UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #12

[Sweeper2000]

I might be misinterpreting what this means?

“Dr Evans replied: “Yes, because you would not necessarily get an instant collapse. It could have occurred over several minutes.”

Baby boy collapsed because of ‘slow injection of air’, Lucy Letby’s trial hears

Letby, 33, is accused of trying to murder Child M on the afternoon of April 9 2016.

www.independent.co.uk

the reason he states it’s over several or three minutes is bec any slower rate wouldn’t cause the seemingly immediate Collapse or even any problems at all but would be filtered out by the lungs

im assuming if it did trickle in over three minutes there would be at least a slight amount of discomfort to which the baby would cry or alarms sound thus notifying the dn there was a problem as she is only a few metres away, well positioned to notice ll tending the baby and definitely within earshot of the baby making any noise.

 

[mummyshark]

I might be misinterpreting what this means?

“Dr Evans replied: “Yes, because you would not necessarily get an instant collapse. It could have occurred over several minutes.”

Baby boy collapsed because of ‘slow injection of air’, Lucy Letby’s trial hears

Letby, 33, is accused of trying to murder Child M on the afternoon of April 9 2016.

www.independent.co.uk

the reason he states it’s over several or three minutes is bec any slower rate wouldn’t cause the seemingly immediate Collapse or even any problems at all but would be filtered out by the lungs

im assuming if it did trickle in over three minutes there would be at least a slight amount of discomfort to which the baby would cry or alarms sound thus notifying the dn there was a problem as she is only a few metres away, well positioned to notice ll tending the baby and definitely within earshot of the baby making any noise.

She reacted to the alarm, not the baby making noise. We don't know if the baby cried and we don't know if she would have heard it from where she was. Also, babies sometimes cry in NNU but the nurse can't always tend to them. If they're crying but the monitors aren't alarming, then a nurse wouldn't necessarily go to that baby, because the chances are they have other things they need to do from a medical perspective. Therefore, even if she did hear the baby cry, it doesn't mean she would have reacted to it if she didn't hear an alarm.

 

[katydid23]

If we go with the pre-poisoning of bags theory, though, then surely one of the best ways of covering one's tracks would be to poison a butt-load of bags which would be guaranteed to get used when you weren't there and 100% verifiably not even in the country?

So someone else poisoned the bags and LL is being blamed?

 

[katydid23]

Catching up a bit - busy week!

There may be more to this that I've missed but from what I've read this whole insulin thing is starting to sound somewhere elaborate and complicated, to say the least!

So, we now have a medical expert saying that "at least" three or four bags could have been contaminated - the way I'm reading that is that this number would need to have been contaminated to produce these results. Isn't this getting all a bit too far fetched? LL would need to be in a position to either contaminate each bag as it was hung up or she'd need to contaminate them all in advance and make sure that they all got to the same baby.

If she is guilty, then I don't think she would care if they all got to the same baby or not. She allegedly targeted a wide array of babies . Almost seemed willy nilly.

She could have easily contaminated a few at once as they were worked on in room one area, right where she was designated that shift.

I think baby L was the only baby getting those kind of bags at that time so it wasn't that difficult for her to pull off, if it happened.

So at least three or four separate illegal acts with the risk of being caught

That^^^ didn't seem to be an issue for her in the past, if allegations are true. She seemed quite willing to make risky moves.

and needing to manage to be in the right place at the right time or potentially one illegal act of contaminating them while in storage which would presumably take some time.

Being in the right place at the right time was quite simple because L and M were in the same room as her 2 babies. And the bags were made up right in the vicinity of room 1, where she was expected to be all shift. She had plenty of time to be in that location.

Also need to have some plan in place to make sure they all got to the same patient consecutively. I guess they may be made up specifically for each patient but I've missed quite a lot.

That would not be a big problem. If they didn't get to the same patient, Oh well, not a big deal. Just one more sick baby in her unit. If they did get to L, that is great.

Is she alleged to have done similar for each patient because of so then it's a hell of a lot of specific and careful planning. That's not to say she didn't do it but the more steps she's alleged to have had to take makes the whole thing increasingly unlikely, surely?

It was not a huge complicated plan. See below:

Professor Peter Hindmarsh, a consultant in paediatric endocrinology and diabetes at University College Hospitals and Great Ormond Street Hospital for Children, gave evidence about the contaminated feed bags.

He told Nick Johnson KC, prosecuting, that it would have been 'fairly easy' to inject the fast-acting insulin, named Actrapid, 'if you were determined to do it'.

'You'd draw it up with a needle and syringe into the infusion bags, either through the portal or directly into the bag. But through the portal would be the easiest way'.

Professor Hindmarsh said the vials of insulin available at the Countess of Chester NNU contained 100 units per millilitre, 'so the volumes we're talking about are quite small and would not be noticeable just on a routine stock check.

'You would not notice a change in the volume within the bag, and norm, because it's a clear substance, would you see any change in the bag.

'Nor would you see any cloudiness in the bag, which you might have seen in older bags that were used many years ago'.

The professor agreed that insulin had a distinctive smell, but said: 'You would only smell insulin if you're drawing it up and if you've got it on your hands. But otherwise, no. Once it's in the bag it's sealed off from you being able to detect it by smell'.

Asked how many bags he thought would have had insulin added to them, he replied: 'A minimum of three, potentially'. There would have been a 'very high concentration' of exogenous insulin.

Mr Johnson asked: 'Someone could put insulin into each bag?'

Professor Hindmarsh replied: 'Yes'.

He added that the nature of insulin meant that it could also have been present on the walls of the tube in the 'giving set' – 'so you will still get insulin passing to the child'.

Lucy Letby tried to kill baby by adding insulin to intravenous bags

Neonatal nurse Lucy Letby tried to kill a premature baby by secretly adding lethal doses of insulin to at least three intravenous bags being used to feed him, a jury at Manchester Crown Court heard today.

www.dailymail.co.uk

 

[katydid23]

It wouldn't guarantee they'd all get to the same patient, though. Unless they are made up specifically for each patient.

Would she really care if it went to one of the other babies?

 

[katydid23]

I would not anticipate overfeeding of milk to cause purple distension, especially in that short of a time period.

"The prosecution alleges Ms Letby overfed Child G with milk through a nasogastric tube or injected air into the same tube."
The jury has previously been told the baby survived but suffered irreversible brain damage and was left with disabilities including quadriplegic cerebral palsy.

The allegation was overfeeding and/or the injection of air.

Lucy Letby: Parents saw baby resuscitated twice, murder trial told

Nurse Lucy Letby is accused of attempting to murder the premature baby girl on two occasions.

www.bbc.com

 

[sapphireminds]

I really wouldn’t have a clue when it comes to the med evidence but the testimony suggests to me that the baby collapsed without prior warning. The designated nurse was in the same room but the baby seemed to just collapse without a single sign beforehand.

That's not my understanding - because I feel it would be harped on that there was no desaturation prior to cardiac arrest. Primary cardiac arrest is so unusual in the NICU, it would be a clear sign that something weird happened.

And this is what is reflected in the US support groups for parents of prem babies, that families cannot afford wheelchairs, physio therapy or to pay their debts off after NICU. Pregnant woman who have to have their babies adopted because they don't have insurance for early check ups and scans. And then not being able to get any cover because they didn't have an early scan. ... so can't afford the birth Etc etc. And then, on the other end of the scale rich pregnant women being kept on bed rest in hospital for months on end with no supporting evidence base and increased risk of blood clots. Paediatrician pumping toddlers full of IV antibiotics at the drop of a hat....
It's a balance. No health care system is perfect.

Absolutely. But it sounds like the NICUs in the UK are struggling.

When a baby is medically well and only in NNU because they need to learn to feed, it is appropriate for them to be on an apnoea alarm only. It is usually around this time that parents start to take the bulk of the responsibility for cares. In the days before my daughter left NNU she was on an apnoea monitor, I recorded on the feeding chart and she even slept in the parents bedroom with us overnight.

My three premature babies got the very best care from NHS NNUs (from three different hospitals) and it didn't cost me a penny!

The issue is that apnea monitors are essentially junk. They won't pick up life-threatening events when they happen and they will false alarm on normal events. That's why they aren't used anymore over here - it's additional stress and a false sense of security. But an apnea monitor alone is not sufficient to monitor a baby.

Same here! Equally, it would seem like something of a leap to go from full monitoring to nothing at all. I see the apnoea monitors as a good way to build up confidence of parents and it's hugely beneficial to the baby to not have constant blinging of monitors going off in their ears. In usual circumstances it doesn't normally seem cause spontaneous collapses, rashes or anything else...

You can do that with taking off the sat probe, taking off the "local" monitor, but with an apnea monitor it's a false sense of security. If they need monitoring, they should be on a real monitor, IMO.

Would she really care if it went to one of the other babies?

It seems like many of the attacks were centered on particular babies, it doesn't seem like it was randomly happening to babies, at least by the charges.

If you take the insulin attacks by themselves and ignore the other accusations that are far more murky, you could have a good argument for random attack.

 

[sapphireminds]

"The prosecution alleges Ms Letby overfed Child G with milk through a nasogastric tube or injected air into the same tube."
The jury has previously been told the baby survived but suffered irreversible brain damage and was left with disabilities including quadriplegic cerebral palsy.

The allegation was overfeeding and/or the injection of air.

Lucy Letby: Parents saw baby resuscitated twice, murder trial told

Nurse Lucy Letby is accused of attempting to murder the premature baby girl on two occasions.

www.bbc.com

Injection of air into the stomach. Same thing, without gross mismanagement, it should not end in death or brain damage.

 

[katydid23]

Purely to do with child m. If mg says ll wasn’t near the cot in the five mins prior to the event then it can’t be an AE.

jmo

I imagine that MG never said that ^^^ or the charges wouldn't have been brought.
Most likely MG herself wasn't at the cot during those previous minutes. But LL had 2 babies in that room so she likely would have been. JMO

 

[katydid23]

Not quite but she did say she looked over her shoulder at the sound of the alarm. At which point she asked ll is that an event or something similar. Implying that ll wasn’t close in that five minutes according to her account.

IMO, that doesn't imply anything of the sort. LL's designated babies were in the same exact room as L and M, the 2 victims.

LL was on the unit @3:45 to sign off on prescribed meds for baby M. For all we know, she went ahead and gave him the meds at that time, putting her exactly there, right before he collapsed.

There is nothing that says she was not in her designated room during that narrow window of time. She was there at 3:45 to sign for M's meds and was right there at room 1 when his alarm went off. Why wouldn't she have been right there the entire time, since her designated babies were in the same room?

 

[Kemug]

I think in some states in America, you can choose whether your case is tried by a jury or a judge.

In Uk, if it is a certain level of offence (such as murder), it has to go to crown court, which means jury trial .

In Australia (or at least in NSW) a person can be tried by a judge alone if the prosecution and the accused agree to it. This didn't work out well for Chris Dawson, who was found guilty of the murder of his wife just last year. He probably thought he had a better chance of getting off with just a judge and no jury. But thankfully not.

 

[esther43]

Indeed!

That's not my understanding - because I feel it would be harped on that there was no desaturation prior to cardiac arrest. Primary cardiac arrest is so unusual in the NICU, it would be a clear sign that something weird happened.

Do you have any supporting documents that verify that babies who have received an air embolism would not experience an acute fall in O2? I am not medically trained but to me, it would stand to reason that a baby who had been injected with air into their blood stream would NOT continue to have stable oxygen levels during an an attack.
Equally, if it wasn't an AE, where were the indicators for an alternative scenario?

 

[esther43]

The issue is that apnea monitors are essentially junk. They won't pick up life-threatening events when they happen and they will false alarm on normal events. That's why they aren't used anymore over here - it's additional stress and a false sense of security. But an apnea monitor alone is not sufficient to monitor a baby.

You can do that with taking off the sat probe, taking off the "local" monitor, but with an apnea monitor it's a false sense of security. If they need monitoring, they should be on a real monitor, IMO.

 

[esther43]

The idea of paying 3,000 a day to have a baby on full monitoring when you are going to remove the sats probe anyway is just bonkers.
No, we wouldn't keep a late preterm baby with no health problems monitored 'up to the nines' when there are no indicators of poor health.
What might we miss here? Other than an opportunity to make the hospital more money?

 

[sapphireminds]

Do you have any supporting documents that verify that babies who have received an air embolism would not experience an acute fall in O2? I am not medically trained but to me, it would stand to reason that a baby who had been injected with air into their blood stream would NOT continue to have stable oxygen levels during an an attack.
Equally, if it wasn't an AE, where were the indicators for an alternative scenario?

I'm not saying they couldn't experience a fall in oxygen, but the typical pattern for an event is desaturation, followed by slowed heartrate. If you have good sats and can't keep the heartrate up, that's a sign that it is not respiratory based and would be a clear sign that it is something out of the ordinary.

In other words, a desat doesn't mean it couldn't be an embolism, but it would be more telling if they could keep the sats up but the HR was not responding. So it would be clearer that there was an issue that was out of the ordinary.

The idea of paying 3,000 a day to have a baby on full monitoring when you are going to remove the sats probe anyway is just bonkers.
No, we wouldn't keep a late preterm baby with no health problems monitored 'up to the nines' when there are no indicators of poor health.
What might we miss here? Other than an opportunity to make the hospital more money?

Why do you think it would cost that much more to keep the baby on a real monitor instead of just an apnea monitor?

Apnea monitors are not considered accurate because they rely on abdominal/chest movements and so it might miss an apnea because the baby was moving or struggling to breathe, or even sometimes they can pick up the heartrate, mistaking that for breathing. So it can miss life-threatening events, but pick up if non-events due to positioning as well. Apnea monitors alone are not used really any more at all in the US and Canada, not without HR monitoring. If the baby has to be sent home with monitoring, we'll usually just send them with a saturation monitor which will capture the HR as well as the saturations. Very rarely they will be sent home with a full monitor - I've never seen it.

Additionally, saturations and HR are much better markers of distress and issues than just an apnea alone. If the baby needs to be monitored, we would want it to be accurate and actually do something. As opposed to what has been suggested, that a child could be near death in their crib for an extended period of time but not picked up because their HR/sats weren't monitored.

Why would you spend the money for any monitoring that wasn't accurate or useful?

 

[marynnu]

This is just my personal take on things. At the centre of this is an average NNU with a sudden dramatic rise in collapses, fatal & non-fatal, which are characterised by being unexpected, impossible to explain by natural events and extremely difficult to resolve. IMO these characteristics with even one such event would be extremely unusual, never mind over 20. The idea that this is just chance just doesn't work, for me anyway. No amount of scrutinising the details, interesting as that is, can change the bigger picture. JMO

 

[JosieJo]

These is just my personal take on things. At the centre of this is an average NNU with a sudden dramatic rise in collapses, fatal & non-fatal, which are characterised by being unexpected, impossible to explain by natural events and extremely difficult to resolve. IMO these characteristics with even one such event would be extremely unusual, never mind over 20. The idea that this is just chance just doesn't work, for me anyway. No amount of scrutinising the details, interesting as that is, can change the bigger picture. JMO

Exactly this

 

[Tortoise]

Recap: Lucy Letby trial, Monday, February 27

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is…

www.chesterstandard.co.uk

8:59am

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is expected to continue today (Monday, February 27).
We will be bringing you updates throughout the day.

 

[Dotta]

Recap: Lucy Letby trial, Monday, February 27

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is…

www.chesterstandard.co.uk

8:59am

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is expected to continue today (Monday, February 27).
We will be bringing you updates throughout the day.

Thanks!
Always on duty

 

[esther43]

I'm not saying they couldn't experience a fall in oxygen, but the typical pattern for an event is desaturation, followed by slowed heartrate. If you have good sats and can't keep the heartrate up, that's a sign that it is not respiratory based and would be a clear sign that it is something out of the ordinary.

In other words, a desat doesn't mean it couldn't be an embolism, but it would be more telling if they could keep the sats up but the HR was not responding. So it would be clearer that there was an issue that was out of the ordinary.

Why do you think it would cost that much more to keep the baby on a real monitor instead of just an apnea monitor?

Apnea monitors are not considered accurate because they rely on abdominal/chest movements and so it might miss an apnea because the baby was moving or struggling to breathe, or even sometimes they can pick up the heartrate, mistaking that for breathing. So it can miss life-threatening events, but pick up if non-events due to positioning as well. Apnea monitors alone are not used really any more at all in the US and Canada, not without HR monitoring. If the baby has to be sent home with monitoring, we'll usually just send them with a saturation monitor which will capture the HR as well as the saturations. Very rarely they will be sent home with a full monitor - I've never seen it.

Additionally, saturations and HR are much better markers of distress and issues than just an apnea alone. If the baby needs to be monitored, we would want it to be accurate and actually do something. As opposed to what has been suggested, that a child could be near death in their crib for an extended period of time but not picked up because their HR/sats weren't monitored.

Why would you spend the money for any monitoring that wasn't accurate or useful?

Because that's how much it costs on average to keep a baby in a NICU in the states.
I think that staff may use their clinical judgement to determine whether the baby would benefit from full monitoring. The babies are not just left alone for hours on end, there are staff and parents feeding and caring for them.
I could understand what you are saying if it was the case that they were moved to this monitoring before particular clinical indicators were in place but you just seem to blame the equipment and assume poor care when in fact there was nothing in the notes to suggest these staff were not vigilant or made the wrong decision.