UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #10

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  • #261
Exactly, that’s my point. To file a murder charge in the first place, the expert evidence must have been that LL’s alleged acts were a substantial cause of baby K’s death. But the expert evidence then apparently changed in the run up to June 2022, leading to the murder charge being abandoned.

I absolutely agree with you that the baby’s premature and fragile condition may have made it virtually impossible to say what the cause of her death was. But if that’s what the medical experts had said in November 2020 when the charges were originally filed, then I don’t think that the prosecution would (or could) have concluded that it was appropriate to file a murder charge for baby K. As public servants, the CPS cannot conclude that it is reasonable to file a murder charge unless at the time they make the charging decision, the medical evidence is that the alleged act was a substantial cause of the death. My point is that the CPS must have been told by the medical experts that LL’s alleged actions were a substantial cause of baby K’s death. But that expert medical evidence must then have changed, leading to the prosecution abandoning the charge in June 2022. And not only just discontinuing the murder charge, but offering “no evidence”, which leads to the judge entering a not guilty verdict in relation to the murder charge of Baby K.


I think it's a lot simpler than that . I think they believed that LL's alleged actions had caused Baby K's death because she never recovered after LL's alleged actions BUT because she was transfered to another hospital later that day and and survived for a few days before dying there a few days later, the defence could have argued that whilst at the other hospital something else caused her to die.

Also because of how premature she was she should have been delivered at a different unit but there wasn't time to get the mother there, so she was born at Chester. So the defence could have used the fact that she should not ideally have been at Chester, as an argument too.

Child K had been born in February 2016, very premature. The court heard births of this type would normally be delivered at Arrowe Park or Liverpool Women's Hospital, but there was not enough time for this to be possible, so Dr Jayaram was present for the birth at the Countess of Chester Hospital.

 
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  • #262
Hello to goodday to you sir and goodday to you.

your post is actually very interesting. I don’t know why but people here don’t seem to believe in second opinions when it comes to medical experts. Especially when they have changed their Minds already and are looking at notes years Later. I think it would have been a good idea for the prosecution to have sought secondary opinions perhaps fortifying the original conclusions.

I think the prospect of two SK on one neonatal ward at the same time is as likely as noticing the completion of a baby in a cot with a canopy in the semi dark from 6’ away to be honest.
Nobody has said anything about two potential SK on the ward. The picture according to the Chester s gives a much truer IMO display of what you could expect on a unit in terms of the levels of light. The Chester cannot add things to the pic and you can still see the sheets thus proving IMO you can see the babies head, it is a nurses job to have been trained to look for paleness. For these reasons, it’s a legal requirement that staff have enough light to see by, the canopy is there to stop direct light reaching the babies eyes thus disturbing sleep I think, in the DM pic it’s actually pitch black which is absurd to assume is a true example of the actual lighting levels and taken by some to fit the already arrived at conclusions, anyone standing in the doorway has a clearer line of sight into the crib, more light is entering the room from the doorway perspective thus Into the crib, the eyes of anyone who is looking into a dark room will adjust to low light levels whereas anyone looking into light will not thus allowing the former to see better in the dark especially when as according to testimony the convo they had would have allowed the eyes enough time to adjust, any nurse using the table will be closer to looking at the canopy rather than into the crib or from the doorway POV, also the nurse looking into any form of light will not have eyes adjusted to low light levels thus preventing shade recognition, we can’t assume both nurses have the same degree of eyesight, one might think LL was actually visually inspecting the baby at the time the comments about the pallor were made, if a baby is white as is the case according to testimony I think a experienced nurse would absolutely notice it and anything that is white stands out more in a dark room which is evident in the picture, if the baby was actually the same colour as the sheets it would most likely be noticed, it is also true that if she was indifferent to the baby and had harmed them she would likely not have pointed out anything potentially wrong with it, if she had and didn’t want negative attention she simply would have had a chat and carried on. The nurse actually stated a distance of five to six feet away, if I can distinguish the sheets in the top left corner from a poor quality photo any nurse actually present would most likely be able to distinguish any shade ie light or dark when actually present. It is also a assumption without evidence to suggest that LL would have known that the pallor would have been something to note if she had actually done something. moo, prove me wrong. As far as I’m concerned it’s a huge reach by the prosecution to suggest the shade of the babies skin couldn’t be determined. That’s what I expect from them now, they have seemingly no evidence that really does give an indication that LL has actually lied or tried to deceive anyone. Like the suggestion that LL would attack baby E just before she expected mum to turn up.

Saying this it’s not really relevant to the stronger cases and their implications. Baby A and F seem to ring out like bells for Christmas.

im still not convinced that is room 2, it should have more beds I think. I know we can’t see the left of the room or it’s contents but it looks to be a small room.

@sapphireminds

i was wondering if baby h could have had those cardiac arrests as a result of the treatment she received. Im not sure but one collapsed lung presumably wouldn’t work very well, that on top of the surfactant not being administered thus preventing efficient gas exchange and a delay in intubation, would this have prevented adequate oxygen reaching the heart thus preventing it from working properly?

 

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  • #263
Hello to goodday to you sir and goodday to you.

your post is actually very interesting. I don’t know why but people here don’t seem to believe in second opinions when it comes to medical experts. Especially when they have changed their Minds already and are looking at notes years Later. I think it would have been a good idea for the prosecution to have sought secondary opinions perhaps fortifying the original conclusions.


Nobody has said anything about two potential SK on the ward. The picture according to the Chester s gives a much truer IMO display of what you could expect on a unit in terms of the levels of light. The Chester cannot add things to the pic and you can still see the sheets thus proving IMO you can see the babies head, it is a nurses job to have been trained to look for paleness. For these reasons, it’s a legal requirement that staff have enough light to see by, the canopy is there to stop direct light reaching the babies eyes thus disturbing sleep I think, in the DM pic it’s actually pitch black which is absurd to assume is a true example of the actual lighting levels and taken by some to fit the already arrived at conclusions, anyone standing in the doorway has a clearer line of sight into the crib, more light is entering the room from the doorway perspective thus Into the crib, the eyes of anyone who is looking into a dark room will adjust to low light levels whereas anyone looking into light will not thus allowing the former to see better in the dark especially when as according to testimony the convo they had would have allowed the eyes enough time to adjust, any nurse using the table will be closer to looking at the canopy rather than into the crib or from the doorway POV, also the nurse looking into any form of light will not have eyes adjusted to low light levels thus preventing shade recognition, we can’t assume both nurses have the same degree of eyesight, one might think LL was actually visually inspecting the baby at the time the comments about the pallor were made, if a baby is white as is the case according to testimony I think a experienced nurse would absolutely notice it and anything that is white stands out more in a dark room which is evident in the picture, if the baby was actually the same colour as the sheets it would most likely be noticed, it is also true that if she was indifferent to the baby and had harmed them she would likely not have pointed out anything potentially wrong with it, if she had and didn’t want negative attention she simply would have had a chat and carried on. The nurse actually stated a distance of five to six feet away, if I can distinguish the sheets in the top left corner from a poor quality photo any nurse actually present would most likely be able to distinguish any shade ie light or dark when actually present. It is also a assumption without evidence to suggest that LL would have known that the pallor would have been something to note if she had actually done something. moo, prove me wrong. As far as I’m concerned it’s a huge reach by the prosecution to suggest the shade of the babies skin couldn’t be determined. That’s what I expect from them now, they have seemingly no evidence that really does give an indication that LL has actually lied or tried to deceive anyone. Like the suggestion that LL would attack baby E just before she expected mum to turn up.

Saying this it’s not really relevant to the stronger cases and their implications. Baby A and F seem to ring out like bells for Christmas.

im still not convinced that is room 2, it should have more beds I think. I know we can’t see the left of the room or it’s contents but it looks to be a small room.

@sapphireminds

i was wondering if baby h could have had those cardiac arrests as a result of the treatment she received. Im not sure but one collapsed lung presumably wouldn’t work very well, that on top of the surfactant not being administered thus preventing efficient gas exchange and a delay in intubation, would this have prevented adequate oxygen reaching the heart thus preventing it from working properly?


I'm not sure what you mean by ..."people here don't seem to believe in second opinions"

All the cases have had that and both experts testimony are there to consider for each case ...albeit on the whole both opinions have been similar
 
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  • #264
The low blood sugar readings started from when LL hung the first (if there were two) TPN bag and carried on throughout her shift then into the next shift, which the medical expert has said shows that the supply of insulin was continuous.The only reading that was slightly higher during LL's shift was the one LL recorded.

If there was a second bag we've been told that they kept "a couple" of stock bags in the fridge so if guilty,it's not like there were 20 odd additional TPN bags in the fridge that she would have had to poison. She could just have poisoned the next one in the fridge if they were stored in the order they would be used ,or if there were only a couple, poisoned both of them.

But we don't know for sure that there even was a second bag. The nurse said she "would've" changed the bag (ie that was what she normally would do) but that she had no independent memory of it. She also said she thought she would have made a note if she hadn't changed it and there was no note... BUT there was no note saying she had changed it either. The medical expert has said that if there was a second bag then it must have contained the same amount of insulin as the first bag that LL hung, as the blood sugar readings stayed low throughout the time the TPN bag/s was/were used. But an alternative explanation is that it was just the one bag throughout. Either way , the continous low blood sugar readings on LL's shift indicate that the TPN bag LL hung contained insulin. The argument is whether there was a second bag that did too or whether the bag was never changed.

The defence have not questioned that Baby F was deliberately poisoned with insulin nor that it was in the TPN bag. They didn't challenge the medical expert at all on those points. And even LL has not challenged that She's just said that she didn't do it. The defence are arguing that as the blood test that showed the high insulin was taken when the alleged second TPN bag was being used, that it can't have been LL. However as explained above the medical expert has said that the continuous low blood sugar levels, which started after LL hung the TPN bag , show that the insulin was administered continously for the period the blood sugars were low... and that period started shortly after LL hung that (first) TPN bag. The implication being that although the insulin blood tests weren't performed until the alleged second TPN bag, they would still have been abnormal if they had been tested on LL's shift.

imo

I lean towards what @katydid23 says in post #252 regarding the tpn bag not being changed and the nurse not noting this.

Don’t know if anyone on here can confirm if medication being dispensed in a hospital would be the same as medication being dispensed at a local pharmacy. I assume they log the serial number and batch number to a patient so it can be traced if recalled and account for medicine.

I would like to think the serial number would be noted at the time of use on patient records at the hospital. So if LL recorded this serial number and the bag wasn’t changed there would be no reason to note the same serial number again by the other nurse just a failure to note this. If bag was changed then other nurse has failed to record this serial number if they do keep records like this.

jmo and hope this makes sense
 
  • #265
I think the prospect of two SK on one neonatal ward at the same time is as likely as noticing the completion of a baby in a cot with a canopy in the semi dark from 6’ away to be honest.
I don't think there were two SK in the ward at the same time.
 
  • #266
I think it's a lot simpler than that . I think they believed that LL's alleged actions had caused Baby K's death because she never recovered after LL's alleged actions BUT because she was transfered to another hospital later that day and and survived for a few days before dying there a few days later, the defence could have argued that whilst at the other hospital something else caused her to die.

Also because of how premature she was she should have been delivered at a different unit but there wasn't time to get the mother there, so she was born at Chester. So the defence could have used the fact that she should not ideally have been at Chester, as an argument too.

Child K had been born in February 2016, very premature. The court heard births of this type would normally be delivered at Arrowe Park or Liverpool Women's Hospital, but there was not enough time for this to be possible, so Dr Jayaram was present for the birth at the Countess of Chester Hospital.

I understand what you’re saying, and that makes sense to me. The reason why I doubt that the prosecution abandoned the murder charge for Baby K on the basis that the defence could argue that something else happened to her after she was transferred to another hospital after the alleged attack by LL, or because the defence could argue that she shouldn’t have been born at COCH in the first place, is because prosecution decided to abandon the murder charge by offering “no evidence” rather than simply discontinuing the charge .

If, as you say, the prosecution did not want to pursue the murder charge because they thought it was doubtful that they could get a conviction on the basis of arguments which the defence would be able to put forward relating to care received at another hospital, and/or the fact that the baby shouldn’t have been born at COCH in the first place (which would be an entirely reasonable decision on behalf of the prosecution in my view), why didn’t the prosecution simply discontinue the charge so that they could file it again at a later date if subsequent medical evidence or advances are able to demonstrate that the alleged attacks by LL actually caused Baby K’s death? To me, that would make the most sense. If there is still the possibility, from the prosecution’s perspective, that LL’s alleged acts caused the death, surely the prosecution would want to preserve its ability to refile a murder charge against her in the future?

The fact that they abandoned the murder charge by offering no evidence, which they knew would lead to a not guilty verdict in relation to this charge, and thus engage double jeopardy, says to me that there was no longer any prospect from the prosecution’s perspective that LL’s alleged acts could be proven to have caused baby K’s death. The only reason I can see that there would now be no prospect of proving causation is that the medical evidence had changed (either because the existing experts revised their opinions, or a fresh, new opinion was obtained.
 
  • #267
yes. in order to state baby K was murdered, the prosecution would have had to prove that the alleged attack was a substantial cause of death, which may have been impossible given the baby's fragile condition.

Causation​

The prosecution must show a causal link between the act/omission and the death. The act or omission must be a substantial cause of death, but it need not be the sole or main cause of death. It must have "more than minimally negligibly or trivially contributed to the death" - Lord Woolf MR in R v HM Coroner for Inner London ex p Douglas-Williams [1999] 1 All ER 344.

<modsnip - discussing moderation>

So, when I was taught it the phrase was "substantial and operating". It has to be both. So if, say, you stab someone, they end up on life support and some murderous nurse comes along and turns the machines off causing them to die then you are guilty of murder even though you didn't personally kill them and even though they were likely to make a full recovery.

I'd guess that if that same nurse came along and shot your victim in the head (as a ridiculously extreme eample) then that would break the chain of causation as the injuries you caused would most likely not be an "operating" cause of death.

In my opinion, obvs.
 
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  • #268
I lean towards what @katydid23 says in post #252 regarding the tpn bag not being changed and the nurse not noting this.

Don’t know if anyone on here can confirm if medication being dispensed in a hospital would be the same as medication being dispensed at a local pharmacy. I assume they log the serial number and batch number to a patient so it can be traced if recalled and account for medicine.

I would like to think the serial number would be noted at the time of use on patient records at the hospital. So if LL recorded this serial number and the bag wasn’t changed there would be no reason to note the same serial number again by the other nurse just a failure to note this. If bag was changed then other nurse has failed to record this serial number if they do keep records like this.

jmo and hope this makes sense


Don't know about serial numbers but as Baby F's TPN bag was a bespoke one that codul be another reaosn they might've kept the same bag rather than replace it with a stock one
 
  • #269
I understand what you’re saying, and that makes sense to me. The reason why I doubt that the prosecution abandoned the murder charge for Baby K on the basis that the defence could argue that something else happened to her after she was transferred to another hospital after the alleged attack by LL, or because the defence could argue that she shouldn’t have been born at COCH in the first place, is because prosecution decided to abandon the murder charge by offering “no evidence” rather than simply discontinuing the charge .

If, as you say, the prosecution did not want to pursue the murder charge because they thought it was doubtful that they could get a conviction on the basis of arguments which the defence would be able to put forward relating to care received at another hospital, and/or the fact that the baby shouldn’t have been born at COCH in the first place (which would be an entirely reasonable decision on behalf of the prosecution in my view), why didn’t the prosecution simply discontinue the charge so that they could file it again at a later date if subsequent medical evidence or advances are able to demonstrate that the alleged attacks by LL actually caused Baby K’s death? To me, that would make the most sense. If there is still the possibility, from the prosecution’s perspective, that LL’s alleged acts caused the death, surely the prosecution would want to preserve its ability to refile a murder charge against her in the future?

The fact that they abandoned the murder charge by offering no evidence, which they knew would lead to a not guilty verdict in relation to this charge, and thus engage double jeopardy, says to me that there was no longer any prospect from the prosecution’s perspective that LL’s alleged acts could be proven to have caused baby K’s death. The only reason I can see that there would now be no prospect of proving causation is that the medical evidence had changed (either because the existing experts revised their opinions, or a fresh, new opinion was obtained.
I honestly think you're reading too much into it. To me it's simple and by offering no evidence for murder but keeping the attempted murder charge, they're still saying they believe LL took the alleged action but they've decided it would prove tricky trying to prove that the action killed her, because of her being moved to the other hospital and not dying straight away. And then there's the added info about her being born at the wrong grade hospital.

As neither of those things are likely to change in the future, there would imo be no point keeping the murder charge on file. And as none of the other allegedly murdered babies were in the same postion as baby K and they all died straight after LL's alleged actions, in the same hospital, the decison to offer no evidence on that charge has no impact on the other charges and is no relecton of the strength of the evidece for those charge. Sure they could have come to that decision sooner, but the fact that they didn't IMO isn't the big red flag you seem to think it is.

imo
 
  • #270
<modsnip>
I lean towards what @katydid23 says in post #252 regarding the tpn bag not being changed and the nurse not noting this.

Don’t know if anyone on here can confirm if medication being dispensed in a hospital would be the same as medication being dispensed at a local pharmacy. I assume they log the serial number and batch number to a patient so it can be traced if recalled and account for medicine.

I would like to think the serial number would be noted at the time of use on patient records at the hospital. So if LL recorded this serial number and the bag wasn’t changed there would be no reason to note the same serial number again by the other nurse just a failure to note this. If bag was changed then other nurse has failed to record this serial number if they do keep records like this.

jmo and hope this makes sense
Hospitals dispense medication in a different way. I don't know exactly the method used there, so I won't comment on it.

IMO, no matter whether the bag had been changed or not, if it was still d10, that is a subtle sign that there may have been a different issue.

Glucose infusion rate is a calculation that professionals use to determine how much sugar is being given via IVF. There are multiple equations that can be used, but the easiest one, IMO is dextrose (as a percent decimal) times how may milliliters per kilogram per day of the fluid the baby is receiving times 0.69,which is a constant. It can be expressed as Dextrose * Volume * 0.69 = Glucose infusion rate (also abbreviated GIR) You can also use a calculator such as this one to also come up with the same number.

Sources such as this from a neonatal handbook suggests that when hypoglycemia is found, the GIR should be increased every time, to provide more glucose. If they were continuing to use D10 based fluid, it would be nearly impossible for them to have increased the GIR appropriately with every hypoglycemia measurement, IMO. IMO, the normal thing would be to hang a fluid with more dextrose, which would mean neither the original TPN or starter TPN would be appropriate, IMO. The baby improved when they finally increased the glucose to 15%.

The only other way the glucose would stay the same, with the same amount of insulin, is if they weren't actually treating the hypoglycemia ever, which is concerning to think about, IMO. So if there were 2 units of insulin the baby was getting, with a gir of 6, and they had low blood sugar, to continue having the same, low blood sugar, would be if they were not adjusting the GIR at all in 24 hours. This is just a logical following of the evidence presented. Baby had consistently low blood sugars that were largely not improving nor deteriorating, which would mean they were not increasing the amount of glucose they were giving, or the insulin was perfectly calibrated that when they increased the infusion of TPN, the insulin increased the perfect amount for the amount of dextrose in the bag.

No matter what, there are things that don't add up.
 
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  • #271
The CPS DID get all the charges reviewed - by Dr Bohin.
I highly doubt they would consider a case of this magnitude which investigations have been undertaken for several years on a wing and a prayer, the charging threshold is incredibly high and the investigations are still ongoing and will be for some years going forward. Also her time at her previous hospital is under review.
It wouldn’t surprise me in the least if more charges follow after this case concludes whatever the outcome.
 
  • #272
So ya know parents who put claims in against the hospital, would the hospital be the one paying if she's guilty?
 
  • #273
What I don't understand is, she was supposed to observe the baby for 15 minutes but the room was dark and the baby was covered by a canopy. So how was she supposed to observe or was she supposed to turn the light on at intervals?
"Observe" in this context doesn't mean looking at. It means to be aware if a monitor alarms, if the baby gets distressed, that sort of thing.
 
  • #274
Sorry if this has been answered before; have the prosecution given any suggestions as how how the TPN bag was tampered with? Did it arrive sealed? Injection into the bag? Wouldn't that show? LL would have to hide the needle etc...

Sounds like the entire hospital ward was a shambles, surely if they had suspicions about LL or anyone else tampering with the bag it should have been a call to the police right there and the. Sounds to me like the bag wasn't changed, correct policies and procedures were not followed across the board and potentially a SK was able to run amok throughout the ward unchallenged due to the awful care and conditions the patients experienced.
 
  • #275
It is never good to leave a child in one's care to another person.
Why couldn't LL go to help this emergency the baby's designated nurse went to?

As a teacher I MUST NOT leave the classroom and ask somebody else to look after children.
If anything happened to one of the pupils, I would be held responsible as they were in MY care.

I think discipline was lax in this ward.
MO
that's not how it works in hospitals. Nurses need to leave rooms for lots of reasons and it's perfectly OK to ask another nurse to keep an eye on your patients.
Discipline was not lax in the slightest.
 
  • #276
Sorry if this has been answered before; have the prosecution given any suggestions as how how the TPN bag was tampered with? Did it arrive sealed? Injection into the bag? Wouldn't that show? LL would have to hide the needle etc...

Sounds like the entire hospital ward was a shambles, surely if they had suspicions about LL or anyone else tampering with the bag it should have been a call to the police right there and the. Sounds to me like the bag wasn't changed, correct policies and procedures were not followed across the board and potentially a SK was able to run amok throughout the ward unchallenged due to the awful care and conditions the patients experienced.
"Mr Allen is now demonstrating how a TPN bag and its connectors work - which does have a connector which can be opened.

4:02pm

The empty TPN bag and its connectors are now being passed around members of the jury and the defence for examination.

4:06pm

Mr Driver is asking Mr Allen about how a quantity of liquid could be added to one of the ports, which is shown to be possible.

4:28pm

Members of the jury are reminded by the judge, having heard a lot of expert evidence in the case today, not to conduct any independent research."

Recap: Lucy Letby trial, Tuesday, November 29


They didn't have suspicions about LL or anyone at the hospital tampering with the bag. That isn't part of the evidence heard.

The baby's blood sugar had returned to normal by the time the results came back, and so they didn't have a need to repeat the blood test.

"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.

10:50am

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."

Recap: Lucy Letby trial, Thursday, November 24
 
  • #277
"Observe" in this context doesn't mean looking at. It means to be aware if a monitor alarms, if the baby gets distressed, that sort of thing.
Hi i missed abit of this one.
So when LL said the baby looked pale was the alarm turned off when the nurse went to check?
 
  • #278
"Mr Allen is now demonstrating how a TPN bag and its connectors work - which does have a connector which can be opened.

4:02pm

The empty TPN bag and its connectors are now being passed around members of the jury and the defence for examination.

4:06pm

Mr Driver is asking Mr Allen about how a quantity of liquid could be added to one of the ports, which is shown to be possible.

4:28pm

Members of the jury are reminded by the judge, having heard a lot of expert evidence in the case today, not to conduct any independent research."

Recap: Lucy Letby trial, Tuesday, November 29


They didn't have suspicions about LL or anyone at the hospital tampering with the bag. That isn't part of the evidence heard.

The baby's blood sugar had returned to normal by the time the results came back, and so they didn't have a need to repeat the blood test.

"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.

10:50am

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."

Recap: Lucy Letby trial, Thursday, November 24
Thank you for taking the time to post that, I appreciate it
 
  • #279
Hi i missed abit of this one.
So when LL said the baby looked pale was the alarm turned off when the nurse went to check?
we haven't heard about it, but the reporting hasn't been great this last week.
 
  • #280
Hi i missed abit of this one.
So when LL said the baby looked pale was the alarm turned off when the nurse went to check?
I don’t think it would be otherwise we would have heard of it. LL testimony and notes says it was in situ but didn’t activate, supported by the DN’s testimony I think. Interesting that we didn’t hear her account of that though, but has been very patchy reporting.
 
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