Health board fined £24,000 after patient contracted Legionnaires' from hospital shower

A health board has been fined £24,000 after a patient contracted Legionnaires’ disease from a hospital shower.

The 64-year-old woman required surgery after contracting the potentially fatal form of pneumonia while being treated at Hartwoodhill Hospital in North Lanarkshire.

At Hamilton Sheriff Court on Friday, NHS Lanarkshire was fined for breaching health and safety laws after legionella bacteria were found in three sources of water at the hospital.

Two of the sources were in the head of the shower the affected patient used every day at the mental health hospital, which closed down last year after the opening of Beckford Lodge Clinic in Hamilton.

Elaine Taylor, head of the Crown’s health and safety division, said: "Over a significant period of time there was no suitable and sufficient assessment or management of the risks of there being legionella bacteria at Hartwoodhill. This resulted in members of the public, including patients who were relying on the hospital for their care, to be exposed to a risk from the bacteria.

"For one lady that exposure resulted in her contracting Legionnaires' disease, becoming very unwell and requiring surgery. The events were entirely avoidable.

"It is vital that there is proper and effective management of water systems when the potential presence of legionella bacteria is a risk. Legionnaires' disease is a very dangerous illness and those who fail to manage their systems adequately and expose persons to risk of contracting it, whether private companies or bodies such as health boards, can expect to be prosecuted."

After becoming ill in November 2008 while at Hartwoodhill, the woman was admitted to Wishaw General Hospital the following month, where it was discovered that she was suffering from pneumonia and severe sepsis as well as Legionnaires' disease.

She was treated with intravenous antibiotics, but required to undergo a tracheotomy on December 1, before she returned to Hartwoodhill on December 23.

Health and Safety Executive inspector Mike Orr said: "This investigation highlights the importance of having robust management arrangements in place to ensure that the risk from legionella is controlled. This is particularly important where potentially vulnerable groups, such as patients in hospitals, are at risk.

"Responsibility for implementing the arrangements should be assigned to a competent senior manager and the effectiveness of the arrangements should be subject to monitoring."

In response to the fine, an NHS Lanarkshire spokesman said: "We deeply regret the occurrence of this lapse in legionella management from our generally very high standards of health and safety management. We have unreservedly apologised to the family and have given an assurance that lessons have been learned.

"We are pleased that the sheriff recognised the immediate steps NHS Lanarkshire took following this incident in 2008 to remedy the situation. He acknowledged that this incident was restricted to one premise and was out of character for the board which has a good health and safety record.

"We have continued a very high focus on health and safety and this has included undertaking independent audits to ensure we have continuous improvement and maintain high standards. We continually review and refine our processes and procedures throughout the organisation. We have improved awareness amongst our staff and have ensured clear responsibilities are embedded in the organisation with performance in key areas being closely monitored."