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. 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. 941-697-3552. Attendance of the course includes access to the database of cases associated to this event on our server at PostDICOM. Left lower leg fracture, a metaphyseal fracture of the left tibia (shin bone) (3rd-10th October 2011). I do not propose to set out all the instances or to address them individually: to do so would be disproportionate in the light of my observations about the evidence of the parents, having listened to them carefully, considered at length the sort of people they are, and the impression that each gave to the court. The X-ray revealed a spiral fracture of the left humerus. 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. 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. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. there is a stage of rickets before it is identifiable radiologically. 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. We adopt the following: i. Clinic Locations. 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. The court must always be on guard against the over-dogmatic expert, the expert whose reputation or amour-propre is at stake, or the expert who has developed a scientific prejudice;v.The judge in care proceedings must never forget that today's medical certainty may be discarded by the next generation of experts, or that scientific research will throw light into corners that are at present dark.". Full access to each case with a full toolset to open, view and manipulate each case alongside the faculty but on your own screen! His research and clinical interests include the pathogenesis [.] British Society of Paediatric Radiology: Paediatric MRI for general radiologists - tips and tricks 16:50 - 17:10 Musculoskeletal (MSK) imaging Dr Karl Johnson, Birmingham Children's Hospital NHS Foundation Trust Learning points In the maturing child, the marrow signal will alter depending on the amount of haemopoietic and fatty tissue within it. 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 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. 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. Because William's parents were unable to explain the fracture the hospital deemed the case suspicious and called in social services. Earlier records that day mention mother and father being present. 2018 Karen Johnson Andrea Schnell, a Internist practicing in Madison, WI March 27, . The father said in oral evidence that S developed a pattern of crying after 3 to 4 weeks old, particularly in the evenings. S was sent for x-ray, which revealed a spiral fracture of the left humerus. T was described as "very attached to his mother" becoming jealous when mother was with S. He was described on examination as very active in clinic, playing with his sister and wanting to hold her. 8. 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. 2023Check Company | Privacy | Terms of Use | Contact Us. Mr Sami Al-Ani The family are very close and have a loving relationship. She said: "How could we celebrate that someone has decided you didn't hurt your child when you know all along you didn't? She was born in 1979. The maternal grandmother's position can most usefully be seen as set out in her position statement of 12th March 2012. 34. Her evidence was therefore protracted and interrupted and I note Miss Trustman's observation that her evidence lasted in Sri Lankan time from 4:05 pm to 8:20 pm, and I have no reason to doubt the accuracy of that record. 06. 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. 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 denies causing any of the injuries and in turn denies the specific causation of each injury. I therefore come to the conclusion that the local authority has not discharged the burden of proof on the balance of probabilities. 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.". 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. 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. 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 x-ray of the left femur had been reported as showing no bony injury on 13 October 2011 and no obvious metaphyseal infraction. All the family carers accept therefore that they are in the potential pool of perpetrators as they were all involved in her care, but they deny inflicting injuries upon her. 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. Take a look at our extensive range of Imaging courses coming up, available virtually, on-demand and in-person, in study . 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. I have taken account of the occasions when S was seen by medical staff. The fractures at 2, 3 and 6 above were only identified by Dr Fairhurst. I have also noted in relation to the injuries that it is 'always open to a judge to rule that the cause of the injury remains unknown' and the case of Re R (Care proceedings: causation) [2011] EWHC 1715, a decision of Mr Justice Hedley. 11. You'll get immediate feedback and learning points from our expert faculty member. 22. 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. I note at p. 3 the following: 'Children's Services have only become involved with this family since 23rd October 2011 therefore there has been limited time to complete any thorough assessment with regards to this family. Apyrexial. On 24th October 2011 a skeletal survey detected what appeared to be two left rib fractures. The Judge was satisfied that neither the mother, father, nor grandmother could be held responsible for causing the injuries. Displaying companies where the director has shareholdings or significant control. To summarise further, I have noted the pattern of the family's care for the children and reviewed the detail of the entries in the GP records which record S's progress and visits with the record of her developing a tendency to cry a lot from 17th August 2011 and the advice that it was possibly colic; the parents' use of Infacol and S's response to that. It must also raise as a real possibility the potential explanation that T may have brought about one or more fractures, along with the possibility less likely, in my view that S may have been injured when the family slept together in one bed. Opportunity to submit questions by email to the faculty. The father completed a course in tourism management and completed a post-graduate degree in business management. 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. Dr. Robert H. Thomas is a Radiologist in Birmingham, AL. 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 endstream endobj startxref 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. 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. Consultant Paediatric Radiologist and Service Group Lead for Radiology, Alder Hey Childrens Hospital, Liverpool, UK. DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. There was then a further sharp issue over which expert should be instructed in this field which was not brought before the court until 24th May 2012. You will maintain your access to the resource throughout your 60 day catch-service period too. At hospital on Saturday 22 October 2011 at 15.30, the triage nurse noted the presenting complaint as "swelling to the left upper arm" and "since Thursday, increased crying". On being released on bail they were immediately suspended from their jobs. I considered that the family members have a very close bond and I did not observe any concerns regarding their attachment. (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. The fractures of the ribs require considerable force and well in excess of day to day handling or even rough play. Based primarily on the evidence of Dr Fairhurst, the local authority has levelled a broad spread of allegations against the three adults in the household at the material time the mother, father and grandmother. 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. Print this page The local authority issued care proceedings on 2nd November 2011. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. 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.' 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. 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. On 16 September 2011, S was seen for her 6-week check. 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. S could not have been injured when in a bouncy chair from normal use. The Judge formed the view that the maternal grandmother was seeking to assist the Court in her evidence. 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 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. Fax 847-678-6286 Tooting whose report is at E76-E 279 and Dr. Karl Johnson, consultant paediatric radiologist at the Birmingham Children's Hospital . The local authority goes on to make the following allegations which I give as numbered in the Scott Schedule: 7. 47. 09. He has co-authored over 35 peer reviewed papers. Again I did not get the impression that this was a man seeking to cover up matters or deal other than truthfully to the best of his ability with matters as he remembered them. UK based, CPD accredited, online courses for doctors in all of the major specialties, Navigation: Prof Amaka Offiah is a Professor in Paediatric MSK Imaging at University of Sheffield, and an Honorary Consultant Paediatric Radiologist at Sheffield Children's Hospital. The maternal grandmother had no concerns in relation to the parents' care for both S and T and would like S to be returned to her parents' care.40. Victoria and Jake Ward and William, right. Have you had a video or telephone consultation with us? s Pediatric Diagnostic Imaging textbook is renowned as one of the oldest and most prominent general textbooks in the field of paediatric text consists of two reasonably sized volumes covering all key areas using an intuitive systems-based approach. They both appear to value education and a need to promote this ethos with their children. 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. Post-immunisation advice was given". The record shows "baby crying and unsettled today. View more radiologists birmingham Consultations Consultations Steelhouse Lane, Birmingham, England. In this case the local authority brings proceedings for Public Law orders relating to S, born on 18th July 2011. He was earnest, straightforward and did not quibble with the questions although he did not always understand the question. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. 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