By: Ranen Salikram / Candidate Attorney / Mooney Ford Attorneys
You are a specialist. For years you have admitted and treated your patients at the same private hospital, on the strength of an arrangement made informally with the man who owned it at the time. Nothing was ever put in writing. Then you are found guilty of unprofessional conduct, suspended from practice for a year, and told to stop working. You serve the year. Your registration is restored. You come back to the hospital expecting to pick up where you left off, and you are told that the hospital has new owners, a new policy and a new committee, and that you must apply for admission privileges like anyone else. Who wins?
The answer, on the Supreme Court of Appeal’s judgment of 29 June 2026 in Ramdhin v Rondebosch Medical Centre (Pty) Ltd, is the hospital. The reason matters to every practitioner who holds admission privileges and to every hospital that grants them.
The Arrangement That Was Never Put to Pen
Dr Ganes Anil Ramdhin, a specialist obstetrician and gynaecologist, was granted admission privileges at Rondebosch Medical Centre in October 2019. The arrangement was concluded with the hospital’s then sole shareholder. There was no application form, no committee, and no written agreement. Beyond the grant of the privileges themselves, the terms were left to what the high court called an unarticulated understanding between the parties.
That informality is common in practice, and it is precisely where the trouble began. Because nothing had been agreed about what would happen if the practitioner could no longer practice, the answer had to be supplied by the law rather than by the parties.
In June 2023, Dr Ramdhin pleaded guilty before the Health Professions Council of South Africa to two charges of unprofessional conduct arising out of his treatment of two patients. He was suspended for three years. Two of those years were suspended on condition that he committed no further similar misconduct and that he practiced under an HPCSA-approved supervisor. The active year ended on 23 May 2024, and he was permitted to resume practice from 3 June 2024, under supervision.
By then, the hospital had changed hands. A Physicians Advisory Board had been established and a formal credentialing policy adopted, requiring an application form, active status on the HPCSA register, and peer evaluation of competency, and directing the board to weigh the need for the practitioner’s services, commercial viability and reputational risk. The board resolved not to grant him privileges. He applied anyway, describing his application as one for the continuation of what he already had. The board declined to decide it, and the matter went to court.
What Section 44 Actually Says
The case turned on a single provision. Section 44 of the Health Professions Act 56 of 1974 provides that a person who has been suspended, or whose name has been removed from the register, is disqualified from practicing his or her profession, and that his or her registration certificate is deemed to be cancelled until the suspension expires or the name is restored.
Counsel for Dr Ramdhin accepted that removal from the register would have ended the privileges outright. Suspension, he argued, was different. The status quo is preserved, and the only consequence is that the practitioner cannot practice for the period of suspension.
The Court held that this is a misreading, and counsel was ultimately driven to concede as much. In both cases the practitioner is disqualified from practicing, and in both cases performance of the contract becomes impossible. The only difference is that on suspension the registration certificate is deemed cancelled until the suspension expires. The registration is treated in law as cancelled, not merely paused.
Terms by Operation of Law
From that reading of the statute, the rest follows. Admission privileges can only be exercised by a practitioner who is entitled to practice. The right to practice is therefore not a background assumption to the contract. It is an essential term implied by law, one of the naturalia of an agreement conferring admission privileges.
Terms implied by law are imposed on the parties. They do not depend on consensus, they derive from the common law, precedent, trade usage, custom or statute, and once recognized they apply to every contract of that class unless the parties expressly exclude them. Dr Ramdhin and the hospital were free to agree that a suspension would merely suspend his privileges rather than end them. They did not. Nothing in their unarticulated understanding suggested otherwise.
The consequence is a significant one for hospitals. Because the privileges fell away by operation of law, no decision to terminate them was ever required, and nothing was taken away that could be attacked. The Court also confirmed that whether a practitioner enjoys admission privileges at a private hospital is a matter of private law. The Promotion of Administrative Justice Act offers no route in.
A New Argument, Raised Too Late
Shortly before the appeal was heard, Dr Ramdhin’s counsel gave notice that he intended to argue something new: that his suspension was a temporary supervening impossibility of performance, so that the contract survived the interruption and simply resumed once the impediment fell away.
The Court refused to entertain the argument. A new point may be raised for the first time on appeal only if it does not result in prejudice to the other party and does not raise new factual issues. Temporary impossibility is a fact-sensitive inquiry. It requires a court to ask whether performance was objectively impossible rather than merely inconvenient, how the contract allocated the risk of interruption, and whether what would be performed afterwards was substantially what had been contracted for. None of that evidence had been led, because the case had never been put that way, and the hospital had never been called upon to answer it.
The point would have failed in any event. Relying on Transnet Ltd t/a National Ports Authority v Owner of MV Snow Crystal, the Court held that impossibility, temporary or otherwise, does not assist a party whose own conduct created the impediment. The impossibility here was self-created. It flowed from culpable and admitted professional misconduct.
Not the Same Practitioner Who Left
The most instructive part of the judgment deals with the practitioner who would have come back. The Court drew a distinction between a short interruption of the kind caused by illness or leave, which merely pauses the work, and a suspension, which prohibits the practitioner from practicing independently at all. The difference is one of kind rather than degree.
The hospital had contracted for an independent, autonomous service provider. What would have come back after the year was a strictly supervised practitioner, subject to mandatory HPCSA-approved oversight, stripped of the clinical autonomy for which the hospital had bargained, returning after a year-long operational vacuum and carrying a further three-year period of heightened contractual risk and reputational exposure. The substratum of the 2019 agreement had disappeared. An innocent party cannot be required to wait on speculative future compliance or to accept a fundamentally different bargain under the guise of temporary impossibility.
The Court made a further point that practitioners should note. Dr Ramdhin submitted a written application for admission privileges on 1 July 2024. In doing so, he acted as a person who did not hold privileges and who needed them to be granted to him. His later insistence that the application was merely for the continuation of privileges he already held did not undo what he had already done. The appeal was dismissed with costs.
What This Means for Medical Practitioners
A suspension does not protect a practitioner’s commercial arrangements while it is being served. Any contract that depends on the right to practice comes to an end, and the hospital is not obliged to keep the practitioner’s place open. A practitioner who intends to return should expect to apply afresh, and should expect to be assessed against the hospital’s policy as it stands on the date of the application, and not the policy that applied when the privileges were first granted.
The deeper lesson is to reduce contractual terms to writing, including provisions regulating situations concerning possible suspension and terms for the restoration of a contract once a period of suspension has been served.
For hospitals, three issues are highlighted:
- Although the termination of privileges occurs automatically in the event of a suspension, it would be prudent to record the decision.
- A regulatory and governance framework should be implemented for reapplication processes.
- A practitioner returning under conditions imposed by the HPCSA does not present the same risk profile as the practitioner who left, and the hospital is entitled to take that into account when considering a fresh application.
In a nutshell, put pen to paper to avoid disputes on status pursuant to disciplinary sanctions being imposed.
