16. 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. I note his view that osteogenesis imperfecta was 'exceptionally unlikely.' A week later William was placed on the council's child protection register. 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. Dr. Foster spent two and a half years working in paediatricsbefore moving into radiology. 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. Read full profile Dr Khushnood Alam Consultant Radiologist Biography pending. 4. 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. 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. hbbd``b`J5 `n\ a#H #e \
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. You will maintain your access to the resource throughout your 60 day catch-service period too. Left lower leg fracture, a metaphyseal fracture of the left tibia (shin bone) (3rd-10th October 2011). Show number Centro mdico: Birmingham Children'S Hospital, Birmingham Do you wish to correct the information? Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. At that point a number of problems faced the court. On 16 September 2011, S was seen for her 6-week check. 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. 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 constellation of findings is highly indicative of non-accidental injury by an adult. He noted that there is no uniformity of Vitamin D testing and it is difficult to measure. 20. It is reasonable to conclude that they were lower before then because she was breastfed. 06. 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. 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 is the radiology lead for child protection, rheumatology, orthopaedic and skeletal dysplasia multidisciplinary meetings at Alder Hey Childrens NHS Foundation Trust. 6. A spiral fracture requires a force to cause a fracture in this way that is 'well beyond that used during normal day to day handling.' 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). 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. S has suffered multiple fractures which have occurred on at least three separate occasions. "There seems to be a small group of expert witnesses who often condemn parents. Tell us your views in a simple 5 minute survey to help us make the service even better. 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. xYYo~o!baX_{da+LV"gy8du|UU]^|^y^]](g1qV&QdLY$aqT\
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g-lZ['#.5\K,H The appearance and identification of the fractures themselves has only emerged after the examination of the x-rays by a number of clinicians. The local authority issued care proceedings on 2nd November 2011. 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. The record shows "baby crying and unsettled today. On 22 October a skeletal survey was performed and reported on by Dr Steven Johnson, Consultant Radiologist. Determined to establish what was wrong they returned twice to the GP, but he was still unable to offer any diagnosis. 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. 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. Left leg thigh bone fracture, a torus fracture of the distal left femur (30th September-10th October 2011). It was also noted that the parents were unsure how it had happened and there had been no recent accidents or falls. No plausible explanation has been offered for any of these injuries. 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. Her parents returned with S on 22.10.11 with a swollen arm. Consultant Paediatric Radiologist, Chair of Paediatric Musculoskeletal Imaging, Chair, University of Sheffield's Black, Asian, and other Minority Ethnic (BAME) Staff Network, University of Sheffield and Sheffield Children's Hospital. 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. On 22 September 2011, S is recorded as having the first of her immunisations at the Medical Centre. 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. She obtained her MBBS while working at Oldchurch Hospital, Essex and trained as a radiologist in Sheffield. Dr. Robert H. Thomas is a Radiologist in Birmingham, AL. (6) It is not possible to say what difference formula feeding might have provided because there is no baseline to measure from. Fee includes 90 days of access with unlimited playback during this time. 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. At 6.20pm on 13 October 2011, S was brought to the local hospital, with the presenting complaint "swollen left knee started yesterday." 11. 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. In all sections, the value of all imaging modalities are stressed. On examination, the left knee was "warmer to touch than the right, with mild erythema and swelling over the knee". Interactive case-based approach using a powerful online DICOM viewer to maximise learning. I considered that the family members have a very close bond and I did not observe any concerns regarding their attachment. The maternal grandmother's position can most usefully be seen as set out in her position statement of 12th March 2012. Aged 20 in December 1999, she had married the father just before he came to England She joined him in this country in October 2003. Within each chapter there are three consistent sections. At para. The Judge formed the strong impression that the parents were careful, child focused parents who had demonstrated good quality parenting dealing with S's older sibling.The Judge took into account the evidence of an endocrinologist who opined that the absence of radiologically identifiable rickets did not mean there were no rickets. Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. 34. The Father said in evidence that when the hospital phoned on Monday morning, his wife told them that S was "fine".21. Mrs A Jester 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. 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. When the cause of his pain could not be found, they took him back twice more. 5 of my judgment on 26th March 2012. Dr Landes is radiology trauma lead and has contributed to the Royal College of Radiologists (RCR) guidance on imaging in paediatric trauma. 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. 2. Book yoUR 2023 CME TODAY. 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. 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. 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. A number of strengths however have been identified during this short involvement. "It was felt that it was a matter of such complexity and range of opinion that it was a matter for court determination.". Formula feeding for 8-9 weeks before the test would have provided some improvement but not enough, as breastfeeding would provide none. On 17 August 2011, S was taken to the clinic at 4 weeks old to be weighed. The book is an important revision aid as well as an up-to-date reference. 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. He was diagnosed with Hirschsprung's disease, remaining under the care of a London hospital's surgical team with 6 monthly checks. 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. 5. 34 0 obj
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49. 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. 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. 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. 14. 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. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. The GP's entry records "crying, excessive ? The GP note for 20 October 2011 records "First meningitis vaccination. 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. 15. Location At one week she was seen by the Community Nurse and was reported to be "thriving, contented and settling well." The first time a fracture was noticed was on 22nd October despite an X-ray having been taken of S's knee on 13th October.S had been in the care of her parents and maternal grandmother when the fractures occurred. When to refer and why Dr Rajendranath Sinha, The Newcastle upon Tyne Hospitals NHS Foundation Trust 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. Post-immunisation advice was given". There are a number of other features of the evidence about the parents which I must take into account as part of the 'wide canvas' of evidence that I have surveyed. 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. 52. 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. General radiologists and senior radiology trainees Radiologists with an interest in Paediatric Radiology The content Ten sessions over two days: Head and Neck Chest Gastrointestinal Genito-urinary MSK: Non-Traumatic Inflicted Injury: Brain MSK 1: Traumatic (inc Inflicted Injury) MSK 2: Differential diagnosis Inflicted Injury: A Medico-Legal Update Erythematous [reddening on the skin]. The parents/grandparent who did not inflict the injuries on each occasion to S failed to protect her. I record at this point in the narrative that an important incidental date occurred on 15 September 2011, namely the starting date when according to Dr Fairhurst, the first fracture may have occurred. Country X-rays An X-ray was performed at the time along with other tests and appeared to present no bony injury and no metaphyseal infraction. She was discharged from hospital on 25 July 2011. The strong impression given is that the parents and maternal grandmother are careful, child-focused and conscientious parents who have demonstrated the quality of the attention they have given to dealing with T's special health needs and to S as they have arisen. Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. I therefore come to the conclusion that the local authority has not discharged the burden of proof on the balance of probabilities. 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. The father completed a course in tourism management and completed a post-graduate degree in business management. But during the family court proceedings serious doubts were cast on Dr Johnson's evidence by other medical experts. 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. The Wards were only allowed to take William home with them when they agreed to be supervised 24 hours a day by Mr Ward's parents, who had to relocate from Devon to move into the couple's home. It soon became clear that both the police and social services were relying heavily on the evidence of Dr Johnson, who said that William had suffered four fractures which had taken place on at least two or more separate occasions. Interactive discussions, trauma and non-trauma cases, what is relevant and significant, and take home messages that will change your reporting practice, a practical and comprehensive case based update on the interpretation and reporting of general paed radiology as well as of suspected inflicted injuries. 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 Birmingham Update in prostate cancer Topics to include: . Father said that he was told it was likely that she would get a high temperature and her thighs might swell. The Judge found that neither parent was seeking to cover up matters or to deal other than truthfully to the best of their ability. 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. colic/reflux." 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. She was discharged home, with instructions to the parents to phone on Monday [19th] to have her reviewed or returned if they were concerned, and to re-present her over the weekend if her temperature, swelling or redness of the leg increased, if she was unsettled or if her feeding reduced. The final section details the imaging findings in a wide variety of clinical conditions. 17. Metaphyseal fractures result from pulling and twisting being applied to the limb. Dr Fairhurst thinks that they may have been sustained as I set out in their approximately chronological order: 1. The Judge formed the view that the maternal grandmother was seeking to assist the Court in her evidence. Earlier records that day mention mother and father being present. 9. 135; "There are areas of ignorance. Furthermore, Professor Tim David, an expert paediatrician, told the court that in this and many other cases, police and social workers were wrong to assume that an unexplained injury could normally be attributed to child abuse. He has co-authored over 35 peer reviewed papers. 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. I have noted the reference to Lancashire County Council v B [2000] AC 147. * Panorama's Please Don't Take Our Child is broadcast on BBC One tomorrow at 8.30pm. Victoria and Jake Ward and William, right. The professional couple were shocked to be told eventually that William had a broken leg. The fractures at 2, 3 and 6 above were only identified by Dr Fairhurst. I return to consider T and his behaviour later in this judgment.12. In the course of surveying the 'wide canvas' of evidence I have reviewed the evidence of the mother, the father and the grandmother. Rent and save from the world's largest eBookstore. Yet even after the criminal case collapsed for lack of evidence and a family court finally decided that the parents posed no threat to their son, the couple were astonished to find that the names of the doctors who had given evidence against them were kept secret. At one point, he mentioned that they had thought it was due to her immunisation that she was not using her left hand. Site map, Please rate your experience out of 5 (with 5 being the highest and 1 being the lowest), Birmingham Women's Hospital The mother, father and grandmother all said that Infacol did eventually help for a time before her crying became worse again.15. 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. I accept the submission that there is a lack of current research on the susceptibility to fracture in babies who are Vitamin D deficient. You can book online your appointment and hire medical insurance online. (10) His view was that it was likely that S was Vitamin D deficient in utero and in the early neonatal period. There is no radiological evidence that S suffers from rickets or any other vitamin deficiency. There were evident deficiencies in translation by the interpreter. This could increase bone fragility and give rise to fractures at a lower force than would otherwise be the case. At 18.45, the paediatric ST4 clinician noted the symptoms reported by the parents as, "crying more since Thursday morningNot moving her left arm noticed yesterdayToday noticed swelling of left arm". Within each chapter there are three consistent sections. 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. greater confidence in managing the imaging of an acutely unwell child. She weighed 6lbs 15 ozs (3.15 kg) at birth and was born by emergency Caesarean section. 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. The deal meant they could never be alone with their own son out of concern that they would cause him further harm. 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