I've pieced together an overview for the allegation of attempted murder of baby J, made up of trial testimony, experts opinions and LL's evidence.
OVERVIEW FOR BABY J
31 Oct 2015 - Baby J was born at 32 + 2. She had a bowel disorder and was operated on the following day at Alder Hey, returning to the Countess on 10 Nov, with two stomas. Between 10 Nov and her collapses and seizures on the nightshift of 26/27 Nov, she had progressed from nursery 1 to nursery 4, and had been due to go home in a day or two. Infection was ruled out as a reason for her collapses and by 28 Nov she was back up to full feeds. On 18 Dec the stoma operation was reversed and her bowel reattached at Royal Manchester Children’s Hospital and she went home on 5 Jan 2016. She has suffered no seizures since.
“In the days beforehand, Child J's mother had described her as "well" and she had been due to go home "within a day or two". A colleague had texted Letby asking how Child J was doing. Letby replied: 'She's good I think, in 4. Doing well with feeds, hoping to get home soon'.”
Lucy Letby trial live: Nurse accused of murdering seven babies to continue giving evidence
Nightshift 26/27 Nov
Nurse Ashleigh Hudson handed over care of baby J to Nicola Dennison in room 4 for the nightshift.
During the shift, twins who had delivered at home were brought in as an emergency at around 6.30am, to nursery 1. LL was not involved in their care.
LL was designated two babies in room 3.
Nicola Dennison’s evidence in February -
“Nicola Dennison, a nursery nurse at Chester's neonatal unit -
worked there since 1985. She cared for baby J- & said she was "a lively, alert and engaging baby, she had stomas, after a bowel operation - but she was a well baby & getting ready to go home."
Nicola Dennison says baby J was moved to nursery 2 for more monitoring when she became unwell during the night & nursing staff took over her care, when she suffered two unexplained collapses. Lucy Letby was part of her care that night, 26/27 November 2015”
https://twitter.com/ElaineWITV
LL’s evidence in chief –
“less experienced band 4 nursery nurses were tasked with changing Child J's stoma bag despite the fact they are not meant to undertake high dependency care tasks.”
she also says about the band 4 nurse –
“she would have been even 'more unfamiliar' with stomas than the intensive care nurses”
and -
“'If they don’t have the training and experience to know what they're looking for when dealing with stomas then it’s potentially dangerous. 'It was so busy at the time, they were just trying to use staff wherever they could'”
https://twitter.com/MrDanDonoghue
LL's cross-examination -
“
she does not "want to name names" on any specific nurses' lack of experience.
Mr Johnson refers to Nicola Dennison's previous experience with stomas, which she said in evidence she had experience of
Letby says over the years, she did not recall any other babies with stomas.”
and
“
she was not referring to Nicola Dennison specifically, but the nursing situation overall.”
LL sent a text to a colleague on 19 Nov saying -
"It's shocking really that they are willing to take the responsibility for things that they have no training or experience etc on. Don't think they appreciate the potential difficulties X"
Asked to explain the text LL said –
"Sometimes I felt nurses would take on roles which I didn't think they were trained enough in".
Mr Johnson says the impression of the court was that band 4 nurses were not qualified in stoma care, and the hospital was 'cutting corners' by assigning such nurses to those tasks.
Letby agrees.”
Recap: Lucy Letby trial, June 2 - cross-examination continues
“
The court is then shown guidelines for stoma care that says they "do not require either Intensive or High Dependency care".
Letby says she raised concerns "generally, [about] nursery nurses having Child J over this period of time". But she says this was not a particular concern at the time the infant collapsed.”
Lucy Letby trial live: Nurse accused of murdering seven babies to continue giving evidence
“LL:
"You need to appreciate the context that the unit was not familiar with stomas."
NJ: "This nurse was familiar with stomas, wasn't she?"
LL: "In her opinion, yes."
Mr Johnson says Letby was deliberately creating the impression to the jury that the care for Child J was deficient.
LL: "
I do think that. I don't think she had a high standard of care.
"I don't think anyone was overly confident in saying 'I know what to do with a stoma'. We were led by the parents..."
Mr Johnson asks why Nicola Dennison was not challenged about this.
LL: "I can't answer that."
Recap: Lucy Letby trial, June 2 - cross-examination continues
27 Nov -
12.02am – LL co-signed for medication for baby J.
4am – Nicola Dennison fed baby J.
4.29am – swipe data shows LL entering the unit
4.40am – Nicola Dennison had left the nursery for a short time and on her return nurse Mary Griffith was assisting baby J with breathing. She had desaturated to the 30s, lasting three minutes, required neopuff, and became pale and mottled.
LL’s evidence in chief - Letby tells the court she had no involvement in Child J prior to her first desaturation.
5.03am – Baby J desaturated again to the 50s. lasting two minutes.
LL’s evidence in chief - Mr Myers: "Did you have any idea this was happening at the time?" Letby: "No."
Baby J was reviewed by a registrar and moved to room 2. Time not stated.
6.24am – LL’s colleague texts her:
Good night?
6.24am to 6.56am – LL is not recorded in the neonatal schedule doing anything for half an hour.
6.28am to 6.49am – LL’s texts with her colleague:
LL:
No. Baby J in 2 screened. Had 2 profound desats and just got 32-week twins born at home, one with cleft lip and only 5 staff x
colleague:
Oh *advertiser censored* 5 staff on today you mean?
LL:
Yeah 5 today x
colleague:
We closed again then. Jesus
LL:
Yeah closed trying to get someone in. cleft baby being tubed I think x
colleague
: what a bloody nightmare
LL:
It’s all a bit *advertiser censored*-up.
colleague:
Sounds it god I really don’t want to come in now
LL’s cross-examination - LL accepts that
by 6.28am, Child J had been moved to room 2.
6.29am - The second twin arrived on the unit.
LL’s cross-examination - LL accepts, from looking at the neonatal schedule, she would have been in room 2 when the emergency twins were admitted to room 1. NJ: "You were in nursery two weren't you?" LL: "Yes". "When the emergency was unfolding relating to the twins who had been admitted," Mr Johnson says. "Yes," says LL. "There would have been lots of distractions with these two emergencies," Mr Johnson says.
"I don't know what you are implying," Letby replies.
"I am implying the medical staff would have had their attention focused on the twins, would you agree?" Mr Johnson says.
"Yes," says Letby.
Text messages show Letby telling her colleague one of the newborn twins was being tubed. Letby says she wasn't "keeping an eye" on what was going on in the room, but was aware of what was unfolding next door.
6.34am – Dr Gibbs arrived at the unit to assist with the twins.
6.49am to 6.56am – LL’s colleague sent her three messages which she didn’t reply to.
6.56am – Baby J’s first seizure, room 2, monitor alarmed.
LL’s evidence in chief - LL is asked if she has recollection of the second pair of events. "Yes." She adds
she has independent recollection of those events.
She said, for 6.56am, she heard the monitor alarm in
room 4 and Child J was "fitting", "She wasn't breathing properly...her eyes were rolling to one side of her head."
"We both heard the monitor and we [LL and Mary Griffith] went in."
Letby said no-one was in room 4 at the time the alarm first went off. Dr Gibbs arrived "very quickly" and Child J was transferred to room 2.
7.11am – Mary Griffith recorded the 6.56am seizure “J’s monitor went off at 6.56 myself and L Letby attended…”
7.20am – LL gave baby J a glucose infusion.
7.24am – Baby J’s second seizure. Dr John Gibbs's notes of 'sudden desats (to unrecordable levels) at 6.56 and at 7.24 and bradycardia. Both associated with clenching of hands, stiff limbs, and on second occasion, eyes deviated to left.'
LL’s evidence in chief - Letby says for the second event, she was called to help, but does not recall who.
Following nightshift 27/28 Nov
LL was baby J’s designated nurse. Baby J’s parents stayed with her on the unit.
Evidence in chief – Letby says she was designated to look after her the following night. "Were there any issues the following night in your care?" Ben Myers KC asks. "No," Letby replies.
Cross-examination – “The following night, nothing happened to Child J – […] the prosecution points out that
Child J's parents were present on the unit.”
LL’s defence –
Mr Johnson asks the same questions he has asked in all cases - if Letby thinks staffing issues, incompetence or individual mistakes contributed to Child I's death.
"It was a very busy shift, but I don't know what exactly happened to [Child J]," Letby says. She says
incompetence or mistakes did not play a part. (Sky News)
Defence opening speech –
For Child J, the defence say "there is not a great deal of explanation" for what caused the deterioration from the prosecution experts.
The defence say there is "an assumption of deliberate harm being used to blame her" when it was actually
"inadequate care" at the hospital.
Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement
Prosecution opening speech –
In his opening address to the jury, Nick Johnson KC, said Baby J's case 'is one where we suggest that its parallels with other cases tell you what happened and who was responsible'.
He added: 'We suggest that it is highly significant that children within the orbit of Lucy Letby persistently and consistently suffered unexplained collapses.
'Sometimes the evidence of her hand at work is more obvious than others and it is remarkable that on many occasions, when children who had suffered unexpected spectacular and life-threatening collapses were removed from her orbit, they had exceptional recoveries'.
'Inconsolable' baby 'proved nurse injected air into them,' trial told
Consultant Dr Gibbs evidence –
Dr John Gibbs, a consultant paediatrician, said Child J had been making "steady, acceptable and encouraging progress".
He added that within two-and-a-half weeks, Child J had moved on to bottles feeds and was "fine" and without any respiratory complications.
But in the early hours of 27 November 2015, Child J suffered seizures and four desaturations with her heart rate also dropping on the third and fourth occasion, the court heard.
"Both occurring together is of more concern than one occurring by itself," Dr Gibbs told the court.
Consultant Dr Brearey’s evidence –
Dr Stephen Brearey, who reviewed medical tests carried out that day, said "nothing explained" why the infant had collapsed.
"She [Child J] normalised very quickly over the course of the day and all the investigations we had undertaken couldn't identify why she had the desaturations or explain why she had a seizure.
"I do know hypoxia causes seizures so that would be possibly the most likely cause.
"There remains the question why was [Child J] hypoxic when two or three weeks beforehand she had been breathing normally in air and there was no suggestion of infection.
"In fact, we stopped antibiotics 36 hours after starting them because there was no evidence of infection in the blood tests and she remained well for weeks afterwards."
He reviewed further tests two days later on 29 November 2015 where he described her as in a "good condition".
"I didn't have any concerns at that stage," he said.
"Looking back on it now we didn't have an explanation for the events on 27 November.
Experts' evidence –
Dr Evans –
“The first pair of collapses were unexpected because she was nice and stable before that.
“The second pair of events were more serious and required more in the way of resuscitation, but again were unexpected and I noted the markers for inflammation were normal which tended to rule out infection.
“The second pair coincided with what the doctors describe as a seizure or a fit. This is indicative of something going wrong with the brain.
“My opinion was that (Child J’s) brain was deprived of oxygen for a sufficient level of time to cause hypoxia ie loss of oxygen to the brain causing fits.
Mr Johnson went on: “If infection had been the cause of her rapid decline would she have recovered as quickly as she did?”
Dr Evans said: “I don’t think she would. Babies who develop an infection usually recover over a period of days.”
Dr Evans agreed with Ben Myers KC, defending, that he could not rule out infection “for sure”.
Dr Bohin –
consultant paediatrician Dr Sandie Bohin, said she had excluded infection.
She told the court: “(Child J) was a well baby. She was ready to go home. Babies who are ready to go home do not have major desaturations which lead to prolonged resuscitation.
“These were completely unexpected and she required the Neopuff (face mask) ventilation for a long time before she came round and was well again.
“I thought that seemed extremely unusual – the speed of the collapse, the longevity of the resuscitations and the fact that she seemed to recover quite quickly.
“That is not the way that infection normally plays out.”
Dr Bohin noted that Child J was clinically well and back to her normal self before she even received antibiotics.
She said: “I exclude infection. I don’t think that was the cause of her collapse.”
Dr Bohin told Mr Myers she had not been able to identify an “obvious cause” for her collapses.
Lucy Letby: Baby girl's seizures 'did not happen naturally'
Lucy Letby: Baby's seizures did not happen naturally, trial hears
