Her evidence was that S was crying, being "fractious and miserable but not hugely distressed", happier lying down than being held. The local authority took action on 26th October 2011 after the Consultant Paediatrician concluded that there must be a high level of suspicion in the absence of explanation of the injury to the left arm that the humeral and left rib fractures may have been sustained as a result of a non-accidental injury. 34. 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. I have taken account of the occasions when S was seen by medical staff. The left tibia fracture was likely to have occurred between 3rd and 10th October and the likely time frame for the left humeral fracture was between 16th and 19th October. I note the entry as follows: 'non-tender, baby permits passive manipulation. 45. The father maintains that there could be some natural explanation for S's injuries.38. 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. At this point I identify the following features: (1) that while there was a possibility that there could be a Vitamin D deficiency there is little, if any, supporting evidence at present for fractures occurring with lower than normal levels of Vitamin D but no radiological evidence of rickets; (2) that there is no correlation between a Vitamin D deficiency and fractures, and a mechanism is required to cause a fracture; (3) she did not accept that there was an increased propensity to fracture due to Vitamin D deficiency and maintained that a sub-optimal bone that is not manifesting itself as radiologically subnormal leaves itself at sufficient strength to resist fractures; (4) S did not show radiological signs of rickets, but Dr Fairhurst stated that she did not know whether S may or may not have had a vitamin level low enough to manifest as rickets; (5) there will inevitably be a stage in the bone changes resulting from insufficiency or deficiency of Vitamin D which will be present but not visible on X-ray, i.e. 14. The child appears by her children's guardian and has been represented by Miss Dixon. an improved understanding of Paediatric imaging interpretation and reporting skills. After 22 September 2011, S was next seen at the GP surgery on the 13 October 2011. It is simply not possible to know where the boundary lies. The parents' first child T was born on 14th February 2008. At one point, he mentioned that they had thought it was due to her immunisation that she was not using her left hand. DAY 3: INFLICTED INJURIES IN CHILDREN - FRIDAY 11 FEBRUARY 2022. S was sent for x-ray, which revealed a spiral fracture of the left humerus. Expert evidence from paediatric radiologist (Dr. Karl Johnson) and consultant paediatrician (Dr Russell Croft) was obtained and they were cross examined in Court. Show number Centro mdico: Birmingham Children'S Hospital, Birmingham Do you wish to correct the information? I have noted and examined the oral evidence of Dr Fairhurst. We adopt the following: i. The family are very close and have a loving relationship. They are, in my survey of the evidence, more likely to have a genuinely accidental cause, but because of the evidence of Professor Nussey taken with the evidence of the parents and from the records available it is not possible to reach a view that is more than speculative as to the timing of the injuries. She weighed 6lbs 15 ozs (3.15 kg) at birth and was born by emergency Caesarean section. S's Vitamin D levels were borderline on 2.11.11 and were never higher than insufficient. The maternal grandmother ('the grandmother') is also a party, as she was present in the family home at the material time, and has been represented by Miss Trustman. One or both of the parents, and/or the grandmother knows what has happened to S on all the occasions she has suffered injury. 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. The Consultant Paediatrician, as the locum consultant paediatrician at the local NHS trust, described himself as a 'relatively recently qualified paediatric consultant.' He has a special interest in paediatric musculoskeletal. On 24th October 2011 a skeletal survey detected what appeared to be two left rib fractures. 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. 4. 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. an understanding of the importance of applying the ALARA principle in Paediatric imaging. A week later William was placed on the council's child protection register. The GP was unable to identify the cause of William's pain, but on returning home the Wards noticed his leg was swollen. 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. "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' All the adults appear to be normal hardworking people concerned for their children. 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. Fee includes 90 days of access with unlimited playback during this time. Find Dr. Thomas's phone number, address, hospital affiliations and more. This person was born in December 1965, which was over 57 years ago. 18. The fact finding hearing began on 23rd March 2012, but on the second day of it, on 26th March, I adjourned the hearing having encountered significant problems on two fronts after hearing evidence from Dr Fairhurst, the health visitor, and the Consultant Paediatrician. This company officer is, or was, associated with at least 1 company roles. The impression given by this family and the parents and grandmother in particular is that they were a normal family dealing with their second baby, which by all accounts up to 13th October and indeed to 22nd October appeared to be unexceptional. Thank you! 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". However, she was very unsettled again by 22nd October 2011 and so the parents and grandmother took her to the A&E Department at the local hospital. 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. 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. An X-ray showed a spiral fracture of the left humerus. "It was a nightmare which seemed to be spiralling out of control.". The second section discusses the differential diagnosis of radiological features. 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. 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. 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. All this with the inherent complexities of the medical evidence meant that much time was taken up and the father's evidence could not be taken until the court could reconvene on 12th September 2012. Several of these fractures are highly specific for non-accidental causation by an adult. The fractures of the ribs require considerable force and well in excess of day to day handling or even rough play. The GP's entry records "crying, excessive ? 09. 8. Since the medical centre was closed, they took S to the local hospital.25. The father recalled that S "cried throughout", crying as soon as the examination started although the doctor carried on. 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. 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. There is no evidence of drugs or alcohol abuse, of anger or violent outbursts, of short temper, volatility, irritability or dysfunction. Prof Amaka Offiah is a Professor in Paediatric MSK Imaging at University of Sheffield, and an Honorary Consultant Paediatric Radiologist at Sheffield Children's Hospital. 14. 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. He has extensive experience and a mature knowledge of research done in this field. Mr Johnson and Dr Vickers declined to comment. A diagnosis of OI (osteogenesis imperfecta) is exceptionally unlikely. This led to a referral by the consultant paediatrician from the local hospital to Social Services. 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. 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. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. (9) He anticipated that S's level was 30-35 when she was born, not adequate and markedly deficient. When Victoria and Jake Ward saw their baby son crying and refusing to feed, they took him to their doctor. 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