Brabners' lawyers uncover fresh concerns in cancer care across Coventry & Warwickshire

At-a-glance:

• New evidence has emerged relating to harmful cancer treatment by neurosurgeons at University Hospitals Coventry and Warwickshire (UHCW) NHS Trust.
• Concerns have now arisen about poor decision making by neurosurgeons on treatment for some patients.
• Over 30 patients are now taking legal action against UHCW, all of which were under the care of now retired neurooncologist, Professor Ian Brown, Ian Edwards and others who promoted prolonged and unnecessary temozolomide chemotherapy, contrary to NICE guidance. This has subsequently been acknowledged in writing by the Trust’s CEO.
• We're raising the alarm on systematic issues with care at UHCW.

Our lawyers who are representing current and former patients of University Hospitals Coventry and Warwickshire NHS Trust (UHCW) have identified concerns with neurosurgical treatment across the trust. We're now calling on them to proactively contact all potentially affected patients, commit to sharing findings transparently and take decisive action to prevent such failings happening again.

Following the exposure of a scandal involving more than 30 patients given unnecessary chemotherapy earlier this year, new evidence has come to light that points to a wider pattern of harm across the trust. We're representing more than 30 current and former patients and have uncovered clear evidence of negligence by neurosurgeons in their handling of neurooncology cases. Alongside this, investigations into broader failures of care within the trust have also uncovered failures by pharmacists to challenge prolonged chemotherapy treatment, which have led to devastating lifelong consequential outcomes for some patients.

Neurosurgical concerns

Earlier this year, cases at UHCW made national news when it emerged that brain tumour patients were being given the chemotherapy drug, temozolomide (sold under the brand name Temodar), for periods far exceeding recommended guidance. In some cases, patients received the drug for more than a decade, despite guidelines recommending a maximum of twelve months and little evidence of benefit for prolonged use. This regime was promoted as lifesaving, yet the Trust has since confirmed it was neither evidence-based nor aligned with NICE guidance.

Through careful and forensic review of patient records and collaboration with leading experts in their field, our ongoing investigation shows that these cases are just the tip of the iceberg. Our work with affected patients has identified a systematic problem with how tumours were treated by the trust’s neurosurgical teams. 

Independent expert reviews have identified a pattern of substandard neurosurgical care, including failures to properly discuss treatment alternatives with patients, incomplete tumour removal, delayed tumour removal leading to progression, failure to follow mandatory post-operative scanning protocols and critical delays in recognising and responding to serious complications. In several cases, these delays resulted in preventable strokes, permanent disability and reduced life expectancy. Patients who should have been offered maximal safe resection were instead given biopsies or partial removal. Post-operative deterioration — including seizures, changes in consciousness and unequal pupils — wasn't escalated with appropriate urgency, leading to avoidable brain injury.

One patient, David Bown, was 31 and working full-time as an IT systems manager when he underwent surgery for a low-grade brain tumour in June 2016. Only a partial resection was achieved, and a mandatory post-operative MRI — due within 24 to 48 hours — was 't performed. Four days later, only a CT scan was carried out. When David began having repeated seizures and his pupils became unequal, indicating dangerous pressure on his brain, there was a critical delay in returning him to theatre. By the time emergency surgery was performed, irreversible neurological damage had occurred. David suffered a stroke, causing permanent visual impairment and cognitive problems. Despite his tumour being confirmed as low-grade, he was then prescribed chemotherapy for over eight years. Today, David is unable to work or live independently and relies on his parents for daily care. "I went from living a normal, active life to being completely dependent on my mum and dad for everything", he said. "It's taken everything from me."

Pharmacist failures

Our investigations also highlight the failure of pharmacists to challenge or prevent the dispensing of temozolomide far beyond the duration recommended by NICE guidance.

Patients routinely prescribed temozolomide attended monthly clinic appointments at UHCW and were given prescriptions to collect from the hospital pharmacy. Each prescription was checked and signed off by Trust pharmacists before being dispensed, even though many patients had been taking the medication for far longer than guidance recommended — a process that continued, in some cases, for over a decade. 

Pharmacists are a critical safeguard in the healthcare system, responsible for identifying prescribing issues and challenging treatments that don't align with clinical guidance. They're expected to be familiar with NICE guidance relevant to the medications that they dispense. The prolonged administration of temozolomide should have been questioned or escalated, particularly given the repeated, routine dispensing over many years. 

Views from our experts

Our own Fiona Tinsley (Partner and Head of Clinical Negligence & Serious Injury), said: 

"What began as concerns about chemotherapy in Coventry now points to systemic failings across a number of practice areas in the trust, involving neuro-oncology clinicians, neurosurgeons, neuroradiologists, clinical nurse specialists and pharmacists at UHCW.

Multiple regulators are now investigating individual clinicians and the Trust itself, including the General Medical Council, the General Pharmaceutical Council and the Care Quality Commission and The Royal College of Physicians. Yet the review by the RCP falls far short of what’s needed. Reviews have been limited in scope, with no input sought from the affected patients or their families. This cannot be seen as a meaningful exercise in accountability — patients and families have been denied transparency and candour, with the Trust failing to provide honest explanations, apologies or meaningful engagement.

Without the bravery of so many patients in coming forward, the extent of the failings across this trust might never have been recognised. The human cost has been devastating. People were told they would have months to live without treatment and endured years of debilitating treatment, believing it was keeping them alive. The burden of these failures has been profound. Patients have suffered physical, psychological and financial harm, including loss of career, fertility and quality of life. 

For many there is also no end in sight, with some patients becoming infertile and going into early menopause and one developing secondary leukaemia requiring a stem cell transplant. All patients involved have also been placed at increased risk of secondary cancers. These patients deserve answers and assurance that the NHS has learned from this, so it never happens again.

We are calling on University Hospitals Coventry and Warwickshire NHS Trust (UHCW) to proactively identify and contact every patient who may have been affected, to commit to sharing findings transparently and to take clear, meaningful action to ensure this never happens again. These patients deserve answers, accountability and assurance that every lesson is being learned. This is in the public interest."

What to do if you've been affected

Following the new concerns, we're encouraging any current or former patients who believe they may have been affected to review their treatment history and — if they wish — to seek independent advice.

As the leading national firm in uncovering and addressing negligence in these cases relating to brain tumours and neurosurgery care, we can help you to understand what went wrong and how to seek justice.

Our specialist team provides:

• Full review of tumour pathology, scan interpretation and neurosurgical decision-making.
• Expert opinions from neurosurgeons, neuroradiologists, neuro-oncologists and neuropathologists.
• Explanation of what went wrong and where errors occurred.
• Guidance through NHS complaints and legal claims.
• Support in securing compensation for the physical, emotional and financial impact.

You can speak to us confidentially for free, no-obligation advice. We can also come to meet you where you’re located.

We offer a free initial consultation and most claims proceed under a ‘no win, no fee’ agreement.

Taking the first step can make all the difference. Talk to us by giving us a call on 0333 004 4488, sending us an email at medneg@brabners.com or completing our contact form.