A UK court has heard testimony from a senior physician who claimed that he witnessed no signs of nurse Lucy Letby providing assistance to a critically ill infant prior to his entry into an intensive care room. Currently, Letby is being tried at Manchester Crown Court, accused of intentionally interfering with the infant girl’s respiratory aid during her night-duty at Countess of Chester Hospital’s neonatal department.
The infant, referred to as ‘Child K’, had been delivered considerably ahead of term at 2.12am on 17th February 2016, with a weight of just 1lb 8oz (approximately 692g). Less than two hours later, she was found in deteriorating conditions.
The prosecution alleges that the moment Dr Ravi Jayaram, a consultant paediatrician, entered the intensive care unit, Letby was found next to Child K’s incubator, appearing to be inactive. The twelve-person jury has heard how Letby was previously found guilty at a different trial for the murder and attempted murder of thirteen infants in total at the same hospital, between June 2015 and June 2016.
In his testimony on Thursday, Dr. Jayaram explained that he was seated at the nurse’s station close to the intensive care room on the day Child K’s nurse designated to her informed him she planned to leave to attend to the labour suite to consult with the Child K’s parents and Letby was slated to take over her duties. Dr. Jayaram shared that a series of abnormal incidents involving infants had been noted in connection with Lucy Letby.
Recalling the incident, he said: “As I got up and walked over, I noticed that [Child K’s] oxygen levels were plummeting, dropping into the low 80s. Lucy Letby was standing beside the incubator, facing my direction but not looking at me or touching the incubator. When I inquired about the situation, Lucy looked up and replied, ‘it seems she is desaturating’.”
According to the doctor, alarm systems were intended to activate when blood oxygen levels descended underneath 90 per cent. However, he mentioned not noticing any sound. He further added he hadn’t checked if the button, that could suspend the alarm, had indeed been triggered while continuously decreasing saturations were observed.
In absence of an alarm, which was supposed to function as a cue for him to intervene and was usually quite prominent, he explained he didn’t have any indication something was amiss.
When the prosecutor, Mr. Nick Johnson KC, enquired if the doctor had actually observed ‘Child K’ himself, he responded positively. The doctor maintained significance should be credited not to the figures displayed on the monitor but to the physical condition of the patient. He noted a discrepancy where previously rhythmic chest movements were now reduced.
He said he utilized a stethoscope, and the previously detectable breath intake and exhalation was now notably inadequate, indicating an alteration in the pattern of her respirations.
Upon quick examination, the doctor couldn’t find any fault with ‘Child K’s’ ventilator, obstructions in her tube, or any issues with her lungs. Furthermore, the doctor detached ‘Child K’ from her ventilator and tried to supply air via a mask and a bag but noticed no improvement in her condition.
In response to the question by Mr. Johnson about the time taken for this examination, Dr. Jayaram responded that it was almost instinctual and equated it to promptly halting a car in an emergency.
When questioned about any evidence of Lucy Letby intervening before his arrival, the doctor responded that he hadn’t witnessed any. He also mentioned missing any distress signal from Lucy Letby, which surprised him, given she hadn’t called for assistance particularly when ‘Child K’ was a premature neonate at 25 weeks, experiencing a drop in her saturations. However, at the time, his focus was primarily ‘Child K’ and he didn’t think twice about these circumstances.
In his court testimony, he stated that he opted to withdraw the tube from Child K’s mouth and administer ventilation again via a mask. “Her recovery was strikingly rapid. There was a noticeable change in her complexion, her saturation levels improved, and I saw that her chest was functioning normally. This was reassuring,” he noted.
He speculated that the ventilation issues could have persisted anywhere from half a minute to two minutes prior to his arrival in the room, but he stressed, “There’s no absolute science to this. There isn’t a consistent rate of decline.”
When queried by Mr Johnson about the possibility of a child in her circumstances self-moving her tube, Dr Jayaram responded, “That could happen, but I’ve never observed it in a baby of such premature age. The tubes are kept in place very solidly. To displace a tube would require considerable effort from the baby.”
At the time, Dr Jayaram had noted that Child K’s blood oxygen concentrations had fallen below 40 per cent prior to her recovery. Asked if such a level was life-threatening, he said, “If it’s not resolved in a timely manner…a rapid downward spiral ensues.”
Following that, due to her extreme prematurity, Child K’s scheduled relocation to a specialised intensive care unit at the Arrowe Park Hospital in Wirral took place on the 17th of February. Although she unfortunately passed away three days afterward, there are no claims from the prosecution that her death was caused by Letby.
Letby, from Hereford, dismisses the single allegation of attempted murder brought against her. Due to a court order, the identities of the deceased and surviving children involved in the case are not permitted to be disclosed.