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

[Tortoise]

Tuesday 18th June 2024 - no live updates

Chester Standard 10% - link Lucy Letby trial: Repeated intubation attempts 'would not have compromised baby'

Medical notes described Child K at birth as “initially dusky, floppy, no respiratory effort” but the duty registrar on the night, Dr James Smith, told jurors at Manchester Crown Court on Tuesday, June 18 that was “not unusual” for a baby of 25 weeks gestation. [...]

A “sudden deterioration” in Child K’s condition is said to have taken place at 3.50am when her blood oxygen levels dropped, the jury heard.

Dr Smith said he was not in nursery one at the time and returned to see on-call consultant paediatrician Dr Ravi Jayaram to the right of Child K’s incubator and assisting with her breathing. [...]

Tuesday's hearing concluded with Dr Ravi Jayaram giving evidence, which he will continue on Wednesday, June 19.

Manchester Evening News 10% - midday link Medics tried to revive baby allegedly attacked by Lucy Letby, jurors hear

On the fourth day of the trial at Manchester Crown Court, today (Tuesday) the doctor who delivered Child K, Dr Jonathan Ford, told jury the birth had been an 'uneventful breach birth'. [...]

Dr James Smith, a locum registrar in paediatrics at the Countess of Chester Hospital at the time, told the jurors Child K needed assistance to breath in the first minutes of life, when she was considered 'dusky and floppy'. [...]

He said he remembered coming into the room and seeing a consultant, Dr Ravi Jayaram, on the right hand side of the incubator disconnecting the infant from the ventilator and attempting to 'bag' the baby via an endotracheal tube. "He was trying to give breaths through the tube which was the correct thing to do but that was not successful. It's not working," said Dr Smith.

Dr Smith said he himself then took two attempts to successfully re-intubate the baby as he had already done it successfully previously. The infant was given a one-off dose of morphine to help the process, the jurors were told.

The witness told the court it was thought the breathing tube 'had moved and was displaced'. [...]

Dr Smith agreed intubation can cause trauma to a baby like Child K. He acknowledged that the medical notes had documented a 'large amount of blood secretions' but he told the jurors he had no memory of blood being suctioned or seeing any blood in the airways or any trauma. "I have no memory of that," he said. [...]


Manchester Evening News 10% - evening link https://www.manchestereveningnews.co.uk/news/uk-news/death-premature-baby-allegedly-attacked-29376494?

Consultant neonatologist Dr Srinrasaro Babarao agreed the outcome for the poorly newborn, referred to as Child K, may have been better had she been moved from the Countess of Chester Hospital. [...]

However, he concluded her care was 'sub-optimal' when taking into account the treatment she received before her arrival including a potential transfer of mother to Arrowe Park before the birth. He concluded the death was 'potentially avoidable' had the mother been moved before the delivery.

He cited 'multiple reasons' for his conclusion including that outcomes 'are different' at more advanced 'tertiary centres'. He said there were delays in transferring Child K to a tertiary centre and delays in providing fluids, antibiotics and nutrition as well as three 'accidental extubations'.

Pressed by the judge Mr Justice Goss, Dr Barbarao confirmed he used information provided to him by the transport team who moved Child K to Arrowe Park for his review and had not had the benefit of medical notes from the Countess of Chester Hospital. [...]

Dr Ravi Jayaram, a consultant paediatrician who was called into the Countess of Chester Hospital on the night of the birth, told the jurors it was 'entirely appropriate' that he was summoned to assist Dr Smith.

Asked whether he should have intervened earlier, Dr Jayaram pointed out there was 'good chest movement' suggesting oxygen was reaching Child K so it was 'appropriate' for Dr Smith to conduct the intubation. He added that if it had been a struggle to ventilate the baby or they needed to secure an airway sooner, he would have taken over following the second attempt to intubate the baby.

He confirmed his notes suggested that, following the birth, Child K was 'pink', not floppy, her pulses 'felt normal' and her tone was 'good'.

 

[Tortoise]

Wednesday 19th June 2024 - no live updates

Chester Standard early report - 10% - Doctor 'saw no evidence’ of Lucy Letby helping deteriorating baby

[...]

Giving evidence on Wednesday, June 19, Dr Jayaram said he was sat at a desk at the nurses’ station near to the intensive care room on February 17 when Child K’s designated nurse told him she was heading to the labour suite to speak to Child K’s parents and Letby would cover for her.

He told the court: “At this time, we had had a number of unusual incidents with babies, and a number of colleagues and myself had noted the association with Lucy Letby being present at these things. [...]

“I stood up and walked in. I saw on the screens that (Child K’s) oxygen saturations were dropping. They were in the low 80s and going downwards.

“Lucy Letby was stood next to the incubator. She wasn’t looking at me. She didn’t have her hands in the incubator. She was definitely facing in my direction.

“As I approached, I said ‘what’s happened?’ and Lucy looked up and said ‘it looks like she is desaturating’.” [...]

He went on: “I didn’t look to see whether the button that can cause the alarm to be suspended was pressed but the saturations were going down and continued to go down.

“There was no alarm and had an alarm gone off, that would have been my prompt to go in. The alarms are loud. If an alarm had gone off, I would have heard it.” [...]

Mr Johnson asked: “Is it possible for a child of this age and in her condition to move her own tube?”

Dr Jayaram said: “It’s a possibility but I have never seen it in a baby of this gestation. The tubes are secured in a fairly robust way. It would be difficult to move. It would take quite a lot of movement from a baby to dislodge a tube.”

[...]

Chester Standard later report - 10% Doctor 'feared retribution’ if he called police on Lucy Letby

[...]

Ben Myers KC, defending, said to the witness: “Why didn’t you pick up the phone to the police?”

Dr Jayaram said: “I think if people were not aware before, people are probably aware now since events in August of the culture for clinicians in the NHS who raise concerns. There was a strategy really to keep us quiet. People didn’t want to listen to us acknowledging problems.

“All that would have happened had I picked up the phone to police is they would have got in touch with the trust, spoken to the medical director and said ‘just ignore them, they are a bunch of complaining paediatricians’.

“If I had known then what I know now I would have found different ways to escalate our concerns. [...]

“We were already told it was inappropriate to involve police, even from June 2016 when the unit was downgraded and Lucy Letby was moved from clinical duties.

“We were being advised from the start that the police would be the wrong route. And the trouble is, it’s a matter of infinite regret that I didn’t handle it differently. If we had actually not had faith in those that were supposed to have been guiding us.” [...]

Mr Myers said: “You didn’t go to any management saying ‘I’ve caught Lucy Letby red-handed, the only possibility is she deliberately dislodged the tube’. You didn’t say that to anyone.”

Dr Jayaram said: “Not formally.”

Mr Myers said: “And you didn’t because it didn’t happen in the way you said it happened.”

Dr Jayaram replied: “I disagree. I mentioned before about thinking the unthinkable, we didn’t believe that people who worked in healthcare go to work wanting to cause harm. There was also knowing that I probably wasn’t going to be believed because we already had issues with not being believed at this stage.” [...]


Manchester Evening News early report 10% - https://www.manchestereveningnews.co.uk/news/greater-manchester-news/lucy-letby-retrial-consultant-tells-29381144?

[...]

Pressed by the KC on what Letby said to him when he arrived, the doctor said: "I don't remember the precise words. It was along the lines of she's desaturating. There's nothing specific I can remember." The medic told the jury he thought there had been an 'issue with the tube' and he did not believe the tube had been blocked because he found no 'massive plug of mucus'.

The doctor agreed it was possible for a baby to move the tube themselves but he told the jury: "I have never seen it in children of this gestation." He said tubes were secured in a 'fairly robust way' with clips and tape and that it would be 'difficult to move'. He said: "It would take quite a large movement for a baby to dislodge it."

[...]

Manchester Evening News later report 10% - https://www.manchestereveningnews.co.uk/news/uk-news/lucy-letby-retrial-consultant-admits-29383774?

[...]

This afternoon jurors in the former nurse's trial were shown an ITV interview with Dr Ravi Jayaram, who had been brought in to oversee the care of the baby, in which he told Paul Brand the 'only possibility' for the infant's sudden collapse was the deliberate dislodging of a breathing tube. "This is a night that's etched on my memory and will be in my nightmares forever," the doctor said in the interview.

[...]

As the trial resumed at Manchester Crown Court today (Wednesday), Ben Myers KC, defending, asked Dr Jayaram whether he was telling the truth when he said in the ITV interview that the 'only possibility' was that the breathing tube had been deliberately dislodged.

The medic answered 'yes' and went on: "I walked in and things that should have been happening weren't happening."

[...]

The witness agreed he would call 999 if someone was harming a member of his family.

The KC suggested to Dr Jayaram it was his maternity unit, that the witness had previously said patient care was paramount and that the reason he had not called police was because 'you didn't see anything worthy of calling police about'.

The doctor replied: "I disagree."

"That's the truth isn't it?" asked the KC, and the doctor again said he disagreed and said the incident happened 'in front of me'. He went on that there was 'an element of fear of retribution from people above me'.

[...]

 

[Tortoise]

Thursday 20th June 2024

Chester Standard live updates - link Recap: Lucy Letby trial, Thursday, June 20 - prosecution continues case

10:40am
Trial judge Mr Justice James Goss and the jury have entered the courtroom, and the trial resumes.

10:44am
Nicholas Johnson KC is asking questions of nurse Joanne Williams, neonatal practitioner, who worked at the Countess of Chester Hospital in February 2016.

10:50am
The court hears Joanne Williams was the designated nurse on February 17 for Child K.
Child K was her "sole responsibility" that night, with other children being reallocated to other nurses after Child K's birth.

10:55am
Ms Williams says the security of the ET Tube is checked upon Child K's arrival at the neonatal unit nursery room.

11:17am
Ms Williams is asked to look at the intensive care chart, the readings are in her writing for 3.30am. Writing for an event timed at 3.50am at the bottom of the chart, for the morphine administration, is in another person's writing.
Mr Johnson asks about a few readings on the 3.30am chart, the 'leak 94' reading, the 'VTE 0.4' and the oxygen saturations of 94. Ms Williams says she cannot remember recording them. She said she noted the 94 leak reading at the time, and her job was "to escalate that".
She adds that clinically, Child K looked well, but she would escalate that reading to Dr James Smith or Dr Ravi Jayaram.

11:19am
Ms Williams says it was "very important" to keep the parents updated.
She says at 3.30am she did "a lot of things" in relation to observation. She said in her statement she had left the unit at 'approximately 3.30am'. She adds the readings taken for 3.30am would not necessarily be recorded at 3.30am exactly.

11:26am
Mr Johnson asks about the time Joanne Williams went to see Child K's parents. She says the labour ward was next to the neonatal unit.
Door swipe data is shown for Joanne Williams at 3.47am, which the court hears is her going from the labour ward to the neonatal unit.
Mr Johnson asks how long, to her recollection, had she been with Child K's mother. Joanne Williams says it is difficult to say, given it was eight years ago, but she says she would not have been gone for long knowing the condition of Child K, and that it was important to update the mother.

11:30am
Ms Williams says she wouldn't know, at the time she planned to leave the neonatal unit, which other nurses were available to look after Child K in her temporary absence.
She adds that she was aware Dr Jayaram was on the unit. She does not recall speaking to him as she left, from memory, but said it would be normal practice to do so.
She adds Child K would be stable. She says she had "important information" to relay to parents.
She says she would have checked the ET Tube was in position as part of the 3.30am checks.

11:33am
Ms Williams says she would have been "very conscious" to come back to Child K, knowing of her condition.
On her return to the neonatal unit, she recalls "alarms going off" from nursery 1, adding "we are trained to respond to them".
She says people were in the room, including Lucy Letby and Dr Ravi Jayaram being there.
NJ: "Was this an emergency?"
JW: "Yes, we were responding to alarms." Ms Williams says she cannot recall the saturation levels, or what Lucy Letby or Dr Ravi Jayaram were doing at the time. She does not recall being part of the resuscitation efforts, but believes she would have been.

11:37am
Nursing notes by Joanne Williams, written retrospectively, are shown to the court.
The note '?ETT dislodged' is read out. Ms Williams agrees that was the working theory at the time.
About the 'large amount blood-stained oral secretions', Ms Williams says she would have seen it, so recorded it.

11:41am
Ms Williams says she recalls that night, from her notes, Child K desaturated a number of times. She does not recall why the desaturations happened a second and third time, or have any memory of those events outside of her nursing notes from that night.

11:54am
The trial is resuming after a short break.
Benjamin Myers KC, for Letby's defence, will now ask Joanne Williams questions.

11:57am
Ms Williams agrees the neonatal unit work is a "team effort". She agrees that although nurses have designated babies, they can - for example - write observations for other nurses' designated babies.

12:07pm
A stock book for the morphine dose was kept on top of a locked fridge in a store room, that room being located near one of the nursing stations in the neonatal unit.
The morphine was recorded as being taken out of the fridge at 3.30am. Joanne Williams is one of the two co-signers. Ms Williams says that morphine would not be applied to the baby instantly as, coming out of the fridge, it is cold.

12:11pm
Ms Williams says she does not remember the specific time she had been gone from the neonatal unit [to see Child K's parents], but from her notes at the time she says she would have left the unit at about 3.30am.

12:20pm
Ms Williams says the morphine infusion would have been prepared as Child K was already intubated. The time of infusion started is noted as 3.50am.

12:22pm
Ms Williams is asked about tubes dislodging. She says 'certain babies' can dislodge tubes. She adds pre-term babies can be active, and dislodging a tube "can happen". She adds she did not have much experience with 25-week gestation babies.

12:23pm
Ms Williams is asked about her return to the nursery room 1. She says she remembers Dr Jayaram asking her 'What's happened?' and who was in the room at the time. Ms Williams agrees that in her statement from 2018 she had said she wasn't there, she had been speaking to the parents.

12:29pm
The judge asks a question about a 25-week gestation baby being active.
Ms Williams says at the time she had little experience of dealing with 25-week gestation babies.

12:42pm
The trial is resuming after a short break, with Simon Driver now prosecuting.
Giving evidence next is a nurse who cannot be named due to reporting restrictions. She was a neonatal nurse shift leader at the Countess of Chester Hospital in February 2016.
She says she has some independent memory of events that day. She was part of the day team which began the shift at 7.30am.

12:50pm
The nurse recalls there was a handover 'huddle' which took place at about 7.25am. At that point Lucy Letby gave a 'call for help' from nursery 1 and all nursing staff and Dr Jayaram went into the room.
She says Lucy Letby had her hands in the incubator, 'Neopuffing' Child K. The nurse said she didn't know the baby at all, and the handover had not taken place at this stage. She recalls other nursing staff and Dr Jayaram went to help, and had noted the ET tube had moved in Child K further than it should have gone, so the tube was removed.
Child K was placed back on the ventilator and the handover continued.
The nurse said she pre-empted that she and nurse Melanie Taylor - Child K's designated nurse - would both be looking after Child K, knowing the gestation and clinical picture for Child K at that point.
The nurse remembers drawing up medication and writing notes for observations and transfer for Child K. Charts are shown to the court showing observation readings initialled by the nurse.

12:55pm
Mr Myers says there are no questions on behalf of Lucy Letby for the nurse, and her evidence is completed.

2:05pm
The trial is now resuming following the lunch break, with the jury back in.

2:18pm
Analyst Kate Tyndall is recalled to give evidence.
Nicholas Johnson KC refers to a line in the neonatal review, regarding a self-extubation for a baby [not Child K] during February 17 at 3.20am.
Ms Tyndall says, in light of the questioning and from reviewing the chart, she says this event happened 24 hours earlier, on February 16.

2:32pm
Amendments to the neonatal schedule in respect of this baby are being relayed to the court.
The jury is told they will receive a hard copy of these amendments by tomorrow.
The court hears the source of the misunderstanding was from undated charts and readings which looked like they referred to the morning of February 17, but when checked with relevant nursing notes, were found to relate to readings made on February 16 and February 18.

2:38pm
Mr Myers rises to clarify how these amendments came about.
He says a page of readings for February 16 ended up in the February 17 order.
He says Ms Tyndall went back to check, and then found that page out of sequence in the order of documents she had been provided by the hospital. Ms Tyndall says that was how the assumption was made.
Mr Myers says there is no criticism to be made.

2:39pm
Simon Driver, prosecuting, is now reading a witness statement on behalf of Anne Kember, a now-retired consultant radiographer who at the time was working at the Countess of Chester Hospital.

2:48pm
Ms Kember describes the process of the portable x-ray machine being used. She confirms she took Child K's x-ray.
The timing of the x-ray on the machine - at 6:07 and 23 seconds - is known to be wrong, Ms Kember says. She adds staff did not know how to change the machine's internal clock.
A statement by Shawn Anderson is also read out. He says the date and time on the x-ray machine was not calibrated.
The judge says, to clarify, the time on the machine was not accurate, but the door swipe data by Anne Kember into the neonatal unit at 6.09am is accurate. The x-ray process took several minutes.

2:49pm
A witness statement by a doctor who cannot be named due to reporting restrictions is read out by Mr Driver.
He said he was working the day shift on February 17, and inserted an arterial line for Child K.

2:54pm
A statement by nurse Caroline Oakley, who was on the night shift at the neonatal unit, is now read out. She says she has no memory of the night shift or Child K, and her recollection is based on medical notes from that night.
The statement says she has no memory of the first desaturation. She says she knows of occasions in the past where an ET Tube has slipped, and of occasions in the past where a tube has been faulty, but cannot say if that was the case here.

2:58pm
A statement by nurse Melanie Taylor is read out. She recalls throughout the morning of February 17, on the daytime shift, Child K's ventilation requirements increased ahead of the transport team's arrival.
A series of medication doses was given to try and raise Child K's low blood pressure, which eventually saw some effect.
At 12.40pm, the transport team took Child K to Arrowe Park Hospital.

3:04pm
A statement by clinical engineering manager Stuart Eccles is read out. His statement is in relation to ventilator system monitors.
He says the hospital's touch-screen monitors are stand-alone, and not networked. He adds nurses will get their observations from the monitor readings and observing of the babies. He adds when monitors record readings which are outside of a preset range, the alarm will sound. The alarm system can be paused with a one-minute countdown, with a visual countdown to the alarm going off. The user can press it again after that minute to pause it for a further minute.
He adds it is possible to pause the alarm in advance of treatment.
It is also possible to silence the alarm with the 'silence alarm' button. In this instance, the alarm will present as a visual indicator.

3:06pm
A seven-minute video demonstrating what an incubator is and how it works is shown to the court.

3:13pm
That concludes the hearing for today. Jurors are told the case will resume at 10.30am tomorrow, and not to discuss it or conduct independent research.

 

[Tortoise]

Thursday 20th June 2024

Manchester Evening News report - https://www.manchestereveningnews.co.uk/news/greater-manchester-news/lucy-letby-retrial-told-certain-29392266?

 

[Tortoise]

Friday 21st June 2024

Chester Standard live updates - Recap: Lucy Letby trial, Friday, June 21 - prosecution continues case

10:28am
The courtroom is filling up with press, public and lawyers. Lucy Letby, the defendant, is also present in court.

10:34am
The judge and jury have come into court.
The trial is now resuming, with jurors presented with pages of 'agreed facts'.

10:36am
Simon Driver, prosecting, reads out agreed facts in relation to how the neonatal unit at the Countess of Chester Hospital was accessed, through swipe cards.

10:43am
The jury hears the Countess of Chester Hospital was reclassed as a level 1 unit in July 2016. The decision was made by the hospital trust itself.
The court also hears no post-mortem examination was carried out for Child K.
Mr Driver says another agreed fact is Lucy Letby was arrested on three occasions, listing when and where they happened - once in Chester, and twice at her parents' home in Hereford.

10:47am
Mr Driver explains when Lucy Letby was interviewed by police. A total of 13 interviews took place in July 2018 over three days. In June 2019, she was interviewed 14 times over three days. In November 2020, there were three interviews.

10:52am
Mr Driver says items seized from Letby's Chester address included a smartphone, the digital contents of which were extracted and are the source of the messages presented as part of the trial.
A digital forensic investigator later accessed her Facebook and email accounts, which included Facebook searches.
Walkthrough videos at the Countess of Chester Hospital, showing the layout and equipment, were presented by staff not involved with the case.

10:54am
Mr Driver reads out an agreed fact in relation to Letby's murder and attempted murder convictions. Letby was convicted last year of the murders of seven babies and the attempted murders of six other infants at the Countess of Chester Hospital between June 2015 and June 2016.

11:02am
More videos are played to the courtroom, the first demonstrating how a Neopuff breathing device works, which is used during resuscitation, stabilisation and pre- and post-intubation.

11:15am
The other video is also related to the Neopuff device.
Mr Driver reads out further agreed facts to the court in relation to definitions of trained medical staff, and how many of each staff were employed at the relevant hospital departments.
A further video is shown to the court, demonstrating a 'Neo Wrap' - used for extreme pre-term babies. Special padding is placed under the baby and the baby is placed in a type of plastic bag, with their head staying out, for extra protection and insulation.

11:26am
A witness statement is read out from Dr Arnand Kamalanathan, who was at Arrowe Park Hospital.
He had a role in transferring Child K to the hospital. He was made aware of Child K's gestational age and birth weight of 692 grammes. He said he and the transport team would have arrived at the Countess of Chester Hospital just before 9am, in an ambulance with blue lights active.
He says there were "some episodes" where Child K's oxygen saturations dropped. He says he introduced himself to the parents, and examined Child K, including the positioning of the ET Tube.
Fluids were increased for Child K, and the oxygen requirement had gone up to "high amounts".
He shared his "concerns" about Child K with the parents, in relation to high oxygen requirements and low blood pressure.
An x-ray was requested to check the ET Tube positioning, and that there was no leak.

11:32am
A plan was made to transfer Child K at 1pm. He adds that when they arrived, Child K was "unwell", and it was "not uncommon" for a 25-week gestational age baby to require high oxygen.
He adds the team would have used blue-light ambulance to transfer to Arrowe Park. Dr Kamalanathan notes he had a conversation with the Arrowe Park team to prepare them for Child K's arrival. The transfer itself was "uneventful".
Child K was "still unwell" upon arrival at Arrowe Park.
A second statement from the doctor reaffirms that he did not have to reintubate Child K during the transfer.

11:33am
Another statement from Dr Danielle Gardner, now a paediatric cardiologist at Alder Hey Children's Hospital but at the time working at Arrowe Park Hospital, is read out by Mr Driver.
She explains what facilities Arrowe Park has to offer for babies born from 23-week gestational age.

11:41am
Dr Gardner refers to the care of Child K for February 19-20, 2016, where the baby girl's condition was deteriorating.
Child K's parents were updated, and Child K was baptised.
The baby girl was on 100% oxygen requirement and her blood pressure had worsened. The parents were informed that Child K was unlikely to recover.
The parents asked Dr Gardner if now was 'the right time' to withdraw treatment for Child K. Dr Gardner advised it was.
Child K was taken to her parents for cuddles.
The baby girl died at 5.28am. The cause of death was noted at severe respiratory distress and extreme prematurity.

11:59am
The trial is now resuming.
Detective Sergeant Danielle Stonier, of Cheshire Constabulary, is called to the courtroom. She confirms to Mr Driver she conducted some of the interviews with Lucy Letby.

12:03pm
Members of the jury have a transcript of some of the police interviews in their jury bundle.
The court hears the interviews overall covered other babies than Child K, while the jury will hear and read about interviews only concerning Child K.
The relevant parts of the 2018 video interviews are now played as a compilation to the court.

12:11pm
Lucy Letby, in the 2018 police interview, is asked about Child K. She says she does not remember the '3.50am event' on February 17 'with any clarity', and her memory of Child K was it "she was a tiny baby".
She says she can read from the notes that Child K's ET Tube had slipped, from reading Melanie Taylor's notes. She says she "does not remember" being present when that happened.

12:13pm
Letby says she does not remember the other events for Child K that night.

12:26pm
A video from Letby's 2019 police interviews is now played to the court, with Letby asked questions about Child K.
Asked about whether she was stood by Child K's incubator at the time, she says she does not remember. Asked if she agrees she was standing there 'doing nothing' while Child K's saturation levels were dropping and alarms were switched off, Letby says she does not agree.

12:38pm
A short adjournment is taking place while a technical issue with the video is resolved.

12:46pm
The adjournment will be longer than first thought, and the trial will instead resume at 2.15pm.

2:14pm
The courtroom is filling up once more, following the lunch break, with Lucy Letby present.

2:16pm
The judge, Mr Justice James Goss, and the jury have also returned, so the trial resumes.

2:21pm
The remainder of the relevant parts of Letby's 2019 police interview is played to the court. The jury has access to the transcript so members are able to follow as footage is played.
The November 2020 interview is now played. Due to Covid restrictions in place at the time, all in the interview room are wearing some form of face masks.

2:28pm
The judge says it was "difficult to hear" the footage on the video, particularly if you didn't have the transcript.

2:33pm
Letby was asked about why she might not react to a baby's saturation levels dropping. She replied she might have been waiting to see if she self-corrected.
A written statement by nurse Elizabeth Morgan, nursing advisory consultant, is read out by Mr Driver. She gives her 'professional opinion' on the situation. She says it is "very unlikely" that a nurse would leave the incubator unless they were confident the baby was stable and the ET Tube was in place, and would alert a nursing colleague to tend to that baby if an alarm should sound in their absence.
She adds in her professional experience, in a poorly saturating baby of Child K's gestational age, it would be 'standard good nursing practice' to observe the baby, ascertain any cause in changes and take any corrective action, calling for help from staffing members if necessary. A series of checks would be carried out, including if the ET Tube had been dislodged.
She added: "I do not believe it would be normal nursing practice to wait and see if the baby self-corrected."

2:34pm
That concludes the case for the prosecution.

2:37pm
Mr Myers says it would be preferable for the defence case to begin on Monday, with the defendant expected to be giving evidence.
The judge says he has regard to timetabling and the appropriate course would be to start the defence case on Monday, with a view to seeing the defence case end on Tuesday.
The judge says the week after next (as the court is not sitting on Wednesday, Thursday, Friday), he will give legal directions and sum up the case.
He adds it is likely, at this stage, the jury will begin their deliberations that week (week commencing July 1).

2:38pm
That concludes the case for this week, and the trial will resume on Monday, June 24, at 10.30am.

 

[Tortoise]

Monday 24th June 2024

[LUCY LETBY'S EVIDENCE IN CHIEF]

Chester Standard live updates - Recap: Lucy Letby trial, Monday, June 24 - Letby gives evidence

9:04am
The defence case is expected to begin today, with the court hearing that this part of the trial is expected to last two days.
In any event, the court will not be sitting on Wednesday, Thursday or Friday this week.

10:44am
The trial judge has entered the courtroom, which has a packed public gallery, and members of the jury are coming in.
The trial will resume, with the defence case beginning.
Lucy Letby will be giving evidence.

10:47am
The judge apologises for the late start.
Nicholas Johnson KC, prosecuting, says there are minor amendments to be made to their jury bundle, which include adding page numbers to the interview transcript. Those are being presented for the jury first.

10:51am
Lucy Letby is called to give evidence.

10:52am
Benjamin Myers KC, for Letby's defence, is asking questions.
Letby denies attempting to kill Child K. She denies intending to do the baby girl any harm at all.

10:52am
Mr Myers raises the issue of previous convictions.
Letby denies she has ever harmed, or attempted to harm, any baby in her care.

10:55am
Mr Myers refers to the events of 3.45-3.50am on February 17, 2016. Letby says she has no recollection of that event.
She says she does have a memory of seeing Child K in nursery 1 at some point, but "cannot be specific with timings".
Mr Myers raises Dr Jayaram's evidence.
Letby says she does not recall anything like that happening, or of the consultant doctor coming in when she was present. She does not recall saying 'she has just begin to desaturate'. She says she does not remember being there in those circumstances.

10:56am
Asked to clarify, Letby denies accepting that it happened.
Asked about Letby's Facebook search in April 2018 for Child K's surname, Letby says: "I'm not sure, I don't have any recollection of why I did it."
She denies it was linked in any way to do her harm.

11:01am
Mr Myers raises the police interviews that Letby was in.
In one of them, Letby was asked about the 3.50am event, and what contact Letby had with Child K.
She said at the time she did not recall why she was in the nursery.
Mr Myers asks about the co-signing of morphine at 3.50am. Letby was asked if that helped her memory, and she said she did not.
Letby says for the police interview, she had a selection of charts and nursing notes, to assist in her memory.
She says she does not have an independent memory for that.
She says the 3.50am time would have come from the prescription charts, and not from her memory.

11:06am
The police interview asked how Letby knew the ET Tube had slipped.
Letby had said in the interview it was from reading nurse Melanie Taylor's notes. She says "she was relying on documentation that was in front of her".
The notes are shown to the court, and are from the day shift, written retrospectively at 4.06pm.
'Written for care handed over from 0730...'
'As commencing shift, ETT ? slipped, loss of colour...saturations dropped...Dr Jayaram resecured ETT...'
Mr Myers asks if Letby was referring to any event around 3.50am.
Letby: "No, I was just relying on these notes."

11:07am
Letby said she remembered Child K: "She was a 25-week gestation baby, which was unusual on the unit.
"I do remember her being on the unit at some point."
Letby has no recollection of any events associated with Child K on the unit.

11:08am
The 2019 police interview is referred to, which includes Dr Jayaram's recollection of the event.
Asked by Mr Myers, Letby says she does not agree that anything like Dr Jayaram's account happened.

11:11am
Mr Myers asks about the sedation for Child K. Letby had agreed Child K was sedated, which she had seen from Melanie Taylor's notes.
Mr Myers asks why Letby was agreeing. Letby says she was relying with what she had in front of her. She says she did not have notes from the time of the event.
Asked if she agreed that she was present in room 1 when Dr Jayaram came in, Letby says: "No."
Letby had also said in interview: "I didn't dislodge her tube."
Asked about that: "Because I didn't dislodge her tube and that is what I thought I was being asked at the time."

11:13am
Mr Myers asks if Child K was 'paralysed' at the time of the first event. Letby says: "No."
Asked why she had agreed, in police interview, with Dr Jayaram's account that Child K was paralysed at 3.50am, Letby says: "I took Dr Jayaram's word to be the truth."

11:16am
Mr Myers asks about an 'earlier' moment where the ET Tube slipped. Letby says it was referred to in Melanie Taylor's notes.
Letby says Child K was not paralysed as she has not seen any medication notes prior to 3.50am for Child K which would effect that.
Letby adds there is a difference between sedation and being paralysed, in terms of the medication administered to effect that.

11:19am
Letby denies being the person present to call for help in room 1. She had said in police interview she would not know why the alarm would be silenced.
Asked about it, she said she could have been "possibly waiting to see if she [Child K] self-corrected" when Child K's saturation levels dropped.
Letby says she was "trying to be helpful" to police and "think of reasons why" she would be in the nursery at the time.
She denies accepting she was in the nursery at that time.

11:25am
The police interview asked Letby about telephone messaging in connection with Child K.
Letby says "it happens frequently" that nursing colleagues message each other about babies. The court is shown an example of that messaging between Letby and a nursing colleague. The colleague is the first to bring up Child K, and Letby responds with details about the baby girl's potential arrival.

11:27am
A message conversation with another colleague, Ailsa Simpson, is relayed to the court. Ms Simpson refers to a '24wkr', which Letby confirms to the court is Child K.

11:29am
Letby is asked about her shift that night on February 16/17. She says she was in room 2, but would go to other rooms to assist other nurses with their babies, or collect medications. She adds room 1 is where most of the medications are kept, for use for the whole unit.
"It was a busy [room], people would be in and out of the nursery [that night]."

11:32am
Letby confirms she was designated nurse for two babies in room 2 that night. A colleague, Sophie Ellis, assists with co-signing of medication that night. Mr Myers says from the chart, Sophie Ellis is designated nurse for babies in rooms 3 and 4.
Letby says it is not a problem that colleagues from other nurseries come to help co-sign, as two nurses are required for such tasks. Asked what would happen to babies in those other nurseries, Letby says a nurse would be asked to look out for those babies while the designated nurse was away from them.

11:35am
Letby says it was "common practice" for her and colleagues to assist other nurses, and she would not have an independent recollection of such assistance.
Mr Myers refers to events and duties from that night, and asks Letby to explain what they were. One of them is a feed via a naso-gastric tube for a baby in room 2 at 12.30am. Letby explains the process.
Mr Myers asks if the feed starts at exactly 12.30am. Letby: "No." Mr Myers says if that time noted gives an idea of how long the process takes. Letby says it does not, and the process of an NGT feed would take approximately 15-20 minutes.

11:37am
Letby says the nursing notes of entries such as '1am' are "an approximation", such as taking observation readings, and would not necessarily be at 1am exactly.

11:40am
Mr Myers refers to the 3.30am readings. Letby is noted as carrying out a feed and observations for a baby that is not Child K.
Letby is also recorded, at 3.30am, as being a co-signer on a log book for getting a 50ml morphine syringe out of a storage fridge. Letby says that was the time when it was withdrawn from the fridge. She adds it would take time for that morphine syringe to warm up to room temperature, and would not be used immediately.
She adds that time it was taken out would be "as accurate" as they could.

11:49am
An observation chart for a baby which Letby was caring for that night (not Child K) is shown to the court.
Letby has signed observation readings for the baby at 9.30pm, 12.30am, 3.30am and 6.30am.
A feed chart is shown for the baby. One of the readings is for 3.30am. She says "this would take a period of time". Asked about an 'average' of time, she says "about 10-15 minutes", which would be longer if there was also a nappy change. She adds the feed would not necessarily be commenced at 3.30am exactly.

11:51am
Letby says she can see from the notes, she had changed this baby's nappy at the 3.30am feed.

11:53am
Mr Myers asks if Letby has any memory of the 3.50am desaturation for Child K.
Letby says she does not, and has no memory of being asked to look after Child K by Joanne Williams.

11:59am
Letby says she has no memory of the circumstances which led her to being involved in the morphine administration for Child K at that time. She is listed as a co-signer for it.
Asked about the 3.30am 'morphine commenced' reading on the fluid chart, Letby says that time would be an 'approximation'.
The chart also shows, in Letby's writing, '0350 100mg kg morphine'. Letby says she does not remember writing that note.
An infusion chart for the prescription of the morphine syringe is shown. Dr Jayaram has signed for the prescription at 3.50am as the doctor's signature. Letby and Joanne Williams have signed for the nurses' signatures. The '3.50am' time is in Dr Jayaram's writing, Letby says.
Letby says the time could not have been before 3.50am.

12:02pm
Letby is noted, on the schedule, as co-signer for a baby (not Child K) that Caroline Oakley was designated nurse for a baby in nursery 1.
Later that night, Caroline Oakley and Lucy Letby are co-signers for medication for Child K. Mr Myers asks if either of them were the designated nurse for Child K. Letby says they were not. Mr Myers asks if there was any significance to that. Letby says there is not.
Letby later adds admission records for Child K on a computer shortly after 6am. The timing on the computer system is accurate, the court hears. She says she does not recall writing the records.
Letby denies interfering with Child K's ET Tube moments later.

12:05pm
A chart for a saline bolus is prescribed for Child K, signed for by Dr Jayaram and administered by Caroline Oakley and Lucy Letby at 6.25am. That timing would be accurate, Letby says.

12:06pm
Letby is asked about the third desaturation. She says has no recollection of it.
Letby's last involvement with Child K recorded is around that time. The court hears her night shift finished around 8am, and she had no further involvement with Child K after that point.
Letby denies trying to hurt Child K, or trying to interfere with her to give the impression she was more unwell.
Letby: "No, absolutely not."

12:07pm
That concludes the questions by Mr Myers.
The court will take a 20-minute break.

 

[Tortoise]

Monday 24th June 2024

[LUCY LETBY'S CROSS-EXAMINATION]

Chester Standard live updates - Recap: Lucy Letby trial, Monday, June 24 - Letby gives evidence

12:33pm
The trial is now resuming.
Nicholas Johnson KC, prosecuting, will be cross-examining Lucy Letby.

12:36pm
Mr Johnson says having a 25-week neonate at Chester was 'very unusual'. Letby: "Yes."
Letby says she had seen quite a few before at Liverpool Women's Hospital, but not at Chester.
She says she remembered seeing Child K.
Mr Johnson says when police came to see her in 2018, she recalled Child K.
Letby says she cannot recall much of her police interview.
Letby is asked about her April 2018 Facebook search for Child K. 11 weeks later, she was arrested by police.
Letby says she does not recall why she was searching for the child's surname.

12:38pm
Mr Johnson says if a nurse deliberately displaced the ET Tube on a child of Child K's gestation, what would likely happen?
"That's a hypothetical question."
Mr Johnson says why wouldn't you?
LL: "You would cause harm to the baby... they can't breathe without that tube."
Mr Johnson says if action isn't taken to correct it quickly, it would be likely to severely compromise their prospects of survival.
Letby agrees.
"That is what you did, isn't it?"
"No."
"You actually did it three times."
"No."

12:39pm
Mr Johnson refers to the first event of about 3.50am. Letby says she is not sure of the precise timing.
"It had happened by the time Joanne Williams came back into the unit [at 3.47am]?"
"Yes."
Letby adds: "I know my actions and I know I did not displace that tube."

12:40pm
Mr Johnson refers to Dr Jayaram's account, asking if he is not telling the truth.
LL: "I don't think I can comment if he is telling the truth, all I know is that did not happen."
Mr Johnson refers again to the doctor's account of events.
NJ: "You're saying that cannot be true?"
LL: "Yes."

12:41pm
Mr Johnson refers to the second event, just after an x-ray, when the tube was 'in the correct place'.
Letby says she cannot remember the event.
The third event had come after the day shift nurse came in. Letby says she cannot remember that event.
She says she cannot comment on that nurse's account of events [whether it was true or not].

12:44pm
Letby: "I don't believe I stood there while that tube was dislodged." [re: the first event]
Letby says for the third event, the nurse 'might be right' of her account of events, when the day shift nurse described Letby Neopuffing Child K.
NJ: "You are just that sort of person [who kills babies]."
LL: "No."
NJ: "You have killed seven babies and tried to kill six others, one on two separate occasions."
LL: "No, I haven't."

12:47pm
Mr Johnson refers to Letby's 2022 defence statement. At the beginning, Letby dealt with general issues, then by the cases on a baby-by-baby basis. Letby agrees.
Mr Johnson refers to the section involving Child K. He asks whether, when she signed it, she made sure what was said in there was true. Letby agrees.

12:52pm
Mr Johnson says he wants to clarify two paragraphs in the statement, which refer to allegations raised her, and her grievance procedure against the hospital.
She adds she 'does not accept the good faith of Dr Jayaram...during this [grievance] process or generally'
"What did you mean by that?"
"That I didn't accept any of the things that had been raised by that point."
Mr Johnson says after being removed from the unit in July 2016, Letby raised a grievance procedure.
Letby agrees she did not accept the good faith of Dr Jayaram during that procedure.
Asked why, LL: "Because of the comments he has made and things that came to light [during that procedure]...and the way he was conducting himself [in those allegations.]"
The statement adds: 'The grievance was resolved in my favour...but it is apparent they [Dr Ravi Jayaram and Dr Stephen Brearey] have been set against me for some time.
"That is obvious from their witness statements and for some of their conduct towards me [from 2015]."
NJ: Are you saying to the court that Dr Jayaram's conduct towards you in 2015-16 gave you a justifiable cynicism to his good faith?
LL: Yes, when I found out his actions, yes.
NJ: At the grievance procedure was resolved in your favour, you were vindicated, weren't you?
LL: Yes.

12:58pm
Mr Johnson says in police interview, Letby had gone on the basis that what Dr Jayaram had said was true.
Letby says she had assumed that police had established fact from what was being put to her, potentially from other people's accounts.
Letby agrees that the allegation depends on what Dr Jayaram had said.
She says when interviewed by police [in 2018], she had assumed what had been said to her could be factually backed up.
Letby says at the time, she was looking at ways that could have factually happened.
Mr Johnson says that was also the case in the 2019 interview.
Letby says she has never accepted his version of events. She said she was not remembering.
Mr Johnson says what Letby is saying now is not what she was saying in police interview, that she did not accept Dr Jayaram's account of events.
"I think it's difficult to look at the context of the interview."
Letby is asked what she means by that.
"At the time I had a lot of different notes I was looking at...but I don't think I ever accepted [that version of events]."
Mr Johnson says there was no shift in Letby's position over the police interviews.

12:59pm
Letby says she had made it clear at police interview that she had not dislodged the ET Tube.

1:03pm
Letby says it is still her case that Child K was not properly intubated, with problems relating to the size of the ET Tube used, and there were other 'issues' with her care.
NJ: "Maybe someone dislodged her tube?"
LL: "Well it wasn't me."
NJ: "Maybe somebody else, if not you?"
LL: "...Yes."
Mr Johnson asks about the potential tube blockage, as Letby said in interview. He asks if that is still her case. Letby: "Yes."
Letby agrees it is her case that Child K received sub-optimal care, and that nursing staff were not experienced with dealing with babies of Child K's gestational age.
Mr Johnson asks where in the statement there is anything that says Dr Jayaram could not be correct as she was not in the nursery room at the time of Child K's desaturation.
LL: "It doesn't, but I have made it quite clear I have done nothing to hurt [Child K]."

2:13pm
The courtroom is filling up following the lunch break, with Mr Johnson due to continue cross-examination of Lucy Letby.

2:17pm
Mr Johnson asks Letby about Child K's mother's statement. Letby says she remembers it.
A photo was taken of Child K in nursery 1 at 4.31am on the morning of February 17.
Letby is asked if she remembers seeing the parents with the baby girl. She says she cannot remember.

2:19pm
The neonatal schedule for that night is shown to Letby.
Letby had earlier said she was involved in the administration of medication to a baby who was in room 1.
The time of that medication was 4.34am. Mr Johnson says the medication would have also come from room 1.
"You saw [them] with their daughter, didn't you?"
Letby says she cannot be sure, she was concentrating on medication for the baby who was in room 1.
"How did you remember their surname?" [the surname of Child K and parents]
"I don't know."

2:20pm
The agreed facts are presented to Letby.
Nothing was found at Letby's address search in relation to the surname of Child K.
Mr Johnson refers to the April 2018 Facebook search for Child K's surname, at nearly midnight.
Letby is asked why: "I can't answer that. I don't know why."

2:23pm
NJ: "You knew on April 20, 2018, that police were asking questions about you and your dealings at the Countess of Chester Hospital?"
LL: "I thought the police were involved from May, but I could be wrong."
Letby is asked if Joanne Williams is a friend of hers. "No."
"I was not aware of what the police were doing or with who."
NJ: "It's just a coincidence that after Joanne Williams had spoken to police about [Child K] that [you searched her name?]"
"Yes, I had no contact with Joanne at this point."
"And you cannot remember why?"
"No."

2:24pm
Letby is asked to agree that she has searched of Facebook for the names of babies that she has been convicted of murdering and attempting to murder. Letby agrees that is the case.
LL: "I am not guilty of what I have been found guilty of."

2:26pm
Asked if it was an "innocent coincidence" that she had searched the names of babies (and parents of babies) that she had been convicted of murdering and attempting to murder, Letby says "yes".
She adds that she has searched for many other parents and babies on Facebook.
Letby says she would have been on her phone, 'day and night', sometimes at work, when conducting these searches, many of which are recorded late at night.

2:28pm
NJ: "This was your habit, wasn't it?"
LL: "I looked at many parents, not just the babies here."
Asked about what her fascination was in looking at these names, Letby replies: "It wasn't a fascination," adding she regularly looked at the names of parents.
Letby: "[Child K] was on the unit very briefly."

2:30pm
Letby: "If I remembered any details, I would say; I cannot remember."
NJ: "Because you are not the sort of person who does this thing?
LL: "No."
NJ: "Were you looking for grief? [Names of] Parents on Facebook sites, were you searching for evidence of grief?"
LL: "No."

2:34pm
Text messages between Letby and a nursing colleague early on February 16 are shown to the court.
Letby: 'Unit is a hive of activity in preparation for the big bods lol x'
The court hears this was at the end of Letby's previous night shift.
Letby sent in a message at 5.26pm that day: "No it [Child K] didn't come but 6cm [dilated] so wouldn't transfer out, imagine it'll have delivered today."
Letby is asked if she had a recollection of the other baby from the February 15/16 shift, when that baby was extubated. She replies she does not. She adds she does remember that baby.

2:37pm
The court is shown a nursing note written between 12.51am and 1.07am by Caroline Oakley for that child.
The note includes 'Longline pressures increasing and then occluding ? positional. Site appears satisfactory. Cares attended to by SN [senior nurse] Letby."
'At 0015 longline pressures observed to have dropped...longline snapped from cannula hub ?? cause.'
Letby denies she had anything to do with the longline snapping.

2:47pm
After a short break, Mr Johnson refers to the birth of Child K as part of the cross-examination.

2:51pm
Letby denies wanting to be part of the care for Child K, as she says she was not the most senior member of nursing staff, and would not be suitable for a baby of Child K's gestational age.
A nursing observational chart for Child K is shown. Letby confirms the 2.45am readings are hers. Asked why she has not signed for it, Letby says: "That is an oversight on my part."
Letby says it would be a "team approach" when Child K arrived on the unit.
Asked again why she did not sign on the chart, LL: "Sometimes things do get missed."
Letby denies she did not sign the 2.45am observation so she could avoid being tied to Child K in the event of any events for her.

2:53pm
The court is shown swipe data for Dr Laura Lo coming into the neonatal unit from maternity at 2.43am, which Mr Johnson says would presumably be with Child K and others.
Mr Johnson says moments later, Letby fills in the data on the chart in the 2.45am column.
He asks Letby if she can remember what else she was doing at this time. She replies she cannot.

2:56pm
A nursing note is shown for a baby Letby was caring for, and the admin note is timed as being opened at 2.36am and being closed at 2.50am.
Letby is asked why she had that open while Child K was admitted. Letby says it would be a team effort for a baby's arrival and it was not unusual for people to leave the computer at the time when such an arrival on the unit happened.
Letby is asked if that was to give the impression she was otherwise engaged when Child K arrived. Letby replies it was not.

3:01pm
Letby is asked about feeding time for a baby she was caring for. She says the times vary on how long a feed takes.
Mr Johnson refers to the 3.30am feed for the nursery 2 baby, and when she "actually" did that.
Letby says there is no way to say exactly, as the times are all "approximations".
Also at 3.30am are the observation readings for a baby and a morphine medication. Letby says the latter would be a precise timing [when the morphine syringe was taken out of the fridge].
Letby says the process takes "seconds" and the morphine could have been taken by Joanne Williams and the prescription taken to a cotside for Letby to cosign.
Letby says the administration would not be given until it had been prescribed.
A reading for '0330 commenced' is shown. Letby says the note is in Joanne Williams' handwriting, and, asked about if that means the morphine infusion commenced at that time, says: 'that is how it presents'.

3:03pm
Letby says the chart has been prescribed at 3.50am [from a prescription note]. She adds while the morphine can be administered before the prescription time of 3.50am, it is 'not good practice'.

3:08pm
NJ: "Did you wait for Joanne Williams to leave the unit before you decided to go into nursery 1?"
LL: "No." Letby adds she does not remember going into room 1.
Mr Johnson refers to the 3.41am transport team note from a conversation with Dr Ravi Jayaram. Letby agrees there are telephones at a nursing station outside the room, as well as one inside room 1.
Letby is asked if she accepts Joanne Williams coming into the neonatal unit at 3.47am. She replies she does.
Mr Johnson asks if the event must have happened before 3.47am. Letby says it does, given Joanne Williams' statement.
Letby says she will agree Dr Jayaram was on the phone, but not sure which one.

3:09pm
Letby says she cannot recall the situation, so she could not say what she would or would not have done.

3:13pm
Mr Johnson refers to the police interviews with Letby. A short video extract of one of them is played to the court.
He says Letby does not say she does not recall why she was in the nursery.
He asks why Letby went along with Dr Jayaram's version of events. Letby denies she did so.
She adds: "This was a highly stressful situation, I was being interviewed about multiple babies on multiple days."
Letby denies a suggestion from Mr Johnson that she is pretending not to remember [the events] so she doesn't have to answer difficult questions.

3:15pm
Letby, asked for clarification by the judge about her referring to say shift nurse Melanie Taylor's nursing notes in relation to Child K's desaturation, says she 'was not clear on the times'. The nursing note refers to a later desaturation Child K had.

3:21pm
Letby is asked about Child K's ET Tube 'slipping'.
Letby is asked why she did not rule out being in the nursery room at the time.
She replies she is trying to be helpful and "try to fill in the gaps".
NJ: "You were hedging your bets, weren't you?"
LL: "No."
NJ: "You were trying to cover for all sorts of unforeseeable eventualities, weren't you?
LL: "No, I was telling the truth."
NJ: "You were prepared to go along with an account of a doctor who you say had it in for you?"
LL: "No, I don't think I have ever accepted his account."
Letby says it was "very intimidating" in the police interview situation.
NJ: "Who were you helping?"
LL: "I don't know. Not me."
LL: "I was trying to be compliant with police in an intimidating, stressful situation."

3:22pm
That concludes the trial for today. The cross-examination will continue on Tuesday.
The trial judge reminds the jury they will not be sitting on Wednesday, Thursday or Friday this week.