UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #6

[LadyEdgeworth]

12:08pm

She confirms she was the designated nurse for Child E during the day of August 3 (8am-8pm), as well as the designated nurse for Child F.
She made a note at 10.42am, regarding family communication: 'mum on unit from 9am onwards, fully updated by myself and reg. Had long periods of skin-to-skin.'
The nurse said she recalled the skin-to-ckin contact, and during this shift, Child F was unable to have a 'cuddle', but 'containment holding' instead.
Child F remained on CPAP (a level of respiratory support), and was not as stable.
Child E was breathing by himself, requiring a little supplementary oxygen, and therefore 'could have as many cuddles as they [the mum and Child E] wanted'.

12:15pm

Child E was, in the nurse's 10.50am 'top to toe' clinical note: 'self ventilating in 25% ambient oxygen, no signs of respiratory distress. Heart rate and temperature stable. Pink and well perfused. Cap refill 1 second'.
The observations were 'normal'.
The nurse added the fluids which were being provided, via a longline infusion.
Child E was on a 'cautious feeding regime', based on guidelines in the neonatal unit.
Child E, it was also noted, 'handles well'.

Recap: Lucy Letby trial, Tuesday, November 15

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

 

[LadyEdgeworth]

12:17pm

A 'minimal to 1ml partially digested milk' was obtained from the NGT aspirates, which the nurse says was normal, and was a sign Child E was digesting the milk being fed.

12:24pm

The nurse's addendum is made, retrospectively, at 5.24pm that day.
A CRP reading was 'less than 1', which the nurse explains any reading of less than 10 is 'a good sign'.
The antibiotics would 'be reviewed at 36 hours [treatment]'.
The blood cultures were 'currently negative' - in absence of bacteria.
Child E remained self ventilating in air, with 'satisfactory' blood gas readings.
The nurse says Child E had a blood sugar reading of 18.5mmols, which was "too high".
A doctor was informed and insulin was 're-commenced t a rate of 0.02/units/kg/hr'.
Feeds were increased as Child E was 'tolerating his feeds'.
The court hears a 'PKU' was taken with parental consent, which was a neonatal blood screening taken from every baby at about Child E's age [if the parents agree], looking for various potential [inherited] conditions, with results to follow.

Recap: Lucy Letby trial, Tuesday, November 15

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

 

[LadyEdgeworth]

12:29pm

An observation chart is shown for Child E, from 6pm on August 2 to 5pm on August 3.
The respiratory rate, the court hears, is 'normal', and the baby boy was said to be stable.
A second observation chart is shown with the nurse signing for readings at 6pm and 7pm.
The nurse agrees with Mr Driver the observations show "stable trends" for Child E.

12:32pm

Mr Driver asks about the blood sugar readings.
The nurse says she found that level in a blood gas reading, which was 'outside the parameter' so constulted a doctor, and action was taken following guidelines for insulin to be commenced.

12:37pm

The blood gas reading chart is shown to the court, which shows the nurse took the sample for Child E at 2.38pm on August 3.
The glucose reading of 18.4 was the only 'abnormal' reading recorded, the court hears.

12:41pm

The neonatal fluid balance chart for Child E on August 3 is shown to the court.
The nurse explains the milk levels given to Child E that day.
The aspirates recorded 1ml partially digested milk at 9am, which was 'replaced [in the NG tube] as [Child E] had worked hard to digest that milk', as 'normal practice'.
The nurse explains the 1ml milk was taken out, put back in, and a 1ml additional milk feed was administered.

12:44pm

'Minimal aspirates' are recorded for 11am and 1pm, with a 'moderately high' level of urine recorded at 1pm.
Minimal aspirates are recoreded at 3pm, with 1ml aspirate at 5pm. That was a 'normal finding' and was replaced.
At 7pm, another 'minimal aspirate' is recorded.
At 7pm, there was also urine recorded, and a sign Child E's bowels had opened by this time.
Asked for the assessment of Child E, the nurse says: "[He] was doing well on that shift, apart from the high blood sugars. It can be a worrying factor, it could be a stress response."

12:48pm

Ben Myers KC, for Letby's defence, asks about Child E's condition on August 3, that he was 'doing well for a baby of that gestation', except for the blood sugar reading.
He asks if the nurse was aware of a number of risk factors associated with him.
The nurse agrees, and agrees Child E was premature, and there were risks associated with that.
She says she would have also been aware of risks of twin births, and agrees with Mr Myers Child E 'could be vulnerable to health complications'.

1:00pm

Mr Myers asks about Child E's first shift involving Child E on the night of July 29-30, referring to the nurse's note at 12.17am: 'NCPAP commenced at 10.50pm as oxygen requirement increased to 30% and required Neopuff x2 for apnoea.'
A chart is also shown of Apnoea/Bradys, recording five such incidents for Child E between August 1-3.
Mr Myers says, talking through the chart with the nurse, one Brady happened at August 1, no apnoea is identified, but heart rate dropped to 79bpm and desat reading was '84', and the duration was 45 seconds.
That is confirmed by a separate doctor's note, which required 'gentle stimulation' to resolve.
The second desat happens on August 2 at 6.20am, with a reading of '83-88', lasting two minutes.
The nurse says gentle stimulation is putting a hand on the abdomen gently, or very carefully giving the baby a light tickle.
She says if the situation does not improve, the baby's chin would be placed into a neutral position to help the airway, and/or administer oxygen.
This episode required, according to a nurse's note, 'facial oxygen was required for a short period - had hiccups at the time'.
The third was a brady and a desat for 30 seconds, which was 'self-correcting'.
The fourth was a Brady and desat at 11.50pm on August 2, lasting 45 seconds, requiring gentle stimulation to resolve.
The fifth and final episode was at 1am on August 3, with brady and desat in the '70s', lasting 45 seconds, requiring gentle stimulation to resolve.

Recap: Lucy Letby trial, Tuesday, November 15

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

 

[Tortoise]

12:41pm

The neonatal fluid balance chart for Child E on August 3 is shown to the court.
The nurse explains the milk levels given to Child E that day.
The aspirates recorded 1ml partially digested milk at 9am, which was 'replaced [in the NG tube] as [Child E] had worked hard to digest that milk', as 'normal practice'.
The nurse explains the 1ml milk was taken out, put back in, and a 1ml additional milk feed was administered.

12:44pm

'Minimal aspirates' are recorded for 11am and 1pm, with a 'moderately high' level of urine recorded at 1pm.
Minimal aspirates are recoreded at 3pm, with 1ml aspirate at 5pm. That was a 'normal finding' and was replaced.
At 7pm, another 'minimal aspirate' is recorded.
At 7pm, there was also urine recorded, and a sign Child E's bowels had opened by this time.
Asked for the assessment of Child E, the nurse says: "[He] was doing well on that shift, apart from the high blood sugars. It can be a worrying factor, it could be a stress response."

Recap: Lucy Letby trial, Tuesday, November 15

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

So the milk feeds that day were two hourly, at

9am, 11am, 1pm, 3pm, 5pm, 7pm

The next feed was very obviously due at 9pm. That is why LL referenced the 9pm feed in her notes, as it was charted.

It makes even less sense that Mr Myers would suggest that the mother brought milk at 10pm.

 

[covid2020]

I bet any medical staff whose names appear on the notes or were working in the unit at the time are utterly terrified the accusers finger could be pointed at them. From all the notes and actions it sounds like a creaky unit where procedure wasn't followed.

 

[Sundial]

I wonder if the parents agree with her account?

I have wondered the same thing. The mention of a hug didn’t seem to have been relayed by the parents. But when we look at the “consent” and permission etc for the memory box, the mother clearly states it was a complete surprise. Very contradictory to the mothers version of events.

 

[CocoChanel]

ADMIN REMINDER:
If what you post is your OPINION, you MUST a be clear about that with a qualifier like IMHO or similar. Otherwise your post reads as a statement of FACT without the required substantiating link, and it is subject to being REMOVED.

 

[LadyEdgeworth]

2:09pm

Ben Myers KC is continuing to ask the nurse questions.
The fluid chart is shown to the court once more for Child E on August 3.
Mr Myers asks about the blood glucose readings, and what the parameters should be.
The nurse says the readings should be above 2.6, and the upper limit is not defined in pre-term babies (Mr Myers says the upper limit is 6 for full-term babies). The nurse says it would be a worrying sign.
Mr Myers asks if the reading of 18.4 is 'worryingly high'. The nurse agrees. She says the cut-off point for insulin to be prescribed would either be '12 or 14'.
She agrees the blood sugar readings of 12.8, 18.4, 13.5, 12.9 are 'at the higher end of normal', with '18.4' being 'particularly high'.

2:15pm

A chart showing a form of insulin - Actrapid - is administered on several occasions to Child E.
The first is on July 31 at 6.45am, and the rate of insulin administration lowers at 2pm on August 1 and is increased slightly again at 2.10am on August 2.
A prescription for 3pm on August 3 is made, but then crossed out, then redone with 'a correct dose'. The nurse says the previous, crossed out one, was 'an incorrect dose' of 0.05units/kg/hr. The second is the 'correct dose' of 0.02units/kg/hr.
Insulin of a neonatal is a "continual infusion", the nurse tells the court.

Recap: Lucy Letby trial, Tuesday, November 15

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

 

[LadyEdgeworth]

2:18pm

Mr Myers says the insulin administration is 'a feature' of Child E's treatment during his time at the neonatal unit. The nurse agrees.
The blood gas chart for August 3 is shown, with the nurse having signed a blood gas reading taken at 2.38pm.
Mr Myers suggests the pH reading of 7.293 is outside the normal range of being under 7.3, by being slightly acidic. The nurse says she was trained that anything above 7.25 was normal.

2:19pm

Mr Myers suggests that the blood gas readings suggest a case of acidosis.
The nurse says the readings taken are within the parameters, and the doctor would, in any case, make the decision.

2:22pm

Mr Driver, for the prosecution, rises to ask a matter of the brady and apnoea chart, which recorded five episodes with Bradys and desats. The nurse did not record any of these episodes.
He asks if the episodes recorded on August 1-3 would lead the nurse to adjust her opinion of Child E's stability/well-being.
The nurse says the chart is "not a worrying trend of information".

2:30pm

Mr Driver asks if the insulin prescription are four separate doses, or one continuous administration.
The nurse says the first dose is administered at July 31, 6.45am, and that dose remains unchanged until 2pm at August 1, and the dose is reduced.
It would be the same infusion, via a syringe of diluted sodium chloride, administered via a computer.
The court hears the insulin would be paused in the event of the syringe being emptied or the insulin expiring, and a replacement dose would have been prescribed prior to that.

Recap: Lucy Letby trial, Tuesday, November 15

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

 

[Tortoise]

The allegation

Letby's notes also show: "prior to 21:00 feed, 16ml mucky slightly bile-stained aspirate obtained and discarded, abdo soft, not distended. SHO [Senior House Officer] informed, to omit feed."
The prosecution say the nursing notes made are false, and fail to mention that Child E was bleeding at 9pm.

"You know he was due to be fed...breastmilk. You know, we say, that is why [the mum] was there.
"This has been wiped out of the records, by Lucy Letby, because she knows the consequences of [the mum] being right about this."


In police interview, Letby said she could remember Child E and he was "stable" at the time of the handover, with nothing of concern "before the large bile aspirate".
She said she and another member of staff had disposed of the aspirate and the advice was to omit the feed.
She said it was after 9pm that the SHO had reviewed Child E but could not recall if it was face-to-face or over the phone.
In a June 2019 interview, she was pressed over a conversation with the SHO.
She said she had no independent memory of it.

The evidence

Dr Christopher Wood has now been called to give evidence.
Dr Wood confirms he was the only senior [house] officer covering paediatrics and the neonatal unit, with Dr Harkness the only registrar covering those units that night.
He confirms that in August 2015, he was on a four-month trainee placement at the Countess of Chester Hospital, as part of his GP training,
Mr Myers (defence) asks if this was Dr Wood's last night shift with the Countess. Dr Wood says he believes the following night was his last one.
He said he was called to the neonatal unit as part of a crash call, having been in the doctors room in the paediatric unit, writing up notes.
He says he didn't recall being on the neonatal unit that night, prior to the crash call at 11.40pm.
Mr Myers asks if Dr Wood recalls at 9-10pm, receiving a report of a bile-stained aspiration on the neonatal unit.
Dr Wood says he doesn't recall - he doesn't remember.
He adds he was on the paediatric unit by himself, and it was his understanding that, therefore, Dr Harkness would have been on the neonatal unit 'at some point during the evening'.
Mr Driver (prosecution) rises to ask about the bile-stained aspirate via a phone call. He asks in Dr Wood's capacity as a GP trainee, if he had received any data/information about a neonatal unit patient, what he would have done.
He replies if he had received a call from a nurse, he would have taken action, and if it was from a registrar, it would have most likely been out of courtesy.
In the former case, he would have recorded it in his notes and would have sought advice from the registrar.

 

[LadyEdgeworth]

2:44pm

Mr Myers asks further about the insulin dose.
The nurse says, for the dose she administered, that was a fresh solution.
The previous one, the notes the previous dose was administered from 2.10am on August 2.
The judge asks if that dose of insulin would have ended after 12 hours, as the insulin would expire thereafter.
The nurse says you would have to check the relevant nursing notes for that. She can only say to the court the insulin dose she administered at 3pm on August 3 was a fresh dose, and Child E had not been on insulin.

2:45pm

The next evidence is an agreed evidence statement from nurse Caroline Oakley, who was shift leader on August 3, and was involved in the resuscitation efforts for Child E, but does not recall who was doing what, as it was a team process.
She adds she does not recall attending a debrief for Child E following his death.

Recap: Lucy Letby trial, Tuesday, November 15

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

 

[LadyEdgeworth]

Think that may be it for the day, wish the live reporting was a bit better in terms of knowing when things are ending

 

[Imnothere]

Question

Why are some of the names of the nurses not disclosed?

 

[cuecard]

I'm still on the fence with this case -but- yes, that sounds oddly officious and annoyed to me. It's not the first thing one would think to say when discussing a tragedy IMO. Perhaps, if innocent, she was feeling guilty / ashamed / like a failure or paranoid that people are thinking she's a rubbish nurse.

Same but I've found a few of her messages quite odd in the way that she speaks/types. I'm not sure if maybe that's just her demeanor in general and just how I am viewing it through my own lens.

 

[Tortoise]

Think that may be it for the day, wish the live reporting was a bit better in terms of knowing when things are ending

Yes I've just checked the Tweets

55 minutes ago -

https://twitter.com/MrDanDonoghue

Court has now adjourned, here's a wrap of today's evidence

Lucy Letby trial: Medics battled for 45 minutes to save baby

 

[Tortoise]

Question

Why are some of the names of the nurses not disclosed?

I'm presuming the witnesses have asked for an order preventing disclosure in the media.

 

[Observant-ADHD-ENFP-BSc]

1:00pm

Mr Myers asks about Child E's first shift involving Child E on the night of July 29-30, referring to the nurse's note at 12.17am: 'NCPAP commenced at 10.50pm as oxygen requirement increased to 30% and required Neopuff x2 for apnoea.'
A chart is also shown of Apnoea/Bradys, recording five such incidents for Child E between August 1-3.
Mr Myers says, talking through the chart with the nurse, one Brady happened at August 1, no apnoea is identified, but heart rate dropped to 79bpm and desat reading was '84', and the duration was 45 seconds.
That is confirmed by a separate doctor's note, which required 'gentle stimulation' to resolve.
The second desat happens on August 2 at 6.20am, with a reading of '83-88', lasting two minutes.
The nurse says gentle stimulation is putting a hand on the abdomen gently, or very carefully giving the baby a light tickle.
She says if the situation does not improve, the baby's chin would be placed into a neutral position to help the airway, and/or administer oxygen.
This episode required, according to a nurse's note, 'facial oxygen was required for a short period - had hiccups at the time'.
The third was a brady and a desat for 30 seconds, which was 'self-correcting'.
The fourth was a Brady and desat at 11.50pm on August 2, lasting 45 seconds, requiring gentle stimulation to resolve.
The fifth and final episode was at 1am on August 3, with brady and desat in the '70s', lasting 45 seconds, requiring gentle stimulation to resolve.

Recap: Lucy Letby trial, Tuesday, November 15

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

I wonder if the defence will try and use these details to say Child E was poorly at this point?
The Nurse says in a further update,
2:22pm

Mr Driver, for the prosecution, rises to ask a matter of the brady and apnoea chart, which recorded five episodes with Bradys and desats. The nurse did not record any of these episodes.
He asks if the episodes recorded on August 1-3 would lead the nurse to adjust her opinion of Child E's stability/well-being.
The nurse says the chart is "not a worrying trend of information".

IMO, I agree with this. Experience when my child was in the NICU was constant bleeping and beeping from every corner of the unit. The machines we referred to as my child's "friends". My child desated many times and just needed a blast of oxygen under her nose, most of the time. The first few weeks, the machines are pretty scary and every alarm causes extreme anxiety but after spending a lot of time on the unit, you learn to look at the machine, read the numbers and blast the oxygen (As a parent), if it goes down too low,(I was advised to call a nurse when it went below 88%, but that was my individual child's recommendation) I would get a nurse. I also want to add that the O2 saturation monitor was strapped to my child's tiny foot (I dont know if this is the most common placement) and she would accidentally kick it off or loose. She was a very tiny baby (1lb10oz) and so didn't move around much but could still manage to get the monitor Velcro stuck on a sheet or blanket and it would come loose and cause the alarm.
My point is, the desats and bradys seem to be a pretty common occurrence with neonates, especially premature babies, who are still basically developing. JMO

 

[cuecard]

Question

Why are some of the names of the nurses not disclosed?

Likely the court has agreed to protect their identity and privacy given the nature of the case. That's what I would imagine anyway, I could be wrong.

 

[Officer Dibble]

So my son died suddenly. His death was recorded as being in a&e with a pediatrician but he wasn’t breathing when we called an ambulance (he was a newborn, but not just born)

They debated about a post-mortem. It wasn’t a case of if we wanted one, it was whether the coroner wanted one. In the end they discussed what they did have with addenbrookes and decided they had enough evidence that a post mortem wasn’t needed. So one wasn’t done.

He presented unwell and saw both a health visitor (gained weight so was happy) and a gp (diagnosed colic) within the 12 hours before he died so this was unexpected and sudden. They chose not to do one however.

I think it largely depends case by case and the specifics of the case. You don’t always get a choice, and in fairness thinking back, we weren’t actually offered one either.

Edit- they knew he had some kind of hemmoragic type bleed. I’m going to guess (because I’ve no idea) it could be a result of the issues he faced before birth? Perhaps it was considered most likely to be the cause and no pm needed?

DCflag what a horrible shock and beyond tragic. My heart goes out to all of you affected by this. I'm really sorry for your loss. Interesting your info re Coroner wanting a PM but hospital deciding not to. Were you consulted at all over that? Or just told? You don't have to answer this of course.

 

[Left Thoughts]

11:20am

Dr Wood had made a note of staff present during the resuscitation - a team of six, including himself, Dr Harkness, a further doctor, and three senior nurses including Lucy Letby.
Clinical notes made by Dr Wood record the efforts to resuscitate Child E from 12.37am. Five doses of adrenaline are administered during the efforts.
While chest compressions stop at 1.01am, with ventilations continuing, Child E's heart rate fell again at 1.15am and CPR recommenced.
At 1.23am, CPR stopped and Child E was cleaned.
At 1.24am, ventilation [efforts] stopped and Child E was given to the parents.

11:24am

A pathology report is shown to the court, showing Child E with 'relevant clinical details: GI bleed'.
Dr Wood says he cannot recall details surrounding this.
Ben Myers KC, for Letby's defence, says Dr Wood was split between the paediatric and neonatal wards.
He says Dr Wood had 'very little experience with neonates'. Dr Wood agrees.
Mr Myers asks if this was Dr Wood's last night shift with the Countess. Dr Wood says he believes the following night was his last one.

11:27am

Mr Myers says if you lose a significant quantity of blood from a neonate, that would be different from an adult losing a significant quantity of blood, as there could be time to 'seal a gastric bleed' in an adult. Dr Wood agrees.
A clinical note is shown with 'plan - discuss with surgeons, with x-rays'.
Mr Myers asks if Dr Wood was aware surgeons were at the Countess of Chester Hospital who were capable of performing gastric surgery on neonates of the size of Child E.
Dr Wood: "I'm not aware of that. I would imagine most [likely] this would be Alder Hey [Hospital in Liverpool]."

Recap: Lucy Letby trial, Tuesday, November 15

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

From the first section I've underlined, as well as the previous statement that Dr Harkniss was the more senior, I believe that Mr Myers may be alluding to distraction / inexperience from Dr Wood to explain the absence of the 9pm omit feed in his notes.

I seems to me that Mr Myers is trying to suggest gastric bleed or some similar issue as a potential cause of death? I have no formal medical understanding so I don't know whether this is a possibility.

Edit to add a thank you to LadyEdgeworth for your updates today