A teenager who had been turned away three times from Broken Hill Hospital’s emergency department Googled “can pain kill you?” on his tablet device before he died from septic shock.
John Braes wept before the NSW Coroners Court on Monday as he recalled the final hours of his son Alex, who he remembered as a “ray of sunshine” with red hair and an infectious laugh.
Broken Hill teenager Alex Braes, who died of an infected toenail.
Mr Braes told the inquest that even once Alex became gravely ill, there was no ambulance available to take him to Broken Hill Hospital, no hospitals willing to admit him in Adelaide and no pilot available to fly him to Sydney.
His wife was left sitting on the tarmac of Broken Hill Airport for hours waiting for a plane to come from Sydney to retrieve their 18-year-old dying son.
“I never got to see him again,” Mr Braes sobbed.
The inquest heard that a mandatory investigation into the cause of Alex’s death was not carried out by Far West Local Health District for a year after he died.
The investigation, known as a root cause analysis, was completed following complaints by hospital whistleblowers and coincided with the first anniversary of Alex’s death.
“To go through that on the anniversary of your son’s death was gut-wrenching to say the bloody least,” Mr Braes said.
Broken Hill Hospital is one of several under the spotlight as a parliamentary inquiry probes the state of regional hospitals.
The inquiry was launched after an investigation by The Sydney Morning Herald exposed troubling circumstances of three deaths and a series of near-misses at hospitals across western NSW.
They included a baby who died after a doctor failed to check her test results, a woman who bled to death in an emergency department without any doctors physically present and a man who was told his ward had “run out” of morphine and paracetamol.
The inquest will investigate the treatment Alex Braes received before he died from a bacterial infection known as Group A Streptococcus (GAS).
Experts remain divided whether Alex had the type of GAS known as necrotising fasciitis, a flesh-eating bacteria which results in the rapid death of the body’s soft tissue.
The inquest heard Mr Braes had an ingrown toenail in August 2017 that was successfully treated with antibiotics.
The following month he began to experience pain in his knee. He turned up three times at the emergency department of Broken Hill Hospital as his knee became increasingly swollen and painful but was sent home each time.
Doctors suspected he had a ruptured tendon and recommended rest and ice.
By the fourth visit Alex was in excruciating pain and the leg was turning a dark purple colour.
Mr Braes said no ambulance came when he called triple zero and he had to drive his son to hospital, where there were further delays while staff tried to locate a wheelchair.
Alex was given a triage category of three, meaning the patient must see a doctor within 30 minutes. A medical student struggled to insert the cannula.
By the time Alex was diagnosed with a bacterial infection he was in septic shock and needed to be medically evacuated to Adelaide.
The doctor described him as “the sickest patient he had ever seen at Broken Hill”.
Broken Hill Hospital.Credit:Google
There was no bed available in Adelaide and a pilot could not take him to Sydney without exceeding his maximum allowable working hours.
The family had to wait several hours for an aircraft to be dispatched from Sydney to collect Alex.
Alex went into cardiac arrest and died upon arrival at Royal Prince Alfred Hospital in Sydney.
Counsel assisting the coroner, Kirsten Edwards, said the delay in transferring Alex would be a “very significant issue” in the inquest.
She described the death of the fitter and turner as “almost unbearable to imagine” for the family.
“The death of a healthy 18-year-old man who first attended a hospital with moderate knee pain is almost incomprehensible,” she said.
There was no autopsy so the cause of death cannot be “definitively determined”, Ms Edwards said.
Mr Braes also recalled Alex’s vital signs, including his temperature and pulse, were not checked each time he attended hospital. A raised temperature is a key indicator of infection.
Ms Edwards said it is a NSW Health policy that hospitals check vital signs before discharging a patient from emergency.
However, at the time of Alex’s death, Broken Hill Hospital had implemented a “business rule” that meant nurses were discouraged from taking vital signs during triage.
“That rule is no longer in place,” Ms Edwards told the inquest.
Mr Braes said the hardest thing was returning home to find his son’s iPad, where the last thing he Googled was “can pain kill you?”
“Every time I pick that iPad up, it just reminds me of him,” he said. “All the stuff he wanted to do, they’re all memories now.”
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Carrie Fellner is an investigative reporter for The Sydney Morning Herald.
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2021-04-19 09:00:00Z
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