The second section discusses the differential diagnosis of radiological features. As for that visit on the 22 September, the Health Visitor said that S was not distressed as far as she could recall.18. 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. Extensive high quality images throughout the book, and additional illustrations, aid the reader with diagnosis and detailed referencing points to further reading. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. Dr. Thomas' office is located at 2204 Lakeshore Dr, Birmingham . 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. John is a Consultant Endocrinologist at Queen Elizabeth Hospital Birmingham (QEHB) and an Honorary Senior Lecturer at the University of Birmingham. Dr. Jackson's office is located at 2204 Lakeshore Dr . The Consultant Paediatrician, in his report of 5 March 2012, picks up on the record that T would become annoyed when S was unable to play with him, not understanding that it was not possible. With Doctuo you can find the doctors you need. The maternal grandmother's position can most usefully be seen as set out in her position statement of 12th March 2012. The father's responses set out a general defence to each allegation setting a number of relevant points that formed part of his evidence. After the birth it became apparent he had a medical problem with intestinal obstructions and severe constipation, requiring a good deal of medical attention and a surgical procedure at 3 weeks. 3. 012 133. (5) S's Vitamin D levels, which were on the borderline on 2nd November 2011, were never higher than insufficient. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. Dr Landes is radiology trauma lead and has contributed to the Royal College of Radiologists (RCR) guidance on imaging in paediatric trauma. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. The report presents what is effectively the high water mark of the extent of the injuries and the existence and extent of these injuries has not been challenged, although Miss Trustman urges the court in respect of the injuries only reported by Dr Fairhurst to approach the existence of such injuries with caution, particularly the torus fracture to the distal femur, since they were not identified by any other clinicians and their identification appears to rest on Dr Fairhurst's own expertise and experience as a consultant paediatric radiologist over 21 years. Finding of Fact Hearing in Respect of a Number of Fractures Sustained by S aged 3 months, On 13 October 2011 S was taken to hospital by her parents with a swelling to her left knee. 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. 55. I have considered the findings invited by the local authority as to the evidence of the family members, the inconsistencies, alleged inaccuracies and inferences that I am invited to draw from them. Her parents returned with S on 22.10.11 with a swollen arm. @ $ lp-5v|v3+F;%`(E4Di She was discharged from hospital on 25 July 2011. septic arthritis." 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. He has been able to contribute vital knowledge and information towards understanding S's condition in August, September and October 2011. 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. 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. colic/reflux." The parents did not mention the previous weekend's symptoms or the trip to the hospital on 13 October 2011.24. 31. At one point, he mentioned that they had thought it was due to her immunisation that she was not using her left hand. An X ray showed a spiral fracture of the left humerus. '(&NJdsB. As to the possible involvement of T, he asserts that he had not witnessed T twisting S's arm (or leg or wrists). . 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. 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. The Consultant Paediatrician, as the locum consultant paediatrician at the local NHS trust, described himself as a 'relatively recently qualified paediatric consultant.' 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. Within each chapter there are three consistent sections. The judgment that I gave that day is subsumed into this fuller judgment of the court.02. (S> $}=I% l S2QBC(*YMhTX^Gf=,HO)t}cg3F 0s/yGUu. All prices include VAT, Viewers will be asked to evaluate each session and will be provided with a CPD certificate upon completion 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". 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. At the time of these proceedings he was employed as a store manager. 45. endstream endobj 38 0 obj <>stream To access the survey, please click here. The parents and the maternal grandmother, she asserts, would all take care of S and T throughout the day. Rib fractures to the antero-lateral aspects of the left 8th and 9th rib (15th-28th September 2011). The father's evidence was that during the morning she had cried more than normal and he confirms that she was "grumpy and crying". Lovely baby." 42. Opportunity to submit questions by email to the faculty. S could not have been injured when in a bouncy chair from normal use. We haven't found any reviews in the usual places. 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. 35. Fee includes 90 days of access with unlimited playback during this time. The local authority sought findings that the injuries had occurred non accidentally with the parents and grandmother as possible perpetrators. I have noted and examined the oral evidence of Dr Fairhurst. Karl John Johnson Radiologist Steelhouse Lane, B4 6Nh, Birmingham, England. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. The child appears by her children's guardian and has been represented by Miss Dixon. (1) D(2) N(3) S(4)S (by her Children's Guardian) Respondents____________________MISS HELEN SOFFA (instructed by the local authority) appeared on behalf of the Applicants.MR UPALI JAYATILAKA (solicitor) appeared on behalf of the Respondent Mother.MISS ALICE DESCHAMPNEUFS (instructed by solicitors) appeared on behalf of the Respondent Father.MISS JUDITH TRUSTMAN (instructed by solicitors) appeared on behalf of the Respondent Maternal Grandmother.MISS SORREL DIXON appeared on behalf of the Children's Guardian.____________________Digital Tape Transcription by:John Larking Verbatim Reporters(Verbatim Reporters and Tape Transcribers)Suite 91, Temple Chambers, 3-7 Temple AvenueLondon EC4Y 0HP.Tel: 020 7404 7464 Fax: 020 7404 7443 DX: 13 Chancery Lane LDE____________________Words: 11,229Folios: 156(FULL) JUDGMENT20th March 2013.01. Victoria and Jake Ward and William, right. On examination by the doctor there was no active movement of that arm. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. No local tenderness in leg or hip", S was x-rayed, but nothing abnormal was observed. 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. The parents were unable to offer any explanations and had not observed any accidental events that may explain these injuries. 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. The first section lists common clinical presentations, the differential causes and the appropriate imaging pathways needed to confirm the diagnosis, with recent imaging advances for each condition. This further hearing took place on 24th October 2012.08. The family's nightmare began one night in July 2005 when, at three months old, William woke up in pain. The record confirms the father's account that they had been advised to use Infacol, had done so and that it was not working. 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. One or both of the parents, and/or the grandmother knows what has happened to S on all the occasions she has suffered injury. UK based, CPD accredited, online courses for doctors in all of the major specialties, Navigation: He arrived at the preliminary conclusion that the humeral and rib fractures must give rise to 'a high level of suspicion' for non-accidental injury. Birmingham B4 6NH, Questionnaire for parents with children aged 5-9, Monday, Wednesday and Thursday/Friday afternoon, Four to six times per year at Queen Elizabeth Hospital on a Tuesday morning. 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. So the records engage even closer scrutiny. There was an additional right wrist fracture which was difficult to date. Hence attendance at A&E.". I noted from her evidence that she was concerned about and focused on the wellbeing of S. It appears that she was the first to notice distress in S; that she appeared to advise that the parents attend a doctor for every aspect of S's wellbeing. There is no evidence of drugs or alcohol abuse, of anger or violent outbursts, of short temper, volatility, irritability or dysfunction. Full access to each case with a full toolset to open, view and manipulate each case alongside the faculty but on your own screen! It is very easy to try and fill those areas of ignorance with what we know but I think that it is very important to accept that we do not necessarily have a sufficient understanding to explain every case.". 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. 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. However, the identities of the expert witnesses in the case remained shrouded in secrecy. 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. Now the Local authority has promptly and appropriately put into effect a revised Care Plan to give effect to the orders made that day. 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 CT and x-ray are the first-line modalities, as these investigations are fast to conduct and have been shown to quickly reveal unexpected findings such as posterior rib fractures, metaphyseal corner fractures, and intracranial haemorrhage (especially subdural haematomas), contusions, and lacerations. 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.'. You'll get immediate feedback and learning points from our expert faculty member. 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. &/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 Radiologists ( RCR ) guidance on imaging in paediatric musculoskeletal disorders, in juvenile... Occurred non accidentally with the parents and grandmother as possible perpetrators has been by... 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