Mrs K Oestreich 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 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. (9) He anticipated that S's level was 30-35 when she was born, not adequate and markedly deficient. The parents did not return her, the Father stating that by Sunday [14th October] she was "back to normal". 5. 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. 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. Mrs A Jester 20. At times she appeared to have poor recollection, which to my mind was not surprising given the sort of detail that she was required to remember after some considerable time. 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. 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. This led to a referral by the consultant paediatrician from the local hospital to Social Services. He denies causing any of the injuries and in turn denies the specific causation of each injury. S's Vitamin D levels were borderline on 2.11.11 and were never higher than insufficient. Upper limb rheumatology/radiology MDT: . Tell us your views in a simple 5 minute survey to help us make the service even better. 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.". 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. Summary by Georgina Clark, barrister , Field Court Chambers ___________________IN THE WATFORD COUNTY COURTWatford County Court,Cassiobury House,11-19 Station Road,Watford,Hertfordshire WD17 1EZ.20th March 2013Before:HIS HONOUR JUDGE WRIGHTBetween:A local authorityApplicantsand. Torus fracture of the distal left femur caused by (a) her left leg being gripped and forcibly bent; (b) she would have shown distress for 15 minutes and would have shown discomfort when the leg was moved; discomfort would have lasted for several days. 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. Dr. 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. Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). 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. In the last week of the last Parliamentary session the judgement was rubber stamped into law. He appeared to be frank and open in his answers and not devious. 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. I have taken account of the fact that she gave her evidence through an interpreter while having at least a working grasp of English. John is a Consultant Endocrinologist at Queen Elizabeth Hospital Birmingham (QEHB) and an Honorary Senior Lecturer at the University of Birmingham. Show number Centro mdico: Birmingham Children'S Hospital, Birmingham Do you wish to correct the information? HkBsD R#\#[(!$D(AyLgtJ%{mc8zA&+;*JV [a%4[)Er_'! I make this observation. S could not have been injured when in a bouncy chair from normal use. Attendance of the course includes access to the database of cases associated to this event on our server at PostDICOM. 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. Rent and save from the world's largest eBookstore. 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. Contents hosted on Doctuo should not be used as substitutes for professional medical advice, diagnosis or treatment. Metaphyseal fractures result from pulling and twisting being applied to the limb. Detectives removed the cot for examination. 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. 37. 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. Dad says that [she] has been miserable all day no temperature". 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. All the adults appear to be normal hardworking people concerned for their children. 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. Have you had a video or telephone consultation with us? . 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.". The appearance and identification of the fractures themselves has only emerged after the examination of the x-rays by a number of clinicians. The father states that the fact that the parents and grandmother took S to A&E on 22nd October 2011 showed that they had noticed a change in her behaviour; they presented S to the local hospital having noticed a swelling to her left arm. 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. Interactive case-based approach using a powerful online DICOM viewer to maximise learning. (5) S's Vitamin D levels, which were on the borderline on 2nd November 2011, were never higher than insufficient. 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. On 24th October 2011 a skeletal survey detected what appeared to be two left rib fractures. Catch-up service: Paediatric Radiology 2022, Catch-up now with our case-based Paediatric Radiology webinar that took place in February 2022. NS>zu=/_jwJa:S 49. Fee includes 90 days of access with unlimited playback during this time. 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. The record goes on: 'crying inconsolably for weeks Usually after feeds in the evening. The note records both mother and grandmother as being present. 36. The record shows "baby crying and unsettled today. I note the entry as follows: 'non-tender, baby permits passive manipulation. Finding of Fact Hearing in Respect of a Number of Fractures Sustained by S aged 3 months, On 13 October 2011 S was taken to hospital by her parents with a swelling to her left knee. an understanding of the importance of applying the ALARA principle in Paediatric imaging. Dr. Gregory D. Jackson is a Radiologist in Birmingham, AL. The conclusions are positive. 44. He has been able to contribute vital knowledge and information towards understanding S's condition in August, September and October 2011. The father had come to the UK in December 1999 as a student. The mother and/or the father and/or the grandmother is the perpetrator of the injuries to S.19. A couple cleared of injuring their baby son have won a legal battle to identify the doctor who gave evidence against them. Their care of the children has been observed as of high quality. 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. 42. 17. England, Population She is the radiology lead for child protection, rheumatology, orthopaedic and skeletal dysplasia multidisciplinary meetings at Alder Hey Childrens NHS Foundation Trust. 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. 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. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. 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. 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 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. He had known his wife (the mother) since 1990. Interpretation & Reporting Webinar for the General Radiologist, DAY 1: GENERAL PAEDIATRIC RADIOLOGY - WEDNESDAY 9 FEBRUARY 2022 This appeared to be strong evidence that William had been abused several times in his short life. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. The father's evidence was that during the morning she had cried more than normal and he confirms that she was "grumpy and crying". 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. 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". I do not propose to go through all the responses to the various fractures but what I have mentioned sets out much of the content and gist of the father's response and denials of the local authority's allegations.39. 17. S's crying was attributed to colic initially and latterly to her having received her vaccination on 20th October 2011. 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. On Wednesday 19 October 2011, S was seen at the clinic to be weighed. On 22 September 2011, S is recorded as having the first of her immunisations at the Medical Centre. 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. When S was born on 18 July 2011, T was 3 years and 5 months old. A week later William was placed on the council's child protection register. Apyrexial. 33. Further X-rays revealed what appeared to be three more fractures and an injury to his arm. You can book online your appointment and hire medical insurance online. The parents agreed to section 20 accommodation on 27.10.11 and on 2.11.11 the local authority issued care proceedings. Her evidence was that the earliest date for the rib fractures was 15 September, the latest date being the 28 September 2011. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. 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. 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. I have also noted in relation to the injuries that it is 'always open to a judge to rule that the cause of the injury remains unknown' and the case of Re R (Care proceedings: causation) [2011] EWHC 1715, a decision of Mr Justice Hedley. At the time of these proceedings he was employed as a store manager. Caroline Coady Specialty: Gastrointestinal Radiology. Dr Neil Stoodley, Consultant Neuroradiologist, Bristol Royal Hospital for Children Dr Musa Kaleem, 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 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. The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children's Hospital. His research and clinical interests include the pathogenesis [.] Notwithstanding that, I formed the impression that she was seeking to assist the court. (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. Thank you! So the records engage even closer scrutiny. On the balance of probability T could not have caused the injuries to S either by (a) jumping on the family bed whilst S was lying on it or (b) pulling her bouncy chair when she was in it. Naturally the Wards hoped social services would follow suit, but they were in for a shock. This led them to suspect that he may have caught his right leg between the bars of his cot and the mattress of their own bed, causing him to fracture it as he struggled to pull it clear. 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. Our imaging courses are very much an interactive experience. At 6.20pm on 13 October 2011, S was brought to the local hospital, with the presenting complaint "swollen left knee started yesterday." It is reasonable to conclude that they were lower before then because she was breastfed. 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. 52. 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. Read full profile Dr Khushnood Alam Consultant Radiologist Biography pending. 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. 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. 14. The parents needed to be careful over his food, medicine and health. 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dr karl johnson radiologist, birmingham
