Yes I had totally missed this from reading the evidence! How was so much vomited/aspirated when only 45mls went in? Pretty damning evidence
What I've been thinking is that we know that with baby E, LL is accused of writing fraudulent nursing notes a good three hours after he died. Most likely (imo) after the doctors and consultant, who had been speaking with the parents, had left the cotside. The "fraudulent" (according to the prosecution) notes were that -
- E's mother visited the unit at 8pm
- There had been a bile-stained aspirate at 9pm which she discarded
- The SHO Dr Wood (on the paediatric ward that night) had advised to omit the 9pm feed
- No mention of mother visiting the unit with expressed milk at 9pm, or of bleeding,
- E's mother had visited the unit at 10pm and became aware of bleeding then and was updated by reg. Harkness.
With baby F, the implication is that LL wrote a false blood glucose reading in his notes -
4am - 1.9
5am - 2.9 (initialled by LL)
8am - 1.7
So I've written up the sequence of what was recorded in baby G's notes, by whom, on the night she projectile vomited, to show who was aware of what at different times. I think from what I've seen here it could be interpreted that LL was carefully managing the time of, or delaying, the recording of information, so that it might go under the radar. It raises the question of why a band 6 nurse would not have flagged up the discrepancy of a 45ml aspirate of milk plus air straight after a large and continuing vomit of milk, when her feeding chart recorded that she was on 3-hourly feeds of 45mls of milk. The doctors never made clinical notes that they were told of the amount aspirated by LL. I'm presuming the aspirate was witnessed by the shift-leader at 2.15am.
2am - G's designated nurse noted on her chart
she fed G 45mls of expressed breast milk. She went on her one-hour break. LL's notes say care was given by her (LL) from 2am.
2.15am - G projectile vomited. The shift-leader Ailsa Simpson (AS) and LL were at the nursing station and they ran to her. They assisted her breathing, she continued to vomit and LL aspirated her NG tube. LL was made the designated nurse by AS. LL then called Reg Ventress to urgently review G.
2.35am - Reg Ventress attended and noted G's abdomen was purple discoloured and distended. She noted she was told
G "had very large projectile vomit reaching the chair next to the cot and canopy". She was called urgently to theatre.
3am - LL noted G's bowels opened.
3.15am - G desaturated and stopped breathing. Reg Ventress was called out of theatre. She decided to intubate and G was moved to Room 1. Reg V called consultant Breary to attend while she intubated G and saw
blood in the windpipe beyond the vocal cords.
3.30am - consultant Breary's clinical note states "called in at 0330,
large vomit and loose watery stool earlier...blood visible on intubation"
3.45am - the parents were called and came in after that.
4.49am - an x-ray showed slightly distended bowel loops and gas noted in rectum (my note - so 100mls of air aspirated just over an hour later wasn't apparent?)
5.15/5.30am - LL signed for medications and infusion prescription for G
5.30am - G had another profound desaturation. G was sedated and the ventilator was changed by Reg V. Consultant B noted need to discuss with Arrowe Park/Liverpool Hosp.
6.05/6.15am - G had another profound desaturation and Reg V decided to reintubate.
The tube was removed and there was a blood clot on the end of it. 100mls of air was aspirated. G was given morphine and Reg V noted
blood-stained fluid in the throat.
8.57am - well after nursing handover and probably doctor's handover - LL wrote up her nursing notes:
[G] had large projectile milky vomit at 2.15am. Continued to vomit++. 45mls of milk obtained from NG tube with air++. Abdomen noted to be distended and discoloured. Colour improved few minutes after aspirating tube, remained distended but soft. Reg. Ventress asked to review. To go nil by mouth with IV fluids. Dr called to theatre."
9am - Reg Harkness noted that G was paralysed and sedated and he planned to discuss with Arrowe Park/Liverpool Hosp.
All MOO
