DAY 2: EMERGENCY PAEDIATRIC IMAGING - THURSDAY 10 FEBRUARY 2022 (1) D(2) N(3) S(4)S (by her Children's Guardian) Respondents____________________MISS HELEN SOFFA (instructed by the local authority) appeared on behalf of the Applicants.MR UPALI JAYATILAKA (solicitor) appeared on behalf of the Respondent Mother.MISS ALICE DESCHAMPNEUFS (instructed by solicitors) appeared on behalf of the Respondent Father.MISS JUDITH TRUSTMAN (instructed by solicitors) appeared on behalf of the Respondent Maternal Grandmother.MISS SORREL DIXON appeared on behalf of the Children's Guardian.____________________Digital Tape Transcription by:John Larking Verbatim Reporters(Verbatim Reporters and Tape Transcribers)Suite 91, Temple Chambers, 3-7 Temple AvenueLondon EC4Y 0HP.Tel: 020 7404 7464 Fax: 020 7404 7443 DX: 13 Chancery Lane LDE____________________Words: 11,229Folios: 156(FULL) JUDGMENT20th March 2013.01. It was also noted that the parents were unsure how it had happened and there had been no recent accidents or falls. Dr Landes is radiology trauma lead and has contributed to the Royal College of Radiologists (RCR) guidance on imaging in paediatric trauma. 35. 3.o-VR;+lZsA30PK#>] FP+irJBp%MU :g I{,8fVn|aQY/,E/sa8Cd8sfhD5wGtkE4*8*q0zW,7(Ic Because William's parents were unable to explain the fracture the hospital deemed the case suspicious and called in social services. Dr. Foster spent two and a half years working in paediatricsbefore moving into radiology. . The Judge was satisfied that neither the mother, father, nor grandmother could be held responsible for causing the injuries. 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.". Interactive case-based approach using a powerful online DICOM viewer to maximise learning. The parents did not return her, the Father stating that by Sunday [14th October] she was "back to normal". At the time of these proceedings he was employed as a store manager. Consistent with this, the father described a happy baby in the first two weeks of her life. The Judge formed the view that the maternal grandmother was seeking to assist the Court in her evidence. Ms Soffa has gone to considerable lengths and much detail to expose what are submitted as matters on which I should mistrust the evidence of the parents or confer on their evidence only little weight. The particular issue of Vitamin D deficiency/insufficiency presents as the current medical frontier and arguably an expanding and uncertain one. This led to a referral by the consultant paediatrician from the local hospital to Social Services. Specialties Country He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. 52. It is reasonable to conclude that they were lower before then because she was breastfed. 941-697-3552. 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. No temperature. Again I did not get the impression that this was a man seeking to cover up matters or deal other than truthfully to the best of his ability with matters as he remembered them. 0121 472 1377. Have you had a video or telephone consultation with us? 51. The father completed a course in tourism management and completed a post-graduate degree in business management. "Unfortunately the job of social workers is to think the unthinkable because sometimes terrible things happen. 5 of my judgment on 26th March 2012. The guardian also represented the other child of the family T, who was born on 14th February 2008. 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". 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. When S was 10 days old, her maternal grandmother arrived from Sri Lanka to live with the family and to help mother look after the children.13. The professional couple were shocked to be told eventually that William had a broken leg. 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. 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. On the contrary, the evidence appears to demonstrate that the parents had the wellbeing of S in mind and acted to seek medical attention. (6) It is not possible to say what difference formula feeding might have provided because there is no baseline to measure from. No local tenderness in leg or hip", S was x-rayed, but nothing abnormal was observed. She was between the 25th and 50th centiles for weight, and maintained the usual track after the usual loss of weight in the first week. 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. BSc, MBBS, MRCP, FRCR, PhD, FHEA 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. 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. (9) He anticipated that S's level was 30-35 when she was born, not adequate and markedly deficient. None of the fractures could have occurred at birth. He also is an expert of considerable renown. The parents did not mention the previous weekend's symptoms or the trip to the hospital on 13 October 2011.24. 16 the following conclusion was offered, and the parents are referred to as N and D: 'Throughout the assessment period N and D were observed to provide a high level of emotional warmth, mental stimulation and basic care for S and T which they sustained throughout the contact sessions. All this with the inherent complexities of the medical evidence meant that much time was taken up and the father's evidence could not be taken until the court could reconvene on 12th September 2012. When Victoria and Jake Ward saw their baby son crying and refusing to feed, they took him to their doctor. After the birth it became apparent he had a medical problem with intestinal obstructions and severe constipation, requiring a good deal of medical attention and a surgical procedure at 3 weeks. I never observed either parent react angrily towards each other or either child. Within each chapter there are three consistent sections. Post-immunisation advice was given". S would often cry and it was initially believed that this was due to her suffering from colic. If there is some innate contradiction in that sentence it appears that the latter part of that sentence represents the stronger conclusion. The record goes on: 'crying inconsolably for weeks Usually after feeds in the evening. 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. DAY 3: INFLICTED INJURIES IN CHILDREN - FRIDAY 11 FEBRUARY 2022. The local authority alleges that the potential perpetrators of the multiple injuries to S are the mother, father and grandmother, who were the carers of the child. N and D are in a stable relationship and have known each other from childhood as they lived in the same village. In reviewing the broad canvas of S's family, therefore, I have taken stock of the mother and father's background and employment and the unfortunate medical problems suffered by the couple's first child T with Hirschsprung's Disease and the particular care and attention that this child required. This new, pocket handbook encompasses all aspects of paediatric radiology. A number of strengths however have been identified during this short involvement. The memories of the parents were assiduously and closely examined by all counsel and compared with the notes written at the time.28. Determined to establish what was wrong they returned twice to the GP, but he was still unable to offer any diagnosis. The parents and the maternal grandmother, she asserts, would all take care of S and T throughout the day. 34. Hence attendance at A&E.". 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. Dr. Johnson is presently the Chair of theBritish Society of Paediatric Radiology. (On examination) Crying ++. Lovely baby." 6. 20. I return to consider T and his behaviour later in this judgment.12. 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. The note records both mother and grandmother as being present. However, the father points out that there were times when S was sleeping in the bedroom; that T would leave the room where he was being supervised to get a toy or use the bathroom; and his case is that it is possible that he may have gone into the bedroom and caused S injury. The 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. It was noted that the parents were unsure how the fracture may have happened and there had been no recent accidents of falls. The father accepts that only he, the mother and the grandmother were caring for S during this time. The outcome of the case, in a landmark High Court judgement, has helped to lift the secrecy surrounding England's family courts, where campaigners claim that a lack of openness creates an environment in which miscarriages of justice can go unnoticed. She 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. 22. "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' At one point, he mentioned that they had thought it was due to her immunisation that she was not using her left hand. On 17 August 2011, S was taken to the clinic at 4 weeks old to be weighed. 2018 Karen Johnson Andrea Schnell, a Internist practicing in Madison, WI March 27, . Dr. Jackson's office is located at 2204 Lakeshore Dr . 2. Find Dr. Thomas's phone number, address, hospital affiliations and more. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. However, the identities of the expert witnesses in the case remained shrouded in secrecy. The record concludes with the GP's comment "All well. Birmingham, 012 133 Controversial issues, more cases and discussion, To provide the Consultant Radiologist with a practical and comprehensive case based update on the interpretation and reporting of general paed radiology, suspected inflicted injuries and challenging cases when on call, Takes delegates through an intensive series of challenging cases with immediate feedback after each case, Short introductory lectures, offering guidance, practical knowledge, what not to miss and how, Faculty of Consultant Paediatric Radiologists who are experts in their fields and from different hospitals in the UK. 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. An X ray showed a spiral fracture of the left humerus. 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. 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. 3. 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. The maternal grandmother had no concerns in relation to the parents' care for both S and T and would like S to be returned to her parents' care.40. 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. The maternal grandmother's position can most usefully be seen as set out in her position statement of 12th March 2012. 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. 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. Take a look at our extensive range of Imaging courses coming up, available virtually, on-demand and in-person, in study . Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. Extensive high quality images throughout the book, and additional illustrations, aid the reader with diagnosis and detailed referencing points to further reading. He therefore accepts that these fractures would have occurred while S was in their joint care. The constellation of findings is highly indicative of non-accidental injury by an adult. 37. 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. . Victoria and Jake Ward and William, right. Contents hosted on Doctuo should not be used as substitutes for professional medical advice, diagnosis or treatment. 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 father's responses set out a general defence to each allegation setting a number of relevant points that formed part of his evidence. The history squares rather more comfortably with the account given by the father in his statement than in his oral evidence. colic/reflux." In relation to the spiral fracture of the distal shaft of the left humerus, the local authority allege that S's arm has been gripped and twisted by an adult carer; she would have shown immediate distress lasting 10-15 minutes; any regular carer would have noticed a change in her behaviour as a result of the fracture with discomfort which would last for up to a week. 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. They were able to discuss and demonstrate that they were able to sustain routines for S during contact sessions and with T in the home. I have noted the words of Butler-Sloss P in Re U: Re B (Serious injury; standard of proof) [2004] 2 FLR 263 and the court's responsibility to survey a 'wide canvas' and in Re L [2011] EWCA Civ 1705 that 'Clearly from the forensic standpoint given any degree of uncertainty in the medical and scientific field the judge's appraisal and confidence in the parent is absolutely crucial to the outcome.'

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