Fee includes 90 days of access with unlimited playback during this time. Mrs K Oestreich 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. 8. The local authority relied upon the evidence of the consultant paediatric radiologist who acknowledged what whilst there could be a Vitamin D deficiency there was little, if any, supporting evidence of fractures being caused by lower than normal Vitamin D levels where there is no evidence of rickets. 9. I have in particular noted the GP entry reports and the visits made by the parents for checks or routine appointments. On the balance of probability T could not have caused the injuries to S. 16. The father maintains that there could be some natural explanation for S's injuries.38. hbbd``b`J5 `n\ a#H #e \ In the course of surveying the 'wide canvas' of evidence I have reviewed the evidence of the mother, the father and the grandmother. The local authority sought findings that the injuries had occurred non accidentally with the parents and grandmother as possible perpetrators. He was Karl Johnson, an eminent radiologist who specialises in non-accidental injuries and has acted a police witness in several cases of child abuse. 35. CT and x-ray are the first-line modalities, as these investigations are fast to conduct and have been shown to quickly reveal unexpected findings such as posterior rib fractures, metaphyseal corner fractures, and intracranial haemorrhage (especially subdural haematomas), contusions, and lacerations. 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. I have examined the process by which the fractures were discovered and that it was not until the report of Dr Fairhurst, consultant paediatric radiologist, of 13th February 2012 that the full extent of the injuries alleged to have been sustained by S were revealed and her report included three new areas of injury not seen or confirmed by earlier reports. A revised care plan was approved for the rehabilitation of S to the care of her parents. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. Mindelsohn Way While the mother, in oral evidence, did not accept that she had noticed S was "not moving her arm" the previous day, although it is clearly noted by two different clinicians, she was very clear that neither she, her husband or her mother had done anything to S, nor could she remember any episode when she had cried more.27. On 24th October 2011 a skeletal survey detected what appeared to be two left rib fractures. The Judge surveyed the 'wide canvas' of the case including the manner in which the parents gave their evidence. Show number Centro mdico: Birmingham Children'S Hospital, Birmingham Do you wish to correct the information? 34 0 obj <> endobj The GP note for 20 October 2011 records "First meningitis vaccination. Mr Johnson and Dr Vickers declined to comment. So, as I review the evidence of the parents and the grandmother, it appears that there is a strong strain in the evidence that runs counter to the evidence and conclusions of Dr Fairhurst, producing by its weight and nature what I would regard as a substantial likelihood that this family would not perpetrate the sort of violence which according to the medical evidence of Dr Fairhurst and the Consultant Paediatrician must have been inflicted upon her. It must also raise as a real possibility the potential explanation that T may have brought about one or more fractures, along with the possibility less likely, in my view that S may have been injured when the family slept together in one bed. It is reasonable to conclude that they were lower before then because she was breastfed. The note records both mother and grandmother as being present. They are set out in a Scott Schedule dated 16th March 2012, which I will duly set out but for the record which I enumerate now before commenting on the parents' and grandmother's responses: 1. This person was born in December 1965, which was over 57 years ago. * Panorama's Please Don't Take Our Child is broadcast on BBC One tomorrow at 8.30pm. It was the maternal grandmother's view that her daughter and son-in-law did not injure S. The maternal grandmother also mentioned that she had cared for her own children, relatives and grandchildren and was capable of ensuring that children are properly and safely cared for. I do not propose to set out all the instances or to address them individually: to do so would be disproportionate in the light of my observations about the evidence of the parents, having listened to them carefully, considered at length the sort of people they are, and the impression that each gave to the court. I take note also that the mother and father completed a parenting assessment. But during the family court proceedings serious doubts were cast on Dr Johnson's evidence by other medical experts. Based primarily on the evidence of Dr Fairhurst, the local authority has levelled a broad spread of allegations against the three adults in the household at the material time the mother, father and grandmother. 17. On examination, the left knee was "warmer to touch than the right, with mild erythema and swelling over the knee". I derive particular assistance from his evidence and the conclusion that S had a greater vulnerability to fracture, which he described as a reasonable conclusion, and at the times when they are likely to have occurred. S would often cry and it was initially believed that this was due to her suffering from colic. This new, pocket handbook encompasses all aspects of paediatric radiology. Find Dr. Jackson's phone number, address, hospital affiliations and more. 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. Presentations are kept to the minimum and then you'll be into the fully featured cloud based DICOM viewer, looking at cases, feeding back your findings using our interactive tools. Interpretation & Reporting Webinar for the General Radiologist, DAY 1: GENERAL PAEDIATRIC RADIOLOGY - WEDNESDAY 9 FEBRUARY 2022 Rib fractures to the antero-lateral aspects of the left 8th and 9th rib (15th-28th September 2011). All the family carers accept therefore that they are in the potential pool of perpetrators as they were all involved in her care, but they deny inflicting injuries upon her. The outcome of the case, in a landmark High Court judgement, has helped to lift the secrecy surrounding England's family courts, where campaigners claim that a lack of openness creates an environment in which miscarriages of justice can go unnoticed. On 3 August 2011, S and the mother were seen at home by the Community Nurse, and the record shows that the mother had no concerns. She said: "How could we celebrate that someone has decided you didn't hurt your child when you know all along you didn't? On 14 January 2013 I made orders and gave a foreshortened (primary) version of the judgment in this case which had run over a substantial period in 2012 and before, because having reserved judgment in what was on any view a difficult case, delays in preparing the judgment for administrative reasons and with difficulties over my own health meant the process became much longer than I would have wished. Dr Karl Johnson Consultant Paediatric Radiologist, Birmingham Dr Sabine Maguire Senior Lecturer Child Health, Cardiff Lady Margaret Wall RCR Lay Representative Dr Tim Jaspan Consultant Neuro-Radiologist, Nottingham Dr Chris Hobbs Consultant Paediatrician, Leeds Dr Neil Stoodley Consultant Neuroradiologist, Bristol The father completed a course in tourism management and completed a post-graduate degree in business management. Her special interests include musculoskeletal radiology and trauma, particularly imaging in inflicted injury. A number of strengths however have been identified during this short involvement. At no point did I observe either child to be wary of their parents. In my judgment their accounts do have a certain coherence and quality that would suggest that they have sought to do their best in bewildering circumstances. I draw the conclusion that it is reasonable in S's case to assume that a lesser degree of force would be required if her bones were sub-optimal as a result of Vitamin D deficiency, which I am satisfied on the evidence that S's bones probably were, viz., Vitamin D deficient. When to refer and why Dr Rajendranath Sinha, The Newcastle upon Tyne Hospitals NHS Foundation Trust Lovely baby." Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. 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. The local authority took action on 26th October 2011 after the Consultant Paediatrician concluded that there must be a high level of suspicion in the absence of explanation of the injury to the left arm that the humeral and left rib fractures may have been sustained as a result of a non-accidental injury. The deal meant they could never be alone with their own son out of concern that they would cause him further harm. 5. (9) He anticipated that S's level was 30-35 when she was born, not adequate and markedly deficient. The left tibia fracture was likely to have occurred between 3rd and 10th October and the likely time frame for the left humeral fracture was between 16th and 19th October. With no help from outside agencies their couple mounted their own investigation into the cause of their son's injuries. "Unfortunately the job of social workers is to think the unthinkable because sometimes terrible things happen. Tell us your views in a simple 5 minute survey to help us make the service even better. They could offer no explanation as to how the fractures may have happened. He has co-authored over 35 peer reviewed papers. 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. 10. The guardian also represented the other child of the family T, who was born on 14th February 2008. Filming William asleep at night they discovered he moved vigorously during his sleep, repeatedly kicking his legs. 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. Clinic Locations. Only now, three years later, have the Wards managed to draw a line under the affair by forcing the name of the key expert witness to be made public. 7. She states that they do not occur accidentally and this type of fracture is highly indicative of non-accidental causation requiring a force well in excess of that used in normal day to day handling of an infant. Had an instructive and engaging educational experience. She also asserted that in her view there was no correlation between Vitamin D deficiency and fractures nor was there an increased propensity to fracture due to a Vitamin D deficiency. He arrived at the preliminary conclusion that the humeral and rib fractures must give rise to 'a high level of suspicion' for non-accidental injury. Steelhouse Lane Mrs A Jester This advanced Infomed webinar is in response to suggestions/feedback from many general radiologists, who have attended Infomed courses, more lately webinars, and now with the easing of the pandemic see the need for a focussed and comprehensive Paediatric Radiology CPD programme. Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). Call. 16. That aspect is not mentioned. The court must always be on guard against the over-dogmatic expert, the expert whose reputation or amour-propre is at stake, or the expert who has developed a scientific prejudice;v.The judge in care proceedings must never forget that today's medical certainty may be discarded by the next generation of experts, or that scientific research will throw light into corners that are at present dark.". 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". Judge Isobel Plumstead finally concluded that Mr and Mrs Ward presented no threat to William, declaring in her judgement: "There is no cogent evidence that these parents injured their son.". We wanted to be able to name expert witnesses in order to help all those other families who are going through what we went through.". 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. S had regained and passed her birth weight. The local authority goes on to make the following allegations which I give as numbered in the Scott Schedule: 7. "It was a nightmare which seemed to be spiralling out of control.". The father said in oral evidence that S developed a pattern of crying after 3 to 4 weeks old, particularly in the evenings. The Judge found that neither parent was seeking to cover up matters or to deal other than truthfully to the best of their ability. The parents agreed to section 20 accommodation on 27.10.11 and on 2.11.11 the local authority issued care proceedings. Now the Local authority has promptly and appropriately put into effect a revised Care Plan to give effect to the orders made that day. 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. She refers to the times when S was seen by the health visitor when, despite the presence of fractures, nothing untoward was seen on as she puts it 25th July 2011, 3rd August 2011, 22nd September 2011, 19th October 2011 and 20th October 2011. 47. They both appear to value education and a need to promote this ethos with their children. She is the radiology lead for child protection, rheumatology, orthopaedic and skeletal dysplasia multidisciplinary meetings at Alder Hey Childrens NHS Foundation Trust. The Consultant Paediatrician, in his report of 5 March 2012, picks up on the record that T would become annoyed when S was unable to play with him, not understanding that it was not possible. The question arose as to whether genetic abnormality of bones, metabolic bone disease or demineralisation of the bone caused by Vitamin D deficiency gave rise to an increased propensity to fracture. courses@infomedltd.co.uk+44(0)20 4520 5081. 135; "There are areas of ignorance. 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. This led them to suspect that he may have caught his right leg between the bars of his cot and the mattress of their own bed, causing him to fracture it as he struggled to pull it clear. Within each chapter there are three consistent sections. He confirmed the presence of the humeral fractures and rib fractures and, following further X-rays, identified what he thought was a healing fracture of the proximal left tibia. N and D appeared able to actively provide a high level of basic care for their children.'. DR KARL JOHN JOHNSON is British and resident in England. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. It is necessary to take account in combination with these reports of the dates provided by Dr Fairhurst for the occurrence of the various fractures to S, the clinicians' observations, also the X-ray and the report of nothing abnormal on 13 October 2011. I therefore granted an adjournment so that a suitable expert could be instructed. NS>zu=/_jwJa:S Dr. Foster spent two and a half years working in paediatricsbefore moving into radiology. No temperature. 18. As to the grandmother, she gave evidence by Skype from Sri Lanka and as I have earlier said her evidence was subject to unavoidable and unfortunate technical difficulties. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. I will quote only two passages, in order to convey the tone and broadly positive view that emerges from this report, at p. 3 and from the Conclusions at p. 16. The father accepts that only he, the mother and the grandmother were caring for S during this time. In the meantime Cambridgeshire applied to the family court for a care order, allowing them to remove William from his parents. The Judge considered that S was seen five times at medical appointments when she was said to be suffering from fractures and noted that at those appointments not only did they not reveal the fractures but nor did they raise any suspicion about the parents. The memories of the parents were assiduously and closely examined by all counsel and compared with the notes written at the time.28. She was between the 25th and 50th centiles for weight, and maintained the usual track after the usual loss of weight in the first week. I have been very grateful for them in undertaking what I have to say has been a difficult task and one which has actually required very much reflection and re-examination. (On examination) Crying ++. I have also noted the case of Re S-B (Children)(Care proceedings; standard of proof) [2009] UKSC 17 and particularly the passage in which their Lordships confirmed that the simple balance of probability test following the House of Lords decision in Re B (above) should be applied in finding that a person was the perpetrator of an injury, confirming the approach where the evidence falls short of that standard in North Yorkshire County Council v SA [2003] EWCA Civ 839 to the effect that an individual will be found to be a possible perpetrator if the evidence establishes a 'real possibility' that they caused the injury. There are a number of other features of the evidence about the parents which I must take into account as part of the 'wide canvas' of evidence that I have surveyed. DR KARL JOHN JOHNSON is British and resident in England. The child appears by her children's guardian and has been represented by Miss Dixon. "It was felt that it was a matter of such complexity and range of opinion that it was a matter for court determination.". Determined to establish what was wrong they returned twice to the GP, but he was still unable to offer any diagnosis. The Judge formed the strong impression that the parents were careful, child focused parents who had demonstrated good quality parenting dealing with S's older sibling.The Judge took into account the evidence of an endocrinologist who opined that the absence of radiologically identifiable rickets did not mean there were no rickets. The responses of the parents and the cases which they have put before the court appear in summary form on the Scott Schedule. Whilst noting Dr Fairhurst's views as to when the fractures occurred and the windows for probability as she saw them, I have taken account of the extended period over which the fractures were identified. Earlier records that day mention mother and father being present. I noted from her evidence that she was concerned about and focused on the wellbeing of S. It appears that she was the first to notice distress in S; that she appeared to advise that the parents attend a doctor for every aspect of S's wellbeing. (6) It is not possible to say what difference formula feeding might have provided because there is no baseline to measure from. You can book online your appointment and hire medical insurance online. 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. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. We operate from Monday to Saturday and also provide an emergency on-call radiography service 24-hours-a-day, seven days a week. 32. At this point I summarise his evidence by identifying the following features: (1) Professor Nussey has a clear and far-reaching understanding of endocrinology and the systems involved with Vitamin D and bone mineralisation. Her parents returned with S on 22.10.11 with a swollen arm. Thus the view of Dr Fairhurst, a considerably experienced and respected radiologist, is that all of the injuries would have required a force in excess of that used during normal day to day handling and that several of the fractures were highly specific for non-accidental causation of injuries. Their most recent appointment, in our records, was to DR K JOHNSON LIMITED on 2015-08-17. I noted in relation to the mother that she gave her evidence calmly, she was quietly spoken, she gave direct and straight answers, she was composed and it appeared that her answers came from her genuine recollection without her giving what might have been expected answers. 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. 17. On 17 August 2011, S was taken to the clinic at 4 weeks old to be weighed. At 6.20pm on 13 October 2011, S was brought to the local hospital, with the presenting complaint "swollen left knee started yesterday." If there is some innate contradiction in that sentence it appears that the latter part of that sentence represents the stronger conclusion. Read full profile Dr Khushnood Alam Consultant Radiologist Biography pending. Birmingham B15 2TG, Birmingham Children's Hospital 09. When Victoria and Jake Ward saw their baby son crying and refusing to feed, they took him to their doctor. 57 0 obj <>stream Within each chapter there are three consistent sections. 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 fractures to the right lower leg took place between 12th September and 10th October. 33. Catch-up service: Paediatric Radiology 2022, Catch-up now with our case-based Paediatric Radiology webinar that took place in February 2022. However, I note the high level of engagement with the medical services throughout T's life and the attention and care that he needed and received, caused by his own particular medical condition. an improved understanding of Paediatric imaging interpretation and reporting skills. Infacol was helping When they stopped giving her that the crying worsened.Small vomits with it usually just food coming up with burpingStarted bottle feeding 1/12 [one month] ago.Yesterday, note that [baby] not happy straightening her left knee. Consultant Paediatric Radiologist and Service Group Lead for Radiology, Alder Hey Childrens Hospital, Liverpool, UK. 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. This led to a referral by the consultant paediatrician from the local hospital to Social Services. However, in September 2006 the Crown Prosecution Service decided not to proceed with the case after detectives said they were unable to prove who had harmed the baby. In the absence of an explanation of the injury to S's left arm, the Consultant Paediatrician considered that there was a "high level of suspicion that the humeral and rib fractures may have been sustained as a result of non-accidental injury". England, Population Dr. Johnson is presently the Chair of theBritish Society of Paediatric Radiology. Injuries to S could not have been caused by a person rolling onto her. &/6kc`&EnFl! h~aka }mfh{p#P\fv}Clh+r9>XY7U&l5 tfL(h~)=O.szywUafH9!dN2-bs4XW+w2?b;NWNl 5ybc i20 V*a Qjff`# 2E,C\v{:]nJI'G,6]$kBEGs0XX'O-J(|- KTg}LzgNY At one point, he mentioned that they had thought it was due to her immunisation that she was not using her left hand. Country 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. She was discharged from hospital on 25 July 2011. With Doctuo you can find the doctors you need. Specialties As it is, her persistent crying which may well have been her response to the injuries can be considered in the light of the reports of the parents about her crying and the possibility of their misinterpretation of her crying emerges as a very real consideration. As to the possible involvement of T, he asserts that he had not witnessed T twisting S's arm (or leg or wrists). 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. Mr Sami Al-Ani The book is an important revision aid as well as an up-to-date reference. The local authority alleges that the injuries were suffered by S and caused by an adult carer and they are non-accidental. . Left knee is swollen, feels hot and tender. It soon became clear that both the police and social services were relying heavily on the evidence of Dr Johnson, who said that William had suffered four fractures which had taken place on at least two or more separate occasions. Nearby doctors Sarah Yusuf Nazia Anwar Kaushal The first time a fracture was noticed was on 22nd October despite an X-ray having been taken of S's knee on 13th October.S had been in the care of her parents and maternal grandmother when the fractures occurred. Dr. Helen Williams is a full time general paediatric radiologist, and has special interests in cross-sectional imaging, feeding studies and radiology training. Site map, Please rate your experience out of 5 (with 5 being the highest and 1 being the lowest), Birmingham Women's Hospital There is no evidence of drugs or alcohol abuse, of anger or violent outbursts, of short temper, volatility, irritability or dysfunction. BSc, MBBS, MRCP, FRCR, PhD, FHEA Find Dr. Thomas's phone number, address, hospital affiliations and more. I have noted the words of Butler-Sloss P in Re U: Re B (Serious injury; standard of proof) [2004] 2 FLR 263 and the court's responsibility to survey a 'wide canvas' and in Re L [2011] EWCA Civ 1705 that 'Clearly from the forensic standpoint given any degree of uncertainty in the medical and scientific field the judge's appraisal and confidence in the parent is absolutely crucial to the outcome.' As to the possibility that rough handling by T might have been responsible for S's injuries, he concluded that while it would be possible he did not think it was probable. 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