UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #9

[ColourPurple]

I think the problem with this overall defense is the surge in unexplained deaths during the time period that LL was on the floor.

I don't think you can explain it by saying the hospital was giving suboptimal care. They have the medical notes showing the care the babies were receiving. And in all of the cases I have read about, the child was doing very well, then suddenly collapsed, from no apparent illness/infection.

IMO I think for the majority of charges we've heard so far the prosecution have put forward a strong case, when suboptimal care has been suggested by the defence.


But with all that aside, I'll be interested to see how the defence are going to explain why when LL moved from night shifts to day shifts, the deaths and collapses moved from the night shift to the day shift, and why they stopped completely when LL was moved to a clerical role.

IMO

 

[katydid23]

He'd never say that though, unless she had admitted that. Indeed, if he had used that defence then it would be a guaranteed conviction on the murder charges as the prosecution only need show an intent to cause GBH from which the victim died to obtain one. She would effectively be admitting the murder charges.

The usage of the word "intentionally" leaves the door open for the jury to find that she was negligent or incompetent, as opposed to malicious. Neither of those could result in a murder conviction or a conviction for attempted murder as they lack the necessary intent to either kill or do GBH.

All IMO, obvs.

I don't think the defense will be able to claim negligence or incompetence, in order to explain away accidental injection of insulin or air into the lines.

On the day one of the babies allegedly received the insulin, there were no other babies prescribed insulin that day. And there was no medical note saying it was administered. So it was not from an accidental action but it was a sneaky purposeful action, imo.

Same problem for the air embolisms. It would be a purposeful thing, no accidental explanation for how someone could push air into the line without meaning to. Especially repeatedly doing so.IMO

 

[MsBetsy]

I don't think the defense will be able to claim negligence or incompetence, in order to explain away accidental injection of insulin or air into the lines.

On the day one of the babies allegedly received the insulin, there were no other babies prescribed insulin that day. And there was no medical note saying it was administered. So it was not from an accidental action but it was a sneaky purposeful action, imo.

Same problem for the air embolisms. It would be a purposeful thing, no accidental explanation for how someone could push air into the line without meaning to. Especially repeatedly doing so.IMO

Right. If a nurse had pushed air through the line four separate times while treating four different babies and they all died, then she would expect the same result when using the same method on a fifth baby.

 

[Marantz4250b]

I don't think the defense will be able to claim negligence or incompetence, in order to explain away accidental injection of insulin or air into the lines.

I think you're looking at it too literally. Mr Myers is never going to come right out and suggest anything like that. He has no need to and, as you say, doing so opens up too many other issues for discussion.

Remember, the defence in no way needs to prove that their client didn't do something, nor do they need to prove that they did something less serious or even non criminal like being incompetent. Although any of these are open to them.

Their sole job is to show that the prosecution has not proved the guilt of their client on the charges they face to the relevant criminal standard. In my opinion, that is precisely what Mr Myers is trying to do with his questions to the prosecution witnesses on such things as the likelihood of death from air embolism. He only needs to show that they have not proved the charge of attempted murder, not that she may actually be guilty of a lesser offence or was negligent or incompetant instead.

 

[katydid23]

I think you're looking at it too literally. Mr Myers is never going to come right out and suggest anything like that. He has no need to and, as you say, doing so opens up too many other issues for discussion.

Remember, the defence in no way needs to prove that their client didn't do something, nor do they need to prove that they did something less serious or even non criminal like being incompetent. Although any of these are open to them.

Their sole job is to show that the prosecution has not proved the guilt of their client on the charges they face to the relevant criminal standard. In my opinion, that is precisely what Mr Myers is trying to do with his questions to the prosecution witnesses on such things as the likelihood of death from air embolism. He only needs to show that they have not proved the charge of attempted murder, not that she may actually be guilty of a lesser offence or was negligent or incompetant instead.

The evidence being put forth is very persuasive because of the long pattern of unexplained collapses over the time span they investigated. Added to that are the discrepancies and inconsistencies in the defendants medical notes about what happened and when, specifically in the cases of the ailing victims.

How is the defense going to show that the prosecution has not proved guilt, if in fact they set forth some damning circumstances which appear to illustrate guilt? There will have to be some explanations offered to prevent the assumption of guilt when the defense takes over to present their case.

They already promised to explain some things. They said they will show that the hospital offered suboptimal care, which is one reason for the unexplained deaths.

Here is a quote from the defense opening statement:

But he said the 'foundation' of the case is medical evidence.He told the court: 'What the case will come down to is the medical evidence and what it can safely prove and what it can't and what we can safely conclude.'

It sounds to me like they will try to set forth their version of what happened, and will do so by attacking the staff at the hospital and the medical experts who have testified.

They will try and prove the experts wrong about how and why the babies died. Maybe they will have some very persuasive experts that will argue against the medical reports offered by the prosecution. They will have to convince the court that the accusations about insulin were untrue.

I think it will be hard to find evidence which contradicts the medical findings about that data which is lear and defined about the blood sugars in the dying babies. Especially in the repetitive attacks and the ones where the children had no issues in the other hospital but had a reoccurrence when back in defendants care.

A reminder of the angle the defence are going for:

"But he said the 'foundation' of the case is medical evidence.He told the court: 'What the case will come down to is the medical evidence and what it can safely prove and what it can't and what we can safely conclude.'

Mr Myers said causes of a baby's deterioration or death are not always clear and there may be a number of reasons.
He added that in this case the babies were 'clinically fragile', and in conditions that could change 'very swiftly and deteriorate very rapidly'.

He said there are five key issues in the medical evidence: the birth condition of the baby, whether there were any problems in the health or care of the child, whether the evidence proves deliberate harm was done, whether Letby was present at the relevant time, and whether there were failings in care by other people or the unit as a whole."

...Miss Letby is adamant she's done nothing intentionally to harm these babies.'

www.dailymail.co.uk/news/article-11312583/PICTUREDL-killed-purpose-post-note-written-nurse-Lucy-Letby.html

Note that he says LL says she did nothing to intentionally harm the babies. He doesn't say "she did intentionally harm them but didn't intend to kill them", or "she did intentionally harm them but she intended to save them" or "She did intentionally harm them but only for the drama of bringing them back from the brink of death". The defence case is that she didn't intentionally harm any babies, full stop.

 

[Tortoise]

They will have to convince the court that the accusations about insulin were untrue.

I think it will be hard to find evidence which contradicts the medical findings about that data which is lear and defined about the blood sugars in the dying babies.

snipped for focus

The defence doesn't dispute insulin was added to the TPN bags, by someone.

In addition there is the evidence of what LL said in her police interviews -

Child F:

Letby was interviewed by police in July 2018 about that night shift.

"She accepted that the signature tended to suggest she had administered it."

"Interestingly, at the end of this part of the interview she asked whether the police had access to the TPN bag that she had connected," Mr Johnson added.

In a June 2019 police interview, Letby agreed with the idea that insulin would not be administered accidentally.

She was asked asked about texting Child F’s blood sugar levels to an off- duty colleague at 8am. She said she must have looked on his chart.

Mr Johnson: "The fact it was done through the TPN bag tells you it wasn't a mistake

Ms Letby denied adding insulin to a TPN bag

Child L:

In police interview, Letby said she was aware of Child L's low blood sugar levels and knew the insulin was kept in a locked fridge, with a variety of other drugs. Keys were passed around nursing staff and there was no record of who held the keys at any time.
She agreed the insulin could not have been administered accidentally, but denied being responsible.
Her explanation was it must have been in one of the bags already being received.
The prosecution say that is not a credible possibility.

Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders


In a police interview, Letby said she was aware of Child L's low blood sugar levels.
She said she knew prolonged hypoglycaemia could cause severe brain damage - or even death.

Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins

 

[Tortoise]

In my opinion, that is precisely what Mr Myers is trying to do with his questions to the prosecution witnesses on such things as the likelihood of death from air embolism. He only needs to show that they have not proved the charge of attempted murder, not that she may actually be guilty of a lesser offence or was negligent or incompetant instead.

snipped for focus

Those witnesses have testified (to date) that air embolisms killed babies A, C, D and E.

The professor of radiology also testified that two of those babies had air beside the spine and in the blood vessels. A third medical expert also agreed with the findings but died before trial.

I feel very confident, IMO, that the defence won't be arguing "likelihood of death" from air embolism (from the angle of low risk as you are suggesting) to show that intention to kill hasn't been proven in the attempted murder charges.

 

[ColourPurple]

Just re-reading some of the info about the twins, Baby A and Baby B. LL's accused of murdering Baby A with an air embolism and then attempting to murder his sister Baby B by the same method. One thing I hadn't been aware of is that apparently with Baby B the doctor asked permission to take photos of the mottling skin rash, as she had never seen it before. Do the prosecution have the photographs?

"She stayed with her son, Baby A, until he was taken away for a post mortem, then went to be with her daughter, Baby B.She briefly held the tiny girl on her chest, where she said she felt “feelings of joy and sadness” before she left briefly with her husband to get food.

Then, their nightmare started again as they were called to come urgently to their daughter’s bedside...A consultant then told the parents that their daughter’s heart and oxygen saturation levels had fallen rapidly, much as their son’s had, but that she had stabilised.

The doctor noted that the girl had developed unusual mottling and asked for permission to take photos. “She said she’d never seen this before. I imagined a consultant would have seen all sorts of things,” the mother said."

'Please don't let my baby die': Desperate mum's plea revealed in 'killer nurse' trial

'I never had the opportunity to hold my son,' grieving mum tells court.

www.nzherald.co.nz

 

[Tortoise]

Just re-reading some of the info about the twins, Baby A and Baby B. LL's accused of murdering Baby A with an air embolism and then attempting to murder his sister Baby B by the same method. One thing I hadn't been aware of is that apparently with Baby B the doctor asked permission to take photos of the mottling skin rash, as she had never seen it before. Do the prosecution have the photographs?

"She stayed with her son, Baby A, until he was taken away for a post mortem, then went to be with her daughter, Baby B.She briefly held the tiny girl on her chest, where she said she felt “feelings of joy and sadness” before she left briefly with her husband to get food.

Then, their nightmare started again as they were called to come urgently to their daughter’s bedside...A consultant then told the parents that their daughter’s heart and oxygen saturation levels had fallen rapidly, much as their son’s had, but that she had stabilised.

The doctor noted that the girl had developed unusual mottling and asked for permission to take photos. “She said she’d never seen this before. I imagined a consultant would have seen all sorts of things,” the mother said."

'Please don't let my baby die': Desperate mum's plea revealed in 'killer nurse' trial

'I never had the opportunity to hold my son,' grieving mum tells court.

www.nzherald.co.nz

The mother said that the blotches had disappeared by the time the camera was arranged.

 

[ColourPurple]

The mother said that the blotches had disappeared by the time the camera was arranged.

How frustrating!

 

[Sweeper2000]

I have found a paper detailing with photos the symptoms associated with air embolism in a newborn neonate weighing around the same as the babies in the case. Does anyone know if this paper could be used by the prosecution? I’m also not sure as this paper details the case of a massive pulmonary vascular rather than intravenous air embolism but I’m not sure how much the symptoms would be different from each other. If at all. I’m just saying this as there are so many statements on just how remarkable the presentation on the skin was in witness statements and according to the papers photos it really really stands out. I don’t think if people saw these photos they would not remember it, it’s so blatant. I’m also not sure what degree of it you could expect in this cases examples as there is a difference in the volume of air, if delivered by syringe there is probably a fraction of the amount compared to the papers. just from my medical laymans opinion I wouldn’t call it a “rash“ either as the nurses did it looks more like swelling or edema, very similar to a staph infection I had once But more red. I wonder if the nurses thought it was like a rash because of the “deep brown”. I would have associated a rash more with inflammation or aggravation to the uppermost layers of skin. I think mr Myers may have noticed this as well

Lucy Letby: Baby had unusual rash before death, nurse trial told

Nurse Lucy Letby is alleged to have killed the baby girl by injecting air into her bloodstream.

www.bbc.co.uk

think mr Myers may have noticed this as well. im actually surprised at this statement as well As it really does stand out And I would assume it’s clinically relevant.

“Dr Jayaram agreed with Ben Myers KC, defending, that he did not reference unusual discoloration in his clinical notes recorded less than three hours after Child A died.”

I think I might agree with mr Myers that more recent accounts of the “rash” have been shaped by talks had since the occurrences.

“Mr Myers went on: “Has your description of what you said to the police and what you say now been influenced by what you saw in that paper?”

Consultant tells Letby murder trial marks ‘didn’t fit with anything he’d seen’

The unusual skin discolouration of a baby boy “didn’t fit with anything I had ever seen”, a doctor told the murder trial of nurse Lucy Letby.

www.herefordtimes.com

I can’t say myself with much certainty but there do seem To be large inconsistencies in statements given since.

im also not sure how the differences in symptoms would be affected by volume of air in the blood. The paper dr jayaram references is probably drawn from accounts of babies who were on ventilators that would have in my own words flooded the arterial system with air whereas in these cases as mentioned earlier there would only be a fraction of the amount of air present if compared. That also explains the differences in “lethality”.

 

[Tortoise]

I have found a paper detailing with photos the symptoms associated with air embolism in a newborn neonate weighing around the same as the babies in the case. Does anyone know if this paper could be used by the prosecution? I’m also not sure as this paper details the case of a massive pulmonary vascular rather than intravenous air embolism but I’m not sure how much the symptoms would be different from each other. If at all. I’m just saying this as there are so many statements on just how remarkable the presentation on the skin was in witness statements and according to the papers photos it really really stands out. I don’t think if people saw these photos they would not remember it, it’s so blatant. I’m also not sure what degree of it you could expect in this cases examples as there is a difference in the volume of air, if delivered by syringe there is probably a fraction of the amount compared to the papers. just from my medical laymans opinion I wouldn’t call it a “rash“ either as the nurses did it looks more like swelling or edema, very similar to a staph infection I had once But more red. I wonder if the nurses thought it was like a rash because of the “deep brown”. I would have associated a rash more with inflammation or aggravation to the uppermost layers of skin. I think mr Myers may have noticed this as well

Lucy Letby: Baby had unusual rash before death, nurse trial told

Nurse Lucy Letby is alleged to have killed the baby girl by injecting air into her bloodstream.

www.bbc.co.uk

think mr Myers may have noticed this as well. im actually surprised at this statement as well As it really does stand out And I would assume it’s clinically relevant.

“Dr Jayaram agreed with Ben Myers KC, defending, that he did not reference unusual discoloration in his clinical notes recorded less than three hours after Child A died.”

I think I might agree with mr Myers that more recent accounts of the “rash” have been shaped by talks had since the occurrences.

“Mr Myers went on: “Has your description of what you said to the police and what you say now been influenced by what you saw in that paper?”

Consultant tells Letby murder trial marks ‘didn’t fit with anything he’d seen’

The unusual skin discolouration of a baby boy “didn’t fit with anything I had ever seen”, a doctor told the murder trial of nurse Lucy Letby.

www.herefordtimes.com

I can’t say myself with much certainty but there do seem To be large inconsistencies in statements given since.

im also not sure how the differences in symptoms would be affected by volume of air in the blood. The paper dr jayaram references is probably drawn from accounts of babies who were on ventilators that would have in my own words flooded the arterial system with air whereas in these cases as mentioned earlier there would only be a fraction of the amount of air present if compared. That also explains the differences in “lethality”.

The experts didn't know about the skin discolouration when making the first diagnosis.

"Dr Evans said he had come to his initial conclusion of an air embolus for Child A before becoming aware of the skin discolouration.
Dr Evans said his conclusion of an air embolus was based on a baby "suddenly crashing" and, "more significantly", followed by "resuscitation which was unsuccessful".
He adds the subsequent x-ray and skin discolouration reports had firmed his opinion.
Dr Evans said the collapse of this speed (seen in Child A) in neonatal unit with full monitoring and care is 'pretty unusual these days...babies don’t go from normal heart rate to stopping breathing'"

Recap: Lucy Letby trial, Tuesday, October 25

 

[ColourPurple]

I have found a paper detailing with photos the symptoms associated with air embolism in a newborn neonate weighing around the same as the babies in the case. Does anyone know if this paper could be used by the prosecution? I’m also not sure as this paper details the case of a massive pulmonary vascular rather than intravenous air embolism but I’m not sure how much the symptoms would be different from each other. If at all. I’m just saying this as there are so many statements on just how remarkable the presentation on the skin was in witness statements and according to the papers photos it really really stands out. I don’t think if people saw these photos they would not remember it, it’s so blatant. I’m also not sure what degree of it you could expect in this cases examples as there is a difference in the volume of air, if delivered by syringe there is probably a fraction of the amount compared to the papers. just from my medical laymans opinion I wouldn’t call it a “rash“ either as the nurses did it looks more like swelling or edema, very similar to a staph infection I had once But more red. I wonder if the nurses thought it was like a rash because of the “deep brown”. I would have associated a rash more with inflammation or aggravation to the uppermost layers of skin. I think mr Myers may have noticed this as well

Lucy Letby: Baby had unusual rash before death, nurse trial told

Nurse Lucy Letby is alleged to have killed the baby girl by injecting air into her bloodstream.

www.bbc.co.uk

think mr Myers may have noticed this as well. im actually surprised at this statement as well As it really does stand out And I would assume it’s clinically relevant.

“Dr Jayaram agreed with Ben Myers KC, defending, that he did not reference unusual discoloration in his clinical notes recorded less than three hours after Child A died.”

I think I might agree with mr Myers that more recent accounts of the “rash” have been shaped by talks had since the occurrences.

“Mr Myers went on: “Has your description of what you said to the police and what you say now been influenced by what you saw in that paper?”

Consultant tells Letby murder trial marks ‘didn’t fit with anything he’d seen’

The unusual skin discolouration of a baby boy “didn’t fit with anything I had ever seen”, a doctor told the murder trial of nurse Lucy Letby.

www.herefordtimes.com

I can’t say myself with much certainty but there do seem To be large inconsistencies in statements given since.

im also not sure how the differences in symptoms would be affected by volume of air in the blood. The paper dr jayaram references is probably drawn from accounts of babies who were on ventilators that would have in my own words flooded the arterial system with air whereas in these cases as mentioned earlier there would only be a fraction of the amount of air present if compared. That also explains the differences in “lethality”.

As the medical expert has said that he came to the conclusion that the cause of death was an air embolism , even without being told about the rash, it isn't that relevant that Dr Jayaram didn't initially mention it. It would be different if Dr Evans had changed his opinion after hearing that there was rash, but that's not what happened. He said he had only one conclusion, that Baby A had received an air embolus through an iV line and that it could not have been done accidentally. So, the rash fits in with the conclusion he had already come to. The rash didn't change or influence his opinion.

"Dr Evans said he had not been presented with evidence of the discolouration, as the court has heard through this trial, for Child A. He said it was not noted in the evidence he had received.

He adds: "I think the rash in [Child A's] collapse fits together and fits a significant diagnosis...of air embolous [injection of air into the circulation]."

"Somehow air had got into the circulation...I found this opinion without knowing about the rash and without anybody suggesting expressing concern of air embolus." He rules out other conditions such as sepsis, a lack of fluids or hypoxia as causes, or contributing factors to the collapse.

He said he had "only one" conclusion, that Child A had received an air embolus, "through an IV line".
He said with the systems in place, and the medical equipment, and medical staff being "obsessive" about making sure patients are not injected with air, "there was no way this could have been done by accident"."


And then Dr Bohin, the second medical expert, who peer reviwed Dr Evans findings also said the "only plausible explanation" for Child A's collapse is an air embolus."

IMO : several people have mentioned seeing this unusual fleeting rash in various babies in this case and only during the period of the deaths and collapses, including LL( though she compared it to an overwhelming sepsis rash) . Therefore, it seems more likely that Dr Jayaram did see a fleeting rash but didn't mention it as he didn't initially realise its significance, than him later making up that he saw a rash at the time. But, as I say it made no difference to Dr Evan's opinion anyway so it's a bit of a red herring really

Recap: Lucy Letby trial, Tuesday, October 25

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

 

[ColourPurple]

This is interesting and I think explains well that Dr Evans was brought in by the national crime agency and what his role was:

"Dr Evans said he was tasked with investigating a "clinical condition", not a "crime", when he became aware of the Countess of Chester Hospital case, when tasked by the National Crime Agency.

He said the scenarios added up to a "constellation of worries" on what went on between June 2015 and June 2016.

He adds that in past cases, he has been brought in by police and the conclusion was accidental, so the case was closed with no further police involvement.

He is asked about his 'state of mind' in his approach to the cases. "My state of mind was very clear - let's find a diagnosis. Nothing to do with crime. Let's identify any specific collapse, and see if I can explain it.

"There were occasions where I couldn't explain it, and occasions where I found something deeply suspicious.

"There were incidents I found disturbing."

He was asked to investigate 33 cases in total, with two insulin cases later.

He said there were two babies were born in unsurvivable conditions, with obvious medical diagnoses.

He said: "The name Lucy Letby meant nothing to me. I didn't know the staff.

"I was the easiest physician and the most difficult. I was a blank sheet of paper. I had no idea and relied entirely on the evidence I could see from the clinical notes and applying my clinical experience and forming an opinion to the cause."

He said he asked to have one case file to have "an idea" of what he was dealing with.

Mr Myers: "Was the phrase 'air embolus' used at all?"

Dr Evans: "No. The first person to use air embolus, as far as I was concerned, was me.

"I need to give the NCA a compliment, they never gave me a steer. They are good, professional people.""

...

"Dr Evans said in 14 of the 17 cases he had completed his preliminary reports by November 2017, and was unaware of any medical staff member being a suspect.

He became aware of the name 'Lucy Letby' for the first time upon her arrest in July 2018 when he read her name in the press.

He said he was the first to come up with a diagnosis of an air embolus, and this had been agreed by a peer review by Dr Sandie Bohin, plus by a medical expert who began to peer review his reports but sadly, before completing the review, became seriously unwell and died."

Recap: Lucy Letby trial, Tuesday, October 25

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

 

[Supernovae]

Does anyone know the correct place for moderation queries?

 

[Dotta]

Does anyone know the correct place for moderation queries?

Click the report button and ask a question

 

[Supernovae]

Click the report button and ask a question

I mean in regards to some of my own posts that got removed, I don't know whether you had that in mind, as well?

 

[Dotta]

I mean in regards to some of my own posts that got removed, I don't know whether you had that in mind, as well?

No

 

[Sweeper2000]

I mean in regards to some of my own posts that got removed, I don't know whether you had that in mind, as well?

I chased a few of my posts that got deleted. The mods I believe are real busy and so generally don’t reply to requests for reasons as to why they get deleted. But you might get lucky. I was told it’s a good idea to have a copy if the post is long. in the notifications section of the bar at the top you get the post deleted notification, that tells you the mod who deleted or altered your post, start a conversation with them and you might be lucky.

 

[Supernovae]

I chased a few of my posts that got deleted. The mods I believe are real busy and so generally don’t reply to requests for reasons as to why they get deleted. But you might get lucky. I was told it’s a good idea to have a copy if the post is long. in the notifications section of the bar at the top you get the post deleted notification, that tells you the mod who deleted or altered your post, start a conversation with them and you might be lucky.

Where should it show the moderator identity? I can only see a question mark avatar.