Doctor suspended after misdiagnosis leads to teen losing testicle

SINGAPORE: A senior doctor has been suspended for a year by the Singapore Medical Council (SMC) for professional misconduct, after an incorrect diagnosis in 2019 led to a teenage patient losing his testicle.

Dr Yeo Khee Hong, a licensed doctor for about 42 years, first diagnosed the teenager with abdominal colic, then swelling and inflammation of the testicles, prescribing stomach medicine and antibiotics.

However, the boy's condition worsened despite repeated visits to Dr Yeo, until he had to undergo surgery to remove his testicle. His true condition was testicular torsion – a condition in which the spermatic cord that provides blood flow to the testicle twists and cuts off the blood supply.

If the boy had been referred to emergency care in time, he would have had between a 90.4 and 97.2 percent chance of saving his testicles, according to the reasons for the decision released Monday (May 27).

THE CASE

Dr Yeo pleaded guilty to a charge of professional misconduct for failing to provide competent and appropriate care and/or exercise due diligence in the management of his patient.

A second charge of failure to provide adequate information to the patient was taken into consideration for sentencing.

The boy was 15 or 16 years old when he visited Dr Yeo at his clinic on March 22, 2019.

He told Dr Yeo that he felt pain in his left abdomen which was coming from his left testicle.

He also had more frequent bowel movements and watery stools.

Dr Yeo examined the boy and found that his abdomen was soft and there was no abnormal mass or twist in his left testicle.

He diagnosed the boy with abdominal colic and prescribed stomach medication.

Five days later, the boy visited Dr Yeo again and told him he was suffering from swelling and pain in his left testicle, which was worse when he sat or walked.

Dr Yeo examined the boy and found that his left testicle was enlarged and tender.

He diagnosed the boy with orchitis and epididymitis – swelling and inflammation – of the left testicle. He prescribed antibiotics for the boy and ordered a complete blood count and urine test to confirm his diagnosis.

However, before making his diagnosis, Dr. Yeo did not consider the possibility of intermittent testicular torsion.

He ruled it out and considered orchitis and epididymitis more likely.

Dr Yeo also failed to refer the boy to a specialist or a hospital accident and emergency department before ruling out testicular torsion.

The next day, Dr Yeo informed the boy's mother of the blood test result and said the likely cause of the swelling was an infection. He asked the boy to continue his antibiotic prescription.

The boy's condition did not improve. His father called Dr Yeo on April 1, 2019 to tell him that his son was in severe pain.

Dr Yeo said the boy's condition was serious and asked him to be urgently taken to the emergency room.

The boy went to the hospital where a scrotal ultrasound revealed torsion of the left testicle.

He was admitted to a surgical ward and underwent surgery to remove his left testicle.

THE DEAL COMES TO SMC

The SMC heard that a “reasonable and competent doctor” in Dr Yeo's position would have considered the possibility of intermittent testicular torsion during the consultation on March 27, 2019 and would not have ruled it out as a differential diagnosis without referral to the before sending the patient to a doctor. specialist or a hospital accident and emergency department.

The applicable standard of care is to consider any acute scrotal pain as testicular torsion until proven otherwise.

The boy's father filed a complaint with the SMC around July 2020, alleging that Dr Yeo was negligent in failing to diagnose and eliminate the risk of testicular torsion, leading to the removal of his son's left testicle.

Dr Yeo responded to the SMC notice of complaint and subsequently sent a letter of apology to the patient and his family.

According to the reasons for the decision, the patient's likely early testicular salvage rate would have been estimated at between 90.4 percent and 97.2 percent if Dr Yeo had referred him to a specialist or the accident and emergency department. from a hospital during the consultation on March 27. , 2019.

SMC lawyers Mr Chia Voon Jiet, Ms Lee I-Lin and Ms Chin Dan Ting of Drew & Napier said Dr Yeo's misconduct delayed the patient's diagnosis and treatment, so that he had lost an important chance to save his left testicle.

The boy suffered not only physical pain, but also emotional and psychological distress following this loss.

The potential harm to the boy also includes fertility problems due to the loss of a testicle, SMC lawyers said.

Dr Yeo, represented by Mr Christopher Chong and Ms Sharon Liu of Dentons Rodyk & Davidson, said he was “deeply saddened” by the patient's plight.

He accepted he should be penalized for failing to refer the boy to an accident and emergency department on March 27, 2019.

However, he said an urgent referral would not have guaranteed the testicle would be retrieved.

The SMC lawyer argued that Dr Yeo acted negligently and his treatment of the patient did not constitute an appropriate management option.

“Although the patient is at risk for testicular torsion and his clinical presentation and age suggest testicular torsion, (Dr. Yeo) simply treated the patient with antibiotics, performed laboratory tests and “making the decision to refer only if the patient was at risk of testicular torsion” the pain and swelling persisted after a few days and depending on the results of the complete blood count,” the lawyers explained.

In response, Dr Yeo said he had considered the possibility of testicular torsion, but his preferred preliminary diagnosis was orchitis and epididymitis based on his physical examination of the patient.

Dr Yeo said his failure to inform the boy of the possibility of testicular torsion was “poor judgement”, but added it was “out of good intention as he did not want to unduly alarm the patient”.

He accepted mistakes on his part, but said he had the boy's welfare and best interests in mind, without suggesting he was acting maliciously or recklessly.

In addition to the 12-month suspension, Dr Yeo will also be censured. He will be required to submit a written undertaking to SMC that he will no longer engage in this or any similar conduct, and he will be required to pay the costs and expenses of the proceedings, including costs incurred by SMC's attorneys.