A neo-natal nurse allegedly killed a baby boy by injecting air into his blood stream before trying to kill a baby girl in the same way the following night, a jury heard.
Lucy Letby, 32, of Arran Avenue, Hereford, is standing trial at Manchester Crown Court accused of murdering seven babies and attempting to murder a further 10, some on more than one occasion, at the Countess of Chester Hospital. Letby denies all 22 counts of murder and attempted murder against her.
The jury has heard that according to hospital records Letby was allegedly present when all 22 murders or attempted murders took place. Suspicions were raised after consultants noticed a higher than normal mortality rate and rate of unexpected and serious collapses, and a further review identified that two babies had been poisoned with insulin, leading to a wide-ranging investigation into multiple cases.
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Nicholas Johnson, KC, prosecuting, began outlining each individual case to the jury this afternoon, starting with babies referred to as Child A, who died, and Child B, who survived a sudden collapse. He said: "No one expected them to face grave problems, yet both suffered unusual symptoms within a short time of each other, which in interview Lucy Letby said were similar.
"The prosecution’s expert paediatricians say that the collapses and skin mottling were the result of air being injected into their bloodstream. The first injection caused the death of Child A; the second the dangerous and life-threatening collapse of Child B. We say that there is no plausible alternative to an air injection.
"The fact that it happened in two cases just over 24 hours apart, shows that these were no accidents. Lucy Letby was the only person with Child A at the time he collapsed, and she was in the room when the same thing happened to Child B with the records written at the time showing her having treated Child B just before she collapsed.
"We suggest you will be able to discount the possibility that different people were responsible for what happened to them because air embolus is so rare – the medical and nursing staff are all well aware of its dangers."
The jury heard Child A was born prematurely in Summer 2015, but was in a stable condition and doing well. The court heard Letby began the night shift between 7.30-8pm on the evening of the boy's death and took over his care after a handover from a day-shift nurse.
According to hospital notes, Letby began administering fluids to Child A using an intravenous line at around 8.10pm, at which point the baby was stable and had good blood saturation levels and a normal heart rate. Mr Johnson told the jury that, 10 minutes later, the baby had suddenly stopped breathing and the alarm was raised.
He said: "[The consultants] responded to the emergency and both noted an unusual discolouration on [Child A's] abdominal skin, with flitting patches of pink over blue skin that seemed to appear and disappear, unlike rashes caused by an infection.
"Neither doctor had ever previously seen such skin discolouration, but this proved to be the first of a series of similar presentations on the skin of babies suddenly and catastrophically collapsing at the Countess of Chester neo-natal unit over the succeeding months.
"We allege that it is a hallmark of some of the cases in which Lucy Letby injected air into the circulations of some of these small babies. All resuscitation techniques which would be expected to bring a baby back to life failed. Child A was pronounced dead at 20:58."
A post-mortem exam at Alder Hey Children's Hospital, and later an inquest, returned an inconclusive cause of death, but the case was reviewed by independent medical experts Dr Dewi Evans and Dr Sandie Bohin later in the investigation.
Mr Johnson said: "Dr Dewi Evans reviewed all the medical records. He concluded that Child A was a well infant in a satisfactory condition immediately prior to the fatal collapse. He suggested that the collapse was consistent with a deliberate injection of air or something else into Child A's blood stream a minute or two prior to his collapse.
"His collapse happened when Lucy Letby was next to him."
The jury heard that the second attack, on Child B, took place the following night. The girl, who was also stable and not expected to collapse, became ill shortly after midnight and around 15 minutes after Letby had administered a bag of feed via an intravenous line.
Another nurse on the unit rushed to help after Child B became blue, stopped breathing and went limp. Mr Johnson told the jury: "[The nurse] began resuscitation and noted a rapid colour change in Child B's skin with purple blotches and white patches all over her body. You have heard that before."
Child B, however, rapidly recovered when she was given medical attention and the treating medics were unable to explain either her collapse or sudden recovery. That case was also reviewed by the independent experts.
Mr Johnson said both Dr Evans and Dr Bohin concluded Child B had been "sabotaged" by having air injected into her circulation via an intravenous line. Both concluded that the strange skin discolouration could only be explained by air in the bloodstream.
The jury were also told that Letby had searched for the families of the babies on Facebook. Mr Johnson said: "Lucy Letby’s interest in the families of the children who we say she attacked is another feature of this case which we will see as the evidence emerges in more detail.
"We suggest it is an unusual interest and we will see in due course, that on occasions she searched in quick succession for several of the families whose children’s names appear on this indictment."
Proceedings will resume tomorrow.
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