(Orders made included discharge of interim Care Order and approval of revised care plan for phased return of S to the care of her parents. 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. &/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]$kBEGs0XX'O-J(|- KTg}LzgNY 47. At one week she was seen by the Community Nurse and was reported to be "thriving, contented and settling well." Excellent peer interaction and collaborative learning. If there is some innate contradiction in that sentence it appears that the latter part of that sentence represents the stronger conclusion. endstream endobj startxref The record shows "baby crying and unsettled today. At no point did I observe either child to be wary of their parents. The local authority made an application for an Emergency Protection Order on 26th October 2011 in respect of both children, and on 27th October the parents agreed to Section 20 accommodation. The book is an important revision aid as well as an up-to-date reference. There is no radiological evidence that S suffers from rickets or any other vitamin deficiency. The mother's tend to be shorter responses but amplify the general stance of the parents as well as the grandmother that while accepting that the fractures occurred and that they occurred while S was in their care they reject the allegations that they caused the injuries in a non-accidental way. Ms Soffa has gone to considerable lengths and much detail to expose what are submitted as matters on which I should mistrust the evidence of the parents or confer on their evidence only little weight. xYYo~o!baX_{da+LV"gy8du|UU]^|^y^]](g1qV&QdLY$aqT\ G~k)UwalB^d!/^I8>goAXX""~vQ^eTT'YC g-lZ['#.5\K,H Because William's parents were unable to explain the fracture the hospital deemed the case suspicious and called in social services. Extensive high quality images throughout the book, and additional illustrations, aid the reader with diagnosis and detailed referencing points to further reading. 4. Dr Paul Humphries, Consultant Paediatric Radiologist, Great Ormond Street Hospital and University College London 12:15 MSK MRI 2 - bone marrow Dr Karl Johnson, Consultant Paediatric Radiologist, Birmingham Children's Hopsital 13:00 Lunch 14:00 Abdominal MRI - techniques, common applications and 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. hbbd``b`J5 `n\ a#H #e \ So the records engage even closer scrutiny. No local tenderness in leg or hip", S was x-rayed, but nothing abnormal was observed. 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.' A revised care plan was approved for the rehabilitation of S to the care of her parents. We operate from Monday to Saturday and also provide an emergency on-call radiography service 24-hours-a-day, seven days a week. 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. 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. Show number Paradoxically, the last fracture-type injury in time to occur (in all probability), the left humeral fracture, was the first to be identified on 22 October 2011. The second section discusses the differential diagnosis of radiological features. ,8KaF"*w!$uOEF!1 The GP's entry records "crying, excessive ? The first time a fracture was noticed was on 22nd October despite an X-ray having been taken of S's knee on 13th October.S had been in the care of her parents and maternal grandmother when the fractures occurred. In surveying the 'wide canvas' further, I take into account the evidence of Professor Nussey because the manifest injuries do call for explanation. She acknowledged that this is a developing and controversial area of medicine. 16. 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. (On examination) Crying ++. The fractures at 2, 3 and 6 above were only identified by Dr Fairhurst. 0121 472 1377. Dr Johnson, however, reported "a number of equivocal appearances on radiographs with respect to the left distal femur and proximal left tibia" and suggested further films. Mrs K Oestreich I found Professor Nussey to be highly knowledgeable in his field; careful; and able to consider and assist the court on all matters put to him. 6. Rent and save from the world's largest eBookstore. To summarise further, I have noted the pattern of the family's care for the children and reviewed the detail of the entries in the GP records which record S's progress and visits with the record of her developing a tendency to cry a lot from 17th August 2011 and the advice that it was possibly colic; the parents' use of Infacol and S's response to that. On 16 September 2011, S was seen for her 6-week check. I note his view that osteogenesis imperfecta was 'exceptionally unlikely.' Left leg thigh bone fracture, a torus fracture of the distal left femur (30th September-10th October 2011). The other parties to the case are S's parents, who are married. (9) He anticipated that S's level was 30-35 when she was born, not adequate and markedly deficient. The report presents what is effectively the high water mark of the extent of the injuries and the existence and extent of these injuries has not been challenged, although Miss Trustman urges the court in respect of the injuries only reported by Dr Fairhurst to approach the existence of such injuries with caution, particularly the torus fracture to the distal femur, since they were not identified by any other clinicians and their identification appears to rest on Dr Fairhurst's own expertise and experience as a consultant paediatric radiologist over 21 years. S, it is stated, settled after being given Calpol following her vaccination on 20th October 2011. Left upper arm fracture, a spiral fracture of the distal shaft of the left humerus (16th-19th October 2011). Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. An X-ray showed a spiral fracture of the left humerus. She weighed 6lbs 15 ozs (3.15 kg) at birth and was born by emergency Caesarean section. The fractures of the ribs require considerable force and well in excess of day to day handling or even rough play. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. Wanted a review(Under 'P') Discussed with Mum and Dad possible colic will continue withInfacol and see how she gets on over next week. 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. The Consultant Paediatrician, as the locum consultant paediatrician at the local NHS trust, described himself as a 'relatively recently qualified paediatric consultant.' The parents had first presented S to A local hospital on 13th October 2011 with a referral from her GP to the paediatric team at the local hospital with swelling of her left knee. %%EOF Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. The Wards took their son to Addenbrooke's hospital in Cambridge, where an x-ray revealed he was suffering from a spiral fracture of the lower right leg, an extremely rare condition in children who have not yet begun to walk. Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). Dr. Helen Williams is a full time general paediatric radiologist, and has special interests in cross-sectional imaging, feeding studies and radiology training. (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. Her evidence was that the earliest date for the rib fractures was 15 September, the latest date being the 28 September 2011. 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. 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. DAY 3: INFLICTED INJURIES IN CHILDREN - FRIDAY 11 FEBRUARY 2022. The local authority took action on 26th October 2011 after the Consultant Paediatrician concluded that there must be a high level of suspicion in the absence of explanation of the injury to the left arm that the humeral and left rib fractures may have been sustained as a result of a non-accidental injury. Filming William asleep at night they discovered he moved vigorously during his sleep, repeatedly kicking his legs. The x-ray of the left femur had been reported as showing no bony injury on 13 October 2011 and no obvious metaphyseal infraction. The family are very close and have a loving relationship. I have also noted the quotation offered by Miss Trustman from R v Harris and others [2005] EWCA Crim 1980 para. You can book online your appointment and hire medical insurance online. 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. Interpretation & Reporting Webinar for the General Radiologist, DAY 1: GENERAL PAEDIATRIC RADIOLOGY - WEDNESDAY 9 FEBRUARY 2022 As I identify the main points in the chronology, I note first that Dr Fairhurst regards the 16 October 3 days after S was first seen and x-rayed at hospital as the "earliest date" on which the fracture to the left humerus occurred, and thinks it probably would have occurred before the 19 October. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. S was referred to hospital as a paediatric emergency, the GP's impression being "?? Attendance of the course includes access to the database of cases associated to this event on our server at PostDICOM. 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. 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. This led them to suspect that he may have caught his right leg between the bars of his cot and the mattress of their own bed, causing him to fracture it as he struggled to pull it clear. I have also noted the guidance to be derived from Re U: Re B (above) given by Butler Sloss P at paragraph 23: "In the brief summary of the submissions set out above there is a broad measure of agreement as to some of the considerations emphasised by the judgment in R v Cannings that are of direct application in care proceedings. S could not have been injured when in a bouncy chair from normal use. 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. 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. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. T would often watch attentively as the parents and grandmother would feed S and hold her. N and D are in a stable relationship and have known each other from childhood as they lived in the same village. EiSNZw_EQL{.y@^y|jJ%5* dN%] w;t|9"v@v(5>S@k 0 T- 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. 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. 941-697-3552. This person was born in December 1965, which was over 57 years ago. It is not possible to know which incidents or movements caused or gave rise to force sufficient to bring about fractures. The conclusions are positive. The Judge found that neither parent was seeking to cover up matters or to deal other than truthfully to the best of their ability. 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. He has a special interest in paediatric musculoskeletal. I came to the conclusion that I was unable to determine the case without further specialist expert evidence. I derive particular assistance from his evidence and the conclusion that S had a greater vulnerability to fracture, which he described as a reasonable conclusion, and at the times when they are likely to have occurred. The Wards were arrested and questioned by police on suspicion of grievous bodily harm and child cruelty towards William. Mrs K Oestreich Prof T Southwood Dr Karl Johnson: Tumour Clinic (LTB Clinic) Tuesdays once per month: Ms Baldrighi: The Transition Clinic : Four to six times per year at Queen Elizabeth Hospital on a Tuesday morning : . Our imaging courses are very much an interactive experience. No plausible explanation has been offered for any of these injuries. Nearby doctors Sarah Yusuf Nazia Anwar Kaushal 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. 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. Studies and radiology training very much an interactive experience bone fracture, a metaphyseal of... Non-Accidental injury and D are in a stable relationship and have known each from... I note his view that osteogenesis imperfecta was 'exceptionally unlikely. Dr Karl Johnson, & # ;! Attendance of the ribs require considerable force and well in excess of day to handling. Suffers from rickets or any other vitamin deficiency Harris and others [ ]. Detailed referencing points to further reading were arrested and questioned by police on suspicion of grievous harm. 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