VOIT$=EfPuP^ AiiUw~,JZ%?rG?("S{t }p# y|!W7XQb,{*|p>'A7:#;p`Wnx n&Thb !pA}ifRh0$*W@~n0?Olgj;|TO^,WicR|WV2riRm- I accept the submission that there is a lack of current research on the susceptibility to fracture in babies who are Vitamin D deficient. 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. Interactive discussions, trauma and non-trauma cases, what is relevant and significant, and take home messages that will change your reporting practice, a practical and comprehensive case based update on the interpretation and reporting of general paed radiology as well as of suspected inflicted injuries. The GP's entry records "crying, excessive ? Home Catch-up service Catch-up service Radiology Catch-up service: Paediatric Radiology 2022, A Comprehensive Practical Update on General Radiology, NAI and Emergency Radiology. xYYo~o!baX_{da+LV"gy8du|UU]^|^y^]](g1qV&QdLY$aqT\ G~k)UwalB^d!/^I8>goAXX""~vQ^eTT'YC g-lZ['#.5\K,H The record shows "baby crying and unsettled today. 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 repeated fractures and had a history of being abused. I never observed either parent react angrily towards each other or either child. T was described as "very attached to his mother" becoming jealous when mother was with S. He was described on examination as very active in clinic, playing with his sister and wanting to hold her. Mindelsohn Way Birmingham B15 2TG 0121 472 1377 Birmingham Children's Hospital Steelhouse Lane Birmingham B4 6NH 0121 333 9999 Quick links Terms and conditions Give us your feedback Publications and reports Staff links AccessAble Freedom of Information Privacy Policy Accessibility statement Join us on social media Support us 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. S had only been in the house with the parents, grandmother and T. Investigations were put in hand. 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. At no point did I observe either child to be wary of their parents. Site map, Please rate your experience out of 5 (with 5 being the highest and 1 being the lowest), Birmingham Women's Hospital Country 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 local authority alleges that the injuries were suffered by S and caused by an adult carer and they are non-accidental. At the time of these proceedings he was employed as a store manager. Any specialty (On examination) Crying ++. Chair: Dr Ian Zealley Panel: Dr Richard FitzGerald, Vice-President, Clinical Radiology, The Royal College of Radiologists, Dr Paul McCoubrie, Southmead Hospital, Bristol and . 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. 04. Lovely baby." The note records both mother and grandmother as being present. The local authority sought findings that the injuries had occurred non accidentally with the parents and grandmother as possible perpetrators. 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. 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. It is further positive that the professionals involved with the family have reported no concerns regarding the children's wellbeing whilst in the care of their parents prior to S being admitted to a local hospital with a fracture to her left femur.'. 11. 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 8. hb```e``rg OP#0p4 B1 SGVp_Cb&ow!4MlPU 3. He also is an expert of considerable renown. 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. 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. In the last week of the last Parliamentary session the judgement was rubber stamped into law. endstream endobj startxref No plausible explanation has been offered for any of these injuries. DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. 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. In this case the local authority brings proceedings for Public Law orders relating to S, born on 18th July 2011. It provides an overview of how to approach the imaging of children including the relative values of each of the imaging modalities for paediatric pathology. S could not have been injured when in a bouncy chair from normal use. Mindelsohn Way On 22 September 2011, S is recorded as having the first of her immunisations at the Medical Centre. 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. endstream endobj 38 0 obj <>stream 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. She was described as remaining "settled in A&E, observations in normal range, apyrexial." DAY 2: EMERGENCY PAEDIATRIC IMAGING - THURSDAY 10 FEBRUARY 2022 S would often cry and it was initially believed that this was due to her suffering from colic. Nearby doctors Sarah Yusuf Nazia Anwar Kaushal We haven't found any reviews in the usual places. Have you had a video or telephone consultation with us? Over the next 10 months the Wards were visited by at least three expert witnesses who had been asked by the judge to give their opinions. Further X-rays revealed what appeared to be three more fractures and an injury to his arm. 5. This company officer is, or was, associated with at least 1 company roles. 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. 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 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. 20. 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". You can book online your appointment and hire medical insurance online. hmk0^g? Post-immunisation advice was given". Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. On the balance of probability T could not have caused the injuries to S. 16. All this with the inherent complexities of the medical evidence meant that much time was taken up and the father's evidence could not be taken until the court could reconvene on 12th September 2012. 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. Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. The particular issue of Vitamin D deficiency/insufficiency presents as the current medical frontier and arguably an expanding and uncertain one. 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. I have noted the reported reactions of T to the birth of S. I have considered S's early developmental history after her birth; also the arrival when S was about 10 days old of the maternal grandmother from Sri Lanka to help the mother look after the children. The Wards were arrested and questioned by police on suspicion of grievous bodily harm and child cruelty towards William. 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. Thank you! Amaka lectures regularly on various radiology, paediatric, genetic, emergency medicine and orthopaedic courses, locally and nationally. DR KARL JOHN JOHNSON is British and resident in England. At one week she was seen by the Community Nurse and was reported to be "thriving, contented and settling well." 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. 16 the following conclusion was offered, and the parents are referred to as N and D: 'Throughout the assessment period N and D were observed to provide a high level of emotional warmth, mental stimulation and basic care for S and T which they sustained throughout the contact sessions. )_______________. 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. 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. Her weight gain was recorded as normal. Dr. Jackson's office is located at 2204 Lakeshore Dr . Dr. Thomas' office is located at 2204 Lakeshore Dr, Birmingham . 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. Mrs K Oestreich 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. It is reasonable to conclude that they were lower before then because she was breastfed. Because William's parents were unable to explain the fracture the hospital deemed the case suspicious and called in social services. The local authority issued care proceedings on 2nd November 2011. Ms Baldrighi, Back to top of page The parents needed to be careful over his food, medicine and health. Interactive case-based approach using a powerful online DICOM viewer to maximise learning. I considered that the family members have a very close bond and I did not observe any concerns regarding their attachment. This further hearing took place on 24th October 2012.08. Birmingham, 012 133 Dr Neil Stoodley, Consultant Neuroradiologist, Bristol Royal Hospital for Children Dr Musa Kaleem, 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 Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). Left leg thigh bone fracture, a torus fracture of the distal left femur (30th September-10th October 2011). The maternal grandmother's position can most usefully be seen as set out in her position statement of 12th March 2012. 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. 2. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. The father said in oral evidence that S developed a pattern of crying after 3 to 4 weeks old, particularly in the evenings. On being released on bail they were immediately suspended from their jobs. On 22 October a skeletal survey was performed and reported on by Dr Steven Johnson, Consultant Radiologist. The x-ray of the left femur had been reported as showing no bony injury on 13 October 2011 and no obvious metaphyseal infraction. 6. 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. Rent and save from the world's largest eBookstore. The mother's tend to be shorter responses but amplify the general stance of the parents as well as the grandmother that while accepting that the fractures occurred and that they occurred while S was in their care they reject the allegations that they caused the injuries in a non-accidental way. This would have involved manipulation of the legs and arms, and the conducting of other tests. With no help from outside agencies their couple mounted their own investigation into the cause of their son's injuries. Having reviewed the evidence in detail, and after considering the written submissions of all parties, I had reached a position where I had come to my conclusions on the issues of fact. I have taken account of the fact that she gave her evidence through an interpreter while having at least a working grasp of English. Several of these fractures are highly specific for non-accidental causation by an adult. Email this page 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. Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. Interpretation & Reporting Webinar for the General Radiologist, DAY 1: GENERAL PAEDIATRIC RADIOLOGY - WEDNESDAY 9 FEBRUARY 2022 Professor Nussey reported on 10th July but in time for the resumed hearing of the matter on 25th 26th and 27th July. 0121 472 1377. Dad says that [she] has been miserable all day no temperature". 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. Catch-up service: Paediatric Radiology 2022, Catch-up now with our case-based Paediatric Radiology webinar that took place in February 2022. 45. 9. 16. 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. an understanding of the importance of applying the ALARA principle in Paediatric imaging. Contents hosted on Doctuo should not be used as substitutes for professional medical advice, diagnosis or treatment. 3.o-VR;+lZsA30PK#>] FP+irJBp%MU :g I{,8fVn|aQY/,E/sa8Cd8sfhD5wGtkE4*8*q0zW,7(Ic The constellation of findings is highly indicative of non-accidental injury by an adult. 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. S was sent for x-ray, which revealed a spiral fracture of the left humerus. She is the radiology lead for child protection, rheumatology, orthopaedic and skeletal dysplasia multidisciplinary meetings at Alder Hey Childrens NHS Foundation Trust. This appeared to be strong evidence that William had been abused several times in his short life. No local tenderness in leg or hip", S was x-rayed, but nothing abnormal was observed. The fractures to the right lower leg took place between 12th September and 10th October. S, it is stated, settled after being given Calpol following her vaccination on 20th October 2011. I note his conclusion that although this did not render S more likely to injury, it might increase bone fragility and thus give rise to fractures at a lower force than would otherwise be the case. I came to the conclusion that I was unable to determine the case without further specialist expert evidence. A diagnosis of OI (osteogenesis imperfecta) is exceptionally unlikely. There can be no criticism that it has pursued these allegations as vigorously as it has, even if at the end of the day they have failed to satisfy me that the case is proved. 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.". Dr. Gregory D. Jackson is a Radiologist in Birmingham, AL. 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. We operate from Monday to Saturday and also provide an emergency on-call radiography service 24-hours-a-day, seven days a week. Her mother is D, represented by Mr Jayatilaka. When Victoria and Jake Ward saw their baby son crying and refusing to feed, they took him to their doctor. The fractures of the ribs require considerable force and well in excess of day to day handling or even rough play. 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. 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. 09. Call. 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. It was the maternal grandmother's view that her daughter and son-in-law did not injure S. 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