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

[LadyEdgeworth]

12:11pm

The original cause of death, post-mortem, was 'pneumonia with acute lung injury', Mr Johnson tells the court.
Dr Bohin explains, in her opinion, Child D's condition at birth was 'good', with good APGAR scores, and delayed cord clamping which would not have been done if Child D was not in a good condition.
She says, upon the observation of Child D becoming 'floppy in her father's arms', she has had "First-time parents are desperately keen to have their baby with them - with skin-to-skin, which has a number of benefits."
Dr Bohin says she means "no disrespect" to Child D's parents, who were first-time parents, that the father could have held Child D in such a way as the baby put their head on to the father's chest, "and that can collapse slightly, their windpipe."
"I see this fairly regularly...and with inflation breaths, the baby seems fine.
"I cannot tell whether this was a clinical collapse, or [simply] an unusual position of the head."

12:12pm

Dr Bohin notes the inconsistent temperatures for Child D showed sign of an infection, and Child D should have been screened at that point.
It was when Child D refused to feed, that she was then, later, transferred to the neonatal unit.

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]

12:16pm

Dr Bohin says newborn babies usually maintain their temperature quite well, but premature babies require more monitoring.
Child D's tempertaure was low on arrival to the neonatal unit, but says the nursing staff 'probably overdid it' in increasing the incubator temperature, as Child D's temperature and heart rate rose to levels outside normal readings.
Dr Bohin says the breathing rate was "high" and she required oxygen support.
"Breathing at that rate is hard work for babies - rather than wait for them to be tired...it's much safer for the baby to intervene rather than wait for them to collapse."

12:17pm

The clinical picture for Child D was 'consistent with infection', Dr Bohin says, even if the x-ray image did not show that.

12:19pm

The second x-ray image showed 'a small patch of' infection in the lung.
Dr Bohin says Child D, throughout June 21, was "well and stable". She required CPAP, but in air, and was "improving" despite having pneumonia as an infection, but was "getting better" with treatment.

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]

12:20pm

Dr Bohin says, regarding the decision to begin feeds for Child D, indicates the baby girl was "stable" as feeds would not be administered if the child was not stable.
She says all three collapses for Child D were "sudden" and "unexpected".
"They came out of the blue...she recovered very quickly with the first two, and two of the episodes were associated with an unusual mottling of the skin.
"They didn't have any clear cause."

12:21pm

Dr Bohin: "She seemed to recover very quickly after the medical team's intervention and she was well again."

12:24pm

Dr Bohin notes, for babies on CPAP, they will often find it uncomfortable as they will try fighting it.
A baby who is "relatively well" will fight it.
However, Dr Bohin said, in relation to one of the nursing notes: "The fact she [Child D] became upset then was a concern to me, as she had tolerated it well up to then."
Dr Bohin says she believes the infection was acquired prior to birth, adding the initial administration of antibiotics was "late".
Dr Bohin said the medical team knew Child D had an infection, but there was nothing to indicate she was at imminent risk of dying.

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]

I am off on my lunch break at half past so if anyone wants to do the live updates during that time, or I will catch them up when I get back.

 

[merrypason]

Child D might be the strongest case so far because the radiologist has said once again the large amount of air is consistent with 'external intravenous air administration' and he can't see what else could have caused it.

The defence's opening statement as to alternative cause of death, was "For Child D, the defence say the hospital "failed to provide appropriate care", and this was "beyond dispute" as the prosecution accepted care was sub-optimal.

Child D "was never able to breathe unaided" and there was a "strong" possibility of infection, and evidence of pneumonia after death."

However, the pneumonia, according to the radiologist did not explain the large amount of air by the spine.

The defence also suggested it happened post mortem - which doesn't explain the rash (again, as with baby A) and the radiologist has said that only happens with overwhelming infection, that this baby did not have.

So, if the experts conclude, " 'consistent with, but diagnostic of, deliberate air administration"

And the defence have no other viable explanation, and LL is the only person who immediately treated both A and D just before they collapsed and showed the rash....

Dr Bohin further debunking the infection/pneumonia theory of the defence

"For pneumonia, Dr Bohin said babies would show a gradual deterioration, with declining blood gases, increased respiration rate, increasing ventilation support, abnormal blood parameters, and additional medication doses.

"Taking into account the sudden nature of the collapses and the very quick recovery...I was very clear it wasn't infection, so the conclusion had to be something unusual and odd."

Makes sense, even something like Covid doesn't kill you suddenly after you start improving, then you recover, and then you collapse again - repeat until death. It's a gradual deterioration.

 

[JosieJo]

12:28pm

For pneumonia, Dr Bohin said babies would show a gradual deterioration, with declining blood gases, increased respiration rate, increasing ventilation support, abnormal blood parameters, and additional medication doses.
"Taking into account the sudden nature of the collapses and the very quick recovery...I was very clear it wasn't infection, so the conclusion had to be something unusual and odd."
Dr Bohin refers to the unusual skin condition medical staff observed.
Other conditions were crossed off as they 'didn't fit'.
She concludes the collapses were caused by intravenous air administration either through the UVC or the cannula.
Dr Bohin says with air embolus, the speed and quantity of the air administered depends on whether it is fatal.
She says the first two administrations of air would have been small, but the third would have been larger to cause circulation to stop.

12:29pm

Dr Bohin says the suddenness of the collapse, with skin discolouration, fitted with cases of air embolus, as did the presence of air found in the 'great vessels' on post-mortem x-rays.

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

 

[JosieJo]

12:31pm

Ben Myers KC, for Letby's defence, is now asking Dr Bohin questions.
He says that 'in the absence of infection', there had to be 'something unusual and odd' found.
Dr Bohin said she had looked at the clinical picture and had excluded the explanations more commonly found, which left the only conclusion as 'something unusual and odd'.

12:38pm

Mr Myers asks about the relevance for Child D being in distress.
Dr Bohin said it was a possible explanation for that seen in adults, they can "be in distress after an air embolus."
She adds there is very poor literature on this for neonatal babies, as there are few cases and little evidence of this.
Mr Myers says Dr Bohin cannot apply to neonatal babies what has been seen in adults.
Dr Bohin says neonatal babies don't have different biological systems, and a lot of the medicine relates to what has previously been done in adults.
She adds Child D had been content with CPAP before, and her being in distress was a sign of concern.

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

 

[JosieJo]

12:46pm

Dr Bohin said Child D was taken off CPAP, following the second collapse, in case she was being distressed.
Mr Myers: "Are you just trying to find any evidence to support your air embolus conclusion?"
Dr Bohin: "No, absolutely not."
Mr Myers: "You just take any bits that you can find to support your diagnosis?"
Dr Bohin: "No, absolutely not."
Dr Bohin adds, in relation to the skin discolouration, the rash observations noted by medical staff were like nothing she has observed for any neonate. She adds she was not there, but those observations by doctors and nurses were not ones she had found in neonates before.
She adds she is not using skin discolouration alone as her diagnosis, but fits as part of a 'constellation of features'.
She says such discolouration would be 'circular, with reddy-brown marks, which came and went', and not 'mottling'.
She adds: "There is no single distinguishing feature of an air embolus."

12:49pm

The 1989 medical journal review into air embolus is presented to the court, mentioning a particular case - 'blanching and migrating areas of cutaneous pallor were noted in several cases and, in one of our own cases, we noted bright pnik vessels against a generally cyanosed...background."
"We have had many particular descriptions - they do not all conform to this, do they?"
"I think they're pretty similar."
"Nowhere in the clinical notes for any of the children in this, have we had
"We have seen reddy-brown patches on a background that is cyanosed, so yes, we have."

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

 

[JosieJo]

12:51pm

Mr Myers says there is 'no uniform presentation' of the skin discolouration to mark it against.
Dr Bohin says it is rare, so there isn't, and agrees that the 1989 medical journal is a reference to such evidence.
She repeats the skin discolouration observations are "remarkably similar".

12:53pm

Mr Myers says there is no discolouration or distress in the third collapse.
Dr Bohin: "Discoluration doesn't [present itself] but there are other features which do."
Dr Bohin says there was a catastrophic collapse and air present in the great vessels post-mortem.
She says it was not just the rapidity of the collapse but the severity of it, and that she could not be resuscitated.


12:59pm

Mr Myers says Child D recovered twice, which, in principle, is inconsistent with an air embolus.
Dr Bohin disagrees, saying it depends on the speed and volume of the air administered.
She said there is a treatment for air embolus.
Mr Myers refers to air embolus experiments in animal testing, and asks how that can compare between animals and neonates.
Dr Bohin said experiments are not done on monkeys any more, they aren't done on rats, but they are done on piglets as the biology is similar.
Mr Myers says Dr Bohin refers to a medical paper in which testing is done on dogs and rabbits.
"What basis do you have?"
"I have the basis in literature."
"Which is based on dogs and rabbits?"
"Yes."
Dr Bohin adds it is not ethical to do such testing in humans.

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]

12:46pm

Dr Bohin said Child D was taken off CPAP, following the second collapse, in case she was being distressed.
Mr Myers: "Are you just trying to find any evidence to support your air embolus conclusion?"
Dr Bohin: "No, absolutely not."
Mr Myers: "You just take any bits that you can find to support your diagnosis?"
Dr Bohin: "No, absolutely not."
Dr Bohin adds, in relation to the skin discolouration, the rash observations noted by medical staff were like nothing she has observed for any neonate. She adds she was not there, but those observations by doctors and nurses were not ones she had found in neonates before.
She adds she is not using skin discolouration alone as her diagnosis, but fits as part of a 'constellation of features'.
She says such discolouration would be 'circular, with reddy-brown marks, which came and went', and not 'mottling'.
She adds: "There is no single distinguishing feature of an air embolus."

12:49pm

The 1989 medical journal review into air embolus is presented to the court, mentioning a particular case - 'blanching and migrating areas of cutaneous pallor were noted in several cases and, in one of our own cases, we noted bright pnik vessels against a generally cyanosed...background."
"We have had many particular descriptions - they do not all conform to this, do they?"
"I think they're pretty similar."
"Nowhere in the clinical notes for any of the children in this, have we had
"We have seen reddy-brown patches on a background that is cyanosed, so yes, we have."

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

"Nowhere in the clinical notes for any of the children in this, have we had
"We have seen reddy-brown patches on a background that is cyanosed, so yes, we have."

Go Dr Bohin! She is great on the stand

 

[Dcflag]

"Nowhere in the clinical notes for any of the children in this, have we had
"We have seen reddy-brown patches on a background that is cyanosed, so yes, we have."

Go Dr Bohin! She is great on the stand

For me this just shows Myers while well researched, is no medical professional. Unfortunately this makes him seem like he’s asking stupid questions.

 

[Marantz4250b]

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

Personally, I would highly doubt that. How do you create a situation of pressure in an exam environment let alone one which mimics someone potentially dying in front of you?

 

[LadyEdgeworth]

For me this just shows Myers while well researched, is no medical professional. Unfortunately this makes him seem like he’s asking stupid questions.

He's certainly got a tough task, he's got a great track record but like you say, it's incredibly difficult to try and refute medical evidence when you have no medical expertise.

 

[Marantz4250b]

Very unprofessional calling another nurse 'the new girl'. She may be new to that hospital but could've had a wealth of experience from elsewhere.

Even if she is newly qualified, you don't want to highlight that to the parents, possibly causing them more anxiety and worry at an already fractious time.

It was a message to her mum though. I can't really see anything abnormal in her language there, to be honest.

 

[Jazmania]

If the defence can't offer their own medical experts with a different account of how these babies died, then it will look like they haven't been able to find a single expert who agrees with their theory imo

 

[Marantz4250b]

But in this case there are 7 murder charges and 15 attempted murder charges.

The quote I responded to, though, stated something along the lines of everyone charged with murder being reminded.

 

[bbsaz]

"...a 'black line' just in front of the spine is a 'striking feature'.
Professor Arthurs says "air is present" on what the court hears is the 'main highway' of the circulation."

Where have we heard this before? Baby A.

I think we heard about this from Dr Evans expert opinion analysis of the reports. I think it's the same child though

 

[bbsaz]

Dr Bohin further debunking the infection/pneumonia theory of the defence

"For pneumonia, Dr Bohin said babies would show a gradual deterioration, with declining blood gases, increased respiration rate, increasing ventilation support, abnormal blood parameters, and additional medication doses.

"Taking into account the sudden nature of the collapses and the very quick recovery...I was very clear it wasn't infection, so the conclusion had to be something unusual and odd."

Makes sense, even something like Covid doesn't kill you suddenly after you start improving, then you recover, and then you collapse again - repeat until death. It's a gradual deterioration.

I have watched 2 relatives die of pneumonia. It took days and we all knew from the start of the gradual decline how it was going to end. Despite best efforts *over days*, the docs couldn't get on top of the pneumonia. It certainly wasn't sudden

 

[WaxLyrical]

I’m a bit bothered by it being stated that these lines of gas on the X-rays are also seen in cases of SIDS. When babies are known to die suddenly and without any clear cause, and this gas presents, that feels like something significant to me. How can experts say the only remaining option is deliberate air embolism, when there is also an option that it was a sudden unexplained death?

It’s also odd that Child D’s final fatal collapse, which allegedly involved more/faster air, didn’t produce the skin discolourations, but the earlier collapses did.

I’m so glad I’m not on this jury.

 

[MsBetsy]

Personally, I would highly doubt that. How do you create a situation of pressure in an exam environment let alone one which mimics someone potentially dying in front of you?

Maybe in a similar way in which CPR is taught and/or by repetition. Administering meds in an emergency would not be uncommon in the NICU or any urgent care setting.