GUILTY UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #8

[LadyEdgeworth]

2:18pm

A photo is shown to the court with black circles indicating where Child G's projectile vomit patches went. One patch is in the cot, another patch is on the floor, and another is on the seat of an adjacent chair.
Mr Johnson continues to talk through the sequence of events, which Dr Evans confirms he has noted throughout his report.

2:19pm

Dr Evans said in his report, for the 100mls aspirate taken from Child G, "It is not clear how much of the 100mls was milk, and how much was air".

2:25pm

Mr Johnson asks about what happens if a baby's stomach is full.
Dr Evans says if you give milk gravitationally, no more milk will go in, as the stomach is full.
He says the baby is unlikely to absorb the final few millilitres of milk if the stomach capacity is, for example, 45ml, and the milk portion is 55ml. While the stomach could expand a little, the likelihood is the milk would drip out.
Dr Evans describes there is a way of "forcing" more milk into the stomach via a syringe, which "you would never do" as it would forcibly distend the stomach.

2:30pm

Dr Evans says he was looking for signs of an infection in the records, as it is one of the most common findings on a neonatal unit, so one is "always alert" to that possibility.
From Child G's blood test at 3.59am on September 7, the findings were all considered "normal" and did not point to a sign of infection, the court hears.
A subsequent blood gas reading, 10-12 hours later which contains 'CRP: 28' is "not particularly high" but is a sign of infection.
The subsequent blood gas reading after that was indicative of infection, Dr Evans tells the court.

Recap: Lucy Letby trial, Monday, December 12

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

 

[LadyEdgeworth]

2:32pm

Dr Evans says Child G, at birth, was "on the margins of survival", but it was the "skill of staff" at Arrowe Park which ensured her stabilisation.
He says there were no signs Child G was unwell prior to her collapse on September 7. He says the only two considerations were the chronic lung condition, which was common and for which she was receiving treatment, and establishing feeds.
"Considering her start in life, this was an extremely satisfactory state".

2:34pm

Child G's weight of 1.985kg was a little low, but she was tolerating bottle feeds every other feed (with naso-gastric tube feeding on the other occasions).
Dr Evans says Child G would likely have still required supplemental oxygen support once she went home.

2:40pm

The photo showing where the projectile vomiting patches landed is shown to the court.
Dr Evans says there are three black circles. The one in the cot indicates the baby was sick, which "would be worthy of note, but not unusual".
The second one between the chair and cot, on the floor.
"For a baby of 2kg to vomit that far is quite remarkable".
Dr Evans says there is a condition which can cause projectile vomiting of that length, as had been mentioned earlier today by one of the doctors, but Child G showed no signs of having that condition.
Dr Evans adds: "Even more astonishing is the vomit that ends up on the chair. That is several feet away.
"I can't recall a baby vomiting on the floor. I can't recall a baby vomiting that distance. It was described quite correctly as extraordinary.
"On top of that it was noted the abdomen was distended."Dr Evans said you cannot measure the volume of the vomit that had fallen.

Recap: Lucy Letby trial, Monday, December 12

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

 

[LadyEdgeworth]

2:43pm

Lucy Letby's note for Child G - 'large projectile milky vomit at 2.15am. Continued to vomit++. 45mls milk obtained from NG tube with air++. Abdomen noted to be distended and discoloured.'
Dr Evans said the 45mls aspirated was in addition to the vomit. 45mls of milk was administered by the feed.
"There can only be one explanation - [Child G] had received far more milk down the NG Tube.
"She may have also received a bolus of air from the feeding tube."
Dr Evans says that would also cause the abdominal distention.
He says the plunger end of the syringe was put over the end of the tube for the milk, which would have caused distention, then would have caused the baby distress, then "she would have vomited because of the gross distention".

2:46pm

The condition which can cause projectile vomiting can be excluded, the court hears, as the vomiting would have continued until the baby would have been taken into theatre for surgery.
Dr Evans says the muscles only 'go one way', and the only time this does not work is if the baby is compromised by something.
"In this case the baby was compromised by receiving a large volume of milk to the stomach".
In that instance, the stomach muscles contracted and that led to the vomit. He says the mechanism is similar to that seen in adults.
He says if an adult drank a large volume of liquid too quickly, there is a chance they could vomit.

Recap: Lucy Letby trial, Monday, December 12

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

 

[LadyEdgeworth]

2:51pm

Dr Evans says Child G's condition thereafter was "incredibly unstable", with "significant amount of oxygen deprivation" and bradycardia.
"Getting [Child G] back to where she was before 2am was extremely challenging and difficult.
"They managed to do so...but during that time she suffered prolonged oxygen desprivation...leading to irreversible brain damage."
The doctor's note of 'blood at the back of the throat' is referred to.
He said the bleeding was found at the initial resuscitation/intubation, and the significance of that was the baby did not have a bleeding disorder, so "therefore the bleeding present from the beginning from more or less the time [Child G] crashed."

2:51pm

Dr Evans says this case has been seen before, "much worse", in Child E.
The bleeding in this case was less, but still significant as it was "unexpected"

2:53pm

Dr Evans stresses Child G's infection happened "after the collapse".

Recap: Lucy Letby trial, Monday, December 12

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

 

[LadyEdgeworth]

2:55pm

Dr Evans says Child G's infection was 'CRP related', as those particular blood gas readings went from 'less than 1' to 'over 200' in the hours following her collapse.

2:59pm

Dr Evans's report from 2021 is now being discussed. He was asked to consider whether an infection was the cause of the projectile vomiting.
"With respect no, I consider the infection happened afterwards.
"An infection would not cause a baby to vomit halfway across the nursery room."
He also asks: "Where would the extra fluid come from?"
He says Child G must have had "far more" than the allocated 45mls milk feed fed to her.

3:02pm

Dr Evans is asked about Lucy Letby's explanation that babies can swallow a lot of air when they vomit.
"Well, they don't." Dr Evans replies.
He says excess air was administered to Child G, in addition to the milk.
He adds a baby with an infection has never presented in this way.
He also says a baby on a naso-gastric feed would not vomit. The NGT system would be set up, Dr Evans says, so the undigested milk would be aspirated prior to anotyher feed. If there is a lot of undigested milk, then caution would be taken before administering another feed.
The pH would be measured before each feed to ensure the tip of the NGT is in the stomach, and not another orifice.

3:03pm

On this occasion, a pH reading of four would indicate the presence of stomach acid, indicating the NGT was in the correct place, Dr Evans says.

Recap: Lucy Letby trial, Monday, December 12

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

 

[LadyEdgeworth]

3:05pm

Dr Evans is asked to read out his further report, in which he says administering excess milk and/or air cannot be done "accidentally".
The effect of the stomach being overfull, the diaphragm "cannot move up or down", meaning "the baby cannot receive air in its lungs", which leads to oxygen deprivation, loss of oxygen saturation, bradycardia, and collapse.

3:08pm

Ben Myers KC, for Letby's defence, is now asking Dr Evans questions.
He says Child G was 'born on the margins of survival', and Dr Evans agrees that is the case, having said so in his May 2018 report.
Mr Myers says a lot of work was needed to get Child G stable. Dr Evans agrees.
He says that, relative to where she began, she was a lot better.
Mr Myers asks if she was still prone to infection. Dr Evans agrees.

3:12pm

Mr Myers refers to Dr Evans, in his report, referring to Child G being treated "inapproporiately" at 2am on September 7, 2015.
Mr Myers says that is worked on the basis that Child G's tummy would have been empty or almost empty at the time, as the nurse responsible would have aspirated Child G's stomach of all milk.
Mr Myers says 'we now know' the stomach was not aspirated prior to 2am.
Dr Evans says that was not the case, as the nurse had aspirated to get a pH reading.
Mr Myers says the nurse had not aspirated the milk, as she would not have done so in a baby as young as Child G as a matter of procedure.
Dr Evans: "No, this is too simple." He says milk is a neutral pH, so if the reading is '4', then that sample was indicative of acid in the stomach.

Recap: Lucy Letby trial, Monday, December 12

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

 

[Dotta]

"Lucy Letby's explanation that babies can swallow a lot of air when they vomit."

Really?????

During retching the airway is protected.
I know this and I am NOT a nurse.

Moo

 

[LadyEdgeworth]

3:13pm

Dr Evans says after the projectile vomiting, over three areas of a nursery, there was an aspiration of 45mls of milk.
"There has to have been a significant amount of additional milk plus air to explain what happened to the little baby at two o'clock in the morning."

3:16pm

Mr Myers refers to the report, saying a nurse empties the stomach contants through aspirates.
Dr Evans: "The pH was 4 [in the stomach], 4 is acid."
Mr Myers says Dr Evans is basing what he says upon having her stomach aspirated before the 2am feed.
Dr Evans says there would have been no milk in Child G's stomach prior to the 2am feed, as the stomach was checked for pH.

3:22pm

Dr Evans says he is "totally satisfied" with his opinion that Child G's stomach was empty prior to the 2am feed.
The amount of vomit plus aspirate was "massive" and only had one explanation - "she had a huge amount of milk plus air".
Mr Myers asks if Dr Evans is basing his opinion on Child G's stomach being emptied of milk just before the 2am feed. Dr Evans says he is.
He says the nurse said she would not normally aspirate all the milk from a stomach [as in completely remove all trace].
Mr Myers says, in the six reports, there is no mention of the plunger to the syringe as a method to force more milk in.
Dr Evans agrees it is not in his reports, but he is telling him now.

Recap: Lucy Letby trial, Monday, December 12

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

 

[LadyEdgeworth]

3:30pm

Mr Myers says 100ml of aspirate was withdrawn at 6.15am, but the quantities of liquid/air were not known. Mr Myers says Dr Alison Ventress said it was "probably air". Dr Evans agrees he heard that evidence.
The clinical note for Child G on September 7, by Dr Ventress, is shown to the court.
Mr Myers relays Dr Evans's note relating to excess fluid inhibiting diaphragm movement.
Mr Myers: "In fact we know that the later collapse and desaturations came after [Child G] vomited [on the morning of September 7]."
He says "that is distinct" as Child G had "settled" by that point.
Dr Evans: "That is not correct, actually - she was in a very unstable condition."
Dr Evans says there is 'hardly' an entry where Child G is stable for any significant period of time that morning.
He says from the time of the vomiting, Child G "never fully stabilised".
He says the medical staff would not have anticipated the oxygen deprivation being "very marked" and for a "more prolonged time than they would have realised", and that was no fault of the staff.
He says Child G's condition was "an improvement" but she was "unstable", and had been "compromised from the point of vomiting".

3:32pm

Dr Evans says it is difficult for medical staff to "provide a running commentary" when trying to save a little baby's life.
The removal of vomit and 45ml aspirate had "got rid of the pressure" and would have led her to be "relatively better" - "and I use the words advisedly".
He tells the court he is "very satisfied" with the explanation he has given.

3:35pm

Mr Myers says the bleeding seen is "not even close" to the case seen with Child E.
Dr Evans says it is in the same area.
Mr Myers says to link it to Child E is to support the prosecution.
Dr Evans says that is not the case, and if he did not have access to the other cases, he would have come to the same conclusion.
He adds that Child G was, chronologically, was the first case he examined.
Mr Myers says there is no evidence of trauma.
Dr Evans says he does not know the cause, but seeing such bleeding was "incredibly concerning" and "worrying".

Recap: Lucy Letby trial, Monday, December 12

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

 

[LadyEdgeworth]

3:36pm

Mr Myers asks if it was possible Child G had a small haemorrhage.
Dr Evans says there would have been no reason for it. "No is the answer to that".
He says the back of the throat is a small area, and the blood was noticed around there.

3:41pm

Mr Myers says babies may vomit for many reasons. Dr Evans agrees.
Mr Myers asks is 'forceful vomiting' can happen. Dr Evans says he is not familiar with the term in that context.
Mr Myers says Dr Evans does not agree with Dr Ventress's evidence on projectile vomiting. Dr Evans says he only disagreed with infection being the cause of the projectile vomiting.
Mr Myers asks if Child G projectile vomited with such force because she was unwell. Dr Evans disagrees, and asks where the extra fluid would have come from.
Mr Myers: "We don't know [the quantity of vomit as it was not measured]."
"No, but it's a lot of vomit."
"We don't know how much, do we?"
"It was...an awful lot of vomit."

3:42pm

Gastro-oesophageal reflux can cause projectile vomiting, Mr Myers asks.
Dr Evans says it can, but that was not mentioned as a diagnosis in the Arrowe Park Hospital discharge letter.
It would not have caused the type of vomiting seen, Dr Evans tells the court.

Recap: Lucy Letby trial, Monday, December 12

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

 

[LadyEdgeworth]

3:50pm

Mr Myers refers to the CRP readings for Child G, which had risen throughout September 7, and was "consistent with infection". Dr Evans agrees.
Mr Myers says that could have been consistent with infection developing before the vomiting.
"No, it cannot."
Dr Evans says the CRP reading is raised at the time the infection presents.
He says the majority of babies, a CRP reading is raised at the time of the infection being present.
In this case, there were no other markers of infection prior to the vomiting.
Mr Myers says there was a "large watery stool", to which Dr Evans says was not unusual.
Mr Myers says there is no finding of aspiration pneumonia when Child G was taken back to Arrowe Park. Dr Evans says she does not believe she had that, but believes she had an infection which "probably kicked in" during the attempts to resuscitate her.
Mr Myers says that does not rule out an infection being present prior to the vomiting.
Dr Evans: "There is no clinical evidence to back up that hypothesis."
He adds: "I don't deal with 'ifs', I deal with evidence."
He says the charts show everything as they should be up to the point of the vomiting and desaturations.

3:54pm

Mr Johnson asks Dr Evans about the 'adding of a suggestion of a plunger being used' in the evidence, in the context of milk feeds.
Dr Evans had referred to the forcible additional milk feed method, without the additional context of a plunger, in his May 2018 report. Dr Evans says the method can only be applied with the use of a plunger.
Mr Johnson asks about the pH aspirate the nurse would have obtained, if the previous milk feed had not been digested/aspirated.
Dr Evans said the aspirate would have looked like undigested milk and the pH reading would have been neutral - around 7.

3:57pm

The feeding chart for September 5 is shown to the court, which Dr Evans says shows no vomiting, and no evidence of gastro-oesophageal reflux.
He says gastro-oesophageal reflux does not happen out of nowhere.
Dr Evans adds Child G was having normal bowel movements as well.

3:58pm

Dr Evans says, for the feeding charts and observations prior to the vomiting, "this is as good as it gets", with "no red flags", and is "very satisfactory".

Recap: Lucy Letby trial, Monday, December 12

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

 

[JerseyGirl]

Lucy Letby: No natural cause for baby's vomiting, doctor tells trial

A doctor tells Lucy Letby's trial he "can't think of a natural cause" for a baby's deterioration.

www.bbc.com

 

[LadyEdgeworth]

4:00pm

Medical expert Dr Sandie Bohin is now being recalled to give evidence.

4:05pm

Mr Johnson takes Dr Bohin through her reports, in which she said there was "no cause for concern" in Child G's condition at the Countess of Chester Hospital prior to September 7, 2015.

Recap: Lucy Letby trial, Monday, December 12

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

 

[LadyEdgeworth]

4:08pm

Dr Bohin confirms Child G was given a 45ml milk feed via the naso-gastric tube at 2am on September 7, 2015.
Mr Johnson refers to the subsequent sequence of events, and that Dr Bohin had recorded what had happened from the medical staff's notes and medical charts.

4:11pm

Dr Bohin said Child G was, prior to the collapse, "very stable", with decreasing oxygen support required, and she was "managing very well" on that.
"From a respiratory point of view, all was well".
Child G was tolerating three-hourly feeds, and she was "progressing very well" for a pre-term baby.
The observation chart prior to the 2am feed on September 7 was "completely normal".

4:15pm

The episode of 'projectile vomiting' was 'concerning' as Dr Bohin said she had not seen babies, particularly those weighing 2kg, doing that.
She found that "extraordinary".
Dr Bohin said the milk must have come from somewhere, and the vomit has to go over the side of a deep-sided cot, on to the floor and the nearby chair "a considerable force has to be generated inside the abdomen".
She says there must have been "much more than 45mls of milk inside the stomach."
Mr Johnson asks if there is an 'innocent explanation' which could have explained the projectile vomiting.
Dr Bohin says "no", as the stomach was empty, with a pH reading of 4. If there was milk in the stomach, it would have 'neutralised' the stomach and the pH reading would have been higher.
"I think the stomach was empty, and she was given excess milk and possibly air...which distended the stomach."

Recap: Lucy Letby trial, Monday, December 12

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

 

[notsure]

If guilty, it's astonishing that no suspicions were followed up at this time, which would have prevented further incidents from happening.

 

[LadyEdgeworth]

4:18pm

Dr Bohin is asked by police about Lucy Letby saying babies can 'take on a lot of air when vomiting'.
Dr Bohin was asked if that was correct or not.
Dr Bohin tells the court: "That's not correct. Babies do not take on air when they vomit."

Recap: Lucy Letby trial, Monday, December 12

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

 

[notsure]

4:08pm

Dr Bohin confirms Child G was given a 45ml milk feed via the naso-gastric tube at 2am on September 7, 2015.
Mr Johnson refers to the subsequent sequence of events, and that Dr Bohin had recorded what had happened from the medical staff's notes and medical charts.

4:11pm

Dr Bohin said Child G was, prior to the collapse, "very stable", with decreasing oxygen support required, and she was "managing very well" on that.
"From a respiratory point of view, all was well".
Child G was tolerating three-hourly feeds, and she was "progressing very well" for a pre-term baby.
The observation chart prior to the 2am feed on September 7 was "completely normal".

4:15pm

The episode of 'projectile vomiting' was 'concerning' as Dr Bohin said she had not seen babies, particularly those weighing 2kg, doing that.
She found that "extraordinary".
Dr Bohin said the milk must have come from somewhere, and the vomit has to go over the side of a deep-sided cot, on to the floor and the nearby chair "a considerable force has to be generated inside the abdomen".
She says there must have been "much more than 45mls of milk inside the stomach."
Mr Johnson asks if there is an 'innocent explanation' which could have explained the projectile vomiting.
Dr Bohin says "no", as the stomach was empty, with a pH reading of 4. If there was milk in the stomach, it would have 'neutralised' the stomach and the pH reading would have been higher.
"I think the stomach was empty, and she was given excess milk and possibly air...which distended the stomach."

Recap: Lucy Letby trial, Monday, December 12

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

No innocent explanation, according to Dr Bohin. Then why wasn't it investigated further?

 

[Jazmania]

Strongest evidence yet imo. No credible explanation other than this baby was fed way more than 45mls of milk. And letby saying babies can suck in air whole vomiting? How stupid did she think the police were?

 

[Anxala]

@ColourPurple and @Eloise

Thanks for your responses. You've both given me helpful food for thought.

 

[notsure]

Strongest evidence yet imo. No credible explanation other than this baby was fed way more than 45mls of milk. And letby saying babies can suck in air whole vomiting? How stupid did she think the police were?

As stupid as all the other people who didn't suspect any wrongdoing at the the time, probably.