Doctor reveals ‘strange’ incident days before Lucy Letby’s first victim
A “very unusual” incident involving a baby occurred at the Countess of Chester Hospital in the fortnight before the Lucy Letby attacks began, it has emerged.
The Thirlwall Inquiry heard evidence from a paediatric registrar who was working at the hospital when there was an unusual spike in deaths in 2015.
Dr Rachel Lambie said that by the time the first unexpected death of Child A occurred in early June 2015, she was “anxious” because of a strange event that happened 10 to 14 days earlier.
Dr Lambie said she had provided a statement to the police about the incident.
“It was very, very unusual, something I’ve never experienced before or since,” she told the hearing.
“So I was already quite anxious going into Child A and Child B because I’d had a particularly unusual event.”
Child A was the first death in the timeline of the Letby murders and the trial did not hear about an earlier collapse or death.
However, Dr Dewi Evans, a key prosecution medical witness, told The Telegraph this weekend that he had passed on a further 25 cases to the police that looked suspicious.
Child A collapsed and died on June 8 2015 and his sister, Child B, also collapsed two days later. Both had unexpected rashes and Dr Lambie said she was worried that there may be a connection.
In a statement to the inquiry, Dr Lambie said: “I was concerned that they [the babies] were geographically close to each other and wondered if there could be a link such as an infection that both children carried, an environmental [link] or some form of product contamination.”
Giving evidence about Child B, she added: “She was covered in a very unusual rash, a rash sometimes we see with meningococcal septicaemia. It was a very blotchy rash but that diagnosis didn’t fit in this situation.
“The rash didn’t look the same. The rash was moving. She also responded remarkably quickly which is not the case for children and sepsis.”
The Thirlwall Inquiry has heard that the Countess of Chester investigated whether a lethal bacterial infection was behind the surge in deaths and collapses.
Dr Lambie said she had “personally raised” the issue of an environmental toxin and that pseudomonas was “being considered”.
Risk reports previously leaked to The Telegraph showed that the bacterium Pseudomonas aeruginosa had colonised taps in the nurseries of the neonatal unit, including intensive care, during 2015 and 2016.
‘Air of anticipation’
Dr Lambie told the inquiry that by September 2015 – three months after the death of Child A – staff were “starting to think the unthinkable” that someone was deliberately causing harm to the infants. She said she had started to feel nervous.
She said: “I was almost expecting something bad to happen.”
“I remember on more than one occasion almost the heartsick feeling of ‘oh gosh’ what is going to happen today?
“The unit felt, I don’t know if busier is the right way to describe it, but it felt different. There was almost an air of anticipation of what’s going to happen.”
Dr Matthew Neame, who worked as a paediatric registrar at the Countess of Chester between September 2015 and March 2016, told the inquiry that there were more unwell babies in the neonatal unit during his placement compared to when he had previously worked at the hospital in 2012 and 2013.
Asked about whether he was concerned about the general standard of care at the unit, he said: “There were times when I felt we were managing babies who were more unwell than I might have expected to, or when we managed babies who had deteriorations, they were not necessarily transferred off the units the way I might have expected them to be.
“I don’t think the processes or culture had necessarily changed but I think there were a greater number of unwell babies during my second placement.”
Dr Neame told the inquiry that before he joined the Countess of Chester in September 2015 he had heard that the neonatal team was “having a bad time” with deaths and unexpected collapses.
“My assumption was that it was bad luck and a bad run,” he said. “I had no recollection of the discussion of a cause.”
Dr Neame was on call for the two collapses of Baby H, a girl who was born prematurely at the hospital on Sept 22 2015, and the unexpected collapse of Child I in October 2015.
Asked by Clare Brown KC, the counsel for the inquiry, whether he had concerns that Letby was present during the collapses, Dr Neame said: “No.”
Following the death of Child P, a triplet boy, in June 2016, a trainee doctor at the time told a nurse: “Nurse Death’s on again.”
Dr Cassandra Barrett told the inquiry: “I did say that. At the time I didn’t have any awareness of the suspicions among the consultant body with regards to Lucy Letby actively causing harm.
“Never did I think the unthinkable, as we mentioned earlier in the day, that somebody would be going to work to actively harm babies.”
Miss Langdale asked: “What association had you made about her though to say ‘Nurse Death’s on again’? ”
Dr Barrett replied: “I had noticed that she was there at a couple of the unexplained child collapse and deaths but I thought that was more about bad luck rather than her being the causative agent.”
Dr Huw Mayberry, who worked alongside Letby in 2016 as a registrar, told the inquiry he did not believe CCTV cameras would have stopped Letby harming infants.
He said: “I’m not sure it would have dealt with a lot of the ways in which she killed and it may have given false reassurance that things were right.”
It would be “hard to tell” from CCTV that someone was injecting air into babies’ bloodstreams, he said.
Dr Mayberry said: “One of the common syringes used to give children’s medications is a 1ml syringe, which is soft and made out of glass. At the point where that is filled with fluids it can sometimes be really hard to tell looking directly at it to see if there is fluid in it or is it filled with air.
“I’m not sure if you would be able to tell from a digital image further away.”
02:37 PM BST
That’s all for today
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02:33 PM BST
Letby hospital suffering from staffing issues
Dr Mayberry described the Countess as a “busy hospital” that was suffering from staffing issues.
He said: “You had to do the equivalent of eight registrars with three and a half”.
He told the inquiry that the Countess had a good reputation for being “supportive” towards junior staff.
Dr Mayberry that at his induction the importance of “handover notes” was emphasised a number of times.
He said that the obsession with handover sheets struck him as “very unusual”.
During Letby’s trial, jurors were told she had taken home a number of handover sheets relating to patients she had murdered.
He said doctors would be fined if they took handover notes home owing to “patient confidentiality”.
02:23 PM BST
Doctor informed external investigations were underway
Dr Mayberry said that Dr Breary later informed him that external investigations were underway.
He said: “At this point this was my first year of being a registrar and my first job in a neonatal unit as a registrar. I think I was largely focused on making sure my own practice was as good as it could be.”
Dr Mayberry added: “I understood that there were processes taking place in the background looking into what had happened and why it had happened.”
He was asked if he was aware of the case of Beverley Allitt prior to starting as a registrar.
He replied: “I knew historically from the news about some of her cases but it didn’t come through training or anything like that, it was more general news…
“It’s not something you would think about on a day to day basis and there were a number of other things which were more likely to affect children and put their lives at risk.”
02:15 PM BST
Growing sense of unease when doctor joined hospital
Dr Huw Mayberry, who worked at the Countess of Chester from March 2016 to September 2016, is now giving evidence.
He told the inquiry that he wasn’t aware of a “growing sense of unease at the time” he joined the hospital.
He said: “I think on arrival it wasn’t something I was particularly aware of.
“Dr Breary did tell me that historically the Countess had a low mortality rate that had increased in the period before I had arrived, and that they had started asking for other people to be involved with that.”
12:46 PM BST
Inquiry breaks for lunch
The inquiry has now broken for lunch and will return at 2pm to hear from Dr Huw Mayberry who will give evidence by videolink.
12:32 PM BST
Registrar called to resuscitate Child I twice
Dr Neame is now giving evidence about the unexpected collapse of Child I in October 2015.
The registrar was called to help resuscitate the little girl on two occasions.
Dr Neame said he did not think it was unusual or clinically implausible that the baby kept collapsing.
“I think there are cases where babies are unstable due to underlying clinical conditions and that might precipitate further events,” he told the inquiry. “That was certainly my interpretation of what was happening by that stage.
“Using adrenaline in the resuscitation in a district general hospital was unusual but managing very unwell children and seeing complications of further instability and further periods of instability felt plausible clinically.”
Asked by Clare Brown KC, counsel for the inquiry, whether he had concerns that Lucy Letby was present during the collapses, Dr Neame said: “No.”
12:24 PM BST
Doctor heard neonatal team at Countess of Chester ‘having a bad time’
Dr Neame told the inquiry that before he joined the Countess of Chester in September 2015 he had heard that the neonatal team was “having a bad time” with deaths and unexpected collapses.
He said: “My assumption was that it was bad luck and a bad run. I had no recollection of the discussion of a cause.”
Dr Neame was on call for the two collapses of Baby H, a girl who was born prematurely at the hospital on Sep 22 2015.
The doctor said that although the collapses were unexpected and required an unusual administration of adrenaline, he did not see the events being linked to the earlier spike in incidents.
He said that x-rays, blood tests and ultrasounds were taken to try and find the cause.
“I did not have any concerns that Child H’s collapse had a suspicious cause,” Dr Neame said in a statement. “I was not aware of any colleagues who may have had suspicions about the cause of Child H’s collapse.”
Letby was charged with two attempted murders of the baby but was found not guilty of one count at trial, and the jury was unable to reach a verdict on the second count.
11:54 AM BST
Higher number of unwell babies during doctor’s second hospital placement
The inquiry is now hearing from Dr Matthew Neame, who worked as a paediatric registrar at the Countess of Chester between September 2015 and March 2016.
Dr Neame said there were more unwell babies in the neonatal unit during his placement, compared to when he had previously worked at the hospital in 2012 and 2013.
Asked about whether he was concerned about the general standard of care at the unit, he said: “There were times when I felt we were managing babies who were more unwell than I might have expected, or when we managed babies who had deteriorations, they were not necessarily transferred off the units the way I might have expected them to be.
“I don’t think the processes or culture had necessarily changed but I think there were a greater number of unwell babies during my second placement.”
11:12 AM BST
Inquiry breaks
The Thirwall Inquiry is taking a break and will return at 11.30am when it will hear from Dr Matthew Neame.
11:12 AM BST
Lethal bacterial infection investigated as cause of deaths and collapses
The Thirlwall Inquiry has heard that the Countess of Chester investigated whether a lethal bacterial infection was behind the surge in deaths and collapses.
Dr Lambie said that she had “personally raised” the issue of an environmental toxin and that pseudomonas was “being considered”.
Risk reports previously leaked to the Telegraph showed that the bacterium Pseudomonas aeruginosa had colonised taps in the nurseries of the neonatal unit, including intensive care during 2015 and 2016.
Pseudomonas is known to be lethal to vulnerable babies. In 2012, a premature baby died and 12 others needed treatment at Southmead Hospital in Bristol after an outbreak of a water-borne bacterium.
Three premature babies also died after contracting the bug at the Royal Jubilee Maternity Hospital in Belfast January 2012. In that case, sink taps were found to be the source of infection. A baby had died from the same infection six weeks earlier in Derry.
10:55 AM BST
Dr Lambie started feeling nervous while working at hospital
Dr Lambie said she started to “feel nervous” when she was working at the Countess of Chester.
She said: “I was almost expecting something bad to happen. I remember on more than one occasion almost the heartsick feeling of ‘oh gosh’ what is going to happen today?
“The unit felt, I don’t know if busier is the right way to describe it, but it felt different. There was almost an air of anticipation of what’s going to happen.”
Dr Lambie added: “It felt like a hypothetical possibility that yes at some point it might be needed to get the police involved if we can’t find that there’s a virus or there’s some contamination.
“It was not suggested to me that it could be a single person and the name Lucy Letby was never mentioned to me.”
10:45 AM BST
Nurses caught checking shift patterns on death and collapse dates
Nurses at the Countess of Chester were caught huddled around a computer checking shift patterns to see if anyone was present at each unexplained death and collapse.
Dr Lambie told the inquiry that by September 2015 - three months after the death of Child A - nurses were “starting to think the unthinkable”.
The registrar said that in the autumn there were discussions in the hospital about there being “something going on that we can’t explain”.
Speaking of one incident in the neonatal intensive care unit, Dr Lambie said: “There was a huddle of nurses in the corner by the computer and I asked what they were doing and one of the nurses replied that they were going through the rota just to make sure that there wasn’t somebody that was on for each one.
“They were starting to think the unthinkable. That there might be a person who’s deliberately causing harm. It was starting to become part of their thought processes.”
10:40 AM BST
Strange event involving another baby ahead of Child A death, says Dr Lambie
Dr Lambie said there was another strange event involving a baby around 10 to 14 days before the death of Child A in June 2015.
Child A was the first death in the timeline of Letby murders and the trial did not hear about an earlier collapse or death.
Dr Lambie said that she had provided a statement to the police about the incident.
“It was very, very unusual, something I’ve never experienced before or since,” she told the hearing.
“So I was already quite anxious going into Child A and Child B because I’d had a particularly unusual event.”
10:35 AM BST
Similar rashes on Child A and Child B, says registrar
Dr Lambie described the “fast moving” rash that was present on Child B when the baby collapsed in June 2015.
Lucy Letby was convicted of attempted murder by injecting air into the baby girl.
Her brother Child A had died two days earlier in similar circumstances with an unusual rash.
In her statement Dr Lambie said: “I was concerned that they [the babies] were geographically close to each other and wondered if there could be a link such as an infection that both children carried, an environmental or some form of product contamination.”
Giving evidence about Child B, she added: “She was covered in a very unusual rash.
“A rash sometimes we see with meningococcal septicaemia. It was a very blotchy rash but that diagnosis didn’t fit in this situation.
“The rash didn’t look the same. The rash was moving. She also responded remarkably quickly which is not the case for children and sepsis.”
10:31 AM BST
Hostility between the midwives and medical staff at Letby hospital
Dr Rachel Lambie, who was a paediatric registrar at the Countess of Chester in 2015 and 2016, said that there was “hostility” between the midwives and medical staff.
The register said that there was a feeling among clinical staff that “you weren’t really welcome”.
She said there was a “difficult relationship” particularly if the midwifery team were asking for medical support if a birth had gone wrong.
She said: “In my experience it was not uncommon to have an air of difficulty between the two teams. It was almost seen as a failure that something had gone wrong for us to be called.
“I wouldn’t say Chester was different. I don’t feel this impacted the quality of care delivered to the babies in the neonatal unit.”
10:28 AM BST
Evidence from Countess of Chester registrars
The Thirlwall Inquiry is today taking evidence from registrars who worked at the Countess of Chester in 2015 and 2016.
It will hear from Dr Rachel Lambie, Dr Matthew Neame, Dr Huw Mayberry via videolink, and Dr Cassandra Barrett who are all paediatric registrars.