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

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Colour Code

Blue text - Lucy Letby's (Defendant's) texts and Facebook searches



Daily Mail article from Thursday 27th October 2022 - extracts:


"Today, the jury was shown messages Letby sent to friends after finishing her shift that morning. [my note 14th June]

[...]

Later the same evening a colleague responds to Letby telling her of Baby C's death by saying: 'Damn. Infection? Crap week. How's (Baby) B'.

Letby said she didn't know how he died, and added: 'Doing well on Optiflow. Then collapsed. All happened very quickly. Sophie had him and is devastated'.

The other nurse asked: 'As quickly as A? Yeah, s*** week'.



Letby also messaged her mother, Susan, that morning and said: 'We lost a little one overnight. Very unexpected and sad.'

[...]

The neonatal nurse went on to tell her: 'He was 800g. Sophie the new girl was looking after him. She was devastated'."


Fellow nurse told Lucy Letby she found hospital baby deaths strange

 

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Colour Code

Green text - Countess of Chester Hospital medical staff



Daily Mail article from Friday 28th October 2022 - extracts:

"Giving evidence from behind a screen, Ms Ellis said Baby C, who weighed 800 grams at birth, was fed for the first time at 11pm on June 13, and she left the room briefly to go to the nurse's station, but was then alerted by an alarm from the baby's monitor.

When asked what she saw when she returned to the room, she said: 'I'd seen Lucy standing by the incubator.'

She said Letby, 32, told her the baby's heart rate and oxygen levels had dropped [...]

Ms Ellis said Baby C's condition resolved by itself and she sat at the computer in the room, but the infant's heart rate and oxygen levels then dropped again.

The witness said: 'Lucy was stood at the incubator. I would have been looking from the computer, it was on the right-hand side.' [...]

Ben Myers KC, defending, suggested Letby was not in the room at the time when Baby C's condition had deteriorated and came in after resuscitation started."

Ms Ellis said: 'I don't agree with that.'

--

"Melanie Taylor, a Band 6 nurse, told the court she had been with Sophie Ellis in Nursery 1 that night. [...]

'I said at the time what I thought needed to be said. I can tell you now that Lucy was there. I approached the incubator and she was standing on the opposite side. She was the one that suggested putting in an airway'. [...]

She replied: [...] I gave this statement a few years ago, but I remember how cool and calm she was at the time. I can tell you that Lucy was there'. "

Nurse tells court how she found Lucy Letby standing by incubator

 

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Monday October 31st 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 12 of Prosecution Evidence

Child C

CoCH Neonatal Nurse - Shift-leader - Nightshift, 13th June 2015

11:33am

The trial is now resuming. The judge, Mr Justice James Goss, apologises for the delayed start, which he said was due to a cancelled Northern Rail train.

11:34am

The first witness to give evidence to day is from a nurse, who cannot be named due to reporting restrictions, who explains she was a shift leader at the Countess of Chester Hospital neonatal unit in June 2015.

11:40am

The nurse explains to the court the types of different care that would be provided to babies arriving in the neonatal unit.

11:43am

The nurse is now being asked questions on Child C.
A reminder that none of the children listed in the charges can be identified, so a naming system of 'Baby/Child A' to 'Baby/Child Q' is being used by the press.

11:47am

The nurse said back in 2015, she was not sure she was the one allocating the designated nurses to the babies for that shift, as the allocation system was in the process of changing.
She said she remembers Sophie Ellis was the designated nurse for Child C that evening.
She says Sophie was a "very competent nurse", having come through the neonatal unit as a student nurse.

11:49am

The nurse remembers there being 'no clinical concerns' for Child C at the start of the shift.

11:50am

The nurse says she remembers Melanie Taylor also being assigned to room 1, with Sophie Ellis who was looking after Child C.
Melanie Talylor "would be there for support, for Sophie".

11:54am

The nurse also recalls Lucy Letby was on duty that night, looking after 'at least' one different baby, in room 3.
The nurse said she had 'concerns over respiratory distress' for that baby at the start of that night shift. He was 'grunting', and such symptoms had not been present prior to that.
The nurse asked Lucy Letby to increase the observations for that baby from two-hourly to one-hourly and call the registrar in.

12:00pm

The prosecution asks the nurse about Child C's collapse at 11.15pm.
"I do not remember where, but I was not in nursery room 1."
She recalls "a shout for help", but does not remember who called it.
She entered room 1 and saw Melanie Taylor and Sophie Ellis, and a Neopuff device was being administered.
She noticed Child C was not breathing and the heart rate was very low.
The Neopuff gave Child C chest movement, but he did not breathe himself.
Child C had a "mottled" skin appearance, the nurse recalled.
She remembers a crash call being put out, and recalls Lucy Letby being present, but does not recall when Letby entered the room.
She recalled Sophie Ellis "becoming emotionally upset" and the nurse said she advised her to step outside.

12:02pm

The nurse remembers resuscitation efforts were made, and Child C was baptised, and overseeing palliative care to make the baby boy more comfortable before he died.

12:05pm

The prosecution asks: "Whose responsibility is it to ensure the memory box is made and who takes care of it?"
The nurse: "The designated nurse at the time, if they're able."
The nurse said Melanie Taylor took over as designated nurse and "partly" arranged the memory box.
The nurse explains she asked Lucy Letby to focus back on a baby in nursery room 3, but Letby went into the family room "a few times". The nurse recalled asking Lucy Letby to leave the family to Melanie Taylor.
The nurse tells the court Letby did not have any designated duties to be in the family room, and told her "more than once" not to be in the family room.

Cross-Examination

12:05pm

Ben Myers KC, for the defence, is now asking the nurse questions.

12:12pm

Mr Myers asks the nurse how busy the unit had been between 2015 and 2016, and from a statement she had made, there were more babies arriving into the unit, and more "intensive unit" babies arriving.
Mr Myers said the number of intensive unit babies arriving seemed more than what Arrowe Park, a tertiary centre, had.
Mr Myers says the nurse, in her 2018 statement, said a ward manager was "fighting" for more nursing staff for the Countess of Chester Hospital neonatal unit. "She still is."
"We sometimes weren't meeting staff guidelines for ratios."
The nurse replies that was the case across the nursing network.
The nurse agrees it was "not an ideal experience for staff."
Mr Myers: "And not an ideal experience for babies? There will be a danger of a knock-on effect."
The nurse replies: "Just because the amount of babies increased does not mean we were not compliant on any shift."
The nurse says she did not say staff were "struggling to cope", after being asked about her statement saying staff were missing breaks during "busy" shifts.

12:17pm

Mr Myers asks about Child C, asking if he was in a "potentially fragile condition". The nurse agrees.
Mr Myers says that due to his size and prematurity, there was a risk he could die. The nurse agrees.

12:21pm

The nurse says she could have changed the staffing allocation for designated nurses for that night shift, had she wanted to.
She says she does not know whether Sophie Ellis had looked after a baby as premature as Child C before, but had confidence in her as Melanie Taylor was there for support.
She says she does not recall if Lucy Letby had asked her to spend some time in that room 1.

12:30pm

Mr Myers asks about Child C's collapse.
The nurse says she was not in room 1 at the time, but saw Sophie Ellis and Melanie Taylor in that room, attempting to assist Child C's breathing with the Neopuff device when she arrived.
The nurse says an initial crash call was put out, followed by one for a consultant.
Mr Myers says the police statement refers to "I think Lucy Letby was in the room by now".
The nurse said she made the statement three years after the incident, and could not recall precisely when Letby had entered.
Mr Myers asks the nurse if she was the one to take an upset Sophie Ellis aside and get her to step down from duty for that time. The nurse agrees.
The nurse said Lucy Letby returned to looking after the other babies "after a number of askings" not to be in the family room, as the nurse and Melanie Taylor were looking after Child C and his parents following the collapse.

Prosecution Re-Direct

12:34pm

Simon Driver, for the prosecution, rises to ask the nurse more questions.
The nurse is asked if, given the busy shift, the quality of care was in any way "diminished" for Child C. The nurse says "no".
The nurse adds she would have allocated Sophie Ellis to look after Child C as the designated nurse, with Melanie Taylor supervising, as she believed her to be competent.
The nurse said she believed another baby on the neonatal unit - the one Lucy Letby was designated to look after that night - should have had more care, including a septic screening, as the nurse believed that child was the most concerning to her that night.

12:38pm

The nurse says, from her police interview, she "believed" Sophie Ellis and Melanie Taylor were in room 1 with the Neopuff device when she arrived.
The court hears the response from police was "ok", followed by the nurse saying: "But I...100 per cent couldn't tell you", which the prosecution say meant she was not 100 per cent sure.

Recap: Lucy Letby trial, Monday, October 31

 

[Tortoise]

Monday October 31st 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 12 of Prosecution Evidence

Child C

Dr Katherine Davis, CoCH Paediatric Registrar, Nightshifts 12 & 13 June 2015

12:49pm

The next witness to give evidence is Dr Katherine Davis, who in June 2015 was a paediatric registrar at the Countess of Chester Hospital.
The court hears she had been working night shifts for the night Child C collapsed, and the previous night.

12:52pm

Dr Davis says she does not recall the previous night shift, but from her nursing notes on the night shift of June 12-13 she recalls the observations for Child C at 9.20pm on June 12, 2015.
The notes include "suspected sepsis" and "jaundice" on a list of ongoing problems. The latter is, the court hears, "very common" in premature babies.

12:54pm

Dr Davis added that, at that point, there had been 'no desaturations' or 'bradys' (bradycardia).
Child C was 'NBM' (nil by mouth) due to "billious aspirates".

1:02pm

Dr Davis's notes include simple drawings of the lungs and abdomen. The lungs had "good air entry", with the abdomen 'soft' and 'not discoloured'.
Dr Davis says there was "nothing worrying" about Child C's tummy at the time, noting that there would likely be air in the stomach due to him being on CPAP.

2:08pm

Dr Katherine Davis is continuing to give evidence, with prosecutor Philip Astbury asking questions in relation to the collapse of Child C.
She said she would have received a 'crash call' bleep, and was "relatively close" to the unit when it happened.
She remembers "a lot of activity" when she went into room 1.
She remembers there being a senior nurse present, but beyond that, is not sure of who was there.

2:12pm

Dr Davis's note is presented to the court, written at 1.30am on June 14 and timed retrospectively.
The note said she was arrived at the unit in "less than one minute" after the crash bleep went off.
A 'Guedel airway in situ' was noted, with chest compressions in progress.
Dr Davis noted 'occasional intermittent gasps noted'.
Dr Davis said she believed Child C "looked pale" when she arrived.
Dr Davis explains chest compressions would stop "briefly" to detect if Child C had a heart rate, and if there was no heart rate, which Dr Davis said "was unusual" from her experience.

2:18pm

Chest compressions were restarted and the on-call consultant was called "urgently".
Dr Davis attempted to intubate Child C, but was unable to do so as Child C's vocal cords were swollen. Dr David tried again with a smaller tube, twice, but was again unable to intubate.
A list of drugs was administered, including several doses of adrenaline.

2:20pm

The next note was at 2am, following a "prolonged attempt" at resuscitation.
Dr Davis: "It became obvious that we were not winning, we hadn't got a heart rate".
The failure to resuscitate was "very unusual" as premature babies usually had some response to resuscitation efforts, even if it was temporary, Dr Davis tells the court. Child C had no response.

2:29pm

Dr Davis said baptism of Child C took place, and it was noted during the resuscitation attempts that a capnograph on Child C had detected carbon dioxide coming out of the baby boy. The on-call consultant was called.
The baptism and blessing were completed.
"Unexpectedly," Dr Davis said, Child C was gasping and had a heart rate at this time.
A discussion was had at the "appropriate way forward", and "unfortunately", it was concluded Child C would have had a lack of oxygen to the brain for a "prolonged time" which would have left him with significant damage to the brain and potential other issues, such as kidney damage.
Morphine was administered to Child C for pain relief, following a discussion with Child C's parents, as Child C was "unlikely to survive".

2:31pm

Dr Davis said she was later called by a family member of Child C to be informed they had believed Child C had died, and she explains she would have carried out the necessary observations, and verified the baby boy had passed away.

Cross-Examination

2:32pm

Ben Myers KC, for Letby's defence, is now asking Dr Davis questions.
He says that Child C "was on the limit" of what the Countess of Chester Hospital could treat, being at 800g birth weight. Dr Davis agrees.

2:34pm

Mr Myers is referring to Dr Davis's notes on June 12, where a "raised CRP" reading is noted, which he says is "a potential marker for infection". Dr Davis agrees.
She also agrees Child C is at increased risk of abdominal problems due to his prematurity.

2:36pm

Mr Myers asks about the billious aspirates.
Dr Davis says any such aspirates, of any colour, are a cause of concern.
Mr Myers: "It's a red flag for a problem, isn't it?"
Dr Davis: "Yes."

2:40pm

Dr Davis said she would have examined the "bigger picture", in that Child C handled well, had a soft abdomen, and there were bowel sounds.
"There was no suggestion we should do anything different."
Dr Davis said there were no other signs of NEC.
Mr Myers said the bile aspirates could be a symptom of something else.
Dr Davis says Child C was examined for other symptoms, but was still "well", and his bowels were not yet open.
Dr Davis adds: "He had a lot of challenges, but he was doing well."
Mr Myers: "He had the potential, as a small baby, to deteriorate rather rapidly?"
Dr Davis: "Yes.

2:44pm

Dr Davis said Child C "was not getting sick" despite the readings of dark bile aspirates.
"It is not something we should ignore, it's something we would keep an eye on...but I don't think there was anything else we should have done."
She adds that dark bile is "not normal", but "not uncommon" in premature babies.
Mr Myers said Child C was not seen by a consultant until three days after he was born, on June 13, and "the appropriate step" would have been for Child C to see him before then.
Dr Davis said such a step would have been discussed prior to June 13.

2:50pm

Mr Myers said the collapse of Child C happened before Dr Davis had a chance to review him. Dr Davis agrees.
Mr Myers refers to the circumstances of Child C's collapse.
He asks if a tertiary unit would have had advanced practitioners capable of intubating a baby.
Dr Davis said they would have had more staff available, but cannot comment on Arrowe Park. She says from her experience in a tertiary centre, there would be advanced nursing practitioners, but they would not work night shifts.

2:53pm

Dr Davis said there would be a risk-benefit discussion for whether a baby would be in a level 2 unit at the Countess of Chester Hospital, or a level 3 unit such as Arrowe Park.
She said there would be risks in transporting a baby in an ambulance to that tertiary centre.
She adds bed availability would not be an issue as they could always transport out of the region if necessary.

2:58pm

Dr Davis said at the time she arrived in room 1, the nursing staff were doing everything they could do.
She says that the decision to intubate was not necessarily the right or wrong thing to do, but had its advantages.
The intubation period would have lasted about 30 seconds, as during that time Child C would not have had Neopuff bag support. Dr Davis said after those 30 seconds, efforts to resuscitate using the Neopuff would resume.

3:02pm

Dr Davis said despite the resuscitation attempts, Child C would have had a "huge amount of time" without a heart rate.
Mr Myers: "Did the delay in intubation cause any difficulties down the line?"
Dr Davis: "No."

Prosecution Re-Direct

3:04pm

Philip Astbury rises to ask if Dr Davis had seen a collapse that sudden or unexpected in a child like Child C before.
Dr Davis: "Absolutely not."
She adds that from her experience, she had seen a lot of babies with significant abdominal issues, and had dealt with babies with NEC, but they didn't "behave or die in the way that [Child C] did."

Recap: Lucy Letby trial, Monday, October 31

 

[Tortoise]

Monday October 31st 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 12 of Prosecution Evidence

Child C

Dr John Gibbs, CoCH Consultant Paediatrician, Day & Nightshifts 13 June 2015 and Debrief 2 Jul 2015

3:17pm

The next witness is Dr John Gibbs, who in June 2015 was working at the Countess of Chester Hospital as a consultant paediatrician, and had been working at the hospital for over 20 years.

3:26pm

He says he had seen Child C a few times during the first few days of his life, and had carried out a review.
"There was no particular concern" about Child C, despite there being gastric aspirates, and while being "small" even for being premature, he was at risk of conditions such as NEC. He said such aspirates were "not uncommon" as gastric acid could accumulate in the stomach, and Dr Gibbs recommended an antacid be given for the stomach.
He says Dr Ogden's note of the abdomen being "soft, not distended" is a "very reassuring sign".
Dr Gibbs said if the aspirates "got steadily larger" that would be a concerning sign, and a symptom of NEC.
It was decided, Dr Gibbs said, to monitor the aspirates and hold off giving feeds at that time.
He said if the aspirates got larger, or came with vomiting, then an abdominal x-ray would be carried out.

3:32pm

Dr Gibbs said he carried out an ultrsound scan of Child C's head, which was recorded as 'normal', a 3.55pm on June 13.
He was next involved with Child C as the on-call consultant, having received an emergency call at about 11.28pm. A note is written, retrospectively, by Dr Gibbs at 12.30am.
He said then when he arrived, efforts were being made by staff to resuscitate Child C.
He said Child C looked "pale and mottled", which he said was "not uncommon" in babies in cardiac arrest.

3:40pm

The notes show Dr Gibbs intubated Child C to provide more effective ventilation.
He adds that ventilation can also be obtained through the Neopuff device.

3:43pm

Dr Gibbs says that babies experiencing a sudden and unexpected collapse would normally be expected to show some signs of responding to resuscitation efforts, and it was "unusual" Child C did not.

3:52pm

The resuscitation attempts were said to have "failed" after 40 minutes.
Dr Gibbs said it was "standard practice" for attempts to cease after 20 minutes, but staff would carry on for a little longer "in the hope" of the baby responding.
Resuscitation efforts continued after the 40-minute point while the priest arrived to baptise Child C.
He said, "surprisingly", there were some "minimal" signs of life in Child C, and he was "not sure what to do" as it was "unexpected".
He was "not sure" why a feeble heart rate, and breathing gasps, were being recorded for Child C.
He relayed to the parents that, due to the prolonged time without oxygen, the chances of Child C being brought back without "profound" brain damage were "extremely remote".

3:53pm

Dr Gibbs said it was planned to offer Child C palliative care for his final hours.

3:55pm

Dr Gibbs said he could not provide a cause of death, so subsequently contacted the coroner's office.

4:01pm

Dr Gibbs said a debrief was carried out for Child C's fatal collapse on July 2, in which the circumstances were discussed.
It was noted, in a summary of the debrief, Child C 'did not seem unwell', was 'active (kept pulling out NG tubes)', an infection was 'suggested' but Child C was on antibiotics.
Dr Gibbs noted in the debrief the collapse was not related to the feed, which was administered shortly before the collapse, as he said he could not see how the administration of a 0.5ml feed could lead to a cardiac arrest.
The resuscitation was performed "technically well", and the "team worked well together".
Dr Gibbs explains the context from the notes, was that the staff had done everything they could to save Child C.

4:04pm

Dr Gibbs said it was not possible to rule out a pulmonary embolus - a blood clot which breaks off from another part in the body, blocking lung circulation.
Another theory was toxins from medicine administered.
The post-mortem had been held at this point, but the results were not available.

4:08pm

The debrief noted that Child C's parents were advised that "further life support measures" were "futile".
Dr Gibbs said the notes said for future situations, rather than prolonging a baby's life with 'token resuscitation efforts' for a priest/vicar to arrive, it would be better for a nursing member of staff to carry out the baptism duties themselves. This would be in the event of following prolonged, and ultimately failed, resuscitation efforts which left a baby with no realistic prospect of survival.
Dr Gibbs said he would have discussed this with the rest of his consultant colleagues.

4:13pm

Dr Gibbs said he wants to clarify that he is not blaming the parents for requesting to allow Child C to be baptised, and the wait that followed for a priest and vicar to arrive.
He said the problem was that Child C's heart and lungs restarted following the token efforts to resuscitate, and he could not think why that was the case.
"Whatever catastrophic event that had happened [to Child C] had reversed, or begun to reverse.
"I don't understand that from a natural disease process."
He said it was right the parents requested for a priest to arrive for baptism. He adds the difficulty was that Child C's heart and breathing restarted following that.

7:24pm

The trial will resume tomorrow.

Recap: Lucy Letby trial, Monday, October 31

 

[Tortoise]

Colour Code

Blue text - Lucy Letby's (Defendant's) texts and Facebook searches




The Guardian article from Monday 31st October 2022 - 10% extract:


"A nurse accused of murdering seven babies would not leave alone the parents of a newborn boy she allegedly killed until she was ordered to do so by her supervisor, a court has heard. [...]

Jurors have previously seen messages sent by Letby during the night shift in which she said being in room three was “eating me up”.

She added that she felt she wanted to return to room one where a baby boy – her alleged first victim – had died, to “get the image out of my head”."

Lucy Letby case: nurse ‘would not leave parents of dead newborn alone’

 

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DM article Monday 31st October 2022 - 10% extracts

"Nurse B, who cannot be named for legal reasons, said her fellow Band 6 nurse Melanie Taylor was the one meant to offer the family a memory box [...]

But she had only done so 'partly'. The rest of the process was carried out, unbidden, by Letby.

[...]

But when he [Ben Myers KC, defending] asked her to confirm that Letby had later gone back to N3 as instructed, she replied: 'Yes – after a number of times asking.'

[...]

Dr Katherine Davis, a paediatric registrar at the hospital, said there had been a 'prolonged attempt' to resuscitate the infant, but this was eventually abandoned.

[...]

Mr Myers, for Letby, put it to her: 'He was right on the very limits of what the Countess of Chester could deal with, wasn't he?'

Dr Davis replied: 'I think our limit was 800g, and he was 800g.'

[...]

Philip Astbury, prosecuting, asked if she had ever seen a collapse as sudden or unexpected as that of Baby C.

Dr Davis replied: 'Absolutely not.'

She said she had seen a lot of babies with significant abdominal issues, along with infants with NEC [necrotising enterocolitis], but they didn’t 'behave or die in the way that' Baby C did."

Lucy Letby: 'Baby killed by nurse showed signs of life for FIVE HOURS'

A baby allegedly murdered by nurse Lucy Letby showed intermittent signs of life for five hours after a medical crash team called off their desperate attempts to resuscitate him, a court heard today.

www.dailymail.co.uk

 

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Episode 1 - 24 October 2022

The Trial of Lucy Letby, Episode 1: Nurse on trial​

In this first episode of The Trial of Lucy Letby, Caroline and Liz go over the background of the case that has grabbed the attention of people all over the world. We’ll find out how the jury has heard that staff at the Countess of Cheshire Hospital grew suspicious of the nurse back in 2015 after an unexplained rise in deaths and serious collapses of babies in the neonatal unit.

The Trial of Lucy Letby, Episode 1: Nurse on trial

www.mailplus.co.uk

 

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Episode 2 - 24 October 2022

The Trial of Lucy Letby, Episode 2: A scrawled post-it note​

This week, Caroline and Liz begin outside the crown court where Liz goes over the opening statements of both the prosecution and the defence. The prosecution accuse Lucy Letby of being ‘a poisoner’ and ‘constant malevolent presence’ on the unit, while the defence say the case against her is based entirely on coincidence and assumption, describing her as a hard working nurse who only tried to help the babies in her care. We’ll also hear from David Banks, a media law expert, who explains the fine line journalists tread when reporting ongoing trials.

The Trial of Lucy Letby, Episode 2: A scrawled post-it note

www.mailplus.co.uk

 

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Episode 3 - 31 October 2022

The Trial of Lucy Letby, Episode 3: Baby A​

In this episode, Liz and Caroline continue their examination of the trial, which is focusing on each baby in turn. They look at what the prosecution say happened to Baby A – the first alleged victim. A premature twin boy, he died 24 hours after his birth in June 2015. We’ll also hear about a rash found on some of the alleged victims and hear text messages Lucy Letby sent to colleagues after Baby A’s death.

The Trial of Lucy Letby, Episode 3: Baby A

www.mailplus.co.uk

Snippets from podcast (my transcript):

“LL also told detectives that she knew Baby A and his twin sister Baby B were much wanted babies and his parents had waited a long time for them. The interviewing officer then asked “who told you that?” and she replied “it was known through the nursing handover we had”. She was then asked if that sort of information would change the way she would deal with parents, and she said “no, I would like to think we treat all the parents the same, but you bear in mind what they’ve gone through to get to this point”.”

------

LL's text (Whatsapp) exchange with colleague Jennifer Jones-Key on Saturday 13th June 2015, during LL's night-shift - the night-shift when Baby C collapsed shortly after 11pm and died after midnight. The conversation starts at 9.48pm and concludes at about 11pm -

9:48pm –

JJ-K: "You ok? x"

LL: "I just keep thinking about Monday. Feel like I need to be in 1 to overcome it, but [nursing colleague] said no x"

JJ-K: "I agree with her, don't think it will help. You need a break from full-on ICU, you have to let it go or it will eat you up."

LL: "Not the vented baby necessarily, I just feel I need to be in 1, to get the image out of my head. To be in 3 is eating me up. All I can see is him in 1. It probably sounds odd but it's how I feel x"

JJ-K: “It sounds very odd and I’d be complete opposite.

LL: “Well that’s how I feel. I don’t expect people to understand but I know how I feel and how I have dealt with it before. I voiced that so can’t do any more, but people should respect that.”

JJ-K: “I think they do respect it but also trying to help you.”
JJ-K: “Why don’t you go in 1 for a bit?”

LL: "Yeah, I have done a couple of meds in 1. I’ll be fine"

LL: "Forget I said anything, I will be fine, it's part of the job but just don't feel like there is much team spirit tonight x"

JJ-K: "I am not going to forget but think you're way too hard on yourself."


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


Times of text conversation and additional text come from Chester Standard's live updates -
this post - UK - Lucy Letby Trial - Media, Maps & Timeline *NO DISCUSSION*

---

[Not in podcast] - Texts between LL and the same colleague Jennifer Jones-Key on the morning of 14th June 2015 after Baby C had died and LL had finished her night-shift -

LL: "Sorry if I was off, just wasn’t a great start to the shift but sadly it got worse."

JJ-K: "You weren't off, you just were not happy and there is nothing I could say that was going to make it any better."

LL: "I was struggling to accept what happened to [Child A], now we’ve lost [Child C] as well and it's all a bit much."

JJ-K: "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".

LL: "[C] is the little 800g baby. He went off very suddenly. I know it happens but it's so sad and cruel."… “I just keep seeing them both. No one should have to see and do the things we do. It’s heartbreaking.”

JJ-K: "Hoping you are going to ok, this is not like you. Sending the biggest hugs."

LL: "It's heartbreaking but it's not about me."

JJ-K: "Chin up chuck we will get through it together."

LL: "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."


Sources:

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

BBC article - Lucy Letby: Nurse said baby's death was 'all a bit much', trial told

 

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Episode 4 - 31 October 2022

The Trial of Lucy Letby, Episode 4: Baby B​

In the latest episode of the Trial of Lucy Letby podcast, Liz and Caroline focus on the case of Baby B, the twin of Baby A. She was allegedly attacked 27 hours after her brother, but survived. We’ll hear testimony from nurses and doctors who successfully resuscitated Baby B when she collapsed. Liz and Caroline also chat to experienced journalist Kim Pilling, who works for the Press Association and has one of just a handful of media seats in the actual courtroom.

The Trial of Lucy Letby, Episode 4: Baby B

www.mailplus.co.uk

 

[Tortoise]

Tuesday November 1st 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 13 of Prosecution Evidence

Child C

Dr John Gibbs, CoCH Consultant Paediatrician, Day & Nightshifts 13 June 2015 and Debrief 2 Jul 2015
Continued...


10:34am

The trial is now resuming, with Dr John Gibbs giving evidence.

10:39am

Philip Astbury has one more question to ask for the prosecution, about monitors in place at the neonatal unit in June 2015.
He asks Dr Gibbs if such monitors record the displayed readings, for people to look up a potential archive of readings. Dr Gibbs says he isn't sure, but doesn't think they did. He adds he hasn't done so, in his practice.

Cross-Examination

10:43am

Ben Myers KC, for Letby's defence, is now asking Dr Gibbs questions.
He asks about the staffing arrangements in place at the hospital at the time.
Dr Gibbs says at the time, he is fairly sure the paediatrician of the week on a rota would cover the children's ward and the neonatal ward. They would not have any planned clinics for that week. Other consultants would cover during the night, as that paediatrician could not cover a 24/7 week, the court hears.

10:47am

Dr Gibbs said the workload would depend on need, and consultants would spend more time on the paediatric ward as there would be much more turnover there than the neonatal unit.
Mr Myers asks if Dr Gibbs would agree consultant cover was stretched during 2015-2016
Dr Gibbs said more consultants arrived after June 2016, but they had been requested for several years.
The consultant cover at the time was "fairly typical" for a level 2 unit, the court hears.

10:51am

Dr Gibbs said the addition of two consultants "had been planned" for many years.
He said "every speciality wants more staff", as did a lot of hospitals, given the context of the staffing pressures of the NHS overall.
"We wanted to increase the number of staff so we could reduce the number of hours".
Mr Myers says the two consultants arrived after the Countess of Chester Hospital was reduced to a level 1 neonatal unit in June 2016.
Dr Gibbs says that is the case, but the two were not linked.

10:54am

Mr Myers asks about Child C being 'on the limit' with birth weight.
He asks whether it would be "almost inevitable" Child C would have faced complications, and asks if in hindsight, Child C should have been cared for at a tertiary unit.
Dr Gibbs: "That depends on what causes sudden and unexpected collapses [leading to his death]."
Mr Myers asks, taking that aside, should Child C have been cared for at a tertiary centre.
Dr Gibbs: "No."

10:58am

Mr Myers asks about the billious aspirates found.
He says if a baby is producing dark bile, if that is a concern.
Dr Gibbs: "It raises some concern, yes."
Mr Myers: "It's potentially serious, is it not?"
Dr Gibbs: "No - it comes from acid reflux...some normal premature babies [produce bile aspirates]."
He adds that is why an antacid was administered to Child C.

11:08am

Mr Myers produces a nursing note from Yvonne Griffiths, which refers to, on June 12, 2mls of 'black stained fluid', plus 'bile on blanket'.
Dr Gibbs says he would have been concerned if Child C had continued to vomit bile, and there was a lot of it.
Mr Myers produces the intensive care unit chart for June 12, showing 'vomit dark bile' at midnight.
He asks if it is a matter for concern.
Dr Gibbs says there is one note of vomit, and says that is a worry, but would be more concerning if it was repeated.
The intensive care unit for June 13 is presented, showing more dark bile readings.
Dr Gibbs says there are no more vomit readings, and the June 13 readings are from aspirates, which can be common in premature babies.

11:12am

Dr Gibbs says the aspirates were not increasing from 0.5ml on June 13.
He said the baby would be examined first, with an examination of the abdomen.
Mr Myers asks if there was a possibility of something other than NEC Child C could have had.
Dr Gibbs says NEC was "a particular risk", but there could have been an obstruction in the body, and medical staff would not have just been focusing on looking for symptoms of NEC.

11:26am

A diagram of the small and large intestine is presented to the court.
Mr Myers asks about the passage of air, and refers to radiograph images for Child C, one taken on June 12, and the accompanying note refers to 'marked gaseous distension of the stomach and proximal small bowel'.
Dr Gibbs says there is 'not much air in the large intestine' shown.
Mr Myers asks if there is an obstruction.
Dr Gibbs says it is a possibility, and the air seen is common for babies on CPAP ventilation.
Mr Myers asks if there is an intestinal blockage.
Dr Gibbs says it is a possibility.
Mr Myers says a symptom of intestinal blockage is vomiting dark bile.
Dr Gibbs says there is only one recorded instance of that, and the symptom would be 'repeated vomiting'.
He says a sign of an intestinal blockage would be a 'very distended abdomen', and when he examined him on June 13, Child C had a 'soft, not distended abdomen'.

11:27am

Dr Gibbs adds the amount of dark bile aspirates, in the case of an intestinal blockage, would increase, and that was not the case with Child C.

11:35am

Dr Gibbs says an obstruction is "a possibility", but "not the explanation".
Mr Myers asks if not looking to see whether Child C had a potential obstuction, in view of vomiting dark bile, was "a potential mistake".
Dr Gibbs repeats there was not repeated vomiting, and dark bile aspirates would be found in normal babies.
The court hears Child C did not have his bowels open during his life.
Dr Gibbs says that was not surprising as he had not been fed.
Mr Myers asks if that was unusual, after three days, for the bowels not to open.
Dr Gibbs said it could be unusual, but Child C had not been fed, so there were not going to be bowel motions.

11:39am

Mr Myers asks if it would have been preferable for Child C to have been examined by a senior consultant prior to June 13.
Dr Gibbs: "It would have been preferable if there had been significant concerns about him, and he had not already been reviewed by the registrar and junior doctor."
Dr Gibbs said he would have carried out daily reviews, without a full examination, of neonatal unit babies.

11:42am

Mr Myers asks about Child C's collapse.
He says Dr Gibbs intubated Child C at the first attempt, and said Dr Gibbs had told the court intubation was more effective than Neopuff.
Dr Gibbs said it was more effective during prolonged resuscitation attempts, and Neopuff by itself was effective too.

11:42am

Dr Gibbs said even if he was unable to intubate Child C, Neopuff administration could have continued.

11:48am

Mr Myers asks about the debriefing notes written by Dr Gibbs on July 2, 2015.
He says no mention is made about the dark bile aspirates.
Dr Gibbs says that is correct.
Mr Myers asks if if is a consideration on the notes that could later be seen as part of legal action, and would that be something Dr Gibbs would be aware of.
Dr Gibbs said the purpose of the debriefings was for the benefit of future patients, not for lawyers.

Prosecution Re-Direct

11:50am

Philip Astbury asks about hours worked by Countess staff.
Dr Gibbs said the long hours worked were a "widespread problem" in the paediatric network, but the quality of care for patients was not diminished.
He added: "It would be better for a consultant to be available every day to carry out comprehensive reviews."
He said that was the case in most units in the UK.

11:52am

Asked about the dark bilious aspirates and the one case of vomiting, Dr Gibbs said Child C was not a cause for concern as the abdomen was soft and the other observations were normal.

LIVE: Lucy Letby trial, Monday, November 1

 

[Tortoise]

Tuesday November 1st 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 13 of Prosecution Evidence

Child C

Dr Andrew Brunton, CoCH Specialist Trainee in Paediatrics,
Child C's Birth 10th June 2015
Agreed Statement


12:16pm

We have had a short adjournment.
The prosecution is now reading out agreed evidence statements.
The first is from Dr Andrew Brunton, a specialist trainee in paediatrics at the Countess of Chester Hospital at the time of June 2015.
He discussed Child C's clinical situation at birth (weighing 800g) with a consultant, who was happy for Child C to be treated at the Countess of Chester Hospital, but that situation would be kept under review.
He noted inserting a UVC into Child C.
He was not on duty at the time of Child C's collapse.


Nurse Bernadette Butterworth, Child C's Designated Nurse on Night-Shifts 10th/11th and 11th/12th June 2015
Agreed Statement


12:24pm

An agreed evidence statement from nurse Bernadette Butterworth is read out.
She recalls seeing the UVC had come out of Child C, which was not a usual sight, and his blanket was wet.
She was designated nurse for Child C for the night shifts of June 10-11 and June 11-12.
On the first shift, she recalled recording readings which included rapid breathing, and the incubator temperature was reduced.
Child C was 'unsettled at times', and oxygen of 'up to 37%' was required to maintain saturation levels.
A further note was made to say the UVC 'continued to ooze'.
The note concludes 'will discuss increasing feeds due to large urine output, continue to observe oozing'.
The nurse said she noted Child C was 'unsettled' and 'poorly' at that time, and on antibiotics.
Child C 'was the same at the end of the shift' as he had been when the nurse began the shift at 1am.

12:30pm

The nurse's notes from the following night are presented to the court.
Child C required varying oxygen support, and continued to breathe at an increased respiratory rate.
The UVC was found, at one point, to be 'out and damp', so had not been out for long.
She noted the abdomen appeared distended, 'soft to firm, not hard, bowels not opened, minimal aspirates'.
Child C was "unsettled at times" and required increased oxygen support after handling.

12:39pm

The nurse says, for the abdomen readings, they were 'distended but soft to firm', and nurses always check for symptoms of NEC.
The distended abdomen can be a sign of the consequences of using CPAP - 'CPAP belly'.
The nurse said from her notes on her night shifts, Child C had minimal, clear aspirates.


LIVE: Lucy Letby trial, Monday, November 1

 

[Tortoise]

Tuesday November 1st 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 13 of Prosecution Evidence

Child C

Dr Dewi Evans - Prosecution Expert Witness Re. Child C

12:49pm

Dr Dewi Evans, independent medical expert, has now returned to court to give evidence in relation to Child C.

12:52pm

Nicholas Johnson KC, for the prosecution, asks Dr Evans to confirm he has made a number of reports for Child C, made between 2017 and September 2022. Dr Evans confirms that is the case.
Dr Evans confirms he was sent records from Alder Hey and the Countess of Chester Hospitals, including images and records taken, after Child C had died.

12:56pm

Dr Evans says Child C was a vulnerable, pre-term baby, with restricted growth meaning he was 800g at birth.
"He had two significant risk factors" that meant admission to a neonatal unit with "careful management" that would have been required of several weeks.
He said Child C would have been at risk of a number of conditions during that time.
The commonest risk would have been to his respiratory system, the second would have related to feeding, as premature babies are not necessarily adapted to receive milk. He would also have been at risk of NEC.
The third would have related to infection.
The fourth complication would have been metabolic, and it was important to maintain glucose levels and be aware of the risk of jaundice.

12:58pm

In relation to the breathing problems, Dr Evans says from the records, Child C's breathing stabilised over the days, with CPAP and oxygen support decreasing. Child C had been taken off CPAP on placed on Optiflow, whichw as "a very encouraging sign" that Child C could begin breathing on his own.
The percentage of oxygen support had decreased from a 'common' support of 40% to 25%, the latter which was 'very low' for breathing support.
"They were good markers of progress," Dr Evans says.

12:59pm

Mr Johnson says Child C also had periods of skin-to-skin contact with his mum without breathing support required.
Dr Evans you "wouldn't dream of doing that" if Child C was unstable on breathing support.

2:05pm

The trial is now resuming after the court adjourned for a lunch break.
Dr Dewi Evans will continue to give evidence.

2:07pm

Dr Evans continues to discuss the 'realistic risks' Child C could have faced.
One was feeding; Dr Evans says all premature babies require naso-gastric feeding.
If the babies cannot tolerate that, then it is clinical practice to administer nutrition via TPNs, via IV.
Child C was fed via the latter method, which was "the right thing to do".

2:09pm

Dr Evans said aspirates would be taken from the stomach prior to feeding.
He said dark bile aspirates could be a symptom of NEC or an obstruction, but it would need to be taken in context with other signs such as the baby's abdomen condition, and the general condition of the baby - and signs of a problem would be whether the heart rate would increase, the breathing rate would increase, and/or whether the oxygen would need to be increased.

2:15pm

Dr Evans said medical staff were aware to monitor Child C's abdomen and make regular notes.
He says there is one entry made in the nursing notes of 'black fluid' - not necessarily bile, but discoloured blood. That was to be 'monitored' and to 'keep an eye' on the baby's condition. It would not, in itself, be a concern.
For the 'one-off' vomit reading, Dr Evans says if there was something 'serious' going on, it would happen more often than once.
The four dark bile aspirate readings, each 0.5ml, are 'a tiny amount', Dr Evans tells the court.
"The good news is it's only 0.5ml. The other good news is the bile aspirate is not increasing [per reading].
"That is an indication the baby is not getting worse."
He said increasing readings would point to an obstruction, as would a distended abdomen.
Dr Evans says Child C's status was "under control".

2:18pm

Dr Evans says Child C was well for a '30-weeker' (in terms of gestational age).
A blood test for CRP had increased from 1 to 22-23 - 'not particularly high', the clinical was 'aware of this' and Child C was placed on antibiotics.
Child C's platelet count had fallen - which 'on their own don't tell you very much', but in combination with an x-ray was a 'non-specific marker pointing to an infection'.

2:21pm

Blood gas readings taken were 'within acceptable values', Dr Evans tells the court, and in terms of metabolic readings, Child C was a 'stable little baby'.
Dr Evans said all premature babies develop symptoms of jaundice.
"The good news with [Child C] is the jaundice levels were very satisfactory".
If Child C had signs of severe jaundice, he would have required phototherapy, Dr Evans explains.

2:25pm

Dr Evans says Child C had a lung infection, of pneumonia, which was "very common" in premature babies, and he was placed on antibiotics in advance of any test results.
Mr Johnson: "Did breathing issues have any direct cause for [Child C's] death?"
Dr Evans: "No."
Mr Johnson: "Did any feeding issues cause his collapse?"
Dr Evans: "No, that cannot explain his collapse either."
Mr Johnson: "Did the infection of pneumonia cause it?"
Dr Evans: "No - the infection was under control and being treated."
Dr Evans explains if the pneumonia treatment was not working, a number of markers would be shown. There would be an increase in heart rate (which did not occur, he says), an increase in respiratory rate - but that stayed the same.
Oxygen saturation levels stayed "absolutely where they should be", whereas in worsening pneumonia conditions those levels would fall.

2:28pm

Mr Johnson: "Did the jaundice/glucose issues cause his collapse?"
Dr Evans: "None at all."
Dr Evans says there were "no worrying trends" recorded in the notes.
"What was the cause of [Child C's] catostrophic collapse and death?"
Dr Evans says, initially, he did not have a conclusion to Child C's death.
He adds one complication is if the abdomen is filled with air.
Dr Evans: "If you get a significant injection of air into the stomach, it can cause splintering of the diaphragm."
As a result, a baby could collapse pretty quickly as they would suffocate.
Dr Evans says that was his conclusion for Child C.

2:31pm

Dr Evans says if the diaphragm is unable to move effectively, the lungs are unable to get fresh oxygen, and that causes the collapse.

LIVE: Lucy Letby trial, Monday, November 1

 

[Tortoise]

Tuesday November 1st 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 13 of Prosecution Evidence

Child C

Dr Dewi Evans - Prosecution Expert Witness Re. Child C


Cross-Examination

2:48pm

After a short adjournment, Ben Myers KC, for Letby's defence, is now asking Dr Dewi Evans questions in relation to Child C.

2:53pm

Mr Myers says Dr Evans has had the case material for Child C for about four and a half years, and has provided such conclusions.
"Before today, you have never suggested that [the collapse on] June 13, the splintering of the diaphragm, is the cause of the death, have you?"
"That is correct."
Mr Myers suggests that Dr Evans's opinion alone would not have reached this conclusion.
Dr Evans said the death could not be explained from the usual causes babies get. He said, taking into account all the other evidence and information from experienced medical people's reports, and reading the pathology report, the splintering of the diaphragm was now his conclusion.
He said he was functioning as a clinician. "The fact is this baby has collapsed having previously been stable, and one has to explain that."
Mr Myers suggests Dr Evans had been influenced into supporting this conclusion.
He says Dr Evans had not provided this 'splintering of the diaphragm' conclusion in his eight previous reports.

2:54pm

Dr Evans says while Child C was at 'constant' risk of a number of conditions, he was under continual observation and was in a neonatal unit.
He confirms his initial conclusion from 2017 was 'one may never identify the cause of his collapse'.

2:58pm

Mr Myers said Dr Evans 'could not rule out infection' in his 2017 conclusion.
Dr Evans said infection was "a factor" in Child C's short life.
"It is possible to suggest that...his pneumonia was under control, he was requiring hardly any oxygen. It was my role, investigating this unexpected collapse, to give an impartial view of all the issues. I don't prepare partisan reports."
He says infection was a part of Child C's status. He adds it did not cause Child C's death.

3:04pm

Dr Evans tells the court the process in accumulating information in reaching his conclusions.
He says while Child C had an infection, he was recovering from it, as he had gone off CPAP support, on to Optiflow.
"Respiratory wise, he didn't stay the same, he was improving."
Mr Myers says up until the evidence of today, he had not provided in his reports an allegation of harm.
Mr Myers: "You are coming up with things to support an allegation of harm."
Dr Evans: "I am coming up with clinical evidence."
Dr Evans says he has read varying reports, but had not read a single medical report that said "I'm wrong, [Child C] died of something else."
Dr Evans says this case "will always be a challenging case" for any clinician as it is difficult to separate the pathological problems from an event where Child C "was placed in harm's way by some kind of deliberate act."

3:09pm

Dr Evans: "You can't exclude infection from [Child C]'s general status.
"He's got an infection, but it's under control."
Mr Myers refers to another of Dr Evans's reports, from 2019, referring to infection being 'probable' as a significant cause in Child C's collapse.
Dr Evans says if he receives additional evidence, then he will change his mind.
Mr Myers says Dr Evans has not received any new evidence on Child C's infection since.

3:17pm

Mr Myers says the 2019 report said Dr Evans raised a possibility of deliberate injection of air from June 12 via the naso-gastric tube.
Dr Evans, reflecting on that report, said: "Can't rule it out".
Mr Myers refers to a 'massive gastric dilation' was 'most likely' due to an injection of air on June 12.
Dr Evans: "That was a possibility, yes."
Mr Myers says in that report, there was no suggestion the diaphragm had been splintered since, and if he wanted to say so in that report, he could have done so.
"If it wasn't said, it wasn't said."
Dr Evans said what was being discussed, on June 12, there was a "distinct possibility" Child C had excess air in the stomach from CPAP belly.
He was "still stable" from a respiratory point of view.
He tell the court: "However the air went in, it would have been insufficient to splinter the diaphragm on the 12th, as he would've collapsed and died on the 12th."
The air which had gone in was 'insufficient' to cause a collapse. There was 'nothing to suggest' the excess air was enough on June 12.
He says the two events on June 12 and 13 "are quite different" in the way they happened.
Mr Myers said that it was Dr Evans's view, a couple of months ago, there was deliberate harm on June 12.
"That was a possibility, yes it was."

3:19pm

Mr Myers: "What you have done today in your evidence is introduce something supporting the allegation."
Dr Evans: "That is incorrect."
He adds that in coming to his conclusion for this case he is not relying solely on his opinions, but taking in other clinical evidence and reports.
"That is what doctors do, we do it all the time." in what Dr Evans says is a "complicated case".

3:28pm

Mr Myers has gone back to the case of Child B to discuss the legibility of a nursing note concerning blotchiness of Child B's skin.
The discussion goes on for several minutes.
Dr Evans adds: "This is just making a meal out of something."
Mr Myers: "You're not independent, as a witness, are you, Dr Evans?"
Dr Evans: "I am completely independent. I am not here for the prosecution, I am not here for the defence, I am here...to assist the jury."
The judge interjects to clarify the meaning of the note, before the case resumes on Child C.

3:31pm

Mr Myers asks about the bile aspirates, and asks if the dark colour was additional concern.
Dr Evans says it could be discoloured blood, and the presence of vomit once would be a concern, but would need to be put in context of the baby's condition.
"You can't choose out something that supports your case - you need to look at the big picture."

3:38pm

Mr Myers says the x-ray from June 12 had helped form Dr Evans's initial view that there had been an air injection into the stomach.
"That was an opinion I have expressed, yes."
Mr Myers asks Dr Evans what evidence there is to support that air had been injected into the stomach on June 13.
Dr Evans: "The baby collapsed and died."
Asked to explain further, Dr Evans says it was part of a differential diagnosis.
He said there were three clinical scenarios - injecting air into the stomach that interfered with his breathing, or that air was injected intraveneously, or from a combination of the two, which Dr Evans says "sounds awful".
Dr Evans says, from his perspective, from an academic point of view, he would not be able to rule out any one of those three scenarios.

3:42pm

Dr Evans says none of the normal processes described why a baby collapsed.
He adds, for further medical information, he would prefer to defer the matter to the radiologist and pathologist.
He said he objects to being accused by Mr Myers of making things up, and says he is putting forward the information in this case as a result of his own opinion and that of other people's reports.

3:46pm

Mr Myers says 'never once' is an air embolus mentioned in Dr Evans's reports.
Dr Evans agrees.
Mr Myers suggests that Dr Evans has just made up information as he has gone along.
"You keep saying that, and I keep disagreeing."
"And you're not an independent witness at all, are you?"
"And again, that is just being insulting."

LIVE: Lucy Letby trial, Monday, November 1

 

[Tortoise]

Tuesday November 1st 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 13 of Prosecution Evidence

Child C

Dr Sandie Bohin - Prosecution Expert Witness Re. Child C

3:50pm

Independent medical expert Dr Sandie Bohin has returned to court to give evidence, this time for Child C.

3:52pm

Dr Bohin confirms, after being asked by Mr Johnson, she has received and reviewed all the case evidence, including from doctors' witness statements.

3:55pm

Dr Bohin says her role was not to 'rubber-stamp' anything, but to come to her own conclusions and see whether they agreed with that of Dr Evans.
She said she set out what she thought were the important facts for Child C. They include an x-ray taken on June 12 following the insertion of a long line.
She noted the long line was in a "low position", but in a "usable position". The stomach looked swollen and had a distended bowel.
She said initially she could not see a naso-gastric tube on the x-ray image on her laptop, but from viewing the x-ray image shown in court in higher resolution, she could detect it was present, 'very high', in 'not an ideal position'.

4:01pm

Dr Bohin is asked about her conclusions regarding Child C.
She said it was known Child C was premature, growth restricted at birth, and 'potentially at risk of complications', but 'managed very well indeed' in his early days, improving to being put on Optiflow. He had 'clearly not liked' being on CPAP, and had been put on skin-to-skin contact with his parents, without CPAP for a couple of hours, and had done well during those times.
"This was not a baby who was ill, this was a baby who was improving."
Dr Bohin noted Child C "clearly" had an infection, which was "an alerting feature" and for which the medical team treated him with antibiotics and did an x-ray confirming left lung pneumonia.
Despite that, Child C had appeared to respond to treatment due to the lessening of respiratory support.

4:03pm

Dr Bohin said it was "very clear" Child C had pneumonia, but a baby with pneumonia will "often survive", but a sign of that will be that they would slowly deteriorate, going from CPAP to ventilator support, increased heart and breathing rate.
Child C's breathing rate was "very stable", despite "effectively breathing with one lung".
Dr Bohin's conclusion was that he had pneumonia, but that did not cause the collapse or kill him.

4:04pm

Dr Bohin said pneumonia would be a factor in the difficulties in response to resuscitation.
She tells the court there would be a sign something was "amiss" prior to the collapse, and a sudden unexpected collapse would be uncommon in babies.

4:09pm

Dr Bohin says babies on CPAP can have CPAP belly, and in order to minimise that, they would aspirate the NGT.
"It is usual practice to note down the volumes of air aspirated to give colleagues an idea [of how much air is coming out of the baby]."
"I couldn't find any evidence of that [in the notes]."
She adds that, for babies not fed, the nursing staff would put the tube on free drainage so air could come out on its own, as well as actively aspirate every four hours or so. She says there was only 'fleeting mention' of free drainage.
If neither of those things happen, Dr Bohin said that would lead to gas accumulation in the stomach.

4:11pm

Dr Bohin said it was not clear from the notes how long the 'free drainage' was in place.
She said one conclusion for Child C's collapse was CPAP accumulation of air, the other being deliberate injection of air.
She said the doctors did not appear to have a concern as they had noted the abdomen to be "soft".

4:14pm

Dr Bohin said Child C died "with his pneumonia, not because of his pneumonia."
She added babies such as Child C do not collapse suddenly and without warning.
She said an infection would not be the cause as that would lead to a gradual deterioration in the baby, not a sudden collapse and no response to resuscitation.

LIVE: Lucy Letby trial, Monday, November 1

 

[Tortoise]

Tuesday November 1st 2022 - Daily Mail report - 10% extract -

‘His collapse is consistent with a volume of air being injected into his stomach,’ Dr Evans said.

Ben Myers KC, defending Letby, suggested Dr Evans had changed his mind about Baby C’s cause of death after subsequently reading the reports of other experts, including pathologist Andreas Marnerides, who carried out a post-mortem following his death.

Mr Myers said that, in the five reports written by Dr Evans between 2017 and 2021, he had initially said Baby C’s death could not be explained and yesterday was the first time that he had claimed Baby C’s diaphragm had ‘splinted’ because he had been deliberately harmed.

But Dr Evans insisted: ‘This baby was put in harm’s way.’

Baby 'suffocated when Lucy Letby injected air into his stomach': trial

The child, Baby C, had pneumonia and needed some respiratory support but was considered stable by doctors at the Countess of Chester Hospital, in Cheshire.

www.dailymail.co.uk

 

[Tortoise]

Wednesday November 2nd 2022 - Tweets - Andy Gill, BBC, @MerseyHack

Hello. I’m back at #Manchester Crown Court where the trial of nurse Lucy #Letby is due to resume. She denies murdering 7 babies at the Countess of #Chester neonatal unit in 2015 and 2016. She’s also pleaded not guilty to the attempted murder of 10 other babies.
@BBCNWT

The court is hearing from Dr Sandie Bohin, a paediatrician expert instructed by the prosecution. Ben Myers KC, defending, suggests alleged victim Child C was very premature and at “at high risk of complications.” Dr Bohin says “He was at risk of complications.”

Mr Myers asks if Dr Bohin agrees with what he calls facts about C. She agrees he never left intensive care. But when it’s suggested he never breathed without assisted breathing, she says it’s more accurate to say without respiratory support, which is less intense.

Dr Bohin agrees that a nurse failed to record the one feed Child C had, and agrees that that is “not good practice”.

Dr Bohin agrees with Mr Myers that the fact that C has pneumonia could be a contributory factor in his death as it would make him less responsive to resuscitation. But…

…but when it’s put to her by the defence that whatever caused C to collapse might not have been fatal were it not for the pneumonia, she says “It’s impossible to say that.”

Mr Myers asks Dr Bohin if she’s “in any way minimising” C’s overall condition, she replies “Absolutely not.”

Dr Bohin disagrees with Mr Myers that distension of C’s bowel seen in an X ray could have caused by an obstruction in his bowel, because other factors don’t indicate that. “Like everything in this case information has to be taken in the round.”

A reminder - the allegation in the case of Child C is that Ms Letby murdered him by injecting air into his stomach. She denies this, and denies all the other charges she faces.

https://twitter.com/MerseyHack

 

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Wednesday November 2nd 2022 - Tweets - Andy Gill, BBC, @MerseyHack

Dr Bohin has said that C died “with” pneumonia but not “of” pneumonia. The judge asks her what the scenario would be if a premature baby like C HAD died of of infection ? 1/2

Dr Bohin says in that case there’d be “a slow but continuous decline”, with an escalation of care being required for breathing and heart problems. “This didn’t happen [in Child C’s case]”.

https://twitter.com/MerseyHack

 

[Tortoise]

Wednesday November 2nd 2022 - no live updates

Re Child C

Chester Standard article - 10%

"Dr Bohin said: “My conclusion was, yes, he had pneumonia, but that was not what caused him to collapse.

“I think the pneumonia contributed to not surviving the resuscitation.”

Prosecutor Nick Johnson KC asked: “When you looked for a reason for (Child C’s) collapse on June 13, can you find an explanation?”

Dr Bohin replied: “No. Babies like this should not collapse. You get prior warning that something is amiss.

“They don’t go from being stable into a cardiorespiratory situation within minutes. They rarely collapse in this way but they are usually responsive to resuscitation and he was not.”

Lucy Letby trial: Murder-accused nurse told police she found baby’s lingering death ‘quite hard’

A NURSE accused of multiple baby murders at the Countess of Chester Hospital told police she found it “quite hard” when one of her alleged…

www.chesterstandard.co.uk

BBC article - 10%

"Ms Letby recalled he deteriorated not long after his first feed by one of the nurses but said she had no involvement in that.
Her only involvement with Child C was when she was asked to help with the resuscitation attempt, she told police.
She added she had a "vague recollection" of taking Child C's hand and foot prints for a memory box while the infant was sat with his parents but "couldn't be certain".
Ms Letby went on to say she found the boy's death "quite hard because he lived several hours [after the collapse]" and she had "not seen that before".

Lucy Letby: Murder-accused nurse found baby's death hard, trial hears

The nurse is accused of killing seven babies and attempting to murder 10 others on a neo-natal ward.

www.bbc.co.uk

Daily Mail - 10%


"Nick Johnson KC, prosecuting, read out a summary of two interviews the alleged killer gave to police about Baby C's death on June 14, 2015.

In the first interview, conducted on July 4, 2018, the nurse agreed that she had gone into the family room during the time the couple were holding their infant son.

Despite having 'some interaction' with the parents, she claimed to have no recollection of making comments suggesting they 'say their goodbyes' to the infant, who was still alive."

[...]

In her first interview about his death the nurse said she recalled him deteriorating 'not long after' he had been given his first feed by her colleague Sophie Ellis, who was his designated nurse on the unit.

She had not been involved in that process, she told officers. Her only involvement had been when she was asked to help with the attempts to resuscitate him following his collapse in Nursery 1.

Letby claimed she could not recall the events leading up to that, and was not aware of the circumstances of Baby C's collapse. She had not been working in N1 that night.

Lucy Letby 'admitted it was hard when one of her baby victims lived'

The newborn, known only as Baby C, is one of seven babies allegedly killed by 32-year-old neonatal nurse just days after his premature birth at Countess of Chester Hospital in 2015.

www.dailymail.co.uk