Broken Hill teen Alex Braes died in 2017. Photo / Supplied via news.com.au
The doctor tasked with taking care of Alex Braes after he went to a country NSW emergency department in the middle of the night in 2017 has addressed the teenager's heartbroken family.
Braes, 18, died at Sydney's Royal Prince Alfred Hospital on September 22, 2017 after he was flown from Broken Hill. He and his mother had been left sitting on the town's airport runway for hours waiting for a plane to take them, with Adelaide previously refusing treatment to Braes because it had no available beds.
His body riddled with infection, Braes went into cardiac arrest on the flight to Sydney, dying in hospital that day.
The teenager had visited Broken Hill's emergency department four times before vital sign observations were done on him, identifying his infected toenail and the state of infection throughout his body.
The inquest is investigating the treatment the teenager received before he died from a bacterial infection known as Group A Streptococcus (GAS).
Braes was a healthy teenager, working as a fitter and turner, when he was put on antibiotics in August 2017 for an infected toenail.
The antibiotics appeared to be successful, however a month later, Braes went to Broken Hill Hospital with pain in his knee.
The doctor and nurse who treated the teenager on September 20, two days before he died, took the stand at the NSW Coroners Court yesterday.
Dr Devinda Arangala, who works at the regional hospital on a fly-in, fly-out scheme due to the lack of senior doctors in country NSW, first saw Braes around 3.30am on September 20.
Arangala spent more than an hour on the stand being questioned about the treatment he gave Braes and how he decided on his diagnosis.
Following this, Arangala directly addressed the teen's heartbroken family, who were sitting in the court.
"I'm so sorry that this has happened to you and no one deserves to lose a child, no one deserves to go through all of this and I can't begin to imagine what this is like for you," he said.
"All I can say is that I hope these proceedings will give you some answers to questions and bring about changes to try and prevent this from happening again."
Arangala's voice broke as he apologised again.
"I'm sorry, I'm sorry for this, and that you had to go through this."
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.
Arangala had started another night shift on September 21 and witnessed Braes being resuscitated by retrieval doctors from the Royal Flying Doctor Service.
"To get the call was extremely sad and I felt really terrible for Alex's parents," he said.
The inquest heard Arangala was almost eight hours into his 12-and-a-half hour shift when Braes arrived at the emergency department with his dad John just before 3.30am on September 20.
Braes had severe pain but had managed to limp into the hospital when they sought help from registered nurse Caroline Anderson, who was in charge that night.
He was triaged as a level four, meaning he needed to see a doctor within an hour or two.
Anderson told the inquest there had been a lot of upgrades to Broken Hill Hospital since Braes' death, including needing to record all vital signs on any patient.
At the time of Braes' death, Broken Hill Hospital had implemented a "business rule" that meant nurses were discouraged from taking vital signs during triage.
"The business rule is non-existent, we've gone back to a full set of ops at every triage," Anderson said.
"It doesn't matter if they come in with paper cut … the smallest to largest thing they get a set of ops."
Anderson said the abandoning of the business rule was a "direct function" of Braes' death.
Anderson did take Mr Braes' pain score, listed as a five out of 10, and his temperature with Arangala present.
Braes' temperature was listed as afebrile, meaning it was between 36 and 38C, a normal range.
A high temperature is typically an indicator for infection.
The inquest heard Broken Hill's entire hospital was only serviced by one doctor overnight, with two nurses stationed across the hospital.
The inquest is investigating if the understaffed hospital, which is regarded as extremely busy for a regional hospital, contributed to Braes' death.
"In terms of getting an extra pair of hands because there are a lot of patients, there aren't many options in terms of what you can do because there just aren't that many doctors in Broken Hill," Arangala said.
Arangala told the inquest that nurses sometimes had to initiate treatment if he was tied up with another patient at night.
The teenager was discharged just before 5am by Arangala with a tubigrip on his knee and crutches to ensure he kept weight off it. He was given ibuprofen and told to ice the knee.
Arangala suspected he was suffering from a fracture or swelling after Braes reported hearing a popping sound on Monday morning, two days before he attended hospital.
Arangala considered a number of diagnoses, including blood clotting or the rupture of the Baker's cyst. Tests proved these were not the case.
And, Braes appeared to be coping with the pain, leading to Arangala diagnosing the teenager with a potential strain.
"I didn't notice overt distress, it was clearly painful but I would not describe him as in extreme pain," he said.
Braes went to Broken Hill again on September 20, at 7pm that night, in worse pain and to get the result of his ultrasound.
He died two days later.