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

[magikarpmagikarp]

I believe that the "almost always" fatal claim likely comes from the 1989 Lee and Tanswell paper:

https://adc.bmj.com/content/archdischild/64/4_Spec_No/507.full.pdf

This was also the paper that was mentioned by Dr Jayaram. I suspect the core problem on both the prosecution and defence side is that this is not a condition where there's an awful lot of empirical information out there, which would be why they're both having to reach back to this one very old case series, as it might be the only relevant paper out there.

Agreed. This paper is on Pulmonary Venous Embolism in premature infants. It does describe the skin changes seen with embolism and it describes the effects of embolism on the body. PVE is specifically an embolism due to damage to the lungs from a ventilator. This happened in the era of neonatology that existed before surfactant replacement therapy, steroids before delivery, and modern "permissive" ventilation strategies that are intended to protect the lungs from damage. Basically ventilator pressures are so high than lung tissue ruptures. Usually that would have resulted in pneumothorax or pulmonary interstitial emphysema, but in some cases it allowed air to enter circulation, causing PVE. You would not see PVE in 2015 except in exceedingly rare circumstances with a very critically ill patient. With an injected air embolism, there is only so much air to go around. It's what was injected in, and no more. With a PVE there's a chance for ongoing air entry, to the point that one of the diagnostic characteristics is frothy blood withdrawn from the umbilical line. The paper's authors recommend switching to 100% FiO2 if PVE is suspected, because having the bubbles be oxygen instead of air (which is mostly nitrogen) may mitigate some of the damage. They also point out that if the patient is on pressures high enough to cause PVE, they are likely already on 100% FiO2. Because this condition was a rare complication of the treatment strategies available at the time, there were eventually enough cases to be written up collectively. On the other hand, cases of air embolism from intravenous lines in infants are most likely going to be the result of medical error, and are typically reported as single cases.

 

[JosieJo]

2:28pm

The court is now being told about the case of Child C - a murder allegation for a baby boy who died on June 14, 2015.

2:29pm

The first 'agreed evidence' statement comes from Child C's mother, dated January 2019.

2:30pm

The mum said she had gone for an anatomy scan at the Countess of Chester Hospital.
She was informed, while everything was 'normal', the baby 'looked very small'.
It was recommended a test was to be taken for any genetic conditions that may be present.

2:33pm

The results of the scan showed there were 'no genetic problems'. The baby was small, 'but it was not known why'.
Further scans were held, along with blood flow checks.
Child C's growth then 'began to falter' later on, and it became delivery would take place 'quite soon'. She was being monitored 'twice weekly'.
In June, the mother had raised blood pressure in a test, and she was admitted to the Countess of Chester Hospital as a precaution.
That night, it was found Child C's heart rate had dropped, and she was moved to the labour ward as concerns had grown.
On this occasion, nothing happened, so she was moved back to the antenatal ward.

2:35pm

The following Monday, the dedicated consultant said it would be best to closely monitor the situation.
On June 10, the mother had a scan, and found there was a risk of a still-born birth. The mum was taken to the labour ward and given various drugs to support the baby.
The mum was then taken to theatre and a Caesarean section took place.
"The birth was extremely stressful," the mother recalls.

Recap: Lucy Letby trial, Wednesday, October 26

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]

2:37pm

Child C was incubated and put on a ventilator, but the mum was told the nursing staff "weren't particularly concerned" for his immediate condition.
The mum was unable to see Child C for several hours afterwards.
She said she was able to see Child C - "tiny", weighing "800 grammes", that night.
Child C was given CPAP and had been taken off ventilator support.
On June 11, the mum and dad had "small periods of time" where they could hold Child C.
The nurse Joanne Williams there was "very supportive".

2:42pm

In the following days, Child C was taken off CPAP and was "calmer" on June 13.
He had a gastric tube fitted. When fluid came out, it was a black colour and staff could not explain what that was.
The family had "a cautious positivity" for Child C. His oxygen levels were being weaned down "as he was doing so well".
She was woken up at 11.20pm by one of the nurses, having been contacted by one of the neonatal nurses to go there "immediately".
She arrived to see CPR being performed on Child C. "He had stopped breathing without any warning.
"This was sudden and unexpected."
The mum told her husband to come to the neonatal unit.
She recalls not being able to take everything in, and was asked by a nurse if she wanted to get in contact with a priest. The mum was shocked and asked if Child C was going to die. The nurse replied in the affirmative.

2:46pm

The mum said while waiting for a priest, her husband arrived. They had to wait for 50 minutes until the priest arrived.
She was told Child C, after being baptised, had passed away. Although there was a pulse, there was no brain activity.
The mum said: "It was awful."
After Child C passed away, the mum handled him.
She was asked by a nurse if they wanted a lock of his hair.
On June 15, she was contacted by the coroner's office at Alder Hey, for the post-mortem.
She was advised the conclusion was "natural causes".

2:49pm

The father's 'agreed evidence' statement is read out to the court.
He said the mum's pregnancy was "highly stressful", and recalls she had elevated blood pressure, requiring a trip to hospital.
He recalls being present for Child C's birth, where the child was placed into an incubator.
He said medical staff were "really pleased" with him, and he followed Child C into the neonatal unit.

Recap: Lucy Letby trial, Wednesday, October 26

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

 

[Sweeper2000]

I do not think its clear 100% when it refers to to be honest . I'm not sure why the police would ask about seeing the parents upset "at a specific time"

It is a reference to the treatment of baby B the following day during treatment for that babies collapse. That’s the reference to “discolouration”.

 

[JosieJo]

2:51pm

He said Child C "was still doing well" in the first few hours, and needed respiratory support, but was "capable of breathing independently".
"At no point did the staff express concern of him not surviving."

2:59pm

He said Child C had contniued to do well, and was at home when he was called by the mum to come to the hospital "right away".
When he arrived, the mum was waiting for her and he was informed Child C had collapsed and stopped breathing.
"She didn't think she could do any more", but they continued trying, until a priest arrived.
Child C then began breathing by himself.
The family were taken into a room, where there were two nurses there, one of whom the father has since been able to identify as Lucy Letby.
The father and mother took turns holding Child C, "as we knew he wasn't going to make it".
He remembers one of the nurses administering morphine to Child C.
At regular intervals, the nurses came in to check on their welfare.
A hand and footprint were taken of Child C, along with toys that were cotside.
The father said he and the mum looked after Child C in that room: "We just wanted to cuddle him and make sure he was pain free."
One of the nurses came in and said something along the lines of 'you've said your goodbyes, now do you want me to put him in here [a basket]?'
The mum said 'he's not dying yet', and the nurse backtracked.
"We remember being really shocked by this."

Recap: Lucy Letby trial, Wednesday, October 26

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

 

[magikarpmagikarp]

The father said he and the mum looked after Child C in that room: "We just wanted to cuddle him and make sure he was pain free."
One of the nurses came in and said something along the lines of 'you've said your goodbyes, now do you want me to put him in here [a basket]?'
The mum said 'he's not dying yet', and the nurse backtracked.
"We remember being really shocked by this."

This is awful.

 

[JosieJo]

3:02pm

The jury is now being waked through the sequence of events for Child C, with the evidence, as was the case for Child A and B, being shown on an interactive display to the court. The electronically stored evidence is also available to view on the juror's iPads.
The jury is informed that, as they are increasingly used to the system and the descriptions of types of medical records, this process will go quicker than that for Child A and B.

3:07pm

Text messages exchanged following the deaths of Child A and B show Lucy Letby asking if there were spare shifts going, adding: "Think I need to throw myself back in on Saturday."
The response: "Hopefully it might settle down by then."
Letby: "I think from a confidence point of view I need to take an ITU [intensive treatment unit] baby soon."
The response: "It does knock you a bit when things like that happen, but it's ok to have time out as well. Enjoy the sun"

3:16pm

The court is shown the nursing night shift for June 13, with a different nurse identified as the designated nurse for Child C, and Letby being a nurse for two other babies.

3:29pm

A message sent to Letby on June 13, at 9.48pm, says: "You ok? x"
Letby replies: "I just keep thinking about Mon. Feel like I need to be in [neonatal unit room] 1 to overcome it, but [nursing colleague] said no x"
The colleague responds: "I agree with her, don't think it will help. You need a break from full-on ITU, you need to let it go or it will eat you up..."
Letby responds: "Not the vented baby necessarily, I just feel I need to be in 1, to get the image out of my head."

3:35pm

Letby adds: "It probably sounds odd but it's how I feel x"
The colleague responds: "Well it's up to you but I don't think it's going to help."
After further messages are exchanged, the colleague suggests: "Why don't you go in 1 for a bit?"
Letby responds: "Yeah, I have done a couple of meds in 1."
Letby later adds: "Forget I said anything, I will be fine, it's part of the job. Just don't feel like there is much team spirit tonight x"
The colleague replies: "I am not going to forget but think you're way too hard on yourself..."
Letby referred to previous events she had seen in a women's hospital, and the support available following such events.

3:36pm

The text message conversation, on Whatsapp, concludes at about 11pm.
Child C collapsed 20 minutes later.

Recap: Lucy Letby trial, Wednesday, October 26

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]

3:02pm

The jury is now being waked through the sequence of events for Child C, with the evidence, as was the case for Child A and B, being shown on an interactive display to the court. The electronically stored evidence is also available to view on the juror's iPads.
The jury is informed that, as they are increasingly used to the system and the descriptions of types of medical records, this process will go quicker than that for Child A and B.

3:07pm

Text messages exchanged following the deaths of Child A and B show Lucy Letby asking if there were spare shifts going, adding: "Think I need to throw myself back in on Saturday."
The response: "Hopefully it might settle down by then."
Letby: "I think from a confidence point of view I need to take an ITU [intensive treatment unit] baby soon."
The response: "It does knock you a bit when things like that happen, but it's ok to have time out as well. Enjoy the sun"

3:16pm

The court is shown the nursing night shift for June 13, with a different nurse identified as the designated nurse for Child C, and Letby being a nurse for two other babies.

3:29pm

A message sent to Letby on June 13, at 9.48pm, says: "You ok? x"
Letby replies: "I just keep thinking about Mon. Feel like I need to be in [neonatal unit room] 1 to overcome it, but [nursing colleague] said no x"
The colleague responds: "I agree with her, don't think it will help. You need a break from full-on ITU, you need to let it go or it will eat you up..."
Letby responds: "Not the vented baby necessarily, I just feel I need to be in 1, to get the image out of my head."

3:35pm

Letby adds: "It probably sounds odd but it's how I feel x"
The colleague responds: "Well it's up to you but I don't think it's going to help."
After further messages are exchanged, the colleague suggests: "Why don't you go in 1 for a bit?"
Letby responds: "Yeah, I have done a couple of meds in 1."
Letby later adds: "Forget I said anything, I will be fine, it's part of the job. Just don't feel like there is much team spirit tonight x"
The colleague replies: "I am not going to forget but think you're way too hard on yourself..."
Letby referred to previous events she had seen in a women's hospital, and the support available following such events.

3:36pm

The text message conversation, on Whatsapp, concludes at about 11pm.
Child C collapsed 20 minutes later.

Recap: Lucy Letby trial, Wednesday, October 26

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

She sounds very disgruntled about not being put to work in room 1 imo

 

[notsure]

I wonder what LL meant about lack of "team spirit" that night.

And "I need to take an ITU [intensive treatment unit] baby soon" is an unfortunate turn of phrase in retrospect.

 

[Imnothere]

I wonder what LL meant about lack of "team spirit" that night.

And "I need to take an ITU [intensive treatment unit] baby soon" is an unfortunate turn of phrase in retrospect.

Maybe she was expecting more sympathy and "you OK hun?" from the doctors and nurses after Child A's death

 

[notsure]

Maybe she was expecting more sympathy and "you OK hun?" from the doctors and nurses after Child A's death

From those texts, she did seem a little "needy" in that respect.

 

[Charlot123]

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.

English is not my first language, but I tend to agree, “on purpose” sounds childish. “With purpose”, however, creates the feeling of power.

 

[Charlot123]

I thought it might be interesting. This is an article with the photo of skin bends in adults, in decompression sickness.

How to recognise skin bends, a recent DAN case study

DCS-related skin changes usually occur within several minutes to several hours after a dive. But how can you tell when it’s serious?

daninsider.org

Maybe to understand what one could see.

 

[BuzzC]

I’m a bit confused about this.

Saying that something was done “on purpose” is perfectly acceptable English. It means “intentionally”.

 

[Charlot123]

Letby is only accused of injecting air into the bloodstreams of the first few babies. Apart from the two she is accused of poisoning with insulin, the rest of the babies she is accused of attacking by inserting massive amounts of air into their digestive systems, not their veins.

And without photos, or Post Mortems, and knowing how late notes can be changed (the new CEO made it a priority to change documentation system, but it happened way later), it is still not a solid case, although I now see how it might have looked like.

Waiting for the insulin cases.

BTW, in our day and age, it would have been so cheap to provide nurses with dictation systems that they could carry into rooms (like voice recorders), so that the nurses would not need to leave the babies to make notes! JMO.

 

[Charlot123]

I’m a bit confused about this.

Saying that something was done “on purpose” is perfectly acceptable English. It means “intentionally”.

Grammatically, it is absolutely correct. But kids often use it. “I burned my toast on purpose”. She was totally correct to use it, but had she said, “I did it with the purpose”, I’d think she felt she was on a mission. Just to think what was going through her mind. (I might be overthinking).

 

[Sweeper2000]

On purpose is the opposite of by mistake not actually completely similar to saying I am guilty or I am not guilty. I think the phrase fits with the general theme of that note that says “because I’m not good enough to care for them”. It’s the title of the note so it follows that she is questioning her aptitude as a nurse. Obviously fitting with the low self esteem evident In the note “I don’t deserve to live” and “I don’t deserve mum and dad”. Potentially.

 

[Sweeper2000]

Grammatically, it is absolutely correct. But kids often use it. “I burned my toast on purpose”. She was totally correct to use it, but had she said, “I did it with the purpose”, I’d think she felt she was on a mission. Just to think what was going through her mind. (I might be overthinking).

The phrase “with purpose” isn’t often used in everyday language. The phrase “on purpose” is much more used especially in the context of emotion. You would hear it more in arguments whereas you would hear “with purpose” more often in a professional context.

 

[BuzzC]

On purpose is the opposite of by mistake not actually completely similar to saying I am guilty or I am not guilty. I think the phrase fits with the general theme of that note that says “because I’m not good enough to care for them”. It’s the title of the note so it follows that she is questioning her aptitude as a nurse. Obviously fitting with the low self esteem evident In the note “I don’t deserve to live” and “I don’t deserve mum and dad”. Potentially.

I really have to disagree.

“On purpose” means “intentionally”. I’m not sure about linking on this site, but any online dictionary will confirm that.

Edit: I’ve responded to the wrong post here. Sorry.

 

[Sweeper2000]

I really have to disagree.

“On purpose” means “intentionally”. I’m not sure about linking on this site, but any online dictionary will confirm that.

Edit: I’ve responded to the wrong post here. Sorry.

I’m not contesting that but these phrases are often more used in certain contexts which is my point. If she had of said “I deliberately killed them” you can be left without a doubt about the meaning of the word. “On purpose” would be used more in the context of a mistake “I didn’t do it on purpose” rather than “I didn’t kill them”.