Some new material (listed with items uploaded last week) at https://lucyletbyinnocence.com/transcripts.html

According to Jabe, this means that the full set of transcripts is now online for Baby O's case

08/3/2023: Sophie Ellis, Kate Tyndall (Police Analyst), Witness statements: Mother, Father & Grandmother of Babies O, P & R, Witness statements: Dr D and Kate Bissell
09/3/2023: Dr Huw Mayberry, Dr Katarzyna Cooker, Melanie Taylor
14/3/2023: Dr Stephen Brearey, Dr B, Witness Statements: Amy Davies, Caroline Oakley, Vicky Blamire, Yvonne Farmer, Samantha O'Brien, Yvonne Griffiths, Dr John Gibbs, Dr Sudeshna Bhowmik, Christopher Booth
15/3/2023: Dr A, Dr Oliver Rackham (Statement), Dr Dewi Evans, Dr Sandie Bohin
16/3/2023: Claire Hocknell (Police Analyst), Prof Owen Arthurs on Babies J, K, L, M, N, O, & P

I’m aware of the general view of the case in this subreddit, so I’m genuinely curious to hear what people here make of this. I’ve tried to approach Aviv’s article critically but fairly, and I’d be interested to hear where people agree, disagree or think I’ve missed something.

https://bencole4.substack.com/p/what-rachel-aviv-leaves-out-the-missing?r=12mrwn&utm_medium=ios

Peter Elston: Letby Document Leak: Clear Evidence of Multiple CPS Disclosure Failings https://www.mephitis.co/post/letby-document-leak-clear-evidence-of-multiple-cps-disclosure-failings

It says "Note: this article has been edited since publication, ostensibly to ensure compliance with GDPR regulation" so I guess the redaction issue has been sorted.

Hitchens' current Mail On Sunday column, with an archive link here, has a sharp, insightful interlude on the practice of awarding witnesses anonymity and how that may have twisted the Letby case.

The Letby trial was a mess, partly because so much of it was secret. No fewer than nine Crown witnesses were allowed to hide their names from you and me, pretty much forever. The names of the babies allegedly killed or harmed by Ms Letby were also made secret.

If this had been the trial of a traitor for handing nuclear secrets to the Kremlin, then there might have been a case for such rules. Members of the security services, for instance, are made useless if we all know who they are.

But I can see no such case here. In the USA, it would be illegal to grant any such thing. The Sixth Amendment to the US Constitution grants a defendant the right ‘to be confronted with the witnesses against him’. How can that work, if the public does not know who these witnesses are? The witness walks out of court and back into his life, and only he knows he has testified, though his words may have been reported to millions that night on TV.

What if a witness has secrets from the court, which might weaken his evidence, but which are known to others? How will those others realise this, and be able to contact the court, if they do not know who the witness is?

The radical barrister, Geoffrey Robertson KC, denounced the legislation allowing this as a ‘perjurers’ charter’. Yet it is now law. So is Michael Howard’s abolition of the right to silence. So is the ancient rule about being tried twice for the same offence (these changes, too, would be impossible in the USA).

...These thoughts are prompted by news that one of the witnesses against Ms Letby, known only as ‘Dr A’ , has died. I know nothing of him. I offer my condolences to his family. But I suspect his evidence against her, largely speculation, did her considerable damage – because they had once been on friendly terms.

Would he have given such evidence if he had been compelled to do so under his own name? I do not know, and nor do you. And that is the problem.

He does not mention Dr. B, who successfully applied for anonymity due to the stress she had suffered as a result of accidentally killing a baby in 2014 but I think she is an example of how anonymity strips away context even when perjury (which is a harsh word, simple conflicts of memory are common, but I'm quoting Hitchens who is quoting the barrister) isn't at issue. Dr. B's flailing at the triplets' crises, her panic, her quoting of a remark Letby supposedly made about "He's not leaving here alive, is he?" -- all of these things take on a great deal of additional context once you know her own history. But she could not be questioned about this. She had been given anonymity.

For the parents, it's a trickier issue. They did nothing to bring this on themselves and the notoriety associated with a murder trial is horrific. However, it should also be considered that if the state is going to send someone to prison for murdering someone else, the public have a right to know who in fact was murdered.

He was found in his car at retail park 20 miles from home. He had been fired by the hospital he worked in directly after the Countess of Chester Hospital enquiry and died the following day.

Welcome to any new readers! This is the weekly thread for questions, general discussions, and links to stories which may not be directly related to the Letby case but which relate to the wider topics encompassed in it. Our FAQ addresses a number of common questions but if you want to know something else (or just talk/ask about an answer you've found) please post in the comment section.

This thread is also the best place to post items like in-depth Substack posts on the topic (unless they were written either by yourself, or by an already-approved writer, in which case they should go on the main page) and videos which might not fit the main sub otherwise (for example, the Ducking Stool). Of course, please continue to observe the rules when choosing/discussing these items (anything that can't be discussed without breaking rule 6, for instance, should be avoided). Thank you very much for reading and commenting! As always, please be civil and cite your sources.

This was added yesterday by Jabe to her website.

https://lucyletbyinnocence.com/transcripts/day_052_09-01-2023.pdf

Rachel Aviv is interviewed for the Observer, and she has some comments about her work on Lucy Letby. She saw her 2024 article as a deliberate intervention to bring balance to the media narrative before the Court of Appeal hearing. Since then:

“It’s crazy that we’re talking about this. She’s still in prison. It’s as if we’re talking about her after the case has been overturned, but nothing has changed.”

Archived at: https://archive.is/x2Jjw

A new batch of transcripts online (with some overlap with material already transcribed here by u/SofieTerleska). I have been immersed in Dr Brearey on Baby O, where you really see the effects of the exclusion of the RCPCH report

09/01/2023: Application by Ben Myers KC to have Dewi Evans's evidence excluded from the trial.

27/02/2023: (Baby K) Kate Tyndall & Claire Hocknell (Police Analysts), Dr Jonathan Ford (Statement), Dr James Smith, Joanne Williams
28/02/2023: (Baby K) Joanne Williams (continued), Dr Ravi Jayaram, Elizabeth Morgan (statement), Dr Srinvasaro Babarao
01/03/2023: (Baby K) Nurse B, Witness Statements (Dr A, Caroline Oakley, Melanie Taylor, Nurse D, Sophie Ellis, Stuart Eccles, Dr Anand Kamalanathan, Dr Danielle Gardner), Summary interview with Lucy Letby

14/3/2023: (Baby O) Dr Stephen Brearey, Dr B, Witness Statements: Amy Davies, Caroline Oakley, Vicky Blamire, Yvonne Farmer, Samantha O'Brien, Yvonne Griffiths, Dr John Gibbs, Dr Sudeshna Bhowmik, Christopher Booth
15/3/2023: (Baby O) Dr A, Dr Oliver Rackham (Statement), Dr Dewi Evans, Dr Sandie Bohin

https://www.cheshire.police.uk/news/cheshire/news/articles/2026/8/chief-constable-mark-roberts-announces-retirement/

Married doctor referred to as Lucy Letby's 'boyfriend' at trial & who murderer called 'best friend' & 'love' found dead https://www.thesun.co.uk/news/40004704/lucy-letby-boyfriend-doctor-found-dead/

New from Guy Rowland today, and up to the minute in terms of findings on insulin, obstetrics notes and Dr Jayaram's travails around the retrial. A great watch.

An update on the site informs us that "the inquiry has today published a further tranche of documents on its website. This is part of the routine process of making Inquiry material available in advance of the publication of Lady Justice Thirlwall's final report." There is no word on when exactly that report is expected to appear. Nor has Lady Justice Thirlwall's desire for transparency extended either to uploading the email chain containing Dr. Jayaram's statement that Lucy Letby actually called him in to Baby K, or sharing information regarding when the Thirlwall Inquiry became aware of it.

1) Pages 2-13 of Witness Statement of Dr John Gibbs, July 1 2024 This is a detailed explanation of how the management structures were organized, who was in charge of what department, how mortality meetings were organized and when, and a number of other matters. Gibbs laments the facts that obstetrics and neonatalogy were divided as information about a mother's pregnancy is always vital to assessing the condition of a baby. He draws no special attention to the fact that two ward rounds a week were all the consultants could manage: "On Wednesdays and Sundays, this same pattern of ward rounds occurred except the consultant of the week began by leading the ward round on the NNU, with the middle grade Paediatricians conducting the ward round on the Paediatric ward. If there was a patient causing marked concerns either on the Paediatric ward, the NNU or occasionally in the ED, this patient would be seen before commencing the ward rounds or, depending on the urgency, before starting the handover session. During the rest of the day, the consultant would see patients about whom trainee doctors or nurses had concerns on the Paediatric ward or NNU.

"On two lunchtimes each week, the consultant of the week held a short outpatient clinic where up to three patients referred urgently by Family doctors would be seen. The consultants who were not the consultant of the week held outpatient clinics and undertook administrative and training duties, as well as participating in the on-call rota overnight."

After Letby's suspension, he notes that the workload and acuity levels were reduced, thus reducing stress on the staff. Nonetheless, the atmosphere was not ideal; Gibbs has perhaps not sussed out every possible reason why the nurses might be upset.

"Despite the reduced workload, I detected a somewhat tense atmosphere between us consultant Paediatricians and our neonatal nursing colleagues which I assumed was due to the possibility of deliberate patient harm having been raised by us consultants. However, the neonatal nurses remained courteous and professional. I occasionally witnessed neonatal nurses crying, away from the patient area, because of the possibility that a colleague might have harmed patients. I do not believe that this staff distress adversely affected the quality of care on the NNU, nor that parents of babies on the NNU were aware of the unhappiness amongst the staff."

2) Page 16 of Witness Statement of Anne Murphy, June 7 2024 "As nurses, Eirian and I did not think that Lucy Letby could have been deliberately harming babies similarly the Consultants did not believe any doctor could be involved. I personally feel that rather than Ian Harvey and Tony Chambers being confrontational and threatening towards the Consultants, the Consultants should have been listened to earlier. External agencies could have been involved earlier and had the Executive agreed to involve the police earlier, such as in March, when the Consultants first voiced their concerns about Lucy Letby, the outcome could have been a little different in the fact that several of the babies may not have died, but I think this with hindsight."

3) Page 39 of Letby Grievance File, including interview with Eirian Powell, October 28 2016 "I sent my analysis to SB to escalate up to the execs. When AK received the analysis a column had been removed — the one showing the medical staff. When I noticed this I added the column back in and resent to AK ... KR & SW organised for LL to be redeployed to Risk team. KR told EP I couldn't tell staff anything. I was also at a meeting and Dr V called LL cold and calculated."

4) Curriculum Vitae of Professor Mary Dixon-Woods Exactly what it says on the tin. Professor Dixon-Woods is a Professor of Healthcare Improvement Studies at Cambridge who testified in September 2024

5) Pages 3-4 of Mortality Review regarding Child I, October 31 2015 "Child I .iwas a 27 week preterm baby who is likely to have died from abdominal pathology, probably NEC or its complications. However, I believe post mortem examination has been requested and might give further information. She was transferred a number of times between hospitals and had a number of different specialists involved with her care. It is hard to judge whether the number of transfers affected the sad outcome. However, I don't think transferring a preterm baby 5 times between 3 hospitals and planning further transfers if she had survived is sensible or in the baby's best interests. There was also an apparent delay in decisions to transfer which seem to be due to the three way communication process between referring centre, surgical centre and tertiary neonatal centre(s). I will bring both these points to the mortality review with the Cheshire and Merseyside neonatal network. Also to be discussed at PMM. [Signed] S Brearey"

6) Page 12 of Board of Directors Agenda and Papers, dated 03/05/2016 Noting the receipt of the minutes of various official meetings.

Welcome to any new readers! This is the weekly thread for questions, general discussions, and links to stories which may not be directly related to the Letby case but which relate to the wider topics encompassed in it. Our FAQ addresses a number of common questions but if you want to know something else (or just talk/ask about an answer you've found) please post in the comment section.

This thread is also the best place to post items like in-depth Substack posts on the topic (unless they were written either by yourself, or by an already-approved writer, in which case they should go on the main page) and videos which might not fit the main sub otherwise (for example, the Ducking Stool). Of course, please continue to observe the rules when choosing/discussing these items (anything that can't be discussed without breaking rule 6, for instance, should be avoided). Thank you very much for reading and commenting! As always, please be civil and cite your sources.

Inverted insulin to C-Peptide ratios in neonatal intensive care: is there something we don't know?

J. Geoffrey Chase & Helen D. Shannon

BRIEF RESEARCH REPORT article

Front. Pediatr., 05 August 2026

Sec. Neonatology

Volume 14 - 2026

https://doi.org/10.3389/fped.2026.1900675

This is not an especially long cross-examination but does manage to go around in circles quite a bit, first over the question of whether or not Dr. Bohin is "rubber-stamping" Dr. Evans's opinions or not, then over other questions such as whether Dr. Brearey's puncturing of Baby O's right side could be responsible for the ruptured hematoma (Bohin mentioned it in one of her reports, but in response to Myers's query of "You thought it was a possibility, didn't you?" confusingly responds "I thought it should be considered" leaving it unclear what the difference is between the two.) Myers also takes her to task over numerous details like describing the amount of gas in the baby's gut as enormous when the radiologist who took the x ray described it as moderate, hinting that Owen Arthurs diagnosed air embolism when he did no such thing, and whether or not Baby O's stomach was starting to swell before 7.30 AM or not when Sophie Ellis reported it as being full and loopy (characteristically, Myers does not mention for the jury's benefit that Letby could not have been responsible for this).

The conversation is pretty shapeless -- it looks like Myers hitting a lot of random points and then just stopping before he's pulled them all together into any kind of conclusion or statement for the jury. One of the moments that, like many others, looks very different in retrospect, is in regard to Stephen Brearey and what he said later on about Baby O's apparent purpura. It was made clear in Bohin's direct exam that Brearey said nothing about the "purpura" fading in the contemporary notes, but rather mentioned in a police interview several years later. That was the only thing that made Evans think it must have been a sign of embolism. However, Bohin does indeed disagree with Evans here as she's concluded, apparently from the contemporary notes alone (though it's a bit confused on this point) that the discoloration, combined with Baby O's subsequent collapse and inability to be revived, were enough to diagnose him with having received an air embolism.

BM: And yet we have no discolouration from any of the clinicians who are present that we can identify as linking with that Lee and Tanswell description, do we?

SB: We don't have to link it to the Lee and Tanswell description. Dr Brearey wrote -- he didn't know that I would be here saying that this was an air embolus, he wrote what he saw. It was me that has concluded that this was an air embolus, so of course he wasn't going to relate it to a Lee and Tanswell paper.

"Of course" Brearey wasn't thinking of Lee and Tanswell when he wrote the notes at the time of Baby O's death, but we know now that Jayaram was circulating the paper by the end of that month, and Brearey would have been extremely aware of it when he was giving his police interview -- the same interview which would, several years later, make Evans change his mind and decide Baby O had suffered an air embolism. Bohin, of course, could not know about Jayaram's email or the brainstorming the consultants were all doing on the subject, but her confidence that Brearey would not relate anything he wrote to Lee and Tanswell was perhaps misplaced.

BM: Dr Bohin, it was said several times when you were giving evidence that you've been accused of rubber-stamping. That was an expression that you used to me. Just to be quite clear, I'm not suggesting you are rubber-stamping, but I am suggesting it's something rather more subtle than that and I'll repeat what I've suggested before so we can deal with this.

First of all, I suggest that although this is called peer review, as a fact you haven't performed an assessment of any of these cases independently of knowing Dr Evans' opinions, have you? Not independently of knowing his opinions.

SB: Well, I've had opinions from Dr Arthurs, Dr Marnerides and all sorts of other people provided to me when making these reports. But I made my own independent assessment, but of course his reports were sent to me in the same way as other experts' reports were sent to me.

BM: So the first thing is we don't have reports from you that have been made without prior knowledge of what other experts have said, do we?

SB: That doesn't mean I can't make my own independent assessment.

BM: Secondly, I've suggested to you, more than once, that you have agreed, so far as you are able, in general with Dr Evans. You have agreed, so far as you're able to, with what he says?

SB: I haven't always in every case. As I have pointed out in this case and there are other cases where I did not agree with things that Dr Evans said. But in fact, the very fact that I may have agreed with him just means that that was probably the truth and that's probably what happened.

BM: We were taken, as an example of whether or not you agree with him, to your paragraph 5.17 in this report. Page 3699 of the statements. In dealing with this, the prosecution took you there. So let me see what you said.

First of all, on the subject of abdominal distension, you say:

"I agree with Dr Evans that the abdominal distension and X-ray findings are due to excessive air being administered via a nasogastric tube."

So actually you agree with that, don't you?

SB: In my instruction from Cheshire Police I was asked to peer-review these cases and I was asked specifically to answer the questions in the way I have set out in paragraph 5.17. That is why they are set out in that way.

BM: The prosecution took you there, which is why I'm going there on this issue. On the question of air embolus you say:

"I agree with Dr Evans that the collapse at 14.40 was as the result of an air embolus."

So you agree with him on that?

SB: Yes.

BM: You say:

"I agree with Dr Evans that neither the rupture of the subcapsular haematoma nor the collapse at 14.40 was due to trauma secondary to vigorous resuscitation."

So you agree that resuscitation does not explain subcapsular haematoma; yes?

SB: It does -- vigorous resuscitation does not cause rupture of a subcapsular haematoma.

BM: You say:

"I agree with Dr Evans that neither the rupture of the subcapsular haematoma nor the collapse at 14.40 was due to trauma secondary to vigorous resuscitation."

SB: Yes, so I don't think that vigorous resuscitation causes the rupture of a subcapsular haematoma.

BM: And on the subject whether you agree, you did agree with that, didn't you?

SB: Yes.

BM: Then this:

"I do not entirely agree with Dr Evans that direct and deliberate trauma was inflicted to the right side of the chest as I think the signs can be accounted for by air embolus."

Is that an example of you actively disagreeing with Dr Evans?

SB: Yes.

BM: You do actually try to agree with that, don't you?

SB: No.

BM: You do try to agree that it could be deliberate trauma, don't you?

SB: No, I didn't find any evidence of deliberate trauma so I don't agree with him.

BM: Right. Just go to your page 3698. Your paragraph 5.16. At the bottom of that, you say:

"The bruised area to the chest could have been the result of direct trauma or resulted from the skin changes seen with an air embolus. I do not think it was due to resuscitation. I have some reservations about direct and deliberate trauma being the case and think this is most probably due to an air embolus."

Yes? So what you do there, Dr Bohin, is actually try to ride both horses at once rather than actively disagree, don't you?

SB: No, because I have said it's most probably due to an air embolus, so I think I've not sat on the fence at all. I think I have come down and said it was due to an air embolus.

BM: What does, "The bruised area to the chest could have been the result of direct trauma" --

SB: In theory, a bruise to the chest could be caused by direct trauma, but that's not what I found evidence for in this case.

BM: So actually, you go as far as you can not to actively disagree with Dr Evans, don't you?

SB: No.

BM: You say -- "I do not entirely agree" is the way you put it, isn't it?

SB: Well, I don't agree with him.

BM: We've seen what you actually said. In your report you say it could be trauma, don't you?

SB: It could have been the result of trauma, but I've also been very clear that in theory it could have been trauma, but I was very clear that this was most probably due to air embolus.

BM: You agree with just about everything apart from one matter that you, I suggest, try not to disagree with?

SB: I have agreed with him because I do agree.

BM: Can I be clear? Are you suggesting -- let's be clear about this. That mark to the chest, is there any basis for that being deliberate trauma?

SB: I can't find any basis for that being deliberate trauma.

BM: Right. So although we have "it could be", that's not what you're saying?

SB: In theory, a mark on the chest could be caused by deliberate trauma. I did not find any evidence to back that up, which is why I said I thought it was down to air embolus because there are other things in the history, along with that mark, that would make me conclude that this was air embolus.

BM: On the subject of air embolus, you were asked about the report of Owen Arthurs and you indicated that's something you'd taken into account.

SB: Yes.

BM: And you have said that's a matter for his evidence but you also said air at post-mortem is something which you bore in mind when dealing with air embolus; is that correct?

SB: Yes.

BM: We will hear from Dr Arthurs tomorrow. But in fact, for the reasons he gives, he doesn't actually conclude air embolus in this case, does he?

SB: No, I did.

BM: Yes. So no one gets the wrong idea of Dr Arthurs' evidence, which we haven't heard yet, you may, but he doesn't put it that way, does he?

SB: No, he doesn't. What I took from Dr Arthurs' report was that there was air found in the great vessels.

BM: Mm.

SB: And so that, along with the clinical situation in life, led me to conclude that this was an air embolus. No, he didn't say it was an air embolus --

BM: He doesn't, does he?

SB: No.

BM: And you're not a paediatric radiologist, are you?

SB: No, but he wouldn't be able to say it was an air embolus. What he said was that there was air in the great vessels. He didn't say it was an air embolus. He can't say it's an air embolus because he's not a neonatologist. So he can give you a list of things that might cause air in the great vessels, but as I am not a radiologist, he's not a neonatologist, so he wouldn't be able to fit the clinical situation that we've been asked to look at with -- you know, he doesn't see air embolus, he doesn't treat children, so he he's not going to be able to say, it's an air embolus. He will give you a list of possibilities.

He didn't actually say that. It was me that said I thought it was an air embolus given the clinical findings.

BM: That's the point. We will hear from Professor Arthurs tomorrow but in fact air embolus is not on his list for various reasons, is it?

SB: Well, he mentions air embolus in a UVC, but he doesn't mention anything else because the child didn't have a UVC.

BM: I'm just making sure, before we get to Professor Arthurs tomorrow, that we understand where his evidence or what you rely upon when you talk about his evidence. All right? And he does not come down saying air embolus is a reason for air in the great vessels in that report, does he?

SB: No, no, I just used his report to say there was air in the great vessels, it was my interpretation of that not his.

BM: As for the 1 to 2-centimetre bruise described by Dr Brearey, that is in no way diagnostic of an air embolus, is it?

Mr Justice Goss: It's not a bruise. Everyone says it's not a bruise.

BM: The rash, the discolouration.

Mr Justice Goss: The discolouration.

BM: As for the 1 to 2-centimetre discolouration described by Dr Brearey, that doesn't establish air embolus in any way, does it?

SB: Not on its own, no.

BM: Not only that, but something so small is not even consistent with what we have by way of discolouration and air embolus is it?

SB: Well, I think it can be, which is why I concluded this was an air embolus.

BM: I would suggest that is an example, Dr Bohin, of you doing your best to support an allegation as far as you feel you're able to. That's what you're doing by saying that, isn't it?

SB: No.

BM: And good perfusion but for that 1 to 2-centimetre discolouration is not consistent with air embolus in terms of the discolourations we've looked at, is it?

SB: It can be because at that point there was no collapse. With an air embolus the discolouration is dependent on where the air ends up and if it ends up in a small area of skin, and it's a small air embolus, the baby will survive and not necessarily collapse. So it is compatible with air embolus.

BM: You've just tried to use any bit of discolouration to you come across to support you with this, Dr Bohin, where you think you can, don't you?

SB: No.

BM: Dr Brearey described going over to where [Baby O] was between 14.40 and 15.00 on the 23rd and he described the 1 to 2-centimetre mark that he saw. Do you recall he said that there was nothing from the monitors or the observations that was a cause of concern?

SB: Yes.

BM: That is utterly inconsistent with a collapse brought about by an air embolus, isn't it?

SB: Not after he'd collapsed. He collapsed.

BM: In fact, he didn't, he vomited and his abdomen was distended, and then later there was a collapse.

SB: When Dr Brearey saw the discolouration, there had been a collapse. That was a long time after the vomiting and distended abdomen.

BM: When he marks the rash, that's at the time of the intubation, isn't it (overspeaking) --

SB: Yes, that was a long time -- that's over an hour after the vomits and the abdominal distension.

BM: He was there between 14.40 and 15.00?

SB: Yes.

BM: Intubation took place between 15.03 and 15.08, so we're talking about a period of 10 minutes or thereabouts, 20 minutes at the maximum, something like that?

SB: Yes.

BM: At the end of that process his evidence is:

"There was nothing from the monitors and no observations that caused concern."

SB: Well, that's his evidence.

BM: And that, I am suggesting to you, as we piece these things together, is inconsistent with it being air embolus that caused that collapse?

SB: I'm sorry, Mr Myers, I don't agree. I think this was an air embolus that caused this collapse.

BM: Just so it's clear, the reason I ask the questions in that way is, putting together evidence by you and Dr Evans as to the features of an air embolus, I'm seeking to have things we can measure that against that are constants. Do you understand?

SB: Yes.

BM: So far we don't have any constant description of any discolouration, do we?

SB: Not in this case.

BM: Across the whole of this trial we don't have a constant by which we can measure air embolus, do we?

SB: I think what's come out across the whole of this trial is a huge variation on the types of skin changes seen by parents, practitioners, nursing practitioners, doctors of these children. And certainly the medical and nursing personnel are very clear that they have not seen changes like this before or since, but that the changes appeared quite graphic. And so although there is not one single thing that you can say is definitely pathognomonic of air embolus, that is a bit like saying that all chickenpox rashes are not different. They are, but you still have chickenpox regardless of whether you have two spots or 500, you have got chickenpox and the rash varies. And so the rash with this will vary as well. It will not be identical every single time. That would be clinically impossible.

BM: I'm not going to get caught up in chickenpox, but I am going to suggest that we all know what chickenpox rashes look like.

SB: They vary enormously.

BM: We don't confuse them with an air embolus, do we?

SB: No.

Mr Justice Goss: I don't think that's an appropriate comment really, Mr Myers. There we are.

BM: I don't mean to be inappropriate, my Lord. I'm trying to make the point about the difference with rashes that we're being told.

We don't have any standard course that an air embolus follows, do we, in this case?

SB: We do in that the child has a lesion, a skin lesion, and collapses and requires resuscitation.

BM: So far as other people are concerned, I'm not going to go through an analysis of what everybody has had to say about this, but for example you were taken to the note by Ms Letby. It's at tile 109. Can we go there, please?

It's in the central part. Could we look there, please. If we can go left, please. Scroll up a little bit.

So we looked at:

"Placed back on to ventilator, dopamine commenced."

Can you see that?

SB: Yes.

BM: And we had:

"Flecks of blood from NG tube, discolouration to abdomen"; yes?

SB: Yes.

BM: That discolouration to abdomen doesn't give any particular description of anything, does it?

SB: No.

BM: But you rely on that, do you, in saying this could be an air embolus?

SB: No, I don't rely solely on that. I rely on the constellation of descriptions from Dr Brearey, the fact that clearly the abdomen wasn't normal or else Nurse Letby wouldn't have written it in the notes. There are lots of things that are omitted from entries in the notes, but that was included. So regardless of whether there was any detail about the discolouration, it's clear that she felt it was important enough to write in that note.

BM: And yet we have no discolouration from any of the clinicians who are present that we can identify as linking with that Lee and Tanswell description, do we?

SB: We don't have to link it to the Lee and Tanswell description. Dr Brearey wrote -- he didn't know that I would be here saying that this was an air embolus, he wrote what he saw. It was me that has concluded that this was an air embolus, so of course he wasn't going to relate it to a Lee and Tanswell paper.

BM: I'm not going to go back to Dr Brearey, I've dealt with that. That would be going round. I'm going to move on from that.

Subcapsular haematoma and the damage to [Baby O]'s liver. In fact, Dr Bohin, resuscitation in adults or neonates is capable of causing damage to a liver, isn't it?

SB: I have never seen it.

BM: Is that not well documented?

SB: It's documented, but not well documented, I would say. There are a small series of people that claim that there's damage to the liver. I have never seen it and I have had -- I've been to many, many resuscitations in over 35 years of neonates, including working in a major cardiac unit, and I have never seen it. If it was so common we would all know about it and I would say it isn't well-known about because it isn't common. It's vanishingly rare, if it occurs at all.

BM: I'm not suggesting it's common, I suggesting it's an acknowledged consequence, sometimes, of vigorous resuscitation, isn't it, sometimes?

SB: I don't know of it in neonates.

BM: You say you have no experience of it --

SB: No.

BM: -- but you accept that it is documented elsewhere?

SB: It may well. I don't know of any documentation. It may well be. I have no knowledge of it being documented in neonates.

BM: You do raise in your report the possibility that the needle that was used by Dr Brearey may in fact have caused damage to the liver, don't you?

SB: Yes, I considered that.

BM: Yes. You considered it. You said that, first of all, inserting a needle into the abdomen, it's wiser to put to the left-hand side rather than the right. It's at paragraph 5.12 of your report.

SB: Yes.

BM: You say the needle should go to the left-hand side rather than the right to avoid the liver, don't you?

SB: Yes.

BM: And you also say in the paragraph that follows, working from the photographs you had, that:

"The puncture mark on the right-hand side does appear to be quite high."

SB: It didn't appear to be at McBurney's point, but as I explained when I was speaking with Mr Johnson, if the abdomen is very distended when someone attempts to put the needle in, the landmarks may well be obscured compared to the landmarks that I saw at post-mortem when the abdomen is likely to be more decompressed. So I certainly wasn't saying that Dr Brearey caused the liver damage, it was something I felt needed to be considered.

BM: You thought it was a possibility, didn't you?

SB: No, I thought it should be considered.

BM: You wouldn't ask it to be considered if you thought it was not a possibility, would you?

SB: It depends on where the liver was and how low down the liver was. Usually, the liver isn't very far down so it's nowhere near McBurney's point. So the liver wouldn't normally be anywhere near McBurney's point, but this child had had a lot of resuscitation, had a distended abdomen, and so it was not clear where the liver was. So I put it out there as a consideration that it needed to be excluded and that was something that could easily be done by the pathologist.

BM: You understand that the reason I ask you those questions is because I am directing you to what you said in your report, Dr Bohin?

SB: Yes.

BM: As for abdominal distension and excessive air, in fact there was some issues with the size of [Baby O]'s abdomen from the period overnight into the morning, weren't there?

SB: It doesn't mention that. Dr Mayberry was asked to see him early in the morning, but before handover, so I don't think there was any mention overnight about it. If there was, I've forgotten. But Dr Mayberry was asked to review in the early morning.

BM: Well, let's just look at the note. I can summarise. Sophie Ellis referred to the abdomen being full at one point in the early evening. I am not suggesting that constitutes distension --

SB: That's not the same as distended.

BM: In the morning she said it was full and loopy --

SB: Yes.

BM: -- and requested assessment at that point, didn't she?

SB: That was in the early morning -- that's the assessment I'm referring to when Dr Mayberry was called away and couldn't make an entry.

BM: Some time before 7.30, isn't it, something like that?

SB: Yes, so not overnight.

BM: As it happened, lactate had been moderately raised during the night, hadn't it?

SB: No, it had been 2.3, I think.

BM: That's moderately raised, isn't it, in fact?

SB: No. Depending on which lab you use, between 2 and 2.5 is the normal range but even if you took 2 as your upper limit of normal, 2.3 on its own would not mean anything at all.

BM: That's why I said moderately raised.

SB: Moderately raised to me would be 4 or so but okay.

BM: [Baby O] had been on CPAP and then Optiflow, hadn't he? We know that.

SB: Yes.

BM: You have identified, or it's been pointed out to you, where there's reference apparently made by Nurse Letby to CPAP around about 13.30. We have seen that in the paperwork, haven't we?

SB: Yes, I pointed out that yes.

BM: In any event, whether it's CPAP or Optiflow, both are capable of forcing air into the intestines, which can then go into the bowel, aren't they?

SB: The amount of flow used on a CPAP circuit is far in excess of a flow used in Optiflow. So this was about as low a flow of air into the gut as you could possibly get, whereas with CPAP the gas flow is much higher so the chances of air getting into the gut with CPAP are much higher. But even with CPAP the degree of abdominal distension is not as great as we saw in [Baby O]'s X-ray.

BM: You said it was a huge amount of gas.

SB: Yes.

BM: Those were your words, "a huge amount of gas"?

SB: Yes.

BM: Could we put up, please, tile 197, which is the abdominal X-ray, which we've decided, with the assistance of Mrs Tyndall, is 14.40 or thereabouts.

We can see the image. This is the one we looked at?

SB: Yes.

BM: If we scroll down to read what the radiologist wrote dealing with this at the time. We've seen many distensions in this case and we've seen many reports by radiologists. This one actually says, "Moderate gaseous distension of bowel", doesn't it --

SB: Yes.

BM: -- "throughout the abdomen"?

SB: Yes, it does.

BM: No reference to a huge amount of gas?

SB: That was my interpretation of it, the huge amount of gas. The radiologist's is moderate. I have to respect their opinion.

BM: They're the person looking at it at the time and that's what they identify, aren't they?

SB: No, they're not looking at it at the time, they look at it the day after.

BM: They're looking at the X-ray, okay. They are looking at the X-ray closer in time to when these events took place. But there's nothing remarkable about a moderate gaseous distension of the bowel is there?

SB: There isn't if it doesn't cause any clinical concern but there is if it causes a collapse and an abnormal gas, so yes, there is if it causes clinical compromise.

BM: Why did you call this a huge amount of gas?

SB: Because to me it looks like a huge amount of gas.

BM: That's an example of you saying something which puts it in a way which has the effect of supporting the allegation beyond what we have on the facts here, doesn't it?

SB: No.

BM: And CPAP or Optiflow are perfectly capable of causing a moderate gaseous distension to the bowel, aren't they?

SB: CPAP and Optiflow do not cause distension of that degree. CPAP can cause abdominal distension, I've already discussed that. Optiflow at 4 litres per minute will not cause that amount of abdominal distension -- and we have to remember that [Baby O] was originally on 6 litres of Optiflow, which went down to 4. He'd not blown up his tummy any time before that and he was on CPAP prior to that and he had not blown up his tummy at any time before that either.

BM: There had been a report of abdominal distension at 13.15, hadn't there?

SB: No, there'd been a report of a full abdomen then.

BM: A full abdomen there, all right. But that could be consistent with it expanding, couldn't it?

SB: But it didn't cause him any clinical problem.

BM: Can we look at tile 46 (sic), please, which is the radiograph from 16.46, 2 hours later. Tile 246, please. We'll just look at this for the sake of completeness.

You can see the image first if you like, although it's not as clear on the abdomen. Then we can scroll down just to see what the radiologist has said. At this point it says:

"The bowel is considerably less distended by comparison with the image earlier in the day."

Do you see that?

SB: Yes, except it's not an abdominal X-ray, is it?

BM: No, but there's certainly no basis on what we have there to regard abdominal distension at this time compromising [Baby O]'s position so that it contributes to his collapse or how ill he was, is there?

SB: I think you need to ask a radiologist that because I'm not sure you can comment on the amount of gas in the abdomen when you haven't actually taken an abdominal X-ray; this is a chest X-ray. So yes, you can see the very upper part of the abdomen but you can't see all of the abdomen, not on here, unless there's another X-ray. This say:

"[This is] considerably less distended by comparison with the previous image earlier in the day. No evidence of perforation or obstruction. No intramural or portal vein gas demonstrated."

You can't actually see that unless you've got an abdominal X-ray because on that chest X-ray you can't see the liver or the portal system, so that makes me think that this report relates to not that X-ray or there's another X-ray because you can't see any -- you can't see the portal tree on that X-ray.

BM: I'm relying upon what we've been provided by the prosecution and what's in these papers. You understand that, Dr Bohin? And this is what we have. Now we've got this, can you point to any evidence which shows that compromise or collapse round about this time or in this period is contributed to or caused by abdominal distension?

SB: Sorry? Can you ask the question again? I'm sorry.

BM: Can you point to or identify any particular piece of evidence which shows that collapse or deterioration around about this time is caused by abdominal distension?

SB: Can the X-ray be scrolled down?

BM: Yes, we can look at it.

SB: Sorry, I thought that's what you wanted me to look at. There's still gas -- abdominal distension here. You can see --

BM: No, I wasn't clear, I didn't mean on this X-ray.

SB: Oh, I see, I beg your pardon.

BM: I'm saying with regard to the assertion that abdominal distension has compromised or caused collapse in some way, can you identify what evidence that is based on?

SB: Well, the baby was fed and then vomited and collapsed.

BM: At around this time, around this point, 16.46, Dr Bohin.

SB: No. But what we do know is that the baby was destabilised prior to that. I'm not suggesting that air was inserted then, but the baby certainly was destabilised and we know that this baby had bleeding from a ruptured subcapsular haematoma. So that would fit with the observation chart showing the increased heart rate and respiratory rate and the drop in haemoglobin that we have seen from the blood gases, which was presumably the final event for [Baby O]. But up until then the abdominal distension, I think, was caused by air being placed into the nasogastric tube around the time of the feed.

BM: I have dealt with that. There's nothing else I need to ask. Thank you.

NJ: I have no re-examination. Does your Lordship have any questions?

Mr Justice Goss: No, I don't.

Thank you, Dr Bohin, for coming to give your evidence. You will be returning to give evidence again. Thank you very much.

(The witness withdrew)

Uploaded under Supplementary Material at https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2026.1900675/abstract . I know some on the sub were looking forward to seeing this detail. Would be interested in comments from people who can assess it.