UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #11

[Tortoise]

We'd be better off finding out if "the consultants" were all Dr. Ravi Jayaram. I heard he was the first to see the "correlation" between her and the events. He was also the one that left the needle in baby H's chest before the cardiac arrest they've accused Lucy of inducing.

"The consultant [Dr John Gibbs] sketched out possible reasons for the collapse in his notes and suggested it could be a "result of trauma from chest drains against the heart", but he told the court subsequent ultrasounds "showed that had not happened"."

Lucy Letby: Doctor rejects chest drain claim, trial told

"Today Dr Sandie Bohin, one of two paediatric experts brought in by the prosecution, was questioned in detail about the drain fitted by Dr Jayaram.

[...]

'But although it had moved, it hadn't moved after the x-ray on September 26, so I don't think that drain can be the cause of the collapses. By then it had been secured'.

[...]

She rejected Mr Myers' suggestion that the explanation for Baby H's two mystery collapses might have been the cumulative effect of a series of procedures she had been through.

'A baby will desaturate as the result of an event, but it's not cumulative and it certainly doesn't cause a cardiac arrest'."

Medics left needle inside baby's chest, Lucy Letby trial hears

 

[Amp_C]

That would explain why Letby agreed that it would not have been done accidentally.

In Baby E's case only Letby signed for the medication. Does that mean there wasn't another nurse there to check that it was prepared properly?

>baby E

Is that true? I thought she co-signed. Did they cover it in the podcast, or are you looking at the transcript from the Chester Standard or something?

 

[Tortoise]

The doctors have stated that insulin wasn't prescribed for any of the babies in the ward (although one of them, I forget which, was given a shot of insulin at birth) but they haven't shown the baby's prescriptions as evidence to back it up. One would assume it would be something they'd keep a record of, but I could be wrong.
The fact that the blood sugars were relatively stable, though too low, could suggest a clerical error. They were expecting the blood sugars to rise with the dextrose solutions. The fact they remained in the 2 -3 range was distressing the doctors, however, it didn't drop below the birth reading. I.e. it wasn't really a poisonous dose.

please provide media links for what you are stating -

1. they haven't shown baby's prescription as evidence
2. blood sugars remained in the 2-3 range and didn't drop below the birth reading.

 

[Tortoise]

"Dr Alison Ventress, who was a registrar at the Countess of Chester in 2015, is now in the witness box. She's taking the court through medicine charts recorded in the days following Child F's birth

She explains that a dose of insulin would always be prescribed by a doctor and it would always be administered as a separate infusion, never added to another fluid"
https://twitter.com/MrDanDonoghue

Ian Allen, CoCH, Pharmacy Re. TPN nutrition bags

The August 4 TPN bag did not have lipids prescribed on the prescription. Mr Allen said such lipids would have been prescribed separately.
Mr Driver asks 'Would there be insulin?' for the TPN bags.
Mr Allen: "No, there would never be insulin prescribed in these bags."
Mr Driver asks how would that [insulin prescription for a baby] be done?
Mr Allen: "...by separate syringes."
Recap: Lucy Letby trial, Tuesday, November 29

 

[Tortoise]

Child L - These are the blood sugar readings for Saturday 9th April, LL's day shift


"For the day shift on April 9, 2016, Lucy Letby is a designated nurse for two babies in nursery 1. Mary Griffith is the designated nurse for Child L and Child M, who are the other two babies in room 1.

Child L records a blood sugar reading of 1.9 at 10am, pre-feed.

Child L's blood sugar reading is 1.6 at 11am.

Child L's blood sugar reading is 1.6 at noon, pre-feed.

Child L's blood sugar reading is recorded as 2.0 at 2pm, and 1.5 at 3pm.

Child L's blood sugar reading at 4pm is 1.5.

Child L's blood sugar reading at 5pm is 1.7, which was "still very low", the prosecution say.

Child L's blood sugar reading at 6pm is 1.9.

The pathology records the lab specimen of a blood sample for Child L. Among the blood test results sought for the sample are insulin and C-peptide.
The insulin level is recorded as 1,099, and the C-peptide is recorded as 264. These readings are entered into the system on April 14, having obtained the results from Liverpool.
The C-peptide "should be 5-10 times the level of insulin", but the ratio is recorded as 0.2.

Child L is recorded to have hypoglacaemia [low blood sugar].
Doctors record the hypoglacaemia continued despite the regular infusions of dextrose throughout the day."

Recap: Lucy Letby trial, Wednesday, February 15

 

[marynnu]

The doctors have stated that insulin wasn't prescribed for any of the babies in the ward (although one of them, I forget which, was given a shot of insulin at birth) but they haven't shown the baby's prescriptions as evidence to back it up. One would assume it would be something they'd keep a record of, but I could be wrong.
The fact that the blood sugars were relatively stable, though too low, could suggest a clerical error. They were expecting the blood sugars to rise with the dextrose solutions. The fact they remained in the 2 -3 range was distressing the doctors, however, it didn't drop below the birth reading. I.e. it wasn't really a poisonous dose.

Could I just ask what you mean by a clerical error?

 

[marynnu]

That would explain why Letby agreed that it would not have been done accidentally.

In Baby E's case only Letby signed for the medication. Does that mean there wasn't another nurse there to check that it was prepared properly?

No, no nurse would check & sign a prescription on their own. I'd say the other checker just forgot to sign.

 

[marynnu]

Like so many other things about this case - how on earth was this sort of stuff not picked up on? Surely a hospital has systems in place to flag unusually high requests for dangerous drugs and equipment? Even if it's only to pick up on staff abusing it for their own purposes - Shipman was a Herion addict, after all!

The incompetence and "couldn't give a toss attitude" seems overwhelming at this place!

On your last point, I wonder whether that extremely detailed search of her house was looking for stuff like this?

In my opinion, it 's unlikey pharmacy would pick up on the higher insulin order. Chances are the vials were ordered now & then through the year, not as a block of 6, so nothing would seem unusual. Orders for controlled drugs like diamorphine are treated differently, obviously.

 

[GoodDayToYouSir]

So if I understand you correctly you believe that there are other similar or identical cases of sudden and unexpected collapses and deaths, flagged as suspicious by independent expert neonatologists, that the prosecution ignored because LL wasn't on duty. And the details of these will be contained in the CQC report. And Dr Evans reviewed all the cases but some of these cases are missing from the trial.

The CPS's reputation would be in tatters if this is the case.

No. The comments I made were in the context of speculating with another poster what evidence the defence might put forward when it gets its turn. The other poster theorised that the defence would bring on witnesses to testify about their experiences of poor care at COCH. I replied that maybe they would also bring someone on to talk about the report where the hospital was downgraded as part of an argument around poor standards of care.

I don’t know if the report contains things which may be useful for the defence. But I was suggesting that one way to strengthen the argument about substandard care would be to bring in the report if possible, because then you have an official regulator verifying your allegations of general substandard care rather than just the defence saying “substandard care” without any other corroborating evidence.

 

[GoodDayToYouSir]

They did explain that the pause option is there so it can be silenced if it's causing a distraction whilst a nurse/doctor is already attending to a baby and carrying out a procedure but LL is accused of allegedly pausing it whilst the monitor showed a baby's oxygen levels were dropping and she was allegedly standing there watching but doing nothing. We're yet to hear the full details of that case though.

Apologies if this is already been answered, but when they talk about “ silencing” or “pausing” the alarms on the monitors, is that the same kind of thing as a “ snooze” button on an alarm clock where you press it to stop it beeping, it is silent for say five minutes, and then it automatically starts beeping again? Or is it the case that if you pause/ silence the monitor, you have to then press something to recommence the beeping?

 

[Sweeper2000]

Apologies if this is already been answered, but when they talk about “ silencing” or “pausing” the alarms on the monitors, is that the same kind of thing as a “ snooze” button on an alarm clock where you press it to stop it beeping, it is silent for say five minutes, and then it automatically starts beeping again? Or is it the case that if you pause/ silence the monitor, you have to then press something to recommence the beeping?

Yeh I think hitting the pause button stops the beeper for a period of time. Think I read it can be stopped a for longer if you push the button more than once.

 

[marynnu]

Apologies if this is already been answered, but when they talk about “ silencing” or “pausing” the alarms on the monitors, is that the same kind of thing as a “ snooze” button on an alarm clock where you press it to stop it beeping, it is silent for say five minutes, and then it automatically starts beeping again? Or is it the case that if you pause/ silence the monitor, you have to then press something to recommence the beeping?

Good analogy! Yes, just like a snooze button. Typically there are 2 buttons - one pauses for a few seconds, the other for a few minutes (3 mins is common). It automatically restarts , but you just press again to reset if you want it to start sooner than the set time.

 

[Tortoise]

No. The comments I made were in the context of speculating with another poster what evidence the defence might put forward when it gets its turn. The other poster theorised that the defence would bring on witnesses to testify about their experiences of poor care at COCH. I replied that maybe they would also bring someone on to talk about the report where the hospital was downgraded as part of an argument around poor standards of care.

I don’t know if the report contains things which may be useful for the defence. But I was suggesting that one way to strengthen the argument about substandard care would be to bring in the report if possible, because then you have an official regulator verifying your allegations of general substandard care rather than just the defence saying “substandard care” without any other corroborating evidence.

Ok, I think they could do that. But I'm not convinced it would have any relevance to the charges. JMO

 

[marynnu]

This is just a personal view, but I feel it's easy to get preoccupied by the minute detail of Baby L's blood sugar history. Though obviously significant, in the end what can't be debated IMO is the fact that this child was given an insulin overdose on 9th April. The only question is by whom.

 

[JosieJo]

The doctors have stated that insulin wasn't prescribed for any of the babies in the ward (although one of them, I forget which, was given a shot of insulin at birth) but they haven't shown the baby's prescriptions as evidence to back it up. One would assume it would be something they'd keep a record of, but I could be wrong.
The fact that the blood sugars were relatively stable, though too low, could suggest a clerical error. They were expecting the blood sugars to rise with the dextrose solutions. The fact they remained in the 2 -3 range was distressing the doctors, however, it didn't drop below the birth reading. I.e. it wasn't really a poisonous dose.

Regarding them not showing proof that other babies at the time were not on insulin..the defence have accepted this therefore no need

 

[JosieJo]

This is a good point. It should be investigated why they used more insulin that year. It wouldn't make a lot of sense, given the babies seemed to mostly have LOW blood sugar. Unless they were worried about accidentally giving them diabetes, and wanted it at hand...

I think that's exactly the point the prosecution are wanting to show yes

 

[JosieJo]

This is just a personal view, but I feel it's easy to get preoccupied by the minute detail of Baby L's blood sugar history. Though obviously significant, in the end what can't be debated IMO is the fact that this child was given an insulin overdose on 9th April. The only question is by whom.

I agree.. its been shown without doubt that 2 babies in this case have been administered large doses of insulin...its just who?
I feel these two insulin cases and the case of the baby that projectile vomited more milk than the nurse had given will be the corner stone to this case

 

[LadyEdgeworth]

I agree.. its been shown without doubt that 2 babies in this case have been administered large doses of insulin...its just who?
I feel these two insulin cases and the case of the baby that projectile vomited more milk than the nurse had given will be the corner stone to this case

Agreed. For me it's been proven that those were deliberate acts of harm, and if not done by her, then who?

 

[bbsaz]

Agreed. For me it's been proven that those were deliberate acts of harm, and if not done by her, then who?

Agree also. But the strange mottling is relevant imo too.

 

[LadyEdgeworth]

Agree also. But the strange mottling is relevant imo too.

For me, definitely, I just have no idea how the jury is thinking!! Hopefully they are seeing the relevance of it.