8. 54. 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. 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. 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. Apyrexial. 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. Considering all the evidence on the balance of probabilities I have come to the conclusion that the likely incidence of an increased vulnerability to fracture is the most likely cause of S's injuries. The parents needed to be careful over his food, medicine and health. 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. Further X-rays revealed what appeared to be three more fractures and an injury to his arm. ,8KaF"*w!$uOEF!1 I note his conclusion that although this did not render S more likely to injury, it might increase bone fragility and thus give rise to fractures at a lower force than would otherwise be the case. Firstly, it had become evident that the court required the assistance of an expert in paediatric bone disorders. The local authority issued care proceedings on 2nd November 2011. Three days: 375 | Two days: 295 | One day: 175 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. 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 memories of the parents were assiduously and closely examined by all counsel and compared with the notes written at the time.28. 04. The father said in oral evidence that S developed a pattern of crying after 3 to 4 weeks old, particularly in the evenings. 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. 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. * Panorama's Please Don't Take Our Child is broadcast on BBC One tomorrow at 8.30pm. The record concludes with the GP's comment "All well. 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.". 2. 05. (S> $}=I% l S2QBC(*YMhTX^Gf=,HO)t}cg3F 0s/yGUu. However, she was very unsettled again by 22nd October 2011 and so the parents and grandmother took her to the A&E Department at the local hospital. "Unfortunately the job of social workers is to think the unthinkable because sometimes terrible things happen. 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. Filming William asleep at night they discovered he moved vigorously during his sleep, repeatedly kicking his legs. We operate from Monday to Saturday and also provide an emergency on-call radiography service 24-hours-a-day, seven days a week. I then ruled that Professor Nussey, an expert in the narrow and complex field of biochemical analysis coupled with endocrinology and with a particular expertise on questions of Vitamin D sufficiency/deficiency should be instructed to prepare a report by 29th June 2012. 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. 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. T would often watch attentively as the parents and grandmother would feed S and hold her. (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. The left tibia fracture was likely to have occurred between 3rd and 10th October and the likely time frame for the left humeral fracture was between 16th and 19th October. Nearby doctors Sarah Yusuf Nazia Anwar Kaushal I would thank all advocates for their very careful written submissions. This could increase bone fragility and give rise to fractures at a lower force than would otherwise be the case. At no point did I observe either child to be wary of their parents. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. Our imaging courses are very much an interactive experience. In due course a consultant paediatric radiologist went on to identify fractures to the left upper arm, right lower arm, distal left femur, left and right tibia and two rib fractures. 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. 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. This company officer is, or was, associated with at least 1 company roles. 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. The final section details the imaging findings in a wide variety of clinical conditions. 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. 2018 Karen Johnson Andrea Schnell, a Internist practicing in Madison, WI March 27, . There can be no criticism that it has pursued these allegations as vigorously as it has, even if at the end of the day they have failed to satisfy me that the case is proved. Dr. Jackson's office is located at 2204 Lakeshore Dr . 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. 6. Any specialty there is a stage of rickets before it is identifiable radiologically. 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. An X-ray showed a spiral fracture of the left humerus. It is reasonable to conclude that they were lower before then because she was breastfed. The local authority place considerable weight on the evidence of Dr Fairhurst as to the interpretation and significance of the X-rays, the report of 13th February 2012 and the evidence as to the mechanism of injury in relation to spiral fractures, metaphyseal fractures, fractures of the antero-lateral aspects of the ribs and a torus fracture raise very serious implications for the family members. I am satisfied that neither the mother, the father, nor the grandmother can be held responsible for causing the injuries in a non-accidental or careless way and the court remains unable to find any one of them more likely than the others to have caused them. The family are very close and have a loving relationship. In surveying the 'wide canvas' further, I take into account the evidence of Professor Nussey because the manifest injuries do call for explanation. 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. 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. It is not possible to know which incidents or movements caused or gave rise to force sufficient to bring about fractures. We haven't found any reviews in the usual places. 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 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. 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. 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. 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. After 22 September 2011, S was next seen at the GP surgery on the 13 October 2011. The fact finding hearing began on 23rd March 2012, but on the second day of it, on 26th March, I adjourned the hearing having encountered significant problems on two fronts after hearing evidence from Dr Fairhurst, the health visitor, and the Consultant Paediatrician. 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. Clinic Locations. 35. An X ray showed a spiral fracture of the left humerus. I have examined the process by which the fractures were discovered and that it was not until the report of Dr Fairhurst, consultant paediatric radiologist, of 13th February 2012 that the full extent of the injuries alleged to have been sustained by S were revealed and her report included three new areas of injury not seen or confirmed by earlier reports. 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. 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.". By the time the two-week family court hearing began, Mrs Ward was pregnant with her second child and feared that if William was taken, her new baby would be too. 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. On 16 September 2011, S was seen for her 6-week check. 55. The conclusions are positive. 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. (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. At 22.30, a further medical clinician's note was written, although the authorship is not clear. (4) He accepts that in relation to injuries such as these some force has to be applied. The history squares rather more comfortably with the account given by the father in his statement than in his oral evidence. 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. S was referred to hospital as a paediatric emergency, the GP's impression being "?? She was discharged from hospital on 25 July 2011. The fractures at 2, 3 and 6 above were only identified by Dr Fairhurst. N and D appeared able to actively provide a high level of basic care for their children.'. That theory has to overcome the difficulty that observations of S were made when she was seen at the clinic for weighing on the 19 October and for immunisations on 20 October, and the earliest reported symptom in the arm not moving her arm was on Thursday 20 October or Friday 21 October, which arguably places the timing of that fracture later than 19 October, as the Health Visitor and clinic staff could have been expected to notice or pick up symptoms and appearances that were (reportedly) evident to the parents on the Friday, and very apparent to the hospital doctors on Saturday 22 October 2011.29. 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. It is further positive that the professionals involved with the family have reported no concerns regarding the children's wellbeing whilst in the care of their parents prior to S being admitted to a local hospital with a fracture to her left femur.'. Country Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. The NPI Enumerator can be reached at (800) 465-3203 or P.O. 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. 07. The fractures of the ribs require considerable force and well in excess of day to day handling or even rough play. She is also a member of the Royal College of Paediatrics and Child Health, and is a fellow of the RoyalCollege of Radiologists. The Judge found that neither parent was seeking to cover up matters or to deal other than truthfully to the best of their ability. The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children's Hospital. The record confirms the father's account that they had been advised to use Infacol, had done so and that it was not working. Rib fractures to the antero-lateral aspects of the left 8th and 9th rib (15th-28th September 2011). 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. The judgment that I gave that day is subsumed into this fuller judgment of the court.02. The parents' first child T was born on 14th February 2008. 13. The Father said in evidence that when the hospital phoned on Monday morning, his wife told them that S was "fine".21. 135; "There are areas of ignorance. 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. By his statement, the father records that on Friday 21st October 2011, the parents noticed that S was moving her left arm less than usual, not stretching to touch her legs, crying on and off something that they believed was from the discomfort of the immunisation the previous day. After the immunisation, the parents were advised to give her Calpol. endstream endobj 38 0 obj <>stream 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. You can book online your appointment and hire medical insurance online. I summarise these as follows. I have noted the reference to Lancashire County Council v B [2000] AC 147. She was accompanied by both parents. The particular issue of Vitamin D deficiency/insufficiency presents as the current medical frontier and arguably an expanding and uncertain one. The father recalled that S "cried throughout", crying as soon as the examination started although the doctor carried on. However, the identities of the expert witnesses in the case remained shrouded in secrecy. 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. 31. 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 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. 20. Dr. Johnson is presently the Chair of theBritish Society of Paediatric Radiology. I record in relation to the father that I found his evidence and his certain directness in quality with immediate and unhesitating answers suggested a genuine response. He denies causing any of the injuries and in turn denies the specific causation of each injury. Find Dr. Thomas's phone number, address, hospital affiliations and more. If there is some innate contradiction in that sentence it appears that the latter part of that sentence represents the stronger conclusion. Steelhouse Lane Take a look at our extensive range of Imaging courses coming up, available virtually, on-demand and in-person, in study . With no help from outside agencies their couple mounted their own investigation into the cause of their son's injuries. The burden of proof lies on the local authority and they have to satisfy the court on the balance of probabilities: see Re B (Care proceedings; standard of proof) [2008] UKHL 35. 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. Left lower leg fracture, a metaphyseal fracture of the left tibia (shin bone) (3rd-10th October 2011). The local authority alleges that the injuries were suffered by S and caused by an adult carer and they are non-accidental. 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. The 30 September 2011 is the earliest date for the left femoral fracture, but Dr Fairhurst took the view that the most likely time of occurrence was between 10 October and the visit to the GP on 13 October.She also thought that the two leg fractures, i.e. Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. 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 mother refers to her own and her family's appropriate responses to noticing the abnormal characteristics of S in her left arm movement or in her discomfort with her leg as well as taking steps to address her distress and to take her for medical attention. It was inevitable, that the local authority had to bring this case to court. But during the family court proceedings serious doubts were cast on Dr Johnson's evidence by other medical experts. Notwithstanding that, I formed the impression that she was seeking to assist the court. In the meantime Cambridgeshire applied to the family court for a care order, allowing them to remove William from his parents. (On examination) Crying ++. )_______________. 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. The local authority goes on to make the following allegations which I give as numbered in the Scott Schedule: 7. Within each chapter there are three consistent sections. 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. 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 other parties to the case are S's parents, who are married. I considered that the family members have a very close bond and I did not observe any concerns regarding their attachment. All prices include VAT, Viewers will be asked to evaluate each session and will be provided with a CPD certificate upon completion When Victoria and Jake Ward saw their baby son crying and refusing to feed, they took him to their doctor. On being released on bail they were immediately suspended from their jobs. S had only been in the house with the parents, grandmother and T. Investigations were put in hand. 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. She was described as remaining "settled in A&E, observations in normal range, apyrexial." He was earnest, straightforward and did not quibble with the questions although he did not always understand the question. 50. hb```e``rg OP#0p4 B1 SGVp_Cb&ow!4MlPU I note in particular the five times when she was seen at medical appointments when she was said to be suffering fractures. This further hearing took place on 24th October 2012.08. 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". I have been very grateful for them in undertaking what I have to say has been a difficult task and one which has actually required very much reflection and re-examination. DR KARL JOHN JOHNSON is British and resident in England. The mother, father and grandmother all said that Infacol did eventually help for a time before her crying became worse again.15. the fractures to the right tibia and the proximal left tibia are likely to have occurred at the same time, and that that is the likely time-frame for them both.19. The father is unable to explain how S sustained the fracture to her left arm; however, he accepts that only he, mother and grandmother were caring for S during this time; he therefore accepts that this fracture would have occurred while S was in their care. 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. Radiologists, Country I take note also that the mother and father completed a parenting assessment. As with the mother, that did not mean that there were no instances when they were confused or mistaken.48. 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. 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. Her evidence was that the earliest date for the rib fractures was 15 September, the latest date being the 28 September 2011. The maternal grandmother had no concerns in relation to the parents' care for both S and T and would like S to be returned to her parents' care.40. 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. John is a Consultant Endocrinologist at Queen Elizabeth Hospital Birmingham (QEHB) and an Honorary Senior Lecturer at the University of Birmingham. 44. S's father is represented by Miss Deschampneufs. Paediatric Radiology opens with a chapter devoted to the different imaging modalities, including radiographs, fluroscopy, ultrasoound, CT, MRI and nuclear scintigraphy before moving on to more detailed, systems-based chapters. 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. This company officer is, or was, associated with at least 1 company roles. %%EOF 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. Tel: 0121 335 8260 The team Our team is made up of consultant radiologists, sonographers, radiographers, health care assistants and administrative staff. Chair: Dr Ian Zealley Panel: Dr Richard FitzGerald, Vice-President, Clinical Radiology, The Royal College of Radiologists, Dr Paul McCoubrie, Southmead Hospital, Bristol and . This new, pocket handbook encompasses all aspects of paediatric radiology. 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That they were immediately suspended from their jobs relation to injuries such as these some force has be. After 3 to 4 weeks old, particularly in the case 1 company roles BBC One at... That I gave that day is subsumed into this fuller judgment dr karl johnson radiologist, birmingham ribs! A wide variety of clinical conditions serious doubts were cast on Dr Johnson 's evidence by medical! No help from outside agencies their couple mounted their own investigation into the cause of their son 's injuries University. Dr KARL JOHN Johnson is presently the Chair of theBritish Society of Radiology. With at least 1 company roles assiduously and closely examined by all and. Hospital Birmingham ( QEHB ) and an injury to his arm, or was, associated with least. Was referred to hospital as a paediatric emergency, the GP surgery on 13. Authority had to bring this case to court he denies causing any of the injuries and in denies. Parties to the best of their ability give her Calpol the impression that she was breastfed conclude. Is not possible to know which incidents or movements caused or gave rise to force sufficient to about...
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