UK - Nurse Lucy Letby, murder of babies, 7 Guilty of murder verdicts; 8 Guilty of attempted murder; 2 Not Guilty of attempted; 5 hung re attempted #36

[Charlot123]

probably not relevant to what i was saying about baby k, the alarm not sounding and dr lee failure to address the fact that the alarm seemed to have been silenced but we will go with it anyway. beam me up scotty

Did D.W. (the nurse) say the alarm was not sounding? That case got into the press. From what I understand she left the unit to talk to some parents. She warned them. Dr. R. and the intern. When she came back the alarm was buzzing and a moment later dr. R. ran in and said what was that? She doesn't remember who babysat baby K.

 

[Ruthbullock]

"The panel concluded that baby four had died from systemic sepsis'

The panel concluded that baby four had died from systemic sepsis, pneumonia and disseminated intravascular coagulation, where blood clots form throughout the circulatory system.

 

[Anxala]

Well, why cats? I asked myself about toxoplasmosis. About 11.8% of people had it in their lives. Google to help you if you are interested!
I checked "asymptomatic carriers" and the list was huge. It is an interesting thing to consider. I am trying to look through more rational explanations before "she killed them".

So do you think there should be a new Inquiry focused on how many COCH nurses, doctors, consultants etc were cat owners? Because if you're going down the cat-as-cause route, then, by your logic, LL's cats are being unfairly treated by you seeing them as the only cats that could have impacted upon the deaths of countless babies.

That, as a 'rational explanation' is as far removed from a rational explanation as it's possible to stretch to.

 

[joltz]

This wasn’t the original pathologist- who also did say pneumonia, this was a second pathologist from Alder Hey who was asked to look at all the babies deaths- she also believes it was pneumonia, with the added complication of breathing difficulties from birth. So now we have 3 separate groups of people examining the evidence - the original pathologist, a second external pathologist and Dr Lee all saying the baby died through care failings and also having untreated pneumonia- yet somehow you still need more experts to disagree with what was presented in the trial. There are more experts speaking out disputing the findings in certain cases than there were making the jury decision.

Realistically none of these experts are going to trump the experienced medics who were there and witnessed the events first hand. They were able to give detailed testimony about an unusual rash which they had never seen before in their medical careers. The descriptions they gave also tally with the expert opinion which prof Linsey gave about what would you would expect to see

Its a few posts above.

 

[Charlot123]

The Lee paper was a catalyst. It did not form the basis of the evidence or the investigation. MOO

OK imagine this. You, the consultant, suspect the babies are being harmed. You don't call the police, you don't care child protective services, you do nothing of sorts. You don't even call Dr. Lee to consult him but then, you use his article that was written in pre-surfactant time. So you either don't understand it or use it for a wrong reason. The only person you do consult is a professional trial witness who's not practicing as doctor for 15 years and has zero NICU experience.

 

[Charlot123]

So do you think there should be a new Inquiry focused on how many COCH nurses, doctors, consultants were cat owners?

I am past this. I think they were so insistent that Lucy was present at each death that I, too, tried to find some realistic explanation. Analysis of the first cases already shows that the event that probably culminated in death of the baby (i don't say "caused" because there was a chain of things before, and only registrars on the unit), but culminated, was started before Lucy ever came to the unit. A PICC line, dry, no fluid through it, because they are waiting for X-ray machine...by the time Lucy comes, they have X-rayed and start fluid. The baby collapses. So, how is Lucy is even responsible for the decision to put the PICC line?

 

[Furore]

OK imagine this. You, the consultant, suspect the babies are being harmed. You don't call the police, you don't care child protective services, you do nothing of sorts. You don't even call Dr. Lee to consult him but then, you use his article that was written in pre-surfactant time. So you either don't understand it or use it for a wrong reason. The only person you do consult is a professional trial witness who's not practicing as doctor for 15 years and has zero NICU experience.

So, with respect to calling the police please see evidence here from Dr Hawdon about how he would involve the police using the hospital safeguarding team because of expertise and policies involving the right police at the right level and relevant information sharing with local authority. https://thirlwall.public-inquiry.uk...024/11/Thirlwall-Inquiry-12-November-2024.pdf So finally direct evidence that most medics would escalate via set processes such as safeguarding or management than call 999 and that is normal and the way things are done.

Another point why doctors calling police in isolation is that sharing medical information is very protected even with police - it would be best practice to ask permission from parents to release information to police (even if suspicion attempted murder etc) and you can imagine how that would go down without good evidence and without telling anyone else. Safeguarding is how it is all done.

Both Shoo Lee and others overestimate the degree to which his paper was used. As Tortoise shared, other experts discussed why air embolism was considered. I personally am not sure of any cases in any legal system where the authors of papers/laws/publications are always called about the use of their public domain literature as evidence.

My interpretation of Lee paper was when looking up strange rashes, air embolism appeared and that triggered the clinicians to go looking. Because the evidence went beyond the Lee paper and also acknowledged in Lee paper only 10% babies had rashes etc it was not considered pivotal evidence and hence rejected by review panel that Lee changing his mind made material difference.

 

[Furore]

<modsnip - quoted post was unapproved sources>

But if the defence want experts, they needed to present them to court for cross examination, like the cross examination of the prosecution witnesses - which remember introduces a degree of doubt into their evidence - not just throw out unexamined evidence into the media. It’s just so unethical and unprofessional IMHO

 

[Charlot123]

This is interesting. I just reviewed Professor Sally Kinsey's evidence in the trial. It seems to negate Dr Lee's claims of what was presented at trial, in the context of his paper being about arterial embolism. IMO


Prof Kinsey is a retired Consultant Paediatric Haematologist ...

Prof Kinsey is now talking the jury through various diagrams which show how the body's air/blood circulation system works ...

Professor Kinsey is explaining, via diagrams, how the blood is pumped through the heart. ...

Mr Johnson asks if air is injected into the system via a syringe, what would happen.
Prof Kinsey explains the heart would be pumping, and the air bubbles would be broken into larger and tiny bubbles. The lungs would be able to cope with the smaller air bubbles, but the lungs would struggle with the larger air bubbles.
In babies, air bubbles would be going in the arterial circulation - blood returning to the heart passing straight out again without being oxygenated through the lungs.
This would lead to the changes in skin colour - a 'fluctuating' colour pattern, and would, the court hears, lead to the types of skin discolourations as described by doctors and nurses so far in the trial. ...

In babies, there is a section of the heart, called the oval foramen, which would still be open, meaning the air bubbles would go to the arterial circulation.
The air bubbles would be absorbed by the haemoglobin, causing skin discolourations which move around the body and a mixture of blue, pink and purple discolouration, Mr Johnson summarises. Professor Kinsey agrees.
...
Mr Myers asks if that can be applied to babies - if an air embolus could always lead to skin discolouration observations. Prof Kinsey said it would not.

Recap: Lucy Letby trial, Tuesday, November 29

Mr. Johnson forgot to ask one more question- if intentional injection of air embolism is the only way for the air to get into the baby's system. Or, could CPAP do it, or several unsuccessful attempts to establish a line, or a 22-minute long CPR. Even if an embolism happened, is it only possible if Lucy caused it?
No presence of air embolism was established. It is all assumed based on the memory of the intern about strange color of the skin. We don't know what he even saw because it is all post factum. He didn't reflect anything in the notes, for starts.

 

[Charlot123]

So, with respect to calling the police please see evidence here from Dr Hawdon about how he would involve the police using the hospital safeguarding team because of expertise and policies involving the right police at the right level and relevant information sharing with local authority. https://thirlwall.public-inquiry.uk...024/11/Thirlwall-Inquiry-12-November-2024.pdf So finally direct evidence that most medics would escalate via set processes such as safeguarding or management than call 999 and that is normal and the way things are done.

Both Shoo Lee and others overestimate the degree to which his paper was used. As Tortoise shared, other experts discussed why air embolism was considered. I personally am not sure of any cases in any legal system where the authors of papers/laws/publications are always called about the use of their public domain literature as evidence.

My interpretation of Lee paper was when looking up strange rashes, air embolism appeared and that triggered the clinicians to go looking. Because the evidence went beyond the Lee paper and also acknowledged in Lee paper only 10% babies had rashes etc it was not considered pivotal evidence and hence rejected by review panel that Lee changing his mind made material difference.

Well, didn't someone have chills or cold swear trickling down his spine when he read the paper? No one needs to speak for dr. Ravi, he did it himself. So it was like "eureka!" when he read that paper. The moment of truth. But, he never called the author and the author now says that the doctor's epiphany was out of profound misunderstanding the material. So here we are.

Air embolism is only postulated. Was it ever confirmed? I think it was "must have been it" assumption way after the babies died.

 

[Furore]

Mr. Johnson forgot to ask one more question- if intentional injection of air embolism is the only way for the air to get into the baby's system. Or, could CPAP do it, or several unsuccessful attempts to establish a line, or a 22-minute long CPR. Even if an embolism happened, is it only possible if Lucy caused it?
No presence of air embolism was established. It is all assumed based on the memory of the intern about strange color of the skin. We don't know what he even saw because it is all post factum. He didn't reflect anything in the notes, for starts.

IMO air embolism was suspected because of multiple medical and nurse recollections about a strange rash/mottling in multiple collapses, in cases that were refractory to resus attempts (in contrast to other common pathologies, which can show even a transient response to problem solving the issue such as oxygen for low oxygen, fluid for low BP in sepsis, sugar for hypoglycaemia etc), and sudden collapses rather than gradual deteriorations, in babies that had been stable.

People are very focused on the post mortems I think without realising they’re often not conclusive, and a forensic post mortem involves a different structure and sometimes type of pathology training. I very much urge interested parties to read Richard Shepherd’s Unnatural Causes and “Seven Ages of Life” for insights first hand from a forensic pathologist, it will help a lot.

 

[Sweeper2000]

Did D.W. (the nurse) say the alarm was not sounding? That case got into the press. From what I understand she left the unit to talk to some parents. She warned them. Dr. R. and the intern. When she came back the alarm was buzzing and a moment later dr. R. ran in and said what was that? She doesn't remember who babysat baby K.

they retrialled for baby k didnt they? i would then assume the evidence was found to be correct. do you also mean by "D.W" J.W instead as joane williams was her designated nurse and she had left the baby by herself to attend to a matter locally. the retrial I believe was based more on DR j's recall of things. You might also be conflating the alarm sounded by Dr J as a response to finding the baby in a dire situation. Dr J is quite clear that the alarm attached to the incubator and the other equipment was not sounding as it should be unless it is deliberately silenced. unless you can find quotes to say otherwise, i can't.

 

[Furore]

Well, didn't someone have chills or cold swear trickling down his spine when he read the paper? No one needs to speak for dr. Ravi, he did it himself. So it was like "eureka!" when he read that paper. The moment of truth. But, he never called the author and the author now says that the doctor's epiphany was out of profound misunderstanding the material. So here we are.

Air embolism is only postulated. Was it ever confirmed? I think it was "must have been it" assumption way after the babies died.

Why would you call the author though? I am confused by this. I have never called the author of a textbook or paper to clarify that I’ve read it correctly. Do you call the author of a journal article to clarify you’ve understood it? Genuinely not trying to be rude I just can’t understand why this is so pivotal a point to you.

Air embolism is challenging to prove particularly as air transports with application of oxygen! One of the key features is immediate cardiac arrest see here

Air Embolism: Diagnosis, Clinical Management and Outcomes - PMC

Air embolism is a rare but potentially fatal complication of surgical procedures. Rapid recognition and intervention is critical for reducing morbidity and mortality. We retrospectively characterized our experience with air embolism during medical ...

pmc.ncbi.nlm.nih.gov

Call the author if you like and can find a number?

 

[Furore]

More recent literature review here - both skin discolouration and visualising air in lines are just SOME diagnostic features hence why attempts to nail down this diagnosis are by definition challenging

Vascular Air Embolism in Neonates: A Literature Review - PubMed

Neonatal vascular air embolism is a rare but often fatal condition. The literature comprises mostly case reports and a few dated systematic reviews. Our objective was to review all case reports of neonatal vascular air embolism to date and provide up-to-date information about patient...

pubmed.ncbi.nlm.nih.gov

 

[marynnu]

Did D.W. (the nurse) say the alarm was not sounding? That case got into the press. From what I understand she left the unit to talk to some parents. She warned them. Dr. R. and the intern. When she came back the alarm was buzzing and a moment later dr. R. ran in and said what was that? She doesn't remember who babysat baby K.

You are incorrect. The alarms were sounding when she returned, but Dr. J was already there because resus was taking place.

 

[Ruthbullock]

But if the defence want experts, they needed to present them to court for cross examination, like the cross examination of the prosecution witnesses - which remember introduces a degree of doubt into their evidence - not just throw out unexamined evidence into the media. It’s just so unethical and unprofessional IMHO

I agree- but it’s a different defence team and different tactics. A new defence team don’t get to do the trial all over again- so they have taken the put everything out in the public arena option. They aren’t the first defence team who have taken over a case and didn’t represent someone at trial to take that approach and they won’t be the last.

 

[joltz]

But if the defence want experts, they needed to present them to court for cross examination, like the cross examination of the prosecution witnesses - which remember introduces a degree of doubt into their evidence - not just throw out unexamined evidence into the media. It’s just so unethical and unprofessional IMHO

That's a major issue I have with this method. They can say what they want and state it as fact. I think under cross examination they would wilt, as they are repeating claims made and dealt with already during the trial. I think McDonald knows this. He could have went about his business in the normal process, instead he has called press conferences and obscured the facts. Fairly shameful IMHO

 

[Charlot123]

Why would you call the author though? I am confused by this. I have never called the author of a textbook or paper to clarify that I’ve read it correctly. Do you call the author of a journal article to clarify you’ve understood it? Genuinely not trying to be rude I just can’t understand why this is so pivotal a point to you.

Air embolism is challenging to prove particularly as air transports with application of oxygen! One of the key features is immediate cardiac arrest see here

Air Embolism: Diagnosis, Clinical Management and Outcomes - PMC

Air embolism is a rare but potentially fatal complication of surgical procedures. Rapid recognition and intervention is critical for reducing morbidity and mortality. We retrospectively characterized our experience with air embolism during medical ...

pmc.ncbi.nlm.nih.gov

Call the author if you like and can find a number?

His email is on his site. He has a LinkedIn account. Lastly, U. of Alberta is a well-known place.

If they invested time and money into such a big process, it would have been a normal precaution. See how it turns out for Dr. Jay now.

Lastly, if air embolism is challenging to prove, how can they state that this is exactly what was the cause of death and this is how Lucy killed them? And, mainly, air embolism happens in ICUs and it is not the result of nefarious activity. Rather, the opposite, everyone is trying to avoid it but it happens.

 

[Sweeper2000]

Well, didn't someone have chills or cold swear trickling down his spine when he read the paper? No one needs to speak for dr. Ravi, he did it himself. So it was like "eureka!" when he read that paper. The moment of truth. But, he never called the author and the author now says that the doctor's epiphany was out of profound misunderstanding the material. So here we are.

Air embolism is only postulated. Was it ever confirmed? I think it was "must have been it" assumption way after the babies died.

His email is on his site. He has a LinkedIn account. Lastly, U. of Alberta is a well-known place.

If they invested time and money into such a big process, it would have been a normal precaution. See how it turns out for Dr. Jay now.

Lastly, if air embolism is challenging to prove, how can they state that this is exactly what was the cause of death and this is how Lucy killed them? And, mainly, air embolism happens in ICUs and it is not the result of nefarious activity. Rather, the opposite, everyone is trying to avoid it but it happens.

we went over what can be expected from an AE so many times and in great detail, we all became way more educated in them than any average person. the two symptoms that i think formed the strongest basis for why it is strong evidence is the 1. unexpected and sharp decline and N2 difficulty in resus. if those two things are present and other possibilities are excluded we get a diagnsosis of AE as evans did. this really was strong evidence at court and I find it very difficult to believe that will be revoked. everything else like a skin presentation becomes secondary and seemingly at court supporting. if we had a forensic pathologist report two things could ahve happened, could have been supporting or it simply could have been dismissed/ruled out but we didnt get that.

we have also gone over the fact dr lee paper is not on a bubble of air injected into the system via veins/arteries but on air forced into babies lungs via ventilators. think the courts stated this means he cannot really speak on what can be expected via the former as well. think we have also learned that a bubble of air which affects blood flow within the heart can be expected to affect the travel of blood throughout a body and what was reported to be seen at the coch can be expected. makes sense to me. i even remember the fiddly bits like what part of the heart the air bubble gets caught in, and how little bubbles won't be of affect but filtered out by the lungs an that a bubble of air needs to be large enough to get caught in the heart itself.

 

[joltz]

The panel concluded that baby four had died from systemic sepsis, pneumonia and disseminated intravascular coagulation, where blood clots form throughout the circulatory system

There was no evidence of sepsis found at post-mortem.

I find it interesting that the panel have come up with different causes of death for each baby, yet there is the same rash linking all of the air embolism cases together. The same rash which was like nothing the consultants had seen in their medical careers. The same rash which a nurse said she not seen anything like, in her decades long career. The same rash which one Dr wanted a camera fetched to document because it was so unusual.