I.-By way of exception, an authorisation for surgical oncology with designation A derogating from the minimum annual activity stipulated in I of article R. 6123-91-4 may be granted or renewed when, after analysis of the needs of the population, access to other sites imposes excessive journey times or waiting times on a significant proportion of the population in the health region.
The dispensatory authorisation referred to in the first paragraph is subject to the conclusion of a written commitment, by means of an agreement or within the framework of a formalised organisation if the same legal entity is involved, with another site authorised, in the same region or in a neighbouring region, for oncology surgery with grade A or B for the same tumour site, complying with its minimum annual activity obligations.
By way of derogation, for the overseas departments and regions, if the cooperation mentioned in the previous paragraph is not possible, the agreement may be drawn up with an authorised site in a metropolitan region.
The terms and conditions of this agreement are defined by order of the Minister for Health on a proposal from the INCA.