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

[WaxLyrical]

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

Woe betide if something like this happened to my child and I discovered they’d deliberately omitted it from the records.

 

[JosieJo]

Woe betide if something like this happened to my child and I discovered they’d deliberately omitted it from the records.

The medical records are not a place to name staff the incident would be recorded without any possible "accusations" ...
This is not about covering up or not telling the parents.
If a mistake or harm is caused the hospital has a duty of candour to keep parents informed. But there are processes for that ...imo the medical notes would not involve anything not yet founded

 

[sapphireminds]

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?

I believe there was a nurse who testified to that. I have no idea why they did.

 

[JosieJo]

I believe there was a nurse who testified to that. I have no idea why they did.

Presumably as they were under oath that is their own experience

 

[marynnu]

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?

For me personally, I wouldn't be waiting for a 25 weeker to self-correct. The most telling thing for me is the absence of chest movement - you can see this immediately and it 's an emergency situation. There are only 2 realistic possibilities - the tube is blocked or out of position.
The problem is IMO we can't say how long LL was at the incubator before Dr. J arrived. Obviously it would take a few moments after an alarm sounds to realise what the problem is, so just observing but not doing anything could be completely innocuous.

 

[sapphireminds]

The medical records are not a place to name staff the incident would be recorded without any possible "accusations" ...
This is not about covering up or not telling the parents.
If a mistake or harm is caused the hospital has a duty of candour to keep parents informed. But there are processes for that ...imo the medical notes would not involve anything not yet founded

You do document what is found factually.

Here's an example of something I've documented before "Called to bedside to evaluate for infant with desaturation. Upon arrival, RN and RT at bedside and providing bag mask ventilation but there is no chest rise and infant HR falling."

You have to keep factual, but you can talk about things.

 

[marynnu]

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

In my personal view 25 weekers do not cough, certainly not effectively. But I agree that tubes can move, especially very tiny ones like this.

 

[Marantz4250b]

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 ...">

It's a verbatim report of things said in court so cannot be sub-judice, I don't think, as long as it accurately attributed to who said it and its context is given. If it was sub-judice the media wouldn't be allowed to report it.

It's correct to say that it's not technically evidence but if that's what the defence are basing their case then then it can't be prejudicial to repeat it.

Willing to be corrected, though and all my own opinion.

 

[JosieJo]

You do document what is found factually.

Here's an example of something I've documented before "Called to bedside to evaluate for infant with desaturation. Upon arrival, RN and RT at bedside and providing bag mask ventilation but there is no chest rise and infant HR falling."

You have to keep factual, but you can talk about things.

My point is .. in my experience..in the UK you would only document the medical facts in a situation like this...anything to do with staff misconduct is dealt with separately jmo

 

[LorriB]

This is the timeline as I understand it for child K. I'm unclear when the second intubation happened. So my question is if the tube slipped and has to be removed at 7.25 could that not also be the case at 3.50?

2.12 k is born

2.25 K is intubated

2.40 k is admitted to room 1

2.45 sats are 70%

3.30 sats are 94% blood sample taken

3.47 designated nurse is called go Labour ward

3.50 alleged incident. Sats drop go 40% and bagging begins by Dr J.

4.31 nurse takes pics of baby and parents

Reintubation and morphine bolus given

6.07 Child K has xray to show ET tube was in the right place

6.15 oxygen levels drop and tube is adjusted

7.25 tube is withdrawn again as it has slipped 2cm

Based on: Recap: Lucy Letby trial, Monday, February 27

 

[Kemug]

Letby mentions one colleague had suspected conjuctivits, but had still come into work, and adds "Hope I haven't caught anything".
Said colleague had also not "done anything but moan" that day, Letby says.
Letby messages the ill colleague saying she hopes that colleague is felling better soon. The colleague responds she was felling better after a day of bed rest, and thanks Letby for her message.

JMO of course, but I am not liking this texting by LL. She so kindly messages her "ill colleague" to hope that she will feel better soon, and is duly thanked for her sympathy. Little does she know that LL has already messaged to another colleague about her "moaning". I wonder if LL had gained a bit of a reputation for this sort of thing? (Which IMO is "two-faced" behaviour). Or did everyone think she was a really lovely person?

 

[LadyEdgeworth]

JMO of course, but I am not liking this texting by LL. She so kindly messages her "ill colleague" to hope that she will feel better soon, and is duly thanked for her sympathy. Little does she know that LL has already messaged to another colleague about her "moaning". I wonder if LL had gained a bit of a reputation for this sort of thing? (Which IMO is "two-faced" behaviour). Or did everyone think she was a really lovely person?

I do think this kind of reputation spreads through a workplace very quickly, you normally know who is being two-faced fairly fast. Or could just be a culture at this ward and if she's talking this way about others, others are talking this way about her too. Now those are the texts I'd love to see!

 

[Tortoise]

It's a verbatim report of things said in court so cannot be sub-judice, I don't think, as long as it accurately attributed to who said it and its context is given. If it was sub-judice the media wouldn't be allowed to report it.

It's correct to say that it's not technically evidence but if that's what the defence are basing their case then then it can't be prejudicial to repeat it.

Willing to be corrected, though and all my own opinion.

Imagine if you will in a totally ficticious scenario that the defence of person "A" is that someone else "B" did a murder.

There was an initial investigation, say by a different police force, which did not find who the perpetrator was.

Witnesses show up in court and give evidence implicating A. The defence says to them it wasn't A, it was B wasn't it, you are making up your evidence about A. No say the witnesses.

It would be totally false to say the initial investigation found that B did it.

It's not prejudicial to say that the defence claims B did it, but it is prejudicial to falsely claim that the initial investigation found that B did it.

It would also be prejudicial to say I know B very well and B did it, the witnesses are lying.

It would not be prejudicial to point out parts of the evidence heard so far, for instance A was at work, how did A get from work to the crime scene, we don't know where B was, etc..

IMO

 

[LadyEdgeworth]

Recap: Lucy Letby trial, Tuesday, February 28

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

www.chesterstandard.co.uk

Also it looks like Chester Standard is there today, it's just not started yet

 

[Tortoise]

9:00am

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, continues today (Tuesday, February 28).
We will be bringing you updates throughout the day.

9:25am

And here is our coverage from yesterday (Monday, February 27): Recap: Lucy Letby trial, Monday, February 27

9:30am

Yesterday the prosecution began delivering evidence in the case of Child K. The prosecution allege Lucy Letby attempted to murder Child K, a baby girl born on February 17, 2016, within a couple of hours of her being born. The defence deny this.
Read more here: Lucy Letby: Nurse ‘tried to murder baby within two hours of her birth’

9:31am

Nicholas Johnson KC, prosecuting, told jurors on Monday: “It is alleged Lucy Letby interfered with the endotracheal (ET) tube and Dr Ravi Jayaram walked in to the immediate aftermath of that.”
When going through the sequence of events yesterday, Mr Johnson told the jury Dr Jayaram would be called in to court to give evidence.

10:28am

The trial is expected to resume shortly.

10:31am

At the end of Monday, Countess of Chester Hospital nurse Joanne Williams began giving evidence. She is continuing to do so this morning.

Recap: Lucy Letby trial, Tuesday, February 28

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

www.chesterstandard.co.uk

 

[Tortoise]

10:36am

Ms Williams is being talked through her nursing note from the morning of February 17, 2016, in which she described Child K being born in 'fair condition'.
She was 'intubated at approx 12 minutes of age with size 2 ETT'.
Ventilation commenced, and a 'high leak noted'. Ms Williams said that is noted via the ventilator, and if there are any concerns, they are highlighted to the medical team.
She says that can sometimes be down to the size of the ET tube.
Staff would be alerted to the leak via the ventilator giving off an alarm, the court hears.

10:42am

Ms Williams says there were no concerns over the leak, as the overall clinical picture for Child K was stable.
Ms Williams says the alarms would go off if the baby's clinical picture declined, such as the heart rate dropping or oxygen desaturation. Initially it would be a 'soft alarm', which is amber and makes a noise, then a more urgent alarm in red and 'more of an alerting' sound.
There is a way to pause the alarms, Ms Williams says. That could be paused for several minutes, once it had been activated, in the event of doing a procedure.
Ms Williams says she cannot recall if the alarm could be disabled in advance. The court hears a newer version of the monitors have since been installed in the hospital, where that is possible.

10:45am

Ms Williams says at the time of the 'high leak', the clinical picture for Child K would have been assessed, and a check the tube was in the right place at the mouth.
The prosecution is now asking about the time period when Ms Williams left the nursery room to inform the family on what had been happening.
She said she would not have done so if Child K was not satisfactorily stable.
She tells the court, other than being born very premature, there was nothing of concern.
She does not remember asking anyone in particular to look after Child K in her absence.

Recap: Lucy Letby trial, Tuesday, February 28

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

www.chesterstandard.co.uk

 

[Tortoise]

10:47am

Ms Williams recalls Child K being 'quite active' as she left, which was normal to see in prematurely born babies.
The court hears Ms Williams left the unit at 3.47am.

10:51am

The intensive care chart for Child K on February 17, 2016 is shown to the court.
A reading at 3.30am says, for morphine, 'commenced'. Ms Williams is asked if that means morphine commenced for that time. Ms Williams agrees.
A reading for 0350 '100mg/kg morphine' is recorded. The note is not in Ms Williams's handwriting, and the court hears that would have been a bolus of morphine.

Recap: Lucy Letby trial, Tuesday, February 28

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

www.chesterstandard.co.uk

 

[Tortoise]

10:56am

There is a prescription note for 0350 for a morphine infusion dose. Ms Williams says this is also not in her handwriting, and it is written by a doctor.
Asked again about the '3.30am' reading, Ms Williams says that would not have begun at 3.30am precisely, but in the time period after. She cannot say whether that happened before she left the room at 3.47am.
She tells the court Child K would have been stable when she left.

Recap: Lucy Letby trial, Tuesday, February 28

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

www.chesterstandard.co.uk

 

[sapphireminds]

<modsnip>

10:47am

Ms Williams recalls Child K being 'quite active' as she left, which was normal to see in prematurely born babies.
The court hears Ms Williams left the unit at 3.47am.

10:51am

The intensive care chart for Child K on February 17, 2016 is shown to the court.
A reading at 3.30am says, for morphine, 'commenced'. Ms Williams is asked if that means morphine commenced for that time. Ms Williams agrees.
A reading for 0350 '100mg/kg morphine' is recorded. The note is not in Ms Williams's handwriting, and the court hears that would have been a bolus of morphine.

Recap: Lucy Letby trial, Tuesday, February 28

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

www.chesterstandard.co.uk

That has to be a typo/misrepresentation - it must be 100 mcg/kg, because 100 mg/kg of morphine is a massive overdose. A "full" dose of morphine is 0.1 mg/kg, aka 100 mcg/kg

 

[Tortoise]

11:04am

When Ms Williams returned, she heard a red alarm, "it seemed like an emergency, something was going on".
She says she felt upset, and it "almost felt frightening to go back into a situation like that".
She recalls Dr Jayaram asked her what had happened, likely near the nursing station after Child K had stabilised. Ms Williams said Dr Jayaram had asked 'how did the [ET tube] move'.
She recalls Child K was reintubated, with a bigger ET Tube.

11:06am

Asked about her '?ETT dislodged, removed and re-intubated' nursing note, Ms Williams tells the court there was a query that the ET tube had been dislodged.

11:08am

Ms Williams had also recorded on her nursing note, for the ET Tube, 'large amount blood-stained oral secretions'.

11:09am

The nursing note also adds 'Initially active on handling but now more settled'.

11:11am

Ms Williams tells the court a morphine bolus would be given, instead of a morphine infusion, when carrying out a procedure such as inserting a UVC line.

Recap: Lucy Letby trial, Tuesday, February 28

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

www.chesterstandard.co.uk