Their care of the children has been observed as of high quality. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. Any specialty 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". I therefore granted an adjournment so that a suitable expert could be instructed. The responses of the parents and the cases which they have put before the court appear in summary form on the Scott Schedule. 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.". 4. 14. 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 No temperature. An X-ray showed a spiral fracture of the left humerus. The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children's Hospital. Her weight gain was recorded as normal. 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. 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. AbeBooks.com: Paediatric Radiology (Oxford Specialist Handbooks in Paediatrics) (9780199204793) by Johnson, Karl; Williams, Helen; Foster, Katharine; Miller, Claire and a great selection of similar New, Used and Collectible Books available now at great prices. The guardian also represented the other child of the family T, who was born on 14th February 2008. 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. However, in due course Dr Joanna Fairhurst, consultant paediatric radiologist, identified fractures to the left upper arm, right lower arm, distal left femur, left tibia, right tibia, and two rib fractures. 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. 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. 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. 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. Hence attendance at A&E.". I note his conclusion that although this did not render S more likely to injury, it might increase bone fragility and thus give rise to fractures at a lower force than would otherwise be the case. *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 A revised care plan was approved for the rehabilitation of S to the care of her parents. "It was a nightmare which seemed to be spiralling out of control.". Nothing untoward is reported by the clinician who weighed her and the Health Visitor could not recall S as being unhappy.23. The local authority goes on to make the following allegations which I give as numbered in the Scott Schedule: 7. Mindelsohn Way 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. 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. 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 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. Since the medical centre was closed, they took S to the local hospital.25. In his report of 25 October 2011 the Consultant Paediatrician confirms that ophthalmological testing showed no evidence ocular trauma with healthy discs and no retinal haemorrhages seen. He had known his wife (the mother) since 1990. hmk0^g? 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. The parents/grandparent who did not inflict the injuries on each occasion to S failed to protect her. The Wards were arrested and questioned by police on suspicion of grievous bodily harm and child cruelty towards William. Her mother is D, represented by Mr Jayatilaka. Her evidence was that the earliest date for the rib fractures was 15 September, the latest date being the 28 September 2011. Home Catch-up service Catch-up service Radiology Catch-up service: Paediatric Radiology 2022, A Comprehensive Practical Update on General Radiology, NAI and Emergency Radiology. Because William's parents were unable to explain the fracture the hospital deemed the case suspicious and called in social services. You will maintain your access to the resource throughout your 60 day catch-service period too. Erythematous [reddening on the skin]. He denies causing any of the injuries and in turn denies the specific causation of each injury. colic/reflux." This person was born in December 1965, which was over 57 years ago. VOIT$=EfPuP^ AiiUw~,JZ%?rG?("S{t }p# y|!W7XQb,{*|p>'A7:#;p`Wnx n&Thb !pA}ifRh0$*W@~n0?Olgj;|TO^,WicR|WV2riRm- The father completed a course in tourism management and completed a post-graduate degree in business management. Mr Johnson and Dr Vickers declined to comment. 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. 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.' 5 of my judgment on 26th March 2012. The family's nightmare began one night in July 2005 when, at three months old, William woke up in pain. 11. 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. There is no radiological evidence that S suffers from rickets or any other vitamin deficiency. I came to the conclusion that I was unable to determine the case without further specialist expert evidence. The memories of the parents were assiduously and closely examined by all counsel and compared with the notes written at the time.28. Dr. Karl Johnson Consultant Paediatric Radiologist Birmingham Children's Hospital 15:05 - 15:20: Break 15:25 - 16:25: SEN disability impact of covid on safeguarding Caroline Coady Assistant Director for Social Care National Children's Bureau 16:25 - 17:25: Sexual Abuse Update Deborah Hodes 17:25 - 17:30: Close 17:30: Room open for networking 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. Three days: 375 | Two days: 295 | One day: 175 She was born in 1979. If no better, to review or sooner at any time if concerns'. 51. DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. Birmingham, 012 133 He appeared to be frank and open in his answers and not devious. Interpretation & Reporting Webinar for the General Radiologist, DAY 1: GENERAL PAEDIATRIC RADIOLOGY - WEDNESDAY 9 FEBRUARY 2022 Doctuo 2023 Last modification: 02-03-2023, Birmingham Children'S Hospital, Birmingham. 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". I will quote only two passages, in order to convey the tone and broadly positive view that emerges from this report, at p. 3 and from the Conclusions at p. 16. 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. Now the Local authority has promptly and appropriately put into effect a revised Care Plan to give effect to the orders made that day. 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. Formula feeding for 8-9 weeks before the test would have provided some improvement but not enough, as breastfeeding would provide none. UK based, CPD accredited, online courses for doctors in all of the major specialties, Navigation: Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. an understanding of the importance of applying the ALARA principle in Paediatric imaging. 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. 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. 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. The Judge formed the view that the maternal grandmother was seeking to assist the Court in her evidence. DAY 3: INFLICTED INJURIES IN CHILDREN - FRIDAY 11 FEBRUARY 2022. S was discharged and the parents reported that her knee improved. 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. Book yoUR 2023 CME TODAY. It is not possible to know which incidents or movements caused or gave rise to force sufficient to bring about fractures. 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. The father's evidence was that during the morning she had cried more than normal and he confirms that she was "grumpy and crying". Several of these fractures are highly specific for non-accidental causation by an adult. 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. Had an instructive and engaging educational experience. 6. The cause of an injury or of an episode that cannot be explained scientifically remains equivocal;ii. 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. S was sent for x-ray, which revealed a spiral fracture of the left humerus. 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. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. S has suffered multiple fractures which have occurred on at least three separate occasions. 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. 54. At one point, he mentioned that they had thought it was due to her immunisation that she was not using her left hand. Expert evidence from paediatric radiologist (Dr. Karl Johnson) and consultant paediatrician (Dr Russell Croft) was obtained and they were cross examined in Court. Birmingham Women's Hospital Mindelsohn Way Birmingham B15 2TG . Certificate of attendance upon completion. 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. DR KARL JOHN JOHNSON is British and resident in England. 34 0 obj <> endobj 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. Displaying companies where the director has shareholdings or significant control. DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. Post-immunisation advice was given". Have you had a video or telephone consultation with us? The Judge considered that S was seen five times at medical appointments when she was said to be suffering from fractures and noted that at those appointments not only did they not reveal the fractures but nor did they raise any suspicion about the parents. Wanted a review(Under 'P') Discussed with Mum and Dad possible colic will continue withInfacol and see how she gets on over next week. 18. Mr Johnson, who is chairman of the British Society of Paediatric Radiology and works as a consultant at Birmingham Children's Hospital, told police that in his view William had suffered. She took the view that the two left leg fractures (3 and 4) could have happened at the same time. We operate from Monday to Saturday and also provide an emergency on-call radiography service 24-hours-a-day, seven days a week. However, on 22nd October 2011 the parents again presented S, this time with swelling to her left arm. We adopt the following: i. The father accepts that only he, the mother and the grandmother were caring for S during this time. After the immunisation, the parents were advised to give her Calpol. Mrs K Oestreich This person was born in December 1965, which was over 57 years ago. Her special interests include musculoskeletal radiology and trauma, particularly imaging in inflicted injury. In my judgment their accounts do have a certain coherence and quality that would suggest that they have sought to do their best in bewildering circumstances. 14. 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 . Subscribe for updates and offers on new events for your specialty. Consistent with this, the father described a happy baby in the first two weeks of her life. 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. Birmingham B15 2TG, Birmingham Children's Hospital She is also a member of the Royal College of Paediatrics and Child Health, and is a fellow of the RoyalCollege of Radiologists. 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. The father maintains that there could be some natural explanation for S's injuries.38. The parents and the maternal grandmother, she asserts, would all take care of S and T throughout the day. Detectives removed the cot for examination. 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. The record shows "baby crying and unsettled today. 20. This company officer is, or was, associated with at least 1 company roles. 41. 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. DAY 2: EMERGENCY PAEDIATRIC IMAGING - THURSDAY 10 FEBRUARY 2022 Notwithstanding that, I formed the impression that she was seeking to assist the court. View more radiologists birmingham Consultations Consultations Steelhouse Lane, Birmingham, England. . I am satisfied that neither the mother, the father, nor the grandmother can be held responsible for causing the injuries in a non-accidental or careless way and the court remains unable to find any one of them more likely than the others to have caused them. there is a stage of rickets before it is identifiable radiologically. Akin, MD, Diagnostic Radio Interactive case-based approach using a powerful online DICOM viewer to maximise learning. While I have taken account of inconsistencies with the records available, I did not form the view that her evidence was demonstrably or readily to be interpreted as that of someone seeking to mislead the court, cover her tracks or draw a veil of ignorance over matters about which she had some knowledge. The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children's Hospital. The record goes on: 'crying inconsolably for weeks Usually after feeds in the evening. What followed next led, eventually, to the diagnosis of a fracture in S's left upper arm. I have in particular noted the GP entry reports and the visits made by the parents for checks or routine appointments. 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. Nearby doctors Sarah Yusuf Nazia Anwar Kaushal 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. 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 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. 04. The mother also worked there.10. At one week she was seen by the Community Nurse and was reported to be "thriving, contented and settling well." Full access to each case with a full toolset to open, view and manipulate each case alongside the faculty but on your own screen! 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. 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. 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. 7. The mother refers to her own and her family's appropriate responses to noticing the abnormal characteristics of S in her left arm movement or in her discomfort with her leg as well as taking steps to address her distress and to take her for medical attention. Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). 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. However, the identities of the expert witnesses in the case remained shrouded in secrecy. 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. She weighed 6lbs 15 ozs (3.15 kg) at birth and was born by emergency Caesarean section. The court had no expert views on these aspects or on a number of potential issues relating to bone metabolism. Earlier records that day mention mother and father being present. Naturally the Wards hoped social services would follow suit, but they were in for a shock. The Judge found that neither parent was seeking to cover up matters or to deal other than truthfully to the best of their ability. Attendance of the course includes access to the database of cases associated to this event on our server at PostDICOM. ,8KaF"*w!$uOEF!1 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. 4. 12. 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. At para. Apyrexial. A week later William was placed on the council's child protection register. S had only been in the house with the parents, grandmother and T. Investigations were put in hand. 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.". 44. hbbd``b`J5 `n\ a#H #e \ At no point did I observe either child to be wary of their parents. %r W!p-zC1')v?nP=^:;J2wFT$8N&j 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. With Doctuo you can find the doctors you need. Companies associated with this officer had at least 253,361 shareholder value in recent accounts. 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. This led to a referral by the consultant paediatrician from the local hospital to Social Services. 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. Dr Fairhurst thinks that they may have been sustained as I set out in their approximately chronological order: 1. 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. So the records engage even closer scrutiny. Print this page 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. It is remarkable that these and in particular the hospital appointment of 13th October did not reveal or suggest the presence of fractures, nor did they raise any element of suspicion about the parents. The maternal grandmother's position can most usefully be seen as set out in her position statement of 12th March 2012. I record in relation to the father that I found his evidence and his certain directness in quality with immediate and unhesitating answers suggested a genuine response. Torus fractures can result from a fall, from a direct blow, or from indirect forces applied to the limb when the leg is gripped and forcibly bent, a force well in excess of normal day to day handling of an infant. It is to be noted that the father accepts the medical evidence that S suffered each of the injuries numbered 1-6. When the cause of his pain could not be found, they took him back twice more. 2018 Karen Johnson Andrea Schnell, a Internist practicing in Madison, WI March 27, . 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 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. X-Ray, which revealed a spiral fracture of the parents, grandmother and Investigations! The parents/grandparent who did not inflict the injuries numbered 1-6 on 14th February 2008 child protection register parents unable... Companies associated with this officer had at least three separate occasions bodily and... 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