PART ONE: Cross Exam of Letby concerning Baby E
Mr Johnson KC asks about the case of Child E.
Letby says: "Possibly yes" to the question if there was medical incompetence that led to Child E's death, in that the night shift team "could have reacted sooner" to the child's bleed.
She says once Child E was bleeding at 10pm, a transfusion could have been made sooner.
She says the "collective team" were responsible.
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
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Letby says it was "an important thing to know" that plumbing issues were a potential contributory factor to the decline of babies' health in the unit.
She said "raw sewage" would come out of the sinks in nursery room 1, as flowback from another unit.
Mr Johnson asks if Letby ever filled in a Datix form for that. Letby says she did not.
Mr Johnson says Letby did fill in a Datix form for Child E.
The form is shown to the court. It is dated August 4, 2015, at 5.53am, which is when the form was signed and filed.
It is classed as a 'clinical incident'.
The risk grading was 'high potential harm'. Letby says she is "not sure about that", as it also says 'Actual harm: None (No harm caused).
It refers to the death of Child E at 1.40am. 'Description: Unexpected death following GI bleed. Full resus unsuccessful. Time of death 01:40.'
The baby's history is recorded in the events leading up to his death. It was filled in by the incident review group panel.
Letby's input on the panel is reporting the incident on the first page of the nine-page report.
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Letby is asked why she, and not Child E's designated nurse Melanie Taylor, signed a correction to a prescription for Child E. Letby says it's standard practice for two nurses to administer prescriptions, and corrections on the form are not based on seniority. She agrees she was keen to raise issues if they needed correcting.
NJ: "Had you fallen out with Melanie Taylor by this stage?"
LL: "No."
Letby denies she had fallen out with anyone.
She agrees she had confidence in her clinical competencies.
NJ: "Do you agree you were a cut above some other nurses, including Mel?"
LL: "No."
A nursing note for Child E from the evening of August 3, 2015 is shown. Letby agrees he was progressing well, although he needed insulin.
Letby agrees Child E at this stage showed no sign of gastro-intenstinal problems.
A rota is shown to the court, showing Letby was the desingated nurse for Child E and Child F in room 1. No other babies/nurses were allocated in that room that night.
Letby is asked if there was anything wrong with this arrangement. Letby: "No."
Mr Johnson says when Letby was giving evidence to Mr Myers, she said when the mother arrived at the unit, she was "bringing milk". Letby says she does not recall from her memory. Mr Johnson says that was what she said on May 5.
Letby: "I can't recall right here right now."
Letby says she cannot remember it specifically, but accepted that version of events. "I don't have any clear memory."
Mr Johnson refers to the transcript from that day, in which Letby told Benjamin Myers KC she believed Child E's mother had arrived at the unit bringing expressed breast milk.
Letby says: "I said 'I think' she brought expressed breast milk." She says it's the same thing.
Mr Johnson asks about the significance of 9pm that night. Letby says: "I don't know what you mean."
Mr Johnson says it's the mother's evidence that she knew Child E was due a feed at 9pm, so came down to the unit for that feed.
Mr Johnson says Letby's recollection that Child E's mother brought milk with her fixes the time as being 9pm.
Letby: "I don't agree."
Mr Johnson asks about the 16ml 'mucky aspirate', which Letby agrees was taken before 9pm.
Mr Johnson asks where the milk for the 9pm feed was coming from.
Letby says the milk would come from the milk fridge in nursery room 1. She says she does "not remember" where the milk would come from for this feed specifically.
No feed was recorded for 9pm.
Mr Johnson says the SHO did not record no feed for 9pm, having said in evidence that would be the sort of thing he would record for a baby.
Letby says sometimes doctors don't record such notes.
Letby is asked why the 'large vomit of fresh blood' is not recorded on the observation chart for 10pm. Letby says she recorded it in her nursing notes, and Dr David Harkness was present when it happened.
Letby is asked why she waited over an hour for the observation of the aspirate to be raised with the doctor.
LL: "I don't recall speaking to a doctor", but Letby recalls speaking to an SHO on the phone about it.
Letby says there was no observation of blood prior to 10pm.
NJ: "Was [Child E's mother] telling the truth about you?"
LL: "In what sense?"
NJ: "In the sense of what you said to her - when she says she came down to see her boys, she saw [Child E] with blood around his lips."
Child E's mother's illustration of what she says was present on Child E's lips is shown to the court.
NJ: "Did you ever see anything like that?"
LL: "[Child E] did have blood like that - after 2200."
Letby adds "there was no blood prior to that."
Letby accepts she was alone in room 1 when the mother came down. She says that would have been around the handover time at 8pm.
NJ: "You are not telling the truth about that, are you?"
LL: "Yes I am."
Letby says she does not accept causing an injury to harm Child E. She denies at any stage 'having a fall out' with Child E's mother.
Letby says she has never seen a baby with blood like that around her mouth in her career. She agrees it was "wholly exceptional".
She denies telling Child E's mother the cause of the bleed was via insertion of the naso-gastrinal tube. She says the insertion could cause "a small amount of blood" from the tube.
Letby is asked if she recalls telling police in the case of Child N that NG Tubes can cause bleeding. Letby says it does cause blood, but not in the mouth.
Mr Johnson says Letby has said that previously it can cause oral bleeding. Letby: "Ok."
She denies saying that happened in this case.
She says "medically speaking", "any baby" could have a bleed like the sort seen by Child E.
A text message from Letby to Jennifer Jones-Key is shown: "...He had massive haemhorrhage could have happened to any baby x"
Letby says "at the time" it was thought Child E could have NEC, and "any baby could have had the condition [Child E] had.
Letby is asked to look at her defence statement.
She says Child E's mother had come down with some expressed milk. The statement is dated February 2021.
Letby, in her statement, said "This may have been later than 2100".
Mr Johnson says Letby is now ruling out a time before 2200.
Letby says she cannot say it definitively, but there was no blood prior to 2200.
Letby is asked why she did not mention the vomit when blood went down the NG Tube in her defence statement.
Mr Johnson says Letby is lying by adding additional detail afterwards. Letby denies this.
Mr Johnson asks about the 'mucky aspirate' for Child E, asking if that is 16ml of 'bile', as per Letby's defence statement. Letby says there was bile in the mucky aspirate.
Mr Johnson says there is a difference between 'bile-stained' and 'bile'. Letby accepts 'there was 16ml of bile' in her defence statement is "an error".
She is asked why she put that in, in those terms.
LL: "I don't know."
Letby says this is a clarification of her earlier statement.
NJ: "You are lying, aren't you?"
LL: "No."
