UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #12

[Tortoise]

3:33pm

Dr Jayaram says the tube blockage would lead to a gradual deterioration, quite quick, but did not fit the pattern of Child K's deterioration.
Mr Myers suggests the care of Child K provided could have been improved.
Dr Jayaram said it could have been better.
Mr Myers suggests Dr Jayaram has added to his account over the years.
Dr Jayaram: "I would disagree with that - you would be questioning my brevity and honesty."

3:36pm

The prosecution rise to ask about a couple of matters.
Dr Jayaram is asked if he has ever seen the electronic sequence of events [being shown in court], or the swipe data collated.
Dr Jayaram replies he has never seen either, nor had cause to see them.

3:43pm

The judge asks about the morphine infusion prescription chart, and asks Dr Jayaram which sections are in Dr Jayaram's handwriting. The sections including the 0350 start time are in his writing.
The infusion would have been administered by the nurses, Dr Jayaram tells the court.
That completes Dr Ravi Jayaram's evidence for Child K.

3:47pm

The court now hears an agreed statement from Elizabeth Morgan, who says in her experience, it is very unlikely a nurse would leave the nursery of a baby if the baby's ET tube was not settled in a position and the baby was settled.
For a baby of this gestational age, it would be standard practice for a nurse to take corrective action, carry out checks and call for help if a desaturation was noted.
It would 'not be normal practice' to wait and see if the baby self-corrects, for a baby of this gestational age.

Recap: Lucy Letby trial, Tuesday, February 28

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

 

[scottishgal]

I wonder thinking earlier if it was Baby G or I which was the linchpin evidence .....now I think it is Baby K for sure that might be the strongest case ?

 

[scottishgal]

Do we think defence might say in their witness testimonies that someone or some people in particular had any personal grudge or vendetta against LL and was invested in pinning the blame on her in particular

or would that have been covered in their opening statement if that's where they were going , and she was just a convenient scapegoat for the hospital (generic / impersonal motive to pin the blame - wrong place wrong time ie)

Noting that everything has stayed very medical / professional / impersonal so far in all testimonies - and no exploration of motive on either side - I know motive is not a legal requirement to establish but still noteworthy here ?

 

[GoodDayToYouSir]

2:20pm

He tells the court: "You wouldn't not have expected" Child K's lungs to have deteriorated to the extent shown in the few minutes Joanne Williams was away from the nursery room.
He says his thought processes for going into the room, when Lucy Letby was present, were only to prove to himself that everything was ok.

[my note - CROSS-EXAMINATION]

2:26pm

Mr Myers says Dr Jayaram was worried about being irrational at the time.
Dr Jayaram said he was concerned and didn't want to see Child K in a different condition. They were not based on a clinical reason, or if Child K had any underlying conditions.
Mr Myers said he believed, from Dr Jayaram's interview with police, the suspicious behaviour had been deliberate.
Dr Jayaram: "That had crossed my mind, yes."
Mr Myers: "You 'got her', then?"
Dr Jayaram: "No."
Dr Jayaram said he wanted this investigated objectively in a proper way, and there was "absolutely no evidence that we could prove anything - as that is not our job, we are doctors."
Mr Myers said he had told the police if the tube had been dislodged on purpose. He asks if he had confronted Lucy Letby.
"No, absolutely not." Dr Jayaram said he was focused on the situation.
Mr Myers says it did not happen in the way Dr Jayaram describes.
Dr Jayaram: "I am interested in why you say that."
Mr Myers says it is not documented in medical notes.
Dr Jayaram says that would not be the sort noted in medical documentation.
Mr Myers says there is nothing to say the tube is dislodged.
Dr Jayaram says it is obvious from the medical notes.

2:30pm

He says, in isolation, the incidents were unusual, and more concerning in a pattern of behaviour.
He said: "We, as a group of consultants by this stage, had experience of an unusual event, and there was one particular nurse.
"All of these events were unusual. Yes, if we put in Datix [incident forms] we could have investigated sooner and been here [in court] sooner."
He said he, and his other consultants, wanted to know how this could be investigated, and tried their best to escalate concerns higher up the hospital.
Mr Myers says there is no record anywhere of the suspicious behaviour noted.
Dr Jayaram says he did not anticipate being sat in a courtroom, years down the line, speaking to Mr Myers.
"If you feel someone is deliberately harming [children], you would do so, wouldn't you?"
Dr Jayaram said concerns had been raised before February 2016, and were raised again following this incident.
Mr Myers says Lucy Letby continued to work at the unit for a further four months.

2:34pm

Dr Jayaram says the concerns were first raised in autumn 2015 with senior management, but were told that there was likely nothing going on.
He said the consultants went 'ok', and against their better judgment, carried on.
"We were stuck, as we had concerns.
"In retrospect, we wished we had bypassed them [senior management] and contacted the police."
"We by no means had played judge and jury, but the association was becoming clearer and clearer.
"This is an unprecedented situation for us - we play by a certain rulebook, and you don't start from a position of deliberate harm.
"It is very easy to see things that aren't there - in confirmation bias.
"But these episodes were becoming more and more and more frequent by associaiton."
Dr Jayaram said it should have been documented throughout more.
He says he discussed the incident, but did not formally document it.
Dr Jayaram said he was getting "a reasonable amount of pressure from senior management not to make a fuss".

Recap: Lucy Letby trial, Tuesday, February 28

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

Question for the nurses on here: when he talks about “senior management”, who is he likely referring to? Are we talking the Doctor who would’ve been the head of the neonatal unit? Or does he mean the board of the hospital? Or someone else?

 

[scottishgal]

I clearly watch too much G's anatomy - was surprised when I realised the consultants werent board members. *too much TV !!!*

 

[GoodDayToYouSir]

2:36pm

Dr Jayaram says he does not understand why an alarm did not go off, and why a call for help had not gone out when Child K was desaturating.
He said, in relation to the suspicions, he "did not want to believe it".
He said it "took a long time for police to be involved".

2:39pm

Dr Jayaram says the tube is 'very unlikely' to have been dislodged by a 25-week gestational age infant, in that short timeframe.
He says that can happen when a baby is 'very vigorous' - heavier, stronger babies, or when a baby is being handled or receiving cares.
Mr Myers said it was still possible for the tube to be dislodged by Child K.
Dr Jayaram says 'anything is possible', but Child K was 'not a very active baby', and a baby of this weight, size and age meant that was unlikely.

Recap: Lucy Letby trial, Tuesday, February 28

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

Dr j says baby k was “not a very active baby” but Joanne Williams just said in her testimony that baby K was “quite active“ when she went out of the room, which was apparently normal for premature babies. This conflicting testimony is not helpful particularly when the issue seems to boil down to whether the baby could have knocked the tube.

 

[magikarpmagikarp]

Surely it wouldn't self correct as the breathing tube had become detached?

So, to reiterate, we have a consultant discovering a nurse he already claims to be suspicious of, standing motionless over a deteriorating baby who's breathing tube is disconnected and absolutely nothing is done about investigating what is obviously an exceptionally serious situation?

MOO, obvs.

It's my understanding that the breathing tube was not detached from the ventilator, which is very visible. It would be very unusual to see someone standing there over a disconnected breathing tube because it is so simple to identify and fix that. My understanding of the testimony is that what Dr. Jayram saw was a baby who had falling saturations, who upon observation had no chest movement. This suggests a problem with the position of the tube inside the baby. It can take several moments to determine there is no chest movement. Dr. J walked in when the baby had a saturation of 80% and ... it's possible my unit does things very differently but 80% is not emergent to me. It gets my attention, and I'm over there looking to see what's up. Standing and looking at a baby who's saturation is 80% may very well be standing and visually assessing. This is not doing nothing.

However it sounds like shortly thereafter, the baby's saturation dropped to 40% (this can't really be measured, that just means it's quite low) and this gives more information about what is happening. Dr. J then detached the breathing tube from the ventilator so he could give breaths using the NeoPuff. This lets him give more pressure and a faster rate more easily. He still saw no chest rise, so he removed the breathing tube and gave mask breaths. The baby then recovered, which suggests the problem was with the breathing tube. The breathing tube was not clogged, and earlier the air leak was not an impediment to adequate ventilation. So this the tube must have been misplaced, probably out of the trachea and into the esophagus. The question is - did the breathing tube become dislodged by natural movement of the baby or did someone purposefully pull on it to dislodge it? That is a question I am turning over and over in my mind and I am not sure what I think.

JMO.

 

[scottishgal]

I didnt understand before , but if they were nervous about leaving her three minutes with K, wonder why they waited some more months to transfer her - now i realise there is no 'they' - there were various ppl involved up the chain and decisions were taken only when the higher ups signed off

do we know if she realised why she had been moved to clerical duties for two years 2016-2018 before police made the first arrest - why didnt she move somewhere else and instead do clerical duties ? or are there nurses who do clerical duties roles and it is not unusual - maybe they told her it was a step up ?

 

[scottishgal]

sorry i realised I sort of barged in here and it is a pretty small group following the trial on here, caught up and read all the earlier threads and have been following for a month now , cheers

 

[Marantz4250b]

It's not always obvious that the breathing tube is dislodged. If the tube was high and even a little tension gets put on it, it can slip out of the trachea and into the esophagus and will not go back into the trachea on its own. We have little CO2 detectors we can put on the end of a tube to see if it is still in place. You also listen to the lungs, can get an xray, look for mist in the tube.

It's amazing how well babies can remove their own ETTs.

He said in his evidence, though, that if it had become dislodged due to handling the baby it would be evident that it had to the nurse doing the handling. I take from that that pretty much any dislocating of the tube is going to be noticed.

This baby was sedated, according to his evidence, which to me essentially makes it highly unlikely it would be moving around enough to dislodge it.

The issue I'm getting at there is that if the allegation is that LL did indeed dislodge the tube (which appears to be what they're getting at or why silence the alarm) then that is clearly an extremely serious allegation or, at the very least, a serious competency problem. Why, in that case, was the matter not taken further by him?

 

[Tortoise]

"Dr Jayaram replied: “As I walked up, I saw Lucy Letby standing by the incubator and the ventilator. She didn’t have her hands in the incubator.

It didn't really make sense to me why the tube became dislodged. It had been secured and (Child K) was not a vigorous baby
Dr Ravi Jayaram
“I saw her and then I looked up at the monitor and (Child K’s) sats (blood oxygen levels) were in the 80s and they continued to drop.

“The ventilator was not alarming and the incubator was not alarming and the monitor is set to alarm when the sats drop below 90%."

10% - Evening Standard - Doctor ‘felt uncomfortable at thought of Lucy Letby being alone with baby girl’

 

[Sweeper2000]

Interesting that she said in police interview that in the situation described the alarm should hav been sounding. So she’s testified that she didn’t pause the alarm but is in a clinically significant situation. If she was just monitoring to see if the baby self corrected, it wouldn’t necessarily be suspicious for her to pause the alarm.

 

[Marantz4250b]

I am pretty sure he did report and voice his concerns to the administrators. There were reports that he did share his suspicions but was told , for whatever reason, to stand down.

Lucy Letby trial hears how doctor raised concerns but was told 'not to make a fuss'

Dr Ravi Jayaram, a paediatrician at the Countess of Chester Hospital, also said the unusual skin discolouration of Letby's first alleged victim, a baby boy known as Child A, "didn't fit with anything I had ever seen".

news.sky.com

A hospital consultant has told the Lucy Letby murder trial how he and other clinicians had previously raised concerns to bosses over an individual present as babies collapsed but were told "not to make a fuss".

Dr Ravi Jayaram, a paediatrician at the Countess of Chester Hospital, added that he "didn't really have any hard evidence apart from the association we had seen" and "it is a matter of regret and I wish I had been more courageous".

....snipped...

Dr Jayaram told Manchester Crown Court that he was aware there was talk on the unit about a "moving" purple rash on the body of Child A's twin sister, Child B, who the Crown allege Letby, 32, tried to kill with a similar air injection the following night.


Dr Jayaram said there were similar discussions following the death of Child D on 22 June 2015, who is also said to have been murdered by the defendant using the same method.

The paediatrician said that around the time of Child A's inquest he and a group of clinicians highlighted to hospital bosses the "association we had seen with an individual being present in those situations and, how do I say diplomatically, being told we really should not really be saying such things and not to make a fuss".

I get what you are saying here but this is all a bit vague for me; with whom did he "raise concerns", when and under what circumstances? He says that is was himself and "other clinicians" raised these concerns - who were they?

Personally, I find this evidence far from satisfactory; I do not believe that a group of clinicians who raised concerns about a staff member's potentially dangerous practices (intentionally or otherwise) in an official capacity would simply be fobbed off by senior management.

All my opinion, obviously.

 

[Tortoise]

He said in his evidence, though, that if it had become dislodged due to handling the baby it would be evident that it had to the nurse doing the handling. I take from that that pretty much any dislocating of the tube is going to be noticed.

This baby was sedated, according to his evidence, which to me essentially makes it highly unlikely it would be moving around enough to dislodge it.

The issue I'm getting at there is that if the allegation is that LL did indeed dislodge the tube (which appears to be what they're getting at or why silence the alarm) then that is clearly an extremely serious allegation or, at the very least, a serious competency problem. Why, in that case, was the matter not taken further by him?

"Dr Jayaram says he did not anticipate being sat in a courtroom, years down the line, speaking to Mr Myers.

"If you feel someone is deliberately harming [children], you would do so, wouldn't you?"

Dr Jayaram said concerns had been raised before February 2016, and were raised again following this incident."

Dr Jayaram says the concerns were first raised in autumn 2015 with senior management, but were told that there was likely nothing going on.

He said the consultants went 'ok', and against their better judgment, carried on.

"We were stuck, as we had concerns.

"In retrospect, we wished we had bypassed them [senior management] and contacted the police."


LIVE: Lucy Letby trial, Tuesday, February 28

 

[Marantz4250b]

But despite his suspicions, we heard that he 'did not make a contemporaneous note of his suspicions or the alarm failing to activate'.

JMO But if you suspect a colleague of incompetence to this degree, at the very least would you not record the facts?

Lucy Letby trial: Doctor interrupted nurse 'as she attempted murder'

I agree. I cannot understand why you would not record this. Also, if you do suspect incompetence, or worse, you have a moral duty to report it or effectively deal with it in some respect.

 

[notsure]

sorry i realised I sort of barged in here and it is a pretty small group following the trial on here, caught up and read all the earlier threads and have been following for a month now , cheers

Don't worry - all are welcome

 

[scottishgal]

how is dr J still going to be able to work there now, after whistleblowing that senior management fobbed off initial concerns

or is even a doctor's career small collateral compared to 17 babies harmed , very very difficult and traumatic case to follow

 

[scottishgal]

Don't worry - all are welcome

thank you

 

[WaxLyrical]

Baby K’s case is the one I’d been waiting for. A sedated baby whereby LL was allegedly caught in the act having dislodged the breathing tube with the child being close to death.

Having read the evidence it feels all a bit underwhelming, and could very much be a case of Dr J went in there expecting to see a crime being committed, and so that’s what he saw.

It sounds like the baby wasn’t sedated, on the contrary was “active” and had a breathing tube that was too small to the extent that 94% of the air leaked around it. The saturations were “in the 80s”, which would seem to be a situation where a nurse would stop and observe and then raise the alarm if needed.

Also, not a behavioural expert by any stretch, but LL’s lack of reaction when Dr J walked in feels important. If someone was in the process of killing a baby and was then unexpectedly caught in the act, I think I’d expect them to overcompensate, “Dr J, come quick, something is wrong”, not just nonchalantly remark that the baby seems to have just started deteriorating.

I think this entire trial will hinge on the insulin cases.

JMO.

 

[notsure]

I agree. I cannot understand why you would not record this. Also, if you do suspect incompetence, or worse, you have a moral duty to report it or effectively deal with it in some respect.

This is what baffles me too. You would absolutely have to do something if you suspected wrongdoing of this nature to small babies, IMO.