MRSA Action UK Annual General Meeting 

Third Annual General Meeting held at Anthony Collins Solicitors, Birmingham

Saturday 7th March 2009

Derek Butler gave a warm welcome to MRSA Action UK's third Annual General Meeting, and gave a special welcome to guests from the USA, Jim Penney from Chicago who had been working with technological developers 'across the pond' who had said he found the subject of MRSA and the work addictive.  Randy Benham was in attendance from Augustine Biomedical and had travelled from the USA to give a presentation on the potential for contaminating the surgical field in operating theatres, he had been introduced by his UK colleagues John Wright and Robin Humble who were also in attendance.  Derek introduced the first of the speakers and host Phil Barnes of Anthony Collins Solicitors.


An update on the Legal Perspective of Healthcare Associated Infections


Phil outlined his background and interest in MRSA.  In 2002/03 he took on a clinical negligence claim for Mrs Cope who had contracted MRSA in her hip, novel arguments were used under the Control of Substances Hazardous to Health (COSHH) Regulations and an out of court settlement was agreed in 2005.  As COSHH Regulations fall under the Health & Safety at Work Act the burden of proof is removed from the claimant.


ONS statistics showed 6,201 deaths in 2002 to 2006.  As highlighted by Edwina Currie at last year's AGM, this was a higher toll than road traffic accident deaths, there was also a caveat on the figures because of non-recording.  The mandatory surveillance scheme was showing a reduction in bacteraemias, but doesn't reflect all MRSA infections or colonisation.  Bloodstream infections are reported as they are of concern, they are more frequently fatal and can get into organs and medical devices.  Phil believed the two main reasons behind the reduction was due to organisations like MRSA Action UK and the Code of Practice for the Prevention and Control of Health Care Associated Infections (The Health Act 2006), effective from the 1st October 2006.  The Code is made up of stringent obligations monitored by the Healthcare Commission.  The Healthcare Commission can check self-assessments by Trusts and can recommend intervention by the Secretary of State.  Improvement notices have been used with Barnet and Chase, Bromley, Ipswich, Ashford and St Peters.  These won't lead to civil or criminal proceedings, but claimants may find it easier to prove where these are in place.


The Care Quality Commission would be the body responsible for regulating health and social care from 1 April 2009, providing a more unified approach.  There would be new registration requirements, which included meeting the standards set out in the Code of Practice for the Prevention and Control of Health Care Associated Infections.  It would be an offence not to register with enforcement action.  New powers include, warning notices, conditions, penalty notices, suspending or cancelling registration and prosecution.


Section 20(5) Health & Social Care Act 2008 retains the requirements for health and social care providers that were effective from 1st October 2006, strengthened with the statement on registration, effective from 1st April 2009:

"4 (i) A person registered as a service provider in respect of the carrying on of a regulated activity, must, as far as is practicable, ensure that patients, healthcare workers and others who may be at risk of acquiring a healthcare associated infection, are protected against identifiable risks of acquiring such an infection by means of

a) The effective operation of systems designed to assess the risk of, prevent, detect, treat and control the spread of such an infection

b) The maintenance of appropriate standards of design, cleanliness and hygiene in relation to i) premises; ii) equipment"


The ante had been raised on actions to reduce infections.  Some hospitals were not decreasing. Some haven't reached half the level of 2004 rate - a government target.


As well as the human cost to healthcare associated infections Phil outlined the astounding cost to the healthcare economy in terms of litigation.  7.5 million pounds had been paid out by the NHS since 2007, with an average payout 70,000 pounds.  The NHS Litigation Authority had a 42 million pound fighting fund.  It was difficult to obtain information on individual cases, only some were higher profile in the media.


Kitty Cope v Bro Morgannwg NHS Trust (2005)

Mrs Cope was an active lady and chair of her bowling club, she went into hospital for a hip replacement.  It was elective surgery and she was not told about an MRSA outbreak.  2-3 weeks after the operation Mrs Cope became ill with an infection.  It wasn't treated and she had to have the hip replacement permanently removed and was left disabled.  Prove causation, and loss.  Medical records didn't help.  Infection control policy, hand hygiene audits.  Infection control policies and procedures were out of date and inadequate, there had been an MRSA outbreak, patients had been not isolated.


The claim was made using common law and COSHH regulations.  The purpose of COSHH is to protect employees from substances hazardous to health.  The employer has a duty to remove or reduce the risk to the hazard.  The regulations also apply to people who are affected by the work of the employer or employee, in the case of the NHS a doctor, nurse or other employee and their work.  It doesn't apply to substance hazardous to health where its part of treatment, for example, chemotherarpy.  MRSA is a bi-product of the failure to apply adequate infection control policies and procedures. COSHH therefore applies.  In this instance the burden shifts from the claimant to the NHS as part of the Health & Safety at Work Act.


Other cases included:


NDRI Moorfields Eye Hospital NHS Trust (2006)

COSHH was argued on the basis that had the tissue been decontaminated the claimant would not have had lost their sight.  However the judge formed the view that the patient was not covered and gave an exemption as the corneal graft was part of the treatment


Joanne Baumber v United Lincolnshire Hospitals NHS Trust (2006) settled out of court for 20,000 pounds using COSHH Regulations


R v Wrightington, Wigan and Leigh NHS Trust (2007) settled out of court for 45,000 pounds, COSHH not argued


Lesley Ash v Chelsea and Westminster (2008) 5 million pounds


Elizabeth Millar in Scotland is going through court proceedings, not applying hand hygiene policies.


This week it was announced that a Dallas jury awarded David Fitzgerald 17.5 million dollars in a medical malpractice suit. The suit is the largest ever in Dallas county.  David Fitzgerald lost both his arms and legs when he contracted MRSA. The suit alleged that had the doctor attending to Fitzgerald treated him correctly, he would not have lost his limbs.  Because of caps on medical malpractice cases he cannot collect about 10 million dollars the jury awarded for pain, mental anguish and physical impairment.  He can collect no more than 250,000 dollars for non economic damages, a limit established in 2003 by the Texas Legislature and applied to all medical malpractice cases. However, lost earnings and medical costs can be collected for life.


Jim Penney asked if this message about the cost of litigation was being used as an incentive for doctors in the UK.  Phil affirmed that this was the case and events featured the legal cost of getting it wrong.  The next guest speaker was Randy Benham from the USA.


J. Randall Benham, Attorney-at-Law, Augustine Biomedical International

The unlawful contamination of operating theatres


Randy Benham gave a talk and presentation on Normothermia and the techniques used to keep patients warm before, during and after surgery.  This has been proven to reduce the risk of surgical site infections.  During surgery a body temperature of below 36c can cause complications.  A 'cold' surgical site can mean a drop in the oxygen supply to the wound area, the immune system consequently shuts down leaving the wound vulnerable to infection.  Patient warming reduces the risk of this happening.


The methods used include blowing warm filtered air onto the patient, which is now believed to be risky.  Randy outlined that the inside of the machinery commonly used in hospital theatres is not able to be decontaminated, and may present a risk.  There have been peer reviewed articles on the risk of bacterial infections from equipment used in theatres and intensive care units, including "Persistent Acinetobacter baumannii, look inside your medical equipment"


Randy said there were safer methods using warming blankets.  These were also more cost effective.  Randy reported a third of UK patients were not warmed where the length of surgery was over one hour.  Around 21,624,000 pound annual spend was required to warm patients effectively.  One hospital had reported that they only warmed for the first three weeks of every month because the budget is depleted in week four of each month.


Nice acknowledged the problem of difficulties with decontamination but still recommend forced air warming.   There is legislation and directives that are designed to protect patients and staff from the risks of contamination from medical equipment:


-        Medical devices directive says suppliers must supply clear decontamination instructions

-        Health Act 2006, revised 2008 is clear on decontamination of medical devices

-        NHS executive circular 1999/179


There were opportunities to ask questions.  Jim Penney, asked if insurers and specialist lawyers, educated doctors about the known risks and their culpability, this was surely an incentive to avoid causing this harm to patients.  Phil confirmed there were lawyers and solicitors that did speak at events to pass on the message, and patient groups also featured the legal implications as well as the human cost.


Maria Cann and Arthur Briggs both raised the question of putting a filter at the output end of warm air machinery.  Randy outlined that this was possible, however this would be less efficient with the need to intensify the output, thus being less cost effective than other methods.


Maria Cann was aware of Acinetobacter outbreaks in London, which despite all efforts had proved difficult to eliminate, ICUs were finding it in the environment for some time after, it would worth be asking the question, have you checked the equipment in theatres?  John Wright also said he had attended the Annual Healthcare Associated Infection Control conferences in London and this had been raised, all the focus was on the wards and not theatres.


Annual report


Derek Butler circulated the Annual Report and gave a presentation with special thanks to the Board of Trustees, Regional Representatives and the membership.  Invitations had been sent to MPs, civil servants and regulators to MRSA Action UK's annual memorial event in July.  A fund raising event was scheduled for the last weekend in June, organised by Jade Hampton in memory of her friend Samantha Killen, a presentation and tribute to Sam has been organised for 17th March.  Derek thanked the sponsors and membership for their continuing support and the Board of Trustees stood down for the annual election process.


Elections followed, and then proposals for office of Chair.  There was one proposal for Derek Butler.  Derek Butler was proud to accept the proposal and was unanimously voted in by the Board of Trustees.


It was proposed that the executive positions remain as 2008/09, these were unanimously accepted by the Trustees.


Thanks went to Samantha Bradley who was retiring as a Trustee but happy to remain as Newsletter Editor.  Thanks were also given to Nicola Mayers who was also retiring as a Trustee following her move to London and the birth of her son Joshua.

If you or someone you care about has been affected by a healthcare infection and you wish to discuss this with us, please contact us at