Ravi Jayaram: Hoisted By His Own Petard

Will He Also Feel the Full Force of the Mighty British Judicial System That Wrongly Convicted Lucy Letby?

Doctor Jay and Baby K

Key evidence in the trials of Lucy Letby, particularly the testimonies of almost all of the medical professionals is being intensely scrutinised and highly criticised. And rightly so.

Dr. Ravi Jayaram, a consultant paediatrician at the CoCH provided testimony regarding the events leading to Baby K's deterioration that was key in Letby being convicted. Letby’s first jury in 2023 did not find her guilty of attempted murder, by displacing Baby K’s endotracheal tube. Letby was retried in 2024 and convicted for the attempted murder of Baby K.

When interviewed by the police in April 2018 Jayaram told them 'It is also the case that Lucy had not called me in to nursery 1 at the point that desaturation had taken place. Quite often a nurse will come looking for a doctor to assist when a baby begins to deteriorate, Lucy didn't.' And, that he couldn’t remember if the alarms in Baby K’s room were sounding, or not. During the trial, he testified with absolute certainty that the alarms were not sounding at that time, the inference being [inference is not only acceptable in circumstantial criminal cases it can also become court fact] and therefore the later findings of the court was, Letby had maliciously turned the alarm off. At both trials nurse Joanne Williams told the court, when she returned to the unit she distinctly heard the alarms and was drawn to them. And, that Jayaram asked her what had happened, and why were the alarms going off?

At Letby’s appeals, one of the appellate judges, Lord Justice William Davis pointed out the inconsistencies in Jayaram’s testimonies:

“It is of some significance that the critical issue for the jury was whether they were sure of the evidence of Dr Jayaram. Although he believed that Letby had deliberately dislodged the endotracheal tube he said nothing at the time nor for many months after.”

Nevertheless, both her leaves to appeal were denied.

David Rose of UnHerd published this article last week:

Leaked Emails

Now the doctors were hoping to involve the police, who at first had seemed reluctant. Jayaram was commenting on a draft of a report they would shortly send to detectives, asking them to investigate.

He was blunt about its purpose: “for the police to have their interest piqued”. To do this, he suggested, the doctors should “highlight explicitly for these cases that LL was in attendance and in close proximity to the incubators (in those situations we know for a fact she was)”. He went on to suggest additions to the report about cases with which he had been involved, “hopefully more in a stating the facts way than a subjective finger pointing way”.

The Emails

should we say “for example air embolism.” The review paper attached describes such rashes in air embolism.

In this ‘interview’, Jayaram is talking about how he almost caught Letby “virtually red-handed” standing over Baby K:

We have since learned from neonatologists that preterm babies dislodging their tubes is so common that neonatal units provide leaflets to inform parents how common it is, even after one hour of insertion. Not only did Jayaram lie about that but so did Dr Sandie Bohin who was the neonatologist expert witness for the prosecution. At Letby’s first trial Bohin told the court that umbilical venous cannulas and PICC (Peripherally Inserted Central Catheter) lines do not move, or migrate to the wrong location, “unless they had been inserted for more than two weeks.” Eight families are currently filing formal complaints against Bohin over their children’s care, which are being considered by the General Medical Council.

From the International Expert Panel’s Summary:

CONVICTION: The consultant [Jayaram] alleged that Baby 11’s [Baby K] first episode of clinical deterioration was caused by deliberate dislodgement of her endotracheal tube, since bagging failed to move the chest and carbon dioxide was not detected by capnography. He alleged that the incubator alarms were deliberately turned off to prevent prompt rescue response because he did not hear the alarms when he entered the room.

PANEL OPINION: Baby 11 required a size 2.5 ETT. Instead, she was traumatically intubated [by Jayaram] with a size 2 ETT, with a resulting 94% air leak. As a result, ventilation was ineffective because 94% of the air was leaking out and only 6% was entering the lung.

Effective gas exchange could not occur and mechanical ventilation could not generate sufficient pressure to keep the small air spaces in the lung open. This led to gradual collapse of the small air spaces in the lung and deteriorating gas exchange. When the tipping point was reached, the infant decompensated, desaturated and collapsed. Bagging to reopen the collapsed small air spaces in the lung requires relatively high pressures. With a 94% air leak, bagging with the Neopuff, which has a safety feature to limit air pressures, did not generate sufficient pressure to move the chest.

Capnography did not work because the device measures build-up of carbon dioxide in the endotracheal tube during expiration, but with 94% air leak, the carbon dioxide could not build-up sufficiently to trigger measurement. There is no evidence to support dislodgement of the endotracheal tube. The consultant stated that he did not hear the alarms, but a nurse (not LL) stated that, “When I returned to the unit, I immediately became aware of the alarms sounding from Baby 11’s incubator.”

CONCLUSION:

1. There is no evidence to support a dislodged endotracheal tube.

2. The clinical deterioration was caused by use of an undersized endotracheal tube.

3. The initial intubation was traumatic and poorly supervised.

4. The consultant did not understand the basics of resuscitation, air leak, mechanical ventilation, and how equipment that were commonly used in the unit work, e.g. Neopuff and capnograph.

5. There is evidence that the incubator alarms were not turned off.

Jayaram had the gall to go on and become a voice for whistleblowers:

An NHS consultant has warned the health service is "almost guaranteeing" another big scandal if whistleblowers are not offered more protection.

Dr Ravi Jayaram has described a "culture of cover-up" he believes has major implications for all institutions, not just the health service, and said many employees are too scared to speak out for "fear of personal harm and retribution."

The Malignant Seven reached out to the British whistleblowing charity Compassion in Care, which was founded to support informers who speak out, who said, Letby’s accusers did not exhibit any of the usual behaviour displayed by those blowing the whistle on malpractice or criminal activity.

Eileen Chubb, who founded Compassion in Care in 2003 and was one of the ‘Bupa7’, the first group to use whistleblowing law in the UK said,

“There were a number of red flags. We’d never come across a whistleblower who, if backed into a corner by an employer at the NHS, hadn’t dialled 999 when people’s lives had been at risk.

That’s what we found staggering. It stood out like a sore thumb, especially in a case where there were such serious concerns. I’ve never seen a whistleblower who thought babies were being harmed who left it for more than a week. But in this case, they left it for a number of years.”

Mrs Chubb, who blew the whistle on colleagues who were abusing frail residents of a Bupa-run home in Bromley, Kent, in 1997, said her charity had since dealt with 14,000 whistleblowers, and said certain patterns were always present.

“Straight away on day one as soon as the verdict came through we all said, these are not whistleblowers,” she said. “The whole thing looked really suspicious to us, they didn’t meet any of the criteria. A lot of the detail which wasn’t there.

Because we deal with health and social care, you see patterns that are always there.

Most whistleblowers would say to you ‘I can remember the moment when this first happened’ and it’s ingrained into your memory like a hot iron, the detail and what you saw but that was not there in this case. All of it is completely wrong.

It’s also very unusual for whistleblowers to keep their jobs. Most are sacked and if they are not, they are forced out constructively.

And you find that when there is a group of whistleblowers, the wrongdoing gets reported even quicker.”