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

[WaxLyrical]

what do you mean?

No idea. I thought the initial response suggested that babies were taken out of the cot to be x-rayed so I was trying to think of reasons why that might be. Ignore me please

 

[Tortoise]

The most concerning thing is the monitor not alarming, from my point of view.

 

[Sweeper2000]

I really go back and forth on this. Based on the testimony that has been given so far, I personally would say it's not clear to me that LL was doing (or not doing) something wrong in the episode where Dr. J walked on her, although I also think it's also possible she was doing exactly what he thought she was doing. The agreed statement from the nursing expert suggests that LL's behavior did not meet standards, and I do think that is important but ..... there's a difference between not meeting standards and criminal behavior. I really need to hear more testimony and I'm very interested in this situation with the tube now being 2cm deeper.

Edit - also, like it is easy for babies to self-extubate, but it's also not easy. I could write paragraphs on this topic and I keep starting and stopping. I don't know. That's really my personal opinion.



The incubators are specially designed to be used for x-rays and the "plate" is placed in a special drawer beneath the baby. One of the nurse's jobs is to make sure there is nothing on or over the baby that will interfere with the picture. The position of the baby's chin can also affect the position of the tube tip so the nurse also has to ensure that the baby's chin is in a neutral position. It really is an art; sometimes it feels like it would be better to have four hands.

So what’s everyones thinking on the tube being 2 cm deeper?
any innocuous reason?

 

[Tortoise]

This didn't come through in the testimony (perhaps a live-reporting issue) but it was explained in opening statements -

The prosecution added: "On these monitors, all readings are set to default values in the neonatal unit.
"Saturation levels falling to the 80s, is a serious issue and if the machine is working properly, it would have an alarm if the saturation levels fell to the 80s, as Dr Jayaram noticed.
"There is an alarm pause button on the screen of the monitor - if you want to treat the child, you don't want the alarm going away. It will pause for one minute.
"Bearing in mind the rate displayed on the monitor, Dr Jayaram estimates the tube would have been dislodged between 30-60 seconds, and that is on the assumption the alarm had been cancelled once."

Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders

 

[WaxLyrical]

Where was Dr J sitting when the designated nurse went off to the labour ward? He said it was round the corner? Possibly the nurses station? Would he have been alerted there to an alarm going off in one of the nurseries (even if it was silenced immediately)? Is there centralised monitoring going on there?

 

[Sweeper2000]

Any ideas on how long a nurse would wait during a desat to 80s before acting?

cant quite figure out the implications of her saying she would have expected the alarm to go off In police interviews as well. Suggests she’s saying she didn’t turn it off.

 

[WaxLyrical]

Any ideas on how long a nurse would wait during a desat to 80s before acting?

cant quite figure out the implications of her saying she would have expected the alarm to go off In police interviews as well. Suggests she’s saying she didn’t turn it off.

I think it suggests it did alarm and she did turn it off, whether she had a memory of it or not. JMO

 

[Cardgame]

Where was Dr J sitting when the designated nurse went off to the labour ward? He said it was round the corner? Possibly the nurses station? Would he have been alerted there to an alarm going off in one of the nurseries (even if it was silenced immediately)? Is there centralised monitoring going on there?

I have spent some time in a NICU (as a parent not a nurse/doctor/baby).

From memory, there were alarms going off all the time, because as someone said earlier, they are super sensitive and seem to go off even when there is no problem.

When the alarm goes off, a nurse always comes to check, and turns off the alarm. In the high intensity rooms, the nurse is never far away. I don't think a doctor would be 'notified' unless it was a crash call activated by a nurse, rather than an automated alarm from a bedside.

I can see how an alarm not going off is - in a weird way - more remarkable than an alarm going off.

 

[Jazmania]

I think that for me what is pivotal to Child K's case is the second desaturation event later on in the morning.

Do the prosecution allege that LL also tried to dislodge the baby's tube at this time? If an X ray showed it was in place 7 minutes or so before suddenly it had moved by 2cm, and LL was there at the crib at the time, and the baby was sedated - that's obviously very suspicious.

However on the other hand if she is not implicated in this second event, then if the tube was naturally dislodged this time, why could it not have been naturally dislodged the time before?

It's unclear from the reporting what the prosecution are saying happened exactly.

Also without testimony from Bohin and Evans, we have only the consultant's view that the tube could not easily have been dislodged naturally. Which makes the case seem a bit weak.

Of course, we still have the fact that once again a baby that was previously stable quickly deteriorated once the nurse in charge left the room, that LL was seen to be doing nothing, and the monitor had been switched off. It's suspicious when taken into context of all the other unexplained collapses at LL's presence, but by itself is it enough?

 

[Tortoise]

Where was Dr J sitting when the designated nurse went off to the labour ward? He said it was round the corner? Possibly the nurses station? Would he have been alerted there to an alarm going off in one of the nurseries (even if it was silenced immediately)? Is there centralised monitoring going on there?

"Dr Jayaram says he was aware Joanne Williams was going to the labour ward to update the parents on Child K.
He said he was sitting at a desk, around the corner from the entrance to nursery room 1.

"I had not been called to review [Child K], I had not been called because alarms had gone off - I would have heard an alarm. I got up and walked through to see [Child K]."
Dr Jayaram entered nursery room 1 through the entrance doors closest to his desk. Child K was at the far side of the nursery room, with Lucy Letby present."

Recap: Lucy Letby trial, Tuesday, February 28



https://twitter.com/LucyLetbyTrial

 

[Cardgame]

I have questions as to why many years after the events involving child K he can remember them in extreme, to-the-minute detail yet didn't say these things in his initial police interviews. That from LL's barrister not me. Also, his assertions that he went into the room to check on LL to allay his own fears that he wasn't "being hysterical" about his concerns around her, do not seem to fit with the fact that he and other consultants had already made their minds up about her and had raised concerns. He must have been well past the "am I being irrational" state of mind by then, imo.

I assumed that his 'I am being hysterical' mindset was as a result of being told to stand down by senior management the first time (ie in October) then, after the Baby K incident, he repeated the concerns to senior management in February 2016.

Do we have specific information that he had already repeated his concerns before Baby K incident?

 

[Tortoise]

Any ideas on how long a nurse would wait during a desat to 80s before acting?

cant quite figure out the implications of her saying she would have expected the alarm to go off In police interviews as well. Suggests she’s saying she didn’t turn it off.

3:47pm

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.

Recap: Lucy Letby trial, Tuesday, February 28

 

[magikarpmagikarp]

Any ideas on how long a nurse would wait during a desat to 80s before acting?

cant quite figure out the implications of her saying she would have expected the alarm to go off In police interviews as well. Suggests she’s saying she didn’t turn it off.

To me it's not the 80s specifically. It's not the number. It's what I see along with the number. If everything looks well (ventilator, chest rise, etc) and the baby is merely rustling around, then it is not necessary to do something (although I usually try to adjust the bedding to make the baby more comfortable - comfortable babies don't self extubate, for one thing, and they need less oxygen for another). But if I see other signs that something else is wrong (on the ventilator data, the chest rise, etc), I'm not waiting for the baby's saturation to get worse before acting because that would be dumb. These collateral details have not been mentioned - they are implied - but they haven't been mentioned directly. That may be because they've been omitted in the reporting, not because they weren't discussed in court.

JMO as usual.

 

[Tortoise]

To me it's not the 80s specifically. It's not the number. It's what I see along with the number. If everything looks well (ventilator, chest rise, etc) and the baby is merely rustling around, then it is not necessary to do something (although I usually try to adjust the bedding to make the baby more comfortable - comfortable babies don't self extubate, for one thing, and they need less oxygen for another). But if I see other signs that something else is wrong (on the ventilator data, the chest rise, etc), I'm not waiting for the baby's saturation to get worse before acting because that would be dumb. These collateral details have not been mentioned - they are implied - but they haven't been mentioned directly. That may be because they've been omitted in the reporting, not because they weren't discussed in court.

Dr J said her chest was not moving.

 

[Cardgame]

I think that for me what is pivotal to Child K's case is the second desaturation event later on in the morning.

Do the prosecution allege that LL also tried to dislodge the baby's tube at this time? If an X ray showed it was in place 7 minutes or so before suddenly it had moved by 2cm, and LL was there at the crib at the time, and the baby was sedated - that's obviously very suspicious.

However on the other hand if she is not implicated in this second event, then if the tube was naturally dislodged this time, why could it not have been naturally dislodged the time before?

It's unclear from the reporting what the prosecution are saying happened exactly.

Also without testimony from Bohin and Evans, we have only the consultant's view that the tube could not easily have been dislodged naturally. Which makes the case seem a bit weak.

Of course, we still have the fact that once again a baby that was previously stable quickly deteriorated once the nurse in charge left the room, that LL was seen to be doing nothing, and the monitor had been switched off. It's suspicious when taken into context of all the other unexplained collapses at LL's presence, but by itself is it enough?

It seems that by this stage the clinicians had formed an awareness not simply of the person who always seemed to be 'around' when these events were happening, but also that the nature of the events themselves formed part of that pattern.

As a layman, I am finding it hard thought process to access, because I don't have that on-the-ground experience of what would be 'normal' or 'expected' on a NICU, which is by its very nature, a life or death frontline type of environment.

So, so, so difficult for the non-medical jury.

 

[Tortoise]

10% BBC - Lucy Letby: Nurse denied dislodging baby's breathing tube, trial hears

"In a police interview, Ms Letby said the baby's designated nurse would not have left unless she was stable and the tube was in place. [...]

Mr Johnson said: "Expert evidence is admitted into a criminal trial to help you understand or to inform you of medical or scientific matters which fall outside of your experience."
He said it was agreed that "nothing either Dr Dewi Evans or Dr Sandie Bohin" could provide would "add to the evidence you have heard so we are not going to call them at this stage"."

 

[Tortoise]

It seems that by this stage the clinicians had formed an awareness not simply of the person who always seemed to be 'around' when these events were happening, but also that the nature of the events themselves formed part of that pattern.

As a layman, I am finding it hard thought process to access, because I don't have that on-the-ground experience of what would be 'normal' or 'expected' on a NICU, which is by its very nature, a life or death frontline type of environment.

So, so, so difficult for the non-medical jury.

I think the doctors are all essentially saying one thing - these events, sudden collapses, were unexpected.

JMO

 

[Sweeper2000]

Ok I get the babies gestational age being an issue in ll not responding as per protocol but I am wondering how long a nurse would wait for a desat to correct itself for a baby of appropriate age and showing no other signs of deterioration?

would the babies heartbeat be an issue here as well? Just thinking if the baby hadn’t breathed in enough air or was not breathing at all we might see some other indication as to how long this baby had been in a compromised position for?

 

[Marantz4250b]

A report from today (restricted to 10%) -

"On Wednesday, prosecutor Nick Johnson KC read to jurors a summary of Letby’s police interviews about the incident, in which she denied any wrongdoing. [...]

Following further questions from police, she suggested that maybe the tube had not been secured properly, he said. She denied that had been done deliberately. [...]

Mr Johnson explained to the jury he was not calling medical experts Dr Dewi Evans and Dr Sandie Bohin.

He said the prosecution and defence had agreed there was nothing they could add to the evidence already heard about Child K."

https://www.itv.com/news/granada/20...n-waiting-for-baby-to-self-correct-trial-told

From the article you quoted from;

The Crown says Letby, from Hereford, attempted to murder the baby girl within two hours of her birth by deliberately dislodging her breathing tube during a night shift.

So what we know now is that the baby was not sedated which is the opposite of what was initially suggested; no one saw her actually do anything at all; there is no other associated evidence which directly ties her to the Crown's version of events.

How can anyone possibly be convicted on this "evidence"? There is literally no evidence other the coincidence, as far as I can see and in my opinion.

 

[magikarpmagikarp]

Dr J said her chest was not moving.

Yes. And the alarm being paused already is another piece of information. With that said, assessment for chest rise doesn't take long, but it cannot be instantaneous. How long did it take Dr. J to assess that the chest wasn't moving when he entered the room? Did he identify that simultaneously with the baby's saturation falling into the 40s? Situations evolve. What is unclear at 10-15 seconds can be blazing obvious at 30 seconds.