Specialties 1808 7th Ave S, Birmingham, AL, 35233 3 other locations (205) 934-3333 OVERVIEW Dr. Johnson graduated from the University of Pittsburgh School of Medicine,University of Pittsburgh School of. 2. "It was felt that it was a matter of such complexity and range of opinion that it was a matter for court determination.". The memories of the parents were assiduously and closely examined by all counsel and compared with the notes written at the time.28. The history squares rather more comfortably with the account given by the father in his statement than in his oral evidence. 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.'. He also is an expert of considerable renown. With Doctuo you can find the doctors you need. 10. 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. The note records both mother and grandmother as being present. I have taken account of the occasions when S was seen by medical staff. Displaying companies where the director has shareholdings or significant control. There were evident deficiencies in translation by the interpreter. 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. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. The Father said in evidence that when the hospital phoned on Monday morning, his wife told them that S was "fine".21. It was also noted that the parents were unsure how it had happened and there had been no recent accidents or falls. 4. DR KARL JOHN JOHNSON is British and resident in England. UK based, CPD accredited, online courses for doctors in all of the major specialties, Navigation: 5. 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. He refused to feed and the next day Mrs Ward took him to see her GP. 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. 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. Karl John Johnson Radiologist Steelhouse Lane, B4 6Nh, Birmingham, England. '(&NJdsB. 54. 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. Firstly, it had become evident that the court required the assistance of an expert in paediatric bone disorders. 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.' 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. 22. 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. 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. A number of strengths however have been identified during this short involvement. She moved back to London, to Great Ormond Street Hospital and the Institute of Child Health, where she obtained a PhD for her thesis, Optimisation of the digital radiographic imaging of suspected non-accidental injury, then returned to Sheffield as a HEFCE-funded Clinical Senior Lecturer in the Academic Unit of Child Health. Read full profile Dr Khushnood Alam Consultant Radiologist Biography pending. I return to consider T and his behaviour later in this judgment.12. I have not found any instances that cannot be attributed to genuine mis-recollection especially given the distance in time over which they were attempting to deal with detailed events. The local authority alleges that the injuries were suffered by S and caused by an adult carer and they are non-accidental. In relation to the spiral fracture of the distal shaft of the left humerus, the local authority allege that S's arm has been gripped and twisted by an adult carer; she would have shown immediate distress lasting 10-15 minutes; any regular carer would have noticed a change in her behaviour as a result of the fracture with discomfort which would last for up to a week. 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. 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. 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. 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 . (5) S's Vitamin D levels, which were on the borderline on 2nd November 2011, were never higher than insufficient. Victoria and Jake Ward and William, right. Nothing untoward is reported by the clinician who weighed her and the Health Visitor could not recall S as being unhappy.23. I have noted the words of Butler-Sloss P in Re U: Re B (Serious injury; standard of proof) [2004] 2 FLR 263 and the court's responsibility to survey a 'wide canvas' and in Re L [2011] EWCA Civ 1705 that 'Clearly from the forensic standpoint given any degree of uncertainty in the medical and scientific field the judge's appraisal and confidence in the parent is absolutely crucial to the outcome.' 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. However, on 22nd October 2011 the parents again presented S, this time with swelling to her left arm. Because William's parents were unable to explain the fracture the hospital deemed the case suspicious and called in social services. His research and clinical interests include the pathogenesis [.] In all sections, the value of all imaging modalities are stressed. The responses of the parents and the cases which they have put before the court appear in summary form on the Scott Schedule. She was born in 1979. Mr Johnson and Dr Vickers declined to comment. 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. He has a special interest in paediatric musculoskeletal. 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. Left lower leg fracture, a metaphyseal fracture of the left tibia (shin bone) (3rd-10th October 2011). He noted that there is no uniformity of Vitamin D testing and it is difficult to measure. (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. 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. 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. 11. England, Population 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. 55. 9. %PDF-1.6 % 14. NS>zu=/_jwJa:S The consultant paediatric radiologist was able to date the fractures as follows: The rib fractures occurred between 15th and 28th September 2011. S has suffered multiple fractures which have occurred on at least three separate occasions. Subscribe for updates and offers on new events for your specialty. 47. 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. I never observed either parent react angrily towards each other or either child. 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.". 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. Dad says that [she] has been miserable all day no temperature". 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.". 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.". ,8KaF"*w!$uOEF!1 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. The mother refers to her own and her family's appropriate responses to noticing the abnormal characteristics of S in her left arm movement or in her discomfort with her leg as well as taking steps to address her distress and to take her for medical attention. sub-optimal bones that have not yet developed radiological signs of rickets; (6) I note that she was not in a position to give an expert opinion on metabolic bone disease which she identified as a very complex subject beyond the radiological aspect and that she would defer to a metabolic expert; (7) she accepted that the lack of evidence for fractures occurring in patients with lower than normal levels of Vitamin D (who did not have radiological evidence of rickets) is the current state of research and acknowledged that there is a need for more study to be done; she further accepted that this is a developing and controversial area of medicine; (8) I noted that it is accepted by all medical experts that it is unknown what level of force would be required to cause the injuries in a baby that had a Vitamin D deficiency or insufficiency; understandably it is not possible for experiments to be carried out. S had regained and passed her birth weight. Interactive discussions, trauma and non-trauma cases, what is relevant and significant, and take home messages that will change your reporting practice, a practical and comprehensive case based update on the interpretation and reporting of general paed radiology as well as of suspected inflicted injuries. 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. S's crying was attributed to colic initially and latterly to her having received her vaccination on 20th October 2011. On 24th October 2011 a skeletal survey detected what appeared to be two left rib fractures. Site map, Please rate your experience out of 5 (with 5 being the highest and 1 being the lowest), Birmingham Women's Hospital Metaphyseal bucket-handle fracture of the distal right radius caused when (a) her right wrist had been pulled and twisted by an adult carer; (b) any person present would be immediately aware she had suffered a significant injury. 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. Further X-rays revealed what appeared to be three more fractures and an injury to his arm. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. All this with the inherent complexities of the medical evidence meant that much time was taken up and the father's evidence could not be taken until the court could reconvene on 12th September 2012. 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". The outcome of the case, in a landmark High Court judgement, has helped to lift the secrecy surrounding England's family courts, where campaigners claim that a lack of openness creates an environment in which miscarriages of justice can go unnoticed. In the last week of the last Parliamentary session the judgement was rubber stamped into law. "It was a nightmare which seemed to be spiralling out of control.". N and D are in a stable relationship and have known each other from childhood as they lived in the same village. Dr Neil Stoodley, Consultant Neuroradiologist, Bristol Royal Hospital for Children Dr Musa Kaleem, 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. Helen Williams is a full time general paediatric radiologist, and has special interests in cross-sectional imaging, feeding studies and radiology training. "There seems to be a small group of expert witnesses who often condemn parents. (8) It is not unreasonable to assume that S's levels would have been at 21 nanomls per litre in pregnancy. 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. Injuries to S could not have been caused by a person rolling onto her. Virgil van Dijk: I should have taken a break before World Cup, Britain's second lockdown was based on 'very wrong' Covid data, Boris Johnson feared, How Boris Johnsons desire to lift lockdown was thwarted by public opinion, Misplaced breathing tube contributed to death of first child Covid victim, inquest rules, William Sitwell reviews St Barts, London: This food will win over any tasting-menu sceptic, How to bring a cosy, Scandi-inspired aesthetic to your wardrobe. Detectives removed the cot for examination. Recurrence is not in itself probative;iii. endstream endobj 38 0 obj <>stream 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. (S> $}=I% l S2QBC(*YMhTX^Gf=,HO)t}cg3F 0s/yGUu. 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. The cause of an injury or of an episode that cannot be explained scientifically remains equivocal;ii. She said: "How could we celebrate that someone has decided you didn't hurt your child when you know all along you didn't? hmk0^g? 012 133. [email protected]+44(0)20 4520 5081. 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 judgment that I gave that day is subsumed into this fuller judgment of the court.02. The parents/grandparent who did not inflict the injuries on each occasion to S failed to protect her. 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. They both appear to value education and a need to promote this ethos with their children. Home Catch-up service Catch-up service Radiology Catch-up service: Paediatric Radiology 2022, A Comprehensive Practical Update on General Radiology, NAI and Emergency Radiology. 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. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. The other parties to the case are S's parents, who are married. I have in particular noted the GP entry reports and the visits made by the parents for checks or routine appointments. In my shorter version of this judgment on 14 January 2013 I provided as clear an indication as I could to the relief, I am quite sure, of the parents of the way in which my mind had worked. DAY 3: INFLICTED INJURIES IN CHILDREN - FRIDAY 11 FEBRUARY 2022. It was the maternal grandmother's view that her daughter and son-in-law did not injure S. The maternal grandmother also mentioned that she had cared for her own children, relatives and grandchildren and was capable of ensuring that children are properly and safely cared for. 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. The particular issue of Vitamin D deficiency/insufficiency presents as the current medical frontier and arguably an expanding and uncertain one. I summarise these as follows. 2. Interpretation & Reporting Webinar for the General Radiologist, DAY 1: GENERAL PAEDIATRIC RADIOLOGY - WEDNESDAY 9 FEBRUARY 2022 I note his view that osteogenesis imperfecta was 'exceptionally unlikely.' 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. (9) He anticipated that S's level was 30-35 when she was born, not adequate and markedly deficient. 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. At one point, he mentioned that they had thought it was due to her immunisation that she was not using her left hand. The record concludes with the GP's comment "All well. 135; "There are areas of ignorance. The maternal grandmother denied harming S and did not accept that her daughter or son-in-law would not do the same. 2023Check Company | Privacy | Terms of Use | Contact Us. 35. The injuries and range of dates are as follows. 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. The mother, father and grandmother all said that Infacol did eventually help for a time before her crying became worse again.15. We adopt the following: i. 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. When the cause of his pain could not be found, they took him back twice more. I accept that given T's reported boisterousness a heightened level of supervision would have been needed but that could not have been known by any of the family members at the time the fractures were likely to have been caused. One or both of the parents, and/or the grandmother knows what has happened to S on all the occasions she has suffered injury. The constellation of findings is highly indicative of non-accidental injury by an adult. He has co-authored over 35 peer reviewed papers. 13. 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. This produces a complex and difficult balance in assessing the likelihood of the infliction of the harm and the injuries as invited by the local authority. 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. The Judge found that neither parent was seeking to cover up matters or to deal other than truthfully to the best of their ability. The fractures to the right lower leg took place between 12th September and 10th October. 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. I would thank all advocates for their very careful written submissions. 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. DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. 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. Time with swelling to her having received her vaccination on 20th October )... | Terms of Use | Contact Us doctors in all of the when... 24Th October 2011 the parents were unsure how it had become evident that the appear! Karl JOHN Johnson Radiologist Steelhouse Lane, B4 6Nh, Birmingham, England strengths however have been 21... Father and grandmother all said that Infacol did eventually help for a time before her crying became worse again.15 married., this time with swelling to her having received her vaccination on 20th October 2011 borderline on 2nd 2011! 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