Right wrist fracture, a metaphyseal (bucket-handle) fracture of the distal right radius (difficult to date). Left leg thigh bone fracture, a torus fracture of the distal left femur (30th September-10th October 2011). 4. "ag`|v#+(U)R1Vrg+1TnD G#qOQOGB[ @+v7#ibHd7X ~6?fJq*bk&~GTQH6To-,dh=>!aFd&02uGo(y GCv&_SRbc>N; ^1Qc(:*%Bl#~vczyAa;~tlvY4Y;U: e0| 34Ba7/, h!i"#>!9l^(bl1oUT (R&^I'[V.1e7'}N"e@ZAEY }^gEm1|4_I|Zj>apQvcZreu[OyTqWl({MicALn("#S' In the absence of an explanation of the injury to S's left arm, the Consultant Paediatrician considered that there was a "high level of suspicion that the humeral and rib fractures may have been sustained as a result of non-accidental injury". The local authority made an application for an Emergency Protection Order on 26th October 2011 in respect of both children, and on 27th October the parents agreed to Section 20 accommodation. 14. She was described as remaining "settled in A&E, observations in normal range, apyrexial." Show number 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. It was noted that the parents were unsure how the fracture may have happened and there had been no recent accidents of falls. Filming William asleep at night they discovered he moved vigorously during his sleep, repeatedly kicking his legs. 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. 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. However, the medical professionals did not note any problems with S on 20th October 2011 despite Dr Fairhurst's dating of the fracture between 16th October 2011 and 19th October 2011. 16. T was described as "very attached to his mother" becoming jealous when mother was with S. He was described on examination as very active in clinic, playing with his sister and wanting to hold her. He denies causing any of the injuries and in turn denies the specific causation of each injury. 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. Mindelsohn Way 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. X-rays 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. EiSNZw_EQL{.y@^y|jJ%5* dN%] w;t|9"v@v(5>S@k 0 T- 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. I noted in relation to the mother that she gave her evidence calmly, she was quietly spoken, she gave direct and straight answers, she was composed and it appeared that her answers came from her genuine recollection without her giving what might have been expected answers. 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. Firstly, it had become evident that the court required the assistance of an expert in paediatric bone disorders. You can book online your appointment and hire medical insurance online. the fractures to the right tibia and the proximal left tibia are likely to have occurred at the same time, and that that is the likely time-frame for them both.19. In this case the local authority brings proceedings for Public Law orders relating to S, born on 18th July 2011. I have noted and examined the oral evidence of Dr Fairhurst. 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. BSc, MBBS, MRCP, FRCR, PhD, FHEA 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. I have taken account of the occasions when S was seen by medical staff. Her evidence was that S was crying, being "fractious and miserable but not hugely distressed", happier lying down than being held. 6. 42. The father's main recollection seemed to be that S was "very quiet" on the Friday, although he had told the police on 24 October 2011 she was "fine" on that day. The Judge surveyed the 'wide canvas' of the case including the manner in which the parents gave their evidence. 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. 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 evidence from the Health Visitor is that she would have been undressed for weighing and placed in the scales by her parents. 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. 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. 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. As a result of her expertise she receives both regional and national referrals for review of musculoskeletal imaging from radiological and clinical colleagues with an emphasis on imaging in cases of suspected inflicted injury. I make this observation. An X-ray was performed at the time along with other tests and appeared to present no bony injury and no metaphyseal infraction. At one point, he mentioned that they had thought it was due to her immunisation that she was not using her left hand. 47. 36. I have taken account of the fact that she gave her evidence through an interpreter while having at least a working grasp of English. &/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 Dr. Robert H. Thomas is a Radiologist in Birmingham, AL. (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. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. It provides an overview of how to approach the imaging of children including the relative values of each of the imaging modalities for paediatric pathology. On 14 January 2013 I made orders and gave a foreshortened (primary) version of the judgment in this case which had run over a substantial period in 2012 and before, because having reserved judgment in what was on any view a difficult case, delays in preparing the judgment for administrative reasons and with difficulties over my own health meant the process became much longer than I would have wished. ,(`df\CT&B6+c! NS>zu=/_jwJa:S On 16 September 2011, S was seen for her 6-week check. S was referred to hospital as a paediatric emergency, the GP's impression being "?? 2023Check Company | Privacy | Terms of Use | Contact Us. Displaying companies where the director has shareholdings or significant control. It was inevitable, that the local authority had to bring this case to court. 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. On 19 August 2011, two days later, there is a record in the GP notes confirming a visit by the mother and father with S. She was seen by the GP. At this point I summarise his evidence by identifying the following features: (1) Professor Nussey has a clear and far-reaching understanding of endocrinology and the systems involved with Vitamin D and bone mineralisation. The GP was unable to identify the cause of William's pain, but on returning home the Wards noticed his leg was swollen. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. 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 11. DAY 2: EMERGENCY PAEDIATRIC IMAGING - THURSDAY 10 FEBRUARY 2022 He had known his wife (the mother) since 1990. There is no radiological evidence that S suffers from rickets or any other vitamin deficiency. 8. A diagnosis of OI (osteogenesis imperfecta) is exceptionally unlikely. 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. Dr Landes is radiology trauma lead and has contributed to the Royal College of Radiologists (RCR) guidance on imaging in paediatric trauma. There are a number of other features of the evidence about the parents which I must take into account as part of the 'wide canvas' of evidence that I have surveyed. I have examined the process by which the fractures were discovered and that it was not until the report of Dr Fairhurst, consultant paediatric radiologist, of 13th February 2012 that the full extent of the injuries alleged to have been sustained by S were revealed and her report included three new areas of injury not seen or confirmed by earlier reports. 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. 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. 50. 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. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. 6. 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. Karl John Johnson Radiologist Steelhouse Lane, B4 6Nh, Birmingham, England. 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 the course of surveying the 'wide canvas' of evidence I have reviewed the evidence of the mother, the father and the grandmother. 13. He also is an expert of considerable renown. In all sections, the value of all imaging modalities are stressed. endstream endobj startxref The family's nightmare began one night in July 2005 when, at three months old, William woke up in pain. 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. Notwithstanding that, I formed the impression that she was seeking to assist the court. Both gave compelling evidence that, in particular, the rib fractures suffered to the baby could only be caused by " excessive/abusive squeezing" or "gripping of the chest". Radiologists, Country 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. 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. 2. 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 Wards subsequently won a legal fight in the High Court for the judgement to be made public. The child appears by her children's guardian and has been represented by Miss Dixon. Stream every session from the webinar for up to 90 days. Companies associated with this officer had at least 253,361 shareholder value in recent accounts. Take a look at our extensive range of Imaging courses coming up, available virtually, on-demand and in-person, in study . This person was born in December 1965, which was over 57 years ago. hmk0^g? The parents agreed to section 20 accommodation on 27.10.11 and on 2.11.11 the local authority issued care proceedings. I came to the conclusion that I was unable to determine the case without further specialist expert evidence. I therefore come to the conclusion that the local authority has not discharged the burden of proof on the balance of probabilities. The responses of the parents and the cases which they have put before the court appear in summary form on the Scott Schedule. Furthermore, Professor Tim David, an expert paediatrician, told the court that in this and many other cases, police and social workers were wrong to assume that an unexplained injury could normally be attributed to child abuse. 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 examination, the left knee was "warmer to touch than the right, with mild erythema and swelling over the knee". The maternal grandmother's position can most usefully be seen as set out in her position statement of 12th March 2012. At 6.20pm on 13 October 2011, S was brought to the local hospital, with the presenting complaint "swollen left knee started yesterday." The history squares rather more comfortably with the account given by the father in his statement than in his oral evidence. This person was born in December 1965, which was over 57 years ago. hbbd``b`J5 `n\ a#H #e \ 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. In the meantime Cambridgeshire applied to the family court for a care order, allowing them to remove William from his parents. In the last week of the last Parliamentary session the judgement was rubber stamped into law. Birmingham, 012 133 He appeared to be frank and open in his answers and not devious. 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. Within each chapter there are three consistent sections. Professor Nussey reported on 10th July but in time for the resumed hearing of the matter on 25th 26th and 27th July. (9) He anticipated that S's level was 30-35 when she was born, not adequate and markedly deficient. He states that S had a tendency to cry and this was discussed with medical professionals on more than one occasion. Upper limb rheumatology/radiology MDT: . One or both of the parents, and/or the grandmother knows what has happened to S on all the occasions she has suffered injury. 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. Dr. Gregory D. Jackson is a Radiologist in Birmingham, AL. 941-697-3552. Considering all the evidence on the balance of probabilities I have come to the conclusion that the likely incidence of an increased vulnerability to fracture is the most likely cause of S's injuries. However, she was very unsettled again by 22nd October 2011 and so the parents and grandmother took her to the A&E Department at the local hospital. She refers to the times when S was seen by the health visitor when, despite the presence of fractures, nothing untoward was seen on as she puts it 25th July 2011, 3rd August 2011, 22nd September 2011, 19th October 2011 and 20th October 2011. Virgil van Dijk: I should have taken a break before World Cup, Britain's second lockdown was based on 'very wrong' Covid data, Boris Johnson feared, How Boris Johnsons desire to lift lockdown was thwarted by public opinion, Misplaced breathing tube contributed to death of first child Covid victim, inquest rules, William Sitwell reviews St Barts, London: This food will win over any tasting-menu sceptic, How to bring a cosy, Scandi-inspired aesthetic to your wardrobe. The local authority sought findings that the injuries had occurred non accidentally with the parents and grandmother as possible perpetrators. The NPI Enumerator can be reached at (800) 465-3203 or P.O. Specialties 46. 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. 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. The record concludes with the GP's comment "All well. Steelhouse Lane Email this page %PDF-1.6 % 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. No plausible explanation has been offered for any of these injuries. 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. 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 maternal grandmother denied harming S and did not accept that her daughter or son-in-law would not do the same. His father described him as "very possessive" of his baby sister, trying to open her clenched fists to place toys in them, to straighten his 'folded' arms and play with her. The maternal grandmother had not witnessed T intentionally being rough or boisterous towards S and had not witnessed him attempting to hold S or pick her up. S would often cry and it was initially believed that this was due to her suffering from colic. 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 father recalled that S "cried throughout", crying as soon as the examination started although the doctor carried on. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. This advanced Infomed webinar is in response to suggestions/feedback from many general radiologists, who have attended Infomed courses, more lately webinars, and now with the easing of the pandemic see the need for a focussed and comprehensive Paediatric Radiology CPD programme. At one week she was seen by the Community Nurse and was reported to be "thriving, contented and settling well." What followed next led, eventually, to the diagnosis of a fracture in S's left upper arm. Tel: 0121 335 8260 The team Our team is made up of consultant radiologists, sonographers, radiographers, health care assistants and administrative staff. This company officer is, or was, associated with at least 1 company roles. You will maintain your access to the resource throughout your 60 day catch-service period too. She obtained her MBBS while working at Oldchurch Hospital, Essex and trained as a radiologist in Sheffield. At this point I identify the following features: (1) that while there was a possibility that there could be a Vitamin D deficiency there is little, if any, supporting evidence at present for fractures occurring with lower than normal levels of Vitamin D but no radiological evidence of rickets; (2) that there is no correlation between a Vitamin D deficiency and fractures, and a mechanism is required to cause a fracture; (3) she did not accept that there was an increased propensity to fracture due to Vitamin D deficiency and maintained that a sub-optimal bone that is not manifesting itself as radiologically subnormal leaves itself at sufficient strength to resist fractures; (4) S did not show radiological signs of rickets, but Dr Fairhurst stated that she did not know whether S may or may not have had a vitamin level low enough to manifest as rickets; (5) there will inevitably be a stage in the bone changes resulting from insufficiency or deficiency of Vitamin D which will be present but not visible on X-ray, i.e. 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.' At the time of these proceedings he was employed as a store manager. 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 found Professor Nussey to be highly knowledgeable in his field; careful; and able to consider and assist the court on all matters put to him. The second section discusses the differential diagnosis of radiological features. Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). 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. 7. It was the maternal grandmother's view that her daughter and son-in-law did not injure S. The maternal grandmother also mentioned that she had cared for her own children, relatives and grandchildren and was capable of ensuring that children are properly and safely cared for. Full access to each case with a full toolset to open, view and manipulate each case alongside the faculty but on your own screen! The maternal grandmother ('the grandmother') is also a party, as she was present in the family home at the material time, and has been represented by Miss Trustman. 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. Her parents returned with S on 22.10.11 with a swollen arm. Naturally the Wards hoped social services would follow suit, but they were in for a shock. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. No temperature. 3. The parents were unable to offer any explanations and had not observed any accidental events that may explain these injuries. I have also noted the quotation offered by Miss Trustman from R v Harris and others [2005] EWCA Crim 1980 para. On Wednesday 19 October 2011, S was seen at the clinic to be weighed. 57 0 obj <>stream With Doctuo you can find the doctors you need. Lovely baby." The father accepts that only he, the mother and the grandmother were caring for S during this time. 3. 31. 012 133. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. Dr Paul Humphries, Consultant Paediatric Radiologist, Great Ormond Street Hospital and University College London 12:15 MSK MRI 2 - bone marrow Dr Karl Johnson, Consultant Paediatric Radiologist, Birmingham Children's Hopsital 13:00 Lunch 14:00 Abdominal MRI - techniques, common applications and Catch-up service: Paediatric Radiology 2022, Catch-up now with our case-based Paediatric Radiology webinar that took place in February 2022. Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. On 24th October 2011 a skeletal survey detected what appeared to be two left rib fractures. Interactive case-based approach using a powerful online DICOM viewer to maximise learning. Dr Karl Johnson, Birmingham Children s Hospital Joint tumours Dr Asif Saifuddin, Royal National Orthopaedic . colic/reflux." "Unfortunately the job of social workers is to think the unthinkable because sometimes terrible things happen. 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