Brighton’s main hospital trust has been sentenced over a legionella outbreak at the Royal Sussex County Hospital.
Brighton and Sussex University Hospitals NHS Trust admitted the breach of health and safety law.
The case was brought by the Health and Safety Executive after a patient, 78-year-old Joan Rayment, died in November 2011.
At Lewes Crown Court, Judge Shani Barnes, the honorary recorder of Brighton and Hove, fined the trust £50,000and ordered it to pay £38,700 costs.
In mitigation, Simon Antrobus, for the hospital trust, said: “This organisation has had to operate within the funding constraints and structural constraints of its premises.”
The Treasury had to approve the sort of building works that might make legionella easier to manage – and as has been seen, he said, that has not been easy.
Mr Antrobus said: “That is why the trust finds itself in premises that are predisposed towards legionella.
“Monitoring was carried out by two separate contractors.
“Biocide disinfectants were applied before this incident.
“As you can see from the contamination of legionella, it wasn’t enough.
“The chlorine dosing systems were in some cases inadequate or under repair for periods of time.
“Far more should have been done … it just didn’t receive the concentrated sort of attention that it should have done.”
Judge Barnes said: “Not enough attention was paid to this by the hospital’s management.”
Mr Antrobus said: “No one had clear responsibility not were they given training. They relied on water management contractors whose contract was inadequate.
He said that these were explanations not justifications – “all of these matters were falling between stools.”
He added: “Nobody was ringing alarm bells … there was a breakdown in communication.
“The contractors were reporting to the trust high legionella readings. That is to be expected.
“The use of biocides were seen as a viable alternative to a compete structural replacement but these were buildings that were due for demolition.”
Judge Barnes said: “But those buildings are still standing.”
Mr Antrobus said: “We are talking about carelessness and a matter of degree. Things were being tried and tried repeatedly but they were being affected by structural issues and those structural issues weren’t being ignored.”
Mrs Rayment died, he said, from fungal pneumonia. But the trust was sorry that she was affected by legionella.
Since 2011, he said, the trust had done all it could to control legionella properly.
Judge Barnes said that the fine was not intended to put a figure or value on Mrs Rayment’s death.
She said that the fine reflected the failure to adequately monitor, manage and control its water systems.
She said earlier that it was intended to balance a recognition of society’s disapproval of the trust’s failure with an acknowledgment of the effect on the trust’s abilities to provide vital health services to the community.
She said that legionella pneumonia was not responsible for Mrs Rayment’s death and she acknowledged the regret expressed by the trust that Mrs Rayment was infected and for any suffering on her part.
Those managing hospitals, the judge said, are required to take particular care to manage properly the risks of legionella.
It came to light in 2007 but wasn’t properly dealt with until Mrs Rayment died in November 2011.
At the time Mrs Rayment was a patient, the judge added, the hospital’s water system was chronically contaminated.
After her death the hospital spent £1.8 million overhauling the water systems at the hospital including in Howard 2, the ward where Mrs Rayment was infected.
The judge quoted the prosecutor, Deanna Heer, who represented the Health and Safety Executive, saying: “it has long been recognised that in any hospital there is likely to be a large population of elderly or infirm patients who are particularly susceptible to legionella infection.”
Judge Barnes said that the breach was not a one-off and the trust had failed to heed previous warnings.
But she gave credit for the immediate expression of sincere regret, the critical internal investigation and the prompt remedial response.
Despite the breaches, she also noted the lack of any previous safety convictions.
Judge Barnes said that the appropriate fine was £50,000 and costs of £38,700 were justified.
She expressed sympathy to Mrs Rayment and her family.
Hospital trust chief executive Matthew Kershaw said that significant changes had been made including training for staff as well as a £1.8 million investment in better water systems.
The trust had been working on the problems before the outbreak, he said, but that had proved to be insufficient.
“There were things we didn’t get right,” he said.
The buildings affected were nearly 200 years old, he said, underlining the need for the modernisation programme on the site.
The trust was sorry and expressed its regret to Mrs Rayment’s family.
