Several of these fractures are highly specific for non-accidental causation by an adult. After 22 September 2011, S was next seen at the GP surgery on the 13 October 2011. 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. I have examined the evidence as to the appearance of the symptoms of both the leg injury and the arm injury and noted the consistency of evidence that S was holding her leg differently before the hospital visit on 13th October 2011, and a consistency as to there being something wrong with S's arm which prompted the parents to seek medical attention. The Judge formed the view that the maternal grandmother was seeking to assist the Court in her evidence. 41 0 obj <>/Filter/FlateDecode/ID[<2E609F2171D9B848924D49576AA30896>]/Index[34 24]/Info 33 0 R/Length 56/Prev 68695/Root 35 0 R/Size 58/Type/XRef/W[1 2 1]>>stream Notwithstanding that, I formed the impression that she was seeking to assist the court. I do not form the impression that they could be seen then or with hindsight can be seen now as a family seeking to hide their ill-treatment of S from the authorities. Thank you! Site map, Please rate your experience out of 5 (with 5 being the highest and 1 being the lowest), Birmingham Women's Hospital Take a look at our extensive range of Imaging courses coming up, available virtually, on-demand and in-person, in study . 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". 50. I accept the submission that there is a lack of current research on the susceptibility to fracture in babies who are Vitamin D deficient. 3. 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. 5 of my judgment on 26th March 2012. Her mother is D, represented by Mr Jayatilaka. Left upper arm fracture, a spiral fracture of the distal shaft of the left humerus (16th-19th October 2011). S could not have been injured when in a bouncy chair from normal use. Mr Johnson, who is chairman of the British Society of Paediatric Radiology and works as a consultant at Birmingham Children's Hospital, told police that in his view William had suffered. 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. Dr Landes is radiology trauma lead and has contributed to the Royal College of Radiologists (RCR) guidance on imaging in paediatric trauma. No local tenderness in leg or hip", S was x-rayed, but nothing abnormal was observed. 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 consultant paediatric radiologist was able to date the fractures as follows: The rib fractures occurred between 15th and 28th September 2011. 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. Aged 20 in December 1999, she had married the father just before he came to England She joined him in this country in October 2003. Radiologists, Country Expert evidence from paediatric radiologist (Dr. Karl Johnson) and consultant paediatrician (Dr Russell Croft) was obtained and they were cross examined in Court. He has co-authored over 35 peer reviewed papers. This new, pocket handbook encompasses all aspects of paediatric radiology. )_______________. 3.o-VR;+lZsA30PK#>] FP+irJBp%MU :g I{,8fVn|aQY/,E/sa8Cd8sfhD5wGtkE4*8*q0zW,7(Ic 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. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. Erythematous [reddening on the skin]. It is reasonable to conclude that they were lower before then because she was breastfed. 9. 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. The Wards subsequently won a legal fight in the High Court for the judgement to be made public. The parents' observations are also a matter of record, as are the consultants' examination. We adopt the following: i. The mother, father and grandmother all said that Infacol did eventually help for a time before her crying became worse again.15. On the balance of probability T could not have caused the injuries to S. 16. 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. I have noted the reported reactions of T to the birth of S. I have considered S's early developmental history after her birth; also the arrival when S was about 10 days old of the maternal grandmother from Sri Lanka to help the mother look after the children. Attendance of the course includes access to the database of cases associated to this event on our server at PostDICOM. You'll get immediate feedback and learning points from our expert faculty member. It was also noted that the parents were unsure how it had happened and there had been no recent accidents or falls. 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 Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. I summarise these as follows. 3. I have also noted the quotation offered by Miss Trustman from R v Harris and others [2005] EWCA Crim 1980 para. At 22.30, a further medical clinician's note was written, although the authorship is not clear. 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. Dr. Thomas' office is located at 2204 Lakeshore Dr, Birmingham . Rent and save from the world's largest eBookstore. I note his evidence as to the prevalence of Vitamin D deficiency, particularly in Asian sub-groups, and his view that the absence of radiological evidence does not mean that there is 'no rickets' i.e. Dr. Foster spent two and a half years working in paediatricsbefore moving into radiology. A revised care plan was approved for the rehabilitation of S to the care of her parents. An X-ray was performed at the time along with other tests and appeared to present no bony injury and no metaphyseal infraction. %%EOF 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. None of the fractures could have occurred at birth. Consistent with this, the father described a happy baby in the first two weeks of her life. The x-ray of the left femur had been reported as showing no bony injury on 13 October 2011 and no obvious metaphyseal infraction. S's father is represented by Miss Deschampneufs. 46. The child appears by her children's guardian and has been represented by Miss Dixon. Location 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. 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. Metaphyseal bucket-handle fracture of the distal right radius caused when (a) her right wrist had been pulled and twisted by an adult carer; (b) any person present would be immediately aware she had suffered a significant injury. The 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. 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. 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 do not propose to set out all the instances or to address them individually: to do so would be disproportionate in the light of my observations about the evidence of the parents, having listened to them carefully, considered at length the sort of people they are, and the impression that each gave to the court. The NPI Enumerator can be reached at (800) 465-3203 or P.O. 11:00-11:30 Imaging of arthritis Dr Emma Rowbotham, Leeds Teaching Hospitals NHS Trust 12:00-12:30 Common paediatric MSK conditions Dr Karl Johnson, Birmingham Children's Hospital NHS Foundation Trust 12:30-13:00 Soft tissue and bone lesions. He has a special interest in paediatric musculoskeletal. 47. The guardian also represented the other child of the family T, who was born on 14th February 2008. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. Left knee is swollen, feels hot and tender. 6. Interactive case-based approach using a powerful online DICOM viewer to maximise learning. Had an instructive and engaging educational experience. 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. While one might have looked for the possibility that in a moment of weakness or exasperation they might have snapped, or when the mother might have momentarily lost her self-control, particularly with a baby who cried persistently, that at least one fracture might have resulted, but for S to be shown with six sets of fractures, three constellations, requiring the sort of force and violence that Dr Fairhurst described, appears to be completely and demonstrably alien to the sort of people the parents and the grandmother appear to be. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. 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. 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. Mr Johnson and Dr Vickers declined to comment. The fractures of the ribs require considerable force and well in excess of day to day handling or even rough play. 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. 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. Excellent peer interaction and collaborative learning. In the meantime Cambridgeshire applied to the family court for a care order, allowing them to remove William from his parents. Karl John Johnson Radiologist Steelhouse Lane, B4 6Nh, Birmingham, England. 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. Tell us your views in a simple 5 minute survey to help us make the service even better. I came to the conclusion that I was unable to determine the case without further specialist expert evidence. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. 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. 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