SINGAPORE: A veteran doctor has been suspended for a year by the Singapore Medical Council (SMC) for professional misconduct, after a misdiagnosis in 2019 resulted in a teenage patient losing his testicle.
Dr Yeo Khee Hong, who has been a registered medical practitioner for about 42 years, first diagnosed the teenager with abdominal colic and later swelling and inflammation in his testicles, prescribing him stomach-related 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 real condition was testicular torsion - a condition where the spermatic cord which provides blood flow to the testicle becomes twisted and cuts off blood supply.
If the boy had been referred for urgent care in time, he had an estimated 90.4 per cent to 97.2 per cent chance of salvaging his testis, according to the grounds of decision on the case, released on Monday (May 27).
THE CASE
Dr Yeo pleaded guilty to one charge of professional misconduct for failing to provide competent and appropriate care and or to exercise due care in the management of his patient.
A second charge of failing to provide adequate information to the patient was taken into consideration for sentencing.
The boy was 15 or 16 when he consulted Dr Yeo at his clinic on Mar 22, 2019.
He told Dr Yeo that he felt pain in his left abdomen that had started from his left testis.
He also had increased bowel movement, 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 testis.
He diagnosed the boy with abdominal colic and prescribed him stomach-related medicine.
Five days later, the boy consulted Dr Yeo again and said he had swelling and pain in his left testis which felt worse when he sat or walked.
Dr Yeo examined the boy, finding his left testis enlarged and tender.
He diagnosed the boy with orchitis and epididymitis - swelling and inflammation - of the left testis. He prescribed antibiotics to the boy and ordered a full blood count and urine test for him to confirm his diagnosis.
However, before arriving at his diagnosis, Dr Yeo did not consider the possibility of intermittent testicular torsion.
He excluded this and considered that orchitis and epididymitis was more probable.
Dr Yeo also did not refer the boy to a specialist or to the accident & emergency department of a hospital before excluding testicular torsion.
The next day, Dr Yeo told the boy's mother about the result of the blood test and said the likely cause of swelling was an infection. He asked that the boy continue his prescription of antibiotics.
The boy's condition did not improve. His father called Dr Yeo on Apr 1, 2019 saying his son was suffering severe pain.
Dr Yeo said the boy's condition was serious and asked him to be taken to an accident & emergency department urgently.
The boy went to a hospital where a scrotal ultrasound revealed left testicular torsion.
He was admitted to a surgical ward and underwent surgery to remove his left testis.
CASE 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 at the consultation on Mar 27, 2019, and would not have excluded it as a differential diagnosis without first referring the patient to a specialist or an accident & emergency department of a hospital.
The applicable standard of care is to consider all acute scrotal pain as testicular torsion until proven otherwise.
The boy's father made a complaint to the SMC around July 2020, alleging that Dr Yeo was negligent in failing to diagnose and eliminate the risk of testicular torsion, resulting in the removal of his son's left testicle.
Dr Yeo responded to the SMC's notice of complaint and later sent an apology letter to the patient and his family.
According to the grounds of decision, the patient's likely early testicular salvage rate would have been an estimated 90.4 per cent to 97.2 per cent if Dr Yeo had referred him to a specialist or the accident & emergency department of a hospital during the consultation on Mar 27, 2019.
Counsel for the SMC, Mr Chia Voon Jiet, Ms Lee I-Lin and Ms Chin Dan Ting from Drew & Napier, said Dr Yeo's misconduct delayed the patient's diagnosis and treatment such that he lost a significant chance of salvaging his left testis.
The boy suffered not only physical pain but emotional and psychological distress from the loss.
The potential harm to the boy also includes fertility issues from losing a testis, said SMC's lawyers.
Dr Yeo, who was represented by Mr Christopher Chong and Ms Sharon Liu from Dentons Rodyk & Davidson, said he was "deeply saddened" by the patient's plight.
He accepted that he ought to be penalised for not referring the boy to an accident & emergency department on Mar 27, 2019.
However, he said an urgent referral would not have guaranteed that the testis would be salvaged.
Counsel for the SMC argued that Dr Yeo had acted negligently and that his treatment of the patient was not an appropriate management option.
"Despite the patient being at risk of testicular torsion and his clinical presentation and age being suggestive of testicular torsion, (Dr Yeo) was content to treat the patient with antibiotics, perform laboratory investigations, and to 'make the decision to refer only if the pain and swelling persisted in a few days and depending on the full blood count test results'," said the lawyers.
In response, Dr Yeo said he had considered the possibility of testicular torsion, but his preferred preliminary diagnosis was orchitis and epididymitis in view of his physical examination of the patient.
Dr Yeo said his failure to inform the boy of the possibility of testicular torsion was "a wrong judgment call", but said it was "out of good intention as he did not want to cause undue alarm to the patient".
He accepted lapses on his part but said he had the boy's well-being and best interests in his mind, with no suggestion he was acting maliciously or recklessly.
On top of the 12-month suspension, Dr Yeo will also be censured. He will have to submit a written undertaking to the SMC that he will not engage in the conduct again or any similar conduct, and he will have to pay the costs and expenses of the proceedings including the costs incurred by SMC's lawyers.
https://www.channelnewsasia.com/singapore/doctor-misdiagnosis-teenage-boy-testicle-suspended-4367751
