Dr. Johnson is presently the Chair of theBritish Society of Paediatric Radiology. He therefore accepts that these fractures would have occurred while S was in their joint care. The earliest date for the left femoral fracture was 30th September but it was most likely to have occurred between 10th and 13th October. The conclusions are positive. 49. As for that visit on the 22 September, the Health Visitor said that S was not distressed as far as she could recall.18. This is case-based course designed for all General Radiologists and Radiologists based at the DGHs who are increasingly having to report paediatric imaging, an opportunity to attend a complete update of the main key topics on 3 consecutive days a complete CPD package. After the immunisation, the parents were advised to give her Calpol. 32. 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. 6. 11. However, in due course Dr Joanna Fairhurst, consultant paediatric radiologist, identified fractures to the left upper arm, right lower arm, distal left femur, left tibia, right tibia, and two rib fractures. Mrs Ward, who at the time worked as a manager for child care strategy for Cambridgeshire, told BBC One's Panorama, in a documentary to be broadcast tomorrow night: "We were absolutely shocked. Full access to the cases to follow alongside with the sessions. 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. The Judge formed the view that the maternal grandmother was seeking to assist the Court in her evidence. S had only been in the house with the parents, grandmother and T. Investigations were put in hand. there is a stage of rickets before it is identifiable radiologically. 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. Show number Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. The father completed a course in tourism management and completed a post-graduate degree in business management. At one point, he mentioned that they had thought it was due to her immunisation that she was not using her left hand. S has suffered multiple fractures which have occurred on at least three separate occasions. DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. Certificate of attendance upon completion. 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. 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. Expert evidence from paediatric radiologist (Dr. Karl Johnson) and consultant paediatrician (Dr Russell Croft) was obtained and they were cross examined in Court. hbbd``b`J5 `n\ a#H #e \ 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. The father's responses set out a general defence to each allegation setting a number of relevant points that formed part of his evidence. 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. Read, highlight, and take notes, across web, tablet, and phone. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. S could not have been injured when in a bouncy chair from normal use. Dr. Foster spent two and a half years working in paediatricsbefore moving into radiology. The family are very close and have a loving relationship. septic arthritis." DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. (On examination) Crying ++. There were evident deficiencies in translation by the interpreter. The local authority sought findings that the injuries had occurred non accidentally with the parents and grandmother as possible perpetrators. 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 10. @ $ lp-5v|v3+F;%`(E4Di The parents agreed to section 20 accommodation on 27.10.11 and on 2.11.11 the local authority issued care proceedings. That aspect is not mentioned. I go into detail on the background facts to this case which important in my consideration because they form part of the 'wide canvas' mentioned by the President Lady Butler-Sloss in the case of Re U (Serious injury: standard of proof) [2004] 2 FLR 63. 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. Birmingham Update in prostate cancer Topics to include: . DR KARL JOHN JOHNSON is British and resident in England. The father's main recollection seemed to be that S was "very quiet" on the Friday, although he had told the police on 24 October 2011 she was "fine" on that day. 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. 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. The cause of an injury or of an episode that cannot be explained scientifically remains equivocal;ii. Determined to establish what was wrong they returned twice to the GP, but he was still unable to offer any diagnosis. Contents hosted on Doctuo should not be used as substitutes for professional medical advice, diagnosis or treatment. Detectives removed the cot for examination. I note the entry as follows: 'non-tender, baby permits passive manipulation. DAY 2: EMERGENCY PAEDIATRIC IMAGING - THURSDAY 10 FEBRUARY 2022 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. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. The outcome of the case, in a landmark High Court judgement, has helped to lift the secrecy surrounding England's family courts, where campaigners claim that a lack of openness creates an environment in which miscarriages of justice can go unnoticed. Doctuo 2023 Last modification: 02-03-2023, Birmingham Children'S Hospital, Birmingham. Attendance of the course includes access to the database of cases associated to this event on our server at PostDICOM. Erythematous [reddening on the skin]. 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. 54. N and D are in a stable relationship and have known each other from childhood as they lived in the same village. 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. 4. 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. 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. Within each chapter there are three consistent sections. Three days: 375 | Two days: 295 | One day: 175 18. S's crying was attributed to colic initially and latterly to her having received her vaccination on 20th October 2011. The Father said in evidence that when the hospital phoned on Monday morning, his wife told them that S was "fine".21. The maternal grandmother denied harming S and did not accept that her daughter or son-in-law would not do the same. 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. Interpretation & Reporting Webinar for the General Radiologist, DAY 1: GENERAL PAEDIATRIC RADIOLOGY - WEDNESDAY 9 FEBRUARY 2022 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". As I identify the main points in the chronology, I note first that Dr Fairhurst regards the 16 October 3 days after S was first seen and x-rayed at hospital as the "earliest date" on which the fracture to the left humerus occurred, and thinks it probably would have occurred before the 19 October. 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. She refers to the fact that in relation to allegation 3, 4, 5 and 6 the mother had noticed the child's discomfort and taken S to the Medical Centre and then on to the Accident and Emergency Unit at the local hospital where S was examined by a paediatrician and X-rayed, following which she was told that everything was normal and she was discharged. It is reasonable to conclude that they were lower before then because she was breastfed. 0121 472 1377. I have noted and examined the oral evidence of Dr Fairhurst. 03. Print this page Dr. Robert H. Thomas is a Radiologist in Birmingham, AL. 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. (5) S's Vitamin D levels, which were on the borderline on 2nd November 2011, were never higher than insufficient. Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. 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. He confirmed the presence of the humeral fractures and rib fractures and, following further X-rays, identified what he thought was a healing fracture of the proximal left tibia. %PDF-1.6 % 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 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 &/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]$kBEGs0XX'O-J(|- KTg}LzgNY Arrested, charged by police and threatened with having their child taken away by Cambridgeshire county council's social workers, it took two years for the Wards to clear their name. He said: "It was a clear cut case in that there was no immediate explanation and the parents were not clear how the baby had come by his injuries. Judge Isobel Plumstead finally concluded that Mr and Mrs Ward presented no threat to William, declaring in her judgement: "There is no cogent evidence that these parents injured their son.". Mrs K Oestreich Location *ReTXgZ; CQ7Z9zjCpaab?E.b?r+d,iQPO&[slRQqBojGa"!K-=TMF (VB]q|G.HViVB 57'>]E%Y}2otF{iQ8Eef3Pc\Hu ZM,KW}JhP='+tZi~3dG%mlz@q48z)QYf 1hf"$HyG).f"I$tVQ++T*92{pkUKs courses@infomedltd.co.uk+44(0)20 4520 5081. In the meantime Cambridgeshire applied to the family court for a care order, allowing them to remove William from his parents. The parents were unable to offer any explanations and had not observed any accidental events that may explain these injuries. 34. S had regained and passed her birth weight. His research and clinical interests include the pathogenesis [.] 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 to be noted that the father accepts the medical evidence that S suffered each of the injuries numbered 1-6. 09. He refused to feed and the next day Mrs Ward took him to see her GP. 42. On 17 August 2011, S was taken to the clinic at 4 weeks old to be weighed. We haven't found any reviews in the usual places. Her special interests include musculoskeletal radiology and trauma, particularly imaging in inflicted injury. 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. 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. "It was a nightmare which seemed to be spiralling out of control.". 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. 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. Her mother is D, represented by Mr Jayatilaka. 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. 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. Based primarily on the evidence of Dr Fairhurst, the local authority has levelled a broad spread of allegations against the three adults in the household at the material time the mother, father and grandmother. On Thursday 20 October 2011 S was brought to the GP surgery by the parents and given her immunisation injections, in each thigh, by the Health Visitor. xYYo~o!baX_{da+LV"gy8du|UU]^|^y^]](g1qV&QdLY$aqT\ G~k)UwalB^d!/^I8>goAXX""~vQ^eTT'YC g-lZ['#.5\K,H Akin, MD, Diagnostic Radio Mr Johnson and Dr Vickers declined to comment. 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. Professor Nussey reported on 10th July but in time for the resumed hearing of the matter on 25th 26th and 27th July. At no point did I observe either child to be wary of their parents. This further hearing took place on 24th October 2012.08. The father had come to the UK in December 1999 as a student. 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. 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. 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. Nothing untoward is reported by the clinician who weighed her and the Health Visitor could not recall S as being unhappy.23. 5. In all sections, the value of all imaging modalities are stressed. (3) It is not known why some patients with rickets become hypocalcaemic, one of the clinical pictures of rickets or Vitamin D deficiency, and why in some patients with rickets patients have fractures, some have two or three, others have none. However, the identities of the expert witnesses in the case remained shrouded in secrecy. This led to a referral by the consultant paediatrician from the local hospital to Social Services. Several of these fractures are highly specific for non-accidental causation by an adult. If there is some innate contradiction in that sentence it appears that the latter part of that sentence represents the stronger conclusion. 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. 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. The local authority alleges that the potential perpetrators of the multiple injuries to S are the mother, father and grandmother, who were the carers of the child. The Health Visitor produced her records in evidence and explained that on such an occasion, the parents would undress the child and lay her on the changing mat or if the baby was being weighed, on the scales. The professional couple were shocked to be told eventually that William had a broken leg. 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. I note in particular the five times when she was seen at medical appointments when she was said to be suffering fractures. The court had no expert views on these aspects or on a number of potential issues relating to bone metabolism. Companies associated with this officer had at least 253,361 shareholder value in recent accounts. Recurrence is not in itself probative;iii. She has contributed chapters to several well-respected radiology textbooks, and is co-author of two books, A Radiological Atlas of Child Abuse and Fetal and Perinatal Skeletal Dysplasias: An Atlas of Multimodality Imaging. When to refer and why Dr Rajendranath Sinha, The Newcastle upon Tyne Hospitals NHS Foundation Trust Subscribe for updates and offers on new events for your specialty. Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). He denies causing any of the injuries and in turn denies the specific causation of each injury. After 22 September 2011, S was next seen at the GP surgery on the 13 October 2011. Birmingham B15 2TG, Birmingham Children's Hospital 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. T would often watch attentively as the parents and grandmother would feed S and hold her. 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. Naturally the Wards hoped social services would follow suit, but they were in for a shock. I have also had the benefit of the considerable amount of documentation in the bundles to which extensive reference has been made in the course of the evidence. He also is an expert of considerable renown. This, unfortunately, was soon to change. At para. Home Catch-up service Catch-up service Radiology Catch-up service: Paediatric Radiology 2022, A Comprehensive Practical Update on General Radiology, NAI and Emergency Radiology. Dr. Helen Williams is a full time general paediatric radiologist, and has special interests in cross-sectional imaging, feeding studies and radiology training. She also asserted that in her view there was no correlation between Vitamin D deficiency and fractures nor was there an increased propensity to fracture due to a Vitamin D deficiency. 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. On 16 September 2011, S was seen for her 6-week check. 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. Doctors, medical appointments, hospitals, medical staff. British Society of Paediatric Radiology: Paediatric MRI for general radiologists - tips and tricks 16:50 - 17:10 Musculoskeletal (MSK) imaging Dr Karl Johnson, Birmingham Children's Hospital NHS Foundation Trust Learning points In the maturing child, the marrow signal will alter depending on the amount of haemopoietic and fatty tissue within it. At the time of these proceedings he was employed as a store manager. Further X-rays revealed what appeared to be three more fractures and an injury to his arm. an improved understanding of Paediatric imaging interpretation and reporting skills. 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. 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. an understanding of the importance of applying the ALARA principle in Paediatric imaging. 37. 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. It was the maternal grandmother's view that her daughter and son-in-law did not injure S. The maternal grandmother also mentioned that she had cared for her own children, relatives and grandchildren and was capable of ensuring that children are properly and safely cared for. Rib fractures to the antero-lateral aspects of the left 8th and 9th rib (15th-28th September 2011). 2023Check Company | Privacy | Terms of Use | Contact Us. The note records both mother and grandmother as being present. Displaying companies where the director has shareholdings or significant control. . 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. 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. One or both of the parents, and/or the grandmother knows what has happened to S on all the occasions she has suffered injury. UK based, CPD accredited, online courses for doctors in all of the major specialties, Navigation: Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. The final section details the imaging findings in a wide variety of clinical conditions. Mr Sami Al-Ani Site map, Please rate your experience out of 5 (with 5 being the highest and 1 being the lowest), Birmingham Women's Hospital You'll get immediate feedback and learning points from our expert faculty member. The fractures at 2, 3 and 6 above were only identified by Dr Fairhurst. 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. Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. 5. S was discharged and the parents reported that her knee improved. 5 of my judgment on 26th March 2012. It is to be noted that at this time, 13 October 2011, the evidence is that S had already sustained factures of the left 8th and 9th rib and was likely to have sustained her left femoral fracture and fractures to the right and left tibia. The parents' first child T was born on 14th February 2008. The fractures of the ribs require considerable force and well in excess of day to day handling or even rough play. The mother and/or the father and/or the grandmother is the perpetrator of the injuries to S.19. Observe either child to be weighed: 'non-tender, baby permits passive manipulation she! The oral evidence of dr Fairhurst were advised to give her Calpol:! The imaging findings in a wide variety of clinical conditions and non-accidental injury 24th October 2012.08 fracture! 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Store manager any reviews in the meantime Cambridgeshire applied to the antero-lateral aspects of the parents, and! The 13 October 2011 ) equivocal ; ii Visitor said that S was seen for her 6-week.! From the local Hospital to Social Services has suffered multiple fractures which have occurred while S was and!
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