Warning: the following true story may be upsetting to some. An eighteen-year-old boy has died after being neglected by health staff in the emergency ward of a hospital. His death was 100% avoidable.

This failure is on the account of Australia’s regional hospital, where there are limited resources and overworked staff. The Australian Institute of Health and Welfare released stats in July that showed the further people live from their capital cities, the higher the rate of possibly avoidable deaths. In other words, for every 100,000, there are 91.6 such deaths in major cities and 248.7 in the remote parts of the country.

The odds were already stacked against Alex Braes. Yet the teenager’s case shocked a group of clinicians who had worked at the Broken Hill Hospital, the institution that failed him, to call out its dangerous structure that had gone on for years. Previously, the doctors had complained about these issues but the management dismissed any criticism. 

Wednesday, September 20, 2017. 3:18 AM

Eighteen-year-old Alex Braes couldn’t sleep due to severe pain in his knee. His father drove him to the Broken Hill Hospital’s emergency department.

“If an 18-year-old comes into an accident and emergency department at three o’clock in the morning, it usually means there’s a serious problem,” said Dr. Benin O’Donohoe, who had worked as an anesthetist there.

However, the medical staff on duty assumed Alex’s pain is from a sporting injury. They didn’t do any basic examination such as checking his pulse, taking his blood pressure or temperature, or testing his blood.

This lack of vital-signs test was the first mistake among many in this tragedy.

The staff told Alex to go home and return in the morning for an ultrasound.

Wednesday. 8:00 AM

Alex and his father were back at the emergency department. 

For a while, it seemed Alex would receive the medical attention he needed. He took his ultrasound, but the doctors were too busy to review his results with him.

That week, the hospital couldn’t get a GP for the fast-track clinic that worked with non-emergency patients. The rest of the staff was too busy and overworked for Alex.

The teenager was told to go home and return later. Again, no one checked his vital signs during this visit.

Wednesday. 6:00 PM

Alex and his father were back, with Alex still in incredible pain. Their third appearance should have alarmed the medical staff.

“Certainly, other hospitals will highlight a second presentation or third presentation, [to ask] ‘have we missed something?’” said Max McLean the after-hours nurse manager at Broken Hill.

And yet, no one properly examined Alex.

Former Broken Hill obstetrician Dr. Simon Stewart-Rattray stated the neglect of a vital-signs test was “indefensible.”

“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. [1]

At least Alex finally got to review his ultrasound results, which showed a possible torn tendon. 

As unbelievable as it sounds, Alex was told—again!—to go home to rest, elevate, and ice his leg. Perhaps come back in two weeks if the pain continued.

Alex did as instructed and woke up the next morning in agony. He couldn’t walk. He called his father at work for help.

Thursday. 10:00 AM

His father called emergency to request an ambulance to take Alex to the hospital. No ambulance was available to help them.

His father came home to carry his son, who was six-foot-three, into the car and rush him back to the hospital.

Alex’s pain was so severe by the time they arrived, he couldn’t leave the car. His father ran inside to ask for assistance. Twenty minutes later, they brought out a wheelchair for him.

“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,” said Dr. Stewart-Rattray, who had complained to the management about the lack of resources and mismanagement. He, like the others, found Alex’s treatment appalling.

Thursday. 11:39 AM

Alex was wheeled into the hospital by his father. At this point, he was weak and in excruciating pain. 

“He complained that he might pass out or faint, so his father asked for a pillow,” said Dr. Kerrie MacDonald, a pediatrician.

The nurse on duty saw Alex through the window and told him to wait. She did not give him the pillow he requested, but she did leave her desk to check on him, finding him sweaty and unwell. She issued him a bed.

Thursday. 12:17 PM

Finally, the staff checked Alex’s vital signs. This was thirty-six hours since he had first presented himself at the hospital.

Thursday. 12:28 PM

Alex’s vital signs deteriorated quickly. The rapid-response team lead by Dr. Benin O’Donohoe was called. When they showed up, Alex had started to pass out.

“Alex was semi-conscious, he was rambling, he wasn’t responding to simple questions,” Dr O’Donohoe said. “He was cold, clammy, sweaty and he was significantly blue and mottled and this mottling colour is really a very ominous feature. It means he’d been unwell for a significant number of hours at that point.”

Finally, they discovered the cause of Alex’s pain: an infected toenail. Somehow, no one had caught this during any of his previous visits.

However, the infection had progressed into the deadly disease called necrotizing fasciitis, which rapidly kills soft tissue in the body.

“The kidneys start to fail in what is an overwhelming sepsis and that is something that we were battling against, because we didn’t actually have the resources to support failing kidneys—that’s why we needed to get him out,” said nurse Max McLean.

Thursday. 1:25 PM

Dr. O’Donohoe resuscitated Alex, and met with the hospital’s director of medical services to tell him “that we had the sickest patient I’d seen since my time in Broken Hill.”

Thursday. 1:47 PM

Royal Adelaide was the nearest tertiary hospital to Broken Hill. However, it was in another state. Still, it was closer than Sydney. The Broken Hill staff requested a bed for Alex at Royal Adelaide, but there were none available. 

Thursday. 2:05 PM

Dr O’Donohoe talked to the Royal Flying Doctor Service at Broken Hill to tell him “that this patient was incredibly sick, incredibly unwell, and needed urgent aeromedical retrieval.”

However, the only available pilot had already maxed his flying hours in accordance with the regulation by the Civil Aviation Safety Authority. The flying doctors couldn’t transport Alex.

Thursday 2:23 PM

The medical staff found a bed for Alex at Sydney’s Royal Prince Alfred Hospital. An air ambulance departed from Sydney to come pick him up, starting their five-hour round trip.

“His parents were just shell-shocked. They sat there. I just think they were trying to grasp the reality of what was facing them and that he was deteriorating very quickly,” McLean said.

Thursday. 5:30 PM

Alex’s mother was sent to the Broken Hill Airport to wait for the air ambulance, while his father drove home to pack some suitcases. The plan was that he would meet his family in Sydney after taking a commercial flight.

Then Alex’s health status plunged. The staff put him on life support before he could be placed on the plane. His mother waited outside the airport for hours, while her son struggled for his life at the hospital.

Thursday. 9:30 PM

Alex was taken to the airport and onto the air ambulance with his mother. As they were in the air, Alex’s condition continued to worsen and the paramedics fought to keep him stable. They phoned doctors for advice. The mother could do nothing but watch.

Friday. 12:50 AM

Alex arrived at the hospital that could treat him in Sydney. His arrival was far too late. His heart stopped beating.

Friday. 2:00 PM

Alex Braes had died.

The Effects of Alex Braes’s Death

Alex’s parents turned down interviews, but they did express that they felt the hospital system treated their son as worthless.

His death deeply impacted the doctors at Broken Hill.

“A young man who died, essentially, from an infected toenail, from the consequences of an untreated and very common infection. I think it was a totally avoidable death,” said Dr. MacDonald. “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.”

Dr. O’Donohoe quit the hospital soon after, not wanting to partake in the mismanagement and patient safety issues there. “We as a medical profession, we as a health service in New South Wales, we failed Alex Braes and we failed his family.” [2]

The South Wales Health Department stats proved Broken Hill to have the highest potentially avoidable death rate in that area, with 189 deaths per 100,000 people. Recent reports show it this number rising.

“What are we doing about avoidable deaths, preventable deaths?” said the NSW member for Barwon. “Because it’s not good enough in 2019 to have people in the far west of New South Wales having worse health outcomes than people in the city.”

The incompetence was not over.

The management at Broken Hill downgraded Alex’s death so that it wasn’t referred for an investigation, a violation of the state’s Health Administration Act.

It took a year for the investigation to be finished, and this was only accomplished because the doctors lobbied the Ministry of Health and wrote to Brad Hazzard, the NSW Health Minister.

McLean spoke up about this issue, but was ignored by the management of the hospital. “I was gobsmacked that it didn’t prompt an investigation straight away.”

“What I do know is it was not a satisfactory outcome and that’s why when I heard about it from the doctors, I had the ministry go back out there, go through it, and determine why this had been downgraded,” said Mr. Hazzard. “And my greatest sympathy and sorrow, actually, to his family. It was a horrific outcome and such a young man, only 18 years old.”

Alex’s story haunts the clinicians at Broken Hill, even the ones who didn’t meet him.

“I didn’t know his family, I didn’t know Alex Braes. I don’t even know what he looks like. But I can say to you that I think of that boy frequently,” said Dr. MacDonald. [3]

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