(a) to (d): There have been sporadic reports of loss of eye sight by the patients coming to the eye camps organized by the Non-Governmental Organizations (NGOs). All these mishap of loss of eye sight due to severe post-operative infections (endophthalmitis) have been thoroughly investigated to find out the factors leading to such mishaps. The details of major eye mishaps as reported by States concerned during the last three years (2012-13, 2013-14 & 2014-15) are as under:-
(i) Eye Mishap at Chhattisgarh:
State Programme Officer (NPCB), Chhattisgarh has reported that an eye camp was organized from 8-12 December, 2012 by Shri Krishna Agarwal Smriti Trust at Bagbahara, district Mahasamund, Chhattisgarh. The camp was conducted with the permission of Chief Medical and Health Officer, Mahasamund, Chhattisgarh. A total 145 patients were identified in the eye camp and operated for cataract at Community Health Centre, Bagbahara. The affected patients were treated at MGM Eye Hospital, Raipur, Chhattisgarh. A total of 16 people were reported to have lost their eye sight during the eye camp.
Action taken by the Govt. of Chhattisgarh
The incidence of eye mishap has been investigated by a committee constituted by the Government of Chhattisgarh Punitive action has been taken against the eye surgeon and other support staff for negligence. Four drugs were found to be below standard and these manufacturers have been banned from Government purchase. The NGO involved in organizing the eye camp has been banned for organizing eye camps in future. The payment of financial claims of the NGO has also been cancelled.
Standard Operating Protocol has been issued and operations in camp mode are banned. Only regular operations in well-equipped base hospitals are permitted to prevent reoccurrence of such incidents.
It has also been informed by the State Programme Officer (NPCB), Chhattisgarh that a compensation of Rs. one lakh each to 16 affected persons was given by the State. In addition, Rs.3.5 lakh has been provided for treatment of the affected persons.
(ii) Eye Mishap at Punjab:
Directorate Health & Family Welfare, Punjab has reported that SKM Netralaya, Mathura, Uttar Pradesh organized screening eye camps in four villages falling in Hoshiarpur, Gurdaspur and Amritsar districts of Punjab in association with Guru Nanak Charitable Hospital, Ghuman, District Gurdaspur in October-November, 2014 and got 130 patients operated for cataract in the operation Theatre of Guru Nanak Charitable Hospital, Ghuman, Punjab between 31.10.2014 to 4.11.2014. No permission was obtained by NGO for screening and surgeries as required under rules from the local authorities. On 4.12.2014, several persons appeared before the District Collector, Amritsar complaining of serious complications as a result of the cataract surgery, who got them admitted to Ram Lal Eye Hospital, Government Medical College, Amritsar, Punjab.
A team from PGI, Chandigarh was rushed to the Government Medical College, Amritsar for assisting the GMC team in providing all possible latest treatment.
Out of 40 patients who had presented themselves at Government Medical College, Amritsar, 29 lost their eye sight in operated eye.
Action taken by the Govt. of Punjab
Government of Punjab ordered a high level probe into the eye mishap. As per report of the Committee of experts constituted to ascertain the cause of eye infection leading to loss of sight of some of the operated patients at the camp organized by the NGO at village Ghuman of District Gurdaspur, the most probable cause of mass infection in the eye camp at village Ghuman can be because of contaminated irrigating fluids and/or contaminated operating instruments. An interim relief of Rs. One lakh to each of the affected families, whose members have lost eyesight in the tragedy, has been announced by the State Government. A monthly pension of Rs.2000/- to each person rendered blind in this camp has also been announced.
(iii) Eye mishap at Himachal Pradesh:
State Programme Officer (NPCB), Himachal Pradesh has reported that an eye screening camp of patients was organized by Nagni Mata Prabandhak Committee from 22.3.2014 to 29.3.2014 at its complex at Baranda, Kandwal, Tehsil Nurpur, district Kangra, Himachal Pradesh through Salarai Eye Hospital, Pathankot, Punjab. The 60 patients, selected for cataract surgery, were shifted to the Salaria Eye Hospital, Pathankot, Punjab for their eye operations by the committee at its own. No eye operations were conducted anywhere within the territorial jurisdiction of the State of Himachal Pradesh.
In this regard an enquiry was ordered on 19.12.2014 by CMO, Kangra. During the course of enquiry, out of 60 surgeries performed by Dr. Nitin Salaria, Salaria Eye Hospital, Pathankot, Punjab, 21 patients were examined and it was found that eyes of 15 patients were totally damaged, 5 patients were normal and one needs vitro retinal surgeon opinion at higher centre.
As per the statement of Dr. Nitin Salaria, operating surgeons, Salaria Hospital, Pathankot and the records submitted by Him, it was the HPMC 2% eye drop that were responsible for the infections, (endophthalmitis).
Action taken by the Government of Himachal Pradesh
In this regard an enquiry was ordered on 19.12.2014 by CMO, Kangra.
All the Chief Medical Officer of the Districts in Himachal Pradesh have been directed to follow the guidelines of the Government of India for granting permission for organizing eye camps in the State. All the Non-Governmental Organizations and Voluntary Organization working in Himachal Pradesh approved under NPCB need to sign a Memorandum of Understanding (MOU) with the district authorities concerned as per the existing guidelines.
Action taken by the Ministry of Health & Family Welfare
1) National Programme for Control of Blindness (NPCB) has circulated “Preoperative, intra-operative and post-operative guidelines” for strict compliance by the eye surgeons and all eye care units including NGO eye hospitals in the Country to improve quality of eye surgery and avoid eye mishaps.
2) Referring the provision of guidelines issued under the NPCB, an advisory was issued to all States/UTs regarding precaution to be followed on Ophthalmic Surgeries to avoid cases of loss of vision. This advisory state, inter alia, that eye operations are to be done only in fixed operation theatres exclusive for eye surgeries. Camps are permitted only for screening of patients and bringing them to the base hospital for eye surgeries. All NGOs and voluntary organization approved under NPCB need to sign a MOU with the district authority as per the Guidelines issued under NPCB.
The advisory also states that all the other NGOs operating but not registered under NPCB are required to obtain the necessary permission from the State Health authorities for approval of the hospital of OPD work and the operation theatres for conducting eye surgeries. The State authorities need to develop their own guidelines/mechanism for this purpose. In case of any negligence on the part of voluntary organization, appropriate penal action should be taken by the State authorities against them.
All the Government and private eye surgeons in all districts of States/UTs have been sensitized to strictly adhere to norms of NPCB and observe universal surgical precautions.