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. 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. 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. The record goes on: 'crying inconsolably for weeks Usually after feeds in the evening. %PDF-1.6 % Birmingham Women's Hospital Mindelsohn Way Birmingham B15 2TG . 41. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. 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. It must also raise as a real possibility the potential explanation that T may have brought about one or more fractures, along with the possibility less likely, in my view that S may have been injured when the family slept together in one bed. Determined to establish what was wrong they returned twice to the GP, but he was still unable to offer any diagnosis. Post-immunisation advice was given". S had only been in the house with the parents, grandmother and T. Investigations were put in hand. 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. Left knee is swollen, feels hot and tender. &/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 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. The local authority took action on 26th October 2011 after the Consultant Paediatrician concluded that there must be a high level of suspicion in the absence of explanation of the injury to the left arm that the humeral and left rib fractures may have been sustained as a result of a non-accidental injury. Victoria and Jake Ward and William, right. 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. 51. Fee includes 90 days of access with unlimited playback during this time. an understanding of the importance of applying the ALARA principle in Paediatric imaging. 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. Particular difficulties were encountered with receiving the evidence of the grandmother by Skype from Sri Lanka with the connection frequently being lost and with further doubts arising over the correctness of the interpretation of her evidence. Akin, MD, Diagnostic Radio Tel: 0121 335 8260 The team Our team is made up of consultant radiologists, sonographers, radiographers, health care assistants and administrative staff. On the contrary, the evidence appears to demonstrate that the parents had the wellbeing of S in mind and acted to seek medical attention. 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 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. Specialties 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. The X-ray revealed a spiral fracture of the left humerus. Doctuo 2023 Last modification: 02-03-2023, Birmingham Children'S Hospital, Birmingham. Full access to the cases to follow alongside with the sessions. He was diagnosed with Hirschsprung's disease, remaining under the care of a London hospital's surgical team with 6 monthly checks. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. 52. In the meantime Cambridgeshire applied to the family court for a care order, allowing them to remove William from his parents. 57 0 obj <>stream )_______________. The local authority alleges that the injuries were suffered by S and caused by an adult carer and they are non-accidental. We adopt the following: i. He noted that there is no uniformity of Vitamin D testing and it is difficult to measure. 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. Subscribe for updates and offers on new events for your specialty. An X ray showed a spiral fracture of the left humerus. Professor Nussey reported on 10th July but in time for the resumed hearing of the matter on 25th 26th and 27th July. It was also noted that the parents were unsure how it had happened and there had been no recent accidents or falls. 17. Country On examination by the doctor there was no active movement of that arm. With Doctuo you can find the doctors you need. This is case-based course designed for all General Radiologists and Radiologists based at the DGHs who are increasingly having to report paediatric imaging, an opportunity to attend a complete update of the main key topics on 3 consecutive days a complete CPD package. I note the entry as follows: 'non-tender, baby permits passive manipulation. 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. (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. 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. His research and clinical interests include the pathogenesis [.] 15. 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. 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. 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 However, the father points out that there were times when S was sleeping in the bedroom; that T would leave the room where he was being supervised to get a toy or use the bathroom; and his case is that it is possible that he may have gone into the bedroom and caused S injury. The advice to 'persist with Infacol' also bears out the father's account. 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. 135; "There are areas of ignorance. In the light of this observation, the involvement of local Children's Services inevitably followed and the proceedings were commenced, as I have indicated in this judgment.30. 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. Amaka lectures regularly on various radiology, paediatric, genetic, emergency medicine and orthopaedic courses, locally and nationally. The Wards subsequently won a legal fight in the High Court for the judgement to be made public. S could not have been injured when in a bouncy chair from normal use. The consultant paediatric radiologist was able to date the fractures as follows: The rib fractures occurred between 15th and 28th September 2011. This judgment relates to the fact finding hearing concerned with the causation of a number of bone fractures sustained by S at about the age of three months. Location 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. I came to the conclusion that I was unable to determine the case without further specialist expert evidence. 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 Consultant Paediatrician, as the locum consultant paediatrician at the local NHS trust, described himself as a 'relatively recently qualified paediatric consultant.' My close examination of this material has focused on the parents' accounts as well as on the evidence they have subsequently given about what they saw. 36. Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. (2) I note his evidence that there is no uniformity of Vitamin D testing in the United Kingdom and that Vitamin D is difficult to measure. All prices include VAT, Viewers will be asked to evaluate each session and will be provided with a CPD certificate upon completion 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. 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. The other parties to the case are S's parents, who are married. 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. 8. This, unfortunately, was soon to change. 3. 12. . ,(`df\CT&B6+c! 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 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. 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. 18. Left leg thigh bone fracture, a torus fracture of the distal left femur (30th September-10th October 2011). The Judge was satisfied that neither the mother, father, nor grandmother could be held responsible for causing the injuries. hb```e``rg OP#0p4 B1 SGVp_Cb&ow!4MlPU N and D appeared able to actively provide a high level of basic care for their children.'. They are, in my survey of the evidence, more likely to have a genuinely accidental cause, but because of the evidence of Professor Nussey taken with the evidence of the parents and from the records available it is not possible to reach a view that is more than speculative as to the timing of the injuries. At 6.20pm on 13 October 2011, S was brought to the local hospital, with the presenting complaint "swollen left knee started yesterday." 941-697-3552. Further X-rays revealed what appeared to be three more fractures and an injury to his arm. S was sent for x-ray, which revealed a spiral fracture of the left humerus. 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. While T was originally the subject of the local authority's applications at the outset when proceedings were issued on 27th October 2011, I made an order on 13th December 2011 returning him to the care of his parents and no continuing orders were made relating to him. Dr. Thomas' office is located at 2204 Lakeshore Dr, Birmingham . 10. I have not found any instances that cannot be attributed to genuine mis-recollection especially given the distance in time over which they were attempting to deal with detailed events. A week later William was placed on the council's child protection register. NS>zu=/_jwJa:S Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). Nearby doctors Sarah Yusuf Nazia Anwar Kaushal 3. The Wards were arrested and questioned by police on suspicion of grievous bodily harm and child cruelty towards William. All the adults appear to be normal hardworking people concerned for their children. Left upper arm fracture, a spiral fracture of the distal shaft of the left humerus (16th-19th October 2011). I have taken account of the occasions when S was seen by medical staff. Tell us your views in a simple 5 minute survey to help us make the service even better. Take a look at our extensive range of Imaging courses coming up, available virtually, on-demand and in-person, in study . 5. endstream endobj startxref Metaphyseal fracture of the proximal right tibia caused when (a) her right leg had been pulled and twisted by an adult carer; (b) she would have shown distress for 10-15 minutes and would have shown discomfort when her leg was moved. 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. (10) His view was that it was likely that S was Vitamin D deficient in utero and in the early neonatal period. Their care of the children has been observed as of high quality. 0121 472 1377. A diagnosis of OI (osteogenesis imperfecta) is exceptionally unlikely. They both appear to value education and a need to promote this ethos with their children. If there is some innate contradiction in that sentence it appears that the latter part of that sentence represents the stronger conclusion. 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. I have considered the findings invited by the local authority as to the evidence of the family members, the inconsistencies, alleged inaccuracies and inferences that I am invited to draw from them. Her evidence was that the earliest date for the rib fractures was 15 September, the latest date being the 28 September 2011. A revised care plan was approved for the rehabilitation of S to the care of her parents. Dr. Foster spent two and a half years working in paediatricsbefore moving into radiology. What followed next led, eventually, to the diagnosis of a fracture in S's left upper arm. Mrs K Oestreich Prof T Southwood Dr Karl Johnson: Tumour Clinic (LTB Clinic) Tuesdays once per month: Ms Baldrighi: The Transition Clinic : Four to six times per year at Queen Elizabeth Hospital on a Tuesday morning : . Rib fractures to the antero-lateral aspects of the left 8th and 9th rib (15th-28th September 2011). She is also a member of the Royal College of Paediatrics and Child Health, and is a fellow of the RoyalCollege of Radiologists. 33. there is a stage of rickets before it is identifiable radiologically. Having reviewed the evidence in detail, and after considering the written submissions of all parties, I had reached a position where I had come to my conclusions on the issues of fact. At hospital on Saturday 22 October 2011 at 15.30, the triage nurse noted the presenting complaint as "swelling to the left upper arm" and "since Thursday, increased crying". She moved back to London, to Great Ormond Street Hospital and the Institute of Child Health, where she obtained a PhD for her thesis, Optimisation of the digital radiographic imaging of suspected non-accidental injury, then returned to Sheffield as a HEFCE-funded Clinical Senior Lecturer in the Academic Unit of Child Health. 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. 13. 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. She acknowledged that this is a developing and controversial area of medicine. The Consultant Paediatrician, in his report of 5 March 2012, picks up on the record that T would become annoyed when S was unable to play with him, not understanding that it was not possible. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. "There seems to be a small group of expert witnesses who often condemn parents. 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dr karl johnson radiologist, birmingham