An inquest into how a Broken Hill teenager died from an infected toenail has heard his condition deteriorated rapidly in his final hours.

Key points:

  • The Coroner’s Court hears evidence about Alex Braes’ medical treatment in his final 12 hours
  • A senior doctor says the 18-year-old was “compensating well”, making it harder for medical staff to assess him
  • The inquest hears the Royal Flying Doctor Service had difficulty finding a suitable pilot due to aviation regulations

Alex Braes died on September 22, 2017, with a suspected flesh-eating bacteria known as necrotising fasciitis ravaging his system, after he was turned away three times from Broken Hill Hospital’s emergency department.

About 21 hours after he first presented to the emergency department, and with 12 hours left to live, the treatment of the 18-year-old was handed over to the chief medical officer of the Royal Flying Doctor Service (RFDS).

Dr Randall Greenberg on Wednesday spoke at length in the New South Wales Coroner’s Court about Mr Braes’ condition, and issues that prevented the RFDS from transferring him to Sydney or Adelaide sooner.

Dr Greenberg told the inquest that he first saw Mr Braes about 2:00pm on September 21, 2017, and from that moment on “I was the team leader”.

Royal Flying Doctors Service, Doctor Randall Greenberg speaking on Spetember 9, 2021

RFDS patient-retrieval specialist Dr Randall Greenberg also works at Dubbo Base Hospital as the Director of Critical Care. (ABC News)

The veteran clinician and patient-retrieval specialist, who has 36 years’ experience, said he believed, in hindsight and now that he was “aware of the outcome”, that there were a number of “ifs”  — including if Mr Braes had been taken to Adelaide instead of Sydney.

‘He fell off the cliff’ 

Tragically, what worked against Mr Braes was his overall health and age, the inquest heard.

Dr Greenberg said the teenager was in a “relatively good” condition for someone who was critically ill.

He revealed all the medical staff “misjudged” Mr Braes, who was “compensating very well” because he was “a young, fit fellow”.

“An older person would’ve been much more unwell, prior to me arriving.”

Mr Braes was conscious and speaking to staff and was “compensating for the sepsis until he couldn’t”.

Pilot supply issues 

The decision not to transfer the teenager to a better-equipped, major hospital sooner was also under the microscope.

It was a call made far more difficult due to a lack of available pilots at the RFDS base in Broken Hill that day.

Due to restrictions imposed by the Civil Aviation Safety Authority, pilots can only fly 11 hours a day, with a possible extension of one hour.

The clock starts ticking “as soon as they get the first phone call”, according to Dr Greenberg.

Unfortunately, the night pilot had called in sick.

An RFDS plane at Broken Hill airport.

The Royal Flying Doctor Service currently has one plane permanently based in Broken Hill. (Supplied)

If they had flown Mr Braes down to Adelaide, the only available pilot would not have been able to return, as their allowed time would have expired.

This would have left the state’s Far West region without a pilot or plane, according to the retrieval specialist.

Dr Greenberg explained to the inquest that the situation was the same in Dubbo, where the pilot’s hours had also expired.

From February 2022, the Broken Hill RFDS base has funding available for a second plane, along with another locally based pilot and nurse.

Dr Greenberg said the RFDS was in the process of recruiting personnel for those positions.

The highly experienced clinician also took time at the end of his testimony to address the Braes family directly.

The inquest continues.

Posted , updated 

Alex Braes inquest told the teen’s ability to cope with pain from infected toenail made it hard to assess him
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