Who should own the med gas, the dedicated exhaust and the sterilizer feed, landlord or tenant?

I've installed and repaired a fair amount of this equipment and I've never seen a lease handle it well, so I want to put the ownership question to people who underwrite these buildings.

In a medical suite the specialized systems get scoped as tenant improvements and paid for out of the TI allowance. Medical gas piping and manifolds, dedicated exhaust for procedure and lab rooms, a steam or water feed for a sterilizer, a supplemental cooling unit for an imaging room, sometimes a shielded slab. Then they get permanently attached to the building and outlive the tenant. Med gas piping in particular has to be certified when it's installed and after any alteration, and the standard for that comes from NFPA 99 as adopted by your state and local code, so what triggers a recertification varies by jurisdiction and needs to be confirmed with the local authority.

Case for the landlord owning and maintaining it. You control the quality of the install, you know the condition when the suite turns, and you keep whatever second-generation value exists for the next tenant of that specialty. You can charge for it in rent. You also just added a maintenance obligation with a specialized vendor and a testing cycle to a building where your other twelve suites need nothing like it.

Case for pushing it to the tenant. Cleaner operating expense line, no vendor to manage, the tenant maintains the thing it depends on. At surrender you inherit whatever they did, or you make them remove it and you're paying to demolish something a future tenant might have wanted. Removal obligations in a specialized building can cost more than the shell rent you saved.

I don't think there's a clean answer at 3,000 sf. There might be at 30,000.