Boy loses testicle after delayed diagnosis

A 15-year-old boy had to have a testicle removed after an exhausted rural doctor took 12 hours to diagnose his condition.

The doctor, who had worked 60 hours in the previous three days, was found to have breached the code of health consumer's rights in a report released this week by the Health and Disability Commission.

Commissioner Ron Paterson also criticised the district health board for allowing doctors in rural hospitals to be overworked.

The boy was taken to hospital by ambulance in the middle of the night on May 5, 2003 after telling his mother he felt like he was being "kicked in the balls".

The ambulance officer examined him and said his testicle was swollen and possibly twisted, a condition known as testicular torsion.

Unless surgery is carried out within eight hours of the onset of symptoms, the testicle "dies" from lack of blood circulation.

When the nurse at the rural hospital contacted the on-call doctor, he was asleep, having worked 60 hours in the past three days because of a shortage of doctors.

He advised her to give the boy pain relief and he would examine him in the morning.

The nurse told the inquiry she mentioned the possibility of testicular torsion, but the doctor said he did not remember this.

Nurses told the inquiry most doctors at the hospital refused to attend patients during the night but Dr B was usually very conscientious.

He saw the patient at 7am but did not examine his groin.

He was about to discharge him when the teen told his mother he still felt pain in his testicle.

Dr B then examined it and noticed it was swollen.

He advised the boy's mother to drive him to the city hospital, but did not tell her how urgent it was.

They arrived at the hospital at 5pm but by then the testicle had died and was removed at 7pm.

The boy's mother, whose claim for medical error was accepted by ACC in December 2003, complained to the commissioner about the care he received from the rural nurse and Dr B.

Mr Paterson found Dr B had breached the patient's rights by failing to properly examine him.

The nurse, who has since left acute care, was not found to have breached the code because it could not be proven whether she had informed the doctor about the possibility of testicular torsion or the existence of ambulance notes.

However, Mr Paterson also held the district health board responsible for allowing a culture of patients waiting to be assessed by a doctor to develop and continue.

The nurse and doctor both apologised to the family.

In a letter to the boy and his family, Dr B said he had a "deep sense of remorse and regret".

"A day has not passed without several thoughts about that day, ... and wishing I had done things differently."

The hospital has since reviewed its systems.

- NZPA