Case study: Imperial Machine Company (2023)
Relevance of this case
I have often been disappointed that despite the attention given to the hierarchy of controls – eliminating hazards, and reducing risk at source – even when the design of equipment is a contributory factor, manufacturers are rarely prosecuted. For example, employers have frequently been prosecuted under the Noise at Work Regulations, but since 2018 when I started tracking this, I’ve never seen a prosecution of a manufacturer under the Supply of Machinery (Safety) Regulations (see Schedule 2, s 1.5.8) or under section 6 of the Health and Safety at Work Act.
This case wasn’t about noise, but it was about a manufacturing error which the manufacturer knew about, and tried to overcome by adding requirements to the installation instructions.
Events
Accounts of the case don’t explain when the macerator was designed and manufactured, but it is stated that it was designed in such a way that the earthing wire could be connected in a way that meant it was ineffective, and the equipment was also permanently live. Installation instructions stated that a residual current device (RCD) should be fitted.
In 2013 McFarlane Telfer were contracted to install the macerator. The installer did not follow the instructions to fit an RCD.
BMI Healthcare (the client) did not spot that the RCD had not been fitted, and the device was usef for several years, it seems without incident
In December 2017 the macerator wasn’t working, so an engineer from Serviceline was called in to fix it. He doesn’t appear to have been an electrical specialist, and didn’t realise that a metal section of the macerator was live. The press release from the HSE and other accounts based on that are ambiguous, stating both that ‘the equipment was permanently live’ and that it was live only because water had entered the machine’s wiring. Either way, it wasn’t safe, and a safer design of the product would have reduced the risk of this occuring.
Sadly, the engineer came into contact with the metal section, was electrocuted, and died from the injury.
Outcome
Imperial Machine Company Limited (manufacturer) pleaded guilty to HSW 6(1). Fined £80,000 + £12,945 costs. The costs and fine reflect an early guilty plea.
McFarlane Telfer Limited (installer) pleaded not guilty, but found guilty under HSW 2(1) and 3(1). Fined £70,000 + £106,753 costs.
BMI Healthcare (client – now Circle Health Group Limited) pleaded not guilty, but found guilty of HSW 2(1) and 3(1). Fined £450,000 + £106,895 costs.
AFE Group Limited (contractor employer – trading as Serviceline) were found not guilty of HSW 2(1) and 3(1).