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

[joltz]

there was also Pseudomonas aeruginosa in the tap

Not attributed to a single collapse.

 

[mrC]

Pseudomonas aeruginosa in the taps raw sewage leaking from the ceilings broken monitors not going to do a premature baby any good you don't have to be a medical expert to work that out

 

[Sweeper2000]

Pseudomonas aeruginosa in the taps raw sewage leaking from the ceilings broken monitors not going to do a premature baby any good you don't have to be a medical expert to work that out

any sources to suggest these were a factor in any of the relevant cases or were of any effect on the unit at all? or at the hospital in the broadest sense. I bet they have legionairres disease somewhere in that clunky old pipe system as well, does not mean its aerosolized and consequently a problem.

 

[joltz]

Pseudomonas aeruginosa in the taps raw sewage leaking from the ceilings broken monitors not going to do a premature baby any good you don't have to be a medical expert to work that out

Regarding the sewage issue. This was dealt with during the trial. A maintenance plumber went through a list of jobs he attended throughout the charge period

The list of jobs was basically the exact same thing you would expect to find in any NHS hospital of a similar age up and down the country.

Alternative hand washing facilities were available if needed, but they never actually used because they didn't need to be.

No collapses or deaths corresponded to any plumbing issues that the unit had.

 

[Sweeper2000]

its ok to have a thoery but you will need to substantiate it with supporting evidence otherwise we could just say anything as an example, "I believe the cause of deaths of all the babies was caused by lactose intolerance because my neighbour said so". sounds absurd doesnt it? or even "i believe the receptionist killed the babies because no one mentions them and they blend in and wear cardigans".

this post was amde purely for educational purposes and i can assure you i have nothing against receptionists or indeed people who wear cardigans, in fact i tend to like people who wear cardigans as they give off such a nice vibe and my gran used to wear particularly nice cardigans and everything she did was nice, particularly the apple sauce i used to have with everything, had proper crunchy chunks in as well which was the best bit.

 

[Marantz4250b]

its not just the sewage its a combination of all these things

What things, please?

 

[Marantz4250b]

DBM

 

[tricia]

Pseudomonas aeruginosa in the taps raw sewage leaking from the ceilings broken monitors not going to do a premature baby any good you don't have to be a medical expert to work that out

Please provide a source for this or we will have to remove your post.
Thank you.

 

[joltz]

Pseudomonas aeruginosa in the taps raw sewage leaking from the ceilings broken monitors not going to do a premature baby any good you don't have to be a medical expert to work that out

Regarding the sewage issue. This was dealt with during the trial. A maintenance plumber went through a list of jobs he attended throughout the charge period

The list of jobs was basically the exact same thing you would expect to find in any NHS hospital of a similar age up and down the country.

Alternative hand washing facilities were available if needed, but they never actually were not used because they didn't need to be

No collapses or deaths corresponded to any plumbing issues that the unit had.

The hospital

im just stating the facts Pseudomonas aeruginosa in the tap sewage coming from the ceiling a brocken baby moniter fact none of these things are good for babys to be around wouldent be good for a normal baby let alone a premature one

Yet there there is absolutely no evidence of this causing any health related issues with the babies.

I'm not sure what your suggestion is?
We have mountains of evidence of what actually happened (Letby killing babies) backed by experts, witness testimony and behavioural evidence. Both juries convicted.

You don't want to believe that, but you will believe something else that there is absolutely no evidence to support?

JMO

 

[mrjitty]

@Tortoise

what is your opinion on the Lee offensive and subsequent barrage of articles in the conversation etc?

i must say not having followed the trial day to day i find it hard to get a grip on it.

 

[Charlot123]

This is copy pasta and a dead horse.

The mottling associated with APS has its own name. It also tends to be persistent because it is caused by blood clots. It wouldn't vanish after a short time.

Not a doctor, just my opinion. But I did read your link. Did you?

Only the doctors say that livedo reticularis is easily seen on preemies because of underdeveloped dermis so that the blood vesssld are seen through the skin. Its sudden appearance may be indicative of any kind of neonatal distress.

 

[Charlot123]

Interesting article

Lucy Letby case: the problems with expert evidence

As an expert in both criminal and medical law, I am concerned with how prosecution teams gather expert evidence in these cases.

theconversation.com

 

[Charlot123]

In furtherance to this and dr lee's statements on it being a thrombus. Dr lee's position is that it the mothers condition that made the thrombus more likely this alone in my laymans opinion discounts that but his position was also that a thrombus travelled tot eh brain and was not found at autopsy as its very difficult to find. it may also be true that the additional evidence (dr arthurs and dr marneridez) actually bolsters dr evans more so than dr lee. dr lee has no evidence to support his position on the thrombus whereas the prosecution do for theirs. im not sure of the extent to which investigations were carrid out for baby A but i would imagine the scans showing the line of gas may also give an indication to any thrombus if present. he would also have to clarify how it is that the skin colour issue would also be present in his thrombus theory.

The true problem is the child was having problems with IV access and hence, didn’t get fluids for several hours, the PICC line was inserted by an intern at 5 pm or so. No IV fluids as X-ray to check its position was unavailable for 3 hours. Lucy comes in at 7:30 pm. About 8 PM, the fluid is started and soon the baby collapses. So lack of fluid itself is bad; the baby is dehydrated. More reasons for thrombosis. In a preemie, a foramen ovale is open so the clot can travel anywhere, into the brain or lungs. But, since so many things were not going well for the baby hours before Lucy emerged, how can they link the collapse to Lucy? I would have hard time blaming it on the resident either because in the absence of any consultant on the unit and baby A born the previous night via C-section from a mother with antiphospholipid syndrome and preeclampsia, hence, not a “doing well baby” by any means, things were bound to happen.

The mother was to have a C-section in another hospital with higher level NICU but in a week. The mother was very unhappy to deliver at COCH. I feel very sorry for her. But could a consultant stop by the next day to take care of the IV line?

 

[Sweeper2000]

The true problem is the child was having problems with IV access and hence, didn’t get fluids for several hours, the PICC line was inserted by an intern at 5 pm or so. No IV fluids as X-ray to check its position was unavailable for 3 hours. Lucy comes in at 7:30 pm. About 8 PM, the fluid is started and soon the baby collapses. So lack of fluid itself is bad; the baby is dehydrated. More reasons for thrombosis. In a preemie, a foramen ovale is open so the clot can travel anywhere, into the brain or lungs. But, since so many things were not going well for the baby hours before Lucy emerged, how can they link the collapse to Lucy? I would have hard time blaming it on the resident either because in the absence of any consultant on the unit and baby A born the previous night via C-section from a mother with antiphospholipid syndrome and preeclampsia, hence, not a “doing well baby” by any means, things were bound to happen.

The mother was to have a C-section in another hospital with higher level NICU but in a week. The mother was very unhappy to deliver at COCH. I feel very sorry for her. But could a consultant stop by the next day to take care of the IV line?

Thats fair enough only thing is Dr Marn has found no evidence of a thrombus and no doubt it was well looked for. entire point of my posts is that Dr Lee suggested it not knowing it was seemingly ruled out and tested for. There is evidence suggestive of but not conclusive proof of air embolus but seemingly none of thrombus. logic might dictate that air embolus is more likely especially as symptomatically the two are the same. I m almost certain that a thrombus would show on the scans checked by Dr arthurs and Dr Marn as well.

 

[Furore]

The true problem is the child was having problems with IV access and hence, didn’t get fluids for several hours, the PICC line was inserted by an intern at 5 pm or so. No IV fluids as X-ray to check its position was unavailable for 3 hours. Lucy comes in at 7:30 pm. About 8 PM, the fluid is started and soon the baby collapses. So lack of fluid itself is bad; the baby is dehydrated. More reasons for thrombosis. In a preemie, a foramen ovale is open so the clot can travel anywhere, into the brain or lungs. But, since so many things were not going well for the baby hours before Lucy emerged, how can they link the collapse to Lucy? I would have hard time blaming it on the resident either because in the absence of any consultant on the unit and baby A born the previous night via C-section from a mother with antiphospholipid syndrome and preeclampsia, hence, not a “doing well baby” by any means, things were bound to happen.

The mother was to have a C-section in another hospital with higher level NICU but in a week. The mother was very unhappy to deliver at COCH. I feel very sorry for her. But could a consultant stop by the next day to take care of the IV line?

JMO.

A dehydrated baby will drop their BP and increase their heart rate. They will become more stable with fluids not collapse, if the problem is lack of fluid. If lack of fluid is the only problem, the cardiac arrest/resus will improve with fluid. Death from lack of fluid would not have been described as inexplicable or warranted enough concern for it to be escalated to regional clinician networks as an unexplained death.

There was no post mortem or radiological evidence of thrombus. Tortoise has linked the evidence describing expert testimony from a haematologist and also experts on clotting disorders in neonates at GOSH. There was post mortem evidence of air.

Air embolism causes sudden deterioration, one that occurs within minutes, and therefore the likely perpetrator through neglect or malice, will be the one present in the previous moments, and not the previous shift, or doctors attending to resuscitate.

If the child had been completely unstable, there would be no need to wait for PICC line xray, one could place an intra osseus device to resuscitate - they obviously felt they could wait for fluids based on infants clinical condition prior to arrest. Clinical Practice Guidelines : Intraosseous access

All JMO

 

[Sweeper2000]

JMO.

A dehydrated baby will drop their BP and increase their heart rate. They will become more stable with fluids not collapse, if the problem is lack of fluid. If lack of fluid is the only problem, the cardiac arrest/resus will improve with fluid. Death from lack of fluid would not have been described as inexplicable or warranted enough concern for it to be escalated to regional clinician networks as an unexplained death.

There was no post mortem or radiological evidence of thrombus. Tortoise has linked the evidence describing expert testimony from a haematologist and also experts on clotting disorders in neonates at GOSH. There was post mortem evidence of air.

Air embolism causes sudden deterioration, one that occurs within minutes, and therefore the likely perpetrator through neglect or malice, will be the one present in the previous moments, and not the previous shift, or doctors attending to resuscitate.

If the child had been completely unstable, there would be no need to wait for PICC line xray, one could place an intra osseus device to resuscitate - they obviously felt they could wait for fluids based on infants clinical condition prior to arrest. Clinical Practice Guidelines : Intraosseous access

All JMO

radiological evidence? you know wha scans Baby A had? Dr lee may be right when he said at PM a thrombus is difficult to detect but the scans would show it maybe?

 

[Furore]

radiological evidence? you know wha scans Baby A had? Dr lee may be right when he said at PM a thrombus is difficult to detect but the scans would show it maybe?

Baby’s post-mortem X-ray had ‘unusual finding’, Lucy Letby trial told

Letby is on trial accused of the murders of seven babies

www.independent.co.uk

 

[magikarpmagikarp]

Only the doctors say that livedo reticularis is easily seen on preemies because of underdeveloped dermis so that the blood vesssld are seen through the skin. Its sudden appearance may be indicative of any kind of neonatal distress.

I am not sure what point you are trying to make here.

Mottling is very very common in newborns. Sometimes it indicates distress. Sometimes the baby is just cold. This kind of mottling is so prevalent it would never be described as unusual or as something the staff had not seen before.

Furthermore, the skin changes associated with APS are (per the link provided by ruth) caused by clots and while they may appear suddenly, they don't vanish suddenly. That is because clots, once formed, do not vanish suddenly.

Jmo

 

[magikarpmagikarp]

In a preemie, a foramen ovale is open so the clot can travel anywhere, into the brain or lungs.

This is an interesting point and a question I have - but not for you Charlot. The PFO supposedly wouldn't have admitted air into the arterial system due to the difference in pressure between the right and left atria. (Higher on the left than right; fluid following the path of least resistance). Yet it was supposed to have admitted a thrombosis from the venous system or right atrium. Do clots more readily traverse the PFO than air? I imagine the same conditions need to be present for both (crying? Increased pulmonary pressure residual from delivery and prematurity?)?
Furthermore it is my understanding that paradoxical embolism in general does exist and is called paradoxical just for that reason.

 

[magikarpmagikarp]

It is my understanding that in the NHS, the line is primed and locked with normal saline in order to prevent occlusion while waiting for the xray. Furthermore, a line which has had a clot form on the tip of it is generally occluded. In that case fluid cannot be infused because the line is blocked. The fact that fluid was started rather suggests to me that the line wasn't blocked. A partial occlusion is also possible but in that case there is no pressure build up. JMO

For reference, I was only able to find NHS Scotland guidelines

Peripherally inserted central catheters (PICC Lines) - Neonatology guideline | NHSGGC

clinicalguidelines.scot.nhs.uk

Informally I have know people to provide intermittent flushes if the wait is very long. Again jmo.