Holding

The revised eye‑camp guidelines dated 9 February 1988 are satisfactory, and the State must pay an additional Rs 12,500 to each victim as humanitarian compensation.

Summary

The Lions Club organized an eye‑camp in Khurja, Uttar Pradesh, inviting Dr. R.M. Sahay to perform cataract surgeries. Post‑operative intra‑ocular infections rendered many operated eyes permanently blind. Two social activists filed a public‑interest writ petition under Article 32 seeking compensation for victims, an inquiry into the causes, revised guidelines for eye‑camps, and legal action against the doctors and officials. The Court examined the adequacy of existing government guidelines, the extent of medical negligence, and the appropriate quantum of relief. It held that the revised guidelines issued on 9 February 1988 were comprehensive, and on humanitarian grounds ordered the State to pay an additional Rs 12,500 to each victim who had already received Rs 5,000 interim relief. The Court refrained from adjudicating on the doctors' criminal liability or state‑action doctrine, directing further administrative steps for pension benefits and costs.

Issues considered

Whether the government‑issued guidelines for the conduct of eye‑camps are sufficiently comprehensive to protect patients.
What monetary or other relief should be awarded to victims of the eye‑camp mishap.

Legislation cited

Constitution of Indias. Article 20(3), s. Article 32
Indian Penal Code, 1860s. 338

Subjects

eye campmedical negligenceprofessional negligencepublic interest litigationcompensationgovernment guidelinesophthalmic surgerypost‑operative infectionstate liabilityhumanitarian relief

Judgment

A.S. MITTAL & ORS.
A
v.
STATE OF U.P. & ORS.

MAY 12, 1989

[RANGANATH MISRA AND M.N VENKATACHALIAH, JJ.] R

Article 32-"Eye Camp"-Conducted-Severai people operated
for cataract-Many becoming totally blind in operated eyes-Victims
granted monetary relief payment on humanitarian considerations
ordered by Court-Necessity for strict compliance with guidelines
issued by Government for conduct of eye camps-Emphasised-
Suggestion to the Union to incorporate some recommendations noted in
c
the judgment made by Expert Sub.:_Committee of the Indian Medical
Council in the Revised Guidelines.

Lions Club, Pottery Town, Khurja (U.P.) actuated by the desire
to provide relief and facilities of opthalmic surgical serviees partlctilarly D
to the persons residing in turai areas, suffering from eye·troubles, ar·
ranged and opened an "Eye Camp" at Khurja after obtaining neces-
sary permission from the Chief Medical Officer, Buland Sahar. In this
connection, the Club invited Dr. R.M. Sahay of the Sahay Hospital at
Jaipur and team of Doctors to do the surgieal job. The Club published
propaganda literature with attractive slogans, e.g., 'Get operated and E
go home', 'No restriction on food', 'No bed rest' and 'No stitches to be
removed'. In response thereto substantial number of patients visited the
Camp.

Dr. Sahay arrived in Khurja on 21.4.1986 and e~amhted about
122 patients. One hundred and eight patients were operated tipoil, 88 of F
them for cataracts. Dr. Sahay left Khurja that evening for Moradabad
where he was schedule to conduct another similar Eye Camp.

It is unforunate that the project which was opened for the good of
the suffering people, proved a disastrous medicai mis-adventure; as the
operated eyes of the patients were irreversibly damaged, owing to a G
post-operative infection of the Intra Ocular Cavities of the operated
eyes, and the eyes were completely damaged. Similar mishap happened
at Moradabad also though on a lesser scale, the number of affected persons
being IS only. To remove the infection that caused this damage, Doctors
gave the necessary treatment but to no avail.
H

241
242 SUPREME COURT REPORTS [1989] 3 S.C.R.

In order to find out the causes of this mishap, i.e., the source of
A
infection, the Government appointed Inquiry Committee, reports
whereof were placed before the Court for favour of perusal.

Two social activists, Shri A.S. Mittal and Shri Om Prakash
Tapas have filed these Writ Petition in the form of a Public Interest
B Litigation.

The Petitioners have made serious allegations about the very bona
/ides behind the sponsoring of ill-fated 'eye-camp' and have alleged
monetary gains on the part of the sponsors but the Court did not find
any material to substantiate the said allegation. The petitioners prayed
that (i) the victims of this medical mishap be given expert rehabilitatory
c treatment and appropriate compensation, (ii) that the Government do
conduct a thorough investigation as to the conditions which rendered a
medical misadventure of such a scale possible and evolve proper
guidelines which will prevent recurrence of such tragedies and, (iii) that
appropriate legal action be instituted against Dr. Sahay and his team
D and other Government officials concerned.

Pursuant to the reports of the Inquiries conducted into the causes
of mishap, penal action had been initiated against Dr. Sahay & others.

The Court considered the following aspects of these proceedings;
E
(a) Whether the Guidelines prescribing norms and conditions for
the conduct of "Eye Camps" are sufficiently comprehensive to ensure
the protection of the patients who are generaly drawn from the poor and
Jess affluent section of the society or whether any further guidelines are
required to be evolved.
F
(b) What relief, monetary or otherwise should be afforded to
those who have suffered?

Disposing of the Writ Petition, this Court,

G HELD: Modern techniques in opthalmic surgery render cataract
a minor operation. A cataract affected eye when properly operated is -')--·
expected to become normal. The operation is meant to remove an
obstruction to vision and restoration of normal eyesight. This implies
that the eyes of patients selected for operation has the potential for
restoration of sight. In the instant case, they have become totally blind
H in the operated eyes. [247H; 248A-B]
A.S. MlTIAL v. STATE OF U.P. 243

A mistake by a medical practitioner which no reasonably com-
A
petent and careful practitioner would have committed is a negligent
one. [2500]

One of the questions that might arise in the appropriate forum is
whether the Doctors judged by the circumstances in which they were
working made a mistake and if so whether such a mistake was B
negligent. [2500-E]

Law recognises the dangers which are inherent iu surgical opera-
tion. Mistakes will occur on occasions despite the exercise of reasonable
skill and care. [250G I

Jackson and Powell on Professional Negligence, 1982 Edn. c
The necessity of the highest standards of aseptic sterile conditions
at places where opthalmic surgery-or any surgery-is conducted
cannot be over-emphasised. It is not merely on the formulation. of
the theoretical standards but really on the pr11fessional commitments D
with which the prescriptions are implemented that the ultimate result
rests. [254B-C]

The factual foundations requisite for establishing the proximate
causal connection for the injury has yet to be established conclusively.
On humanitarian consideration, the victims should be afforded some E
monetary relief by the State Government. 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 of the victims. The victims
entitled to receive the additional payment shall be the same as those who
had the benefit of the interim relief of Rs.5,000. [2550-F J
F
That the Revised Guidelines dated 9.2.1988 with the suggested
modifications can be held to be satisfactory. [254F]

The Court abstained from pronouncing on the question of culp-
able rashness or negligence on the part of the Doctors or others against
whom separate action is either pending or contemplated. [246G J G

Dr. Laxman Balakrishna Joshi v. Trimbak Bapu Godbola, AIR
1969 S.C. 128, Para 11 and Street on Torts, [1983] (7th Edn.), referred
to.
ORIGINAL JURISDICTION: Writ Petition (Civil) No. 1247 of H
1986.
244 SUPREME COURT REPORTS [1989] 3 S.C.R.

(Under Article 32 of the Constitution of India).
A
Ranji Thomas and T. Sridharan for the Petitioners.

B.P. Beri; B.R. Agarwala, Miss Sushma Manchanda, Miss A,
Subhashini, B.D. Sharma, R.S. Yadav, Yogeshwar Prasad, Mrs. S.
B Dikshit, H.K. Puri and P. Paremeshwaran for the Respondents. ::,_.

The following Order of the Court was delivered:

ORDER

c PotteryTheTown
facts of this case are indeed, distressing. The Lions Club,
at Khurja in Ottat Pradesh arranged and conducted, as
part of its social service programme, an "Eye-Camp" intended to ex-
tend facilities of expert Ophthalmic surgical services to the residents of
the town. The Club invited Dr. R.M. Sahay of the Sahay Hospital,
Jaipur and his team of doctors to offer the surgical services. The Camp
D was arranged in 'Aggarwal Dharamshala' at Novelty Road, Khurja.
Dr. R.M. Sahay and his team of doctros 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
E Khurja that evening for Moradabad where he was scheduled to con-
duct similar operations at another "Eye-Camp."

But the whole programme at Khurja, however laudable the
intentions with which it might have been launched, proved a disastrous
medical misadventure for the patients. The operated-eyes of the
F patients were irreversibly damaged, owing to a post-operative infec-
tion 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 infec-
tion. Dr. Sahay returned on the 24th April and undertook himself
some ameliorative treatment. But the operated eyes had been
G 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.

It is now undisputed that this terrible medical mishap was due to
1-1 a common contaminating source. The suggestion in the Report of the
A.S. MIITAL v. STATE OF U.P. 245

enquiries that ensued is that, in all probability, the source of the infec-
A
tion, referred to as E coli infection of the intra ocular cavity, was the
"normal saline" used on the eyes at the ti;Tie of surgery. Dr. Sahay
who had himself brought all medicines and surgical instruments for use
at the Camp claims to have purchased the Saline from a certain M/s.
Mehtaad Company, Jaipur on 22.3.1986 under Invoice No. 1533.
B
2. The matter was brought before this Court in the form of a
Public Interest Litigation under Article 32 by two social activists, Shri
A.S. Mittal and Shri Om Prakash Tapas, acting on behalf of an organi-
sation 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, Buland Sahar District (U .P.) and the Lions Club of C
Pottery Town, Khurja. However, this Court by its order dated
26. 9. 1986 directed the Indian Medical Council and the Union of India
to be impleaded as parties to the proceedings. All the respondents
have filed their respective ·CO!tnter-affidavits.

In the Writ Petition, the petitioners have made serious allega- D
tions about the very bona /ides 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 are that: the victims of this medical mishap
be given expert rehabilitatory treatment and appropriate compensa- E
ti on; that Government do conduct a thorough investigation as to the
conditions which rendered a medical misadventure of such a scale
possible and evolve proper gµide-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 bre.a- F
ches of duty in sanctioning permission for the conduct of the 'eye-
camp' without ensuring a strict compliance with the conditions pre-
scribed in the Guidelines prescribed by the Government in that behalf
and in not effectively discharging the duties enjoined upon them to
over-see the satisfactory and safe functioning of the camp.
G
-..( 3. At the directions of the Government of Uttar Pradesh, the
Deputy Director (Eye Treatment} conducted an inquiry i!ltO Ute hi!p-
penings and his report and recommendations submittec! to the G1ivern-
ment >1re produced in the proceec!ings. Similarly, the inquiry rnport
dated 8.6.1986 condpcted by Shri Shatrughan Singh, Sub-Divisional
Magistrate, Khurja as to the incident, are also before the Court. We H
246 SUPREME COURT REPORTS [1989] 3 S.C.R.

have perused these reports and the counter-affidavits and heard
A learned counsel.

4. So far as the grievance in the Writ Petition of prosecutorial
inaction on the part of the Government and the need to direct Govern-
ment to initiate appropriate action against those responsible for the
B tragedy is concerned, it was submitted before us that persuant to the
results of the inquiries conducted by the Deputy Director (Eye Treat-
ment) and the Sub-Divisional Magistrate, appropriate follow-up
action is contemplated by the Government against persons concerned
and that, indeed, a criminal case has been registered against Dr. R.M.
Sahay under Section 338 of the Indian Penal Code.
c It was, however, submitted on behalf of Dr. R.M. Sahay,
Respondent No. 2, that we should abstain from saying anything which
might tend to pre-judge merits of the prosecution. In his counter-
affadivit, Dr. Sahay says:

D "The police has registered a case u/s 338 of the Indian
Penal Code, against the Answering Respondent, and he
has been admitted to bail. Any process by which the
answering respondent would be compelled to disclose, in
advance, his defence at the criminal trial by replying to
specific allegations in the Writ Petition would be violative
E of Art. 20(3) of the Constitution of India, in so far as it
concerns the Answering Respondent."

Referring to the limited scope of the present proceedings, Dr.
Sahay expresses the confidence:

F " ...... that in view of the noble objective of this kind of
litigation, it will not in any manner be prejudicial to th.e
answering respondent."

We think we should accept the submission of the doctor and
should .abstain from pronouncing on the question of culpable rashness
G or negligence on the part of the doctors or others against whom sepa-
rate action is either pending or contemplated.

5. But there are some assumptions and Statements in counter-
affidavit of Dr. Sahay that cannot be allowed to pass without com-
ment. It is undisputed that out of those operated at Khurja, at least 84
H persons suffered permanent damage of the operated eyes. It is said ·
A.S. MITI.AL v. STATE OF U.P. 247

that about 15 similar cases occurred at the Moradabad 'Eye-Camp'.
Indeed, in the course of his counter-affidavit, Dr. Sahay admitted the A
unfortunate event which he called a "Mishap":

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

r
I

B
"Despite all possible care MISHAPS cannot always be
ti
~· avoided in human effors because the error of one link in the
entire chain may sometime result in a total failure."
). )
•"1
But the doctor's description of what happened to the victims is
somewhat of an over-simplification. As to the. devastation the almost
universal post-operative infection left behind in its trial, the doctor c
says:

"It is unfortunate that despite every care taken by the Ans-
wering Respondent and his associates and assistants a large
number of patients could not regain their vision in the D
Khur ja Camp. "

"It is extremely unfortunate that some 84 patients' vision
could not be restored despite every care bestowed by the
answering respondent and his associates and assistants."
E
"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 ..... "
} (Emphasis supplied)
F
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." These are not
mere cases of .eye-sight of the patients not having been restored in the
sense that the surgical operations conducted on them did not yield the G
··"( desired result; or that no positive benefit was derived by them from the
surgery. But the picture is entirely different. 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. Even according to Dr. Sahay the modern techni- H
248 SUPREME COURT REPORTS [19891 3 S.CR.

A ques in opthalmic surgery render cataract a minor operation. A
cataract affected eye when properly operated is expected to become
normal. The operation is meant to remove an obstruction to vision and
restoration of normal eye sight. This implies that the eyes of patients
selected for operation had the potential for restoration of sight. In the
present cases, they have become totally blind in the operated eyes.
B
Apart altogether from the causal-connection between the wide-
spread infection and medication or surgical procedures, as the case
may be, applied or employed, it is really undisputed that such a
general and widespread post-operative infection did occur. Referring
to the medical management of the emerging crisis, Dr. Sahay himself
C says:

"It may be mentioned that on the morning of 22nd April,
1986, Dr. R. Sekhri opened the bandage and suspected
intra ocular infection and therefore commenced antibiotic
treatment both local and oral. On the 22nd April, Dr.
D Sekhri reached Moradabad for consultations. The Answer-
ing Respondent approved of the antibiotic medicines and
sent Dr. M. Punjabi with additional supplies of medicines
of Khurja. On 23.4.1986 both Dr. Sekhri and Dr. M.
Punjabi gave anterior chamber wash and antibiotic medi-
cines. At about midnight the answering respondent rushed
E by road to Khurja without any consideration for his
personal comfort and commenced attending the patients.
He washed anterior chambers performed vitrectomy
(removing the infected part) and administered pain reliev-
ing medicines. The petitioners have inexactly described the
doings as operation, sedation and removal of Cornea. All ~
F this was done in the same room in which the earlier opera- '·
tions were performed."

6. One of the points brought out in the petition is that the prop-
aganda literature published by the Lions Club in relation to the camp
was that allurements, prohibited by medical ethics, were held out to
G the patients with attractive slogans such as 'Get Operated and go
home', 'No restriction of food', 'No bed rest', and 'No stitches to be )-
removed' etc., etc. It was alleged that the guidelines required a minimal
instit\Jtional post operative care for few days under constant compe-
tent medical supervision and that in the present case the patients were
allowed to go back immediately after the operations. Dr. Sahay's
H affidavit, in a way, does not deny this kind of propaganda or lack of
A.S. MIITAL v. STATE OF U.P. 249

institutional post-operation care. Indeed, some justification is plea-
A
ded. Dr. Sahay says in his counter-affidavit:

"It is true that in the modern technique a cataract opera-
tion by Crye-Micro Surgery System does not require 10
days immobility or liquid diet and the like, because the
modern sutures securely seal the operation incision and B
make it water tight. The sutures are seldom removed-and
the patient is, in normal cases fit enough to move about
within few hours of the operation. The Khurja Camp
operations were conducted between the hours of about 11
A.M. to 6 P.M. with half an hour's break. The 9 operation
tables for three surgeons gave ample room and time for
pre-operation steps and post-operative procedures." c

How far the lack of intensive post operative institutional care
contributed to the infection or the aggravation of its effects is a matter
which cannot be decided in these proceedings. These are technical
matters for professional medical assessments. But the guidelines pre- D
scribed by Government do not prima-facie, seem to encourage such
complacence in regard to the imperatives of post operative care.

,l 7. The problems of the Ophthalmic Health Status of the Indian
citizen are of a dimension causing an under-standable concern. The
very large number of cases of impairment of visual acuity in the E
country needs the purposeful involvement of voluntary social organi-
sations so as to provide an augmented, broad-based, participatory
medi-care for the general improvement of the tone of ophthalmic
health in the country. Government of India, evolved a comprehensive
) policy and programme for control of blindness, which, amongst other
. things, envisaged a programme for the promotion of eye-care through F
'eye-camps' organised by social and voluntary organisations and to
provide financial assistance to them.

Our attention was drawn to the circular No. T. 12011/4/82/
OPTH dated 13.10.1982 issued by the Ministry of Health and Family
Welfare to all the States and Union Territories, laying down certain G
-~ norms and guidelines for the conduct of such 'eye-camps'. A copy of
that circular is annexure 'R-1' to the counter-affidavit dated 10.1.1987
filed on behalf of the State of U.P. Pursuant thereto, on 18.4.1984
State Government issued appropriate directions to its officers and
authorities for strict compliance with the guidelines issued by the
Central Government. It is on the basis of these guidelines that permis- H
250 SUPREME COURT REPORTS [1989) 3 S.C.R.

A sion was accorded to the Lions Club to conduct the eye-camp. The
y
permission granted by Chief Medical Officer, Buland Shahar on
·,
21.4.1986 says:
'I'

"The Lions Club, Pottery Town, Institute/organisation is
permitted to hold free eye camps applied with the specific :1
B condition that the camps will be organised in rural areas -Y.. •.'
and supervised by Senior Ophthalmic Surgeon & the
·operation will be performed by the qualified Ophtalmic
surgeon and staff oand that competent ophthalmic
Surgeon(s) would remain at the camp site throughout the :'J-.- 1
duration of the camp till the last patient is discharged."
c 8. Though the events at the eye-camp raise several questions of
interest on the law as to professional-negligence, we do not want to be
understood as intending to record any findings on the conduct of Dr.
R.M. Sahay and his team or the officers of U.P. Government who
granted permission for the eye camp and who, allegedly, did not dis-
D charge their duties implicit in the guidelines issued by Government. A
mistake by a medical practitioner which no reasonably competent and
a careful practitioner would have committed is a negligent one. One of
the questions that might arise in the appropriate forum is whether the
doctors, judged by the circumstances in which they were working, -(
made a mistake and if so whether such a mistake was negligent.
E
A vast amount of legal literature concerns the concept of
'reasonable man' in the Law of Torts. To some, like Sir Allen Herbert,
he is "never a woman"; to some others 'an odious and insufferable

F
creature who never makes a mistake'; and according to Lord Radcliff
the parties would become disembodied spirits in whose place arises the
idea of a reasonable man as the "anthropomorphic conception of
*
justice."

9. But the law recognises the dangers which are inherent in
surgical operations. Mistakes will occur on occasions despite the
exercise of reasonable skill and care. Jackson and Powell on 'Profes-
G sional Negligence', (1982 Edn.) say:

" ..... In White v. Board of Governors of Westminister
Hospital, a surgeon accidentally cut the retina during an
operation on the plaintiff's right eye. As a result the eye
became useless and had to be removed. Thompson J ac-
H quitted the surgeon of any negligence. He was working
A.S. MITIAL v. STATE OF U.P. 251

within a very few millimeters and exercised due skill, care
A
and judgment ...... "
(Page 232)

But, in a case where the plaintiff developed meningitis as a result
of some infection in the apparatus used in the operation it was held
1 that there must have been some negligence by the hospital staff for
which the hospital authority was responsible. (ibid para 6.53) But
B.

where the operation is a race against time, the Court will make greater
allowance for mistake on the part of the surgeon or his assistants,
taking into account the 'Risk-benefit' test. In Dr. Laxman Balakrishna
Joshi v. Trimback Bapu Godbola, A.LR. 1969 S.C. 128, Para 11, this
Court held:
c
"The duties which a doctor owes to his patient are clear. A
person who holds himself out ready to give medical advice
and treatment impliedly undertakes that he is possessed of
skill and knowledge for the purpose. Such a person when
consulted by a patient owes him certain duties, viz., a duty D
of care in deciding whether to undertake the case, a duty of
care in deciding what treatment to give or a duty of care in
the administration of that treatment. A breach of any of
those duties gives a right of action for negligence to the
patient. The practitioner must bring to his task a reason-
able degree of skill and knowledge and must exercise a E
reasonable degree of care. Neither the very highest nor a
very low degree of care and competence judged in the light
of the particular circumstances of each case is what the law
' requires: The doctor no doubt has a discretion in choosing
J /•
treatment which he proposes to _give to the eatient and such
discretion is relatively ampler in case of emergency ...... " F

Streeton Torts (1983) (7th edn.) suggests that doctrine of Res Ipso
Loquitur is attracted: ·

" ..... where an unexplanied accident occurs from a thing
under the control of the defendant, and medical or other G
experts evidence shows that such accidents would not
happen if proper care were used, there is at least evidence
of negligence for a jury."
(P. 126)

Charlsworth & Percy on 'Negligence' refer to a case where a H
252 SUPREME COURT REPORTS [1989] 3 S.C.R.

woman was placed in the same ward with another suspected of, and
A
later found to be suffering from, puerperal fever and as a result she got
puerperal fever herself. The doctor was held negligent in not isolating
her when the other case was suspected and in not taking steps to
prevent her from being infected.
(See P. 546).
B
The explanation of the doctors appears to be that the infection
occurred despite all precaution. Though it is not said so in so many
words, the drift of the explanation is that the saline, used to irrigate
the eyes during surgery to maintain turgidity of the operational
surface, which was purchased from a reputed manufacturer might be
the source of the contamination. If that be so, the question of the
c liability of the manufacturer for what is called "product-liability" and
the further question whether in such cases of mass-use, a pre-test for
safety and purity of the article was necessary and whether failure to do
so would be actionable. These questions are necessarily to be
answered on evidence. In these proceedings neither do we have full
o evidence nor does the scope of the proceedings permit such findings to
be recorded conclusively.

10. The aspects to which the present proceedings are confined
are:

E (a) Whether the Guidelines prescribing norms and conditions
for the conduct of 'eye-camps' are sufficiently comprehensive to
ensure the protection of the patients who are generally drawn
from the poorer and less affluent section of society or whether
any further guidelines would require to be evolved?
~--
F (b) What relief, monitary or otherwise, should be afforded to
those who have suffered?

Re: Point (a):

11. After the institution of these proceedings Central Govern-
G men!, 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 existing guidelines or evolve fresh ones. As a result of
the deliberations of the said Committee and pursuant to its recommen-
dations, the guidelines for conduct of eye-camps earlier issued have
H been updated and revised. A copy.of the Revised Guidelines issued on
A.S. MIITAL •. STATE OF U.P. 253

9.2.1988 by the Ministry of Health & Family Welfare vide their No. T. A
12019/41/86 OPTH (Pt II) dated 9.2.1988, is filed before the Court.
We have perused these guidelines which are sent to all the States for
implementation.

The Indian Medical Council, after its impleadment in these pro-
ceedings also constituted a sub-committee with Dr. P. Shiva Reddy B
and other members. The Committee deliberated on the issue and its
recommendations in regard to the norms for the conduct and manage-
ment of eye-camps have been filed before this Court. We place u.1
record our appreciation of the assistance rendered by the Council.

12. We have examined the revised guidelines issued on 9.2.1988 C
by the Union Government and the recommendation of the sub-
committee cif the Indian Medical Council. The two sets of norms
though evolved independently, substantially cover all the important
areas. We think that the Revised nofll]S issued by the Union Govern-
·ment on 9.2.1988 arrived at after a careful study of all aspects of the
problem are quite comprehensive. However, we venture to suggest D
that some points made in the Report and Recommendation of the
expert sub-committee of the Indian Medical Council may be consi-
dered by the Union Government for incorporation in their Revised
_). .. Guidelines dated 9.2.1988. The prescriptions referred to by the said
sub-committee of the Indian Medical Council at pages 4,5 and 10.
respectively, of the report are these: E

"Staff: The operations in the camp should only be
performed by qualified, experienced Ophthalmic Surgeons
registered with Medical Council of India or any State Medi-
cal Council. The camp should not be used as a training
ground for post-graduate students, and operative work F
should not be entrusted to post-graduate students."

"There should be a pathologist to examine Urine, blood,
sugar etc.

It is preferable to have a Dentist to check the teeth for G
sepsis and a Physician for general medical check-up."

"Midication:

(a) All medicines to be used should be of standard quality
duly verified by the doctor in-charge of the camp." H
254 SUPREME COURT REPORTS [1989) 3 S.C.R.

These aspects are generally covered in the Government's Revised
A Guidelines dated 9.2.1988. But, for the sake of special emphasis keep-
ing their importance in view the above aspects stressed in the Report
of the Sub-committee of the Indian Medical Council may be consi-
dered for incorporation in the Revised Guidelines of 9th February,
1988. We direct accordingly.
B
13. The necessity of maintenance of the highest standards of a
septic and sterile conditions at places where Ophthalmic surgery-or
.,
I

any surgery-is conducted cannot be over-emphasised. It is not merely
on the formulation of the theoretical standards but really on the
professional commitment with which the prescriptions are imple-
C mented that the ultimate result rests. Government, States and Union,
incur enormous expenditure of public money on health care. But, the
standards of cleanliness and hygiene in public hospitals unfortunately,
leave greatly to be desired. The.maintenance of steriles, aseptic condi-
tions in hospitals to prevent cross-infections should be ordinary,
routine and minimal incidents of maintenance of hospitals. Purity of
D the drugs and medicines intended for man-use would have to be
ensued by prior tests and inspection. But, owing to a general air of
cynical irreverence towards values that has, unfortunately, developed
and to the mood of complacence with the continuing deterioration of
standards, the very concept of standards and the imperatives of their
observance tend to be impaired. This is a disturbing feature. The
E remedy lies in a ruthless adherence to the virtue of method and laying
down practical procedures in the minutes of detail and by exacting-
not merely expecting-strict adherence to these procedures.

14. On point (a), we think that the Revised guidelines dated
9.2.1988, with the suggested modifications, can be held to be ~·
F satisfactory.

15. Re: Point (b):

Pursuant to earlier orders of this Court, each of the victims had
been paid a sum of Rs.5,000.00 by the State Government by way of
G interim relief. Shri Ranji Thomas, learned 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. Learned counsel also sought to rest the right
of the victims for damages on the footing that the persons who
H organised the 'eye-camp' were acting pursuant to and under the
A.S. MITIAL v. STATE OF u.r.· 255

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. A
accordingly be held vicariously liable. In regard to the quantum of
relief, learned counsel submitted that the unfortunate victims had
suffered irreversible damage of the eyes which has rendered them
wholly incapacitated.
B
16. We are afraid in the circumstances of this case, the factual
foundations laid before the Court and the limited. scope of the pro'

-·----' ceedings no appeal could be made to the doctrine of State action. Shri
Yogeshwar Prasad, learned Senior Counsel appearing for the State of
Uttar Pradesh, submitted that the State would approach the matter not
with the spirit of a litigant in any adversy action but would look upon
the proceedings as a participatory exploration for relief to the victims. c
He further submitted that the State would indeed, be willing to render
help to the victims within the constraints of its resources.

Indeed, the factual foundations requisite for establishing the
proximate causal-connection for the in jury has yet to be established D
conclusively. These matters would have to be gone into in the criminal
and other proceedings that may be pending or in the contemplation of
the Government.

However, we think that on humanitarian consideration, the
victims should be afforded some monitary relief by the State Govern- E
ment. We direct 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. The victims entitled to receive the

J additional payment shall be the same as those who had the benefit of
the interim relief of Rs.5,000. The amount shall be deposited, as was
done in the matter of distribution of interim relief, with the District F
Judge who shall arrange to distribute the same in accordance with the
procedure adopted at the time of administration of the interim relief.
The deposit shall be made within two months from today and the
District Judge shall ensure distribution within the next two months.

17. We further direct that, additionally, if any of the victims are, G
otherwise, eligible for any benefit of pension under any of the existing
schemes now in force in the State, their cases shall be considered for
such benefit. The Legal Aid and Advice Board of U.P. State shall
take-up this issue anll process the claims of the victims for such other
benefits under any of the existing Government schemes providing for
aid to the aged, the disabled, and the destitute, subject to the condi- H
256 SUPREME COURT REPORTS [1989) 3 S.C.R.

A lion that the victims otherwise satisfy the conditions of those schemes.

18. We place on record the services rendered by the petitioners
in espousing the cause of these unfortunate victims and prosecuting it
with diligence. We direct the State of U .P. to pay their costs which is
B quantified at Rs.5,000. The Writ Petitionn is disposed ofaccordingly.

Y.L. Petition disposed of.

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