I should have had more courage over Letby concerns, consultant tells inquiry

A consultant has told a public inquiry he “should have had more courage” and voiced his concerns about Lucy Letby after he had to resuscitate a baby girl.

The nurse was later convicted of the attempted murder of Child K by dislodging her breathing tube before senior paediatrician Dr Ravi Jayaram walked into a nursery room in the Countess of Chester Hospital’s neonatal unit in February 2016.

The prosecution at Letby’s trial said she was caught “virtually red-handed” by Dr Jayaram, although he did not tell anyone at the hospital, or the police, about the incident at the time.

Giving evidence on Wednesday at the Thirlwall Inquiry into the events surrounding Letby’s crimes, Dr Jayaram said he had been sitting outside the nursery reading medical notes when he realised Letby was alone with Child K and felt “significant discomfort”, but also thought he was being “completely irrational and ridiculous”.

He decided to go in “just to make sure everything was fine”, he said.

I should have been braver and should have had more courage because it was not just an isolated thing

He said: “There has been a lot of speculation but I didn’t walk in and see anything. What I walked in and saw was a baby clearly deteriorating and when I went to assess Baby K the ET (endotracheal tube) was dislodged.

“My priority was to resuscitate Baby K, which I did successfully. I will take this with me to my grave. At that point I thought ‘How has that happened?'”

Explaining why he said nothing about the incident at the time, Dr Jayaram said: “It is something of a mea culpa. Why didn’t I? I lie awake thinking about this.

“It’s the fear of not being believed. It’s the fear of ridicule. It’s the fear of accusations of bullying.

“I should have been braver and should have had more courage because it was not just an isolated thing. There was already a lot of other information.

“I should have had more courage.”

Dr Jayaram said he first became aware that Letby could be causing “inadvertent or even deliberate harm” to infants when he returned from leave after the death of a baby girl, Child I, in October 2015.

He recalled conversations in corridors with fellow consultants about the repeated associated presence of Letby and sudden and unexplained deaths on the unit.

I could have been more forthright. I could have have specifically said 'You must remove her from the unit' and I didn't say that

He said: “I can’t recall who among us was the first to articulate possibilities of deliberate harm but when expressed openly it became clear that I was not the only consultant with those concerns.”

He added: “My impression was that all of us began to consider whether her presence was of significance rather than coincidence or bad luck… We were still finding it difficult to think the unthinkable but once that’s on your radar it’s very hard to shut it away and you run the risk of confirmation bias as well and whether you are seeing things that aren’t there.”

Following the incident with Child K, Dr Jayaram said the fears of Letby causing deliberate harm had become “an elephant in the room which was becoming bigger and bigger”.

He said: “We felt completely impotent to know how to deal with it.”

An external thematic review around the same time identified that Letby was on duty at or just prior to nine out of 10 deaths on the unit in 2015, the inquiry has heard.

Dr Jayaram said: “I naively assumed that the nursing director and the medical director would look at that, see the pattern and act.”

He said that Letby should have been removed from the neonatal unit at that point.

He told the inquiry he felt the consultants did not have enough information to raise their suspicions until the third week of June when he passed on his concerns to Karen Townsend, divisional director of urgent care nursing, in a hospital cafe.

He said: “I said, as a group of consultants, we were extremely concerned about these events and we were all at a point, as a group, where we felt natural causes had been excluded as far as they could be, and we were really concerned about her being on the unit.

“My intention was to get some help and support as to what to do because we were not comfortable with Letby continuing to work unsupervised on the unit.

“I could have been more forthright. I could have have specifically said ‘You must remove her from the unit’ and I didn’t say that.”

I would like to apologise for any personal failings and omissions I may have made in the period leading up to June 2016 and afterwards that might potentially have made a difference to avoiding problems

Letby went on to murder Child P, a baby boy, before she was finally moved from the neonatal unit to clerical duties in July 2016 after the consultants expressed similar concerns to the hospital’s executive team.

Hospital bosses then opted to carry out a number of reviews into the increased mortality and did not call in Cheshire Police to investigate until May 2017.

At the start of his evidence, Dr Jayaram told the hearing: “I would like to say to the parents and families of the babies affected by this awful tragedy… I would like to apologise for any personal failings and omissions I may have made in the period leading up to June 2016 and afterwards that might potentially have made a difference to avoiding problems.

“I want to acknowledge that I will take personal responsibility for things that I could have done better and in retrospect some fairly obvious (things) that could have been done better.

“And I would like to apologise as well for the systemic failings that could have contributed to this not being picked up as soon as it could.”

The then clinical lead for children’s services said he did not believe that hospital executives initially took their concerns about Letby seriously.

He said he recalled chief executive Tony Chambers saying to him: “I can see how that would be a convenient explanation for you, but surely there must be something else?”

It just didn't smell right

Dr Jayaram told the inquiry: “What I realise now is that, right from that point, there was a reluctance to consider what we were suggesting could be going on.

“I had no reason to not trust these people. You know they are wise and they are paid large amounts of money to run hospitals.

“I was too trusting… Well, why shouldn’t I be trusting the people who run an organisation in which I work? But it just didn’t smell right.”

He added: “I feel a sense of shame that I allowed myself for such a long time to be treated like that because of my misplaced faith and to believe that maybe I was the problem and I was making completely unfounded allegations.

“There were attempts to sort of try to divide us and play people off against each other but ultimately it is because there were seven of us (consultants) who all had the same concerns that we managed to stick together.

“I never considered myself a whistleblower.”

Dr Jayaram accepted that failing to spot raised insulin levels from the blood tests of two babies, Child F and Child L, whom Letby poisoned in August 2015 and April 2016, was a “collective failure” by the consultant body and they were both “missed opportunities”.

“If you do a test you are trying to find something out and results should be looked at… You can’t assume it is going to be normal,” he said.

Dr Jayaram also conceded he should have told a coroner at an inquest in October 2016 into Child A’s death more than a year earlier that he thought a member of hospital staff may be responsible.

He said: “I had the parents sitting 10ft away from me and yes obviously there is duty of candour. I just didn’t have the courage to say it.”

Letby, 34, from Hereford, is serving 15 whole-life orders after she was convicted at Manchester Crown Court of murdering seven infants and attempting to murder seven others, with two attempts on one of her victims, between June 2015 and June 2016.

The inquiry, sitting at Liverpool Town Hall, is expected to sit until early 2025, with findings published by late autumn of that year.