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

[LadyEdgeworth]

1:55pm

Mr Myers asks about the staffing levels that night, and asks what would have happened if he had been called to the A&E department.
Dr Harkness said he would have contacted the on-call consultant at that time to come over in that instance.
Mr Myers: "I would suggest you were out of your depth at this point."
"I disagree."
He adds that is "wrong and disrespectful to my ability."
Mr Myers says blood transfusion is not considered.
"But we do have a plan, and we do have a discussion with a consultant."
Mr Myers says the intubation should have happened earlier.
Dr Harkness says there are benefits to an elective intubation compared to an emergency intubation, as the latter could cause stress and complications to the baby.
He said that 'now' this would still have been the course to take in that situation.

1:57pm

The court hears the preparations are made for the intubation during a half hour.
Dr Harkness disagrees with Mr Myers that it was a "delay" and was using his time "appropriately".
"You make more mistakes when you are not taking your time."

1:59pm

Mr Myers says the blood transfusion is mentioned for the first time at a later note, after 11.40pm.
Dr Harkness says it would not have been appropriate to give more saline boluses without administrating fresh blood.
He disagrees a blood transfusion was not considered earlier.
He says his documentation is not as thorough as it would be now, and agrees in hindsight, it should have been documented more clearly.

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]

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.

LL said she could not remember the mum coming into the room at 9pm, or the child being upset with blood coming from its mouth. She said she would not have told the mam to go back downstairs. If there was any blood she said she would have noted it.

 

[LadyEdgeworth]

2:04pm

The 'skin discolouration' observation is noted, and that it later 'remained' on the abdomen.
A nursing colleague had referred to 'discoloured abdomen' in a retrospectively written note at 1.30am.
Mr Myers said Dr Harkness had referred to the discolouration being 'strange' and 'unusual', and 'appearing and disappearing'.
That does not appear in the medical note, Mr Myers says.
Dr Harkness says that observation had "stayed with him" and the clinical note he made at the time was not 'forensic'.

2:10pm

Mr Myers reads out part of Dr Harkness's statement to the police, referring to the discolouration being on the abdomen.
Dr Harkness says he does not recall the part of the statement of the discolourations' 'path to the body', and said he would not agree with the wording of that.
He says he has not been in discussions with anyone in relation to these observations.
Mr Myers said by October 2018 (by the time of his police statement), there had been discussions in the hospital about the skin discolourations.
Dr Harkness said there were discussions to say it was unusual, but refutes any of the details of the discolourations had been discussed.
Mr Myers says Dr Harkness is 'putting details together' from various observations. Dr Harkness: "No."
Mr Myers says Child A's skin discolouration, as referred to by Dr Harkness in court earlier in the trial, were not mentioned in the clinical note at the time or the note to the coroner.
Mr Myers says 'red patches' found on Child A were not mentioned for Child E.
Dr Harkness said the overall discolouration observations were 'similar enough'.

2:11pm

Mr Myers refers to Child E's collapse 'in front of the medical staff'.
He says by this point, "there had still been no transfusion".
Dr Harkness said there was no further evidence of bleeding after the second bleed.
Mr Myers: "The reaction to the second haemorrhage was far too slow wasn't it?"
Dr Harkness: "I disagree."

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]

2:13pm

Mr Myers says a blood transfusion, for O-negative blood, is noted at 12.50am on the medical notes.
Dr Harkness says the O-negative blood [a type which can be suitable for all blood transfusions] would be used in this instance as seeking a specifically matched blood type at this stage would take too long in acquiring it from the donor fridge.

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]

2:19pm

The note of 12.36am - CPR commenced, is mentioned. The transfusion would have followed.
Mr Myers says, in 'distressing detail' relayed by Dr Harkness earlier in court, it had been discussed about blood coming from Child E's mouth and nose during CPR.
Dr Harkness said blood would 'keep coming out' until the cause of it is found.
Mr Myers says the cause of death would be 'acute blood loss'.
Dr Harkness said that cannot be known without a post-mortem examination.
He says the blood loss could be a factor, but it is not 'black and white'.
He said it was 'not his place' to call for a post-mortem examination.
Mr Myers says the blood loss seen would normally be 'fatal'.
Dr Harkness said it could be 'linked'.
Mr Myers asks if the actions taken were 'far too slow'.
Dr Harkness: "No."
"Would you have admitted it if it was?"
"Yes."

2:21pm

The prosecution rise to ask about the timing of Dr Harkness 'meeting the mother of Child E'. Dr Harkness said that would have been the case, based on a nursing note.
The prosecution ask if that was from looking at Letby's note.
Dr Harkness agrees.
The prosecution say Dr Harkness's clinical note does not refer to meeting the family.
Dr Harkness said it could be documented, but would depend on the level of detail of the discussion.

2:27pm

Dr Harkness's interview with police from September 2018 is relayed to the court.
Dr Harkness is asked about the skin discolouration, and says it is 'similar [between Child A and Child E]' and is not a rash.
The interview transcript says Child E's discolouration was 'around the abdomen and chest', with 'purple patches' that 'suddenly come on'.
"It came so quickly - not affected by the monitors or anything".
"It was just this purple and pale patches".
He was asked in the police interview if that was symptomatic of other cases, and Dr Harkness said that was not.

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

 

[ShireChe]

It's possible LL had already caused to damage at that point...but delayed getting the Dr to closer till 10pm

But are they not saying the weird colourings (indicative of AE) were also seen. So its either that LL tried this method again with colleagues right by which I'm not discounting btw or these weird colourings are found in various situations and not just AE

 

[Jazmania]

But are they not saying the weird colourings (indicative of AE) were also seen. So its either that LL tried this method again with colleagues right by which I'm not discounting btw or these weird colourings are found in various situations and not just AE

I don't think colleagues would have had to have been right there.

I think what the prosecution are saying is that LL administered an air bubble some time between 10.30pm (which was the approx time that the large amount of blood came up the NG tune) and 11.40pm (when E collapsed and showed the purple markings on his abdomen).

During that time Dr Harkness was in the unit coming up with a plan of action, prescribing drugs, preparing to intubate etc, but he wouldn't have been by the bed the whole time. The plan was for LL to monitor E closely that time so she would have been close to E, but other medics may not have been in the room the whole time and probably weren't.

 

[JosieJo]

But are they not saying the weird colourings (indicative of AE) were also seen. So its either that LL tried this method again with colleagues right by which I'm not discounting btw or these weird colourings are found in various situations and not just AE

It's difficult to say ...the evidence so far has said it can take a few minutes from injection of the air to collapse..or even a little longer if the amount of air injected was small.
It's not to say the Dr and nurse were in the room a few minutes before the collapse..only at the time of collapse

 

[LadyEdgeworth]

No updates in a little while, it's very annoying that the live reporting seems to end abruptly like that. Also when they take breaks/adjournments etc instead of saying 'there will now be a lunch break' we get 'there has been a short break' after an hour of silence. Grr

 

[JosieJo]

It's interesting that the collapse and rash occurred around the time the Dr suggested an x ray followed by him talking to Alder Hay

 

[JosieJo]

No updates in a little while, it's very annoying that the live reporting seems to end abruptly like that. Also when they take breaks/adjournments etc instead of saying 'there will now be a lunch break' we get 'there has been a short break' after an hour of silence. Grr

Frustrating..thanks for the updates

 

[Sweeper2000]

I don't think colleagues would have had to have been right there.

I think what the prosecution are saying is that LL administered an air bubble some time between 10.30pm (which was the approx time that the large amount of blood came up the NG tune) and 11.40pm (when E collapsed and showed the purple markings on his abdomen).

During that time Dr Harkness was in the unit coming up with a plan of action, prescribing drugs, preparing to intubate etc, but he wouldn't have been by the bed the whole time. The plan was for LL to monitor E closely that time so she would have been close to E, but other medics may not have been in the room the whole time and probably weren't.

i think AE is expected to be of effect almost immediately after it’s administered. However people with professional expertise on ws have said it could vary in how much time it takes to get to the heart and to be of full effect.

“Medical expert Dr Dewi Evans suggested Child A's collapse was "consistent with a deliberate injection of air or something else into [Child A]'s circulation a minute or two prior to deterioration“

Multiple medical experts concluded the cause of Child A's collapse was "not some natural disease process".
One said his collapse was "consistent" with a "deliberate injection" a minute or two prior to his deterioration - at a time when only Lucy Letby was present.

it is also consistent with the allegations that many of the babies suffered quick deteriorations.

UK - Lucy Letby Trial - Media, Maps & Timeline *NO DISCUSSION*

Lucy Letby is on trial in the UK, charged with the murders of 7 infants and the attempted murder of 15 other infants. Media, Maps & Timelines can be posted here. *NO DISCUSSION* in this thread or your post will be removed.

www.websleuths.com

this is taken from a study involving adults with AE.

“The degree of morbidity and mortality in venous air emboli are associated with the volume of gas, the rate of accumulation, and the patient’s position at the time of the event. The estimated adult lethal dose of air has been estimated at between 200 and 300 mL (3–5 mL/kg) [1], an amount which can be introduced in just 2–3 s with a 14-gauge needle and a pressure gradient of 5 cm H2O [11]. Essentially, the closer the air entry is to the right heart, the less volume of air is required to have fatal consequences.”

Air Embolism: Diagnosis, Clinical Management and Outcomes

Air embolism is a rare but potentially fatal complication of surgical procedures. Rapid recognition and intervention is critical for reducing morbidity and mortality. We retrospectively characterized our experience with air embolism during medical procedures ...

www.ncbi.nlm.nih.gov

 

[Jazmania]

i think AE is expected to be of effect almost immediately after it’s administered. However people with professional expertise on ws have said it could vary in how much time it takes to get to the heart and to be of full effect.

“Medical expert Dr Dewi Evans suggested Child A's collapse was "consistent with a deliberate injection of air or something else into [Child A]'s circulation a minute or two prior to deterioration“

this is taken from a study involving adults with AE.

“The degree of morbidity and mortality in venous air emboli are associated with the volume of gas, the rate of accumulation, and the patient’s position at the time of the event. The estimated adult lethal dose of air has been estimated at between 200 and 300 mL (3–5 mL/kg) [1], an amount which can be introduced in just 2–3 s with a 14-gauge needle and a pressure gradient of 5 cm H2O [11]. Essentially, the closer the air entry is to the right heart, the less volume of air is required to have fatal consequences.”

Air Embolism: Diagnosis, Clinical Management and Outcomes

Air embolism is a rare but potentially fatal complication of surgical procedures. Rapid recognition and intervention is critical for reducing morbidity and mortality. We retrospectively characterized our experience with air embolism during medical procedures ...

www.ncbi.nlm.nih.gov

Right, so it must have (in the prosecution's case) been administered fairly close to the 11.40pm collapse. Within 10 minutes say. Dr Harkness was in the room when E collapsed, but we don't know how long he had been there.

 

[LadyEdgeworth]

Right, so it must have (in the prosecution's case) been administered fairly close to the 11.40pm collapse. Within 10 minutes say. Dr Harkness was in the room when E collapsed, but we don't know how long he had been there.

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.

Pretty much as you say, he was in the room for the collapse at 11:40 but could have been out of the room at 11:38 for example.

 

[Sweeper2000]

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.

Pretty much as you say, he was in the room for the collapse at 11:40 but could have been out of the room at 11:38 for example.

“A record of feeds - a feeding chart - is shown to the court.
At 9pm, Letby has recorded information to detail the volume of fluids given via the IV line and a line in Child E's left leg, and the 9pm feed is 'omitted'.
In the 10pm column is '15ml fresh blood'.
The SHO said he had no recollection of giving advice to omit the 9pm feed.
He was on the paediatric ward most of that night, until Child E entered a terminal decline. He believes the only time he had anything to do with Child E was in a secondary role to the registrar in an examination at 10.20pm.

12:37pm

The registrar recalled being told Child E had suffered a blood-flecked vomit.
He does not recall seeing any blood on Child E's face, but regarded the presentation as undramatic.
But "around half an hour to an hour later there was a large amount of fresh blood which had come up" Child E's tube.
The prosecution said: "This was the first indication of any serious problem so far as the medical staff were concerned.
"There was a further loss of 13 mls of blood at 23:00 hrs."
"13mls may not sound much, but [the doctor] had never seen a small baby bleed like this."
This was the equivalent to 25 per cent of Child E's blood volume, a figure which the prosecution say is an under-estimate in context.“

“He was on the paediatric ward most of that night, until Child E entered a terminal decline. He believes the only time he had anything to do with Child E was in a secondary role to the registrar in an examination at 10.20pm.”
UK - Lucy Letby Trial - Media, Maps & Timeline *NO DISCUSSION*

 

[Marantz4250b]

Yes, either the mom is wrong and has a false memory, or Letby has lied. If so, that it perhaps the most damning evidence for baby E and the trial so far.

Or genuinely doesn't recall it.

 

[Jazmania]

Or genuinely doesn't recall it.

Yes true she could have forgotten the 9pm interaction, and had a false memory about the 8pm and 10pm interaction.

 

[Sweeper2000]

I’m not sure how well the timings on this suggest an AE if a collapse is expected within minutes of an AE. The first serious deterioration happens at 11.40 so presumably the AE would have to have been administered before then?

“The note of 12.36am - CPR commenced, is mentioned. The transfusion would have followed.”

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

that’s an hour after it was supposedly administered. Would it take an hour to cause the heart to stop? I could probably guess there isn’t much research on how long it takes assuming the air reached the heart intermittently.

in that research paper it states the amount of time is affected by how close to the right side of the heart the air is administered.

@LadyEdgeworth

following on from where the doctor was immediately preceding the 11.40 collapse I’m led to think he was on the unit If it ws him who made these prescriptions then he was local.

“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.
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.”

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

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...

www.websleuths.com

I think he probably was in unit 1 from approx 11.30 until the 11.40 Collapse. I’m not sure I can see how LL was supposed to have administered the AE if that’s the case And there is apparently only a very very limited window of opportunity and apparently it’s under the direct observation of a consultant.

 

[JosieJo]

I’m not sure how well the timings on this suggest an AE if a collapse is expected within minutes of an AE. The first serious deterioration happens at 11.40 so presumably the AE would have to have been administered before then?

“The note of 12.36am - CPR commenced, is mentioned. The transfusion would have followed.”

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

that’s an hour after it was supposedly administered. Would it take an hour to cause the heart to stop? I could probably guess there isn’t much research on how long it takes assuming the air reached the heart intermittently.

in that research paper it states the amount of time is affected by how close to the right side of the heart the air is administered.

@LadyEdgeworth

following on from where the doctor was immediately preceding the 11.40 collapse I’m led to think he was on the unit If it ws him who made these prescriptions then he was local.

“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.
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.”

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

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...

www.websleuths.com

I think he probably was in unit 1 from approx 11.30 until the 11.40 Collapse. I’m not sure I can see how LL was supposed to have administered the AE if that’s the case And there is apparently only a very very limited window of opportunity and apparently it’s under the direct observation of a consultant.

Problem is just because the Dr's were on the neonatal unit for a certain length of time does not mean they were in room 1 ..there will be main desk (nurses station) outside room 1 doors that's the main desk for the unit.

 

[Music2022]

Why isn’t the prosecution outlining what they suggest happened? Are the jurors supposed to guess when and what LL might’ve done? It’s very difficult and vague. Surely the prosecution should say something like: “we suggest at x o’clock she did so and so, then after 30 mins she did this and that. Then she..”
Is this going to be part of the trial?