The advice to 'persist with Infacol' also bears out the father's account. "Unfortunately the job of social workers is to think the unthinkable because sometimes terrible things happen. The left tibia fracture was likely to have occurred between 3rd and 10th October and the likely time frame for the left humeral fracture was between 16th and 19th October. @ $ lp-5v|v3+F;%`(E4Di S was discharged and the parents reported that her knee improved. However, I note the high level of engagement with the medical services throughout T's life and the attention and care that he needed and received, caused by his own particular medical condition. She moved back to London, to Great Ormond Street Hospital and the Institute of Child Health, where she obtained a PhD for her thesis, Optimisation of the digital radiographic imaging of suspected non-accidental injury, then returned to Sheffield as a HEFCE-funded Clinical Senior Lecturer in the Academic Unit of Child Health. "It was a nightmare which seemed to be spiralling out of control.". 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 Recurrence is not in itself probative;iii. The particular issue of Vitamin D deficiency/insufficiency presents as the current medical frontier and arguably an expanding and uncertain one. It is simply not possible to know where the boundary lies. (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. Subscribe for updates and offers on new events for your specialty. Only now, three years later, have the Wards managed to draw a line under the affair by forcing the name of the key expert witness to be made public. Find Dr. Jackson's phone number, address, hospital affiliations and more. Location 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. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. Dr. Robert H. Thomas is a Radiologist in Birmingham, AL. . 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. 941-697-3552. 09. When the cause of his pain could not be found, they took him back twice more. I have taken account of the occasions when S was seen by medical staff. 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. It is reasonable to conclude that they were lower before then because she was breastfed. 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. 35. The GP's entry records "crying, excessive ? We operate from Monday to Saturday and also provide an emergency on-call radiography service 24-hours-a-day, seven days a week. 34. )_______________. 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. 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. 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. Injuries to S could not have been caused by a person rolling onto her. 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. Fractures of the antero-lateral aspects of the left 8th and 9th ribs were caused by (a) a direct blow or compressive forces applied to her chest by an adult carer, (b) she would have shown distress for 10-15 minutes and shown discomfort when her chest was moved such as when she was dressed and a regular carer would know this was as a result of these fractures with discomfort lasting for a week. 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. Interpretation & Reporting Webinar for the General Radiologist, DAY 1: GENERAL PAEDIATRIC RADIOLOGY - WEDNESDAY 9 FEBRUARY 2022 Mrs K Oestreich 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. 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. S's Vitamin D levels were borderline on 2.11.11 and were never higher than insufficient. 05. Wanted a review(Under 'P') Discussed with Mum and Dad possible colic will continue withInfacol and see how she gets on over next week. The local authority issued care proceedings on 2nd November 2011. 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. Left leg thigh bone fracture, a torus fracture of the distal left femur (30th September-10th October 2011). However, on 22nd October 2011 the parents again presented S, this time with swelling to her left arm. On 14 January 2013 I made orders and gave a foreshortened (primary) version of the judgment in this case which had run over a substantial period in 2012 and before, because having reserved judgment in what was on any view a difficult case, delays in preparing the judgment for administrative reasons and with difficulties over my own health meant the process became much longer than I would have wished. endstream endobj startxref England, Population 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. Attendance of the course includes access to the database of cases associated to this event on our server at PostDICOM. An X-ray showed a spiral fracture of the left humerus. the fractures to the right tibia and the proximal left tibia are likely to have occurred at the same time, and that that is the likely time-frame for them both.19. On 24th October 2011 a skeletal survey detected what appeared to be two left rib fractures. "There seems to be a small group of expert witnesses who often condemn parents. 11. 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. Metaphyseal fracture of the proximal left tibia caused when (a) her left leg had been pulled and twisted by an adult carer; (b) any person present would be immediately aware she had suffered a significant injury with discomfort lasting several days. Father said that he was told it was likely that she would get a high temperature and her thighs might swell. "It was felt that it was a matter of such complexity and range of opinion that it was a matter for court determination.". BSc, MBBS, MRCP, FRCR, PhD, FHEA 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. 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. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. The note records both mother and grandmother as being present. 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. You can book online your appointment and hire medical insurance online. The father maintains that there could be some natural explanation for S's injuries.38. No temperature. An X-ray was performed at the time along with other tests and appeared to present no bony injury and no metaphyseal infraction. The constellation of findings is highly indicative of non-accidental injury by an adult. 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. To access the survey, please click here. 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. Fee includes 90 days of access with unlimited playback during this time. 3.o-VR;+lZsA30PK#>] FP+irJBp%MU :g I{,8fVn|aQY/,E/sa8Cd8sfhD5wGtkE4*8*q0zW,7(Ic On examination, the left knee was "warmer to touch than the right, with mild erythema and swelling over the knee". Have you had a video or telephone consultation with us? You'll get immediate feedback and learning points from our expert faculty member. Several of these fractures are highly specific for non-accidental causation by an adult. He refused to feed and the next day Mrs Ward took him to see her GP. So the records engage even closer scrutiny. The Judge formed the view that the maternal grandmother was seeking to assist the Court in her evidence. Birmingham B4 6NH, Questionnaire for parents with children aged 5-9, Monday, Wednesday and Thursday/Friday afternoon, Four to six times per year at Queen Elizabeth Hospital on a Tuesday morning. Catch-up service: Paediatric Radiology 2022, Catch-up now with our case-based Paediatric Radiology webinar that took place in February 2022. (9) He anticipated that S's level was 30-35 when she was born, not adequate and markedly deficient. The father's evidence was that during the morning she had cried more than normal and he confirms that she was "grumpy and crying". 22. The parents needed to be careful over his food, medicine and health. Show number . Book yoUR 2023 CME TODAY. Birmingham B15 2TG, Birmingham Children's Hospital Full access to the cases to follow alongside with the sessions. The father's main recollection seemed to be that S was "very quiet" on the Friday, although he had told the police on 24 October 2011 she was "fine" on that day. N and D appeared able to actively provide a high level of basic care for their children.'. (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. hbbd``b`J5 `n\ a#H #e \ 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. Left upper arm fracture, a spiral fracture of the distal shaft of the left humerus (16th-19th October 2011). The paediatric clinicians note records that "yesterday evening the parents noted [her] crying and unsettled, left leg persistently held in a flexed position." No local tenderness in leg or hip", S was x-rayed, but nothing abnormal was observed. The other parties to the case are S's parents, who are married. The family's nightmare began one night in July 2005 when, at three months old, William woke up in pain. 3. 7. 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. Any specialty The memories of the parents were assiduously and closely examined by all counsel and compared with the notes written at the time.28. Doctuo 2023 Last modification: 02-03-2023, Birmingham Children'S Hospital, Birmingham. Virgil van Dijk: I should have taken a break before World Cup, Britain's second lockdown was based on 'very wrong' Covid data, Boris Johnson feared, How Boris Johnsons desire to lift lockdown was thwarted by public opinion, Misplaced breathing tube contributed to death of first child Covid victim, inquest rules, William Sitwell reviews St Barts, London: This food will win over any tasting-menu sceptic, How to bring a cosy, Scandi-inspired aesthetic to your wardrobe. (8) It is not unreasonable to assume that S's levels would have been at 21 nanomls per litre in pregnancy. Dr. 43. They are, in my survey of the evidence, more likely to have a genuinely accidental cause, but because of the evidence of Professor Nussey taken with the evidence of the parents and from the records available it is not possible to reach a view that is more than speculative as to the timing of the injuries. 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 repeated fractures and had a history of being abused. Filming William asleep at night they discovered he moved vigorously during his sleep, repeatedly kicking his legs. The Wards subsequently won a legal fight in the High Court for the judgement to be made public. an improved understanding of Paediatric imaging interpretation and reporting skills. He has co-authored over 35 peer reviewed papers. 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. 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. 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. I therefore come to the conclusion that the local authority has not discharged the burden of proof on the balance of probabilities. She was accompanied by both parents. 20. 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. 49. 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. All prices include VAT, Viewers will be asked to evaluate each session and will be provided with a CPD certificate upon completion 6. 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. S was sent for x-ray, which revealed a spiral fracture of the left humerus. 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. 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. ,(`df\CT&B6+c! The record confirms the father's account that they had been advised to use Infacol, had done so and that it was not working. 6. I have noted and examined the oral evidence of Dr Fairhurst. Hence attendance at A&E.". Mindelsohn Way there is a stage of rickets before it is identifiable radiologically. He has been able to contribute vital knowledge and information towards understanding S's condition in August, September and October 2011. 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. Dr. Johnson is presently the Chair of theBritish Society of Paediatric Radiology. Naturally the Wards hoped social services would follow suit, but they were in for a shock. 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. The father completed a course in tourism management and completed a post-graduate degree in business management. 5. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. The Wards were arrested and questioned by police on suspicion of grievous bodily harm and child cruelty towards William. He asserts that he had not witnessed the mother or grandmother behave in this way and did not believe they would have done so when he was not present. Our imaging courses are very much an interactive experience. His claim that William had suffered four fractures on at least two occasions was contradicted by their assertion that he had only two fractures, both of which had probably been caused at the same time. 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. 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. The parents agreed to section 20 accommodation on 27.10.11 and on 2.11.11 the local authority issued care proceedings. The Judge surveyed the 'wide canvas' of the case including the manner in which the parents gave their evidence. 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. Course in tourism management and completed a post-graduate degree in business management would follow suit, but were! Child cruelty towards William account of the case are S 's injuries.38 because! 'Wide canvas ' of the left humerus has been there since 1998 and arguably an expanding and one... Of his pain could not be found, they took him to see her.! 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