UK - Nurse Lucy Letby, Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #26

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I don’t know why she refused to admit to texting in the actual rooms. And it doesn’t need 2 hands to do a feed, does it? Once you’ve set up the feed (2 hands), you then just need to hold it up and let gravity take over (which requires one hand). So you could be holding the feed while it drips in and texting with the other hand.

I don’t get why she didn’t say that or why it would have been so bad to admit to texting in the wards (given the many worse things she was being accused of).

My understanding is you would need to support the baby with one hand and feed them with the other, so you’d need two hands free. Perhaps @marynnu could offer further insight?
 
Dan O'Donoghue
@MrDanDonoghue
·
13s


We're back after a break. Mr Johnson is turning to further incidents involving Child N. There were two separate incidents on the day shift of 15 June 2016


2m



On the day shift of 14 June, Child N had been doing well. He was demanding expressed breast milk and taking more than the required volumes. The court has heard that he was almost ready to go home.


1m



Overnight he was in nursery three. At the beginning of the night shift just after Ms Letby had handed him over, Child N was described as being “very unsettled”. At 01:00 on 15 June he was found to be “pale, mottled and veiny” with slight abdominal distension
 
2:10pm

The trial is now resuming after its lunch break.
Mr Johnson is continuing the case of Child N, referring to events on June 15, 2016.



 
There's something about this answer that I find so alarming but I can't quite describe what it is.

I wonder if it is the attitude of it, that makes it seem like she's not thinking of feeding a baby, even though we know that Mr Johnson was alluding to it anyway. So maybe it's the callous way she answered about a callous act.
Its the sort of answer I can imagine my 12yo giving me when she knows she's done wrong. You can really read the tone of it.
 
2:21pm

He says the day before, on June 14, Letby was Child N's designated nurse. It was planned for Child N to go home that week.
On June 14, notes are shown showing Child N had a 45ml feed at 7.40am.
At 8.17am, Letby "complained" she had had to feed Child N - she messaged: 'bottle not done'.
Mr Johnson says the 45ml feed took until about 8.15am.
Letby had noted Child N was almost 'ready for home'.
Child N's mother fed Child N at 11.50am. Mr Johnson says Letby noted at 2.20pm: 'mummy visiting this morning, carried out cares and feed...aware that once jaundice treatment discontinued infant will be ready for home...'
Mr Johnson says Letby did something to destabilise Child N at the end of her day shift to give the impression of an underlying problem.
Jennifer Jones-Key reported that, in the night, Child N was "unsettled". She wrote in nursing notes: "At start of shift, baby nursed in incubator with eye protection in situ...baby very unsettled early part of night."
Mr Johnson asks what had happened to unsettle Child N that night. He says it is similar to the case of Child P, just over a week later.
Child N started to desaturate at 1am, looking mottled, and it was escalated to Belinda Simcock and Kathryn Percival-Ward. A male doctor reviewed Child N and noted he looked normal. Child N had a number of desaturations and the male reviewing doctor believed it was the beginning of an infection, so ran a test for it. The outcome showed there was no infection, Mr Johnson says.
A repeat blood gas test had "reassuring" results. The male doctor said there was no NG Tube in place, and Child N was nil by mouth.
A colleague texted Letby at 5.25am: "Baby [N] screened, looks like s**t". Letby almost immediately responded: "Really?!"
Mr Johnson says that is the reason Letby went straight to Child N when she went in early. "She saw an opportunity."

 
2:31pm

Swipe data showed Letby came in "extra early" at 7.12am. Mr Johnson said as soon as she entered, she texted the male doctor: 'I've escaped being in 1, back in 3'. Moments later, Child N collapsed.
Mr Johnson said Jennifer Jones-Key said Child N had 'fleeting desaturations' early in the morning.
An observation chart "showed no worrying signs at all" at 5am and 7am for Child N, Mr Johnson says, with 100% oxygen saturation levels.
Child N had a "big desaturation" at 7.15am. He says Letby knew she had a chance to sabotage Child N as it would be busy. A colleague had texted her: '5 admissions, 1 vent'.
Jennifer Jones-Key said she recalled Letby had gone over and noticed Child N was pale. She said Letby had 'just come in to say hello as they were friends'.
Mr Johnson says Letby had been texting two colleagues, not Jennifer Jones-Key, the previous day, and continued the texts with a nursing colleague and a doctor colleague up to 7.12am.
Mr Johnson says if she was going in to talk to her friend, she would have gone to the nursing colleague who she had been texting and was on duty.
Letby, in police interview, said she had 'assumed something had happened for Child N to move because of the observations [on the chart]'. She said she had 'no independent memory' of Child N.
The nursing note suggested Child N was desaturating on handover. Mr Johnson says the impression given by the note is she was inheriting the problem of the child already desaturating by the time she came on shift. He says Letby was "trying to avoid an audit trail".
Child N's parents were called in urgently, and they saw him being given CPR. The parents recalled Lucy Letby being present.
Mr Johnson says Letby made more "misleading notes" after this collapse for Child N.





Dan O'Donoghue

@MrDanDonoghue
·
1m


Ms Letby was Child N's designated nurse again on the day of 15 June 2016. She came was in for her day shift early at 07:12. Ms Letby went in to see Child N - who desaturated at 07:15, three minutes after her arrival
 
2:43pm

Letby noted, in family communication at 2.10pm: 'Parents contacted by SN Butterworth during intubation. Both phones switched off and no answer on landline. message left. Call returned shortly after'.
Mr Johnson says that note must refer to the 8am intubation done by a male doctor. His note of 'intubation drugs given'.
Mr Johnson says it had been said the parents' statements were agreed, but now they are not.
Child N's father said Lucy Letby rang him up and gave details. He added, in response to the phone call: "I didn't get the impression he was still unwell."
He said a different nurse rang up 10 minutes later, telling him to go to the hospital as soon as possible, and they arrived at 9am. This was on the day Child N was due to go home.
Mr Johnson says if Child N had been 'a bit unwell during the night', then he was worse now. He says the parents were told Child N was 'ok now', which was not true.
He says the parents 'might just remember the call' to tell them there had been an issue with Child N.
He says none of this was dealt with when Letby gave evidence to her own counsel. He says when cross-examined, Letby said she believed there was a note by Bernadette Butterworth on family communication.
Mr Johnson says this chapter of evidence is "littered with irreconcilable contradiction". He asks why it was played down to the parents that Child N was unwell.
He says that when Letby made the call, she would not have known Jennifer Jones-Key had already recorded Letby had been hands-on with Child N. In police interview, Letby said she "couldn't remember".
Mr Johnson says the nursing note was "completely misleading", and suggested S/N Butterworth had been unable to get through to the father of Child N. He says Letby came in early to sabotage Child N. He says if someone looked at the records, it would look like Letby 'had a peripheral role' in Child N's care that day.


Dan O'Donoghue
@MrDanDonoghue
·
1m


Mr Johnson takes the court over the nursing note, which suggested Child N was desaturating on handover. Mr Johnson says the impression given by Ms Letby's note is that she was inheriting a problem of the child already desaturating

Dan O'Donoghue
@MrDanDonoghue
·
47s


Mr Johnson reminds the jury of the evidence of a doctor, who said the back of Child N's throat had 'unusual' swelling and that there was blood

Dan O'Donoghue
@MrDanDonoghue
·
1m


'Unexplained blood or swelling in throat of a child is another common feature in many of these cases',

Mr Johnson says 'These are not innocent coincidences'



Andy Gill
@MerseyHack
·
2m


Mr Johnson says Lucy Letby’s alleged falsification of medical records in the case of alleged victim N “indicates how determined Lucy Letby was to carry on her campaign of violence against these children.”
 
2:49pm

A subsequent examination at Alder Hey, of Child N, showed he had no abnormality with his airway.
Child N was intubated. The male doctor said upon the intubation attempt, he saw blood. He couldn't see the source of the blood, and said the swelling was "unusual".
He said in cross-examination: "It must have been unusual for me to see it."
He said, in cross-examination, it was possible the bleed could have been caused by an implement used before the first intubation, but if that was the case, he said he would have noticed blood on the equipment.
Dr Brearey said he could not think of a natural cause why Child N had collapsed.
At 11.29am, Letby messaged: 'Small amounts of blood from mouth & 1ml from NG. Looks like pulmonary bleed on Xray. Given factor 8 - wait and see...'
Mr Johnson says Letby was building a narrative.

2:52pm

When asked about the 1ml fresh blood reading on an intensive care chart at 10am in interview, Letby said she did not remember, and "I don't know what I did".
Mr Johnson said if this reading is true, she would have escalated it to a doctor, as a child with haemophilia. He says if it is not true, it is still a point against Letby - why would she make a note?

2:54pm

Mr Johnson says the jury know it wasn't escalated as there weren't any doctor's notes.

 
2:59pm

Child N's parents came in, and left for a break to get something to eat, and at that point, Child N collapsed.
"The power of circumstantial evidence," Mr Johnson says. He adds Letby 'wrote it off as an innocent coincidence'.
The next event was at 2.59pm, when doctors were crash bleeped to Child N.
He says it is a "repeat" of Child E, with a bleed.
Dr Satyanarayana Saladi encountered a "large swelling at the end of the epiglottis" and had never seen it before in a newborn baby. The swelling 'perplexed Dr Gibbs as well'.
Dr Brearey was called in by Dr Saladi to help. He said they were worried about pulmonary haemhorrhage and full intubation was still required. Mr Johnson says we know now that it was not pulmonary haemhorrhage.
Mr Johnson says the suggestion Letby first saw blood at this point is "completely unconvincing".

 
3:07pm

Mr Johnson says the text to a doctor colleague by Letby is made at 11.29am, mentioning 'small amounts of blood from mouth & 1ml from NG.', and another note is on her family communication. Mr Johnson says Letby omitted that in interview.
He says the truth is Letby made a damaging admission in interview, and "proves she sabotaged" Child N before the arrival of the doctor.
'Sorry if I was off during intubation, Bernie winds me up faffing etc , I like things to be tidy and calm...'
Mr Johnson says Bernadette Butterworth was 'getting on Lucy Letby's nerves that day'.
Letby recorded another 1ml of blood at 6pm.
When the Alder Hey transport team arrived, a female doctor said Letby was "agitated" and approached the doctor saying "who are these people? Who are these people?"
Mr Johnson says this is contradictory to what Letby said in interview, when she said she was 'relieved' the transport team arrived. He says this is all 'part of the gaslighting' on her colleagues.
The female doctor felt Letby's behaviour was "out of character" from what she had previously experienced.
Dr Gibbs said at 7.40pm he was discussing matters with the transport team when someone called for help for Child N as his saturation levels had dropped. Mr Johnson asks if this was an innocent coincidence when all the doctors were 'distracted', 'in a huddle'.

3:13pm

Mr Johnson says thanks to the skill of the medical team, they were able to bring Child N back following resuscitation efforts. Child N's time in Alder hey was 'uneventful' and he was discharged three days later.
Professor Sally Kinsey said the blood seen by the male doctor at 8am could not have been spontaneous - "somebody caused the bleeding", and could not have been seen for the first time hours later by Letby, Mr Johnson says.
Mr Johnson says the person who injured Child N was "undoubtedly" Lucy Letby.

 
Last edited:
Dan O'Donoghue

@MrDanDonoghue
·
7m


Mr Johnson reminds the jury what a doctor, who cannot be named for legal reasons, told the court when a team of specialists from Alder Hey Hospital arrived to help with Child N's treatment.

Dan O'Donoghue

@MrDanDonoghue
·
7m


The doctor said: "(Letby) 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."

Dan O'Donoghue

@MrDanDonoghue
·
6m


The doctor said Ms Letby appeared 'agitated'. Mr Johnson suggests why she was agitated. 'Outside eyes… you can gaslight people you’re with all the time, but independent people coming in from the outside… they sniff it out don’t they, that’s why she was agitated'
 
My understanding is you would need to support the baby with one hand and feed them with the other, so you’d need two hands free. Perhaps @marynnu could offer further insight?

Not marynnu, but if the baby was in the crib or isolette and positioned safely on their side, you would need one hand to hold the feed once you got it started. However, , I simply can’t imagine texting while doing a NG feeding. What a horrible practice, if that’s what she did. You need to be observing the baby and monitor during a feeding— not texting. Horrible// If that’s what she did, if guilty. Editing to add— and of course she’s been accused of much worse— it’s inconceivable at times.
 
Last edited:
3:26pm

Mr Johnson turns to the final case, Child Q, who was "doing just fine until he came into contact with Lucy Letby".


Dan O'Donoghue

@MrDanDonoghue
·
2m


Mr Johnson now turns to Child Q - the final child on this indictment.

Dan O'Donoghue

@MrDanDonoghue
·
2m


Child Q was born in late June 2016 and was "initially stable" after his birth, but jurors heard he deteriorated and needed breathing support shortly after 09:00 on 25 June.

The prosecution said Ms Letby injected air and fluid into the boy's stomach via a nasogastric tube.

Dan O'Donoghue

@MrDanDonoghue
·
2m


Mr Johnson says Child Q was 'doing just fine until he came into contact with Lucy Letby'
 
3:29pm

Child Q had a 2ml bile aspirate overnight on June 23-24, and feeds were stopped as a precaution. His bowels were noted to be working. Samantha O'Brien fed Child Q tiny amounts of milk the following night. His respiratory condition was "stable" and was tolerating the feeds. The aspirates were "possibly more than you would expect", but said he was stable and there was 'nothing you wouldn't expect' from the baby boy.

3:32pm

For the day shift of June 25, Child Q's abdomen was noted at the beginning of the shift to be 'soft and non-distended' in a note by Lucy Letby.
Letby was in room 2, designated nurse for Child Q, and a child in room 1. Mary Griffith was the designated nurse for the other baby in room 2.
Letby and Mary Griffith co-signed for medication for a baby in room 3 at 8.34am. Mary Griffith left the unit shortly after that, and Child Q then collapsed, Mr Johnson tells the court.

 
3:35pm

The 9am observation chart for Child Q is unfinished - "almost as if she was interrupted by something", and the 9am fluid chart also has gaps, with no initial.
Mary Griffith came back on to the unit at 9.01am.
Mr Johnson says while Mary Griffith was out, Letby took the opportunity to inject clear liquid and air down Child Q's NG Tube.

3:36pm

In interview, Letby said "repeatedly" at the time of the collapse, she had been in room 1, and gave the full name of the designated baby in there.
Mr Johnson says Letby has a good memory for that baby, "but she doesn't remember [Child D]."
Mr Johnson adds the reason Letby remembered that baby is the room 1 baby "was her alibi".

3:38pm

In Letby's 2020 police interview, she said she needed to see the room 1 baby as she needed 'cares'. Colleague Minna Lappalainen said cares were needed 'every four hours'. Letby had last given cares for the room 1 baby at 8.30am, and Mr Johnson says the explanation to police of cares is a "hopeless excuse".
He adds Letby sabotaged Child Q.

 
Perhaps because there would be about a billion germs on her hands showing she was not hygienic and all that she accused the smoking doctor of, I would think.
Indeed . I just find it extraordinary that she apparently decided she preferred not to offer up that as an explanation (which would have helped her out in several respects) but instead prioritised being able to criticise others for unhygienic practices.

The lesser evil for her was to clearly admit she was texting in clinical areas, and not bother to badmouth other peoples hygiene. But apparently, it is more important for her to stick to the line that she didn’t text in clinical areas, and badmouth her colleagues.
 
Not marynnu, but if the baby was in the crib or isolette and positioned safely on their side, you would need one hand to hold the feed once you got it started. However, , I simply can’t imagine texting while doing a NG feeding. What a horrible practice, if that’s what she did. You need to be observing the baby and monitor during a feeding— not texting. Horrible// If that’s what she did, if guilty. Editing to add— and of course she’s been accused of much worse— it’s inconceivable at times.

Yes, it’s awful if that did happen. I was looking up some guidelines on feeding within neonatal clinics and it seems that having completely clean and sterile hands is important too, something you likely would not have if you’re holding a phone in one hand as they’re probably one of the most bacteria laden things we use on a day to day basis! (He says as he’s typing away on it, now feeling a little icky)
 
3:49pm

Child Q's alarm sounded, Mary Griffith called for help and Minna Lappalainen arrived to help.
Mr Johnson says Letby had noted, at 9.10am, 'air++ aspirated' from Child Q and the baby was 'mottled++'.
He says this is something which has been seen before, air which hadn't been seen before the desaturation.
Mr Johnson says Minna Lappalainen didn't see the aspiration of the air or the mottling, as she was focused on stabilising on Child Q. He says that is something to consider when the defence mention about differing accounts by doctors and nurses on skin discolourations flitting, coming and going.
The discharge note by a male doctor for Child Q 'Profuse vomit with desaturation on morning 25/06/16.' He said he wasn't there, and Mr Johnson says this information must have been given to him by nursing staff.
He said Child Q's blood gas before 7am was good, and the one before 10am showed respiratory acidosis.
Mr Johnson says this was "no minor desaturation" and took the doctor away from the children's ward.
Dr Gibbs said the collapse was "not in keeping" with a baby such as Child Q who was getting tired.
Letby had messaged later: "Do I need to be worried about what Dr Gibbs was asking?"
Dr Gibbs had said he had a 'heightened concern' on the NNU. Mr Johnson says Letby had a heightened concern at this time that people were on to her.

3:49pm

NJ: "Letby's text messages proved that Dr Gibbs' instinct was absolutely right."
He says Child Q had been sabotaged by Letby.

3:53pm

Mr Johnson says if this was a minor collapse, as the defence suggest, why was Dr Gibbs so interested into what had happened?
A male doctor noted 'small loops in the bowel' 24 hours after the collapse, and Child Q was transferred to Alder Hey. Mr Johnson says it is all irrelevant to what happened 24 hours earlier.
A doctor at Alder Hey said Child Q's abdomen had normalised by June 27 and he was transferred back to Chester. He said it was another case where a child recovered quickly when 'taken out of the orbit of Lucy Letby'.

 
Dan O'Donoghue
@MrDanDonoghue
·
5m


Mr Johnson reminds the jury what consultant paediatrician Dr John Gibbs said after Child Q's collapse. He said that by late June 2016 there was a "height[en]ed concern" about baby deaths at the hospital.

Dan O'Donoghue
@MrDanDonoghue
·
5m


Dr Gibbs previously said "I remember wanting to know who had been looking after (Child Q) at time he had desaturated", he said.

"I wouldn’t normally want to know who was looking after patients."

"I was worried about what was happening on the unit", he added.

Dan O'Donoghue
@MrDanDonoghue
·
4m


Mr Johnson said Dr Gibbs had a 'heightened concern about what was going on' and 'Lucy Letby clearly had a height[en]ed concern that people were working out what she was up to'
 
4:04pm

Professor Stivaros later found evidence of a brain injury in Child Q, which Mr Johnson says proves the collapse was not a minor one.
Dr Evans was cross-examined on the 'fluid being injected' as a 'late addition' to his evidence. Mr Johnson says the defence said air being administered via Neopuffed was an explanation for 'air++ aspirated', and the description of the collapse was a 'gross exaggeration' of what had happened.
Mr Johnson said such criticism was 'unfair', as Dr Evans had referred to 'profuse' from a male doctor's note on the discharge letter. Mr Johnson adds Child Q suffered a brain injury.
Dr Evans said a significant amount of fluid appearing on Child Q did not have a natural cause, and was "suspicious of the volume of air aspirated", although he accepts the air could have been introduced by the Neopuff.
Mr Johnson says if that was the case, what caused the collapse in the first place? NJ: "He had no naturally occurring problem at the time to cause that extremity of collapse."
Minna Lappalainen noted a 'distinction' between 'mucus' and "Clear fluid+++". Letby recorded: 'Vomited clear fluid nasally and from mouth'. The doctor recorded: 'Profuse vomit with desaturation'.
Mr Johnson says the jury can be 'confident' with the 'contemporaneous evidence' that what came out was 'not just mucus'. He says it could not have been milk as Child Q only had 0.5ml of milk each 2 hours.
Dr Bohin noted if there was 'clear fluid+++' for Child Q, there was "no innocent explanation" for that. The observation chart showed whatever happened at 9.10am was "an acute event" and it happened in the space of 'minutes'.
She added that could not have been from the milk Child Q had earlier. She added if Child Q did have NEC, he recovered too quickly for that.

 
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