Behavioral Finance

Trading pattern cheat sheets that misunderstand trading

Summarising

• She said we had so much in common and that the first thing we had in common was my boyfriend.
• She told me how her taste in men was changing and then proceeded to describe my boyfriend to a T.
• She very awkwardly introduced my boyfriend to her parents while I was there and I was kind of the tag along like “oh yeah and this is his gf”.

Nicholas Johnson KC, for the prosecution, will now cross-examine Lucy Letby.
He first asks about the 'conspiracy gang' of four doctors, as Letby previously said there was in the Countess of Chester Hospital last Thursday.
Here was our story about it last Thursday: https://www.chesterstandard.co.uk/news/23532467.letby-gang-four-consultants-pinned-baby-deaths/
He clarifies a minor matter about it.

Child E

Mr Johnson KC asks about the case of Child E.
Letby says: "Possibly yes" to the question if there was medical incompetence that led to Child E's death, in that the night shift team "could have reacted sooner" to the child's bleed.
She says once Child E was bleeding at 10pm, a transfusion could have been made sooner.
She says the "collective team" were responsible.

Letby says it was "an important thing to know" that plumbing issues were a potential contributory factor to the decline of babies' health in the unit.
She said "raw sewage" would come out of the sinks in nursery room 1, as flowback from another unit.
Mr Johnson asks if Letby ever filled in a Datix form for that. Letby says she did not.

Letby then says it is an "important factor to note there were often plumbing issues within the unit".
Letby is asked what this has to do with the death of Child E - or any of the children involved.
She says there was "raw sewage coming out of the sinks and running onto the floor in the intensive care unit".
She says this could have had an effect as well as staff being unable to properly wash their hands.

Mr Johnson says Letby did fill in a Datix form for Child E.
The form is shown to the court. It is dated August 4, 2015, at 5.53am, which is when the form was signed and filed.
It is classed as a 'clinical incident'.
The risk grading was 'high potential harm'. Letby says she is "not sure about that", as it also says 'Actual harm: None (No harm caused).
It refers to the death of Child E at 1.40am. 'Description: Unexpected death following GI bleed. Full resus unsuccessful. Time of death 01:40.'
The baby's history is recorded in the events leading up to his death. It was filled in by the incident review group panel.
Letby's input on the panel is reporting the incident on the first page of the nine-page report.

Letby is asked if she remembers sending a text message to Jennifer Jones-Key saying it was "too Q word" on August 2, 2015. Letby says she cannot recall, but accepts that would be something she could send.
The 'Q word' is 'quiet', the court hears.
Letby says "there is always something to do", but "sometimes they can be long nights if you haven't got many babies".
She says she enjoyed being busy "when it was managed".

Letby is asked why she, and not Child E's designated nurse Melanie Taylor, signed a correction to a prescription for Child E. Letby says it's standard practice for two nurses to administer prescriptions, and corrections on the form are not based on seniority. She agrees she was keen to raise issues if they needed correcting.
NJ: "Had you fallen out with Melanie Taylor by this stage?"
LL: "No."
Letby denies she had fallen out with anyone.
She agrees she had confidence in her clinical competencies.
NJ: "Do you agree you were a cut above some other nurses, including Mel?"
LL: "No."

A nursing note for Child E from the evening of August 3, 2015 is shown. Letby agrees he was progressing well, although he needed insulin.
Letby agrees Child E at this stage showed no sign of gastro-intenstinal problems.
A rota is shown to the court, showing Letby was the desingated nurse for Child E and Child F in room 1. No other babies/nurses were allocated in that room that night.
Letby is asked if there was anything wrong with this arrangement. Letby: "No."
Mr Johnson says when Letby was giving evidence to Mr Myers, she said when the mother arrived at the unit, she was "bringing milk". Letby says she does not recall from her memory. Mr Johnson says that was what she said on May 5.
Letby: "I can't recall right here right now."
Letby says she cannot remember it specifically, but accepted that version of events. "I don't have any clear memory."
Mr Johnson refers to the transcript from that day, in which Letby told Benjamin Myers KC she believed Child E's mother had arrived at the unit bringing expressed breast milk.
Letby says: "I said 'I think' she brought expressed breast milk." She says it's the same thing.

Mr Johnson asks about the significance of 9pm that night. Letby says: "I don't know what you mean."
Mr Johnson says it's the mother's evidence that she knew Child E was due a feed at 9pm, so came down to the unit for that feed.
Mr Johnson says Letby's recollection that Child E's mother brought milk with her fixes the time as being 9pm.
Letby: "I don't agree."
Mr Johnson asks about the 16ml 'mucky aspirate', which Letby agrees was taken before 9pm.
Mr Johnson asks where the milk for the 9pm feed was coming from.
Letby says the milk would come from the milk fridge in nursery room 1. She says she does "not remember" where the milk would come from for this feed specifically.
No feed was recorded for 9pm.
Mr Johnson says the SHO did not record no feed for 9pm, having said in evidence that would be the sort of thing he would record for a baby.
Letby says sometimes doctors don't record such notes

On 3 August 2015, Child E was recorded as making very good progress. He would be dead less than 24 hours later.
"I wouldn't say he was very well, but yes he [was] making progress with his feeds," Letby tells the court.
The twins were the only occupants of nursery one - and Letby was the only nurse in this specific room. All other babies were elsewhere being looked after by other staff.
"You had the nursery to yourself?" Nick Johnson, prosecuting, asks.
"I was the only nurse allocated babies, yes," Letby replies.
Child E's mother brought expressed breast milk to the unit to feed her children - Letby is now asked about what happened when she appeared.
She says she does not remember. Nick Johnson then reads a transcript from her questioning by her defence lawyer, Ben Myers, from last week.
Myers: Do you recall why she had come down?
Letby: I don't recall specifically no.
Myers: Did she have anything with her?
Letby: I think she brought breast milk down.
He asks why Letby was unable to answer the question a few minutes ago.
The insinuation is the mother brought the milk at 9pm - at the time it was believed Child E was already bleeding, and when he was due a feed.
Letby says she believes Child E's mother came down later.
Letby says she spoke to an on-call doctor about omitting his 9pm feed. But the prosecution is suggesting this "conversation never happened".

Letby is asked why the 'large vomit of fresh blood' is not recorded on the observation chart for 10pm. Letby says she recorded it in her nursing notes, and Dr David Harkness was present when it happened.
Letby is asked why she waited over an hour for the observation of the aspirate to be raised with the doctor.
LL: "I don't recall speaking to a doctor", but Letby recalls speaking to an SHO on the phone about it.
Letby says there was no observation of blood prior to 10pm.
NJ: "Was [Child E's mother] telling the truth about you?"
LL: "In what sense?"
NJ: "In the sense of what you said to her - when she says she came down to see her boys, she saw [Child E] with blood around his lips."
Child E's mother's illustration of what she says was present on Child E's lips is shown to the court.
NJ: "Did you ever see anything like that?"
LL: "[Child E] did have blood like that - after 2200."
Letby adds "there was no blood prior to that."
Letby accepts she was alone in room 1 when the mother came down. She says that would have been around the handover time at 8pm.
NJ: "You are not telling the truth about that, are you?"
LL: "Yes I am."
Letby says she does not accept causing an injury to harm Child E. She denies at any stage 'having a fall out' with Child E's mother.
Letby says she has never seen a baby with blood like that around her mouth in her career. She agrees it was "wholly exceptional".
She denies telling Child E's mother the cause of the bleed was via insertion of the naso-gastrinal tube. She says the insertion could cause "a small amount of blood" from the tube.

Letby is asked if she recalls telling police in the case of Child N that NG Tubes can cause bleeding. Letby says it does cause blood, but not in the mouth.
Mr Johnson says Letby has said that previously it can cause oral bleeding. Letby: "Ok."
She denies saying that happened in this case.
She says "medically speaking", "any baby" could have a bleed like the sort seen by Child E.
A text message from Letby to Jennifer Jones-Key is shown: "...He had massive haemhorrhage could have happened to any baby x"
Letby says "at the time" it was thought Child E could have NEC, and "any baby could have had the condition [Child E] had."

Letby is asked to look at her defence statement.
She says Child E's mother had come down with some expressed milk. The statement is dated February 2021.
Letby, in her statement, said "This may have been later than 2100".
Mr Johnson says Letby is now ruling out a time before 2200.
Letby says she cannot say it definitively, but there was no blood prior to 2200.
Letby is asked why she did not mention the vomit when blood went down the NG Tube in her defence statement.
Mr Johnson says Letby is lying by adding additional detail afterwards. Letby denies this.
Mr Johnson asks about the 'mucky aspirate' for Child E, asking if that is 16ml of 'bile', as per Letby's defence statement. Letby says there was bile in the mucky aspirate.
Mr Johnson says there is a difference between 'bile-stained' and 'bile'. Letby accepts 'there was 16ml of bile' in her defence statement is "an error".
She is asked why she put that in, in those terms.
LL: "I don't know."
Letby says this is a clarification of her earlier statement.
NJ: "You are lying, aren't you?"
LL: "No."
The defence statement also refers to 'blood in the nappy' for Child E after he died. Mr Johnson says if that has been heard in her evidence. Letby says she cannot recall.
Letby says it is written in her nursing notes, and nothing was done about it as Child E was deceased by that time.
Letby is asked to look at her nursing notes.

Letby is asked as to why her case "has changed" since she gave a full statement to the police. A number of details, the prosecution claims, now contradict what she is saying in court.
"You are lying, aren't you Lucy Letby," Nick Johnson asks, not for the first time referring to her by her full name.
"No," Letby replies.
She is then asked about a statement she made claiming there was blood in Child E's nappy after his death.
She says she wrote something about this in her nursing notes.
The prosecution then hands her a copy of her nursing notes - a short break is called so Letby can reread her notes.
Before the break, Letby was handed a copy of her nursing notes from the night Child E died.
She previously claimed she had recorded in her notes there was blood in his nappy. Letby now tells the court her notes show she did not write anything about blood in Child E's nappy.
"You knew that wasn't true," Nick Johnson, prosecuting, asks.
"No, I couldn't recall my notes specifically at that time."
The prosecution claims Letby has repeatedly falsified medical notes - this being another example of how her recollection of events has changed.

Mr Johnson says Letby's nursing notes for Child E, as read by Letby during the break, do not record blood in the nappy.
Letby says she could not recall her notes specifically at this time.
Mr Johnson reads about what other medical staff observed following Child E's collapse.
Dr David Harkness recorded, for Child E's observations following the collapse, 'kind of strange purple patches that appeared on the outside of his tummy'. Letby says it was purple, but not patches.
Letby said the other parts were 'more pale' than the pink described by Dr Harkness.
Dr Harkness said he'd only ever seen it before with Child A.
Letby disagrees. She says it was "not the same".
Asked to explain the differences between the two, Letby says it was a "solid block of purpleness" for Child E, and a "more mottled look" for Child A.
Letby agrees it was over the abdomen, but disagrees the purple patches moved around.
Mr Johnson reads through another doctor's observations, who said she had not seen the discolouration, but Dr Harkness was "animated" when he was describing what he had seen to her.
Letby says she was not there for any conversation between the two of them.

Letby is asked to read her retrospective nursing note for Child E, which described Child E's collapse and subsequent decline until he died in his parents' arms at 1.40am.
The note would have been made with reference to medical notes, Letby tells the court.
Letby is asked to look at an observation chart and a blood gas chart.
Letby says when things are going on, it would be standard practice to write, also, on the back of handover sheets or spare bits of paper.
Letby is asked about a "purple band" of discolouration she had recorded for Child E. In her police interview, Letby accepts struggling to recall the size of it at that time.
Mr Johnson says for May 5's evidence, Letby said it was a "red horizontal banding across his abdomen", and only on the abdomen.
Letby agrees with Dr Harkness it was on the abdomen, but does not agree with Dr Harkness's observation it was patches.

Letby is asked to look at a chart showing aspirates for Child E, which included 'minimal aspirates' prior to the collapse.
Letby agrees that showed no signs of gastro-intenstinal issues for Child E, until the 9pm reading of 16ml 'mucky' aspirate, in her writing.
Letby "cannot recall" why Belinda Simcock had written in the 10pm aspirates column. Letby "assumes" the blood came out following those 10pm readings.
"Why was Belinda there at all?"
"I can't say for sure."
Letby says Belinda had come to assist for the 16ml aspirate observed an hour earlier.
Letby says she "cannot say" why Belinda was carrying out observations at that time.
Letby says she "cannot explain" why the blood aspirate is not recorded in the aspirate chart, but is in her nursing notes.
Letby is asked to read a note on the schedule for Child E, in which it is said Belinda Simcock gave a feed to a child in room 2 at 10pm.
Letby says she cannot recall why Belinda Simcock had come to room 1 for the 10pm readings.
Mr Johnson asks if Belinda Simcock was brought in to sign paperwork at the time of the collapse to cover for Letby's actions. Letby denies this.
Letby said Belinda Simcock had carried out the drip readings for Child E, and signed it, as specific information like that is not passed on from one nurse to another.

Letby is asked if she recalls who rang Child E's mother when Child E collapsed.
She said it would have been a "collective decision" to contact the midwifery staff.
Letby accepts Child E's mother made a phone call at 9.11pm, but does not accept the evidence of the conversation about Child E 'bleeding from his mouth' and there was 'nothing to worry about'.
Benjamin Myers KC, for Letby's defence, rises to say Letby cannot say what was or was not said in a phone call she was not part of.
NJ: "You killed [Child E], didn't you?"
LL: "No."
NJ: "Why in the aftermath were you so obsessed with [Child E and F's mother]?"
LL: "I don't think I was obsessed."
Letby says she "often" thought of Child E and Child F.
Mr Johnson says the name of Child E and F's mother was searched for nine times, and the name of the father once.
Letby said she searched "to see how [Child F] was doing."
One of the searches was when Child F was on the neonatal unit.
Letby said the other searches were made after Child F had left the unit, so "collectively" what she had said was correct.
Mr Johnson says Letby was looking for the family's reaction. Letby disagrees.
One of the searches is on Christmas Day. "Didn't you have better things to do?"
Letby said the family were on her mind.

Child G

Mr Johnson tells the court he is now looking at the case of Child G. He will go 'out of sequence', chronologically, and deal with Child F at a later point.
Letby says she cannot recall what Child G's due date would have been [Child G having been born at a gestational age of 23 weeks and 6 days on May 31, with the date of one of the events "not standing out" to her.
A message from Letby's phone to a colleague: "Due date today!"
Letby says she knew at the time [September 21, 2015].
Letby says the date of the event for Child G was "a coincidence".
Letby says Child G had "extreme prematurity" which had complications requiring additional care.
Letby disagrees that Child G was "fine" by the time she came to the Countess of Chester Hospital, saying she had a number of ongoing issues.

Child G was born extremely premature, at a different hospital, before being moved to the Countess of Chester.
Letby initially claims she did not remember Child G's due date.
But a September 2015 text shown to the court says: "Due date today!"
"By the time she arrived at Chester [Hospital], she was fine, wasn't she?" Nick Johnson, barrister for the prosecution, asks.
"I don't agree she was fine, she had a number of ongoing issues," Letby replies.
The prosecution says Child G was due to go home when she first collapsed - she was in nursery four, the one for the lowest dependency babies.
Letby disputes this.
"Are you exaggerating her problems?" Mr Johnson asks.
"No," Letby replies.
She says Child G was still being tube fed and needed a higher level of care. But the prosecution asks Letby what specific problems the infant may have had that meant she wasn't due to go home imminently.
"As of the 7 September, what were the unusual problems that Child G had?" Mr Johnson asks.
"I can't answer that," says Letby.

Letby denies that Child G was ready to go home by the date of the first event on September 7, saying babies in the special care room, nursery 4, can still be there for several weeks.
Letby says Child G had a number of previous problems including relating to feeding, and had sepsis.
Letby says Child G was on oxygen and had feeding issues by September 7, 2015.
Mr Johnson asks Letby to look at Child G's nursing records for her days leading up to her projectile vomit. Letby agrees there is nothing "unusual" in those days.
Feeding charts are shown for Child G for September 5 and 6. Child G is being fed expressed breast milk via the NGT or bottle. Letby agrees the picture is looking good for Child G from these charts.
Mr Johnson says the feed at 11pm on September 6 would not have been done twice by mistake. Letby says she has never suggested that has happened.
Letby agrees the observations for Child G before 2am on September 7 are "good".

Letby has claimed Child G still needed oxygen - but charts from the time show this was removed two days prior.
"I know she was back on it by the 7 September," Letby says.
"Of course, she was because by that point she had brain damage," prosecution lawyer Mr Johnson replies.
He then asks: "Would you agree, all the signs on the 5th are good?"
"Yes."
Letby also agrees Child G's vitals were "good" the following day.
"Do you agree the picture shown by the data is a good one?" Mr Johnson asks.
"Yes."
Child G first collapsed as she celebrated a particular life milestone - which the staff had been planning to mark.
A text Letby sent to a colleague after the first collapse is show to the court.
It said: "Awful isn't it. We'd all been sat at desk at start of night making banner".

NJ: "You knew this was day 100 of [Child G's] life, didn't you?"
LL: "Yes."
NJ: "It was a big day for her."
LL: "Yes."
Letby agrees she and other nurses would celebrate 100-day-old babies on the unit, and a banner had been prepared to mark the occasion.
A staffing rota for the night shift of September 6-7 is shown to the court. Letby is in room 1 as the designated nurse for one baby, and Ailsa Simpson is the designated nurse for one other baby in room 1. A nursing colleague is in room 2 as the designated nurse for Child G.
Letby rules out staffing levels or staff incompetence as a contributory factor in Child G's death.
Asked if anyone had made a mistake, Letby says "potentially", Child G had been overfed by a nursing colleague, but that was not what she was saying had happened.
Letby: "I can't say for definite that didn't happen. I'm not saying she did do that, but it is a possibility."
Letby says it is a "possibility" the amount of milk was mismeasured when calculating the feed.
NJ: "Are you suggesting it's a realistic possibility?"
LL: "No."

Nick Johnson, the prosecution barrister, is continuing to question Letby's claims her colleague (who cannot be named for legal reasons) overfed Child G.
"To have fed Child G twice as much presumably would have taken twice as long?" Mr Johnson asks.
"Yes," Letby replies.
Letby says the experts presented evidence of overfeeding.
"How would they know? Which experts?" Mr Johnson asks.
Letby takes a sip of her water and does not reply to this question, staring straight ahead in silence.
Mr Johnson then asks about the scene when Letby and her colleagues discovered Child G had vomited onto the floor.

Nicholas Johnson KC continues to cross-examine Lucy Letby in the case of Child G.
Letby says it was a "possibility" Child G was overfed by a nursing colleague, but adds: "I don't believe that happened."
Mr Johnson says to overfeed Child G twice as much would have taken twice as long.
Letby says 45mls of milk feed would take around 15-20 minutes.
Letby refers to medical experts Dr Evans and Dr Bohin that overfeeding was a possibility.
Mr Johnson describes what Letby had seen, including that Child G's abdomen was "firm and red", with the sight of that and vomit on the floor leaving her "shocked".
"That was a clear recollection you had last week, giving evidence?"
Letby says that happened at approximately 2.15am.
Her nursing note is shown to the court: '[Child G] had large projectile milky vomit at 0215. Continued to vomit++. 45mls milk obtained from NG tube with air++. Abdomen noted to be distended and discoloured. Colour improved few minutes after aspirating tube, remained distended but soft...to go nil by mouth with IV fluids...'
Letby says she disagrees with the evidence of Dr Sandie Bohin, saying a pH reading of 4 can be obtained from milk aspirated from the stomach

A photo of Child G's cot, with circles marking where the vomit fell outside of the cot, is shown to the court.
Letby is asked to look at her police interview for Child G.
Letby said it was in her cot.
NJ: "This was an extraordinary vomit, the likes of which you had not seen in your career."
LL: "I have, but not in neonates."
Letby says it's an "oversight" she had not mentioned the extent of the vomit in police interview.
Letby says Child G was "still vomiting" when she went in to see Child G with Ailsa Simpson.
NJ: "You were not there with her, were you?"
LL: "Yes I was."
Letby is asked to look at her police interview. She says at the time of the vomit she did not remember where she was, then went into the room where Child G was.
Letby is asked why there is no mention of Ailsa Simpson in the interview. Letby says she was describing her own response.
The neonatal schedule is shown to the court for Child G.
Mr Johnson says Letby deliberately misstated the time at which Child G had her vomit [at 2.15am], and says it was much closer to 2am. Letby disagrees.

The prosecution now says Letby "misrepresented" the time Child G vomited - which she says was 2.15pm.
Letby claims she and a colleague (who cannot be named for legal reasons) were at the nursing station at the time Child G collapsed.
But notes from the unit show this colleague was feeding a different baby at 2.15pm - and the length of time it would have taken for her to defrost and warm that baby's milk would have made it impossible to be where Letby says she was.
This colleague also says she was called to Child G at 2.35pm.
The prosecution says Letby changed the time to try to point suspicion in the direction of the colleague, who was her "best friend".
"No," Letby says.
"You deliberately overfed her," says Mr Johnson.
"No, that's not true," Letby says.

Mr Johnson refers to Dr Alison Ventress's notes 'Called to v [Child G] at 2.35'.
He says that is an accurate time, and Letby had misstated the time so Letby's colleague could instead be blamed for overfeeding, and Letby overfed Child G.
Letby: "That's not true."
Mr Johnson asks where the air came from before 'Neopuffing'. Letby says she cannot say without looking at the nursing notes.
Letby's note: '...45mls milk obtained from NG Tube with air++...'
The note does not mention Neopuffing. Letby says that is "an oversight".
Mr Johnson: "The truth is that you injected [Child G] with milk and air, didn't you?"
Letby: "No."

Letby is asked to look at her second police interview for Child G.
In it, Letby said air had got in through the feeding syringe.
She tells the court it had been suggested to her as a possibility.
Mr Johnson refers to Child G's 3.15am collapse, with Dr Alison Ventress recalling 'blood-stained fluid coming up'.
Letby denies inserting something into Child G's airway and/or causing the deterioration.

Child G's attacks had "echoes" of the deaths of babies C and E, prosecuting barrister Nick Johnson says to Lucy Letby.
Mr Johnson: "You inserted something into Child G's airway, didn't you?"
Letby: "No."
Mr Johnson: "You caused the bleeding, as you did with many of these children."
Letby: "No, that's not true."

Dr Ventress and a doctor colleague said '100ml of aimilk' had been aspirated from Child G following the 6.05am desaturation.
Letby says she does not recall the 100mls coming out, and asks if it was documented.
Dr Alison Ventress's note is shown to the court. It includes '...NG aspirated as abdo appeared v large ~100mls aspirated...'
Letby: "I don't know how the air got there. It's after Neopuffing."
She accepts the note as an account of what happened.
Letby is shown nursing notes made for the following day shift by a colleague. Letby agrees there are no signs Child G had a build-up of fluid or air from the notes made.

After Letby finished her shift, she returned to the neonatal unit later that day - she claims to sign some paperwork.
"You went to visit Child G didn't you?" Nick Johnson, the prosecution barrister, asks.
"I didn't visit Child G, no. I went to do what I needed to do," she says, adding that she was sorting some documentation.
"Were you looking for an opportunity to finish her off?" Mr Johnson asks.
"No," Letby says.
Mr Johnson asks Letby about a statement from Child G's father that, on 7 September, she was no longer the same baby.
"I can't comment on that," Letby says - saying that nobody knows their own child like the parents.

Child G, 2nd Charge

Mr Johnson refers to the second bout of vomiting on September 21, 2015. Letby said she thought she recalled the mother was there as it was during visiting time.
Letby had said she did not believe it was an emergency, and did not recall Child G "going blue".
Asked if she agrees with Child G's father that Child G was "not the same" after the first deterioration, Letby replies: "I can't comment on that, nobody knows their babies like the parents do."
Mr Johnson asks why Letby was giving Child G the 9.15am feed on September 21.
Letby: "She wasn't awake and she was due her immunisations."
Letby says, "feeding wise", she had no concerns with Child G. She said there was an ongoing issue with Child G's low temperature.

For that September 21 day shift, the court is shown the rota, and Lucy Letby was the designated nurse for Child G that day in room 4, along with two other babies.
Lucy Letby was also responsible for a fourth baby 'rooming in with parents'.
NJ: "Did it annoy you that you were in nursery room 4?"
LL: "Not at all."
Mr Johnson says that Letby, when giving evidence, aspirating can interrupt digestion. Letby said when fully aspirating, that can happen.
She tells the court on this occasion, NGT feeds would be preferable for babies receiving immunisations as they can be quite unwell after them and may need rest.

The court is shown a feeding chart for Child G. A 40ml feed of expressed breast milk was given at 9.15am, signed by Letby.
After the feed, there were 30ml 'two projectile milk vomits', Letby noted. Child G also had a large bowel motion, 'loose, watery green', and there was a 'review by Drs'. The note is signed by Letby. She says she cannot recall which doctors carried out the review from that note.
The 9am reading is recorded on the observation chart for the temperature. Mr Johnson suggests there are two 'dots' in that column recording temperatures. Letby says she cannot recall what the line is below the dot.
NJ: "Did you go back and cook the charts to make it look like [Child G] was declining?"
LL: "No."
Letby says both dots are "in the normal range".
Letby: "I haven't misdocumented anything." Two dots are recorded in the 3am column [when Letby was not on shift], and Letby suggests someone else has misdcoumented.

Letby's notes for that day are shown to the court.
They include... 'at 1015 x2 large projectile milky vomits, brief self resolving apnoea and desaturation to 35% with colour loss. NG tube aspirated - 30mls undigested milk discarded. Abdomen distended, soft. Drs asked to review. Temperature remains low, tachycardiac >18bpm since vomit.'
Mr Johnson says it's "not an innocent coincidence" that Child G deteriorated one hour after being fed by Letby.
Letby: "Yes it is."
Letby is asked to look at her defence statement. It included: "I did not shout for help as I did not think this was an emergency."
Letby is asked if she sought to minimise what had happened. LL: "No."
Mr Johnson refers to Dr Peter Fielding's note. It says: "[Child G] had an episode @~10.20 where she had 2 projectile vomits witnessed by nursing staff...nurse called for help."
Letby denies 'minimising' events, saying this was a "self-correcting" event for Child G.

Letby sent in a text to her work colleague: '...looked rubbish when I took over this morning and then she vomited at 9 and I got her screened'
Mr Johnson says that text has two lies in it. Letby accepts she got the time wrong but says she was not asked about Child G's colour. Mr Johnson says Child G was doing well.
Mr Johnson shows a nursing colleague's note from the previous night shift and Letby's nursing note from that day shift. "Any suggestion [Child G] was looking 'rubbish'?"
Letby says Child G looked 'pale', but didn't use "rubbish", in clinical notes.
Letby denies deliberately falsifying times or making up negative observations for Child G.
Letby denies "passing off responsibility to other people", as suggested by Mr Johnson.
NJ: "In fact, you are the person causing all these problems."
LL: "No I'm not."

Child G, charge 3

Mr Johnson asks Letby to look at her defence statement for the 3.30pm incident for Child G.
Letby said she looked round the screen and saw Child G's monitor was off, she was alone, and behind the screen.
Mr Johnson asks if that was correct.
Letby: "Yes."
The statement adds Letby wanted the matter of Child G being left alone on the procedural trolley behind the screens by a doctor ["to be reported" seems to be missing from Chester Standard], but a nursing colleague did not want to report this.
Letby agrees it was "an innocent coincidence" that she was the only nurse in the room at this time.
Mr Johnson said Letby had told in evidence that Letby was preoccupied with other babies in the room she was caring for, while doctors tried to cannulate Child G behind screens "for some time".

The court is shown a neonatal schedule for Child G and other babies for September 21. Letby is recorded as having three duties for other babies in the 90 minutes prior to Child G's collapse. One of the three events was for a differently designated nurse's baby in room 2.
Letby says that does not mean she was not preoccupied with the babies, and may have been dealing with their families or other duties.
Letby is asked about the event and her looking behind the screen, that Child G was 'dusky, blue and not breathing'.
Letby is asked if that was true. "Yes."
Letby agrees she picked Child G up, put her in a cot and Neopuffed her. She says the Neopuff equipment would not stretch to the trolley.
A nursing colleague "froze" and went to get a separate nursing colleague.
Letby said, in evidence, she was "very concerned" by what had happened.
Mr Johnson says one thing not mentioned in the defence statement was Letby moving Child G from the trolley to the cot. He asks why Letby had not mentioned that. Letby says she cannot say.
Mr Johnson says Letby "took advantage of a situation that presented itself". Letby: "No."

Mr Johnson says when the cannulation process was taking place, Letby must have been in the room. Letby says she would not have been there all the time.
One of the charts is shown for a baby that Letby was looking after, with the chart requiring readings that took 'about 5 minutes' to make.
Letby says she was "in and out of the nursery all day", on activities that did not require being cotside. She says she does not recall "at any point" being told by doctors they had finished with the cannulation process for Child G.
Letby says it would have been "up to the doctors" to remove the screens and make sure Child G was safely back in her cot following the cannulation.

Child H

Mr Johnson moves on to the case of Child H. Letby says she does recall Child H, due to the chest drains that were put in place.
Letby said chest drains had to be couriered from Arrowe Park Hospital, as it was "unacceptable" they didn't have sufficient supplies at the Countess of Chester Hospital. Mr Johnson asks if Letby filled in a Datix form for that. Letby says she does not recall.
Letby is asked about the text message she sent to Yvonne Griffiths on September 26, 2015 about the "not so positive comments that have been made recently", with regard to Letby and colleague Shelley Tomlins working in room 1, over their relative lack of experience.
Letby says she cannot recall which nurses, specifically, had been making those comments, but they were band 6 nurses. Letby agrees this message followed events for Child H.
Mr Johnson refers to the staffing rota for September 25-26. Letby says it was not the night staff who were making the comments. Mr Johnson asks if it was the day staff, why did they allocate Child H to Letby? Letby replies the comments had come in recent days prior to this.
Letby, in her defence statement, questioned how familiar the doctors were with chest drains.
Letby, when questioned on this, says this would be non-consultants.
In her defence statement, Letby said she could not recall the specific details of Child H's collapses.

Letby is asked to refer to her defence statement, in which she said her memory for both nights when Child H's collapses "merged into one". Letby added she was also looking after a severely disabled baby.
Letby now accepts the disabled baby was born later in the shift.
Letby tells the court staffing levels were not a contributory factor in Child H's collapses.
Letby said she would "question whether the [chest] drains were securely put in" for Child H, as a potential contributory factor in Child H's collapses.
Letby accepts Child H was born in a good condition, and that she recovered quickly.
She tells the court she cannot comment on her interpretation of the security of the chest drains, from her observations.

Letby has previously said she was looking after "another severely disabled baby" at the time Child H first collapsed.
But paperwork from the unit shows the severely disabled baby in question was born later in the shift.
When asked if medical incompetence contributed to the infant's collapse, Letby says she is not sure.
But she says she questions "if some of the drains were securely put in".
Nick Johnson, for the prosecution, asks: "Do you agree that Child H was born in good condition?"
"I can't comment on that," Letby replies.
Medical notes shown to the court indicate this was the case.

• X-Ray #1, December 2021: Negative for everything. "No acute pulmonary process."
• X-Ray #2, April 2023 (compared to December 2021): "No active process. Chronic perihilar infiltrates. No change." Taken about 7 days post positive Covid test.
• X-Ray #3, May 2023 (compared to April 2023): "Mild bronchitis or central pulmonary vascular congestion. Slightly increased."

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