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

[Sweeper2000]

I don’t think they need to prove that tool was used they only need to prove the injury happened. It’s the alleged injury not being present in the charges that interests me.

 

[LadyEdgeworth]

I don’t think they need to prove that tool was used they only need to prove the injury happened. It’s the alleged injury not being present in the charges that interests me.

Why? If I punch you in the face and then murder you afterwards, I'm probably only going to get charged with murder. Which is what happened here

 

[Sweeper2000]

Before the investigation started has an air embolism been noticed for any of the babies as a cause of collapse/death?

I believe in a few cases it was suspected but wasn’t noted on some post mortems. Specifically baby A

3:30pm

Medical expert Dr Dewi Evans suggested Child A's collapse was "consistent with a deliberate injection of air or something else into [Child A]'s circulation a minute or two prior to deterioration," Mr Johnson told the court. Only Letby was present.
Another medical expert said the cause was "not some natural disease process, but a dose of air "deliberately administered".
An independent pathologist described the cause of death was 'unascertained', in that there was nothing in the autopsy that pointed to why Child A had died, but the cause was most likely 'exogenous air administration through the longline or UVC'.

3:31pm

Said explanations are also backed up, the prosecution say, by an independent radiologist.

LIVE: Trial of Lucy Letby accused of Countess of Chester Hospital baby murders

 

[Sweeper2000]

Why? If I punch you in the face and then murder you afterwards, I'm probably only going to get charged with murder. Which is what happened here

If the prosecution can prove the injury it bolsters the allegations as is one of the other cases, its also illegal and by itself wouldn’t necessarily be deemed “attempted murder” But might if the second alleged attack actually did cause the death.
“
Child O

Child O was in good condition and stable up until the afternoon of June 23 when he suffered a “remarkable deterioration”, the court heard.

A post-mortem examination found unclotted blood in his body from a liver injury and a coroner certified death on the basis of natural causes and intra-abdominal bleeding.

The expert also concluded child O had fatefully received excessive amounts of air into the bloodstream and through a nasogastric tube.”

Full list: the deaths and collapses Hereford nurse Lucy Letby is accused of causing

THE METHODS Hereford nurse Lucy Letby is alleged to have used to harm babies in her care have been revealed in her trial.

www.herefordtimes.com

it does seem the prosecution are using the stronger examples of alleged foul play to bolster credibility Of the supposedly less clear charges.

 

[LadyEdgeworth]

Some of this mornings evidence wrapped up here Lucy Letby trial: Medical tool may have injured baby, expert says

 

[Kemug]

Just leaping ahead here, as I am still not caught up, and am still back on #7. But while I have just been quickly reading I have noticed something that I had not fully comprehended before - that the doctors attending these soon-to-die babies had no idea that the babies were so near to their deaths, were apparently not overly concerned, and were considering treatment options with no great sense of urgency. And then they were extremely shocked when the babies suddenly died. It is not just the increased number of deaths which seems suspicious, but the shocking and sudden unexpected deaths (with the unusual skin mottling). So it does seem to me that there are only 2 possible explanations - either some very unusual condition was at play in the babies, or in their environment, or else someone was deliberately killing them.

 

[cuecard]

The thing that strikes me about this case is how rare and unusual things seem to be. You have the blotchy rashes found on the babies skin, the haemorrhage, the gas found in the x-rays etc and yet all these rare and unusual things just seemed to happen one after another after another after another in what was a pretty short and condensed time frame. Of course, rare and unusual doesn't mean it can't happen, and that's important in the context of this case but it really makes you think imo.

 

[BabaVanga]

If I said what words are in my mind right now I would be banned from here so I’ll leave it to the imagination however I hope justice is served

 

[Observant-ADHD-ENFP-BSc]

Assuming the units are separate rather than conjoined. It’s this bit that gets my attention atm

“She said she would not have told the mum to go back upstairs.”

UK - Lucy Letby Trial - Media, Maps & Timeline *NO DISCUSSION*

Lucy Letby is on trial in the UK, charged with the murders of 7 infants and the attempted murder of 15 other infants. Media, Maps & Timelines can be posted here. *NO DISCUSSION* in this thread or your post will be removed.

www.websleuths.com

does that mean the mother has definitely come from outside the card swipe doors? I believe the cctv is probably used at the doors to monitor access but not actually on the unit Itself but does ”cover key areas of the unit”.

Baby E's mum has said it took 10 minutes to get to the NICU but she had just had a c-section so it was taking her more time but still this suggests the wards are not cojoined. JMO

 

[Tortoise]

The PA Media articles have slightly more than today's tweeters

They say that Dr Evans at first said it wasn't possible to be certain that the bleeding was caused by deliberate harm but he changed his view after being provided with baby E's mother's statement. So I take it previously he'd only seen LL's (allegedly false) nursing notes and the doctor's clinical notes which excluded this information.

Rigid wire could have caused baby´s `extraordinary bleeding´, court...

 

[Tortoise]

I'm disappointed with the reporting today. Unless Mr Myers didn't have much to say to the expert witnesses, cross-examination seems like it was over before it started.

It feels like many reporters treat the public like we don't really need or want to know the details, (unless it's of a salacious nature of course) as long as they tell us the bare basics, there is someone in the witness box, they are being cross-examined and some facts from the police interviews have been agreed. Rubbish reporting!!

https://twitter.com/MrDanDonoghue

Prosecution have just read a summary of Ms Letby's police interviews in 2018 and 2019 in relation to the death of Child E. Ms Letby denied causing any intentional harm to the infant.

Like come on, what is even the point of paying them to be there all day?! (IMO)

Prosecution opening statement said she said all of 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 Child E's abdomen was becoming fuller and there was a purple discolouration, so had asked a doctor to review Child E.
She said she had got blood from the NG tube.
She was asked about the 10pm note and said if there had been any blood prior to the 9pm feed, "she would have noted it".
She said it was after 9pm that the SHO had reviewed Child E but could not reall if it was face-to-face or over the phone.
She said she could remember the mum leaving after 'the 10pm visit'.
In a June 2019 interview, she was pressed over a conversation with the SHO.
She said she had no independent memory of it.
She said she could not remember the mum coming into the room at 9pm with milk, nor Child E being upset, with blood coming from the mouth.
She said she would not have told the mum to go back upstairs.
In a November 2020 interview, Letby is asked why she had sent a text referring to Child E had queried whether he had Down Syndrome.
She said she could not remember whether there had ever been any mention of Downs in the medical notes.

Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders

 

[magikarpmagikarp]

Just leaping ahead here, as I am still not caught up, and am still back on #7. But while I have just been quickly reading I have noticed something that I had not fully comprehended before - that the doctors attending these soon-to-die babies had no idea that the babies were so near to their deaths, were apparently not overly concerned, and were considering treatment options with no great sense of urgency. And then they were extremely shocked when the babies suddenly died. It is not just the increased number of deaths which seems suspicious, but the shocking and sudden unexpected deaths (with the unusual skin mottling). So it does seem to me that there are only 2 possible explanations - either some very unusual condition was at play in the babies, or in their environment, or else someone was deliberately killing them.

I agree. When I first heard of this case, before I'd heard the details, I assumed this was a case of a hospital blaming an individual for systematically poor care. A person who happened to be at the wrong place at the wrong time, or a person/people who were put into an impossible, unreasonable or unsafe situation. However, the testimony thus far has not supported this conclusion. These deaths are extremely shocking. Dr. Harkness's testimony in particular was very compelling for me, as the steps he took at the time would have been reasonable had Baby E been suffering a natural deterioration. I believe the expert testimony has supported that.

Additionally the hospital, it seems, really began the investigation with the assumption that it could have been systematically poor care that caused these deaths. Hospitals have self-review systems intended to discover systematic weaknesses which compromise patient safety through medical errors. The investigation began with CoC's initial self-review, first at the unit level, then at the hospital level (I'm sorry I cannot find this particular timeline, but I believe it was among one of @Tortoise's many well-sourced posts). CoC then voluntarily made a request for outside review: (Neonatal Review and Update | Countess of Chester Hospital) Those are good faith actions of a unit that is trying to do better for the patients, not one that is looking for a scapegoat. It seems that only once "medical error" didn't make sense were the police involved. (Neonatal Update - Thursday 18 May | Countess of Chester Hospital)

 

[Tortoise]

I'm only as far as reading Dr. Harkness's testimony. He comes across and thorough and earnest. This answers some questions I have had. I believe/speculate that multiple things have happened here.

1. There was trauma inflicted on Baby E around the time that mum saw him. Based on the testimony, I would guess the damage was not in his upper throat as LL suggested to mum, but maybe lower in his esophagus.

2. From that trauma came the bleeding. I find it very believable and reasonable that Dr. H felt the first 14 mL blood loss would not have been an emergency, in and of itself. I also find it reasonable that he attempted to proceed in an urgent and rational but non-emergency manner in order to reduce the possibility of mistakes and be safer for Baby E.

3. If air was deliberately injected as alleged, it would have happened shortly before the purple discoloration. Slow injection would give the body time to clear the air (from capillary bed of lungs to alveoli) before it became a problem, rather than delaying a collapse. The air won't accumulate unless there is constant entry (such as described in the paper from 80s describing air entry from ventilator induced lung trauma). I think the most likely time would be between 11:30 and 11:40 when a lot of prescriptions were being written and meds were being given. If any meds were given IV push, air could been injected right into whatever venous access was being used. This could look like actually giving a medication, or flushing it in, or flushing the line to check for patency before connecting an infusion. All these are completely unremarkable actions during a situation like this. Less likely to me, would be air being put into one of the lines of fluids to slowly work it's way to the baby, unless it was accidental.

4. I await the expert testimony but I expect they will suggest that the combination of tissue trauma, large amounts of bleeding and an air embolism resulted in a lot of Tissue Factor being released, which would rapidly lead to massive clotting followed by massive bleeding (this is known as DIC) due to exhausted clotting factors. That could be what happened when poor little E was being resuscitated and a large amount of blood was coming out of his mouth. That is what I believe Dr. Harkness was referring to when he mentioned seeing "this amount of bleeding" in a teenager.

This is all just my opinion.

You were spot on.

[Dr Dewi Evans] "said a second “major” issue was “significant haemorrhaging from the upper gastrointestinal tract, somewhere between the mouth and the stomach”."
Rigid wire could have caused baby’s ‘extraordinary bleeding’, court hears

I guess but I don't know that if the trauma had been in the upper throat the doctor would have seen it when he did an emergency intubation at 11.45pm.

 

[magikarpmagikarp]

You were spot on.

[Dr Dewi Evans] "said a second “major” issue was “significant haemorrhaging from the upper gastrointestinal tract, somewhere between the mouth and the stomach”."
Rigid wire could have caused baby’s ‘extraordinary bleeding’, court hears

I guess but I don't know that if the trauma had been in the upper throat the doctor would have seen it when he did an emergency intubation at 11.45pm.

Yes, I share this opinion. If there was damage in the back of the throat (where the curve of an NG tube would rub) or really anywhere above the epiglottis, it seems likely to me that Dr. Harkness would have seen clotting, bleeding or swelling, or that he might have had trouble with the intubation.

 

[Tortoise]

I think the word "could" is probably an abbreviation of the expert testimony.

this report gives a fuller description of his testimony today - restricted to 10% for copyright

"[...] (Child E) suffered trauma [...] and there were a number of bits of equipment on a neo-natal unit that are relatively rigid.

Plastic tubes used for suction [...] it could have been interference with that.”

[...] another medical instrument known as an introducer [...] would be “more than sufficient to cause trauma if used inappropriately”.

Dr Evans said: “I cannot be 100 per cent certain what caused the trauma to the gastrointestinal system but it had to be some kind of relatively stiff (equipment) [...].”

Dr Evans [...] told the court he later saw the type of [NG] tube used by the hospital at the time and ruled out it could be capable of causing such damage.

Prosecutor Nick Johnson KC asked the consultant paediatrician if there could be an “innocent explanation” for the level of bleeding. Dr Evans replied: “No. "

Rigid wire could have caused baby’s ‘extraordinary bleeding’, court hears

 

[JosieJo]

As a Consultant he would be able to know via ..neonatal anatomy , the colour and amount of blood , the testimony and notes enough to give examples on how the baby could have been injured

 

[crowmarsh]

@JudithMoritz
Also reporting again today, slightly different wording from her here:

"12:08pm
The expert witness suggests that a piece of equipment made of rigid plastic may have been used to cause the injury to baby E."

MOO it's a very strong implication, suggesting a potential 'weapo

I think the word "could" is probably an abbreviation of the expert testimony.

this report gives a fuller description of his testimony today - restricted to 10% for copyright

"[...] (Child E) suffered trauma [...] and there were a number of bits of equipment on a neo-natal unit that are relatively rigid.

Plastic tubes used for suction [...] it could have been interference with that.”

[...] another medical instrument known as an introducer [...] would be “more than sufficient to cause trauma if used inappropriately”.

Dr Evans said: “I cannot be 100 per cent certain what caused the trauma to the gastrointestinal system but it had to be some kind of relatively stiff (equipment) [...].”

Dr Evans [...] told the court he later saw the type of [NG] tube used by the hospital at the time and ruled out it could be capable of causing such damage.

Prosecutor Nick Johnson KC asked the consultant paediatrician if there could be an “innocent explanation” for the level of bleeding. Dr Evans replied: “No. "

Rigid wire could have caused baby’s ‘extraordinary bleeding’, court hears

"Child E suffered trauma" is not a fact it is his speculation and he cannot say with 100% certainty that the type of n/g tube used in the unit is incapable of causing harm to a neonate , it is this type of medical testimony that worries me I am undecided about this case so far but I do not find this type of testimony at all helpful. Also the narrative of the attending doctors has in the main (and I paraphrase here) been that they always gave the best care at the optimal time and are blameless, all the babies were doing great, doctors always close ranks, cover each others backs and never admit their errors so I take all of their testimony with a grain of salt,

 

[Supernovae]

I'd be interested to hear from @magikarpmagikarp and @JosieJo, if there's anything a nurse could legitimately be doing, of even just semi-questionably but not malicious, that could cause damage. The other thing I'd interested in hearing from anyone medically qualified is whether it's a problem that the baby was apparently stable for an hour+ after then 9 o'clock incident, whatever it was.

 

[katydid23]

<modsnip - quoted post was off topic>
'Educated guesswork' is all through every criminal trial. It's impossible to avoid unless every portion of a crime has been captured on cctv. JMO

 

[Tortoise]

"Child E suffered trauma" is not a fact it is his speculation and he cannot say with 100% certainty that the type of n/g tube used in the unit is incapable of causing harm to a neonate , it is this type of medical testimony that worries me I am undecided about this case so far but I do not find this type of testimony at all helpful. Also the narrative of the attending doctors has in the main (and I paraphrase here) been that they always gave the best care at the optimal time and are blameless, all the babies were doing great, doctors always close ranks, cover each others backs and never admit their errors so I take all of their testimony with a grain of salt,

He actually said "I think E suffered trauma', and I snipped the part 'I think' to reduce the amount of words I was copying here, due to copyright laws, because I was focusing on how he framed his opinion in relation to what could have caused the injury. I don't agree he is speculating about the cause of the hemorrhage, I think he is giving an opinion based on his training, qualifications and experience.