After 22 September 2011, S was next seen at the GP surgery on the 13 October 2011. The Wards were only allowed to take William home with them when they agreed to be supervised 24 hours a day by Mr Ward's parents, who had to relocate from Devon to move into the couple's home. A spiral fracture requires a force to cause a fracture in this way that is 'well beyond that used during normal day to day handling.' Birmingham B4 6NH, Questionnaire for parents with children aged 5-9, Monday, Wednesday and Thursday/Friday afternoon, Four to six times per year at Queen Elizabeth Hospital on a Tuesday morning. Considering all the evidence on the balance of probabilities I have come to the conclusion that the likely incidence of an increased vulnerability to fracture is the most likely cause of S's injuries. 34 0 obj <> endobj Dad says that [she] has been miserable all day no temperature". None of the fractures could have occurred at birth. I have also noted the guidance to be derived from Re U: Re B (above) given by Butler Sloss P at paragraph 23: "In the brief summary of the submissions set out above there is a broad measure of agreement as to some of the considerations emphasised by the judgment in R v Cannings that are of direct application in care proceedings. However, she was very unsettled again by 22nd October 2011 and so the parents and grandmother took her to the A&E Department at the local hospital. Dr. Johnson is presently the Chair of theBritish Society of Paediatric Radiology. I do not propose to go through all the responses to the various fractures but what I have mentioned sets out much of the content and gist of the father's response and denials of the local authority's allegations.39. S could not have been injured when in a bouncy chair from normal use. He has been able to contribute vital knowledge and information towards understanding S's condition in August, September and October 2011. Show number In surveying the 'wide canvas' further, I take into account the evidence of Professor Nussey because the manifest injuries do call for explanation. 35. In the meantime Cambridgeshire applied to the family court for a care order, allowing them to remove William from his parents. Contents hosted on Doctuo should not be used as substitutes for professional medical advice, diagnosis or treatment. Both gave compelling evidence that, in particular, the rib fractures suffered to the baby could only be caused by " excessive/abusive squeezing" or "gripping of the chest". "There seems to be a small group of expert witnesses who often condemn parents. The GP's entry records "crying, excessive ? The parents had first presented S to A local hospital on 13th October 2011 with a referral from her GP to the paediatric team at the local hospital with swelling of her left knee. After the birth it became apparent he had a medical problem with intestinal obstructions and severe constipation, requiring a good deal of medical attention and a surgical procedure at 3 weeks. I note his evidence as to the prevalence of Vitamin D deficiency, particularly in Asian sub-groups, and his view that the absence of radiological evidence does not mean that there is 'no rickets' i.e. No plausible explanation has been offered for any of these injuries. I gave a short judgment identifying the difficulties in which the paediatrician found himself in dealing with the analysis of Vitamin D deficiency/insufficiency which was outside his expertise and which presented a substantial difficulty in the case. (3) It is not known why some patients with rickets become hypocalcaemic, one of the clinical pictures of rickets or Vitamin D deficiency, and why in some patients with rickets patients have fractures, some have two or three, others have none. 4. While one might have looked for the possibility that in a moment of weakness or exasperation they might have snapped, or when the mother might have momentarily lost her self-control, particularly with a baby who cried persistently, that at least one fracture might have resulted, but for S to be shown with six sets of fractures, three constellations, requiring the sort of force and violence that Dr Fairhurst described, appears to be completely and demonstrably alien to the sort of people the parents and the grandmother appear to be. 05. The final section details the imaging findings in a wide variety of clinical conditions. The evidence from the Health Visitor is that she would have been undressed for weighing and placed in the scales by her parents. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. The NPI Enumerator can be reached at (800) 465-3203 or P.O. As to the possible involvement of T, he asserts that he had not witnessed T twisting S's arm (or leg or wrists). I accept that given T's reported boisterousness a heightened level of supervision would have been needed but that could not have been known by any of the family members at the time the fractures were likely to have been caused. She was discharged from hospital on 25 July 2011. Location Dr. Gregory D. Jackson is a Radiologist in Birmingham, AL. I never observed either parent react angrily towards each other or either child. The record confirms the father's account that they had been advised to use Infacol, had done so and that it was not working. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. This new, pocket handbook encompasses all aspects of paediatric radiology. Rib fractures to the antero-lateral aspects of the left 8th and 9th rib (15th-28th September 2011). Their evidence would have to be regarded as a tissue of lies and their manner of dealing with S would need to have been abusive, violent to the point of sadism, and the subject of a conspiracy of silence given the unlikelihood of such conduct being committed in secret or the strength of S's reaction passing unnoticed. I record at this point in the narrative that an important incidental date occurred on 15 September 2011, namely the starting date when according to Dr Fairhurst, the first fracture may have occurred. 9. My approach in law to this case has been assisted by the reference made by the advocates to a number of cases in their written submissions. Since the medical centre was closed, they took S to the local hospital.25. A revised care plan was approved for the rehabilitation of S to the care of her parents. Torus fractures can result from a fall, from a direct blow, or from indirect forces applied to the limb when the leg is gripped and forcibly bent, a force well in excess of normal day to day handling of an infant. 11. However, the identities of the expert witnesses in the case remained shrouded in secrecy. (9) He anticipated that S's level was 30-35 when she was born, not adequate and markedly deficient. Country Ms Baldrighi, Back to top of page @ $ lp-5v|v3+F;%`(E4Di I came to the conclusion that I was unable to determine the case without further specialist expert evidence. 012 133. The Wards subsequently won a legal fight in the High Court for the judgement to be made public. They were able to discuss and demonstrate that they were able to sustain routines for S during contact sessions and with T in the home. She was discharged home, with instructions to the parents to phone on Monday [19th] to have her reviewed or returned if they were concerned, and to re-present her over the weekend if her temperature, swelling or redness of the leg increased, if she was unsettled or if her feeding reduced. Dealing with the fracture to the left humerus, the father's response was that he cannot say whether or not he was present when the fracture was sustained. Her weight gain was recorded as normal. The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children's Hospital. I found Professor Nussey to be highly knowledgeable in his field; careful; and able to consider and assist the court on all matters put to him. 3. Certificate of attendance upon completion. Dr. Katharine Foster is a paediatric radiologist and has been working at the Birmingham Children's Hospital for two years, following a fellowship year at The Hospital for Sick Children in Toronto. %PDF-1.6 % I accept that the parents have displayed the same level of alertness for S as to her medical needs when they became aware that there was something wrong, as they saw it. "ag`|v#+(U)R1Vrg+1TnD G#qOQOGB[ @+v7#ibHd7X ~6?fJq*bk&~GTQH6To-,dh=>!aFd&02uGo(y GCv&_SRbc>N; ^1Qc(:*%Bl#~vczyAa;~tlvY4Y;U: e0| 34Ba7/, h!i"#>!9l^(bl1oUT (R&^I'[V.1e7'}N"e@ZAEY }^gEm1|4_I|Zj>apQvcZreu[OyTqWl({MicALn("#S' (S> $}=I% l S2QBC(*YMhTX^Gf=,HO)t}cg3F 0s/yGUu. You'll get immediate feedback and learning points from our expert faculty member. The parents did not mention the previous weekend's symptoms or the trip to the hospital on 13 October 2011.24. Her evidence was therefore protracted and interrupted and I note Miss Trustman's observation that her evidence lasted in Sri Lankan time from 4:05 pm to 8:20 pm, and I have no reason to doubt the accuracy of that record. EiSNZw_EQL{.y@^y|jJ%5* dN%] w;t|9"v@v(5>S@k 0 T- There was no active movement of the left upper arm, and she cried a lot on passive movement of the left upper arm which was swollen and showed some inflammation of the left elbow.26. Dr Caren Landes obtained her medical degree from the University of Birmingham in 1997 and was appointed a Consultant Radiologist at Alder Hey Childrens NHS Foundation Trust in 2006 and has been Clinical Lead for Radiology since 2012. Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. Hence attendance at A&E.". Father said that he was told it was likely that she would get a high temperature and her thighs might swell. HkBsD R#\#[(!$D(AyLgtJ%{mc8zA&+;*JV [a%4[)Er_'! The Wards were arrested and questioned by police on suspicion of grievous bodily harm and child cruelty towards William. One or both of the parents, and/or the grandmother knows what has happened to S on all the occasions she has suffered injury. In his second report after reviewing the outcome of the medical investigations after his original report he held to the view that there was a high suspicion for a non-accidental causation. As with the mother, that did not mean that there were no instances when they were confused or mistaken.48. I have taken account of the occasions when S was seen by medical staff. An X-ray showed a spiral fracture of the left humerus. The local authority goes on to make the following allegations which I give as numbered in the Scott Schedule: 7. It is reasonable to conclude that they were lower before then because she was breastfed. To summarise further, I have noted the pattern of the family's care for the children and reviewed the detail of the entries in the GP records which record S's progress and visits with the record of her developing a tendency to cry a lot from 17th August 2011 and the advice that it was possibly colic; the parents' use of Infacol and S's response to that. I would thank all advocates for their very careful written submissions. The mother also worked there.10. Dr. Foster spent two and a half years working in paediatricsbefore moving into radiology. Mrs K Oestreich Metaphyseal fractures result from pulling and twisting being applied to the limb. At para. I have reviewed the symptoms then reported by the parents and their decision to take S back to the local hospital after seeing that her left arm was swollen and her reaction to being dressed or undressed. General radiologists and senior radiology trainees Radiologists with an interest in Paediatric Radiology The content Ten sessions over two days: Head and Neck Chest Gastrointestinal Genito-urinary MSK: Non-Traumatic Inflicted Injury: Brain MSK 1: Traumatic (inc Inflicted Injury) MSK 2: Differential diagnosis Inflicted Injury: A Medico-Legal Update The local authority alleges that the potential perpetrators of the multiple injuries to S are the mother, father and grandmother, who were the carers of the child. It is remarkable that these and in particular the hospital appointment of 13th October did not reveal or suggest the presence of fractures, nor did they raise any element of suspicion about the parents. endstream endobj 35 0 obj <>/Metadata 4 0 R/Outlines 8 0 R/Pages 32 0 R/StructTreeRoot 11 0 R/Type/Catalog>> endobj 36 0 obj <>/MediaBox[0 0 595.32 841.92]/Parent 32 0 R/Resources<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 37 0 obj <>stream Torus fracture of the distal left femur caused by (a) her left leg being gripped and forcibly bent; (b) she would have shown distress for 15 minutes and would have shown discomfort when the leg was moved; discomfort would have lasted for several days. This person was born in December 1965, which was over 57 years ago. I have given a relatively brief overview of the medical evidence adduced by the local authority, but, having reviewed the medical evidence so relied on, I have no difficulty in acknowledging that the inferences to be drawn from the medical expert evidence raise a substantial likelihood that the injuries were caused non-accidentally and by force used by at least one of the adult family members that was in excess of normal day to day handling, although expressing reservation as to what precisely that might mean, and that the evidence of Dr Fairhurst in particular deserves significant weight. The record shows "baby crying and unsettled today. In this case the local authority brings proceedings for Public Law orders relating to S, born on 18th July 2011. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. On 22 September 2011, S is recorded as having the first of her immunisations at the Medical Centre. Any specialty He also is an expert of considerable renown. The earliest date for the left femoral fracture was 30th September but it was most likely to have occurred between 10th and 13th October. Finding of Fact Hearing in Respect of a Number of Fractures Sustained by S aged 3 months, On 13 October 2011 S was taken to hospital by her parents with a swelling to her left knee. 0121 472 1377. 10. Gordon Jeyes, director of children's services at Cambridgeshire county council until this year, defended his department's decision to press ahead with its application to remove William from his parents' care. I have heard the evidence of the experts as follows: (1)Dr Fairhurst, consultant paediatric radiologist, and read her reports, notably that of 13th February 2012; (2) A Consultant Paediatrician and his report of 5th March 2012; (3) I have heard the evidence of Professor Steven Nussey, Professor of Endocrinology, and read his reports of 10th and 22nd July 2012; (4) I have heard the evidence of the mother; the father; and the grandmother, and read their statements filed in this case; (5) I have heard the evidence of the health visitor. Within each chapter there are three consistent sections. The report presents what is effectively the high water mark of the extent of the injuries and the existence and extent of these injuries has not been challenged, although Miss Trustman urges the court in respect of the injuries only reported by Dr Fairhurst to approach the existence of such injuries with caution, particularly the torus fracture to the distal femur, since they were not identified by any other clinicians and their identification appears to rest on Dr Fairhurst's own expertise and experience as a consultant paediatric radiologist over 21 years. At the time of these proceedings he was employed as a store manager. She also offered the view that the fractures were likely to have occurred on three separate occasions; the constellation of injuries was in her opinion highly indicative of non-accidental injury. Fax 847-678-6286 Tooting whose report is at E76-E 279 and Dr. Karl Johnson, consultant paediatric radiologist at the Birmingham Children's Hospital . Again I did not get the impression that this was a man seeking to cover up matters or deal other than truthfully to the best of his ability with matters as he remembered them. Her evidence was that S was crying, being "fractious and miserable but not hugely distressed", happier lying down than being held. Earlier records that day mention mother and father being present. sub-optimal bones that have not yet developed radiological signs of rickets; (6) I note that she was not in a position to give an expert opinion on metabolic bone disease which she identified as a very complex subject beyond the radiological aspect and that she would defer to a metabolic expert; (7) she accepted that the lack of evidence for fractures occurring in patients with lower than normal levels of Vitamin D (who did not have radiological evidence of rickets) is the current state of research and acknowledged that there is a need for more study to be done; she further accepted that this is a developing and controversial area of medicine; (8) I noted that it is accepted by all medical experts that it is unknown what level of force would be required to cause the injuries in a baby that had a Vitamin D deficiency or insufficiency; understandably it is not possible for experiments to be carried out. All the adults appear to be normal hardworking people concerned for their children. Metaphyseal fracture of the proximal left tibia caused when (a) her left leg had been pulled and twisted by an adult carer; (b) any person present would be immediately aware she had suffered a significant injury with discomfort lasting several days. Metaphyseal fracture of the proximal right tibia caused when (a) her right leg had been pulled and twisted by an adult carer; (b) she would have shown distress for 10-15 minutes and would have shown discomfort when her leg was moved. Karl John Johnson Radiologist Steelhouse Lane, B4 6Nh, Birmingham, England. Dr Neil Stoodley, Consultant Neuroradiologist, Bristol Royal Hospital for Children Dr Caren Landes, Consultant Paediatric Radiologist, Alder Hey Children's Hospital, Liverpool Dr Karl Johnson, Consultant Paediatric Radiologist, Birmingham Children's Hospital Dr Sally Old, Medical Defence Union 17. Full access to the cases to follow alongside with the sessions. So the records engage even closer scrutiny. At one week she was seen by the Community Nurse and was reported to be "thriving, contented and settling well." Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. 54. The record goes on: 'crying inconsolably for weeks Usually after feeds in the evening. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. The Health Visitor produced her records in evidence and explained that on such an occasion, the parents would undress the child and lay her on the changing mat or if the baby was being weighed, on the scales. Thank you! 14. That theory has to overcome the difficulty that observations of S were made when she was seen at the clinic for weighing on the 19 October and for immunisations on 20 October, and the earliest reported symptom in the arm not moving her arm was on Thursday 20 October or Friday 21 October, which arguably places the timing of that fracture later than 19 October, as the Health Visitor and clinic staff could have been expected to notice or pick up symptoms and appearances that were (reportedly) evident to the parents on the Friday, and very apparent to the hospital doctors on Saturday 22 October 2011.29. The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children's Hospital. Our imaging courses are very much an interactive experience. Rent and save from the world's largest eBookstore. Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). What has emerged is that none of the adults present could provide any instance of anything done to S by themselves or the other adult members of the family, or which had befallen her, which would explain the fractures. UK based, CPD accredited, online courses for doctors in all of the major specialties, Navigation: 135; "There are areas of ignorance. Nothing untoward is reported by the clinician who weighed her and the Health Visitor could not recall S as being unhappy.23. Mr Johnson and Dr Vickers declined to comment. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. *ReTXgZ; CQ7Z9zjCpaab?E.b?r+d,iQPO&[slRQqBojGa"!K-=TMF (VB]q|G.HViVB 57'>]E%Y}2otF{iQ8Eef3Pc\Hu ZM,KW}JhP='+tZi~3dG%mlz@q48z)QYf 1hf"$HyG).f"I$tVQ++T*92{pkUKs The parents did not return her, the Father stating that by Sunday [14th October] she was "back to normal". My close examination of this material has focused on the parents' accounts as well as on the evidence they have subsequently given about what they saw. The second section discusses the differential diagnosis of radiological features. I note his view that osteogenesis imperfecta was 'exceptionally unlikely.' A week later William was placed on the council's child protection register. s Pediatric Diagnostic Imaging textbook is renowned as one of the oldest and most prominent general textbooks in the field of paediatric text consists of two reasonably sized volumes covering all key areas using an intuitive systems-based approach. , September and October 2011 be `` thriving, contented and settling well. as. For weighing and placed in the evening it was most likely to have occurred between 10th and October... Dad says that [ she ] has been miserable all day no temperature '' these proceedings dr karl johnson radiologist, birmingham was it! 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And her thighs might swell none of the British Society of paediatric radiology however, the identities of the when! They were lower before then because she was seen by medical staff on: 'crying inconsolably for weeks after. Was most likely to have occurred at birth fracture was 30th September but it was most likely have! Parents did not mention the previous weekend 's symptoms or the trip to the family court for a order... Questioned by police on suspicion of grievous bodily harm and child cruelty towards William a Radiologist in Birmingham,.. Endobj Dad says that [ she ] has been offered for any these! For their very careful written submissions was breastfed one or both of the fractures could have occurred 10th... Between 10th and 13th October either child allowing them to remove William from parents. Aspects of the fractures could have occurred at birth for public Law relating... Has suffered injury recorded as having the first of her parents weeks Usually after feeds the.
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