Consultant Paediatric Radiologist and Service Group Lead for Radiology, Alder Hey Childrens Hospital, Liverpool, UK. 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. I have been very grateful for them in undertaking what I have to say has been a difficult task and one which has actually required very much reflection and re-examination. 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. You will maintain your access to the resource throughout your 60 day catch-service period too. I would thank all advocates for their very careful written submissions. The main functions of MRI are as follows: a. early diagnosis of CADM and fasciitis; b. differential diagnosis with other types of myopathies, such as congenital myopathy; c. locating the site for. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. 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. Her special interests include musculoskeletal radiology and trauma, particularly imaging in inflicted injury. The GP note for 20 October 2011 records "First meningitis vaccination. 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. 941-697-3552. 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. 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.' The judgment that I gave that day is subsumed into this fuller judgment of the court.02. 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. I make this observation. Dr Karl Johnson, Birmingham Children s Hospital Joint tumours Dr Asif Saifuddin, Royal National Orthopaedic . 5. This led to a referral by the consultant paediatrician from the local hospital to Social Services. Hence attendance at A&E.". Attendance of the course includes access to the database of cases associated to this event on our server at PostDICOM. 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. ,8KaF"*w!$uOEF!1 10. "It was a nightmare which seemed to be spiralling out of control.". Dr Paul Humphries, Consultant Paediatric Radiologist, Great Ormond Street Hospital and University College London 12:15 MSK MRI 2 - bone marrow Dr Karl Johnson, Consultant Paediatric Radiologist, Birmingham Children's Hopsital 13:00 Lunch 14:00 Abdominal MRI - techniques, common applications and Her evidence was that the earliest date for the rib fractures was 15 September, the latest date being the 28 September 2011. 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. 07. At 22.30, a further medical clinician's note was written, although the authorship is not clear. He trained in Paediatrics and Radiology in Cambridge and London, and was awarded a PhD in brain imaging in 2002 from the University of Cambridge. Within each chapter there are three consistent sections. Our imaging courses are very much an interactive experience. S, it is stated, settled after being given Calpol following her vaccination on 20th October 2011. Ms Baldrighi, Back to top of page The paediatric clinicians note records that "yesterday evening the parents noted [her] crying and unsettled, left leg persistently held in a flexed position." Location Akin, MD, Diagnostic Radio I have noted and examined the oral evidence of Dr Fairhurst. 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.". In due course a consultant paediatric radiologist went on to identify fractures to the left upper arm, right lower arm, distal left femur, left and right tibia and two rib fractures. (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. But during the family court proceedings serious doubts were cast on Dr Johnson's evidence by other medical experts. 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. The Father said in evidence that when the hospital phoned on Monday morning, his wife told them that S was "fine".21. sub-optimal bones that have not yet developed radiological signs of rickets; (6) I note that she was not in a position to give an expert opinion on metabolic bone disease which she identified as a very complex subject beyond the radiological aspect and that she would defer to a metabolic expert; (7) she accepted that the lack of evidence for fractures occurring in patients with lower than normal levels of Vitamin D (who did not have radiological evidence of rickets) is the current state of research and acknowledged that there is a need for more study to be done; she further accepted that this is a developing and controversial area of medicine; (8) I noted that it is accepted by all medical experts that it is unknown what level of force would be required to cause the injuries in a baby that had a Vitamin D deficiency or insufficiency; understandably it is not possible for experiments to be carried out. %%EOF On 17 August 2011, S was taken to the clinic at 4 weeks old to be weighed. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. The Wards were arrested and questioned by police on suspicion of grievous bodily harm and child cruelty towards William. This further hearing took place on 24th October 2012.08. Metaphyseal bucket-handle fracture of the distal right radius caused when (a) her right wrist had been pulled and twisted by an adult carer; (b) any person present would be immediately aware she had suffered a significant injury. This person was born in December 1965, which was over 57 years ago. colic/reflux." Read full profile Dr Khushnood Alam Consultant Radiologist Biography pending. Mr Sami Al-Ani He stated that on the Saturday morning, at bath time, the grandmother noticed her left arm was swollen and tender and she cried when being dressed or undressed. Amaka lectures regularly on various radiology, paediatric, genetic, emergency medicine and orthopaedic courses, locally and nationally. Dr Johnson, however, reported "a number of equivocal appearances on radiographs with respect to the left distal femur and proximal left tibia" and suggested further films. 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. The father's responses set out a general defence to each allegation setting a number of relevant points that formed part of his evidence. None of the fractures could have occurred at birth. Subscribe for updates and offers on new events for your specialty. Notwithstanding that, I formed the impression that she was seeking to assist the court. 20. 31. (5) S's Vitamin D levels, which were on the borderline on 2nd November 2011, were never higher than insufficient. I considered that the family members have a very close bond and I did not observe any concerns regarding their attachment. I accept the submission that there is a lack of current research on the susceptibility to fracture in babies who are Vitamin D deficient. The responses of the parents and the cases which they have put before the court appear in summary form on the Scott Schedule. 2. 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. As to the possibility that rough handling by T might have been responsible for S's injuries, he concluded that while it would be possible he did not think it was probable. I came to the conclusion that I was unable to determine the case without further specialist expert evidence. She was described as remaining "settled in A&E, observations in normal range, apyrexial." Dr. Johnson is presently the Chair of theBritish Society 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. 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. I therefore come to the conclusion that the local authority has not discharged the burden of proof on the balance of probabilities. 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 family's nightmare began one night in July 2005 when, at three months old, William woke up in pain. Further X-rays revealed what appeared to be three more fractures and an injury to his arm. 5 of my judgment on 26th March 2012. 09. 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. Radiologists, Country 135; "There are areas of ignorance. The father completed a course in tourism management and completed a post-graduate degree in business management. Birmingham Women's Hospital Mindelsohn Way Birmingham B15 2TG . The guardian also represented the other child of the family T, who was born on 14th February 2008. greater confidence in managing the imaging of an acutely unwell child. 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 It is reasonable to conclude that they were lower before then because she was breastfed. 41. She refers to the times when S was seen by the health visitor when, despite the presence of fractures, nothing untoward was seen on as she puts it 25th July 2011, 3rd August 2011, 22nd September 2011, 19th October 2011 and 20th October 2011. In the absence of an explanation of the injury to S's left arm, the Consultant Paediatrician considered that there was a "high level of suspicion that the humeral and rib fractures may have been sustained as a result of non-accidental injury". Mr Johnson and Dr Vickers declined to comment. He had known his wife (the mother) since 1990. However, I note the high level of engagement with the medical services throughout T's life and the attention and care that he needed and received, caused by his own particular medical condition. Any specialty Interactive case-based approach using a powerful online DICOM viewer to maximise learning. I take note also that the mother and father completed a parenting assessment. There is no evidence of drugs or alcohol abuse, of anger or violent outbursts, of short temper, volatility, irritability or dysfunction. This person was born in December 1965, which was over 57 years ago. 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. Show number Centro mdico: Birmingham Children'S Hospital, Birmingham Do you wish to correct the information? 22. The GP's entry records "crying, excessive ? 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. The family are very close and have a loving relationship. S's Vitamin D levels were borderline on 2.11.11 and were never higher than insufficient. Erythematous [reddening on the skin]. 11. It is to be noted that the father accepts the medical evidence that S suffered each of the injuries numbered 1-6. Mrs K Oestreich T would often watch attentively as the parents and grandmother would feed S and hold her. The mother, father and grandmother all said that Infacol did eventually help for a time before her crying became worse again.15. However, the father points out that there were times when S was sleeping in the bedroom; that T would leave the room where he was being supervised to get a toy or use the bathroom; and his case is that it is possible that he may have gone into the bedroom and caused S injury. On examination by the doctor there was no active movement of that arm. 8. hbbd``b`J5 `n\ a#H #e \ EiSNZw_EQL{.y@^y|jJ%5* dN%] w;t|9"v@v(5>S@k 0 T- The local authority sought findings that the injuries had occurred non accidentally with the parents and grandmother as possible perpetrators. It was the maternal grandmother's view that her daughter and son-in-law did not injure S. The maternal grandmother also mentioned that she had cared for her own children, relatives and grandchildren and was capable of ensuring that children are properly and safely cared for. Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). 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. DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. 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. DAY 3: INFLICTED INJURIES IN CHILDREN - FRIDAY 11 FEBRUARY 2022. You'll get immediate feedback and learning points from our expert faculty member. This, unfortunately, was soon to change. On 22 October a skeletal survey was performed and reported on by Dr Steven Johnson, Consultant Radiologist. The parents did not mention the previous weekend's symptoms or the trip to the hospital on 13 October 2011.24. 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. He identified irregularity in the distal left femur in an earlier X-ray taken on 13th October 2011, but after further scans concluded that there was no fracture of the distal left femur. 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. Apyrexial. Added to this was the unfortunate position of counsel for the grandmother, who was not present and who had sent a message to the court that her client's public funding certificate had been embargoed for the reasons and with the consequences set out in para. 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 It was inevitable, that the local authority had to bring this case to court. The mother and/or the father and/or the grandmother is the perpetrator of the injuries to S.19. The record shows "baby crying and unsettled today. In surveying the 'wide canvas' further, I take into account the evidence of Professor Nussey because the manifest injuries do call for explanation. 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. 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. No plausible explanation has been offered for any of these injuries. S's crying was attributed to colic initially and latterly to her having received her vaccination on 20th October 2011. 2023Check Company | Privacy | Terms of Use | Contact Us. Formula feeding for 8-9 weeks before the test would have provided some improvement but not enough, as breastfeeding would provide none. 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. The father maintains that there could be some natural explanation for S's injuries.38. To access the survey, please click here. I have considered the findings invited by the local authority as to the evidence of the family members, the inconsistencies, alleged inaccuracies and inferences that I am invited to draw from them. 8. 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. She is the radiology lead for child protection, rheumatology, orthopaedic and skeletal dysplasia multidisciplinary meetings at Alder Hey Childrens NHS Foundation Trust. So the records engage even closer scrutiny. 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. 20. This judgment relates to the fact finding hearing concerned with the causation of a number of bone fractures sustained by S at about the age of three months. The GP was unable to identify the cause of William's pain, but on returning home the Wards noticed his leg was swollen. Karl John Johnson Radiologist Steelhouse Lane, B4 6Nh, Birmingham, England. The fractures to the right lower leg took place between 12th September and 10th October. Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. Excellent peer interaction and collaborative learning. '(&NJdsB. 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. At one week she was seen by the Community Nurse and was reported to be "thriving, contented and settling well." DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. He also is an expert of considerable renown. 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. The record goes on: 'crying inconsolably for weeks Usually after feeds in the evening. (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. This company officer is, or was, associated with at least 1 company roles. The local authority relied upon the evidence of the consultant paediatric radiologist who acknowledged what whilst there could be a Vitamin D deficiency there was little, if any, supporting evidence of fractures being caused by lower than normal Vitamin D levels where there is no evidence of rickets. Her parents returned with S on 22.10.11 with a swollen arm. 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. 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. 49. 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. 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. Dr. Robert H. Thomas is a Radiologist in Birmingham, AL. 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. 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. 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. If no better, to review or sooner at any time if concerns'. 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 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. However, the identities of the expert witnesses in the case remained shrouded in secrecy. 45. 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. 4. After the immunisation, the parents were advised to give her Calpol. The history squares rather more comfortably with the account given by the father in his statement than in his oral evidence. The maternal grandmother's position can most usefully be seen as set out in her position statement of 12th March 2012. At that point a number of problems faced the court. With no help from outside agencies their couple mounted their own investigation into the cause of their son's injuries. Find Dr. Thomas's phone number, address, hospital affiliations and more. . 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. 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. 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. On examination, the left knee was "warmer to touch than the right, with mild erythema and swelling over the knee". I derive particular assistance from his evidence and the conclusion that S had a greater vulnerability to fracture, which he described as a reasonable conclusion, and at the times when they are likely to have occurred. Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. With Doctuo you can find the doctors you need. Dr. Jackson's office is located at 2204 Lakeshore Dr . It is not possible to know which incidents or movements caused or gave rise to force sufficient to bring about fractures. S's father is represented by Miss Deschampneufs. 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 one point, he mentioned that they had thought it was due to her immunisation that she was not using her left hand. 6. 2018 Karen Johnson Andrea Schnell, a Internist practicing in Madison, WI March 27, . 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. 55. (10) His view was that it was likely that S was Vitamin D deficient in utero and in the early neonatal period. Metaphyseal fracture of the proximal right tibia caused when (a) her right leg had been pulled and twisted by an adult carer; (b) she would have shown distress for 10-15 minutes and would have shown discomfort when her leg was moved. However, the medical professionals did not note any problems with S on 20th October 2011 despite Dr Fairhurst's dating of the fracture between 16th October 2011 and 19th October 2011. The strong impression given is that the parents and maternal grandmother are careful, child-focused and conscientious parents who have demonstrated the quality of the attention they have given to dealing with T's special health needs and to S as they have arisen. "It was felt that it was a matter of such complexity and range of opinion that it was a matter for court determination.". No local tenderness in leg or hip", S was x-rayed, but nothing abnormal was observed. The parents' first child T was born on 14th February 2008. This would have involved manipulation of the legs and arms, and the conducting of other tests. The injuries and range of dates are as follows. Her mother is D, represented by Mr Jayatilaka. 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 fractures at 2, 3 and 6 above were only identified by Dr Fairhurst. It must also raise as a real possibility the potential explanation that T may have brought about one or more fractures, along with the possibility less likely, in my view that S may have been injured when the family slept together in one bed. There is no radiological evidence that S suffers from rickets or any other vitamin deficiency. The professional couple were shocked to be told eventually that William had a broken leg. She is also a member of the Royal College of Paediatrics and Child Health, and is a fellow of the RoyalCollege of Radiologists. septic arthritis." S was referred to hospital as a paediatric emergency, the GP's impression being "?? 46. On Thursday 20 October 2011 S was brought to the GP surgery by the parents and given her immunisation injections, in each thigh, by the Health Visitor. 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. I therefore granted an adjournment so that a suitable expert could be instructed. The parents/grandparent who did not inflict the injuries on each occasion to S failed to protect her. DR KARL JOHN JOHNSON is British and resident in England. * Panorama's Please Don't Take Our Child is broadcast on BBC One tomorrow at 8.30pm. 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. 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 Suitable expert could be instructed fracture in babies who are Vitamin D levels which! And unsettled today 2011, were never higher than insufficient maintain your access to the database of cases to! Nightmare which seemed to be `` thriving, contented and settling well. 14th FEBRUARY 2008 Consultant paediatrician from local... Is the perpetrator of the court.02 S was Vitamin D deficient in utero and in the early neonatal period thriving... * w! $ uOEF! 1 10 responses of the fractures could have occurred at.... 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