Lucy Letby's murder trial continues at Manchester Crown today. Her defence barrister Ben Myers KC is expected to wrap up his closing speech to the jury. For the last nine months the nurse has been on trial for the murder of seven babies and the attempted murder of a further 10
Mr Myers is on his feet, he's continuing to take the jury back over the evidence for triplet brother Child O. The court heard he was stable up until 23 June 2016, when he suffered a "remarkable deterioration", he stabilised but later suffered a further fatal collapse.
Mr Myers says the explanation of the experts - that there was an assault which resulted in a trauma to the liver and air embolus - is 'confusing'. He invites the jury to consider 'how, where and when' this things happened. He said it's 'very unclear'.
Mr Myers says the prosecution has not identified a time or place where these alleged offences took place.
Mr Myers has pulled up the neonatal review - which has been pulled together by police analysts and is a timeline of events - it shows that Child O was given medicines by two other nurses at 14:39. Ms Letby is seen as doing an infusion at 14:40, just before the collapse
Mr Myers notes the door swipe data which shows Ms Letby only arrived at 14:39 on the unit. He drills deeper into the clinical notes which show Child O collapsed at 14:40 and then Ms Letby, on instruction from a doctor, began an infusion in response at 14:40 ie after the event
Mr Myers says 'it's important to keep this in mind, the suggestion has been made that at 14:40 somehow Ms Letby was involved in what took place before the collapse, she was not'
Mr Myers picks up on the evidence of an independent pathologist, who reviewed the case. He said the boy suffered an "impact injury" akin to a road traffic collision - which caused bruising on his liver
Mr Myers says 'the truth is' we 'don't know' how much force it took to make those bruises. He says the pathologist picked 'graphic examples' but cannot say how 'little force' it would take to cause those injuries in a neonate
The barrister says it is a 'possibility' that the bruising was a result of CPR during the failed resuscitation attempts on Child O
Mr Myers is pulling up messages sent between Ms Letby and a doctor who cannot be named on 1 July 2016. They were talking about the events surrounding Child O's collapse
The doctor tells Ms Letby that one of his doctor colleagues was 'was upset' as the boy's liver issue 'may have been cause by her chest compressions'. He said he had to reassure the doctor for 20minutes
Mr Myers says this 'raises the possibility that injury can be caused by CPR, plainly this was something she was concerned about'. He invites the jury to keep this in mind
Mr Myers notes that the prosecution have made much of Ms Letby's Facebook searches for the parents of Child O. He says 'nothing about those' searches establishes guilt and says 'how is that meant to indicate she had done something to harm' him
Mr Myers now turns to Child O's triplet brother, Child P. At 09:35 BST on 24 June 2016, a registrar found he was "self-ventilating in air" and stable, but 15 minutes later, he collapsed and required breathing support.
He collapsed several more times, before being pronounced dead at 16:00. A medical expert for the prosecution said the collapses were consistent with an "additional amount of air being given to this baby"
Mr Myers says this case is another example of the Crown trying to 'shunt blame Ms Letby's way', he says the management of Child P's care was 'poor'. He notes that the baby had a pneumothorax and a X-ray which would have shown this was delayed
Mr Myers says Child P's 'death was in all likelihood a consequence of poor medical procedure' after his 09:40 collapse. He says this case is 'a prime opportunity to hide poor performance and bad outcomes' and blame Ms Letby
A registrar Dr Ukoh recorded that at 09:35 on 24 June that Child P was self-ventilating in air. 15 minutes later, he suffered an acute deterioration at 09:50 hrs. Mr Myers says the Crown's case is that at some point between 09:35 and 09:50 Ms Letby injected the child with air
He says 'whatever has happened, there is no opportunity' for Ms Letby to do this and says given the cast of doctors and nurses in the room it is implausible in the extreme
Mr Myers is taking the jury back over medical notes for Child P from the early hours of 24 June. He says they show the 'direction of travel', he says he was nil by mouth at this time. The senior nurse on duty said the child's abdomen appeared distended at 04:00
Mr Myers is going over the evidence for Child P final and fatal collapse when medics were waiting on a transport team from Arrowe Park to take him. A doctor who cannot be named recalled Ms Letby saying 'he's not going to leave here alive is he'
The doctor gave a vivid account of how she felt this was inappropriate and that Child P had just had a good gas was okay. But Mr Myers has said the clinical evidence shows Child P had an undiagnosed pneumothorax
He also notes that the doctor had said by this stage she was aware of rumours about Ms Letby - but he said 'there’s not even a datix report, not in the notes, no complaint, no issue raised about' what Ms Letby is alleged to have said
Mr Myers says the evidence does show the child was unwell and the doctor, in charge of his care, 'felt out of her depth' - she said in evidence how she was counting down the minutes waiting for the transport team to take him
Mr Myers says if Ms Letby did make the remark alleged it may have been out of 'social awkwardness' and does not prove murder
He says the allegation here against Ms Letby is 'utterly implausible'. He also cites the fact a senior doctor was seen by the mother of Child P 'googling' how to insert a chest drain - he says that is 'indicative of the level of care at the Countess of Chester'
Mr Myers is now on Child Q - the last child on this indictment. He was born in late June 2016 and was "initially stable" after his birth, but jurors heard he deteriorated and needed breathing support shortly after 09:00 on 25 June.
The prosecution said Ms Letby injected air and fluid into the boy's stomach via a nasogastric tube. A medical expert for the prosecution said vomit found on Child Q was evidence that liquid had been given to him and his respiratory problems were likely caused by the fluid
Mr Myers says there's 'no evidence of her having done anything at all' to cause Child Q's collapse
Mr Myers says the clinical evidence is 'consistent with early stage Necrotising enterocolitis (NEC)' - this is a serious condition that can affect newborn babies

