Babies breathing tubes became dislodged on 40 per cent 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, the public inquiry into her crimes heard today.
Letby, 34, completed two work placements at Liverpool Womens 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 seven more at the Countess during a year-long killing spree, between June 2015 and June 2016.
In his opening statement, Richard Baker KC, representing 12 families, said that collapses in neonatal units involving unusual complications, such as dislodgement of endotracheal tubes, were uncommon.
It generally occurs in less than one per cent of shifts, the barrister said.
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Lucy Letby (pictured) is serving 15 whole-life orders after she was convicted of murdering seven infants and attempting to murder seven others, with two attempts on one of her victims
But he added: You will hear that an audit carried out by Liverpool Womens Hospital recorded that, whilst Lucy Letby was working there, dislodgement of endotracheal tubes occurred in 40 per cent of shifts that she worked. One may wonder why?
Mr Baker said the convictions and the indictments against Letby did not tell the full story.
Earlier this year a jury found her guilty at a retrial of attempting to murder Baby K, a very premature infant she was caught attacking virtually red-handed hours after she was born. Baby K was transferred to a specialist hospital where she died three days later.
Letby, of Hereford, was originally charged with the baby girls murder, but the charge was later dropped before trial and no evidence offered.
Sources have told the Mail that prosecutors feared they would not be able to prove the causal link between Letbys actions and the babys subsequent death.
But Mr Baker said Baby Ks parents believe with justification that their daughter was murdered by the nurse.
A court artists sketch of Lucy Letby giving evidence at Manchester Crown Court on July 24
Lady Justice Thirlwall arrives at Liverpool Town Hall ahead of the hearings beginning
A sign outside the entrance to Liverpool Town Hall
Lady Justice Thirlwall, pictured yesterday, is chairing the investigation at Liverpool Town Hall
Dr Dewi Evans, the lead prosecution expert who gave evidence on 17 separate occasions over the ten-month trial at Manchester Crown Court, previously told the Mail he had suspicions that Letby experimented with moving babies breathing tubes as a method of causing harm before she began injecting air into their bloodstreams, or into their tummies via their nasal feeding tubes in a bid to kill.
One thing we can be reasonably sure of is that Lucy Letby did not turn up to work one day and decide to inject a baby with air into their bloodstream, he said.
I think the modus operandi evolved over time and I think that prior to air embolus tube displacement was probably something that she did.
A review by Cheshire Constabulary of the care of some 4,000 babies admitted to both hospitals while Letby was working as a neonatal nurse remains ongoing.
Both Mr Baker and Peter Skelton KC, representing another seven families, singled out the hospitals executive team for serious criticism in their opening speeches.
Mr Baker said just weeks before Letby murdered her first victim, Baby A, another nurse, Victorina Chua, was jailed for killing two patients at a hospital less than 40 miles east of Chester, at Stepping Hill, in Stockport.
Mr Baker said, in that context, it was surprising in the extreme that bosses at the Countess regarded the possibility of a healthcare worker harming patients at their Trust as unthinkable.
Worse, Mr Baker said, was that families now believe the executive team had deliberately lied, covered up and suppressed concerns about Letbys conduct and the harm she had caused their children to protect reputations.
The families regard the approach of the Trust as going beyond a lack of candour, Mr Baker said. 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.
Body worn camera footage from Cheshire Constabulary of the arrest of Lucy Letby in 2018
A sign outside the Countess of Chester Hospital in Chester
Letby worked on the neonatal unit at the Countess of Chester Hospital (pictured) between June 2015 and June 2016
The investigation at Liverpool Town Hall (pictured yesterday) will examine how Letby was able to attack babies on the Countess and Chester Hospitals neo-natal unit in 2015 and 2016
Mr Skelton singled out medical director Ian Harvey, adding: It is most striking that even now, eight or nine years later, Ian Harvey simply doesnt accept personal responsibility for Letby not being caught sooner.
He does not accept that when he was told of suspicions about Letby he should have informed the police. Instead, he and others repeat the mantra that the paediatric consultants never presented evidence that she was connected to the deaths.
Mr Skelton 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.
The barrister said a report into Beverley Allitt, a nurse who killed children at Grantham Hospital, Lincolnshire, in 1991, sought to ensure that healthcare staff were prepared to keep their minds open to the possibility of criminal conduct.
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.
Thats a vital exercise so that it and the wider NHS may learn from those failings.
Peter Skelton referred to the case of Angel of Death serial killer Beverley Allitt (pictured)
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.