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

[magikarpmagikarp]

<modsnip>

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.

Possibly they added a piggyback of more concentrated dextrose - d12.5, d15, d20. Then they could titrate the GIR without changing the basal infusion of TPN and still deliver protein and fat which is better quality nutrition.

 

[MsBetsy]

Thanks for sharing your experience (and welcome to the thread ) . I don't really want to bring the whole discussion up again but I thnk since the post I was quoting was made we've also heard how other nurses were questioning LL suitability to looking after sicker babies, and then even LL herself was saying how it always seemed to happen to "her babies", so it seems pretty clear that her presence at the collapses and deaths was the reason concerns were raised by Dr Jayaram.

There were also other consultants who went to the Director to voice their concerns so it wasn't just Dr. J who noticed.

As early as the first three unexplained deaths staff were discussing how odd they were. One nurse questioned LL in a text whether the circumstances were "really that different."

The consultants would have observed LL being involved with all the serious or fatal incidents but some of the nurses would have been around Letby more often.
I wouldn't be surprised if they noticed the connection before the Doctors.

 

[JosieJo]

Do we know anything at all about the time of the supposed visit by mum of child E at all by staff? Just think it’s strange that it’s LL vs mum at this point. No staff testimony at nine or ten including the place she came from. Tbh I am surprised that she came alone and at all. If she was just delivering milk I might think staff would do this assuming there is no other benefit to her attending either for her or baby. Ie night cares like skin contact and maybe for mum the feelings and bonding. Considering she must have been feeling very fragile and tired at that point one might think staff would be there for support or care.

jmo though

might be difficult to get the funding.

It's normal for mums to feed their babies as much as possible on neonatal..most mums want to.

I do not see it as mum vs LL on the time of the visit at all. IMO it's clear cut.

Firstly 9pm was the time the milk was due not 10pm

Secondly she phoned her husband just after the incident as was worried about the baby crying so hard and blood

The phone records confirm 9.10pm

 

[JosieJo]

Dbm double post

 

[ShireChe]

Do we know anything at all about the time of the supposed visit by mum of child E at all by staff? Just think it’s strange that it’s LL vs mum at this point. No staff testimony at nine or ten including the place she came from. Tbh I am surprised that she came alone and at all. If she was just delivering milk I might think staff would do this assuming there is no other benefit to her attending either for her or baby. Ie night cares like skin contact and maybe for mum the feelings and bonding. Considering she must have been feeling very fragile and tired at that point one might think staff would be there for support or care.

jmo though

might be difficult to get the funding.

We do have to remember that at the point of the staff being asked questions, the events took place a few years earlier. Now it's likely they remember the mum being there, but unless they made any notes, it's hugely unlikely they remember exactly what time things were happening.

 

[Tortoise]

What if you consider the possibility that whoever is harming babies, is doing so for attention, accolades or sympathy, some form of self validation or generally just to be the centre of the discussion regardless of the reason?

I think the nature of the attacks on the babies was so heinous and cruel and intended to cause suffering, that the reward was not attention but absolutely perverse satisfaction and excitement from wielding the power and being able to do it. A release and venting of some kind of a sick hatred of either babies or parents, or families, which had been present for a very long time - since childhood. Whoever did it. JMO

 

[esther43]

There were also other consultants who went to the Director to voice their concerns so it wasn't just Dr. J who noticed.

As early as the first three unexplained deaths staff were discussing how odd they were. One nurse questioned LL in a text whether the circumstances were "really that different."

The consultants would have observed LL being involved with all the serious or fatal incidents but some of the nurses would have been around Letby more often.
I wouldn't be surprised if they noticed the connection before the Doctors.

I think LL would have spent long periods working alongside regular staff plus her extra shifts and band 6 position would have increased the diversity of colleagues who she worked among. But a consultant team (of around 6) would have more of a bird's eye view given that they are a small team covering the unit every day, working with all babies and not just 2-3 per day.
The other insight that consultant staff will have (that possibly maybe more diluted at ground level) is their level of experience in the unit.
Most hospitals 'grow their own' consultants, taking the average doctor at least 15-20 years to acquire the position. Though in the units I've worked in, some consultants careers span across 30-40 years.
This is only relevant if you are considering the consultant teams ability to soundly judge the potential impact of LL during her comparatively short time working at CoC. JMO

 

[Tortoise]

It's normal for mums to feed their babies as much as possible on neonatal..most mums want to.

I do not not see it as mum vs LL on the time of the visit at all. IMO it's clear cut.

Firstly 9pm was the time the milk was due not 10pm

Secondly she phoned her husband just after the incident as was worried about the baby crying so hard and blood

The phone records confirm 9.10pm

Also one has to factor in the many differences in the scene that the mother saw and the scene that the doctor saw. Mother said LL was alone in the room with her twins, and baby not only had blood covering his chin but he was screaming.

From 9.40pm to 10.10pm Dr Harkness was performing checks on the baby and removing his nasogastric tube. Baby was not even crying and had no blood on his face, so it had already been cleaned. Doctor saw an aspirate that had been collected, mother didn't. Doctor didn't know why baby was bleeding, so the mother would have asked him and not needed to ask LL why he was bleeding, and LL would not have said the things she did, such as cause/doctor is on his way/go back to your ward, which matches with the mother being on the ward 10 minutes after feed time ringing her husband. The mother would have seen doctor removing the nasogastric tube.

It's pretty apparent that the mother was confronted with a completely different scene, before the doctor came, when she was expected to be there at feed time. IMO

She would also not needed to be taking milk at 10pm because LL wrote that the feed was to be omitted on the advice of a different doctor, so clearly there was a problem at 9pm, just a problem that doesn't match anything baby E's mother testified to, which bears an uncanny resemblance to the same problem that was later reported by LL to doctors.

SHO's testimony also doesn't agree with LL's account.

JMO

 

[esther43]

There were also other consultants who went to the Director to voice their concerns so it wasn't just Dr. J who noticed.

As early as the first three unexplained deaths staff were discussing how odd they were. One nurse questioned LL in a text whether the circumstances were "really that different."

The consultants would have observed LL being involved with all the serious or fatal incidents but some of the nurses would have been around Letby more often.
I wouldn't be surprised if they noticed the connection before the Doctors.

I think LL would have spent long periods working alongside regular staff plus her extra shifts and band 6 position would have increased the diversity of colleagues who she worked among. But a consultant team (of around 6) would have more of a bird's eye view given that they are a small team covering the unit every day, working with all babies and not just 2-3 per day.
The other insight that consultant staff will have (that possibly maybe more diluted at ground level) is their level of experience in the unit.
Most hospitals 'grow their own' consultants, taking the average doctor at least 15-20 years to acquire the position. Though in the units I've worked in, some consultants careers span across 30-40 years.
This is only relevant if you are considering the

We do have to remember that at the point of the staff being asked questions, the events took place a few years earlier. Now it's likely they remember the mum being there, but unless they made any notes, it's hugely unlikely they remember exactly what time things were happening.

I think the nature of the attacks on the babies was so heinous and cruel and intended to cause suffering, that the reward was not attention but absolutely perverse satisfaction and excitement from wielding the power and being able to do it. A release and venting of some kind of a sick hatred of either babies or parents, or families, which had been present for a very long time - since childhood. Whoever did it. JMO

teams ability to soundly judge the potential impact of LL during her comparatively short time working at CoC. JMO

We do have to remember that at the point of the staff being asked questions, the events took place a few years earlier. Now it's likely they remember the mum being there, but unless they made any notes, it's hugely unlikely they remember exactly what time things were happening.

The thing that intrigues me about child E is that mum said LL told her to back to the post natal ward. LL denies ever saying this, though tbh it would have made sense if she had said this as the conversation was timed at the point of handover when parents were not allowed on the ward (according to the poster on the unit entry door.
LL claimed the time frame was wrong but this would have made sense if mums visit was during handover. Moo.

 

[esther43]

Also one has to factor in the many differences in the scene that the mother saw and the scene that the doctor saw. Mother said LL was alone in the room with her twins, and baby not only had blood covering his chin but he was screaming.

From 9.40pm to 10.10pm Dr Harkness was performing checks on the baby and removing his nasogastric tube. Baby was not even crying and had no blood on his face, so it had already been cleaned. Doctor saw an aspirate that had been collected, mother didn't. Doctor didn't know why baby was bleeding, so the mother would have asked him and not needed to ask LL why he was bleeding, and LL would not have said the things she did, such as cause/doctor is on his way/go back to your ward, which matches with the mother being on the ward 10 minutes after feed time ringing her husband. The mother would have seen doctor removing the nasogastric tube.

It's pretty apparent that the mother was confronted with a completely different scene, before the doctor came, when she was expected to be there at feed time. IMO

She would also not needed to be taking milk at 10pm because LL wrote that the feed was to be omitted on the advice of a different doctor, so clearly there was a problem at 9pm, just a problem that doesn't match anything baby E's mother testified to, which bears an uncanny resemblance to the same problem that was later reported by LL to doctors.

SHO's testimony also doesn't agree with LL's account.

JMO

 

[esther43]

Yes, (from memory) I think the SHO said when testifying that he would not have told her to go ahead and give the feed.
IMO the Mother is not going to 'forget' what happened at such a significant point in her life.
If this was foul play, I can only imagine that the 'emergence' of blood was not intended to be discovered as early as it was.
Had the blood not been discovered by mum, I am not convinced the bloody aspirate would have been revealed in the way it was.
IMO there would have then been a 12 hour period where the gasteral bleed could have gone undetected and mistaken for the appearance of NEC. Which on visual appearance would also show a hard distented tummy with bluish markings, a symptom that would also be evident in an undetected GB.
I am unaware of doctors carrying out regular throat checks during neonatal ward rounds. Only during periods of ventilation which would further impede their ability to detect a GI bleed in normal circumstances and in a timely manner.
JMO

 

[Tortoise]

The thing that intrigues me about child E is that mum said LL told her to back to the post natal ward. LL denies ever saying this, though tbh it would have made sense if she had said this as the conversation was timed at the point of handover when parents were not allowed on the ward (according to the poster on the unit entry door.
LL claimed the time frame was wrong but this would have made sense if mums visit was during handover. Moo.

Well this is not entirely accurate. LL didn't claim the time frame was wrong for telling the mother to go, she said she would not have told the mother to go. Also the mother had already attended to cares between 6.30pm and 7pm, which matches with the day shift 7pm nursing note of nappy change, way before handover, so there's no purpose to her going again at 8pm to do the cares, from a logical point of view and also if as you say there is no visiting allowed at that time. I would say having been with baby all day it was entirely normal that she would need to eat, and rest and express milk for the next feed, as she said she did. JMO

LL's case is that the mother wasn't already there at 8pm but she went down at 8pm.

"Mr Myers suggests the mum went down at about 8pm, at the time of the hand-over, and went down at about 10pm with the breast milk, and went again when Child E was being resuscitated.
The mum says she "absolutely" disagrees with that."
Recap: Lucy Letby trial, Monday, November 14

 

[Tortoise]

Yes, (from memory) I think the SHO said when testifying that he would not have told her to go ahead and give the feed.
IMO the Mother is not going to 'forget' what happened at such a significant point in her life.
If this was foul play, I can only imagine that the 'emergence' of blood was not intended to be discovered as early as it was.
Had the blood not been discovered by mum, I am not convinced the bloody aspirate would have been revealed in the way it was.
IMO there would have then been a 12 hour period where the gasteral bleed could have gone undetected and mistaken for the appearance of NEC. Which on visual appearance would also show a hard distented tummy with bluish markings, a symptom that would also be evident in an undetected GB.
I am unaware of doctors carrying out regular throat checks during neonatal ward rounds. Only during periods of ventilation which would further impede their ability to detect a GI bleed in normal circumstances and in a timely manner.
JMO

The SHO said he would not have told her to omit the feed without speaking to the ward doctor and he would have made a note. The ward doctor, Dr Harkness, has said he was on the neonatal ward from when he came on shift, so there would have been no reason for LL to contact the SHO on paediatric ward.

 

[katydid23]

I think it is possible to think of odd, fluky kinds of defense explanations on a case by case basis. We can imagine that the pharmacy accidentally added the insulin into the TPN's. And that on another occasion, a particular machine acted up and shot air into the line, but was then rebooted so it was never caught. And on another occasion there was a faulty diagnosis and there was a natural cause for the death that was not determined. And we'd have to do so 22 times in a row.

The problem for me is that I can't see how that would have happened so many times, back to back, and over and over, specifically to LL. And once those freakish coincidences began happening, she didn't step away---she leaned into it and wanted even more time in room 1 with the fragile babies.

It just doesn't ring true to me that each of these cases could have strange, one off, odd explanations and it is just an odd coincidence that LL was ever present. Especially when I add in the strange notes she wrote about it. Those statements do not fit with these all being accidental pharmacy mistakes and glitchy machinery and false medical diagnosis issues, IMO.

 

[esther43]

Well this is not entirely accurate. LL didn't claim the time frame was wrong for telling the mother to go, she said she would not have told the mother to go. Also the mother had already attended to cares between 6.30pm and 7pm, which matches with the day shift 7pm nursing note of nappy change, way before handover, so there's no purpose to her going again at 8pm to do the cares, from a logical point of view and also if as you say there is no visiting allowed at that time. I would say having been with baby all day it was entirely normal that she would need to eat, and rest and express milk for the next feed, as she said she did. JMO

LL's case is that the mother wasn't already there at 8pm but she went down at 8pm.

"Mr Myers suggests the mum went down at about 8pm, at the time of the hand-over, and went down at about 10pm with the breast milk, and went again when Child E was being resuscitated.
The mum says she "absolutely" disagrees with that."
Recap: Lucy Letby trial, Monday, November 14

I think we are saying the same things. That there were varying accounts on whether the conversation happened and the proposed timings the mother was on the ward.
I think my only point was, if LL's timing account was accurate, she could have simply argued at interview that it was handover time and therefore mum was asked to leave as per unit rules which the mother also references in her testimony.
However in interview LL denied the conversation around asking her to leave.
Agree that Mother's visits are more likely to align with cares and feeding, given that the unit appears quite regimented in it's approach to family integrated care. This is reflected in their 'visiting' times, asking parents to stay out of the unit during handover, when they should be allowed 24 hour access to their baby to enable them to be an integral part of the care team at all times.

 

[Sweeper2000]

It's normal for mums to feed their babies as much as possible on neonatal..most mums want to.

I do not see it as mum vs LL on the time of the visit at all. IMO it's clear cut.

Firstly 9pm was the time the milk was due not 10pm

Secondly she phoned her husband just after the incident as was worried about the baby crying so hard and blood

The phone records confirm 9.10pm

In all honesty I do think the timing of the call at 9.10 would correspond with her being worried. Factoring in the walk between units, time to speak with staff upon return, Time to find the phone and dial and what seems to be via her account a sharp command to return to her unit by LL. ie turns up at nine, very brief visit, heads back to ward and upon return calls husband. Strange though, the accounts given suggest she was just delivering the milk and wasn’t planned to feed her baby which one might think is the norm. There was another call closer to ten I think. Is a potential that this was the worried call.

I find the absence of supporting testimony either in timings of the visit or about the baby crying in what seems to be a concerning way unusual. If it was that piercing one might think other staff would notice.

I am not sure though. Seems strange that LL fully aware presumably that mom was due any moment would then attack the baby. I could understand if it was done some time before and then any resulting problems could be cleaned up or hidden. did she have the opportunity though?

 

[GoodDayToYouSir]

I think it is possible to think of odd, fluky kinds of defense explanations on a case by case basis. We can imagine that the pharmacy accidentally added the insulin into the TPN's. And that on another occasion, a particular machine acted up and shot air into the line, but was then rebooted so it was never caught. And on another occasion there was a faulty diagnosis and there was a natural cause for the death that was not determined. And we'd have to do so 22 times in a row.

The problem for me is that I can't see how that would have happened so many times, back to back, and over and over, specifically to LL. And once those freakish coincidences began happening, she didn't step away---she leaned into it and wanted even more time in room 1 with the fragile babies.

It just doesn't ring true to me that each of these cases could have strange, one off, odd explanations and it is just an odd coincidence that LL was ever present. Especially when I add in the strange notes she wrote about it. Those statements do not fit with these all being accidental pharmacy mistakes and glitchy machinery and false medical diagnosis issues, IMO.

For me, a very important (and as yet unanswered) question is, what were the circumstances of the other cases where LL is not charged? We know that there were 15 deaths within 2015 and 2016. LL is charged in relation to 7 of those deaths. I really want to know about these other deaths. Just on their own, ignoring the ones LL is charged with, these deaths represent a spike in the death rate of that unit. If the prosecution is saying that these deaths were not the result of some unlawful action taken by a medical professional, then what caused them? Why did those excess deaths occur during 2015 and 2016 when there had not been such a spike in the death rate before or after those dates? What are the circumstances surrounding those deaths? Are there similar medical aspects in these cases compared to the ones LL is charged with, but the difference is that LL was not on duty/did not have the opportunity to cause those deaths? Can the deaths be attributed to the allegation that COCH was not fit for purpose as a hospital with its designated level at that time? I know that the hospital was downgraded around the time of the last alleged murder/AM in 2016. Can the spike in the death rate to be attributed to the fact that the COCH was caring for patients much more poorly than it was capable of?

That’s just the cases relating to the murder charges.

Then we have the cases where LL is charged with AM. I don’t think we have been given an overall figure for the number of near fatal collapses not resulting in death which occurred on that unit during 2015 and 2016 in order to get a sense of how many of those collapses are being attributed to LL and her alleged malicious activity. Are the numbers similar to the proportions described above for the number of deaths/murders?

 

[Sweeper2000]

Dr evan

For me, a very important (and as yet unanswered) question is, what were the circumstances of the other cases where LL is not charged? We know that there were 15 deaths within 2015 and 2016. LL is charged in relation to 7 of those deaths. I really want to know about these other deaths. Just on their own, ignoring the ones LL is charged with, these deaths represent a spike in the death rate of that unit. If the prosecution is saying that these deaths were not the result of some unlawful action taken by a medical professional, then what caused them? Why did those excess deaths occur during 2015 and 2016 when there had not been such a spike in the death rate before or after those dates? What are the circumstances surrounding those deaths? Are there similar medical aspects in these cases compared to the ones LL is charged with, but the difference is that LL was not on duty/did not have the opportunity to cause those deaths? Can the deaths be attributed to the allegation that COCH was not fit for purpose as a hospital with its designated level at that time? I know that the hospital was downgraded around the time of the last alleged murder/AM in 2016. Can the spike in the death rate to be attributed to the fact that the COCH was caring for patients much more poorly than it was capable of?

That’s just the cases relating to the murder charges.

Then we have the cases where LL is charged with AM. I don’t think we have been given an overall figure for the number of near fatal collapses not resulting in death which occurred on that unit during 2015 and 2016 in order to get a sense of how many of those collapses are being attributed to LL and her alleged malicious activity. Are the numbers similar to the proportions described above for the number of deaths/murders?

dr evans I believe was originally tasked with reviewing case files for 16 deaths, But a total of around thirty case files I believe. If i am correct.

mr Myers has given testimony that there is other collapses (not sure deaths have been mentioned) on the unit at the time not attributed to LL. all the collapses and events directly relating to the charges are present as arranged by the prosecution but any not are omitted from the prosecution’s evidence. I think we will have to wait and hear the defence for info on that though.

it seems a central point of the defences opening speech that this was a unit that was not performing adequately. I’m confident that mr Myers will be able to back that up.
moo

 

[katydid23]

Dan O'Donoghue

11m

I'm back at Manchester Crown Court for the murder trial of nurse Lucy Letby - jury won't be in court today as lawyers are discussing a legal matter

 

[Sweeper2000]

Dan O'Donoghue
11m

I'm back at Manchester Crown Court for the murder trial of nurse Lucy Letby - jury won't be in court today as lawyers are discussing a legal matter

Expect more info on Monday I reckon.