The Court found that the medical evidence raised a substantial likelihood that the injuries were caused non accidentally and by force used by at least one of the adult members of the household. The deal meant they could never be alone with their own son out of concern that they would cause him further harm. 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. 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. (6) It is not possible to say what difference formula feeding might have provided because there is no baseline to measure from. Left lower leg fracture, a metaphyseal fracture of the left tibia (shin bone) (3rd-10th October 2011). 15. This, unfortunately, was soon to change. I note his evidence as to the prevalence of Vitamin D deficiency, particularly in Asian sub-groups, and his view that the absence of radiological evidence does not mean that there is 'no rickets' i.e. Thank you! 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. 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. I note in particular the five times when she was seen at medical appointments when she was said to be suffering fractures. The record concludes with the GP's comment "All well. xYYo~o!baX_{da+LV"gy8du|UU]^|^y^]](g1qV&QdLY$aqT\ G~k)UwalB^d!/^I8>goAXX""~vQ^eTT'YC g-lZ['#.5\K,H There is no radiological evidence that S suffers from rickets or any other vitamin deficiency. I go into detail on the background facts to this case which important in my consideration because they form part of the 'wide canvas' mentioned by the President Lady Butler-Sloss in the case of Re U (Serious injury: standard of proof) [2004] 2 FLR 63. Notwithstanding that, I formed the impression that she was seeking to assist the court. 22. The family are very close and have a loving relationship. An X-ray showed a spiral fracture of the left humerus. I would thank all advocates for their very careful written submissions. ,8KaF"*w!$uOEF!1 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. The report states that S: 'cried a lot last few weeksMore over last 2 weeks and then doesn't want to be fedTends to cry more in the eveningHave used Infacol under advice from the H/V but no improvement yet. He also is an expert of considerable renown. 7. She weighed 6lbs 15 ozs (3.15 kg) at birth and was born by emergency Caesarean section. 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. 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. 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 Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. 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. Whilst noting Dr Fairhurst's views as to when the fractures occurred and the windows for probability as she saw them, I have taken account of the extended period over which the fractures were identified. If no better, to review or sooner at any time if concerns'. 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 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. Firstly, it had become evident that the court required the assistance of an expert in paediatric bone disorders. 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 note his view that osteogenesis imperfecta was 'exceptionally unlikely.' Karl John Johnson Radiologist Steelhouse Lane, B4 6Nh, Birmingham, England. (5) S's Vitamin D levels, which were on the borderline on 2nd November 2011, were never higher than insufficient. Interactive case-based approach using a powerful online DICOM viewer to maximise learning. I have in particular noted the GP entry reports and the visits made by the parents for checks or routine appointments. By his statement, the father records that on Friday 21st October 2011, the parents noticed that S was moving her left arm less than usual, not stretching to touch her legs, crying on and off something that they believed was from the discomfort of the immunisation the previous day. Her special interests include musculoskeletal radiology and trauma, particularly imaging in inflicted injury. Left leg thigh bone fracture, a torus fracture of the distal left femur (30th September-10th October 2011). 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. 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. I do not form the impression that they could be seen then or with hindsight can be seen now as a family seeking to hide their ill-treatment of S from the authorities. Paediatric Radiology opens with a chapter devoted to the different imaging modalities, including radiographs, fluroscopy, ultrasoound, CT, MRI and nuclear scintigraphy before moving on to more detailed, systems-based chapters. 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. 54. The parents were unable to offer any explanations and had not observed any accidental events that may explain these injuries. A number of strengths however have been identified during this short involvement. 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. 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. "It was a nightmare which seemed to be spiralling out of control.". I make this observation. None of the fractures could have occurred at birth. Presentations are kept to the minimum and then you'll be into the fully featured cloud based DICOM viewer, looking at cases, feeding back your findings using our interactive tools. 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. Their care of the children has been observed as of high quality. Mrs K Oestreich Prof T Southwood Dr Karl Johnson: Tumour Clinic (LTB Clinic) Tuesdays once per month: Ms Baldrighi: The Transition Clinic : Four to six times per year at Queen Elizabeth Hospital on a Tuesday morning : . 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. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. The NPI Enumerator can be reached at (800) 465-3203 or P.O. 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.". The family's nightmare began one night in July 2005 when, at three months old, William woke up in pain. I considered that the family members have a very close bond and I did not observe any concerns regarding their attachment. 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. This company officer is, or was, associated with at least 1 company roles. Steelhouse Lane UK based, CPD accredited, online courses for doctors in all of the major specialties, Navigation: 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. 3. Attendance of the course includes access to the database of cases associated to this event on our server at PostDICOM. 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. When to refer and why Dr Rajendranath Sinha, The Newcastle upon Tyne Hospitals NHS Foundation Trust Take a look at our extensive range of Imaging courses coming up, available virtually, on-demand and in-person, in study . VOIT$=EfPuP^ AiiUw~,JZ%?rG?("S{t }p# y|!W7XQb,{*|p>'A7:#;p`Wnx n&Thb !pA}ifRh0$*W@~n0?Olgj;|TO^,WicR|WV2riRm- Dr. Jackson's office is located at 2204 Lakeshore Dr . 35. On being released on bail they were immediately suspended from their jobs. 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. The mother, father and grandmother all said that Infacol did eventually help for a time before her crying became worse again.15. 45. Detectives removed the cot for examination. At 6.20pm on 13 October 2011, S was brought to the local hospital, with the presenting complaint "swollen left knee started yesterday." The local authority place considerable weight on the evidence of Dr Fairhurst as to the interpretation and significance of the X-rays, the report of 13th February 2012 and the evidence as to the mechanism of injury in relation to spiral fractures, metaphyseal fractures, fractures of the antero-lateral aspects of the ribs and a torus fracture raise very serious implications for the family members. S would often cry and it was initially believed that this was due to her suffering from colic. Find Dr. Jackson's phone number, address, hospital affiliations and more. Excellent peer interaction and collaborative learning. , B4 6Nh, Birmingham, England i formed the impression that she was seeking to assist the court the. Careful written submissions and It was a nightmare which seemed to be suffering fractures become evident that the court the. Initially believed that this was due to her suffering from colic fracture of the distal femur! 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