Prosecution evidence, February 22nd 2023, Day 59
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Twin - Child M
Consultant Dr Ravi Jayaram 9th April 2016
Paediatric consultant Dr Ravi Jayaram is now in the witness box. Dr Jayaram was the on call consultant on 9 April
Asked if any concerns about Child M had been brought to his attention at the start of his shift that day, he said 'no, not at all'
Dr Jayaram recalls receiving a crash call - as it was a Saturday he doesn't remember whether he was on site or at home at the time. When he arrived on the unit, Child M was receiving CPR
Dr Jayaram is taking the court through his notes from 9 April. They show he arrived at 16:15. Child M had already received three doses of adrenaline and had been intubated
Dr Jayaram recalls having a conversation with Child M's family after 20mins of resus about whether they should stop. 'Generally the longer it goes on for, the less likely it is to have a good outcome. These decisions are very, very difficult', he tells the court.
He said after 25mins, Child M 'suddenly recovered' - he said it wasn't due to a 'any specific intervention' by medics
'I couldn’t really explain what had caused it and why he suddenly got better', he added.
Dr Jayaram tells the court that during CPR he noticed 'bright pink blotches' on Child M's torso - these blotches 'would appear and disappear'
He said once circulation was restored and Child M was stable 'they vanished'. Dr Jayaram tells the court that he observed similar blotches in another baby in this case - they later prompted him to begin researching air embolis (the injection of air) as a potential cause
He told the court: 'In June 2016, after a number of further unusual, unexpected and inexplicable events on the neonatal unit, the whole consultant body sat down and thought we have to work out what's going on here.
'One of the things that came up in discussion was could this be air embolis, I can’t remember who suggested it.
'It prompted me to do a literature search. I remember sitting on my sofa at home with my ipad, researching. I remember the physical chill that went down my spine when I read that because it fitted with what we were seeing'
Cross-Examination
Ben Myers KC, defending, is now questioning Dr Jayaram. He points out that his notes from the time of Child M did not make any reference to 'pink blotches' - he says surely this would be an important detail that should have been recorded
Mr Myers suggests it is 'incompetent' not to have noted the blotches - Dr Jayaram explains at the time many other things were happening and full relevance of blotches wasn't realised
Mr Myers said: 'Details of decolourisation doesn’t appear in notes or statements because it is not what you saw, is it?' Dr Jayaram again rejected the assertion.
Mr Myers went on to claim that Ms Letby had been “a focus of interest” for Dr Jayaram since the death of another child in this case, Child D, in June 2015.
He told the court another senior medic, Dr Stephen Breary, had “flagged” to Dr Jayaram that Ms Letby had been working when a number of infants had collapsed or died in that month.
“All eyes were on Ms Letby then”, Mr Myers said.
“Clearly yes”, Dr Jayaram said.
Mr Myers said in that case, there is “absolutely no way” he would have failed to record the blotches on Child M. Dr Jayaram again explained: “I recorded what I felt was relevant.”
