A senior doctor told a jury he “feared retribution” from hospital bosses if he called police to say he suspected a nurse was killing babies.

Consultant paediatrician Dr Ravi Jayaram is said to have caught Lucy Letby “virtually red-handed” in dislodging an infant’s breathing tube in the neo-natal unit at the Countess of Chester Hospital.

Giving evidence at Manchester Crown Court on Wednesday, he said he saw “no evidence” that she had done anything to help a deteriorating baby, Child K, before he walked into the unit’s intensive care room on February 17, 2016 and saw the defendant standing next to the infant’s incubator.

Dr Jayaram said he heard no call for help from Letby or alarms sounding as Child K’s blood oxygen levels suddenly dropped.

Less than two hours earlier, Child K was born extremely premature, weighing 1lb 8oz (692g).

The jury of six men and six women has been told that Letby, 34, was convicted at a trial last year of the murders of seven babies – five before February 2016 – and the attempted murders of six other infants at the Countess of Chester between June 2015 and June 2016.

Dr Jayaram told the court: “I was surprised that the alarm was not going off, although my priority was (Child K) and I didn’t question it at the time. In retrospect I was surprised that help was not called given (Child K) was a 25-week gestation baby and her saturations were dropping.

“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.

“We had had a thematic external review which had not found any other obvious factors.”

Ben Myers KC, defending, said to the witness: “Why didn’t you pick up the phone to the police?”

Dr Jayaram said: “I think if people were not aware before, people are probably aware now since events in August of the culture for clinicians in the NHS who raise concerns. There was a strategy really to keep us quiet. People didn’t want to listen to us acknowledging problems.

“All that would have happened had I picked up the phone to police is they would have got in touch with the trust, spoken to the medical director and said ‘just ignore them, they are a bunch of complaining paediatricians’.

“If I had known then what I know now I would have found different ways to escalate our concerns.

“We had spent a lot of time as a group trying to escalate our concerns and were running into walls to the point that I have realised now the risk we were putting ourselves in, in terms of our professions, our careers and our lives, by continuing to raise concerns.

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

Mr Myers went on: “The easiest thing to do is pick up the phone and say there is a nurse on the unit killing babies – what stopped you doing that?”

Dr Jayaram said: “We added this to our list of concerns. We had faith in the system at the time, doing the right things. I guess putting faith in our medical leaders at senior executive level to do the right thing and it is a matter of enormous regret to me that I didn’t handle this differently.”

Mr Myers said: “This is your unit, your babies. Patient care is paramount. You didn’t call the police because you didn’t see anything worthy of calling the police about, that’s the truth, isn’t it?”

Dr Jayaram said: “No, I disagree. There was an element of denial, an element of fear of retribution from those people above.

“We were already told it was inappropriate to involve police, even from June 2016 when the unit was downgraded and Lucy Letby was moved from clinical duties.

“We were being advised from the start that the police would be the wrong route. And the trouble is, it’s a matter of infinite regret that I didn’t handle it differently. If we had actually not had faith in those that were supposed to have been guiding us.”

Mr Myers said: “Your explanation for not calling police is because of the situation with managers, is that what you are saying? Why were you prepared for this nurse to potentially go on killing?”

Dr Jayaram said: “None of us were prepared but we were in uncharted territory. There is absolutely no precedent or training for us knowing how to deal with this.

“We were meeting big resistance from people at the top, and knowing what I know now I would challenge that hierarchy. Unfortunately then I didn’t.”

Mr Myers said: “You didn’t go to any management saying ‘I’ve caught Lucy Letby red-handed, the only possibility is she deliberately dislodged the tube’. You didn’t say that to anyone.”

Dr Jayaram said: “Not formally.”

Mr Myers said: “And you didn’t because it didn’t happen in the way you said it happened.”

Dr Jayaram replied: “I disagree. I mentioned before about thinking the unthinkable, we didn’t believe that people who worked in healthcare go to work wanting to cause harm. There was also knowing that I probably wasn’t going to be believed because we already had issues with not being believed at this stage.”

Letby was removed from the unit in the wake of the deaths of two triplet boys in June 2016 following a meeting of the whole consultant group who raised concerns again with their bosses, the court heard.

Nick Johnson KC, prosecuting, asked Dr Jayaram: “Did you receive support from management so far as concerns that you were articulating to them about Lucy Letby?”

Dr Jayaram said: “We were explicitly told at that stage it was the wrong thing to go to the police because it would be bad for the reputation of the trust and there would be blue and white tape everywhere.”

Child K’s condition improved after she received breathing support and she was transferred to a specialist intensive care unit at Wirral’s Arrowe Park Hospital later on February 17 because of her extreme prematurity.

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.

A court order prohibits reporting of the identities of the surviving and dead children involved in the case.

The trial continues on Thursday, June 20. The Standard will continue to provide updates.