Had an instructive and engaging educational experience. In the last week of the last Parliamentary session the judgement was rubber stamped into law. The parents agreed to section 20 accommodation on 27.10.11 and on 2.11.11 the local authority issued care proceedings. The local authority place considerable weight on the evidence of Dr Fairhurst as to the interpretation and significance of the X-rays, the report of 13th February 2012 and the evidence as to the mechanism of injury in relation to spiral fractures, metaphyseal fractures, fractures of the antero-lateral aspects of the ribs and a torus fracture raise very serious implications for the family members. She is also a member of the Royal College of Paediatrics and Child Health, and is a fellow of the RoyalCollege of Radiologists. He noted that there is no uniformity of Vitamin D testing and it is difficult to measure. 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. 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. 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. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. ,(`df\CT&B6+c! I have heard the evidence of the experts as follows: (1)Dr Fairhurst, consultant paediatric radiologist, and read her reports, notably that of 13th February 2012; (2) A Consultant Paediatrician and his report of 5th March 2012; (3) I have heard the evidence of Professor Steven Nussey, Professor of Endocrinology, and read his reports of 10th and 22nd July 2012; (4) I have heard the evidence of the mother; the father; and the grandmother, and read their statements filed in this case; (5) I have heard the evidence of the health visitor. Now the Local authority has promptly and appropriately put into effect a revised Care Plan to give effect to the orders made that day. The local authority sought findings that the injuries had occurred non accidentally with the parents and grandmother as possible perpetrators. 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. His father described him as "very possessive" of his baby sister, trying to open her clenched fists to place toys in them, to straighten his 'folded' arms and play with her. 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. Dr. Helen Williams is a full time general paediatric radiologist, and has special interests in cross-sectional imaging, feeding studies and radiology training. 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. hbbd``b`J5 `n\ a#H #e \ Dr. I note in particular the five times when she was seen at medical appointments when she was said to be suffering fractures. He denies causing any of the injuries and in turn denies the specific causation of each injury. With Doctuo you can find the doctors you need. S was discharged and the parents reported that her knee improved. 8. She states that they do not occur accidentally and this type of fracture is highly indicative of non-accidental causation requiring a force well in excess of that used in normal day to day handling of an infant. Rent and save from the world's largest eBookstore. You'll get immediate feedback and learning points from our expert faculty member. The question arose as to whether genetic abnormality of bones, metabolic bone disease or demineralisation of the bone caused by Vitamin D deficiency gave rise to an increased propensity to fracture. Dr Karl Johnson Consultant Paediatric Radiologist, Birmingham Dr Sabine Maguire Senior Lecturer Child Health, Cardiff Lady Margaret Wall RCR Lay Representative Dr Tim Jaspan Consultant Neuro-Radiologist, Nottingham Dr Chris Hobbs Consultant Paediatrician, Leeds Dr Neil Stoodley Consultant Neuroradiologist, Bristol All the adults appear to be normal hardworking people concerned for their children. She was born in 1979. Interactive case-based approach using a powerful online DICOM viewer to maximise learning. On 17 August 2011, S was taken to the clinic at 4 weeks old to be weighed. Her evidence was that S was crying, being "fractious and miserable but not hugely distressed", happier lying down than being held. Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. The mother, father and grandmother all said that Infacol did eventually help for a time before her crying became worse again.15. At 22.30, a further medical clinician's note was written, although the authorship is not clear. The father completed a course in tourism management and completed a post-graduate degree in business management. She refers to the times when S was seen by the health visitor when, despite the presence of fractures, nothing untoward was seen on as she puts it 25th July 2011, 3rd August 2011, 22nd September 2011, 19th October 2011 and 20th October 2011. The GP note for 20 October 2011 records "First meningitis vaccination. Birmingham, 012 133 The father's responses set out a general defence to each allegation setting a number of relevant points that formed part of his evidence. This led to a referral by the consultant paediatrician from the local hospital to Social Services. She weighed 6lbs 15 ozs (3.15 kg) at birth and was born by emergency Caesarean section. 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". The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children's Hospital. 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. 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. 36. It is reasonable to conclude that they were lower before then because she was breastfed. Book yoUR 2023 CME TODAY. 17. 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. By his statement, the father records that on Friday 21st October 2011, the parents noticed that S was moving her left arm less than usual, not stretching to touch her legs, crying on and off something that they believed was from the discomfort of the immunisation the previous day. Dr. Thomas' office is located at 2204 Lakeshore Dr, Birmingham . The history squares rather more comfortably with the account given by the father in his statement than in his oral evidence. 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 note records both mother and grandmother as being present. Apyrexial. The advice to 'persist with Infacol' also bears out the father's account. She presented with no bony injury and was discharged. We adopt the following: i. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. He found it was not possible to conclude at what point normal day to day handling crossed over to the point when S's vulnerable bone structure was compromised and exceeded. On examination by the doctor there was no active movement of that arm. 2. 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. 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. The record shows "baby crying and unsettled today. There were evident deficiencies in translation by the interpreter. The second section discusses the differential diagnosis of radiological features. I adjourned the hearing with directions for written submissions but anticipated that the particular difficulties of the case, its subject matter and the possible issues arising over evidence, required a further hearing for the parties to address the court having exchanged their submissions. %PDF-1.6 % 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. Since the medical centre was closed, they took S to the local hospital.25. 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.". Further X-rays revealed what appeared to be three more fractures and an injury to his arm. The Judge formed the view that the maternal grandmother was seeking to assist the Court in her evidence. 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. hmk0^g? I accept the submission that there is a lack of current research on the susceptibility to fracture in babies who are Vitamin D deficient. Call. Certificate of attendance upon completion. While I have taken account of inconsistencies with the records available, I did not form the view that her evidence was demonstrably or readily to be interpreted as that of someone seeking to mislead the court, cover her tracks or draw a veil of ignorance over matters about which she had some knowledge. Three days: 375 | Two days: 295 | One day: 175 In the meantime Cambridgeshire applied to the family court for a care order, allowing them to remove William from his parents. Formula feeding for 8-9 weeks before the test would have provided some improvement but not enough, as breastfeeding would provide none. 20. 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. Country 5. Radiologists, Country 17. EiSNZw_EQL{.y@^y|jJ%5* dN%] w;t|9"v@v(5>S@k 0 T- 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. 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. 41. This person was born in December 1965, which was over 57 years ago. 34 0 obj <> endobj 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. ,8KaF"*w!$uOEF!1 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. 3. N and D appeared able to actively provide a high level of basic care for their children.'. On examination, the left knee was "warmer to touch than the right, with mild erythema and swelling over the knee". On 22 September 2011, S is recorded as having the first of her immunisations at the Medical Centre. 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. Injuries to S could not have been caused by a person rolling onto her. Rib fractures to the antero-lateral aspects of the left 8th and 9th rib (15th-28th September 2011). 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. Thank you! The record confirms the father's account that they had been advised to use Infacol, had done so and that it was not working. 5 of my judgment on 26th March 2012. (S> $}=I% l S2QBC(*YMhTX^Gf=,HO)t}cg3F 0s/yGUu. 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