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. Read, highlight, and take notes, across web, tablet, and phone. To access the survey, please click here. Having reviewed the evidence in detail, and after considering the written submissions of all parties, I had reached a position where I had come to my conclusions on the issues of fact. Victoria and Jake Ward and William, right. This person was born in December 1965, which was over 57 years ago. 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. 16. There were evident deficiencies in translation by the interpreter. Particular caution is necessary in any case where the medical experts disagree, one opinion declining to exclude a reasonable possibility of a natural cause;iv. He noted that there is no uniformity of Vitamin D testing and it is difficult to measure. 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 evidence from the Health Visitor is that she would have been undressed for weighing and placed in the scales by her parents. (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. The advice to 'persist with Infacol' also bears out the father's account. BSc, MBBS, MRCP, FRCR, PhD, FHEA The Judge formed the view that the maternal grandmother was seeking to assist the Court in her evidence. 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. In surveying the 'wide canvas' further, I take into account the evidence of Professor Nussey because the manifest injuries do call for explanation. 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. The paediatric clinicians note records that "yesterday evening the parents noted [her] crying and unsettled, left leg persistently held in a flexed position." He was earnest, straightforward and did not quibble with the questions although he did not always understand the question. So the records engage even closer scrutiny. 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. %PDF-1.6 % In reviewing the broad canvas of S's family, therefore, I have taken stock of the mother and father's background and employment and the unfortunate medical problems suffered by the couple's first child T with Hirschsprung's Disease and the particular care and attention that this child required. Her case is that she came to the United Kingdom specifically to support her daughter and son-in-law with the day to day care of the children. 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 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. This company officer is, or was, associated with at least 1 company roles. However, on 22nd October 2011 the parents again presented S, this time with swelling to her left arm. This would have involved manipulation of the legs and arms, and the conducting of other tests. Ms Baldrighi, Back to top of page 17. 2023Check Company | Privacy | Terms of Use | Contact Us. He stated that on the Saturday morning, at bath time, the grandmother noticed her left arm was swollen and tender and she cried when being dressed or undressed. 4. In the last week of the last Parliamentary session the judgement was rubber stamped into law. 54. Dr Landes is radiology trauma lead and has contributed to the Royal College of Radiologists (RCR) guidance on imaging in paediatric trauma. S, it is stated, settled after being given Calpol following her vaccination on 20th October 2011. But the drama turned into a nightmare when they were accused of having deliberately harmed their little boy. NS>zu=/_jwJa:S You can book online your appointment and hire medical insurance online. (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. I therefore granted an adjournment so that a suitable expert could be instructed. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. He states that S had a tendency to cry and this was discussed with medical professionals on more than one occasion. I have also noted the quotation offered by Miss Trustman from R v Harris and others [2005] EWCA Crim 1980 para. 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. On 22 September 2011, S is recorded as having the first of her immunisations at the Medical Centre. What has emerged is that none of the adults present could provide any instance of anything done to S by themselves or the other adult members of the family, or which had befallen her, which would explain the fractures. 42. Caroline Coady Specialty: Gastrointestinal Radiology. Dr. Robert H. Thomas is a Radiologist in Birmingham, AL. The local authority sought findings that the injuries had occurred non accidentally with the parents and grandmother as possible perpetrators. I summarise these as follows. )_______________. Tel: 0121 335 8260 The team Our team is made up of consultant radiologists, sonographers, radiographers, health care assistants and administrative staff. The parents did not mention the previous weekend's symptoms or the trip to the hospital on 13 October 2011.24. He appeared to be frank and open in his answers and not devious. 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. 03. On the balance of probability T could not have caused the injuries to S either by (a) jumping on the family bed whilst S was lying on it or (b) pulling her bouncy chair when she was in it. She acknowledged that this is a developing and controversial area of medicine. I have examined the evidence as to the appearance of the symptoms of both the leg injury and the arm injury and noted the consistency of evidence that S was holding her leg differently before the hospital visit on 13th October 2011, and a consistency as to there being something wrong with S's arm which prompted the parents to seek medical attention. Wanted a review(Under 'P') Discussed with Mum and Dad possible colic will continue withInfacol and see how she gets on over next week. The fact finding hearing began on 23rd March 2012, but on the second day of it, on 26th March, I adjourned the hearing having encountered significant problems on two fronts after hearing evidence from Dr Fairhurst, the health visitor, and the Consultant Paediatrician. 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. When Victoria and Jake Ward saw their baby son crying and refusing to feed, they took him to their doctor. (6) It is not possible to say what difference formula feeding might have provided because there is no baseline to measure from. 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. Extensive high quality images throughout the book, and additional illustrations, aid the reader with diagnosis and detailed referencing points to further reading. Ms Soffa has gone to considerable lengths and much detail to expose what are submitted as matters on which I should mistrust the evidence of the parents or confer on their evidence only little weight. Her special interests include musculoskeletal radiology and trauma, particularly imaging in inflicted injury. 2018 Karen Johnson Andrea Schnell, a Internist practicing in Madison, WI March 27, . 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. By the time the two-week family court hearing began, Mrs Ward was pregnant with her second child and feared that if William was taken, her new baby would be too. 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. They both appear to value education and a need to promote this ethos with their children. 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. 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. 45. DAY 3: INFLICTED INJURIES IN CHILDREN - FRIDAY 11 FEBRUARY 2022. The father completed a course in tourism management and completed a post-graduate degree in business management. 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. 11:00-11:30 Imaging of arthritis Dr Emma Rowbotham, Leeds Teaching Hospitals NHS Trust 12:00-12:30 Common paediatric MSK conditions Dr Karl Johnson, Birmingham Children's Hospital NHS Foundation Trust 12:30-13:00 Soft tissue and bone lesions. On 22 October a skeletal survey was performed and reported on by Dr Steven Johnson, Consultant Radiologist. the fractures to the right tibia and the proximal left tibia are likely to have occurred at the same time, and that that is the likely time-frame for them both.19. 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. The Judge found that neither parent was seeking to cover up matters or to deal other than truthfully to the best of their ability. I noted in relation to the mother that she gave her evidence calmly, she was quietly spoken, she gave direct and straight answers, she was composed and it appeared that her answers came from her genuine recollection without her giving what might have been expected answers. I then ruled that Professor Nussey, an expert in the narrow and complex field of biochemical analysis coupled with endocrinology and with a particular expertise on questions of Vitamin D sufficiency/deficiency should be instructed to prepare a report by 29th June 2012. He indicated that in addition to the spiral fracture of the upper left arm, healing fractures of the left anterior 8th and 9th ribs were noted, with the amount of callus "suggesting that these fractures are not acute". X-rays 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 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 am satisfied that neither the mother, the father, nor the grandmother can be held responsible for causing the injuries in a non-accidental or careless way and the court remains unable to find any one of them more likely than the others to have caused them. She has contributed chapters to several well-respected radiology textbooks, and is co-author of two books, A Radiological Atlas of Child Abuse and Fetal and Perinatal Skeletal Dysplasias: An Atlas of Multimodality Imaging. Both gave compelling evidence that, in particular, the rib fractures suffered to the baby could only be caused by " excessive/abusive squeezing" or "gripping of the chest". I considered that the family members have a very close bond and I did not observe any concerns regarding their attachment. 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. There is no evidence of drugs or alcohol abuse, of anger or violent outbursts, of short temper, volatility, irritability or dysfunction. I came to the conclusion that I was unable to determine the case without further specialist expert evidence. My close examination of this material has focused on the parents' accounts as well as on the evidence they have subsequently given about what they saw. Clinic Locations. I accept that the parents have displayed the same level of alertness for S as to her medical needs when they became aware that there was something wrong, as they saw it. 6. 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". Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). 37. I return to consider T and his behaviour later in this judgment.12. (4) He accepts that in relation to injuries such as these some force has to be applied. The X-ray revealed a spiral fracture of the left humerus. 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. His father described him as "very possessive" of his baby sister, trying to open her clenched fists to place toys in them, to straighten his 'folded' arms and play with her. 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 T would often watch attentively as the parents and grandmother would feed S and hold her. "Unfortunately the job of social workers is to think the unthinkable because sometimes terrible things happen. 5. The left tibia fracture was likely to have occurred between 3rd and 10th October and the likely time frame for the left humeral fracture was between 16th and 19th October. Her evidence was that S was crying, being "fractious and miserable but not hugely distressed", happier lying down than being held. England, Population The earliest date for the left femoral fracture was 30th September but it was most likely to have occurred between 10th and 13th October. Arrested, charged by police and threatened with having their child taken away by Cambridgeshire county council's social workers, it took two years for the Wards to clear their name. Birmingham Update in prostate cancer Topics to include: . The mother also worked there.10. Mindelsohn Way The case against the Wards also relied on the view of Dr David Vickers, a community paediatrician, that if no obvious explanation could be found for an injury then child abuse was likely. 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. Accepts that in relation to injuries such as these some force has be! 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