Allegation:
Plaintiff Alleged Failure to Diagnose Testicular Torsion.
The Case:
A 13 YOM (5’4”, 120 lbs.), who was vacationing with a friend and their family, presented to an urgent care in the late afternoon complaining of left testicular pain rated 10/10. The pain began spontaneously, approximately one hour prior to arrival, and without reported trauma. The patient was not experiencing a fever, penile discharge, or erythema. He was not sexually active. There was no other significant medical history.
Vital signs were stable except for a slightly elevated blood pressure of 139/90. The patient reported episodes of nausea and vomiting after arrival at the urgent care. The defendant family medicine physician testified he ordered a urinalysis, but stated that the patient was unable to urinate. The urinalysis order, however, was not supported by documentation. An ultrasound was not available at the urgent care center.
The physical exam by the defendant family medicine physician revealed moderate swelling and tenderness of the left epididymis, with mild testicular swelling and tenderness, but without apparent torsion. The resulting diagnosis was left epididymitis. Treatment included a Rocephin® injection and Motrin® 600 mg. The pain resolved approximately 90 minutes after the administration of medication. The defendant physician spoke with the patient’s parents by phone, and discussed his assessment and treatment. He recommended immediate re-evaluation at an ED for recurrent, significant scrotal pain. However, in deposition testimony, the patient’s parents disputed this instruction took place. The patient was discharged with prescriptions for doxycycline and Motrin, scrotal elevation, and rest for 24 hours.
The patient returned to his home that evening, and awoke in the morning with pain at a level of 7/10. The patient was seen by an urologist later that day. During the appointment, he stated the pain was better but that swelling persisted. He did not have urinary problems or fever. An ultrasound was performed with normal right testis measuring 2.9 x 2.2 x 2.8 cm, and an enlarged, edematous left testis measuring 4.4 x 3.0 x 2.7 cm. Some venous spectral flow was evident, but there appeared to be no color flow or arterial spectral flow. Hydrocele was not identified and the epididymis was unremarkable. The impression was the left testis showed no flow consistent with torsion.
The urologist recommended same day left scrotal exploration, which revealed a necrotic and torsed left testicle. Although the degree of torsion was not documented, a left orchiectomy and right orchiopexy were performed. Post-procedure, the patient was transferred to the PACU in stable condition. Pathology confirmed a left hemorrhagic testicle consistent with torsion. Recovery was uneventful with the patient presenting for two scheduled follow-up visits.
More than a year later, the patient returned to the urologist with complaints of intermittent mild right flank pain and upper lumbar pain. The urologist scheduled an ultrasound but the patient did not return for the procedure. No further healthcare visits were noted for the patient.
The plaintiff alleged a failure to diagnose testicular torsion, resulting in him losing his left testicle, and having pain and suffering, embarrassment, humiliation, and mental anguish. The plaintiff’s family medicine expert testified the standard of care based on the plaintiff’s presenting symptoms required the defendant physician to refer the plaintiff for an ultrasound and urology evaluation. The plaintiff’s expert stated there was a high index for suspicion of torsion; the referral should have been made despite the plaintiff’s decrease in pain prior to discharge from the urgent care.
The defense expert disagreed and testified that the defendant family medicine physician performed a comprehensive physical exam, including a visual inspection, palpation, a cremasteric reflex test, and manual testicle examination including the epididymis and spermatic cord. The defense expert further noted the pain and tenderness was specific to the epididymitis, resulting in the diagnosis and the appropriate treatment plan.
The defendant family medicine physician believed the care provided was appropriate and wanted to defend his care. At the conclusion of a jury trial, a verdict was rendered in favor of the defense.
Verdict:
The defendant family medicine physician’s comprehensive documentation of his assessment, treatment plan, and the phone conversation with the patient’s parents were valuable to the successful defense against the plaintiff’s claims.
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