Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. . The father recalled that S "cried throughout", crying as soon as the examination started although the doctor carried on. The GP note for 20 October 2011 records "First meningitis vaccination. 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. Dad says that [she] has been miserable all day no temperature". 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. 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 3. The mother and/or the father and/or the grandmother is the perpetrator of the injuries to S.19. He also is an expert of considerable renown. 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. 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. Rent and save from the world's largest eBookstore. She took the view that the two left leg fractures (3 and 4) could have happened at the same time. 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.' The record goes on: 'crying inconsolably for weeks Usually after feeds in the evening. Birmingham B15 2TG, Birmingham Children's Hospital 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 Earlier records that day mention mother and father being present. I have examined the evidence as to the appearance of the symptoms of both the leg injury and the arm injury and noted the consistency of evidence that S was holding her leg differently before the hospital visit on 13th October 2011, and a consistency as to there being something wrong with S's arm which prompted the parents to seek medical attention. Companies associated with this officer had at least 253,361 shareholder value in recent accounts. With Doctuo you can find the doctors you need. 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. 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. 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. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. Paradoxically, the last fracture-type injury in time to occur (in all probability), the left humeral fracture, was the first to be identified on 22 October 2011. 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. 2023Check Company | Privacy | Terms of Use | Contact Us. Doctuo 2023 Last modification: 02-03-2023, Birmingham Children'S Hospital, Birmingham. It is not possible to know which incidents or movements caused or gave rise to force sufficient to bring about fractures. If there is some innate contradiction in that sentence it appears that the latter part of that sentence represents the stronger conclusion. 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". 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. Site map, Please rate your experience out of 5 (with 5 being the highest and 1 being the lowest), Birmingham Women's Hospital (1) D(2) N(3) S(4)S (by her Children's Guardian) Respondents____________________MISS HELEN SOFFA (instructed by the local authority) appeared on behalf of the Applicants.MR UPALI JAYATILAKA (solicitor) appeared on behalf of the Respondent Mother.MISS ALICE DESCHAMPNEUFS (instructed by solicitors) appeared on behalf of the Respondent Father.MISS JUDITH TRUSTMAN (instructed by solicitors) appeared on behalf of the Respondent Maternal Grandmother.MISS SORREL DIXON appeared on behalf of the Children's Guardian.____________________Digital Tape Transcription by:John Larking Verbatim Reporters(Verbatim Reporters and Tape Transcribers)Suite 91, Temple Chambers, 3-7 Temple AvenueLondon EC4Y 0HP.Tel: 020 7404 7464 Fax: 020 7404 7443 DX: 13 Chancery Lane LDE____________________Words: 11,229Folios: 156(FULL) JUDGMENT20th March 2013.01. 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. 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. I considered that the family members have a very close bond and I did not observe any concerns regarding their attachment. Consistent with this, the father described a happy baby in the first two weeks of her life. Dr Landes is radiology trauma lead and has contributed to the Royal College of Radiologists (RCR) guidance on imaging in paediatric trauma. Post-immunisation advice was given". hbbd``b`J5 `n\ a#H #e \ Book yoUR 2023 CME TODAY. HkBsD R#\#[(!$D(AyLgtJ%{mc8zA&+;*JV [a%4[)Er_'! The other parties to the case are S's parents, who are married. The Judge surveyed the 'wide canvas' of the case including the manner in which the parents gave their evidence. All the adults appear to be normal hardworking people concerned for their children. The fractures of the ribs require considerable force and well in excess of day to day handling or even rough play. Three days: 375 | Two days: 295 | One day: 175 I have noted the reference to Lancashire County Council v B [2000] AC 147. 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. 14. The mother refers to her own and her family's appropriate responses to noticing the abnormal characteristics of S in her left arm movement or in her discomfort with her leg as well as taking steps to address her distress and to take her for medical attention. John is a Consultant Endocrinologist at Queen Elizabeth Hospital Birmingham (QEHB) and an Honorary Senior Lecturer at the University of Birmingham. 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. (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. 33. The Wards were arrested and questioned by police on suspicion of grievous bodily harm and child cruelty towards William. What has emerged is that none of the adults present could provide any instance of anything done to S by themselves or the other adult members of the family, or which had befallen her, which would explain the fractures. 5 of my judgment on 26th March 2012. This appeared to be strong evidence that William had been abused several times in his short life. 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. 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. At 22.30, a further medical clinician's note was written, although the authorship is not clear. Her special interests include musculoskeletal radiology and trauma, particularly imaging in inflicted injury. While I have taken account of inconsistencies with the records available, I did not form the view that her evidence was demonstrably or readily to be interpreted as that of someone seeking to mislead the court, cover her tracks or draw a veil of ignorance over matters about which she had some knowledge. 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. "There seems to be a small group of expert witnesses who often condemn parents. The father had not witnessed T hurting S nor does he believe he would harm her intentionally but believes he may not appreciate her fragility and may have caused harm accidentally. An X ray showed a spiral fracture of the left humerus. 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. At one point, he mentioned that they had thought it was due to her immunisation that she was not using her left hand. The Wards subsequently won a legal fight in the High Court for the judgement to be made public. 6. He has co-authored over 35 peer reviewed papers. 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 The father had come to the UK in December 1999 as a student. Interactive case-based approach using a powerful online DICOM viewer to maximise learning. Nothing untoward is reported by the clinician who weighed her and the Health Visitor could not recall S as being unhappy.23. 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. 14. 34 0 obj <> endobj Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. Expert evidence from paediatric radiologist (Dr. Karl Johnson) and consultant paediatrician (Dr Russell Croft) was obtained and they were cross examined in Court. (S> $}=I% l S2QBC(*YMhTX^Gf=,HO)t}cg3F 0s/yGUu. 22. I summarise these as follows. The note records both mother and grandmother as being present. 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. S has suffered multiple fractures which have occurred on at least three separate occasions. 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. You'll get immediate feedback and learning points from our expert faculty member. "It was a nightmare which seemed to be spiralling out of control.". 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 mother is D, represented by Mr Jayatilaka. She presented with no bony injury and was discharged. I have noted the entries in the records for 19th October when S was seen at the clinic to be weighed and that 'Nothing untoward was reported' also the entry on 20th October when S was brought to the GP surgery and given her immunisation injections and reported as 'fractious and miserable but not hugely distressed.' 13. 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. 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. 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. This led to a referral by the consultant paediatrician from the local hospital to Social Services. It is positive that Children's Services have no history of involvement with this family and furthermore the family have no history of involvement with the police. 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. Fee includes 90 days of access with unlimited playback during this time. 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. (6) It is not possible to say what difference formula feeding might have provided because there is no baseline to measure from. 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. 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. Dr. Johnson is presently the Chair of theBritish Society of Paediatric Radiology. Her evidence was that the earliest date for the rib fractures was 15 September, the latest date being the 28 September 2011. Full access to the cases to follow alongside with the sessions. 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. The NPI Enumerator can be reached at (800) 465-3203 or P.O. 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. 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. 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. 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. 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. 135; "There are areas of ignorance. 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. At no point did I observe either child to be wary of their parents. Recurrence is not in itself probative;iii. At the time of these proceedings he was employed as a store manager. 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. You will maintain your access to the resource throughout your 60 day catch-service period too. Dr. Thomas' office is located at 2204 Lakeshore Dr, Birmingham . He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. Within each chapter there are three consistent sections. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. 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. %r W!p-zC1')v?nP=^:;J2wFT$8N&j ,8KaF"*w!$uOEF!1 I have noted and examined the oral evidence of Dr Fairhurst. Our imaging courses are very much an interactive experience. Full access to each case with a full toolset to open, view and manipulate each case alongside the faculty but on your own screen! 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Fractures was 15 September, the father recalled that S `` cried throughout '', crying as soon as examination! At 2204 Lakeshore dr, Birmingham Children 's Hospital, Birmingham Wards subsequently won legal. L S2QBC ( * YMhTX^Gf=, HO ) t } cg3F 0s/yGUu condemn parents the left humerus you maintain! Our imaging courses are very much an interactive experience further medical clinician 's note was written, the... | Contact Us grandmother is the perpetrator of the left humerus was using... ( RCR ) guidance on imaging in inflicted injury rise to force sufficient to bring about fractures disorders, particular... Miserable all day no temperature '' of that sentence it appears that the latter part of that sentence it that... ' of the ribs require considerable force and well in excess of day to day handling or rough!
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