Blinding Reality, fact-finding into Madhya Pradesh Cateract blindings

Investigation blames un-controlled quality conditions drug procurement as the chief cause for the loss of sight of patients who are poor

Poorly sanitized operation conditions including questionable hygiene and untested quality of drugs, fluids and injections were the primary cause for the tragic loss of vision of 66 persons during the eye cataract surgery camp jointly organized and conducted by the Barwani District Hospital and Lion’s Club between November 16 to 24, 2015, under the District Blindness Control Programme, part of National Blindness Control Programme in Madhya Pradesh. Initially reports suggested that 24 persons had lost vision in one eye but the probe suggests that the figure is higher.
 
These are the major findings of a fact-finding team and investigation conducted by representatives of the Jan Swasthya Abhiyan and Narmada Bachao Andolan that were released on December 17, 2015.
 
The report sums up some of the worst cases and recommends that patients who have fallen victims to this institutional callousness should be immediately referred to higher referral hospitals outside the state (Madhya Pradesh) and every efforts be made by the government to ensure eye replacement surgeries. The issue of fair compensation (reparation) to all the survivors has also been flagged in the report.   At least one member of each affected household should be provided means of regular livelihood and free Medical facilities should be provided to all affected families.
 
Critically, the state government needs to order a high level and ‘independent’ inquiry into the whole issue of the facts and circumstances behind this eye-camp and the conduct of unregulated health camps in general that have subjected many, especially the poor, to unspeakable tragedies. This enquiry should include the process of quality and procurement of all the drugs, fluids, equipment, and the medical process followed at such camps.

The really sticklish and politically and administratively sensitive issue includes pinning of responsibility. The report of people’s organization has also demanded that strict action should be taken against the offending doctors/medical officers/collector/and others involved in the camp. The suspensions of the collector (district magistrate), CMHO (chief medical health officer) and nodal officers of National Blindness Control Programme have also been demanded with immediate effect. Instead of pinning all blame on the single doctor who conducted the surgery/surgeries on the days when the incidents took place, institutional responsibility needs to be investigated and pinned down. If needed then, due criminal action needs to be taken.

Twenty-four persons (initially) lost their eye-sight as a result of  result of an eye cataract surgery camp which was jointly organised by Barwani District Hospital and Lion’s Club between November, 16-24, 2015, under the District Blindness Control Programme, part of National Blindness Control Programme. (The report today states that 66 of the 86 persons on whom surgeries were conducted had lost vision in one eye)  A committee is formed under the District Blindness Control Programme which is chaired by the District Collector. This committee allocates budget to non-governmental organizations (NGOs) for conducting the camp and procures drugs, injections, and other necessary items through state level tender, or local tender or direct purchase under the guidelines set by the government.
 
According to newspaper reports, the state government had suspended eye specialist R.S. Palod and initiated action against the authorities of the Lions Club. The government has also set up a three-member committee to probe the matter. A total of 86 patients from Sendhwa, Silawad, Dhanora, Warla, Chachria, Balwadi, Pansemal, Niwali, Piplaj, Ekkalwara, Kashta, and Dharamrai of Barwani and Dhar district of Madhya Pradesh were operated upon in the camp.
 
Findings of the Independent Fact-finding report:-

• Ringer’s Lactate solution was used during the eye surgeries which is usually packaged in plastic bottles. This packaging leaves the substance vulnerable to catch fungus. The particulars and quantity of which pre-operative medicines, intra-operative medicines, and post operative medicines that were used in the eye-camp is not known and has not been disclosed by the authorities.  It is a matter of serious concern whether these medicines were procured through a process of procuring state-level tenders, local tenders or through a direct purchasing process.
• After the operations had been conducted, at the time of discharge, the patients were advised to visit their nearest health centre for a follow-up. Based on findings and interviews with patients and their relatives, it is known that the patients were prescribed Moxicip Eye Drop (Moxifloxacin), batch number C850127 of Cipla, Zoxan D of FDC Ltd, Atropine Sulphate of Jawa Pharmacy, Biotin, Levofloxacin and Ibuprofen at discharge. The question (that is a matter for further investigation) is where these medicines were sourced from, centrally from Bhopal or locally at Barwani.
• On the second or third day after the surgery, patients went to health centers/or to the district hospital with complaints of a burning sensation and pain in the eyes.
• They were given injections and some medicines and were asked to return for a further follow-up. Some patients went to private hospitals and spent from their pockets for follow-ups as the district hospital was too far away. The patients got no relief from their symptoms.
• By November 18-19, 2015, similar multiple complaints of pain, itching and watering eyes had started pouring in from the first batch of patients; despite that, surgeries of new patients were continued. It is beyond comprehension as to why fresh surgeries were continued even after knowing that things were amiss and earlier patients had caught severe infections.
• When the complaints became acute and widespread, most patients were asked to come to the District Hospital where they were admitted for follow-up treatment. But none of the patients got any relief from this treatment. Some of the patients were taken to a private hospital namely to the Dr. Rajendra Malviya-owned, Saraswati Eye Hospital. From the information gathered from the interviews with patients, it has come to light that the letterhead portion of the prescription of Dr. Malviya was (has been) torn off and the rest of the prescription was filed in the hospital file. The investigators are in possession of sample copies of Dr. Malviya’s prescriptions (where the letterhead is as mentioned above) and the same has been attached to this report.
• Following this, most of the patients were referred to Sri Aurobindo Institute of Medical Science (SAIMS), Indore. Some patients were referred to M.Y.H. Hospital (Maharaja Yeshwantrao Hospital), Indore where they were kept for a day, followed by moving them to SAIMS. [SAIMS advertises itself as a hospital, medical college, nursing and an institute of allied health services]. It is also a matter to be investigated why patients were referred to SAIMS instead of being treated at M.G.M. Medical College attached hospitals despite MYH Hospital having adequate numbers of ophthalmologist specialists of all levels.
• According to state government rules, in case of any emergency, patients should be referred from the District Hospital to the M.Y.H. Hospital attached to M.G.M Medical College. It is clear from a close examination of the case files of the patients that that they were referred to M.Y.H. Hospital. But what is completely unclear is on what basis and on whose orders were then, thereafter, sent to SAIMS.  It is relevant to note that SAIMS has been in the midst of a controversy earlier. Around three years back, the state government had attempted privatisation and wanted to shift the M.Y.H. Hospital to SAIMS under PPP model, in the guise of knowledge partnership. At that time, this was stopped by sustained campaigns and collective efforts of local citizens’ organizations, individuals, medical fraternity. This had received wide publicity in the media.
• It is not clear whether and how, after sending the suffering patients to a private setup, how many patients could or did,  save their eye sight fully or partially.
• At the time of the referral to Indore, only few of the patients had actually lost the vision in the eyes, according to the fact-finding report. After getting admitted to SAIMS, the patients underwent repeated eye surgeries. During this period, while the patients were either in the district hospital or later on admitted to SAIMS, 66 out of 86 patients, had lost sight in one eye, completely. The condition of the remaining 20 patients needs to be made public. The committee/ state government investigation team should publish a complete list of the medical condition of all 86 patients including their particulars, detailed condition at present, whether any of them have recovered their sight at all, how much has been spent on each patient by the hospital management, at the minimum.
• The first referral to Indore occurred on December 3, 2015 whereas infections were reported between November 18 and 19, 2015. What was the cause for this inexplicable delay even after infections were confirmed? There is no clarity, to date, on how infections erupted almost one month after the eye-camp had conducted the cateract operations.
• The state government investigation team has not yet disclosed to the public, the batch numbers, quality test reports, company names, and procurement detail of drugs, injections and fluids used. These should be made available to the public immediately. The Companies from where drugs were procured and beneficiaries of these companies or people who stand to profit from of these companies should also be disclosed.
• The issue of supply of sub standard drugs throughout the state of Madhya Pradesh has been raised even earlier, but the government has not taken the matter seriously.

 
Case Study of Rashid Khan, son of Kaasam Khan
 
Rashid Khan came to the District Hospital of Barwani on  November 14,  2015 for the treatment of his eye. On the same day at 6 pm, he underwent the cataract operation. He was discharged the next day, on Novemeber 15, 2015 from the hospital. Around eight days later, he complained of severe discomfort in his eye. He came back to the hospital on November 24, 2015 and was sent back home after giving treatment. However, he got no relief. He went to Dr. Malviya of Saraswati Hospital on November 28, 2015, spent Rs. 200 on medical fees and Rs. 1400 on medicines. His bills are available. He got no respite from the pain and itching in his eye. He was sent to SAIMS Indore on December 3, 2015. Rashid Khan has now lost sight of his eye.
 
 
Case Study of Nania
 
Nania, son of Junga, from Village Kashta, Dharamrai, Nisarpur Block, Dhar went to the house of Dr. Radhesham Palod on November 18, 2015 for the treatment of his eye. He paid a fee of Rs. 200 fees and Rs. 2500 for the cataract operation. His surgery was carried out the next day at the eye camp in the District Hospital. After the operation, he was discharged the next day. He started getting pain and burning in his eyes. He came back to the district hospital on November 28, 2015 and saw Dr. Malviya on November 29. His symptoms did not change at all and he got no relief. He was sent to SAIMS on December 6, 2015. Nania has lost sight of his eye.
 
(The investigation has been conducted by Rakesh Chandore,  Dhara, Amulya Nidhi, S.R Azad – Jan Swasthya Abhiyan Medha Patkar, Devisingh Tomar, Bhagirath Dhangar, Rahul Yadav of the Narmada Bachao Andolan)
 

 
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