Tort Law

A.S. Mittal v. State of Uttar Pradesh

(1989) 3 SCC 223

Facts

• A large eye camp was organised at Khurja in Uttar Pradesh.
• More than one hundred persons underwent cataract or other eye operations.
• Many patients came from economically weaker sections and depended upon the organisers for safe treatment.
• A substantial number developed severe post-operative infection.
• Numerous operated eyes were irreversibly damaged.
• Several patients permanently lost their sight in the treated eye.
• A similar incident occurred in another eye camp at Moradabad.
• Investigations indicated a common source of infection.
• Contaminated saline used during the surgery was suspected as a principal cause.
• Serious concerns arose regarding:
o sterilisation;
o cleanliness;
o medicine quality;
o qualifications of personnel;
o patient screening;
o post-operative care; and
o governmental supervision.
• Public-interest proceedings were filed seeking compensation, treatment, investigation and improved standards.
• The Supreme Court examined the incidents while considering systemic medical safety and victim relief.

• What standard of reasonable care applies to mass surgical camps.
• Whether widespread common-source infection supported an inference of negligence.
• What responsibilities rested upon doctors, organisers and State authorities.
• Whether free or charitable medical treatment could operate under lower standards.
• What relief should be provided to the victims.

• Doctors must exercise reasonable professional knowledge, skill and care.
• Organisers of surgical camps must ensure:
o qualified and experienced surgeons;
o sterile premises;
o properly sterilised instruments;
o tested medicines and saline;
o pathology and medical support;
o suitable patient selection;
o adequate post-operative treatment; and
o effective supervision.
• Where an occurrence ordinarily would not happen without negligence and the relevant instrumentalities were controlled by the defendants, res ipsa loquitur may support an inference of negligence.
• Charitable or free medical treatment is not subject to a lower safety standard.
• Public authorities organising or supervising medical camps must implement safeguards in practice rather than merely issue paper guidelines.

• Properly conducted cataract surgery under sterile conditions does not ordinarily cause a large number of patients to develop identical destructive infections.
• The simultaneous injuries strongly indicated systemic failure rather than unrelated individual complications.
• The suspected common saline source raised questions of:
o defective procurement;
o inadequate testing;
o contamination;
o poor storage; and
o failure to verify the materials before use.
• The patients had no practical means of testing the competence of the surgical team or the sterility of the supplies.
• They were entirely dependent upon the organisers and State authorities.
• The fact that the operations were conducted for public welfare could not excuse deficient care.
• The Supreme Court emphasised that eye camps must not become training exercises for inexperienced surgeons or operate without proper diagnostic and emergency facilities.
• Because the public-interest proceeding did not contain complete evidence for identifying the individual fault of every doctor or manufacturer, the Court did not finally determine all private civil liabilities.
• It nevertheless regarded compensation and enforceable preventive measures as necessary responses to the avoidable disaster.

• The Supreme Court directed monetary relief for affected patients, supplementing the interim payments already made.
• It approved and strengthened revised national guidelines governing eye camps.
• It emphasised qualified surgeons, tested medicines, sterilisation, pathology facilities and strict administrative supervision.
• The scale and common nature of the infection demonstrated a grave medical and institutional failure.
• Individual civil or product-liability claims could be pursued separately with fuller evidence.