Breathing tubes became dislodged on 40% of shifts that Lucy Letby worked as a trainee nurse in Liverpool before she went on her killing spree at the Countess of Chester Hospital, a public inquiry has heard.
Letby, 34, is understood to have completed two work placements at Liverpool Women’s Hospital between October and December 2012, and January and February 2015.
The Thirlwall Inquiry is examining how the 34-year-old was able to murder seven babies and attempt to murder others from June 2015 to June 2016.
In his opening statement on Thursday, Richard Baker KC, representing nine families, said that collapses in neonatal units involving “unusual” complications such as dislodgement of endotracheal tubes was “uncommon”.
He said: “It generally occurs in less than 1% of shifts.
“You will hear that an audit carried out by Liverpool Women’s Hospital recorded that whilst Lucy Letby was working there, dislodgement of endotracheal tubes occurred in 40% of shifts that she worked.
“One may wonder: why?”
Earlier this year, a jury found Letby guilty at retrial of attempting to murder Child K, a baby girl, by deliberately dislodging her breathing tube in February 2016.
She was transferred to a specialist hospital where she died three days later. Mr Baker said Child K’s parents believe “with justification” that she was murdered by the nurse.
Letby targeted Child K after the infant was moved from the delivery room to the neonatal unit shortly after her premature birth, prosecutors had said.
She was initially charged with Child K’s murder but the allegation was dropped in June 2022 as the Crown offered no evidence.
Mr Baker said the parents of another baby girl, Child J, say they too “had no doubt” that Letby caused an unexpected collapse in November 2015.
Jurors could not reach a verdict on the allegation of attempted murder, but parents believe Letby also targeted their daughter the following month, although no charge was brought.
A review by Cheshire Constabulary of the care of some 4,000 babies admitted to hospital while Letby was working as a neonatal nurse remains ongoing.
The period covers her spell at the Countess of Chester from January 2012 to the end of June 2016, and also the work placements in Liverpool.
Peter Skelton KC, representing another seven families, told Lady Justice Thirlwall that a number of “basic failures” by the hospital had “fatal consequences”.
He said: “The first failure was to conduct swift, careful and methodical investigations into why each of the deaths occurred and whether there were connections between the deaths.
“That was a major and catastrophic failure.”
Mr Skelton said it meant vital information was overlooked and that the cluster of deaths and collapses should have been escalated to senior management within the hospital trust immediately, so they could have overseen investigations.
He added: “From the outset, and without prejudice and without pre-judgment, it should have been in the minds of those conducting and overseeing the investigations that the cluster of unexpected and unexplained deaths might have been caused by the criminal acts of a member of hospital staff.”
As well as the Allitt case, Mr Skelton said that in May 2015, just before Letby’s crimes began, nurse Victorino Chua was sentenced for murdering patients at Stepping Hill Hospital.
He said: “It is difficult to understand why events at Stepping Hill did not at the very least alert those at the Countess of Chester from the start that the cluster of unexpected deaths were the result of potential criminality and that active steps were required to rule out that possibility.”
Mr Skelton said the police and coroner should have been informed at the outset, which could have had a “profound effect” on the course of events.
Another failure was not to inform the families that the deaths were being investigated with a view to finding out why they occurred, he said.
Mr Skelton said: “You will hear from some of the parents over the next few weeks about how they were kept in the dark about the collapses of the babies and the concerns and investigations that were being undertaken into their babies’ deaths.”
He said the consultants who flagged concerns about Letby “deserved the gratitude” of the families and had acted with “tenacity” and “courage” in “genuine fear of adverse professional consequences”.
But he said they should have outlined their concerns clearly and formally in writing and ensured they were brought to the attention of the management and the board. Furthermore, they should have spoken to the police if they were not satisfied, he said.
Mr Skelton said it seemed the hospital’s then-medical director Ian Harvey does not accept he should have told the police sooner about Letby, or accept personal responsibility that she was not caught sooner.
He said: “It was not for Mr Harvey to assess the validity of the concerns.
“The consultants were treated by him as a problem that would not shut up and go away.”
Mr Baker said families were not informed about known issues over the care of their children.
He said: “Some families were given information that was misleading or dishonest. The families will say that the trust’s interactions with them, especially following June 2016, were lacking in transparency and were dishonest.
“They believe that the senior management at the Countess of Chester Hospital deliberately misled them in order to hide the truth and in order to protect their own reputations and those of the trust.”
The inquiry heard the hospital accepted there were failings and would not “seek to shirk” its responsibilities.
Andrew Kennedy KC, representing the Countess of Chester Hospital Trust, said: “The trust accepts that from July 2016 there were significant communication failings such that it failed in its duty of candour towards the parents.”
He added: “The trust remains committed to assist in any way it can and it recognises that the inquiry will identify failings on its part and potentially on the part of others.
“That’s a vital exercise so that it and the wider NHS may learn from those failings.”
Letby, 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.
The inquiry is expected to sit until early 2025, with findings published by late autumn of that year.
A court order prohibits reporting of the identities of the surviving and dead children involved in the case.
