Ms Baldrighi, Back to top of page 5. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. 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. Mr Sami Al-Ani Naturally the Wards hoped social services would follow suit, but they were in for a shock. 16. BSc, MBBS, MRCP, FRCR, PhD, FHEA She presented with no bony injury and was discharged. Rent and save from the world's largest eBookstore. The memories of the parents were assiduously and closely examined by all counsel and compared with the notes written at the time.28. View more radiologists birmingham Consultations Consultations Steelhouse Lane, Birmingham, England. 941-697-3552. The parents did not return her, the Father stating that by Sunday [14th October] she was "back to normal". However, the identities of the expert witnesses in the case remained shrouded in secrecy. The court had no expert views on these aspects or on a number of potential issues relating to bone metabolism. Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). The GP note for 20 October 2011 records "First meningitis vaccination. Consultant Paediatric Radiologist, Chair of Paediatric Musculoskeletal Imaging, Chair, University of Sheffield's Black, Asian, and other Minority Ethnic (BAME) Staff Network, University of Sheffield and Sheffield Children's Hospital. Mrs K Oestreich Mr Johnson and Dr Vickers declined to comment. The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children's Hospital. Virgil van Dijk: I should have taken a break before World Cup, Britain's second lockdown was based on 'very wrong' Covid data, Boris Johnson feared, How Boris Johnsons desire to lift lockdown was thwarted by public opinion, Misplaced breathing tube contributed to death of first child Covid victim, inquest rules, William Sitwell reviews St Barts, London: This food will win over any tasting-menu sceptic, How to bring a cosy, Scandi-inspired aesthetic to your wardrobe. 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. 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. The mother and/or the father and/or the grandmother is the perpetrator of the injuries to S.19. The X-ray revealed a spiral fracture of the left humerus. The parents had first presented S to A local hospital on 13th October 2011 with a referral from her GP to the paediatric team at the local hospital with swelling of her left knee. On the contrary, the evidence appears to demonstrate that the parents had the wellbeing of S in mind and acted to seek medical attention. Extensive high quality images throughout the book, and additional illustrations, aid the reader with diagnosis and detailed referencing points to further reading. At 18.45, the paediatric ST4 clinician noted the symptoms reported by the parents as, "crying more since Thursday morningNot moving her left arm noticed yesterdayToday noticed swelling of left arm". 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. On 24th October 2011 a skeletal survey detected what appeared to be two left rib fractures. I therefore come to the conclusion that the local authority has not discharged the burden of proof on the balance of probabilities. Paediatric Radiology opens with a chapter devoted to the different imaging modalities, including radiographs, fluroscopy, ultrasound, CT, MRI and nuclear scintigraphy before moving on to more detailed, systems-based chapters. Metaphyseal fractures result from pulling and twisting being applied to the limb. The first section lists common clinical presentations, the differential causes and the appropriate imaging pathways needed to confirm the diagnosis, with recent imaging advances for each condition. At this point I summarise his evidence by identifying the following features: (1) Professor Nussey has a clear and far-reaching understanding of endocrinology and the systems involved with Vitamin D and bone mineralisation. N and D are in a stable relationship and have known each other from childhood as they lived in the same village. Specialties CT and x-ray are the first-line modalities, as these investigations are fast to conduct and have been shown to quickly reveal unexpected findings such as posterior rib fractures, metaphyseal corner fractures, and intracranial haemorrhage (especially subdural haematomas), contusions, and lacerations. Victoria and Jake Ward and William, right. At this point I identify the following features: (1) that while there was a possibility that there could be a Vitamin D deficiency there is little, if any, supporting evidence at present for fractures occurring with lower than normal levels of Vitamin D but no radiological evidence of rickets; (2) that there is no correlation between a Vitamin D deficiency and fractures, and a mechanism is required to cause a fracture; (3) she did not accept that there was an increased propensity to fracture due to Vitamin D deficiency and maintained that a sub-optimal bone that is not manifesting itself as radiologically subnormal leaves itself at sufficient strength to resist fractures; (4) S did not show radiological signs of rickets, but Dr Fairhurst stated that she did not know whether S may or may not have had a vitamin level low enough to manifest as rickets; (5) there will inevitably be a stage in the bone changes resulting from insufficiency or deficiency of Vitamin D which will be present but not visible on X-ray, i.e. Several of these fractures are highly specific for non-accidental causation by an adult. 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. (9) He anticipated that S's level was 30-35 when she was born, not adequate and markedly deficient. 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 He found it was not possible to conclude at what point normal day to day handling crossed over to the point when S's vulnerable bone structure was compromised and exceeded. 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. A week later William was placed on the council's child protection register. Clinic Locations. I therefore granted an adjournment so that a suitable expert could be instructed. Over the next 10 months the Wards were visited by at least three expert witnesses who had been asked by the judge to give their opinions. 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. Displaying companies where the director has shareholdings or significant control. Again I did not get the impression that this was a man seeking to cover up matters or deal other than truthfully to the best of his ability with matters as he remembered them. 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. An X-ray showed a spiral fracture of the left humerus. I note his evidence as to the prevalence of Vitamin D deficiency, particularly in Asian sub-groups, and his view that the absence of radiological evidence does not mean that there is 'no rickets' i.e. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. Attendance of the course includes access to the database of cases associated to this event on our server at PostDICOM. What followed next led, eventually, to the diagnosis of a fracture in S's left upper arm. Caroline Coady Specialty: Gastrointestinal Radiology. The mother also worked there.10. Amaka lectures regularly on various radiology, paediatric, genetic, emergency medicine and orthopaedic courses, locally and nationally. 04. The constellation of findings is highly indicative of non-accidental injury by an adult. 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. Post-immunisation advice was given". Dr Karl Johnson, Birmingham Children s Hospital Joint tumours Dr Asif Saifuddin, Royal National Orthopaedic . 8. 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. In this case the local authority brings proceedings for Public Law orders relating to S, born on 18th July 2011. 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. 012 133. An X-ray was performed at the time along with other tests and appeared to present no bony injury and no metaphyseal infraction. 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. The consultant paediatric radiologist was able to date the fractures as follows: The rib fractures occurred between 15th and 28th September 2011. (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. 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 x-ray of the left femur had been reported as showing no bony injury on 13 October 2011 and no obvious metaphyseal infraction. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. As to the possible involvement of T, he asserts that he had not witnessed T twisting S's arm (or leg or wrists). If S were to be found responsible he offered the view that that would imply very poor supervision of T over a period of time. Dr 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 I would thank all advocates for their very careful written submissions. Torus fractures can result from a fall, from a direct blow, or from indirect forces applied to the limb when the leg is gripped and forcibly bent, a force well in excess of normal day to day handling of an infant. Find Dr. Jackson's phone number, address, hospital affiliations and more. Dr. The Consultant Paediatrician, as the locum consultant paediatrician at the local NHS trust, described himself as a 'relatively recently qualified paediatric consultant.' The guardian also represented the other child of the family T, who was born on 14th February 2008. I have also noted the guidance to be derived from Re U: Re B (above) given by Butler Sloss P at paragraph 23: "In the brief summary of the submissions set out above there is a broad measure of agreement as to some of the considerations emphasised by the judgment in R v Cannings that are of direct application in care proceedings. Further X-rays revealed what appeared to be three more fractures and an injury to his arm. I have examined the evidence as to the appearance of the symptoms of both the leg injury and the arm injury and noted the consistency of evidence that S was holding her leg differently before the hospital visit on 13th October 2011, and a consistency as to there being something wrong with S's arm which prompted the parents to seek medical attention. 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.' All prices include VAT, Viewers will be asked to evaluate each session and will be provided with a CPD certificate upon completion 11. She weighed 6lbs 15 ozs (3.15 kg) at birth and was born by emergency Caesarean section. 3.o-VR;+lZsA30PK#>] FP+irJBp%MU :g
I{,8fVn|aQY/,E/sa8Cd8sfhD5wGtkE4*8*q0zW,7(Ic He was diagnosed with Hirschsprung's disease, remaining under the care of a London hospital's surgical team with 6 monthly checks. 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. . 135; "There are areas of ignorance. Yet even after the criminal case collapsed for lack of evidence and a family court finally decided that the parents posed no threat to their son, the couple were astonished to find that the names of the doctors who had given evidence against them were kept secret. S had regained and passed her birth weight. 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. 36. 6. The maternal grandmother ('the grandmother') is also a party, as she was present in the family home at the material time, and has been represented by Miss Trustman. Left upper arm fracture, a spiral fracture of the distal shaft of the left humerus (16th-19th October 2011). However, on 22nd October 2011 the parents again presented S, this time with swelling to her left arm. 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. 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. Because William's parents were unable to explain the fracture the hospital deemed the case suspicious and called in social services. A number of strengths however have been identified during this short involvement. 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. 5 of my judgment on 26th March 2012. The parents' observations are also a matter of record, as are the consultants' examination. He noted that there is no uniformity of Vitamin D testing and it is difficult to measure. 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. Email this page 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. 9. You'll get immediate feedback and learning points from our expert faculty member. This, unfortunately, was soon to change. They are set out in a Scott Schedule dated 16th March 2012, which I will duly set out but for the record which I enumerate now before commenting on the parents' and grandmother's responses: 1. 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. Rib fractures to the antero-lateral aspects of the left 8th and 9th rib (15th-28th September 2011). I have taken account of the fact that she gave her evidence through an interpreter while having at least a working grasp of English. 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. 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. The fractures at 2, 3 and 6 above were only identified by Dr Fairhurst. We operate from Monday to Saturday and also provide an emergency on-call radiography service 24-hours-a-day, seven days a week. This person was born in December 1965, which was over 57 years ago. 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. 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. At times she appeared to have poor recollection, which to my mind was not surprising given the sort of detail that she was required to remember after some considerable time. I adjourned the hearing with directions for written submissions but anticipated that the particular difficulties of the case, its subject matter and the possible issues arising over evidence, required a further hearing for the parties to address the court having exchanged their submissions. 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.". EiSNZw_EQL{.y@^y|jJ%5* dN%] w;t|9"v@v(5>S@k 0 T-
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. You can book online your appointment and hire medical insurance online. It is not possible to know which incidents or movements caused or gave rise to force sufficient to bring about fractures. 17. (10) His view was that it was likely that S was Vitamin D deficient in utero and in the early neonatal period. On 14 January 2013 I made orders and gave a foreshortened (primary) version of the judgment in this case which had run over a substantial period in 2012 and before, because having reserved judgment in what was on any view a difficult case, delays in preparing the judgment for administrative reasons and with difficulties over my own health meant the process became much longer than I would have wished. On 22 October a skeletal survey was performed and reported on by Dr Steven Johnson, Consultant Radiologist. %PDF-1.6
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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. Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. The father accepts that only he, the mother and the grandmother were caring for S during this time. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. 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. 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 GP was unable to identify the cause of William's pain, but on returning home the Wards noticed his leg was swollen. 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. 6. The book is an important revision aid as well as an up-to-date reference. 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. 03. DAY 2: EMERGENCY PAEDIATRIC IMAGING - THURSDAY 10 FEBRUARY 2022 Recurrence is not in itself probative;iii. Show number The Father said in evidence that when the hospital phoned on Monday morning, his wife told them that S was "fine".21. This produces a complex and difficult balance in assessing the likelihood of the infliction of the harm and the injuries as invited by the local authority. We adopt the following: i. 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. Take a look at our extensive range of Imaging courses coming up, available virtually, on-demand and in-person, in study . 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 parents did not mention the previous weekend's symptoms or the trip to the hospital on 13 October 2011.24. 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. 32. s Pediatric Diagnostic Imaging textbook is renowned as one of the oldest and most prominent general textbooks in the field of paediatric text consists of two reasonably sized volumes covering all key areas using an intuitive systems-based approach. At para. 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. The parents were unable to offer any explanations and had not observed any accidental events that may explain these injuries. 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. 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. Detectives removed the cot for examination. 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. A revised care plan was approved for the rehabilitation of S to the care of her parents. The parents' first child T was born on 14th February 2008. 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. The responses of the parents and the cases which they have put before the court appear in summary form on the Scott Schedule. Gordon Jeyes, director of children's services at Cambridgeshire county council until this year, defended his department's decision to press ahead with its application to remove William from his parents' care. But during the family court proceedings serious doubts were cast on Dr Johnson's evidence by other medical experts. Doctuo 2023 Last modification: 02-03-2023, Birmingham Children'S Hospital, Birmingham. At the time of these proceedings he was employed as a store manager. 3. 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. To access the survey, please click here. On 16 September 2011, S was seen for her 6-week check. The father maintains that there could be some natural explanation for S's injuries.38. Mindelsohn Way 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. Interactive case-based approach using a powerful online DICOM viewer to maximise learning. 2. 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. The final section details the imaging findings in a wide variety of clinical conditions. DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. Read, highlight, and take notes, across web, tablet, and phone. Her parents returned with S on 22.10.11 with a swollen arm. 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