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Monday November 14th 2022 -


Day 21 of Prosecution Evidence

Twins : Child E & Child F


Mother's Evidence

Tweets



I'm back at the Lucy Letby trial in Manchester. The court is now hearing evidence from the mother of identical twin boys. Nurse Letby is accused of murdering one of the twin boys (baby E) and attempting to murder the other (baby F). We cannot identify the family for legal reasons

The twins were born at the end of July 2015. They were on the neonatal unit at @TheCountessNHS and their mum was an inpatient on the postnatal ward.

The twins' mum says that they were progressing really well in the days after their birth. They were born at 29 weeks, but she says they were thriving: "We were absolutely thrilled that both boys were doing so well. I was just absolutely over the moon. My two boys were perfect"

Court hears that on the evening of the babies' 5th day, their mum came down to the neonatal ward to bring breast milk which she'd expressed for them to be fed with...

As she came along the corridor she could hear screaming.. She says "I could hear my son crying, and it was like nothing I’d heard before, and I walked over to the incubator to see that he had blood coming out of his mouth and I panicked.. I felt that there was something wrong"

The twins' mum says "It was a sound that shouldn’t have come from a tiny baby. I can’t explain what it was - it was horrendous. It was more of a scream than a cry".

The twins' mum says that her son (baby E) had blood around his mouth. She says that Lucy Letby was the only person in the room with the babies but was not by the incubator - she was standing at the workstation.

Baby E's mum says she asked Lucy Letby what was wrong with her son. Nurse Letby told her that the feed tube from the back of his tube had been rubbing and had caused the blood.

Prosecution: Did you accept that explanation?
Mum of baby E: Yes
Pros: Were you concerned about the explanation?
Mum: Yes
Pros: Did Lucy Letby say anything else to you?
Mum: She told me to go back to the ward.
Pros: - Did you do what you were told by Lucy Letby?
Mum of baby E: Yes
Pros: Why did you do what you were told by her?
Mum: Because she was an authority and she knew better than me and I trusted her completely.

The court hears that a midwife came to get her from the postnatal ward, and when she got back to the neonatal unit she saw that baby E was being worked on by medics who were trying to resuscitate him. They were unsuccessful.

Baby E's mum says that after baby E died "I was asked if I would like to bath him and at that moment I didn’t feel that I was able to. I was just broken, and I couldn’t, so Lucy Letby bathed him in front of me in the neonatal unit"

Baby E's mum says that after he died "Lucy Letby gave us a memory box, which totally surprised me.. it had footprints, a lock of his hair, a candle, a teddy. I was so overcome by emotions that this had been provided for me as I had no other memories other than that".



I'm back at Manchester Crown Court for the murder trial of nurse Lucy Letby. We're expecting to hear evidence from the parents of Child E this morning

The mother of twins Child E and F is now giving evidence. She tells the court her sons, despite being born premature, were in 'good condition for the gestation they were in' at birth

The mother tells the court that in the days after their birth there was discussion about moving the boys to a hospital closer to home, she says 'I was under the impression both my boys were well enough to travel'

She says both babies were off respiratory support and were breathing 'great' in early August 2015. She said: 'They were doing really well...we were absolutely thrilled that both boys were doing so well. We couldn't have asked for anymore than that'

The mother is now telling the jury about the events of an evening in early August 2015. She said she went up to the post-natal ward to express breast milk 'between 7pm and 8.30pm'. She then took the expressed breast milk 'straight down' to the neonatal unit where her twins were

She said she arrived on the unit to find nurse Lucy Letby in there with her two sons. 'I could hear my son crying. I walked over to the incubator to see he had blood coming out of his mouth', she said

'I panicked, I was panicking, I felt like there was something wrong', she said. The mother tells the court that Ms Letby was stood at a work station between the two incubators where her sons were

The mother says Child E's crying 'was a sound that shouldn’t have come from a tiny baby'. 'I can’t explain what that sound was, it was horrendous'

The mother asked Ms Letby what was wrong. The nurse is said to have told her that Child E's feeding tube had rubbed and caused the bleeding, she told the mum to go back to the postnatal ward and told her a registrar was on the way and she would be called if there was a problem

She told the court that she went back to the postnatal ward and called her husband. 'I knew there was something very wrong', she said

The mother has told the court how she went back down to the neonatal later that evening to find medics desperately trying to resuscitate Child E - who sadly did not recover

In the hours afterward, the mother has told the court that Ms Letby 'bathed Child E in front of me...I couldn’t, I was broken. After he was bathed, he was placed in a white gown, I just remember being thankful because we had no clothes for him because he was so little'
 
Monday November 14th 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 21 of Prosecution Evidence

Twins : Child E & Child F


Mother's Cross-Examination

11:32am

Ben Myers KC, for Letby's defence, expresses his sympathy for what the mum has gone through, and says that nothing he says will seek to minimise anything the mum did in caring for her twins.
The mum confirms these were her first babies.

11:34am

The mum is asked if any of the times she said to the court were not correct, on her recollection, given she made a statement to police two years after the events.
The mum confirms the time she went to the neo-natal unit on August 3, 2015 was correct.

11:35am

Mr Myers suggests the mum went down at about 8pm, at the time of the hand-over, and went down at about 10pm with the breast milk, and went again when Child E was being resuscitated.
The mum says she "absolutely" disagrees with that.

11:37am

Mr Myers says, for that supposed 9pm time, the observations were the screaming and the blood coming out of Child E's mouth. The mum agrees.
Mr Myers asks, for the crying, there were other staff about at the time.
"At no other time did any other staff come into the room, did they?"
"No."

11:39am

Mr Myers suggests the screaming was "not as bad as that [horrendous]."
The mum says it was horrendous.
Mr Myers asks about the blood seen.
The mum says, other than around the chin, the other blood seen was above the lip, and no blood anywhere else, and the blood was "not coming out" or "going on the bedding".

11:42am

The mum agrees with her statement the blood was "not fresh".
The mum says, and nods, it was blood.
Mr Myers asks about the midwife seen. The mum says this was the first time she had seen this midwife, as there had been others seen, and she was "distraught".
She said she was "distraught" and "knew there was something very wrong".
She confirms the first name of the midwife, when asked by Mr Myers if the midwife was "Susan Brooks".

11:45am

The mum said she told her husband "there was something very wrong", cannot remember telling the midwife that, but said she was very upset at the time.
Mr Myers says, for the 10.52pm phone call, she mentioned to her husband about the blood coming out of Child E.
The mum says she does not remember the 10.52pm phone call as the midwife got in contact with the husband.
Mr Myers suggests the mum was not as worried at the 9.11pm phone call as she was at 10.52pm.
The mum says she disagrees with that.

11:48am

Mr Myers says he suggests the mum went with the breast milk as 'late as 10pm', that Lucy Letby never mentioned the tube was 'irritating Child E'.
The mum disagrees with both those suggestions.
The mum says she did not see anyone else at 9pm when she went to the unit.
Mr Myers asks if there was a conversation between Letby, a doctor, and her, regarding medication.
The mum says she disagrees, and said she was told by Letby the registrar 'would be down [to the neonatal unit room]', but did not make an appearance.

11:49am

Mr Myers asks about the resuscitation attempt. The mum says she could not see what was going on, other than several medical staff being present at the time.
The mum says she is now aware there are bereavement procedures, such as memory boxes.

11:50am

Mr Myers asks about the discussion with the post-mortem was with a female doctor. He asks if it was because there was 'little point' in having one, according to the doctor.
The mum says she felt 'persuaded' not to have one in that case.

Prosecution Re-Direct


11:54am

The mum is asked, by Nicholas Johnson KC, about the appearance of the blood on Child E. It was "stained - not dripping, smudged. It didn't look completely dry, but it was darker."
She says it is "really hard to explain" the colour. It was "not bright red, it was darker than that. I don't know how else to explain that."

11:54am

That completes the mum's evidence.

LIVE: Lucy Letby trial, Monday, November 14

--------------------------------------------------------------------------------------------------------------------

Tweets


Ms Letby's defence lawyer Ben Myers KC is now cross examining the mother - he puts it to her that Ms Letby never told her that blood around Child E's mouth had been caused by a feeding tube. The mother rejects this



Lucy Letby's defence barrister Ben Myers KC is cross-examining baby E's mum. He suggests that baby E wasn't upset to the degree she's described. Baby E's mum: "It was horrendous". BM KC: "I suggest it wasn’t as horrendous as you were saying".
 
Monday November 14th 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 21 of Prosecution Evidence

Twins : Child E & Child F


Father's Evidence


12:09pm

The father of Child E and Child F is now giving evidence.

12:14pm

He confirms the birth date for Child E and Child F.
Mr Johnson asks about the progress on their twins.
The father says he was "very happy" with the twins' progress before the phone call on August 3, they were doing "good".
He confirms he had gone home on the evening of August 3, and then received a phone call from his wife that night.
He tells the court the phone call he received from his wife at 9.11pm, who was "upset and very worried" about the bleeding from the baby's mouth.
He said he was sure the medical staff knew what they were doing, and she was panicking over nothing.
The second phone call was split between the midwife and his wife. He was told: "Don't panic, but get over here now."
Mr Myers asks if the bleeding was referred to at the 10.52pm phone call, rather than 9.11pm. The father replies it was not; that was referred to in the 9.11pm phone call.

12:16pm

That completes the father's evidence.


www.chesterstandard.co.uk

Recap: Lucy Letby trial, Monday, November 14

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
www.chesterstandard.co.uk www.chesterstandard.co.uk



Tweets



Very brief evidence from Child E's father as the court only sought to confirm the time of the phone calls he made to his wife on that evening
 
Monday November 14th 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 21 of Prosecution Evidence

Twins : Child E & Child F


Claire Hocknell, Police Intelligence Analyst, electronic evidence


12:16pm

Nicholas Johnson KC says the court will now go through the sequence of events, with intelligence analyst Claire Hocknell directing the jury through the electronic evidence bundle for Child E and Child F.

A reminder the jury have access to the evidence in this case on iPads, rather than the traditional paper bundles.

12:19pm

The first evidence refers to text messages sent to and from Lucy Letby's phone on July 27, asking if Letby, on her time off, will be back in time for a debrief regarding the death of Child A. Letby says she will be looking to get back in time for that.

12:21pm

Child E was 1.327kg at birth (2lb 14oz), with APGAR scores of 7/10 at 1 minute and 9/10 at five minutes (APGAR scores recording how well a baby is presenting in the minutes after birth).
Clinical notes refer to the admission of the twins to the neonatal unit.

12:27pm

The debrief for Child A takes place on July 30, with Letby having confirmed her attendance in a text message prior.
Letby is then the designated nurse for Child F on the night shift of August 1 and August 2. Melanie Taylor was the designated nurse for Child E on the night of August 2.
Melanie Taylor's notes record for Child E for that night shift: "Self ventilating in 24% oxygen, resps 6-70, minimal recession evident."

12:31pm

A message sent from nursing colleague Jennifer Jones-Key to Lucy Letby at 10.34pm on August 2 says: "Hope work ok".
Letby replies: "...yeah it's fine, bit too Q word really."
The reply: "Don't complain as Wed and Thurs horrible lol! It will pick up again."

12:37pm

The court is shown further nursing notes by Melanie Taylor recording two Brady desats (slow heart rate) at the early hours of August 3, requiring 'gentle stimulation' to correct. One of the Bradys is recorded as lasting 45 seconds.
Child E's tummy was 'soft, not distended', had satisfactory blood gas readings and heart/respiratory rate, and fluids were being administered. The bowels were not yet opened.

12:40pm

Melanie Taylor's notes at the end of the night shift said 'feeds tolerated, tummy remains soft'.
A family communication note is also made by the nurse.
"Mum and dad visiting at start of shift, mum has been 2x with [expressed breast milk] overnight."

12:43pm

A 'Kangaroo care record' is presented to the court, documenting the times when the parents were able to have physical contact for Child E, and how long it lasted, and how well it was tolerated.
A nurse's record notes for that day that mum 'had long periods of skin to skin [contact]'.

12:48pm

The note records, at 10.44am, Child E was 'self ventilating in 25% ambient oxygen. No signs of respiratory distress...pink and well perfused....handles well. Caffeine given as prescribed.'
A doctor's note at 11.45am on August 3 records Child E has 'suspected sepsis', 'hyperglycaemia', and was 'off lights' for jaundice, with 'good gases'.
Child E was 'tolerating well' expressed breast milk.
The baby boy was 'not examined at present as having cuddles with mum'.
The plan was to 'examine later' and increase feeds.
Aspirates were 'ok'.

12:50pm

Dr Emily Thomas made clinical notes at 2.10pm on August, noting: 'examination of [Child E] as having skin to skin on [ward round earlier that day]. Good tone and movements, handling appropriately throughout the day.'

12:56pm

Child E was placed on a small dose of insulin, given via infusion.


12:58pm

A nursing note at 5.24pm said Child E was 'self ventilating in air', blood gas reading was 'satisfactory', and feeds were increased.

1:00pm

At 7.30pm, Dr Emily Thomas made clinical notes, with a CRP reading less than 1, Child E was on 23% oxygen, and antibiotics were 'likely to stop at 36 hours as improving'.
A series of other observations are made.

LIVE: Lucy Letby trial, Monday, November 14
 
Monday November 14th 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 21 of Prosecution Evidence

Twins : Child E & Child F


Claire Hocknell, Police Intelligence Analyst, electronic evidence continued

2:07pm

The trial is now resuming, following a lunch break.

2:10pm

A shift handover for August 3, 2015, the night shift, is shown to the court. Letby is named as a designated nurse.
Letby is the designated nurse for both Child E and Child F in nursery room 1 that night.
The list shows three babies in room 2, one in room 3, and four in room 4. There is also a baby in the transitional care unit.

2:12pm

Letby's note for 8pm at August 3 is written, written at 4.51am retrospectively, to say: "Mummy was present at start of shift attending to cares."

2:16pm

A further Letby note reads: 'Prior to 9pm feed, 16ml 'mucky' slightly bile stained aspirate' recorded for Child E.
The neonatal fluid chart for the 9pm column records, under milk feeds, 'omitted', and the word 'discarded' is in a non-specific line. For aspirates, the note '16ml mucky' is made.
To the right of that, at the 10pm column, is '15ml fresh blood' on aspirates.
The two columns for that chart are signed by Lucy Letby's initials.

2:17pm

The phone records showing the calls made from Child E and Child F's mum to the father are also shown, including calls at 9.11pm and 10.52pm.

2:19pm

An observation chart is shown for Child E.
The 'cares' row has one tick, recorded at 7pm, signed by Letby's colleague from the day shift.

2:25pm

Dr David Harkness records readings from 9.40pm, written at 10.10pm, 'asked to see patient re: gastric bleed'.
'Large, very slightly bile-stained aspirate 30 mins ago.'
14ml of blood vomit is also recorded.
Letby records: "At 10pm large vomit of fresh blood. 14ml fresh blood aspirate obtained from NG tube. Reg Harkness attended. Blood gas satisfactory..."
Child E was 'handling well'.
Letby's further note: 'Mum visited again approx 10pm. Aware that we had obtained blood from his NG tube and were starting [treatment]...'
Dr Harkness noted Child E was 'alert, pink, well perfused', with an abdomen which was 'soft, not distended' and no bowel sounds.
The note adds 'G I [gastrointestinal] bleed ? Cause'

2:28pm

A neonatal fluid balance chart is shown to the court, with no name or notes for the 11pm column.
Letby's retrospective nursing notes said: 'NG tube on free drainage. Further 13mls blood obtained by 11pm. Beginning to desaturate and perfusion poor. Oxygen given via Neopuff'.
Child E was said by Letby to be 'cold to the touch' and was beginning to 'decline'.
Dr Harkness noted '13ml blood-stained fluid from NGT on free drainage.'
Child E's blood pressure was 'stable' and saturates' remained 60-70%', and 'making good respiratory effort', and was 'crying'.
A plan of action, including x-rays and medication, was made.

2:30pm

A note for 11.30pm on the observation chart has no record of a heart rate made, and blank readings for cot temperature, and no initials recorded. Blood pressure and respiratory rate are recorded.

2:33pm

Child E then collapsed at about 11.40pm.
Letby recorded, retrospectively: "11.40pm became Bradycardiac, purple band of discolouration over abdomen, perfusion poor, CRT 3secs.
"Emergency intubation successful and placed on ventilator..."
Dr Harkness records, in clinical notes at this time, written retrospectively, 'Sudden deterioration at 11.40pm, brady 80-90bpm, sats 60%, poor perfusion, colour change over abdomen purple discoloured patches'.
The note adds, after an improvement in sats, 'purple discolouration in abdomen remained', and a plan of action noted for Child E.

2:35pm

Further notes by Letby: 'Required 100% oxygen, saturations 80%, SIMV 22/5 rate 60. Further saline bolus and morphine bolus given. 2nd peripheral line sited..."
"Once [Child E] began to deteriorate, midwifery staff were contacted."
The latter note is written, retrospectively, at 4.51am.

2:41pm

A further observation reading for Child E, made by Letby, is taken at 12.15am, with a heart rate 'down from where it had been earlier', and a drop in temperature, recording he was on 100% oxygen.
A consultant paediatrician arrives at the neonatal unit at 12.25am.
An x-ray is taken at 12.27am, relating to the chest and abdomen.
A further, 'acute deterioration' for Child E, is noted by Letby at 12.36am. 'Resus commenced as documented'.
The consultant paediatrician noted CPR commenced, along with ventilations, and medications.

2:48pm

A blood transfusion is started for Child E at 12.50am, and several adrenaline doses are administered.
Letby's note, for 1.01am, reads 'chest compressions no longer required'.
For 1.15am, Letby notes 'further decline, resus recommenced'.
CPR was discontinued at 1.23am - 'resus discontinued when [Child E] was given to parents. [Child E] was actively bleeding...'
The time of death was recorded as 1.40am on August 4.

2:50pm

Letby's note: 'both parents present during the resus. Fully updated by nursing and medical team throughout. Parents wished for [Child E] to be baptised....
'Child E was bathed by myself and photographs taken as requested, both were present during this. Consent obtained for [hair] and hand/footprints...
'Both distraught...'

2:52pm

The official documented report for the incident is made by Letby - 'unexpected death following gastrointestinal bleed. Full resus unsuccessful'.

2:54pm

A 'checklist for staff following neonatal death' is presented to the court, for Child E.
It records what levels of 'emotional support' were offered to the parents.
Letby noted at 8.21am 'Parents resident on unit overnight. Wish to be left alone'.

3:14pm

A series of text messages to and from Letby's phone are shown to the court.

3:17pm

Ben Myers KC asks to clarify that the nursing notes made, which have been gone through in 'broken up parts' in the sequence of events, are actually made of larger notes. The intelligence analyst agrees.
Mr Myers also refers to the sequence of events showing Letby searched for the mum of Child E and Child F several times on Facebook in the weeks and months after Child E died. He asks if it is correct Letby also searched for the names of parents who are not part of this case. The intelligence analyst agrees.

3:31pm

The text message sent from a colleague of Letby to Letby's phone at 8.58am on August 4 says: "You ok? Just heard about [Child E]. Did you have him? Sending hugs xx"
Letby responds: "News travels fast - who told you? Yeah I had them both, was horrible."
The colleague responded that she had been informed by someone at the handover 'told me just now'. 'Had he been getting poorly or was it sudden?'
Letby responds Child E had a 'massive gastrointestinal haemorrhage'.
The colleague said Child E 'had always struggled feeding'.
Letby responds that Child E was 'IUGR [Intrauterine growth restriction] and REDF [Reversal of umbilical artery end-diastolic flow]' and believed Child E was 'high risk'.
She added: "I feel numb".

3:38pm

At 7.55pm, Jennifer Jones-Key messaged Lucy Letby: "Hey how's you?"
Letby responds: "Not so good, we lost [Child E] overnight."
The response: "That is sad. You are on a terrible run at the moment. Were you in [room] 1?"
Letby: "I had him and [Child F]"
Ms Jones-Key: "That is not good, you need a break..."
Letby: "It's the luck of the draw...unfortunately."
Ms Jones-Key: "You do seem to be having some very bad luck..."
Letby: "Not a lot I can do really - he had a massive haemorrhage, could have happened to any baby really."
Ms Jones-Key says Letby "did everything you could", adding she had seen a haemorrhage in babies before, and was 'horrible' to see.
Letby replies: "This was abdominal", and she had previously only seen pulmonary.

3:44pm

On August 9, at 10.17pm, Letby messages a colleague saying she had said goodbye to the parents of Child E and Child F, and said they had cried and both hugged her, saying they would never forget the care the staff provided.
The colleague responds: "It's heartbreaking, but you have done your job to the highest standard with compassion and professionalism."
The colleague added: "You should feel very proud of yourself."
Letby responded she felt sad after what had happened.
The colleague adds: "They know everything possible was done" and was in Child E's "best interests".

3:50pm

The court is shown evidence that Letby searched for the mum and dad of Child E and Child F on Facebook nine times in the following months, the vast majority for the mother. The first of the searches was on August 6 at 7.58pm, and one of the searches is at 11.26pm on December 25.
The final two searches were made in January 2016, the last on January 10 at 11.03pm.

4:21pm

A round-up story from today's coverage, as the mum of Child E and Child F fought back tears as she gave evidence in court: Lucy Letby trial: Mother 'completely trusted' nurse to care for 'screaming' son

5:00pm

The trial has adjourned for today.
We will continue to provide live coverage of the case tomorrow (Tuesday, November 15).

Recap: Lucy Letby trial, Monday, November 14
 
Monday November 14th 2022 -


Day 21 of Prosecution Evidence

Twins : Child E & Child F


Claire Hocknell, Police Intelligence Analyst, electronic evidence


Tweets




Intelligence analyst Claire Hocknell is now talking the jury through sequencing evidence for Child E and F

We're back now....intelligence analyst Claire Hocknell is continuing to talk the jury through the sequence of events leading up to Child E's death. We're being shown oxygen levels/nursing observation notes from the evening before his death

Ms Letby recorded that Child E was 'handling well'. One note from Ms Letby stated: 'Mum visited again approx 10pm. Aware that we had obtained blood from his NG tube and were starting [treatment]' Note says mum 'would be contacted' if condition changed

A retrospective note made by Ms Letby for 23:40 states that Child E 'began to decline', he 'became bradycardiac' and a 'purple band of discolouration' was seen on his abdomen

A note made by Letby, for 12.15am, states Child E's heart rate was 'down from where it had been earlier'. Shortly after 12.30am Child E was placed on breathing support and given medicat after resuscitation. Shortly before 1.30am resus was needed again, but was sadly unsuccessful

Ms Letby's notes recorded after Child E's death state 'parents wished for (Child E) to be baptised, Chaplin attended and carried out baptism and supported parents. Mum and dad held (Child E) hand as he passed away'

Jury now being shown text messages sent between Ms Letby and colleagues on the morning after Child E's death. Ms Letby to a former colleague, who cannot be named for legal reasons, says she felt 'numb'

When her former colleague says 'you seem to be having some very bad luck' Ms Letby replies: 'Not a lot I can do really he had a massive haemorrhage, could have happened to any baby x'

The court has just been shown data from Ms Letby's social media which shows the nurse carried out a number of searches for the mother of Child E in the weeks and months that followed the infant's death - one such search was carried out at 23:26 on Christmas Day 2015

Court has now adjourned for today, back tomorrow
 
"Ben Myers KC, defending, said: “What happened that night, it must have been very intense and very upsetting?”
“Yes,” replied the witness.
Mr Myers said: “I am suggesting there were three times you went down that evening.
“I am going to suggest you went down about 8pm… then actually it’s nearer to 10pm – rather than 9pm – when you went down with the breast milk. And you then went back again when (Child E) was being resuscitated at about 11pm.
“Do you disagree with that?”
Child E’s mother said: “Absolutely.”
Mr Myers went on: “I am not going to suggest that (Child E) was not upset when you went down. I am going to suggest he was not as upset to the degree you described. It was not as bad as that?”
The witness replied: “ It was horrendous.”
Mr Myers said: “You said what you saw was blood. Is it possible what you saw was some sort of dark liquid with flecks of material – aspirates?
Child E’s mother said: “It was blood.”
Mr Myers said: “I suggest to you that there was no time that Miss Letby said the tube was irritating (Child E)?
The witness said: “I disagree.”

10% - Express and Star Mother ‘completely trusted’ nurse when she left ‘screaming’ son in her care
 
Baby E

Colleagues of Lucy Letby told her she was 'terrible run of bad luck'

Video of Neonatal Unit in article.

(More details of texts at link)

"Ms Jones-Key said: 'That’s sad. You’re on a terrible run at the moment. Were you in Room 1?'

Letby replied: 'I had him and [Baby] F'.

Expressing sympathy, Ms Jones-Key then said: 'That’s not good. You need a break from it being on your shift'.

Letby replied: 'It’s the luck of the draw unfortunately…Only three trained (nurses), so I ended up having them both'.

Her colleague responded: 'You seem to be having some very bad luck though'.

Letby then said: 'Not a lot I could do really. He had a massive haemorrhage. It could happen to any baby really'.
 
Tuesday November 15th 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 22 of Prosecution Evidence

(Twin) Child E


Susan Brookes, Midwife, CoCH, night shift 3rd/4th August 2015, Witness Statement

10:52am

Members of the jury are now coming into court, and the trial will resume.

10:53am

The judge, Mr Justice James Goss, says "travel difficulties" have caused the delay this morning for the court.

11:01am

Agreed evidence is now being read out by prosecutor Simon Driver.
A statement by Susan Brookes is read out, dated April 2, 2019. She was a registered midwife at the Countess of Chester Hospital in August 2015.
She said there would have been two midwives working that night shift.
She said her responsibilities included making sure the mother was well and providing emotional support when needed.
Her 'midwife notes' are presented to the court, showing the mum of Child E was 'post-natal well', and one of the twins had 'deteriorated slightly'.
At 11.30pm on August 3 she had a call from the neonatal unit to ask Child E's mother to go down in 30 minutes as Child E had a bleed and required intubating - 'very poorly'.
She said the mum was very upset and she thought the 30-minute was 'unreasonable' and asked to go sooner.
At midnight, the midwife stayed with Child E's mother for 10 minutes in the corridor outside the neonatal nursery room where Child E and Child F were, and the mum was eventually allowed in once medical staff had stabilised Child E.

LIVE: Lucy Letby trial, Tuesday, November 15
 
Tuesday November 15th 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 22 of Prosecution Evidence

(Twin) Child E


Dr Christopher Wood, Senior House Officer (SHO), CoCH, night shift 3rd/4th August 2015

11:05am

Dr Christopher Wood has now been called to give evidence.
He confirms that in August 2015, he was on a four-month trainee placement at the Countess of Chester Hospital, as part of his GP training, and was present at the birth of Child E and Child F.
After assisting with the delivery, he did not have contact with the twin boys until the night of August 3-4.
He said he was on call, primarily on the paediatric unit as it was an area where he was "more comfortable", but would be called to the neonatal unit if needed.
He was the more junior doctor to the other one present that night, Dr David Harkness.

11:07am

He said he was called to the neonatal unit as part of a crash call, having been in the doctors room in the paediatric unit, writing up notes.

11:13am

He says he didn't recall being on the neonatal unit that night, prior to the crash call at 11.40pm.
He confirms signing for a prescription of morphine bolus for Child E.
Dr Wood says he would have had very little experience of intubating babies, so he would have done the prescription as a formality.
The accompanying medical note by Dr Wood says 'Sats 60-70%
'Morphine bolus - sats improved to 80%'.
He recalls he immediately attended upon notification of the crash call.
He said a number of people were ready, and resuscitation attempts had already begun upon his arrival.
He said the best thing to do was do other jobs while more experienced members of the team did more specialised aspects of the resusciation.
He recorded notes and made sure things weren't missed.

11:20am

Dr Wood had made a note of staff present during the resuscitation - a team of six, including himself, Dr Harkness, a further doctor, and three senior nurses including Lucy Letby.
Clinical notes made by Dr Wood record the efforts to resuscitate Child E from 12.37am. Five doses of adrenaline are administered during the efforts.
While chest compressions stop at 1.01am, with ventilations continuing, Child E's heart rate fell again at 1.15am and CPR recommenced.
At 1.23am, CPR stopped and Child E was cleaned.
At 1.24am, ventilation [efforts] stopped and Child E was given to the parents.

11:24am

A pathology report is shown to the court, showing Child E with 'relevant clinical details: GI bleed'.
Dr Wood says he cannot recall details surrounding this.

Cross-Examination

Ben Myers KC, for Letby's defence, says Dr Wood was split between the paediatric and neonatal wards.
He says Dr Wood had 'very little experience with neonates'. Dr Wood agrees.
Mr Myers asks if this was Dr Wood's last night shift with the Countess. Dr Wood says he believes the following night was his last one.

11:27am

Mr Myers says if you lose a significant quantity of blood from a neonate, that would be different from an adult losing a significant quantity of blood, as there could be time to 'seal a gastric bleed' in an adult. Dr Wood agrees.
A clinical note is shown with 'plan - discuss with surgeons, with x-rays'.
Mr Myers asks if Dr Wood was aware surgeons were at the Countess of Chester Hospital who were capable of performing gastric surgery on neonates of the size of Child E.
Dr Wood: "I'm not aware of that. I would imagine most [likely] this would be Alder Hey [Hospital in Liverpool]."

11:28am

Mr Myers says, for the birth, there were 'potential complications' for the twins. Dr Wood agrees.
Mr Myers says the doctors for the neonatal unit were shared with the maternity and paediatric units, and their duties were split.
Dr Wood says that was the case, but the doctors would normally be assigned a specific unit per shift.

11:31am

Mr Myers refers to the night of August 3.
Dr Wood confirms he was the only senior health officer covering paediatrics and the neonatal unit, with Dr Harkness the only registrar covering those units that night.
Mr Myers asks if Dr Wood recalls at 9-10pm, receiving a report of a bile-stained aspiration on the neonatal unit.
Dr Wood says he doesn't recall - he doesn't remember.
Mr Myers asks if doctors would receive news of such reports from the neonatal unit.
Dr Wood says he probably would not have received a call from the registrar to him about it.
He adds he was on the paediatric unit by himself, and it was his understanding that, therefore, Dr Harkness would have been on the neonatal unit 'at some point during the evening'.

Prosecution Re-Direct

11:34am

Mr Driver rises to ask about the bile-stained aspirate via a phone call. He asks in Dr Wood's capacity as a GP trainee, if he had received any data/information about a neonatal unit patient, what he would have done.
He replies if he had received a call from a nurse, he would have taken action, and if it was from a registrar, it would have most likely been out of courtesy.
In the former case, he would have recorded it in his notes and would have sought advice from the registrar.

LIVE: Lucy Letby trial, Tuesday, November 15
 
Tuesday November 15th 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 22 of Prosecution Evidence

(Twin) Child E


Unnamed Nurse, CoCH, Designated Nurse for Twins E and F, Day Shift 3rd August 2015

11:59am

The trial has had a short adjournment, and is now resuming.
The next witness to give evidence is a nurse who cannot be named due to reporting restrictions.

12:01pm

The Countess of Chester Hospital neonatal nurse has previously given evidence earlier in the trial.
She has returned to give evidence in the case of Child E.

12:08pm

She confirms she was the designated nurse for Child E during the day of August 3 (8am-8pm), as well as the designated nurse for Child F.
She made a note at 10.42am, regarding family communication: 'mum on unit from 9am onwards, fully updated by myself and reg. Had long periods of skin-to-skin.'
The nurse said she recalled the skin-to-skin contact, and during this shift, Child F was unable to have a 'cuddle', but 'containment holding' instead.
Child F remained on CPAP (a level of respiratory support), and was not as stable.
Child E was breathing by himself, requiring a little supplementary oxygen, and therefore 'could have as many cuddles as they [the mum and Child E] wanted'.

12:15pm

Child E was, in the nurse's 10.50am 'top to toe' clinical note: 'self ventilating in 25% ambient oxygen, no signs of respiratory distress. Heart rate and temperature stable. Pink and well perfused. Cap refill 1 second'.
The observations were 'normal'.
The nurse added the fluids which were being provided, via a longline infusion.
Child E was on a 'cautious feeding regime', based on guidelines in the neonatal unit.
Child E, it was also noted, 'handles well'.

12:17pm

A 'minimal to 1ml partially digested milk' was obtained from the NGT aspirates, which the nurse says was normal, and was a sign Child E was digesting the milk being fed.

12:24pm

The nurse's addendum is made, retrospectively, at 5.24pm that day.
A CRP reading was 'less than 1', which the nurse explains any reading of less than 10 is 'a good sign'.
The antibiotics would 'be reviewed at 36 hours [treatment]'.
The blood cultures were 'currently negative' - in absence of bacteria.
Child E remained self ventilating in air, with 'satisfactory' blood gas readings.
The nurse says Child E had a blood sugar reading of 18.5mmols, which was "too high".
A doctor was informed and insulin was 're-commenced t a rate of 0.02/units/kg/hr'.
Feeds were increased as Child E was 'tolerating his feeds'.
The court hears a 'PKU' was taken with parental consent, which was a neonatal blood screening taken from every baby at about Child E's age [if the parents agree], looking for various potential [inherited] conditions, with results to follow.

12:29pm

An observation chart is shown for Child E, from 6pm on August 2 to 5pm on August 3.
The respiratory rate, the court hears, is 'normal', and the baby boy was said to be stable.
A second observation chart is shown with the nurse signing for readings at 6pm and 7pm.
The nurse agrees with Mr Driver the observations show "stable trends" for Child E.

12:32pm

Mr Driver asks about the blood sugar readings.
The nurse says she found that level in a blood gas reading, which was 'outside the parameter' so consulted a doctor, and action was taken following guidelines for insulin to be commenced.

12:37pm

The blood gas reading chart is shown to the court, which shows the nurse took the sample for Child E at 2.38pm on August 3.
The glucose reading of 18.4 was the only 'abnormal' reading recorded, the court hears.

12:41pm

The neonatal fluid balance chart for Child E on August 3 is shown to the court.
The nurse explains the milk levels given to Child E that day.
The aspirates recorded 1ml partially digested milk at 9am, which was 'replaced [in the NG tube] as [Child E] had worked hard to digest that milk', as 'normal practice'.
The nurse explains the 1ml milk was taken out, put back in, and a 1ml additional milk feed was administered.

12:44pm

'Minimal aspirates' are recorded for 11am and 1pm, with a 'moderately high' level of urine recorded at 1pm.
Minimal aspirates are recoreded at 3pm, with 1ml aspirate at 5pm. That was a 'normal finding' and was replaced.
At 7pm, another 'minimal aspirate' is recorded.
At 7pm, there was also urine recorded, and a sign Child E's bowels had opened by this time.
Asked for the assessment of Child E, the nurse says: "[He] was doing well on that shift, apart from the high blood sugars. It can be a worrying factor, it could be a stress response."

Cross-Examination

12:48pm

Ben Myers KC, for Letby's defence, asks about Child E's condition on August 3, that he was 'doing well for a baby of that gestation', except for the blood sugar reading.
He asks if the nurse was aware of a number of risk factors associated with him.
The nurse agrees, and agrees Child E was premature, and there were risks associated with that.
She says she would have also been aware of risks of twin births, and agrees with Mr Myers Child E 'could be vulnerable to health complications'.

1:00pm

Mr Myers asks about Child E's first shift involving Child E on the night of July 29-30, referring to the nurse's note at 12.17am: 'NCPAP commenced at 10.50pm as oxygen requirement increased to 30% and required Neopuff x2 for apnoea.'
A chart is also shown of Apnoea/Bradys, recording five such incidents for Child E between August 1-3.
Mr Myers says, talking through the chart with the nurse, one Brady happened at August 1, no apnoea is identified, but heart rate dropped to 79bpm and desat reading was '84', and the duration was 45 seconds.
That is confirmed by a separate doctor's note, which required 'gentle stimulation' to resolve.
The second desat happens on August 2 at 6.20am, with a reading of '83-88', lasting two minutes.
The nurse says gentle stimulation is putting a hand on the abdomen gently, or very carefully giving the baby a light tickle.
She says if the situation does not improve, the baby's chin would be placed into a neutral position to help the airway, and/or administer oxygen.
This episode required, according to a nurse's note, 'facial oxygen was required for a short period - had hiccups at the time'.
The third was a brady and a desat for 30 seconds, which was 'self-correcting'.
The fourth was a Brady and desat at 11.50pm on August 2, lasting 45 seconds, requiring gentle stimulation to resolve.
The fifth and final episode was at 1am on August 3, with brady and desat in the '70s', lasting 45 seconds, requiring gentle stimulation to resolve.

2:09pm

Ben Myers KC is continuing to ask the nurse questions.
The fluid chart is shown to the court once more for Child E on August 3.
Mr Myers asks about the blood glucose readings, and what the parameters should be.
The nurse says the readings should be above 2.6, and the upper limit is not defined in pre-term babies (Mr Myers says the upper limit is 6 for full-term babies). The nurse says it would be a worrying sign.
Mr Myers asks if the reading of 18.4 is 'worryingly high'. The nurse agrees. She says the cut-off point for insulin to be prescribed would either be '12 or 14'.
She agrees the blood sugar readings of 12.8, 18.4, 13.5, 12.9 are 'at the higher end of normal', with '18.4' being 'particularly high'.

2:15pm

A chart showing a form of insulin - Actrapid - is administered on several occasions to Child E.
The first is on July 31 at 6.45am, and the rate of insulin administration lowers at 2pm on August 1 and is increased slightly again at 2.10am on August 2.
A prescription for 3pm on August 3 is made, but then crossed out, then redone with 'a correct dose'. The nurse says the previous, crossed out one, was 'an incorrect dose' of 0.05units/kg/hr. The second is the 'correct dose' of 0.02units/kg/hr.
Insulin of a neonatal is a "continual infusion", the nurse tells the court.

2:18pm

Mr Myers says the insulin administration is 'a feature' of Child E's treatment during his time at the neonatal unit. The nurse agrees.
The blood gas chart for August 3 is shown, with the nurse having signed a blood gas reading taken at 2.38pm.
Mr Myers suggests the pH reading of 7.293 is outside the normal range of being under 7.3, by being slightly acidic. The nurse says she was trained that anything above 7.25 was normal.

2:19pm

Mr Myers suggests that the blood gas readings suggest a case of acidosis.
The nurse says the readings taken are within the parameters, and the doctor would, in any case, make the decision.

Prosecution Re-Direct

2:22pm

Mr Driver, for the prosecution, rises to ask a matter of the brady and apnoea chart, which recorded five episodes with Bradys and desats. The nurse did not record any of these episodes.
He asks if the episodes recorded on August 1-3 would lead the nurse to adjust her opinion of Child E's stability/well-being.
The nurse says the chart is "not a worrying trend of information".

2:30pm

Mr Driver asks if the insulin prescription are four separate doses, or one continuous administration.
The nurse says the first dose is administered at July 31, 6.45am, and that dose remains unchanged until 2pm at August 1, and the dose is reduced.
It would be the same infusion, via a syringe of diluted sodium chloride, administered via a computer.
The court hears the insulin would be paused in the event of the syringe being emptied or the insulin expiring, and a replacement dose would have been prescribed prior to that.

Re-Cross-Examination

2:44pm

Mr Myers asks further about the insulin dose.
The nurse says, for the dose she administered, that was a fresh solution.
The previous one, the notes the previous dose was administered from 2.10am on August 2.

Judge's Question

The judge asks if that dose of insulin would have ended after 12 hours, as the insulin would expire thereafter.
The nurse says you would have to check the relevant nursing notes for that. She can only say to the court the insulin dose she administered at 3pm on August 3 was a fresh dose, and Child E had not been on insulin.

LIVE: Lucy Letby trial, Tuesday, November 15
 
Tuesday November 15th 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 22 of Prosecution Evidence

(Twin) Child E


Nurse Caroline Oakley, CoCH, night shift-leader, 3rd/4th August 2015, Witness Statement

2:45pm

The next evidence is an agreed evidence statement from nurse Caroline Oakley, who was shift leader on August 3, and was involved in the resuscitation efforts for Child E, but does not recall who was doing what, as it was a team process.

She adds she does not recall attending a debrief for Child E following his death.

LIVE: Lucy Letby trial, Tuesday, November 15
 
Wednesday November 16th 2022 - (no live updates from the trial)

Tweets

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 23 of Prosecution Evidence

(Twin) Child E


Unnamed Paediatric Consultant, CoCH, night shift 3rd/4th August 2015


The court is hearing from a consultant paediatrician who was on duty when Babies E and F were on the neonatal unit. Court orders mean we can’t name the alleged victims or this doctor.Nurse Letby allegedly murdered Child E and allegedly attempted to murder his twin F.

The doctor was on call in hospital accommodation on the night Baby E became ill. She’s recalling telephone discussions with a junior colleague who was treating E. The junior doctor’s notes concern 2 incidents when E had blood loss from his mouth and had a fall in blood oxygen.

The consultant says the notes show on the 2nd occasion Baby E’s blood oxygen level stayed at 60-70% despite being given 100% oxygen. “This suggests something dramatic has changed in their clinical condition.” @BBCNWT 1/2

“It suggests there’s not a problem with his breathing effort that’s making his oxygen saturation low.” @BBCNWT 2/2

It’s alleged that Nurse #Letby murdered Baby E by injecting air into his blood. She denies this, as she denies all the charges she faces.

When the consultant got to the neonatal unit E’s blood oxygen level was 80% in 100% oxygen. “They’ve improved since ventilation but they’re still not as good as we would like them to be.”

An x ray showed E’s heart size was normal and his lungs were clear. “There’s no indication from the X ray why E’s saturation was low” says the consultant.

11 minutes after the consultant arrived at the neonatal unit her notes say E’s blood oxygen had fallen to 50-60% in 100% oxygen and he had “no detectable [heart rate]”, so CPR was started.

The consultant was the team leader for resuscitation efforts for Baby E. She says she wouldn’t get involved in the physical tasks because you “lose awareness of the overall situation.”

The consultant says her notes “[don’t] tell me anything about what caused the collapse, just that [E] is extremely poorly.”

Resuscitation efforts for E were not successful and CPR was stopped. The notes say he was “transferred to Mum and Dad for cuddles”.

The doctor says at the time she thought E’s cause of death was necrotising enterocolitis (NEC), where part of the bowel becomes inflamed and may die. It occurs in newborns who are premature or otherwise unwell.

She thought this because E was an at risk baby, he had gastro-intestinal bleeding and he had skin discolouration. She agreed with the coroner that that she be put as his cause of death. But she now says she doubts he had NEC because …

…”[E’s] observations were stable right up to the point of collapse” and that’s not what happens with NEC, where deterioration is normally slower. There was also no sign of NEC on the X ray….

“I don’t think I gave that enough weight at the time, that the X ray was normal.” The doctor say she didn’t push the idea of E having a post mortem because his parents were so upset, “which is now something I regret.”

Cross-Examination

The doctor is now being cross examined by Ben Myers KC who’s defending Nurse #Letby. She agrees with him that as a premature baby E faced specific problems.

She also agrees with Mr Myers that a condition E and his twin F had where they shared a placenta can increase risks for them. Those risks can include NEC. Dr agrees E was at high risk for a number of conditions.

In a police statement in Nov 2018 the doctor said she discussed with a colleague that E had “an unusual deterioration but in a high risk baby that was not entirely unexpected.”

Mr Myers says E’s blood glucose levels were high during his time in hospital were high and this can mean baby is labouring under stress. The doctor agrees but says they’re not unusual in babies like E.

When Mr Myers suggest again suggests that Baby E was at risk because he was less robust physically, the doctor says “His deterioration was well outside what we would expect.”

Mr Myers suggests that the notes show that although E lost blood and fluid there was no discussion, as there should have been, of replacing fluid or transfusing blood. The doctor says though it’s not in the notes, blood transfusion was discussed.

Mr Myers suggests the consultant (who was on call) should have gone to the neonatal unit sooner than she did to treat E. “With hindsight I should have attended but I don’t think I would have made any different decisions [from the doctors who were at the unit]”.

Mr Myers: “You should have been there.”
Consultant “Yes.”

The consultant disagrees with Mr Myers when he suggests the Countess of Chester neonatal unit was “too slow” to intubate* E. (* where a tube is inserted into the windpipe to aid breathing).

Mr Myers suggests the consultant is “minimising the impact of a late blood transfusion” for E. Consultant: “I am minimising it as I don’t think a late blood transfusion led to [E’s] collapse and death.”

Mr Myers says the consultant should have ensured that Baby E had a post mortem. She says “I apologise to them [E’s parents] that I didn’t push for that.” @BBCNWT
 
Wednesday November 16th 2022 - (no live updates from the trial)

Tweets

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 23 of Prosecution Evidence

(Twin) Child E


Unnamed Paediatric Consultant, CoCH, night shift 3rd/4th August 2015


Lucy Letby trial: the jurors are continuing to hear medical detail about the case of baby E, a premature twin boy who the nurse is accused of murdering in Aug 2015. They’ve been listening to a consultant paediatrician who led the attempts to resuscitate him before he died.

We can’t identify the baby, his parents, or this doctor, for legal reasons.

The consultant has been going through the medical notes which she made on the night that he died. They detail the attempts made to save baby E. At the end, they read:

CPR stopped at 0123
No heart rate, breath sounds or movement,
Over 5 mins
Death confirmed
RIP (baby E)

The consultant says that at the time she thought baby E had died from a condition called NEC (a serious condition that can affect newborns, where tissue in the bowel becomes inflamed).

She says she discussed this with the coroner, and it was registered as the cause of death, but she no longer believes that it was the cause. She says “I don’t think I gave enough weight at the time that his x-rays had been normal”

After baby E’s death he wasn't given a post mortem. The doctor says “His parents were understandably devastated that he had died and weren't keen on a post mortem, and I didn’t want to make what was a terrible situation any worse, so I didn’t push which is something I now regret”

Cross Examination

The consultant is being cross-examined by Ben Myers KC (defence). He suggests baby E was a high risk premature baby.. She says "Although he was a high risk baby and we are used to looking after high risk babies his deterioration was well outside what we would expect"

The jury hears that the consultant was 'on-call' but was in the medics' accommodation when baby E started to deteriorate. She was in phone contact with the registrar (her junior) who was on the neonatal ward.

Ben Myers KC (defence): "You should have got there sooner, and you know that don’t you?"
Doctor: "I do and I wish I had got there sooner"

Ben Myers KC suggests to the consultant that she should have recommended a post mortem for baby E. The doctor turns to the baby's parents, sitting in court, and says "I apologise to them that I did not push for doing that"
 
Wednesday November 16th 2022 - 10% Chester Standard

The doctor told the court: “At the time I felt (Child E) had NEC which had led to his collapse and deterioration so I discussed that with the coroner and we agreed for that to be put as (Child E’s) cause of death.”

She said the infant was a “high-risk baby” and also took into account a colleague’s observations of gastro-intestinal bleeding and abdominal discolouration.

Lucy Letby trial: Doctor apologises over lack of post-mortem examination on baby
 
Thursday November 17th 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 24 of Prosecution Evidence

(Twin) Child E


Dr David Harkness, CoCH, registrar, night shift, 3rd/4th August 2015

11:23am

The judge, Mr Justice James Goss, explains that travel difficulties have led to the court's delayed start.

Philip Astbury, for the prosecution, is calling Dr David Harkness to give evidence.

11:26am

Dr Harkness, a paediatric registrar at the Countess of Chester Hospital in summer 2015, is being asked about Child E on the night shift of August 3.
He says they started that shift at about 8.30-9pm. He explains, with working in different hospitals, it is difficult to remember the shift patterns.
He explains there would have been a handover period, where he would have read a handover sheet for the various patients and any outstanding conditions those patients had.
There would be one sheet for the paediatric ward and one for the neonatal ward.
If there were any sick children in A&E, the doctors would have been responsible in attending to them too.
He says the handover period would have lasted about 30 minutes.

11:29am

He says some tasks would have required him to work with Dr Christopher Wood, his colleague on the night, and some would have been done solo.
He says his tasks would have included speaking to nurses and seeing the neonatal unit babies.
He says if there was nothing outstanding happening on the neonatal unit, he would be there at 10-10.30pm.
He says for this night he was called over at 10pm, having been called over because Child E had blood in his vomit.
'Small amounts of blood' - minuscule blood flecks - were spotted when the NG Tube was brought out of Child E, he recalls.

11:42am

The court is shown Dr Harkness's note from 10.10pm on August 3, which says 'asked to see patient [Child E] regarding gastric bleed.
'Large, very slightly bile-stained aspirate 30mins ago.'
The note adds: 'Sudden large vomit of fresh blood and 14ml aspirate.'
The doctor is given the opportunity to look through his clinical notes, and Lucy Letby's nursing notes from that shift, to see the chronology of events that night.

11:47am

The court is now shown the 10.10pm note.
He says it is not clear, from his note, how much of the 14ml aspirate contained 'fresh blood'.
He says the fresh blood was what he had witnessed, having been called over to see it. The court hears he did not see the child vomit, but saw the fresh blood as a product of it.

11:51am

He notes Child E's blood pressure was 'very good', a CRT reading was good, the heart rate was 'normal' and saturation rates were good, with minimal oxygen support.
"At that point in time, everything is fine, except for the blood in the aspirate," he tells the court.
Child E was also 'pink, well perfused', the lungs were 'clear', the abdomen was 'soft, not distended'.

11:54am

Dr Harkness notes 'GI bleed ? Cause', and tells the court that is a possible diagnosis for the bleeding, and a plan of action with administration of antibiotics is made.
The note 'close observation' is made, emphasising the designated nurse - Lucy Letby - was to monitor Child E closely in room 1.

11:59am

Dr Harkness says, from his recollection, he does not believe he left the unit as the bleed was 'something unusual' in Child E so he does not believe he went very far.
For the 11pm note, he says Letby called him into room 1, where 'Further GI blood loss and desaturation to 70%' is noted.
A '13ml blood-stained fluid from NGT on free drainage' is noted.
He says he remembers seeing 'fresh, red blood in the tube', with the contents of the stomach.
He says the free drainage setup would have allowed the vomit to come out rather than go into the baby's lungs.
He says the origin of the blood must have come from somewhere in the oesophageal tract, down to the stomach. It rules out blood coming from the lungs.

12:01pm

The saturates 'remained 60-70% in 100% O2', with Dr Harkness said 'because of Child E's condition', the oxygen requirement had gone up from 'minimal support'.
He says Child E was still trying to breathe at this time.
The comment 'crying' is added in the note.
Dr Harkness says the child is still well enough to be awake enough and conscious to cry.
He said just the note 'crying' would suggest it was a 'typical cry'.

12:03pm

Dr Harkness says the fact Child E was crying would mean he would have had to have been taking deep breaths to do so.
The plan of action was 'replace losses' - getting fluid back in.
'Strict fluid balance' - the court hears, 'knowing how much to put back in'.
Dr Harkness says he is planning to intubate Child E and do an x-ray to check Child E's lungs and abdomen to try and explain why the baby was deteriorating.

12:05pm

The type of intubation was 'elective', which was not on the level of 'an emergency situation', the court hears.
Dr Harkness says he would discuss the result of the x-ray with surgeons at Alder Hey and seek advice from them.

12:10pm

Dr Harkness said he would then have been preparing to intubate and get the equipment ready.
Prescriptions are made from 11.28pm-11.30pm for a number of drugs.

12:17pm

A further note, written in retrospect, is made at 1.45am.
He records 'sudden deterioration at 11.40pm'
Prior to that, Child E was still to be 'under close observation' by Lucy Letby.
Dr Harkness tells the court he was in the room when the 'sudden deterioration' happened, and was there with Lucy Letby and another nurse. Those nurses would have been gathering the drugs to be administered.
The notes record 'brady 80-90bpm, sats 60%, poor perfusion, colour change over abdomen, purple discoloured patches'.
He says: "This was a strange pattern over the tummy and abdomen, which didn't fit with the poor perfusion - the rest was still pink, but there were these strange purple patches."
He says some of the patches were still pink, but others were purple-blue, were unusual.
He likens the purple-blue colour to be what you would see after going for a swim in cold water and coming out, with 'purple-blue' colour on the lips.
The rest of the skin was 'normal colour'.
The abdomen had 'purple patches', which didn't fit with an anatomical part of the body. He says it is difficult to describe in any detail, without a photo.
He says he has seen this in Child A before and had not seen it on any other baby, outside of the babies in the case.

12:20pm

The patches were 'different sizes' and in the region of 1-2cm big - 'not dots'.
The areas were 'on the abdomen - not above the chest or below the groin - in the middle section'.
The patches 'did not fit with the perfusion' seen.
He tells the court if the abdomen was dusky or white, then the whole of the body would gradually take that colour too.
He says in the case of an affected blood supply, the blood would be lost from the legs first and the body would pull the blood 'into the middle of the body'.
"But on this occasion, it is the middle where you are seeing these discolourations?"
"Yes."

12:21pm

Dr Harkness confirms he has never seen these discolourations before or since, outside of the babies in this case.

12:22pm

Dr Harkness's notes record 'intubated as an emergency at 11.45pm'
He says although there were risks associated with this, the 'safer option' for Child E was to do things as an emergency.

12:25pm

An ET tube was inserted, with 'good air and chest movement' recorded, and the tube was recorded to be in the correct place.
Child E was also 'put on ventilator', with 100% oxygen.
The saturation readings were '60-70%', and after a morphine bolus was administered, those improved to 80%.

12:31pm

The 'purple discolouration of abdomen remained', it is noted.
Child E's blood pressure had dropped but was still in the normal range.
The plan was to administer further medication, but there was a concern that administering a drug to make the heart beat faster would lead to 'worse bleeding'.
Dr Harkness says 'from his recollection' the blood had settled and there was no further substantial amount of blood recorded.

12:32pm

Dr Harkness said he and a colleague were stood at the end of the incubator, discussing what medication and plans were being put in place for Child E, when Child E collapsed "in front of our face when we were stood there".

12:37pm

Dr Harkness recalls the resuscitation efforts began, and Child E's heart rate recovered at 1.01am, and the parents had arrived by that time.
He tells the court the blood supply was 'very poor'. He says during CPR, blood was coming out of Child E's nose and mouth, suggesting the blood pressure was low. He says the sight was "not very nice, particularly".

12:40pm

Dr Harkness is asked about the bleeding seen on Child E.
He says: "I have never seen it in a baby, to this extent." He says he had seen the level of blood in a teenager, but not, relatively, in a baby as small as Child E.

12:44pm

Dr Harkness is asked about Letby's nursing note made on the night shift of August 3, which refer to Child E's mum visiting at 10pm and she was informed by Letby and Dr Harkness about blood coming from the NG Tube. It refers to 'she was updated by Reg Harkness and contained [Child E]'.
The note is shown to the court.
Dr Harkness confirms it was the note shown to him. He does not know what 'contained' meant in the context.
He says he does not remember if the mum was present at that time.

12:47pm

A pathology report for Child E is shown, with 'PT and APTT' readings. Those are two tests for blood clotting measurements. They were 'high, but not enough to be shocked by'.
The readings were 19.5 and 53.6, compared to the normal ranges of '12.5-15' and '26-35' respectively.

LIVE: Lucy Letby trial, Thursday, November 17
 
Thursday November 17th 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 24 of Prosecution Evidence

(Twin) Child E


Dr David Harkness, CoCH, registrar, night shift, 3rd/4th August 2015

Cross-Examination​


1:23pm

Ben Myers KC, for Letby's defence, opens by mentioning about Letby's note made.
Mr Myers says a 'containment technique' was used, as described by Child E's mother, to clarify the 'contained' comment. It was a technique used to calm a baby.

1:28pm

Mr Myers asks about the sequence of events.
He refers to a police statement Dr Harkness made, where the doctor says: "I was asked to review [Child E] by Letby [following the finding of a dirty aspirate].
'Looking at the notes it was 10pm-10.30pm...I only came on at 9pm'.
He described, in the statement, the aspirate which was largely mucus-y.
He said he could not be sure if there was a fleck of blood around Child E's face [on examination].
'[Child E] looked relatively settled and there was nothing to suggest that was going to change'.

1:30pm

The statement adds: 'However, around half an hour to an hour later there was a large amount of fluid which came up the tube.
'From memory it was 12-14ml of blood which for a baby was a substantial amount'.
Child D brought up further 'fresh blood' in quantities which he had 'not seen [in sudden cases] since'.

1:38pm

Mr Myers asks about the initial stages from the first clinical note, at 10.10pm.
Dr Harkness confirms he has been asked to review Child E, following the bile-stained aspirate '30 mins ago'.
Mr Myers said all of what had happened in the 10.10pm note, had happened by 10.10pm.
Dr Harkness says this was a 40-minute period of several year ago. He said this was potentially a period of 9.30-10.10pm.
He said it would 'match up' with the note.
In the police statement, Dr Harkness said he would have been 'bleeped' by Lucy Letby.
He says that would have been the most common approach to be alerted to the nursery room 1.
He said he had seen 'a dirty aspirate which may have contained blood flecks and bile'.
Mr Myers says the police statement said Child E had 'nothing dramatic' around the baby's face, and could not be sure if there were any blood flecks.
Child E was 'not in distress' and 'appeared fine'.
Dr Harkness says he does not know if he saw Child E's mother, and does not have a clear recollection. He says it could be the case, looking at the notes provided.

1:39pm

Mr Myers asks if Dr Harkness had 'any particular concerns' from the first reading. Dr Harkness says there wasn't. He agrees the second note, with blood vomit, was 'more concerning' and suggested a gastrointestinal bleed.
Mr Myers asks if such a bleed was 'serious'.
"Potentially," Dr Harkness replies.

1:41pm

Mr Myers suggests that a GI bleed should have led to a blood transfusion.
Dr Harkness says if there were other observations which collated that, he would have done so, but at this point, he would not have done so, as the blood vomit could have had other causes.
He said a blood transfusion 'may have come up in a conversation' with a fellow doctor. Mr Myers asks why that wasn't documented. Dr Harkness says he cannot answer that.

1:47pm

The clinical note for 11pm is shown to the court, which the court hears refers to the 'large amount of fresh blood'. Dr Harkness was called into the unit.
The '13ml blood-stained fluid' is a 'significant quantity', Dr Harkness confirms.
Mr Myers said this follows other blood which came out earlier, and a typical baby would have had something 'in the region of 120ml' in him at that time.
Dr Harkness agrees.
Mr Myers said there had been 27mls of blood and aspirate taken from him in that time, which was 'up to a quarter' of Child E's blood. Dr Harkness agrees.
Mr Myers says the heart rate is 'normal', but the saturation rate is 'low'. He says the heart rate 'should be higher'.
Dr Harkness says: "Not necessary - there are multi factors to that. It's part of a separate conversation with expert witnesses."
He says it is not as simple as saying one reading should go up in line with others. He says blood pressure was normal, and there were other factors to consider.
Mr Myers says the pairing of heart rate and saturations is 'not normal'. Dr Harkness says it is abnormal, in the sense that the heart rate is normal and the saturations rate is abnormal.

1:51pm

Mr Myers asks why a consulation with surgeons was required following x-rays.
Dr Harkness says advice would have been taken from them once the extra results would have been acquired from the x-rays.
Mr Myers says he could have been dealing with a 'very serious situation indeed'.
Dr Harkness: "Potentially."
Dr Harkness says things were "changing" but Child E was still "stable".
Mr Myers: "Are you suggesting that a baby who has lost a quarter of its blood is not an emergency situation?"
Dr Harkness "What I'm suggesting is there are things to do and there is time to do it."
Mr Myers says transfusion was not being considered at this point, and one of the 'obvious things' to consider.
"It is something you had failed to consider, isn't it?"
Dr Harkness says it was likely considered, but accepts it was not documented at the 11pm note.

1:51pm

Mr Myers suggests it was a "serious mistake" not to consider blood transfusion.
Dr Harkness: "I disagree."

1:55pm

Mr Myers asks about the staffing levels that night, and asks what would have happened if he had been called to the A&E department.
Dr Harkness said he would have contacted the on-call consultant at that time to come over in that instance.
Mr Myers: "I would suggest you were out of your depth at this point."
"I disagree."
He adds that is "wrong and disrespectful to my ability."
Mr Myers says blood transfusion is not considered.
"But we do have a plan, and we do have a discussion with a consultant."
Mr Myers says the intubation should have happened earlier.
Dr Harkness says there are benefits to an elective intubation compared to an emergency intubation, as the latter could cause stress and complications to the baby.
He said that 'now' this would still have been the course to take in that situation.

1:57pm

The court hears the preparations are made for the intubation during a half hour.
Dr Harkness disagrees with Mr Myers that it was a "delay" and was using his time "appropriately".
"You make more mistakes when you are not taking your time."

1:59pm

Mr Myers says the blood transfusion is mentioned for the first time at a later note, after 11.40pm.
Dr Harkness says it would not have been appropriate to give more saline boluses without administrating fresh blood.
He disagrees a blood transfusion was not considered earlier.
He says his documentation is not as thorough as it would be now, and agrees in hindsight, it should have been documented more clearly.

2:04pm

The 'skin discolouration' observation is noted, and that it later 'remained' on the abdomen.
A nursing colleague had referred to 'discoloured abdomen' in a retrospectively written note at 1.30am.
Mr Myers said Dr Harkness had referred to the discolouration being 'strange' and 'unusual', and 'appearing and disappearing'.
That does not appear in the medical note, Mr Myers says.
Dr Harkness says that observation had "stayed with him" and the clinical note he made at the time was not 'forensic'.

2:10pm

Mr Myers reads out part of Dr Harkness's statement to the police, referring to the discolouration being on the abdomen.
Dr Harkness says he does not recall the part of the statement of the discolourations' 'path to the body', and said he would not agree with the wording of that.
He says he has not been in discussions with anyone in relation to these observations.
Mr Myers said by October 2018 (by the time of his police statement), there had been discussions in the hospital about the skin discolourations.
Dr Harkness said there were discussions to say it was unusual, but refutes any of the details of the discolourations had been discussed.
Mr Myers says Dr Harkness is 'putting details together' from various observations. Dr Harkness: "No."
Mr Myers says Child A's skin discolouration, as referred to by Dr Harkness in court earlier in the trial, were not mentioned in the clinical note at the time or the note to the coroner.
Mr Myers says 'red patches' found on Child A were not mentioned for Child E.
Dr Harkness said the overall discolouration observations were 'similar enough'.

2:11pm

Mr Myers refers to Child E's collapse 'in front of the medical staff'.
He says by this point, "there had still been no transfusion".
Dr Harkness said there was no further evidence of bleeding after the second bleed.
Mr Myers: "The reaction to the second haemorrhage was far too slow wasn't it?"
Dr Harkness: "I disagree."

2:13pm

Mr Myers says a blood transfusion, for O-negative blood, is noted at 12.50am on the medical notes.
Dr Harkness says the O-negative blood [a type which can be suitable for all blood transfusions] would be used in this instance as seeking a specifically matched blood type at this stage would take too long in acquiring it from the donor fridge.

2:19pm

The note of 12.36am - CPR commenced, is mentioned. The transfusion would have followed.
Mr Myers says, in 'distressing detail' relayed by Dr Harkness earlier in court, it had been discussed about blood coming from Child E's mouth and nose during CPR.
Dr Harkness said blood would 'keep coming out' until the cause of it is found.
Mr Myers says the cause of death would be 'acute blood loss'.
Dr Harkness said that cannot be known without a post-mortem examination.
He says the blood loss could be a factor, but it is not 'black and white'.
He said it was 'not his place' to call for a post-mortem examination.
Mr Myers says the blood loss seen would normally be 'fatal'.
Dr Harkness said it could be 'linked'.
Mr Myers asks if the actions taken were 'far too slow'.
Dr Harkness: "No."
"Would you have admitted it if it was?"
"Yes."

Prosecution Re-Direct​

2:21pm

The prosecution rise to ask about the timing of Dr Harkness 'meeting the mother of Child E'. Dr Harkness said that would have been the case, based on a nursing note.
The prosecution ask if that was from looking at Letby's note.
Dr Harkness agrees.
The prosecution say Dr Harkness's clinical note does not refer to meeting the family.
Dr Harkness said it could be documented, but would depend on the level of detail of the discussion.

2:27pm

Dr Harkness's interview with police from September 2018 is relayed to the court.
Dr Harkness is asked about the skin discolouration, and says it is 'similar [between Child A and Child E]' and is not a rash.
The interview transcript says Child E's discolouration was 'around the abdomen and chest', with 'purple patches' that 'suddenly come on'.
"It came so quickly - not affected by the monitors or anything".
"It was just this purple and pale patches".
He was asked in the police interview if that was symptomatic of other cases, and Dr Harkness said that was not.

LIVE: Lucy Letby trial, Thursday, November 17
 
Friday November 18th 2022 - (no live updates from the trial)

Tweets

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 25 of Prosecution Evidence

(Twin) Child E


Dr Dewi Evans, Prosecution Medical Expert Witness


I'm back at Manchester Crown Court for the trial of nurse Lucy Letby. We're expecting to hear expert medical evidence from Dr Dewi Evans today

Dr Dewi Evans was approached by the National Crime Agency to review the case in 2017. In a report he produced in 2018, Dr Evans set out that a number of babies in this case died as a result of an intentional injection of air into the bloodstream

Dr Evans is talking the jury through his assessment of Child E's condition in the days before his death. He says that the infant's bloods, white blood cell levels, saturation were as 'stable as you can get'....'he was active and pink, all was satisfactory'

Dr Evans is summarising that for the first five days of Child E's life he was 'stable' and that there was nothing to suggest there was 'something wrong' with him

The court is being shown heart-rate and respiratory charts from the day before Child E's death, again Dr Evans says these show he was a 'stable' and 'well little baby'

Asked if it was a point of concern that the baby needed insulin, Dr Evans says 'no', he explains 'he needed insulin to control his glucose values, that’s fine, that’s what neonatal units are for'

We're now looking at medical notes and charts from the evening before Child E's collapse and death. Between 18:00 and 21:00, Dr Evans says everything was 'normal' and 'stable'

Dr Evans is now giving his overall observations of Child E. He explains the reason for the need for insulin was that as a premature baby, his own insulin production had not yet kicked in. He notes that the baby was at risk of necrotising enterocolitis (NEC)

This is a condition that can affect newborn babies, where tissue in the bowel (small and large intestines) becomes inflamed - doctors were aware of this at the time and held off with oral feeds for the first few days of his life

Dr Evans is asked if NEC is a 'viable' explanation for what happened to Child E, he says 'no'

Earlier this week, Child E's mother told the court that the evening before her infant son died, she found him with "blood on his face" and making "horrendous" sounds. Dr Evans said this is 'difficult to explain'

He adds: 'This is not something I've seen other than in this case'

Asked for his reasoning behind Child E's death, he said there are 'two major' factors - he says the baby suffered some kind of 'trauma' which caused gastric bleeding. He says there is no innocent explanation for this and says it could have been caused with a 'stiff' implement

The second reasoning is air embolism - the intentional injection of air into the bloodstream

Cross-Examination

On the intentional trauma that Dr Evans cites, Ben Myers KC, defending, put it to the medic that he was "looking for possible items just to support the allegation, than simply looking at all the available facts".

Dr Evans repeated that he believed Child E was subjected to a trauma that did not result from a 'natural phenomenon'. He earlier suggested this could have been caused by the inappropriate use of a surgical tool known as an introducer (a thin piece of wire covered in plastic)
 
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