UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #10

[Tortoise]

The facts of the case are being totally obscured in these discussions about whether babies take in air. That's what happens when you mix up the different testimonies and cases, and ponder over whether babies can swallow air. Dr Bohin's evidence was specifically about baby G taking in air while projectile vomiting. Nothing to do with her screaming or crying. Baby G was asleep until she projectile vomited. The allegation is of air and milk being forcibly pumped into her stomach through the nasogastric tube.

Electronic evidence:

Further medication is administered to Child G at 1.46am, signed by the designated nurse and Ailsa Simpson.
At 2am, the designated nurse records observations for Child G and a neonatal feeding chart records this is Child G's 100th day since birth.
She received 45mls of milk via the nasogastric tube, with 'ph4' aspirates recorded. Child G was noted to be 'asleep' at this stage.
The milk was expressed breast milk, plus fortifier and Gaviscon.


Lucy Letby writes a note, written in retrospect at 8.57am
The note says "written in retrospect for care given from 2am to present. [Child 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[istrar] Ventress asked to review. To go nil by mouth with IV fluids. Dr called to theatre."

Recap: Lucy Letby trial, Thursday, December 1



Lucy Letby's Police Interview Summaries

She was asked about the significance of the air in the NGT. She says sometimes air is taken in when babies vomit.
She said she was not sure of the cause of the air in Child G's abdomen.

Recap: Lucy Letby trial, Wednesday, January 18



Dr Bohin's evidence:

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

 

[Tortoise]

This is interesting! Was the next victim baby F who was allegedly poisoned with insulin, and one instance happened to occur after LL had finished her shift? I think this is the event they claim LL tampered with the bag that was delivering other fluids or lipids. They allege it was set up to run and then LL went home and baby F deteriorated.
If so, if guilty, this message from her colleague saying she needs a break from it being on her shift, may have encouraged her to switch methods and try to get a collapse to happen when she wasn’t on shift. If guilty, MOO.

ETA - I’m not certain on this as we’ve heard so much evidence it’s possible I’ve got mixed up, but if this did occur then it’s certainly something to consider IMO

That is exactly the order of what happened.

Baby E died on the early morning of 4th August.
That text was sent to LL at 8pm on the evening of 4th August, the start of LL's next night shift.
Baby F received insulin in his TPN during that night shift (according to EXPERT testimony) at 12.25am on 5th August.
LL went off shift at 8am, while baby F was still receiving the contaminated feed and continued to be hypoglycaemic throughout the day.

 

[marynnu]

The insulin in TPN scenario for Baby F is just too full of doubts, in my opinion. The idea of LL contaminating a stock bag is a bit unlikely, in that long lines rarely tissue, so nobody would anticipate a new line being inserted that day. My suspicion is that the original bag didn't get changed, but there is no way of knowing this. I've been puzzled from the start as every drug and infusion has to be prescribed by a doctor and signed for by 2 nurses. So if a new bag was put up this surely has to be recorded? It seems a simple thing to verify but somehow nothing has been mentioned, as far as I can see.

 

[Tortoise]

Liz Hull

@lizhull
·
2h

The jury in the trial of alleged killer nurse Lucy Letby is not sitting today and tomorrow but the latest episode of
@LucyLetbyTrial podcast is out later with @RadioCaroline_ and special guest criminologist @ProfDavidWilson - listen on
@mailplus

 

[Tortoise]

The insulin in TPN scenario for Baby F is just too full of doubts, in my opinion. The idea of LL contaminating a stock bag is a bit unlikely, in that long lines rarely tissue, so nobody would anticipate a new line being inserted that day. My suspicion is that the original bag didn't get changed, but there is no way of knowing this. I've been puzzled from the start as every drug and infusion has to be prescribed by a doctor and signed for by 2 nurses. So if a new bag was put up this surely has to be recorded? It seems a simple thing to verify but somehow nothing has been mentioned, as far as I can see.

I think it makes most sense that the same bag was put up when the line was changed. Especially with it being bespoke.

The lack of a record of a new bag, is as you say, another indication of this. JMO

 

[Tortoise]

The low blood sugar readings started from when LL hung the first (if there were two) TPN bag and carried on throughout her shift then into the next shift, which the medical expert has said shows that the supply of insulin was continuous.The only reading that was slightly higher during LL's shift was the one LL recorded.

If there was a second bag we've been told that they kept "a couple" of stock bags in the fridge so if guilty,it's not like there were 20 odd additional TPN bags in the fridge that she would have had to poison. She could just have poisoned the next one in the fridge if they were stored in the order they would be used ,or if there were only a couple, poisoned both of them.

But we don't know for sure that there even was a second bag. The nurse said she "would've" changed the bag (ie that was what she normally would do) but that she had no independent memory of it. She also said she thought she would have made a note if she hadn't changed it and there was no note... BUT there was no note saying she had changed it either. The medical expert has said that if there was a second bag then it must have contained the same amount of insulin as the first bag that LL hung, as the blood sugar readings stayed low throughout the time the TPN bag/s was/were used. But an alternative explanation is that it was just the one bag throughout. Either way , the continous low blood sugar readings on LL's shift indicate that the TPN bag LL hung contained insulin. The argument is whether there was a second bag that did too or whether the bag was never changed.

The defence have not questioned that Baby F was deliberately poisoned with insulin nor that it was in the TPN bag. They didn't challenge the medical expert at all on those points. And even LL has not challenged that She's just said that she didn't do it. The defence are arguing that as the blood test that showed the high insulin was taken when the alleged second TPN bag was being used, that it can't have been LL. However as explained above the medical expert has said that the continuous low blood sugar levels, which started after LL hung the TPN bag , show that the insulin was administered continously for the period the blood sugars were low... and that period started shortly after LL hung that (first) TPN bag. The implication being that although the insulin blood tests weren't performed until the alleged second TPN bag, they would still have been abnormal if they had been tested on LL's shift.

imo

Also important, IMO, to take note of the following testimony -

"The next witness to give evidence is Professor Peter Hindmarsh, an expert witness.
He explains to the court he is professor of paediatric endocrinology at University College London and consultant in paediatric endocrinology and diabetes at University College London Hospitals.

The court is now shown Child F's observation chart for the night of August 4-5. Child F's heart rate rose from around 150bpm to 200-210bpm between 1.15am-4am.
Child F had received a TPN bag of nutrition at 12.25am on August 5.
Child F's blood sugar reading at 1.54am was 0.8. Professor Hindmarsh says it is a "significant" difference and "extremely low".
Mr Johnson: "Was it a cause for concern?"
Professor Hindmarsh: "Absolutely."

A table, created by Professor Hindmarsh, records all of Child F's blood sugar readings from 11.32pm on August 4 to 9.17pm on August 5.
They are:
5.5 (August 4, 11.32pm)
0.8 (August 5, 1.54am)

<snipped by me>

Recap: Lucy Letby trial, Friday, November 25


[Prof Hindmarsh] "said Child F’s initial rise in heart rate was “consistent with the release of adrenaline, your first line of defence against a low blood glucose”. [...]

Baby’s heart rate soared after receiving insulin, murder trial told

 

[Sweeper2000]

Agree on the bespoke bag matter. The fridge stock take system on the unit was weird, it's restocked each day and fridge could stock up to three customised bags. (For each baby presumably?)
A prescription goes to pharmacy and it has three bags on the order. (So nnu fridge must empty)
Bag 1 gets made up and administered by LL. It contains insulin but bag 2 doesn't get made up until later the next afternoon, it's then dropped at unit at 4pm.
Moral of the story? The nurse who was working after LL who claims to have changed the line and set up a new fluid bag could not have set up a customised one because it hadn't arrived back from pharmacy so, if there was a second bag, it would have had to have been a bulk standard one. - apologies if this is old ground! X

thats good info to learn of. I’m not sure of what you mean by “made up” though,I would have thought a nurse would via protocol only handle the bag upon aquisition. According to the testimony LL hung the bag. Interesting though. I’m still not sure exactly when it is assumed that LL had the opportunity to put insulin in the bags. Again it’s quite a blatant thing to do. The stock or generic bags go straight i the fridge,whereas presumably the bespoke bag might stay out to reach room temp. One might think the stock bag being out would presumably be noticed or all three, jmo though.

 

[Tortoise]

"The court is shown a nutrition prescription for Child F for August 4.
Mr Allen confirms he is familiar with the type of prescription shown, and the worksheet which is also shown to the court.
He said this particular TPN would have followed the standard protocols in the pharmacy, and was reflective of the prescription.
He said the bag would have been transferred from the pharmacy to the neonatal unit fridge.

A copy of the label for that TPN bag on August 4 would have been made for the pharmacy's records.
The label has a use-by date of August 11, to be stored between 2-8 degrees C."

Recap: Lucy Letby trial, Tuesday, November 29

 

[Sweeper2000]

Two things----first, I don't think anyone has said that babies never swallow air. [although not when projectile vomiting] They do swallow air, and it gives them hiccups and gas, etc.

But 2nd, when they swallow air, it does not give them mottled red skin, nor does it end up as a deadly air embolism. Injecting air into the feeding lines is not the same outcome as a baby swallowing air.




There is ,allegedly, nothing in LL"s notes to suggest trauma----but why would there be?
However Baby E's mum described the blood and the piercing screams from her very upset baby. And LL was doing nothing to comfort him when Mum arrived. That suggests trauma to me. He was dead 5 hours later.

Mother walked in on nurse Lucy Letby trying to kill baby, court told

Defendant accused of murdering seven babies allegedly said ‘trust me, I’m a nurse’ when interrupted

www.theguardian.com

The infant, who weighed 1.3kg (just under 3lbs) at birth, rapidly deteriorated and was pronounced dead less than five hours after Letby was seen attacking him, the jury was told.


Experts later concluded that Baby E died as a result of gas intentionally injected into his bloodstream and “bleeding indicative of trauma”, the jury was told.


The nurse allegedly “wiped out” the mother’s visit from the medical records then falsely claimed to be in another room when Baby E collapsed. This, the prosecution alleged, was Letby trying to establish an “alibi in someone else’s medical records”.


I find that alleged action ^^^ very damning to the defense. It its not the only time she has been accused of changing or omitting facts from her patient notes.


[I am confused by your post above because of the jumping from Baby E, to Baby N to baby F .... Are you comparing them or just talking about them separately? ]




Is there an inconsistency above? I don't see any--it just seems to be the facts as noted.


I see some elevated levels of supposed intent.

Recap: Prosecution continues opening of Lucy Letby trial

The prosecution continues its opening in the trial of Lucy Letby, accused of multiple baby murders at the Countess of Chester Hospital.

www.chesterstandard.co.uk

The doctor saw "fresh blood" in Child N's throat, which the prosecution say was the same seen in Childs C, E and G.

The doctor was unable to get the breathing tube down the throat of Child N as he was unable to visualise the child's tracheal inlet.

He was “surprised by his anatomy more than anything else … I could not visualise parts of the back of his throat because of swelling”.

And later that same day, 3rd attempt:

Child N collapsed just before 3pm and a consultant was called at 2.59pm. While awaiting a consultant, a junior doctor looked into the airway of Child N and saw a “large swelling at the end of his epiglottis” he could only just see the bottom of the vocal cords. He had never seen anything like this before in a newborn baby.

The prosecution said Child N was "so unwell" that attempts were made to reintubate him, but the doctor could not see down Child N's throat as the view was obscured by fresh blood. A more specialist team was called to carry out the intubation.

Here is another issue:
At 11.29am Letby sent a Facebook message to the doctor telling him “small amounts of blood from mouth and 1ml from ng. Looks like pulmonary bleed on x ray [i.e. a bleed from the lungs]. Given factor 8 – wait and see”. Other than that phone message, there is no evidence that Lucy Letby brought the bleeding to the attention of any of the medical staff.

The prosecution said this is surprising given the problems Child N had suffered.


SO YOUR POINT IS THAT YOU DON'T SEE HER TRYING HARDER TO KILL THIS BABY? Does it matter? Isn't the real issue that she allegedly did try three times to severely harm him?


I am not sure where child F comes into your argument though. But it is another very troubling case where she continued allegedly, to keep assaulting babies with potentially deadly actions.

its just surprising that In the cases of a distended bowel or other internal organs the possibility that it was caused by something not nefarious hasn’t been mentioned. Not just CPAP belly but crying as well.

in regards to the alleged trauma by LL on child E there is nothing In the doctors notes who inspected her around the ten pm note. His testimony is that the baby had a Undramatic presentation. My point regarding the inflicted trauma before the 9pm mark. Was that there isn’t anything medically to suggest it. If the injury was that significant and painful one might think a desat would have accompanied it but there is no note of anything the alleged trauma would Presumably have caused Either by LL or the attending doctor. No bruising, no redness specific to the area, no swelling and no blood.

in regards to the mothers account of the babies disproportionate screaming, one might think a fellow nurse would have noticed it But again not one professional suggestion of it.

I was comparing them yes. I just think that suggesting increased effort to kill between the efforts of the two insulin cases would be present in all of them if she was guilty. We don’t see that Imo. The majority of fatalities occurred early on in the cases.


I am wondering if there was Anything at all that would give an indication that child E had suffered an injury in the five hours preceding his unfortunate and untimely passing.

in regards to the x ray and pulmonary bleed, I’m not sure that texting a doc and doing an x ray is fitting with someone trying to conceal evidence.
jmo though

 

[JosieJo]

thats good info to learn of. I’m not sure of what you mean by “made up” though,I would have thought a nurse would via protocol only handle the bag upon aquisition. According to the testimony LL hung the bag. Interesting though. I’m still not sure exactly when it is assumed that LL had the opportunity to put insulin in the bags. Again it’s quite a blatant thing to do. The stock or generic bags go straight i the fridge,whereas presumably the bespoke bag might stay out to reach room temp. One might think the stock bag being out would presumably be noticed or all three, jmo though.

The tpn and insulin were in the same fridge inside a room ...so imo the indication is she added it when she collected the bag from the fridge (allegedly)

 

[Sweeper2000]

The tpn and insulin were in the same fridge inside a room ...so imo the indication is she added it when she collected the bag from the fridge (allegedly)

Is the nurse supposed to have adjusted anything with the bag at all?
for instance removing a seal, adjusting the connectors ready for administration?

 

[JosieJo]

Is the nurse supposed to have tampered with the bag at all?
for instance removing a seal, adjusting the connectors ready for administration?

The TPN bag has a self sealing port where you could inject into

 

[Sweeper2000]

IMO it’s such a shame that that bag or both were not kept for investigation. I’m just wondering how It was that the possibility that somehow insulin was administered at the time wasnt noticed for child F. I can understand how anything other than insulin would slip under the net So to speak. Ie air embolis, trauma excess milk or air. But the spike in blood sugars when it isn’t expected is curious. Would they have disposed of the tpn bags after use? It’s as close as you will get to hard evidence imo really wouldnt leave any doubt at all. Could test for injection site etc. One might think it would be protocol to test equipment after use in cases of potential mistakes.

 

[JosieJo]

IMO it’s such a shame that that bag or both were not kept for investigation. I’m just wondering how It was that the possibility that somehow insulin was administered at the time wasnt noticed for child F. I can understand how anything other than insulin would slip under the net So to speak. Ie air embolis, trauma excess milk or air. But the spike in blood sugars when it isn’t expected is curious. Would they have disposed of the tpn bags after use? It’s as close as you will get to hard evidence imo really wouldnt leave any doubt at all. Could test for injection site etc. One might think it would be protocol to test equipment after use in cases of potential mistakes.

They wouldn't have any reason at the time to suspect insulin in a TPN ... it was only after the C Peptide results came back they would know there was synthetic insulin involved.
By that point the TPN bag would have been thrown away

 

[Sweeper2000]

They wouldn't have any reason at the time to suspect insulin in a TPN ... it was only after the C Peptide results came back they would know there was synthetic insulin involved.
By that point the TPN bag would have been thrown away

It seems a bit like all the cases. The possibility of human error or faulty equipment was never taken into consideration at the time.

 

[Sweeper2000]

Have found the case that Dr evans reviewed first of all, just to get an idea of what he was dealing with.

“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

 

[Tortoise]

It seems a bit like all the cases. The possibility of human error or faulty equipment was never taken into consideration at the time.

which equipment are you referring to?

 

[Sweeper2000]

which equipment are you referring to?

Any and all of it. one might think the processes involved with finding out the causes of these unexplained and unusual events would be as follows. 1. Natural causes (if excluded) - 2. human error (if excluded) - 3. Faulty equipment (if excluded) - 4. Human action. Seems to be a reasonable course of the process of elimination with human action being the least likely cause. Jmo though. In other words if it’s not this it could be this.

 

[DianaWW]

I think that's exactly what happened though. The hospital did their own review into the high number of deaths, and I'd be vey surprised if the first three things you mention weren't considered during that review. But they still couldn't find a reason for a number of these deaths which is when they asked the police to review them. MOO.

 

[Tortoise]

I just think that suggesting increased effort to kill between the efforts of the two insulin cases would be present in all of them if she was guilty. We don’t see that Imo. The majority of fatalities occurred early on in the cases.

In the insulin cases it was obvious that the first dose didn't kill, so an increased dose would be needed if that was the aim.

In the alleged early air embolism cases senior staff and other colleagues had clearly noticed something wasn't right and Dr Jayaram was doing his own research. It wouldn't have continued to fly under the radar had that exact pattern continued.

I am wondering if there was Anything at all that would give an indication that child E had suffered an injury in the five hours preceding his unfortunate and untimely passing.

Yes, the mother's evidence which said there was blood from his mouth, all around and under his chin, not blood coming out of the ngt, and screaming, and LL told her it was from the tube rubbing his throat.

JMO