At 6.20pm on 13 October 2011, S was brought to the local hospital, with the presenting complaint "swollen left knee started yesterday." courses@infomedltd.co.uk+44(0)20 4520 5081. Nearby doctors Sarah Yusuf Nazia Anwar Kaushal 54. There is no evidence of an incident of any kind suggestive or on which an inference could be drawn that either of the parents was responsible for an injury (other of course than the X-rays of the fractures). 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. This person was born in December 1965, which was over 57 years ago. At 17.10, the presenting complaint was noted as "swelling and pain in the left upper arm, since yesterday" [Friday] those symptoms noted by the parents "yesterday" with swelling of the left arm and "crying ++" when she was moved. Clinic Locations. 43. I note the entry as follows: 'non-tender, baby permits passive manipulation. The particular issue of Vitamin D deficiency/insufficiency presents as the current medical frontier and arguably an expanding and uncertain one. Dr. Karl Johnson Consultant Paediatric Radiologist Birmingham Children's Hospital 15:05 - 15:20: Break 15:25 - 16:25: SEN disability impact of covid on safeguarding Caroline Coady Assistant Director for Social Care National Children's Bureau 16:25 - 17:25: Sexual Abuse Update Deborah Hodes 17:25 - 17:30: Close 17:30: Room open for networking 3.o-VR;+lZsA30PK#>] FP+irJBp%MU :g I{,8fVn|aQY/,E/sa8Cd8sfhD5wGtkE4*8*q0zW,7(Ic The guardian also represented the other child of the family T, who was born on 14th February 2008. Mindelsohn Way I have noted the reference to Lancashire County Council v B [2000] AC 147. After 22 September 2011, S was next seen at the GP surgery on the 13 October 2011. 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.' 2. BSc, MBBS, MRCP, FRCR, PhD, FHEA Certificate of attendance upon completion. Find Dr. Jackson's phone number, address, hospital affiliations and more. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. (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. 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. On being released on bail they were immediately suspended from their jobs. Mrs Ward, who at the time worked as a manager for child care strategy for Cambridgeshire, told BBC One's Panorama, in a documentary to be broadcast tomorrow night: "We were absolutely shocked. "There seems to be a small group of expert witnesses who often condemn parents. No temperature. He was earnest, straightforward and did not quibble with the questions although he did not always understand the question. I take note also that the mother and father completed a parenting assessment. Lord Justice Munby agreed with their request and in a landmark judgement in January this year ruled that expert witnesses in family courts could now be named. colic/reflux." 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. In the light of this observation, the involvement of local Children's Services inevitably followed and the proceedings were commenced, as I have indicated in this judgment.30. Her responses in the Schedule point out that the allegations are made on the presumption that S did not have any genetic abnormality or bone disease. Fee includes 90 days of access with unlimited playback during this time. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. 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. The Court found that the medical evidence raised a substantial likelihood that the injuries were caused non accidentally and by force used by at least one of the adult members of the household. The Judge was satisfied that neither the mother, father, nor grandmother could be held responsible for causing the injuries. Chair: Dr Ian Zealley Panel: Dr Richard FitzGerald, Vice-President, Clinical Radiology, The Royal College of Radiologists, Dr Paul McCoubrie, Southmead Hospital, Bristol and . At the time of these proceedings he was employed as a store manager. He noted that there is no uniformity of Vitamin D testing and it is difficult to measure. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. Dr. Thomas' office is located at 2204 Lakeshore Dr, Birmingham . 47. In his report of 25 October 2011 the Consultant Paediatrician confirms that ophthalmological testing showed no evidence ocular trauma with healthy discs and no retinal haemorrhages seen. A spiral fracture requires a force to cause a fracture in this way that is 'well beyond that used during normal day to day handling.' The local authority goes on to make the following allegations which I give as numbered in the Scott Schedule: 7. Metaphyseal fracture of the proximal left tibia caused when (a) her left leg had been pulled and twisted by an adult carer; (b) any person present would be immediately aware she had suffered a significant injury with discomfort lasting several days. The father's responses set out a general defence to each allegation setting a number of relevant points that formed part of his evidence. A revised care plan was approved for the rehabilitation of S to the care of her parents. She also offered the view that the fractures were likely to have occurred on three separate occasions; the constellation of injuries was in her opinion highly indicative of non-accidental injury. ,8KaF"*w!$uOEF!1 Upper limb rheumatology/radiology MDT: . 34. 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. There is no evidence of drugs or alcohol abuse, of anger or violent outbursts, of short temper, volatility, irritability or dysfunction. However, the identities of the expert witnesses in the case remained shrouded in secrecy. The family's nightmare began one night in July 2005 when, at three months old, William woke up in pain. 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. I found Professor Nussey to be highly knowledgeable in his field; careful; and able to consider and assist the court on all matters put to him. 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. 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. 8. 6. 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. Karl John Johnson Radiologist Steelhouse Lane, B4 6Nh, Birmingham, England. It was inevitable, that the local authority had to bring this case to court. Site map, Please rate your experience out of 5 (with 5 being the highest and 1 being the lowest), Birmingham Women's Hospital Stream every session from the webinar for up to 90 days. Extensive high quality images throughout the book, and additional illustrations, aid the reader with diagnosis and detailed referencing points to further reading. Doctors, medical appointments, hospitals, medical staff. Several of these fractures are highly specific for non-accidental causation by an adult. This company officer is, or was, associated with at least 1 company roles. 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. Determined to establish what was wrong they returned twice to the GP, but he was still unable to offer any diagnosis. This could increase bone fragility and give rise to fractures at a lower force than would otherwise be the case. Erythematous [reddening on the skin]. The court had no expert views on these aspects or on a number of potential issues relating to bone metabolism. 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. Dr. Helen Williams is a full time general paediatric radiologist, and has special interests in cross-sectional imaging, feeding studies and radiology training. 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. Her special interests include musculoskeletal radiology and trauma, particularly imaging in inflicted injury. Interpretation & Reporting Webinar for the General Radiologist, DAY 1: GENERAL PAEDIATRIC RADIOLOGY - WEDNESDAY 9 FEBRUARY 2022 N and D appeared able to actively provide a high level of basic care for their children.'. Dr. Gregory D. Jackson is a Radiologist in Birmingham, AL. The Wards took their son to Addenbrooke's hospital in Cambridge, where an x-ray revealed he was suffering from a spiral fracture of the lower right leg, an extremely rare condition in children who have not yet begun to walk. 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. 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. There was an additional right wrist fracture which was difficult to date. 15. She was described as remaining "settled in A&E, observations in normal range, apyrexial." The advice to 'persist with Infacol' also bears out the father's account. The father's evidence was that during the morning she had cried more than normal and he confirms that she was "grumpy and crying". 55. 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. In the course of surveying the 'wide canvas' of evidence I have reviewed the evidence of the mother, the father and the grandmother. The record shows "baby crying and unsettled today. Left upper arm fracture, a spiral fracture of the distal shaft of the left humerus (16th-19th October 2011). 4. 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. Apyrexial. Firstly, it had become evident that the court required the assistance of an expert in paediatric bone disorders. But in clarification of this remark Professor Nussey said that it would be reasonable to use the words 'increased vulnerability to fracture' in relation to S. 53. 33. Print this page 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 Excellent peer interaction and collaborative learning. He found it was not possible to conclude at what point normal day to day handling crossed over to the point when S's vulnerable bone structure was compromised and exceeded. DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. 2023Check Company | Privacy | Terms of Use | Contact Us. 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. 5. The case against the Wards also relied on the view of Dr David Vickers, a community paediatrician, that if no obvious explanation could be found for an injury then child abuse was likely. He had known his wife (the mother) since 1990. The father said in evidence that her crying was first mentioned then, although there is no entry about it in the record, but the following record in the GP Notes does suggest that the Health Visitor had "advised giving her Infacol" at this point, so it probably was raised then. 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.". But the drama turned into a nightmare when they were accused of having deliberately harmed their little boy. You'll get immediate feedback and learning points from our expert faculty member. 12. DAY 3: INFLICTED INJURIES IN CHILDREN - FRIDAY 11 FEBRUARY 2022. The local authority alleges that the injuries were suffered by S and caused by an adult carer and they are non-accidental. No local tenderness in leg or hip", S was x-rayed, but nothing abnormal was observed. The GP note for 20 October 2011 records "First meningitis vaccination. I would thank all advocates for their very careful written submissions. The record concludes with the GP's comment "All well. 09. Read, highlight, and take notes, across web, tablet, and phone. I never observed either parent react angrily towards each other or either child. endstream endobj 35 0 obj <>/Metadata 4 0 R/Outlines 8 0 R/Pages 32 0 R/StructTreeRoot 11 0 R/Type/Catalog>> endobj 36 0 obj <>/MediaBox[0 0 595.32 841.92]/Parent 32 0 R/Resources<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 37 0 obj <>stream Her weight gain was recorded as normal. 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. 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. S would often cry and it was initially believed that this was due to her suffering from colic. 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. I therefore granted an adjournment so that a suitable expert could be instructed. You can book online your appointment and hire medical insurance online. They could offer no explanation as to how the fractures may have happened. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. (10) His view was that it was likely that S was Vitamin D deficient in utero and in the early neonatal period. If there is some innate contradiction in that sentence it appears that the latter part of that sentence represents the stronger conclusion. "ag`|v#+(U)R1Vrg+1TnD G#qOQOGB[ @+v7#ibHd7X ~6?fJq*bk&~GTQH6To-,dh=>!aFd&02uGo(y GCv&_SRbc>N; ^1Qc(:*%Bl#~vczyAa;~tlvY4Y;U: e0| 34Ba7/, h!i"#>!9l^(bl1oUT (R&^I'[V.1e7'}N"e@ZAEY }^gEm1|4_I|Zj>apQvcZreu[OyTqWl({MicALn("#S' 11:00-11:30 Imaging of arthritis Dr Emma Rowbotham, Leeds Teaching Hospitals NHS Trust 12:00-12:30 Common paediatric MSK conditions Dr Karl Johnson, Birmingham Children's Hospital NHS Foundation Trust 12:30-13:00 Soft tissue and bone lesions. I note in particular the five times when she was seen at medical appointments when she was said to be suffering fractures. The NPI Enumerator can be reached at (800) 465-3203 or P.O. A diagnosis of OI (osteogenesis imperfecta) is exceptionally unlikely. He refused to feed and the next day Mrs Ward took him to see her GP. He therefore accepts that these fractures would have occurred while S was in their joint care. 52. 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. 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. With no help from outside agencies their couple mounted their own investigation into the cause of their son's injuries. Birmingham, 012 133 3. Right wrist fracture, a metaphyseal (bucket-handle) fracture of the distal right radius (difficult to date). The concerns of the local authority and the allegations raised against the family members arise from the appearance on X-ray scans first seen on 22nd October 2011 of a significant fracture to S's left upper arm. endstream endobj 38 0 obj <>stream You will maintain your access to the resource throughout your 60 day catch-service period too. 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 Birmingham B15 2TG, Birmingham Children's Hospital 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. 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. '(&NJdsB. 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 first section lists common clinical presentations, the differential causes and the appropriate imaging pathways needed to confirm the diagnosis, with recent imaging advances for each condition. His research and clinical interests include the pathogenesis [.] The fact finding hearing began on 23rd March 2012, but on the second day of it, on 26th March, I adjourned the hearing having encountered significant problems on two fronts after hearing evidence from Dr Fairhurst, the health visitor, and the Consultant Paediatrician. 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. Her case is that she came to the United Kingdom specifically to support her daughter and son-in-law with the day to day care of the children. Dr. Jackson's office is located at 2204 Lakeshore Dr . 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. I return to consider T and his behaviour later in this judgment.12. 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