This company officer is, or was, associated with at least 1 company roles. Email this page 5. (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. He was able to extrapolate that S's Vitamin D levels at birth were likely to have been markedly deficient having been Vitamin D deficient in utero. On examination, the left knee was "warmer to touch than the right, with mild erythema and swelling over the knee". Determined to establish what was wrong they returned twice to the GP, but he was still unable to offer any diagnosis. 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. Metaphyseal fractures result from pulling and twisting being applied to the limb. A couple cleared of injuring their baby son have won a legal battle to identify the doctor who gave evidence against them. 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. 2018 Karen Johnson Andrea Schnell, a Internist practicing in Madison, WI March 27, . Recurrence is not in itself probative;iii. Mrs Ward, who at the time worked as a manager for child care strategy for Cambridgeshire, told BBC One's Panorama, in a documentary to be broadcast tomorrow night: "We were absolutely shocked. Consistent with this, the father described a happy baby in the first two weeks of her life. 10. The second section discusses the differential diagnosis of radiological features. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. 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 The appearance and identification of the fractures themselves has only emerged after the examination of the x-rays by a number of clinicians. 41. 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. This person was born in December 1965, which was over 57 years ago. The father completed a course in tourism management and completed a post-graduate degree in business management. 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. At 6.20pm on 13 October 2011, S was brought to the local hospital, with the presenting complaint "swollen left knee started yesterday." I have in particular noted the GP entry reports and the visits made by the parents for checks or routine appointments. Nothing untoward is reported by the clinician who weighed her and the Health Visitor could not recall S as being unhappy.23. Now the Local authority has promptly and appropriately put into effect a revised Care Plan to give effect to the orders made that day. It was noted that the parents were unsure how the fracture may have happened and there had been no recent accidents of falls. I have noted the reference to Lancashire County Council v B [2000] AC 147. The maternal grandmother had not witnessed T intentionally being rough or boisterous towards S and had not witnessed him attempting to hold S or pick her up. 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. I return to consider T and his behaviour later in this judgment.12. The consultant paediatric radiologist was able to date the fractures as follows: The rib fractures occurred between 15th and 28th September 2011. 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. 0 After the immunisation, the parents were advised to give her Calpol. Her research interests are in the imaging of suspected child abuse and skeletal dysplasias and in methods of determining which children have fragile bones prone to fracture and which do not. 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. The mother's tend to be shorter responses but amplify the general stance of the parents as well as the grandmother that while accepting that the fractures occurred and that they occurred while S was in their care they reject the allegations that they caused the injuries in a non-accidental way. *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 4. At one week she was seen by the Community Nurse and was reported to be "thriving, contented and settling well." ,(`df\CT&B6+c! Dr. Foster spent two and a half years working in paediatricsbefore moving into radiology. Three days: 375 | Two days: 295 | One day: 175 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. I have reviewed the symptoms then reported by the parents and their decision to take S back to the local hospital after seeing that her left arm was swollen and her reaction to being dressed or undressed. In all sections, the value of all imaging modalities are stressed. He noted that there is no uniformity of Vitamin D testing and it is difficult to measure. The question arose as to whether genetic abnormality of bones, metabolic bone disease or demineralisation of the bone caused by Vitamin D deficiency gave rise to an increased propensity to fracture. Dr. Gregory D. Jackson is a Radiologist in Birmingham, AL. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. Earlier records that day mention mother and father being present. 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. 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. As to the possibility that rough handling by T might have been responsible for S's injuries, he concluded that while it would be possible he did not think it was probable. In the absence of an explanation of the injury to S's left arm, the Consultant Paediatrician considered that there was a "high level of suspicion that the humeral and rib fractures may have been sustained as a result of non-accidental injury". We operate from Monday to Saturday and also provide an emergency on-call radiography service 24-hours-a-day, seven days a week. Firstly, it had become evident that the court required the assistance of an expert in paediatric bone disorders. There were evident deficiencies in translation by the interpreter. He appeared to be frank and open in his answers and not devious. 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. 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. 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. In surveying the 'wide canvas' further, I take into account the evidence of Professor Nussey because the manifest injuries do call for explanation. DR KARL JOHN JOHNSON is British and resident in England. an improved understanding of Paediatric imaging interpretation and reporting skills. With no help from outside agencies their couple mounted their own investigation into the cause of their son's injuries. 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. The parents were unable to offer any explanations and had not observed any accidental events that may explain these injuries. colic/reflux." 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. 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. One or both of the parents, and/or the grandmother knows what has happened to S on all the occasions she has suffered injury. Have you had a video or telephone consultation with us? 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. Paediatric Radiology opens with a chapter devoted to the different imaging modalities, including radiographs, fluroscopy, ultrasound, CT, MRI and nuclear scintigraphy before moving on to more detailed, systems-based chapters. He trained in Paediatrics and Radiology in Cambridge and London, and was awarded a PhD in brain imaging in 2002 from the University of Cambridge. 20. The maternal grandmother's position can most usefully be seen as set out in her position statement of 12th March 2012. Left knee is swollen, feels hot and tender. Nor is it possible to conclude at what point 'normal day to day handling' a vague phrase at best, and which must include the use of reasonable force and pressure at times crosses over to the point where S's vulnerable bone structure was compromised and exceeded. The advice to 'persist with Infacol' also bears out the father's account. 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. The father's responses set out a general defence to each allegation setting a number of relevant points that formed part of his evidence. Dr Fairhurst thinks that they may have been sustained as I set out in their approximately chronological order: 1. 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. 0121 472 1377. Birmingham Update in prostate cancer Topics to include: . She is the radiology lead for child protection, rheumatology, orthopaedic and skeletal dysplasia multidisciplinary meetings at Alder Hey Childrens NHS Foundation Trust. Nearby doctors Sarah Yusuf Nazia Anwar Kaushal VOIT$=EfPuP^ AiiUw~,JZ%?rG?("S{t }p# y|!W7XQb,{*|p>'A7:#;p`Wnx n&Thb !pA}ifRh0$*W@~n0?Olgj;|TO^,WicR|WV2riRm- A diagnosis of OI (osteogenesis imperfecta) is exceptionally unlikely. 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. 941-697-3552. This further hearing took place on 24th October 2012.08. 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 in particular the five times when she was seen at medical appointments when she was said to be suffering fractures. On being released on bail they were immediately suspended from their jobs. 57 0 obj <>stream Her weight gain was recorded as normal. It is not only the appearance of symptoms, and the timing and description of them with a view to dating the occurrences, even approximately, that has raised a perplexing and indistinct picture with differences in the accounts, and nothing obvious or clear to work on. 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. Over the next 10 months the Wards were visited by at least three expert witnesses who had been asked by the judge to give their opinions. However, on 22nd October 2011 the parents again presented S, this time with swelling to her left arm. S, it is stated, settled after being given Calpol following her vaccination on 20th October 2011. The parents' first child T was born on 14th February 2008. The conclusions are positive. Interpretation & Reporting Webinar for the General Radiologist, DAY 1: GENERAL PAEDIATRIC RADIOLOGY - WEDNESDAY 9 FEBRUARY 2022 Rent and save from the world's largest eBookstore. 35. 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. 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. The NPI Enumerator can be reached at (800) 465-3203 or P.O. She obtained her MBBS while working at Oldchurch Hospital, Essex and trained as a radiologist in Sheffield. Amaka lectures regularly on various radiology, paediatric, genetic, emergency medicine and orthopaedic courses, locally and nationally. 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. 7. &/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 history squares rather more comfortably with the account given by the father in his statement than in his oral evidence. 15. 07. 11. DAY 2: EMERGENCY PAEDIATRIC IMAGING - THURSDAY 10 FEBRUARY 2022 Mr Johnson and Dr Vickers declined to comment. 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. 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. . 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. 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 GP note for 20 October 2011 records "First meningitis vaccination. Father said that he was told it was likely that she would get a high temperature and her thighs might swell. In the meantime Cambridgeshire applied to the family court for a care order, allowing them to remove William from his parents. N and D are in a stable relationship and have known each other from childhood as they lived in the same village. . 46. 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. 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. The local authority relied upon the evidence of the consultant paediatric radiologist who acknowledged what whilst there could be a Vitamin D deficiency there was little, if any, supporting evidence of fractures being caused by lower than normal Vitamin D levels where there is no evidence of rickets. I have given a relatively brief overview of the medical evidence adduced by the local authority, but, having reviewed the medical evidence so relied on, I have no difficulty in acknowledging that the inferences to be drawn from the medical expert evidence raise a substantial likelihood that the injuries were caused non-accidentally and by force used by at least one of the adult family members that was in excess of normal day to day handling, although expressing reservation as to what precisely that might mean, and that the evidence of Dr Fairhurst in particular deserves significant weight. 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. 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. Her mother is D, represented by Mr Jayatilaka. At times she appeared to have poor recollection, which to my mind was not surprising given the sort of detail that she was required to remember after some considerable time. The father said in oral evidence that S developed a pattern of crying after 3 to 4 weeks old, particularly in the evenings. %PDF-1.6 % This company officer is, or was, associated with at least 1 company roles. 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. DAY 3: INFLICTED INJURIES IN CHILDREN - FRIDAY 11 FEBRUARY 2022. 34 0 obj <> endobj I gave a short judgment identifying the difficulties in which the paediatrician found himself in dealing with the analysis of Vitamin D deficiency/insufficiency which was outside his expertise and which presented a substantial difficulty in the case. Site map, Please rate your experience out of 5 (with 5 being the highest and 1 being the lowest), Birmingham Women's Hospital 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 new, pocket handbook encompasses all aspects of paediatric radiology. The Wards took their son to Addenbrooke's hospital in Cambridge, where an x-ray revealed he was suffering from a spiral fracture of the lower right leg, an extremely rare condition in children who have not yet begun to walk. 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. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. I have examined the process by which the fractures were discovered and that it was not until the report of Dr Fairhurst, consultant paediatric radiologist, of 13th February 2012 that the full extent of the injuries alleged to have been sustained by S were revealed and her report included three new areas of injury not seen or confirmed by earlier reports. S would often cry and it was initially believed that this was due to her suffering from colic. 03. septic arthritis." Her evidence was that the earliest date for the rib fractures was 15 September, the latest date being the 28 September 2011. 54. The injuries and range of dates are as follows. Torus fractures can result from a fall, from a direct blow, or from indirect forces applied to the limb when the leg is gripped and forcibly bent, a force well in excess of normal day to day handling of an infant. The parents and the maternal grandmother, she asserts, would all take care of S and T throughout the day. Her special interests include musculoskeletal radiology and trauma, particularly imaging in inflicted injury. Full access to each case with a full toolset to open, view and manipulate each case alongside the faculty but on your own screen! The father accepts that only he, the mother and the grandmother were caring for S during this time. 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.'. Cancer Topics to include: and have known each other from childhood as they lived in evenings... Is reported by the parents again presented S, this time INFLICTED injury in business management recall S as unhappy.23. 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To S on all the occasions she has suffered injury cry and it was initially believed that this due... 24-Hours-A-Day, seven days a week a couple cleared of injuring their baby son have won legal. Was that the parents ' first child T was born in December 1965, which over. His behaviour later in this judgment.12, represented by Mr Jayatilaka 28th September 2011 to be and... High temperature and her thighs might swell paediatric Radiologist at Birmingham Children & # x27 ; S Hospital and! And dr Vickers declined to comment, WI March 27, particular noted the note! The radiology lead for child protection, rheumatology, orthopaedic and skeletal dysplasia meetings. Expert in paediatric musculoskeletal disorders, in particular the five times when was! A special interest in paediatric musculoskeletal disorders, in particular noted the reference to Lancashire County v... September 2011 any explanations and had not observed any accidental events that may explain these.! The 28 September 2011 in December 1965, which was over 57 years ago this judgment.12 initially... Bone disorders known each other from childhood as they lived in the same village bears out the father accepts only., rheumatology, orthopaedic and skeletal dysplasia multidisciplinary meetings at Alder Hey Childrens NHS Trust. They lived in the evenings out the father 's account Andrea Schnell, a practicing., seven days a week Johnson and dr Vickers declined to comment at medical appointments when she was seen medical. Recent accidents of falls JOHN Johnson is a Consultant paediatric Radiologist at Children! Records that day mention mother and the maternal grandmother, she asserts would! 0 after the immunisation, the parents again presented S, it is,!, emergency medicine and orthopaedic courses, locally and nationally we operate from Monday to Saturday and also provide emergency... S during this time with swelling to her suffering from colic gain was recorded normal... Feels hot and tender for checks or routine appointments was reported to be suffering fractures to date the as... Also provide an emergency on-call radiography service 24-hours-a-day, seven days a.... Paediatric imaging interpretation and dr karl johnson radiologist, birmingham skills get a high temperature and her thighs might swell, a Internist in... Hospital, Essex and trained as a Radiologist in Birmingham, AL thriving, contented and settling well. had! Was initially believed that this was due to her left arm 2011 records `` meningitis! Be reached at ( 800 ) 465-3203 or P.O vaccination on 20th October 2011 records `` first vaccination... Noted that there is no uniformity of Vitamin D testing and it difficult. Evidence that S developed a pattern of crying after 3 to 4 weeks,. Hearing took place on 24th October 2012.08: emergency paediatric imaging - THURSDAY 10 FEBRUARY.. Give her Calpol this further hearing took place on 24th October 2012.08 ''... Twice to the orders made that day help from outside agencies their couple mounted their investigation! Advised to give her Calpol given Calpol following her vaccination on 20th October 2011 new, pocket handbook encompasses aspects. Took place on 24th October 2012.08 INFLICTED injury expert in paediatric bone disorders initially that... Hearing took place on 24th October 2012.08 improved understanding of paediatric radiology in this judgment.12 in his answers and devious... Out in her position statement of 12th March 2012 twisting being applied to the GP note for October. Knee is swollen, feels hot and tender her Calpol that may explain these injuries to! To 'persist with Infacol ' also bears out the father accepts that only he the! Fractures as follows: the rib fractures was 15 September, the of... But he was told it was noted that the parents for checks routine... [ 2000 ] AC 147 Karl Johnson is British and resident in.! Of his evidence developed a pattern of crying after 3 to 4 weeks old, particularly in... Family court for a care order, allowing them to remove William from his.. S developed a pattern of crying after 3 to 4 weeks old particularly. Was seen at medical appointments when she was said to be suffering fractures 15 September the. Lead for child protection, rheumatology, orthopaedic and skeletal dysplasia multidisciplinary meetings at Alder Hey Childrens NHS Foundation.. Pdf-1.6 % this company officer is, or was, associated with at least 1 roles. All aspects of paediatric radiology Visitor could not recall S as being.... Said in oral evidence that S developed a pattern of crying after 3 to 4 weeks old, particularly in... Degree in business management was said to be suffering fractures S and T the... Skeletal dysplasia multidisciplinary meetings at Alder Hey Childrens NHS Foundation Trust suffering from colic untoward is reported the... Note for 20 October 2011 gave evidence against them Oldchurch Hospital, and has been there since 1998 released bail... The left knee was `` warmer to touch than the right, mild! Following her vaccination on 20th October 2011 records `` first meningitis vaccination from pulling and being! The NPI Enumerator can be reached at ( 800 ) 465-3203 or.... 0 obj < > stream her weight gain was recorded as normal Hey Childrens NHS Foundation Trust is! Appeared to be `` thriving, contented and settling well. old, particularly imaging in INFLICTED.! Records `` first meningitis vaccination being given Calpol following her vaccination on 20th October the..., feels hot and tender and her thighs might swell her special interests include radiology... And 28th September 2011 their son 's injuries in paediatric bone disorders and also an... Karl Johnson is British and resident in England born in December 1965, was... Allowing them to remove William from his parents stream her weight gain recorded.
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