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

[Tortoise]

https://twitter.com/MrDanDonoghue

We're back after a break. Lucy Letby's defence barrister Ben Myers KC is now questioning expert Dr Dewi Evans

Mr Myers says 'It's important not to hurry to a conclusion of deliberate harm if there is no direct evidence?' Dr Evans responds: 'You never hurry with a diagnosis which has such serious consequences'

Mr Myers is asking whether there was any suggestion of deliberate harm when the NCA first contacted Dr Evans. He tells the court 'no' and sets out that there was a 'constellation of worries' around what had happened at the Countess of Chester

'This was a hospital where three or four babies died a year on average, but somehow, over a very short period, the hospital had loads of deaths', he said

Dr Evans tells the court that he originally examined 33 baby deaths

 

[Tortoise]

2:40pm

Dr Evans said he was tasked with investigating a "clinical condition", not a "crime", when he became aware of the Countess of Chester Hospital case, when tasked by the National Crime Agency.
He said the scenarios added up to a "constellation of worries" on what went on between June 2015 and June 2016.
He adds that in past cases, he has been brought in by police and the conclusion was accidental, so the case was closed with no further police involvement.
He is asked about his 'state of mind' in his approach to the cases.
"My state of mind was very clear - let's find a diagnosis. Nothing to do with crime. Let's identify any specific collapse, and see if I can explain it.
"There were occasions where I couldn't explain it, and occasions where I found something deeply suspicious.
"There were incidents I found disturbing."
He was asked to investigate 33 cases in total, with two insulin cases later.
He said there were two babies were born in unsurvivable conditions, with obvious medical diagnoses.
He said: "The name Lucy Letby meant nothing to me. I didn't know the staff.
"I was the easiest physician and the most difficult. I was a blank sheet of paper. I had no idea and relied entirely on the evidence I could see from the clinical notes and applying my clinical experience and forming an opinion to the cause."

LIVE: Lucy Letby trial, Tuesday, October 25

 

[Tortoise]

2:42pm

He said he asked to have one case file to have "an idea" of what he was dealing with.
Mr Myers: "Was the phrase 'air embolus' used at all?"
Dr Evans: "No. The first person to use air embolus, as far as I was concerned, was me.
"I need to give the NCA a compliment, they never gave me a steer. They are good, professional people."

LIVE: Lucy Letby trial, Tuesday, October 25

 

[Tortoise]

2:48pm

Mr Myers turns to the case of Child A.
He asks that pre-term babies such as Child A are 'prone to complications'?
Dr Evans: "That is why we have neonatal units."
He adds that the care he received meant he had overcome the most difficult parts of his life and was "stable" prior to his deterioration.

LIVE: Lucy Letby trial, Tuesday, October 25

 

[Marantz4250b]

https://twitter.com/MrDanDonoghue

'This was a hospital where three or four babies died a year on average, but somehow, over a very short period, the hospital had loads of deaths', he said

Dr Evans tells the court that he originally examined 33 baby deaths

That's a lot more than the, what, seven/eight deaths at issue in this case! It doesn't say over what time period these deaths occurred but from the statement it's knocking on for the equivalent of ten years worth! This is a massive increase in deaths.

This leads one to ask, either; was LL around for all of these but has only been charged with some or; has she just been charged with the ones which coincide with her shifts/physical presence?

 

[Tortoise]

2:50pm

Mr Myers asks if Child A was "perfectly satisfactory" prior to the collapse, as according to Dr Evans's notes.
Dr Evans says he does not want to engage in semantics, but adds that, for a pre-term baby in the position he was in, Child A was "satisfactory" and "really good".

LIVE: Lucy Letby trial, Tuesday, October 25

 

[Tortoise]

2:53pm

A clinical note is presented to the court, with a number of 'problems' listed.
Dr Evans: "I would call them issues, not problems.
"This is what any competent junior doctor would list as the issues present.
"We have got to deal with the fact he is pre-term, he has breathing support, we need to establish feeds, there are concerns over suspected sepsis.
"Any doctor would write this things down."

2:55pm

An x-ray review is presented, with the note 'RDS [respiratory distress syndrome] type picture'.
Dr Evans is asked about that comment. He says: "I have seen the report, it's not too bad actually. This is why we put babies on CPAP."

LIVE: Lucy Letby trial, Tuesday, October 25

 

[JosieJo]

2:50pm

Mr Myers asks if Child A was "perfectly satisfactory" prior to the collapse, as according to Dr Evans's notes.
Dr Evans says he does not want to engage in semantics, but adds that, for a pre-term baby in the position he was in, Child A was "satisfactory" and "really good".

LIVE: Lucy Letby trial, Tuesday, October 25

Dr Evans says he does not want to engage in semantics, but adds that, for a pre-term baby in the position he was in, Child A was "satisfactory" and "really good".

Standing no messing it seems

 

[Honeybirdette]

I would imagine there’s many more babies that have died in suspicious circumstances that they suspect letby has been involved in, but the evidence is soft and therefore they don’t want to risk the entire trial collapsing. Therefore it makes sense they have picked out the “strongest” cases if you will.

 

[Sweeper2000]

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...

She was texting a colleague after baby A And stated she didn’t want to be in room 1 and didn’t want to see the parents of both baby A and B. Apparently it was a alteration the staff could ask for after something tragic. She said she needed time off a few weeks after. Room 1 was the intensive care unit.

I wouldn’t think these are the actions and words of someone who felt guilty or had something to hide.

 

[TraderJones]

The “on purpose“ might actually be the words used by someone who has thought I might have hurt them by accident? suggests she may have been feeling guilty about perceived failings in the care delivered which is fitting with the notes general theme. Low self esteem “not good enough“, I“I don’t deserve to live“ “I am a horrible evil person”. She literally might just be saying the opposite of what she actually believes which does happen and often. If you look at how that note pans out it’s much more emotional and less lucid towards the second phase. Suggesting something other than a lucid and genuine state of mind. That whole note speaks of turmoil and depression rather than someone actually confessing which would be less emotional and much more straightforward. Certainly wouldn’t be preceded by the words “I haven’t done anything wrong“

I don't understand your point because 'on purpose' is the polar opposite of 'by accident'. One implies intent, the other implies no intent. 'I killed them intentionally' has exactly the same meaning.

 

[Charlot123]

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.

I don’t know about UK TV persons. And I couldn’t find much about the dates of TV appearance for Dr. Jay. I thought he only worked at the NICU and then was interviewed about the case. Questions:

- did Dr. Jay ever appeared on TV before this case, and if so, in what year?
- did he get catapulted to the National TV after 2018?
- what programs is he on?

TV doctor strongly skews this case.

 

[Sweeper2000]

I don't understand your point because 'on purpose' is the polar opposite of 'by accident'. One implies intent, the other implies no intent. 'I killed them intentionally' has exactly the same meaning.

That’s what im saying. Did she think she may have caused harm by accident and so said the opposite of what she actually thought in a heated moment. People do say the opposite of what they mean. I was actually thinking the press of the accusations against her maybe made her take on the feeling that she may have done something But by being “not good enough“ rather than murdered intentionall.

 

[JosieJo]

2:59pm

A blood gas record showing a 'high' number for lactate (2.6 - outside the range up to 2) is shown.
Dr Evans explains he wouldn't be "particularly" concerned at such a reading, in the "whole picture", as he says one or two readings would be outside the normal range.
He describes the reading as "marginal", with all the other readings "normal", and Child A was "handling well".
He said he would not interpret an oxygen reading from a capilliary sample from a 'heel prick'.
He says if he saw such readings, knowing if the baby was "in air", he would not be "rushing to stick needles in him" unless there was a change in condition in the baby.

3:07pm

A NICU observation chart is presented for Child A, including the respiratory rate.
Mr Myers says the readings are "not stable."
Dr Evans disagrees, saying the readings are "within range".
The 'increase' in the respiratory rate readings were down to the insertion of the long line and UVC, handling of the baby and a heel price procedure which caused the baby discomfort.
Dr Evans said he would expect the heart rate to go up with an increased respiratory rate, which would be a concern. But as the heart rate had remained stable, he said he would "not be concerned" and Child A "was not even requiring oxygen", with saturation levels at about 97-99 per cent, "was about as good as it gets".

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

 

[JosieJo]

3:10pm

Dr Evans says "it happens" that children on neonatal units can go without fluids for four hours.
He said it was not ideal, and "unfortunate", but it did not make a "clinical difference" in this case.
He said a child which had missed out on that level of fluids for that time would not have subsequently collapsed and died.

3:12pm

Dr Evans reiterates that the context of other readings had "all the markers" of a stable baby.
"This was a baby who was stable prior to him collapsing," he said, referring to the words other doctors had made in evidence.

3:18pm

Dr Evans dismisses alternatives put forward by the defence, including 'infection', saying such evidence would appear on a post-mortem examination.
He dismisses a suggestion of a 'rapidly spreading infection' in the baby as "ridiculous", as he said such evidence would again be found post-mortem by a pathologist.

3:22pm

Dr Evans said his conclusion of an air embolus was based on a baby "suddenly crashing" and, "more significantly", followed by "resuscitation which was unsuccessful".
He adds the subsequent x-ray and skin discolouration reports had firmed his opinion.

3:24pm

"A collapse of this speed in a baby unit, with full medical care, is very unusual these days."

3:27pm

He adds that Child A, given all the factors, is normal, and in "the safest place on the planet" for their needs.
"Neonatal unit care is as good as it gets.
"It has come on leaps and bounds [over the years]."

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

 

[JosieJo]

3:29pm

Mr Myers says skin discolouration can be a sign of illness, or due to underlying circulation problems, or infection, or blood pressure issues (secondary to something else).
Dr Evans agrees.
Mr Myers asks if it would be "flawed" to diagnose skin discolouration as an air embolus.
Dr Evans: "Discolouration is a general term, noting there is something present on the skin, as noted by a doctor or nurse. You can't say it is due to a specific condition."

3:34pm

Mr Myers refers to a 1989 study which showed, following 50 cases involving an air embolism, only '11 per cent' involved skin discolouration.
Dr Evans said he had come to his initial conclusion of an air embolus for Child A before becoming aware of the skin discolouration.

3:41pm

The judge rephrases a question of Mr Myers to ask that "failure of resuscitation", of itself and in isolation, is not a consequence of an air embolus.
Dr Evans agrees. He says in combination with all factors already presented - including air in the great vessels, sudden collapse and skin discolouration, the conclusion is that of an air embolus.
He says an air embolus is not "common", but is rare and unusual.

3:48pm

Dr Evans said in 14 of the 17 cases he had completed his preliminary reports by November 2017, and was unaware of any medical staff member being a suspect.
He became aware of the name 'Lucy Letby' for the first time upon her arrest in July 2018 when he read her name in the press.
He said he was the first to come up with a diagnosis of an air embolus, and this had been agreed by a peer review by Dr Sandie Bohin, plus by a medical expert who began to peer review his reports but sadly, before completing the review, became seriously unwell and died.

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

 

[JosieJo]

4:03pm

Mr Myers presents a clinical note to the court from June 19, 12 days after Child B was born, noting there were desaturations recorded - if not on the same scale as those recorded during the non-fatal the collapse - and on June 20 when "the apnoea alarm went off" on three occasions, with oxygen saturation "down to 70-80% each occasion".
A paediatric asessment dated July 14 for Child B is presented to the court, in which 'breathing problems' are noted along with 'mottling'.
Mr Myers: "There are some respiratory issues associated with her health?"
Dr Evans: "Nothing compared to what we would call the 'index event' (the collapse). She needed resuscitating."

3:54pm

Mr Myers asks about the non-fatal collapse of Child B, who needed breathing support at birth, as a clinical note shown to the court shows.
An x-ray review has the note 'RDS type picture', as also shown for Child A.
Dr Evans agrees with Mr Myers that a child such as Child B is 'prone to desaturations'.


4:07pm

Mr Myers asks about the differential diagnosis for Child B, concluding there was either an air embolus, suffocation, or someone had removed the prongs on purpose.
Dr Evans said, in his opinion, he was "on the ball from the start" in considering an air embolus.
He said his opinion was reinforced by colour changes "every 10 seconds" as mentioned by a Countess staff member in court.


4:09pm

The theory of removing the CPAP prongs on purpose is discussed.
He says it's possible for a baby to move them by accident.
He is asked if smothering is a possibility, to which Dr Evans says he has since discounted.


4:16pm

Mr Myers said it is a 'key aspect' that the inability to successfully resuscitate Child A had led to an air embolus. He adds that child B recovered, and that is "inconsistent" and "contradicts the air embolus theory".
Dr Evans: "No it does not. We cannot do studies where we inject air into babies and see what happens."
He adds that the volume and speed at which air is injected, along with the skill of the resuscitation attempts, can make a difference as to whether the baby survives or dies.

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

 

[notsure]

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

This was heartbreaking.

 

[MissMarbles]

I think Dr Evans is doing a great job answering Mr Myers' questions (who is asking the same questions I would be asking if I were him). Good work on both sides.

 

[GraceVPrice]

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 100% agree with this theory.