On 28 August 2010, the Claimant (C) was admitted to a hospital of the Defendant trust (D) complaining of pain in his right testicle. He underwent a testicular exploration and the doctor diagnosed that he had an infection. He prescribed antibiotics and C made a good recovery.
On 9 January 2011, at 7pm C presented at the A&E department of D with severe left testicular pain which had started at 6.15pm. The medical notes record that the left testicle was firm and tender. The A&E doctor thought that there was a possibility that C might have a testicular torsion and referred him to a Specialist Registrar for a surgical opinion.
C was examined again by the Registrar who concluded that he thought C was suffering from an infection and not a torsion, however he said he could only be 100 per cent sure by performing exploratory surgery, and he did not want C to undergo such unnecessary surgery. Instead he prescribed pain relief and discharged him home.
Prior to leaving the hospital, C complained of such severe pain, he was given morphine for further relief of his symptoms.
At home C continued to have severe pain in his left testis which rendered him virtually immobile over the course of the next few days and this grew in intensity.
At 11.20am on 13 January, C returned to hospital. By that stage he was noted to have a fever and his left testicle was grossly enlarged, red and tender.
An urgent ultrasound scan was performed and this showed that C did in fact have a testicular torsion. What is more, the scan showed that there was no blood flow to the testicle at that time. C underwent immediate surgery and the left testicle had to be removed. During the operation C had the right testis fixed in place to prevent any further torsion occurring.
As a result of the misdiagnosis, C underwent a removal of the left testicle, which left him with a significant cosmetic defect and the possibility of impaired fertility.
The legal case
A testicular torsion is a medical emergency. It is a twisting of the spermatic cord, which cuts off the blood supply to the testicle. Surgery is usually required to remedy the problem and should be performed as soon as possible after symptoms begin. Usually, if surgery is performed within 6 hours, most testicles can be saved.
C brought a claim against D alleging that it was negligent in (i) failing to fix the testis in August 2010; (ii) failing to perform proper investigations, including a testicular exploration on 9 January 2011.
C alleged that on 28 August 2010 there was little, if any, clinical indication that he had an infection. He was not sexually active and that should have indicated that there was little risk of infection. The hospital should have done further explorations and fixed the testis on both sides at that time, which would have prevented any further episodes of torsion.
C further alleged that when he presented on 9 January 2011 with a sudden onset of pain with acute swelling that should have indicated torsion. Further investigations should have been undertaken to check whether the testis was torted or not, including an ultrasound to look at the blood supply. A urine test should also have been done to check for infection. It was not appropriate to discharge C without having made a proper diagnosis. Additionally, if an exploration had been carried out on 9 January, the testis would have been untwisted, somewhere between two and six hours post torsion, which would in all probability have saved the testis. It would have then been fixed to prevent a further occurrence.
Liability was admitted by the Defendant and an out of Court settlement in the sum of £12,000 was agreed.
The case was settled on a global basis with no particular breakdown of damages. However, General Damages for the pain, suffering and loss of amenity were estimated at £10,000.