Medical Matters

Council for Medical Aid Schemes and Another v Genesis Medical Scheme and Others

  • This case involved the liability of medical aid schemes to pay for members treatment regarding minimum benefits prescribed under the Medical Schemes Act 131 of 1998, as the respondent disputed the liability of payment of a members medical treatment. In this instance, it was accepted that the fitting of a prosthesis was a prescribed minimum benefit however the respondent alleges that in terms of its rules, by which members were bound, it was not obliged to compensate such done at private institutions.
  • The Registrar of Medical Schemes held that the respondent was liable for such costs at the rate it would have been provided at a public hospital. The respondent then appealed such to the Appeal Committee and then the Appeal Board which in both instances, the appeals were dismissed. This was then appealed to the High Court which ruled in favour of the respondent and the applicant now appeals the case to the Supreme Court of Appeal.
  • The Supreme Court of Appeal however held that if the medical aid schemes rules conflict with the Act, the rules do not take precedence over the Act and therefore the respondent could not be allowed to contract out of these provisions. Therefore the appeal was upheld and the respondent was liable for such costs.


Oppelt v Department of Health, Western Cape

  • The case dealt with whether the conduct of health care workers of a government hospital was negligent and violated the right to emergency medical as contained in section 27(3) of the Constitution as after suffering a spinal injury from a rugby game, the applicant was left a quadriplegic.
  • The High Court found the delays taken to provide the treatment was unreasonable and was thus refused such emergency medical treatment. The Supreme Court of Appeal held however that Oppelt failed to prove a causal link between the delay and the injury sustained and thus reversed the High Court decision.
  • This decision was then appealed to the Constitutional Court which held that strict adherence to protocol that does not accommodate emergencies was not a valid excuse for such delay and that such a treatment was neither expensive nor unable to be performed promptly.
  • The court held that given the reputation of the hospital being a specialist in spinal injuries, a reasonable doctor would have transferred the patient to such a hospital immediately and not delayed in doing such. Therefore  such conduct was seen to be both  negligent and violating the right to emergency medical treatment.

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