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

[Tortoise]

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.

Well it's obvious that it wasn't faulty equipment. Medical staff would know if a machine was malfunctioning, clearly it wasn't because other babies weren't affected in between these events.

Do you think her defence is not serving her well in not raising these issues at trial?

JMO

 

[Becky53]

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

That’s just it. All medicine should be accountable/traceable according to RCN and imo.

• whether there is a process to ensure that where
a medicine is prescribed and then dispensed/ supplied and/or administered that a clear record is kept against the patient’s record of the medicine, batch number, and expiry date of the medicine

• that there is a process for regular audit and review of medicines prescribed, dispensed/ supplied and/or administered by the service.

https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/SSHM%20and%20Admin/RCN%20RPS%20additional%20guidance.pdf?ver=2020-03-05-121229-987

 

[JosieJo]

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

Human error was looked into

The pharmacy that supplies the TPN took the stand and went through the strict guidelines on preparing TPN ..he stated no insulin would ever go into tpn accidentally

There were no babies receiving insulin on the unit at the time ...that rules out drug error

The defence are not saying that the insulin was not in the tpn

 

[Becky53]

That’s just it. All medicine should be accountable/traceable according to RCN and imo.

• whether there is a process to ensure that where
a medicine is prescribed and then dispensed/ supplied and/or administered that a clear record is kept against the patient’s record of the medicine, batch number, and expiry date of the medicine

• that there is a process for regular audit and review of medicines prescribed, dispensed/ supplied and/or administered by the service.

https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/SSHM%20and%20Admin/RCN%20RPS%20additional%20guidance.pdf?ver=2020-03-05-121229-987

just to add and I don’t think insulin is a controlled drug but would assume the same applies. I’ve added link it shows as the blue 1

1

8.8.9

Management of Controlled Drugs in wards and departments: Controlled Drug stock checks Within NHS Tayside all wards and departments possessing stocks of Controlled Drugs must carry out a stock balance reconciliation every 24 hours. The Registered Nurse/Midwife in Charge is responsible for ensuring that this is carried out. Two registered nurses, midwives or other registered health professionals should perform this check. Where possible the staff undertaking this check should be rotated periodically. The following procedure must be followed: Each page of the CD register must be checked against the contents of the CD cupboard, not the reverse, to ensure all balances are checked. The physical stock of each item should be counted. It is not necessary to open packs with intact tamper-evident seals for stock checking purposes, e.g. manufacturer's complete sealed packs. Stock balances of liquid medicines should generally be checked by visual inspection but periodic volume checks may be helpful. The balance must be confirmed to be correct on completion of a bottle. A record must be made that the stock check has been carried out and this record must include, as a minimum, the date and time of the reconciliation check and be signed by both members of staff. See Appendix 7 for recording form. Any discrepancy must be investigated in accordance with Section 8.2 Dealing with Discrepancies. Minor discrepancies in volumes of liquid CDs will be corrected by a Registered Nurse/Midwife or Pharmacist/Pharmacy Technician and countersigned by the Nurse/Midwife in Charge or deputy. A minor discrepancy is considered to be 5% of the volume contained in the bottle or 10mL, whichever is the smaller volume. 1

 

[Tortoise]

That’s just it. All medicine should be accountable/traceable according to RCN and imo.

• whether there is a process to ensure that where
a medicine is prescribed and then dispensed/ supplied and/or administered that a clear record is kept against the patient’s record of the medicine, batch number, and expiry date of the medicine

• that there is a process for regular audit and review of medicines prescribed, dispensed/ supplied and/or administered by the service.

https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/SSHM%20and%20Admin/RCN%20RPS%20additional%20guidance.pdf?ver=2020-03-05-121229-987

I'm willing to bet these things have been raised in the courtroom, barristers are very thorough. I think we're just having a hard time following it from a handful of tweets. I still can't believe they had two expert witnesses in the case of baby G and the BBC reporter couldn't be bothered to write one word about their evidence.

 

[marynnu]

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.


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

And there is no way a naso/orogastric tube would cause significant bleeding, or any bleeding whatsoever really. I must have nursed hundreds of babies with feeding tubes and have never seen, or even heard of, such a thing.

 

[Sweeper2000]

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 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.


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

i agree that it would be in line with a more concerted effort to kill to increase the dose, but one might think the medical intervention might have been factored in. I’m not sure either that kind of suggests a would be killer would have paid attention to the amount of insulin present in the vessel. I would have thought an indiscriminately large amount would be more likely. Moo. What do you think?

I am also not in the opinion that we do see an increased effort to kill across the cases. After child E we see less fatality but more injury /suspicious events.

I get your second point btw, cases do seem to involve a shift in method if guilty. Just out of curiosity is there a presentation on the skin indicating the symptoms of air embolism in all cases of alleged AE?

for child E I was thinking about the med notes, anything suggestive there? I know mr Myers has stated no evidence which seems to be true but anything to backup the claim of trauma before 9 would be good.

Well it's obvious that it wasn't faulty equipment. Medical staff would know if a machine was malfunctioning, clearly it wasn't because other babies weren't affected in between these events.

Do you think her defence is not serving her well in not raising these issues at trial?

JMO

I don’t think there would have to be a permanent fault in the machines that would be present in other cases giving an indication that there was a broken machine. I dread saying it but if they turned it on and off again it might reset. If a user changes the settings or uses the wrong settings for that situation I think it could explain it. Falls into the human error category Or maybe a combo of the two. We also don’t know anything about other events on the unit, we won’t until we hear the defence.

I really couldn’t say tortoise On the defence. It seems there is other potentials not mentioned but I really couldn’t claim to know enough about it to suggest the reasons or absence of them Currently at least.

what do you think?

its kind of more my Point that anything other than natural causes were thought of as a potential explanation for the events at the time. If natural stuff was excluded your not left with many options IMO, one might think that these breaks from what’s normal might have given a reason for further investigation. Might have saved a great deal of hurt and potentially unnecessary injury. Thoughts to all affected by this.

 

[Becky53]

I'm willing to bet these things have been raised in the courtroom, barristers are very thorough. I think we're just having a hard time following it from a handful of tweets. I still can't believe they had two expert witnesses in the case of baby G and the BBC reporter couldn't be bothered to write one word about their evidence.

I agree that they’d “leave no stone unturned“ as they say… and that we just haven’t got the full account with the lack of reporting.

I‘d actually like to hear what her demeanor is like as in all honesty she can’t be just sat there like a frump when she hears something she doesn’t agree with. The woman who reported for Hull Live for the Pawel Relowicz case did a grand job.
God bless Libby it’s her anniversary in a couple of days.

 

[Sweeper2000]

Would be interesting to find out how insulin would mix with the contents of a tpn bag. For instance if it’s an oil it would sit on top of any water based liquid but I think I remember that fats are present in them. Would insulin bind more to a fat than water or bind/mix with any of the other liquids present?


interesting as well, the pharmacy has testified but we haven’t been given info from them to push away the possibility that human error was out of the question at source. Granted we know no other child was being given insulin at the ward but we don’t know if the same mix up/ human error didn’t occur at the pharmacy. One might think the records would indicate that insulin was/ was not being used in preparation at the pharmacy at the time the bespoke bag was made up, that would really push that possibility out of the question. Jmo though. Wouldn’t that be very solid evidence that the bag was contaminated after delivery to the unit?

 

[marynnu]

just to add and I don’t think insulin is a controlled drug but would assume the same applies. I’ve added link it shows as the blue 1

1

8.8.9

Management of Controlled Drugs in wards and departments: Controlled Drug stock checks Within NHS Tayside all wards and departments possessing stocks of Controlled Drugs must carry out a stock balance reconciliation every 24 hours. The Registered Nurse/Midwife in Charge is responsible for ensuring that this is carried out. Two registered nurses, midwives or other registered health professionals should perform this check. Where possible the staff undertaking this check should be rotated periodically. The following procedure must be followed: Each page of the CD register must be checked against the contents of the CD cupboard, not the reverse, to ensure all balances are checked. The physical stock of each item should be counted. It is not necessary to open packs with intact tamper-evident seals for stock checking purposes, e.g. manufacturer's complete sealed packs. Stock balances of liquid medicines should generally be checked by visual inspection but periodic volume checks may be helpful. The balance must be confirmed to be correct on completion of a bottle. A record must be made that the stock check has been carried out and this record must include, as a minimum, the date and time of the reconciliation check and be signed by both members of staff. See Appendix 7 for recording form. Any discrepancy must be investigated in accordance with Section 8.2 Dealing with Discrepancies. Minor discrepancies in volumes of liquid CDs will be corrected by a Registered Nurse/Midwife or Pharmacist/Pharmacy Technician and countersigned by the Nurse/Midwife in Charge or deputy. A minor discrepancy is considered to be 5% of the volume contained in the bottle or 10mL, whichever is the smaller volume. 1

Just to say, you wouldn't follow the above procedure for all drugs, just controlled ones. It would take hours otherwise!

 

[Tortoise]

I would have thought an indiscriminately large amount would be more likely. Moo. What do you think?

I am also not in the opinion that we do see an increased effort to kill across the cases. After child E we see less fatality but more injury /suspicious events.

Nick Johnson KC says Letby "deliberately" set out to kill Child L.
"She had failed to kill Child F and so she increased the dose," the prosecutor tells the jury.
"The level of insulin was greater than the range the machine could measure," Mr Johnson says.
Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins

Well it seems that might be because the alternative alleged methods were not as efficient a method of killing.

for child E I was thinking about the med notes, anything suggestive there? I know mr Myers has stated no evidence which seems to be true but anything to backup the claim of trauma before 9 would be good.

If LL caused trauma why do you expect she would make a nursing note of it? She didn't call in the doctor, so he wouldn't have made any notes.

There is evidence of dishonesty too in a nursing note recording things that did not happen close to 9pm, according to the SHO.

JMO

 

[Sweeper2000]

Nick Johnson KC says Letby "deliberately" set out to kill Child L.
"She had failed to kill Child F and so she increased the dose," the prosecutor tells the jury.
"The level of insulin was greater than the range the machine could measure," Mr Johnson says.
Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins

Well it seems that might be because the alternative alleged methods were not as efficient a method of killing.



If LL caused trauma why do you expect she would make a nursing note of it? She didn't call in the doctor, so he wouldn't have made any notes.

There is evidence of dishonesty too in a nursing note recording things that did not happen close to 9pm, according to the SHO.

JMO

Interesting, very very interesting. i was wondering if in cases of ngt air method we see an increase in splinted diaphram. Would suggest more matter was forced into the ngt.

i wouldn’t expect her to note the trauma at all. I would as a guess expect a desat. I don’t think you could hide that from other staff. Nor do I think if trauma was present before 9pm the doc would not have noticed it when he made his notes. i would assume a significant injury like the one alleged would present with increasing deterioration from the time of injury noticed by the doc. He didn’t note anything that would give a indication that this was a potentially mortally wounded baby.

 

[marynnu]

Would be interesting to find out how insulin would mix with the contents of a tpn bag. For instance if it’s an oil it would sit on top of any water based liquid but I think I remember that fats are present in them. Would insulin bind more to a fat than water or bind/mix with any of the other liquids present?


interesting as well, the pharmacy has testified but we haven’t been given info from them to push away the possibility that human error was out of the question at source. Granted we know no other child was being given insulin at the ward but we don’t know if the same mix up/ human error didn’t occur at the pharmacy. One might think the records would indicate that insulin was/ was not being used in preparation at the pharmacy at the time the bespoke bag was made up, that would really push that possibility out of the question. Jmo though. Wouldn’t that be very solid evidence that the bag was contaminated after delivery to the unit?

Insulin is not an oil. When given to infants it's mixed with saline & given as an infusion. I don't think it would be visible in TPN.
I fail to see how insulin would be added in error in pharmacy. It's never added to TPN at all, and in any case they have stringent procedures in place as it's essential they add the correct drugs in the correct amount.

 

[GoodDayToYouSir]

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.


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

Perhaps it’s just due to the limitations of the reporting of the proceedings which we receive, but so often I find myself frustrated because it seems like very obvious follow-up questions are not asked of witnesses by either the prosecution or defence.

For baby E, LL allegedly told his mother that the blood the mother witnessed around the baby’s mouth and chin was due to his feeding tube rubbing. Now I know that Dr Evans has said the feeding tube rubbing didn’t cause the bleeding . But obviously Dr Evans is a very experienced Doctor with many years experience. LL is a band six nurse , so it is fair IMO to say that she, and indeed any band six nurse, would not have the same knowledge as a doctor with the qualifications and experience of Dr Evans.

What I wish the prosecution had asked Dr Evans was whether, based on the mother’s description of the amount of blood around the baby’s mouth and chin, a band six nurse could reasonably have concluded that the cause of that bleeding was, or is likely to have been, due to a feeding tube rubbing. I would also like to know the severity of a feeding tube rubbing a baby’s throat and causing bleeding. If a medical professional notes that a baby is bleeding due to a feeding tube rubbing, is that likely to constitute an emergency which requires immediate attention? Or is it something that whilst it needs to be looked at by a doctor, is something that can wait for a little while to be seen?

If a band six nurse could reasonably have concluded that a feeding tube rubbing could have caused the bleeding, and a feeding tube rubbing and causing bleeding does not constitute an emergency situation requiring immediate attention, then whilst LL comes across as somewhat uncaring and unprofessional by not immediately cleaning the blood off of the baby’s face, her inaction arguably looks less suspicious.

If, however, a band six nurse, encountering that level of bleeding could not reasonably have concluded that the feeding tube was causing the bleeding, meaning that there was some other unknown cause, then the fact that L L allegedly, told the mother not to worry because it was just a feeding tube rubbing looks much more suspicious. Equally, even if it could have been a feeding tube rubbing, if a feeding tube rubbing the throat enough to cause bleeding would constitute an emergency, then LL’s alleged inaction looks very suspicious.
JMO, as always.

 

[Imogenia]

Some of that would be unit protocol, which I don't know. <modsnip - "I heard" is not an approved source>

<modsnip - insider info without being verified>

There weren't any other insulin cases around the same time. But this baby had been on insulin prior, and his twin brother was too, I'm a little fuzzy at the moment on the timeline between when his brother died and when he had his glucose issues.

I'm not sold it was in the TPN ever.

You’re saying that this baby had been prescribed and given insulin previously?

Was this a ‘once only’ prescription of insulin?

The relevant prescription would have been written on his medication chart and signed off as being discontinued, is that correct?

You’re saying that this baby’s twin brother was also prescribed insulin, but that this twin brother sadly passed away?

Possible Errors.

I don’t think it can definitely be said that, because no other baby in the unit was being prescribed insulin at that time, the insulin administration to this particular baby could not have been in error.

Hard Copy Medication and Recording Systems (for example).

Errors in medicine administration can happen (for example) if a nurse is confused about a previous prescription having been definitely discontinued. A date of discontinuation and initials solely in small boxes (for instance) would be too easy to miss. Were there the advised horizontal and vertical lines clearly striking out the insulin hitherto prescribed?

Where were the insulin prescription charts for the twin brother?

Key for Medicines Fridge.

The manufacturers tend to supply two keys. They tend to offer a digital key code alternative at a slightly higher price. I would approve of the latter, along with a camera recording exactly what is going on as insulin (or anything) is taken out or put back in the fridge, in addition to meticulous record keeping.

12 Hours Working Sometimes No Breaks.

I keep seeing such working patterns being reported.

I don’t think it’s acceptable that any possibly overtired overworked nurse can (while maybe confused about a prescription), on their own, just take a vial of insulin out of the fridge, especially in NICU.

Any nurse who is overwhelmed, exhausted, and distracted can make a medication error. I’m thinking of the American nurse who gave vecuronium instead of versed intravenously.

It seems to me that such patterns of overworking and not getting proper breaks have to be stopped if errors are to be minimised.

I am interested in your not being absolutely convinced that the rogue insulin administered to this particular baby was ever in the TPN bag(s). What do you mean?

 

[Tortoise]

Would be interesting to find out how insulin would mix with the contents of a tpn bag. For instance if it’s an oil it would sit on top of any water based liquid but I think I remember that fats are present in them. Would insulin bind more to a fat than water or bind/mix with any of the other liquids present?


interesting as well, the pharmacy has testified but we haven’t been given info from them to push away the possibility that human error was out of the question at source. Granted we know no other child was being given insulin at the ward but we don’t know if the same mix up/ human error didn’t occur at the pharmacy. One might think the records would indicate that insulin was/ was not being used in preparation at the pharmacy at the time the bespoke bag was made up, that would really push that possibility out of the question. Jmo though. Wouldn’t that be very solid evidence that the bag was contaminated after delivery to the unit?

"The next witness to give evidence is Ian Allen, who worked in the Countess of Chester Hospital's pharmacy department in summer 2015.
Simon Driver, prosecuting, asks about the responsibilities Mr Allen had, which involved quality assurance and production of TPN bags for the neonatal unit.

3:16pm

Mr Driver focuses on the TPN bags, and a video which has been produced for the benefit of the court showing how a TPN bag is made.
Mr Allen confirms he has seen the video.
He describes the types of TPN nutrition bags - one would be used for the baby's first two days of life, and the other would be a maintenance 'stock' bag, supplied to the unit through the department.

3:20pm

Mr Allen says the initial order would be faxed down to the pharmacy from the neonatal unit. It would be handed to a pharmacist, reviewed by them, processed into a worksheet [a set of instructions on how to make the bag and the ingredients needed to make it].
A label would be generated.
A member of the pharmacy team would gather the ingredients/quantities required. Every medicine would come with a batch sheet number as part of the 'assembly'.
"Every step in the process has a standard operating procedure"
Staff would be trained in the process through nationally recognised quality assurance, he tells the court.

3:25pm

The items would be sprayed and wiped to sterilise them, and then made in a controlled environment.
Two operators would make the bag, with checks in place confirming the identity and quantity of the ingredients.

3:28pm

A pharmacist would check what has been used, looking at empty vials and ampoules to confirm what has been used.
The pharmacist would be ultimately reponsible for the product.
The unit would be subject to regulatory monitoring to ensure the safety, quaity and effectiveness of the products."

Recap: Lucy Letby trial, Tuesday, November 29

 

[esther43]

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.

Hi. So LL signed for the first bag at 2pm before the night of the attack. The prescription was made up of three bags. It doesn't seem that all three bags were made up.(as in customised nutrients specific to the baby added)
Further more 2nd bag didn't make it to the fridge on the nnu until 26 hours later, several hours after it is proposed the bag would have been changed.

 

[Tortoise]

i wouldn’t expect her to note the trauma at all. I would as a guess expect a desat. I don’t think you could hide that from other staff. Nor do I think if trauma was present before 9pm the doc would not have noticed it when he made his notes. i would assume a significant injury like the one alleged would present with increasing deterioration from the time of injury noticed by the doc. He didn’t note anything that would give a indication that this was a potentially mortally wounded baby.

Can you say why you would expect a desaturation?

Is that something that has been said by the experts?

The doctor wasn't there to make notes. He attended when LL called him to the baby around 45 minutes later.

The baby wasn't dying from the bleed when the doctor was called. Further blood loss was recorded over the next two hours and then he started to decline and desaturate. It is alleged he was then injected with air too and the planned intubation became an emergency procedure to get him on a ventilator.

JMO

 

[JosieJo]

You’re saying that this baby had been prescribed and given insulin previously?

Was this a ‘once only’ prescription of insulin?

The relevant prescription would have been written on his medication chart and signed off as being discontinued, is that correct?

You’re saying that this baby’s twin brother was also prescribed insulin, but that this twin brother sadly passed away?

Possible Errors.

I don’t think it can definitely be said that, because no other baby in the unit was being prescribed insulin at that time, the insulin administration to this particular baby could not have been in error.

Hard Copy Medication and Recording Systems (for example).

Errors in medicine administration can happen (for example) if a nurse is confused about a previous prescription having been definitely discontinued. A date of discontinuation and initials solely in small boxes (for instance) would be too easy to miss. Were there the advised horizontal and vertical lines clearly striking out the insulin hitherto prescribed?

Where were the insulin prescription charts for the twin brother?

Key for Medicines Fridge.

The manufacturers tend to supply two keys. They tend to offer a digital key code alternative at a slightly higher price. I would approve of the latter, along with a camera recording exactly what is going on as insulin (or anything) is taken out or put back in the fridge, in addition to meticulous record keeping.

12 Hours Working Sometimes No Breaks.

I keep seeing such working patterns being reported.

I don’t think it’s acceptable that any possibly overtired overworked nurse can (while maybe confused about a prescription), on their own, just take a vial of insulin out of the fridge, especially in NICU.

Any nurse who is overwhelmed, exhausted, and distracted can make a medication error. I’m thinking of the American nurse who gave vecuronium instead of versed intravenously.

It seems to me that such patterns of overworking and not getting proper breaks have to be stopped if errors are to be minimised.

I am interested in your not being absolutely convinced that the rogue insulin administered to this particular baby was ever in the TPN bag(s). What do you mean?

It couldn't have been a drug error as the insulin had to be running through the ton across the day ..the paediatric Endocrinology specialist confirms that

 

[JosieJo]

Perhaps it’s just due to the limitations of the reporting of the proceedings which we receive, but so often I find myself frustrated because it seems like very obvious follow-up questions are not asked of witnesses by either the prosecution or defence.

For baby E, LL allegedly told his mother that the blood the mother witnessed around the baby’s mouth and chin was due to his feeding tube rubbing. Now I know that Dr Evans has said the feeding tube rubbing didn’t cause the bleeding . But obviously Dr Evans is a very experienced Doctor with many years experience. LL is a band six nurse , so it is fair IMO to say that she, and indeed any band six nurse, would not have the same knowledge as a doctor with the qualifications and experience of Dr Evans.

What I wish the prosecution had asked Dr Evans was whether, based on the mother’s description of the amount of blood around the baby’s mouth and chin, a band six nurse could reasonably have concluded that the cause of that bleeding was, or is likely to have been, due to a feeding tube rubbing. I would also like to know the severity of a feeding tube rubbing a baby’s throat and causing bleeding. If a medical professional notes that a baby is bleeding due to a feeding tube rubbing, is that likely to constitute an emergency which requires immediate attention? Or is it something that whilst it needs to be looked at by a doctor, is something that can wait for a little while to be seen?

If a band six nurse could reasonably have concluded that a feeding tube rubbing could have caused the bleeding, and a feeding tube rubbing and causing bleeding does not constitute an emergency situation requiring immediate attention, then whilst LL comes across as somewhat uncaring and unprofessional by not immediately cleaning the blood off of the baby’s face, her inaction arguably looks less suspicious.

If, however, a band six nurse, encountering that level of bleeding could not reasonably have concluded that the feeding tube was causing the bleeding, meaning that there was some other unknown cause, then the fact that L L allegedly, told the mother not to worry because it was just a feeding tube rubbing looks much more suspicious. Equally, even if it could have been a feeding tube rubbing, if a feeding tube rubbing the throat enough to cause bleeding would constitute an emergency, then LL’s alleged inaction looks very suspicious.
JMO, as always.

A neonatal nurse would be very experienced with ng tubes and would know whether they rub or not.

But if she thought that was the case ...even though imo extremely unlikely..why did she not record it as that in her notes?
And why did she move the bleeding along almost an hour in her notes...and not mention the mum being present and her concern