comes over as being not really something that an adult, and a well educated and intelligent adult at that, would tend to write.

We know that LL wrote it, as the defence haven't queried it's authenticity, but there is just something about that sentence which stands out to me as not being "right" in the greater context.
 
Interesting that on a ward “meticulous“ about not injecting air an individual would set about administering air deliberately In an effort to kill or harm. Lucy would have definitely been aware of this and had she a mind to kill presumably wouldn’t have used this form?
Hmm...not necessarily. We are assuming her mind was to kill... if at all, maybe it was to create drama. After all, it's not a fail safe method (injecting air) as there are lots of attempted murder charges with air as well.

For what it's worth, I lean towards the munchausens by Proxy concept here. That she created these situations for the drama and all that surrounded that eg getting to be a saviour, being up close to the grief, being the trusted 'friend' at a horrific time etc...
 
I'm just on catch-up as the past few days have been stupid busy!

That phrase stuck out to me as being strange. I know the whole note is strange of itself but the phrase, "I killed them on purpose" comes over as being not really something that an adult, and a well educated and intelligent adult at that, would tend to write.

We know that LL wrote it, as the defence haven't queried it's authenticity, but there is just something about that sentence which stands out to me as not being "right" in the greater context.
Yeh it’s opposed to ”by mistake“ I think? Does that suggest Lucy might have entertained the idea that the care she had delivered was “not good enough” and so maybe guilt about her own performance?Which may or may not be the reason she is being accused in her own mind? She did state “I did not intentionally harm any babies“ in her statement to the court.
 
Perhaps she was crazy with jealousy of happy young couples having babies? Because maybe she believed that she would never be so fortunate as to have that happiness? She is still only 32, I think, so when these attacks were happening, she was in her mid 20's. Still very young. But has she ever had a boyfriend, do we know? If not, that might have really hurt, made her feel different, and angry. Just an idea.
She would have been 25 at the time of the first alleged offences. Boyfriend or not, 25 isn't particularly old and I'd consider it unusual for someone of that age to be thinking like that. Indeed, marriage and babies seem to be things that people tend to put off till later in life these days. I'd have thought that was especially true of someone like her who it seems had very clear and well defined career goals in her mind. She was already quite qualified for her age, I think, so clearly devoted a lot of time to work and study.

She's not unattractive and seems reasonably social from her pics. Unless she has an intensely bizarre or objectionable personality I don't see why she'd be worrying unduly about those sorts of things. Tends to suggest that these were fears expressed when the investigation had been ongoing for quite some time, I think.
 
Hmm...not necessarily. We are assuming her mind was to kill... if at all, maybe it was to create drama. After all, it's not a fail safe method (injecting air) as there are lots of attempted murder charges with air as well.

For what it's worth, I lean towards the munchausens by Proxy concept here. That she created these situations for the drama and all that surrounded that eg getting to be a saviour, being up close to the grief, being the trusted 'friend' at a horrific time etc...
I wouldn’t associate her behaviour after child A to be in line with someone creating drama for the attention especially with Lucy stating she didn’t want to see the parent And would like to have time off with family. there is nothing out of character with Lucy seemingly by all accounts especially with her “mentors” approval.
 
I wouldn’t associate her behaviour after child A to be in line with someone creating drama for the attention especially with Lucy stating she didn’t want to see the parent And would like to have time off with family. there is nothing out of character with Lucy seemingly by all accounts especially with her “mentors” approval.
Can you remember if she texted her friend between babies A and B? If it was after both incidents involving A&B, then I wonder if, assuming this was intentional AND it was her first crimes, that she felt extreme guilt and remorse initially and wanted to run away from what she had done. If she text between the 2 babies then it does seem odd that she would want to stay away, but then go back in for an attempt on Baby B just hours later...
 
1:08pm

Dr Evans is recalled to give evidence for Child B's non-fatal collapse.
He said the collapse was "not really" likely as "all the markers were satisfactory" and the medical staff had elt comfortable enough to allow the baby girl to be out of the incubator for a short time so she could be handled by the mum.
He said that was "not something you would do" if the child was not stable.

1:10pm

He said the two conclusions he had for Child B's collapse were "smothering" or an "air embolus".
He said the discolouration was a "striking feature" which had been seen in Child A arrived and went "very quick".
He said if the rash was associated with other conditions, it "tends to stay".

1:17pm

Dr Evans tells the court the collapse was "very similar" to that of Child A, but what happened was "less severe".
He said "either the volume of air [injected] was less, or the volume of air in the circulation got there more slowly, or a combination of the two."
Asked by Mr Johnson if there were any other possibilities to the cause of the collapse, Dr Evans replies: "I could not think of anything else.
"The doctors did a really good job in saving her.
"There was no evidence of sepsis, problems with the lungs, nothing unusual about the chest x-rays, lungs were full of air...nothing else to explain this collapse which again was sudden and unexpected."
He added: "We have heard numerous doctors saying they have never seen this before. I feel I can say the same. It's very unusual."

1:54pm

The court has adjourned for the lunch break, with the trial resuming at 2.10pm.
Dr Evans will be cross-examined by the defence this afternoon in relation to the collapses of Child A and Child B.

LIVE: Lucy Letby trial, Tuesday, October 25
 
2:16pm

The trial has resumed.
Ben Myers KC, defending, says Dr Evans has prepared a "large number of reports" over the years, and air emboluses feature in "a number of them" - "literally dozens". Dr Evans agrees.
Dr Evans is asked to explain the features of an air embolus.
He adds: "An air embolus will lead to a sudden and unexpected collapse. A patient, otherwise stable, collapses. And by collapse, I mean change of colour, stops breathing...reduced heart rate, and death. This occurs all of a sudden.
"There are additional features - you don't get all the features in all the cases. The two main associated features are unusual skin discolouration and the presence of air in 'great vessels' - various parts of the body. Those are the compounding features which lead to a diagnosis of air embolus.
"This occurs when there is no other explanation...which fits the collapse, and when resuscitation is unsuccessful.
"Resuscitating patients [for doctors] is part of our bread and butter, so resuscitating is well known. When that is unsuccessful, it adds to the confirmation [of an air embolus diagnosis]."

2:20pm

Dr Evans relays one case of a baby who had died in Swansea from an air embolus, from what "should have been a regular surgical procedure", when recalling it was "absolutely awful" and led to a criminal trial.
He said he had not been involved in the report so was unaware of any discolouration in that baby.
He says he has never come across such skin discolouration in a collapse in 'hands-on experience'.
"That is something I am relieved and pleased about, actually."

2:21pm

Mr Myers said the diagnosis is 'one of exclusion' - ruling out alternatives until there is one explanation left.
Dr Evans said there is more to the case than that. He said his original conclusion was without knowing about the skin discolouration in Child A.
He adds that if you discover additional information, that "simply firms up your diagnosis".

2:26pm

Dr Evans states that air embolus cases are difficult as there are "isolated" case reports, and the systems are put in place in modern times so the conditions are not repeated - "that is not a criticism, that is a compliment", hence there is "very little new research".
He adds that doctors may be reluctant to "spread news" of mistakes in cases where there may have been an air embolus.

LIVE: Lucy Letby trial, Tuesday, October 25
 
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