In public hospitals, doctors are generally employed by the state and are authorised to treat patients under their employment contracts and appointments within the public health system.
In private hospitals, by contrast, most specialists are independent practitioners who are not employed by the hospital. In terms of the HPCSA Ethical Rules of Conduct, entities not registered under the Health Professions Act (No. 56 of 1974) are not permitted to employ medical practitioners, save for recognised employment agencies approved by the HPCSA.
Therefore, the medical practitioner’s ability to admit and treat patients at private hospitals depends on being granted admission privileges, which arise from a contractual relationship with the specific hospital and are subject to the hospital's credentialing, governance and risk-management requirements.
In Ramdhin v Rondebosch Medical Centre (Pty) Ltd, the Supreme Court of Appeal confirmed that private hospital admission privileges are contractual rights. Their continued existence depends on the practitioner remaining legally entitled to practise and meeting the standards applied by the hospital.
The dispute
Dr Ganes Anil Ramdhin, an obstetrician and gynaecologist, had enjoyed admission privileges at Rondebosch Medical Centre since 2019 under an informal agreement.
In June 2023, the Health Professions Council of South Africa found him guilty of unprofessional conduct and suspended him from practice.
Dr Ramdhin thereafter successfully applied to the HPCSA to have his suspension lifted, and his registration was reinstated. He was permitted by the HPCSA to resume practice as an obstetrician and gynaecologist from 3 June 2024, subject to certain conditions, including the requirement that he be supervised.
While he was unable to practise, the hospital’s ownership and management structures changed. It established a Physicians Advisory Board and introduced a more formal policy for granting admission privileges.
The policy required practitioners to provide proof of their qualifications and active HPCSA registration and to undergo peer evaluation. It also allowed the hospital to suspend, revoke or modify privileges following non-compliance with hospital procedures, ethical misconduct, substandard clinical performance, regulatory action or another reason considered appropriate by the board and hospital management.
When Dr Ramdhin sought to return, the hospital required him to apply afresh. Its board ultimately decided not to grant him admission privileges, having considered clinical, commercial, regulatory, reputational and insurance-related concerns.
Dr Ramdhin approached the High Court and later the SCA, arguing that his original agreement had not ended. On his version, the suspension had merely interrupted his ability to perform under the contract and his admission privileges should have continued once he was again permitted to practise.
Why the original agreement ended
The SCA rejected the argument that the admission privileges remained in place during the suspension.
Section 44 of the Health Professions Act provides that a suspended practitioner is disqualified from practising and that their registration certificate is deemed to be cancelled for the duration of the suspension. The Court found that a practitioner’s qualification and entitlement to practise are prerequisites for both the granting and continued existence of hospital admission privileges.
The original agreement therefore contained an implied term that Dr Ramdhin would remain legally entitled to practise. Once that entitlement was removed, the admission privileges and the agreement establishing them terminated by operation of law. No separate decision by the hospital was required to bring the agreement to an end.
The Court also considered the substantial change in the professional relationship. Dr Ramdhin had previously practised as an independent and autonomous specialist. He would return under compulsory supervision and within a different regulatory and risk framework.
The hospital could not be compelled to accept this materially altered arrangement under the previous contract. To obtain admission privileges again, Dr Ramdhin and the hospital would have to enter into a new agreement that complied with the hospital’s policy then in force.
Self-created impossibility does not preserve the contract
Dr Ramdhin also attempted to rely on temporary impossibility of performance. He argued that his contractual obligations had merely been suspended while he was prohibited from practising.
The SCA found that this argument had not been properly raised before the High Court and would have required evidence about the nature of the agreement, the allocation of risk and whether performance after the suspension would remain substantially the same.
In any event, the doctrine of impossibility of performance could not assist him. His inability to perform did not arise from an unforeseen event outside his control. It resulted from his own admitted professional misconduct.
Relying on the principles confirmed in MV Snow Crystal, the Court reiterated that a party cannot rely on impossibility of performance when the impossibility is self-created or caused by that party’s fault.
Private contractual relationship
The judgment also confirms that admission privileges at a private hospital are governed by private law.
Their termination did not constitute administrative action under the Promotion of Administrative Justice Act. The dispute concerned contractual rights rather than the exercise of public power.
This does not remove the need for hospitals to follow clear and consistently applied procedures. Admission agreements and policies should identify the standards practitioners must maintain, the circumstances in which privileges may be suspended or withdrawn and the process that will apply when a practitioner seeks admission or readmission.
Hospitals should also document their assessment of clinical competence, regulatory standing, patient safety, operational requirements and institutional risk. A carefully recorded process strengthens the hospital’s position should its decision later be challenged under contractual or other private-law principles.
For practitioners, the judgment makes clear that HPCSA reinstatement is only one part of returning to practice. It does not create an automatic right to resume treating patients at a particular hospital. Admission privileges must still be obtained from that hospital under its applicable standards and contractual arrangements.
For advice concerning hospital admission privileges, healthcare regulation or related disputes, contact Julia Penn (juliap@thomsonwilks.co.za) and Justine Paries (justine@thomsonwilks.co.za)
