Count 22: Attempted murder of Baby Q on 25 June 2016. Alleged mechanism: Air/Fluid injected into NGT (NO VERDICT)
Mr Myers is now on Child Q - the last child on this indictment. He was born in late June 2016 and was "initially stable" after his birth, but jurors heard he deteriorated and needed breathing support shortly after 09:00 on 25 June. The prosecution said Ms Letby injected air and fluid into the boy's stomach via a nasogastric tube. A medical expert for the prosecution said vomit found on Child Q was evidence that liquid had been given to him and his respiratory problems were likely caused by the fluid
Mr Myers says there's 'no evidence of her having done anything at all' to cause Child Q's collapse Mr Myers says the clinical evidence is 'consistent with early stage Necrotising enterocolitis (NEC)' - this is a serious condition that can affect newborn babies Mr Myers says 'what an earth is (Ms Letby) meant to have done, there's no evidence of an attack'
Intelligence analyst Kate Tyndall is now talking the court through what is likely to be the prosecution's final sequence of events, this being the case of Child Q.
22nd June 2016
4.09am: Child Q was born at 4.09am on June 22, 2016, in initially poor condition, appearing
'blue, occasional gasp, poor tone'. Inflation breaths were given and oxygen support at 80%
O2 was administered. The 'Apgar scores', indicating a newborn baby's condition out of 10,
are '4' at one minute, '7' at five minutes and '9' at 10 minutes. Registered nurse Amy
Davies said child Q cried at delivery, was stabilised and transferred to the neonatal unit,
intubated and given antibiotics.
8.30am: The sequence says Child Q was treated at the neonatal unit between 8.30am on June 22 to 7.40am on June 24. On June 23, at 5.47pm, Child O died and at 6pm, Child P had an event where his abdomen was distended.
24th June 2016
The day shift of June 24 is when Child P - triplet brother of Child O
- died, prosecutor Nicholas Johnson KC reminds the court. Child P had a collapse at 9.30am
on June 24.
The sequence records a series of observations taken for Child Q throughout the day. Child P's time of death is 4pm on June 24.
9.06pm: Nursing notes for Child Q, written by Amanda MacKenzie, record at 9.06pm: 'Thought to have a few bradycardias in a cluster this morning but seemed to be a loose ECG lead when checked - none noted following changing the lead. Nystatin not given - very heavy workload on unit'.
11pm: The medication for nystatin is prescribed at 11pm.
11.49pm: A Facebook message
sent from a doctor [Dr A] to Lucy Letby at 11.49pm: 'Did you talk to Belinda about allocation for
tomorrow?'
Letby: 'Yes, she's going to try and give me a lighter workload...' Letby adds this will
be difficult given there are only five on the staff rota.
Child Q was noted as having small levels of bile in his aspirates from the fluid chart, but these were not enough to stop him being fed as normal.
25th June 2016
5.20am: Nurse Samantha
O'Brien recorded, within her nursing notes at 5.20am on June 25: 'Having trophic feeds of
donor expressed breast milk, 0.5mls 2 hourly due to moderate aspirates. Abdomen is full but
soft.' No respiratory distress was observed.
6.36am: Letby messages a nursing colleague at 6.36am enquiring about the night shift. The reply begins 'OK', before giving details of what was done that night and babies in the unit.
7.30am: Nurse Samantha O'Brien records at 7.30am a blood gas test result was 'not as good' as the one previously, but still 'acceptable'.
The day shift handover takes place at 7.30am. Lucy Letby is a designated nurse for Child Q, in room 2, and a baby in room 1. Three babies are in room 1, two in room 2, three in nursery 3 and four in room 4. One nurse is looking after two babies in room 1, one nurse is looking after four babies in rooms 2-4, and another nurse is looking after four babies in rooms 3-4.
An observation chart is shown for Child Q for June 24-25. The heart rate and breathing rate are shown as being in the normal range up until 9am, when Child Q collapsed. Both then increase to an area out of the normal range at the time of the collapse. Child Q had been 'in air' prior to the collapse.
9am: A fluid balance chart is shown for Child Q. The 9am reading is not initialled, and do not record a feed at that time. Child Q collapsed at 9.01am.
9.10am: A correction is being made to the sequence of events - the timing of Child Q's collapse should not read '09.01am'. The court had heard the time of the collapse has been noted as 9.10am.
An apnoea/brady/fit chart is shown to the court - the brady is '98', desat '68', fit '?', duration '3 minutes intermittently'. Baby found to be very mucousy, clear mucous from nasopharynx oropharynx, clear fluid+++ , O2 via Neopuff, given post-suctioning. Dr...emergency called to attend. 'NGT used to aspirate stomach by nurse Lucy Letby'.
9.10am: The prosecution say Child Q had been fed 1.5mls of milk from the night, and had been due to be fed at 9am. Lucy Letby, in a nursing note, records: '0910 ...Child Q had vomited clear fluid nasally and from mouth. Desaturation and brady, mottled++. Neopuff and suction applied. Air++ aspirated from NG Tube...' The doctor called to the unit records 'called to NNU @ 0917 desaturation Had just vomited and then desaturated to low 60s. Minor bradycardia. Bagged with Neopuff circuit...' Child Q was transferred from nursery room 2, the high dependency unit, to nursery room 1, the intensive treatment unit.
Medication is administered to Child Q during the morning. Child Q is x-rayed and the report notes: 'Respiratory deterioration now needing CPAP'. The x-ray records nothing unusual, the prosecution say.
12.53pm: Letby writes notes for child Q, written retrospectively at 12.53pm: 'Septic screen carried out....NG Tube on free drainage. -3mls milk/mucous aspirate. Abdomen soft and non-distended. Perfusion improved...intermittent episodes of tachypnoea...'
1pm: Letby records for family communication at 1pm: 'Parents visited shortly after [Child Q] had been screened and commenced on CPAP. Mum upset++ and dad has since stated mum upset that she was not contacted on postnatal ward about need for intervention.' Letby adds she explained the situation and apologies were given.
1.16pm: Letby messages a nursing colleague about the situation on the neonatal unit, adding: 'All going on lol' Letby also messages a doctor colleague between 12.18-1.16pm.
Further observations are made for Child Q during the afternoon. Letby notes: 'Observations stable, continues to have low respiratory rate with minimal effort at times. Appears plethoric++ this afternoon....Remains on free drainage...' For the family communication note, Letby notes: 'Midwife phoned on behalf of mum to express concern that staff had not contacted parents when [Child Q] needed CPAP. Explained reasons for this and encouraged mum to visit...' The parents visited the unit. Letby adds: 'Apologies were given for not updating them but...[treating Child Q] was priority at the time. Mum appears happier...'
6.40pm: Letby messages a nursing colleague via WhatsApp at 6.40pm 'Girls all rushing around outside', adding one of the nurses was 'stressing', and the situation was 'madness lol'. Further medication is administered to Child Q in the evening.
A deterioration is noted in Child Q which required his intubation. The notes are recorded by a doctor.
7.30pm: Letby notes before the shift handover at 7.30pm: 'Respiratory rate declining (15-19bpm) and intermittent pauses in breathing. Blood gas stable but on downward trend and [Child Q] appearing 'tired'. Oxygen requirement developing....decision made [following consultation with doctor] to electively intubate. Drugs given as prescribed...'
Care of Child Q was handed over to staff nurse Amy Davies.
A diagram shown at the end of the June 25, 2016 day shift shows there are three babies, including Child Q, in nursery 1, two in room 2, three in room 3 and four in room 4. Letby is the designated nurse for Child Q only at the end of the shift, with care of her other designated baby being transferred to another nurse.
8.31pm: A record of Facebook messages between Letby and a doctor colleague [Dr A] is recorded between 4.11pm and 8.31pm. Letby then adds: 'Wow, I think I might be almost finished' to the doctor.
She also
messages her mother.
Colleague Minna Lappalainen then messages: 'Thank you for being a good
friend today', adding a heart emoji.
Letby: 'Don't need to thank me Minna, I'm always here for you. Please don't feel you're
alone...'
Lappalainen: '...But really I'm really happy u were there for me....'
Letby: 'Take care, hope you sleep well, see you tomorrow'.
Sophie Ellis messages: 'Hope your feeling ok today'
Letby: 'Thanks Soph, another busy day today but ok today and off tomorrow....'
Ellis: 'I think you deserve more than a day off...'
Letby: '...It's been awful but we'll be ok'.
Nurse Amy Davies, in her nursing notes, records Child Q was '...unsettled at the beginning of the shift but has settled. Temperature is elevated, humidity and incubator temp altered accordingly. HR is elevated up to 208 at times. Dad has visited...' Observations are taken for Child Q.
10.48pm: Letby messages a doctor [Dr A] at 10.48pm:
'Do I need to be worried about
what Dr Gibbs was asking?'
Response: 'No. He was asking to make sure that normal procedures
were being carried out' What exactly did he ask?'
Letby replies Dr Gibbs had been asking
colleague Mary Griffiths who was present in the room (when Child Q had collapsed) and how
quickly someone had gone to him because Lucy Letby had not been there.
The response: 'All he
was doing was checking there was not a delay and that a room had been left empty...there is
nothing to worry about'.
The doctor adds: 'You can't be with two babies in different
nurseries at the same time, let alone predict when they're going to crash'.
Letby: 'I know, and I didn't leave them alone'.
The response: Nobody has accused you of
neglecting a baby or causing a deterioration'.
Letby responds she wonders if, following the
deaths of two babies, she is doing well enough.
The doctor replies he would be willing to
provide a statement to back Letby up in any event.
He adds: 'It's why I am so happy to work
with you. You don't flap, you give perfectly sensible suggestions... No more doubt - it's
not you, it's the babies.'
Letby adds: 'So relieved that it's you who has been there
throughout.'
[Dr A] replies: 'It's true. You are one of a few nurses across the
region...that I would trust with my own children...
Letby: Don't know what to say, thank you.
The doctor replies: 'Self-doubt finished?'
Letby: 'I think so, thank you ++'
Here is a fuller version of the text messages between Lucy Letby and
the [Dr A] from 10.47pm on Saturday, June 25, 2016. The doctor [Dr A], who cannot be named, is for
this purpose listed as 'R' for 'Response':
Letby: Do I need to be worried about what Dr Gibbs was asking?
R: No
R: He was asking to make sure that normal procedures were being carried out.
R: What exactly did he ask?
LL: I walked into equipment room, he was asking Mary who was present in room and how
quickly someone had gone to him as I wasn't in the room.
LL: He asked who was there, I said I had popped out of room but Mary was in room and
Minna at the desk.
R: All he was doing was checking that there wasn't a delay and that a room had been left
empty. Was he HDU level because of uvc? There is nothing to worry about.
LL: Ok. Was worried because I Wasn't with him at time, but Mary was in room and Minna
outside, I had [designated baby who was not Child Q] in 1. ITU because of uvc
R: You can't be with two babies in different nurseries at the same time, let alone
predict when they're going to crash......
LL: I know, and I didn't leave him on his own. They both knew I was leaving the room.
Feel better now
R: Nobody has accused you of neglecting a baby or causing a
deterioration.
LL: I know. Just worry i haven't done enough
R: How?
LL: We've lost 2 babies I Was caring for and now this happened today, makes you think
'am I missing something/good enough'
R: Lucy, if anyone knows how hard you've worked over the last three days it's me. The
standard of care delivered is tertiary nicu level. if *anybody* says anything to you about
not being good enough or performing adequately I want you to promise me that you'll give my
details to provide a statement. I don't care who it is and I don't care if I've left the
trust.
R: Promise?
LL: Well I sincerely hope I won't ever be needing a statement But thank you, I promise
R: And I don't either. You'll know that the coch nicu mortality rate is
a bit higher than the network average. It makes people (consultants) look at trends and
patterns. That may have been why DrG came to ask. As for the self-doubt - you asked me this
morning did I dream because I was worried about having missed something? No, and I don't
think you did either. In fact for [another baby] you knew he was unwell and flagged it up
immediately. I don't know the beginning of the [a separate baby] story because i arrived
after the bleep. You didn't miss anything that I would expect an experienced itu trained
nurse to spot. From a resus point out view you were flawless. It's why I am so happy to work
with you. You don't flap, you give perfectly sensible suggestions and things run seamlessly.
(You must be good Rackham said so (seldom praises)).
R: No more doubt - it's not you, it's the babies. I don't know what happened to [Child
O] and [Child P], and accept that the pm may not give any useful answers. I Do wonder if
they may have had adenovirus - it's terrible in neonates / perinates. [Child Q] is
different. His behaviour is more bacterial (tachy, temp, reduced uo) I wouldn't be surprised
if his bc comes back positive.
LL: Thanks, really appreciate you saying that.
LL: So relieved that it's you who has been there throughout.
R: It's true. You are one of a few nurses across the region...that I
would trust with my own children. If you're worried - I'm worried. You should do the APNP [sic - Advanced Neonatal Nurse Pracitioner?]
course, you'd be excellent.
LL: Don't know what to say Thank you
R: Self-doubt finished?
LL: I think so, thank you ++
The messages continue on a social/work nature until 1.36am, but have no further reference to Child Q.
26th June 2016
The sequence of events says the messages between Letby and the doctor [Dr A]
continue from 12.18am-1.36am on June 26, on topics not related to Child Q.
2am-6.23am: on June 26, nurse Amy Davies records for Child Q, improved blood gas readings through the night. From 0200-0600 [Child Q] was very settled, minimal handling carried out, HR reduced to 158-170....Gas repeated at 0623, poor result...Dr contacted [and reviewed]...'
Child Q was transferred to Alder Hey on June 26 and was treated there until June 28.
7.50am: On June 26, Letby is messaging a nursing colleague from 7.50am. The
nursing colleague was working at the time.
The nurse says Child Q was improving but then had
'crap gas' at 5am. She adds 'staffing is s***e isn't it'.
Letby: 'Bloody hell. It's not safe is it especially with what's gone on' I worry that we
have got a bug or virus on the unit'
The nursing colleague replies: 'Virus would explain a
lot'.
Letby messages the doctor colleague [Dr A]: 'Will you let me know how [Child
Q] gets on today please'
Of course I will' is the reply.
The messages continue throughout
the morning.
The doctor adds at 12.19pm: '[Child Q] has nec'
Letby: 'Ok that's good in a way to have a cause. Going to AHCH [Alder Hey Children's
Hospital]? Is he stable?'
Doctor: 'Ish. Ventilation was up and down overnight...'
Letby messages a nursing colleague to say Child Q was 'unwell with
NEC, going to picu'
The response: 'Oh no poor [Child Q]! Who's told you that?'
Letby responds that the doctor let her know.
The nurse later messages They think [Child Q] could be a volvulus apparently'
Letby responds: 'Oh no.'
27th June 2016
10.55am: [Dr A] messages Letby on June 27 at 10.55am - 'Not sure if the
unit is open for transfers. Few managers/directors around this morning'. The doctor adds
it's 'odd' Child M was only at Alder Hey for 14 hours as he was coming back to the Countess
of Chester Hospital. He says there is a lack of beds at Alder Hey, and it's disruptive for
the parents. Letby agrees.
28th June-25th July 2016
The final sequence of events concludes by noting Child Q was
looked after at the Countess of Chester Hospital between June 28 and July 25, 2016, when he
was discharged.
The jury is now being shown text/facebook messages from 26 June onwards between Ms Letby and colleagues (in relation to Child Q)
In messages to a colleague on 27 June, Ms Letby complains that the neonatal unit is 'way over capacity', she says the 'unit needs properly assessing, I don’t think equipment gets cleaned properly….we haven’t got space to maintain hygiene'
We've just been shown messages between Ms Letby and a colleague where she says she is 'worried' after being asked by a senior nurse not to come in for her night shift and that she would be on days from now on
She said to one colleague it was 'worrying in case they think I missed something or whatever'. She says the fact she had a call late on 27 June was 'messing with her head' and making her worry - in responses, two of her colleagues are reassuring her
Ms Letby tells a colleague that the call from a senior nurse telling her not to come in had sent her into a 'meltdown' and that she was 'completely overwhelmed' with worry
We've seen an extensive number of messages between Ms Letby and a doctor who cannot be named for legal reasons in early July 2016. We're currently being shown an email that the doctor forwarded to Ms Letby on 6 July - it was addressed to him from Dr Stephen Brearey
The court has previously heard that it was Dr Brearey who had first raised concerns that Ms Letby was working when a number of babies at the hospital had crashed
The email from Dr B to the doctor is asking him to set out details of some of the collapses of babies. The doctor tells Ms Letby 'this email has to stay between us'
Court now being shown an email, sent by a senior nurse, to all staff. It states that there would be an external review and that for a period members of staff would have to be placed under clinical supervision - starting with Ms Letby The nurse said that it was 'not meant to be a blame or competency issue but a way forward to ensure our practice is safe'
Ms Letby says, in a message to a colleague, that she has made a 'timeline' of all the events over the last year adding: 'If they have nothing or minimal on me they’ll look silly'
Lucy Letby was given a role in a hospital's risk and patient safety office after doctors raised concerns over her alleged involvement in baby deaths
Chester Standard article 06-04-2023
LUCY LETBY messaged a nursing colleague: "If they have nothing or minimal on me they'll look silly" during a Countess of Chester Hospital investigation into unexplained baby deaths.
The trial at Manchester Crown Court saw the latest collection of messages recovered from Letby's phone, revealing relevant messages between June and September 2016.
Letby denies murdering seven babies and attempting to murder 10 others between June 2015 and June 2016.
The messages displayed to the court were after Child Q – the 17th and final baby in the case, chronologically – had suffered a collapse which could not be explained at the time.
'I'm worried I'm in trouble'
On June 27, 2016, Letby messaged a doctor colleague at 5.41pm: "Eirian [Lloyd Powell, neonatal unit manager] has just phoned telling me not to come in tonight & do days instead. I asked if there was a problem & she said No, just trying to protect me a bit & we can have a chat about it tomorrow but now I'm worried."
Letby also messaged a nursing colleague at the same time: "E just phoned telling me to do days this week and not Go in tonight as trying to protect me. 😔"
Neither of the colleagues can be named.
After the nursing colleague asked: "What's that mean?", Letby replied: "I don't know. Asked if there was a problem and she said No just trying to protect me as had a difficult run just before holidays, less people on nights etc and we can have a chat etc tomorrow.
"But Im worried Im in trouble or something."
The nurse colleague replied: "Don't worry, how can you be in trouble you haven't done anything wrong.
"Just very unfortunate."
Letby: "I know but worrying in case they think i missed something or whatever. Why leave it til now to ring."
The nurse colleague replied: "It is very late I agree. Maybe she's getting pressure from elsewhere?"
Letby: "She said it's busy so more support for me on days and can look at the paperwork bits etc. She was nice enough I just worry. This job messes with your head"
Letby later messaged the doctor: "I can't do this job if it's going to be like this. My head is a mess. Why is she ringing at this time. There must be a problem."
The doctor replied: "Lucy - you did nothing wrong at all. It is an odd time to ring, but you've had a rough few days and a good manager would realise that."
'Meltdown'
After the doctor messaged with further reassurance, Letby responded: "I can't talk about this now. Sorry, I just need a bit of time.
"Sorry, that was rude. Felt completely overwhelmed & panicked for a minute. We all worked tirelessly & did everything possible, i don't see how anyone can question that. E has always been very supportive.
"Im having a meltdown++ but think that's what I need to do."
Letby worked long day shifts from June 28-30 at the neonatal unit – her last days there.
On July 6, the doctor messaged Letby: "You need to keep this to yourself. The meeting this afternoon looked at everything with Baby O & Baby P from birth onwards. [NB. Name of Baby O and P redacted]
"We reviewed everything. Room / meds / medical reviews and actions. We looked at all documentation med & nur. If you've any doubt about how good you are at your job - stop now.
"The documentation was perfect, everybody commented about the appropriateness of your request for a review of Baby O following vomit. (name of baby O redacted). Your documentation of the resus / incubation / drugs was faultless.
"There is absolutely nothing for you to worry about. Please don't.
"There are going to be some recommendations based on staffing / kit but there was no criticism of either resus.
"This is staying quiet until has been to exec's. We're looking at [third triplet] care on Thur.
"E had nothing but good things to say about you."
Letby replied: "Ok......I Really appreciate you telling me - it won't go any further. I was one member of a huge team effort, but you know I've been carrying the worry of the 'what if I wasn't enough' - it's reassuring to hear that it doesn't appear that anything could have been done differently, or that I didn't act on or do something I should have. Thank you."
Letby is sent an email, made by Countess Dr Stephen Brearey, advising that the deaths of Child O and Child P were likely to result in an inquest, as the cause of both deaths was 'unexplained'.
Letby asked: "It's a bit of a worry if it's going that far. Do you think I'll be involved?" Letby is reassured: "Probably not."
The doctor added: "I know you won't say anything - this email has to stay between us, is that ok?"
On July 15, 2016, neonatal manager Eirian Lloyd Powell messages nursing staff advising them in preparation for "the external review", "all members of staff need to undertake a period of clinical supervision", acknowledging there are "staffing issues".
Lucy Letby is recorded as agreeing to undergo the supervision commencing from July 18.
The email adds: "I appreciate that this process may be an added stress factor in an already emotive environment, but we need to ensure that we can assure a safe environment, in addition to safeguarding not only our babies but our staff.
"This is not meant to be a blame or competency issue – but a way forward to ensure that our practice is safe."
The same day, Letby messages her nursing colleague: "I've done a timeline of this year."
'I haven't done anything wrong'
The colleague responds: "Fab. And how quite afew babies weren't compatable with life anyway. I wonder if midwives get this with amount of stillbirths......"
Letby: "Yeah and some went off within hours/on handover.
"Or were already acutely unwell when I took over.
"And put that when Baby Q went off No other staff able to care for him etc (name of Baby Q redacted)."
The colleague responds: "Not like all behaving fantastically till right into shift."
Letby: "Hoping to get as much info together as possible -if they have nothing or minimal on me they'll look silly, not Me."
On July 19, Letby began work in the patient experience team.
On August 8, Letby messages the nursing colleague: "Tony phoned. He's going to speak to Karen and insist on the review being no later than 1st week of Sept but said he definitely wouldn't advise pushing to get back to unit until it's taken place. Asked about social things and he said it's up to me but would advise not speaking with anyone in case any of them are involved with the review process. Thinks I should keep head down.and ride it out and can take further once over.
"Feel a bit like Im being shoved in a corner and.forgotten about by.the trust. It's my life and career.
"He's not been.given any information about the evidence he asked for.which is good. He's not sure what the external people.are going to look at in relation to me but we are in the process now.so have to ride it out"
The colleague responds: "Ok well just have to take his advice then suppose 😞"
Letby: "Still can't believe this has happened. It's making me feel like I should hide away by saying not speak to anyone and going on for months etc - I haven't done anything wrong."
The colleague responds: "Me neither! I know it's all so ridiculous."
Letby: "I can't see where it will all end"
The colleague responds: "I'm sure this time after xmas it'll all b a distant memory."
After Letby received an email announcing she had been seconded to the Risk & Patient Safety office for three months, she messaged the nursing colleague again, saying: "Bloody hell fuming. Im in email and makes it sound like my choice."
The timeline records Letby met with a review panel on September 1. On September 7, she registered a grievance procedure.
The trial will resume shortly. Mr Myers will be asking Lucy Letby questions in the case of Child Q, the final of the 17 babies in the trial. Child Q, a baby boy, was born on June 22, 2016, weighing 2,076g.
Child Q was born at 31 weeks and 3 days gestation at the Countess of Chester Hospital. Mr Myers tells the court there was one event for Child Q on the morning of June 25, vomiting, desaturation, bradycardia, with "air++" aspirated from the NG Tube. A doctor gave a diagnosis of "probable NEC" the following day and Child Q was transferred to Alder Hey on June 27, returning to the Countess of Chester Hospital the following day.
A handover sheet for June 28, 2016 is shown to the court, in which Lucy Letby is designated nurse for three babies, not Child Q, that day, in room 3. Letby said she was "drained and emotionally exhausted" by June 25, following the events for Child O and Child P.
A day shift for June 25 is shown. Rebecca Morgan is on duty as a student nurse. Letby tells the court she was no longer the mentor as she had said she could not give her that time to do so, and so Ms Morgan was overseen by other nurses. Letby is the designated nurse for Child Q in room 2 and a baby in room 1. Letby tells the court: "You'd have to split yourself between the nurseries" when given designated care for two babies in two different nursery rooms.
Nursing notes for June 24-25: '...[Child Q] self ventilating in air...feet pink and warm. New lipid syringe put up overnight...having trophic feeds of donor ebm, 0.5mls 2 hourly due to moderate aspirates. Abdomen full but soft.' Letby says the 'trophic feeds' are to get a baby's digestive system going. The aspirates indicated Child Q was not ready to tolerate larger feeds yet.
A feeding chart for June 23 is shown to the court for Child Q. A '2ml milky' aspirate is recorded at 2030. At this point, the court hears, Child Q had received a total of 3.5ml of milk. Letby said "you would hope" the aspirates would be decreasing throughout this time. A 3ml aspirate is recorded at 3am on June 24. Letby says it "wouldn't be of great concern...but ideally we would want the aspirate [to be] the least possible".
At the time of the handover on the morning of June 25, Letby said she noticed from the observation chart he was "on the cold side" and she would want him reviewed by a doctor before the 9am feed. Letby said she was concerned about the temperature, Child Q was "on the borderline" of being too cold on the chart, and the incubator temperature was increased from 30.2C to 32C throughout the day. The temperature remained low which Letby said "was a concern". Letby said she should not feed Child Q until the doctors had reviewed him at 9am.
Letby said she was also caring for an intensive care baby in room 1. She said for cares to be given in room 1, she would have to ensure a nurse remained present in room 2. She informed two nurses when she said she needed to go to room 1. One nurse was sat at the nursing station and the doctors were starting their ward round at about 9am. Letby said she went to room 1 just after 9am. She does not recall how the room 1 baby was doing.
A neonatal schedule for June 25 is shown to the court. Letby is recorded as making observations at 9am for Child Q. Letby assists a nurse in room 1 for medication at 9.04am. Letby says she was in room 1 for "a few minutes" and could hear something going on outside the nursery. "I went out through the door and I could see down the corridor" Letby went to Child Q's cotside, where there were two nurses present. Letby heard from a colleague Child Q had vomited a 'mucusy vomit'. He had stopped and "recovered" by the time Letby arrived.
Letby's notes: '[0800]...observations as charted - temperature low, incubator increased x2. Tachycardiac. Active and alert...abdomen soft and non-distended. 0910 [Child Q] attended to by S/N Lappalainen - he had vomited clear fluid nasally and from mouth, desaturation and bradycardia, mottled++. Neopuff and suction applied. Reg attended. Air++ aspirated from NG Tube.'
Letby says all this was relayed to her, and not from her observation. Nurse Minna Lappalainen wrote: 'Baby found to be very mucousy, clear mucus from nasopharynx oropharynx removed. Clear fluid+++ O2 via Neopuff...Dr...emergency to attend...NGT used to aspirate stomach by nurse Lucy Letby.' Letby confirms the description of the type of fluid was the only one she heard. She did not administer the Neopuff breathing support. Letby confirms she continued to care for Child Q after he was transferred to room 1.
Mr Myers asks, in the context of the trial and every day at the
hospital, whether this had been a significant event.
Letby: "This wasn't a significant event - this is something we deal with on a routine
basis. Not that it's not important...he needed minimal intervention."
Mr Myers: "And in the course of the day, did [Child Q] have any further collapse?"
Letby: "No."
Lety's notes: '...respiratory rate declining...and intermittent pauses in breathing...blood gas stable but on downward trend and [Child Q] appearing 'tired'. Oxygen requirement developing. Discussed with consultant Gibbs and decision made to electively intubate...uneventful intubation...care handed over' Letby says, other than Child Q requiring CPAP, there were no other outstanding issues for him.
A nursing note by Lucy Letby for Child Q is shown for June 29 and June 30. Letby confirms she was Child Q's designated nurse for those days. She does not recall, outside of the notes, being the designated nurse for Child Q those days.
Messages are shown between Letby and a doctor [Dr A]: "Do I need to be
worried about what Dr Gibbs was asking?" Letby said she had become aware during the shift
on who was present in the nursery when Child Q had his episode. She said she was worried
she would be blamed for leaving him alone in the nursery. Letby messaged: "I walked into
equipment room, he was asking Mary who was present in room and how quickly someone had
gone to him as I wasn't in the room. "He asked who was there, I said I had popped out of
room but Mary was in room and Minna at the desk."
The reply: "All he was doing was checking that there wasn't a delay and that a room
had been left empty. Was he HDU level because of uvc? There is nothing to worry about."
Letby: "Ok. Was worried because I Wasn't with him at time, but Mary was in room and
Minna outside, I had B in 1. ITU because of uvc"
Letby tells the court Child Q had not been left unattended, but felt she may have been accused of leaving him unattended, and/or that she should not have left room 2. Letby did not work on the unit after June 30, 2016.
Letby says for the annual leave on July 4-6, 2016, she was on a family holiday. She recalls, the day before she was due to go back to work, she received the news she was going to a meeting with Eirian Powell. She would not be going back to the unit 'for the time being', the court hears.
Further messages between Letby and the doctor [Dr A]
are shown to the court: "Did you manage some sleep? Back on nnu....They want to send
[Child Q] back as a medical NEC. Not sure if the unit is open for transfers. Few managers
/ medical director around this morning."
Letby: "Yes got some sleep , did you? Good news about both. Hope they don't rush
[Child Q] back…"
Letby tells the court other babies had been brought back to the Countess
too soon, including Child I and Child G.
The doctor: "Got about 3 hours, coffee is good!
It was odd - he's only been there for 14 hours, I think this is a sign of how AH it's
going to be. They are so short of beds that they can only accommodate emergency patients.
It's not good holistic care, and it's rubbish for his parents."
Letby says 'they' refers
to Alder Hey, and Child Q was 'no longer an emergency baby', so was sent back.
Letby's
messages between herself and a nursing colleague are shown, for June 27:
Letby: 'I reckon there's going to big meetings etc about what's gone on with unit
being closed, lack of staff etc'.
Letby tells the court the unit being 'closed' was closed to new arrivals. Letby had messaged: 'were way over capacity, and its skill mix too.' - Letby tells the court it was "an ongoing issue".
Late that day, Letby messaged her: "E just phoned telling me to do days this week and
not Go in tonight as trying to protect me 😔""
Response: "What's that mean?"
LL: "I don't know. Asked if there was a problem and she said No just trying to protect
me as had a difficult run just before holidays, less people on nights etc and we can have
a chat etc tomorrow. "
"But Im worried Im in trouble or something"
Letby said "it seemed an unusual thing to do".
Response: "Don't worry, how can you be in trouble you haven't done anything wrong
"Just very unfortunate"
LL: "I know but worrying in case they think i missed something or whatever. Why leave
it til now to ring."
Letby says she thought she might have overlooked something. She tells the court getting things right in her work "was my life, my job". Letby is asked why a Datix report is on her phone - Letby said this was something she needed to do for Child O and Child P. Letby says she cannot recall if she did these tasks.
The email from Yvonne Griffiths on July 15 is shown to the court referring to Letby's redeployment to an office-based role in the hospital. Letby said she "wasn't happy" about the move, and it had been imposed on her. She said she was aware that, by this time, the Countess neonatal unit had been redesignated to a level 1 unit.
Letby's message on August 8 to a nursing colleague:
"Tony phoned. He's going to speak to Karen and insist on the review being no later
than 1st week of Sept but said he definitely wouldn't advise pushing to get back to unit
until it's taken place. Asked about social things and he said it's up to me but would
advise not speaking with anyone in case any of them are involved with the review process.
Thinks I should keep head down and ride it out and can take further once over."
"Feel a bit like Im being shoved in a corner and forgotten about by the trust. It's my
life and career."
"He's not been given any information about the evidence he asked for which is good.
He's not sure what the external people are going to look at in relation to me but we are
in the process now so have to ride it out"
Reply: "Ok well just have to take his advice then suppose 😞"
LL: "Still can't believe this has happened.
"It's making me feel like I should hide away by saying not speak to anyone and going
on for months etc - I haven't done anything wrong."
Letby said she was expected to lie about things going on, that she was 'happy' to be
redeployed elsewhere.
After the email was sent about secondments, Letby said: "Omg She's sent email about
secondments!"
Reply: "😂😂😂"
"Email is on fire!"
LL: "Bloody hell fuming"
"Im in email and makes it sound like my choice"
The court hears Letby had filed a grievance procedure against the hospital. Letby tells the court that by this point: "I didn't know what to do - it was having a massive impact on all aspects of my life. "It was emotionally very difficult, I was lonely...I didn't know what was going on."
The court is resuming after a short break. A picture from Letby's office is shown to the court. Letby says she would not have written it all at once. The writing is at various angles. Asked about it: "That is what I do...I write things down." It includes Letby's signature - "doodling".
Letby says "she couldn't say" if this was at the time she was being blamed. There are repeated 'Everything is manageable', written six times. A lady in the occupational department had said that to Letby, which 'resonated' with her. The love hearts are "just doodling".
Various names including a doctor, Karen Rees - "director of nursing", Minna, "They were important people to me at that time - they were the main people I could talk to."
Also written is "I can't do this anymore". Letby said she was "fighting for my life, my job" Also written is "HELP ME" and "Please help". Letby says "at this point I had lost everything...I just wanted someone to help me. I couldn't understand how all this was happening to me."
Another sheet is shown to the court. It has densely-packed handwriting at different angles.
The allegations were, Letby said: "beyond comprehension"
Mr Myers: "Could you cope with it?"
Letby: "No."
The note: "I really can't do this anymore - I just want to be as it was I want to be happy in the job that I loved...Really I don't belong anywhere - I am a problem to those who know me..."
The note adds "Please help me [doctor] LOVE PLEASE HELP ME [doctor] You were my best friend [doctor]."
Becoming tearful, Letby denies causing harm or there was any truth in her intending to kill babies, in administering insulin. "I only ever did my best."
That concludes Mr Myers questions.
The trial is resuming after a short break. Mr Johnson clarifies from a text message sent to a doctor colleague, Letby did have two designated babies at the start of that shift, one of whom was Child P.
He now turns to the case of Child Q. Letby, in her defence statement, said she cannot recall much from the shift given what had happened in the previous days. She said she did not understand why feeding was continued for Child Q when it was not being digested. Letby said Child Q was sick and when she arrived, from the records, she aspirated 'air+++' from Child Q. She says she does not know how that air got there, and she did not cause it. Child Q was not put on a ventilator as there were concerns over NEC. She did not deliberately retain a handover sheet for Child Q. Letby says she would like to amend the statement, to say she was on duty after June 25, 2016.
Medical expert witness Dr Dewi Evans was challenged by the defence on his use of the word 'crashed' for Child Q, saying that was a 'gross exaggeration'. Letby says a more appropriate word for what happened to Child Q would be "deterioration". A doctor colleague had referred to the event, in a message, as an 'acute deterioration'. Letby said that would be accurate. She said the difference would be a crash would require a crash call being put out.
Mr Johnson says Child Q was transferred to nursery room 1.
NJ: "He was in a serious condition after that, wasn't he?
LL: "No I disagree."
NJ: "He needed one-to-one care, didn't he?
LL: "Yes, he was assessed as ITU care."
The rota for June 25, 2016, at the beginning of the shift, is shown to the court. Child Q was in room 2, designated nurse Lucy Letby. One other baby is in room 2, with a different designated nurse. Letby was a designated nurse for a baby in room 1. Two other babies are in room 1. Three babies were in room 3 and four babies in room 4. Nurse Mary Griffith had designated babies in rooms 2, 3 and 4. Letby rules out staffing levels or staffing mistakes or medical incompetence as contributory factors for Child Q's collapse.
Letby agrees Child Q required some breathing support at birth. She also agrees Child Q "made good progress" after birth, according to Mr Johnson. Letby says, "other than some temperature issues", the overall condition of Child Q was positive.
Child Q was looked after by Samantha O'Brien on the night of June 24-25, and Child Q was being fed 0.5ml of milk every two hours at 3am, 5am and 7am. A blood gas reading at 6.58am was "very good", Mr Johnson says. Letby agrees.
Letby adds there had been a 'slight increase' in the lactate, and the pH reading was slightly lower, but accepts it was a good reading overall. Letby said at the time of Child Q's handover on the morning of June 25: "There were concerns for his abdomen and his feeds." Asked who else had raised these concerns but her, Letby replies she does not know.
Letby had previously told her defence that, due to temperature concerns and aspirates, she wanted Child Q to be reviewed by doctors before feeding at 9am on June 25. The neonatal schedule shows Letby made observations for the designated baby in room 1 at 8.30am. She also co-signed for medication at 8.32-8.34am for a baby in room 3.
At 9am, Mary Griffith is doing observations for a baby in room 2. An unsigned entry is made for Letby's designated baby in room 1 at this time. Also at this time, Letby is recorded doing observations for Child Q. Letby says she does not recall doing the observations or being interrupted. Mr Johnson says he uses the word 'interrupted' as swipe data shows Mary Griffith entering the neonatal unit at 9.01am. He suggests Letby pumped Child Q with some clear liquid while Mary Griffith was out. Letby denies this.
Letby is asked why she has only done 'half a job' for the 9am June 25
observation for Child Q.
LL: "I can't explain why I haven't filled the saturations."
NJ: "You were interrupted by Mary Griffith, weren't you?"
LL: "No, I don't know why those weren't filled in."
Letby said she left room 2 to go to room 1 as she needed to attend to cares for the other designated baby just after 9am. Mr Johnson says that is a lie. Letby says the baby didn't need a nappy change, but that baby "was an intensive care baby who needed regular attention". Letby agrees she had not filled in the saturation readings, but otherwise 'the job was done' for Child Q's 9am observation.
Letby says she was not present in the room at the time Child Q vomited. She says she cannot recall aspirating air from the NG Tube afterwards, but may have done so. Letby's nursing note: '...mottled++. Neopuff and suction applied....air++ aspirated from NG Tube.' Letby says that information may have been relayed to her. She says the air in Child Q might have come from the Neopuffing process. Letby agrees it could be dangerous if the Neopuffing and suction was done if there was clear liquid in Child Q's system. Letby said Child Q had vomited over his bedding.
Child Q, in a doctor's notes, had “just vomited” and his oxygen
saturation dropped to the “low 60s”.
NJ: "There was a concern that [Child Q] had inhaled some liquid, wasn't there?"
Letby replies that is a concern any time a baby vomits.
The doctor's observations with Child Q continue for 53 minutes.
NJ: "This was no everyday, minor desaturation, was it?"
Letby replies it was not
serious enough to require an emergency crash call.
NJ: "You pumped him with a clear liquid, didn't you?"
LL: "No."
Messages sent to a nursing colleague from 1.13pm are shown to the
court:
'[Child Q] on CPAP' Minna has taken [other baby] off me so just got him. Almost had
a tube earlier but gases improving'.
Letby denies the event was 'trivial', saying Child Q
had deteriorated but it was not on the same level as some of the other events that have
been discussed, and did not need a crash call or resuscitation efforts.
Nurse Amy Davies recorded on June 25, 2016 for the night shift that
Child Q had "settled".
NJ: "He became much better, hadn't he?"
Letby agrees.
NJ: "A child that was put in your hands in good condition, left your hands in a
ventilator in intensive care, but by this time was returning to normality."
Letby says by
the night shift, Child Q was still on a ventilator and had a poor blood gas record on
6.23pm.
NJ: "You had nearly killed him, hadn't you?"
LL: "No, I hadn't nearly killed him." Letby says she was later concerned she was being
blamed for something that did not happen, by leaving the nursery room unattended.
NJ: "The truth is that you pumped him [Child Q] with liquid and air?"
LL: "No."
NJ: "Because you tried to kill him?"
LL: "No, I didn't."
The trial is now resuming. Nicholas Johnson KC, for the prosecution, is continuing to cross-examine Lucy Letby. Before that begins, Benjamin Myers KC, for Letby's defence, rises to make a statement. He says Letby was cross-examined on a telephone call it was alleged she had made to Child N's father. Letby had disputed what the court said was agreed evidence. Mr Myers says the dispute was raised by Letby in advance with them, and it was the defence team's mistake to agree that evidence in advance.
Mr Johnson says Letby said, in evidence, she found she was not going back to the neonatal unit the day before she went back to work on June 27, 2016. Letby agrees.
Letby says at the end of June 2016, she "liked all the doctors" she worked with. Letby says she did not know what the issue was, she had not been informed what was happening. She says she was worried she had "made a mistake" and "was in trouble for something". Asked about the timing of the call, she said she was worried about receiving the call "so late in the day" [after 5pm] in advance of working a night shift. She agrees she was worried it was something serious.
Letby agrees this was in the aftermath of Child Q's collapse and Dr
John Gibbs making enquiries. She said she was "upset and worried".
LL: "I was upset and I was concerned something was wrong."
Letby says she was worried about the next day, but not concerned it
had gone 'right to the top'.
NJ: "You knew they were on to you, didn't you?"
LL: "No."
Letby had messaged a doctor about it: "I can't talk about this now."
She writes, 12 minutes later: "Sorry, that was rude. Felt completely overwhelmed & panicked
for a minute.
"We all worked tirelessly & did everything possible, i don't see how anyone
can question that.
"Im having a meltdown++ but think that's what I need to do"
Letby says she was having a 'dramatic' meltdown.
LL: "It was all happening very last minute and in the evening - it was not normal."
She says this is different from work pressures as "this was personal". She denies that people were 'sussing' her.
A message on Letby's phone at 11.29pm included: "Death datix x 2
Datix - no bicarb, delay in io access
Sign out ffp on meditech & pink chart
[Child O] charts obs
Fluids in sluice
Sign drugs
Sign curosurf out
Traffic light drug compatibility - inotropes, and no policy for panc
Delay in people doing drugs"
Letby said this was documents she had not yet completed for babies she had cared for.
A message sent by Letby's nursing colleague to Letby: "[doctor] came
in chatting to me at the start of last nights shift n I said [baby] needs L.L soon as uvc
been in nearly 2wks n he said something about [child O]s already being changed n I said it
hadn't n he told me about the open port!"
Letby's responded: "I told her about it that night.
"Yes because Thought it's a massive infection risk and risk of air embolism, don't
know how long it had been like that."
A Datix form for the clinical incident is shown to
the court - June 30, 2016, 3pm, with the port on one of the lumens noted to not have a
bung on the end and was therefore 'open'. Registrar informed. Letby is the reporter of the
incident. Mr Johnson says this was a potential case of accidental air embolus which Letby
had reported.
NJ: "You had your thinking cap on, didn't you?"
LL: "No." Letby said this was something which needed to be reported.
NJ: "You removed the port and covered it as a clinical incident, didn't you?"
LL: "No."
NJ: "This is an insurance policy - so you could show the hospital was so lax..."
LL: "No."
NJ: "It was to cover for accidental air embolus."
LL: "No."
Letby is asked about the investigation and Letby being seconded to
an office-based role.
Letby messaged: "Hoping to get as much info together as possible -if they have nothing
or minimal on me they'll look silly, not Me"
"Did you think attack was the best form of defence?"
"This was me responding what was happening to me."
Letby's message on August 8: "Tony phoned. He's going to speak to Karen and insist on the review being no later than 1st week of Sept but said he definitely wouldn't advise pushing to get back to unit until it's taken place. Asked about social things and he said it's up to me but would advise not speaking with anyone in case any of them are involved with the review process. Thinks I should keep head down and ride it out and can take further once over. Feel a bit like Im being shoved in a corner and forgotten about by the trust. It's my life and career."
Letby said she was feeling isolated and not able to speak to anybody on the unit. Mr Johnson asks if that was really the case. Letby said she spoke to some friends who she was allowed to speak to about the details of the investigation. They were two nursing colleagues and a doctor.
Letby's message: "It's making me feel like I should hide away by saying not speak to
anyone and going on for months etc - I haven't done anything wrong."
NJ: "You knew at this stage you were being blamed for the collapses and deaths of
these children?"
LL: "No."
See also: INQ0098315 – Thirlwall Inquiry Witness Statement of Christopher Booth, dated 16/05/2024
Neonatal nurse Christopher Booth, in a statement, said he did not remember Child Q independently, but did so from looking at notes made at the time.See also: INQ0101331 – Witness Statement of Mary Griffith, dated 06/06/2024
Giving evidence at Manchester Crown Court on Monday, April 3, during the 23rd week of the trial before a jury, nurse Mary Griffith said Letby had asked if she could keep an eye on Child Q while she went to check on another baby in a different nursery.See also: INQ0101319 – Witness Statement on Minna-Maria Lappalainen, dated 31/05/2024
Asked what she saw when she was first to arrive at the incubator, Ms Lappalainen said: “He had been sick. I turned him on his side and made sure his airway was alright.”See also:
INQ0008978 - Pages 4 & 5 of letter from Dr John Gibbs to Mother & Father C re Child C's death, dated 24/09/2015
INQ0001993 – Page 14 of Witness statement of Dr John Michael Gibbs, for the trial of R v Letby, dated 20/11/2017
Dr John Gibbs' oral testimony at the Thirlwall Inquiry
See also: Dr A/U's oral testimony at the Thirlwall Inquiry
Ben Myers KC, defending, earlier questioned a doctor [Dr A], who cannot be named for legal reasons, about messages he sent to Ms Letby in late June 2016 in relation to the death of Child O.Dr Arthurs was asked by Cheshire Police to review a number of radiographs for Child Q. He tells the court that on one of the radiographs, taken 20hours after the baby boy's collapse, he noticed an 'abnormality'
Dr Arthurs is talking the jury through the radiograph, he points out two areas in the bowel of Child Q - he says it could be a sign of pneumatosis, which is an early sign of necrotizing enterocolitis (a serious condition in newborns)