Company fined £600,000 following prisoner’s Legionnaires’ disease death

A company has been issued a £600,000 fine after its failure to manage the risk of legionella bacteria in water systems at a prison resulted in a prisoner’s death. Graham Butterworth died on December 5, 2017, after contracting Legionnaires’ disease while serving a prison sentence at HMP Lincoln. Amey Community Limited, which was responsible for providing facilities management services at the prison, pleaded guilty to a health and safety offense. The company indicated that numerous “complicating factors” made it “hard to completely manage the risk” of contracting legionella. Mr. Butterworth, from Countesthorpe in Leicestershire, had been incarcerated for 11 years in 2016 after being found guilty of 10 counts of indecent assault against two boys aged 14 and 15 in the 1980s. The Health and Safety Executive (HSE) reported that water samples taken from Butterworth’s cell and nearby shower blocks tested positive for legionella days after the 71-year-old’s passing. Amey Community Limited admitted to breaching Section 3(1) of the Health and Safety at Work Act 1974. An investigation conducted by the HSE determined that the company had failed to act upon a risk assessment carried out in 2016. The investigation found that the firm did not possess a scheme for preventing and controlling legionella risks, neglected to ensure appropriate water temperatures were maintained, and failed to monitor water temperatures in the system during October and November 2017. According to the HSE, these omissions allowed the bacteria to multiply “rapidly.” The company was fined £600,000 and ordered to pay £15,186.85 in costs at Lincoln Magistrates’ Court on Tuesday. A spokesperson for Amey Community Limited stated: “ACL accepts that while it had an extensive legionella testing and management regime in place at HMP Lincoln, in a small number of areas it was not fully compliant with all elements of this regime.” The spokesperson added, “There were a number of complicating factors, mainly due to the ageing infrastructure, which made it particularly hard to completely manage the risk from exposure to the legionella bacteria at the prison.” HSE inspector Stacey Gamwell commented: “There is a legal duty to keep workers and inmates safe in prisons.” She further asserted, “The occupants of HMP Lincoln had been put at risk of legionella bacteria and developing Legionnaires’ disease because of Amey Community Limited’s failures.”