Manitoba toddler's arm burned during cast removal, mom says

A mother from Sandy Bay First Nation in Manitoba is worried her two-year-old daughter may be scarred for life after a cast removal at Portage District General Hospital left her arm covered in burns and the child terrified of strangers.

Lana Roulette brought Ambriel to the emergency department Feb. 8 for what she thought would be a painless procedure — the removal of the fibreglass cast from her two-year-old daughter's left arm. The toddler was recovering from breaking two bones during a fall on Jan. 15.

Roulette said her daughter seemed afraid and tried to resist as soon as the doctor took hold of her arm. But as he switched on the machine and moved the saw through her cast, she had never seen her so upset.

"She was just crying, and kicking and screaming. Her little face, her little cheeks were just red. I knew there was something wrong, but I knew … it's not supposed to cut the skin or anything, and I thought she was just, like, that scared," said Roulette.

"I just felt so bad for her, I was just rubbing her legs, like, 'It's OK my girl, he's just going to take it off,'" said Roulette. "And I was just talking to her through all that noise," she added.

"Her feet ... she was just digging her feet into the bed. Kicking."

Earlier in January, a different doctor used a similar saw to remove a plaster cast from Ambriel's arm. That cast, which was fitted by the same doctor who removed the fibreglass one, was too loose. Ambriel did not cry during the removal of the first cast, said Roulette, so she couldn't understand the way her daughter was reacting the second time around.

"You could just see her little veins in her cheeks. Crying. But I didn't know. I didn't know she was actually burning from it," she said. The entire process took about five minutes, she added.

Once the cast was off, Roulette said, the physician used scissors to cut through the layer of cotton underneath. As her skin was revealed, Roulette was shocked to see a thin white line running the length of her daughter's arm.

"I said, 'Look at what you did to her arm,'" she said she told the physician.

"'Oh,' he's rubbing her arm, 'That's just a scratch,' he says to me, and then he just walks out."

Roulette said she asked a nurse to put a dressing over the marks on either side of her daughter's arm. Once home, she said, Ambriel whimpered and held her arm for the rest of the evening.

The next morning, the marks had blistered into wounds.

No followup

Roulette called Portage District General Hospital that weekend to complain. She described her child's injuries and spoke to the manager of the emergency department, she said, but was not told to return to the hospital to have the injuries assessed.

Unsatisfied with the lack of response from hospital staff, Roulette brought her daughter to the health centre in Sandy Bay First Nation on Feb. 13.

Virginia Lukianchuk, assistant health director at the Sandy Bay First Nation health centre, said she was alarmed to see the extent of the child's injuries.

"It is unacceptable for a child to have gone through that. I couldn't believe how many burns there were," said Lukianchuk.

She advised Roulette to take her daughter to a clinic to have a physician assess the injuries as she was concerned about infection, so Roulette followed her suggestion.

"She's not only going to be scarred physically, but emotionally. The poor child is going to be afraid to see a doctor," said Lukianchuk, who was also worried about the long-term effects on the girl's mother.

"The mom is traumatized. It's not only physical damage but emotional for both mom and baby."

Lukianchuk helped draft a letter of complaint from Roulette to the hospital, outlining Ambriel's injuries, the lack of followup and disclosure by hospital staff about the incident. She said the complaint process was developed at the community level because members felt their complaints were "falling on deaf ears" with the hospital's process.

Roulette hasn't yet decided whether she will pursue legal action.

'Fairly simple process'

Cast removal is a "fairly simple process," according to Jeff Lambkin, a registered orthopedic technologist at the Grace Hospital.

Since the oscillating cast saw has a vibrating instead of a rotating blade, the skin can generally withstand contact without being cut, he said, though injuries are possible with improper technique.

"You can't drag it. If you drag it, you could burn somebody or possibly cut them," he said. "It's an up-and-down motion as you're moving along the cast from one end to the other, and that's how you're supposed to cut it off."

Roulette said the doctor left the blade embedded in the fibreglass as he tugged back and forth to "saw" through the cast. She claims he did not remove the blade from the fibreglass until he had to cut the other side.

According to Lambkin, the cotton padding underneath the cast serves a dual role in comfort and protecting the skin from the heat and blade. Using an up-and-down motion of the saw, not leaving the blade embedded in the cast for too long and responding to the patient are key to making sure they don't get hurt, he said.

"Listen to your patient. If they're saying, 'Hey, hey, it hurts, it hurts,' then maybe there's an issue," he said.

Girl afraid of strangers

Ambriel won't let anyone see her arm now. The cast was removed nearly two weeks ago, but she still keeps it against her chest and cries, holding her arm, when she sees a stranger. Her mother said she has woken up from naps screaming, holding her arm.

"I felt so bad for her, I felt awful for taking her there, I felt awful for not even telling him to stop, but I knew that it's not supposed to hurt the skin. I thought she was more scared but she was in actual pain, and I didn't know that," said Roulette.

After the CBC passed photos and a request for comment to the doctor at Portage District General Hospital, Roulette said the doctor called her over the weekend to apologize.

But the apology can't undo her daughter's trauma, she said.

"She's going to be scarred for life. She'll be scarred. But that's going to be always a constant reminder, what happened to her," she said. "He's not going to be the one living with it."

Roulette recently took Ambriel to see a different doctor, but the young girl screamed, clutched her arm and backed up against the door. Roulette said she's worried that her daughter will be afraid of every doctor now.

"She's not the same anymore," she said.

A spokesperson for Southern Health-Santé Sud said in an email to CBC News that the hospital has not yet received a complaint, but if they do, they cannot comment for privacy reasons.