SA Health, for its part, has commenced discussions with its NSW counterpart on how to continue to best provide services on an ongoing basis. However, the rule did not comply with NSW Health policy, was "potentially dangerous" and should not have been introduced, according to Ryan. a coroner has heard. "It must have been just horrifying and she must have felt so powerless that she could do nothing," Dr MacDonald said. Counsel assisting Coroner Kristen Edwards asked Arangala how it felt getting the call from doctors at Royal Prince Alfred Hospital in Sydney, informing him Braes had died on September 22. The teen's vitals were only observed during his fourth and final presentation, and a suspected toenail infection was identified. "Yes that's my understanding," replied Ms Anderson. Deputy State Coroner Magistrate, Elizabeth Ryan, asked Ms Murphy whether the rule resulted in fewer cases of vital signs being taken and recorded at the hospital once implemented. 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. Alex Braes, 18, died at Sydney's Royal . Alex arrived at Broken Hill Hospital's emergency department. "A young man who died, essentially, from an infected toenail, from the consequences of an untreated and very common infection. Several changes had occurred to the patient triage process at Broken Hill base hospitals emergency department since the September 2017 death of Alex Braes, the registered nurse Kristy Kelly told the NSW coroners court on Wednesday. Alex Braes, 18, died at the Royal Prince Alfred Hospital in . The first doctor to treat a limping teenager, whose sudden death from a fast-acting infection is under coronial investigation, says in retrospect he should have taken a full set of basic readings such as blood pressure. It was far too late. (Supplied) Friday, 12.50am More than 14 hours after his father had first called an ambulance, Alex finally arrived at RPA Sydney a hospital that could actually treat him. Alex Braes is believed to have died from a type of flesh eating bacteria, known as necrotising fasciitis, after he was turned away three times from Broken Hill Hospital's emergency department in . Doctors, who failed to check the vital signs of a teen who died from sepsis, are not responsible for the tragedy, according to a coroner who says they were prevented from doing so under a hospital business rule. Crucially, no-one did vital-signs observations such as check Alex's pulse, blood pressure, or temperature and they didn't take any blood for testing. Dr. Piazza - Injury and Thrombosis. Alex Braes, 18, died at Sydney's Royal Prince . Inquest into the death of Alex BRAES CORONIAL LAW: death of a young man - cause of death sepsis - was clinical care at Broken Hill Base Hospital adequate - were arrangements or airlift to a tertiary hospital appropriate - recommendations Download Inquest into the death of Alex BRAES PDF File (358.2 KB) Last updated: 27 May 2020 The death of a healthy 18-year-old man who first attended a hospital with moderate knee pain is almost incomprehensible, she said. "Twelvehours passed before hisemergency flight landed at Sydney's Royal Price Alfred Hospital," Ms Ryan said. "He complained that he might pass out or faint, so his father asked for a pillow," she said. On the first day, the Broken Hill hearings heard that Alex mighthave died from an infection, invasive Grade A Streptococcus, possibly from the ingrown toenail or a cut. 7 (PDF, 113.1 KB), Coffs Harbour Local Court, 2-16 Beryl St, Coffs Harbour 2450, Before her Honour Magistrate Forbes, Deputy State Coroner, Forensic Medicine and Coroners Court Complex, 1A Main Ave, Lidcombe, Before his Honour Magistrate Lee, Deputy State Coroner, Forensic and Coroners Court Complex, 1A Main Ave, Lidcombe, Inquest into the Death of A.W. I think it was a totally avoidable death," Dr MacDonald said. The 18-year-old died about 1am on 22 September soon after landing in Sydney after a prolonged effort to evacuate him from Broken Hill. 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. Mr Braes, 18, was misdiagnosed as having a torn knee tendon while he was battling a life-threatening bacterial infection. 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. Before Alex's death, doctors had complained repeatedly that management was not open to criticism and did not listen to safety concerns they raised. She noted that there was no realistic possibility that his specific infection could have been identified and successfully treated on September 20, 2017. A teenager who had been turned away three times from Broken Hill Hospitals emergency department Googled can pain kill you? on his tablet device before he died from septic shock. It was far too late. Ryan also outlined major delays in transferring Braes to the Sydney hospital where he died in the early hours of 22 September 2017, after he was refused admission at a South Australian tertiary facility due to a policy preventing interstate transfers. The inquest heard Mr Braes had an ingrown toenail in August 2017 that was successfully treated with antibiotics. Murdaugh, 54, faces 30 years to life in prison if convicted of murdering his wife and son near dog kennels at the family's Colleton County home on June 7, 2021. The inquest heard that a mandatory investigation into the cause of Alexs death was not carried out by Far West Local Health District for a year after he died. "All I can say is since I became aware of the death of Alex Braes, I don't think I have stopped thinking about that young man.". On Monday, New South Waless deputy state coroner, Elizabeth Ryan, handed down her findings into Braes death, saying there was a serious and unacceptable deficiency in his treatment at Broken Hill base hospital. Inquest into death of Alex Braes hears of 'distressing' hospital rule and resourcing concerns, Follow the action from the third Test between India and Australia in Delhi in our live blog, Former government services minister Stuart Robert is being questioned at theRobodebt inquiry, Keep up with the latest ASX and business news. In a statement, the FarWest Local Health District said it expressedits deepest sympathies to the family of Mr Braes and acknowledgedthe heartache caused by his death. Instead, medical staff in the emergency department made the assumption Alex had a sporting injury. A NSW coronial inquest is examining the care Mr Braes received at Broken Hill Hospital, why his vital signs weren't taken until his third visit to the emergency department in two days and why it took hours for the 18-year-old to be medically evacuated out of the country town. We acknowledge Aboriginal and Torres Strait Islander peoples as the First Australians and Traditional Custodians of the lands where we live, learn, and work. One of them, DrAli Baalbaki, told the inquest he longer celebratedhis own birthday because it falls on the same day he reviewed the teenager. From February 2022, the Broken Hill RFDS base has funding available for a second plane, along with another locally based pilot and nurse. It's something that troubles local MP Roy Butler. Deputy State Coroner Elizabeth Ryan delivered the inquest's findings in the Broken Hill courthouse on Monday. Broken Hill hadn't been able to get a GP that week to staff the fast-track clinic which saw less-serious patients, so that put enormous pressure on the emergency department. Broken Hill Base Hospital in NSW had a 'business rule' that discouraged the taking of routine vital signs at ED triage, reports hearing into Alex Braes' death in 2017. The decision not to transfer the teenager to a better-equipped, major hospital sooner was also under the microscope. Please note: Registered nurse Kristy Kelly, who was the team leader in the hospital's emergency department on the morning of September 21, 2017, told the inquest she was bound by that rule. "I was gobsmacked that it didn't prompt an investigation straight away," he said. Eighteen-year-old Alex Braes' knee was so painful, he asked his father to take him to Broken Hill Hospital. Broken Hill staff had missed something, but still, no-one did proper observations of Alex. "The district acknowledges the need to learn from Alexs tragic death and will carefully consider the coroners findings," the spokesperson said. Each season is dedicated to a different series in horror. But one nurse was still responsible for both triaging patients in the waiting room and overseeing the departments nursing team. Please allow a few minutes for this process to complete. "This was a seriousand unacceptabledeficiency in his care and it was a missed opportunity to identify his underlying, evolving illness," she said. ': Teen searched internet before dying of suspected toenail infection, inquest hears, Doctor tells inquest why he can't celebrate his birthday since teenager's death, Inquest begins into teen's death from infected toenail, The death of Alex Braes still haunts doctors who didn't even know him, Outside her tent, next to a popular city walking track, homeless Tasha is past caring what people think. The local proceedings of inquest into the death of Broken Hill teenager Alex Braes has finished after hearing of a "distressing"hospital business rule, staffing resources and apologetic doctors. Alex Braes died at Sydney's Royal Prince Alfred Hospital after going to another hospital four times. Broken Hill Hospital management downgraded the categorisation of Alex's death, meaning it wasn't referred immediately for an investigation, as is required under the state's Health Administration Act. There was no bed available in Adelaide and a pilot could not take him to Sydney without exceeding his maximum allowable working hours. She told Four Corners that by this stage, Alex was desperately unwell, yet he was again left waiting. After arriving at Broken Hill base hospital on 21 September, Braes was put in a non-acute bed. As for the delays in Braes' transfer, the coroner pointed out that the teen was not taken to South Australia's (SA) Royal Adelaide Hospital despite the facility being the closest hospital suitable for his care. Key points: Mr Braes' cause of death identified as multi-organ failure due to sepsis from a group A streptococcus infection This service may include material from Agence France-Presse (AFP), APTN, Reuters, AAP, CNN and the BBC World Service which is copyright and cannot be reproduced. 'An unthinkable tragedy': How did this train crash happen? They sat there. Mr Braes was a healthy teenager, working as a fitter and turner, when he was put on antibiotics in August 2017 for an infected toenail. . Elizabeth Keft returned, with IV bag in hand, to see doctors and nurses working on Braes in a resuscitation bay. Were working to restore it. Former Broken Hill obstetrician Dr Simon Stewart-Rattray told Four Corners the failure to do vital-signs observations was "indefensible". It took 25 minutes for a wheelchair to be brought out so Alex could be taken from the car into the hospital. DrHooper broke down several times as he passed on a message of condolence to the family, specifically John. Doctor leading team in NSW's far west 'deeply shocked' to learn 18-year-old died after being evacuated to Sydney Broken Hill doctor who led team working on 18-year-old Alex Braes teenager has. Ms Anderson said 'yes' and that the rule was notin place at the hospital any longer. She described the death of the fitter and turner as almost unbearable to imagine for the family. Broken Hill teen Alex Braes died in 2017. Broken Hill teen Alex Braes died in 2017. All rights reserved. "Furthermore, Alex was not transferred to the closest hospital suitable forhis care, which was South Australia's Royal Adelaide Hospital," Ms Ryan said. CORONIAL LAW - cause and manner of death, underlying cardiac pathology, methamphetamine use, conduct of police officers, execution of arrest warrant Inquest into the disappearance and suspected death of Alexander Stetz Decision of Deputy State Coroner Kennedy Coronial law, cause and manner of death, missing person, police search, dementia Counsel Assisting the inquest, Kirsten Edwards, asked Ms Kelly whether she was aware of any level of disgruntlement amongst the nurses about it. Broken Hill teenagerAlex Braes, who died of an infected toenail. Broken Hill teen Alex Braes died in 2017. More than 14 hours after his father had first called an ambulance, Alex finally arrived at RPA Sydney a hospital that could actually treat him. Did you find what you were looking for? He suffered multi-organ failure due to sepsis from a group A streptococcus infection, one month after treatment for an infected ingrown toenail. "What are we doing about avoidable deaths, preventable deaths?" It was not until his fourth and final presentationmore than 30 hours laterthat vital observations were taken of him and a suspected toenailinfection was identified. Alex's father wheeled him into the emergency department and a nurse observed him through a window and asked him to wait. A retrieval team from Sydney then made the return trip to Broken Hill. The 18-year-old died about 1am on September 22 soon after landing in Sydney after a prolonged effort to evacuate him from Broken Hill. Alex Braes (Credit: ABC "Four Corners," family photograph) The death has traumatised Braes' family and hospital staff alike. the NSW member for Barwon said. "Every person (from) the smallest thing to the largest thing, they get a set of obs.". the death prevention role of the coroner family privacy sensitivity of the findings possible harm from making an investigation publically available In general, authorised findings for publication will include: all public inquest findings motor vehicle crashes long-term missing persons cases homicides after the criminal process has been completed Alex's ultrasound showed a possible torn tendon and again Alex was sent home and told to rest, ice and elevate his leg and to come back in two weeks if the pain hadn't stopped. Broken Hill teenager Alex Braes' parents remember him as a ray of sunshine, a funny and smart . Mr Braes said the hardest thing was returning home to find his sons 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. The 18-year-old TAFE student's death was featured in a Four Corners report, which revealed he presented to Broken Hill Hospital's emergency department four times before vital signs observations were administered. Dr Kerrie MacDonald is a paediatrician who used to work at Broken Hill Hospital and is still in the NSW health system. An autopsy is an examination of the body of a deceased person, carried out by a qualified pathologist. "I was aware that many of the staff felt that it affected the way they triaged and potentially could affect the accuracy of their triages," replied Ms Kelly. A medical student struggled to insert the cannula. Ms Ryan's report also noted that experts assembled for the inquest could not say what the original source of Alex's infection was. We acknowledge Aboriginal and Torres Strait Islander peoples as the First Australians and Traditional Custodians of the lands where we live, learn, and work. Alex Braes, 18, died at Sydney's Royal Prince Alfred Hospital about 46 hours after limping into Broken Hill Base Hospital at 3am on September 20, 2017. Ms Anderson was then asked when the rule was disbanded. Experts assembled for the inquest said they had notcompletely agreed on the cause of Alex's death. John Braes told the inquest at its first day of local hearings that his son had looked up 'can pain kill you' on his iPad in the days before his death. These figures meant the odds were against Alex Braes from the start. He suffered multi-organ failure due to sepsis . Bol says B sample clears him of doping positive. Sign up to receive an email with the top stories from Guardian Australia every morning. During the flight Alex continued to decline and, as his mother watched, the paramedics struggled to keep him stable, having to phone doctors for advice. Dr O'Donohoe later quit work at Broken Hill Hospital over what he saw as mismanagement, leading to patient safety issues. Alex Braes, 18, died at Sydney's Royal Prince Alfred Hospital about 46 hours after limping into Broken Hill Base Hospital at 3am on September 20, 2017. Download the ABC News app for all the latest. . Braes was in "excruciating pain" and was described by one doctor as "the sickest patient the hospital had ever seen" by the time he visited the hospital for the third time, according to the outlet. "[I] informed him that we had the sickest patient I'd seen since my time in Broken Hill," he said. As for the delays in Braes' transfer, the coroner pointed out that the teen was not taken to South Australia's (SA) Royal Adelaide Hospital despite the facility being the closest hospital suitable for his care. "I've worked in 13 different locum hospitals since I've retired and I've never seen anything like Broken Hill in my entire career," he said. The inquest will investigate the treatment Alex Braes received before he died from a bacterial infection known as Group A Streptococcus (GAS). Alex Braes, from Broken Hill died from a deadly flesh-eating diseases in 2017 Inquest into the 18-year-old's sudden death reveals doctors missed vital signs Young man complained of severe pain. There was no "grab and go" for Alex and that would have devastating consequences. We acknowledge Aboriginal and Torres Strait Islander peoples as the First Australians and Traditional Custodians of the lands where we live, learn, and work. AEST = Australian Eastern Standard Time which is 10 hours ahead of GMT (Greenwich Mean Time), abc.net.au/news/senior-treating-doctor-reflects-on-day-two-of-alex-braes-inquest/100703130, Get breaking news alerts directly to your phone with our app, Help keep family & friends informed by sharing this article, China leaving US behind on development of critical technologies, report finds, Former minister takes 'absolute responsibility' for Robodebt, admits defending scheme despite knowing it could be unlawful, 'Sickening, callous and brazen': Sydney man dies in hail of bullets in front of 12yo son, Evelyn worked three jobs when she was in her 20s to build up her super. abc.net.au/news/alex-braes-inquest-findings-health-systems-criticised/101109422 The Deputy State Coroner has criticised a regional hospital's treatment of a boy who was repeatedly sent home before dying from sepsis. In addition to being told to return home on his first three visits to Broken Hill Hospital, Braes was also refused admission at a South Australian tertiary facility on Sept. 21, 2017, due to a policy preventing interstate transfers. It recently handed down 44 recommendations to boost the rural medical workforce and improve the standard of care. Two New Fatal Earthquakes Hit Turkey Days After Deadliest Quake Killed 44,000 . "We've gone back to the full set of obs (observations) at every triage," she said. A New South Wales regional hospital where a teenager was sent home three times days before his death is still not safe due to staff shortages, a coroner has heard. You often need to be in two places at once, she told Braes inquest. Jurors in the murder trial of disbarred South Carolina attorney Alex Murdaugh heard Monday about autopsy evidence on a day the court also publicly released body camera videos from law enforcement . Ms Ryan was also concerned that Mr Braes' retrieval and transfer out of Broken Hill Hospital was beset by numerous delays. Broken Hill teenager Alex Braes, who died of septic shock. "I just wanted to send my condolences and I'm so sorry that it happened. Ryan found it was potentially dangerous and against NSW Health policy, but a systemic failure that could not be attributed to individual hospital staff. Please don't include personal or financial information here, My property was damaged or destroyed in the fires FAQ. Ms Murphy also told the inquest that there was about a 10-minutewait in the emergency department from the time Alex came to the triage window to when he was looked at by her, as she was busy triaging another patient. Editor's note: This article contains graphic descriptions from autopsy reports and witness testimony. "A significant one was the failure on September 20, 2017, to perform vital signs observations," Ms Ryan said. The delayed transfer also deprived his parents of seeing him in his final hours, as they left the hospital to prepare to travel with him. 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Alex Braes, 18, died on 22 September 2017 from multi-organ failure due to sepsis from a Group A streptococcus infection. My first thought was I havent finished obs for him, I havent done anything for him, have I missed something? she told the inquest. Alex Braes, of Broken Hill, died in the early hours of Sept. 22, 2017, upon arriving at Royal Prince Alfred Hospital in Sydney, 7News.com.au reported. This was due to a business rule, which discouraged staff from taking vitals during the triage stage in order to improve efficiency. Broken Hill teenager Alex Braes, who died of an infected toenail. Alex died in the early hours of September 22, 2017, at Royal Prince Alfred Hospital, Sydney, after being transferred from his local hospital. Browse for your location and find more local ABC News and information. Alex Braes, from Broken Hill died from a deadly flesh-eating diseases in 2017 Inquest into the 18-year-old's sudden death reveals doctors missed vital signs Young man complained of severe pain. Alex's father called triple zero to ask an ambulance to take his son to hospital, but no ambulance was available. Report. Coroner in Alex Braes inquest scathing of care at Broken Hill Hospital provided to 18yo who died of sepsis, Follow the action from the third Test between India and Australia in Delhi in our live blog, Former government services minister Stuart Robert is being questioned at theRobodebt inquiry, Keep up with the latest ASX and business news. Labor set a superannuation trap and Dutton immediatelytook the bait, Here's what the super tax changes might mean for you, NT Labor candidate confirms involvement in fatal car crash that led to conviction of driving without due care, Freya is one of 15,000 Australians who must find a new life-saving medication or pay a much higher price, Man who murdered Jay Brogden convicted of contempt of court, Live: Australia loses first wicket on day two but still on top in Indore. They include a significant number of items from the mid to late 18th century, although the practice of forwarding all inquisitions to the King's Bench appears to have fallen into disuse in the early 18th century. The clock starts ticking "as soon as they get the first phone call", according to Dr Greenberg. Alex's parents were too distressed to be interviewed, but conveyed to Four Corners the loss of their son had left them feeling that, to the hospital system, he was worth nothing. The "first and only option" available to a specialist doctor treating a gravely ill teenager in a country hospital was to fly him elsewhere, a coroner has been told. 'An unthinkable tragedy': How did this train crash happen? An inquest into his death by the NSW Coroners Court is investigating the treatment the teenager received before he died from a bacterial infection known as Group A Streptococcus (GAS). "It is entirely possible that Alex had a severe cellulitis without reaching the threshold of necrotising fasciitis, which led to his bloodstream infection and sepsis.". "I'm so sorry that this happened to you," said DrArangala to the Braes family in an emotional, sombre tone. In lieu of an autopsy, a panel of experts . That rule is no longer in place, Ms Edwards told the inquest. One nurse is responsible for two jobs at the Broken Hill hospital, the inquest into the death of Alex Braes has heard. Key points: The Coroner's Court hears evidence about Alex Braes' medical treatment in his final 12 hours "One of the things that really stood out for me when I saw you that night was how sweetly you and Alex treated one another," he said. It can also be seen on . "Unfortunately it's a very serious omission that somebody who's been repeatedly in the emergency department hasn't been gone over with a fine-tooth comb," he said. Counsel assisting the coroner, Kirsten Edwards, said the delay in transferring Alex would be a very significant issue in the inquest. "And my greatest sympathy and sorrow, actually, to his family. "Many changes have already been implemented by Far West NSW Health District and NSW Ambulance.". An inquest into how a Broken Hill teenager diedfrom an infected toenailhas heard his condition deteriorated rapidly in his final hours. Alex Braes. 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