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. As with the mother, that did not mean that there were no instances when they were confused or mistaken.48. The Court reminded itself of the guidance in Re U: Re B (Serious injury: standard of proof) [2004] 2 FLR 263 and Re L [2011] EWCA Civ 1705 noting that where there is uncertainty in the medical and scientific evidence the Judge's appraisal and confidence in the parents is crucial. Find Dr. Jackson's phone number, address, hospital affiliations and more. We haven't found any reviews in the usual places. At the time of these proceedings he was employed as a store manager. endstream endobj startxref I note his evidence as to the prevalence of Vitamin D deficiency, particularly in Asian sub-groups, and his view that the absence of radiological evidence does not mean that there is 'no rickets' i.e. * Panorama's Please Don't Take Our Child is broadcast on BBC One tomorrow at 8.30pm. 46. Dr Fairhurst thinks that they may have been sustained as I set out in their approximately chronological order: 1. He has been able to contribute vital knowledge and information towards understanding S's condition in August, September and October 2011. The responses of the parents and the cases which they have put before the court appear in summary form on the Scott Schedule. 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. Ms Baldrighi, Back to top of page DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. The record confirms the father's account that they had been advised to use Infacol, had done so and that it was not working. I have in particular noted the GP entry reports and the visits made by the parents for checks or routine appointments. 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. Location In surveying the 'wide canvas' further, I take into account the evidence of Professor Nussey because the manifest injuries do call for explanation. The guardian also represented the other child of the family T, who was born on 14th February 2008. 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. 8. The father recalled that S "cried throughout", crying as soon as the examination started although the doctor carried on. 42. Since the medical centre was closed, they took S to the local hospital.25. He was diagnosed with Hirschsprung's disease, remaining under the care of a London hospital's surgical team with 6 monthly checks. The Judge found that neither parent was seeking to cover up matters or to deal other than truthfully to the best of their ability. Consultant Paediatric Radiologist, Chair of Paediatric Musculoskeletal Imaging, Chair, University of Sheffield's Black, Asian, and other Minority Ethnic (BAME) Staff Network, University of Sheffield and Sheffield Children's Hospital. &/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 Opportunity to submit questions by email to the faculty. 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. 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. 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. 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. The parents' first child T was born on 14th February 2008. hbbd``b`J5 `n\ a#H #e \ We adopt the following: i. But during the family court proceedings serious doubts were cast on Dr Johnson's evidence by other medical experts. 9. The concerns of the local authority and the allegations raised against the family members arise from the appearance on X-ray scans first seen on 22nd October 2011 of a significant fracture to S's left upper arm. 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. 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. The father had not witnessed T hurting S nor does he believe he would harm her intentionally but believes he may not appreciate her fragility and may have caused harm accidentally. Mindelsohn Way Birmingham B15 2TG 0121 472 1377 Birmingham Children's Hospital Steelhouse Lane Birmingham B4 6NH 0121 333 9999 Quick links Terms and conditions Give us your feedback Publications and reports Staff links AccessAble Freedom of Information Privacy Policy Accessibility statement Join us on social media Support us So the records engage even closer scrutiny. There is no evidence of drugs or alcohol abuse, of anger or violent outbursts, of short temper, volatility, irritability or dysfunction. 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 This person was born in December 1965, which was over 57 years ago. All prices include VAT, Viewers will be asked to evaluate each session and will be provided with a CPD certificate upon completion (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. 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. "It was a nightmare which seemed to be spiralling out of control.". 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. Dr. Jackson's office is located at 2204 Lakeshore Dr . I accept the submission that there is a lack of current research on the susceptibility to fracture in babies who are Vitamin D deficient. The court had no expert views on these aspects or on a number of potential issues relating to bone metabolism. Subscribe for updates and offers on new events for your specialty. Several of these fractures are highly specific for non-accidental causation by an adult. Tel: 0121 335 8260 The team Our team is made up of consultant radiologists, sonographers, radiographers, health care assistants and administrative staff. there is a stage of rickets before it is identifiable radiologically. Have you had a video or telephone consultation with us? There was an additional right wrist fracture which was difficult to date. The second section discusses the differential diagnosis of radiological features. This company officer is, or was, associated with at least 1 company roles. The particular issue of Vitamin D deficiency/insufficiency presents as the current medical frontier and arguably an expanding and uncertain one. The Wards were arrested and questioned by police on suspicion of grievous bodily harm and child cruelty towards William. 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. 11. The memories of the parents were assiduously and closely examined by all counsel and compared with the notes written at the time.28. 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. In all sections, the value of all imaging modalities are stressed. UK based, CPD accredited, online courses for doctors in all of the major specialties, Navigation: The record shows "baby crying and unsettled today. John is a Consultant Endocrinologist at Queen Elizabeth Hospital Birmingham (QEHB) and an Honorary Senior Lecturer at the University of Birmingham. '(&NJdsB. This could increase bone fragility and give rise to fractures at a lower force than would otherwise be the case. 55. S was referred to hospital as a paediatric emergency, the GP's impression being "?? She is also a member of the Royal College of Paediatrics and Child Health, and is a fellow of the RoyalCollege of Radiologists. While T was originally the subject of the local authority's applications at the outset when proceedings were issued on 27th October 2011, I made an order on 13th December 2011 returning him to the care of his parents and no continuing orders were made relating to him. One or both of the parents, and/or the grandmother knows what has happened to S on all the occasions she has suffered injury. It is necessary to take account in combination with these reports of the dates provided by Dr Fairhurst for the occurrence of the various fractures to S, the clinicians' observations, also the X-ray and the report of nothing abnormal on 13 October 2011. His claim that William had suffered four fractures on at least two occasions was contradicted by their assertion that he had only two fractures, both of which had probably been caused at the same time. In due course a consultant paediatric radiologist went on to identify fractures to the left upper arm, right lower arm, distal left femur, left and right tibia and two rib fractures. 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. 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. The local authority made an application for an Emergency Protection Order on 26th October 2011 in respect of both children, and on 27th October the parents agreed to Section 20 accommodation. 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. 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. On Thursday 20 October 2011 S was brought to the GP surgery by the parents and given her immunisation injections, in each thigh, by the Health Visitor. The note records both mother and grandmother as being present. I never observed either parent react angrily towards each other or either child. Father said that he was told it was likely that she would get a high temperature and her thighs might swell. Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. The mother and/or the father and/or the grandmother is the perpetrator of the injuries to S.19. Email this page 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. 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.'. 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. 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. Companies associated with this officer had at least 253,361 shareholder value in recent accounts. Their most recent appointment, in our records, was to DR K JOHNSON LIMITED on 2015-08-17. I note his view that osteogenesis imperfecta was 'exceptionally unlikely.' 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. The parents needed to be careful over his food, medicine and health. 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. It is simply not possible to know where the boundary lies. This person was born in December 1965, which was over 57 years ago. 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. 07. 3. Their care of the children has been observed as of high quality. S's early developmental history, after her birth on 18 July 2011, was unremarkable at first sight: more would come to be known about her Vitamin D deficiency later, with ensuing events. Radiologists, Country 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. On 16 September 2011, S was seen for her 6-week check. While one might have looked for the possibility that in a moment of weakness or exasperation they might have snapped, or when the mother might have momentarily lost her self-control, particularly with a baby who cried persistently, that at least one fracture might have resulted, but for S to be shown with six sets of fractures, three constellations, requiring the sort of force and violence that Dr Fairhurst described, appears to be completely and demonstrably alien to the sort of people the parents and the grandmother appear to be. They were able to discuss and demonstrate that they were able to sustain routines for S during contact sessions and with T in the home. S would often cry and it was initially believed that this was due to her suffering from colic. *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 6. View more radiologists birmingham Consultations Consultations Steelhouse Lane, Birmingham, England. 51. A diagnosis of OI (osteogenesis imperfecta) is exceptionally unlikely. I would thank all advocates for their very careful written submissions. S was sent for x-ray, which revealed a spiral fracture of the left humerus. 45. The GP was unable to identify the cause of William's pain, but on returning home the Wards noticed his leg was swollen. 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. an understanding of the importance of applying the ALARA principle in Paediatric imaging. On 19 August 2011, two days later, there is a record in the GP notes confirming a visit by the mother and father with S. She was seen by the GP. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. The mother, father and grandmother all said that Infacol did eventually help for a time before her crying became worse again.15. It is to be noted that at this time, 13 October 2011, the evidence is that S had already sustained factures of the left 8th and 9th rib and was likely to have sustained her left femoral fracture and fractures to the right and left tibia. 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. Our imaging courses are very much an interactive experience. 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. Birmingham Update in prostate cancer Topics to include: . 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. 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. On 22 September 2011, S is recorded as having the first of her immunisations at the Medical Centre. 34. Firstly, it had become evident that the court required the assistance of an expert in paediatric bone disorders. Their evidence would have to be regarded as a tissue of lies and their manner of dealing with S would need to have been abusive, violent to the point of sadism, and the subject of a conspiracy of silence given the unlikelihood of such conduct being committed in secret or the strength of S's reaction passing unnoticed. The father states that the fact that the parents and grandmother took S to A&E on 22nd October 2011 showed that they had noticed a change in her behaviour; they presented S to the local hospital having noticed a swelling to her left arm. Her parents returned with S on 22.10.11 with a swollen arm. The paediatric clinicians note records that "yesterday evening the parents noted [her] crying and unsettled, left leg persistently held in a flexed position." 2018 Karen Johnson Andrea Schnell, a Internist practicing in Madison, WI March 27, . 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