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. %%EOF 03. I return to consider T and his behaviour later in this judgment.12. S's father is represented by Miss Deschampneufs. Particular difficulties were encountered with receiving the evidence of the grandmother by Skype from Sri Lanka with the connection frequently being lost and with further doubts arising over the correctness of the interpretation of her evidence. hbbd``b`J5 `n\ a#H #e \ Metaphyseal fractures result from pulling and twisting being applied to the limb. It is reasonable to conclude that they were lower before then because she was breastfed. Her case is that she came to the United Kingdom specifically to support her daughter and son-in-law with the day to day care of the children. (5) S's Vitamin D levels, which were on the borderline on 2nd November 2011, were never higher than insufficient. @ $ lp-5v|v3+F;%`(E4Di The local authority goes on to make the following allegations which I give as numbered in the Scott Schedule: 7. Mrs K Oestreich The deal meant they could never be alone with their own son out of concern that they would cause him further harm. 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. the fractures to the right tibia and the proximal left tibia are likely to have occurred at the same time, and that that is the likely time-frame for them both.19. DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. Wanted a review(Under 'P') Discussed with Mum and Dad possible colic will continue withInfacol and see how she gets on over next week. 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 She moved back to London, to Great Ormond Street Hospital and the Institute of Child Health, where she obtained a PhD for her thesis, Optimisation of the digital radiographic imaging of suspected non-accidental injury, then returned to Sheffield as a HEFCE-funded Clinical Senior Lecturer in the Academic Unit of Child Health. Her evidence was that S was crying, being "fractious and miserable but not hugely distressed", happier lying down than being held. I have considered the findings invited by the local authority as to the evidence of the family members, the inconsistencies, alleged inaccuracies and inferences that I am invited to draw from them. 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. The father's responses set out a general defence to each allegation setting a number of relevant points that formed part of his evidence. 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. Notwithstanding that, I formed the impression that she was seeking to assist the court. 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. (8) It is not unreasonable to assume that S's levels would have been at 21 nanomls per litre in pregnancy. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. 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. 46. 47. 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. hmk0^g? Mr Sami Al-Ani Interactive case-based approach using a powerful online DICOM viewer to maximise learning. On being released on bail they were immediately suspended from their jobs. 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. The Court found that the medical evidence raised a substantial likelihood that the injuries were caused non accidentally and by force used by at least one of the adult members of the household. At one week she was seen by the Community Nurse and was reported to be "thriving, contented and settling well." The father maintains that there could be some natural explanation for S's injuries.38. 13. Nor is it possible to conclude at what point 'normal day to day handling' a vague phrase at best, and which must include the use of reasonable force and pressure at times crosses over to the point where S's vulnerable bone structure was compromised and exceeded. Attendance of the course includes access to the database of cases associated to this event on our server at PostDICOM. 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's Vitamin D levels were borderline on 2.11.11 and were never higher than insufficient. I summarise these as follows. On examination by the doctor there was no active movement of that arm. 37. A week later William was placed on the council's child protection register. As to the possible involvement of T, he asserts that he had not witnessed T twisting S's arm (or leg or wrists). The family are very close and have a loving relationship. 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. 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 colic/reflux." "It was felt that it was a matter of such complexity and range of opinion that it was a matter for court determination.". 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. 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. In the light of this observation, the involvement of local Children's Services inevitably followed and the proceedings were commenced, as I have indicated in this judgment.30. '(&NJdsB. I draw the conclusion that it is reasonable in S's case to assume that a lesser degree of force would be required if her bones were sub-optimal as a result of Vitamin D deficiency, which I am satisfied on the evidence that S's bones probably were, viz., Vitamin D deficient. 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. I never observed either parent react angrily towards each other or either child. The father completed a course in tourism management and completed a post-graduate degree in business management. This company officer is, or was, associated with at least 1 company roles. 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. Right wrist fracture, a metaphyseal (bucket-handle) fracture of the distal right radius (difficult to date). Erythematous [reddening on the skin]. 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. The Judge surveyed the 'wide canvas' of the case including the manner in which the parents gave their evidence. The court had no expert views on these aspects or on a number of potential issues relating to bone metabolism. "There seems to be a small group of expert witnesses who often condemn parents. 11:00-11:30 Imaging of arthritis Dr Emma Rowbotham, Leeds Teaching Hospitals NHS Trust 12:00-12:30 Common paediatric MSK conditions Dr Karl Johnson, Birmingham Children's Hospital NHS Foundation Trust 12:30-13:00 Soft tissue and bone lesions. N and D appeared able to actively provide a high level of basic care for their children.'. Book yoUR 2023 CME TODAY. Nothing untoward is reported by the clinician who weighed her and the Health Visitor could not recall S as being unhappy.23. The father said in evidence that her crying was first mentioned then, although there is no entry about it in the record, but the following record in the GP Notes does suggest that the Health Visitor had "advised giving her Infacol" at this point, so it probably was raised then. 4. Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. The record confirms the father's account that they had been advised to use Infacol, had done so and that it was not working. In the meantime Cambridgeshire applied to the family court for a care order, allowing them to remove William from his parents. 135; "There are areas of ignorance. 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 mother and/or the father and/or the grandmother is the perpetrator of the injuries to S.19. The fractures at 2, 3 and 6 above were only identified by Dr Fairhurst. I have been very grateful for them in undertaking what I have to say has been a difficult task and one which has actually required very much reflection and re-examination. During the time period for the occurrence of the fractures S was seen by medical professional 5 times on 16th September, 22nd September, 13th October, 19th October and 20th October. I considered that the family members have a very close bond and I did not observe any concerns regarding their attachment. 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. 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. Dr. Thomas' office is located at 2204 Lakeshore Dr, Birmingham . The record concludes with the GP's comment "All well. This new, pocket handbook encompasses all aspects of paediatric radiology. 12. On 22 September 2011, S is recorded as having the first of her immunisations at the Medical Centre. 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. 0121 472 1377. 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 GP's entry records "crying, excessive ? She acknowledged that this is a developing and controversial area of medicine. 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. Full access to the cases to follow alongside with the sessions. 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. At that point a number of problems faced the court. 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. She weighed 6lbs 15 ozs (3.15 kg) at birth and was born by emergency Caesarean section. I have noted the reported reactions of T to the birth of S. I have considered S's early developmental history after her birth; also the arrival when S was about 10 days old of the maternal grandmother from Sri Lanka to help the mother look after the children. The book is an important revision aid as well as an up-to-date reference. Formula feeding for 8-9 weeks before the test would have provided some improvement but not enough, as breastfeeding would provide none. Since the medical centre was closed, they took S to the local hospital.25. At 22.30, a further medical clinician's note was written, although the authorship is not clear. I have taken account of the occasions when S was seen by medical staff. Dad says that [she] has been miserable all day no temperature". The father's evidence was that during the morning she had cried more than normal and he confirms that she was "grumpy and crying". %PDF-1.6 % The conclusions are positive. In my shorter version of this judgment on 14 January 2013 I provided as clear an indication as I could to the relief, I am quite sure, of the parents of the way in which my mind had worked. My close examination of this material has focused on the parents' accounts as well as on the evidence they have subsequently given about what they saw. 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". He identified irregularity in the distal left femur in an earlier X-ray taken on 13th October 2011, but after further scans concluded that there was no fracture of the distal left femur. Dr. 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. S was referred to hospital as a paediatric emergency, the GP's impression being "?? 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. Dr. Foster spent two and a half years working in paediatricsbefore moving into radiology. It is very easy to try and fill those areas of ignorance with what we know but I think that it is very important to accept that we do not necessarily have a sufficient understanding to explain every case.". 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. 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. The local authority alleges that the injuries were suffered by S and caused by an adult carer and they are non-accidental. 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. The consultant paediatric radiologist was able to date the fractures as follows: The rib fractures occurred between 15th and 28th September 2011. The family's nightmare began one night in July 2005 when, at three months old, William woke up in pain. 41 0 obj <>/Filter/FlateDecode/ID[<2E609F2171D9B848924D49576AA30896>]/Index[34 24]/Info 33 0 R/Length 56/Prev 68695/Root 35 0 R/Size 58/Type/XRef/W[1 2 1]>>stream Angry that parents like themselves could be put through such an ordeal without being able to challenge the credibility of experts called to give evidence against them, the Wards returned to the High Court. 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. 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 do not propose to go through all the responses to the various fractures but what I have mentioned sets out much of the content and gist of the father's response and denials of the local authority's allegations.39. An X-ray showed a spiral fracture of the left humerus. It is simply not possible to know where the boundary lies. Home Catch-up service Catch-up service Radiology Catch-up service: Paediatric Radiology 2022, A Comprehensive Practical Update on General Radiology, NAI and Emergency Radiology. Tel: 0121 335 8260 The team Our team is made up of consultant radiologists, sonographers, radiographers, health care assistants and administrative staff. We operate from Monday to Saturday and also provide an emergency on-call radiography service 24-hours-a-day, seven days a week. 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. 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