An inquest has found that the lack of preventive blood-thinning treatment at the private Lister Hospital contributed to the death of Lady Joan Branson after a fatal pulmonary embolism. Professor Fiona Wilcox, the Westminster Coroner, said the 80-year-old would likely have survived if she had received anticoagulation after admission.
The finding matters now because it gives a formal answer to the question surrounding her death on November 24: whether the care she received in hospital helped to save her, or whether a missed step helped kill her. Lady Joan Branson had been admitted on November 17, and the gap between those dates was the period in which she received no prophylactic anticoagulation and no immediate Venous Thromboembolism assessment, despite the risks being described at the inquest as extreme.
Westminster Coroner’s Court heard that the clot that killed her grew out of deep vein thrombosis after a fall weeks earlier on Necker Island left her with fractures to her pelvis and right hip. Dr George Adams told the court that her immobility and fracture were the biggest risks by far, that prophylactic anticoagulation reduces the number and size of clots, and that appropriate treatment would probably have prevented her death.
The missing treatment point is where the case becomes harder to square with the conclusion. Professor Wilcox said it was not a case of neglect and that there wasn’t an absence of treatment, even as she found that Lady Joan Branson did not receive anticoagulants despite a very high risk of developing deep vein thrombosis. She said the lack of anticoagulation did cause or contribute to the death probably, a finding that puts the focus on a decision not made rather than on an overt error made in the open.
Dr Adams also said any patient who comes into hospital should have an immediate VTE assessment to determine their risk of bleeding, a step he said was not done here. The coroner’s conclusion does not leave the cause of death in doubt: the pulmonary embolism was the result of a clotting process that, in her view, should likely have been interrupted. What remains unanswered is why prophylactic anticoagulation was withheld once the risk was known, and that question now hangs over the care that followed her fall, her admission and the final seven days of her life.
