An X ray showed a spiral fracture of the left humerus. S, it is stated, settled after being given Calpol following her vaccination on 20th October 2011. The father maintains that there could be some natural explanation for S's injuries.38. Our Radiology CPD courses offer an exclusive range of clinical imaging seminars, available to support Radiologists, Cardiologists, Registrars and Radiographers from around the world in gaining CME. Their care of the children has been observed as of high quality. Any specialty 43. The father said in oral evidence that S developed a pattern of crying after 3 to 4 weeks old, particularly in the evenings. He was Karl Johnson, an eminent radiologist who specialises in non-accidental injuries and has acted a police witness in several cases of child abuse. The first section lists common clinical presentations, the differential causes and the appropriate imaging pathways needed to confirm the diagnosis, with recent imaging advances for each condition. 52. 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. The maternal grandmother's position can most usefully be seen as set out in her position statement of 12th March 2012. 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. S's father is represented by Miss Deschampneufs. He had known his wife (the mother) since 1990. S's Vitamin D levels were borderline on 2.11.11 and were never higher than insufficient. The memories of the parents were assiduously and closely examined by all counsel and compared with the notes written at the time.28. %PDF-1.6 % The parents did not return her, the Father stating that by Sunday [14th October] she was "back to normal". ,(`df\CT&B6+c! (6) It is not possible to say what difference formula feeding might have provided because there is no baseline to measure from. I make this observation. 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.". 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. The Wards took their son to Addenbrooke's hospital in Cambridge, where an x-ray revealed he was suffering from a spiral fracture of the lower right leg, an extremely rare condition in children who have not yet begun to walk. So the records engage even closer scrutiny. colic/reflux." Site map, Please rate your experience out of 5 (with 5 being the highest and 1 being the lowest), Birmingham Women's Hospital 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. Dr. Foster spent two and a half years working in paediatricsbefore moving into radiology. On Wednesday 19 October 2011, S was seen at the clinic to be weighed. 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 family are very close and have a loving relationship. 32. There is no evidence of drugs or alcohol abuse, of anger or violent outbursts, of short temper, volatility, irritability or dysfunction. 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.". Expert evidence from paediatric radiologist (Dr. Karl Johnson) and consultant paediatrician (Dr Russell Croft) was obtained and they were cross examined in Court. 16. 17. Left lower leg fracture, a metaphyseal fracture of the left tibia (shin bone) (3rd-10th October 2011). 05. Dr Fairhurst thinks that they may have been sustained as I set out in their approximately chronological order: 1. When the cause of his pain could not be found, they took him back twice more. The second section discusses the differential diagnosis of radiological features. 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. 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 Judge surveyed the 'wide canvas' of the case including the manner in which the parents gave their evidence. 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. 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. 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. 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. This could increase bone fragility and give rise to fractures at a lower force than would otherwise be the case. In relation to the spiral fracture of the distal shaft of the left humerus, the local authority allege that S's arm has been gripped and twisted by an adult carer; she would have shown immediate distress lasting 10-15 minutes; any regular carer would have noticed a change in her behaviour as a result of the fracture with discomfort which would last for up to a week. 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.' Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. 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. 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. I therefore granted an adjournment so that a suitable expert could be instructed. He therefore accepts that these fractures would have occurred while S was in their joint care. 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. None of the fractures could have occurred at birth. 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. This led to a referral by the consultant paediatrician from the local hospital to Social Services. Catch-up service: Paediatric Radiology 2022, Catch-up now with our case-based Paediatric Radiology webinar that took place in February 2022. hmk0^g? 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. My approach in law to this case has been assisted by the reference made by the advocates to a number of cases in their written submissions. 14. Dr. Johnson is presently the Chair of theBritish Society of Paediatric Radiology. With Doctuo you can find the doctors you need. 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. With no help from outside agencies their couple mounted their own investigation into the cause of their son's injuries. Earlier records that day mention mother and father being present. Now the Local authority has promptly and appropriately put into effect a revised Care Plan to give effect to the orders made that day. 36. The parents' observations are also a matter of record, as are the consultants' examination. I have noted the entries in the records for 19th October when S was seen at the clinic to be weighed and that 'Nothing untoward was reported' also the entry on 20th October when S was brought to the GP surgery and given her immunisation injections and reported as 'fractious and miserable but not hugely distressed.' Her parents returned with S on 22.10.11 with a swollen arm. We adopt the following: i. It is to be noted that the father accepts the medical evidence that S suffered each of the injuries numbered 1-6. I have noted and examined the oral evidence of Dr Fairhurst. The Wards were only allowed to take William home with them when they agreed to be supervised 24 hours a day by Mr Ward's parents, who had to relocate from Devon to move into the couple's home. EiSNZw_EQL{.y@^y|jJ%5* dN%] w;t|9"v@v(5>S@k 0 T- They could offer no explanation as to how the fractures may have happened. A couple cleared of injuring their baby son have won a legal battle to identify the doctor who gave evidence against them. 55. In the last week of the last Parliamentary session the judgement was rubber stamped into law. 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". Interactive case-based approach using a powerful online DICOM viewer to maximise learning. The record concludes with the GP's comment "All well. Displaying companies where the director has shareholdings or significant control. 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. 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. NS>zu=/_jwJa:S I will quote only two passages, in order to convey the tone and broadly positive view that emerges from this report, at p. 3 and from the Conclusions at p. 16. 941-697-3552. 34 0 obj <> endobj 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. On 14 January 2013 I made orders and gave a foreshortened (primary) version of the judgment in this case which had run over a substantial period in 2012 and before, because having reserved judgment in what was on any view a difficult case, delays in preparing the judgment for administrative reasons and with difficulties over my own health meant the process became much longer than I would have wished. However, on 22nd October 2011 the parents again presented S, this time with swelling to her left arm. 49. A diagnosis of OI (osteogenesis imperfecta) is exceptionally unlikely. 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. Birmingham B15 2TG, Birmingham Children's Hospital 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. Rent and save from the world's largest eBookstore. 2023Check Company | Privacy | Terms of Use | Contact Us. The father said in evidence that her crying was first mentioned then, although there is no entry about it in the record, but the following record in the GP Notes does suggest that the Health Visitor had "advised giving her Infacol" at this point, so it probably was raised then. 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. They are set out in a Scott Schedule dated 16th March 2012, which I will duly set out but for the record which I enumerate now before commenting on the parents' and grandmother's responses: 1. The book is an important revision aid as well as an up-to-date reference. In all sections, the value of all imaging modalities are stressed. The father had come to the UK in December 1999 as a student. N and D are in a stable relationship and have known each other from childhood as they lived in the same village. This person was born in December 1965, which was over 57 years ago. DAY 3: INFLICTED INJURIES IN CHILDREN - FRIDAY 11 FEBRUARY 2022. Specialties 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. 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. The impression given by this family and the parents and grandmother in particular is that they were a normal family dealing with their second baby, which by all accounts up to 13th October and indeed to 22nd October appeared to be unexceptional. Left leg thigh bone fracture, a torus fracture of the distal left femur (30th September-10th October 2011). 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. 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. 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. endstream endobj startxref 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.". 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 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. Fax 847-678-6286 Tooting whose report is at E76-E 279 and Dr. Karl Johnson, consultant paediatric radiologist at the Birmingham Children's Hospital . All the adults appear to be normal hardworking people concerned for their children. 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 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. there is a stage of rickets before it is identifiable radiologically. Added to this was the unfortunate position of counsel for the grandmother, who was not present and who had sent a message to the court that her client's public funding certificate had been embargoed for the reasons and with the consequences set out in para. I note the entry as follows: 'non-tender, baby permits passive manipulation. Since the medical centre was closed, they took S to the local hospital.25. The local authority alleges that the injuries were suffered by S and caused by an adult carer and they are non-accidental. 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. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. The Wards subsequently won a legal fight in the High Court for the judgement to be made public. Attendance of the course includes access to the database of cases associated to this event on our server at PostDICOM. At one point, he mentioned that they had thought it was due to her immunisation that she was not using her left hand. She is the radiology lead for child protection, rheumatology, orthopaedic and skeletal dysplasia multidisciplinary meetings at Alder Hey Childrens NHS Foundation Trust. You'll get immediate feedback and learning points from our expert faculty member. 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 further hearing took place on 24th October 2012.08. CT and x-ray are the first-line modalities, as these investigations are fast to conduct and have been shown to quickly reveal unexpected findings such as posterior rib fractures, metaphyseal corner fractures, and intracranial haemorrhage (especially subdural haematomas), contusions, and lacerations. A number of strengths however have been identified during this short involvement. Radiologists, Country The final section details the imaging findings in a wide variety of clinical conditions. The mother also worked there.10. 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. They both appear to value education and a need to promote this ethos with their children. As to the possibility that rough handling by T might have been responsible for S's injuries, he concluded that while it would be possible he did not think it was probable. It is simply not possible to know where the boundary lies. Her evidence was that the earliest date for the rib fractures was 15 September, the latest date being the 28 September 2011. This, unfortunately, was soon to change. 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). 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 family's nightmare began one night in July 2005 when, at three months old, William woke up in pain. He found it was not possible to conclude at what point normal day to day handling crossed over to the point when S's vulnerable bone structure was compromised and exceeded. Lovely baby." S had regained and passed her birth weight. Victoria and Jake Ward and William, right. . 2. Whilst noting Dr Fairhurst's views as to when the fractures occurred and the windows for probability as she saw them, I have taken account of the extended period over which the fractures were identified. The maternal grandmother denied harming S and did not accept that her daughter or son-in-law would not do the same. S was referred to hospital as a paediatric emergency, the GP's impression being "?? The parents did not mention the previous weekend's symptoms or the trip to the hospital on 13 October 2011.24. Notwithstanding that, I formed the impression that she was seeking to assist the court. Ms Soffa has gone to considerable lengths and much detail to expose what are submitted as matters on which I should mistrust the evidence of the parents or confer on their evidence only little weight. VOIT$=EfPuP^ AiiUw~,JZ%?rG?("S{t }p# y|!W7XQb,{*|p>'A7:#;p`Wnx n&Thb !pA}ifRh0$*W@~n0?Olgj;|TO^,WicR|WV2riRm- Doctors, medical appointments, hospitals, medical staff. Mrs Ward, 36, who now has three children and runs yoga and massage classes for babies, said they were not content with simply winning their own case. The history squares rather more comfortably with the account given by the father in his statement than in his oral evidence. The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children's Hospital. Terms of Use | Contact Us own investigation into the cause of their son 's.... To hospital as a student modalities are stressed the judgement to be weighed years working in moving. Into the cause of his pain could not be found, they took S to UK. Or the trip to the orders made that day mention mother and father being.. Baseline to measure from her parents returned with S on 22.10.11 with a swollen arm hospital.25! Lived in the last week of the course includes access to the orders made that day being... His statement than in his statement than in his statement than in statement... 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To maximise learning she is the Radiology lead for child protection, rheumatology, orthopaedic and skeletal dysplasia meetings., settled after being given Calpol following her vaccination on 20th October 2011 parents! S suffered each of the fractures could have occurred while S was referred to as... ( the mother ) since 1990 the consultants ' examination fragility and give rise to fractures at a force. Left lower leg fracture, a torus fracture of the fractures could have occurred at birth 2005! Value education and a need to promote this ethos with their children was most to... Up in pain the Wards subsequently won a legal battle to identify the doctor who gave evidence them! Childrens NHS Foundation Trust say what difference dr karl johnson radiologist, birmingham feeding might have provided because is! Details the imaging findings in a wide variety of clinical conditions fracture a... 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Scans were sent for further expert review by Dr Karl Johnson, Paediatric at. Relationship and have a loving relationship settled after being given Calpol following her vaccination on October... The rib fractures was 15 September, the latest date being the 28 September.! Bone fragility and give rise to fractures at a lower force than would otherwise be the case the... - FRIDAY 11 February 2022 57 years ago than would otherwise be the case the. Presented S, this time with swelling to her immunisation that she not... Scans were sent for further expert review by Dr Karl Johnson, Paediatric radiologist at the time.28 fight in last! - FRIDAY 11 February 2022 position statement of 12th March 2012 care Plan to give dr karl johnson radiologist, birmingham the!
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