Lucy Letby is GUILTY of murdering seven babies and attempting to murder six babies. No verdicts were returned with four further babies and may face a possible retrial.
This wiki is about the trial of Nurse Lucy Letby who was charged with the murder and attempted murder of 17 babies at the Countess of Chester Hospital, between June 2015 and June 2016. There are 22 charges in total, 7 murder and 15 attempted murder. Lucy pleaded not guilty to all charges and the trial started in October 2022.
In August 2023, Lucy was found guilty of murdering 7 babies, attempting to murder 6 babies and four other babies were left with no verdict and may face a possible retrial.
The wiki contains only information taken from the live reporting from court and other sources of factual information.
Verdict Summary:
Guilty of murder x 7
Child A (majority 10:1)
Child C (majority 10:1)
Child D (majority 10:1)
Child E (majority 10:1)
Child I (majority 10:1)
Child O (unanimous)
Child P (majority 10:1)
Guilty of attempted murder x 6
Child B (majority 10:1)
Child F (unanimous)
Child G (majority 10:1) x 2 charges (plus one charge not guilty)
Child L (unanimous)
Child M (majority 10:1)
Child N (majority 10:1) (plus two charges no verdict)
No Verdict x 4
Child H (plus one charge not guilty)
Child J
Child K
Child Q
Not guilty of attempted murder
Child G (1 charge)
Child H (1 charge)
Wiki Navigation
Due to the volume of information coming out of court we have multiple pages to the wiki.
Chester Standard gave the most detailed live reporting links however at times during the trial there was no live reporting so some links will be to daily round up article.
Wednesday 15th February - Child L & M (twins) - sequence of events from records - mother - father - midwife - Dr Sudeshna Bhowmik - Amy Davies - Dr Anthony Ukoh
Friday 3rd February - Child I - Dr Rachel Chang - Nurse Christopher Booth - Nurse Melanie Taylor - Nurse Valerie Thomas
Thursday 2nd February - Child I - Nurse Shelley Tomlins - Nurse Joanne Williams - Dr David Harkness - Doctor unnamed - Sequence of events - Sympathy Card - Nurse Ashleigh Hudson
Wednesday 18th January - child G - Dr Dewi Evans - Dr Sandie Bohin - Police interview summary - Child H - parent statements - sequence of events from records
Court Adjourned from Friday 16th December to Wednesday 18th January 2023.
Articles: Chester Standard - Lucy Letby was ‘stunned’ at death of first alleged victim Chester Standard - Lucy Letby found death of twin boy in her care ‘very traumatic’
Thursday 18th May 2023
First full day of cross examination by the prosecution. General questions regarding various matters such as handover sheets, shredder, sympathy card, notes and insulin, followed by specific questions relating to babies A, B and C.
Articles: BBC News - Nurse accuses doctors of conspiracy against her
Chester Standard - Lucy Letby denies photographing sympathy card ‘to get thrill’
Daily Mail - 'Baby killer' nurse Lucy Letby tells murder trial that 'gang of four' consultants 'conspired to get her' over deaths of newborn infants on neonatal unit so they could 'cover up failings at the hospital'
Friday 19th May 2023
Second full day of cross examination by the prosecution. Court adjourned early for 12.30pm lunch break and did not resume in the afternoon.
Articles: BBC News - Nurse denies enjoying aftermath of baby's death
Daily Mail - Lucy Letby's friend told her 'You're having such a tough time' when baby died on her unit, murder trial hears - but nurse told police she couldn't remember details of tot's fatal collapse
Wednesday 24th May 2023
Third full day of cross examination by the prosecution. Babies E, G, H
Articles: The Guardian - Lucy Letby says raw sewage may have contributed to babies’ unexplained deaths Daily Mail - Nurse Lucy Letby tells murder trial that 'raw sewage coming out of the sinks' in hospital neonatal unit may have been a contributory factor in deaths of babies she was caring for BBC News - Nurse says 'dirty' ward was factor in baby deaths
Thursday 25th May 2023
Fourth full day of cross examination by the prosecution. Babies H and I. Court adjourned early, at the afternoon break.
Articles: Mail+ - Letby 'attacked nine babies while parents were away from bedsides' LBC - Nurse Lucy Letby 'murdered baby while mother was on school run' and ‘attacked children after parents left cotsides'
Monday 5th June 2023
Babies K and L. This was only a short day as juror sent home unwell.
Friday 9th June 2023
Prosecution questioning Lucy on the events that followed after baby Q. Includes questioning her on Facebook, notes, relationship with Dr A, lies about police arrests and social life. Ben Myers for the defence reexamines Lucy with further questions. Lucy’s time giving evidence is complete.
Hospital Background[/B]
Prosecuting, Nicholas Johnson KC said everyone should be aware of the city of Chester, and its busy general hospital. Said hospital includes a neonatal unit, caring for premature and sick babies. "It is a hospital like so many others in the UK," he added. "But unlike so many others, within the neonatal unit, a poisoner was at work."
The statistics of the mortality rate were comparable, prior to January 2015, but there was "a significant rise" in the number of babies dying or having "catastrophic collapses". This rise was "noticed" and the concern was the babies had died "unexpectedly", and when babies collapsed, they did not respond to sufficient resuscitation. The collapses "defied" the expectations of the treating doctors.
Usually, when an intervention is taken, a positive response can be expected, he told the jury. Babies "who had not been unstable at all" or "on the mend", "suddenly deteriorated", "for no reason at all".
Consultants noted there was "one common denominator" - the presence of neonatal nurse Lucy Letby.
There were between 25-30 nurses and 15-20 nursery unit nurses in that part of the hospital, working day/night shifts. More would work on the day than the night shifts, typically.
Parents tended to visit their sick children during the day, Mr Johnson added.
Incidents & Investigation
Many of the events occurred "during the night shifts".
When Letby was moved to the day shifts, the rate of collapses "shifted to the day shift pattern".
Police were then called in, and commissioned a "painstaking review" by "experienced doctors with no connection to the Countess of Chester Hospital".
The review concluded that two children were "poisoned" with insulin.
The prosecution say the "only reasonable conclusion" is the babies were poisoned "deliberately - these were no accidents".
The prosecution say other collapses could be due to "sabotaging".
The prosecution adds these deaths and non-fatal collapses were deliberate, and Letby was the "constant malevolent presence" when things took a turn for the worse in these 17 children, Mr Johnson added.
Mr Johnson said there were "a very restrictive number of people" who could have entered the neonatal unit, due to the security arrangements in place at the hospital.
We will hear further details on the two babies the prosecution say were deliberately poisoned by Lucy Letby.
The babies, each a twin belonging to a separate family, were "poisoned with insulin", the prosecution said.
Mr Johnson said: "Both boys’ blood sugar inexplicably dropped to dangerous levels – the sort of levels that can result in all sorts of medical problems and ultimately in death if not rapidly rectified. Both boys survived because of the skill of the medical staff."
The cause of 'poisoning' "simply did not occur to medical staff working at the Countess that someone in the neonatal unit "would have injected them with insulin", the court heard.
Both babies 'targeted' with insulin had brothers. The prosecution say they too were "attacked" by Letby. One of the brothers "was killed".
Mr Johnson: The method by which these two babies were "attacked" was "by having air injected into the bloodstream – what the doctors call an air embolus."
Mr Johnson: For other babies, some were "harmed and killed" by the 'injection of air' into the bloodstream or via a tube into the stomach."
"Sometimes they were injected with 'too much' milk or some other fluid, or air, that can have catastrophic effects on the baby... sometimes insulin."
"But the constant presence at all these events was Lucy Letby."
There are "many events" that will mirror the counts in the indictment, that the jury will hear, the prosecution tells the court.
A chart is displayed to the jury about the presence of staff on duty at the time the babies were "attacked", with Letby present for all 24 incidents listed between 2015 and 2016.
The majority of incidents are at night-time. No other member of registered nurse and/or nursery nurse staff is present for more than a total of seven incidents.
“It is a process of elimination," Mr Johnson tells the court.
The case "concerns seven allegations of murder of seven babies and the attempted murder of 10 other babies."
Mr Johnson tells the court: "Sometimes Lucy Letby tried to kill the same baby more than once – and sometimes a baby that she succeeded in managing to kill was not killed the first or second time, and in one case, even the third time."
All the children involved in the case were in the neonatal unit and, Mr Johnson said, Letby "was either responsible for their care or got involved with them."
the opening statement then goes on to discuss each baby in more detail - see Wiki Navigation for the baby A-Q sections
Mr Johnson: "Following those events, the consultants suspected that the deaths and life-threatening collapses of these 17 children were not medically explicable and were the result of the actions of Lucy Letby.
"No doubt they were acutely aware that making such an allegation against a nurse was as serious as it gets.
"They, at the time, did not have the benefit of the evidence that you will hear and the decision was taken by the hospital took the decision to remove Lucy Letby from a hands-on role. She was moved to clerical duties where she would not come into contact with children.
"The police were contacted and began a very lengthy and complex enquiry.
"This involved the police contacting independent paediatricians and other specialists to review many cases which had passed through the NNU at the CoCH. Following that review, the decision was taken to arrest Lucy Letby – the first arrest came in July 2018.
House search
"On July 3 she was arrested at her home, where the house was searched.
"In addition to some of the paperwork, they found sme other interesting items.
"There were some Post-it notes with closely written words on them, some of which included the names of some of her colleagues.
"On some of the notes were phrases such as “Why/how has this happened – what process has led to this current situation. What allegations have been made and by who? Do they have written evidence to support their comments?"
"In her writings, she expressed frustration at the fact that she was not being allowed back on the neonatal unit and wrote 'I haven’t done anything wrong and they have no evidence so why have I had to hide away?'
"Her notes also expressed concern for the long-term effects of what she feared was being alleged against her and there are also many protestations of innocence."
"On another piece of paper, she wrote: 'I don’t deserve to live. I killed them on purpose because I’m not good enough”.
“'I am a horrible evil person' and in capital letters, 'I AM EVIL I DID THIS'.
"That, in a nutshell," Mr Johnson tells the court, "is your case."
Gallery - Photo and Video Evidence
The below images and videos shown in court were all released by Cheshire Police/Crown Prosecution Service to the general media.
A video and picture of the drip given to Baby M was also shown to jurors to help them try to understand how, the prosecution say, Lucy Letby injected air into his bloodstream, causing his collapse.
Witness Evidence - Eirian Powell - neonatal unit ward manager
Eirian Powell, who was the neonatal unit ward manager at the Countess of Chester Hospital between 2011-2017, is being recalled to give evidence.
Mr Myers has a few questions to ask Ms Powell.
Ms Powell first met Lucy Letby when the latter was a University of Chester student on a four-week placement.
She agrees Letby was "very keen to improve her practice" and saw her to the point when she was working on the neonatal unit.
Mr Myers: "She was an exceptionally good nurse?"
Ms Powell: "Yes, she was."
Ms Powell confirms Letby was "committed" in progressing with her training, including training in intensive treatment units.
She said Letby was 'hard-working and flexible' - "extraordinarily so", and worked a lot with premature babies in the neonatal unit.
"She was very particular with attention to detail".
Mr Myers asks about the 2016 reallocation to day shifts, following a number of deaths on the neonatal unit.
Ms Powell said the move to the day shift was to give Letby "more support" in staffing numbers, and was not "a punishment".
Mr Myers said the unit remained busy during those days.
Mr Myers asks about the redeployment of Lucy Letby away from the neonatal unit in July 15, 2016, which was announced in an email signed by Ms Powell, as part of a period of clinical supervision.
The email said 'This is not meant to be a blame or a competency issue', and was in preparation for an external review.
Ms Powell confirms Lucy Letby was "upset" at being removed from the unit.
Ms Powell recalls the review meeting was "very upsetting" for Lucy Letby and herself. She does not recall if Lucy Letby was told not to talk to several other members of staff.
"She was distraught at that point". Ms Powell said Letby was upset at what was said in the meeting, about what was suggested Letby may have done.
Ms Powell said everyone's competency was being reviewed at that time, but "not to the extent" of Letby's.
She adds she was "keen" to get Letby back on the unit.
Nicholas Johnson KC, for the prosecution, rises to ask a couple of questions.
He asks if Letby made mistakes.
Ms Powell said Letby made mistakes, as everyone did, but was "good at reporting mistakes", and would report mistakes that other nurse practitioners or medical staff had made, regardless of seniority.
Mr Johnson asks what was said in the review meeting.
Ms Powell said that Letby would have to come off the unit, but could not recall what else was said.
Mr Johnson asks what was being suggested in that meeting.
"That she was the common [element] in all of the deaths".
Timeline of hospital investigation and Lucy’s response
June 2015: [/B]Dr Brearey conducted informal review of Child D’s death (taken from Chester Standard 14/03/23)
An “association” with Letby and her presence at a number of collapses up to that point were noted, the court heard.
Dr Brearey told the court a meeting followed with director of nursing Alison Kelly in late June or early July 2015.
He said: “I think my comment at the time during the meeting was ‘it can’t be Lucy, not nice Lucy’. February 2016: Review of collapses by a neonatologist from Liverpool Women’s hospital (taken from Chester Standard 14/03/23)
A further review of collapses at the unit from a neonatologist based at Liverpool Women’s Hospital took place in February 2016, the court was told.
Dr Brearey said he sent a report of those findings to the director of nursing and the hospital’s medical director as he asked for another meeting.
23rd June 2016: Baby O died 24th June 2016: Baby P died
“So, following the staff debrief, I phoned the duty executive on call, Karen Rees, senior nurse in the urgent care division.
“She was familiar with our concerns already. I explained what had happened and and I didn’t want nurse Letby to come back to work the following day or until this was all investigated properly.
“Karen Rees said ‘no’ to that and that there was no evidence.
“I put it to her was she happy to take responsibility for this decision in view of the fact that myself and my consultant colleagues all wouldn’t be happy with nurse Letby going to work the following day.
“She responded she was happy to take that responsibility.
“We had further conversations with executives the following week and action was taken.”
Letby messaged a doctor colleague at 5.41pm: "Eirian [Lloyd Powell, neonatal unit manager] has just phoned telling me not to come in tonight & do days instead. I asked if there was a problem & she said No, just trying to protect me a bit & we can have a chat about it tomorrow but now I'm worried."
Letby also messaged a nursing colleague at the same time: "E just phoned telling me to do days this week and not Go in tonight as trying to protect me."
Neither of the colleagues can be named.
After the nursing colleague asked: "What's that mean?", Letby replied: "I don't know. Asked if there was a problem and she said No just trying to protect me as had a difficult run just before holidays, less people on nights etc and we can have a chat etc tomorrow.
"But I'm worried I'm in trouble or something."
The nurse colleague replied: "Don't worry, how can you be in trouble you haven't done anything wrong.
"Just very unfortunate."
Letby: "I know but worrying in case they think i missed something or whatever. Why leave it til now to ring."
The nurse colleague replied: "It is very late I agree. Maybe she's getting pressure from elsewhere?"
Letby: "She said it's busy so more support for me on days and can look at the paperwork bits etc. She was nice enough I just worry. This job messes with your head"
Letby later messaged the doctor: "I can't do this job if it's going to be like this. My head is a mess. Why is she ringing at this time. There must be a problem."
The doctor replied: "Lucy - you did nothing wrong at all. It is an odd time to ring, but you've had a rough few days and a good manager would realise that."
After the doctor messaged with further reassurance, Letby responded: "I can't talk about this now. Sorry, I just need a bit of time.
"Sorry, that was rude. Felt completely overwhelmed & panicked for a minute. We all worked tirelessly & did everything possible, i don't see how anyone can question that. E has always been very supportive.
"I'm having a meltdown++ but think that's what I need to do."
28th-30th June 2016: Letby worked long day shifts from June 28-30 at the neonatal unit – her last days there. (Taken from Chester Standard 06/04/2023)
29th June 2016: A Datix form is filed in which Child O 'suddenly and unexpectedly collapsed' [not clear by who]
Dr Jayaram said: “After a number of further unusual, unexplained and inexplicable events on the neo-natal unit the whole consultant body sat down and said ‘we really need to work out what is going on here’.
He said that “one thing that came up in our discussion” was air embolism – when gas bubbles enter a vein or artery and can block blood supply.
Dr Jayaram said it prompted him that evening to conduct a literature search in which he found a research paper which described the effects of air embolism.
He said: “I remember sitting on my sofa at home with the iPad and reading that description, and the physical chill that went down my spine because it fitted with what we were seeing.”
Dr Jayaram emailed colleagues a link to the research paper the next day.
30th June 2016:
Letby files a Datix form on June 30, in which it was recorded that equipment required for a procedure during resuscitation was not available on the unit.
The (unnamed) doctor messaged Letby: "You need to keep this to yourself. The meeting this afternoon looked at everything with Baby O & Baby P from birth onwards. [NB. Name of Baby O and P redacted]
"We reviewed everything. Room / meds / medical reviews and actions. We looked at all documentation med & nur. If you've any doubt about how good you are at your job - stop now.
"The documentation was perfect, everybody commented about the appropriateness of your request for a review of Baby O following vomit. (name of baby O redacted). Your documentation of the resus / incubation / drugs was faultless.
"There is absolutely nothing for you to worry about. Please don't.
"There are going to be some recommendations based on staffing / kit but there was no criticism of either resus.
"This is staying quiet until has been to exec's. We're looking at [third triplet] care on Thur.
"E had nothing but good things to say about you."
Letby replied: "Ok......I Really appreciate you telling me - it won't go any further. I was one member of a huge team effort, but you know I've been carrying the worry of the 'what if I wasn't enough' - it's reassuring to hear that it doesn't appear that anything could have been done differently, or that I didn't act on or do something I should have. Thank you."
Letby is sent an email, made by Countess Dr Stephen Brearey, advising that the deaths of Child O and Child P were likely to result in an inquest, as the cause of both deaths was 'unexplained'.
Letby asked: "It's a bit of a worry if it's going that far. Do you think I'll be involved?" Letby is reassured: "Probably not."
The doctor added: "I know you won't say anything - this email has to stay between us, is that ok?"
Neonatal manager Eirian Lloyd Powell messages nursing staff advising them in preparation for "the external review", "all members of staff need to undertake a period of clinical supervision", acknowledging there are "staffing issues".
Lucy Letby is recorded as agreeing to undergo the supervision commencing from July 18.
The email adds: "I appreciate that this process may be an added stress factor in an already emotive environment, but we need to ensure that we can assure a safe environment, in addition to safeguarding not only our babies but our staff.
"This is not meant to be a blame or competency issue – but a way forward to ensure that our practice is safe."
The same day, Letby messages her nursing colleague: "I've done a timeline of this year."
The colleague responds: "Fab. And how quite a few babies weren't compatible with life anyway. I wonder if midwives get this with amount of stillbirths......"
Letby: "Yeah and some went off within hours/on handover.
"Or were already acutely unwell when I took over.
"And put that when Baby Q went off No other staff able to care for him etc (name of Baby Q redacted)."
The colleague responds: "Not like all behaving fantastically till right into shift."
Letby: "Hoping to get as much info together as possible -if they have nothing or minimal on me they'll look silly, not Me."
8th August 2016:
(Taken from Chester Standard 06/04/2023)
Letby messages the nursing colleague: "Tony phoned. He's going to speak to Karen and insist on the review being no later than 1st week of Sept but said he definitely wouldn't advise pushing to get back to unit until it's taken place. Asked about social things and he said it's up to me but would advise not speaking with anyone in case any of them are involved with the review process. Thinks I should keep head down and ride it out and can take further once over.
"Feel a bit like I'm being shoved in a corner and forgotten about by the trust. It's my life and career.
"He's not been given any information about the evidence he asked for which is good. He's not sure what the external people are going to look at in relation to me but we are in the process now.so have to ride it out"
The colleague responds: "Ok well just have to take his advice then suppose"
Letby: "Still can't believe this has happened. It's making me feel like I should hide away by saying not speak to anyone and going on for months etc - I haven't done anything wrong."
The colleague responds: "Me neither! I know it's all so ridiculous."
Letby: "I can't see where it will all end"
The colleague responds: "I'm sure this time after xmas it'll all b a distant memory."
After Letby received an email announcing she had been seconded to the Risk & Patient Safety office for three months, she messaged the nursing colleague again, saying: "Bloody hell fuming. I'm in email and makes it sound like my choice."
1st September 2016: The timeline records Letby met with a review panel. (Taken from Chester Standard 06/04/2023)
Original pathology: The case was referred to the coroner and the cause of Child A's death was 'unascertained' at the time.
Reviewing pathology (Dr Andreas Marnerides): Dr Marnerides said it appeared Child A, a twin boy, died as a result of an injection of air into his bloodstream.
He reviewed tissue samples from Child A. The medic says from his review, he found 'globules' in the veins in the lungs and brain tissue that were most likely air, he said this air 'most likely went there while this baby was alive' Child C
Original pathology: The cause of death was ‘widespread hypoxic/ischaemic damage to the heart/myocardium’ due to lung disease, with maternal vascular under perfusion as a contributory factor.
Reviewing pathology (Dr Andreas Marnerides):
The prosecution added an independent pathologist said the skin colour changes in Child C were likely caused by prolonged unsuccessful resuscitation.
Child C had pneumonia, but the pathologist concluded Child C died as a result of having an excessive quantity of air injected into his stomach via the nasogastric tube (NGT). Child D
Original pathology: The coroner gave the cause of death as "pneumonia with acute lung injury."
Reviewing pathology (Dr Andreas Marnerides): The “likely explanation” for the death of Child D, a girl, was an air embolism into her circulation. Child E
The parents did not wish to have a post-mortem, the consultant did not deem one necessary, and the coroner's office agreed. Child I
Original pathology: The cause of death was given by the coroner as Hypoxic ischaemic damage of brain and chronic lung due to prematurity and 1b. Extreme prematurity. All loops of bowel showed significantly dilated lumen due to increased air content – in layman’s terms they were expanded like a partially inflated balloon. There was no sign of NEC (bowel necrosis) or any other bowel problem.
Reviewing pathology (Dr Andreas Marnerides):
Child I, received an excessive injection of air into her stomach, he said.
Child O
Original pathology:
A post-mortem examination found free un-clotted blood in the peritoneal (abdominal)space from a liver injury. There was damage in multiple locations on and in the liver. The blood was found in the peritoneal cavity. He certified death on the basis of natural causes and intra-abdominal bleeding.
He observed that the cause of this bleeding could have been asphyxia, trauma or vigorous resuscitation.
Reviewing pathology (Dr Andreas Marnerides):
Dr Andreas Marnerides, the reviewing pathologist, thought that the liver injuries were most likely the result of impact type trauma and not the result of CPR.
He thought that the excess air via the NGT was likely to have led to stimulation of the vagal nerve which has an effect on heart rate and would have compromised Child O's breathing.
He could not say whether it was either of these factors in isolation or in combination which caused Child O's death.
He certified the cause of death to be “Inflicted traumatic injury to the liver and profound gastric and intestinal distension following acute excessive injection or infusion of air via a naso-gastric tube” and air embolus.
Child P
Original pathology: A post-mortem examination had the coroner concluding Child P died from Sudden Unexpected Postnatal Collapse but he was unable to identify the underlying cause. He certified the cause of death as “prematurity”.
Reviewing pathology (Dr Andreas Marnerides):
Dr Marnerides said: “In my view, the cause of death was inflicted traumatic injury to the liver, profound gastric and intestinal distension following acute excessive injection/infusion of air via a naso-gastric tube and air embolism due to administration into a venous line.”
Arrests, house searches & police interviews
taken from Chester Standard 17/04/23
Letby was arrested on three occasions. The first was at 6am on July 3, 2018, at Letby's home address. Letby was re-arrested at her parents’ home on June 10, 2019 and November 11, 2020
Agreed facts are evidence which has been agreed by both the prosecution and defence.
Cheshire Police officer DC Collin Johnson has been called to give evidence, as exhibits officer in the Lucy Letby investigation.
He is confirming what his role and duties are as an exhibits officer and the process of gathering exhibits.
The prosecution asks about the home searches in July 2018, and a "considerable number of exhibits" being recovered.
Crime scene investigators took photos and recorded what they saw.
A chronology of this part of the investigation is now taking place, firstly with Letby's home search at Westbourne Road, Chester, at 6.05am on July 3, 2018. The search ended on July 6 at 5.30pm.
A diagram of Letby's home is displayed to the court.
Photos of Letby's home interior are now shown to the court. In her bedroom, the prosecutor points out, are two handbags, near the stand-alone mirror.
Inside the handbag, three handwritten notes were uncovered.
The three handwritten notes are shown to the court.
One is a blue post-it note, with handwriting featuring Letby's thoughts. The other two feature the name of a doctor several times, one saying "[name of doctor] I loved you" and "[name of doctor] my best friend."
Other messages on the notes, which have been densely-packed and messages among swirls of writing, read:
"I can't do this any more"
"Help me"
"We tried our best and it wasn't enough"
"I want someone to help me but they can't"
One message, in thicker handwriting overlaid on the yellow note, has the message "HELP".
Another photo of Letby's bedroom is shown, with a wall slogan 'Leave Sparkles wherever you go'. The message is repeated on a small tabletop decoration.
A page from Letby's 2016 diary is shown to the court, with a note on April 8: 'LD [long day] twins'. The following day is 'LD twins resus]. It is followed in a different coloured pen by 'Salsa - Buckley'.
A page of June 20-26 from Letby's diary, has for June 23: 'LD ([name of Child O's initial])'
June 24: 'LD ([name of Child P's initial) A+E'
June 25: 'LD ([name of Child Q's initial)'
The diary also shows, on June 25, 'Salsa Mold', and for June 26 'Las Iguanas 1800'.
The post-it note, found inside the diary, is one which was shown in the first week of the trial.
It has the message 'I am evil I did this' at its end.
Also featured are the words 'Slander discrimination', 'I haven't done anything wrong', 'I can't breathe', 'All getting too much', 'I killed them on purpose because I'm not good enough' and 'I am a horrible evil person'.
A very densely packed handwritten note is shown to the court, again in Letby's handwriting.
The broken sentences feature medical terms, and the words 'debriefing' 'sterility', 'foreign objects', 'workforce', 'haemhorrhage', 'non-availability', 'cellulite' 'aggravating factors', 'confidentiality', 'Don't know if I want to do this', 'Inadequate', 'Diagnosis', 'Implicating', 'Administration'.
Several of the words are written multiple times. The first names of Countess staff are also written occasionally.
A section which is scribbled and crossed out reads 'I don't know if I killed them maybe I did maybe this is all down to me'.
A photo of an Ibiza-emblazoned bag for life is shown to the court, recovered from Letby's bedroom.
The contents of the bag feature a number of documents and Lucy Letby's NHS name badge 'registered children's nurse neonatal unit'.
Nursing handover sheets for June 23 and June 24, 2016 are shown to the court. The names of babies not on the indictment have been blacked out for the court. They do include the names of Child O and Child P.
Handwritten documents of medical information and observations for babies, including for Child O and Child P, are shown to the court.
A nursing handover sheet for June 25 is also shown, with Child Q named. On the back of the sheet are handwritten notes and observations for Child Q and another baby.
A handover sheet for June 28, 2016 is shown which, the court hears, is outside the indictment period so no names of babies are shown to the court on this document.
The court hears there is handwriting on the rear of this note, which mentions Child O, and again the document features medical observations and notes.
A Morrisons bag for life was recovered from Letby's home, which included a blood gas printout and a paper towel with handwritten resuscitation notes for Child L.
Also in the Morrisons bag were a number of nursing handover neonatal unit notes - 31 in total.
Most of the notes refer to babies which did not feature in the indictment, and included on 17 of the notes there are multiple references to 13 of the 17 babies in the indictment period.
The court is shown photos of other rooms in Letby's home.
One room, which has a cartoon painted tree and wood animals on the wall, has a black paper shredder in the corner.
Shredded paper was identified. Police investigators identified the documents as bank statements.
A floorplan of Letby's parents' home is shown to the court.
A photo of Lucy Letby's bedroom at the Hereford address is shown to the court.
A photo is shown inside Letby's wardrobe, and Mr Astbury asks about the 'Asda five-sheet strip cut paper shredder' - there was no shredder in the box, but inside were five nursing handover sheets, not related to the indictment.
Handwriting on the box says 'keep'.
Letby's work address was also searched, between 10.15-11.50am on July 3, 2018.
A blue folder of papers was recovered from a desk, containing 'various items of paperwork'.
One sheet, an 'annual leave request', has a lot of handwriting by Letby on both sides of the paper.
This includes hearts, 'Tigger + Smudge', 'I loved you but it wasn't enough'
'PLEASE HELP ME [name of doctor] LOVE PLEASE HELP ME [name of doctor] You were my best friend [name of doctor]'
'I just want to be as it was I want to be happy in the job that I loved....Really don't belong anywhere - I am a problem to those who do know me and it would be much easier for everyone if I just went away.'
The names of a few Countess staff are named, repeatedly, as are the words 'malnutrition' and 'assessment'.
A photo of Letby's Westbourne Road home garage is shown.
Inside the garage is a black bin liner, and inside was a further note seized by police.
The note contains very densely packed handwriting.
Notes include 'Appropriate workforce', 'Consultant', 'Countess of Chester Hospital' 'Equality and Diversity', 'No-one will ever know what happened and why + I am a failure'
'I can't recover from this'
'Keep this between ourselves', I don't think I can ever go back Too much has happened/changed'
'Insulin diabetes'
'Killing me softly' features at least twice.
The words 'management' and 'ombudsman' feature about a dozen times on the sheet of paper.
Cheshire place names also feature.
Benjamin Myers KC, for Letby's defence, says a total of 257 handover sheets were recovered in the police search. Of those, 21 related to babies in the indictment.
Four of them were in the 'Ibiza bag' and 17 were in the Morrisons bag.
DC Johnson agrees.
Mr Myers says that meant 236 handover sheets were not in relation to the indictment.
DC Collin Johnson confirms four of the babies in relation to the indictment do not feature in any of the handover notes recovered at Letby's addresses.
Police Interviews
Letby was interviewed in police custody in Blacon, Chester, over a series of 13 interviews in July 3-5, 2018.
Further interviews, a total of 14, were held in June 10-12, 2019.
A further three interviews were held in November 10-11, 2020.
The interviews were fully recorded with Letby having legal representation throughout.
The interview transcripts from the three times Lucy Letby was arrested will be read out to the court.
These will be summarised from the original full-length footage of the interviews, which were fully transcribed.
The summaries are agreed by both the prosecution and defence.
Prosecutor Philip Astbury and a Cheshire Police officer will be reading through the transcripts to the court.
Child A[/B]
Letby recalls, in the first interview, the care she provided for Child A.
She recalls Child A appeared 'quite pale and mottled' and required 'full resuscitation'.
She remembered Child A, and going to his cotside. He appeared 'a bit jittery' - 'making involuntary jerking movements', 'can be a sign of low blood sugar'.
"It's common for pre-term babies."
She said staff were conscious to get Child A fluids.
At the time of fluid administration of the time of the shift handover, there were "no concerns". She was with nurse Melanie Taylor.
Child A had gone a few hours without fluids, which was "not ideal".
She said after the fluids were connected, Child A's "colour changed".
Letby said she did not recall having physical contact with Child A at that point, until after he deteriorated.
It was 'within maybe five minutes' of the TPN bag being administered that Child A became 'pale and mottled'.
He had become 'pale, almost white', and said there was 'something wrong' - Child A could have had a 'sudden collapse'.
The mottled appearance 'could be a sign of low blood sugars', where a baby could be pale but have 'reddy-purple' patches. Child A was 'pale' in the centre and the mottling was on the 'hands and feet.' Child A was not breathing.
Letby said she went to observe Child A and saw he 'was not breathing'. Dr David Harkness was also in the room, Letby said, as was nurse Melanie Taylor. Dr Harkness was called over.
Asked to describe the rash, Letby says she thinks it was 'on the side the line was in', on the left side, but there was 'predominantly paleness'.
The advice was to 'stop the fluids immediately' as there may have been an issue with the long line for Child A.
Letby says there was 'no reason' why Child A's perfusion was very poor.
Letby said it was 'awful' that Child A had passed away, and twin Child B was present when this was 'all happening'.
'I think just all of us, as a team, dealed with it', and a formal debrief was held a few days later. Letby says there was nothing in particular from the outcome, although one possibility was health issues the mother had.
Letby said she had seen babies pass away before, from her time working in Liverpool Women's Hospital involving very pre-term babies, but Child A's death was 'unexpected'.
Letby says she believed Melanie Taylor would have connected the TPN bag, as she was sterile (and in a position to attach the bag). She tells police there may have been uncertainty over what the bag of fluid contained.
She says she and Melanie Taylor would have checked the TPN bag together prior to administration.
Letby says she had about 20 minutes in contact with Child A in total.
Letby told police there may have been an issue with the line, and/or the fluid attached from the TPN bag - whether it had contained the correct prescription.
Following taken from Dan O’Donohue Twitter 20/04/23
Jury are now being read summaries of Ms Letby's police interviews in relation to Child A. Cheshire Police detective Danielle Stonier is reading Ms Letby's responses, while prosecutor Philip Astbury is reading the questions asked
In that interview, Ms Letby was told about the expert opinion of Dr Dewi Evans that Child A had been injected with air - her response was 'I did not deliberately give him any air'
She was told about the expert opinion of Dr Owen Arthurs, who noticed air on radiographs of Child A - she was asked if she could explain how the air got there, she said 'no I can’t explain how that air got there'
Child B
We're now moving onto Ms Letby's interview in relation to Child A's twin sister, Child B. The Crown say Ms Letby attempted to murder the infant in June 2015
Ms Letby was asked in her interview her recollections of Child B, she recalled seeing the baby girl with a 'sort of purply red rash' and looking mottled. She didn't recall in that interview what she did after seeing the rash (she wasn't Child B's designated nurse)
Asked if she had an explanation for Child B's collapse she said 'No, there's no explanation' She added: 'I didn’t do anything deliberately to (Child B) to harm her' Asked if she was responsible for attempted murder, she said 'no'
Child C
We're now onto the summary of the interview in relation to Child C - a premature baby boy, who weighted just 800grams on birth in early June 2015. Ms Letby is said to have caused baby's death by inserting air into the boy's stomach via a nasogastric tube.
In her interview, Cheshire Police put it to Ms Letby that one of her nursing colleagues, Sophie Ellis, had told them that when she heard Child C's alarm and went in to nursery 1 to check on him, Ms Letby was already in there stood at his cotside
At the time, Ms Letby was a designated nurse for another baby in nursery three. She was asked why she was in nursery one - she responded 'I don’t recall from memory' and said she may have been in N1 to carry out checks, use the computer or may have heard C's alarm
The court has heard that six minutes before Child C's collapse, Ms Letby was texting an off-duty colleague saying that she had wanted to be in N1 as it would be cathartic – would help her wellbeing - to see a living baby in the space previously occupied by Child A
Ms Letby agreed with the interviewing officer that she was 'frustrated' by the text conversation as she wasn't receiving the emotionally supportive messages she expected
The officer asked: 'Did you cause him to collapse six minutes after that conversation?' 'No', Ms Letby said
Ms Letby agreed that she was 'feeling frustrated and upset' at not being in N1 and with the text conversation, but denied attacking Child C
Child D
We're now moving onto the interview summary for Child D. The prosecution allege that the baby girl was the third child murdered by Ms Letby in a two-week period in June 2015
Ms Letby again told police in her interview that she 'did not deliberately do anything to harm (Child D)'
Police asked Ms Letby why she messaged a colleague after Child D's death saying ‘I think there is an element of fate involved. There is a reason for everything.’ Ms Letby said she was 'not sure' and said was just 'because sometimes things can’t be fully explained'
Child E
We're now onto interview summaries for Child E, a premature twin boy born in late July 2015. The court has heard that Child E lost 25% of his blood volume before his death in the early hours of 4 August.
Medical expert Dr Dewi Evans has previously told the court that this could have been the result of an "inappropriate" use of a medical tool.
In those interviews Ms Letby again denied causing any harm.
Child F
We've moved now to Child E's twin brother, Child F - who the Crown say Ms Letby allegedly poisoned with insulin
The Crown say the insulin was most likely added to the baby's Total Parenteral Nutrition (TPN) bag, which is used to intravenously provide feeds to infants.
The investigating officer asked Ms Letby in her interview whether anything would be added to the bag - 'no, not that I’m aware of', she said
When asked whether she had added insulin to the infant's TPN bag she said 'no' and asked officers if the bags had been kept/checked after the incident - they had not
Ms Letby was asked by officers why she had carried out searches for the mother of Child E and F on Facebook. She said she did not remember carrying out the searches, but would have been to check to see how Child F was doing.
Ms Letby was asked if she was 'obsessed' with the family of E and F as five months after they had left the hospital, she was still searching on Facebook for the family - she said 'no'
Child G
We're now moving onto a summary of Ms Letby's interview in relation to Child G. At the start of that interview, the officer pointed out that there had been a 'spike' in baby deaths/collapses in June 2015. He noted Ms Letby had been involved in all the cases
The officer said 'you dealt with all of these, what do you put that down to, bad luck?’ She said ‘yes’
Child H
We're now onto the interview summaries for Child H, Ms Letby is alleged to have caused the girl to collapse on successive shifts in the early hours of September 26 and 27, 2015
Asked by police if she did anything to harm Child H, she said: 'I didn’t do anything'
Following taken from Dan O’Donohue Twitter 21/04/23
Child I
We're currently hearing about Child I's first (of four) collapses on 30 September. Ms Letby was the infant's designated nurse
Ms Letby said she was not 'unduly concerned' about Child I at the start of her day shift. At around 15:00 Ms Letby noted that Child I appeared mottled in colour with a distended abdomen. At around 16:30 an emergency crash call went out as her heart rate had dropped
Ms Letby told detectives she could not recall the specifics of this incident. She is then asked about the baby's second collapse on 12/13 October. Ms Letby recalls this incident, 'oh yes, this was when she was found apnoeic in her cot at night', she said
She told detectives she and a nursing colleague found Child I 'gasping' for breath - she gave rescue breaths via neopuff and doctors were called to assist
Asked about Child I's final and fatal collapse on 23 October 2015 - Ms Letby she can't recall the specifics of the night, but said she 'remembers her dying and her parents having time with her'
Ms Letby said she wanted to attend Child I's funeral but she couldn't as she was working
Ms Letby was asked about the card she sent to the parents of Child I after her death, she told detectives she sent it as it was 'not very often you get to know a family as well as we did with child I'
Detectives found the image on Ms Letby's phone. She was asked why she took a pic of the card, she said it was 'upsetting losing (Child I) and I think it was nice to remember the kind words I shared with that family'
She also said she 'often takes pictures of any cards I send even birthday cards'. She said this was the first and only card she had sent to a family of a baby she had treated
Ms Letby is asked about the incident on 12/13 October. Her colleague Ashleigh Hudson told police that she saw Ms Letby was stood in the doorway of the nursery where Child I was in the early hours and commented that she looked pale.
Nurse Hudson turned on the light and saw that Child I appeared at the point of dying and was not breathing. Detectives asked Ms Letby if she 'knew she was looking pale because you just attacked her?' 'No', Ms Letby said
Detectives point out that Ms Letby had carried out Facebook searches for the family of Child I seven months after her death. She is asked why she did this, she told detectives she did not remember carrying out the searches
The reporting is missing child J - not clear if missed in court too.
Child K
We're now moving to interview summaries for Child K - a baby girl Ms Letby allegedly attempted to murder on 17 February 2016. It is claimed a doctor, Ravi Jayaram, walked in on Ms Letby as she attempted to kill her.
Ms Letby told detectives that she had 'very little memory' of Child K, other than the fact she was a 25week prem baby
In his evidence Dr Jayaram reported that when he arrived on the unit Child I's ET tube had slipped and her oxygen saturations were in 80s. Ms Letby was, according to the medic, stood near to the baby's ventilator
Ms Letby denied dislodging the baby's ET tube and said if she had noticed the saturation levels she would have summoned help
Child L
We're now onto summaries for Child L, a twin boy who it is alleged Ms Letby attempted to murder on 9 April 2016. Asked if she 'inflicted any injury' on Child L she told police 'no'
The Crown say that Ms Letby gave Child L an unauthorised dose of insulin. In her interview Ms Letby is asked where insulin is kept on the unit and what the process for administering it to a patient is - she told officers it was kept in a fridge and it would have to be prescribed
Ms Letby explained that the insulin was in a locked fridge in the equipment room - the keys for which are passed around among neonatal nursing staff as and when they are needed
Detectives asked Ms Letby if she attempted to murder Child L by injecting him with insulin, she said 'no'. Asked if he could have been injected by mistake, she said 'I don’t really see how' and said it was 'unlikely' such a mistake could be made
Police put the expert evidence of Dr Dewi Evans to Ms Letby, that insulin had been administered - she said 'that wasn't done by me'
Ms Letby was asked if she had 'any explanation whatsoever' for how insulin ended up in his circulation. She said 'no, not unless it was already in one of the bags he was already receiving'. Asked if she added insulin to a bag, she said no
Child M
We're now moving onto interview summaries for Child M - Child L's twin brother - who the Crown say Ms Letby attempted to kill on the same day
The court has previously heard that Child M suffered an unexpected life-threatening collapse at around 16:00 hrs on 9 April 2016. His heart rate and breathing dropped dramatically and he required full resuscitation by medical staff.
Ms Letby told detectives she did not know why Child M desaturated. The only thing she could recall was that it was a 'busy shift' as it was 'not very often we had that many babies in nursery one'
Asked if she had caused the infants collapse, she said 'I didn’t cause that and I don’t know who would have'. She denied administering air in a bid to kill Child M
Ms Letby was asked about a paper towel found at her home address when it was searched in 2018. The towel was used in 2016 as a make do drugs chart for Child M during his resuscitation - police asked Ms Letby why this was in her possession and why was it in her home
Ms Letby said it was an 'error' on her part that it had been taken home. Asked why it had not been destroyed, she said it must have been put to one side and forgotten about. She denied keeping it to remind her of 'when she attacked' Child M
Among the items seized by police was also Ms Letby's diary, on 8 April 2016 is written: "LD [long day] twins". The following day is written: "LD twins resus" Ms Letby was asked why she had logged this - she said it was because it was a 'significant event'
Child N
We're now onto summaries for Child N - a baby boy it is claimed Ms Letby attempted to murder three times - once on 3 June 2016, and twice on 15 June 2016.
In her police interview, Ms Letby said she was 'not sure' why Child N was bleeding
Asked 'are you responsible for the attempted murder of (Child N)', Ms Letby said 'no'
Child O
We're now onto the summaries for Child O, a baby triplet who Ms Letby is alleged to have murdered on 23 June 2016.
Manchester Crown Court has previously heard how Child O was in good condition and stable up until the afternoon of 23 June when he suffered a "remarkable deterioration" and died
Ms Letby agreed when asked if Child O's death was 'unexpected'
She denied harming Child O. 'I did not physically injure (Child O)', she said
Child P
We're now onto the interview summary for Child P - Child O's triplet brother, who the Crown say was murdered by Ms Letby the day after Child O's death
Ms Letby said Child P's death was unexpected.
She told police the parents had asked her to take pictures of the twins after their deaths top and tail in a Moses basket. 'If that’s what they wanted, I wanted to do it', she said
Police asked Ms Letby about a comment from nurse Kathryn Percival-Calderbank. She said Letby expressed that she was unhappy at being put in the outside nurseries. "She said it was boring and she didn't want to feed babies. She wanted to be in the intensive care."
Ms Letby said 'I don’t recall calling my work boring in any capacity'
The following taken from Chester Standard 27/04/23
Child Q
The read through the interviews continues with Child Q.
Letby recalls the medical observations/procedures carried out at the neonatal unit.
She recalls that Mary Griffith was the other nurse in room 2, and there was a concern Child Q had a low temperature, but was 'well enough to be left'.
She recalls she had been in room 1, returned to room 2, and saw Child Q had had 'an intervention' and she recorded Child Q having a 'mottled' skin appearance.
Letby said she believed she told Mary Griffith when she was leaving room 2. She recalls the other nurse was at the incubator.
She said she came back from room 1 and saw there was at least one nurse treating Child Q when she returned, and there was administration of Neopuff by the other staff.
She said she did not see Child Q vomit, but it would have been described to her.
Letby said she was unsure why Child Q would have vomited. She says sometimes babies do vomit and that can lead to a desaturation.
Letby tells police she does not recall if she aspirated Child Q.
When asked about the excess air aspirated from his stomach, she suggested babies sometimes gulp air when they vomit.
Letby says she believes she continued to look after Child Q as her designated baby following the desaturation.
In a follow-up interview, Letby said she did not cause Child Q's collapse. She said she had taken observations and raised Child Q's incubator temperature.
She said Child Q was "stable" before she left room 2.
She denies being responsible for Child Q's collapse, or injecting air into Child Q.
In a third police interview, Letby says she did not give Child Q anything prior to the collapse.
She denies leaving the room so the blame for the collapse could be put on another member of nursing staff.
Asked about a text message she sent to a doctor colleague about whether she should feel 'worried' about what Dr John Gibbs had been saying, Letby said: "I became aware of Dr Gibbs asking where I was - it was discussed then, obviously...I was concerned that I was going to be a problem"
Asked if she was seeing reassurance from the doctor she had messaged, Letby agrees.
She adds: "I wouldn't have just left a baby unattended," having said Mary Griffith was also in room 2.
The interviews now move on to more general, 'overarching' questions including questions on exhibits found at Letby's address.
Letby was asked about a post-it note: "I just wrote it as everything had gone on top of me."
"I felt people were blaming my practice...and made me feel guilty...they made me stop talking to people.
"I was blaming myself, not for what I've done, but [for the way people were blaming me]."
Asked about the underlined 'not good enough' note, Letby replies that was what people felt she was in terms of her competence.
She says she did not know how to feel or what to do.
"It just felt like it was all happening out of my control."
Letby says she received some anti-depressants from her GP.
She said she had been told she may have to redo her clinical care 'competencies' as part of the process, and she would not be the only member of nursing staff to do so.
Letby said she had concerns over the raised mortality rate in the neonatal unit, saying there were more babies with more complex needs, and this was "unusual".
After being removed from the unit in July 2016, she believed other staff felt she was not competent, and "they were going to think I had done something wrong", "that the police woyuld get involved and I would lose my job".
She added that she "loved her job".
Asked about why she thought the police would get involved, Letby replies: "I don't know, I just panicked."
She said she thought she would be referred to the NMC - [the Nursing and Midwifery Council] - and they would refer it to the police.
She said she felt 'so isolated and alone', as she could only speak to two friends, and had written a 'kill myself' note.
She said she believed she had not done anything wrong, but was worried they would believe she was not good enough.
She said she believed the trust and consultants - Dr Ravi Jayaram and Dr Stephen Brearey - were blaming her in harming the babies.
She felt she had had a good working relationship with the two consultants.
She said: "They were trying to make it my problem, because I was there."
She said she did not have any issues with the two consultants, and had a professional relationship with them.
She had spoken to her 'best friend', a nursing colleague, about some of the issues, but not about the 'kill myself' feelings she had.
Letby said she had been banned from contacting anyone, and the redeployment to another unit in the hospital 'would have gone on her record'.
Letby said she had "lost everything", and had lost being part of a "good ursing team", who were "like a family".
She said the note was a way of getting her feelings on paper, and this note was written "all in one session".
Letby adds: "I didn't kill them on purpose."
She said she was worried: "Other people would perceive me as evil if I had missed anything".
"I felt so guilty that they [mum and dad] had to go through this."
Asked about the 'kill them on purpose' note, Letby replies: "I didn't kill them on purpose."
Letby said at the time she felt there may have been practices and competencies in clinical care which she may have missed, which led to the deaths of babies. She said, having reviewed her practices, she did not feel she had failed on the competencies.
She said she was the first member of her family to go to university, and her parents were disappointed she had been removed from the neonatal unit. She confirms she had told him.
She said she was "career focused" and was worried that the investigation would lead to her losing her job and "change what people would think of me".
Asked about the 'I AM EVIL I DID THIS' note: "That's how it all made me feel at the time...not intentionally, but I felt if my practice was not good enough, then it made me feel like an evil person..."
She adds she 'wouldn't deserve to have children' on the basis she had been redeployed to another unit.
She said the trust had redeployed her as they felt her competencies were an issue.
She said she felt, at the time, she had caused the disappointments. She asked 'Why me' on the note as she wondered why she was the only one to undergo the redployment.
Asked about 2016 as a whole, Letby said nursing staff morale fell during the year as the unit continued to have sick babies.
"We were seeing more babies with complex needs and chest strains...stomas...quite a few extreme prematurity babies with congenital defects...we had the twins and the triplets."
Letby says a lot of staff were "feeling the strain, physically and emotionally", and staff were not offered enough support, and there were issues with equipment availability on the unit.
"I felt there wasn't a good management support structure...that was my personal opinion."
She said the unit was "quite bottom heavy" with a lot of new starters, plus staff on sick leave.
She says no staff intentionally gave poor care at the unit.
Letby says while equipment availability was an issue, it was not the cause of any initial collapses of the babies.
She said if staffing was "better" in terms of numbers, the care could have been better. Child Q was an instance, Letby says, where she was stretched between caring for babies in room 1 and 2.
She says for one of the babies, it was "quite chaotic" when resuscitating.
Letby said she was made aware in May 2016, formally, of the higher mortality rate among babies, and that was when she was moved to day shifts.
She said she first noted it was unusual to have a high mortality rate on the unit in June 2015, when three babies died.
Letby agrees she felt people's attitudes changed towards her when she was moved to day shifts in April 2016 and she felt she doubted her abilities.
Letby is asked if she had taken any paperwork home in relation to the babies, Letby denies she has taken papers home, then adds: "I don't know - I might have taken some handover sheets accidentally. Not medical notes.
"They [the handover sheets] might have been taken [home] in my pocket."
Asked about another of the notes, which has the word 'HATE' in a circle in bold letters, Letby said she had just been removed from the job she loved and she had been prevented from talking to people.
She said about the note: 'they thought I was doing it in purpose - not that I felt I did do it on purpose'.
She adds: "I am very hard on myself...I felt as though I wasn't good enough."
Police ask: "Lucy, were you responsible for the deaths of these babies?"
Letby: "No."
In a third overarching interview, Letby is asked about the handover sheets.
She said, 'ideally', the handover sheets should be put in the confidential waste bin at the end of her shifts.
She said that at times, they would come home with her.
She is asked about 'a large quantity of handover sheets' at Letby's home address. She replies there was "no specific reason" why she had taken them home.
She said she would have been aware she still had the handover sheets when she got home, and put them in a folder in the spare room.
She said she "didn't know how to dispose of them" and no-one else had seen them.
She said she would have seen those handover sheets at home "hardly ever".
She said she did not have a shredder and those sheets were at home 'inadvertently'.
Other paperwork at home would have been policy sheets from different hospitals, in relation on how to care when a patient presents with various symptoms.
Letby said she 'had just not done anything' about the handover sheets when she got home.
Asked about the mobile phone she used in 2015-2016, she said she would have used the phone at work, and not have let anyone else use it.
There was one nursing colleague she would have contacted often, Letby says, using Whatsapp, FB Messenger and text messages.
The messages would discuss patients, relaying information if they were unwell or had passed away.
She said she had a "support network" and it was "helpful to speak to a colleague" in relation to babies.
She added she would speak to her mum each day. She would not speak in as much detail if a baby had passed away to her, as she would to nursing colleagues, but would talk for support.
Letby says she had reassurance from a doctor colleague, and was "close to him in the later stages".
Letby said after a diffiult day at work, she would 'seek reassurance', including a doctor colleague, and she would seek information about some debriefs when babies had died in which she had been involved in their care.
Letby says she had started working on a neonatal unit in January 2012. She continued her training across a range of skills over the following years.
In May 2015 there was a course for medicine administration via a bolus at the hospital, where - under supervision from a doctor - nurses would be able to administer medication via a long line.
She said it was "different", and a "lot more risk", and said she was "competent" having done that training.
Letby confirms she attended resuscitation training for infants, a course which is done every four years.
She says there was no training she had failed, that she was aware of.
Letby is asked about air embolism training. Letby says she did not have training for that, and was only aware of air embolisms in adults, after people had had a pulmonary embolism.
Asked if air embolisms had been an issue in the neonatal unit, Letby replies it had not.
The final overarching interview saw Letby identify her personal diaries, and confirmed only she wrote and had access to those diaries.
Letby says she does not recall, in what way, why she had written the names of babies in her diary on particular dates.
She said: "I just internalise things and think about them in my own time."
She says she would have written them to note which babies she was looking after and how many babies she was the designated nurse for them.
Asked about the 'kill me' note, she said she 'hated' working in the office and had 'lost everything'.
She said, about on the of the notes, it had 'become a doodle thing', having started out as a note.
Asked why she had kept the 'doodle note', she replies she was "not sure". Although undated, the note being in the 2016 diary meant the note could have been written after Letby had been redeployed away from the neonatal unit in July 2016. Letby agrees that would be the case.
Defence
Benjamin Myers KC, for Letby's defence, is now asking Cheshire Police detective Danielle Stonier, who has read out the interviews, a few questions.
The detective confirms Letby and her legal representative, in advance of the interviews, would have received 'advanced disclosure', which would include a number of the documents police had, such as key nursing notes, feeding charts and observation charts "but not a detailed suite" of all the documents featured throughout the course of the trial.
As an example, Letby had provided details of a particular shift for one of the babies, having had sight of relevant nursing documents for that child.
Mr Myers asks about one day when Letby asked for the interview to stop as she was tired.
He says on that day, Letby had been asked about a large number of babies, in interviews spanning several hours.
Other Agreed facts
The prosecution is now presenting some more 'agreed facts', that is evidence agreed by both the prosecution and defence.
Philip Astbury, prosecuting, says this is in addition to agreed facts presented before.
The facts are that Letby was interviewed in police custody in Blacon, Chester, over a series of 13 interviews in July 3-5, 2018.
Further interviews, a total of 14, were held in June 10-12, 2019.
A further three interviews were held in November 10-11, 2020.
The interviews were fully recorded with Letby having legal representation throughout.
Further agreed facts are now being read out. They include that an HTC One smartphone was seized from Letby's home address.
The digital contents were extracted from it, featuring Whatsapp, text message and Facebook Messenger messages.
Photos recovered included ones of a thank-you card taken from the parents of Child E and Child F. Child E had died but the parents thanked the nursing staff for being able to bring Child F home.
There is also a photo of a sympathy card, with Letby's handwriting, for Child I, for the day of Child I's funeral.
A digital forensic investigator downloaded the contents of Letby's Facebook messages and emails, including Facebook search data.
A chart showing which members of the neonatal unit nursing staff were on duty for the shifts when the babies in this case collapsed is shown to the court.
The chart covers the period from June 2015-June 2016.
Lucy Letby's name is highlighted as being the only one present on all 24 shifts for when the babies collapsed.
A second sheet shows which junior doctors and consultants were present for those events.
This chart was shown during the prosecution opening in the first week of the trial.
A 'heat map' of total staffing presence says Letby was present for all 24 events.
The next highest is consultant Dr John Gibbs, present at 10 events. Five nursing staff, and one doctor, were each present for seven of the events.
The 'heat map' shows which of the other medical staff were present for six, five, four, three, two and one of the events.
The agreed facts now discuss how some photos and videos were taken as part of the investigation.
They include one which represented a nursery room in low-level lighting, as part of evidence.
A competency assessment for administration via IV lines was also obtained.
The competency checklist for Lucy Letby shows ticks for all 20 required boxes, and the candidate - Letby - is deemed to have passed.
The assessment is dated May 31, 2015.
A blood transfusion workbook was also obtained from Lucy Letby's HR file at the Countess of Chester Hospital.
One of the questions lists 'Give 4 potential complications of having a UAC/UVC line in situ'. Letby writes, for one of the four answers, 'air embolysm [sic]'.
A transfusion competency assessment also has questions listed, which Letby has provided responses. The assessment is dated May 11, 2016.
It was agreed the handwritten notes seized from Letby's home included resuscitation notes for Child M.
Letby, the court hears, has no previous criminal convictions or cautions.
The Countess of Chester Hospital Trust's neonatal unit was redesignated as a 'level one' unit on July 7, 2016. This was a decision taken by the trust.
That concludes the prosecution case, the court hears.
Mr Myers: "It is difficult to think of allegations that may be harder to stand back and look fairly and look at the actual evidence.
"The sympathy of everyone will rightly be with families of the children...involved in this case. We all share the same feelings and experiences."
"It is natural to sympathise - we all do it. We recognise the sadness, distress and anger that come with allegations like these.
"We acknolwedge the great loss suffered by all families.
"Nothing I can say in this trial is intended to diminish that in any way.
"It is obvious...where we have such terrible allegations, it would be terribly easy for emotion to overcome reason, and convict without hearing a word of evidence."
"There is a real danger people will simply accept the prosecution 'theory' of guilt.
"It is a theory built 'firmly' on coincidence."
"What we are left with is coincidence.
"In the events that happened. Sometimes what happened was the result of deterioration in a baby.
"Sometimes, no-one can say what caused a deterioration.
"Sometimes, things have gone wrong, or the necessary standards of care have not been met, irrespective of anything to do with Lucy Letby. For that, she should not get the blame."The assumption is "The worse it sounds, the more guilty she must be."Mr Myers outlines the 'key issues' for the defence, in what he says will assist the jury and will place everything into context.
He said his speech, at this stage, will take about a couple of hours, and will break down the defence into three general areas: Letby and the general area of her defence, coincidence, and the medical evidence.
He tells the court the medical evidence is a key area, and there are 'key issues' for each count.Letby was a "dedicated nurse" "who did her best" to care for infants and did not intentionally cause "any harm" to any baby, My Myers said.
"She loved her job...and cared for the babies' families.""You won't get your answers [to what Letby is like] through seeing her in thed dock.
"This is what she is like six years after the allegations started. That, as you can imagine, is gruelling for anyone.
"You may want to keep that in mind as we go through the evidence in this case.""A young woman who trained hard to be a nurse...and looked after many vulnerable babies for years.
"A young woman who loved what she did, and found she was being blamed for the deaths of the babies she cared for.
"We are dealing with a real person dealing with...a litany of allegations...not one of which has been proved."Mr Myers refers back to the note shown to the court just before the break.
He said it is a note written in anguish and despair.
She was "going through a grievance procedure" with the NHS at the time, the court hears, and knew what was being said about her before her arrest.
The allegations were "destructive", the court hears.
The note is headed 'not good enough'. The defence notes it does not say 'guilty'.
The note adds: "I will never have children or marry".
Another part of the note says "I haven't done anything wrong".
Mr Myers: "We say people can pour feelings on to paper.
"This [paper] represents the anguished state of mind Letby felt when accused of killing children she had cared for.
"We say this paper represents 'anguish' and not 'guilt'.
There was further paperwork the police took from Letby's address at the time of her arrest.
The defence say the paperwork was "nothing more extraordinary" that Letby being someone who scribbles a lot of work down, and keeps hold of it.
The defence say the prosecution case is "driven by the assumption of someone doing deliberate harm combined by the coincidence of Letby's presence."That is, Mr Myers said, combined with Letby "not doing" what is alleged against her.
"You will find, from what we have heard, no evidence of her actually doing harm to a child.
"These allegations are of attacks. You will have heard words of poisoning, sabotage - words likely to have had an emotional impact on you.
"You will have to refer to whether Letby is engaged in any of the attacks alleged.
"Using syringes to inject air? No. Tampering with bags of fluid - or poisoning them? No. Physically assaulting children? Smothering them?
"We are dealing with 24 events and we say there is nothing [to suggest that].""The time of Letby's presence has itself become an explanation for the deterioration."The list on nursing staff on duty for all the fatal and non-fatal collapses, with Letby on duty for all events, is shown again to the court.
"This table exists because the prosecution created it, and was put together for the purpose of the prosecution."It was to show what were declared to be key events.
"This is a self-serving document. What we have here is because the prosecution have chosen to present it this way."
The defence says it does not show the 'individual health of the children concerned, or any problems they had from birth, or the risks, or the course of treatment and/or problems encountered by said treatment'.
The chart does not show 'other collapses or desaturations' for the children when Letby is not present.The table does not show 'shortcomnigs in care' which 'could have impacted the health of the baby', or 'how busy the unit was', or 'what Letby was actually doing at the time of the event', My Myers tells the court.It doesn't show 'whether Lucy Letby was anywhere near to a child at the time of the event' or if there was 'a problem which could be traced before Letby's arrival'.Regarding the explanations for what happened, My Myers said: "This is something which is quite a difficult question, even for experts to look at.""What the case will come down to is the medical evidence, on what can be safely proved and what it can't."Regarding the medical evidence, Mr Myers said: "The cause of the deteriorations, or deaths, is not clear and have a number of possibilities.
"Generally, we are dealing with babies who are fragile, and their condition can change and deteriorate very rapidly."
Mr Myers adds the premature and vulnerable babies can come with developmental conditions that require extra treatment, and are prone to infections.
"It is crucial to consider the starting point in these cases.
"There is a question to whether this hospital should have been caring for this number of children."Mr Myers: "We suggest whether an event that clearly fits an ongoing and difficult condition has been covnerted into an event of deep suspicion that harm is being done."For a nurse standing in the neonatal unit next to an infant is "unremarkable", without a "suspicion of guilt", Mr Myers tells the court.
"When we come to the experts, you will need to consider their evidence and how strong it is."The defence say there are five 'important' considerations for the evidence:
The birth condition of the infant.
If there were any problems in the care leading up to the event - events 'can come up from nowhere'
Whether the prosecution expert evidence concludes there was deliberate harm done
Whether Lucy Letby was present at the relevant time, and what she was doing
Whether there were failings in care by other people or the neonatal unit as a wholeThe birth condition of the infant
Mr Myers tells the court: "We are dealing with some of the most medically fragile babies under the most intense medical care.
"All of them, bar one, are premature to varying degrees. Some had considerable problems.
"These babies are already at risk of deterioration and this can happen unexpectedly and it can be rapid."The matters leading up up to the event
Mr Myers refers to the medical situation and condition of the children involved.
Sometimes that includes 'the ability of doctors and nurses to spot' signs of problems in the build-up to the event.Sometimes that would be a problem if the unit was "understaffed and overstretched," Mr Myers saidThe defence say in relation to the evidence, "we have to be careful of the assumption or theory of guilt," and the "dangers of opinion" in relation to the conclusions of "deliberate harm".
"We say that if an expert sets out within expectation a suspicion of harm being done, that may make it more likely they will reach conclusions which are harm based...rather than innocent explanations.
"When there is no explanation, there is a danger of the expert filling the absence of an explanation with one...by the prosecution.""If someone looks for something, and has something in mind, they will look for that."
"Confirmation bias," added Mr Myers"There is plenty of disagreement" between the prosecution expert evidence and the defence.Medical evidence
Mr Myers tells the court that sometimes deteriorations are unexplained, and if Lucy Letby cannot provide an explanation, that does not make her responsible.
For every count, Letby is "adamant" she has "done nothing wrong" to cause any deliberate harm to any of the babies in the case, Mr Myers adds.
Regarding the point of air embolus cases The defence "accept it is a theoretical possibility", but that "does not establish very much".
"You will hear in this case, that the air present after death does not indicate an air embolus."
Mr Myers said air present in the abdomen "can happen post-mortem".
the opening statement then goes on to discuss each baby in more detail - see the baby A-Q sections below
Mr Myers added there are two further areas to consider.
"It is important not to guess, or proceed on a presumption of guilt."
"Even when we have timings...some will be more precise than others."
There were many occasions when "Lucy Letby was simply not there" when harm was being alleged.
"Lucy Letby was a young nurse with no family commitment, who had built her life around the neonatal unit.
"She was often called in to help babies with severe health issues...she was more likely to be there to cover for clinically difficult babies."
The defence say Letby's lack of recollecting details in police interviews should be put into context, like other witnesses, who may not be able to recall anything beyond the notes they made at the time.
"Goodness knows how many babies she will have cared for over the years," Mr Myers said.
Other staff
Mr Myers said this is important - it would be "unbalanced and unfair" if the focus was on Lucy Letby without focusing on problems with other staff, or how the unit was run.
"We do not suggest for one moment the doctors and nurses did anything other than the best they could.
"What they do is admirable and crucial."
"We say there were problems with the way the unit performed which had nothing to do with Lucy Letby."
Examples of sub-optimal care for babies previously mentioned and conceded by the prosecution are relayed to the jury.
"There are many other examples of sub-optimal care of babies in this unit," Mr Myers.
The defence say the prosecution have referred how babies improved rapidly when moved to a tertiary unit - "when moved away from Lucy Letby"
The defence says the improvement could be because they had been "moved away from the Countess of Chester Hospital".
It is evidence that the unit "did not always deliver the level of care that it should have provided" and to blame Letby "is unfair and inaccurate".
Mr Myers explains the neonatal unit is a level 2 unit, with level 3 offering the highest specialist care for new-borns, such as in Arrowe Park.
Either 'through lack of technical level of skill among the staff, or because it was too busy and could not deliver with the level of staff it had available.'
The Countess of Chester Hospital neonatal unit was subsequently 'resdesignated' as a level 1 unit after Letby was redeployed in July 2016, Mr Myers said.
"You can imagine in a situation like that, there is bound to be concern."
The defence also refer to Dr Ravi Jayaram, and his 'concern' about Letby's behaviour as detailed by the prosecution in the opening.
"You may wonder what on earth that is all about.
"If Dr Jayaram had these suspicions, when did that start?
"You may think that if consultants had suspicions, then why did Letby continue?
"You may wonder if there was any basis for suspicion at all.
"You may think that suspicions by one or more consultants like that, if Letby is to blame, then that is fertile self-serving territory for an assumption of guilt to take hold."
Mr Myers said Letby became a "target" for blame.
"It would be very unfair to judge Lucy Letby by standards or expectations different to other staff in the unit," Mr Myers said.
The defence say if it can be interpreted the unit is understaffed, treatment is "hurried," "mistakes made" and records "not kept". Mistakes may "not be immediate".
Mr Myers: If the unit has "failed" in its care which has led to this "uncharateristic spike in deaths", you can imagine "pressures" which call for an explanation, 'distancing the blame from those running the hospital' through "confirmation bias".
"The blame is far too great for just one person," Mr Myers added.
"In that dock is a woman who says this is not her fault."
Defence Witness - Plumber Lorenzo Mansutti
From Chester Standard - Wednesday 14th June 2023
Benjamin Myers KC says to the court there is one witness to give evidence in relation to the sanitation of the hospital.
Lorenzo Mansutti, who works at the Countess of Chester Hospital, has had many years of experience in plumbing.
He has provided a witness statement.
He says the plumbing in the Countess of Chester Hospital's Women's and Children's Building, between 2015-2016, had been built in the 1960s and 1970s, and says there were "issues with the drainage system".
He says he had to deal with "various blockages" and the cast-iron piping would crack for "a number of reasons" including age.
Asked what would happen if the pipes were blocked, he replies it would come back through the next available point, such as toilets or wash basins. He confirms that would include sewage.
He says when alerted to it, it would come through the helpdesk, and it would be rectified "as quickly as possible".
He says he would be called out "weekly" to fix problems.
He says there was an occasion when they had a blockage in the room next door adjacent to the neonatal unit. He says a colleague attended it, the drainage had backed up and the neonatal nursery room 1 hand wash basin had "foul water" coming out of it.
He agrees with Mr Myers that "foul water" would include "human waste...sewage".
He says he is unable to confirm exactly when that happened during 2015-2016.
Mr Myers says there were Datix forms presented to Mr Mansutti, one dated January 26, 2016.
It is a 'non-clincial incident' of a 'flood' type.
Nursery 4 was closed at 2.30am 'due to plumbing work/deep cleaning of nursery.' 'Mixer tap was switched on, and sink completely blocked.' 'Floor noted to be completely flooded'. 'Water within sink noted to contain much black debris. Sink still blocked however'.
The nursery was 'noted to be flooded again at approximately 4.30am', with the 'floor almost completely flooded again'.
Nurse Christopher Booth reported the incident.
Mr Mansutti confirms this is an incident different from that which was reported in room 1.
A service report of 'blocked drains' is shown to the court.
Mr Mansutti says these service reports are "usually" urgent. The report shown to the court is on July 4, 2015. It happened in the maternity wing of the Countess of Chester Hospital, in the central labour suite [CLS], ward 35.
He says incidents would be delegated to team members.
A second incident is shown reported at August 8, 2015, a 'flood in the CLS' (ward 35), for which Mr Mansutti was called out.
Another is on October 2, 2015, for blocked drains in the CLS.
Another is on October 6, 2015, in the neonatal unit, to 'investigate flood'.
Mr Mansutti says it could be a waste pipe, or rainwater.
Another report is on January 26, 2016, a 'leak in the neonatal unit/SCBU'.
Another is on February 24, 2016, a 'burst pipe in sluice' in 'ward 35 CLS'.
Another is on March 18, 2016, in the neonatal unit, nursery room 2 and the kitchen. There were two 'blocked sinks'.
Another is on April 10, 2016, in ward 35 CLS, as 'Sluicemaster and drains blocked'. Mr Mansutti says the Sluicemaster is a bedpan machine.
Another report is on June 6, 2016, a 'flood in courtyard' of the neonatal unit. Mr Mansutti says this may have followed a heavy downpour. He does not believe the foul drainage runs that way, so it would more likely be surface water.
Another report is on July 5, 2016, in ward 35/CLS, for 'various plumbing jobs in NNU'.
'Check pall water filters for poor flow'
'Check that all valves in the ceiling void are fully open - NNU and by theatres...'
'Leaking sink in Sluiceroom - please check'.
Mr Myers asks about the last of these jobs.
Mr Mansutti says it is likely a leak in one of the sinks. He says there is not a Sluiceroom in the neonatal unit.
Nicholas Johnson KC, for the prosecution, asks Mr Mansutti questions.
Mr Mansutti agrees that one of the problems for the flooding was adults 'putting things down sinks'.
One incident is somebody 'forcing a wipe towel down a sink'. Mr Mansutti accepts an incident did take place.
He says none of the incidents led to no hand washing facilities availability, and there is a system in place.
He says there has been 'sewage floods' in the neonatal unit. He says there was once incident, undated, not on a Datix form, where there was sewage on neonatal unit room 1.
He says he has knowledge of it because of "disgust", and work was done on moving sewage pipes away from the unit room in future, "so it couldn't happen again".
He says, for his recollection, it was a "one-off".
Mr Johnson says half the incidents listed did not take place in the neonatal unit. Mr Mansutti says there would not have been a direct effect on that unit for those days.
That completes Mr Mansutti's evidence.
It also completes the evidence presented in the Lucy Letby trial.
On Thursday, June 15, trial judge Mr Justice James Goss gave his first set of directions of law to the jury of eight women and four men ahead of the prosecution and defence delivering their closing speeches at Manchester Crown Court from next week.
He told jurors, who were sworn in last October, they should decide the case solely on the evidence placed before them.
He said: “As I said at the very beginning of the trial, you must not approach the case with any pre-conceived views and you must cast out of your decision-making process any response or approach to the case based on emotion or any feelings of sympathy or antipathy you may have.
“It is instinctive for anyone to react with horror to any allegation of deliberately harming, let alone killing a child – the more so a vulnerable premature baby.
“You will naturally feel sympathy for all the parents in this case, particularly those who have lost a child and the harrowing circumstances of their deaths.
“You must, however, judge the case on all the evidence in the case in a fair, calm, objective and analytical way – applying your knowledge of human behaviour, how people act and react, using your common sense and collective good judgment in your assessment of the evidence and the conclusions to be drawn from it.”
Mr Justice Goss told jurors it was not their role to “resolve every conflict in the evidence”.
He said: “It would, you may think, be a remarkable and exceptional case in which a jury could say we know everything about what happened in any case and why.
“You are not detectives.
“If you are sure that someone on the unit was deliberately harming a baby or babies, you do not have to be sure of the precise harmful act or acts. In some instances there may have been more than one.
“To find the defendant guilty, however, you must be sure that she deliberately did some harmful act to the baby the subject of the count on the indictment and the act or acts was accompanied by the intent and, in the case of murder, was causative of death.”
He told the jury they also did not need to certain of any motive for deliberately harming a baby.
Mr Justice Goss said: “Motives for criminal behaviour are sometimes complex and not always clear. You only have to make decisions on those matters that will enable you to say whether the defendant is guilty or not of the particular charge you are considering.
“Any decision you do make must be based on evidence and not speculation.”
Turning to the subject of “circumstantial evidence and the unlikelihood of coincidence”, he said this was a case in which the prosecution “substantially, but not wholly” rely upon circumstantial evidence.
Mr Justice Goss went on: “The defendant was the only member of the nursing and clinical staff who was on duty each time that the collapses of all the babies occurred and had associations with them at material times, either being the designated nurse or working in the unit.
“If you are satisfied so that you are sure in the case of any baby that they were deliberately harmed by the defendant then you are entitled to consider how likely it is that other babies in the case who suffered unexpected collapses did so as a result of some unexplained or natural cause rather than as a consequence of some deliberate harmful act by someone.
“If you conclude that this is unlikely then you could, if you think it right, treat the evidence of that event and any others, if any, which you find were a consequence of a deliberate harmful act, as supporting evidence in the cases of other babies and that the defendant was the person responsible.
“When deciding how far, if at all, the evidence in relation to any of the cases supports the case against the defendant on any other or others, you should take into account how similar or dissimilar, in your opinion, the allegations and the circumstances of and surrounding their collapses are.
“The defence say that there are possible causes for many of the collapses other than an intentional harmful act, that the prosecution expert evidence cannot be relied on in terms of providing explanations for many of the collapses and that there is insufficient evidence to lead you to the conclusion that these events were related and were a consequence of any harmful act by the defendant rather than a series of unrelated collapses that, in some cases, ended in death.”
When considering the seven counts of murder, Mr Justice Goss told jurors they must be sure Letby deliberately did something to the child that was “more than a minimal cause” of the death.
He said: “The children were all premature and vulnerable, some had mild respiratory distress syndrome of prematurity and some had specific health issues.
“There were also a few cases of delays in the administration of appropriate medicine or other clinical failings. Some of the causes of death were unascertained.
“In the case of each child, without necessarily having to determine the precise cause or causes of their death and for which no natural or known cause was said to be apparent at the time, you must be sure that the act or acts of the defendant, whatever they were, caused the child’s death in that it was more than a minimal cause.
“The defendant says she did nothing inappropriate, let alone harmful to any child. Her case is that the sudden collapses and death were, or may have been, from natural causes or for some unascertained reason or from some failure to provide appropriate care, and they were not attributable to any deliberate harmful act by her.”
