UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #4

[merrypason]

About the blotchiness, nothing can be explained IMHO if no one made photos of it. They were making photos of arms and legs for parents, how come no one made photos of the blotchiness?

Did you read the doctor's testimony of why there were no photos? Because by the time they came back with a hospital camera the blotchiness had disappeared.

You can't take medical photos of patients on a personal phone. There is protocol here - it's a hospital in the UK not some backwaters doctor's office. Data privacy and GDPR are very important, it could be a sackable or suspension worthy offence to take and save photos of body parts on anything but an official device or storage - that is secured and encrypted.

What the nurses were doing - well, that too would have been on a work device, not their personal phones. Synced up to an official hospital platform that allows these memory books to be securely created. If they did it on the parent's phone, that is completely different as it's their child.

Frankly this blotchiness being corroborated by a doctor and the head nurse is good enough evidence, as other cases have also had other nurses and doctors comment on it. I don't think even the defence is arguing the blotchiness didn't exist.

 

[JosieJo]

About the blotchiness, nothing can be explained IMHO if no one made photos of it. They were making photos of arms and legs for parents, how come no one made photos of the blotchiness?

There are now multiple people that have been on the stand saying they have never seen anything like it and describing it

 

[Charlot123]

I think it's more than just the tabloids, to be honest. All the papers seem to be doing it.

They've always done this sort of stuff. They know that it's inappropriate but they also know that they can get away with saying anything they like as long as its a factual quote from something said in court as court proceedings are privileged as regards defamation actions. All they need to do is to put quote marks around it and it's taken as privileged regardless of in what context the papers publish it.

But if they just says, “accused”, “alleged”, “suspected”. I understand, the prosecution and the lawyer may feel the need to be somewhat theatrical, although at the end, it bodes down to how many documents and witnesses each side has presented, and how convincing they are. But why spend the money on the lengthy trial, if the public opinion has already condemned her? And what if she is acquitted but the public is so incited that they revert to mob court after this?

 

[Charlot123]

Did you read the doctor's testimony of why there were no photos? Because by the time they came back with a hospital camera the blotchiness had disappeared.

You can't take medical photos of patients on a personal phone. There is protocol here - it's a hospital in the UK not some backwaters doctor's office. Data privacy and GDPR are very important, it could be a sackable or suspension worthy offence to take and save photos of body parts on anything but an official device or storage - that is secured and encrypted.

What the nurses were doing - well, that too would have been on a work device, not their personal phones. Synced up to an official hospital platform that allows these memory books to be securely created. If they did it on the parent's phone, that is completely different as it's their child.

Frankly this blotchiness being corroborated by a doctor and the head nurse is good enough evidence, as other cases have also had other nurses and doctors comment on it. I don't think even the defence is arguing the blotchiness didn't exist.

But without any evidence, how can any search or “neonatal rashes” be done? They say it is consistent with “air embolism”, and I would like to search this statement. I can’t blame the registrars or junior doctors because when the babies collapsed, they did what they could to save them. Makes me wonder, did they have a work device, though?

 

[Kittybunny]

But if they just says, “accused”, “alleged”, “suspected”. I understand, the prosecution and the lawyer may feel the need to be somewhat theatrical, although at the end, it bodes down to how many documents and witnesses each side has presented, and how convincing they are. But why spend the money on the lengthy trial, if the public opinion has already condemned her? And what if she is acquitted but the public is so incited that they revert to mob court after this?

Personally, I do not believe that many things are more worthy of spending public funds on than finding out the truth about how a number of helpless babies died. At the end of the day, this is not really prosecutors looking to railroad Lucy Letby - although certainly her fate hangs in the balance - it is about these families getting justice, if justice indeed needs to be meted out.

I do find the expert witness testimony quite compelling.

 

[merrypason]

But without any evidence, how can any search or “neonatal rashes” be done? They say it is consistent with “air embolism”, and I would like to search this statement. I can’t blame the registrars or junior doctors because when the babies collapsed, they did what they could to save them. Makes me wonder, did they have a work device, though?

Well that's for the defence to question and come up with alternative theories. But they haven't, maybe because there isn't one.

 

[merrypason]

Also we know in some of the other cases too other nurses and doctors noticed a rash. It's very hard to doubt a rash if multiple different people on different occasions have spotted it. So by the end of the trial, you may have a large list of witnesses to this rash, not needing a photo as evidence. In fact I think for one of the other cases, it was noted in the medical notes at the time as well.

 

[Marantz4250b]

I admit it’s difficult to get a full, clear picture of what is going on. But from what we’ve read, it’s interesting that the defence aren’t pushing too hard against the assertion that there was an air embolus (although they haven’t accepted it explicitly either)

They’ve been exploring the possibility that it could’ve been caused by other means such as the insertion of the line, CPR etc.

Yes they don't need to show that there wasn't one. They can't in any event as it seems that the x-rays shows that there was one.

The defence only need to remind the court (jury) that the prosecution has not shown that any air embolism got there via the unlawful act of the defendant. Which, as far as I can see, they are succeeding in doing as the prosecution has, as yet, shown no such thing.

 

[ShireChe]

I am not sure if I have got this right..but it seems to be suggesting that Child A had an x-ray showing what the expert says is an air embolism..yet for Child B who also had x-rays after a collapse there is nothing showing at all. Weren't the prosecution saying the same method was used in the cases of child A & B . If I am understanding this correctly it's certainly something to throw some doubts in there

 

[notsure]

It would be interesting to be informed how long these doctors/nurses had been working on the unit. Even after many years of experience in such a setting, there will always be conditions they have never seen before.

I think lay people often have the idea that a qualified doctor will know almost everything about every medical condition/complication, and nothing could be further from the truth!

 

[ConcernedThirdParty]

It's funny how we come away with different perceptions. To me, the last couple days testimony were much more a win for the defence.

The prosecution's opening statement framed it as the only explanation would be LL caused deliberate air embolism.

Yesterday we heard that Baby A's care hadn't been straightforward and significantly the first act LL or possibly her colleague did just after 8pm was connect up fluids which hadn't been given for the previous 4 hours.

Today we heard the expert say that air seen on the x-ray was consistent with air embolism but acknowledge there are various other possible causes. He acknowledged his sample size was very small, consisting of only 38 babies under 2 months of whom 8 showed similar gases. He confusingly stated there were "no unexplained cases" of gases in that location, despite also saying the explanation for some was "sudden unexpected infant death", which in layman's terms means "sometimes babies die unexpectedly and there isn't an obvious cause" or "unexplained" - which doesn't mean you couldn't find a cause if you looked or that they're all the same cause, but you have to decide how much investigating you're going to do for each death and it might be no amount would find the cause because the evidence is long gone. I'm not sure if he's suggesting there's a difference between this and SIDS/SUID apart from they have a theory the LL injected the baby with air - or why the defence didn't pick up on that - even to clarify what it meant for the benefit of the jury?

So far as regards the blotchiness - the camera was to be brought in for Baby B not A, it's B where it was documented. So far we have one doctor who said it was very striking and he'd never seen anything like it, but also completely forgot it and didn't remember it the second time he saw it either but only when being interviewed about the second case a few years later. We have one nurse who has just mentioned it and hasn't been cross examined yet. I don't doubt that this strange pattern appeared on Baby B. We'll wait to hear if the nurse also only remembered it much later.

In itself, it isn't significant at all though. If the prosecution expert witness can explain who the blotchy pattern isn't unknown to other doctors/nurses and what the identified cause was in those cases, it would add evidence to these babies dying of similar causes. Presumably the argument will be that this is a symptom of air embolism because although these doctors found it really strange, there are records of it in other cases of air embolism.

At that point, it begins to look a lot more likely that several of these babies died or collapsed from air embolism as the prosecution allege. That still doesn't get us very close to: "this was caused intentionally by someone".

We've also started to poke holes in a lot of the things the prosecution has alleged about notes being made to cover things up - we've acknowledged that retrospective notes are not unusual, and now that rough times are estimated after the fact and so there's nothing particularly unusual about notes seeming to suggest someone was in two places at once.

We have also begun to touch on why your signature appears on documents for patients other than your assigned patient and that it is fairly normal to conduct routine hourly observations for other nurses' patients.

 

[merrypason]

Yes they don't need to show that there wasn't one. They can't in any event as it seems that the x-rays shows that there was one.

The defence only need to remind the court (jury) that the prosecution has not shown that any air embolism got there via the unlawful act of the defendant. Which, as far as I can see, they are succeeding in doing as the prosecution has, as yet, shown no such thing.

But they have proven that, because 3 medicals experts Dewey, Bohin and now Arthurs have all concluded that considering everything the amount of gas in the baby and the fact it was by the base of the spine all point to it being deliberately administered air.

Then coupled with Dewey and Bohin's conclusions that the blotches could also only be caused by administered air further proves this was a deliberate act.

The defence has asked if the air could also be caused by other medical procedures and placement, like CPR, long line and the post mortem process. Arthurs said it could but also said he has never seen this amount of gas in a baby, and at the base of the spine which is why he believes it was administered.

The defence will now have to show expert testimony that the blotches could be caused by something else that would also show unusually high levels of gas seen in the unusual location by the spine, in the 4-5 cases of air embolisms that happened. Because the prosecutions experts have pointed to one conclusion and all the other witnesses say they've never seen this before.

So far they have not done that.

 

[Marantz4250b]

So, we are now two work weeks (less a day of legal discussion at the start) into this trial. The prosecution's evidence consists of a doctor speaking of unusual skin discoloration on baby A, which he didn't record at the time but several weeks, if not months afterwards, after having having his memory "jogged" when seeing it on another baby; a couple of nurses who saw it and some people stating that it was "consistent" with an air embolism.

Air embolisms clearly do happen (not common, but not uncommon either, and the manufacturer of a machine in use says they are a risk) and all these doctors and nurses have seen them before so why haven't they seen this colouration before? More to the point, how can they say that it's "consistent with" something which happens from time-to-time yet they have never seen it even though they have seen the condition they claim it is consistent with?

Even if it is consistent with an air embolism and even if the prosecution show that it can only result from same then they have still failed to prove, so far, that the AE was deliberately and unlawfully caused by someone who intended to do harm by doing it, let alone showing that that person was Lucy Letby.

Now, perhaps this is all going to be proved in the coming days and weeks but it appears to be remarkably "thin" at present. In fact, it seems to be drifting towards the "she was there so she must have done it" argument.

 

[merrypason]

So, we are now two work weeks (less a day of legal discussion at the start) into this trial. The prosecution's evidence consists of a doctor speaking of unusual skin discoloration on baby A, which he didn't record at the time but several weeks, if not months afterwards, after having having his memory "jogged" when seeing it on another baby; a couple of nurses who saw it and some people stating that it was "consistent" with an air embolism.

Air embolisms clearly do happen (not common, but not uncommon either, and the manufacturer of a machine in use says they are a risk) and all these doctors and nurses have seen them before so why haven't they seen this colouration before? More to the point, how can they say that it's "consistent with" something which happens from time-to-time yet they have never seen it even though they have seen the condition they claim it is consistent with?

Even if it is consistent with an air embolism and even if the prosecution show that it can only result from same then they have still failed to prove, so far, that the AE was deliberately and unlawfully caused by someone who intended to do harm by doing it, let alone showing that that person was Lucy Letby.

Now, perhaps this is all going to be proved in the coming days and weeks but it appears to be remarkably "thin" at present. In fact, it seems to be drifting towards the "she was there so she must have done it" argument.

It's not the air embolism itself, but the fact it was administered (meaning by force) to the babies that is being concluded by medical experts. Hence the x-rays shown today with gas at the base of the spine. That's what's unusual and differs from other natural cause or embolisms caused by accidental medical placement or procedures. Gas in the stomach - could be anything, gas at the base of spine in those quantities - not really.

You also now have a doctor, the senior nurse practitioner who is much more senior and experienced than a staff nurse like LL and the others commenting on the rash that Dewey and Bohin said could only be caused by administered air i.e deliberate. There is proof the doctor thought the rash was unusual, as did the nurse because they did call for a medical camera at the time and that has been recorded.

We know in other cases of the administered air, the blotches were recorded in medical notes, a parent remembers seeing them and other doctors and nurses have seen them too. And Arthurs has seen this level of gas at the spine on another one of LL's patients too.

 

[ConcernedThirdParty]

I am not sure if I have got this right..but it seems to be suggesting that Child A had an x-ray showing what the expert says is an air embolism..yet for Child B who also had x-rays after a collapse there is nothing showing at all. Weren't the prosecution saying the same method was used in the cases of child A & B . If I am understanding this correctly it's certainly something to throw some doubts in there

Baby B was alive and recovered - so one could argue that there may have been less air injected to start with, and/or that by the time the child was x-rayed the air had been cleared, hence the recovery - I assume we are talking about seeing bubbles on the x-ray but I can't say that I definitely read that or if that's me filling in blanks.

 

[JosieJo]

Did you read the doctor's testimony of why there were no photos? Because by the time they came back with a hospital camera the blotchiness had disappeared.

You can't take medical photos of patients on a personal phone. There is protocol here - it's a hospital in the UK not some backwaters doctor's office. Data privacy and GDPR are very important, it could be a sackable or suspension worthy offence to take and save photos of body parts on anything but an official device or storage - that is secured and encrypted.

What the nurses were doing - well, that too would have been on a work device, not their personal phones. Synced up to an official hospital platform that allows these memory books to be securely created. If they did it on the parent's phone, that is completely different as it's their child.

Frankly this blotchiness being corroborated by a doctor and the head nurse is good enough evidence, as other cases have also had other nurses and doctors comment on it. I don't think even the defence is arguing the blotchiness didn't exist.

Agree !

It's funny how we come away with different perceptions. To me, the last couple days testimony were much more a win for the defence.

The prosecution's opening statement framed it as the only explanation would be LL caused deliberate air embolism.

Yesterday we heard that Baby A's care hadn't been straightforward and significantly the first act LL or possibly her colleague did just after 8pm was connect up fluids which hadn't been given for the previous 4 hours.

Today we heard the expert say that air seen on the x-ray was consistent with air embolism but acknowledge there are various other possible causes. He acknowledged his sample size was very small, consisting of only 38 babies under 2 months of whom 8 showed similar gases. He confusingly stated there were "no unexplained cases" of gases in that location, despite also saying the explanation for some was "sudden unexpected infant death", which in layman's terms means "sometimes babies die unexpectedly and there isn't an obvious cause" or "unexplained" - which doesn't mean you couldn't find a cause if you looked or that they're all the same cause, but you have to decide how much investigating you're going to do for each death and it might be no amount would find the cause because the evidence is long gone. I'm not sure if he's suggesting there's a difference between this and SIDS/SUID apart from they have a theory the LL injected the baby with air - or why the defence didn't pick up on that - even to clarify what it meant for the benefit of the jury?

So far as regards the blotchiness - the camera was to be brought in for Baby B not A, it's B where it was documented. So far we have one doctor who said it was very striking and he'd never seen anything like it, but also completely forgot it and didn't remember it the second time he saw it either but only when being interviewed about the second case a few years later. We have one nurse who has just mentioned it and hasn't been cross examined yet. I don't doubt that this strange pattern appeared on Baby B. We'll wait to hear if the nurse also only remembered it much later.

In itself, it isn't significant at all though. If the prosecution expert witness can explain who the blotchy pattern isn't unknown to other doctors/nurses and what the identified cause was in those cases, it would add evidence to these babies dying of similar causes. Presumably the argument will be that this is a symptom of air embolism because although these doctors found it really strange, there are records of it in other cases of air embolism.

At that point, it begins to look a lot more likely that several of these babies died or collapsed from air embolism as the prosecution allege. That still doesn't get us very close to: "this was caused intentionally by someone".

We've also started to poke holes in a lot of the things the prosecution has alleged about notes being made to cover things up - we've acknowledged that retrospective notes are not unusual, and now that rough times are estimated after the fact and so there's nothing particularly unusual about notes seeming to suggest someone was in two places at once.

We have also begun to touch on why your signature appears on documents for patients other than your assigned patient and that it is fairly normal to conduct routine hourly observations for other nurses' patients.

I feel it may depend on whether they can show LL was dealing with babies not under her name when there was no need ..the prosecution touched on a lead nurse having to tell her to go back to her own babies ..or similar..so I'm interested to see what that is about.
Obviously there is not going to be a smoking gun here but I feel it will depend on if they can show without doubt the victims died in rare situations that were not a natural decline and that LL was the only person who could have done it.
I feel for the Jury it's a lot to take in ..I'll still be amazed if it runs its course till verdict with only 12 Jury left and the possibility of a hung verdict

 

[ConcernedThirdParty]

It's not the air embolism itself, but the fact it was administered (meaning by force) to the babies that is being concluded by medical experts. Hence the x-rays shown today with gas at the base of the spine. That's what's unusual and differs from other natural cause or embolisms caused by accidental medical placement or procedures. Gas in the stomach - could be anything, gas at the base of spine in those quantities - not really.

You also now have a doctor, the nurse practitioner who is much more senior and experienced than a staff nurse like LL and the others commenting on the rash that Dewey and Bohin said could only be caused by administered air i.e deliberate. There is proof the doctor thought the rash was unusual, as did the nurse because they did call for a medical camera at the time and that has been recorded.

We know in other cases of the administered air, the blotches were recorded in medical notes, a parent remembers seeing them and other doctors and nurses have seen them too. And Arthurs has seen this level of gas at the spine on another one of LL's patients too.

Do you have access to more information than was on the Chester Standard Live updates page? Because I didn't get a lot of that from the testimony today.

One mention a way back that it would have required some force to get air in through the long line - meaning I think that it's a narrow tube and it's long so if you want to push an air bubble through it requires some effort - not necessarily a lot in absolute terms, I think they were getting at it would be hard to do unintentionally/accidentally.

From what was quoted, the placement by the spine was not unusual in itself, he was just describing the location in this instance. The quantity of air he noted as unusual, and the only other case where he'd seen as much was another of the cases we're considering here. He also only reviewed 8 other unrelated cases of babies under 2 months, I'm not sure whether his reference for an unusually large quantity of air is the other cases he looked at in a study, or that he sees this often beyond that in clinical work and it struck him as unusual.

I also took his "natural cause" to be a bit of a weird use of the term, as he seemed to contrast it with a list that included car accidents (sure), infection (umm?) and SIDS/SUID (what????).

I also don't think we'll hear any of the medical experts claim that deliberate air embolism is the only possible explanation. That's why they keep saying it's "consistent with" this or that cause. A point I think the defence will be able to raise is that these cases were reviewed quite a bit before the police investigation and mostly found no definitive conclusion, it's only when approached by a police murder investigation with a list of unexplained deaths that may have been murder that these experts concluded that they were consistent with a number of methods that someone may deliberately kill and therefore the most likely explanation "in the absence of any other explanation" is etc etc...

 

[JosieJo]

So, we are now two work weeks (less a day of legal discussion at the start) into this trial. The prosecution's evidence consists of a doctor speaking of unusual skin discoloration on baby A, which he didn't record at the time but several weeks, if not months afterwards, after having having his memory "jogged" when seeing it on another baby; a couple of nurses who saw it and some people stating that it was "consistent" with an air embolism.

Air embolisms clearly do happen (not common, but not uncommon either, and the manufacturer of a machine in use says they are a risk) and all these doctors and nurses have seen them before so why haven't they seen this colouration before? More to the point, how can they say that it's "consistent with" something which happens from time-to-time yet they have never seen it even though they have seen the condition they claim it is consistent with?

Even if it is consistent with an air embolism and even if the prosecution show that it can only result from same then they have still failed to prove, so far, that the AE was deliberately and unlawfully caused by someone who intended to do harm by doing it, let alone showing that that person was Lucy Letby.

Now, perhaps this is all going to be proved in the coming days and weeks but it appears to be remarkably "thin" at present. In fact, it seems to be drifting towards the "she was there so she must have done it" argument.

What makes you feel the Dr's and nurses have seen air embolism before? It's quite rare

 

[JosieJo]

But they have proven that, because 3 medicals experts Dewey, Bohin and now Arthurs have all concluded that considering everything the amount of gas in the baby and the fact it was by the base of the spine all point to it being deliberately administered air.

Then coupled with Dewey and Bohin's conclusions that the blotches could also only be caused by administered air further proves this was a deliberate act.

The defence has asked if the air could also be caused by other medical procedures and placement, like CPR, long line and the post mortem process. Arthurs said it could but also said he has never seen this amount of gas in a baby, and at the base of the spine which is why he believes it was administered.

The defence will now have to show expert testimony that the blotches could be caused by something else that would also show unusually high levels of gas seen in the unusual location by the spine, in the 4-5 cases of air embolisms that happened. Because the prosecutions experts have pointed to one conclusion and all the other witnesses say they've never seen this before.

So far they have not done that.

Totally agree ..its a danger to ignore the medical experts...who are in this case certainly experienced ...unless the Defence can bring them down which at present they haven't...of course we await the defence evidence

 

[merrypason]

Except the defence hasn't raised or questioned most of these points you have made....they certainly haven't questioned him on any biases he may have because of it being a police investigation. In fact they haven't tried to discredit him in any way. Even after all their questioning and hypothesising he maintained his conclusion that it was administered air. His research started long before the police investigation in any case.

That's the only evidence the jury have so far. Credible expert testimony from 3 medical experts from different parts of the country, practice and reviewing different information - all of whom have said the air was administered. Professor Arthur in particular will come across very credibly as GOSH is the largest centre of research into children's health in Europe and also at the forefront of child health care in this country. His thinking and conclusions will be very powerful. I think the defence would struggle to find an expert as credible tbh.

The defence hasn't introduced reasonable doubt yet, because there's still no explanation for the blotches that also work for the air at the base of the spine. If I was on a jury, I would trust 3 medical experts over a defence lawyer....

Looking at one of the post-mortem X-rays, he highlighted to the court there was gas within the bowel, he said a normal feature, and also the heart.
Prosecutor Nick Johnson QC asked if there was anything unusual about the X-ray.
Dr Arthurs replied: "You can also see a line of gas just in front of the spine. That is an unusual finding."
He said such an image would not be seen in deaths by natural causes but had been documented in cases of road traffic accidents and sepsis infection.
"In my opinion this was an unusual appearance. In the absence of any other explanation this appearance is consistent with, but not diagnostic, of air having been administered," he said.

Mr Johnson asked: "Have you ever seen this much gas in a baby that has not been explained?" to which Dr Arthurs replied: "Only in one other case."

When Mr Johnson said: "One of the other children in this case?", the doctor replied: "That's right."

Dr Arthurs said he based his opinion on a published peer-reviewed study in 2015 which looked at how common it is that gas occurs in older children who have died, albeit with "very few babies" included in the study.
He went on to review the deaths of 500 infants at Great Ormond Street. Mr Myers says Prof Arthurs looked at 500 cases at Great Ormond Street Hospital, which after narrowing down the criteria, amounted to 38 babies aged under two months, and of those, eight had gases in the greater vessels"