UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #8

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mart321

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Just to backtrack a bit. With Baby F and the insulin test that was sent to Liverpool and came back sky high.

Was there a reason given, why this wasnt further investigated at the time, as this seems like it could have been a missed opportunity.
 

katydid23

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Two staff in rooms with unattended babies seems reasonable. There are not many babies in these neonatal units, and they are so vulnerable. There should at least be someone keeping an eye on the cameras if only one nurse is present.

It would safeguard not only the babies, but the staff members against possible accusations, so everyone benefits.
I agree it seems reasonable. But it probably doubles the payroll at the same time, which could be problematic.

I do agree that they should have someone watching the cameras though. That seems more doable. And if a child does suddenly have a problem, there are ways to quickly see what was going on. JMO

And I agree that it does protect the medical staff as well.
 

Whitehall 1212

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And I agree that it does protect the medical staff as well.

What it doesn't do though is protect the NHS from negligence claims and worse.

Only this week BBC Newsnight have been reporting on significant issues at University Hospitals Birmingham NHS Foundation Trust, where it is alleged there is a climate of fear caused by senior management towards medical staff who highlight serious concerns.

I can guarantee that the NHS do not like their dirty laundry washed in public.....it's the broken culture which is pervasive.

Therefore, any suggestion of a system that would support evidence of clinical error, negligence, malpractice or criminality would not be supported by the powers that be.

 

magikarpmagikarp

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Feeding tubes for neonates usually have a priming volume (the amount of liquid held within the tube) of 1mL or less. You can search for Medela feeding tubes; this is a common type.

Milk is given through the tube using a syringe, either by gravity flow, by using the syringe plunger, or using a syringe pump.

If milk or large amounts of air were given illegitimately, it would be easiest to do by using a plunger. Pushing it in fast might cause vomiting.
 

Tortoise

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That is very true. I was assuming the milk wouldnt be seen as it would be in the tube inside of the body and out of sight, which it could of well been, but depending on how much the actualy tube can hold then it could be visible too. From a brief search there are different kinds of tubing for the neonatal NG tubes, so some might be a little wider and hold more?

The video explaining the tube feeding is called Understanding feeding tubes and was posted by Children's Wisconsin on youtube. The specific part about Neonatal NG feeding starts at 1:07 minutes
On second thoughts I don't think the tube can hold 45mls because if the milk is all in the syringe to start with, when the feed is first started the tube fills and starts delivering milk into the stomach, but most of the milk is still seen in the syringe.

Going back to my original point, if the registrar and the consultant had been told that 45mls of milk was aspirated with loads of air after projectile vomiting, they would have known that she'd been given double her feed.

LL didn't write it in her nursing notes until the doctors had gone off shift, probably at a time when the day shift doctors were focused on her current status and not suspecting any discrepancy between nursing and clinical notes for the original event. LL withheld information from the doctors, imo.

Why would she not tell them, and why would she not have thought the designated nurse overfed her? Right there and then they could have had answers to why baby G vomited and stopped breathing.

I don't think it would wash with a 15 minute interval after the designated nurse went on her break, and baby G's monitor alarms going off 15 minutes later

The same thing happened a week later when LL fed her, after baby G returned from Arrowe Park.

MOO
 
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Tortoise

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Just to backtrack a bit. With Baby F and the insulin test that was sent to Liverpool and came back sky high.

Was there a reason given, why this wasnt further investigated at the time, as this seems like it could have been a missed opportunity.
the doctor's testimony -

10:34am

The first witness is a doctor who has previously given evidence in the trial, but cannot be named due to reporting restrictions.
She says she didn't have any direct treating care role for Child F.

10:42am

The doctor says the cortisol reading was 'normal', the insulin at a reading of 4,657 was "too high for a baby who has a low blood sugar".
The doctor says it would be expected, with a baby in low blood sugar, for insulin to stop being produced, so that would also be low.
The insulin c-peptide reading of 'less than 169' does not correlate with the insulin reading. The insulin and insulin-cpep readings would be 'proportionate' with each other.
The doctor says it was likely insulin was given as a drug or medicine, rather than being produced by Child F, to account for this insulin reading.
"This is something we found very confusing at the time," the doctor says, and said there weren't any other babies in the unit being prescribed insulin at that time, which would rule out "accidental administration".

10:43am

The doctor says there are "some medical conditions" where a low blood sugar reading would also see a high insulin reading, but the low insulin c-peptide reading meant those conditions would be ruled out.
The insulin reading was "physiologically inappropriate", the court hears.

10:45am

The doctor said those readings would be repeated, but as Child F's blood sugar levels had returned to normal by the time the test results came back several days later, there would be "no way" to repeat the test and expect similar results.

10:46am

The doctor tells the court that Child F had received 'rapid acting insulin' on July 31, but the effect of that insulin would have "long gone" by the time the hypoglycaemia episode was recorded on August 5.

10:47am

The clinical note added 'as now well and sugars stable, for no further [investigations].
"If hypoglycaemia again at any point for repeat screen."
The doctor says if Child F had any further episodes of low blood sugar, then the blood test would be carried out again.

10:50am

The prosecution ask if anything was done with this data.
The doctor says it was looked to see if anyone else at the time was prescribed insulin in the whole neonatal unit, for a possible 'accidental administration', but there were no other babies at that time. No further action was taken.

Cross-Examination

Ben Myers KC, for Letby's defence, asks to clarify that Child F's blood sugar had stabilised at that time. The doctor agrees.

Judge's Question

The doctor clarifies, on a question from the judge Mr Justice James Goss, that the scope of the 'insulin prescription' checks were made for August 4 and August 5.

LIVE: Lucy Letby trial, Thursday, November 24
 

Blondiexoxo

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I really want to hear more about what colleagues personally felt about LL asking them all these questions about the babies or if they had any suspicions when they were texting about her ‘bad luck’. Did they think that she was obsessing over certain babies - coincidentally the ones that ended up collapsing or dying. OR was she always obsessing over every baby and not just the ones in this case. I wonder if there were text messages pertaining to other babies not listed in the charges discussing their obs and asking her colleagues to update her while she was off shift.

Did her colleagues (mainly the ones she was texting) begin to notice a pattern themselves, surely they can’t have continued to put it down to just ‘bad luck’ each and every time. Were they discussing the unusual circumstances surrounding LL behind her back? Was it common knowledge on the ward that so many babies she had been in contact with ended up dying suddenly or becoming gravely ill with no prior sign of being unwell?

I would like to know if there were text messages sent between colleagues about her also. Were they discussing how it was strange, suspicious, or that her behaviour was a little erratic or obsessive? Or did they honestly believe it was just the luck of the draw and that LL was having a bad run?

Are the prosecution allowed to ask the other nurses about own thoughts at the time? Can they ask ‘did you feel that this was just a whole lot of ‘bad luck’ for LL?’ Or ‘was it unusual for LL to be texting you about what was happening at work or is this something she did regularly?’

IMO it would help if we knew how the people she worked with felt about the sudden rise in deaths, did they notice, did they think there was something nefarious going on? Did they notice that LL seemed to be hovering around on each occasion? We know that the one consultant had suspicions, but what about the nurses LL worked alongside and spoke to outside work, were they beginning to second guess LL? And at what point did they start to think ‘this is getting a little weird now’?

All MOO of course
 

crystalline

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Some interesting points. One thing that is bugging me a little is - The accused had a picture taken whereby they were holding a baby-grow. In the background there is a bag hanging up - is that a TPN bag? Now unless there were babies in the unit hooked up at the time of the picture being taken - is it normal for those bags to just be hanging up, I'm sure it is normal if it's just been disconnected for a little time while equipment is being changed etc. It just looks a little strange to me for some reason, maybe because it looks full. Do those bags have to be removed from the fridge a couple of hours before use maybe? If so how are they then stored, and where and who has access...

I think i may be getting the bags mixed up - TPN bags are milky colour?
 

Tortoise

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Some interesting points. One thing that is bugging me a little is - The accused had a picture taken whereby they were holding a baby-grow. In the background there is a bag hanging up - is that a TPN bag? Now unless there were babies in the unit hooked up at the time of the picture being taken - is it normal for those bags to just be hanging up, I'm sure it is normal if it's just been disconnected for a little time while equipment is being changed etc. It just looks a little strange to me for some reason, maybe because it looks full. Do those bags have to be removed from the fridge a couple of hours before use maybe? If so how are they then stored, and where and who has access...

I think i may be getting the bags mixed up - TPN bags are milky colour?
It looks like a clear saline drip to me. I'm not seeing any milky looking fluids if I'm looking at the same picture.
 

crystalline

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It looks like a clear saline drip to me. I'm not seeing any milky looking fluids if I'm looking at the same picture.
Yes I believe I got the bag colours confused - it's only the TPN bags they believe were spiked with the insulin isn't it.

Are these used straight from the fridge? I'm assuming they need to be kept at a certain temperature.
 
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Tortoise

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Yes I believe I got the bag colours confused - it's only the TPN bags they believe were spiked with the insulin isn't it.

Are these used straight from the fridge? I'm assuming they need to be kept at a certain temperature.
They're stored in the fridge but are administered at room temp if they are left up for 12 hours, I would think.
 

Tortoise

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I really want to hear more about what colleagues personally felt about LL asking them all these questions about the babies or if they had any suspicions when they were texting about her ‘bad luck’. Did they think that she was obsessing over certain babies - coincidentally the ones that ended up collapsing or dying. OR was she always obsessing over every baby and not just the ones in this case. I wonder if there were text messages pertaining to other babies not listed in the charges discussing their obs and asking her colleagues to update her while she was off shift.

Did her colleagues (mainly the ones she was texting) begin to notice a pattern themselves, surely they can’t have continued to put it down to just ‘bad luck’ each and every time. Were they discussing the unusual circumstances surrounding LL behind her back? Was it common knowledge on the ward that so many babies she had been in contact with ended up dying suddenly or becoming gravely ill with no prior sign of being unwell?

I would like to know if there were text messages sent between colleagues about her also. Were they discussing how it was strange, suspicious, or that her behaviour was a little erratic or obsessive? Or did they honestly believe it was just the luck of the draw and that LL was having a bad run?

Are the prosecution allowed to ask the other nurses about own thoughts at the time? Can they ask ‘did you feel that this was just a whole lot of ‘bad luck’ for LL?’ Or ‘was it unusual for LL to be texting you about what was happening at work or is this something she did regularly?’

IMO it would help if we knew how the people she worked with felt about the sudden rise in deaths, did they notice, did they think there was something nefarious going on? Did they notice that LL seemed to be hovering around on each occasion? We know that the one consultant had suspicions, but what about the nurses LL worked alongside and spoke to outside work, were they beginning to second guess LL? And at what point did they start to think ‘this is getting a little weird now’?

All MOO of course
We've heard from one nurse early on in the trial, about her thoughts at the time, but nothing about LL specifically

"Countess of Chester Hospital neonatal nurse assistant Lisa Walker said, in her agreed evidence statement, she was not working in the neonatal room 1, but knew it was "very busy" that night.
She said she could "recall the sadness in the atmosphere in the unit" that night.
She added she could recall an increase in the number of neonatal unit deaths at the time, and prior to that, in her 10 years, "there was only news of a couple of deaths".
She added: "I remember thinking, 'what on earth is happening?'" in relation to the increased number of neonatal unit deaths."

I think with the last three babies, E being her designated baby and F and G being other nurse's babies, we're starting to see that her note-keeping was not reflecting the events that have been reported by parents and doctors. I think her colleagues wouldn't have been aware that she was (allegedly) beginning to the hide really major information from the doctors - baby E's first bleeding from the mouth, baby F's low blood sugar reported by LL as improving so he wasn't checked for the next three hours, and baby G's over-feeding.

All MOO
 

Tortoise

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A little schedule showing the room numbers and designations on the cases heard so far in the trial -

8 Jun 2015 - Twin Baby A - murder charge - boy - night – room 1 - designated nurse
10 Jun 2015 - Twin Baby B - attempted murder charge – girl - night – room 1 - not designated nurse – LL room 3
Handover sheet for Baby B found at LL’s home during police search
14 Jun 2015 - Baby C - murder charge – boy - night – room 1 - not designated nurse – LL room 3
22 Jun 2015 - Baby D - murder charge - girl- night – room 1 - not designated nurse – LL room 1
4 Aug 2015 - Twin Baby E - murder charge - boy - night – room 1 - designated nurse
5 Aug 2015 - Twin Baby F - attempted murder charge - boy - night – room 2 - not designated nurse – LL room 2
7 Sep 2015 - Baby G - attempted murder charge – girl - night – room 2 - not designated nurse – LL room 1
 

ColourPurple

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A little schedule showing the room numbers and designations on the cases heard so far in the trial -

8 Jun 2015 - Twin Baby A - murder charge - boy - night – room 1 - designated nurse
10 Jun 2015 - Twin Baby B - attempted murder charge – girl - night – room 1 - not designated nurse – LL room 3
Handover sheet for Baby B found at LL’s home during police search
14 Jun 2015 - Baby C - murder charge – boy - night – room 1 - not designated nurse – LL room 3
22 Jun 2015 - Baby D - murder charge - girl- night – room 1 - not designated nurse – LL room 1
4 Aug 2015 - Twin Baby E - murder charge - boy - night – room 1 - designated nurse
5 Aug 2015 - Twin Baby F - attempted murder charge - boy - night – room 2 - not designated nurse – LL room 2
7 Sep 2015 - Baby G - attempted murder charge – girl - night – room 2 - not designated nurse – LL room 1

Oh wow so the night where she texted saying how much she needed to be back in room 1, to help her deal with Baby A's death, Baby C was in room 1. Then 20 minutes after the text exchange Baby C collapsed in room 1 and later died, and LL is accused of killing Baby C in the same room as she allegedly killed Baby A, and tried to kill Baby B in just days earlier. If guilty, this suggests that rather than needing to go back in room 1 to help her get over Baby A's death, she may have actually wanted to go back in there to relive it!

And then all the other charges happen in that same room, room 1, up until Baby F who's in room 2 (but twin of Baby E who died in room 1 the day before) then the next charge is alleged to have occurred in room 2 too.
 

Kemug

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8 Jun 2015 - Twin Baby A - murder charge - boy - night – room 1 - designated nurse
10 Jun 2015 - Twin Baby B - attempted murder charge – girl - night – room 1 - not designated nurse – LL room 3
Handover sheet for Baby B found at LL’s home during police search
14 Jun 2015 - Baby C - murder charge – boy - night – room 1 - not designated nurse – LL room 3
22 Jun 2015 - Baby D - murder charge - girl- night – room 1 - not designated nurse – LL room 1
4 Aug 2015 - Twin Baby E - murder charge - boy - night – room 1 - designated nurse
5 Aug 2015 - Twin Baby F - attempted murder charge - boy - night – room 2 - not designated nurse – LL room 2
7 Sep 2015 - Baby G - attempted murder charge – girl - night – room 2 - not designated nurse – LL room 1
Wow! So in these 7 cases of murder/attempted murder, LL was the designated nurse in only 2 of them. My mental gymnastics tell me that's about 29%. Which tells me that either she is innocent, or she is a very busy girl, flitting in and out to interfere with other nurses' designated babies. If the latter, then either it is to avoid suspicion of herself, and/or to put suspicion onto other nurses.
Edited to add: Or, just because she saw a chance and took it. :(
 

Observe_dont_Absorb

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Wow! So in these 7 cases of murder/attempted murder, LL was the designated nurse in only 2 of them. My mental gymnastics tell me that's about 29%. Which tells me that either she is innocent, or she is a very busy girl, flitting in and out to interfere with other nurses' designated babies. If the latter, then either it is to avoid suspicion of herself, and/or to put suspicion onto other nurses.
Edited to add: Or, just because she saw a chance and took it. :(

Or there’s something very specific to room 1 - if so, what could it be ? I would like to know what the possible differences are in all aspects.
 

Observant-ADHD-ENFP-BSc

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A little schedule showing the room numbers and designations on the cases heard so far in the trial -

8 Jun 2015 - Twin Baby A - murder charge - boy - night – room 1 - designated nurse
10 Jun 2015 - Twin Baby B - attempted murder charge – girl - night – room 1 - not designated nurse – LL room 3
Handover sheet for Baby B found at LL’s home during police search
14 Jun 2015 - Baby C - murder charge – boy - night – room 1 - not designated nurse – LL room 3
22 Jun 2015 - Baby D - murder charge - girl- night – room 1 - not designated nurse – LL room 1
4 Aug 2015 - Twin Baby E - murder charge - boy - night – room 1 - designated nurse
5 Aug 2015 - Twin Baby F - attempted murder charge - boy - night – room 2 - not designated nurse – LL room 2
7 Sep 2015 - Baby G - attempted murder charge – girl - night – room 2 - not designated nurse – LL room 1
I see a pattern, I think.
Five out of seven times, for both charges she was assigned to the room in which the alleged charges took place, even when not the designated nurse. LL was still assigned to these room. The other two times she was assigned to a different room and thus not a designated nurse. These two charges are for Baby B and Baby C both in Room 1, while LL was assigned to Room 3 both times.
Room 3 is the quieter calm room where most babies are almost ready to go home, its almost like a nursery someone might have in a home. The nurses dont really go in unless there is some routine work going on and to care for the baby. Someone please correct me if I am wrong but I think I remember reading one of the text messages Mentioning room 3 being "boring"?
Plus, when police searched her home they found the handover sheet for Baby B.
This period between Baby B and C may be a more frenzied period? Taking sheets home and going into rooms she is not assigned to. Could there possibly be some anger for being assigned to Room 3 too?
This is of course all my opinion but I saw a pattern and even made a Venn diagram! I'm hoping someone else might see a pattern too.
 
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