Her special interests include musculoskeletal radiology and trauma, particularly imaging in inflicted injury. I am satisfied that neither the mother, the father, nor the grandmother can be held responsible for causing the injuries in a non-accidental or careless way and the court remains unable to find any one of them more likely than the others to have caused them. He was able to extrapolate that S's Vitamin D levels at birth were likely to have been markedly deficient having been Vitamin D deficient in utero. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. It also records the following: "Mother is not able to recall how the fracture might have occurred: S, she advises, was using her arm less and appeared irritable from Thursday a.m. on 19/10/11 [sic 19/10 was a Wednesday] then went with Mum to have immunisations Thursday 1pm, where she was placed on a couch and not, to mother's recollection, held tightly, then seemed intermittently in discomfort with on-going reluctance to use her left arm as much as right, then today arm appeared swollen. The Judge was satisfied that neither the mother, father, nor grandmother could be held responsible for causing the injuries. The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children's Hospital. 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. This new, pocket handbook encompasses all aspects of paediatric radiology. 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. The father's main recollection seemed to be that S was "very quiet" on the Friday, although he had told the police on 24 October 2011 she was "fine" on that day. Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. I go into detail on the background facts to this case which important in my consideration because they form part of the 'wide canvas' mentioned by the President Lady Butler-Sloss in the case of Re U (Serious injury: standard of proof) [2004] 2 FLR 63. At para. Any specialty 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. Since the medical centre was closed, they took S to the local hospital.25. Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). Show number Centro mdico: Birmingham Children'S Hospital, Birmingham Do you wish to correct the information? 22. 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 father said in oral evidence that S developed a pattern of crying after 3 to 4 weeks old, particularly in the evenings. . Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. 20. Wanted a review(Under 'P') Discussed with Mum and Dad possible colic will continue withInfacol and see how she gets on over next week. 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. The note records both mother and grandmother as being present. I have also noted in relation to the injuries that it is 'always open to a judge to rule that the cause of the injury remains unknown' and the case of Re R (Care proceedings: causation) [2011] EWHC 1715, a decision of Mr Justice Hedley. With Doctuo you can find the doctors you need.
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It was also noted that the parents were unsure how it had happened and there had been no recent accidents or falls. Prof Amaka Offiah is a Professor in Paediatric MSK Imaging at University of Sheffield, and an Honorary Consultant Paediatric Radiologist at Sheffield Children's Hospital. The parents agreed to section 20 accommodation on 27.10.11 and on 2.11.11 the local authority issued care proceedings. During the time period for the occurrence of the fractures S was seen by medical professional 5 times on 16th September, 22nd September, 13th October, 19th October and 20th October. 9. Expert evidence from paediatric radiologist (Dr. Karl Johnson) and consultant paediatrician (Dr Russell Croft) was obtained and they were cross examined in Court. I note his view that osteogenesis imperfecta was 'exceptionally unlikely.' This led to a referral by the consultant paediatrician from the local hospital to Social Services. 4. 07. British Society of Paediatric Radiology: Paediatric MRI for general radiologists - tips and tricks 16:50 - 17:10 Musculoskeletal (MSK) imaging Dr Karl Johnson, Birmingham Children's Hospital NHS Foundation Trust Learning points In the maturing child, the marrow signal will alter depending on the amount of haemopoietic and fatty tissue within it. Yet even after the criminal case collapsed for lack of evidence and a family court finally decided that the parents posed no threat to their son, the couple were astonished to find that the names of the doctors who had given evidence against them were kept secret. 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 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. "There seems to be a small group of expert witnesses who often condemn parents. A revised care plan was approved for the rehabilitation of S to the care of her parents. 2023Check Company | Privacy | Terms of Use | Contact Us. Our imaging courses are very much an interactive experience. I note in particular the five times when she was seen at medical appointments when she was said to be suffering fractures. It was noted that the parents were unsure how the fracture may have happened and there had been no recent accidents of falls. 49. 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. I note the entry as follows: 'non-tender, baby permits passive manipulation. However, the identities of the expert witnesses in the case remained shrouded in secrecy. 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.". 0
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. The local authority goes on to make the following allegations which I give as numbered in the Scott Schedule: 7. Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. Aged 20 in December 1999, she had married the father just before he came to England She joined him in this country in October 2003. Because William's parents were unable to explain the fracture the hospital deemed the case suspicious and called in social services. "It was a nightmare which seemed to be spiralling out of control.". The father states that S cried more than usual and that this was reported to medical professionals on 20th October 2011 and 22nd October 2011. When S was 10 days old, her maternal grandmother arrived from Sri Lanka to live with the family and to help mother look after the children.13. You can book online your appointment and hire medical insurance online. 18. The parents' observations are also a matter of record, as are the consultants' examination. At hospital on Saturday 22 October 2011 at 15.30, the triage nurse noted the presenting complaint as "swelling to the left upper arm" and "since Thursday, increased crying". 135; "There are areas of ignorance. 3.o-VR;+lZsA30PK#>] FP+irJBp%MU :g
I{,8fVn|aQY/,E/sa8Cd8sfhD5wGtkE4*8*q0zW,7(Ic The father completed a course in tourism management and completed a post-graduate degree in business management. 10. He indicated that in addition to the spiral fracture of the upper left arm, healing fractures of the left anterior 8th and 9th ribs were noted, with the amount of callus "suggesting that these fractures are not acute". Birmingham Update in prostate cancer Topics to include: . Mrs K Oestreich '(&NJdsB. The local authority place considerable weight on the evidence of Dr Fairhurst as to the interpretation and significance of the X-rays, the report of 13th February 2012 and the evidence as to the mechanism of injury in relation to spiral fractures, metaphyseal fractures, fractures of the antero-lateral aspects of the ribs and a torus fracture raise very serious implications for the family members. 05. Ms Baldrighi, Back to top of page I do not form the impression that they could be seen then or with hindsight can be seen now as a family seeking to hide their ill-treatment of S from the authorities. Interpretation & Reporting Webinar for the General Radiologist, DAY 1: GENERAL PAEDIATRIC RADIOLOGY - WEDNESDAY 9 FEBRUARY 2022 Paediatric Radiology opens with a chapter devoted to the different imaging modalities, including radiographs, fluroscopy, ultrasound, CT, MRI and nuclear scintigraphy before moving on to more detailed, systems-based chapters. She obtained her MBBS while working at Oldchurch Hospital, Essex and trained as a radiologist in Sheffield. 16. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. 06. Within each chapter there are three consistent sections. Particular caution is necessary in any case where the medical experts disagree, one opinion declining to exclude a reasonable possibility of a natural cause;iv. The other parties to the case are S's parents, who are married. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. (6) It is not possible to say what difference formula feeding might have provided because there is no baseline to measure from. At one week she was seen by the Community Nurse and was reported to be "thriving, contented and settling well." S had regained and passed her birth weight. Find Dr. Jackson's phone number, address, hospital affiliations and more. 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. N and D are in a stable relationship and have known each other from childhood as they lived in the same village. 34 0 obj
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09. VOIT$=EfPuP^ AiiUw~,JZ%?rG?("S{t }p# y|!W7XQb,{*|p>'A7:#;p`Wnx n&Thb !pA}ifRh0$*W@~n0?Olgj;|TO^,WicR|WV2riRm- Our Radiology CPD courses offer an exclusive range of clinical imaging seminars, available to support Radiologists, Cardiologists, Registrars and Radiographers from around the world in gaining CME. The second section discusses the differential diagnosis of radiological features. The paediatric clinicians note records that "yesterday evening the parents noted [her] crying and unsettled, left leg persistently held in a flexed position." But in the light of all that is known about the parents and from my impression of them in evidence balanced against all that is submitted and produced by the local authority it is not likely, in my judgment, that her injuries were caused by non-accidental force. Her evidence was that the earliest date for the rib fractures was 15 September, the latest date being the 28 September 2011. S was discharged and the parents reported that her knee improved. (8) It is not unreasonable to assume that S's levels would have been at 21 nanomls per litre in pregnancy. 17. The Consultant Paediatrician, as the locum consultant paediatrician at the local NHS trust, described himself as a 'relatively recently qualified paediatric consultant.' They both appear to value education and a need to promote this ethos with their children. (7) It is safe to extrapolate from the mother's levels taken in May 2012 that Vitamin D levels would have been lower in pregnancy. A diagnosis of OI (osteogenesis imperfecta) is exceptionally unlikely. 57 0 obj
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The maternal grandmother had no concerns in relation to the parents' care for both S and T and would like S to be returned to her parents' care.40. NS>zu=/_jwJa:S The court had no expert views on these aspects or on a number of potential issues relating to bone metabolism. He noted that there is no uniformity of Vitamin D testing and it is difficult to measure. He has extensive experience and a mature knowledge of research done in this field. At times she appeared to have poor recollection, which to my mind was not surprising given the sort of detail that she was required to remember after some considerable time. 941-697-3552. Naturally the Wards hoped social services would follow suit, but they were in for a shock. She was discharged from hospital on 25 July 2011. View more radiologists birmingham Consultations Consultations Steelhouse Lane, Birmingham, England. 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. 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. DR KARL JOHN JOHNSON is British and resident in England. But the drama turned into a nightmare when they were accused of having deliberately harmed their little boy. 46. While T was originally the subject of the local authority's applications at the outset when proceedings were issued on 27th October 2011, I made an order on 13th December 2011 returning him to the care of his parents and no continuing orders were made relating to him. Specialties (5) S's Vitamin D levels, which were on the borderline on 2nd November 2011, were never higher than insufficient. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. The NPI Enumerator can be reached at (800) 465-3203 or P.O. 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. Virgil van Dijk: I should have taken a break before World Cup, Britain's second lockdown was based on 'very wrong' Covid data, Boris Johnson feared, How Boris Johnsons desire to lift lockdown was thwarted by public opinion, Misplaced breathing tube contributed to death of first child Covid victim, inquest rules, William Sitwell reviews St Barts, London: This food will win over any tasting-menu sceptic, How to bring a cosy, Scandi-inspired aesthetic to your wardrobe. 7. 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. 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 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. Arrested, charged by police and threatened with having their child taken away by Cambridgeshire county council's social workers, it took two years for the Wards to clear their name. She moved back to London, to Great Ormond Street Hospital and the Institute of Child Health, where she obtained a PhD for her thesis, Optimisation of the digital radiographic imaging of suspected non-accidental injury, then returned to Sheffield as a HEFCE-funded Clinical Senior Lecturer in the Academic Unit of Child Health. hb```e``rg OP#0p4 B1 SGVp_Cb&ow!4MlPU
Dr. Thomas' office is located at 2204 Lakeshore Dr, Birmingham . S's crying was attributed to colic initially and latterly to her having received her vaccination on 20th October 2011. Email this page This hearing has run over a prolonged period of months in the course of 2012; in particular because it encountered difficulties in the procurement of the services of one of the experts necessary to address the issues in the case, and also because of practical difficulties in the hearing itself in adducing the important evidence of the children's grandmother from Sri Lanka. 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. Post-immunisation advice was given". Particular difficulties were encountered with receiving the evidence of the grandmother by Skype from Sri Lanka with the connection frequently being lost and with further doubts arising over the correctness of the interpretation of her evidence. 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. The parents/grandparent who did not inflict the injuries on each occasion to S failed to protect her. He also is an expert of considerable renown. 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. An X-ray showed a spiral fracture of the left humerus. 2. S's father is represented by Miss Deschampneufs. 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. (10) His view was that it was likely that S was Vitamin D deficient in utero and in the early neonatal period. "Unfortunately the job of social workers is to think the unthinkable because sometimes terrible things happen. The father's evidence was that during the morning she had cried more than normal and he confirms that she was "grumpy and crying". S has suffered multiple fractures which have occurred on at least three separate occasions. Lovely baby." 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. The parents were unable to offer any explanations and had not observed any accidental events that may explain these injuries. Attendance of the course includes access to the database of cases associated to this event on our server at PostDICOM. Fee includes 90 days of access with unlimited playback during this time. 03. S could not have been injured when in a bouncy chair from normal use. The conclusions are positive. Left leg thigh bone fracture, a torus fracture of the distal left femur (30th September-10th October 2011). 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. 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. Chair: Dr Ian Zealley Panel: Dr Richard FitzGerald, Vice-President, Clinical Radiology, The Royal College of Radiologists, Dr Paul McCoubrie, Southmead Hospital, Bristol and . 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. 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. Akin, MD, Diagnostic Radio The cause of an injury or of an episode that cannot be explained scientifically remains equivocal;ii. N and D appeared able to actively provide a high level of basic care for their children.'. Her parents returned with S on 22.10.11 with a swollen arm. Ms Soffa has gone to considerable lengths and much detail to expose what are submitted as matters on which I should mistrust the evidence of the parents or confer on their evidence only little weight. Considering the totality of the evidence the Judge found the likely incidence of an increased vulnerability to fracture was the most likely cause of S's injuries. The maternal grandmother ('the grandmother') is also a party, as she was present in the family home at the material time, and has been represented by Miss Trustman. They are, in my survey of the evidence, more likely to have a genuinely accidental cause, but because of the evidence of Professor Nussey taken with the evidence of the parents and from the records available it is not possible to reach a view that is more than speculative as to the timing of the injuries. Within each chapter there are three consistent sections. The fractures of the ribs require considerable force and well in excess of day to day handling or even rough play. 45. DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. 17. 15. there is a stage of rickets before it is identifiable radiologically. 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. There was an additional right wrist fracture which was difficult to date. "It was felt that it was a matter of such complexity and range of opinion that it was a matter for court determination.". 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. Mr Sami Al-Ani BSc, MBBS, MRCP, FRCR, PhD, FHEA 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.' Summary by Georgina Clark, barrister , Field Court Chambers ___________________IN THE WATFORD COUNTY COURTWatford County Court,Cassiobury House,11-19 Station Road,Watford,Hertfordshire WD17 1EZ.20th March 2013Before:HIS HONOUR JUDGE WRIGHTBetween:A local authorityApplicantsand. I came to the conclusion that I was unable to determine the case without further specialist expert evidence. Left lower leg fracture, a metaphyseal fracture of the left tibia (shin bone) (3rd-10th October 2011). 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. 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. 4. Her mother is D, represented by Mr Jayatilaka. Fractures of the antero-lateral aspects of the left 8th and 9th ribs were caused by (a) a direct blow or compressive forces applied to her chest by an adult carer, (b) she would have shown distress for 10-15 minutes and shown discomfort when her chest was moved such as when she was dressed and a regular carer would know this was as a result of these fractures with discomfort lasting for a week. It is to be noted that at this time, 13 October 2011, the evidence is that S had already sustained factures of the left 8th and 9th rib and was likely to have sustained her left femoral fracture and fractures to the right and left tibia. Stream every session from the webinar for up to 90 days. We adopt the following: i. The judgment that I gave that day is subsumed into this fuller judgment of the court.02. I have not found any instances that cannot be attributed to genuine mis-recollection especially given the distance in time over which they were attempting to deal with detailed events. Extensive high quality images throughout the book, and additional illustrations, aid the reader with diagnosis and detailed referencing points to further reading. By his statement, the father records that on Friday 21st October 2011, the parents noticed that S was moving her left arm less than usual, not stretching to touch her legs, crying on and off something that they believed was from the discomfort of the immunisation the previous day. These are referred to in more detail in her evidence and indeed in the local authority's threshold document, and she has set out fully in her expert report to the court her opinion on the fractures she found, the dating of S's injuries, the mechanism of injury, possible explanations and her conclusions. Represented by Mr Jayatilaka be suffering fractures of basic care for their.. Birmingham Consultations Consultations Steelhouse Lane, Birmingham, England the latest date being 28! 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