The Vadilal Sarabhai General Hospital and the Chinai Maternity Hospital, Ahmedbad — the last bastion left for the poor of Ahmedabad to access affordable and qaulity medical care. Photo by Sindhu Thirumalaisamy.
These brimming, flourishing hospitals with a strong pro-poor character are under siege from the land grabbing Ahmedabad Municipal Corporation. Photo by Sindhu Thirumalaisamy.
10th April, 2013.
The saga of the Vadilal Sarabhai General Hospital and Chinai Maternity Hospital, Ahmedabad:
A first-hand view of ‘governance’ in Gujarat.
The Vadilal Sarabhai General Hospital and Chinai Maternity Hospital, Ahmedabad, are unique, public charitable institutions that have demonstrated, for over 80 years, how partnership between government and philanthropy minded citizens can result in the delivery of quality health care at free or highly subsidized rates to the poorest residents of the city.
These unique hospitals situated on the banks of the River Sabarmati, on historic land where the Indian tricolor was first raised in Gujarat, are today the only and last bastion of medical care for the poorest resident of Ahmedabad, who irrespective of caste or creed, have felt safe here and come in enormous numbers, many since at least three or four generations.
These running, flourishing hospitals are now under attack from the Bharatiya Janata Party, the ruling party in the Ahmedabad Municipal Corporation (AMC) which is engaged in a no holds barred attempt to gain control of these uniquely conceived institutions. These hospitals are owned by a Trust and governed by an independent Board of Management, equally balanced between AMC corporators and representatives of the original donor families, whose presence acts as a watchdog to ensure public interest.
The building of the Vadilal Sarabhai General and Chinai Maternity Hospitals was initiated in 1929 when prominent Ahmedabad families responded to then President of the AMC, Sardar Vallabhbhai Patel’s invitation to create health care facilities for the city’s poorest citizens. The cash-strapped AMC did not have the funds to create health infrastructure. At that time the Sarabhai’s contributed Rs. Four lakhs; the Chinai’s Rs.1.20 lakhs towards the construction of the hospital buildings and the Ahmedabad Municipal Corporation (AMC) paid Rs.20,000 for the purchase of the land. The proportional value of these initial donor family investments would today run into crores of rupees.
At that time the donor families, who had paid an amount 20 times more than the AMC, could have easily paid the Rs.20,000 for purchase of the land and claimed that the entire property belongs to them. That they did not do so was because the political leaders of that time and our forefathers understood that the building of public institutions for the poor requires a strong involvement of the State, particularly in areas of public health and education. Private sector, however philanthropic minded, cannot indefinitely provide free or heavily subsidized services to the poorest on its own.
The two donor families and the municipal authorities worked out separate agreements over how their gifts were to be managed. These state that the hospitals will be managed by a Trust which is registered with the Charity Commissioner and is governed by the rules of the Bombay Public Trust Act. The AMC, on its part, gave a commitment of providing for all the running costs of the hospital thereafter. It was also agreed that the hospitals are created to provide free or highly subsidized, quality medical care for the poorest residents of the city.
The ‘Sheth Vadilal Sarabhai General Hospital and Sheth Chinai Maternity Hospital Board of Management’ consists of nine members — four are corporators nominated by the ruling party in the Ahmedabad Municipal Corporation, which includes the Board Chairperson who is also the City Mayor; four are from the two original donor families of Ahmedabad — the Sarabhai and Chinai families — who hold two seats each. The ninth seat was held by the City Civil Surgeon who had no voting right and was there in an advisory capacity.
During the 1960’s, space for a ninth Board member with voting rights, was created on the persuasion of the then Congress Party Mayor, Jaikrishna Harivallabhdas. There was a clear understanding that this seat is to represent the opposition party in the AMC. This mix of representation has sought to ensure that the Board operates democratically, with transparency and public accountability; with decisions made on the basis of debate, persuasion and consensus.
Today after 84 years of fruitful partnership, the Sarabhai and Chinai Hospitals, which initially started with a total of 120 beds, have grown to around 1,200 beds. Ideally situated, it is equidistant from all corners of the city. The hospital has attracted some of the finest medical talent in the city and it is widely believed that the care provided here is better than that of private hospitals. Thus the glorious achievements of the Sarabhai and Chinai Hospitals – evident in the huge flow of patients and flourishing services is a joint achievement of the hospital staff across the board – as also its Board of Management and the AMC, through the course of decades.
Since 2012 however, the independent Board Members began to apprehend that the future survival of the hospital along with its pro-poor character, is in serious jeopardy. This finally became evident when the AMC revealed its plans to turn the VS hospital campus into a ‘multi-speciality hospital’ that will also become a ‘hub for medical tourism’.
Outlining these plans in a letter dated 22nd March, 2013, which was delivered to the VS Board during its meeting of 28th March, 2013, AMC Commissioner, Mr. G. Mohapatra says the proposed 1600 bed hospital (whose construction has already commenced) will have facilities such as a helicopter pad; green technology, air-conditioning, hold more clinics and create more jobs, amongst other aspects.
The letter further reveals the AMC’s plan to demolish the existing 1200 bed Sarabhai and Chinai Hospitals on the grounds that it needs more land for the ‘multi-speciality’ hospital. It states that the original 120 beds with which both hospitals had started in 1929 will be transferred to the new hospital, into a ward with the donor’s names on the door. The balance of the 1,080 beds, which the AMC claims are owned by them, will be absorbed into the new hospital, the letter states.
This seems to imply that only 120 free or subsidized beds will be kept for the poor in the new hospital, as compared to the 1,200 beds available to them now in the existing Sarabhai and Chinai Hospitals. Thus barring these 120 beds for poor patients, the balance of 1,480 beds in the new multi-speciality hospital will be for paying patients.
While the AMC Commissioner’s letter speaks of serving the poor and middle income group, Ahmedabad NGO’s working amongst the poor ask how many patients who today use the services of the Sarabhai and Chinai Hospitals, will be able to enter this high profile multi-speciality hospital? The AMC Commissioner’s letter does not say what percentage of beds will be reserved for BPL (Below Poverty Line) card holders and whether they get admission on priority. It does not quote any public health expert on whether Ahmedabad needs yet a public sector ‘multi-speciality hospital’ when so many already exist within the private sector. Neither does it explain why the government should be using tax payer’s money to create high-end facilities when the poor of Ahmedabad need basic, good quality services that are obtained at a reasonable cost, says Gagan Sethi of Centre for Social Justice, an NGO working amongst minority and marginalized communities.
The AMC Commissioner in his letter also claims that the existing Chinai and Sarbhai hospital buildings are old and dilapidated. He states that they should be demolished as this land is required for the new hospital complex. (An RTI application filed by the donor family representatives sought the building plans from the AMC Commissioner but it has been ignored so far. Sources indicate plans to create a car park for 2,000 vehicles on the land where the Sarabhai and Chinai hospitals exist). The AMC Commissioner then proceeds to tell the donor families to “hand over control of their gifts”.
The Commissioner does not have any independent reputed agency backing his claim that the existing hospital buildings are dilapidated. On the contrary, these buildings constructed in 1929 are of heritage value, have strong foundations that withstood earthquakes and provide ample scope for restoration and expansion at far lower costs, says Brijesh Chinai, an architect who restores heritage properties and is a VS Board member, representing the Chinai family.
While the Gujarat Government, according to the AMC Commissioner’s letter, is giving a grant of Rs.330 crores for the multi-speciality hospital, donor family representatives ask why some of these funds cannot be used to maintain or renovate the Sarabhai and Chinai Hospitals, which are heritage structures with solid foundations? The existing 1200 beds in these hospitals can continue to be used for poor patients. If they need a car park for 2,000 vehicles they can easily build that within the basement or podiums of the new multi-speciality building. What is the need to demolish these existing, solid hospital buildings, they ask.
The AMC’s motive, for all purposes, seems to be running these hospitals and medical colleges as a commercial business, without interference from any “outsiders” and while abdicating its responsibility to the poor.
The strategy to achieve this goal was first put in place in 2009 when the AMC created a Trust, known as Medical Education Trust (MET). Manned by bureaucrats and politicians, it started as a paper body with no tangible assets. It has no record of praise-worthy performance, its efforts to turn the LG Hospital at Maninagar, Ahmedabad, into ‘world-class facilities’ speaks volumes, says a doctor working there.
MET seeks to raise finances by charging hefty fees to medical students seeking a seat in public teaching hospitals such as VS General Hospital. With undergraduate medical students reported to be paying Rs.3 lakhs; postgraduates Rs. 4 lakhs and NRI US$25,000 per year as official fees, it will have a disastrous impact on the future of medical education in India, say public health experts. It will limit access to the rich and further entrench rapacious medical practices in fleecing the urban poor, while the rural and marginalized populations remain ignored, they say.
The AMC corporators first drew attention of the VS Board to the existence of MET around September 2012, when it sought to pass an order that MET would pay the salaries of teaching hospital doctors employed by the VS Board of Management. This move faced stiff resistance from the independent VS Board members as it amounted to giving entry or allowing interference from an extraneous Trust.
Thereafter, in a move to assert its will on the VS Board, the AMC, during the Board meeting of 30th October, 2012, announced in the Agenda that the seat of the AMC opposition party member (representing the Congress Party) on the VS Board of Management was vacant, following that party’s resignation from all Standing Committees of the AMC. When independent members pointed out that the VS Board was independently managed and was bound to consider the resignation letter before accepting it, they were overruled. A ruling party corporator was then immediately installed, thereby tilting the majority in their favour.
AMC’s unauthorized effort to involve MET in the affairs of the VS Board and bypass it, is manifest in written AMC administrative orders related to key appointments or tenders awards. For instance, the VS Board was not consulted in the MET conducted appointment of the VS Hospital Superintendent. When the post of Deputy Superintendent fell vacant – a VS Hospital doctor of their choice — was placed in this seat without any formal application or interview process on the grounds. When questioned they said it is a temporary appointment.
On 28th March, 2013, the AMC Commissioner’s letter (22nd March, 2013, referred to above) was produced at the VS Board Meeting and read aloud, without any previous warning of its appearance on the Board’s Agenda. Thereafter, the Chairperson, Mr. Hasit Vora, produced an ‘Emergency Agenda’ which sought a resolution accepting this letter. Despite the protests of the independent Members, the AMC corporators went on to pass it by asserting their brute majority. Thus in five minutes flat, utilizing illegal and brute majority, the AMC corporators passed a resolution that they claimed amounts to bifurcation of the VS Hospital Board of Management and reduces its jurisdiction to the original 120 beds.
Then at the next Board meeting on 5th April, 2013, yet another surprise ‘Emergency Agenda’ sought to transfer all VS and Chinai Hospital staff under the control of MET. The Chairperson told the Board that the staff had been sent individual notices asking them to state their preference within ten days. If there was no written response forthcoming the order of their transfer to the MET Board would be passed, he said.
The AMC notice of 5th April, 2013, placed in the main building, claims that VS staff accepting to come under the MET Board would not be transferred to other corporation hospitals. During a meeting with the independent Board members in October 2012, the AMC Commissioner, while trying to convince them about why MET was required, had bluntly said that bringing hospital staff under the control of MET and using the threat and weapon of transfer was the only means the AMC has in dealing with the rampant staff indiscipline in VS Hospital.
Meanwhile the stand of the independent VS Board members and the donor families is as follows:
AMC attempt to take control of the donor family gifts held in trust for the poorest citizens of Ahmedabad violates contractual agreements and is thus illegal.
MET is an extraneous body that has no legal right to involve itself or interfere in the affairs of the independent VS Hospital Board of Management.
The Donor Families, both Chinai and Sarabhai strongly assert that the AMC cannot shirk its responsibility in providing free or highly subsidized medical care for the poorest citizens of Ahmedabad irrespective of caste or creed. It will not be allowed to bypass its commitments made in the Trust Deeds with the donor families, to cover all costs of running and maintaining these hospitals.
The proposed 1600 bed multi-speciality hospital coming up in the VS Hospital compound usurps 1200 beds from the Chinai and Sarabhai Hospitals. Thus for a mere addition of 400 beds, the AMC’s proposal of demolishing heritage buildings with strong foundations; stopping a running, flourishing 1200 bed institution, brimming with poor patients, does not make any sense.
Thus the donor families yet again assert: AMC cannot tamper with the 1200 beds Sarabhai and Chinai hospitals; its independent Board of Management; its staff and sturdy buildings or the land on which they stand. The AMC-MET’s designs to strangulate the hospitals of funds and staff and encroach on the hospital property must be challenged and fought tooth and nail.
As independent members of the VS Board of Management who are first hand witness to such dastardly and illegal moves, we wish to inform the VS and Chinai Hospital staff; the donor families and all concerned citizens that there is an urgent need to create enormous social and legal pressure from every corner.
The institutions created by our national leaders and forefathers, whose running costs are supported by the tax paying public, will remain as they are in status quo, in perpetuity, despite all attempts by vested interest parties to thwart or destroy them completely for ulterior reasons and motives.
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