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

[merrypason]

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.

This SIDS theory was explained by Dr Evans for Child A. That SIDS in a hospital setting is not a possibility. It's for at home care cases. Probably because SIDS is normally due to sleep position - and this is monitored for babies in an ITU. Also they can't just stop breathing as some of them are on machines to support it, unlike at home.

 

[LadyEdgeworth]

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.

Forgive me if I'm wrong here but SIDS usually does have a cause, unsafe sleeping, which doesn't really happen in hospitals. Not all cases of SIDS of course but look how much the rates dropped once safe sleep practices became more widespread

 

[MsBetsy]

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.

How would sudden unexplained death be an option? Any unexplained death would require investigating by the hospital, wouldn't it?

 

[WaxLyrical]

My understanding of SIDS is that they still don’t know the cause. This doesn’t include the accidental suffocation deaths that are incorrectly categorised as SIDS.

There are various theories on what cases SIDS, such as the inability of the child to arouse from sleep. But I don’t think they really know what causes it?

I may be wrong, so happy to be corrected.

 

[WaxLyrical]

How would sudden unexplained death be an option? Any unexplained death would require investigating by the hospital, wouldn't it?

SUDI/SIDS is a cause of death in babies and is unexplainable.

 

[LadyEdgeworth]

2:00pm

The court is now resuming the case following a lunch break.

2:01pm

Mr Myers resumes questioning Dr Bohin.
He suggests Dr Bohin has disregarded or minimised 'certain facts that show how unwell [Child D] was'.
Dr Bohin disagrees.

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

 

[merrypason]

My understanding of SIDS is that they still don’t know the cause. This doesn’t include the accidental suffocation deaths that are incorrectly categorised as SIDS.

There are various theories on what cases SIDS, such as the inability of the child to arouse from sleep. But I don’t think they really know what causes it?

I may be wrong, so happy to be corrected.

Not in an ITU though - these babies were on ventilation support and their sleep position was being monitored regularly.

That's why Dr Evans explicitly discounted it for child A. SIDS in an ITU is not a viable cause for those reasons. Also - if the defence thought it could be SIDS, they'd have probed the experts on it further as they've done the other diagnoses. So they too don't believe it's SIDS.

 

[Jazmania]

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.

I think the experts are saying that it is the combination of all these things - the clinical picture of the babies at the time, the sudden collapse and sometimes recovery, plus the skin discolourations and X ray together and the inability to resuscutate- that mean that air embolus is the only thing that explains them.

By itself the scan doesn't prove it, as you say if all you had was the scan then you couldn't really discount SIDS or air being introduced through resuscitation. But SIDS is incredibly rare, and I would think even more so in a specialist unit treating babies where you are monitored by health staff constantly.

The 80s paper which is the only study of air embolus in infants said that the rash didn't always occur.

 

[LadyEdgeworth]

2:06pm

A nursing chart from June 20 is presented to the court at birth.
Mr Myers says Child D was 'very unwell' at birth.
Dr Bohin says she disagrees.
Mr Myers refers to the note at 12 minutes, she was 'very unwell indeed'. Dr Bohin said she had 'an event' which required intervention, but it was not clear what her overall condition was.
Mr Myers says she had referred to the father's handling of the baby as the cause of the event.
Dr Bohin said that was one possibility, but not the only one.
She said she was "very clear" the father was not responsible for the collapse, as new fathers are nervous with holding babies, and you cannot tell whether it was an obstruction or part of a clinical condition.
Mr Myers says the mother had noted Child D 'looked lifeless' when the baby was presented to her.
Dr Bohin said Child D had just been delivered, and the cord had not been cut. If a baby was 'in extremis', the baby would not have been presented to the mother, she tells the court.

2:10pm

Mr Myers refers to the nursing notes made in the hours following Child D's birth.
Dr Bohin said it was clear, by the time of the neonatal unit admission, Child D had signs of an infection and was unwell.
Mr Myers said the mother had referred to being "really worried" about Child D, being 'limp' and 'without colour - a bit grey, purple', making 'grunting noises', not 'responsive'.
"That's a really poorly baby, isn't it, Dr Bohin?"
"That's the mother's interpretation, but I can't believe [the midwifery team] would have allowed...the baby to be fed or stay on the post-natal ward in that condition."
Mr Myers says the midwife team did not administer antibiotics to Child D at this stage.
Dr Bohin said that would have been a medical staff decision, not a midwifery decision, to administer antiobiotics. She agrees antibiotics were not administered at that point.

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

 

[obelix71]

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

Sure but we haven't heard from defence witnesses yet. Have to hear from prosecution witnesses first. I suspect defence has been able to identify many medical experts who disagree with the accounts we have heard so far from prosecution witnesses. Furthermore, many of them will I suspect have agreed to testify as defence witnesses. From The Prosecution Process : "During the trial, the prosecution will call witnesses and present evidence to support its case against the defendant. The defendant can decide whether to give evidence before the court or put other evidence forward to support their innocence."

 

[LadyEdgeworth]

2:16pm

Dr Bohin says the low blood gas reading would be a concern, but would need to be put in a clinical context as part of a trend as part of the overall clinical picture.
Mr Myers refers to a table of blood gas readings, and Dr Bohin says they have deteriorated as Child D was being moved off ventilator support on to CPAP.
Mr Myers says Child D had an infection on June 21, and that was not a sign of a well baby.
Dr Bohin said she was very clear Child D had pneumonia, but was on antibiotics and improving, and 'coping on CPAP' without needing to go on a ventilator.
She agrees Child D did not manage well with being taken off CPAP, and was put back on.

Mr Myers says 'the fact a baby desaturates like that...is a sign of poor health, isn't it?'
Dr Bohin said the clinical team made a 'good judgment call' in attempting to take Child D off CPAP, as they cannot stay on CPAP forever, but it was 'perfectly acceptable' for her to be on CPAP and she was quickly put back on it.

2:18pm

Mr Myers refers to a blood gas reading at 1.14am on June 22 which he says is 'not normal' and a 'deterioration' on the one before.
Dr Bohin says it is not as good as the one before, but is marginal, and needs to be taken in the overall clinical context.
Mr Myers asks if Dr Bohin is sure she isn't trying to minimise such evidence as this in her overall findings.
Dr Bohin: "I'd like to make it clear my duty is to the court, to present my findings in an impartial way."

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

 

[Jazmania]

Sure but we haven't heard from defence witnesses yet. Have to hear from prosecution witnesses first. I suspect defence has been able to identify many medical experts who disagree with the accounts we have heard so far from prosecution witnesses. Furthermore, many of them will I suspect have agreed to testify as defence witnesses. From The Prosecution Process : "During the trial, the prosecution will call witnesses and present evidence to support its case against the defendant. The defendant can decide whether to give evidence before the court or put other evidence forward to support their innocence."

Yes I'm aware that the prosecution go first with their witnesses, then the defence offer their own. But in the opening statement where the defence outlined their argument they suggested that they were not going to provide their own medical witnesses.

 

[obelix71]

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.

I don't think it is his job to refute the medical evidence. That is up to his defence team's medical experts whom we have yet to hear from. His job at this stage is, as a non medical expert, to find/uncover any inconsistencies in prosecution medical expert testimony. I think he has done quite well so far on that front, laying the ground nicely for his own witnesses.

 

[obelix71]

Yes I'm aware that the prosecution go first with their witnesses, then the defence offer their own. But in the opening statement where the defence outlined their argument they suggested that they were not going to provide their own medical witnesses.

Can you provide details of that suggestion?

 

[MsBetsy]

SUDI/SIDS is a cause of death in babies and is unexplainable.

Yes, but that's only when they have ruled out every other possibility. The diagnosis would only be made after all other causes are ruled out. If they still can't come to a conclusion after autopsy, a review of the medical history and an investigation, then the cause of death would be SIDS. Imo

 

[LadyEdgeworth]

2:26pm

Dr Bohin says the lack of antibiotics at one stage was a 'blip' in the care Child D had received, but she presented as a 'well' baby throughout June 21.
Mr Myers says about the decision to take Child D off CPAP, after the second collapse, there would be a 'low threshold to intervene' if there were further desaturations.
He says Child D desaturated again, and says that would have been a moment to increase ventilation support.
Dr Bohin: "Not necessarily."
She said the doctor would have noted the overall clinical picture for Child D.
Dr Bohin is asked if the decision to feed Child D was a 'bad decision'.
She replies it was not a bad decision as the clinical position was stable.
Mr Myers says the decision to take Child D off CPAP was a bad one.
Dr Bohin says, given the clinical parameters, the decision to take Child D off CPAP was a right one to make.

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

 

[merrypason]

I think the experts are saying that it is the combination of all these things - the clinical picture of the babies at the time, the sudden collapse and sometimes recovery, plus the skin discolourations and X ray together and the inability to resuscutate- that mean that air embolus is the only thing that explains them.

By itself the scan doesn't prove it, as you say if all you had was the scan then you couldn't really discount SIDS or air being introduced through resuscitation. But SIDS is incredibly rare, and I would think even more so in a specialist unit treating babies where you are monitored by health staff constantly.

The 80s paper which is the only study of air embolus in infants said that the rash didn't always occur.

Yes, you're right. I noted the rash times.

3am: At 3am, Child D collapsed for the second time.

The nursing note recorded for 3am: '[Child D] crying and desaturated again to 70s, commenced on 100% O2 via CPAP and picked up well but skin discoloured again.

3.20am: At 3.20am, a further neonatal infusion prescription is made, with Lucy Letby being one of the signatories.

3.45am: At 3.45am, Child D collapses for the third and final time.

The nursing note recalled the alarm went off and Child D 'desaturated and then became apneoic. Called Letby...' Resuscitation efforts began but to 'no effect'

So they haven't reported on any of the other medical notes made at the 3rd collapse i.e Dr Brunton's notes, the notes on paper napkin etc. So actually not sure if there was maybe a rash visible on the 3rd occasion. It was mentioned these notes would be shared with the jury and discussed with each witness - so I assume the reporting just hadn't captured it.

The thing Dr Brunton did say about the second time the rash appeared, "Dr Brunton noted skin discolouration again on the abdomen but not as pronounced as the first occasion, the court was told."

 

[LadyEdgeworth]

2:31pm

Mr Myers asks if Child D had respiratory difficulties throughout her life.
Dr Bohin disagrees.
Mr Myers: "But she was on CPAP."
Dr Bohin said Child D was stable on CPAP, and it was not possible to see how Child D was breathing unaided unless she was taken off CPAP.
Dr Bohin adds she believed Child D died with pneumonia, not because of pneumonia.
Mr Myers concludes by asking if Dr Bohin has been 'influenced' in making her conclusions rather than looking at all the facts. Dr Bohin disagrees.

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

 

[Jazmania]

Can you provide details of that suggestion?

Yes

https://twitter.com/x/status/1580549767217958912

The recap of the defence opening has Myers calling into question the prosecution's medical experts and saying 'doctors and experts' don't always have the answer. Surely if he had his own experts he would say 'but we will present evidence from specialists who disagree with their findings'.
I could be wrong, and to be fair if the defence do have medical experts who say that the babies died in other ways, or even that there is no way of knowing why the babies died, then that could change everything

 

[LadyEdgeworth]

2:38pm

Intelligence analyst Kate Tyndall has now been recalled to court to provide the jury with a few corrections on their electronic bundle of evidence.
A reminder that members of the jury are accessing the evidence for this case on iPads which contain evidence such as nursing notes, 'swipe data' for Countess of Chester Hospital staff entering and exiting the neonatal at certain times, details of medication, x-ray results and relevant text messages recovered from Lucy Letby's phone.

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