Child D Timeline (Part 2 of 2 - from 22 June 2015)
Note – quotes from the opening statements are NOT testimony or evidence. Witness evidence for Child D is not complete yet, so this timeline is incomplete. Where a time is not stated in media reports I’ve inserted the event in the timeline with a “Time ?” where I think it makes sense, but this may be incorrect.
Initials used:
Prosecution Opening Statement (“OS”)
Intelligence Analyst Kate Tyndall (“KT”) evidence 3/11/22
Intelligence Analyst Claire Hocknell (“CH”) evidence 4/11/22
Nurse Caroline Oakley (“CO”)
Colour code used:
Nursing notes
Cross examination*
Opening statements*
Key events
LL’s texts and Facebook Searches
Prosecution case* and
Defence case* in relation to Child D
22 Jun 2015, Monday
1am –
CO remembers going on her one-hour break from 1am to 2am, in the resuscitation room where staff had their breaks (source CO).
1.05am - The fluids chart also notes what CO believes is
a task carried out for Child D by LL at 1.05am, which she said would have been noted retrospectively, as CO would have started her break at this time (source CO).
In cross-examination - A fluids chart is presented, showing the gastric tube change recording '0105 - suction pp ll, AXR, bolus'. CO says she believes she has written that retrospectively, and has summarised what she was told for that 1.05am. She has summarised that they wanted a bolus and an abdominal x-ray. She says she would have been told all this by Lucy Letby, by another nurse Kate Percival-Ward, or a combination of both.
1.14am – blood gas readings taken. “satisfactory”.
In cross-examination CO says she is not sure this is her handwriting (source CO).
1.15am – D’s heart rate peaked (still within normal parameters) but could have been after handling and/or a nappy change (source CO). CO’s recorded observations on D.
In cross-examination CO says she would have usually expected to write these observations at 1.30am (all her other observations are taken at 30 minutes past the hour – 11.30pm, 12.30am, 2.30am and 3.30am. She said she may have written them retrospectively (source CO).
1.25am – LL and CO sign for a saline dose prescription (source KT). CO and LL noted the start of an infusion
(source OS). CO says usually the nurse looking after the baby will administer it. CO confirms the two signatures made, showing they had checked the fluid. CO adds: "I would presume that I connected the fluid".
In cross examination CO says the prescription is not in her handwriting (source CO).
LL said to police she couldn’t remember how she got involved (with D). She seemed to accept she had administered meds with a syringe at 1.25am (source OS).
CO cannot account for the timing of the medication administration and being on her break. She remembers going on her break at 1am and being called back at 1.30pm (source CO).
??1.29am – a doctor noticed an unusual rash on D.
Nursing notes suggest LL and CO called the doctor to the room, although LL’s
nursing notes show that she was looking after a different baby at the time. The prosecution allege that LL’s notes were inaccurate or she was creating an alibi for herself
(source OS). In a June 2019 police interview, LL said she could not remember calling back the doctor when Child D collapsed, but it was possible she had
(source OS). (my note – not sure if it relates to this collapse or the 2nd or 3rd)
1.30am –
D’s first collapse.
CO was called to Room 1 by two senior nurses, one of them LL. She remembers being very happy with D before going on her break and going into the nursery saying “what’s happening?” She saw D had lost colour, had saliva coming from her mouth and deep red-brown discolourations to her trunk, legs, arm and chin, different to mottling. A doctor was called (source CO). CO’s
nursing note written retrospectively but timestamped for 1.30am “Called to nursery by senior nurse […] and senior nurse Letby; [Child D] had desaturated to 70s, required oral suction as was bubbly [bubbly saliva] and had lost colour. Discolourations to skin observed, trunk/legs/arm/chin. Dr Brunton called to review." (sources KT and CO). CO says she hadn’t seen this skin discolouration/rash before, in her 20 yrs of nursing. CO says some of this note was what she had been told had happened. The “oral suctions” referred to what was being done to D before she arrived back in room 1, and the part of the note from “discolourations to skin observed” was her own observations (source CO).
In cross-examination CO says it was a short distance from the resuscitation room to room 1, and does not recall who came to get her. Mr Myers said Child D responded well to the oxygen, and no resuscitation was required. Mrs Oakley agrees (source CO).
1.30am - A 1.30am fluids reading records 'nil by mouth' at the time for Child D, along with 'oral secretion ++' for aspirates (source CO).
Time? – A
nursing note says: 'Saturations to 100% and O2 weaned to air. Observations satisfactory." CO said she couldn't recall who was doing what, but the oxygen was turned up on the CPAP machine, and Child D responded. The note adds: "Dr Newby called in to review; fluids increased..." and a number of drugs and solutions were administered and prescribed. The note adds: "Discolourations resolved. [Abdominal x-ray] taken satisfactory. Continue supportive treatment [ie antibiotics]. Maintain UVC [ie don't take it out]. Decision to speak to parents later as [Child D] stable and doctors required on paediatrics. Repeat gas good." CO confirms the rash-like appearance had 'resolved' between 1.30am and after the doctor's review. She says Child D had had an episode but had responded "quickly" and "normal parameters" had resumed within an hour. As Child D was "very stable again", and the doctors were "busy", the decision was made to let the parents rest and inform them in the morning (source CO).
2.30am – CO is asked to put into context further observation readings at 2.30am for Child D, which had "returned to normal". She says they would be considered "stable" (source CO).
2:40am – medication was administered by LL & CO. CO then left the room
(source OS). An infusion prescription chart is recorded for a sodium chloride dose with 10% dextrose. LL is one of the two nurses signing for it (source KT).
2.44am - The medication administration update is made on the computer (source KT).
3am –
D’s Second collapse. D was distressed and crying.
CO was not in the room, LL was in the room. Child D was resuscitated
(source OS).
3am - The
nursing note recorded: '[Child D] crying and desaturated again to 70s, commenced on 100% O2 via CPAP and picked up well but skin discoloured again but less than previously. Dr Brunton called to review;
take off NCPAP, further fluid bolus and gas 1 hour cares attended to; [passed urine] +++ and passed meconium." CO says she cannot recall the events around this collapse, and says her memory of it is limited to that of her notes." (source KT and CO).
In cross-examination Mr Myers suggests that CO was present at the time of the collapse. CO says she would have been in the vicinity at the time, and does not remember what she was doing. Mr Myers says it was an episode which resolved 'quickly' and resulted in a decision to take Child D off CPAP. He asks whether there had been a discussion about Child D's breathing support difficulties earlier that day. CO says she does not remember. She says she believes if the desaturations had gone to the 70s, the alarms would have gone off and she would have been alerted to Child D (source CO).
On prosecution re-direct CO is asked how the rash had changed by 3am. CO replies the rash wasn't as pronounced, not "as bad", but she was not expecting Child D to deteriorate again. She says she had previously experienced 'mottled' appearance in babies - 'newborn spots', or 'mottled', but "we don't specifically get rashes, in my experience" (source CO).
3:20am –
there is a record of LL starting an infusion and another record shows her caring for another baby in the room at 3:30am (source OS). A further neonatal infusion prescription is made, with Lucy Letby being one of the signatories (source KT). A
nursing note of drug infusion, which CO says the doctors believed Child D would need more fluid on board, is noted at 3.20am (source CO).
3.30am - The fluid chart records for 3.30am 'restart expressed breast milk (1ml).' The prosecution say the collapses had been of concern to nurses, and why the doctors were called. CO said after the review, the doctors were "happy with her" and for fluids to continue to be administered. She added Child D had passed urine and had a wet nappy, and so she was comfortable in changing her nappy. "If I thought she was unstable, I would not have chosen to change her nappy. If the baby's unstable, they do not tolerate handling. Even cleaning them could cause them to be unsettled, with their heart rate going up." CO added 'observations satisfactory' and Child D was 'handling well'. The final observation readings were all in normal parameters at 3.30am (source CO).
3.45am –
Third and final collapse. The monitor alarm sounded. CPR began but D could not be revived.
Nursing note: "Monitor alarming, [Child D] desaturated again and [stopped breathing]. Called senior nurse Letby to help. Stimulation given." (source CO). The nursing note recalled the alarm went off and Child D 'desaturated and then became apnoeic. Called Letby...' Resuscitation efforts began but to 'no effect'. A bleep alarm went off and doctors were called to the neonatal unit (source KT).
In cross-examination Mr Myers says at that point, Child D had been taken off CPAP. CO replies: "Honestly, you would have to check the times for me." "She was stable in between these two times?" "Definitely." Mr Myers says there is then a more marked deterioration, as Child D stopped breathing, and nurse Oakley called for help. CO agrees (source CO).
3.52am - Use of Neopuff was given at 3.52pm. A senior house officer was called to help. Dr Brunton called to help, resuscitation efforts began. The prosecution asks if CO has a memory of this. She says she does not, it was "just a blur, just very busy. She 'misbehaved' [had gone poorly again]. I don't remember specifically." She does not recall if an alarm went off. She would have been in the room or sitting just outside it. From her notes, she called LL to assist. The initial 'stimulation' effort was to tickle the feet, trunk, ears, which can in itself get a baby stimulated enough to start breathing. CO says she played a part in the resuscitation efforts (source CO).
The court is shown a number of clinical notes are made by doctors for this time. These clinical notes will be discussed further when the doctors involved in them come to court to give evidence in the coming days. They include the resuscitation efforts, administration of adrenaline doses and the decision, ultimately, to discontinue CPR (source KT).
Abt. 4am – Mother and father woken up by a nurse and told to come quickly as D was poorly. Rushed downstairs and saw Dr Brunton holding D and trying to resuscitate her. Mother recognised LL from her visit to see D in the unit the evening before. LL was holding a phone to Dr Brunton’s ear. Father said the person Dr Brunton was talking to (a consultant) seemed to be confused over which baby had collapsed. Dr. Brunton kept shouting 'This is D!' He was quite agitated. 'A doctor next to him (Dr Elizabeth Newby) was tapping him on the shoulder, saying 'You've got to let her go'. Mother said LL was in the unit when D died. Mother was taken to a private room where D was, with father, another family member and a nurse she hadn’t seen before. She did not see LL again (source mother’s and father’s testimony).
4.25am – Baby D died (source KT). The coroner gave the cause of death as pneumonia with acute lung injury (source OS).
4.46am – CO’s retrospective nursing note for the nightshift written (see 8pm).
A
nursing note by Yvonne Farmer recorded that Child D was blessed by a reverend with the family present, with hand and footprints obtained. The note added: "Parents had lots of cuddles and said goodbye to [Child D]." The parents were also given a bereavement box with mementoes and information on the Sands (Stillbirth and Neonatal Death Society) charity (source KT).
8am – night-shift finishes.
8.36am – LL’s text exchange with a colleague –
LL:
"We had such a rubbish night. "Our job is just far too sad sometimes."
Colleague: "No what happened?"
LL:
"We lost [Child D]."
Colleague: "What!!!! But she was improving. What happened? "Wanna chat? I can't believe you were on again. You are having such a tough time."
LL refers to Child D being "
messed about a couple of times" and refers to a rash that "
looked like overwhelming sepsis". She adds that two members of staff said the circumstances "
would be investigated".
Colleague: "Dad was very anxious all day." and adds, in relation to the investigation, "What the delay in treatment?"
LL: "
Just overall looking into the case. And reviewing what antibiotics she was on if sepsis."
Colleague: Child D "was behaving septic". "Oh hun, you need a break."
LL: "
But it's part of the job and it's hard for everyone."
Colleague: "Yes but you have had it all recently."
LL: "
Hmm well it's happened and that is it, got to carry on..." before referring to her planned time off. The conversation then discusses staffing arrangements, and the difficulties of the job, before noting an instance of a happier occasion on the unit.
LL: "
But then sometimes I think how is it such sick babies get through and others die so suddenly and unexpectedly. Guess it's how it is meant to be."
Colleague: "We just don't have magic wands..." The colleague refers to what Child D looked like in their care.
LL: "
I think there is an element of fate involved. There is a reason for everything."
LL says it had been “
another shock for us all”, adding “
feel a bit numb this time” (source BBC).
Colleague: "It's important to remember that a death is not a failure."
Colleague described their job as the "shi**est" but also the "best"
LL: "
Absolutely, on a day to day basis it is an incredible job with so many positives but it's just so sad to watch what families go through."
Colleague: “you go to bed, you’re an excellent nurse Lucy, don’t forget it."
8pm – nightshift – LL working
23 June 2015, Tuesday –
8am – LL’s nightshift ends.
-
8pm – Nightshift – LL working.
Evening - Further messages are exchanged between LL and her colleague -
Colleague: "How you doing?"
LL:
"I'm ok - trying not to think about it. Work busy but at least we have 6 tonight."
Colleague enquires about Child D and whether anything had been said about not "bringing her through sooner on Saturday".
LL: "
I don't think so", before adding there was a theory Child D may have had meningitis.
Colleague: "I'm worried I missed something."
LL: "
I don't think any of us did and she [Child D] was on the right antibiotics."
Colleague: "Yeah, just would treatment sooner have made a difference."
LL asks her colleague if Child D had a lumbar puncture.
The colleague replies she was not sure it ever got done, given that the baby girl was ill and had been on CPAP. She adds her gas reading was "appalling" when she first came through to the unit.
LL: "
I think we did what we could." LL then refers to the condition of the mother of Child D.
24 Jun 2015 - Wednesday
8am – LL’s nightshift ends.
25 Jun 2015 – Thursday
(LL not working)
9.51pm –
LL searched for both the parents' names of Child D on Facebook.
26 Jun 2015 – Friday
(LL not working)
LL sent a message to a colleague Minna Lappalainen: "
Work has been awful."
Colleague: "Oh dear. Staffing probe?"
LL: "
We have had three unexpected deaths, transfer out, few sick ones, unit full”. "
What I’ve seen has really hit me tonight."
Colleague: "Have you worked today?"
LL: "
No, been off since Wednesday morning and now it has all hit me."
Colleague asks if LL tries "talking to a proper counsellor".
LL replies that she does not think she can.
Colleague: "Why not?"
LL: "
I can't talk about it now...I can't stop crying...I just need to get it out of my system."
Colleague advises LL to think carefully what to do, before adding: "Maybe you need to take time off."
LL: "
Work is always my priority. I won’t let it affect it. I just haven’t let myself cry over it until now. Once I’ve let it out my head will be clear." (source Daily Express)
27 Jun 2015, Saturday
8am to 8pm – LL working long dayshift
28 Jun 2015, Sunday
8am to 8pm – LL working long dayshift
29 Jun 2015, Monday
(LL not working)
30 Jun 2015, Tuesday
(LL not working)
LL and a colleague exchanged messages about the condition of Child B.
Colleague: "There's something odd about that night and the other three that went so suddenly."
LL:
"What do you mean? Odd that we lost three and in different circumstances?'
Colleague: "I don't know, were they that different?" "Ignore me, I'm speculating."
LL: "
[Child C] was tiny, obviously compromised in utero. [Child D] septic. It's [Child A] I can't get my head around."
October 2015 (4 months after D died) – (could be 3rd, 10th, 17th, 24th or 31st) LL made a Facebook search for the name of baby D’s father on a Saturday tea time (source BBC tweet).
Prosecution’s case:
D had a risk factor because her mother’s waters broke early and the prosecution accepts the mother should have been given antibiotics (source OS).
Dr Evans says that the two recoveries are inconsistent with the fatal evolution of antenatal pneumonia. The discolouration and distress seen is indicative of an air embolus (source OS).
Another medical expert said the clinical status of Child D the previous night was not that of a deteriorating baby who would be dead a few hours later.
She added the injection of '3-5ml per kilogram' of air would be sufficient to kill.
Child D had been observed in distress prior to her death, and the medical expert added this would also be consistent with cases of air embolus (air injected into the system) (source OS).
Defence’s case:
Regarding the point of air embolus cases
The defence "accept it is a theoretical possibility", but that "does not establish very much".
For Child D, the defence say the hospital "failed to provide appropriate care", and this was "beyond dispute" as the prosecution accepted care was sub-optimal.
Child D "was never able to breathe unaided" and there was a "strong" possibility of infection, and evidence of pneumonia after death.
Links -
Parents’ evidence: Daily Mail
Mother of murdered baby tells how she watched the infant die
CO’s testimony Chester Standard:
Recap: Lucy Letby trial, Friday, November 4
CO’s testimony Daily Mail:
Nurse 'had never seen' unusual rash that appeared on 'murdered' baby
Chester Standard updates 3/11/22:
UK - Lucy Letby Trial - Media, Maps & Timeline *NO DISCUSSION*
4/11/22:
Recap: Lucy Letby trial, Friday, November 4
Prosecution Opening statement re D:
UK - Lucy Letby Trial - Media, Maps & Timeline *NO DISCUSSION*
Defence Opening statement re D:
UK - Lucy Letby Trial - Media, Maps & Timeline *NO DISCUSSION*
LL’s texts:
Express:
Nurse accused of murdering babies told colleague 'fate' part of deaths
BBC: -
Nurse hovered over baby before she died, jury told - BBC News
