Iranian asylum seeker Hamid Kehazaei could have been taken off Manus Island the day doctors requested a transfer if the immigration department had believed there to be a "clinical imperative", an inquest has heard.
The 24-year-old, who developed septicaemia from a cut on his foot, died in Brisbane's Mater Hospital in September 2014 two weeks after his first treatment on the island.
A coronial inquest in Brisbane on Wednesday heard doctors first requested a medical transfer on August 25 and there was a commercial flight available at 5.30pm that day.
The request reached Amanda Little, the immigration department's then-director of Detention Health Operations, who claimed she was told an 11am flight the next morning was the first available.
But during her evidence to Brisbane Coroner's Court, Ms Little - who was in meetings for more than five hours that afternoon - admitted the earlier flight was a possibility in the case of medical emergencies.
International Health and Medical Services (IHMS) was required to supply accurate clinical information.
"That's not my decision to determine the clinical imperative," she said.
"We could do it by exception, would be a way to describe it based on the clinical advice."
Ms Little said a recommendation for medical movement form did not "paint a picture of urgency".
That document stated: "This client has exhausted all antibiotic treatment that is available on Manus Island and this client is displaying deterioration despite treatment with available antibiotics".
It identified the risks including "the infection spreading, leading to sepsis, life-threatening systemic infection".
Before sending the request up the chain-of-command, Ms Little sought to clarify whether the doctors meant there was a shortage of antibiotics on the island.
Ms Little said she was not a decision-maker but an escalator and clarifying the information would speed up the process.
"For a non-clinical person, I'd say there's lots of ambiguity in there," she said.
Mr Kehazaei's condition worsened overnight and he was medically evacuated to Port Moresby the next morning.
He was declared brain dead in Brisbane on September 2 and died three days later.
The inquest continues.
