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Jersey Unreported Judgments |
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You are here: BAILII >> Databases >> Jersey Unreported Judgments >> AG -v- States of Employment Board [2017] JRC 132 (18 August 2017) URL: http://www.bailii.org/je/cases/UR/2017/2017_132.html Cite as: [2017] JRC 132 |
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Before : |
T. J. Le Cocq, Esq., Deputy Bailiff, and Jurats Blampied and Ronge. |
The Attorney General
-v-
States Employment Board
Sentencing by the Inferior Number of the Royal Court, following a guilty plea to the following charge:
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1 count of: |
Contravention of Article 21(1)(a) of the Health and Safety at Work (Jersey) Law 1989, as amended. |
Plea: Guilty.
Details of Offence:
None provided.
Details of Mitigation:
None provided.
Previous Convictions:
None provided.
Conclusions:
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Count 1: |
£50,000 fine. |
Costs sought towards the prosecution in the sum of £10,000.
Sentence and Observations of Court:
Conclusions granted.
C. M. M. Yates, Esq., Crown Advocate.
Advocate D. A. Corbel for the Defendant.
JUDGMENT
THE DEPUTY BAILIFF:
1. On the 2nd March, 2016, the deceased sustained serious head injuries when she fell from a bath hoist to the ground whilst being bathed by two nurses on Oak Ward, Rosewood House. The deceased did not recover and subsequently died as a result of her injury. This was a wholly avoidable and unnecessary loss of her life.
2. Without going into details which have been set out fully by the Crown this prosecution is brought and culpability accepted on the basis that the Health and Social Services Department staff employed by the State's Employment Board were inadequately trained and had established poor procedures. It is the case that neither of the nurses bathing the deceased had been familiar with her care plan which noted her preference for female staff and her propensity to be violent. She had gone rigid which, in part, had caused her fatal fall, on other occasions.
3. The two staff bathing her, one male and one female, did not apply the seatbelt on the hoist nor the brakes when she was being dried. Neither nurse was aware of the deceased's care plan or had received training on the bath hoist, including the need for the use of a seat belt. There were, in our view, inadequate systems in place to ensure those things happened and this seems to us to be a failure at all levels of management.
4. As we would expect the State's Employment Board and indeed the Health and Social Services Department has cooperated fully with the investigation. As far as we are aware this is the first prosecution of the State's Employment Board with reference to failures in the Health and Social Services Department, although there have been three other prosecutions recorded with regard to different departments. We do not think we should treat the previous convictions of the State's Employment Board as lending any weight to culpability as they relate to different departments. In other words we accept the defence's contention that it is a department by department basis that should be viewed by us.
5. We have noted what the defence has said by way of mitigation. Clearly many steps have been taken to remedy the situation and there are now better procedures in place and better training and this will not, we are satisfied, be likely to happen again and that must be a comfort to members of the public.
6. The Crown, however, points to a catalogue of failures over a significant period and a lack of awareness of the hoist lift's recognised risks. The Crown also points to the fatal consequences as an aggravating feature, which we accept.
7. We think that the sentence moved for by the Crown, which was not in dispute by the defence, correctly reflects this and accordingly we impose a fine of £50,000 and make an order for costs in the sum of £10,000.
