Context
Dr Ravi Jayaram was a consultant paediatrician on the Countess of Chester neonatal unit and co-signatory of the September 2016 consultants’ letter. At the Child K retrial in June-July 2024, his eyewitness account was central to the single count on which the first jury had been unable to agree. This page presents his contemporaneous 2016 records alongside his 2024 oral testimony, because independent analysts have pointed to material differences between the two.
The two sections below come from different documents. The 2016 record is taken from his evidence to the Thirlwall Inquiry on 13 November 2024, where he was cross-examined about what he did and did not write down at the time. The retrial account is taken from the contemporaneous court reporting of 19 June 2024; that reporting is a journalist’s record rather than an official transcript, and where it does not present words as his we do not either. The difference between the two accounts is not our characterisation — it was put to him at the Inquiry, and his answers are quoted below.
2016 contemporaneous record (summary)
There is almost no contemporaneous record. Cross-examined at the Thirlwall Inquiry on 13 November 2024, Dr Jayaram accepted that he had made no clinical note of what he saw. Asked whether he had accepted at both criminal trials that he had not made any clinical notes, he answered: “I accepted that at the time yes.” He filed no Datix incident report either. Asked whether he should have: “I think in retrospect because even if there’s accidental tube dislodgment it probably should be Datixed because then you look into why the tube may have dislodged. But I didn’t.”
The one written trace, and what it says. The single contemporaneous document is the note taken by the transport team when he telephoned to arrange Child K’s transfer. It records his account in four words: “Baby dislodged the tube.” Asked what he had said, he replied: “I would almost certainly have said the tube was dislodged”, adding “because it had done it passively”, and noting that the person he spoke to “wasn’t a clinical person. It was an administrative person.”
He told nobody at the time. Counsel put to him that his conclusion had been that she deliberately dislodged the tube. He answered: “That was the thought that went through my head there”, and that “in isolation it wouldn’t even have crossed my mind but in the context of the other concerns…” Asked why he had not mentioned it to anyone, he said it was “the first time it really hit me”, having “been hoping to walk in and find everything was okay”. The collapse happened in the early hours of 17 February 2016; he met the CQC inspectors that same afternoon.
2024 trial testimony (summary)
The account given to the retrial jury. Giving evidence on 19 June 2024, Dr Jayaram described sitting at a nursing station outside nursery room 1 after the assigned nurse left to update the parents. He told the court that by February 2016 “we had had a number of unusual incidents with babies, and a number of colleagues had noted an association with Lucy Letby”, and described his own hesitation: “I was sitting…and I will be very honest I was very uncomfortable. I just had a feeling, knowing what happened before, and my internal dialogue was ‘stop being stupid, get on with your work’, and I just wanted to go in and reassure everything was ok.” He put the delay at “around 2.5, 3 minutes” before he stood up and walked in.
What he said he saw. “The first thing I did was look up at the monitors… I saw [Child K’s] oxygen saturations were dropping, in the 80s and going lower.” Of Letby: “She was not looking at me, she did not have her hands in the incubator. She was facing in my direction, but she was not looking at the monitor.” He said he asked something like “What’s happening?” and that she replied “It looks like she’s desaturating.” On the alarms he told the court: “What’s of note is the monitors usually alarm if desaturation is below 90%. I didn’t see if the button to suspend the alarms had pressed.” Asked directly by prosecuting counsel whether there was a sound of the alarm, he answered: “No.”
On the tube itself. He said there was no obvious evidence the tube had been interfered with, and that the suddenness of the desaturation would go against a tube blockage. He accepted self-dislodgement was a possibility but said he had never seen a baby of Child K’s gestation dislodge their own tube, and that it would take quite a lot of movement. Asked about the recorded high leak, he said he did not believe it was significant in connection with the deterioration. He estimated the ventilation problem had lasted “probably 30-60 seconds” before he entered the room.
How the two accounts differ, on his own evidence. The Inquiry put the change to him. In his April 2018 police interview he could not remember whether the alarms were sounding; in February 2023 he gave clear evidence that neither the ventilator alarm nor the monitor alarm was sounding. Asked whether his memory of that detail had got clearer as time went on, he answered: “It had”, explaining that the first interview was “kind of an overarching interview to discuss everything” and that “I wasn’t prompted to go into the room because alarms were going off”. Asked whether it was his clear memory now that the alarms were not sounding, he said: “Yes.”
What to read alongside this
Independent analysts, including contributors to lucyletbyinnocence.com, have highlighted differences between the 2016 and 2024 accounts — location, sequence, who was present, and whether the alarm was sounding. See our Child K evidence page for the clinical context and the Panel’s view that ET-tube dislodgement is routine at 25-week gestation.