Ellen Cornwall, 77, of Penicuick, was on her way to visit her husband in the hospital when she was struck by the reversing van on April 21, 2009.
She suffered multiple injuries and despite receiving immediate medical care from hospital staff she later died.
The incident was jointly investigated by the Health and Safety Executive (HSE) and Police and a prosecution brought against Lothian Health Board, also known as NHS Lothian, for serious safety failings.
It emerged that no risk assessment was carried out on traffic at the site, which was regularly used by reversing delivery vans due to overcrowding in the car park. And investigators lerned that man had been struck by a reversing van on the crossing two years before Mrs Cornwall was killed.
Edinburgh Sheriff Court heard today that a pedestrian walkway, marked by white painted rectangles on the road surface, led diagonally across an access road to the entrance of the outpatients department, which is heavily used by staff, patients and visitors.
The layout meant those using the crossing would generally face away from any oncoming traffic heading towards the kitchen service yard.
Car parking issues on the site, which had been ongoing for some years, meant that delivery vehicles often reversed down the access road as they were unable to turn at the bottom due to other parked vehicles.
The court was told that on the date of the incident, the van driver, an employee of the health board, was using the van to return empty food trolleys to the Western General Hospital kitchens.
As was normal practice, he positioned the van to allow him to reverse it down to the kitchen area, a manoeuvre which would take him over the marked pedestrian crossing.
At this time, Mrs Cornwall had arrived and was walking across the road towards the entrance when she was hit by the nearside of the reversing van.
She was knocked to the ground and the rear nearside wheel drove over her.
The driver realised he had hit something, stopped the vehicle and found Mrs Cornwall lying on the ground partially underneath the vehicle behind the front nearside wheel.
Mrs Cornwall was still breathing and staff from the hospital went to her aid, but despite treatment she died a short time later.
The joint investigation found that there were no risk assessments in relation to the access road leading to the kitchen service area, any of the hospital’s delivery areas or in respect of any traffic management issues within the site.
A reconstruction of the circumstances of the incident concluded that the driver would have only been able to potentially see Mrs Cornwall for less than two seconds, before she was lost to view behind the van and he could have easily missed her when carrying out his mirror checks.
The layout of the road and buildings contributed to the collision as the narrow access road meant delivery vehicles had to reverse a significant distance, passing over the crossing point, and there were no physical barriers to separate pedestrians and traffic. It was also found that car parking issues had been a long term issue at the hospital, particularly in the kitchen service area.
Internal and external staff had reported their concerns about the crossing on various occasions but the issues were not dealt with. An incident took place in 2007 when a man was struck by a vehicle on the crossing, although he was not visibly injured. Management were informed but no changes were implemented.
There were also no warning signs to inform drivers or pedestrians of the risks and no security barriers to control access to the area.
Lothian Health Board, of Waverley Gate, Waterloo Place, Edinburgh, was fined £40,000 after pleading guilty to breaching Section 3 of the Health and Safety at Work etc Act 1974.
Following the case, HSE inspector David Stephen said: “Even a cursory examination of the site quickly revealed shortcomings, and these should have been readily apparent to the extensive management team involved.
“Had a risk assessment been carried out, it would have identified the underlying problems in making deliveries and potential areas of improvement to avoid or reduce the risks. But despite concerns being raised, no action was taken.
“The failure by Lothian Health Board to provide a safe pedestrian route for patients, staff and members of the public into one of the main entrances of the hospital resulted in the tragic and needless death of Mrs Cornwall.”