Settlement for family of vicar, 88, who died after incorrect prescription of anticoagulant medication

The Rev Canon Geoffrey Grant from Nacton was sent home from West Suffolk Hospital without the necessary instructions to pause his anticoagulant medication. Geoffrey died after suffering a second intracranial haemorrhage and sepsis. 

An inquest into Geoffrey's death on 4 November 2022 concluded that Geoffrey's death was contributed to by the incorrect prescription of anticoagulant medication, Rivaroxaban. The coroner also identified significant failings in Geoffrey's care received from West Suffolk Hospital, the Care Home and the GP. 

Geoffrey spent his life in service to others: as a school governor, a school chaplain and a church minister of five parishes until he retired at the age of 81. 

He had been married to Wendy for 60 years and lived with her until December 2021, when he went to respite care, at Marham House Care Home following a hospital admission due to Covid. 

On 22 February 2022, Geoffrey had a stroke whilst at the care home. He presented to West Suffolk hospital with signs of a stroke and a CT scan revealed a right occipital lobe intracranial haemorrhage. He was given Octaplex to reverse the effects of his anticoagulation. He was discharged back to his care home on 2nd March 2022 and a decision was made to withhold his anticoagulants until a MRI review had been undertaken. 

A hospital discharge summary was written but not sent, and the instructions to stop his Rivaroxaban was not received by his GP surgery until 5 April 2022. His Rivaroxaban was prescribed by a dispensing pharmacist at the GP surgery. It was commenced by staff at the care home on 28 March 2022, despite the note from a GP confirming that the Rivaroxaban had been stopped. Geoffrey's family also made the care home aware that the consultant had advised to stop Rivaroxaban. As far as family was aware, the medication had been stopped. However, the GP continued to dispense the medication, and the care home continued to administer this to Geoffrey for a further two weeks. 

As a result, Geoffrey had another intracranial haemorrhage and was admitted to hospital on 11 April 2022. He was discharged back to the care home on 14th April 2022. He was readmitted to hospital on  in the early hours of 21 April showing signs of infection and deterioration. Geoffrey died on 23 April 2022.

Geoffrey's family instructed Leigh Day clinical negligence solicitor Firdous Ibrahim to represent them in their claim for clinical negligence. Firdous argued that Geoffrey's wife, Wendy, spent countless hours by his side each day, both at the care home and later in the hospital. She remained constantly present to ensure he received proper care, even as she had to witness his condition deteriorate. Despite her repeated reminders for the care home not to administer the anticoagulant medication, they continued to give it to him.

West Suffolk NHS Foundation Trust admitted that the delay in sending the discharge letter and summary was a breach of duty of care. Angel Hill GP Surgery also admitted failure to arrange a follow up call to the care home after being notified that the family had been told Geoffrey's medication had been stopped.

An out of court settlement was agreed in April 2025.

Geoffrey's daughter said:

"Dad's love for others was central to everything he did. He treated everyone with respect and dignity. He believed that every person, no matter how young or old was precious and to be valued. He is greatly missed by us and all those who knew him”.

"As a family, it has been heartbreaking to witness and relive the immense suffering Dad was forced to endure as a result of the failings by those we entrusted with his care. We constantly repeatedly expressed our concerns to his care home and the hospital, but these concerns were ignored”.

"Inquests are to establish the facts, Trust investigations are for learning, but for families it is about the accountability and responsibility for the suffering caused by systemic failings, avoidable harm, and preventable deaths. As a family, we hope that the lessons learned from Dad's death will prevent other people going through the same suffering”. 

"We will always be grateful to Firdous for representing our family and for succeeding in securing justice for our beloved Dad."

Firdous Ibrahim, senior associate solicitor in the clinical negligence department at Leigh Day said:

"It was my privilege to assist Mrs Grant and her family throughout the course of this case. From the outset, it was evident just how deeply Geoffrey was cherished, not only by his immediate family, but also by the wider community who held him in such high regard”.

"While no legal outcome can ever fully compensate for the loss of a loved one, I sincerely hope that this resolution offers the Grant family a measure of justice and peace. It is my hope that through this process, they are able to find some comfort in knowing that Geoffrey's life and legacy have been honoured, and that their voices were heard".