Broken Baby Bones

Unexplained injuries lead to NICU nurse arrest

Content note: This post discusses child abuse and abuse by a medical provider.

Imagine your baby is born prematurely and is admitted from the delivery room immediately to the neonatal intensive care unit. It’s a harrowing experience. His life hangs in the balance, and you hope he will survive. You have to commute from home to the hospital to see your newborn, or you’re staying with family near the hospital, or you’re going broke on hotels, or maybe you’re lucky enough to have access to a sleep space near the unit. After a harrowing time, it seems your baby will survive. You’re stressed, you’re exhausted, but you’re starting to feel hopeful.

Then you show up to visit your beautiful, tiny baby, or maybe you receive a phone call from a concerned-sounding physician. Your baby’s leg has a fracture - his thigh bone is broken. This doesn’t make sense. Certainly kids can get broken bones, but from playing on park equipment or falling. Your sweet baby is in an incubator, surrounded by medical staff.

The physician is also unsure about the injury but doesn’t want to sound alarmist. They tell you it might be caused by an injection near the bone, but they’re not actually sure.

And it doesn’t sit right with you.

But the staff is amazing, and you’re so grateful your child is alive and otherwise improving. What choice do you have but to trust the people caring for your child?

Image of infant arm and rib fractures from a conference on infant fractures. These images are from a 20-day-old infant with child abuse injuries.

Malicious Wounding

On January 2, 2025, Erin Elizabeth Ann Strotman, a former neonatal nurse, was arrested for malicious wounding and felony child abuse after an infant suffered injuries under her care. Surveillance video in the NICU on November 10, 2024 captured Ms. Strotman assaulting a 5-month-old baby boy in the NICU and fracturing his left femur (thigh bone). Further imaging also found a fractured right tibia (lower leg bone) and multiple rib fractures.

While she has been charged in one infant case, the white 26-year-old Virginia NICU nurse is also suspected in at least six other mysterious neonatal injury cases at Henrico Doctor’s Hospital in Virginia between 2023 and 2024.

Henrico County Sherrif’s Office Inmate Detail: Erin Strotman

“Currently, the Henrico County Police Division is utilizing all available resources to ensure a thorough investigation into this matter. This involves reviewing dozens of videos from inside the NICU. As previously mentioned, detectives are re-examining the 2023 and 2024 cases as part of this broader investigation.”

- Henrico County Sherriff’s office statement

Charges have been brought regarding one infant. However, a string of mysterious NICU injuries between 2023-2024 suggests Strotman may be to blame for them all. Investigations into all of these injuries are being re-examined.

The first report came in 2023 after a parent described injuries to his mother - a retired NICU nurse. The baby’s grandmother, recognizing the highly suspicious broken bone in an infant, reported the incident to Child Protective Services. The investigation that followed was eventually closed when no suspects were identified.

Based on quotes from DailyMail.com, Strotman allegedly targeted Black infants for abuse. A January 7 press release from the sheriff’s office disputes this claim: “The preliminary investigation indicates this information is not factual.”

Strotman currently faces two charges:

1. malicious wounding, and

2. child abuse and neglect, serious injury

If the racism allegations from DailyMail sources are backed by evidence in court, Strotman may also face hate crime charges. Hate crimes are motivated by bias against the victims. In Virginia, criminal punishments are increased when this conviction is added. She would also potentially face federal hate crime charges.

Fragile Baby Bones

Beyond birth trauma from shoulder dystocia or forceps delivery, many neonatal fractures fall into an “unexplained” category. However, two known risk factors for neonatal fractures include osteogenesis imperfecta (a genetic condition leading to easy bone breaks) and prematurity (a frequent reason for NICU admission). As NICU patients, babies in this case are highly likely to have been born prematurely. Among all infants, both of these risk factors are infrequent compared to non-accidental trauma, a medical way to reference child abuse. Some neonatal fractures - especially rib fractures - are “silent” and only found when getting an x-ray for another reason. Such was the case with the baby from November 10th: the team only went looking for other fractures after the baby’s thigh bone was found to be broken.

What we don’t expect to be a risk factor is staff purposefully harming their patients.

NICU Culture of Protection

To harm one’s patient purposefully is profoundly and perversely outside the culture of neonatology.

In fragile neonates, it doesn’t take much to cause harm. NICU babies, often with immature nervous systems, under developed lungs, and congenital conditions can be easily injured or lead to life-threatening breath holding, which can in turn lead to cardiac arrest. NICU nurses are notoriously protective of their patients. As a volunteer “cuddler” in the NICU¹, I was only allowed to support the oldest, most robust babies who were near discharge. In our pediatrics rotation in medical school, we learned quickly never to touch a baby without the nurse’s permission and oversight. Even as a resident in the NICU, I wouldn’t even examine a baby without the nurse there to make sure the patient remained stable while I listened to their heart and lungs.

The bedside culture of NICU nursing is one of fierce protection. To physically abuse one’s patient is unimaginable, especially in this nursing subculture.

Mandatory Reporting Laws and Hospital Responsibility

Virginia’s mandatory reporting laws require that a report be filed if there is a suspicion of abuse. This means that it’s not a hospital’s responsibility to conduct an investigation in isolation. Between August 5 and September 5, 2023, four children were discovered to have “unexplained fractures,” but neither the Virginia Department of Health (VDH) nor social services were notified until September 20.

One of the mothers from one of the 2023 cases says she even pointed out that bruising on her child looked like fingerprints. Fingerprint bruises are often seen in grabbing and squeezing abusive injuries.

I’m not entirely surprised that the hospital failed initially to see what was happening as possible child abuse. In hospitals, we usually see nonaccidental trauma cases when a child is admitted with serious injuries. Usually, the perpetrator is a parent, relative, or babysitter. Combine this with the culture of protection in the NICU, it would be hard to imagine one’s colleague purposefully bearing weight on a baby’s limbs to break them.

It’s highly unusual to suspect that the danger is from within the hospital's walls. In health care, we want to assume that everyone in the house of medicine is in it for the same reasons and with the same motivations.

But cases like Strotman’s show we need to keep our minds open to the idea that that’s not necessarily true.

This lapse of recognition decision led to an unannounced visit from the Centers for Medicare and Medicaid Services (CMS) on September 26, 2023. CMS cited the hospital for failing to protect patients from harm. In addition to the failure the report child abuse, CMS cited the hospital’s inability to determine exactly which nurse was caring for which patient. Without this information, an investigation was unlikely to identify a cause or culprit.

Based on interview and document review it was determined that the facility failed to protect and promote each patient's rights as evidenced by: failing to report suspicion of abuse for four (4) premature infants in the Neonatal Intensive Care Unit (NICU) within twenty-four (24) hours of having reason to suspect a reportable offense of child abuse (A145); and failing to ensure that the facility is able to identify all staff members who come into contact with each patient in the NICU.

- CMS Citation

In response, Henrico Doctors' Hospital also says they implemented more safety measures, including:

• Additional daily examinations of each NICU baby led by the neonatologist

• New unit-wide in-person safety training program

• Two new security systems, including cameras in each NICU room so parents could view their babies 24 hours a day

This intervention from CMS to light a fire under the hospital to amp up security and oversight likely prevented more infant injuries.

Nurses Placed on Leave

Around the time of the hospital’s response to the CMS citation, several nurses, including Strotman, were placed on paid administrative leave. During this time, the hospital conducted an internal investigation into the initial four cases. Strotman’s leave was extended until September 2024.

After Strotman returned to the bedside, three new infant fractures occurred between November and December 2024. The timeline leads us to believe that there were no unexplained infant fractures while Strotman and her colleagues were on leave.

The NICU was closed to new patients on December 26. New infants in need of neonatal care will be transferred to other facilities.

Closing a likely profitable unit is a major step with significant financial consequences for the organization. A single incident of nurse abuse of an infant would have been national news. Now that Strotman has been arrested and the case is out in the open, who would choose to admit their unwell child to this facility? By closing the NICU, this prevents parents with an unexpected need for neonatal services from landing at a facility in the middle of a patient safety crisis. This will lay different challenges on new parents, who won’t be able to have their child at the facility where they delivered.

Skip Passing the Trash

The callous injury of these infants is inexcusable. Thankfully, Strotman didn’t have the sense to leave Henrico Doctor’s Hospital for another job, nor did the hospital quietly allow her to leave her position voluntarily. Serial offenders in medicine often jump from facility to facility once they feel their dangerous behavior is gaining scrutiny. The strategic relocating of problematic staff, initially named in education spaces, is called passing the trash.

Such migratory behavior is often facilitated by health systems, which can avoid the responsibility, hassle, and public relations consequences of reporting to regulators by allowing staff to quietly leave their jobs to take positions elsewhere. Serial killer physicians like Michael Swango and neurosurgeon Christopher Dunstsch (aka Dr Death) serve as egregious examples of this tactic, as they practiced for years before being caught.

What’s Next

This week, a judge denied Strotman’s bond request. This was at least partly to prevent harm to Strotman due to public attention on her case. Her attorney argued she’s at risk of retaliation in jail. However, the judge determined she needed to remain in custody.

Ms. Strotman’s next court date is May 12, 2025. I’ll be interested to see what comes out in court about the infants involved and the pattern of abuse. Will she be charged with the injury of other children? How and to what degree was infant race a factor? What other injuries did children suffer? What other concerns/complaints were made about this nurse in addition to the abuse? Serious allegations are rarely the beginning in a pattern of behavior. I’m sure the defense will have creative ideas about how to insert doubt about her role in this baby’s case and in others.

Resources

• Henrico Police Addresses Editorial Social Media Videos and Calls into the DEC. Henrico Police News Release. January 7, 2025. https://henrico.gov/assets/240107.-Update-3.-Investigation.-Henrico-Doctors-Hospital-NICU.pdf (accessed on January 16, 2025.)

• Uber E. Virginia nurse arrested after babies in NICU suffer unexplained injuries. January 5, 2025 (updated). https://www.washingtonpost.com/dc-md-va/2025/01/04/henrico-hospital-nicu-nurse/ (accessed on January 16, 2025.)

• Henrico County, Virginia Sherriff’s Office. Inmate Detail: Erin Strotman. https://www.henricosheriff.org/search/mobileDetail.aspx?id=000505873 (accessed on January 16, 2025.)

• Neonatal Intensive Care. Henrico Doctor’s Hospital website. https://www.hcavirginia.com/locations/henrico-doctors-hospital/specialties/womens-care/labor-and-delivery#nicu (accessed on January 7 and 16, 2025)

• Gordon J. Virginia nurse accused of targeting black babies at Henrico doctors' office. Daily Mail. January 6, 2025. https://www.dailymail.co.uk/news/article-14255261/virginia-nurse-erin-strotman-targeting-black-babies-henrico-doctors.html. (Accessed on January 16, 2025.)

• Poleo G. Disgusting excuse given by Virginia hospital after 'evil nurse fractured bones of premature baby' whose twin died. DailyMail.com. January 13, 2025. https://www.dailymail.co.uk/news/article-14268043/henrico-hospital-reason-erin-strotman-murder-premature-baby-virginia.html (Accessed on January 16, 2025.)

• Henrico Doctor’s Hospital response to Department of Health and Human Services Centers for Medicare and Medicaid. https://drive.google.com/file/d/1kuBsm3ZIWa9HPctlzels67M2yF3iIK1R/view (accessed on January 16, 2025)

• Bishop N, et al. Unexplained fractures in infancy: looking for fragile bones. Arch Dis Child. 2007 Mar;92(3):251-6. doi: 10.1136/adc.2006.106120. PMID: 17337685; PMCID: PMC2083418.

• HW Petska, et al. Patterned Bruises From Abusive Squeezing. Pediatr Emerg Care. 2021 Jun 1;37(6):e351-e353. doi: 10.1097/PEC.0000000000001717. PMID: 30624423.

• Brown R. Bond denied for former NICU nurse charged with abuse. 12 On Your Side. January 13, 2025. https://www.12onyourside.com/2025/01/13/bond-hearing-fmr-nicu-nurse-charged-with-abuse-happening-monday/ (accessed on January 16, 2025)

1. A NICU Cuddler is a volunteer who goes to the NICU to cuddle babies. If you like babies, it’s the coziest and most lovely volunteer work. When medical school classes were out for the day, I would spend an hour or so in a rocking chair, cuddling and cooing and singing lullabies to little sweeties.