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Caught In The Web Of Regulations
The reluctance of housing societies to provide ‘Change
of User’ certificate to nursing homes has owners up in arms, reports
Jayata Sharma
Plagued with several stringent regulations, nursing homes in Mumbai have recently
knocked on the doors of BMC for help. Despite being the backbone of the healthcare
delivery system in Mumbai and accounting to for over 70 per cent of the city’s
healthcare needs, over 1,700 nursing homes in the city today are riddled saddled
with regulations that raise questions about their future existence.
The ‘latest’ requirement which has raised hackles is a certificate
called ‘Change of User’. Interestingly, this certification is has
been in force since for decades. “I had started my nursing home, Dr Sheth’s
Nursing Home (now closed down), in the early 1950’s and got the certification
done in the early 1970’s, when the BMC officials informed me about it,”
says Dr Shudha Sheth, President, Bombay Nursing Home Association. In spite of
the certification being in existence for so long, it was not made mandatory
in the process of the registration of nursing homes. “In and around the
area of Cuffe Parade (South Mumbai), where I had my nursing home, the vigilance
was strict. As a result, most of the nursing homes in our locality already have
the ‘Change Of User’ certificate,” informs Dr Sheth.
The doctors are still ready to submit the certificate, but the real problem
lies somewhere elsewhere. It is the housing societies who are not ready to co-operate.
The reason? “It is the theory idea of ‘Not In My Backyard’. Everybody
wants to have a nursing home nearby, but not in their society itself,”
says Dr Bipin Pandit, President, AMC. “It is a fact that residential societies
get are disturbed if a commercial activity is conducted in their premises,”
says Advocate Vinod Sampat, who mostly specialises in housing society matters.
He further adds that the elderly persons in the society are the ones who get
disturbed the most and hence cause trouble when the nursing homes require the
certificate.
The strict regulations and numerous hurdles may lead to closure
of a few nursing homes, say analysts. “I have thought of quitting many
times,” reveals Dr Ketan Parikh, Former President and Zonal Director, AMC
and owner of Tara Neo-Surg Nursing Home.
Sustaining a nursing home is not an easy task. The
tedious list of regulations one has to adhere to speaks volumes about it.
Here are a few of the hurdles:
- Biomedical waste disposal
- Shops and Establishments Act regulations
- Co-operative Housing Society regulations
- Difficulty in obtaining registration certificate under BNHRA from
BMC
- Non-availability of qualified nursing staff
- Physical voilence violence against nursing homes by patients/relatives
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| For any internal change in the premises of a clinic,
/nursing home the doctor is required to seek permission of the BMC as well
as the society. In a number of cases even the report of structural engineer/architect
is also essential for change in the premises of the society. The certificate
thus obtained is called the 'Change Of User'. If any doctor wishes to convert
his clinic by using the adjacent room by pulling down the wall, for that
purpose also the Change of user is required |
Possible Solutions
To find a solution to these hurdles, the Association of Medical Consultants
(AMC) recently arranged discussions of representatives from the State Government,
consumer activists, legal luminaries and co-operative society experts. Suggestions
for improvement were put forward to the BMC officials. Reportedly, Dr PP Doke,
Director General, Health Services, Maharashtra State and Dr JJ Thanekar, Executive
Health Officer, BMC have promised positive steps in this matter.
Numerous solutions were given a thought considered to help ease the operations
of nursing homes. “We can have a provision to make the nursing home a deemed
user of the premises if it is running for seven years or more at the same place,”
suggests Advocate DS Vader, Chairman, Federation of Housing Societies. “A
separate system to manage nursing homes is a difficult preposition. Instead,
we need to think of how emerging ones can be self-regulatory and provide optimum
facilities,” opines Ameeta Pitre, Consumer Activist, Cehat.
“The nursing homes can give us the a list of the housing societies who
are not willing to help. We will personally go and make the societies understand
the importance of providing the certificate,” says Vader.
Instead of having a retrospective approach, the doctors are of the opinion to
setting a benchmark for the formalities of certification.
“The doctors planning to open a nursing home can obtain the change of user
at the time of construction of the building, when the society is still yet not
in the picture,” suggests Dr Thanekar, Executive Health Officer, BMC.
The State Hydrological Department granted nursing homes a permission to have
a separate water line without obtaining a NOC from the landlord. Similar steps
are possible in the above problems too. “If the BMC makes up its mind,
nothing is impossible,” concludes Dr Sheth.
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