High on hysterectomies: Losing wombs to medical malpractice

Four Karnataka hospitals have been suspended for performing the procedure unnecessarily, often on poor young women

February 25, 2017 10:30 pm | Updated March 01, 2017 01:27 pm IST - KALABURAGI/HASSAN

Pinku Bai at her small tin-shed at Belamagi Tanda in Kalaburagi district.

Pinku Bai at her small tin-shed at Belamagi Tanda in Kalaburagi district.

An unusually large number of hysterectomies performed in Kalaburagi district of Karnataka has led to a State government probe, and an order suspending the licenses of four hospitals.

During a 30-month period, the four institutions are said to have removed the uterus of women, often without medical justification and allegedly for entirely commercial reasons.

A spate of complaints prompted the State government to form an expert committee, headed by A. Ramachandra Bairy in October 2015.

Its investigation found that 2,258 hysterectomy procedures were done in 30 months in Kalaburagi district.

The four hospitals at the centre of the probe — Girish Noola Surgical & Maternity Hospital, Basava Hospital, L.M Care Hospital, and Sudha Memorial Smruti Maternity & Surgical Nursing Home — were probed for alleged violation of various provisions of the Karnataka Private Medical Establishments Act (KPME) 2007 and Rules, 2009.

Based on the inquiry, Deputy Commissioner Ujjwal Kumar Ghosh suspended the licences of Noola hospital in November 2016, and the other three hospitals on January 10, 2017, for six months. Mr. Ghosh wrote to the Karnataka Medical Council (KMC) on January 23, 2017, recommending disciplinary action against Dr. Girish Noola and Dr. Smita Noola, who conducted over 600 hysterectomies in two years, in alleged violation of law and professional ethics. The KMC has yet to take a call on this.

Young women

The surgeries have left young mothers in Belamagi Lambani tanda of Aland taluk in Kalaburagi district, in rural Karnataka in a daze.

Pinku Bai married at 13, had three children by 19, and underwent a hysterectomy at 24 because her doctor warned her of “serious health complications due to a swollen uterus”. Severe abdominal pain and vaginal discharge had prompted her to seek medical help.

With the dire warning of the “Big C leading to death” ringing in her ears, she underwent a hysterectomy in November 2014, paying ₹30,000 with money borrowed from relatives. Today, wiping away tears, Pinku Bai says, “I agreed to the surgery as I kept thinking, what would happen to my children if I were to die?” But the procedure did not end her difficulties. She developed severe backache, weakness, prolonged tiredness, chest pain, and partial vision loss.

Many young women of the Lambani community and the Golla community went under the knife. Illiteracy, poverty and unethical doctors ‘making a fast buck’ have pushed the Pinku Bais to undergo unnecessary hysterectomies, health activists say.

In Arsikere and Kadur taluks, Chitradurga, Davangere and Tumakuru districts, in Chincholi, Aland, Chittapur and Jevargi taluks of Kalaburagi, Yadgir and Raichur districts, there are many stories of women approaching gynaecologists with complaints of bleeding, nagging abdominal pain, or a simple urinary tract infection, only to return home without a uterus.

Omkaramma, 30, of Kolagunda gollarahatti in Hassan, had a hysterectomy four years ago after just one consultation. She was ready to do anything to get rid of the excruciating pain. Three other women from the same village were operated upon the same day. One of them died three months later.

Lalitha Bai’s medical examination pointed to a urinary tract infection. “Noola Hospital in Kalaburagi told me I would die soon, and convinced me to have a hysterectomy. I was operated upon even though we had no money. But I was discharged only after we paid ₹ 25,000,” she recalled. Post-surgery, her infection persists and she spends hard-earned money buying drinking water, hoping it would help.

In most cases, the hysterectomies were performed without a prior medical examination, save for a sonography, the government inquiry committee found.

Karnataka Janarogya Chalavali (KJC), a group of public health activists, took up the issue in 2015.

KJC activists and victims allege that the doctors identified by the probe are continuing with unwarranted hysterectomies. They demand the cancellation of the registration of the doctors and booking of criminal cases against them. They are also demanding suitable compensation for the victims.

More evidence unearthed

A survey of 35 tandas (habitations) done by the KJC claims the ratio of households to hysterectomies is high. In Ambalaga tanda, Kalaburagi, it was 55 households to 15 hysterectomies; in Ajjanahalli, Hassan district, it was 40:13; at V.K. Salagar tanda it was 40:25; and in Belamagi tanda, 80:25.

A Health Department survey in 2015 found 371 cases in the gollarahattis (hamlets) in Arsikere taluk, Hassan district.

Teena Xavier, a KJC health activist, said the hospitals capitalise on the ignorance of the women. Umarga in Osmanabad district in Maharashtra, has also emerged as a ‘hysterectomy hub’ and gets patients from border villages in Kalaburagi district.

On why the health issue has snowballed, Roopa Hassan, writer and social activist said: “It’s largely due to unhygienic customs that women are forced to adopt in the gollarahattis. During menstruation, they have to stay away from their homes, in a shelter which is not clean. Many find hysterectomy a relief from this monthly ordeal. Doctors capitalise on this. Those who performed hysterectomy for flimsy reasons actually violated the sexual and reproductive health rights of women. I have spoken to many women and none had a biopsy or pap smear done before having the uterus removed.”

Concurring with this, R. Venkatesh, a gynaecologist and District Health Officer in Hassan, says, “Hysterectomy should be done as the last option when all other medications fail to control abnormal bleeding, infection, and fibroids, and that too after conducting a biopsy, pap smear, and other examinations.”

Another inquiry committee constituted by the Karnataka State Commission for Women in September 2015, headed by social activist K. Neela, investigated the issue in Kalaburagi district and submitted a 105-page report in April 2016. “We have provided sufficient and solid evidence to prosecute the doctors and hospitals involved. Yet, no action has been taken,” she says.

The expert committee constituted by the State Health Department headed by T.R. Sudha found that Dr. Dayanand, a government doctor at Biruru Community Health Centre in Chikkamagaluru, conducted 1,428 “unnecessary hysterectomies” at a private establishment between 2012 and 2014. More than 40% of the women who underwent the surgery were below the age of 35. A CID inquiry is under way even after two years. The only action taken up was the transfer of the doctor from Birur to Davangere.

The hospitals in question dismiss the allegations. “We never performed unwarranted hysterectomies on innocent people. On the contrary, people who were afraid of cancer themselves forced us to conduct the surgery despite our advice against it. We used to give medicines for their ailments and advise them to wait for 3-4 months. When they were persistent, we had to perform the surgery,” Dr. Sambashivarao, Managing Director, Sudha Memorial Smruti Maternity & Surgical Nursing Home told The Hindu .

No hysterectomy was done at his hospital during the past 11 months. After his hospital’s registration was cancelled, he got a new registration under the name of Sudha Memorial Smruti General & Surgical Nursing Home. “I am deeply hurt at being defamed. This is the gift that I am honoured with, at the age of 75, for serving the people for 48 years. I won’t approach the court. If I am given four months, I will just wind up the hospital and leave the city forever,” he added.

Dr. Smita Noola, who has moved the Karnataka High Court against the Deputy Commissioner’s order suspending the registration of her hospital, refused to comment.

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