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

[Tortoise]

I think it might be because they were planning to intubate him and transfer him to a larger facility.

Ah, I hadn't realised they were planning to move him at that stage. I'm not sure the doctor ever did speak to Alder Hey, I think it was something they were going to do later after doing x-rays. I know he said the bleeding had settled at that point.

 

[Tortoise]

The Trial of Lucy Letby, Episode 7: Baby E, 'I trusted her completely...'

www.mailplus.co.uk

In this episode Caroline and Liz examine what happened to Baby E, a premature twin boy who Lucy Letby allegedly attacked with a plastic medical tube or wire before she murdered him. We hear from his mother, who the prosecution say, interrupted the nurse while she was attacking her son, and about more text messages Lucy Letby exchanged with colleagues after his death. We also chat to former Old Bailey court reporter and media law expert Tim Cook, professor of journalism at London's Goldsmiths University, about why court reporting is still important in the modern era.

 

[ColourPurple]

I would imagine that the glucose injections were prescribed by the Dr's to counteract the low blood sugars.
My impression was she was singing for legitimate medication but I suppose we will see when it's covered

We've only heard about her signing for the lipid syringe so maybe the glucose injections are something they keep to hand without prescriptions. But the odd bit is why she was giving them to Baby F when she wasn't his designated nurse and why the staff were taken by surprise by his sudden drop in blood sugars after LL had finished her shift, if they'd already been dropping and needing glucose to correct them while LL was on shift.

If LL had legitimately been giving him glucose injections during her shift because his blood sugar had been dropping after she attached the new TPN bag, then you'd expect this to be noted and for his designated nurse to be aware and for them to possibly have already investigated why it was dropping and maybe even checked his insulin levels, like they did later. Yet they seem to have been taken by surprise at them suddenly dropping, which makes me think maybe LL didn't make them aware that they were dropping and didn't make them aware that she had been giving him glucose injections to keep them in the normal range. I could be totally wrong of course. Hopefully we'll find out when the case resumes.

 

[magikarpmagikarp]

Ah, I hadn't realised they were planning to move him at that stage. I'm not sure the doctor ever did speak to Alder Hey, I think it was something they were going to do later after doing x-rays. I know he said the bleeding had settled at that point.

Oh, I think you're right. This is confusing. I didn't realize that the midwife was contacted by the neonatal unit for the first time at 10:52, to report that baby E was "declining." That is puzzling. It's not inappropriate, but it's also not completely expected. Who from the neonatal unit made that call? And then at 11:30 the midwife was called again to ask the mom to go down within 30 minutes?

 

[magikarpmagikarp]

Ok, I think I've sorted myself out now. I think by 11:30 even if they hadn't decided to transfer E, they had decided to intubate, and would soon be making a decision about transfer. A decision to intubate reflects a fairly significant change in status, and parents are usually updated as soon as possible. But the 10:52 call is still puzzling to me.

 

[Tortoise]

I don't really understand the defence's strategy in questioning everyone's observations of the purple-blue blotches that have been a feature of all of these cases so far, as if they didn't exist. It just doesn't seem like a reasonable strategy to me, with so many different medics and nurses having observed and written it in the notes.

I also don't understand how they can say there are no signs of air embolism when the experts have identified them as being a feature, especially with two of the babies having x-rays which showed air by their spines. What is the defence's explanation for the blotches that staff had never seen before? Why isn't the defence putting its explanation to the experts so that they can answer?

 

[notsure]

I don't really understand the defence's strategy in questioning everyone's observations of the purple-blue blotches that have been a feature of all of these cases so far, as if they didn't exist. It just doesn't seem like a reasonable strategy to me, with so many different medics and nurses having observed and written it in the notes.

I also don't understand how they can say there are no signs of air embolism when the experts have identified them as being a feature, especially with two of the babies having x-rays which showed air by their spines. What is the defence's explanation for the blotches that staff had never seen before? Why isn't the defence putting its explanation to the experts so that they can answer?

Perhaps the defence is trying to suggest that all these factors, if observed at the time, were not sufficient to suggest foul play. IMOO.

 

[Jazmania]

Ok, I think I've sorted myself out now. I think by 11:30 even if they hadn't decided to transfer E, they had decided to intubate, and would soon be making a decision about transfer. A decision to intubate reflects a fairly significant change in status, and parents are usually updated as soon as possible. But the 10:52 call is still puzzling to me.

Wasn't 10.52 shortly after baby E had the significant bleed? It's after that bleed that they decided to do an x ray and an elective intubation. It was a significant decline in baby E's health so would surely merit a call? The 11.30 call to say 'cone down in 30' was presumably shortly before they planned to begin the intubation procedure. That's how I pictured it anyway

 

[Dotta]

Perhaps the defence is trying to suggest that all these factors, if observed at the time, were not sufficient to suggest foul play. IMOO.

This case seems to me like a jigsaw puzzle.

Only when ALL elements are fitted together, one can finally see the whole picture.

Moo

 

[Tortoise]

Perhaps the defence is trying to suggest that all these factors, if observed at the time, were not sufficient to suggest foul play. IMOO.

The staff hadn't seen air embolisms before, so it seems fair that they wouldn't suspect foul play based on the blotching.

 

[notsure]

This case seems to me like a jigsaw puzzle.

Only when ALL elements are fitted together, one can finally see the whole picture.

Moo

They could be fitted together to suit various different scenarios, IMO

 

[magikarpmagikarp]

The staff hadn't seen air embolisms before, so it seems fair that they wouldn't suspect foul play based on the blotching.

Obviously no one can know what they would have thought in a situation like this unless they were in it... but I think I would have assumed it was medical error or incompetence before I ever assumed it was deliberately inflicted harm. The cognitive dissonance you'd have to overcome to suspect a colleague of deliberately harming someone you have an ethical and legal duty to protect is.... huge.

 

[Tortoise]

Obviously no one can know what they would have thought in a situation like this unless they were in it... but I think I would have assumed it was medical error or incompetence before I ever assumed it was deliberately inflicted harm. The cognitive dissonance you'd have to overcome to suspect a colleague of deliberately harming someone you have an ethical and legal duty to protect is.... huge.

I agree.

 

[Kemug]

There's also something of a mismatch between LL's actions and the consultant's and the doctor's actions, early on, IMO.

LL called the midwifery unit before 10.52pm, to get the father to come in (the don't panic but get here call), and then contacted the midwife again at 11.30pm to tell the parents to come down at midnight.

At the 10.52pm point LL's notes said E was 'cold to the touch' and was beginning to 'decline'.

This seems like it might be a level above the doctor's concerns. The consultant didn't come in until after the unexpected collapse at 11.40pm, and Dr Harkness was saying at the 10.52pm point that he had time to take his time for the elective intubation, and E was making good respiratory effort and crying which showed he was taking deep breaths.

So at 10.52pm LL said that Baby E was cold to the touch and beginning to decline. And at exactly the same time Dr Harkness said that Baby E was making good respiratory effort and crying. So which was it?

 

[Supernovae]

I don't really understand the defence's strategy in questioning everyone's observations of the purple-blue blotches that have been a feature of all of these cases so far, as if they didn't exist. It just doesn't seem like a reasonable strategy to me, with so many different medics and nurses having observed and written it in the notes.

I also don't understand how they can say there are no signs of air embolism when the experts have identified them as being a feature, especially with two of the babies having x-rays which showed air by their spines. What is the defence's explanation for the blotches that staff had never seen before? Why isn't the defence putting its explanation to the experts so that they can answer?

My interpretation is that the suggestion is that- while they undoubtedly observed and recorded some kind of skin discolouration- they may have built it up into something more specific/meaningful, in the years since, than what it was at the time due to confirmation bias around the air embolism narrative.

 

[katydid23]

I agree
One of the biggest things for me also is why was LL standing away from the incubator when the baby was crying so badly and had blood around the mouth.

Also LL did not deny it was blood to the mum when she asked

Then she recorded the 9pm aspirates as bile and put the blood back approx an hour and delayed calling a Dr

I cant think of any innocent explanation for this

And it wasn't lost on me how urgently the defense counsel seemed to be trying to make the grieving mum back down from her recollection of events.

 

[LadyEdgeworth]

Morning everyone, looks like chester standard is back with updates live today so I'll be back on those

Here is a recap of Thursdays last live reports

Recap: Lucy Letby trial, Thursday, November 17

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

and Friday's write up

Lucy Letby trial: Wire could have caused baby's 'extraordinary bleeding'

A RIGID wire or tube may have been used to cause "extraordinary bleeding" in a baby boy allegedly murdered by nurse Lucy Letby, a court…

www.chesterstandard.co.uk

In case anyone has not seen these yet

 

[Tortoise]

My interpretation is that the suggestion is that- while they undoubtedly observed and recorded some kind of skin discolouration- they may have built it up into something more specific/meaningful, in the years since, than what it was at the time due to confirmation bias around the air embolism narrative.

well, this was Dr Harkness's clinical note on the night E collapsed

: 'Sudden deterioration at 11.40pm, brady 80-90bpm, sats 60%, poor perfusion, colour change over abdomen purple discoloured patches'. The note adds, after an improvement in sats, 'purple discolouration in abdomen remained', and a plan of action noted for E. (electronic evidence)

LL's note: 11.40pm became Bradycardiac, purple band of discolouration over abdomen,...

A nursing colleague had referred to 'discoloured abdomen' in a retrospectively written note at 1.30am.


I don't think there was an air embolus narrative at the hospital.

Dr Harkness also testified he has not been in discussions with anyone in relation to these observations.


For baby B, this was the on-call consultant's note -
The court is shown clinical notes made by her, written retrospectively at 2.40am on June 10, 2015.
She was called at home at 12.36am, and arrived at the neonatal unit at 12.50am.
She recorded Child B "went apnoeic [stopped breathing]", followed by "suddenly purple blotching of body all over, with slowing of heart rate."The consultant says the 'purple blotching' would have been the registrar's account of events, relayed to her.The consultant noted, for her observation: "Upon my arrival purple blotching right mid-abdomen and right hand." The baby was "pink and active".
The consultant's notes add: "Spoke to parents. "Purple discolouration almost resolved. "?? cause."
She tells the court: "I think this was something I was puzzled about, and wondering what it would be."
She says other causes were ruled out as such a rash had "come out of nowhere" and had "almost completely gone" a couple of hours later. The consultant says, from looking at her notes, she was "quite puzzled" by that as there were two question marks.The doctor says she was 'puzzled' by Child B's deterioration. Describing the 'rash' that covered her, she said: 'It was so florid, it came out of nowhere. One and a half hour's later it is completely gone'

Dr Evans said [...] his original conclusion was without knowing about the skin discolouration in Child A. I think this shows he hadn't even seen the statements made to the police when he made his diagnosis.
He adds that if you discover additional information, that "simply firms up your diagnosis".

I could go on, finding very similar witness statements for babies C and D.

And it's not just Dr Evans and Dr Bohin coming up with a narrative, Professor Arthurs also says the air on the x-rays available is consistent with air being administered and not consistent with death from natural causes or post mortem changes.



Seen in a cluster of sudden unexpected collapses in babies who were stable and showed no signs of slow deterioration, 'confirmation bias' is not a very convincing strategy, IMO

 

[LadyEdgeworth]

No updates in over an hour... the way this case has been reported is incredibly frustrating. I know we can't always get the full story through live tweets/updates but my word it could certainly be better than this

 

[LadyEdgeworth]

11:05am

The trial has now resumed.
The jury is being shown the sequence of events for Child F, the twin boy of Child E.

11:08am

Child F was born on July 29, 2015, at the Countess of Chester Hospital, and had required some resuscitation at birth and was later intubated, ventilated and given medicine to help his lungs.
On July 31, a high blood sugar reading was recorded for him, and he was prescribed a tiny dose of insulin to correct it. At this time his breathing tube was removed and he was given breathing support.

11:12am

In the early hours of August 4, Child E had died.
Later that day, just before 5pm, a nursing note records family communication in which Child F's parents wish to transfer care to another hospital in the North West, but transport was unavailable due to an emergency. The note adds 'sincere apologies given to parents'.

Recap: Lucy Letby trial, Tuesday, November 22

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