Daniel E. Holloway
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Children’s Healthcare of Atlanta complaint alleges splint and cast pressure injury before debridement

The complaint alleges that Hughes Spalding Hospital staff splinted a 9-month-old patient’s fractured leg on May 11, 2019, without guarding against a pressure injury. Her toes soon swelled and turned purple, and a nurse practitioner later found a stage 1 wound on her foot. On May 17, 2019, providers replaced the splint with a cylinder cast despite the existing pressure injury. The cast slipped and rubbed the wound, and by May 29, 2019, she had a 3-to-4-centimeter circular wound on the top of her foot. She was admitted to Egleston Hospital with a stage 3 wound containing necrotic tissue and underwent surgical debridement on June 4, 2019. She was discharged on June 9, 2019, and has needed further treatment for the injury since.

System
Children’s Healthcare of Atlanta
Facility
Hughes Spalding Hospital and Egleston Hospital
Providers involved
Children’s Healthcare of Atlanta, Inc. d/b/a Hughes Spalding Hospital / Kimberly Willis, RN / Bruce Chien, MD / The Emory Clinic, Inc. / Emory Healthcare, Inc. / Emory University / Joshua Myers, NP / Nicholas Fletcher, MD / Children’s Physician Group Specialty Providers, LLC
Pattern
Alleged failure to recognize and protect against a splint- and cast-caused pressure injury on an infant’s foot
Harm
Alleged skin necrosis, exposed tendon, and a stage 3 wound requiring surgical debridement

Overview

This page concerns a public complaint alleging that hospital and clinic staff caused and then worsened a pressure injury while treating an infant’s leg fracture.

Chronology

The complaint alleges as follows:

  1. On May 11, 2019, a nurse at Hughes Spalding Hospital splinted the patient’s fractured left leg without recognizing the risk of a pressure injury.
  2. Her toes swelled and turned purple after the splint was applied, and staff told her mother this was normal.
  3. On May 17, 2019, a nurse practitioner found a stage 1 pressure injury on her foot. The nurse practitioner and a physician then chose to replace the splint with a cylinder cast despite the injury.
  4. By May 20, 2019, the cast had slipped and was rubbing the pressure injury, removing part of her skin.
  5. On May 29, 2019, she was transferred to Egleston Hospital and admitted with a stage 3 wound, 4 by 4 centimeters, containing necrotic tissue.
  6. On June 4, 2019, a surgeon debrided about half of the underlying fascia during surgery, and the toe extensor tendons were noted.
  7. She was discharged from Egleston Hospital on June 9, 2019, after treatment with a wound vac.

Alleged failures

The complaint alleges the following failures:

  • The nurse and the emergency physician did not use adequate padding and applied the splint too tightly, risking a pressure injury.
  • The nurse practitioner and a physician chose a cylinder cast despite the existing pressure injury and did not recognize the risk of making it worse.
  • Providers did not properly supervise the cast’s application or protect the wound from further injury.
  • The corporate defendants failed to have any or adequate policies for assessing and monitoring splints and casts to prevent injury.
  • The complaint pleads negligence, negligent hiring and supervision, and vicarious liability, and attaches expert affidavits under O.C.G.A. § 9-11-9.1. It also seeks punitive damages and attorney’s fees for bad faith and stubborn litigiousness.

Entities and tags

Children’s Healthcare of Atlanta, Inc.Hughes Spalding HospitalEgleston HospitalKimberly Willis, RNBruce Chien, MDJoshua Myers, NPNicholas Fletcher, MDPressure injuryDeKalb CountyPressure ulcersEmergency medicinePediatric orthopedicsWound care