UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #6

[Tortoise]

This part (BBM) is confusing to me. Mrs Oakley was on her break in the resuscitation room from 01:00 and signed for the infusion prescription at 01:25. Does that mean she wasn't present when it was administered? Or maybe this was this when she was called back?

Just after that the reporting says

"The prosecution ask about the timing of the 1.25am medication, and if the nurse can account for that. Mrs Oakley says she cannot."

 

[Tortoise]

Just to confuse us even further, this is what the prosecution opening says -

"At 1.29am a doctor noted "an unusual...spreading, non-blanching rash" on Child D.
There is a note in Lucy Letby's records she was engaged in the care of a different baby at the time, but the prosecution say nursing notes suggest Letby and the designated nurse called the doctor to the room.
The prosecution allege either the notes recorded were simply inaccurate, or Letby was setting herself up with an alibi in someone else's medical records.
Child D was successfully resuscitated."

 

[Tortoise]

12:28pm

Nurse Oakley's nursing note adds: "[3am 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."
Mrs Oakley says she cannot recall the events around this collapse, and says her memory of it is limited to that of her notes.

12:35pm

A nursing note of drug infusion, which Mrs Oakley says the doctors believed Child D would need more fluid on board, is noted at 3.20am.
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.
Mrs Oakley 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."

12:37pm

The nurse added 'observations satisfactory' and Child D was 'handling well'.
The final observation readings were all in normal parameters at 3.30am.

12:42pm

At 3.45am, the nurse noted: "Monitor alarming, [Child D] desaturated again and [stopped breathing]. Called senior nurse Letby to help. Stimulation given."
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 Mrs Oakley has a memory of this.
She says she does note, 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. From her notes, she called Letby to assist.
The initial 'stimulation' effort was, the court hears, to tickle the feet, trunk, ears, which can in itself get a baby stimulated enough to start breathing.
Mrs Oakley says she played a part in the resuscitation efforts.

Recap: Lucy Letby trial, Friday, November 4

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[BabaVanga]

This part (BBM) is confusing to me. Mrs Oakley was on her break in the resuscitation room from 01:00 and signed for the infusion prescription at 01:25. Does that mean she wasn't present when it was administered? Or maybe this was this when she was called back?

Sounds like her break was 1am-2am but she was called back because baby D was poorly

 

[Tortoise]

Same, it makes little sense to me "She said she had been gone because Child D was poorly." is direct from the Chester standard but may be corrected later on today as the texts were yesterday. I'll keep an eye out/check another live report stream for clarity


EDIT: I checked another live report HERE and it was exactly the same wording. Very likely it will be clarified/corrected later as it makes no sense. If anyone has seen another live report saying different please let me know

It's the same reporter Mark Dowling.

 

[Tortoise]

12:47pm

Ben Myers KC, for Letby's defence, is now asking Caroline Oakley questions.
He asks if she was aware of the 'increased mortality rate' between June 2015 and July 2016, and in a police statement, said it was a 'busy and stressful time'. Mrs Oakley agrees.
He asks whether that was from increased admissions to the neonatal unit.
"There were a lot of babies."
She said she couldn't say if that was an increase, and would have to see the statistics.
Asked if there were an increased number of acutely poorly babies, Mrs Oakley replies: "I'm not sure, I worked there a long time. We used to take a lot of 24-weekers when I started [over 20 years prior].
"I remember midwives bringing babies in when we were busy."

12:49pm

She says she does not remember the unit being "unduly short-staffed".
Mr Myers suggests that at times of crisis, they had the staff they required.
Nurse Oakley: "Yes, as they would be called from other patients."
Mr Myers: "But maybe at other times, you didn't have as many staff as you needed?"
Nurse Oakley: "I'm not sure."

12:52pm

He refers to Child D as an intensive care baby.
Mrs Oakley says she wasn't a 'poorly' intensive care baby as she wasn't on ventilator support.
She says Child D was classified as an intensive care baby.
The chart showing Mrs Oakley looking after Child D in room 1 and a baby in room 2.
He says intensive care babies require one-to-one support.
"Ideally yes"
He says the fact Mrs Oakley was looking after another baby too that night fell outside the guidelines.
"That isn't in the guidelines, is it?"
Mrs Oakley: "Strictly speaking no, but it does happen."

Recap: Lucy Letby trial, Friday, November 4

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[Tortoise]

12:59pm

Mr Myers: "It's important that with babies like [Child D] you remain vigilant, as they can deteriorate quite suddenly, can't they?"
Mrs Oakley: "They can, yes."
Mr Myers asks if Mrs Oakley was aware Child D had been on a ventilator until the early hours of June 21.
She says she only knows that from the medical notes.

Recap: Lucy Letby trial, Friday, November 4

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[LadyEdgeworth]

It's the same reporter Mark Dowling.

Thought so! Hard to find other live reporters so hopefully the later report rewords it. I assume they mean she was called back off break due to Baby D becoming unwell but the timeline is a little unclear for me right now

 

[Supernovae]

Same, it makes little sense to me "She said she had been gone because Child D was poorly." is direct from the Chester standard but may be corrected later on today as the texts were yesterday. I'll keep an eye out/check another live report stream for clarity


EDIT: I checked another live report HERE and it was exactly the same wording. Very likely it will be clarified/corrected later as it makes no sense. If anyone has seen another live report saying different please let me know

Possibly she was in particular need of a break as she had had to provide more intensive care?

 

[Tortoise]

I've heard (from the Mail podcast) that most of the reporters are in a different court altogether, watching it on a screen. I can imagine that the conditions in there would be a little noisier than in the actual courtroom. Some journos are in the actual courtroom of course, so this is just a guess.

 

[Tortoise]

BBC hasn't provided any clarity on the confusing evidence we've heard-

"Giving evidence, Ms Oakley recalled that Child D, who had been born prematurely, was "stable" the evening before her death.

At around 01:30 BST on 22 June, 2015, Ms Oakley said she had been called off her break to assist Ms Letby and another nurse with Child D, who had deteriorated."

Lucy Letby: Baby had unusual rash before death, nurse trial told

Nurse Lucy Letby is alleged to have killed the baby girl by injecting air into her bloodstream.

www.bbc.co.uk

 

[LadyEdgeworth]

1:45pm

We've had an adjournment for a shorter-than-usual lunch break. The trial is now resuming.

Recap: Lucy Letby trial, Friday, November 4

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

Looks like we're due to start up again, happy to continue live updating as work is very slow today

 

[Tortoise]

Thank you @LadyEdgeworth

 

[LadyEdgeworth]

1:48pm

Ben Myers KC is continuing to ask nurse Caroline Oakley questions.
He asks if she knew there had been a delay in giving Child D antibiotics after birth.
She says she cannot remember, but can see from the notes.
Mr Myers refers to a nursing note from June 21, during the day, that there were signs of respiratory acidosis after extubation.
Mrs Oakley says she cannot remember that note, but she would have been told about it during the shift handover.

1:49pm

Mr Myers refers to the note continuing with 'blood gas repeated 2 hours later showed a further deterioration 'with increasing metabolic acidosis'.
He asks whether she would have been informed of this.
Mrs Oakley: "I'm sure it would've been mentioned [at the handover], yes.

1:51pm

Mr Myers asks about the attempt to take Child D off CPAP at 7.15pm, but Child began shallow breathing again, so was put back on CPAP.
"What we have is a baby who has been struggling to breathe unaided [throughout the day]?"
"Yes."
Mr Myers says there are warning signs she was not in an optimal state, and an indication she was "unwell".
"If she needs help with her breathing, yes."

Recap: Lucy Letby trial, Friday, November 4

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[Tortoise]

He's focusing on the day before the evening shift, when notes reflect she was stable and "breathing beautifully", until nurse Oakley went on her break.

 

[LadyEdgeworth]

1:58pm

The observation chart is shown for Child D for the night shift is shown again to the court.
Mr Myers then refers, for context, to the previous 24 hours, showing Child D's observations were in 'the warning zone' for heart rate and breathing rate on several hourly observation readings from late on June 20 throughout the day of June 21.

2:06pm

A blood gas readings chart is shown to the court.
The PH readings recorded at 10.14am and 12.10pm on June 21, of 7.194 and 7.173 are 'acidic'. Mrs Oakley agrees. She adds that doctors would have a better idea of the parameters of what would be normal readings for babies.

Mr Myers, referring to other readings, says the situation is 'not as good' at 11.52pm as it was at a reading from 6.44pm.
Mrs Oakley agrees.
Mr Myers says the blood gas readings are worse at 1.14am, and point to a deterioration.
Mrs Oakley says the readings to her are not as good as earlier, and says the doctors would take action based on them.

2:08pm

Mr Myers refers to the break Mrs Oakley took between 1-2am.
Mes Oakley says she is not sure the 1.14am blood gas reading notes are in her handwriting.
Mr Myers refers to the 1.15am observation chart reading note, which has Mrs Oakley's signature initials.
Mrs Oakley says she would have expected to write those observations at 1.30am, and may have written them retrospectively - "it does happen".

Recap: Lucy Letby trial, Friday, November 4

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[Tortoise]

Hopefully the second nurse referred to will testify too.

At 1.30am, nurse Oakley's notes record: 'called to nursery by senior nurse...and senior nurse Letby; [Child D] had desaturated to 70s, required oral suction as was bubbly and had lost colour. Discolourations to skin observed; trunk/legs/arm/chin. Dr Brunton called to review'.

 

[LadyEdgeworth]

2:12pm

An IV prescription chart, with Mrs Oakley's signature initials at 1.25am, is presented to the court.
Mrs Oakley said the prescription is not in her handwriting.
Mr Myers says it's not unusual for nurses to help each other out, particularly for procedures which could involve two nurses. Mrs Oakley agrees.

2:15pm

A fluids chart is presented, showing the gastric tube change recording '0105 - suction pp ll, AXR, bolus'.
Mrs Oakley says she believes she has written that retrospectively, and has summarised what 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.

2:19pm

Mr Myers refers to the 1.30am collapse of Child D.
Mrs Oakley 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.

Recap: Lucy Letby trial, Friday, November 4

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[LadyEdgeworth]

Got to say this is odd from Myers IMO, today he's pointed out that Mrs Oakley acted out of guidelines by looking after another baby, but brushes over someone else signing a prescription as her?

 

[Tortoise]

2:12pm

An IV prescription chart, with Mrs Oakley's signature initials at 1.25am, is presented to the court.
Mrs Oakley said the prescription is not in her handwriting.
Mr Myers says it's not unusual for nurses to help each other out, particularly for procedures which could involve two nurses. Mrs Oakley agrees.

2:15pm

A fluids chart is presented, showing the gastric tube change recording '0105 - suction pp ll, AXR, bolus'.
Mrs Oakley says she believes she has written that retrospectively, and has summarised what 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.

2:19pm

Mr Myers refers to the 1.30am collapse of Child D.
Mrs Oakley 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.

Recap: Lucy Letby trial, Friday, November 4

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

How confusing - is she saying she didn't sign at 1.25am?