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. She presented with no bony injury and was discharged. The burden of proof lies on the local authority and they have to satisfy the court on the balance of probabilities: see Re B (Care proceedings; standard of proof) [2008] UKHL 35. Upper limb rheumatology/radiology MDT: . Lord Justice Munby agreed with their request and in a landmark judgement in January this year ruled that expert witnesses in family courts could now be named. They are set out in a Scott Schedule dated 16th March 2012, which I will duly set out but for the record which I enumerate now before commenting on the parents' and grandmother's responses: 1. 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. All the adults appear to be normal hardworking people concerned for their children. He had known his wife (the mother) since 1990. The GP note for 20 October 2011 records "First meningitis vaccination. Having reviewed the evidence in detail, and after considering the written submissions of all parties, I had reached a position where I had come to my conclusions on the issues of fact. 3. 22. sub-optimal bones that have not yet developed radiological signs of rickets; (6) I note that she was not in a position to give an expert opinion on metabolic bone disease which she identified as a very complex subject beyond the radiological aspect and that she would defer to a metabolic expert; (7) she accepted that the lack of evidence for fractures occurring in patients with lower than normal levels of Vitamin D (who did not have radiological evidence of rickets) is the current state of research and acknowledged that there is a need for more study to be done; she further accepted that this is a developing and controversial area of medicine; (8) I noted that it is accepted by all medical experts that it is unknown what level of force would be required to cause the injuries in a baby that had a Vitamin D deficiency or insufficiency; understandably it is not possible for experiments to be carried out. It was noted that the parents were unsure how the fracture may have happened and there had been no recent accidents of falls. A couple cleared of injuring their baby son have won a legal battle to identify the doctor who gave evidence against them. 07. As for that visit on the 22 September, the Health Visitor said that S was not distressed as far as she could recall.18. The conclusions are positive. Formula feeding for 8-9 weeks before the test would have provided some improvement but not enough, as breastfeeding would provide none. Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). The father recalled that S "cried throughout", crying as soon as the examination started although the doctor carried on. He has a special interest in paediatric musculoskeletal. Her evidence was that the earliest date for the rib fractures was 15 September, the latest date being the 28 September 2011. 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. (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. 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. 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. 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. 34. They could offer no explanation as to how the fractures may have happened. S had only been in the house with the parents, grandmother and T. Investigations were put in hand. The GP was unable to identify the cause of William's pain, but on returning home the Wards noticed his leg was swollen. 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. I come to the conclusion that Dr Fairhurst's evidence as to the identification of the injuries is, taken as a whole, and in the light of all the evidence and my acceptance of Dr Fairhurst's evidence in her own field of specialism, reliable and acceptable. S has suffered multiple fractures which have occurred on at least three separate occasions. She was born in 1979. There is no evidence of an incident of any kind suggestive or on which an inference could be drawn that either of the parents was responsible for an injury (other of course than the X-rays of the fractures). The maternal grandmother's position can most usefully be seen as set out in her position statement of 12th March 2012. He said: "It was a clear cut case in that there was no immediate explanation and the parents were not clear how the baby had come by his injuries. S was discharged and the parents reported that her knee improved. 44. 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. 05. An X-ray showed a spiral fracture of the left humerus. Within each chapter there are three consistent sections. At that point a number of problems faced the court. 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. Detectives removed the cot for examination. The injuries and range of dates are as follows. 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. She is the radiology lead for child protection, rheumatology, orthopaedic and skeletal dysplasia multidisciplinary meetings at Alder Hey Childrens NHS Foundation Trust. Tel: 0121 335 8260 The team Our team is made up of consultant radiologists, sonographers, radiographers, health care assistants and administrative staff. We wanted to be able to name expert witnesses in order to help all those other families who are going through what we went through.". Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. Erythematous [reddening on the skin]. I therefore come to the conclusion that the local authority has not discharged the burden of proof on the balance of probabilities. 42. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. Find Dr. Thomas's phone number, address, hospital affiliations and more. Site map, Please rate your experience out of 5 (with 5 being the highest and 1 being the lowest), Birmingham Women's Hospital The father had come to the UK in December 1999 as a student. On 22 October a skeletal survey was performed and reported on by Dr Steven Johnson, Consultant Radiologist. Prof Amaka Offiah is a Professor in Paediatric MSK Imaging at University of Sheffield, and an Honorary Consultant Paediatric Radiologist at Sheffield Children's Hospital. 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. It is not possible to know which incidents or movements caused or gave rise to force sufficient to bring about fractures. The fact finding hearing began on 23rd March 2012, but on the second day of it, on 26th March, I adjourned the hearing having encountered significant problems on two fronts after hearing evidence from Dr Fairhurst, the health visitor, and the Consultant Paediatrician. 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 consultant paediatric radiologist was able to date the fractures as follows: The rib fractures occurred between 15th and 28th September 2011. The father accepts that only he, the mother and the grandmother were caring for S during this time. Dr. Johnson is presently the Chair of theBritish Society of Paediatric Radiology. Several of these fractures are highly specific for non-accidental causation by an adult. She states that they do not occur accidentally and this type of fracture is highly indicative of non-accidental causation requiring a force well in excess of that used in normal day to day handling of an infant. S had regained and passed her birth weight. It was inevitable, that the local authority had to bring this case to court. 6. Dr Landes is radiology trauma lead and has contributed to the Royal College of Radiologists (RCR) guidance on imaging in paediatric trauma. 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. 135; "There are areas of ignorance. Read, highlight, and take notes, across web, tablet, and phone. Dr Caren Landes obtained her medical degree from the University of Birmingham in 1997 and was appointed a Consultant Radiologist at Alder Hey Childrens NHS Foundation Trust in 2006 and has been Clinical Lead for Radiology since 2012. 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. 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. 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. She acknowledged that this is a developing and controversial area of medicine. Full access to the cases to follow alongside with the sessions. Have you had a video or telephone consultation with us? 0
Gordon Jeyes, director of children's services at Cambridgeshire county council until this year, defended his department's decision to press ahead with its application to remove William from his parents' care. Dealing with the fracture to the left humerus, the father's response was that he cannot say whether or not he was present when the fracture was sustained. 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. On Wednesday 19 October 2011, S was seen at the clinic to be weighed. 50. I have noted and examined the oral evidence of Dr Fairhurst. Mr Johnson and Dr Vickers declined to comment. Birmingham Update in prostate cancer Topics to include: . NS>zu=/_jwJa:S He has co-authored over 35 peer reviewed papers. It is positive that Children's Services have no history of involvement with this family and furthermore the family have no history of involvement with the police. He appeared to be frank and open in his answers and not devious. The record confirms the father's account that they had been advised to use Infacol, had done so and that it was not working. 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. DR KARL JOHN JOHNSON is British and resident in England. The note records both mother and grandmother as being present. At no point did I observe either child to be wary of their parents. 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. I have taken account of the occasions when S was seen by medical staff. 13. 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. The book is an important revision aid as well as an up-to-date reference. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. . 46. DR KARL JOHN JOHNSON is British and resident in England. 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. The X-ray revealed a spiral fracture of the left humerus. %%EOF
54. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. Expert evidence from paediatric radiologist (Dr. Karl Johnson) and consultant paediatrician (Dr Russell Croft) was obtained and they were cross examined in Court. 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 x-ray of the left femur had been reported as showing no bony injury on 13 October 2011 and no obvious metaphyseal infraction. 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. She said: "How could we celebrate that someone has decided you didn't hurt your child when you know all along you didn't? 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. Contents hosted on Doctuo should not be used as substitutes for professional medical advice, diagnosis or treatment. Rent and save from the world's largest eBookstore. Her special interests include musculoskeletal radiology and trauma, particularly imaging in inflicted injury. 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. I return to consider T and his behaviour later in this judgment.12. Both gave compelling evidence that, in particular, the rib fractures suffered to the baby could only be caused by " excessive/abusive squeezing" or "gripping of the chest". 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. Recurrence is not in itself probative;iii. 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. I noted in relation to the mother that she gave her evidence calmly, she was quietly spoken, she gave direct and straight answers, she was composed and it appeared that her answers came from her genuine recollection without her giving what might have been expected answers. Firstly, it had become evident that the court required the assistance of an expert in paediatric bone disorders. 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. Torus fracture of the distal left femur caused by (a) her left leg being gripped and forcibly bent; (b) she would have shown distress for 15 minutes and would have shown discomfort when the leg was moved; discomfort would have lasted for several days. Post-immunisation advice was given". 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.'. 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. 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. 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 memories of the parents were assiduously and closely examined by all counsel and compared with the notes written at the time.28. "ag`|v#+(U)R1Vrg+1TnD G#qOQOGB[ @+v7#ibHd7X ~6?fJq*bk&~GTQH6To-,dh=>!aFd&02uGo(y
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}^gEm1|4_I|Zj>apQvcZreu[OyTqWl({MicALn("#S' She was described as remaining "settled in A&E, observations in normal range, apyrexial." Book yoUR 2023 CME TODAY. Further X-rays revealed what appeared to be three more fractures and an injury to his arm. When S was born on 18 July 2011, T was 3 years and 5 months old. None of the fractures could have occurred at birth. Doctuo 2023 Last modification: 02-03-2023, Birmingham Children'S Hospital, Birmingham. 35. 36. This led to a referral by the consultant paediatrician from the local hospital to Social Services. 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. Paradoxically, the last fracture-type injury in time to occur (in all probability), the left humeral fracture, was the first to be identified on 22 October 2011. 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. '(&NJdsB. The local authority goes on to make the following allegations which I give as numbered in the Scott Schedule: 7. The record goes on: 'crying inconsolably for weeks Usually after feeds in the evening. Their care of the children has been observed as of high quality. The fractures at 2, 3 and 6 above were only identified by Dr Fairhurst. In surveying the 'wide canvas' further, I take into account the evidence of Professor Nussey because the manifest injuries do call for explanation. Particular difficulties were encountered with receiving the evidence of the grandmother by Skype from Sri Lanka with the connection frequently being lost and with further doubts arising over the correctness of the interpretation of her evidence. Her evidence was that S was crying, being "fractious and miserable but not hugely distressed", happier lying down than being held. 15. In all sections, the value of all imaging modalities are stressed. there is a stage of rickets before it is identifiable radiologically. The Wards were arrested and questioned by police on suspicion of grievous bodily harm and child cruelty towards William. 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. She also offered the view that the fractures were likely to have occurred on three separate occasions; the constellation of injuries was in her opinion highly indicative of non-accidental injury. 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. There was an additional right wrist fracture which was difficult to date. However, she was very unsettled again by 22nd October 2011 and so the parents and grandmother took her to the A&E Department at the local hospital. He identified irregularity in the distal left femur in an earlier X-ray taken on 13th October 2011, but after further scans concluded that there was no fracture of the distal left femur. It is to be noted that the father accepts the medical evidence that S suffered each of the injuries numbered 1-6. Our imaging courses are very much an interactive experience. In the meantime Cambridgeshire applied to the family court for a care order, allowing them to remove William from his parents. While T was originally the subject of the local authority's applications at the outset when proceedings were issued on 27th October 2011, I made an order on 13th December 2011 returning him to the care of his parents and no continuing orders were made relating to him. 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. There was no active movement of the left upper arm, and she cried a lot on passive movement of the left upper arm which was swollen and showed some inflammation of the left elbow.26. HkBsD R#\#[(!$D(AyLgtJ%{mc8zA&+;*JV [a%4[)Er_'! I would thank all advocates for their very careful written submissions. I accept the submission that there is a lack of current research on the susceptibility to fracture in babies who are Vitamin D deficient. 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. 03. 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