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WorkSafe has accepted an Enforceable Undertaking (EU) from Hawke’s Bay District Health Board (HBDHB) following a May 2018 incident in which a patient fell from a patient lifter while being transferred from an air ambulance to a road ambulance.

The patient later died in hospital from a respiratory infection.

Following the filing of charges in relation to the incident, HBDHB successfully applied for an EU as an alternative to prosecution. An EU is a voluntary agreement between WorkSafe and a duty holder following a breach of the Health and Safety at Work Act 2015.

WorkSafe’s Head of Specialist Interventions Simon Humphries said the DHB had proposed a series of commitments within their application that would help ensure the incident would not happen again, not just in Hawke’s Bay but New Zealand wide.

“The standard for acceptance is a high one. We need to be confident that the proposals offered support our key objectives, and provide sufficient benefit to cease the prosecution process.

“In this instance the DHB responded quickly with remedial action following the incident. An immediate ban was placed on the use of the lifter unless a patient was on a stretcher.

“A number of initiatives were also created and prioritised to ensure a similar incident did not occur again including, risk management procedures, new flight nurse handbooks and training in using the lifter for all staff.

“The DHB’s application for an EU was well considered. It was targeted towards the circumstances that lead to the incident and it will provide real benefit to workers, industry and community.”

Under the EU, HBDHB has committed to:

  • Creating and implementing a patient transport risk assessment tool that will be required for each patient when they are transported to or from other facilities.
  • Purchasing equipment that will provide for safer transfer between transport vehicles.
  • Purchasing mechanical lifts for safer transfer between transport vehicles.
  • Appointing permanent flight nurses who will work closely with the Medical Director responsible for flight

Hawke’s Bay DHB’s Executive Director People and Quality Kate Coley said the district health board was committed to ensuring the safety of its patients and staff and had already made significant progress in addressing the commitments made.

WorkSafe will continue to monitor compliance of this enforceable undertaking to ensure that commitments are met.

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Phone: 021 823 007 or

Email: media@worksafe.govt.nz