UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #7
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LadyEdgeworth
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12:36pm
Prof Kinsey noted she had observed from the nursing notes, a naso-gastric tube had been present for Child E, and the aspirates were 'unremarkable'. The abdomen was 'soft, not distended' and Child E's bowels opened.
At August 3, 10.44am, Child E was 'pink and well perfused'.
The professor confirms she had recorded Lucy Letby's nursing note for August 4, 2015, an observation chart for Child E on August 4, and blood gas record for Child E recording a decline for the baby boy.
12:40pm
Prof Kinsey said the "striking thing" was there had been a big change [a drop] in the haemoglobin levels for Child E from 10.21pm at August 3 to 1.05am on August 4.
It was significant in that Child E had lost blood in the aspirates, and would only have had a calculated total blood volume of 142ml in his system at that time.
12:41pm
Prof Kinsey said, for her conclusion for Child E, the haemoglobin count had been normal, as had the platelet count, prior to the deterioration.
"This was spontaneous bleeding, with no clear explanation."
12:46pm
The case now turns to Child F.
Mr Johnson says the significance of Child F is on a comparative basis to identical twin brother Child E.
Prof Kinsey confirms she has had access to Child F's medical records, which was for the context of Child E on a haematological level.
She said she looked at the history of Child F, and 'one or two things happened' which helped her in her investigation.
She said there were three blood investigations for Child F, over the space of two and a half years, which showed 'normal results'.
Child F had had a physical accident when a small child, and there were no haematological-related problems when he was checked, the court hears.
Child F was said to be 'slightly iron deficient' when tested at the age of two years old, but that was 'normal for infants'.
The blood results were "completely normal" for Child F.
The bleeding for Child E in August 2015, based on that medical history, was "not spontaneous", Professor Kinsey tells the court.
12:50pm
Skin discolourations were noted for Child E, the court is told.
Mr Johnson asks about the issue of air embolus as a cause for Child E's death.
Prof Kinsey has produced diagrams to display how an air embolus in the body can present itself externally.
These diagrams are shown to the court.
12:52pm
Haemoglobin is found in red blood cells.
Deoxygenated haemoglobin is blue in colour, while oxygenated haemoglobin is bright red.
A diagram is shown on how part of the air/blood circulation system works in a body.
www.chesterstandard.co.uk
Prof Kinsey noted she had observed from the nursing notes, a naso-gastric tube had been present for Child E, and the aspirates were 'unremarkable'. The abdomen was 'soft, not distended' and Child E's bowels opened.
At August 3, 10.44am, Child E was 'pink and well perfused'.
The professor confirms she had recorded Lucy Letby's nursing note for August 4, 2015, an observation chart for Child E on August 4, and blood gas record for Child E recording a decline for the baby boy.
12:40pm
Prof Kinsey said the "striking thing" was there had been a big change [a drop] in the haemoglobin levels for Child E from 10.21pm at August 3 to 1.05am on August 4.
It was significant in that Child E had lost blood in the aspirates, and would only have had a calculated total blood volume of 142ml in his system at that time.
12:41pm
Prof Kinsey said, for her conclusion for Child E, the haemoglobin count had been normal, as had the platelet count, prior to the deterioration.
"This was spontaneous bleeding, with no clear explanation."
12:46pm
The case now turns to Child F.
Mr Johnson says the significance of Child F is on a comparative basis to identical twin brother Child E.
Prof Kinsey confirms she has had access to Child F's medical records, which was for the context of Child E on a haematological level.
She said she looked at the history of Child F, and 'one or two things happened' which helped her in her investigation.
She said there were three blood investigations for Child F, over the space of two and a half years, which showed 'normal results'.
Child F had had a physical accident when a small child, and there were no haematological-related problems when he was checked, the court hears.
Child F was said to be 'slightly iron deficient' when tested at the age of two years old, but that was 'normal for infants'.
The blood results were "completely normal" for Child F.
The bleeding for Child E in August 2015, based on that medical history, was "not spontaneous", Professor Kinsey tells the court.
12:50pm
Skin discolourations were noted for Child E, the court is told.
Mr Johnson asks about the issue of air embolus as a cause for Child E's death.
Prof Kinsey has produced diagrams to display how an air embolus in the body can present itself externally.
These diagrams are shown to the court.
12:52pm
Haemoglobin is found in red blood cells.
Deoxygenated haemoglobin is blue in colour, while oxygenated haemoglobin is bright red.
A diagram is shown on how part of the air/blood circulation system works in a body.
Recap: Lucy Letby trial, Tuesday, November 29
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
1:07pm
Further diagrams explaining the circulation system are presented to the court.
(I think they're on a lunch break now)
www.chesterstandard.co.uk
Further diagrams explaining the circulation system are presented to the court.
(I think they're on a lunch break now)
Recap: Lucy Letby trial, Tuesday, November 29
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
https://twitter.com/MrDanDonoghue
Expert witness Professor Sally Kinsey is now giving evidence. She was approached by Cheshire Police to review the files of several babies in this case. Prof Kinsey is a retired Consultant Paediatric Haematologist
Today Prof Kinsey will deal with reports she prepared on the deaths of Child A, B and E
Before getting into Prof Kinsey's expert reports, the jury are being given summaries of Child A and B's birth (they were twins) and subsequent care/treatment. Jury heard this in fuller detail in October
Prof Kinsey is explaining that Child A and B's mother had a rare auto-immune disease. She is asked whether this could have been a significant factor in the death of Child A
In short, Prof Kinsey explains that the condition can cause clotting in the mother, premature birth and danger to unborn child. But she says in this case the condition did not pass to the children and it was not a factor in the death of Child A
Asked whether she agreed with the conclusion that Child A had died as a result of an air embolism (injection of air) Prof Kinsey says that the descriptions of purple/blue/red patches on the baby had "cemented" her view
She told the court that she had not seen air embolis in her practical experience, only in medical literature, but said the skin discolurations were a 'pretty stark description of what sounded to be air embolis to me'
Asked if there could be any other haematological explanation for the child's collapse, she says there is 'no evidence of that at all'
We're now on Child E, jury again being given a summary of the infant's birth and subsequent treatment
Last week the jury heard that Child E lost 25% of his blood volume in what was described as a "catastrophic haemorrhage". Asked about this bleed, Prof Kinsey said: 'This was spontaneous bleeding with no explanation'
Prof Kinsey is now talking the jury through various diagrams which show how the body's air/blood circulation system works
Expert witness Professor Sally Kinsey is now giving evidence. She was approached by Cheshire Police to review the files of several babies in this case. Prof Kinsey is a retired Consultant Paediatric Haematologist
Today Prof Kinsey will deal with reports she prepared on the deaths of Child A, B and E
Before getting into Prof Kinsey's expert reports, the jury are being given summaries of Child A and B's birth (they were twins) and subsequent care/treatment. Jury heard this in fuller detail in October
Prof Kinsey is explaining that Child A and B's mother had a rare auto-immune disease. She is asked whether this could have been a significant factor in the death of Child A
In short, Prof Kinsey explains that the condition can cause clotting in the mother, premature birth and danger to unborn child. But she says in this case the condition did not pass to the children and it was not a factor in the death of Child A
Asked whether she agreed with the conclusion that Child A had died as a result of an air embolism (injection of air) Prof Kinsey says that the descriptions of purple/blue/red patches on the baby had "cemented" her view
She told the court that she had not seen air embolis in her practical experience, only in medical literature, but said the skin discolurations were a 'pretty stark description of what sounded to be air embolis to me'
Asked if there could be any other haematological explanation for the child's collapse, she says there is 'no evidence of that at all'
We're now on Child E, jury again being given a summary of the infant's birth and subsequent treatment
Last week the jury heard that Child E lost 25% of his blood volume in what was described as a "catastrophic haemorrhage". Asked about this bleed, Prof Kinsey said: 'This was spontaneous bleeding with no explanation'
Prof Kinsey is now talking the jury through various diagrams which show how the body's air/blood circulation system works
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Obviously, all of the crimes are horrendous...but if she's guilty of deliberating trying to kill both of their babies, knowing how long they had waited for them and how wanted these babies were, that is a whole other level of vindictiveness and spite. I can't even put it into strong enough words. It's just evil.
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I also wondered if the fact that one baby was awaiting tests for Downs syndrome had any relevance to her too, if guilty. With it being a reason that some pregnancies are terminated.
LadyEdgeworth
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2:16pm
The trial is now resuming following a lunch break.
Professor Kinsey is explaining, via diagrams, how the blood is pumped through the heart.
She is now explaining an embolus, which is something which "shouldn't be there" in the body.
It is most commonly found from a blood clot which has broken off, and an embolus gets stuck in the blood vessel, causing damage.
She adds there are other types of emboli, such as a fat embolus, or embolic conditions which can cause a stroke or heart attack.
www.chesterstandard.co.uk
The trial is now resuming following a lunch break.
Professor Kinsey is explaining, via diagrams, how the blood is pumped through the heart.
She is now explaining an embolus, which is something which "shouldn't be there" in the body.
It is most commonly found from a blood clot which has broken off, and an embolus gets stuck in the blood vessel, causing damage.
She adds there are other types of emboli, such as a fat embolus, or embolic conditions which can cause a stroke or heart attack.
Recap: Lucy Letby trial, Tuesday, November 29
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
LadyEdgeworth
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2:20pm
Mr Johnson asks if air is injected into the system via a syringe, what would happen.
Prof Kinsey explains the heart would be pumping, and the air bubbles would be broken into larger and tiny bubbles. The lungs would be able to cope with the smaller air bubbles, but the lungs would struggle with the larger air bubbles.
In babies, air bubbles would be going in the arterial circulation - blood returning to the heart passing straight out again without being oxygenated through the lungs.
This would lead to the changes in skin colour - a 'fluctuating' colour pattern, and would, the court hears, lead to the types of sin discolourations as described by doctors and nurses so far in the trial.
2:23pm
The court hears, in adults, the air bubbles would go to the lungs, if not blocked. If the bubbles are blocked, it could cause a pulmonary embolism.
In babies, there is a section of the heart, called the oval foramen, which would still be open, meaning the air bubbles would go to the arterial circulation.
The air bubbles would be absorbed by the haemoglobin, causing skin discolourations which move around the body and a mixture of blue, pink and purple discolouration, Mr Johnson summarises. Professor Kinsey agrees.
2:26pm
Ben Myers KC, for Letby's defence, is now asking Prof Kinsey questions.
He says his questions are more concerned on the nature of an air embolus.
For the haematology, he asks for Child E, whether it is a general point that such a child would not develop the levels of blood clotting as you would see in a more developed child or adult. Prof Kinsey agrees.
Asked about the 'no explanation for spontaneous bleeding', Mr Myers says if that is from a haematological reason. Prof Kinsey agrees.
Mr Myers says that does not rule out the possibility Child E had a gastro-intestinal haemorrhage. Prof Kinsey agrees.
2:29pm
Mr Myers asks about the principle of experts giving evidence, and their areas of expertise.
He refers to Prof Kinsey's expertise in haematology and certain paediatric specialisms, and her reports. They include focus on cancers and blood disorders.
Mr Myers: "Air embolus does not feature in your expertise, does it?"
Prof Kinsey: "No."
www.chesterstandard.co.uk
Mr Johnson asks if air is injected into the system via a syringe, what would happen.
Prof Kinsey explains the heart would be pumping, and the air bubbles would be broken into larger and tiny bubbles. The lungs would be able to cope with the smaller air bubbles, but the lungs would struggle with the larger air bubbles.
In babies, air bubbles would be going in the arterial circulation - blood returning to the heart passing straight out again without being oxygenated through the lungs.
This would lead to the changes in skin colour - a 'fluctuating' colour pattern, and would, the court hears, lead to the types of sin discolourations as described by doctors and nurses so far in the trial.
2:23pm
The court hears, in adults, the air bubbles would go to the lungs, if not blocked. If the bubbles are blocked, it could cause a pulmonary embolism.
In babies, there is a section of the heart, called the oval foramen, which would still be open, meaning the air bubbles would go to the arterial circulation.
The air bubbles would be absorbed by the haemoglobin, causing skin discolourations which move around the body and a mixture of blue, pink and purple discolouration, Mr Johnson summarises. Professor Kinsey agrees.
2:26pm
Ben Myers KC, for Letby's defence, is now asking Prof Kinsey questions.
He says his questions are more concerned on the nature of an air embolus.
For the haematology, he asks for Child E, whether it is a general point that such a child would not develop the levels of blood clotting as you would see in a more developed child or adult. Prof Kinsey agrees.
Asked about the 'no explanation for spontaneous bleeding', Mr Myers says if that is from a haematological reason. Prof Kinsey agrees.
Mr Myers says that does not rule out the possibility Child E had a gastro-intestinal haemorrhage. Prof Kinsey agrees.
2:29pm
Mr Myers asks about the principle of experts giving evidence, and their areas of expertise.
He refers to Prof Kinsey's expertise in haematology and certain paediatric specialisms, and her reports. They include focus on cancers and blood disorders.
Mr Myers: "Air embolus does not feature in your expertise, does it?"
Prof Kinsey: "No."
Recap: Lucy Letby trial, Tuesday, November 29
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
I've got to be honest I'm not following the scientific explanations being given today about how an embolus would cause the skin colourations seen. It's no doubt from dodgy reporting, but It seems to suggest that the colours of the rash are from the blood being deoxygenated. But deoxygenated blood isn't blue, as reported by the Chester Standard. It's dark red!
LadyEdgeworth
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2:33pm
Mr Myers refers to the diagrams of gas exchange, which are 'standard images' in the way gas exchange works in the body.
Mr Myers: "In no way are they designed to explain an air embolus."
Prof Kinsey: "They were produced to explain the gas exchange and circulation."
Mr Myers: "What you are doing in your evidence is to take that understanding of circulation and gas exchange and use it to explain how an air embolus is displayed."
Prof Kinsey: "Yes."
www.chesterstandard.co.uk
Mr Myers refers to the diagrams of gas exchange, which are 'standard images' in the way gas exchange works in the body.
Mr Myers: "In no way are they designed to explain an air embolus."
Prof Kinsey: "They were produced to explain the gas exchange and circulation."
Mr Myers: "What you are doing in your evidence is to take that understanding of circulation and gas exchange and use it to explain how an air embolus is displayed."
Prof Kinsey: "Yes."
Recap: Lucy Letby trial, Tuesday, November 29
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
LadyEdgeworth
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I think it may be explaining the charts shown? Like those ones in school where it was shown in blue? Then the air bubbles being absorbed would show as the blotchy discolorations that are blue/purple in colour which does happen due to lack of oxygen in the blood aka cyanosis
LadyEdgeworth
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2:42pm
Mr Myers says Prof Kinsey has, at times, commented on the issue of air embolus in her reports for Childs A, B and E.
Prof Kinsey: "Only in the changes to the colour of the skin, very impactful."
Mr Myers refers to the summary/opinion for Child A, and whether there was any haematological significance for Child A. He says that is not in dispute.
He refers to the conclusion, which he says relies on comment from [medical experts] Dr Dewi Evans and Dr Sandie Bohin, and the description from [Countess of Chester Hospital consultant] Dr Ravi Jayaram of the skin discolouration for Child A.
Mr Myers refers to the 1989 medical journal review: "mentioning a particular case - 'blanching and migrating areas of cutaneous pallor were noted in several cases and, in one of our own cases, we noted bright pink vessels against a generally cyanosed...background."
Prof Kinsey confirms she is drawing a parallel between the 1989 journal review and what had been observed by doctors and nurses.
She tells the court she was "shocked" by Dr Jayaram's description of skin discolouration for Child A, which she said came before she had considered the possibility of air embolus.
She said she knew this is what air embolus was like, and knew from her own education, before seeing that description matched what was said in the 1989 medical journal review.
2:45pm
Mr Myers says Dr Jayaram's clinical note - 'legs noted to look very white and pale before cardiac arrest' does not contain the full details from her report. Dr Jayaram did not add anything further to the skin discolouration observation in the report to the coroner, Mr Myers adds.
Mr Myers: "The description you read came from his statement [to police] two and a half years later."
Prof Kinsey agrees.
www.chesterstandard.co.uk
Mr Myers says Prof Kinsey has, at times, commented on the issue of air embolus in her reports for Childs A, B and E.
Prof Kinsey: "Only in the changes to the colour of the skin, very impactful."
Mr Myers refers to the summary/opinion for Child A, and whether there was any haematological significance for Child A. He says that is not in dispute.
He refers to the conclusion, which he says relies on comment from [medical experts] Dr Dewi Evans and Dr Sandie Bohin, and the description from [Countess of Chester Hospital consultant] Dr Ravi Jayaram of the skin discolouration for Child A.
Mr Myers refers to the 1989 medical journal review: "mentioning a particular case - 'blanching and migrating areas of cutaneous pallor were noted in several cases and, in one of our own cases, we noted bright pink vessels against a generally cyanosed...background."
Prof Kinsey confirms she is drawing a parallel between the 1989 journal review and what had been observed by doctors and nurses.
She tells the court she was "shocked" by Dr Jayaram's description of skin discolouration for Child A, which she said came before she had considered the possibility of air embolus.
She said she knew this is what air embolus was like, and knew from her own education, before seeing that description matched what was said in the 1989 medical journal review.
2:45pm
Mr Myers says Dr Jayaram's clinical note - 'legs noted to look very white and pale before cardiac arrest' does not contain the full details from her report. Dr Jayaram did not add anything further to the skin discolouration observation in the report to the coroner, Mr Myers adds.
Mr Myers: "The description you read came from his statement [to police] two and a half years later."
Prof Kinsey agrees.
Recap: Lucy Letby trial, Tuesday, November 29
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
That would make sense if the expert was directing the jury's attention to the chart, saying the blue bits are the deoxygenated blood returning to the heart. From the reporting it sounded like she was saying deoxygenated blood is blue!
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2:53pm
Mr Myers refers to the case of Child B, and the summary/opinion Prof Kinsey made in her report.
He says, for air embolus, Prof Kinsey again draws parallels between the 1989 medical journal and the skin discoluration observations seen for Child B.
The clinical note of 'widespread purple discolouration with white patches' for Child B, made at the time, is shown to the court, along with a subsequent 'improvement in skin perfusion'.
A doctor's note on June 10, shown to the court: 'suddenly purple blotching of body all over...upon my arrival purple blotching...[later] purple discolouration almost resolved'.
Lucy Letby's note on June 10 is also shown to the court: 'Cyanosed in appearance...colour changed rapidly to purple blotchiness with white patches'.
Mr Myers: "In none of those is there any description of a bright pink or red feature?"
Prof Kinsey: "No."
2:59pm
Prof Kinsey's report, dated November 1, 2022, is referred to.
Mr Myers says Prof Kinsey was asked to give further consideration as to how an air embolism worked.
She says she was asked to give further explanation on the features of an air embolism. She said she was not an expert in such mechanisms, but has provided an explanation.
Mr Myers says the report notes there is very little medical literature in relation to air emboli.
Mr Myers: "You have used your knowledge of blood and circulation to assist this?"
Prof Kinsey: "Yes."
Mr Myers says part of the limited medical literature relates to decompression in deep-sea divers, colloquially known as 'the bends', and that in those circumstances, nitrogen bubbles would be in the circulation longer than oxygen bubbles. He asks Prof Kinsey if that is the case.
Prof Kinsey: "I don't know the answer to that question."
www.chesterstandard.co.uk
Mr Myers refers to the case of Child B, and the summary/opinion Prof Kinsey made in her report.
He says, for air embolus, Prof Kinsey again draws parallels between the 1989 medical journal and the skin discoluration observations seen for Child B.
The clinical note of 'widespread purple discolouration with white patches' for Child B, made at the time, is shown to the court, along with a subsequent 'improvement in skin perfusion'.
A doctor's note on June 10, shown to the court: 'suddenly purple blotching of body all over...upon my arrival purple blotching...[later] purple discolouration almost resolved'.
Lucy Letby's note on June 10 is also shown to the court: 'Cyanosed in appearance...colour changed rapidly to purple blotchiness with white patches'.
Mr Myers: "In none of those is there any description of a bright pink or red feature?"
Prof Kinsey: "No."
2:59pm
Prof Kinsey's report, dated November 1, 2022, is referred to.
Mr Myers says Prof Kinsey was asked to give further consideration as to how an air embolism worked.
She says she was asked to give further explanation on the features of an air embolism. She said she was not an expert in such mechanisms, but has provided an explanation.
Mr Myers says the report notes there is very little medical literature in relation to air emboli.
Mr Myers: "You have used your knowledge of blood and circulation to assist this?"
Prof Kinsey: "Yes."
Mr Myers says part of the limited medical literature relates to decompression in deep-sea divers, colloquially known as 'the bends', and that in those circumstances, nitrogen bubbles would be in the circulation longer than oxygen bubbles. He asks Prof Kinsey if that is the case.
Prof Kinsey: "I don't know the answer to that question."
Recap: Lucy Letby trial, Tuesday, November 29
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
LadyEdgeworth
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3:04pm
Mr Myers says the research paper in question [for 'the bends'] dealt with four overweight deep-sea diving adults.
Prof Kinsey: "Yes, there were many limitations to their findings."
Mr Myers said the results were "very specific based to the people [in that study]."
Mr Myers asks if the symptoms of decompression sickness would always result in skin discolouration. Prof Kinsey said it would not.
Mr Myers asks if that can be applied to babies - if an air embolus could always lead to skin discolouration observations. Prof Kinsey said it would not.
3:07pm
Prof Kinsey says the problem with decompression syndrome, in comparison to air embolus in infants, is the bubbles get larger as the deep-sea diver returns to the surface.
Mr Myers says that is another limitation of the available medical literature for air emboli.
Prof Kinsey says the reason that study was used in her report was that skin discolouration had been an observation in that study, as it had been in cases of air embolus.
3:08pm
Prof Kinsey says the scale of the air embolus problem would depend on the size of the air bubble and the type of vessel that it is in.
www.chesterstandard.co.uk
Mr Myers says the research paper in question [for 'the bends'] dealt with four overweight deep-sea diving adults.
Prof Kinsey: "Yes, there were many limitations to their findings."
Mr Myers said the results were "very specific based to the people [in that study]."
Mr Myers asks if the symptoms of decompression sickness would always result in skin discolouration. Prof Kinsey said it would not.
Mr Myers asks if that can be applied to babies - if an air embolus could always lead to skin discolouration observations. Prof Kinsey said it would not.
3:07pm
Prof Kinsey says the problem with decompression syndrome, in comparison to air embolus in infants, is the bubbles get larger as the deep-sea diver returns to the surface.
Mr Myers says that is another limitation of the available medical literature for air emboli.
Prof Kinsey says the reason that study was used in her report was that skin discolouration had been an observation in that study, as it had been in cases of air embolus.
3:08pm
Prof Kinsey says the scale of the air embolus problem would depend on the size of the air bubble and the type of vessel that it is in.
Recap: Lucy Letby trial, Tuesday, November 29
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
https://twitter.com/MrDanDonoghue
Ms Letby's defence lawyer Ben Myers KC is now cross examining Prof Kinsey. He puts it to her that her comments on Child E 'does not assist with what the cause of death actually was', to which she agrees
Mr Myers is now quizzing the expert on her conclusions around air embolus. She told the court earlier, that in the case of Child A, the rashes observed were 'a pretty stark description of what sounded to be air embolus to me'
Prof Kinsey says she had an 'intake of breath' when she saw the description of the rash on Child A as she knew that to be symptoms of air embolus.
Mr Myers points out that the description she is referring to came from a statement Dr Jayaram made to Police two and half year's after the death of Child A, not from his clinical note recorded at the time
Ms Letby's defence lawyer Ben Myers KC is now cross examining Prof Kinsey. He puts it to her that her comments on Child E 'does not assist with what the cause of death actually was', to which she agrees
Mr Myers is now quizzing the expert on her conclusions around air embolus. She told the court earlier, that in the case of Child A, the rashes observed were 'a pretty stark description of what sounded to be air embolus to me'
Prof Kinsey says she had an 'intake of breath' when she saw the description of the rash on Child A as she knew that to be symptoms of air embolus.
Mr Myers points out that the description she is referring to came from a statement Dr Jayaram made to Police two and half year's after the death of Child A, not from his clinical note recorded at the time
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3:10pm
Upon a question from the judge, Prof Kinsey says she has never encountered any discussion about nitrogen bubbles in the system, other than in deep-sea divers.
She says the biggest factors for any air embolus would be the size of the air bubble and the vessel that it is in.
What was not a factor in her discussions was the quantities that made up the air [ie what amount was nitrogen, what amount was oxygen, carbon dioxide, etc].
3:14pm
The next witness to give evidence is Ian Allen, who worked in the Countess of Chester Hospital's pharmacy department in summer 2015.
Simon Driver, prosecuting, asks about the responsibilities Mr Allen had, which involved quality assurance and production of TPN bags for the neonatal unit.
www.chesterstandard.co.uk
Upon a question from the judge, Prof Kinsey says she has never encountered any discussion about nitrogen bubbles in the system, other than in deep-sea divers.
She says the biggest factors for any air embolus would be the size of the air bubble and the vessel that it is in.
What was not a factor in her discussions was the quantities that made up the air [ie what amount was nitrogen, what amount was oxygen, carbon dioxide, etc].
3:14pm
The next witness to give evidence is Ian Allen, who worked in the Countess of Chester Hospital's pharmacy department in summer 2015.
Simon Driver, prosecuting, asks about the responsibilities Mr Allen had, which involved quality assurance and production of TPN bags for the neonatal unit.
Recap: Lucy Letby trial, Tuesday, November 29
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
LadyEdgeworth
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3:16pm
Mr Driver focuses on the TPN bags, and a video which has been produced for the benefit of the court showing how a TPN bag is made.
Mr Allen confirms he has seen the video.
He describes the types of TPN nutrition bags - one would be used for the baby's first two days of life, and the other would be a maintenance 'stock' bag, supplied to the unit through the department.
3:20pm
Mr Allen says the initial order would be faxed down to the pharmacy from the neonatal unit. It would be handed to a pharmacist, reviewed by them, processed into a worksheet [a set of instructions on how to make the bag and the ingredients needed to make it].
A label would be generated.
A member of the pharmacy team would gather the ingredients/quantities required. Every medicine would come with a batch sheet number as part of the 'assembly'.
"Every step in the process has a standard operating procedure"
Staff would be trained in the process through nationally recognised quality assurance, he tells the court.
www.chesterstandard.co.uk
Mr Driver focuses on the TPN bags, and a video which has been produced for the benefit of the court showing how a TPN bag is made.
Mr Allen confirms he has seen the video.
He describes the types of TPN nutrition bags - one would be used for the baby's first two days of life, and the other would be a maintenance 'stock' bag, supplied to the unit through the department.
3:20pm
Mr Allen says the initial order would be faxed down to the pharmacy from the neonatal unit. It would be handed to a pharmacist, reviewed by them, processed into a worksheet [a set of instructions on how to make the bag and the ingredients needed to make it].
A label would be generated.
A member of the pharmacy team would gather the ingredients/quantities required. Every medicine would come with a batch sheet number as part of the 'assembly'.
"Every step in the process has a standard operating procedure"
Staff would be trained in the process through nationally recognised quality assurance, he tells the court.
Recap: Lucy Letby trial, Tuesday, November 29
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
LadyEdgeworth
Well-Known Member
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- Nov 3, 2022
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- 559
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3:25pm
The items would be sprayed and wiped to sterilise them, and then made in a controlled environment.
Two operators would make the bag, with checks in place confirming the identity and quantity of the ingredients.
3:28pm
A pharmacist would check what has been used, looking at empty vials and ampoules to confirm what has been used.
The pharmacist would be ultimately reponsible for the product.
The unit would be subject to regulatory monitoring to ensure the safety, quaity and effectiveness of the products.
3:31pm
The video explaining how a TPN bag is made at the pharmacy department is played to the court for the second time - it was first shown on Monday.
The prosecution say they may intervene at various points in the video to ask Mr Allen questions about what is shown to the court.
www.chesterstandard.co.uk
The items would be sprayed and wiped to sterilise them, and then made in a controlled environment.
Two operators would make the bag, with checks in place confirming the identity and quantity of the ingredients.
3:28pm
A pharmacist would check what has been used, looking at empty vials and ampoules to confirm what has been used.
The pharmacist would be ultimately reponsible for the product.
The unit would be subject to regulatory monitoring to ensure the safety, quaity and effectiveness of the products.
3:31pm
The video explaining how a TPN bag is made at the pharmacy department is played to the court for the second time - it was first shown on Monday.
The prosecution say they may intervene at various points in the video to ask Mr Allen questions about what is shown to the court.
Recap: Lucy Letby trial, Tuesday, November 29
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
LadyEdgeworth
Well-Known Member
- Joined
- Nov 3, 2022
- Messages
- 559
- Reaction score
- 4,691
4:00pm
Mr Allen is now demonstrating how a TPN bag and its connectors work - which does have a connector which can be opened.
4:10pm
The court is shown a nutrition prescription for Child F for August 4.
Mr Allen confirms he is familiar with the type of prescription shown, and the worksheet which is also shown to the court.
He said this particular TPN would have followed the standard protocols in the pharmacy, and was reflective of the prescription.
He said the bag would have been transferred from the pharmacy to the neonatal unit fridge.
4:14pm
A copy of the label for that TPN bag on August 4 would have been made for the pharmacy's records.
The label has a use-by date of August 11, to be stored between 2-8 degrees C.
4:18pm
The August 4 TPN bag did not have lipids prescribed on the prescription. Mr Allen said such lipids would have been prescribed separately.
Mr Driver asks 'Would there be insulin?' for the TPN bags.
Mr Allen: "No, there would never be insulin prescribed in these bags."
Mr Driver asks how would that [insulin prescription for a baby] be done?
Mr Allen: "...by separate syringes."
4:25pm
Ben Myers KC, for Letby's defence, rises to clarify one matter on the TPN bag, which had an expiration date of seven days.
He says normally, TPN bags could last for up to two months, but once the extra items are added to the prescription, the expiration would be reduced.
Mr Allen: "That's correct."
The court hears the stability of the bag is reduced.
Mr Allen explains, upon questions from the judge, there would be nothing added by a pharmacist other than trace vitamins. The TPN bag would contain components such as 10% dextrose.
The judge asks about the storage of the TPN bags.
Mr Allen says there would be a stock level of TPN bags - they would be 'off-the-shelf' bags and a number would be stored in the pharmacy, and a smaller number would be stored in the unit's refrigeration area.
4:28pm
Members of the jury are reminded by the judge, having heard a lot of expert evidence in the case today, not to conduct any independent research.
www.chesterstandard.co.uk
Mr Allen is now demonstrating how a TPN bag and its connectors work - which does have a connector which can be opened.
4:10pm
The court is shown a nutrition prescription for Child F for August 4.
Mr Allen confirms he is familiar with the type of prescription shown, and the worksheet which is also shown to the court.
He said this particular TPN would have followed the standard protocols in the pharmacy, and was reflective of the prescription.
He said the bag would have been transferred from the pharmacy to the neonatal unit fridge.
4:14pm
A copy of the label for that TPN bag on August 4 would have been made for the pharmacy's records.
The label has a use-by date of August 11, to be stored between 2-8 degrees C.
4:18pm
The August 4 TPN bag did not have lipids prescribed on the prescription. Mr Allen said such lipids would have been prescribed separately.
Mr Driver asks 'Would there be insulin?' for the TPN bags.
Mr Allen: "No, there would never be insulin prescribed in these bags."
Mr Driver asks how would that [insulin prescription for a baby] be done?
Mr Allen: "...by separate syringes."
4:25pm
Ben Myers KC, for Letby's defence, rises to clarify one matter on the TPN bag, which had an expiration date of seven days.
He says normally, TPN bags could last for up to two months, but once the extra items are added to the prescription, the expiration would be reduced.
Mr Allen: "That's correct."
The court hears the stability of the bag is reduced.
Mr Allen explains, upon questions from the judge, there would be nothing added by a pharmacist other than trace vitamins. The TPN bag would contain components such as 10% dextrose.
The judge asks about the storage of the TPN bags.
Mr Allen says there would be a stock level of TPN bags - they would be 'off-the-shelf' bags and a number would be stored in the pharmacy, and a smaller number would be stored in the unit's refrigeration area.
4:28pm
Members of the jury are reminded by the judge, having heard a lot of expert evidence in the case today, not to conduct any independent research.
Recap: Lucy Letby trial, Tuesday, November 29
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
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