This website began as a copy of the Tattle Life wiki about the Lucy Letby trial, after it was blocked to non-subscribers.
It has now been expanded to include information showing that Lucy Letby is innocent of all charges and that a miscarriage of justice has occurred.
Count 1: Murder of Baby A on 8th June 2015 - GUILTY.
Count 2: Attempted murder of Baby B between 8 June 2015 and 11 June 2015 - GUILTY.
Count 3: Murder of Baby C on 14 June 2015 - GUILTY.
Count 4: Murder of Baby D on 22 June 2015. - GUILTY.
Count 5: Murder of Baby E on 4 August 2015 - GUILTY.
Count 6: Attempted murder of Baby F on 5 August 2015 - GUILTY.
Count 7: Attempted murder of Baby G on 7 September 2015 - GUILTY.
Count 8: Attempted murder of Baby G on 21 September 2015, at about 10.15 hours - GUILTY.
Count 9: Attempted murder of Baby G on 21 September 2015, at about 15.30 hours - NOT GUILTY.
Count 10: Attempted murder of Baby H on 26 September 2015 - NOT GUILTY.
Count 11: Attempted murder of Baby H on 27 September 2015 - NO VERDICT.
Count 12: Murder of Baby I on 23 October 2015 - GUILTY.
Count 13: Attempted murder of Baby J on 27 November 2015 - NO VERDICT.
Count 14: Attempted murder of Baby K on 17 February 2016 - NO VERDICT.
Count 15: Attempted murder of Baby L on 9 April 2016 - GUILTY.
Count 16: Attempted murder of Baby M on 9 April 2016 - GUILTY.
Count 17: Attempted murder of Baby N on 3 June 2016 - GUILTY.
Count 18: Attempted murder of Baby N on 15 June 2016, at about 7.15 to 7.30 hours - NO VERDICT.
Count 19: Attempted murder of Baby N on 15 June 2016, at about 15.00 hours - NO VERDICT.
Count 20: Murder of Baby O on 23 June 2016 - GUILTY.
Count 21: Murder of Baby P on 24 June 2016 - GUILTY.
Count 22: Attempted murder of Baby Q on 25 June 2016 - NO VERDICT
The International Panel's summary reports can be viewed/downloaded here:
International Expert Panel Report (3rd Feb 2025)
International Expert Panel Report of additional 10 cases (2nd April 2025)
Summary of Joint Expert Witness Insulin Report on Babies F and L (2nd April 2025)
Prosecutor Nicholas Johnson KC says this is "the beginning of the end" of the trial.
Documents are now handed out among members of the jury.
Mr Johnson asks the jury to look at an agreed fact which has been 'crossed through'. He says, in case jurors enquire, it has become "irrelevant". He says it has been a long time since October when he introduced the case. He says the detail given back then is "nothing" compared to what the jury now know about the case.
He says the introduction, evidence and cross-examination has been largely chronologically presented. He says the trial judge is likely to be a chronological presentation too. Mr Johnson says 'drawing together the strands of this case' requires a different approach, and "point out the similarities" and the "evolution" of "Lucy Letby's murderous assaults on these children" and "point out how calculating and devious she has been". "We suggest that Lucy Letby gaslighted staff at the hospital - professional people with many many years of experience." Letby "persuaded" staff the incidents were "just bad luck". The laboratory synthesised insulin found in two babies wasn't "just bad luck", he added.
Mr Johnson says Letby picked Mr Mansutti, a plumber, as a defence witness to pick on incidents "which aren't actually relevant" to the case. He says there may have been one occasion when there was a backed up sink in neonatal room 1, but it did not correlate with any of the incidents heard. If it had, someone would have noted it. NJ: "His evidence isn't going to help you decide in this case. "He was called, we suggest, to bolster the tattered credibility of Lucy Letby - and you might ask yourself why."
Mr Johnson says Child P's injuries, combined with the insulin poisonings, had nothing to do with the plumbing. NJ: "Please do not be distracted." Letby "got away with her campaign of violence for so long" as it was not contemplated that a nurse could do such acts, he adds. Mr Johnson says the "similarities" in these cases "shows who this person was".
Mr Johnson refers to Dr Stephen Brearey's evidence in court. NJ: "Lucy Letby had used ways of killing babies...that didn't leave much of a trace. "Her behaviour persuaded many of her colleagues that most of the collapses were 'normal' - they couldn't see the wood through the trees. "No-one - no-one, was contemplating the possibility of foul play." Mr Johnson says Dr Brearey said, in relation to 'confirmation bias', that senior nursing staff "didn't believe this could be true", but the year was spent "with increasing suspicion with each incident...none of us wanted to believe it either." "Then we stopped to take a step back, to think about it...the unexpected collapses...the unusual rash on a number of occasions, the association with Lucy Letby. "Each time it became more statistically improbable." Mr Johnson says Dr Brearey didn't know about the liver injury or the insulin poisonings at that time. Dr Ravi Jayaram had said it was an "unprecedented" situation - "it seems utterly preposterous, then more and more happens. "It seems easy to see things which aren't there." "We are taught to think about common things, less common things, rare things. We do not generally consider unnatural causes or deliberate things."
Mr Johnson refers to the 'gang of four conspiracy theory'. He says in Letby's defence statement, there is a suggestion that the collapses and deaths were a product of staff shortages, or mistakes, or insufficiently qualified staff. Mr Johnson says Letby said that was a "medical opinion", but the jury have not had any 'medical opinion' to back that up. NJ: "The only things that matter is to concentrate on the issues in this case. Concentrate on the 17 children in this case...and see if there are any shortcomings. "We suggest that was an uncomfortable exercise for Lucy Letby."
Mr Johnson says for Child A, Letby said there were issues with the long line, and "if we agree" it was an air embolus, that Melanie Taylor would have done so. Mr Johnson says Child A did not die of dehydration, and it was not Melanie Taylor who supplied the air embolus. For Child B, nothing. For Child C, nothing.
For Child D, Letby said there was a delay in antibiotics - but Child D did not die from an infection, Mr Johnson says. For Child E, it was delay in response to the bleeding. Mr Johnson asks where did the bleed come from in the first place. For Child F, nothing. For Child G, initial blame with a colleague, but Letby went back on that. For Child H, 'some of the drains were not securely put in', and 'potential incompetence'. Mr Johnson says Letby uses the word 'potential a lot'.
For Child I, nothing on event one or three. For event two, Ashleigh Hudson was blamed for not full monitoring after Child I was taken off antibiotics within 48 hours, but Child I had been off antibiotics for 'much longer'. In the fourth event, 'potential medical staff issues' with doctors being absent may have contributed. For Child J, nothing. For Child K, nothing. For Child L, nothing. For Child M, the 'unit was very stretched' and Child M was not in a proper bed. For Child N, the unit was 'very busy', but Child N was due to go home. For child O, nothing. For child P, concern overnight for Child P's condition - but there was no medical record of this. For Child Q, nothing. Mr Johnson adds: "Do you really think the [gang of four] would say things to get Lucy Letby convicted?" He says: "What did the doctors say that wasn't true?"
Mr Johnson says the 'gang of four' didn't do a very good of scapegoating Lucy Letby, as they missed the insulin evidence - "the best bit of evidence". He says "all the clues point in one direction, don't they? She's sitting in the back of court." He says the four "didn't even know" about the "wildly out of kilter" insulin readings when they "blew the whistle".
"Lucy Letby, we say, put a lot of effort in trying to pull the wool over your eyes." He says Letby spent a lot of time talking about being isolated from her friends. He refers to the 'I AM EVIL I DID THIS' notes - he says "we will come back to them at the end", but says "there are more important things in this case". He says it was established Lucy Letby was "not isolated" and was "still in contact" with people she had "not been allowed to contact". "Even though she knew what we had from our phone, she did repeat the lie. "We went to the spreadsheet and the lie was exposed, wasn't it? "She thought that if she said something often enough...it would be accepted. "We suggest that Lucy Letby was an opportunist - she used their vulnerabilities as camouflage." He says the misperception of the vulnerabilities "gave her away". He says Letby thought Child A and Child B had an inherited blood disorder, and that allowed her the cover to target them. "If she had left it there- she probably would have got away with it."
"Her ignorance of insulin c-peptide...and the ratio [to insulin]...allowed her to poison [Child E and Child L]. "What she didn't know about the disconnection [between the insulin and insulin c-peptide ratio] leaves a biological footprint which leaves foul play. "She would have got away with that - if police hadn't...referred the cases to Dr [Dewi] Evans." He says Letby returned from a holiday in June 2016 and embarked on a "killing spree", with Child O and Child P killed and attempting to murder Child Q. He says Letby put in 'false data sheets' to cover her tracks, and first put in the theory of an air embolus at June 30, 2016.
Mr Johnson says he will look at five cases in one go - twins Child E&F, twins Child L&M, and Child K. He says for E&F and L&M, one twin was poisoned with insulin and the other deliberately administered air. The cases were months apart. "What are the chances of that?" He says Letby "invented" other cases of problems where none existed. With Child K, it was that she was a 'serial tube dislodger', but Child K had been "sedated". For the two poisoned with insulin, they were "deliberately targeted". Mr Johnson says when Letby was "interrupted" for Child E, she 'invented' that Child E really did have a problem.
Mr Johnson refers to Child E and Child F's mother's evidence, given several months ago, for events from July 30, 2015. Mr Johnson says the mother was a "very very important" witness. He says the evidence was that providing milk was a big priority for her twins, as it as the only thing she could do. Child E was crying 'like nothing she had ever heard before' - 'it was horrendous, more of a scream than a cry'. Mr Johnson says screaming was also recorded for Child I and Child N.
Mr Johnson says the mother described Child E's blood around the mouth - 'like a goatee beard'. Letby had said the blood came from the NG Tube and the registrar was 'on his way'. Letby told the mother to go back to the post-natal ward, and had done so by 9.11pm. NJ: "This is a head-on credibility contest between [the mother] and Lucy Letby." "You can be sure Lucy Letby is lying on this - plainly, as any parent will understand, provision of milk and food to any newborn infant is important, and 2100 was [Child E's] feeding time." "Crying like nothing I'd heard before - it was a sound which shouldn't have come from a tiny baby, it was horrendous... "You may think [the mother] would have a very good reason to remember this. "Either she saw blood or didn't - why would she make it up?" If she did see blood at 2100, then Letby's nursing notes are "false", Mr Johnson says.
Dr Sandie Bohin says the NG Tube for Child E had been in place from July 29 to August 3, 2015. Mr Johnson says that was never disputed. He asks why the tube was the cause of the bleed, as said by Letby. NJ: "It was a panicked reaction, told to a mother who knew no better, and it was designed to cover her tracks."
Mr Johnson refers to the '1ml bleed' Letby recorded for Child N. Letby, interviewed on that, had said the tube insertion 'can cause a bleed' - "just a small amount". Mr Johnson says the mother of Child E recorded a small amount of blood at 9pm. He says if that was the case, then Child E was 'producing lots of blood' by 10pm. He says Letby 'falsified' nursing notes for Child E. He says the jury "can be sure" the mother was telling the truth, as the mother rang her husband, and the phone call record "proves that" at 9.11pm, in a call lasting over 4 minutes. He says the father's evidence backs up the mother's evidence on the content of the phone call. "Have [the parents] made that up, to get at Lucy Letby? Are they in on it? Are they a sub-gang of two?"
Mr Johnson says of all the things to see in your life, "you would remember" seeing your son "in terminal decline", as the mother recalled returning later to see efforts to save Child E's life. He says if the parents are telling the truth, then Letby's account is a "lie". He says there is a "fundamental difference" between the mother's "compelling account" and Letby's "lie" in the notes. Dr David Harkness's note for 11pm, Mr Johnson says, coincides with the telephone call from the midwife at 10.52pm to the father of Child E, in a call which lasts over 14 minutes. Letby's family communication note records 'both parents present during the resus.' Mr Johnson says the pieces of the jigsaw 'fit only one way' and the parents' recollection is at odds with Letby's. Mr Johnson says the prosecution say Letby attacked Child E and was interrupted first time, then attacked again. He says of the mother's account: "It's powerful evidence - independent of the medical evidence - that Lucy Letby murdered [Child E]."
Mr Johnson says Dr David Harkness, in evidence, gave a chronological sequence of what happened. He says he accepted he had been on the neonatal unit from 9.30pm. A fluid balance chart for Child E is shown to the court. '15ml fresh blood' is written in the 10pm column, accepted it was written in Letby's handwriting. Mr Johnson says it was signed by Belinda Simcock [Williamson] deliberately so Letby could 'disassociate' herself on the paperwork from the incident, "so it looked" that someone else was there at the time. Letby had said she "assumed" it came after Belinda Simcock's documentation. Mr Johnson refers to a case in Child I, where Letby 'altered the timing' for her designated baby that was due to be transferred to Stoke.
Mr Johnson says Letby needed an "innocent reason" for why Child E's 9pm feed was omitted, and does so by suggesting Dr David Harkness was on the unit earlier in the shift. Dr Harkness had suspected a gastrointestinal bleed for Child E, but all the observations were 'good' and did not point to that. Dr Harkness was "insulted" at the suggestion, in evidence, he was "out of his depth".
NJ: "None of these doctors suspected sabotage - they all looked for a natural cause. "It was not a level playing field - there was no natural cause." Dr Harkness had said something had been "interfering" with Child E's oxygen flow into the bloodstream. He said Letby had been looking "A strange pattern over the tummy area which didn't fit with the poor perfusion - there were these strange kind of purple patches. "There were patches in one area, then in another...it was unusual for a baby [in Child E's condition]."
Dr David Harkness had said he had not seen these patches - "no smaller than 1-2cm", "didn't remain constant", outside of the babies in this case - Child A and Child E. DH: "It was something that was so unusual it's hard to give a clear description". Mr Johnson says this was what a doctor had said. He says Dr Harkness was "traumatised" by what he had seen, in the way Child E had bled in the way he did. He said Letby, by comparison, on the day Child E died, texted "one of those things"; "nothing to see here," Mr Johnson adds. He says Letby was "gaslighting her colleagues".
Mr Johnson says Dr Harkness was not one of the 'gang of four'. He asks the jury if Dr Harkness was lying. He says one of Dr Harkness's colleagues, also a doctor, recalled Dr Harkness was "animated" when describing the discolouration. He says if Dr Harkness is lying, then the doctor colleague is also lying. "How deep does this conspiracy go?" He says Letby had described 'strange discolouration' on Child E, with 'red horizontal banding' around the stomach. Mr Johnson says if Letby agrees there was discolouration on Child E, why was Dr Harkness taken to task for describing it in cross-examination? He suggests it was an attack on Dr Harkness.
"No-one now suggests seriously [Child E] had [gastrointestinal disorder] NEC." A doctor had since expressed regret that they agreed a post-mortem examination was not necessary, Mr Johnson tells the court. A medical expert had excluded the possibility of a congenital blood disorder. Dr Dewi Evans said stress for Child E had been ruled out, and the "graphic" skin discolouration provided by Dr Harkness was 'clear evidence' of air administered into Child E's system. Mr Johnson says there is only one person who could have been responsible for administering air into Child E. He says, for the bleed, "this was no naturally occurring bleed". Dr Sandie Bohin said Child E had been "incredibly stable" prior to the deteriorations. The 16ml aspirate at 9pm "struck" her as "really odd" in that context. She was "at a loss to explain where this had come from". Mr Johnson says this discrepancy is also seen in Child N and Child G - and the similarities are "all down to Lucy Letby's behaviour", he adds, pointing to Letby in the dock.
Dr Bohin had agreed with Dr Evans to say air had been injected. The haemorrhage seen by babies such as Child E on this scale was "vanishingly rare". The purple patches, Dr Bohin said, "didn't fit with any explanation other than air embolus".
Dr Bohin rejected a suggestion that stress in Child E caused excess stomach acid which caused the bleeding, Mr Johnson adds. Mr Johnson says Child E declined within about an hour of Letby coming on duty that night. "What are the chances of that?" Mr Johnson says the point of circumstantial evidence is pointing at the threads of evidence, and the collapses "always happen" when Letby is in the neonatal unit. He adds: "There are no innocent reasons for [Child E's] collapse and death."
He says the level of insulin in Child L was double that found in Child F several months earlier. NJ: "That tells you a lot about intention, doesn't it?" He says for Child A, Letby was interviewed about it and said in the aftermath she had 'asked for the [dextrose] bag to be kept' in June 2015. It was put in a sluice room, and a colleague had confirmed this was done. He says that Letby knew no-one subsequently examined the bag. He says Letby "taunted the police" by repeatedly asking the question if police 'had the bag' [which had insulin in]. "She thought the fact they didn't have the bag would give her a free pass. "But she was wrong, because what she didn't know was insulin c-peptide."
Mr Johnson says experts had given evidence from the laboratory to show results [indicating insulin and insulin c-pep levels] from there were "reliable", and Letby had accepted this in evidence. Mr Johnson said it was ruled out that insulin could have been applied to the nutrition bag in the pharmacy prior to its arrival on the ward. Evidence had been heard by one of the pharmacy team to this effect and it was not challenged.
Mr Johnson says the 'murderer' had to have been working both night shifts for Child F and Child L. "Only three" people were working both shifts. One was a nursery nurse and would not have been in room 1. Another was Belinda Simcock, and the third was Lucy Letby, who 'hung up the bag for Child F'. Child L got "more than one poisoned bag of insulin". Mr Johnson: "These are not random poisonings". He says it's "obvious" who is responsible, as there is only one person who could be responsible.
Mr Johnson shows to the court a "tiny vial of insulin", which had been added by someone who had access to the nutrition bags in the fridge, of which there were "a limited number of candidates". Mr Johnson says "we have heard from all of them" and there is only one candidate left. Mr Johnson says it does not need to be found "how it was done", as the evidence shows "it was done". "Anyone, if they wanted to, could inject 0.6ml of insulin into that bag. "A tiny amount of insulin could have fatal consequences. "What is the state of mind of someone who does that? Is it someone who watches someone freshly born desaturating [for up to half a minute - in the case of Child K]. "Is it a sick person? "This was a targeted attack."
Mr Johnson says "we know from evidence" that insulin is "never put into a TPN bag". The case of Child F had been referred to medical experts as the events for Child E were "suspicious". He says the first contaminated bag was put up for Child F at 12.25am, and Child F vomited less than an hour later. A medical expert said this was a symptom of low blood sugar, as a self-defence mechanism for the body. There was also a 'sudden rise in heart rate' as the body produced adrenaline to combat it. The blood sugar level of 0.8 was a "life-threatening situation for [Child F]."
No other child on the unit was receiving TPN bags that day, in the case of Child F. The turnover of TPN bags was "very low" according to evidence by Yvonne Griffiths. The bag "was only ever going to one child, isn't it?" "It's so sly, isn't it?" Mr Johnson says the insulin-contaminated bag was going to be administered when 'the poisoner' was not on duty, to be administered by "an unsuspecting colleague" - "a member of her 'family'". "What does that tell you about the mindset?" "It shows you a cynical, cold-blooded" planner, Mr Johnson says. The amount of insulin in the two bags was 'about the same', which showed there had been thought put into the preparation. Mr Johnson says Letby "told some interesting lies" about Child F in police interview. "She claimed she hadn't been aware of any concerns about [Child F's] blood sugar." He says Letby otherwise had a very good memory. "You know she is lying [from] the text message[s] she sent to [a nursing colleague]." Police broke the news of insulin c-peptide to Letby in November 2020, Mr Johnson adds. The 'surreptitious' searching of Child E&F's mother on Facebook was "never properly explained." Mr Johnson says Letby was "Cold, calculated, cruel and relentless."
The trial will be resuming shortly after its break for lunch.
Mr Johnson refers to the cases of Child L and Child M, the twins. He says fluids were calculated for Child L by Dr Sudeshna Bhowmik. Letby had recorded 'myself and shift leader A. Davies have discussed this with Reg. Bhowmik as it does not follow the hypoglycaemia pathway'. Amy Davies had not recalled this conversation. Mr Johnson says Letby was "setting up an issue" for Child L. Child L's blood sugar level had improved so monitoring was not required. Nurse Tracey Jones said she didn't change the dextrose bag during her shift. Mr Johnson says for the day shift on April 9, 2016, Mary Griffith was the designated nurse for Child L and Child M, on a "busy shift". Mr Johnson says if people were "very busy", then they might not have the time to monitor what Letby was up to. Mary Griffith was "certainly out of the room" by 9.30am as she was in room 4 administering medication to children in there, Mr Johnson says. He says that means Lucy Letby would have been "alone" with Child L at that time. He says that would be when insulin was put into Child L's dextrose bag, as Prof Hindmarsh, in evidence, said it had to be by 9.30am. A blood sample taken for Child L taken at 10am showed an increase in the amount of dextrose given but a drop in the level of blood sugar - "when the opposite should have been true". Mr Johnson says the "fingerpoint of evidence" is the ratio between insulin and insulin c-peptide later recorded. The 'podding' of the blood sample was delayed due to Child M's collapse, Mr Johnson says, and the timing of the sample taken must be taken from several accounts. He says it "must have been taken about 3.45pm".
The blood sample "would have been treated as urgent" and the nurse said she had been distracted by "an emergency" with Child M, which was timed at 4pm. The blood was put into a vial and envelope and labelled. The request for the blood test was entered at 3.45pm on a 'lab specimen internal inquiry' form at the Countess of Chester Pathology. The form is shown to the court. The process and analysis were "interrupted" by "Lucy Letby's attack on [Child M]," Mr Johnson adds.
An infusion therapy sheet for a 10% dextrose prescription is at 3.40pm. Mr Johnson says this explains why the lab result shows a slightly higher blood sugar reading for Child L than the other readings, and that the blood sample was taken at 3.45pm. Dr John Gibbs said the low blood sugar level should have meant the level of insulin in Child L was also low. He said it had "never occurred to him" that someone was administering insulin to Child L. He said he had never received the lab results for Child L - they went to junior doctors who "didn't appreciate its significance" at the time.
Mr Johnson said scientist Dr Sarah Davies had phoned through the results to the hospital "as they were so unusual". The lab at Liverpool was "performing very well" and Mr Johnson says it can be discounted as a possibility that the lab results were in any way "misleading". He adds "it speaks volumes" that the levels of insulin were double that found for Child E months earlier. "The poisoner, Lucy Letby, upped the dose for [Child L]." He says, for timings, the insulin was put in "after the bag was hung" for Child L.
Mr Johnson says Letby was co-responsible for hanging up the bag for Child L at noon on April 9, and had also co-signed for the previous bag on April 8 at noon. Prof Hindmarsh says the bag was "not poisoned" before midnight on April 8/9, as the blood sugar readings are "following an upward trend" for Child L. Insulin "must have been put in" between midnight at 10am on April 9. Mr Johnson says insulin went into the bag sometime before or at 9.36am, given insulin's half-life of 24 minutes. Mr Johnson says it "had to have been a targeted attack", and is "not a random poisoning". He says "whoever is responsible" must have been on duty between midnight at 9.36am. Mr Johnson says the jury must ask if it could have been a different person. He says "it must have been the same person", and they could "get away with it" as long as "they didn't do it too often". He says Letby came on duty between 7.30am-8am on April 9.
The insulin that poisoned Child L "was put into more than one bag" and all the staff on duty said they were not responsible for that. Mr Johnson says the first poisoning was when the bag was already hanging, and the second one was administered to Child L as well. He says at 9.30am on April 9, Mary Griffith was in room 4. She was not working on the day when Child E was poisoned.
A third bag was being put together for Child L at the time Child M collapsed. "Somebody also spiked that bag," Mr Johnson says. He says it was "spiked" sometime after it was hung up at 4.30pm. Mr Johnson asks if somebody did this to "frame" Lucy Letby, and if she didn't do this, then somebody also targeted Child E, and targeted Lucy Letby to take the blame. "We suggest that is not a reasonable possibility - that is why all the other cases are so important, they are not coincidences."
Mr Johnson moves to Child M, who was "a picture of health" after his birth, and "was doing just fine". "The fact that his twin was poisoned puts his case into sharp relief. "What are the chances of a healthy baby boy collapsing in such an extreme way? The evidence, as you have heard from the doctors, is not very big. "What are the chances of this happening at the same time his brother was poisoned...and [point] you to the identity of the attacker?"
Mr Johnson says "circumstantial evidence" can be "very very powerful", and this is a case where it is. Child M suffered a "profound collapse", from which "he made a miraculous recovery" - "how many times have you heard that before [in this case[?]]" He said this was "entirely out of natural process".
Dr Anthony Ukoh had noted there were issues with aspirates and a slightly distended abdomen for Child M, "but nothing to indicate he was to become seriously unwell". On April 9 at 3.30pm he was put on to 10% dextrose, co-signed by Lucy Letby and Mary Griffith. He did not get a bag with insulin in, Mr Johnson tells the court. Mr Johnson says Mary Griffith was about to take a blood sample for Child L and make up a 12.5% dextrose solution, which would take time. Mr Johnson says Letby would have administered this 10% dextrose infusion for Child M. The parents of Child L and Child M had given evidence to say one of the doctors was "pressing [Child M's] chest" '10 minutes after we had left the boys'. Child M had gone from "fine" to "life-threatening emergency CPR" and the father was left "praying", Mr Johnson says. He says it can be discounted this was all 'unlucky coincidence'.
Mr Johnson refers to a paper towel on the resuscitation notes for Child M "which found its way, under its own steam, to Letby's home". NJ: "It 'quote', "came home with me" - sounds like a dog following home, doesn't it? "Her explanation - I collect paper. "How long has Lucy Letby had to come up with a reason? Here we are now, 7 years later, and her best reason is 'I collect paper'." "Most collectors know what they collect - [it's] absolute nonsense." He adds: "Somebody sabotaged [Child M], didn't they?" The attacks were "almost signature" as Child M deteriorated, and six adrenaline doses were given. "It is a signature of the consequences of many of these attacks." Child M was "at the very edge of life" and the resuscitation "took 30 minutes with no response". 20 minutes is "the usual watershed", according to Dr Ravi Jayaram. Dr Jayaram had the 'difficult conversation' with the parents, but Child M had a "miraculous recovery." Mr Johnson says Dr Jayaram 'wasn't sure what we had done' [to make Child M recover]. Dr Jayaram had noted skin discolouration on Child M, that "flitted around" "appearing and disappearing". Dr Jayaram said: "Because [Child M] was darker skinned, it was more obvious." He added: "I have never seen this before [Child A]." Letby, in interview and cross-examination, had suggested the lighting in room 1 was 'not very good' and that was a possible reason why she could not see what Dr Jayaram had seen. Mr Johnson refers to Child I, when Letby could see in very poor lighting what her condition was.
Dr Jayaram had asked, in cross-examination, if he was being accused of making things up. "What is Lucy Letby's case, if Dr Jayaram is making things up?" Mr Johnson said it had been suggested Dr Jayaram had, in cross-examination, 'added dramatic detail' by mentioning the skin discolouration descriptions but not recording it contemporaneously in notes at the time, and had been accused of 'dramatic detail' when he said a 'shiver had gone down his spine' when he first read about the effects of air embolus. NJ: "We suggest that not only is Letby murdering babies, she is also prepared to trash the reputations of professional people in order to get away with it."
The trial is now resuming after a short break.
Mr Johnson says after the collapse of Child M, the night-shift of April 9/10 happened, and a Countess doctor described there was a plan to remove Child M's ET tube, following an "astonishing" recovery. He was put on to 'bi-pap' within 12 hours, and there was "no cause for concern" for a child who had had "such a devastating collapse". Dr Gibbs had queries NEC and sepsis at the time, but those could be excluded by following evidence. Child M required a dose of caffeine for a slowing breathing rate at the end of the following day. Dr Stavros Stivaros later said Child M had suffered a brain injury. Mr Johnson says this was as a result of the collapse. Mr Johnson says 'a fairly typical picture' in this case is of babies collapsing rapidly and unexpectedly, and recovering just as quickly. Medical expert Dr Dewi Evans said there had been no reason to do blood tests for infection, and subsequent tests ruled that out in any case. Dr Evans and Dr Sandie Bohin had said the cause of the collapse was an air embolus. Mr Johnson says there had been "evolving means of attack" by Letby.
Mr Johnson says there is only one conclusion, as said at the beginning of the trial - "there was a poisoner at work" in the Countess of Chester Hospital's neonatal unit. He says it has not been suggested by Letby or the defence that anyone was responsible for poisoning Child F and Child L. Child F was poisoned with two bags, and Child L was poisoned "with at least two bags", until the 15% dextrose bag was fitted and he began to improve. "Lucy Letby and Belinda [Simcock] were the only ones present when both [Child F and Child L] were poisoned." Mr Johnson says: "You can dismiss the possibility that two murderers were working in the same unit at the same time." Mr Johnson says Letby has 'rowed back' from disputing the accuracy of the insulin readings between her defence statement and giving evidence, and says it will be 'interesting' how the defence get her out 'of that particular creek'.
Mr Johnson moves to the case of Child K. He recalls the evidence heard by Dr Ravi Jayaram that Lucy Letby was "standing over" Child K as the alarm was not sounding and she did nothing. Mr Johnson says Letby had displaced Child K's ET Tube. The Child K case "shines a bright light" for what happened in Child E, Mr Johnson says, when Letby "was almost caught red-handed".
Mr Johnson says nurse Joanne Williams said it was "strange" Child K desaturated two further times, and the second and third incidents saw Child K 'well sedated'. The 6.15am desaturation (the second incident), happened between 6.07am and 23 seconds, and 6.15am, Mr Johnson says. An x-ray, timestamped at 6.07am and 23 seconds, shows Child K's x-ray, with a report the ET Tube was 'in satisfactory position'. By 6.15am, Child K was desaturating, Mr Johnson says. The tube had "gone down her throat" then had to be removed. "How on earth had that happened in a 25-week-old [gestational age] baby who had been on morphine?" Mr Johnson says Letby had no memory of this. He says Letby had been responsible for the admission process for Child K. He says the cross-examination at this time was a "somewhat tortuous process". He relays the cross-examination of this, in which he concluded he got told off for saying they 'danced the dance' in arriving at the point. He says they got there, 'in the end', in that Letby was in room 1 to obtain the medical notes for Child K to input the admission details on the computer, in a record between 6.04am-6.10am on the computer. He says those notes would have to be returned to the cotside in room 1 afterwards.
He says the coincidence between Letby's presence and Child K's desaturation "is not an innocent one". He says the third event for Child K happened at handover, which Mr Johnson says was not the only occasion.
Mr Johnson says once Child K's ET Tube was moved to the correct position, 'she picked up immediately'. Mr Johnson says after nearly being caught red-handed, like in Child E, she 'pressed home her advantage' and tried to create more of a problem for Child K which led her to desaturate again, by moving her ET Tube.
Mr Johnson refers to police interviews with Letby, in which she said Child K's tube had slipped earlier in the shift. Mr Johnson says Letby had, in interview, 'created the impression' of 'innocent tube movement' for Child K.
Mr Johnson says Joanne Williams had left at 3.47am to see Child K's mother, and had left Lucy Letby 'babysitting' room 1, Letby having fed a designated baby. It had been suggested to Dr Jayaram he was 'inventing' an allegation for Lucy Letby, to cover for shortcomings in Child K. "What did Dr Jayaram invent? What was it that was so offensive to their case?" Mr Johnson says Dr Jayaram said Joanne Williams had left and Letby was 'babysitting'. Dr Jayaram was 'suspicious' - "Letby can't say what was on his mind." Dr Jayaram walked into room 1 and saw Letby by the incubator. NJ: "What was Letby's case here?" Mr Johnson says he can't help the jury as Letby was saying one thing and then said another. He says if the jury is confused, then they have to ask why - he says the reason is because Letby won't commit herself. He asks if that is the case, then why? Dr Jayaram said Child K's observations dropped - there was no dispute about that. The alarm was not on, and that was not disputed. He said the cause was a displaced tube - that was not disputed. "Is Dr Jayaram a wicked liar to make up allegations about one of his colleagues?...or is he telling the truth?" Mr Johnson adds: "What lie did Dr Jayaram tell? We suggest it's all smoke and mirrors, that all these doctors are bad, that they tell lies, that they stitch her up."
Mr Johnson says evidence was heard to say a nurse would not leave a baby unattended without checking the tube was secure. Joanne Williams had checked the equipment and made sure the tube was secure, Mr Johnson said. A 'big play' was made of the 'high air leak' on the ventilator. It had been accepted the ventilator was sub-optimal, but said the oxygen saturations were 'optimal'. Mr Johnson says the leak was not having any impact on Child K.
A note was made of 'large blood-stained oral secretions' by Joanne Williams, but she could not confirm she had been present to see that. A doctor had said if he had seen blood stains during reintubation of Child K, he would have noted it and made Dr Jayaram aware of it. Mr Johnson says that note of 'large blood-stained oral secretions' had 'only come from Lucy Letby', and was "entirely typical behaviour by Lucy Letby". He says in Child K's remaining days before she passed away, the ET Tube did not dislodge again. Mr Johnson counts the number of seconds, each one, up to 30, for a 25-week-gestational age baby desaturating, which he says was the sight Letby saw from Child K's cotside. NJ: "It's uncomfortable isn't it? Even talking about it is uncomfortable. "That is why it's attempted murder."
The trial is now resuming. Nicholas Johnson KC is turning to the cases of Child O and Child P.
He says the evidence of Dr Andreas Marnerides is uncontested, that Child O had a significant liver injury. That injury and the "lacerations" in the surface of the liver are "the best evidence you could ever have" of someone "inflicting a violent injury on a small child", he tells the court.
Lucy Letby's 'HELP' post-it note is shown to the court. Mr Johnson says it began with the note to all three triplets: 'Today is your birthday, but you aren't here + I am so sorry for that...I'm sorry that you couldn't have a chance at life... 'I can't do this anymore. I want someone to help me but they can't. What's the point in asking. Hate my life.' Mr Johnson says this note would have been written in June 2017 or June 2018. The note was found in Letby's handbag.
The note shown to the court.
Mr Johnson says Dr John Gibbs had given evidence to say if he had seen Letby 'in the act', he would have reported it to police at the time. He said the deaths of Child O and Child P were a "tipping point" that something was "very wrong" on the neonatal unit. He had been asked, in cross-examination, why he hadn't reported that to the police. He said: "At that stage, I didn't know two children had been poisoned with insulin." "At the time of the events I had never seen before which were unusual and unexpected - that's what raised the concern. "Medicine is not an exact science...just occasionally a patient dies, and [a post-mortem examination does not give an answer]. "But this was happening again and again on our unit. And that cannot be just coincidence or bad luck. There must be a cause. "That's when...one common cause was identified." Mr Johnson tells the jury they have one advantage is they know two children were poisoned with insulin, and knew who hung up the bags.
There had been "no concerns" for Child O or Child P on the shifts prior to the deterioration, Mr Johnson says. Letby had, in evidence, said concerns had been raised by Sophie Ellis and were not dealt with. Mr Johnson says Letby is "trying to persuade" the jury that a problem existed when there was none available.
Dr Huw Mayberry "remembered" Child O and he was "very well" with a "mildly distended abdomen" but all observations within normal limits. Mr Johnson says Letby's 'issue' for Child O did not exist. He says Letby pointed out that Dr Mayberry did not make a note. Mr Johnson says there were two occasions when Letby made up notes for doctors. One was a telephone call in the case of Child E, and another was the 'imaginary examination' of Child I by a doctor. Mr Johnson says Sophie Ellis's notes record that 'Reg Mayberry' was involved in being informed and 'reviewed' on June 23, 2016 for Child O. That was the difference, Mr Johnson explains, as Letby's notes do not attribute any doctor.
Mr Johnson says student nurse Rebecca Morgan was on her first day on the ward, fed Child O, and got a trace aspirate. Shift leader Melanie Taylor said there were no concerns for Child O at the start of the shift. "She did not expect [Child O] to collapse."
An examination of child O's abdomen revealed "no concerns" and this situation was "uncomplicated", and ruled out the possibility of liver haematomas at that stage. Had there been one, Child O would have had symptoms of deteriorating. Mr Johnson said it was accepted by Letby that Child O's liver injury happened during her day shift, and accepted the evidence of Dr Andreas Marnerides.
Mr Johnson says Letby was missing a doctor colleague and had been in a text conversation with him: "Bit rubbish that you couldn't stay on nnu". He said at 10.36am he should be finished on clinic duty in an hour. He then went to observe Child Q on his arrival. He then saw Child O. Letby recorded 'no problems' at 12.30pm. Mr Johnson says it is "obvious" Child O was "deliberately overfed" by Letby at this stage. There was "an issue" at 1.15pm.
Mr Johnson says Child O had been 'supposedly' fed 13ml of milk. By this stage he had vomited and his abdomen was distended. Letby was 'fulfilling two objectives', Mr Johnson says, by 'sabotaging' Child O and 'attracting the attention' of the doctor at the same time. Letby had recorded Child O was 'tachycardiac', which Mr Johnson says was 'an exaggeration'. Samantha O'Brien had said, in agreed evidence, Child O had a distended abdomen but looked otherwise normal. Letby messaged: "Blew up abdomen think it's sepsis" to a nursing colleague at 9.15pm and, for Child P the following day: "Just blew tummy up and had apnoeas, downward spiral. Similar to [Child O]." Mr Johnson says the 1.15pm vomiting by Child O was 'unusual', as observed by a doctor, but Mr Johnson says this is not so much in the context of Child E, Child F, Child G and Child L.
Mr Johnson says Letby made a false reading for Child O at 1.20pm on the blood gas chart. "Even by the standards of mis-recording information, this is right up there." He says the note Child O was put on to CPAP from Optiflo was "a lie", and it had been spotted by Dr Sandie Bohin. Mr Johnson says someone looking at the paperwork, retrospectively, might conclude this note could form an innocent explanation as to why Child O had died. Letby had said in evidence 'he wasn't on the full CPAP machine, he may have been receiving CPAP via Neopuff, I don't know.' A doctor had noted Child O's abdomen was distended. Mr Johnson says this was because Letby had pumped Child O full of air.
Nurse Melanie Taylor had said to Letby 'I don't think he looks as well as he did before', and queried if Child O should be moved to nursery room 1. Letby had said no, to leave Child O in room 2 with his brother. NJ: "Lucy Letby was so insistent, Melanie Taylor felt put out - she felt undermined."
Nurse Melanie Taylor had said to Letby 'I don't think he looks as well as he did before', and queried if Child O should be moved to nursery room 1. Letby had said no, to leave Child O in room 2 with his brother. NJ: "Lucy Letby was so insistent, Melanie Taylor felt put out - she felt undermined."
Nurse Melanie Taylor had said to Letby 'I don't think he looks as well as he did before', and queried if Child O should be moved to nursery room 1. Letby had said no, to leave Child O in room 2 with his brother. NJ: "Lucy Letby was so insistent, Melanie Taylor felt put out - she felt undermined."
Mr Johnson explains Facebook messages were exchanged between Letby and a doctor. Child O collapsed a few minutes after the last message Letby sent. The collapse was a sign for Child O of a cardiac arrest if there had been no intervention by medical staff, the doctor had said in evidence. Professor Arthurs said the gas in Child O's bowel, as shown in an x-ray from that afternoon, was more than there should be. The causes were NEC - which Mr Johnson says had been ruled out - or someone injecting air down the Nasogastric Tube. Mr Johnson says this is "even after a vomit", which would decompress the stomach.
Mr Johnson says the liver injury for Child O had "been inflicted by about this stage", and this was "long before" CPR. A '"small rash" had been seen on Child O's chest, a "purpuric rash - which is very, very rare in a neonatal infant", similar to a sign of meningitis. Dr Stephen Brearey, who had noted it, thought at the time it could have been a sign of sepsis.
Two doctors entered the NNU at 3.53pm and saw Child O 'being bagged by the nurse', and Child O was "very unwell". A female doctor was "shocked by what she saw" as it had been "completely unexpected". The doctors said there had been "good air entry" but Child O's saturation levels "were not improving", Mr Johnson says. Child O was reintubated and cannulated. Dr Brearey was called to help. Child O had been resuscitated. Spontaneous circulation had been re-established - "a miraculous recovery", Mr Johnson tells the court. "But [Child O's] perfusion was not as good as before." Dr Brearey said the rash was "perplexing" and something he had never seen before, Mr Johnson explains. An experienced doctor said the series of collapses were also like nothing she had seen before. Mr Johnson tells the jury: "You know the reason for it, don't you?" Mr Johnson says Child O's mother gave a description of the rash. The father said of Child O: "You could see his veins, all bright blue, changing colour... "You could see something oozing through his veins."
During Child O's resuscitation in his final collapse, a doctor had said efforts were made to decompress Child O's abdomen. In cross-examination it had been suggested this was the cause of the liver injury. Dr Brearey and Dr Marnerides had rejected this, Mr Johnson tells the court. An x-ray was taken of Child O, and Professor Owen Arthurs had explained the bowel gas which was "unusual" and showed an NG Tube in situ and no presence of NEC. Child O and Child P didn't have bowel obstructions, and Prof Arthurs said you are left with injection of air by the NG Tube. Dr Brearey said all triplets had been born in good condition and were "following a healthy path", and these events were "exceptionally unusual", and the type of rash was 'something he had never seen before or since'. NJ: "All natural causes were excluded...even with the benefit of all the years that intervened." Another doctor said it was "incredibly unexpected".
Mr Johnson says Letby took Child O to his death. He says Letby was "sowing the seeds" for Child P the following day. The message sent by Letby to a nursing colleague at 9.33pm on June 23, 2016: "Worry as identical".
A conversation between the doctor and Letby is shown to the court. The doctor said he hoped he was able to help. Letby replied: "Yes you did++" NJ: "Two plusses was the best he was going to get." A Datix form is shown to the court, recorded by Letby, which Mr Johnson says was inaccurate in the 'peripheral access lost' note. Dr Brearey said "it's not correct". Mr Johnson says "it's a lie". He says Letby is trying to invent evidence that peripheral access was lost. If it was, Mr Johnson say, then air could not be injected into the infant. He says if that note was accepted, it would support her case that this was not air embolus. Mr Johnson asks the jury to find why Letby was lying - "to cover up what she had done...we are sure this was air embolus."
Dr Dewi Evans was "taken to task" for changing his opinion while writing his numerous reports in cross-examination, Mr Johnson says, having come up with a number of theories. Mr Johnson says more information came to light during the course of writing his reports between 2017-2019. One was Dr Brearey's note about the purpuric rash 'disappearing'. It was established there had been no mention in medical notes of the rash disappearing, and he was only informed about it by Dr Brearey's witness statement in 2019. Mr Johnson says is the impression by the defence to say Dr Evans "doesn't know what he's talking about?" He says it would be "astonishing" if Dr Evans hadn't changed his mind when handed new information.
Mr Johnson says Dr Evans said in court: "Inevitably, one amends one's opinion as a result." Dr Evans was asked about chest compressions for Child O. He had said he had known no case that chest compressions had resulted in a liver haematoma as seen in the case of Child O. A doctor had said chest compressions were carried out correctly for Child O. Dr Bohin had "spotted that lying entry in the gas chart". She had taken all the evidence into account, including that of Child O's father, of the description of the veins, like 'prickly heat', Mr Johnson tells the court. Mr Johnson said it had been suggested Prof Arthurs had ruled out air embolus as a cause. NJ: "Nothing could be further from the truth." He says Prof Arthurs said the air in the great vessels could be from a number of causes, including air injected, or CPR or trauma. Mr Johnson asks the jury why CPR was required for Child O - he says it was because of air embolus. Prof Arthurs was 'deliberately not doing' what the jury can do, and was treating the cases independently. Prof Arthurs added radiographic evidence of air embolus is "very rare".
Dr Andreas Marnerides' evidence is "compelling and uncontroverted", Mr Johnson says. He says the conclusions were that "significant" force was applied It was "certainly not" an injury formed by CPR. He had never seen, heard of or read of this kind of injury caused by CPR. Mr Johnson says the idea this is the only time this has happened by CPR is "truly fanciful". He says there is no corresponding puncture injury from a needle. The outer surface injury was likely caused after death as there was no 'active circulation' for Child O. There was 'profound gastric and intestinal distention' - i.e. they were 'blown up with air'. Dr Andreas Marnerides concluded it was by injected air and air embolus. Mr Johnson says this case was among the most violent carried out by Letby. He adds: "Of all the offences, all the appalling examples - some of the earliest were less violent but no less devastating." He cites the case of Child E as one of the early, violent examples. He says Letby had "misplaced confidence" following her return from Ibiza "that she could do pretty much what she wanted." He adds: "Frankly, by this stage, she was completely out of control, and was determined to mete out [the same kind of attack to Child P] the very next day."
The trial is resuming after a short break.
Mr Johnson turns to the case of Child P, who was 'doing well'. His case "caused confusion" with several witnesses as to when he came off breathing support, he says. Child P was breathing in air from 6.30am on June 23, 2016 and his antibiotics were stopped, and he was put on expressed breast milk. His observations were 'unremarkable'. A further examination at 6pm was carried out. Dr Gibbs said, following Child O's death: "Oh no, not another one". He said he had become increasingly concerned about the number of incidents on the neonatal unit, and that Letby had been involved in all of them. Child P's abdomen was 'full...mildly distended'. Letby had said the student nurse had fed Child P that evening. Mr Johnson says this was a lie. Child P was "remarkably well - excellent for a triplet baby". Blood tests were taken as a precaution at 6.45pm, showing "no evidence of infection". As a precaution, Child P was put on to antibiotics. Dr Gibbs said the abdominal distention was 'CPAP belly', but he said he had 'misread the chart' - Child P had not had CPAP for two days, and had been taken off Optiflo. "That was not CPAP belly," Mr Johnson tells the court. Mr Johnson says Letby overfed Child P just before she left her shift so she could give the impression this was a child who was deteriorating.
Mr Johnson says what happened here "mirrors" what happened with Child N earlier that month in June 2016. He says Letby did not leave the unit until 9pm that night on June 23. A message sent by Letby to a doctor colleague said she was finishing up notes for Child O. Emphasis had been put on a good blood gas reading for Child P at 8.27pm on June 23 by the defence, Mr Johnson says, but Sophie Ellis gave evidence to say Child P desaturated and had a '14ml part digested milk aspirate' at the 8pm feed. Mr Johnson asks what possible other cause is there other than Letby overfeeding Child P for the baby's last feed before the end of her shift? Mr Johnson says that is why Letby says the last feed was done by the student nurse. Overnight, another large part-digested aspirate was obtained and Child P's were stopped as a precaution. The NG Tube was placed on free drainage. Kathryn Percival-Ward [Calderbank] said Child P was "a well baby" but his abdomen was distended, so she decided to aspirate the stomach. This was recorded at 4am. A further 5mls of air and 2mls of milk were aspirated by Sophie Ellis at 7am. Mr Johnson says the problem Letby had created had been "resolved by proper nursing care" by the two night-shift nurses.
Child P had been, quote, "a little angel overnight", as said in agreed evidence. Letby came on duty, and Child P collapsed shortly afterwards. Mr Johnson says this was Letby at her most malevolent. The 'worry as identical' was "gaslighting at its very best - or worst", as Letby had been laying the lines for what would happen to Child P the next day, Mr Johnson says. "There was nothing wrong with [Child P] at the end of that night shift". Mr Johnson says Letby 'decided to use the template from the day before'. Letby recorded in notes: 'Abdomen full - loops visible, soft to touch.' Mr Johnson says that note wasn't written until 13 hours later, and was a "fabricated note" to give the impression of what had been happening earlier that day for Child P. He says Sophie Ellis recorded for Child O - 'abdo looks full, slightly loopy'. Mr Johnson says this is the equivalent of copying someone's work. He says this observation "happened out of nowhere" for Child P, for a child on free drainage, having been stable. He says if that was observed, Letby would have escalated it immediately, in light of what had happened the previous day. Mr Johnson says instead Letby was texting a doctor colleague at 8.04am. 'I'll be watching them both like a hawk. I’m ok. Don't want to be here really. Hoping I may get the new admissions...' She also mentioned 'I've got [other triplet] and [Child P], [Child P] has stopped feeds as large asps.' Mr Johnson says there is no mention of a loopy bowel for Child P, by Letby to her doctor colleague, as "there is no problem".
At 9.35am on June 24, Dr Anthony Ukoh did a ward round and examined Child P, finding a mildly distended abdomen with bloating. Letby had said looping was visible at this time, and Dr Ukoh had noted this. Mr Johnson says the note was checked and it was not noted. The abdomen was 'soft', he recorded. A consultant doctor noted nothing of concern, other than a distended abdomen. Mr Johnson says there is another case of Letby falsifying notes here. A nursing note by Letby said Child P had been 'Neopuffed for a minute before being examined by Dr Ukoh'. Mr Johnson says it is suggested this is a deliberate mis-recording, minutes before Child P's collapse around 9.40am. He says it is a way of 'covering what she did', by 'pumping [Child P] full of air.' Child P 'crashed', stopped breathing and his heart stopped. He was 'dusky and mottled', according to a witness. A doctor was alerted to Child P in room 2 at 9.50am, it was 'not an emergency, but something he should be called to'. Letby was "not in the room" according to student nurse Rebecca Morgan. Mr Johnson says the jury should consider why that would be the case, as Letby didn't have any designated babies outside of room 2.
Dr Ukoh said Child P "appeared very different" from earlier. He added: "Whoever was doing the Neopuff was very keen on getting [the doctor] in". Mr Johnson says to the jury it's clear who that would be, that Letby wanted this doctor colleague to be present. NJ: "For some reason, she enjoyed these situations, and he was there."
Mr Johnson says the second deterioration happened at 11.30am, and CPR was required. One female doctor said Child P was "vigorous" and fighting the ventilator, something which was unusual as it would not fit the sign of a baby fighting infection. Mr Johnson says Child P was being sabotaged - blood tests excluded infection for Child P. An x-ray at 11.57am showed a pneumothorax and air in the bowel. Just after noon, a female doctor saw several nurses including Letby, and told the people there the transport team would be there soon. The doctor said: "I was thinking out loud" - and, Mr Johnson says, Letby replied "He's not leaving here alive is he?" This is something which was not disputed by the defence, and Letby had said in cross-examination it was said out of concern. In police interview, Letby said she could not remember saying that, Mr Johnson adds.
Letby had agreed in cross-examination it was "not the done thing" to say such a thing, then she had said she couldn't remember saying it. Mr Johnson says it was not disputed she had said it, the question was "Why?" NJ: "She was controlling things - she was enjoying what was going on and happily predicting what was going to happen - she was 'playing god'." The female doctor had said: "Don't say that." in response. The comment was "highly unusual" and "shocking", the female doctor said.
Child P's 12.28pm collapse should be thought in the context of Child K, Mr Johnson says. Two doctors had taken a break when a shout for help happened at this time. When they returned, Lucy Letby was in the room. A doctor said it looked like Child P had "dislodged his ET Tube". Mr Johnson says if the tube was blocked, it had done so in a short period of time, having only been put in hours earlier. Mr Johnson says this collapse happened "at the precise moment" the two doctors had left the room, and Letby was present, and the ET Tube dislodged in Child K, when Letby was present, doing nothing. He says the jury should take that all into account. He says the jury can also take account of Letby's remark "He's not getting out of here alive is he?" made shortly before this collapse. Mr Johnson says the ET Tube was not blocked, Letby had dislodged it. Child P was reintubated and further resuscitation efforts began. Dr Bohin said the pneumothorax was a contributory factor in the collapse of Child P, but not the overall cause.
Dr Stephen Brearey reviewed the circumstances of Child P's death, and regarded the events that day as "exceptional", and could not find a cause. A doctor could not identify any cause as to what had gone on. He thought it 'highly unlikely' the death was complications over the pneumothorax'.
The trial judge, Mr Justice James Goss, says as the day will end a little earlier than usual, this afternoon will be one extended session without a break.
Mr Johnson describes what happened for the final collapse for Child P, after the transport team had arrived. He says despite Child P's situation, there was good air entry and the ET Tube was in a good place. There was "no explanation" for why Child P's condition had changed, according to a doctor.
At 4pm, it was determined the resuscitation attempts were futile. The father said the circumstances for Child P's death were similar to Child O, but could not recall seeing a veiny appearance for Child P (as he had done with Child O). The mother said the third triplet had no problems and was discharged after 11 days. Mr Johnson says that should have been the case with all three. A female consultant said Letby was "animated" and "so excited" asking about a memory box and her behaviour was "inappropriate". In cross-examination, the 'talking enthusiastically' was said that it would 'soften the blow' for the grieving parents who had lost two of the three triplets. NJ: "We suggest that is absurd. Lucy Letby was enjoying the drama, the control, the extremity of grief that she was causing to other people." The father, in the aftermath of Child P's death, was "sobbing" and begged doctors to transfer the third triplet to be taken with the transport team. The female doctor said what had happened was "not normal".
Mr Johnson: "Something was seriously wrong. They just couldn't put their finger on it." The female doctor had said in cross-examination she was not dramatising anything, the situation was dramatic enough as it was. Mr Johnson says nothing was identified medically as the cause of Child P's death. Dr Brearey said the deaths of Child O and Child P caused him great concern. The rash, he had not seen before or since. At the debrief, Dr Brearey asked Letby how she was feeling, and suggested she needed time off, "but she didn't seem upset", and was due to work the next day. Mr Johnson said that caused Dr Brearey "real concern".
Dr Andreas Marnerides did not look at the cases in the context of any other. There was "no natural cause" for Child P's death. He concluded Child P had "excessive air injected into the nasogastric tube". Dr Evans said there was no natural cause, and the cause was air administered. Dr Bohin pointed out a discrepancy between Letby's 'Neopuff' note and it not being mentioned to Dr Ukoh when he examined Child P, Mr Johnson says. Mr Johnson says this is "yet another false example" in the notes, designed to create the impression Child P had an ongoing problem.
Dr Bohin also said Child P had been injected with air, Mr Johnson says. Mr Johnson says if the jury conclude Child O received a liver injury through some inflicted trauma, then Child P's liver injury the following day can be explained by Letby's actions. NJ: "Lucy Letby predicted [Child P's] death when Dr Brearey thought it was under control. How could she have known?" "The number of coincidences here is all too much. [Child O and Child P] were murdered by Lucy Letby."
Mr Johnson says Letby had said she had taken one note/handover sheet home deliberately as it contained information to write up as nursing notes when she returned to work. Mr Johnson says the note only included 'caffeine', so her reason for keeping it was 'a lie'. Mr Johnson says one of the handover sheets contained a name of one of the baby's parents, a difficult to spell name, that she could research on Facebook later. He says Letby's explanations for keeping the handover sheets don't stand up "to any sensible analysis".
Mr Johnson refers to this note. He says the words 'I AM EVIL I DID THIS' should be taken literally. He says the 'anguish', as the defence said was Letby's frame of mind, needs to be taken into context. He says Letby introduced the suggestion she was "isolated" to explain the notes and her behaviour. On the final day of cross-examination, the contents of Letby's phone, diary and photographs "set out her social life" from July 2016- July 2018. Letby "accepted" she had "a very, very active social life" which included "socialising with many of her former colleagues" including "those she had been forbidden from having contact with". She said she was "at least allowed a social life". Mr Johnson says it was "never our suggestion" that she wasn't allowed to have a social life. He says Letby was "deliberately trying to mislead you" and trying to invoke "pity" from the jury. NJ: "We say she is a liar, she lied to you, and the lie is proved by analysis of her social life."
Mr Johnson recaps the seven baby's cases he has dealt with so far, of the total 17. He says if they are all taken into context, the "picture is crystal clear". He says he will take the next cases in chronological order, with twins Child A and Child B.
Mr Johnson says the judge directed that the questions given by counsel are not the evidence, but the answers. He asks if Dr Jayaram and Dr Harkness 'made up' their observations for Child A and Child B to blame Letby. He says before the cases of Child A and Child B, Letby had completed a course on IV lines, which highlighted the dangers of air embolus. Mr Johnson asks if that was a "coincidence".
Mr Johnson says Child A had been doing well and was on hourly observations, and handling well. Child A crashed minutes after Letby came on duty. Mr Johnson says there is no doubt Letby had been involved with Child A's care. He says the evidence was that Lucy Letby was "literally standing over him" at the time of the collapse. He says the circumstances of the collapse are similar to that of Child L and Child M, with Letby "operating in plain sight".
Mr Johnson says despite air going in and out, Child A's saturation levels and heart rate were falling. He says Dr David Harkness described "very unusual patches of skin [discolouration]" which he had "never seen before" and only saw once again with Child E. He described "patches of blue, purple, red and white" that didn't fit with Child A's condition, and the rash "flitting around". He said he was too busy trying to save Child A's life to get a full description. He was criticised in cross-examination for not noting it down. It was suggested by the defence that he had been influenced to apply this description to Child A, and not putting this in his statement. Mr Johnson asks what the implication was - that he didn't see anything? It was suggested discussions had deep-set in his mind. Dr Harkness said he had seen it in Child A and Child E, that made him realise how significant this discolouration was. He was "animated" in the latter case, Mr Johnson says. Dr Ravi Jayaram had said Child A's heart trace showed "no problem" with the baby's heart.
Dr Jayaram had described 'pink patches that appeared mainly on the torso that appeared and disappeared - I had never seen anything like this before,' Mr Johnson says. He had said it "doesn't fit with any disease process I had seen or read about".
Dr Jayaram was 'taken to task' by the defence, Mr Johnson says, as he had not mentioned the discolouration in notes. He said he had not realised the significance of it at the time, and only realised it when later examples came up in other babies. Mr Johnson says the accusation by the defence that Dr Jayaram had made it up is "smoke and mirrors" to distract jurors from the truth. He says there is other evidence, not disputed, to back Dr Jayaram's account. He refers to Letby's July 2018 police interview. Letby had referred to the rash for Child A as a 'rash like' 'reddy-purple' 'more on the side that had his line in - it was his left'. NJ: "How did Lucy Letby remember that? Because it wasn't actually in her notes - just like Dr Jayaram and Dr Harkness." Mr Johnson says Letby referred to it as 'normal mottling' and Child A was 'more pale than mottling'. Mr Johnson says that is "a lie". Mr Johnson says if Letby accepts that as "unusual", it "causes real problems for her defence". He says Letby used the word 'blotchiness' for Child A in police interview. Letby had said 'mottling' and 'blotchiness' were interchangeable.
Mr Johnson says Letby had said in cross-examination, if it was agreed Child A had died of an air embolus, then it would have been administered by colleague Melanie Taylor, and not by her. NJ: "We suggest Lucy Letby was as good as accepting that [Child A] died of an air embolus. "But it doesn't end there." Mr Johnson says Letby's nursing colleague, a friend, came into the unit when Child A collapsed and did CPR for Child A, and noted a 'strange skin discolouration' she had "never seen before". He says the colleague described "blotchiness" - the same word Letby had used in her defence. The colleague was challenged on the description for Child A's skin discolouration, that it might have been mixed with the description for Child B. She said she had not been influenced by what anyone had said. Mr Johnson says the nursing colleague was not accused of making it up. He says it is the defence's case to picture the "doctors are bad".
Dr Rachel Lambie had described 'blotchy' 'purple' marks which would appear and disappear on Child A, Mr Johnson said. She said she had "never seen anything like it before", with "flushes of what looked like bruising underneath" "that would appear for 10 seconds, go, then appear somewhere else", Mr Johnson adds. Mr Johnson says all the other colleagues had proved what Dr Harkness and Dr Jayaram was saying was the truth. He asks the jury if that is the case, then what purpose is the attacks on their integrity? He says the purpose was to deflect the jury from the evidence, to make it about personalities, to destabilise Dr Jayaram "who has been an important witness in many cases", including for Child K. NJ: "Lucy Letby knows how devastating his evidence is in the case of [Child K]." He says it is the defence's case that the nurses are overworked and the doctors are "bad", that there is a "medical conspiracy" involving the "gang of four", and an unnamed police officer 'tipped off' Dr Evans about air embolus.
Mr Johnson says after Letby got home, she advised Melanie Taylor about an administrative note, then searched for the mother of Child A on Facebook.
Mr Johnson turns to the case of Child B. Mr Johnson says "we know that Letby didn't like" being in nursery room 3, and there are "many" text messages sent between Letby and four people over the course of two hours. Five minutes after Child B desaturated around midnight on the June 9-10 shift, Mr Johnson says, Letby turned up in room 1 as she co-signed for medication. No-one signed for the observation readings for Child B at midnight. Letby has signed for a blood gas reading for Child B at 12.16am. Child B had collapsed at 12.30am. The mother of Child A and Child B said it was "a very similar situation to [Child A]", and the consultant asked for pictures to be taken of the mottling as she had "never seen it before". By the time a camera had been sourced, the mottling had disappeared. Dr Lambie had made a note of the discolouration at the time. A nursing colleague said Child B "suddenly looked very ill - like her brother the night before", with the discolouration. Mr Johnson says the colleague had said: "Oh no, not again", and made a note of it, which read "changed rapidly to purple blotchiness with white patches".
Mr Johnson says Letby had used the words a 'rash-like appearance' as it looked like a rash on Child B, and it was "unusual". "Lucy Letby, we suggest, could not keep out of nursery 1. She elbowed her mate...out of the way." Letby signed for a blood gas record for Child B at 12.51am while Child B was being resuscitated, and signed for a 1am observation reading, and co-signed for a morphine administration at 1.10am. NJ: "She was relentless, ladies and gentlemen - she thought she had the cover of antiphospholipid syndrome [for Child B]." Letby searched for Child A and Child B's mother again on Facebook on June 12 and September 2, 2015.
Mr Johnson says the presence of air was the cause of, or the need for, resuscitation. Prof Arthurs says the gas was "not diagnostic" of air embolus, but added it was "the most pragmatic conclusion", Mr Johnson says. He adds the only time he saw that much gas was in the case of Child D. Mr Johnson says medical expert evidence from Dr Andreas Marnerides had shown an air bubble was found in Child A's brain, which was "highly suggestive" of air embolus. He found "no evidence of any natural disease" and "took the view" that the most likely cause was "air embolus". Mr Johnson says the picture is clear, from the witnesses' accounts - including Letby's, that air embolus was the cause of Child A's death, and if that is the case, then Letby was responsible.
Dr Dewi Evans says, for Child A, the baby was "perfectly stable" prior to the collapse. He cited air embolus as the cause, and that conclusion was reached even before Dr Jayaram's account, as Dr Jayaram's description had not been in the notes. He said for Child B, there was nothing that could account for that baby's collapse. He said the rapid appearance and disappearance of the skin discolouration was significant in his conclusion of air embolus.
Nicholas Johnson KC resumes the closing speech for the prosecution, starting with the final part for the case of twins Child A and B. Medical expert Dr Sandie Bohin said Child A had been stable, and the misplaced UVC [line] "had no bearing" on his collapse. She said Child A had received an air embolus. In cross-examination, it was suggested she could not exclude genetic causes for the death of Child A. She replied she did not know of any genetic condition that causes a baby to collapse and die within 24 hours of birth. Mr Johnson says Letby's case "floats the spectre of possibilities" without going into specifics.
Mr Johnson said dehydration was also ruled out as a possible cause of death for Child A. Asked about an 'innocent air embolus' via the catheter, Dr Bohin said she had "never heard of it happening in a neonatal unit" due to the equipment used. For Child B, Dr Bohin had said the baby was "in good shape". She concluded Child B had received an air embolus.
Mr Johnson says the jury has an advantage over medical experts, in that they can look at all the pieces of evidence presented in the case, including Letby's Facebook searches for the parents, her presence on the unit, standing by babies, and there being a "poisoner at work" on the unit, to draw conclusions. "It's the cumulative evidence", Mr Johnson says is key. He says Child A and Child B had similar skin discolourations, and a "concession" from Letby that "if we agree", that Child A died of an air embolus.
Mr Johnson said Lucy Letby "migrated" to room 1 shortly before Child B's collapse, to use the word of Kathryn Percival-Ward.
Mr Johnson turns to the case of Child C. He says Dr John Gibbs first gave evidence on Halloween 2022. He was asked if Child C should have been treated at a tertiary centre. Dr Gibbs replied it depended on what caused Child C's collapse. He denied that in any event it would have been more suitable for Child C to be treated there. Mr Johnson says there has been no evidence presented to suggest the babies in this case would have been better treated at a tertiary unit. [The Countess of Chester Hospital being a Level 2 unit at the time]. Mr Johnson says the jury should ask if there had been any specific shortcomings for the babies in each case. He says the babies would have been better off away from Lucy Letby. He says that may have been what Dr Gibbs meant.
Mr Johnson says Child C, a baby boy, was "born in good condition" and "made good progress" and was "handling well". A nursing family communication note on June 12, for 6.30pm, 'parents spent most of the day with [Child C]...enjoyed kangaroo care most of the afternoon' - Mr Johnson says this was a good sign. Dr Katherine Davies was asked about traces of bile found. She was asked, in evidence, if that was a sign the baby would later collapse. She replied: "Absolutely not." Mr Johnson tells the court she said Child C's abdomen was soft, and if he had an abdominal problem, it would be sore, but he was handling well, and his other observations were stable, which was why he had been out for kangaroo care. By June 13, 2015, Child C was given tiny milk feeds 'to get things moving' in the gut.
"Witness after witness" gave evidence to say the bile aspirates were "very small", and the "black colour" was "altered blood", not bile. Dr Gibbs said the blood had come from inflammation in the stomach, and Child C was given a drug to treat that. Mr Johnson says the jury know, as a fact, from Dr Andreas Marnerides, that Child C did not have a problem with his gut, as there was no sign of infection or sepsis. There was no evidence of Child C having had an obstruction in his bowel. "This is not a case of NEC," he adds.
Nurse Yvonne Griffiths described Child C as an active baby who was "happiest" when receiving kangaroo care, and nurse Sophie Ellis said Child C was "feisty". Mr Johnson says all the treating staff for Child C said he was doing very well - on the three days Letby was not on the unit. He says within a few hours of Letby coming on to the unit, Child C collapsed, and within a few hours of that collapse, died. Mr Johnson said Dr Gibbs could not explain how Child C's heart could have restarted after the collapse, as it did not follow any natural disease process.
Dr Sally Ogden said Child C's abdomen was, on June 13, soft. Mr Johnson says he was "doing well" as observations were normal and he was put on to Optiflo, having gone off CPAP breathing support. Letby's nursing colleague suggested to Letby that the baby in room 3 was more of a priority as that baby had breathing difficulties, than Child C in room 1. "Lucy Letby was not happy about being in nursery room 3," Mr Johnson says. Letby texted colleague Jennifer Jones-Key: "I keep thinking about Mon. Feel like I need to be in 1 to overcome it but [colleague] said no" "Not the vented baby necessarily, I just feel I need to be in 1 to get the image out of my head. Mel said the same and [colleague] let her go. Being in 3 is eating me up, all I can see is him in 1 x" Mr Johnson says the baby who was not vented would be Child C. Mr Johnson says there was no reason for Letby to be in room 1. Letby texted Jennifer Jones-Key: "Yeah I've done couple of meds in 1. I'll be fine X" Mr Johnson says this is something Letby has since revised in her evidence. The neonatal schedule shows Letby being a co-signer for babies in room 3. Mr Johnson says it "stretches the definition" to suggest Mr Johnson says it was "repeatedly" questioned whether Sophie Ellis - "the new girl" as was "up to the mark" to look after Child C. Three nurses dismissed that suggestion. Mr Johnson says in cross-examination that was taken up with Letby. NJ: "The person who had what you wanted wasn't sufficiently qualified for the job?" LL: "No, Sophie wasn't, I think, in the correct position to care for [Child C]." NJ: "Why was that?" LL: "She was recently qualified, she didn't have the skills." LL: "She didn't have experience of premature babies, babies like [Child C]." LL: "I am not saying Sophie caused anything with [Child C], she was just the least experienced. She had very little experience with premature babies." NJ: "So she had something you wanted?" LL: "No." Mr Johnson asks the jury what Sophie Ellis failed to do that a senior nurse would have done. He says there is no evidence of anything, and asks why that suggestion was made to three nurses in cross-examination. He says it is trying to create "something seriously wrong at the hospital" and is "gaslighting" the jury.
Mr Johnson says the series of text messages, and its content in relation to , suggests Letby was not rushed off her feet but had "death on her mind" and sabotaged Child C. Sophie Ellis aspirated Child C's stomach and found a small amount of green bile. There was no air or anything else, Mr Johnson says. She left the room and within a short amount of time, the alarm went off. Upon her return, Letby was standing by Child C, and Letby said words to the effect of: "He's just had a brady/desat". Nurse Melanie Taylor was challenged "repeatedly" on her account of the event. She said she remembered Letby being "at the centre of events". She said she was "surprised how cool and calm" Letby was. Dr Kathrine Davies was 'crash bleeped' to the room. There were no heart sounds or respiration, and this was "very unusual". She said even with the smallest, sickest babies [who had collapsed], there would be some heartbeat, or respiration rate, but with Child C there was "nothing at all". During intubation, Child C's vocal cords were seen by Dr Davies to be swollen. Mr Johnson says that is found in five of the babies' cases, in Child E, Child G, Child H and Child N. "Somebody put something down [Child C's] throat. Who do you think that was?"
Dr Gibbs said if there had been an abdominal obstruction, there would have been 'repeated vomiting'. Child C's parents had given evidence in an agreed statement, when Child C had started breathing after being baptised. "We held him for hours...and he was given another dose of morphine." The 'rally' of survival lasted "a long time", Mr Johnson says. He says during the time with the family, they were interrupted by a nurse the father believed to be Letby. The father recalled the nurse said words to the effect of: "You've said your goodbyes now, do you want to put him in here?" A nursing colleague had told Letby 'more than once' to look after her designated baby, as she had been going 'in and out' of the family room. Mr Johnson asks why Letby had a fascination with that room, and cites her behaviour as noted in the cases of Child I and Child P. "It is not an innocent coincidence." He says Letby, in cross-examination, "could not give a plausible reason" why she kept going into that family room instead of looking after her designated baby that night.
Text messages between Letby and a colleague were exchanged on June 30, 2015: Colleague: "Yeah. There's something odd about that night and the other 3 that went so suddenly." LL: "What do you mean? "Odd that we lost 3 and in different circumstances?" C: I dunno. Were they that different? C: Ignore me. I'm speculating LL: Well Baby C was tiny, obviously compromised in utero. Baby D septic. It's Baby A I can't get my head around C: Was she definitely septic. Did the PM confirm? LL: I don't think the full PM is back yet. Debrief is next week but I’m away. C: 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 tho. LL: Ah not sure but Baby C's is Thursday and Baby D next week LL: No mention of Baby A"
Mr Johnson says Dr Dewi Evans was justifiably criticised for not giving a cause of death for Child C in written evidence, then giving a cause in the witness box. He says if anyone was caught by surprise, he returned to give evidence on 14 more occasions. Mr Johnson says Dr Evans's evidence can be disregarded if there had been any confusion for this case, as Dr Marnerides had given more detailed evidence on this. Dr Bohin excluded the possibility of a bowel obstruction. Dr Marnerides said there was "nothing unusual" about Child C's bowel. He concluded Child C died "with pneumonia not from pneumonia" and the gas in the bowel could not be explained by infection or an abnormality in the bowel. He said "air must have been injected into the nasogastric tube", splinting the diaphragm, which would have compromised Child C's breathing and killed him. He added: "I have never in the past 10 years, come across even a suggestion that 'CPAP belly' would lead to the deterioration of a baby, let alone this gastric distention that would lead to [a baby's death]." Mr Johnson says Child C came off CPAP 12 hours before his collapse, and "did so well" after kangaroo care he was put on to Optiflo, a 'much less invasive method of breathing support, and his NG Tube had been aspirated shortly before his collapse, and no air was found. Dr Marnerides described "massive" gastric distention, using the word "ballooning".
Mr Johnson says Letby's interviews are very important in this case. Letby had said her only involvement with Child C was with his resuscitation. She said she did not remember being the nurse who fed him. She claimed she was not the person who discovered Child C collapsing. She said rough notes on the resuscitation would be transposed into medical notes and then disposed of. She confirmed she had contact with Child C's family when Child C was dying. She would not accept Sophie Ellis's account of her 'standing over' Child C. When asked why she would have been in room 1, Letby said perhaps she was checking the resus trolley, or getting drugs for her baby, or using the computer. Mr Johnson says 'why would you be checking the resus trolley?' and 'why would you use a computer in the dark'? Letby was asked about the text message conversation with Jennifer Jones-Key. NJ: "She claimed, unbelievably, she didn't know what that conversation was about or where she was [when that text conversation took place]. "We say that is incredible, that is not believable." Of the message 'being in 3 is eating me up', Letby accepted she was frustrated she was not in nursery 1. NJ: "She [Letby] accepted she was in room 1 at the time of the collapse, that she was the only staff member there, and she was feeling frustrated and upset." In the 2020 police interview, Letby said she did not remember being involved with Child C's family after Child C's collapse. She said she "wasn't sure" why she had searched for Child C's family on Facebook. She said she "didn't specifically remember what she was thinking" prior to the collapse of Child C.
Mr Johnson says the collapse and death is "inconsistent" with all natural causes, according to the medical evidence. Letby was in her own interview 'angry and frustrated' about not being in room 1. NJ: "She started the interview process by lying about where she was and the reasons for being in room 1" Child C had "massive ballooning of the stomach" and "it's obvious what happened" even without the context of the other cases. NJ: "It's as plain as the nose on your face that Lucy Letby must have injected air down the nasogastric tube [into Child C]. "It was one of her favourite ways of trying to kill children in this case." Mr Johnson says there is a "constellation of coincidences" that can make the jury sure Child C did not die of natural causes and that Lucy Letby killed him.
The trial is now resuming after a short break. Mr Johnson turns to the case of Child D. He says Letby "didn't really remember" the baby girl, as she had said that in police interview. He says the absence from the paperwork of her involvement would "give her plausible deniability". He says "thanks to the hard work of the police", they can put her in the room. He says Letby's interview is undermined by the rota diagram putting her in room 1 on the night shift [with Child D], and for her searching for the parents' names on Facebook. He says Letby could have got the names from the handover sheets - but the handover sheets do not have the parents' names on them. Mr Johnson says this is similar to Child K, when Letby searched for the parents on Facebook 26 months after Child K's time on the neonatal unit. Letby said she could not explain it. Mr Johnson says that is a lie. NJ: "Why won't she tell you the truth?"
Mr Johnson says there is "no doubt" Child D and her mother suffered sub-optimal care, but her progress went "upward" upon her transfer to the neonatal unit. Child D was "stable" with "minimal" oxygen support, and "responding well to treatment". The court had previously heard evidence Child D was on CPAP, "responsive when handled" and her "chest was clear" with "regular respiratory effort". He abdomen was "soft and non-distended". Mr Johnson turns to the night shift on June 21-22, 2015. Mr Johnson says June 21 was Father's Day that year. Child D's designated nurse Caroline Oakley also had a designated baby in room 2. Child D was in room 1. Letby's designated baby in room 3 from the Child C case was now in room 1, again as Letby's designated baby (along with one other baby in room 1). Child D's observations were "all completely normal" according to Caroline Oakley, and she was "breathing beautifully in air", with 100% oxygen saturation - "the highest they can be". Mr Johnson says this couldn't be better for a child with pneumonia.
Dr Andrew Brunton said the plan was for Child D to start receiving milk. Mr Johnson says there were no problems until Caroline Oakley left the room for a break. He cites other cases when this happened of staff members who left and babies collapsed. The alarm went off and when Kathryn Percival-Ward arrived, she found Letby in room 1. She said, in cross-examination, she "couldn't be certain". Mr Johnson says who else could it have been? Who else had children to care for in that room? He says it wasn't any of the other nurses on duty that night - one was looking after babies in room 2, and another was Elizabeth Marshall, a nursery nurse, who said she saw Letby doing chest compressions on Child C in room 1. Kathryn Percival-Ward said the rash on Child D was "something she had never seen before". In cross-examination, she was accused of "adding detail" to the skin discolouration description. Mr Johnson says it was in the original recording she had made to police, a "mosaic, a mottling colour of blotchiness". Caroline Oakley recalled being called back to room 1 by Kathryn Percival-Ward and Lucy Letby.
Mr Johnson had asked Letby, in cross-examination, why she was writing in Child D's chart. Letby said she "could not comment" if she had been in room 1 throughout. The timing on the neonatal schedule, shown to the court, says the note was made at the time of Child D's collapse. Mr Johnson says an observation reading for Child D is timed 1.15am on June 22, written by Caroline Oakley. Those details were "told to her by the girls". Mr Johnson asks who 'of the girls' would have provided those readings. Mr Johnson says Letby did not want the paperwork to attach her to the case of Child D, and that was why she minimised her involvement in police interview. A blood gas chart for Child D at 1.14am is not signed. Letby, in cross-examination, said: "I don't know" when asked if it was in her writing. Letby accepted the elevated '14' on '0114' is in her style of writing. Letby said the lack of a signature was an "error", and said the following entry was also unsigned, and happens "from time to time". Mr Johnson says it's the timing of this absent signature which is "the power of circumstantial evidence".
Mr Johnson says Letby gave an IV infusion to Child D 5 minutes before the baby collapsed. It was signed for by her and Caroline Oakley. Ms Oakley said she couldn't explain the signature as she was on her break. She described the rash on Child D as something she had not seen before in her 20+ years of working with neonates. She described it as: "a deep red brown - different from mottling, different to what I had seen before". Dr Emily Thomas said in agreed evidence that Child D came out in a rash, which faded after treatment. Mr Johnson says the description she provided was "remarkably similar" to that provided by others, but wasn't challenged on it. Dr Brunton said Child D had "developed a rash". In his notes: 'Nurses noted that became extremely mottled +++ 'Also noted to have tracking lesions - dark brown/black across trunk.' Mr Johnson says this explains "I don't remember". He says if Letby had remembered Child D, she would also have to admit it was either her or somebody else in the room with her that gave this description to Dr Brunton. Letby had said, several times: "I don't remember that being discussed at the time." Mr Johnson says it was recorded here.
Dr Brunton said the collapse was " a completely unusual situation I had never seen before", with changes in the skin colour which could not be explained. Dr Elizabeth Newby described two 'bruised areas' on Child D's abdomen, 'like evolving purpura'.
Mr Johnson says the similar descriptions given by the doctors and nurses of the discolouration because the causes of the collapses was the same. Child D's discolouration had gone by 2.35am. Dr Brunton noted the skin discolouration "reappeared" at the second collapse. Mr Johnson: "What are the chances?" At 3.45am, Child D had a third and fatal collapse. Dr Thomas said she was with another baby, when he was alerted by a nurse 'with brown hair' and believed she was the designated nurse for Child D, and believed she had also been the designated nurse for Child A. Dr Thomas said Letby had said: "This is my second baby this has happened to me," and was upset. Mr Johnson says even here, Letby was associating what happened to Child D with what happened to Child A. Dr Brunton had "never seen a baby behave like this" prior or since. Dr Brunton was "struck" by Child D's rapid collapses and recoveries. Mr Johnson says Dr Brunton say, because he didn't know, that the collapses were similar to other children in this case. Mr Johnson says 'it tells you' Child D was sabotaged, and Letby was lying when she said she didn't remember.
Mr Johnson says Letby's interviews were unremarkable, but said of babies' deaths in evidence: "You don't forget things like that, they stay with you. Mr Johnson asks if this is the same case as someone who doesn't remember a baby collapsing three times and dying. He asks if Letby was trying to gain sympathy from the jury. Mr Johnson said Letby said in police interview if the events of Child D upset her: "I honestly can't remember"
Letby said in a message to a colleague on June 22, 2015: '[Child D] collapsed & had full resus. So upsetting for everyone. Parents absolutely distraught, dad screaming'. Mr Johnson says this was on Father's Day. He says Letby, from the text messages, did remember Child D. Prof Owen Arthurs said, in evidence, the minor infection in Child D was improving. He added one of the lines of gas, in the post-mortem examination, was "highly unusual" and had similar findings in Child A and Child O. He said he had 'never seen so much air' [in the great vessels]. Another medical expert, Dr Marnerides, had ruled out sepsis, and concluded Child D was killed by an air embolus. Dr Sandie Bohin said Child D was recovering from pneumonia, and the speed of the collapse was "very unusual and not indicative of infection". She concluded the cause of the collapse was air embolus. Child D's distress and rash description supported her opinion. She rejected the evidence that taking Child D off CPAP caused her death. Dr Dewi Evans viewed the case as one where the air embolus was the "only viable cause" of death. He was cross-examined about the blood gas record for Child D. Mr Johnson says Dr Bohin had given evidence to say that blood gas record was "satisfactory".
The trial is now resuming after its lunch break. Mr Johnson says he is turning to the case of Child G, on three counts of attempted murder.
Child G was the most premature of all the babies, with the lowest birth weight. He says Child G's mother's name is not the easiest to spell - the reason why he mentions that is clear to the jury. Child G had the "grossest misfortune to meet Lucy Letby" when she was transferred to the Countess of Chester Hospital, Mr Johnson says. He refers to Child G's 100th day of life on September 7, 2015, when a banner was up, and a cake had been baked to mark the occasion. He says on that day, she suffered a severe brain injury which has left her dependent on her parents.
Mr Johnson says all the experts agree Child G was in a "very satisfactory position" prior to her collapse. He says "odd coincidences to happen in life - but do you believe in coincidences in this?" Mr Johnson says Letby knew Child G's 100th day, and the premature baby's due date. Mr Johnson says Dr Evans had described Child G's vomit on September 7 was "extraordinary" and nurses had described the extent of the vomit was something they had never seen before. He says there are two choices - that Child G was sabotaged by being overfed, or having tolerated escalating amounts of milk, she then vomited with unprecedented force due to an infection which no staff had ever seen present itself before or since. "Some people say there is a first time for everything" Mr Johnson says, but adds this is "no naturally occurring event" and has been seen in several other babies' cases including Child C, Child J, Child K and Child N.
Mr Johnson says nursing notes showed a 'normal baby, feeding properly' in the hours before Child G's vomit on September 7. At 8pm on September 6, nursing colleagues said Child G was stable and well. A staffing rota for the night is shown for September 6-7 - "a quiet night", and Child G received a full feed from a bottle at 11pm and was "thriving". Mr Johnson says "little babies don't take full feeds from bottles unless they are happy little babies." He says Letby has "massaged the times", as she had done in several other cases. Mr Johnson says the prosecution suggest the vomit was at 2.30am, not 2.15am. Nursing colleague Ailsa Simpson initially said she was with Letby when Child G projectile vomited at 2.15am, and if that was true, Letby could not have been the cause of it. In a subsequent interview, she said she didn't know where the other nurses were. Mr Johnson says Letby's nursing note on September 7 includes: Care given from 0200 to present. [Child G] had large projectile milky vomit at 0215.' Mr Johnson says it's an interesting line that Letby had given care from 2am. He says this note is written six-and-a-half hours later, and the jury should take that with care, especially with Letby, as she "habitually mis-recorded" information. Mr Johnson says Child G wouldn't have tolerated a 45ml milk feed under gravity if the stomach was already containing undigested milk. He says Ailsa Simpson's original account does not correspond with the neonatal review, as Ailsa Simpson fed a different child in room 1 at 2.20am [Child G being in room 2]. That child was "demanding food", Mr Johnson says, and that takes time. Medication was co-signed for Child G at 1.42am by Ailsa Simpson, and another child at 2.13am. Mr Johnson says all this material shows she was busy at this time, and "cannot be accurate" with the 2.15am timing of the event. Dr Alison Ventress recorded Child G was 'called to r/v [Child G] urgently at 2.35am...[Child G] had very large projectile vomit (reaching chair next to cot and canopy)'. Mr Johnson says Dr Ventress was called urgently as Child G suffered a catastrophic brain injury, and the doctor arrived within minutes as they would not wait around. Mr Johnson says Ailsa Simpson was distracted in room 1, her colleague had gone on a break, and that gave Letby "the perfect time" to sabotage Child G, and misrepresent it in the notes.
Mr Johnson says the longer the gap between the feed and vomit, the less likely the feed would be the reason for the vomit. Dr Ventress said Child G's abdomen appeared "purple and distended" upon her return to see Child G after the vomit. A "large watery stool passed", after which Child G's abdomen was "slightly better". Mr Johnson says this was not the situation earlier, when she had taken on a feed by a nursing colleague. Mr Johnson says Child G was force-fed milk and air, injecting by using the plunger in the syringe. He says Letby "took advantage" of taking on Child G's care. Dr Ventress was later called out of theatre to intubate Child G, and noted blood-stained secretions coming from the vocal cords. Dr Stephen Brearey, asked about Child G's deteriorations on the ventilator, said: "I can't explain that - it's unusual for babies to desaturate on ventilators...the fact that Dr Ventress was getting chest movement [from Child G] was perplexing, and I cannot think of a natural cause of why that would happen." Mr Johnson say the truth was it was "an unnatural process" by Letby.
Mr Johnson asks what would cause Child G's throat to bleed, as similar to the cases of child E, Child N, Child O and Child H. He says it was sabotage by Letby. NJ: "It is a signature of many of her attacks on these babies".
After 6am on September 7, 100ml of air/fluid was aspirated from Child G. Mr Johnson says the only source of that was from Lucy Letby, who had caused the baby a "devastating brain injury". After that, Child G's saturation levels improved and she did not have issues with her stomach. Mr Johnson says what was vomited and aspirated was nothing to do with infection. Mr Johnson says Dr Sandie Bohin had been "very stable" prior to the collapse. The pH reading showed Child G's stomach was empty and discounted the possibility of there being undigested milk. If there had been an infection, there would have been 'subtle markers' present in observations. She rejected the suggestion by Letby in interview that Child G swallowed air when vomiting. Dr Bohin said Child G was "extraordinarily premature" and an observation of 'blood-stained secretions was down to the use of a tube on June 14, 2015. Letby, in interview, remembered her colleague was on a break and would not have left Child G alone. Letby suggested the vomit "had not left the cot". Mr Johnson says this is at odds with agreed evidence and and a note made at the time by Dr Ventress. Letby said she had "seen [Child G] vomiting."
Upon Child G's return to the Countess of Chester Hospital [having been transferred to Arrowe Park Hospital for several days], she "had the misfortune", Mr Johnson says, to be in Letby's care on September 21, her due date.
On September 21, Letby was designated nurse for Child G and two other babies in room 4. Letby said in a nursing note that at 10.15am, Child G 'produced two large projectile milky vomits...' Mr Johnson says Child G had been sabotaged again by Letby, shortly after recording 'entirely normal' observations. Child G's abdomen was noted to be 'more distended than usual'. Mr Johnson says Letby "misrepresented" what the situation was when she texted a nursing colleague that night, saying Child G 'looked rubbish when I took over this morning' and she had inherited a problem, which Mr Johnson says "was untrue". Mr Johnson says if Child G did look so bad, she would have referred her to a doctor first before feeding. "It's a lie to divert the suspicion," Mr Johnson adds.
Letby was involved in a text message conversation for the 'looked rubbish...this morning'. Letby added : 'I personally felt it was a big jump considering how sick she was just a week ago. Being in 4 is bad enough & then having NN [nursery nurses] that just don't always know... "Mum said she hasn't been herself for a couple of days" Mr Johnson says it fits Letby's narrative that nursery nurses are 'bad'. He says the "false narrative" "could not be clearer" as Letby also recorded Child G's poor condition in nursing notes written retrospectively.
The trial is now resuming after a short break. Mr Johnson moves to the second incident on September 21, 2015 for Child G. He says this is when Child G was having a cannula inserted behind a screen at about 3.30pm, and there were problems with insertion. Child G was put on to a trolley to carry out the procedure. A nursing colleague said, in evidence, she had contacted police one month prior, to say Letby had not switched off the monitor in this event, and one of the doctors had apologised to her for not putting the monitor back on. Dr Gibbs said if the nursing colleague said it was true, he accepted it was true. Dr David Harkness said the monitor was "definitely not turned off" said they were "so keen to get fluids going again" for Child G, as it had been 6 hours since she last had fluids, and Child G was 'not just left alone'. In cross-examination, it was put to him he had previously said collapses among neonates of Child G's age was quite common. He replied that was his experience in Chester, but his experience in other places since had showed that was not the case, and now refuted the suggestion. Mr Johnson says the nurse was out of the room for Child G, and Letby was in room 4 with Child G. The nursing colleague said Child G was back in the cot, after hearing Lucy Letby shouting for help. Letby had said she moved Child G from the trolley to the cot and Neopuffed her. Mr Johnson says it is not a credible suggestion. Dr Gibbs had said "whatever the position was with the monitor", he would have made sure Child G was stable when he left her, post-cannulation, and would have told someone he had finished with the cannulation. Mr Johnson says if the nursing colleague wasn't in the room, the other person who would have been contacted would have been Letby. Mr Johnson says this is another occasion where Letby had attempted to kill Child G. The nursing colleague said she could not remember a conversation about being cross that Child G had been left alone on a trolley with the monitor off, or that a Datix form should be filled in for that event.
Dr Dewi Evans said the first September 21 incident was all indicative that Child g had been overfed with "potentially catastrophic consequences". Dr Sandie Bohin said it was "basic arithmetic" - two large milky vomits, plus 30mls aspirate, meant Child G was fed much more than she should have been.
Mr Johnson turns to the case of Child H. He refers to a form from the Countess of Chester Hospital to Arrowe Park for transfer, shown to the court, of Child H's deterioration and the chest drains used. The form ends: 'The acute episodes with desaturations and bradycardias do not seem to be directly related to the respiratory problems' Child H's mother said Child H was "like a completely different baby at Arrowe Park". Mr Johnson says Child H had respiratory distress syndrome, which is "not unusual" for a neonatal baby, and was not particularly premature. There were two events where Child H desaturated which were unusual. Cross-examination of Letby said staffing levels did not contribute to the collapse of Child H. She "always had one-to-one nursing care" and the delay in issuing surfactant did not have anything to do with the collapse, Mr Johnson says. Mr Johnson says for the two counts, the tube was not blocked and staff could hear air going in and out of Child H's lungs.
Professor Arthurs, a professor in radiology, "made a significant contribution" to the debate on chest drains, Mr Johnson said. He said chest drains do not normally cause bradycardia or desaturations, and chest drain positions are not examined in detail as they do not cause problems. He said the interpretation of a chest drain position was his area of expertise. He said in his opinion, the chest drains were in the space they were supposed to be. Mr Johnson says the jury don't have to accept his evidence, but there is no evidence to contradict it. Mr Johnson says the first significant collapse happened on September 25-26, 2015. Letby was the designated nurse in room 1. No other babies were in room 1. The father's statement was read out to court. He said he and his wife had spent time in the neonatal unit until September 25. He said he had been there until 'about midnight', had come back to the house, and was awoken by a call needing to go back to the hospital. He said when he got back, "I definitely remember Lucy being there, doing the chest massaging. It was explained to us [Child H] had a collapse. "[Child H] was a very strange colour - I remember the mottling was running out of her skin towards her fingers." Letby, in nursing notes: '...2330 bradycardia and desaturation requiring Neopuff in 100% to recover. 10ml ai[r] aspirated from chest drain by Reg Ventress. Following poor blood gas and 100% oxygen requirement consultant Gibbs attended the unit and inserted a 3rd chest drain' Mr Johnson says 2330 is the time put in by Letby. Dr Ventress recorded '2350 Several episodes of desaturation in past two hours...' Mr Johnson said Letby had told her of 'several' episodes - "where has that come from?" Dr Ventress: '1st one after gas taken (good gas)...'. Mr Johnson says Letby wrote on an intensive care chart a desaturation to 52% at 2210, which does not appear "at all" in the notes. Mr Johnson says there is nothing in the observation charts to suggest there is anything wrong during this period. He says the parent has an uneventful night before he left. The doctor is given a long list of problems, but there is nothing in the nursing record to what Letby told Dr Ventress. Mr Johnson says this was getting other people to record problems for a child when none existed, as was the case for Child E. NJ: "[Child E] hadn't got a problem, until Lucy Letby caused a problem." Dr Ventress had recorded a second chest drain was "almost out". Mr Johnson says moving chest drains was a "very effective way" of sabotaging a child, as would moving an ET Tube.
Mr Johnson says Child H was in "very, very poor shape", and after being in arrest for 22 minutes, the father noted the mottling. Dr Gibbs ruled out all natural causes for Child H. He ruled out involvement of the chest drains. Mr Johnson says the evidence of Prof Arthurs 'puts this all to bed anyway'. For the second event for Child H, Dr Matthew Neame believed Letby was the designated nurse for Child H on that shift, when it was nurse Shelley Tomlins. Mr Johnson says Letby had 'elbowed her colleague aside'. Letby had messaged her colleague that night: 'I've been helping Shelley so least still involved but haven't got the responsibility'. Mr Johnson says this builds Letby's 'plausible deniability'. He says "we know" Letby was supposed to be in nursery room 2, not in room 1 where Child H was. Mr Johnson says it shows the state of mind Letby was in that night, similar to the state of mind for when she killed Child C.
Mr Johnson says this was another case where a child was desaturating "to life-threatening levels" despite good air entry. The ET tube was checked by Shelley Tomlins and there was no blockage. "Mercifully, [Child H] was revived." An x-ray showed there was no issue with the pneumothorax. The father said Child H was ok in the day, then it was 'shortly after' he had gone to get some rest when he had a knock on the door to go and be with Child H at the cotside as she had deteriorated. Mr Johnson says this was "yet another opportunity" for Letby to sabotage a child.
Dr Neame recalled it was Lucy Letby who briefed him on the second collapse for Child H. He recalled he was more concerned by this second collapse. A further collapse occurred at 3.30am despite Child H having 'good air entry', and she was transferred to Arrowe Park, where she recovered quickly. Dr Evans said the pneumothorices were not the cause of the arrests. He ruled out infection as a cause of the collapses, as they were rapid and catastrophic collapses, she was on antibiotics, and a lumbar puncture proved she did not have an infection. He was "at a loss" to explain the collapse, but it was "not one of natural causes". Dr Bohin said there were delays with the surfactant. She said she could find no clinical or mechanical cause for the collapses. She said she had never known a chest drain to cause collapses, or stresses by the baby resulting in a cardiac arrest. Professor Arthurs saw "no problem" with the chest drains. Mr Johnson says the chest drains can be ruled out as a problem. He adds there was no disease or mechanical factor, and it was "undoubtedly" sabotage by Letby. He says both collapses happened "just after" Child H's parents had left, which had "parallels" with other cases, and was a "signature" of Letby's work.
The trial is now resuming. Mr Johnson says there are four children left to go through - Child I, Child J, Child N and Child Q. He first details the case of Child I.
Mr Johnson says evidence had been heard of Child I, that medics do not worry about self-correcting desaturations. Mr Johnson says having failed to kill Child G and Child H, she turned her attention to Child I, and was designated nurse for two of the four occasions in which she tried to kill the baby girl, and falsified notes along the way. Mr Johnson says it was important to note from the post-mortem evidence that Child I did not have NEC [a gastrointestinal disease].
Mr Johnson says Child I's first collapse was marked with a desaturation to the 30s and had vomited, on September 30. He says the day before, Dr Lucy Beebe had reviewed Child I. She remembered seeing Child I from memory, as the girl became unwell, was shipped out and recovered well, and came back, which she said was unusual, for her short time at the unit. Dr Beebe had said she was shocked and frustrated by Child I's death, as she felt there was something going on which they [the staff] were not aware of. Dr Beebe said the aim for Child I, after the September 29 review, was to continue feeding and growing the baby girl.
The day rota for September 30 had Letby as designated nurse for Child I and two other babies in room 3. Mr Johnson says Letby "did not like" being in room 3. The plan was to give Child I immunisations, as was the case for Child G. He says there was nothing wrong with Child I, who was receiving cares from the mother and a feed. Mr Johnson says Child I produced a small stool at the 10am feed. The 10am feeding chart note is signed by Letby. "The doctors were very happy with [Child I]," Mr Johnson says.
Dr Beebe's note is shown to the court for September 30. Mr Johnson says it is important to note the reason for the review. It was 'asked to review as reduced temperature'. Mr Johnson says Child I was taking full bottles, gaining weight, and Dr Beebe recorded that Child I was handling well. Child I, during the examination, produced a yellow, seedy stool, which indicated good gut health, he tells the court. Dr Beebe said this was not a sign of NEC. Mr Johnson says Child I was "not in distress", the abdomen was the same as yesterday, and the plan was to monitor Child I closely, raise the cot temperature, but Child I appeared clinically well. Mr Johnson asks what was going on at this stage. Child I's mother, in evidence, said Lucy Letby raised the issue with her about Child I's stomach. Mr Johnson says that was not the same reason Letby gave to Dr Beebe. NJ: "So what was going on here?"
Mr Johnson says no concern was expressed to medical staff about Child I's abdomen by Letby. "Why was Lucy Letby expressing concern to [Child I's mother] about the abdomen? Why did Lucy Letby not raise the issue with Dr Beebe?" Mr Johnson says Letby was gaslighting the mother by suggesting a problem with Child I that didn't exist, until she caused the problem.
Mr Johnson says "everything was unremarkable" for Child I until 1pm when she was asleep, and fed via a NGT. The mother said she had gone to meet the family in the canteen at this time. The feed chart shows a 35ml feed for Child I, which Mr Johnson says would take some time - "about 15 minutes", taking until 1.15pm. He says the nursing notes are accurate as they are time-stamped by the computer automatically. The note is written between 1.36pm-1.48pm - it was "at most" 20 minutes after the feed ended. Mr Johnson says the details of the feed and review recorded are not correct. He says the addendum, of a '1500' 'Drs' examination of Child I, is "a complete fabrication". A male doctor's note records examining Child I at 4.30pm. Mr Johnson asks who these doctors were who examined Child I at 3pm. He adds the '3pm note' contains: '[Child I] appeared mottled in colour with distended abdomen and more prominent veins.' Mr Johnson says there is no corresponding doctor's note for this examination of 'mottling'. Letby's note: 'Full monitoring recommenced'. An observation note records this was done from 3pm. Mr Johnson says Dr Beebe had advised it at 11.40am. He asks why did Letby only recommence full monitoring after Child I's mother had left the unit. Mr Johnson says Letby is transposing events, including a note of a yellow seedy stool, from 11.40am to 3pm to an examination - "which never actually happened".
Mr Johnson says it is a "very calculated way" of giving the impression a child who had no problem at all, "had a problem". Child I's mother had a routine for each day, visiting Child I at regular times, and the father would come in from after 5pm. Mr Johnson said the time between 3pm and 5pm was "her window of opportunity" to attack Child I. NJ: "What are the chances of these things happening at precisely this point?" Letby had written: 'Mummy present when reviewed by Drs. Had left unit when [Child I] had large vomit and transferred to nursery 1.' Mr Johnson says Letby had tried to give the impression the Neopuff caused the inflated stomach for Child I. He says "remarkably", Child I improved, and there were 'minimal aspirates'. "Yet another miraculous recovery...all good once Lucy Letby had left." Medical expert Dr Dewi Evans ruled out infection and said the only explanation was a dose of air administered through the NG Tube. Dr Sandie Bohin agreed, and the effect would have been to splint the diaphragm. She discounted the possibility of NEC. Professor Owen Arthurs said the stomach and almost all of the gut had been distended. Mr Johnson says that was from administered air.
The second incident for Child I, on October 13, 2015 at 3.20am, is now detailed by Mr Johnson - the 'see in the dark' incident, he calls it. He says Child I had been progressing well.
The first part of the night shift had Child I being fed normally. Mr Johnson says the second event was much more serious than the first. Before it, Child I had been in a good clinical condition, Mr Johnson says. He says it was expected she was coming up for discharge from the hospital in a couple of weeks. Letby was the designated nurse for a baby in room 1. Nurse Ashleigh Hudson was the designated nurse for Child G, Child I and one other baby in room 2. She left room 2 to tend to another baby in room 1, assisting colleague Laura Eagles, and asked a colleague to monitor Child I - either Caroline Oakley or Lucy Letby. Caroline Oakley had no recollection of being called. Ms Hudson said she had been in room 1, and some milk needed defrosting for Child I's feed, and when she got back, there were no adults in the room. She started to prepare the milk, with her back to Child I. The next thing she remembered was Lucy Letby in the doorway, who pointed out that Child I 'looked pale' - she was 'about 5ft-6ft away' from Child I. She said something along the lines of 'Don't you think [Child I] looks pale?" Ms Hudson said the light in room 2 was low, and the lights were on in the corridor outside room 2. Mr Johnson reminds the jury what Lucy Letby said about this in interview.
Mr Johnson refers to Letby's 2019 police interview, in which she said room 2's light was off, and there was 'an element of light coming from the doorway', and Child I was by the window. Ashleigh Hudson said Child I had a blanket over her, and a 'tent structure' keeping her secure. She said she could not see Child I due to the canopy and the lighting. Mr Johnson says Letby did not have a better view. Ms Hudson said she switched on the light and looked at Child I, who was 'gasping', 'incredibly pale', and in a 'very bad way'. Ms Hudson initially thought the deterioration was so rapid she thought she was too late to save her. She said you "cannot see" a child from the position Lucy Letby was in. Mr Johnson says we have a "head-on credibility conflict", of two accounts who "don't live in the same world". Mr Johnson says in cross-examination, Letby was asked about looking from a brightly lit corridor into a dark room would improve her ability to see. He says her first response was "I don't know". NJ: "She 'conceded' she would not have been able to see, yet she persisted that she could see [Child I]. NJ: "We had a break, we came back, and I asked Lucy what she had said in interview... He says Letby had said "Maybe I spotted something Ashleigh couldn't spot." Mr Johnson had asked Letby: "You don't have better eyesight than Ashleigh, do you?" LL: "No." NJ: "The question is, how would you be able to spot the colouring [of Child I better than Ashleigh Hudson from the same point of view]?" LL: "I had more experience so I knew what I was looking for/at." Mr Johnson adds: "You will remember the way she corrected herself." He says there was a very long pause. He added at the time: "Your answer, you explain it." He said Letby was "finding it difficult to concentrate on all the dates". Mr Johnson said there was nothing about the dates in this context. He says did Letby make an innocent mistake, or did something else slip out, under the pressure of the witness box? He says Letby caused the problem for Child I. He says Child I recovered well.
Mr Johnson says Letby had timed her note, having seen Ashleigh Hudson's nursing note first, so it appeared she saw Child I first. Mr Johnson says it is another case of 'plausible deniability'. Professor Arthurs said Child I's large bowel was distended, and the NG Tube was in the curled up in the oesophagus rather than the stomach. Dr Evans said the only explanation was air administered to Child I via the NG Tube. Mr Johnson says Dr Bohin explained Child I was sabotaged by air administered via the NG Tube and via and IV line. Dr Anne Boothroyd's x-ray report on September 30 recorded: 'There is splinting of the diaphragm due to bowel distention'.
For the third event for Child I, Dr Ravi Jayaram said there were 'no clinical concerns' for Child I before the night of October 13-14. Mr Johnson says evidence was heard to say Child I was "stable". This was the second time Letby was the designated nurse. Mr Johnson says this was the second time she had the opportunity to falsify notes. Dr Matthew Neame's 5.55am note is shown to the court for October 14. Mr Johnson says this is not a retrospectively written note, as it includes a note of a prescription which is timestamped at 5.56am, and an urgent x-ray is timed at 6.05am. He says Letby's addendum note, made at 8.43am, after Child I had desaturated: 'At 0500 abdomen noted to be more distended and firmer in appearance with area of discolouration spreading on right hand side, Veins more prominent' Mr Johnson asks why would Lucy Letby do this? He says to bear in mind what happened the previous night, if these symptoms were shown, then the doctor would be called urgently. He says the absence of a doctor called shows there was no problem at 5am.
Mr Johnson says, from the paper trail, if anyone 'puts two and two together' and thinks there is a problem with Lucy Letby, they are "thrown off the scent". Dr Neame said the mottling was "unusual", which was why he recorded. NJ: "How many times have we heard that in this case?" Mr Johnson says the abdomen was distended. Dr Andreas Marnerides had excluded NEC. Mr Johnson says the only possibility is pushing air in down the NG Tube. Dr Neame said Child I looked uncomfortable when examined and "grimaced". He noted the abdominal distention. Prof Arthurs said, of the x-ray image, the stomach was 'markedly dilated', and the small bowel and the large bowel were also dilated, with 'no symptoms of NEC'. Another image at 8.03am had the stomach decompressed, and a third image the following day showed 'no problems at all'. Dr Neame recorded a further desaturation for Child I at 7am, and the ET Tube was reintubated. It was noted there was 'good air entry' for Child I, but - as Mr Johnson says, in so many other cases for babies in this trial - Child I was desaturating.
Child I had further desaturations on October 14-15, which Mr Johnson said were 'explicable' as there were secretions in the NG Tube. Child I had a 'miraculous recovery' after being transferred to Arrowe Park, and improved, until coming into the "misfortune" of contact with Lucy Letby, he adds. Dr Evans thought Child I's stomach had been injected with air, and air injected into the intravenous system. There was an "astonishing amount of air" in Child I's stomach. Dr Bohin concluded Child I had air administered.
The trial is now resuming after a short break. Mr Johnson turns to the fourth and final event for Child I, on October 22-23, 2015, in which Child I died.
Mr Johnson says Ashleigh Hudson had given evidence to say Child I was "very easy to settle", and although Child I was in nursery room 1, that was as a precaution given her history of episodes. Child I was self-ventilating in air and her saturations "optimal", and she "looked very well", and "pink, well-perfused" and a "soft, non-distended abdomen". Caroline Oakley said in a statement Child I's abdomen was "fine" and "soft, non-distended". Mr Johnson says that is the background to Child I when Lucy Letby came on shift that night.
Letby was designated nurse for a baby in room 2 and a baby in room 3. Ashleigh Hudson was designated nurse for Child I and another baby. Child I was in a "virtually perfect" clinical scenario, Mr Johnson says. He says Letby "got herself involved". Child I gave a 'cry that had not been heard before' - 'loud and relentless', according to Ashleigh Hudson, who interpreted it as "distress". When she was repositioned on her tummy at about midnight, Child I stopped breathing. Resuscitation efforts began and Child I then began to fight the ventilator. Dr John Gibbs was told Child I had had an abnormal cry. He was 'perplexed' at Child I's rapid deterioration and recovery, which would not show a sign of infection. Mr Johnson says Letby falsified paperwork for one of her designated babies at this time - the baby to be transferred to Stoke. Letby recorded a note at 10.50-10.52pm note of a 10% glucose infusion for the 'Stoke baby'. The infusion note is written as starting at '2300', and that writing is changed to '2400'. Mr Johnson says it was changed to give Letby an "alibi" for midnight. Mr Johnson says further times are overwritten/changed on Child I's infusion chart - from 12.15am to 12.25am, and one to a time at 1.25am, which Mr Johnson says puts it out of sequence between '1.28am' and '1.48am' on the chart.
Ashleigh Hudson said she was alerted to Child I at 1.06am by either the alarm going off or Child I crying. She said, in room 1, Letby was already there at Child I's cotside and "had her hands in the incubator". Mr Johnson says Letby had sabotaged Child I, and caused Child I to cry. Mr Johnson says Letby 'put Ashleigh Hudson off' by saying: "She just needs to settle". 'Air++' was aspirated from Child I. Mr Johnson asks how that could have got there other than being forced in by Lucy Letby. Dr Rachel Chang could see air entry and chest movement on Child I, but Child I wasn't recovering. She said Child I's death was "inexplicable". Dr John Gibbs noted mottling on Child I. He said he "could not understand" why Child I had died and referred the case to the coroner. The grieving parents agreed to bathe Child I. Mr Johnson said despite having two designated babies to care for, and Child I not being her designated baby, Letby met the parents. The mother said: "Lucy came back in. She was smiling and kept going on about how she was present at [Child I's] first bath and how much she [Child I] had loved it." "I wish she had just sopped talking. Eventually I think she realised and stopped. It wasn't what we wanted to hear then."
Dr Evans says this was "another" case, in Child I, receiving air administered. He thought the nature of the collapse, the crying, the prolonged resuscitation, and the purple and white discolouration, were all symptoms of air embolus. There was no account of natural disease. Dr Bohin said the cause of death was air embolus - from the unexpected catastrophic collapse, Child I being unsettled and agitated, the 'extremely unusual' crying meaning Child I was in excruciating pain. In cross-examination, Dr Bohin was asked if she had a coherent explanation for an air embolus. Mr Johnson said Dr Bohin's answer, without hesitation, lasted for about 10 minutes. She was asked about Child I's poor weight gain, and Dr Bohin said that did not make her more likely to have a cardiac arrest [as Child I had]. Prof Arthurs said it was 'unusual' to see the amount of dilation in Child I's stomach. He excluded CPAP belly as a cause. He said it was "reasonable to infer" air administered. Dr Marnerides said at the time of Child I's death, she had no acute illnesses or abnormalities in the bowel, other than presence of air. The presence of gas had "no pathological cause". He said the collapses were air administered from the NG Tube. Mr Johnson says Child I's case is a "stark one". He says Letby made repeated efforts to kill Child I, and falsified notes both for Child I and another baby. She 'gave herself away' in the event with Ashleigh Hudson. "Lucy Letby's behaviour in the aftermath [of Child I's death] was bizarre and inappropriate. She revelled in what she had done." "Her voyeuristic tendencies caused her to look up [Child I's mother] on Facebook." "Having killed her [Child I], she wrote a condolence card. It was still on her phone when it was seized by the police."
Mr Johnson details the case of Child J. He says when Letby was giving evidence in this case, she said band 4 nurses [nursery nurses] cannot do intensive care or high dependency babies, or handling of stomas. Letby said the unit was very busy as an explanation why a band 4 nurse was caring for Child J. Mr Johnson says the implication of that exchange was to give that Child J received incompetent care, and staffing levels were compromised. Letby had messaged a colleague on November 19, 2015: "It's shocking really that they are willing to take on the responsibility for things that they have no training or experience etc on. Don't think they appreciate the potential difficulties" Mr Johnson says the jury will remember witnesses had been cross-examined about nursing guidelines. He says the part that was never quoted was the bit about stomas. The care, shown to the court, says special care day nurses can include care of a stoma. Mr Johnson says that whole evidence "was designed to mislead you". "It's the same type of behaviour that Lucy Letby engaged in with her colleagues."
Mr Johnson says Child J had no respiratory difficulties and was being bottle fed, and did not need respiratory support, and was in room 4. Nurse Nicola Dennison said Child J was 'getting ready to go home' with a stoma by November 26, 2015. She wrote in notes that Child J was 'stable'. Child J's mother left at the end of the day, intending to return at 8am the following day, but received an emergency call overnight. Letby was in room 3, designated nurse for two babies that night shift. Nicola Dennison was the designated nurse for Child J and one other baby in room 4.
Child J desaturated at 4.40am on November 27. Mary Griffiths was working in room 2. She said in evidence Child J was a 'joy to look after', and described the first desaturation, which she and Nicola Dennison dealed with. The desaturation was "alarmingly low". Ms Dennison said, after cross-examination, Child J collapsed after her feed. Dr Kalyilil Verghese recorded the shift was busy. Twins had been admitted to room 1 at 6.10am. He said he reviewed Child J once, and all information was given to him by nursing staff. He noted there had been 'two profound desaturations', timed at 5.15am. Child J was moved to nursery 2 when the designated nurse was Mary Griffith. Mr Johnson says Letby was then involved in care of babies in room 2, despite her designated babies being in room 3.
Letby had said, in a text, the unit was 'closed' trying to get someone in. At 6.49am she messaged 'It's all a bit t**s up' Mr Johnson says resources had been diverted to room 1, and this was the "perfect opportunity" for Letby to attack Child J. At 6.56am, Child J collapsed.
Mr Johnson says Child J's saturations dropped, as did Child J's heart rate. Mary Griffith noted '[Child J's] monitor went off at 0650 myself and L Letby attended. Found baby with pale hands and baby very rigid. Sats went to 7 and heart rate to 68. [Child J] Neopuffed with little improvement....Dr Gibbs on unit and called to help. Neopuff continued for 16 mins until sats improved.' Mr Johnson says this was a serious enough incident for the consultant to be called. A glucose bolus was started at 7.20am, which Mr Johnson says was administered by Letby. At 7.40am, according to nursing notes, Child J desaturated again, and her fists were clenched, her eyes were rolling to the left, and Letby got involved again. Dr Gibbs recorded at 7.35am: 'Two seizures' - he said he remembered Mary Griffith and Lucy Letby were there when he arrived. A seizure was 'reasonably long', about '10 minutes'. Mr Johnson says prior to these events, Child J had never had a seizure, and she had not had one since. She "recovered very well" afterwards. He adds blood tests were normal and showed no signs of infection, and a brain scan showed no abnormality, nor in an x-ray. Dr Gibbs said an oxygen drop was the reason for the seizure, but could not find a reason for the oxygen drop. Dr Stephen Brearey said there "was no explanation" for the deteriorations.
Dr Evans said there was no marker of infection for Child J. He said if there had been, the recovery would not have been so quick. He agreed there had been a lack of oxygen, and it had not been an epileptic seizure. Dr Bohin said babies who are ready to go home do not have collapses which require prolonged resuscitation and a quick recovery. Mr Johnson says the cause of collapses "bear all the hallmarks" of an attack by Lucy Letby. He said Child J was "prospering" prior to the attacks, and the attack happened while the unit was distracted by two emergency admissions. He says at that time, when it was 'all hands to the pump', Letby was on her phone. He says Letby stopped texting seven minutes before Child J's collapse. Letby's suggestion that she had little memory of the event is "not realistic", Mr Johnson says, as that night was punctuated by two emergency admissions to the unit. He says Letby "was running with the I don't remember line to avoid answering questions." He says Letby searched for Child J's parents, which is 'inexplicable', other than through an 'unnatural interest in them'.
Mr Johnson moves to the case of Child N. He says Child N was sabotaged by Lucy Letby as he was getting ready to go home. The first incident was "characteristic of Lucy Letby's handiwork", Mr Johnson says. Dr Christopher Booth had gone on a break. Mr Johnson suggests Letby was "in her least favourite room" that day, in nursery 4, with 'only' two babies, and had time on her hands by texting about Melanie Taylor's shortcomings and a male doctor. He says that includes the 'go commando' comment, which he says Letby lied about not knowing its meaning. NJ: "If she's not even prepared to tell you the truth on something so trivial, what is she prepared to tell you the truth about?"
Mr Johnson says Letby's interviews are "very revealing" in relation to the texts in the case of Child N. He refers to the 2020 police interview. Letby was asked if she knew Child N had haemophilia. She replied she didn't know. Mr Johnson says that was a lie, as there was a handover sheet in the 'Morrisons bag' at her home which documented Child N had haemophilia. On June 2, 2016, Letby was recorded caring for two babies in room 4, including giving a feed to one of the babies, a 50ml feed to a baby who was asleep. Mr Johnson says it would take 15-20 minutes. He says the 2030 time could mean any time between 2015-2045. Mr Johnson says the 'keypad on Lucy Letby's phone must have been hot' as Letby was texting constantly at this time. He says it is accepted people do text at work, but giving an NG Tube feed is a two-handed process, and "you can't do that if you're texting at the same time". He says there are 41 text messages in the conversation, and that "cannot be done" if you are giving, "in the proper way", an NG Tube feed. Mr Johnson says Letby was asked about this, how it could be done: LL: "You can't." Mr Johnson had told Letby there was one method of administering a feed quickly. Letby added: "You think I pushed it in?" NJ: "That's what you were doing, wasn't it? LL: "No."
Designated nurse Christopher Booth said, for the incident, he went for a break around 1am on June 3. Sophie Ellis was giving a feed at the time and had only a vague memory of child N, and had a number of designated babies that night. Melanie Taylor was making an entry on a fluid balance chart and had no memory of Child N. Valerie Thomas was a nursery nurse who would not have been in room 1. Mr Johnson says the process of elimination was it was Lucy Letby who was in room 1, as she wasn't recorded doing anything at that time. Dr Jennifer Loughnane noted Child N was 'unsettled' and desaturations had gone to 40%, and he was 'dusky and mottled'. He was "screaming". Mr Johnson says Dr Loughnane sat back in the witness box when reading the word 'screaming'. Mr Johnson says he asked Letby if she remembered Dr Loughnane doing that, and she said she did. Dr Evans said the 30-min crying was unusual, as was the speed of decline. He could think of no naturally occurring or innocent cause. Dr Bohin said the desaturation was 'life-threatening', and there was 'nothing to suggest it was an innocent event', and there 'must have been an inflicted painful stimulus' to cause a life-threatening collapse. Mr Johnson says that same kind of injury was inflicted by Letby on Child O, 20 days later, causing a liver injury. He says this attack happened on a baby who was perfectly well just after the designated nurse had gone on a break.
The trial is now resuming after its lunch break. Mr Johnson is continuing the case of Child N, referring to events on June 15, 2016.
He says the day before, on June 14, Letby was Child N's designated nurse. It was planned for Child N to go home that week. On June 14, notes are shown showing Child N had a 45ml feed at 7.40am. At 8.17am, Letby "complained" she had had to feed Child N - she messaged: 'bottle not done'. Mr Johnson says the 45ml feed took until about 8.15am. Letby had noted Child N was almost 'ready for home'. Child N's mother fed Child Child N at 11.50am. Mr Johnson says Letby noted at 2.20pm: 'mummy visiting this morning, carried out cares and feed...aware that once jaundice treatment discontinued infant will be ready for home...' Mr Johnson says Letby did something to destabilise Child N at the end of her day shift to give the impression of an underlying problem. Jennifer Jones-Key reported that, in the night, Child N was "unsettled". She wrote in nursing notes: "At start of shift, baby nursed in incubator with eye protection in situ...baby very unsettled early part of night." Mr Johnson asks what had happened to unsettle Child N that night. He says it is similar to the case of Child P, just over a week later. Child N started to desaturate at 1am, looking mottled, and it was escalated to Belinda Simcock and Kathryn Percival-Ward. A male doctor reviewed Child N and noted he looked normal. Child N had a number of desaturations and the male reviewing doctor believed it was the beginning of an infection, so ran a test for it. The outcome showed there was no infection, Mr Johnson says. A repeat blood gas test had "reassuring" results. The male doctor said there was no NG Tube in place, and Child N was nil by mouth. A colleague texted Letby at 5.25am: "Baby [N] screened, looks like s**t". Letby almost immediately responded: "Really?!" Mr Johnson says that is the reason Letby went straight to Child N when she went in early. "She saw an opportunity."
Swipe data showed Letby came in "extra early" at 7.12am. Mr Johnson said as soon as she entered, she texted the male doctor: 'I've escaped being in 1, back in 3'. Moments later, Child N collapsed. Mr Johnson said Jennifer Jones-Key said Child N had 'fleeting desaturations' early in the morning. An observation chart "showed no worrying signs at all" at 5am and 7am for Child N, Mr Johnson says, with 100% oxygen saturation levels. Child N had a "big desaturation" at 7.15am. He says Letby knew she had a chance to sabotage Child N as it would be busy. A colleague had texted her: '5 admissions, 1 vent'. Jennifer Jones-Key said she recalled Letby had gone over and noticed Child N was pale. She said Letby had 'just come in to say hello as they were friends'. Mr Johnson says Letby had been texting two colleagues, not Jennifer Jones-Key, the previous day, and continued the texts with a nursing colleague and a doctor colleague up to 7.12am. Mr Johnson says if she was going in to talk to her friend, she would have gone to the nursing colleague who she had been texting and was on duty. Letby, in police interview, said she had 'assumed something had happened for Child N to move because of the observations [on the chart]'. She said she had 'no independent memory' of Child N. The nursing note suggested Child N was desaturating on handover. Mr Johnson says the impression given by the note is she was inheriting the problem of the child already desaturating by the time she came on shift. He says Letby was "trying to avoid an audit trail". Child N's parents were called in urgently, and they saw him being given CPR. The parents recalled Lucy Letby being present. Mr Johnson says Letby made more "misleading notes" after this collapse for Child N.
Letby noted, in family communication at 2.10pm: 'Parents contacted by SN Butterworth during intubation. Both phones switched off and no answer on landline. message left. Call returned shortly after'. Mr Johnson says that note must refer to the 8am intubation done by a male doctor. His note of 'intubation drugs given'. Mr Johnson says it had been said the parents' statements were agreed, but now they are not. Child N's father said Lucy Letby rang him up and gave details. He added, in response to the phone call: "I didn't get the impression he was still unwell." He said a different nurse rang up 10 minutes later, telling him to go to the hospital as soon as possible, and they arrived at 9am. This was on the day Child N was due to go home. Mr Johnson says if Child N had been 'a bit unwell during the night', then he was worse now. He says the parents were told Child N was 'ok now', which was not true. He says the parents 'might just remember the call' to tell them there had been an issue with Child N. He says none of this was dealt with when Letby gave evidence to her own counsel. He says when cross-examined, Letby said she believed there was a note by Bernadette Butterworth on family communication. Mr Johnson says this chapter of evidence is "littered with irreconcilable contradiction". He asks why it was played down to the parents that Child N was unwell. He says that when Letby made the call, she would not have known Jennifer Jones-Key had already recorded Letby had been hands-on with Child N. In police interview, Letby said she "couldn't remember". Mr Johnson says the nursing note was "completely misleading", and suggested S/N Butterworth had been unable to get through to the father of Child N. He says Letby came in early to sabotage Child N. He says if someone looked at the records, it would look like Letby 'had a peripheral role' in Child N's care that day.
A subsequent examination at Alder Hey, of Child N, showed he had no abnormality with his airway. Child N was intubated. The male doctor said upon the intubation attempt, he saw blood. He couldn't see the source of the blood, and said the swelling was "unusual". He said in cross-examination: "It must have been unusual for me to see it." He said, in cross-examination, it was possible the bleed could have been caused by an implement used before the first intubation, but if that was the case, he said he would have noticed blood on the equipment. Dr Brearey said he could not think of a natural cause why Child N had collapsed. At 11.29am, Letby messaged: 'Small amounts of blood from mouth & 1ml from NG. Looks like pulmonary bleed on Xray. Given factor 8 - wait and see...' Mr Johnson says Letby was building a narrative.
When asked about the 1ml fresh blood reading on an intensive care chart at 10am in interview, Letby said she did not remember, and "I don't know what I did". Mr Johnson said if this reading is true, she would have escalated it to a doctor, as a child with haemophilia. He says if it is not true, it is still a point against Letby - why would she make a note?
Mr Johnson says the jury know it wasn't escalated as there weren't any doctor's notes.
Child N's parents came in, and left for a break to get something to eat, and at that point, Child N collapsed. "The power of circumstantial evidence," Mr Johnson says. He adds Letby 'wrote it off as an innocent coincidence'. The next event was at 2.59pm, when doctors were crash bleeped to Child N. He says it is a "repeat" of Child E, with a bleed. Dr Satyanarayana Saladi encountered a "large swelling at the end of the epiglottis" and had never seen it before in a newborn baby. The swelling 'perplexed Dr Gibbs as well'. Dr Brearey was called in by Dr Saladi to help. He said they were worried about pulmonary haemorrhage and full intubation was still required. Mr Johnson says we know now that it was not pulmonary haemorrhage. Mr Johnson says the suggestion Letby first saw blood at this point is "completely unconvincing".
Mr Johnson says the text to a doctor colleague by Letby is made at 11.29am, mentioning 'small amounts of blood from mouth & 1ml from NG.', and another note is on her family communication. Mr Johnson says Letby omitted that in interview. He says the truth is Letby made a damaging admission in interview, and "proves she sabotaged" Child N before the arrival of the doctor. 'Sorry if I was off during intubation, Bernie winds me up faffing etc , I like things to be tidy and calm...' Mr Johnson says Bernadette Butterworth was 'getting on Lucy Letby's nerves that day'. Letby recorded another 1ml of blood at 6pm. When the Alder Hey transport team arrived, a female doctor said Letby was "agitated" and approached the doctor saying "who are these people? Who are these people?" Mr Johnson says this is contradictory to what Letby said in interview, when she said she was 'relieved' the transport team arrived. He says this is all 'part of the gaslighting' on her colleagues. The female doctor felt Letby's behaviour was "out of character" from what she had previously experienced. Dr Gibbs said at 7.40pm he was discussing matters with the transport team when someone called for help for Child N as his saturation levels had dropped. Mr Johnson asks if this was an innocent coincidence when all the doctors were 'distracted', 'in a huddle'.
Mr Johnson says thanks to the skill of the medical team, they were able to bring Child N back following resuscitation efforts. Child N's time in Alder hey was 'uneventful' and he was discharged three days later. Professor Sally Kinsey said the blood seen by the male doctor at 8am could not have been spontaneous - "somebody caused the bleeding", and could not have been seen for the first time hours later by Letby, Mr Johnson says. Mr Johnson says the person who injured Child N was "undoubtedly" Lucy Letby.
Mr Johnson turns to the final case, Child Q, who was "doing just fine until he came into contact with Lucy Letby".
Child Q had a 2ml bile aspirate overnight on June 23-24, and feeds were stopped as a precaution. His bowels were noted to be working. Samantha O'Brien fed Child Q tiny amounts of milk the following night. His respiratory condition was "stable" and was tolerating the feeds. The aspirates were "possibly more than you would expect", but said he was stable and there was 'nothing you wouldn't expect' from the baby boy.
For the day shift of June 25, Child Q's abdomen was noted at the beginning of the shift to be 'soft and non-distended' in a note by Lucy Letby. Letby was in room 2, designated nurse for Child Q, and a child in room 1. Mary Griffith was the designated nurse for the other baby in room 2. Letby and Mary Griffith co-signed for medication for a baby in room 3 at 8.34am. Mary Griffith left the unit shortly after that, and Child Q then collapsed, Mr Johnson tells the court.
The 9am observation chart for Child Q is unfinished - "almost as if she was interrupted by something", and the 9am fluid chart also has gaps, with no initial. Mary Griffith came back on to the unit at 9.01am. Mr Johnson says while Mary Griffith was out, Letby took the opportunity to inject clear liquid and air down Child Q's NG Tube.
In interview, Letby said "repeatedly" at the time of the collapse, she had been in room 1, and gave the full name of the designated baby in there. Mr Johnson says Letby has a good memory for that baby, "but she doesn't remember [Child D]." Mr Johnson adds the reason Letby remembered that baby is the room 1 baby "was her alibi".
In Letby's 2020 police interview, she said she needed to see the room 1 baby as she needed 'cares'. Colleague Minna Lappalainen said cares were needed 'every four hours'. Letby had last given cares for the room 1 baby at 8.30am, and Mr Johnson says the explanation to police of cares is a "hopeless excuse". He adds Letby sabotaged Child Q.
Child Q's alarm sounded, Mary Griffith called for help and Minna Lappalainen arrived to help. Mr Johnson says Letby had noted, at 9.10am, 'air++ aspirated' from Child Q and the baby was 'mottled++'. He says this is something which has been seen before, air which hadn't been seen before the desaturation. Mr Johnson says Minna Lappalainen didn't see the aspiration of the air or the mottling, as she was focused on stabilising on Child Q. He says that is something to consider when the defence mention about differing accounts by doctors and nurses on skin discolourations flitting, coming and going. The discharge note by a male doctor for Child Q 'Profuse vomit with desaturation on morning 25/06/16.' He said he wasn't there, and Mr Johnson says this information must have been given to him by nursing staff. He said Child Q's blood gas before 7am was good, and the one before 10am showed respiratory acidosis. Mr Johnson says this was "no minor desaturation" and took the doctor away from the children's ward. Dr Gibbs said the collapse was "not in keeping" with a baby such as Child Q who was getting tired. Letby had messaged later: "Do I need to be worried about what Dr Gibbs was asking?" Dr Gibbs had said he had a 'heightened concern' on the NNU. Mr Johnson says Letby had a heightened concern at this time that people were on to her.
NJ: "Letby's text messages proved that Dr Gibbs' instinct was absolutely right." He says Child Q had been sabotaged by Letby.
Mr Johnson says if this was a minor collapse, as the defence suggest, why was Dr Gibbs so interested into what had happened? A male doctor noted 'small loops in the bowel' 24 hours after the collapse, and Child Q was transferred to Alder Hey. Mr Johnson says it is all irrelevant to what happened 24 hours earlier. A doctor at Alder Hey said Child Q's abdomen had normalised by June 27 and he was transferred back to Chester. He said it was another case where a child recovered quickly when 'taken out of the orbit of Lucy Letby'.
Professor Stivaros later found evidence of a brain injury in Child Q, which Mr Johnson says proves the collapse was not a minor one. Dr Evans was cross-examined on the 'fluid being injected' as a 'late addition' to his evidence. Mr Johnson says the defence said air being administered via Neopuffed was an explanation for 'air++ aspirated', and the description of the collapse was a 'gross exaggeration' of what had happened. Mr Johnson said such criticism was 'unfair', as Dr Evans had referred to 'profuse' from a male doctor's note on the discharge letter. Mr Johnson adds Child Q suffered a brain injury. Dr Evans said a significant amount of fluid appearing on Child Q did not have a natural cause, and was "suspicious of the volume of air aspirated", although he accepts the air could have been introduced by the Neopuff. Mr Johnson says if that was the case, what caused the collapse in the first place? NJ: "He had no naturally occurring problem at the time to cause that extremity of collapse." Minna Lappalainen noted a 'distinction' between 'mucus' and "Clear fluid+++". Letby recorded: 'Vomited clear fluid nasally and from mouth'. The doctor recorded: 'Profuse vomit with desaturation'. Mr Johnson says the jury can be 'confident' with the 'contemporaneous evidence' that what came out was 'not just mucus'. He says it could not have been milk as Child Q only had 0.5ml of milk each 2 hours. Dr Bohin noted if there was 'clear fluid+++' for Child Q, there was "no innocent explanation" for that. The observation chart showed whatever happened at 9.10am was "an acute event" and it happened in the space of 'minutes'. She added that could not have been from the milk Child Q had earlier. She added if Child Q did have NEC, he recovered too quickly for that.
Mr Johnson says he has 'deliberately not spent a long amount of time' on handover sheets. He says Letby hasn't told the truth on them, as the truth doesn't help her. He says the point is very simple for the notes overall - the notes contain admissions, regarding her 'isolation from friends'. He says it has been categorically proved that was a lie, as shown by her social engagements [in a folder]. He says after Letby left the neonatal unit, she put in a 'lying Datix form', for Letby 'getting her defence in first'. The messages Letby sent 'clearly showed she knew there was going to be an investigation'. The Datix form, timed 3pm on June 30, 2016 is a "devious effort to avoid suspicion."
Mr Johnson lists the common events for the babies in this indictment by categorisation. By ones who collapsed despite having good air entry but saturations were dropping: Child A, C, D, G, H [second event], I [third event and fourth event], M, O [twice], P. By bleeds and/or bleeding in throat: Child C, E, G, H, N, plus 'false note by Letby' in K. Unusual discolouration: Child A, B, D, E, I, M, O, H. Suffered life-threatening collapses out of nowhere then recovered very quickly: Child B, D, H [both collapses], I [events one to three], M, N, O, P. Children who collapsed when designated nurse left or leaving the room: Child C, D, G [first event], I [second event and fourth event], K, N [first event], P [third collapse - when doctors were out of the room], Q [slight variation - when Letby got herself out of the room]. Premature babies screaming/crying uncharacteristically at time of collapse: Child D, E, I, N. Children who collapsed shortly after being visited by their parents: Child B, H, I [first event], M, N, O, P. Children who recovered quickly when taken to other hospitals: Child H, I [after 3rd collapse], N, Q. Mr Johnson says Child K's tube never moved after being transferred out of the Countess. When Letby participated in inappropriate post-death behaviours: Child C, I, O. Poisoned by insulin: F, L. Mr Johnson says if Letby had not sabotaged seven babies, they would all have gone home. The other 10 babies, Letby attempted to murder.
That concludes the prosecution's closing speech.
