Companies associated with this officer had at least 253,361 shareholder value in recent accounts. He refused to feed and the next day Mrs Ward took him to see her GP. Rent and save from the world's largest eBookstore. 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. Left leg thigh bone fracture, a torus fracture of the distal left femur (30th September-10th October 2011). He indicated that in addition to the spiral fracture of the upper left arm, healing fractures of the left anterior 8th and 9th ribs were noted, with the amount of callus "suggesting that these fractures are not acute". 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. 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. The guardian also represented the other child of the family T, who was born on 14th February 2008. The Judge surveyed the 'wide canvas' of the case including the manner in which the parents gave their evidence. The Wards were only allowed to take William home with them when they agreed to be supervised 24 hours a day by Mr Ward's parents, who had to relocate from Devon to move into the couple's home. Notwithstanding that, I formed the impression that she was seeking to assist the court. Upper limb rheumatology/radiology MDT: . 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. This, unfortunately, was soon to change. My approach in law to this case has been assisted by the reference made by the advocates to a number of cases in their written submissions. 8. The local authority alleges that the injuries were suffered by S and caused by an adult carer and they are non-accidental. septic arthritis." 31. It also records the following: "Mother is not able to recall how the fracture might have occurred: S, she advises, was using her arm less and appeared irritable from Thursday a.m. on 19/10/11 [sic 19/10 was a Wednesday] then went with Mum to have immunisations Thursday 1pm, where she was placed on a couch and not, to mother's recollection, held tightly, then seemed intermittently in discomfort with on-going reluctance to use her left arm as much as right, then today arm appeared swollen. Certificate of attendance upon completion. 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. Take a look at our extensive range of Imaging courses coming up, available virtually, on-demand and in-person, in study . The Court found that the medical evidence raised a substantial likelihood that the injuries were caused non accidentally and by force used by at least one of the adult members of the household. But in the light of all that is known about the parents and from my impression of them in evidence balanced against all that is submitted and produced by the local authority it is not likely, in my judgment, that her injuries were caused by non-accidental force. The father recalled that S "cried throughout", crying as soon as the examination started although the doctor carried on. 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. This new, pocket handbook encompasses all aspects of paediatric radiology. 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. This company officer is, or was, associated with at least 1 company roles. Post-immunisation advice was given". 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. 09. 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. Mrs K Oestreich 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. Dr. Robert H. Thomas is a Radiologist in Birmingham, AL. 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. 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. 5. The professional couple were shocked to be told eventually that William had a broken leg. Dr. Helen Williams is a full time general paediatric radiologist, and has special interests in cross-sectional imaging, feeding studies and radiology training. The father maintains that there could be some natural explanation for S's injuries.38. Because William's parents were unable to explain the fracture the hospital deemed the case suspicious and called in social services. Her mother is D, represented by Mr Jayatilaka. As to the possible involvement of T, he asserts that he had not witnessed T twisting S's arm (or leg or wrists). Victoria and Jake Ward and William, right. 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. She presented with no bony injury and was discharged. Expert evidence from paediatric radiologist (Dr. Karl Johnson) and consultant paediatrician (Dr Russell Croft) was obtained and they were cross examined in Court. On 17 August 2011, S was taken to the clinic at 4 weeks old to be weighed. 52. 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.' 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. The main functions of MRI are as follows: a. early diagnosis of CADM and fasciitis; b. differential diagnosis with other types of myopathies, such as congenital myopathy; c. locating the site for. One or both of the parents, and/or the grandmother knows what has happened to S on all the occasions she has suffered injury. His research and clinical interests include the pathogenesis [.] An X-ray was performed at the time along with other tests and appeared to present no bony injury and no metaphyseal infraction. (6) It is not possible to say what difference formula feeding might have provided because there is no baseline to measure from. The parents were unable to offer any explanations and had not observed any accidental events that may explain these injuries. The GP was unable to identify the cause of William's pain, but on returning home the Wards noticed his leg was swollen. This person was born in December 1965, which was over 57 years ago. Dr Landes is radiology trauma lead and has contributed to the Royal College of Radiologists (RCR) guidance on imaging in paediatric trauma. 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. I note his evidence as to the prevalence of Vitamin D deficiency, particularly in Asian sub-groups, and his view that the absence of radiological evidence does not mean that there is 'no rickets' i.e. There was then a further sharp issue over which expert should be instructed in this field which was not brought before the court until 24th May 2012. 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. 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 father completed a course in tourism management and completed a post-graduate degree in business management. 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. In this case the local authority brings proceedings for Public Law orders relating to S, born on 18th July 2011. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. UK based, CPD accredited, online courses for doctors in all of the major specialties, Navigation: An X-ray showed a spiral fracture of the left humerus. S was sent for x-ray, which revealed a spiral fracture of the left humerus. 22. As it is, her persistent crying which may well have been her response to the injuries can be considered in the light of the reports of the parents about her crying and the possibility of their misinterpretation of her crying emerges as a very real consideration. ,8KaF"*w!$uOEF!1 When the cause of his pain could not be found, they took him back twice more. The fractures to the right lower leg took place between 12th September and 10th October. S's crying was attributed to colic initially and latterly to her having received her vaccination on 20th October 2011. Father said that he was told it was likely that she would get a high temperature and her thighs might swell. This further hearing took place on 24th October 2012.08. 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. 46. 43. 3.o-VR;+lZsA30PK#>] FP+irJBp%MU :g I{,8fVn|aQY/,E/sa8Cd8sfhD5wGtkE4*8*q0zW,7(Ic The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children's Hospital. He has co-authored over 35 peer reviewed papers. 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. The injuries and range of dates are as follows. Stream every session from the webinar for up to 90 days. Metaphyseal fractures result from pulling and twisting being applied to the limb. The family are very close and have a loving relationship. 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. 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. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. At 6.20pm on 13 October 2011, S was brought to the local hospital, with the presenting complaint "swollen left knee started yesterday." 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. Consistent with this, the father described a happy baby in the first two weeks of her life. greater confidence in managing the imaging of an acutely unwell child. 50. I note his view that osteogenesis imperfecta was 'exceptionally unlikely.' I came to the conclusion that I was unable to determine the case without further specialist expert evidence. 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 John is a Consultant Endocrinologist at Queen Elizabeth Hospital Birmingham (QEHB) and an Honorary Senior Lecturer at the University of Birmingham. Amaka lectures regularly on various radiology, paediatric, genetic, emergency medicine and orthopaedic courses, locally and nationally. Detectives removed the cot for examination. Nearby doctors Sarah Yusuf Nazia Anwar Kaushal Mindelsohn Way 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. On the balance of probability T could not have caused the injuries to S. 16. He also is an expert of considerable renown. Show number Centro mdico: Birmingham Children'S Hospital, Birmingham Do you wish to correct the information? 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.' 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. Extensive high quality images throughout the book, and additional illustrations, aid the reader with diagnosis and detailed referencing points to further reading. 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. Dr. Thomas' office is located at 2204 Lakeshore Dr, Birmingham . 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. 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. She also asserted that in her view there was no correlation between Vitamin D deficiency and fractures nor was there an increased propensity to fracture due to a Vitamin D deficiency. At no point did I observe either child to be wary of their parents. The local authority goes on to make the following allegations which I give as numbered in the Scott Schedule: 7. On examination by the doctor there was no active movement of that arm. It was noted that the parents were unsure how the fracture may have happened and there had been no recent accidents of falls. I never observed either parent react angrily towards each other or either child. The Father said in evidence that when the hospital phoned on Monday morning, his wife told them that S was "fine".21. The 30 September 2011 is the earliest date for the left femoral fracture, but Dr Fairhurst took the view that the most likely time of occurrence was between 10 October and the visit to the GP on 13 October.She also thought that the two leg fractures, i.e. 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. There is no evidence of drugs or alcohol abuse, of anger or violent outbursts, of short temper, volatility, irritability or dysfunction. The father's responses set out a general defence to each allegation setting a number of relevant points that formed part of his evidence. The record confirms the father's account that they had been advised to use Infacol, had done so and that it was not working. 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. 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. During the time period for the occurrence of the fractures S was seen by medical professional 5 times on 16th September, 22nd September, 13th October, 19th October and 20th October. At one week she was seen by the Community Nurse and was reported to be "thriving, contented and settling well." 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 evidence from the Health Visitor is that she would have been undressed for weighing and placed in the scales by her parents. 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. Ms Baldrighi, Back to top of page Several of these fractures are highly specific for non-accidental causation by an adult. Within each chapter there are three consistent sections. You can book online your appointment and hire medical insurance online. The consultant paediatric radiologist was able to date the fractures as follows: The rib fractures occurred between 15th and 28th September 2011. 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. DR KARL JOHN JOHNSON is British and resident in England. Tell us your views in a simple 5 minute survey to help us make the service even better. 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.". In the last week of the last Parliamentary session the judgement was rubber stamped into law. 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. The other parties to the case are S's parents, who are married. 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. General radiologists and senior radiology trainees Radiologists with an interest in Paediatric Radiology The content Ten sessions over two days: Head and Neck Chest Gastrointestinal Genito-urinary MSK: Non-Traumatic Inflicted Injury: Brain MSK 1: Traumatic (inc Inflicted Injury) MSK 2: Differential diagnosis Inflicted Injury: A Medico-Legal Update The parents' first child T was born on 14th February 2008. The X-ray revealed a spiral fracture of the left humerus. Since the medical centre was closed, they took S to the local hospital.25. (8) It is not unreasonable to assume that S's levels would have been at 21 nanomls per litre in pregnancy. The paediatric clinicians note records that "yesterday evening the parents noted [her] crying and unsettled, left leg persistently held in a flexed position." There were evident deficiencies in translation by the interpreter. 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. Book yoUR 2023 CME TODAY. On examination, the left knee was "warmer to touch than the right, with mild erythema and swelling over the knee". Erythematous [reddening on the skin]. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. When Victoria and Jake Ward saw their baby son crying and refusing to feed, they took him to their doctor. He therefore accepts that these fractures would have occurred while S was in their joint care. 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. As with the mother, that did not mean that there were no instances when they were confused or mistaken.48. In surveying the 'wide canvas' further, I take into account the evidence of Professor Nussey because the manifest injuries do call for explanation. 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.". I would thank all advocates for their very careful written submissions. At that point a number of problems faced the court. Reviews aren't verified, but Google checks for and removes fake content when it's identified, Oxford Specialist Handbooks in Paediatrics, Medical / Allied Health Services / Imaging Technologies. 6. 16. Birmingham B15 2TG, Birmingham Children's Hospital Fax 847-678-6286 Tooting whose report is at E76-E 279 and Dr. Karl Johnson, consultant paediatric radiologist at the Birmingham Children's Hospital . 35. He has been able to contribute vital knowledge and information towards understanding S's condition in August, September and October 2011. It was inevitable, that the local authority had to bring this case to court. When S was born on 18 July 2011, T was 3 years and 5 months old. The mother, father and grandmother all said that Infacol did eventually help for a time before her crying became worse again.15. 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. 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. 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. 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. Had an instructive and engaging educational experience. 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. All prices include VAT, Viewers will be asked to evaluate each session and will be provided with a CPD certificate upon completion Determined to establish what was wrong they returned twice to the GP, but he was still unable to offer any diagnosis. Dr. Jackson's office is located at 2204 Lakeshore Dr . 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. 5 of my judgment on 26th March 2012. 03. 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. That theory has to overcome the difficulty that observations of S were made when she was seen at the clinic for weighing on the 19 October and for immunisations on 20 October, and the earliest reported symptom in the arm not moving her arm was on Thursday 20 October or Friday 21 October, which arguably places the timing of that fracture later than 19 October, as the Health Visitor and clinic staff could have been expected to notice or pick up symptoms and appearances that were (reportedly) evident to the parents on the Friday, and very apparent to the hospital doctors on Saturday 22 October 2011.29. None of the fractures could have occurred at birth. He denies causing any of the injuries and in turn denies the specific causation of each injury. The impression given by this family and the parents and grandmother in particular is that they were a normal family dealing with their second baby, which by all accounts up to 13th October and indeed to 22nd October appeared to be unexceptional. 11. On 16 September 2011, S was seen for her 6-week check. Attendance of the course includes access to the database of cases associated to this event on our server at PostDICOM. You will maintain your access to the resource throughout your 60 day catch-service period too. The father had come to the UK in December 1999 as a student. 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. The Judge formed the view that the maternal grandmother was seeking to assist the Court in her evidence. hb```e``rg OP#0p4 B1 SGVp_Cb&ow!4MlPU Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. 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. 0 The parents needed to be careful over his food, medicine and health. I have also noted the guidance to be derived from Re U: Re B (above) given by Butler Sloss P at paragraph 23: "In the brief summary of the submissions set out above there is a broad measure of agreement as to some of the considerations emphasised by the judgment in R v Cannings that are of direct application in care proceedings.
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