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

[Tortoise]

Wednesday October 26th 2022 - Live updates from the trial

Day 9 of Prosecution Case

Cross-Examination of Expert Witness Dr Sandie Bohin - re Child A and Child B

10:52am

Ben Myers KC, for Letby's defence, is now asking questions to Dr Bohin.
Mr Myers asks if it is important that medical experts have current day-to-day experience in a medical environment.
Dr Bohin: "Not necessarily no - what you can't do is dispel the exerience they have had over many years."
She adds it is not "crucial" they have on-the-job current day-to-day experience. After further questions, she said such experience would be "advantageous".

10:56am

Mr Myers refers to GMC guidance in giving evidence as an expert witness, and asks if someone who retired from clinical practice is still in the same position to give evidence for events which happened in 2015.
Dr Bohin says comeone does not lose their knowledge after retiring from on-the-job clinical practice, but if they keep up to date with clinical practice, they are not at a disadvantage.

10:58am

Dr Bohin said the first time she had contact with other medical expert Dr Evans was earlier this year, to discuss one of the cases in the trial, via a telephone conversation, as there had been a difference of opinion.

11:01am

Dr Bohin said she had previously seen one example of an air embolus, and it was in a neonatal case, but was "very long ago". She said she could not recall the specifics of the case, but the air bubbles seen in the imagery were "very striking".
She said she had formed her views after excluding other possibilities.

11:04am

Dr Bohin said she is unaware of any genetic condition which would cause a baby to collapse and die within 24 hours.
She said genetic screening would only be done if staff had a suspicion the baby had a genetic condition.

Child A

11:07am

Mr Myers says Dr Bohin said Child A was "extremely stable" prior to collapse.
She said there was "nothing which was cause for concern".

11:09am

The blood gas record for Child A is shown, and Dr Bohin says the lactate number of 2.6-2.7 is 'slightly elevated' (a normal reading at the Countess was '2'), but has to be taken in context with other parameters which were normal.

11:11am

The NICU Observation Chart is shown to the court for Child A.
Mr Myers says the respiration rate is "not stable".
Dr Bohin says it's above the normal rate, but "is stable". She said the range is 60-80 breaths, which is outside the normal range, but with CPAP breathing support, and 'in air'.
She said during the afternoon there would have been interventions which would have caused the respiration rate to rise.

11:13am

She said the respiratory rate, in conjunction with other factors, would have been something staff "would have been aware of".
Mr Myers: "Would you say this was an alert?"
Dr Bohin: "Yes, but there was nothing else that needed to be done. He wasn't having a lot of desaturations.
"The next step would have been to ventilate him...and he didn't require that."

11:15am

Dr Bohin: "Handling in a baby with respiration support can make the respiration go up."
Mr Myers asks if the heart rate would also go up.
Dr Bohin: "It can do...but not necessarily."


11:22am

Mr Myers refers to the insertion of the UVC and long lines.
Dr Bohin said the long line was not in the "best" position, but was in a "fine" position that was "safe" and would not cause problems with the heart.

11:27am

Dr Bohin said a long line can move if left in "for two weeks or more".
She said the long line would not have moved in the space of a day, and the recommendation is not to x-ray every day.

11:28am

Mr Myers refers to Child A's lack of fluids for four hours.
Dr Bohin says it was "not ok", and "would not be optimal care", but he had "no IV access" and the doctors had to prioritise other matters on duty, and adds "it wouldn't cause a sudden collapse like with [Child A]."
"The only deterioration he could possibly have would be to drop his blood sugar."

11:31am

Mr Myers: "Would you agree the whole situation is sub-optimal at that moment?"
Dr Bohin: "No."
Mr Myers asks if the lack of fluids means the whole situation is sub-optimal for Child A.
Dr Bohin: "No."

11:32am

Mr Myers refers to the skin discolouration.
Dr Bohin explains there is a difference between a rash, such as chickenpox, and changes to colour in the skin, where it can go blue, or pale, or mottled.

11:38am

Mr Myers refers to a paper published by the International Journal of Critical Illness and Injury Services on air embolisms, which reports air can enter via the UVC during negative pressure in the vessel systems.
Dr Bohin says she knows this sort of thing can happen, but in adults, and is not aware of any neonatal cases.


Child B


11:42am

Mr Myers now refers to the case of Child B.
He says the UVC procedure had to be repeated with her. He asks if that was "sub-optimal". Dr Bohin replies: "No. Ideally you would want it in first time."

11:44am

A clinical note refers to Child B not getting fluids "for a couple of hours".
He asks if that was "sub-optimal".
Dr Bohin agrees.

11:49am

Mr Myers refers to a clinical note showing it took five attempts to insert a long line for Child B, and asks if that was sub-optimal.
Dr Bohin: "Five attempts is what it took - it's incredibly difficult to site these - they are a millimetre wide. At times it just won't thread for you.
"If it won't thread for you...you are very aware you are handling this baby and the easier thing is to take it out and reinsert it," she adds, rather than "fiddling about with it" in the baby's body.

11:50am

Mr Myers: "[Five attempts to insert the long line] This is standard, is it, in practice?"
Dr Bohin: "Yes, it is."

11:53am

Referring to treatment, Dr Bohin said "nothing can ever be done immediately" in the hospital, but the size of the neonatal unit care was standard for a unit of that size.

12:02pm

Dr Bohin agrees there were breathing problems for Child B at birth.
Mr Myers: "Do you agree that Child B could deteriorate without deliberate harm?"
Dr Bohin: "It is a possibility."
Mr Myers: "Air embolus is usually fatal, isn't it?"
Dr Bohin agrees there is a risk.
Dr Bohin says a small quantity of air could create an air embolus. She said it is the volume and speed which are the factors.
Mr Myers says it is "almost always" fatal.
Dr Bohin replies that can be the case with adults [to which there have been medical reports published].

12:08pm

A clinical note refers to the "purple blotching...pink and active" for Child B, and is shown to the court.
Mr Myers asks if 'pink and active' refers to the baby.
Dr Bohin: "Yes."

Recap: Lucy Letby trial, Wednesday, October 26

 

[Tortoise]

Wednesday October 26th 2022 - Live updates from the trial

Day 9 of Prosecution Case

Pros. Re-Direct of Expert Witness Dr Sandie Bohin - re Child A and Child B

12:23pm

The prosecution, led by Nicholas Johnson KC, is clarifying a few matters from Dr Bohin's evidence.
Dr Bohin said she needs to be "completely independent" and base her conclusion on the evidence presented to her.

12:30pm

The blood gas record is shown to the court.
One of the parameters from a blood capilliary reading, a 'PO2' recording, is typically "disregarded" as it is not reliable, Dr Bohin says.

12:32pm

Dr Bohin presents a UVC to the court, and explains how it is administered and left so there is no air left in the tube.
She explains a long line looks similar, but has a wire inside it.

12:39pm

Dr Bohin clarifies she has never heard of a case, in clinical experience or in educational courses, or in published literature, of a neonatal having an air embolus as a result of negative air pressure, as described in the medical paper concerning air embolisms in adults.

12:41pm

Dr Bohin is asked if there is any link between Child B not getting fluids and the collapse which happened 28-30 hours later.
Dr Bohin: "No."

12:45pm

A note, dated July 14, relays a progress report for Child B.
Mr Johnson asks if there is any evidence of breathing problems in that note.
Dr Bohin says there isn't.

12:47pm

Dr Bohin says the colour change 'on its own' is not diagnostic of an air embolus, but needs to be taken into context with the sudden and unexpected collapse.

Recap: Lucy Letby trial, Wednesday, October 26

 

[Tortoise]

Wednesday October 26th 2022 - Live updates from the trial

Day 9 of Prosecution Case

Prosecution witness - Claire Hocknell - Police Intelligence Analyst - re Child A and Child B

12:52pm

Intelligence analyst Claire Hocknell is now being brought back into court to point out a few corrections made in the bundle of evidence for Child A and Child B. The corrections are largely typos and names for text messages being the wrong way around. All such evidence was corrected during the course over the past few days and has been automatically updated on the jurors' electronic bundles.

Recap: Lucy Letby trial, Wednesday, October 26

 

[Tortoise]

Wednesday October 26th 2022 - Live updates from the trial

Day 9 of Prosecution Case

Agreed Summary of Lucy Letby's Police Interview - re Child A and Child B

2:11pm

The jury is now coming back in.
Nicholas Johnson KC, for the prosecution, explains to the jurors he will now read a summary of the police interview Lucy Letby had in respect of Child A and Child B.
The wording of the summary has been agreed between the prosecution and defence.

2:14pm

For the case of Child A - the first interview took place in July 2018.
Letby was allowed to look through the case notes, and was asked if she remembered the specific shift. She replied: "Yes."
Letby gave details of the handover and the long line administration.
She said she checked the fluids and a nurse colleague "had the bag out".
She said they noticed Child A was "pale and mottled", and a crash call was put out.
She said full resuscitation attempts followed.
She said Child A had been "a little bit jittery in appearance" and believed that was due to low blood sugar levels.
She said a colleague was there with the fluids at the handover.

2:15pm

She was asked why the fluids were a priority, and Letby explains Child A had gone 'a few hours' with a lack of fluids.
She said that "wasn't ideal".

2:15pm

She said Child A went pale after a colleague had connected the fluids. She said Child A had "gone pale" 'about five minutes' after the fluids were administered.

2:17pm

She said Child A had a rash-like appearance, which Letby put as being the result of an infection, or being cold.
"He was more pale than the areas of the mottling."
She was asked if anyone had seen the mottling. Letby replies: "Yes."
She said they were advised to stop administration of the fluids.
Child A was then not breathing, and Dr Harkness was called over.

2:20pm

Letby said she could not recall Child A's resuscitation, but recalled Dr Jayaram had entered the room.
She said the death of Child A "had been difficult" for her, and said there was a support network among the nursing team.
She said she could not recall who attached the fluids line, but believed it was her nursing colleague Melanie Taylor who had connected the fluids.
She said photos were taken of Child A in accordance with the parents' wishes on their phone, along with a lock of hair and hand/footprints.

2:23pm

She agreed she had been taught to prime lines so air could not get in them.
She denied having done so via Child A's long line or UVC.
She said she didn't know exactly what an air embolism was.
She said her relationship with the child's parents was "strictly professional" and could not explain or remember why she had searched the mum's name on Facebook several times in the following weeks.
She explained, for a later search, she may have been searching for their names for an update on Child B.

2:27pm

For Child B, Letby explained the discolouration was a different appearance to that of Child A.
Child B's appearance was observed before resuscitation attempts began.
She did not recall having had any concerns for Child B, or any alarm going off for her.
She confirmed she would have handled Child B to an extent for medication and to attach lines.
She said she did not recall how upset Child A and B's parents were at the time.

Recap: Lucy Letby trial, Wednesday, October 26

 

[Tortoise]

Wednesday October 26th 2022 - Live updates from the trial

Day 9 of Prosecution Case

Child C

Agreed Evidence - Statements of Child C's Parents

2:28pm

The court is now being told about the case of Child C - a murder allegation for a baby boy who died on June 14, 2015.

2:29pm

The first 'agreed evidence' statement comes from Child C's mother, dated January 2019.

2:30pm

The mum said she had gone for an anatomy scan at the Countess of Chester Hospital.
She was informed, while everything was 'normal', the baby 'looked very small'.
It was recommended a test was to be taken for any genetic conditions that may be present.

2:33pm

The results of the scan showed there were 'no genetic problems'. The baby was small, 'but it was not known why'.
Further scans were held, along with blood flow checks.
Child C's growth then 'began to falter' later on, and it became delivery would take place 'quite soon'. She was being monitored 'twice weekly'.
In June, the mother had raised blood pressure in a test, and she was admitted to the Countess of Chester Hospital as a precaution.
That night, it was found Child C's heart rate had dropped, and she was moved to the labour ward as concerns had grown.
On this occasion, nothing happened, so she was moved back to the antenatal ward.

2:35pm

The following Monday, the dedicated consultant said it would be best to closely monitor the situation.
On June 10, the mother had a scan, and found there was a risk of a still-born birth. The mum was taken to the labour ward and given various drugs to support the baby.
The mum was then taken to theatre and a Caesarean section took place.
"The birth was extremely stressful," the mother recalls.

2:37pm

Child C was incubated and put on a ventilator, but the mum was told the nursing staff "weren't particularly concerned" for his immediate condition.
The mum was unable to see Child C for several hours afterwards.
She said she was able to see Child C - "tiny", weighing "800 grammes", that night.
Child C was given CPAP and had been taken off ventilator support.
On June 11, the mum and dad had "small periods of time" where they could hold Child C.
The nurse Joanne Williams there was "very supportive".

2:42pm

In the following days, Child C was taken off CPAP and was "calmer" on June 13.
He had a gastric tube fitted. When fluid came out, it was a black colour and staff could not explain what that was.
The family had "a cautious positivity" for Child C. His oxygen levels were being weaned down "as he was doing so well".
She was woken up at 11.20pm by one of the nurses, having been contacted by one of the neonatal nurses to go there "immediately".
She arrived to see CPR being performed on Child C. "He had stopped breathing without any warning.
"This was sudden and unexpected."
The mum told her husband to come to the neonatal unit.
She recalls not being able to take everything in, and was asked by a nurse if she wanted to get in contact with a priest. The mum was shocked and asked if Child C was going to die. The nurse replied in the affirmative.

2:46pm

The mum said while waiting for a priest, her husband arrived. They had to wait for 50 minutes until the priest arrived.
She was told Child C, after being baptised, had passed away. Although there was a pulse, there was no brain activity.
The mum said: "It was awful."
After Child C passed away, the mum handled him.
She was asked by a nurse if they wanted a lock of his hair.
On June 15, she was contacted by the coroner's office at Alder Hey, for the post-mortem.
She was advised the conclusion was "natural causes".

2:49pm

The father's 'agreed evidence' statement is read out to the court.
He said the mum's pregnancy was "highly stressful", and recalls she had elevated blood pressure, requiring a trip to hospital.
He recalls being present for Child C's birth, where the child was placed into an incubator.
He said medical staff were "really pleased" with him, and he followed Child C into the neonatal unit.


2:51pm

He said Child C "was still doing well" in the first few hours, and needed respiratory support, but was "capable of breathing independently".
"At no point did the staff express concern of him not surviving."

2:59pm

He said Child C had contniued to do well, and was at home when he was called by the mum to come to the hospital "right away".
When he arrived, the mum was waiting for her and he was informed Child C had collapsed and stopped breathing.
"She didn't think she could do any more", but they continued trying, until a priest arrived.
Child C then began breathing by himself.
The family were taken into a room, where there were two nurses there, one of whom the father has since been able to identify as Lucy Letby.
The father and mother took turns holding Child C, "as we knew he wasn't going to make it".
He remembers one of the nurses administering morphine to Child C.
At regular intervals, the nurses came in to check on their welfare.
A hand and footprint were taken of Child C, along with toys that were cotside.
The father said he and the mum looked after Child C in that room: "We just wanted to cuddle him and make sure he was pain free."
One of the nurses came in and said something along the lines of 'you've said your goodbyes, now do you want me to put him in here [a basket]?'
The mum said 'he's not dying yet', and the nurse backtracked.
"We remember being really shocked by this."

Recap: Lucy Letby trial, Wednesday, October 26

 

[Tortoise]

Wednesday October 26th 2022 - Live updates from the trial

Day 9 of Prosecution Case

Child C

Lucy Letby's Text Messages and Night-Shift Records

3:02pm

The jury is now being waked through the sequence of events for Child C, with the evidence, as was the case for Child A and B, being shown on an interactive display to the court. The electronically stored evidence is also available to view on the juror's iPads.
The jury is informed that, as they are increasingly used to the system and the descriptions of types of medical records, this process will go quicker than that for Child A and B.

3:07pm

Text messages exchanged following the deaths of Child A and B show Lucy Letby asking if there were spare shifts going, adding: "Think I need to throw myself back in on Saturday."
The response: "Hopefully it might settle down by then."
Letby: "I think from a confidence point of view I need to take an ITU [intensive treatment unit] baby soon."
The response: "It does knock you a bit when things like that happen, but it's ok to have time out as well. Enjoy the sun"

3:16pm

The court is shown the nursing night shift for June 13, with a different nurse identified as the designated nurse for Child C, and Letby being a nurse for two other babies.

3:29pm

A message sent to Letby on June 13, at 9.48pm, says: "You ok? x"
Letby replies: "I just keep thinking about Mon. Feel like I need to be in [neonatal unit room] 1 to overcome it, but [nursing colleague] said no x"
The colleague responds: "I agree with her, don't think it will help. You need a break from full-on ITU, you need to let it go or it will eat you up..."
Letby responds: "Not the vented baby necessarily, I just feel I need to be in 1, to get the image out of my head."

3:35pm

Letby adds: "It probably sounds odd but it's how I feel x"
The colleague responds: "Well it's up to you but I don't think it's going to help."
After further messages are exchanged, the colleague suggests: "Why don't you go in 1 for a bit?"
Letby responds: "Yeah, I have done a couple of meds in 1."
Letby later adds: "Forget I said anything, I will be fine, it's part of the job. Just don't feel like there is much team spirit tonight x"
The colleague replies: "I am not going to forget but think you're way too hard on yourself..."
Letby referred to previous events she had seen in a women's hospital, and the support available following such events.

3:36pm

The text message conversation, on Whatsapp, concludes at about 11pm.
Child C collapsed 20 minutes later.

4:48pm

The trial has now concluded for today.

Recap: Lucy Letby trial, Wednesday, October 26

 

[Tortoise]

Wednesday October 26th 2022 - Evening article Daily Mail, 10% summary

[Re: Child C]


"A nurse he thought may have been Letby came in with a ventilated basket. She allegedly told the couple: 'You've said your goodbyes. Do you want me to put him in here?'

[...]

The court heard that Baby C was born by Caesarean section at 3.31pm on June 10, 2015.

After three days he was doing so well that staff were planning to give him his first feed of milk.

But at 11.20pm on June 14 the infant's mother was woken in the post-natal ward [...]

'It was explained that his heart rate had suddenly dropped and he had stopped breathing [...]

'They'd given him a very small amount of milk a few minutes before, but they didn't think this was relevant.

[...]

She described the nurse as being in her mid to late 20s with a fair complexion and her hair in a ponytail.

[...]

[Re: Child B]

Dr Bohin said that having reviewed the case she had been 'left with a conclusion that this was an air embolus'.

She told Ben Myers, KC, prosecuting, she had come to this view partly because she had excluded what she saw as other possibilities, including infection or cardiac arrhythmia, and partly because of the 'very florid descriptions' medical staff had given of changes in the infant's skin colour.

Premature baby survived 'injection of air', Lucy Letby trial hears

 

[Tortoise]

Wednesday October 26th 2022 - BBC Reporter Tweets

https://twitter.com/MerseyHack

I’m back at court for the trial of Lucy #Letby, the nurse who’s accused of murdering 7 babies at the Countess of #Chester Hospital in 2015 and 2016, and with attempting to murder 10 others. She denies all the charges. Updates here,
@BBCNWT
and
@bbcmerseyside
.

The court is hearing from Dr Sandy Bohin, an expert instructed by the prosecution. She reviewed Child B’s medical record and a report on B* by another prosecution instructed expert.
(* For legal reasons we can’t name the alleged victims.)

Dr Bohin says B, who was premature, needed some support with breathing when born but stabilised and was doing well after that. She says there were no warning signs that B was going to collapse in the way she did. B had become well enough to have skin to skin contact with her mum

Dr Bohin says after reviewing B’s case and being able to rule out causes like infection and heart problems, she concluded that B’s collapse was caused by an air embolism. Ms Letby is accused of trying to kill B by injecting air into her bloodstream, which she denies.

Asked by Ben Myers KC, defending, if it’s important for an expert to have current clinical experience, Dr Bohin says “No, so long as they are current in their thinking and reading. The fact that they are not doing day to day hands on work make very little difference at all.”

Dr Bohin tells Mr Myers that her conclusion that B had an air embolism is based on ruling out other causes of collapse, and on the”florid discolouration” of her skin which doctors and nurses saw at the time of her [B’s] collapse.

Dr Bohin agrees with Ms Letby’s defence that it’s important in a case like this not to start with an assumption of deliberate harm and look for things that could support that [idea].

Mr Myers, defending, asks “Are you trying to explain away risks that could have contributed to collapse [of Child A] ? Are you doing that in any way ?” De Bohin replies “No.”

(Child A was the male twin of Child B. Lucy #Letby is accused of murdering him, and attempting to murder Child B. She denies these, and all the other allegations she faces.)

Mr Myers asks if air can get into the bloodstream through medical “lines” into a patient [such as Child A had]. She says are examples in medical literature about adults but she’s seen no reports about it for neonates. 1/2

But she agrees with Mr Myers that it could potentially happen [in small babies.] 2/2

On Child B, Mr Myers suggests the fact that she made rapid & good recovery [after collapsing] is less suggestive of an air embolism. Dr Bohin replies “Not necessarily, no.”

Mr Myers asks “Are you deliberately excluding something that reduces the likelihood of air embolism ?” Dr Bohin says “No.”


---

Nicholas Johnson KC, prosecuting, is reading an agreed summary of what Lucy #Letby said in police interviews about Child A and Child B. The jury will get more information about the police interviews later in the trial.


---

Jury now hearing statement read on behalf of mother of Child C. It’s alleged Lucy #Letby murdered him in June 2015, a few days after the alleged attacks on Child A and Child B.

Child C’s mum says she had various problems with her pregnancy including the baby being small, growth faltering, no blood flow through umbilical cord. She also had high blood pressure. Eventually had a Caesarian section.

After C was born he needed help with breathing but his mum said medical staff were not necessarily concerned for him. In the couple of days that followed his parents were able to hold him and they had “cautious positivity” that he was doing all that was expected of him.

3 days after his birth C’s mum was called to the nursery urgently. When she got there she could see CPR being performed on her son. “His heart rate had suddenly dropped and he had stopped breathing. It was very sudden and unexpected.

“I didn’t really take in what was happening and didn’t take in the severity”. A nurse asked her if she wanted to call a priest. C’s mum asked if he was going to die. Nurse replied “Yes I think so.”

Mum says it seemed to take forever for the priest to arrive and CPR continued all the while. C was baptised “A way to able to validate that he had been here.” Then CPS stopped. C was now breathing on his own but he died a few hours later.

In a statement from C’s father read to the court he said although his son needed assistance “At no time did staff express any concern of him not surviving.” He was called to the hospital from home when his son collapsed.

C’s parents were given him to hold after CPR stopped but they knew he “wasn’t going to make it.” “There was nothing else that could be done. It was just a matter of time. We just wanted to cuddle him and make sure he was pain free.”

---

Jury shown texts from Lucy #Letby to a colleague referring to the death earlier of Child A. “Think I need to to throw myself back in on Saturday. From a confidence point of view I need to take an ITU baby soon.”

https://twitter.com/MerseyHack

 

[Tortoise]

Wednesday October 26th 2022 - BBC report - 10% extract

"The mother was initially told her son - referred to as Child C - had died after his baptism, but said when she held him he was still breathing.

The court heard she and her husband, who also called their parents to the hospital, stayed with their son until he died on the morning of 14 June."

Lucy Letby: Baby stopped breathing without warning, trial told

The change in the child's condition was "very sudden and unexpected", the trial of Lucy Letby hears.

www.bbc.co.uk

 

[Tortoise]

Thursday October 27th 2022 - Live updates from the trial

Day 10 of Prosecution Case

Child C

Lucy Letby's Text Messages 14 June 2015, after Child C died.

10:34am

The trial is now resuming.

10:37am

Intelligence analyst Kate Tyndall is continuing to give evidence, providing a walkthrough of the clinical notes and other documents, presented in electronic form, to the jury.

10:58am

Text messages and Whatsapp messages sent to and from Letby's phone the morning after Child C died are shown to the court.
Letby messages a colleague: "Sorry I was just off [last night], was not a great start to shift but sadly it got worse."
The colleague responds: "You weren't off, you just were not happy and there is nothing I could say that was going to make it any better."

11:04am

Letby: "I was struggling to accept what happened to [Child A], now we have lost [Child C] overnight and it's all a bit much."
The colleague replies: "It will be but it does happen to these babies unfortunately."
"It's a very sad part of our job."
The colleague recalls a baby who had previously died in the neonatal unit, but had "overwhelming sepsis" so "nothing would have saved that baby".
Letby: "[C] is the little 800g baby...went off very suddenly. I know it happens but it's so sudden..."
Messages are relayed detailing how nursing staff on the night were upset by what happened.
Letby's colleague messages: "This is where we have to pull together and look after each other."
Letby: "Think we support each other brilliantly...just such a shock especially after Monday."
Letby is advised to "switch off for a bit".

11:05am

Letby messaged her mum that morning to say: "We lost a little one overnight. Very unexpected and sad xx"

11:10am

Letby added, in the message to her mum: "He only weighted 800g...new girl was looking after him, she is devastated."
Letby's colleague, in a message to Letby, said: "Hoping you are going to ok, this is not like you. Sending the biggest hugs."
Letby, in her reply, says: "It's heartbreaking but it's not about me."
Letby's colleague, in her reply, says to use a 'northern phrase': "Chin up chuck we will get through it together."
Letby: "It's not about me or anybody else, it's those poor parents who have to walk away without their baby."

11:12am

Letby messages another colleague asking when she is next work, before adding: "We lost little [Child C] overnight, everyone's devastated."
The colleague responds: "Damn. Infection? Crap week. How is [Child B]?"
Letby gives an update and says, for Child C, "it happened very quickly."
The colleague responds: "Damn. As quick as [Child A]? Yeah, s*** week."

11:15am

Letby messaged the colleague: "Parents sat with [Child C] in the family room...persuaded them to have hand and footprints but they just wanted to go home."
The colleague responds: "That is so sad, don't know what to say."
Letby: "There are no words, it's been awful."
The colleague: "It's a really tough week, especially for you."
The conversation ends at 10.12am.

11:15am

Letby searched for both the parents of Child C on Facebook later that day, at 3.32pm.

11:18am

A conversation Letby has with a third colleague, later that day, is shown to the court.
Letby: "I don't really want to go in tonight."
The colleague responds: "I don't particularly but we will get each other through it."
Letby: "We are a good team and we will get through. You did so so well."
The colleague: "We all did - so lucky to work with such an amazing and supportive team."



Recap: Lucy Letby trial, Thursday, October 27

 

[Tortoise]

Thursday October 27th 2022 - Live updates from the trial

Day 10 of Prosecution Case

Child C

Prosecution Witness Dr Sally Ogden, Paediatric Registrar CoCH
Re. Child C (Birth) 10th June 2015 thru 11th June 2015 & 13 June 2015

11:26am

The court is now hearing evidence from Dr Sally Ogden, who in 2015 was a paediatric registrar at the Countess of Chester Hospital.
Child C was born at 3.31pm on June 10, 2015, with Dr Ogden confirming she was present at the birth and facilitated the baby boy's transfer to the neonatal unit.
Child C was "smaller than expected for that gestation", with a C-section made necessary.

11:29am

The birth weight of 800g was within the range for Child C to be allowed to be treated at a Level 2 neonatal facility - the one at the Countess of Chester Hospital.
An 'Apgar score', recording how well the new-born is doing immediately after birth, is noted, rising from 7, to 9 out of 10.

11:33am

A clinical note showed there were 'no RF [risk factors] for sepsis', and Child C was "born in good condition", "came out crying, good resp[iratory] effort...no resus[citation] needed...pink...well perfused."
The heart rate was ">100", the saturation was "95% air".
Dr Ogden said those latter two readings were what would have been expected.

11:36am

Upon arrival to the neonatal unit, Dr Ogden noted symptoms Child C was starting to struggle breathing, including grunting and subcostal recessions.
The note added: "Decision to intubate", which Dr Ogden said would have been her decision.
The respiratory signs "can change quite quickly after birth", Dr Ogden says, so such support for babies of Child C's pre-term "would not be unusual".

11:39am

Ventilator support was set up for Child C, with "standard settings...for the context" set up on the machine.

11:46am

A note of medical communication with the parents is shown to the court.
Dr Ogden's colleague recorded observations taken by her, relaying to the parents that Child C was born in a good condition with good breathing.
Another clinical note showed a 10% dextrose solution would be administered via a TPN bag, through a UVC.
A note on a discussion between the hospital and the Liverpool Women's Hospital was made - due to Child C's weight. The discussion would have raised the possibility of Child C being transferred to Liverpool.

12:04pm

The clinical note, regarding a possible transfer for Child C, concludes: "Happy for patient to remain @ CoCH [Countess of Chester Hospital] at present. If clinical concern overnight for rediscussion with [Liverpool Women's Hospital]."

12:10pm

A clinical note, dated June 11, 2015 at 11am, is made by Dr Ogden, with a number of medical observations.
They include details of the respiratory support and feeds.
Dr Ogden says Child C was on CPAP support by this time, on 41% oxygen - a "moderate" amount for a pre-term baby, with other readings being normal.
There was an increased breathing rate noted.
A high lactate reading was noted, "which needed to be noted in context" with other readings. It was a "sign of multiple different conditions" and, Dr Ogden says, was a sign to look out for such conditions.

12:20pm

Child C's blood sugar levels were stable.
Child C was screened for sepsis, and placed on antibiotics "as a precautionary measure".
There were "no concerns" on the cardiovascular system.
Child C was observed to be "active, pink, well perfused", with "chest clear, slight increase in work of breathing".
Other observations were recorded as normal.
The overall picture was Child C was "responding as to be expected".
The prosecution say a 'generic plan' of next steps was put forward for Child C, to which Dr Ogden agrees.

12:28pm

Another note by Dr Ogden at June 13, 9.30am is made for Child C.
The list of 'problems' is noted, including 'RDS' and 'suspected sepsis'.
Dr Ogden says the oxygen levels had gone down on CPAP to 26%, as had the lactate reading.
Child C's breathing was "stable and possibly improved".
"Very dark bilious aspirates" are noted from the feeding section.
This was "not normal" and "suggested a problem with his abdomen", or a sign of how Child C's bowels were responding to being pre-term.
"That would have been a concern," Dr Ogden said.

12:40pm

Child C had a long line put in place by this time.
Other observations made included that chest was clear with no increased work of breath.
The abdomen was "soft, not distended", which Dr Ogden said was a "reassuring sign", amid a concern from Child C's aspirates that the gastro-intestinal disease NEC was a possibility.

12:43pm

The reviewing doctor suggested to "hold off feeds" for now and review in the afternoon if the aspirates did not get any worse.

Recap: Lucy Letby trial, Thursday, October 27

 

[Tortoise]

Thursday October 27th 2022 - Live updates from the trial

Day 10 of Prosecution Case

Child C

Cross- Examination of Pros. Witness Dr Sally Ogden, Paediatric Registrar CoCH
Re. Child C (Birth) 10th June 2015 thru 11th June 2015 & 13 June 2015

12:45pm

Ben Myers KC, for Letby's defence, is now asking questions to Dr Ogden.
He refers to the decision about which hospital Child C should have been placed in.
Liverpool Women's Hospital offered Level 3 neonatal care, with the Countess of Chester Hospital offering Level 2 care at the time.

12:46pm

Dr Ogden said she "believed" the minimum weight for Level 2 care centres to treat babies was 800g - the birth weight of Child C.
Mr Myers: "He was right on the borderline of what could be accepted at the Countess?"
Dr Ogden: "Yes."

12:49pm

Mr Myers refers to the conditions detected that led to the C-section.
He asks if one of the conditions that could follow would be NEC.
Dr Ogden agrees.
Mr Myers said for such babies, there would be an increased risk of infant mortality. Dr Ogden agrees.
She also agrees that Child C would be a "high risk" baby.
She says that for the context, and taking the considerations for those conditions into account, Child C was in a good condition.

12:51pm

Mr Myers refers to the Apgar score for Child C at birth, with readings at one minute, five minutes and 10 minutes. Child C scored 7/10, 9/10 and 9/10 respectively.
The scores are "subjective" and based on observations.

12:54pm

Mr Myers asks about the clinical note which refers to the discussion between the Countess and the Level 3 Liverpool Women's Hospital.
Mr Myers: "At this early point, your view was that Liverpool Women's Hospital needed some communication [in relation to whether Child C would need to be transferred]?"
Dr Ogden: "Yes, that's right."
Mr Myers says if Child C had other problems, along with a 'borderline' weight, then that may affect the decision to transfer a baby to a tertiary centre.
Dr Ogden: "Potentially, it would depend on the circumstances."
Dr Ogden said the decision to transfer would be a joint one made between the hospitals and made via consultants.

12:56pm

Dr Ogden said if Liverpool Women's Hospital could not accommodate a baby, there would have been other tertiary centres available if necessary.
Mr Myers says the Countess would have required sufficient numbers of staff to care for Child C.
He asks if June 2015 "was a particularly busy time for [the neonatal unit in] Chester?"
Dr Ogden: "Yes."

12:58pm

Mr Myers said with the number of babies, another factor would be the individual care required for each baby, which included a number of pre-term babies in June 2015.

2:15pm

Mr Myers now refers to the case of Child C.
He asks about the risk of infection, which Dr Ogden was "not immediately a concern" at the time of his birth.
Mr Myers says infection "is always a potential risk".
He asks about the breathing issues Child C had at birth, and asks whether such issues could be a "sign of infection". Dr Ogden agrees.

2:20pm

The court is shown an x-ray review in which a staff member had noted "hazy left lung field".
Dr Ogden said she hadn't seen the x-ray, but agrees the note in the review means there could be a sign of infection.
The list of 'problems' in a clinical note is raised, including 'suspected sepsis'.
Dr Ogden says there was a treatment plan in place for 'suspected sepsis'. The 'high lactate' noted is an indicator of a potential, non-specific issue with the baby, the court hears.

2:25pm

The clinical note from June 13 is raised.
Mr Myers suggests there are 'increased issues' for Child C.
Dr Ogden: "It's hard to say."
Mr Myers refers to the 'very dark...black aspirates', and Dr Ogden agrees they are "a cause for concern".

2:27pm

Mr Myers asks if the aspirates are a 'red flag' warning sign.
Dr Ogden: "It's certainly a worrying sign which would need more investigation."

2:30pm

A nursing note is presented which showed Child C's weight, by June 13, had dropped to 717g. The note adds: "Doctors aware."
Mr Myers says if that was the weight of Child C at birth, he would not have been card for at the Countess.
Dr Ogden: "I don't think so, no."

2:31pm

Dr Ogden agrees at this point, there would have been some concerns with Child C, and he would've needed close monitoring care.

2:34pm

That concludes Dr Ogden's evidence.

Recap: Lucy Letby trial, Thursday, October 27

 

[Tortoise]

Thursday October 27th 2022 - Live updates from the trial

Day 10 of Prosecution Case

Child C

Prosecution Witness Dr Gail Beech, Paediatric Registrar CoCH
Re. Child C Day-Shifts 11th and 12th June 2015

2:34pm

Dr Gail Beech is now being called to give evidence.

2:43pm

In June 2015, Dr Beech was working at the Countess of Chester Hospital as a registrar.
She confirms working day shifts on June 11-12 and had involvement with Child C and his parents.
She confirms she carried out an ultrasound scan for child C on June 11, and the reviewing doctor recorded 'NAD' - no abnormalities detected.

2:53pm

Dr Beech's note made on June 12, 10.15am is shown to the court.
She recorded, from data, Child C was on CPAP, 30-40% oxygen assistance from CPAP, the saturation levels for Child C were '91-98%', with 'no documented desaturations'. Gases were 'satisfactory'.
"It looks like he was pretty stable on those CPAP settings," Dr Beech tells the court. The gases refer to the blood gases.
The urine levels were "slightly high, but not concerning yet".
Under the heading 'sepsis', a CRP reading going up was "something to be aware of" but "not a huge rise", according to Dr Beech, and a note 'awaiting lumbar puncture' was made.

2:57pm

The lactate reading recorded is 1.8-2.8. Dr Beech says 2.8 is "high" but had been falling from a higher number.


2:59pm

Dr Beech said there was "nothing there" on the clinical chart numbers which was "worrying", with a few readings being "something to be mindful of".
He was a "nice stable baby" as he had been allowed out of his incubator to be allowed skin-to-skin contact with his mum, Dr Beech added.

3:01pm

Dr Beech said the UVC had come out of Child C during a previous shift, and a note was made for a long line to be inserted later.

3:06pm

The follow-up note showed Dr Beech had inserted the long line under sterile conditions, and was secured in at the third attempt, with the note 'happy with position', adding 'patient left comfortable'.
An x-ray of Child C, timed 12.36pm on June 12, shows the long line having been inserted.

3:12pm

An x-ray review recorded, in the comments, 'large stomach bubble, gaseous bowel'.
Dr Beech said this "wouldn't be a huge concern" given Child C was on CPAP.

3:16pm

Dr Beech reiterates there were no significant concerns for Child C at that point, but there were "matters to be mindful of".

Recap: Lucy Letby trial, Thursday, October 27

 

[Tortoise]

Thursday October 27th 2022 - Live updates from the trial

Day 10 of Prosecution Case

Child C

Cross-Examination of Pros. Witness Dr Gail Beech, Paediatric Registrar CoCH
Re. Child C Day-Shifts 11th and 12th June 2015

3:19pm

Mr Myers now asks Dr Beech questions on behalf of Lucy Letby.
The three attempts to insert a long line, from a clinical note, are shown to the court again.
Mr Myers asks if there is a guide to the number of attempts, or who should administer them.
Dr Beech said it would be a procedure by a doctor, not a nurse, and would be done by the most junior doctor present, to get them experience, subject to availability and the complexity of the procedure.
Dr Beech said there was "an unwritten rule" a registrar would have two or three attempts before escalating the procedure to someone more senior.

3:21pm

Dr Beech explains the note 'flushed' is made as confirmation the long line has been 'flushed' to ensure there is no air in it.

3:28pm

The x-ray of Child C with the long line in is presented to the court again.
The dark areas in the stomach and bowel areas refer to air inside the body, the court hears. It is compared to an x-ray taken of Child C at birth, where there was also a pocket of air in the stomach.
Dr Beech noted, from the June 12 x-ray, it was "very gaseous", and the result of CPAP.
Mr Myers asks if that could also be termed 'CPAP belly'.
Dr Beech says it could.

3:30pm

Dr Beech has concluded giving evidence.

Recap: Lucy Letby trial, Thursday, October 27

 

[Tortoise]

Thursday October 27th 2022 - Live updates from the trial

Day 10 of Prosecution Case

Child C

Yvonne Griffiths, CoCH Neonatal Unit Deputy Manager & Senior Nurse -
Re. Child C's medical notes for Day-Shift 12th June 2015

3:59pm

The court is now hearing evidence from Yvonne Griffiths, who was the Countess of Chester Hospital neonatal unit deputy manager in June 2015 and a senior nursing practitioner.
An 'admin error' had resulted in Ms Griffiths' notes for child C being written in the file for a different child, but the error was spotted and rectified quickly.
The note is written on June 14 on reflection notes from June 12, with care from 8am that day.
The notes record "assistance with ventilation by NCPAP", with oxygen levels varying from 37% to 25%.
Child C was "unsettled at times". Ms Griffiths said he "only loved to be held by parents in a kangaroo style".
The long line was administered, and at 6.30pm, 'bile noted on blanket'. Ms Griffiths said with any baby there is a worry with introducing feeds too early. On this occasion bile came out "spontaneously".
Ms Griffiths said the naso-gastric tube was aspirated as a matter of procedure and 2mls of black stained fluid appeared.
Child C was "too unsettled" for a lumbar puncture - plan to reassess later".
Ms Griffiths said they would not want to take the risk if the baby was too active, as a lumbar puncture would involve a needle.
Ms Griffiths added she came in the morning after Child C had died, to assist staff.


Cross-Examination

4:01pm

Mr Myers says Child C was "at the limit" [for weight] for being accepted into care at the Countess of Chester Hospital.
Ms Griffiths had said, in a police statement, the hospital did not often care for babies of that weight.
She tells the court there is a decision to be made whether the baby is suitable to be cared for at the Countess, or risking transfer to a tertiary centre, and that is made following consultation.

4:12pm

Ms Griffiths said, in the police statement, "it was very uncertain" what the outcome would be for Child C.
She confirms she was the designated nurse for Child C on June 12. She also confirms Letby was not in the unit that day.
Mr Myers talks through the nursing notes from the previous night shift, for June 11-12. At that point no bile aspirates had been recorded.
He refers to a note about Child C requiring an increase in oxygen when handling as Child C was desaturating.
Ms Griffiths says, in relation to the air in the stomach, the nurses "did everything" they could through the naso-gastric tube to aspirate air.

4:18pm

The note referring to bile found on the blanket and 2mls of black stained fluid being aspirated from June 12 at 6.30pm is referred to.
Mr Myers asks if dark bile is a matter for concern.
"Any bile is a matter of caution," Ms Griffiths replies, and feeds would be stopped as a precaution.
She added Child C did not desaturate when vomiting a small amount of fluid. She agrees it was important for close monitoring on Child C.
Mr Myers: "It is a potentially serious issue, isn't it?"
Ms Griffiths: "Yes - and I did get the doctor to review."

4:24pm

Ms Griffiths has finished giving evidence.
The court has now adjourned for today.

Recap: Lucy Letby trial, Thursday, October 27

 

[Tortoise]

Thursday October 27th 2022 - BBC Reporter Tweets (Bolding by me)

https://twitter.com/MerseyHack

I’m back at #Manchester Crown Court for the trial of nurse Lucy #Letby. She denies the murder of 7 babies at the Countess of #Chester Hospital in 2015 and 2016. She’s also pleaded not guilty to attempting to murder 10 other children. Updates here, @BBCNWT and @bbcmerseyside

The court is hearing from a Cheshire Police intelligence analyst Kate Tyndall who’s dealing with the sequence of alleged events for Child C, a baby Ms Letby allegedly murdered.

In text messages with a colleague, Ms Letby said “I was struggling to accept what happened to [Child A - another alleged victim]. Now we’ve lost [Child C] as well and it’s all a bit much.”

In another text Ms Letby said “ [Child C] is the little 800g baby. He went off very suddenly. I know it happens but it’s so sad and cruel.” Later she texted the colleague “It’s been horrible for all involved.”.

In a text to her mother Lucy #Letby said “We lost a little one overnight. Very unexpected and sad.” Her mother replied she was sorry to hear that and, in a later text, said “We are so proud of you.”

Replying to a colleague who texted about how deaths affect nurses, Ms Letby said “It’s not about me or anyone else. It’s these poor parents who have to walk away without their baby. It’s so unbelievably sad.”.


--

Court now hearing from Dr Sally Ogden who was working at Countess of Chester Hospital as a paediatric registrar in June 2015. Her notes from then say Child C was “born in good condition, came out crying, no resus needed, pink, well perfused.”

Later C started to struggle with breathing and needed more help. Dr Ogden’s notes say she decided to intubate C (tube placed in windpipe to help breathing). Dr Ogden says these problems were not exceptional in pre-term babies.

Dr Ogden’s notes from the next day show Child C was on a less intrusive level of breathing support. He was on CPAP ( continuous positive air pressure) rather than having a tube in his windpipe. “This was progress” says Dr Ogden.

At 4 days old Dr Ogden’s notes record C had “very dark bilious aspirates” (liquid from C’s stomach). This was a concern because it could indicate a problem where a portion of the bowel becomes inflamed and may die, or indicate a problem with infection.

Under cross examination by Ben Myers KC, defending, Dr Ogden agrees that C’s low weight and short gestation “put him right on the borderline at what could be accepted at the C’tess of Chester.” C of C was a mid tier neonatal unit- other hospitals could give higher levels of care.

Mr Myers asks if a baby of low weight and prematurity could have other problems which would mean they should go to a tertiary (higher level of care) neonatal unit like #Liverpool Women’s Hospital ? Dr Ogden says “Potentially, yes.”

Dr Ogden agrees that C of Chester had 3 very premature babies (A, B and C - all alleged victims in this case) at the time and that that made it a very busy time for the neonatal unit. The level of care needed, not just numbers, would make it busy.

---

A nurse Yvonne Griffiths, questioned by Ms Letby’s defence , agrees that in a police statement she said, “ [Child C] was very small and very vulnerable and it was a very precarious time.”

 

[Tortoise]

Thursday October 27th 2022 - The Guardian Report - 10% extract



In a message to her colleague Jennifer Jones-Key, she said: “Sorry if I was off, just wasn’t a great start to the shift but sadly it got worse.”

[...] “I just keep seeing them both. No one should have to see and do the things we do. It’s heartbreaking.”

She told her mother the baby [...] was being looked after by a “new girl”, Sophie Ellis, who was “devastated”.

Letby later messaged Ellis and told her: “We are a good team and we’ll get through. You did so, so well.”

Lucy Letby trial: nurse described newborns’ deaths as ‘sad and cruel’

 

[Tortoise]

Friday October 28th 2022 - Live updates from the trial

Colour Code

Blue text - Lucy Letby's (Defendant's) texts and Facebook searches
Green text - Countess of Chester Hospital medical staff
Black text - Police/Intelligence Analysts evidence
Orange text - Medical expert witnesses
Purple text - Agreed Facts and Parents evidence


-----

Day 11 of Prosecution Evidence

Child C

Joanne Williams, CoCH Nurse - Child C Day-Shift Nursing, 13th June 2015

10:04am

The trial has now resumed, with evidence being heard in the case of Child C.
The first witness to give evidence today is Joanne Williams, who previously gave evidence, in an agreed evidence statement, for the case of Child A and Child B.
The court is reminded she was a neonatal unit nurse in June 2015.

10:10am

Mrs Williams recalls she was the designated nurse for Child C on June 13, and had cared for him prior to that day.
She said that particular day shift was 'not too busy'.
She recalls Child C was small and premature, and weighed 800g at birth.

10:14am

A nursing note by Mrs Williams is presented to the court, written retrospectively at 4.19pm on June 13, shows Child C was on NCPAP with 23-26% oxygen - "a minimal amount of oxygen".
Mrs Williams said that was "a good sign".
A blood gas reading was "very good" at 9am, but Child C was noted to be "very unsettled and fractious", which Ms Williams tells the court was not that uncommon for a baby of his size.
The note adds Child C was allowed to be taken off CPAP to have skin-to-skin contact with mum.
Mrs Williams says such contact is "extremely powerful" for a new-born baby and is "really beneficial" for them. The note adds Child C "calmed down straight away while on mummy, just required some facial [oxygen] while out. No signs of increased work of breathing".

10:17am

Child C was weaned off CPAP for two hours and placed on Optiflow at 1pm as, it was noted, the baby boy was "so unsettled on NCPAP".
The court hears Optiflow is a less invasive form of breathing support than CPAP.
Child C was "very settled this afternoon" with a "slight increase in respiratory rate".
A further blood gas reading was taken later in the afternoon with readings "not quite as good", which Mrs Williams was "something to be taken into consideration" and had followed Child C being placed on Optiflow.
The note adds: "Clinically remain stable but aware do not want to push [Child C]."

10:21am

Mrs Williams said fluids were increased, with 10% dextrose discontinued as it was day 4, and the dextrose would not have been needed with lipids [fats] increased to support nutrition.
The note adds: "Continues to have dark bile aspirates, frequently this morning".
Mrs Williams says it's "not reassuring" as it could be a sign of NEC [a gastro-intestinal disease].
Philip Astbury, prosecuting: "Was it of concern?"
Mrs Williams: "Yes."
It was escalated to an on-duty doctor that day.
Mrs Williams says Child C was on nil-by-mouth and a cautious feeding regime.

10:28am

The court hears Child C had pulled out two oral gastric tubes during the morning due to being "feisty" and unsettled.
A naso-gastric tube was "on free drainage" to drain air from Child C, reducing air build-up in the stomach, and check for any aspirates.
The notes adds: "Abdo[men] full but soft". The court hears that was "quite normal for a baby...for [Child C]."
The abdomen had a "slight shine but not veiny or distended".
The court hears a distended abdomen would be a symptom of NEC.

10:30am

The note adds: "If aspirates improve can start [trophic] feeds this evening".
Rantidine was administered via an IV to counteract the bile aspirates.
The weight of 717g was noted, which Mrs Williams says is not unusual as all babies lose weight in the first few days.
She said doctors were aware of the weight update.
A cranial ultrasound scan was carried out, with 'no abnormalities detected'.

10:39am

An intensive care unit chart for Child C is now presented to the court, which details the various readings and notes corresponding to Mrs Williams's nursing note.
The aspirates of dark bile are recorded at 9am and 1pm. 0.5ml dark bile is recorded at the latter, which was a "small" amount, but any dark bile was a "concern", Mrs Williams says.
A further 0.5ml of dark bile is aspirated at 4pm.

10:43am

A nursing note of 'family communications', from June 13, is shown to the court, written by Mrs Williams.
She records: "Mummy and daddy on the unit during the day, both have had skin-to-skin with [Child C]. Pleased to see him more settled this afternoon.
"Appear happy with plan of care."

10:45am

A further nursing note showed a blood gas reading at 6pm was "improvement from previous CBG", but lactate levels had increased.
Child C remained on Optiflow and was "stable".
The aspirates were "reduced this evening".
The note adds: "?? Commence entral feed tonight"
Mrs Williams clarifies: "Query query."

10:46am

Mrs Williams said you would "always be cautious of a baby that size", referring to Child C.
Mr Astubry: "How was the progress during that shift?"
"He had done well, weaned off to Optiflow, he had benefitted from time with mum and dad."


Cross-Examination


10:51am

Ben Myers KC, for Letby's defence, is now asking Mrs Williams questions.
She agrees that "you can never be complacent" with a child like Child C, and however stable he is, he would require close monitoring.
She said it was important to carry out observations, and look for "subtle signs".

10:54am

Mr Myers says the observations for Child C need to be taken into context for a baby the size of Child C.
Mrs Williams says that could "potentially" be the case.
She adds she was aware of pre-existing concerns raised at Child C's birth.

10:57am

Mr Myers asks if Child C still needed breathing support with Optiflow, and would not have been switched if he had been settled on NCPAP.
Mrs Williams says he had good blood gases so was able to "step down" respiratory support to Optiflow.

11:00am

Mr Myers: "You are documenting all the little changes made [on the nursing notes], because he is such a little baby?"
Mrs Williams: "It is important to be thorough."

11:03am

The note of 'aware do not want to push [Child C]' is raised.
Mrs Williams: "It's making sure we are doing individual care and very aware of what's happening with [Child C] and what he needs."
Not wanting to push Child C was not to tire him, and/or administer procedures such as a lumbar puncture.
Mrs Williams said not wanting to push Child C, in this context, was in relation to breathing.
Mr Myers: "Could that apply to feeding as well?"
Mrs Williams: "Yes."

11:03am

The matter of dark bile aspirates is mentioned.
Mr Myers: "We have seen from the chart, that aspirates have been taken throughout the day, and they have been there the day before?"
Mrs Williams: "Yes."

11:05am

A distended abdomen could be a symptom of other conditions, Mrs Williams adds, but NEC would be one which would be of concern.

11:07am

The 'trophic feeds', as mentioned on the nursing note, would be via expressed breast milk if the aspirates improved, along with the "overall clinical picture", Mrs Williams tells the court.

11:09am

The weight of 717g is "a significant reduction, isn't it?" Mr Myers asks.
Mrs Williams says it would need to be taken into context, and it was important to administer feeds safely.
The plan to do so would be, following a discussion, to commence entral feeds that night.


Prosecution Re-Direct


11:12am

Mr Astbury rises to ask one more question on CPAP: "Would you ever take a baby off CPAP just if they were unsettled?"
Mrs Williams: "No."
The court hears the step down to Optiflow would be done in consideration with other factors.
Mrs Williams has now finished giving evidence for Child C.
There will now be a short break in court before the trial resumes.

Recap: Lucy Letby trial, Friday, October 28

 

[Tortoise]

Friday October 28th 2022 - Live updates from the trial

Colour Code

Blue text - Lucy Letby's (Defendant's) texts and Facebook searches
Green text - Countess of Chester Hospital medical staff
Black text - Police/Intelligence Analysts evidence
Orange text - Medical expert witnesses
Purple text - Agreed Facts and Parents evidence


-----

Day 11 of Prosecution Evidence

Child C

Sophie Ellis, CoCH Nurse - Child C's Designated Nurse, Night-Shift 13th June 2015

11:34am

The next witness to give evidence in court is Sophie Ellis, who was working as a neonatal unit nurse in June 2015.
She recalls Child C, and first saw him first when he was delivered, as an observer, learning in the nursing role.

11:36am

She said she was on duty for the night-shift of June 13, starting at 7.30am [my note, should be 7.30pm], ending at 8am the following day.
She said she was allocated to look after Child C for that shift, on her own, with support from another staff member as she was junior in her role.

11:38am

The nursing staff roles for that shift are presented to the court, with Ms Ellis the designated nurse for Child C, and Lucy Letby looking after two other babies in the neonatal unit.

11:45am

She said she was aware Child C had been moved to Optiflow, and knew the subject of feeds was a topic being discussed, that they were "hopefully" going to start feeds.
Her nursing note is shown to the court, showing care taken over at 8pm.
"Safety checks completed and fluid requirements calculated...Optiflow...in 25% [oxygen]. Observations satisfactory...[respiratory rate]...elevated at times as previously been for past few days.
"Pink and well perfused. Active and alert."
The fluids dose is stated "due to birth weight of below 1000g".
The long line site was "satisfactory".
A blood gas reading was to be taken at 2am.
Trophic feeds were agreed to be started.

11:46am

Ms Ellis said she was not present for the first desaturation as she had left the room.

11:48am

A discussion on trophic feeds was had "before 11pm", with the feed administered at 11pm.
Ms Ellis said "there was nothing particularly striking" about the care for Child C between 8-11pm, he was "doing well" and was "feisty" at that time.

11:53am

A retrospective note written by Ms Ellis says: "Had 2x fleeting [Bradycardia]s - self correcting not needing any intervention shortly before prolonged [Bradycardia] and apneoa requiring resus[citation].
She said she had left the room "just around the corner", then the alarm went off. She said she could not recall which type of alarm it was - a lower-level yellow or a more frequent [urgent] red alarm.
She said she went into the nursery, having been out for "not a long" time.
She recalls, upon entering: "I saw Lucy standing at [Child C's] incubator. She said he had just had a Brady and a desaturation. I can't remember what she was doing at the time."

11:57am

"After that, the 'brady' and the desat resolved quite quickly."
Ms Ellis said she didn't do or see anything being done to correct the desat and bradycardia, as Child C self corrected.
She added she then sat at a computer which faced a wall, with Child C behind, out of view.
She explains Lucy Letby was still in there, but not sure about anybody else.
Child C, Ms Ellis tells the court, had a further 'brady' and desaturation which did not resolve and required resuscitation.
She said when she turned around, Lucy Letby was stood at the incubator.
A nursing colleague had asked her to put out a crash call.

11:58am

Prior to administering the 11pm feed, Miss Ellis said she had aspirated a tiny amount of 'light green bile' from Child C.

12:00pm

A nursing colleague who was in the room said to put out a crash call, and Miss Ellis left the room, she tells the court.
She said she left the room "not long".
She said when she returned, a nursing colleague was getting ready to administer drugs, and for her to continue chest compressions.
She said Lucy Letby was at the side of the incubator, but cannot recall what she was doing.
Miss Ellis said the medical team of registrars arrived along with a doctor to the unit at some point.

12:03pm

Miss Ellis adds the parents were then informed.
She said she became upset herself as this was "the first time" something like this had happened in her experience, and she found it "overwhelming".
Lucy Letby said to her: "Do you want me to take over?" to which she said: "Yes."
Miss Ellis said she then left the room, taking a minute to compose herself, before returnnig to the unit to look after other babies.

12:05pm

The nursing note says care for Child C was handed over to senior nurse Melanie Taylor following the collapse.
Miss Ellis reiterates that, from memory, there was nothing that concerned her about Child C's condition between 8pm-11pm.


Cross-Examination

12:06pm

Mr Myers asks how long Miss Ellis had been working at the Countess - she replied it was since January 2015.

12:08pm

Miss Ellis she had not previously cared for a baby as small as Child C.
Mr Myers asks: "How is it that someone as inexperienced as you [was given the responsibility of looking after Child C]?"
"Child C was very stable and I was being supported by Mel[anie Taylor].
"You were very well supported at the Countess of Chester Hospital."

12:09pm

Miss Ellis said there was "always a nurse" in the room looking after Child C, even when she left the room briefly. She said Lucy Letby was in there, and cannot recall if Melanie Taylor was also in there.

12:12pm

Miss Ellis says Child C "could have had" two bradys, as they are quite common.
She said she did not know whether Melanie Taylor was in the room at the time of the collapse.

12:13pm

Miss Ellis tells the court for one of the two bradys, Lucy Letby was in the room for the second one, but not the first.

12:18pm

Mr Myers refers to the 8.46am, June 14 nursing note and said there was nothing prior to the 11.15pm collapse.
He asks why the first bradys are not mentioned.
Miss Ellis: "I would have forgotten to write it - it was a traumatic shift".
Miss Ellis says she would have added the detail of that on her subsequent nursing note.
She says she does not remember if Melanie Taylor was in the room at the start of the collapse.
Mr Myers puts it to Miss Ellis that Lucy Letby was not in there at the time of the collapse, and only arrived later [during the resuscitation efforts].
Miss Ellis: "I don't agree with that."
Mr Myers: "You have placed her there when you spoke to the police several years later."
Miss Ellis: "I don't agree with that."

12:21pm

Miss Ellis has finished giving evidence for Child C.

Recap: Lucy Letby trial, Friday, October 28

 

[Tortoise]

Friday October 28th 2022 - Live updates from the trial

Colour Code

Blue text - Lucy Letby's (Defendant's) texts and Facebook searches
Green text - Countess of Chester Hospital medical staff
Black text - Police/Intelligence Analysts evidence
Orange text - Medical expert witnesses
Purple text - Agreed Facts and Parents evidence


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Day 11 of Prosecution Evidence

Child C

Melanie Taylor, CoCH Nurse -
Child C's Designated Nurse Night-Shift 12th/13th June 2015,
Designated Nurse for a different baby in Room 1 Night-Shift 13th/14th June 2015, also supervising/supporting Sophie Ellis, Child C's designated nurse


12:39pm

The next witness to give evidence in the case of Child C is Melanie Taylor, who has previously given evidence for Child A and Child B.
The court is shown Melanie Taylor's observation chart for Child C on the night shift from June 12-13, where "normal" readings are made for the heart and respiration rate. Two of the readings were "slightly elevated" but were normal given the context Child C was on CPAP at the time.
Temperature readings were "stable and in normal limits - what you would expect".
Other readings were considered to be normal.

12:45pm

Other CPAP readings were "normal".
Fluid readings are recorded on a fluid chart, including the "dark bile aspirate".
Ms Taylor says: "We would be concerned about NEC [with those aspirates]."

12:52pm

Ms Taylor concludes Child C was a "stable baby".
There were concerns over bile aspirates but they were not uncommon in neonatal babies.
She adds the aspirates found were: "Not a major cause for concern"

12:56pm

Ms Taylor says further observations were made to check for symptoms of NEC, but the 'tummy soft, not distended' was a good sign.
The registrar was made aware of the dark bile aspirates.
Ms Taylor: "From what I've written, he was a stable baby."

1:47pm

The handover note for the June 13 night shift is presented to the court, showing Melanie Taylor is one of the nurses on duty that night, and a designated nurse for one of the babies (not Child C) that night.
She confirms she was present in room 1 that night, in the same room as colleague Sophie Ellis.
"Sophie was a very competent nurse. She was completely able to look after [Child C]. I had no concerns [with her], he had been stable. I was there for support if she needed it."

1:50pm

Ms Taylor said her memory of the collapse was that she did not know where she was at the time Child C deteriorated, but when she arrived at the incubator, Lucy Letby "was already there".
She did not know if anybody else was in the room at that point.
She recalls: "I think also Sophie was there - as she was caring for him."
Ventilation support was provided via a Neopuff device, and Ms Taylor struggled to get any chest movement for Child C.

1:51pm

Ms Taylor said Lucy Letby suggested using a type of ventilation support - a Guedel device - to aid Child C.

1:54pm

The Guedel device was followed by use of the Neopuff.
Ms Taylor said a crash call was put out. She added, from her statement, chest compressions began before the first doctors arrived in the unit.
The on-call registrar was first to arrive, Ms Taylor said.

1:57pm

Ms Taylor recalled the chest compressions and resuscitation attempts went on for some time.
Child C later died, the time of death recorded as 5.58am on June 14.
A retrospective nursing note by Ms Taylor, written a couple of hours later, said: "Called to help as baby had brady desat, when arrived to baby, baby apnoiec..."

2:01pm

The notes describe the resuscitation attempts made.
An addendum made at 8.14am said: "Parents sta[y]ed with [Child C], they took him round to quiet room...registrar went round to quiet room, as mum concerned he is still gasping and has pulse. Doctor explained that it is a brainstem response following resuscitation, further discussion with parents, parents happy for [Child C] to have IV morphine for comfort.
"Maternal and paternal grandparents present, discussed with parents what they would like to do, and offered that we can do it at their pace when they are ready."
The note concludes that a camera was left with the parents if they wished to take photos of Child C. They declined, and had taken some photos on their phone. Child C's hand and footprints were made for the parents.


Cross-Examination

2:02pm

Mr Myers is now asking Ms Taylor questions about dark bile aspirates.
He said Child C was "a stable baby", with the aspirates not being "a major cause for concern".
Ms Taylor said:"It's not something we would initially be very worried about, but would take into consideration...and act very cautiously when we find bile.
"I was not necessarily concerned he was unstable."

2:03pm

Ms Taylor: "You have to look at the bigger picture and see what it could possibly be, and see if it could be NEC, and act on that and take it as a consideration."

2:05pm

"We do encounter it [bile] in premature babies. We would have to act appropriately and if there are no other signs of NEC then we would treat accordingly."
Mr Myers asks if there could be other, more immediate problems associated with dark bile.
Ms Taylor said that would be a matter for doctors to examine if there was a possibility of that.
"There is no room for error with a baby like [Child C] is there?"
Ms Taylor agrees, and agrees there are "inherent risks" with treating such a baby.

2:06pm

Mr Myers asks about the experience of colleague Sophie Ellis.
Ms Taylor: "You do have a foundation training in neonatal care and you would look after a baby on CPAP. New nurses have to get experience and I was supervising and she was very competent.
"She would not have been left alone."

2:10pm

Mr Myers: "It was a very busy shift, wasn't it?"
Ms Taylor: "Yes."
Mr Myers says Ms Taylor was not sure she was in the room when the collapse happened.
"The only person you remember [being there] was Lucy?"
Ms Taylor agrees. She adds she assumed Sophie Ellis was also present.
Mr Myers: "It is from your account, Lucy is there, no-one else is present, maybe Sophie?"
Ms Taylor: "Yes."
Mr Myers: "I am going to suggest, you were in the nursery when this happened?"
Ms Taylor says she doesn't believe so.
Mr Myers: "That it was Sophie Ellis who called you?"
Ms Taylor: "It might have been."
Mr Myers: "That Lucy Letby was not there at the start of this?"
Ms Taylor: "I disagree."

2:14pm

Mr Myers says Ms Taylor, in her police statement, said she was "pretty sure" she was "already in nursery room 1", feeding another baby, at the time of the collapse.
Ms Taylor says her memory has deteriorated since then, and what is in her police statement is correct.
Mr Myers says Ms Taylor's police statement said she was called over by Sophie Ellis, and there is no mention of Lucy Letby.
Ms Taylor: "No, but she was there."


Prosecution Re-Direct

2:19pm

Ms Taylor said she read her police statement for the first time this morning and had not memorised everything from it.
She added: "I didn't say Lucy Letby called me over.
"I likely wasn't asked [by police] if Lucy Letby was there.
"Now I have been shown that [statement], I can remember Sophie called me over.
"Years have passed since this has happened."
Ms Taylor said she has not changed her mind about who was present there.
"I tell you now, when I approached the incubator, she [Lucy Letby] was there on the other side."
She added she remembered how "cool and calm" Lucy Letby looked at the time.
Ms Taylor said she hadn't said Lucy Letby was not in room 1 at the time of the collapse.

2:20pm

Ms Taylor tells the court said she didn't think it was necessary at the time to include that information [of Letby's presence] to police.

3:20pm

The trial has been adjourned for today - the jury had been made aware there would be an early finish for this day.
Here is a round-up story of what happened in court today: Lucy Letby trial: Accused nurse ‘stood by baby’s incubator after heart rate and oxygen alert’

3:20pm

The trial will resume on Monday, October 31.
We will continue to provide live coverage throughout the day.

Recap: Lucy Letby trial, Friday, October 28