2 The Agreed Statement of Facts is as follows:
3. At all material times the Defendant conducted a business of a plumbing contractor from 43 Arakoon Street, Kincumber, in the said State.
4. At all material times the Defendant, by contract, performed plumbing and plumbing maintenance services at the Salvation Army Woodport Retirement Village at 120 The Entrance Road, Erina, in the State of New South Wales ("Woodport") and was a person who had to any extent control of plant, namely a Rada 15BK Thermostatic mixing valve ("the mixing valve") in non-domestic premises which had been provided for the use or operation for persons at work not being the Defendant's employees.
5. Woodport was a retirement village operated by the Salvation Army which provided aged and nursing care to persons such as Ms Jill Barker. At all material times Woodport employed Mr Raphael Claverie ("Claverie") as an Assisting in Nursing.
6. The Defendant had to some extent control of plant, namely the mixing valve referred to in paragraph 11 below, in non-domestic premises namely Woodport.
7. The Defendant conducted plumbing and plumbing maintenance service at Woodport from 1993 until 7 June 1998 and, inter alia, had the responsibility to ensure that the plumbing at Woodport, including the hot water system taps and mixing valves, were appropriately maintained so that they were safe and without risk to health.
8. One such water system and mixing valves which was serviced by the Defendant related to the mixing valve which serviced the tap in the bath in bathroom 2, Wing 5 at Woodport. The bath serviced by the tap, which was serviced by the mixing valve, was available for use by employees of Woodport in the course of their employment at work at Woodport in the carrying out of aged and nursing care services. Patients and residents of Woodport, including Ms Jill Barker, would be bathed in that bath.
9. Ms Barker had been in a coma for 3 years prior to the relevant incident, having suffered hypoxic brain damage secondary to an intracerebral bleed.
10. At approximately 6.20am on 7 June 1998 at Woodport, Claverie was bathing Ms Jill Barker in the course of his employment with Woodport. Ms Barker was placed onto a bed bath in bathroom 2 of Wing 5 at Woodport. Ms Barker was placed onto the bed bath and the tap was turned on by Claverie causing the water to "pool" around Ms Barker. Claverie had noticed the water had become extremely hot and noticed that some areas of Ms Barker's skin had reddened. Claverie drained the water from the bath and then administered First Aid to Ms Barker. He then left the bathroom to telephone for emergency assistance.
11. In the subject incident Ms Barker suffered first and second degree burns to 30% to 40% of her body.
12. Ms Barker died on the 10 June 1998 of acute bilateral bronchopneumonia as a result of the effects of her first and second degree burns.
13. The tap in the bath in bathroom 2 of Wing 5 was serviced by a mixing valve. The mixing valve was a Rada 15BK Thermostatic mixing valve ("the mixing valve"). It was the responsibility of the Defendant to service and maintain the said mixing valve.
14. The mixing valve failed suddenly on 7 June 1998 as a result of deterioration of the thermoscopic element. The Defendant failed to adequately ensure the recording of the monitoring of the water temperature at the outlet from the mixing valve during the period when the Defendant was performing maintenance duties at Woodport. 15. The Defendant failed to ensure that the mixing valve was safe and without risk to health. The Defendant failed to take all necessary steps to ensure Woodport properly recorded the temperature of the water from the tap connected to the mixing valve.
16. The Defendant had regard to, and relied upon, the NSW Code of Practice governing installation, maintenance and serving of thermostatic mixing valves and the manufacturer's product manual and service instructions. It is noted that the aforementioned documents contained no information recommending the periodic replacement of the thermoscopic element nor any information as to its service life.
17. Further, on or about 30 July 1998 when the subject thermoscopic assembly was examined on behalf of Workcover by M A Martin, Mechanical Engineer, it appeared intact and undamaged. The mixing valve failed due to the leakage from the thermoscopic element of the polyeutectic compound contained within the element. Leakage occurred from two points discovered by Mr Brook Hinckley, Metallurgical Engineer, with the aid of stereo microscopic magnification.
18. An inquest in relation to Ms Barker's death took place before the Coroner on 21, 22, 23 June and 27, 28 and 29 October 1999. The Coroner delivered his finding and report on 21 February 2000. Pursuant to Section 49(4) of the 1983 Act, the Prosecutor said that the commission of an offence against Section 17(1) of the 1983 Act was apparent from the Coroner's Report and/or the proceedings at the Inquest. Proceedings were commenced within two (2) years of the date of the Coroner's Report dated 21 February 2000 pursuant to Section 49(4) of the 1983 Act.
3 Mr J.P. Phillips of counsel appeared for the prosecutor. Mr J.A. Springthorpe appeared for the defendant. An Agreed Statement of Facts was relied upon. The prosecutor tendered the industrial record of the company. There are no prior convictions. Also relied upon was Inspector Farrell's Factual Inspection Report, a number of photographs taken by the Inspector from an Expert's Report of 21 October 1999. The Report of Mr Brook Hinckley was also tendered.