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

[Tortoise]

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.

I would say it is never appropriate for a nurse to diagnose the cause of an internal bleed or to decide if it constitutes an emergency whatever she thinks. The fact she told the mum, according to the mum's testimony, that she'd already notified the doctor and he was on his way shows she was aware of what she was meant to do, but didn't. JMO

 

[esther43]

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<modsnip: Quoted post was removed>

Hi. So from experience of daughter being given insulin in neonatal care the procedure involved in infusion has a number of steps.
1. Machinery. - designated nurse needs to get a special piece of equipment from equipment room to administer the infusion.
2. The insulin comes in a special cartridge that fits with the machine. This machine can't be used for other things e.g administering a standard tpn.
3. Two staff members need to sign for the drugs. There was no other baby recieving insulin that day. So there was (a) no need for a machine (b) no need for insulin.
4. The machine itself has a computerised system which monitors how much insulin is administered and when.
5. There are no medical notes that say 'insulin infused'

If this was an error, it would have to be a deliberate cover up of an error, that later framed LL. IMO that would be unlikely but obviously not impossible.

 

[Becci]

Sure i read at the beginning that LL thought the bag weren't what it seems & wanted it kept aside or something on them lines. (In police interview) ?
Or was that mentioned for the nxt insulin case coming up? Ty

 

[MsBetsy]

Sure i read at the beginning that LL thought the bag weren't what it seems & wanted it kept aside or something on them lines. (In police interview) ?
Or was that mentioned for the nxt insulin case coming up? Ty

Yes, when they asked about the bag she said something like, 'maybe it wasn't what we thought it was.'

She also agreed that the insulin could not have been administered in error and asked them if they had access to the bag.

 

[FoxyLoxy1]

Honestly this case is just highlighting to me how inept and dangerous the entire ward was.

 

[squish]

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

I suspect the nurses aren't being clear because they don't want to admit they re-used a bag.

 

[Sweeper2000]

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

“Medical expert Dr Dewi Evans said he believed the deterioration of Child N "was consistent with some kind of inflicted injury which caused severe pain".

Dr Sandie Bohin said such a profound desaturation followed by a rapid recovery, in the absence of any painful or uncomfortable procedure, suggested an inflicted painful stimulus.

She said – “this is life threatening. He was also noted to be … ‘screaming’ and apparently cried for 30 minutes. This is most unusual. I have never observed a premature neonate to scream”

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

I definitely think whatever happened to child E would probably be enough to cause a desat If it did happen. I also don’t think LL would have tried to hide that. Indeed in most cases when alone with a baby needing care she actually does summon help.

I absolutely do not think the baby would have to be dying for a doctor to notice at least one thing that would indicate either a wound or a potentially mortal wound is present. Rather than describe a Babies presentation as “undramatic”.

 

[Imogenia]

I suspect the nurses aren't being clear because they don't want to admit they re-used a bag.

The nurses would have to be extremely clear, and admit what they truthfully remember, because someone is on trial for murder.

Within healthcare practice, it is a general legal truism that, if something is not written or recorded, (when it should have been), then it did not happen.

Where are the intravenous fluid record sheets containing the identification details of the new bag? These are legal documents and should ultimately be filed into the patient’s case notes.

Confusing Insulin and Heparin With Disastrous Results (a Preventable Error).

Safety alerts have been issued previously regarding a TPN bag for neonates, accidentally containing insulin instead of heparin.

We should learn from mistakes in 2007.

Nurses and Doctors Need to Act Decisively and Swiftly.

If a baby becomes and resolutely remains hypoglycaemic while on TPN, despite efforts to increase the blood sugar, the safety alert in the supplied link suggests stopping the TPN (while obviously still addressing the hypoglycaemia).

According to the warning, the hypoglycaemia will not resolve until the TPN bag containing insulin is stopped.

The TPN bag and contents should be analysed professionally at a lab.

Human Error.

Apparently, heparin and insulin can be confused (or were in the safety report issued) because of similarities in colour of vials, or due to a ‘mental slip’ causing a human error, maybe because both drugs are measured in units.

https://www.nj.gov/health/healthcarequality/documents/ps/ps_alert_april07.pdf

 

[Tortoise]

“Medical expert Dr Dewi Evans said he believed the deterioration of Child N "was consistent with some kind of inflicted injury which caused severe pain".

Dr Sandie Bohin said such a profound desaturation followed by a rapid recovery, in the absence of any painful or uncomfortable procedure, suggested an inflicted painful stimulus.

She said – “this is life threatening. He was also noted to be … ‘screaming’ and apparently cried for 30 minutes. This is most unusual. I have never observed a premature neonate to scream”

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

I definitely think whatever happened to child E would probably be enough to cause a desat If it did happen. I also don’t think LL would have tried to hide that. Indeed in most cases when alone with a baby needing care she actually does summon help.

I absolutely do not think the baby would have to be dying for a doctor to notice at least one thing that would indicate either a wound or a potentially mortal wound is present. Rather than describe a Babies presentation as “undramatic”.

Baby N desaturating because of inflicted injury or an injection of air, does not mean baby E would have desaturated because of an inflicted injury. That's a misunderstanding of the evidence.

Dr Bohin cited the desaturation as evidence of a life-threatening event in the case of baby N.

Neither Dr Evans nor Dr Bohin described baby E's bleed at 9pm, witnessed by the mother, as a life-threatening event or that it would have been accompanied by a desaturation, and I'd rather rely on the experts' opinions.

Baby N:

"Independent medical experts said the baby’s sudden deterioration was consistent with some kind of "inflicted injury" or him having received an injection of air."
Who are the children alleged to have been murdered by Lucy Letby? | ITV News

Independent medical experts said this was "consistent with inflicted injury or having received an injection of air", jurors were told.
Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins

Baby E:

The doctor did notice blood had been aspirated when he was called about 45 minutes to an hour after the mum left, and he queried a gastric bleed.


JMO

 

[Tortoise]

The nurses would have to be extremely clear, and admit what they truthfully remember, because someone is on trial for murder.

Within healthcare practice, it is a general legal truism that, if something is not written or recorded, (when it should have been), then it did not happen.

Where are the intravenous fluid record sheets containing the identification details of the new bag? These are legal documents and should ultimately be filed into the patient’s case notes.

Confusing Insulin and Heparin With Disastrous Results (a Preventable Error).

Safety alerts have been issued previously regarding a TPN bag for neonates, accidentally containing insulin instead of heparin.

We should learn from mistakes in 2007.

Nurses and Doctors Need to Act Decisively and Swiftly.

If a baby becomes and resolutely remains hypoglycaemic while on TPN, despite efforts to increase the blood sugar, the safety alert in the supplied link suggests stopping the TPN (while obviously still addressing the hypoglycaemia).

According to the warning, the hypoglycaemia will not resolve until the TPN bag containing insulin is stopped.

The TPN bag and contents should be analysed professionally at a lab.

Human Error.

Apparently, heparin and insulin can be confused (or were in the safety report issued) because of similarities in colour of vials, or due to a ‘mental slip’ causing a human error, maybe because both drugs are measured in units.

https://www.nj.gov/health/healthcarequality/documents/ps/ps_alert_april07.pdf

Baby F wasn't on Heparin or Insulin. I'm not sure what that has to do with this trial.

 

[Sweeper2000]

Baby N desaturating because of inflicted injury or an injection of air, does not mean baby E would have desaturated because of an inflicted injury. That's a misunderstanding of the evidence.

Dr Bohin cited the desaturation as evidence of a life-threatening event in the case of baby N.

Neither Dr Evans nor Dr Bohin described baby E's bleed at 9pm, witnessed by the mother, as a life-threatening event or that it would have been accompanied by a desaturation, and I'd rather rely on the experts' opinions.

Baby N:

"Independent medical experts said the baby’s sudden deterioration was consistent with some kind of "inflicted injury" or him having received an injection of air."
Who are the children alleged to have been murdered by Lucy Letby? | ITV News

Independent medical experts said this was "consistent with inflicted injury or having received an injection of air", jurors were told.
Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins

Baby E:

The doctor did notice blood had been aspirated when he was called about 45 minutes to an hour after the mum left, and he queried a gastric bleed.


JMO

interesting. Any ideas on why they don’t consider an injury that has supposedly caused a loss of a quarter of that babies blood, as life threatening or an inflicted painful stimulus?

 

[esther43]

Yes, when they asked about the bag she said something like, 'maybe it wasn't what we thought it was.'

She also agreed that the insulin could not have been administered in error and asked them if they had access to the bag.

In one of the cases (can't remember if child F?) LL said she requested after a shift that a bag was 'kept' but it later transpired that there was no record of this discussion.

 

[Tortoise]

interesting. Any ideas on why they don’t consider an injury that has supposedly caused a loss of a quarter of that babies blood, as life threatening or an inflicted painful stimulus?

The blood was lost gradually over three to four hours, we're specifically talking about when it first happened, at 9pm, not after further losses.

 

[Tortoise]

In one of the cases (can't remember if child F?) LL said she requested after a shift that a bag was 'kept' but it later transpired that there was no record of this discussion.

Her comment was in relation to baby A's IV fluids bag.

 

[esther43]

Her comment was in relation to baby A's IV fluid bag.

Thanks Tortoise!
I wonder why she forwarded that as a suggestion in relation to child A?

 

[Sweeper2000]

The blood was lost gradually over three to four hours, we're specifically talking about when it first happened, at 9pm, not after further losses.

I know but im not sure an injury that significant wouldnt be deemed an inflicted painful stimulus. The baby would have been bleeding out when checked by the doc around ten but nothing to suggest the presence of a significant injury noted by him. Not even a patch of redness or bruise, a seemingly content baby.

 

[sapphireminds]

I think people are getting some of the babies mixed up - It's very easy to do, since they don't have "names" and there are several accusations are very similar to each other.

 

[MsBetsy]

I know but im not sure an injury that significant wouldnt be deemed an inflicted painful stimulus. The baby would have been bleeding out when checked by the doc around ten but nothing to suggest the presence of a significant injury noted by him. Not even a patch of redness or bruise, a seemingly content baby.

I don't think there was a significant amount of blood loss at 10:00 pm. The bleeding occurred over a period of two and a half hours but at what point did they diagnose the internal injury?

 

[Tortoise]

Her comment was in relation to baby A's IV fluids bag.

Just thought I'd attach the quote in case anyone thought I was mixing up the babies.


"When interviewed by police regarding the circumstances over Child A's death, Letby said she had given fluids to Child A at the time of the change of shifts.
She said within "maybe" five minutes, Child A developed 'almost a rash appearance, like a blotchy red marks on the skin'.
She said she had wondered whether the bag of fluid "was not what we thought it was".
In an interview in June 2019, Letby said she had asked for all fluids to be kept from the bag at the end to be checked, but the prosecution said there was was no record of her having made such a request.
It was suggested by police that Letby had administered an air emolus. She replied it would have been very hard to push air through the line."
Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders

 

[Sweeper2000]

I don't think there was a significant amount of blood loss at 10:00 pm. The bleeding occurred over a period of two and a half hours but at what point did they diagnose the internal injury?

Only the pathologist recognised the injury to the liver, but could be from the resus.