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 #37

[WaneLyrical]

The telephone call was about sonething they rarely did. They called her as she had given this particular infusion earlier, so presumably had been given instructions about how to do so.
Re. the clotting, as I understand it Baby A did not inherit Mom's condition. Generally speaking nurses would know about significant conditions & risks with any baby.ng
The standard pricedure is to flush any line regularly if there is no infusion in situ.

Thanks.

Just to be clear, Lee isn’t saying that the condition was inherited. Just that the antibodies would still be present in the baby for a little while after birth increasing clot risk (not sure how much of an increase though, could be nothing).

When you say flush regularly? Is leaving it for 4 hours normal with a baby that has no additional risks? It doesn’t feel particularly long but I have no context. What’s the norm? (Thanks, very much appreciate your insight. You might recall a long time ago I asked you incessantly about the glucose bags because I wondered whether Letby might have poisoned the bottle of dextrose!)

 

[marynnu]

Thanks.

Just to be clear, Lee isn’t saying that the condition was inherited. Just that the antibodies would still be present in the baby for a little while after birth increasing clot risk (not sure how much of an increase though, could be nothing).

When you say flush regularly? Is leaving it for 4 hours normal with a baby that has no additional risks? It doesn’t feel particularly long but I have no context. What’s the norm? (Thanks, very much appreciate your insight. You might recall a long time ago I asked you incessantly about the glucose bags because I wondered whether Letby might have poisoned the bottle of dextrose!)

Re. long line flushing, I can only tell you what we did until the line was confirmed as usable, namely to infuse saline at 0.5mls/hr. The alternative for peripheral cannullas could be as little as twice a day. I'm not sure if we know what they were doing at CoC.

 

[mrC]

have to see what the net email says

 

[joltz]

well then he cant really complain if people infer from that he lied in a court of law he had a chance to correct the record

Only dimwitted people would think that...

JMO

 

[mrC]

well a lot of people do think it but im sure they would listen to his explanation funny he doesn't want to give one when hes normally so keen to talk

 

[joltz]

and sewage on the ward

Please clearly explain to me how

"sewage on the ward"

Caused any events at COC. Is there a single shred of evidence to link "sewage" to any collapse of any baby at COC?


The answer is no.

 

[joltz]

well a lot of people do think it but im sure they would listen to his explanation funny he doesn't want to give one when hes normally so keen to talk

I don't think Dr Jayaram feels the need to explain himself to the flat earth society.

 

[mrC]

well the point he was given a chance to as he has failed to do it he cant complian what is inferred from his uncharacteristic silence

 

[WaneLyrical]

Re. long line flushing, I can only tell you what we did until the line was confirmed as usable, namely to infuse saline at 0.5mls/hr. The alternative for peripheral cannullas could be as little as twice a day. I'm not sure if we know what they were doing at CoC.

Lee’s thing is saying two central catheters in place with no infusion for up to 4 hours. Would that be common? Risky? They’re then saying the baby collapsed shortly after the infusion was switched on, likely a clot had formed at the end of the catheter. Also a clot in the liver on post mortem demonstrates a thrombotic event had occurred. Does this suggestion sound wacko to you?

 

[Charlot123]

The telephone call was about sonething they rarely did. They called her as she had given this particular infusion earlier, so presumably had been given instructions about how to do so.
Re. the clotting, as I understand it Baby A did not inherit Mom's condition. Generally speaking nurses would know about significant conditions & risks with any baby.ng
The standard pricedure is to flush any line regularly if there is no infusion in situ.

Well, I looked into it. Antiphospholipid syndrome may be genetic or accompany autoimmune conditions such as lupus, but it seldom manifests at birth. However, the antibodies that are elevated in it are:

Anticardiolipin (aCL) antibodies (IgG, IgM) and Anti–beta-2 glycoprotein I antibodies (IgG, IgM).

One type of antibodies is enough to promote clotting.

IgM antibodies do not cross the placenta. IgG antibodies do.

So one day after birth, the baby born from a mother with antiphospholipid syndrome can have antiphospholipid antibodies of IgG type that he received from the mother via placenta and that are circulating in his blood . His risk of clotting can be higher.

The question asked by judge Johnson at trial was not well-formulated. "Did the baby get the condition from the mother?" Or rather, "did the mother "pass it on to a baby?" My question was, "pass on what?"

The answer of the hematologist was "no" but it is not that simple.

"Pass on" the APL syndrome "genetically"? - the answer is "no", or maybe, "not yet". Can the mother pass on antibodies that cause clotting? Of IgM type - no, but of IgG type - yes. It can never be a sharp "no" in such cases. The best answer is, "here are the tests we did, the antibodies we checked, here are the odds." But this is not what I heard.

But the main issue was that if a baby is not receiving fluid for 4 hours, that by itself could have caused thrombosis.

And remember that there was no venous access, that the picc line was inserted around 5 pm when Lucy wasn't even at work and only at 8 pm when X-ray was done was the fluid started.

And before anyone says I am not a neonatal hematologist: the 14-expert panel refuted the opinion of the court-appointed hematologist. But mostly, the issue is complicated, and there is a jury, and all these issues had to be explained to the ordinary folks weighing on the fate of a nurse and a very complicated medical issue.

 

[Sweeper2000]

Thanks.

Just to be clear, Lee isn’t saying that the condition was inherited. Just that the antibodies would still be present in the baby for a little while after birth increasing clot risk (not sure how much of an increase though, could be nothing).

When you say flush regularly? Is leaving it for 4 hours normal with a baby that has no additional risks? It doesn’t feel particularly long but I have no context. What’s the norm? (Thanks, very much appreciate your insight. You might recall a long time ago I asked you incessantly about the glucose bags because I wondered whether Letby might have poisoned the bottle of dextrose!)

yeh when great ormond street cleared the baby of that condition they also cleared the condition of being of any effect whatsoever so those antibodies were presumably known about and ruled out. think we have been over this before. was also a professor that cleared that and gave evidence in the trial. I don't know why Dr Lee thought this wasn't known and ruled out already.

 

[Charlot123]

The consultants were the ones with concerns and they were the ones who had to explain those concerns so that police knew whether an investigation was warranted initially.

How were police supposed to assess whether an investigation was required? Were the consultants supposed to hide their valid suspicions?

There is no evidence whatsoever that the consultants had anything to do with the police investigation beyond giving witness interviews and statements, as all the doctors and nurses did.

If you'd read the minutes of the initial meeting between police and the consultants you would know that it was not at all the case you have described. The consultants were concerned for the safety of their patients.

You continue to criticise Dr Evans, a career paediatrician, expert witness, for spotting that a crushed liver, the like of which only happens in serious road accidents, shouldn't have happened on a neonatal unit. That's what is ludicrous, IMO. And so is anyone bringing up the fact over and over again that he was once criticised by another judge. The jury knew about it and the court of appeal found he was more than suitably qualified and experienced in his field, to act as an expert.

Dr. Evans is not a "career pediatrician". Simple Wikipedia contains enough information explaining why he had to leave pediatrics. Today, the reprimands for his statements would be way more serious. Let us not praise Dr. Evans.

 

[Charlot123]

He doesn't dance to the tune of the media.

Surely a successful TV doctor should be able to dance to the tune of the media, or am I wrong? (Not negatively at all). Dr. Ravi was a famous TV doctor. TV is nothing but media.

 

[Charlot123]

Please clearly explain to me how

"sewage on the ward"

Caused any events at COC. Is there a single shred of evidence to link "sewage" to any collapse of any baby at COC?


The answer is no.

"Sewage on the ward" literally means "poo in NICU".

Can an extremely premature baby have an untoward event due to such unsanitary condition? They are on ventilators, remember.

As a mom, I'd say, yes. As a human, I feel much compassion to anyone working there, too.

 

[MamsBestGirl]

There is still nothing to say his entry to the room didn't happen exactly as he said, before he saw her at the incubator and upon LL seeing him calling him over to the baby desaturating.

Letby has always maintained she waited to see if the baby would self correct. She also said she would have called for help if Ravi hadn’t walked in. Just another desperate attempt to whip up media frenzy, with no substance.

Lucy Letby: Nurse may have been waiting for baby to ‘self-correct’

A NURSE accused of multiple attacks on babies told police she may have been waiting to see if an infant “self-corrected” before intervening, a…

www.chesterstandard.co.uk

 

[magikarpmagikarp]

Lee’s thing is saying two central catheters in place with no infusion for up to 4 hours. Would that be common? Risky? They’re then saying the baby collapsed shortly after the infusion was switched on, likely a clot had formed at the end of the catheter. Also a clot in the liver on post mortem demonstrates a thrombotic event had occurred. Does this suggestion sound wacko to you?

Clotted lines are clogged lines. You can't start an infusion if the line is clotted. You can't even flush it if it's a complete occlusion*. The treatment is a TPA dwell. This breaks up the clot and restores patency.

*a partially occluded line can infuse but not give back blood return. These are common. Same treatment- TPA dwell. I administer this treatment pretty often. Never seen a patient stroke out....

Sometimes a clot will form on the outside of the line. I've seen this happen exclusively with lines that had fluid infusing in them. The infusion does not disturb the clot. The treatment is Lovenox.

Regarding the antiphospholipid syndrome, the antibodies that passed from mom to baby were not the antibodies that would cause the baby to have increased risk of clotting. This was queried at the time of the baby's collapse. It was also discussed at trial.

When doctors speak of APS being passed on to the baby or not being passed on, they are speaking of the antibodies, not a genetic inheritance.

 

[May72031]

I see the nonsense about "sewage" has popped up yet again!

I repeat - there is no evidence whatsoever that sewage affected the health of the babies. Just as there is no evidence whatsoever that understaffing affected the health of the babies.

Oh, and what's this about someone gibbering about how the police shouldn't have conversed with the consultants in their investigations? What's that even about? Of course police would have spoken to them. They spoke to them, the doctors, the management, and everybody who worked there. Some of the above comments make it sound like the police were somehow shepherded through their years-long investigation by the consultants to arrive at a specific conclusion. No evidence at all that this was case.

 

[magikarpmagikarp]

Also I have occasionally seen lines clot off with no infusion for several hours. They are clogged. You can't use them. You either tpa the line or take it out and put another one in.

Like Mary said, if there is no infusion the line can be flushed intermittently. We don't know what they were doing at Chester but there is a current NHS policy to lock the line with saline while waiting for x ray. I posted a link in a previous post.

 

[katydid23]

Honestly, I think we have to be careful about throwing diagnoses at someone who we haven’t seen, but Munchausen-by-proxy, especially. The diagnosis emerged in the 70es, was likely overused in the 90es and should probably be obsolete or very rare. A huge hospital in US is obliged to pay a compensation - not for poor treatment, but for wrongly diagnosing MBP and keeping a child away from the mother. There is another lawsuit in PA.
Here is article from UK. Even the author of the term felt it was used frivolously.

Persistent Problems With the Munchausen Syndrome by Proxy Label

After nearly 30 years of clinical and legal experience, the definition of Munchausen syndrome by proxy remains controversial. As a result, mothers who present the problems of their children in ways perceived as unusual or problematic have become entangled in legal battles that should have been...

jaapl.org

I think some of the cases of MBP will be revised.

The MBP cases in this trial will not be revised. Nurse Letby purposely made those babies sick and injured, then she 'helped' save many of them, and soaked up the attention and credit for doing so.


The current medical term for Munchausen by proxy is Factitious Disorder Imposed on Another (FDIA). This term reflects the fact that the disorder involves a caregiver fabricating or inducing illness in another person, typically a child.

Learn more

She is the ultimate example of this horrible disorder, imo.

 

[magikarpmagikarp]

And while I'm on a roll, I work in a high volume unit with about 1300 admissions a year. We see really sick kids. We see collapses. We even see medical error. I assumed it was medical error or poor staffing when I began following the trial. Once I heard the testimony, I understood why there was a trial. It was because the collapses in the trial were completely anomalous.

To compare to a real situation where a doctor and nurse were thrown under the bus by a hospital, look up the case of Jack Adcock and Dr. Bawa Garba. She was charged with manslaughter and convicted, but had been put in an impossible situation, a true example of thr swiss cheese model of medical error.