Lucy Letby - have you changed your mind pt. 5

[Typicalwave]

New thread

Part 4 here - https://www.mumsnet.com/talk/_chat/5400564-lucy-letby-have-you-changed-your-mind-thread-4?utm_campaign=thread&utm_medium=app_share

Originally started by @kittybythelighthouse

Yes - baby G was a very fragile child, and the evidence linking anything that happened to her with Lucy Letby is extraordinarily tenuous.

There was a poster on Reddit who used to post reflections on each case from the point of view of an NICU nurse. Her post on baby G is very long and very effective:

https://www.reddit.com/r/scienceLucyLetby/s/CXlar1FI2f

Poor effort @Firefly1987

Please do find the expert testimony.

Please do consider how an internal injury of such force could be achieved without observation or other signs. On a hospital ward. I refer you back to my previous post about the liver injury, with points about size and location of premature babies livers.

Your unwillingness to engage suggests you can't explain it either. Put your money where your mouth is. How did she do it?

Thanks for the link. It’s proving very interesting reading.

Dr Marnerides didn't rule out vigorous CPR entirely for the liver injury, he did say it was possible but not probable and some nonsense about if a man was found dead in the desert with a saucepan next to his head and it could be possible that a helicopter dropped it on his head but it wasn't probable.....

I'd say it's far more probable that it was vigorous CPR rather than LL inflicting an injury that was the force of a car crash on the baby, without being noticed especially seeing as we know there was indeed CPR.

The author gives a summary in bullet points lower down in the comments too, which is short enough to quote here:

•Child G was born at 23 weeks and 6 days, weighing just about 535g, which is considered an ELBW baby, or extremely low birth weight.

•75% of ELBW babies develop chronic lung disease, or BPD, of which Child G had.

•BPD can lead to a decreased functional residual capacity in the lungs, meaning simple physiological stress can make it easier for them to have a cardiorespiratory event.

•Child G was also at risk of gastroesophageal reflux, or acid reflux, due to the lower tone of her esophagus and lower esophageal sphincter, and having a feeding tube in place.

•Child G was on Gaviscon, which delayed gastric emptying. As a preemie, the stomach empties much slower, and the additional medications could make it even slower, leaving more milk in the stomach between feeds.

•Child G’s feeding tube had minimal aspirates with a pH of 4, however, feeding tubes can be misplaced nearly 50% of the time, and cannot always account for everything in the stomach, as the tube is much smaller than the stomach. It’s possible to get a positive reading of being in the stomach while being in the esophagus or past the stomach.

•Child G was being overfed already with 180ml/kg/day of food due to poor growing, but a neonate with her diagnosis of BPD should be fluid restricted to an average of 140ml/kg/day.

•Child G had signs of infection, including potential gastroenteritis due to watery green stool and vomiting, and signs of sepsis, with increasing CRP levels, metabolic acidosis blood gases, lack of urine output, and low blood pressures. She did not have signs of aspiration pneumonia on chest xray, which would have been related to the vomiting. Vomiting on its own could cause a cardiorespiratory event due to the decreased FRC, however, it would not have caused systemic symptoms like the above.

•Child G, who was in an unstable position, was left for 15 min while a doctor attended a delivery instead of receiving the intubation that she needed. This led to hypoxia affecting her brain.

•She continued to have desaturations while ventilated, and it took several hours to go through the DOPE acronym that looks at why neonates may desaturate on ventilators, leading to more hypoxia of her brain.

•Her blood gases showed signs of sepsis, and she was treated for infection when she went to APH. Induced vomiting with excessive fluid would not have caused a systemic infection.

•Child G then had several events of projectile vomiting for the remainder of her time in NICU, despite the court only focusing on two.

•She continued to be a victim of negligence when she was left behind a screen without a monitor on and had a cardiorespiratory event.

Thank you, yes.

The point I'm trying to make to Firefly is that this evidence / charge is incredibly thin and a reach. If it can't be pin pointed how it happened, just pointing at Lucy Letby and saying it was down to her because she was "there" and other incidents happened is shockingly poor practise, and should never have made it into a court of law.

It smacks of old school police practise where low level criminals got extra charges on their rap sheet to make crime solving figures look better regardless whether they'd done it or not. We were supposed to have moved on from that.

In this case it seems clear to me the liver injury was purely included for dramatic and emotive effect.

And they tried to pin the monitor being off on LL too - iirc the Dr who had turned it off jd then left ig off had to apologise

I have a feeling the was a lot of incidents of Drs fucking up and then trying to pin it on nurses

How anyone can say she was doing well, I do not know.

And can how anyone can say her care by COCH was adequate?

And of course, the court would only focus on the projectile vomiting events they could pin on LL and say ‘OVERFEEDING AND AIR’ nonsense, the other events were highly inconvenient.

The more I see, the more my lack of faith ij our system grows.

Yes they said it in the prosecution opening statement and the nurse heard and came forward to say that 2 doctors left it off and apologised over it, and I'm also sure she said she reported it at the time too.

What I can't understand is how that nurse wasn't questioned in the first place, during the investigation, she responded to LLs call for help during one of the crashes, yet she was never questioned??

Poorly worded-it was late and I was tired. I didn't mean baby G was fine for the entire 100 days, I'm well aware of her history and fact she was only given 5% chance of survival at birth. That's what makes it all the more unusual that it was 100 days when she suddenly collapsed. IIRC she was in an outside nursery at that point. And the dad knew there was a change in her after one of those attacks as she stopped responding to him the same. She wouldn't have been far off going home at that point. Baby G was the most premature by far, if any baby was going to die it would have been her (and long before she was well enough to be transferred to COCH). So any claims that these are sickly babies who could collapse and die any minute is not credible at all.

On Tuesday, jurors at Manchester Crown Court were read a statement from a nurse who took over Child G’s care at the end of Letby’s night shift.
The nurse, who cannot be identified for legal reasons, stated: “I remember (Child G) being very poorly that day which surprised me and the staff because prior to September 7 (Child G) was very stable.”
She said Child G had been “feeding and growing” in the outside nursery rooms of the unit following her transfer from Wirral’s Arrowe Park Hospital.
The nurse said she remembered September 7 because Child G was 100 days old and that was a regular milestone marked in which a staff member would bake a cake for a child, with balloons placed around the bedside.
She went on: “Lucy told me (Child G) had vomited while under the care of (another nurse) and then became unwell.
“She told me she had taken over as designated nurse because (the other nurse) did not have her intensive care course qualification.”

https://www.chesterstandard.co.uk/news/23173722.baby-very-poorly-alleged-attack-nurse-lucy-letby/

She was very stable prior to that. It's there in black and white. Lucy managed to worm her way into that room didn't she, super nurse that she is.

@Firefly1987
Taking over because the other nurse did not have her intensive care qualification is hardly 'worming her way in'.

So you think you know more than a doctor who examined the medical records?

it was possible but not probable and some nonsense about if a man was found dead in the desert with a saucepan next to his head and it could be possible that a helicopter dropped it on his head but it wasn't probable.....

Seems like a pretty simple analogy to me. Perhaps you'd prefer he said that he can't rule out aliens coming down and attacking a child but it's not probable?

She said that kind of thing a lot...couldn't help herself. No one was as good or competent as her. Yet somehow in her note she was apparently worried about her competencies not being good enough...yeah right.

The child had been stable (which doesn't mean well) but was developing an infection and struggling with digestion, both common risks in a child in an NICU. While babies are most at risk in their first days of life, this doesn't mean they follow a linear cause after that. Children who are vulnerable to infection and have immature respiratory and digestive systems will deteriorate if they contact infections. There is nothing startling or suspicious in that.

You speak about having to respect what parents say. I respect it, but I don't see how their observations on how well or ill their child seemed at a given moment has any connection with Lucy Letby.

How come Dr Neil whatshisface one of the expert panel can't explain the liver injury? It's alright for him to say it doesn't matter that he can't explain it, but not Dewi Evans...

How do they know any parent abused a child? Is there video footage?

You are mixing up qualification and competencies there.

Lucy Letby was one of only two level 5 nurses qualified in specialism. This means that she could nurse a baby needing one-to-one intensive care.

When baby G deteriorated, she was moved to one-to-one intensive care. The child Lucy Letby was caring for was moved to one-to-two care, and baby G was allocated to Lucy Letby. This would have been the shift leader's decision, and it's quite an obvious one.

Competencies are the tasks nurses should be able to perform. In July 2016, all nurses in Chester were told they would be tested on their competencies following the deaths on the unit. This did happen to some extent at least. So all nurses were encouraged to reflect on their competencies and the message was that, if babies were dying, their competencies might be at fault.

A nurse with higher qualifications, like Lucy Letby, would be expected to have more competencies. Any nurse at any level could fall short on their competencies, but there is no evidence that Lucy Letby or anyone else at Chester did.

Neil Aiton? Why do you think he can't explain the liver injury?

His position is that the subcapsular hematoma either ruptured spontaneously, as they can do, or was ruptured by the accidental insertion of a needle intended to aspirate the abdomen.

The attempted aspiration drew blood, but it was not reported to the pathologist who examined the baby's body. This is unfortunate since the liver was examined without this key information. This presumably is why the pathologist who examined the body believed the hematoma ruptured spontaneously (due to prematurity).

But as Aiton has said, his full report is with the CCRC and he's happy to have that scrutinised in full in due course - that's just a very brief summary.

No I would rather him not talk gibberish.

He said 'we're not discussing possibilities here, we're discussing probabilities' but obviously all possibilities should have been considered and it should also be explained more clearly to the jury. Possible but not probable, what does that even mean? 1 in a 100 chance, 1 in a million? No one knows....

It's a stupid analogy, if the autopsy then showed a head injury which could have indeed been caused by being struck by a falling object then the improbable theory becomes a lot more likely doesn't it!!

Please show us where Neil Aiton said he cannot explain it.

I’ll wait

Thank you.

I was sitting on my hands again.

And just a reminder to the glowy one - the standard in criminal cases is beyond reasonable doubt, not the balance of probabilities or the reading of chicken entrails with a gut full of "feels".

It doesn't surprise me you don't like/understand analogies.

His position is that the subcapsular hematoma either ruptured spontaneously, as they can do, or was ruptured by the accidental insertion of a needle intended to aspirate the abdomen.

If it's true that they can rupture spontaneously than he needs to explain how/why for those of us that are not experts. How does a liver rupture all by itself for no reason? Did the prosecution experts say they can rupture spontaneously? If it ruptured spontaneously then that isn't a doctor killing the baby is it? Anyone who suggested (actually accused) that should be sued.

What he said isn't altogether different to Dewi Evans and he was absolutely jumped on for saying he wasn't sure exactly where she injected air.

But as Aiton has said, his full report is with the CCRC and he's happy to have that scrutinised in full in due course - that's just a very brief summary.

Can't wait!

https://pmc.ncbi.nlm.nih.gov/articles/PMC9571888/

Google is your friend.

Spontaneously is the word you need to understand there. I don't think Neil Aiton needs to explain it personally, or that non experts will struggle with it unless they want to. He's just stating an established medical fact.

There is an enormous difference between stating as a fact that one thing is clinically attested and then stating that this does not happen (Evans), and stating from the outset that a medical event happened for one of two possible reasons.

So it's rare then. Another rare event only happening around one nurse. There's still causes-what was the cause in this particular case? Oh right, birth injury despite a totally normal healthy c-section.