LL Part 1: Hospital Wastewater
Lucy Letby and The Plumber
Following on from the previous post (here)
The journey for me started five days ago on hearing the evidence of Mr Lorenzo Mansutti.
14th June, 2023: Lucy Letby Trial - Day 129
(summarised for your benefit)
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While giving evidence in chief, Mr Mansutti described how he has many years experience as a plumber, and works at the Countess of Chester Hospital (CoCH).
The jury were told that plumbing in the Women’s and Children’s Building where the delivery suites and neonatal care unit were located dated back around 50 years to the 1960’s and 1970’s. He described how he had to deal with many issues and various blockages and that the cast-iron pipes would crack due to a variety of issues, including age.
Mr Ben Myers KC, Lucy’s defence barrister, asked what would happen if the pipes blocked. Mr Mansutti replied that the hospital wastewater (HWW) would come back up through the next available point, such as a toilet or wash basin. He confirmed that HWW would include sewerage - including human excrement.
He also described how he was being called out to the building to fix issues such as this with the plumbing weekly.
He recalled one occassion when there was a blockage in the room adjacent to the neonatal unit and one of his colleagues found HWW had backed up, and the neonatal nursery room 1 hand basin had foul water coming out of it.
He was shown a report from one of the hospital’s data systems that described a different incident in Nursery Room 4 where a hand basin had overflowed with HWW containing much black debris and describing how even after the plumbing staff had rectified the blockage, the sink overflowed again around two hours later, almost completely flooding the floor of the nursery.
Reports of a further 10 incidents over the intervening months during which Lucy stands accused of harming the neonates were introduced into evidence that described: blocked sluicemaster, drains and sinks; flooding; possible retarded valves and a burst pipe in the floor of the ward directly above the neonatal unit (therefore in the ceiling void directly above the neonates); blocked HWW filters; and a variety of leaks.
On cross, Mr Nicholas Johnson KC for the prosecution sought to initially to shift blame from the old hospital premises and poor maintenance onto adults putting things down sinks and thus causing the flooding. He continued in this way by having the plumber confirm that while events described in the report may have taken a basin here or there out of service, there were always hand washing facilities available around the unit.
During cross, Mr Mansutti recalled and described a further incident not recorded in the hospital system (therefore demonstrating that the hospital data system for recording incidents and maintenance was incomplete) in which sewerage had flooded neonatal room 1. He said he recalled it because of the disgust it had evoked and that work had been done to move that particular burst pipe around and away from the room. Mr Johnson KC’s final rejoinder was that half of the incidents listed during evidence in chief occured outside the neonatal unit, to which Mr Mansutti replied that there should not have been a direct effect on the (neonatal) unit for those days.
For several reasons this witness’ testimony, and the prosecutor’s manner during cross examination, stood out to me.
Hospital Wastewater (HWW) is a well known and common source of some very lethal disinfectant- and antibiotic-resistant pathogens. Even with the best measures of hospital care worker (HCW) cleanliness and aseptic technique they have been seen to persist on surfaces and in fixtures, and to compomise already infirm patients, long after the original colonisation of the pathogen.
There have been many hundreds of reports of outbreaks related to HWW pathogens in hospitals, mostly in ICU and NICU units, over the last four decades. However, and somewhat incredibly, some systematic reviews have shown that while incidents have increased in almost every other country during the last decade, reports from NHS hospitals have declined to, in some cases, zero. With some studies failing to identify any reports of outbreaks in the UK since 1989 (e.g.: Hu & Robinson, 2010). It would be incredible (meaning not credible) to think that they are occuring everywhere else in the world EXCEPT the UK. This suggests that doctors in the UK are either: (i) failing to test for cases; (ii) failing to identify cases; (iii) failing to report and document cases; (iv) failing to publish such reports; or (v) an institutional policy to cover up the existence of some outbreaks.
That the final imputation from the prosecution barrister and the response he clearly intended the jury to hear1 were intended to mislead the jury into believing that if a HWW incident occured in the area next door to the neonatal unit, this could not lead to transferance of potentially harmful pathogens into the neonatal unit. As we will see as my series of articles progresses, this is not the case. The ways in which some HWW pathogens can be unwittingly transferred across hospital campuses, and even between hospitals, is simply mindboggling.
In the next article we will consider the most frequent and therefore most likely pathogens that can colonise a hospital ward, especially as it relates to HWW. Over the course of the next couple of articles we will look at research that shows that HWW pathogens colonise neonatal units more frequently than any other part of the hospital, that they infect premature and underweight babies more often than any other patient, and consider the pathophysiology of HWW pathogen infection and compare it to the signs and symptoms described by the medical witnesses in Lucy’s case.
The next post in this series can be found here
It is commonly taught in legal schools that you don’t ask a question you don’t already know the answer to. In this case the response received from Mr Mansutti was very likely the response Mr Johnson intended the jury to hear.