INDIA: Unneeded surgeries for women expose nationwide corruption
Shuriah Niazi – WNN Features
(WNN) Raipur, State of Chhattisgarh, INDIA, SOUTH ASIA: Long range investigations into a stark and disturbing trend in medical corruption is continuing in Central India. In the Hasda village of Raipur District in India’s State of Chhattisgarh, women are being subjected to deceit and physical loss. These loses have not yet been prosecuted as public crimes. But they have been committed behind medical doors.
As the state government in India, district magistrates and local hospitals probe an overwhelming number of possible insurance medical fraud cases, women victims on the receiving end of medical procedures are suffering with lives that will never be the same again.
What has been described as ‘unwarranted surgical procedures; are now causing a crisis for women throughout India.
In what may include manipulation of locally administered welfare programs, including false claims made by processing offices, clinic teams as well as doctors, have been placed under investigative scrutiny by local magistrates.
But exactly what are those who are accused of the crimes accused of doing? Across the Chhattisgarh District of Raipur, 3,500 separate cases of women living in 90 separate villages, many of them younger than 30, have undergone what a majority of them now feel were completely unnecessary surgeries.
In a region known before 2008 for its lower than average rates of hysterectomy surgeries, the State of Chhattisgarh in India is now the opposite.
According to an exclusive poll taken by Reuters Trustlaw last July, India is currently the ‘worst place to be a women’ compared to all other world nations who are part of the G20. The poll indicates that India ranks especially low on issues that cover violence, exploitation, safety, gender equality and access to decent healthcare.
“Officials estimate more than 2,000 women were talked into having their wombs removed in the last six months,” said the BBC news in a report on Chhattisgarh made in July 2012. Current legal accusations in what may be exposed as a criminal medical negligence include 34 medical centers who are currently being investigated for insurance fraud after opportunistic doctors ordered unneeded hysterectomies for their women patients.
The problems are not an ‘India only’ problem. Unwanted hysterectomies have also been an going issue inside the United States.
“Each year 750,000 hysterectomies are performed and 2,500 women die during the operation. These are not sick women, but healthy women who go into the hospital and do not come out,” says Dr. Herbert Goldfarb, a gynecologist and assistant clinical professor at New York University School of Medicine in his book “No Hysterectomy Option: Your Body–Your Choice.”
The widespread use of cashless healthcare smart cards in India initiated RSBY – Rashtriya Swasthya Bima Yojana smart card healthcare program in 2008, may also be part of the problem. Providing government monies and an easy-to-use credit card that has worked to bring healthcare to millions of people in India, regardless of their poverty level, the Indian government began distributing the cards in 2008 to enable families from all levels of Indian society to have access to better high quality medical care.
The smart cards allow payment of healthcare to be immediate, with coverage of up to 30,000 Rs ($555 USD). It may seem like a good deal, but this amount is shared among all the members in one family per year. There is no doubt the smart cards have allowed many patients to receive life-saving medical procedures, but they have also encouraged some medical doctors to prescribe hysterectomies that have not been needed.
Each smart card includes 11 types of software that provides a patient’s information, medical history and medical expenditures. The program seems amazing where a patient can choose from almost 1,000 private or government hospitals throughout India.
“The general ward of Beena Prakash hospital – situated in the small, breezy town of Bijnore in western Uttar Pradesh – has been bustling for the past few months. Locals claim that this heightened buzz of patients is ‘unprecedented’,” said OneWorld South Asia in 2009 after smart cards were distributed to many districts in India. The 2009 story may show how the cards have improved healthcare in India, but in 2013 the increase in medical procedures is showing a trend toward misuse of government funds.
While the smart cards seek to provide assurance that the correct person is receiving the right medical treatment, along with monitoring and limiting double charges for the same service, the cards do not protect a patient from going ahead with a surgery based on manipulative and inaccurate advice from a doctor.
Actions of physicians who have been accused of taking advantage of India’s healthcare system have caused numerous human rights activists to question the impunity of a medical doctor who delivers misaligned advice as a ‘medical expert’ and feels they cannot be questioned or challenged by a patient.
“The pervasive spread of corruption is not limited to the public sector. The private sector is also working under low thresholds
of integrity. Patients are exploited by being made to undergo unnecessary tests only for making money,” outlined the WHO – World Health Organization.
Unnecessary treatments and prescriptions by medical providers are considered to be a key ingredient in contributing to corruption within government sponsored healthcare programs, said Oxford Journal Health Policy and Planning in a 2008 release.
All the women in the Sahu family, in India’s mostly rural State of Chhattisgarh, have undergone what they now claim are unneeded medical procedures under hysterectomy procedures. These procedures, which doctors advised were necessary, continue to be questioned.
Without realizing the great impact the decision to remove their uterus would have on their lives, the decision to allow their surgeries to go ahead as advised is now being seen as a ‘grave mistake’ by the women of the Sahu family. Included in the family is Ms. Pancho Bai, along with her sister-in-law Ms. Budhiyari Bai, as well as two daughters-in-law Nadani and Kesar. All are different ages. All were told that removal of their uterus was their only option to rid them of problems that, in the end, may prove otherwise.
In 2008, when Nadani complained of back pain she made an appointment with a woman doctor who worked in Chhattisgarh’s capital city of Rapipur, which numbers over one million people. After performing a diagnostic ultrasound, the physician told Nadani that she had a severe internal infection. She also told her that the infection had spread to the uterus which would have to be surgically removed immediately to save Nadani’s life.
As the youngest woman in her family, Nadani underwent her uterine surgery when she was only 24 years old. Because of what has been described by her as “an unnecessary procedure” she is now frustrated, depressed and unable to have children.
“Our profession is entrenched in terms of doing hysterectomies,” said U.S. based Ernst Bartsich, M.D., a gynecological surgeon and professor of medicine at Weill Cornell Medical College in New York, outlined CNN in 2007. “I’m not proud of that. It may be an acceptable procedure, but it isn’t necessary in so many cases,”continued Dr. Bartich.
“In fact, he [Dr. Bartshich] adds, of the 617,000 hysterectomies performed annually, ‘from 76 to 85 percent’ may be unnecessary,” continued CNN.
At the time when Nadani was told by the doctor about her condition she was worried, but did assume the doctor’s assessment must be correct and true. To make sure her patient would go through with the surgical procedure, Nadani’s doctor asked her to sign a ‘contract’ that also outlined the price due for the procedure.
“The doctor took [had me sign] a ‘contract’ for Rs 9,000 ($180 USD) for the operation,” outlined Nadani. This service also required specific medicines to be purchased from the doctor.
“Medicines worth around Rs 10,000 ($200 USD) were purchased from the shop run by the doctor,” continued Nadami.
For Nadami, who wanted desperately to be free of pain, signing the contract was easy. But after the surgery she realized the final outcome was not good.
“Ever since the operation I have been battling serious health problems,” she said. “I’ve become so weak that it is difficult to even stand up.” she said.
Like all surgeries uterine removal is not a completely safe medical procedure. Complications may also come later. Negative outcomes with hysterectomy surgery can include danger during surgery under anesthesia, and increased chance of blood clots, internal infection, or bladder damage. Dangers from the surgery may also cause death. Long term, the medical procedure can contribute to increased depression, fatigue, hot flashes, headache, stress and anxiety, as well as pelvic pain.
“Occasionally, surgery is a necessary last resort for women who experience chronic pelvic pain that clearly arises in the uterus. However, hysterectomy provides no relief from many forms of pelvic pain, and an unnecessary hysterectomy may create new problems. Seek careful evaluation before proceeding with such major surgery,” advises the internationally respected U.S. based Mayo Clinic, which is a worldwide leader in medical care, research and education.
Like her sister-in-law Nadani, Kesar Sahu was also in her twenties when her uterus was removed by a doctor who prescribed immediate needs for her to have surgery. Like Nadani, Kesar had come to her doctor complaining of pain. Her pain was in the lower part of her abdomen. The diagnosis she received was ‘inflammation in the uterus’ which, the doctor advised, required quick surgical intervention.
Not surprisingly, Nadini’s mother-in-law Pancho Bai, along with her husband’s Aunt Budhiyari, had the same surgery which ended in hysterectomies for both women who received their surgery at the Amanpur Hospital in the city of Raipur.
As the women of the Sahu family face ongoing recovery from medical procedures they say were unnecessary, or in some cases ‘harmful’, they also now have to pay approximately 3,000 to 4,000 Rs ($80 USD) each month on medicines for chronic conditions that appeared following their surgeries.
Neera Sahu has been chronically ill ever since the removal of her uterus. After seeing half-a-dozen doctors not one physician has been able to diagnose her problem. To pay for the mounting medical costs her husband Kalyan recently sold the family land.
It would have been ‘better to die’ than have my uterus removed, Neera outlines, as the problems following her operation have become worse.
When 40-year-old Hemin went to her doctor she told her doctor she had pain in her legs. Once a diagnosis by her doctor had been made Hemin was told that her uterus was ‘diseased’ and would have to be removed immediately. Because of this procedure and the ongoing costs of other medical treatments Hemin was also forced to sell her ancestral land.
As reports of doctor fraud reached epic proportions in Chhatisgarh, Chief Minister Dr. Raman Singh, along with the Minister of Health and Family Welfare Amar Agrawal, have ordered a detailed criminal probe in the region. Health Commissioner Pratap Singh has also jumped into the investigation asking medical and health officers from each district in the State to provide a list of all surgeries performed during the past six months that include the removal of a woman’s uterus. This investigation includes private clinics, public hospitals as well as private nursing homes.
Ongoing investigations by the Department of Health throughout Chhattisgarh reveal that the surrounding villages of Hasda, Manikchauri and Dongitarai are beginning now to show clear evidence that doctors, along with others, have been involved directly with fraudulent medical procedures.
As more reports come in, additional information is being revealed that proves other unethical behavior may be involved in these crimes.
Evidence is being discovered that numerous operations may have been set up and scheduled by misrepresented agents working for unscrupulous doctors, especially those working in India’s pharmacies. These agents have received commissions for referrals made to doctors who then prescribe unneeded surgeries. Commission fees as high as 5,00 Rs ($92 USD) have been reported.
Reports also indicate that numerous women who were told they had cancer of the uterus were never given a cancer biopsy test before or after their operations.
“In most cases, a biopsy is the only sure way to tell whether cancer is present,” says medical experts at the U.S. Department of Health and Human Services.
“The uterus of the women were removed after [their physicians were] giving them false information that their organs were cancerous,” outlined Dr. Meena Samuel, who is one of the active members of the medical investigation team in Chhattisgarh.
“Most of the women didn’t require this surgery,” continued Dr. Samuel. “They were told that the surgery was essential to save their lives.”
In the village of Dongitarai, which is less than 50 km (31 miles) south of Chhattisgarh’s capital city of Raipur, over 100 cases involving medical fraud with the unauthorized use of surgery with removal of the uterus has been reported in the last five years. Of of these cases, 15 percent of the operations were performed within the last year, outlines the ongoing investigation.
“So far we’ve received information that [the] uteruses of 145 women have been removed,” said Shivlal Sahu, head council member during investigations conducted in the village of Dongitarai.
“We’re making house-to-house contact to create awareness among women,” says Kunti Dhruv, council head of the village of Beltukdi.
In Beltukdi over 50 percent of the women have undergone misleading medical procedures under hysterectomy.
In the neighboring village of Hasda, a staggering 80 percent of the women living there now admit that they have been involved in surgeries where they feel doctors tricked them into hysterectomies.
“These cases are a scourge on the medical profession,” says current District Secretary for the Indian Medical Association in Raipur Dr. Manoj Saini.
In one village after another, emerging facts in cases of deceptive surgeries overwhelmingly reveal how doctors have manipulated women in order to work the system for personal financial gain. Medical complaints as routine as menstrual cramps have been shown to be one of the reasons doctors performed surgeries.
“Those who play with the health of the rural women will not be spared. In Raipur district, a team of doctors has begun investigation in affected villages,” said Chhattisgarh’s Minister of Health and Family Welfare.
“It is totally wrong to remove the entire ovary or uterus to treat problems like inflammation of uterus. Such problems can be cured with medicines,” said IMA – Indian Medical Association senior surgeon Dr. A.R. Dalla. “The doctors should tell on what basis they concluded that the women’s organs were cancerous. Cancer can’t be confirmed through sonography alone. The biopsy should have been performed before removing the uterus to confirm if the organ was really cancerous.”
Although the entire region of India is currently suffering under an increasing weight of corrupt medical clinics, pharmacies and others medical outlets, it is uncertain if the federal government of India will step in completely to stop the corruption. Surprisingly no physicians in India, from 2008 to 2012, have had their medical license revoked insideo the country.
“No market can function or sustain itself unless there is a minimal level of integrity, fair play and rule of law. Therefore, if insurance and contracting the private sector are to be the new ways of expanding access and financing health, then it is essential that values of probity,
nurturing of informed consumers and wider participation through good governance be ensured,” outlined the WHO – World Health Organization 3 years ago.
New evidence shows that women in India are being exploited and facing serious health problems, due to under-investment in healthcare by the Indian government and the proliferation of private for-profit clinics. Many private clinics are being driven by financial incentives to carry out dangerous and costly procedures regardless of whether or not there is any benefit to the patient. Women, particularly from poor communities, are being left with crippling debts and health problems after being made to have unnecessary hysterectomies and Cesarean births. These are procedures that come with huge price tags and high medical risks. This 3:09 min February 2013 Youtube release is a Oxfam International production. For more information on this important story go to Oxfam International
For more information on this topic:
- “Corruption in Medical Field in India,” Prezi – Ideas Matter presentation by Siroch Kanapongrussamee, September 2012;
- “Financing and Delivery of Health Care Services in India,” WHO – World Health Organization with Ministry of Health and Family Welfare India, September 2005;
- “Review of Corruption in the Health Sector: theory, methods and interventions,” Oxford Journal – Health Policy and Planning, February 2008;
- “Severe complications of hysterectomy: the VALUE study,” BJOG – International Journal of Obstetrics and Gynaecology, July 2004.
WNN correspondent Shuriah Niazi is based in the Central Madhya Pradesh region of India. In 2006, he received award recognition at the sixth Sarojini Naidu journalism awards hosted by The Hunger Project – India. In 2011 Niazi received a UNFPA Ladlii Media Award for Best web writing for a WNN story on dalit women who have suffered severely under accusations of witchcraft in Chhattisgarh rural India. Another WNN article (via Niazi) also received international attention through a 2011 ELi Lilly / REACH MDR-TB Award for outstanding writing on tuberculosis with a story covering India’s TB and the widows of miners who often die shortly after their husbands. This WNN story was also featured with our media partner The Guardian News Global Development Network.
Additional sources for this story include Press Information Bureau Government of India, Transparency International, WHO – World Health Organization, BBC news, U.S. Department of Health and Human Services, CNN newsroom, Thomson Reuters Foundation Trustlaw, Oxford Journal – Health Policy and Planning, BJOG – International Journal of Obstetrics and Gynaecology, Mayo Clinic, GPFI – Global Partnership for Financial Inclusion, Prezi – Ideas Matter, Indian Medlars Centre and OneWorld South Asia.
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