UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #6

[Observe_dont_Absorb]

6 months is a long time to be on a jury. Most working people could not take that time off regardless of any monies they may get from the government (and it is not much!).

There are many people, including law professionals who are in favour of a different system. The alternate system would be a large pool of diverse but reasonably well educated people who are rigorously trained in understanding in how courts work and how legal argument and forensic evidence is given. They would then be called upon in their capacity as a 'professional juror'. This means the general public would get fairer outcomes in cases as they can be assured the jury have listened, digested, and understood the arguments on both sides. Plus the jurors would not be able to be 'nobbled' by gangsters, they wouldn't have their lives totally disrupted by long cases, and they would be given the skills and resources to emotionally handle distressing content. I find it hard to believe the average juror can take on board the content of what is being said and would welcome a new system.

 

[Observe_dont_Absorb]

I would think part of their training would include calculating the doses under pressure, especially in an environment such as the NICU.

Is the suggestion that LL can't calculate doses in her head? If so, what method does she use? I would imagine that calculating inside one's head is wide open to error and that if one isn't amazing at maths, the best idea would be to refer to a chart or use a calculator.

 

[kittythehare]

Is the suggestion that LL can't calculate doses in her head? If so, what method does she use? I would imagine that calculating inside one's head is wide open to error and that if one isn't amazing at maths, the best idea would be to refer to a chart or use a calculator.

I didn't read any suggestion.

Here you go.
It's not difficult, they are calculated by weight

Pediatric Dose Calculator

The pediatric dose calculator allows you to compute pediatric drug dosages (volume vs weight).

www.omnicalculator.com

 

[merrypason]

I've just had a re-read of the defence's opening and they don't mention bringing their own expert witnesses.

All they say is that the defence disagrees with the prosecution expert evidence. It seems to me that the way to do this (even if they have their own experts) is to challenge the prosecution's experts on the stand, so that they can answer the defence's alternative theories put to them at that time. The example given in one of your earlier posts was that they might be able to find an expert to prove that babies had died of infections of which there was zero evidence in the autopsies, to counter Dr Evans saying that there was no evidence of infection at Baby A's post mortem.

Agree with this. Also the defence would have had to share all their evidence with the prosecution already - and Dr Evans/Bohin would have been able to see this as well. Dr Evans did say that he has changed his opinion on some occasions based on other evidence he has seen and did tell Myers he'd be willing to do so again if there was something compelling. Do think this is why the case has taken so long to build and why some patients had so many reviews - probably a back and forth between expert witnesses on either side.

Also think that Myers listed out all the alternative theories in his opening statement and is cross examining the prosecution's experts on those. So I highly doubt anything radically different will be presented later on.

 

[annpats]

That's a stretch! It is common workplace talk and an identifier. I hear the term 'new girl' or 'new guy' at work all the time.

But it's derogatory in a healthcare and professional environment.
It might be alright as office banter, but nowhere else.

I'm since informed by another poster LL called her that in a personal text to her mother. Just as well. You can't be disrespectful to other healthcare colleagues.

 

[annpats]

Jurors who are employed can claim up to £129.91 per day for a trial lasting over 10 days. That's £649.55 per week, or £2,598.20 per 4 week month.

Jury service

They can claim "up to"....but the jury service doesn't pay more than their regular salary. It just replaces the amount..

 

[Left Thoughts]

Hello, new here but have read a few threads in the past

This is utterly bizarre that she found it so strange a nurse knew this that she had to ask how the nurse knew.

Which makes me realise that we don’t actually know much about LL as a nurse, her skill or confidence level or.. anything. All we have are assumptions made based on how quickly she became a band 6 nurse.

I've also noticed a distinct lack of a personality being given to LL, however we are very early stage into this trial currently, so I think maybe the defense will address this at a later stage?

England has a high standard within the courts imo, as many other countries do also, and so far I'm inclined to agree the defense seems to have done a poor job. But of course the system is not without fault and LL has been held on remand for a long time if the previous info is correct.

Out of curiosity to any contributors familiar with the CPS system, the minimum Jury number was discussed much earlier and mentioned to be 11(?). What would occur if that number was no longer met during this trial?

All just MOO and I don't ask the last question to scare monger after the Jurors illness, just out of genuine interest.

 

[Tortoise]

Hello, new here but have read a few threads in the past



I've also noticed a distinct lack of a personality being given to LL, however we are very early stage into this trial currently, so I think maybe the defense will address this at a later stage?

England has a high standard within the courts imo, as many other countries do also, and so far I'm inclined to agree the defense seems to have done a poor job. But of course the system is not without fault and LL has been held on remand for a long time if the previous info is correct.

Out of curiosity to any contributors familiar with the CPS system, the minimum Jury number was discussed much earlier and mentioned to be 11(?). What would occur if that number was no longer met during this trial?

All just MOO and I don't ask the last question to scare monger after the Jurors illness, just out of genuine interest.

Juries start out with 12 members.

The minimum number of jurors required to carry a verdict is 9, which means that they could lose/excuse up to 3 jurors, for valid reasons, say death or prolonged illness or other serious issue, without risking the trial collapsing.


Juries Act 1974

16Continuation of criminal trial on death or discharge of a juror​

(1)Where in the course of a trial of any person for an offence on indictment any member of the jury dies or is discharged by the court whether as being through illness incapable of continuing to act or for any other reason, but the number of its members is not reduced below nine, the jury shall nevertheless (subject to subsections (2) and (3) below) be considered as remaining for all the purposes of that trial properly constituted, and the trial shall proceed and a verdict may be given accordingly.

17Majority verdicts​

(1)Subject to subsections (3) and (4) below, the verdict of a jury in proceedings in the Crown Court or the High Court need not be unanimous if—

(a)in a case where there are not less than eleven jurors, ten of them agree on the verdict; and

(b)in a case where there are ten jurors, nine of them agree on the verdict.

 

[magikarpmagikarp]

When the other nurse said in reply, something to the effect of I just know and I suggest you learn it I don't think she was referring to the ability to actually do the calculations on the spot (although she may have been), I think she meant that she'd essentially memorised the doses through having done it and seen similar charts over many more years than LL had been working at that point.

[....]
LL clearly does know how to do the drug calcs as she's a qualified nurse so would have had to pass that bit - it's a 100% pass too, I believe. The requirement is to know how to make the calcs, not to be able to do them under pressure. And, let's face it, if it was an easy thing to do then there wouldn't be a piece of paper with them noted on it attached to the bed!

I agree with this. When you do weight based calculation, you need the patient's weight, the dose in mg and then the concentration of the medication to give you the dose in mL. That's three places where you can make a calculation error (wrong weight, wrong dose, wrong concentration), not to mention the possibility for decimal error. The sheet at the bedside would have been a "weight based dosage sheet." This sheet will have all the doses for resuscitation pre-calculated based on the standard concentration of the drugs available, with the final mL calculation easily available.

Having the doses memorized vs referring to the sheet is somewhat a "generational" thing. It's now a practice recommendation to use the pre-calculated dose sheets instead of doing mental math because errors are easy to make under pressure. (See this article for an explanation: NursingALD.com - New Tool to Decrease Errors During Neonatal Resuscitation)

The older, more experienced nurse had the doses memorized because in her day, they didn't have weight based calculation sheets - you stood there and did the math on a paper towel or your glove or the surface of the cart. Do that enough times and it's just ingrained. When the practice change came, the older nurse retained that information, while the newer nurses haven't had time to absorb it yet. (And the older nurse seems like a wizard!)

The older nurse was also right that one SHOULD have the doses memorized, but the trend in healthcare is to structure things in a way that discourages you from functionally memorizing things. We used to do dose calculation by hand; now we are discouraged from doing that and told to use a calculator. We almost never prepare our own drug dilutions and drips anymore (pharmacy does). We don't even manually program most of our IV pumps. It's automated now. It wouldn't surprise me if newer nurses were told NOT to memorize and to always use the reference materials. All this is in the name of patient safety, and is supposed to take the element of human error out of things, but you'll hear a lot of nurses say that they feel like automation and increased specialization leads to a loss of skills.

(Since I have no wish to be a verified user, you can take this post as my opinion and not a statement of expert knowledge.)

 

[Observe_dont_Absorb]

I agree with this. When you do weight based calculation, you need the patient's weight, the dose in mg and then the concentration of the medication to give you the dose in mL. That's three places where you can make a calculation error (wrong weight, wrong dose, wrong concentration), not to mention the possibility for decimal error. The sheet at the bedside would have been a "weight based dosage sheet." This sheet will have all the doses for resuscitation pre-calculated based on the standard concentration of the drugs available, with the final mL calculation easily available.

Having the doses memorized vs referring to the sheet is somewhat a "generational" thing. It's now a practice recommendation to use the pre-calculated dose sheets instead of doing mental math because errors are easy to make under pressure. (See this article for an explanation: NursingALD.com - New Tool to Decrease Errors During Neonatal Resuscitation)

The older, more experienced nurse had the doses memorized because in her day, they didn't have weight based calculation sheets - you stood there and did the math on a paper towel or your glove or the surface of the cart. Do that enough times and it's just ingrained. When the practice change came, the older nurse retained that information, while the newer nurses haven't had time to absorb it yet. (And the older nurse seems like a wizard!)

The older nurse was also right that one SHOULD have the doses memorized, but the trend in healthcare is to structure things in a way that discourages you from functionally memorizing things. We used to do dose calculation by hand; now we are discouraged from doing that and told to use a calculator. We almost never prepare our own drug dilutions and drips anymore (pharmacy does). We don't even manually program most of our IV pumps. It's automated now. It wouldn't surprise me if newer nurses were told NOT to memorize and to always use the reference materials. All this is in the name of patient safety, and is supposed to take the element of human error out of things, but you'll hear a lot of nurses say that they feel like automation and increased specialization leads to a loss of skills.

(Since I have no wish to be a verified user, you can take this post as my opinion and not a statement of expert knowledge.)

Thank you for this amazing insight!

I am wondering, is it possible that someone else miscalculated any factor of any treatment for these babies and yet LL was the one got left with the consequence? Maybe she herself was puzzled as to what was going on? Her question, texts, and even the FB searching and the note could possibly add up to someone feeling suspicious on the one hand, unsure of what’s going on, second guessing herself and maybe trying to figure things out? Just my thoughts only.

 

[magikarpmagikarp]

Thank you for this amazing insight!

I am wondering, is it possible that someone else miscalculated any factor of any treatment for these babies and yet LL was the one got left with the consequence? Maybe she herself was puzzled as to what was going on? Her question, texts, and even the FB searching and the note could possibly add up to someone feeling suspicious on the one hand, unsure of what’s going on, second guessing herself and maybe trying to figure things out? Just my thoughts only.

I have wondered this myself. The expert testimony so far has been very thorough and while medical error has been raised as a possibility I don't think there has been much evidence to support that. With Baby A, the defense has suggested air entry via long line (at insertion), which doesn't fit the timing of collapse. With Baby D, it sounds like defense is trying to make the case that it could have been sepsis that was not treated adequately - again, I don't think the evidence really supports this because the baby was on antibiotics for 30 hours at that point and was weaning off respiratory support. In the case of Baby D, this baby from all appearances should not have collapsed three times, recovering fully in between. So whether or not the third resuscitation was botched (and I don't think we have heard any evidence so far to support that), there should never have been a third resuscitation in the first place.

 

[Eloise]

Jurors who are employed can claim up to £129.91 per day for a trial lasting over 10 days. That's £649.55 per week, or £2,598.20 per 4 week month.

Jury service

I don't know about the UK because I don't know how that much money relates to the average UK wage, but here our over-10-days allowance doesn't even come close to the average wage - or maybe it did like, 20 years ago but it now works out to the equivalent of a $30k a year loss of pay compared to the average salary!

Long jury trials just aren't going to ever be a true cross-section of the community IMO because you just need your employer to say "we can't lose this person to a trial that long" and you get out of it.

There are many people, including law professionals who are in favour of a different system. The alternate system would be a large pool of diverse but reasonably well educated people who are rigorously trained in understanding in how courts work and how legal argument and forensic evidence is given. They would then be called upon in their capacity as a 'professional juror'. This means the general public would get fairer outcomes in cases as they can be assured the jury have listened, digested, and understood the arguments on both sides. Plus the jurors would not be able to be 'nobbled' by gangsters, they wouldn't have their lives totally disrupted by long cases, and they would be given the skills and resources to emotionally handle distressing content. I find it hard to believe the average juror can take on board the content of what is being said and would welcome a new system.

This sounds great!

They can claim "up to"....but the jury service doesn't pay more than their regular salary. It just replaces the amount..

Yeah, so if you earn much over it, it's not really going to be very enticing. You're going to be very motivated to get out of any trials estimated to take longer than 10 working days. I didn't see in the link about juries in the UK, but in Australia (or NSW at least) for the first 10 days your employer pays you the difference between the allowance and your usual salary and then after the 10 days, the employer no longer has to pay you and its all just the allowance.

 

[LadyEdgeworth]

9:26am

The court has been advised said member of the jury was feeling better and we should have the trial resuming, with a full day of evidence, today.

10:31am

The trial is now resuming.

Recap: Lucy Letby trial, Friday, November 11

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

 

[Tortoise]

https://twitter.com/MrDanDonoghue

Lucy Letby's murder trial at Manchester Crown Court will resume at 10.30am. We'll be hearing from medical experts in relation to the deaths of Child D and C in June 2015. There'll be a pause in proceedings at 11am to observe a two minute silence for Armistice Day.

 

[Tortoise]

Child C? I thought they'd finished evidence for Child C

Still no write up from Dr Evans' testimony on Wednesday in BBC news.

 

[LadyEdgeworth]

Recap: Lucy Letby trial, Friday, November 11

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

Child C? I thought they'd finished evidence for Child C

Still no write up from Dr Evans' testimony on Wednesday in BBC news.

Same.. perhaps they're calling an expert in for Child C who wasn't free before this to give evidence when the case for Child C was being presented? Or someone to potentially draw a clear link between C & D

For such a massive case IMO the coverage is spotty at best and I don't really understand why

 

[LadyEdgeworth]

10:36am

An additional agreed evidence statement is being read out for Dr Sally Ogden in respect of Child C, in relation to a clinical note.
She refers to the clinical note from June 13, which include "bowel sounds heard".
She said she heard Child C's bowel sounds as part of a routine examination, and documented that bowel sounds were heard.
She said each individual finding forms part of the overall condition.
She couldn't recall any more information about the bowel sounds, but if they had sounded 'abnormal', then that would have been documented as an 'important' finding.
She said Child C's abdominal condition, from her observation, was 'normal'.

10:37am

Professor Owen Arthurs has been recalled to give evidence in respect of Child C and Child D.

Recap: Lucy Letby trial, Friday, November 11

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

 

[Tortoise]

https://twitter.com/MrDanDonoghue

Jury now hearing evidence from Professor Owen Arthurs, a consultant paediatric radiologist. Prof Arthurs is an expert witness and prepared reports on the deaths of Child C and D.

Prof Arthurs is currently talking the jury through an X-ray of Child C taken on 10 June 2015, the X-ray shows 'no abnormality'

 

[LadyEdgeworth]

10:43am

Professor Arthurs, a medical expert witness, confirms he has compiled reports for Child C and Child D.
Nicholas Johnson KC, for the prosecution, asks about Child C specifically.
Pictures are shown to the court, the first are radiograph images for Child C taken on June 10.
He points out Child C is small and can almost fit entirely on the one x-ray image.
The x-rays were taken to check for positioning of the UVC.
He says the tube has been brought in a little too far and should be brought back a little.
He says the problem with x-rays is they are 2D images of a 3D person, so there is difficulty with interpreting the picture 'without the baby in front of you'.

10:46am

Another x-ray of Child C is shown, taken at 10.38pm, showing the line had been withdrawn. There was 'normal gas' in the stomach and bowel.
He says the most striking abnormality is the right lung on the image (the left lung from the child's perspective) is 'white', meaning there is 'something in the lung' preventing the x-ray light passing through, which would indicate an infection.

Recap: Lucy Letby trial, Friday, November 11

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

 

[LadyEdgeworth]

10:48am

A further x-ray image is shown for Child C at June 12 at 12.36pm, which is centred at the child's abdomen.
He says the most striking feature about this image is the dilatation of the stomach, which is 'full of gas'.

10:49am

He says this is more gas in the stomach 'than you would expect for a child of this age'.
There was a 'small tube' in the stomach taking out air.
The left lung cannot be seen on this x-ray image.

10:51am

Professor Arthurs says, for his conclusion for Child C, that the 'marked gas dilatation' in the stomach noted at June 12 had several potential causes, including CPAP belly, sepsis, NEC or exogenous administration of air by someone.

Recap: Lucy Letby trial, Friday, November 11

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