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. Her research interests are in the imaging of suspected child abuse and skeletal dysplasias and in methods of determining which children have fragile bones prone to fracture and which do not. What followed next led, eventually, to the diagnosis of a fracture in S's left upper arm. The fractures to the right lower leg took place between 12th September and 10th October. Birmingham B15 2TG, Birmingham Children's Hospital septic arthritis." (10) His view was that it was likely that S was Vitamin D deficient in utero and in the early neonatal period. The Judge formed the view that the maternal grandmother was seeking to assist the Court in her evidence. The Judge considered that S was seen five times at medical appointments when she was said to be suffering from fractures and noted that at those appointments not only did they not reveal the fractures but nor did they raise any suspicion about the parents. 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. I take note also that the mother and father completed a parenting assessment. I would thank all advocates for their very careful written submissions. Mrs Ward, 36, who now has three children and runs yoga and massage classes for babies, said they were not content with simply winning their own case. I have noted the reference to Lancashire County Council v B [2000] AC 147. At 22.30, a further medical clinician's note was written, although the authorship is not clear. 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. Now the Local authority has promptly and appropriately put into effect a revised Care Plan to give effect to the orders made that day. DR KARL JOHN JOHNSON is British and resident in England. Doctors, medical appointments, hospitals, medical staff. The record confirms the father's account that they had been advised to use Infacol, had done so and that it was not working. At 6.20pm on 13 October 2011, S was brought to the local hospital, with the presenting complaint "swollen left knee started yesterday." 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. With Doctuo you can find the doctors you need. The father completed a course in tourism management and completed a post-graduate degree in business management. The parents and the maternal grandmother, she asserts, would all take care of S and T throughout the day. "It was a nightmare which seemed to be spiralling out of control.". (S> $}=I% l S2QBC(*YMhTX^Gf=,HO)t}cg3F 0s/yGUu. 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. hmk0^g? 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. There can be no criticism that it has pursued these allegations as vigorously as it has, even if at the end of the day they have failed to satisfy me that the case is proved. 8. 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.". The Father said in evidence that when the hospital phoned on Monday morning, his wife told them that S was "fine".21. I therefore granted an adjournment so that a suitable expert could be instructed. 52. 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. 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. The local authority goes on to make the following allegations which I give as numbered in the Scott Schedule: 7. 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. This, unfortunately, was soon to change. 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. %r W!p-zC1')v?nP=^:;J2wFT$8N&j Upper limb rheumatology/radiology MDT: . He was earnest, straightforward and did not quibble with the questions although he did not always understand the question. Within each chapter there are three consistent sections. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. Torus fractures can result from a fall, from a direct blow, or from indirect forces applied to the limb when the leg is gripped and forcibly bent, a force well in excess of normal day to day handling of an infant. Amaka lectures regularly on various radiology, paediatric, genetic, emergency medicine and orthopaedic courses, locally and nationally. Detectives removed the cot for examination. This appeared to be strong evidence that William had been abused several times in his short life. 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. Dr. Johnson is presently the Chair of theBritish Society of Paediatric Radiology. A week later William was placed on the council's child protection register. Their evidence would have to be regarded as a tissue of lies and their manner of dealing with S would need to have been abusive, violent to the point of sadism, and the subject of a conspiracy of silence given the unlikelihood of such conduct being committed in secret or the strength of S's reaction passing unnoticed. 46. He noted that there is no uniformity of Vitamin D testing and it is difficult to measure. DAY 2: EMERGENCY PAEDIATRIC IMAGING - THURSDAY 10 FEBRUARY 2022 Her parents returned with S on 22.10.11 with a swollen arm. Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. 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. 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. Based primarily on the evidence of Dr Fairhurst, the local authority has levelled a broad spread of allegations against the three adults in the household at the material time the mother, father and grandmother. 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". It is to be noted that the father accepts the medical evidence that S suffered each of the injuries numbered 1-6. 34. 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. 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. Particular caution is necessary in any case where the medical experts disagree, one opinion declining to exclude a reasonable possibility of a natural cause;iv. She was described as remaining "settled in A&E, observations in normal range, apyrexial." He was Karl Johnson, an eminent radiologist who specialises in non-accidental injuries and has acted a police witness in several cases of child abuse. 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. 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. He therefore accepts that these fractures would have occurred while S was in their joint care. S had regained and passed her birth weight. Clinic Locations. 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. 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. 41. 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.'. Their most recent appointment, in our records, was to DR K JOHNSON LIMITED on 2015-08-17. Injuries to S could not have been caused by a person rolling onto her. 51. )_______________. The parents did not mention the previous weekend's symptoms or the trip to the hospital on 13 October 2011.24. The mother also worked there.10. 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. 941-697-3552. 5. However, the father points out that there were times when S was sleeping in the bedroom; that T would leave the room where he was being supervised to get a toy or use the bathroom; and his case is that it is possible that he may have gone into the bedroom and caused S injury. 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. Their most recent appointment, in particular juvenile arthritis and non-accidental injury suffered each of the injuries 1-6! 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