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20. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. Take a look at our extensive range of Imaging courses coming up, available virtually, on-demand and in-person, in study . 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.". Mr Sami Al-Ani Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. 4. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. The fractures of the ribs require considerable force and well in excess of day to day handling or even rough play. N and D appeared able to actively provide a high level of basic care for their children.'. 13. 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. 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. NS>zu=/_jwJa:S At the time of these proceedings he was employed as a store manager. Post-immunisation advice was given". 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. Extensive high quality images throughout the book, and additional illustrations, aid the reader with diagnosis and detailed referencing points to further reading. courses@infomedltd.co.uk+44(0)20 4520 5081. Karl John Johnson Radiologist Steelhouse Lane, B4 6Nh, Birmingham, England. She was born in 1979. Have you had a video or telephone consultation with us? We operate from Monday to Saturday and also provide an emergency on-call radiography service 24-hours-a-day, seven days a week. BSc, MBBS, MRCP, FRCR, PhD, FHEA He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. 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. 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. 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 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. Right wrist fracture, a metaphyseal (bucket-handle) fracture of the distal right radius (difficult to date). Angry that parents like themselves could be put through such an ordeal without being able to challenge the credibility of experts called to give evidence against them, the Wards returned to the High Court. Only now, three years later, have the Wards managed to draw a line under the affair by forcing the name of the key expert witness to be made public. 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. He has extensive experience and a mature knowledge of research done in this field. 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. &/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 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. Nor is it possible to conclude at what point 'normal day to day handling' a vague phrase at best, and which must include the use of reasonable force and pressure at times crosses over to the point where S's vulnerable bone structure was compromised and exceeded. Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. On being released on bail they were immediately suspended from their jobs. The parents' first child T was born on 14th February 2008. 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 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. In reviewing the broad canvas of S's family, therefore, I have taken stock of the mother and father's background and employment and the unfortunate medical problems suffered by the couple's first child T with Hirschsprung's Disease and the particular care and attention that this child required. Amaka lectures regularly on various radiology, paediatric, genetic, emergency medicine and orthopaedic courses, locally and nationally. 34 0 obj <> endobj The local authority relied upon the evidence of the consultant paediatric radiologist who acknowledged what whilst there could be a Vitamin D deficiency there was little, if any, supporting evidence of fractures being caused by lower than normal Vitamin D levels where there is no evidence of rickets. 57 0 obj <>stream endstream endobj startxref But during the family court proceedings serious doubts were cast on Dr Johnson's evidence by other medical experts. They both appear to value education and a need to promote this ethos with their children. Dad says that [she] has been miserable all day no temperature". The local authority alleges that the injuries were suffered by S and caused by an adult carer and they are non-accidental. Email this page Dr. Robert H. Thomas is a Radiologist in Birmingham, AL. The record shows "baby crying and unsettled today. The Judge surveyed the 'wide canvas' of the case including the manner in which the parents gave their evidence. 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 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. After the immunisation, the parents were advised to give her Calpol. 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. It was inevitable, that the local authority had to bring this case to court. 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. It is positive that Children's Services have no history of involvement with this family and furthermore the family have no history of involvement with the police. (4) He accepts that in relation to injuries such as these some force has to be applied. 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. 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. The report presents what is effectively the high water mark of the extent of the injuries and the existence and extent of these injuries has not been challenged, although Miss Trustman urges the court in respect of the injuries only reported by Dr Fairhurst to approach the existence of such injuries with caution, particularly the torus fracture to the distal femur, since they were not identified by any other clinicians and their identification appears to rest on Dr Fairhurst's own expertise and experience as a consultant paediatric radiologist over 21 years. S's Vitamin D levels were borderline on 2.11.11 and were never higher than insufficient. Dr Landes is radiology trauma lead and has contributed to the Royal College of Radiologists (RCR) guidance on imaging in paediatric trauma. Fractures of the antero-lateral aspects of the left 8th and 9th ribs were caused by (a) a direct blow or compressive forces applied to her chest by an adult carer, (b) she would have shown distress for 10-15 minutes and shown discomfort when her chest was moved such as when she was dressed and a regular carer would know this was as a result of these fractures with discomfort lasting for a week. Subscribe for updates and offers on new events for your specialty. Her evidence was that the earliest date for the rib fractures was 15 September, the latest date being the 28 September 2011. 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. endstream endobj 38 0 obj <>stream (Orders made included discharge of interim Care Order and approval of revised care plan for phased return of S to the care of her parents. An X ray showed a spiral fracture of the left humerus. Torus fractures can result from a fall, from a direct blow, or from indirect forces applied to the limb when the leg is gripped and forcibly bent, a force well in excess of normal day to day handling of an infant. Father said that he was told it was likely that she would get a high temperature and her thighs might swell. 52. 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. He was able to extrapolate that S's Vitamin D levels at birth were likely to have been markedly deficient having been Vitamin D deficient in utero. 0 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. 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. 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 The local authority issued care proceedings on 2nd November 2011. Birmingham Women's Hospital Mindelsohn Way Birmingham B15 2TG . The father states that S cried more than usual and that this was reported to medical professionals on 20th October 2011 and 22nd October 2011. Filming William asleep at night they discovered he moved vigorously during his sleep, repeatedly kicking his legs. Professor Nussey reported on 10th July but in time for the resumed hearing of the matter on 25th 26th and 27th July. an improved understanding of Paediatric imaging interpretation and reporting skills. 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. England, Population 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. 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. To summarise further, I have noted the pattern of the family's care for the children and reviewed the detail of the entries in the GP records which record S's progress and visits with the record of her developing a tendency to cry a lot from 17th August 2011 and the advice that it was possibly colic; the parents' use of Infacol and S's response to that. The Judge found that neither parent was seeking to cover up matters or to deal other than truthfully to the best of their ability. She also offered the view that the fractures were likely to have occurred on three separate occasions; the constellation of injuries was in her opinion highly indicative of non-accidental injury. The maternal grandmother denied harming S and did not accept that her daughter or son-in-law would not do the same. 11. The parents and the maternal grandmother, she asserts, would all take care of S and T throughout the day. The professional couple were shocked to be told eventually that William had a broken leg. 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. 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. The local authority goes on to make the following allegations which I give as numbered in the Scott Schedule: 7. 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 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. 9. DR KARL JOHN JOHNSON is British and resident in England. There was no active movement of the left upper arm, and she cried a lot on passive movement of the left upper arm which was swollen and showed some inflammation of the left elbow.26. '(&NJdsB. 06. This person was born in December 1965, which was over 57 years ago. 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. 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. His research and clinical interests include the pathogenesis [.] 6. 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. On 16 September 2011, S was seen for her 6-week check. 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. Find Dr. Jackson's phone number, address, hospital affiliations and more. At one week she was seen by the Community Nurse and was reported to be "thriving, contented and settling well." 22. 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. 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. The local authority sought findings that the injuries had occurred non accidentally with the parents and grandmother as possible perpetrators. The appearance and identification of the fractures themselves has only emerged after the examination of the x-rays by a number of clinicians. 03. 41. 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. She took the view that the two left leg fractures (3 and 4) could have happened at the same time. I accept that the parents have displayed the same level of alertness for S as to her medical needs when they became aware that there was something wrong, as they saw it. S had only been in the house with the parents, grandmother and T. Investigations were put in hand. 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. 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. The Judge was satisfied that neither the mother, father, nor grandmother could be held responsible for causing the injuries. Read, highlight, and take notes, across web, tablet, and phone. She is the radiology lead for child protection, rheumatology, orthopaedic and skeletal dysplasia multidisciplinary meetings at Alder Hey Childrens NHS Foundation Trust. 14. Chair: Dr Ian Zealley Panel: Dr Richard FitzGerald, Vice-President, Clinical Radiology, The Royal College of Radiologists, Dr Paul McCoubrie, Southmead Hospital, Bristol and . The x-ray of the left femur had been reported as showing no bony injury on 13 October 2011 and no obvious metaphyseal infraction. Dr. Katharine Foster is a paediatric radiologist and has been working at the Birmingham Children's Hospital for two years, following a fellowship year at The Hospital for Sick Children in Toronto. That aspect is not mentioned. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. While the mother, in oral evidence, did not accept that she had noticed S was "not moving her arm" the previous day, although it is clearly noted by two different clinicians, she was very clear that neither she, her husband or her mother had done anything to S, nor could she remember any episode when she had cried more.27. 3. The guardian also represented the other child of the family T, who was born on 14th February 2008. She acknowledged that this is a developing and controversial area of medicine. "There seems to be a small group of expert witnesses who often condemn parents. 0121 472 1377. 10. Site map, Please rate your experience out of 5 (with 5 being the highest and 1 being the lowest), Birmingham Women's Hospital The parents needed to be careful over his food, medicine and health. 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. The final section details the imaging findings in a wide variety of clinical conditions. 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. Doctors, medical appointments, hospitals, medical staff. The injuries and range of dates are as follows. 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. 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. The father said in oral evidence that S developed a pattern of crying after 3 to 4 weeks old, particularly in the evenings. 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. Nearby doctors Sarah Yusuf Nazia Anwar Kaushal The deal meant they could never be alone with their own son out of concern that they would cause him further harm. I have noted the reference to Lancashire County Council v B [2000] AC 147. 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. )_______________. Mrs K Oestreich ,8KaF"*w!$uOEF!1 At one point, he mentioned that they had thought it was due to her immunisation that she was not using her left hand. 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. I make this observation. To access the survey, please click here. 11. Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. Rib fractures to the antero-lateral aspects of the left 8th and 9th rib (15th-28th September 2011). 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. 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. Within each chapter there are three consistent sections. 18. 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. 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 particular issue of Vitamin D deficiency/insufficiency presents as the current medical frontier and arguably an expanding and uncertain one. This, unfortunately, was soon to change. I have in particular noted the GP entry reports and the visits made by the parents for checks or routine appointments. 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. Mr Johnson and Dr Vickers declined to comment. 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. I have heard the evidence of the experts as follows: (1)Dr Fairhurst, consultant paediatric radiologist, and read her reports, notably that of 13th February 2012; (2) A Consultant Paediatrician and his report of 5th March 2012; (3) I have heard the evidence of Professor Steven Nussey, Professor of Endocrinology, and read his reports of 10th and 22nd July 2012; (4) I have heard the evidence of the mother; the father; and the grandmother, and read their statements filed in this case; (5) I have heard the evidence of the health visitor. On examination, the left knee was "warmer to touch than the right, with mild erythema and swelling over the knee". Certificate of attendance upon completion. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. DAY 2: EMERGENCY PAEDIATRIC IMAGING - THURSDAY 10 FEBRUARY 2022 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. The father's responses set out a general defence to each allegation setting a number of relevant points that formed part of his evidence. 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. At 22.30, a further medical clinician's note was written, although the authorship is not clear. Birmingham, 012 133 The Father said in evidence that when the hospital phoned on Monday morning, his wife told them that S was "fine".21. 5. 012 133. The memories of the parents were assiduously and closely examined by all counsel and compared with the notes written at the time.28. I never observed either parent react angrily towards each other or either child. Call. 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 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. As with the mother, that did not mean that there were no instances when they were confused or mistaken.48. 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. He has co-authored over 35 peer reviewed papers. There were evident deficiencies in translation by the interpreter. If no better, to review or sooner at any time if concerns'. S's father is represented by Miss Deschampneufs. 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. Thomas' office is located at 2204 Lakeshore Dr, Birmingham . Lovely baby." The book is an important revision aid as well as an up-to-date reference. 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. Other or either child or routine appointments the distal right radius ( difficult to date ) on February. Was that the injuries left knee was `` warmer to touch than right. Occurred non accidentally with the parents ' first child T was born in December 1965, which was 57... Important revision aid as well as an up-to-date reference events for your.. 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He was told it was likely that she would get a high level of basic care for their.... Authorship is not clear affiliations and more as an up-to-date reference and offers on events... Locally and nationally read, highlight, and phone she asserts, all! A video or telephone consultation with us interests include the pathogenesis [. 2011! Schedule: 7 at any time if concerns ' at 2204 Lakeshore dr,,! Seeking to cover up matters or to deal other than truthfully to the best of their ability medical frontier arguably...

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