UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #12

[WaxLyrical]

Your comment about mixing the bags is 100% correct.
The higher concentration fluid - 50% glucose - comes in glass bottles. They have a rubber top so you withdraw using a needle & syringe. It's stored in a drug cupboard normally, though I can't speak for CoC of course.
You withdraw what you need then discard. (If 2 babies happened to need it at the same time you could use the same bottle, obviously).
IMO putting insulin in this wouldn't be something anybody would do. Apart from anything else, the baby would have to be significantly hypogycaemic already for 50% glucose to be used. And I have a feeling the rubber cap is covered with a metal ring pull in any case, though I might be making that up! (I retired 7 years ago).

Thank you.

Ok so the 50% solution is discarded pretty much immediately, so the insulin must have been in the 10% bags to start with then (at least for the 3rd bag anyway).

To clarify, I wasn’t suggesting the 50% solution contained insulin by accident, more questioning whether it would be “less risky” to poison that one container, than poison a selection of 10% bags. But anyway, sounds like it’s not just one container of 50%, so that puts an end to that theory! JMO.

 

[JosieJo]

What do you suppose the medical mechanism of vomiting killing the baby was?

The prosecution case is splinted diaphragm causing oxygen deprivation..

 

[sapphireminds]

The prosecution case is splinted diaphragm causing oxygen deprivation..

That's the problem I have - even if you have splinting of the diaphragm, it would not be lethal unless the baby in distress was completely ignored and untreated. Aspiration of the stomach is also routine part of resuscitation - which would resolve the pressure on the diaphragm.

When babies get massively distended, they can definitely have trouble breathing, which is why we might intubate them to help them, but the distension is not typically fatal - that mechanism of injury doesn't make sense medically to me.

 

[GoodDayToYouSir]

Just going back to baby F and the issue of whether there were one or two bags of TPN: I know that what we’ve had so far is that it seems that there should have been two bags because the prosecution witnesses say that practice was to change the bag. And we know that LL was not on shift for the second bag change.

Obviously, there are various possibilities, including that the bag was never changed, and that someone had pre-poisoned all the TPN bags in the fridge, and indeed that the bags were poisoned before they even got to the ward.

But just to explore the theory that there were two bags and they were poisoned almost immediately before they were hooked up to baby F: we know LL wasn’t on shift for the second bag change. But was there another member of staff who was on shift for both the first and the second bag changes, assuming there were two back changes?

Because it occurred to me that given the way shift patterns run, how possible is it that there was someone on shift for both the bag changes? Unless someone was putting in a back to back double shift, presumably there wouldn’t be any one ? @marynnu perhaps one for you to answer , if you’d be so kind

 

[marynnu]

Just going back to baby F and the issue of whether there were one or two bags of TPN: I know that what we’ve had so far is that it seems that there should have been two bags because the prosecution witnesses say that practice was to change the bag. And we know that LL was not on shift for the second bag change.

Obviously, there are various possibilities, including that the bag was never changed, and that someone had pre-poisoned all the TPN bags in the fridge, and indeed that the bags were poisoned before they even got to the ward.

But just to explore the theory that there were two bags and they were poisoned almost immediately before they were hooked up to baby F: we know LL wasn’t on shift for the second bag change. But was there another member of staff who was on shift for both the first and the second bag changes, assuming there were two back changes?

Because it occurred to me that given the way shift patterns run, how possible is it that there was someone on shift for both the bag changes? Unless someone was putting in a back to back double shift, presumably there wouldn’t be any one ? @marynnu perhaps one for you to answer , if you’d be so kind

I don't think anybody could be on shift for both bag changes as the first was put up by the night staff, LL being one of them, and the 2nd in the afternoon I believe.

 

[GoodDayToYouSir]

I don't think anybody could be on shift for both bag changes as the first was put up by the night staff, LL being one of them, and the 2nd in the afternoon I believe.

Thanks very much indeed.

Because it seems one way to help resolve the issue of whether there was one bag or two is to see if any member of staff was on duty at both hypothetical bag changes. If no one was , then the whole theory of someone on the ward poisoning the bags immediately before administration falls away.

So the jury can then decide which is the most plausible explanation from:

1) random pre poisoning of all bags in fridge
2) Poisoning before the bags reached the ward
3) There was only ever one TPN bag given to baby F.

As an aside, I would really love to see that table, the prosecution prepared showing all the collapses and listing each member of staff who was on duty at the time of each collapse.

 

[katydid23]

They have excluded anything but active murder as the cause in their reports. They acknowledge on cross examination, but when presenting to the court initially, they are not mentioning things that disagree with their findings.

I think they are also looking at the big picture and the overall pattern of the surge in unexplained collapses.

Once we look at some of the cases being potentially malicious attacks, that makes the other ones even more likely to be the same. Especially when we take into account some of the damning coincidences.

Like the two sets of twins, having mirror image incidents. >>>Back to back collapses, one from insulin poisoning and the other from an unexplained AE. Two sets of twins born in the same hospital with identical strange occurrences.

And in another incident, she had been on vacation for 8 days----no unexplained collapses in that time.

The very day she returned there were THREE unexplained collapse, three nights in a row---babies O, P and Q. Those were the final 3 before she was taken off the floor.

<modsnip: sub judice>

 

[marynnu]

Thanks very much indeed.

Because it seems one way to help resolve the issue of whether there was one bag or two is to see if any member of staff was on duty at both hypothetical bag changes. If no one was , then the whole theory of someone on the ward poisoning the bags immediately before administration falls away.

So the jury can then decide which is the most plausible explanation from:

1) random pre poisoning of all bags in fridge
2) Poisoning before the bags reached the ward
3) There was only ever one TPN bag given to baby F.

As an aside, I would really love to see that table, the prosecution prepared showing all the collapses and listing each member of staff who was on duty at the time of each collapse.

All JMO.

If I had to guess, I'd opt for no bag change. This is fine for ordinary IV infusions but not for long lines, as these have to be treated as sterile. To be fair, the staff probably can't remember for certain after so long. I've rambled on about this for what seems like a decade, but if a stock bag were started there surely has to be a record as all meds & infusions have to be prescribed. IMO no such record exists as you'd think this would have been produced by now.

 

[JosieJo]

That's the problem I have - even if you have splinting of the diaphragm, it would not be lethal unless the baby in distress was completely ignored and untreated. Aspiration of the stomach is also routine part of resuscitation - which would resolve the pressure on the diaphragm.

When babies get massively distended, they can definitely have trouble breathing, which is why we might intubate them to help them, but the distension is not typically fatal - that mechanism of injury doesn't make sense medically to me.

It wasn't fatal?

 

[katydid23]

Personally I feel the projectile vomiting charge is one of the strongest second to the insulin cases

Bowel problems were ruled out

Aspiration had been occurring regularly with no problems.

The stomach was aspirated prior to being given 40 ml via gravity

A small amount was aspirated to test PH so unlikely a problem with tube

The pH of the aspirate prior to the feed indicated no milk residue

The vomit was so severe the baby crashed.

Despite not being able to accurately measure the vomit ..it was enough to travel.to the chair and floor and still aspirate the original 40 ml.

<modsnip: sub judice>

I agree, partly because the jury will be able to understand this one pretty well. Many of them will have been parents or aunts/uncles or older siblings and would have experience with bottle feeding. I think they will understand the concept of overfeeding. It is very logical.

And most of us know the difference between vomiting and severe projectile vomiting. My children did projectile vomit a few memorable times----but never as total newborns.

 

[sapphireminds]

It wasn't fatal?

For it to be considered an attempted murder, it would need to have the potential to be fatal.

 

[ColourPurple]

All JMO.

If I had to guess, I'd opt for no bag change. This is fine for ordinary IV infusions but not for long lines, as these have to be treated as sterile. To be fair, the staff probably can't remember for certain after so long. I've rambled on about this for what seems like a decade, but if a stock bag were started there surely has to be a record as all meds & infusions have to be prescribed. IMO no such record exists as you'd think this would have been produced by now.

And presumably as they hadn't received another bespoke bag at that point, it would make sense to keep the original bespoke bag up rather than swap it for a stock bag that hadn't been made up to baby F's specifications.

 

[Supernovae]

For it to be considered an attempted murder, it would need to have the potential to be fatal.

Not to say that it's relevant in this case but legally that's not necessarily true so long as a perpetrator thought and intended it to be fatal. In any case I would be surprised if the jury aren't offered section 18 GBH as an alternative.

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[JosieJo]

For it to be considered an attempted murder, it would need to have the potential to be fatal.

Absolutely...but we were discussing the cause of the collapse.
Then we have ..did LL consider it potentially fatal or a reasonable person.

Add on the fact that potentially her actions..albeit various methods..did cause death ..yet she potentially went on on to "sabotage" other babies.

Plenty of food for thought for jury imo

 

[katydid23]

For it to be considered an attempted murder, it would need to have the potential to be fatal.

Are we discussing baby G?

Accused killer nurse Lucy Letby allegedly force-fed baby ‘massive’ amounts of milk

Accused serial killer nurse Lucy Letby allegedly tried to kill a premature baby girl by force-feeding her “massive” amounts of milk through a nasal tube, a UK court has heard.

nypost.com

Accused serial killer nurse Lucy Letby allegedly tried to murder a premature baby girl by force-feeding her “massive” amounts of milk through a nasal tube, a UK court has heard.

Letby, 32, is accused of overfeeding the sick baby — known only as Child G — while watching over her in the Countess of Chester Hospital’s neonatal unit in September 2015, the BBC reported.

In the early hours of Sept. 7, Breary said, he received an emergency call because the baby had “very large projectile vomit” that landed on the floor and a chair next to her crib.

“For a baby of 2kg [4.4 pounds] to vomit that far is quite remarkable. Even more astonishing is the vomit that ends up on the chair. That is several feet away,” he told the court.

The baby’s health rapidly declined in the wake of the vomiting — and she had to be intubated and placed on a ventilator.

Evans said the only explanation was that Child G “had received far more milk” than the approved 45mls [1.5 ounces] in her feeding tube, adding that it “cannot occur accidentally.”

The baby survived but was left with irreversible brain damage in the wake of the ordeal, the court heard.


She may not have died but she was left with irreversible brain damage. <modsnip: Opinions of guilt or innocence are sub judice>

 

[sapphireminds]

Are we discussing baby G?

Accused killer nurse Lucy Letby allegedly force-fed baby ‘massive’ amounts of milk

Accused serial killer nurse Lucy Letby allegedly tried to kill a premature baby girl by force-feeding her “massive” amounts of milk through a nasal tube, a UK court has heard.

nypost.com

Accused serial killer nurse Lucy Letby allegedly tried to murder a premature baby girl by force-feeding her “massive” amounts of milk through a nasal tube, a UK court has heard.

Letby, 32, is accused of overfeeding the sick baby — known only as Child G — while watching over her in the Countess of Chester Hospital’s neonatal unit in September 2015, the BBC reported.

In the early hours of Sept. 7, Breary said, he received an emergency call because the baby had “very large projectile vomit” that landed on the floor and a chair next to her crib.

“For a baby of 2kg [4.4 pounds] to vomit that far is quite remarkable. Even more astonishing is the vomit that ends up on the chair. That is several feet away,” he told the court.

The baby’s health rapidly declined in the wake of the vomiting — and she had to be intubated and placed on a ventilator.

Evans said the only explanation was that Child G “had received far more milk” than the approved 45mls [1.5 ounces] in her feeding tube, adding that it “cannot occur accidentally.”

The baby survived but was left with irreversible brain damage in the wake of the ordeal, the court heard.


She may not have died but she was left with irreversible brain damage. Sounds like Attempted Murder to me.

Correct - which is why I was critiquing its method of being fatal. The other user pointed out that technically the baby survived. Yes. But the mechanism of action is still not there for me.

 

[katydid23]

Correct - which is why I was critiquing its method of being fatal. The other user pointed out that technically the baby survived. Yes. But the mechanism of action is still not there for me.

Where do you think the irreversible brain damage came from? The medical experts believed it was from the aftermath from her collapse. She had to be intubated and placed on a ventilator. She was very weak and never fully recovered.

She was being fed through the nose. Is it impossible that someone overfed her?

 

[JosieJo]

Correct - which is why I was critiquing its method of being fatal. The other user pointed out that technically the baby survived. Yes. But the mechanism of action is still not there for me.

Well we will see if the defence come up with something around this as our opinions are not what the Jury will make their decision on

 

[Tortoise]

For it to be considered an attempted murder, it would need to have the potential to be fatal.

This is not true under British law.

 

[katydid23]

Well we will see if the defence come up with something around this as our opinions are not what the Jury will make their decision on

I think the jurors will go more upon common sense than technical medical expertise.

In my non-medically educated sense of things, if someone purposely grossly overfeeds a tiny newborn so much that they projectile vomit, have to be intubated and ventilated and they never recover, and have irreparable brain damage-----that is attempted murder. And I would have to look at their caregivers as the potentially guilty parties. JMO