UK - Lucy Letby Trial - Media, Maps & Timeline *NO DISCUSSION*

[Tortoise]

END OF PROSECUTION OPENING SPEECH

Chester Standard:

11:37am

Mr Johnson: "Following those events, the consultants suspected that the deaths and life-threatening collapses of these 17 children were not medically explicable and were the result of the actions of Lucy Letby.
"No doubt they were acutely aware that making such an allegation against a nurse was as serious as it gets.
"They, at the time, did not have the benefit of the evidence that you will hear and the decision was taken by the hospital took the decision to remove Lucy Letby from a hands-on role. She was moved to clerical duties where she would not come into contact with children.

"The police were contacted and began a very lengthy and complex enquiry.

"This involved the police contacting independent paediatricians and other specialists to review many cases which had passed through the NNU at the CoCH. Following that review, the decision was taken to arrest Lucy Letby – the first arrest came in July 2018.

"On July 3 she was arrested at her home, where the house was searched.
"In addition to some of the paperwork, they found some other interesting items.
"There were some Post-it notes with closely written words on them, some of which included the names of some of her colleagues.
"On some of the notes were phrases such as “Why/how has this happened – what process has led to this current situation. What allegations have been made and by who? Do they have written evidence to support their comments?"

11:37am

"In her writings, she expressed frustration at the fact that she was not being allowed back on the neonatal unit and wrote 'I haven’t done anything wrong and they have no evidence so why have I had to hide away?'
"Her notes also expressed concern for the long-term effects of what she feared was being alleged against her and there are also many protestations of innocence."

11:39am

"On another piece of paper, she wrote: 'I don’t deserve to live. I killed them on purpose because I’m not good enough”.
“'I am a horrible evil person' and in capital letters, 'I AM EVIL I DID THIS'.
"That, in a nutshell," Mr Johnson tells the court, "is your case."

11:40am

That is the conclusion of the prosecution opening.

Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement



Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins

 

[Tortoise]

Thursday October 13th 2022 - Live updates from the trial

DEFENCE OPENING SPEECH (NOTE THIS IS NOT EVIDENCE)


11:40am

That is the conclusion of the prosecution opening.
The defence, led by Benjamin Myers KC, will give a defence statement after a short adjournment.


12:13pm

Mr Myers: "It is difficult to think of allegations that may be harder to stand back and look fairly and look at the actual evidence.
"The sympathy of everyone will rightly be with families of the children...involved in this case. We all share the same feelings and experiences."

12:15pm

"It is natural to sympathise - we all do it. We recognise the sadness, distress and anger that come with allegations like these.
"We acknolwedge the great loss suffered by all families.
"Nothing I can say in this trial is intended to diminish that in any way.
"It is obvious...where we have such terrible allegations, it would be terribly easy for emotion to overcome reason, and convict without hearing a word of evidence."

12:16pm

"There is a real danger people will simply accept the prosecution 'theory' of guilt.
"It is a theory built 'firmly' on coincidence."

12:18pm

"What we are left with is coincidence.
"In the events that happened. Sometimes what happened was the result of deterioration in a baby.
"Sometimes, no-one can say what caused a deterioration.
"Sometimes, things have gone wrong, or the necessary standards of care have not been met, irrespective of anything to do with Lucy Letby. For that, she should not get the blame."

12:19pm

The assumption is "The worse it sounds, the more guilty she must be."

12:22pm

Mr Myers outlines the 'key issues' for the defence, in what he says will assist the jury and will place everything into context.
He said his speech, at this stage, will take about a couple of hours, and will break down the defence into three general areas: Letby and the general area of her defence, coincidence, and the medical evidence.

12:23pm

He tells the court the medical evidence is a key area, and there are 'key issues' for each count.

12:24pm

Letby was a "dedicated nurse" "who did her best" to care for infants and did not intentionally cause "any harm" to any baby, My Myers said.
"She loved her job...and cared for the babies' families."

12:26pm

"You won't get your answers [to what Letby is like] through seeing her in thed dock.
"This is what she is like six years after the allegations started. That, as you can imagine, is gruelling for anyone.
"You may want to keep that in mind as we go through the evidence in this case."

12:27pm

"A young woman who trained hard to be a nurse...and looked after many vulnerable babies for years.
"A young woman who loved what she did, and found she was being blamed for the deaths of the babies she cared for.
"We are dealing with a real person dealing with...a litany of allegations...not one of which has been proved."

12:32pm

Mr Myers refers back to the note shown to the court just before the break.
He said it is a note written in anguish and despair.
She was "going through a grievance procedure" with the NHS at the time, the court hears, and knew what was being said about her before her arrest.
The allegations were "destructive", the court hears.
The note is headed 'not good enough'. The defence notes it does not say 'guilty'.
The note adds: "I will never have children or marry".
Another part of the note says "I haven't done anything wrong".
Mr Myers: "We say people can pour feelings on to paper.
"This [paper] represents the anguished state of mind Letby felt when accused of killing children she had cared for.
"We say this paper represents 'anguish' and not 'guilt'."

12:33pm

There was further paperwork the police took from Letby's address at the time of her arrest.
The defence say the paperwork was "nothing more extraordinary" that Letby being someone who scribbles a lot of work down, and keeps hold of it.

12:34pm

The defence say the prosecution case is "driven by the assumption of someone doing deliberate harm combined by the coincidence of Letby's presence."

12:37pm

That is, Mr Myers said, combined with Letby "not doing" what is alleged against her.
"You will find, from what we have heard, no evidence of her actually doing harm to a child.
"These allegations are of attacks. You will have heard words of poisoning, sabotage - words likely to have had an emotional impact on you.
"You will have to refer to whether Letby is engaged in any of the attacks alleged.
"Using syringes to inject air? No. Tampering with bags of fluid - or poisoning them? No. Physically assaulting children? Smothering them?
"We are dealing with 24 events and we say there is nothing [to suggest that]."

12:39pm

"The time of Letby's presence has itself become an explanation for the deterioration."

12:43pm

The list on nursing staff on duty for all the fatal and non-fatal collapses, with Letby on duty for all events, is shown again to the court.
"This table exists because the prosecution created it, and was put together for the purpose of the prosecution."It was to show what were declared to be key events.
"This is a self-serving document. What we have here is because the prosecution have chosen to present it this way."
The defence says it does not show the 'individual health of the children concerned, or any problems they had from birth, or the risks, or the course of treatment and/or problems encountered by said treatment'.
The chart does not show 'other collapses or desaturations' for the children when Letby is not present.

12:44pm

The table does not show 'shortcomings in care' which 'could have impacted the health of the baby', or 'how busy the unit was', or 'what Letby was actually doing at the time of the event', My Myers tells the court.

12:44pm

It doesn't show 'whether Lucy Letby was anywhere near to a child at the time of the event' or if there was 'a problem which could be traced before Letby's arrival'.

12:45pm

Regarding the explanations for what happened, My Myers said: "This is something which is quite a difficult question, even for experts to look at."

12:46pm

"What the case will come down to is the medical evidence, on what can be safely proved and what it can't."

12:49pm

Regarding the medical evidence, Mr Myers said: "The cause of the deteriorations, or deaths, is not clear and have a number of possibilities.
"Generally, we are dealing with babies who are fragile, and their condition can change and deteriorate very rapidly."
Mr Myers adds the premature and vulnerable babies can come with developmental conditions that require extra treatment, and are prone to infections.
"It is crucial to consider the starting point in these cases.
"There is a question to whether this hospital should have been caring for this number of children."

12:50pm

Mr Myers: "We suggest whether an event that clearly fits an ongoing and difficult condition has been converted into an event of deep suspicion that harm is being done."

12:52pm

For a nurse standing in the neonatal unit next to an infant is "unremarkable", without a "suspicion of guilt", Mr Myers tells the court.
"When we come to the experts, you will need to consider their evidence and how strong it is."

12:55pm

The defence say there are five 'important' considerations for the evidence:

• The birth condition of the infant.
• If there were any problems in the care leading up to the event - events 'can come up from nowhere'
• Whether the prosecution expert evidence concludes there was deliberate harm done
• Whether Lucy Letby was present at the relevant time, and what she was doing
• Whether there were failings in care by other people or the neonatal unit as a whole

12:57pm

The birth condition of the infant
Mr Myers tells the court: "We are dealing with some of the most medically fragile babies under the most intense medical care.
"All of them, bar one, are premature to varying degrees. Some had considerable problems.
"These babies are already at risk of deterioration and this can happen unexpectedly and it can be rapid."


2:16pm

The matters leading up up to the event
Mr Myers refers to the medical situation and condition of the children involved.
Sometimes that includes 'the ability of doctors and nurses to spot' signs of problems in the build-up to the event.

2:17pm

Sometimes that would be a problem if the unit was "understaffed and overstretched," Mr Myers said.

2:19pm

The defence say in relation to the evidence, "we have to be careful of the assumption or theory of guilt," and the "dangers of opinion" in relation to the conclusions of "deliberate harm".
"We say that if an expert sets out within expectation a suspicion of harm being done, that may make it more likely they will reach conclusions which are harm based...rather than innocent explanations.
"When there is no explanation, there is a danger of the expert filling the absence of an explanation with one...by the prosecution."

2:20pm

"If someone looks for something, and has something in mind, they will look for that."
"Confirmation bias," added Mr Myers.

2:21pm

"There is plenty of disagreement" between the prosecution expert evidence and the defence.

Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement

 

[Tortoise]

Thursday October 13th 2022 - Live updates from the trial (text colours added by me)

DEFENCE OPENING SPEECH (NOTE THIS IS NOT EVIDENCE)


2:24pm

Medical evidence
Mr Myers tells the court that sometimes deteriorations are unexplained, and if Lucy Letby cannot provide an explanation, that does not make her responsible.
For every count, Letby is "adamant" she has "done nothing wrong" to cause any deliberate harm to any of the babies in the case, Mr Myers adds.

2:27pm

Regarding the point of air embolus cases
The defence "accept it is a theoretical possibility", but that "does not establish very much".
The defence do not accept, for Child A, an air embolus was the cause, but one of "sub-optimal care", as a result of either "lack of fluids" or "various lines put into him, with potential to interfere with his heart rate".

2:28pm

"You will hear in this case, that the air present after death does not indicate an air embolus."
Mr Myers said air present in the abdomen "can happen post-mortem".

2:29pm

For Child B, the defence say she had been born in a "precarious condition" and there were no signs of diagnosing an "air embolus".
The defence say prosecution experts had been "influenced" into believing harm was done.
The defence say Child B had other episodes where she struggled to breathe, after the indictment.

2:34pm

For Child C, the defence say it is accepted that someone had injected air as a "theoretical possibility", but that is "a very long way from proving what has taken place".
Mr Myers said the jury would have to look at the practicalities of that, and consider alternative explanations.
Child C was "subject to a variety of complications" due to being born premature, the jury is told.
"We say, for a starting point, he should have been at a unit providing more specialist care."
The defence say pathology identified acute pneumonia in Child C.
The defence suggest a structural blockage could have caused distention.

2:36pm

For Child D, the defence say the hospital "failed to provide appropriate care", and this was "beyond dispute" as the prosecution accepted care was sub-optimal.
Child D "was never able to breathe unaided" and there was a "strong" possibility of infection, and evidence of pneumonia after death.

2:38pm

For Child E, the defence say there is "no evidence of an air embolus", or of "direct trauma" that led to blood loss.
There was "no clear explanation" on the cause of death, but that was not a presumption of guilt.
The defence say the absence of a post-mortem meant the prosecution could "float suggestions of deliberate harm".

2:43pm

For Child F and Child L, the children allegedly poisoned with insulin, the defence "cannot say what has happened".
"It is difficult to say if you don't know," Mr Myers said.
"So much has been said about these. These are not simple allegations which can automatically lead to a conviction."
The defence say Child E's [my note this should say Child F] TPN bag was put up by Letby in August 2015 and hours later there were blood sugar problems. That bag was replaced, in the absence of Letby, but the problems continued.
The sample taken came from "the second bag", the defence say.
A professor had given "three possible explanations", none of which identified Letby as a culprit.
For Child L, there were issues with the documentation provided, so those are challenged, the defence say.
There is "nothing to say" Letby was directly involved in the acts.

2:45pm

For Child G, the defence say the child was extremely premature, "on the margins of viability" - "there will be problems," Mr Myers said.
Child G was a "high risk baby", "irrespective of anything to do with Lucy Letby".
Child G also displayed "signs of infection".

2:48pm

For Child H, the defence say she was treated with three chest drains and her case, as said by the prosecution, was complicated by "sub-optimal treatment".
Butterfly needles were left in for hours "which may have punctured her lung".
The prosecution experts "appear to have no explanation" for what happened.
The harm "was nothing to do with Lucy Letby" and a cause of Child H's deterioration included "infection".

2:50pm

For Child I, the defence say her death was a result of "ongoing clinical problems caused by her extreme prematurity".
The air embolus is "not accepted" as a cause by the defence.

2:51pm

The defence say CPAP treatment may have caused 'CPAP belly' in Child I, causing a distended abdomen.

2:53pm

For Child J, the defence say "there is not a great deal of explanation" for what caused the deterioration from the prosecution experts.
The defence say there is "an assumption of deliberate harm being used to blame her" when it was actually "inadequate care" at the hospital.

2:55pm

For Child K, the defence say the tube was dislodged, and the prosecution say that was Letby's doing. "Letby does not agree she did that, nor is she seen to have done that."
The prosecution say Child K had been sedated.
The defence say it is disputed, that Child K was able to move, and there would be evidence to follow on that.
The defence say there was "sub-optimal care" and Child K "should not have been at the Countess of Chester Hospital in the first place", but in a hospital providing tertiary care.

2:57pm

For Child M, the defence say "there is no obvious cause of collapse" in this case, but it is not established the "obvious" one is an air embolus.
"We are back in the territory of blaming Lucy Letby because there is no other cause.
"The mere fact she is there is being used as an explanation."

3:00pm

For Child N, the defence say there are "many reasons" why a baby would shout or scream.
"It was far more likely to be hunger" - "you certainly won't find evidence of anything else".
Regarding the allegation Letby did something to cause Child N to bleed, the prosecution say the intubating doctor already saw blood, because Letby harmed him.
The defence disagree and say blood was "not identified until intubation had already happened, or was in the process of happening".
There were three attempts to intubate him.
The defence say, again, there was "sub-optimal care" for Child N.

3:02pm

For Child O, the allegations are "various". An air embolus is "not accepted" and the defence point towards an infection, along with "CPAP belly".

3:03pm

The "liver injury" was "caused during resuscitation", the defence say. The prosecution "do not accept that", Mr Myers tells the court.

3:06pm

For Child P, the defence agree the collapse could have occurred by a splintered diaphragm, but do not agree with how it was caused.
The defence say Optiflow is a cause.
The defence agree once Child P collapsed, it was unclear why he did not respond to resuscitation, but that did not point to deliberate harm.

3:07pm

For Child Q, the defence say there was viral-drawn aspirates, indicating a bowel problem, supported by a diagnosis of NEC.
"A poorly funcitioning bowel" had led to Child Q vomiting.



Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement

 

[Tortoise]

Thursday October 13th 2022 - Live updates from the trial

DEFENCE OPENING SPEECH (NOTE THIS IS NOT EVIDENCE)

3:11pm

Mr Myers added there are two further areas to consider.
"It is important not to guess, or proceed on a presumption of guilt."
"Even when we have timings...some will be more precise than others."
There were many occasions when "Lucy Letby was simply not there" when harm was being alleged.

3:14pm

"Lucy Letby was a young nurse with no family commitment, who had built her life around the neonatal unit.
"She was often called in to help babies with severe health issues...she was more likely to be there to cover for clinically difficult babies."

3:15pm

The defence say Letby's lack of recollecting details in police interviews should be put into context, like other witnesses, who may not be able to recall anything beyond the notes they made at the time.
"Goodness knows how many babies she will have cared for over the years," Mr Myers said.

3:17pm

Other staff
Mr Myers said this is important - it would be "unbalanced and unfair" if the focus was on Lucy Letby without focusing on problems with other staff, or how the unit was run.
"We do not suggest for one moment the doctors and nurses did anything other than the best they could.
"What they do is admirable and crucial."

3:18pm

"We say there were problems with the way the unit performed which had nothing to do with Lucy Letby."
Examples of sub-optimal care for babies previously mentioned and conceded by the prosecution are relayed to the jury.
"There are many other examples of sub-optimal care of babies in this unit," Mr Myers.

3:19pm

The defence say the prosecution have referred how babies improved rapidly when moved to a tertiary unit - "when moved away from Lucy Letby"
The defence says the improvement could be because they had been "moved away from the Countess of Chester Hospital".
It is evidence that the unit "did not always deliver the level of care that it should have provided" and to blame Letby "is unfair and inaccurate".

3:23pm

Mr Myers explains the neonatal unit is a level 2 unit, with level 3 offering the highest specialist care for new-borns, such as in Arrowe Park.
Either 'through lack of technical level of skill among the staff, or because it was too busy and could not deliver with the level of staff it had available.'
The Countess of Chester Hospital neonatal unit was subsequently 'resdesignated' as a level 1 unit after Letby was redeployed in July 2016, Mr Myers said.
"You can imagine in a situation like that, there is bound to be concern."

3:26pm

The defence also refer to Dr Ravi Jayaram, and his 'concern' about Letby's behaviour as detailed by the prosecution in the opening.
"You may wonder what on earth that is all about.
"If Dr Jayaram had these suspicions, when did that start?
"You may think that if consultants had suspicions, then why did Letby continue?
"You may wonder if there was any basis for suspicion at all.
"You may think that suspicions by one or more consultants like that, if Letby is to blame, then that is fertile self-serving territory for an assumption of guilt to take hold."
Mr Myers said Letby became a "target" for blame.

3:30pm

"It would be very unfair to judge Lucy Letby by standards or expectations different to other staff in the unit," Mr Myers said.
The defence say if it can be interpreted the unit is understaffed, treatment is "hurried," "mistakes made" and records "not kept". Mistakes may "not be immediate".
Mr Myers: If the unit has "failed" in its care which has led to this "uncharateristic spike in deaths", you can imagine "pressures" which call for an explanation, 'distancing the blame from those running the hospital' through "confirmation bias".
"The blame is far too great for just one person," Mr Myers added.
"In that dock is a woman who says this is not her fault."

3:34pm

That concludes the defence outline case.
It is also the end that the jury sits as 14 members, as one juror has indicated they can no longer serve on the jury. The reserve juror has taken their place.
The second reserve juror has also been discharged.
The jury will now sit as 12.

Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement

 

[Tortoise]

Friday October 14th 2022 - Live updates from the trial.

Day 1 of Evidence


10:32am

The case is now resuming. The jury of 12 is now filing into court.

[...]

11:45am

Medical expert Dr Dewi Evans is now being called to give evidence.
He has been named several times during the prosecution opening.

11:49am

Dr Dewi Evans is a consultant pediatrician. He is giving his background and experience.
The court hears he has specialist knowledge of new-born babies, in providing healthcare, including intensive care, in the 1980s and 1990s in Swansea.

11:54am

Dr Evans confirms he has never been employed at the Countess of Chester Hospital, nor has hae had any involvement with the care of babies involved in this case.
He said he was involved in the development of neonatal care.
"It was an essential and important part of our generation that we provided good services for these ill babies.
"A lot of my experience was not about reading books, but was hands-on. You were there, with a sick baby in the incubator. You support the monitoring - nothing as good as it is now. A lot of it was 'touch and go', really. It could be quite fraught as there were ther deamdns on children's services.
"We were passionate about these babies to get money for developments...and...publicity for baby care.
"In 1980 in Swansea, the health board built a brand new children's department with a new neonatal unit that I had designed.
"Life became easier as...we had some superb nursing staff and by that time there were far more junior doctors developing an interest in baby care."

11:55am

"Babies arrived in all sorts of conditions. The most common were associated with prematurity. One would have to see them through the first few days of life - giving them oxygen...CPAP - which has saved thousands of lives over the past few decades.
"If not CPAP, it would be intubation - a breathing tube into the lungs and put them on...a breathing machine.
"The initial machines were primitive...but they worked.
"In addition to giving babies ventilation support, we would give them IV fluids to help them absorb milk."

11:56am

Cannulas would also be used to help babies get adequate fluid, such as glucose and amino acids.
Sometimes a 'cocktail' of nutrition would be required for each baby.

11:58am

"All the neonatal units are dedicated units. They are responsible only for new-born babies.
"Usually they are next door to the maternity unit. They tend to be divided into sections - the sickest in the intensive care area, babies who are recovering are in a high dependency area, and babies who are recovering but too sick to go home are in the 'ordinary' area."

12:02pm

Dr Evans said he gave up his full-time medical practice in 2009 after 30 years. He has done a few short-term locums since then, but has since dedicated his time to the courts, providing reports for baby care.
He had done reports involving clinical negligence - the first in 1988. He said he does not take on new cases involving that now.
He now says he takes time in family courts and crown court, involving serious cases of babies having died suspiciously or being injured.
He has prepared reports for police authorities, such as the National Crime Agency.
He has also prepared reports on behalf of defendants.

12:09pm

The court is being reminded of the 'tiered' hospital structure locally, with Arrowe Park and Liverpool Women's Hospital designated as 'level three' units, able to provide the most complex neonatal care.
The Countess of Chester Hospital was designated as a 'level two' unit, able to provide intensive care for vulnerable babies up to 48 hours, after which they would be transferred to a level three unit.
Other hospitals in Cheshire, such as Leighton, were designated as 'level one'.
Alder Hey was the designated surgical hospital unit.

12:15pm

The court hears the Countess of Chester Hospital neonatal unit has four rooms - room 1 the ICU, room 2 the HDU, and rooms 3 and 4 the special care rooms.
Babies would be moved between the rooms as their condition changed, with transtitional care cots available.
Entry to the neonatal unit was controlled through locked doors. One from the public entrance side, the other from the maternity/labour side.
Swipe cards would be used by staff to gain access to the neonatal unit, and their dates and times would be recorded.

12:17pm

Times when this would not record someone would be:
a) when person A swipes to open the door, and person B also enters at the same time
b) from inside the hospital via a push-button to open the door
c) via the buzz system of gaining entry - pressing a buzzer and a member of staff would provide entry for individuals
The system of entry is 'commonplace', the court hears.

12:20pm

The court is now being shown a walk-through of the neonatal unit at the Countess of Chester Hospital, dated September 2021 - which has changed following hospital upgrades since 2016.

12:26pm

The 10-minute video is being played to the jury, showing all the rooms in the neonatal unit, and what purpose the rooms served back in 2016.

12:30pm

The court is hearing from a list of agreed facts - ie, evidence agreed by the prosecution and defence.
The hierarchy of the Countess of Chester Hospital staff is being explained to the court.

12:33pm

Doctors would be alerted by two forms of 'bleep' - one non-urgent, the other 'urgent' - the latter being labelled a 'crash call'.

12:37pm

The neonatal unit baby monitors, used to monitor vulnerable/unwell babies, are now being explained to the court.
Dr Evans says if levels fall below specified values, or if monitoring equipment falls off the baby, an alarm will go off to alert medical staff.

12:39pm

A video explaining the technicalities of the Phillips IntelliVue monitors is played to the court.
They are similar to monitors found for hospital patients, but the values are set to a 'neonatal profile', and cannot be changed.
Dr Evans explains the values for neonatal babies are different to children, and to adults. Values for neonatal babies would be "far too fast" for children.

12:41pm

A heart-rate of 140 is "fine" for a neonatal baby, but a sign of sickness for an adult.
Over oxygenation "can lead to blindness" so greater care should be taken for such babies.

12:44pm

Alarm parameter settings can be adjusted by a nurse, but must be in 'clincially safe' settings, the video explains.
For example, a heart rate range can be between 50bpm and 165bpm, with the alarm sounding if the heart rate goes outside that range.

12:46pm

Dr Evans explains the monitor also shows wavy lines which show how regular the heart rate is, and the pattern of breathing.

12:51pm

The video, played to the jury, demonstrates what alarms sound when a 'yellow alarm' goes off, and a 'red alarm'. The red alarm is for more immediate emergencies, and has a different tone to the yellow alarm sound.

12:53pm

The alarms can be 'paused', via the 'pause' button, which turns the alarm off for one minute.

12:53pm

A light will continue to show on the monitor, either yellow or red, depending on the type of alarm that sounded, even when paused.

12:58pm

The alarms can be manually turned off, the video explains, for each parameter.
If done so, a display on the monitor would show the alarm for that parameter had been turned off.
"This would not be standard practice," the court is told.
If the monitor numbers then headed outside the alarm parameters, the numbers on display would then start flashing.

2:14pm

Dr Dewi Evans is being asked about medical terms, such as 'air embolism', apnoea, blood gases, capilliary, and medical equipment.

2:16pm

A video is now being presented to the court showing what a cannula is, and a demonstration of how it is administered to a patient.

2:22pm

A video is now explaining what happens in 'neopuffing', more crudely known as 'bagging' of patients, "one of the most important pieces of equipment" in a neonatal unit, which can give artificial breaths to a baby.

2:23pm

There is a dial which can deliver varying amounts of oxygen, from 21% (air) to 100%.
The pressure can also be altered depending on the prematurity of the babies, "to help open their lungs".

2:24pm

The neopuff machines are checked "once each shift" by neonatal staff.

2:26pm

The video played to the court shows a demonstration of a neopuff machine, with the mask being attached to a dummy baby's nose and mouth.

2:27pm

'Five inflation breaths', each for three seconds at a time, are given to babies with breathing difficulties or for babies who have collapsed.

2:30pm

The neopuff machine can also be applied to intubated babies, as the video demonstrates.
A second video, titled 'neopuff consumables', is played to the court demonstrating additional equipment.

2:35pm

The process of getting 'aspirates' from the stomach, via a naso-gastric tube, is also explained to the court.
Dr Dewi Evans says it is important for the stomach to be empty, prior to a next feed for a baby, as the presence of milk aspirate could suggest problems with that child.

2:39pm

The video demonstrates that any aspirate found has a 0.5ml sample checked for pH levels.
Dr Evans explains the syringe used is purple in colour - it is a syringe only used for naso-gastric tube, and cannot be used for IV feeds - you cannot be used to inject milk into a vein, for example, as the shape is different.

2:44pm

The video played to the court says action can be taken by medical staff to withdraw air from the baby's tummy if the abdomen becomes distended.
Dr Evans says 'free drainage' means the naso-gastric tube (NGT) is left in the stomach, the other end is left open, so if any air is in the stomach, it can escape through the NGT.

2:52pm

The court is now hearing the definition of the term 'NEC', pronounced as 'neck' "in the business", a gastro-intestinal disease in the small intestine.
Dr Evans says the causes can be poor blood flow, as a result of infection. Sometimes it can appear "without being sure why".
"The sicker the baby, the greater the risk," Mr Evans tells the court.
Other symptoms are 'a bit' of abdominal distension, bile aspirates and blood in the stool. Early diagnosis is important to lower the need for surgery.
The prosecution says NEC will be referred to a lot in the course of the trial.

2:53pm

"Doctors, if they suspect NEC, start treatment immediately" - even if they are not 100 per cent sure of a diagnosis, Dr Evans adds.

2:55pm

One of the reasons for this is some of the babies may not "tolerate" surgery.
The court hears NEC is a "serious" medical emergency.
The prosecution says if symptoms are detected, they treat swiftly.
"And properly," Dr Evans adds.

2:58pm

Different types of rashes are discussed, in particular a purpuric rash where if you press on the skin, the rash does not fade.
It is associated with sepsis, or blood clotting, and is a "serious medical problem".

3:01pm

The process of intubation is demonstrated on a video presented to the court.

3:15pm

CPAP is the "least invasive form" of giving breathing support to babies, the court hears.
BiPAP is the next stage, and 'full ventilation' "requires a very sophisticated ventilator" and is the most invasive form.
A positive sign of "returning to normal" is for the oxygen saturation levels return to over 90%.
The respiratory rate is then controlled via the ventilator setting.
If the baby 'fights' against that, by trying to breathe independently, that baby is sedated so it can benefit the most from the ventilator.

3:22pm

A video is presented to the court displaying the process of CPAP, and what responsibilities nurses and doctors have while the equipment is attached.
The video says it is "inevitable" air will pass into the stomach and intestines, and with time, can lead to "distension of the stomach and intestines". To avoid this, an NGT is inserted into the stomach to help ventilate excess gases.
The video says "Despite this, some babies on CPAP will still develop some degree of CPAP belly."
Dr Evans says CPAP is the "safest method" as it is the "least invasive".

3:23pm

The video explains there are "other important causes of abdominal distension and it is the doctor's responsibility to distinguish CPAP belly from other conditons, particularly...NEC."

Recap: Lucy Letby trial, Friday, October 14

 

[Tortoise]

Friday October 14th 2022 - Live updates from the trial.

Day 1 of Evidence

3:25pm

Dr Evans will shortly be cross-examined by the defence's Ben Myers KC on the medical matters raised so far.

3:37pm

We've had a short adjournment.
Mr Myers KC is going to discuss some general points raised today with Dr Evans.

3:39pm

Mr Myers asks if the procedure for intubation would be different in a neonatal unit at 3am, compared to that in a lecture on a training dummy.
Dr Evans: "The procedure for intubating a baby would be the same."
"The atmosphere would be quite different?"
"No."
He adds the atmosphere might be different in an ambulance, for example.
Dr Evans says there is a "limit" to what you can learn from the videos.

3:40pm

Dr Evans: "What you have is, if you have a baby that requires resuscitation, by definition that is the sickest baby in the unit and requires treatment by the most experienced doctors and nurses."
Mr Myers: "I am talking generally. Would the atmosphere in a generally functioning unit, such as fitting a cannula, be different?"
Dr Evans: "Well of course it would."

3:41pm

Dr Evans adds the size of premature babies would vary, from about 600g to over 2kg, and would generally be smaller than that of the mannequin seen in the video.

3:43pm

Dr Evans explains how intubations may not be possible, generally due to "swelling in the surrounding area", in the cords and epiglottis area.

3:46pm

Mr Myers explains the role and clinical experience gained by a neonatologist by working in the unit, which can include "discussions with colleagues" and "variations in different patients and conditions".
Dr Evans agrees.
Sometime the differences can be "subtle", Mr Myers says.
Dr Evans says: "It can depend on each case."

3:47pm

Mr Myers says Dr Evans is not a consultant neonatologist.
"I'm a consultant pediatrician," Dr Evans responds.

3:48pm

"The bulk" of Dr Evans' experience is via the unit he set up in the 1980s-2007/8, Mr Myers says, with much of that in the 1980s, alongside other pediatric duties.
"In that sense, you were not working exclusively in neonatology," Mr Myers says.
"That is correct," replies Dr Evans.

3:56pm

Mr Myers details Dr Evans' CV and says his duties are shared between neonatology and pediatrician.
Mr Myers: "Would you agree you didn't have day-to-day sole experience [of neonatology] over a period of years?"
Dr Evans: "I don't really agree - I'll tell you why. We were where we were in the 1980s as neonatology, which was relatively new. Our generation was inspired to improve the services.
"Because there were so few consultants around, you had greater contact with babies than with 10 neonatologists.
"The other consultants deferred to my interests in neonatalogy development.
"My experience was huge.
"Our on-call system was one in four. I was on call every one in four weekends.
"In the 80s and 90s I was looking after neonatals in Swansea and Neath.
"My hands-on experience of developing neonatal experience is, I am more than happy to say, is as extensive as anybody's.
"I attended neonatal courses...You can attach labels all you want, but in terms of the neonatal experience is...extensive.
"I reckon I could intubate a baby today. It's like riding a bicycle.
"I am very happy with my neonatal experience, expertise and background."

3:57pm

Mr Myers says Dr Evans had not seen a Phillips machine monitor.
Dr Evans said a Hewlett-Packard machine was used in his experience, and had introduced them to the hospital.

3:59pm

Mr Myers said Dr Evans retired from clinical practice in 2009, and was not working in neonatology in 2015/6. Dr Evans agrees.
Dr Evans says his interest has been in child safeguarding since.

3:59pm

Mr Myers: "This case has involved you in a great deal of neonatology.
"That hasn't been the case before, has it?"
Dr Evans: "It has, actually. In clinical negligence, a lot of the cases invovled babies.
"I have kept fully up to speed with neonatal practice."

4:03pm

Mr Myers: "Would you agree the optimal position would be current clinical practice?"
Dr Evans: "I think the important thing is clinical experience.
"You develop your professionalism through the whole of your career. You do not spend the whole of your 40 years attached to an exclusive clinical scenario."
Myers: "Clinical practice evolves over years."
Dr Evans: "It does."
M: "If you are not in practice, you are at a disadvantage?"
DrE: "No - you don't simply forget, the day you finish."
M: "I am not suggesting you have forgotten, but if new approaches are made -"
DrE: "If you can tell me of any new approach, then do so, but babies...do not change in the approach of their conditions, and that has not changed in the past 10 years."

4:06pm

"I have not retired, I should remind everybody," Dr Evans adds, as he reiterates his experience, adding it would be difficult for him to be present in court if he was working five days a week in a neonatal unit in Swansea.
He is able to give an "objective and clear" opinion on the evidence presented.
Mr Myers: "Being an expert witness as been your chief activity [since 2009]?"
Dr Evans: "Yes, I suppose it has."

4:09pm

Mr Myers adds one of the training courses is in expert witnesses and 'how to avoid pitfalls'.
Dr Evans: "It's to help prepare for court."
Dr Evans is asked about being 'an expert' in being 'an expert witness'.
Dr Evans: "I think that's far too flash for me. My role is to assist the court on some extremely challenging issues.
"I call myself an independent medical witness, not an expert."

4:11pm

That concludes the trial for today.

Recap: Lucy Letby trial, Friday, October 14

 

[Tortoise]

Monday October 17th 2022 - Live updates from the trial

Day 2 of Evidence


11:24am

The prosecution will now focus on the cases of Childs A and B, having outlined their cases last week.

11:29am

Letby is charged with the murder of Child A on June 8, 2015, and the attempted murder of Child B, between June 8-11, 2015.
Child A, a boy, was born premature in June 2015, the younger of a twin sister (Child B).
A reminder that reporting restrictions mean none of the children can be named in this case, and a naming convention of 'Baby/Child A-Q' is being used by the media.

11:30am

Agreed facts are now being read out to the court. 'Agreed facts' are evidence which is agreed by both the prosecution and the defence - ie, the defence does not challenge them.

11:38am

The first witness statement is dated from 2017 and is from the mother of Child A and B.
She confirms she had been diagnosed, prior to her pregnancy, with a blood disorder, and had been given medication to treat it.
She discovered she was pregnant and it was decided the blood condition would be monitored and managed throughout.
It was planned for the babies to be delivered at a medical centre outside of Chester, at full term.

11:41am

The mother was admitted to the Countess of Chester Hospital, and was "very upset", as there had been medical issues diagnosed, and she had been only a week away from moving to the area where the specialist outside of Chester would have delivered the babies.

11:45am

The mother had an emergency caesarean section as her blood pressure levels were high, and the twins were delivered.
Afterwards the doctor was "surprised" at how well she was doing, and the mother asked if she could see her children. She was told once she was well enough to sit in a chair, she would be taken to see them.
As time passed, she said: "I was getting a little anxious as I just wanted to see my children".
It was about 12-1pm on June 8 when she went to see Child A and B, who were both in incubators.


11:48am

She stayed with the twins for about an hour, and was told to rest on advice of the nursing staff back in her room.
At about 8pm, a male member of staff came into the room.
"You need to come in quickly, there is something wrong with twin 2."
"All I can remember is coming in and seeing what felt like hundreds of people trying to resuscitate [Child A]."
The mum was asked for permission by medical staff to stop resuscitative attempts.
"I couldn't bring myself to say stop.
"The only thing I could bring myself to do was nod my head.
"One of the things that upsets me the most is I never had the chance to hold him in my arms."

11:51am

The mum said, following the death of Child A: "I was frantic, anxious and extremely upset."
Afterwards, the mum said she wanted a member of the family to keep an eye on Child B at all times.
After saying goodbyes to Child A, upon her return, she was asked if she wanted to hold Child B, who couldn't be out of the incubator for a prolonged period of time.
"I felt joy and sadness at the same time."

11:55am

The couple were woken up by a female member of staff to come quickly to see Child B.
She said: "My heart sank - not my baby, not again."
They were told Child B had suffered a similar situation to Child A, but had stabilised.
Blotches and mottling had been on Child B.
"[The consultant said] she had never seen this before - I remember being surprised by this."
Said consultant had asked to take photos of the blotches, but by the time a camera was arranged, the blotches had disappeared.
The mum did take a photo the following day, noticing the hands and feet were still "a little discoloured".
The photo, dated June 10 in the morning, is presented to the court.

11:57am

The mum said she would always go to see Child B at the neonatal unit each day from 9am, until the start of the night shift, and would set an alarm to call the designated parent line every 2 hours during the night.
"I was, and still am, extremely protective of her."
"I couldn't help myself."

12:00pm

It was said to the mum from a member of the Countess staff that Child A's death, if 'unascertained' from the coroner, could have come from her blood condition. She was "furious" upon being told this, and sought answers.
That concludes her statement.

12:06pm

The father of Child A and B has also provided a statement.
He said everything was "fine" with the pregnancy up to the 28-week check-up appointment, when concerns were raised over the mum's medical symptom.
The mum had contacted the specialist doctor based outside of Chester to see if it was possible for the babies to be delivered as planned, but the couple were told it was "too risky".

12:11pm

The father said the mum did not have the opportunity to see the children that first night, having had general anaesthetic for the birth.
He said he took several photos of Child A and B in the neonatal unit that night, and showed them to the mum.
The mum had said no-one else in the family was allowed to see the children before she had the opportunity to do so.

12:17pm

The father said the mum was getting increasingly anxious to see the children, and with assistance, was able to get in a wheelchair to the neonatal unit.
The father remembered "a nurse called Lucy" explained the baby monitor machines to him, as he was nervous about them.
The parents returned to the delivery room after about an hour.
Later, they were told by a nurse to come to the neonatal unit: "There's something wrong."
"You need to come quick, it's twin 2."
I can only remember seeing 'hundreds' of people trying resuscitate.
"We were asked if we were religious, and if we would like to say a prayer."
The parents were told resuscitative attempts had failed.
"Neither one of us wanted to say stop.
"[The mum] was hysterical.
"I said something along the lines of 'you have to let him go, he's not there any more, you have to let him go'.
"She nodded her head and that gave permission.
"One thing that upsets us both is we never had the chance to hold [Child A] when he was alive.
"We were told he was doing fine, breathing by himself, and doing well."

12:20pm

While the mum rested, the father stayed with other family members and Child B.
The father said Child A was brought to them by Lucy Letby, prior to the child's transfer to Alder Hey for a post-mortem examination.
Upon their return, they were asked if they wanted to hold Child B. The father said he was too scared to, because of Child B's tiny size, and the child needed to be kept in an incubator or her body temperature would drop.

12:23pm

It was 'shortly after shift change-over' at 8pm when the parents returned to the neonatal unit and had had very little sleep. The other family members had left the unit for rest.
This was the first time since that none of the family members were by Child B.
It was shortly afterwards when a nurse came in to say: "You need to come now"
The father said: "I didn't know what to think. My heart sank."
They found Child B had stabilised, after the oxygen saturation levels had fallen sharply.
The father had said the consultant nurse had given a 'crossed-fingers' to the nurse on duty when she left, as a 'good luck - I hope the child survives]'.

12:25pm

Child B was in the neonatal unit for a further 4 weeks, and the mum went to hospital on a daily basis, including after she had been discharged as a patient herself, arriving at 9am.
The father said they had wanted to be kept updated on Child B, day and night, 'no matter what'.



Recap: Lucy Letby trial, Monday, October 17

 

[Tortoise]

Monday October 17th 2022 - Live updates from the trial

Day 2 of Evidence

12:30pm

The third 'agreed fact' statement is from the grandmother of Child A and B.
She recalls the whole family was "thrilled" at the news of the pregnancy, and were aware of her daughter's blood condition, and arrangements had been made for her treatment prior to, and for the delivery itself.

12:31pm

The grandmother recalls a "commotion" in the operating theatre, and incubators being brought in.
The mum was "quite poorly" afterwards.

12:32pm

Nursing staff had told the mum the babies were "doing well" and "both fine", the grandmother recalled.

12:35pm

The grandmother had popped in to the neonatal unit to see the babies "very briefly", noting they were "very small and fragile" before returning to see her daughter in the labour ward, as she was still poorly.
It was 'about 8.30-9pm' on Monday, June 8, when one of the nurses ran past the door, saying "It's one of the twins".
"I could tell there was a problem, my heart sank. I just immediately thought she was referring to [my daughter's] babies."

12:37pm

"Your baby is very poorly, or has collapsed - it was something along those lines.
"We went into the neonatal unit room 1. A member of staff held the doors open for us.
"The minute I went into that room and saw that baby boy, I knew he was gone.
"Everybody was desperately trying to help him.
"The room seemed full of medical staff.
"[My daughter] was sobbing uncontrollably at this point - 'please don't let my baby die, please don't let my baby die'."
The family were told the situation was not good for Child A.

12:39pm

The grandmother said a doctor had come over to say, three or four times during the resuscitation attempts, saying the situation did not look good and if Child A survived, he would likely be left with brain damage and other complications.
Eventually the mum nodded her head silently to indicate to staff to stop.

12:42pm

The grandmother recalled that the following, Child A was placed into a cot, adjacent to Child B's incubator. A nurse had placed a comfortable chair for the mum to sit in, next to the babies.
She said the mum would not leave the children unsupervised.

12:45pm

Later, the grandmother was awoken by a mobile phone call from the father.
"The only words I could remember him saying were 'the baby's collapsed, she's really poorly."
The family members made their way to the neonatal unit.
She said: "I was having chest pains, thinking I was going to have a heart attack. I was struggling to breathe, I couldnt think anything other than I hope [Child B] is OK.
"Once we got in, she was not looking good. There was mottling."
Child B later stabilised.

12:46pm

The court hears medical records are now going to be looked at.

12:51pm

The court is hearing from Claire Hocknell, intelligence analyst employed by Cheshire Police.
She explains data has been obtained from medical records, Lucy Letby's mobile phone, and door swipe data showing access/exits by medical staff at the Countess of Chester Hospital's neonatal unit.
Nicholas Johnson KC says if that includes social media searches carried out by Letby.
Ms Hocknell confirms that is correct.

12:57pm

Ms Hocknell confirms all the evidence collated for the data records has been served upon the defence in advance of the trial.
After the defence had sight of the evidence, additional data record material was sought and added, and any mistakes made in its compilation were corrected.

1:00pm

The court is now adjourning for the lunch break, and will resume later, where it will discuss the medical records further.

Recap: Lucy Letby trial, Monday, October 17

 

[Tortoise]

Monday October 17th 2022 - Live updates from the trial

Day 2 of Evidence

2:12pm

The judge, Mr Justice Goss, has returned to the courtroom. The trial shall resume shortly.

2:14pm

The sequence of events, packaged in an electronic display, is presented to the courtroom and on jurors' iPads.
The first slides are the original, scanned, neonatal admission for Child A, and a typed up transcription of the doctor's notes.

2:25pm

The package records Child A was transferred to the neonatal unit at 2.41am on June 8, as a note written retrospectively recorded.
A 24-hour observation chart records Child A's heart rate, respirations and body temperature.
Clinical notes are also shown, along with Ms Hocknell's transcription.

2:43pm

Further medical charts are shown as part of the electronic evidence package, along with the intelligence analyst's transcribed summary.
At this stage, the full details of these charts will not be analysed. The prosecutor, Nicholas Johnson KC, explains doctors and nurses will be called into court later to provide more context on these notes.

2:47pm

One of the clinical notes includes a very basic sketch of lungs and the abdomen, to describe Child A's condition, which noted the child looked stable.

2:51pm

The medical records also show an x-ray was taken on Child A, using a portable x-ray machine.

3:02pm

A record labelled 'family update' is made at 7.12am about how 'dad had visited [the neonatal unit] multiple times throughout the night', with the mum not being well enough to visit the twins as she was still in recovery.
Another note, made for 7.30am, describes who was working in what role for the following shift, such as the paediatrician of the week, the on-call consultant, the registrar and other clinical staff, registered nursing staff including the shift leader, the designated nurse, and other nurses.
Other staff listed for this shift are a nursery nurse and a student placement.

3:07pm

The evidence also shows text messages sent between Letby and colleagues.
At 9.21am, a message is sent to Letby asking her to split her shifts. She replies: "Yes that's fine...is it busy?"
The reply: "We have 3 on CPAP...twins last night...wanted six staff on."
Letby replies: "No problem."
At 9.25am, an outgoing Whatsapp message from Letby to a friend says: "...I'm working tonight and tomorrow now as busy."

3:12pm

Letby sends another Whatsapp message: "Will just have a quiet one today. Slept well. They have 3 30wkers on CPAP."
Her colleague replies: "It will calm down again soon then."
Further Whatsapp messages are exchanged, which go into 'a social nature', up until 10.10am.

3:18pm

A message from another colleague of Letby's is sent to Letby.
She replies: "I've been moved forward as busy. Doing tonight and tom."
After friendly messages are exchanged, the conversation then turned to work, and how busy work had been.

3:21pm

The evidence records an x-ray taken of Child A's chest and abdomen taken, along with notes at 1.53pm indicating no concerns with the child at that time.

3:22pm

Letby's colleague sends a Whatsapp at 2.11pm to Letby: "Oh well, you'll just have to kick me if I start nodding off."

3:27pm

The medical charts show hourly observations are made of Child A.

3:30pm

At 4pm, a cannula is tissued and Child A begins to be fed expressed breast milk for the first time.
The note for fluids also shows 10% glucose is provided at 8pm by Lucy Letby.

3:34pm

Swipe data shows the nurses coming on for their night shift. They include, at 7.22pm, Lucy Letby.

3:37pm

Child A was said to be 'stable' in a nursing note, which concludes 'Care handed over to Lucy Letby at 8pm'.

3:39pm

Letby's nursing note is written in retrospect at 7.56am the following day, after Child A had died.
Part of the note was 'care taken over at 8pm, emergency equipment checked, fluids calculated.
'[Child A] nursed on CPAP, peep 5-6cm in air. Observations stable.'

3:41pm

A medical note shows there is no record on the 8pm time slot of Child A's temperature - but there are other hours on the chart prior to that where the temperature is not recorded either, the court hears.

3:47pm

A chart shows any 'major events' that took place for Child A. One was UVC lines at 1pm.
The prosecution point out the '10% glucose commenced at 8.05pm', signed by Lucy Letby, as a 'major event' on the chart for the 8pm timeslot.

3:51pm

A further retrospective nursing note, by Letby, refers to the administration of 10% glucose via a long line.
Child A was noted by Letby, to be 'jittery'.

3:57pm

Records show a nurse other than Letby is 'using the computer' at 8.14-8.15pm, where she is referring to the family of Child A and B being updated on the condition of Child B.
Lucy Letby's retrospective note recorded: 'At 8.20pm Child A's hands and feet noted to be white. Centrally pale and poor perfusion.'

3:59pm

Further nursing notes are shown to the court showing the registrar was called for, as Child A had become apnoeic.
He was then 'making nil respiratory effort' and, later, no heart rate was detected.
The nursing notes record that, despite 'full resuscitation efforts', Child A 'passed away at 8.58pm'.

4:07pm

The doctor who recorded notes dealing with the efforts to resuscitate Child A, and the time of death recorded, will be coming to court to give evidence, Mr Johnson tells the court.

4:11pm

A minor technical difficulty has curtailed events at court for the day by a few minutes.
The trial will resume tomorrow morning (Tuesday, October 18).

Recap: Lucy Letby trial, Monday, October 17

 

[Tortoise]

Tuesday October 18th 2022 - Live updates from the trial

Day 3 of Evidence

10:33am

The trial is now resuming, with members of the jury filing into court.

10:37am

The prosecution is continuing its examination of the medical notes evidence, collated into an electronic bundle, for Child A.
Claire Hocknell, intelligence analyst, is talking through the various electonic slides.
The first is a slide showing which nurses were the designated nurses for the children in the neonatal unit on June 8 for the night-shift. Letby was the designated nurse for Child A.

10:52am

The court is shown a series of doctors' clinical notes, written in retrospect on the collapse of Child A before 8.30pm on June 8, and the failed attempts to resuscitate him.
The court hears the doctors, including consultant Dr Ravi Jayaram, will provide further explanations and context for their notes when they are called to give evidence in court later.

11:06am

Letby's notes, written in retrospect, record the time of death for Child A, at 8.58pm, that Child A and B were baptised together, and a lock of hair and hand/footprints taken for Child A in accordance with the parents' wishes.

11:09am

Letby searched on Facebook for Child A's mum's name at 9.58am on June 9.
A message to Letby from a colleague, shortly afterwards on June 9, following the death of Child A, began: "Luckily it doesn't happen very often here, not that that's any consolation at all."

11:13am

A nurse's note on June 9 records that the family of Child A were offered support throughout the day, and declined to receive a memory box for Child A and photographs at that time as they were too upset and bereaved.
The note concludes that the parents were made aware the mementos were there for the family to keep, when they were ready to receive them.

11:17am

Letby sent a Whatsapp message to a colleague saying she "didn't want to see" Child A's parents.
A colleague responds: "That's understandable."
Letby says: "Don't mind being in [nursery room] 1 but don't want to have [Child B]."
The colleague offers to look after Child B, with Letby also present in the room. Letby agrees and says: "I think it'd be good for you."

11:19am

Letby messages another colleague: "I think we did everthing we could under very difficult circumstances."
She added, in another message: "...I can't look after [Child B] because I just don't know how to feel seeing parents..."

11:21am

Letby responds, in regards to her previous night-shift: "It was the hardest thing I've ever had to do."

11:23am

Letby Whatsapped a colleague, after her night shift started on June 9, to say: "Hard coming back in tonight."

11:29am

The evidence documents move to the non-fatal collapse of Child B.
A nurse records Child B's CPAP prongs were found to have been pushed out at midnight, and Child B collapsed at 12.30am.

11:40am

Letby is recorded making another search on Facebook for the mum of Child A and B at 11.31pm on June 10.

11:42am

A further search is made on June 25 at 9.50pm.

11:50am

The court has also been shown a series of messages sent between Letby and nursing colleagues in relation to the death of Child A and the non-fatal collapse of Child B.
On June 30, following the deaths of Child A, C and D, and the non-fatal collapse of Child B, Letby's colleague messaged her there was something 'odd' about that night.
Letby replies: 'What do you mean? Odd that we lost three and in different cicrumstances?'
Letby's colleague responds: "I don't know, were they that different?"
The colleague added: "Ignore me, I'm speculating."

1:20pm

A small clarification for the 11.50am entry - the messages between Letby and her colleague, written on June 30, initially talk about 'that night' as the night Child A collapsed. The conversation then moved on to the wider topic of Child A, Child C and Child D having collapsed and died in the same month (June).
Letby's messages from and to her colleagues will be revisited by the prosecution later in the trial.

LIVE: Lucy Letby trial, Tuesday, October 18

 

[Tortoise]

Tuesday October 18th 2022 - Live updates from the trial

Day 3 of Evidence

12:03pm

The court had earlier heard messages sent between Letby and colleagues.
Letby said in one message to a colleague, regarding the death of Child A: "Think we all need answers."
She later messaged to say she had been watching 'An Hour to Save Your Life', about a life working in a neonatal unit.
Letby's colleague responded: "...don't really watch things like that...get enough in work".
Letby responded: "I just find it interesting, to see how our work is portrayed to the public."

12:07pm

Letby later messaged another colleague, who had been off work after looking after Child A, to say: "Hi [nurse] - you may have heard by now but wanted to let you know that we lost little [Child A] on Monday. Knew you looked after him."
The colleague responded: "I didn't know actually, thanks for letting me know. That's terrible!"
Letby: "It was awful...he died very suddenly and unexpectedly just after handover. Not sure why. It's gone to the coroner."
The colleague: "Oh god, he was doing really well when I left."

12:08pm

Letby had made a further search on Facebook for the mum of Child A on September 2, 2015.

12:10pm

In the same conversation between Letby and her colleague, Letby said: "I was not supposed to be in either - [boss] swapped my nights as unit busy - but these things happen unfortunately."
Letby's colleague: "Yeah it's the business we are in unfortunately...hopefully [Child B] will be ok in the end."

12:21pm

Intelligence analyst Claire Hocknell is continuing the walkthrough of electonic evidence to help jurors navigating through it.

12:24pm

Ms Hocknell confirms to the court that not all messages found on Letby's phone are in the evidence bundle; some messages are ones which the prosecution and defence are aware of, but do not deem that relevant for the case.

12:31pm

Kate Tyndall, intelligence analyst employed by Cheshire Police, is now giving evidence.

12:40pm

Ms Tyndall is showing the jury a walkthrough of the 'neonatal unit review schedule' electronic documents, which are to be presented to the court.
The talking through of this set of evidence is for Child A. It is a seven-page document showing a timeline of data for all babies being treated in the neonatal unit around the time of Child A's collapse.
It is split into the date and time, the baby's name, what type of record is made, a summary of that activity, the member of staff administering that activity (if known), and a cross-reference to where further details of this activity can be found in the electronic evidence bundle.

12:50pm

The timeline highlights events for Child A and recorded activity for Lucy Letby.

1:03pm

Ms Tyndall has finished giving her evidence.
The court is now adjourning for the lunch break, and will resume later today.

LIVE: Lucy Letby trial, Tuesday, October 18

 

[Tortoise]

Tuesday October 18th 2022 - Live updates from the trial

Day 3 of Evidence

2:10pm

The trial has now resumed.
The next electronic evidence bundle is being shown, for Child B. Intelligence analyst Claire Hocknell has returned to give evidence.

2:34pm

The medical notes presented to the court are in the same format as for Child A.

2:45pm

Child B's lungs were examined to be "clear" and the child was "very alert" and "active", on the morning of June 9.
A 'weaning programme' note is made at 11am, which is for the weaning of Child B off breathing support.

2:49pm

A further nursing note showed Child B was 'very stable' after being weaned off CPAP and allowed time to be with Child B's mum, before returning to CPAP with a view to further weaning off.

3:00pm

A nursing note recorded in the afternoon of June 9 said "maximum support" was being offered to the family of Child A and B, who were still "understandably" very upset.

3:07pm

A diagram of the neonatal unit, showing which nurses were designated to which rooms during the relevant shift on the night of June 9, is presented to the court.
Child B is in room 1, while Letby is assigned to look after two babies in room 3.
The court hears one of Letby's colleagues is the designated nurse for Child B and another baby in room 1. Following Child B's collapse, another nurse took over looking after the other baby in room 1.

3:19pm

Nursing notes written by the designated nurse, written in retrospect, found Child B's CPAP prongs had been pushed out of the nose, and oxygen saturation levels had fallen to 75%, before midnight. The prongs were repositioned, and after "a little while", the oxygen levels recovered.
The heart rate was stable and there was "good respiratory effort throughout". Child B was observed to be "stable" prior to midnight.
Letby is then involved with administering nutrition at 12.05am.

3:23pm

Letby is a co-signer for the nutrition prescription at 12.05am on June 10.

3:30pm

A blood gases record by Letby of Child B is made at 12.16am and another at what appears to be 12.51am, the latter "during neopuffing".

3:33pm

The designated nurse's record for the desaturation and collapse event at 12.30am, written retrospectively, includes the notes: "Sudden desaturation to 50%.
"Colour changed rapidly to purple blotchiness with white patches.
"Emergency call for doctors put out."
A 'fast bleep' alert for a nurse to attend the neonatal unit as soon as they can is made at 12.33am.
The court hears this is a 'crash call'.

3:40pm

Following emergency treatment, Child B was placed on a ventilator and 'good air entry' was noted. A doctor entered the neonatal unit at 12.34am and the on-call consultant was called at home at 12.36am.
Child B's "colour started to improve almost as quickly as it had deteriorated", and morphine treatment began, while the parents were called to the unit and kept informed at cotside.

3:43pm

Clinical notes recorded by the consultant recorded for 12.50am: "Suddenly purple blotching of body all over with slowing of heart rate.
"Bagged and then tubed by registrar. Heart rate came up. Adrenaline not required."

3:45pm

Letby is recorded taking the hourly observations at 1am for Child B in room 1.
The prosecution reminds the court Letby was the designated nurse for two babies in room 3 at the start of her shift.

3:48pm

A note timed at 1.09am from an x-ray said Child B's lungs were "mildly hyperinflated" and "clear".

3:52pm

Child B was also noted, from a note at 12.45am, to have a "full/mildly distended" abdomen.

4:02pm

Further medication is administered to Child B during the night, with Letby again listed as a co-signer.

4:06pm

At 2.40am, the 'purple discolouration' had been 'almost resolved'. The cause was '??', and Child B had been 'stabilised at present'.

4:32pm

Our coverage of the Letby trial has concluded for today.
We will be back tomorrow for the resumption of the trial as the prosecution continues to give evidence.

Recap: Lucy Letby trial, Tuesday, October 18

 

[Tortoise]

BBC report - day 3 of evidence:



[...] Five days later, she told a colleague Child B had moved to a recovery room in the unit following her collapse earlier in the month.

Her colleague told her there was "something odd about that night and the other three that went so suddenly", which prompted Ms Letby to ask: "What do you mean? Odd that we lost three and in different circumstances?"

The colleague messaged back to question if they were different, adding: "Ignore me, I'm speculating."

Ms Letby then replied again, stating that Child C "was tiny, obviously compromised in utero. [Child D] septic. It's [Child A] I can't get my head round."

The court was told a staff debrief into the death of Child A was held on 30 July.

Ms Letby is alleged to have murdered a fifth baby, Child E, on 4 August and then tried to kill his twin brother, Child F, the next day.

[...]

Lucy Letby: Nurse told colleagues of baby death heartbreak, court told

 

[Tortoise]

Wednesday October 19th 2022 - Live updates from the trial

Day 4 of Evidence

9:25am

This will be the eighth day the jury will have been in Manchester Crown Court for the trial.
A reminder that the case is expected to last six months. The 12 jurors have to make themselves available for every day the trial will be taking place.

10:35am

The trial is now resuming, with Nicholas Johnson KC prosecuting.

10:36am

Claire Hocknell, intelligence analyst employed by Cheshire Police, is continuing to provide the jury with a walkthrough of the electronic evidence bundle in relation to Child B.

10:39am

A nursing note made by one of Letby's colleagues on Wednesday, June 10 at 8.09am recorded that the family were "very upset" after the non-fatal collapse of Child B at 12.30am the previous night.
Child A, the twin brother, had earlier died on the evening of June 8.

10:45am

A message sent from Lucy Letby on Whatsapp to a colleague at 12.04pm included the request: "Will you let me know if any change with [Child B]."

10:53am

The colleague's response said the shift had been "manic", and there had been "no change" with Child B.
Letby enquired again about Child B that night, at 10.08pm, and was informed Child B was "looking really good".

10:58am

A text message at the end of June, from Letby, said: "I had a mini meltdown last night about what's happened at work...
"I just need some time off with mum and dad."
The message was sent following the deaths of Child A, C and D and the non-fatal collapse of Child B.

11:10am

Ms Hocknell is asked by the defence about Letby's Facebook searches.
She is asked whether Letby searched on Facebook for the parents of children other than those listed in the charges.
Ms Hocknell confirms that is the case. "There are a lot of searches for different people."

11:12am

Further agreed evidence is now being read out to the court.

11:16am

The consultant doctor who looked after the mum of Child A and Child B said he had no recollection of the delivery, but could recall the pre-existing conditions the mum had and the "intensive input of care" she received as a result.
He said the mum was classed as a "high risk" pregnancy.


11:19am

The consultant recalls in his statement he first met the mum on June 7.
"An extensive plan" of care had in place for her by other consultants.
He was later informed of a "deterioration" in her blood results and a rise in her blood pressure.
The decision was made to transfer the mum to a labour ward to stabilise the pressure.


11:23am

The consultant added further medication was administered to try and stabilise the blood pressure, and the decision was taken to deliver with the permission of the mum.
The mum was transferred into the theatre for delivery.

11:25am

Further medication was administered in the theatre as the mum's blood pressure remained high, the consultant adds.
The consultant said the priority was to stabilise the mum's blood pressure before general anaesthetic was administered.

11:27am

There were "no complications" and "minimal blood loss" in what was described as a "routine Caesarean section operation".

11:30am

The court is now hearing a statement from a midwife at the Countess of Chester Hospital, which again is 'agreed evidence', in that neither the prosecution or the defence dispute its contents.

11:38am

The midwife recalled her memory of that night shift, and had recorded that following the birth, she told the parents the babies were "doing well".

11:54am

The next 'agreed evidence' statement is from Dr Gail Beech, who worked at the Countess of Chester Hospital at the time.
She recalls, in a statement, the care she provided to Child A in the minutes after he was born, including breathing support via a neopuff device to inflate the lungs, to get the required heart rate. Child A then cried.
Further ventilation support was given to Child A with the neopuff device "for a short time" to reduce the pauses in between breathing.
He was then recorded as having "very good" oxygen levels, so the use of the neopuff device was reduced and Dr Beech noted Child A was "fully breathing by himself".
Administering breathing support was "not expected" for a pre-term baby.
The decision was then taken to transfer him to a neonatal unit.
Dr Beech recalls showing Child A briefly to his family en route to the unit.

11:57am

She recalls 'chest compressions' were seen on Child B, which she interpreted as "a bad sign".
"It was difficult to know which baby to assist," Dr Beech recalled, as Child A was still not yet stable.
Another doctor entered and Dr Beech said for that doctor to look after Child B.
Dr Beech said she did not have any direct care for Child B that night shift.

LIVE: Lucy Letby trial, Wednesday, October 19

 

[Tortoise]

Wednesday October 19th 2022 - Live updates from the trial

Day 4 of Evidence

12:17pm

We've had a short adjournment - and the prosecution will now continue giving agreed evidence.

12:21pm

Dr Beech's recorded observations at the time (June 9) for Child B are shown to the court. There was 'suspected sepsis' and 'jaundice'.
A management plan to 'start allowing time off CPAP', among other treatments, is noted.

12:26pm

Dr Beech's note at 2.50pm asked for an "urgent post-mortem" for Child A to look for signs of thrombosis, "as this may have implications for [Child B]".

12:33pm

A video is now played to the court of what the interior of the Countess of Chester Hospital neonatal unit nursery room 1 looked like.

12:36pm

An agreed evidence statement by Dr Andrew Brunton is read out to the court.
He records that at 11.50pm on June 7, he carried out observations for Child A, who "appeared well" and was "clinically stable on CPAP".

12:42pm

An x-ray review had shown Child A had a symptom of newborn respiratory distress syndrome, but this was "nothing unusual" for a pre-term baby. The review was recorded during the night of June 7.

12:52pm

The next agreed evidence comes from someone who was a trainee doctor at the time, who is explaining how certain medical procedures were carried out for Child A.

12:59pm

The trainee doctor was called to insert a UVC (a catheter) into Child A on the afternoon of June 8. Following an X-ray, the catheter was "not ideally placed".
The trainee doctor then removed and re-sited the UVC, following discussion with more senior doctors.

1:20pm

The court has adjourned for the lunch break.
It will resume with further prosecution evidence later this afternoon.

LIVE: Lucy Letby trial, Wednesday, October 19

 

[Tortoise]

Wednesday October 19th 2022 - Live updates from the trial

Day 4 of Evidence (continued)

2:09pm

The trial will resume shortly at Manchester Crown Court.

2:13pm

The prosecution is now giving an agreed evidence statement from Dr Sally Ogden, who looked after Child A.

2:31pm

A short adjournment is now being made for preparations to be made for the next witness due to give evidence in court.


2:38pm

The next witness to give evidence is Melanie Taylor, who is in court. She was employed as a nurse at the Countess of Chester Hospital in the neonatal unit in 2015.


2:52pm

The court hears she came on duty at about 7.30am on June 8, the twins having been born the previous night shift.
A computerised record shows she was the designated nurse for that day shift for Child A.
Miss Taylor explains records of the various medical charts would be cotside, including hourly observations.
"The observation charts would be written as we were doing them," Miss Taylor explains.

3:02pm

Miss Taylor confirms she had recently become a band 6 nurse in 2015, having worked at the hospital for several years.
She tells the court Child A and B were in neighbouring incubators in the neonatal unit.
Child A was "stable", on nasal CPAP.

3:10pm

Miss Taylor explains the medical observations made for Child A during the day shift, via retrospective notes.
The respiratory rate was 'slightly raised at times', but Miss Taylor said this was not unusual.

3:21pm

Miss Taylor: "I had no concerns with him, he was stable - on CPAP, but stable.
"One thing was he didn't have fluids for a couple of hours because of issues with lines.
"The cannula - that 'tissued' at some point during the shift [the vein has 'gone' and it cannot be suitable for a cannula to be used there].
"A UVC was attempted to be put in - but it has to be x-rayed and under sterile conditions and in the right position before we can use that line."
The UVC was in the 'wrong position' twice - it had been taken out and re-inserted, but was still in the wrong place. Another option was sought.
"They attempted to...[use a] long line, which again has to be done under sterile conditions by a doctor, and again x-rays have to be used."
Miss Taylor said Child A would not have had fluids for 'about a couple of hours'. A reading on the chart to say 'cannula tissued' is made by Miss Taylor in the 4pm row.
A small amount of expressed breast milk is administered at 4pm and 6pm via the naso-gastric tube.

3:26pm

Miss Taylor said she had "no concerns" from the neonatal intensive care unit observation chart measuring Child A's heart rate, respiratory rate and body temperature each hour.

3:31pm

An addendum by Miss Taylor just after 7pm recorded the UVC was in the wrong position, and was reinserted, but was still in the wrong position.
Notes shown on the screen record: "Aware no fluids running for a couple of hours," adding a long line was inserted by the registrar.

3:41pm

Miss Taylor said she would have relayed the observations to Lucy Letby at the hand-over, and there were no concerns other than the lack of fluids Child A had had for a couple of hours.
The 10% dextrose IV fluid is prescribed, via long line, prescribed by a doctor. A prescription form is shown the court and Miss Taylor explains the various columns and signatures.
Miss Taylor: "All fluids will be checked by two nurses - it is signed [on the prescription form] that I have checked it with Lucy Letby."
The time and date the medication is started is June 8 at 8.05pm.


3:46pm

Miss Taylor explains emergency equipment checks are made at the time of the hand-over - in this case, 8pm.

3:54pm

Miss Taylor said she would have started writing up a nursing note, but Child A then started deteriorating, so the note would not have been saved on the computer.
She said she would have been able to see Child A's incubator when sat at the computer.
She said: "Lucy Letby was standing by the incubator. Initially I stayed there [when Child A started deteriorating] as he was fairly stable and Lucy Letby was there, but when I realised he was not recovering from deterioration I got up to help Lucy Letby."
She said the baby monitor would have alarmed.
Miss Taylor said she is unable to say how long she had been away from the incubator, and thinks it was after the dextrose was administered.
Miss Taylor said she thought Child A was going to recover "quite quickly" as such desaturations were not that uncommon, but when it became clear he was not going to recover she went to help.
"I kept thinking he was going to recover, but he didn't."
Miss Taylor said she was not directly involved in the resuscitation, but involved in getting adrenaline medication.
The following day Miss Taylor was called back to the hospital to finish the notes which had not been completed at the time, 'due to the trauma of what had gone on'.

LIVE: Lucy Letby trial, Wednesday, October 19

 

[Tortoise]

Wednesday October 19th 2022 - Live updates from the trial

Day 4 of Evidence (continued)

3:55pm

Ben Myers KC, for the defence, is now questioning Miss Taylor.

3:57pm

Mr Myers: "Do you find that even with the notes, it can be difficult to recall what happened?"
Miss Taylor: "It is, but...in my witness statement, if I was not sure, I said I was not sure."

4:02pm

Mr Myers examines the staffing levels at the Countess of Chester Hospital neonatal unit.
'For babies in intensive care, it should be one nurse to one baby', he tells the court, and 'one nurse to two babies' for high-dependency babies, and 'one nurse to four babies' in the special care nursery room, he tells the court.
Rotas would be relayed to staff "a month in advance", Miss Taylor says.
"If they [the neonatal unit] were busy", then some nurses would be asked to come in "at short notice".

4:06pm

Miss Taylor explains the shift leader gives the hand-over to the new nurses coming in for the following shift in a 'huddle', lasting '10-15 minutes'. The shift leader would be a 'band 6 nurse'. The shift leader is "usually pre-allocated", but could change.
There would be a 'handover sheet' with babies' names and an outline of care provided the previous shift.

4:07pm

Mr Myers: "And that handover sheet would be kept by him or her throughout the shift?"
Miss Taylor: "Yes, that's correct."

4:08pm

"Generally," that handover would last until about 8pm, the court hears.

4:13pm

Mr Myers explains that some duties "require two nurses", such as administering medication and checking it is correct.
Mr Myers points to a section of the intensive care unit chart for Child A, where a different nurse to the designated nurse has signed for the observations at 4am on June 8. The designated nurse has signed for other hours including 2am, 3am and 5am.
He asked Miss Taylor: "There is absolutely nothing unusual about that, is there?"
Miss Taylor responds: "No."

4:18pm

The court is now adjourning for today.
Mr Myers will continue to ask Miss Taylor to give evidence tomorrow (Thursday, October 20).
We will provide updates throughout the day.

LIVE: Lucy Letby trial, Wednesday, October 19

 

[Tortoise]

"Paediatric registrar Dr Sally Ogden clocked off on June 8 before Child A’s rapid deterioration on the night shift. [...]

Dr Ogden returned to duty for the following day shift and she and her team were told by a fellow doctor that Child A had died during the evening, the court was told.

In a witness statement, the registrar said: “I remember this came as a big surprise. It was completely out of the blue and very upsetting.

“(Child A) showed no signs of any problems throughout the day. He was handling well.

“I had no concerns at all for him or his twin sister.”"

Death of baby in Lucy Letby case came ‘out of the blue’, says witness

 

[Tortoise]

Thursday October 20th 2022 - Live updates from the trial

Day 5 of Evidence - continuation of cross-examination of nurse Melanie Taylor


10:00am

When the trial resumes this morning, Letby's defence, led by Ben Myers KC, is expected to continue to question nurse Melanie Taylor about the night Child A died on June 8, 2015.

10:33am

The trial has now resumed.
Mr Myers asks Miss Taylor about the layout of the Countess of Chester Hospital neonatal unit.

10:38am

Mr Myers said Child A would have required "constant observation" despite being deemed "stable" in the neonatal unit. Miss Taylor agrees.
He added that pre-term babies would also be "prone to infection". Miss Taylor agrees.
Mr Myers: "They can be prone to collapses, can't they?"
Miss Taylor: "I don't know if I would agree with that, exactly."

10:44am

Mr Myers said a baby fitted with a UVC would be 'intensive care'. Miss Taylor agrees. Child A had become an 'intensive care baby' during the day shift as he had required.
Mr Myers said Miss Taylor would have been looking after an intesive care baby (ITU), as well as another baby which required a lot of care - which falls outside the guidelines.
"In terms of ITU, they technically are intensive care, but not as intensive - some babies require a lot of hands-on, one-to-one care. Some technically become ITU, but in terms of care, they are more like HDU."
Mr Myers: "Were there, at the time, a lot of poorly babies?"
Miss Taylor said that particular shift was a busy one, she recalls. She accepts that an increased number of poorly babies coming into the unit would create an increased demand on nursing staff.

10:45am

Mr Myers asks why a baby's temperature would not necessarily be recorded every hour on the chart.
Miss Taylor says the temperature records involve putting a thermometer under the baby's arm, which the "babies don't like", while a heart rate is done on the monitor, while the respiratory rate would be manually counted through observation.

10:49am

Mr Myers asks if handling babies (for example, to take their temperature) could led to an increase in the baby's stress, which would lead to an increased risk of deterioration.
Miss Taylor: "...to a certain degree, yes."
She adds if a temperature is recorded for one hour in a stable reading, the baby's temperature would not necessarily be taken on the following hourly check.

10:55am

Melanie Taylor's nursing note for June 8 is shown to the court, at 1pm.
It documents the insertion of the UVC for Child A.
Miss Taylor said she cannot remember the two attempts of insertion of the UVC, but sees it is made on her notes.
The note, written at 7.05pm, says: "UVC in wrong position, reinserted...again in wrong position. Cannula tissued. Doctors busy on ward 30. Aware no fluids running for a couple of hours. Long line inserted by Reg Harkness. awaiting X-ray. Remains settled on NCPAP. Enteral feeds of donor expressed breast milk started at 1ml/2hourly."

10:59am

The intensive care chart is shown to the court, showing 'cannula tissued' at 4pm.
Miss Taylor explains she might have written 'cannula tissued' retrospectively, so it could be before or after 4pm when that was noted.
Mr Myers said Miss Taylor would have had to wait for a doctor to put a long line in.
Mr Myers: "You said it was very busy - and that caused a delay, didn't it?"
Miss Taylor: "Yes."

11:05am

Mr Myers: "It's important to make sure the tip of the long line is in the right position, isn't it?"
Miss Taylor: "Yes."
"It's a sterilised procedure? It's very thin."
"Yes."
Miss Taylor says she's not too familiar with the long lines as she is not involved with the procedure.
The judge clarifies Mr Myers' question, asking if it is important to get fluid in once the long line is in place. Miss Taylor agrees.

11:08am

Miss Taylor says she is not aware of anything that might have been running through the long line prior to the 8pm 10% dextrose administration.
Mr Myers adds "the conventional practice" is for fluids to be administered immediately in the long line after it is inserted.
"Yes. Ideally we would get an x-ray first."
Mr Myers says there was a delay because the doctor was delayed elsewhere.
Miss Taylor: "I think so."

11:12am

Miss Taylor is asked about the retrospectively written note at 9.28pm on June 8, which begins.
"Observations stable, pink, well perfused. UVC still insitu, but in wrong position, to be used if no other access available.
"Long line inserted by reg Dr Harkness, secured, x-rayed. 10% dextrose run through and connected to long line."

11:17am

An observation chart showing the respiration rate is 'elevating', Mr Myers says, throughout the day is shown to the court.
"Yes, a little," replies Miss Taylor.
A blood gas record chart shows the lactate levels had increased on the records of 12.13am, 6.37am and after 2pm, with levels at 1.6, 2.6 and 2.7. The latter two readings are, Mr Myers says, outside of the desired area. No other records are given.

11:21am

Miss Taylor says she does not know what time the long line was inserted.
Mr Myers says there was a delay in getting the x-ray.
Miss Taylor: "From memory, I cannot remember the timings, but possibly."
Letby's notes, written retrospectively at 7.56am on June 9, are shown to the court. They begin: "Glucose commenced via long line...UVC remained in situ from day shift, instructed line not to be used by registrar.
"[Child A] noted to be jittery, was due to have blood gas and blood sugar taken.
"At 8.20pm [Child A] hands and feet noted to be white. Centrally pale and poor perfusion..."
Mr Myers: "He should have been getting fluids during this four-hour period, shouldn't he?
Miss Taylor: "Yes."

11:24am

Miss Taylor says she cannot remember whether it was herself or Lucy Letby who administered the fluids.
Mr Myers said "two nurses" are involved in the process, and one has to be in sterile conditions.
Miss Taylor: "I honestly don't know whether it was me or Lucy [who was in sterile clothing]."

11:26am

The defence say it was Miss Taylor who was the one in sterile clothing for the fluid administration, with Lucy Letby assisting. Miss Taylor says it could have been that, or the other way around.

11:30am

Mr Myers: "When the deterioration commenced, you were at your computer making notes?"
"Yes."
A note by Miss Taylor is made at 8.18pm for Child B.
"It shows you were at the computer at 8.18pm?"
"Yes."
"Was Dr Harkness also in that room?"
"I don't remember."
"You could see where [Child A] incubator was, and the alarm sounded."
"Yes."
"When you went over to Child A, could you recall whether he was breathing or not?"
"I don't recall."
"Would it be fair to say that what followed makes it difficult to recall - that there is a lot of activity surrounding the cot?"
"When you realise that extra support is needed, yes."

11:31am

Mr Myers: "Lucy Letby went to support the family at one point, do you recall that?"
Miss Taylor: "I don't remember that."
Miss Taylor says if Letby was the designated nurse, she would be involved with assisting the resuscitation attempts.
She adds that designated nurses would often be the one to provide support to the family afterwards.

11:32am

Memory boxes, Miss Taylor says, are collated with permission of the family.
Mr Myers: "Do you recall about whether there was any discussion about whether the fluid bag should be kept?"
Miss Taylor: "I don't recall that, no."

11:39am

Miss Taylor is presented with an interview transcript, dated February 7, 2018, one of a series of interviews she had involving babies in her care at the Countess of Chester Hospital.
The interview says Miss Taylor believed that sometimes, babies collapsed with no explanation.
Miss Taylor: "When I said that, that is what I believed to be true - whether that's my rational brain, trying to rationalise what happened."
Mr Myers reads from the statement: "It's a shock to us, because we have such a low rate."
Miss Taylor: "That is what I believed, that was my opinion at the time. I tried to rationalise what happened at the time. Whether that's true - I'm not medical - but that was my opinion at the time."

[My note: Redirect - Prosecution]

The prosecution say this interview concerned a different set of twins.

Miss Taylor: "I feel like I shouldn't have said that - I tried to rationalise that, because as a nurse, that is what I tried to do."

11:43am

The prosecution shows the intensive care chart to the court again, focusing on the feeding records between 4pm-8pm.
The feeding of expressed breast milk at 4pm and 6pm were "trophy feeds". Miss Taylor explains small amounts of food are for the stomach to be lined so it could help get the stomach used to future feeds.
A 6pm 'output' of 25mls of urine is noted. Miss Taylor says that is weighed via the nappy - a "tried and trusted method", the prosecution say.
"Does that show fluids were passing through [Child A]?"
"That does."
"Does it follow that fluids that go out must have gone in?"
"It does that fluids that have gone in through the day, yes."

11:48am

Blood gases records were noted by the defence as "being outside the optimum range".
The prosecution say with those records in mind, was Child A still 'stable'?
Miss Taylor: "Yes."
She explains the elevated respiratory rate was not uncommon, and other symptoms, such as the baby grunting, would be noted as part of a bigger picture. The elevated respiratory rate and blood gas level would not be, in isolation, uncommon, but still "relevant".
Miss Taylor says she does not remember Child A being "jittery", and had not documented it in her notes. She says if she had seen Child A being jittery, she would have noted it.
She adds it would be considered as part of a bigger picture. "It does not necessarily [mean] a concerning cause, but it is something to consider."

11:49am

That concludes Miss Taylor's evidence for Child A and B.
The court hears she will be asked to return to court to give evidence on other babies.

LIVE: Lucy Letby trial, Thursday, October 20

 

[Tortoise]

Thursday October 20th 2022 - Live updates from the trial

Day 5 of Evidence - Evidence of Dr David Harkness - Re: Child A

12:07pm

The next witness to give evidence is Dr David Harkness.
The court hears that in 2015 he was a paediatric registrar, sometimes based at the Countess of Chester Hospital.
He confirms he has, since then, been interviewed by police, and made witness statements about more than one baby which was a patients at the neonatal unit.
He is being asked about the case of Child A.

12:12pm

He confirms that at the time, he was a registrar and was on duty on the evening of June 8.
His clinical notes, written in retrospect at 9.30pm, record for 5pm: "UVC in situ on my arrival on NICU at 5pm. No definitive access at this point, so I've left in situ with plan to remove if long line sited or pull back to low position is long line not successful."
He said he was looking after children outside of the neonatal unit prior to 5pm, and on his arrival, his "first port of call" was seeing Child A.

12:15pm

He says the UVC is preferred as a feeding method to the long line, and can be moved to a low position as a short-term measure until something better is in place.
The prosecution say a UVC was in place, an x-ray was taken before it was used for purpose of administering fluids.
If it is "imperfect" in position, the options are withdrawing, or adjusting it. The latter would be on a short-term basis. The doctor agrees.

12:19pm

A note by Dr Harkness at 7pm: "Long line inserted at 1st attempt."
A sticker confirming the insertion of the long line is placed.
An x-ray review sticker is also placed, timed 7.09pm.
Dr Harkness said he was junior at the time, so would have recommended the long line be moved back slightly, as outlined in his recorded note, but now he would say the long line was in the right position.

12:24pm

Dr Harkness said because the night of June 8 was a "traumatic event", his memory of entering the unit room was "quite fresh" and he explains there were three babies in the nursery room 1 - the intensive care unit, at the time, and two of them would have been Child A and Child B. He describes which incubators they would have been in, which are adjacent to each other.
A video of the layout of the nursery room one is played to the court and Dr Harkness confirms where Child A and Child B would have been located.

12:31pm

Dr Harkness's x-ray review said at the time the x-ray was available to review, he was "scrubbed inserting a line into another patient", which meant he had to adhere to sterilised conditions, he explains.
The doctor's opinion at the time was the position of the long line was "less than perfect", the prosecution said.
Dr Harkness said that following consultation and in accordance with guidelines, the position of the longline was "actually correct".

12:35pm

He said he was "just about finished with [another baby]" when he was called to Child A at 8.26pm.
Bagging was started "via Neopuff immediately".
The saturations, which "should be in the 90%'s", were in the '70s-80%'s'. The heart rate was "slightly on the lower side", Dr Harkness records.
He said he can remember the events.

12:37pm

He said he was called "by nursing staff" over problems with Child A's breathing.
A junior doctor took on the responsibility of making contemporaneous notes for Dr Harkness during the event, the court hears.

12:39pm

He said it was "most likely nursing staff" who started the Neopuff bagging process by the time he arrived.
"Good chest movement seen" meant there was not a blockage, Dr Harkness explains.

12:44pm

Dr Harkness said as far as he was concerned the longline was the last thing which was inserted, so he removed it at 8.27pm.
He said: "That was my immediate thought. In hindsight...there was no possible link [between its insertion and the collapse]."
He said if the long line had been moved further in, towards the heart, it could have caused a significant increase in the heart rate, or other heart complications. There was no evidence then, or since, which had supported that, he explains.
Help was called at 8.27pm.
Child A was "intubated at the first attempt".

12:56pm

The note records intubation was at 8.28pm.
Child A's heart rate fell to 60-70 the same minute, it was noted. Dr Harkness had said ideally the heart rate should be above 100, and chest compressions are started when the heart rate is at 60.
Chest compressions were started and fluids including adrenaline are administered.
The court hears while air was still getting into the lungs, "unfortunately" there was no heart rate detected at about 8.33pm.
Further chest compressions and medicinal doses are given up to 8.49pm.
A heart rate of 50-60 is noted at 8.50pm, and a further adrenaline dose is given, but then there is no heart rate again, and CPR continues until 8.57pm.
At that point a review was carried out by Dr Ravi Jayaram in attendance, and no heart rate was present.
Dr Harkness says: "It was felt the kindest thing to do was to stop resuscitation."

1:17pm

Dr Harkness said the circumstances of Child A's death were "very unusual and very unexpected."
He said: "It was very surprising to be called back [to Child A] at this time [as he had been stable].
"It was very unusual - the skin [patterns] I had never seen before, and I have only seen again at the Countess of Chester Hospital.
"I was faced with a baby unexpectedly deteriorating."
Dr Harkness noted there was "unusual skin colouring."

1:20pm

Dr Harkness said he had only ever seen this "patchy" skin colouring and pattern in one other baby at the Countess of Chester Hospital, when dealing with the case of Child E and F.

1:56pm

Dr Harkness said he could not remember the exact pattern of the skin at the time as he was "busy trying to save [Child A's] life" at the time, but "it was unusual enough for me to make notes and document it."
He added he had, with his experience of being a doctor, "unfortunately" seen dying or dead children patients and the type of skin blotching and patterns that would be found, "but not a pattern like this".

2:16pm

Dr Harkness is asked to examine a clinical note.
During the time he was looking at a third baby in the room, he was scrubbed up and sterilised for a procedure which "takes a lot of concentration."
"Typically, you are left to your own devices."
He said it was shortly after that (about 1-2 minutes), he was urgently called to Child A.

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