Doctor apologises for not 'pushing' post-mortem examination on baby allegedly murdered by Lucy Letby

A doctor has apologised in court for not “pushing” for a post-mortem examination of a baby boy allegedly murdered by nurse Lucy Letby.

Lucy Letby, 32, denies the murders of seven babies and the attempted murders of 10 other babies between June 2015 and June 2016.

Letby, who is originally from Hereford, is said to have administered a fatal amount of air into the bloodstream of the infant while he was being cared for in the neo-natal unit at the Countess of Chester Hospital.

The death of the premature-born twin, referred to as Child E, was the fourth baby murdered by the defendant in a six-week period, according to the prosecution.

During her evidence on Wednesday 16 November, a consultant paediatrician – who cannot be identified for legal reasons – turned from the witness box to Child E’s parents sitting in the public gallery and made her apology.

The doctor was the on-call consultant when Child E deteriorated rapidly late on the evening of 3 August 2015 and died in the early hours the following day.

Jurors heard that necrotising enterocolitis (NEC), a serious gastro-intestinal disorder, was entered as the cause of death on Child E’s death certificate.

The doctor told the court: “At the time I felt (Child E) had NEC which had led to his collapse and deterioration so I discussed that with the coroner and we agreed for that to be put as (Child E’s) cause of death.”

She said the infant was a “high-risk baby” and also took into account a colleague’s observations of gastro-intestinal bleeding and abdominal discolouration.

Prosecutor Simon Driver asked: “Any clinical factors that militated against that conclusion?”

The consultant replied: “I considered them fully at the time but the fact that (Child E’s) observations were very stable up to the point of collapse does not normally fit with NEC.

“And the abdominal X-ray not showing any signs of NEC over an hour before he died – I don’t think I gave that enough weight at the time; that the X-ray had been normal.”

She told the court she now did not think NEC was the cause of death.

The doctor went on: “A post-mortem would take place if we didn’t feel we had a cause of death. It can be requested for any baby who dies if the parents want that investigation.

“The parents were understandably devastated that Child E had died and were not keen on a post-mortem and I didn’t want to make a terrible situation any worse so I didn’t push, which is something I now regret.”

Ben Myers KC, defending, said: “This is precisely the type of situation where a post-mortem would have been very helpful, isn’t it?”

The witness said: “And I regret for not pushing for a post-mortem at that time.”

Mr Myers said: “But at the time you were questioning NEC and at the time you didn’t have an obvious explanation?”

The doctor replied: “I completely agree with hindsight. I should have requested a post-mortem. I was keen to avoid that, to avoid any distress.”

She turned to Child E’s parents and said: “I apologise to them that I didn’t push for that.”

Mr Myers suggested: “You, in effect, steered them away from a post-mortem?”

The witness said: “I don’t believe that was the case.”

On Monday, Child E’s mother told jurors the doctor told them a post-mortem “would not tell us very much”.

She said she and her husband decided not to ask for one “largely” because it was explained to them there was “little point”.

The consultant paediatrician was phoned twice by registrar David Harkness, at about 10.10pm and 11pm, in response to a decline in Child E’s condition, the court heard.

The first time, he diagnosed a gastrointestinal bleed but queried the cause because a large vomit of fresh blood was also noted.

A treatment plan was put in place, which the consultant deemed appropriate as she told the court: “I would have done the same thing if I was present on the ward at the time.”

The second phone conversation indicated further blood loss and no improvement in oxygen levels, which “suggests something dramatic has changed”, she said.

Another plan was put in place, which she agreed with, but a “sudden deterioration” in Child E’s condition took place at 11.40pm and she left her accommodation nearby at about midnight.

Medics tried to resuscitate the infant but he was pronounced dead at 1.40am.

The consultant told Mr Myers that at some point she and Dr Harkness had earlier discussed a potential blood transfusion but did not document the exchange.

She said “with hindsight” she would have liked to have been at the neonatal unit earlier than she arrived, when he was in a “critical condition”.

The consultant disagreed with Mr Myers that a blood transfusion given to Child C at 12.40am was “far too late”.

She said: “I don’t believe his collapse was due to blood loss. All the clinical signs were he was making good progress.

“If it had been blood loss that had led to his collapse there would have been other clinical signs on his observations that would have alerted to us to that fact.”

Jurors were told there had been complications with the mother’s pregnancy and the boys had been diagnosed with twin to twin transfusion syndrome, a rare condition which occurs when identical twins share a placenta and grow unevenly because of the way blood and nutrients flow between the babies in the womb.

Letby is also accused of attempting to murder Child E’s twin brother, Child F, by poisoning him with insulin.

She denies the murders of seven babies and the attempted murders of 10 others between June 2015 and June 2016.

The trial continues.