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

[scottishgal]

is the witness list available to press....wondering if defense will call the TPN bag producers and pharmacy staff who prepared the bags

 

[Marantz4250b]

Is it just me or is Mr Myers being very rude to Dr J ?

I was actually wondering last week if Dr J was the one behind the screen when LL cried and walked away as I thought he was coming in for baby K , guess not , that was definitely a registrar at the time then.

He is defending someone accused of exceptionally serious charges and the good Dr's evidence appears to be somewhat inconsistent. I don't think he's being rude at all.

 

[marynnu]

I am following the case but still struggling how they are so sure the bags were not a defective batch from the ......bag producer...the makers of the TPN bags

hope this is not confirmation bias or whatever the term is

They can't have been defective, in my view, assuming you mean an error was involved. In fact, personally I would be surprised if the manufacturers even had insulin available to them. IMO someone deliberately gave this child insulin.

 

[Dotta]

I get what you are saying here but this is all a bit vague for me; with whom did he "raise concerns", when and under what circumstances? He says that is was himself and "other clinicians" raised these concerns - who were they?

Personally, I find this evidence far from satisfactory; I do not believe that a group of clinicians who raised concerns about a staff member's potentially dangerous practices (intentionally or otherwise) in an official capacity would simply be fobbed off by senior management.

All my opinion, obviously.

IMO
All concerns should be addressded in formal, written way.
E.g. a note explaining things signed by a doctor and/or other doctors and sent via an office to this senior management.
The note and a copy are stamped in the office.
It means a doctor has an evidence of raising alarm, and nobody can tell him to hush things up but has the duty to investigate.

That is the way in my place of work.

JMO

 

[magikarpmagikarp]

From Chester Standard:

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

"The court now hears an agreed statement from Elizabeth Morgan, who says in her experience, it is very unlikely a nurse would leave the nursery of a baby if the baby's ET tube was not settled in a position and the baby was settled.

For a baby of this gestational age, it would be standard practice for a nurse to take corrective action, carry out checks and call for help if a desaturation was noted.

It would 'not be normal practice' to wait and see if the baby self-corrects, for a baby of this gestational age.'

 

[Sillybilly]

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.

Hopefully this will explain.

Notice that even the defence opening is careful not to state the information as fact at this point. Their opening is peppered with “if” and “whether” and “sometimes”. They do not say "This is what happened".

If there were any problems in the care leading up to the event
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

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,"

If the focus was on Lucy Letby without focusing on problems with other staff, or how the unit was run.

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

If the unit has "failed" in its care which has led to this "


As we can see, even the defence does not make a direct statement that these events/conditions did actually occur or exist and that is why we insist on links to support statements of fact.

So, splitting hairs if you will, but this is why the media and members of the public can not publicize opinions or make direct statements that the deaths of these infants were “initially found to be because of incompetence/lack of proper care” and “it was later they were decided to be something else”. That is not something that has been presented to the jury as a given, and is something that can affect how the jury views the guilt or innocence of the accused, thus affecting trial outcome. That is part of what violates the underlying principle of sub judice.

Members are expected to preview their own posts to ensure they are not expressing opinions or making direct statements that can affect trial outcome as it relates to guilt or innocence.

Any further questions in that regard, please do not ask them or debate them on the thread. Use the Report feature to ask and a Mod or Admin will try to get back to you.

 

[Marantz4250b]

It's my understanding that the breathing tube was not detached from the ventilator, which is very visible. It would be very unusual to see someone standing there over a disconnected breathing tube because it is so simple to identify and fix that. My understanding of the testimony is that what Dr. Jayram saw was a baby who had falling saturations, who upon observation had no chest movement. This suggests a problem with the position of the tube inside the baby. It can take several moments to determine there is no chest movement. Dr. J walked in when the baby had a saturation of 80% and ... it's possible my unit does things very differently but 80% is not emergent to me. It gets my attention, and I'm over there looking to see what's up. Standing and looking at a baby who's saturation is 80% may very well be standing and visually assessing. This is not doing nothing.

However it sounds like shortly thereafter, the baby's saturation dropped to 40% (this can't really be measured, that just means it's quite low) and this gives more information about what is happening. Dr. J then detached the breathing tube from the ventilator so he could give breaths using the NeoPuff. This lets him give more pressure and a faster rate more easily. He still saw no chest rise, so he removed the breathing tube and gave mask breaths. The baby then recovered, which suggests the problem was with the breathing tube. The breathing tube was not clogged, and earlier the air leak was not an impediment to adequate ventilation. So this the tube must have been misplaced, probably out of the trachea and into the esophagus. The question is - did the breathing tube become dislodged by natural movement of the baby or did someone purposefully pull on it to dislodge it? That is a question I am turning over and over in my mind and I am not sure what I think.

JMO.

My bad on the use of language there - he actually said "dislodged". He also said that it would be obvious to any nurse who had caused it via handling the baby. He obviously noticed it.

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

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...

www.websleuths.com

 

[Dotta]

very very plain speak here - and mods pls delete if its not right - but as a British person of Indian /Asian origin myself - scary and difficult to speak out and accuse for anyone in this situation, but esp so as a non white person. I know that does not excuse a delay. and we still dont even know if LL is innocent or guilty anyway but just talking to possibly why he hesitated and made sure before speaking out . I might not be right at all.

Sorry, but I do not think ethnicity played a role here.
JMO

 

[Marantz4250b]

I didnt understand before , but if they were nervous about leaving her three minutes with K, wonder why they waited some more months to transfer her - now i realise there is no 'they' - there were various ppl involved up the chain and decisions were taken only when the higher ups signed off

do we know if she realised why she had been moved to clerical duties for two years 2016-2018 before police made the first arrest - why didnt she move somewhere else and instead do clerical duties ? or are there nurses who do clerical duties roles and it is not unusual - maybe they told her it was a step up ?

Well, as far as I recall, we've only heard from one person (Dr J) who has personally given evidence about harboring concerns about LL. If other consultants had similar concerns (which Dr J say they did along with him) why have we not heard from them? Perhaps we will in due course?

I'm still having great trouble as to why a senior doctor, who was so concerned about the conduct of a nurse that he felt he couldn't allow her to be unaccompanied with a patient for even three minutes, had not tried to move heaven and earth to get her investigated. It's utterly bizarre, IMO.

All IMO, obvs.

 

[Sundial]

I get what you are saying here but this is all a bit vague for me; with whom did he "raise concerns", when and under what circumstances? He says that is was himself and "other clinicians" raised these concerns - who were they?

Personally, I find this evidence far from satisfactory; I do not believe that a group of clinicians who raised concerns about a staff member's potentially dangerous practices (intentionally or otherwise) in an official capacity would simply be fobbed off by senior management.

All my opinion, obviously.

JMO here;
reading through the threads so far; like others I have been curious by baby Ks case.

If it was already reported to senior hospital staff (as given in evidence), in 2015, this suggests a grievance procedure (or even a safeguarding concern) which would have been raised again in 2016. I understand Dr J stated they were told not to makes a fuss, but if I had this nagging undeniable concern and was told not to make a fuss, why didn’t he keep a diary, document something for future reference, go to the Union for advice etc?
He states “they” had concerns as a collective group of consultants and I really hope this was documented or we will hear more about who “they” were.

At some point, there must have been a documented discussion as part of a grievance procedure with management prior to her arrest otherwise she would not have been moved to admin duties. If there is no documentation of a staff grievance particularly with safeguarding like this despite (allegedly twice) reporting it, I would be absolutely stunned.

All my own view of course.

 

[JosieJo]

Well, as far as I recall, we've only heard from one person (Dr J) who has personally given evidence about harboring concerns about LL. If other consultants had similar concerns (which Dr J say they did along with him) why have we not heard from them? Perhaps we will in due course?

I'm still having great trouble as to why a senior doctor, who was so concerned about the conduct of a nurse that he felt he couldn't allow her to be unaccompanied with a patient for even three minutes, had not tried to move heaven and earth to get her investigated. It's utterly bizarre, IMO.

All IMO, obvs.

He spoke to the nurse director and medical director months apart ..the medical director was to arrange a meeting but 3 months later it hadn't been arranged

"Dr Jayaram said the team told the senior director of nursing in autumn 2015 but nothing was done. He said it was raised again in February 2016, and the hospital’s medical director was told at this point. The doctors asked for a meeting but didn’t hear back for another 3 months."

Link in earlier post

 

[JosieJo]

JMO but it is extremely difficult at some hospital trusts to get anything done ...they are very into "a no blame culture "...imo its gone to the extreme

 

[Marantz4250b]

how is dr J still going to be able to work there now, after whistleblowing that senior management fobbed off initial concerns

or is even a doctor's career small collateral compared to 17 babies harmed , very very difficult and traumatic case to follow

Has he, though? He's not stated any names or specific positions, as far as I have seen in the evidence. We don't even know who these "other consultants" are he says held similar reservations about her.

In his evidence about walking into the room where LL was standing over baby K he said that he did so in order to "...convince himself he wasn't imagining it or being hysterical.." or words to that effect. Why would one have such self doubt if you knew that several other consultants agreed with him and had already raised concerns the previous year. If you and your peers all agree on something then you are surely way past the point of "doubting oneself"? Yet he says he still had reservations about his feelings in his evidence!

Al MOO, obvs.

 

[JosieJo]

Has he, though? He's not stated any names or specific positions, as far as I have seen in the evidence. We don't even know who these "other consultants" are he says held similar reservations about her.

In his evidence about walking into the room where LL was standing over baby K he said that he did so in order to "...convince himself he wasn't imagining it or being hysterical.." or words to that effect. Why would one have such self doubt if you knew that several other consultants agreed with him and had already raised concerns the previous year. If you and your peers all agree on something then you are surely way past the point of "doubting oneself"? Yet he says he still had reservations about his feelings in his evidence!

Al MOO, obvs.

He has stated positions...nurse Director and medical director

 

[Marantz4250b]

Baby K’s case is the one I’d been waiting for. A sedated baby whereby LL was allegedly caught in the act having dislodged the breathing tube with the child being close to death.

Having read the evidence it feels all a bit underwhelming, and could very much be a case of Dr J went in there expecting to see a crime being committed, and so that’s what he saw.

It sounds like the baby wasn’t sedated, on the contrary was “active” and had a breathing tube that was too small to the extent that 94% of the air leaked around it. The saturations were “in the 80s”, which would seem to be a situation where a nurse would stop and observe and then raise the alarm if needed.

Also, not a behavioural expert by any stretch, but LL’s lack of reaction when Dr J walked in feels important. If someone was in the process of killing a baby and was then unexpectedly caught in the act, I think I’d expect them to overcompensate, “Dr J, come quick, something is wrong”, not just nonchalantly remark that the baby seems to have just started deteriorating.

I think this entire trial will hinge on the insulin cases.

JMO.

I agree with all of this. I'm not convinced by the insulin cases, thugh, as pointed out previously.

 

[Sundial]

Perhaps there was also (unintentional?) gaslighting of Dr J by the managers. He’s apparently raised concerns before now and they brushed them off. So in his mind, he might already be thinking that he is a bit crazy with his suspicions because he has essentially been told as much when he was dismissed by senior management.

I suppose it depends on how senior management was generally. If senior management had always in Dr Jays experience acted reasonably, then it makes sense that he would follow their advice when they told him to drop it, because he has no reason to distrust them. But if senior management has generally been pretty poor, there is more of an argument that he should have pressed ahead with his concerns even when they were telling him to stop.

In some way, whistleblowing (esp in the care sector and from my experience with the nhs), it can be notoriously difficult to air a concern without being caught in some kind of vicious crossfire.

I have heard of similar stories reported where even if you try and do the right thing, there can be a bad backlash of consequences in some places of whistleblowing. Many do not want to accept the unthinkable even if it’s right in plain sight. Not implying guilt or innocence either way with the trail here and this is all my own view, but it does and continues to happen, every day.

 

[Marantz4250b]

very very plain speak here - and mods pls delete if its not right - but as a British person of Indian /Asian origin myself - scary and difficult to speak out and accuse for anyone in this situation, but esp so as a non white person. I know that does not excuse a delay. and we still dont even know if LL is innocent or guilty anyway but just talking to possibly why he hesitated and made sure before speaking out . I might not be right at all.

I see what you're getting at but this guy is a slightly famous TV doctor so certainly not apprehensive of bringing attention on himself.

 

[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?

<modsnip> if his acccount IS 100% true and accurate, what are your thoughts on the version of events he has put forward? I don't mean what do you think he should have done next in terms of reporting it. Dr J isn't on trial.

I mean what are your thoughts on what he says happened and on what he says LL was doing or not doing? What are your thoughts on LL's alleged actions in this situation?

 

[Marantz4250b]

Seems baby K wasn’t sedated at the time


Dr Jayaram is asked about the morphine infusion recorded, which appears on the notes above a note added, timed at 3.50am.
Dr Jayaram says, having seen the prescription chart, the morphine infusion would not have happened before the desaturation.
Mr Myers said Dr Jayaram had told police Child K had been sedated with morphine. Dr Jayaram said that was what he had believed at the time.
Dr Jayaram says Child K was not on a morphine infusion prior to the desaturation. "However", she was not a vigorous baby.
He says, in retrospect, he will accept the morphine was not running prior to the desaturation.
He says he is "surprised" it was not running sooner.
He says he believed, "in good faith", the morphine was running at the time.

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

Yes, that's come into evidence since I posted and caught up. So, not unlikely that the baby dislodged it herself? Yet he still questions LL actions and harboured "concerns" about her.

 

[LorriB]

Updated timeline following today's testimonies. Some discrepancies here so have captured both versions.


2.12 k is born

2.25 K is intubated with size 2 tube

2.40 k is admitted to room 1

2.45 sats are 70%

2.45 according to Dr J and 3 according to nurse Williams surfactant given.

3.30 sats are 94% blood sample taken. Air leak of 94% recorded

3.30 note states morphine began. Appears it didn't until 3.50

3.47 desinated nurse Williams is called to Labour ward

3.50 alleged incident. Dr J arrives and notes sats at 80% when LL cotside. Sats drop to 40% and bagging begins by Dr J.

After 3.50 reintubation occurs with 2.5 size tube

3.50 morphine infusion. Nurse Williams says Child K would have received morphine after being intubated, not at the time of intubation.

3.50ish nurse Williams returns to a red alarm

After 3.50 and K stabilised, nurse Williams says Dr J asks what happened re alleged incident - she replied she doesn't know as she wasn't in the room. Dr J says he cannot recall this and '
Why would I ask her what happened in the room when she wasn't there?"

4.31 nurse takes pics of baby and parents
6.07 Child K has xray to show current ET tube in the right place

6.15 oxygen levels drop and tube is adjusted. Dr J records 'began to have lower sats'.

7.25 blood pressure drops, tube is withdrawn again as it has slipped 2cm

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

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