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. Since the medical centre was closed, they took S to the local hospital.25. I have reviewed the symptoms then reported by the parents and their decision to take S back to the local hospital after seeing that her left arm was swollen and her reaction to being dressed or undressed. 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. Her evidence was therefore protracted and interrupted and I note Miss Trustman's observation that her evidence lasted in Sri Lankan time from 4:05 pm to 8:20 pm, and I have no reason to doubt the accuracy of that record. 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. This person was born in December 1965, which was over 57 years ago. S was sent for x-ray, which revealed a spiral fracture of the left humerus. Call. 2. The question arose as to whether genetic abnormality of bones, metabolic bone disease or demineralisation of the bone caused by Vitamin D deficiency gave rise to an increased propensity to fracture. 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. Dr. Jackson's office is located at 2204 Lakeshore Dr . He arrived at the preliminary conclusion that the humeral and rib fractures must give rise to 'a high level of suspicion' for non-accidental injury. On 16 September 2011, S was seen for her 6-week check. Dr Landes is radiology trauma lead and has contributed to the Royal College of Radiologists (RCR) guidance on imaging in paediatric trauma. an understanding of the importance of applying the ALARA principle in Paediatric imaging. 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. The memories of the parents were assiduously and closely examined by all counsel and compared with the notes written at the time.28. The note records both mother and grandmother as being present. The X-ray revealed a spiral fracture of the left humerus. Contents hosted on Doctuo should not be used as substitutes for professional medical advice, diagnosis or treatment. I note in particular the five times when she was seen at medical appointments when she was said to be suffering fractures. 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 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. 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. There is no evidence of drugs or alcohol abuse, of anger or violent outbursts, of short temper, volatility, irritability or dysfunction. The earliest date for the left femoral fracture was 30th September but it was most likely to have occurred between 10th and 13th October. Full access to the cases to follow alongside with the sessions. Akin, MD, Diagnostic Radio S's father is represented by Miss Deschampneufs. I considered that the family members have a very close bond and I did not observe any concerns regarding their attachment. In his second report after reviewing the outcome of the medical investigations after his original report he held to the view that there was a high suspicion for a non-accidental causation. The Judge formed the view that the maternal grandmother was seeking to assist the Court in her evidence. 57 0 obj
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But during the family court proceedings serious doubts were cast on Dr Johnson's evidence by other medical experts. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. Now the Local authority has promptly and appropriately put into effect a revised Care Plan to give effect to the orders made that day. In the last week of the last Parliamentary session the judgement was rubber stamped into law. 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. On 3 August 2011, S and the mother were seen at home by the Community Nurse, and the record shows that the mother had no concerns. 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 repeated fractures and had a history of being abused. 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. It is not only the appearance of symptoms, and the timing and description of them with a view to dating the occurrences, even approximately, that has raised a perplexing and indistinct picture with differences in the accounts, and nothing obvious or clear to work on. endstream
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Professor Nussey reported on 10th July but in time for the resumed hearing of the matter on 25th 26th and 27th July. Dealing with the fracture to the left humerus, the father's response was that he cannot say whether or not he was present when the fracture was sustained. endstream
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I note the entry as follows: 'non-tender, baby permits passive manipulation. 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. A spiral fracture requires a force to cause a fracture in this way that is 'well beyond that used during normal day to day handling.' Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). What followed next led, eventually, to the diagnosis of a fracture in S's left upper arm. '(&NJdsB. 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. They both appear to value education and a need to promote this ethos with their children. 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. 44. Detectives removed the cot for examination. They were able to discuss and demonstrate that they were able to sustain routines for S during contact sessions and with T in the home. At one week she was seen by the Community Nurse and was reported to be "thriving, contented and settling well." "It was felt that it was a matter of such complexity and range of opinion that it was a matter for court determination.". DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. Dr. Karl Johnson Consultant Paediatric Radiologist Birmingham Children's Hospital 15:05 - 15:20: Break 15:25 - 16:25: SEN disability impact of covid on safeguarding Caroline Coady Assistant Director for Social Care National Children's Bureau 16:25 - 17:25: Sexual Abuse Update Deborah Hodes 17:25 - 17:30: Close 17:30: Room open for networking Over the next 10 months the Wards were visited by at least three expert witnesses who had been asked by the judge to give their opinions. Read, highlight, and take notes, across web, tablet, and phone. At no point did I observe either child to be wary of their parents. 36. To access the survey, please click here. Left upper arm fracture, a spiral fracture of the distal shaft of the left humerus (16th-19th October 2011). 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 consultant paediatric radiologist was able to date the fractures as follows: The rib fractures occurred between 15th and 28th September 2011. DAY 2: EMERGENCY PAEDIATRIC IMAGING - THURSDAY 10 FEBRUARY 2022 If no better, to review or sooner at any time if concerns'. 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. I make this observation. As to the possible involvement of T, he asserts that he had not witnessed T twisting S's arm (or leg or wrists). An X-ray was performed at the time along with other tests and appeared to present no bony injury and no metaphyseal infraction. 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. 52. With no help from outside agencies their couple mounted their own investigation into the cause of their son's injuries. This would have involved manipulation of the legs and arms, and the conducting of other tests. EiSNZw_EQL{.y@^y|jJ%5* dN%] w;t|9"v@v(5>S@k 0 T-
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. Mr Johnson and Dr Vickers declined to comment. He trained in Paediatrics and Radiology in Cambridge and London, and was awarded a PhD in brain imaging in 2002 from the University of Cambridge. It was also noted that the parents were unsure how it had happened and there had been no recent accidents or falls. On the contrary, the evidence appears to demonstrate that the parents had the wellbeing of S in mind and acted to seek medical attention. After 22 September 2011, S was next seen at the GP surgery on the 13 October 2011. When to refer and why Dr Rajendranath Sinha, The Newcastle upon Tyne Hospitals NHS Foundation Trust Have you had a video or telephone consultation with us? There were evident deficiencies in translation by the interpreter. He was earnest, straightforward and did not quibble with the questions although he did not always understand the question. 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. 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. Catch-up service: Paediatric Radiology 2022, Catch-up now with our case-based Paediatric Radiology webinar that took place in February 2022.
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. 16 the following conclusion was offered, and the parents are referred to as N and D: 'Throughout the assessment period N and D were observed to provide a high level of emotional warmth, mental stimulation and basic care for S and T which they sustained throughout the contact sessions. 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. Consistent with this, the father described a happy baby in the first two weeks of her life. The second section discusses the differential diagnosis of radiological features. The x-ray of the left femur had been reported as showing no bony injury on 13 October 2011 and no obvious metaphyseal infraction. Find Dr. Jackson's phone number, address, hospital affiliations and more. 2. Left knee is swollen, feels hot and tender. 46. None of the fractures could have occurred at birth. 49. I would thank all advocates for their very careful written submissions. 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. Their care of the children has been observed as of high quality. N and D are in a stable relationship and have known each other from childhood as they lived in the same village. This hearing has run over a prolonged period of months in the course of 2012; in particular because it encountered difficulties in the procurement of the services of one of the experts necessary to address the issues in the case, and also because of practical difficulties in the hearing itself in adducing the important evidence of the children's grandmother from Sri Lanka. 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. ,(`df\CT&B6+c! The case against the Wards also relied on the view of Dr David Vickers, a community paediatrician, that if no obvious explanation could be found for an injury then child abuse was likely. Gordon Jeyes, director of children's services at Cambridgeshire county council until this year, defended his department's decision to press ahead with its application to remove William from his parents' care. He has co-authored over 35 peer reviewed papers. 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. Dr. Gregory D. Jackson is a Radiologist in Birmingham, AL. 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. 6. Read full profile Dr Khushnood Alam Consultant Radiologist Biography pending. 37. 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. 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. The father maintains that there could be some natural explanation for S's injuries.38. 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. 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. 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. Book yoUR 2023 CME TODAY. It is not possible to know which incidents or movements caused or gave rise to force sufficient to bring about fractures. The particular issue of Vitamin D deficiency/insufficiency presents as the current medical frontier and arguably an expanding and uncertain one. NS>zu=/_jwJa:S When S was born on 18 July 2011, T was 3 years and 5 months old. The Judge surveyed the 'wide canvas' of the case including the manner in which the parents gave their evidence. 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 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. %PDF-1.6
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Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. In all sections, the value of all imaging modalities are stressed. An X-ray showed a spiral fracture of the left humerus. N and D appeared able to actively provide a high level of basic care for their children.'. 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. This company officer is, or was, associated with at least 1 company roles. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. Subscribe for updates and offers on new events for your specialty. The guardian also represented the other child of the family T, who was born on 14th February 2008. Print this page Their most recent appointment, in our records, was to DR K JOHNSON LIMITED on 2015-08-17. 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. 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.". 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. 03. The Consultant Paediatrician, as the locum consultant paediatrician at the local NHS trust, described himself as a 'relatively recently qualified paediatric consultant.' The professional couple were shocked to be told eventually that William had a broken leg. Her responses in the Schedule point out that the allegations are made on the presumption that S did not have any genetic abnormality or bone disease. This could increase bone fragility and give rise to fractures at a lower force than would otherwise be the case. Mr Sami Al-Ani What has emerged is that none of the adults present could provide any instance of anything done to S by themselves or the other adult members of the family, or which had befallen her, which would explain the fractures. Determined to establish what was wrong they returned twice to the GP, but he was still unable to offer any diagnosis. 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. In my judgment their accounts do have a certain coherence and quality that would suggest that they have sought to do their best in bewildering circumstances. I accept the submission that there is a lack of current research on the susceptibility to fracture in babies who are Vitamin D deficient. 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.' This company officer is, or was, associated with at least 1 company roles. 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