A TV paediatrician has told a public inquiry that he lies awake at night thinking about how he should have had more courage and voiced his concerns about Lucy Letby after virtually catching her.
Letby was convicted of the attempted murder of Child K by dislodging her breathing tube before Dr Ravi Jayaram walked into a nursery room in the Countess of Chester Hospitals neonatal unit in February 2016.
The prosecution at Letbys 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 Letbys crimes, Dr Jayaram said he had been sitting outside the nursery reading medical notes when he realised Letby was alone with Child K.
He said he felt significant discomfort, but also thought he was being completely irrational and ridiculous before deciding to go in just to make sure everything was fine.
Senior paediatrician Dr Ravi Jayaram says he should have had more courage and voiced his concerns about Lucy Letby
Letby was convicted of the attempted murder of Child K by dislodging her breathing tube before Dr Ravi Jayaram walked into a nursery room in 2016
He said: There has been a lot of speculation but I didnt 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 didnt I? I lie awake thinking about this.
Its the fear of not being believed. Its the fear of ridicule. Its 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.
This comes after a specialist doctor claimed she had been misled by hospital bosses after asking to review baby deaths at a hospital where Lucy Letby murdered patients.
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.
He said: I cant 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.
Letby was convicted of murdering seven babies and trying to kill seven more at the hospital between June 2015 and June 2016
Childrens nurse Lucy Letby (pictured in a custody photo, left; and while working in hospital, right) went on a year-long killing spree while working at the Countess of Chester Hospital
We were still finding it difficult to think the unthinkable but once thats on your radar its very hard to shut it away and you run the risk of confirmation bias as well and whether you are seeing things that arent 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 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 Towsend, divisional director of urgent care nursing, in a hospital cafe.
He explained: 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 didnt say that.
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 hospitals 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.
The neonatal nurse was redeployed into an administrative role after doctors demanded she be moved off the unit following the deaths of two triplet brothers on consecutive shifts in July 2016. Pictured: The Countess of Chester Hospital
Supporters of ex-nurse Lucy Letby demonstrate outside the High Court during her appeal hearing on April 25
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 childrens 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?
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 shouldnt I be trusting the people who run an organisation in which I work? But it just didnt smell right.
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 cant assume it is going to be normal, he said.
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.