Nottingham City Hospital NHS Trust has been fined £15,000 and ordered to pay £5,000 costs under health and safety legislation after one patient died and two others caught malaria after being treated with a 100ml multi-use vial of saline that had been contaminated after use to treat a previous malaria patient.
A 22-year-old man died 12 days after being discharged following treatment for pneumonia on the hospital's 13-bed infectious diseases ward. The other two, including a 91-year-old woman, recovered.
An inquest into the death ruled that the death was accidental. The coroner said that the hospital had committed "a basic lack of medical care".
A health and safety inquiry found that a bottle of saline had been contaminated with blood from a malaria patient. It had then been reused for other patients instead of being sent for disposal.
Ms Noelle Walker, prosecuting for the Health and Safety Executive, told Nottingham magistrates court on February 14: "No-one is able to say what happened to the contaminated bottle, but the investigation established that on March 1, 1999, all three patients who contracted malaria had received saline solution. There was not a safe system of disposal and no-one was charged with the task of disposing of the bottles properly."
She added that the 100ml bottles had now been replaced by single use containers.
For the trust, Mr Paul Southby said that over £250,000 had been spent on implementing the recommendations of an inquiry after the incident and settling compensation for the three families.
The trust admitted failing to ensure the safety of its employees and the public, in breach of section three of the Health and Safety at Work Act 1974.