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. In all sections, the value of all imaging modalities are stressed. Catch-up service: Paediatric Radiology 2022, Catch-up now with our case-based Paediatric Radiology webinar that took place in February 2022. I summarise these as follows. an improved understanding of Paediatric imaging interpretation and reporting skills. Left lower leg fracture, a metaphyseal fracture of the left tibia (shin bone) (3rd-10th October 2011). The parents agreed to section 20 accommodation on 27.10.11 and on 2.11.11 the local authority issued care proceedings. His research and clinical interests include the pathogenesis [.] hmk0^g? 54. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. 2018 Karen Johnson Andrea Schnell, a Internist practicing in Madison, WI March 27, . 9. 17. The father's responses set out a general defence to each allegation setting a number of relevant points that formed part of his evidence. On 22 September 2011, S is recorded as having the first of her immunisations at the Medical Centre. 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. 2023Check Company | Privacy | Terms of Use | Contact Us. As to the possible involvement of T, he asserts that he had not witnessed T twisting S's arm (or leg or wrists). He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. 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. The family's nightmare began one night in July 2005 when, at three months old, William woke up in pain. Mrs K Oestreich Prof T Southwood Dr Karl Johnson: Tumour Clinic (LTB Clinic) Tuesdays once per month: Ms Baldrighi: The Transition Clinic : Four to six times per year at Queen Elizabeth Hospital on a Tuesday morning : . The parents were unable to offer any explanations and had not observed any accidental events that may explain these injuries. Consistent with this, the father described a happy baby in the first two weeks of her life. 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. Victoria and Jake Ward and William, right. My close examination of this material has focused on the parents' accounts as well as on the evidence they have subsequently given about what they saw. She was born in 1979. 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. 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 impression given by this family and the parents and grandmother in particular is that they were a normal family dealing with their second baby, which by all accounts up to 13th October and indeed to 22nd October appeared to be unexceptional. The final section details the imaging findings in a wide variety of clinical conditions. I therefore granted an adjournment so that a suitable expert could be instructed. DR KARL JOHN JOHNSON is British and resident in England. In the last week of the last Parliamentary session the judgement was rubber stamped into law. A week later William was placed on the council's child protection register. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. 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. 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. No plausible explanation has been offered for any of these injuries. 31. Right wrist fracture, a metaphyseal (bucket-handle) fracture of the distal right radius (difficult to date). Read, highlight, and take notes, across web, tablet, and phone. Amaka lectures regularly on various radiology, paediatric, genetic, emergency medicine and orthopaedic courses, locally and nationally. She presented with no bony injury and was discharged. Opportunity to submit questions by email to the faculty. 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. Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). 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 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. 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. Determined to establish what was wrong they returned twice to the GP, but he was still unable to offer any diagnosis. The family are very close and have a loving relationship. 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. 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. Interactive case-based approach using a powerful online DICOM viewer to maximise learning. You will maintain your access to the resource throughout your 60 day catch-service period too. Mrs A Jester Companies associated with this officer had at least 253,361 shareholder value in recent accounts. Rib fractures to the antero-lateral aspects of the left 8th and 9th rib (15th-28th September 2011). But the drama turned into a nightmare when they were accused of having deliberately harmed their little boy. Birmingham Update in prostate cancer Topics to include: . I therefore come to the conclusion that the local authority has not discharged the burden of proof on the balance of probabilities. Her evidence was that the earliest date for the rib fractures was 15 September, the latest date being the 28 September 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.' 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. ,8KaF"*w!$uOEF!1 22. The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children's Hospital. The burden of proof lies on the local authority and they have to satisfy the court on the balance of probabilities: see Re B (Care proceedings; standard of proof) [2008] UKHL 35. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. 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. 57 0 obj <>stream (4) He accepts that in relation to injuries such as these some force has to be applied. The GP note for 20 October 2011 records "First meningitis vaccination. 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 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). Steelhouse Lane Her mother is D, represented by Mr Jayatilaka. 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. 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 Had an instructive and engaging educational experience. 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 local authority issued care proceedings on 2nd November 2011. 5 of my judgment on 26th March 2012. She states that they do not occur accidentally and this type of fracture is highly indicative of non-accidental causation requiring a force well in excess of that used in normal day to day handling of an infant. 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. He has a special interest in paediatric musculoskeletal. An X-ray was performed at the time along with other tests and appeared to present no bony injury and no metaphyseal infraction. *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 She took the view that the two left leg fractures (3 and 4) could have happened at the same time. Akin, MD, Diagnostic Radio 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. He states that S had a tendency to cry and this was discussed with medical professionals on more than one occasion. 46. The parents did not return her, the Father stating that by Sunday [14th October] she was "back to normal". She is also a member of the Royal College of Paediatrics and Child Health, and is a fellow of the RoyalCollege of Radiologists. 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. On 22 October a skeletal survey was performed and reported on by Dr Steven Johnson, Consultant Radiologist. "Unfortunately the job of social workers is to think the unthinkable because sometimes terrible things happen. 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". The guardian also represented the other child of the family T, who was born on 14th February 2008. 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. 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. The note records both mother and grandmother as being present. Full access to the cases to follow alongside with the sessions. Her parents returned with S on 22.10.11 with a swollen arm. It was noted that the parents were unsure how the fracture may have happened and there had been no recent accidents of falls. Her special interests include musculoskeletal radiology and trauma, particularly imaging in inflicted injury. In the course of surveying the 'wide canvas' of evidence I have reviewed the evidence of the mother, the father and the grandmother. 34. Our imaging courses are very much an interactive experience. In reviewing the broad canvas of S's family, therefore, I have taken stock of the mother and father's background and employment and the unfortunate medical problems suffered by the couple's first child T with Hirschsprung's Disease and the particular care and attention that this child required. There was an additional right wrist fracture which was difficult to date. Several of these fractures are highly specific for non-accidental causation by an adult. Contents hosted on Doctuo should not be used as substitutes for professional medical advice, diagnosis or treatment. 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. 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. In surveying the 'wide canvas' further, I take into account the evidence of Professor Nussey because the manifest injuries do call for explanation. 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.". At no point did I observe either child to be wary of their parents. The conclusions are positive. 6. 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. hbbd``b`J5 `n\ a#H #e \ Fractures of the antero-lateral aspects of the left 8th and 9th ribs were caused by (a) a direct blow or compressive forces applied to her chest by an adult carer, (b) she would have shown distress for 10-15 minutes and shown discomfort when her chest was moved such as when she was dressed and a regular carer would know this was as a result of these fractures with discomfort lasting for a week. The NPI Enumerator can be reached at (800) 465-3203 or P.O. To access the survey, please click here. S was sent for x-ray, which revealed a spiral fracture of the left humerus. An X-ray showed a spiral fracture of the left humerus. Within each chapter there are three consistent sections. You'll get immediate feedback and learning points from our expert faculty member. 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. HkBsD R#\#[(!$D(AyLgtJ%{mc8zA&+;*JV [a%4[)Er_'! Controversial issues, more cases and discussion, To provide the Consultant Radiologist with a practical and comprehensive case based update on the interpretation and reporting of general paed radiology, suspected inflicted injuries and challenging cases when on call, Takes delegates through an intensive series of challenging cases with immediate feedback after each case, Short introductory lectures, offering guidance, practical knowledge, what not to miss and how, Faculty of Consultant Paediatric Radiologists who are experts in their fields and from different hospitals in the UK. I make this observation. Particular caution is necessary in any case where the medical experts disagree, one opinion declining to exclude a reasonable possibility of a natural cause;iv. S had regained and passed her birth weight. His claim that William had suffered four fractures on at least two occasions was contradicted by their assertion that he had only two fractures, both of which had probably been caused at the same time. 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. Notwithstanding that, I formed the impression that she was seeking to assist the court. The job of social workers is to think the unthinkable because sometimes things... Contents hosted on Doctuo should not be used as substitutes for professional medical advice, or! That she was `` back to normal '' 's nightmare began one night in July 2005,. To establish what was wrong they returned twice to the conclusion that the local issued! 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