I think something as significant as Dr J coming into the room and finding you doing nothing to help a baby who is collapsing and having to take over resuscitation attempts is something she’d remember, but IMO doesn’t want to admit to it due to it being harmful to her defence.
Dr J fitted the ET tube, it was in the right place an X-ray showed it was, baby K was breathing with the ET in place and was in neonatal. Then comes the part when the designated nurse went on her break…
This is the summary about that part in bold, sorry it’s long:
Dr Jayaram said he could hear Child K's heartbeat, and air going in and out of both lungs.
He said, for a 25-week gestation baby, he was "happy" with Child K's progress.
Dr Jayaram said he was happy the ventilator was working, as observed by Child K's chest moving, and being in good colour.
He tells the court that at this point, he informed the transport team about the situation, and they had advised there was a bed at Arrowe Park Hospital, and they advised for a UVC line to be inserted prior to transport.
Dr Jayaram is now being asked about Child K's desaturation at 3.50am.
A plan of the neonatal unit layout is shown to the court.
Dr Jayaram said he was "happy" with how Child K was "very very settled", having had to make only minor adjustments to the ventilator settings.
An infusion chart for the morphine is shown to the court, with a start time of 3.50am. He confirms that 3.50am would be the time that would be adminsitered.
Dr Jayaram says he was aware Joanne Williams was going to the labour ward to update the parents on Child K.
He said he was sitting at a desk, around the corner from the entrance to nursery room 1. He says he was writing in notes, or waiting for the transfer team to come back to him regarding arrangements.
He said he had been told Lucy Letby would be 'babysitting' at the time - a common term used by the hospital to describe a neonatal nurse temporarily looking after a baby in the absence of its designated nurse.
He says, at this point, in February 2016, he was aware of 'unexpected/unusual events' that had happened recently, and that Lucy Letby had been present.
He said: "I felt extremely uncomfortable [with Lucy Letby being there alone in the room with Child K]
"You can call me hysterical, completely irrational, but because of this association...
"This thought kept coming into my head. After two, two and a half minutes...I went to prove to myself that I was being ridiculous and irrational and got up.
"I think it was 2.5, 3 minutes after Jo had gone to the labour ward.
"I had not been called to review [Child K], I had not been called because alarms had gone off - I would have heard an alarm. I got up and walked through to see [Child K]."
Dr Jayaram entered nursery room 1 through the entrance doors closest to his desk. Child K was at the far side of the nursery room, with Lucy Letby present.
He said: "I saw Lucy Letby standing by the incubator. I saw her, and looked up at the monitor, and K's saturations were dropping, in the 80s and continued to drop. The ventilator was not giving out an alarm.
"I recall looking up and saying 'what's going on?' and Lucy said something along the lines of 'She's having a desaturation'."
Asked what Letby was doing, Dr Jayaram replied: "Nothing."
He says Letby didn't say anything to Dr Jayaram until he had walked over and he had asked her what was going on.
Dr Jayaram said he was looking at Child K. He disconnected the ventilator from the ET Tube and he tried to give breaths via the ET Tube, but Child K's chest was not moving.
He said he switched into 'professional mode' to resolve the situation, and it 'didnt make sense why the tube was dislodged'
He said he removed the tube - which wasn't blocked - and put a face mask to ventilate Child K. As soon as that was done, Child K's chest went up and down, without too much difficulty.
He says he does not remember anything else Lucy Letby said. He says he was probably telling her to bring equipment.
Dr Jayaram says the original tube was not blocked, and there would be no reason for that to have been blocked, for the time it had been on Child K.
Dr James Smith reintubated Child K, and the same ventilator settings were selected, indicating - Dr Jayaram tells the court - Child K had not been declining.
Dr Jayaram's notes are shown to the court, where he had described it as a 'sudden desaturation'.
The oxygen saturation levels fell to 40%.
The tube was removed, Child K was bagged via a face mask, and 'sats recovered quickly'.
A size 2.5 ET tube was placed. 'Ventilator settings as previously'.
The size of the tube "did not have an impact" on the previous ventilation, Dr Jayaram tells the court, as Child K was "ventilating effectively" and did not have an impact on the "sudden deterioration".
Dr Jayaram says he cannot recall how long Joanne Williams had been away before the sudden deterioration had taken place.
He tells the court the transport team and the parents were updated, but he does not believe they were updated about "this event".
The court is shown Dr Jayaram's notes, plus writing by someone else at 5.40am recording a vial of Curosurf given.
Notes by Dr Jayaram are written retrospectively at 7.50am. He recorded at 6.15am, Child K 'began to have lower sats'.
He says the blood gas record from that point suggested the cause of that 6.15am deterioration was an issue with ventilation. He tells the court low blood pressure is also recorded.
Saline is administered but the blood pressure remained low.
The ET tube was pulled back but saturations remained low, so the ET Tube was removed. Child K's oxygen saturation levels improved in response to bagging.
The blood pressure dropped again at 7.25am. The saturations and heart rate dropped.
Child K was taken off the ventilator and Neopuff was administered.
Cardiac compressions were started as it was 'not sure enough blood was being pumped around the body' - Child K had not gone into cardiac arrest, but the heart rate had gone under 100 beats per minute.
The ET Tube "wasn't working", as it had 'gone in further' than it should have gone, the court hears.
Child K was recorded as 'now stable'.
Dr Jayaram says he had observed a chest x-ray for Child K showing the ET Tube was in the right place.
IMO this suggests that someone had purposely dislodged the tube. As an X-ray had shown it was in the right place and baby Knwas doing relatively well for her gestation until yet again, LL entered her orbit.
MOO
