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

[Sweeper2000]

Primary cardiac arrests - where you would see the heart stop or go into a non-functional rhythm - almost never happen in the NICU. If they have evidence that the heart was the first thing, as might happen with an embolus, that would be very indicative of embolism. 99% of codes in a NICU are respiratory based - meaning their sats go down, then their heart slows/stops. If we reestablish adequate ventilation, they recover quickly. For a baby to have adequate sats and be bradying, I would be worried about pericardiac effusion/pneumopericardium or tension pneumothorax, along with the "normals" of electrolyte imbalances.


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

As well it should. Jurors have rules they have to adhere to, and if they searched information, whether they found it or not, it would be a violation of the rules.


Thankfully, in the NICU we're spared that. That is more of an issue with the older children and adults. NICU doesn't care about money - medicaid covers a lot of the NICU babies here. There are a few laws that allow us to never turn anyone away for ability to pay as well. We don't have the social safety nets though to help them on discharge.

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.

 

[esther43]

Primary cardiac arrests - where you would see the heart stop or go into a non-functional rhythm - almost never happen in the NICU. If they have evidence that the heart was the first thing, as might happen with an embolus, that would be very indicative of embolism. 99% of codes in a NICU are respiratory based - meaning their sats go down, then their heart slows/stops. If we reestablish adequate ventilation, they recover quickly. For a baby to have adequate sats and be bradying, I would be worried about pericardiac effusion/pneumopericardium or tension pneumothorax, along with the "normals" of electrolyte imbalances.


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

As well it should. Jurors have rules they have to adhere to, and if they searched information, whether they found it or not, it would be a violation of the rules.


Thankfully, in the NICU we're spared that. That is more of an issue with the older children and adults. NICU doesn't care about money - medicaid covers a lot of the NICU babies here. There are a few laws that allow us to never turn anyone away for ability to pay as well. We don't have the social safety nets though to help them on discharge.

 

[esther43]

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.

 

[JosieJo]

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.

It appears that is exactly why the experts feel its AE ...no deterioration beforehand

 

[Sweeper2000]

"Alas, a few months is far too short a time to be among such excellent and admirable posters”.
This quote is changed by me to fit the purpose

After so much evidence and so much discussion I feel old Dotta, I might not sound it but I feel it, stretched like butter over too much bread. X

quote changed to fit the purpose

 

[JosieJo]

Yeh that’s why I think it’s a risk. That might backfire on the docs as if the witnesses state that LL couldn’t have delivered the AE as alleged then it’s something else. That casts doubt on allot imo as it might reflect on other charges. If LL was not In The vicinity to actually deliver the AE as alleged then what was it? could look bad on the unit really as if they missed something significant.



Hadn’t thought of that tbh but yeh I see your point.

Jmo but I really can't see any problem with LL having the opportunities

 

[Sillybilly]

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[Sweeper2000]

Jmo but I really can't see any problem with LL having the opportunities

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

 

[Dotta]

After so much evidence and so much discussion I feel old Dotta, I might not sound it but I feel it, stretched like butter over too much bread. X

quote changed to fit the purpose

Evil is evil. Lesser. Greater. Middling. It's all the same.

Not changed.

(Sapkowski is SlavicTolkien)

 

[esther43]

<modsnip: Quoted post was removed>

I think that this is a really crucial time for the prosecution and its case . This is just my opinion (obviously) but I think that if the prosecution is not able to persuade the jury to convict LL on the two insulin cases (baby F and baby L), then it is unlikely that they will secure guilty verdicts for any of the other charges.

The reason I think that is because for the two insulin cases, both prosecution and defence agreed that they are attempted murders. The defence is simply saying that LL isn’t responsible. For the other 20 charges, it is different, because there is no common agreement between the prosecution and the defence on whether there has been a murder or AM. The defence says out right that another cause was behind the collapse, or says that there are other possibilities which do not support the collapse being a murder or an attempted murder.

If a jury is not persuaded of LL guilt on baby F and baby L, my theory is that they will find it very hard in their minds to convict of any of the other charges, because the implication of convicting of other charges and not of baby F and L is that you are saying that there are at least two serial killers operating at the same time in the same hospital: the person responsible for babies F and L (because everyone agrees that these were deliberate acts), and then LL for the other babies (on the hypothetical assumption that you convict her of these charges).

I think that the jury would find that a very difficult result to reach.

I think Myers accepts air embolism as a possibility in the case of child A.

"The defence accepts there is a "possibility" that Child A died as the result of an air embolus (an injection of air). "

Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins

Latest updates on day four of the Lucy Letby trial, with the prosecution showing the court handwritten "confessions" from the nurse in which she allegedly admitted she was "evil", and the defence saying the hospital was "well out of its depth". Letby denies all charges.

news.sky.com

 

[Dotta]

This case is so complex.

High risk tiny baby patients.

Alleged poor hospital care/understaffing, feeling of "burnt out", etc.

Mysterious collapses of patients.

Symptoms never seen before (moving blotches, mottled skin).

Alleged maniacal serial killer lurking?

Or alleged potential malpractice of staff?

Insulin poisoning?

Or carelessness and errors?

Alleged potential mental health issues?

Or potential incompetence?

Who can answer these questions?

Sending good vibes to the Jury.

JMO

 

[esther43]

This case is so complex.

High risk tiny baby patients.

Alleged poor hospital care/understaffing, feeling of "burnt out", etc.

Mysterious collapses of patients.

Symptoms never seen before (moving blotches, mottled skin).

Alleged maniacal serial killer lurking?

Or alleged potential malpractice of staff?

Insulin poisoning?

Or carelessness and errors?

Alleged potential mental health issues?

Or potential incompetence?

Who can answer these questions?

Sending good vibes to the Jury.

JMO

True, then you it all these questions into context with Ben Myers's Wish list.
He asked jurors to consider:

1. The birth condition of the baby.

2. Whether there were any problems in the health and care of the child leading up to the event we are considering.

3. Whether the prosecution expert medical evidence proves there was deliberate harm done.

4. Whether Letby was present at the time and what the evidence can establish about what she was doing if she was there.

5. If there were failings in care with the baby we are looking at, or at the unit as a whole.

Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins

Side note* child M is scoring 5/5 right now for me.

 

[mummyshark]

That you use in a hospital? Wow. I would never have imagined that the UK struggled that much with obtaining equipment and monitoring for their units!

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!

 

[esther43]

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!

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...

 

[mummyshark]

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

But has she said that?

 

[Sweeper2000]

But has she said that?

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.

 

[mummyshark]

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...

Agree 100%. If my daughter had gone from 9 weeks of full monitoring to the leads only coming off when she was discharged, I would have been terrified! In my experience, NNUs in the UK are very good at working closely with parents to ensure they feel confident with caring for such a small and vulnerable baby once they go home. It didn't feel like we were just shoved out the door as soon as she was medically fit.

 

[mummyshark]

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.

Exactly...she had to look over her shoulder in order to see where the baby was. To me this indicates that her back was turned to the baby.

You have also asked about what the dn might have heard. I'm not sure if you've ever heard a premature baby cry but it isn't very loud. Incubators do a lot of muffle sound as well. I'm not sure what you expect the dn to have heard that would have immediately alerted her to there being a problem.

 

[mummyshark]

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.

Also, if she was asking LL if it was an event, to me that implies that LL was closer than the dn was.

 

[ColourPurple]

But has she said that?

No. And nobody has said that she would have needed to have been by the cot five minutes before the alarm went off either.

LL co-signed for medication for baby M at 3.45pm which was to be adminstered through a port on the drip. Records show her colleague was on the computer at 3.45pm. 15 minutes later Baby M stopped breathing. Dr Evans believes that she injected air through that port and that doing it that way would have meant the baby wouldn't have instantly collapsed. He appears IMO to be saying it took from whenever the medication was adminstered after it was signed for at 3.45pm to when the baby stopped breathing at 4pm.


Expert witness Dr Dewi Evans said he believes air “trickled” into the infant’s circulation via a connecting port on his intravenous drip.

The defendant co-signed for an antibiotic given via a port on the drip at 3.45pm – 15 minutes before Child M stopped breathing followed by a dip in his heart rate and oxygen levels.

Letby was near the doorway of room one, helping a colleague prepare medication for Child M’s twin brother, when the alarm sounded at 4pm, the court heard on Thursday.

Consultant paediatrician Dr Evans said using a syringe to inject air via a port would be slower than a direct injection into the bloodstream.

Prosecutor Nick Johnson KC asked: “Would it follow, if someone chose to do it that way, they would not necessarily be standing over the baby at the time of the collapse?”

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

ETA link to where it says her colleague was on the computer at 3.45pm:

At 3.30pm, a fluid bag was attached to Child M. At 3.45pm, he received intravenous antibiotics.

The notes showed Letby was one of two to administer the medicine. Digital records show Letby's colleague was using the computer at 3.45pm.

Recap: Prosecution continues opening of Lucy Letby trial

The prosecution continues its opening in the trial of Lucy Letby, accused of multiple baby murders at the Countess of Chester Hospital.

www.chesterstandard.co.uk