Mid and South Essex NHS Foundation Trust

5. Ms I complains about the care the Trust provided her father, Mr I in May 2025. Specifically, she says staff misdiagnosed him with Parkinson’s disease and prescribed a medication for this which worsened his heart failure.

6. She considers her father’s death was preventable. She says failings in his care contributed to his death. She says witnessing these events caused her distress.

7. Ms I also complains about the way staff communicated with her. She says they did not keep her updated on her father’s condition, did not listen to her about his symptoms and wrongly told her he choked to death on medication.

8. She says this left her feeling ignored and caused her unnecessary distress at an already distressing time.

9. In bringing the complaint to us, Ms I would like the Trust to acknowledge what wrong, apologise and make service improvements. She would also like it to pay her a financial remedy.

10. What follows is a summary of events. We have not included all details as both parties are aware of this.

11. Mr I was an older adult with a history of diabetes, heart failure and recent falls. Staff admitted him to hospital in early May following a fall. Initial scans and a frailty assessment did not identify a specific cause for the fall and clinicians considered his repeated falls were multifactorial.

12. On admission Mr I reported increased ankle swelling, hallucinations and difficulty managing at home. Staff noted he had a resting tremor and a shuffling gait. They considered his symptoms suggested he may have Parkinson’s and trialled him on medication for this, although they did not formally diagnose this during the admission.

13. Over the following days staff diagnosed him with congestive heart failure. Midway through the admission he tested positive for COVID-19. Staff treated him with intravenous furosemide (a medication to remove excess fluid and reduce symptoms of heart failure).

14. He developed signs of infection and staff suspected he had a chest infection. They started intravenous antibiotics before changing this to oral. They adjusted his heart failure treatment by increasing the dose of furosemide before stopping this as it was causing low blood pressure.

15. Later in the admission Mr I developed swallowing difficulties and a sore throat whilst receiving treatment for heart failure and infection. Clinicians continued to monitor his heart failure and infection. They also discussed resuscitation with him which led them to complete a do not attempt cardiopulmonary resuscitation form.

16. Towards the end of May staff inserted a pacemaker and continued to provide specialist heart failure care. A few days later he became unresponsive. Staff recognised he was dying and informed his family before he sadly died shortly afterwards.

Suspected Parkinson’s and prescribed medication

20. Ms I complains staff misdiagnosed her father with Parkinson’s and prescribed a medication for this that worsened his heart failure. She says staff did not listen to her explanation that he had experienced a tremor for many years following an accident.

21. The relevant guidance for this aspect of the complaint is NICE guidance on Parkinson’s disease in adults. This says doctors should suspect Parkinson’s in people presenting with tremor, stiffness, slowness, balance problems and/or gait disorders. It explains if doctors suspect Parkinson’s they should involve a specialist with expertise in diagnosing the condition.

22. Clinical records show that both before and during the admission Mr I had a tremor, shuffling gait and a history of recurrent falls. He also told staff he had been experiencing hallucinations. This led clinicians to suspect he may have Parkinson’s.

23. Ms I does not believe her father had Parkinson’s. She says staff ignored her explanations around this and decided he had the condition after a brief review. She considers they did not do a detailed assessment or factor in his medical history.

24. We have seen evidence clinicians discussed Mr I’s medical history with his daughter and documented her views on his tremor and shuffling gait. This suggests that whilst clinicians may not have agreed with Ms I’s interpretation of her father’s symptoms, they did listen.

25. Our adviser reviewed the records and said a tremor, shuffling gait and history of recurrent falls are all symptoms of Parkinson’s. They said it was reasonable for clinicians to suspect Mr I may have had the condition.

26. Clinicians decided to trial Mr I on medication for Parkinson’s. Ms I considers this medication was inappropriate and worsened his heart failure. Our adviser noted the medication prescribed was recommended in NICE guidance. They said it was clinically appropriate for clinicians to prescribe this as Mr R had predominantly motor symptoms and confirmed the dose prescribed was correct.

27. Ms I is concerned about the impact medication may have had on her father’s health. Our adviser acknowledged clinicians should be cautious when prescribing Parkinson’s medication to patients with cardiovascular disease as it can cause low blood pressure and affect the heart rhythm. This does not mean clinicians should not prescribe the medication to people with heart failure but that they should be mindful of any side effects that occur.

28. Our adviser said this medication can cause oedema (swelling or fluid in the tissues) which is a symptom Mr I was already experiencing before his admission. They explained that the medication is usually tolerated well by patients and the positive effects on stability, mobility and harm can be beneficial for overall health. This was relevant in Mr I’s case as the medication decreased the risks of future falls.

29. We acknowledge Ms I’s concern that Parkinson’s medication caused her father’s heart failure to worsen, especially as the condition was largely under control before his admission.

30. Heart failure is a progressive condition, meaning it typically worsens over time. In Mr I’s case he was known to have ischemic heart disease and heart muscle impairment. He had experienced a previous ischaemic event which temporarily left his heart function at 20%.

During the admission Mr I had COVID-19 and a chest infection and was found to have a complete heart block that required a permanent pacemaker.

31. Our adviser said complete heart block is a cause of heart failure and explained it was likely that the combination of his illnesses, frailty and pre-existing heart failure was likely the cause of his deteriorating cardiac function and not the medication doctors prescribed.

32. We recognise Ms I considers her father did not have Parkinson’s and is concerned that a wrongly prescribed medication negatively impacted his health. Our adviser saw no issues with the way clinicians assessed and treated Mr I during the admission.

33. The records show that whilst doctors did not formally diagnose the condition, they acted in line with NICE guidance in suspecting Parkinson’s based on Mr I’s symptoms and providing medication for this.

34. We consider clinicians assessed and treated Mr I in line with the relevant guidance. The evidence suggests Mr I’s deterioration was caused by a combination of his illnesses and frailty, rather than because of any mistake on the Trust’s part. We have seen no indication of failing in this aspect of the complaint.

35. We recognise Ms I did not feel listened to and are sorry for the distress this caused. We hope this section of our decision provides her with some reassurance.

Communication

36. Ms I complains staff did not keep her updated on her father’s condition. She says this left her confused as she did not understand how unwell he was and thought he was fine.

37. The relevant guidance for this aspect of the complaint is the GMC’S Good Medical Practice. This focuses on the importance of listening to patients, responding to their preferences and involving others in their care in line with the patient’s wishes. The guidance states in situations where a patient does not have capacity, doctors should assume the patient would want them to share information with their loved ones.

38. Our adviser noted clinicians did not have any concerns about Mr I’s capacity meaning it was reasonable for them to communicate directly with him. They said it was up to Mr I to decide what information was passed on to his daughter and that they would only expect staff to update her when he consented to this.

39. The records show instances where Mr I asked staff not to pass information on to his family. We consider this explains occasions where Ms I was not kept up to date. We can also see staff did pass on information to Ms I when her father asked for this.

40. We understand Ms I wanted to be kept fully informed about her father’s condition throughout his admission. We recognise how difficult and distressing it can be when a loved one chooses not to share information about their health with family members.

41. We appreciate Mr I’s wishes meant there were occasions when Ms I did not have a full understanding of what was happening with his care. We recognise this added to the distress of what was already a very difficult time for her.

42. GMC guidance is clear that clinicians should respect a patient's wishes about sharing information with loved ones. Having considered the available evidence, we are satisfied staff followed Mr I’s wishes when sharing information with his daughter.

43. We recognise the information Ms I received did not meet her expectations. We have seen no indication of any failing here. For this reason, we are not continuing our consideration of this specific point of complaint.

44. Ms I also complains about the way staff communicated with her about her father’s death. Specifically, a doctor told her he had choked to death on his medication. She says she only found out this was not the case when she received the post-mortem report.

45. Our principles say organisations should provide information that is clear, accurate and complete. We consider the Trust did not meet this requirement when it gave Ms I incorrect information about her father’s cause of death.

46. We recognise Ms I was grieving the loss of her father. The Trust’s miscommunication will have caused avoidable distress at an already painful time. She experienced this additional distress for several weeks until a post-mortem confirmed cause of death.

47. We can see the Trust has apologised, acknowledged the impact of its mistakes and taken steps to prevent similar issues in future. Having considered this in line with our remedy guidance, we are satisfied these actions are proportionate to the injustice Ms I experienced.

48. For these reasons we have decided to take no further action in Ms I’s complaint.

49. We understand how upsetting these events have been for Ms I. We hope we have been able to provide some reassurance that we have carefully considered her concerns, and we thank her for bringing this complaint to our office.

1. We have carefully considered Ms I’s complaint about Mid and South Essex NHS Foundation Trust (the Trust). We are sorry to hear about her father’s death. We recognise the impact this loss has had and continues to have for Ms I.

2. We have seen no indication that anything went wrong with the care Mr I received or the way staff updated Ms I about his condition. We have decided to take no further action on these parts of Ms I’s complaint.

3. We can see an indication that something went wrong in the Trust’s communication. It incorrectly told Ms I that her father had died choking on medication. We recognise this caused her distress at an already difficult time. We can see the Trust has acknowledged its mistake and apologised for this. We think this is proportionate to put right the upset and distress this caused Ms I.

4. We have set out our reasoning in this decision statement.