The inquest into the death of Broken Hill teenager Alex Braes, who died of an infected toenail four years ago, will begin on Monday.

Alex Braes, 18, died at the Royal Prince Alfred Hospital in Sydney on September 22, 2017, after being transferred from the local hospital.

The story of Mr Braes’s death, including the four times he presented to Broken Hill Hospital’s emergency department before vital signs observations were administered on him and an infected toenail was identified, was discussed in a Four Corners report in 2019.

Mr Braes’s father, John Braes, is due to speak at the commencement of the five-day inquest, along with a nurse present at Mr Braes’s first presentation at Broken Hill Hospital.

Clinical concerns

A former clinician at Broken Hill Hospital who blew the whistle on Mr Braes’s death said she and other former colleagues had wanted to see improvements at the hospital before the teen died.

Retired paediatrician Kerrie MacDonald said there had been attempts to warn the Local Health District (LHD) about clinical governance concerns at the hospital.

“In March of 2017, we recommended, as a group of doctors, that an external and independent review of patient care take place, and that did not happen,” she said.

“Then in June 2017 … a medical staffing working group meeting took place … to formalise a document over a couple [of] months, which would outline the risk of the patients under the current medical staffing that happened at Broken Hill Hospital.

“It was to include the gaps in clinical delivery and try and present some solutions.

“We were pretty keen to see things improve.”

A former clinician at Broken Hill Hospital claims a number of senior doctors left the hospital a year or two after Alex Braes’s death out of concerns about clinical governance.Photo: ABC: Noah Schultz-Byard

‘Living document’

Dr MacDonald claimed that at a June 2017 meeting of medical staff she requested the working group establish a “risk register”.

According to a NSW Health risk management document, a risk register “provides an accurate and complete record of risk assessment and management activities”.

“[It] is to be a ‘living document’ subject to regular review and updates as risks are addressed and new risks identified, and strategies for current risks updated,” the NSW Health document said.

Dr MacDonald claimed no register was in place at the time of the meeting.

“The ministry had mandated that each LHD have such a risk register in place, and they had mandated that almost two years before then – but we didn’t have one in place in June of 2017,” she said.

“Since Alex died, 10 of the 18 senior doctors working at Broken Hill Hospital left Broken Hill over the next one to two years.

“I spoke to all of those doctors and 70 per cent – seven out of 10 – gave as the reason as the ‘poor clinical governance’ that was in place.

“They saw risks both to themselves and to their patients.”

District says issues addressed

The Far West Local Health District said it had reviewed and strengthened its clinical governance systems, having listened to and learned from staff and patient experiences.

A spokesman said the LHD had a robust incident management system and was confident that it had effective oversight of safety and quality systems.

He said the LHD extended its sincere condolences to Mr Braes’s family and friends and appreciated that it had been an extremely difficult time for them.

The spokesman said it would be inappropriate to comment further while the inquest was ongoing.

Ombudsman probe continues

Dr MacDonald and the other former clinicians who raised concerns about Mr Braes’s death also wrote to the NSW Ombudsman’s Office last year calling for an investigation into what they said were the systemic failures of the health authorities in the state’s outback.

The Ombudsman’s office told the ABC last week that it was still pursuing the complaint.

The LHD and the office of Health Minister Brad Hazzard previously stated they would cooperate fully with any inquiries.

Mr Hazzard’s office said at the time that it had tried to address the clinicians’ concerns on several occasions.

-ABC