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

[crowmarsh]

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.

But it is speculation because there is no documented evidence of trauma because there was no post mortem

 

[magikarpmagikarp]

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.

Just want to reiterate that I have chosen not to have my identity verified so this is my opinion and I may indeed be a 13 year old in my mom's basement. Take my posts as pure speculation and wondering aloud.

If it were the stiff PVC type of feeding tube, and a nurse was in a hurry, ang maybe it was in more than three days so it was extra stiff and should have been replaced, and the baby popped it out, and the nurse decided to just pop back it in, but the baby was crying, and the nurse had poor technique and it wasn't going in, so s/he forced it..... yeah maybe damage could be done that causes bleeding. I would expect that bleeding would be right in the back of the nose or throat where it curves, because that is the most common place to encounter resistance, not lower down. And maybe in a panic the nurse noticed some blood and then did not say anything about difficulty reinserting the feeding tube for fear of being blamed for causing harm.

Another possibility might be that for whatever reason (baby vomited and had a bradycardia?) the nurse decided the baby needs to be suctioned, so they use a little suction tool but they put it down the baby's throat too deep and too hard (could be bad technique, not necessarily malicious, just rough and poorly trained, IMO, although in my previous long post I did find a case report where there was accidental injury to a newborn baby due to use of a large stiff suction catheter) that could in theory cause damage. Whether it would cause the degree of bleeding they saw, I truly don't know. Obviously this is not something one sees much of, and none of the articles I've encountered reported copious bleeding as the first sign. (Edit again this would probably be pretty high up, most likely above the airway.)

If the bleeding was fairly slow and below the airway (so it didn't choke the baby), then yes it is believable the baby would remain stable for some time. 14 mL on a 1.2 kg baby is about 12 mL/kg. That's a little less than what one would give for a unit of blood (15mL/kg) - not good to lose that much blood, but should not lead to immediate circulatory collapse especially if it the bleeding was slowing down as Dr. Harkness reported in his testimony.

 

[Dotta]

But it is speculation because there is no documented evidence of trauma because there was no post mortem

The evidence of trauma seems to me baby's bleeding through his mouth and significant loss of blood.

Also, his suffering manifested by "horrendous" screaming is not a speculation but a fact - according to Mum's testimony.

Moo

 

[Tortoise]

But it is speculation because there is no documented evidence of trauma because there was no post mortem

I don't agree. He is using evidence like quantity of blood loss, the noise baby E was making, the sight of his face, the x-rays, the clinical notes, and methodically excluding other causes of this extent of blood loss because they don't fit. Speculating is based in uneducated guesswork.

 

[magikarpmagikarp]

I don't agree. He is using evidence like quantity of blood loss, the noise baby E was making, the sight of his face, the x-rays, the clinical notes, and methodically excluding other causes of this extent of blood loss because they don't fit. Speculating is based in uneducated guesswork.

Tortoise, has there been mention of what they saw on Xrays for Baby E?

 

[Anxala]

They have pulled it into a complete forensic narrative though. You are getting 10% of the details reported and shared with the jurors. This trial has taken 6 years and multi million pounds, the jurors are getting a lot more details and context than we are - for the simple reason we are reliant on journalist live texting (many days they don't do this) and the jurors are not.

"This trial has taken 6 years and multi million pounds..."

This is what gives me pause for thought, even while I'm keeping an open mind.

The gravity of the charges, the length of time it took for the case to come to trial and the collective time and effort it must have involved for all parties concerned. There's no entering lightly here. But that must surely have included a meticulous eye on incidents of same-setting past miscarriages of justice and the prosecution to conclude and be confident that this will not turn into one of those.

Without moving off the fence, I'm hoping that's the case, that we will in time be convinced BARD by the prosecution's arguments, because the alternative is too horrifying to contemplate.

JMO and still on the fence.

 

[Tortoise]

Tortoise, has there been mention of what they saw on Xrays for Baby E?

I have this in my timeline

12.27am - An x-ray is taken at 12.27am, relating to the chest and abdomen.(electronic evidence) Consultant’s testimony – x-ray showed E’s heart size was normal and his lungs were clear. “there’s no indication from the x-ray why E’s saturation was low” she says.

and this

Consultant testimony-at the time she thought E’s cause of death was NEC. She thought this because E was an at-risk baby, taking into consideration her colleague’s observations of gastro-intestinal bleeding and abdominal discolouration. She discussed with the coroner and they agreed for that to be put as E’s cause of death. She now doubts NEC because his observations were stable right up to the point of collapse and with NEC deterioration is normally slower. There were also no signs of NEC on the x-ray.

 

[magikarpmagikarp]

I don't agree. He is using evidence like quantity of blood loss, the noise baby E was making, the sight of his face, the x-rays, the clinical notes, and methodically excluding other causes of this extent of blood loss because they don't fit. Speculating is based in uneducated guesswork.

Yes, DE revised his opinion to "trauma" only after hearing the mother's testimony. Doctors hypothesize and then revise that hypothesis when new information becomes available.

I have this in my timeline

12.27am - An x-ray is taken at 12.27am, relating to the chest and abdomen.(electronic evidence) Consultant’s testimony – x-ray showed E’s heart size was normal and his lungs were clear. “there’s no indication from the x-ray why E’s saturation was low” she says.

Thank you. One thing I had been wondering was if there was esophageal perforation that led to air in the cavity surrounding the lungs or heart. That (pneumomediastinum) could cause decompensation but it would have been seen on this x-ray. This supports the idea, to me, that the medical team had not missed anything key up to this point.

 

[crowmarsh]

The evidence of trauma seems to me baby's bleeding through his mouth and significant loss of blood.

Also, his suffering manifested by "horrendous" screaming is not a speculation but a fact - according to Mum's testimony.

Moo

There are many medical reasons for bleeding without the involvement of trauma and the mothers testimony is not fact. It is her recollection of a point in time.

 

[JosieJo]

"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,

Thing is if we cannot trust witnesses on oath and expert witnesses where does that leave us ? It's the only information the Jury will use to make their decision.

In relation to Dr's not admitting their errors .. The consultant actually said it was a mistake she didn't ask for a post mortem , should have put more emphasis on the X Ray and turned an apologised to the parents in the most public of arenas ..so imo that's not always the case

 

[magikarpmagikarp]

There are many medical reasons for bleeding without the involvement of trauma and the mothers testimony is not fact. It is her recollection of a point in time.

Are there, though? I think what DE is getting at in his testimony is that spontaneous bleeding from the esophagus or stomach of an otherwise healthy premature baby would most likely be iatrogenic (whether it was intentional or accidental).

 

[Tortoise]

There are many medical reasons for bleeding without the involvement of trauma and the mothers testimony is not fact. It is her recollection of a point in time.

If the expert is already of the firm opinion that somebody deliberately injected air into the baby, and there is much circumstantial evidence to back up the mother's statement, ie. baby was actually due to be fed and the doctor mentioned in the nursing note as having advised to omit the feed not being consulted that night, and with the expectation that a person causing such an injury deliberately would not write it in the nursing notes, I think he is entitled to give as much weight to the mother's statement as he sees fit.

IMO

 

[magikarpmagikarp]

And yes, DE is suggesting that it was intentional damage, which I suppose is the point of contention here - can he suggest that? I think the reason why he says this is because of the location. If there was damage to the esophagus above the level of the airway, one would expect someone to have seen it. If it was below the level of the airway, it's hard to imagine a way that could have happened accidentally, as the tools and items that would normally go in a premature infant's mouth and throat in the course of normal caregiving are either too soft or not long enough.

 

[crowmarsh]

I don't agree. He is using evidence like quantity of blood loss, the noise baby E was making, the sight of his face, the x-rays, the clinical notes, and methodically excluding other causes of this extent of blood loss because they don't fit. Speculating is based in uneducated guesswork.

So why did the attending doctors not take any of this into account at the time

 

[Tortoise]

So why did the attending doctors not take any of this into account at the time

They weren't told that the mother had come across her baby bleeding an hour earlier, and LL didn't tell them either, writing up her notes with this event wiped out, and false information added into them (according to the two doctors' testimonies) 3-4 hours after he'd died.

 

[katydid23]

So why did the attending doctors not take any of this into account at the time

Did they have ALL of this info and data in real time? I don't think the attending doctors knew about the discrepancy between Mom's version of events and LL's notes, in real time, for example.

Nor did they see the larger pattern made by the 10 or 15 victims at the time.

 

[Rubypearlcats]

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.

Clearly correct, non biased and evidenced based jmo

 

[Kemug]

The evidence of E's mother is vitally important in this case, it may be what clinches things. It is one of the few absolutely indisputable facts, thanks to her phone call to her husband at 9.11pm being an absolute. It has certainly led me to my (probable) final conclusion.

 

[Kemug]

As I am following the case, and am coming to certain conclusions, I wonder if LL's parents are doing the same thing. Those poor people.

 

[MsBetsy]

They weren't told that the mother had come across her baby bleeding an hour earlier, and LL didn't tell them either, writing up her notes with this event wiped out, and false information added into them (according to the two doctors' testimonies) 3-4 hours after he'd died.

I think Baby E was trying to tell them something in the only way he could! He was screaming out in pain. No wonder his parents were so alarmed. He suffered a prolonged and painful death.