PICTURED: ‘I killed them on purpose’: The post-It note ‘written by nurse Lucy Letby’

On day four of her trial at Manchester Crown Court the jury was told that messages written by Letby, 32, were found at her home after her arrest including one that said: ‘I AM EVIL I DID THIS.’

The Post-it was among other papers and notes which also contained ‘many protestations of innocence’, Nick Johnson KC, prosecuting, told the jury.

Letby denies attacking newborn children in a variety of ways, including poisoning, during an alleged killing spree on the neonatal unit at Countess of Chester Hospital between June 2015 and June 2016.

PICTURED: ‘I killed them on purpose’: The post-It note ‘written by nurse Lucy Letby’

Ben Myers KC, defending Letby, insisted the notes showed his client’s ‘anguish not guilt’, telling the jury they were the ‘outpouring of a young woman when she learnt she was being accused of killing children, that she’d done her best to care for’.

‘Interesting items’ were found during a search of her house on Westbourne Road in Chester, including paperwork relating to many of the children who died or suffered collapses and Post-it notes with closely written words which included the names of some of her colleagues, Mr Johnson said.

‘But I want to show you one note in particular,’ Mr Johnson said, as a green Post-it note was shown on TV screens to the jury.

Mr Johnson said: ‘She wrote, “I don’t deserve to live. I killed them on purpose because I’m not good enough to care for them”, “I am a horrible evil person” and in capital letters “I am evil I did this”.’

Mr Johnson added: ‘Well, ladies and gentlemen, that in a nutshell is your task in this case. Whether or not she did these dreadful things is the decision you will have to make when you have heard all the evidence.’

Along with the ‘I am evil…’ note, there were other written notes, the jury heard.

Mr Johnson said these included phrases such as ‘Why/how has this happened – what process has led to this current situation. What allegations have been made and by who?’ and ‘Do they have written evidence to support their comments?’.

The prosecutor said that in her writings Letby expressed frustration because she was not being allowed back on the neonatal unit and wrote: ‘I haven’t done anything wrong and they have no evidence so why have I had to hide away?’

Mr Johnson added: ‘Her notes also expressed concern for the long-term effects of what she feared was being alleged against her and there are many protestations of innocence.’

As the fourth day of Letby’s trial continues, the court has heard so far: 

• Letby, 32, denies murdering seven premature babies and attempting to murder 10 more over 12 months. The deaths occurred at the Countess of Chester Hospital between June 2015 and June 2016. Letby was arrested three years after the death of her first alleged victim, Baby A;
• ICU nurse is alleged to have injected babies with insulin, air or pumped with milk to kill them – often during night shifts when parents were less likely to be there;
• Letby allegedly targeted twins on more than one occasion – and in some cases one was murdered and their sibling survived; 
• She is said to have searched for the families of her alleged victims’ parents on Facebook and social media, including on Christmas Day;
• In some cases, Letby is alleged to have tried to kill babies on up to four occasions, including two times in one shift;
• Nurse was ‘smiling’ after one child’s death and sent her parents a sympathy card, which was ‘not normal’. On a separate occasion, a paediatric consultant claimed he walked in on Letby as she was trying to kill a child; 
• Doctors moved her off night shifts after being concerned about correlation between suspicious deaths and her presence; 
• Lucy Letby wrote handwritten messages found in her home after her arrest on suspicion of murdering seven babies including one that said: ‘I AM EVIL I DID THIS’. Police discovered yellow and green post-it notes in the ICU nurse’s Chester house including one that said: ‘I don’t deserve to live. I killed them on purpose because I’m not good enough to care for them. I am a horrible evil person.’;
• She photographed two of three triplets lying dead together in a cot after allegedly murdering them after telling a doctor that one of them was ‘not leaving here alive’;
• One doctor spoke to Letby before ‘Baby P’ died, predicting his survival, so was surprised when the nurse replied: ‘He’s not leaving alive here, is he?’

Later Mr Myers, representing Letby, gave a short introduction to her defence case and told jurors anyone who approached the matter ‘as some kind of done deal has got this very badly wrong’.

He told the jury: ‘The fact that Lucy Letby has been present at the time of the deterioration of a child has itself become the explanation of that deterioration, even though there’s no evidence to show she has caused that to happen. Miss Letby is adamant she’s done nothing intentionally to harm these babies’.

The barrister pointed at his client sitting in the dock and told jurors: ‘It is important to be careful that blame is not heaped on that woman when there may be others who have made mistakes or a system which has failed.’ He added that absence of evidence ‘does not convert into evidence of guilt’.

In some cases, the defence say, no one could say why a particular child deteriorated or died. He said: ‘She should not get the blame if she is not responsible and it is amazing, is it not, how with allegations like this everyone turns and focuses on Lucy Letby. Some people, we say at the outset, with the rather trusting presumption because the allegations have been brought that she is guilty, she must be guilty.’

Mr Myers asked the jury to consider the birth condition of the babies Letby is supposed to have harmed, claiming some ‘should not have been in the Countess of Chester in the first place’.

He said: ‘We are hardly starting from a base line of robust good health. Look very carefully to what’s happened on the way to the events we are looking at.’ He said identifying problems before they escalate involves doctors and nurses watching, recording and communicating, but this may be difficult if a unit is ‘understaffed and over-stretched’.

He said in some cases the care infants had received at the Countess of Chester had been ‘suboptimal’, with staff being responsible for errors and sometimes ‘unacceptable’ delays in procedures.

In one case – that of Child J – Mr Myers said ‘the hospital was well of its depth’ with regard to treating her.

He added: ‘We say there were problems with the way this unit performed, and they have nothing to do with Lucy Letby.’

He cited the significant number of children who recovered well once they were moved away from the Countess of Chester Hospital.

‘The improvement in some of these children is evidence of how it did not always deliver the level of care it should have provided. To turn it back on Lucy Letby is unfair and inaccurate.’

Letby denies all 22 charges and is being supported by her parents Susan and John Letby at Manchester Crown Court.

Mr Myers said: ‘The defence say that Lucy Letby was a dedicated nurse. She trained hard to be a neo-natal nurse and what she wanted was to care for babies she looked after.

‘In no way did she want to harm them. The defence say she is not guilty of causing intentional harm to any baby or to killing any baby.

‘She loved her job. She cared deeply about the babies and also cared for their families.

‘She had a fulfilling life, had friends, a life outside work. You won’t get the answers to this case looking at this woman in the dock now. This is how she is and where she is six years after starting to face allegations like this.

‘You can imagine that must be utterly gruelling for anyone. This is an important part of her case. The requirement to keep context in mind and to distinguish how she was when events were said to have taken place, compared to how she is now.

‘With these allegations we are dealing with a real person who is where she is now. Anyone who approaches this as some kind of a done deal has got this very badly wrong.’

Mr Myers said the jury had been shown Letby’s text messages, her Facebook searches on the families of babies she is alleged to have harmed and, ‘pieces of paper’, and mentioned ‘amateur psychology’.

But he said the ‘foundation’ of the case is medical evidence.

He told the court: ‘What the case will come down to is the medical evidence and what it can safely prove and what it can’t and what we can safely conclude.’

Mr Myers said causes of a baby’s deterioration or death are not always clear and there may be a number of reasons.

He added that in this case the babies were ‘clinically fragile’, and in conditions that could change ‘very swiftly and deteriorate very rapidly’.

He said there are five key issues in the medical evidence: the birth condition of the baby, whether there were any problems in the health or care of the child, whether the evidence proves deliberate harm was done, whether Letby was present at the relevant time, and whether there were failings in care by other people or the unit as a whole.

Mr Myers showed the jury a prosecution exhibit, a grid with the names of staff on duty across the top and across one side the names of the children allegedly attacked.

An X marked Letby being on duty at the time when a child was said to have been harmed or killed, eight times on day shifts, 16 times on night shifts.

But Mr Myers said this was a ‘self-serving document’.

He said it did not show the treatment each child was receiving, the health of the baby in question, collapses by babies when Letby was not present, shortcomings in care of others, how busy the unit was, and what Letby was doing at the time of each event.

Mr Myers said the defence would look at the prosecution’s expert medical evidence and whether it proves harm was done deliberately.

He said: ‘In cases like this, there’s a danger of an expert being drawn into fulfilling an absence of explanation.’

The jury was told this can lead to a ‘harm-based’ explanation which may not be the only explanation and that this was an example of ‘confirmation bias’.

Mr Myers added: ‘Doctors don’t always have the answers and nor do medical experts.

‘The fact that Miss Letby can’t explain a particular event does not mean she must be responsible for it.’

Mr Myers then outlined the defence case for each of the counts of murder and attempted murder, adding: ‘Miss Letby is adamant she’s done nothing intentionally to harm these babies.’

He said with Baby A, the first murder count, the defence does not accept that an air embolus, or air bubble, was the cause of death. Letby is accused of injecting air into the child.

Mr Myers said the ‘polite’ way of describing the care of child A on the unit was ‘sub-obtimal’.

With Baby B, who was Baby A’s twin sister, who Letby is accused of trying to kill, it was a ‘good example’ of the ‘assumption of guilt’ and experts had been ‘influenced by the theory of harm’.

Baby C was a baby boy Letby is alleged to have murdered by injecting him with air through a nose tube.

Mr Myers said C was a ‘very premature’ baby, born at 30 weeks and weighing only 800g.

He said such babies were vulnerable, especially to infection, and C should have been at a specialist children’s hospital.

Baby D was a baby girl Letby is alleged to have murdered with air.

Mr Myers said the hospital failed to provide adequate care.

He said it is ‘beyond dispute’ that Baby D should have been given antibiotics hours before she was treated with them, and there was more evidence that infection played a part in her death rather than Letby killing her with air.

Ben Myers KC told jurors the Crown alleged Letby injected Baby E with a fatal amount of air and attacked him in front of his mother.

He said: ‘We say there is no clear explanation in his case for what happened. That being so, it is not right to rely on the assumption of guilt.’

He next turned to allegations that Letby attempted to murder Baby F – the twin brother of Baby E – and Baby L by poisoning them with insulin. The barrister said there was ‘nothing in fact’ to establish any such actions.

Baby G – who Letby is accused of attempting to murder on three occasions – was an ‘extremely premature’ baby who was ‘high risk’ with predicted problems, he said.

The defence did not accept Letby did anything to contribute to Baby G’s health problems in the neonatal unit.

Baby H, said to be have been attacked by Letby twice, was another example of ‘sub-optimal care’ by the Countess of Chester Hospital and ‘nothing to do with Lucy Letby’, he said.

Ben Myers KC said the defence did not accept Letby caused any harm to Child I, a baby girl she is said to have tried to kill on three occasions before she succeeded on the fourth attempt.

He said: ‘We will say her collapses and ultimately death were part of a series of clinical problems which may well have been inevitable given her extreme prematurity.’

Mr Myers said the Countess of Chester Hospital was ‘well out of its depth’ with Child J – who Letby is said to have tried to murder – and knowing how to treat her.

He said an assumption of deliberate harm had been made rather than an alternative explanation of a baby receiving inadequate care.

Child K – subject of another count of attempted murder – was said to have been harmed with the deliberate dislodging of a breathing tube, but Mr Myers said the probable cause was the child inadvertently moving the tube herself.

Her case was another example of ‘sub-optimal care’ in that she should have been treated at a more specialist unit, Mr Myers said, adding: ‘She should not have been in the Countess of Chester in the first place.’

Lucy Letby wrote handwritten messages found in her home after her arrest on suspicion of murdering seven babies including one that said: ‘I AM EVIL I DID THIS’, a court heard today.

Police discovered yellow and green post-it notes in the ICU nurse’s Chester house including one that said: ‘I don’t deserve to live. I killed them on purpose because I’m not good enough to care for them. I am a horrible evil person’.

The words ‘Hope, Panic and Fear’ were among other words crowded on to a piece of paper, which also read: ‘I will never have children or marry. I’ll never know what it’s like to have a family’. Some of the other scribbled lines included the word ‘HATE’ in capitals, along with ‘There are no words…’, ‘I can’t breathe’ and ‘Kill’.

Concluding the prosecution opening, which began on Monday,  Nick Johnson KC showed a yellow Post-it note on TV screens to the jury, and said: ‘She wrote, ‘I don’t deserve to live. I killed them on purpose because I’m not good enough’. ‘I am a horrible evil person’ and in capital letters, ‘I AM EVIL I DID THIS’.’

Mr Johnson said it was found after Letby was arrested in July 2018. Her house on Westbourne Road in Chester was searched, ‘interesting items’ were discovered, he said.

‘But I want to show you one note in particular,’ Mr Johnson told jurors. Highlighting the yellow Post-it note with the words written in ink by Letby. Referring to her words, including about being ‘evil’, Mr Johnson said to the jury: ‘Well, ladies and gentlemen, that in a nutshell is your task in this case. Whether or not she did these dreadful things is the decision you will have to make when you have heard all the evidence.’

But opening the defence case this afternoon, Letby’s barrister, Ben Myers KC, insisted the notes showed his client’s ‘anguish not guilt’, telling the jury they were the ‘outpouring of a young woman when she learnt she was being accused of killing children, that she’d done her best to care for’.

Concluding the prosecution opening, which began on Monday, Mr Johnson said: ‘I have already told you that the police found a large quantity of hospital paperwork relating to many of the children whose deaths and collapses you are now considering.

‘They also found some other interesting items. There were some Post-it notes with closely-written words, some of which included the names of some of her colleagues.

‘On some of the notes were phrases like as ‘Why/how has this happened – what process has led to this current situation.

”What allegations have been made and by who? Do they have written evidence to support their comments?’

‘In her writings, she expressed frustration at the fact that she was not being allowed back on to the neo-natal unit and wrote, ‘I haven’t done anything wrong and they have no evidence, so why have I had to hide away?’

‘And notes also expressed concern for the long-term effects of what she feared was being alleged against her and there are also many protestations of innocence’.

In total, she is accused of murdering seven premature babies and attacking 10 more over a year by poisoning them with insulin, injecting air into their bloodstreams or over-feeding them milk.

Baby P suffered a sudden and ‘acute deterioration’ before preparations were put in place to move him to another hospital, the court heard today.

Just before the planned transfer, a doctor was said to be ‘optimistic’ about his prospects but then ‘all of a sudden Lucy Letby said to him something like ‘he’s not leaving alive here, is he?”, said prosecutor Nick Johnson KC said today. Shortly after that exchange Baby P collapsed and died, Manchester Crown Court heard.

The KC said said: ‘That remark surprised (the doctor) but Lucy Letby’s prediction came true. After all, she knew what she had done to him and therefore she knew what was likely to happen. It is certainly what she intended because it was something she had done to so many other children.’

A coroner recorded the death as ‘prematurity’ but independent experts who were tasked with reviewing Child P’s case said the most likely cause was air injected into his stomach which compromised his breathing.

After Child P’s death, Letby spent time with his parents and took a picture. She denies murdering seven babies and the attempted murder of ten more.

The final incident, outlined by prosecutor Nick Johnson QC, was the alleged attempted murder by Lucy Letby of Baby Q on June 25 2016, the day after she allegedly killed baby P.

The Crown say the neo-natal nurse injected Baby Q with excess air and a clear fluid, possibly water or saline, into his stomach via a nasogastric tube in a bid to murder him.

The youngster was later transferred to another hospital, where he went on to make a ‘rapid recovery’ when removed from the ‘orbit of Lucy Letby’, said the prosecutor.

Mr Johnson said that following the events of June 2015 to June 2016, the consultants suspected the deaths and life-threatening collapses of the 17 children were ‘not medically explicable and were the result of the actions of Lucy Letby’.

The prosecutor told jurors: ‘No doubt they were acutely aware that making such an allegation against a nurse was as serious as it gets.

‘They did not, at the time, have the benefit of the evidence that you are going to hear and the decision was made by the hospital to remove Lucy Letby from a hands-on role.

‘She was moved to clerical duties where she would not come into contact with children.’

The police were contacted and a ‘very lengthy and complex’ investigation followed which involved instructing independent paediatricians and other specialists to review many cases that passed through the neo-natal unit, the court heard.

Letby’s parents, Susan and John, are supporting her at her six-month trial at Manchester Crown Court.

She denies all 22 charges. The hearing continues.