Henrico Doctors’ Hospital was slow to report potential abuse of newborn babies in its neonatal intensive care unit in 2023, an investigation by the state health department determined. The law requires staffers to report potential abuse within 24 hours, but the hospital waited more than six weeks after the first fracture was found.
The hospital also failed to document which nurses drew blood from the infants, making it difficult, if not impossible, to determine which staffers were responsible for the injuries. Inspectors determined the hospital had violated federal regulations that require patients be free from abuse and that hospital leadership properly supervise its staff.
Wes Hester, a spokesperson for HCA Healthcare, which owns Henrico Doctors’, said that when hospital leaders discovered the fractures, they started an internal investigation. After they determined the fractures could have been the result of abuse, they contacted Henrico County’s Child Protective Services.
In 2023 and 2024, the hospital discovered seven babies suffered unexplained fractures.
Following the 2023 incidents, the hospital installed security cameras in each room of the neonatal intensive care unit, or NICU, which treats infants born prematurely or with complications.
Strotman
When the additional injuries were discovered in 2024, police used the footage to arrest a nurse, Erin Elizabeth Ann Strotman, and charge her with malicious wounding and child abuse. Strotman has been charged in connection to one baby. If authorities find evidence that she is responsible for the other injuries, they will issue more charges, said Shannon Taylor, commonwealth’s attorney for Henrico.
The health department’s investigation did not determine who was responsible for the injuries, but it was evident the fractures might not have been accidental. It is not clear if the health department tried to determine who or what broke the babies’ bones. A spokesperson for the department did not answer the question.
The hospital did eventually report the injuries to Henrico’s CPS office, which investigates potential child abuse. But police ultimately closed their investigation without making an arrest, and it is not clear why. Taylor said her office would seek to determine why law enforcement did not proceed with its investigation in 2023 and whether there is a flaw in the system.
Ultimately, the hospital failed to protect babies in the NICU. More than a year later, three more infants suffered broken bones. The following account is based on the health department’s report, obtained in a public records request.
In 2023 and 2024, hospital leaders discovered seven patients in the neonatal intensive care unit, or NICU, at Henrico Doctors’ Hospital had experienced fractures for no obvious reason. The hospital has stopped accepting new patients to the unit.
1 infant suffered 4 fractures
On a Thursday morning in September 2023, two inspectors from the Virginia Department of Health stepped inside the doors of the Henrico Doctors’ NICU. A day earlier, the hospital had reported that four premature infants suffered bone fractures between Aug. 5 and Sept. 5 of that year.
After interviewing staffers and reviewing documents, investigators found a newborn, referred to as Patient No. 1, had experienced a break in a growth plate of the large bone in the lower left leg, called the tibia, causing a piece of the bone to become misaligned.
“Concern for nonaccidental trauma is raised,” said a doctor who reviewed the baby’s X-ray. Physicians use the term “nonaccidental trauma” to mean the caregiver intentionally caused the injury.
Patient No. 2 had four fractures — one in each bone of the same forearm, one in the sixth right rib and another in the wide section of the femur. Patient No. 3 had suffered a fracture in the baby’s left radius, the large bone in the forearm. The break went perpendicular across the bone and caused the bone to misalign. Staffers found the crack on an X-ray even though they were not looking for one at the time.
Patient No. 4 had a break in the left radius. The injury was called a buckle fracture, in which sudden pressure is placed on the end of a bone, causing it to give way and bulge outward.
After the hospital discovered the injuries, it contacted the state health department and the Henrico Department of Social Services. But it did not do so until more than six weeks after the first fracture was discovered. The hospital’s policy and the state’s administrative code require staffers notify authorities within 24 hours.
Asked why the hospital waited so long to report the potential abuse, Hester of HCA said that when the hospital first discovered the fractures, it launched an internal investigation and notified families.
“Fractures in premature babies are not unheard of in neonatal intensive-care units, given the development and size of the babies,” Hester said. “Once we determined that the fractures could have been caused by something other than the development and size of the babies, we reported the fractures to the appropriate authorities, including (Child Protective Services), and fully assisted in the investigations they launched.”
According to the health department’s report, Henrico Doctors’ brought in outside doctors with expertise in X-rays, bones and newborns. An orthopedist who reviewed the cases said it was possible the fractures did not occur by accident.
“We have discussed with the NICU team that non accidental trauma needs to be considered,” the doctor said.
A labor and delivery room at Henrico Doctors’ Hospital is shown. In early 2024, Henrico Doctors’ installed two new security systems that include cameras in each NICU room, allowing parents to view their babies 24 hours a day.
Hospital added cameras, extra exams
It was difficult to determine who was responsible for the injuries. A staffer told investigators the NICU does not document which employees collect blood or other samples from a baby. The job is typically done by two nurses – one to print the label, the other to collect the sample. Only the nurse who printed the label was documented, a violation of hospital policy.
Following the investigation, the hospital implemented a number of changes. It directed doctors to conduct additional head-to-toe examinations of infants’ muscular and skeletal systems each day and look for signs of abuse. It trained employees on how quickly they must report potential abuse and how to safely handle premature infants. The hospital began documenting which nurse collected blood from an infant, where the blood was collected on the body and the baby’s pain level. Hospital leaders started auditing medical records for accuracy.
In early 2024, Henrico Doctors’ installed two new security systems that include cameras in each NICU room, allowing parents to view their babies 24 hours a day. The hospital called its errors a “gap in the hospital’s policy and lack of staff awareness.”
The current health of the affected babies is unclear. A doctor recommended staff put a splint on one of the newborns who suffered an arm fracture and that the baby received an X-ray of the entire skeleton to make sure there were no other issues.
Henrico Doctors’ called its errors a “gap in the hospital’s policy and lack of staff awareness.”
For more than a year, the injuries stopped. Then in December 2024, the hospital reported three more babies in the NICU had suffered fractures, and the health department launched another investigation. Department officials began working with the hospital to determine the cause of the injuries and implement a better safety plan, which included halting admissions beginning Dec. 21.
On Jan. 1, the health department placed the hospital’s license on conditional renewal, in which the NICU is still not accepting new patients, is working with the health department to establish better safety processes and is allowing further inspection by the health department.
A day later, on Jan. 2, police arrested Strotman and charged her with malicious wounding and child abuse.
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