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

[Marantz4250b]

I think, if guilty, Baby K's case highlights two things.

1:How quickly LL is allegedly able to take advantage of an opportunity to harm a baby or is possibly already waiting for one.
2: How little time is needed to allegedly achieve the result.

Baby K's designated nurse had only left room 1 at 3.47am and by 3.50am LL was found standing over Baby K whose breathing tube (that had been secured down with tape) had been dislodged),whose chest wasn't moving, and whose oxygen levels were plummeting with no alarm sounding.

If LL IS guilty, and WAS trying to kill Baby K, and HAD paused the monitor, then if Dr Jayaram hadn't been suspicious and gone to check, LL could have been in and out within minutes, or even stayed there till the latest one minute pause ran out, and the alarm went off and claimed to just be there responding to the alarm. We are talking literally minutes. IF guilty of course. IMO

---------
"The jury has previously been told how Dr Jayaram realised at 03:50am on February 17 that Lucy Letby was alone in Nursery 1 with Baby K, who had been born at 25 weeks.

Mr Johnson said in his opening address: 'Feeling uncomfortable with this because he was beginning to notice the coincidence between the unexplained deaths/serious collapses and the presence of Lucy Letby, Dr Jayaram decided to check on her and (Baby) K.

'As he walked into Room 1, he saw Letby standing over K's incubator. She did not have her hands inside the incubator, but he could see from the monitor that K's oxygen saturation level was falling dangerously to somewhere in the 80s.

'However, the alarm was not sounding as it should have been. Lucy Letby had not called for help and was making no effort to help K.

'Dr Jayaram went straight to treat K and found her chest was not moving. He asked Letby if anything had happened, to which she replied: "She's just started deteriorating now".

The paediatrician found that the infant's breathing tube had been dislodged. 'Whilst it is possible for a baby to cause this if sufficiently active, K was not only very premature but she was sedated and inactive.

'The tube was secured by tape and attached to K's headgear. Its dislodging can happen accidentally on handling, but any member of staff responsible for such an accident would realise straight away.

'Dr Jayaram was troubled as Nurse Letby had been the only person in the room'.

Mr Johnson said that the monitors in Nursery 1 were set to activate automatically if readings fell outside neonatal values.

He added: 'Given the values witnessed by Dr Jayaram, the alarm should have sounded. There is an alarm pause button on the screen of the monitor, and by pushing this the operator can pause the alarm for one minute. It will then reactivate unless paused again.

'Bearing in mind the rate displayed on the monitor, Dr Jayaram estimates the tube would have been dislodged between 30-60 seconds before he entered the room. This would be on the assumption that the alarm had been cancelled/suspended once only'."

Lucy Letby trial: Doctor interrupted nurse 'as she attempted murder'

Dr Ravi Jayaram described the moment he encountered nurse Lucy Letby 'making no effort to help' as a baby's oxygen level began to plunge.

www.dailymail.co.uk

You see, this is what I just don't get; here we have an account of a very experienced doctor which, on the face of it seems completely damning with the implication of guilt (or at the very least extreme, almost willful, incompetence) towards LL, yet it appears that absolutely nothing at all is done in response to it. No attempt to discipline, investigate, assess a need for re-training, or anything else, nothing!

To me, IMO, an account such as this is bordering on the fantastical and is on the very outer verges of believability. Do professional medics actually brush off events like this as a matter of course?

 

[ColourPurple]

You see, this is what I just don't get; here we have an account of a very experienced doctor which, on the face of it seems completely damning with the implication of guilt (or at the very least extreme, almost willful, incompetence) towards LL, yet it appears that absolutely nothing at all is done in response to it. No attempt to discipline, investigate, assess a need for re-training, or anything else, nothing!

To me, IMO, an account such as this is bordering on the fantastical and is on the very outer verges of believability. Do professional medics actually brush off events like this as a matter of course?

I think it would have been hard for him to prove that she hadn't just arrived that second and noticed the deterioration but at the time his priority would be Baby K. He didnt have access to all the additional information we have now. All he had at that point was concern that LL seemed to be present at all of the collapses. We know he's said that concerns about LL were brushed aside . Not sure if that was before or after this incident. It'll be interesting to find out

 

[magikarpmagikarp]

This is one of the charges that I have been most curious to hear testimony on.

These are just my thoughts and personal opinion.

I do not think it is unusual to try to see if the baby will self-correct. Sometimes the baby's oxygen saturation does get better, while other times it gets worse. It's also not strange to pause alarms or observe for chest rise for a moment before starting to intervene. It would be typical to give more time for self-correction the less severe the vital signs changes are, and be hastier to act the more serious they are. There is a workflow for dealing with desaturation or bradycardia in intubated patients, and it doesn't take long to go through it and either resolve the problem or decide to hit the code bells. It is more common for less experienced nurses to hesitate and usually that is when a more experienced coworker will jump in. We've heard testimony in the past of LL being the more experienced nurse, giving breaths via NeoPuff, etc, so inexperience is not an explanation. But, I also think it can be hard to walk into a situation and say that the person who was at the bedside was not acting quickly enough, in a deliberate and malicious way. Right now I am not sure how one would go about proving that. So it is just my gut feeling but I think there must be many more details to explain this charge, and I am expecting to hear that testimony tomorrow.

Once again, just my opinion.

 

[sapphireminds]

ADMIN NOTE:

This is a trial discussion thread to discuss trial testimony; it is sub judice to post opinions suggesting guilt or innocence of the accused.

Unless there is evidence or suggestion by the defence at trial that incompetence or lack of proper monitoring or care by staff is responsible, it is sub judice and off topic in this discussion.

The entire defense is essentially that it is incompetence and lack of proper monitoring that caused these issues, which makes it incredibly salient.

 

[sapphireminds]

<modsnip: Quoted post was removed> ...IMO it's very easy to stray away from the core question of what happened to cause the crisis in the first place.

Per Dr. Evans, air embolus was the primary cause of death, not the bleeding. If it were the bleeding, the medical providers would be implicated.

 

[sapphireminds]

This is one of the charges that I have been most curious to hear testimony on.

These are just my thoughts and personal opinion.

I do not think it is unusual to try to see if the baby will self-correct. Sometimes the baby's oxygen saturation does get better, while other times it gets worse. It's also not strange to pause alarms or observe for chest rise for a moment before starting to intervene. It would be typical to give more time for self-correction the less severe the vital signs changes are, and be hastier to act the more serious they are. There is a workflow for dealing with desaturation or bradycardia in intubated patients, and it doesn't take long to go through it and either resolve the problem or decide to hit the code bells. It is more common for less experienced nurses to hesitate and usually that is when a more experienced coworker will jump in. We've heard testimony in the past of LL being the more experienced nurse, giving breaths via NeoPuff, etc, so inexperience is not an explanation. But, I also think it can be hard to walk into a situation and say that the person who was at the bedside was not acting quickly enough, in a deliberate and malicious way. Right now I am not sure how one would go about proving that. So it is just my gut feeling but I think there must be many more details to explain this charge, and I am expecting to hear that testimony tomorrow.

Once again, just my opinion.

Yes, it is very normal to see if the baby will self-correct. Often the desat will go on until it's <70 or the HR goes down.

We try and minimize the exposure to oxygen, because it damages the eyes and lungs. The goal saturations for a micro preemie is 88-92%. If they are >92, oxygen should be turned down.

 

[Marantz4250b]

I think it would have been hard for him to prove that she hadn't just arrived that second and noticed the deterioration but at the time his priority would be Baby K. He didnt have access to all the additional information we have now. All he had at that point was concern that LL seemed to be present at all of the collapses. We know he's said that concerns about LL were brushed aside . Not sure if that was before or after this incident. It'll be interesting to find out

He said he saw her "Standing over K's incubator" though and said that she said ".....she's just started deteriorating now..." which means she hadn't just arrived that second because how would she know? He also said he saw the readings "dropping" which means that he and LL were in the same room at the same time.

In addition, the breathing tube was dislodged and LL didn't have her hands in the incubator; therefore, if it is alleged that she dislodged it, which it obviously is, then she'd been there long enough to do that, remove her hands and silence the alarm.

She hadn't just walked on that second according to his evidence.

So, on the face of it, we are to believe that this experienced consultant, who apparently already had his suspicions about LL walks in on this extremely serious situation, remembers it in this much detail and then absolutely nothing is done about it what so ever??? A situation where, at the very least a dangerous level of incompetence appears to be present and he nor anyone else appears to do anything to try to find out how it came about, really?

Or maybe we shouldn't take his evidence quite at face value?

Lucy Letby trial: Doctor interrupted nurse 'as she attempted murder'

Dr Ravi Jayaram described the moment he encountered nurse Lucy Letby 'making no effort to help' as a baby's oxygen level began to plunge.

www.dailymail.co.uk

MOO

 

[Marantz4250b]

This is one of the charges that I have been most curious to hear testimony on.

These are just my thoughts and personal opinion.

I do not think it is unusual to try to see if the baby will self-correct. Sometimes the baby's oxygen saturation does get better, while other times it gets worse. It's also not strange to pause alarms or observe for chest rise for a moment before starting to intervene. It would be typical to give more time for self-correction the less severe the vital signs changes are, and be hastier to act the more serious they are. There is a workflow for dealing with desaturation or bradycardia in intubated patients, and it doesn't take long to go through it and either resolve the problem or decide to hit the code bells. It is more common for less experienced nurses to hesitate and usually that is when a more experienced coworker will jump in. We've heard testimony in the past of LL being the more experienced nurse, giving breaths via NeoPuff, etc, so inexperience is not an explanation. But, I also think it can be hard to walk into a situation and say that the person who was at the bedside was not acting quickly enough, in a deliberate and malicious way. Right now I am not sure how one would go about proving that. So it is just my gut feeling but I think there must be many more details to explain this charge, and I am expecting to hear that testimony tomorrow.

Once again, just my opinion.

Surely it wouldn't self correct as the breathing tube had become detached?

So, to reiterate, we have a consultant discovering a nurse he already claims to be suspicious of, standing motionless over a deteriorating baby who's breathing tube is disconnected and absolutely nothing is done about investigating what is obviously an exceptionally serious situation?

MOO, obvs.

 

[sapphireminds]

Surely it wouldn't self correct as the breathing tube had become detached?

So, to reiterate, we have a consultant discovering a nurse he already claims to be suspicious of, standing motionless over a deteriorating baby who's breathing tube is disconnected and absolutely nothing is done about investigating what is obviously an exceptionally serious situation?

MOO, obvs.

It's not always obvious that the breathing tube is dislodged. If the tube was high and even a little tension gets put on it, it can slip out of the trachea and into the esophagus and will not go back into the trachea on its own. We have little CO2 detectors we can put on the end of a tube to see if it is still in place. You also listen to the lungs, can get an xray, look for mist in the tube.

It's amazing how well babies can remove their own ETTs.

 

[Sillybilly]

The entire defense is essentially that it is incompetence and lack of proper monitoring that caused these issues, which makes it incredibly salient.

It is my understanding the defence has yet to present their case at trial. Members have asked for links to support such claims and those links have not been provided as requested.

If the defence has made such claims at trial, please provide appropriate links to support..

Thank you.

 

[sapphireminds]

It is my understanding the defence has yet to present their case at trial. Members have asked for links to support such claims and links have not been provided.

If I am wrong in that regard, please provide a link to trial testimony where they have made such a claim.

Thank you.

They have presented in the opening statements, which is that it was care issues that caused some of the issues (not the insulin ones)

From the opening statement:

"Sometimes, no-one can say what caused a deterioration.

"Sometimes, things have gone wrong, or the necessary standards of care have not been met, irrespective of anything to do with Lucy Letby. For that, she should not get the blame."The assumption is "The worse it sounds, the more guilty she must be."Mr Myers outlines the 'key issues' for the defence, in what he says will assist the jury and will place everything into context.

He said his speech, at this stage, will take about a couple of hours, and will break down the defence into three general areas: Letby and the general area of her defence, coincidence, and the medical evidence.
He tells the court the medical evidence is a key area, and there are 'key issues' for each count.Letby was a "dedicated nurse" "who did her best" to care for infants and did not intentionally cause "any harm" to any baby, My Myers said.
<snip>
The defence says it does not show the 'individual health of the children concerned, or any problems they had from birth, or the risks, or the course of treatment and/or problems encountered by said treatment'.

The chart does not show 'other collapses or desaturations' for the children when Letby is not present.The table does not show 'shortcomnigs in care' which 'could have impacted the health of the baby', or 'how busy the unit was', or 'what Letby was actually doing at the time of the event', My Myers tells the court.It doesn't show 'whether Lucy Letby was anywhere near to a child at the time of the event' or if there was 'a problem which could be traced before Letby's arrival'.Regarding the explanations for what happened, My Myers said: "This is something which is quite a difficult question, even for experts to look at.""What the case will come down to is the medical evidence, on what can be safely proved and what it can't."Regarding the medical evidence, Mr Myers said: "The cause of the deteriorations, or deaths, is not clear and have a number of possibilities.

<snip>

"There is a question to whether this hospital should have been caring for this number of children."Mr Myers: "We suggest whether an event that clearly fits an ongoing and difficult condition has been covnerted into an event of deep suspicion that harm is being done."For a nurse standing in the neonatal unit next to an infant is "unremarkable", without a "suspicion of guilt", Mr Myers tells the court.

"When we come to the experts, you will need to consider their evidence and how strong it is."The defence say there are five 'important' considerations for the evidence:

The birth condition of the infant.
If there were any problems in the care leading up to the event - events 'can come up from nowhere'
Whether the prosecution expert evidence concludes there was deliberate harm done
Whether Lucy Letby was present at the relevant time, and what she was doing
Whether there were failings in care by other people or the neonatal unit as a wholeThe birth condition of the infant

<snip>

Sometimes that includes 'the ability of doctors and nurses to spot' signs of problems in the build-up to the event.Sometimes that would be a problem if the unit was "understaffed and overstretched," Mr Myers saidThe defence say in relation to the evidence, "we have to be careful of the assumption or theory of guilt," and the "dangers of opinion" in relation to the conclusions of "deliberate harm".

<snip>

Mr Myers said this is important - it would be "unbalanced and unfair" if the focus was on Lucy Letby without focusing on problems with other staff, or how the unit was run.

<snip>

"There are many other examples of sub-optimal care of babies in this unit," Mr Myers.
The defence say the prosecution have referred how babies improved rapidly when moved to a tertiary unit - "when moved away from Lucy Letby"

<snip>

It is evidence that the unit "did not always deliver the level of care that it should have provided" and to blame Letby "is unfair and inaccurate".

<snip>

The defence say if it can be interpreted the unit is understaffed, treatment is "hurried," "mistakes made" and records "not kept". Mistakes may "not be immediate".

Mr Myers: If the unit has "failed" in its care which has led to this "uncharateristic spike in deaths", you can imagine "pressures" which call for an explanation, 'distancing the blame from those running the hospital' through "confirmation bias".

"The blame is far too great for just one person," Mr Myers added.

 

[katydid23]

He said he saw her "Standing over K's incubator" though and said that she said ".....she's just started deteriorating now..." which means she hadn't just arrived that second because how would she know? He also said he saw the readings "dropping" which means that he and LL were in the same room at the same time.

In addition, the breathing tube was dislodged and LL didn't have her hands in the incubator; therefore, if it is alleged that she dislodged it, which it obviously is, then she'd been there long enough to do that, remove her hands and silence the alarm.

She hadn't just walked on that second according to his evidence.

So, on the face of it, we are to believe that this experienced consultant, who apparently already had his suspicions about LL walks in on this extremely serious situation, remembers it in this much detail and then absolutely nothing is done about it what so ever??? A situation where, at the very least a dangerous level of incompetence appears to be present and he nor anyone else appears to do anything to try to find out how it came about, really?

Or maybe we shouldn't take his evidence quite at face value?

Lucy Letby trial: Doctor interrupted nurse 'as she attempted murder'

Dr Ravi Jayaram described the moment he encountered nurse Lucy Letby 'making no effort to help' as a baby's oxygen level began to plunge.

www.dailymail.co.uk

MOO

I am pretty sure he did report and voice his concerns to the administrators. There were reports that he did share his suspicions but was told , for whatever reason, to stand down.

Lucy Letby trial hears how doctor raised concerns but was told 'not to make a fuss'

Dr Ravi Jayaram, a paediatrician at the Countess of Chester Hospital, also said the unusual skin discolouration of Letby's first alleged victim, a baby boy known as Child A, "didn't fit with anything I had ever seen".

news.sky.com

A hospital consultant has told the Lucy Letby murder trial how he and other clinicians had previously raised concerns to bosses over an individual present as babies collapsed but were told "not to make a fuss".

Dr Ravi Jayaram, a paediatrician at the Countess of Chester Hospital, added that he "didn't really have any hard evidence apart from the association we had seen" and "it is a matter of regret and I wish I had been more courageous".

....snipped...

Dr Jayaram told Manchester Crown Court that he was aware there was talk on the unit about a "moving" purple rash on the body of Child A's twin sister, Child B, who the Crown allege Letby, 32, tried to kill with a similar air injection the following night.


Dr Jayaram said there were similar discussions following the death of Child D on 22 June 2015, who is also said to have been murdered by the defendant using the same method.

The paediatrician said that around the time of Child A's inquest he and a group of clinicians highlighted to hospital bosses the "association we had seen with an individual being present in those situations and, how do I say diplomatically, being told we really should not really be saying such things and not to make a fuss".

 

[Sillybilly]

They have presented in the opening statements, which is that it was care issues that caused some of the issues (not the insulin ones)

From the opening statement:

"Sometimes, no-one can say what caused a deterioration.

"Sometimes, things have gone wrong, or the necessary standards of care have not been met, irrespective of anything to do with Lucy Letby. For that, she should not get the blame."The assumption is "The worse it sounds, the more guilty she must be."Mr Myers outlines the 'key issues' for the defence, in what he says will assist the jury and will place everything into context.

He said his speech, at this stage, will take about a couple of hours, and will break down the defence into three general areas: Letby and the general area of her defence, coincidence, and the medical evidence.
He tells the court the medical evidence is a key area, and there are 'key issues' for each count.Letby was a "dedicated nurse" "who did her best" to care for infants and did not intentionally cause "any harm" to any baby, My Myers said.
<snip>
The defence says it does not show the 'individual health of the children concerned, or any problems they had from birth, or the risks, or the course of treatment and/or problems encountered by said treatment'.

The chart does not show 'other collapses or desaturations' for the children when Letby is not present.The table does not show 'shortcomnigs in care' which 'could have impacted the health of the baby', or 'how busy the unit was', or 'what Letby was actually doing at the time of the event', My Myers tells the court.It doesn't show 'whether Lucy Letby was anywhere near to a child at the time of the event' or if there was 'a problem which could be traced before Letby's arrival'.Regarding the explanations for what happened, My Myers said: "This is something which is quite a difficult question, even for experts to look at.""What the case will come down to is the medical evidence, on what can be safely proved and what it can't."Regarding the medical evidence, Mr Myers said: "The cause of the deteriorations, or deaths, is not clear and have a number of possibilities.

<snip>

"There is a question to whether this hospital should have been caring for this number of children."Mr Myers: "We suggest whether an event that clearly fits an ongoing and difficult condition has been covnerted into an event of deep suspicion that harm is being done."For a nurse standing in the neonatal unit next to an infant is "unremarkable", without a "suspicion of guilt", Mr Myers tells the court.

"When we come to the experts, you will need to consider their evidence and how strong it is."The defence say there are five 'important' considerations for the evidence:

The birth condition of the infant.
If there were any problems in the care leading up to the event - events 'can come up from nowhere'
Whether the prosecution expert evidence concludes there was deliberate harm done
Whether Lucy Letby was present at the relevant time, and what she was doing
Whether there were failings in care by other people or the neonatal unit as a wholeThe birth condition of the infant

<snip>

Sometimes that includes 'the ability of doctors and nurses to spot' signs of problems in the build-up to the event.Sometimes that would be a problem if the unit was "understaffed and overstretched," Mr Myers saidThe defence say in relation to the evidence, "we have to be careful of the assumption or theory of guilt," and the "dangers of opinion" in relation to the conclusions of "deliberate harm".

<snip>

Mr Myers said this is important - it would be "unbalanced and unfair" if the focus was on Lucy Letby without focusing on problems with other staff, or how the unit was run.

<snip>

"There are many other examples of sub-optimal care of babies in this unit," Mr Myers.
The defence say the prosecution have referred how babies improved rapidly when moved to a tertiary unit - "when moved away from Lucy Letby"

<snip>

It is evidence that the unit "did not always deliver the level of care that it should have provided" and to blame Letby "is unfair and inaccurate".

<snip>

The defence say if it can be interpreted the unit is understaffed, treatment is "hurried," "mistakes made" and records "not kept". Mistakes may "not be immediate".

Mr Myers: If the unit has "failed" in its care which has led to this "uncharateristic spike in deaths", you can imagine "pressures" which call for an explanation, 'distancing the blame from those running the hospital' through "confirmation bias".

"The blame is far too great for just one person," Mr Myers added.

What the prosecution or defence say in their opening speech is not evidence. Posters making statements that there is incompetence or lack of monitoring is not in evidence and is therefore sub judice.

<Admin edited to specify "... prosecution or defence ...">

 

[JosieJo]

It's not always obvious that the breathing tube is dislodged. If the tube was high and even a little tension gets put on it, it can slip out of the trachea and into the esophagus and will not go back into the trachea on its own. We have little CO2 detectors we can put on the end of a tube to see if it is still in place. You also listen to the lungs, can get an xray, look for mist in the tube.

It's amazing how well babies can remove their own ETTs.

Even a 25 week baby who had not long had morphine?

 

[sapphireminds]

Even a 25 week baby who had not long had morphine?

Yes, if they turn their head or cough, it can come out, depending on where the tube is and how it was secured.

 

[LorriB]

I am pretty sure he did report and voice his concerns to the administrators. There were reports that he did share his suspicions but was told , for whatever reason, to stand down.

But despite his suspicions, we heard that he 'did not make a contemporaneous note of his suspicions or the alarm failing to activate'.

JMO But if you suspect a colleague of incompetence to this degree, at the very least would you not record the facts?

Lucy Letby trial: Doctor interrupted nurse 'as she attempted murder'

 

[JosieJo]

But despite his suspicions, we heard that he 'did not make a contemporaneous note of his suspicions or the alarm failing to activate'.

JMO But if you suspect a colleague of incompetence to this degree, at the very least would you not record the facts?

Lucy Letby trial: Doctor interrupted nurse 'as she attempted murder'

JMO but it's not the type of thing you would write in medical notes.
You would write the medical event

Anything to do with staff you would deal with separately

 

[LorriB]

JMO but it's not the type of thing you would write in medical notes.
You would write the medical event

Anything to do with staff you would deal with separately

You wouldn't write that an alarm had been silenced but you expect the baby was dropping approximately 30-60 seconds prior? To me, that does feel pertinent and a medical event.

 

[WaxLyrical]

Wasn’t there someone in the witness box a while back who suggested it was ridiculous that a nurse would wait for a baby to self correct?

I’m confused? Is it normal to wait and observe the baby or not?

 

[JosieJo]

You wouldn't write that an alarm had been silenced but you expect the baby was dropping approximately 30-60 seconds prior? To me, that does feel pertinent and a medical event.

You would write about the Sat's dropping and perhaps nurse was present...but you definitely wouldn't write about a member of staff imo