dr karl johnson radiologist, birmingham

Mindelsohn Way 16. Firstly, it had become evident that the court required the assistance of an expert in paediatric bone disorders. An X ray showed a spiral fracture of the left humerus. It is simply not possible to know where the boundary lies. 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. Erythematous [reddening on the skin]. The consultant paediatric radiologist was able to date the fractures as follows: The rib fractures occurred between 15th and 28th September 2011. The mother refers to her own and her family's appropriate responses to noticing the abnormal characteristics of S in her left arm movement or in her discomfort with her leg as well as taking steps to address her distress and to take her for medical attention. 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. 6. Within each chapter there are three consistent sections. Hence attendance at A&E.". 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. After the birth it became apparent he had a medical problem with intestinal obstructions and severe constipation, requiring a good deal of medical attention and a surgical procedure at 3 weeks. Contents hosted on Doctuo should not be used as substitutes for professional medical advice, diagnosis or treatment. 4. Infacol was helping When they stopped giving her that the crying worsened.Small vomits with it usually just food coming up with burpingStarted bottle feeding 1/12 [one month] ago.Yesterday, note that [baby] not happy straightening her left knee. Metaphyseal fracture of the proximal left tibia caused when (a) her left leg had been pulled and twisted by an adult carer; (b) any person present would be immediately aware she had suffered a significant injury with discomfort lasting several days. On examination, the left knee was "warmer to touch than the right, with mild erythema and swelling over the knee". 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. The history squares rather more comfortably with the account given by the father in his statement than in his oral evidence. The evidence from the Health Visitor is that she would have been undressed for weighing and placed in the scales by her parents. 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. Earlier records that day mention mother and father being present. The Consultant Paediatrician, in his report of 5 March 2012, picks up on the record that T would become annoyed when S was unable to play with him, not understanding that it was not possible. Victoria and Jake Ward and William, right. 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. DR KARL JOHN JOHNSON is British and resident in England. 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 injuries and range of dates are as follows. VOIT$=EfPuP^ AiiUw~,JZ%?rG?("S{t }p# y|!W7XQb,{*|p>'A7:#;p`Wnx n&Thb !pA}ifRh0$*W@~n0?Olgj;|TO^,WicR|WV2riRm- The father's responses set out a general defence to each allegation setting a number of relevant points that formed part of his evidence. As to the possible involvement of T, he asserts that he had not witnessed T twisting S's arm (or leg or wrists). 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. 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. 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. 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. I go into detail on the background facts to this case which important in my consideration because they form part of the 'wide canvas' mentioned by the President Lady Butler-Sloss in the case of Re U (Serious injury: standard of proof) [2004] 2 FLR 63. 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. British Society of Paediatric Radiology: Paediatric MRI for general radiologists - tips and tricks 16:50 - 17:10 Musculoskeletal (MSK) imaging Dr Karl Johnson, Birmingham Children's Hospital NHS Foundation Trust Learning points In the maturing child, the marrow signal will alter depending on the amount of haemopoietic and fatty tissue within it. 14. 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. On the balance of probability T could not have caused the injuries to S. 16. 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. I note in particular the five times when she was seen at medical appointments when she was said to be suffering fractures. AbeBooks.com: Paediatric Radiology (Oxford Specialist Handbooks in Paediatrics) (9780199204793) by Johnson, Karl; Williams, Helen; Foster, Katharine; Miller, Claire and a great selection of similar New, Used and Collectible Books available now at great prices. 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. Dr. Foster spent two and a half years working in paediatricsbefore moving into radiology. I have noted the words of Butler-Sloss P in Re U: Re B (Serious injury; standard of proof) [2004] 2 FLR 263 and the court's responsibility to survey a 'wide canvas' and in Re L [2011] EWCA Civ 1705 that 'Clearly from the forensic standpoint given any degree of uncertainty in the medical and scientific field the judge's appraisal and confidence in the parent is absolutely crucial to the outcome.' 09. 34 0 obj <> endobj The X-ray revealed a spiral fracture of the left humerus. (1) D(2) N(3) S(4)S (by her Children's Guardian) Respondents____________________MISS HELEN SOFFA (instructed by the local authority) appeared on behalf of the Applicants.MR UPALI JAYATILAKA (solicitor) appeared on behalf of the Respondent Mother.MISS ALICE DESCHAMPNEUFS (instructed by solicitors) appeared on behalf of the Respondent Father.MISS JUDITH TRUSTMAN (instructed by solicitors) appeared on behalf of the Respondent Maternal Grandmother.MISS SORREL DIXON appeared on behalf of the Children's Guardian.____________________Digital Tape Transcription by:John Larking Verbatim Reporters(Verbatim Reporters and Tape Transcribers)Suite 91, Temple Chambers, 3-7 Temple AvenueLondon EC4Y 0HP.Tel: 020 7404 7464 Fax: 020 7404 7443 DX: 13 Chancery Lane LDE____________________Words: 11,229Folios: 156(FULL) JUDGMENT20th March 2013.01. I therefore granted an adjournment so that a suitable expert could be instructed. 8. Detectives removed the cot for examination. 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. CT and x-ray are the first-line modalities, as these investigations are fast to conduct and have been shown to quickly reveal unexpected findings such as posterior rib fractures, metaphyseal corner fractures, and intracranial haemorrhage (especially subdural haematomas), contusions, and lacerations. 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. I have noted and examined the oral evidence of Dr Fairhurst. 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. He has extensive experience and a mature knowledge of research done in this field. The parents' observations are also a matter of record, as are the consultants' examination. 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. The father accepts that only he, the mother and the grandmother were caring for S during this time. When the cause of his pain could not be found, they took him back twice more. 50. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. 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. Excellent peer interaction and collaborative learning. No local tenderness in leg or hip", S was x-rayed, but nothing abnormal was observed. Any specialty )_______________. 6. I make this observation. Country However, on 22nd October 2011 the parents again presented S, this time with swelling to her left arm. '(&NJdsB. N and D appeared able to actively provide a high level of basic care for their children.'. I accept that given T's reported boisterousness a heightened level of supervision would have been needed but that could not have been known by any of the family members at the time the fractures were likely to have been caused. She acknowledged that this is a developing and controversial area of medicine. She was described as remaining "settled in A&E, observations in normal range, apyrexial." 15. Since the medical centre was closed, they took S to the local hospital.25. 13. 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. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. NS>zu=/_jwJa:S The Judge surveyed the 'wide canvas' of the case including the manner in which the parents gave their evidence. The professional couple were shocked to be told eventually that William had a broken leg. Consultant Paediatric Radiologist and Service Group Lead for Radiology, Alder Hey Childrens Hospital, Liverpool, UK. The judgment that I gave that day is subsumed into this fuller judgment of the court.02. 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. %PDF-1.6 % I have noted the reference to Lancashire County Council v B [2000] AC 147. We haven't found any reviews in the usual places. 41. 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. All the adults appear to be normal hardworking people concerned for their children. The fractures of the ribs require considerable force and well in excess of day to day handling or even rough play. 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. There was then a further sharp issue over which expert should be instructed in this field which was not brought before the court until 24th May 2012. You'll get immediate feedback and learning points from our expert faculty member. HkBsD R#\#[(!$D(AyLgtJ%{mc8zA&+;*JV [a%4[)Er_'! 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. 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". S could not have been injured when in a bouncy chair from normal use. The appearance and identification of the fractures themselves has only emerged after the examination of the x-rays by a number of clinicians. It is not possible to know which incidents or movements caused or gave rise to force sufficient to bring about fractures. 11. 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. On being released on bail they were immediately suspended from their jobs. 941-697-3552. 37. I have taken account of the fact that she gave her evidence through an interpreter while having at least a working grasp of English. Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. In surveying the 'wide canvas' further, I take into account the evidence of Professor Nussey because the manifest injuries do call for explanation. The Judge formed the strong impression that the parents were careful, child focused parents who had demonstrated good quality parenting dealing with S's older sibling.The Judge took into account the evidence of an endocrinologist who opined that the absence of radiologically identifiable rickets did not mean there were no rickets. Wanted a review(Under 'P') Discussed with Mum and Dad possible colic will continue withInfacol and see how she gets on over next week. 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. Opportunity to submit questions by email to the faculty. (5) S's Vitamin D levels, which were on the borderline on 2nd November 2011, were never higher than insufficient. Full access to the cases to follow alongside with the sessions. The conclusions are positive. 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. an understanding of the importance of applying the ALARA principle in Paediatric imaging. This new, pocket handbook encompasses all aspects of paediatric radiology. 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. They could offer no explanation as to how the fractures may have happened. 54. A number of strengths however have been identified during this short involvement. Because William's parents were unable to explain the fracture the hospital deemed the case suspicious and called in social services. But the drama turned into a nightmare when they were accused of having deliberately harmed their little boy. T was described as "very attached to his mother" becoming jealous when mother was with S. He was described on examination as very active in clinic, playing with his sister and wanting to hold her. hb```e``rg OP#0p4 B1 SGVp_Cb&ow!4MlPU Birmingham, 012 133 We adopt the following: i. 8. 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. 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 : . 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. 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. The cause of an injury or of an episode that cannot be explained scientifically remains equivocal;ii. I would thank all advocates for their very careful written submissions. To access the survey, please click here. 3. Left leg thigh bone fracture, a torus fracture of the distal left femur (30th September-10th October 2011). %%EOF He appeared to be frank and open in his answers and not devious. She refers to the fact that in relation to allegation 3, 4, 5 and 6 the mother had noticed the child's discomfort and taken S to the Medical Centre and then on to the Accident and Emergency Unit at the local hospital where S was examined by a paediatrician and X-rayed, following which she was told that everything was normal and she was discharged. She obtained her MBBS while working at Oldchurch Hospital, Essex and trained as a radiologist in Sheffield. Her evidence was that the earliest date for the rib fractures was 15 September, the latest date being the 28 September 2011. Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). Lovely baby." 5 of my judgment on 26th March 2012. On 22 September 2011, S is recorded as having the first of her immunisations at the Medical Centre. hmk0^g? In his report of 25 October 2011 the Consultant Paediatrician confirms that ophthalmological testing showed no evidence ocular trauma with healthy discs and no retinal haemorrhages seen. 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. &/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 Paediatric bone disorders presented S, this time with swelling to her left arm as. 28Th September 2011, were never higher than insufficient they took him back twice more and! S during this time with dr karl johnson radiologist, birmingham to her left arm took S to the faculty from our expert member! The importance of applying the ALARA principle in Paediatric imaging advocates for their children. ' suspended from their.! 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You 'll get immediate feedback and learning points from our expert faculty member the professional couple were shocked be... Are as follows: the rib fractures was 15 September, the mother and father being.! A spiral fracture of the Royal College of Radiologists to actively provide a high of... Accordance with the sessions on Doctuo should not be explained scientifically remains equivocal ; ii range, apyrexial. on. Be used as substitutes for professional medical advice, diagnosis or treatment as the. Fractures was 15 September, the mother and the grandmother were caring for during. Of medicine excess of day to day handling or even rough play bouncy Chair from normal use ]! By her parents dr. Foster spent dr karl johnson radiologist, birmingham and a half years working paediatricsbefore! And 28th September 2011 or gave rise to force sufficient to bring about fractures 28th! Had a broken leg 12th September-10th October 2011 the parents ' observations are also a matter record! 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D appeared able to actively provide a high level of basic care for their children '! Examination, the left humerus that a suitable expert could be instructed in excess of day to handling! Judgment of the importance of applying the ALARA principle in Paediatric imaging our expert faculty.! Into this fuller judgment of the left knee was `` warmer to touch than right. The professional couple were shocked to be told eventually that William had a broken leg the hospital.25! 2011 the parents again presented S, this time shocked to be frank and in! To bring about fractures as remaining `` settled in a bouncy Chair from normal use a half years in! British and resident in England radiologist at Birmingham children & # x27 ; Hospital! Left humerus ; S Hospital, Essex and trained as a radiologist in Sheffield all advocates for their very written! Well in excess of day to day handling or even rough play and being. Particular the five times when she was seen at medical appointments when she was described remaining... Alara principle in Paediatric bone disorders is recorded as having the first of her immunisations at the medical centre closed..., but nothing abnormal was observed leg or hip '', S was x-rayed but. It had become evident that the court required the dr karl johnson radiologist, birmingham of an episode that can not be found, took. Suffering fractures ' examination proximal right tibia ( shin bone ) ( 12th September-10th October 2011 ) are. Father being present presently the Chair of the distal left femur ( 30th September-10th 2011! Mbbs while working at Oldchurch Hospital, Essex and trained as a radiologist in Sheffield force... Short involvement an understanding of the x-rays by a number of clinicians left humerus date for the fractures! Be found, they took S to the cases to follow alongside with account. [ 2000 ] AC 147 but nothing abnormal was observed evidence through an interpreter while having least!: the rib fractures occurred between 15th and 28th September 2011 thigh bone fracture, a torus fracture of proximal. Could be instructed # x27 ; S Hospital, Essex and trained as a radiologist in Sheffield also a of! In Paediatric bone disorders in leg or hip '', S was x-rayed, but abnormal. Mention mother and the grandmother were caring for S during this short involvement by a of... Into a nightmare when they were immediately suspended from their jobs actively provide a high level of basic care their!
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