A fact-finding report on the death of Anannyah Kumari Alex, a transgender woman in Kerala who is believed to have died by suicide, has alleged gross medical negligence by the private hospital which was providing gender affirmation procedures for her. The report sought better healthcare for trans persons in the state, and for medical professionals to follow international norms on the same. The fact-finding team has also asked for a second post-mortem of Anannyah’s body, and has said that the police investigation into the death was shoddy. The report was released on April 24, 2022 in the presence of Anannyah’s father Alex, who said that despite repeated complaints, the police has been unresponsive on the case.
Anannyah was a 28-year-old makeup artist, radio jockey, and aspiring politician, who was found dead in her apartment in Ernakulam on July 20, 2021. This was just days after she had alleged medical negligence by doctors who operated on her, as part of a gender affirming procedure. The surgery was performed in June 2020 at the Renai Medicity in Kochi. Anannyah in a video interview to The Cue had alleged that the surgery had been botched up by the doctors, and that she was facing multiple health issues because of it, including constant pain. She had been admitted to the hospital multiple times post-surgery for complications arising out of the procedure.
Three days after Anannyah’s death, her partner, 36-year-old Jiju Girija, was also found dead in an apparent suicide in his friend’s house. Jiju had informed the police about Anannyah’s death.
The fact-finding was conducted by the Justice for Anannyah Action Council, an independent body of queer activists and medical professionals including queer affirmative psychologists and doctors. They found that Anannyah was not given adequate mental health support by the medical team involved in her surgery and post-surgical care. Further, the fact-finding team did not find any documentary evidence of pre-surgery mental health support for Anannyah, the report said, adding that she was not adequately informed about the risks associated with the surgery. The report also said the medical team did not provide proper care for post-surgery complications, and alleged hostile treatment by the hospital staff on at least one occasion.
"So many transgender persons have died by suicide or have been murdered before Anannyah, and it will not stop with her either. We want authorities to mark Anannyah's death as one among many such suicides, and to investigate why such incidents are recurring in the transgender community. The community had pointed out several times that the deaths of LGBTQIA+ persons are not being properly investigated. It was in the absence of transparent action by authorities that the action council decided to do a fact-finding investigation,” the report said.
Fifteen transgender persons gave their testimony on their experiences of gender affirmative surgeries, regarding the lack of adequate representation while framing state policies, and the urgent need to revamp protocols of hospitals to ensure equitable healthcare. Doctors including plastic surgeon Arjun Asok, who treated Anannyah, and the team who performed Anannyah’s post-mortem examination refused to give testimonies.
The report documents 18 deaths of LGBTQIA+ persons in Kerala, apart from Anannyah’s, in the period 2018-2022. Thirteen of these deaths were suicides or deaths under suspicious circumstances. During the 2013-2017 period, five deaths were reported and all of them were unnatural.
Noting that most gender affirmation surgeries in the state do not follow the World Professional Association for Transgender Health (WPATH) norms, the report asked the state government to take the initiative to train doctors, psychologists, psychiatrists and social workers by sending them to institutions outside the state which have expertise in such surgeries. The WPATH is an international association which has articulated Standards of Care (SOC) for the health of transgender and gender non-conforming persons.
A trans person who wishes to undergo surgical procedures for gender affirmation has to consult two mental health professionals and get written certificates from them confirming that they are ready for surgery. This is the procedure recommended by WPATH, and is followed across the world for gender affirmation surgeries, including in India, and is done to ensure the well-being of the trans persons, and for holding medical professionals accountable. However, in Anannyah’s case, the fact-finding team said that due process was not followed, and that the surgery may have been rushed. The only evidence of Anannyah meeting a psychologist and endocrinologist was on May 2, 2019, the report said.
The surgery was performed by Dr Arjun Asok of Renai Medicity on June 14, 2020, while the first appointment to decide on the surgery was on May 17, 2020. She was discharged five days after surgery, but had to be readmitted to the hospital the day after her discharge, due to post-surgical complications. On June 28, an additional surgery was performed to fix issues arising out of the first operation. Anannyah was admitted to the same hospital four times and on the fourth time, Anannyah and her friend were manhandled by security officials over a dispute regarding a bill.
The trauma experienced by her after the surgery shows that there were major lapses from the mental health professionals who were part of the GAS team, the report said. As Anannyah's death was alleged to be due to a suicide, which in many occasions results from severe mental health struggles, these lapses are serious, it added.
Anannyah’s father Alex said during the report release that the police failed to properly investigate the circumstances surrounding Anannyah’s death. “The sling bag that she was using when I met her for the last time was missing,” he said, “I searched but I couldn't find the bag. I checked all the bills. Four phones, somebody else’s treatment documents etc. were collected by the police as evidence. After a few days when I was summoned by the police, I asked them about the phones. The official told me to collect them from the court,” Alex said.
“The phone has all the evidence,” he said, “I had told the Assistant Commissioner of Police that the phone contains some crucial evidence. In eight months, I have filed five complaints, but no police official contacted me to inform me of any progress in the investigation. In the video call conducted with the Health Minister, she promised that everything will be probed, but nothing has happened.”
PV Baby, Assistant Commissioner of Police, Thrikkakkara who is in charge of investigating Anannyah’s suicide, said that the phone used by Anannyah is under examination at the Forensic Sciences Laboratory. "It is important to examine Anannyah’s phone to find out if there are any triggers that led to the suicide," he said. "We failed to investigate Anannyah's partner Jiju, who informed us about the death."
The report also said transgender persons lack choices when it comes to hospitals offering gender affirmation procedures. They are often forced to stay silent despite multiple incidents of failed surgeries and procedures. The shortage of facilities for trans healthcare denies them a space to register a protest. “For a trans woman, raising complaints about the failure in gender affirmative surgery adds pressure on her as she would be mocked and humiliated in public," the report said.
The report has recommended legislation for standardising the cost of gender affirmation surgeries in Kerala, extension of financial aid for additional surgeries and formation of an expert panel of doctors to recommend action if medical negligence is identified in the course of treatment.
Mrudula Bhavani is a freelance journalist based in Kerala. She reports on state policies with a focus on gender spectrum, law, public health, caste, and environment.
If you are aware of anyone facing mental health issues or feeling suicidal, please provide help. Here are some helpline numbers of suicide-prevention organisations that can offer emotional suppport to individuals and families.
Tamil Nadu
State health department's suicide helpline: 104
Sneha Suicide Prevention Centre - 044-24640050 (listed as the sole suicide prevention helpline in Tamil Nadu)
Andhra Pradesh
Life Suicide Prevention: 78930 78930
Roshni: 9166202000, 9127848584
Karnataka
Sahai (24-hour): 080 65000111, 080 65000222
Kerala
Maithri: 0484 2540530
Chaithram: 0484 2361161
Both are 24-hour helpline numbers.
Telangana
State government's suicide prevention (tollfree): 104
Roshni: 040 66202000, 6620200
SEVA: 09441778290, 040 27504682 (between 9 amd and 7 pm)
Aasara offers support to inidviduals and families during an emotional crisis, for those dealing with mental health issues and suicidal ideation, and to those undergoing trauma after the suicide of a loved one.
24x7 Helpline: 9820466726
Click here for working helplines across India.