NEWS
HEALTH BOARD FINED FOLLOWING THE DEATH OF AN ELDERLY PATIENT
A Health Board has been fined following the death of a vulnerable patient who left a hospital ward unnoticed through an unsecured door.
The Health and Safety Executive (HSE) investigation concluded that Cwm Taf Morgannwg Health Board failed to act on previous absconding incidents, which would have better protected 74-year-old Lynwen Thomas, who went on to fall in icy conditions in the hospital grounds and suffer a fatal head injury.
On 13 November 2019 Mrs Thomas, a patient on Llynfi Ward at Maesteg hospital, who was a known wanderer, left the hospital after 8pm unnoticed by hospital staff. That evening was very cold with snow on the ground. Mrs Thomas fell on a path resulting in her fatal injury.
An investigation by the Health and Safety Executive found that despite previous absconding incidents, including one involving Mrs Thomas, no reasonably practicable measures were taken at Llynfi Ward until after the fatal incident to protect vulnerable patients from wandering and potentially coming to serious harm.
Following another patient absconding incident at Princess of Wales Hospital, HSE served an Improvement Notice on the Health Board on 30 September 2020. The Notice applied to the Bridgend locality and required the Health Board to assess the risk to patients from escaping, absconding or wandering. The Notice was not complied with by the due date.
Before Cardiff Magistrates’ Court, Cwm Taf Morgannwg Health Board pleaded guilty to charges of breaching Section 3(1) and Section 33(1)(a) of the Health and Safety at Work etc. Act 1974 and were fined £850,000 with full costs awarded of £10,627.30
Speaking after the hearing, HSE inspector Helen Turner, said: “Lynwen Thomas was a vulnerable patient, and known to abscond. Cwm Taf Morgannwg Health Board had a duty to protect her and other patients on Llynfi Ward, and they failed to identify or act on absconding risk.
“Despite significant warnings, there was no risk assessment or physical security measures introduced to prevent vulnerable patients from leaving the ward unnoticed. This incident was easily preventable and the risks should have been identified.”
MANUFACTURING COMPANY PROSECUTED AFTER WORKER LOSES PART OF HAND
Laxtons Limited, a West Yorkshire manufacturing company, has been fined for safety breaches after a worker lost part of their hand in a textile machine.
On 24 March 2021 an employee of Laxtons Limited was running a number of textile machines. When he opened a guard to check on a build-up of fibres, he reached in to remove material, losing part of his hand.
An investigation by the Health and Safety Executive (HSE) found that one of the machines had a defective
interlock device. This allowed the machine to continue running when the guard, which was located over a pair of in-running rollers and gears, was opened.
Laxtons Ltd of Baildon, Shipley, West Yorkshire pleaded guilty to breaching Regulation 11 (1) of the Provision and Use of Work Equipment Regulations 1998. The company was fined £15,750 and ordered to pay £759 in costs at Leeds Magistrates’ Court.
HSE inspector Julian Franklin said: “Machine guarding should be in line with the appropriate standard, and regularly checked.
“This incident could so easily have been avoided by simply training staff in the safe and correct way of operating machinery, and regularly checking that safety devices are functioning.”
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