Emergency Medical Supplies and Training CC (Trading as EMS) v Health Professions Council of South Africa

The appellant, a training institution for emergency care practitioners (paramedics), applied for and was granted accreditation by the Professional Board for Emergency Care Practitioners in 1999-2003 to conduct specific courses: four Basic Ambulance Assistance (BAA) courses, three Ambulance Emergency Assistance (AEA) courses, and one Critical Care Assistance (CCA) course. By the end of 2004, the Board discovered that the appellant was conducting training well beyond its accreditation - 11 BAA courses, five AEA courses, and two CCA courses - without obtaining prior approval. The Board investigated and found that the appellant's facilities, equipment, and standard of training were below par. In November 2006, the Board conducted examinations of the appellant's CCA students who performed poorly, and none passed. In November 2006, the Board withdrew the appellant's accreditation. The appellant appealed to the Western Cape High Court in terms of s 20 of the Health Professions Act 56 of 1974. This was the second appeal to courts on this matter; an earlier appeal to the SCA on the same question was struck from the roll as the matter was not properly before the court.

• Whether the appeal under s 20 of the Health Professions Act 56 of 1974 is a 'wide appeal' or a 'narrow appeal' (an appeal in the ordinary sense)
• Whether the Supreme Court of Appeal could adjudicate on this question given that an earlier appeal on the same issue was struck from the roll
• Whether the court hearing a s 20 appeal could consider review grounds (such as bias and conflict of interest) in addition to the merits
• Whether the Board was correct in withdrawing the appellant's accreditation based on: (a) the appellant conducting training beyond its approved accreditation contrary to s 16(1) of the Act, (b) the poor quality of training, and (c) the poor performance of students in the November 2006 examination

The appeal was dismissed with costs including the costs of two counsel.

An appeal under s 20 of the Health Professions Act 56 of 1974 is an appeal in the ordinary sense (a narrow appeal), being a rehearing on the merits but limited to the evidence or information on which the decision under appeal was given, and in which the only determination is whether the decision was right or wrong. Such an appeal does not permit the court to consider review grounds (such as bias, conflict of interest, or other administrative law grounds) separately from the merits. The court hearing a s 20 appeal is bound by the precedent established in De Bruin and De Beer. A training institution conducting training beyond the scope of its approved accreditation without obtaining further approval violates s 16(1) of the Health Professions Act.

The court noted that the Health Professions Council of South Africa, as the statutory custos morum of the medical profession, is mainly composed of members of the profession who know and appreciate the standards demanded, and therefore has considerable advantages over a court in the consideration and evaluation of standards sought to be maintained. While the distinction between appeals and reviews is clear and merits may sometimes intrude in review proceedings, this does not obliterate the fundamental distinction between an appeal and a review (citing Rustenburg Platinum Mines Ltd v CCMA and Bato Star Fishing). The court observed that the courts below erred in proceeding to deal in detail with review grounds after having found that the s 20 appeal was limited to the merits.

This case authoritatively clarifies the nature of appeals under s 20 of the Health Professions Act 56 of 1974, confirming that such appeals are narrow appeals in the ordinary sense, not wide appeals. It reinforces the distinction between appeals and reviews in South African administrative law, emphasizing that an appeal on the merits does not permit consideration of review grounds such as bias or procedural irregularity unless those grounds affect the correctness of the decision on the merits. The judgment reaffirms the deference courts should accord to professional regulatory bodies like the Health Professions Council when evaluating professional standards, recognizing their specialized expertise. It also clarifies that an appeal struck from the roll on procedural grounds does not create res judicata on substantive issues not finally determined.