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. We haven't found any reviews in the usual places. S was sent for x-ray, which revealed a spiral fracture of the left humerus. It is remarkable that these and in particular the hospital appointment of 13th October did not reveal or suggest the presence of fractures, nor did they raise any element of suspicion about the parents. After 22 September 2011, S was next seen at the GP surgery on the 13 October 2011. Detectives removed the cot for examination. N and D appeared able to actively provide a high level of basic care for their children.'. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. Their most recent appointment, in our records, was to DR K JOHNSON LIMITED on 2015-08-17. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. Specialties The parents needed to be careful over his food, medicine and health. Determined to establish what was wrong they returned twice to the GP, but he was still unable to offer any diagnosis. 54. There is no evidence of an incident of any kind suggestive or on which an inference could be drawn that either of the parents was responsible for an injury (other of course than the X-rays of the fractures). I take note also that the mother and father completed a parenting assessment. Within each chapter there are three consistent sections. Find Dr. Thomas's phone number, address, hospital affiliations and more. 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. 11. Fee includes 90 days of access with unlimited playback during this time. 5 of my judgment on 26th March 2012. No local tenderness in leg or hip", S was x-rayed, but nothing abnormal was observed. Her evidence was therefore protracted and interrupted and I note Miss Trustman's observation that her evidence lasted in Sri Lankan time from 4:05 pm to 8:20 pm, and I have no reason to doubt the accuracy of that record. If there is some innate contradiction in that sentence it appears that the latter part of that sentence represents the stronger conclusion. The court had no expert views on these aspects or on a number of potential issues relating to bone metabolism. I therefore come to the conclusion that the local authority has not discharged the burden of proof on the balance of probabilities. * Panorama's Please Don't Take Our Child is broadcast on BBC One tomorrow at 8.30pm. Her parents returned with S on 22.10.11 with a swollen arm. UK based, CPD accredited, online courses for doctors in all of the major specialties, Navigation: 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. 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. 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. I have noted the entries in the records for 19th October when S was seen at the clinic to be weighed and that 'Nothing untoward was reported' also the entry on 20th October when S was brought to the GP surgery and given her immunisation injections and reported as 'fractious and miserable but not hugely distressed.' Apyrexial. The history squares rather more comfortably with the account given by the father in his statement than in his oral evidence. When S was born on 18 July 2011, T was 3 years and 5 months old. They could offer no explanation as to how the fractures may have happened. 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. 35. On 17 August 2011, S was taken to the clinic at 4 weeks old to be weighed. Stream every session from the webinar for up to 90 days. The paediatric clinicians note records that "yesterday evening the parents noted [her] crying and unsettled, left leg persistently held in a flexed position." Mindelsohn Way I note in particular the five times when she was seen at medical appointments when she was said to be suffering fractures. Have you had a video or telephone consultation with us? 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. Find Dr. Jackson's phone number, address, hospital affiliations and more. The local authority sought findings that the injuries had occurred non accidentally with the parents and grandmother as possible perpetrators. All the adults appear to be normal hardworking people concerned for their children. 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. S had regained and passed her birth weight. 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. 135; "There are areas of ignorance. At that point a number of problems faced the court. So the records engage even closer scrutiny. %%EOF The cause of an injury or of an episode that cannot be explained scientifically remains equivocal;ii. NS>zu=/_jwJa:S Several of these fractures are highly specific for non-accidental causation by an adult. 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. X-rays It was noted that the parents were unsure how the fracture may have happened and there had been no recent accidents of falls. 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. This hearing has run over a prolonged period of months in the course of 2012; in particular because it encountered difficulties in the procurement of the services of one of the experts necessary to address the issues in the case, and also because of practical difficulties in the hearing itself in adducing the important evidence of the children's grandmother from Sri Lanka. 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. 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. 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. There is no evidence of drugs or alcohol abuse, of anger or violent outbursts, of short temper, volatility, irritability or dysfunction. In all sections, the value of all imaging modalities are stressed. 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. 8. If no better, to review or sooner at any time if concerns'. Left lower leg fracture, a metaphyseal fracture of the left tibia (shin bone) (3rd-10th October 2011). As it is, her persistent crying which may well have been her response to the injuries can be considered in the light of the reports of the parents about her crying and the possibility of their misinterpretation of her crying emerges as a very real consideration. 57 0 obj <>stream 4. Left upper arm fracture, a spiral fracture of the distal shaft of the left humerus (16th-19th October 2011). This, unfortunately, was soon to change. The conclusions are positive. S could not have been injured when in a bouncy chair from normal use. She acknowledged that this is a developing and controversial area of medicine. An X ray showed a spiral fracture of the left humerus. 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. Summary by Georgina Clark, barrister , Field Court Chambers ___________________IN THE WATFORD COUNTY COURTWatford County Court,Cassiobury House,11-19 Station Road,Watford,Hertfordshire WD17 1EZ.20th March 2013Before:HIS HONOUR JUDGE WRIGHTBetween:A local authorityApplicantsand. I have given a relatively brief overview of the medical evidence adduced by the local authority, but, having reviewed the medical evidence so relied on, I have no difficulty in acknowledging that the inferences to be drawn from the medical expert evidence raise a substantial likelihood that the injuries were caused non-accidentally and by force used by at least one of the adult family members that was in excess of normal day to day handling, although expressing reservation as to what precisely that might mean, and that the evidence of Dr Fairhurst in particular deserves significant weight. 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. 14. Added to this was the unfortunate position of counsel for the grandmother, who was not present and who had sent a message to the court that her client's public funding certificate had been embargoed for the reasons and with the consequences set out in para. This company officer is, or was, associated with at least 1 company roles. 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. With no help from outside agencies their couple mounted their own investigation into the cause of their son's injuries. The judgment that I gave that day is subsumed into this fuller judgment of the court.02. 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. Amaka lectures regularly on various radiology, paediatric, genetic, emergency medicine and orthopaedic courses, locally and nationally. 20. 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. 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". Dad says that [she] has been miserable all day no temperature". Doctors, medical appointments, hospitals, medical staff. 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