sceawian
PhD in Visual Perception
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I'm not sure a jury traipsing around any NICU would be a very sensible idea!
UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #12
- Thread starter sleuth777
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I'm not sure a jury traipsing around any NICU would be a very sensible idea!
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Ahh thanks tortoise … I wasn’t sure if it was still “ as was “ so to speak.
So many repercussions on so many levels.
So many repercussions on so many levels.
7. Nobody can remember
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I had forgotten they had had a virtual walk round - that was nearly FIVE months ago.
It must feel never ending for all involved.
It must feel never ending for all involved.
Exactly this ^^^^Slightly different situation but I've recently started working for a public sector body (not NHS) and had safeguarding training and when I raised an issue, I felt like it was completely ignored. I was also told, not in so many words, not to get involved. I did get involved because I'm that kind of person but also I'm not bothered about the job. However, if I had been there for years and it was my career, it might have been a different story. Other colleagues had similar experiences and also got involved but I was the only one who raised a formal complaint via email to the relevant person (nothing was done). In my view, this lack of action is because those at the top level of public sector bodies have a very nice salary and a very nice pension and it's all about protecting themselves.
See also, the Mid Staffs hospital scandal. A quote from the article below states ""Staff who spoke out felt ignored and there is strong evidence that many were deterred from doing so through fear and bullying."
Mid Staffs hospital scandal: the essential guide
Study the issue in depth and learn all you need to know about what happens next with our essential guidewww.theguardian.com
GoodDayToYouSir
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I think LL is only charged in relation to the first desat? The second desat was what the original murder charge for baby k related to , which the prosecution offered no evidence for? I think..
GoodDayToYouSir
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I think LL is only charged in relation to the first desat? The second desat was what the original murder charge for baby k related to , which the prosecution offered no evidence for? I think..
GoodDayToYouSir
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I think LL is only charged in relation to the first desat? The second desat was what the original murder charge for baby k related to , which the prosecution offered no evidence for? I think..
There is nothing in the reporting to support this.
The murder charge was for the date of 20 February 2016.
The attempted murder charge was for the date of 17 February 2016.
These were alternative charges according to the reporting.
I've collated the reporting about bleeding in the throat re. baby K
Dr James Smith
evidence in chief
(first intubation shortly after birth) :
"He successfully intubated Child K on the third attempt with a size 2.0 tube."
"He tells the court if he had seen any signs of trauma, such as bleeding, on Child K at the time of intubation, he would have passed the procedure on. To the best of his recollection, he did not see any signs of trauma.
He tells the court there is nothing in the notes of any sign of trauma at this point."
(re-intubation after 3.50am collapse) :
"Dr Smith says he did not see any evidence of trauma, and if there was anything obvious to show that, he would have informed Dr Ravi Jayaram, but he "did not see anything"."
cross-exam
"Dr Smith says he did not recall any injury/blood/trauma with Child K, and if he had done so, he would have referred it to Dr Ravi Jayaram and asked them to take over the intubation process.
Mr Myers asks if, hypothetically, he had seen blood before intubation, if he would have checked for the source of it.
Dr Smith says it would depend on the amount of blood seen that would lead to how concerned he would be. He said if he had seen blood-stained secretions, he would make a note of it."
Nurse Joanne Williams
evidence in chief
"Asked about her '?ETT dislodged, removed and re-intubated' nursing note, Ms Williams tells the court there was a query that the ET tube had been dislodged.
Ms Williams had also recorded on her nursing note, for the ET Tube, 'large amount blood-stained oral secretions'."
cross-exam
Mr Myers asks about the nursing note made by Ms Williams 'large blood-stained secretions'.
Ms Williams says she does not recall where that came in the timeframe of events.
She adds it is difficult to write notes retrospectively and highlight the significant events. She says it is likely that would have been seen at the time of the re-intubation as she would have been present.
re-examination
Ms Williams's nursing note is shown to the court. She is asked if the note, written retrospectively, is written chronologically. Ms Williams says that ideally, that would be the case.
Dr Ravi Jayaram
cross-exam
Dr Jayaram says he is not aware of a nursing note recording 'blood-stained oral secretions'.
The nursing note by Joanne Williams which refers to this is shown to the court.
Dr Jayaram says that is in the back of Child K's mouth, not in the tube, and is not clinically relevant. It was "not a significant finding".
He says he would have noted if the tube had been blocked, and he would have noted it.
sources -
Dr Smith :
Recap: Lucy Letby trial, Monday, February 27
Nurse Williams and Dr Jayaram :
Recap: Lucy Letby trial, Tuesday, February 28
Dr James Smith
evidence in chief
(first intubation shortly after birth) :
"He successfully intubated Child K on the third attempt with a size 2.0 tube."
"He tells the court if he had seen any signs of trauma, such as bleeding, on Child K at the time of intubation, he would have passed the procedure on. To the best of his recollection, he did not see any signs of trauma.
He tells the court there is nothing in the notes of any sign of trauma at this point."
(re-intubation after 3.50am collapse) :
"Dr Smith says he did not see any evidence of trauma, and if there was anything obvious to show that, he would have informed Dr Ravi Jayaram, but he "did not see anything"."
cross-exam
"Dr Smith says he did not recall any injury/blood/trauma with Child K, and if he had done so, he would have referred it to Dr Ravi Jayaram and asked them to take over the intubation process.
Mr Myers asks if, hypothetically, he had seen blood before intubation, if he would have checked for the source of it.
Dr Smith says it would depend on the amount of blood seen that would lead to how concerned he would be. He said if he had seen blood-stained secretions, he would make a note of it."
Nurse Joanne Williams
evidence in chief
"Asked about her '?ETT dislodged, removed and re-intubated' nursing note, Ms Williams tells the court there was a query that the ET tube had been dislodged.
Ms Williams had also recorded on her nursing note, for the ET Tube, 'large amount blood-stained oral secretions'."
cross-exam
Mr Myers asks about the nursing note made by Ms Williams 'large blood-stained secretions'.
Ms Williams says she does not recall where that came in the timeframe of events.
She adds it is difficult to write notes retrospectively and highlight the significant events. She says it is likely that would have been seen at the time of the re-intubation as she would have been present.
re-examination
Ms Williams's nursing note is shown to the court. She is asked if the note, written retrospectively, is written chronologically. Ms Williams says that ideally, that would be the case.
Dr Ravi Jayaram
cross-exam
Dr Jayaram says he is not aware of a nursing note recording 'blood-stained oral secretions'.
The nursing note by Joanne Williams which refers to this is shown to the court.
Dr Jayaram says that is in the back of Child K's mouth, not in the tube, and is not clinically relevant. It was "not a significant finding".
He says he would have noted if the tube had been blocked, and he would have noted it.
sources -
Dr Smith :
Recap: Lucy Letby trial, Monday, February 27
Nurse Williams and Dr Jayaram :
Recap: Lucy Letby trial, Tuesday, February 28
8:56am
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 (Thursday, March 2).
We will be bringing you live updates throughout the day.
9:01am
The prosecution is expected to begin delivering evidence in the case of Child N, a baby boy who was born in June 2016.
The prosecution allege Lucy Letby attempted to murder Child N three times. The defence deny this.
9:30am
Previously, the court heard June 2016 was the last full month in which Lucy Letby worked at the Countess of Chester Hospital's neonatal unit.
The following month, the neonatal unit was redesignated from a 'Level 2' unit down to a 'Level 1' unit.
Earlier this week, the court heard very premature babies, such as Child K, would be cared for, long-term, at a tertiary centre - or 'Level 3' unit, such as at Wirral's Arrowe Park Hospital.
www.chesterstandard.co.uk
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 (Thursday, March 2).
We will be bringing you live updates throughout the day.
9:01am
The prosecution is expected to begin delivering evidence in the case of Child N, a baby boy who was born in June 2016.
The prosecution allege Lucy Letby attempted to murder Child N three times. The defence deny this.
9:30am
Previously, the court heard June 2016 was the last full month in which Lucy Letby worked at the Countess of Chester Hospital's neonatal unit.
The following month, the neonatal unit was redesignated from a 'Level 2' unit down to a 'Level 1' unit.
Earlier this week, the court heard very premature babies, such as Child K, would be cared for, long-term, at a tertiary centre - or 'Level 3' unit, such as at Wirral's Arrowe Park Hospital.
Recap: Lucy Letby trial, Thursday, March 2
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…
Dan O'Donoghue
@MrDanDonoghue
·
3m
I'm back at Manchester Crown Court for the murder trial of nurse Lucy Letby. Today we'll be hearing evidence in relation to Child N. Ms Letby is accused of attempting to murder the premature boy on three occasions in June 2016. She denies all charges.
@MrDanDonoghue
·
3m
I'm back at Manchester Crown Court for the murder trial of nurse Lucy Letby. Today we'll be hearing evidence in relation to Child N. Ms Letby is accused of attempting to murder the premature boy on three occasions in June 2016. She denies all charges.
Dan O'Donoghue
@MrDanDonoghue
·
4m
The court has previously heard that Child N's clinical condition was "excellent" after birth, although he did have mild haemophilia, a disorder which makes someone more prone to bleeding.
Dan O'Donoghue
@MrDanDonoghue
·
2m
The prosecution allege that his haemophilia gave Ms Letby "cover" to attack him, because if he bled it would be put down to the condition.
@MrDanDonoghue
·
4m
The court has previously heard that Child N's clinical condition was "excellent" after birth, although he did have mild haemophilia, a disorder which makes someone more prone to bleeding.
Dan O'Donoghue
@MrDanDonoghue
·
2m
The prosecution allege that his haemophilia gave Ms Letby "cover" to attack him, because if he bled it would be put down to the condition.
10:31am
The trial has now resumed, with evidence being given in the case of Child N.
10:39am
The court is now hearing a statement from the mother of Child N, who was born on June 2, 2016 at 1.42pm, via C-section.
The mother first visited the neonatal unit, where Child N was, at 10pm that night. Child N was kept there due to prematurity, and for the first 13 days there were no problems reported to the parents.
Child N had haemophilia and on June 15, the parents were informed the baby boy had had a bleed. The parents were informed to attend hospital as soon as possible.
Child N was in intensive care, and on arrival Lucy Letby was there with other people.
They were told they had tried to intubate Child N between 4-8am.
Child N had two collapses that day - the parents were told to go out and get some fresh air in between the two collapses. While they were out, Child N had his second collapse.
A 'spur of the moment' baptism took place. Lucy Letby stayed beyond the end of her shift, and Child N was transferred to Alder Hey, where he recovered quickly over the following couple of days.
10:42am
A statement is now being read from Child N's father, who says Child N's mother was a haemophia carrier.
He said he could not go to all the scans, but at one of them there was a concern Child N appeared to stop growing, so steroids were prescribed.
A C-section was planned, several weeks early.
When Child N was born, he weighed 3lb 11oz.
It was "a little scary" when he was first born, as Child N needed a little oxygen, but he was then ok.
For the first 13 days, the only issue reported to the parents was an issue with Child N's liver, which he was being treated for with light therapy.
The parents visited daily.
www.chesterstandard.co.uk
The trial has now resumed, with evidence being given in the case of Child N.
10:39am
The court is now hearing a statement from the mother of Child N, who was born on June 2, 2016 at 1.42pm, via C-section.
The mother first visited the neonatal unit, where Child N was, at 10pm that night. Child N was kept there due to prematurity, and for the first 13 days there were no problems reported to the parents.
Child N had haemophilia and on June 15, the parents were informed the baby boy had had a bleed. The parents were informed to attend hospital as soon as possible.
Child N was in intensive care, and on arrival Lucy Letby was there with other people.
They were told they had tried to intubate Child N between 4-8am.
Child N had two collapses that day - the parents were told to go out and get some fresh air in between the two collapses. While they were out, Child N had his second collapse.
A 'spur of the moment' baptism took place. Lucy Letby stayed beyond the end of her shift, and Child N was transferred to Alder Hey, where he recovered quickly over the following couple of days.
10:42am
A statement is now being read from Child N's father, who says Child N's mother was a haemophia carrier.
He said he could not go to all the scans, but at one of them there was a concern Child N appeared to stop growing, so steroids were prescribed.
A C-section was planned, several weeks early.
When Child N was born, he weighed 3lb 11oz.
It was "a little scary" when he was first born, as Child N needed a little oxygen, but he was then ok.
For the first 13 days, the only issue reported to the parents was an issue with Child N's liver, which he was being treated for with light therapy.
The parents visited daily.
Recap: Lucy Letby trial, Thursday, March 2
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…
Last edited:
10:45am
On the day Child N was due to come home, on June 15, the father was at work. He received a call from Lucy LEtby saying Child N was 'a bit unwell' during the night, but was fine now. He did not get the impression that Child N was still unwell.
He then received a call from child N's mother to come to the hospital as soon as possible.
When he arrived, Lucy Letby was in the room with Child N, giving cares. There was "no urgency". Lucy said: "Hi. He's been a bit unwell during the night."
He said he was "shocked" when he saw Child N, as he had dried reddy-brown blood around the mouth.
"I remember being confused and thinking, 'what's wrong with him?'"
"No-one told us what happened, or why."
After going outside for a bite to eat, they returned to the neonatal unit and found the blinds were down. A staff member on reception said Child N was "really unwell" and if they would like a priest.
www.chesterstandard.co.uk
On the day Child N was due to come home, on June 15, the father was at work. He received a call from Lucy LEtby saying Child N was 'a bit unwell' during the night, but was fine now. He did not get the impression that Child N was still unwell.
He then received a call from child N's mother to come to the hospital as soon as possible.
When he arrived, Lucy Letby was in the room with Child N, giving cares. There was "no urgency". Lucy said: "Hi. He's been a bit unwell during the night."
He said he was "shocked" when he saw Child N, as he had dried reddy-brown blood around the mouth.
"I remember being confused and thinking, 'what's wrong with him?'"
"No-one told us what happened, or why."
After going outside for a bite to eat, they returned to the neonatal unit and found the blinds were down. A staff member on reception said Child N was "really unwell" and if they would like a priest.
Recap: Lucy Letby trial, Thursday, March 2
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…
A reminder of opening speeches regarding baby N
Prosecution :
2:46pm
Child N - attempted murder (three allegations)
Child N, a boy, was born in June 2016. He was a couple of weeks premature and he was admitted to the neonatal unit. His clinical condition was "excellent".
The prosecution say there are three separate occasions on which Lucy Letby tried to kill him.
2:48pm
Child N had haemophilia. Subseuqent investigation found him to have a mild version of the disease, and children of his age do not bleed for no reason, particularly in the throat, the prosecution say.
The prosecution said Lucy Letby used Child N's haemophilia as a "cover" to attack him.
2:50pm
On the night of June 2, Letby was on the shift and not the designated nurse for Child N.
She had earlier texted friends and sent a message to a colleague saying “we’ve got a baby with haemophilia”. She sent a further text saying, “everyone bit panicked by seems of things although baby appears fine”.
At 8.04pm she sent a text saying that she was going to “Google” haemophilia. 7 minutes later Letby texted her coleague: “complex condition, yeah 50:50 chance antenatally”.
2:54pm
The designated nurse said Child N was stable and left for a break at about 1am. He would have asked a colleague to look after Child N, but he could not recall whch one.
Letby had two babies to care for, in room 4.
At 1.05am, Child N's oxygen saturation levels fell from 99% to 40%.
"Unusually", for a baby, he was described as crying and "screaming".
Child N recovered quickly, while the doctor was then called to another emergency.
Medical expert Dr Dewi Evans said he believed the deterioration of Child N "was consistent with some kind of inflicted injury which caused severe pain".
Dr Sandie Bohin said such a profound desaturation followed by a rapid recovery, in the absence of any painful or uncomfortable procedure, suggested an inflicted painful stimulus.
She said – “this is life threatening. He was also noted to be … ‘screaming’ and apparently cried for 30 minutes. This is most unusual. I have never observed a premature neonate to scream.”
2:57pm
12 days later, there were two separate incidents on June 15 for Child N.
Letby had been the designated nurse for the previous day.
Overnight he was in nursery 3. At the beginning of the night shift, Child N was 'very unsettled'.
Letby was to be the desigated nurse for June 15. The use of her phone appeared to show she was awake by 5.10am and in for her shift at 7.12am. She had texted a colleague that she had “escaped [room] 1 [and was] back in 3”.
2:59pm
A colleague said Lucy Letby same into the room to say hello, but when the nurse's back was turned, Letby told her Child N had desaturated before assiting with the breathing. There was no evidence of an alarm sounding or if Letby waited to see if he self-corrected.
Doctors were called and an attempt was made to intubate Child N.
He was “surprised by his anatomy more than anything else … I could not visualise parts of the back of his throat because of swelling”.
3:01pm
The doctor saw "fresh blood" in Child N's throat, which the prosecution say was the same seen in Childs C, E and G.
The doctor was unable to get the breathing tube down the throat of Child N as he was unable to visualise the child's tracheal inlet.
He attempted to intubate Child N on three occasions.
3:07pm
An intensive care chart is presented to the court, which records the amount of dextrose going into Child N.
The bleeding record, of 10am '1ml fresh blood', recording aspirates from the NG tube.
Said bleeding, the prosecution say, is not recorded anywhere in the medical notes. It was more than 2 hours after the attempts to intubate.
At 11.29am Letby sent a Facebook message to the doctor telling him “small amounts of blood from mouth and 1ml from ng. Looks like pulmonary bleed on x ray [i.e. a bleed from the lungs]. Given factor 8 – wait and see”. Other than that phone message, there is no evidence that Lucy Letby brought the bleeding to the attention of any of the medical staff.
The prosecution said this is surprising given the problems Child N had suffered.
In an update recorded on the computer notes by Lucy Letby at 1.53pm she wrote that Child N was “stiff” on handling and extending upper limbs, back arching … settled in between episodes.
The prosecution say this is similar to that found in other cases heard so far.
At 3pm there is a further entry in Letby's writing of '3ml blood', initialled not by Letby and coincides with a second collapse that day.
3:10pm
Child N collapsed just before 3pm and a consultant was called at 2.59pm. While awaiting a consultant, a junior doctor looked into the airway of Child N and saw a “large swelling at the end of his epiglottis” he could only just see the bottom of the vocal cords. He had never seen anything like this before in a newborn baby.
The junior doctor's notes made at 4.30pm recorded: "desaturated this afternoon at 2:50pm with blood in the oropharynx + blood in the NG tube. Improved with bagging. Elective intubation planned following ??? unsuccessful attempts with 2 registrars and 2 consultants cords difficult to visualise …”
Letby recorded at 6.30pm: "approx. 14:50 infant became apnoeic, with desaturation to 44%, heart rate 90 bpm. Fresh blood noted from mouth and 3mls blood aspirated from NG tube. … Drs crash called”.
The prosecution said Child N was "so unwell" that attempts were made to reintubate him, but the doctor could not see down Child N's throat as the view was obscured by fresh blood. A more specialist team was called to carry out the intubation.
3:11pm
Child N continued to be unwell on June 15 and difficulties with ventilation persisted. Eventually he was transferred to Alder Hey, where the prosecution say he recovered quickly.
3:13pm
Medical expert Dr Dewi Evans said the blood seen in Child N's stomach had originated there, caused not from intubation attempts but "instead some preceding trauma".
He suggested that “thrusting” a NG tube into the back of the throat might be the mechanism used to inflict the injury.
Dr Sandie Bohin suggested only two possible explanations; either inflicted trauma or a spontaneous bleed. She considers the latter less likely as the haemophilia was 'only moderate'.
Dr Bohin’s view was that the likely cause of the bleeding was trauma to the mouth, to the throat or to the oropharynx, most likely from a NGT or suction catheter.
3:14pm
Professor Sally Kinsey describes the collapse on June 3 as dramatic with no recognised medical cause. She excluded the possibility of a pulmonary haemorrhage - in other words, bleeding in the lungs, causing the collapse on June 15. In her opinion such bleeding would not have occurred spontaneously in a child with Child N's degree of haemophilia.
It follows, the prosecution say, the bleeding was caused by trauma.
Professor Kinsey also ruled out heavy-handed intubation as a cause.
3:15pm
In police interview, Letby had difficulty remembering Child N.
She did recall an occasion when doctors had difficulty intubating him. She agreed that she had seen blood but denied being responsible for causing him harm.
She could not explain the entry in her notes timed at 10am on June 15 in which she recorded aspirating more fresh blood which she had not apparently brought to the attention of anyone else.
Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders
-----------------------------------------------------------------------------------------------------------------------------------------------------
Sky News:
The prosecution allege Letby tried to kill him on three occasions.
He was born with haemophilia, a disease which can cause bleeding for no reason, or a trivial reason. Staff at the hospital attributed many of the episodes to this.
However, Nick Johnson KC says: "Subsequent investigation has shown Child N has a mild version of the disease.
"Children with a mild level of haemophilia rarely bleed for no reason."
This, Mr Johnson says, "gave her cover to attack Child N".
He continues: "Because if she caused a bleed she thought it would be put down as haemophilia.
"She was right."
Letby later texted a friend saying she was going to Google haemophilia, saying it was a "complex condition, yeah 50:50 chance antenatally".
Mr Johnson tells the court: "No doubt this is what her Google research had told her.
"It appears therefore that Lucy Letby thought Child N was lucky to be alive."
14:57
At 1.05am Child N experienced a "sudden deterioration" which was consistent with some kind of "inflicted injury which caused sever pain, distress and destabilised him", the prosecution says.
Unusually for a pre-term baby, he was described as "crying and screaming".
Independent medical experts said this was "consistent with inflicted injury or having received an injection of air", jurors were told.
His recovery was prompt - which would not be consistent with an infection.
One of the medical experts wrote: "This is life threatening. He was also noted to be... 'screaming' and apparently cried for 30 minutes.
"This is most unusual.
"I have never observed a premature neonate to scream."
15:09
At 8am, Child N's oxygen levels had fallen to 48%. A decision was made to intubate him.
The doctor doing so said "he was surprised by his anatomy more than anything else. I couldm't visualise the back of his throat because of swelling".
There was "fresh blood" in Child N's throat - something, the prosecution says, that had been seen before in previous children.
He attempted to intubate Child N on three occasions but was "unable to get the breathing tube down his throat".
Medical notes shown to the jury show that Letby later recorded that Child N had vomited 1ml blood.
The prosecution says that apart from one Facebook message to a doctor, there is "no evidence she brought the bleeding to the attention of any of the medical staff on the ward, which is surprising", given that Child N had collapsed in the first three hours of the shift.
15:16
At 2.56pm on 15 June 2016, medical staff were crash bleeped because Child N was suffering a "life threatening" collapse.
While waiting for another doctor to arrive, one doctor on the ward looked into Child N's airway and found a "large swelling" and could only just see the bottom of the baby's vocal chords.
"He had never seen anything like this before in a newborn baby," prosecutor Nick Johnson KC tells the court.
There were more attempts made to reintubate Child N, as he was so unwell, but doctors were "unable to see down Child N's throat because the view was obscured by fresh blood".
"Something - somebody, we say - had caused Child N to bleed again," the court is told.
A more specialist team was called in to carry out the intubation.
15:20
An independent medical expert said there are only two possible explanations, "either inflicted trauma or spontaneous bleeds", the prosecution says.
The doctor said the swelling to the baby's throat was "further evidence" that trauma had taken place that day.
When interviewed by police, Letby said she had difficulty remembering Child N.
She agreed she had seen blood but denied being responsible for causing him harm.
Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins
Defence :
3:00pm
For Child N, the defence say there are "many reasons" why a baby would shout or scream.
"It was far more likely to be hunger" - "you certainly won't find evidence of anything else".
Regarding the allegation Letby did something to cause Child N to bleed, the prosecution say the intubating doctor already saw blood, because Letby harmed him.
The defence disagree and say blood was "not identified until intubation had already happened, or was in the process of happening".
There were three attempts to intubate him.
The defence say, again, there was "sub-optimal care" for Child N.
Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement
Prosecution :
2:46pm
Child N - attempted murder (three allegations)
Child N, a boy, was born in June 2016. He was a couple of weeks premature and he was admitted to the neonatal unit. His clinical condition was "excellent".
The prosecution say there are three separate occasions on which Lucy Letby tried to kill him.
2:48pm
Child N had haemophilia. Subseuqent investigation found him to have a mild version of the disease, and children of his age do not bleed for no reason, particularly in the throat, the prosecution say.
The prosecution said Lucy Letby used Child N's haemophilia as a "cover" to attack him.
2:50pm
On the night of June 2, Letby was on the shift and not the designated nurse for Child N.
She had earlier texted friends and sent a message to a colleague saying “we’ve got a baby with haemophilia”. She sent a further text saying, “everyone bit panicked by seems of things although baby appears fine”.
At 8.04pm she sent a text saying that she was going to “Google” haemophilia. 7 minutes later Letby texted her coleague: “complex condition, yeah 50:50 chance antenatally”.
2:54pm
The designated nurse said Child N was stable and left for a break at about 1am. He would have asked a colleague to look after Child N, but he could not recall whch one.
Letby had two babies to care for, in room 4.
At 1.05am, Child N's oxygen saturation levels fell from 99% to 40%.
"Unusually", for a baby, he was described as crying and "screaming".
Child N recovered quickly, while the doctor was then called to another emergency.
Medical expert Dr Dewi Evans said he believed the deterioration of Child N "was consistent with some kind of inflicted injury which caused severe pain".
Dr Sandie Bohin said such a profound desaturation followed by a rapid recovery, in the absence of any painful or uncomfortable procedure, suggested an inflicted painful stimulus.
She said – “this is life threatening. He was also noted to be … ‘screaming’ and apparently cried for 30 minutes. This is most unusual. I have never observed a premature neonate to scream.”
2:57pm
12 days later, there were two separate incidents on June 15 for Child N.
Letby had been the designated nurse for the previous day.
Overnight he was in nursery 3. At the beginning of the night shift, Child N was 'very unsettled'.
Letby was to be the desigated nurse for June 15. The use of her phone appeared to show she was awake by 5.10am and in for her shift at 7.12am. She had texted a colleague that she had “escaped [room] 1 [and was] back in 3”.
2:59pm
A colleague said Lucy Letby same into the room to say hello, but when the nurse's back was turned, Letby told her Child N had desaturated before assiting with the breathing. There was no evidence of an alarm sounding or if Letby waited to see if he self-corrected.
Doctors were called and an attempt was made to intubate Child N.
He was “surprised by his anatomy more than anything else … I could not visualise parts of the back of his throat because of swelling”.
3:01pm
The doctor saw "fresh blood" in Child N's throat, which the prosecution say was the same seen in Childs C, E and G.
The doctor was unable to get the breathing tube down the throat of Child N as he was unable to visualise the child's tracheal inlet.
He attempted to intubate Child N on three occasions.
3:07pm
An intensive care chart is presented to the court, which records the amount of dextrose going into Child N.
The bleeding record, of 10am '1ml fresh blood', recording aspirates from the NG tube.
Said bleeding, the prosecution say, is not recorded anywhere in the medical notes. It was more than 2 hours after the attempts to intubate.
At 11.29am Letby sent a Facebook message to the doctor telling him “small amounts of blood from mouth and 1ml from ng. Looks like pulmonary bleed on x ray [i.e. a bleed from the lungs]. Given factor 8 – wait and see”. Other than that phone message, there is no evidence that Lucy Letby brought the bleeding to the attention of any of the medical staff.
The prosecution said this is surprising given the problems Child N had suffered.
In an update recorded on the computer notes by Lucy Letby at 1.53pm she wrote that Child N was “stiff” on handling and extending upper limbs, back arching … settled in between episodes.
The prosecution say this is similar to that found in other cases heard so far.
At 3pm there is a further entry in Letby's writing of '3ml blood', initialled not by Letby and coincides with a second collapse that day.
3:10pm
Child N collapsed just before 3pm and a consultant was called at 2.59pm. While awaiting a consultant, a junior doctor looked into the airway of Child N and saw a “large swelling at the end of his epiglottis” he could only just see the bottom of the vocal cords. He had never seen anything like this before in a newborn baby.
The junior doctor's notes made at 4.30pm recorded: "desaturated this afternoon at 2:50pm with blood in the oropharynx + blood in the NG tube. Improved with bagging. Elective intubation planned following ??? unsuccessful attempts with 2 registrars and 2 consultants cords difficult to visualise …”
Letby recorded at 6.30pm: "approx. 14:50 infant became apnoeic, with desaturation to 44%, heart rate 90 bpm. Fresh blood noted from mouth and 3mls blood aspirated from NG tube. … Drs crash called”.
The prosecution said Child N was "so unwell" that attempts were made to reintubate him, but the doctor could not see down Child N's throat as the view was obscured by fresh blood. A more specialist team was called to carry out the intubation.
3:11pm
Child N continued to be unwell on June 15 and difficulties with ventilation persisted. Eventually he was transferred to Alder Hey, where the prosecution say he recovered quickly.
3:13pm
Medical expert Dr Dewi Evans said the blood seen in Child N's stomach had originated there, caused not from intubation attempts but "instead some preceding trauma".
He suggested that “thrusting” a NG tube into the back of the throat might be the mechanism used to inflict the injury.
Dr Sandie Bohin suggested only two possible explanations; either inflicted trauma or a spontaneous bleed. She considers the latter less likely as the haemophilia was 'only moderate'.
Dr Bohin’s view was that the likely cause of the bleeding was trauma to the mouth, to the throat or to the oropharynx, most likely from a NGT or suction catheter.
3:14pm
Professor Sally Kinsey describes the collapse on June 3 as dramatic with no recognised medical cause. She excluded the possibility of a pulmonary haemorrhage - in other words, bleeding in the lungs, causing the collapse on June 15. In her opinion such bleeding would not have occurred spontaneously in a child with Child N's degree of haemophilia.
It follows, the prosecution say, the bleeding was caused by trauma.
Professor Kinsey also ruled out heavy-handed intubation as a cause.
3:15pm
In police interview, Letby had difficulty remembering Child N.
She did recall an occasion when doctors had difficulty intubating him. She agreed that she had seen blood but denied being responsible for causing him harm.
She could not explain the entry in her notes timed at 10am on June 15 in which she recorded aspirating more fresh blood which she had not apparently brought to the attention of anyone else.
Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders
-----------------------------------------------------------------------------------------------------------------------------------------------------
Sky News:
Letby used Child N's haemophilia as a 'cover to attack' him
The prosecution opening has now moved on to Child N, who was born premature, but his clinical condition was described as "excellent".The prosecution allege Letby tried to kill him on three occasions.
He was born with haemophilia, a disease which can cause bleeding for no reason, or a trivial reason. Staff at the hospital attributed many of the episodes to this.
However, Nick Johnson KC says: "Subsequent investigation has shown Child N has a mild version of the disease.
"Children with a mild level of haemophilia rarely bleed for no reason."
This, Mr Johnson says, "gave her cover to attack Child N".
He continues: "Because if she caused a bleed she thought it would be put down as haemophilia.
"She was right."
Letby later texted a friend saying she was going to Google haemophilia, saying it was a "complex condition, yeah 50:50 chance antenatally".
Mr Johnson tells the court: "No doubt this is what her Google research had told her.
"It appears therefore that Lucy Letby thought Child N was lucky to be alive."
14:57
Pre-term baby 'screamed' for 30 minutes after injury 'inflicted by Letby'
The child's designated nurse said he was stable until he went for a break at around 1am.At 1.05am Child N experienced a "sudden deterioration" which was consistent with some kind of "inflicted injury which caused sever pain, distress and destabilised him", the prosecution says.
Unusually for a pre-term baby, he was described as "crying and screaming".
Independent medical experts said this was "consistent with inflicted injury or having received an injection of air", jurors were told.
His recovery was prompt - which would not be consistent with an infection.
One of the medical experts wrote: "This is life threatening. He was also noted to be... 'screaming' and apparently cried for 30 minutes.
"This is most unusual.
"I have never observed a premature neonate to scream."
15:09
Incident one: Child N had swollen throat with 'fresh blood'
Twelve days later, on 15 June 2016, there were two more incidents, the prosecution tells jurors.At 8am, Child N's oxygen levels had fallen to 48%. A decision was made to intubate him.
The doctor doing so said "he was surprised by his anatomy more than anything else. I couldm't visualise the back of his throat because of swelling".
There was "fresh blood" in Child N's throat - something, the prosecution says, that had been seen before in previous children.
He attempted to intubate Child N on three occasions but was "unable to get the breathing tube down his throat".
Medical notes shown to the jury show that Letby later recorded that Child N had vomited 1ml blood.
The prosecution says that apart from one Facebook message to a doctor, there is "no evidence she brought the bleeding to the attention of any of the medical staff on the ward, which is surprising", given that Child N had collapsed in the first three hours of the shift.
15:16
'Something - somebody - had caused Child N's throat to bleed again'
We are hearing about Child N as the prosecution opening continues.At 2.56pm on 15 June 2016, medical staff were crash bleeped because Child N was suffering a "life threatening" collapse.
While waiting for another doctor to arrive, one doctor on the ward looked into Child N's airway and found a "large swelling" and could only just see the bottom of the baby's vocal chords.
"He had never seen anything like this before in a newborn baby," prosecutor Nick Johnson KC tells the court.
There were more attempts made to reintubate Child N, as he was so unwell, but doctors were "unable to see down Child N's throat because the view was obscured by fresh blood".
"Something - somebody, we say - had caused Child N to bleed again," the court is told.
A more specialist team was called in to carry out the intubation.
15:20
Swelling in throat was 'evidence' of trauma
Child N was a "stable baby" who did not suffer any other "spontaneous bleeds" at any time as a result of his condition.An independent medical expert said there are only two possible explanations, "either inflicted trauma or spontaneous bleeds", the prosecution says.
The doctor said the swelling to the baby's throat was "further evidence" that trauma had taken place that day.
When interviewed by police, Letby said she had difficulty remembering Child N.
She agreed she had seen blood but denied being responsible for causing him harm.
Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins
Defence :
3:00pm
For Child N, the defence say there are "many reasons" why a baby would shout or scream.
"It was far more likely to be hunger" - "you certainly won't find evidence of anything else".
Regarding the allegation Letby did something to cause Child N to bleed, the prosecution say the intubating doctor already saw blood, because Letby harmed him.
The defence disagree and say blood was "not identified until intubation had already happened, or was in the process of happening".
There were three attempts to intubate him.
The defence say, again, there was "sub-optimal care" for Child N.
Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement
Mel Barham
@MelBarhamITV
·
26m
I’m in court again today for the trial of #lucyletby, the nurse accused of murdering 7 babies and attempting to murder 10 others. She denies all the charges against her. Follow my feed for what happens in court today.
Mel Barham
@MelBarhamITV
·
15m
Today we’re hearing evidence about Baby N who was born prematurely at 33 weeks with a condition called haemophilia. Jury hearing statements from his parents
Mel Barham
@MelBarhamITV
·
5m
Court hears baby N collapsed 3 times. In Dad’s statement he says he walked into room after first collapse to see “dry blood around his lips”. He was later transferred to Alder Hey. Just before this Baby N’s dad said Lucy Letby came up to his partner and gave her a hug…(1)
Mel Barham
@MelBarhamITV
·
4m
(2)… “maybe she even gave her a kiss” and said she’d stayed on after the end of her shift, saying to the parents “I hope he will be alright”
@MelBarhamITV
·
26m
I’m in court again today for the trial of #lucyletby, the nurse accused of murdering 7 babies and attempting to murder 10 others. She denies all the charges against her. Follow my feed for what happens in court today.
Mel Barham
@MelBarhamITV
·
15m
Today we’re hearing evidence about Baby N who was born prematurely at 33 weeks with a condition called haemophilia. Jury hearing statements from his parents
Mel Barham
@MelBarhamITV
·
5m
Court hears baby N collapsed 3 times. In Dad’s statement he says he walked into room after first collapse to see “dry blood around his lips”. He was later transferred to Alder Hey. Just before this Baby N’s dad said Lucy Letby came up to his partner and gave her a hug…(1)
Mel Barham
@MelBarhamITV
·
4m
(2)… “maybe she even gave her a kiss” and said she’d stayed on after the end of her shift, saying to the parents “I hope he will be alright”
10:51am
Someone came into the maternity room, where Child N's mother was staying with the father. The staff member said: "You'd better come - he's really ill this time."
Upon their arrival to the intensive treatment unit, resuscitation efforts were being administered to Child N.
The father said he could not watch what was going on. Staff from Alder Hey Children's Hospital were among the staff members in the room.
After a breathing tube was fitted, Child N stabilised and 'calmed down'.
The parents spoke to a haemophiliac specialist nurse who had come from Alder Hey via taxi.
Child N was taken to the transport team, in a process "which seemed like forever", by 11pm.
Lucy Letby came to the parents and said she had stayed beyond the end of her shift and hoped that Child N was going to be alright.
Child N was taken to Alder Hey, where he stayed for a couple of weeks before going home.
When home, the parents noticed Child N had 'twitches', then later 'spasms', and at one point was not breathing.
He was taken to the Countess of Chester Hospital, and transferred to Alder Hey, where he stayed for 1-2 weeks.
www.chesterstandard.co.uk
Someone came into the maternity room, where Child N's mother was staying with the father. The staff member said: "You'd better come - he's really ill this time."
Upon their arrival to the intensive treatment unit, resuscitation efforts were being administered to Child N.
The father said he could not watch what was going on. Staff from Alder Hey Children's Hospital were among the staff members in the room.
After a breathing tube was fitted, Child N stabilised and 'calmed down'.
The parents spoke to a haemophiliac specialist nurse who had come from Alder Hey via taxi.
Child N was taken to the transport team, in a process "which seemed like forever", by 11pm.
Lucy Letby came to the parents and said she had stayed beyond the end of her shift and hoped that Child N was going to be alright.
Child N was taken to Alder Hey, where he stayed for a couple of weeks before going home.
When home, the parents noticed Child N had 'twitches', then later 'spasms', and at one point was not breathing.
He was taken to the Countess of Chester Hospital, and transferred to Alder Hey, where he stayed for 1-2 weeks.
Recap: Lucy Letby trial, Thursday, March 2
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…
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