UK - Nurse Lucy Letby, Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #24

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1:00pm

Legal teams, members of the public and the press have entered the courtroom at Manchester crown Court. Lucy Letby has also arrived.
The judge, Mr Justice James Goss, has also arrived.

1:01pm

Members of the jury are now coming into court.
The trial will now resume, and is expected to hear evidence until around 4pm.

1:04pm

Nicholas Johnson KC, for the prosecution, continues to cross-examine Letby in the case of Child I. He moves on to the third incident, on October 14, 2015.
Mr Johnson says Letby does not refer to this incident in her statement. Letby, in her evidence, said she did not recall this night.

1:05pm

Letby rules out staffing levels, medical incompetence or staffing mistakes as a contributory factor in the collapse of Child I for this incident.

 
1:16pm

The staffing rota for October 13-14, 2015 is shown to the court, with Letby in room 1 as the designated nurse for Child I. Joanne Williams is the designated nurse for two other babies in room 1 that night.
Letby is asked to look at her nursing notes for that night. Mr Johnson says Child I was tolerating handling and 'tone appears improved', according to Letby's notes.
The notes add: 'At 0500 abdomen noted to be more distended and firmer in appearance with area of discolouration spreading on right-hand side, veins more prominent. Oxygen requirement began to increase, colour became pale...gradually requiring 100% oxygen...blood gases poor as charted. Clear air entry, slightly reduced on left, chest movement reduced...continued to decline. Reintubated at approx 0700 - initially responded well. Abdomen firm and distended. Overall colour pale. Xrays carried out...resuscitation commenced as documented...night and day staff members present'
Letby says she cannot recall the discolouration now. She does not recall it moved, but it was spreading by getting larger.
NJ: "Where did you get the time of 5 o'clock from?"
LL: "I don't know. I don't know if it's from paper charts or memory."
Mr Johnson says if Letby had seen this, she would have escalated it to a doctor.
LL: "I can't comment on what time the doctor did come."
Mr Johnson says almost 24 hours earlier, Child I was found "almost dead", and then this incident happened. He asks what Letby would have done.
LL: "I would have escalated it to someone, senior like a doctor."
Mr Johnson shows the doctor's note, which mentions: "Abdomen distended and mottled".
LL: "I can't say specifically what time I asked him to come, the note says he came at 5.55am".
Mr Johnson says this would have been an emergency for Child I.
LL: "I don't believe it was an emergency, I believe it showed a decline."
NJ: "You sabotaged [Child I] at about 6 o'clock, didn't you?"
LL: "No."

 
I'm so confused about why the defence are doing this:

Letby rules out staffing levels, medical incompetence or staffing mistakes as a contributory factor in the collapse of Child I for this incident.

If she is innocent then obviously wouldn't know what has caused it. There is no need for her to say what DIDN'T cause it. Is this a defence strategy, something she is doing of her own back or prosecution somewhat leading it?
 
speaking of “co-incidences” I was reading on another website (don’t think a link would be allowed) about the insulin cases both coinciding with “Black Wednesday” when all junior doctors who are on training programs rotate to new placements. Given that the results were missed and not acted upon is quite relevant with the timings of this - moo.
Baby F was 5th Aug 2015 and baby L 8th Apr 2016


I can only find a link for 2015/16 dates on the Scottish Government website but believe dates relate to the the UK as a whole.


'Black Wednesday' doesn't apply to NNUs (and I suspect any specialist area). Firstly, rotating doctors are Senior House Doctor level so not total newbies. Secondly, senior doctors (and ANNPs if the unit has them) take a much more hands-on role and even avoid taking annual leave! Nobody lets inexperienced staff loose unsupervised.
 
LL needing a break last Thursday seems to have worked in her favour… the line of questioning about ‘I knew what I was looking for’ has ended and she’s managed to escape further questioning on that statement. IMO it’s becoming clear that whenever LL feels caught up in a lie she suddenly needs a break. I just hope the jurors are noticing this too.

MOO
 
I'm so confused about why the defence are doing this:

Letby rules out staffing levels, medical incompetence or staffing mistakes as a contributory factor in the collapse of Child I for this incident.

If she is innocent then obviously wouldn't know what has caused it. There is no need for her to say what DIDN'T cause it. Is this a defence strategy, something she is doing of her own back or prosecution somewhat leading it?
This is the prosecution cross examining. So the prosecutor NJ is asking her whether staffing levels, medical incompetence or mistakes were a factor in each incident. She tells the court that each can be ruled out.

They are letting her rule it out so if she suddenly tries to say that someone made a mistake then NJ can tell the court that she ruled these things out before questioning began. Plus obviously like you’ve said, if innocent, how would LL know what caused the collapses? There could well have been a mistake she didn’t know about so ruling it out entirely doesn’t gel with her assertion of having no involvement in the collapse IMO.

JMO
 
I'm so confused about why the defence are doing this:

Letby rules out staffing levels, medical incompetence or staffing mistakes as a contributory factor in the collapse of Child I for this incident.

If she is innocent then obviously wouldn't know what has caused it. There is no need for her to say what DIDN'T cause it. Is this a defence strategy, something she is doing of her own back or prosecution somewhat leading it?
It stems from this -

Letby says 'conspiracy group' of colleagues blamed her for baby deaths and collapse​

Lucy Letby is asked about people she worked with in the neonatal unit, and if she had problems with any of her colleagues.
Nick Johnson KC questions Lucy Letby on a "conspiracy group" against her - four of Letby's colleagues, including doctors, who raised concern over a possible link to Letby's presence and incidents involving babies on the unit.
"What is the conspiracy?" Mr Johnson asks.
"That they have apportioned blame on to me," Letby replies.
Asked what the motive would be, she says: "I believe to cover failings at the hospital."
Mr Johnson indicates he'll give Letby the opportunity to explain what hospital failings were involved in each case against her.

Lucy Letby trial live: Nurse accused of murdering seven babies to continue giving evidence
 
I'm so confused about why the defence are doing this:

Letby rules out staffing levels, medical incompetence or staffing mistakes as a contributory factor in the collapse of Child I for this incident.

If she is innocent then obviously wouldn't know what has caused it. There is no need for her to say what DIDN'T cause it. Is this a defence strategy, something she is doing of her own back or prosecution somewhat leading it?
Part of her defence strategy appears to be that she is a scapegoat for hospital failings. So the prosecution begins every case by asking her if she thinks staffing levels, incompetence or mistakes could have caused what happened to each of these babies. She has said no most of the time. JMO.
 
Are you talking about the dates the blood results came back or the dates of the poisonings? Because Baby L was poisoned on a Saturday, day of the Grand National.
I put the dates of the poisonings but the results that came back were not interpreted possibly due to the naivety of the new SHO’s.

Rotation dates were 5th Aug 15 and 6th Apr 16.

I recall Dr Brearey saying he was unaware that 2 babies had returned blood results which showed abnormally high insulin levels and the SHO‘s (if they were newly rotated) didn’t know the significance of the results.
 
1:24pm

A prescription chart shows Dr Matthew Neame prescribed morphine sulphate for Child I, and the infusion was commenced at 5.50am.
A fluid chart shows '0530 abdo distended++' in Letby's writing.
Letby says by 6am, the oxygen requirement had gone up to 100% for Child I, from 60% at 5am.
Letby had written 'squeaky' for the oxygen level at 5am. Letby tells the court this meant the air entry for Child I was not clear.
Letby says squeaky air entry is not an emergency.
Mr Johnson says there is also expanding discolouration and a distended abdomen.
Letby denies copying the word 'squeaky' for the 5am oxygen column from Dr Neame's 5.55am note. Letby: "I disagree."
Letby says she recalls Dr Neame saying the mottling was unusual; she cannot recall the mottling specifically.

1:26pm

A report showed Child I's gaseous distention of the bowel had increased on October 14 since the previous x-ray at October 13. Child I had been on a ventilator and nil by mouth.
Letby denies injecting air into Child I.
NJ: "You had inflated [Child I] with air, hadn't you?"
LL: "No."

1:28pm

At 7am, Child I had a significant desaturation.
Letby's note: 'Reintubated at approx 0700 - initially responded well. Abdomen firm and distended. Overall colour pale. Xrays carried out.'
NJ: "That is because you were sabotaging her, isn't it?"
LL: "No."

1:29pm

Letby says she does not remember the 7am desaturation "with any clear detail".

 
1:34pm

Mr Johnson moves to the final event for Child I, when she died on October 23.
Prior to that, Child I had been moved to Arrowe Park Hospital before returning to the Countess of Chester Hospital's neonatal unit.
Mr Johnson shows Letby observation charts for Child I from the previous day. Letby accepts Child I's observations were stable, save for one slightly raised respiration rate reading.
She agrees Child I was self-ventilating in air at this point. She accepts Child I's abdomen was, the previous day, soft and non-distended.

1:35pm

NJ: "Would you agree that despite three life-threatening events in the previous three weeks, [Child I] appeared to be in a stable condition?"
LL: "Yes."

 
'Black Wednesday' doesn't apply to NNUs (and I suspect any specialist area). Firstly, rotating doctors are Senior House Doctor level so not total newbies. Secondly, senior doctors (and ANNPs if the unit has them) take a much more hands-on role and even avoid taking annual leave! Nobody lets inexperienced staff loose unsupervised.
Thank you for giving me an insight. I only gave this input regarding the missed/significance of the insulin results being overlooked and not acted upon when received.
 
For clarity and continuity, here is a summary of the start of questions of Baby I:
BABY I:

Mr Johnson began to ask LL about Baby I—she was very premature, having been born at 27 weeks when her mother’s waters broke early.

LL was accused of attacking her three times before allegedly murdering her on the fourth attempt when she was around 11 weeks old on October 23rd, though you might remember that nurses last the countess knew Baby I well because she’d also spent time being cared for there—

And a feature of Baby I was that her tummy was often swollen or distended.

LL told jurors that this was a topic of conversation among staff at COCH because they wondered if she was getting the treatment that she needed

She denied Mr Johnson’s suggestion that she’d use this problem as an opportunity but he said it was the pros case that she’d injected air into Baby I’s feeding tube causing her tummy to bloat and to crush her lungs

LL said she didn’t remember a great deal about two collapses suffered by her on Sept 30th -one at half past 4 in afternoon and another at half past seven pm.


But Mr Johnson highlighted this date *advertiser censored* being significant because by this time doctors were so confident that she had been progressing well, that they’d recommended she be given her first set immunisations in a few days.


[This also mirrored the case go Baby G, who was also earmarked for immunisations. ]


Mr Johnson said LL had cared for Baby I many times and she knew the routine of her mother well. She denied this but he insisted she knew baby I’d mom left the hospital in the afternoon to go pick up her other children from school and while she was away on the school run at around 4 pm, LL pumped excessive amounts of milk or air into her while giving her a routine milk feed via her nasal tube to try and kill her.


Q: You had pumped her with air or milk, hadn’t you?

LL: No

Q: Were you excited by what you did?

LL: I fed Baby I a normal tube feed


Mr Johnson then reminded the jury about the 2nd alleged attack on Baby I which took place around a fortnight later on a night shift in the early hours of October 13th, and just to recap, it was Nurse Ashley Huston looking after Baby I on this shift. She told the court that she had asked either LL or Caroline Oakley to keep an eye on Baby I because she was nipping away to help another colleague. She told the jury that the main light was off in Nursery two and Baby I’d cot had a canopy over it keeping her face in shadow, but when she returned about a quarter of an hour later, Lucy Letby was already in the doorway, and she told her the baby looked pale.


Nurse Hudson gave evidence in person and she became tearful when she was asked questions about the event which happened around 3 am. And here is a recap:


Nurse Hudson: I looked towards Baby I. I could see she was in the cot but I couldn’t see the top half of her because she was obscured by the lighting and the canopy so I turned around and switched the main light on the nursery —I pushed back the canopy and pulled back the blankets to have a proper look at her and assess her. That’s when I recognised she was in quite poor condition. She was incredibly pale in colour, almost white. She didn’t respond to me—she was very still. She was floppy and she was making gasping breathing movements, a handful of times within a minute. My first thought and worry, was that she had deteriorated so rapidly that it was too late. The change in her had been remarkable.


So Mr Johnson asked LL about this event and she claimed Nurse Hudson was inexperienced and should have had Baby I on a monitor. …or noticed changes in her condition sooner. But she agreed that it was not her case that any incompetence or mistakes made by staff contributed to Baby I’s collapse on this occasion.


She also accepted that less than 2 hours before her collapse, Baby I had taken a full bottle feed, was breathing for herself and had been demanding milk—which were all good signs.


LL said she had no memory of being asked to look after Baby I , while Nurse Hudson went to help her colleague. She also disputed that she was already standing by the door when Nurse Hudson returned and instead insisted that they’d arrived at Nursery 2 together. She also said the lights were not turned off in the room and instead she thought they were on low on a dimmer.


LL: There’s ALWAYS enough light in the unit to illuminate the nursery she said.

Q: How long after arriving did you notice that Baby I looked pale?

LL: I can’t put it into time but it was very quick

Q: How did you get physically to the doorway of Nursery two?

LL I could have come from the corridor

Q:Are the lights on in the corridor?

LL: Yes

Q: What is the effect if you go from a bright corridor into a dim nursery? What does it do to your eyesight?

LL: I don’t know

Q: You really don’t know? You’re a nurse, everybody knows don’t they, if you go from bright into dark light, what effect does it have on your ability to see in the dark?

LL: It depends upon the brightness, but you wouldn’t be able to see as well…

Q: You’ve noticed it right away because you have caused what you were purporting to notice isn’t it?

LL: No


Johnson showed the photo reconstruction, and the baby’s cot, which had a canvas canopy to protect the baby’s head from bright lights…he said it showed how the nursery was lit on the night of the alleged attack but Lucy told the jury the picture was not accurate


LL: The room will be lighter and the cots would be nearer the workbench

Q: How big are the hands of a child of Baby I’s age?

LL: small

Q: tiny aren’t they?

LL: yes

Q: And her head is small as well, isn’t it?

LL Yes

Q: She was covered in a baby throw?

LL: Yes

Q: There was almost nothing to see, was there?

LL: No, just her hands and face

Q: Which would have been covered by that tent-like structure

LL: Not entirely, no

Q: Ashley Hudson was right when she said you couldn’t see anything from that doorway

LL: No

Q: Do you remember what you told the police when they asked you about this? They asked ‘how could you see Baby I was pale?’ You said what…

LL: Maybe I spotted something that Ashley wasn’t able to spot —the rooms aren’t always dark so you couldn’t see the bay at all…


Q: You don’t have better eyesight than Ashley do you?

LL: No

Q: You were putting all this down to your greater experience, is that right?

LL: No

Q: How are you able to spot it if you’re both in the same place?

LL: I had more experience so I knew what I was looking for—at

Q: What do you mean, looking for?

LL: I don’t mean it like that—I’m finding it quite hard to concentrate on all these dates at the minute..


At this point LL appeared upset and agitated so the judge halted proceedings for the day, about a half an hour early…telling the jurors it had been a long day for the witness
 
1:40pm

For the night of October 22-23, Lucy Letby is a designated nurse for a baby in nursery room 2 and one in room 3. Ashleigh Hudson is the designated nurse for Child I in room 1 and one other baby.
Mr Johnson tells the court the baby in room 2 went to a hospital in Stoke during that night shift.
Letby says there were staffing issues, which were "not ideal", which were a contributory factor in the treatment of Child I following the collapse, in that a doctor had to be called away during the event.
Letby: "Considering what [Child I] had been through, she was a poorly baby, the doctors were not with her at all times...once she deteriorated."
Letby adds she believed Ashleigh Hudson was capable of looking after Child I, for Child I's nursing needs at this stage.

1:45pm

The neonatal schedule for that night is shown to the court.
Letby sent a message on October 22 at 8.47pm to a colleague: '...Unit nice. Transport on way to take my baby back to Stoke. Only 8 babies. Off duty not out. X'
Mr Johnson says this refers to the baby he mentioned earlier who was transferred out during that night.
The court hears that transfer process, noted as completing at 1am, is not a 'five-minute' process, and takes time and involves family communication.

 
I put the dates of the poisonings but the results that came back were not interpreted possibly due to the naivety of the new SHO’s.

Rotation dates were 5th Aug 15 and 6th Apr 16.

I recall Dr Brearey saying he was unaware that 2 babies had returned blood results which showed abnormally high insulin levels and the SHO‘s (if they were newly rotated) didn’t know the significance of the results.
The lab actually telephoned the hospital to alert them to the insulin results because they were so out of the ordinary. The doctor who took the call didn’t do anything with that information.
 
1:58pm

Child I collapsed at 11.57pm.
Letby denies falsifying a note for the Stoke-transfer baby prior to that at 11pm.
The court is shown a nursing note by Ashleigh Hudson, which the court heard was timed at 10.57pm. 'Longline removed due to constant occlusions; neonatal nurse Lucy Letby unable to flush, so Paeds Reg Rachel Chang informed.'
Dr Chang had written, for the Stoke-transfer baby at 10pm, the baby was safe for transfer.
Letby's note for this baby was written at 10.50pm, and completed at 10.52pm. It included a documentation of a longline infusion with a 10% dextrose fluid. Letby has co-signed the document.
Mr Johnson says the 'original 2300' reading has been changed to '2400' by Letby.
Letby said the '2300' reading was an error and it was changed to '2400' as the correct time. She adds: "The charts are there for everybody to look at."

 
I'm so confused about why the defence are doing this:

Letby rules out staffing levels, medical incompetence or staffing mistakes as a contributory factor in the collapse of Child I for this incident.

If she is innocent then obviously wouldn't know what has caused it. There is no need for her to say what DIDN'T cause it. Is this a defence strategy, something she is doing of her own back or prosecution somewhat leading it?
I think its a prosecution strategy. NJ trying to pre-empt Myers impending defence, that the unit was understaffed etc etc.
He is demanding that the defence identify the very specific occasions that the unit was poorly run, to prevent them making generic statements in the summing up.
 



Judith Moritz

@JudithMoritz

Lucy Letby trial: After a break of 8 days, the trial is now continuing. Lucy Letby is in the witness box for the 10th day. She is still being cross-examined by lead prosecution counsel Nick Johnson KC.

Nick Johnson KC is continuing to question Lucy Letby about baby I - a little girl - who the nurse is accused of murdering in October 2015. She denies this. The prosecution allege that she tried unsuccessfully to kill the baby 3 times before succeeding on the 4th attempt.

Nick Johnson is looking at Lucy Letby's nursing notes from the occasion of the 3rd alleged attack on the baby. He compares them to other clinical records.


NJKC: "This is another example isn’t it, of you writing a nursing note that creates an impression of a more gradual decline than really happened" Lucy Letby: "I don’t agree" NJKC: "You sabotaged (baby I) didn’t you" LL: "No"

NJKC: "You had inflated baby I with air hadn’t you?" LL: "No" ... NJKC: "And this is one of those cases where air was going in and out of her but she was not oxygenating" LL: "Yes" ... NJKC: "You were sabotaging her, weren’t you?" LL: "No"

Lucy Letby is now being asked about the 4th occasion when she's alleged to have attacked baby I - this time resulting in her death.

Jury hears that baby I had been transferred to a different hospital and made good progress there. She was returned to
@TheCountessNHS
. Lucy Letby agrees that 24 hours before baby I died, despite 3 life threatening situations within 3 weeks she was in a good condition.

Nick Johnson KC suggests to Lucy Letby that she "cooked the records" to make it look as though she was busy with another baby, at the time baby I collapsed. Nurse Letby denies this.
 
2:05pm

Letby denies falsifying a fluid balance chart for the Stoke-transfer baby.
Mr Johnson asks if Letby recalls what Ashleigh Hudson said for the 11.57pm desaturation. He says Ms Hudson gave evidence to say Child I was crying, making a noise she had not heard before, different to a cry for hunger.
Letby: "I did not hear that cry at that point. When I entered that nursery, she was quiet...and apnoeic."
Letby says for this event, it was a case where one of the three nurses on duty that night would have had to come and assist in room 1.

2:11pm

Letby says she does not recall Ashleigh Hudson going to call for Child I's parents.
Letby says there is an error on the IV chart, and the time has changed.
Mr Johnson: "Three different mistakes on two different babies?"
Letby says she does not know who wrote in the different times.
NJ: "How do those sorts of mistakes happen?
Letby says when the unit gets busy, "we" can make errors on the paperwork.
NJ: "We? Or you?"
LL: "I don't believe it would have been me - we would both have been there for it."
NJ: "Or is it you altering medical records to put some time between you and serious events for [Child I]?"
LL: "No."
Letby adds: "I did not deliberately falsify any paperwork."

 





Judith Moritz


The trial earlier heard evidence from another nurse who said that when baby I collapsed she heard a cry the like of which she’d never heard before. Lucy Letby says she didn't hear such a noise, and the baby wasn't screaming.


Nick Johnson KC identifies 3 mistakes in the nursing paperwork within 25 minutes. He says "You were altering medical records to put some time between yourself and serious events weren’t you?" Lucy Letby answers "No... I did not falsify any paperwork."
 
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