Defence Case Thursday 8th June 2023 - LUCY LETBY'S CROSS-EXAMINATION
CHILD O
Chester Standard Updates - https://www.chesterstandard.co.uk/news/23575178.live-lucy-letby-trial-june-8---cross-examination-continues/
10:41am
Nicholas Johnson KC, for the prosecution, moves to the case of Child O.
Letby, in her defence statement, said she did "nothing to hurt [Child O]."
She noted a "change in [Child O's] appearance", but it was "not dramatic".
He had a deterioration and Letby noted Child O's abdomen was "red and distended".
She says she didn't notice a rash on Child O, and no-one mentioned it.
She said the abdomen was "very swollen", and there was a struggle to get lines in. Letby tells the court one of the lines had tissued.
She said one of the doctors had gone out to smoke a cigarette during the time of Child O's resuscitation, and when that doctor returned, they did not wash their hands.
10:43am
Letby is asked if there is anything she wishes to change in her account of evidence so far. This is a question Mr Johnson asks at the start of most sessions during the cross-examination. Letby says there is nothing.
10:45am
Letby agrees with Mr Johnson it was "big news" to see naturally conceived triplets on the unit, as it was a rare occurrence. Child O and Child P were two of the three triplets.
Messages are shown to the court between Letby and Jennifer Jones-Key from June 22.
Letby confirms when she is back in, adding: "Yep probably be back in with a bang lol"
M Johnson says within 72 hours of that, two of the triplets were dead and Child Q had collapsed.
10:48am
Letby is asked why she was "so interested" in the triplets. Letby tells the court it was "general conversation" between staff colleagues as it was "something unusual on the unit".
She accepts that all went well with the birth, and accepts that the triplets had been doing well, with Child O being "fine".
Letby accepts that Child O was doing well on the night shift for June 22-23, and had been moved off CPAP on to Optiflow breathing support.
Letby accepts Sophie Ellis's description there was 'nothing concerning' about Child O's presentation.
10:56am
Letby is asked to look at an observation chart for Child O for June 22-23. There is a reading which, the court is told, appears to have been changed from '1430' to '1330'.
Letby says Child O's temperature is a little unstable in the hours prior to 1.30pm on June 23, but accepts he was otherwise "stable".
The court is shown a lab result, that there was no bacterial infection found in a blood sample taken on June 23 for Child O.
A feeding chart showed Child O was "tolerating his feeds very well", Mr Johnson says. Letby agrees.
11:05am
Mr Johnson asks Letby where the 'problem' is for Child O's abdomen that she had said was not dealt with, as there is no data to show it.
Letby says, after looking at the data, she does not know what the problem was.
Mr Johnson says there is no problem shown in the paperwork.
Letby says there was "no formal note" made.
The court is shown Sophie Ellis's note at 7.32am: Abdo looks full slightly loopy. Appeared uncomfortable after feed....reg Mayberry reviewed. Abdo soft, does not appear in any discomfort on examination. Has had bo. To continue to feed but to monitor.'
Letby says the doctor did not formally record it.
Letby accepts a review was carried out at 9am and Child O's liver was reviewed, finding no injury. Letby accepts the liver injury happened 'on her watch'. She says she accepts it happened on her shift, but does not know how it happened.
She denies it happened on her hand.
11:07am
A shift rota for June 23 is shown. Letby was designated nurse for two of the three triplets in room 2 - Child O and Child P - plus one other baby. The third triplet was in room 1, with Child Q and two other babies.
Letby rules out staffing levels as a contributory factor in Child O's collapse or death, or staffing mistakes.
11:17am
Letby says Rebecca Morgan was a student nurse on the unit. She accepts that the student nurse would not always be in room 2, and would sometimes be chatting to parents.
Letby says the two triplets she was designated nurse for were in the high-dependency room, and if she left the room for a period of time, she would ask someone to 'keep an eye' on them.
A note by Dr Katarzyna Cooke at 9.30am is shown to the court, which included: 'No nursing concerns, observations normal'.
Letby says she left the unit at one point to get donor milk for the babies.
Letby is shown a series of text messages between herself and a doctor prior to 9.30am. Letby expresses disappointment in the message the doctor will not be on the unit ['Boo']. Letby says she got on well with the doctor.
Letby asks if the doctor would be on the unit in the afternoon in the message. She adds: 'My student is glued to me.....'
She adds: 'Bit rubbish that you couldn't stay on nnu'. Mr Johnson asks if Letby was 'missing' him. Letby replies this was the first day back from her Ibiza holiday.
Letby sent a message at 9.55am: 'I lost my handover sheet - found it in the donor milk freezer!! (clearly I should still be in Ibiza)'
Letby is asked if it was a 'busy' morning for her. She says "reasonably, not exceptionally".
Letby is asked how she finds the time to text when at work. She says she would not use her phone at the cotside or a clinical area, but would use her phone elsewhere in the unit.
11:24am
A feeding chart for Child O is shown to the court. Letby is recorded as signing for feeds at 10.30am and 12.30pm. She says the writing above is not by her, but by Rebecca Morgan. She says if she has signed, then Rebecca Morgan does not need to sign.
Letby denies feeding Child O. She denies overfeeding Child O.
Nurse Melanie Taylor, at about 1pm, entered room 2 and said 'he doesn’t look as well now as he did earlier. Do you think we should move him back to [room] 1 to be safe?'
Letby declined. She said she doesn't remember being very dismissive.
Letby says "That's Mel's opinion" to the evidence that Melanie Taylor had told the jury she felt Letby was 'undermining her authority'.
She adds that Melanie Taylor had the right to override that and 'take Child O off her'.
Letby denies she had sabotaged Child O, or that this would have meant Child O would have 'escaped her influence'.
11:29am
Letby denies she 'lied' to the doctor colleague about a 'trace aspirate' for Child O at 12.30pm.
Mr Johnson says he is mistaken, as a doctor's note records '0 bile' for the 'trace aspirate'.
Letby says the 160-170 heart rate for Child O, as recorded by the doctor, is higher than normal, and higher than ideal. Mr Johnson says the abnormal readings start, on the observation chart, 180bpm.
Letby had recorded 'tachycardiac' for Child O. Letby tells the court when she reviewed Child O, there was a spike in the heart rate, and in her opinion, Child O was tachycardiac.
11:33am
Mr Johnson says Letby made a 'false, lying entry' in a different chart. A blood gas chart is shown to the court for Child O.
Mr Johnson asks where the lying entry is on the chart.
LL: "I don't know."
Mr Johnson points to the 'CPAP' note on a column. Letby says Child O had some CPAP pressure. Mr Johnson says Child O had not been on CPAP breathing support for "hours and hours".
NJ: "You were covering for air you had given him, weren't you?"
LL: "No."
An x-ray report for Child O is shown, including: 'Moderate gaseous distention of bowel loops throughout the abdomen.'
Letby is asked why she wrote CPAP in her notes.
LL: "I can't answer that now, I don't know."
Letby says she does not know if Child O might have been on some CPAP pressure via Optiflow.
Letby denies 'forgetting to make a false entry on the observation chart'.
11:41am
Letby is asked about messages exchanged between her and a doctor when, at 2.30pm, she was recorded as taking observations for Child O.
The messages were sent at 2.20pm and 2.23pm.
Child O collapsed shortly after 2.40pm. In her defence statement, she said the doctor colleague was on the unit at the time.
Swipe data shows Letby has arrived on the neonatal unit from the labour ward at 2.39pm.
Letby says she cannot say, definitively, where she was at that time. She denies 'nipping out' of the neonatal unit to make it look like she was elsewhere at the time Child O collapsed.
11:44am
The doctor's note is shown to the court: 'Called to see [Child O] at ~1440 desaturation, bradycardia and mottled...'
Letby says she believes she called the doctor to the nursery room. She denies it was to get personal attention; Letby says it was because he was there to assist Child O.
12:09pm
The trial is resuming after a short break.
Letby says a 20ml saline bolus was given to Child O in response to a poor blood gas record. She says there was a delay as there was an issue with getting the line for Child O. She says she believes the bolus, which has 'time started: 1440', was in response to Child O's collapse.
A doctor's note recorded for the '~1440' collapse: '10ml/kg 0.9% sodium chloride bolus already given.'
Letby agrees the two desaturations for Child O that day were "profound" ones.
Letby's note: 'Approx 1440 [Child O] had a profound desaturation to 30s followed by bradycardia. Mottled++ and abdomen red and distended. Transferred to nursery 1 and Neopuff ventilation commenced. Perfusion poor'
Letby, when questioned, says babies would "frequently desaturate", to this level, and this happened prior to June 2015, and "often".
12:14pm
Letby says the redness to the abdomen on Child O was abnormal, and the description of mottling was normal.
Mr Johnson says during the intubation, Dr Stephen Brearey, in evidence on March 15, said Child O had a rash on his chest, on the right side, about 1-2cm in size. He said it was an "unusual" rash that was initially pupuric, and it later disappeared.
Letby says: "I don't believe that's what I saw. I saw mottling. If that's what Dr Brearey saw, then if that's what you could take as being true, then yes."
12:20pm
Mr Johnson says when the doctor went to see Child O's parents, and during that time, Child O desaturated again, for the final time.
Letby says she does not remember this declining moment, but said she put out a crash call.
LL: "I remember the death, but not this precise moment where he declined and I put out a crash call."
Child O was intubated and efforts were made to resuscitate him. Letby says she did not recall seeing the rash disappear. She says she did not see what Dr Brearey and Dr Ravi Jayaram had seen.
Letby says she did not pull an NG Tube out of Child O's stomach.
An x-ray report for Child O is made at 4.46pm. It record: 'NG Tube in situ with its tip close to the cardia, this should be advanced by 10-15mm.'
An earlier x-ray report said the NG Tube was 'in a good position'.
Letby says a dislodged tube would still drain, as it would still be in the stomach.
Letby says the tube could be moved during the intubation process at 2.40pm.
12:24pm
Mr Johnson says Child O's mother, in agreed evidence, said her baby was 'changing colour' with 'prominent veins.' She says she later saw that in Child P.
Letby says she didn't see that herself.
The father of Child O said 'you could see his different veins - it looked like he had prickly heat, like something oozing through his veins'.
Letby says she did not see anything like that.
She accepts she saw a red-purply blotchy rash and a red abdomen.
12:28pm
In police interview, Letby said she believed she had done chest compressions and drew up some drugs. Letby says after looking at records, she now believes she was just involved in medications.
Mr Johnson suggests Letby is distancing herself from the CPR so it could not be said she caused the liver injury to Child O. Letby denies this.
Letby says she "does not know" how Child O got the liver injury.
Letby denies injecting air into Child O to cause an air embolous, or inflicting a liver injury on him.
NJ: "These things all happened on your watch, didn't they?"
LL: "Yes."
Letby says she disputes an account that Dr Brearey told her not to come in after that shift.
NJ: "Were you bothered by what you witnessed?"
LL: "Of course I was bothered."
12:35pm
Messages are shown between Letby and the doctor from 9.14pm on June 23:
Doctor: 'Your notes must have taken a long time - Had you documented anything from this morning?'
LL: 'Only a little. Had the other 2 to write on as well and sorting out the ffp etc. Left signing for drugs until tomorrow'
A nurse also messaged Letby: '*advertiser censored**in hell, what happened?'
LL: 'Can't Think straight so took a while'
LL: 'Blew up abdomen think it's sepsis'
Letby says it's not a term she uses often, but she had seen it before.
LL: 'Had big tummy overnight but just ballooned after lunch and went from there'
Letby tells the court that is what she said, having been reviewed by a doctor and Child O had a loopy bowel. She says she is referring to distention found prior to 8am.
LL, at 9.33pm: 'Worry as identical'
Mr Johnson: "Were you setting up a false narrative here?"
Letby: "No, that's not what I'm suggesting at all."
NJ: "You had already set your plan in motion by pumping air into [Child P] before you left."
LL: "No."
Sky News Updates - https://news.sky.com/story/lucy-letby-murder-trial-latest-former-nurse-tells-court-why-she-repeatedly-searched-for-dead-babys-mother-on-facebook-12868375
10:55
'Back in with a bang': Letby's text before two triplets died
Child O was born at the end of June 2016. He died within the first week of his life.
At the time of his birth, Letby was abroad in Ibiza on holiday with friends - including one of her colleagues.
She returned the day before Child O died.
Text messages she sent a colleague include one on 22 June in which she wrote, responding to a question about when she was returning to work: "
Yep probably be back in with a bang lol".
Within 72 hours of that text, Children O and P had died, and Child Q had collapsed.
Letby agrees this was the case.
She texted a male colleague - one she allegedly had a crush on - and asked about the triplets.
"Did you want to get involved with them?" Mr Johnson asks.
"I was just making inquiries," Letby tells the court.
The triplets were born with few complications - and one had been moved to a lower grade nursery.
11:10
Letby agrees child sustained liver damage 'on her watch'
Medical notes shown to the court indicate Child O was "stable overnight" before Lucy Letby arrived at the unit in June 2016.
"He had some temperature issues, but yes," Letby says.
In a police statement, Letby claimed a nurse had raised concerns about Child O's abdomen and said: "
I do not accept this was dealt with adequately."
Nick Johnson KC, for the prosecution, now asks her: "You are suggesting there was a problem but you are not in a position to tell us the problem?"
"Yes."
Mr Johnson points out there is no evidence of this in the charts.
Letby's colleague made the following note about Child O on 23 June at 7.02am: "
Abdomen looks full, lightly loopy. Appeared uncomfortable after feed. Registrar reviewed, abdomen soft does not appear in any discomfort on examination. Bowels open. To continue to feed but to monitor."
Letby tells the court: "People have stated that if something is not written down, or if somebody writes something it might not be correct."
Child O was found with liver damage.
At 9.30am, another doctor examined Child O and "excluded there being an injury at that point".
"Yes," says Letby.
"Does it follow that the liver injury Child O did sustain happened, in effect, on your watch?" Mr Johnson asks.
"Yes."
"Do you accept that somebody must have inflicted that liver injury on CO during that day shift?"
"I agree it happened during that shift, I don't know how it happened," Letby says.
11:29
Letby accused of sabotaging baby to get crush's attention
Lucy Letby is asked if staffing levels or a doctor's mistake contributed to the death of Child O on 23 June 2016.
She says "no" to both.
The court is shown a series of texts Letby sent that day to her colleague - whom she allegedly had a crush on. She has previously denied this and said she "loved him as a friend".
At 9.32am, Letby texted him "
Boo" after he said he was not on the neonatal unit.
"Were you disappointed he wasn't there, on the unit?" Mr Johnson asks.
"Yes, I enjoyed working with [colleague]," Letby says.
"Did you want to get his attention?" Mr Johnson says.
"No."
"Is that the reason you sabotaged Child O?"
"No."
More texts are shown to the court.
Colleague (9.33am): I thought something similar
Letby (9.36am): Are you here this aft
Colleague (9.37am): Yes back after the clinic
Letby (9.39am): Have fun
Letby (9.40am): My student is glued to me
Colleague (9.41am): Awww. Could be a challenge
Further texts are shown to the court.
Letby (9.45am): Bit rubbish that you couldn't stay on NNU
"Were you missing him?" Mr Johnson asks.
Letby denies this and says it was her first day back.
Letby (9.55am): I lost my handover sheet - found it in the donor milk freezer!! (clearly I could still be in Ibiza)
Letby is asked how she found the time to send so many text messages when on shift. Letby says staff would often use their phones on the unit - but not when they were at the cot side.
11:33
Letby 'insistent' Baby O should not be moved from her care
Lucy Letby is accused of "deliberately overfeeding" Child O.
A senior colleague said to her: "Child O didn't look well."
The senior colleague previously told the court that Letby "undermined" her. Previous messages shown to the court indicate Letby and this person - who cannot be named for legal reasons - were no longer getting on, though Letby says she got on with everyone in a "professional" context.
"What else did she suggest?" Nick Johnson KC, for the prosecution, asks.
"From her recollection that we should move him to nursery one," Letby says.
"And you refused, insistently," Mr Johnson replies.
"I don't recall the details of the conversation," Letby says.
She adds: "I don't recall that but [senior colleague] would have been perfectly within her rights to override me and take the baby off me."
"You had sabotaged Child O, hadn't you?" Mr Johnson asks.
"No."
"Which is why you didn't want him moving outside your control into nursery one," Mr Johnson says.
"No."
11:49
Letby 'falsified medical notes'
Letby is accused of falsifying a medical note, saying Child O was on CPAP (continuous positive airway pressure therapy) when he was not.
"
The level of gas in the bowel is more than would have been expected in a normal baby," one doctor's note said.
"Why did you write CPAP in the gas chart?" Mr Johnson asks.
"I can't answer that now," Letby says.
"Do you accept he wasn't on CPAP?"
"He wasn't on the full CPAP machine," Letby says, but adds that he could have been receiving CPAP via neopuff.
Mr Johnson continues to take the court through what happened on the afternoon of 23 June 2016, the day Child O died.
The colleague whom Letby allegedly had a crush on came to intubate Child O.
The pair exchanged a series of Facebook messages between 2.08pm and 2.37pm, discussing the procedure - and the male colleague's lunch.
Letby disputes she was on the unit at this time, hence why the two were texting.
Medical notes show Letby was allegedly attending to Child O at 2.30pm.
11:50
'Did you want his attention?' - Letby asked about crush
Swipe data shows Letby re-entered the neonatal unit at 2.39pm on 23 June 2016, the day Child O died.
"Where were you at around this time?" Nick Johnson KC, for the prosecution, asks.
"I can't say definitively, but I have come through the labour ward," Letby says.
"Had you just nipped out to make it look like you weren't around when Child O collapsed?"
"No."
Letby is now asked why she called a colleague she allegedly had a crush on to attend Child O.
"Were you trying to get his attention?" Mr Johnson asks.
"Yes, I wanted him to review [Child O]," Letby replies.
"But his personal attention?"
"No."
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Judith Moritz
@JudithMoritz
·
56m
Lucy Letby agrees that it was "big news" on the neonatal unit when the triplets were born. The first time she'd ever come across naturally conceived triplets in her career.
Judith Moritz
@JudithMoritz
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53m
Lucy Letby was on holiday in Ibiza when the triplets were born. She texted another nurse about her return to work after the holiday saying she'd “probably be back in with a bang”. Nick Johnson KC says "within 72 hours of that text, babies O and P both died and baby Q collapsed".
Judith Moritz
@JudithMoritz
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52m
Lucy Letby accepts that all went well for the triplets when they were born, and there were no concerns for their health after their birth.
Judith Moritz
@JudithMoritz
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40m
In her legal defence statement Lucy Letby said she didn't believe that a problem with baby O's abdomen was dealt with adequately. Nick Johnson KC now asks her what the inadequacy was. Nurse Letby says she doesn't know.
Judith Moritz
@JudithMoritz
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35m
Lucy Letby accepts that an injury to baby O's liver happened "on her watch"
Nick Johnson KC: "Would you accept therefore that somebody must have inflicted that injury on baby O on that shift?"
LL: "I agree that its happened on the shift, but I don’t know how it’s happened"
Judith Moritz
@JudithMoritz
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33m
On the day of baby O's death, Lucy Letby was the designated nurse caring for both him and his brother baby P. The third triplet was in another part of the unit with another nurse.
Judith Moritz
@JudithMoritz
·
32m
Nick Johnson KC: "Are you suggesting that staffing levels caused or contributed to baby O's death?"
Lucy Letby: "No"
NJKC: "Are you suggesting any nursing mistake contributed to his collapse?"
LL: "No"
Judith Moritz
@JudithMoritz
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28m
Court shown a text which Lucy Letby sent to a doctor (we can't name). It said "Boo"
Nick Johnson KC: "Were you trying to get his attention?
Lucy Letby: "It was my response to him not being on the unit that day" (1/2)
Judith Moritz
@JudithMoritz
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27m
(2/2) NJKC: "Were you disappointed he wasn’t there?"
LL: "Yes, I enjoyed working with him. Yes"
NJKC: "Did you want to get his attention?"
LL: "No"
NJKC: "Is that the reason you sabotaged baby O?"
LL: "No"
Judith Moritz
@JudithMoritz
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22m
Nick Johnson KC: "You overfed baby O, didn't you"
Lucy Letby: "No I did not overfeed him"
Judith Moritz
@JudithMoritz
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17m
Court has previously heard from another nurse who says she saw baby O looking unwell, and that she told Lucy Letby that he should be moved out of the nursery room he was in with her, and into Intensive Care. She said that nurse Letby had resisted this.
Judith Moritz
@JudithMoritz
·
17m
NJKC: "You’d sabotaged baby O hadn’t you and that’s why you didn’t want him moving out of your control to nursery 1?" LL: "No"
NJKC: "This would have meant baby O escaping your influence wouldn’t it?"
LL: "I disagree"
Judith Moritz
@JudithMoritz
·
11m
Nick Johnson KC suggests that Lucy Letby made false entries on a nursing chart to show that baby O was given some ventilation known as CPAP. He says the baby didn't receive this.
NJKC: "You were covering for air you’d given him weren’t you?"
Lucy Letby: "No"
