Wednesday 12th June 2024 continued
Chester Standard - link
Recap: Prosecution opens case in Lucy Letby retrial
2:17pm
The trial is now resuming.
Nicholas Johnson KC continues the prosecution opening.
2:19pm
He explains the baby girl [which for this blog shall henceforth be named Child K] was intubated at 2.32am, prior to the transfer to the neonatal unit at 2.40am. To explain this process, a video is played to the jury.
2:28pm
Mr Johnson says there are a number of times the tube moved for Child K.
2:35pm
Mr Johnson says for that shift, Dr John Gibbs was the paediatrician for that week. Dr Ravi Jayaram is listed as the on-call consultant between 4.30pm and 8.30am.
Nursing staff are shift leader Caroline Oakley, with designated nurse Joanne Williams, and other nurses Lucy Letby and Sophie Ellis, plus nursery nurse Valerie Thomas.
A floorplan shows Letby was the designated nurse for two babies in nursery room 2 at the start of that night shift.
Two babies were being looked after in room 1 by designated nurse Caroline Oakley.
Joanne Williams was designated nurse for a baby in room 2. She was later designated as the nurse for Child K that night.
2:36pm
Between 2.36am and 2.50am, Lucy Letby was making nursing notes for one of the two babies she was designated to look after in room 2.
2:38pm
At 2.45am, Child K was given surfactant down an ET tube, to help with her lungs.
2:43pm
At 3am, IV fluids for Child K were set up by nurses Joanne Williams and Caroline Oakley.
At that time, Lucy Letby was making entries on the notes for one of the babies she was designated nurse for - between 3.02am-3.12am.
At 3.11am, Joanne Williams entered the neonatal unit from the labour ward, Mr Johnson tells the court.
2:44pm
Notes from the transport service say Dr Ravi Jayaram made a call to them at 3.15am, to arrange transport for Child K, to a level 3 hospital. At this time, Lucy Letby was giving medication to a baby she was a designated nurse for in room 2.
2:49pm
At 3.30am, Letby recorded observations for that room 2 baby.
Also at that time, "a lot of things were being recorded", Mr Johnson says. Letby signed for morphine for Child K with Joanne Williams. The morphine was a painkiller and sedation. It was to be given as Child K had been intubated, Mr Johnson tells the court.
It is so they don't interfere with the tube, he adds.
2:53pm
Joanne Williams records the vital signs for Child K at 3.30am.
Just before 3.40am, Caroline Oakley was away from the unit as, at 3.40am, there is a digital record of her coming back into the unit.
Nursery nurse Valerie Thomas, looking after babies in rooms 3 and 4, was out of the unit, as again there is a record of her returning to the unit at 3.40am.
2:55pm
At about that time, Dr Ravi Jayaram is recorded as communicating with the transport team, being on the phone at the nurses' station.
It was about this time that Child K collapsed, Mr Johnson tells the court.
The allegation, he says, is "straightforward".
2:57pm
He says Joanne Williams had left the neonatal unit at this time to see Child K's mother, having left Child K ventilated and sedated.
Dr Jayaram was "distracted" and other nurses were out of the unit.
"That would leave Sophie Ellis and Lucy Letby in the unit covering four nurseries," Mr Johnson added.
While Joanne Williams was out of room 1, Lucy Letby was in there on her own. That is what Dr Jayaram saw when he went in there at the time of the collapse, Mr Johnson says.
3:00pm
Mr Johnson says Child K was connected to a machine checking her heart rate and oxygen levels. Those machines should have alarmed if there was an issue, but they did not. Someone had disabled them, Mr Johnson says.
"Not only that, but Lucy Letby was doing nothing.
"We say that in those circumstances, the only reasonable thing for a nurse to have done was to call for help and/or use the Neopuff to breathe for the child."
The ET Tube had become displaced, Mr Johnson says.
"The fact Lucy Letby was doing nothing and the alarm was not sounding was...that Letby... the convicted murderer, had displaced the tube."
3:01pm
Nursing notes, written retrospectively by Joanne Williams, said Child K had begun to desaturate to "dangerous" levels.
Child K's ET Tube was "dislodged". It was removed and she was reintubated on the second attempt.
Mr Johnson asks the issue is how did the tube become dislodged.
3:05pm
Child K was given a loading dose of morphine "to guard against the possibility that this very premature child had wriggled to extubate herself".
The morphine dose and infusion administration were timed at 3.50am. It is initialled 'JW', but in the handwriting of Lucy Letby.
"Lucy Letby had been caught virtually red-handed by Dr Jayaram," Mr Johnson says, adding that Child K's ET Tube later dislodged twice more, and the evidence establishes that Lucy Letby was there, even though the babies she was to look after were in room 2.
3:07pm
Lucy Letby "became closely involved" with Child K's care "despite" having primary responsibility in room 2.
She was "making [Child K] part of her business", Mr Johnson tells the jury.
At 4.20am Letby cosigned for medication for Child K while Joanne Williams was coming from the labour ward.
About 20 minutes later, medication was given to Child K by Lucy Letby and Caroline Oakley.
Between 4.48am and 5.07am, Child K's designated nurse was completing nursing notes for the baby girl. While that was happening, Lucy Letby and Caroline Oakley were giving further medication to Child K.
At 5.23am, Letby was again involved.
3:08pm
At 5.53am, a note from the transport team recorded Dr Jayaram was keen to get Child K to Arrowe Park Hospital. It was noted: 'keen not to miss window of opportunity whilst baby stable'.
3:14pm
Between 6.04am-6.10am, Letby formally booked in Child K to the neonatal unit on the computer system.
In the checklist is the care of an ET Tube.
Much of the computerised record is taken from a handwritten form. Mr Johnson says the handwritten notes are kept with the baby by the incubator.
Mr Johnson: "She would have had to get the records for [Child K] from the incubator. Once she had completed that, she would have had to return the handwritten records to the incubator."
3:15pm
During that time, recorded at 6.07am and 23 seconds, an X-ray is taken of Child K, by radiographer Anne Kember, using a mobile machine. The x-ray was taken in nursery room 1.
A video, demonstrating how an intubated baby has an x-ray taken by the mobile machine, is played to the court.
3:21pm
The X-ray reports 'ET Tube in satisfactory position'.
It adds: 'NG Tube [feeding tube] in satisfactory position with its tip in the gastric body'.
Mr Johnson says the time the x-ray is recorded may not be accurate.
At 6.09am, Anne Kember is recorded as entering the neonatal unit. He says the process of the x-ray takes about 10-15 minutes, which means the x-ray happened at about 6.20am.
Within a few minutes of that, the ET Tube was dislodged again.
Mr Johnson says that Lucy Letby was trying to create the impression that Child K, "heavily sedated", had dislodged her own tube.
3:26pm
The third desaturation happened at the time of the handover to the day shift.
A nursing colleague was the shift leader at this time. As she came in, she heard a call for help from Lucy Letby, who was not the designated nurse for Child K.
Letby was at the incubator of Child K in nursery room 1.
3:29pm
The day shift leader, Dr Jayaram, Mel Taylor and nurse Williams went in. The issue was the ET Tube was too far in - by 1.5cm, or about 20% too far in.
The ET Tube was withdrawn and Child K picked up immediately, Mr Johnson says.
He adds this [Child K's ET Tube being dislodged] was the same problem, twice after Dr Jayaram had witnessed it.
"We say that is coincidences too far," Mr Johnson tells the court.
He says Letby had tried to "create the impression" Child K had a problem.
3:31pm
Mr Johnson says Child K was moved to the transport incubator at noon, then handed over to the team taking her to Arrowe Park at 12.25pm.
3:33pm
Later that day, Letby replied to a text by a nursing colleague, saying: "25wkr delivered so fairly busy".
Child K died at Arrowe Park Hospital on February 20. Mr Johnson says the prosecution do not say what Lucy Letby did caused Child K's death.
On April 20, 2018, at 11.56pm, Letby searched on Facebook for the surname of Child K.
3:34pm
Mr Johnson says that "has significance" when taken in conjunction with Letby's other Facebook searches for parents of babies she killed.
3:36pm
Mr Johnson says the case may come down to a single issue - 'do you believe Dr Jayaram saying what he saw? Do you believe he is telling you the truth about what he saw? And if you do, do you accept what we allege Lucy Letby was trying to do, bearing in mind what we have also proved.'
3:37pm
That concludes the prosecution opening.
3:38pm
Benjamin Myers KC, for Letby's defence, now gives the opening statement for the defence.
He acknowledges the sympathy for the family of Child K, and recognises the loss of Child K.
"Nothing I do or say is intended to diminish that."
3:41pm
Mr Myers says "it could be very easy for some people to approach" that Lucy Letby "must be guilty" or, 'equally as bad', that they "don't care if she is guilty or not".
He says if that was the case, the idea of a fair trial would be gone.
He adds this trial jury does not feature such people. He says they are to give a true verdict on the evidence, not one of emotional reaction, or of sympathy, or of anything heard outside the courtroom.
"A fair trial on the basis of the evidence is what this is all about."
3:45pm
Mr Myers says he wished to identify "key issues" for the defence, and this is "an outline", and will not be the same length as the prosecution opening.
He says the defence speech will come after the evidence is heard in the trial.
He adds there is no record of exactly where Dr Ravi Jayaram was or what he was doing at the time Child K desaturated.
3:48pm
He says there are three areas, focusing on aspects of the case, for jurors to keep in mind.
The first is how fragile Child K was, clinically. He says any baby born under 37 weeks is classed as premature. At 25 weeks, Child K was "extremely premature".
He says ideally, Child K would not have been born at the Countess, but at a level 3 unit, providing the most intense and specialised level of care. He says that could not be done as doctors caring for the mother concluded the risk transferring her to a suitable unit was "too great".
The Countess was "not the level of unit designed" to care for the prematurity of the baby.
3:51pm
The second area is the problems of care, including intubation.
He says Child K was struggling to breathe from the start of life, and was unable to breathe unaided, which he says "sadly, is unsurprising", given the level of her prematurity.
He says it is known Child K suffered an oxygen desaturation between 3.45am-3.50am. A reason for that would be the ET Tube moved.
He says the prosecution allegation is Letby deliberately moved the tubing. The defence case is Letby did not do that, and "has been blamed wrongly".
3:54pm
Mr Myers says they will look at how realistic the prosecution's theories are, that Letby deliberately dislodged the ET Tube multiple times, during the trial.
He says the third factor is to look at what people said and did at the time, and to decide whether that is consistent with what the prosecution now allege, in particular Dr Ravi Jayaram.
3:58pm
Mr Myers says Dr Jayaram was the lead clinician on the unit that night, the senior doctor with overall responsibility.
Mr Myers outlines Dr Jayaram's account, that he suspect the tube had been deliberately dislodged, and the alarm was not sounding.
He says Lucy Letby does not remember specifically the events of that night. He says in the background of caring for hundreds of babies, that is "hardly surprising, if she did nothing wrong".
He says the case comes to a "pretty stark issue", that Child K desaturated because Lucy Letby interfered with the ET Tube, or not.
That depends on whether Dr Jayaram's account is true and accurate, or not. He says if it is not, the jury cannot convict.
He says the prosecution and defence are in agreement that the evidence of Dr Jayaram is crucial.
4:00pm
Mr Myers says Letby is not guilty of this allegation. He refers to the previous convictions.
"It is important these convictions do not prove this allegation".
4:01pm
He says however much dramatic impact those previous convictions have, it is crucial that the jury looks on the evidence that happened on February 17, 2016.
He says that evidence "does not support what has been alleged".
4:05pm
That completes the opening statements.
Trial judge Mr Justice James Goss asks if the main 12 members of the jury are able to continue to serve as jurors. They agree.
The two reserve jurors, who have been present today, are released back into the general pool of jurors. They are urged, to preserve the integrity of the trial, that they do not speak about the case to any of the 12 jurors about the case until the trial is all over.
He says the same applies to the 12, not to speak to the two reserve jurors, or anyone else, about the case.
4:07pm
That concludes today's case before the jury, and they are to return to court on Thursday at 10.30am.
He reminds them the case will not be sitting on Friday. Additionally, the case will not be heard before noon on Monday, June 17.
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