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

[Sweeper2000]

The doctor reporting today mentions the blood as being related to the ng tube, supporting LL testimony and quote to the concerned mother. Doesn’t explain it though or why there is no notes.

Yes I think that is what he is trying to do - discredit the doctor and build a 'this hospital is failing' narrative.

However in my opinion while it does damage the reputation of the doctor and hospital a bit, it also backfires as I think it makes Mr Myers appear like he also thinks there ought to have been a post-mortem because the death was suspicious. This goes against his 'vulnerable babies dying of natural causes' theory.

mr Myers stated previously that the lack of post mortems doesn’t help the prosecution and doesn’t help the defence either. It’s also in line with his suggestion that the lack of anything concrete about the medical side of the cases has presented the prosecution with the ability to speculate on the cause of death. In essence the lack of post motems means the prosecution’s doctors can make anything fit the bill More or less. He’s not saying it was suspicious just that the lack of a pm gives no indication as to cause of death.

 

[LadyEdgeworth]

11:47am

The court is now shown the 10.10pm note.
He says it is not clear, from his note, how much of the 14ml aspirate contained 'fresh blood'.
He says the fresh blood was what he had witnessed, having been called over to see it. The court hears he did not see the child vomit, but saw the fresh blood as a product of it.

Recap: Lucy Letby trial, Thursday, November 17

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]

Yes I think that is what he is trying to do - discredit the doctor and build a 'this hospital is failing' narrative.

However in my opinion while it does damage the reputation of the doctor and hospital a bit, it also backfires as I think it makes Mr Myers appear like he also thinks there ought to have been a post-mortem because the death was suspicious. This goes against his 'vulnerable babies dying of natural causes' theory.

I agree I do not think it's causes too much problem for the prosecution...in fact I think the Dr turning to the parents in court and apologising may have helped them

 

[LadyEdgeworth]

11:51am

He notes Child E's blood pressure was 'very good', a CRT reading was good, the heart rate was 'normal' and saturation rates were good, with minimal oxygen support.
"At that point in time, everything is fine, except for the blood in the aspirate," he tells the court.
Child E was also 'pink, well perfused', the lungs were 'clear', the abdomen was 'soft, not distended'.

Recap: Lucy Letby trial, Thursday, November 17

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]

11:54am

Dr Harkness notes 'GI bleed ? Cause', and tells the court that is a possible diagnosis for the bleeding, and a plan of action with administration of antibiotics is made.
The note 'close observation' is made, emphasising the designated nurse - Lucy Letby - was to monitor Child E closely in room 1.

11:59am

Dr Harkness says, from his recollection, he does not believe he left the unit as the bleed was 'something unusual' in Child E so he does not believe he went very far.
For the 11pm note, he says Letby called him into room 1, where 'Further GI blood loss and desaturation to 70%' is noted.
A '13ml blood-stained fluid from NGT on free drainage' is noted.
He says he remembers seeing 'fresh, red blood in the tube', with the contents of the stomach.
He says the free drainage setup would have allowed the vomit to come out rather than go into the baby's lungs.
He says the origin of the blood must have come from somewhere in the oesophageal tract, down to the stomach. It rules out blood coming from the lungs.

Recap: Lucy Letby trial, Thursday, November 17

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

 

[MsBetsy]

Well they could have suggested it to give her a break.
If she knew at 1st it was because she was suspect its hard to believe she'd carry on working there.

Yes, I doubt she knew at first they were considering her as a suspect. One of the supervising nurses suggested Letby see a "proper therapist" another strongly suggested she needed a break from her shift after all the stress that occurred on the night shift, so that may be why she was switched to the day shift, where her bad "luck" followed her. So when she was moved to admin duties, she may have been told it was for the same reason. That may also be why she went to Ibiza for a week. All her colleagues seemed to think she was overwhelmed and stressed by the tragic deaths occurring over her shifts.

 

[LadyEdgeworth]

12:01pm

The saturates 'remained 60-70% in 100% O2', with Dr Harkness said 'because of Child E's condition', the oxygen requirement had gone up from 'minimal support'.
He says Child E was still trying to breathe at this time.
The comment 'crying' is added in the note.
Dr Harkness says the child is still well enough to be awake enough and conscious to cry.
He said just the note 'crying' would suggest it was a 'typical cry'.

12:03pm

Dr Harkness says the fact Child E was crying would mean he would have had to have been taking deep breaths to do so.
The plan of action was 'replace losses' - getting fluid back in.
'Strict fluid balance' - the court hears, 'knowing how much to put back in'.
Dr Harkness says he is planning to intubate Child E and do an x-ray to check Child E's lungs and abdomen to try and explain why the baby was deteriorating.

Recap: Lucy Letby trial, Thursday, November 17

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

 

[mart321]

11:54am

Dr Harkness notes 'GI bleed ? Cause', and tells the court that is a possible diagnosis for the bleeding, and a plan of action with administration of antibiotics is made.
The note 'close observation' is made, emphasising the designated nurse - Lucy Letby - was to monitor Child E closely in room 1.

11:59am

Dr Harkness says, from his recollection, he does not believe he left the unit as the bleed was 'something unusual' in Child E so he does not believe he went very far.
For the 11pm note, he says Letby called him into room 1, where 'Further GI blood loss and desaturation to 70%' is noted.
A '13ml blood-stained fluid from NGT on free drainage' is noted.
He says he remembers seeing 'fresh, red blood in the tube', with the contents of the stomach.
He says the free drainage setup would have allowed the vomit to come out rather than go into the baby's lungs.
He says the origin of the blood must have come from somewhere in the oesophageal tract, down to the stomach. It rules out blood coming from the lungs.

Recap: Lucy Letby trial, Thursday, November 17

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

The pattern I'm seeing here is the baby is fine before LL comes on shift. The 9pm incident happened according to the Mam. Then the doctor comes later and everything seems to be fine again. But there was spots of blood. That he noted. So LL said the 9pm incident with the mother never happened and everything was fine at 8pm when SHE says the mam came. Just a bile aspirate, later. Dr says there was blood and the mam says there was blood at 9pm when she was there.

LL is then left to care for baby and suddenly there is a rapid deterioration.


So the prosecution are saying she was covering up what was going on at 9pm with a fasle note to create a "bile aspirate" ?

Then she gets another chance to finish what she started when she is alone again with baby after the Dr had been and everything was ok?

 

[Sweeper2000]

This equipment change is a real problem. As it stands is it impossible for the prosecution to state certainly that LL was responsible for the alleged presence of insulin?

I think there is a another option available that could explain why the symptoms of insulin poisoning continued after the first tpn bag was changed and that is the possibility however unlikely that all the tpn bags had insulin in them suggesting a mistake on the part of the dispenser. That’s one way that it could have happened but only relevant if all the equipment was changed.

@JosieJo

was I correct in thinking that every bit of equipment including the direct access lines after the giving set would be changed if contamination was suspected? I just don’t understand why you would change only the bag or bag and giving set if contamination was suspected?

 

[LadyEdgeworth]

12:05pm

The type of intubation was 'elective', which was not on the level of 'an emergency situation', the court hears.
Dr Harkness says he would discuss the result of the x-ray with doctors at Alder Hey and seek advice from them.

12:10pm

Dr Harkness said he would then have been preparing to intubate and get the equipment ready.
Prescriptions are made from 11.28pm-11.30pm for a number of drugs.

Recap: Lucy Letby trial, Thursday, November 17

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]

The doctor reporting today mentions the blood as being related to the ng tube, supporting LL testimony and quote to the concerned mother. Doesn’t explain it though or why there is no notes.

Well it kind of does support LL's testimony, but only because she wouldn't have/didn't mention the blood around the mouth that the mother reports she saw at 9pm. So she called the doctor because of the NG tube aspirate blood drawn from the stomach, but made no mention of blood around the mouth at this point.

 

[mart321]

Well it kind of does support LL's testimony, but only because she wouldn't have/didn't mention the blood around the mouth that the mother reports she saw at 9pm. So she called the doctor because of the NG tube aspirate blood drawn from the stomach, but made no mention of blood around the mouth at this point.

That doesn't support LL though does it? She denied saying the NG tube had caused it. She said she wouldn't say this.

I thought LL had denied anything like this happened with mam. Her notes read mam came at 8pm and attended to cares. No mention of blood at all.

 

[Jazmania]

That doesn't support LL though does it? She denied saying the NG tube had caused it. She said she wouldn't say this.

I thought LL had denied anything like this happened with mam. Her notes read mam came at 8pm and attended to cares. No mention of blood at all.

Yes I think I was referring to LL's notes where she said she called the doctor Harkness to review the baby around 10 because of blood in the NGT. This is true as his notes confirm this.

I'm not saying that LLs testimony regarding the mom and what was said to her is true.

 

[LadyEdgeworth]

12:17pm

A further note, written in retrospect, is made at 1.45am.
He records 'sudden deterioration at 11.40pm'
Prior to that, Child E was still to be 'under close observation' by Lucy Letby.
Dr Harkness tells the court he was in the room when the 'sudden deterioration' happened, and was there with Lucy Letby and another nurse. Those nurses would have been gathering the drugs to be administered.
The notes record 'brady 80-90bpm, sats 60%, poor perfusion, colour change over abdomen, purple discoloured patches'.
He says: "This was a strange pattern over the tummy and abdomen, which didn't fit with the poor perfusion - the rest was still pink, but there were these strange purple patches."
He says some of the patches were still pink, but others were purple-blue, were unusual.
He likens the purple-blue colour to be what you would see after going for a swim in cold water and coming out, with 'purple-blue' colour on the lips.
The rest of the skin was 'normal colour'.
The abdomen had 'purple patches', which didn't fit with an anatomical part of the body. He says it is difficult to describe in any detail, without a photo.
He says he has seen this in Child A before and had not seen it on any other baby, outside of the babies in the case.

Recap: Lucy Letby trial, Thursday, November 17

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

The patches were 'different sizes' and in the region of 1-2cm big - 'not dots'.
The areas were 'on the abdomen - not above the chest or below the groin - in the middle section'.
The patches 'did not fit with the perfusion' seen.
He tells the court if the abdomen was dusky or white, then the whole of the body would gradually take that colour too.
He says in the case of an affected blood supply, the blood would be lost from the legs first and the body would pull the blood 'into the middle of the body'.
"But on this occasion, it is the middle where you are seeing these discolourations?"
"Yes."

12:21pm

Dr Harkness confirms he has never seen these discolourations before or since, outside of the babies in this case.

12:22pm

Dr Harkness's notes record 'intubated as an emergency at 11.45pm'
He says although there were risks associated with this, the 'safer option' for Child E was to do things as an emergency.

Recap: Lucy Letby trial, Thursday, November 17

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]

12:25pm

An ET tube was inserted, with 'good air and chest movement' recorded, and the tube was recorded to be in the correct place.
Child E was also 'put on ventilator', with 100% oxygen.
The saturation readings were '60-70%', and after a morphine bolus was administered, those improved to 80%.

Recap: Lucy Letby trial, Thursday, November 17

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'm away from my desk for the next 30 mins, if anyone would like to do the live updates in that time or I'll catch them up when I'm back

 

[Sweeper2000]

That doesn't support LL though does it? She denied saying the NG tube had caused it. She said she wouldn't say this.

I thought LL had denied anything like this happened with mam. Her notes read mam came at 8pm and attended to cares. No mention of blood at all.

No she said she said to the mother the blood on the chin has come from the ng tube, she denies telling the mother to leave the ward while a dr was called. She also contests the mothers presence at 9pm.

im still not sure what notes were written retrospectively by LL on this night and why the prosecution have alleged she had a reason to falsify the notes. The event happened around 11 pm and is suspected air embolus and currently no suspected trauma So I’m not sure how the blood on the chin is relevant to the allegation other than it’s possibility to be a part of some other medical ailment. I don’t see how it fits with her allegedly trying to hide the air embolism when presumably anything before 11pm isn’t relevant to the event if AE.

 

[JosieJo]

The doctor reporting today mentions the blood as being related to the ng tube, supporting LL testimony and quote to the concerned mother. Doesn’t explain it though or why there is no notes.


mr Myers stated previously that the lack of post mortems doesn’t help the prosecution and doesn’t help the defence either. It’s also in line with his suggestion that the lack of anything concrete about the medical side of the cases has presented the prosecution with the ability to speculate on the cause of death. In essence the lack of post motems means the prosecution’s doctors can make anything fit the bill More or less. He’s not saying it was suspicious just that the lack of a pm gives no indication as to cause of death.

Coming up the NGT doesn't really indicate its due to the tube rubbing as LL said ...blood coming up the ngt and vomiting suggests the opposite

The doctor reporting today mentions the blood as being related to the ng tube, supporting LL testimony and quote to the concerned mother. Doesn’t explain it though or why there is no notes.


mr Myers stated previously that the lack of post mortems doesn’t help the prosecution and doesn’t help the defence either. It’s also in line with his suggestion that the lack of anything concrete about the medical side of the cases has presented the prosecution with the ability to speculate on the cause of death. In essence the lack of post motems means the prosecution’s doctors can make anything fit the bill More or less. He’s not saying it was suspicious just that the lack of a pm gives no indication as to cause of death.

The doctor reporting today mentions the blood as being related to the ng tube, supporting LL testimony and quote to the concerned mother. Doesn’t explain it though or why there is no notes.

Blood coming up the tube wouldn't indicate it was due to the tube as LL.told the mother

 

[JosieJo]

No she said she said to the mother the blood on the chin has come from the ng tube, she denies telling the mother to leave the ward while a dr was called. She also contests the mothers presence at 9pm.

im still not sure what notes were written retrospectively by LL on this night and why the prosecution have alleged she had a reason to falsify the notes. The event happened around 11 pm and is suspected air embolus and currently no suspected trauma So I’m not sure how the blood on the chin is relevant to the allegation other than it’s possibility to be a part of some other medical ailment. I don’t see how it fits with her allegedly trying to hide the air embolism when presumably anything before 11pm isn’t relevant to the event if AE.

No she said she said to the mother the blood on the chin has come from the ng tube?

Is this what she said I understood it as it was "caused" by the tube irritating