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

[Tortoise]

Dr Evans told Mr Myers: “That was my opinion at the time. As a clinician, if I receive additional information that allows me to change or modify my opinion, that is what we do as clinicians.”

This is not evidence of guesswork.

 

[Sweeper2000]

"It could just as easily have been due to a faulty machine. It’s just the lack of any doctors suggesting it even as the remotest possibility even after excluding all other possibilities that I’m paying attention to That as well as a Doctor/s not needing to be suspicious to think of it."


Did any of those faulty machines continue acting up, and pushing air into babies bloodstream after LL left the floor and went into clerical duties?

we certainly would. Giving an indication that indeed an air embolism had been thought of by doctors at the time.

“In July 2016, when the unit changed admission arrangements and stopped providing intensive care, the trust asked the Royal College of Paediatrics and Child Health (RCPCH) to conduct a review into the increased mortality rate.”

Report found inadequate staffing numbers at Hospital | ITV News

The neonatal unit at the Countess of Chester hospital was found to have inadequate staffing numbers, according to a report. | ITV News Granada

www.itv.com

 

[katydid23]

we certainly would. Giving an indication that indeed an air embolism had been thought of by doctors at the time.

“In July 2016, when the unit changed admission arrangements and stopped providing intensive care, the trust asked the Royal College of Paediatrics and Child Health (RCPCH) to conduct a review into the increased mortality rate.”

Report found inadequate staffing numbers at Hospital | ITV News

The neonatal unit at the Countess of Chester hospital was found to have inadequate staffing numbers, according to a report. | ITV News Granada

www.itv.com

How does that answer the question?

You proposed that it might have been a faulty machine, that was forcing air into the babies lines, killing them.

So I asked if that faulty machine continued to do so after LL left the Neo-natal unit?

If not, then there was not ample reason to believe this was due to a faulty machine, imo.

 

[Sweeper2000]

If symptoms of air embolism are particular to it, I don’t see why trained doctors wouldn’t think of it as being a theoretical possibility considering they should know the symptoms. Regardless of how it is caused. Machine, accidentally, deliberately or otherwise.

 

[katydid23]

we certainly would. Giving an indication that indeed an air embolism had been thought of by doctors at the time.

“In July 2016, when the unit changed admission arrangements and stopped providing intensive care, the trust asked the Royal College of Paediatrics and Child Health (RCPCH) to conduct a review into the increased mortality rate.”

Report found inadequate staffing numbers at Hospital | ITV News

The neonatal unit at the Countess of Chester hospital was found to have inadequate staffing numbers, according to a report. | ITV News Granada

www.itv.com

From your link:
The Countess of Chester Hospital Hospital Foundation Trust has asked police to investigate a higher than usual number of baby deaths on the neonatal unit between June 2015 and June 2016.

Two babies died on the unit in 2013 and there were three deaths in 2014.

But eight deaths were recorded in 2015. And in 2016, up until June, five babies died on the unit.


So they were investigating deaths during the time LL was on the floor. Not afterwards, so that theory about it being a faulty machine is not credible.

 

[katydid23]

If symptoms of air embolism are particular to it, I don’t see why trained doctors wouldn’t think of it as being a theoretical possibility considering they should know the symptoms. Regardless of how it is caused. Machine, accidentally, deliberately or otherwise.

They DID think of it. That's why it is included in several murder charges.

 

[LadyEdgeworth]

11:41am

Child I was born at a gestational age of 27 weeks at 8.47pm on August 7, 2015.
She was transferred to the Countess of Chester Hospital on August 18, being cared from 8.30pm.
She was transferred back to Liverpool on September 6, before going back to Chester on September 13, at 11pm.
On September 21, Letby was working a long day shift. During that day, Child G suffered a significant deterioration at 10.15am.
Letby worked a number of night shifts on September 23, 24, 25 and 26. during this time, Child H suffered two significant deteriorations.
Letby then had a few days off work before returning on September 30.

11:47am

A note by the day shift nurse, Shelley Tomlins, gave a brief update on Child I for September 29, recording the mother had been present for 'cares', and regular 35ml feeds of expressed breast milk and fortified milk were administered every three hours.
A subsequent note recorded Child I 'remains pale but managing to complete bottles (slow to feed as windy).'

11:51am

The overnight shift nurse, Jennifer Jones-Key, said Child I continued to be fed regularly, with her tummy 'full but soft', and the father present for cares.

Recap: Lucy Letby trial, Wednesday, January 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

 

[katydid23]

If symptoms of air embolism are particular to it, I don’t see why trained doctors wouldn’t think of it as being a theoretical possibility considering they should know the symptoms. Regardless of how it is caused. Machine, accidentally, deliberately or otherwise.

Are you thinking that the doctors are wrong about air embolisms being the cause of some of the cases?

 

[Sweeper2000]

No just that with AE symptoms having been noticed sooner these events may have been stopped or prevented sooner and or if someone is responsible still brought to justice. Just wondering why with AE and not causing them being such common knowledge the symptoms were missed more than once.

 

[katydid23]

No just that with AE symptoms having been noticed sooner these events may have been stopped or prevented sooner and or if someone is responsible still brought to justice. Just wondering why with AE and not causing them being such common knowledge the symptoms were missed more than once.

I think it was because a very cunning attacker was changing up their mode of attacks, which kept the investigators confused and second guessing themselves.

They were trying urgently to figure out why there was a spike in deaths and collapses, but the cases were not all the same so it was hard to find a cause or a diagnosis for quite awhile.

 

[DianaWW]

IMO I don't think the symptoms themselves are common knowledge, as many of the doctors have testified the rash for example, is something that they haven't seen before, or since these cases. As air embolisms are so rare (because of the machines and the training medical staff are given), it's very unlikely they would have seen an air embolism for themselves. But they should definitely been aware of what they were. MOO

 

[Sweeper2000]

Doctors are trained to spot symptoms and diagnose.

 

[DianaWW]

Doctors are trained to spot symptoms and diagnose.

Of course, but they are not infallible. If none of them have experience of something, it is unlikely to be the first conclusion they come to. I don't think anybody disagrees that this should have been discovered sooner, but I can unfortunately understand why it wasn't. MOO.

 

[LadyEdgeworth]

12:11pm

Letby was looking after three babies in room three that day, including Child I.
Child G was in room 2, with two other babies.
Two babies were in room 1.

12:14pm

Consultant paediatrician Dr Elizabeth Newby records, as part of an inspection for Child I as part of a 'grand round', for feeds to continue.
Feeds are continued for Child I during the day at 10am, 1pm and 4pm, of 35mls expressed breast milk and fortifier. The 10am feed is by bottle, the 1pm and 4pm are via naso-gastric tube with Child I being recorded as asleep for the latter two feeds.

12:20pm

On September 30, at 12.15pm, Child H is transferred back to the Countess of Chester Hospital.
At 1.36pm, Letby records Child I's temperature in the hotcot.
She adds, after a note on the 3x8 feeds: "'Abdomen appears full and slightly distended. Soft to touch, straining++. Bowels have been opened. Mum feels it is more distended to yesterday and that [Child I] is quiet. Appears generally pale. Not on monitor...[will continue to monitor situation]"
"Mummy visiting, carrying out feeds and cares".

Recap: Lucy Letby trial, Wednesday, January 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

 

[LadyEdgeworth]

12:22pm

A note for the feed at 1pm is read out to the court - 'EBM+fortifier, NGT, vomit aspirated 5ml, ph5'. It is signed by Letby.

12:24pm

Letby records, for 3pm: 'Reviewed by Drs as [Child I] appeared mottled in colour with distended abdomen and more prominent veins. Advised to continue. Temperature within normal range with hot cot at 38 degrees. Full monitoring recommenced. within normal range.'
Observations are commenced more regularly for Child I, the court hears.

Recap: Lucy Letby trial, Wednesday, January 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

 

[Sweeper2000]

"It could just as easily have been due to a faulty machine. It’s just the lack of any doctors suggesting it even as the remotest possibility even after excluding all other possibilities that I’m paying attention to That as well as a Doctor/s not needing to be suspicious to think of it."


Did any of those faulty machines continue acting up, and pushing air into babies bloodstream after LL left the floor and went into clerical duties?

actually with the closure of the unit to anything other than level 1 babies, there is the potential that those machines relevant would have not been in use after. At which point any routine inspections on the machines would have identified the problem and fixed it. But that’s besides the point anyway.

And yes machines are no different to doctors, far from perfect.

 

[LadyEdgeworth]

12:28pm

A 35ml feed at 4pm for Child I has an aspirate of 3ml, with Child I 'asleep'. It is signed by Letby's initials.
Letby notes: 'did not wake for feed at 1600 therefroe NG Tube feed given'.
Child I then suffers a deterioration at 4.30pm.

12:28pm

4.30pm on the feed chart records, for Child I, 'large vomit and apnoea - nil by mouth'. It is not signed by anyone.

12:32pm

Letby notes: 'At 1630 [Child I] had a large vomit from mouth and nose++ suction given. Became apnoeic with bradycardia and desatuartion (30s). Help summoned and IPPV given for approx 3min in 100% oxygen to recover. Drs were crash called.
'Transferred to nursery 1...'
A doctor [who cannot be named] records he is crash called. He notes 'Chest clear... Abdomen distended, active bowel sounds all zones'

2:35pm

Letby's mentor replies to a message Letby had sent earlier, expressing birthday wishes, at 5.23pm: 'Ah thank you so much. You ok? x'

12:37pm

An x-ray is taken of Child I at 5.39pm, with the radiologist recording: 'There is splinting of the diaphragm due to bowel distension...there is moderately severe bowel distention which is thought to involve both large and small bowel.
'The appearances are suspicious of NEC...'

12:39pm

Medication of glucose and sodium chloride is co-signed by Letby at 5.45pm and 6pm.
A CRP blood reading for Child I is 'less than 1'.

12:47pm

Child I suffered another deterioration at 7.30pm.
Letby's notes, written in retrospect at 8.26pm, record: 'At 1930 [Child I] became apnoeic - abdomen distended++ and firm. Bradycardia and desaturation followed, SHO in attendance and registrar called...
'Nil by mouth. NG tube on free drainage. Cannula inserted but tissued during saline bolus (5mls given).
'Colour appears pale but improved from earlier in shift. Abdomen appears full and distended. Veins more prominent. Not further vomits. Responsive but quiet on handling.'
For the family communications: 'Mummy present when reviewed by Drs. Had left unit when [Child I] had large vomit and transferred to nursery 1. [Mother] up to date with current plan...'
Nurse Bernadette Butterowrth, who took over care of Child I for the night shift, records: 'During handover [Child I] abdo became more distended and hard she had become apnoeic nad bradycardiac and sats had dropped. IPPV given and despite a good seal with Neopuff there was still no chest movement...'

12:48pm

The doctor records 'ticks' for temperature instability and apnoea for Child I at 8pm.

12:50pm

Letby's final note from 8.26pm: '[Child I] is now very pale and quiet.

12:52pm

Letby responds to her mentor: 'Yes thank you. Hope you are rnjoying your celebrations. X'

Recap: Lucy Letby trial, Wednesday, January 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]

If symptoms of air embolism are particular to it, I don’t see why trained doctors wouldn’t think of it as being a theoretical possibility considering they should know the symptoms. Regardless of how it is caused. Machine, accidentally, deliberately or otherwise.

You keep speaking as if it was common knowledge all along that an air embolism could cause a fleeting rash and that it was something all the medical staff should've have been aware of and suspected every time there was a collapse with a fleeting rash. But from what we've heard nobody had ever seen this fleeting rash before, and it wasn't common knowledge that it coudl be a sign of an air embolism and it was only much later when Dr Jayaram read a research paper that he realised the significance of the rash. Air emobolism is not common in babies, and in addition to that nurses are trained to ensure they don't accidentally inject air and there are safety systems in place to alert if there is air in the line too. Therefore, this is not something nurses or doctors would often encounter. There isn't much research on air embolism in neonates, as it's so rare and obviously it's not something you would deliberately recreate for research purpsoes.

So even ignoring the fact that nobody would dream that a nurse was allegedly injecting air, if you've got something that very rarely happens, and one of the possible symptoms of it isn't common knowledge, why would you expect the medical staff to assume this was the cause whenever they saw a fleeting rash and a collapsed baby?

All the medical staff who saw the rash said they had never seen anything like it before, I think even Dr Evans the medical expert said he'd never personally witnessed it. Yet suddenly we have numerous babies at Chester collapsing and presenting with this fleeting rash , with some dying and others having to be resuscitated. Along side that we heard that up until the start of the twelve month period from June 2015- June 2016 it was rare to ever have to use adrenalin to resuscitate babies and then during that period it became that common, that apaprently a Dr who had not worked in that role anywhere else assumed it was a normal occurance and didn't realise it wasn't common until he worked elsewhere afterwards.

 

[LadyEdgeworth]

1:04pm

The court is shown a series of text messages sent to and from Letby's phone from that night.

Recap: Lucy Letby trial, Wednesday, January 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

 

[Dotta]

You keep speaking as if it was common knowledge all along that an air embolism could cause a fleeting rash and that it was something all the medical staff should've have been aware of and suspected every time there was a collapse with a fleeting rash. But from what we've heard nobody had ever seen this fleeting rash before, and it wasn't common knowledge that it coudl be a sign of an air embolism and it was only much later when Dr Jayaram read a research paper that he realised the significance of the rash. Air emobolism is not common in babies, and in addition to that nurses are trained to ensure they don't accidentally inject air and there are safety systems in place to alert if there is air in the line too. Therefore, this is not something nurses or doctors would often encounter. There isn't much research on air embolism in neonates, as it's so rare and obviously it's not something you would deliberately recreate for research purpsoes.

So even ignoring the fact that nobody would dream that a nurse was allegedly injecting air, if you've got something that very rarely happens, and one of the possible symptoms of it isn't common knowledge, why would you expect the medical staff to assume this was the cause whenever they saw a fleeting rash and a collapsed baby?

All the medical staff who saw the rash said they had never seen anything like it before, I think even Dr Evans the medical expert said he'd never personally witnessed it. Yet suddenly we have numerous babies at Chester collapsing and presenting with this fleeting rash , with some dying and others having to be resuscitated. Along side that we heard that up until the start of the twelve month period from June 2015- June 2016 it was rare to ever have to use adrenalin to resuscitate babies and then during that period it became that common, that apaprently a Dr who had not worked in that role anywhere else assumed it was a normal occurance and didn't realise it wasn't common until he worked elsewhere afterwards.

LL seemed to know what air e. was - didn't she watch (as reported) a programme about the dangers of it?
But, of course, she never mentioned it in her texts with diagnoses
JMO