dr karl johnson radiologist, birmingham

Consultant Paediatric Radiologist, Chair of Paediatric Musculoskeletal Imaging, Chair, University of Sheffield's Black, Asian, and other Minority Ethnic (BAME) Staff Network, University of Sheffield and Sheffield Children's Hospital. s Pediatric Diagnostic Imaging textbook is renowned as one of the oldest and most prominent general textbooks in the field of paediatric text consists of two reasonably sized volumes covering all key areas using an intuitive systems-based approach. The local authority alleges that the potential perpetrators of the multiple injuries to S are the mother, father and grandmother, who were the carers of the child. The court had no expert views on these aspects or on a number of potential issues relating to bone metabolism. 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. The concerns of the local authority and the allegations raised against the family members arise from the appearance on X-ray scans first seen on 22nd October 2011 of a significant fracture to S's left upper arm. 09. Country 20. It is to be noted that at this time, 13 October 2011, the evidence is that S had already sustained factures of the left 8th and 9th rib and was likely to have sustained her left femoral fracture and fractures to the right and left tibia. 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. She acknowledged that this is a developing and controversial area of medicine. Rent and save from the world's largest eBookstore. 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. The NPI Enumerator can be reached at (800) 465-3203 or P.O. 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. 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. On 22 October a skeletal survey was performed and reported on by Dr Steven Johnson, Consultant Radiologist. 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. 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. 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. 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. 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. When Victoria and Jake Ward saw their baby son crying and refusing to feed, they took him to their doctor. Her mother is D, represented by Mr Jayatilaka. The X-ray revealed a spiral fracture of the left humerus. 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. General radiologists and senior radiology trainees Radiologists with an interest in Paediatric Radiology The content Ten sessions over two days: Head and Neck Chest Gastrointestinal Genito-urinary MSK: Non-Traumatic Inflicted Injury: Brain MSK 1: Traumatic (inc Inflicted Injury) MSK 2: Differential diagnosis Inflicted Injury: A Medico-Legal Update This advanced Infomed webinar is in response to suggestions/feedback from many general radiologists, who have attended Infomed courses, more lately webinars, and now with the easing of the pandemic see the need for a focussed and comprehensive Paediatric Radiology CPD programme. Left upper arm fracture, a spiral fracture of the distal shaft of the left humerus (16th-19th October 2011). Injuries to S could not have been caused by a person rolling onto her. When the cause of his pain could not be found, they took him back twice more. (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. A couple cleared of injuring their baby son have won a legal battle to identify the doctor who gave evidence against them. Arrested, charged by police and threatened with having their child taken away by Cambridgeshire county council's social workers, it took two years for the Wards to clear their name. 04. On being released on bail they were immediately suspended from their jobs. The father accepts that only he, the mother and the grandmother were caring for S during this time. Call. A diagnosis of OI (osteogenesis imperfecta) is exceptionally unlikely. 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. One or both of the parents, and/or the grandmother knows what has happened to S on all the occasions she has suffered injury. The note records both mother and grandmother as being present. The strong impression given is that the parents and maternal grandmother are careful, child-focused and conscientious parents who have demonstrated the quality of the attention they have given to dealing with T's special health needs and to S as they have arisen. The parents did not mention the previous weekend's symptoms or the trip to the hospital on 13 October 2011.24. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. 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. Since the medical centre was closed, they took S to the local hospital.25. %r W!p-zC1')v?nP=^:;J2wFT$8N&j 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. They are set out in a Scott Schedule dated 16th March 2012, which I will duly set out but for the record which I enumerate now before commenting on the parents' and grandmother's responses: 1. 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. Our Radiology CPD courses offer an exclusive range of clinical imaging seminars, available to support Radiologists, Cardiologists, Registrars and Radiographers from around the world in gaining CME. 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. 3. But in clarification of this remark Professor Nussey said that it would be reasonable to use the words 'increased vulnerability to fracture' in relation to S. 53. 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. @ $ lp-5v|v3+F;%`(E4Di HkBsD R#\#[(!$D(AyLgtJ%{mc8zA&+;*JV [a%4[)Er_'! If there is some innate contradiction in that sentence it appears that the latter part of that sentence represents the stronger conclusion. This led to a referral by the consultant paediatrician from the local hospital to Social Services. 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. It provides an overview of how to approach the imaging of children including the relative values of each of the imaging modalities for paediatric pathology. "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' We wanted to be able to name expert witnesses in order to help all those other families who are going through what we went through.". 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. On 16 September 2011, S was seen for her 6-week check. 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. 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. 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. Hence attendance at A&E.". 5 of my judgment on 26th March 2012. He appeared to be frank and open in his answers and not devious. The fractures of the ribs require considerable force and well in excess of day to day handling or even rough play. I return to consider T and his behaviour later in this judgment.12. S's Vitamin D levels were borderline on 2.11.11 and were never higher than insufficient. 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. 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. With Doctuo you can find the doctors you need. 54. BSc, MBBS, MRCP, FRCR, PhD, FHEA 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. 5. Dr. Foster spent two and a half years working in paediatricsbefore moving into radiology. 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. Interpretation & Reporting Webinar for the General Radiologist, DAY 1: GENERAL PAEDIATRIC RADIOLOGY - WEDNESDAY 9 FEBRUARY 2022 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. 49. 06. But the drama turned into a nightmare when they were accused of having deliberately harmed their little boy. 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. 31. Location 36. (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. (5) S's Vitamin D levels, which were on the borderline on 2nd November 2011, were never higher than insufficient. She presented with no bony injury and was discharged. 012 133. Tel: 0121 335 8260 The team Our team is made up of consultant radiologists, sonographers, radiographers, health care assistants and administrative staff. On 14 January 2013 I made orders and gave a foreshortened (primary) version of the judgment in this case which had run over a substantial period in 2012 and before, because having reserved judgment in what was on any view a difficult case, delays in preparing the judgment for administrative reasons and with difficulties over my own health meant the process became much longer than I would have wished. She was born in 1979. 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. I make this observation. Dr. Jackson's office is located at 2204 Lakeshore Dr . 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. EiSNZw_EQL{.y@^y|jJ%5* dN%] w;t|9"v@v(5>S@k 0 T- 13. At this point I summarise his evidence by identifying the following features: (1) Professor Nussey has a clear and far-reaching understanding of endocrinology and the systems involved with Vitamin D and bone mineralisation. 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. 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. Left leg thigh bone fracture, a torus fracture of the distal left femur (30th September-10th October 2011). While one might have looked for the possibility that in a moment of weakness or exasperation they might have snapped, or when the mother might have momentarily lost her self-control, particularly with a baby who cried persistently, that at least one fracture might have resulted, but for S to be shown with six sets of fractures, three constellations, requiring the sort of force and violence that Dr Fairhurst described, appears to be completely and demonstrably alien to the sort of people the parents and the grandmother appear to be. At 6.20pm on 13 October 2011, S was brought to the local hospital, with the presenting complaint "swollen left knee started yesterday." The mother, father and grandmother all said that Infacol did eventually help for a time before her crying became worse again.15. Further X-rays revealed what appeared to be three more fractures and an injury to his arm. S could not have been injured when in a bouncy chair from normal use. On 22 September 2011, S is recorded as having the first of her immunisations at the Medical Centre. Nearby doctors Sarah Yusuf Nazia Anwar Kaushal I have also noted in relation to the injuries that it is 'always open to a judge to rule that the cause of the injury remains unknown' and the case of Re R (Care proceedings: causation) [2011] EWHC 1715, a decision of Mr Justice Hedley. 4. Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). View more radiologists birmingham Consultations Consultations Steelhouse Lane, Birmingham, England. Had an instructive and engaging educational experience. S was discharged and the parents reported that her knee improved. Have you had a video or telephone consultation with us? N and D are in a stable relationship and have known each other from childhood as they lived in the same village. It is reasonable to conclude that they were lower before then because she was breastfed. 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. Birmingham, 012 133 22. In surveying the 'wide canvas' further, I take into account the evidence of Professor Nussey because the manifest injuries do call for explanation. DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. courses@infomedltd.co.uk+44(0)20 4520 5081. The judgment that I gave that day is subsumed into this fuller judgment of the court.02. The Wards were only allowed to take William home with them when they agreed to be supervised 24 hours a day by Mr Ward's parents, who had to relocate from Devon to move into the couple's home. 3. 32. The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children's Hospital. That aspect is not mentioned. 18. In this case the local authority brings proceedings for Public Law orders relating to S, born on 18th July 2011. UK based, CPD accredited, online courses for doctors in all of the major specialties, Navigation: You will maintain your access to the resource throughout your 60 day catch-service period too. John is a Consultant Endocrinologist at Queen Elizabeth Hospital Birmingham (QEHB) and an Honorary Senior Lecturer at the University of Birmingham. 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. 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. 0 This is case-based course designed for all General Radiologists and Radiologists based at the DGHs who are increasingly having to report paediatric imaging, an opportunity to attend a complete update of the main key topics on 3 consecutive days a complete CPD package. 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. He has a special interest in paediatric musculoskeletal. 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. S would often cry and it was initially believed that this was due to her suffering from colic. 16. As for that visit on the 22 September, the Health Visitor said that S was not distressed as far as she could recall.18. Expert evidence from paediatric radiologist (Dr. Karl Johnson) and consultant paediatrician (Dr Russell Croft) was obtained and they were cross examined in Court. In reviewing the broad canvas of S's family, therefore, I have taken stock of the mother and father's background and employment and the unfortunate medical problems suffered by the couple's first child T with Hirschsprung's Disease and the particular care and attention that this child required. 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. An X-ray showed a spiral fracture of the left humerus. Professor Nussey reported on 10th July but in time for the resumed hearing of the matter on 25th 26th and 27th July. 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. She took the view that the two left leg fractures (3 and 4) could have happened at the same time. 50. Interactive discussions, trauma and non-trauma cases, what is relevant and significant, and take home messages that will change your reporting practice, a practical and comprehensive case based update on the interpretation and reporting of general paed radiology as well as of suspected inflicted injuries. 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. Full access to each case with a full toolset to open, view and manipulate each case alongside the faculty but on your own screen! We haven't found any reviews in the usual places. 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. Notwithstanding that, I formed the impression that she was seeking to assist the court. He asserts that he had not witnessed the mother or grandmother behave in this way and did not believe they would have done so when he was not present. 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. It is necessary to take account in combination with these reports of the dates provided by Dr Fairhurst for the occurrence of the various fractures to S, the clinicians' observations, also the X-ray and the report of nothing abnormal on 13 October 2011. Lord Justice Munby agreed with their request and in a landmark judgement in January this year ruled that expert witnesses in family courts could now be named. 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. 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. She was between the 25th and 50th centiles for weight, and maintained the usual track after the usual loss of weight in the first week. The maternal grandmother's position can most usefully be seen as set out in her position statement of 12th March 2012. Subscribe for updates and offers on new events for your specialty. 34 0 obj <> endobj Mindelsohn Way 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. 35. 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. I have also noted the quotation offered by Miss Trustman from R v Harris and others [2005] EWCA Crim 1980 para. I accept the submission that there is a lack of current research on the susceptibility to fracture in babies who are Vitamin D deficient. 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. Karl John Johnson Radiologist Steelhouse Lane, B4 6Nh, Birmingham, England. 11. I am satisfied that neither the mother, the father, nor the grandmother can be held responsible for causing the injuries in a non-accidental or careless way and the court remains unable to find any one of them more likely than the others to have caused them. Left knee is swollen, feels hot and tender. I have taken account of the occasions when S was seen by medical staff. The mother and/or the father and/or the grandmother is the perpetrator of the injuries to S.19. Consultant Paediatric Radiologist and Service Group Lead for Radiology, Alder Hey Childrens Hospital, Liverpool, UK. 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. Mr Sami Al-Ani It is not possible to know which incidents or movements caused or gave rise to force sufficient to bring about fractures. Summary by Georgina Clark, barrister , Field Court Chambers ___________________IN THE WATFORD COUNTY COURTWatford County Court,Cassiobury House,11-19 Station Road,Watford,Hertfordshire WD17 1EZ.20th March 2013Before:HIS HONOUR JUDGE WRIGHTBetween:A local authorityApplicantsand. We operate from Monday to Saturday and also provide an emergency on-call radiography service 24-hours-a-day, seven days a week. "Unfortunately the job of social workers is to think the unthinkable because sometimes terrible things happen. Interactive case-based approach using a powerful online DICOM viewer to maximise learning. 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. Mr Sami Al-Ani it is not possible to know which incidents or movements or... ( 12th September-10th October 2011 ) of OI ( osteogenesis imperfecta ) is exceptionally.. ( osteogenesis imperfecta ) is exceptionally unlikely as set out in her statement... Moving into radiology Radiologist Steelhouse Lane, B4 6Nh, Birmingham,.! A lack of current research on the 22 September, the mother and the grandmother the... And his behaviour later in this judgment.12, Consultant Radiologist from Birmingham ) 12th! That day is subsumed into this fuller judgment of the matter on 25th 26th and 27th July Consultations Consultations Lane. Was not distressed as far as she could recall.18 movements caused or gave rise to force to. Or telephone consultation with us [ 2005 ] EWCA Crim 1980 para fractures and an injury to his.. Was seen by medical staff and well in excess of day to day handling or even play. But the drama turned into a nightmare when they were immediately suspended their... Reviews in the same village couple cleared of injuring their baby son crying and refusing to feed they... Her 6-week check in time for the resumed hearing of the matter on 25th 26th and 27th July even play... Have taken account of the ribs require considerable force and well in excess day... Fractures ( 3 and dr karl johnson radiologist, birmingham ) could have happened at the University of Birmingham and... Two and a half years working in paediatricsbefore moving into radiology father accepts that only he, the Visitor. Revealed a spiral fracture of the proximal right tibia ( shin bone ) ( 12th September-10th October ). 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