Building use(BS) certificate: 400 Ahmedabad hospitals face closure

Ahmedabad: The members of Ahmedabad Hospitals & Nursing Homes Association (AHNA) have informed the media persons in a press conference that around 400 hospitals and nursing homes in the city are facing an imminent threat of closure in the city due to the non-renewal of Form C, which is required for the registration of a medical establishment.  

As per a media report in the Indian Express, the Ahmedabad Hospitals and Nursing Homes Association (AHNA) on Saturday appealed to the Ahmedabad Municipal Corporation (AMC) to waive the mandatory requirement of valid building use (BU) certificate for renewal of Form-C registration for medical establishments. 

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The appeal was made to prevent the closure of almost 400-450 small hospitals and nursing homes in the city, which may be extended upto 1000, said the AHNA. 

As per a media report in the Times of India, the Ahmedabad Municipal Corporation rule would be responsible for the closure as the rule stipulates the need for BU permission for the renewal of Form C. The renewal rule was revised following the directions given by the judiciary which observed the need for all hospitals to follow stringent fire and building safety regulations.

Stating that such closures would be unprecedented all over the country, Dr. Viren Shah, the secretary of AHNA said, "Since 1949, all medical establishments have been providing the necessary documents under the Bombay Nursing Homes Registration Act, 1949," adding, "All hospitals pay the necessary professional fees, taxes, etc. In a majority of the cases, the buildings — when made — were part of a different civic body and did not have the same rules as now." 

Dr. Shah added that no BU permission was required for filing Form C till October 2021. Such a requirement is "impractical and complicated" for several small medical establishments, according to the AHNA. 

The press note accessed by the Medical Dialogues team stated that "Since October 2021, AMC started demanding a valid Building Use (BU) permission for the registration under the said act, which has resulted in the current situation. Till Oct 2021, BU permission was never required for the registration of nursing homes and hospitals. AMC would verify the staff details including qualifications and then issue the Registration Certificate, know commonly as Form"C". Furthermore, out of all cities, only Ahmedabad Corporation has demanded such as Permission for the Registration. It's further ironic that this permission is required only for healthcare facilities dealing with modern medicine."

According to AHNA, the laws governing BU are complex, and they do not mention any separate parameters for small healthcare facilities or daycare facilities as these don't require such strict parameters. The press note states, "Ahmedabad's 70 to 80% healthcare needs are met by these small nursing homes and hospitals. And that is the reason that a common man can afford healthcare services. The laws of BU have changed periodically and have evolved over time. Since the city expanded, Ahmedabad Urban Development Authority (AUDA) was formed in 1978 and the first development plan was sanctioned in 1987. A revised plan was declared on 18th May 2002. Till almost Dec 2003, most small hospitals and nursing homes were developed on the basis of the old Development plans only. Since healthcare was in its nascent stage, most of these facilities were converted from standalone clinics to small nursing homes in the residential areas. There was no requirement of "Change of Use" for the same. Till 2007. Obtaining BU permission was never a stringent prerequisite for starting healthcare facilities. At that time, parking requirements too were not much as the city had very few vehicles. Apart from this, each city of Gujarat had different laws for the BU." 

However, buildings built after 2014 have BU permissions as many laws were made. 

Dr. Jigar Shah, Joint Secretary, AHNA said that if the BU requirement for Form "C" renewal is not kept aside till a practical solution is arrived at, in the coming years, almost 900 to 1000 small nursing homes and hospitals will face closures. Common people have to travel long distances for availing any healthcare. The costs will increase as well as the time to reach there will increase, leading to loss of lives. Hospital staff will lose their livelihood. And, God forbids, if there is another Covid, wave, we can just imagine what will be the consequences because of the non-availability of beds.

AHNA treasurer Dr. Divyang Brahmbhatt informed that any laws are made for public safety. However, due to the non-renewal of Form "C", small hospitals and nursing homes will close down, leading to the nonavailability of cost-effective healthcare near residential areas. 

According to AHNA president Dr. Bharat Gadhvi, nearly 50% of buildings might not have permission under the existing laws if we look at the existing BU rules. Gadhvi said, "Under the aegis of AHNA, we have ensured that more than 99% of hospitals have fire safety norms in place." adding, "But when it comes to hospitals in commercial spaces, why are only doctors targeted?"

Dr. Gadhvi further observed that there should be some lacuna in the law the town planning department's own submission as nearly 50 percent of the buildings don't have valid BU permits, a submission also put forth before the Gujarat HC by the state government in public interest litigation concerning fire and building safety. The court order was initiated after a fire at the Shrey Hospital in August 2020 due to which eight patients were killed. The doctor noted, "This policy does not take into account the fact that for small medical establishments which do not see ambulance movements or don't have emergency facilities like that at bigger hospitals." 

Putting forth their demands, AHNA said, "we appeal you to renew the Form "C" registration of all the nursing homes and hospitals. We have repeatedly represented to the state government as well as AMC officials for the same. But we have not been provided any solution till date."

Dr. Shashikala Sahu, a gynecologist who has been associated with Bhagyodaya Maternity and Nursing Home in Ranip in Ahmedabad said, "The building was made in 1984 and being in the jurisdiction of gram panchayat as Ranip was a 'gamtal' initially, followed by the municipality and now a municipal corporation. During the state's impact fee regularisation scheme a decade ago, we were told that BU permit is not needed if we have not made any changes to the building plan, which we haven't, as the establishment is small and falls under rural jurisdiction. We have had no issues in renewing Form-C earlier but this time we have received a query on the BU permit and thus renewal remains pending. With no Form-C, we can only conduct OPD services as indoor patient admissions are not allowed," reports the Indian Express. 

Further, the AHNA is also planning to hold Medical Bandh, rallies, Dharna (Sit-ins) and Footpath Clinics in order to make the people and the government aware of their situation. The press note stated, "We apologize for any inconvenience caused to the general public due to such protests and expect that the government will take immediate steps to rectify the issues. We have to come to the streets in order to ensure that the healthcare services continue to be nearer to the general public and remain cost effective."

Speaking to the Medical Dialogues team, Dr. Viren Shah, the secretary of AHNA said, "For current rally & strike by hospital we have still not issued press note."   

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