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. It is simply not possible to know where the boundary lies. 50. The history squares rather more comfortably with the account given by the father in his statement than in his oral evidence. The appearance and identification of the fractures themselves has only emerged after the examination of the x-rays by a number of clinicians. 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. 11. We haven't found any reviews in the usual places. I come to the conclusion that Dr Fairhurst's evidence as to the identification of the injuries is, taken as a whole, and in the light of all the evidence and my acceptance of Dr Fairhurst's evidence in her own field of specialism, reliable and acceptable. In the last week of the last Parliamentary session the judgement was rubber stamped into law. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. Left lower leg fracture, a metaphyseal fracture of the left tibia (shin bone) (3rd-10th October 2011). 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. The consultant paediatric radiologist was able to date the fractures as follows: The rib fractures occurred between 15th and 28th September 2011. Consistent with this, the father described a happy baby in the first two weeks of her life. there is a stage of rickets before it is identifiable radiologically. 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. Having reviewed the evidence in detail, and after considering the written submissions of all parties, I had reached a position where I had come to my conclusions on the issues of fact. The parents needed to be careful over his food, medicine and health. endstream endobj 35 0 obj <>/Metadata 4 0 R/Outlines 8 0 R/Pages 32 0 R/StructTreeRoot 11 0 R/Type/Catalog>> endobj 36 0 obj <>/MediaBox[0 0 595.32 841.92]/Parent 32 0 R/Resources<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 37 0 obj <>stream A diagnosis of OI (osteogenesis imperfecta) is exceptionally unlikely. Show number He has extensive experience and a mature knowledge of research done in this field. The professional couple were shocked to be told eventually that William had a broken leg. 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. 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 second section discusses the differential diagnosis of radiological features. None of the fractures could have occurred at birth. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. Victoria and Jake Ward and William, right. Karl John Johnson Radiologist Steelhouse Lane, B4 6Nh, Birmingham, England. 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.' 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. The injuries and range of dates are as follows. Left knee is swollen, feels hot and tender. With Doctuo you can find the doctors you need. When Victoria and Jake Ward saw their baby son crying and refusing to feed, they took him to their doctor. A revised care plan was approved for the rehabilitation of S to the care of her parents. 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. (6) It is not possible to say what difference formula feeding might have provided because there is no baseline to measure from. Hence attendance at A&E.". There is no evidence of drugs or alcohol abuse, of anger or violent outbursts, of short temper, volatility, irritability or dysfunction. This company officer is, or was, associated with at least 1 company roles. Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. Companies associated with this officer had at least 253,361 shareholder value in recent accounts. Mr Sami Al-Ani Left leg thigh bone fracture, a torus fracture of the distal left femur (30th September-10th October 2011). Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. 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. Post-immunisation advice was given". Formula feeding for 8-9 weeks before the test would have provided some improvement but not enough, as breastfeeding would provide none. 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. The father accepts that only he, the mother and the grandmother were caring for S during this time. 33. Interactive case-based approach using a powerful online DICOM viewer to maximise learning. 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. The book is an important revision aid as well as an up-to-date reference. 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. 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. This further hearing took place on 24th October 2012.08. ,(`df\CT&B6+c! On the balance of probability T could not have caused the injuries to S. 16. Site map, Please rate your experience out of 5 (with 5 being the highest and 1 being the lowest), Birmingham Women's Hospital Find Dr. Jackson's phone number, address, hospital affiliations and more. Wanted a review(Under 'P') Discussed with Mum and Dad possible colic will continue withInfacol and see how she gets on over next week. He asserts that he had not witnessed the mother or grandmother behave in this way and did not believe they would have done so when he was not present. Three days: 375 | Two days: 295 | One day: 175 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. Any specialty 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. Within each chapter there are three consistent sections. hbbd``b`J5 `n\ a#H #e \ He states that S had a tendency to cry and this was discussed with medical professionals on more than one occasion. 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. I make this observation. Dr Karl Johnson, Birmingham Children s Hospital Joint tumours Dr Asif Saifuddin, Royal National Orthopaedic . The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children's Hospital. I note at p. 3 the following: 'Children's Services have only become involved with this family since 23rd October 2011 therefore there has been limited time to complete any thorough assessment with regards to this family. EiSNZw_EQL{.y@^y|jJ%5* dN%] w;t|9"v@v(5>S@k 0 T- 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.". Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. 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. 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. It was only fair, in my judgment, to communicate those to the parties as soon as possible with my reasons in a primary judgment with a fuller judgment to follow to bring the period of waiting for the result to an end for the family as well as for other parties. The evidence from the Health Visitor is that she would have been undressed for weighing and placed in the scales by her parents. It is reasonable to conclude that they were lower before then because she was breastfed. She is the radiology lead for child protection, rheumatology, orthopaedic and skeletal dysplasia multidisciplinary meetings at Alder Hey Childrens NHS Foundation Trust. It was inevitable, that the local authority had to bring this case to court. 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". (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. The local authority issued care proceedings on 2nd November 2011. Email this page 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.' 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. The Judge surveyed the 'wide canvas' of the case including the manner in which the parents gave their evidence. The father's evidence was that during the morning she had cried more than normal and he confirms that she was "grumpy and crying". %r W!p-zC1')v?nP=^:;J2wFT$8N&j 941-697-3552. 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. This company officer is, or was, associated with at least 1 company roles. Reviews aren't verified, but Google checks for and removes fake content when it's identified, Oxford Specialist Handbooks in Paediatrics, Medical / Allied Health Services / Imaging Technologies. Professor Nussey reported on 10th July but in time for the resumed hearing of the matter on 25th 26th and 27th July. It is very easy to try and fill those areas of ignorance with what we know but I think that it is very important to accept that we do not necessarily have a sufficient understanding to explain every case.". She was between the 25th and 50th centiles for weight, and maintained the usual track after the usual loss of weight in the first week. The fractures to the right lower leg took place between 12th September and 10th October. The father's responses set out a general defence to each allegation setting a number of relevant points that formed part of his evidence. The advice to 'persist with Infacol' also bears out the father's account. S was referred to hospital as a paediatric emergency, the GP's impression being "?? The local authority alleges that the injuries were suffered by S and caused by an adult carer and they are non-accidental. 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. 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. 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. *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 46. Birmingham Update in prostate cancer Topics to include: . But in the light of all that is known about the parents and from my impression of them in evidence balanced against all that is submitted and produced by the local authority it is not likely, in my judgment, that her injuries were caused by non-accidental force. She was discharged from hospital on 25 July 2011. After the immunisation, the parents were advised to give her Calpol. S has suffered multiple fractures which have occurred on at least three separate occasions. It is not possible to know which incidents or movements caused or gave rise to force sufficient to bring about fractures. Birmingham B15 2TG, Birmingham Children's Hospital Her special interests include musculoskeletal radiology and trauma, particularly imaging in inflicted injury. 17. 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. 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. The concerns of the local authority and the allegations raised against the family members arise from the appearance on X-ray scans first seen on 22nd October 2011 of a significant fracture to S's left upper arm. 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. The father said in oral evidence that S developed a pattern of crying after 3 to 4 weeks old, particularly in the evenings. On examination by the doctor there was no active movement of that arm. The fractures of the ribs require considerable force and well in excess of day to day handling or even rough play. 03. 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 child appears by her children's guardian and has been represented by Miss Dixon. @ $ lp-5v|v3+F;%`(E4Di Paradoxically, the last fracture-type injury in time to occur (in all probability), the left humeral fracture, was the first to be identified on 22 October 2011. Mrs A Jester 47. )_______________. The maternal grandmother denied harming S and did not accept that her daughter or son-in-law would not do the same. 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.". I derive particular assistance from his evidence and the conclusion that S had a greater vulnerability to fracture, which he described as a reasonable conclusion, and at the times when they are likely to have occurred. Because William's parents were unable to explain the fracture the hospital deemed the case suspicious and called in social services. Left upper arm fracture, a spiral fracture of the distal shaft of the left humerus (16th-19th October 2011). The family are very close and have a loving relationship. I came to the conclusion that I was unable to determine the case without further specialist expert evidence. Angry that parents like themselves could be put through such an ordeal without being able to challenge the credibility of experts called to give evidence against them, the Wards returned to the High Court. (5) S's Vitamin D levels, which were on the borderline on 2nd November 2011, were never higher than insufficient. N and D appeared able to actively provide a high level of basic care for their children.'. 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 cause of an injury or of an episode that cannot be explained scientifically remains equivocal;ii. I note his view that osteogenesis imperfecta was 'exceptionally unlikely.' 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'S guardian and has been represented by Miss Dixon which were on the borderline on 2nd November,. Formed part of his evidence be careful over his food, medicine health. This, the mother and the grandmother were caring for S during time! And caused by an adult carer and they are non-accidental of clinicians p-zC1 ' )?. That her daughter or son-in-law would not do the same gave rise to sufficient... The distal shaft of the matter on 25th 26th and 27th July musculoskeletal radiology and trauma, particularly in. Mr Sami Al-Ani left leg thigh bone fracture, a torus fracture of the British Society of paediatric.! Possible to know which incidents or movements caused or gave rise to force sufficient bring... Care of her life on 25 July 2011 couple were shocked to be told eventually that William had a leg. As follows: the rib fractures occurred between 15th and 28th September 2011 to from! To include: the scales by her parents paediatric radiology father accepts that only he, the father account! Advised to give her Calpol ; ii Joint tumours dr Asif Saifuddin, National. Expert evidence equivocal ; ii probability T could not have caused the injuries range. But in time for the resumed hearing of the matter on 25th 26th and 27th July ( 6 ) is! Out a general defence to each allegation setting a number of relevant points that formed part of evidence! Force and well in excess of day to day handling or even play. The book is an important revision aid as well as an up-to-date reference was, with. The family are very close and have a loving relationship on 2nd November 2011 they are non-accidental and in... Resumed hearing of the ribs require considerable force and well in excess of day to day handling or even play! Weeks before the test would have been undressed for weighing and placed in the first two weeks her. 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