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

[marynnu]

I think they are looking at it from what the jury needs to know.

Gosh, two babies had a load of insulin put in their feeds.
Well if she did it, how did she get hold of that much insulin?
Can you buy it? Nope.
Was there enough insulin on the ward for her to have taken that much?
Don't know. They haven't told us. Perhaps there wasn't and that's why they haven't said.
Prosecution - there were four extra bottles of insulin issued to the unit above the previous year's levels.

JMO

IMO You'd only need a few mls of insulin in a 500ml bag of fluid to have an impact. I'd go full nerd & put the maths, but not sure it's allowed!!

 

[Tortoise]

IMO You'd only need a few mls of insulin in a 500ml bag of fluid to have an impact. I'd go full nerd & put the maths, but not sure it's allowed!!

I think they said it was nearly 10mls for baby F. And baby L received more.

baby F - 0.56ml per hour for 17 hours.

 

[Tortoise]

We're back after a break. We're hearing statements of agreed evidence from other nurses who worked on 8/9/10 April 2016 (at time of Child M's collapse)

Report of today’s evidence

https://twitter.com/MrDanDonoghue

Lucy Letby: Dr had 'physical chill' over baby events, trial told

A doctor tells Lucy Letby's trial how he began to suspect someone was injecting air into babies.

www.bbc.co.uk

 

[marynnu]

[

I think they said it was nearly 10mls for baby F. And baby L received more.

baby F - 0.56ml per hour for 17 hours.

I'm sure, given the levels shown on the tests. 10mls is only 1 vial, not too hard for this to go unnoticed. And in the end it had to have come from somewhere.

 

[Sweeper2000]

10 ml vial is 1000 units of insulin.

1 vial contains 10 ml equivalent to 1,000 international units. 1 ml solution contains 100 international units insulin human* (equivalent to 3.5 mg).

Actrapid 100 international units/ml, Solution for Injection in a vial - Summary of Product Characteristics (SmPC) - (emc) | 3849

Actrapid 100 international units/ml, Solution for Injection in a vial - Summary of Product Characteristics (SmPC) by Novo Nordisk Limited

www.medicines.org.uk

act rapid is a short term fast acting insulin according to prof hindmarsh.

 

[Tortoise]

From that link Lucy Letby: Dr had 'physical chill' over baby events, trial told

Mr Myers said: "I'm not going to suggest you are incompetent, but suggest it is incompetent missing out a detail like that."
Dr Jayaram disagreed, saying that the notes were "not a priority at the time" as Child M was still recovering and that he had "no anticipation" of the future significance of the blotches.

 

[Tortoise]

"Dr Jayaram told the court: “They were patches of very bright pink on his torso that flittered around. They would appear and disappear.

“Once circulation was restored and his heart rate came up above 100 (beats per minute) they vanished.”

He said the discolouration was “very similar” to what he had seen in his treatment of Child A, the first alleged murder victim. [...]

A meeting of a consultants was held on June 29 2016, the court heard. [...]

Dr Jayaram said it prompted him that evening to conduct a literature search in which he found a research paper which described the effects of air embolism. [...]

Dr Jayaram emailed colleagues a link to the research paper the next day."

10% Irish News -
‘A chill went down my spine' over possible baby deaths cause, doctor tells court

 

[Tortoise]

LL never went back to work in the nnu after that meeting of consultants.

 

[GoodDayToYouSir]

Hmm I have a tendency to agree with BM here. If “all eyes had been on Letby” for what would appear to be many months, and this fleeting mottling kept occurring and was rare and remarkable, then why on earth was it not noted down. Why would Dr J deem it irrelevant. JMO.

Presumably to bolster their argument and Dr J’s claim that he had suspicions at this time, and that he isn’t reshaping his recollections or exaggerating the seriousness of the concerns he raised at the time, the prosecution is going to have to bring on the senior managers to whom Dr J raised concerns at the time and who apparently told him to back off?

That’s certainly going to be squeaky bum time for the hospital’s lawyers. You are going to have senior hospital managers admitting in open court that they ignored warnings about an alleged serial killer operating in the hospital, which then allegedly left the accused to allegedly carry out more attacks. Allegedly.

 

[LorriB]

I do wish we knew what else was in the bag. It's quite important IMO, so frustrating that we have such gaps in information that's being reported. However I think a paper towel is slightly different to an actual document, makes it a little more difficult to understand why it was kept. The hospital wouldn't have needed to keep it after all. JMO.

JMO but I thought it was just something handy to write on. I just recall going to a midwife appointment a few years ago and the midwife writing notes on a paper towel as nothing else was to hand!

 

[JosieJo]

This is very damning imo.

I agree I think the last few days have been "good" for the prosecution

 

[magikarpmagikarp]

I have the opposite feeling of Mr. Myers. Dr. Jayram is a doctor, not a police officer. He's looking to record medical information that is relevant to the treatment of the baby, not for criminal court proceedings. JMO

 

[Sweeper2000]

I agree I think the last few days have been "good" for the prosecution

Not sure about that. I’m not seeing how ll could have done as alleged with the other nurse being in the room at the same time. She seemed to say LL wasn’t close to child M at or preceding the time of the collapse.

 

[Tortoise]

3.30pm - At 3.30pm, a fluid bag was attached to Child M.

3.35pm – LL co-signed meds for child L. Mary Griffith takes blood from child L to send to the lab. Bolus dextrose prescribed.

3.40pm – child L given a bolus of dextrose

3.45pm - At 3.45pm, child M received intravenous antibiotics. The notes showed LL was one of two to administer the medicine. Digital records show LL's colleague was using the computer at 3.45pm. In police interview, LL agreed she had connected a fluid bag to Child M (3.30pm) and had co-signed for medication at 3.45pm but could not be sure if she had administered it.

4pm - Child M's monitor alarmed and Letby was first to the cot.

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

 

[marynnu]

I have the opposite feeling of Mr. Myers. Dr. Jayram is a doctor, not a police officer. He's looking to record medical information that is relevant to the treatment of the baby, not for criminal court proceedings. JMO

I agree. It's easy to be clever after the event. A lot had gone on, the child almost died, so a rash which disappeared would be low on the list of priorities at the time.

 

[DianaWW]

JMO but I thought it was just something handy to write on. I just recall going to a midwife appointment a few years ago and the midwife writing notes on a paper towel as nothing else was to hand!

Yes I agree with that, I just meant, it's more difficult to understand why she kept it for so long, than it would be to understand her keeping a real document. But it may well be that she's just a little messy! JMO

 

[WaxLyrical]

I think he attempted to explain it by saying there was a lot going on at the time----that was the 2nd baby with an unexplained total collapse within last 20 hours and they were twins.

That is a lot of intense stress and pressure on the medical team. Most of his notes were probably about which emergency medications and treatments were immediately needed. And he would be jotting down vitals and test results too, and anything else coming to mind to save this baby.

He missed making note of the mottling. I don't think that is an earth shattering mistake for an emergency doctor to make. Both babies were brought back from the brink of death, so I do credit the team with that.

I thought only one of the twins collapsed? Was there another baby around the same time as these? Just to be clear, I wasn’t talking about his failure to note the mottling in the early cases, just these 2016 cases whereby there was already a suspicion of foul play.

 

[Sweeper2000]

“Her notes from that afternoon state Child M was 'settled'. But at 16:00, her notes state: 'Baby went apnoeic and had a profound bradycardia and desaturation. Full resus commenced at 16:02'

Asked about the crash, she recalls: '(Child M's)alarm went off, I looked over my shoulder, the lights were flashing. Lucy went over to see and said yes it's an event, it needs to be sorted. At that point I stuck my head out round the door and asked for a resus call to be put out'”

https://twitter.com/mrdandonoghue?lang=ar-x-fm

if it was an administered air embolism she has to be in direct proximity to the lines within about two minutes of the alarm call not fifteen minutes prior. Judging by mg testimony LL wasn’t that close. Is there notes or accounts of what she was doing immediately prior to the crash?

i find it strange the prosecution made out mg was in another room at the applicable time. Her own testimony suggests she was in that room at the same time as when LL allegedly gave the air embolism

 

[Dotta]

"Physical Chill"

"On 29 June 2016, after a number of further unusual, unexpected and inexplicable events on the neonatal unit, the whole consultant body sat down and thought we have to work out what's going on here.

One of the things that came up in discussion was could this be air embolism, I can't remember who suggested it."

"Dr Jayaram said after the meeting he went home and did a searched for literature on the subject, eventually finding a research paper from 1989.
said: "I remember sitting on my sofa at home with my iPad, researching. I remember the physical chill that went down my spine when I read that, because it fitted with what we were seeing."

Lucy Letby: Dr had 'physical chill' over baby events, trial told

A doctor tells Lucy Letby's trial how he began to suspect someone was injecting air into babies.

www.bbc.com

 

[Tortoise]

i find it strange the prosecution made out mg was in another room at the applicable time. Her own testimony suggests she was in that room at the same time as when LL allegedly gave the air embolism

When did the prosecution do that?