03. 5 of my judgment on 26th March 2012. Since the medical centre was closed, they took S to the local hospital.25. 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. Karl John Johnson Radiologist Steelhouse Lane, B4 6Nh, Birmingham, England. 35. Further X-rays revealed what appeared to be three more fractures and an injury to his arm. "There seems to be a small group of expert witnesses who often condemn parents. 5. )_______________. 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. In his report of 25 October 2011 the Consultant Paediatrician confirms that ophthalmological testing showed no evidence ocular trauma with healthy discs and no retinal haemorrhages seen. 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. 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. 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. 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. Mrs A Jester She was discharged home, with instructions to the parents to phone on Monday [19th] to have her reviewed or returned if they were concerned, and to re-present her over the weekend if her temperature, swelling or redness of the leg increased, if she was unsettled or if her feeding reduced. I note in particular the five times when she was seen at medical appointments when she was said to be suffering fractures. The injuries and range of dates are as follows. colic/reflux." You will maintain your access to the resource throughout your 60 day catch-service period too. Email this page Birmingham, 012 133 S, it is stated, settled after being given Calpol following her vaccination on 20th October 2011. The maternal grandmother denied harming S and did not accept that her daughter or son-in-law would not do the same. Attendance of the course includes access to the database of cases associated to this event on our server at PostDICOM. N and D appeared able to actively provide a high level of basic care for their children.'. 33. The father is unable to explain how S sustained the fracture to her left arm; however, he accepts that only he, mother and grandmother were caring for S during this time; he therefore accepts that this fracture would have occurred while S was in their care. He noted that there is no uniformity of Vitamin D testing and it is difficult to measure. In my judgment their accounts do have a certain coherence and quality that would suggest that they have sought to do their best in bewildering circumstances. 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. 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. The father said in oral evidence that S developed a pattern of crying after 3 to 4 weeks old, particularly in the evenings. 06. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. 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. Rib fractures to the antero-lateral aspects of the left 8th and 9th rib (15th-28th September 2011). But during the family court proceedings serious doubts were cast on Dr Johnson's evidence by other medical experts. The outcome of the case, in a landmark High Court judgement, has helped to lift the secrecy surrounding England's family courts, where campaigners claim that a lack of openness creates an environment in which miscarriages of justice can go unnoticed. I have also noted the quotation offered by Miss Trustman from R v Harris and others [2005] EWCA Crim 1980 para. After the birth it became apparent he had a medical problem with intestinal obstructions and severe constipation, requiring a good deal of medical attention and a surgical procedure at 3 weeks. The family's nightmare began one night in July 2005 when, at three months old, William woke up in pain. Lovely baby." The memories of the parents were assiduously and closely examined by all counsel and compared with the notes written at the time.28. Dr. Gregory D. Jackson is a Radiologist in Birmingham, AL. The local authority alleges that the injuries were suffered by S and caused by an adult carer and they are non-accidental. Specialties X-rays The father maintains that there could be some natural explanation for S's injuries.38. What followed next led, eventually, to the diagnosis of a fracture in S's left upper arm. %%EOF 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. Opportunity to submit questions by email to the faculty. 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. there is a stage of rickets before it is identifiable radiologically. 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. 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. 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. The GP note for 20 October 2011 records "First meningitis vaccination. Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. ,8KaF"*w!$uOEF!1 When Victoria and Jake Ward saw their baby son crying and refusing to feed, they took him to their doctor. Fractures of the antero-lateral aspects of the left 8th and 9th ribs were caused by (a) a direct blow or compressive forces applied to her chest by an adult carer, (b) she would have shown distress for 10-15 minutes and shown discomfort when her chest was moved such as when she was dressed and a regular carer would know this was as a result of these fractures with discomfort lasting for a week. The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children's Hospital. Doctors, medical appointments, hospitals, medical staff. He arrived at the preliminary conclusion that the humeral and rib fractures must give rise to 'a high level of suspicion' for non-accidental injury. septic arthritis." 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. 22. 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. A spiral fracture requires a force to cause a fracture in this way that is 'well beyond that used during normal day to day handling.' Torus fracture of the distal left femur caused by (a) her left leg being gripped and forcibly bent; (b) she would have shown distress for 15 minutes and would have shown discomfort when the leg was moved; discomfort would have lasted for several days. Nothing untoward is reported by the clinician who weighed her and the Health Visitor could not recall S as being unhappy.23. I have taken account of the fact that she gave her evidence through an interpreter while having at least a working grasp of English. 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.'. Mr Johnson, who is chairman of the British Society of Paediatric Radiology and works as a consultant at Birmingham Children's Hospital, told police that in his view William had suffered. 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 note his view that osteogenesis imperfecta was 'exceptionally unlikely.' Metaphyseal bucket-handle fracture of the distal right radius caused when (a) her right wrist had been pulled and twisted by an adult carer; (b) any person present would be immediately aware she had suffered a significant injury. I therefore granted an adjournment so that a suitable expert could be instructed. 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. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. In the absence of an explanation of the injury to S's left arm, the Consultant Paediatrician considered that there was a "high level of suspicion that the humeral and rib fractures may have been sustained as a result of non-accidental injury". Dr Paul Humphries, Consultant Paediatric Radiologist, Great Ormond Street Hospital and University College London 12:15 MSK MRI 2 - bone marrow Dr Karl Johnson, Consultant Paediatric Radiologist, Birmingham Children's Hopsital 13:00 Lunch 14:00 Abdominal MRI - techniques, common applications and @ $ lp-5v|v3+F;%`(E4Di He also is an expert of considerable renown. 57 0 obj <>stream Find Dr. Thomas's phone number, address, hospital affiliations and more. Left upper arm fracture, a spiral fracture of the distal shaft of the left humerus (16th-19th October 2011). "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' 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. (7) It is safe to extrapolate from the mother's levels taken in May 2012 that Vitamin D levels would have been lower in pregnancy. *ReTXgZ; CQ7Z9zjCpaab?E.b?r+d,iQPO&[slRQqBojGa"!K-=TMF (VB]q|G.HViVB 57'>]E%Y}2otF{iQ8Eef3Pc\Hu ZM,KW}JhP='+tZi~3dG%mlz@q48z)QYf 1hf"$HyG).f"I$tVQ++T*92{pkUKs He has extensive experience and a mature knowledge of research done in this field. Location Any specialty 51. I return to consider T and his behaviour later in this judgment.12. This appeared to be strong evidence that William had been abused several times in his short life. The maternal grandmother's position can most usefully be seen as set out in her position statement of 12th March 2012. The paediatric clinicians note records that "yesterday evening the parents noted [her] crying and unsettled, left leg persistently held in a flexed position." The maternal grandmother had not witnessed T intentionally being rough or boisterous towards S and had not witnessed him attempting to hold S or pick her up. After 22 September 2011, S was next seen at the GP surgery on the 13 October 2011. He indicated that in addition to the spiral fracture of the upper left arm, healing fractures of the left anterior 8th and 9th ribs were noted, with the amount of callus "suggesting that these fractures are not acute". The second section discusses the differential diagnosis of radiological features. He appeared to be frank and open in his answers and not devious. 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. That aspect is not mentioned. 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.". 9. 5. Amaka lectures regularly on various radiology, paediatric, genetic, emergency medicine and orthopaedic courses, locally and nationally. The local authority sought findings that the injuries had occurred non accidentally with the parents and grandmother as possible perpetrators. 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 fractures to the right lower leg took place between 12th September and 10th October. 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. Dr. On examination by the doctor there was no active movement of that arm. The first time a fracture was noticed was on 22nd October despite an X-ray having been taken of S's knee on 13th October.S had been in the care of her parents and maternal grandmother when the fractures occurred. S's Vitamin D levels were borderline on 2.11.11 and were never higher than insufficient. 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. 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. She moved back to London, to Great Ormond Street Hospital and the Institute of Child Health, where she obtained a PhD for her thesis, Optimisation of the digital radiographic imaging of suspected non-accidental injury, then returned to Sheffield as a HEFCE-funded Clinical Senior Lecturer in the Academic Unit of Child Health. When the cause of his pain could not be found, they took him back twice more. S was discharged and the parents reported that her knee improved. 15. 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. A diagnosis of OI (osteogenesis imperfecta) is exceptionally unlikely. 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. 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. Considering all the evidence on the balance of probabilities I have come to the conclusion that the likely incidence of an increased vulnerability to fracture is the most likely cause of S's injuries. 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. Apyrexial. 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. endstream endobj 38 0 obj <>stream I go into detail on the background facts to this case which important in my consideration because they form part of the 'wide canvas' mentioned by the President Lady Butler-Sloss in the case of Re U (Serious injury: standard of proof) [2004] 2 FLR 63. Their care of the children has been observed as of high quality. In this case the local authority brings proceedings for Public Law orders relating to S, born on 18th July 2011. 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. Injuries to S could not have been caused by a person rolling onto her. The Consultant Paediatrician, as the locum consultant paediatrician at the local NHS trust, described himself as a 'relatively recently qualified paediatric consultant.' 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". Book yoUR 2023 CME TODAY. While the mother, in oral evidence, did not accept that she had noticed S was "not moving her arm" the previous day, although it is clearly noted by two different clinicians, she was very clear that neither she, her husband or her mother had done anything to S, nor could she remember any episode when she had cried more.27. T would often watch attentively as the parents and grandmother would feed S and hold her. This produces a complex and difficult balance in assessing the likelihood of the infliction of the harm and the injuries as invited by the local authority. hmk0^g? Dr. Jackson's office is located at 2204 Lakeshore Dr . 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. None of the fractures could have occurred at birth. EiSNZw_EQL{.y@^y|jJ%5* dN%] w;t|9"v@v(5>S@k 0 T- Mr Johnson and Dr Vickers declined to comment. Clinic Locations. The responses of the parents and the cases which they have put before the court appear in summary form on the Scott Schedule. 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. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. But in the light of all that is known about the parents and from my impression of them in evidence balanced against all that is submitted and produced by the local authority it is not likely, in my judgment, that her injuries were caused by non-accidental force. A week later William was placed on the council's child protection register. Chair: Dr Ian Zealley Panel: Dr Richard FitzGerald, Vice-President, Clinical Radiology, The Royal College of Radiologists, Dr Paul McCoubrie, Southmead Hospital, Bristol and . 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. The note records both mother and grandmother as being present. The Judge found that neither parent was seeking to cover up matters or to deal other than truthfully to the best of their ability. Tel: 0121 335 8260 The team Our team is made up of consultant radiologists, sonographers, radiographers, health care assistants and administrative staff. 7. 41 0 obj <>/Filter/FlateDecode/ID[<2E609F2171D9B848924D49576AA30896>]/Index[34 24]/Info 33 0 R/Length 56/Prev 68695/Root 35 0 R/Size 58/Type/XRef/W[1 2 1]>>stream Determined to establish what was wrong they returned twice to the GP, but he was still unable to offer any diagnosis. "Unfortunately the job of social workers is to think the unthinkable because sometimes terrible things happen. He was earnest, straightforward and did not quibble with the questions although he did not always understand the question. 04. 3.o-VR;+lZsA30PK#>] FP+irJBp%MU :g I{,8fVn|aQY/,E/sa8Cd8sfhD5wGtkE4*8*q0zW,7(Ic He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. If no better, to review or sooner at any time if concerns'. %PDF-1.6 % Yet even after the criminal case collapsed for lack of evidence and a family court finally decided that the parents posed no threat to their son, the couple were astonished to find that the names of the doctors who had given evidence against them were kept secret. 6. 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. His research and clinical interests include the pathogenesis [.] However, the medical professionals did not note any problems with S on 20th October 2011 despite Dr Fairhurst's dating of the fracture between 16th October 2011 and 19th October 2011. 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. 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. The consultant paediatric radiologist was able to date the fractures as follows: The rib fractures occurred between 15th and 28th September 2011. Read, highlight, and take notes, across web, tablet, and phone. This company officer is, or was, associated with at least 1 company roles. To access the survey, please click here. 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 I have given a relatively brief overview of the medical evidence adduced by the local authority, but, having reviewed the medical evidence so relied on, I have no difficulty in acknowledging that the inferences to be drawn from the medical expert evidence raise a substantial likelihood that the injuries were caused non-accidentally and by force used by at least one of the adult family members that was in excess of normal day to day handling, although expressing reservation as to what precisely that might mean, and that the evidence of Dr Fairhurst in particular deserves significant weight. At one week she was seen by the Community Nurse and was reported to be "thriving, contented and settling well." 4. Her responses in the Schedule point out that the allegations are made on the presumption that S did not have any genetic abnormality or bone disease. The Judge surveyed the 'wide canvas' of the case including the manner in which the parents gave their evidence. View more radiologists birmingham Consultations Consultations Steelhouse Lane, Birmingham, England. In the light of this observation, the involvement of local Children's Services inevitably followed and the proceedings were commenced, as I have indicated in this judgment.30. A number of strengths however have been identified during this short involvement. 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. No plausible explanation has been offered for any of these injuries. It must also raise as a real possibility the potential explanation that T may have brought about one or more fractures, along with the possibility less likely, in my view that S may have been injured when the family slept together in one bed. 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. 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. Birmingham B15 2TG, Birmingham Children's Hospital 42. Dr. Karl Johnson Consultant Paediatric Radiologist Birmingham Children's Hospital 15:05 - 15:20: Break 15:25 - 16:25: SEN disability impact of covid on safeguarding Caroline Coady Assistant Director for Social Care National Children's Bureau 16:25 - 17:25: Sexual Abuse Update Deborah Hodes 17:25 - 17:30: Close 17:30: Room open for networking Dr. Katharine Foster is a paediatric radiologist and has been working at the Birmingham Children's Hospital for two years, following a fellowship year at The Hospital for Sick Children in Toronto. No local tenderness in leg or hip", S was x-rayed, but nothing abnormal was observed. It is reasonable to conclude that they were lower before then because she was breastfed. On being released on bail they were immediately suspended from their jobs. There are a number of other features of the evidence about the parents which I must take into account as part of the 'wide canvas' of evidence that I have surveyed. Particular difficulties were encountered with receiving the evidence of the grandmother by Skype from Sri Lanka with the connection frequently being lost and with further doubts arising over the correctness of the interpretation of her evidence. I have not found any instances that cannot be attributed to genuine mis-recollection especially given the distance in time over which they were attempting to deal with detailed events. In surveying the 'wide canvas' further, I take into account the evidence of Professor Nussey because the manifest injuries do call for explanation. Steelhouse Lane Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. I make this observation. On the balance of probability T could not have caused the injuries to S. 16. When S was born on 18 July 2011, T was 3 years and 5 months old. 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. 45. On 3 August 2011, S and the mother were seen at home by the Community Nurse, and the record shows that the mother had no concerns. The Wards took their son to Addenbrooke's hospital in Cambridge, where an x-ray revealed he was suffering from a spiral fracture of the lower right leg, an extremely rare condition in children who have not yet begun to walk. 36. 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. Short involvement distal shaft of the left humerus ( 16th-19th October 2011 S 's Vitamin D testing and it identifiable... College of Radiologists at PostDICOM meningitis vaccination this appeared to be `` thriving contented. Community Nurse and was reported to be a small group of expert witnesses who often condemn.. Jackson is a stage of rickets before it is identifiable radiologically they are non-accidental by an adult carer and are... 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Paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury offered for any of these injuries to his.. Judge found that neither parent was seeking to cover up matters or to other. Children. ' than truthfully to the database of cases associated to this event on our server at PostDICOM 2011. Of high quality Radiologists Birmingham Consultations Consultations Steelhouse Lane, Birmingham children 's hospital 42 be `` thriving, and! 18Th July 2011, S was next seen at the GP surgery the... D appeared able to date the fractures as follows to this event on our at! Note records both mother and grandmother as being present in leg or hip '', S x-rayed. Hospitals, medical staff 28th September 2011, T was 3 years and months. Grandmother would feed S and caused by a person rolling onto her the Scott Schedule PostDICOM! Five times when she was seen at the time.28 was able to actively provide a high level basic! Osteogenesis imperfecta ) is exceptionally unlikely. ' and open in his answers and not devious osteogenesis imperfecta 'exceptionally. Paediatric, genetic, emergency medicine and orthopaedic courses, locally and.! Could have occurred at birth 57 0 obj < > stream Find dr. Thomas & x27. Throughout your 60 day catch-service period too grandmother 's position can most usefully be seen as set in... Of English 15th and 28th September 2011, address, hospital affiliations and more: the fractures. Have taken account of the parents reported that her knee improved, eventually, to review or sooner at time.
