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

[Tortoise]

I hope the jury get full access to that chart - obviously for privacy reasons we never will, but I'd really ike to know if any staff members presence matches up with specific types of incident, eg, was anyone else present for all the insulin cases?

I think a defence strategy could well be claiming natural causes for the less clear cases, and blaming A.N. Other for those which seem clearly deliberate (they don't even need to pick a name if there's few enough of those cases to have a few other staff in the frame).

I tend to find the air embolus cases a bit speculative; it fits, yes, but it seems so rare and without clear diagnostic process other than one of exclusion, that I could see natural causes being possible too. The insulin on the other hand seems clear to me that it couldn't have happened naturally (and as the nurses caring for baby F have confirmed he wasn't given insulin, accidental overdose by someone putting a decimal point in the wrong place appears also excluded). So perhaps a combined approach to the defence is the best they can aim for.

(edit for spelling, even after reading over it I still can't spell embolus...)

It's much more than exclusion.

Two of the babies had x-rays showing air, which Professor Owen Arthurs testified about. All five babies (A to E) had sudden colourful blotches and patches flitting around their bodies that none of the doctors or consultants at the hospital had seen before. All of the collapses were sudden and unexpected, in babies who had been stable at that point. Some of the babies improved between collapses which did not fit with infection status.

I have no reason to think that the medical experts are not independent, very qualified and experienced in neonatology, and objective. We've heard from Dr Sandie Bohin that she was even researching exceedingly rare conditions to try to explain spontaneous bleeding. Dr Evans has shown that he was not working with police information, but just the medical files, because he didn't know about A's discoloured abdomen when he diagnosed air embolus. He reviewed all the deaths and collapses on the unit and obviously there were some from natural causes. What he was left with was 7 deaths and 17 collapses which he deemed unnatural. His opinions were peer reviewed by two experts who agreed with him, but one of the experts died before trial. The ALLEGED unnatural unexplained deaths would explain why the hospital had sufficient concerns about its neonatal mortality rates that they asked for independent review by the Royal College and then called in the police.

If we take Dr Evans at his word, he highlighted the ALLEGED unnatural deaths and collapses, and it happened that police identified that LL was present for all of them. No other staff member was. He testified he hadn't heard the name Lucy Letby until she was arrested. Police review (evidence now heard from LL's colleagues) has indeed shown that LL was in rooms she was asked not to be in, and involved with the babies who died/collapsed at the relevant time, but she was not always on duty with the same mix of nurses.

I don't know why anyone here feels sufficiently qualified to argue these experts' findings, which are backed up by other experts in their fields from Great Ormond Street Hospital, in radiology and diabetes. The defence has NOT put alternative explanations to the experts that they haven't been able to dismiss with reasons why.

It keeps being said that the doctors weren't suspicious at the time. Well actually they did become suspicious over time and the hospital did think those staff had no evidence, (the police uncovered the ALLEGED evidence over years of investigation) they did move LL to admin and ask for independent review. To me it seems unsurprising, with different consultants on call, one doctor finishing his placement and leaving, air embolus not being something they had seen before, different methods of sabotage being ALLEGED, babies ALLEGEDLY being set up to collapse when LL went off duty, a mixture of LL's designated and non-designated babies collapsing, and cognitive dissonance being such that it would be the last thing in the world to suspect that a nurse who has been there a few years by now has ALLEGEDLY begun to deliberately harm and try to kill the babies. Post mortems were carried out for babies A, C and D, and doctors would have had that information to work with at the time.

Unless we hear from the defence on this, I have no reason to think the prosecution experts are not credible. A few people here who have expressed doubts about the experts' opinions aren't even following the trial reports and have stated that the experts aren't certain and haven't said it was deliberate. This is incorrect.

All MOO

 

[BabaVanga]

Good morning everyone. Fingers crossed for some detailed live reporting today

 

[JosieJo]

I hope the Endocrinology consultant covers a few things

I'm interested to know how long after the original TPN was stopped any insulin in the blood would continue to drop the blood sugar ..I'd think it would be hours but would like to hear more.

Also the TPN had "tissued" so a fair amount of the TPN would have absorbed into the tissues (enough to make it swell)
I'd be interested to know how long any insulin that was in the tissues would continue to be absorbed back into the blood stream and how slowly

 

[BabaVanga]

LIVE: Lucy Letby trial, Thursday, November 24

 

[LadyEdgeworth]

Morning guys, I'm going on holiday this afternoon so I won't be able to do live updates today or tomorrow. Hopefully we get some though!

 

[JosieJo]

10:31am

The trial is now resuming.

10:34am

The first witness is a doctor who has previously given evidence in the trial, but cannot be named due to reporting restrictions.
She says she didn't have any direct treating care role for Child F.

10:38am

The court is shown clinical notes on August 13 from a junior doctor colleague, in which she received genetic test results from Liverpool Women's Hospital.
The test had been conducted to check for signs of Down's Syndrome.
The doctor says Child F did not show any clinical signs of Down's at birth, and the test result showed no signs that was the case either.
The 'hypo screen results' were from a series of blood tests done when a baby has a "persistent" low blood sugar score. Some tests are conducted in the Countess of Chester hospital, some are taken to a laboratory in Liverpool, the court hears.

LIVE: Lucy Letby trial, Thursday, November 24

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]

10:42am

The doctor says the cortisol reading was 'normal', the insulin at a reading of 4,657 was "too high for a baby who has a low blood sugar".
The doctor says it would be expected, with a baby in low blood sugar, for insulin to stop being produced, so that would also be low.
The insulin c-peptide reading of 'less than 169' does not correlate with the insulin reading. The insulin and insulin-cpep readings would be 'proportionate' with each other.
The doctor says it was likely insulin was given as a drug or medicine, rather than being produced by Child F, to account for this insulin reading.
"This is something we found very confusing at the time," the doctor says, and said there weren't any other babies in the unit being prescribed insulin at that time, which would rule out "accidental administration".

10:43am

The doctor says there are "some medical conditions" where a low blood sugar reading would also see a high insulin reading, but the low insulin c-peptide reading meant those conditions would be ruled out.
The insulin reading was "physiologically inappropriate", the court hears.

LIVE: Lucy Letby trial, Thursday, November 24

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]

10:45am

The doctor said those readings would be repeated, but as Child F's blood sugar levels had returned to normal by the time the test results came back several days later, there would be "no way" to repeat the test and expect similar results.

10:46am

The doctor tells the court that Child F had received 'rapid acting insulin' on July 31, but the effect of that insulin would have "long gone" by the time the hypoglycaemia episode was recorded on August 5.

10:47am

The clinical note added 'as now well and sugars stable, for no further [investigations].
"If hypoglycaemia again at any point for repeat screen."
The doctor says if Child F had any further episodes of low blood sugar, then the blood test would be carried out again.

The prosecution ask if anything was done with this data.

The doctor says it was looked to see if anyone else at the time was prescribed insulin in the whole neonatal unit, for a possible 'accidental administration', but there were no other babies at that time. No further action was taken.

Ben Myers KC, for Letby's defence, asks to clarify that Child F's blood sugar had stabilised at that time. The doctor agrees.

The doctor clarifies, on a question from the judge Mr Justice James Goss, that the scope of the 'insulin prescription' checks were made for August 4 and August 5.

LIVE: Lucy Letby trial, Thursday, November 24

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]

10:55am

A video is now shown to the court demonstrating how an Alaris pump, for infusions, is used at the Countess of Chester Hospital.
The pump has an air sensor at the machine part, and the video explains there is no real way air could be added at any point in the infusion line.
The machine can be set to administer an infusion from a syringe, down a line, at variable rates per 24 hour periods.

10:57am

The machine gives off an alarm if there is an 'occlusion' - or blockage - along the line.
The alarm can be silenced for two minutes by pressing a button. While that alarm is silenced, a red button would flash on the top of the machine

11:03am

An event log is displayed on the machine showing when the infusion starts/stops, if the rate is changed, and if it is primed.
The machine can store 100 events, and the log cannot be deleted by staff while it is on.
If the pump is switched off, and on restarting the option 'clear setup' is made, the event log is wiped.
The video explains that typically the events on there are not logged by Countess staff unless they are in relation to a serious health issue with the patient.

LIVE: Lucy Letby trial, Thursday, November 24

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]

11:07am

The video demonstrates what happens when an 'air bolus' - or air down the line - is in place when the machine is active.
The machine displays an 'occlusion' text warning and an alarm goes off.
A harsher sounding alarm then sounds, with 'air-in-line' displayed on the screen.
The machine can infuse at a maximum rate of 100ml/hr, the court hears.

LIVE: Lucy Letby trial, Thursday, November 24

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]

11:14am

The next witness to give evidence is Dr John Gibbs, who was a consultant paediatrician in August 2015.
He was the 'consultant of the week' the week when Child E and Child F were born, and the clincial responsibility meant he would go around the neonatal unit for a full examination, in addition to going around the unit every other day for observations, but not a full examination.
He said that was 'standard practice' for consultants in hospitals across the nation, as had been the case for many years.
He adds the number of neonatal unit deaths up to 2015 were within the normal range or lower than the average, up to 2015-2016.
He said the practice has since changed in 2016, in many hospitals, for there to be a 'consultant of the week' in the neonatal unit, and a separate 'consultant of the week' in the paediatric ward.
He said, for the Countess of Chester Hospital, it had followed the higher than expected mortality rate in the neonatal unit in 2015-16.

11:17am

Dr Gibbs says the blood glucose levels for Child F, as noted by a colleague, soon after birth were 'satisfactory' at 2.7, as it should ideally be 'above 2.6'.
He said the following reading was '1.9', and that can be a 'natural consequence of the separation of baby from mother', so was not unusual in itself, and was more commonly seen in premature babies, the court is told.
Child F was "struggling with his breathing", so was started with an infusion with glucose.

11:21am

The blood gas readings for Child F are shown for July 30-31, Child F having been born on July 29.
The glucose reading at 9.57pm for July 30 is '15.1' - an 'abnormally high' amount.
Dr Gibbs says the reading shouldn't go above 7.
He says that could be an indication for infection, and Child F was on antibiotics.
A single high blood sugar level reading would be monitored, and repeat high readings would lead to action taken, Dr Gibbs tells the court.
Because the blood sugar level reading on July 31 at 12.22am was 13.9, Child F was administered with insulin, "in a very small dose, carefully controlled", Dr Gibbs says.

LIVE: Lucy Letby trial, Thursday, November 24

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]

11:22am

Dr Gibbs says the administration of insulin at 3.40am meant the junior doctors had waited until a couple of high blood glucose readings had been recorded.
At 4.41am, the blood glucose level was 8.7, and Dr Gibbs says that meant Child F was "responding well" to the insulin infusion.

11:24am

Dr Gibbs says the insulin infusion progress is "fairly predictable" and "you would expect" the blood sugar levels to decrease gradually.
He said: "It remained lower," so the insulin infusion was stopped at 6.20am.

11:30am

Dr Gibbs' notes from August 2 are shown to the court, for his examination of Child F, a 'routine ward round'.
Dr Gibbs said he had seen Child F's twin brother, Child E, just before.
Child F was recovering from 'respiratory distress syndrome', was being treated for suspected sepsis, and had lost weight from birth, which was normal in newborn babies, the court hears.
The blood sugar levels were still 'moderately high', between 5-10.
He had 'some jaundice, which is common in premature babies', and a note for a heart murmur is made, but Dr Gibbs said he had not heard that upon examination of Child F.
Child F was on 'standardised' TPN fluid nutrition administration, plus nasal gastric feeds with expressed breast milk.
Dr Gibbs said 'standard' TPN bags would continue to be administered with newborn babies, with any tailored additives for babies, despending on their requirements, administered via a separate infusion method

LIVE: Lucy Letby trial, Thursday, November 24

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]

11:33am

Child F had 'intermittent desaturations', which were not a cause for concern, the court hears.
Dr Gibbs said he couldn't hear a heart murmur, but the CPAP machine was on, so that may explain why he could not have heard any heart murmur - "or there may have been no heart murmur there".
Nurses had tried Child F off CPAP [breathing support] earlier that morning, which had led to oxygen desaturations, so he was put back on CPAP.
Dr Gibbs said Child F was likely recovering from respiratory distress syndrome.
The plan was to increase Child F's naso-gastric milk 'as tolerated'.

11:38am

Dr Gibbs says the milk feeds were subsequently increased in the following days.
At August 5, at 1.30am, Dr Gibbs was on call when Dr Harkness reviewed Child F, following concerns over vomit and heart rate. Dr Gibbs was telephoned at 3.30am.
Dr Gibbs was told about the 'multiple small milky vomits and 9ml milky aspirate', and a heart rate above 200bpm, which he says was "high even for a premature baby".
Dr Gibbs said otherwise, Child F presented as a healthy baby.
The "sudden" increase of heart rate to over 200bpm was "very unusual".
Dr Harkness had 'assumed' the change in observations was down to an infection, and Dr Gibbs agreed, but Dr Gibbs said it was "a very rapid change, even for infection", and there would normally be signs of Child F deteriorating beforehand.
The plan was to rescreen for infection and start a new line for different, second-stage antibiotics.

 

[JosieJo]

11:43am

The August 5 intensive care chart for Child F is shown to the court.
Dr Gibbs said as the naso-gastric feed tube was stopped [nil by mouth], that meant the TPN bag had to be changed to account for the administration of new medication, via a long line.
The blood glucose reading for Child F is 0.8 - "abnormally low" at 1.54am.
The August 3-4 readings shown are between 3.8 and 5.4, which Dr Gibbs

11:47am

Dr Gibbs says 0.8 is a "worryingly low reading for a baby".
A bolus of glucose was administered, with Dr Harkness giving an additional administration of glucose and sodium chloride, to 'keep the blood sugar level up'.
The following blood glucose reading of 2.3 at 2.55am was "much improved" but still low, so the plan for that would have been to continue to monitor the readings "carefully", Dr Gibbs says.

11:52am

The additional provision was administered at 4am.
A reading of 2.9 was subsequently recorded.
Dr Gibbs said Dr Harkness likely had concerns over the heart rate raising suddenly, wondering if Child F had an "inherent problem" with the heart rate - [Supraventricular tachycardia (SVT)]. However, those readings would see a heart rate of over 300bpm, so was recorded as "unlikely" on Dr Harkness's clinical note.
The consultation on the phone concluded infection as a possible cause, but the readings were "unusual to have such a sudden change in his observations".
Dehydration was also a possible cause.
Fluids and saline were administered to treat the possible causes.

 

[JosieJo]

11:56am

Dr Gibbs said that Child F had an "extremely high" level of insulin in his body later that day, as revealed by a subsequent test result.
He added: "It makes it likely that his symptoms were related to very low blood sugar, [and can only be explained] by him receiving a high dose of insulin."
He said this was something he had concluded in hindsight. He had not come to this conclusion at 3.30am [during the telephone consultation], as he would not have had any reason to believe insulin had been administered.

12:01pm

Dr Gibbs' notes from 8.30am on August 5 recorded a 'natual increase in heart rate' due to Child F's stress.
The blood glucose reading was '1.7' despite administrations of glucose.
He also had signs of decreased circulation - a sign that he was "stressed, dehydrated, or had an infection".
While the blood sugar levels had risen to the '2's during the night, the latest reading of 1.7 was unusual and "unexpected" as Child F had had glucose administered, but did not seem to be responding.
Dr Gibbs: "At the time we didn't know this was because he had a large dose of insulin inside him".
Query marks were put on the note for sepsis - but the blood gas reading showed no sign of this, and for gastro-intestinal disease NEC, which had 'no clinical signs', as Dr Gibbs notes.
A plan was to give a 'further glucose bolus'.
The 'query query' was to consult the new 'consultant of the week' for a possible abdominal x-ray to look for signs of NEC, but Dr Gibbs tells the court this was not likely.

12:08pm

At 11am, the TPN, which includes 10% dextrose, was 'off' as the line had "tissued", and it was restarted at noon. That TPN was stopped at 7pm, and replaced with a 15% dextrose infusion, Dr Gibbs tells the court.
Dr Gibbs says the blood sugar levels remained "low, sometimes worryingly low" throughout the day.
The reading was 1.9 for much of the afternoon, despite three 10% dextrose boluses being administered during the day.
He adds after 7pm, the blood sugar readings, "at last", go to a "normal reading" of 4.1 by 9pm.
Dr Gibbs says the dextrose administrations had some minor effect at times, other times no effect.
He tells the court the assumption was infection, but it was "unusual" to have the blood sugar level remain so low, even with administration of 10% dextrose boluses, and that was what led to the call for a blood test to be carried out at the laboratory in the Royal Liverpool Hospital.

12:13pm

The blood sugar reading at 5.56pm on August 5 was "abnormally low" at 1.3, and the test was sent out to another laboratory as testing for insulin levels was a relatively "unusual" test.
The test result is shown to the court.
Dr Gibbs explains the readings.
He says the cortisol reading is 'satisfactory', but the "more relevant" reading was insulin.
"There should be virtually no insulin detected in the body...rather than that, there is a very high reading of 4,657".
The insulin C-peptide reading should, for natural insulin, should be even higher [than 4,657] in this context, Dr Gibbs explains, but it is "very low"
The ratio of C-peptide/insulin is marked as '0.0', when it should be '5.0-10.0'
Dr Gibbs says the insulin c-peptide reading should be at 20,000-40,000 to correlate with the insulin reading in this test.
The doctor says this insulin result showed Child F had been given a pharmaceutical form of insulin administered, and he "should have never received it".

 

[JosieJo]

11:56am

Dr Gibbs said that Child F had an "extremely high" level of insulin in his body later that day, as revealed by a subsequent test result.
He added: "It makes it likely that his symptoms were related to very low blood sugar, [and can only be explained] by him receiving a high dose of insulin."
He said this was something he had concluded in hindsight. He had not come to this conclusion at 3.30am [during the telephone consultation], as he would not have had any reason to believe insulin had been administered.

12:01pm

Dr Gibbs' notes from 8.30am on August 5 recorded a 'natual increase in heart rate' due to Child F's stress.
The blood glucose reading was '1.7' despite administrations of glucose.
He also had signs of decreased circulation - a sign that he was "stressed, dehydrated, or had an infection".
While the blood sugar levels had risen to the '2's during the night, the latest reading of 1.7 was unusual and "unexpected" as Child F had had glucose administered, but did not seem to be responding.
Dr Gibbs: "At the time we didn't know this was because he had a large dose of insulin inside him".
Query marks were put on the note for sepsis - but the blood gas reading showed no sign of this, and for gastro-intestinal disease NEC, which had 'no clinical signs', as Dr Gibbs notes.
A plan was to give a 'further glucose bolus'.
The 'query query' was to consult the new 'consultant of the week' for a possible abdominal x-ray to look for signs of NEC, but Dr Gibbs tells the court this was not likely.

12:08pm

At 11am, the TPN, which includes 10% dextrose, was 'off' as the line had "tissued", and it was restarted at noon. That TPN was stopped at 7pm, and replaced with a 15% dextrose infusion, Dr Gibbs tells the court.
Dr Gibbs says the blood sugar levels remained "low, sometimes worryingly low" throughout the day.
The reading was 1.9 for much of the afternoon, despite three 10% dextrose boluses being administered during the day.
He adds after 7pm, the blood sugar readings, "at last", go to a "normal reading" of 4.1 by 9pm.
Dr Gibbs says the dextrose administrations had some minor effect at times, other times no effect.
He tells the court the assumption was infection, but it was "unusual" to have the blood sugar level remain so low, even with administration of 10% dextrose boluses, and that was what led to the call for a blood test to be carried out at the laboratory in the Royal Liverpool Hospital.

12:13pm

The blood sugar reading at 5.56pm on August 5 was "abnormally low" at 1.3, and the test was sent out to another laboratory as testing for insulin levels was a relatively "unusual" test.
The test result is shown to the court.
Dr Gibbs explains the readings.
He says the cortisol reading is 'satisfactory', but the "more relevant" reading was insulin.
"There should be virtually no insulin detected in the body...rather than that, there is a very high reading of 4,657".
The insulin C-peptide reading should, for natural insulin, should be even higher [than 4,657] in this context, Dr Gibbs explains, but it is "very low"
The ratio of C-peptide/insulin is marked as '0.0', when it should be '5.0-10.0'
Dr Gibbs says the insulin c-peptide reading should be at 20,000-40,000 to correlate with the insulin reading in this test.
The doctor says this insulin result showed Child F had been given a pharmaceutical form of insulin administered, and he "should have never received it".

LIVE: Lucy Letby trial, Thursday, November 24

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

 

[Kemug]

Giving evidence from behind a screen, Ms Ellis said Baby C, who weighed 800 grams at birth, was fed for the first time at 11pm on June 13, and she left the room briefly to go to the nurse's station, but was then alerted by an alarm from the baby's monitor.

When asked what she saw when she returned to the room, she said: 'I'd seen Lucy standing by the incubator.'

She said Letby, 32, told her the baby's heart rate and oxygen levels had dropped [...]

Ms Ellis said Baby C's condition resolved by itself and she sat at the computer in the room, but the infant's heart rate and oxygen levels then dropped again.

The witness said: 'Lucy was stood at the incubator. I would have been looking from the computer, it was on the right-hand side.' [...]

This is pretty damning, IMO.

 

[Kemug]

Re the photo of LL holding a baby for some sort of hospital promotion - now I am beginning to wonder if LL put herself forward for this role. Perhaps she needed the attention?

 

[Tortoise]

12:32pm

The court is resuming after a short adjournment.
Ben Myers KC, for Letby's defence, explains on this count [for Child F], Dr Gibbs will not be asked any questions on his evidence.
He adds that Dr Gibbs will be cross-examined on a future occasion in the trial on evidence that has been raised.

12:33pm

The video showing the Alaris pump demonstration is shown to the court once more.
Technical difficulties meant the final 90 seconds of the video were not replayed first time round.

LIVE: Lucy Letby trial, Thursday, November 24

 

[Tortoise]

"At 11am, the TPN, which includes 10% dextrose, was 'off' as the line had "tissued", and it was restarted at noon. That TPN was stopped at 7pm, and replaced with a 15% dextrose infusion, Dr Gibbs tells the court.

[...]

Ben Myers KC, for Letby's defence, explains on this count [for Child F], Dr Gibbs will not be asked any questions on his evidence."

Very interesting. Unchallenged evidence about the same TPN being restarted.