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. Catch-up service: Paediatric Radiology 2022, Catch-up now with our case-based Paediatric Radiology webinar that took place in February 2022. Location 13. S was discharged and the parents reported that her knee improved. He was diagnosed with Hirschsprung's disease, remaining under the care of a London hospital's surgical team with 6 monthly checks. 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. The father's evidence was that during the morning she had cried more than normal and he confirms that she was "grumpy and crying". 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 Court reminded itself of the guidance in Re U: Re B (Serious injury: standard of proof) [2004] 2 FLR 263 and Re L [2011] EWCA Civ 1705 noting that where there is uncertainty in the medical and scientific evidence the Judge's appraisal and confidence in the parents is crucial. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. The conclusions are positive. 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. Dad says that [she] has been miserable all day no temperature". On the balance of probability T could not have caused the injuries to S either by (a) jumping on the family bed whilst S was lying on it or (b) pulling her bouncy chair when she was in it. hbbd``b`J5 `n\ a#H #e \ In the course of surveying the 'wide canvas' of evidence I have reviewed the evidence of the mother, the father and the grandmother. She acknowledged that this is a developing and controversial area of medicine. Doctors, medical appointments, hospitals, medical staff. 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. 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. He also is an expert of considerable renown. This led to a referral by the consultant paediatrician from the local hospital to Social Services. Metaphyseal fractures result from pulling and twisting being applied to the limb. 0121 472 1377. 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. 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. The NPI Enumerator can be reached at (800) 465-3203 or P.O. 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. Rent and save from the world's largest eBookstore. I have taken account of the fact that she gave her evidence through an interpreter while having at least a working grasp of English. 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. She took the view that the two left leg fractures (3 and 4) could have happened at the same time. The advice to 'persist with Infacol' also bears out the father's account. * Panorama's Please Don't Take Our Child is broadcast on BBC One tomorrow at 8.30pm. S's early developmental history, after her birth on 18 July 2011, was unremarkable at first sight: more would come to be known about her Vitamin D deficiency later, with ensuing events. 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. 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. Further X-rays revealed what appeared to be three more fractures and an injury to his arm. 941-697-3552. Recurrence is not in itself probative;iii. Determined to establish what was wrong they returned twice to the GP, but he was still unable to offer any diagnosis. 5. Subscribe for updates and offers on new events for your specialty. 4. 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. Dr Landes is radiology trauma lead and has contributed to the Royal College of Radiologists (RCR) guidance on imaging in paediatric trauma. Rib fractures to the antero-lateral aspects of the left 8th and 9th rib (15th-28th September 2011). Companies associated with this officer had at least 253,361 shareholder value in recent accounts. Interactive case-based approach using a powerful online DICOM viewer to maximise learning. I note in particular the five times when she was seen at medical appointments when she was said to be suffering fractures. I have noted the reference to Lancashire County Council v B [2000] AC 147. 34. As a result of her expertise she receives both regional and national referrals for review of musculoskeletal imaging from radiological and clinical colleagues with an emphasis on imaging in cases of suspected inflicted injury. With Doctuo you can find the doctors you need. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. Any specialty there is a stage of rickets before it is identifiable radiologically. Contents hosted on Doctuo should not be used as substitutes for professional medical advice, diagnosis or treatment. If there is some innate contradiction in that sentence it appears that the latter part of that sentence represents the stronger conclusion. 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. 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 S, it is stated, settled after being given Calpol following her vaccination on 20th October 2011. I never observed either parent react angrily towards each other or either child. 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. 12. I have also had the benefit of the considerable amount of documentation in the bundles to which extensive reference has been made in the course of the evidence. However, on 22nd October 2011 the parents again presented S, this time with swelling to her left arm. Dr. Helen Williams is a full time general paediatric radiologist, and has special interests in cross-sectional imaging, feeding studies and radiology training. The final section details the imaging findings in a wide variety of clinical conditions. Nothing untoward is reported by the clinician who weighed her and the Health Visitor could not recall S as being unhappy.23. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. (4) He accepts that in relation to injuries such as these some force has to be applied. There is no evidence of drugs or alcohol abuse, of anger or violent outbursts, of short temper, volatility, irritability or dysfunction. 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. He said: "It was a clear cut case in that there was no immediate explanation and the parents were not clear how the baby had come by his injuries. As with the mother, that did not mean that there were no instances when they were confused or mistaken.48. 2018 Karen Johnson Andrea Schnell, a Internist practicing in Madison, WI March 27, . 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 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. Opportunity to submit questions by email to the faculty. 07. This hearing has run over a prolonged period of months in the course of 2012; in particular because it encountered difficulties in the procurement of the services of one of the experts necessary to address the issues in the case, and also because of practical difficulties in the hearing itself in adducing the important evidence of the children's grandmother from Sri Lanka. Right wrist fracture, a metaphyseal (bucket-handle) fracture of the distal right radius (difficult to date). By the time the two-week family court hearing began, Mrs Ward was pregnant with her second child and feared that if William was taken, her new baby would be too. I have taken account of the occasions when S was seen by medical staff. 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. At one point, he mentioned that they had thought it was due to her immunisation that she was not using her left hand. There was an additional right wrist fracture which was difficult to date. 55. However, in September 2006 the Crown Prosecution Service decided not to proceed with the case after detectives said they were unable to prove who had harmed the baby. 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". Detectives removed the cot for examination. DR KARL JOHN JOHNSON is British and resident in England. Dr. 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. &/6kc`&EnFl! h~aka }mfh{p#P\fv}Clh+r9>XY7U&l5 tfL(h~)=O.szywUafH9!dN2-bs4XW+w2?b;NWNl 5ybc i20 V*a Qjff`# 2E,C\v{:]nJI'G,6]$kBEGs0XX'O-J(|- KTg}LzgNY The evidence from the Health Visitor is that she would have been undressed for weighing and placed in the scales by her parents. 36. 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. Thank you! 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. 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. On 22 September 2011, S is recorded as having the first of her immunisations at the Medical Centre. (2) I note his evidence that there is no uniformity of Vitamin D testing in the United Kingdom and that Vitamin D is difficult to measure. Full access to each case with a full toolset to open, view and manipulate each case alongside the faculty but on your own screen! Site map, Please rate your experience out of 5 (with 5 being the highest and 1 being the lowest), Birmingham Women's Hospital S's crying was attributed to colic initially and latterly to her having received her vaccination on 20th October 2011. It is simply not possible to know where the boundary lies. Dr Fairhurst thinks that they may have been sustained as I set out in their approximately chronological order: 1. 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. 54. 42. (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. The Judge was satisfied that neither the mother, father, nor grandmother could be held responsible for causing the injuries. 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. 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. The fractures to the right lower leg took place between 12th September and 10th October. 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 parents' observations are also a matter of record, as are the consultants' examination. When Victoria and Jake Ward saw their baby son crying and refusing to feed, they took him to their doctor. Their most recent appointment, in our records, was to DR K JOHNSON LIMITED on 2015-08-17. 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 I take note also that the mother and father completed a parenting assessment. The Judge found that neither parent was seeking to cover up matters or to deal other than truthfully to the best of their ability. "There seems to be a small group of expert witnesses who often condemn parents. 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. It was inevitable, that the local authority had to bring this case to court. Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. The x-ray of the left femur had been reported as showing no bony injury on 13 October 2011 and no obvious metaphyseal infraction. 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. Fax 847-678-6286 Tooting whose report is at E76-E 279 and Dr. Karl Johnson, consultant paediatric radiologist at the Birmingham Children's Hospital . 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. 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. The Wards were only allowed to take William home with them when they agreed to be supervised 24 hours a day by Mr Ward's parents, who had to relocate from Devon to move into the couple's home. 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. 18. Mrs K Oestreich 43. S has suffered multiple fractures which have occurred on at least three separate occasions. There were evident deficiencies in translation by the interpreter. Read full profile Dr Khushnood Alam Consultant Radiologist Biography pending. 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. HkBsD R#\#[(!$D(AyLgtJ%{mc8zA&+;*JV [a%4[)Er_'! The responses of the parents and the cases which they have put before the court appear in summary form on the Scott Schedule. 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. 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. 5. 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. The mother and/or the father and/or the grandmother is the perpetrator of the injuries to S.19. It was noted that the parents were unsure how the fracture may have happened and there had been no recent accidents of falls. '(&NJdsB. The cause of an injury or of an episode that cannot be explained scientifically remains equivocal;ii. 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. The Father said in evidence that when the hospital phoned on Monday morning, his wife told them that S was "fine".21. 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