This, unfortunately, was soon to change. 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. 11:00-11:30 Imaging of arthritis Dr Emma Rowbotham, Leeds Teaching Hospitals NHS Trust 12:00-12:30 Common paediatric MSK conditions Dr Karl Johnson, Birmingham Children's Hospital NHS Foundation Trust 12:30-13:00 Soft tissue and bone lesions. an improved understanding of Paediatric imaging interpretation and reporting skills. 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". The maternal grandmother ('the grandmother') is also a party, as she was present in the family home at the material time, and has been represented by Miss Trustman. The parents agreed to section 20 accommodation on 27.10.11 and on 2.11.11 the local authority issued care proceedings. 22. On the balance of probability T could not have caused the injuries to S. 16. 44. He also is an expert of considerable renown. 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. In this case the local authority brings proceedings for Public Law orders relating to S, born on 18th July 2011. 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. 04. 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. Considering the totality of the evidence the Judge found the likely incidence of an increased vulnerability to fracture was the most likely cause of S's injuries. Earlier records that day mention mother and father being present. 35. 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. %PDF-1.6 % Interpretation & Reporting Webinar for the General Radiologist, DAY 1: GENERAL PAEDIATRIC RADIOLOGY - WEDNESDAY 9 FEBRUARY 2022 The judgment that I gave that day is subsumed into this fuller judgment of the court.02. 11. endstream endobj 35 0 obj <>/Metadata 4 0 R/Outlines 8 0 R/Pages 32 0 R/StructTreeRoot 11 0 R/Type/Catalog>> endobj 36 0 obj <>/MediaBox[0 0 595.32 841.92]/Parent 32 0 R/Resources<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 37 0 obj <>stream At 22.30, a further medical clinician's note was written, although the authorship is not clear. Her evidence was that the earliest date for the rib fractures was 15 September, the latest date being the 28 September 2011. But the drama turned into a nightmare when they were accused of having deliberately harmed their little boy. John is a Consultant Endocrinologist at Queen Elizabeth Hospital Birmingham (QEHB) and an Honorary Senior Lecturer at the University of Birmingham. The father accepts that only he, the mother and the grandmother were caring for S during this time. You can book online your appointment and hire medical insurance online. 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. Country I draw the conclusion that it is reasonable in S's case to assume that a lesser degree of force would be required if her bones were sub-optimal as a result of Vitamin D deficiency, which I am satisfied on the evidence that S's bones probably were, viz., Vitamin D deficient. Mindelsohn Way Birmingham B15 2TG 0121 472 1377 Birmingham Children's Hospital Steelhouse Lane Birmingham B4 6NH 0121 333 9999 Quick links Terms and conditions Give us your feedback Publications and reports Staff links AccessAble Freedom of Information Privacy Policy Accessibility statement Join us on social media Support us Nothing untoward is reported by the clinician who weighed her and the Health Visitor could not recall S as being unhappy.23. Karl John Johnson Radiologist Steelhouse Lane, B4 6Nh, Birmingham, England. The NPI Enumerator can be reached at (800) 465-3203 or P.O. (9) He anticipated that S's level was 30-35 when she was born, not adequate and markedly deficient. We adopt the following: i. 14. &/6kc`&EnFl! h~aka }mfh{p#P\fv}Clh+r9>XY7U&l5 tfL(h~)=O.szywUafH9!dN2-bs4XW+w2?b;NWNl 5ybc i20 V*a Qjff`# 2E,C\v{:]nJI'G,6]$kBEGs0XX'O-J(|- KTg}LzgNY 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. The maternal grandmother's position can most usefully be seen as set out in her position statement of 12th March 2012. This led to a referral by the consultant paediatrician from the local hospital to Social Services. Ms Baldrighi, Back to top of page I therefore come to the conclusion that the local authority has not discharged the burden of proof on the balance of probabilities. The local authority issued care proceedings on 2nd November 2011. Dr Landes is radiology trauma lead and has contributed to the Royal College of Radiologists (RCR) guidance on imaging in paediatric trauma. endstream endobj 38 0 obj <>stream X-rays Interactive case-based approach using a powerful online DICOM viewer to maximise learning. At para. The x-ray of the left femur had been reported as showing no bony injury on 13 October 2011 and no obvious metaphyseal infraction. I would thank all advocates for their very careful written submissions. hmk0^g? 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 When the cause of his pain could not be found, they took him back twice more. Father said that he was told it was likely that she would get a high temperature and her thighs might swell. 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.'. Caroline Coady Specialty: Gastrointestinal Radiology. S's Vitamin D levels were borderline on 2.11.11 and were never higher than insufficient. S could not have been injured when in a bouncy chair from normal use. He was diagnosed with Hirschsprung's disease, remaining under the care of a London hospital's surgical team with 6 monthly checks. The parents and the maternal grandmother, she asserts, would all take care of S and T throughout the day. VOIT$=EfPuP^ AiiUw~,JZ%?rG?("S{t }p# y|!W7XQb,{*|p>'A7:#;p`Wnx n&Thb !pA}ifRh0$*W@~n0?Olgj;|TO^,WicR|WV2riRm- 941-697-3552. Companies associated with this officer had at least 253,361 shareholder value in recent accounts. On the contrary, the evidence appears to demonstrate that the parents had the wellbeing of S in mind and acted to seek medical attention. The mother, father and grandmother all said that Infacol did eventually help for a time before her crying became worse again.15. 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. 13. The father maintains that there could be some natural explanation for S's injuries.38. 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. 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. He found it was not possible to conclude at what point normal day to day handling crossed over to the point when S's vulnerable bone structure was compromised and exceeded. I am satisfied that neither the mother, the father, nor the grandmother can be held responsible for causing the injuries in a non-accidental or careless way and the court remains unable to find any one of them more likely than the others to have caused them. Considering all the evidence on the balance of probabilities I have come to the conclusion that the likely incidence of an increased vulnerability to fracture is the most likely cause of S's injuries. 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. Doctuo 2023 Last modification: 02-03-2023, Birmingham Children'S Hospital, Birmingham. 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 in particular noted the GP entry reports and the visits made by the parents for checks or routine appointments. 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 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. She refers to the fact that in relation to allegation 3, 4, 5 and 6 the mother had noticed the child's discomfort and taken S to the Medical Centre and then on to the Accident and Emergency Unit at the local hospital where S was examined by a paediatrician and X-rayed, following which she was told that everything was normal and she was discharged. 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. Her parents returned with S on 22.10.11 with a swollen arm. I return to consider T and his behaviour later in this judgment.12. 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. Dr Neil Stoodley, Consultant Neuroradiologist, Bristol Royal Hospital for Children Dr Caren Landes, 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, 012 133 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. Detectives removed the cot for examination. The Father said in evidence that when the hospital phoned on Monday morning, his wife told them that S was "fine".21. He noted that there is no uniformity of Vitamin D testing and it is difficult to measure. A week later William was placed on the council's child protection register. 43. Birmingham Update in prostate cancer Topics to include: . Doctors, medical appointments, hospitals, medical staff. 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. This would have involved manipulation of the legs and arms, and the conducting of other tests. Akin, MD, Diagnostic Radio Her weight gain was recorded as normal. 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 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. They both appear to value education and a need to promote this ethos with their children. 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. 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. 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. She was born in 1979. Dr Johnson, however, reported "a number of equivocal appearances on radiographs with respect to the left distal femur and proximal left tibia" and suggested further films. 0121 472 1377. I make this observation. 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. 42. I adjourned the hearing with directions for written submissions but anticipated that the particular difficulties of the case, its subject matter and the possible issues arising over evidence, required a further hearing for the parties to address the court having exchanged their submissions. Her mother is D, represented by Mr Jayatilaka. 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. I considered that the family members have a very close bond and I did not observe any concerns regarding their attachment. 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. She presented with no bony injury and was discharged. 17. 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. 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.". He has been able to contribute vital knowledge and information towards understanding S's condition in August, September and October 2011. Birmingham Women's Hospital Mindelsohn Way Birmingham B15 2TG . When S was born on 18 July 2011, T was 3 years and 5 months old. The Judge formed the view that the maternal grandmother was seeking to assist the Court in her evidence. S would often cry and it was initially believed that this was due to her suffering from colic. 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. 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. 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. Full access to the cases to follow alongside with the sessions. The parents' observations are also a matter of record, as are the consultants' examination. 55. I have taken account of the fact that she gave her evidence through an interpreter while having at least a working grasp of English. This advanced Infomed webinar is in response to suggestions/feedback from many general radiologists, who have attended Infomed courses, more lately webinars, and now with the easing of the pandemic see the need for a focussed and comprehensive Paediatric Radiology CPD programme. 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. 15. S had regained and passed her birth weight. I record in relation to the father that I found his evidence and his certain directness in quality with immediate and unhesitating answers suggested a genuine response. 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. On examination, the left knee was "warmer to touch than the right, with mild erythema and swelling over the knee". Recurrence is not in itself probative;iii. *ReTXgZ; CQ7Z9zjCpaab?E.b?r+d,iQPO&[slRQqBojGa"!K-=TMF (VB]q|G.HViVB 57'>]E%Y}2otF{iQ8Eef3Pc\Hu ZM,KW}JhP='+tZi~3dG%mlz@q48z)QYf 1hf"$HyG).f"I$tVQ++T*92{pkUKs Within each chapter there are three consistent sections. If S were to be found responsible he offered the view that that would imply very poor supervision of T over a period of time. 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. * Panorama's Please Don't Take Our Child is broadcast on BBC One tomorrow at 8.30pm. Fee includes 90 days of access with unlimited playback during this time. In the course of surveying the 'wide canvas' of evidence I have reviewed the evidence of the mother, the father and the grandmother. Extensive high quality images throughout the book, and additional illustrations, aid the reader with diagnosis and detailed referencing points to further reading. The parents did not mention the previous weekend's symptoms or the trip to the hospital on 13 October 2011.24. 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