In the meantime Cambridgeshire applied to the family court for a care order, allowing them to remove William from his parents. Within each chapter there are three consistent sections. He has been able to contribute vital knowledge and information towards understanding S's condition in August, September and October 2011. 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. 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. 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". 6. 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. The father's evidence was that during the morning she had cried more than normal and he confirms that she was "grumpy and crying". Full access to each case with a full toolset to open, view and manipulate each case alongside the faculty but on your own screen! 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. Left knee is swollen, feels hot and tender. 135; "There are areas of ignorance. 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. Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. 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. 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. Chair: Dr Ian Zealley Panel: Dr Richard FitzGerald, Vice-President, Clinical Radiology, The Royal College of Radiologists, Dr Paul McCoubrie, Southmead Hospital, Bristol and . (6) It is not possible to say what difference formula feeding might have provided because there is no baseline to measure from. 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. 4. The history squares rather more comfortably with the account given by the father in his statement than in his oral evidence. I have also noted the case of Re S-B (Children)(Care proceedings; standard of proof) [2009] UKSC 17 and particularly the passage in which their Lordships confirmed that the simple balance of probability test following the House of Lords decision in Re B (above) should be applied in finding that a person was the perpetrator of an injury, confirming the approach where the evidence falls short of that standard in North Yorkshire County Council v SA [2003] EWCA Civ 839 to the effect that an individual will be found to be a possible perpetrator if the evidence establishes a 'real possibility' that they caused the injury. hmk0^g? 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 Dr Landes is radiology trauma lead and has contributed to the Royal College of Radiologists (RCR) guidance on imaging in paediatric trauma. A week later William was placed on the council's child protection register. In the course of surveying the 'wide canvas' of evidence I have reviewed the evidence of the mother, the father and the grandmother. At this point I identify the following features: (1) that while there was a possibility that there could be a Vitamin D deficiency there is little, if any, supporting evidence at present for fractures occurring with lower than normal levels of Vitamin D but no radiological evidence of rickets; (2) that there is no correlation between a Vitamin D deficiency and fractures, and a mechanism is required to cause a fracture; (3) she did not accept that there was an increased propensity to fracture due to Vitamin D deficiency and maintained that a sub-optimal bone that is not manifesting itself as radiologically subnormal leaves itself at sufficient strength to resist fractures; (4) S did not show radiological signs of rickets, but Dr Fairhurst stated that she did not know whether S may or may not have had a vitamin level low enough to manifest as rickets; (5) there will inevitably be a stage in the bone changes resulting from insufficiency or deficiency of Vitamin D which will be present but not visible on X-ray, i.e. He appeared to be frank and open in his answers and not devious. greater confidence in managing the imaging of an acutely unwell child. Nearby doctors Sarah Yusuf Nazia Anwar Kaushal Since the medical centre was closed, they took S to the local hospital.25. It was inevitable, that the local authority had to bring this case to court. Her special interests include musculoskeletal radiology and trauma, particularly imaging in inflicted injury. Consultant Paediatric Radiologist and Service Group Lead for Radiology, Alder Hey Childrens Hospital, Liverpool, UK. Consistent with this, the father described a happy baby in the first two weeks of her life. Dr Karl Johnson, Birmingham Children s Hospital Joint tumours Dr Asif Saifuddin, Royal National Orthopaedic . While one might have looked for the possibility that in a moment of weakness or exasperation they might have snapped, or when the mother might have momentarily lost her self-control, particularly with a baby who cried persistently, that at least one fracture might have resulted, but for S to be shown with six sets of fractures, three constellations, requiring the sort of force and violence that Dr Fairhurst described, appears to be completely and demonstrably alien to the sort of people the parents and the grandmother appear to be. They could offer no explanation as to how the fractures may have happened. I found Professor Nussey to be highly knowledgeable in his field; careful; and able to consider and assist the court on all matters put to him. This would have involved manipulation of the legs and arms, and the conducting of other tests. hb```e``rg OP#0p4 B1 SGVp_Cb&ow!4MlPU DR KARL JOHN JOHNSON is British and resident in England. Thank you! The injuries and range of dates are as follows. The father recalled that S "cried throughout", crying as soon as the examination started although the doctor carried on. 2. Opportunity to submit questions by email to the faculty. His research and clinical interests include the pathogenesis [.] (Orders made included discharge of interim Care Order and approval of revised care plan for phased return of S to the care of her parents. He also is an expert of considerable renown. She is the radiology lead for child protection, rheumatology, orthopaedic and skeletal dysplasia multidisciplinary meetings at Alder Hey Childrens NHS Foundation Trust. 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.'. Certificate of attendance upon completion. I have taken account of the fact that she gave her evidence through an interpreter while having at least a working grasp of English. 3.o-VR;+lZsA30PK#>] FP+irJBp%MU :g I{,8fVn|aQY/,E/sa8Cd8sfhD5wGtkE4*8*q0zW,7(Ic Further X-rays revealed what appeared to be three more fractures and an injury to his arm. Book yoUR 2023 CME TODAY. The Judge found that neither parent was seeking to cover up matters or to deal other than truthfully to the best of their ability. This appeared to be strong evidence that William had been abused several times in his short life. He was diagnosed with Hirschsprung's disease, remaining under the care of a London hospital's surgical team with 6 monthly checks. 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. The parents and the maternal grandmother, she asserts, would all take care of S and T throughout the day. The Wards were arrested and questioned by police on suspicion of grievous bodily harm and child cruelty towards William. 34. 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. We adopt the following: i. Birmingham, 012 133 (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. Three days: 375 | Two days: 295 | One day: 175 I have noted the reported reactions of T to the birth of S. I have considered S's early developmental history after her birth; also the arrival when S was about 10 days old of the maternal grandmother from Sri Lanka to help the mother look after the children. Karl John Johnson Radiologist Steelhouse Lane, B4 6Nh, Birmingham, England. Interpretation & Reporting Webinar for the General Radiologist, DAY 1: GENERAL PAEDIATRIC RADIOLOGY - WEDNESDAY 9 FEBRUARY 2022 The X-ray revealed a spiral fracture of the left humerus. He arrived at the preliminary conclusion that the humeral and rib fractures must give rise to 'a high level of suspicion' for non-accidental injury. Mrs Ward, 36, who now has three children and runs yoga and massage classes for babies, said they were not content with simply winning their own case. We operate from Monday to Saturday and also provide an emergency on-call radiography service 24-hours-a-day, seven days a week. 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. I take note also that the mother and father completed a parenting assessment. There were evident deficiencies in translation by the interpreter. All prices include VAT, Viewers will be asked to evaluate each session and will be provided with a CPD certificate upon completion She is also a member of the Royal College of Paediatrics and Child Health, and is a fellow of the RoyalCollege of Radiologists. 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. 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. 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. Formula feeding for 8-9 weeks before the test would have provided some improvement but not enough, as breastfeeding would provide none. S had regained and passed her birth weight. S was referred to hospital as a paediatric emergency, the GP's impression being "?? I note the entry as follows: 'non-tender, baby permits passive manipulation. 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. 012 133. The father had come to the UK in December 1999 as a student. 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. (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. Fee includes 90 days of access with unlimited playback during this time. The earliest date for the left femoral fracture was 30th September but it was most likely to have occurred between 10th and 13th October. On being released on bail they were immediately suspended from their jobs. 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. 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. At 22.30, a further medical clinician's note was written, although the authorship is not clear. I have in particular noted the GP entry reports and the visits made by the parents for checks or routine appointments. ,8KaF"*w!$uOEF!1 52. 5 of my judgment on 26th March 2012. 5. The father said in oral evidence that S developed a pattern of crying after 3 to 4 weeks old, particularly in the evenings. VOIT$=EfPuP^ AiiUw~,JZ%?rG?("S{t }p# y|!W7XQb,{*|p>'A7:#;p`Wnx n&Thb !pA}ifRh0$*W@~n0?Olgj;|TO^,WicR|WV2riRm- 11. 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. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. Displaying companies where the director has shareholdings or significant control. 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. Mrs K Oestreich The child appears by her children's guardian and has been represented by Miss Dixon. 7. 10. Father said that he was told it was likely that she would get a high temperature and her thighs might swell. DR KARL JOHN JOHNSON is British and resident in England. 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 parents needed to be careful over his food, medicine and health. When S was born on 18 July 2011, T was 3 years and 5 months old. 31. I have heard the evidence of the experts as follows: (1)Dr Fairhurst, consultant paediatric radiologist, and read her reports, notably that of 13th February 2012; (2) A Consultant Paediatrician and his report of 5th March 2012; (3) I have heard the evidence of Professor Steven Nussey, Professor of Endocrinology, and read his reports of 10th and 22nd July 2012; (4) I have heard the evidence of the mother; the father; and the grandmother, and read their statements filed in this case; (5) I have heard the evidence of the health visitor. I note his view that osteogenesis imperfecta was 'exceptionally unlikely.' He has a special interest in paediatric musculoskeletal. Mr Sami Al-Ani I have noted and examined the oral evidence of Dr Fairhurst. Left leg thigh bone fracture, a torus fracture of the distal left femur (30th September-10th October 2011). Metaphyseal fracture of the proximal right tibia caused when (a) her right leg had been pulled and twisted by an adult carer; (b) she would have shown distress for 10-15 minutes and would have shown discomfort when her leg was moved. Location 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. Her weight gain was recorded as normal. I accept that the parents have displayed the same level of alertness for S as to her medical needs when they became aware that there was something wrong, as they saw it. an improved understanding of Paediatric imaging interpretation and reporting skills. Interactive case-based approach using a powerful online DICOM viewer to maximise learning. 4. 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 constellation of findings is highly indicative of non-accidental injury by an adult. Clinic Locations. At para. Dr. 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. 2. Doctors, medical appointments, hospitals, medical staff. Within each chapter there are three consistent sections. 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 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. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. 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. She was described as remaining "settled in A&E, observations in normal range, apyrexial." 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. The Wards took their son to Addenbrooke's hospital in Cambridge, where an x-ray revealed he was suffering from a spiral fracture of the lower right leg, an extremely rare condition in children who have not yet begun to walk. I have given a relatively brief overview of the medical evidence adduced by the local authority, but, having reviewed the medical evidence so relied on, I have no difficulty in acknowledging that the inferences to be drawn from the medical expert evidence raise a substantial likelihood that the injuries were caused non-accidentally and by force used by at least one of the adult family members that was in excess of normal day to day handling, although expressing reservation as to what precisely that might mean, and that the evidence of Dr Fairhurst in particular deserves significant weight. The local authority issued care proceedings on 2nd November 2011. N and D appeared able to actively provide a high level of basic care for their children.'.
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dr karl johnson radiologist, birmingham