'I should have had more courage to report Letby'

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

Dr Ravi Jayaram walked in on Letby stood over the infant - known as Child K - whose breathing tube had been dislodged, in the Countess of Chester Hospital in February 2016.

The neonatal nurse was later convicted of attempting to murder Child K.

Dr Jayaram told the Thirlwall Inquiry, which is examining the circumstances around Letby's crimes, that he had been outside a nursery on the neonatal unit when he realised she was alone with the baby.

He said he felt "significant discomfort" and decided to go in, despite thinking he was being "irrational and ridiculous".

“There has been a lot of speculation but I didn’t walk in and see anything," he said.

"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."

Dr Jayaram was able to resuscitate Baby K, and said he thought: "How has that happened?"

Asked why he said nothing about the incident at the time, Dr Jayaram told the inquiry: “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 babies 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 presence of Letby during sudden and unexplained deaths on the unit.

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 Townsend, divisional director of urgent care nursing, in a hospital cafe.

He said: “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.”

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."

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.

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