On September 19, 2003, Leelamma Joseph underwent a botched hysterectomy that would forever alter the course of her life, pushing her down a torrid path of several more exhausting surgeries and medical procedures, unending health issues, and piling medical bills running into lakhs of rupees. She spent one and a half years of her life within the confines of her room, Leelamma tells TNM, needing diapers and a rubber sheet to cope with the loss of her urinary bladder control. “It was impossible for me to walk, urine was flowing down my body all the time,” she says. She also needed massive doses of antibiotics over the next few years to combat various infections, the prolonged use of which led to complications that persist even today, 20 years down the lane, she adds.
But despite the intense mental and physical agony that spanned two decades, the 67-year-old is yet to receive her due compensation, or even accountability, from the GG Hospital in Thiruvananthapuram, and the gynaecologist who wronged her. “It has been 20 years since the initial surgery, and 18 years since we first filed a complaint. In 2013, the Kerala State Consumer Disputes Redressal Commission (KSCDRC) ruled in our favour, and in May this year, the National Consumer Disputes Redressal Commission (NCDRC) too upheld that judgement in toto. But the doctor is still attempting to delay justice to my wife,” Leelamma’s husband J Joseph tells TNM. According to their advocate Reghukumar S, the accused gynaecologist Dr Valsamma Chacko has now obtained a Kerala High Court order, allowing a conditional stay on the payment of the compensation that the KSCDRC had ordered her to pay the couple.
The KSCDRC judgement, dated February 22, 2013, had stated that Dr Valsamma and the GG Hospital were liable to pay a sum of Rs 22 lakh to Leelamma as compensation for the “negligence and deficiency” in their service, as well as the cost of the treatment. As per the order, this amount was supposed to be paid within a period of two months from the date of its receipt, failing which they are also liable to pay an interest of 12% per annum from the date of complaint (September 1, 2005) till the date of payment. As of June this year, the amount has grown to a total of more than Rs 70 lakh. The order said the complainant is also entitled to receive from the doctor and the hospital an additional sum of Rs 20,000, towards the cost of the proceedings before the Commission.
Dr Valsamma subsequently moved the NCDRC with an appeal. In March 2023, another 10 years after the judgement, the NCDRC upheld the State Commission order in its entirety. “Now the doctor has approached the Kerala High Court and obtained a stay. It seems the aim is to simply delay the payment for as long as possible,” says Leelamma.
It was August 2003 when Leelamma was first informed that she might soon need to undergo a hysterectomy — a surgical procedure to remove all or a part of the uterus. While in Mumbai, where she and her husband Joseph were staying at the time, she had approached Dr Sreelata Gupta due to severe menstrual pain, when the doctor informed her that her scans indicated the existence of a precancerous condition. The doctor suggested taking a second opinion, for which the couple met a senior gynaecologist in Andheri, Dr SD Shinde, who agreed with Dr Sreelata’s opinion after a series of tests.
“Dr Shinde told us that I was in need of an immediate hysterectomy and that it had to be an open surgery because my ovaries, fallopian tubes, and a portion of the vagina too would have to be removed. Besides, there was a possibility that areas of my uterus might show clearer indication of the condition suggested earlier, and a proper visual examination by an experienced surgeon would be invaluable since they would be able to determine if any specific area needed further tests,” says Leelamma. Dr Shinde also gave them a referral letter, she adds, which he explained was unambiguous about an open surgery, especially since there was a chance that difficulties could arise during the hysterectomy.
So they decided to go to Thiruvananthapuram for the surgery, in the hope that she would get better postoperative rest at her husband’s house. “After many enquiries, we met Dr Valsamma Chacko, who had recently retired from the local government medical college as head of the Department of Gynecology,” says Leelamma.
“During the initial consultation itself, at the GG Hospital, Dr Valsamma agreed with the referral opinions and scheduled the open hysterectomy within a couple of days. She said that based even solely on the available reports, an immediate hysterectomy was imperative. When I mentioned that laparoscopy (keyhole surgery) had been ruled out by Dr Shinde, she gave me very detailed explanations about why an open abdominal surgery had been advised in my case,” Leelamma recalls. Incidentally, Dr Valsamma would later claim before the Consumer Commission that the patient was “adamant” about having the surgery, which the doctor herself thought was not required. As per the KSCDRC judgement, the doctor deposed at the consumer forum that she had told Leelamma she needed only a cone-biopsy, conservative management, and follow-up treatment, which Leelamma denies was the case.
Records show that the physician, to whom Leelamma was sent for the routine pre-surgery clearance, had also issued a clearance for an open hysterectomy, says Adv Reghukumar. Yet, at the operation theatre, Dr Valsamma conducted a Laparoscopically Assisted Vaginal Hysterectomy (LAVH) — which is a keyhole surgery — without the informed consent of the patient or her husband, he adds.
When the expected difficulties arose, the gynaecologist attempted a second repair surgery, again by laparoscopy, which led to further complications. “In our subsequent discussions with doctors, we were told that it is accepted standard practice to proceed with opening up the abdomen for repair surgery, if there were complications in the keyhole surgery. But she went for a laparoscopic surgery the second time as well,” Joseph tells TNM.
Leelamma and Joseph later learnt that during the course of the first and second laparoscopic surgeries, a few small tears were caused – one tear of about 3 inches x 3 inches in Leelamma’s urinary bladder, which is an organ of about five inches in size. Both ureters had been torn out of the bladder, which had to be later repositioned with mechanical stents inside.
“Available records show that the entire urinary system was entrapped in sutures, leaving the outward flow of urine impossible. Even so, a drug to stimulate the production of urine (Lasix) was administered to her multiple times in the next few hours. Urine accumulated within the body as a result and would have resulted in her death due to uric acid poisoning. Only god’s grace saved her from this terrible situation,” Joseph says.
After Dr Valsamma’s second attempt at a reparative laparoscopic surgery, a urologist — Dr Sasikumar — was called in. He recorded that on opening up the abdomen for a third surgery on the same day, he saw that he was unable to do anything. “Yet, at various points during the course of the legal proceedings, the gynaecologist has attempted to establish that the internal damage had been caused by the urologist,” Adv Reghukumar says.
Dr Sasikumar tells TNM that after the hospital called him to help with the surgery, Dr Valsamma told him that she didn’t require his aid, as she had already done all the necessary repairs. So he came out after simply putting a tube inside the patient to monitor the urine output, for which he had to open her up, he says. “What (Dr Valsamma) was trying to establish later was that in spite of my coming (to the operation theatre), I did not do a proper repair. But the truth is that she did not let me do anything, stating that this was her patient. When she later got into trouble, she instead tried to shirk responsibility,” he says.
Leelamma was subsequently shifted to the Kerala Institute of Medical Sciences (KIMS) in Thiruvananthapuram, where she was subjected to another seven-hour surgery, the fourth one in 24 hours. In the surgery led by Dr Vikraman, the stitches binding her abdomen were cut open again. About three litres of urine was recorded as having accumulated in her body by then, as against a person’s normal urine accumulation of about 700 ml. Massive repairs and subsequent suturing of the delicate urinary bladder were required.
“A doctor whom we later consulted told us that I owed my life to the expertise of Dr Vikraman, who did a wonderful job in an extraordinarily challenging situation,” Leelamma says.
But unfortunately, the sutures from the fourth surgery failed to hold and broke away in a few days, resulting in a total absence of her urinary bladder functions. “From the end of September 2003 till the end of January 2004, I had to almost entirely be confined to a single room, lying in bed on a rubber sheet, with a single cotton cloth covering me. Every drop of urine produced in my body was flowing out then and there, totally unchecked and unhindered, all through the day and night,” she says.
Four further surgeries in Mumbai and Chennai were required over the next one and a half years to repair the damage caused to Leelamma’s bladder, Joseph says. “Instead of spending a few days in one hospital following an open hysterectomy, Leelamma became an inpatient for about 140 days in many hospitals due to the negligence in the first surgery. She had to be subjected to deep anaesthesia about 15 times during the course of various surgeries, cystoscopies, and other procedures, and also undergo many rounds of X-rays in the years that followed,” he says.
“In 2006, during one of her checkups in Chennai, a set of suspected cancerous growths were discovered in her urinary bladder, which was not present previously. The growth was surgically removed in the eighth surgery and was confirmed to be non-cancerous only after the tissues were examined first in Chennai, then in Mumbai and finally, for the third time in the USA,” says Joseph.
In late 2009, as a direct result of prolonged usage of antibiotics, she was diagnosed with Interstitial lung disease and an erratic heart rhythm, and she had to avail the additional supervision of a pulmonologist for the newly discovered situation, he adds.
“One doctor’s lack of prudence, gross negligence, and wilful non-disclosure of material facts cost me a lot in life,” Leelamma says. “I approached the court for justice, for compensation for the disruption to my life, that of my husband’s, my two sons, and those near and dear to me. It is for the excruciating mental agony, physical tribulations, and social trauma I have undergone. We have been forced to incur a massive expenditure on my behalf, and there will be more unavoidable expenses in the years to come on account of the medical and physical restrictions that have been imposed upon me. I am seeking compensation not only for what I have lost in my past but also for what I have already lost from my future.”
Leelamma says she is now seeing it as her social duty to bring what happened to her out into the open, so that other victims of medical negligence may not have to travel the same, agonisingly tortuous path.