Knott v Newham NHS Healthcare Trust (CA) (13 May 2003) (Unreported)

Manual handling – duty to assess risk – causation

The NHS Trust lost its appeal against an award of £420,000 damages to a nurse who sustained a serious back injury, due to the Trust’s inadequate system for manually handling patients.  As a result of her injuries, K was unable to lie down flat and had difficulties sleeping; was unable to have children; suffered from bladder dysfunction causing incontinence and experienced a loss of sensation which affected her sex life.

K had worked on an acute medical ward which catered for highly dependent patients (sickle cell, HIV and cardiac patients) all of whom needed constant care and attention. The ward consisted of 28 beds and shared facilities with another ward.  Among the shared facilities was a hoist used to lift patients.

K’s case was that, due partly to staff shortages, she had had to do an extensive amount of manual handling of patients and that she suffered prolapses to the discs in her upper back as a result of trauma caused by the heavy lifting. The Trust argued that K had exaggerated the amount of manual lifting she did; that the lifting  was not heavy and continuous such as to cause K’s back injury; and that K’s injury was the result of a degenerative disc disease, unrelated to her work, which had been aggravated by a slip when getting out of the bath.

The High Court decided in favour of K, finding that the Trust’s arrangements for lifting were inadequate properly to protect their staff and patients. In particular, there was no evidence that the Trust had made any risk assessment, nor that it had taken appropriate steps to reduce the risk of injury caused by the manual handling of patients to the lowest level reasonably practicable, as it was bound to under the Manual Handling Operations Regulations 1992.  The judge found that the “Drag lift” was habitually used to move patients on K’s ward, despite that lift having been heavily criticised as dangerous both to patients and staff since 1981.  Further, it was clear from the evidence that there was only one hoist which could be used in the two wards and that the hoist was often inoperable, either because it had broken down or because the slings were being cleaned.

On the question of causation, the judge accepted K’s evidence that her degenerative disease had been advanced by the process of lifting during her employment with the Trust; that she had suffered a protrusion of her lumbar discs which was directly attributable to the lifting and that that protrusion had caused further damage to her spinal column and adjacent nerve roots, resulting in K’s neurological symptoms. Notably, the Court made these findings, despite rejecting K’s evidence that staff shortages had led to her carrying out significantly more manual lifting of patients than would otherwise have been necessary.

The Court of Appeal refused to disturb those findings. It found that the High Court had addressed the Trust’s arguments on causation and had given adequate reasons for accepting K’s medical evidence.

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