Misdiagnosed emergency: Doctor's appeal is denied in the case of teen patient who lost his only testicle

A Quebec doctor whose 14-year-old patient lost the only testicle he had two days after coming in with complaints of sudden, intense pain has lost his appeal to reverse a four-month suspension imposed on him by the Collège des médecins du Québec. Dr. Cristian Lucian Budeci, a Montreal family doctor, argued during the appeal hearing that the physical examination he conducted during the patient’s initial visit in August 2016 did not allow him to diagnose the patient correctly with testicular torsion. He also told the college’s discipline tribunal that the patient was calm and smiling during his initial appointment. The patient, who was born with only one testicle, is now sterile. Dr. Budeci, who told the tribunal he had never before encountered a case of testicular torsion, diagnosed the patient as having orchiepididymitis and prescribed an antibiotic, Tylenol and Advil. He asked the patient to come back in two days and recommended he go for an ultrasound and a consultation with a urologist, both of which he considered non-urgent at the time, according to the tribunal’s decision document. Read: 'Disproportionate, unfair' and speculative: Professions tribunal overturns college ruling When the patient returned two days later, it was apparent that his condition had worsened. Dr. Budeci sent him to emergency, where he was found to have diffuse and severe hemorrhagic necrosis and sent in for emergency surgery to remove his testicle. While the patient—the son of Syrian refugees—had poor command of French and English, the tribunal noted that the difficulties in communicating with him and his parents did not hinder Dr. Budeci from ascertaining that he was suffering from pain, which Dr. Budeci described in his notes as being sudden in varying in intensity. An expert witness for the college testified during the hearing that, given the circumstances of the initial appointment, Dr. Budeci erred in concluding that the patient had orchiepididymitis. He should have worked to rule out the possibility of testicular torsion and transferred the patient immediately to a specialist in urology. Read: Expelled twice, revoked this time: Montreal doctor lied about getting kicked out from two U.S universities A question that was raised during the hearing was whether a correct diagnosis and immediate referral to a urologist would have saved the patient’s testicle. The expert witness cited scientific literature that points to a low- to nil save rate if an untreated testicle is not addressed appropriately within 24 hours. However the witness could not comment on the viability of the patient’s testicle when he first came in to see Dr. Budeci. Read: Neurosurgeon gets two-month suspension for not doing five-minute brain drainage check

Misdiagnosed emergency: Doctor's appeal is denied in the case of teen patient who lost his only testicle

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