Updated draft timeline for baby F following today's evidence
29 Jul 2015, Wednesday
Identical twin boys E and F born, prematurely, at 29 weeks, by C-Section. They shared a placenta which can increase the risks for NEC. (consultant’s testimony) Dr Christopher Wood (SHO) was present at the births. Dr Gail Beech was also present at the births and looked after E. Her first involvement with F was on the day shift on 4 Aug 2015.
E weighed 2lb 14oz (1.327kg). He was given oxygen then weaned to air and transferred to Room 1. He was at risk of NEC and started on antibiotics, IV fluids and caffeine. He had a nasogastric tube inserted.
F was marginally younger, and he required some resuscitation at birth. His birth weight was 3lb 2oz (1.434kg). He was later intubated, ventilated and given medicine to help his lungs.
30 Jul 2015, Thursday
Mother says she was able to visit the twins in the neonatal unit, from upstairs in the post-natal wards. She said that would take about 5-10 minutes to get from one place to the other, due to having had a C-section, which made the journey time longer. She said she was able to cuddle E as he wasn't on CPAP, while F was on CPAP.
31 Jul 2015, Friday
A high blood sugar reading was recorded and F was prescribed a tiny dose of insulin to correct it. His breathing tube was removed and he was given breathing support.
1 Aug 2015, Saturday
Mother said E was progressing better, of the two twins, over July 30-31, but both were doing "really well" by August 1. She was keen to get home and was keen to transport both babies to a hospital closer to home, and was waiting for two ambulances to be provided. She said she and her partner were under the impression both babies were well enough to travel. By that stage, she had had skin-to-skin contact with both twins, and both were managing "fine". "We were never informed about anything to say they weren't fine."
8pm night shift – LL was designated nurse for F.
2 Aug 2015, Sunday
By August 2, mother says they were still waiting for transport. She said on that day, the twins were both out of their incubators by this stage. [E] was breathing "easily" and [F] was "great".
8pm night shift – LL was designated nurse for F. Melanie Taylor was designated nurse for E.
10.34pm – LL’s texts with nursing colleague:
JJ-K: "Hope work ok".
LL: "...yeah it's fine, bit too Q word really."
JJ-K: "Don't complain as Wed and Thurs horrible lol! It will pick up again."
3 Aug 2015, Monday
Mother says by August 3 the twins were "great - doing really well". "We were absolutely thrilled that both boys were doing so well and we couldn't have asked for any more than that. They were both progressing."
8am -8pm day-shift - “unnamed nurse” [in court testimony] was the designated nurse for E & F.
7.30-8pm night shift – LL is designated nurse for twins E & F in room 1. Nurse Caroline Oakley was the shift-leader. There were 3 babies in room 2, one baby in room 3, and four babies in room 4. There is also a baby in the transitional care unit.
Just prior to 9pm – Allegation against LL of intentionally inflicting injury to baby E's upper gastrointestinal tract, with bleeding contributing to his death
9.13pm – LL made a note in twin F’s records. (opening statement)
Just prior to 11.40pm - Allegation against LL of intentionally injecting air into baby E, causing his collapse and death
4 Aug 2015, Tuesday
1.40am – Baby E's time of death was recorded as 1.40am.
8am – End of LL’s night shift
Day shift - Registrar Dr Gail Beech was on duty. A ‘ward round-up’ filled in in preparation for Wednesday’s weekly consultant ‘grand round’ ward round-up is presented to the court. The list of problems, readings and observations for each child is noted, concluding with a management plan. The note recorded that E had died aged 6 days. Dr B explains F was on Optiflow with 'suspected sepsis' noted, a raised urea and creatinine, 'jaundice' but not on phototherapy at this stage. F was also 'establishing feeds' and awaiting genetics test for Down's, but F was not showing any clinical features, and 'hyperglycaemia - resolved'. Prosecutor says the genetic test results were received on August 7. Dr B said they confirmed there wasn't a presence of Down's. Dr B confirms she was satisfied the hyperglycaemia [high blood sugar] level had been resolved. Dr B said a standard list of medication was prescribed. The Optiflow reading was not supplemented with oxygen - F had been 'in air since 3.30am'. Oxygen saturation levels were 92-97%, which were 'satisfactory'. Dr B says there 'weren't any concerns' on the cardiovascular system. F weighed 1.296kg [2lb 13oz], from a birth weight of 1.434kg [3lb 2oz] - Dr B said this was not a concern as babies, particularly neonates, lose weight in the first days following birth. Dr B confirms F was receiving nutrition via a TPN bag. F was 'active, moving all 4 limbs'. F was 'active and pink', with a 'clear' chest, no increased rate of breathing. A note saying F required further tests on 'mouth and palate', and 'eyes', as part of a 'top to toe examination'. The management plan says, for F, 'wean Optiflow flow when in air.' 'Complete 7 days of antibiotics'. "Continue increasing feeds as tolerated'. 'Chase genetics [for results]'. 'Complete examination and baby check later (parents arrived, upset about twin 1)'. Dr B is now asked to look at a chart for a prescription for Babiven, which she has dated, but does not recall writing it. She had signed for a rate of lipid, but that was zero as it wasn't required. Babiven is a "standard bag" which would be given at a bespoke rate for F. Dr B says the second prescription, with different Babiven levels and a new lipid level, was made as F had been made 'nil by mouth' and the increased levels were so F could acquire the same level of nutrients in his body. Dr B is asked if there was anything notable from previous clinical records that she could recall in respect of F. She says there was not. X-exam – Dr B clarifies she was waiting for genetic test results for F for the presence of Down's Syndrome. Those results came back on August 7, with no evidence of Down's Syndrome. Defence asks if a further, microarray genetics test can be conducted to show for further potential genetic disorders; Dr B confirms that is the case. Defence says on August 4, the fluids were being administered via TPN, and milk coming in via the NGT [nasogastric tube], with no lipid required as F was getting milk in. Defence asks about the management plan - 'continue increasing feeds as tolerated'. He then refers to the two August 4 prescriptions of fluids [the first being crossed out], and if Dr B had completed the figures; Dr B confirms that was the case, and that she signed for them. At the first one, there is no component of lipid. Dr B says she would have written these figures after the ward round, so the TPN could be made up. Dr B says it would take some time from prescribing the TPN bag to it then being administered. Defence asks for clarity on how the second prescription comes to be made, with a different rate of administration of Babiven and a new lipid and new 10% dextrose doses; Dr B confirms she did not prescribe these additional nutritions, as they are signed by a colleague. The total nutrition administration is now 165ml and the rate is slightly increased from the first, crossed-out prescription of total 150ml fluid. Dr B says the additional nutrition would come on separate infusions. That concludes Dr B's evidence. (Dr Beech’s evidence)
8.21am - LL noted: 'Parents resident on unit overnight. Wish to be left alone.' (electronic evidence)
8.58am – LL’s texts
Colleague who can’t be named: "You ok? Just heard about baby [E]. Did you have him? Sending hugs xx"
LL: "News travels fast - who told you? Yeah I had them both, was horrible."
Colleague responded that someone at the handover 'told me just now'. 'Had he been getting poorly or was it sudden?' ‘Poor you. You’re having a
time of it.”
LL: E had a 'massive gastrointestinal haemorrhage'.
Colleague: ‘Damn. He’d always struggled feeding. I just feel for his parents and you. You’ve had really tough times recently.’
LL: “E was 'IUGR [Intrauterine growth restriction] and REDF [Reversal of umbilical artery end-diastolic flow]'. Guess he was very high risk. Was just awful, he was bleeding from everywhere during resus. Got him back but gas incompatible. Parents completely distraught. I feel numb.” (source Mail Podcast)
4pm – Baby F’s bespoke TPN bag was delivered to the neonatal unit. It had to be used within 48 hours of 11.30pm on the 4th. (opening speech)
Just before 5pm - a nursing note records family communication in which F's parents wish to transfer care to another hospital in the North West, but transport was unavailable due to an emergency. The note adds 'sincere apologies given to parents'.
7.30-8pm - LL night shift starts. Baby F had been moved to room 2. LL was not baby F’s designated nurse. LL was designated a single baby that night, also in room 2. Belinda Simcock was the shift leader. There were 7 babies in the unit that night, and 5 nurses working. Room 3 – 1 baby. Room 4 – twins. Two other babies whose location hasn’t been established from the records. (electronic evidence Tues 22/11/2022)
7.55pm – LL’s texts
Jennifer Jones-Key: "Hey how's you?"
8.01pm -
LL: "Not so good, we lost [E] overnight."
8.02pm -
JJ-K: "That’s sad. ‘We’re on a terrible run at the moment. Were you in 1? x"
8.02pm
LL: "Yes. I had him and baby [F] x"
JJ-K: "That’s not good, you need a break from it being on your shift. x"
LL: "It's the luck of the drawer (sic) isn’t it, unfortunately. Only three trained, so I ended up having both, whereas just baby F the other shifts."
JJ-K: "You seem to be having some very bad luck though."
LL: "Not a lot I can do really. He had massive haemorrhage could have happened to any baby. x"
JJ-K: "No, you did everything you could, I know it can happen to any baby, very scary", I have seen one, my baby did it in nursery 3 once, horrible.”
LL: "Wasn’t nice. This was abdominal. I’ve only seen pulmonary before.”
JJ-K: Hope your be ok. Chin up”
LL: I’m ok. Went to [colleague] for a chat earlier on and with nice people tonight.
JJ-K: Hope your night goes ok.” (Mail podcast and Chester Standard)
9-10pm: The court is shown medication is being administered to F at this time, between 9-10pm.
Dr Wood’s last night shift with the CoCH as he’d come to the end of his 4-month training placement. (Dr Wood's testimony for E)
11.32pm - A blood gas result shows a blood glucose level of 5.5. (electronic evidence)
5 August 2015, Wednesday
[12.10am – In police interview in July 2018, LL confirmed signing for a lipid syringe at 12.10am. The prosecution say she should have had someone to co-sign for it. "She accepted that the signature tended to suggest she had administered it." "Interestingly, at the end of this part of the interview she asked whether the police had access to the TPN bag that she had connected," Mr Johnson added. (prosecution opening speech)]
12.25am - A 48-hour bag prescription of nutrition is signed, solely, by LL, recording it ending at 12.25am on August 5. (electronic evidence)
12.25am - Two records are shown for the next administration, the first being crossed out. The second nutrition bag has a higher level of babiven, along with quantities of lipid and 10% dextrose that weren't on the first, crossed out, administration. The babiven is stated to start at 12.25am, and the lipid administration is signed to begin at 3am. LL is a co-signer for both the babiven prescriptions, but not the lipid administration. The 12.25am prescription for the TPN bag starts to be administered at 12.25am. F then suffered a deterioration, the court hears. (electronic evidence)
Allegation against LL of intentional insulin poisoning of F
[In police interview in July 2018 LL confirmed her signature on the TPN form. She had no recollection of having had involvement with administering the TPN bag contents to F, but confirmed giving F glucose injections and taking observations. (prosecution opening speech) The defence say F's TPN bag was put up by LL and hours later there were blood sugar problems. That bag was replaced, in the absence of LL, but the problems continued. The sample taken [at 5.56pm] came from "the second bag", the defence say. (defence opening speech)]
1am - A fluid chart shows in the 'NGT aspirate/vomit' column, four '+' signs. The nursing note, written retrospectively and timed for 1am, records: "large milky vomit. Heart rate increased to 200-210. [respiration rate] increased to 65-80. [Oxygen saturation levels] >96%. Became quieter than usual. Abdomen soft and not distended. Slightly jaundiced in appearance but no loss of colour. Dr Harkness R/V." (electronic evidence)
1.15am - An observation chart for F: The heart rate is shown having increased, along with the respiration rate, at this time, into the 'yellow area', which the court has previously heard is something medical staff would note and raise concerns if necessary. Prosecutor Nicholas Johnson KC says the relevant nurse will be asked to give further details on this in due course. (electronic evidence)
1.54am – A blood gas reading has F’s blood glucose level as 0.8. (electronic evidence)
2.05am – Medication of 10% dextrose is administered intraveneously, along with various other medications. (electronic evidence)
2.15am - 2.17am – Blood tests are ordered for F by doctors at 2.15am and 2.17am. (electronic evidence)
2.33-2.45am – Blood tests are collected between 2.33am and 2.45am. (electronic evidence)
2.55am - F's blood glucose level is recorded as 2.3. This is still "below where it should safely have been", Mr Johnson tells the court. (electronic evidence)
3am – (see entry at 12.25am) - the lipid administration is signed to begin at 3am.
3.10am - The lipid prescription is administered. (electronic evidence)
3.35am - 0.9% saline administered (electronic evidence)
3.50am - A 10% dextrose infusion is recorded (electronic evidence)
4.02am - F's blood glucose reading is 1.9. (electronic evidence)
4.25am – Further saline and 10% dextrose medications are administered (electronic evidence)
5am – F’s blood glucose level is recorded as 2.9 (electronic evidence)
7.30 -8am – The shift handover is carried out at 7.30am (electronic evidence)
8am – day shift nurse Shelley Tomlins recorded F’s blood glucose level as 1.7. Prosecutor Mr Johnson says this is a "dangerously low level". (electronic evidence)
8am – LL’s night shift ended.
Prior to 10am – LL has been messaging the night-shift designated nurse for F;
LL: "Did you hear what [F]'s sugar was at 8[am]?"
Nurse: "No?"
LL: "1.8"
Nurse: "[S***]!!!!", adding she felt "awful" for her care of F that night.
LL: "Something isn't right if he is dropping like that," adding that F's heel has to be taken into consideration [as blood gas tests are taken via heel pricks, and cannot be done too regularly].
Nurse: "Exactly, he had so much handling. No something not right. Heart rate and sugars."
LL: "Dr Gibbs came so hopefully they will get him sorted. "He is a worry [though]."
Nurse: "Hpe so. He is a worry."
LL: "Hope you sleep well...let me know how [F] is tonight please."
Nurse: "I will hun".
(electronic evidence)
[In police interview LL was asked about the text, and she said she must have looked on his chart. (opening speech)]
10am – Dr Ogden records a blood glucose level for F of '1.3'. (electronic evidence)
Time? –A doctor instructed the nursing staff to stop the TPN via the long line, provide dextrose, and move the TPN to a peripheral line while a new long line was put in. (opening speech, Chester Standard)
Morning (time? 11am?) – Further medication administrations are made throughout the morning. A new long line is also inserted at this time. (electronic evidence)
11am – All fluids were interrupted while a new long-line was put in. (opening speech)
11.46am – Nurse Shelley Tomlins recorded a blood glucose reading of 1.4. (electronic evidence)
[Noon – A TPN bag was re-fitted to F. This was either the same bag that was interrupted at 11am, which LL had signed for, or a stock bag from the fridge. (opening speech)]
12 midday - F's blood glucose level is recorded by a doctor as 2.4. (electronic evidence)
2pm - F's blood glucose level is recorded as being 1.9 (electronic evidence)
3.01pm - F's blood glucose level is recorded as being 1.3 (electronic evidence)
c.3pm - 10% dextrose solution is administered. (electronic evidence & Dr Beech’s testimony)
4pm - The blood glucose level is still "very low", the court hears, at 1.9 (electronic evidence)
4pm - 10% dextrose solution is administered. (Dr Beech’s testimony)
[4pm – A new bespoke TPN was delivered to the unit for F. (opening speech)]
4pm - At 4pm, LL’s phone receives an invitation from an estate agency firm confirming a viewing for a property in Chester, near the hospital. This home would be the address where LL stayed until her 2018 arrest. (electronic evidence) The court heard the defendant had a house-viewing appointment the following day (6 Aug). (source Independent)
5.40pm – Dr Beech’s note at 5.40pm on August 5 documented 'asked to prescribe 150ml/kg/day 15% dextrose over 24hr at handover with 5ml/kg/day in it. "Also to stop TPN, check urinary [sodium], cortisol and insulin." Dr B says she cannot remember if F had been prescribed additional dextrose doses. She says the 15% dextrose - a "high amount" - would normally be due to low blood sugar levels. An intensive care chart is shown to the court, showing blood sugar levels which are "all low". "2.9 [the 5am reading] isn't bad for a neonate - anything less than 2.6 is considered low." Readings of 1.8 and 1.9 are shown for much of the day, up to 6pm. 10% dextrose solutions are administered at 3pm and 4pm. (Dr Beech’s testimony)
5.56pm – F's blood glucose level is recorded as being 1.3 at 5.56pm. A blood test is recorded for insulin to the Royal Liverpool Hospital at 5.56pm. The court hears those results did not come back for a week. (electronic evidence). A blood test is recorded at 5.56pm, sent to a laboratory, with 'relevant clinical details: preterm neonate, hypoglycaemia, on 10% dextrose'. The blood glucose levels recorded are 1.3. The 'lab sample' "tends to be more accurate" than one on a blood gas machine, Dr B tells the court. The cortisol reading is 364, which is within the range of 155 to 607. The insulin reading is 4,657. The insulin c-pep reading is less than 169. Dr B says the insulin reading is "very high" - while there is no 'normal upper limit', that reading could be considered high, the court hears. The insulin c-pep reading is the lowest reading the machine can record. The two readings [insulin and insulin c-pep] are "expected to be similar," Dr B tells the court. (Dr Beech’s testimony)
[5.56pm – F's blood sample at 5.56pm had a very low glucose level, and after he was taken off the TPN and replaced with dextrose, his blood glucose levels returned to normal by 7.30pm. He had no further episodes of hypoglycaemia. "These episodes were sufficiently concerning" that medical staff checked F's blood plasma level. The 5.56pm sample recorded a "very high insulin measurement of 4,657". F's hormone level of C-peptide was very low - less than 169. "That, we say, means that somebody gave F synthetic insulin - somebody poisoned him." "All experienced medical and nursing members of staff would know the dangers of introducing insulin into any individual whose glucose values were within the normal range and would know that extreme hypoglycaemia, over a prolonged period of time, carries life threatening risks. "No other baby on the neonatal unit was prescribed insulin at the time." In a June 2019 police interview, LL agreed with the idea that insulin would not be administered accidentally. (prosecution opening speech)]
6pm - F's blood glucose level is recorded as 1.9 at 6pm. (electronic evidence)
6pm – LL’s texts to a colleague Minna Lappalainen:
LL: "Hi! Are you going to salsa tonite?"
Coll: "Should do really as I haven't been for ages. Meet at TF 2020?”
LL: 'ok' emoji. LL adds: "Need to try and find some sort of nites energy", before clarifying "post nites"
Coll: “Don’t have to stay late.”
LL: "Hasta luego".
(electronic evidence)
6.43pm –A urine sample sent at 6.43pm had 'no unusual readings', but Dr B tells the court she cannot think, off the top of her head, how to interpret those results recorded. (Dr Beech’s testimony)
7pm – A chart showing a 7pm prescription of 15% dextrose, with sodium chloride, is administered intraveneously. Dr B has signed that. (Dr Beech’s testimony)
7pm - A nursing note records there was a change from the TPN/lipid and 10% dextrose administration to 'just 15% dextrose with sodium chloride added'. The new fluids were commenced at 7pm. (electronic evidence)
8pm – night shift – The designated nurse for the previous night shift returns to care for F on the night shift for August 5-6.
Texts:
She messaged LL: "He is a bit more stable, heart rate 160-170." (The long line had "tissued" and F's thigh was "swollen". It was thought the tissued long line "may be" the cause of the hypoglycemia.)
Colleague: "Changed long line but sugars still 1.9 all afternoon. Seems like long line tissued was not cause of sugar problem, doing various tests to try to find answers”
LL: "Oh dear, thanks for letting me know."
Nurse: "He’s defo better tho. Looks well, handling fine."
LL: "Good."
(electronic evidence)
9.17pm - F's blood glucose level is recorded as being 4.1. (electronic evidence)
11.58pm – LL’s text to same colleague (designated nurse)
LL: "Wonder if he has an endocrine problem then. Hope they can get to bottom of it. "On way home from salsa with Minna. Feel better now I’ve been out."
Colleague: "Good, glad you feel better. Maybe re endocrine. Maybe just prematurity."
LL: "How are parents?"
Colleague: "OK. Tired. They've just gone to bed."
LL: "Glad they feel able to leave him."
Colleague: "Yes. they know we'll get them so good they trust us."
LL: Yes.
?: "Hope you have a good night."
(electronic evidence)
6 August 2015, Thursday
1.30am - F's blood glucose levels rose to 9.9 (electronic evidence)
2am - a repeat blood glucose 9.9 reading. (electronic evidence)
7.58pm - LL did Facebook searches on the mother of E&F, as well as on August 23, September 14, September 21st, November 5, December 7, 11.26pm on December 25 and twice in January 2016. The last search was January 10th 2016. She searched the father of E&F on Facebook at 1.17am on October 5 2015. (opening speech and electronic evidence)
7 August 2015, Friday (about, a few days after giving E’s parents a memory box)
LL gave the mother a photograph of [F] 'holding' E's teddy. The mother had just made one of her daily visits to the hospital's chapel of rest. 'Lucy Letby told me 'I got this picture. I thought it was so amazing I took a picture for you'. She was suggesting F had rolled over and cuddled the bear'.
9 August 2015, Sunday
10.17pm – LL’s texts
LL texted the designated nurse of F on the night shift of the insulin allegation: I said goodbye to [E&F’s parents] as [F] might go tomorrow. They both cried and hugged me saying they will never be able to thank me for the love and care I gave to [E] and for the precious memories I’ve given them. It’s heartbreaking’
Coll: 'It’s heart-breaking, but you’ve done your job to the highest standard with compassion and professionalism. 'When we can’t save a baby we can try to make sure that the loss of their child is the one regret the parents have. It sounds like that’s exactly what you have done. You should feel very proud of yourself esp as you’ve done so well in such tough heartbreaking circumstances. Xx’
LL: 'I just feel sad that they’re thanking me when they have lost him and for something that any of us would have done. But it’s really nice to know that I got it right for them. That’s all I want.'
Coll: ‘It has been tough. You’ve handled it all really well. They know everything possible was done and that no-one gave up on E till it was in his best interest. As a parent you want the best for your child and sometimes that isn’t what you’d choose. Doesn’t mean that your [sic] not grateful to those that helped your child and you tho.’
LL: ‘Thank you xx’ (electronic evidence)
12 Nov 2015 – LL’s texts
8.32pm
Another colleague texted LL: E&F’s parents brought a gorgeous huge hamper in today. Felt awful as couldn’t remember who they were till opened the card. Was very nice of them though n F looks 'fab x'.
LL: 'Oh gosh, did they, awe wish I could have seen them. That’ll stay with me forever. Lovely family x'. (electronic evidence)
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Attempted Murder charge baby F – by alleged insulin poisoning
Prosecution Opening speech – Chester Standard Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders
Prosecution Opening speech – ITV Who are the children alleged to have been murdered by Lucy Letby? | ITV News
Defence opening speech - Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement
Dr Wood (SHO)’s testimony – Recap: Lucy Letby trial, Tuesday, November 15
Mother’s testimony for baby E – Recap: Lucy Letby trial, Monday, November 14
Unnamed nurse’s testimony (day shift 3 Aug) – Recap: Lucy Letby trial, Tuesday, November 15
Electronic evidence – Recap: Lucy Letby trial, Monday, November 14
Supplementary text details Daily Mail Colleagues of Lucy Letby told her she was 'terrible run of bad luck'
Electronic evidence 22 Nov 2022 - Recap: Lucy Letby trial, Tuesday, November 22
Dr Gail Beech’s evidence Recap: Lucy Letby trial, Tuesday, November 22
Round up 22/11 2022 Independent - Accused nurse went salsa dancing the night after ‘murder bid’, court told
Mail podcast (additional text info) The Trial of Lucy Letby, Episode 7: Baby E, 'I trusted her completely...'...
29 Jul 2015, Wednesday
Identical twin boys E and F born, prematurely, at 29 weeks, by C-Section. They shared a placenta which can increase the risks for NEC. (consultant’s testimony) Dr Christopher Wood (SHO) was present at the births. Dr Gail Beech was also present at the births and looked after E. Her first involvement with F was on the day shift on 4 Aug 2015.
E weighed 2lb 14oz (1.327kg). He was given oxygen then weaned to air and transferred to Room 1. He was at risk of NEC and started on antibiotics, IV fluids and caffeine. He had a nasogastric tube inserted.
F was marginally younger, and he required some resuscitation at birth. His birth weight was 3lb 2oz (1.434kg). He was later intubated, ventilated and given medicine to help his lungs.
30 Jul 2015, Thursday
Mother says she was able to visit the twins in the neonatal unit, from upstairs in the post-natal wards. She said that would take about 5-10 minutes to get from one place to the other, due to having had a C-section, which made the journey time longer. She said she was able to cuddle E as he wasn't on CPAP, while F was on CPAP.
31 Jul 2015, Friday
A high blood sugar reading was recorded and F was prescribed a tiny dose of insulin to correct it. His breathing tube was removed and he was given breathing support.
1 Aug 2015, Saturday
Mother said E was progressing better, of the two twins, over July 30-31, but both were doing "really well" by August 1. She was keen to get home and was keen to transport both babies to a hospital closer to home, and was waiting for two ambulances to be provided. She said she and her partner were under the impression both babies were well enough to travel. By that stage, she had had skin-to-skin contact with both twins, and both were managing "fine". "We were never informed about anything to say they weren't fine."
8pm night shift – LL was designated nurse for F.
2 Aug 2015, Sunday
By August 2, mother says they were still waiting for transport. She said on that day, the twins were both out of their incubators by this stage. [E] was breathing "easily" and [F] was "great".
8pm night shift – LL was designated nurse for F. Melanie Taylor was designated nurse for E.
10.34pm – LL’s texts with nursing colleague:
JJ-K: "Hope work ok".
LL: "...yeah it's fine, bit too Q word really."
JJ-K: "Don't complain as Wed and Thurs horrible lol! It will pick up again."
3 Aug 2015, Monday
Mother says by August 3 the twins were "great - doing really well". "We were absolutely thrilled that both boys were doing so well and we couldn't have asked for any more than that. They were both progressing."
8am -8pm day-shift - “unnamed nurse” [in court testimony] was the designated nurse for E & F.
7.30-8pm night shift – LL is designated nurse for twins E & F in room 1. Nurse Caroline Oakley was the shift-leader. There were 3 babies in room 2, one baby in room 3, and four babies in room 4. There is also a baby in the transitional care unit.
Just prior to 9pm – Allegation against LL of intentionally inflicting injury to baby E's upper gastrointestinal tract, with bleeding contributing to his death
9.13pm – LL made a note in twin F’s records. (opening statement)
Just prior to 11.40pm - Allegation against LL of intentionally injecting air into baby E, causing his collapse and death
4 Aug 2015, Tuesday
1.40am – Baby E's time of death was recorded as 1.40am.
8am – End of LL’s night shift
Day shift - Registrar Dr Gail Beech was on duty. A ‘ward round-up’ filled in in preparation for Wednesday’s weekly consultant ‘grand round’ ward round-up is presented to the court. The list of problems, readings and observations for each child is noted, concluding with a management plan. The note recorded that E had died aged 6 days. Dr B explains F was on Optiflow with 'suspected sepsis' noted, a raised urea and creatinine, 'jaundice' but not on phototherapy at this stage. F was also 'establishing feeds' and awaiting genetics test for Down's, but F was not showing any clinical features, and 'hyperglycaemia - resolved'. Prosecutor says the genetic test results were received on August 7. Dr B said they confirmed there wasn't a presence of Down's. Dr B confirms she was satisfied the hyperglycaemia [high blood sugar] level had been resolved. Dr B said a standard list of medication was prescribed. The Optiflow reading was not supplemented with oxygen - F had been 'in air since 3.30am'. Oxygen saturation levels were 92-97%, which were 'satisfactory'. Dr B says there 'weren't any concerns' on the cardiovascular system. F weighed 1.296kg [2lb 13oz], from a birth weight of 1.434kg [3lb 2oz] - Dr B said this was not a concern as babies, particularly neonates, lose weight in the first days following birth. Dr B confirms F was receiving nutrition via a TPN bag. F was 'active, moving all 4 limbs'. F was 'active and pink', with a 'clear' chest, no increased rate of breathing. A note saying F required further tests on 'mouth and palate', and 'eyes', as part of a 'top to toe examination'. The management plan says, for F, 'wean Optiflow flow when in air.' 'Complete 7 days of antibiotics'. "Continue increasing feeds as tolerated'. 'Chase genetics [for results]'. 'Complete examination and baby check later (parents arrived, upset about twin 1)'. Dr B is now asked to look at a chart for a prescription for Babiven, which she has dated, but does not recall writing it. She had signed for a rate of lipid, but that was zero as it wasn't required. Babiven is a "standard bag" which would be given at a bespoke rate for F. Dr B says the second prescription, with different Babiven levels and a new lipid level, was made as F had been made 'nil by mouth' and the increased levels were so F could acquire the same level of nutrients in his body. Dr B is asked if there was anything notable from previous clinical records that she could recall in respect of F. She says there was not. X-exam – Dr B clarifies she was waiting for genetic test results for F for the presence of Down's Syndrome. Those results came back on August 7, with no evidence of Down's Syndrome. Defence asks if a further, microarray genetics test can be conducted to show for further potential genetic disorders; Dr B confirms that is the case. Defence says on August 4, the fluids were being administered via TPN, and milk coming in via the NGT [nasogastric tube], with no lipid required as F was getting milk in. Defence asks about the management plan - 'continue increasing feeds as tolerated'. He then refers to the two August 4 prescriptions of fluids [the first being crossed out], and if Dr B had completed the figures; Dr B confirms that was the case, and that she signed for them. At the first one, there is no component of lipid. Dr B says she would have written these figures after the ward round, so the TPN could be made up. Dr B says it would take some time from prescribing the TPN bag to it then being administered. Defence asks for clarity on how the second prescription comes to be made, with a different rate of administration of Babiven and a new lipid and new 10% dextrose doses; Dr B confirms she did not prescribe these additional nutritions, as they are signed by a colleague. The total nutrition administration is now 165ml and the rate is slightly increased from the first, crossed-out prescription of total 150ml fluid. Dr B says the additional nutrition would come on separate infusions. That concludes Dr B's evidence. (Dr Beech’s evidence)
8.21am - LL noted: 'Parents resident on unit overnight. Wish to be left alone.' (electronic evidence)
8.58am – LL’s texts
Colleague who can’t be named: "You ok? Just heard about baby [E]. Did you have him? Sending hugs xx"
LL: "News travels fast - who told you? Yeah I had them both, was horrible."
Colleague responded that someone at the handover 'told me just now'. 'Had he been getting poorly or was it sudden?' ‘Poor you. You’re having a
time of it.”LL: E had a 'massive gastrointestinal haemorrhage'.
Colleague: ‘Damn. He’d always struggled feeding. I just feel for his parents and you. You’ve had really tough times recently.’
LL: “E was 'IUGR [Intrauterine growth restriction] and REDF [Reversal of umbilical artery end-diastolic flow]'. Guess he was very high risk. Was just awful, he was bleeding from everywhere during resus. Got him back but gas incompatible. Parents completely distraught. I feel numb.” (source Mail Podcast)
4pm – Baby F’s bespoke TPN bag was delivered to the neonatal unit. It had to be used within 48 hours of 11.30pm on the 4th. (opening speech)
Just before 5pm - a nursing note records family communication in which F's parents wish to transfer care to another hospital in the North West, but transport was unavailable due to an emergency. The note adds 'sincere apologies given to parents'.
7.30-8pm - LL night shift starts. Baby F had been moved to room 2. LL was not baby F’s designated nurse. LL was designated a single baby that night, also in room 2. Belinda Simcock was the shift leader. There were 7 babies in the unit that night, and 5 nurses working. Room 3 – 1 baby. Room 4 – twins. Two other babies whose location hasn’t been established from the records. (electronic evidence Tues 22/11/2022)
7.55pm – LL’s texts
Jennifer Jones-Key: "Hey how's you?"
8.01pm -
LL: "Not so good, we lost [E] overnight."
8.02pm -
JJ-K: "That’s sad. ‘We’re on a terrible run at the moment. Were you in 1? x"
8.02pm
LL: "Yes. I had him and baby [F] x"
JJ-K: "That’s not good, you need a break from it being on your shift. x"
LL: "It's the luck of the drawer (sic) isn’t it, unfortunately. Only three trained, so I ended up having both, whereas just baby F the other shifts."
JJ-K: "You seem to be having some very bad luck though."
LL: "Not a lot I can do really. He had massive haemorrhage could have happened to any baby. x"
JJ-K: "No, you did everything you could, I know it can happen to any baby, very scary", I have seen one, my baby did it in nursery 3 once, horrible.”
LL: "Wasn’t nice. This was abdominal. I’ve only seen pulmonary before.”
JJ-K: Hope your be ok. Chin up”
LL: I’m ok. Went to [colleague] for a chat earlier on and with nice people tonight.
JJ-K: Hope your night goes ok.” (Mail podcast and Chester Standard)
9-10pm: The court is shown medication is being administered to F at this time, between 9-10pm.
Dr Wood’s last night shift with the CoCH as he’d come to the end of his 4-month training placement. (Dr Wood's testimony for E)
11.32pm - A blood gas result shows a blood glucose level of 5.5. (electronic evidence)
5 August 2015, Wednesday
[12.10am – In police interview in July 2018, LL confirmed signing for a lipid syringe at 12.10am. The prosecution say she should have had someone to co-sign for it. "She accepted that the signature tended to suggest she had administered it." "Interestingly, at the end of this part of the interview she asked whether the police had access to the TPN bag that she had connected," Mr Johnson added. (prosecution opening speech)]
12.25am - A 48-hour bag prescription of nutrition is signed, solely, by LL, recording it ending at 12.25am on August 5. (electronic evidence)
12.25am - Two records are shown for the next administration, the first being crossed out. The second nutrition bag has a higher level of babiven, along with quantities of lipid and 10% dextrose that weren't on the first, crossed out, administration. The babiven is stated to start at 12.25am, and the lipid administration is signed to begin at 3am. LL is a co-signer for both the babiven prescriptions, but not the lipid administration. The 12.25am prescription for the TPN bag starts to be administered at 12.25am. F then suffered a deterioration, the court hears. (electronic evidence)
Allegation against LL of intentional insulin poisoning of F
[In police interview in July 2018 LL confirmed her signature on the TPN form. She had no recollection of having had involvement with administering the TPN bag contents to F, but confirmed giving F glucose injections and taking observations. (prosecution opening speech) The defence say F's TPN bag was put up by LL and hours later there were blood sugar problems. That bag was replaced, in the absence of LL, but the problems continued. The sample taken [at 5.56pm] came from "the second bag", the defence say. (defence opening speech)]
1am - A fluid chart shows in the 'NGT aspirate/vomit' column, four '+' signs. The nursing note, written retrospectively and timed for 1am, records: "large milky vomit. Heart rate increased to 200-210. [respiration rate] increased to 65-80. [Oxygen saturation levels] >96%. Became quieter than usual. Abdomen soft and not distended. Slightly jaundiced in appearance but no loss of colour. Dr Harkness R/V." (electronic evidence)
1.15am - An observation chart for F: The heart rate is shown having increased, along with the respiration rate, at this time, into the 'yellow area', which the court has previously heard is something medical staff would note and raise concerns if necessary. Prosecutor Nicholas Johnson KC says the relevant nurse will be asked to give further details on this in due course. (electronic evidence)
1.54am – A blood gas reading has F’s blood glucose level as 0.8. (electronic evidence)
2.05am – Medication of 10% dextrose is administered intraveneously, along with various other medications. (electronic evidence)
2.15am - 2.17am – Blood tests are ordered for F by doctors at 2.15am and 2.17am. (electronic evidence)
2.33-2.45am – Blood tests are collected between 2.33am and 2.45am. (electronic evidence)
2.55am - F's blood glucose level is recorded as 2.3. This is still "below where it should safely have been", Mr Johnson tells the court. (electronic evidence)
3am – (see entry at 12.25am) - the lipid administration is signed to begin at 3am.
3.10am - The lipid prescription is administered. (electronic evidence)
3.35am - 0.9% saline administered (electronic evidence)
3.50am - A 10% dextrose infusion is recorded (electronic evidence)
4.02am - F's blood glucose reading is 1.9. (electronic evidence)
4.25am – Further saline and 10% dextrose medications are administered (electronic evidence)
5am – F’s blood glucose level is recorded as 2.9 (electronic evidence)
7.30 -8am – The shift handover is carried out at 7.30am (electronic evidence)
8am – day shift nurse Shelley Tomlins recorded F’s blood glucose level as 1.7. Prosecutor Mr Johnson says this is a "dangerously low level". (electronic evidence)
8am – LL’s night shift ended.
Prior to 10am – LL has been messaging the night-shift designated nurse for F;
LL: "Did you hear what [F]'s sugar was at 8[am]?"
Nurse: "No?"
LL: "1.8"
Nurse: "[S***]!!!!", adding she felt "awful" for her care of F that night.
LL: "Something isn't right if he is dropping like that," adding that F's heel has to be taken into consideration [as blood gas tests are taken via heel pricks, and cannot be done too regularly].
Nurse: "Exactly, he had so much handling. No something not right. Heart rate and sugars."
LL: "Dr Gibbs came so hopefully they will get him sorted. "He is a worry [though]."
Nurse: "Hpe so. He is a worry."
LL: "Hope you sleep well...let me know how [F] is tonight please."
Nurse: "I will hun".
(electronic evidence)
[In police interview LL was asked about the text, and she said she must have looked on his chart. (opening speech)]
10am – Dr Ogden records a blood glucose level for F of '1.3'. (electronic evidence)
Time? –A doctor instructed the nursing staff to stop the TPN via the long line, provide dextrose, and move the TPN to a peripheral line while a new long line was put in. (opening speech, Chester Standard)
Morning (time? 11am?) – Further medication administrations are made throughout the morning. A new long line is also inserted at this time. (electronic evidence)
11am – All fluids were interrupted while a new long-line was put in. (opening speech)
11.46am – Nurse Shelley Tomlins recorded a blood glucose reading of 1.4. (electronic evidence)
[Noon – A TPN bag was re-fitted to F. This was either the same bag that was interrupted at 11am, which LL had signed for, or a stock bag from the fridge. (opening speech)]
12 midday - F's blood glucose level is recorded by a doctor as 2.4. (electronic evidence)
2pm - F's blood glucose level is recorded as being 1.9 (electronic evidence)
3.01pm - F's blood glucose level is recorded as being 1.3 (electronic evidence)
c.3pm - 10% dextrose solution is administered. (electronic evidence & Dr Beech’s testimony)
4pm - The blood glucose level is still "very low", the court hears, at 1.9 (electronic evidence)
4pm - 10% dextrose solution is administered. (Dr Beech’s testimony)
[4pm – A new bespoke TPN was delivered to the unit for F. (opening speech)]
4pm - At 4pm, LL’s phone receives an invitation from an estate agency firm confirming a viewing for a property in Chester, near the hospital. This home would be the address where LL stayed until her 2018 arrest. (electronic evidence) The court heard the defendant had a house-viewing appointment the following day (6 Aug). (source Independent)
5.40pm – Dr Beech’s note at 5.40pm on August 5 documented 'asked to prescribe 150ml/kg/day 15% dextrose over 24hr at handover with 5ml/kg/day in it. "Also to stop TPN, check urinary [sodium], cortisol and insulin." Dr B says she cannot remember if F had been prescribed additional dextrose doses. She says the 15% dextrose - a "high amount" - would normally be due to low blood sugar levels. An intensive care chart is shown to the court, showing blood sugar levels which are "all low". "2.9 [the 5am reading] isn't bad for a neonate - anything less than 2.6 is considered low." Readings of 1.8 and 1.9 are shown for much of the day, up to 6pm. 10% dextrose solutions are administered at 3pm and 4pm. (Dr Beech’s testimony)
5.56pm – F's blood glucose level is recorded as being 1.3 at 5.56pm. A blood test is recorded for insulin to the Royal Liverpool Hospital at 5.56pm. The court hears those results did not come back for a week. (electronic evidence). A blood test is recorded at 5.56pm, sent to a laboratory, with 'relevant clinical details: preterm neonate, hypoglycaemia, on 10% dextrose'. The blood glucose levels recorded are 1.3. The 'lab sample' "tends to be more accurate" than one on a blood gas machine, Dr B tells the court. The cortisol reading is 364, which is within the range of 155 to 607. The insulin reading is 4,657. The insulin c-pep reading is less than 169. Dr B says the insulin reading is "very high" - while there is no 'normal upper limit', that reading could be considered high, the court hears. The insulin c-pep reading is the lowest reading the machine can record. The two readings [insulin and insulin c-pep] are "expected to be similar," Dr B tells the court. (Dr Beech’s testimony)
[5.56pm – F's blood sample at 5.56pm had a very low glucose level, and after he was taken off the TPN and replaced with dextrose, his blood glucose levels returned to normal by 7.30pm. He had no further episodes of hypoglycaemia. "These episodes were sufficiently concerning" that medical staff checked F's blood plasma level. The 5.56pm sample recorded a "very high insulin measurement of 4,657". F's hormone level of C-peptide was very low - less than 169. "That, we say, means that somebody gave F synthetic insulin - somebody poisoned him." "All experienced medical and nursing members of staff would know the dangers of introducing insulin into any individual whose glucose values were within the normal range and would know that extreme hypoglycaemia, over a prolonged period of time, carries life threatening risks. "No other baby on the neonatal unit was prescribed insulin at the time." In a June 2019 police interview, LL agreed with the idea that insulin would not be administered accidentally. (prosecution opening speech)]
6pm - F's blood glucose level is recorded as 1.9 at 6pm. (electronic evidence)
6pm – LL’s texts to a colleague Minna Lappalainen:
LL: "Hi! Are you going to salsa tonite?"
Coll: "Should do really as I haven't been for ages. Meet at TF 2020?”
LL: 'ok' emoji. LL adds: "Need to try and find some sort of nites energy", before clarifying "post nites"
Coll: “Don’t have to stay late.”
LL: "Hasta luego".
(electronic evidence)
6.43pm –A urine sample sent at 6.43pm had 'no unusual readings', but Dr B tells the court she cannot think, off the top of her head, how to interpret those results recorded. (Dr Beech’s testimony)
7pm – A chart showing a 7pm prescription of 15% dextrose, with sodium chloride, is administered intraveneously. Dr B has signed that. (Dr Beech’s testimony)
7pm - A nursing note records there was a change from the TPN/lipid and 10% dextrose administration to 'just 15% dextrose with sodium chloride added'. The new fluids were commenced at 7pm. (electronic evidence)
8pm – night shift – The designated nurse for the previous night shift returns to care for F on the night shift for August 5-6.
Texts:
She messaged LL: "He is a bit more stable, heart rate 160-170." (The long line had "tissued" and F's thigh was "swollen". It was thought the tissued long line "may be" the cause of the hypoglycemia.)
Colleague: "Changed long line but sugars still 1.9 all afternoon. Seems like long line tissued was not cause of sugar problem, doing various tests to try to find answers”
LL: "Oh dear, thanks for letting me know."
Nurse: "He’s defo better tho. Looks well, handling fine."
LL: "Good."
(electronic evidence)
9.17pm - F's blood glucose level is recorded as being 4.1. (electronic evidence)
11.58pm – LL’s text to same colleague (designated nurse)
LL: "Wonder if he has an endocrine problem then. Hope they can get to bottom of it. "On way home from salsa with Minna. Feel better now I’ve been out."
Colleague: "Good, glad you feel better. Maybe re endocrine. Maybe just prematurity."
LL: "How are parents?"
Colleague: "OK. Tired. They've just gone to bed."
LL: "Glad they feel able to leave him."
Colleague: "Yes. they know we'll get them so good they trust us."
LL: Yes.
?: "Hope you have a good night."
(electronic evidence)
6 August 2015, Thursday
1.30am - F's blood glucose levels rose to 9.9 (electronic evidence)
2am - a repeat blood glucose 9.9 reading. (electronic evidence)
7.58pm - LL did Facebook searches on the mother of E&F, as well as on August 23, September 14, September 21st, November 5, December 7, 11.26pm on December 25 and twice in January 2016. The last search was January 10th 2016. She searched the father of E&F on Facebook at 1.17am on October 5 2015. (opening speech and electronic evidence)
7 August 2015, Friday (about, a few days after giving E’s parents a memory box)
LL gave the mother a photograph of [F] 'holding' E's teddy. The mother had just made one of her daily visits to the hospital's chapel of rest. 'Lucy Letby told me 'I got this picture. I thought it was so amazing I took a picture for you'. She was suggesting F had rolled over and cuddled the bear'.
9 August 2015, Sunday
10.17pm – LL’s texts
LL texted the designated nurse of F on the night shift of the insulin allegation: I said goodbye to [E&F’s parents] as [F] might go tomorrow. They both cried and hugged me saying they will never be able to thank me for the love and care I gave to [E] and for the precious memories I’ve given them. It’s heartbreaking’
Coll: 'It’s heart-breaking, but you’ve done your job to the highest standard with compassion and professionalism. 'When we can’t save a baby we can try to make sure that the loss of their child is the one regret the parents have. It sounds like that’s exactly what you have done. You should feel very proud of yourself esp as you’ve done so well in such tough heartbreaking circumstances. Xx’
LL: 'I just feel sad that they’re thanking me when they have lost him and for something that any of us would have done. But it’s really nice to know that I got it right for them. That’s all I want.'
Coll: ‘It has been tough. You’ve handled it all really well. They know everything possible was done and that no-one gave up on E till it was in his best interest. As a parent you want the best for your child and sometimes that isn’t what you’d choose. Doesn’t mean that your [sic] not grateful to those that helped your child and you tho.’
LL: ‘Thank you xx’ (electronic evidence)
12 Nov 2015 – LL’s texts
8.32pm
Another colleague texted LL: E&F’s parents brought a gorgeous huge hamper in today. Felt awful as couldn’t remember who they were till opened the card. Was very nice of them though n F looks 'fab x'.
LL: 'Oh gosh, did they, awe wish I could have seen them. That’ll stay with me forever. Lovely family x'. (electronic evidence)
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Attempted Murder charge baby F – by alleged insulin poisoning
Prosecution Opening speech – Chester Standard Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders
Prosecution Opening speech – ITV Who are the children alleged to have been murdered by Lucy Letby? | ITV News
Defence opening speech - Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement
Dr Wood (SHO)’s testimony – Recap: Lucy Letby trial, Tuesday, November 15
Mother’s testimony for baby E – Recap: Lucy Letby trial, Monday, November 14
Unnamed nurse’s testimony (day shift 3 Aug) – Recap: Lucy Letby trial, Tuesday, November 15
Electronic evidence – Recap: Lucy Letby trial, Monday, November 14
Supplementary text details Daily Mail Colleagues of Lucy Letby told her she was 'terrible run of bad luck'
Electronic evidence 22 Nov 2022 - Recap: Lucy Letby trial, Tuesday, November 22
Dr Gail Beech’s evidence Recap: Lucy Letby trial, Tuesday, November 22
Round up 22/11 2022 Independent - Accused nurse went salsa dancing the night after ‘murder bid’, court told
Mail podcast (additional text info) The Trial of Lucy Letby, Episode 7: Baby E, 'I trusted her completely...'...
