Maheshwari Chowdhary remembers being in constant pain after undergoing a hernia surgery in November 2017. She was told by her doctors at Hyderabad’s Nizam Institute of Medical Sciences that such acute pain was common after a major surgery. But one night in February 2018, her pain became unbearable. Her husband Harshvardhan, who rushed her to the hospital at 2 am, recalled that she was in extreme distress. It was an abdominal scan that revealed that her pain was caused by the surgical forceps left inside her abdomen by doctors during the hernia procedure.
Maheshwari had to undergo one more surgery – this time to remove the surgical forceps that were pressing against her intestine on the left side of the abdomen. “I was in terrible pain. They gave me painkillers and asked me to rest it out. Little did I know that my misery was an outcome of grave medical negligence,” the 36-year-old told TNM.
Though post-operative symptoms like pain are common in patients for a few weeks, what made Maheshwari’s predicament more traumatic is the lack of investigation into the reason behind her pain, even after she complained about it for almost four months. “We had no idea, it was only after the second surgery that we figured out what had happened,” Harshvardhan said.
Four years later, Maheshwari is still battling severe pain and a relapse of the hernia, for which she has now resorted to home remedies like heat pads because she is tired of constantly taking medication. And her experience is not as uncommon as one may think.
Very often, when news reports about surgical instruments being left inside patients emerge, the instant reaction it prompts is horror. Sometimes, the wildness of the error also elicits a chuckle of disbelief. But what remains undocumented is the excruciating pain, financial drain, never-ending court cases, and deterioration in the quality of life that haunts the victims. The problem is intertwined with legal, medical, and human shortcomings, and affects women more owing to their complex anatomy and gender roles.
If Maheshwari suffered for four months, for Hafsa, the issue remained undiagnosed for four years. A resident of Mangaluru’s Kotekar village, Hafsa was 31 when she was admitted to the Mangalore Nursing Home to remove a uterine fibroid in 2010. It was only later that she realised the doctors had left a pair of surgical forceps inside her abdomen, completely derailing the course of her life. “She was in extreme pain after the surgery because the pointed end of the scissors was poking at her stitch. But at the time we did not know that and the doctors assured us the pain was a routine surgical consequence. They prescribed antibiotics as well as painkillers,” said Hafsa’s brother Moideen.
The instrument was removed from her abdomen only in 2014 at the Unity Health Complex in Mangaluru, but Hafsa passed away in 2016 after suffering multiple complications.
Cases like those of Hafsa and Maheshwari fall under what is broadly called medical negligence, wherein a doctor breached the duty of care towards a patient, causing them injury.
Hafsa’s lawyer Sarfaraz explained how medical negligence laws work in India. “An aggrieved person has two kinds of remedies – invoke Section 304A of the Indian Penal Code (IPC) to file a criminal case, which prescribes both imprisonment and fine. And for compensation, they can approach consumer courts at the district, state, and national levels. In Hafsa’s case, it was gross medical negligence and a criminal trial is underway at the Mangalore Judicial First Class Magistrate court. We have also approached the state consumer court in Bengaluru, where the case is in the argument stage,” he told TNM.
Though the law interprets medical negligence intending to help patients, implementation is a tedious process. Patients are made to run from pillar to post for years seeking financial relief and justice.
Chennai-based advocate Shankar, who has been arguing similar cases for the last 30 years, pointed out that in case of a criminal trial, the burden of proof lies with the aggrieved patient, making justice a far cry because collecting evidence against a doctor for a procedure that happened a while ago is a difficult task. He also said that hospitals and doctors can withhold X-ray copies and other documents or alter them, further disadvantaging the patients.
“I once appeared for a woman from a remote village in Tamil Nadu who had developed discomfort after a C-section delivery. The doctors had left behind a strip of cotton gauze inside her abdomen and nobody knew until she started experiencing pain. The follow-up was done at a different hospital because the C-section was done in her native place and she had moved back to her husband’s home. One day, the gauze passed out along with her stool and she even thoughtfully preserved it for evidence. But unfortunately, she could not prove in court that it was deposited inside her abdomen during the delivery and the case was dismissed,” Shankar told TNM.
Sarfaraz said that in Hafsa’s case, the hospital’s defence was that the forceps could have been left inside her during a surgical procedure for infertility that was previously done at another hospital. “But this backfired in court… if the scissors were already inside her when she was operated upon, the question arose as to how Mangalore Nursing Home missed it,” he said.
Typically, in cases of medical negligence, the doctor and assisting staff members are made a party in the case. The hospital is also liable, and this is called vicarious liability where an employer becomes vicariously liable for a lapse from an employee. Shankar added that while hospitals prefer to settle the matter by paying compensation, the odds are still stacked in their favour.
“First of all, no doctor will testify against another doctor. The imbalance of power is huge when a common person decides to go to court against a community of often powerful professionals. Courts can refer the case to a government medical board for testimony but again, very few courts do this suo motu unless an applicant specifically asks for it. As for compensation, in my experience I have seen that it takes generations compared to vehicle or other claims that are passed quickly in consumer courts,” he said.
There are, of course, several doctors who testify in court, explaining facts as they have witnessed. TNM reached out to a surgeon who testified in a similar medical negligence case, and because the matter is subjudice, he refused to give an elaborate comment. Nonetheless, he said that he told the court what he saw when he assisted in the surgery to remove the forceps from the woman’s body.
Shankar also observed from experience that most judges in consumer courts are unable to make a precise conclusion in the absence of third-party testimony and often ask the aggrieved patient and family to settle for whatever compensation the hospital or doctor may be willing to offer. “The party will finally just take what is given and leave because otherwise, the case would drag on with no end in sight,” he said.
Hafsa’s family is also awaiting a compensation order from the consumer court so that they can pay back the cost incurred at Unity Health Complex to remove the scissors from her abdomen and other follow-ups. “The hospital treated her on credit. The bill is Rs 10 lakh and we are hoping to pay it once the case comes through. My sister suffered a lot and she will never come back. In her last years, she was always in pain and had to use a urine drainage bag. Had the doctors given her appropriate post-operative care, she need not have suffered so badly,” her brother Moideen said.
Maheshwari and her husband had initially lodged a complaint at the Panjagutta police station in Hyderabad, but later withdrew it after the hospital agreed to treat her free for life.
The problem, however, is not just limited to finance. Sloppy post-operative care, lack of proper diagnostic investigations, and the reluctance of doctors to take the concerns of patients seriously make medical procedures a nightmare for many women like Hafsa and Maheshwari.
But doctors have another side of the story to tell, although they agree that such negligence should never happen.
In Kerala, 32-year-old Harshina has been protesting inaction from authorities after surgical forceps were left in her abdomen post a C-section surgery at the Kozhikode Medical College Hospital in 2017. The forceps remained inside her for five years, throughout which she suffered extreme pain. The forceps were removed in October 2022, but she is yet to receive compensation.
Dr Sulphi, a central working committee member of the Indian Medical Association (IMA), the largest represented organisation of doctors in the country, said that Harshina’s is a notorious case of negligence. He pointed out that medical negligence is also a mix of many systemic shortcomings that individual doctors are often powerless to remedy.
“No doctor will purposefully land themselves in trouble by doing something like this. So we must also look at whether our system is conducive for doctors to give patients and surgical procedures enough time,” he said, elaborating on how such lapses are cumulative outcomes of many intersecting factors. One crucial point he made was about understaffing and the lack of scrub nurses in India.
Scrub nurses are nursing professionals who assist surgeons and medical staff in the operation theatre. They are responsible for making sure the surgery is ready to be executed, including keeping count of the surgical instruments used and numbering them before and after use. While hospitals in most countries in the West have scrub nurses, Dr Sulphi said Indian hospitals do not. “This could be because it is not affordable for hospitals, but that cannot be an excuse. Often, while a surgeon in the West sees a maximum of 15 patients in a day, here government surgeons meet at least 200 patients. We are understaffed and overworked, sometimes making it impossible to give individual patients enough time for post-operative examinations,” he noted.
Dr Anupama R, Managing Director and chief consultant gynaecologist at PRAN Hospital in Thiruvananthapuram, also echoed Dr Sulphi’s thoughts. “First of all, there is no justifying medical negligence. But as doctors, we also have concerns that need intervention. In a major surgery, the surgeon will definitely be concentrating on the big, apparent problems. So quite a lot depends on the staff members who are assisting, to keep a tab on aspects that the surgeon may not. In the government sector as well, nursing staff and doctors are so overworked that in the absence of more hands and minds to assist in the operation theatre, things sometimes go wrong. Working consecutive night shifts also takes a toll on them,” she said.
But Maheshwari, Hafsa, and Harshina did go to their respective doctors complaining of pain post-surgery, and were not taken seriously. Though this is a lapse, Dr Anupama threw light on why detecting instruments in the abdomen is tricky and how outcomes differ according to the material that the instrument is made of and the patient’s gender.
In Hafsa’s case, the forceps had gotten stuck to her stomach wall, near the kidney, causing it to stay intact for many years. “We noticed that the wound of her fibroid removal did not heal, but we did not know why. Then, when the forceps were detected inside, we could see that it had been embedded into the skin of her stomach wall, near the kidney on one side, and was poking at the stitches. Had it moved around, we may have known earlier, who knows,” Moideen recalled.
His doubts are not entirely unfounded. Maheshwari, too, had the forceps settle near her intestine, to one particular side, and this may have played a role in it going undetected.
Dr Anupama explained that the abdomen is a big cavity, and when a woman undergoes a hernia, uterus removal, or C-section surgery, a space forms in the abdomen in place of whatever was removed. “The intestines are the only loose organs in our abdomen, while other organs are fixed. So the intestines move around and mildly stick to the skin in these newly formed spaces. Instruments like forceps may become entangled in them or covered by them. The abdomen is also a structure with many hidden spaces and its anatomy itself may lead to objects deposited not being discovered,” she elaborated.
She also said that in such cases, a normal ultrasound scan will not reveal the instrument even in cases where timely diagnostic procedures are done post-operation. An MRI scan or an X-ray may be required, and these scans are expensive and not covered by insurance. “So even if a doctor thinks a patient needs diagnostic investigation, they may not do it due to lack of affordability. They will instead take painkillers and leave it at that,” she added.
Though medical negligence is the reason these women suffered so drastically, gender roles play a huge part in determining how badly such negligence impacts them. For most women, pain is normalised as an inevitable female experience and they are expected to put up with it. Thankfully for Maheshwari, Hafsa, and Harshina, their families were cognisant of their pain and took them to the hospital whenever needed.
Dr Anupama said that women also postpone surgeries to accommodate the schedules and convenience of their family members, such as children’s school or exams, and therefore when they come in for a procedure, they often have an aggravated problem.
“Anaemia, diabetes, and hypertension are common in women, especially those from marginalised social locations. After childbirth, their muscles become loose, and several women also go through excessive menstrual flow and multiple abortions. But such aspects are neglected until it culminates in a severe problem. In an emergency surgery, the doctor may have to overlook their medical history and that’s one of the reasons that complications may arise,” Dr Anupama told TNM. Therefore, though surgical objects being left inside patients’ bodies are not limited to women, the consequences are exacerbated in women as compared to men.
Additionally, the material of the object left inside also plays a crucial role in determining how soon symptoms show up and how badly they progress. For example, Dr Anupama said that there are several materials that the body accepts without any reaction such as stents or rings used in sterilisation procedures. But in the case of cloth like linen, the patient may develop fever, pain, diarrhoea, and vomiting, among other discomforts. Forceps or instruments made of surgical steel do not induce any reaction to a large extent. “Only when they interfere with other organs do they produce dull pain, and dull pains are an almost everyday occurrence for most people. They may not bother to get it checked,” she added.
Even as doctors cite the many layers of systemic, anatomical, and financial factors that aggravate the problem when negligence occurs, they agree that there is no justification for it and neither can the trauma be reversed. The problem needs intervention at multiple levels and speeding up the legal process is one of them.
In December 2022, Dravida Munnetra Kazhagam (DMK) MP Kanimozhi Somu urged the Union government to establish medical tribunals at the state and national levels to facilitate the speedy disposal of cases. It was also reported that the Union Health Ministry was considering a consolidated regulatory framework to address medical negligence as India does not have a specific Act to deal with it.
Dr Sulphi pointed out that we already have laws that address medical negligence, and remedies can also be sought through Human Rights Commissions and National Medical Commissions that decide on revoking the licences of defaulting doctors. “We have legislation, but many people are not aware of their rights. So building awareness of the rights of patients is crucial,” he said.
Advocate Shankar added how consumer courts – which are overloaded with cases – and judges are at a disadvantage when it comes to subject-specific issues of medical negligence. “Sometimes, judges propose an easy justice. Therefore, a separate tribunal for medical negligence with experts from the field will be a big boon for patients and the courts,” he said.
While nothing can compensate for the loss that families like Hafsa’s suffer, systemic interventions in the legal process, awareness building, as well as rigour on the part of the healthcare sector can minimise the trauma women like Harshina and Maheshwari are pushed to live with.
This reporting is made possible with support from Report for the World, an initiative of The GroundTruth Project.