Dr. The cause of an injury or of an episode that cannot be explained scientifically remains equivocal;ii. 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. 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. When to refer and why Dr Rajendranath Sinha, The Newcastle upon Tyne Hospitals NHS Foundation Trust The mother also worked there.10. Extensive high quality images throughout the book, and additional illustrations, aid the reader with diagnosis and detailed referencing points to further reading. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. The X-ray revealed a spiral fracture of the left humerus. Consultant Paediatric Radiologist, Chair of Paediatric Musculoskeletal Imaging, Chair, University of Sheffield's Black, Asian, and other Minority Ethnic (BAME) Staff Network, University of Sheffield and Sheffield Children's Hospital. A week later William was placed on the council's child protection register. 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. 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.". 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. So the records engage even closer scrutiny. At 22.30, a further medical clinician's note was written, although the authorship is not clear. 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. The father completed a course in tourism management and completed a post-graduate degree in business management. 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. 941-697-3552. 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. 31. 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. 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. This led to a referral by the consultant paediatrician from the local hospital to Social Services. S has suffered multiple fractures which have occurred on at least three separate occasions. On 24th October 2011 a skeletal survey detected what appeared to be two left rib fractures. 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. 37. 41 0 obj <>/Filter/FlateDecode/ID[<2E609F2171D9B848924D49576AA30896>]/Index[34 24]/Info 33 0 R/Length 56/Prev 68695/Root 35 0 R/Size 58/Type/XRef/W[1 2 1]>>stream Erythematous [reddening on the skin]. This produces a complex and difficult balance in assessing the likelihood of the infliction of the harm and the injuries as invited by the local authority. Radiologists, Country 11. septic arthritis." However, on 22nd October 2011 the parents again presented S, this time with swelling to her left arm. I then ruled that Professor Nussey, an expert in the narrow and complex field of biochemical analysis coupled with endocrinology and with a particular expertise on questions of Vitamin D sufficiency/deficiency should be instructed to prepare a report by 29th June 2012. T would often watch attentively as the parents and grandmother would feed S and hold her. 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. As to the possible involvement of T, he asserts that he had not witnessed T twisting S's arm (or leg or wrists). Akin, MD, Diagnostic Radio Mrs Ward, 36, who now has three children and runs yoga and massage classes for babies, said they were not content with simply winning their own case. DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. At one week she was seen by the Community Nurse and was reported to be "thriving, contented and settling well." She was discharged from hospital on 25 July 2011. He denies causing any of the injuries and in turn denies the specific causation of each injury. The Judge was satisfied that neither the mother, father, nor grandmother could be held responsible for causing the injuries. At para. He therefore accepts that these fractures would have occurred while S was in their joint care. 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. N and D are in a stable relationship and have known each other from childhood as they lived in the same village. The evidence from the Health Visitor is that she would have been undressed for weighing and placed in the scales by her parents. Mr Johnson, who is chairman of the British Society of Paediatric Radiology and works as a consultant at Birmingham Children's Hospital, told police that in his view William had suffered. The record confirms the father's account that they had been advised to use Infacol, had done so and that it was not working. The parents needed to be careful over his food, medicine and health. One or both of the parents, and/or the grandmother knows what has happened to S on all the occasions she has suffered injury. S, it is stated, settled after being given Calpol following her vaccination on 20th October 2011. 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. Specialties 3. The Judge surveyed the 'wide canvas' of the case including the manner in which the parents gave their evidence. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. The paediatric clinicians note records that "yesterday evening the parents noted [her] crying and unsettled, left leg persistently held in a flexed position." It is to be noted that the father accepts the medical evidence that S suffered each of the injuries numbered 1-6. (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. 2. Dr. Gregory D. Jackson is a Radiologist in Birmingham, AL. I never observed either parent react angrily towards each other or either child. 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. In surveying the 'wide canvas' further, I take into account the evidence of Professor Nussey because the manifest injuries do call for explanation. The Wards subsequently won a legal fight in the High Court for the judgement to be made public. 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. Injuries to S could not have been caused by a person rolling onto her. In my shorter version of this judgment on 14 January 2013 I provided as clear an indication as I could to the relief, I am quite sure, of the parents of the way in which my mind had worked. S's Vitamin D levels were borderline on 2.11.11 and were never higher than insufficient. 06. Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. On being released on bail they were immediately suspended from their jobs. greater confidence in managing the imaging of an acutely unwell child. On the balance of probability T could not have caused the injuries to S either by (a) jumping on the family bed whilst S was lying on it or (b) pulling her bouncy chair when she was in it. (6) It is not possible to say what difference formula feeding might have provided because there is no baseline to measure from. The record concludes with the GP's comment "All well. Rib fractures to the antero-lateral aspects of the left 8th and 9th rib (15th-28th September 2011). 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. We operate from Monday to Saturday and also provide an emergency on-call radiography service 24-hours-a-day, seven days a week. 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. 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. I note in particular the five times when she was seen at medical appointments when she was said to be suffering fractures. 1808 7th Ave S, Birmingham, AL, 35233 3 other locations (205) 934-3333 OVERVIEW Dr. Johnson graduated from the University of Pittsburgh School of Medicine,University of Pittsburgh School of. The Consultant Paediatrician, as the locum consultant paediatrician at the local NHS trust, described himself as a 'relatively recently qualified paediatric consultant.' I note the entry as follows: 'non-tender, baby permits passive manipulation. Professor Nussey reported on 10th July but in time for the resumed hearing of the matter on 25th 26th and 27th July. 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 would thank all advocates for their very careful written submissions. 07. 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. 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. The father is unable to explain how S sustained the fracture to her left arm; however, he accepts that only he, mother and grandmother were caring for S during this time; he therefore accepts that this fracture would have occurred while S was in their care. 0121 472 1377. It was noted that the parents were unsure how the fracture may have happened and there had been no recent accidents of falls. 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. Companies associated with this officer had at least 253,361 shareholder value in recent accounts. The Judge formed the view that the maternal grandmother was seeking to assist the Court in her evidence. 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. Doctuo 2023 Last modification: 02-03-2023, Birmingham Children'S Hospital, Birmingham. She refers to the fact that in relation to allegation 3, 4, 5 and 6 the mother had noticed the child's discomfort and taken S to the Medical Centre and then on to the Accident and Emergency Unit at the local hospital where S was examined by a paediatrician and X-rayed, following which she was told that everything was normal and she was discharged. He asserts that he had not witnessed the mother or grandmother behave in this way and did not believe they would have done so when he was not present. *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 An X-ray was performed at the time along with other tests and appeared to present no bony injury and no metaphyseal infraction. Interpretation & Reporting Webinar for the General Radiologist, DAY 1: GENERAL PAEDIATRIC RADIOLOGY - WEDNESDAY 9 FEBRUARY 2022 If S were to be found responsible he offered the view that that would imply very poor supervision of T over a period of time. hmk0^g? 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. It was only fair, in my judgment, to communicate those to the parties as soon as possible with my reasons in a primary judgment with a fuller judgment to follow to bring the period of waiting for the result to an end for the family as well as for other parties. The parents' observations are also a matter of record, as are the consultants' examination. 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. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. (Orders made included discharge of interim Care Order and approval of revised care plan for phased return of S to the care of her parents. 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. I adjourned the hearing with directions for written submissions but anticipated that the particular difficulties of the case, its subject matter and the possible issues arising over evidence, required a further hearing for the parties to address the court having exchanged their submissions. 34. (4) He accepts that in relation to injuries such as these some force has to be applied. All prices include VAT, Viewers will be asked to evaluate each session and will be provided with a CPD certificate upon completion Had an instructive and engaging educational experience. I record in relation to the father that I found his evidence and his certain directness in quality with immediate and unhesitating answers suggested a genuine response. 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. The Father said in evidence that when the hospital phoned on Monday morning, his wife told them that S was "fine".21. I came to the conclusion that I was unable to determine the case without further specialist expert evidence. 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. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. S was discharged and the parents reported that her knee improved. 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. Nearby doctors Sarah Yusuf Nazia Anwar Kaushal Paediatric Radiology opens with a chapter devoted to the different imaging modalities, including radiographs, fluroscopy, ultrasoound, CT, MRI and nuclear scintigraphy before moving on to more detailed, systems-based chapters. He was diagnosed with Hirschsprung's disease, remaining under the care of a London hospital's surgical team with 6 monthly checks. the fractures to the right tibia and the proximal left tibia are likely to have occurred at the same time, and that that is the likely time-frame for them both.19. Stream every session from the webinar for up to 90 days. "Unfortunately the job of social workers is to think the unthinkable because sometimes terrible things happen. 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. The mother and/or the father and/or the grandmother is the perpetrator of the injuries to S.19. Mrs A Jester After 22 September 2011, S was next seen at the GP surgery on the 13 October 2011. 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. 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. 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. 14. Rent and save from the world's largest eBookstore. The maternal grandmother had not witnessed T intentionally being rough or boisterous towards S and had not witnessed him attempting to hold S or pick her up. Wanted a review(Under 'P') Discussed with Mum and Dad possible colic will continue withInfacol and see how she gets on over next week. I have noted the reference to Lancashire County Council v B [2000] AC 147. But the drama turned into a nightmare when they were accused of having deliberately harmed their little boy. 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. The final section details the imaging findings in a wide variety of clinical conditions. 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". Read, highlight, and take notes, across web, tablet, and phone. 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 . UK based, CPD accredited, online courses for doctors in all of the major specialties, Navigation: 04. If no better, to review or sooner at any time if concerns'. The father recalled that S "cried throughout", crying as soon as the examination started although the doctor carried on. Full access to each case with a full toolset to open, view and manipulate each case alongside the faculty but on your own screen! endstream endobj 38 0 obj <>stream There were evident deficiencies in translation by the interpreter. Call. She obtained her MBBS while working at Oldchurch Hospital, Essex and trained as a radiologist in Sheffield. Doctors, medical appointments, hospitals, medical staff. This would have involved manipulation of the legs and arms, and the conducting of other tests. As a result of her expertise she receives both regional and national referrals for review of musculoskeletal imaging from radiological and clinical colleagues with an emphasis on imaging in cases of suspected inflicted injury. Mindelsohn Way 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.' In relation to the spiral fracture of the distal shaft of the left humerus, the local authority allege that S's arm has been gripped and twisted by an adult carer; she would have shown immediate distress lasting 10-15 minutes; any regular carer would have noticed a change in her behaviour as a result of the fracture with discomfort which would last for up to a week. 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. The conclusions are positive. Her evidence was that S was crying, being "fractious and miserable but not hugely distressed", happier lying down than being held. 2018 Karen Johnson Andrea Schnell, a Internist practicing in Madison, WI March 27, . Firstly, it had become evident that the court required the assistance of an expert in paediatric bone disorders. The GP note for 20 October 2011 records "First meningitis vaccination. 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. 9. At 18.45, the paediatric ST4 clinician noted the symptoms reported by the parents as, "crying more since Thursday morningNot moving her left arm noticed yesterdayToday noticed swelling of left arm". 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. Because William's parents were unable to explain the fracture the hospital deemed the case suspicious and called in social services. 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. What followed next led, eventually, to the diagnosis of a fracture in S's left upper arm. 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