UK - Nurse Lucy Letby, Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #25

[Kemug]

And I've been meaning to issue a warning to all the nurses here, in fact to all nurses everywhere - please be very very careful when going home to make sure you're not being followed by handover sheets, or any other pieces of paper. And watch out for any of them jumping into your pockets, or worming their way into your bag. These pesky critters can cause a great deal of trouble. So please be on your guard nurses, you have been warned!

 

[Tortoise]

I thought the experts who were to appear should have been listed at the beginning of the trial
(as Prosecution presented the experts we saw)
for both Prosecution and Defence to prepare themselves properly.

Not somebody at the last minute.

JMO

That is standard procedure, but say for instance something that the defence wasn't aware of at the beginning of the trial came to their attention during the trial, there are procedures for late admission which have to go before the judge for permission, so that in the event of a conviction it wouldn't become an appeal issue, with grounds for a re-trial based on evidence or witnesses being excluded from trial. But it's all speculation from me, they could be dealing with something else entirely. If that is what it is, I might expect the prosecution to make a point of it in cross-examination, like, 'when did you prepare your report?'

JMO

 

[Penny68]

And I've been meaning to issue a warning to all the nurses here, in fact to all nurses everywhere - please be very very careful when going home to make sure you're not being followed by handover sheets, or any other pieces of paper. And watch out for any of them jumping into your pockets, or worming their way into your bag. These pesky critters can cause a great deal of trouble. So please be on your guard nurses, you have been warned!

The Pied Piper of Nurseland.

 

[Dotta]

And I've been meaning to issue a warning to all the nurses here, in fact to all nurses everywhere - please be very very careful when going home to make sure you're not being followed by handover sheets, or any other pieces of paper. And watch out for any of them jumping into your pockets, or worming their way into your bag. These pesky critters can cause a great deal of trouble. So please be on your guard nurses, you have been warned!

And if not careful they can even settle under your bed like little monsters -
and not even your trusted shredder would be able to cope!

 

[CS2C]

I think I will attend the closing speeches and the judges summing up (provided that doesn’t take place tomorrow)

I wish I had been in court nearer the start of the trial as they went through Lucy’s police interviews from start to finish. I don’t suppose there is any way to obtain the full transcripts of these interviews once the case is concluded?

 

[Tortoise]

I think I will attend the closing speeches and the judges summing up (provided that doesn’t take place tomorrow)

I wish I had been in court nearer the start of the trial as they went through Lucy’s police interviews from start to finish. I don’t suppose there is any way to obtain the full transcripts of these interviews once the case is concluded?

Apply for a transcript of a court or tribunal hearing

How to get a transcript of a hearing: restrictions, how to apply, costs, complaints

www.gov.uk

 

[Sundial]

And if not careful they can even settle under your bed like little monsters -
and not even your trusted shredder would be able to cope!

Infestation, multiplying like little eggs

 

[Dotta]

Infestation, multiplying like little eggs

And never be tempted to buy half price shredders (on sale).

They might turn out to be phantom ones - appearing and disappearing at will

 

[gerbil]

And never be tempted to buy half price shredders (on sale).

They might turn out to be phantom ones - appearing and disappearing at will

You must never ever feed them after midnight.

 

[Sundial]

And never be tempted to buy half price shredders (on sale).

They might turn out to be phantom ones - appearing and disappearing at will

Gifted ones too.. was it established she bought it or was it her parents, do we know for definite? It’s irrelevant really in hindsight, but owning a shredder in this case has turned out to be one of her most disastrous household items, it seems. Who knew such a household item could become so powerful. Most ones I’ve had have had proper flimsy teeth on them.

Moo

 

[CS2C]

Apply for a transcript of a court or tribunal hearing

How to get a transcript of a hearing: restrictions, how to apply, costs, complaints

www.gov.uk

I have just requested a quote for the entire trial up to the present. If I am reading it correctly It costs £1.40 per 70 words !!

Let’s see what the estimate is…

 

[Sweeper2000]

If anyone needs a shredder that’s built for that job, won’t go missing and actively scares infestations of handovers away this is your go to resource. 20% off

TW 160PH Wood Chipper | 6" Road Tow Wood Chipper | Timberwolf

Timberwolf's popular TW 160PH 6" road tow wood chipper is the perfect wood chipper for those just starting out in the tree surgery business. Book a demo today.

timberwolf-uk.com

 

[Sweeper2000]

Dbm

 

[Sundial]

You must never ever feed them after midnight.

To be fair she was working nights a lot of the time to start with; perhaps that’s what it was. But then she allegedly just didn’t feed it at all. Poor thing its teeth must have gone rusty.

 

[Sundial]

If anyone needs a shredder that’s built for that job, won’t go missing and actively scares infestations of handovers away this is your go to resource. 20% off

TW 160PH Wood Chipper | 6" Road Tow Wood Chipper | Timberwolf

Timberwolf's popular TW 160PH 6" road tow wood chipper is the perfect wood chipper for those just starting out in the tree surgery business. Book a demo today.

timberwolf-uk.com

Blimey, that beast could eat a whole house, never mind dozens of handovers!! She’d never have any problem feeding that!!

 

[Sweeper2000]

Blimey, that beast could eat a whole house, never mind dozens of handovers!! She’d never have any problem feeding that!!

I bet she still would as well lol

 

[magikarpmagikarp]

This is a really critical point. My understanding is that if a contaminated product were found there would be a standard operating procedure for the hospital to follow. This would likely involve mandatory reporting to the manufacturer so a full investigation could ensue. The manufacturer would also issue a full batch recall post haste.

Do we know if the manufacturer were contacted? If not it begs the questions did the hospital even entertain the idea that the insulin had come from an external source? And if not why not?

Also what happened to those bags, where did they go?

Moo JMO if guilty.

I think it is very unlikely that the "insulin labs" were sent because of suspicion that the bags were contaminated. Transient neonatal hyperinsulinemia is actually pretty common, especially in growth restricted babies or infants of diabetic mothers. The treatment is a few days of dextrose or TPN infusion and a wean off. But when a baby has a persistently high or unexpected need for dextrose, there's a particular set of labs sent to evaluate the hormones regulating blood sugar. These labs must be taken while the baby's blood sugar is low otherwise they are meaningless. They take a few days to result and then are reviewed by an endocrinologist. Depending on what they show, sometimes the baby is put on medication for a few months while the baby's insulin production normalizes. This is much more rare but not unheard of. This is probably the reason the labs were sent. They incidentally provided an unexpected result which suggested exogenous insulin administration but that is most like NOT the reason they were sent.

When doctors send labs it's only because they want to do something with the information - to make treatment decisions. In the case of the two babies, their blood sugars normalized and then there were no further episodes of hypoglycemia. If there is no more hypoglycemia then there is no further reason to consult the endocrinologist or to make a decision about medication. Also those bags of fluid were long gone. So, by the time those results came, 1) there would have been no way to re-take them, and 2) it's possible the results were dismissed as specious or clinically irrelevant, since the babies had apparently recovered with no harm done. It would have been best if there had been any kind of follow up at all, but there was also incomplete information, hardly enough to even enter as a Datix. I actually don't think, at the time, that it was as big of a failing as it was made out to be now.

Again, just my opinion only!

edit- At least where I work, if we get a result that is crazy unexpected, our docs usually want to repeat the test before making treatment decisions. Those results may have only become meaningful in hindsight.

 

[Jayney404]

I think it is very unlikely that the "insulin labs" were sent because of suspicion that the bags were contaminated. Transient neonatal hyperinsulinemia is actually pretty common, especially in growth restricted babies or infants of diabetic mothers. The treatment is a few days of dextrose or TPN infusion and a wean off. But when a baby has a persistently high or unexpected need for dextrose, there's a particular set of labs sent to evaluate the hormones regulating blood sugar. These labs must be taken while the baby's blood sugar is low otherwise they are meaningless. They take a few days to result and then are reviewed by an endocrinologist. Depending on what they show, sometimes the baby is put on medication for a few months while the baby's insulin production normalizes. This is much more rare but not unheard of. This is probably the reason the labs were sent. They incidentally provided an unexpected result which suggested exogenous insulin administration but that is most like NOT the reason they were sent.

When doctors send labs it's only because they want to do something with the information - to make treatment decisions. In the case of the two babies, their blood sugars normalized and then there were no further episodes of hypoglycemia. If there is no more hypoglycemia then there is no further reason to consult the endocrinologist or to make a decision about medication. Also those bags of fluid were long gone. So, by the time those results came, 1) there would have been no way to re-take them, and 2) it's possible the results were dismissed as specious or clinically irrelevant, since the babies had apparently recovered with no harm done. It would have been best if there had been any kind of follow up at all, but there was also incomplete information, hardly enough to even enter as a Datix. I actually don't think, at the time, that it was as big of a failing as it was made out to be now.

Again, just my opinion only!

edit- At least where I work, if we get a result that is crazy unexpected, our docs usually want to repeat the test before making treatment decisions. Those results may have only become meaningful in hindsight.

Ok that makes sense, however, an investigation to identify the source would surely have been relevant once it was established that it was not infact transient neonatal hyperinsulinemia?

If the lab rang through the readings with urgency they must have had some level of certainty about their results. They would be running these tests frequently and this was a significant anomaly.

I appreciate now the fact the link would not have immediately been made as to how the administration of the insulin occurred. I also now understand why the bags would have been disposed of pre- results.

Despite these incidents occurring 9 months apart they should still in my opinion have warranted investigation. The lack of enquiry in these events seems purely due to the fact that (luckily) the babies recovered. I do however apppreciate that with the benefit of hindsight these things often seem more obvious than they are at the time of occurrence.

JMO imo if guilty moo etc

 

[magikarpmagikarp]

Ok that makes sense, however, an investigation to identify the source would surely have been relevant once it was established that it was not infact transient neonatal hyperinsulinemia?

If the lab rang through the readings with urgency they must have had some level of certainty about their results. They would be running these tests frequently and this was a significant anomaly.

I appreciate now the fact the link would not have immediately been made as to how the administration of the insulin occurred. I also now understand why the bags would have been disposed of pre- results.

Despite these incidents occurring 9 months apart they should still in my opinion have warranted investigation. The lack of enquiry in these events seems purely due to the fact that (luckily) the babies recovered. I do however apppreciate that with the benefit of hindsight these things often seem more obvious than they are at the time of occurrence.

JMO imo if guilty moo etc

I do agree there should have been SOME kind of follow up after each instance. Really, a Datix at the least. You don't have to solve the matter yourself but kick it down to the person whose job it is to look into these things.

With that said, the lab is required to phone through results above and below certain thresholds but the interpretation is reserved for the doctors. Phoning through means that on their end, in their lab, they are confident they have not made any errors in the processing of the sample, and the sample result is "out of range" (abnormal). But it does not mean there has not been some type of "pre-analytic" error either in ordering the lab itself (ordering labs which are not warranted by the clinical situation can introduce error to the whole process) or in the sample collection. So the labs are always interpreted in context of the whole situation.

The medical team sent labs that were warrented. They were looking for expectedly normal results or expectedly abnormal results. And instead, they got results that were unexpectedly abnormal. When that happens, the doctor will try to "correlate clinically" meaning look for confirmation that the result is accurate by examining the patient and the situation, and/or repeat the lab. As the baby had recovered, there was now no way to repeat the lab, there was nothing to examine in the situation (the bags or baby) and so at the time, in isolation, I can see how in each incident, an otherwise competent doctor might have dismissed that lab as now irrelevant and possibly in error. It looks like a single point of information. It turns out to be a mistake in hindsight, but if you weren't looking for contamination of the bags, that's not on the "differential" so to speak. Perhaps it should have been, but I honestly cannot fault them for it. I work in a fairly busy unit and send these "critical insulin labs" somewhat regularly. No one is ever looking for insulin overdose. If we got an unexpectedly abnormal result, I would expect the doctor to ask for a redraw the next time the baby exhibited low blood sugar. (This would be the first step in follow up.) If that never happens again, then the labs will never be repeated.

My guess is it took some time to get all the information on the same page where someone could see a pattern developing. Now there is more information and in light of that, these lab results take on new meaning.

As always, just my opinion.

 

[magikarpmagikarp]

I do wonder if there had been standing orders to repeat those insulin labs on both babies, only the babies never had low blood sugar again, and therefore the repeat labs were never done. JMO.