Doctor accused of rape: Medical experts give conflicting interpretations of erectile dysfunction report

SINGAPORE — A vascular surgeon who found a general practitioner on trial for rape to be suffering from erectile dysfunction told the High Court on Friday (Oct 19) that he was surprised that the findings of a first test on Jan 13, 2016 had shown otherwise.

That test on Jan 13, 2016, showed that Wee Teong Boo, accused of raping a 23-year-old patient in his clinic, had normal readings for an erection — save for varicocele, or leaks in the veins that deliver blood to the testicles.

This, defence witness Dr Sriram Narayanan said, "didn't fit" with a test he conducted on June 7 this year.

"I find it strange (that the first report) looks like (the results of) a normal 16-year-old who has got varicocele. But Dr Wee is in his 60s," said Dr Narayanan, who saw the result of the 2016 test only after he conducted the test on Wee in June.

But a prosecution witness who conducted a separate test in April 2016 told the court on Friday he did not find the January 2016 test result surprising.

Wee, then 64, is accused of raping a 23-year-old patient in his clinic in Bedok on Dec 30, 2015. He was referred to Dr Narayanan by his urologist, Dr Peter Lim, on June 7 after the findings of two erectile dysfunction tests in January 2016 and April 2016 contradicted each other. 

Dr Lim, who testified on Thursday as a defence witness, had ordered the first test which was done at Asia HealthPartners, a health screening firm.

The second was done at Changi General Hospital at the request of the police investigating the rape case.

The court heard on Thursday that Wee had gone to see Dr Lim on Jan 5, 2016, to complain of erectile dysfunction and difficulty in passing urine for the past three years.

He also had a medical history of diabetes and high blood pressure.

Wee told Dr Lim that he had never used any medication such as Viagra or Cialis to treat his erectile dysfunction.

The third erectile dysfunction test by Dr Narayanan, which is an objective test using a machine unlike the previous two conducted by radiologists, confirmed that Wee had erectile dysfunction and the lowest Erection Hardness Score of 1.

This indicates a penis that is larger but not hard. The highest score of 4 means full hardness and rigidity.

“The first test was an absolutely normal result, which doesn’t fit in with everything else (Wee's medical history of diabetes and high blood pressure). I don’t know how to explain that,” said Dr Narayanan, who is also an adjunct assistant professor at the National University of Singapore's Yong Loo Lin School of Medicine.

Describing the first test result as "pristine", Dr Narayanan added: “I wish I have that kind of results when I am 64 (years old).”

Prosecution witness Dr Teo Jin Kiat however testified that it was not surprising for the first test result to be “pristine”.

When Dr Teo, who conducted the second test in April 2016 at the request of the police, was asked why by Justice Chua Lee Ming, the consultant urologist at Changi General Hospital said: "To me, it’s (a matter of) why not?"

"I assume that all tests are properly administered," Dr Teo added, although he noted that any error in any test depends on the radiologist administering it.

Dr Teo’s test of Wee in April 2016 had found that he had erectile dysfunction.

When asked by Deputy Public Prosecutor (DPP) Wong Kok Weng to explain the possible reasons for the discrepancies between the Jan 2016 and April 2016 tests, Dr Teo said there could be an operator error, and that “no two ultrasounds (results) can be the same”.

DPP Wong proceeded to ask Dr Teo which test — Jan 2016 or April 2016 — had a higher likelihood of error, to which Dr Teo said that if there was an error, the test values would be lower and not higher.  A lower reading would indicate erectile dysfunction.

When asked why an error in administering the test would result in a lower reading, rather than higher, Dr Teo said: "If (a vein is) diseased, it should be of a lower value, no matter (how the test probe was angled)."

"The January 2016 report is reliable and correct because it shows a higher reading?" DPP Wong asked Dr Teo, before Justice Chua reminded him that the latter has never conducted such a test, which was administered by a radiologist.

Dr Narayanan, who was similarly asked about the discrepancies between the findings from the first and second report, said: "Given all I know, the April report seems far more in tune with (Wee's) actual condition."

He added that it was "unlikely" for someone with a normal erection in 2016 to degenerate so quickly in two years.

"For someone to (degenerate) so quickly, it is possible if he has spine surgery, trauma, cancer, or something that damages the nerves. If it is a chronic disease, I expect (it to be progressive)," he added.

Wee's case will be heard again on Oct 23.