Child A -part 4: LL police interviews, Defense case interviews, and Prosecution cross examinations
Day 9 of Prosecution Case
Agreed Summary of Lucy Letby's Police Interview - re Child A
Nicholas Johnson KC, for the prosecution, explains to the jurors he will now read a summary of the police interview Lucy Letby had in respect of Child A and Child B.
The wording of the summary has been agreed between the prosecution and defence.
For the case of Child A - the first interview took place in July 2018.
Letby was allowed to look through the case notes, and was asked if she remembered the specific shift. She replied: "Yes."
Letby gave details of the handover and the long line administration.
She said she checked the fluids and a nurse colleague "had the bag out".
She said they noticed Child A was "pale and mottled", and a crash call was put out.
She said full resuscitation attempts followed.
She said Child A had been "a little bit jittery in appearance" and believed that was due to low blood sugar levels.
She said a colleague was there with the fluids at the handover.
She was asked why the fluids were a priority, and Letby explains Child A had gone 'a few hours' with a lack of fluids.
She said that "wasn't ideal".
2:15pm
She said Child A went pale after a colleague had connected the fluids. She said Child A had "gone pale" 'about five minutes' after the fluids were administered.
She said Child A had a rash-like appearance, which Letby put as being the result of an infection, or being cold.
"He was more pale than the areas of the mottling."
She was asked if anyone had seen the mottling. Letby replies: "Yes."
She said they were advised to stop administration of the fluids.
Child A was then not breathing, and Dr Harkness was called over.
Letby said she could not recall Child A's resuscitation, but recalled Dr Jayaram had entered the room.
She said the death of Child A "had been difficult" for her, and said there was a support network among the nursing team.
She said she could not recall who attached the fluids line, but believed it was her nursing colleague Melanie Taylor who had connected the fluids.
She said photos were taken of Child A in accordance with the parents' wishes on their phone, along with a lock of hair and hand/footprints.
She agreed she had been taught to prime lines so air could not get in them.
She denied having done so via Child A's long line or UVC.
She said she didn't know exactly what an air embolism was.
She said her relationship with the child's parents was "strictly professional" and could not explain or remember why she had searched the mum's name on Facebook several times in the following weeks.
She explained, for a later search, she may have been searching for their names for an update on Child B.
For Child B, Letby explained the discolouration was a different appearance to that of Child A.
Child B's appearance was observed before resuscitation attempts began.
She did not recall having had any concerns for Child B, or any alarm going off for her.
She confirmed she would have handled Child B to an extent for medication and to attach lines.
She said she did not recall how upset Child A and B's parents were at the time.
Recap: Lucy Letby trial, Wednesday, October 26
LIVE UPDATES CHESTER STANDARD
LIVE: Lucy Letby trial, Friday, May 5 - defence continues
Defence Case
8:58am
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is expected to continue today (Friday, May 5).
We will be bringing you updates throughout the day.
CHILD A
Benjamin Myers KC is continuing to ask Lucy Letby questions today.
The focus turns to the case of Child A, born on June, 7, 2015, twin of Child B. Child A died the following day.
10:34am
Mr Myers is retelling the notes for Child A's birth. Child A, a baby boy, was born with antiphospholipid syndrome.
He died the following day.
Mr Myers refers to nursing notes, referring to the UVC line being in the wrong position on June 8 for Child A. It was reinserted but was still in the wrong position. A long line was inserted.
Care was handed over to Lucy Letby at 8pm.
Mr Myers refers to retrospective nursing notes written by Lucy Letby on the morning of June 9.
The notes include: 'Instructed line not to be used by registrar. [Child A] noted to be jittery, was due to have blood gas and blood sugar taken.
'At 20.20 [Child A's] hands and feets noted to be white. Centrally pale and poor perfusion. [Child A] became apnoeic. Reg in the nursery. [Child A] making nil respiratory effort...'
Child A later died.
Lucy Letby says that, around the time of this taking place, she had moved to Ash House in June 2015.
She said she was "still in the process of moving an unpacking" at the time of Child A's events.
She says she had received a text message that morning asking her to work that night's shift.
A text message from Yvonne Griffiths from 9.21am on June 8, 2015 is shown to the court asking Lucy Letby to work that night.
Letby tells the court she was "frequently" asked to come in and cover neonatal unit shifts at short notice, saying she was very "flexible".
Letby tells the court the first she knew she was going to be caring for Child A, in nursery room 1 was when she arrived for the handover at 7.30pm.
She recalls there was "a lot of activity" in the nursery, with Dr David Harkness doing a line procedure and nurse Melanie Taylor sorting fluids for Child A. She explained Child A had been without fluids for a few hours.
An intensive care chart is shown for Child A - after 4pm on June 9, the 'cannula tissued' which meant Child A's fluids had stopped, the court is told.
A clinical note is shown to the court about the UVC and long line insertions.
Letby says she was told by Dr Harkness and nurse Taylor the long line was suitable for use to administer 10% glucose.
A collective handover had taken place prior to Letby arriving at the nursery, lasting about 20 minutes.
Letby tells the court when fluids are administered via a long line, one of the two nurses present has to be sterilised, and in this case that was nurse Melanie Taylor, handling the bag, cleaning the long line, attaching the bag to the long line 'port' on Child A's left arm and making sure the line was 'flushed'.
Letby was, she says, the 'dirty nurse' (ie unsterilised) for this procedure.
Letby say she turned her attention to hanging the bag on to the drip stand cotside and programming the pump.
Letby says the "usual practice" is for the line to be flushed with sodium chloride prior to fluid administration. She says she did not observe if that took place.
The 10% dextrose solution is shown from a fluid prescription chart as beginning at 8.05pm.
Letby says Melanie Taylor went over to a computer to start writing up notes.
Letby said she was doing some checks - on cotside equipment, suction points, emergency equipment.
She says Dr Harkness at this point was doing a procedure on twin Child B at this point.
Letby says she observed Child A to be "jittery".
Letby says "jittery" was an abnormal finding for Child A. It was "an involuntary jerking of the limbs".
She says she remembered it was "noticeable".
Child A's monitor sounded and his "colour changed".
Letby says the alarm sounded, but she did not know what it indicated at the time.
She says she noted Child A' "hands and feet were white".
She went over to Child A, who was not breathing, so they went to Neopuff him.
Letby and nurse Taylor disconnected the 10% dextrose, on Dr Harkness's advice.
Referring to 'centrally pale', Letby says that refers to Child A being pale in the abdomen and torso.
Child A was apnoeic - "not breathing".
Nurse Caroline Bennion was also in nursery room 1, and had been during handover, the court hears.
Letby says she began the 'usual procedure' of administering Neopuff to Child A.
Child A's heart stopped and a 'crash call' was put out. Letby says that is an emergency line for doctors to arrive urgently. Dr Ravi Jayaram arrived immediately and another nurse arrived shortly afterwards.
Letby says she cannot recall the resuscitation efforts, and says it was "an unexpected, huge shock", saying she had just gone through the doors and "then this was happening".
Child A died shortly before 9pm.
Letby says she, as designated nurse, arranged hand and foot prints for Child A as part of the hospital's 'bereavement checklist' which the court heard about on Tuesday. A nursing colleague helped assist in the hand and footprints, as that was a two-staff procedure.
A baptism was offered to Child A during resuscitation, and Child A and Child B were baptised together. The court hears this was part of the practice.
Letby said she felt after Child A, the bag of fluids and the long line "should be retained". She says she labelled the bag as "at the time...we should be checking everything in relation to the line and fluids" as it could be "tested" afterwards.
She says she did not know what happened to the bag afterwards.
Letby said, in reaction to Child A's death, she was "stunned, in complete shock...it felt like we had walked through the door into this awful situation - that was the first time I met [Child A] and [Child A's] parents".
A nursing colleague messaged Letby on June 9, praising her for how she handled the sitation with Child A: "...You did fab."
Letby responded: "...Appreciate you saying that & Thanks for letting me do it but supporting me so well x"
Letby says the network of support among colleagues in messaging each other outside of work was "something we all did".
Mr Myers asks why Letby searched for the mum of Child A on June 9 at 9.58am.
Letby says "it was just curiosity" that she wanted to see the people behind that "awful" event, and the parents "were on my mind".
She says it was a "pattern of behaviour" she had, as she searched the name as part of a "quick succession" of name searches in a short period of time.
Letby says there was a debrief after Child A had died, a few days later, led by Dr Jayaram, which discussed if there was anything to learn from the event.
Letby said it was "more clinically based" rather than emotional support.
She said the event "affected her" emotionally, and denies causing Child A any deliberate harm.
Letby says, of that night: "You never forget something like that".
CHILD A
Chester Standard - Recap: Lucy Letby trial, May 18 - prosecution cross-examines Letby
Mr Johnson asks about the case of Child A.
Letby says she did have independent memory of Child A.
"Before [Child A], had you ever known a child to die unexpectedly within 24 hours of birth?"
LL: "I can't recall - I'm not sure."
Letby says she can recall "two or three" baby deaths prior at the Countess of Chester Hospital, and "several" at her placement in Liverpool Women's Hospital.
Mr Johnson says Letby had previously told police it was "two" at Liverpool. Letby says her memory would have been clearer back then.
Letby says it was discussed at the time Child A's antiphospholipid syndrome could have been a contributing factor at the time.
Letby tells the court "in part", staffing levels were a contributing part in Child A's death, due to a lack of fluids for four hours and issues with the UVC line.
She says they were "contributing factors", and put Child A "at increased risk of collapse".
"I can't tell you how [Child A] died, but there were contributing factors that were missed."
Letby says the issues with Child A's lines "made him more vulnerable", with one of the lines "not being connected to anything".
Letby is asked why she didn't record this on a 'Datix form'.
LL: "It was discussed amongst staff at the time...I didn't feel the need to do a Datix, it had been raised verbally with two senior staff, one Dr Jayaram, one a senior nursing staff."
She adds: "I don't know why [Child A] died."
Letby says if the cause of death was established as air embolus, then it would have come from the person connecting the fluids, "which wasn't me".
Mr Johnson: "Do you accept you were by [Child A] at the time he collapsed?"
LL: "I accept that I was in his cot space, checking equipment, yes...I was in his close vicinity."
NJ: "Could you reach out and touch him?"
LL: "I could touch his incubator - the incubator was closed."
NJ: "Could you touch his lines?"
LL: "No."
Letby says "there's no way of knowing" from the signatures, who administered the medication between the two nurses, Letby or nurse Melanie Taylor.
Dr David Harkness recalled to the court: "There was a very unusual patchiness of the skin, which I have never seen before, and only seen since in cases at the Countess of Chester Hospital."
Letby disagrees with that skin colour description for Child A.
She agrees with Dr Harkness that Child A had "mottling", with "purple and white patches".
Letby says she cannot recall any blotchiness.
"I didn't see it - if he says he saw it...that's for him to justify.
"It's not something I saw.
"I was present and I did not see those."
Dr Ravi Jayaram said Child A was "pale, very pale", and referred to "unusual patches of discolouration."
Letby: "I don't agree with the description of discolouration, I agree he was pale."
Letby disagrees with the description of Child A being blue, with pink patches 'flitting around'.
An 'experienced nurse of 20 years', who the court hears was a friend of Letby, said: "I've never seen a baby look that way before - he looked very ill."
Letby agrees Child A looked ill. She disagrees with the nurse's statement of the discolouration, or the blotchiness on Child A's skin.
"I agree he was white with what looked like purple markings."
Letby agrees with the statement that the colouring "came on very suddenly".
Mr Johnson refers to Letby's police interview, in which Letby was asked to interpret what she had seen on Child A.
Letby explained to police mottling was 'blotchy, red markings on the skin'
"Like, reddy-purple".
Child A was "centrally pale".
In police interview, Letby was asked about what she saw on Child A. She said: "I think from memory it [the mottling] was more on the side the line was in...I think it was his left."
Letby tells the court she felt Child A was "more pale than mottled".
She says it was "unusual" for Child A to be pale and to have discolouration on the side", but there was "nothing unusual" about the type of discolouration itself.
Mr Johnson asks about the bag being kept for testing.
Letby says she cannot recall if she followed it up if the bag was tested. She had handed it over to the shift leader.
Letby is asked if she accepts Child A did not have a normal respiratory problem. Letby agrees.
Mr Johnson asks if Letby has ever seen an arrhythmia in a neonate. Letby: "No, I don't think so, no."
Mr Johnson says air bubbles were found in Child A afterwards.
"Did you inject [Child A] with air?"
"No."
Mr Johnson asks if Letby was "keen" to get back to room 1 after this event.
Letby says from her experience at Liverpool Women's, she was taught to get back and carry on as soon as possible.
Letby had been asked what the dangers of air embolus were, and she had not known.
"Were you playing daft?"
"No - every nurse knows the dangers."
Letby said she did not know how an air embolus would progress, but knew the ultimate risk was death.
The trial is now resuming. Nicholas Johnson KC says there is one thing he overlooked from the morning's evidence.
He asks Lucy Letby why she said "blotchiness" rather than "mottling" in part of her police statement.
"I think they are interchangeable," Letby tells the court.
Sky News - Lucy Letby trial: Facebook searches of nurse accused of murdering babies read out in court
4h ago12:37
Letby accepts she was in Child A's cot space when he collapsed
Nick Johnson KC moves to questions about the individual babies involved in the case.
He begins with Child A, a boy, who died on 8 June 2015. The prosecution previously told the court he "most likely" died after being injected with air.
Mr Johnson asks Lucy Letby if before Child A, she had ever known a child to die unexpectedly within 24 hours of birth.
"I can't comment on that, I'm not sure," she replies.
He later questions Letby on her location at the time of Child A's collapse that evening.
"Do you accept you were standing over Child A at the time he collapsed?" Mr Johnson asks, to which Letby says she was in his cot space checking equipment.
Letby tells the court she was in close vicinity to the baby but could not touch his lines as the incubator was closed.
Letby says she disagrees with colleagues' recollection of events
Nick Johnson KC, for the prosecution, proceeds to take Lucy Letby through the evidence relating to Child A given by Countess of Chester colleagues during the trial.
A doctor told the court during questioning that Child A had "very unusual patchiness of his skin" - Letby says she doesn't agree with the description.
She also disagrees with his statement that Child A had patches of blue/purple, as well as of red and white in places.
Mr Johnson asks if Letby is suggesting the doctor's recollection is made up.
"I didn't see it, if he saw something I didn't see that's something for him to justify."
Letby also disagrees with the recollection of a nurse - who she said was a friend - of discolouration and blotchiness.
She tells the court she doesn't remember Child A having any "abnormal discolouration".
4h ago13:02
'Did you inject Child A with air?'
Nick Johnson KC says a medical review of Child A found an air bubble in his brain and lungs.
"Did you inject Child A with that?" Letby is asked.
She replies: "No."
Other doctors also discovered air bubbles. Mr Johnson puts to her: "That's because you injected him with air, isn't it?"
Letby denies that she did.
The prosecutor asks Letby if she wanted to get straight back into nursery one of the Countess of Chester's neonatal unit, where Child A was being cared for, after his death.
She agrees and says from her experience at Liverpool Women's Hospital, "if you've lost a baby in a certain cot space you go back... so you can move on from that first experience".
Letby denies 'playing daft' in police interview
The defendant is asked about her police interview, in which she suggested to officers that she didn't know the dangers of air embolisms.
"Were you playing daft?" Nick Johnson KC asks Letby.
She replies that every nurse would know the dangers.
Letby tells the court she knew that the "ultimate serious outcome" would be death, "but what that would appear as in symptoms of a baby I don't know"
BBC Blog - https://www.bbc.co.uk/news/live/uk-65602988/page/2
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