Guy's and St Thomas' NHS Foundation Trust

3. Mrs E complains doctors at the Trust did not identify her husband’s brain tumour quickly enough. She is particularly concerned about the actions of Dr L (a consultant neurologist), who reviewed her husband on 17 January 2020. She questions whether her husband would have survived, or had a better quality of life, if doctors had recognised and treated the tumour sooner. She wants the Trust to recognise its failings and apologise to her.

4. Mr E (in his late 50s at the time) attended an appointment with Dr L on 17 January 2020 following a referral from his GP. Mr E had been experiencing problems with his balance over the previous eight months. He also described a trembling in his right leg, which Dr L observed at the appointment.

5. Dr L diagnosed Mr E with Parkinson’s disease and explained the diagnosis to him. He arranged for a referral to a specialist and a brain scan. He wrote to Mr E’s GP and said there was a low probability of cancer, so he had removed him from the neurology pathway.

6. On 22 June 2020 Mr E saw Dr N (a consultant neurologist). Dr N noted Mr E’s history of balance problems and recorded several symptoms. She also observed a tremor in his right arm. She agreed with Dr L’s diagnosis. Mr E had the planned scan later in the week, which had been delayed because of COVID-19 restrictions, and this also supported a diagnosis of Parkinson’s disease. He started treatment the following month and there were some initial signs of improvement.

7. In early August 2020 Dr N became concerned that Mr E’s symptoms appeared to be worsening. He had mobility problems and facial weakness. Dr N arranged a referral to the stroke team and asked for a CT scan. Further investigations showed he had a tumour on the right side of his brain. This was a glioblastoma multiforme, which is rare and incurable.

8. Doctors decided not to treat Mr E with chemotherapy or radiotherapy because they would not have cured the disease. Sadly, Mr E died in October 2020.

11. Mrs E says there was too much emphasis on her husband having Parkinson’s disease. She says doctors ignored the weakness that was affecting the left side of his body. She says when Dr N referred her husband for further investigations she did so using the same information that had been available earlier. She is particularly concerned Dr L was, in her opinion, too quick to accept a single diagnosis when her husband had two problems.

12. The clinical adviser told us Dr L should have followed the NICE Guideline at his consultation with Mr E. This explains how doctors should diagnose and manage people who have Parkinson’s disease. It says the diagnosis is clinical and is based on symptoms listed by the UK Parkinson’s Disease Society. It also says clinicians should suspect Parkinson’s disease in people presenting with tremor or balance problems. It explains how doctors should treat the disease.

13. The doctors should also have followed the GMC’s ‘Good Medical Practice’. This says they must provide a good standard of practice and care. This includes assessing the patient’s conditions and examining them as much as is necessary. It says doctors must provide or arrange suitable advice, investigations or treatment where needed as soon as they are needed. They must also refer a patient to another practitioner when this serves the patient’s needs.

14. Dr L’s clinical records from the consultation on 17 January 2020 refer to several symptoms Mr E had and which are considered to be evidence of Parkinson’s disease. These were:

• reduced facial expression • tremor of the right leg • micrographia (small writing) • reduced sensitivity to smells • rigidity (stiffness of limbs) • slow finger movements • postural instability.

15. The clinical adviser told us Dr L’s assessment appeared to be of a reasonable standard. The clinical records show Dr L considered Mr E’s history and examined him. Dr L assessment seems to have assessed Mr E enough. He also arranged appropriate further investigations. The consultation appears to have been in line with the NICE Guideline and the GMC’s ‘Good Medical Practice’.

16. We can also see similar symptoms at the first appointment Mr E attended with Dr N in June 2020. While there was reference to weakness in his left leg, the other symptoms she recorded were all clearly linked to Parkinson’s disease. Dr N considered the issue with the left leg had resulted from his right-sided weakness and the additional pressure this was causing to the left side. There was nothing to suggest any problem with the brain or spinal cord.

17. The clinical records suggest there was a change in Mr E’s symptoms by the time he saw Dr N again on 3 August 2020. At this consultation Mr E described feeling cold down his left side and said he had increased difficulties with mobility. This led Dr N to arrange a referral to the stroke team and for further investigations, including a scan.

18. The clinical adviser told us Mr E’s tumour was on the right side of his brain. The left side of the brain controls movement on the right side of the body and vice versa. This means the tumour could not have been responsible for the tremor in Mr E’s right leg. The clinical adviser said the signs are Mr E developed Parkinson’s disease in 2019 and, coincidentally and very unfortunately, also had an aggressive brain tumour from July 2020.

19. The clinical adviser told us the doctors could have identified the tumour earlier but that given the aggressive and rapidly progressive nature of this type of tumour it is extremely unlikely earlier discovery of the tumour would have had a positive influence on Mr E’s prognosis.

20. We recognise Mrs E recalls her husband having left-sided weakness at the time of his appointments at the Hospital in January and June 2020. There is little recorded about left-sided weakness or any possible signs of a right-sided brain tumour. There are very detailed references to a range of other symptoms that showed Mr E had Parkinson’s disease. We are persuaded the clinical records of the consultations are accurate. There is no suggestion in the clinical records that Mr E had signs of cancer before August 2020.

21. It is understandable Mrs E feels the doctors missed signs of her husband’s tumour at an earlier stage given the short time between the two diagnoses. Clearly, this was shocking and distressing for Mr and Mrs E. We can see no sign the doctors fell below the relevant standards, which are the NICE Guideline and the GMC’s ‘Good Medical Practice’, at the consultations in question. On that basis we have decided not to start a detailed investigation.

1. The Parliamentary and Health Service Ombudsman has carefully considered Mrs E’s complaint about Guy’s and St Thomas’ NHS Foundation Trust (the Trust). Mrs E complains doctors failed to diagnose her husband’s brain tumour quickly enough. She questions whether his death was avoidable or if his quality of life could have been improved. We can see how devastating these events have been for Mrs E. We offer our sincere condolences to her for her loss.

2. We have seen no signs the doctors fell below the necessary standard when they reviewed Mr E. This means we have decided not to carry out a detailed investigation. We recognise this is likely to be distressing for Mrs E. We hope she is reassured that we have considered all the available evidence in reaching this decision.