Richard Branson’s wife Joan could have survived if she had received anti-clotting medication, inquest finds

Lady Joan Branson’s death could likely have been prevented if she had been given medication to prevent blood clots after being admitted to hospital, an inquest has concluded.

The wife of Sir Richard Branson, 80, died at The Lister Hospital in Chelsea on November 24, 2025, after developing a pulmonary embolism caused by deep vein thrombosis.

Westminster Coroner’s Court heard that Lady Branson had been at particularly high risk of developing a blood clot following a fall that left her with pelvic and right hip fractures. Despite her medical history of blood clots and previous use of anti-clotting injections, she was not given prophylactic anticoagulants, including Enoxaparin, during the early part of her hospital stay.

Professor Fiona Wilcox, senior coroner for Inner West London, concluded that the failure to administer anticoagulation probably caused or contributed to her death.

Joan Branson was at high risk of blood clots

Lady Branson was admitted to The Lister Hospital on November 17, following a referral from her GP. She had suffered a fall at the family’s Necker Island retreat two weeks earlier and continued to experience significant pain.

The inquest heard that she had a history of blood clots dating back to 2018. She had previously received injections of an anti-clotting medication when travelling by air and during earlier hospital admissions.

Yet she was not given Enoxaparin after her admission, despite what the coroner described as a “very high risk of developing deep vein thrombosis”.

Giving her conclusion, Professor Wilcox said Lady Branson’s death would likely have been prevented and that the lack of anticoagulation “did cause or contribute to her death probably”.

The coroner said Lady Branson had been admitted after persistent pain following her fall and sadly died in hospital seven days later.

Holly Branson questioned why the medication was not given

Lady Branson’s daughter, Dr Holly Branson, sent an email to the court before the inquest outlining her concerns about her mother’s treatment.

Dr Branson said she did not want to attribute blame to any individual doctor, but questioned why her mother had not been offered Enoxaparin, a medication she had used extensively during flights and previous hospital stays.

She also rejected the suggestion that her mother had refused the injections because of concerns about pain, needles or bleeding.

According to Dr Branson, her mother had always taken the medication when doctors advised her to do so.

“The suggestion she refused Enoxaparin due to prior pain or bleeding concerns is not consistent with her usual practice or attitude,” she said.

Dr Branson was with her mother during the first two days of her hospital admission and said Enoxaparin was never offered.

Had she known her mother was not receiving the injections, Dr Branson said she would have been concerned because of Lady Branson’s recent long-haul travel and medical history.

She said that unless the risk of bleeding outweighed the potential benefit of preventing clots, she would have encouraged her mother to take the medication.

Dr Branson also told the court that her mother had apparently not been given compression stockings for up to 48 hours after arriving at hospital.

She noticed that Lady Branson was not wearing them and asked nursing staff about it. Her impression was that this had been an oversight. Once the importance of the stockings was discussed, Lady Branson wore them.

Doctor accepted he should have prescribed the injections

Dr Basir Kunduzi, who was on duty at The Lister, was questioned about whether Lady Branson should have received anticoagulant injections.

He agreed that she should have and accepted that prescribing the medication was his responsibility.

Dr Kunduzi explained that Lady Branson had recently fallen and had been mobilised afterwards, creating a concern about possible bleeding. He therefore decided to wait until a CT scan had been carried out to make sure there was no internal bleeding that the medication could worsen.

He recorded his decision not to give the anti-clotting drugs in Lady Branson’s medical notes.

Asked how another doctor would have known that he had deliberately chosen not to prescribe them, Dr Kunduzi said he expected the doctor taking over her care to review the decision.

He told the court that he now understood the importance of communication between members of the medical team and had changed the way his team worked as a result.

Dr Kunduzi said the decision not to administer the medication would remain with him for the rest of his life and offered his deepest condolences to Lady Branson’s family.

Another doctor said anticoagulants should have been given within 12 hours

Dr Nevil Pavithran, who later took over Lady Branson’s care, told the inquest that she should have received anticoagulants within 12 hours of being admitted.

When asked whether prescribing the medication was a straightforward decision on November 18, he agreed that it was.

Dr Pavithran also said there was no bleeding risk from the anticoagulants at that point. He believed Lady Branson was unlikely to have been wearing compression stockings.

During a late-evening ward round on November 18, consultant Dr Inaki Bovill asked for Lady Branson to be given compression stockings.

The following evening, Dr Ben Thomas, a consultant anaesthetist at The Lister, assessed Lady Branson while considering whether she needed a pain-killing injection into her spine.

He did not ultimately perform the injection, but asked whether she was taking blood-thinning medication because such an injection could result in excessive bleeding if a patient was anticoagulated.

Dr Thomas told the inquest that Lady Branson said she was not taking blood thinners routinely, that she avoided them and disliked the bruising caused by the injections, although she took them when flying.

After Lady Branson died, Dr Thomas learned of her death through a news report and contacted Dr Bovill. The two discussed what had happened.

At 6.21pm, Dr Thomas sent Dr Bovill a message about the use of anticoagulants. He wrote that he had asked about anti-coagulants when he first met Lady Branson and that she had said she did not normally take them, using an injection only when flying.

Dr Thomas later clarified that he had not meant to suggest she had declined medication. His understanding was that she did not routinely take the injections but used them specifically when flying.

He told the court that he regretted not going into greater detail at the time.

Doctors acknowledged the risk should have been identified

Dr Bovill told the inquest that Lady Branson had fallen at her home on Necker Island after tripping over slippers beside her bed.

She was unable to get up and was in considerable pain. She was diagnosed in the British Virgin Islands with fractures to her pelvis and right hip.

Dr Bovill said he knew Lady Branson well and had also known Dr Holly Branson for many years because they had worked within the same hospital trust.

He was aware that Lady Branson had an umbrella-shaped metal filter in the vena cava, the major vein carrying blood towards the heart, designed to prevent blood clots from reaching it.

Based on the medication information available when Lady Branson arrived at hospital, Dr Bovill believed she was not taking anticoagulants. She was taking a number of other medications, including low-dose aspirin.

Dr Bovill saw her on November 17 but was unaware that an assessment of her bleeding risk had not been carried out.

Asked whether a VTE assessment should have been completed and anti-clotting medication prescribed when she was admitted, he agreed that both should have happened.

He said he regretted not recognising the issue that evening.

The following day, after finishing his NHS clinic at Chelsea and Westminster Hospital at around 5pm, Dr Bovill travelled to The Lister by moped.

During his ward round, he said there were no contraindications to giving Lady Branson anticoagulants, apart from the question of whether she might need a spinal injection for pain relief.

Confusion over whether Lady Branson had refused the injections

Dr Bovill acknowledged that his recollection of the decision made on November 18 was not completely clear.

After Lady Branson’s death, he spoke with Dr Pavithran, who told him that Lady Branson had declined the injections because of her concerns about pain, needles and bruising.

Dr Bovill said he had been extremely distressed by what had happened and that his mind had been “numb”, making it difficult for him to recall the details.

The coroner questioned why he had not simply persuaded Lady Branson to accept the medication, given her previous use of the injections.

Dr Bovill said he had reflected extensively on the decision and accepted that he should perhaps have been more forceful in persuading her.

He said it was a matter of great regret and that encouraging her to take the medication would normally have been his practice.

He also confirmed that compression stockings and low-dose aspirin would not have been sufficient to prevent the blood clots.

Asked whether he later reconsidered the decision not to prescribe the anticoagulants, Dr Bovill said that, again with great regret, he had not.

New electronic prescribing system also came under scrutiny

Another issue raised during the inquest was the hospital’s recently introduced electronic prescribing system, Expanse.

Dr Bovill said that before the new system was introduced, it would have been immediately apparent from a paper drug chart whether a medication had been prescribed or not.

With Expanse, he said, the situation was less obvious while staff were still becoming accustomed to the system.

He accepted that he should have revisited the decision not to prescribe the anticoagulants.

The inquest also examined who was responsible for carrying out the VTE assessment and prescribing anti-clotting medication.

Dr Bovill said junior doctors normally handled those tasks in the hospitals where he had worked, but ultimately the responsibility rested with consultants.

“I have to accept that,” he said.

Family remembers Joan Branson as the heart of the family

A statement from Lady Branson’s family was read to the inquest by the coroner.

They described her as a deeply loved wife, mother, grandmother and friend, remembered for her warmth, kindness and compassion.

The family said Joan was the heart of their family and had played a central role in creating a close and loving environment.

They also remembered her ability to connect with people from many different backgrounds and bring diverse groups together.

Born Joan Templeman in Glasgow, she was described by her family as a trusted confidante who was known for her generosity and kindness towards others.

Her relationship with Sir Richard Branson was described as being built on mutual strength and enduring affection, with the family saying she had left a lasting impression on those who knew her.

A 50-year partnership

Lady Branson had been Sir Richard’s partner for 50 years. The couple married on Necker Island in 1989 and had three children together.

After her death, Sir Richard described Joan on Instagram as the “most wonderful mum and grandmum” for their children and grandchildren.

Her death came on November 24, 2025, at the age of 80, after complications following the fall that had brought her to hospital.

The inquest ultimately found that the pulmonary embolism, caused by deep vein thrombosis, was probably preventable and that the failure to provide appropriate anticoagulation contributed to her death.