UK - Lucy Letby Trial - Media, Maps & Timeline *NO DISCUSSION*
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Tortoise
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Thursday November 3rd 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 15 of Prosecution Evidence
Child D
Child D's Mother's Evidence
9:40am
In the past week, members of the jury have been hearing evidence in relation to the fatal collapse of Child C at the neonatal unit in the Countess of Chester Hospital.
It is expected that today the case will turn to the fatal collapse of Child D in June 2015. The prosecution say that Lucy Letby, as in the case of Child A, B and C, administered a fatal air injection.
The defence deny this.
9:45am
During the prosecution opening statement, the jury has heard Child D, a baby girl, died following three collapses in the early hours of June 22, 2015.
As has been the case for the other children in the case so far, the court will hear evidence of the circumstances which happened in the days leading up to Child D's collapse.
10:10am
As ever, the case is being heard in Manchester Crown Court, in front of a jury of eight women and four men, and the trial is expected to last six months. This is the fourth week of the trial being heard before a jury.
10:37am
Child D's mother is now being called to give evidence.
10:43am
The prosecution, led by Nicholas Johnson KC, ask Child D's mother to confirm details.
Child D's mother tells the court she developed a concern about her waters breaking, which the court hears was "well founded" as her waters broke when she woke up on June 18.
The hospital told her to "monitor the situation". She waited, and rang the hospital again, and was then told to go to hospital.
At 11.30am, she arrived at hospital, and staff confirmed her waters had broken, but did not test.
They then checked her and her baby, "not for very long".
10:45am
"Were you, in effect, sent home after being examined?"
"Yes."
The following day, the mother returned to the hospital, and saw a midwife.
"Were you examined and various checks performed on you?"
"Yes...not straight away. I had to wait."
"Did you express concern to staff at the Countess."
The mum said her waters had broken over 24 hours before, she didn't "feel right" and the baby "didn't seem to move as well" and she was concerned about infection as she hadn't been given any antibiotics.
10:46am
The decision was then taken to induce.
She said staff were "very busy", and she was not placed on an IV but not for "many hours".
It was "very delayed", the mother tells the court.
10:47am
The mother said she was "very worried and scared", "unwell" and "not in control" and "forgotten by the staff", as it was nearly 48 hours after her waters had broken.
On a trip to the bathroom, she noted blood had come out. She asked someone to do something.
10:49am
She said she remembered seeing a doctor, and recalled a description for her.
It was the first time she had seen a doctor since her admission.
She was told that essentially both her and her baby girl were ok, and that a natural birth would be considered, and that would be reviewed 4 hours later at 11am.
10:53am
At 11am, the mother was assessed again, by a different doctor. She recalls a description for the male doctor.
She was told there had been "little progress" and she said he was the "first professional who spoke to me and addressed my concerns".
The mother said it had been about 50 hours since the waters had broken and a C-section was considered, as there had been no dilation.
The mother was informed a natural birth would be the preferred option to a C-section.
By 3pm, the mother had discussed the situation with her husband and concluded she would be 'less patient' and call for a C-section if there had been no progress.
10:55am
At 3pm, the mother was reviewed by the same male doctor, and he was "more concerned" about the situation, as she appeared more tense.
The doctor then confirmed she would receive a C-section as he said it was "not a good idea to wait any longer" as the baby appeared 'distressed'.
Events then moved on "a lot more quickly" after staff had initially appeared "chilled".
After the C-section decision was made, matters "moved a lot more quickly".
10:57am
Child D was delivered and lifted over the screen for the mother to see.
The mother recalls seeing "no life - lifeless - she did not scream, everything was quiet in the room."
Mr Johnson asks if there was a nurse in the theatre room at this stage. The mother does not recall.
The mother was taken to a ward, while medical professionals dealt with Child D.
10:59am
The mother recalls seeing Child D very briefly, in the operating theatre, before they [the staff] took her away as they had "concerns".
The mother said she was "very aware" of things going on, despite having received anaesthetic.
She did not have physical contact with Child D, but her husband did.
The mother was taken to a ward.
11:03am
The mother was taken to a further room, and it was there where she had physical contact with Child D.
Her impression of Child D condition at that point was "really worried as she [was brought to my chest] but she didn't have any movement, she looked limp and pale - struggled to breathe and was making a groaning noise.
"She wasn't really responsive. There was a split-second where she opened her eyes and looked at me, and then no response.
"I tried to breastfeed her, but she was completely limp, so I was worried."
A male paediatrician informed the mother 'not to worry' as the delivery had been through C-section so the breathing wasn't as clear.
The mother said she didn't believe what he said. His attitude seemed "too careless".
11:04am
The mother said she thought something was wrong with Child D and one of the midwives would assess her in 'a couple of hours'.
She said she did not want to wait that long and wanted another doctor's opinion.
The same doctor came back, but he had spoken to a consultant.
The mother said she was "not reassured" but "was glad someone took me seriously". She was then worried as Child D was taken straight to neonatal unit intensive care.
11:06am
The mother said she felt "rubbish...drained" and didn't feel any relief. She was "in pain" and "knackered".
The mother said it was around 7-8pm when she was separated from Child D.
11:08am
The following day was Father's Day.
The mother was given news that Child D had been "up and down" all night, struggling with feeding, and staff "didn't seem too concerned then", but Child D "wasn't great".
The mother believed she had been spoken to by a female consultant doctor that morning.
11:10am
The mother said she recalled Child D needed to be on a CPAP machine and every time they tried to take her off she would crash.
She said staff did not seem overly concerned as Child D was a good-size baby and making progress, despite being 'poorly'.
Other tests showed she seemed 'fine'.
The mother said she was able to see Child D at about 7pm that day.
11:14am
The mother said she had spoken to a doctor before heading to the neonatal unit.
A drawing that the mother had made, showing a plan of the neonatal unit room, is shown to the court, showing the positioning of Child D's cot, other cots, and crosses identifying a number of medical machinery.
11:16am
Child D's mother said she had spoken to Dr Andrew Brunton at 9-9.30pm, and was told he was "very happy" with Child D's test results.
They had "done more scans" and she was "well" and promised her she would be able to hold and cuddle her the following day.
The mother said she was not in a good condition herself, being moved in a wheelchair and '10/10 pain', on morphine, but was happy with Child D.
Child D looked like "a good pink baby", "tiny but chubby", and looked "healthy".
11:18am
The next time she saw Dr Brunton was the following night.
She and her husband were woken up 'about 4am' by a nurse to 'come quickly' as Child D was poorly.
They "rushed downstairs" and Dr Brunton was "holding her" and trying "really hard" to resuscitate her.
11:19am
"We were just standing there looking at [Child D] dying."
The doctor was "quite agitated" and the couple heard they "had to let [Child D] go."
The mother said she could not stay there any more and asked to be taken away.
11:22am
A nurse, who the mother believed to be Lucy Letby, was holding a phone to Dr Brunton's ear, she recalled.
The mother said she had seen Lucy Letby before, when she went to see Child D in the neonatal unit at about 7pm.
The mother recalls as she was wheeled into the room, Lucy Letby was "hovering around, not doing much" with Child D, and had a clipboard, and was looking at the machinery.
"I didn't understand what she was doing", and the mother asked if Child D was fine, to which Lucy Letby said she was.
Lucy Letby "just stuck around" and was "just watching, looking over us".
The mother said she asked for Lucy Letby to "just go away and leave us [in privacy]."
11:25am
Mr Johnson asks if Lucy Letby was in the neonatal unit room at the time Child D died. The mother agrees, and says other doctors were in that room.
The mother says she did not stay in that room.
The mother recalls she was taken to a private room, where Child D was, along with her husband and another family member, and a nurse she had not seen before.
The mother said she did not see Lucy Letby again.
Cross-Examination
11:25am
Ben Myers KC, for the defence, is now asking the mother questions.
11:28am
Mr Myers says it is an "awful experience" what the mother went through, and says he has one or two questions to ask.
He asks about the 7pm neonatal unit visit on June 21.
The mother says she went there with her husband. She recalls 7pm as she 'must have looked at the clock'.
She said there was "an exchange of few words" between her and Lucy Letby.
Mr Myers asks if that was possibly another nurse. The mother replies: "I don't think so."
Judge's Question
The judge, Mr Justice Goss, asks for clarification.
The mother said she would not have known the name of Lucy Letby at the time, but would after seeing her picture after she had been arrested.
Recap: Lucy Letby trial, Thursday, November 3
Tweets BBC https://twitter.com/MerseyHack
The jury is hearing evidence from the mother of Child D. The mum is in the witness box. A reminder - for legal reasons we can’t identify the alleged victims or their families.
Child D’s mum explains that her waters broke early but there were delays at the Countess of Chester Hospital in deciding what to do. “I didn’t feel right. The baby didn’t seem to be moving as well. I was concerned for infection because I hadn’t been given antibiotics.”
Eventually Child D was delivered by C-section. “She seemed very lifeless. She didn’t scream. There was no sound. Everything was quiet in the room.” says D’s mum.
D’s mum continued to have concerns when baby brought to her after delivery: “She was quite limp… she seemed to struggle to breathe.” A doctor told the mum the baby’s condition was due to being delivered by C section, but mum was not reassured.
Child D was taken to the neonatal unit. Next day 21/6/15 was Father’s Day. Mum was told D was struggling to breathe and wasn’t feeding, but she says staff didn’t seem too worried at that stage.
D was on CPAP (continuous positive airway pressure) but every time they tried to take her off it she crashed. But staff didn’t seem worried “ as she was a good sized baby. They didn’t seem overly concerned. She was poorly but making good progress.” says mum.
The jury is shown a plan of the neonatal unit drawn by D’s mum showing where her baby was in the unit at the Countess of #Chester.
“[A doctor] promised me I would be able to hold her and feed her the next day.” But the next morning mum was called to the unit because D was really ill. She saw the same doctor trying to resuscitate D. “We were just standing there watching [D] die.”
Mum tells jury about a time before D died when Lucy #Letby was the only nurse in the room when she and her husband went to see D. Mum says Ms Letby was “sort of hovering by the incubator but not doing much. She sort of just was watching us.”
Ben Myers KC for Miss Letby asks D’s mum if it could have been a different nurse by the incubator on that occasion. “I don’t think so.” She agrees she knows it was Ms Letby because she saw her picture in the paper.
The judge asks Mr Myers if it’s disputed that the nurse on that occasion was Ms Letby, and Mr Myers says it is.
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 15 of Prosecution Evidence
Child D
Child D's Mother's Evidence
9:40am
In the past week, members of the jury have been hearing evidence in relation to the fatal collapse of Child C at the neonatal unit in the Countess of Chester Hospital.
It is expected that today the case will turn to the fatal collapse of Child D in June 2015. The prosecution say that Lucy Letby, as in the case of Child A, B and C, administered a fatal air injection.
The defence deny this.
9:45am
During the prosecution opening statement, the jury has heard Child D, a baby girl, died following three collapses in the early hours of June 22, 2015.
As has been the case for the other children in the case so far, the court will hear evidence of the circumstances which happened in the days leading up to Child D's collapse.
10:10am
As ever, the case is being heard in Manchester Crown Court, in front of a jury of eight women and four men, and the trial is expected to last six months. This is the fourth week of the trial being heard before a jury.
10:37am
Child D's mother is now being called to give evidence.
10:43am
The prosecution, led by Nicholas Johnson KC, ask Child D's mother to confirm details.
Child D's mother tells the court she developed a concern about her waters breaking, which the court hears was "well founded" as her waters broke when she woke up on June 18.
The hospital told her to "monitor the situation". She waited, and rang the hospital again, and was then told to go to hospital.
At 11.30am, she arrived at hospital, and staff confirmed her waters had broken, but did not test.
They then checked her and her baby, "not for very long".
10:45am
"Were you, in effect, sent home after being examined?"
"Yes."
The following day, the mother returned to the hospital, and saw a midwife.
"Were you examined and various checks performed on you?"
"Yes...not straight away. I had to wait."
"Did you express concern to staff at the Countess."
The mum said her waters had broken over 24 hours before, she didn't "feel right" and the baby "didn't seem to move as well" and she was concerned about infection as she hadn't been given any antibiotics.
10:46am
The decision was then taken to induce.
She said staff were "very busy", and she was not placed on an IV but not for "many hours".
It was "very delayed", the mother tells the court.
10:47am
The mother said she was "very worried and scared", "unwell" and "not in control" and "forgotten by the staff", as it was nearly 48 hours after her waters had broken.
On a trip to the bathroom, she noted blood had come out. She asked someone to do something.
10:49am
She said she remembered seeing a doctor, and recalled a description for her.
It was the first time she had seen a doctor since her admission.
She was told that essentially both her and her baby girl were ok, and that a natural birth would be considered, and that would be reviewed 4 hours later at 11am.
10:53am
At 11am, the mother was assessed again, by a different doctor. She recalls a description for the male doctor.
She was told there had been "little progress" and she said he was the "first professional who spoke to me and addressed my concerns".
The mother said it had been about 50 hours since the waters had broken and a C-section was considered, as there had been no dilation.
The mother was informed a natural birth would be the preferred option to a C-section.
By 3pm, the mother had discussed the situation with her husband and concluded she would be 'less patient' and call for a C-section if there had been no progress.
10:55am
At 3pm, the mother was reviewed by the same male doctor, and he was "more concerned" about the situation, as she appeared more tense.
The doctor then confirmed she would receive a C-section as he said it was "not a good idea to wait any longer" as the baby appeared 'distressed'.
Events then moved on "a lot more quickly" after staff had initially appeared "chilled".
After the C-section decision was made, matters "moved a lot more quickly".
10:57am
Child D was delivered and lifted over the screen for the mother to see.
The mother recalls seeing "no life - lifeless - she did not scream, everything was quiet in the room."
Mr Johnson asks if there was a nurse in the theatre room at this stage. The mother does not recall.
The mother was taken to a ward, while medical professionals dealt with Child D.
10:59am
The mother recalls seeing Child D very briefly, in the operating theatre, before they [the staff] took her away as they had "concerns".
The mother said she was "very aware" of things going on, despite having received anaesthetic.
She did not have physical contact with Child D, but her husband did.
The mother was taken to a ward.
11:03am
The mother was taken to a further room, and it was there where she had physical contact with Child D.
Her impression of Child D condition at that point was "really worried as she [was brought to my chest] but she didn't have any movement, she looked limp and pale - struggled to breathe and was making a groaning noise.
"She wasn't really responsive. There was a split-second where she opened her eyes and looked at me, and then no response.
"I tried to breastfeed her, but she was completely limp, so I was worried."
A male paediatrician informed the mother 'not to worry' as the delivery had been through C-section so the breathing wasn't as clear.
The mother said she didn't believe what he said. His attitude seemed "too careless".
11:04am
The mother said she thought something was wrong with Child D and one of the midwives would assess her in 'a couple of hours'.
She said she did not want to wait that long and wanted another doctor's opinion.
The same doctor came back, but he had spoken to a consultant.
The mother said she was "not reassured" but "was glad someone took me seriously". She was then worried as Child D was taken straight to neonatal unit intensive care.
11:06am
The mother said she felt "rubbish...drained" and didn't feel any relief. She was "in pain" and "knackered".
The mother said it was around 7-8pm when she was separated from Child D.
11:08am
The following day was Father's Day.
The mother was given news that Child D had been "up and down" all night, struggling with feeding, and staff "didn't seem too concerned then", but Child D "wasn't great".
The mother believed she had been spoken to by a female consultant doctor that morning.
11:10am
The mother said she recalled Child D needed to be on a CPAP machine and every time they tried to take her off she would crash.
She said staff did not seem overly concerned as Child D was a good-size baby and making progress, despite being 'poorly'.
Other tests showed she seemed 'fine'.
The mother said she was able to see Child D at about 7pm that day.
11:14am
The mother said she had spoken to a doctor before heading to the neonatal unit.
A drawing that the mother had made, showing a plan of the neonatal unit room, is shown to the court, showing the positioning of Child D's cot, other cots, and crosses identifying a number of medical machinery.
11:16am
Child D's mother said she had spoken to Dr Andrew Brunton at 9-9.30pm, and was told he was "very happy" with Child D's test results.
They had "done more scans" and she was "well" and promised her she would be able to hold and cuddle her the following day.
The mother said she was not in a good condition herself, being moved in a wheelchair and '10/10 pain', on morphine, but was happy with Child D.
Child D looked like "a good pink baby", "tiny but chubby", and looked "healthy".
11:18am
The next time she saw Dr Brunton was the following night.
She and her husband were woken up 'about 4am' by a nurse to 'come quickly' as Child D was poorly.
They "rushed downstairs" and Dr Brunton was "holding her" and trying "really hard" to resuscitate her.
11:19am
"We were just standing there looking at [Child D] dying."
The doctor was "quite agitated" and the couple heard they "had to let [Child D] go."
The mother said she could not stay there any more and asked to be taken away.
11:22am
A nurse, who the mother believed to be Lucy Letby, was holding a phone to Dr Brunton's ear, she recalled.
The mother said she had seen Lucy Letby before, when she went to see Child D in the neonatal unit at about 7pm.
The mother recalls as she was wheeled into the room, Lucy Letby was "hovering around, not doing much" with Child D, and had a clipboard, and was looking at the machinery.
"I didn't understand what she was doing", and the mother asked if Child D was fine, to which Lucy Letby said she was.
Lucy Letby "just stuck around" and was "just watching, looking over us".
The mother said she asked for Lucy Letby to "just go away and leave us [in privacy]."
11:25am
Mr Johnson asks if Lucy Letby was in the neonatal unit room at the time Child D died. The mother agrees, and says other doctors were in that room.
The mother says she did not stay in that room.
The mother recalls she was taken to a private room, where Child D was, along with her husband and another family member, and a nurse she had not seen before.
The mother said she did not see Lucy Letby again.
Cross-Examination
11:25am
Ben Myers KC, for the defence, is now asking the mother questions.
11:28am
Mr Myers says it is an "awful experience" what the mother went through, and says he has one or two questions to ask.
He asks about the 7pm neonatal unit visit on June 21.
The mother says she went there with her husband. She recalls 7pm as she 'must have looked at the clock'.
She said there was "an exchange of few words" between her and Lucy Letby.
Mr Myers asks if that was possibly another nurse. The mother replies: "I don't think so."
Judge's Question
The judge, Mr Justice Goss, asks for clarification.
The mother said she would not have known the name of Lucy Letby at the time, but would after seeing her picture after she had been arrested.
Recap: Lucy Letby trial, Thursday, November 3
Tweets BBC https://twitter.com/MerseyHack
The jury is hearing evidence from the mother of Child D. The mum is in the witness box. A reminder - for legal reasons we can’t identify the alleged victims or their families.
Child D’s mum explains that her waters broke early but there were delays at the Countess of Chester Hospital in deciding what to do. “I didn’t feel right. The baby didn’t seem to be moving as well. I was concerned for infection because I hadn’t been given antibiotics.”
Eventually Child D was delivered by C-section. “She seemed very lifeless. She didn’t scream. There was no sound. Everything was quiet in the room.” says D’s mum.
D’s mum continued to have concerns when baby brought to her after delivery: “She was quite limp… she seemed to struggle to breathe.” A doctor told the mum the baby’s condition was due to being delivered by C section, but mum was not reassured.
Child D was taken to the neonatal unit. Next day 21/6/15 was Father’s Day. Mum was told D was struggling to breathe and wasn’t feeding, but she says staff didn’t seem too worried at that stage.
D was on CPAP (continuous positive airway pressure) but every time they tried to take her off it she crashed. But staff didn’t seem worried “ as she was a good sized baby. They didn’t seem overly concerned. She was poorly but making good progress.” says mum.
The jury is shown a plan of the neonatal unit drawn by D’s mum showing where her baby was in the unit at the Countess of #Chester.
“[A doctor] promised me I would be able to hold her and feed her the next day.” But the next morning mum was called to the unit because D was really ill. She saw the same doctor trying to resuscitate D. “We were just standing there watching [D] die.”
Mum tells jury about a time before D died when Lucy #Letby was the only nurse in the room when she and her husband went to see D. Mum says Ms Letby was “sort of hovering by the incubator but not doing much. She sort of just was watching us.”
Ben Myers KC for Miss Letby asks D’s mum if it could have been a different nurse by the incubator on that occasion. “I don’t think so.” She agrees she knows it was Ms Letby because she saw her picture in the paper.
The judge asks Mr Myers if it’s disputed that the nurse on that occasion was Ms Letby, and Mr Myers says it is.
Tortoise
Well-Known Member
- Joined
- Oct 15, 2015
- Messages
- 26,332
- Reaction score
- 132,799
Thursday November 3rd 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 15 of Prosecution Evidence
Child D
Child D's Father's Evidence Statement
11:31am
The court is now hearing an agreed evidence statement from the father of Child D.
The court hears, from the statement, Child D died at 4.25am on Monday, June 22.
He said he does not remember any specific problems from the mother's pregnancy, but had "immediate concerns" when she was born, as she "appeared grey" and was not crying.
"Initially, we were reassured by the staff" - and he said he believed them, and never thought Child D would die in the circumstances she did.
11:34am
The father recalls the circumstances leading up to the birth, as recalled by the mother.
He recalled the mother did not respond to inducement measures, and had mild contractions between 2am-3am on June 20, but had not dilated.
She was "encouraged to wait" for inducement methods, but she "did not want to" as she had been in labour for some time.
They were told medical staff were "monitoring the situation" and were told antibiotics were "not necessary" at this stage.
They said they agreed on a C-section, and at about 4pm, the mother went for an emergency C-section.
11:39am
Child D was held above the sheet, momentarily, and wrapped up, taken to the scales.
"We weren't informed of any issues" - "I was led to believe everything was ok".
He said Child D was very quiet, which was unexpected, and held her in his arms.
He said he was not sure if Child D was given any breathing support at this stage.
He went back to the ward with Child D for a brief time, and he and the mother put pyjamas on her. However "she didn't seem interested in feeding at all".
They said they were told Child D was doing well.
"We repeatedly asked if she was ok. We just weren't comfortable with how she was."
Medical staff kept telling her Child D was ok.
A few hours later, a different paediatrician came and Child D was taken to the neonatal unit.
The parents were later told Child D was not well.
"It was a bit of a shock" when the father saw Child D in the neonatal unit, as she was "very poorly...wasn't feeding...and had lots of tubes in her mouth".
Nursing staff "always made" the father feel welcome when he arrived.
11:41am
On June 21, the father went to see Child D and was "almost certain" he saw she had been taken off CPAP.
He said he frequently visited the neonatal unit, and asked staff
"It was Father's Day, and I was given a handmade father's Day card.
"The staff had put it together, and it had a message from [Child D] - with a photo stuck inside.
"On the first photo, she has CPAP. I took that with me.
"Later that day, I was given a welcome card, and a photo which showed her looking better, and not on CPAP."
11:46am
In the early hours of June 22, he was woken by a nurse and to go to the neonatal unit as Child D was "poorly", and they were taken there quickly.
"When we walked in, we understood immediately it was a very serious situation.
"Andrew, the senior doctor, seemed to be in charge.
"I remember someone mentioning adrenaline, and there was a sense of urgency.
"Andrew had a phone held up to him, and he was discussing the situation with someone on the other end.
"There seemed to be some confusion over what baby they were talking about.
"The person on the other end seemed to be referring to a different child.
"They were unsuccessful in resuscitating [Child D]. they said they had been trying to resuscitate [Child D] for over 20 minutes.
"I couldn't tell you which staff were in...as I wasn't paying much attention. I didn't want to look."
He added the parents weren't in the room for too long, about five minutes.
He said he does not recall seeing Lucy Letby at this time.
He went back to the ward and informed another family member of the news.
Recap: Lucy Letby trial, Thursday, November 3
Tweets BBC https://twitter.com/MerseyHack
In a statement read to court, D’s father says “We were never given the impression that [her] condition was life threatening. It never crossed my mind that she was in danger of dying. When she died were just not prepared for it.”
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 15 of Prosecution Evidence
Child D
Child D's Father's Evidence Statement
11:31am
The court is now hearing an agreed evidence statement from the father of Child D.
The court hears, from the statement, Child D died at 4.25am on Monday, June 22.
He said he does not remember any specific problems from the mother's pregnancy, but had "immediate concerns" when she was born, as she "appeared grey" and was not crying.
"Initially, we were reassured by the staff" - and he said he believed them, and never thought Child D would die in the circumstances she did.
11:34am
The father recalls the circumstances leading up to the birth, as recalled by the mother.
He recalled the mother did not respond to inducement measures, and had mild contractions between 2am-3am on June 20, but had not dilated.
She was "encouraged to wait" for inducement methods, but she "did not want to" as she had been in labour for some time.
They were told medical staff were "monitoring the situation" and were told antibiotics were "not necessary" at this stage.
They said they agreed on a C-section, and at about 4pm, the mother went for an emergency C-section.
11:39am
Child D was held above the sheet, momentarily, and wrapped up, taken to the scales.
"We weren't informed of any issues" - "I was led to believe everything was ok".
He said Child D was very quiet, which was unexpected, and held her in his arms.
He said he was not sure if Child D was given any breathing support at this stage.
He went back to the ward with Child D for a brief time, and he and the mother put pyjamas on her. However "she didn't seem interested in feeding at all".
They said they were told Child D was doing well.
"We repeatedly asked if she was ok. We just weren't comfortable with how she was."
Medical staff kept telling her Child D was ok.
A few hours later, a different paediatrician came and Child D was taken to the neonatal unit.
The parents were later told Child D was not well.
"It was a bit of a shock" when the father saw Child D in the neonatal unit, as she was "very poorly...wasn't feeding...and had lots of tubes in her mouth".
Nursing staff "always made" the father feel welcome when he arrived.
11:41am
On June 21, the father went to see Child D and was "almost certain" he saw she had been taken off CPAP.
He said he frequently visited the neonatal unit, and asked staff
"It was Father's Day, and I was given a handmade father's Day card.
"The staff had put it together, and it had a message from [Child D] - with a photo stuck inside.
"On the first photo, she has CPAP. I took that with me.
"Later that day, I was given a welcome card, and a photo which showed her looking better, and not on CPAP."
11:46am
In the early hours of June 22, he was woken by a nurse and to go to the neonatal unit as Child D was "poorly", and they were taken there quickly.
"When we walked in, we understood immediately it was a very serious situation.
"Andrew, the senior doctor, seemed to be in charge.
"I remember someone mentioning adrenaline, and there was a sense of urgency.
"Andrew had a phone held up to him, and he was discussing the situation with someone on the other end.
"There seemed to be some confusion over what baby they were talking about.
"The person on the other end seemed to be referring to a different child.
"They were unsuccessful in resuscitating [Child D]. they said they had been trying to resuscitate [Child D] for over 20 minutes.
"I couldn't tell you which staff were in...as I wasn't paying much attention. I didn't want to look."
He added the parents weren't in the room for too long, about five minutes.
He said he does not recall seeing Lucy Letby at this time.
He went back to the ward and informed another family member of the news.
Recap: Lucy Letby trial, Thursday, November 3
Tweets BBC https://twitter.com/MerseyHack
In a statement read to court, D’s father says “We were never given the impression that [her] condition was life threatening. It never crossed my mind that she was in danger of dying. When she died were just not prepared for it.”
Tortoise
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Thursday November 3rd 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 15 of Prosecution Evidence
Child D
Child D's Family Member's Evidence Statement
11:47am
A statement from another family member of Child D is read out to the court.
They said they had visited Child D in the neonatal unit: "It didn't even cross my mind that she was in danger of dying.
"When she died, we just weren't prepared for it.
"Nothing I saw appeared out of the ordinary...but I didn't have anything to compare their actions to."
Recap: Lucy Letby trial, Thursday, November 3
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 15 of Prosecution Evidence
Child D
Child D's Family Member's Evidence Statement
11:47am
A statement from another family member of Child D is read out to the court.
They said they had visited Child D in the neonatal unit: "It didn't even cross my mind that she was in danger of dying.
"When she died, we just weren't prepared for it.
"Nothing I saw appeared out of the ordinary...but I didn't have anything to compare their actions to."
Recap: Lucy Letby trial, Thursday, November 3
Tortoise
Well-Known Member
- Joined
- Oct 15, 2015
- Messages
- 26,332
- Reaction score
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Thursday November 3rd 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 15 of Prosecution Evidence
Child D
Kate Tyndall Police Intelligence Analyst's Evidence - Sequence of Events
12:05pm
The court has had a short adjournment.
It will next hear, from the prosecution, the sequence of events.
As has been the case for Child A, Child B and Child C, the evidence has been presented to the jury electronically on iPads.
12:06pm
Intelligence analyst Kate Tyndall has returned to give evidence and give a walkthrough to the jury on the evidence 'tiles' in the electronic bundle.
12:10pm
The first evidence shown to the court is Lucy Letby's shift patterns for June 2015.
It shows which days Letby was on 'long day' shifts, and 'night' shifts.
She worked long day shifts on June 2, 4, 17, 19, 27 and 28.
She worked night shifts on June 8, 9, 13, 14, 21, 22 and 23.
Child A died on the night of June 8-9, and Child B had a non-fatal collapse on June 9-10.
Child C died on the night of June 13-14.
Child D died on the night of June 21-22.
12:12pm
The evidence shown to the court shows Child D was born at 4.01pm on June 20, weighing 3.13kg [6lb 14oz], and required breathing support at birth.
The Apgar scores were 8 [out of 10] at 1 minute after birth, and 9 at 5 minutes.
12:14pm
Child D was admitted to the neonatal unit at 7.30pm on June 20 'for respiratory support requiring ventilation'.
Child D was 'grunting' and her colour was 'dusky', it was observed.
12:21pm
Child D was placed on CPAP, with 40% oxygen support, and placed on 'double phototherapy'.
Doctor Ahmed Chowdhury noted discussing Child D with the parents, saying 'on moving baby to labour ward baby became blue/dusky. Sats 47% on arrival NNU - had bagging, sats picked up. Given antibiotics, baby put on CPAP. Not explained to parents yet'.
12:24pm
Notes record the administration of antibiotics and sodium chloride to Child D.
The court hears phototherapy was carried out to treat Child D's jaundice.
12:31pm
Child D was administered with an endotracheal tube on the second attempt.
The nursing notes record Child D was 'starting to out a few breaths in for herself now'.
12:33pm
An x-ray reading for Child D showed 'shadowing consistent with transient tachypnoea of the newborn [TTN, a respiratory disorder]'.
12:34pm
A nurse's note recorded meeting the father, who had visited the neonatal unit, and it was explained to him that Child D would be on the neonatal unit for "at least 48 hours", and the dad was "visibly upset", so "lots of reassurance" was given to him.
12:42pm
A further nursing note at 4.30am on June 21 showed Child D was making 'good respiratory effort', and blood gas readings were 'good', so ventilation support was reduced.
12:45pm
Another nursing note at 7.21am recalls the father's visit to the neonatal unit.
It includes: "[Father] appeared overwhelmed so lots of reassurance given."
12:53pm
A note from nurse Kate Bissell reads, at 9am on June 21, that Child D was 'extubated...following satisfactory blood gas'.
Child D was 'initially apnoeic and required stimulation...via Neopuff/CPAP', but the breathing became more regular after a couple of minutes.
Kate Bissell, in a subsequent nursing note, said a blood gas reading at 10.15am was subsequently taken and the results showed signs of respiratory acidosis, so Child D was put back on CPAP.
The blood gas was repeated two hours later and 'showed further deterioration with increasing metabolic acidosis'. Child D's perfusion was 'poor' and a doctor approved a decision to administer medication.
Dr Ahmed Chowdhury recorded a UVC and a UAC were inserted.
2:10pm
The court is continuing to go through the sequence of events, which is up to the afternoon of Sunday, June 21, 2015.
2:13pm
A 'family communication' note is made at 5.53pm - "Dad visiting most of the day, he is up to date with the plan of care. Mum has visited this evening."
Both parents were 'anxious' about the levels of care provided.
2:18pm
A nursing note at 7.15pm said attempts were made to get Child D off CPAP, but breathing was still 'shallow' off that, so CPAP resumed.
Swipe data showed Lucy Letby arrived at the neonatal unit at 7.26pm.
The handover note showed Letby was one of the nurses on duty that night, with a different nurse being the designated nurse for Child D, in room 1.
Letby was the designated nurse for two other babies in room 1.
2:19pm
At this time, another nurse was looking after Child B in room 3 for that night.
The court had previously heard Child B had suffered a non-fatal collapse earlier that month.
2:28pm
Further observations for Child D are documented throughout that night shift, until after 1am.
2:31pm
A neonatal infusion prescription chart at 1.25am, for Child D, is shown to the court. Lucy Letby is one of the two nurses to provide a signature for a saline dose prescription at that time.
2:32pm
Child D then first collapsed at 1.30am.
Mr Johnson: "This is within a very short time of the document with Lucy Letby's signature on, isn't it?"
Kate Tyndall: "Yes."
2:34pm
A nursing note, timestamped for 1.30am but written retrospectively, recalls: "Called to nursery ward...[Child D] had desaturated to 70s, required oral suction as was bubbly and had lost colour. Discolourations to skin observed, trunk/legs/arm/chin."
2:39pm
Notes of medication are made.
At 2.40am, a neonatal infusion prescription chart is recorded for a sodium chloride dose with 10% dextrose. Letby is one of the two nurses signing for it.
2:41pm
The medication administration update is made on the computer at 2.44am.
At 3am, Child D collapsed for the second time.
The nursing note recorded for 3am: '[Child D] crying and desaturated again to 70s, commenced on 100% O2 via CPAP and picked up well but skin discoloured again..."
2:44pm
At 3.20am, a further neonatal infusion prescription is made, with Lucy Letby being one of the signatories.
At 3.45am, Child D collapses for the third and final time.
The nursing note recalled the alarm went off and Child D 'desaturated and then became apneoic. Called Letby...' Resuscitation efforts began but to 'no effect'.
A bleep alarm went off and doctors were called to the neonatal unit.
2:47pm
The court is shown a number of clinical notes are made by doctors for this time. These clinical notes will be discussed further when the doctors involved in them come to court to give evidence in the coming days.
They include the resuscitation efforts, administration of adrenaline doses and the decision, ultimately, to discontinue CPR.
Child D died at 4.25am.
4:13pm
A nursing note by Yvonne Farmer recorded that Child D was blessed by a reverend with the family present, with hand and footprints obtained.
The note added: "Parents had lots of cuddles and said goodbye to [Child D]."
The parents were also given a bereavement box with mementoes and information on the Sands charity.
Recap: Lucy Letby trial, Thursday, November 3
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 15 of Prosecution Evidence
Child D
Kate Tyndall Police Intelligence Analyst's Evidence - Sequence of Events
12:05pm
The court has had a short adjournment.
It will next hear, from the prosecution, the sequence of events.
As has been the case for Child A, Child B and Child C, the evidence has been presented to the jury electronically on iPads.
12:06pm
Intelligence analyst Kate Tyndall has returned to give evidence and give a walkthrough to the jury on the evidence 'tiles' in the electronic bundle.
12:10pm
The first evidence shown to the court is Lucy Letby's shift patterns for June 2015.
It shows which days Letby was on 'long day' shifts, and 'night' shifts.
She worked long day shifts on June 2, 4, 17, 19, 27 and 28.
She worked night shifts on June 8, 9, 13, 14, 21, 22 and 23.
Child A died on the night of June 8-9, and Child B had a non-fatal collapse on June 9-10.
Child C died on the night of June 13-14.
Child D died on the night of June 21-22.
12:12pm
The evidence shown to the court shows Child D was born at 4.01pm on June 20, weighing 3.13kg [6lb 14oz], and required breathing support at birth.
The Apgar scores were 8 [out of 10] at 1 minute after birth, and 9 at 5 minutes.
12:14pm
Child D was admitted to the neonatal unit at 7.30pm on June 20 'for respiratory support requiring ventilation'.
Child D was 'grunting' and her colour was 'dusky', it was observed.
12:21pm
Child D was placed on CPAP, with 40% oxygen support, and placed on 'double phototherapy'.
Doctor Ahmed Chowdhury noted discussing Child D with the parents, saying 'on moving baby to labour ward baby became blue/dusky. Sats 47% on arrival NNU - had bagging, sats picked up. Given antibiotics, baby put on CPAP. Not explained to parents yet'.
12:24pm
Notes record the administration of antibiotics and sodium chloride to Child D.
The court hears phototherapy was carried out to treat Child D's jaundice.
12:31pm
Child D was administered with an endotracheal tube on the second attempt.
The nursing notes record Child D was 'starting to out a few breaths in for herself now'.
12:33pm
An x-ray reading for Child D showed 'shadowing consistent with transient tachypnoea of the newborn [TTN, a respiratory disorder]'.
12:34pm
A nurse's note recorded meeting the father, who had visited the neonatal unit, and it was explained to him that Child D would be on the neonatal unit for "at least 48 hours", and the dad was "visibly upset", so "lots of reassurance" was given to him.
12:42pm
A further nursing note at 4.30am on June 21 showed Child D was making 'good respiratory effort', and blood gas readings were 'good', so ventilation support was reduced.
12:45pm
Another nursing note at 7.21am recalls the father's visit to the neonatal unit.
It includes: "[Father] appeared overwhelmed so lots of reassurance given."
12:53pm
A note from nurse Kate Bissell reads, at 9am on June 21, that Child D was 'extubated...following satisfactory blood gas'.
Child D was 'initially apnoeic and required stimulation...via Neopuff/CPAP', but the breathing became more regular after a couple of minutes.
Kate Bissell, in a subsequent nursing note, said a blood gas reading at 10.15am was subsequently taken and the results showed signs of respiratory acidosis, so Child D was put back on CPAP.
The blood gas was repeated two hours later and 'showed further deterioration with increasing metabolic acidosis'. Child D's perfusion was 'poor' and a doctor approved a decision to administer medication.
Dr Ahmed Chowdhury recorded a UVC and a UAC were inserted.
2:10pm
The court is continuing to go through the sequence of events, which is up to the afternoon of Sunday, June 21, 2015.
2:13pm
A 'family communication' note is made at 5.53pm - "Dad visiting most of the day, he is up to date with the plan of care. Mum has visited this evening."
Both parents were 'anxious' about the levels of care provided.
2:18pm
A nursing note at 7.15pm said attempts were made to get Child D off CPAP, but breathing was still 'shallow' off that, so CPAP resumed.
Swipe data showed Lucy Letby arrived at the neonatal unit at 7.26pm.
The handover note showed Letby was one of the nurses on duty that night, with a different nurse being the designated nurse for Child D, in room 1.
Letby was the designated nurse for two other babies in room 1.
2:19pm
At this time, another nurse was looking after Child B in room 3 for that night.
The court had previously heard Child B had suffered a non-fatal collapse earlier that month.
2:28pm
Further observations for Child D are documented throughout that night shift, until after 1am.
2:31pm
A neonatal infusion prescription chart at 1.25am, for Child D, is shown to the court. Lucy Letby is one of the two nurses to provide a signature for a saline dose prescription at that time.
2:32pm
Child D then first collapsed at 1.30am.
Mr Johnson: "This is within a very short time of the document with Lucy Letby's signature on, isn't it?"
Kate Tyndall: "Yes."
2:34pm
A nursing note, timestamped for 1.30am but written retrospectively, recalls: "Called to nursery ward...[Child D] had desaturated to 70s, required oral suction as was bubbly and had lost colour. Discolourations to skin observed, trunk/legs/arm/chin."
2:39pm
Notes of medication are made.
At 2.40am, a neonatal infusion prescription chart is recorded for a sodium chloride dose with 10% dextrose. Letby is one of the two nurses signing for it.
2:41pm
The medication administration update is made on the computer at 2.44am.
At 3am, Child D collapsed for the second time.
The nursing note recorded for 3am: '[Child D] crying and desaturated again to 70s, commenced on 100% O2 via CPAP and picked up well but skin discoloured again..."
2:44pm
At 3.20am, a further neonatal infusion prescription is made, with Lucy Letby being one of the signatories.
At 3.45am, Child D collapses for the third and final time.
The nursing note recalled the alarm went off and Child D 'desaturated and then became apneoic. Called Letby...' Resuscitation efforts began but to 'no effect'.
A bleep alarm went off and doctors were called to the neonatal unit.
2:47pm
The court is shown a number of clinical notes are made by doctors for this time. These clinical notes will be discussed further when the doctors involved in them come to court to give evidence in the coming days.
They include the resuscitation efforts, administration of adrenaline doses and the decision, ultimately, to discontinue CPR.
Child D died at 4.25am.
4:13pm
A nursing note by Yvonne Farmer recorded that Child D was blessed by a reverend with the family present, with hand and footprints obtained.
The note added: "Parents had lots of cuddles and said goodbye to [Child D]."
The parents were also given a bereavement box with mementoes and information on the Sands charity.
Recap: Lucy Letby trial, Thursday, November 3
Last edited:
Tortoise
Well-Known Member
- Joined
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Thursday November 3rd 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 15 of Prosecution Evidence
Child D
Kate Tyndall Police Intelligence Analyst's Evidence - Lucy Letby's Texts and Facebook Searches
[22nd June 2015]
3:11pm
A text message sent from Lucy Letby to a colleague said, at 8.36am: "We had such a rubbish night.
"Our job is just far too sad sometimes."
The colleague replied: "No what happened?"
Letby: "We lost [Child D]."
The colleague: "What!!!! But she was improving. What happened?
"Wanna chat? I can't believe you were on again. You are having such a tough time."
3:15pm
Letby refers to Child D being "messed about a couple of times" and refers to a rash that "looked like overwhelming sepsis".
She adds that two members of staff said the circumstances "would be investigated".
The colleague replies: "Dad was very anxious all day." and adds, in relation to the investigation, "What the delay in treatment?"
Letby replies: "Just overall looking into the case.
"And reviewing what antibiotics she was on if sepsis."
3:31pm
The colleague says Child D "was behaving septic".
She adds, to Letby: "Oh hun, you need a break."
Letby said, in her response: "But it's part of the job and it's hard for everyone."
The colleague responds: "Yes but you have had it all recently."
Letby, in her response, says: "Hmm well it's happened and that is it, got to carry on..." before referring to her planned time off.
The conversation then discusses staffing arrangements, and the difficulties of the job, before noting an instance of a happier occasion on the unit.
Letby says: "How do such sick babies get through and others get to [die] so unexpectedly?"
Her colleague, in her response, says: "We just don't have magic wands..."
The colleague refers to what Child D looked like in their care.
Letby replies: "I think there is an element of fate involved. There is a reason for everything."
3:38pm
The colleague adds: "It's important to remember that a death is not a failure," and says Letby is "an excellent nurse."
Letby, in her response, accepts the need to take positives from the job, but it's "just so sad to watch what families go through."
4:20pm
Further messages are echanged between Letby and her colleague the following evening.
The colleague asks: "How you doing?"
Letby replies: "I'm ok - trying not to think about it. Work busy but at least we have 6 tonight."
The colleague enquires about Child D and whether anything had been said about not "bringing her through sooner on Saturday".
Letby replies: "I don't think so", before adding there was a theory Child D may have had meningitis.
The colleague responds: "I'm worried I missed something."
Letby: "I don't think any of us did and she [Child D] was on the right antibiotics."
4:24pm
The colleague replies: "Yeah, just would treatment sooner have made a difference."
Letby asks her colleague if Child D had a lumbar puncture.
The colleague replies she was not sure it ever got done, given that the baby girl was ill and had been on CPAP.
She adds her gas reading was "appalling" when she first came through to the unit.
4:25pm
Letby, in her response, says: "I think we did what we could."
She then refers to the condition of the mother of Child D.
The court hears at 9.51pm on June 25, Letby searched for both the parents' names of Child D on Facebook.
4:36pm
Towards the end of June, Letby sent a message to a colleague: "Work has been awful."
The colleague responds: "Oh dear. Staffing probe?"
Letby, in her response, says: "We have had three unexpected deaths," adding the unit is "full".
She adds: "What I have seen has really hit me tonight."
The colleague asks: "Have you worked today?"
Letby: "No, been off since Wednesday morning and now it has all hit me."
The colleague asks if Letby tries "talking to a proper counsellor".
Letby replies that she does not think she can.
The colleague: "Why not?"
Letby: "I can't talk about it now...I can't stop crying...I just need to get it out of my system."
The colleague advises Letby to think carefully what to do, before adding: "Maybe you need to take time off."
Letby: "Work is always my priority," adding she had not cried about the incidents until then.
Recap: Lucy Letby trial, Thursday, November 3
Tweets BBC https://twitter.com/MerseyHack
In a What’s App message to a colleague after D died Lucy Letby said “We had such a rubbish night. Our job is just far too sad sometimes.” And later to same colleague “We lost [D].”
The colleague replied “What ! But she was improving, what happened ?” “I can’t believe you were on again. You are having such a hard time.”
3 days after Child D died Lucy Letby searched for the names of her parents on Facebook.
4 days after D died Ms Letby messaged a colleague saying “I can’t talk about it [the deaths at the unit]. I can’t stop crying. I just need to get it out of my system.”
In October 2015 (4 months after D died) Lucy Letby made a Facebook search for the name of the baby’s father on a Saturday tea time.
I’ll have a round up of today’s evidence in the Lucy #Letby trial on @bbcmerseyside at 1720. I’m not in court tomorrow, but my colleague @MrDanDonoghue will keep you up to date. Ms Letby denies murder and attempted murder relating to 17 babies at the Countess of #Chester Hospital
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 15 of Prosecution Evidence
Child D
Kate Tyndall Police Intelligence Analyst's Evidence - Lucy Letby's Texts and Facebook Searches
[22nd June 2015]
3:11pm
A text message sent from Lucy Letby to a colleague said, at 8.36am: "We had such a rubbish night.
"Our job is just far too sad sometimes."
The colleague replied: "No what happened?"
Letby: "We lost [Child D]."
The colleague: "What!!!! But she was improving. What happened?
"Wanna chat? I can't believe you were on again. You are having such a tough time."
3:15pm
Letby refers to Child D being "messed about a couple of times" and refers to a rash that "looked like overwhelming sepsis".
She adds that two members of staff said the circumstances "would be investigated".
The colleague replies: "Dad was very anxious all day." and adds, in relation to the investigation, "What the delay in treatment?"
Letby replies: "Just overall looking into the case.
"And reviewing what antibiotics she was on if sepsis."
3:31pm
The colleague says Child D "was behaving septic".
She adds, to Letby: "Oh hun, you need a break."
Letby said, in her response: "But it's part of the job and it's hard for everyone."
The colleague responds: "Yes but you have had it all recently."
Letby, in her response, says: "Hmm well it's happened and that is it, got to carry on..." before referring to her planned time off.
The conversation then discusses staffing arrangements, and the difficulties of the job, before noting an instance of a happier occasion on the unit.
Letby says: "How do such sick babies get through and others get to [die] so unexpectedly?"
Her colleague, in her response, says: "We just don't have magic wands..."
The colleague refers to what Child D looked like in their care.
Letby replies: "I think there is an element of fate involved. There is a reason for everything."
3:38pm
The colleague adds: "It's important to remember that a death is not a failure," and says Letby is "an excellent nurse."
Letby, in her response, accepts the need to take positives from the job, but it's "just so sad to watch what families go through."
4:20pm
Further messages are echanged between Letby and her colleague the following evening.
The colleague asks: "How you doing?"
Letby replies: "I'm ok - trying not to think about it. Work busy but at least we have 6 tonight."
The colleague enquires about Child D and whether anything had been said about not "bringing her through sooner on Saturday".
Letby replies: "I don't think so", before adding there was a theory Child D may have had meningitis.
The colleague responds: "I'm worried I missed something."
Letby: "I don't think any of us did and she [Child D] was on the right antibiotics."
4:24pm
The colleague replies: "Yeah, just would treatment sooner have made a difference."
Letby asks her colleague if Child D had a lumbar puncture.
The colleague replies she was not sure it ever got done, given that the baby girl was ill and had been on CPAP.
She adds her gas reading was "appalling" when she first came through to the unit.
4:25pm
Letby, in her response, says: "I think we did what we could."
She then refers to the condition of the mother of Child D.
The court hears at 9.51pm on June 25, Letby searched for both the parents' names of Child D on Facebook.
4:36pm
Towards the end of June, Letby sent a message to a colleague: "Work has been awful."
The colleague responds: "Oh dear. Staffing probe?"
Letby, in her response, says: "We have had three unexpected deaths," adding the unit is "full".
She adds: "What I have seen has really hit me tonight."
The colleague asks: "Have you worked today?"
Letby: "No, been off since Wednesday morning and now it has all hit me."
The colleague asks if Letby tries "talking to a proper counsellor".
Letby replies that she does not think she can.
The colleague: "Why not?"
Letby: "I can't talk about it now...I can't stop crying...I just need to get it out of my system."
The colleague advises Letby to think carefully what to do, before adding: "Maybe you need to take time off."
Letby: "Work is always my priority," adding she had not cried about the incidents until then.
Recap: Lucy Letby trial, Thursday, November 3
Tweets BBC https://twitter.com/MerseyHack
In a What’s App message to a colleague after D died Lucy Letby said “We had such a rubbish night. Our job is just far too sad sometimes.” And later to same colleague “We lost [D].”
The colleague replied “What ! But she was improving, what happened ?” “I can’t believe you were on again. You are having such a hard time.”
3 days after Child D died Lucy Letby searched for the names of her parents on Facebook.
4 days after D died Ms Letby messaged a colleague saying “I can’t talk about it [the deaths at the unit]. I can’t stop crying. I just need to get it out of my system.”
In October 2015 (4 months after D died) Lucy Letby made a Facebook search for the name of the baby’s father on a Saturday tea time.
I’ll have a round up of today’s evidence in the Lucy #Letby trial on @bbcmerseyside at 1720. I’m not in court tomorrow, but my colleague @MrDanDonoghue will keep you up to date. Ms Letby denies murder and attempted murder relating to 17 babies at the Countess of #Chester Hospital
Tortoise
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- Oct 15, 2015
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- 26,332
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Thursday November 3rd 2022
[...]
The following morning she and her husband had been woken by a nurse in the post-natal ward who told them: '(Baby D) is very poorly. You need to come down'. [...]
As they burst in she saw a paediatric doctor, Andrew Brunton, holding the infant and trying to resuscitate her. [...]
She recalled a nurse she later identified as Lucy Letby holding a phone to Dr Brunton's ear as he spoke to a consultant. The person on the other end of the line seemed confused about the identity of the baby being resuscitated.
'Someone was holding a phone to his ear and he kept shouting 'This is D!' He was quite agitated.
'A doctor next to him was tapping him on the shoulder, saying 'You've got to let her go'. [...]
Nick Johnson, KC, prosecuting, asked if the mother knew the name of the nurse who had been holding the phone to Dr Brunton's ear.
She replied: 'Lucy Letby'.
The mother said she had previously seen Letby the night before when she walked into a room on the neonatal unit to see her daughter [...]
Mr Johnson asked: 'What was going on when you went in?'
She replied: 'That's a question I asked. As I was pushed in she (Letby) was sort of hovering around D, but not doing much. She had a clipboard to take notes. [...]
'I would have expected she could have just left us to it. It was the first time I'd seen D (since her birth). She just stuck around. I asked my husband to ask her to go away, to give us some privacy'. [...]
She smiled briefly as she recalled seeing her baby that evening, June 21, in the presence of Dr Brunton. 'She looked like a good pink, healthy baby'.
The baby's father was allowed to remain with his wife during the night. It was around 4am that they were awoken and told to rush to the neonatal unit. [...]
The news of his daughter's death was broken to him by Dr Elizabeth Newby.
'I think Dr Newby had to tell Andrew to let her go. She seemed shocked and upset'.
www.dailymail.co.uk
[...]
The following morning she and her husband had been woken by a nurse in the post-natal ward who told them: '(Baby D) is very poorly. You need to come down'. [...]
As they burst in she saw a paediatric doctor, Andrew Brunton, holding the infant and trying to resuscitate her. [...]
She recalled a nurse she later identified as Lucy Letby holding a phone to Dr Brunton's ear as he spoke to a consultant. The person on the other end of the line seemed confused about the identity of the baby being resuscitated.
'Someone was holding a phone to his ear and he kept shouting 'This is D!' He was quite agitated.
'A doctor next to him was tapping him on the shoulder, saying 'You've got to let her go'. [...]
Nick Johnson, KC, prosecuting, asked if the mother knew the name of the nurse who had been holding the phone to Dr Brunton's ear.
She replied: 'Lucy Letby'.
The mother said she had previously seen Letby the night before when she walked into a room on the neonatal unit to see her daughter [...]
Mr Johnson asked: 'What was going on when you went in?'
She replied: 'That's a question I asked. As I was pushed in she (Letby) was sort of hovering around D, but not doing much. She had a clipboard to take notes. [...]
'I would have expected she could have just left us to it. It was the first time I'd seen D (since her birth). She just stuck around. I asked my husband to ask her to go away, to give us some privacy'. [...]
She smiled briefly as she recalled seeing her baby that evening, June 21, in the presence of Dr Brunton. 'She looked like a good pink, healthy baby'.
The baby's father was allowed to remain with his wife during the night. It was around 4am that they were awoken and told to rush to the neonatal unit. [...]
The news of his daughter's death was broken to him by Dr Elizabeth Newby.
'I think Dr Newby had to tell Andrew to let her go. She seemed shocked and upset'.
Mother of murdered baby tells how she watched the infant die
The prosecution allege child D was the third child murdered by Lucy Letby, 32, in a two-week period, with another baby suffering a life-threatening collapse at the Countess of Chester Hospital during that time.
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Thursday November 3rd 2022
Ms Letby then referred to Child D being "messed about a couple of times" and referred to a rash that "looked like overwhelming sepsis".
She said it had been a "shock", adding "feel a bit numb this time".
Her colleague went on to respond saying: "You go to bed, you're an excellent nurse Lucy, don't forget it."
www.bbc.com
Ms Letby then referred to Child D being "messed about a couple of times" and referred to a rash that "looked like overwhelming sepsis".
She said it had been a "shock", adding "feel a bit numb this time".
Her colleague went on to respond saying: "You go to bed, you're an excellent nurse Lucy, don't forget it."
Nurse hovered over baby before she died, jury told - BBC News
Nurse Lucy Letby is alleged to have injected air into the bloodstream of a baby girl.
www.bbc.com
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Thursday November 3rd 2022
She described the unexpected death, the third on the unit in two weeks, as "another shock for us all" and said she felt "numb". But she added it was "part of the job" and she would "keep ploughing on".
When her colleague described their job as the "shi**est" but also the "best", Ms Letby responded: "Absolutely, on a day to day basis it is an incredible job with so many positives.
"But then sometimes I think how is it such sick babies get through and others die so suddenly and unexpectedly. Guess it's how it is meant to be." [...]
She messaged another friend, Minna Lappalainen, and said: "Work has been awful. We have had three unexpected deaths, transfer out, few sick ones, unit full. What I've seen has really hit me tonight." [...]
Ms Lappalainen suggested she might need some time off work, to which Ms Letby replied: "Work is always my priority. I won't let it affect it. I just haven't let myself cry over it until now. Once I've let it out my head will be clear."
www.express.co.uk
She described the unexpected death, the third on the unit in two weeks, as "another shock for us all" and said she felt "numb". But she added it was "part of the job" and she would "keep ploughing on".
When her colleague described their job as the "shi**est" but also the "best", Ms Letby responded: "Absolutely, on a day to day basis it is an incredible job with so many positives.
"But then sometimes I think how is it such sick babies get through and others die so suddenly and unexpectedly. Guess it's how it is meant to be." [...]
She messaged another friend, Minna Lappalainen, and said: "Work has been awful. We have had three unexpected deaths, transfer out, few sick ones, unit full. What I've seen has really hit me tonight." [...]
Ms Lappalainen suggested she might need some time off work, to which Ms Letby replied: "Work is always my priority. I won't let it affect it. I just haven't let myself cry over it until now. Once I've let it out my head will be clear."
Nurse accused of murdering babies told colleague 'fate' part of deaths
Nurse Lucy Letby told a colleague there was an "element of fate" in the deaths of babies.
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Friday November 4th 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 16 of Prosecution Evidence
Child D
Claire Hocknell, Police Intelligence Analyst's Evidence - Neonatal Unit Records
10:35am
The trial is now resuming, with intelligence analyst Claire Hocknell returning to provide a walkthrough for the jury on neonatal unit evidence.
10:46am
The chart being shown to the court is the neonatal review schedule, showing when electronic records are made, including e-prescriptions, with Lucy Letby's name highlighted on the chart.
Nicholas Johnson KC, for the prosecution, highlights the three 'infusion started' notes, each one of them happening before Child D's collapses. Lucy Letby and Caroline Oakley are the two nurses to sign for the medication and administering the infusion.
10:48am
The neonatal unit review chart also shows a long list of clinical notes made following the final collapse, made by doctors, regarding the efforts to try and save Child D's life, before ultimately the decision is made to discontinue resuscitation efforts and record the time of death at 4.25am on June 22, 2015.
10:58am
Ben Myers KC, for Letby's defence, asks about a note which said Letby administered to a baby 'whose location is unconfirmed [as recorded on a map of the neonatal unit for that night]' on the night of June 21. Letby was a designated nurse for that baby, and two babies in room 1, that night.
Mr Myers asks about Lucy Letby and Caroline Oakley administering medication to a number of different of babies that night. Claire Hocknell confirms the records.
11:00am
Mr Johnson asks to clarify the map which includes the detail about the baby 'whose location is unconfirmed' - he tells the court Letby was initially the designated nurse for that baby until 10.45pm that night on June 21, and then care was passed to a different nurse.
LIVE: Lucy Letby trial, Friday, November 4
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 16 of Prosecution Evidence
Child D
Claire Hocknell, Police Intelligence Analyst's Evidence - Neonatal Unit Records
10:35am
The trial is now resuming, with intelligence analyst Claire Hocknell returning to provide a walkthrough for the jury on neonatal unit evidence.
10:46am
The chart being shown to the court is the neonatal review schedule, showing when electronic records are made, including e-prescriptions, with Lucy Letby's name highlighted on the chart.
Nicholas Johnson KC, for the prosecution, highlights the three 'infusion started' notes, each one of them happening before Child D's collapses. Lucy Letby and Caroline Oakley are the two nurses to sign for the medication and administering the infusion.
10:48am
The neonatal unit review chart also shows a long list of clinical notes made following the final collapse, made by doctors, regarding the efforts to try and save Child D's life, before ultimately the decision is made to discontinue resuscitation efforts and record the time of death at 4.25am on June 22, 2015.
10:58am
Ben Myers KC, for Letby's defence, asks about a note which said Letby administered to a baby 'whose location is unconfirmed [as recorded on a map of the neonatal unit for that night]' on the night of June 21. Letby was a designated nurse for that baby, and two babies in room 1, that night.
Mr Myers asks about Lucy Letby and Caroline Oakley administering medication to a number of different of babies that night. Claire Hocknell confirms the records.
11:00am
Mr Johnson asks to clarify the map which includes the detail about the baby 'whose location is unconfirmed' - he tells the court Letby was initially the designated nurse for that baby until 10.45pm that night on June 21, and then care was passed to a different nurse.
LIVE: Lucy Letby trial, Friday, November 4
Tortoise
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- Joined
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Friday November 4th 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 16 of Prosecution Evidence
Child D
Caroline Oakley, Senior Neonatal Nurse, Child D's Designated Nurse, Night-Shift 21st/22nd June 2015
11:17am
Caroline Oakley is now being called to give evidence. In June 2015, she was employed as a senior neonatal unit nurse at the Countess of Chester Hospital.
Mrs Oakley confirms she would at times be a shift leader, and would look after the people on that shift, not necessarily working with managers.
11:18am
She confirms she had direct involvement with Child D on the night shift from June 21-22, and was her designated nurse during that shift.
11:25am
Mrs Oakley says she does not recall which nurses were designated nurses for which babies that night.
Her nursing note, written retrospectively at 4.46am on June 22 for the night shift, is presented to the court.
The note records, at the handover, 'lower limbs dusky and feet bruised. Doctors aware. Feet cool to slightly warm. Observations satisfactory.'
Mrs Oakley added Child D was 'nursed on CPAP in air. antibiotics given as prescribed.'
11:26am
Mrs Oakley tells the court Child D was not pink yet, and might have been sampled with heel pricks, which could make the feet bruised.
She said it was something to monitor, but was not a concern at that stage, and those observations had been relayed to doctors.
11:28am
The nurse said Child D's circulation was not "100 per cent brilliant" at that point, but this was common in newborn babies.
The note records Child D was reviewed by Dr Andrew Brunton.
The decision was made to 'commence feeds and increase as tolerated', with expressed breast milk.
Blood gas readings taken at 11.52pm and 1.14am were 'satisfactory'.
11:31am
Mrs Oakley said she remembered "being very happy with her" at that point of the night shift. While Child D was an intensive care patient in the neonatal unit, she was 'only requiring a little assistance' with breathing, and she was "stable".
11:35am
The observation chart for Child D for that night shift is shown to the court, which shows Caroline Oakley's initials signing hourly observation readings.
The heart rate, respiration rate and temperature are recorded.
Child D's heart rate says for the first few hours, the heart rate was "completely normal" up to 12.30am. It had peaked at 1.15am, but could have been after handling and/or a nappy change, Mrs Oakley tells the court.
She said that reading was "still within normal parameters".
11:36am
The respiration rate was at the "upper end of what would be considered ideal", but was still within normal parameters, Mrs Oakley adds.
The temperature readings are also "completely normal" with "no high temperature".
11:43am
A further observation chart records the readings made for Child D being on CPAP.
The chart recorded Child D did not require oxygen support at this stage, having been taken off that in the early hours of June 21.
The oxygen saturation levels were '100', which meant Child D was "breathing beautifully".
11:51am
Another intensive care chart is shown to the court, showing fluids administered during the evening and night of June 21.
A 'minimal' amount of 'acidic' aspirates is recorded from the stomach in the evening.
It was followed by 'mostly clear' aspirates, with occasional darker bits.
Mrs Oakley says there was "nothing" she was "worried about" from those readings.
11:54am
The neonatal infusion prescription chart at 1.25am is shown to the court.
It is signed by Caroline Oakley and Lucy Letby.
Mrs Oakley says usually the nurse looking after the baby will administer it.
She confirms the two signatures made, showing they had checked the fluid.
Mrs Oakley adds: "I would presume that I connected the fluid".
11:58am
At 1.30am, nurse Oakley's notes record: 'called to nursery by senior nurse...and senior nurse Letby; [Child D] had desaturated to 70s, required oral suction as was bubbly and had lost colour. Discolourations to skin observed; trunk/legs/arm/chin. Dr Brunton called to review'.
Mrs Oakley says she remembers being on her break at 1am-2am, so was in the resuscitation room where staff had their breaks. She said she had been gone because Child D was poorly.
The prosecution ask about the timing of the 1.25am medication, and if the nurse can account for that. Mrs Oakley says she cannot.
She says: "To the best of my knowledge, I remember going on my break, and remember being called back.
"I had only been gone half an hour, and had been happy with her before I left.
"I remember saying: 'What's happening?'"
12:00pm
Asked about the note, Mrs Oakley said the 'bubbly' bit is for bubbly saliva.
She says she does not remember specifically the exact rash discolouration, but "hadn't seen it before - it was dark, it was unusual, and the rash struck me."
Asked to expand on that, she says: "I haven't seen that rash before on a baby I have looked after. To the best of my knowledge, in my years of neonates (over 20), no."
12:01pm
Mrs Oakley adds: "It was unusual, I had not seen it before, and probably struggled to describe it. It was a deep red-brown...different from mottling, different from what I'd seen before."
She says sometimes babies can look 'generally white' with a 'mottled all over' appearance, whereas this was a rash 'in specific places'.
12:02pm
She says: "It was just different from what I'd seen before, that's what stayed with me."
12:03pm
The nursing note adds: 'Saturations to 100% and O2 weaned to air. Observations satisfactory."
Mrs Oakley said she couldn't recall who was doing what, but the oxygen was turned up on the CPAP machine, and Child D responded.
12:09pm
The note adds: "Dr Newby called in to review; fluids increased..." and a number of drugs and solutions were administered and prescribed.
The note adds: "Discolourations resolved. [Abdominal x-ray] taken satisfactory. Continue supportive treatment [ie antibiotics]. Maintain UVC [ie don't take it out]. Decision to speak to parents later as [Child D] stable and doctors required on paediatrics. Repeat gas good."
Mrs Oakley confirms the rash-like appearance had 'resolved' between 1.30am and after the doctor's review.
She says Child D had had an episode but had responded "quickly" and "normal parameters" had resumed within an hour.
As Child D was "very stable again", and the doctors were "busy", the decision was made to let the parents rest and inform them in the morning.
12:15pm
Mrs Oakley is asked to put into context further observation readings at 2.30am for Child D, which had "returned to normal".
She says they would be considered "stable".
12:21pm
A 1.30am fluids reading records 'nil by mouth' at the time for Child D, along with 'oral secretion ++' for aspirates.
12:24pm
The fluids chart also notes what Mrs Oakley believes is a task carried out for Child D by Lucy Letby at 1.05am, which she said would have been noted retrospectively, as Mrs Oakley would have started her break at this time.
12:28pm
Nurse Oakley's nursing note adds: "[3am Child D] crying and desaturated again to 70s. Commenced on 100% O2 via CPAP and picked up well but skin discoloured again but less than previously. Dr Brunton called to review; take off NCPAP, further fluid bolus and gas 1 hour cares attended to; [passed urine] +++ and passed meconium."
Mrs Oakley says she cannot recall the events around this collapse, and says her memory of it is limited to that of her notes.
12:35pm
A nursing note of drug infusion, which Mrs Oakley says the doctors believed Child D would need more fluid on board, is noted at 3.20am.
The fluid chart records for 3.30am 'restart expressed breast milk (1ml).'
The prosecution say the collapses had been of concern to nurses, and why the doctors were called.
Mrs Oakley said after the review, the doctors were "happy with her" and for fluids to continue to be administered.
She added Child D had passed urine and had a wet nappy, and so she was comfortable in changing her nappy.
"If I thought she was unstable, I would not have chosen to change her nappy. If the baby's unstable, they do not tolerate handling. Even cleaning them could cause them to be unsettled, with their heart rate going up."
12:37pm
The nurse added 'observations satisfactory' and Child D was 'handling well'.
The final observation readings were all in normal parameters at 3.30am.
12:42pm
At 3.45am, the nurse noted: "Monitor alarming, [Child D] desaturated again and [stopped breathing]. Called senior nurse Letby to help. Stimulation given."
Use of Neopuff was given at 3.52pm. A senior house officer was called to help. Dr Brunton called to help, resuscitation efforts began.
The prosecution asks if Mrs Oakley has a memory of this.
She says she does note, it was "just a blur, just very busy. She 'misbehaved' [had gone poorly again]. I don't remember specifically."
She does not recall if an alarm went off. From her notes, she called Letby to assist.
The initial 'stimulation' effort was, the court hears, to tickle the feet, trunk, ears, which can in itself get a baby stimulated enough to start breathing.
Mrs Oakley says she played a part in the resuscitation efforts.
Cross-Examination
12:47pm
Ben Myers KC, for Letby's defence, is now asking Caroline Oakley questions.
He asks if she was aware of the 'increased mortality rate' between June 2015 and July 2016, and in a police statement, said it was a 'busy and stressful time'. Mrs Oakley agrees.
He asks whether that was from increased admissions to the neonatal unit.
"There were a lot of babies."
She said she couldn't say if that was an increase, and would have to see the statistics.
Asked if there were an increased number of acutely poorly babies, Mrs Oakley replies: "I'm not sure, I worked there a long time. We used to take a lot of 24-weekers when I started [over 20 years prior].
"I remember midwives bringing babies in when we were busy."
12:49pm
She says she does not remember the unit being "unduly short-staffed".
Mr Myers suggests that at times of crisis, they had the staff they required.
Nurse Oakley: "Yes, as they would be called from other patients."
Mr Myers: "But maybe at other times, you didn't have as many staff as you needed?"
Nurse Oakley: "I'm not sure."
12:52pm
He refers to Child D as an intensive care baby.
Mrs Oakley says she wasn't a 'poorly' intensive care baby as she wasn't on ventilator support.
She says Child D was classified as an intensive care baby.
The chart showing Mrs Oakley looking after Child D in room 1 and a baby in room 2.
He says intensive care babies require one-to-one support.
"Ideally yes"
He says the fact Mrs Oakley was looking after another baby too that night fell outside the guidelines.
"That isn't in the guidelines, is it?"
Mrs Oakley: "Strictly speaking no, but it does happen."
12:59pm
Mr Myers: "It's important that with babies like [Child D] you remain vigilant, as they can deteriorate quite suddenly, can't they?"
Mrs Oakley: "They can, yes."
Mr Myers asks if Mrs Oakley was aware Child D had been on a ventilator until the early hours of June 21.
She says she only knows that from the medical notes.
1:48pm
Ben Myers KC is continuing to ask nurse Caroline Oakley questions.
He asks if she knew there had been a delay in giving Child D antibiotics after birth.
She says she cannot remember, but can see from the notes.
Mr Myers refers to a nursing note from June 21, during the day, that there were signs of respiratory acidosis after extubation.
Mrs Oakley says she cannot remember that note, but she would have been told about it during the shift handover.
1:49pm
Mr Myers refers to the note continuing with 'blood gas repeated 2 hours later showed a further deterioration 'with increasing metabolic acidosis'.
He asks whether she would have been informed of this.
Mrs Oakley: "I'm sure it would've been mentioned [at the handover], yes."
1:51pm
Mr Myers asks about the attempt to take Child D off CPAP at 7.15pm, but Child began shallow breathing again, so was put back on CPAP.
"What we have is a baby who has been struggling to breathe unaided [throughout the day]?"
"Yes."
Mr Myers says there are warning signs she was not in an optimal state, and an indication she was "unwell".
"If she needs help with her breathing, yes."
1:58pm
The observation chart is shown for Child D for the night shift is shown again to the court.
Mr Myers then refers, for context, to the previous 24 hours, showing Child D's observations were in 'the warning zone' for heart rate and breathing rate on several hourly observation readings from late on June 20 throughout the day of June 21.
2:06pm
A blood gas readings chart is shown to the court.
The PH readings recorded at 10.14am and 12.10pm on June 21, of 7.194 and 7.173 are 'acidic'. Mrs Oakley agrees. She adds that doctors would have a better idea of the parameters of what would be normal readings for babies.
Mr Myers, referring to other readings, says the situation is 'not as good' at 11.52pm as it was at a reading from 6.44pm.
Mrs Oakley agrees.
Mr Myers says the blood gas readings are worse at 1.14am, and point to a deterioration.
Mrs Oakley says the readings to her are not as good as earlier, and says the doctors would take action based on them.
2:08pm
Mr Myers refers to the break Mrs Oakley took between 1-2am.
Mes Oakley says she is not sure the 1.14am blood gas reading notes are in her handwriting.
Mr Myers refers to the 1.15am observation chart reading note, which has Mrs Oakley's signature initials.
Mrs Oakley says she would have usually expected to write those observations at 1.30am [prior readings are 11.30pm and 12.30am, with subsequent readings at 2.30am and 3.30am], and may have written them retrospectively - "it does happen".
2:12pm
An IV prescription chart, with Mrs Oakley's signature initials at 1.25am, is presented to the court.
Mrs Oakley said the prescription is not in her handwriting.
Mr Myers says it's not unusual for nurses to help each other out, particularly for procedures which could involve two nurses. Mrs Oakley agrees.
2:15pm
A fluids chart is presented, showing the gastric tube change recording '0105 - suction pp ll, AXR, bolus'.
Mrs Oakley says she believes she has written that retrospectively, and has summarised what was told for that 1.05am. She has summarised that they wanted a bolus and an abdominal x-ray.
She says she would have been told all this by Lucy Letby, by another nurse Kate Percival-Ward, or a combination of both.
2:19pm
Mr Myers refers to the 1.30am collapse of Child D.
Mrs Oakley says it was a short distance from the resuscitation room to room 1, and does not recall who came to get her.
Mr Myers said Child D responded well to the oxygen, and no resuscitation was required. Mrs Oakley agrees.
2:22pm
Mr Myers refers to the skin discolouration of Child D at the time of the first collapse.
Mr Myers: "Does that suggest the skin discolouration was all over her body?"
Mrs Oakley: "The front of it yes, but I don't know if it was all the trunk. I don't think it was all the trunk, all the legs."
Mr Myers refers to her finding the rash-like appearance being 'unusual', and a 'struggle to describe it'.
"You said you couldn't remember it - was a deep red-brown what you saw?"
"I just remember the rash, I don't remember the specifics of it, I just remember it was an unusual rash."
"Would it be fair to say the fact it was unusual that stuck in your mind?"
"It always has, yes."
2:24pm
Mr Myers refers to the 3am collapse of Child D.
He suggests that Mrs Oakley was present at the time of the collapse.
Mrs Oakley says she would have been in the vicinity at the time, and does not remember what she was doing.
2:28pm
Mr Myers says it was an episode which resolved 'quickly' and resulted in a decision to take Child D off CPAP.
He asks whether there had been a discussion about Child D's breathing support difficulties earlier that day.
Mrs Oakley says she does not remember.
She says she believes if the desaturations had gone to the 70s, the alarms would have gone off and she would have been alerted to Child D.
The 3.45am collapse is now being referred to.
Mr Myers says at that point, Child D had been taken off CPAP.
Mrs Oakley replies: "Honestly, you would have to check the times for me."
"She was stable in between these two times?"
"Definitely."
Mr Myers says there is then a more marked deterioration, as Child D stopped breathing, and nurse Oakley called for help.
Mrs Oakley agrees.
Prosecution Re-Direct
2:31pm
The prosecution rise once more, led by Simon Driver, to ask about the discolouration of Child D's skin at 1.30am.
He asks what it was that struck her about the rash appearance that was unusual at 1.30am.
"I'd not seen it before."
He asks how it had changed by 3am.
She replies the rash wasn't as pronounced, not "as bad", but she was not expecting Child D to deteriorate again.
She says she had previously experienced 'mottled' appearance in babies - 'newborn spots', or 'mottled', but "we don't specifically get rashes, in my experience".
Judge's Question
2:34pm
The judge, Mr Justice James Goss, asks to clarify one matter from the 1.30am collapse.
"You said some of that was what you had been told had happened."
Mrs Oakley says the 'oral suctions' referred to what was being done to Child D before she arrived back in room 1. The part of the note from 'discolourations to skin observed' were her own observations.
LIVE: Lucy Letby trial, Friday, November 4
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 16 of Prosecution Evidence
Child D
Caroline Oakley, Senior Neonatal Nurse, Child D's Designated Nurse, Night-Shift 21st/22nd June 2015
11:17am
Caroline Oakley is now being called to give evidence. In June 2015, she was employed as a senior neonatal unit nurse at the Countess of Chester Hospital.
Mrs Oakley confirms she would at times be a shift leader, and would look after the people on that shift, not necessarily working with managers.
11:18am
She confirms she had direct involvement with Child D on the night shift from June 21-22, and was her designated nurse during that shift.
11:25am
Mrs Oakley says she does not recall which nurses were designated nurses for which babies that night.
Her nursing note, written retrospectively at 4.46am on June 22 for the night shift, is presented to the court.
The note records, at the handover, 'lower limbs dusky and feet bruised. Doctors aware. Feet cool to slightly warm. Observations satisfactory.'
Mrs Oakley added Child D was 'nursed on CPAP in air. antibiotics given as prescribed.'
11:26am
Mrs Oakley tells the court Child D was not pink yet, and might have been sampled with heel pricks, which could make the feet bruised.
She said it was something to monitor, but was not a concern at that stage, and those observations had been relayed to doctors.
11:28am
The nurse said Child D's circulation was not "100 per cent brilliant" at that point, but this was common in newborn babies.
The note records Child D was reviewed by Dr Andrew Brunton.
The decision was made to 'commence feeds and increase as tolerated', with expressed breast milk.
Blood gas readings taken at 11.52pm and 1.14am were 'satisfactory'.
11:31am
Mrs Oakley said she remembered "being very happy with her" at that point of the night shift. While Child D was an intensive care patient in the neonatal unit, she was 'only requiring a little assistance' with breathing, and she was "stable".
11:35am
The observation chart for Child D for that night shift is shown to the court, which shows Caroline Oakley's initials signing hourly observation readings.
The heart rate, respiration rate and temperature are recorded.
Child D's heart rate says for the first few hours, the heart rate was "completely normal" up to 12.30am. It had peaked at 1.15am, but could have been after handling and/or a nappy change, Mrs Oakley tells the court.
She said that reading was "still within normal parameters".
11:36am
The respiration rate was at the "upper end of what would be considered ideal", but was still within normal parameters, Mrs Oakley adds.
The temperature readings are also "completely normal" with "no high temperature".
11:43am
A further observation chart records the readings made for Child D being on CPAP.
The chart recorded Child D did not require oxygen support at this stage, having been taken off that in the early hours of June 21.
The oxygen saturation levels were '100', which meant Child D was "breathing beautifully".
11:51am
Another intensive care chart is shown to the court, showing fluids administered during the evening and night of June 21.
A 'minimal' amount of 'acidic' aspirates is recorded from the stomach in the evening.
It was followed by 'mostly clear' aspirates, with occasional darker bits.
Mrs Oakley says there was "nothing" she was "worried about" from those readings.
11:54am
The neonatal infusion prescription chart at 1.25am is shown to the court.
It is signed by Caroline Oakley and Lucy Letby.
Mrs Oakley says usually the nurse looking after the baby will administer it.
She confirms the two signatures made, showing they had checked the fluid.
Mrs Oakley adds: "I would presume that I connected the fluid".
11:58am
At 1.30am, nurse Oakley's notes record: 'called to nursery by senior nurse...and senior nurse Letby; [Child D] had desaturated to 70s, required oral suction as was bubbly and had lost colour. Discolourations to skin observed; trunk/legs/arm/chin. Dr Brunton called to review'.
Mrs Oakley says she remembers being on her break at 1am-2am, so was in the resuscitation room where staff had their breaks. She said she had been gone because Child D was poorly.
The prosecution ask about the timing of the 1.25am medication, and if the nurse can account for that. Mrs Oakley says she cannot.
She says: "To the best of my knowledge, I remember going on my break, and remember being called back.
"I had only been gone half an hour, and had been happy with her before I left.
"I remember saying: 'What's happening?'"
12:00pm
Asked about the note, Mrs Oakley said the 'bubbly' bit is for bubbly saliva.
She says she does not remember specifically the exact rash discolouration, but "hadn't seen it before - it was dark, it was unusual, and the rash struck me."
Asked to expand on that, she says: "I haven't seen that rash before on a baby I have looked after. To the best of my knowledge, in my years of neonates (over 20), no."
12:01pm
Mrs Oakley adds: "It was unusual, I had not seen it before, and probably struggled to describe it. It was a deep red-brown...different from mottling, different from what I'd seen before."
She says sometimes babies can look 'generally white' with a 'mottled all over' appearance, whereas this was a rash 'in specific places'.
12:02pm
She says: "It was just different from what I'd seen before, that's what stayed with me."
12:03pm
The nursing note adds: 'Saturations to 100% and O2 weaned to air. Observations satisfactory."
Mrs Oakley said she couldn't recall who was doing what, but the oxygen was turned up on the CPAP machine, and Child D responded.
12:09pm
The note adds: "Dr Newby called in to review; fluids increased..." and a number of drugs and solutions were administered and prescribed.
The note adds: "Discolourations resolved. [Abdominal x-ray] taken satisfactory. Continue supportive treatment [ie antibiotics]. Maintain UVC [ie don't take it out]. Decision to speak to parents later as [Child D] stable and doctors required on paediatrics. Repeat gas good."
Mrs Oakley confirms the rash-like appearance had 'resolved' between 1.30am and after the doctor's review.
She says Child D had had an episode but had responded "quickly" and "normal parameters" had resumed within an hour.
As Child D was "very stable again", and the doctors were "busy", the decision was made to let the parents rest and inform them in the morning.
12:15pm
Mrs Oakley is asked to put into context further observation readings at 2.30am for Child D, which had "returned to normal".
She says they would be considered "stable".
12:21pm
A 1.30am fluids reading records 'nil by mouth' at the time for Child D, along with 'oral secretion ++' for aspirates.
12:24pm
The fluids chart also notes what Mrs Oakley believes is a task carried out for Child D by Lucy Letby at 1.05am, which she said would have been noted retrospectively, as Mrs Oakley would have started her break at this time.
12:28pm
Nurse Oakley's nursing note adds: "[3am Child D] crying and desaturated again to 70s. Commenced on 100% O2 via CPAP and picked up well but skin discoloured again but less than previously. Dr Brunton called to review; take off NCPAP, further fluid bolus and gas 1 hour cares attended to; [passed urine] +++ and passed meconium."
Mrs Oakley says she cannot recall the events around this collapse, and says her memory of it is limited to that of her notes.
12:35pm
A nursing note of drug infusion, which Mrs Oakley says the doctors believed Child D would need more fluid on board, is noted at 3.20am.
The fluid chart records for 3.30am 'restart expressed breast milk (1ml).'
The prosecution say the collapses had been of concern to nurses, and why the doctors were called.
Mrs Oakley said after the review, the doctors were "happy with her" and for fluids to continue to be administered.
She added Child D had passed urine and had a wet nappy, and so she was comfortable in changing her nappy.
"If I thought she was unstable, I would not have chosen to change her nappy. If the baby's unstable, they do not tolerate handling. Even cleaning them could cause them to be unsettled, with their heart rate going up."
12:37pm
The nurse added 'observations satisfactory' and Child D was 'handling well'.
The final observation readings were all in normal parameters at 3.30am.
12:42pm
At 3.45am, the nurse noted: "Monitor alarming, [Child D] desaturated again and [stopped breathing]. Called senior nurse Letby to help. Stimulation given."
Use of Neopuff was given at 3.52pm. A senior house officer was called to help. Dr Brunton called to help, resuscitation efforts began.
The prosecution asks if Mrs Oakley has a memory of this.
She says she does note, it was "just a blur, just very busy. She 'misbehaved' [had gone poorly again]. I don't remember specifically."
She does not recall if an alarm went off. From her notes, she called Letby to assist.
The initial 'stimulation' effort was, the court hears, to tickle the feet, trunk, ears, which can in itself get a baby stimulated enough to start breathing.
Mrs Oakley says she played a part in the resuscitation efforts.
Cross-Examination
12:47pm
Ben Myers KC, for Letby's defence, is now asking Caroline Oakley questions.
He asks if she was aware of the 'increased mortality rate' between June 2015 and July 2016, and in a police statement, said it was a 'busy and stressful time'. Mrs Oakley agrees.
He asks whether that was from increased admissions to the neonatal unit.
"There were a lot of babies."
She said she couldn't say if that was an increase, and would have to see the statistics.
Asked if there were an increased number of acutely poorly babies, Mrs Oakley replies: "I'm not sure, I worked there a long time. We used to take a lot of 24-weekers when I started [over 20 years prior].
"I remember midwives bringing babies in when we were busy."
12:49pm
She says she does not remember the unit being "unduly short-staffed".
Mr Myers suggests that at times of crisis, they had the staff they required.
Nurse Oakley: "Yes, as they would be called from other patients."
Mr Myers: "But maybe at other times, you didn't have as many staff as you needed?"
Nurse Oakley: "I'm not sure."
12:52pm
He refers to Child D as an intensive care baby.
Mrs Oakley says she wasn't a 'poorly' intensive care baby as she wasn't on ventilator support.
She says Child D was classified as an intensive care baby.
The chart showing Mrs Oakley looking after Child D in room 1 and a baby in room 2.
He says intensive care babies require one-to-one support.
"Ideally yes"
He says the fact Mrs Oakley was looking after another baby too that night fell outside the guidelines.
"That isn't in the guidelines, is it?"
Mrs Oakley: "Strictly speaking no, but it does happen."
12:59pm
Mr Myers: "It's important that with babies like [Child D] you remain vigilant, as they can deteriorate quite suddenly, can't they?"
Mrs Oakley: "They can, yes."
Mr Myers asks if Mrs Oakley was aware Child D had been on a ventilator until the early hours of June 21.
She says she only knows that from the medical notes.
1:48pm
Ben Myers KC is continuing to ask nurse Caroline Oakley questions.
He asks if she knew there had been a delay in giving Child D antibiotics after birth.
She says she cannot remember, but can see from the notes.
Mr Myers refers to a nursing note from June 21, during the day, that there were signs of respiratory acidosis after extubation.
Mrs Oakley says she cannot remember that note, but she would have been told about it during the shift handover.
1:49pm
Mr Myers refers to the note continuing with 'blood gas repeated 2 hours later showed a further deterioration 'with increasing metabolic acidosis'.
He asks whether she would have been informed of this.
Mrs Oakley: "I'm sure it would've been mentioned [at the handover], yes."
1:51pm
Mr Myers asks about the attempt to take Child D off CPAP at 7.15pm, but Child began shallow breathing again, so was put back on CPAP.
"What we have is a baby who has been struggling to breathe unaided [throughout the day]?"
"Yes."
Mr Myers says there are warning signs she was not in an optimal state, and an indication she was "unwell".
"If she needs help with her breathing, yes."
1:58pm
The observation chart is shown for Child D for the night shift is shown again to the court.
Mr Myers then refers, for context, to the previous 24 hours, showing Child D's observations were in 'the warning zone' for heart rate and breathing rate on several hourly observation readings from late on June 20 throughout the day of June 21.
2:06pm
A blood gas readings chart is shown to the court.
The PH readings recorded at 10.14am and 12.10pm on June 21, of 7.194 and 7.173 are 'acidic'. Mrs Oakley agrees. She adds that doctors would have a better idea of the parameters of what would be normal readings for babies.
Mr Myers, referring to other readings, says the situation is 'not as good' at 11.52pm as it was at a reading from 6.44pm.
Mrs Oakley agrees.
Mr Myers says the blood gas readings are worse at 1.14am, and point to a deterioration.
Mrs Oakley says the readings to her are not as good as earlier, and says the doctors would take action based on them.
2:08pm
Mr Myers refers to the break Mrs Oakley took between 1-2am.
Mes Oakley says she is not sure the 1.14am blood gas reading notes are in her handwriting.
Mr Myers refers to the 1.15am observation chart reading note, which has Mrs Oakley's signature initials.
Mrs Oakley says she would have usually expected to write those observations at 1.30am [prior readings are 11.30pm and 12.30am, with subsequent readings at 2.30am and 3.30am], and may have written them retrospectively - "it does happen".
2:12pm
An IV prescription chart, with Mrs Oakley's signature initials at 1.25am, is presented to the court.
Mrs Oakley said the prescription is not in her handwriting.
Mr Myers says it's not unusual for nurses to help each other out, particularly for procedures which could involve two nurses. Mrs Oakley agrees.
2:15pm
A fluids chart is presented, showing the gastric tube change recording '0105 - suction pp ll, AXR, bolus'.
Mrs Oakley says she believes she has written that retrospectively, and has summarised what was told for that 1.05am. She has summarised that they wanted a bolus and an abdominal x-ray.
She says she would have been told all this by Lucy Letby, by another nurse Kate Percival-Ward, or a combination of both.
2:19pm
Mr Myers refers to the 1.30am collapse of Child D.
Mrs Oakley says it was a short distance from the resuscitation room to room 1, and does not recall who came to get her.
Mr Myers said Child D responded well to the oxygen, and no resuscitation was required. Mrs Oakley agrees.
2:22pm
Mr Myers refers to the skin discolouration of Child D at the time of the first collapse.
Mr Myers: "Does that suggest the skin discolouration was all over her body?"
Mrs Oakley: "The front of it yes, but I don't know if it was all the trunk. I don't think it was all the trunk, all the legs."
Mr Myers refers to her finding the rash-like appearance being 'unusual', and a 'struggle to describe it'.
"You said you couldn't remember it - was a deep red-brown what you saw?"
"I just remember the rash, I don't remember the specifics of it, I just remember it was an unusual rash."
"Would it be fair to say the fact it was unusual that stuck in your mind?"
"It always has, yes."
2:24pm
Mr Myers refers to the 3am collapse of Child D.
He suggests that Mrs Oakley was present at the time of the collapse.
Mrs Oakley says she would have been in the vicinity at the time, and does not remember what she was doing.
2:28pm
Mr Myers says it was an episode which resolved 'quickly' and resulted in a decision to take Child D off CPAP.
He asks whether there had been a discussion about Child D's breathing support difficulties earlier that day.
Mrs Oakley says she does not remember.
She says she believes if the desaturations had gone to the 70s, the alarms would have gone off and she would have been alerted to Child D.
The 3.45am collapse is now being referred to.
Mr Myers says at that point, Child D had been taken off CPAP.
Mrs Oakley replies: "Honestly, you would have to check the times for me."
"She was stable in between these two times?"
"Definitely."
Mr Myers says there is then a more marked deterioration, as Child D stopped breathing, and nurse Oakley called for help.
Mrs Oakley agrees.
Prosecution Re-Direct
2:31pm
The prosecution rise once more, led by Simon Driver, to ask about the discolouration of Child D's skin at 1.30am.
He asks what it was that struck her about the rash appearance that was unusual at 1.30am.
"I'd not seen it before."
He asks how it had changed by 3am.
She replies the rash wasn't as pronounced, not "as bad", but she was not expecting Child D to deteriorate again.
She says she had previously experienced 'mottled' appearance in babies - 'newborn spots', or 'mottled', but "we don't specifically get rashes, in my experience".
Judge's Question
2:34pm
The judge, Mr Justice James Goss, asks to clarify one matter from the 1.30am collapse.
"You said some of that was what you had been told had happened."
Mrs Oakley says the 'oral suctions' referred to what was being done to Child D before she arrived back in room 1. The part of the note from 'discolourations to skin observed' were her own observations.
LIVE: Lucy Letby trial, Friday, November 4
Tortoise
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Monday November 7th 2022 - (no live updates from Chester Standard)
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 17 of Prosecution Evidence
Child D
Dr Andrew Brunton, CoCH Specialist Trainee in Paediatrics,
NightShift 20th/21st June 2015 and Nightshift 21st/22nd June 2015
Tweets
https://twitter.com/MrDanDonoghue
I'm back at Manchester Crown Court this week for the murder trial of nurse Lucy Letby. This morning we're expecting to hear evidence from former colleagues in regards to the death of Child D in June 2015.
Dr Andrew Brunton, who is now a consultant neonatologist but was a trainee doctor in 2015, is in the witness box. He is running the jury through his notes from June 20. He notes at the start of his shift that Child D was in 'respiratory distress'
His notes from around 21:45 that evening state: 'Explained (to father) that safest option at present would be to intubate and ventilate her now with the hope of weaning her off the ventilator quickly'
Child D was deemed 'clinically stable' at around 23:15 after being placed on a ventilator.
At that time, parents were told 'if prolonged ventilation is required or a deterioration, we may have to think of transferring to Arrowe Park Hospital or Liverpool Women's Hospital'
Another note from 01:50 on 21 June, 2015 shows an improvement in Child D's condition. Dr Brunton took the decision around this time to wean her off the ventilator.
Later that day, Child D was taken off a ventilator and placed back on a less invasive form of respiratory support (continuous positive airway pressure or CPAP therapy). Dr Brunton's notes from that night [my note 9.40pm – given the next tweet 4 hours later] state that she was 'clinically improving' and 'well enough' to take milk’
Four hours later at around 01:40 on June 22, Dr Brunton was called 'urgently' to attend to Child D. His note from that morning states: 'Called urgently to review baby. Nurses noted that became extremely mottled also noted to have tracking lesions dark brown/black across trunk'
Dr Brunton tells the court that a consultant was called as 'this was a completely unusual situation that I hadn’t seen before', he said he 'couldn’t explain' the discolouration of Child D's skin
After treatment, an hour later notes show Child D's condition had 'improved' and areas of discolouration had 'completely disappeared'
Dr Brunton was 'urgently' called back to attend Child D again at 03:15. His notes from that morning show that the rash had reappeared.
It is the Crown's case that the rash was a result of Ms Letby injecting air into the bloodstream
At around 03:55, emergency treatment commenced. Dr Brunton recalls running from another area of the hospital after receiving a crash call. He along with other medics began chest compressions after Child D stopped breathing. Adrenaline was administered shortly after 04:00
Dr Brunton's notes show that five adrenaline doses were administered over the next 10 minutes. 'This was necessary because (Child D) was in effect dying in front of us', he told the court.
After a conversation with Child D's parents, CPR was stopped after 28 minutes. Asked to summarise the events of that evening, he said: 'From when I came in on my night shift there weren't any particular worries or concerns regarding (Child D).
He added: 'By 01:40 to her death (Child D) had dramatic deteriorations at different points. It was completely unclear to me why that was occurring 'I've never seen a baby behave in that matter prior to this or after this'
(Cross-Examination)
Ben Myers KC, defending Ms Letby, is now taking jurors back through Dr Brunton's notes. Mr Myers has said it is important to look at the 'whole clinical picture' when assessing Child D's health
He has previously told the jury there was more evidence that infection played a part in Child D's death and the hospital failed to provide adequate care
Mr Myers is putting it to Dr Brunton that there was nothing to support (in terms of Child D's condition) his decision to move her off CPAP. Dr Brunton rejects this, he says her clinical readings were moving in the right direction. He added that it was a 'natural process' on a neonatal unit to try and move a baby off CPAP.
Court has now adjourned, back in an hour.
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 17 of Prosecution Evidence
Child D
Dr Andrew Brunton, CoCH Specialist Trainee in Paediatrics,
NightShift 20th/21st June 2015 and Nightshift 21st/22nd June 2015
Tweets
https://twitter.com/MrDanDonoghue
I'm back at Manchester Crown Court this week for the murder trial of nurse Lucy Letby. This morning we're expecting to hear evidence from former colleagues in regards to the death of Child D in June 2015.
Dr Andrew Brunton, who is now a consultant neonatologist but was a trainee doctor in 2015, is in the witness box. He is running the jury through his notes from June 20. He notes at the start of his shift that Child D was in 'respiratory distress'
His notes from around 21:45 that evening state: 'Explained (to father) that safest option at present would be to intubate and ventilate her now with the hope of weaning her off the ventilator quickly'
Child D was deemed 'clinically stable' at around 23:15 after being placed on a ventilator.
At that time, parents were told 'if prolonged ventilation is required or a deterioration, we may have to think of transferring to Arrowe Park Hospital or Liverpool Women's Hospital'
Another note from 01:50 on 21 June, 2015 shows an improvement in Child D's condition. Dr Brunton took the decision around this time to wean her off the ventilator.
Later that day, Child D was taken off a ventilator and placed back on a less invasive form of respiratory support (continuous positive airway pressure or CPAP therapy). Dr Brunton's notes from that night [my note 9.40pm – given the next tweet 4 hours later] state that she was 'clinically improving' and 'well enough' to take milk’
Four hours later at around 01:40 on June 22, Dr Brunton was called 'urgently' to attend to Child D. His note from that morning states: 'Called urgently to review baby. Nurses noted that became extremely mottled also noted to have tracking lesions dark brown/black across trunk'
Dr Brunton tells the court that a consultant was called as 'this was a completely unusual situation that I hadn’t seen before', he said he 'couldn’t explain' the discolouration of Child D's skin
After treatment, an hour later notes show Child D's condition had 'improved' and areas of discolouration had 'completely disappeared'
Dr Brunton was 'urgently' called back to attend Child D again at 03:15. His notes from that morning show that the rash had reappeared.
It is the Crown's case that the rash was a result of Ms Letby injecting air into the bloodstream
At around 03:55, emergency treatment commenced. Dr Brunton recalls running from another area of the hospital after receiving a crash call. He along with other medics began chest compressions after Child D stopped breathing. Adrenaline was administered shortly after 04:00
Dr Brunton's notes show that five adrenaline doses were administered over the next 10 minutes. 'This was necessary because (Child D) was in effect dying in front of us', he told the court.
After a conversation with Child D's parents, CPR was stopped after 28 minutes. Asked to summarise the events of that evening, he said: 'From when I came in on my night shift there weren't any particular worries or concerns regarding (Child D).
He added: 'By 01:40 to her death (Child D) had dramatic deteriorations at different points. It was completely unclear to me why that was occurring 'I've never seen a baby behave in that matter prior to this or after this'
(Cross-Examination)
Ben Myers KC, defending Ms Letby, is now taking jurors back through Dr Brunton's notes. Mr Myers has said it is important to look at the 'whole clinical picture' when assessing Child D's health
He has previously told the jury there was more evidence that infection played a part in Child D's death and the hospital failed to provide adequate care
Mr Myers is putting it to Dr Brunton that there was nothing to support (in terms of Child D's condition) his decision to move her off CPAP. Dr Brunton rejects this, he says her clinical readings were moving in the right direction. He added that it was a 'natural process' on a neonatal unit to try and move a baby off CPAP.
Court has now adjourned, back in an hour.
Tortoise
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Monday November 7th 2022 - (no live updates from Chester Standard)
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 17 of Prosecution Evidence
Child D
Dr Joanne Davies, CoCH Consultant Obstetrics and Gynaecology,
Antenatal Care of Child D's Mother
Tweets
https://twitter.com/MrDanDonoghue
We're back. Dr Joanne Davies, who is a consultant in obstetrics and gynaecology at the Countess of Chester, is now giving evidence. She's discussing the health of Child D's mother. She says that it was a 'low risk' pregnancy.
The court previously heard that Child D's mother was left waiting more than 50 hours for treatment after her waters broke early. Last week the mother told the court: 'I felt very worried and scared, I felt unwell and not in control. I felt I was being forgotten by the staff'
Dr Davies tells the court that the mother's 'care followed the guidelines'. She said the guidance is to 'leave someone for 24 hours to see if they labour by themselves', they are then offered inducement - but it is 'not unusual' for this to take another 24 hours
(Cross-Examination)
When pressed by Ms Letby's defence barrister, Dr Davies does however acknowledge that there was a shortfall in the care of Child D's mother as an oral antibiotic was not initially provided after her waters broke
Dr Davies says she doubts whether the antibiotic 'would have had any effect in this case'. Mr Myers responds saying, 'you may doubt, but you don't know do you?' 'I don’t know', Dr Davies says
Dr Davies told the court that the mother did not present with any signs of infection prior to the birth, but accepted the findings of a pathologist's report into the death of Child D which deemed the cause of death was pneumonia. Mr Myers described this as a 'conundrum'
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 17 of Prosecution Evidence
Child D
Dr Joanne Davies, CoCH Consultant Obstetrics and Gynaecology,
Antenatal Care of Child D's Mother
Tweets
https://twitter.com/MrDanDonoghue
We're back. Dr Joanne Davies, who is a consultant in obstetrics and gynaecology at the Countess of Chester, is now giving evidence. She's discussing the health of Child D's mother. She says that it was a 'low risk' pregnancy.
The court previously heard that Child D's mother was left waiting more than 50 hours for treatment after her waters broke early. Last week the mother told the court: 'I felt very worried and scared, I felt unwell and not in control. I felt I was being forgotten by the staff'
Dr Davies tells the court that the mother's 'care followed the guidelines'. She said the guidance is to 'leave someone for 24 hours to see if they labour by themselves', they are then offered inducement - but it is 'not unusual' for this to take another 24 hours
(Cross-Examination)
When pressed by Ms Letby's defence barrister, Dr Davies does however acknowledge that there was a shortfall in the care of Child D's mother as an oral antibiotic was not initially provided after her waters broke
Dr Davies says she doubts whether the antibiotic 'would have had any effect in this case'. Mr Myers responds saying, 'you may doubt, but you don't know do you?' 'I don’t know', Dr Davies says
Dr Davies told the court that the mother did not present with any signs of infection prior to the birth, but accepted the findings of a pathologist's report into the death of Child D which deemed the cause of death was pneumonia. Mr Myers described this as a 'conundrum'
Tortoise
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Monday November 7th 2022 - (no live updates from Chester Standard)
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 17 of Prosecution Evidence
Child D
Junior Nurse Lisa Walker, CoCH, Child D's Birth (@ 3.31pm 10th June 2015)
Tweets
https://twitter.com/MrDanDonoghue
Junior nurse Lisa Walker is now in the witness box. She is describing seeing Child D in the moments after her birth. 'She looked very blue in colour. I immediately shouted for help', she said
She said a doctor that was present 'looked shocked I shouted for help'. She said he 'wondered why I shouted for help...he didn’t know what was going on' Ms Walker said following the incident she filled out an internal form to express concern over his (lack of) action
Court has now adjourned for today, back tomorrow.
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 17 of Prosecution Evidence
Child D
Junior Nurse Lisa Walker, CoCH, Child D's Birth (@ 3.31pm 10th June 2015)
Tweets
https://twitter.com/MrDanDonoghue
Junior nurse Lisa Walker is now in the witness box. She is describing seeing Child D in the moments after her birth. 'She looked very blue in colour. I immediately shouted for help', she said
She said a doctor that was present 'looked shocked I shouted for help'. She said he 'wondered why I shouted for help...he didn’t know what was going on' Ms Walker said following the incident she filled out an internal form to express concern over his (lack of) action
Court has now adjourned for today, back tomorrow.
Tortoise
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- Joined
- Oct 15, 2015
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Monday November 7th 2022 - Daily Mail - 10% extracts - Link Lucy Letby trial: Nurse 'told off' colleague who shouted for help
----
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 17 of Prosecution Evidence
Child D
Dr Andrew Brunton, CoCH Specialist Trainee in Paediatrics,
NightShift 20th/21st June 2015 and Nightshift 21st/22nd June 2015
----
"Dr Brunton told jurors [...] that child D was 'clinically improving' on the evening of June 21, but he was called to urgently review her at 1.40am the next day.
[...] her oxygen levels had dropped and she had developed a rash.
Child D quickly recovered and the rash vanished, [...], but Dr Brunton contacted the on-call consultant to review the infant. [...]
He was called again at 3am as he was informed Child D was upset and crying, her oxygen requirements had risen again and the rash had reappeared.
Dr Brunton said: 'I can't remember the specifics but I remember her being quite agitated and upset. This stuck in my mind as she had not been like that when I examined her before.'
[...] he said he decided to withdraw CPAP (continuous positive airway pressure) respiratory support, as he thought at the time it may be the source of her agitation. [...]
At 3.45am he was asked again to attend [...]
Child D had stopped breathing and chest compressions had started by the time he arrived, [...]
"[...] I had never seen a baby behave in that manner prior to this and I have never seen a baby behave in that manner after this."
[...]
(Cross-Examination)
[...] 'When you took the decision that she should come off CPAP, did it cross your mind it may lead to a deterioration?'
Dr Brunton replied: 'Absolutely not. If we are trialling a baby off CPAP they can go back on it if we think they are not able to cope with it.'"
----
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 17 of Prosecution Evidence
Child D
Dr Andrew Brunton, CoCH Specialist Trainee in Paediatrics,
NightShift 20th/21st June 2015 and Nightshift 21st/22nd June 2015
----
"Dr Brunton told jurors [...] that child D was 'clinically improving' on the evening of June 21, but he was called to urgently review her at 1.40am the next day.
[...] her oxygen levels had dropped and she had developed a rash.
Child D quickly recovered and the rash vanished, [...], but Dr Brunton contacted the on-call consultant to review the infant. [...]
He was called again at 3am as he was informed Child D was upset and crying, her oxygen requirements had risen again and the rash had reappeared.
Dr Brunton said: 'I can't remember the specifics but I remember her being quite agitated and upset. This stuck in my mind as she had not been like that when I examined her before.'
[...] he said he decided to withdraw CPAP (continuous positive airway pressure) respiratory support, as he thought at the time it may be the source of her agitation. [...]
At 3.45am he was asked again to attend [...]
Child D had stopped breathing and chest compressions had started by the time he arrived, [...]
"[...] I had never seen a baby behave in that manner prior to this and I have never seen a baby behave in that manner after this."
[...]
(Cross-Examination)
[...] 'When you took the decision that she should come off CPAP, did it cross your mind it may lead to a deterioration?'
Dr Brunton replied: 'Absolutely not. If we are trialling a baby off CPAP they can go back on it if we think they are not able to cope with it.'"
Tortoise
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- Oct 15, 2015
- Messages
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Monday November 7th 2022 - BBC - 10% extracts - Link Lucy Letby: Baby given adrenaline in bid to save her, jury told
----
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 17 of Prosecution Evidence
Child D
Dr Andrew Brunton, CoCH Specialist Trainee in Paediatrics,
NightShift 20th/21st June 2015 and NightShift 21st/22nd June 2015
----
[...] medics desperately administered five doses of adrenaline in a bid to save a baby, a murder trial has heard.
Dr Andrew Brunton told the court the baby needed urgent treatment three times on the morning of her death.
Medical notes show that at about 03:55, Dr Brunton received an emergency call to attend Child D for what would be the final time.
When asked to summarise the events of that morning, he said: "From when I came in on my night shift there weren't any particular worries or concerns regarding Child D.
"By 01:40 to her death, Child D had dramatic deteriorations at different points.
"It was completely unclear to me why that was occurring."
[...]
Junior Nurse Lisa Walker, CoCH - An incident involving a baby not part of the charges
The court later heard how Ms Letby "told off" a colleague who shouted for help when a baby's oxygen levels dropped.
Miss Walker agreed with Ben Myers, KC, defending, that she could not remember the date of the incident, or the name and sex of the baby involved.
----
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 17 of Prosecution Evidence
Child D
Dr Andrew Brunton, CoCH Specialist Trainee in Paediatrics,
NightShift 20th/21st June 2015 and NightShift 21st/22nd June 2015
----
[...] medics desperately administered five doses of adrenaline in a bid to save a baby, a murder trial has heard.
Dr Andrew Brunton told the court the baby needed urgent treatment three times on the morning of her death.
Medical notes show that at about 03:55, Dr Brunton received an emergency call to attend Child D for what would be the final time.
When asked to summarise the events of that morning, he said: "From when I came in on my night shift there weren't any particular worries or concerns regarding Child D.
"By 01:40 to her death, Child D had dramatic deteriorations at different points.
"It was completely unclear to me why that was occurring."
[...]
Junior Nurse Lisa Walker, CoCH - An incident involving a baby not part of the charges
The court later heard how Ms Letby "told off" a colleague who shouted for help when a baby's oxygen levels dropped.
Miss Walker agreed with Ben Myers, KC, defending, that she could not remember the date of the incident, or the name and sex of the baby involved.
Last edited:
Tortoise
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Monday November 7th 2022 - Gazette & Herald - 10% extracts - Link Nurse Lucy Letby ‘told off’ colleague over shout for help, murder trial hears
----
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 17 of Prosecution Evidence
Child D
Junior Nurse Lisa Walker, CoCH - An incident involving a baby not part of the charges
---
[...]
She said they were feeding infants in opposite corners of the room when an alarm monitor sounded at the cot where Letby was.
Giving evidence from behind a screen on Monday, Miss Walker said [...] Letby stopped the feed through a nasogastric tube, commenced “gentle stimulation” of the baby and, when that did not work, she gave oxygen via a facial mask [...].
She said the baby did not respond to the oxygen at first and she shouted for help as a nurse walked past the door. [...]
[...]: “Then Lucy said to me, ‘Why did you shout for help?'” [...]
Mr Astbury said: “Why has it stuck in your memory?”
The witness said: “It’s because I was told off for shouting for help.” [...]
(Cross-Examination)
She told Mr Myers she did not get the impression that Letby asked the question because she felt help was unnecessary in the situation.
----
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 17 of Prosecution Evidence
Child D
Junior Nurse Lisa Walker, CoCH - An incident involving a baby not part of the charges
---
[...]
She said they were feeding infants in opposite corners of the room when an alarm monitor sounded at the cot where Letby was.
Giving evidence from behind a screen on Monday, Miss Walker said [...] Letby stopped the feed through a nasogastric tube, commenced “gentle stimulation” of the baby and, when that did not work, she gave oxygen via a facial mask [...].
She said the baby did not respond to the oxygen at first and she shouted for help as a nurse walked past the door. [...]
[...]: “Then Lucy said to me, ‘Why did you shout for help?'” [...]
Mr Astbury said: “Why has it stuck in your memory?”
The witness said: “It’s because I was told off for shouting for help.” [...]
(Cross-Examination)
She told Mr Myers she did not get the impression that Letby asked the question because she felt help was unnecessary in the situation.
Tortoise
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- Oct 15, 2015
- Messages
- 26,332
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EDIT TO EARLIER POST #114
CHILD D WAS BORN @ 4.01pm 20th June 2015
CHILD D WAS BORN @ 4.01pm 20th June 2015
Monday November 7th 2022 - (no live updates from Chester Standard)
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 17 of Prosecution Evidence
Child D
Junior Nurse Lisa Walker, CoCH, Child D's Birth (@ 4.01pm 20th June 2015)
Tweets
https://twitter.com/MrDanDonoghue
Junior nurse Lisa Walker is now in the witness box. She is describing seeing Child D in the moments after her birth. 'She looked very blue in colour. I immediately shouted for help', she said
She said a doctor that was present 'looked shocked I shouted for help'. She said he 'wondered why I shouted for help...he didn’t know what was going on' Ms Walker said following the incident she filled out an internal form to express concern over his (lack of) action
Court has now adjourned for today, back tomorrow.
Tortoise
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- Joined
- Oct 15, 2015
- Messages
- 26,332
- Reaction score
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Tuesday November 8th 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 18 of Prosecution Evidence
Child D
Dr Sarah Rylance, Registrar @ CoCH, Neonatal, Long-Day Shifts 20th June 2015 and 21st June 2015
10:30am
The trial will resume shortly. Letby has arrived in court with a custody officer, as has been the case for each day of the trial.
10:41am
An interpreter will be required in court today, for an unusual reason.
The next doctor witness will be giving evidence from Switzerland, via videolink. Under Swiss law, the doctor's evidence will be coming from a court in Switzerland, and a French-speaking Swiss prosecutor will be present. What is said in Manchester, and the doctor's evidence, will be translated into French by the interpreter in the Swiss court for the benefit of the Swiss prosecutor.
10:46am
Through discussions between the two courts, it is now understood everyone in the Swiss court can understand English.
The judge in Manchester, Mr Justice Goss, has said the proceedings will carry on in English, and translation will only be required if there are either technical difficulties or the odd word which will require interpreting into French.
10:49am
Members of the jury have now come into court, and matters have been explained to them about the international videolink arrangement.
The next witness to give evidence is Dr Sarah Rylance.
10:54am
Dr Rylance confirms she was employed at the Countess at Chester Hospital as a registrar in June 2015, and worked a long day shift on June 20 that day.
She confirms she has the clinical notes for Child D to hand.
A reminder that, due to reporting restrictions, none of the children in this case can be identified.
11:03am
Dr Rylance says she does not believe she was present at the birth of Child D.
The details are recorded retrospectively, that Child D was born at 4.01pm on June 20.
The note includes: 'Bleeped again as midwife not happy with her colour' - she is not able to say whether that was her being bleeped again.
Child D 'looked dusky' and had 'poor respiratory [efforts]', with initial oxygen saturations at 48%, poor respiratory effort at 7.30pm.
The note adds 'transferred into incubator'.
After being given breathing assistance via Neopuff, Child D 'pinked up quickly and started regular resps'.
11:05am
The prosecution ask for what Child D would have been assessed as.
Dr Rylance: "She responded well to the ventilation support she has been given."
"In relation to the blood gases, it's difficult to assess how that reflects on her clinical condition."
The blood gases suggest Child D had difficulties with breathing and metabolism, but Dr Rylance said she would not use the blood gases alone to make a diagnosis, but take it into context with other readings and observations.
11:07am
Child D was 'transferred on to CPAP', and an IV saline solution was administered.
Child D was also started on 'triple lights' as part of phototherapy to treat her jaundice symptoms. That was the "maximum treatment" level, Dr Rylance, tells the court.
11:09am
Dr Rylance's notes, also record, for Child D at 8pm, the baby girl was on CPAP, 40% oxygen, and '[saturations] 100%'.
Child D's heart sounds were "normal", with an "ok" pulse rate, and it was noted there were regular breathing efforts, "but fairly shallow" and the abdomen was not distended.
The plan was to continue CPAP and administer dextrose, and repeat a blood gas test at 8.45pm.
11:12am
Dr Rylance's notes at 8.20pm record the parents were updated on Child D's condition, with "likely sepsis" and she was receiving antibiotics "to treat infection".
The doctor tells the court Child D's condition was, at this point, "responding well to interventions" and "appeared to be stabilised on the CPAP and making respiratory efforts."
"Overall I was happy with the the progress she had made, but she needed to be closely monitored and assessed."
11:18am
A further entry is made at June 21, 2pm, in the clinical notes.
The entry records the insertion of a UAC and UVC into Child D.
The UVC was removed as it was 'only able to advance to 5cm'. Dr Rylance says usually "you are expected to advance it much further.
"It can be difficult and fiddly to do this procedure in new-born babies."
The UAC was inserted to 20.5cm, but did not get a blood sample back. An x-ray review found it was advanced 'way too far', and the route was 'not typical of a UAC'.
The UAC "should follow a typical route", the court hears, and the line was pulled back to 9cm.
A blood gas reading was taken and the readings were 'much improved'.
A second x-ray showed the UAC position was 'better', but the route was 'still not typical'.
11:23am
The 'much improved' blood gas reading was, Dr Rylance believes, a comparison with the previous blood gas reading.
The UAC was 'actually a UVC' and adjusted to be used as a UVC.
The plan was to continue CPAP for Child D and repeat a blood gas reading, and 'try to sample UVC' for various readings.
A review is carried out at 7pm on June 21, with 'presumed sepsis' noted.
A CRP reading of 1 is recorded, having previously been 6.
Dr Rylance, commenting on those readings: "I wouldn't attach particular significance to it," as both readings were "low", and would need to be taken in context with the baby's clinical condition and observations.
11:25am
Child D had been on CPAP all day, but 'in air' and 'saturating well', with 'no desat[urations].'
The initial blood gases post-extubation at 9am were 'not good', so Child D was put back on to CPAP at 10.30am.
Dr Rylance said Child D had made good progress, and her ventilation status was "very satisfactory" at the time she reviewed her.
11:32am
Under the heading 'sepsis', the CRP reading was '1', and Child D had 'not had [lumbar puncture] yet.'
Such a test is done in clinically stable babies to test infection has not spread, the court hears, but Child D was 'not stable enough' for that to be carried out.
Other observations were noted by Dr Rylance that Child D was 'responsive on handling', with 'chest clear, regular resp effort, minimal recession', abdomen 'soft, not distended'.
The feet were 'quite purple', but Dr Rylance says that would be as a result of frequent tests carried out. The court has previously heard heel prick tests would be done to get results such as blood gas readings.
Dr Rylance added: "Overall my observations were that she was stable and handling well...and responding well to treatment she had received throughout the course of the day."
Under 'impressions', Dr Rylance noted: 'stable on CPAP, tried taking her off but resp effort became irregular and desaturated a few times so put back on'.
Dr Rylance said she would not have attached a lot of significance to this, as "it takes babies some time to settle. She was obviously unwell when she came to the neonatal unit the previous evening.
"She needed a bit more time from the CPAP...allow us to transition having been ventilated and moving to breathing.
"If they don't seem to tolerate it well, you can just put them back on [CPAP].
"She was heading in the right direction, she just needed a little support from the [CPAP] machine without added oxygen."
11:34am
The note added, as part of the plan, 'leave on CPAP, await CRP...leave UVC for now to allow sampling for gases, continue [antibiotics].'
Dr Rylance says she was "happy" with Child D's clinical condition, having had "a very satisfactory day" and was improving, in good colour, not needing oxygen support.
"She has shown good improvement from the condition when I first saw her on the neonatal unit the previous evening."
Cross-Examination
11:37am
Ben Myers KC, for Letby's defence, is now asking Dr Sarah Rylance questions.
He says there were two instances of her examining Child D.
He said that at the end of the June 20 examination, she was "happy with [Child D's] progress".
"Would you agree she was at risk of complications?"
Dr Rylance says Child D had responded well to treatment, but the blood gases were not in the normal range, and that would require close observation.
11:41am
Mr Myers points to Child D having 'lost colour' and 'floppy' when in her father's arms moments after birth.
"Do you agree that is worrying at that stage?"
Dr Rylance agrees the Apgar scores of 8/10 and 9/10 aren't relevant for 12 minutes later.
Mr Myers asks if the progress of Child D is based on the reference point from the worrying signs just after birth.
Dr Rylance: "My opinion of her at the end of the shift, my reference point is from when I first had contact with her on the neonatal unit, from when she required ventilation support.
"I wasn't involved at her birth...I can't comment on her condition at the time. My writing [on the clinical notes] is based on what I had been told.
"It's my summary, but not my observations, if that makes sense."
11:42am
Mr Myers: "You will have known...she started grunting in theatre...reviewed after 1.5 hours, 'grunting but otherwise observations ok'."
Mr Myers asks if grunting can refer to respiratory effort difficulties.
Dr Rylance: "Yes it can."
11:45am
Dr Rylance says she is unable to recollect whether she saw Child D prior to her neonatal unit admission, but does not believe she was involved in the review to bring her to the unit.
She said: "From the point she came to the unit, these were my direct observations."
Mr Myers asks if Dr Rylance reviewed Child D at about 7.30pm.
Mr Myers: "She presents as a baby who is seriously ill?"
Dr Rylance: "Yes...at that point she was an unwell baby."
11:48am
Dr Rylance says she believes the first time she reviewed Child D was in the neonatal unit. Had she done so before, she would have noted that from a ward observation.
The venous gases taken at that time show 'marked acidosis', Mr Myers asks. Dr Rylance agrees.
Mr Myers: "You explained to us these were abnormal and indicate difficulty with the respiratory system and metabolic components?"
Dr Rylance: "Yes, that's correct."
Mr Myers says those readings are taking into account the clinical condition for Child D.
Dr Rylance: "Yes."
Mr Myers: "But at this stage, weighing up the clinical picture, it was not a good picture, was it?"
Dr Rylance: "No."
11:52am
Mr Myers said at one point, Dr Rylance had referred to the examination as being 'normal', but there was quite a lot of Child D being 'abnormal'.
Dr Rylance says Child D was "not a healthy baby at this point in time".
She says she is aware Child D was later put on to a ventilator.
Mr Myers says infection is a 'leading cause' in neonatal deaths and can 'develop very quickly'.
Dr Rylance: "It can."
"As a rule, antibiotics should be given to a neonatal baby...
"There are different guidelines on whether babies should receive antibiotics, with clinical risk factors.
"When you have concerns...then you want the antibiotics as soon as possible."
Mr Myers says Child D's mother had her waters break many hours before giving birth, and that Child D was, at birth, 'floppy' and at risk of collapse.
Dr Rylance agrees Child D should have received antibiotics at this stage.
She adds this is reliant on someone else's documentation, and it is difficult to say precisely how Child D was responding at that time.
She says it would have been a good idea to start antibiotics as quickly as could be done, and that was done upon her arrival at the neonatal unit.
11:55am
Mr Myers: "The reality is, from the point of collapse at 12 minutes...given everything we know, [the plan] would have been give antibiotics rapidly?"
"Yes, I think so."
Mr Myers says Child D was not given antibiotics until nearly four hours after birth, at the neonatal unit.
Dr Rylance agrees that would be the case.
"There was a four-hour delay in the delivery of antibiotics after birth?"
"Yes."
"You may not be responsible, but that falls below the standard of care for a new-born baby, doesn't it?"
"Yes."
"The purpose of antibiotics is to treat and reduce the risk of infection?"
"Yes."
12:00pm
Mr Myers refers to the blood gas readings on the afternoon of June 21.
Dr Rylance says there would have been a blood gas chart and the readings were presumably an improvement on what was previously taken.
Dr Rylance tells the court the intention was to insert a UVC and a UAC, "if it's possible to do so."
The court hears the 'UAC' inserted acted as a suitable UVC instead.
12:08pm
Mr Myers refers to the 'presumed sepsis CRP 1'.
He says the CRP reading increases from CRP 1 to CRP 6 later that night.
He says from those readings, they cannot diagnose infection on their own.
Dr Rylance: "Yes."
Mr Myers refers to an attempt to take Child D off CPAP by Dr Rylance, as noted, and an accompanying nursing note referring to the oxygen levels desaturating to the 80s.
He says "that is not a healthy state to be in, is it?"
"It reflects she needed more respiratory support, but the fact she had moved on from ventilator support, and needed no oxygen support, suggested it was improving.
"By trying to take her off CPAP, we wouldn't have done that if she wasn't stable.
"She didn't tolerate it, so we put her back on."
The improving clinical condition, Dr Rylance says, was from Child D arriving at the neonatal unit to her observation the following day.
Mr Myers says the 'satisfactory examination' of Child D was carried out while she was on CPAP.
Dr Rylance says a lumbar puncture is "quite an invasive" procedure and there is a risk of that being carried out if a baby is still on breathing support.
In Child D's case, it was "weighed up" and it was felt it was not needed to be done at that time.
12:09pm
Mr Myers said Dr Rylance had identified sepsis and acidosis "at various points" and during the time she was cared for, Child D required breathing support.
He says that when Child D was taken off CPAP, she began deteriorating.
Dr Rylance agrees.
Prosecution Re-Direct
12:13pm
The prosecution, led by Simon Driver, rises to clarify about the notes made for Child D following birth.
"As of your last review on 7pm on June 21, what was your assessment of her at that stage?"
"From what I documented, [Child D] was stable...with minimal respiratory support and no additional oxygen support.
"In handling, she was responsive and making good progress and making good response to treatments over the previous 24 hours.
"She was not a healthy baby at that time [due to still requiring CPAP], but...clinically she was stable and making a lot of progress."
LIVE: Lucy Letby trial, Tuesday, November 8
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 18 of Prosecution Evidence
Child D
Dr Sarah Rylance, Registrar @ CoCH, Neonatal, Long-Day Shifts 20th June 2015 and 21st June 2015
10:30am
The trial will resume shortly. Letby has arrived in court with a custody officer, as has been the case for each day of the trial.
10:41am
An interpreter will be required in court today, for an unusual reason.
The next doctor witness will be giving evidence from Switzerland, via videolink. Under Swiss law, the doctor's evidence will be coming from a court in Switzerland, and a French-speaking Swiss prosecutor will be present. What is said in Manchester, and the doctor's evidence, will be translated into French by the interpreter in the Swiss court for the benefit of the Swiss prosecutor.
10:46am
Through discussions between the two courts, it is now understood everyone in the Swiss court can understand English.
The judge in Manchester, Mr Justice Goss, has said the proceedings will carry on in English, and translation will only be required if there are either technical difficulties or the odd word which will require interpreting into French.
10:49am
Members of the jury have now come into court, and matters have been explained to them about the international videolink arrangement.
The next witness to give evidence is Dr Sarah Rylance.
10:54am
Dr Rylance confirms she was employed at the Countess at Chester Hospital as a registrar in June 2015, and worked a long day shift on June 20 that day.
She confirms she has the clinical notes for Child D to hand.
A reminder that, due to reporting restrictions, none of the children in this case can be identified.
11:03am
Dr Rylance says she does not believe she was present at the birth of Child D.
The details are recorded retrospectively, that Child D was born at 4.01pm on June 20.
The note includes: 'Bleeped again as midwife not happy with her colour' - she is not able to say whether that was her being bleeped again.
Child D 'looked dusky' and had 'poor respiratory [efforts]', with initial oxygen saturations at 48%, poor respiratory effort at 7.30pm.
The note adds 'transferred into incubator'.
After being given breathing assistance via Neopuff, Child D 'pinked up quickly and started regular resps'.
11:05am
The prosecution ask for what Child D would have been assessed as.
Dr Rylance: "She responded well to the ventilation support she has been given."
"In relation to the blood gases, it's difficult to assess how that reflects on her clinical condition."
The blood gases suggest Child D had difficulties with breathing and metabolism, but Dr Rylance said she would not use the blood gases alone to make a diagnosis, but take it into context with other readings and observations.
11:07am
Child D was 'transferred on to CPAP', and an IV saline solution was administered.
Child D was also started on 'triple lights' as part of phototherapy to treat her jaundice symptoms. That was the "maximum treatment" level, Dr Rylance, tells the court.
11:09am
Dr Rylance's notes, also record, for Child D at 8pm, the baby girl was on CPAP, 40% oxygen, and '[saturations] 100%'.
Child D's heart sounds were "normal", with an "ok" pulse rate, and it was noted there were regular breathing efforts, "but fairly shallow" and the abdomen was not distended.
The plan was to continue CPAP and administer dextrose, and repeat a blood gas test at 8.45pm.
11:12am
Dr Rylance's notes at 8.20pm record the parents were updated on Child D's condition, with "likely sepsis" and she was receiving antibiotics "to treat infection".
The doctor tells the court Child D's condition was, at this point, "responding well to interventions" and "appeared to be stabilised on the CPAP and making respiratory efforts."
"Overall I was happy with the the progress she had made, but she needed to be closely monitored and assessed."
11:18am
A further entry is made at June 21, 2pm, in the clinical notes.
The entry records the insertion of a UAC and UVC into Child D.
The UVC was removed as it was 'only able to advance to 5cm'. Dr Rylance says usually "you are expected to advance it much further.
"It can be difficult and fiddly to do this procedure in new-born babies."
The UAC was inserted to 20.5cm, but did not get a blood sample back. An x-ray review found it was advanced 'way too far', and the route was 'not typical of a UAC'.
The UAC "should follow a typical route", the court hears, and the line was pulled back to 9cm.
A blood gas reading was taken and the readings were 'much improved'.
A second x-ray showed the UAC position was 'better', but the route was 'still not typical'.
11:23am
The 'much improved' blood gas reading was, Dr Rylance believes, a comparison with the previous blood gas reading.
The UAC was 'actually a UVC' and adjusted to be used as a UVC.
The plan was to continue CPAP for Child D and repeat a blood gas reading, and 'try to sample UVC' for various readings.
A review is carried out at 7pm on June 21, with 'presumed sepsis' noted.
A CRP reading of 1 is recorded, having previously been 6.
Dr Rylance, commenting on those readings: "I wouldn't attach particular significance to it," as both readings were "low", and would need to be taken in context with the baby's clinical condition and observations.
11:25am
Child D had been on CPAP all day, but 'in air' and 'saturating well', with 'no desat[urations].'
The initial blood gases post-extubation at 9am were 'not good', so Child D was put back on to CPAP at 10.30am.
Dr Rylance said Child D had made good progress, and her ventilation status was "very satisfactory" at the time she reviewed her.
11:32am
Under the heading 'sepsis', the CRP reading was '1', and Child D had 'not had [lumbar puncture] yet.'
Such a test is done in clinically stable babies to test infection has not spread, the court hears, but Child D was 'not stable enough' for that to be carried out.
Other observations were noted by Dr Rylance that Child D was 'responsive on handling', with 'chest clear, regular resp effort, minimal recession', abdomen 'soft, not distended'.
The feet were 'quite purple', but Dr Rylance says that would be as a result of frequent tests carried out. The court has previously heard heel prick tests would be done to get results such as blood gas readings.
Dr Rylance added: "Overall my observations were that she was stable and handling well...and responding well to treatment she had received throughout the course of the day."
Under 'impressions', Dr Rylance noted: 'stable on CPAP, tried taking her off but resp effort became irregular and desaturated a few times so put back on'.
Dr Rylance said she would not have attached a lot of significance to this, as "it takes babies some time to settle. She was obviously unwell when she came to the neonatal unit the previous evening.
"She needed a bit more time from the CPAP...allow us to transition having been ventilated and moving to breathing.
"If they don't seem to tolerate it well, you can just put them back on [CPAP].
"She was heading in the right direction, she just needed a little support from the [CPAP] machine without added oxygen."
11:34am
The note added, as part of the plan, 'leave on CPAP, await CRP...leave UVC for now to allow sampling for gases, continue [antibiotics].'
Dr Rylance says she was "happy" with Child D's clinical condition, having had "a very satisfactory day" and was improving, in good colour, not needing oxygen support.
"She has shown good improvement from the condition when I first saw her on the neonatal unit the previous evening."
Cross-Examination
11:37am
Ben Myers KC, for Letby's defence, is now asking Dr Sarah Rylance questions.
He says there were two instances of her examining Child D.
He said that at the end of the June 20 examination, she was "happy with [Child D's] progress".
"Would you agree she was at risk of complications?"
Dr Rylance says Child D had responded well to treatment, but the blood gases were not in the normal range, and that would require close observation.
11:41am
Mr Myers points to Child D having 'lost colour' and 'floppy' when in her father's arms moments after birth.
"Do you agree that is worrying at that stage?"
Dr Rylance agrees the Apgar scores of 8/10 and 9/10 aren't relevant for 12 minutes later.
Mr Myers asks if the progress of Child D is based on the reference point from the worrying signs just after birth.
Dr Rylance: "My opinion of her at the end of the shift, my reference point is from when I first had contact with her on the neonatal unit, from when she required ventilation support.
"I wasn't involved at her birth...I can't comment on her condition at the time. My writing [on the clinical notes] is based on what I had been told.
"It's my summary, but not my observations, if that makes sense."
11:42am
Mr Myers: "You will have known...she started grunting in theatre...reviewed after 1.5 hours, 'grunting but otherwise observations ok'."
Mr Myers asks if grunting can refer to respiratory effort difficulties.
Dr Rylance: "Yes it can."
11:45am
Dr Rylance says she is unable to recollect whether she saw Child D prior to her neonatal unit admission, but does not believe she was involved in the review to bring her to the unit.
She said: "From the point she came to the unit, these were my direct observations."
Mr Myers asks if Dr Rylance reviewed Child D at about 7.30pm.
Mr Myers: "She presents as a baby who is seriously ill?"
Dr Rylance: "Yes...at that point she was an unwell baby."
11:48am
Dr Rylance says she believes the first time she reviewed Child D was in the neonatal unit. Had she done so before, she would have noted that from a ward observation.
The venous gases taken at that time show 'marked acidosis', Mr Myers asks. Dr Rylance agrees.
Mr Myers: "You explained to us these were abnormal and indicate difficulty with the respiratory system and metabolic components?"
Dr Rylance: "Yes, that's correct."
Mr Myers says those readings are taking into account the clinical condition for Child D.
Dr Rylance: "Yes."
Mr Myers: "But at this stage, weighing up the clinical picture, it was not a good picture, was it?"
Dr Rylance: "No."
11:52am
Mr Myers said at one point, Dr Rylance had referred to the examination as being 'normal', but there was quite a lot of Child D being 'abnormal'.
Dr Rylance says Child D was "not a healthy baby at this point in time".
She says she is aware Child D was later put on to a ventilator.
Mr Myers says infection is a 'leading cause' in neonatal deaths and can 'develop very quickly'.
Dr Rylance: "It can."
"As a rule, antibiotics should be given to a neonatal baby...
"There are different guidelines on whether babies should receive antibiotics, with clinical risk factors.
"When you have concerns...then you want the antibiotics as soon as possible."
Mr Myers says Child D's mother had her waters break many hours before giving birth, and that Child D was, at birth, 'floppy' and at risk of collapse.
Dr Rylance agrees Child D should have received antibiotics at this stage.
She adds this is reliant on someone else's documentation, and it is difficult to say precisely how Child D was responding at that time.
She says it would have been a good idea to start antibiotics as quickly as could be done, and that was done upon her arrival at the neonatal unit.
11:55am
Mr Myers: "The reality is, from the point of collapse at 12 minutes...given everything we know, [the plan] would have been give antibiotics rapidly?"
"Yes, I think so."
Mr Myers says Child D was not given antibiotics until nearly four hours after birth, at the neonatal unit.
Dr Rylance agrees that would be the case.
"There was a four-hour delay in the delivery of antibiotics after birth?"
"Yes."
"You may not be responsible, but that falls below the standard of care for a new-born baby, doesn't it?"
"Yes."
"The purpose of antibiotics is to treat and reduce the risk of infection?"
"Yes."
12:00pm
Mr Myers refers to the blood gas readings on the afternoon of June 21.
Dr Rylance says there would have been a blood gas chart and the readings were presumably an improvement on what was previously taken.
Dr Rylance tells the court the intention was to insert a UVC and a UAC, "if it's possible to do so."
The court hears the 'UAC' inserted acted as a suitable UVC instead.
12:08pm
Mr Myers refers to the 'presumed sepsis CRP 1'.
He says the CRP reading increases from CRP 1 to CRP 6 later that night.
He says from those readings, they cannot diagnose infection on their own.
Dr Rylance: "Yes."
Mr Myers refers to an attempt to take Child D off CPAP by Dr Rylance, as noted, and an accompanying nursing note referring to the oxygen levels desaturating to the 80s.
He says "that is not a healthy state to be in, is it?"
"It reflects she needed more respiratory support, but the fact she had moved on from ventilator support, and needed no oxygen support, suggested it was improving.
"By trying to take her off CPAP, we wouldn't have done that if she wasn't stable.
"She didn't tolerate it, so we put her back on."
The improving clinical condition, Dr Rylance says, was from Child D arriving at the neonatal unit to her observation the following day.
Mr Myers says the 'satisfactory examination' of Child D was carried out while she was on CPAP.
Dr Rylance says a lumbar puncture is "quite an invasive" procedure and there is a risk of that being carried out if a baby is still on breathing support.
In Child D's case, it was "weighed up" and it was felt it was not needed to be done at that time.
12:09pm
Mr Myers said Dr Rylance had identified sepsis and acidosis "at various points" and during the time she was cared for, Child D required breathing support.
He says that when Child D was taken off CPAP, she began deteriorating.
Dr Rylance agrees.
Prosecution Re-Direct
12:13pm
The prosecution, led by Simon Driver, rises to clarify about the notes made for Child D following birth.
"As of your last review on 7pm on June 21, what was your assessment of her at that stage?"
"From what I documented, [Child D] was stable...with minimal respiratory support and no additional oxygen support.
"In handling, she was responsive and making good progress and making good response to treatments over the previous 24 hours.
"She was not a healthy baby at that time [due to still requiring CPAP], but...clinically she was stable and making a lot of progress."
LIVE: Lucy Letby trial, Tuesday, November 8
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Tuesday November 8th 2022
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 18 of Prosecution Evidence
Child D
Dr Sarah Rylance, Registrar @ CoCH, Neonatal, Long-Day Shifts 20th June 2015 and 21st June 2015
Tweets
https://twitter.com/MrDanDonoghue
Lucy Letby's murder trial resumes at Manchester Crown Court this morning. Today we're hearing evidence from from colleagues in relation to the death of Child D in June 2015.
Imagine it'll be a fairly challenging morning technology wise. A witness is giving evidence via live link from Switzerland - there's an interpreter translating to French and back at that end. Already issues with an echo on the audio.
Another interpreter has just arrived in court in Manchester. Prosecution and judge currently debating how many are needed
It's now been settled that as everyone understands English, no interpreter is actually needed...
Jury now in court. We will soon be hearing evidence from consultant paediatrician Dr Sarah Rylance
Dr Rylance, who was a registrar at the Countess of Chester in 2015, is going over notes from the period. They show in the hours after Child D's birth she was 'bleeped' as a midwife was 'not happy' with the infant's colour. Notes show she needed respiratory support via neopuff.
Asked to assess her condition after respiratory and medicinal support, Dr Rylance said 'overall I was happy', adding: 'She had responded well to the interventions'
A note from 20:20 on June 20, made by Dr Rylance, stated: 'Parents updated. Explained likely sepsis, needing help with breathing on CPAP at present, she may need further support with ventilation, receiving antibiotics'
At 19:00 on June 21, the evening before Child D's death, Dr Rylance states in her clinical notes: 'Presumed sepsis'
Her 19:00 review of Child D also states that the infant had made good progress, and her ventilation status was 'very satisfactory'. Note states that the baby was 'responsive on handling' and there were 'no abnormal movements'
Asked for her opinion on Child D before she finished her shift that night, she said: 'I was clinically very happy with her'
(Cross-Examination)
Ms Letby's defence lawyer, Ben Myers KC, is now questioning Dr Rylance.
Mr Myers is taking Dr Rylance back over her notes from June 20. Notes show that at 12mins of age Child D was 'in Dad's arms, lost colour and floppy' He asks Dr Rylance is that is a worrying sign, 'yes' she says
Mr Myers summarises that Dr Rylance first reviews Child D three and half hours after her birth. He says this was a baby presenting as 'seriously ill'...Dr Rylance agrees, adding: 'She was an unwell baby'
Dr Rylance agrees with Mr Myers that infection is a leading cause of death among newborns...he asks if antibiotics should be given within an hour of birth if concerns.
Dr Rylance says there are differing guidelines, but as a 'general as soon as you have concerns then you would want to give antibiotics ASAP'
Mr Myers notes how there was 60 hours between Child D's mothers waters breaking and birth. That the infant was born 'floppy', that within 12 mins she was in a state of collapse. He asks Dr Rylance if, had she been there at that time, would she have given antibiotics immediately.
'Yes I think so', she responds
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 18 of Prosecution Evidence
Child D
Dr Sarah Rylance, Registrar @ CoCH, Neonatal, Long-Day Shifts 20th June 2015 and 21st June 2015
Tweets
https://twitter.com/MrDanDonoghue
Lucy Letby's murder trial resumes at Manchester Crown Court this morning. Today we're hearing evidence from from colleagues in relation to the death of Child D in June 2015.
Imagine it'll be a fairly challenging morning technology wise. A witness is giving evidence via live link from Switzerland - there's an interpreter translating to French and back at that end. Already issues with an echo on the audio.
Another interpreter has just arrived in court in Manchester. Prosecution and judge currently debating how many are needed
It's now been settled that as everyone understands English, no interpreter is actually needed...
Jury now in court. We will soon be hearing evidence from consultant paediatrician Dr Sarah Rylance
Dr Rylance, who was a registrar at the Countess of Chester in 2015, is going over notes from the period. They show in the hours after Child D's birth she was 'bleeped' as a midwife was 'not happy' with the infant's colour. Notes show she needed respiratory support via neopuff.
Asked to assess her condition after respiratory and medicinal support, Dr Rylance said 'overall I was happy', adding: 'She had responded well to the interventions'
A note from 20:20 on June 20, made by Dr Rylance, stated: 'Parents updated. Explained likely sepsis, needing help with breathing on CPAP at present, she may need further support with ventilation, receiving antibiotics'
At 19:00 on June 21, the evening before Child D's death, Dr Rylance states in her clinical notes: 'Presumed sepsis'
Her 19:00 review of Child D also states that the infant had made good progress, and her ventilation status was 'very satisfactory'. Note states that the baby was 'responsive on handling' and there were 'no abnormal movements'
Asked for her opinion on Child D before she finished her shift that night, she said: 'I was clinically very happy with her'
(Cross-Examination)
Ms Letby's defence lawyer, Ben Myers KC, is now questioning Dr Rylance.
Mr Myers is taking Dr Rylance back over her notes from June 20. Notes show that at 12mins of age Child D was 'in Dad's arms, lost colour and floppy' He asks Dr Rylance is that is a worrying sign, 'yes' she says
Mr Myers summarises that Dr Rylance first reviews Child D three and half hours after her birth. He says this was a baby presenting as 'seriously ill'...Dr Rylance agrees, adding: 'She was an unwell baby'
Dr Rylance agrees with Mr Myers that infection is a leading cause of death among newborns...he asks if antibiotics should be given within an hour of birth if concerns.
Dr Rylance says there are differing guidelines, but as a 'general as soon as you have concerns then you would want to give antibiotics ASAP'
Mr Myers notes how there was 60 hours between Child D's mothers waters breaking and birth. That the infant was born 'floppy', that within 12 mins she was in a state of collapse. He asks Dr Rylance if, had she been there at that time, would she have given antibiotics immediately.
'Yes I think so', she responds