A nurse leader at the hospital where Lucy Letby murdered babies had assumed that doctors who first raised the alarm about Letby were doing so because they had a personal issue with her.
Karen Rees, head of nursing for urgent care at the Countess of Chester Hospital between August 2015 and March 2018, told the Thirlwall Inquiry on Monday that the Letby case had led to a “breakdown” in relationships between nurses and doctors.
“Rightly or wrongly, I admit at that time I thought there’s a personal issue going on here”
Karen Rees
The inquiry is examining how Letby, 34, was able to murder seven babies and attempt to murder seven others between June 2015 and June 2016 while working as a neonatal nurse at the hospital.
Asked about the working relationship between doctors and nurses on the neonatal unit at that time, Ms Rees said: “Initially I thought they worked quite well together, my observation was that.
“I think things became a little strained as time moved on and when circumstances started to unfold.”
She said there was a “change” in the trust held between doctors and nurses after suspicions started to be raised about Letby, noting that “the nursing team had one view and the medical team had another”.
As heard in other witness sessions at the inquiry, consultants were leading the charge for Letby to be removed from the unit, but nurses thought there was not enough evidence to accuse her of wrongdoing.
Ms Rees said she thought that the consultants had taken a “cloak and dagger” approach by going directly to the executive team with their concerns rather than to nursing leaders overseeing the neonatal unit in the first instance such as herself and ward manager Eirian Powell.
Things came to a head on Friday, 24 June 2016 when consultants Dr Ravi Jayaram and Dr Stephen Brearey demanded that Letby was taken off the shift that she was scheduled to work that weekend because they thought that she was purposely harming babies.
Ms Rees went to speak to Dr Brearey in his office and asked why he had these concerns, to which he replied: “I have got a gut feeling and I have got a drawer of doom”, as he pointed to a drawer in his desk, the inquiry heard.
Recalling what happened next, Ms Rees said she asked to see the contents of the drawer, Dr Brearey refused but continued to insist that Letby was removed from the unit.
Ms Rees said she responded by saying: “I can’t remove a nurse from a clinical practice just because of gut feeling and a drawer of doom, [the contents of which] you will not share with me.”
She then informed the trust’s executive director of nursing Alison Kelly of the conversation, and sought assurance from senior nurse Yvonne Farmer who told Ms Rees she had no concerns about any of the nurses due to be on shift that weekend, which would have included Letby.
Ms Rees, who is now retired from nursing, told the inquiry that she made the assumption that the reason why the doctors were raising concerns about Letby was “personal”.
“In my nursing career, certainly latterly in my last years, on a number of occasions I have had consultants demand I remove nurses either from their team or from their ward or unit because personal and professional relationships have broken down for varying reasons,” she told the inquiry.
“And initially, I thought because both Ravi Jayaram and Steve Brearey were reticent to give me further details, I thought at that time it was personal. Rightly or wrongly, I admit at that time I thought there’s a personal issue going on here.”
On the evening of Friday, 24 June, Ms Rees received a phone call at home from Dr Brearey asking for confirmation that Letby was being taken off the neonatal unit, to which Ms Rees reiterated that she “can’t take a nurse off a unit without just cause”.
Ms Rees admitted during the inquiry that the phone call may have made her “a bit cross” and said: “I felt I was being bullied and intimidated to make a decision about moving a nurse that nobody else had been prepared to do until that point.”
After the call with Dr Brearey, Ms Rees spoke again with nursing director Ms Kelly to “escalate” the issue, but Letby remained on shift that weekend when she was alleged to have attacked child Q, although she was not convicted of this charge during the trial.
“I think things became a little strained as time moved on and when circumstances started to unfold”
Karen Rees
At this stage, Ms Rees had seen a table showing a link between Letby being on shift and babies dying or coming to harm in unexplained and unexpected ways.
However, Ms Rees remained insistent during the inquiry that she “wasn’t given enough to act upon”.
On reflection, she agreed that she should have referred the issue to safeguarding to investigate and apologised for not doing so.
From July 2016, Letby was removed from the unit while investigations took place and Ms Rees began meeting with her on a weekly basis to support her health and wellbeing and keep her updated on the progress of the investigations.
Letby’s planned return to the unit was delayed several times and Ms Rees, in September 2016, wrote a letter to Ms Kelly describing the delays as “wrong and immoral based on a senior clinician having a gut feeling with no evidence”.
Asked why she sent this letter, Ms Rees said she had witnessed Letby’s state during these weekly meetings as being “absolutely devastated” and “distraught” and it was “hard” to keep delivering bad news to her.
Pressed on whether she became “too close” to Letby, Ms Rees said: “I think the answer to that is yes, because I was tasked to meet with her on a near-weekly basis for nearly two years and as I said previously witnessing her distress, yes, I acknowledge that.”
As the situation carried on unresolved, Ms Rees claimed that she and then deputy director of nursing Sian Williams “pleaded” with Ms Kelly to call the police.
Ms Rees accepted that the police should have been called earlier when suspicions became apparent.
The inquiry continues.
Read more from the Thirlwall Inquiry