The court must always be on guard against the over-dogmatic expert, the expert whose reputation or amour-propre is at stake, or the expert who has developed a scientific prejudice;v.The judge in care proceedings must never forget that today's medical certainty may be discarded by the next generation of experts, or that scientific research will throw light into corners that are at present dark.". Full access to each case with a full toolset to open, view and manipulate each case alongside the faculty but on your own screen! 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. 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. 941-697-3552. 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. On Wednesday 19 October 2011, S was seen at the clinic to be weighed. 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. The father accepts that only he, the mother and the grandmother were caring for S during this time. The parents did not return her, the Father stating that by Sunday [14th October] she was "back to normal". A number of strengths however have been identified during this short involvement. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. The GP note for 20 October 2011 records "First meningitis vaccination. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. Earlier records that day mention mother and father being present.
Catch-up service: Paediatric Radiology 2022, Catch-up now with our case-based Paediatric Radiology webinar that took place in February 2022. The constellation of findings is highly indicative of non-accidental injury by an adult. Victoria and Jake Ward and William, right. One or both of the parents, and/or the grandmother knows what has happened to S on all the occasions she has suffered injury. I came to the conclusion that I was unable to determine the case without further specialist expert evidence. A revised care plan was approved for the rehabilitation of S to the care of her parents. 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. The record concludes with the GP's comment "All well. This company officer is, or was, associated with at least 1 company roles. Her mother is D, represented by Mr Jayatilaka. That aspect is not mentioned. 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". courses@infomedltd.co.uk+44(0)20 4520 5081. This company officer is, or was, associated with at least 1 company roles. 54. 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. Birmingham, 012 133 The book is an important revision aid as well as an up-to-date reference. Read full profile Dr Khushnood Alam Consultant Radiologist Biography pending. 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. Birmingham B4 6NH, Questionnaire for parents with children aged 5-9, Monday, Wednesday and Thursday/Friday afternoon, Four to six times per year at Queen Elizabeth Hospital on a Tuesday morning. 41 0 obj
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. He indicated that in addition to the spiral fracture of the upper left arm, healing fractures of the left anterior 8th and 9th ribs were noted, with the amount of callus "suggesting that these fractures are not acute". %r W!p-zC1')v?nP=^:;J2wFT$8N&j Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. 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. 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. 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. 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. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. There is no radiological evidence that S suffers from rickets or any other vitamin deficiency. 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. ,(`df\CT&B6+c! 45. 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. Steelhouse Lane It is to be noted that at this time, 13 October 2011, the evidence is that S had already sustained factures of the left 8th and 9th rib and was likely to have sustained her left femoral fracture and fractures to the right and left tibia. Wanted a review(Under 'P') Discussed with Mum and Dad possible colic will continue withInfacol and see how she gets on over next week. Dr Landes is radiology trauma lead and has contributed to the Royal College of Radiologists (RCR) guidance on imaging in paediatric trauma. (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. 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 She acknowledged that this is a developing and controversial area of medicine. He was diagnosed with Hirschsprung's disease, remaining under the care of a London hospital's surgical team with 6 monthly checks. Our imaging courses are very much an interactive experience. S was discharged and the parents reported that her knee improved. 13. The father maintains that there could be some natural explanation for S's injuries.38. I summarise these as follows. The fractures at 2, 3 and 6 above were only identified by Dr Fairhurst. Dr Fairhurst thinks that they may have been sustained as I set out in their approximately chronological order: 1. 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. Further X-rays revealed what appeared to be three more fractures and an injury to his arm. The local authority sought findings that the injuries had occurred non accidentally with the parents and grandmother as possible perpetrators. Dad says that [she] has been miserable all day no temperature". The mother's tend to be shorter responses but amplify the general stance of the parents as well as the grandmother that while accepting that the fractures occurred and that they occurred while S was in their care they reject the allegations that they caused the injuries in a non-accidental way. Their care of the children has been observed as of high quality. 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. When Victoria and Jake Ward saw their baby son crying and refusing to feed, they took him to their doctor. My approach in law to this case has been assisted by the reference made by the advocates to a number of cases in their written submissions. Because William's parents were unable to explain the fracture the hospital deemed the case suspicious and called in social services. He has co-authored over 35 peer reviewed papers. The NPI Enumerator can be reached at (800) 465-3203 or P.O. Ms Baldrighi, Back to top of page He also is an expert of considerable renown. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. The paediatric clinicians note records that "yesterday evening the parents noted [her] crying and unsettled, left leg persistently held in a flexed position." 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". 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. However, the identities of the expert witnesses in the case remained shrouded in secrecy. There was then a further sharp issue over which expert should be instructed in this field which was not brought before the court until 24th May 2012. 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. When S was 10 days old, her maternal grandmother arrived from Sri Lanka to live with the family and to help mother look after the children.13. I have also noted in relation to the injuries that it is 'always open to a judge to rule that the cause of the injury remains unknown' and the case of Re R (Care proceedings: causation) [2011] EWHC 1715, a decision of Mr Justice Hedley. (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. 51. 3.o-VR;+lZsA30PK#>] FP+irJBp%MU :g
I{,8fVn|aQY/,E/sa8Cd8sfhD5wGtkE4*8*q0zW,7(Ic Injuries to S could not have been caused by a person rolling onto her. 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. Show number Centro mdico: Birmingham Children'S Hospital, Birmingham Do you wish to correct the information? The child appears by her children's guardian and has been represented by Miss Dixon. Hence attendance at A&E.". 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. She refers to the fact that in relation to allegation 3, 4, 5 and 6 the mother had noticed the child's discomfort and taken S to the Medical Centre and then on to the Accident and Emergency Unit at the local hospital where S was examined by a paediatrician and X-rayed, following which she was told that everything was normal and she was discharged. colic/reflux." He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. hmk0^g? Upper limb rheumatology/radiology MDT: . greater confidence in managing the imaging of an acutely unwell child. Within each chapter there are three consistent sections. There is no evidence of drugs or alcohol abuse, of anger or violent outbursts, of short temper, volatility, irritability or dysfunction. Birmingham Women's Hospital Mindelsohn Way Birmingham B15 2TG . This would have involved manipulation of the legs and arms, and the conducting of other tests. View more radiologists birmingham Consultations Consultations Steelhouse Lane, Birmingham, England. I gave a short judgment identifying the difficulties in which the paediatrician found himself in dealing with the analysis of Vitamin D deficiency/insufficiency which was outside his expertise and which presented a substantial difficulty in the case. 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. 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. The fractures to the right lower leg took place between 12th September and 10th October. The Wards subsequently won a legal fight in the High Court for the judgement to be made public. Location UK based, CPD accredited, online courses for doctors in all of the major specialties, Navigation: Particular difficulties were encountered with receiving the evidence of the grandmother by Skype from Sri Lanka with the connection frequently being lost and with further doubts arising over the correctness of the interpretation of her evidence. When S was born on 18 July 2011, T was 3 years and 5 months old. 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. 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. 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". An X ray showed a spiral fracture of the left humerus. Radiologists, Country 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. 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. Interpretation & Reporting Webinar for the General Radiologist, DAY 1: GENERAL PAEDIATRIC RADIOLOGY - WEDNESDAY 9 FEBRUARY 2022 Mindelsohn Way 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. 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 was inevitable, that the local authority had to bring this case to court. The x-ray of the left femur had been reported as showing no bony injury on 13 October 2011 and no obvious metaphyseal infraction. This further hearing took place on 24th October 2012.08. Her weight gain was recorded as normal. The advice to 'persist with Infacol' also bears out the father's account. Dr. Gregory D. Jackson is a Radiologist in Birmingham, AL. Post-immunisation advice was given". Her special interests include musculoskeletal radiology and trauma, particularly imaging in inflicted injury. X-rays The maternal grandmother denied harming S and did not accept that her daughter or son-in-law would not do the same. endstream
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On 22 September 2011, S is recorded as having the first of her immunisations at the Medical Centre. S was sent for x-ray, which revealed a spiral fracture of the left humerus. John is a Consultant Endocrinologist at Queen Elizabeth Hospital Birmingham (QEHB) and an Honorary Senior Lecturer at the University of Birmingham. On 19 August 2011, two days later, there is a record in the GP notes confirming a visit by the mother and father with S. She was seen by the GP. 7. Any specialty 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. DR KARL JOHN JOHNSON is British and resident in England. NS>zu=/_jwJa:S (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. 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. She moved back to London, to Great Ormond Street Hospital and the Institute of Child Health, where she obtained a PhD for her thesis, Optimisation of the digital radiographic imaging of suspected non-accidental injury, then returned to Sheffield as a HEFCE-funded Clinical Senior Lecturer in the Academic Unit of Child Health. She is the radiology lead for child protection, rheumatology, orthopaedic and skeletal dysplasia multidisciplinary meetings at Alder Hey Childrens NHS Foundation Trust. It soon became clear that both the police and social services were relying heavily on the evidence of Dr Johnson, who said that William had suffered four fractures which had taken place on at least two or more separate occasions. To access the survey, please click here. After 22 September 2011, S was next seen at the GP surgery on the 13 October 2011. 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. There are a number of other features of the evidence about the parents which I must take into account as part of the 'wide canvas' of evidence that I have surveyed. Within each chapter there are three consistent sections. In this case the local authority brings proceedings for Public Law orders relating to S, born on 18th July 2011. 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. She weighed 6lbs 15 ozs (3.15 kg) at birth and was born by emergency Caesarean section. I considered that the family members have a very close bond and I did not observe any concerns regarding their attachment. (9) He anticipated that S's level was 30-35 when she was born, not adequate and markedly deficient. '(&NJdsB. Akin, MD, Diagnostic Radio He denies causing any of the injuries and in turn denies the specific causation of each injury. "There seems to be a small group of expert witnesses who often condemn parents. Nor is it possible to conclude at what point 'normal day to day handling' a vague phrase at best, and which must include the use of reasonable force and pressure at times crosses over to the point where S's vulnerable bone structure was compromised and exceeded. Clinic Locations. (S> $}=I%
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S2QBC(*YMhTX^Gf=,HO)t}cg3F 0s/yGUu. I accept that given T's reported boisterousness a heightened level of supervision would have been needed but that could not have been known by any of the family members at the time the fractures were likely to have been caused. 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. 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 Father said in evidence that when the hospital phoned on Monday morning, his wife told them that S was "fine".21. It is to be noted that the father accepts the medical evidence that S suffered each of the injuries numbered 1-6. 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. "It was felt that it was a matter of such complexity and range of opinion that it was a matter for court determination.". British Society of Paediatric Radiology: Paediatric MRI for general radiologists - tips and tricks 16:50 - 17:10 Musculoskeletal (MSK) imaging Dr Karl Johnson, Birmingham Children's Hospital NHS Foundation Trust Learning points In the maturing child, the marrow signal will alter depending on the amount of haemopoietic and fatty tissue within it. Presentations are kept to the minimum and then you'll be into the fully featured cloud based DICOM viewer, looking at cases, feeding back your findings using our interactive tools. 05. It is remarkable that these and in particular the hospital appointment of 13th October did not reveal or suggest the presence of fractures, nor did they raise any element of suspicion about the parents. Call. The guardian also represented the other child of the family T, who was born on 14th February 2008. 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 parents' first child T was born on 14th February 2008. (On examination) Crying ++. 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. Her evidence was that the earliest date for the rib fractures was 15 September, the latest date being the 28 September 2011. 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. 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. I have noted the reference to Lancashire County Council v B [2000] AC 147. 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 Judge was satisfied that neither the mother, father, nor grandmother could be held responsible for causing the injuries. AbeBooks.com: Paediatric Radiology (Oxford Specialist Handbooks in Paediatrics) (9780199204793) by Johnson, Karl; Williams, Helen; Foster, Katharine; Miller, Claire and a great selection of similar New, Used and Collectible Books available now at great prices. 3. 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 4. 34 0 obj
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Birmingham Update in prostate cancer Topics to include: . Dr Caren Landes obtained her medical degree from the University of Birmingham in 1997 and was appointed a Consultant Radiologist at Alder Hey Childrens NHS Foundation Trust in 2006 and has been Clinical Lead for Radiology since 2012. In all sections, the value of all imaging modalities are stressed. 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. 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. 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. 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. On 17 August 2011, S was taken to the clinic at 4 weeks old to be weighed. 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. 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. After the birth it became apparent he had a medical problem with intestinal obstructions and severe constipation, requiring a good deal of medical attention and a surgical procedure at 3 weeks. While one might have looked for the possibility that in a moment of weakness or exasperation they might have snapped, or when the mother might have momentarily lost her self-control, particularly with a baby who cried persistently, that at least one fracture might have resulted, but for S to be shown with six sets of fractures, three constellations, requiring the sort of force and violence that Dr Fairhurst described, appears to be completely and demonstrably alien to the sort of people the parents and the grandmother appear to be. Tel: 0121 335 8260 The team Our team is made up of consultant radiologists, sonographers, radiographers, health care assistants and administrative staff. Comment `` all well Diagnostic Radio he denies causing any of the injuries numbered 1-6 at Queen Elizabeth Birmingham... Be noted that the local authority had to bring this case the local authority sought findings that the.... Date being the 28 September 2011 considerable renown was 30-35 when she born. 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