Suicide of Kerala trans woman: Investigative team alleges gross medical negligence

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Anannyah, a 28-year-old radio jockey, was found dead in her flat in Ernakulam days after alleging medical negligence by doctors who performed gender-affirming surgery on her.

An inquest report into the death of Anannyah Kumari Alex, a transgender woman from Kerala who is believed to have died by suicide, has alleged gross medical negligence by the private hospital that provided her with gender affirmation procedures. The report called for better healthcare for trans people in the state and for healthcare professionals to follow international standards in this regard. The investigative team also requested a second autopsy of Anannyah’s body and said 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 failed to respond to the case.

Anannyah was a 28-year-old make-up artist, radio jockey and aspiring politician, who was found dead in her flat in Ernakulam on July 20, 2021. This was just days after she alleged medical negligence by doctors who had operated on it, as part of a gender affirmation procedure. The surgery was performed in June 2020 at Renai Medicity in Kochi. Anannyah, in a video interview with The Cue, had alleged that the surgery was botched by doctors and that she faced multiple health issues as a result, including constant pain. She had been admitted to the hospital several times after the operation for complications arising from the procedure.

Three days after Anannyah’s death, her partner, Jiju Girija, 36, was also found dead in an apparent suicide at his friend’s house. Jiju had informed the police of Anannyah’s death.

The survey was conducted by the Justice for Anannyah Action Council, an independent body of gay activists and medical professionals, including gay-affirming psychologists and doctors. They found that Anannyah had not received adequate mental health support from the medical team involved in her surgery and post-surgery care. Additionally, the investigative team found no documentary evidence of pre-surgery mental health support for Anannyah, the report said, adding that they were insufficiently informed about the risks associated with the operation. operation. The report also states that the medical team failed to provide proper care for post-operative complications and alleged hostile treatment by hospital staff on at least one occasion.

“So many transgender people died by suicide or were murdered before Anannyah, and it won’t stop with her either. The community has repeatedly pointed out that deaths of LGBTQIA+ people are not properly investigated. It was in the absence of transparent action by the authorities that the action council decided to carry out an investigative investigation,” the report said.

Fifteen transgender people testified about their experiences of gender-affirming surgeries, regarding the lack of adequate representation during state policy-making and the urgent need to revamp hospital protocols to ensure equitable health care. Doctors including plastic surgeon Arjun Asok, who treated Anannyah, and the team that performed Anannyah’s autopsy declined to testify.

The report documents 18 deaths of LGBTQIA+ people in Kerala, excluding Anannyah, during the period 2018-2022. Thirteen of these deaths were suicides or deaths under suspicious circumstances. During the period 2013-2017, five deaths were reported and all were unnatural.

Noting that most gender-affirming surgeries in the state do not meet World Professional Association for Transgender Health (WPATH) standards, the report called on the state government to take the lead in train doctors, psychologists, psychiatrists and social workers by sending them to outside institutions. the state who have expertise in such surgeries. WPATH is an international association that has defined standards of care (SOC) for the health of transgender and gender non-conforming people.

What the report found in Anannyah’s case

A trans person who wishes to have gender affirming surgery should see two mental health professionals and obtain written certificates from them confirming that they are ready for surgery. This is the procedure recommended by WPATH and followed worldwide for gender affirmation surgeries including in India and is performed to ensure the well-being of trans people and to empower healthcare professionals . However, in Anannyah’s case, the investigation team said due process was not followed and the operation may have been rushed. The only evidence that Anannyah met with a psychologist and an endocrinologist was on May 2, 2019, according to the report.

The operation was performed by Dr. Arjun Asok of Renai Medicity on June 14, 2020, while the first appointment to decide the operation was on May 17, 2020. She was discharged five days after the operation , but had to be readmitted to the hospital the day after her discharge, due to post-surgical complications. On June 28, additional surgery was performed to address issues arising from the first operation. Anannyah has been admitted to the same hospital four times, and the fourth time Anannyah and her friend were roughed up by security guards over a dispute over a bill.

The trauma she suffered after the operation shows that there were major failings by the mental health professionals who were part of the GAS team, according to the report. As Anannyah’s death is believed to be due to suicide, which often results from serious mental health issues, these shortcomings are serious, he added.

Anannyah’s father, Alex, said when the report was released that police failed to properly investigate the circumstances surrounding Anannyah’s death. “The shoulder bag she was using when I last met her was missing,” he said, “I looked but couldn’t find the bag. I checked all the bills. Four phones, someone else’s processing documents, etc. were recovered 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 contains all the evidence,” he said, “I had told the deputy police commissioner that the phone contained crucial evidence. the police only contacted me to inform me of the progress of the investigation.In the video call conducted with the Minister of Health, they promised that everything would be investigated, but nothing happened.

PV Baby, Thrikkkakara Police Deputy Commissioner investigating Anannyah’s suicide, said the phone used by Anannyah was being examined at the forensic science lab. “It is important to examine Anannyah’s phone to find out if there are any triggers that led to the suicide,” he said. “We have not investigated Anannyah’s partner, Jiju, who informed us of the death.”

Health issues of trans people in Kerala

The report also indicates that transgender people lack choice when it comes to hospitals offering gender-affirming procedures. They are often forced to remain silent despite multiple incidents of failed surgeries and procedures. The shortage of facilities for trans healthcare deprives them of a space to register a protest. “For a trans woman to complain about failed gender affirmative surgery adds pressure on her as she would be mocked and humiliated in public,” the report said.

The report recommended legislation to standardize the cost of gender affirmation surgeries in Kerala, the extension of financial assistance for additional surgeries and the formation of an expert panel of doctors to recommend action if a medical negligence is identified during treatment.

Mrudula Bhavani is a freelance journalist based in Kerala. She reports on state policies with a focus on the gender spectrum, law, public health, caste and the environment.

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