Lucy Letby was ‘trying to kill baby girl when paediatric consultant walked in on her’

‘Cold-blooded’ nurse Lucy Letby tried to kill a second set of twins and murdered two of three triplets, it was claimed today – as jurors heard allegations TV doctor Dr Ravi Jayaram walked in on her as she was attacking a baby girl.    

The 32-year-old is accused of attacking two sets of twins by injecting them with insulin and air. One child, Baby E, would die but his sibling survived. The Crown has already accused Letby of attempting to murder two other twins in similar circumstances eight months before. 

At the time, Letby was supposed to only to be working day shifts because the consultants were concerned about the correlation between her presence and unexpected deaths on night shifts, the prosecution said. 

The nurse murdered two out of three triplets – Children O and P – on successive days in June 2016, it is alleged, but the third, Child N, survived. 

In total, she is accused of murdering seven premature babies and attacking 10 more over a year by poisoning them with insulin, injecting air into their bloodstreams or over-feeding them milk. 

On one night in February 2016, Dr Jayaram, a paediatric consultant who has appeared on ITV’s This Morning and the One Show on BBC, walked in as she was trying to kill a baby identified only as Child K, it is claimed. 

Nick Johnson KC, prosecuting, told the jury: ‘Feeling uncomfortable with this because he had started to notice the coincidence between the unexplained deaths, serious collapses and the presence of Lucy Letby, Dr Jayaram decided to check on where Lucy Letby was and how Child K was.

‘As he walked into room one, he saw Letby standing over Child K’s incubator. She did not have her hands inside the incubator, but Dr Jayaram could see from the monitor on the wall that Child K’s oxygen saturation level was falling dangerously low, to somewhere in the 80s.

‘But the alarm was not sounding as it should have been and Lucy Letby had not called for help, despite child K’s oxygen levels falling. We allege she was trying to kill Child K when Dr Jayaram walked in.’

As the third day of Letby’s trial continues, the court has heard over the trial so far:    

• Letby, 32, denies murdering seven premature babies and attempting to murder 10 more over 12 months. The deaths occurred at the Countess of Chester Hospital between June 2015 and June 2016. Letby was arrested three years after the death of her first alleged victim, Baby A;
• ICU nurse is alleged to have injected babies with insulin, air or pumped with milk to kill them – often during night shifts when parents were less likely to be there;
• Letby allegedly targeted twins on more than one occasion – and in some cases one was murdered and their sibling survived; 
• She is said to have searched for the families of her alleged victims’ parents on Facebook and social media, including on Christmas Day;
• In some cases, Letby is alleged to have tried to kill babies on up to four occasions, including two times in one shift;
• Nurse was ‘smiling’ after one child’s death and sent her parents a sympathy card, which was ‘not normal’; 
• On a separate occasion, a paediatric consultant claimed he walked in on Letby as she was trying to kill a child; 
• Doctors moved her off night shifts after being concerned about correlation between suspicious deaths and her presence; 
• Made notes about at least one of her attacks in a diary but denied this was a ‘souvenir’; 
• Used a baby’s haemophilia as ‘cover’ to attack him, thinking that this would give her an excuse for his bleeding; 

Later the same morning at 7.30, Letby was again at Child K’s cot calling for help, the court heard. She was assisting the baby with her breathing and it was found Child K’s breathing tube had this time slipped too far into her throat. Child K was transferred to another hospital later that day but remained unwell and died two days later. Letby is not accused of her murder.

One independent medical expert said it was ‘very likely’ the dislodgement of the breathing tube was a deliberate act and another did not believe an ‘accidental or innocent dislodgement’ was a plausible explanation, the court heard.

Under police interview, Letby said she had not initially sounded the alarm over child K when Dr Jayaram walked in because she was ‘possibly waiting to see if she self-corrected, we don’t normally intervene straight away if they weren’t dangerously low’ in oxygen. Mr Johnson told the court a nursing expert said that given how premature the baby was, Letby’s explanation for delaying intervention, ‘didn’t wash’.

Today, Letby sat in the dock wearing a black jacket as she listened to the prosecution lay out an allegation of murder against Child I and O, two of attempted murder against Child H, and further the attempted murders of Child J, K, L, M and N.   

Mr Johnson described the case of Child I  as ‘an extreme example even by the standards of this overall case’. He said Letby first tried to kill Child I by injecting air into the infant’s stomach.  After Letby’s third alleged attempt on her life, Child I was transferred to another hospital where she made a dramatic recovery. But after being returned to Letby’s care, the infant collapsed and needed cardiac compressions, the court heard. 

‘Baby I was born very early and very small – but she survived the first two months of her life and was doing well by the time Lucy Letby got her hands on her,’ Mr Johnson said. 

After Child I’s death, her parents were taken to a private room and asked if they wanted to bathe her. Mr Johnson said that as the baby’s mother ‘bathed her recently departed child, Letby came into the room and, in the words of the mother, was ”smiling and kept going on about how she was present at Child I’s first bath and how much Child I had loved it”.’ 

The nurse later sent a sympathy card to the parents, something that was ‘not normal’. In a police interview, she told officers this was the only time she had done it, ‘but it is not often the nurses got to know a family as well as they had known Child I’s’. She admitted to officers that she’d kept an image of the card on her phone.     

Mr Johnson said: ‘We suggest that it is highly significant that children within the orbit of Lucy Letby persistently and consistently suffered unexplained collapses.

‘Sometimes the evidence of her hand at work is more obvious than others and it is remarkable that on many occasions when children who had suffered unexpected spectacular and life-threatening collapses were removed from her orbit, they had exceptional recoveries.’ 

Letby’s parents, Susan and John, are supporting her at her six-month trial at Manchester Crown Court. 

Nick Johnson, KC opened today’s hearing by outlining Letby’s first alleged attempt to kill Child H when she was the infant’s designated nurse. 

The prosecutor said the ICU chart shows she gave Child H a dose of morphine at 1.25am and saline at 2.50am. The following night, the infant’s oxygen levels began to drop profoundly at 22.53pm and 3.30am after being ‘relatively stable’ during the day shift. 

Letby was not her designated nurse at the time, but the nurse who had this role later said she could not recall whether she had taken a break during the shift but confirmed she had been out of the room at least some of the time.    

He went on to describe ‘interesting Facebook searches’ by Letby after the incidents. 

He told the court that about a week after Child H’s second collapse, at about 1.15am, within about three minutes she searched for Child H’s mother, the father of twin children E and F and the mother of Child I. At the time she was on her day off. 

Introducing the case of Baby I, Mr Johnson said: ‘There were four separate occasions on which we allege Lucy Letby tried to kill Baby I. She was resilient, but ultimately, at the fourth attempt, Lucy Letby succeeded in killing her’. 

Baby I weighed 970 grams when she was born in Liverpool Women’s Hospital on August 7, 2015. She was transferred to the Countess of Chester on August 18.

By September 29, the infant was eight weeks old and the clinical concerns about her had diminished.

She had no breathing problems, was ‘in air’, gaining weight and being fed both by bottles and a tube.

Mr Johnson alleged that Letby carried out her first attack on Baby I the following day, September 30 – ‘a couple of days after she had tried to kill Baby H and a week or so after events two and three for Baby G.

Letby was on a 12-hour shift that began at 8am, and she was Baby I’s designated nurse. 

She had two other babies to look after in Room 3, yet despite this she was also involved that shift with G and H. 

According to Baby I’s mother, Letby expressed some concern to her and indicated that the infant would be reviewed by a doctor.

Mr Johnson said: ‘When she made the requisite note, Letby reversed the concern, saying that it was Baby I’s mother who had raised an issue about her abdomen, writing ‘Mum feels it is more distended to yesterday and that I is quiet…not on monitor but nil increased work of breathing’.

He asked the jury: ‘Was it Lucy Letby trying to cover for what she was going to do?’ 

She fed the sleeping baby 35mls of expressed breast milk via the NGT at 4pm. Half an hour later an emergency ‘crash call’ was put out.

Baby I had vomited, desaturated, her heart rate had dropped and she was struggling to breath. Her airway had to be cleared and she was given breathing support before being moved to Room 1.

X-rays revealed a massive amount of gas in her stomach and bowel, and her lungs appeared ‘squashed’ and of small volume. It was the prosecution case that this air had been injected into the baby’s stomach.

The crisis passed, but medical notes record that Letby adjusted the infant’s glucose infusion and gave her an injection of saline.

‘Within moments, Baby I deteriorated again. However, as I have said, Baby I was resilient and overnight her condition’.

Thereafter the baby enjoyed a period of such stability that she did not even need a monitor. 

In the early hours of October 13, Baby I was well and being bottle-fed every four hours. At about 3am her designated nurse briefly left the room and asked Letby and another colleague to listen out for the infant.

Mr Johnson told the court: ‘When she returned to Room 2, at about 3.20am, Lucy Letby was stood in the doorway. The room was darkened because it was night time. But as soon as she came in Lucy Letby told her Baby I looked pale.

‘When the other nurse turned on the light, she saw that Baby I appeared at the point of death and was not breathing. 

‘When she reconsidered later she thought that perhaps I was breathing once at least every 20 seconds, because if she hadn’t been the apnoea alarm would have sounded’.

Turning to the jury, Mr Johnson said: ‘You might want to consider how it was that Lucy Letby could see that I was pale from the door of a room in which there was minimal lighting.

‘And you may want to consider the possibility that someone had silenced the alarm or turned it off’.

The third incident happened on October 14 when Baby I suffered desaturation caused by gas in her abdomen. Again she needed to be resuscitated. She was ‘brought back from the brink of death’ at 7.48am.

‘So I had the same problem as she had had before,’ said Mr Johnson. ‘And yet again there was Lucy Letby who was her designated nurse. Same nurse, same problem – a problem that doesn’t happen when she isn’t around’.

Baby I was transferred to Arrowe Park on October 15 and quickly stabilised before returning to Letby’s hospital on October 17.

Baby I became unsettled just after midnight on October 23. Letby and the designated nurse went to her, but the infant collapsed and needed cardiac compressions.

Both an on-call registrar and an on-call consultant were called in. The latter noticed a mottled blue appearance in her trunk and peripheries. After five minutes of CPR the infant’s saturation rate picked up to 100 per cent.

An x-ray showed massive dilation of the bowel and this was noted by the medics as ‘large stomach bubble’. Baby I was successfully resuscitated and recovered.

At 1.06am the infant’s designated nurse left the nursery temporarily, but then responded to the alarm. She returned to see Letby at the incubator. 

Realising the infant was very distressed, the nurse wanted to intervene. But Letby assured her that they would be able to settle the baby.

‘Baby I then collapsed,’ said Mr Johnson, before adding: ‘This exchange foreshadows what was to happen when Child O collapsed six or so months later’.

The same on-call registrar arrived at 1.12am and led the attempts at resuscitation. She was joined by the registrar at 1.25am and he noted purple and white mottling.

‘All resuscitative efforts were unsuccessful and treatment was withdrawn at 2.10am,’ Mr Johnson said. ‘Baby I was pronounced dead at 2.30am on October 23.’ 

Immediately after her death the infant’s parents were taken to a private room. The mother was asked if she wanted to bathe her daughter.

‘As [the mother] bathed her recently-deceased child, Lucy Letby came into the room and in the mother’s words ”was smiling and kept going on about how she was present at Baby I’s first bath and how much Baby I had loved it”.’

A post mortem revealed that all the loops in the infant’s bowel were significantly dilated due to increased air content. ‘In layman’s terms they were expanded like a partially-inflated balloon,’ Mr Johnson said. 

Dr Dewi Evans, the expert paediatrician later called in by Cheshire Police, said he thought the apnoea monitor must have been tampered with or switched off.

He also believed an IV bolus of air had been injected into her bloodstream around midnight on October 22-23. ‘In support of that, he points to Baby I screaming – followed quickly by her collapse,’ Mr Johnson said. 

The court heard that Letby had sent a sympathy card to the parents.

‘She said that to send a card was not normal – indeed this was the only time she had done it; but that it was not often the nurses got to know a family as well as they had known Baby I’s,’ Mr Johnson said. 

‘She accepted that she had kept an image of the card on her phone. She denied giving Baby I air via the NGT.

She challenged her colleague’s account of Baby I’s collapse in the darkened room, claiming that because she was more experienced she might have ‘spotted something that she wasn’t able to spot’.

Mr Johnson told the jury: ‘Baby I was born very early and very small. But she survived the first two months of her life and was doing well by the time Lucy Letby got her hands on her.

‘What happened to Baby I followed the pattern of what had happened to others before and what was yet to happen to others., All of a sudden, out of nowhere, came vomiting, breathing problems and critical desaturations’.

In the first incident there had been a vomit followed by lots of air and some milk; in the second Letby had been seen ‘coolly watching Baby I who was in crisis’; in the third the infant pumped with air; and in the fourth the designated nurse returning in response to the alarm and finding Letby standing over her.

‘It was persistent, calculated and cold-blooded,’ said Mr Johnson. 

Child J was born prematurely at 32 weeks and two days gestation, on October 31, 2015, at the Countess of Chester Hospital.

She had an operation for a bowel disorder at Alder Hey Children’s Hospital in Liverpool before returning to the neonatal unit at Chester on November 10, 2015.

Days later, her medical notes showed she was doing well and was healthy, the jury at Chester Crown Court heard.

But she suffered an unexplained collapse overnight on November 26/27 when  Letby was one of the six nurses working the night shift.

Before her shift started, Letby texted a work colleague complaining that the babies she was to look after, including Child J, only needed help feeding.

Mr Johnson told the jury: ‘It appears, we suggest, that working in nurseries three and four was not sufficiently stimulating for Lucy Letby.’  

The prosecutor  claimed Letby attempted to murder Child L and Child M, twin boys, in similar circumstances to two other twin boys, Child E and Child F.

Eight months earlier the Crown says the defendant murdered Child E by injecting air into his bloodstream and attempted to murder his brother, Child F, by poisoning him with insulin.

On April 9, 2016 Letby was working a day shift when she is said to have given an unauthorised dose of insulin to Child L and while that attack was under way she turned her attentions to Child M by administering air into his circulation.

Mr Johnson said: ‘By this time Lucy Letby was supposed only to be working day shifts because the consultants were concerned about the correlation between her presence and unexpected deaths and life-threatening episodes on the night shifts.’

The Crown say the defendant volunteered to work an extra shift on April 9 after she noted Child L’s low glucose levels shortly after his birth the previous day. 

Mr Johnson said: ‘We say that in effect she saw the opportunity to complete what she had attempted with (Child F).’

He said the defendant went on to agree the insulin could not have been given accidentally but said she was not responsible.

Her only explanation was it must have already been in one of the bags he was receiving but the Crown say that was ‘not a credible possibility’, he added.

Mr Johnson said Child M came ‘close to death’ after his heart rate and breathing dropped dramatically without warning but improved on the night-shift that followed and went on to make a speedy recovery. 

When Letby’s home in Chester was searched two years later, a number of medical notes were found which detailed how many doses of adrenaline were given to Child M during his collapse.

A note of his collapse was also recorded in her diary, the court heard.

Mr Johnson said: ‘She thought she had taken home the notes by accident and simply noted what had happened in her diary.

‘She denied that the notes were a souvenir and she denied deliberately trying to harm (Child M).

‘We suggest these cases (children E, F, L and M) are similar in that one of each pair suffered an insulin overdose whereas it is suggested the other suffered an air embolism.

‘What are the chances of that happening innocently? We suggest coincidences like that simply do not happen innocently.’

Letby is also accused of murdering two male triplets, child O and child P, on successive days in June 2016.

Child O was in good condition and stable up until the afternoon of June 23 when he suffered a ‘remarkable deterioration’, the court heard.

A post-mortem examination found unclotted blood in his body from a liver injury and a coroner certified death on the basis of natural causes and intra-abdominal bleeding.

Mr Johnson told jurors: ‘Of course it would not occur to him (the coroner) that a nurse would have assaulted a child in the neo-natal unit’.

He said an independent pathologist had since reviewed the case and was of the opinion the liver injury was not the result of chest compressions in resuscitation.

Mr Johnson said the most likely cause was an impact-type trauma, adding: ‘In brutal terms, an assault.’

The expert also concluded child O had fatefully received excessive amounts of air into the bloodstream and through a nasogastric tube.

The trial continues tomorrow .