Pune With the Pune municipal corporation’s health department having failed to resolve the issue of inordinate delays in the renewal of licence of small hospitals and clinics, medical associations in the city have escalated the matter to the Prime Minister’s office(PMO) and the chief minister office (CMO).While the Indian Medical Association (IMA – Pune Chapter) has sought a change in the nomenclature of small hospitals, Dr Nitin Bhagali, a Maharashtra Orthopaedic Society member and past president of the Pune Orthopaedic Society, has sought the intervention of the PMO and CMO in this matter. In its report on July 21, ‘Pune municipal corporation’s health department red tape delays licence renewal of small hospitals’ this newspaper had highlighted how PMC’s health department has introduced some questionable criteria for renewal of medical licences of small hospitals in the city which has caused extreme discontent in the medical fraternity.In a new precedent, the health department has withheld renewal of medical licences of small hospitals which were unable to show employment of nurses registered with the Maharashtra nursing council, amongst other issues. The Indian medical association (IMA) has, however, maintained that this was an unreasonable demand as it is not mandatory as per the provisions in the Bombay Nursing Home Registration Act, 1949. The national accreditation board for hospitals and healthcare providers (NABH) defines small and medium hospitals as those with less than 50 beds.With the matter being unresolved, senior surgeon, Dr Nitin Bhagali, has sought the intervention of the PMO and CMO in this matter while citing a protocol followed by the Royal College of Surgeons, London. He has suggested that small hospitals be recognised as ‘day care surgical centres’. IMA Pune’s hospital board has also proposed that small hospitals be designated as “ambulatory surgical centres.” Almost 80 per cent of the small hospitals in Pune are awaiting licence renewal by the PMC health authorities. Most of these hospitals carry out day surgeries, such as eye surgeries, dental surgeries, stone removal, vasectomy, endoscopic, arthroscopic, UTI and medical termination of pregnancy (MTP), among others, which require admission of less than a day and do not have an elaborate setup and staff. Dr Bhagali said that the ‘day care surgery centre’ concept has been recognised internationally and is needed in India in view of the bureaucratic red tape as is being witnessed in Pune.In his letter, dated August 1 to the PMO and CMO, he has pointed out that the PMC’s insistence on employment of registered nurses by small hospitals and other new criteria was proving troublesome as day surgeries require less than 23 hours of admission.“We have observed that there is 35 per cent rise in elective or planned surgeries. We have sought guidance and help from the higher authorities looking at the trend and rise in such surgeries. Recognition of such centres will only help to ease the act or the procedure upon them; as they do not need such regulations which are forced by the body,” Dr Bhagali has said in his letter. Dr Sanjay Patil, chairman of the hospital board, Indian Medical Association, Pune, said that the IMA is drafting a proposal to the health authorities that hospitals which carry out ‘no admission surgeries’ should be called as ‘ambulatory surgical centres.’ IMA will also propose that this concept be introduced in the medical curriculum and in the medical ecosystem as a whole.