Child N
2nd and 3rd allegations of attempted murder on day-shift of 15th June 2016
Draft Timeline Part 2
14 Jun 2016, Tuesday
7.40am - N takes a feed of expressed breast milk. (electronic evidence)
8am –
LL’s day-shift. LL records notes at the handover at 8am.
She was N’s designated nurse.
LL messages a colleague to complain about having to finish up a previous shift' nurse's work, and had left a bottle 'dirty'. (electronic evidence)
Day-shift 8am to 8pm - LL records regular temperature readings for N which are all recorded in a 'normal range'. The court had previously been told readings in the 'yellow area' (too high, or too low) would be considered abnormal, but none of the temperature readings recorded as being too high or too low. LL notes: 'Demand feeding EBM via own bottle, completing more than required volumes. repeat SBR this morning on downward trend but not yet >50...otherwise ready for home'. In a family communication note: 'Mummy visiting this morning, carried out cares and feed. Put infant to breast. Discussed feeding at home' The notes show N was ready to go home, apart from further treatment required for jaundice, and was on phototherapy. Other family members visited N at the neonatal unit that day. (electronic evidence)
8pm – For the night shift of June 14, N was in
nursery room 3. Nurse Jennifer Jones-Key, in a note written retrospectively, records N was 'nursed in incubator with eye protection in situ. Baby demand bottle feeding' at the start of the shift at 8pm. (electronic evidence). JJ-K’s evidence: She was on a night shift on 14 June 2016 and was N's designated nurse along with Neonatal assistant Lisa Walker. They took over N's care from LL, she tells the court there was no concerns on handover
After 8pm (assumed post-shift) –
LL is involved in a Whatsapp message conversation with a nurse, and a Facebook messenger conversation with a doctor at this time: -
The nurse colleague complains about work colleagues on that night shift.
LL says she has had a "lovely run of shifts in 3". "Nice babies and parents"
LL messages the doctor to say she was planning to go to Torquay with her parents in July 2016, and discusses about her having had hypothyroidism since she was 11, and had been giving her tremors/had 'blips over the past 12 months'. (electronic evidence)
15 Jun 2016, Wednesday
Just after 1am - A nursing note by JJ-K just after 1am on June 15 records N had become 'very unsettled' and 'looked very pale, mottled and veiny' with slight abdominal distension. A blood test was taken for analysis. Further observations are taken. (electronic evidence)
JJ-K evidence - She recalls that over that morning N 'started to have a few desaturations' and was placed on full monitoring.
5.10am – LL was awake according to the use of her phone -
LL to colleague at 5.10am: 'Awake already'
Colleague: "I wouldn't come in!"
LL: "Oh...why"
Colleague: "5 admissions, 1 vent"
LL: "OMG"
Colleague: "Baby [N] screened, looks like s**t" (electronic evidence)
5.51am – JJ-K writes her retrospective nursing note for 1am.
Bef. 6am - JJ-K's note before 6am: 'baby looked worst this morning and cap refil after 3 secs. Reviewed again by paeds.'
From 7am – JJ-K’s evidence – JJ-K testifies that N 'settled down' but 'from 7am onwards he was having more desaturations'
Bef. 7.10am
–
LL messages doctor saying she might be back in '1' again for her next day shift (in nursery room 1).
7.10am – LL is recorded as entering the neonatal unit.
She messages the doctor: "No repeat today. I've escaped being in 1, back in 3". (electronic evidence)
7.15am –
[2nd alleged attempted murder] - The sequence of events shows N had a desaturation at 7.15am. Nurse JJ-K records: 'at 0715 baby crying and dropped saturations - as seen by NNU nurse Lucy [Letby].' The nurse adds N had to be given 100% oxygen support by a doctor. (electronic evidence)
JJ-K’s evidence – JJ-K testifies that shortly after 7am, LL came in to 'say hello'. At that point, she said 'I think the monitor went off, so Lucy went over to see. He went quite pale, I think he’d stopped breathing, I got the neopuff'. She's asked by the prosecutor where LL was in the room, she doesn't remember. She is asked again why LL was in the room - 'just to say hello, because we were friends', she says. She doesn't remember any conversation between them. She says the decision was taken to provide respiratory support to N. A nursing note from that morning states: 'noted to be mottled all over body and blue in colour and cold to touch'. X-exam: Mr Myers says essentially LL said hello to JJ-K then responded when N's monitor went off – JJ-K agrees.
[Opening speech: LL went into N’s room to say hello. When a 2nd nurse had her back turned LL told her N had lost oxygen and assisted with his breathing. There had been no alarm sounding and LL didn’t wait to see if he self-corrected. A doctor was unable to put a breathing tube into Child N because his throat was so swollen and he had fresh blood inside his mouth. He attempted 3 times.]
8am -
N was transferred to nursery room 1 at 8am. A note (by JJ-K?) is made on the re-siting of the NG Tube: 'NG resited in right nostril with acid reaction. At handover baby dropped saturations and required Neopuff. Care handed over to NNU nurse Lucy Letby'. (electronic evidence)
LL is recorded as being the designated nurse for the day shift on June 15, and records, in a note written retrospectively: 'Infant transferred to nursery 1 on handover. Mottled, desaturating requiring Neopuff and oxygen...cold to touch.' (electronic evidence)
Time? Is this in 8am notes?? - LL's notes state that N's parents had been informed and that they were 'understandably upset' (electronic evidence)
Abt. 9am - LL records for 9am (in a note written at 1.53pm): 'Unable to intubate - fresh blood noted in mouth and yielded via suction ++.' (electronic evidence)
Bef. 10am
–
LL messages her colleague on Whatsapp before 10am: 'Thanks for staying to help. Much appreciated.' (electronic evidence)
10am – LL records '1ml fresh blood aspirated' from N at 10am. (electronic evidence)
[opening speech: An intensive care chart is presented to the court, which records the amount of dextrose going into Child N. The bleeding record, of 10am '1ml fresh blood', recording aspirates from the NG tube. Said bleeding, the prosecution say, is not recorded anywhere in the medical notes. It was more than 2 hours after the attempts to intubate.]
Morning - mother’s statement – parents were informed N had had a bleed and to attend hospital as soon as possible. On arrival N was in intensive care and LL was there with other people. They were told they had tried to intubate N between 4am and 8am.
Morning - father’s statement - On the day Child N was due to come home, on June 15, the father was at work. He received a call from Lucy Letby saying Child N was 'a bit unwell' during the night, but was fine now. He did not get the impression that Child N was still unwell. He then received a call from child N's mother to come to the hospital as soon as possible. When he arrived, Lucy Letby was in the room with Child N, giving cares. There was "no urgency". Lucy said: "Hi. He's been a bit unwell during the night." He said he was "shocked" when he saw Child N, as he had dried reddy-brown blood around the mouth and his skin was 'blueish in colour'. "He had dried blood around his lips. His lips weren't fully covered in blood, there was loads spattered over him like he'd coughed. "I remember being confused and thinking, 'what's wrong with him?'" "No-one told us what happened, or why."
Bef. 11am –
The doctor (who had done the earlier intubation) messages LL before 11am to ask: "Is he ok?"
11am - LL notes (retrospectively) for 11am: 'Small amount of fresh blood orally and 1ml from NG tube' (mix Dan Donoghue tweets and Chester Standard update)
11.29am –
LL messages the doctor in response: 'Small amounts of blood from mouth & 1ml from NG. Looks like pulmonary bleed on xray. [Given factor 8 – wait and see - opening speech] apnoeas have improved. Sorry if I was off during intubation (then refers to how another nurse was faffing) I like things to be tidy & calm (Well, as much as possible!)"
Doctor: "No, you were perfectly fine with me...I thought you were wanting to just get on with in case there was another desat."
LL: 'Well I have got my hair in a bun today, it's only fitting that I was 'serious Lucy' !!' LL adds: 'no more bleeding thankfully', in relation to N. [opening speech - Other than that phone message at 11.29am, there is no evidence that LL brought the bleeding to the attention of any of the medical staff.]
Time? Abt 2pm? – father’s statement - after staying on the neonatal unit for a few hours, the parents went out for "20 to 25 minutes" to buy some food, as they had not eaten that day. When they returned to the neonatal unit, they found the blinds were down and a staff member on reception told them Child N was "really unwell". The father said he was "scared" as medics soon after needed to give Child N resuscitation." (BBC)
After going outside for a bite to eat, they returned to the neonatal unit and found the blinds were down. A staff member on reception said Child N was "really unwell" and if they would like a priest. (Chester Standard) In written statements read to the court, the parents expressed surprise that the neonatal unit had no Factor 8 for their baby, even though they were aware he had haemophilia. At one point a specialist haemophilia nurse had been sent from Alder Hey Children's Hospital to bring some factor in a taxi.
Lucy Letby 'hugged mother after trying to kill her baby three times'
The father said the baby’s condition deteriorated twice more, once when he and his partner left to get food and again when they left to seek medical advice for his partner, who was feeling unwell.
Lucy Letby hugged mother after alleged attempt to murder baby, court hears
[opening speech - 1.53pm - In an update recorded on the computer by LL at 1.53pm she wrote that Child N was “stiff” on handling and extending upper limbs, back arching … settled in between episodes.]
1.53pm - LL recorded a retrospective note for 9am (see above). (electronic evidence)
Time? Abt 2.45pm?? – mother’s statement - The parents were told to go out and get some fresh air. While they were out N had his second collapse.
2.50pm –
[3rd alleged attempted murder] - At 14:50 N had a profound desaturation. LL’s notes written retrospectively at 6.30pm: 'Infant became apnoeic with desat to 44%. heart rate 90bpm. Fresh blood noted from mouth and 3mls blood aspirated from NG tube. Drs crash called'. Nursing notes record that there was difficulty trying to insert an ET tube. With two doctors failing to 'obtain a secure airway'. Two consultants from the anaesthetic team were called to help, but they also had difficulty fitting an ET tube, the nursing notes show. (electronic evidence and opening speech)
[opening speech - 2.59pm – A consultant was called at 2.59pm. While awaiting a consultant, a junior doctor looked into the airway of Child N and saw a “large swelling at the end of his epiglottis” he could only just see the bottom of the vocal cords. He had never seen anything like this before in a newborn baby. A further attempt to insert a breathing tube again found blood in his throat. The junior doctor's notes made at 4.30pm recorded: "desaturated this afternoon at 2:50pm with blood in the oropharynx + blood in the NG tube. Improved with bagging. Elective intubation planned following ??? unsuccessful attempts with 2 registrars and 2 consultants cords difficult to visualise” The prosecution said Child N had been "so unwell" that attempts were made to reintubate him, but the doctor could not see down Child N's throat as the view was obscured by fresh blood. A more specialist team was called to carry out the intubation.]
[opening speech - At 3pm there is a further entry in LL's writing of '3ml blood', initialled not by LL.]
Time? – mother’s statement – A spur of the moment baptism took place. In a statement, the baby’s mother said: “Lucy was our main point of contact through the day because she was tending to (Child N) in between consultants being with him. “We had (Child N) baptised during the day and that was recommended to us by Lucy.” (Evening Standard)
Bef. 5.25pm
Doc to LL: 'Only a few hours to go and it's holiday time - do you think you'll manage to hand over quickly?'
5.25pm -
LL: 'I'll still be here. He's (Child N) poorly, bled again and became apnoeic. Two anaesthetic consultants failed to intubate.
[opening speech - 6.30pm – LL recorded at 6.30pm her notes for 2.50pm.]
7.40pm - Notes from 19:40 on June 15 show that there was a further 'profound desaturation'. Child N had 'colour loss' and required neopuff breathing support (electronic evidence)
7.48pm - At 19:48 baby N required resuscitation and a number of doses of adrenaline.
He eventually stabilised.
LL said in a message to a colleague, who can't be named for legal reasons, that Child N's parents were present and had had the boy christened. (electronic evidence)
Time? 7.40pm collapse? – father’s statement - Someone came into the maternity room, where Child N's mother was staying with the father. The staff member said: "You'd better come - he's really ill this time." Upon their arrival to the intensive treatment unit, resuscitation efforts were being administered to Child N. The father said he could not watch what was going on. Staff from Alder Hey Children's Hospital were among the staff members in the room. After a breathing tube was fitted, Child N stabilised and 'calmed down'.
After 7.40pm - father’s statement - The parents spoke to a haemophiliac specialist nurse who had come from Alder Hey via taxi. Child N was taken to the transport team, in a process "which seemed like forever", by 11pm.
Unnamed female doctor’s evidence - The doctor has told the court she remembers the events of that evening and Ms Letby. She said LL 'seemed quite agitated' when a team of specialists arrived from Alder Hey to help with Child N's treatment. 'She approached me a few times and said who are these people, who are these people....from working alongside the nurses and doctors at Chester, I felt that it was out of character from what I’d experienced previously in a medical emergency', she said.
Around 8pm or later??
-
At the end of her shift, Ms Letby sent a WhatsApp message to a nursing colleague, who also cannot be named, saying: 'Losing the will' (electronic evidence)
Prob. Around 8pm? –
LL: 'Sat having a quiet moment and want to cry. Just mad with so many people and lack of space etc.'
Doc: 'Oh Lucy, poor little thing and you.
Doc: 'Are you OK? Have a cry, you'll feel better for it I'm sure. You're welcome to take my car home if you're too tired to walk. I sort out picking it up in the morning.
Doc: 'So sorry you've had a rubbish day at the end of your long run - holiday well and truly deserved.'
LL: 'I'm OK just feel like I've been running around all day and not really achieved anything positive for him.
LL: 'Don't want to cry in front of people here, maybe when I'm home! That's very kind re the (car) but should be OK. Have you managed to switch off at all and sleep?'
Doc: 'No not really. Your day sounds as though as it's been horrible. Poor you. Are you going to be OK?
Doc: 'I'm sure he's had the best care possible today and that you will have done everything you can for him.
Doc: 'Are you doing anything nice before you go on holiday? You're not having to do a long run of shifts to get the time off for that are you?'
LL: 'No off for nearly 2 weeks!'
Doc: 'Oh what an end to a rubbish day. I haven't been back to Torbay for a few years .. I'm always surprised how little it changes when I go back. Happy memories.
Doc: 'I used to love Cockington in the summer - it always looked so pretty when the flowers were out. Have you handed over yet?'
Guess later than 8pm -
Doc: 'Look on the top shelf. Right hand side. For the walk home. Your [sic] still welcome to the car.'
LL: 'Cockington is gorgeous!! We always go there for afternoon tea. Dad was offered a job in Paignton many moons ago, could have been a very different childhood growing up by the sea. Looking forward to going back.
LL: 'Hope little man is OK and your night isn't too stressful. On the home straight now at least.
LL: 'You are a sweetie (name of doctor), thank you.'
Doc: 'Chocolate makes bad days a little better. Hope you liked it.'
LL: 'That's true. Just a shame I don't usually eat chocolate ... but on this occasion ...'
Doc: 'It was well deserved today. Are you OK?
LL: 'Yes thank you. Just glad he's (Child N) OK.
LL: 'Hopefully I'll sleep well tonight and can enjoy getting ready for hols. Are you OK?'
After 8pm - Father’s statement - He said Letby approached them as they were waiting for the baby to be transferred to Merseyside’s Alder Hey Children’s Hospital, where he made a full recovery. He said: “Lucy then came up to us. “She told us she’d stayed on late past the end of her shift and she said to (my partner), ‘I hope he’s OK’ and gave my partner a hug. “She might have given (my partner) a kiss, I’m not sure.”
Lucy Letby hugged mother after alleged attempt to murder baby, court hears
Time? 10pm guess –
LL: 'What do you think caused his (Child N's) bleed?'
Doc: 'I think there will be a haemangioma or collection. If it was epiglottitis his crp should have been higher because he was starting to become unwell'. Doctor says he's 'optimistic he'll be okay'
LL: 'That's brilliant news, thanks for letting me know'
Abt 11pm
Doc to LL: 'He's just left the building. I'd be surprised if you didnt sleep well after so many long days zzz.'
LL: 'Glad he got off safely.'
Doc: 'My night is complete! Just been handed a 3-week-old for a cuddle, who am I to refuse!!'
LL: 'Aww baby cuddles make everything seem better.'
[opening speeches – Prosecution: Experts suggested blood in Child N’s throat was a result of the thrusting of a tube into the back of his throat to inflict injury. Dr Bohin’s view was that the likely cause of the bleeding was trauma to the mouth, to the throat or to the oropharynx, most likely from a NGT or suction catheter. Prof Sally Kinsey excluded the possibility of a pulmonary haemorrhage - in other words, bleeding in the lungs, causing the collapse on June 15. In her opinion such bleeding would not have occurred spontaneously in a child with Child N's degree of haemophilia. It follows, the prosecution say, the bleeding was caused by trauma. Professor Kinsey also ruled out heavy-handed intubation as a cause. Defence: Regarding the allegation Letby did something to cause Child N to bleed, the prosecution say the intubating doctor already saw blood, because Letby harmed him. The defence disagree and say blood was "not identified until intubation had already happened, or was in the process of happening". There were three attempts to intubate him. The defence say, again, there was "sub-optimal care" for Child N.]
[opening speech - In police interview, Letby had difficulty remembering Child N.
She did recall an occasion when doctors had difficulty intubating him. She agreed that she had seen blood but denied being responsible for causing him harm.
She could not explain the entry in her notes timed at 10am on June 15 in which she recorded aspirating more fresh blood which she had not apparently brought to the attention of anyone else.]
Links
Evening Standard -
Lucy Letby hugged mother after alleged attempt to murder baby, court hears
Chester Standard 2 Mar
Recap: Lucy Letby trial, Thursday, March 2
Tweets
https://twitter.com/MerseyHack
https://twitter.com/MrDanDonoghue
https://twitter.com/MelBarhamITV