Tortoise
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A timeline I've produced for baby E which contains a combination of information from the prosecution opening speech (so some events not in evidence yet) and the testimony we heard yesterday:
29 Jul 2015, Wednesday –
Identical boy twins Child E and Child F born, prematurely, at 29 weeks.
Child E weighed 2lb 14oz (1.327kg). He was given oxygen then weaned to air and transferred to Room 1. He was at risk of NEC and started on antibiotics, IV fluids and caffeine. He had a nasogastric tube inserted.
Child F was marginally younger, and he required some resuscitation at birth. He was later intubated, ventilated and given meds to help his lungs. He was recorded as having high blood sugar so was prescribed a tiny dose of insulin. His breathing tube was removed and he was given breathing support. He had a long line.
30 Jul 2015, Thursday
A staff debrief into the death of Child A was held.
Mother says she was able to visit the twins in the neonatal unit, from upstairs in the post-natal wards. She said that would take about 5-10 minutes to get from one place to the other, due to having had a C-section, which made the journey time longer.
She said she was able to cuddle Child E as he wasn't on CPAP, while Child F was on CPAP.
1 Aug 2015, Saturday
Mother said Child E was progressing better, of the two twins, over July 30-31, but both were doing "really well" by August 1. She was keen to get home and was keen to transport both babies to a hospital closer to home, and was waiting for two ambulances to be provided. She said she and her partner were under the impression both babies were well enough to travel. By that stage, she had had skin-to-skin contact with both twins, and both were managing "fine". "We were never informed about anything to say they weren't fine."
8pm night shift – LL was designated nurse for Child F.
2 Aug 2015, Sunday
By August 2, mother says the couple were still waiting for transport. She said on that day, the twins were both out of their incubators by this stage. Child E was breathing "easily" and Child F was "great".
8pm night shift – LL was designated nurse for Child F. Melanie Taylor was designated nurse for Child E.
8pm – Melanie Taylor’s nursing notes record (for Child E): "Self-ventilating in 24% oxygen, resps 6-70, minimal recession evident."
10.34pm – LL’s texts:
From nursing colleague JJ-K to LL: "Hope work ok".
LL: "...yeah it's fine, bit too Q word really."
JJ-K: "Don't complain as Wed and Thurs horrible lol! It will pick up again."
3 Aug 2015, Monday
Early hours - nursing notes by Melanie Taylor recording two Brady desats (slow heart rate) at the early hours of August 3, requiring 'gentle stimulation' to correct. One of the Bradys is recorded as lasting 45 seconds. Child E's tummy was 'soft, not distended', had satisfactory blood gas readings and heart/respiratory rate, and fluids were being administered. The bowels were not yet opened.
8am end of night shift - Melanie Taylor's notes said 'feeds tolerated, tummy remains soft'. A family communication note is also made by the nurse: "Mum and dad visiting at start of shift, mum has been 2x with [expressed breast milk] overnight."
Mother says by August 3 the twins were "great - doing really well". "We were absolutely thrilled that both boys were doing so well and we couldn't have asked for any more than that. They were both progressing."
A nurse's record notes for that day that mum 'had long periods of skin to skin [contact]'.
10.44am – nursing note: Child E was 'self-ventilating in 25% ambient oxygen. No signs of respiratory distress...pink and well perfused....handles well. Caffeine given as prescribed.'
11.45am - A doctor's note records Child E has 'suspected sepsis', 'hyperglycaemia', and was 'off lights' for jaundice, with 'good gases'. Child E was 'tolerating well' expressed breast milk. The baby boy was 'not examined at present as having cuddles with mum'.
The plan was to 'examine later' and increase feeds. Aspirates were 'ok'.
2.10pm - Dr Emily Thomas made clinical notes: 'examination of [Child E] as having skin to skin on [ward round earlier that day]. Good tone and movements, handling appropriately throughout the day.'
Time? - Child E was placed on a small dose of insulin, given via infusion.
Abt. 5pm – Father left the hospital to go home. Mother was having skin-to-skin contact with Child E, until about 6.30pm.
5.24pm - A nursing note: Child E was 'self-ventilating in air', blood gas reading was 'satisfactory', and feeds were increased.
6.30pm – before 7pm – Mother says she changed his nappy and cleaned him around the eyes and neck. She went back up to the post-natal ward to express breast milk and have something to eat, between 7 and 8.30pm.
7pm – “cares” row on the observation chart has a tick signed by the day shift nurse.
7.30pm - At 7.30pm, Dr Emily Thomas made clinical notes, with a CRP reading less than 1, Child E was on 23% oxygen, and antibiotics were 'likely to stop at 36 hours as improving'. A series of other observations are made.
8pm nightshift – LL is designated nurse for twins E & F in room 1.
8pm – LL’s barrister suggests the mum went down to the neonatal unit at 8pm, (not with the breast milk at that time) at the time of the handover. The mother disagrees. LL’s nursing note for 8pm written retrospectively at 4.51am: "Mummy was present at start of shift attending to cares."
Just before 9pm – Mother says; she took her expressed breast milk down to the neonatal unit, room 1; LL was the only other adult in room 1; mother heard Child E “screaming more than crying” from the corridor before she entered the room; LL was not near Child E’s incubator, she was busy doing something, standing between the two incubators at a work station; there was blood on his face around his mouth; she was there for about 10 minutes; she asked LL why he was bleeding; LL told her the NGT was rubbing the back of his throat; LL told her to go back to her ward and the registrar was on his way and if there was a problem someone would ring up to the ward. The mother went back to the ward. Mother agrees with LL’s barrister that no other staff came into the room when Child E was screaming. LL’s barrister says the screaming was not as bad as the mother describes. Mother disagrees. LL's notes: "prior to 21:00 feed, 16ml mucky slightly bile-stained aspirate obtained and discarded, abdo soft, not distended. SHO [Senior House Officer] informed, to omit feed." Pros says these notes are false.
9pm – LL recorded information to detail the volume of fluids given via the IV line and a line in Child E's left leg, and the 9pm feed is 'omitted'. The SHO said he had no recollection of giving advice to omit the 9pm feed. He believes the only time he had anything to do with Child E was in a secondary role to the registrar in an examination at 10.20pm.
c.9.10pm – Large v.slightly bile-stained aspirate is reported as happening at 9.10pm, to Dr Harkness at 9.40pm.
9.11pm – Child E’s mother phoned her husband in a call lasting 4 mins 25 secs. She says she knew there was something very wrong. Father confirms that the mother was upset and very worried about bleeding from Child E’s mouth in this call. He said he was sure the medical staff knew what they were doing and she was panicking over nothing.
9.11pm to 10.52pm – mother was waiting to hear about Child E, panicking and talking to the midwife. Mother had not seen this midwife before. She confirms the first name of the midwife was Susan. She was later told by a midwife to call her husband.
9.13pm – LL made a note in twin F’s records.
9.40pm - Dr David Harkness records readings from 9.40pm, (written at 10.10pm), 'asked to see patient re: gastric bleed'. 'Large, very slightly bile-stained aspirate 30 mins ago.' (my note - that would be 9.10pm). 14ml of blood vomit is also recorded. Dr Harkness noted Child E was 'alert, pink, well perfused', with an abdomen which was 'soft, not distended' and no bowel sounds. The note adds 'G I [gastrointestinal] bleed ? Cause'
10pm – LL’s barrister suggests that the mother went to the neonatal unit with her breast milk. “The mother absolutely disagrees.” LL’s barrister suggests LL never mentioned the feeding tube irritating Child E. Mother disagrees. LL’s barrister asks if there was a conversation between LL a doctor and her, regarding medication. Mum disagrees and says she was told (at 9pm visit) a doctor would be down to see Child E.
10pm - In the 10pm column of LL’s nursing notes for aspirates: '15ml fresh blood'. LL’s notes: "At 10pm large vomit of fresh blood. 14ml fresh blood aspirate obtained from NG tube. Reg Harkness attended. Blood gas satisfactory..." Child E was 'handling well'.
LL’s further note: 'Mum visited again approx. 10pm. Aware that we had obtained blood from his NG tube and were starting [treatment]...'
10.20pm - SHO believes the only time he had anything to do with Child E was in a secondary role to the registrar in an examination at 10.20pm.
Bef.10.52pm – neonatal unit contacted the midwife and told of deterioration.
10.52pm – the midwife called the father telling him to come to the hospital, after the neonatal unit rang the maternity ward. LL’s barrister suggests this is the call where the mother told her husband about Child E bleeding, and the mum was not as worried at the 9.11pm call as she was at 10.52pm. mother disagrees. Father says this call was split between the midwife and the mother and he was told not to panic but to get over here now. He tells LL’s barrister the bleeding was not referred to in this call.
11pm - A neonatal fluid balance chart is shown to the court, with no name or notes for the 11pm column. LL’s retrospective nursing notes said: 'NG tube on free drainage. Further 13mls blood obtained by 11pm. Beginning to desaturate and perfusion poor. Oxygen given via Neopuff'. Child E was said by LL to be 'cold to the touch' and was beginning to 'decline'.
Time? 11pm? - Dr Harkness noted '13ml blood-stained fluid from NGT on free drainage.' Child E's blood pressure was 'stable' and saturates' remained 60-70%', and 'making good respiratory effort', and was 'crying'. A plan of action, including x-rays and medication, was made.
11.30pm - A note for 11.30pm on the observation chart has blood pressure and respiratory rate recorded, no record of a heart rate made, and blank readings for cot temperature, and no initials recorded.
11.40pm – Child E collapsed. LL recorded, retrospectively: "11.40pm became Bradycardiac, purple band of discolouration over abdomen, perfusion poor, CRT 3secs. "Emergency intubation successful and placed on ventilator..." Further notes by LL: 'Required 100% oxygen, saturations 80%, SIMV 22/5 rate 60. Further saline bolus and morphine bolus given. 2nd peripheral line sited..." "Once [Child E] began to deteriorate, midwifery staff were contacted." The latter note is written, retrospectively, at 4.51am.
11.40pm - Dr Harkness records, in clinical notes at this time, written retrospectively, 'Sudden deterioration at 11.40pm, brady 80-90bpm, sats 60%, poor perfusion, colour change over abdomen purple discoloured patches'. The note adds, after an improvement in sats, 'purple discolouration in abdomen remained', and a plan of action noted for Child E.
Time? – Mother (and father?) returned to the neonatal unit and sat in the corridor while Child E was being worked on by medics trying to resuscitate him.
4 Aug 2015, Tuesday
12.15am - A further observation reading for Child E, made by LL, is taken at 12.15am, with a heart rate 'down from where it had been earlier', and a drop in temperature, recording he was on 100% oxygen.
12.25am - A consultant paediatrician arrived at the neonatal unit.
12.27am - An x-ray is taken at 12.27am, relating to the chest and abdomen.
12.30am - Shortly after 12.30am Child E was placed on breathing support and given medication after resuscitation.
12.36am - A further, 'acute deterioration' for Child E, is noted by Letby at 12.36am. 'Resus commenced as documented'. The consultant paediatrician noted CPR commenced, along with ventilations, and medications.
12.50am - A blood transfusion is started for Child E at 12.50am, and several adrenaline doses are administered.
1.01am - LL's note, for 1.01am, reads 'chest compressions no longer required'.
1.15am - LL notes 'further decline, resus recommenced'.
1.23am - CPR was discontinued at 1.23am - 'resus discontinued when [Child E] was given to parents. [Child E] was actively bleeding...'
1.40am – The time of death was recorded as 1.40am on August 4. No post-mortem was conducted.
LL’s note: 'both parents present during the resus. Fully updated by nursing and medical team throughout. Parents wished for [Child E] to be baptised....
'Child E was bathed by myself and photographs taken as requested, both were present during this. Consent obtained for [hair] and hand/footprints... 'Both distraught...'
The official documented report for the incident is made by LL - 'unexpected death following gastrointestinal bleed. Full resus unsuccessful'.
Time? - The mum says the husband asked a few questions and they were told by the (female) doctor a post-mortem "wouldn't tell them much" more than what they had already been told by the doctor, and it would delay the transfer back home.
"We just wanted to take him home."
Time? – Mother says LL bathed Child E and dressed him in a white gown. LL gave the parents a memory box. Baby E's mum says that after he died "Lucy Letby gave us a memory box, which totally surprised me.. it had footprints, a lock of his hair, a candle, a teddy. I was so overcome by emotions that this had been provided for me as I had no other memories other than that".
4.51am - LL made “fraudulent” (per opening speech) nursing notes, failing to mention that his throat was bleeding at 9pm, and falsely claiming the mother had visited at the start of the shift and later at 10pm, and that there had been a meeting between the mother and the registrar.
8am – End of LL’s night shift
8.21am - LL noted at 8.21am 'Parents resident on unit overnight. Wish to be left alone'.
8.58am – LL’s texts
Colleague: "You ok? Just heard about [E]. Did you have him? Sending hugs xx"
LL: "News travels fast - who told you? Yeah I had them both, was horrible."
Colleague responded that she had been informed by someone at the handover 'told me just now'. 'Had he been getting poorly or was it sudden?' ‘Poor you. You’re having a tough time of it.”
LL responds E had a 'massive gastrointestinal haemorrhage'.
Colleague: ‘Damn. He’d always struggled feeding. I just feel for his parents and you. You’ve had really tough times recently.’
LL responds that E was 'IUGR [Intrauterine growth restriction] and REDF [Reversal of umbilical artery end-diastolic flow]' and believed E was 'high risk'. She went on to describe how she felt ‘just awful’ and reported that the parents were distraught, saying "I feel numb".
7.55pm – LL’s texts
Jennifer Jones-Key: "Hey how's you?"
LL: "Not so good, we lost [E] overnight."
JJ-K: "That’s sad. You’re on a terrible run at the moment. Were you in room 1?"
LL: "I had him and Baby [F]"
JJ-K: "That is not good, you need a break from it being on your shift."
LL: "It's the luck of the draw unfortunately. Only three trained (nurses), so I ended up having them both."
JJ-K: "You seem to be having some very bad luck though."
LL: "Not a lot I could do really. He had a massive haemorrhage. It could happen to any baby really."
JJ-K says Letby "did everything you could", adding she had seen a haemorrhage in babies before, and was 'horrible' to see.
LL: "This was abdominal. I’ve only seen pulmonary before.”
JJ-K asked after E’s parents.
LL: “Ok. Tired. They’ve just gone to bed.”
8pm - LL night shift starts
7 August 2015, Friday (about - a few days after giving E’s parents a memory box)
LL gave the mother a photograph of [F] 'holding' E's teddy.
The mother had just made one of her daily visits to the hospital's chapel of rest. 'Lucy Letby told me 'I got this picture. I thought it was so amazing I took a picture for you'. She was suggesting F had rolled over and cuddled the bear'.
9 August 2015, Sunday
LL gave an account to JJ-K of saying her goodbyes to the [E&F’s] parents.
She told Ms Jones-Key that both parents had cried and hugged her: ‘saying they’d never be able to thank me enough for the love and care I gave them'.
JJ-K: 'It’s heart-breaking, but you have done your job to the highest standard with compassion and professionalism. 'When you can’t save a baby you can try to make sure that the loss of their child is their only regret. You should feel very proud of yourself'.
LL: 'I just feel sad that they’re thinking of me when they’ve lost him'.
Abt Nov 2015 - LL was told that the parents of Baby E and Baby F had come into the neonatal unit with a 'gorgeous huge hamper' for the staff. She was also told their surviving son looks 'fab'.
LL said: 'Oh gosh, did they? I wish I could have seen them. That will stay with me forever'.
Murder charge Child E – air (allegedly) injected into bloodstream and bleeding indicative of trauma.
29 Jul 2015, Wednesday –
Identical boy twins Child E and Child F born, prematurely, at 29 weeks.
Child E weighed 2lb 14oz (1.327kg). He was given oxygen then weaned to air and transferred to Room 1. He was at risk of NEC and started on antibiotics, IV fluids and caffeine. He had a nasogastric tube inserted.
Child F was marginally younger, and he required some resuscitation at birth. He was later intubated, ventilated and given meds to help his lungs. He was recorded as having high blood sugar so was prescribed a tiny dose of insulin. His breathing tube was removed and he was given breathing support. He had a long line.
30 Jul 2015, Thursday
A staff debrief into the death of Child A was held.
Mother says she was able to visit the twins in the neonatal unit, from upstairs in the post-natal wards. She said that would take about 5-10 minutes to get from one place to the other, due to having had a C-section, which made the journey time longer.
She said she was able to cuddle Child E as he wasn't on CPAP, while Child F was on CPAP.
1 Aug 2015, Saturday
Mother said Child E was progressing better, of the two twins, over July 30-31, but both were doing "really well" by August 1. She was keen to get home and was keen to transport both babies to a hospital closer to home, and was waiting for two ambulances to be provided. She said she and her partner were under the impression both babies were well enough to travel. By that stage, she had had skin-to-skin contact with both twins, and both were managing "fine". "We were never informed about anything to say they weren't fine."
8pm night shift – LL was designated nurse for Child F.
2 Aug 2015, Sunday
By August 2, mother says the couple were still waiting for transport. She said on that day, the twins were both out of their incubators by this stage. Child E was breathing "easily" and Child F was "great".
8pm night shift – LL was designated nurse for Child F. Melanie Taylor was designated nurse for Child E.
8pm – Melanie Taylor’s nursing notes record (for Child E): "Self-ventilating in 24% oxygen, resps 6-70, minimal recession evident."
10.34pm – LL’s texts:
From nursing colleague JJ-K to LL: "Hope work ok".
LL: "...yeah it's fine, bit too Q word really."
JJ-K: "Don't complain as Wed and Thurs horrible lol! It will pick up again."
3 Aug 2015, Monday
Early hours - nursing notes by Melanie Taylor recording two Brady desats (slow heart rate) at the early hours of August 3, requiring 'gentle stimulation' to correct. One of the Bradys is recorded as lasting 45 seconds. Child E's tummy was 'soft, not distended', had satisfactory blood gas readings and heart/respiratory rate, and fluids were being administered. The bowels were not yet opened.
8am end of night shift - Melanie Taylor's notes said 'feeds tolerated, tummy remains soft'. A family communication note is also made by the nurse: "Mum and dad visiting at start of shift, mum has been 2x with [expressed breast milk] overnight."
Mother says by August 3 the twins were "great - doing really well". "We were absolutely thrilled that both boys were doing so well and we couldn't have asked for any more than that. They were both progressing."
A nurse's record notes for that day that mum 'had long periods of skin to skin [contact]'.
10.44am – nursing note: Child E was 'self-ventilating in 25% ambient oxygen. No signs of respiratory distress...pink and well perfused....handles well. Caffeine given as prescribed.'
11.45am - A doctor's note records Child E has 'suspected sepsis', 'hyperglycaemia', and was 'off lights' for jaundice, with 'good gases'. Child E was 'tolerating well' expressed breast milk. The baby boy was 'not examined at present as having cuddles with mum'.
The plan was to 'examine later' and increase feeds. Aspirates were 'ok'.
2.10pm - Dr Emily Thomas made clinical notes: 'examination of [Child E] as having skin to skin on [ward round earlier that day]. Good tone and movements, handling appropriately throughout the day.'
Time? - Child E was placed on a small dose of insulin, given via infusion.
Abt. 5pm – Father left the hospital to go home. Mother was having skin-to-skin contact with Child E, until about 6.30pm.
5.24pm - A nursing note: Child E was 'self-ventilating in air', blood gas reading was 'satisfactory', and feeds were increased.
6.30pm – before 7pm – Mother says she changed his nappy and cleaned him around the eyes and neck. She went back up to the post-natal ward to express breast milk and have something to eat, between 7 and 8.30pm.
7pm – “cares” row on the observation chart has a tick signed by the day shift nurse.
7.30pm - At 7.30pm, Dr Emily Thomas made clinical notes, with a CRP reading less than 1, Child E was on 23% oxygen, and antibiotics were 'likely to stop at 36 hours as improving'. A series of other observations are made.
8pm nightshift – LL is designated nurse for twins E & F in room 1.
8pm – LL’s barrister suggests the mum went down to the neonatal unit at 8pm, (not with the breast milk at that time) at the time of the handover. The mother disagrees. LL’s nursing note for 8pm written retrospectively at 4.51am: "Mummy was present at start of shift attending to cares."
Just before 9pm – Mother says; she took her expressed breast milk down to the neonatal unit, room 1; LL was the only other adult in room 1; mother heard Child E “screaming more than crying” from the corridor before she entered the room; LL was not near Child E’s incubator, she was busy doing something, standing between the two incubators at a work station; there was blood on his face around his mouth; she was there for about 10 minutes; she asked LL why he was bleeding; LL told her the NGT was rubbing the back of his throat; LL told her to go back to her ward and the registrar was on his way and if there was a problem someone would ring up to the ward. The mother went back to the ward. Mother agrees with LL’s barrister that no other staff came into the room when Child E was screaming. LL’s barrister says the screaming was not as bad as the mother describes. Mother disagrees. LL's notes: "prior to 21:00 feed, 16ml mucky slightly bile-stained aspirate obtained and discarded, abdo soft, not distended. SHO [Senior House Officer] informed, to omit feed." Pros says these notes are false.
9pm – LL recorded information to detail the volume of fluids given via the IV line and a line in Child E's left leg, and the 9pm feed is 'omitted'. The SHO said he had no recollection of giving advice to omit the 9pm feed. He believes the only time he had anything to do with Child E was in a secondary role to the registrar in an examination at 10.20pm.
c.9.10pm – Large v.slightly bile-stained aspirate is reported as happening at 9.10pm, to Dr Harkness at 9.40pm.
9.11pm – Child E’s mother phoned her husband in a call lasting 4 mins 25 secs. She says she knew there was something very wrong. Father confirms that the mother was upset and very worried about bleeding from Child E’s mouth in this call. He said he was sure the medical staff knew what they were doing and she was panicking over nothing.
9.11pm to 10.52pm – mother was waiting to hear about Child E, panicking and talking to the midwife. Mother had not seen this midwife before. She confirms the first name of the midwife was Susan. She was later told by a midwife to call her husband.
9.13pm – LL made a note in twin F’s records.
9.40pm - Dr David Harkness records readings from 9.40pm, (written at 10.10pm), 'asked to see patient re: gastric bleed'. 'Large, very slightly bile-stained aspirate 30 mins ago.' (my note - that would be 9.10pm). 14ml of blood vomit is also recorded. Dr Harkness noted Child E was 'alert, pink, well perfused', with an abdomen which was 'soft, not distended' and no bowel sounds. The note adds 'G I [gastrointestinal] bleed ? Cause'
10pm – LL’s barrister suggests that the mother went to the neonatal unit with her breast milk. “The mother absolutely disagrees.” LL’s barrister suggests LL never mentioned the feeding tube irritating Child E. Mother disagrees. LL’s barrister asks if there was a conversation between LL a doctor and her, regarding medication. Mum disagrees and says she was told (at 9pm visit) a doctor would be down to see Child E.
10pm - In the 10pm column of LL’s nursing notes for aspirates: '15ml fresh blood'. LL’s notes: "At 10pm large vomit of fresh blood. 14ml fresh blood aspirate obtained from NG tube. Reg Harkness attended. Blood gas satisfactory..." Child E was 'handling well'.
LL’s further note: 'Mum visited again approx. 10pm. Aware that we had obtained blood from his NG tube and were starting [treatment]...'
10.20pm - SHO believes the only time he had anything to do with Child E was in a secondary role to the registrar in an examination at 10.20pm.
Bef.10.52pm – neonatal unit contacted the midwife and told of deterioration.
10.52pm – the midwife called the father telling him to come to the hospital, after the neonatal unit rang the maternity ward. LL’s barrister suggests this is the call where the mother told her husband about Child E bleeding, and the mum was not as worried at the 9.11pm call as she was at 10.52pm. mother disagrees. Father says this call was split between the midwife and the mother and he was told not to panic but to get over here now. He tells LL’s barrister the bleeding was not referred to in this call.
11pm - A neonatal fluid balance chart is shown to the court, with no name or notes for the 11pm column. LL’s retrospective nursing notes said: 'NG tube on free drainage. Further 13mls blood obtained by 11pm. Beginning to desaturate and perfusion poor. Oxygen given via Neopuff'. Child E was said by LL to be 'cold to the touch' and was beginning to 'decline'.
Time? 11pm? - Dr Harkness noted '13ml blood-stained fluid from NGT on free drainage.' Child E's blood pressure was 'stable' and saturates' remained 60-70%', and 'making good respiratory effort', and was 'crying'. A plan of action, including x-rays and medication, was made.
11.30pm - A note for 11.30pm on the observation chart has blood pressure and respiratory rate recorded, no record of a heart rate made, and blank readings for cot temperature, and no initials recorded.
11.40pm – Child E collapsed. LL recorded, retrospectively: "11.40pm became Bradycardiac, purple band of discolouration over abdomen, perfusion poor, CRT 3secs. "Emergency intubation successful and placed on ventilator..." Further notes by LL: 'Required 100% oxygen, saturations 80%, SIMV 22/5 rate 60. Further saline bolus and morphine bolus given. 2nd peripheral line sited..." "Once [Child E] began to deteriorate, midwifery staff were contacted." The latter note is written, retrospectively, at 4.51am.
11.40pm - Dr Harkness records, in clinical notes at this time, written retrospectively, 'Sudden deterioration at 11.40pm, brady 80-90bpm, sats 60%, poor perfusion, colour change over abdomen purple discoloured patches'. The note adds, after an improvement in sats, 'purple discolouration in abdomen remained', and a plan of action noted for Child E.
Time? – Mother (and father?) returned to the neonatal unit and sat in the corridor while Child E was being worked on by medics trying to resuscitate him.
4 Aug 2015, Tuesday
12.15am - A further observation reading for Child E, made by LL, is taken at 12.15am, with a heart rate 'down from where it had been earlier', and a drop in temperature, recording he was on 100% oxygen.
12.25am - A consultant paediatrician arrived at the neonatal unit.
12.27am - An x-ray is taken at 12.27am, relating to the chest and abdomen.
12.30am - Shortly after 12.30am Child E was placed on breathing support and given medication after resuscitation.
12.36am - A further, 'acute deterioration' for Child E, is noted by Letby at 12.36am. 'Resus commenced as documented'. The consultant paediatrician noted CPR commenced, along with ventilations, and medications.
12.50am - A blood transfusion is started for Child E at 12.50am, and several adrenaline doses are administered.
1.01am - LL's note, for 1.01am, reads 'chest compressions no longer required'.
1.15am - LL notes 'further decline, resus recommenced'.
1.23am - CPR was discontinued at 1.23am - 'resus discontinued when [Child E] was given to parents. [Child E] was actively bleeding...'
1.40am – The time of death was recorded as 1.40am on August 4. No post-mortem was conducted.
LL’s note: 'both parents present during the resus. Fully updated by nursing and medical team throughout. Parents wished for [Child E] to be baptised....
'Child E was bathed by myself and photographs taken as requested, both were present during this. Consent obtained for [hair] and hand/footprints... 'Both distraught...'
The official documented report for the incident is made by LL - 'unexpected death following gastrointestinal bleed. Full resus unsuccessful'.
Time? - The mum says the husband asked a few questions and they were told by the (female) doctor a post-mortem "wouldn't tell them much" more than what they had already been told by the doctor, and it would delay the transfer back home.
"We just wanted to take him home."
Time? – Mother says LL bathed Child E and dressed him in a white gown. LL gave the parents a memory box. Baby E's mum says that after he died "Lucy Letby gave us a memory box, which totally surprised me.. it had footprints, a lock of his hair, a candle, a teddy. I was so overcome by emotions that this had been provided for me as I had no other memories other than that".
4.51am - LL made “fraudulent” (per opening speech) nursing notes, failing to mention that his throat was bleeding at 9pm, and falsely claiming the mother had visited at the start of the shift and later at 10pm, and that there had been a meeting between the mother and the registrar.
8am – End of LL’s night shift
8.21am - LL noted at 8.21am 'Parents resident on unit overnight. Wish to be left alone'.
8.58am – LL’s texts
Colleague: "You ok? Just heard about [E]. Did you have him? Sending hugs xx"
LL: "News travels fast - who told you? Yeah I had them both, was horrible."
Colleague responded that she had been informed by someone at the handover 'told me just now'. 'Had he been getting poorly or was it sudden?' ‘Poor you. You’re having a tough time of it.”
LL responds E had a 'massive gastrointestinal haemorrhage'.
Colleague: ‘Damn. He’d always struggled feeding. I just feel for his parents and you. You’ve had really tough times recently.’
LL responds that E was 'IUGR [Intrauterine growth restriction] and REDF [Reversal of umbilical artery end-diastolic flow]' and believed E was 'high risk'. She went on to describe how she felt ‘just awful’ and reported that the parents were distraught, saying "I feel numb".
7.55pm – LL’s texts
Jennifer Jones-Key: "Hey how's you?"
LL: "Not so good, we lost [E] overnight."
JJ-K: "That’s sad. You’re on a terrible run at the moment. Were you in room 1?"
LL: "I had him and Baby [F]"
JJ-K: "That is not good, you need a break from it being on your shift."
LL: "It's the luck of the draw unfortunately. Only three trained (nurses), so I ended up having them both."
JJ-K: "You seem to be having some very bad luck though."
LL: "Not a lot I could do really. He had a massive haemorrhage. It could happen to any baby really."
JJ-K says Letby "did everything you could", adding she had seen a haemorrhage in babies before, and was 'horrible' to see.
LL: "This was abdominal. I’ve only seen pulmonary before.”
JJ-K asked after E’s parents.
LL: “Ok. Tired. They’ve just gone to bed.”
8pm - LL night shift starts
7 August 2015, Friday (about - a few days after giving E’s parents a memory box)
LL gave the mother a photograph of [F] 'holding' E's teddy.
The mother had just made one of her daily visits to the hospital's chapel of rest. 'Lucy Letby told me 'I got this picture. I thought it was so amazing I took a picture for you'. She was suggesting F had rolled over and cuddled the bear'.
9 August 2015, Sunday
LL gave an account to JJ-K of saying her goodbyes to the [E&F’s] parents.
She told Ms Jones-Key that both parents had cried and hugged her: ‘saying they’d never be able to thank me enough for the love and care I gave them'.
JJ-K: 'It’s heart-breaking, but you have done your job to the highest standard with compassion and professionalism. 'When you can’t save a baby you can try to make sure that the loss of their child is their only regret. You should feel very proud of yourself'.
LL: 'I just feel sad that they’re thinking of me when they’ve lost him'.
Abt Nov 2015 - LL was told that the parents of Baby E and Baby F had come into the neonatal unit with a 'gorgeous huge hamper' for the staff. She was also told their surviving son looks 'fab'.
LL said: 'Oh gosh, did they? I wish I could have seen them. That will stay with me forever'.
Murder charge Child E – air (allegedly) injected into bloodstream and bleeding indicative of trauma.
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