UK - Nurse Lucy Letby, Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #27

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  • #761
It was testified to by Prof Arthurs in the case of baby D. One of the potential explanations for gases being found in the great vessels post mortem.
I wonder if someone on the defense team reminded the judge that he left that out?
 
  • #762
  • #763
Yesterday I entertained myself making möbius strips, and they represented this case clearly to me with the never ending loops of attacks and murders returning to LL
Obviously just playing with mathematics and therefore just my brain giving its opinion
 
  • #764






Dan O'Donoghue

@MrDanDonoghue

Judge Mr Justice James Goss will continue to sum up the evidence at the murder trial of nurse Lucy Letby today. Ms Letby is accused of murdering seven babies and attempting to kill a further 10 at the Countess of Chester Hospital between 2015 and 2016. She denies all charges


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2:28 AM · Jul 5, 2023
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  • #765
@MrDanDonoghue
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Judge Goss has moved to summarising the case of Child H. She was born prematurely in September 2015 and had breathing difficulties.

The prosecution said her case was "complicated" by "sub-optimal treatment" as there was an "unacceptable delay" in helping her and needles were left in her chest which may have punctured her lungs.

The court heard Ms Letby allegedly caused the girl to collapse on 26 and 27 September 2015, but she survived and went to make a full recovery.
 
  • #766
If any case might have some doubts, this case of Baby H could, because of the needles left in the chest. that is something that seems might cause a collapse, IMO. And is actually a real example of sub-optimal care.
 
  • #767
10:36am

The trial is due to resume this morning, after a delayed start.

10:46am

The trial is now resuming. Trial judge Mr Justice James Goss will continue his summing up of the case, referring to Child H.

10:52am

Child H was born in good condition on September 22, 2015 at the Countess of Chester Hospital, weighing 2.33kg (5lb 2oz), and was admitted to the neonatal unit.
Child H was very unstable into September 24, suffering desaturations, bradycardia and pnemothoraces. Dr Dewi Evans and Dr Sandie Bohin agreed Child H should have had surfactant earlier, and the judge says it is accepted that care was sub-optimal. There was also "an unacceptable delay" in intubation. They said although the pneumothoraces were a complication, and some of the sub-optimal care may have led to later pnemothoraces, none led to the later collapses of Child H on September 26-27, for which neither could find a cause.

10:57am

Child H was later transferred to Arrowe Park Hospital, where she improved, and had no further cardiac arrests. She returned to the Countess of Chester Hospital on September 30.
The prosecution say, acknowledging the sub-optimal care and challenges Child H faced, the coincidence of the collapses when Letby was present and being involved in Child H's care, the unexplained collapses, and Letby's interest in the family and other events, that she was responsible, by whatever method, for the collapses by deliberate harm on two occasions.
Letby denied harming Child H. She raised the issue of sub-optimal care, issues with the chest drains, and said there was a 'cumulative effect' for Child H which led to her collapses. The defence say an innocent explanation for the collapses cannot be ruled out.

11:05am

The judge details the events for Child H prior to September 26-27, which involved two chest drains being put in place in response to desaturations Child H had. The tip of the second chest drain moved around. In cross-examination, Dr Ravi Jayaram said the second chest drain tip would not come into contact with the heart, and it was "very unlikely" it would come into contact with the sac around the heart, and he had not heard of any event where that had happened.
Letby had messaged Sophie Ellis on September 25 saying it was 'pretty bad so far' how busy the unit was. In evidence, she said she had come across chest drains in Liverpool where the drains were stitched in, but not in Chester, and no-one seemed familiar, and a third chest drain had to be obtained from a children's ward.

 
  • #768
Dan O'Donoghue

@MrDanDonoghue
·

Judge Goss says the Crown's case is that while recognising Child H had 'a challenging condition and sub optimal care', the jury is urged to look at the overall picture and the coincidence of Ms Letby being on the ward and having involvement with Child H when she collapsed

He says the prosecution has said given Ms Letby's interest in the family and collapses when she was working, they - according to the Crown - can be 'led to the sure conclusion that however she did it, the defendant was responsible for the sudden and life threatening collapses'
 
  • #769
11:12am

Dr Alison Ventress said the second chest drain on September 25-26 had 'amost fallen out', and Child H's oxygen requirements gradually increased.
Dr John Gibbs said "unusually", Child H had developed another tension pneumothorax, and the two chest drains were blocked with serous fluid, and a third chest drain was inserted. Both Dr Gibbs and Dr Jayaram said drains can become blocked. There was then "a marked improvement", the judge tells the court, for Child H.
Letby said, in evidence, ruled out staffing levels as an issue, but said there was "potential incompetence" in relation to where the chest drains were located. She recorded at 2210 Child H had a desaturation at the time of the heel prick, and serous fluid++ was recorded on the drains. She added the SHO was informed. There was no note by an SHO. The prosecution say Letby falsified notes, and there was an error on the timing on the blood transfusion note. Letby, in evidence, said these were mistakes, and she was not deliberately fabricating them. She denied sabotaging the drains, and said they had not been stitched in place.

 
  • #770
11:26am

At 3.22am on September 26, Child H collapsed, and full resuscitation began. Child H quickly improved and resuscitation was stopped.
The cardiac arrest had 'no obvious pneumothorax' and there was no evidence of fluid around the heart, a blood clot, and Child H's temperature was normal. Dr Gibbs concluded the event was caused by hypoxia (lack of oxygen), but the explanation for that was not clear.
Child H had chest drains and was deemed 'unstable' for transport, so remained at the Countess of Chester Hospital or September 26-27, when she collapsed at 12.55am on the latter day.
Dr Matthew Neame said his recollection was when Child H collapsed, Letby was Neopuffing her, and assumed she was Child H's designated nurse that night [Shelley Tomlins was the designated nurse for Child H that night]. He noted thick secretions blocking the ET Tube.
Shelley Tomlins had noted Child H had a 'profound desaturation to 40% despite equal bilateral entry and positive capnography.'
Letby, in cross-examination, was referred to text messages of her involvement with Child H that night. She said she had been assisting that night.
Child H had another collapse at 3.30am and Dr Neame responded, and believed Letby was present. Child H was reintubated and her oxygen level and heart rate remained low.
Dr Satyanarayana Saladi had been called to assist with the resuscitation, and contacted a consultant at Arrowe Park as there was no explanation for the collapse.
A blood test revealed a raised result for an infection marker [CRP levels], and Child H was transferred to Arrowe Park.

11:29am

Letby, in police interviews, recalled caring for Child H as she had chest drains in. She did not recall where she was when the first profound desaturation took place. She thought the cause could have been some form of airway problem. She was unable to explain the collapse and denied deliberate harm. She agreed she had searched for Child H's mother on Facebook, but did not know why.
Letby, in evidence, denied she was 'bored' on her shift, and said the timing of her messages could have meant she was on a break. She denied having interfered with Child H's tubes on any occasion.

 
  • #771
11:36am

Dr Evans said it was unusual for a baby to have three chest drains. He said the deterioration of Child H would have been much more gradual if she had had infection.
He said a pneumothorax was a complication of Child H's clinical condition. He said the overall picture for Child H was that she 'improved significantly and quickly' when responding to treatment.
Dr Bohin noted the presence of respiratory distress syndrome, and that had surfactant been given earlier, that would have reduced, but not removed, the likelihood of a pneumothorax developing. There was an 'unacceptable delay' in the first intubation, and a needle 'may have punctured lung tissue'.
The collapses on September 26 and 27 mirrored each other in having no obvious cause and were not quickly resolved, Dr Bohin had said. She could not identify any cause for these "significant collapses".
Prof Owen Arthurs said the radiograph images showed a recurrent pneumothorax. He said there was 'no ideal position' for a chest drain. He said there was movement of the second chest drain. He said they are not known generally to cause bradycardias, particularly in neonates.

 
  • #772
11:41am

The judge refers to the case of Child I, born on August 7, 2015 in Liverpool Women's Hospital, before being transferred to the Countess of Chester Hospital on August 18, "where she was expected to improve with no ongoing concerns".
Child I died on October 23 in the hospital. The prosecution case is on four occasions, Child I suffered sudden and unexplained episodes, and a consequence of deliberate harm by Letby. They say the final event caused her death, and Letby is responsible for murder.
Letby says she did not harm Child I on any occasion, and whatever the causes of her deteriorations, she was not responsible. She said there were periods when Child I desaturated and was being treated for infection, suspected infection and suepcted NEC.
The prosecution say for three of the four events, Child I rapidly recovered, and the other desaturations and infections are explicable.

11:49am

The judge refers to an event in late August 2015, when Letby was not on duty, when Child I had a distended abdomen and an NG Tube dislodged. Dr Bohin, in cross-examination, said this decline differed from later events, and Child I had slowly deteriorated due to signs of infection and needed the use of a ventilator. Child I was returned to Liverpool Women's Hospital with suspected NEC. While there, she had a profound bradycardia, with her airway found to have large secretions in the ET Tube. Child I recovered from the episode.

 
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  • #773
Dan O'Donoghue
@MrDanDonoghue
·

Judge Goss says the Crown's case is that while recognising Child H had 'a challenging condition and sub optimal care', the jury is urged to look at the overall picture and the coincidence of Ms Letby being on the ward and having involvement with Child H when she collapsed

He says the prosecution has said given Ms Letby's interest in the family and collapses when she was working, they - according to the Crown - can be 'led to the sure conclusion that however she did it, the defendant was responsible for the sudden and life threatening collapses'

Judge Goss is now summarising the evidence for the case of Child I. She was born prematurely at Liverpool Women's Hospital and transferred to the Countess of Chester on 18 August 2015. On 30 September, she needed emergency attention after she vomited and her heart-rate dropped.

She collapsed again on 13 and 14 October, before a fatal deterioration on 23 October. A medical expert for the prosecution told the court she had been "been subjected to an infusion of air", which prosecutors said Ms Letby had administered

Judge Goss says the Crown's case is that Child I died as a 'consequence of her being deliberately harmed by the defendant', they say the jury can rule out natural causes for her fatal collapse

Judge Goss says 'the defendant's case is that she did nothing to harm (Child I) on any occasion, whatever the cause of her desaturations she was not responsible'
 
  • #774
11:56am

The judge refers to the first of the four events, on September 30, when nursing staff were "very happy" with Child I at this point.
Lisa Walker carried out a skin patch test on Child I that day, which she would not have done if Child I was not well.
On September 30, Letby was the designated nurse for Child I and two other babies in room 3 for the long day. Letby said, in evidence, she did not do anything to cause the event for Child I.
Dr David Harkness said in agreed evidence, other than being pale and a slightly enlarged abdomen, there was "nothing to worry about". Dr Elizabeth Newby said they were at a plan of establishing feeds.
The judge refers to the target weight gain for babies. Child I was at the lowest percentile end. Dr Newby said Child I's weight was low, and dropped down the percentile guidelines, but there had been numerous events in life when they had been unable to feed Child I due to adominal distension. Dr Bohin said it was "no surprise" Child I's weight was low, and Child I was unable to be fed as she had been ill.

12:09pm

The trial judge says he will not be going beyond 4pm today or tomorrow on his summing up, and apologises to the jury for the late finish yesterday. He says he will confirm timings next week when, it is expected, the jury will go out to consider verdicts.

 
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  • #775
12:20pm

The judge says Letby had noted, of Child I's abdomen: "mum feels it is more distended to yesterday and that [Child I] is quiet". In evidence, she said Child I waking for feeds was for the 10am feed. At an addendum, Child I was 'reviewed by Drs at 1500 as she was mottled and montoring was recommenced'. There was no corresponding doctor's note. In evidence, Letby said she believed it had been a male doctor, and it was the same name given when she was interviewed by police.
She denied force feeding and causing a vomit for Child I. The mother of Child I had, by the time of the desaturation, left the unit and the father was at work. Child I desaturated and had a large vomit at 4.30pm, after a feed recorded by Letby of '35ml via NGT' at 4pm.
A doctor had made a note for Child I's event, where Child I had dropped to 30% saturation, but by the time he arrived, Child I was breathing well and was pink, and the chest signs were clear. The abdomen was a little distended.
Bernadette Butterworth recalled Child I's heart rate dropping and she desaturated, and required Neopuff. She saw Child I's stomach distending, and milk and 'air+++' aspirated.
Letby said she did not know why so much air was aspirated. She said, in evidence, she had not pumped Child I full of air.
Dr Harkness saw Child I that night, and Child I was breathing well for herself, and a blood test showed no obvious signs of infection. She did not like being handled.
Nurse Ashleigh Hudson noted Child I was stable on October 1.

12:23pm

By October 12, Child I's feeds and weight were up, with feeds given every four hours of about 55ml of milk.
At 1.30am on October 13, she took a 55ml bottle feed.

 
  • #776
12:31pm

For the second event, the judge says Ashleigh Hudson noted Lucy Letby saying Child I looked quite pale. When the light was turned on, Child I looked very pale, and the monitor was not sounding. Neopuffing was established, heart rate in 50s.
Letby wrote her note later, and the judge says she would have been able to see nurse Hudson's note at the time of writing. Letby: 'Child I noted to be pale in cot by myself...SN Hudson present. Apnoea alarm in situ and had not sounded...minimal shallow breaths followed by gasping observed'.
Child I was given a blood transfusion. An x-ray showed "marked gaseous distention of bowel loops." A blood test showed no bacterial growth after 5 days.
Ashleigh Hudson confirmed she had given Child I a feed at 1.30am, and Child I 'seemed very stable' and her waking for feeds was "really encouraging".
She had assisted Laura Eagles with a procedure for about 15 minutes. She would not have left Child I alone if she was unstable, and would have asked a colleague to keep an eye on the baby. The other colleague on duty, Caroline Oakley, has no memory of being asked to do this.
In evidence, nurse Hudson said Letby was standing in the doorway, standing 5-6ft away from the cot, the light was switched off, and the corridor light provided some illumination. There was a canopy over the upper part of the cot, and blankets were on Child I. She switched the main light on, and was closer to Child I than the defendant, and could see Child I was pale. She pushed back the canopy and blankets to tend to Child I. The apnoea alarm had "not sounded" and the deterioration was "very surprising".

12:35pm

Letby, when interviewed, remembered the event. She said when she and nurse Hudson went into the nursery room, they put the light on, and saw Child I was pale.
She denied injecting air into Child I's stomach. She thought they were at the doorway and had just put on the lights, and the nursery "was never that dark that you would not be able to see the baby".
In second interview, she said "maybe I spotted something that Ashleigh wasn't able to spot". She said from her position, she noted Child I was pale.
In her evidence, she was asked how she could spot Child I - 'she knew what she was looking for', which she corrected to 'at', the judge says.
In evidence, she said she could not recall looing after Child I prior to this event. She recalled herself and nurse Hudson going into room 2 together, and could see Child I's face and hands. Child I was 'gasping and shallow breathing', so the alarms didn't go off. She remembered telling nurse Hudson was 'a little pale'. She said room 2's lights were on a dimmer switch, and it was not as dark as a photo identified by Ashleigh Hudson in evidence.

 
  • #777
12:39pm

Dr Elizabeth Newby said she was called to the room. As she arrived, she passed Letby in the corridor.
Resuscitation took place on Child I, and it took 12 minutes before signs of life were detected. She said it was "definitely a serious state of affairs".
The ETT was seen, by Dr Matthew Neame, to be too far in, and the NGT was also not in the right position.
By the following day, Child I was seen by Dr Harkness and assessed to be 'sick but stable'.

12:47pm

The judge refers to the third event for Child I on October 13-14.
Child I was in room 1.
Dr Neame reviewed Child I, who was 'settled and pink', with breathing 'a bit squeaky' - normal in ventilated babies, the abdomen distended but soft.
Letby noted for Child I on October 14: 'At 05:00hrs abdomen noted to be more distended and firmer in appearance with area of discolouration spreading on right hand side. Veins more prominent'. The judge says there are no corresponding medical notes for this.
Child I 'grimaced' on Dr Neame palpating the abdomen, which was noted to be mottled and distended. His impression was that the increasing abdominal distention caused the lungs to be "squashed". The increased tenderness and skin discolouration stood out to him. He consulted Dr Jayaram, who was told of the distention, and it was decided to continue with the ventilator settings. After Dr Jayaram consulted Alder Hey Children's Hospital, they said they would contact the Countess of Chester Hospital with a plan in the morning.

12:50pm

Child I had a cardiac arrest at 7am. Shelley Tomlins noted Child I was pale and veiny, with 'slightly greyish discolouration', and Dr Neame thought the swollen abdomen was squashing the lungs. By the time Dr Jayaram arrived, Child I was stable. An x-ray showed no evidence of a pneumothorax.
Letby, in evidence, said she did not have any recollection of the shift, other than from the notes. She agreed the signs were initially good for Child I. She said she had not inflated Child I with air or sabotaging her.

12:55pm

Child I 'responded very quickly' to treatment, and stabilised after being transferred to Arrowe Park on October 15. She returned to the Countess of Chester Hospital on October 17.

12:56pm

The judge reminds, and stresses, the jurors of their obligation not to research the case, and not to discuss it among themselves before their deliberation.
 
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  • #778
12:56pm

The judge reminds, and stresses, the jurors of their obligation not to research the case, and not to discuss it among themselves before their deliberation.

So,
it seems the Jurors are forbidden to talk about the case among themselves, even when all together separate from others (before formal deliberations).

Also,
did the Judge hint that his Summing Up might proceed into the next week?
That was my impression.
 
  • #779
12:39pm

Dr Elizabeth Newby said she was called to the room. As she arrived, she passed Letby in the corridor.
Resuscitation took place on Child I, and it took 12 minutes before signs of life were detected. She said it was "definitely a serious state of affairs".
The ETT was seen, by Dr Matthew Neame, to be too far in, and the NGT was also not in the right position.
By the following day, Child I was seen by Dr Harkness and assessed to be 'sick but stable'.

12:47pm

The judge refers to the third event for Child I on October 13-14.
Child I was in room 1.

It's a good job what the barristers say is not evidence.

Myers told the jury that there was no NG tube in place. :rolleyes:
 
  • #780
2:00pm

The trial is now resuming following the lunch break.

2:08pm

The trial judge is resuming the summing up in the case of Child I, and refers to the fourth and fatal event.
Child I was pronounced dead on October 23, at 2.30am.
Child I was not an intensive care baby but was in room 1 as a precaution, the court is told.
Designated nurse Ashleigh Hudson had agreed Child I was 'settled and stable' the night of October 21-22. The following day, Child I remained nil by mouth, and was unsettled at times - as recorded by Caroline Oakley - but settled with a dummy. Her cares were attended to by Child I's mother.
For the night of October 22-23, Ashleigh Hudson was again the designated nurse for Child I. Letby said she did not recall, in evidence, much of the night shift when Child I died. She said staffing levels might have played a part.

 
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