September 30, 2022

A.S. Mittal & Ors vs State of U.P- An analysis

This article is part of our Medical Negligence Series

The case of ‘A.S. Mittal & Ors vs State Of U.P.: 1989’ is an important case on ‘medical negligence in charity eye camps’ and also on ‘medical negligence’. It is also called ‘eye-camp case’.

Facts of the Case

  • The Lions Club, Pottery Town at Khurja in Uttar Pradesh arranged and conducted, as part of its social service programme, an “Eye-Camp” intended to extend facilities of expert Ophthalmic surgical services to the residents of the town.  
  • Invited Dr. R.M. Sahay and his team of doctors and para-medical staff, who arrived in Khurja on 21st April, 1986, examined about 122 patients. One hundred and eight patients were operated upon, 88 of them for Cataract which, with the modern advances in Ophthalmic Surgery, is considered a relatively minor and low-risk surgery. Dr. Sahay left Khurja that evening for Moradabad where he was scheduled to conduct similar operations at another “Eye-Camp.”
  • But the operated-eyes of the patients were irreversibly damaged, owing to a post-operative infection of the Intra Ocular Cavities of the operated eyes. The doctors present at the Camp got in touch with Dr. Sahay at Moradabad and administered anti- biotic medication, both oral and local, for the infection.
  • Dr. Sahay returned on the 24th April and undertook himself some ameliorative treatment. But the operated eyes had been damaged completely. Similar mishap, but on lesser scale affecting some 15 patients, repeated itself at Moradabad.
  • Some of the victims were later sent to and treated at Dr. Sahay’s Hospital at Jaipur. But their condition did not improve. At least 84 persons suffered permanent damage of the operated eyes.
  • The suggestion in the Report of the enquiries that ensued is that, in all probability, the source of the infection, referred to as E coli infection of the intra ocular cavity, was the “normal saline” used on the eyes at the time of surgery.

Writ Petition before the Supreme Court

  • Against this negligence, a write petition under article 32, was filed by two social activists, Shri A.S. Mittal and Shri Om Prakash Tapas, acting on behalf of an organisation called ‘Union for Welfare and Human Rights’.
  • Originally, the four respondents were the State of U.P., Dr. R.M. Sahay, the Chief Medical Officer, BulandSahar District (U.P.) and the Lions Club of Pottery Town, Khurja.
  • However, supreme Court also directed the Indian Medical Council and the Union of India to be impleaded as parties to the proceedings.

Allegations against the Club by the Petitioners

  • In the Writ Petition, the petitioners have made serious allegations about the very bona fides of, and the intention behind, the sponsoring of the ill-fated ‘eye-camp’ and have alleged that motives of monetary gains by way of State and International subsidies. But no material is placed before the Court to substantiate this allegation.

The prayers in the writ petition were that

  • the victims of this medical negligence be given expert rehabilitatory treatment and appropriate compensation;
  • that Government do conduct a thorough investigation as to the conditions which rendered a medical misadventure of such a scale possible and evolve proper guide-lines which will prevent recurrence of such tragedies; and
  • that appropriate legal action be instituted against Dr. R.M. Sahay and his team and also

against officers of the Government who, according to allegations, committed serious breaches of duty in sanctioning permission for the conduct of the ‘eye-camp’ without ensuring a strict compliance with the conditions prescribed in the Guidelines prescribed by the Government in that behalf and in not effectively dis- charging the duties enjoined upon them to over-see the satisfactory and safe functioning of the camp.

Inquiry Reports

Two inquiry reports were submitted before the courts-

One, the Deputy Director (Eye Treatment). conducted an inquiry into the happenings.

Two, the inquiry report conducted by Shri Shatrughan Singh, Sub-Divisional Magistrate, Khurja as to the incident.

The prayer of appropriate legal proceeding

So far as the grievance in the Writ Petition of prosecutorial inaction on the part of the Government and the need to direct Government to initiate appropriate action against those responsible for the tragedy is concerned, then pursuant to the results of the inquiries conducted by the Deputy Director (Eye Treatment) and the Sub-Divisional Magistrate, appropriate follow-up action was contemplated by the Government against persons concerned and a criminal case registered against Dr. R.M. Sahay under Section 338 of the Indian Penal Code.

As the criminal proceeding was initiated against dr. sahay, the supreme court abstained itself from commenting any further on the rashness and negligence of Dr. sahay. But, the court could not resist itself from commenting on the statement of counter-affidavit filed by Dr. Sahay.

With other statement, in his affidavit, dr. sahay stated that,

“The medical mishap at the Khurja Camp is the only one he has encountered in his entire extensive experience.”

“Despite all possible care MISHAPS cannot always be avoided in human errors because the error of one link in the entire chain may sometime result in a total failure.”

“It is extremely unfortunate that some 84 patients’ vision could not be restored despite every care bestowed by the answering respond- ent and his associates and assistants.”

“The number of patients operated upon at Moradabad Camp for cataract were about 380 and the vision of about 10 of them could not be restored. A small percentage of failures is considered normal …… “

The court considered these comments as over-simplification of matter and said,

“We are afraid, the doctor may not be justified in this description of the large-scale and calamitous effects the operation had on the hapless victims. It is, perhaps, a euphemism to call the incident as one where “some 84 patients’ vision could not be restored.”

“It is not merely that the unfortunate patients did not derive any benefit from the surgery but were greatly worse-of than they were before the surgery, owing to the post-operative intra ocular infection that damaged the operated eyes beyond redemption.”

Prayer for Guidelines

After the institution of these proceedings Central Government, in the wake of reports of mishaps in ‘Eye- Camps’, constituted a Committee under the Chairmanship of the Union Health Minister with six State Health Ministers and four experts as members to re-examine and update the then existing guidelines or evolve fresh ones.

As a result of the deliberations of the said Committee and pursuant to its recommendations, the guidelines for conduct of eye-camps earlier issued have been updated and revised.

Prayer for compensation to Victims

Pursuant to earlier orders of supreme Court, each of the victims had been paid a sum of Rs. 5,000.00 by the State Government by way of interim relief.

Vicarious liability of the State

However, Counsel for the petitioners, submitted that this was a wholly avoidable mishap and is entirely the result of the composite negligence on the part of the surgical team and the authorities of the U.P. Government, who failed to ensure obedience to the norms.

Counsel also sought to rest the right of the victims for damages on the footing that the persons who organised the ‘eye-camp’ were acting pursuant to and under the authority of Government and that on the doctrine of the State action the activity must be reckoned as that of the State itself which must, accordingly be held vicariously liable.

On this contention, the court said that, in the circumstances of this case, the factual foundations laid before the Court and the limited scope of the proceedings no appeal could be made to the doctrine of State action. But the court on humanitarian consideration, ordered that the victims should be afforded some monetary relief by the State Government. and directed that in addition to the sum of Rs.5,000, already paid by way of interim relief, the State Government shall pay a further sum of Rs. 12,500 to each to the victims.

Reference

A.S. Mittal & Ors vs State Of U.P.: 1989 AIR 1570, 1989 SCR (3) 241