The Cork boy, who was 14 at the time, was rushed to CUH after being ‘bowled over with pain’
Doctor’s desk with stethoscope and laptop (stock)
A Cork teenager had to have surgery to remove one of his testicles after a GP allegedly failed to diagnose a well-known emergency condition relating to a swollen testicle, a medical inquiry has heard.
Dr Alicia Marton Martinez is accused of a series of allegations of professional misconduct and poor professional performance in relation to her treatment of two young patients while she working as a locum GP with SouthDoc – an out-of-hours GP service based in Cork and Kerry – three years ago.
They include that she failed to refer a three-week-old baby with a fever and mottled skin, who was subsequently diagnosed with viral meningitis, to an emergency department.
An expert witness claimed the baby boy might have died but for the persistence of his parents.
Dr Marton Martinez, who qualified as a doctor in Spain in 1988, did not attend the fitness-to-practise inquiry and is not legally represented at the hearing being held by the Medical Council.
The GP gave a voluntary undertaking to the High Court in September 2023 not to practice medicine until further notice after the Medical Council had sought an interim suspension order against her.
She is accused of failing to have adequate regard to the symptoms of both patients as communicated by their parents and failing to directly refer them to an emergency department or escalate their care appropriately.
The mother of the Cork teenager – identified only as Patient A – said her son, who was aged 14 at the time, had complained early on the morning of October 10, 2022 of a swollen testicle and being in a lot of pain and discomfort.
The witness said she had looked up the symptoms on the internet and had packed a bag for hospital because it looked like her son might have a testicular torsion – a medical emergency where the blood flow is cut off to a testicle.
The woman gave evidence of contacting South Doc and receiving a call back about an hour later from Dr Marton Martinez who said her son’s condition was normal for a teenage boy.
The inquiry heard that the locum advised that the boy should place “a cold compress” on his testicle and take Ibuprofen three times daily for a week.
The woman replied that she would prefer if he could be examined by the GP who had seemed “brisk and impatient” on the phone.
She told counsel for the Medical Council, Brian Gageby BL, that she had not mentioned a testicular torsion to Dr Marton Martinez as she did not want to come across as “a Google doctor.”
The inquiry heard that the teenager was examined a short time later at the SouthDoc clinic in Midleton, Co Cork by the locum who repeated her earlier advice.
His mother said the examination only lasted about two minutes but she felt relieved that he did not have a testicular torsion.
The woman said she was outside of Ireland a week later when heard her son had been referred to Cork University Hospital where he had a testicle removed after being “bowled over with pain.”
She accepted that a note by Dr Marton Martinez which recorded “not real pain but discomfort” might be based on what her son had told the locum.
The father of the three-week-old baby – known as Patient B – gave evidence of calling SouthDoc on November 12, 2022 as his son had a fever from the previous night and was very irritable, while also making a lot of grunting noises, feeding slowly and having pale and mottled skin.
The man said they felt his son’s symptoms were worrying.
However, he said Dr Marton Martinez said they did not sound very severe and asked if the baby had been given Calpol.
Patient B’s father said the GP said a baby under two months could be given Calpol, despite him stating a number of times that he did not think that was the case.
He told the inquiry that Dr Marton Martinez accepted that he was correct after she checked the issue out.
The witness said he had lost confidence in her at that stage and asked to be referred to another doctor.
The inquiry heard another GP, Anas Matar, believed the baby’s symptoms were “red flags” and immediately gave them an urgent referral to Cork University Hospital.
Patient B’s father said his son was diagnosed with viral meningitis and had spent several days in hospital.
The man rejected claims by Dr Marton Martinez that he had been aggressive on the phone or that he had suggested his son was nine years old.
In correspondence with the Medical Council, the GP said Patient A did not tell her he was hurting in the genitalia area but did feel “a bit uncomfortable” which she claimed was “a very difficult symptom to interpret or to understand.”
Dr Marton Martinez said she had a “bit of a misunderstanding” about Patient B with the baby’s father as her English was “not perfect.”
The GP said she does not know why but she believed the patient was nine years old instead of nine days old which is why she had asked if the young boy had been given Calpol.
However, she claimed the patient’s father “just went mad.”
Dr Marton Martinez recalled that she got “a bit nervous” after claiming that the boy’s father became “aggressive” and “threatening.”
The GP said he decided after 20 seconds that she was not right or good for his son and had immediately asked to be passed to another doctor.
She went to Dr Matar straight away and he offered to give another opinion after being informed one was being sought by Patient B’s father.
An expert witness, Tom O’Dowd, told the inquiry that there would have been a 90% chance of salvaging Patient A’s testicle if he had been referred to an emergency department by Dr Marton Martinez.
Prof O’Dowd observed that the teenager was left with a life-long disability that was ”entirely preventable.”
He said it was “incompetent practice” by the locum to instruct the teenager to apply a cold compress and take pain relief for a week.
He remarked that the cold compress was likely to have added to the boy’s pain and discomfort.
Prof O’Dowd said there was a serious failure by the GP to meet the standards of competence and knowledge expected of doctors.
He said testicular torsion was one of a few emergencies widely known in general practice.
Prof O’Dowd said every competent GP should assume any male aged 12-25 who had such symptoms has a testicular torsion and refer them immediately to an emergency department or urologist.
He agreed with Mr Gageby that Patient A had symptoms which should “raise alarm bells” and also observed that the locum had been handed the diagnosis “on a plate” by information from the boy’s mother and a triage nurse.
Prof O’Dowd said it was “indefensible” that Dr Marton Martinez had diagnosed the patient as having “orchitis” (a swollen testicle) but had not escalated the care.
In relation to Baby B, he said the baby had alarming symptoms and was “on the verge of circulatory collapse.”
Prof O’Dowd said doctors have to be particularly vigilant with the care of babies and infection because of the risk of things like meningitis.
He claimed Dr Marton Martinez had disgraced the profession and dishonoured the patients in both cases.
The inquiry was adjourned and will resume on Tuesday.
