Preliminary Timeline for Baby H. (babies G & I included for proximity)
21 Sep 2015, Mon
8am – LL’s day shift – designated baby G
2 x allegations of attempted murder of Baby G, at 10.15am and 3.30pm
LL searched baby G’s parents on Facebook. A few minutes later LL looked at the Facebook of the mother of E&F and another mother of a baby listed in the charges.
22 Sep 2015, Tue
Baby H, a girl, was born at 34 weeks, weighing 5lb 2oz.
6.40pm – H was admitted to the Neonatal Unit, Room 1. She had breathing difficulties shortly after birth. Independent experts say there was an "unacceptable delay" intubating her and administering a protein which helps the lungs, which the prosecution say means the case is complicated by "sub-optimal treatment" at the hospital. Additionally, H "was put on a ventilator, she was not paralysed; she was also left with butterfly needles in her chest for prolonged periods which may have punctured her lung tissues and contributed to further punctured lungs." (Opening Speech)
23 Sep 2015, Wed
LL texts a colleague she's rearranging her shifts, and will be working with her.
LL also texts her mother she's working that night as an extra shift.
LL messages another colleague to say how busy the unit is likely to be that night.
8pm – LL’s nightshift 23rd/24th.
H deteriorated on the night of September 23 and required ventilator support and intubation, followed later by oxygen support. H responded to intervening treatment, but desaturations were "frequent" and "significant". Mr Johnson said all but two events could be explained medically and responded to with routine resuscitative measures. The two events - in the early hours of September 26 and 27, were "uncharacteristic" and required CPR. (Opening Speech)
24 Sep 2015, Thu
Early morning - Dr Alison Ventress testifies she will always remember Child H as she was the first baby she performed a pneumothorax aspiration on (needle in the chest to remove air). Child H had poor blood gas and had a profound desaturation down to 'the 50%s and needed bagging with neopuff'. H slowly recovered and was placed on Bipap (a small machine that pushes air through a mask and into child's airway and lungs). Child H's breathing 'remained gasping pattern'. Dr Ventress says this is 'more serious than grunting' and agrees that it was 'indicative of a serious respiratory problem'
8am – end of LL’s nightshift 23rd/24th.
LL messaged a colleague: "It's completely unsafe ☹ "
LL messaged a friend: “I won’t be able to make it to hula hoop – work mad so doing extra nights x”
LL messaged colleague Sophie Ellis: “Oh Soph it was pretty bad – 18 babies, intubating on handover & baby with sugar of 0.1! On again tonight tomorrow & Sat. Not had chance to see Corrie, was it good? Xx”
8pm – LL’s nightshift 24th/25th –
LL designated nurse for H.
25 Sep 2015, Fri
1.14am - Notes from the early hours show another desaturation. At 1:14am Dr Ventress was 'bleeped urgently' as Child H had 'poor chest movement and poor colour'. She was placed on neopuff. She noted that Child H's chest drain, which had been fitted as she had a collapsed lung, was 'no longer functioning, blood-stained fluid leaking from drain'. Dr Ventress says that is 'not uncommon' with chest drains. She says fluid was not indicative of any infection.
1.25am – Dr Ventress’s notes show that at 1.25am Child H had another profound desaturation. Oxygen levels down to 30%. Dr Ventress performed an emergency pneumothorax aspiration, 70ml of air was aspirated – “quite a lot for a baby that size”.
1.40am – X-ray taken.
1.45am – Dr Ventress - Child H's sats improved after the procedure, but there was a further desaturation at 1.45am. Second aspiration was then needed and another butterfly needle inserted into lower chest, this again worked and drained a further 60mls of air - again sats improved.
2.29am – X-ray taken. H diagnosed with punctured left lung. Dr Ravi Jayaram records a desaturation for H and a test was carried out for a collapsed lung.
3am - Dr Alison Ventress – H’s sats remained in the stable range until 3am when she had another profound desaturation, her blood oxygen fell to 26%. 85mls of air aspirated and her sats again improved. A plan was drawn up to insert a further chest drain.
3.07am –
LL texted a colleague: "Can I go now??"
Colleague: "Yes. Let's run off together and rescue [colleague] too."
5am – LL’s nursing note recorded the "profound desaturation", with the fingers on the right hand noted to be white, along with a white patch on the abdomen.
8am – end of LL’s nightshift 24th/25th
Time? –
LL messaged colleague Ailsa Simpson: “Sorry didn’t reply last night – you’ve certainly picked right week to be on hols! Haha. …Hope you are lucky with Glastonbury. I got tickets for Ellie at Echo xx”
Afternoon - The intelligence analyst talks through descriptions of the care being given to H throughout the day on September 25, which includes another desaturation in the afternoon.
4.23pm - The cardiac arrest team is beeped at 4.23pm to attend the neonatal unit. (electronic evidence)
8pm – LL’s nightshift 25th/26th – designated baby H, room 1. No other babies are in room 1. four babies (including G) in room 2, four in room 3 and four in room 4.
Starting about 9.50pm – H had ‘several episodes of desaturation’ according to Dr Ventress’s clinical note at 11.50pm.
11.05pm - A blood transfusion for H begins at 11.05pm.
11.30pm – LL’s nursing note written retrospectively at 4.14am records a desaturation for H. Observations are being taken more regularly due to the blood transfusion.
11.50pm – Dr Ventress records at 23.50 that there had been 'several episodes of desaturation in the previous two hours'.
26 Sep 2015, Sat
Around 1am – Dr Ventress - Child H's ventilation had to be increased, Dr V again suspected a pneumothorax. She called a consultant for further advice.
1.30am – LL administered a morphine bolus to H at 1.30am.
2am - the blood transfusion is recorded by LL as being completed at 2am.
2.15am - Consultant Dr John Gibbs records chest x-ray showed a re-accumulation of H's left-sided pneumothorax (a collapsed lung). A further, third chest drain was inserted to relieve the pressure.
2.50am - LL administered a dose of saline, to run for 20 mins. (Opening Speech)
3.05am - a separate, handwritten paper record shows the blood transfusion having been completed at 3.05am. This separate record is not signed by anyone.
Time? 3.05am? - LL records: 'poor blood gas and 100% oxygen requirement' and a third chest drain was inserted.
3.22am – LL’s nursing note: 'profound desaturation and colour loss to 30%, good chest movement and air entry, colour change on CO2 detector, neopuff commenced in 100% oxygen and help requested. Serous fluid +++ from all 3 drains, became bradycardic. Drs crash called and resus commenced as documented'.
1st attempted murder charge. (Attending doctor concluded the episode was due to hypoxia (shortage of oxygen) - opening speech)
3.24am - An intensive care chart for H, initialled by LL, records:
'blood complete 0324 - RESUS'. Dr Alison Ventress confirms in a clinical record she was crash called at 3.24am as H "had desat requiring bagging...Sats 60s then heart rate down to less than 100 so nurses crash called,
wasn't being handled at all, no trigger identified.'
Upon her arrival, H was 'being bagged via ETT, good chest movement, capnograph positive, sats 60%, heart rate 70 down to 50 [beats per minute]'. A test for a collapsed lung was carried out and air was removed. Dr Ventress testifies that while desaturations are not uncommon with babies experiencing these sorts of [lung] problems, arrests are not common.
3.26am - Dr Ventress testimony - CPR was commenced at 03.26 and three doses of adrenaline were administered between 03.30 and 03.39.
3.30am – Consultant Dr John Gibbs was called from home.
3.36am – Consultant Dr John Gibbs arrived at the neonatal unit. He saw 'CPR in progress', and H had no pulse when chest compressions stopped. Medications were administered to H.
3.46am - LL's nursing note records, for 3.46am: 'x3 doses adrenaline and x1 dose atropine given...chest compressions stopped at 0346, heart rate 180, saturations >90, placed back on to a ventilator, 30% oxygen'. Dr Ventress testimony - At 03.46 chest compressions were stopped as Child H's heart rate had improved and her colour started improving - treatment was successful.
Early hours – mother describes being woken and told to go to the unit right away. She found them resuscitating baby H.
4.14am – LL wrote up her retrospective note for the 11.30pm desaturation.
4.28am - LL records a family communication: 'Parents visiting at start of shift. Updated on condition and advised to try and rest overnight. Midwife contacted during resus to [help take mum to the unit].'
5.21am – LL noted a conversation between herself, the attending doctor and H’s parents. Parents were concerned about the possibility of brain damage, and H remained poorly and could relapse.
Consultant Dr John Gibbs offered a blessing to be administered and the parents accepted the offer. H was then blessed with parents and family members present.
7am - LL recorded 'good blood gas at 0700 - ventilation reduced to 22/4, and rate reduced...in 26% oxygen. [H] appears settled.'
8am – end of LL’s night shift 25th/26th
Just before 9am –
Deputy manager Yvonne Griffiths messaged LL: Hope you have a good sleep. I just want to commend you for all your hard work these last few nights. You composed yourself very well during a stressful situation. It’s nice to see your confidence grow as you advance through your career.”
LL showed this message to a colleague and asked her how she should reply. Her colleague expressed surprise. The conversation alluded to a disagreement among the neonatal unit staff regarding a Christening for one of the babies in the unit.
LL to YG: “Thank you. That’s really nice to hear as I gather you are aware of some of the not so positive comments that have been made recently regarding my role which I have found quite upsetting. Our job is a pleasure to do and just hope I do the best for the babies and their family. Thank you to you & [another colleague] for your support x.”
LL to colleague: “I’m still frustrated/upset with what’s gone on but don’t think such rubbish nights & being tired help.”
Colleague: “Good reply as it’s important they know about the bitchiness which is all it is. Yes re tired Anyway you’re a star. You’ve done yourself proud. You’ve given positive memories to the family whatever the outcome. Let’s hope they can tease her in a few yrs about her ‘attention seeking’ ways. Sleep well. xx Always a pleasure to work with you even if we’re a ‘[s***] magnet’ team.”
Day - Medical notes record H's parents were present as treatment continued for the baby girl, with further medication administered during the day of September 26.
8pm – LL’s night shift 26th/27th –
Shelley Tomlins was the designated nurse for H in room 1 - the only baby in that room that night.
LL was the designated nurse for two babies in room two, with another nurse, Christopher Booth, looking after G in room 2. Four babies, including baby I, were being looked after in room 3, and four babies were being looked after in room 4.
8.49pm - There is a profound desaturation for H, with a crash call made at 8.49pm. Dr Matthew Neame recorded attending the neonatal unit.
9.31pm –
LL, on shift, messaged a colleague to give an update on H's progress throughout the day.
LL messaged Dr Alison Ventress a couple of moments later: [H] had a stable day, and took out the original drain at 8pm, 'just blocked tube, lots of secretions!'.
LL messaged her colleague: “I've been helping Shelley [Tomlins, designated nurse for H that night] so least still involved but haven't got the responsibility”.
Dr Alison Ventress to LL: "Never known a baby block tubes so often!! Glad she's had a stable day..."
Just before 11pm –
LL texts a colleague: “I forgot to record strictly tonight x BBC iPlayer doesn’t work on my iPad.”
11pm – H’s mother says she and the father left the unit at about 11pm to go to sleep in a room nearby, but they later received a knock at the door with an almost identical scene as the previous night.
27 Sep 2015, Sun
12.45-12.46am - LL is recorded as being on Facebook at 12.45am and 12.46am, liking a post and photo.
12.55am - H has a 'profound desaturation' timed at 12.55am. Nurse Shelley Tomlins recorded: 'profound desaturation to 40% despite equal bilateral entry and positive capnography'. Staff were crash called to the neonatal unit room 1. [LL’s signatures on medicine administrations, per opening speech]
1.07am - Dr Matthew Neame reintubated H and chest compressions were started at 1.07am. H's heart rate dropped to 40bpm. Adrenaline was administered.
1.13am - Chest compressions were discontinued at 1.13am. A request was made to transfer H to Arrowe Park Hospital. "No explanation" could be found for why H had had such a profound desaturation.
3.30am - H had a further desaturation at 3.30am, and medication was administered. [LL was treating & gave the history to the attending doctor despite not being H’s designated nurse. Pink-tinged secretions around mouth - Opening Speech].
2nd attempted murder charge.
4.10am - The transport team arrived at 4.10am
4.45am - H was handed to the transport incubator at 4.45am and the handover was completed at 5.20am.
6.10am - H was cared for at Arrowe Park Hospital, returning to CoCH on Sep 30th.
8am – end of LL’s nightshift 26th/27th.
Just after 11am –
LL messaged Dr Alison Ventress on Facebook, and another colleague, what had happened to H that night.
2nd colleague: “There’s something odd with [H]”
LL: “Hopefully she’ll sort herself out.”
LL to Dr AV: “[H] had resus again but not as bad/long-lasting as with us. Went to Arrowe.”
Dr.AV: “Oh crap. Do they know why she did it this time? I’m glad she’s been transferred! How are you? Really rough set of nights for you. Xx”
LL: “No did exactly what she did for us, desat then didn’t pick up & dropped heartrate. Looked fine again after though but made decision to transfer which I think was sensible! X”
LL to 2nd colleague: “None of us had breaks what with [H], transfer and then this. It’s all just so rubbish lately isn’t it. And always seems to happen at night when less people. I think everyone is pretty burnt out and unit been awful. Yvonne working way more than she should.”
LL & 2nd colleague then discuss about looking “at a change of unit”.
LL: “I still think about the women’s, if only it were closer, would make decision much easier.”
1.11pm –
DrAV: "Try to think of all the babies you’ve saved and have gone home happily with their parents. You’re a fab nurse. Hope you manage some sleep xx”
LL: “Thanks Ali Xx”
30 Sep 2015, Wed
8am –
LL working long day-shift – designated nurse for baby I in room 3.
12.15pm - H returned to the CoCH.
Afternoon – 1st alleged attempted murder of baby I.
8pm –
End of LL’s day-shift
5 Oct 2015, Mon
1.15-1.18am - LL searched on Facebook for the mother of H, as well as the parents of E&F, and I, in the space of three minutes.
9 Oct 2015, Fri
5.05pm - H was discharged
--
Source for additional text info
Hereford nurse murder trial: baby ‘improved dramatically’ after hospital move
Lucy Letby: Nurse 'commended' for work during 'stressful situation'
www.chesterstandard.co.uk
www.itv.com
www.dailymail.co.uk
