Did doctors in Chennai mislead this woman into believing she was pregnant?

With shoulders hunched and downcast eyes, M Aseena Begum was still grieving for the child she never had. Nine days ago, she thought she was going to deliver her first child, a moment she and her husband had been looking forward to for seven years of their married life. But last week, around the time she was supposed to deliver the baby, she was told that she was never pregnant.

“I had been going to the government hospital for regular checkups for the last eight months,” said 28-year-old Aseena Begum. “The last time I visited the hospital was two weeks ago, where they performed an ultrasound and told me that my baby was healthy.”

Aseena Begum said that on November 14, the doctors at Chennai’s Government Kasturba Gandhi Hospital, had told her that there was also a cyst developing in her uterus along with the baby. “They told me that they would deliver the baby through C-section and then remove the uterus as the cyst was large,” she said.

Aseena Begum had been very upset at the prospect of not being able to have another child. But her family had consoled her saying that one healthy child was enough, especially after such a long wait.

On November 20, Aseena Begum experienced a searing pain in her abdomen during her return from Vandavasi in Tiruvanamalai district, where she had gone to visit her husband’s relatives. Her husband, Amir Ali, took her back to Vandavasi where they visited a private clinic. While performing the ultrasound, the doctors at this clinic said that they could only see a cyst. They said there was no baby.

Dashed hopes

For the past nine months, Aseena Begum had been staying at her mother’s house in Kannagi Nagar, a large housing colony on the outskirts of Chennai, home to slum-dwellers who had been relocated from other parts of the city, especially after the 2004 tsunami. Aseena Begum’s mother had raised her three daughters on a salary of just Rs 4000 a month, working as a caretaker for school children. Their father had abandoned the family several years ago.

Only one of Aseena Begum’s sisters is a college graduate. She herself had studied only upto Class 8. Her husband dropped out of school after Class 7 and worked as a vegetable vendor in Vandavasi.

In January, Aseena Begum underwent an operation at Kasturba Gandhi Hospital for the removal of a cyst that was developing in her uterus. She was then given medicines to prevent further infection. Later, in April, after having missed her period for two months, Aseena Begum visited the hospital and was told that she was pregnant, after taking a urine test.

Her entire family was delighted with the news. “We did not allow her to do any work around the house,” said her sister Nazrath. “We made sure she went for regular checkups with either her husband or our mother.”

Aseena Begum’s aunt Kala produced a small notebook that the hospital had given her, with the doctor’s comments for each visit. In April, the doctor had recorded that the urine test for pregnancy had yielded positive results. In May, the doctor noted that the estimated date of delivery was November 18, 2016. In subsequent entries, the doctor had prescribed Folic acid tablets to be taken everyday for the development of a healthy foetus.

“She got an ultrasound done three times, during the third month, sixth month and in the ninth month,” said Kala. “But the scan report was never given to us. Nothing was ever written in the notebook about the ultrasound.”

Aseena Begum said that different doctors performed the checkup almost every time she visited. She said that when they had asked to see the scan report, the doctors had casually reassured them that there was no need to worry about it, and they would look after the formalities.

On November 20, when the doctors at the private clinic told her that she was not pregnant, Aseena Begum and her family could not believe them. “We were so shocked that we started to scold the doctor,” said Kala. “We said that this was impossible and that we couldn’t have been cheated this way.”

The entire family visited the government hospital once again for a scan. This time the doctors said that she was not pregnant. They also told her that there was no report of any of the scans that had been done previously.

“One of the doctors even accused me if I was trying to cheat them,” said Aseena Begum. “When I said I would bring my mother in to meet her, the doctor said, ‘Who is the patient, you or your mother?’”

Possible medical negligence?

On November 22, the distraught family members began to gather in front of the hospital and demand an explanation from the doctors. The hospital authorities then told the press that Aseena Begum may have left the hospital premises after checking only her weight and blood pressure, and without completing the scan. The Director of the hospital Dr. S Vijaya told The Hindu: “She (Aseena Begum) did not come in September and there is a chance that in August or October she possibly did not go into the scan room or did not wait for the scan.”

Dr. Vijaya also told The New Indian Express, “I think she had psuedocyesis. It is a condition where the person believes she’s pregnant, when she’s actually not.”

Pseudocyesis is a condition where the body behaves exactly like it is pregnant, but there is actually no pregnancy, said Dr Nikhil Datar, Medical Director of Cloud Nine Hospital in Mumbai. “Before the advent of ultrasound, rarely, we used to hear of cases in which doctors would sometimes end up operating on someone to find a cyst but not the baby. But with the advent of sonography, it is not possible to miss pregnancy.”

The urine pregnancy test available now is very sensitive, said Datar, and very rarely do doctors get a false positive report, where the woman may not be pregnant, and yet the test is positive.

Dr Puneet Bedi, gynaecologist and obstetrician with a few private hospitals in Delhi, agreed. “A urine pregnancy test is 100 percent correct, unless it is of substandard quality,” he said. “It is possible she had a pregnancy and miscarried.”

Bedi said cases of psuedocyesis were not uncommon, even among educated patients. “You tell them they are not pregnant, they go to another doctor.”

The chances of oversight are greater in a government hospital where laboratory reports routinely get mixed up, he added.

Datar pointed out that the government hospital should have filled a form at the time of the sonography. This is mandatory under the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act. The doctors could have also done a vaginal examination. “Before we had sonography, we used to diagnose pregnancy by conducting a vaginal examination,” said Datar.

It was not clear whether the government hospital had done either.

Support flowing in

An enquiry by the National Human Rights Commission will hopefully settle these questions.

On November 24, the Commission issued a notice taking suo moto cognisance of media reports on the alleged medical negligence in the case. The Commission observed that if the media reports were true, it was a serious violation of human rights of Aseena Begum.

The Commission finds the following human rights violation of the lady in her treatment:-
(i) She was not correctly diagnosed or she was misdiagnosed for the pregnancy and she was wrongly administered medicines as if she was pregnant.
(ii) Tumor in the ovary was not diagnosed initially and she was deprived of her valuable right for treatment.
(iii) She and her husband were made to believe that the lady was pregnant. When they were informed that she was not really pregnant, the mental shock which they received was unimaginable

— National Human Rights Commission

The Commission also observed that there were still many women visiting state-run hospitals who were not being treated correctly, which was their right.

Doctors and hospitals are expected to provide medical treatment with all the knowledge and skills. The patient approaching a doctor / a hospital expects treatment with all the knowledge and skills that doctors possess and to bring relief to the medical problem.
It is well recognized human right of a patient for correct diagnosis of the disease.

— National Human Rights Commission

Aseena Begum’s family is overwhelmed by the support they are receiving from their friends and even strangers. But their main concern at the moment is Aseena Begum’s health.

“We want to get her operated to remove the cyst,” said Kala. “We just hope that she will be healthy once again, and be able to have a baby.”