Patients and their families will be hit twice as hard from Sunday, when both nurses and doctors – for the first time in memory – apply sanctions simultaneously.The Israel Medical Association charged on Thursday evening that the state “backtracked” on agreements it reached on the number of night and weekend shifts that would be required of doctors.“We returned to square one,” it said.On Sunday, doctors’ sanctions will shut down all elective surgery except emergency and oncological surgery. On Monday, all hospitals and community health fund clinics owned by Clalit Health Services will strike, except for urgent cases. On Tuesday, the Sunday schedule of sanctions except for urgent and oncological surgery will be held. On Wednesday, only urgent and oncological operations will be held in hospitals. In addition, hospital outpatient clinics, diagnostic clinics, psychiatric and geriatric hospitals and day hospitals in general will shut down.On Thursday, the same schedule of sanctions as on Wednesday will be held.The doctors have been applying sanctions intermittently for two-and-a-half months, demanding a new contract and reforms involving doctors in the periphery, residents, interns and pensioners.The Nurses’ Association, a part of the Histadrut, says its members will cut by two the number of beds in each hospital’s internal medicine department where seriously ill patients are attached to ventilators and thus require much more supervision and treatment. The association charges that the Finance and Health Ministries have reneged on its agreement in January – at the height of the flu season – to add 190 nursing slots in hospital intensive care units. The Health Ministry has not commented, while the Treasury did not give a clear answer.Nurses union chief Ilana Cohen has charged that only a handful of nurses have been added since then to the wards.The action will be taken to “protect lives,” said the association, as too few nurses on duty mean too little treatment for patients.In the agreement last winter, the two ministries agreed that maximum capacity in internal medicine departments would be 120 percent by the end of this year, with a further reduction to 115% at the end of 2012 and to 110% a year thereafter.“As agreed, we will not admit patients to internal medicine departments beyond these capacity rates,” Cohen added.The IMA has voiced its support for the nurses‚ struggle.Meanwhile, Kadima MK Rachel Adatto, a gynecologist by profession, sent a letter to Prime Minister and formally health minister Binyamin Netanyahu to dismiss Deputy Health Minister Ya’acov Litzman (United Torah Judaism), who actually runs the ministry.Adatto said that Litzman’s position that residents and interns should work only 16 hours at a time instead of the current 24 hours was “populistic” as there are not enough doctors to actually do so. She said that Litzman “must back down or resign” if he does not annul his statement on shifts and that he is “not connected to reality.”“Behind the explosion in negotiations between the Treasury and IMA on Thursday stands the baseless stubbornness of the deputy minister,” she claimed.Litzman, who has rarely intervened during the long period of sanctions and let the Treasury take the lead, maintained that he had reached agreement with the Finance Ministry to allocate 160 additional slots to government hospitals by the end of 2012 plus 100 more residents’ slots by the end of 2013.