Read full profile Dr Khushnood Alam Consultant Radiologist Biography pending. At times she appeared to have poor recollection, which to my mind was not surprising given the sort of detail that she was required to remember after some considerable time. On examination, the left knee was "warmer to touch than the right, with mild erythema and swelling over the knee". The family are very close and have a loving relationship. Left upper arm fracture, a spiral fracture of the distal shaft of the left humerus (16th-19th October 2011). Again I did not get the impression that this was a man seeking to cover up matters or deal other than truthfully to the best of his ability with matters as he remembered them. 09. I therefore granted an adjournment so that a suitable expert could be instructed. I come to the conclusion that Dr Fairhurst's evidence as to the identification of the injuries is, taken as a whole, and in the light of all the evidence and my acceptance of Dr Fairhurst's evidence in her own field of specialism, reliable and acceptable. Right wrist fracture, a metaphyseal (bucket-handle) fracture of the distal right radius (difficult to date). 45. A diagnosis of OI (osteogenesis imperfecta) is exceptionally unlikely. Book yoUR 2023 CME TODAY. She was accompanied by both parents. It is further positive that the professionals involved with the family have reported no concerns regarding the children's wellbeing whilst in the care of their parents prior to S being admitted to a local hospital with a fracture to her left femur.'. I have also noted the case of Re S-B (Children)(Care proceedings; standard of proof) [2009] UKSC 17 and particularly the passage in which their Lordships confirmed that the simple balance of probability test following the House of Lords decision in Re B (above) should be applied in finding that a person was the perpetrator of an injury, confirming the approach where the evidence falls short of that standard in North Yorkshire County Council v SA [2003] EWCA Civ 839 to the effect that an individual will be found to be a possible perpetrator if the evidence establishes a 'real possibility' that they caused the injury. 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. The Judge found that neither parent was seeking to cover up matters or to deal other than truthfully to the best of their ability. Having reviewed the evidence in detail, and after considering the written submissions of all parties, I had reached a position where I had come to my conclusions on the issues of fact. It is not only the appearance of symptoms, and the timing and description of them with a view to dating the occurrences, even approximately, that has raised a perplexing and indistinct picture with differences in the accounts, and nothing obvious or clear to work on. 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. Injuries to S could not have been caused by a person rolling onto her. The father maintains that there could be some natural explanation for S's injuries.38. The final section details the imaging findings in a wide variety of clinical conditions. 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. It is positive that Children's Services have no history of involvement with this family and furthermore the family have no history of involvement with the police. @ $ lp-5v|v3+F;%`(E4Di This led to a referral by the consultant paediatrician from the local hospital to Social Services. Mrs Ward, who at the time worked as a manager for child care strategy for Cambridgeshire, told BBC One's Panorama, in a documentary to be broadcast tomorrow night: "We were absolutely shocked. Print this page This company officer is, or was, associated with at least 1 company roles. 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. He noted that there is no uniformity of Vitamin D testing and it is difficult to measure. 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 17. 4. Professor Nussey reported on 10th July but in time for the resumed hearing of the matter on 25th 26th and 27th July. The father recalled that S "cried throughout", crying as soon as the examination started although the doctor carried on. 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. I note the entry as follows: 'non-tender, baby permits passive manipulation. As to the possibility that rough handling by T might have been responsible for S's injuries, he concluded that while it would be possible he did not think it was probable. HkBsD R#\#[(!$D(AyLgtJ%{mc8zA&+;*JV [a%4[)Er_'! Judge Isobel Plumstead finally concluded that Mr and Mrs Ward presented no threat to William, declaring in her judgement: "There is no cogent evidence that these parents injured their son.". On 22 October a skeletal survey was performed and reported on by Dr Steven Johnson, Consultant Radiologist. It is simply not possible to know where the boundary lies. He confirmed the presence of the humeral fractures and rib fractures and, following further X-rays, identified what he thought was a healing fracture of the proximal left tibia. He states that S had a tendency to cry and this was discussed with medical professionals on more than one occasion. 42. "ag`|v#+(U)R1Vrg+1TnD G#qOQOGB[ @+v7#ibHd7X ~6?fJq*bk&~GTQH6To-,dh=>!aFd&02uGo(y GCv&_SRbc>N; ^1Qc(:*%Bl#~vczyAa;~tlvY4Y;U: e0| 34Ba7/, h!i"#>!9l^(bl1oUT (R&^I'[V.1e7'}N"e@ZAEY }^gEm1|4_I|Zj>apQvcZreu[OyTqWl({MicALn("#S' I accept the submission that there is a lack of current research on the susceptibility to fracture in babies who are Vitamin D deficient. 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. As to the possible involvement of T, he asserts that he had not witnessed T twisting S's arm (or leg or wrists). He has been able to contribute vital knowledge and information towards understanding S's condition in August, September and October 2011. At one point, he mentioned that they had thought it was due to her immunisation that she was not using her left hand. Paediatric Radiology opens with a chapter devoted to the different imaging modalities, including radiographs, fluroscopy, ultrasoound, CT, MRI and nuclear scintigraphy before moving on to more detailed, systems-based chapters. Dr. Foster spent two and a half years working in paediatricsbefore moving into radiology. 1808 7th Ave S, Birmingham, AL, 35233 3 other locations (205) 934-3333 OVERVIEW Dr. Johnson graduated from the University of Pittsburgh School of Medicine,University of Pittsburgh School of. sub-optimal bones that have not yet developed radiological signs of rickets; (6) I note that she was not in a position to give an expert opinion on metabolic bone disease which she identified as a very complex subject beyond the radiological aspect and that she would defer to a metabolic expert; (7) she accepted that the lack of evidence for fractures occurring in patients with lower than normal levels of Vitamin D (who did not have radiological evidence of rickets) is the current state of research and acknowledged that there is a need for more study to be done; she further accepted that this is a developing and controversial area of medicine; (8) I noted that it is accepted by all medical experts that it is unknown what level of force would be required to cause the injuries in a baby that had a Vitamin D deficiency or insufficiency; understandably it is not possible for experiments to be carried out. He has co-authored over 35 peer reviewed papers. At hospital on Saturday 22 October 2011 at 15.30, the triage nurse noted the presenting complaint as "swelling to the left upper arm" and "since Thursday, increased crying". On Wednesday 19 October 2011, S was seen at the clinic to be weighed. "There seems to be a small group of expert witnesses who often condemn parents. Firstly, it had become evident that the court required the assistance of an expert in paediatric bone disorders. The 30 September 2011 is the earliest date for the left femoral fracture, but Dr Fairhurst took the view that the most likely time of occurrence was between 10 October and the visit to the GP on 13 October.She also thought that the two leg fractures, i.e. The family's nightmare began one night in July 2005 when, at three months old, William woke up in pain. Dr. Gregory D. Jackson is a Radiologist in Birmingham, AL. Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. S would often cry and it was initially believed that this was due to her suffering from colic. 14. Ms Baldrighi, Back to top of page X-rays colic/reflux." (5) S's Vitamin D levels, which were on the borderline on 2nd November 2011, were never higher than insufficient. 4. Furthermore, Professor Tim David, an expert paediatrician, told the court that in this and many other cases, police and social workers were wrong to assume that an unexplained injury could normally be attributed to child abuse. 47. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. Full access to the cases to follow alongside with the sessions. I will quote only two passages, in order to convey the tone and broadly positive view that emerges from this report, at p. 3 and from the Conclusions at p. 16. 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.". Several of these fractures are highly specific for non-accidental causation by an adult. 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. This further hearing took place on 24th October 2012.08. As with the mother, that did not mean that there were no instances when they were confused or mistaken.48. Determined to establish what was wrong they returned twice to the GP, but he was still unable to offer any diagnosis. 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. Birmingham, 012 133 The book is an important revision aid as well as an up-to-date reference. 54. 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. I note in particular the five times when she was seen at medical appointments when she was said to be suffering fractures. 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. The father had come to the UK in December 1999 as a student. In all sections, the value of all imaging modalities are stressed. This could increase bone fragility and give rise to fractures at a lower force than would otherwise be the case. 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. All prices include VAT, Viewers will be asked to evaluate each session and will be provided with a CPD certificate upon completion 44. 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 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 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 maternal grandmother had no concerns in relation to the parents' care for both S and T and would like S to be returned to her parents' care.40. 12. EiSNZw_EQL{.y@^y|jJ%5* dN%] w;t|9"v@v(5>S@k 0 T- 14. This would have involved manipulation of the legs and arms, and the conducting of other tests. Contents hosted on Doctuo should not be used as substitutes for professional medical advice, diagnosis or treatment. S's father is represented by Miss Deschampneufs. The other parties to the case are S's parents, who are married. Consultant Paediatric Radiologist and Service Group Lead for Radiology, Alder Hey Childrens Hospital, Liverpool, UK. S had only been in the house with the parents, grandmother and T. Investigations were put in hand. He was able to extrapolate that S's Vitamin D levels at birth were likely to have been markedly deficient having been Vitamin D deficient in utero. %r W!p-zC1')v?nP=^:;J2wFT$8N&j Dr Neil Stoodley, Consultant Neuroradiologist, Bristol Royal Hospital for Children Dr Musa Kaleem, Consultant Paediatric Radiologist, Alder Hey Children's Hospital, Liverpool Dr Karl Johnson, Consultant Paediatric Radiologist, Birmingham Children's Hospital Dr Sally Old, Medical Defence Union 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. 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