UK - Lucy Letby Trial - Media, Maps & Timeline *NO DISCUSSION*

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Prosecution evidence, April 5th 2023, Day 82 - Tweets https://twitter.com/MrDanDonoghue

Child Q

Lucy Letby's murder trial continues at Manchester Crown Court this morning (couldn't sit yesterday due to a juror illness). We'll be hearing evidence in relation to Child Q, who the Crown say Ms Letby attacked in late June 2016. The nurse denies all charges

Ms Letby is accused of attempting to murder the infant on 25 June 2016 after allegedly murdering two triplets, Child O and P, on the previous two days.

Unnamed Doctor (Doctor A)

First in the witness box today is a doctor, who can't be named for legal reasons. He worked the 25 June day shift

The medic was called to the neonatal unit shortly after 9am to treat Child Q after he vomited and needed breathing support. The court previously heard that Ms Letby was Child Q's designated nurse that day. Ms Letby was caring for another baby when Child Q desaturated

The doctor's notes record that after an hour Child Q's sats had improved and was no longer needing as intensive breathing support

His notes from that morning state 'presumed sepsis with secondary jaundice' for the cause of Child Q's collapse

Child Q made a reasonable recovery through the day, but by 19:20 he was described as 'looking tired' and the doctor took the decision to intubate him and place on a ventilator

The following day, Child Q's gases were unsatisfactory and it was suspected that he had necrotising enterocolitis (a serious condition that can affect newborns). He was transferred to Alder Hey where he quickly stabilised - his breathing tube was removed on 27 June

Cross-Examination

Ms Letby's defence lawyer, Ben Myers KC, is now questioning the doctor. He points out that the medic arrived on neonatal unit at 09:17 (Child Q crashed just after 9am). Myers says 'a fair amount of activity had happened already at that point', the doctor agrees

He also agrees that Child Q had a 'rapid' recovery from the collapse

Mr Myers has just asked the doctor to explain to the court, in simple terms, what NEC is and what impact it has on babies

Mr Myers is taking the doctor over messages he sent to Ms Letby in late June/early July in regards to Child O - one of the triplet brothers who died. The court has previously heard that the boy was found with an 'impact' injury to his liver in post-mortem

In the messages, the doctor tells Ms Letby that another doctor on the unit was concerned that Child O's liver injury 'may have been caused by her chest compressions'

He says in those messages to Ms Letby that he spent '20mins in a cubicle going over everything' with the doctor, he says 'CPR was all at fifth rib space between the nipples'

But he says to Mr Myers that he does not have any independent recollection of that resuscitation and that he was managing the airway during it

The defence have previously argued that the liver injury sustained by Child O was a result of CPR - this is something that was rejected by expert pathologist Dr Andreas Marnerides, who reviewed the case, last week



Consultant Dr John Gibbs

We're back after lunch. Consultant paediatrician Dr John Gibbs is up in the witness box next. The court has previously heard that after the deaths of triplet brothers Child O and P on the 23 and 24 June, Dr Gibbs had become 'concerned' about Ms Letby's presence on the unit.

Dr Gibbs is asked about a message, Ms Letby sent to a doctor - who cannot be named - on the night of 25 June. Letby asks if she should be 'worried' about what Dr Gibbs had been asking nurses on the unit that day

From his recollection, Dr Gibbs tells the court he was asking nurses who was caring for Child Q at the time of his collapse as he had become increasingly concerned about unusual collapses and deaths on the unit. He said he would not normally ask who was looking after a child



Dr Dewi Evans, Prosecution Expert Witness

Medical expert Dr Dewi Evans, who was asked to review the case by Cheshire Police in 2017, is now in the witness box

Dr Evans has said that he believes Child Q's collapse on the morning of 25 June was a result of air and liquid - possibly saline or water - being injected via the NG tube into his stomach. This he says caused Child Q's breathing problems, as it splinted diaphragm

 

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"Medical expert Dr Dewi Evans, who was asked to review the case by Cheshire Police in 2017, told jurors vomit found on Child Q on the morning of 25 June was evidence liquid had been given to him by someone.

He said: "Clearly there was enough fluid injected down his nasogastric tube into his stomach to make him vomit, he only would have vomited if he had quite a significant amount of fluid."

He agreed with prosecutors the fluid had been "forced" down the tube.

Dr Evans said the subsequent respiratory problems experienced by Child Q was likely caused by the fluid, which placed pressure on his diaphragm and prevented him from breathing normally.

"Once he vomited, it was nature's way of un-splinting the diaphragm and easier for the resuscitation to be successful"."

Fluid and air forced into baby's stomach, jury told - BBC News

A medical expert agrees with prosecutors who allege liquid was "forced" down a baby's nasogastric tube.

www.bbc.co.uk

 

[Tortoise]

Dr Evans told the court that Child Q was 'not quite well' from the night before and was apparently unable to tolerate small feeds of milk, but he said the feeding problem would not explain the 'very significant' deterioration.

[...]

The baby was transferred to intensive care at Alder Hey Children's Hospital but surgeons there found no further issues and he was returned to the Countess two days later.

[...]

Dr Evans said he was 'certain' that the suspected bowel problem, necrotising enterocolitis (NEC), was not a factor in the vomiting incident.

Ben Myers KC, defending, pointed out to Dr Evans that in three earlier reports he had concluded that the deterioration was due to 'inappropriate care' with 'a lot of air' given via his NGT.

Mr Myers said: 'I am going to suggest that fluid is something you have added at a late stage.'

Dr Evans replied: 'I think in all these cases I have said in evidence, on a number of occasions, that I had to rely on notes that I have been presented with and the more accurate the information we get the more accurate the opinion is.'

Mr Myers said: 'What you are focusing on at that point exclusively is air.

Now you have reached this point where you have added fluid now to keep the mechanism going, keep the allegation going, rather than reflect the facts?' Dr Evans said: 'No, no, no. You have got it wrong again.

'We are here now and we have heard the evidence from the people who were looking after him.

'So going on about what I wrote in 2017 and 2018 is rather missing the point.' Letby, originally from Hereford, denies the murders of seven babies and the attempted murders of 10 others between June 2015 and June 2016.

[...]

Lucy Letby harmed baby by 'pouring clear liquid down his throat'

Letby, 33, originally from Hereford, is on trial at Manchester Crown Court accused of murdering seven babies and attempting to murder a further 10 between June 2015 and June 2016.

www.dailymail.co.uk

Lucy Letby: Baby ‘had clear liquid forced down his throat’

A BABY boy allegedly attacked by a nurse had a clear liquid forced down his throat which caused him to vomit, a court has heard.

www.chesterstandard.co.uk

 

[Tortoise]

Prosecution evidence, April 6th 2023, Day 83 - Tweets https://twitter.com/MrDanDonoghue

Child Q

Lucy Letby's murder trial continues at Manchester Crown Court this morning. We'll be hearing evidence from a medical expert in relation to Child Q, Ms Letby's final alleged victim. The nurse denies all charges against her.

Dr Sandie Bohin, Prosecution Expert Witness

Medical expert Dr Sandie Bohin is now in the witness box. She was asked to review the findings of Dr Dewi Evans - who reviewed all the cases on instruction from Cheshire Police in 2017

Prosecutor Nick Johnson KC asks Dr Bohin if there could be a natural/obvious explanation for 'clear fluid' being aspirated from Child Q on the morning of 25 June (soon after the baby boy collapsed and required resuscitation)

She says: 'No, I don’t know where plus plus plus of clear fluid (as written on nursing note) comes from given at that time he had not had any feed since 2hrs previously, only a very tiny amount of milk..

She added: 'What was aspirated here was clear fluid not milk, I can’t explain where it would have come from'. She concludes that liquid/air was forced down his NG tube

Cross-Examination

Ben Myers KC, defending, is now cross examining Dr Bohin. He references evidence from a nurse, who cannot be named, who said she saw mucous at Child Q's mouth, he puts it to her that this could be clear liquid referred to and asks if it was could it cause breathing difficulty

She says it is unlikely it would be mucous, but says if it was, in that volume, it could cause issues




Lucy Letby Police Interview Summary

Nick Johnson KC has just read a summary of Ms Letby's police interview in relation to the collapse of Child Q. In this she denied doing anything to harm the baby boy and said it was a 'coincidence he became unwell when she came on duty'



Lucy Letby Text Messages

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 were 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'

Wrap of today’s evidence. Back April 17.

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 death

Lucy Letby trial: Nurse moved to risk office after baby deaths, jury told

Lucy Letby was given a role in patient safety after doctors raised concerns about her, a court hears.

www.bbc.co.uk

 

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On Thursday the court was read a Facebook message exchange a week later on June 30 between Letby and a doctor, who cannot be identified for legal reasons.

The doctor wrote: “Did J tell you what was wrong earlier?”

Letby replied: “Not really. We started talking but then people came into the nursery and she dashed off.”

The doctor said: “I’m not sure where that information has come from. It seems that on the SHO (senior house officer) grapevine somebody at LWH (Liverpool Women’s Hospital) has said that one of the triplets was found to have a ruptured liver.

“J was upset that this may have been caused by her chest compressions.”

[...]

The court heard the J referred to was senior house officer Dr Jessica Burke, “a relatively junior doctor at the time”.

Lucy Letby trial: Doctor ‘upset she may have injured baby’

A JUNIOR doctor told a colleague she was “upset” she may have injured a baby with her chest compressions, the Lucy Letby murder trial has heard.

www.chesterstandard.co.uk

 

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The court heard on 1 September, Ms Letby attended a meeting with a review panel and six days later, she registered a grievance procedure.

[...]

Prosecutor Nick Johnson KC, reading a summary of Ms Letby's police interview, said the nurse denied causing the boy any harm.

He said Ms Letby accepted that Child Q collapsed "within minutes of her leaving nursery two [but] she said he was stable when she left and [that she] wouldn't have left him if that was not the case".

Mr Johnson said she "denied deliberately leaving the room to blame other staff" for Child Q's collapse.

He said Ms Letby also denied injecting air or fluid into Child Q's NG tube and said it was a "coincidence he became unwell when she came on duty".

"She noted premature babies could deteriorate at any time," he added.

Lucy Letby trial: Nurse moved to risk office after baby deaths, jury told

Lucy Letby was given a role in patient safety after doctors raised concerns about her, a court hears.

www.bbc.co.uk

 

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[...]

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.

Lucy Letby 'worried' she was 'in trouble' over baby deaths

LUCY LETBY messaged a nursing colleague: "If they have nothing or minimal on me they'll look silly" during a Countess of Chester Hospital…

www.chesterstandard.co.uk

Details of Letby's removal came today as the jury at Manchester Crown Court was shown the final segment of WhatsApp and Facebook traffic between Letby and some of her colleagues on the unit – including a male registrar she is said to have 'flirted' with. [...]

He repeatedly offers reassurance about her abilities as a nurse, saying she has 'nothing to be worried about'. At one point he forwards her a confidential email in which he is asked to prepare a statement ahead of an inquest into one of the recent deaths. [...]

At one stage in the WhatsApp and Facebook messages Letby mentions the possibility of an air embolism being the cause of a baby's death. [...]

When asked by a detective about air in the baby's stomach, she suggested that infants sometimes gulp air when they vomit. Medical experts called by the prosecution have said this is impossible.

Letby agreed that Q had become unwell shortly after she came on duty, but denied using a nasogastric tube or any other method to cause Q's collapse. She noted that premature babies could deteriorate at any time. [...]

As late as July 15 Letby [...] telling a nursing colleague: 'Hoping to get as much info together as possible today – if they have nothing or minimal on me they'll look silly, not me'.

On August 8 she tells the same nursing colleague that a hospital manager has rung to say he 'wouldn't advise pushing' to get back to the unit until the 'review' had been completed. He thought she should keep her head down and ride it out.

She told the nurse in a WhatsApp message: 'Feel a bit like I'm being shoved in a corner and forgotten about by the trust. It's my life and my career…

'Still can't believe this has happened…It's making me feel like I should hide away by saying not to speak to anyone and going on for months etc – I haven't done anything wrong'. [...]

Lucy Letby was transferred from unit over doctors' fears, trial hears

Hospital managers transferred neonatal nurse Lucy Letby to a patient 'risk and safety' unit after consultants insisted on having her removed from frontline work with babies, a trial heard today.

www.dailymail.co.uk

 

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Texts and some events (compiled from media reports)


Sat Jun 25th

LL day shift - alleged attempted murder of Q. Q moved to room 1

12.18pm to 1.16pm - LL messages doc between 12.18-1.16pm.

Just after 1pm - LL messages a nursing colleague about the situation on the neonatal unit, adding: 'All going on lol'

4.11pm to 8.31pm - A record of Facebook messages between LL and doc is recorded between 4.11pm and 8.31pm.

6.40pm - LL 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'.

Night-shift - Care of Q was handed over to staff nurse Amy Davies.

8.31pm - LL to Doc: 'Wow, I think I might be almost finished'. She also messages her mother.

Colleague Minna Lappalainen to LL: 'Thank you for being a good friend today', adding a heart emoji.
LL: Don't need to thank me Minna, I'm always here for you. Please don't feel you're alone...'
ML: '...But really I'm really happy u were there for me....'
LL: Take care, hope you sleep well, see you tomorrow.

Sophie Ellis to LL: 'Hope your feeling ok today'
LL: 'Thanks Soph, another busy day today but ok today and off tomorrow....'
SE: 'I think you deserve more than a day off...'
LL: '...It's been awful but we'll be ok'.

10.48pm
LL: Do I need to be worried about what Dr Gibbs was asking?
Doc. No. He was asking to make sure that normal procedures were being carried out. 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. He asked who was there, I said I had popped out of room but Mary was in room and Minna at the desk.
Doc: 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
Doc: 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
Doc: Nobody has accused you of neglecting a baby or causing a deterioration.
LL: I know. Just worry I haven't done enough
Doc: How?
11.21pm
LL: We've lost 2 babies I was caring for and now this happened today. Makes you think 'am I missing something/good enough'
11.25pm
Doc: 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. Promise?
LL: Well, I sincerely hope I won't ever be needing a statement but thank you, I promise
Doc: 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 Dr G 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 of 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)). 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. So relieved that it's you who has been there throughout.

Sun Jun 26th

00.12am
Doc: It's true. You are one of a few nurses across the region (I’ve worked pretty much everywhere) that I would trust with my own children. If you're worried - I'm worried. You should do the APNP course, you'd be excellent. (In a second reference to his children he adds) They’re possibly a bit too big now.
LL: Don't know what to say Thank you.
Doc: Self-doubt finished?
LL: I think so, thank you ++
1.36am
The messages continue on a social/work nature until 1.36am, but have no further reference to Child Q.

7.50am
LL 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'.
LL: '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'.

time?
LL to doc: 'Will you let me know how [Child Q] gets on today please'
Doc: 'Of course I will'.
The messages continue throughout the morning.

12.19pm
The doctor adds at 12.19pm: '[Child Q] has nec'
LL: '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...'

LL 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?'
LL responds that the doctor let her know.

The nurse later messages LL: They think [Child Q] could be a volvulous apparently'
LL responds: 'Oh no.'


Child Q was transferred to Alder Hey on June 26 and was treated there until June 28.



Mon Jun 27th


LL expecting to be working night shift.


10.55am
Doc to LL: 'Not sure if the unit is open for transfers. Few managers/directors around this morning'.
The doctor adds it's 'odd' Child Q 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. LL agrees.

A reference is made to clarify paperwork for a prescription for child O during resus attempts.

Doctor B raised her concerns with colleagues including the neonatal lead and the nnu manager at their regular Monday meeting.


Unknown time
LL messaged a colleague complaining that the nnu is “way over capacity”. LL says “the unit needs properly assessing, I don’t think equipment gets cleaned properly…we haven’t got space to maintain hygiene”

5.41pm
LL to doc: Eirian [nnu 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.

LL to nurse colleague: E just phoned telling me to do days this week and not go in tonight as trying to protect me.
Nurse: 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 I'm worried I'm in trouble or something.
Nurse: 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.
Nurse: It is very late I agree. Maybe she's getting pressure from elsewhere?
LL: 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.

Later:
LL to doc: 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.
Doc: 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.
Doc: I can't fault anything with your delivery of care to either baby last week. If there was anything I would have said so. Eirian knows you. Has there ever been a reason for you not to trust her?
LL: I can't talk about this now. Sorry, I just need a bit of time.

12 mins later:
LL: 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.
(Doc asks if LL is ok now)
LL: I’m having a meltdown++ but think that's what I need to do.
Doc to LL about baby Q: There isn’t anything to question.


Tue Jun 28th

Child Q returned to CoCH and was discharged on Jul 25th.

LL worked day-shift


Wed Jun 29th

LL worked day-shift

A Datix form is submitted referring to O’s “sudden and unexpected collapse”.

Consultants held a meeting to work out what was going on at which someone suggested air embolus. Dr Jayaram went home and researched it that evening.


Thu Jun 30th

Dr Jayaram emailed his colleagues with the air embolus study.

LL filled in a Datix report related to O, stating resources not available on unit for resus and that staff obtained equipment from the children’s ward which was delayed because of staff needed for infant care needs.

LL worked day shift (her last)


Doc: Did J [SHO Dr Jessica Burke] tell you what was wrong earlier?
LL: Not really. We started talking but then people came into the nursery and she dashed off.
Doc: I’m not sure where that information has come from. It seems that on the SHO (senior house officer) grapevine somebody at LWH (Liverpool Women’s Hospital) has said that one of the triplets was found to have a ruptured liver. J was upset that this may have been caused by her chest compressions.
LL: Oh no that’s awful. No wonder she’s upset. Were you able to reassure her?
Doc: We spent 20 minutes in a cubicle going over everything. The CPR was all at the 5th rib space between the nipples

Later:
Doc: I’m not sure I believe it. It was a coroner’s PM (post-mortem). It usually takes weeks to get any report.
LL: It seems a bit like rumour mill has gone into overdrive. The boys were only returned today. Don’t see how info would be out that quick?
Doc: No me either.
LL: Not nice for J though. Can see how it would play on her mind. It’s good she felt able to tell you.
Doc: I’m good for a hug and a chat. I think it helped.
LL: She said she’d spoken (and cried on) you … and was feeling better for it.


Fri Jul 1st

-

Sat Jul 2nd

LL to Torquay with parents for almost 2 weeks


Wed Jul 6th

Doc: You need to keep this to yourself. The meeting this afternoon looked at everything with Baby O & Baby P from birth onwards. 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. Your documentation of the resus / incubation / drugs was faultless. There is absolutely nothing for you to worry about. Please don't.
(Doc says he is) ‘so sorry that you were upset when Eirian called about that when I knew you’d done a perfect job’. 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.
LL: 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.

LL is sent a confidential email addressed to the doc from 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'. The email asks the doc to [per BBC - set out details of some of the collapses of babies][per Daily Mail – prepare a statement ahead of an inquest into one of the recent deaths].

LL: It's a bit of a worry if it's going that far. Do you think I'll be involved?
Doc: Probably not. I know you won't say anything - this email has to stay between us, is that ok?


Fri Jul 15th

LL due back from hols??

nnu manager Eirian Powell informs nursing staff:
“all members of staff need to undertake a period of clinical supervision in preparation for an external review. Due to our staffing issues it has been difficult to determine how we undertake this process. We can only support one member of staff at a time, therefore we have decided that it would be useful to commence with staff who have been involved in many of the acute events, facilitating a supportive role to each individual. Therefore Lucy has agreed to undergo this supervision first commencing on Monday 18th July 2016. 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. It will probably be developed into a competence based programme to be undertaken every 2-3 years in line with our mandatory update training."

LL to a nurse colleague: I've done a timeline of this year.
Colleague: Fab. And how quite a few babies weren't compatible with life anyway. I wonder if midwives get this with amount of stillbirths......"
LL: 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
Colleague: Not like all behaving fantastically till right into shift.
LL: Hoping to get as much info together as possible today -if they have nothing or minimal on me they'll look silly, not me.


Mon Jul 18th

-

Tue Jul 19th

LL began work in the patient experience team.


Mon Aug 8th

LL to nurse 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 I'm 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
Colleague: 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.
Colleague: Me neither! I know it's all so ridiculous.
LL: I can't see where it will all end
Colleague: I'm sure this time after xmas it'll all b a distant memory.


Tue Aug 9th

NNU manager Eirian Powell email to all:
'Hi All, There are currently opportunities for staff to apply for secondment throughout the Trust. It is therefore come at an opportune time for us and we were able to facilitate this for Lucy.
'Lucy is currently seconded to the Risk & Patient Safety office for a period of 3 months.
'Laura is currently seconded to the Haemodialysis unit and will be returning in November 2016.
'Should anyone have an interest in other areas please discuss this further during your appraisal – or come to me directly.
Kindest regards,
Eirian'.

LL to nursing colleague: Bloody hell fuming. I’m in email and makes it sound like it’s my choice.


No date provided: At one stage in the WhatsApp and Facebook messages LL mentions the possibility of an air embolism being the cause of a baby's death. Lucy Letby was transferred from unit over doctors' fears, trial hears


Thu Sep 1st

LL met with review panel

Wed Sep 7th

LL registered a grievance procedure

 

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The Trial of Lucy Letby, Episode 27: Baby Q “I was worried about what was happening on our unit.” - The Mail

www.mailplus.co.uk

The Trial of Lucy Letby, Episode 27: Baby Q “I was worried about what was happening on our unit.”​

This week, Caroline and Kim Pilling, standing in for Liz, go over what the court heard about the final baby in this case, Baby Q. He was a baby boy who was considered to be stable, until one morning when he collapsed just after Lucy Letby had left the nursery he was in. The prosecution allege that the clear fluid Baby Q had vomited before his collapse was water or saline which had been forced down his nasogastric tube by Lucy Letby.

 

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The Trial of Lucy Letby, Episode 28: Off the ward - The Mail

www.mailplus.co.uk

The Trial of Lucy Letby, Episode 28: Off the ward​

In this episode Caroline and Liz outline how Lucy Letby was telephoned at short notice by her manager and asked not to work her night shift following the collapse of the 17th baby in the case, Baby Q. In a series of text messages to colleagues she said the call had ‘messed with her head’ and prompted her to have a ‘meltdown’ because she was worried she was ‘in trouble.’

Follow The Trial of Lucy Letby on Twitter @LucyLetbyTrial

Listen to the full series on catch-up

 

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Prosecution evidence, April 17th 2023, Day 84 - Live Updates Recap: Lucy Letby trial, Monday, April 17

12:37pm

Agreed facts are now being read out to the court.
Letby was arrested on three occasions, the court hears. The first was at 6am on July 3, 2018, at Letby's home address, the other two occasions when Letby had moved back with her parents in Hereford.
In 2018, at Letby's home address, a police search was carried out, as was her parents' address, and Letby's workplace at the Countess of Chester Hospital in July 2018.
Further searches took place in June 2019.

12:39pm

Agreed facts are evidence which has been agreed by both the prosecution and defence.
Cheshire Police officer DC Collin Johnson has been called to give evidence, as exhibits officer in the Lucy Letby investigation.
He is confirming what his role and duties are as an exhibits officer and the process of gathering exhibits.

12:42pm

The prosecution asks about the home searches in July 2018, and a "considerable number of exhibits" being recovered.
Crime scene investigators took photos and recorded what they saw.
A chronology of this part of the investigation is now taking place, firstly with Letby's home search at Westbourne Road, Chester, at 6.05am on July 3, 2018. The search ended on July 6 at 5.30pm.

12:46pm

A diagram of Letby's home is displayed to the court.
Photos of Letby's home interior are now shown to the court. In her bedroom, the prosecutor points out, are two handbags, near the stand-alone mirror.
Inside the handbag, three handwritten notes were uncovered.

12:55pm

The three handwritten notes are shown to the court.
One is a blue post-it note, with handwriting featuring Letby's thoughts. The other two feature the name of a doctor several times, one saying "[name of doctor] I loved you" and "[name of doctor] my best friend."
Other messages on the notes, which have been densely-packed and messages among swirls of writing, read:
"I can't do this any more"
"Help me"
"We tried our best and it wasn't enough"
"I want someone to help me but they can't"
One message, in thicker handwriting overlaid on the yellow note, has the message "HELP".

1:00pm

Another photo of Letby's bedroom is shown, with a wall slogan 'Leave Sparkles wherever you go'. The message is repeated on a small tabletop decoration.
A page from Letby's 2016 diary is shown to the court, with a note on April 8: 'LD [long day] twins'. The following day is 'LD twins resus]. It is followed in a different coloured pen by 'Salsa - Buckley'.
A page of June 20-26 from Letby's diary, has for June 23: 'LD ([name of Child O's initial])'
June 24: 'LD ([name of Child P's initial) A+E'
June 25: 'LD ([name of Child Q's initial)'

1:03pm

The diary also shows, on June 25, 'Salsa Mold', and for June 26 'Las Iguanas 1800'.

1:07pm

The post-it note, found inside the diary, is one which was shown in the first week of the trial.
It has the message 'I am evil I did this' at its end.
Also featured are the words 'Slander discrimination', 'I haven't done anything wrong', 'I can't breathe', 'All getting too much', 'I killed them on purpose because I'm not good enough' and 'I am a horrible evil person'.

1:15pm

A very densely packed handwritten note is shown to the court, again in Letby's handwriting.
The broken sentences feature medical terms, and the words 'debriefing' 'sterility', 'foreign objects', 'workforce', 'haemhorrhage', 'non-availability', 'cellulite' 'aggravating factors', 'confidentiality', 'Don't know if I want to do this', 'Inadequate', 'Diagnosis', 'Implicating', 'Administration'.
Several of the words are written multiple times. The first names of Countess staff are also written occasionally.
A section which is scribbled and crossed out reads 'I don't know if I killed them maybe I did maybe this is all down to me'.

1:25pm

A photo of an Ibiza-emblazoned bag for life is shown to the court, recovered from Letby's bedroom.
The contents of the bag feature a number of documents and Lucy Letby's NHS name badge 'registered children's nurse neonatal unit'.
Nursing handover sheets for June 23 and June 24, 2016 are shown to the court. The names of babies not on the indictment have been blacked out for the court. They do include the names of Child O and Child P.
Handwritten documents of medical information and observations for babies, including for Child O and Child P, are shown to the court.
A nursing handover sheet for June 25 is also shown, with Child Q named. On the back of the sheet are handwritten notes and observations for Child Q and another baby.

1:28pm

A handover sheet for June 28, 2016 is shown which, the court hears, is outside the indictment period so no names of babies are shown to the court on this document.
The court hears there is handwriting on the rear of this note, which mentions Child O, and again the document features medical observations and notes.

2:18pm

The trial is now resuming. The trial judge is informing the jury there will be several days in the next few weeks which the jury will not be sitting. They include Tuesday and Friday this week. A full rundown will be provided at the end of the day.

2:21pm

Prosecutor Philip Astbury is continuing to ask questions about the exhibits found with DC Collin Johnson.
A Morrisons bag for life was recovered from Letby's home, which included a blood gas printout and a paper towel with handwritten resuscitation notes for Child L.

2:39pm

Also in the Morrisons bag were a number of nursing handover neonatal unit notes - 31 in total.
Most of the notes refer to babies which did not feature in the indictment, and included on 17 of the notes there are multiple references to 13 of the 17 babies in the indictment period.

2:42pm

The court is shown photos of other rooms in Letby's home.
One room, which has a cartoon painted tree and wood animals on the wall, has a black paper shredder in the corner.
Shredded paper was identified. Police investigators identified the documents as bank statements.

2:46pm

A floorplan of Letby's parents' home is shown to the court.
A photo of Lucy Letby's bedroom at the Hereford address is shown to the court.
A photo is shown inside Letby's wardrobe, and Mr Astbury asks about the 'Asda five-sheet strip cut paper shredder' - there was no shredder in the box, but inside were five nursing handover sheets, not related to the indictment.
Handwriting on the box says 'keep'.

2:52pm

Letby's work address was also searched, between 10.15-11.50am on July 3, 2018.
A blue folder of papers was recovered from a desk, containing 'various items of paperwork'.
One sheet, an 'annual leave request', has a lot of handwriting by Letby on both sides of the paper.
This includes hearts, 'Tigger + Smudge', 'I loved you but it wasn't enough'
'PLEASE HELP ME [name of doctor] LOVE PLEASE HELP ME [name of doctor] You were my best friend [name of doctor]'
'I just want to be as it was I want to be happy in the job that I loved....Really don't belong anywhere - I am a problem to those who do know me and it would be much easier for everyone if I just went away.'
The names of a few Countess staff are named, repeatedly, as are the words 'malnutrition' and 'assessment'.

2:58pm

A photo of Letby's Westbourne Road home garage is shown.
Inside the garage is a black bin liner, and inside was a further note seized by police.
The note contains very densely packed handwriting.
Notes include 'Appropriate workforce', 'Consultant', 'Countess of Chester Hospital' 'Equality and Diversity', 'No-one will ever know what happened and why + I am a failure'
'I can't recover from this'
'Keep this between ourselves', I don't think I can ever go back Too much has happened/changed'
'Insulin diabetes'
'Killing me softly' features at least twice.
The words 'management' and 'ombudsman' feature about a dozen times on the sheet of paper.
Cheshire place names also feature.

3:00pm

Benjamin Myers KC, for Letby's defence, says a total of 257 handover sheets were recovered in the police search. Of those, 21 related to babies in the indictment.
Four of them were in the 'Ibiza bag' and 17 were in the Morrisons bag.
DC Johnson agrees.
Mr Myers says that meant 236 handover sheets were not in relation to the indictment.

3:02pm

DC Collin Johnson confirms four of the babies in relation to the indictment do not feature in any of the handover notes recovered at Letby's addresses.

3:32pm

That completes DC Johnson's evidence.
The next stage of the trial will be evidence of police interviews with Lucy Letby after she was arrested. The court has previously heard summarised evidence read out at the end of each case during the trial.

3:36pm

The interview transcripts from the three times Lucy Letby was arrested will be read out to the court.
These will be summarised from the original full-length footage of the interviews, which were fully transcribed.
The summaries are agreed by both the prosecution and defence.

3:46pm

Prosecutor Philip Astbury and a Cheshire Police officer will be reading through the transcripts to the court.
Letby recalls, in the first interview, the care she provided for Child A.
She recalls Child A appeared 'quite pale and mottled' and required 'full resuscitation'.
She remembered Child A, and going to his cotside. He appeared 'a bit jittery' - 'making involuntary jerking movements', 'can be a sign of low blood sugar'.
"It's common for pre-term babies."
She said staff were conscious to get Child A fluids.
At the time of fluid administration of the time of the shift handover, there were "no concerns". She was with nurse Melanie Taylor.
Child A had gone a few hours without fluids, which was "not ideal".
She said after the fluids were connected, Child A's "colour changed".

3:50pm

Letby said she did not recall having physical contact with Child A at that point, until after he deteriorated.
It was 'within maybe five minutes' of the TPN bag being administered that Child A became 'pale and mottled'.
He had become 'pale, almost white', and said there was 'something wrong' - Child A could have had a 'sudden collapse'.
The mottled appearance 'could be a sign of low blood sugars', where a baby could be pale but have 'reddy-purple' patches. Child A was 'pale' in the centre and the mottling was on the 'hands and feet.' Child A was not breathing.

3:54pm

Letby said she went to observe Child A and saw he 'was not breathing'. Dr David Harkness was also in the room, Letby said, as was nurse Melanie Taylor. Dr Harkness was called over.
Asked to describe the rash, Letby says she thinks it was 'on the side the line was in', on the left side, but there was 'predominantly paleness'.
The advice was to 'stop the fluids immediately' as there may have been an issue with the long line for Child A.

4:01pm

Letby says there was 'no reason' why Child A's perfusion was very poor.
Letby said it was 'awful' that Child A had passed away, and twin Child B was present when this was 'all happening'.
'I think just all of us, as a team, dealed with it', and a formal debrief was held a few days later. Letby says there was nothing in particular from the outcome, although one possibility was health issues the mother had.
Letby said she had seen babies pass away before, from her time working in Liverpool Women's Hospital involving very pre-term babies, but Child A's death was 'unexpected'.

4:04pm

Letby says she believed Melanie Taylor would have connected the TPN bag, as she was sterile (and in a position to attach the bag). She tells police there may have been uncertainty over what the bag of fluid contained.
She says she and Melanie Taylor would have checked the TPN bag together prior to administration.

4:08pm

Letby says she had about 20 minutes in contact with Child A in total.

4:09pm

Letby told police there may have been an issue with the line, and/or the fluid attached from the TPN bag - whether it had contained the correct prescription.

4:11pm

The trial judge, Mr Justice James Goss, tells the jury the sitting days over the next two weeks will be Wednesday and Thursday of this week, and Tuesday, Thursday and Friday of next week.

5:16pm

A round-up story from today in court - 'Nurse accused of baby murders weeps in the dock': Lucy Letby: Nurse accused of baby murders weeps in the dock

 

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An A4-size piece of paper containing similarly jumbled handwritten notes was also found in the diary, the court heard.

One sentence read: 'I killed them. I don't know if I killed them. Maybe I did. Maybe this is down to me.' [...]

Other words appearing on the A4 paper were 'foreign objects', 'slander', 'tired', 'crime number', 'diagnosis compromised', 'risk factors' and, repeatedly, 'help me'. [...]

An annual leave request form from Letby - covered with untidily written jumbled words - was found in a blue folder of papers during the office search, the court heard.

Hearts were doodled on the form along with random words 'Tigger', 'Smudge', 'Bergerac' and 'Help Me'. [...]

Six pages of medical notes of children unrelated to the trial were found at her parents' home on the same date.

A total of 257 handover sheets were recovered during searches in the investigation, of which 21 included the names of babies she is alleged to have harmed.

Nurse Lucy Letby accused of murdering seven babies weeps during trial

Letby (pictured), originally from Hereford, was first arrested in July 2018 on suspicion of attacking infants in her care - two years after she worked her last shift at Chester Hospital's neo-natal unit.

www.dailymail.co.uk

 

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What police saw inside Lucy Letby's Chester home at time of 2018 arrest

THIS was the scene when crime scene investigators searched Lucy Letby's home in July 2018 at the time of her arrest.

www.chesterstandard.co.uk

 

[Tortoise]

Lucy Letby: The handwritten messages found in her bedroom

HANDWRITTEN messages found by police at Lucy Letby's Chester home have been revealed.

www.chesterstandard.co.uk

 

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A juror illness has meant the case has been adjourned until Thursday at the earliest.

The trial is not due to sit on Friday, April 21, Monday, April 24 or Wednesday, April 26.

Lucy Letby trial adjourned due to juror illness on April 19

THE trial of Lucy Letby, who denies the murders of seven babies and the attempted murders of 10 others between June 2015 and June 2016, has been…

www.chesterstandard.co.uk

 

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Prosecution evidence, April 20th 2023, Day 85 - tweets https://twitter.com/MrDanDonoghue

Child Q

Dr Owen Arthurs Prosecution Expert Witness

I'm back at Manchester Crown Court this morning for the trial of nurse Lucy Letby, we're first hearing from medical expert witness Dr Owen Arthurs - he is back in to give evidence on Child Q (he couldn't appear before Easter to do this)

Manchester Crown Court has previously heard how Child Q, who was Ms Letby's final alleged victim, was 'stable' on the evening before his collapse. Jurors have heard that the infant deteriorated and needed breathing support shortly after 09:00 on 25 June.

The Crown say Ms Letby injected air and fluid into the boy's stomach via a nasogastric tube in an attempt to kill him.

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)

 

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Tweets from April 17th - https://twitter.com/MrDanDonoghue

Lucy Letby Police Interviews

Child A

Cheshire Police detective Danielle Stonier, who interviewed Ms Letby, is now in the witness box

Court is now being read a transcript of Ms Letby's first police interview on 4 July 2018. We're hearing questions and answers in relation to Child A, who the Crown say Ms Letby murdered in June 2015

The interview has been summarised from the original (summary has been agreed by the defence)

Ms Letby said in that interview that 'within maybe five minutes' of a TPN bag being administered Child A became 'pale and mottled' and desaturated. She said she 'can't recall' where she was in relation to Child A when he collapsed or what attracted her to his cot (whether alarm)

Asked how Child A's death made her feel, Ms Letby said it was 'awful'. Asked how she coped with it, she said as 'all of us as a team supported one another'

 

[Tortoise]

Prosecution evidence, April 20th 2023, Day 85 - tweets https://twitter.com/MrDanDonoghue

Lucy Letby Police Interviews

Child A (continued)

Jury are now being read summaries of Ms Letby's police interviews in relation to Child A. Cheshire Police detective Danielle Stonier is reading Ms Letby's responses, while prosecutor Philip Astbury is reading the questions asked

In that interview, Ms Letby was told about the expert opinion of Dr Dewi Evans that Child A had been injected with air - her response was 'I did not deliberately give him any air'

She was told about the expert opinion of Dr Owen Arthurs, who noticed air on radiographs of Child A - she was asked if she could explain how the air got there, she said 'no I can’t explain how that air got there'

Child B

We're now moving onto Ms Letby's interview in relation to Child A's twin sister, Child B. The Crown say Ms Letby attempted to murder the infant in June 2015

Ms Letby was asked in her interview her recollections of Child B, she recalled seeing the baby girl with a 'sort of purply red rash' and looking mottled. She didn't recall in that interview what she did after seeing the rash (she wasn't Child B's designated nurse)

Asked if she had an explanation for Child B's collapse she said 'No, there's no explanation' She added: 'I didn’t do anything deliberately to (Child B) to harm her' Asked if she was responsible for attempted murder, she said 'no'

Child C

We're now onto the summary of the interview in relation to Child C - a premature baby boy, who weighted just 800grams on birth in early June 2015. Ms Letby is said to have caused baby's death by inserting air into the boy's stomach via a nasogastric tube.

In her interview, Cheshire Police put it to Ms Letby that one of her nursing colleagues, Sophie Ellis, had told them that when she heard Child C's alarm and went in to nursery 1 to check on him, Ms Letby was already in there stood at his cotside

At the time, Ms Letby was a designated nurse for another baby in nursery three. She was asked why she was in nursery one - she responded 'I don’t recall from memory' and said she may have been in N1 to carry out checks, use the computer or may have heard C's alarm

The court has heard that six minutes before Child C's collapse, Ms Letby was texting an off-duty colleague saying that she had wanted to be in N1 as it would be cathartic – would help her wellbeing - to see a living baby in the space previously occupied by Child A

Ms Letby agreed with the interviewing officer that she was 'frustrated' by the text conversation as she wasn't receiving the emotionally supportive messages she expected

The officer asked: 'Did you cause him to collapse six minutes after that conversation?' 'No', Ms Letby said

Ms Letby agreed that she was 'feeling frustrated and upset' at not being in N1 and with the text conversation, but denied attacking Child C

Child D

We're now moving onto the interview summary for Child D. The prosecution allege that the baby girl was the third child murdered by Ms Letby in a two-week period in June 2015

Ms Letby again told police in her interview that she 'did not deliberately do anything to harm (Child D)'

Police asked Ms Letby why she messaged a colleague after Child D's death saying ‘I think there is an element of fate involved. There is a reason for everything.’ Ms Letby said she was 'not sure' and said was just 'because sometimes things can’t be fully explained'

Child E

We're now onto interview summaries for Child E, a premature twin boy born in late July 2015. The court has heard that Child E lost 25% of his blood volume before his death in the early hours of 4 August.

Medical expert Dr Dewi Evans has previously told the court that this could have been the result of an "inappropriate" use of a medical tool.

 

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Prosecution evidence, April 20th 2023, Day 85 - tweets https://twitter.com/MrDanDonoghue

Lucy Letby Police Interviews

Child E (continued)

In those interviews Ms Letby again denied causing any harm.

Child F

We've moved now to Child E's twin brother, Child F - who the Crown say Ms Letby allegedly poisoned with insulin

The Crown say the insulin was most likely added to the baby's Total Parenteral Nutrition (TPN) bag, which is used to intravenously provide feeds to infants.

The investigating officer asked Ms Letby in her interview whether anything would be added to the bag - 'no, not that I’m aware of', she said

When asked whether she had added insulin to the infant's TPN bag she said 'no' and asked officers if the bags had been kept/checked after the incident - they had not

Ms Letby was asked by officers why she had carried out searches for the mother of Child E and F on Facebook. She said she did not remember carrying out the searches, but would have been to check to see how Child F was doing.

Ms Letby was asked if she was 'obsessed' with the family of E and F as five months after they had left the hospital, she was still searching on Facebook for the family - she said 'no'

 

[Tortoise]

Prosecution evidence, April 20th 2023, Day 85 - tweets https://twitter.com/MrDanDonoghue

Lucy Letby Police Interviews

Child G

We're now moving onto a summary of Ms Letby's interview in relation to Child G. At the start of that interview, the officer pointed out that there had been a 'spike' in baby deaths/collapses in June 2015. He noted Ms Letby had been involved in all the cases

The officer said 'you dealt with all of these, what do you put that down to, bad luck?’ She said ‘yes’

Child H

We're now onto the interview summaries for Child H, Ms Letby is alleged to have caused the girl to collapse on successive shifts in the early hours of September 26 and 27, 2015

Asked by police if she did anything to harm Child H, she said: 'I didn’t do anything'