An expert medical witness has denied “reaching for things” to support allegations faced by nurse Lucy Letby.
Dr Dewi Evans also branded as “insulting” a suggestion by Letby‘s barrister Ben Myers KC that he is not an independent witness.
The consultant paediatrician told jurors at Letby‘s murder trial at Manchester Crown Court he believes one of the defendant’s alleged victims died because of “splinting of the diaphragm”.
Letby, 32, is accused of murdering Child C days after he was born prematurely, weighing 800 grams, at the Countess of Chester Hospital in June 2015.
The Crown says Letby caused his sudden collapse and death on the neonatal unit night-shift of June 13 by injecting a fatal amount of air into his stomach via a nasogastric tube (NGT).
Giving evidence on Tuesday, Dr Evans told prosecutor Nick Johnson KC: “One problem that can cause a baby to suddenly stop breathing is if the abdomen is filled with air.
“A baby can tolerate a certain amount of gas in his abdomen but if you get a significant amount of air in the stomach it will cause splinting of the diaphragm.
“If you get a kind of pressure in your abdomen, that diaphragm cannot move. Then you get splinter. Then you will soon suffocate and collapse pretty quickly.”
He said he took into account the findings of another medical expert, a pathologist, when forming his opinion.
Cross-examining Dr Evans - who was asked to review unexplained collapses at the hospital - Mr Myers said: “If you really thought that splinting the diaphragm was a cause of death you would have stated that before today, wouldn’t you?”
Dr Evans said: “In virtually all of the cases, I have benefited from additional information since then.”
Mr Myers said: “I suggest you have been driven by something that leads you to support the allegation rather than by the facts.”
Dr Evans replied: “The fact is this baby collapsed.”
The witness agreed he did not suggest splinting of the diaphragm as the cause of death in eight reports completed for the investigation, including the most recent - a joint expert report in August this year.
In a 2017 report, Dr Evans wrote of Child C: “One may never know the cause of (his) collapse. He was at great risk of unexpected collapse.”
He also said he could not rule out infection as a possible cause, the court was told.
In another report in 2019, Dr Evans said “infection may be a significant factor in his collapse”.
Dr Evans told Mr Myers: “That was my opinion at the time. As a clinician, if I receive additional information that allows me to change or modify my opinion, that is what we do as clinicians.”
In 2019, Dr Evans also noted his “suspicion” someone inserted air into Child C’s stomach on June 12 to cause “discomfort and distress”.
He told the court the incident was “quite different” to the collapse the next day as there was “insufficient air to destabilise (Child C) from a respiratory point of view”.
Mr Myers said: “What you have done in your evidence today is introduce something new with the purpose of supporting the allegation rather than explaining the facts.”
Dr Evans said: “That is incorrect. I’m trying to explain what led to a baby, who was very small, suddenly collapsing and where resuscitation was unsuccessful.
“I’m not relying on my opinion alone, I’m relying on other people’s opinions as well. That is what doctors do, that is what we do.
“I’m here to assist members of the jury in what is a very complicated case.”
Mr Myers said: “You are reaching for things to support the allegations rather than reflecting the facts.”
Dr Evans said: “I disagree with you.”
Mr Myers said: “You are not independent as a witness, are you?”
Dr Evans replied: “I’m completely independent. I have been giving evidence in court for a long time. I know about impartiality; I know about the rules.
“I’m not here for the prosecution. I’m not here for the defence. I’m here for the court.”
Asked repeatedly what evidence he relied on to show air was forced down an NGT, Dr Evans said there were “three scenarios” - air through the NGT, air travelling intravenously or a combination of both.
He agreed with Mr Myers that he had not previously suggested an intravenous injection in Child C’s case.
Dr Evans said: “If pressed to come up with an alternative explanation, I feel obliged to assist the court to say what are other explanations.”
Mr Myers said: “You just came up with that now to support the allegation. You are not independent at all.”
Dr Evans replied: “Again, that’s just insulting.”
Letby, originally from Hereford, denies murdering seven babies and trying to murder 10 others at the Countess of Chester Hospital between June 2015 and June 2016.
A court order bans the reporting of the identities of the children allegedly attacked by Letby, while identifying parents or witnesses connected with the children is also banned.
The trial continues on Wednesday.
