Letby Case (part 2)

[OneFrenchEgg]

www.mumsnet.com/talk/_chat/4652340-lucy-letby-court-case?reply=121815754

follow up, remember rules around discussion of active cases

If the TPN was changed (as the nurse who testified said it would have been) shouldn't it have been put in the notes, or is it just assumed that if the line was changed because it tissued, then the TPN would automatically be changed?

Also do the TPN bags have numbers? So if they did change the bad would they have to note the number down?

And the original bag was signed for by 2 nurses, so would the second bag then have to be signed for by 2 nurses?

I suppose this all happened so long ago, no one can actually remember, and can only go by the notes. But, if the notes aren't very thorough, then we have no idea whether the bag was actually changed or not!!

I'm leaning towards that the bag was not changed hence baby F deteriorating again, but it's not beyond reasonable doubt.

Any change in fluids should be prescribed by a doctor. It should also be noted on the baby's fluid chart.

I was a nurse for 37 years, 31 on neonatal, and definitely wouldn't have known till this case!

That’s good to know. The push for specialisms means we can get really siloed can’t we?

I learnt something the other day that was so basic I’m embarrassed to admit it but honestly I’m so deep into my area I just didn’t know!!

I suppose that's true, but I don't think I ever knew to be honest. Having said that, I've never heard the expression 'siloed' either, so that might just be me. 😁 (I understand it means pigeonholed!!).

@NNUJan this is why I'm wondering if this lack of knowledge might be what trips up a person who would misuse insulin. Obviously I don't want to get a post deleted but think it might be significant.

I agree. The problem is, it doesn't in itself point to one individual. I think the similar case, Child L, might be clearer.

I knew about the tests for synthetic and natural insulins but I've watched a documentary on Beverley Allitt and I am sure it's been mentioned in some old American forensics show too. Going by previous posters, the insulin info doesn't appear to be common, or certainly not universal, knowledge

If someone was planning to poison someone with insulin would you not have expected them to have researched it and found this type of thing out though?

If we accept the evidence so far that the insulin wasn't accidentally given then it was either a thought out and researched method to cause harm or possibly an impulsive act. This is something that we might never know. Still nothing concrete to link LL yet. It's such a mess. The poor families. I hope they get answers.

Possibly. I was also just thinking, they have all LL's electronic records because of the Facebook searches presented, so if LL had done any relevant Google searches about insulin effects, air embolisms, previous poisoning cases etc. I'm sure we would have hear about it in the opening.

I think most people would think it was undetectable because you naturally make insulin. I don't think many people would research natural Vs synthetic insulin unless that was their specialism/area of interest. Its something everyone has heard of and would probably think would be the perfect way to hurt someone without it being noticed.
Tbh I think injecting air would probably be similar. People know enough to know it's dangerous, but not if it can be found out.

Whether or not the acts were deliberate and who did them if so is another question though

People know all sorts of weird and wonderful things nowadays that would previously have been considered 'specialist knowledge' from watching Netflix-type documentaries about criminal investigations

Wasn't it presented early in the trial that LL had watched a documentary about air embolism? it was in a text? Agree that if there was evidence of her researching insulin poisoning it would probably have been made known before now.

But LL isn't 'most people' she's surely a smart woman with a degree and specialist training - and murderous HCPs have been caught before now presumably by comparing the 2 types of insulin which would be a warning to any intelligent person that it's not the perfect murder weapon?

I do agree tho' that linking LL to the insulin overdose is a tricky particularly if the 2 contaminated bags theory is to be believed as she must have tampered with the 2nd bag from home! What's more are there any staff on duty at midnight and also at midday?

.

I'm not sure you would. You'd have to suspect there was something to research in the first place.

I think most people would think it was undetectable because you naturally make insulin. I don't think many people would research natural Vs synthetic insulin unless that was their specialism/area of interest.

Granddaughter of a type 1 diabetic so some small knowledge but even I knew this. A nurse would know this, surely.

I agree. We need a rationale for the second bag.

Hello. Retired midwife of 20 years. To be perfectly honest. We can all sit and try and pick this case apart. But from what I've seen, in practice, in a changing and extremely challenged NHS, it could be highly possible that this is either extreme negligence, incompetence, or deliberate foul play. I think it is quite unthinkable to the general public quite how dire the situation is in the NHS and why I am still very much on the fence in this case.

Having used different types of drug cupboard, even electronic fingerprint access cupboards, there are easy ways in which insulin can be accessed and administered to a patient who wasn't supposed to have it. I have known for unopened insulin to be in a locked box, but the open insulin for a patient to be forgotten about it and kept in an easy access fridge long after it was prescribed or needed. I don't think there is any issue with stock tpn and prescribed tpn. If you're a murderer why would you mind which baby gets the tampered tpn? Perhaps coincidental the same baby gets both. Perhaps that wasn't what was intended. Perhaps this happened in the pharmacy and ends up adding to a growing body of evidence against LL.

In the chaos and disorganisation I have witnessed I wouldn't be surprised if this goes either way. I also hope that either way, it is a massive indication that the NHS needs reform, so mistakes or deliberate foul play is not so easy.

I agree!

Is the trial on today? I can’t seem to find the live updates

If you're a murderer why would you mind which baby gets the tampered tpn?

Arguably because if you’re trying to kill someone with an insulin infusion you’d need a sufficient dose over a sufficient length of time. And because the more bags you lace with insulin going to different babies the more likely you are to get caught.

I really agree with the rest of your post. Although to negligence, incompetence, or deliberate foul play I’d add overstretched services with insufficient integration leading to poor outcomes.

The neonatal unit wasn't overstretched though, was it? And no matter how busy you are, it wouldn't lead to giving a child a massive dose of insulin.

I'm sorry but that's not strictly accurate- the Service Review by the Royal Coll of Paediatrics [2016/17]- downgraded the unit from a Level 2 to Level 1 facility because it wasn't considered safe - due to a multitude of problems including not following protocols/correct procedure, significant workforce issues [nursing and medical],
etc

It was in real crisis

All I can say is the night of 4th August they had 5 nurse to 7 patients. And going by much of the evidence so far, the nursing staff appeared to have breaks.
But regardless of any of this, no amount of so-called understaffing causes insulin to be incorrectly administered.