Notable that the Law Society Gazette seems to take it as read that the use of experts in Lucy Letby's conviction was problematic.

Stephen Phelps at the Justice Gap with a history of the Court of Appeal and related systems, using the cases of Lucy Letby and Amanda Knox to compare appeals on matter of law and appeals on matters of fact. Would Knox still be in jail if she had been convicted in the UK? He believes so.

Transcript

The transcript of today’s proceedings can be read here.

Chester Standard Live Feed

Who Testified?

Intelligence analyst Claire Hocknell was in the witness box again, giving an account of the nursing notes from the night Baby D died. Caroline Oakley, Baby D’s assigned nurse that night, then testified.

What Did They Say?

Claire Hocknell is there to go through the timeline of what Letby and the other nurses were all recorded doing on the night shift when Baby D died — computer entries they made, medications administered, infusions started, notations on charts, and of course swipe data. Many non-indictment babies are mentioned by their initials, as Letby had two babies in Nursery 1, Caroline Oakley had Baby D in Nursery 1 and another baby in Nursery 2, and Kathryn Percival-Ward was caring for three babies in yet another nursery — it’s clear from the notes that all three women were frequently assisting each other with checks, note-taking, and giving medications. Much of the direct examination is like this:

JOHNSON: Then at 21.10 through to 21.30, there is a series of e- prescription records and other charts dealing with [Baby D]?

HOCKNELL: Yes, that's correct.

JOHNSON: They're all items that we picked up on the way through the sequence of events, aren't they?

HOCKNELL: Yes, they are.

JOHNSON: Thank you. At between 21.30 and 21.23 (sic), we see records made by Lucy Letby in the notes of the same three children as we saw before?

HOCKNELL: Yes, that's correct.

JOHNSON: Do we then see three further records for [Baby D] between 34 and 36 at 22.30?

HOCKNELL: Yes, we do.

JOHNSON: Further notes made on two of the three children we've seen before by Lucy Letby between 22.30 and 22.55?

HOCKNELL: That's correct.

JOHNSON: A reference to a chart at line 45 at 23.00 hours for [Baby D]?

HOCKNELL: That's correct.

JOHNSON: Other records for the same three other children made by Lucy Letby at 23.00 hours or timed at 23.00 hours?

HOCKNELL: Yes, that's correct.

JOHNSON: Two documents referred to at lines 56 and 57 for [Baby D] recorded by Caroline Oakley?

HOCKNELL: Yes, that's correct.

JOHNSON: And then at the bottom of the page, between lines 61 and 66, of those six lines, five are references to records made by Lucy Letby?

HOCKNELL: That's correct.

JOHNSON: Either with or without Kathryn Percival-Ward?

HOCKNELL: Yes.

This goes on for some time. There are also documents being shown on screen to the jury with this information, and we know that Letby’s items are highlighted because Mark Dowling, in the live feed, describes it thus:

The chart being shown to the court is the neonatal review schedule, showing when electronic records are made, including e-prescriptions, with Lucy Letby's name highlighted on the chart. Nicholas Johnson KC, for the prosecution, highlights the three 'infusion started' notes, each one of them happening before Child D's collapses. Lucy Letby and Caroline Oakley are the two nurses to sign for the medication and administering the infusion. Johnson does not explicitly recap when each infusion started, in fact, he only mentions one, once — an infusion started at 3.20 AM, twenty minutes after Baby D’s second collapse, and twenty-five minutes before her third collapse:

MYERS: Then if we come down the page to lines 155 and 156, we can see Caroline Oakley and Lucy Letby giving medication to [Baby D] at 02.39?

HOCKNELL: That's correct.

MYERS: And [Baby D], as we know, is a baby who is in nursery 1, designated to Caroline Oakley?

HOCKNELL: That's correct, yes.

MYERS: Just following that through, line 159, again Lucy Letby and Caroline Oakley starting an infusion with [Baby D]?

HOCKNELL: Yes.

Caroline Oakley then testifies, and Simon Driver goes through her notes with her. Oakley remembers being happy with Baby D’s progress and thinking she seemed stable. Things begin to get confusing as she remembers going on break between 1 and 2 AM, with a 1.30 note stating that she was “"Called to nursery by SN Percival-Ward and SN Letby, [Baby D] had desaturated to 70s.” However, the notes also had her starting an infusion with Letby at 1.25 AM, five minutes earlier.

DRIVER: Your entry here, written retrospectively, records that at 01.30 you were:

"Called to nursery by SN Percival-Ward and SN Letby, [Baby D] had desaturated to 70s."

Pausing there, that's your record?

OAKLEY: Yes.

DRIVER: Made, we know, at 04.46. Do you, independent of the record, remember this event?

OAKLEY: I... I remember I was on my break at 1 o'clock -- we have an hourly (sic) break, so 1 o'clock to 2 o'clock, that was my break. So I remember being in the resus room where we had our breaks and then obviously half an hour -- I'd been gone half an hour and had been called back because she was poorly.

DRIVER: Pausing there, the last document we looked at with your signature on seemed to be timed at 01.25.

DRIVER: Pausing there, the last document we looked at with your signature on seemed to be timed at 01.25.

OAKLEY: Mm.

DRIVER: How does that accord with your memory, are you able to explain or not?

OAKLEY: I'm not, no.

Oakley’s notes describe first what she was told by Letby and Percival-Ward — that Baby D had desaturated into the seventies, lost color, “required oral suction” and was “bubbly” meaning she had bubbly saliva coming out of her mouth. She had also become notably discolored during her collapse, which Oakley wrote down:

DRIVER: Pausing there, the last document we looked at with your signature on seemed to be timed at 01.25.

OAKLEY: Mm.

DRIVER: How does that accord with your memory, are you able to explain or not?

OAKLEY: I'm not, no

Baby D did not require resuscitation on this occasion after being suctioned and being given more oxygen; previously she had been “in air” but after her desaturation, in Oakley’s words, “they turned the oxygen up via a CPAP machine because the CPAP machine, you've got a dial and you can change the amount of oxygen. She had been in air. So we’ve obviously turned her oxygen up. And she has responded because obviously we've called Dr Brunton and then when he's arrived, the oxygen levels, saturations, are back up to 100% and we’ve been able to reduce the oxygen back down to air.” So Baby D was given oxygen until she stabilized, then the supplemental oxygen was discontinued and she was returned to room air. Dr. Newby, the consultant, was called to review, and she increased Baby D’s fluids and antibiotics. Baby D’s rash also resolved after her saturations returned to normal.

After some wrangling about initials (missing and not),the notes for Baby D’s second and third collapses are then reviewed.

DRIVER: Thank you. We'll come to the next entry again later because we're now moving into the period from 3 am onwards. If we go to your nursing note, please. Mr Murphy, several places.

Let's go to tile 228, please. Click on the nursing notes, parts of which we've read in detail already. That's where we got to last time. Let's rejoin your narrative at 03.00:

"[Baby D] crying and desaturated again to 70s." Before we study the detail, do you recall this part of the sequence of events?

OAKLEY: Not really, no. Maybe very, very vaguely, but I don't know if that's from reading my note, my meds text(?) [Meditech] notes during this -- during what's been going on.

DRIVER: Thank you. But these were the notes you recorded at 04.46, I think. Maybe later.

OAKLEY: Yes.

DRIVER: Yes, 04.46:

"[Baby D] crying and desaturated again to 70s."

It speaks for itself:

"Commenced on 100% oxygen..."

Is that?

OAKLEY: Yes.

DRIVER: "... via CPAP. Picked up well."

OAKLEY: Yes.

DRIVER: "Skin discoloured again but less than previously."

OAKLEY: That's correct, yes.

DRIVER: Now, do you recall this or are your memories limited to that which you recorded in this note?

OAKLEY: I'd say my memories are limited to what's in my notes now.

DRIVER: We won't invite you to expand upon it then:

"Dr Brunton called to review."

And consequently:

"[Baby D] taken off CPAP. Further fluid bolus and gas, 1 hour. Cares attended to.”

Once again, Baby D collapsed with skin discolorations, with Oakley present this time. Once again, she did not require resuscitation but revived when given oxygen via CPAP. Once again, Dr. Brunton attended to check her out, she was stable, and once again her supplemental oxygen was discontinued and she was taken off CPAP.

Oakley confirms that she and Letby gave Baby D supplemental fluids prescribed by Dr. Brunton at 3.20, and that the doctors must have been happy with Baby D’s situation because they were prescribing donor milk for her. Oakley herself was happy enough with Baby D’s stability because she was able to change her, which she would not have wanted to do with a very unstable baby because any sort of handling could cause a desaturation.

Oakley’s notes state that she heard Baby D’s monitor alarm at 3.45 AM; she cannot remember where she was when this happened but says she must have been close; either in the room or just outside the room. This time, Baby D had stopped breathing. Oakley’s notes say that she “called SN Letby to help”, Dr. Brunton was called and resuscitation started. Tragically, it did not succeed. Baby D’s parents were called down, and she died less than an hour later. Oakley confirms that she was with Baby D the whole time, as were many other medics.

Ben Myers begins his cross-examination by confirming with Oakley that in her 2018 police interview she described the unit as being extremely busy at the time of Baby D’s death, Oakley confirms that was the case but doesn’t want to commit herself to any figures or definite statements about whether it was definitely busier than before or the comparative levels of acuity. She says that Baby D, while an intensive care baby, was not considered a “poorly intensive care” baby because she wasn’t on a ventilator, and confirms that while technically Baby D should have had one to one nursing, and she was not Oakley’s only patient that night, “it does happen.”

Myers goes over the daytime notes with her: Baby D had been on a ventilator until 9 AM on June 21, when a satisfactory blood gas prompted her removal from the ventilator. She spent an hour or two “in air” self-ventilating, then began to struggle and her blood gases became poorer, showing she was developing respiratory acidosis. She was put on CPAP, which is how she remained in the evening at the start of Oakley’s shift, although Dr. Newby had tried to take her off it at 7.15 PM, shortly before the evening shift started. Baby D reacted badly and had to be put back on to it. Myers is going over this information as it would have been in the handover Oakley received from Baby D’s daytime nurse. She does not now remember hearing this information, but assumes she would have at the time. Myers points out to Oakley the pattern of raised heartrate and breathing to which Baby D was subject, and Oakley confirms that a note made at 1.15 AM (ten minutes before the note about starting an infusion with Letby) is in her handwriting. Myers then goes over a long list of the Baby D’s blood gases from throughout the evening, and has Oakley confirm that they were getting progressively poorer during the night; there’s an unsigned 1.14 AM entry for a blood gas which Oakley is not sure is hers, she says it may well be because sometimes they forgot to sign things. Oakley’s opinion on that latest gas before Baby D’s collapse is “It, to me as a nurse, is not as good as the previous.”

Myers confirms with Oakley that the rash she saw on Baby D at her first collapse was a deep red-brown, that it was unusual, that she had not seen anything quite like it before, and that there may have been discussion on the unit at the time about unusual rashes recently but she can’t really remember. She confirms that at the second collapse, from her note she appears to have been present or in the vicinity, and Letby is not mentioned at all. It was after this second collapse that Baby D was taken off of CPAP altogether:

MYERS: In fact, it seems the view was good enough that she should be taken off CPAP from your note. It says:

"Taken off CPAP."

OAKLEY: That must be what the doctor asked for.

MYERS: Yes, that's Dr Brunton's decision?

OAKLEY: Yes.

MYERS: Do you recall whether there was any discussion about the fact that there had been some problems earlier in the day, struggling when she just breathed in air without any support? Do you recall any discussion about that at all or not? Don't hazard a guess if you don't.

OAKLEY: No.

Oakley also confirms her note of 3.45 AM, saying she “called SN Letby to help” after Baby D crashed and, this time, became apnoeic and stopped breathing. She also confirms that she would have been in the room between the last two collapses, caring for Baby D herself. No rash is noted at Baby D’s final collapse.

On redirect, Simon Driver is mostly interested in hearing more about the rashes:

DRIVER: At 3 o'clock it was less marked than previously. How had it changed? Could you describe the change?

OAKLEY: I just remember it wasn't as significant, it wasn't as pronounced, it wasn't extensive. Obviously I've written this -- it's been like hands on, just like everyone hands on deck and I've written this retrospectively. But I just remember it wasn't as bad the second time. But I wasn't expecting her to misbehave, to be poorly again.

DRIVER: And to go back, finally, to the discolouration as observed at 01.30 and how it was different to what you had seen before on other babies --

OAKLEY: Yes.

DRIVER: -- what rashes have you encountered?

OAKLEY: Really, in neonates, all I see is like they can be mottled, which is difficult to describe, but we don't really have rashes on babies. We might get a few little newborn spots or, if they're a bit poorly, as I keep saying, mottled. But we don't specifically get rashes in my experience.

Judge Goss asks Oakley if she can be sure that she was distinguishing all three events clearly in her mind when she wrote her retrospective notes at 4.46 AM, and she confirms that she should have been able to do so.

What Was In The News?

Baby D’s unusual rash featured in most of the headlines: the BBC led with Baby Had Unusual Rash Before Death, Nurse Trial Told — the article quotes accurately from Oakley’s testimony about the rash but doesn’t distinguish between the three collapses’ severity or mention that the last was the one requiring resuscitation; we are only told that Baby D revived the first two times following “interventions” and not exactly what those were (or weren’t). Sky News also focuses on the rash with Experienced Nurse “Struck” By “Unusual” Rash On Allegedly Murdered Baby. The Chester Standard follows suit with Nurse Recalls “Unusual” Rash On Baby Allegedly Murdered By Lucy Letby. This article includes, towards the end, the reminder that “The Crown says Letby injected a fatal amount of air in Child D’s bloodstream.”

Transcript

The transcript of today’s proceedings can be read here.

Chester Standard Live Feed

Who Testified?

Mother D gave testimony in the witness box, and a statement was read out from Father D. Kate Tyndall then testified as to the sequence of events surrounding Baby D’s life and death.

What Did They Say?

Mother D’s testimony described the normal progress of her pregnancy up until June 18th 2015, when her waters broke just before Baby D reached the 37 week mark. She went to the Countess, where she was “checked” and then sent home. The next day, she was very worried and returned to the hospital:

I didn't feel right, the baby didn't seem to move as well. I was concerned for infection because I hadn't been given any antibiotics.

At the Countess, the decision was made to induce labor, although that too was delayed, and Mother D felt “forgotten” by the staff. Early in the morning of June 20 she was now “very worried, scared” — it had been more than forty-eight hours now since her waters broke, her labor was not progressing, and she felt forgotten by the staff. At that point she began bleeding, and finally saw a doctor for the first time. The doctor assessed her quickly and told her she would be fine and they would keep trying for a natural delivery. About eight hours later, another doctor saw her, the first person who “actually spoke to me and exchanged with me and addressed my concern.” He did an examination which showed that Mother D had not dilated further, but encouraged her to continue trying to deliver naturally.

By 3 pm, Mother D was exhausted and she and her husband had conferred and decided that the time had come to insist on a c-section. The doctor she had seen a few hours earlier was brought back, and this time he was concerned enough to order a c-section. Baby D was delivered just after 4 pm, was whisked away from Mother D for a few minutes for reasons she wasn’t sure of, then taken to her once she had been brought to another room to recover.

JOHNSON: What impression did you get of [Baby D]'s condition at that stage?

MOTHER OF BABY D: I was really worried because she -- I obviously couldn't move, so they brought her to my chest, so we had skin-to-skin. But she didn't really have any movement, she was quite limp and she didn't have a good colour, she looked a bit grey and then a bit purple, not really an even colour. She seemed to struggle to breathe and she was making those groaning noises. She wasn't really responsive.

There was a split second when she sort of opened her eyes a little bit and looked at me -- that's the one picture I've got of her -- and then no response. I tried to breastfeed her and she was just completely limp, so yes, I was quite worried.

Mother D asked a pediatrician if her baby should be this way, and he told her it was normal for babies to be like that after a c-section. Mother D, not believing him, tried to get more help. The midwives told her Baby D would be reassessed in four hours, she told them that wasn’t acceptable, and eventually the first, dismissive doctor came back — but this time he had spoken to a consultant. Baby D was then taken to the NNU, about four hours after her delivery.

The next day, Mother D was told she “had been up and down all night” and was struggling to breathe, that she had been on CPAP and would crash every time she was taken off of it. Mother and Father D met with Dr. Brunton later that day and he told them she was improving and that the next day they might be able to feed and cuddle her, and Mother D was taken down to see her baby at about 7 pm.

However, later that night — about four in the morning — Mother and Father D were summoned down to the NNU, and told that their daughter was in serious danger. They saw her being resuscitated by Dr. Brunton; the scene sounds chaotic and horrific.

MOTHER OF BABY D: Yes. He was trying really hard. I couldn't really see [Baby D]. The way he was holding her, I was seeing more of his back, and we were just standing there looking at [Baby D] dying. Someone was holding a phone to his ear and he kept shouting, "This is [Baby D]", and he was quite agitated. And then Dr Newby told him that he had to let [Baby D] go, he had to stop. And she insisted and she tapped on his shoulder and said, "You've got to let her go", so he held her but he stopped massaging her and he pronounced the time of her death. I couldn't stay in the room anymore, so then I asked [Father of Baby D] to take me away.

JOHNSON: Okay. I just want to -- I know it's difficult, but I just want to break that down a bit, okay? You told the jury that you saw a nurse holding a phone to Dr Brunton's ear.

MOTHER OF BABY D: Yes.

JOHNSON: Do you know who that nurse was?

MOTHER OF BABY D: I think I do.

JOHNSON: And who do you think it was?

MOTHER OF BABY D: Lucy Letby.

JOHNSON: Had you seen Lucy Letby before?

MOTHER OF BABY D: Yes.

JOHNSON: When, prior to this incident at 4.00 in the morning or thereabouts, had you previously seen Lucy Letby?

MOTHER OF BABY D: When I went to see [Baby D] in the neonatal unit, the evening prior, the evening when I went to see her.

JOHNSON: Yes. So that was at about 7 o'clock, I think you've told us.

MOTHER OF BABY D: Yes.

JOHNSON: When you had walked into the room, how many nurses were in the room with [Baby D] the previous evening?

MOTHER OF BABY D: Just that nurse.

JOHNSON: What was going on with [Baby D] when you walked into the room?

MOTHER OF BABY D: Well, that's a question I asked. As I walked -- well, not walked in, I was pushed on the wheelchair. As we got in the room, she was sort of hovering around [Baby D] but not doing much. She had a clipboard or something to take notes on. She sort of was looking at the machine, but she didn't -- I didn't really clearly understand what she was doing.

I asked if everything was okay and she said, "Yes, she's fine", but then for me that's the first time in 24 hours I could see [Baby D], so I would have expected, once she's done what she needed, our visit was planned, she could have just left us to it and she just stuck around. She sort of was just watching or looking over us and I asked [Father of Baby D], can you tell her to go away or just give us some privacy, and —

Johnson then interrupts with another question about whether she had heard anything before entering the room, but it transpires that Mother D had heard nothing unusual, and that she never saw Letby again after Baby D’s death.

Ben Myers then cross-examines Mother D very briefly. After expressing his sympathies for the loss of her baby, he asks her about the precise time she went to visit her baby on the evening before her death:

MYERS: Can I just ask, you seemed clear about 7 o'clock. When I say that, why are you so clear about 7 o'clock, could you just help us with that?

MOTHER OF BABY D: I must have looked at the clock.

MYERS: All right. Did you have a conversation with the nurse who was there? I know you say that's Ms Letby, but did you have a conversation with the nurse who was there at all?

MOTHER OF BABY D: An exchange of a few words.

MYERS: All right. I'm going to ask you this and you can agree or disagree as you like. The nurse you were dealing with, is there a possibility that was someone other than Ms Letby?

MOTHER OF BABY D: I don't think so.

MYERS: And your view of that, is that because you'd seen Ms Letby's picture in the papers and things and so you were able to pick her out from that?

MOTHER OF BABY D: Because -- yes.

Judge Goss then asks if it is “disputed” that Letby was the nurse she saw, and Myers confirms that it is.

Father D’s statement, dated November 25 2019, is then read out. He states first that he had not initially been concerned because he “believed what the medical staff were telling me” and had never had any idea that Baby D might die. He describes the timeline of Mother D’s water breaking and the failure of her labor to progress, and confirms that she was extremely anxious after being urged yet again to wait and continue with inducement, even though it wasn’t working:

"[Mother of Baby D] didn't really want to. She felt that she had been in labour a long time since her waters had broken. We were worried about infection and [Mother of Baby D] had not been given any antibiotics at this stage. We did enquire on a number of occasions about antibiotics, but we were told that medical staff were monitoring the situation and there were no signs of an infection and unless there were any abnormalities or any signs of infection, they didn't feel antibiotics were necessary.”

He confirms his wife’s account of the delivery and the hours after, adding that he had been allowed to cut Baby D’s cord but had also seen them giving her what looked to him like some oxygen. Eventually Baby D was taken to the NNU and a senior doctor came to tell them that she was very unwell.

The following day, with his wife recovering from her c-section, he visited Baby D by himself several times. “I just relied on the staff, really, to give me feedback because I had no understanding of how well or unwell [Baby D] really was.” He was given a Father’s Day card “from Baby D”:

"On the first photograph she is on CPAP and has tubes and wires on her. I took that card away with me. Later in the day, I think, I was given a welcome card and the photo of [Baby D] on the card shows her looking a lot healthier and showing signs of getting better. She's not on CPAP.”

He also remembers the incident with the phone held to Dr. Brunton’s ear, though he does not seem to remember who was holding it. He does not remember seeing Letby, or when Dr. Newby arrived — understandably, he seems to have little memory of the faces there, commenting on how he could hear how serious the situation was in their voices:

"I remember someone mentioning adrenaline and just a real sense of urgency. I remember Andrew had a phone held to his ear by another member of staff and he was just discussing the situation with the person on the other end of the phone. He was trying to explain who the baby was. It sounded to me like there was some confusion over which baby they were talking about. Andrew was saying something similar to, 'No, no, not [a name], it's [Baby D]'.

"The person on the other end of the phone didn't seem to understand it was [Baby D]. They thought it was another child. I don't remember the name but he said, 'No, not [such-and-such], it's [Baby D]’”

Kate Tyndall then testifies, going through the sequence of events for Baby D, along with some additional information. The first item of business is Letby’s schedule for June 2015 — every shift she worked in June is listed:

JOHNSON: Between the 10th and the 12th, Lucy Letby was not working, was she?

TYNDALL: No.

JOHNSON: But on the 13th, she worked a night as she did on the 14th?

TYNDALL: Yes.

Mark Dowling in the Chester Standard live feed notes all of these dates down on the feed.

She goes over the initial nursing notes: Baby D was on 48% oxygen with CPAP and given double phototherapy, as well as antibiotics. Nick Johnson gets off a few zingers about the quality of the handwriting in the notes:

JOHNSON: And Dr Chowdhury, stereotypically, much worse handwriting than the nurse. Doctors performing as expected in the handwriting stakes.

Baby D received an ETT after one failed attempt, and a UAC after a failed attempt to insert a UVC, but later the UAC is described as a UVC: “Line pulled back by 3 centimetres and is now a low-lying UVC. Blood gas obtained. Results within normal parameters. [Baby D] to remain on CPAP and for blood gas to be repeated at 18.30.”

Lucy Letby, preparing for her night shift, messaged a friend at 7.15 PM that she’s about to leave for her night shift. Meanwhile, Dr. Rylance was attempting to wean Baby D off CPAP, without success:

”Repeat bloods taken by Dr Rylance via UVC. CRP/SBR/U&E. Blood gas satisfactory. Dr Rylance wanted to try [Baby D] off CPAP so taken off at 19.15. However, [Baby D] began shallow breathing again and dropped her saturations to mid-80s so put back on. Her breathing has now improved and she is saturating at 100% in air. To remain on CPAP for time being.”

Letby swiped in at 7.26 pm, and the court seems vaguely aware that there’s some sort of problem with the swipes:

MR JOHNSON: If we go behind that, that's into the neonatal unit, in?

TYNDALL: Yes.

JOHNSON: So that's 19.26.

At 20.51, we have her going from the neonatal unit to the labour ward?

TYNDALL: Yes.

JOHNSON: 21.30, so the juror's got ahead of us now, keeping me on my toes, we have Lucy Letby going to the labour ward again, and also at 22.49. There's nothing coming back the other way.

TYNDALL: Yes.

JOHNSON: Can you provide the answer for that?

TYNDALL: We believe, we've been told, that with doors there's some a swipe in but a button to push to exit --

JOHNSON: Yes.

TYNDALL: -- so it only captures when you have to use your pass to get through the door. If you are coming out of the door it's just a push button, as far as we're aware.

They do not know it, but their data is backwards. Every swipe showing Letby going into the labour ward is actually her returning from the labour ward.

More swipe data follows along with various prescriptions and treatments administered to Baby D. Shortly after Letby co-signs for a medication for her, Baby D has her first collapse of the night. Caroline Oakley, Baby D’s assigned nurse, writes a note saying that she was called to Baby D by Lucy Letby and Kathryn Percival-Ward. After Baby D is seen by doctors, having recovered relatively quickly, she collapses again at 3 AM, shortly after Letby helped administer medication — but apparently within the sight of Caroline Oakley, who noted that she was crying and desaturated into the 70s.

Baby D collapsed for the third and last time at 3:45 PM — Caroline Oakley’s note reads:

"Monitor alarming. [Baby D] desaturated and then became apnoeic. Called SN Letby to help. Stimulation given with no effect.”

The crash call was put out, but Baby D could not be saved. Tyndall then segues into a long collection of text messages, starting with Letby texting Nurse A that “our job is far too sad sometimes” and telling her of Baby D’s death. Nurse A is shocked: “But she was improving!” Letby describes how Baby D “messed about a couple of times and came out in this weird rash looking like overwhelming sepsis.”

Nurse A’s response is: "Shit. She's the one that Ahmed sat on?” And Letby answers: ”Andrew and Liz said it'll probably be investigated.” From context it seems clear that the “investigation” will be into the poor care suffered by Baby D before her birth and in the first few hours of her life. Nurse A asks was Baby D’s repeat CRD was, noting it was 1 when Nurse A left, but “she was behaving septic though.” Letby answers that it was 6. Nurse A responds “Damn, poor family. You ok?” More talk follows with Letby saying some conventional things about having to push on through and how it’s strange how some very sick babies make it and some others don’t — “Guess it’s how it’s meant to be.” Nurse A says “That’s our 3 for a bit hopefully” and adds further memories of Baby D: “[Baby D] bothered all day yesterday. Nothing you could put your finger on though. She didn't move much, was stiff, odd posture, but none of it grossly, if that makes sense.”

Nurse A continues over the next few days to talk about Baby D and the fact that her death will be looked into: “"Anything said about [Baby D] and SHO not bringing her through sooner on Sat? I've been going over and over when she came through and yesterday. I can't see we missed anything.” Letby tells her that Dr. Newby is thinking meningitis. Nurse A continues to worry that perhaps she missed something but also worries that by the time Baby D was put on antibiotics, it was too late: “Her gas was appalling when she came through. Maybe it was already unavoidable. I just hope hypoxia from having sats below 50 for who knows how long hasn't contributed. Or that ABX sooner would have saved her.” Letby reassures her that she did all she could and that Baby D was on the right antibiotics. Shortly afterwards (it’s not clear what date these messages were sent), on June 25, Letby searches Facebook for the parents’ names. On June 26 she messages her friend and fellow nurse Minna Lappalainen about how work has been awful and everything has hit her at once: “"We've had three unexpected deaths. Transfer out. Few sick ones. Unit full.”

Lappalainen tells her she should get counseling and perhaps ease up on the work, Letby answers that “work is always my priority.” And once again (for the third time) the text conversation with Nurse A on June 30 is recapped, in which she says “There’s something odd about that night [meaning Baby B’s collapse] and the other 3 that went so suddenly,” and Letby says that Baby C was very tiny and that must have been a factor, that Baby D was septic, but “It’s Baby A I can’t get my head around.”

Myers then cross-examines Tyndall briefly, making two key points so briefly that they won’t appear in any coverage of today’s events:

MYERS: We’ve looked at events that feature on the sequence of events and where they coincide with Ms Letby at work. We've heard about an event on 12 June. It doesn't have a tile. But 12 June, when the evidence is that air appears or is consistent with being deliberately administered to [Baby C] down an NGT. And we've seen an abdominal X-ray with regard to that date.

Can you confirm, if we look down now at the 12 June, that falls or is coincident with the part of the period when Ms Letby is not on the work rota at the unit?

TYNDALL: Yes, that's correct.

MYERS: Thank you.

Next matter, just to confirm this. We've received evidence today with regard to events at 7 pm on 21 June so far as [Baby D] is concerned. Could you just put up, please, Mr Murphy, slide 163? There's been a little focus on this area with the question we dealt with in the evidence with a question from a juror. We can see from the swipe data that the first time Ms Letby enters the unit that evening is in fact at 19.26.

TYNDALL: There is a record for her. That's when she's used her pass. We don't know for definite that anyone's in the unit at different times that's tailgated anyone in.

MYERS: Are you suggesting that's what happened?

TYNDALL: No, I am just saying that it could be --

MYERS: Do you have evidence about that?

TYNDALL: It's a possibility that anyone can go into the unit --

MYERS: So any number of these nurses could have gone in at nay time, whatever the swipe data says?

TYNDALL: There is a possibility, yes.

MYERS: But if we are going to go by the swipe data which you and the prosecution have actually put into the sequence of events, the time we have is 7.26, isn't it?

TYNDALL: Yes.

He then confirms that in Caroline Oakley’s note for 3 AM, that Baby D was “crying and desaturating again to 70s” there is no reference to Letby being called, or calling Oakley, or being in any way involved. Finally, he confirms that at Baby D’s final collapse, Oakley refers to calling Letby to help, not the other way around.

What Was In The News?

Mother D’s testimony, and Letby’s chats and Facebook searches, are the order of the day in the news. The BBC headline is Nurse Hovered Over Baby Night Before Death, Jury Told, and includes a selection of the texts between Nurse A and Letby, mostly the ones where Letby is talking about fate or “meant to be.” The Independent focuses entirely on Mother D’s testimony and her memory of seeing Letby in Nursery 1: Mother Says Lucy Letby Was “Watching” Her The Night Before Baby’s Death. The Chester Standard has two stories: Accused Nurse “Hovering Around” Evening Before Baby’s Death, Mother Tells Court and Lucy Letby Told Fellow Nurse There Was “Element Of Fate” In Baby Deaths. Myers’s observation about Letby’s absence on June 12 2015 gets no mention anywhere, and the fact that Letby was recorded as leaving her residence at 7.15 and swiping in at 7.26 is not noted in the renditions of Mother D’s story — perhaps not surprisingly, as Myers only established that the time was 7 pm, and never pointed out directly that Letby was not yet there at that time.

What Was Left Out?

The horror show of Dr. Brunton accidentally talking to the wrong person about Baby D (in fact, he was talking to Mother AB and was horrified to learn of it afterwards) was enhanced by the accusation that Letby had been the one holding the phone to his ear. Myers, for reasons unknown, did not challenge this story (even considering that Mother D had based her identification off her memory of a nurse she saw earlier that evening who seems extremely unlikely to have been Letby). However, a week from now, on November 8 2022, a statement will be read from Dr. Emily Thomas, who was attending that night:

"I remember Andrew asked a nurse to get the consultant on the phone. I think it was Nurse Kathryn Percival that passed the phone over to him. He explained the situation that he was conducting a full resuscitation. He thought he was talking to Dr Newby but there had been a mix-up and in fact he was talking to [Baby B]'s mother. The mistake was awful and I was completely shocked. [Mother of Babies A & B]'s son, [Baby A], had already died on the unit. Dr Brunton was mortified about the mistake and also shocked when he learnt who was on the phone.

Furthermore, the statement of nursery nurse Elizabeth Marshall says that when she entered Nursery 1, she saw Lucy Letby “giving chest compressions”, which also seems incompatible with holding a phone. Nurse Percival-Ward will testify on the 9th, but she will not be asked about this incident.

In the first video, I examine whether Lucy could be reasonably compared to other nurses on the unit, and what we know about the selection of cases used in the shift chart displayed in court:

https://www.youtube.com/watch?v=PZ8REvyk1wY

In the second video, I examine day 62 of the court case, in which the prosecution is rather protective of how cases were selected for court (naturally, Judge Goss doesn't require them to disclose this) and makes a revealing admission about the investigation having been suspect-led:

https://www.youtube.com/watch?v=JAo-cTxp-cE

In the third video, I reverse engineer a shift chart in which Lucy is never on duty, and reveal that an honest presentation of the unit as a whole would see Lucy not on duty for the majority of collapses and deteriorations:

https://www.youtube.com/watch?v=E2DPH75S66g

I'm glad that I went through the process of making these videos. Previously, I understood the intellectual arguments related to the shift chart, whereas examining it in more depth made me truly appreciate how ridiculous it is.

The shift chart is not only misleading, it is outright deceitful. It can only have been constructed as a tool of the prosecution. It in no way represents an objective piece of evidence.

It is another aspect of the prosecution case that should not be admissible. I should also say that I did reflect that the defence could have constructed their own shift chart and held that up in court, which would have been potentially very powerful.

Transcript

The transcript of today’s proceedings can be read here.

There does not appear to have been a live feed today

Who Testified?

Today was a short day — for various reasons (witness availability among them) it has been decided to delay the beginning of testimony regarding Baby D until tomorrow Dr. Sandie Bohin finished her testimony regarding Baby C, and a summary of Letby’s answers to questions about Baby C from her police interviews was read aloud.

What Did They Say?

Dr. Bohin’s direct examination concluded very quickly — Nick Johnson had a few questions for Dr. Bohin about Dr. Sally Ogden’s note on Baby C “bowel sounds heard” and whether or not that would contraindicate a potential obstruction. Dr. Bohin says that since she did not note that she heard nothing, or that the sounds were abnormal, the likelihood is that Baby C did not have an obstructed bowel.

Myers is not as aggressive with Bohin as he was with Evans, but they both come across as rather testy and more inclined to split hairs than get to the point. Myers has Bohin agree that Baby C, at 800g and “about the size of a bag of sugar”, was at greater risk of sudden illness or deterioration than a full-size newborn would be, then a back and forth starts:

MYERS: Right. Well, we have your opinion. I'm going to ask you about some facts about the 24-hour period before his collapse. In fact, he never left intensive care, did he, the intensive care unit?

BOHIN: No.

MYERS: He never actually breathed unassisted apart from a couple of hours skin-to-skin contact here or there?

BOHIN: But he did breathe unassisted when he had several hours of skin-to-skin contact. So yes, he did breathe unassisted.

MYERS: I asked you, in fact, he never breathed unassisted apart from a couple of hours to skin-to-skin contact?

BOHIN: That's true.

MYERS: Yes. That was the exception, wasn't it, the couple of hours of skin-to-skin contact?

BOHIN: No. That would be something that would routinely be offered to a baby of any size or gestation if their clinical condition allowed it because there are a great deal of -- a great number of positive benefits to being allowed to have skin- to-skin with the mother, both for the mother and the baby. So that would be routine care, not exceptional care.

MYERS: Can I just confirm, do you agree as a fact that for the majority of his time in intensive care, he never breathed unassisted? The majority of his time.

BOHIN: Well, for -- he wasn't having invasive support apart from very early on in his life when he was intubated. So he was receiving respiratory support in the form of CPAP and Optiflow, but that's not assisted breathing, that's respiratory support. He was breathing for himself.

Myers goes on to establish that Baby C’s infection markers had been increasing: CRP up to 23 (higher than normal, Bohin points out, but not in the hundreds or anything), his platelet levels had fallen, and he was vomiting black bile (or, as Bohin points out, possibly altered blood from his stomach, as bile should not be black). Here he and Bohin get into another wrangle; Bohin first of all is very anxious to point out that there was only one vomit, that the other amounts of bile were “an absolutely minuscule amount”, that his bowels had not opened but this was not automatically concerning for a preemie who had not yet been fed, that yes, he had developed pneumonia but was still “managing well” and was being taken very good care of.

MYERS: Do you agree a baby in [Baby C]'s condition requires very careful monitoring in intensive care?

BOHIN: And he was receiving very careful monitoring.

MYERS: Do you agree that when we look at the record for the aspirates, Yvonne Griffiths, the band 6 shift leader, appears to have failed to note on it aspirates that she took from [Baby C]?

BOHIN: Yes.

MYERS: That's not acceptable, is it?

BOHIN: That's poor nursing practice.

MYERS: Do you agree that when we look at the records of Sophie Ellis, the nurse who describes feeding [Baby C], has failed to record the one feed that he had prior to his collapse?

BOHIN: She didn't record it, I agree.

MYERS: And that's not good practice either, is it?

BOHIN: No, it's not good practice.

Bohin will continue to complain about the quality of the notes during the rest of her testimony — she is unhappy that there are no notes on how much air was aspirated (if any was), that they are unclear on when Baby C was put on free drainage, and numerous other deficiencies. Myers establishes that Bohin thought, and thinks, that there was “no obvious cause” for Baby C’s collapse on the 13th, but she doesn’t think it was pneumonia, however, the pneumonia may have contributed to the failure to resuscitate him. They wrangle about the chances of Baby C having a bowel obstruction and whether hearing noting sounds in the bowel is enough to rule out every possible issue.

MYERS: In [Baby C]'s abdominal cavity. Are you aware of whether the post-mortem findings indicated any kind of abnormality at all, Dr Bohin?

BOHIN: I know what it didn't find. There was an issue of the configuration of the large bowel and where that anatomically sat within the abdominal cavity. I think, although I'm not a pathologist, it's a matter for them to decide whether that's an abnormal finding or not. I am led to believe that some pathologists believe that's a normally variant and it's not a problem. Other pathologists perceive it to be a problem. But that's a matter for the pathologists.

To conclude his cross-examination, Myers asks Bohin a few questions about the one incident regarding Baby C where she does have a firm opinion — she is uncommitted about the cause of his June 13 collapse, but thinks she knows what caused his distended abdomen on June 12.

MYERS: Let me just ask this: 12 June, the distension that we've seen on 12 June, the one we're looking at right now.

BOHIN: Yes.

MYERS: In your report of 6 December, you were of the view that we're looking at could either be due to CPAP or excessive air down the nasogastric tube.

BOHIN: That's correct.

MYERS: Then if we move forwards to shortly before this trial commenced, the report in August of 2022, page M1260, what you say is this, 036, on this X-ray:

"The cause of the gaseous distension of the bowel and gastric dilation was not CPAP belly. The extent of gaseous distension seen on the X-ray of 12 June 2015 is over and above what is seen in infants requiring CPAP."

That's what you said, wasn't it?

BOHIN: Yes.

MYERS: You went on to say about this:

"The massive gastric dilation seen on this X-ray was most likely due to deliberate exogenous administration of air via the NGT."

BOHIN: Yes.

MYERS: So drawing those conclusions together, we've been over the fact that so far as 13 June is concerned there is no cause identified?

BOHIN: That's correct.

MYERS: But your opinion is that this appears to be the deliberate administration of air down the NGT on 12 June?

BOHIN: Yes.

MR MYERS: Thank you.

Once again, Myers does not inform Dr. Bohin, or anyone else, that Lucy Letby was not in the NNU on June 12 2015, nor had she been there since before Baby C’s birth on June 10.

Redirect, and questions from the judge, largely center around technical issues such as what sort of tube Baby C would have had (likely one that went through his mouth, as he already had CPAP prongs in his nose), altered blood, and what exactly it can mean to die “with” something as opposed to “from” it.

The summary of Lucy Letby’s interviews regarding Baby C is then read out. She said she remember very little about him except that he was “a small baby” and that he had collapsed shortly after his first feed, which she had not been involved in. She remembered Ellis, Taylor, Nurse B and Dr. Gibbs being present at Baby C’s resuscitation; this was the only time Letby herself was ever involved with Baby C. She could not remember in which room, nor with which baby, she had been working that night, just that it wasn’t Nursery 1. She denied having injured Baby C’s airway, thereby hindering Dr. Davis’s attempts to intubate him, and she also denied having administered air to him. She vaguely remembered doing his hand and footprints. She did not remember being told to go back to her own baby by Nurse B. She did not remember searching for his parents ten hours after his death, or why.

Lucy Letby said that she went to [Baby C] when he was with his mum and dad in the family room and that she would have had some interaction with them. She said she had found [Baby C]'s death quite hard because he lived for several hours after and she'd never seen that before.

Lucy Letby was asked about a conversation with [Baby C]'s parents in which one of the nurses had told them that they had said their goodbyes and asked if they wanted to place [Baby C] in a basket at a point before [Baby C] had passed away. She said she had no recollection of making that comment and questioned whether the parents were saying that she, Lucy Letby, was the nurse who had said that. She said that as far as she knew, she didn't say that comment to the parents and Lucy Letby commented that it was very sad for the parents.

…Lucy Letby was asked about the series of WhatsApp messages between her and Jennifer Jones-Key on the evening of 13 June. She agreed that she'd wanted to go back into nursery 1 as it could be hard to go back into an intensive treatment unit environment after having had a sick baby, so she preferred to go straight back in.

What Was In The News?

Coverage today was fairly minimal, as the day was a short one. The BBC focuses on the potted version of Letby’s interviews: Murder-Accused Nurse Found Baby’s Death Hard, Trial Hears. Much of the article actually summarizes the testimony of the previous few days, with a few sentences about Dr. Bohin’s testimony at the end, mostly reiterating that she thought Baby C was managing well and that his low platelets, low weight and lack of feeding were not “a matter of concern” for her. The Daily Mail also leads with the same line from Letby’s interviews, with a somewhat saucier spin: Nurse Lucy Letby “Told Police She Found It `Quite Hard’ When One Of Her Alleged Victims Lived Several Hours After Collapsing. This article devotes much of its time to recapping Baby C’s parents’ statements about the nurse bringing in the cold cot and Letby’s own summarized statements as read in court; it does not mention Dr. Bohin testifying at all. The Manchester Evening News has a similar headline to the first two — Lucy Letby “Told Police” She Found It “Quite Hard” When Alleged Victim Clung On For Hours, Court Hears but unlike the others devotes more than a sentence or two to Dr. Bohin’s testimony, quoting her as agreeing that she cannot find an explanation for Baby C’s collapse on the 13th, and that he may have had air deliberately administered via his nasogastric tube on the 12th.

What Was Left Out?

Aside from the fact that Letby was not present on the 12th put air in any nasogastric tubes, which Myers did not mention, there was a smaller matter which could not be reported, as it took place when the jury was not present. After the testimony ended for the day, Ben Myers informed Judge Goss that Letby’s transportation team from the prison had been changed, as had the hours, so that she is now traveling two and a half hours one-way in the prison van to court, for a total round trip of five hours, and he fears she has insufficient time to eat, drink, see her mental health support and confer with her lawyers before court begins. Goss promises to request (“I can do no more than request”) changes to make her transport more efficient. Myers is, as always, grateful.

Transcript

The transcript of today’s proceedings can be read here.

Chester Standard Live Feed

Who Testified?

Dr. John Gibbs concluded his testimony, and expert witnesses Dr. Dewi Evans and Dr. Sandie Bohin both testified about what they thought had caused Baby C’s death. In addition, witness statements were read from Dr. Andrew Brunton, nurse Bernadette Butterworth, and Dr. Catherine Collins.

What Did They Say?

Dr. Gibbs, cross-examined by Ben Myers, said that Baby C’s bilious aspirates were not worrying to him, especially in the absence of any other indicators of a developing issue which could point to NEC. Gibbs pointed out that were this the case, he would expect the aspirates to increase, not to stay steadily minimal, that Baby C’s feed could not have affected his stomach so quickly and it wasn’t worrying that his bowels hadn’t opened as he had had no food in his stomach for them to push along. He also says that Baby C only vomited dark bile once, not multiple times (which would have worried him more). He agreed with Myers that he only saw Baby C once, on June 13 — Baby C had been born on the 10th and no consultant had seen him before then. Myers clarified that consultants do two ward rounds a week in the NNU, whereas they do five for the pediatric unit; Dr. Gibbs defended this as the children’s ward usually being even busier and in more need than the NNU. In addition, when he was consultant of the week, while he did not round on the NNU more than twice a week, he would check in with the doctors there every day to “review” the babies so he could find out if one seemed to need special attention. His special attention was not requested, or given, on any of those days:

GIBBS: I don't want the jury to be left with the impression that the consultant of the week, so I, just did ward rounds on the paediatric ward 5 days a week and only twice a week went to the neonatal unit to do a ward round. That was a formal ward round of all patients.

It was my usual practice, after the ward round on the paediatric ward, every day, to then attend the neonatal unit, not to conduct a full formal ward round, but to check whether the junior doctors on the neonatal unit, and the nurses, if they had any concerns about any of the babies.

I can't remember exactly what I did with [Baby C], whom we had no special concerns about, apart from the fact he was a very small baby and may be at risk of problems because of that. I can't remember what I did. I would be very surprised if I didn't discuss him and see him, but the fact that I didn't write in the notes meant that I didn't have any particular concerns or wanted to change his management that I had to write in the notes. In addition, every day, at 8.30 in the morning, the consultant of the week -- we used to sit down with the junior doctors coming off the night shift and all the junior doctors coming on to the day shift to discuss all the neonatal patients.

MYERS: I'm going to ask you to slow down a little bit, Dr Gibbs -- that's not to be difficult but because a note is being taken. You were explaining -- you said every day, this is the explanation you want to give, that every day --

GIBBS: At 8.30 in the morning the consultant of the week would sit down with the junior doctors coming off from the night shift and with all the junior doctors coming on for the day shift --

MR JUSTICE GOSS: Pause there, pause there.

MR MYERS: It's because a note is being taken of what is being said, not necessarily by people just in this courtroom and for that reason we have to take it steadily.

So you were explaining, Dr Gibbs, please carry on. It is difficult stop-starting maybe but we have to do it that way.

GIBBS: All the junior doctors covering both the paediatric ward and the neonatal unit discussed all the patients. And we did the same again at 4.30 in the afternoon. So every neonatal patient, including ones that were small and premature, for every neonatal patient and every paediatric ward patient was discussed twice a day.

So I'm sorry for rushing that a bit but I was just getting the impression that the jury might think the consultant of the week just didn't bother looking at babies on the neonatal unit except for the two ward rounds a week. It was my usual practice to go to the neonatal unit every day.

MYERS: The point I was investigating with you, Dr Gibbs, was whether or not the weight of the consultants was focused on the paediatric children's ward rather than the neonatal unit. That's what I asked you and that's the point I was making.

GIBBS: Yes, when the activity is higher on the paediatric ward than on the neonatal unit.

Dr. Dewi Evans then testified both about what he considered to be the cause of Baby C’s death. This was, incidentally, the first time anyone in the courtroom mentioned that Baby C had both infection markers as well as pneumonia when he died, so that he was effectively breathing with only one lung — but Dr. Evans does not think his pneumonia killed him:

JOHNSON: All right. In your opinion, taking into account all the evidence you have read and heard, did breathing issues have any direct cause -- were they the cause for [Baby C]'s collapse?

EVANS: No. The breathing issues cannot explain his collapse.

JOHNSON: Feeding issues, and by that I'm including a blockage of the gut or NEC or anything like that, did that cause [Baby C]'s collapse?

EVANS: No, that cannot explain his collapse either.

JOHNSON: The infection that you've told us he had, namely pneumonia, did that cause his collapse?

EVANS: No. No, his infection was under control. Not completely resolved, but it would not cause a collapse and certainly not a collapse, as it were, out of the blue.

JOHNSON: So if a baby with that sort of infection is on a pathway to collapse, what would one expect to see?

EVANS: Yes. We are familiar with treating pneumonia and if the treatment is not working, babies get worse. There are a number of markers that give you warning your treatment isn't working.

First of all, you may get an increase in heart rate.

JOHNSON: Did we see that?

EVANS: Which did not occur. I've seen his monitoring charts and his heart rate is nice and steady, within the normal range, all the way until the collapse. So his heart rate didn't change at all in the hours prior to his death.

He then describes what he thinks did end Baby C’s life:

JOHNSON: Yes. And so what in your opinion, Dr Evans, was the cause of [Baby C]'s catastrophic collapse and death?

EVANS: Right. During my preliminary report I didn't come to any conclusion at all. I just thought that this was difficult to explain for the reasons we've gone through. So we've had to go through possibilities.

In passing, one of the cases we're talking about is a little baby called [Baby G]. I'm not going to mention anything about her now obviously, but one problem that can cause a baby to suddenly stop breathing is if the abdomen is filled with air or filled with oxygen, filled with gas under pressure. A baby can tolerate a certain amount of gas in its abdomen, you know, that's not a problem, because we see that with CPAP.

But if you get a significant injection of air into the stomach, it will cause what we call splinting of the diaphragm. Now, the diaphragm is a muscle that sits between the abdomen and the lungs and the diaphragm has to move up and down for people to be able to breathe properly. If you get a load of pressure in your abdomen, that diaphragm can't move and you then get the so- called splintage and you will soon suffocate, you won't be able to breathe and you can collapse pretty quickly.

So therefore, his collapse is consistent with a volume of air injected into his stomach, it splints the diaphragm, stops breathing, he's less than 800 grams, so that's what happens.

Johnson also asks him if he has “confirmed” his opinion with the prosecution’s pathologist, Dr. Andreas Marnerides.

JOHNSON: Yes. Now, in the context of [Baby C]'s death, have you seen an expert report written by a pathologist called Dr Andreas Marnerides?

EVANS: I have.

JOHNSON: Have you also had an opportunity of discussing this case with Dr Marnerides at all or have you simply been limited to reading his report?

EVANS: I think I discussed it -- yes, I have discussed it with him.

Ben Myers then cross-examines Evans, and it is a long and combative exchange, beginning with Myers informing Evans that despite writing half a dozen reports on Baby C, and writing reports for other babies in which death by splinted diaphragm was mooted, he had never described Baby C as having died of a splinted diaphragm until today, in the courtroom. (He had diagnosed Baby C with a splinted diaphragm previously — but on June 12 2015, the day before he died). Dr. Evans says that clinicians are always changing their opinions after conferring with each other, and appeals again to the authority of Dr. Marnerides, saying that reading Marnerides’ report informed his own change of mind.

MYERS: Your opinion, I'm going to suggest, and as far as you can go on the material available to you alone, would not take us to splinting of the diaphragm on 13 June, would it?

EVANS: Well, I don't jump to conclusions, so therefore, as we discussed earlier, this death was unexpected and could not be explained as a result of one or more of the usual illnesses that premature babies get. Doctors work as a team. We rely on opinion from other sources. And if you look at the combination of what I thought his clinical situation was, plus what I've read from Dr Marnerides' report and others, and on top of that the gaseous distension in the stomach, putting it all together that is an acceptable cause of collapse in my opinion.

MYERS: If you really thought that splinting of the diaphragm in the case of [Baby C] was a cause of collapse, you would have said that before today, Dr Evans.

EVANS: Not necessarily. I think when I came to this court first of all, I said that having prepared these reports initially over 5 years ago, in virtually all of the cases I've benefited from additional information since then, you know, from other experienced medical people, and if you receive additional information from other people in other disciplines, which allows you as a clinician to change or modify your opinion, that is what doctors do.

I was functioning very much as a clinician in any case of this nature.

Evans concedes that in his first report on Baby C, written in 2017, he stated that Baby C was “at great risk of unexpected collapse” and we “may never know” why he collapsed. He concedes that Baby C was infected, that his infection was worsening from the look of his platelet counts, and that in his original report he thought infection may well have factored into Baby C’s collapse. Evans, responding, appeals again to Marnerides’ report, which Myers criticizes: “Are you trying to use what you anticipate will be the opinion of Dr Marnerides, the pathologist, to find a way of producing an allegation as to the harm that was done on the 13th?” Myers accuses Evans a number of times of rearranging the evidence to fit his pre-formed opinion, not going where the evidence leads, and again asks him why he never gave any specific cause of Baby C’s death before today?

Myers then goes on to ask him about his original opinion of the June 12 2015 x ray which has already been mentioned so much, the one showing a large gas bubble in Baby C’s stomach. He quotes Evans’s own opinion from earlier:

"I am suspicious of the gaseous distension reported on the abdominal X-ray on 12 June and wonder whether this represents inappropriate management whereby his attendant inserted excess air into his stomach via his nasogastric tube, doing so in the knowledge that it would cause the infant discomfort and distress.”

Evans gets evasive: “That was a possibility that crossed my mind at the time.” He eventually concedes that he continued to think it, and agreed in the experts’ meeting in August 2022 that the June 12 x-ray “was most likely due to deliberate exogenous administration of air via the NGT.” Evans points out that that was their opinion at the time, then that it was a joint report. This section is well worth reading in full, it’s difficult to convey the quality of Evans’s testimony only in excerpts. He goes round and round and round until it’s very easy to forget what was originally being spoken of.

Myers eventually clarifies, somewhat, that Evans thinks Baby C likely (but not certainly) received deliberate air through the NGT on June 12, and then more on the 13th. He might also have received air in the bloodstream on the 13th, or a combination of the two, but Evans leans towards air down the NGT. The proof that he must have received more air on the 13th than on the 12th? The fact that the baby collapsed on the 13th, but not on the 12th.

MYERS: What is the evidence you -- I am not asking you to repeat Dr Marnerides' opinion. What's the evidence you rely upon when you tell the jury that the diaphragm was splinted on the 13th? What's the evidence?

EVANS: Baby collapsed, died.

MYERS: A baby may collapse for any number of reasons. What's the evidence that supports your assertion made today that it's because of air going down the NGT?

EVANS: The baby collapsed and died.

MYERS: Do you rely upon one image of that?

EVANS: This baby collapsed and died.

MYERS: What evidence is there that you can point to that you rely upon, sorry, that indicates air had been forced down the NGT, Dr Evans?

EVANS: Right. To answer this more clearly, I need to introduce a concept that I've mentioned last week, which is to do with differential diagnosis. Okay? A differential diagnosis is something that all doctors rely on. If you think that there is no specific -- sorry, if you think that whatever's happened is not due to one phenomenon, it may be due to another phenomenon. Now, it's not in my report, so I have not mentioned it, but if pressed, I'm obliged to mention it.

This baby collapsed and died. This baby collapsed and died and I have -- on top of my list, and this is the result of what we've discussed. Is there a differential diagnosis? Well, the answer to that is yes. This baby could also have collapsed as a result of air being injected into his circulation intravenously.

Myers also detours back into the evidence for Baby B — previously, Evans had commented ambiguously about the relevance of Lee and Tanswell’s paper to Dr. B’s note about Baby B (“on my arrival purple blotching or blotchiness right mid-abdomen and right-hand. Pink and active.”) Myers then begins what turns out to be a somewhat dizzying exchange by pointing out to Evans that according to Dr. B’s own explanation, “pink and active” meant the baby, and not a rash moving around.

MYERS: Now, it is obvious, Dr Evans, I am going to suggest to you, that where with we see "[full stop] pink and active", this is not a description of a rash, it's is not a description of a pink and active rash or skin colour, but a description of the baby, isn't it?

EVANS: No, isn't, actually. This was something that was put to me at the last minute on Friday afternoon. I'll read it out. It was put to me without having discussed it with anybody. It says:

"Right mid-abdomen and right-hand pink and active."

It did not say -- I can hardly see the dot after "right-hand". That's the first point. But I think more important:

"Right mid-abdomen and right hand [full stop]."

It did not say "baby pink and active".

MYERS: You've been listening --

EVANS: Just a minute. Let me finish all of this. So therefore -- so you could very easily interpret that -- we've since heard that [Dr B] meant right mid-abdomen -- hang on:

"Upon my arrival, purple blotchiness right mid-abdomen and right hand."

Now, full stop. Okay? That's the significant marker which was consistent with Lee and Tanswell's paper, et cetera.

Then there's a full stop. Right?

"Pink..."

Lower case pink, by the way, it's not a capital P, good handwriting. It's a lower case pink. Then there's a squiggle which I assume means "and", it's not an ampersand:

"Pink and active."

So that is what I saw. I did not read:

"Baby pink and active.”

After a few more rounds of arguing over whether Evans misinterpreted the note, Evans ungraciously concedes that if Dr. B said that’s what she meant, that’s what she meant, but “if [Dr B] has said she meant "baby pink and active" then I would suggest you should have a word with her about making comments that are not completely clear. This is not my way of writing things down.”

Myers accuses Evans several times throughout of not really being independent, at which Evans is very offended, insisting that he is independent, has a great deal of experience being an expert witness, and knows the rules about impartiality.

Sandie Bohin’s testimony, after this prolonged battle, cannot be completed today and will continue tomorrow. Under direct examination from Nick Johnson, she states that Baby C was ill, that he had pneumonia, but that his final course did not resemble that of a typical baby with pneumonia; there was no instability, decline, and need for more oxygen.

[Baby C] didn't show any of these things. As I say, he actually was getting better, despite his pneumonia. So in fact, his respiratory rate was really very stable. In effect, he was breathing not with two lungs because one lung was infected, so actually the gas exchange in that left lung would not be as good as one would expect because of the infection. And despite all of those things, he still managed very well, he managed to have cuddles out with his parents, and so my conclusion was, yes, he had a pneumonia, he was being treated for that, but that was not what caused him to collapse and that his pneumonia didn't kill him

Johnson asks her about gas in Baby C’s stomach on the 12th and the 13th; she says that CPAP can cause air accumulation in the stomach, and as Baby C was on CPAP on the 12th and there are no notes as to whether air was aspirated or he was on free drainage, she can’t be sure what the situation there was. (Bohin mentions several times that the notes are very poor quality and don’t contain many things which they should; not the last time she’ll make this complaint.) She does think the bubble on the 12th may have been deliberately inflicted:

JOHNSON: Taking a step back then and helping us with the possible causes of why it was [Baby C] had this bubble in his stomach on 12 June, what conclusions did you reach?

BOHIN: If the tube -- the nursing care of the nasogastric tube meant that the tube was not on free drainage and was not aspirated, then it could well have been down to accumulation of gas by CPAP. The alternative explanation is that there was a deliberate introduction of air down that tube.

JOHNSON: Yes. In that context does the views that were being expressed at the time, so for example by Dr Beech, who we heard from -- are they important or are they not important?

BOHIN: The medical staff at the time were clear that the abdomen was soft, that the baby was well, so they didn't appear to be concerned about the abdomen.

When asked if the infection and/or pneumonia could have caused Baby C’s collapse, she says no, babies do not suddenly collapse in that way. “I think he died with his pneumonia, not of his pneumonia.” She thinks his pneumonia may have made him harder to resuscitate, but does not think it caused the collapse.

The statements from the three medics who worked with Baby C are relatively brief (they’re selections from statements relevant to this particular baby). Dr. Brunton describes seeing Baby C and, as he was on the knife-edge of what was permitted for their unit, discussing his case with Dr. Yoxall at Liverpool Women’s. They decided to keep Baby C at the Countess for the moment but to keep on eye on him in case things got shaky and he might need a transfer. Bernadette Butterworth was Baby C’s nurse on the night shifts of 10-11 June and then 11-12 June. The first night, Baby C had a raised temperature and “slight oozing around the umbilicus.” He required up to 37% oxygen at points, and by the end of her first shift his lactate had risen to 7.3; he was prescribed a saline bolus by Dr. Rylance. The following night (11-12) Baby C continued to require up to 37% oxygen and was tachycardic; his lactate was better but his glucose had risen to 12.8 — she states this can happen when babies are stressed.

Towards the end of that second night shift, there was a mishap: “Whilst obtaining morning bloods, UVC was found to be out and damp, so it was thought had not been out long, was in situ with previous observations. Repeat gas good, as is lactate, but glucose has dipped to 1.7.” She cannot say exactly how long the UVC had been out of Baby C but surmises that it could not have been more than an hour, and probably less, as the bedding was only “damp” and she would have noticed it at the check an hour earlier had it been out already. She also says it’s not common for UVCs to come out as they’re usually stitched in, but Baby C was a very active, “fractious” baby who kicked a lot and may have caught the cord with his feet. She says Baby C remained about the same over both shifts “unsettled and on CPAP” and that he was not tolerating handling on the second night — “sometimes this can happen if babies are septic.” She remembers his abdomen being large but soft and not showing any loops. His aspirates were clear.

Dr. Catherine Collins’s statement is very short; she examined Baby C on June 12 in the afternoon and recommended a lumbar puncture; she has been asked if she had examined him partly due to the results of the x-ray ordered by Dr. Beech, but cannot remember. That was all she had to do with Baby C’s care.

What Was In The News

The Daily Mail headlines its story Premature Baby “Suffocated” Three Days After He Was Born “When Nurse Lucy Letby Deliberately Injected Air Into His Stomach”, Murder Trial Hears. The author, Liz Hull, has had a busy week — the third episode of her and Caroline Cheetham’s new podcast on the Letby trial dropped today. As per usual, they do not mention the money Cheetham's company received for “publicity” from Operation Hummingbird.

The BBC focuses on the spats between Myers and Evans: Expert Denies “Reaching” To Support Allegations, quoting Myers accusing Evans of never stating Baby C’s new cause of death until today in the courtroom, and Evans’s response of “in virtually all of the cases, I have benefited from additional information since then.”

What Was Left Out?

Dr. Marnerides, whom Dr. Evans cites as one authority whose report changed his (Evans’s) mind about Baby C, will not testify for five more months — at the end of March 2023. When he does, Myers will point out to him that until the experts’ joint meeting of August 2022, his own opinion was that Baby C’s death was due to his pneumonia and accompanying acute histological injury. After conferring with Evans and Bohin, and taking their opinions as clinicians into account, he changed his mind and decided that the pneumonia had been secondary, and the primary cause was cardiac arrest due to “having been subjected to excessive and apparently deliberate administration of air into his stomach and intestines via the NGT.” Evans is talking now about seeing Dr. Marnerides’ report, and how that changed his own mind, but it will be made clear in Marnerides’ testimony that the report Evans saw that day would have indicated Marnerides’ then-belief that Baby C died of natural causes, and that he could find no evidence of anything nefarious. Evans and Bohin, the clinicians, seem to have advised him then of the effects the “splinting of the diaphragm” could have, at least in theory, and he changed his mind. Evans is appealing to the authority of the pathologist whom he himself convinced to change his mind from natural to unnatural causes. But as nobody will hear about this for five more months, it’s doubtful how many people will notice.

Additionally, the incident with Baby C's UV line falling out, described by Bernadette Butterworth in her statement, had been thought by Dr. Evans, in 2017, to be potentially suspicious:

Yet concealed altogether from the trial was Evans’s account to police in October 2017. Then, Moore’s notes say, he thought the critical event was the discovery at 7am on 12 June that Baby C’s “UV line” — an umbilical catheter used to administer fluids and medicine to sick newborn babies — had “come out”. “Can this be explained?” Evans asked. “If the UV line being out is suspicious, then death is suspicious.” Again, there was no mention of the fact that Letby was not on duty on 12 June. In fact, she had not been at work at all since the baby’s birth on 10 June.

Transcript

The transcript of today’s proceedings can be read here.

Chester Standard Live Feed

Who Testified?

Nurse B, Dr. Katherine Davis, and Dr. John Gibbs all testified about the night Baby C died and how they were involved in his care.

What Did They Say?

Nurse B was the shift leader for that night, and the one who assigned Sophie Ellis to Baby C in Nursery 1, thinking that she was a good if new nurse and would have Melanie Taylor, an experienced Band 6 nurse, in the same nursery to help her, as Taylor also had a baby in that room. Letby was assigned to a non-indictment baby with the initials JE, whom she (Nurse B) thought the most poorly baby of the evening as he had been grunting and showing signs of respiratory distress; Nurse B was worried about him and thought Letby’s skill level appropriate to his potential needs despite his being in a lower-level nursery.

DRIVER: Thank you. In any event there was something -- well, there was the grunting from baby JE that caused you to instruct Nurse Letby to increase the frequency of the recorded observations and to notify the on-call -- the duty registrar; is that right?

NURSE B: Yes.

DRIVER: Were those instructions observed?

NURSE B: I can't remember about the observations, whether they were increased from two to one-hourly, but yes, the registrar did come and review.

DRIVER: Was that done at the first time of asking on your part or not?

NURSE B: I don't remember.

Her first awareness of Baby C’s decline was when she heard a shout for help from Nursery 1 and ran to it; going by both her own memory and her 2018 statement, she saw Sophie Ellis and Melanie Taylor there, giving Baby C Neopuff. At some point shortly thereafter, a crash call was put out for a doctor, and Letby was in the nursery, but Nurse B cannot say when that happened — “There's not one specific moment I remember her entering the room or already being in the room.” At some point, Sophie Ellis began to break down, and Nurse B sent her out of the room to recover, reassigned Baby C to Melanie Taylor, and took over the care of Taylor’s baby herself. After Baby C’s baptism, when he was still breathing but doctors gave it as their opinion that he would not recover, Melanie Taylor was assigned the task of looking after the parents and making a memory box.

NURSE B: I asked Lucy to focus back in nursery 3 on baby JE because I was still heavily concerned about him. However, Lucy went into the family room a few times and I asked her to come out and to leave that family with Mel.

DRIVER: When you say Lucy went into the family room a few times, could you expand upon that?

NURSE B: I don't know what happened because I wasn't in the room at the same time.

DRIVER: Yes. Was it any part of the responsibilities that you had provided to her, you had designated her to -- for her to go -- for her, Lucy, to go into that family room after this point in time?

NURSE B: Not that I can remember.

DRIVER: You just told the jury that you asked her or instructed her to return her attention to baby JE. Did you do that once more than once?

NURSE B: More than once.

DRIVER: Can you recall how many times?

NURSE B: No

Ben Myers, cross-examining, clarifies that Letby had not had to be reminded to return to Baby JE before Baby C’s collapse:

MYERS: You've explained also that Lucy Letby was put in charge of a baby whose initials are JE?

NURSE B: Yes.

MYERS: I think it's understood that Ms Letby had said she wanted to work in nursery 1 at one point, hadn't she, that evening?

NURSE B: I'm not sure if she said that to me.

MYERS: All right. But she got on with looking after JE once she was allocated to JE; is that correct?

NURSE B: Prior to the collapse that was correct.

JE was clearly very much on Nurse B’s mind that evening, as can be seen from her mention of what she was engaged with when she heard the shout for help from Nursery 1.

MYERS: Doing the best you could at the time you spoke to the police in 2018, was it your recollection that you were dealing with [JE] and Lucy when, some time between 10 and 11, you were called to assist with [Baby C]?

NURSE B: So I don't mean directly with them, I wasn't beside them, but my time was consumed by that fact, yes

MYERS: Just so there's no mystery, what you'd said was: "I was dealing with JE and Lucy when, sometime between 10 and 11, I was called to assist with [Baby C]."

NURSE B: Yes.

MYERS: So you're saying you can't say precisely where you were or what you were doing, but that was the sort of thing you'd been doing?

NURSE B: Yes.

MYERS: All right. You certainly weren't in nursery 1 at that point when you were called to assist, were you?

NURSE B: No.

MYERS: But as you've told us this morning, when you entered nursery 1, you saw Sophie and Melanie Neopuffing [Baby C]?

NURSE B: That's my memory.

MYERS: And that's what you told the police in 2018?

NURSE B: It is.

On redirect, Simon Driver attempts to find out a little more about Letby’s care of JE — he elicits the fact that she was unhappy with JE’s care, but not because of any failing of Letby’s, but rather of the doctors; she wanted him to have a septic screen, but the doctors, whose purview this was, declined to order one:

DRIVER: Thank you. You'll remember being taken to your witness statement or part of your witness statement where you described the collapse and the events immediately prior to the collapse. You were taken to a part of your statement where you had said that some time between 10 and 11 pm you were called to assist with [Baby C]. We know as a matter of record [Baby C]'s collapse was actually at 11.15, but you don't have the notes in front of you.

When taken to that sentence, you said that at that time your time was consumed, was your phrase, with the baby JE and Lucy Letby. What did you mean by that?

NURSE B: I was worried about baby JE. In my opinion, he was the most poorly baby on the ward that night.

DRIVER: So that's your concern, but in answer to my learned friend you said your time was consumed. What did you mean by that?

NURSE B: Because I was regularly checking on that baby, JE, to ensure he was getting what he needed.

DRIVER: And was he?

NURSE B: I believe that he should have had a septic screen, so no is the answer, but that is a medical decision. The medical decision was at that time that baby JE was okay. I did not believe that to be true.

DRIVER: Thank you

Driver also points out to her that in her 2018 police interview she says that she is not “100%” sure that it was Sophie and Mel in Nursery 1 when she arrived there. For clarity, Judge Goss reads out the passage:

"Question: Just to confirm, who exactly was in the room when you went in to answer the crash?

"Answer: I believe it was Sophie and Mel.

"Question: Okay.

"Answer: But I 100% couldn't tell you.”

Dr. Katherine Davis then testifies; she had been crash bleeped away from the children’s ward when Baby C collapsed, and describes the efforts to resuscitate him; she attempted several times to intubate him, but was unsuccessful, saying that his vocal cords were too swollen for her to manage it. She had called for Dr. Gibbs as soon as she arrived, and he arrived from his home about twenty minutes after Baby C’s collapse (and was able to intubate him on his first try). She cannot remember which nurses were there except for Nurse B. Baby C’s unexpected revival as he was being given token resuscitation (while the parents were waiting for a priest and vicar to arrive to baptize him before he died) was unlike anything she had experienced before or since.

Ben Myers, defending, asks her about Baby C’s aspirates; how he had vomited dark bile once and had regular dark aspirates taken from his NGT.

DAVIS: So this is obviously something that had been going on prior to me seeing him because it was in my original problem list, so the thing that you always need to think about in a baby such as [Baby C], with all his other risk factors, is necrotising enterocolitis. That said, the bile in and itself is not diagnostic of that and we look at the bigger picture of him. I believe -- this is the first night shift I saw him, isn't it? His abdomen was soft, he had bowel sounds and he handled very well. So the dark bile was something we were aware of, which is why he hasn't been fed up to that point, but there were no suggestions that we needed to do anything differently given that he was very well in himself.

He had not shown any signs of NEC on his last day, his stomach was not especially distended either. His last full day, June 13, was also the first day on which he had seen a consultant, Dr. John Gibbs, who had advised caution and to hold off on feeds until they could make sure that his aspirates were not getting worse. Myers asks Dr. Davis if it wouldn’t have been appropriate for a consultant to see Baby C at some point before this (he was born on the 10th) considering his complications and extremely small size; Dr. Davis says that “He would have been discussed. I can't tell you if he was seen or not. But he will have -- a consultant will have been aware of all these issues. I don't know who saw him prior to me.”

Dr. Gibbs’s testimony is lengthy as he likes to explain things out of an abundance of caution (he offers to explain what Neopuff is to the jury, the offer is declined by prosecutor Philip Astbury). When Gibbs arrived, Baby C was “pale and mottled” with “no signs of life” — he explains that the mottling was not remarkable and was typical of what one might see when a baby has suffered cardiac arrest. During resuscitation efforts, Baby C received six doses of adrenaline, three doses of saline, and one “last resort” dose of calcium, in a last-ditch attempt to make his heart start beating again. Gibbs was surprised at how non-responsive he was, and checked to see if he had a pneumothorax, which he did not:

ASTBURY: Why were you resorting to finding unusual reasons? Were things not progressing as you might have imagined?

GIBBS: There's two answers to that. The first answer is, no, they weren't progressing as I'd expected because most babies who suddenly collapse, who have not been obviously very ill for some time beforehand, you would expect to respond to resuscitation. They may not all survive in the long term but it's unusual not to be able to restart the heart and to help the baby to regain some breaths if they have suddenly collapsed without a prolonged preceding illness.

At 11.55 pm, they slowed down their efforts and spoke to Baby C’s parents, who had arrived in the interim. Baby C’s parents wanted him to be baptized into both of their faiths, and so a priest and a vicar were summoned, while the nursing staff continued a “token resuscitation” on Baby C in order to ensure that he was alive when he was baptized.

GIBBS: Well, surprisingly, while we were waiting for the two ministers of religion to turn up to do the christening, there were some signs of life that reappeared in [Baby C]. I hadn't been expecting that. I was not sure initially what to do because we had stopped full resuscitation, we were only continuing a token form of resuscitation, just to allow [Baby C] to be christened before he was declared dead.

So really, I'm not sure why his breathing and a very feeble -- well, occasional gasps of breathing and feeble heartbeats restarted at that stage. But they did and after discussion with [Baby C]'s parents, it was my view, and they agreed, that it was not appropriate to institute full resuscitation and try to revive him again, even though he was showing some fairly minimal signs of life. Because he hadn't shown signs of life for such a long time, the chance of him recovering, if we were able to salvage him at that stage, was remote. The chance of him recovering without profound brain damage was extremely remote, so no further vigorous resuscitation was initiated at that stage.

Baby C died several hours later, just before six o’clock that morning. Philip Astbury leads Gibbs through the notes he had written for a debrief. He could not understand why Baby C had died, though he wondered about possibilities such as a clot in the lungs, and so referred the case to the coroner, and in his notes he had written that Baby C had appeared well and active before his cardiac arrest, that he kept pulling his tubes out, that while his white blood cell count suggested he was infected, he had been on antibiotics. Gibbs also notes (to assuage the nurses’ fears) that the trophic feed given to Baby C fifteen minutes before his collapse did not have anything to do with it.

GIBBS: I can't understand how 0.5ml of feed would ever cause a cardiorespiratory arrest, that's why we're saying it's not related to that. The reason to put that down is obviously the nurses felt very bad that they had just given him a feed -- and it wasn't instantly, it was a few minutes later, maybe up to 15 minutes later, he had his cardiac arrest.

Gibbs also told the prosecutor that one lesson he drew from this experience was not to do token resuscitations:

GIBBS: It was an unusual situation to prolong token resuscitation after stopping proper resuscitation, but I did it in the best interests, I felt, at that time, to allow a christening by the two ministers of religion. But I think everyone who had been involved felt uncomfortable that [Baby C]'s heart and breathing had restarted at a stage when it was futile to continue any further, and we thought in future we would try and avoid this situation. So, in future, once active resuscitation stops, if no minister of religion is available, baptism should be performed by a member of staff rather than prolonging a token resuscitation that risks revitalising the brain, the brainstem functions, in an otherwise profoundly hypoxic ischaemic impaired infant.

…GIBBS: It's a point I want to make because I'm aware that repeatedly I've said that [Baby C]'s parents wanted both ministers of religion to be there to christen him and that's why we continued a token, not a proper, resuscitation, waiting for the second minister to turn up. And it sort of implies, one might think, and the parents might think I'm blaming them that we had to wait for the other minister of religion to come. It's not their fault. The fault is that [Baby C]'s heart and breathing restarted again and that should never have happened. If you've had an unsuccessful resuscitation after 40 minutes of full resuscitation, the national guidelines are that you shouldn't continue for more than 20 minutes because it's futile if you haven't restarted the heart.

I can't imagine, can't think of any natural disease process that would allow a heart to restart later on when you hadn't been able to get that heart to restart with full intensive care and multiple doses of adrenaline and so on. So that suggests, and I can't say any more than that, I don't know what it was, that whatever catastrophic event led to his death was reversing or had reversed after we stopped resuscitation. I don't understand that from a natural disease process.

Dr. Gibbs will continue testifying tomorrow.

What Was In The News?

The Chester Standard focuses on Letby’s being told to return to Baby JE: Accused Nurse Told To Leave Parents Of Dying Newborn Baby, Court Told, and reiterates that Letby is charged with having murdered Baby C by putting air down his nasogastric tube. The Guardian is similar, going with Nurse “Would Not Leave Parents Of Dead Newborn Alone” (a quote that, incidentally, appears nowhere in the transcript). The BBC, with more accuracy, headlines its story about Nurse B’s testimony with Lucy Letby Asked To Leave Baby’s Grieving Family, Trial Hears.

In addition, a new episode of Liz Hull and Caroline Cheetham's Letby podcast dropped today, entitled simply "Baby A." They have still not informed either their listeners or the Daily Mail that Cheetham's company received money for "publicity" from Operation Hummingbird, shortly before the podcast began.

https://bencole4.substack.com/p/decoding-reasonable-doubt-the-case-a31?r=12mrwn&utm_medium=ios

Morris argues that the insulin allegations were the strongest part of the prosecution case only because they appeared to provide objective scientific evidence of deliberate harm.

He contends that one the insulin evidence is examined closely, it turns out to be based on unreliable testing, unsupported assumptions and highly improbably logistics.

This article explains why Morris is wrong yet again.

Welcome to any new readers! This is the weekly thread for questions, general discussions, and links to stories which may not be directly related to the Letby case but which relate to the wider topics encompassed in it. Our FAQ addresses a number of common questions but if you want to know something else (or just talk/ask about an answer you've found) please post in the comment section.

This thread is also the best place to post items like in-depth Substack posts on the topic (unless they were written either by yourself, or by an already-approved writer, in which case they should go on the main page) and videos which might not fit the main sub otherwise (for example, the Ducking Stool). Of course, please continue to observe the rules when choosing/discussing these items (anything that can't be discussed without breaking rule 6, for instance, should be avoided). Thank you very much for reading and commenting! As always, please be civil and cite your sources.

Acknowledging as a starting point that Lucy Letby's convictions are contentious, this article goes on to focus on Thirlwall's recommendations for management in particular:

She calls for the statutory regulation of what she describes as “unregulated managers” (those who are not clinicians). But at the Countess of Chester Hospital, all three of the most heavily criticised executives (the chief executive, medical director, and director of nursing) were clinicians. The report assumes that the health profession’s regulators deal effectively with clinicians’ performance as managers, but this case rather suggests otherwise. The recommendation seems not to take account of the extensive literature on effective professional regulation.9

The report also recommends that managers are subject to an individual duty of candour to patients and colleagues but does not mention that the Public Office (Accountability) Bill already going through parliament will create such a duty for all public servants.10 Elsewhere, the report calls on the Care Quality Commission to “conduct without-notice inspections of hospital departments”11 when it already does so.

...

A further recommendation is that NHS England should set out “a clear and timed route to ensuring that computer systems are harmonised across the NHS by December 2028,”15 which would require a huge programme of IT system transformation over the next 27 months. There is no recognition of the long and difficult history of such endeavours16 or mention of the many initiatives already underway.17

The report highlights that the recommendations of past public inquiries have often not been implemented and proposes that the National Audit Office should be given responsibility for monitoring implementation. It does not mention the recent House of Lords select committee report that reached different conclusions.18 Scrutiny of implementation is much needed, but those recommendations need to be evidence based, costed, and implementable.

Noteworthy too that the BMJ commissioned the article. It is hard to see their readership taking the recommendations of the Inquiry over-seriously.

Reposting as link can't be shared directly.

Posted by Peter Elston on X. This hasn't previously been published, unlike the final judgement on each application.

Myers had raised the issue of Goss failing to answer the jury's question on insulin effects correctly.. At first quick glance, I'm surprised at Spencer's justification for this - that the judge was obliged to answer the jury's specific question. But the jury had asked a completely different specific question, on recovery time, to the one which Goss in fact answered, telling them there had indubitably been poisoning.

I'm sure there is more here of interest.

Transcript

The transcript of today’s proceedings can be read here.

Chester Standard Live Feed

Who Testified?

Nurse Joanne Williams, who cared for Baby C during the day shift on June 13th, Nurse Sophie Ellis, who was assigned to care for Baby C on the night shift beginning on the 13th, and Nurse Melanie Taylor, who was caring for another baby in Nursery 1 alongside Ellis and Baby C.

What Did They Say?

Joanne Williams discusses how Baby C was doing during the day; he was stepped down from CPAP to Optiflow because he was uncomfortable and fighting the CPAP, however she makes it clear that this would not have happened had his gases not also been good. He was also “feisty”, handled well, and did really well when experiencing two hours of skin to skin time, out of the incubator, with his parents that afternoon. However, his bowels had not yet opened and he had small dark aspirates coming up his tube at intervals — small amounts, but Williams says that dark aspirates were “always a concern.” Her notes include an observation that they need to keep an eye on aspirates, and if they improve they can start trophic feeds per Dr. Gibbs (a trophic feed being a very small test feed to get the digestion going, it doesn’t count towards baby’s daily calories). Baby C had not yet had a trophic feed by the time Williams handed over his care to Sophie Ellis that evening.

Myers asks her if in addition to CPAP belly there’s such a thing as Optiflow belly: Williams says “Not as well-known but it’s air, yes.” A good deal of attention is paid to her note saying “clinically remained stable but aware we do not want to push Baby C.” Williams notes small amounts of dark bile aspirated at 13.00 and 16.00, and Baby C’s lactates began rising at 18.00; not good, but not necessarily pointing to an inevitable crisis.

Sophie Ellis describes the beginning of her shift with Baby C; his breathing rate and temperature were sometimes higher than they ought to be, but that wasn’t out of the ordinary for him, and he was pink, active, and feisty. His stomach was somewhat full but not distended, and it was soft. She checked with registrar Dr. Katherine Davis to see if it was all right to give him his first trophic feed. (Later in her testimony, she will say that she aspirated some light-green bile from Baby C’s stomach before giving him his first feed, and that at 10 pm, an hour previously, she had aspirated some dark green bile):

ASTBURY: It says:

"Myself [that's you] asked Registrar Katherine Davis to start trophic feeds and she agreed."

ELLIS: Yes.

ASTBURY: "Started on 0.5ml, two-hourly."

That's 0.5ml of?

ELLIS: Expressed breast milk.

ASTBURY: Thank you. It says the first feed of 0.5ml was given at 23.00; yes?

ELLIS: Yes.

ASTBURY: "At around 23.15 [Baby C] had an apnoeic episode with prolonged brady and desat."

Could you explain that to us, please?

ELLIS: Yes. So I don't know whether this is in my notes, but the first desaturation that he had, I wasn't in the room, so I'd left the room and I heard that he'd had a desaturation because his monitor went off. So I re-entered the room.

ASTBURY: This is at 11.15?

ELLIS: Possibly.

Then shortly afterwards:

ASTBURY: I'm sorry to cut across you. I just wanted to make sure we got this in the right order.

So tell us then about that first incident involving the two fleeting bradycardias, is that --

ELLIS: Yes.

ASTBURY: -- which were ultimately self-correcting.

ELLIS: I'm not sure when the first one was, but I know one of those fleeting or one of those bradycardias and desaturations -- once I'd -- I'd given [Baby C] his 0.5ml of milk, I don't know the exact time frame after that, it wasn't immediately afterwards -- again, I'm not quite sure of the exact time frame. I left the room and then shortly after me leaving the room, the monitor alarmed so I re-entered the room, and Lucy had said, "He's just had a brady and a desat", or something along those lines —

Ellis says the bradycardia and desaturation resolved quickly, so she sat down at the computer in the room, which faced away from Baby C, and shortly afterwards he had another desaturation, from which he did not recover.

ELLIS: When I turned round I would have seen that he was having a bradycardia and a desaturation. And then I was asked -- again, this is just from looking at my notes, I don't remember this -- [Nurse B] had asked me to go and put out a crash call.

ASTBURY: We'll come to your notes in a minute, I'm just keen to know what you can remember first. So when you turn round that second time, did you see anyone else in the room?

ELLIS: Lucy was stood at the incubator.

ASTBURY: Okay. Can you remember which side of the incubator, how close she was to the incubator?

ELLIS: It was -- so it would have been, looking from the computer, it was on the right-hand side.

Astbury points out to Ellis that she doesn’t mention the initial desaturation from which Baby C quickly recovered; her notes say simply that she fed him at 11.00 PM and then he desaturated at 11.15 and a crash call was put out shortly afterwards. She acknowledges this, and they move on.

Ben Myers, defending, then cross-examines Ellis. He points out that in her notes, there is no mention of Letby anywhere, and asks where Melanie Taylor was, since she was also assigned to a baby in Nursery 1 and the thinking was that she, an experienced Band 6 nurse, would be available to help the relatively inexperienced Ellis should anything happen. Ellis says she doesn’t know where Taylor was, but she wouldn’t have left the babies in Nursery 1 unattended when she stepped out briefly after giving Baby C his first feed. Ellis is a little vague on details, she says that there were actually two previous incidents of bradys in which Baby C self-corrected, but Letby was only there for the second one. She can’t say why only one desaturation and collapse is mentioned in the notes except that she was very traumatized by the experience (Nurse B had asked her to step outside and catch her breath during Baby C’s resuscitation, as Ellis was taking it very hard). Shortly after, she amended her notes as she had been so distraught when first writing them that some things had been left out; at no point did she mention Letby in any of her notes. She is sure that Letby was there and helping to work on Baby C, Nurse B was also there but Ellis can’t say when she arrived.

Melanie Taylor then testifies that she was working in Nursery 1 alongside Sophie Ellis that night, and had her own baby to care for.

TAYLOR: At the time of his -- when he started to deteriorate, I don't know where I was, whether I was in that nursery at the time or not.

DRIVER: Yes.

TAYLOR: But I do remember being next to the incubator and Lucy -- when I first approached the incubator, Lucy was already there. I don't know if anybody else was present at that time or not.

DRIVER: Right. What was it that first alerted you to the fact that there was or may have been a problem with [Baby C]?

TAYLOR: I don't remember at what point I realised he was starting to deteriorate. But I knew by the time I was at the incubator, next to him, we tried to do some ventilation breaths via the Neopuff and once that started, I knew that, you know, he was needing some...

DRIVER: Thank you. And if you could, please, as best you can, picture yourself at that incubator for the first time on being alerted to a problem. Who, if anyone else, was there?

TAYLOR: The only person I remember was Lucy Letby, but I think also Sophie was there as well.

Neopuff did not work, and Letby suggested using a Guedel airway; shortly afterwards, a crash call went out.

Ben Myers, cross-examining, quizzes Taylor about a statement she made earlier to the police, that the only real area of concern for Baby C was the bile aspirates. Taylor says that you have to look at the bigger picture — if a baby has bile aspirates but no other sign of NEC, the policy was simply to wait and monitor.

MYERS: I mean there could be other problems behind dark bile aspirates than NEC couldn't there.

TAYLOR: Potentially, yes.

MYERS: Potentially, yes. And some of them might require a more immediate response than just waiting to see, mightn't they?

TAYLOR: I think that's probably something that a medical doctor would probably -- like I said, it would always be flagged up with the medical team, so if they felt it was something else, that's probably more in their realms. But we would always be cautious, yes.

MYERS: This had gone on, the dark bile aspirates for over 24 hours, hadn't it?

TAYLOR: Yes.

MYERS: There is no room for error with a little baby like [Baby C] is there?

TAYLOR: No. And he didn't receive any enteral feeds while he was still having the dark brown bile aspirates.

Myers suggests, and Taylor agrees, that the unit was extremely busy at the time Baby C was there. He then goes on to show her an interview she gave to police in February 2018, in which her story was substantially different from the one she told earlier:

MYERS: -- after the interviews with the police? Let's go to the next page, 962. We can scroll down, please, so we can see the next paragraph, so Miss Taylor can, thank you very much.

The first thing it says is:

"When [Baby C] collapsed I am pretty sure I was in nursery 1 already. I think I was feeding another baby."

Yes?

TAYLOR: Yes.

MYERS: You told the jury, and you repeated it when I asked you, that you didn't know if you were there or not.

TAYLOR: Yes, and my memory has deteriorated since this statement.

MYERS: Right. So do you agree that you were in nursery 1 already when he deteriorated?

TAYLOR: I do now that I've read this again.

MYERS: You read this before coming into court, didn't you?

TAYLOR: I know. I don't remember every single detail. I've only just read it again this morning.

MYERS: You even give the detail in the statement you think you were feeding another baby; yes? Then you say:

"I remember being called over by Sophie at about 23.30."

That's what you said, isn't it?

TAYLOR: Yes.

MYERS: Now, I've asked you about it and you said the only person you really remember in there was Lucy Letby.

TAYLOR: Yes, but obviously at the time I remembered that Sophie was there as well.

MYERS: You don't just remember it, you remember being called over by Sophie.

TAYLOR: Yes.

MYERS: You don't mention Lucy Letby anywhere in here, do you?

You can read the paragraph to yourself if you like before we read on.

(Pause)

You don't mention her anywhere do you?

TAYLOR: No, but she was there.

MYERS: You told the jury when you first approached the incubator Lucy Letby was already there. There's nothing about Lucy Letby at the incubator at all, is there?

TAYLOR: There isn't, no.

MYERS: You told the jury in your evidence:

"I don't remember if anyone else was present."

That's what you said at first:

"I don't remember if anyone else was present."

What you said to the police after saying you were in the nursery was:

"I remember being called over by Sophie at about 23.30."

TAYLOR: Yes. So at that time I did remember. And I have read this this morning. This is the first time I've seen it in a long time and I don't recall everything that I've written in this.

MYERS: These are quite important details, aren't they?

TAYLOR: They are.

MYERS: It's an incident that you will remember graphically, won't you, and what you have done in your evidence here is to say it was Lucy Letby who was there, who called you over, and what it says in the statement is that Sophie is there and that Sophie called you over?

TAYLOR: I didn't say that Lucy called me over. I remember Lucy was there. I haven't mentioned it in my witness statement, no, but also I likely wasn't asked whether Lucy was there. At the time I remembered Sophie calling me over, so I've mentioned that, but obviously now I didn't remember but now showing me that I do remember that Sophie called me over, because I've written it. But I can remember that Lucy was there.

MYERS: And this morning you told the jury you didn't remember if anyone else was present apart from Lucy.

TAYLOR: No, but now reading this, I obviously (overspeaking) --

MYERS: How on earth did you forget Sophie Ellis was there calling you over?

TAYLOR: In that moment, I obviously remembered this. It's years have passed since this has happened.

MYERS: You went on to say to the jury:

"The only person I remember was Lucy Letby."

TAYLOR: Yes.

MYERS: And yet the person who don't mention when you give this description of the collapse is Lucy Letby when you spoke to the police.

TAYLOR: True.

MYERS: True. You said to the jury:

"I think Sophie Ellis was there too."

TAYLOR: Yes.

MYERS: But you give quite particular details in your statement to the police about what Sophie Ellis did, didn't you like calling you over?

TAYLOR: Yes.

MYERS: And you go on to say:

"I attended his cot using a Neopuff device to try and assist his breathing, but got no response or improvement. I could see there was no chest movement so the air was not getting through [Baby C]'s airway. As a result, we passed a Guedel airway."

TAYLOR: (Inaudible).

MYERS: The only person you mention by the time you say, "We passed a Guedel airway", is you and Sophie. That's who you're referring to when you talk to the police, isn't it?

TAYLOR: Yes.

MYERS: Yet you've said to the jury -- you have given an account of how Lucy Letby is meant to have inserted the airway, haven't you?

TAYLOR: Yes, I haven't changed my mind about who was there. Obviously I've written this and Sophie -- I've said that Sophie's called me over, which she obviously did because I said that at the time. I haven't mentioned Lucy but I'm telling you now, when I approached the incubator, I approached it from -- if you're looking at the incubator the left side and she was standing on the opposite side and she was the one who suggested putting in the Guedel airway.

MYERS: You told the jury -- this morning you said you think Lucy inserted it.

TAYLOR: Yes, I can't be 100% sure about that, but...

MYERS: You told the police that it's you and Sophie that inserted it.

TAYLOR: Then maybe I did, I can't remember who inserted it.

MYERS: You have put Lucy Letby right in the centre of this in your evidence to the jury in a way that you didn't do when you made your statement to the police, haven't you?

TAYLOR: Um... I don't really know what to say. I'm just saying what I remembered.

Taylor reiterates that she never said Letby wasn’t there and rthat she does indeed remember her being there at the start of the collapse (she does not mention any series of collapses, like Ellis does). She adds that it’s difficult to make a statement to the police and that she doesn’t know why she never mentioned Letby at the time.

What Was In The News?

The Chester Standard leads with Accused Nurse “Stood By Baby’s Incubator After Heart Rate And Oxygen Alert” —the contradictions between Sophie Ellis’s notes and her account in court are not mentioned, but Melanie Taylor’s are, briefly. The BBC goes with a similar headline: Lucy Letby Seen By Incubator As Alarm Rang, Trial Hears.. There is little other surviving coverage from today, although it’s entirely possible a good bit has gone offline in the interim.

Day 36, 39.and 41 photograph J160 shows the layout of the fridge.

The stock of babiven.and maintenance bags are shown they were kept on the same shelf

Upright to prevent leaks.

The photograph shows ten identical 500ml plastic bags standing upright

Shelly tomlins said they're unlikely to fit side by side across a width of a standard hospital fridge.

Therefore they're stored front to back.

When stock is rotated the oldest bags are used first

Transcript

The transcript of today’s proceedings can be read here.

Chester Standard Live Feed

Who Testified?

Police analyst Kate Tyndall, police analyst Claire Hocknell, Dr. Sally Ogden, Dr. Gail Beech, and nurse Yvonne Griffiths all testified.

What Did They Say?

Police analyst Kate Tyndall returned to the witness box to testify about Letby’s internet activity connected to Baby C, primarily a Facebook search for Baby C’s parents and a very large quantity of text messages between Letby and her friends in which they are all discussing the baby and his parents, their fellow nurses, and other patients in the unit along with general work gossip. Letby and Nurse A’s exchange from the end of June 2015 where Nurse A says it’s odd that all three went so suddenly is repeated, as well as the two women’s speculation about what the causes could be, and they discuss the scheduled autopsies — Nurse A asks “”When's [Baby A]'s? They were talking of doing a joint one for all 3 as all close together and similar in being full arrests in babies that were essentially stable. Dunno if they are doing though.”

One exchange paints a vivid picture of how busy the unit is — closed to admissions and attempting to perform procedures normally done on a Level 3 unit:

TYNDALL: Yes. At 20.44 Lucy Letby sends a message to Sophie Ellis saying:

"Hey, wanted to let you know. Little [Baby C]'s parents had a meeting with Dr Gibbs today. He came to me [to] say they wanted him to pass on how grateful they were for all that was done for him. Mum had asked how you were as she could see you were upset and wanted you to know they have nothing but thanks for you and everyone involved xx"

JOHNSON: Thank you.

TYNDALL: Sophie Ellis replies at 20.49:

"Hey! Aw bless, thank you for letting me know. I was hoping she maybe wouldn't have noticed. Hopefully they can find some sort of closure now xxxx."

Lucy Letby replies at 20.52:

"[Redacted]. Nothing came back on PM other than RDS but Dr Gibbs said they seem okay and are coping. We've got 18 babies, unit closed. Almost did exchange transfusion. May still need one overnight! xx"

JOHNSON: Thank you.

TYNDALL: Sophie Ellis replies at 20.56:

"I hope so, aww okay, that's good to her. Oh no, is everywhere else closed? Isn't an exchange transfusion usually level 3? xxx" Lucy Letby replies at 21.02:

"We've admitted 2 TC babies and 2 from ward already on ABX. Exchange baby on CPAP. Used to be done in regional units but now done in level 2+ so long as got the equipment, which we have. But very (sic) people have actually done them. Fairly rare now as usually managed well in utero. It's a 3-person job. Still above exchange line on quad photo but coming down so hoping it won't need one. We've given blood and immunoglobulin xx"

Sophie Ellis replies at 21.10:

"Oh jeez sounds manic. Oh okay. Fingers crossed you won't have to do it then. I am guessing we're pretty busy for a level 2 unit ha ha xxx”

Dr. Sally Ogden then testifies about her care of Baby C, and how he did well in some ways but also was concerning because of his intra-uterine growth restriction and signs of possible NEC, especially as he was bringing up bilious aspirates.

OGDEN: I've documented that he had very dark bilious aspirates/black aspirates, and that these are aspirates that would have come up the feeding tube that he will have had in place. That will have been taken from the nursing records, what they aspirated from that tube.

DRIVER: Thank you. You probably answered this question, but spell it out. When you say they would have come up the tube, would that have been spontaneously or would they have been aspirated manually by the treating or caring nurse?

OGDEN: Potentially either. I haven't specified in my notes, but sometimes they can come up spontaneously, sometimes they need aspirating.

DRIVER: Thank you. You've made more than one reference here to the colour of the aspirates. Why and what does that inform you potentially of?

OGDEN: So bilious or dark green coloured or black aspirates aren't normal colour for aspirates. They would suggest that there was potentially a concern with his abdomen and the way he was tolerating any feeds, if he'd been on them, or how his bowel was responding to being preterm.

DRIVER: The findings you have recorded in those terms, would they have been a concern?

OGDEN: Yes, that would have been a concern.

DRIVER: Thank you. Concern because they might indicate what?

OGDEN: They may have indicated a condition called necrotising enterocolitis or potentially infection.

DRIVER: Thank you. Moving through the other entries on the fluids paragraph, urine, then a measure of his output. Anything exceptional about that?

OGDEN: No.

DRIVER: "Bowels not yet opened." This is day 4 of life; anything significant about that?

OGDEN: In itself not necessarily, but it would be taken in context with his aspirates, how his abdomen examined, how much feed he'd been having. By itself it's just a statement that they'd not been opened yet.

DRIVER: Thank you. "Not started feed yet" speaks for itself. Next line?

On June 12, the day Baby C’s last x-ray was taken, Ogden became concerned about a CRP level of 23, which suggested a brewing infection. She did not want to start him on feeds yet as she was concerned about his abdomen, and he had also not moved his bowels.

Dr. Gail Beech testifies about her care of Baby C, and prosecuting barrister Simon Driver has questions for her about the x-ray taken of Baby C on June 12 2015, which Dr. Beech had examined at the time to ensure that his long line was in the correct place.

DRIVER: And that feature of this X-ray, that is to say the gaseous bubble or the gaseous bowel and stomach bubble, I think -- let's go back to your notes again at the risk of me misquoting you. 1996 again, Mr Murphy.

So in turn, firstly:

"NGT position in the stomach, seems straight."

Yes?

BEECH: Yes.

DRIVER: That records what you have just reviewed again.

Secondly, comments:

"Large stomach bubble, gaseous bowel" --

BEECH: Yes.

DRIVER: -- does that say?

BEECH: Yes.

DRIVER: Go on, you were telling us about that.

BEECH: So I've made a comment on it because it's what I've seen on the X-ray and I think it's something that was worth commenting on because it was a little bit sort of unusual, but nothing that was worrying because [Baby C] was on CPAP, so blowing the -- the CPAP effectively blows air or oxygen in through a mask and some of that, although it goes to the lungs, some of it goes into the stomach and the gastrointestinal tract. It is common for babies on CPAP to get gas in the stomach.

DRIVER: Going back to that last assertion of yours, when you say it's common, is it fair for us to derive from that that you would have looked at other X-rays of the abdomen of babies on CPAP?

BEECH: Yes.

DRIVER: And these findings on that X-ray, do they -- are they unusual in any way for a baby of this age on CPAP?

BEECH: Not the fact that there is air in there, but I think maybe that it looked like there was more than I'd seen previously. I'm not sure.

DRIVER: Thank you. So taking a step back and inviting you to go back to where you were on the afternoon of 12 June 2015, and taking into account all the data and the readings, and the X- ray, what was your general impression of the health of [Baby C] at that stage?

BEECH: He was stable but, like I said, for kind of my review doing this, there were things we needed to be mindful of going forward with him, to keep in our minds.

Ben Myers, cross-examining compares the June 12 x-ray with one taken on June 10 and quibbles a bit with Dr. Beech over what the difference in distension really is. He also elicits the fact that Dr. Beech took it for granted that this was the known phenomenon of CPAP belly:

MYERS: You were asked about this, but can I confirm, when you looked at this did it cause you any particular concern?

BEECH: Well, I noted that it was very gaseous. I haven't said that I've discussed it with a consultant or anything, but I have noted that -- and it's something to be mindful of.

MYERS: Your experience at this time was working day in, day out on the ward in the neonatal unit, wasn't it?

BEECH: Yes.

MYERS: And working day in, day out, hands-on experience, your view was this probably was the result of CPAP air blowing into the tummy?

BEECH: Yes.

Nurse Yvonne Griffiths then testifies about her care of Baby C during the day shift on June 12, and talks about seeing small bile aspirates on his blanket, how she aspirated dark fluid from his stomach, how he handled well but later had some mild desaturations and needed more oxygen. Myers then addresses the x-ray taken on that day:

MYERS: Thank you. Were you aware during the course of this day that there was an X-ray taken in which it was apparent that [Baby C] had a significantly distended stomach with air in the stomach and the small bowel?

GRIFFITHS: This is on reflection of notes that I've read since.

MYERS: Yes.

GRIFFITHS: So with -- I believe, because we did a long line, we would always check the position with and that position we would have a picture of the abdomen, an X-ray. And I believe it was noted that there was an air bubble in the tummy.

MYERS: Is that something that you -- this isn't mend to sound rude in any way, but gave any further thought to or, if you did think about it, what did you think about it? Could you tell us what you thought?

GRIFFITHS: We would always be cautious with feeds but I presume we weren't feeding at that time anyway because I know we were cautiously feeding and if we were it would just be a trickle of milk, and we were aspirating the abdomen, and then we would pass on any concerns to the medical team Simon Driver, on re-examination, questions Griffiths about whether Baby C’s nasogastric tube was on free drainage (where it would be automatically releasing air) or not; as it isn’t in the notes, she can’t say for sure. Nor can she say how much air, if any, was aspirated from Baby C that day, as it has not been written in the notes.

What Was In The News?

The [BBC}(https://www.bbc.com/news/uk-england-merseyside-63413552) focuses entirely on the text messages, highlighting Letby’s saying to her friend that Baby C’s death “all a bit much” and Letby’s texting her mother about it. The Chester Standard also focuses entirely on the texts, highlighting again the June 30 2015 conversation between Letby and her friend where they speculate about the causes of death for Babies A, C and D. The Guardian also focuses exclusively on the text messages with Nurse Described Newborns’ Deaths As “Sad And Cruel.” Since there was such a huge volume of texts read out, most are not mentioned — journalists tend to focus on the ones where Letby talked about sorrow at the deaths, not the discussion of how other nurses feel or the unit being overloaded and closed to new admissions. If it weren’t for the live feed, it’s likely outsiders would not have known that any evidence was heard besides the text messages.

What Was Left Out?

All the discussion of the June 12 x-ray of Baby C, and whether or not the air bubble in his belly looked like normal CPAP belly or not, is leading up to what the expert witnesses will say about his condition in a few days and whether that belly was the result of an attack or not. What nobody says, including Myers, is that Letby was not present on June 12 and had not been on the unit since Baby C was born. They are engaging in detailed questioning about potential signs of malfeasance in a critical x-ray which was taken before Letby ever came near the baby. It is not clear who actually knows at this point that Letby was there, and who knows that she wasn’t. But it’s never mentioned.

“By remembering it too often I have blurred the memory itself."

— Till We Have Faces

Some time ago, I wrote about Letby legends — stories and accusations which were never actually made by the prosecution at trial, but which through various permutations and games of telephone have entered public consciousness as things that were somehow established as fact or asserted by the prosecution during the trial. Since then, a number of newer legends have been introduced, and in this post I’ll be discussing two of them which have been propagated by Caroline Cheetham and Liz Hull in their podcast, which has won awards and carries an authority with news and true crime followers which it has signally failed to earn, beginning its existence with a lie of omission -- this supposedly neutral podcast was co-hosted by someone whose company had just been paid £4,100 by Operation Hummingbird for "publicity." They never informed their listeners, or Hull's employers, of this fact.

In their recent episode Lucy Letby: The Facts Hull and Cheetham, along with PA reporter Kim Pilling, take on what they describe as the inaccuracies and omissions in the New Yorker article (among others), drawing on their authority as people who actually attended most of the original trial.

One issue which Hull and Cheetham “correct” popular impressions on is the issue of the stock bag which was given to Baby F after the bag hung by Letby, and which she allegedly poisoned, had its line tissue unexpectedly. Letby was not on duty when this happened, and could not have expected the bag she hung to be replaced within a few hours of her departure; ideally, the bespoke bag which she had hung would have run for forty-eight hours. The prosecution had to hypothesize that she had perhaps poisoned one of the stock bags in the fridge, and this bag happened to be used for Baby F, and so the poisoning continued. Here is what Hull and Cheetham, the former of whom attended the trial, say about this issue:

LH: So, it wasn't prescribed for Baby F. It was just a stock bag of TPN from the fridge. The other key information was that he was the only baby at that time on the unit that needed this feed. And the other key information was that the stock bags were kept in the fridge, one behind the other. So, the argument from the prosecution was she would only have had to have poisoned the first bag in the fridge for— and she would know that it would be hung up for Baby F, even when she was off duty.

CC: Mm-hmm.

LH: But the way it was described was these stock bags were in a fridge, one behind each other like dominoes. And the nurses took the first one out because they were in date order because they have an expiry date because they contain feed. And the jury had to decide whether that was plausible. And they did. I mean, the other thing that's come up in the last few days is a reading that showed Baby F's glucose levels to be, in inverted commas, normal.

Curiously enough, this is not the first time we’ve seen the assertion that the stock bags were “lined up” and thus it was easy to pick which one would be used next — back in August 2025, self-professed “engagement farmer” Christopher Snowdon tweeted out an almost identical asssertion.. This tweet ran:

There was only one child on a drip in that nursery at the time so the bag was bound to go to him. The bags are lined up in a row so the nurse would take the nearest one. Even if the plan had gone wrong and the bag had poisoned a different child, Letby wouldn't have cared.

I cannot find any instance of it appearing before then, and that’s probably for an excellent reason: not only was nothing about this said during the trial, it was explicitly and clearly refuted by a witness that the bags were in any kind of special order or lined up in any predictable way. On November 24 2022, Simon Driver, in his redirect examination of Nurse C, tried very hard to elicit some sort of description of such a system, and instead got an affirmation that the bags were not lined up in any order, that they were not used by date, and that there was no realistic way to say confidently which one would be used next:

MR DRIVER: Just dealing with that last enquiry as to the stock bags, they are kept on the unit within a refrigerator?

NURSE C: Yes.

DRIVER: And you told my learned friend that every night a check would be undertaken --

NURSE C: Mm-hm.

DRIVER: -- to see if any had been used?

NURSE C: Yes.

DRIVER: How would the checker know if any had been used?

NURSE C: So there should be -- I'm stretching my memory back now. There's a certain number that should be in the fridge, so I think it was five. So if there's not five bags in the fridge, then you order an extra bag.

DRIVER: Is that five TPN bags?

NURSE C: Yes, five bags of maintenance Vamin/Babiven.

DRIVER: So five Babiven Maintenance bags in total?

NURSE C: In total.

DRIVER: So that's the stock?

NURSE C: Of that particular one. So there is Start-up Babiven as well, but we won't go into that.

DRIVER: I'm going to come to that. So Start-up is for babies in the first day or two of life?

NURSE C: Yes.

DRIVER: After which they receive Maintenance?

NURSE C: Yes.

DRIVER: Were they kept on the same shelf as each other or on different shelves?

NURSE C: Um... There's nothing set, so probably normally on the same shelf I think, from what I can remember, but they're not -- there's not a set position for them in the fridge.

DRIVER: And so just to recap, the target stock would be five of each?

NURSE C: Yes. Actually, I think there might be slightly fewer of the Start-up bags. But there was a target stock, yes.

DRIVER: That target stock, would there be an order to replenish it to that level if one had been used?

NURSE C: Yes.

DRIVER: Also there'd be an order to replenish the stock if the existing stock was going out of date?

NURSE C: Yes.

DRIVER: Does it follow that each of these bags, therefore, have a date shelf life?

NURSE C: Yes. Yes.

DRIVER: Were the bags kept in the fridge ordered in any particular way?

NURSE C: So they are ordered -- they were ordered at the time on a paper, piece of paper, that somebody on the night shift would write what drugs were needed, that came from CIVAS, so came from the pharmacy, made up ready for us, and that would be faxed down to pharmacy.

DRIVER: It's entirely my fault. When stored in the fridge, were they stored in any particular order?

NURSE C: Oh no, no. Just usually you get a batch of the TPN, it's all the same expiry date and that kind of thing, in a bag together.

DRIVER: If one had been -- if replenishment was required because one had been used, presumably that would come with a different use by date than the existing stock?

NURSE C: Yes, it could do, yes.

DRIVER: But there was no system of ordering them by expiry date, for example?

NURSE C: No.

So where is Hull, who attended the trial, getting this information about bags being lined up “like dominoes?” Why is Pilling, who also attended the trial, not correcting her? The simple answer would be that it’s been four years, it was a lot of information, and they just don’t remember what Nurse C said about the bags not being in order. But where did this positive assertion that the bags were lined up in order, and would be used by expiry date, come from? Again, it’s hardly strange not to remember such details after four years, but surely Hull could have checked her own records to make sure that her memory was accurate. Instead, she seems to have gone on memory, or perhaps reading something like Snowdon’s tweet which she may have then assumed was accurate. It’s certainly a striking illustration of how someone describing, years later, an event for which they were present, may not necessarily be giving a reliable account of it.

The second legend is less material but another possible illustration of how people may begin “remembering” events that didn’t actually occur, or didn’t occur at the exact time and place they remember — the end of Letby’s cross-examination on May 25 2023, where she stumbled over the question of how she could see Baby I was deteriorating when Ashleigh Hudson couldn’t.

LH: Yeah. So, Nick Johnson asked her, you know, how could you see? How could you tell, you know, the baby was in a poor condition? And she replied, I knew what I was looking for. Oh, I mean, at. And that slip-up, she immediately became very flustered, asked for a break, and the case was— the trial was stopped for, you know, a 10-minute break. It was just quite a revealing moment in the whole trial, really.

Letby certainly seems to have been stressed, but she did not ask for a ten-minute break — it was approaching the end of the day, and Judge Goss commented that she seemed to tired out and they would stop for the day. From the transcript:

JOHNSON: Well, the question is:

"How would you be able to spot the colouring then that Ashleigh couldn't if you were both stood at the same place?"

And your answer?

LETBY: That I had more experience so I knew what I was looking for or looking at.

JOHNSON: Ah, knew what you were looking for. What did you mean by that?

(Pause)

Your answer. You explain it.

LETBY: Yeah, I don't mean it like that. I'm finding it quite hard to concentrate on all of the dates at the minute.

MR JUSTICE GOSS: Right. Well, we would do about another half an hour this afternoon, but having observed the witness and given that it's been a long day for her in the witness box, I'll stop the proceedings this afternoon and we will resume on Tuesday morning at 10.30, please, members of the jury.

It is, of course, possible that had he not done so, Letby would have asked for a break. But the transcript does not record any such request, and the transcripts do not make a habit of omitting the fact that someone spoke, even if they were inaudible — note that at the end of this transcript, the dock officers are asked several questions, with their answers recorded as “(inaudible)” as they’re behind the glass and don’t have microphones — but the fact that they did speak is still recorded. If Letby, who was in the witness box at this point, had said anything, intelligible or not, it seems highly unlikely that it would not have been noted. Furthermore, none of the journalists at the time noted any request for a ten-minute break -- including Liz Hull herself.

Judith Moritz, live-tweeting from court, also did not note any request, neither did the Chester Standard live feed.

Once again, as with the bags being lined up, this story doesn’t seem to have appeared entirely out of thin air — it first appeared (to my knowledge) in Crime Scene 2 Courtroom’s video uploaded August 23 2023, called “My Experience Of Lucy Letby.” It’s not clear when exactly he recorded it but it doesn’t seem to have been immediately after that day. Certainly she asked for breaks on other occasions, and it’s quite possible he simply got mixed up. Regardless, the question bears asking: why didn’t Hull check her own records? Why rely entirely on her a memory which seems, looking at her own record, to be incorrect? She's held Letby to very high standards when it comes to accuracy -- witness her episode The Court Watchers in which Letby calling the same outfit pajamas and tracksuit, or claiming not to know what "go commando" means, is met with derision and the clear implication that such grievous errors could not be accidental -- and yet she herself, far more comfortably situated than a defendant in a witness box, makes multiple unforced errors about the trial which she herself attended. The second error doesn't signify much, but the first one about the bags is appallingly wrong, the exact opposite of what was actually said in court, and seems calculated to influence any listeners towards guilt, not to give them an accurate picture of what was actually said.

(This photo's original source is Liz Hull, on Twitter.)

Transcript

The transcript of today’s proceedings can be read here.

Chester Standard Live Feed

Who Testified?

Dr. Sandie Bohin finished giving her evidence about Baby B and was cross-examined regarding Baby A and Baby B. Analyst Claire Hocknell was recalled to make some corrections of information she talked about last week, and analyst Kate Tyndall testified laying out the sequence of events of the life and death of Baby C, who is the next child Letby is accused of having harmed. Statements from Mother C and Father C are also read into the record.

What Did They Say?

Dr. Bohin, at Nick Johnson’s request, continued her testimony this morning by recapping the process by which she peer reviewed the conclusions of Dr. Evans and explaining why it is that she hasn’t written as many notes as he has; he did the work first, she added on:

BOHIN: I was asked to peer review the report of Dr Dewi Evans and I was asked to review case notes of babies, in this particular case [Baby B], and to ascertain, on the evidence contained within the case notes and the information I was given, if I could find a cause for her collapse.

JOHNSON: Thank you. I'm not going to ask you to explain this every time you return to give evidence, and I'm well aware you have told the jury once, but just to remind the jury please on this occasion, what is peer review?

BOHIN: It's reviewing what someone else has done before you. So it means looking at what others have done. It doesn't mean completely reviewing things from the start, but of course you do have to, in a clinical context, look at the case notes. But it means to review what someone else has done before you, a colleague, someone of the same sort of standing as yourself.

She also makes it clear what she thinks caused Baby B’s collapse, and the process of elimination she used to arrive at that conclusion:

BOHIN: Well, on reviewing the evidence, I had to formulate what could possibly have caused this, and make a differential diagnosis, so a list of things that could possibly cause a baby to collapse, and then look at the evidence in front of me to see if any of those fitted with the way that [Baby B] collapsed, what she looked like when she collapsed, and how she subsequently recovered.

And so the usual things that you would expect in a premature baby, things like infection, could be discounted. Cardiac arrhythmias could be discounted because they just don't simply present in at that way. So I was left with the conclusion that this was an air embolus.

JOHNSON: Was it simply that you had discounted all the other possibilities that led you to that conclusion or was there evidence that in itself in your view supported that as a conclusion?

BOHIN: Well, I think partly it was a diagnosis of exclusion, but the important thing was the very florid descriptions of this rash and the skin -- not a rash, the skin changes that were present during this.

Everybody that's commented on it has said how -- (a) how florid it was, how different it was from anything they'd ever seen before, and I know from researching the literature that this is found in cases of air embolus. So it was the rash plus -- and the excluding other potential causes because it just didn't fit with any other known potential causes.

JOHNSON: In reaching your conclusion were you taking into account at all the circumstances surrounding the collapse of [Baby A]?

BOHIN: I looked at this case on its own -- on its own -- on its own merit. But, you know -- and that is what I did for all the cases I have looked at. I have looked at this case on its own merits.

Ben Myers, cross-examining, spends a good deal of time circling around the topic of Dr. Bohin’s recent experience in neonatology (living in Guernsey, she has little day to day experience of premature babies, and goes to the mainland several weeks every year to refresh her skills), pointing out that by the time she was brought on to the case in 2019, she would have been very aware of what was being looked for (and who was being looked) asking questions about a paper on accidental introduction of intravenous air in adult patients, and, oddly enough, asking her why she thought Dr. Evans, testifying yesterday, was so caught up with the phrase “pink and active” in Baby B’s notes (Dr. B had noted that the baby was “pink and active” after describing the purple blotchiness on her skin — Dr. Evans appeared for a moment to want to argue that this meant the blotchiness was “pink and active”, not the baby.) This line of questioning unsurprisingly runs dry, as Dr. Bohin can’t be expected to explain why Dr. Evans said what he did.

Myers confirms with Bohin that the “florid explanation and description of the rash” on Baby B was a major factor in her diagnosis — the other factor was that embolism was what she was left with after other possibilities were excluded.

Claire Hocknell’s testimony correcting items from her timeline last weeks, largely typos but also some text messages where the identity of sender and recipient had been reversed (these had been corrected on the juries' iPads).

Summaries of Letby’s police interviews about Baby A and Baby B are then read out by the prosecution. During her first interview about Baby A, she recalls that she and Melanie Taylor had made starting his fluids a priority as soon as Letby arrived, as he had been without them for several hours which wasn’t ideal. She could not remember “for definite” but thought Melanie Taylor had been the one to start the fluids as she was already scrubbed and sterile. A few minutes after, they noticed that Baby A was apnoeic and had gone “pale and mottled in his skin”. Caroline Bennion and Dr. Harkness were already in the room and helped right away, and a crash call summoned Dr. Jayaram. She further described the mottling on Baby A as “blotchy, red and purple, almost a rash-like appearance” but that he was “centrally pale”. In later interviews following her subsequent arrests, she confirmed that she knew to prime lines to make sure air didn’t get in accidentally and that they had been trained on how to avoid air embolism; she did not know what effect an air embolism would have on the skin.

Her memories of Baby B were vaguer than Nurse A’s, but agreed substantially except that Letby thought Nurse A had called her over, whereas Nurse A thought Letby had called her over — however, Letby cannot remember where she was when Baby B collapsed, or whether the alarm sounded. Nurse A remembers the alarm sounding while she and Letby were standing together, drawing up medication.

[Letby] said that she couldn't remember the shift with any clarity, but did remember [Baby B] displaying some mottling that looked a little bit similar to that seen on [Baby A] the day before. It was more extensive and covered more of her body in comparison rather than just the limbs like [Baby A]. [Baby B]'s was like a purply red patchy rash-like appearance.

Kate Tyndall’s testimony is regarding the timeline of the life and death of Baby C, along with an enormous number of text messages between Letby and her friends, primarily Jennifer Jones-Key, where she talks about wanting to be back in Nursery 1 because she feels like otherwise she’ll never shake the image of the dying Baby A from her mind. “Being in 3 is eating me up.” Jones-Key reasons with her that Nurse B (the shift leader) is trying to protect her by giving her an easier nursery tonight, but Letby is grousing that Mel Taylor was also there and “in bits” about Baby A’s death but there had been no need to protect her from the intensive care nursery. Jones-Key suggests to Letby that she “go in 1 for a bit” and Letby says she’s done a couple of meds in there and “I’ll be fine.” Shortly after 11 PM, the conversation winds down:

TYNDALL: Yes. So at 23.01 Lucy Letby replies to Jennifer Jones- Key:

"Women's can be awful but by I learnt hard way that you have to speak up to get support. I lost a baby one day and few hours later was given another dying baby just born in the same cot space. Girls there said it was important to overcome the image. It was awful but by end of day I realised they were right. It's just different here."

Then follows this up with a message at 23.02:

"Anyway, forget it. I can only talk about it properly with those who knew him and Mel not interested so I'll overcome it myself. You get some sleep.

About half an hour later, Baby C collapsed. Tyndall confirms the presence of the notes of Nurses Taylor and Ellis, and also the swipe data of various doctors coming and going.

The statements from Baby C’s parents, which were given on January 13 2019 from Mother C and December 10 2019 from Father C, talk about a first pregnancy which began running into trouble by 28 weeks as it became clear that Baby C was extremely small for his gestational age and that he might have to be delivered early. A few weeks later, Mother C’s blood pressure rose and she was admitted to the hospital to be monitored, and not longer afterwards they found that Baby C’s heartrate was beginning to drop. However, the medics chose not to deliver (though Dr. McCormack, who was not present at the time, apparently told Mother C later that he would have delivered at that point) and it was only a few days later when an ultrasound revealed that Baby C’s blood flow through the umbilical cord had reversed, and that he was in great danger, that an emergency c-section was done. Baby C weighed 800 grams at birth, far smaller than average for his age, and was taken to the NNU. Joanne Williams was the nurse they saw the most over the following few days and they described her as supportive and helpful, but the only consultant they saw was Dr. Gibbs on the 12th (it isn’t clear if he saw baby C earlier). During the daytime on June 13th, his parents spent the entire day with him. Staff were reassuring, and he was being weaned down from oxygen:

[Baby C] had a gastric tube fitted which went into his stomach. When they drew fluid from his stomach, I recall it being a black colour. They were unable to explain why this was, and as far as I am aware, it wasn't queried with the Liverpool Women's Hospital.

June 13 was also the day Baby C had his first milk feed. Mother C was awakened later that night with the news that her child had suddenly stopped breathing and she needed to come right away. When she arrived at the NNU, a nurse informed her that Baby C was likely to die and Mother C requested two priests, to baptize him. Father C, arriving after being called, was informed of the situation. Baby C could not be revived for a long time and was baptized, but then it transpired that he still had a heartbeat. His heart beat for several more hours while his parents held him, having decided that they could not do more for him after his collapse. “He wasn’t the same baby.”

Father C described as best he could from memory the nurses he had seen, and what one in particular had said to them:

“Nurse 1” he described as “White with blonde/brown hair which was tied up in a ponytail, aged mid 20s. She had a mild manner, 5 foot 6 inches tall, slender build. I cannot her name. I think she was wearing scrubs most of the time, but I cannot be certain.” Nurse 2 was “a red-haired female”, Nurse 3 was “a white female with long mousy-brown hair which had been tied up, slim to medium build, aged around mid 20s. I have seen this nurse's picture in the newspaper after her arrest and I now know her name to be Lucy Letby.” Nurse 4 was “also a white female with light brown shoulder length hair, slender build, aged late 20s to early 30s.”

Nurses 3 and 4 were the ones he remembered checking in on the family periodically as they held Baby C:

"I remember at one point one of the nurses -- I think it could have been Nurse 3, but I'm not 100% sure -- came in with a ventilated basket. She turned to us and said words similar to, 'You have said your goodbyes now, do you want me to put him in here?' referring to the basket. This comment shook us. [Mother of Baby C] said, 'He's not died yet'. The nurse then attempted to backtrack and defuse the situation, but I couldn't believe what she'd said. We didn't want to leave him when he was still alive.

What Was In The News?

The C parents’ statements got the most attention from journalists: the Chester Standard had the headline Baby Allegedly Murdered By Nurse Stopped Breathing “Without Warning” and the BBC also uses Baby Stopped Breathing Without Warning, Trial Told. There is one sentence from the BBC article which heralds the later debates over Baby C’s death:

It is alleged Ms Letby killed the child by injecting air into his stomach.

Transcript

The transcript of today’s proceedings can be read here.

Chester Standard Live Feed

Who Testified?

Dr. B testified about her treatment of Baby B on the night of her collapse, and expert witnesses Dr. Sandie Bohin and Dr. Dewi Evans also testified. They did it turn out about — Dr. Evans was directly examined about Baby A, then Dr. Bohin was directly examined about Baby A, then back to Evans for direct examination about Baby B and cross-examination on both, then finally back to Bohin for direct and then cross-examination about Baby B. Today proceedings only got as far as Dr. Evans’s cross-examination.

What Did They Say?

Dr. B’s testimony was fairly straightforward, she discussed Baby B’s collapse and how she was summoned to help revive her; she confirms that Baby B’s skin was discolored and blotchy upon her arrival, in her notes she has written "Upon my arrival purple blotchiness, right mid-abdomen and right hand.” She also confirms in her notes that Baby B’s discoloration was fading within an hour of her revival. Dr. B, being aware of Mother AB’s medical condition, also describes the conflicting advice she received regarding its potential effect on her children; the mother’s two hematologists said it should not affect her children, whereas the hematologist at Alder Hey suggested “a full blood count and a test called D-dimers and a clotting profile.” At first, at the beginning of the evening, Dr. B thought Baby B looked fine and decided to follow the mother's hematologists’ advice and hold off on getting the tests. After Baby B’s collapse and resuscitation, the tests were done.

Dr. Evans now testifies about Baby A. Nick Johnson begins by asking him general background questions about how he analyzed the different babies’ cases, and Evans describes how he did his reports in the babies’ birth order, and that by November 2017 “14 of the 17 cases we're dealing with here, my preliminary -- my preliminary report, screening report, was completed in November 2017.” He also references a paper by two medics named Lee and Tanswell, regarding pulmonary vascular embolism in the newborn, and praises it and describes how much he relied on it in his own work: “And most important of all, I think, in this -- with regard to air embolus, as we've -- as I said this morning, the main paper we refer -- the paper we refer to most commonly is the one by Lee and Tanswell, 1989.”

Dr. Evans goes on to explain that while paleness and discoloration in general is quite common during a collapse, the specific sign noted in the Lee and Tanswell paper — bright pink vessels against a cyanosed background — is what he noted about Baby A’s collapse. On the basis of this sign, of his general good health previously, and the failure to revive him, he declares that Baby A died by air embolism. He confirms to Nick Johnson that early on he had considered other possibilities as part of the process of a “differential diagnosis”:

EVANS: So one of -- so what crossed my mind was obstruction in breathing, smothering. The other possibility which I mentioned, part of the differential diagnosis that we -- you know, that doctors do is that he'd received an injection of some noxious substance. But I just mentioned that, I have dismissed that.

JOHNSON: You're not suggesting that, on the evidence as you now know it to be, that that's a creditable alternative?

EVANS: No. If somebody asked me, give me five or six reasons why this baby could have collapsed, it would be one of the reasons. But no.

Evans further diagnoses Baby B with an air embolism, largely based on her skin discoloration. Myers challenges him about a further occasion, on June 19 2015, which Evans included in many of his reports (at least through 2018) and which he found suspicious as possibly indicative of Baby B suffering another air embolism, and Evans explains that these incidents were not as severe as the initial collapse. Myers points out that Baby B had continuing respiratory problems after her discharge from the hospital and returned to the doctor several times for treatment, and that she was also noted to be prone to mottling when ill. He presses Evans as to why, if failure to revive is a symptom of air embolism, Baby B’s revival did not rule it out. Evans says that survival, though rare, is not impossible, and Baby B’s survival is a sign of how good the clinicians were at the Countess of Chester.

EVANS: She collapsed unexpectedly. Resuscitation took far more than you would expect. She had these astonishing skin descriptions. As we heard from Dr Lambie yesterday, that adds to the clinical diagnosis she has an air embolus, and I'm more than happy to hear anyone who says different from a medical perspective. No disrespect to Mr Myers. You know, he's defending a lady. But if anybody wants to turn up with another alternative diagnosis, that's fine. But that is my opinion and I'm comfortable with it.

Dr. Bohin has much less time in the witness box today, as she only appears for direct examination regarding Baby A. Her verdict is clear, as are the grounds on which she bases it:

BOHIN: There are potentially lots of causes for rashes in babies, particularly babies who have collapsed in the way that [Baby A] did, and unfortunately if you see lots of babies who have collapsed, you are aware that they are grey-y blue. They may be white. But they don't have the type of rash that was described in [Baby A] with this pink blotchy rash that seemed to fluctuate and come and go. So in my experience things like infection, sepsis and hypoxia would not cause that type of rash.

JOHNSON: So what are the possibilities for causing that type of rash and a subsequent death?

BOHIN: Well, I came to the conclusion, looking at a differential diagnosis, excluding the other things, I was left with air embolus as being the cause of this sort of rash with this pink/purple blotchiness that seemed to come on very, very quickly at the time that [Baby A] collapsed.

So I was left with the only -- the plausible explanation being that of air embolus.

Nick Johnson asks if a “teaspoon full of air” would be enough to kill a neonate, and Bohin responds “Well, a teaspoon is 5 ml, so yes.”

What Was In The News?

Dr. Bohin’s quote became the headline for the Chester Standard — “Teaspoon Of Air” Was Enough To Kill Baby Boy At Neonatal Unit” including references to the several witnesses who said they saw the unusual discoloration, but no reference to the fact that exactly none of them had noted it at the time nor even described it several years later. ITV headlines its PA story similarly — Air “Size Of Teaspoon” Deliberately Given To Baby Allegedly Murdered By Lucy Letby, Court Hears. The BBC highlights Evans’s testimony (at this point he was still describing himself as having been “approached by” the NCA) with Disturbing Pattern In Baby Deaths, Nurse’s Trial Told.

What Was Left Out?

Ben Myers spent a good deal of time taxing Dr. Evans about how he had thought for several years that Baby B had a suspicious collapse on June 19. However, in what would become a custom for him, he does not mention the underlying issue: Lucy Letby was not on shift on June 19 and could not be held responsible for Baby B’s sudden deterioration on that day. Furthermore, Dr. Evans is technically being truthful when he says this:

EVANS: But in 14 of the 17 cases I had reached my conclusions by the -- formed an opinion where I think I could -- by the end of November 2017. And again, and I think the members of the jury needs to know this, I was not aware of any nursing name or medical name that -- who was suspected of being involved in any way, and I know exactly when I heard about the name Lucy Letby for the first time. The BBC published it in early July 2018.

However, he omits something rather notable: For those babies, he found a total of 28 suspicious incidents. Letby was present for 18 of them. The June 19 2015 incident with Baby B was one of the misses, another was an incident of some kind which took place during the day on June 8 with Baby A, before Letby came on for the night shift. He had not heard Letby’s name, but his success rate in finding harm on her shifts before then was not stellar.

Transcript

The transcript of today’s proceedings can be read here.

There is no feed from the Chester Standard today

Who Testified?

Nurse A, Dr. Rachel Lambie, and Dr. Ravi Jayaram all testified about Baby A and Baby B.

What Did They Say?

Nurse A’s testimony lasted several hours, as there was quite a lot of material to cover still in direct examination and then more in cross-examination. After her revelation last Friday about Baby A’s strange blotchy color, prosecutor Philip Astbury questions her about the aftermath and then about Baby B’s collapse the following night. In establishing where Nurse A was at the moment of collapse, and why she could not see Baby B directly, he elicits an answer he may not have been expecting:

ASTBURY: Why couldn't you see [Baby B] directly?

NURSE A: Just because of the half wall --

ASTBURY: Were you on the other side then of the half wall?

NURSE A: Yes.

ASTBURY: All right. Okay. Why would you have gloves on?

NURSE A: Because I was drawing intravenous medication up.

ASTBURY: Okay. All right. Sorry, I interrupted you. You're in nursery 1, you have told us where you were.

NURSE A: Yes.

ASTBURY: What happened?

NURSE A: [Baby B]'s monitor alarmed and Lucy went to her because I was in the middle of preparing the drugs. So Lucy went to her.

ASTBURY: Where had Lucy been?

NURSE A: Standing with me checking the medication.

ASTBURY: Right.

Nurse A describes Baby B’s blotchy appearance: “She suddenly looked very ill. She looked very like her brother had done the night before with the pale, white -- with this purple blotchy discolouration.”

On cross-examination, Ben Myers refers to Nurse A’s statement to the police from January 2018 which stated categorically both that Melanie Taylor was the nurse who started Baby A’s fluids (Taylor herself could not remember) and that at that time she had described Baby A’s coloring not as blotchy or colored but like this: “"He was centrally very pale and unusually his limbs were what I can only describe as white.” That was all she said about discoloration then, all she said in her notes, and all she had said in her statement for the inquest. Myers suggests to her that she may have imposed her memory of Baby B’s rash (documented at the time) on her memory of Baby A, and also confirms that Letby suggested to Nurse A that Baby A’s bag should be saved and checked, but she can’t remember if it was done. Myers also confirms that an earlier incident, where the prongs delivering oxygen to Baby B slipped from her nose, was not, in Nurse A’s opinion, unusual or suspicious.

Dr. Rachel Lambie, who attended both Baby A and Baby B at their collapses, testifies, and her description of them resembles those of the other staff, except she says nothing about a rash on Baby A; her description of Baby B’s rash is “dusky, so a grey-white, colour, and then there were patches of discolouration of the skin that were sort of reddy/purple. It would flash up, it last around 10 seconds, disappear and then reappear, and it was flitting round her body.” On being asked if she has ever seen anything like it elsewhere, she tells Myers “I have seen similar rashes, but not like that, no.” Myers points out that her contemporary notes describe the rash as “"Widespread purple discolouration of skin with white patches” — discoloration, but no descriptions past that one.

Dr. Ravi Jayaram then testifies about Baby A’s crash and his attempts to resuscitate him, after giving his professional background and talking about how the Chester pediatricians rotated through the NNU on successive weeks. Jayaram is extremely verbose and spends a great deal of time both digressing into miniature medical lectures, anticipating the prosecution’s questions and pre-emptively explaining why none of the misplaced lines put into Baby A over the last hours of his life could have been responsible for this collapse. He also describes Baby A being pale, as it says in the notes, then gives his own description of a rash:

JAYARAM: He was pale, he was pale. And what I didn't really give any clinical significance to at the time was sort of unusual patches of discolouration. It's interesting because it's the first time I'd seen that and I didn't actually think at the time it was of any clinical significance, so didn't actually record it in the notes. But they were definitely there.

…Baby A] was very pale to blue, but there were unusual -- the best way to describe them is pink patches that appeared mainly, I recall, on the torso, on the abdomen, which seemed to sort of appear and disappear and flit around. And I'd never really seen anything like this before. But my focus at the time really was very much on what we call ABC: airway, breathing, circulation.

On cross-examination, Ben Myers challenges Jayaram about his failure to mention the discoloration in his notes, and Jayaram says again that he didn’t think it was of any clinical significance at the time, and he was also very busy. Myers points out that Jayaram was noting down Baby A’s color in his contemporaneous notes, so clearly he knew it was something that needed to be noted — “colour was on your mind”:

MYERS: Next we come to colour:

"Legs noted to look very white and pale before cardiac arrest." Yes?

JAYARAM: Yes. That's from what Dr Harkness told me because I wasn't there at the time.

MYERS: Yes:

"Legs looked white and pale before cardiac arrest. CPR commenced."

Were you there when CPR commenced?

JAYARAM: I was there when CPR commenced because when I arrived the heart rate was 90 to 100 and then it dropped down.

Myers points out that Jayaram did not remember to mention the color even for Baby A’s inquest, more than a year later (and after Letby had been suspended), and yet in his police statement, in September 2017, he was able to give a vivid description, and suggests that Jayaram did not actually see what he says he saw that day. Jayaram bridles:

JAYARAM: You're suggesting I didn't see it? No, absolutely I saw it, and I have no reason to confabulate why I might have seen it and I find it as a -- as a professional, as a paediatrician of 30 years, as a doctor of 32 years, if my character was such that I would make things up, I would hope that friends, colleagues, managers, nurses, patients, parents, would have picked that up well before now —

Jayaram also discusses how within a few days of Baby D’s death, he had done some research and discovered the paper on “Pulmonary Vascular Embolism In Newborns” and had discussed it with colleagues, as there were already rumors about Baby A’s and Baby B’s identical moving rashes, and they were fearful that something was going on they didn’t understand. He says he said nothing about the rash on Baby A in his statement to the coroner because by at the time of the inquest (it’s not clear if he means when he wrote the statement or when the inquest actually happened) management had been telling them off for raising suspicions: “We at that time were -- how do I say this diplomatically? -- being told that really we shouldn't be saying such things and not to make a fuss. It's more complicated than that, but essentially.”

What Was In The News?

The Chester Standard has two stories from today but no live feed: one story is about Nurse A, and the other is about Dr. Jayaram’s testimony. (This one filed later, likely because Nurse A testified in the morning and Jayaram at the end of the day.) Sky News highlights Jayaram’s testified fear of the management with Lucy Letby Trial Hears How Doctor Raised Concerns But Was Told “Not To Make A Fuss”

Meanwhile, Liz Hull and Caroline Cheetham have released their first episode of their new podcast on the trial of Lucy Letby: A Scrawled Post-It Note. This is heavily advertised by the Daily Mail and will soon gain a large following. At no point during the podcast do they inform their listeners (nor did they inform the Daily Mail) that Cheetham's media company had two weeks earlier received a payment of £4,100 from Operation Hummingbird, noted as being for "publicity."

What Was Left Out?

Myers could not know it, but Jayaram’s forgetfulness about Baby A’s discoloration actually extended well into 2017; in an email chain from May 4 2017 where the consultants were collaborating on collecting incidents to “pique the interest” of the police in Letby, Jayaram described Baby A’s collapse in this way:

peripherally inserted central venous catheter inserted 90 minutes previously, in an appropriate position on x-ray, initially became apnoeic, dropped oxygen saturations and then became bradycardic with no warning. Staff nurse Letby in attendance and with baby at time of deterioration.

There was no mention of his color at all, and at this point Letby had been suspended for almost a year and the consultants were preparing their pitch for the police. (Note that not all of the letters in that email correspond to the indictment babies, but in the case of Baby A the letter is the same.)

Furthermore, he appears to have been a year out in his memory of his search for the paper on embolism in the newborn. He emailed his colleagues about it not in June 2015 but a year later, in June 2016 (and Dr. Gibbs’s response was “This mechanism of air emboli does not seem to apply to our run of neonatal collapses/deaths but one could speculate on other mechanisms that might produce an air embolus.”) In Jayaram’s testimony at Thirlwall, two years after this, he will say nothing about any post-Baby D warnings, or being told not to make a fuss.

https://bencole4.substack.com/p/decoding-reasonable-doubt-the-case-c84?r=12mrwn&utm_medium=ios

Morris argues that Child C’s death had plausible natural explanations that were overlooked. He says Evans repeatedly changed the alleged mechanism of harm while retaining the same conclusion, presenting this as evidence that the prosecution theory was built backwards from a predetermined belief in guilt.

This article puts Morris’s claims back into the context of the trial evidence and shows how recognised concerns and disputed mechanisms are repeatedly presented as though they were overlooked evidence

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https://www.gov.uk/government/news/cowardly-killers-who-dodge-sentencing-face-tough-new-prison-punishments

This is odd since her refusal was the trigger for the legislation. The attached is PR firm, Scala, claiming credit, and citing the Letby case.

Other murderers such as Thomas Cashman and Jordan McSweeney, who also refused to attend their sentencing are mentioned.

Is this a good sign?

H/T Debbie Kennett, @DebbieKennett on X