Doctor suspended after teenager loses testicle due to misdiagnosis

SINGAPORE: An experienced doctor has been suspended for one year by the Singapore Medical Council (SMC) for professional misconduct after a teenage patient lost his testicle due to misdiagnosis in 2019.

Dr. Yeo Khee Hong, a doctor for around 42 years, initially diagnosed the teenager with abdominal colic and later swelling and inflammation in the testicles and prescribed stomach medication and antibiotics.

Despite repeated visits to Dr. Yeo, the boy’s condition continued to deteriorate until he finally had to undergo surgery to remove his testicle. His real problem was testicular torsion – a condition in which the spermatic cord that supplies blood to the testicle twists and cuts off blood supply.

Had the boy been referred for emergency care in time, he would have had an estimated 90.4 to 97.2 percent chance of saving his testicles, according to the verdict published on Monday (May 27).

THE CASE

Dr. Yeo pleaded guilty to one count of professional misconduct for failing to provide competent and appropriate care or to exercise due care in the treatment of his patient.

A second charge, namely inadequate information for the patient, was taken into account in sentencing.

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

He told Dr. Yeo that he felt pain in the left side of his abdomen originating from his left testicle.

He also had increased bowel movements with watery stools.

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

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

Five days later, the boy consulted Dr. Yeo again and said he had swelling and pain in his left testicle, which felt worse when sitting or walking.

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 the boy antibiotics 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 this out and considered orchitis and epididymitis more likely.

Dr. Yeo also did not refer the boy to a specialist or to a hospital emergency room 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 that the boy continue to be prescribed antibiotics.

The boy’s condition did not improve. His father called Dr. Yeo on April 1, 2019, saying his son was in severe pain.

Dr Yeo said the boy’s condition was serious and called for him to be taken to the emergency room urgently.

The boy went to the hospital, where an ultrasound scan of the scrotum revealed torsion of the left testicle.

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

Case comes to SMC

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

The current standard of care is to consider all acute testicular pain as testicular torsion until proven otherwise.

The boy’s father filed a complaint with the SMC around July 2020, claiming that Dr Yeo was negligent in failing to diagnose and rule out the risk of testicular torsion, which led to the removal of his son’s left testicle.

Dr Yeo responded to the SMC’s complaint and later sent a letter of apology to the patient and his family.

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

SMC’s legal advisers Mr Chia Voon Jiet, Ms Lee I-Lin and Ms Chin Dan Ting of Drew & Napier said Dr Yeo’s misconduct had delayed the patient’s diagnosis and treatment to such an extent that he lost a significant opportunity to save his left testicle.

The boy suffered not only physical pain from the loss, but also emotional and psychological stress.

The possible harm to the boy also includes the possibility of him becoming infertile due to the loss of a testicle, SMC’s lawyers said.

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

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

However, he said that an urgent referral would not have guaranteed that the testicle could be saved.

Counsel for the SMC argued that Dr Yeo was negligent and that his treatment of the patient was not an appropriate treatment option.

“Although the patient was at risk of testicular torsion and his clinical presentation and age were consistent with testicular torsion, (Dr Yeo) was content to treat the patient with antibiotics, conduct laboratory tests and ‘make the decision to refer only when the pain and swelling persisted after a few days and dependent on the results of the complete blood count,'” the lawyers said.

Dr. Yeo replied that he had considered the possibility of testicular torsion, but based on the patient’s physical examination, he preferred a provisional diagnosis: orchitis and epididymitis.

Dr Yeo said his failure to inform the boy of the possibility of testicular torsion was “a misjudgment”, but added it was “done with good intentions as he did not want to cause unnecessary distress to the patient”.

While he acknowledged failings on his part, he said he had the boy’s welfare and interests at heart and there was no evidence that he had acted maliciously or recklessly.

In addition to the 12-month suspension, Dr Yeo will also be reprimanded, required to provide the SMC with a written undertaking that he will not repeat the same or similar conduct, and will be required to pay the costs and expenses of the proceedings, including the SMC’s attorneys’ fees.