SAMWUMED halted from excluding Melomed Gatesville, Mitchells Plain hospitals from network

The South African Municipal Workers Union National Medical Scheme (SAMWUMED) has been temporarily barred from removing Melomed facilities from its list of healthcare providers in a ruling delivered by the South Gauteng High Court in Johannesburg.

The judgment comes after SAMWUMED's negotiations with the National Hospital Network (NHN), which includes the Melomed Group, reached a deadlock.

SAMWUMED had indicated that its agreement with the NHN, which commenced in January 2021, had expired and it excluded Melomed Gatesville and Mitchells Plain hospitals.

Speaking at the time, SAMWUMED's Principal Office, Francina Mosoeu, said the union could not reach a mutual agreement with the NHN and as a result reached out to the Melomed Group to allow their facilities most frequented by members as "filler hospitals" in the union's network but again could not reach an agreement.

"It should be made clear that neither the NHN Group nor the Melomed Group were prepared to come to a mutual agreement with SAMWUMED and that SAMWUMED exhausted all avenues to come to a mutual agreement with Melomed and NHN," she said.

The NHN criticised the development between SAMWUMED and Melomed Hospitals. 

“The decision to terminate is shocking, illogical and highly questionable as its impact directly affects the livelihood of patients,” Loedt Zemanay Group Operations Manager for the NHN said at the time.

Zemanay said that Melomed had employed more than 5,000 staff, mainly from the Cape Flats, and they will be negatively affected by this new development.

"The decision by the SAMWUMED’s leadership flies in the face of low tariffs, accessibility, economic transformation and job creation on the Cape Flats,” he added.

After the situation reached an impasse, NHN brought an urgent application against SAMWUMED where Medscheme and Fedhealth medical scheme were listed as respondents.

The NHN's application to the court argued that the exclusion of Melomed facilities would have immediate negative effects on patient care.

Judge Nelisa Phiwokazi Mali underscored this sentiment, noting that once a facility is excluded from the network, repercussions are swift and cannot be easily reversed.

"Specialists move lists, patient flows are redirected, community expectations adjust, and reputation signals harden against the excluded facility... A later setting aside order cannot restore lost alignment, reconstitute referral habits, or reverse reputational attrition," said the judge.

Judge Mali further stated that Melomed Mitchells Plain is the only acute hospital in the area. Excluding it from the network would force beneficiary patients to seek care at a hospital outside Mitchells Plain.

"These hospitals are Mediclinic Louis Leipoldt which is Bellville West and Life Kingsbury in Claremont. The travelling distance between Melomed Mitchells Plain and Louis Leipoldt is at least 20 kilometres. The traveling distance between Melomed Mitchells Plain and Life Kingsbury is at least 21 Kilometres."

The judge added that the exclusion of Melomed from the network places a financial burden on patients, particularly those dependent on public transport. Furthermore, she said medical practitioners will be negatively impacted by a reduction in the number of patients accessing their services and will not open practices at these hospitals, emphasising the adverse effects of the decision.

SAMWUMED has been interdicted pending final determination of part B of the application.

Cape Times