UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #8

[LadyEdgeworth]

11:30am

A blood gas record is shown for Child G, from August 14 to September 7. Lucy Letby has signed for the last of those records.
An x-ray of Child G is taken at 4.49am. Consultant radiologist Dr Amer Rehman records, for the abdomen, 'generally slightly distended bowel loops, but gas noted in rectum, no transition point, mural or free gas detected on balance'.

11:34am

Lucy Letby and Alisa Simpson are co-signers for medications for Child G at 5.15am, and for a neonatal infusion prescription at 5.30am.
Dr Alison Ventress notes, for 5.30am, 'approx 0530 had another profound desat, hr down ton 60 and sats to 40%. Taken off vent and IPPV neopuff via ETT.
'Recovered slowly but desat when back on vent ? ventilator problem so flow sensor changed + then whole ventilator changed'.
Dr Brearey also records Dr Ventress changed the ETT with 'less leak'.
Child G had 'one further brady and poor perfusion.'
Child G was sedated and 'will need discussion with Arrowe Park Hospital/Liverpool Women's Hospital'.
The parents were kept informed, the note adds.

11:37am

Dr Ventress notes, from 6.05am - 'profound desat to 40% + HR down to 80. Decision to reintubate. IPPV given via ETT initiall. Heart rate 120 but sats remained 50% [despite increase in oxygen]
'ETT removed at 6.10am. Thick secretions ++ in mouth. Blood clot at end of ETT. IPPV via facemask given
'NG aspirated as abdo appeared v large ~100mls aspirated.
'Reintubated 0615 ETT with intubation drugs. Blood-stained fluid in oropharynx.
'Capnograph positive.'
The plan was to continue a series of medication, plus morphine, and keep parents updated.

Recap: Lucy Letby trial, Thursday, December 1

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[LadyEdgeworth]

11:39am

Lucy Letby noted: 'Reintubated at 0615 with intubation drugs...clear air entry and bilateral chest movement. Blood gases as charted...10% glucose commenced. Morphine running...[Child G] agitated and fighting ventilator. [Medication given]. Now synchronising well.

11:40am

Medication is administered, with Lucy Letby being a co-signer along with Alisa Simpson.
Dr Rehman has a further x-ray report at 6.36am, comparing observations with the previous x-ray. Among his observations, he notes: 'Lungs with slightly improved appearances, probably reflecting improved inspiration.'

11:46am

The former designated nurse are written retrospectively at 7.49am.
For the night '[Child G] was being nursed in a Kanbed with moniroting...
'Feeds 180ml/kg 3x8 ebm with fortifier and Gaviscon via alternate bottle/NGT. Abdomen full but soft with no discolouration. Aspirates minimal, partial digested milk. Passed urine and bowels open++. Short period of straining/uncomfortable at start of night when having cuddles with dad. Dr Ventress aware.'
The note adds care was transferred to Lucy Letby following Child G's large milky vomit just after 2am.
The nurse adds, for family communication 'dad present for early part of night shift, had cuddles with [Child G]. Parents called by me approx 3.45am...arrived shortly after'.

Recap: Lucy Letby trial, Thursday, December 1

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[LadyEdgeworth]

11:57am

The trial is now resuming after a short break.

12:01pm

The care of Child G was then handed over to another designated nurse for the day shift on September 7.
Letby had written a note, retrospectively at 8.57am, recording what happened during the night shift: 'Abdomen appears less distended and soft. Bowels opened large green watery stool at 0300. Urine output...NG tube on free drainage...
'Blood noted beyoned vocal cords during intubation.
'[Child G] having frequent profound desaturations on ventilator, requiring neopuff with high pressures and 100% oxygen, takes several minutes to recover.'

12:04pm

Dr David Harkness, in a clinical note at 9am, records Child G was 'paralysed and sedated, well perfused. [Abdomen] soft...
'Plan...discuss with tertiary centre [ie Arrowe Park/Liverpool Women's]'
Letby, at 9.15am: 'Parents attended the unit and have been fully updated...by myself, Reg Ventress and consultant Brearer. Anxious but understand need for ventilation.'
At 10am, Dr Harkness noted Child G's colour had 'improved'.

Recap: Lucy Letby trial, Thursday, December 1

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[Tortoise]

Disclosure Manual: Chapter 15 - Defence Disclosure | The Crown Prosecution Service

www.cps.gov.uk

"The defence must provide the details of any witnesses, irrespective of the reason why they are calling them at trial. "

"There is no requirement for the defence to supply any statement from the witness to the investigator or the prosecutor before the interview. The investigator and the prosecutor are unlikely to know what evidence the witness may give"

Seems they must say who they are calling as a witness but they have no obligation to say what their witness will attest to. However, if they put forward evidence which "relies on a matter which should have been mentioned in the defence statement but was not" or "puts forward a defence not mentioned in or different from that in the defence statement" then they can certainly run into trouble, and alienate a jury.

That's defence witnesses, the defence must disclose the defendant's defence statement in advance of trial.

"Defence disclosure:

• assists in the management of the trial by helping to identify the issues in dispute;
• provides information that the prosecutor needs to identify any material that should be disclosed; and
• prompts reasonable lines of enquiry, whether they point to or away from the accused."

"In the defence statement, the accused should:

• set out the nature of the defence, including any particular defences on which the accused intends to rely;
• indicate the matters of fact on which the accused takes issue with the prosecution;
• outline, in the case of each such matter, why the accused takes issue with the prosecution;
• set out particulars of matters of fact on which he intends to rely for the purposes of his defence;
• indicate any point of law (including any point as to the admissibility of evidence or an abuse of process) which the accused wishes to take, and any authority on which he or she intends to rely for that purpose; and
• comply with any regulations made by the Secretary of State as to the details of matters that are to be included in defence statements."

"An adequate defence statement must - where the defence differs from the facts on which the prosecution is based - state those differences and the reasons for them in the defence statement, and set out particulars of fact on which the defendant intends to rely on in his/her defence. This will ensure that the prosecution has a proper opportunity of investigating the facts giving rise to any differences."

"Section 6A of the CPIA states that the defence is required to set out any positive assertions to be relied on, namely the details of the actual defence. "

 

[LadyEdgeworth]

That's defence witnesses, the defence must disclose the defendant's defence statement in advance of trial.

"Defence disclosure:

• assists in the management of the trial by helping to identify the issues in dispute;
• provides information that the prosecutor needs to identify any material that should be disclosed; and
• prompts reasonable lines of enquiry, whether they point to or away from the accused."

"In the defence statement, the accused should:

• set out the nature of the defence, including any particular defences on which the accused intends to rely;
• indicate the matters of fact on which the accused takes issue with the prosecution;
• outline, in the case of each such matter, why the accused takes issue with the prosecution;
• set out particulars of matters of fact on which he intends to rely for the purposes of his defence;
• indicate any point of law (including any point as to the admissibility of evidence or an abuse of process) which the accused wishes to take, and any authority on which he or she intends to rely for that purpose; and
• comply with any regulations made by the Secretary of State as to the details of matters that are to be included in defence statements."

"An adequate defence statement must - where the defence differs from the facts on which the prosecution is based - state those differences and the reasons for them in the defence statement, and set out particulars of fact on which the defendant intends to rely on in his/her defence. This will ensure that the prosecution has a proper opportunity of investigating the facts giving rise to any differences."

"Section 6A of the CPIA states that the defence is required to set out any positive assertions to be relied on, namely the details of the actual defence. "

So they should outline their defence in the opening statements and they can't call surprise witnesses or surprise evidence. But the witnesses they call may say something not outlined the defence statement, however it would not look good if they did so and could cause issues. Have I got that right?

I don't think they are going to be producing 'evidence' of their own and I do think not cross examining yesterday was a weird move if they do intend to do so.

 

[LadyEdgeworth]

12:07pm

Lucy Letby sends a text message to a colleague in relation to the care of a different child on the neonatal unit from the previous night at 10.46am.

12:17pm

A longline is inserted into Child G at 3pm.

Recap: Lucy Letby trial, Thursday, December 1

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[Tortoise]

So they should outline their defence in the opening statements and they can't call surprise witnesses or surprise evidence. But the witnesses they call may say something not outlined the defence statement, however it would not look good if they did so and could cause issues. Have I got that right?

I don't think they are going to be producing 'evidence' of their own and I do think not cross examining yesterday was a weird move if they do intend to do so.

That clause is about the prosecution having the opportunity to interview defence witnesses before trial, and the defence only needing to provide the prosecution with the names/addresses of their witnesses, not what evidence or statements they've provided to the defence.

 

[LadyEdgeworth]

That clause is about the prosecution having the opportunity to interview defence witnesses before trial, and the defence only needing to provide the prosecution with the names/addresses of their witnesses, not what evidence or statements they've provided to the defence.

Understood. So if the defence did call a witness, the prosecution would already know exactly what evidence they would be presenting to the court and presumably would know what/how to cross examine them before they even open their mouths.

Wonder why the defence doesn't seem to have done the same and has let some prosecution witnesses go unchallenged, unless there literally is nothing to dispute, which is probably the impression the jury get

 

[LadyEdgeworth]

12:24pm

Dr Ravi Jayaram's clinical note at 3.30pm - 'spoke with consultant neonatalogist at Arrowe. Agrees current managemnt plan.'
Child G's observations are noted, with 'cool hands and feet', 'abdomen - distended but soft'.
The blood gases had raised metabolic acidosis.

Recap: Lucy Letby trial, Thursday, December 1

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[Tortoise]

Understood. So if the defence did call a witness, the prosecution would already know exactly what evidence they would be presenting to the court and presumably would know what/how to cross examine them before they even open their mouths.

Wonder why the defence doesn't seem to have done the same and has let some prosecution witnesses go unchallenged, unless there literally is nothing to dispute, which is probably the impression the jury get

Yes, it must be evidence that isn't in dispute. They can hardly say they dispute it in closing arguments if they didn't say anything to the witness at the time they were on the stand about why they were either lying, mistaken, not knowledgeable, or wrong.

 

[LadyEdgeworth]

12:36pm

A doctor's note at 4.30pm says Child G required a 2nd longline, and Child G 'remained unwell'.

12:46pm

The day-shift designated nurse's notes, at 8.13pm, include 'during [morning] handover required x2 eposdes of neopuff. Ventilation increased...
'BP deteriorated and cannula site became white. Moved to another cannula. BP again imrpoved. Drs trying to otain longline for better access...
'Chest clear and [blood gases] continue to be metabolic acidosis...
'Minimal urine output all day.'
The family communication says, for 8.51pm: 'Parents on unit throughout day and updated. Aware that BP is too low and IV access difficult. Understandable very upset and struggling to see her this poorly again.
'Have looked at 100-day cake, are trying to remain positive at this time...'

12:49pm

Medication for Child G continues into the night of September 7.
A consultant paediatrician said at 9.45pm, '[Arrowe Park Hospital consultant says] they are happy to accept [Child G there] - he will discuss with transport team.'
The call to the Arrowe Park transport team is made at 10.08pm.

12:56pm

The ambulance is booked at 10.43pm.
At 11pm, further observations are made for Child G.
Nurse Belinda Simcock records, at 11.35pm, a series of observations for child G, which include longlines, morphine administered and antibiotics.
The note adds 'infant to be transferred to Arrowe awaiting transport team'.

1:00pm

The transfer team arrived at the Countess of Chester Hospital at midnight.
A consultant paediatrician's clinical notes record Child G was still 'very sick', the court hears, despite the series of medications throughout the day.
More observations are made for Child G at 1am. At 1.05am on September 8, the transfer team noted Child G's abdomen was 'full and veiny'.

Recap: Lucy Letby trial, Thursday, December 1

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[Legal]

So this was another case where the designated nurse was not LL. Wild stab in the dark but if she's guilty, could it be a jealousy/competitive thing, where she was either jealous she wasn't responsible for the baby in question, or she wanted her babies to do better than the other nurses' babies? JMO

Reading this I'm wishing so so much they'd just kept baby G at Arrowe Park hospital. God knows what her parents are thinking/ feeling. I think she might be the one who survived but was permanently disabled

 

[LadyEdgeworth]

So this was another case where the designated nurse was not LL. Wild stab in the dark but if she's guilty, could it be a jealousy/competitive thing, where she was either jealous she wasn't responsible for the baby in question, or she wanted her babies to do better than the other nurses' babies? JMO

Reading this I'm wishing so so much they'd just kept baby G at Arrowe Park hospital. God knows what her parents are thinking/ feeling. I think she might be the one who survived but was permanently disabled

Yes sadly Child G suffered "irreversible brain damage". Just awful, especially as like you say when transferred to Arrowe Park they "recovered remarkably". Then when transferred back to Countess, LL was the designated nurse on the day shift when the damage happened.

 

[LadyEdgeworth]

1:42pm

During the course of September 7, a number of text messages were exchanged between Lucy Letby and her colleagues.
One conversation began at 1.33pm from Jennifer Jones-Key, who messaged Letby: "How you doing x"
Letby replied: "Had rubbish nights. x"
Jones-Key: "Yeah gathered. x"
Letby: "Thought someone would have told you x
"Nothing else to say really, just hope they are both ok"
Jones-Key: "Don't know ins and outs as tried to avoid it, needed a break. Found Thursday horrendous, not really slept since then. Hope you're ok"
Letby: "That is understandable, won't tell you anything."
The conversation then turned to Letby asking which of the team had informed Jennifer Jones-Key about the events of the night-shift for September 6-7. After a few guesses, the name 'Ali', in the messages, is said to be correct.
Jones-Key: "Ali. She not having a good time x"
Letby: "No, I know. It's been awful for her but she's coped with it brilliantly and got back-up when needed etc x"
Jones-Key: "Yeah I don't know how she's done it. She was fab on Thursday..."

1:48pm

The daytime designated nurse for Child G is in a text cnversation with Lucy Letby for much of the afternoon on September 7, the court is told.
Much of the conversation relates to the condition of Child G, although messages are also exchanged in which the designated nurse is 'venting' about a number of colleagues.
The nurse added Child G's parents were "devastated but determined...thought that if she got to 100 [days] they could feel confident she would be fine."

1:50pm

Letby responded that, at the start of that night shift, the team had been sat at a desk "preparing a banner [for Child G's 100-day milestone]."
The nurse responded: "Yep. [Colleague] brought her cake in."

Recap: Lucy Letby trial, Thursday, December 1

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[LadyEdgeworth]

1:55pm

Later in the afternoon, the nurse messaged Letby that Child G's condition was still very poor.
Letby responds: "any idea what's caused in [sic]?"
The nurse responds, at 6.06pm, "Nope. Just seems to be a circulation collapse. Chest sounds clear."
Letby: "Hmm, what can cause that.
"Is it that she is an extreme premature who had long-term inotrope and vent dependency and now she is older and doing more for herself...it just takes a little...something to tip her over."
The nurse responds: "We are going with sepsis..."
Child G was noted to be looking "grim".

2:00pm

Letby had seen Child G that night on September 7, messaging the nurse at 10.56pm to say the baby girl "looks awful, doesn't she".
The nurse responds: "Yeah, going to APH [Arrowe Park Hospital]. On triple antibiotics."
Letby relays a blood gas reading for Child G to the nurse.
The nurse responds: "So no better. Damn" adding: "I have a bad feeling."
Letby messaged: "But at least going to where she is known."
"Just hope they get her there."
The nurse replies: "Hmmmmm not sure they will."
Letby: "On today of all days."
Letby added Child G was "declining bit by bit".

Recap: Lucy Letby trial, Thursday, December 1

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[LadyEdgeworth]

".it just takes a little...something to tip her over."

grim.

 

[LadyEdgeworth]

2:17pm

The sequence of events contniues to be talked through.
Belinda Simcock records nursing notes for 1.30am and 1.40am on September 8, written in retrospect at 5.19am.
The 1.40am note reads - 'Suctioned-nil from ETT, moderate amount thick white secretions obtained orally.'
An increase in the dose of adrenaline is made for Child G.
The transport team handover is formally made at 2.35am.
Child G leaves the Countess of Chester Hospital in an ambulance at 3am, to be transferred to Arrowe Park Hospital.
Belinda Simcock's note records that the parents were kept informed of the developments.
Alisa Simpson later messages Lucy Letby to say: "Hi Lucy. Just to let you know that [Child G] has successfully been transferred out at 3am athis morning to APH. She is stable and latest CBG [capilliary blood gas] has improved! Fingers crossed for her!"
Letby responds: "That is good news. Thanks for letting me know"
Child G was then treated at Arrowe Park Hospital between September 8 and September 16, 2015, before returning to the Countess of Chester Hospital.

2:22pm

The court is now shown a chart illustrating the neonatal unit's staff duties and who recorded/administrated what for September 6-7, 2015.
At a point between 2am and 3.30am, a different nurse takes over the care for what had been Lucy Letby's designated baby for that night shift.

2:27pm

The final chart shows Child G was moved from nursery room 2 to room 1 at 3.15am. One other baby was moved from room 1 to room 2 at 3.30am.

Recap: Lucy Letby trial, Thursday, December 1

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[LadyEdgeworth]

2:31pm

Philip Astbury is now reading the relevant parts of Child G's parents. The court hears this agreed evidence, and is not contested.
The first statement is Child G's mother.
"Things went ok" with the pregnancy until week 22, when she started bleeding. She was taken to hospital for checks.
At week 23, she was taken to Arrowe Park, as her waters had broken and she was having stomach aches.
She said she was struggling to sleep and went to the bathroom - she then gave birth to Child G.
She said she rang for the emergency, but it wasn't working. Someone in the next door heard, and went for help.
She said to medical staff: "Save [Child G]."
"She was only 1lb 2oz, a tiny little fighter.
"During our time at Arrowe Park, she showed doctors she was a fighter. She made good progress."
After a change of several cots, and at seven weeks, Child G was moved to the high-dependency unit and available for skin-to-skin contact.
By 12 weeks old - she was 'so well' she could go to Chester.

Recap: Lucy Letby trial, Thursday, December 1

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[Sundial]

This I find interesting;

“The conversation then turned to Letby asking which of the team had informed Jennifer Jones-Key about the events of the night-shift for September 6-7. After a few guesses, the name 'Ali', in the messages, is said to be correct.
Jones-Key: "Ali. She not having a good time x"
Letby: "No, I know. It's been awful for her but she's coped with it brilliantly and got back-up when needed etc x"
Jones-Key: "Yeah I don't know how she's done it. She was fab on Thursday..."

Also the “venting” of colleagues by another nurse, starting to get a bit of a feel of the unit amongst them here. The part also highlighted in bold actually makes me wonder “what” was going on with this other nurse.. childcare, loss of own child, time off etc, why is she “not having a good time, been awful, coped with “it” brilliantly” JMO

 

[LadyEdgeworth]

2:53pm

Child G turned 100 days old and Lucy Letby was looking after her that day.
"When we got to the hospital, she was in intensive care...it was such a shock and it looked like she was going to die."
Child G was taken back to Arrowe Park for nine days, before returning to Chester in the HDU.
Child G got sick again, and had to return to the intensive care unit.
She "looked different" - and after brain scans, it was said she would just be 'a little clumsy'.

3:00pm

The mum adds she had gone to get a coffee and when she went back to the high-dependency unit, Child G was "freaking out". Lucy Letby was there with another nurse.
She said she told them she wanted to hold Child G as that would calm her down, and did so.
Child G went to the intensive treatment unit that day.
There were three times, she aid, Child G was transferred to the ITU.
She said she would always ring the hospital twice a day - once at 6am and one at 7-8pm; the latter to find out who would be looking after the baby girl that night.
During the day, she would stay with Child G at the hospital.
When Child G came home in November 2015, at 156 days old, she had been left with quadraplegic cerebral palsy and was visually impaired, and was being fed by stomach, and nil by mouth.

Recap: Lucy Letby trial, Thursday, December 1

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk