I have also noted the quotation offered by Miss Trustman from R v Harris and others [2005] EWCA Crim 1980 para. Wanted a review(Under 'P') Discussed with Mum and Dad possible colic will continue withInfacol and see how she gets on over next week. As to the grandmother, she gave evidence by Skype from Sri Lanka and as I have earlier said her evidence was subject to unavoidable and unfortunate technical difficulties. 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. Formula feeding for 8-9 weeks before the test would have provided some improvement but not enough, as breastfeeding would provide none. DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. 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 local authority alleges that the injuries were suffered by S and caused by an adult carer and they are non-accidental. He trained in Paediatrics and Radiology in Cambridge and London, and was awarded a PhD in brain imaging in 2002 from the University of Cambridge. He denies causing any of the injuries and in turn denies the specific causation of each injury. At no point did I observe either child to be wary of their parents. You'll get immediate feedback and learning points from our expert faculty member. Opportunity to submit questions by email to the faculty. (3) It is not known why some patients with rickets become hypocalcaemic, one of the clinical pictures of rickets or Vitamin D deficiency, and why in some patients with rickets patients have fractures, some have two or three, others have none. All the adults appear to be normal hardworking people concerned for their children. 941-697-3552. The parents agreed to section 20 accommodation on 27.10.11 and on 2.11.11 the local authority issued care proceedings. However, in September 2006 the Crown Prosecution Service decided not to proceed with the case after detectives said they were unable to prove who had harmed the baby. . It is to be noted that at this time, 13 October 2011, the evidence is that S had already sustained factures of the left 8th and 9th rib and was likely to have sustained her left femoral fracture and fractures to the right and left tibia. Left knee is swollen, feels hot and tender. It is further positive that the professionals involved with the family have reported no concerns regarding the children's wellbeing whilst in the care of their parents prior to S being admitted to a local hospital with a fracture to her left femur.'. However, on 22nd October 2011 the parents again presented S, this time with swelling to her left arm. 7. Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. The appearance and identification of the fractures themselves has only emerged after the examination of the x-rays by a number of clinicians. (8) It is not unreasonable to assume that S's levels would have been at 21 nanomls per litre in pregnancy. He found it was not possible to conclude at what point normal day to day handling crossed over to the point when S's vulnerable bone structure was compromised and exceeded. I note the entry as follows: 'non-tender, baby permits passive manipulation. hmk0^g? No local tenderness in leg or hip", S was x-rayed, but nothing abnormal was observed. 3. 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. But in clarification of this remark Professor Nussey said that it would be reasonable to use the words 'increased vulnerability to fracture' in relation to S. 53. 47. 0121 472 1377. S's crying was attributed to colic initially and latterly to her having received her vaccination on 20th October 2011. If no better, to review or sooner at any time if concerns'. 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. endstream endobj 38 0 obj <>stream The parents and the maternal grandmother, she asserts, would all take care of S and T throughout the day. Her weight gain was recorded as normal. On being released on bail they were immediately suspended from their jobs. She took the view that the two left leg fractures (3 and 4) could have happened at the same time. Thank you! Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. 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. With Doctuo you can find the doctors you need. The GP note for 20 October 2011 records "First meningitis vaccination. The GP was unable to identify the cause of William's pain, but on returning home the Wards noticed his leg was swollen. *ReTXgZ; CQ7Z9zjCpaab?E.b?r+d,iQPO&[slRQqBojGa"!K-=TMF (VB]q|G.HViVB 57'>]E%Y}2otF{iQ8Eef3Pc\Hu ZM,KW}JhP='+tZi~3dG%mlz@q48z)QYf 1hf"$HyG).f"I$tVQ++T*92{pkUKs 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. S, it is stated, settled after being given Calpol following her vaccination on 20th October 2011. VOIT$=EfPuP^ AiiUw~,JZ%?rG?("S{t }p# y|!W7XQb,{*|p>'A7:#;p`Wnx n&Thb !pA}ifRh0$*W@~n0?Olgj;|TO^,WicR|WV2riRm- 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. 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. Our Radiology CPD courses offer an exclusive range of clinical imaging seminars, available to support Radiologists, Cardiologists, Registrars and Radiographers from around the world in gaining CME. Companies associated with this officer had at least 253,361 shareholder value in recent accounts. 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. 18. %%EOF It is reasonable to conclude that they were lower before then because she was breastfed. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. The guardian also represented the other child of the family T, who was born on 14th February 2008. Read, highlight, and take notes, across web, tablet, and phone. 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. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. 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. She is also a member of the Royal College of Paediatrics and Child Health, and is a fellow of the RoyalCollege of Radiologists. The father states that the fact that the parents and grandmother took S to A&E on 22nd October 2011 showed that they had noticed a change in her behaviour; they presented S to the local hospital having noticed a swelling to her left arm. Naturally the Wards hoped social services would follow suit, but they were in for a shock. 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. 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. 8. I have in particular noted the GP entry reports and the visits made by the parents for checks or routine appointments. "Unfortunately the job of social workers is to think the unthinkable because sometimes terrible things happen. S was discharged and the parents reported that her knee improved. 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.' 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 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. Added to this was the unfortunate position of counsel for the grandmother, who was not present and who had sent a message to the court that her client's public funding certificate had been embargoed for the reasons and with the consequences set out in para. Earlier records that day mention mother and father being present. Several of these fractures are highly specific for non-accidental causation by an adult. 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. On the balance of probability T could not have caused the injuries to S either by (a) jumping on the family bed whilst S was lying on it or (b) pulling her bouncy chair when she was in it. So the records engage even closer scrutiny. Based primarily on the evidence of Dr Fairhurst, the local authority has levelled a broad spread of allegations against the three adults in the household at the material time the mother, father and grandmother. Aged 20 in December 1999, she had married the father just before he came to England She joined him in this country in October 2003. 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 Consultant Paediatrician, as the locum consultant paediatrician at the local NHS trust, described himself as a 'relatively recently qualified paediatric consultant.' Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. I make this observation. 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. 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. The concerns of the local authority and the allegations raised against the family members arise from the appearance on X-ray scans first seen on 22nd October 2011 of a significant fracture to S's left upper arm. (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. 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. As I identify the main points in the chronology, I note first that Dr Fairhurst regards the 16 October 3 days after S was first seen and x-rayed at hospital as the "earliest date" on which the fracture to the left humerus occurred, and thinks it probably would have occurred before the 19 October. an improved understanding of Paediatric imaging interpretation and reporting skills. Consultant Paediatric Radiologist and Service Group Lead for Radiology, Alder Hey Childrens Hospital, Liverpool, UK. This person was born in December 1965, which was over 57 years ago. Birmingham Women's Hospital Mindelsohn Way Birmingham B15 2TG . S has suffered multiple fractures which have occurred on at least three separate occasions. The NPI Enumerator can be reached at (800) 465-3203 or P.O. 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. 14. 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. 06. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. After 22 September 2011, S was next seen at the GP surgery on the 13 October 2011. 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 injuries and range of dates are as follows. 52. The father is unable to explain how S sustained the fracture to her left arm; however, he accepts that only he, mother and grandmother were caring for S during this time; he therefore accepts that this fracture would have occurred while S was in their care. There were evident deficiencies in translation by the interpreter. I have also had the benefit of the considerable amount of documentation in the bundles to which extensive reference has been made in the course of the evidence. 5 of my judgment on 26th March 2012. 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. I never observed either parent react angrily towards each other or either child. 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. In the course of surveying the 'wide canvas' of evidence I have reviewed the evidence of the mother, the father and the grandmother. 54. 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. British Society of Paediatric Radiology: Paediatric MRI for general radiologists - tips and tricks 16:50 - 17:10 Musculoskeletal (MSK) imaging Dr Karl Johnson, Birmingham Children's Hospital NHS Foundation Trust Learning points In the maturing child, the marrow signal will alter depending on the amount of haemopoietic and fatty tissue within it. Excellent peer interaction and collaborative learning. On examination, the left knee was "warmer to touch than the right, with mild erythema and swelling over the knee". The local authority issued care proceedings on 2nd November 2011. 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. Birmingham Update in prostate cancer Topics to include: . On Thursday 20 October 2011 S was brought to the GP surgery by the parents and given her immunisation injections, in each thigh, by the Health Visitor. 2023Check Company | Privacy | Terms of Use | Contact Us. When Victoria and Jake Ward saw their baby son crying and refusing to feed, they took him to their doctor. They both appear to value education and a need to promote this ethos with their children. To access the survey, please click here. 46. 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". He was Karl Johnson, an eminent radiologist who specialises in non-accidental injuries and has acted a police witness in several cases of child abuse. The father said in evidence that her crying was first mentioned then, although there is no entry about it in the record, but the following record in the GP Notes does suggest that the Health Visitor had "advised giving her Infacol" at this point, so it probably was raised then. (7) It is safe to extrapolate from the mother's levels taken in May 2012 that Vitamin D levels would have been lower in pregnancy. @ $ lp-5v|v3+F;%`(E4Di A diagnosis of OI (osteogenesis imperfecta) is exceptionally unlikely. Paediatric Radiology opens with a chapter devoted to the different imaging modalities, including radiographs, fluroscopy, ultrasoound, CT, MRI and nuclear scintigraphy before moving on to more detailed, systems-based chapters. 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. She said: "How could we celebrate that someone has decided you didn't hurt your child when you know all along you didn't? 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. Tell us your views in a simple 5 minute survey to help us make the service even better. I note his view that osteogenesis imperfecta was 'exceptionally unlikely.' I have noted the reference to Lancashire County Council v B [2000] AC 147. 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. 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 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. , but on returning home the Wards noticed his leg was swollen Use | us! Happened at the same time following her vaccination on 20th October 2011 records `` First vaccination! 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