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

[ColourPurple]

I directly quoted from another post where he was quoted. It's his direct quote that I was bringing up.

I think I confused matters by quoting some of the info about later cases that was given at the start of the trial. They haven't got to those cases yet so the Dr hasn't been questioned about who he reported his concerns to or about anything else to do with those cases. That's yet to come.

 

[Sundial]

I think I confused matters by quoting some of the info about later cases that was given at the start of the trial. They haven't got to those cases yet so the Dr hasn't been questioned about who he reported his concerns to or about anything else to do with those cases. That's yet to come.

There was a report some while back shortly before the trial started; that someone who appeared to have some kind of knowledge (with the hospital) was actually claiming the chief exec was aware of some of the issues raised and then allegedly resigned with full pension very soon after her first arrest.
This is all of course **allegedly** but it was heavily indicated at the time people were actually reporting these things. It appears (and this is just my opinion) if true, people may have jumped ship somewhat. It really is quite concerning but of course, more will be revealed as the case progresses.

 

[Kasmeer]

"A chart is displayed to the jury about the presence of staff on duty at the time the babies were "attacked", with Letby present for all 24 incidents listed between 2015 and 2016.

The majority of incidents are at night-time. No other member of registered nurse and/or nursery nurse staff is present for more than a total of seven incidents."

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

I hope the jury get full access to that chart - obviously for privacy reasons we never will, but I'd really ike to know if any staff members presence matches up with specific types of incident, eg, was anyone else present for all the insulin cases?

I think a defence strategy could well be claiming natural causes for the less clear cases, and blaming A.N. Other for those which seem clearly deliberate (they don't even need to pick a name if there's few enough of those cases to have a few other staff in the frame).

I tend to find the air embolus cases a bit speculative; it fits, yes, but it seems so rare and without clear diagnostic process other than one of exclusion, that I could see natural causes being possible too. The insulin on the other hand seems clear to me that it couldn't have happened naturally (and as the nurses caring for baby F have confirmed he wasn't given insulin, accidental overdose by someone putting a decimal point in the wrong place appears also excluded). So perhaps a combined approach to the defence is the best they can aim for.

(edit for spelling, even after reading over it I still can't spell embolus...)

 

[Dotta]

"Police video of the neonatal unit presented to the Jury"

Video shows room at neonatal unit where Lucy Letby allegedly murdered baby

The trial of neonatal nurse Lucy Letby continues in the UK. The jury was shown video of a room in the hospital where it is alleged Letby killed a baby by injecting air into its bloodstream.

www.foxnews.com

 

[Kasmeer]

From that article

"Miss Tomlins told the court she recalled a new TPN intravenous feed bag being set up for Baby E after a longline tube needed to be replaced because it had 'tissued'.

This would have come from the padlocked fridge on the unit. Nurses had access to bespoke TPN bags for individual babies and stock bags for more general use or where there was no time to wait for a bespoke bag. [...]

Asked what type of feed bag would have been used on August 4, Miss Tomlins replied: 'It would depend on whether there were any more bags made up for him.

'If we had run out I assume we would have just attached to one of our stock bags and ordered more for him. It took a few hours for them to come from the pharmacy'."

Argh, confusing reporting again! I initially thought this said Baby F had definitely had a second bag after the line was changed, which would really have set the cat among the pigeons... but it says Baby E. Jeez.

Still, the clarification that bespoke bags may also be made up and ready is a very useful one, as I'd assumed a second bag would be a stock bag - it's a shame it all seems to be "it would depend" and "I assume we would have", and nobody has the "it was this reference number so this type of bag was fitted/the original bag stayed in place throughout", which would answer the question once and for all.

 

[Tortoise]

Argh, confusing reporting again! I initially thought this said Baby F had definitely had a second bag after the line was changed, which would really have set the cat among the pigeons... but it says Baby E. Jeez.

Still, the clarification that bespoke bags may also be made up and ready is a very useful one, as I'd assumed a second bag would be a stock bag - it's a shame it all seems to be "it would depend" and "I assume we would have", and nobody has the "it was this reference number so this type of bag was fitted/the original bag stayed in place throughout", which would answer the question once and for all.

It's baby F, they've made a mistake with that. Baby E wasn't on TPN before he died.

I'm waiting to hear the rest of the evidence, because opening speech seems to contradict this nurse's recollection.

 

[WaxLyrical]

On this TPN bag business, and whether the first and second bag were both contaminated, I believe it was mentioned in the opening statements that they had a sample from bag 2? Do we know anything more about that?

 

[Kasmeer]

It's baby F, they've made a mistake with that. Baby E wasn't on TPN before he died.

Thanks! Well in that case I hope* it was a bespoke bag prepared before LL went off shift, otherwise... oof. That'd really make things very unclear; I don't like needing to believe a stored stock bag was poisoned and just happened to reach the intended target when every other case is presented as very carefully targetted. Nor do I like needing to believe a contaminated line would continue providing the exact same amount of insulin as a poisoned bag while being flushed through by a clean bag for several hours.

*(Actually I don't hope it; I hope she's innocent and most the poor babies were not murdered after all, but if she did do it, I want it to be clear and not have big holes in the narrative which require mental gymnastics to make it work...)

 

[Tortoise]

On this TPN bag business, and whether the first and second bag were both contaminated, I believe it was mentioned in the opening statements that they had a sample from bag 2? Do we know anything more about that?

"The defence say Child F's TPN bag was put up by Letby in August 2015 and hours later there were blood sugar problems. That bag was replaced, in the absence of Letby, but the problems continued. The sample taken came from "the second bag", the defence say."

I think they're talking about the blood sample taken later that day, although it's a funny way of saying it.

 

[WaxLyrical]

"The defence say Child F's TPN bag was put up by Letby in August 2015 and hours later there were blood sugar problems. That bag was replaced, in the absence of Letby, but the problems continued. The sample taken came from "the second bag", the defence say."

I think they're talking about the blood sample taken later that day, although it's a funny way of saying it.

Ah, that would make sense. Thanks!

 

[Tortoise]

Opening speech -

"As a matter of practice", insulin is "never" added to a TPN bag.
Insulin is "given via its own infusion, usually in a syringe which delivers an automatic dose over a period of time".
The prosecution adds insulin is not added to a TPN bag as it would "stick to the plastic - or bind" to the bag, making it difficult to accurately give a reliable dose.

Professor Peter Hindmarsh said the insulin "had to have gone in through the TPN bag" as the the hypoglycaemia "persisted for such a long time" despite five injections of 10% dextrose.

Professor Hindmarsh said the following possibilities happened.
That the same bag was transferred over the line, that the replacement stock bag was contaminated, or that some part of the 'giving set' was contaminated by insulin from the first TPN bag which had bound to the plastic, and therefore continued to flow through the hardware even after a non-contaminated bag was attached.
"There can be no doubt that somebody contaminated that original bag with insulin."

---

I don't know but I think of it as being sticky, like honey, so unless there was a whole new 'giving set' it would continue to contaminate whatever bag, old or new, that flowed through it.

 

[Marantz4250b]

I hope the jury get full access to that chart - obviously for privacy reasons we never will, but I'd really ike to know if any staff members presence matches up with specific types of incident, eg, was anyone else present for all the insulin cases?

I think a defence strategy could well be claiming natural causes for the less clear cases, and blaming A.N. Other for those which seem clearly deliberate (they don't even need to pick a name if there's few enough of those cases to have a few other staff in the frame).

I tend to find the air embolus cases a bit speculative; it fits, yes, but it seems so rare and without clear diagnostic process other than one of exclusion, that I could see natural causes being possible too. The insulin on the other hand seems clear to me that it couldn't have happened naturally (and as the nurses caring for baby F have confirmed he wasn't given insulin, accidental overdose by someone putting a decimal point in the wrong place appears also excluded). So perhaps a combined approach to the defence is the best they can aim for.

(edit for spelling, even after reading over it I still can't spell embolus...)

I have to say that this is the one thing which sits very uncomfortably with me. Saying that some condition was present because it can be diagnosed from the symptoms observed is one thing. A lot of what seems to be being "diagnosed" though appears to be so on the basis of things such as "well, we think we've excluded most things so it must be this". And, let's not forget that these things were never diagnosed at the time but are being diagnosed years after the events. Also the phrase "consistent with" (which doesn't exclude it being consistent with something else) gives me an uneasy feeling.

Work and life in general means that I'm not getting the time to follow this in detail; has any doctor or expert stated unequivocally that an air embolus was the definite cause of any of these deaths or collapses without qualifying their statement?

 

[Tortoise]

I have to say that this is the one thing which sits very uncomfortably with me. Saying that some condition was present because it can be diagnosed from the symptoms observed is one thing. A lot of what seems to be being "diagnosed" though appears to be so on the basis of things such as "well, we think we've excluded most things so it must be this". And, let's not forget that these things were never diagnosed at the time but are being diagnosed years after the events. Also the phrase "consistent with" (which doesn't exclude it being consistent with something else) gives me an uneasy feeling.

Work and life in general means that I'm not getting the time to follow this in detail; has any doctor or expert stated unequivocally that an air embolus was the definite cause of any of these deaths or collapses without qualifying their statement?

Yes, both experts have said unequivocally that air was the cause of the deaths. I will bring over the summary again.

 

[Tortoise]

Prosecution Expert Opinions In Letby

Child A

Dr Dewi Evans

"He rules out other conditions such as sepsis, a lack of fluids or hypoxia as causes, or contributing factors to the collapse.
He said he had "only one" conclusion, that Child A had received an air embolus, "through an IV line".

"there was no way this could have been done by accident"."

Recap: Lucy Letby trial, Tuesday, October 25

Dr Sandie Bohin

"Mr Johnson: "What, in your opinion, killed [Child A]?"
Dr Bohin: "[Child A] was killed by an air embolus."

Recap: Lucy Letby trial, Tuesday, October 25


Child A's mother wept in the public gallery as Dr Bohin said she was left with only one "plausible explanation" for her son's collapse and death, which was an air embolism."

Lucy Letby: Disturbing pattern in baby deaths, nurse's trial told


Child B

Dr Dewi Evans

"He says the cause of her collapse - like her brother Child A - was an air embolism, 'there was nothing else to explain this collapse, which was so sudden and unexpected', he said"

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

Dr Sandie Bohin

"Dr Bohin said other factors, such as infection or cardiac arrhythmia, could be discounted, and the only conclusion left was "air embolus"."

Recap: Lucy Letby trial, Wednesday, October 26


Child C

Dr Dewi Evans


"He says infection was a part of Child C's status. He adds it did not cause Child C's death."

"He says while Child C had an infection, he was recovering from it, as he had gone off CPAP support, on to Optiflow.
"Respiratory wise, he didn't stay the same, he was improving."

"He said there were three clinical scenarios - injecting air into the stomach that interfered with his breathing, or that air was injected intraveneously, or from a combination of the two"

Recap: Lucy Letby trial, Tuesday, November 1



Dr Sandie Bohin

"This was not a baby who was ill, this was a baby who was improving."

Dr Bohin's conclusion was that he had pneumonia, but that did not cause the collapse or kill him.

She added babies such as Child C do not collapse suddenly and without warning.
She said an infection would not be the cause as that would lead to a gradual deterioration in the baby, not a sudden collapse and no response to resuscitation.

She said one conclusion for Child C's collapse was CPAP accumulation of air, the other being deliberate injection of air. She said the doctors did not appear to have a concern as they had noted the abdomen to be "soft".

Recap: Lucy Letby trial, Tuesday, November 1


Child D

Dr Dewi Evans


Dr Evans says his conclusion in Child D’s case is that death was caused by an injection of air into her bloodstream.

Ben Myers KC, defending, asks Dr Evans why he thinks this. Dr Evans gives 5 reasons. 1. D’s collapse was rapid and v striking. 2. The presence of discolouration on D’s body “a pattern experienced [nurses and doctors] had never seen before and never since and it came and went. 3. Attempts to resuscitate D were unsuccessful. 4. The presence [at post mortem] of air in D’s blood vessels and 5. None of the other issues, eg pneumonia were relevant.

“What we have in [D’s] case is a full house of clinical characteristics consistent with her having suffered an air embolism, ie air has been injected into her.” says Dr Evans.

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



Dr Sandie Bohin

"Taking into account the sudden nature of the collapses and the very quick recovery...I was very clear it wasn't infection, so the conclusion had to be something unusual and odd." Other conditions were crossed off as they 'didn't fit'.
She concludes the collapses were caused by intravenous air administration either through the UVC or the cannula.
Dr Bohin says with air embolus, the speed and quantity of the air administered depends on whether it is fatal. She says the first two administrations of air would have been small, but the third would have been larger to cause circulation to stop. Dr Bohin says the suddenness of the collapse, with skin discolouration, fitted with cases of air embolus, as did the presence of air found in the 'great vessels' on post-mortem x-rays. Dr Bohin adds she believed Child D died with pneumonia, not because of pneumonia.

Recap: Lucy Letby trial, Friday, November 11

Child E

Dr Dewi Evans

He told the jury that this "trauma" had "no" innocent explanation and suggested it could have been caused by a medical tool called an introducer. "I can't be certain about what caused trauma, but it was some kind of relatively stiff thing, sufficient to cause extraordinary bleeding." The expert went on to tell the court that a "more significant factor" in Child E's death was the injection of air into his bloodstream.

Lucy Letby trial: Medical tool may have injured baby, expert says

Dr Evans tells the court he believes that baby E died as a result of an injection of air, with the massive bleed caused by trauma as a contributory factor.

https://twitter.com/JudithMoritz



Dr Sandie Bohin

Dr Bohin says baby E died as a result of an injection of air, and that his catastrophic bleed was not the cause of his collapse.

https://twitter.com/JudithMoritz

 

[katydid23]

But there were alleged attempts at harming babies after those results came back, I think. Somebody would have reviewed those results, presumably.

Right, but it cannot be done in real time. It is done during an investigative review, taking into account all the relevant interviews, medical tests and data, and the opinions of medical experts who take it all into account.

 

[katydid23]

I hope the jury get full access to that chart - obviously for privacy reasons we never will, but I'd really ike to know if any staff members presence matches up with specific types of incident, eg, was anyone else present for all the insulin cases?

I think a defence strategy could well be claiming natural causes for the less clear cases, and blaming A.N. Other for those which seem clearly deliberate (they don't even need to pick a name if there's few enough of those cases to have a few other staff in the frame).

I tend to find the air embolus cases a bit speculative; it fits, yes, but it seems so rare and without clear diagnostic process other than one of exclusion, that I could see natural causes being possible too. The insulin on the other hand seems clear to me that it couldn't have happened naturally (and as the nurses caring for baby F have confirmed he wasn't given insulin, accidental overdose by someone putting a decimal point in the wrong place appears also excluded). So perhaps a combined approach to the defence is the best they can aim for.

(edit for spelling, even after reading over it I still can't spell embolus...)

The problem for the defense is really going to be the insulin cases. Because if the jurors believe the prosecution in those cases----it would be hard to then consider the previous cases of air embolism as a natural occurrence. What are the chances that a nurse cares for a baby twin that dies of an unusual natural circumstance, and days later same nurse attacks the surviving twin with insulin drip?

 

[MissMarbles]

Opening speech -

"As a matter of practice", insulin is "never" added to a TPN bag.
Insulin is "given via its own infusion, usually in a syringe which delivers an automatic dose over a period of time".
The prosecution adds insulin is not added to a TPN bag as it would "stick to the plastic - or bind" to the bag, making it difficult to accurately give a reliable dose.

Professor Peter Hindmarsh said the insulin "had to have gone in through the TPN bag" as the the hypoglycaemia "persisted for such a long time" despite five injections of 10% dextrose.

Professor Hindmarsh said the following possibilities happened.
That the same bag was transferred over the line, that the replacement stock bag was contaminated, or that some part of the 'giving set' was contaminated by insulin from the first TPN bag which had bound to the plastic, and therefore continued to flow through the hardware even after a non-contaminated bag was attached.
"There can be no doubt that somebody contaminated that original bag with insulin."

---

I don't know but I think of it as being sticky, like honey, so unless there was a whole new 'giving set' it would continue to contaminate whatever bag, old or new, that flowed through it.

What does "giving set" mean please, does anyone know??

 

[JosieJo]

What does "giving set" mean please, does anyone know??

It's the line that carries the fluid from the bag to the patient it comes in a sterile packet separate to the fluid bag

 

[Tortoise]

I have absolutely no knowledge of IV equipment but I'm assuming there were connectors for lipids and glucose to be administered, somewhere in this apparatus, as well as the TPN bag. I thought that's what was meant by 'set', in addition to the line. The line was new.

 

[MissMarbles]

It's the line that carries the fluid from the bag to the patient it comes in a sterile packet separate to the fluid bag

Thank you. I, like some others, are finding the evidence on Baby F confusing because of changing around of bags. And for some reason I had thought giving set meant the original TPN bag, which was compounding my confusion, so I'm glad you cleared that up.