UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #5

[kittythehare]

Most likely yes.
But ...if the person just wanted to cause a collapse by injecting a smaller amount of air ?
If they did die because of the act that would be murder albeit the intention was only to cause serious harm

Prem babies?
You will kill them with any amount of air.
But re the point you are making, a crisis could be caused by several interventions not involving the injection of any substance including air.

 

[JosieJo]

Prem babies?
You will kill them with any amount of air.
But re the point you are making, a crisis could be caused by several interventions not involving the injection of any substance including air.

Yes of course ...my only point was someone "could" potentially insert less air if the intention was not to kill .but to cause harm

 

[JosieJo]

“With intent to kill or cause GBH” I would also assume you are not suggesting she didn’t have the intention to kill but to cause GBH? which is relevant to what I was saying in those 9 cases of AE.

As I said yes ...the intention does not "have" to be to kill ...I'm also surprised you didn't know

 

[Observe_dont_Absorb]

Injecting air via any route or mechanism is an intention to kill.
There is no way to spin it.

Not if equipment is faulty or it was done unintentionally

 

[Sweeper2000]

Prem babies?
You will kill them with any amount of air.
But re the point you are making, a crisis could be caused by several interventions not involving the injection of any substance including air.

Yeh that’s my point as well, with nothing at all to indicate she was doing this for the drama or attention that comes with the collapses which would be munchausen the only other explanation is she desired to kill. If she did why didn’t she use more lethal means known to her in all cases rather than just some. And if she did have the intent why would she give smaller doses?

Yes of course ...my only point was someone "could" potentially insert less air if the intention was not to kill .but to cause harm

Sorry didn’t mean to be rude.

 

[kittythehare]

Not if equipment is faulty or it was done unintentionally

To inject air, a syringe must bee primed, attached and pushed.
An exception might be if an IV line had disconnected and was reconnected to the patient without eliminating air in the line.
It's impossible to do it unintentionally because these matters are high priority training issues.

 

[MsBetsy]

I think that’s how I have it and wasn’t referring to the counts. I was referring to the counts with either stomach AE or AE as a supposed method. 9 out of 17 children are said to have received some form of air being inserted as a means to kill. Out of those 9 seven are fatalities and I’m trying to ascertain why some but not others recovered. Kind of working with the theory that less than 4ml was administered in those two explaining the recoveries. It’s my belief those two do not fit with the alleged method or the thought that a certain amount of air was deliberately measured because presumably if it had been it would have been fatal.

Oh, I see. I think it stands to reason that some babies may have been stronger than others.

Even as a tiny baby, there is a natural instinct to fight for survival, imo.

In some cases a delay in calling for help may have played a role. I would think 'seconds' matter.

LL must have been standing by Baby K's incubator for at least a minute when Dr J found her there, doing nothing.

 

[BabaVanga]

Not if equipment is faulty or it was done unintentionally

Everything seemed to work perfectly fine when Lucy wasn’t around

 

[Music2022]

with nothing at all to indicate she was doing this for the drama

Not sure, from her texts it seems to me she likes the drama afterwards the pity/admiration of how tough her job it. Woe-is-me type of attention seeking maybe? So yeah not the typical attention seeking but maybe something a bit different, pity seeking?

 

[gill1109]

One reason might be because it didn't work the first or second time for some babies. Baby I had large amounts of air deliberately administered into her stomach via a naso-gastric tube.

She was attacked four times before finally dying, the last attempt with air injected directly into her bloodstream.

So maybe different amounts were used each time until finally working? I wouldn't think it would take much, though.

It seems Baby I was also a 'fighter.'

Hold it @MsBetsy, you are repeating the claim of the prosecution. The defence does not agree with this interpretation of the facts, such as they are. I wasn't there and have no idea. An important principle is "innocent till proven guilty".

 

[Sweeper2000]

Hah it is himself, hello DR Gill and welcome. It’s going to be very interesting to have your expertise in this discussion. Thanks for posting.

We are currently trying to figure out if there is any pattern amongst the tragic fatalities and seeing if there is any escalation of “lethality of method”. It’s not looking likely IMO. The case msbetsy was referring to was one of a few instances where there is allegedly multiple attempts on the same baby suggesting concerted efforts on the part of the accused if guilty. It’s hypothetical atm.

 

[Dcflag]

Firstly we have no idea if her intention was to kill ..or to cause serious harm ...or maybe she didn't care either way as long as she got what she needed ...whether that be ..drama ...sympathy..or whatever "rush" she got ...if she did this.

We do not know if she was interupted? In the times she administration less air ?

We do not know if it was a quick decision and she grabbed the nearest syringe

It the scheme of things it doesn't really matter

The important factors are surely..were the deaths due to foul play and if so is LL the only person who could have carried it out

I’ve been thinking along these lines for a while actually. What if the intention was never to kill, but that killing was a welcome by product of the destruction she was causing

Of course you could argue that by administering air or unneeded insulin is an intent to kill because it makes the likelihood of death a real possibility. But she could actually be craving the response from serious health implications or death from parents and colleagues around her rather than the actual death itself.

I also think when she’s gone into the parents and asked them if they want to put him in a basket. It was her way of finding out if he was dead yet without suspiciously asking anyone if he had yet died. It does seem important to her to know (for example when the baby was transferred and she was surprised to see he was leaving alive)

I think someone has mentioned it before, but grief tourism.

 

[gill1109]

Everything seemed to work perfectly fine when Lucy wasn’t around

The prosecution has selected occasions when Lucy was around and when (in retrospect) everything did not seem to work perfectly. Deeply upsetting things happen all the time in a neonatal ward, and in some hospitals more than others. The prosecution has not taken on the services of a statistician to find out if it is actually true that bad things happened more often when Lucy was there, taking account of all relevant factors. And even if a statistically significant correlation could be found, that does not prove causation, since correlation can also be caused by not-controlled-for and possibly unknown confounding factors.

I don't have an opinion as to whether Lucy is innocent or guilty. I am worried that the investigations into LL might have been severely afflicted by bias.

 

[MsBetsy]

Most likely yes.
But ...if the person just wanted to cause a collapse by injecting a smaller amount of air ?
If they did die because of the act that would be murder albeit the intention was only to cause serious harm

I would expect this to be the case if the motive was munchausen by proxy. Not clear on motive yet, but I'm starting to think it may be two-fold.

 

[Legally Bland]

10:34am

The trial is now resuming, with Dr John Gibbs giving evidence.


10:39am

Philip Astbury has one more question to ask for the prosecution, about monitors in place at the neonatal unit in June 2015.
He asks Dr Gibbs if such monitors record the displayed readings, for people to look up a potential archive of readings. Dr Gibbs says he isn't sure, but doesn't think they did. He adds he hasn't done so, in his practice.

10:43am

Ben Myers KC, for Letby's defence, is now asking Dr Gibbs questions.
He asks about the staffing arrangements in place at the hospital at the time.
Dr Gibbs says at the time, he is fairly sure the paediatrician of the week on a rota would cover the children's ward and the neonatal ward. They would not have any planned clinics for that week. Other consultants would cover during the night, as that paediatrician could not cover a 24/7 week, the court hears.

10:47am

Dr Gibbs said the workload would depend on need, and consultants would spend more time on the paediatric ward as there would be much more turnover there than the neonatal unit.
Mr Myers asks if Dr Gibbs would agree consultant cover was stretched during 2015-2016
Dr Gibbs said more consultants arrived after June 2016, but they had been requested for several years.
The consultant cover at the time was "fairly typical" for a level 2 unit, the court hears.

10:51am

Dr Gibbs said the addition of two consultants "had been planned" for many years.
He said "every speciality wants more staff", as did a lot of hospitals, given the context of the staffing pressures of the NHS overall.
"We wanted to increase the number of staff so we could reduce the number of hours".
Mr Myers says the two consultants arrived after the Countess of Chester Hospital was reduced to a level 1 neonatal unit in June 2016.
Dr Gibbs says that is the case, but the two were not linked.

10:54am

Mr Myers asks about Child C being 'on the limit' with birth weight.
He asks whether it would be "almost inevitable" Child C would have faced complications, and asks if in hindsight, Child C should have been cared for at a tertiary unit.
Dr Gibbs: "That depends on what causes sudden and unexpected collapses [leading to his death]."
Mr Myers asks, taking that aside, should Child C have been cared for at a tertiary centre.
Dr Gibbs: "No."

10:58am

Mr Myers asks about the billious aspirates found.
He says if a baby is producing dark bile, if that is a concern.
Dr Gibbs: "It raises some concern, yes."
Mr Myers: "It's potentially serious, is it not?"
Dr Gibbs: "No - it comes from acid reflux...some normal premature babies [produce bile aspirates]."
He adds that is why an antacid was administered to Child C.

11:08am

Mr Myers produces a nursing note from Yvonne Griffiths, which refers to, on June 12, 2mls of 'black stained fluid', plus 'bile on blanket'.
Dr Gibbs says he would have been concerned if Child C had continued to vomit bile, and there was a lot of it.
Mr Myers produces the intensive care unit chart for June 12, showing 'vomit dark bile' at midnight.
He asks if it is a matter for concern.
Dr Gibbs says there is one note of vomit, and says that is a worry, but would be more concerning if it was repeated.
The intensive care unit for June 13 is presented, showing more dark bile readings.
Dr Gibbs says there are no more vomit readings, and the June 13 readings are from aspirates, which can be common in premature babies.

11:12am

Dr Gibbs says the aspirates were not increasing from 0.5ml on June 13.
He said the baby would be examined first, with an examination of the abdomen.
Mr Myers asks if there was a possibility of something other than NEC Child C could have had.
Dr Gibbs says NEC was "a particular risk", but there could have been an obstruction in the body, and medical staff would not have just been focusing on looking for symptoms of NEC.

Recap: Lucy Letby trial, Tuesday, November 1

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

 

[Legally Bland]

11:26am

A diagram of the small and large intestine is presented to the court.
Mr Myers asks about the passage of air, and refers to radiograph images for Child C, one taken on June 12, and the accompanying note refers to 'marked gaseous distension of the stomach and proximal small bowel'.
Dr Gibbs says there is 'not much air in the large intestine' shown.
Mr Myers asks if there is an obstruction.
Dr Gibbs says it is a possibility, and the air seen is common for babies on CPAP ventilation.
Mr Myers asks if there is an intestinal blockage.
Dr Gibbs says it is a possibility.
Mr Myers says a symptom of intestinal blockage is vomiting dark bile.
Dr Gibbs says there is only one recorded instance of that, and the symptom would be 'repeated vomiting'.
He says a sign of an intestinal blockage would be a 'very distended abdomen', and when he examined him on June 13, Child C had a 'soft, not distended abdomen'.

11:27am

Dr Gibbs adds the amount of dark bile aspirates, in the case of an intestinal blockage, would increase, and that was not the case with Child C.

11:35am

Dr Gibbs says an obstruction is "a possibility", but "not the explanation".
Mr Myers asks if not looking to see whether Child C had a potential obstuction, in view of vomiting dark bile, was "a potential mistake".
Dr Gibbs repeats there was not repeated vomiting, and dark bile aspirates would be found in normal babies.
The court hears Child C did not have his bowels open during his life.
Dr Gibbs says that was not surprising as he had not been fed.
Mr Myers asks if that was unusual, after three days, for the bowels not to open.
Dr Gibbs said it could be unusual, but Child C had not been fed, so there were not going to be bowel motions.

11:39am

Mr Myers asks if it would have been preferable for Child C to have been examined by a senior consultant prior to June 13.
Dr Gibbs: "It would have been preferable if there had been significant concerns about him, and he had not already been reviewed by the registrar and junior doctor."
Dr Gibbs said he would have carried out daily reviews, without a full examination, of neonatal unit babies.

11:42am

Mr Myers asks about Child C's collapse.
He says Dr Gibbs intubated Child C at the first attempt, and said Dr Gibbs had told the court intubation was more effective than Neopuff.
Dr Gibbs said it was more effective during prolonged resuscitation attempts, and Neopuff by itself was effective too.

11:42am

Dr Gibbs said even if he was unable to intubate Child C, Neopuff administration could have continued.

Recap: Lucy Letby trial, Tuesday, November 1

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

 

[Legally Bland]

11:48am

Mr Myers asks about the debriefing notes written by Dr Gibbs on July 2, 2015.
He says no mention is made about the dark bile aspirates.
Dr Gibbs says that is correct.
Mr Myers asks if if is a consideration on the notes that could later be seen as part of legal action, and would that be something Dr Gibbs would be aware of.
Dr Gibbs said the purpose of the debriefings was for the benefit of future patients, not for lawyers.

11:50am

Philip Astbury asks about hours worked by Countess staff.
Dr Gibbs said the long hours worked were a "widespread problem" in the paediatric network, but the quality of care for patients was not diminished.
He added: "It would be better for a consultant to be available every day to carry out comprehensive reviews."
He said that was the case in most units in the UK.

11:52am

Asked about the dark bilious aspirates and the one case of vomiting, Dr Gibbs said Child C was not a cause for concern as the abdomen was soft and the other observations were normal.

12:16pm

We have had a short adjournment.
The prosecution is now reading out agreed evidence statements.
The first is from Dr Andrew Brunton, a specialist trainee in paediatrics at the Countess of Chester Hospital at the time of June 2015.
He discussed Child C's clinical situation at birth (weighing 800g) with a consultant, who was happy for Child C to be treated at the Countess of Chester Hospital, but that situation would be kept under review.
He noted inserting a UVC into Child C.
He was not on duty at the time of Child C's collapse.

12:24pm

An agreed evidence statement from nurse Bernadette Butterworth is read out.
She recalls seeing the UVC had come out of Child C, which was not a usual sight, and his blanket was wet.
She was designated nurse for Child C for the night shifts of June 10-11 and June 11-12.
On the first shift, she recalled recording readings which included rapid breathing, and the incubator temperature was reduced.
Child C was 'unsettled at times', and oxygen of 'up to 37%' was required to maintain saturation levels.
A further note was made to say the UVC 'continued to ooze'.
The note concludes 'will discuss increasing feeds due to large urine output, continue to observe oozing'.
The nurse said she noted Child C was 'unsettled' and 'poorly' at that time, and on antibiotics.
Child C 'was the same at the end of the shift' as he had been when the nurse began the shift at 1am.

12:30pm

The nurse's notes from the following night are presented to the court.
Child C required varying oxygen support, and continued to breathe at an increased respiratory rate.
The UVC was found, at one point, to be 'out and damp', so had not been out for long.
She noted the abdomen appeared distended, 'soft to firm, not hard, bowels not opened, minimal aspirates'.
Child C was "unsettled at times" and required increased oxygen support after handling.

Recap: Lucy Letby trial, Tuesday, November 1

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

 

[Legally Bland]

12:39pm

The nurse says, for the abdomen readings, they were 'distended but soft to firm', and nurses always check for symptoms of NEC.
The distended abdomen can be a sign of the consequences of using CPAP - 'CPAP belly'.
The nurse said from her notes on her night shifts, Child C had minimal, clear aspirates.

12:49pm

Dr Dewi Evans, independent medical expert, has now returned to court to give evidence in relation to Child C.

12:52pm

Nicholas Johnson KC, for the prosecution, asks Dr Evans to confirm he has made a number of reports for Child C, made between 2017 and September 2022. Dr Evans confirms that is the case.
Dr Evans confirms he was sent records from Alder Hey and the Countess of Chester Hospitals, including images and records taken, after Child C had died.

12:56pm

Dr Evans says Child C was a vulnerable, pre-term baby, with restricted growth meaning he was 800g at birth.
"He had two significant risk factors" that meant admission to a neonatal unit with "careful management" that would have been required of several weeks.
He said Child C would have been at risk of a number of conditions during that time.
The commonest risk would have been to his respiratory system, the second would have related to feeding, as premature babies are not necessarily adapted to receive milk. He would also have been at risk of NEC.
The third would have related to infection.
The fourth complication would have been metabolic, and it was important to maintain glucose levels and be aware of the risk of jaundice.

12:58pm

In relation to the breathing problems, Dr Evans says from the records, Child C's breathing stabilised over the days, with CPAP and oxygen support decreasing. Child C had been taken off CPAP on placed on Optiflow, whichw as "a very encouraging sign" that Child C could begin breathing on his own.
The percentage of oxygen support had decreased from a 'common' support of 40% to 25%, the latter which was 'very low' for breathing support.
"They were good markers of progress," Dr Evans says.

12:59pm

Mr Johnson says Child C also had periods of skin-to-skin contact with his mum without breathing support required.
Dr Evans you "wouldn't dream of doing that" if Child C was unstable on breathing support.

Recap: Lucy Letby trial, Tuesday, November 1

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

 

[MsBetsy]

Hold it @MsBetsy, you are repeating the claim of the prosecution. The defence does not agree with this interpretation of the facts, such as they are. I wasn't there and have no idea. An important principle is "innocent till proven guilty".

Yes, I'm aware of that. I haven't yet heard the defence suggest who might be responsible. They have suggested other ways the babies could have died, so it may be they are not going to point the finger in another direction.

 

[gill1109]

To inject air, a syringe must bee primed, attached and pushed.
An exception might be if an IV line had disconnected and was reconnected to the patient without eliminating air in the line.
It's impossible to do it unintentionally because these matters are high priority training issues.

<modsnip>

Actually, we quite simply don't know how often an IV line is accidentally disconnected and improperly reconnected, because just about no-one has any interest in finding out the truth. And it would be very difficult indeed to find out the truth. Hence plenty of myths are perpetuated "this can never happen", "such and such an event never ever occurs", which are quite simply wishful thinking and more or less deliberate blindness to evidence which might discredit the myth.