Texts and some events
Sat Jun 25th
LL day shift - alleged attempted murder of Q. Q moved to room 1
12.18pm to 1.16pm - LL messages doc between 12.18-1.16pm.
Just after 1pm - LL messages a nursing colleague about the situation on the neonatal unit, adding: '
All going on lol'
4.11pm to 8.31pm - A record of Facebook messages between LL and doc is recorded between 4.11pm and 8.31pm.
6.40pm - LL messages a nursing colleague via Whatsapp at 6.40pm: '
Girls all rushing around outside', adding one of the nurses was '
stressing', and the situation was 'madness lol'.
Night-shift - Care of Q was handed over to staff nurse Amy Davies.
8.31pm - LL to Doc: '
Wow, I think I might be almost finished'. She also messages her mother.
Colleague Minna Lappalainen to LL: '
Thank you for being a good friend today', adding a heart emoji.
LL:
Don't need to thank me Minna, I'm always here for you. Please don't feel you're alone...'
ML: '...
But really I'm really happy u were there for me....'
LL:
Take care, hope you sleep well, see you tomorrow.
Sophie Ellis to LL: '
Hope your feeling ok today'
LL: '
Thanks Soph, another busy day today but ok today and off tomorrow....'
SE: '
I think you deserve more than a day off...'
LL: '...
It's been awful but we'll be ok'.
10.48pm
LL:
Do I need to be worried about what Dr Gibbs was asking?
Doc.
No. He was asking to make sure that normal procedures were being carried out. What exactly did he ask?
LL:
I walked into equipment room, he was asking Mary who was present in room and how quickly someone had gone to him as I wasn't in the room. He asked who was there, I said I had popped out of room but Mary was in room and Minna at the desk.
Doc:
All he was doing was checking that there wasn't a delay and that a room had been left empty. Was he HDU level because of uvc? There is nothing to worry about.
LL:
Ok. Was worried because I wasn't with him at time, but Mary was in room and Minna outside, I had [designated baby who was not Child Q] in 1. ITU because of uvc
Doc:
You can't be with two babies in different nurseries at the same time, let alone predict when they're going to crash.
LL:
I know, and I didn't leave him on his own. They both knew I was leaving the room. Feel better now
Doc:
Nobody has accused you of neglecting a baby or causing a deterioration.
LL:
I know. Just worry I haven't done enough
Doc:
How?
11.21pm
LL:
We've lost 2 babies I was caring for and now this happened today. Makes you think 'am I missing something/good enough'
11.25pm
Doc:
Lucy, if anyone knows how hard you've worked over the last three days it's me. The standard of care delivered is tertiary nicu level. if *anybody* says anything to you about not being good enough or performing adequately I want you to promise me that you'll give my details to provide a statement. I don't care who it is and I don't care if I've left the trust. Promise?
LL:
Well, I sincerely hope I won't ever be needing a statement but thank you, I promise
Doc:
And I don't either. You'll know that the coch nicu mortality rate is a bit higher than the network average. It makes people (consultants) look at trends and patterns. That may have been why Dr G came to ask. As for the self-doubt - you asked me this morning did I dream because I was worried about having missed something? No, and I don't think you did either. In fact for [another baby] you knew he was unwell and flagged it up immediately. I don't know the beginning of the [a separate baby] story because I arrived after the bleep. You didn't miss anything that I would expect an experienced itu trained nurse to spot. From a resus point of view you were flawless. It's why I am so happy to work with you. You don't flap, you give perfectly sensible suggestions and things run seamlessly. (You must be good Rackham said so (seldom praises)). No more doubt - it's not you, it's the babies. I don't know what happened to [Child O] and [Child P], and accept that the pm may not give any useful answers. I do wonder if they may have had adenovirus - it's terrible in neonates / perinates. [Child Q] is different. His behaviour is more bacterial (tachy, temp, reduced uo) I wouldn't be surprised if his bc comes back positive.
LL:
Thanks, really appreciate you saying that. So relieved that it's you who has been there throughout.
Sun Jun 26th
00.12am
Doc:
It's true. You are one of a few nurses across the region (I’ve worked pretty much everywhere) that I would trust with my own children. If you're worried - I'm worried. You should do the APNP course, you'd be excellent. (In a second reference to his children he adds) They’re possibly a bit too big now.
LL:
Don't know what to say Thank you.
Doc:
Self-doubt finished?
LL:
I think so, thank you ++
1.36am
The messages continue on a social/work nature until 1.36am, but have no further reference to Child Q.
7.50am
LL is messaging a nursing colleague from 7.50am. The nursing colleague was working at the time.
The nurse says Child Q was improving but then had 'crap gas' at 5am. She adds '
staffing is s***e isn't it'.
LL: '
Bloody hell. It's not safe is it especially with what's gone on'. 'I worry that we have got a bug or virus on the unit'.
The nursing colleague replies: '
Virus would explain a lot'.
time?
LL to doc: '
Will you let me know how [Child Q] gets on today please'
Doc: '
Of course I will'.
The messages continue throughout the morning.
12.19pm
The doctor adds at 12.19pm: '
[Child Q] has nec'
LL: '
Ok that's good in a way to have a cause. Going to AHCH [Alder Hey Children's Hospital]? 'Is he stable?'
Doctor: '
Ish. Ventilation was up and down overnight...'
LL messages a nursing colleague to say Child Q was '
unwell with NEC, going to picu'
The response: '
Oh no poor [Child Q]! Who's told you that?'
LL responds that the doctor let her know.
The nurse later messages LL:
They think [Child Q] could be a volvulous apparently'
LL responds: '
Oh no.'
Child Q was transferred to Alder Hey on June 26 and was treated there until June 28.
Mon Jun 27th
LL expecting to be working night shift.
10.55am
Doc to LL: '
Not sure if the unit is open for transfers. Few managers/directors around this morning'.
The doctor adds
it's 'odd' Child Q was only at Alder Hey for 14 hours as he was coming back to the Countess of Chester Hospital. He says there is a lack of beds at Alder Hey, and it's disruptive for the parents. LL agrees.
A reference is made to clarify paperwork for a prescription for child O during resus attempts.
Doctor B raised her concerns with colleagues including the neonatal lead and the nnu manager at their regular Monday meeting.
Unknown time
LL messaged a colleague complaining that the nnu is “
way over capacity”. LL says “
the unit needs properly assessing, I don’t think equipment gets cleaned properly…we haven’t got space to maintain hygiene”
5.41pm
LL to doc:
Eirian [nnu manager] has just phoned telling me not to come in tonight & do days instead. I asked if there was a problem & she said no, just trying to protect me a bit & we can have a chat about it tomorrow but now I'm worried.
LL to nurse colleague:
E just phoned telling me to do days this week and not go in tonight as trying to protect me.
Nurse:
What's that mean?
LL:
I don't know. Asked if there was a problem and she said no just trying to protect me as had a difficult run just before holidays, less people on nights etc and we can have a chat etc tomorrow. But I'm worried I'm in trouble or something.
Nurse:
Don't worry, how can you be in trouble you haven't done anything wrong. Just very unfortunate.
LL:
I know but worrying in case they think I missed something or whatever. Why leave it til now to ring.
Nurse:
It is very late I agree. Maybe she's getting pressure from elsewhere?
LL:
She said it's busy so more support for me on days and can look at the paperwork bits etc. She was nice enough I just worry. This job messes with your head.
Later:
LL to doc:
I can't do this job if it's going to be like this. My head is a mess. Why is she ringing at this time. There must be a problem.
Doc: Lucy -
you did nothing wrong at all. It is an odd time to ring, but you've had a rough few days and a good manager would realise that.
Doc:
I can't fault anything with your delivery of care to either baby last week. If there was anything I would have said so. Eirian knows you. Has there ever been a reason for you not to trust her?
LL:
I can't talk about this now. Sorry, I just need a bit of time.
12 mins later:
LL:
Sorry, that was rude. Felt completely overwhelmed & panicked for a minute. We all worked tirelessly & did everything possible, I don't see how anyone can question that. E has always been very supportive.
(Doc asks if LL is ok now)
LL:
I’m having a meltdown++ but think that's what I need to do.
Doc to LL about baby Q:
There isn’t anything to question.
Tue Jun 28th
Child Q returned to CoCH and was discharged on Jul 25th.
LL worked day-shift
Wed Jun 29th
LL worked day-shift
A Datix form is submitted referring to O’s “sudden and unexpected collapse”. Consultants held a meeting to work out what was going on at which someone suggested air embolus. Dr Jayaram went home and researched it that evening.
Thu Jun 30th
Dr Jayaram emailed his colleagues with the air embolus study. LL filled in a Datix report related to O, stating resources not available on unit for resus and that staff obtained equipment from the children’s ward which was delayed because of staff needed for infant care needs.
LL worked day shift (her last)
Doc:
Did J [SHO Dr Jessica Burke] tell you what was wrong earlier?
LL:
Not really. We started talking but then people came into the nursery and she dashed off.
Doc:
I’m not sure where that information has come from. It seems that on the SHO (senior house officer) grapevine somebody at LWH (Liverpool Women’s Hospital) has said that one of the triplets was found to have a ruptured liver. J was upset that this may have been caused by her chest compressions.
LL:
Oh no that’s awful. No wonder she’s upset. Were you able to reassure her?
Doc:
We spent 20 minutes in a cubicle going over everything. The CPR was all at the 5th rib space between the nipples
Later:
Doc:
I’m not sure I believe it. It was a coroner’s PM (post-mortem). It usually takes weeks to get any report.
LL:
It seems a bit like rumour mill has gone into overdrive. The boys were only returned today. Don’t see how info would be out that quick?
Doc:
No me either.
LL:
Not nice for J though. Can see how it would play on her mind. It’s good she felt able to tell you.
Doc:
I’m good for a hug and a chat. I think it helped.
LL:
She said she’d spoken (and cried on) you … and was feeling better for it.
Fri Jul 1st
-
Sat Jul 2nd
LL to Torquay with parents for almost 2 weeks
Wed Jul 6th
Doc:
You need to keep this to yourself. The meeting this afternoon looked at everything with Baby O & Baby P from birth onwards. We reviewed everything. Room / meds / medical reviews and actions. We looked at all documentation med & nur. If you've any doubt about how good you are at your job - stop now. The documentation was perfect, everybody commented about the appropriateness of your request for a review of Baby O following vomit. Your documentation of the resus / incubation / drugs was faultless. There is absolutely nothing for you to worry about. Please don't.
(Doc says he is)
‘so sorry that you were upset when Eirian called about that when I knew you’d done a perfect job’. There are going to be some recommendations based on staffing / kit but there was no criticism of either resus. This is staying quiet until has been to exec's. We're looking at [third triplet] care on Thur. E had nothing but good things to say about you.
LL:
Ok......I really appreciate you telling me - it won't go any further. I was one member of a huge team effort, but you know I've been carrying the worry of the 'what if I wasn't enough' - it's reassuring to hear that it doesn't appear that anything could have been done differently, or that I didn't act on or do something I should have. Thank you.
LL is sent a confidential email addressed to the doc from Dr Stephen Brearey, advising that the deaths of Child O and Child P were likely to result in an inquest, as the cause of both deaths was 'unexplained'. The email asks the doc to [per BBC - set out details of some of the collapses of babies][per Daily Mail – prepare a statement ahead of an inquest into one of the recent deaths].
LL:
It's a bit of a worry if it's going that far. Do you think I'll be involved?
Doc:
Probably not. I know you won't say anything - this email has to stay between us, is that ok?
Fri Jul 15th
LL due back from hols??
nnu manager Eirian Powell informs nursing staff:
“all members of staff need to undertake
a period of clinical supervision in preparation for an
external review. Due to our staffing issues it has been difficult to determine how we undertake this process. We can only support one member of staff at a time, therefore we have decided that it would be useful to commence with staff who have been involved in many of the acute events, facilitating a supportive role to each individual. Therefore Lucy has agreed to undergo this supervision first commencing on
Monday 18th July 2016. I appreciate that this process may be an added stress factor in an already emotive environment, but we need to ensure that we can assure a safe environment, in addition to safeguarding not only our babies but our staff. This is not meant to be a blame or competency issue – but a way forward to ensure that our practice is safe. It will probably be developed into a competence based programme to be undertaken every 2-3 years in line with our mandatory update training."
LL to a nurse colleague:
I've done a timeline of this year.
Colleague:
Fab. And how quite a few babies weren't compatible with life anyway. I wonder if midwives get this with amount of stillbirths......"
LL:
Yeah and some went off within hours/on handover. Or were already acutely unwell when I took over. And put that when Baby Q went off no other staff able to care for him etc
Colleague: Not like all behaving fantastically till right into shift.
LL:
Hoping to get as much info together as possible today -if they have nothing or minimal on me they'll look silly, not me.
Mon Jul 18th
-
Tue Jul 19th
LL began work in the patient experience team.
Mon Aug 8th
LL to nurse colleague:
Tony phoned. He's going to speak to Karen and insist on the review being no later than 1st week of Sept but said he definitely wouldn't advise pushing to get back to unit until it's taken place. Asked about social things and he said it's up to me but would advise not speaking with anyone in case any of them are involved with the review process. Thinks I should keep head down and ride it out and can take further once over. Feel a bit like Im being shoved in a corner and forgotten about by the trust. It's my life and career. He's not been given any information about the evidence he asked for which is good. He's not sure what the external people are going to look at in relation to me but we are in the process now so have to ride it out
Colleague:
Ok well just have to take his advice then suppose
LL:
Still can't believe this has happened. It's making me feel like I should hide away by saying not speak to anyone and going on for months etc - I haven't done anything wrong.
Colleague:
Me neither! I know it's all so ridiculous.
LL:
I can't see where it will all end
Colleague:
I'm sure this time after xmas it'll all b a distant memory.
Tue Aug 9th
NNU manager Eirian Powell email to all:
'Hi All, There are currently opportunities for staff to apply for secondment throughout the Trust. It is therefore come at an opportune time for us and we were able to facilitate this for Lucy.
'Lucy is currently seconded to the Risk & Patient Safety office for a period of 3 months.
'Laura is currently seconded to the Haemodialysis unit and will be returning in November 2016.
'Should anyone have an interest in other areas please discuss this further during your appraisal – or come to me directly.
Kindest regards,
Eirian'.
LL to nursing colleague:
Bloody hell fuming. I’m in email and makes it sound like it’s my choice.
No date provided: At one stage in the WhatsApp and Facebook messages
LL mentions the possibility of an air embolism being the cause of a baby's death.
Lucy Letby was transferred from unit over doctors' fears, trial hears
Thu Sep 1st
LL met with review panel
Wed Sep 7th
LL registered a grievance procedure
www.dailymail.co.uk
