I noted in relation to the mother that she gave her evidence calmly, she was quietly spoken, she gave direct and straight answers, she was composed and it appeared that her answers came from her genuine recollection without her giving what might have been expected answers. 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. greater confidence in managing the imaging of an acutely unwell child. Mrs A Jester The GP note for 20 October 2011 records "First meningitis vaccination. NS>zu=/_jwJa:S hbbd``b`J5 `n\ a#H #e \ He appeared to be frank and open in his answers and not devious. Read, highlight, and take notes, across web, tablet, and phone. Wanted a review(Under 'P') Discussed with Mum and Dad possible colic will continue withInfacol and see how she gets on over next week. Location A number of strengths however have been identified during this short involvement. 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. 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. The Judge surveyed the 'wide canvas' of the case including the manner in which the parents gave their evidence. (On examination) Crying ++. An X-ray showed a spiral fracture of the left humerus. 43. The second section discusses the differential diagnosis of radiological features. It was inevitable, that the local authority had to bring this case to court. She states that they do not occur accidentally and this type of fracture is highly indicative of non-accidental causation requiring a force well in excess of that used in normal day to day handling of an infant. Determined to establish what was wrong they returned twice to the GP, but he was still unable to offer any diagnosis. I return to consider T and his behaviour later in this judgment.12. It is to be noted that the father accepts the medical evidence that S suffered each of the injuries numbered 1-6. 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. 06. @ $ lp-5v|v3+F;%`(E4Di 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 conclusions are positive. These are referred to in more detail in her evidence and indeed in the local authority's threshold document, and she has set out fully in her expert report to the court her opinion on the fractures she found, the dating of S's injuries, the mechanism of injury, possible explanations and her conclusions. The father recalled that S "cried throughout", crying as soon as the examination started although the doctor carried on. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. At one point, he mentioned that they had thought it was due to her immunisation that she was not using her left hand. The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children's Hospital. All the family carers accept therefore that they are in the potential pool of perpetrators as they were all involved in her care, but they deny inflicting injuries upon her. The responses of the parents and the cases which they have put before the court appear in summary form on the Scott Schedule. 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. At 17.10, the presenting complaint was noted as "swelling and pain in the left upper arm, since yesterday" [Friday] those symptoms noted by the parents "yesterday" with swelling of the left arm and "crying ++" when she was moved. This could increase bone fragility and give rise to fractures at a lower force than would otherwise be the case. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. This would have involved manipulation of the legs and arms, and the conducting of other tests. The father maintains that there could be some natural explanation for S's injuries.38. 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. On 17 August 2011, S was taken to the clinic at 4 weeks old to be weighed. 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. 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. 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. The local authority alleges that the injuries were suffered by S and caused by an adult carer and they are non-accidental. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. . The advice to 'persist with Infacol' also bears out the father's account. The report states that S: 'cried a lot last few weeksMore over last 2 weeks and then doesn't want to be fedTends to cry more in the eveningHave used Infacol under advice from the H/V but no improvement yet. Infacol was helping When they stopped giving her that the crying worsened.Small vomits with it usually just food coming up with burpingStarted bottle feeding 1/12 [one month] ago.Yesterday, note that [baby] not happy straightening her left knee. Dr. Jackson's office is located at 2204 Lakeshore Dr . This person was born in December 1965, which was over 57 years ago. 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. I have in particular noted the GP entry reports and the visits made by the parents for checks or routine appointments. Mindelsohn Way Birmingham B15 2TG 0121 472 1377 Birmingham Children's Hospital Steelhouse Lane Birmingham B4 6NH 0121 333 9999 Quick links Terms and conditions Give us your feedback Publications and reports Staff links AccessAble Freedom of Information Privacy Policy Accessibility statement Join us on social media Support us (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. At 6.20pm on 13 October 2011, S was brought to the local hospital, with the presenting complaint "swollen left knee started yesterday." 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. He had known his wife (the mother) since 1990. None of the fractures could have occurred at birth. Filming William asleep at night they discovered he moved vigorously during his sleep, repeatedly kicking his legs. there is a stage of rickets before it is identifiable radiologically. The note records both mother and grandmother as being present. What followed next led, eventually, to the diagnosis of a fracture in S's left upper arm. Their care of the children has been observed as of high quality. Within each chapter there are three consistent sections. On examination by the doctor there was no active movement of that arm. Considering the totality of the evidence the Judge found the likely incidence of an increased vulnerability to fracture was the most likely cause of S's injuries. S was sent for x-ray, which revealed a spiral fracture of the left humerus. She was accompanied by both parents. I note the entry as follows: 'non-tender, baby permits passive manipulation. 13. In the last week of the last Parliamentary session the judgement was rubber stamped into law. S had regained and passed her birth weight. 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. Apyrexial. Victoria and Jake Ward and William, right. S has suffered multiple fractures which have occurred on at least three separate occasions. Catch-up service: Paediatric Radiology 2022, Catch-up now with our case-based Paediatric Radiology webinar that took place in February 2022. Right wrist fracture, a metaphyseal (bucket-handle) fracture of the distal right radius (difficult to date). If no better, to review or sooner at any time if concerns'. Her research interests are in the imaging of suspected child abuse and skeletal dysplasias and in methods of determining which children have fragile bones prone to fracture and which do not. 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. I would thank all advocates for their very careful written submissions. Thank you! 9. Radiologists, Country T would often watch attentively as the parents and grandmother would feed S and hold her. Left leg thigh bone fracture, a torus fracture of the distal left femur (30th September-10th October 2011). 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. 17. 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". *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 What has emerged is that none of the adults present could provide any instance of anything done to S by themselves or the other adult members of the family, or which had befallen her, which would explain the fractures. The father's evidence was that during the morning she had cried more than normal and he confirms that she was "grumpy and crying". Their evidence would have to be regarded as a tissue of lies and their manner of dealing with S would need to have been abusive, violent to the point of sadism, and the subject of a conspiracy of silence given the unlikelihood of such conduct being committed in secret or the strength of S's reaction passing unnoticed. To summarise further, I have noted the pattern of the family's care for the children and reviewed the detail of the entries in the GP records which record S's progress and visits with the record of her developing a tendency to cry a lot from 17th August 2011 and the advice that it was possibly colic; the parents' use of Infacol and S's response to that. Read full profile Dr Khushnood Alam Consultant Radiologist Biography pending. 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. 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. All prices include VAT, Viewers will be asked to evaluate each session and will be provided with a CPD certificate upon completion 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. I considered that the family members have a very close bond and I did not observe any concerns regarding their attachment. 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. Within each chapter there are three consistent sections. Left upper arm fracture, a spiral fracture of the distal shaft of the left humerus (16th-19th October 2011). 37. 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). He states that S had a tendency to cry and this was discussed with medical professionals on more than one occasion. He was earnest, straightforward and did not quibble with the questions although he did not always understand the question. This new, pocket handbook encompasses all aspects of paediatric radiology. England, Population The parents and the maternal grandmother, she asserts, would all take care of S and T throughout the day. 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. I have not found any instances that cannot be attributed to genuine mis-recollection especially given the distance in time over which they were attempting to deal with detailed events. 07. 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 father's responses set out a general defence to each allegation setting a number of relevant points that formed part of his evidence. 04. The father had not witnessed T hurting S nor does he believe he would harm her intentionally but believes he may not appreciate her fragility and may have caused harm accidentally. Print this page On 24th October 2011 a skeletal survey detected what appeared to be two left rib fractures. 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. 49. Her special interests include musculoskeletal radiology and trauma, particularly imaging in inflicted injury. His research and clinical interests include the pathogenesis [.] 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 The parents' first child T was born on 14th February 2008. 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. 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.". They could offer no explanation as to how the fractures may have happened. The parents agreed to section 20 accommodation on 27.10.11 and on 2.11.11 the local authority issued care proceedings. N and D are in a stable relationship and have known each other from childhood as they lived in the same village. 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. 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. 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 Judge found that neither parent was seeking to cover up matters or to deal other than truthfully to the best of their ability. Mrs K Oestreich Extensive high quality images throughout the book, and additional illustrations, aid the reader with diagnosis and detailed referencing points to further reading. It also records the following: "Mother is not able to recall how the fracture might have occurred: S, she advises, was using her arm less and appeared irritable from Thursday a.m. on 19/10/11 [sic 19/10 was a Wednesday] then went with Mum to have immunisations Thursday 1pm, where she was placed on a couch and not, to mother's recollection, held tightly, then seemed intermittently in discomfort with on-going reluctance to use her left arm as much as right, then today arm appeared swollen. 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. An X ray showed a spiral fracture of the left humerus. This person was born in December 1965, which was over 57 years ago. However, the father points out that there were times when S was sleeping in the bedroom; that T would leave the room where he was being supervised to get a toy or use the bathroom; and his case is that it is possible that he may have gone into the bedroom and caused S injury. Judge Isobel Plumstead finally concluded that Mr and Mrs Ward presented no threat to William, declaring in her judgement: "There is no cogent evidence that these parents injured their son.". After the immunisation, the parents were advised to give her Calpol. 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. The Judge was satisfied that neither the mother, father, nor grandmother could be held responsible for causing the injuries. Tel: 0121 335 8260 The team Our team is made up of consultant radiologists, sonographers, radiographers, health care assistants and administrative staff. 5. It is not only the appearance of symptoms, and the timing and description of them with a view to dating the occurrences, even approximately, that has raised a perplexing and indistinct picture with differences in the accounts, and nothing obvious or clear to work on. However, I note the high level of engagement with the medical services throughout T's life and the attention and care that he needed and received, caused by his own particular medical condition. The maternal grandmother denied harming S and did not accept that her daughter or son-in-law would not do the same. Controversial issues, more cases and discussion, To provide the Consultant Radiologist with a practical and comprehensive case based update on the interpretation and reporting of general paed radiology, suspected inflicted injuries and challenging cases when on call, Takes delegates through an intensive series of challenging cases with immediate feedback after each case, Short introductory lectures, offering guidance, practical knowledge, what not to miss and how, Faculty of Consultant Paediatric Radiologists who are experts in their fields and from different hospitals in the UK. &/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 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. But during the family court proceedings serious doubts were cast on Dr Johnson's evidence by other medical experts. 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". One or both of the parents, and/or the grandmother knows what has happened to S on all the occasions she has suffered injury. 1808 7th Ave S, Birmingham, AL, 35233 3 other locations (205) 934-3333 OVERVIEW Dr. Johnson graduated from the University of Pittsburgh School of Medicine,University of Pittsburgh School of. 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. 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.' The family are very close and have a loving relationship. His father described him as "very possessive" of his baby sister, trying to open her clenched fists to place toys in them, to straighten his 'folded' arms and play with her. Johnson 's evidence by other medical experts immunisation, the parents agreed to section 20 on... The parents were advised to give her Calpol Judge found that neither the mother, father nor. For 20 October 2011 records `` First meningitis vaccination Johnson is a Consultant Paediatric Radiologist Birmingham. 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