Dr Ravi Jayaram,a consultant paediatrician,says the incident will forever 'be in his nightmares'

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A doctor has admitted that if he “had more courage” he would have called police immediately after he claimed to have caught Lucy Letby attempting to murder a baby.

Letby,34,is on trial accused of deliberately displacing a child’s breathing tube while she worked a night shift at the Countess of Chester Hospital’s neonatal unit.

Less than two hours earlier,the baby – known as Child K – was born extremely premature at 2.12am on February 17 2016,weighing 1lb 8oz (692g).

The prosecution said Dr Ravi Jayaram,caught the defendant “virtually red-handed” as he entered the unit’s intensive care room and saw Letby standing next to Child K’s incubator and “doing nothing”.

Giving evidence at Manchester Crown Court,Dr Jayaram was asked repeatedly by Ben Myers KC,defending,why,if he thought Letby had just tried to murder a child,he had not immediately called 999.

Dr Jayaram said he was worried that if he called the police they would contact the Countess of Chester Hospital NHS Foundation Trust.

He said that both he and Dr Stephen Brearey,who had already raised concerns about Letby by this point,were worried hospital bosses would tell the police they were just “complaining paediatricians”.

Letby is on trial accused of deliberately displacing a child's breathing tube at the Countess of Chester Hospital's neonatal unit

Credit: Cheshire Constabulary

Dr Jayaram added: “There was a fear of retribution – we were told it would have been inappropriate to contact police [by hospital bosses].

“We were advised from the start that contacting the police would be the wrong thing [to do].”

Mr Myers pressed him on why,despite his fears,he hadn’t picked up the phone given the gravity of his concerns and the possibility of more children being harmed.

Dr Jayaram replied: “Had I had more courage maybe I would have picked up the phone to police.”

The jury of six men and six women has been told that Letby was convicted at a trial last year of the murders of seven babies and the attempted murders of six other infants at the Countess of Chester between June 2015 and June 2016.

‘I felt very uncomfortable’

He told the court: “At this time,we had had a number of unusual incidents with babies and a number of colleagues and myself had noted the association with Lucy Letby being present at these things.

“I will be honest,I felt very uncomfortable. Objectively,you can say that was completely irrational. I just had a feeling,knowing what had happened before.

“My internal dialogue was very much ‘stop being stupid,get on with your work’ but I just needed to go in and reassure myself that everything was OK.”

Dr Jayaram said that when he walked into the room he saw Letby standing next to the incubator while on the monitors Child K’s oxygen saturation levels were dropping.

He added: “As I approached,I said ‘what’s happened?’ and Lucy looked up and said ‘it looks like she is desaturating’.”

Alarms were supposed to sound if blood oxygen levels dipped below 90 per cent but he did not hear any,the doctor said.

He said he quickly went through a series of checks to try and identify the problem but found no malfunction with Child K’s ventilator,no tube blockage and no lung issues.

Dr Ravi Jayaram testified: 'We had had a number of unusual incidents with babies and a number of colleagues and myself had noted the association with Lucy Letby being present at these things'

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Dr Jayaram said he also disconnected Child K from the ventilator and attempted to breathe air into her via a bag and mask but he said “she didn’t pick up and the chest didn’t move either”.

He told the court that he decided to remove the tube from Child K’s mouth and ventilated her again through a face mask.

“She picked up extremely quickly. Her colour improved,her saturations improved,I could see her chest was moving normally. That was a relief,” he said.

Under cross-examination,Mr Myers accused Dr Jayaram of fabricating the silenced alarms.

He said: “What I am suggesting to you is you have said things to create suspicion where it did not exist.

“If you had seen anything like you are suggesting you would have gone to police or raised it with managers.”

He also noted that rather than removing Letby from the ward immediately,Dr Jayaram was content to allow her to finish her shift and to continue looking after Child K for the next four hours.

Dr Jayaram said he knew Letby would not be working alone and said the incident would forever “be in his nightmares”.

He said: “I only wish I had the courage to escalate [my concerns] in a different way. I only wish I had the courage to do that. That is why it is going to be in my nightmares forever.”

Child K’s planned transfer to a specialist intensive care unit at Wirral’s Arrowe Park Hospital because of her extreme prematurity took place later on February 17.

She died there three days later,although the prosecution does not allege Letby caused her death.

Letby,of Hereford,denies a single count of attempted murder.