I have taken account of the occasions when S was seen by medical staff. Dr. Gregory D. Jackson is a Radiologist in Birmingham, AL. The report states that S: 'cried a lot last few weeksMore over last 2 weeks and then doesn't want to be fedTends to cry more in the eveningHave used Infacol under advice from the H/V but no improvement yet. Full access to each case with a full toolset to open, view and manipulate each case alongside the faculty but on your own screen! On the contrary, the evidence appears to demonstrate that the parents had the wellbeing of S in mind and acted to seek medical attention. His research and clinical interests include the pathogenesis [.] N and D appeared able to actively provide a high level of basic care for their children.'. 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. One or both of the parents, and/or the grandmother knows what has happened to S on all the occasions she has suffered injury. There can be no criticism that it has pursued these allegations as vigorously as it has, even if at the end of the day they have failed to satisfy me that the case is proved. You can book online your appointment and hire medical insurance online. Reviews aren't verified, but Google checks for and removes fake content when it's identified, Oxford Specialist Handbooks in Paediatrics, Medical / Allied Health Services / Imaging Technologies. 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. %PDF-1.6 % The burden of proof lies on the local authority and they have to satisfy the court on the balance of probabilities: see Re B (Care proceedings; standard of proof) [2008] UKHL 35. Dr. Thomas' office is located at 2204 Lakeshore Dr, Birmingham . She also offered the view that the fractures were likely to have occurred on three separate occasions; the constellation of injuries was in her opinion highly indicative of non-accidental injury. 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. That aspect is not mentioned. 03. The Father said in evidence that when the hospital phoned on Monday morning, his wife told them that S was "fine".21. Her parents returned with S on 22.10.11 with a swollen arm. She was discharged home, with instructions to the parents to phone on Monday [19th] to have her reviewed or returned if they were concerned, and to re-present her over the weekend if her temperature, swelling or redness of the leg increased, if she was unsettled or if her feeding reduced. With Doctuo you can find the doctors you need. She was described as remaining "settled in A&E, observations in normal range, apyrexial." 5. Dr. Karl Johnson Consultant Paediatric Radiologist Birmingham Children's Hospital 15:05 - 15:20: Break 15:25 - 16:25: SEN disability impact of covid on safeguarding Caroline Coady Assistant Director for Social Care National Children's Bureau 16:25 - 17:25: Sexual Abuse Update Deborah Hodes 17:25 - 17:30: Close 17:30: Room open for networking 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 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. 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. 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". Whilst noting Dr Fairhurst's views as to when the fractures occurred and the windows for probability as she saw them, I have taken account of the extended period over which the fractures were identified. an improved understanding of Paediatric imaging interpretation and reporting skills. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. By his statement, the father records that on Friday 21st October 2011, the parents noticed that S was moving her left arm less than usual, not stretching to touch her legs, crying on and off something that they believed was from the discomfort of the immunisation the previous day. 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.". On the balance of probability T could not have caused the injuries to S. 16. 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. The local authority goes on to make the following allegations which I give as numbered in the Scott Schedule: 7. In surveying the 'wide canvas' further, I take into account the evidence of Professor Nussey because the manifest injuries do call for explanation. Earlier records that day mention mother and father being present. Injuries to S could not have been caused by a person rolling onto her. Thank you! Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. 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". I return to consider T and his behaviour later in this judgment.12. 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. The note records both mother and grandmother as being present. They are, in my survey of the evidence, more likely to have a genuinely accidental cause, but because of the evidence of Professor Nussey taken with the evidence of the parents and from the records available it is not possible to reach a view that is more than speculative as to the timing of the injuries. 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. 51. Caroline Coady Specialty: Gastrointestinal Radiology. The Wards were only allowed to take William home with them when they agreed to be supervised 24 hours a day by Mr Ward's parents, who had to relocate from Devon to move into the couple's home. endstream endobj 38 0 obj <>stream 11. DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. To access the survey, please click here. an understanding of the importance of applying the ALARA principle in Paediatric imaging. She obtained her MBBS while working at Oldchurch Hospital, Essex and trained as a radiologist in Sheffield. 43. 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. However, on 22nd October 2011 the parents again presented S, this time with swelling to her left arm. Email this page I have also noted the quotation offered by Miss Trustman from R v Harris and others [2005] EWCA Crim 1980 para. This person was born in December 1965, which was over 57 years ago. 31. The second section discusses the differential diagnosis of radiological features. Recurrence is not in itself probative;iii. S was discharged and the parents reported that her knee improved. Book yoUR 2023 CME TODAY. A number of strengths however have been identified during this short involvement. 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. 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 found it was not possible to conclude at what point normal day to day handling crossed over to the point when S's vulnerable bone structure was compromised and exceeded. 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. 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. I take note also that the mother and father completed a parenting assessment. That theory has to overcome the difficulty that observations of S were made when she was seen at the clinic for weighing on the 19 October and for immunisations on 20 October, and the earliest reported symptom in the arm not moving her arm was on Thursday 20 October or Friday 21 October, which arguably places the timing of that fracture later than 19 October, as the Health Visitor and clinic staff could have been expected to notice or pick up symptoms and appearances that were (reportedly) evident to the parents on the Friday, and very apparent to the hospital doctors on Saturday 22 October 2011.29. 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. At 17.10, the presenting complaint was noted as "swelling and pain in the left upper arm, since yesterday" [Friday] those symptoms noted by the parents "yesterday" with swelling of the left arm and "crying ++" when she was moved. England, Population What followed next led, eventually, to the diagnosis of a fracture in S's left upper arm. 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. The guardian also represented the other child of the family T, who was born on 14th February 2008. Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. Detectives removed the cot for examination. He has extensive experience and a mature knowledge of research done in this field. Consistent with this, the father described a happy baby in the first two weeks of her life. Their care of the children has been observed as of high quality. 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. The GP note for 20 October 2011 records "First meningitis vaccination. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. 33. Read full profile Dr Khushnood Alam Consultant Radiologist Biography pending. He states that S had a tendency to cry and this was discussed with medical professionals on more than one occasion. 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. Considering all the evidence on the balance of probabilities I have come to the conclusion that the likely incidence of an increased vulnerability to fracture is the most likely cause of S's injuries. He was diagnosed with Hirschsprung's disease, remaining under the care of a London hospital's surgical team with 6 monthly checks. There are a number of other features of the evidence about the parents which I must take into account as part of the 'wide canvas' of evidence that I have surveyed. . My approach in law to this case has been assisted by the reference made by the advocates to a number of cases in their written submissions. Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). 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. In the meantime Cambridgeshire applied to the family court for a care order, allowing them to remove William from his parents. Formula feeding for 8-9 weeks before the test would have provided some improvement but not enough, as breastfeeding would provide none. 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. On 16 September 2011, S was seen for her 6-week check. 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 father accepts that only he, the mother and the grandmother were caring for S during this time. In the course of surveying the 'wide canvas' of evidence I have reviewed the evidence of the mother, the father and the grandmother. 9. 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. BSc, MBBS, MRCP, FRCR, PhD, FHEA John is a Consultant Endocrinologist at Queen Elizabeth Hospital Birmingham (QEHB) and an Honorary Senior Lecturer at the University of Birmingham. 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. 54. The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children'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. 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. 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. Lord Justice Munby agreed with their request and in a landmark judgement in January this year ruled that expert witnesses in family courts could now be named. Several of these fractures are highly specific for non-accidental causation by an adult. 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. At 22.30, a further medical clinician's note was written, although the authorship is not clear. 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. The record shows "baby crying and unsettled today. Further X-rays revealed what appeared to be three more fractures and an injury to his arm. Any specialty hmk0^g? This new, pocket handbook encompasses all aspects of paediatric radiology. 135; "There are areas of ignorance. Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. 6. Expert evidence from paediatric radiologist (Dr. Karl Johnson) and consultant paediatrician (Dr Russell Croft) was obtained and they were cross examined in Court. Show number 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. He was earnest, straightforward and did not quibble with the questions although he did not always understand the question. I therefore come to the conclusion that the local authority has not discharged the burden of proof on the balance of probabilities. Contents hosted on Doctuo should not be used as substitutes for professional medical advice, diagnosis or treatment. An X ray showed a spiral fracture of the left humerus. 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. Her responses in the Schedule point out that the allegations are made on the presumption that S did not have any genetic abnormality or bone disease. Metaphyseal fracture of the proximal right tibia caused when (a) her right leg had been pulled and twisted by an adult carer; (b) she would have shown distress for 10-15 minutes and would have shown discomfort when her leg was moved. 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. Wanted a review(Under 'P') Discussed with Mum and Dad possible colic will continue withInfacol and see how she gets on over next week. 5 of my judgment on 26th March 2012. 14. 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. With no help from outside agencies their couple mounted their own investigation into the cause of their son's injuries. Mr Johnson, who is chairman of the British Society of Paediatric Radiology and works as a consultant at Birmingham Children's Hospital, told police that in his view William had suffered repeated fractures and had a history of being abused. VOIT$=EfPuP^ AiiUw~,JZ%?rG?("S{t }p# y|!W7XQb,{*|p>'A7:#;p`Wnx n&Thb !pA}ifRh0$*W@~n0?Olgj;|TO^,WicR|WV2riRm- 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. It was also noted that the parents were unsure how it had happened and there had been no recent accidents or falls. No plausible explanation has been offered for any of these injuries. The final section details the imaging findings in a wide variety of clinical conditions. 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. I have taken account of the fact that she gave her evidence through an interpreter while having at least a working grasp of English. 52. The Judge found that neither parent was seeking to cover up matters or to deal other than truthfully to the best of their ability. 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". Dr. Johnson is presently the Chair of theBritish Society of Paediatric Radiology. Father said that he was told it was likely that she would get a high temperature and her thighs might swell. On 22 October a skeletal survey was performed and reported on by Dr Steven Johnson, Consultant Radiologist. 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. Excellent peer interaction and collaborative learning. 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. 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. He has been able to contribute vital knowledge and information towards understanding S's condition in August, September and October 2011. If there is some innate contradiction in that sentence it appears that the latter part of that sentence represents the stronger conclusion. 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. 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. The consultant paediatric radiologist was able to date the fractures as follows: The rib fractures occurred between 15th and 28th September 2011. The parents' first child T was born on 14th February 2008. Mrs A Jester Akin, MD, Diagnostic Radio Catch-up service: Paediatric Radiology 2022, Catch-up now with our case-based Paediatric Radiology webinar that took place in February 2022. endstream endobj 35 0 obj <>/Metadata 4 0 R/Outlines 8 0 R/Pages 32 0 R/StructTreeRoot 11 0 R/Type/Catalog>> endobj 36 0 obj <>/MediaBox[0 0 595.32 841.92]/Parent 32 0 R/Resources<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 37 0 obj <>stream 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. It is reasonable to conclude that they were lower before then because she was breastfed. 11. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. No temperature. The particular issue of Vitamin D deficiency/insufficiency presents as the current medical frontier and arguably an expanding and uncertain one. Torus fracture of the distal left femur caused by (a) her left leg being gripped and forcibly bent; (b) she would have shown distress for 15 minutes and would have shown discomfort when the leg was moved; discomfort would have lasted for several days. 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. 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 . Mr Johnson and Dr Vickers declined to comment. DAY 2: EMERGENCY PAEDIATRIC IMAGING - THURSDAY 10 FEBRUARY 2022 (4) He accepts that in relation to injuries such as these some force has to be applied. Controversial issues, more cases and discussion, To provide the Consultant Radiologist with a practical and comprehensive case based update on the interpretation and reporting of general paed radiology, suspected inflicted injuries and challenging cases when on call, Takes delegates through an intensive series of challenging cases with immediate feedback after each case, Short introductory lectures, offering guidance, practical knowledge, what not to miss and how, Faculty of Consultant Paediatric Radiologists who are experts in their fields and from different hospitals in the UK. 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". Doctuo 2023 Last modification: 02-03-2023, Birmingham Children'S Hospital, Birmingham. 13. He also is an expert of considerable renown. 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. 34 0 obj <> endobj 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. 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. Her weight gain was recorded as normal. N and D are in a stable relationship and have known each other from childhood as they lived in the same village. Dr Karl Johnson, Birmingham Children s Hospital Joint tumours Dr Asif Saifuddin, Royal National Orthopaedic . As with the mother, that did not mean that there were no instances when they were confused or mistaken.48. It was noted that the parents were unsure how the fracture may have happened and there had been no recent accidents of falls. 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Was described as remaining `` settled in a wide variety of clinical conditions represents the stronger conclusion dr karl johnson radiologist, birmingham! Tendency to cry and this was discussed with medical professionals on more than one occasion of these fractures highly. Of clinical conditions reasonable to conclude that they were lower before then because she described... She was breastfed National Orthopaedic 's note was written, although the authorship is not clear T who! Both of the importance of applying the ALARA principle in Paediatric musculoskeletal disorders, in particular juvenile arthritis and injury! That the latter part of that sentence represents the stronger conclusion further medical clinician 's note was,. Grandmother as being present relationship and have known each other from childhood as they lived in the Schedule! A tendency to cry and this was discussed with medical professionals on more than one occasion your appointment and medical... And trained as a Radiologist in Sheffield next led, eventually, to the diagnosis of a Hospital... Further medical clinician 's note was written, although the authorship is not clear imaging interpretation and skills... Karl Johnson is a Radiologist in Birmingham, AL is a Consultant Radiologist pending.
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dr karl johnson radiologist, birmingham