Transfer ‘only option’ after teen Alex Braes went into septic shock in Broken Hill hospital, coroner hears
The “first and only option” available to a specialist doctor treating a gravely ill teenager in a New South Wales country hospital was to fly him elsewhere, a coroner has been told.
Infectious diseases specialist Dr Phillip Braslins said he was considering amputation after 18-year-old Alex Braes went into septic shock at Broken Hill Base hospital on 21 September 2017.
Braes deteriorated while lying in a “non-acute” bed in the emergency department about midday, having been driven to hospital in crippling pain by his father because no ambulances were available.
Braslins, who led the team working on the very unstable teenager, said he suspected flesh-eating disease or necrotising fasciitis may have been causing the sepsis.
The fast-acting condition has a high death rate, even with aggressive intervention such as the amputation of infected limbs.
“That’s the question we were asking ourselves, whether we needed to amputate his leg in order to save his life,” the doctor told Braes’ inquest on Thursday.
He ordered a surgeon to perform a fasciotomy, which cuts the fascia to relieve swelling and pressure. When Braslins couldn’t see any evidence of necrotising fasciitis, he was reassured amputation wasn’t required.
But, regardless, the hospital didn’t have the option of amputation as it required an intensive care unit to handle the patient after surgery, the inquest was told.
“My first and only option was to transfer Alex,” Braslins said.
Following a prolonged effort to evacuate him from the far west NSW town, Braes landed in Sydney in the early hours of 22 September and died soon after.
The NSW coroners court, sitting in Broken Hill, has been told Braes appeared to improve after the intervention about midday, even giving a verbal history of his left knee pain to Braslins.
“His colour improved, I was encouraged by his improvement,” the doctor said.
He handed over the patient to another doctor and said he was “deeply shocked” when he later learned Braes had died.
“The reassurance I gave [Alex’s parents in the hospital] was heartfelt and sincere and I was very hopeful Alex would survive,” he said on Thursday.
But he now believed, on the balance of probabilities, the teenager had necrotising fasciitis.
“With the aid of retrospect, there was probably nothing we could do to save his life and I’m deeply sorry for that,” he said, breaking down.
The exact cause of death remains unknown because, while blood culture showed the teen had invasive group A streptococcal, an autopsy was never performed.
Braslins said the most likely source of the infection was an infected toenail on Braes’s left foot for which he had appropriately received antibiotics in August.
The inquest will resume in Sydney on 31 August. It will examine the prolonged process to evacuate Braes and why it took the hospital nearly a year to investigate the case.
Several staff members directly involved in Braes’ care on 20-21 September have testified this week they were not interviewed for the root-cause analysis.