The pitfalls of reception desk admission forms

There is considerable confusion in the medical industry about who is legally liable under a doctor’s contract for treatment. This uncertainty arises, in part, because so many different parties may become involved—each occupying a different social or familial status, and each with their own expectations. Patient, parent, spouse, grandparent, medical scheme, school, or employer: any one of them might appear at the point of service.

Yet South African law does not assign liability based on status, role, or perceived responsibility. In this legal fog, doctors often do not know who their true debtor is, and accounts go unpaid—not because people are dishonest, but because the contract was never clear.

In South African law, liability is not derived from social or familial status—it flows from agreement. A person is not liable simply because they are:

• A spouse or ex-spouse
• A parent or grandparent
• The “main member” of a medical scheme
• Listed as the “responsible party” on a form

Nor does someone escape liability just because they are a minor, a widow, or a dependant. The test remains simple: Was there a valid contract in place between the parties?

To address the problem, many practices adopt the idea of a “family account”, loosely inspired by models used by retailers and pharmacies. The involved parties are grouped under terms like:

• Main member
• Responsible person
• Account holder
• Guardian

But these labels have no legal meaning in and of themselves. A medical services contract is not a sales contract.  That distinction matters.

In retail, the person collecting the goods is not automatically liable for payment. But where goods are delivered to a household, courts often infer that the recipient was acting with the authority of the account holder—especially if the goods are for common household use, and this has happened before.

Medical services are different. The person receiving treatment is not assumed to have authority from someone else to incur the debt. And the benefit is personal, not household-wide. As a result, intent to assume liability must be clearly proven—not presumed.

When someone other than the patient agrees or is assumed to pay, the situation becomes one of delegation of debt. In South African law, this is only valid where three-way consent exists:

• The original debtor (patient),
• The new debtor (person taking over the obligation),
• The creditor (doctor).

This ensures the doctor retains the right to reject a financially weaker substitute.

Delegation may be valid in respect of future debt, provided the obligation is clearly defined and all parties—original debtor, new debtor, and creditor—give informed consent. But in practice, we seldom encounter proper documentation of such arrangements in the healthcare sector.

At a minimum, a valid delegation clause or agreement should:

• Identify the person receiving treatment (the beneficiary);
• Name the third party assuming payment (e.g., a parent or employer);
• Record the doctor’s or practice’s consent to the substitution;
• Define the scope of services covered (e.g., general, emergency, or chronic);
• Clarify that the delegation applies prospectively, not retrospectively;
• Be signed by all three parties: patient, new debtor, and doctor or authorised representative.

Clearly, this type of clause is difficult to implement in practice. It requires foresight, cooperation, and formal signatures from multiple parties—often in time-pressured or emotionally charged circumstances.

For this reason, some suggest that the route of agency may offer a more practical alternative. But does it?

The law of agency is often cited as a solution to third-party liability problems. In theory, an agent can bind a principal to a contract—provided they act within the scope of actual or ostensible authority.

Examples commonly include:

• A grandparent bringing a child to the doctor on the parent’s behalf;
• A school teacher arranging care for a pupil with delegated permission;
• An ex-spouse acting in terms of a parenting plan or court order.

But in practice, agency is seldom the easier route. It presents its own difficulties:

• Must the agent produce a written mandate or power of attorney?
• Is verbal authority sufficient—and how is it proven later?
• What happens if the principal disowns the arrangement?

Doctors and their staff are rarely in a position to verify the legitimacy of such authority at reception. Agency may be valid in theory, but in practice, it is fraught with evidentiary risk. The principal may never be liable. The agent might turn out not to have had the authority. The contract may not exist at all.

If none of the above routes are available, then the safest course is to require that whoever signs the patient registration or consent form does so in their personal capacity—as debtor, co-debtor, or surety. This avoids ambiguity and does not depend on proving status, agency, or prior agreement.

To give effect to this, a strongly worded clause should be included. For example:

“I, the undersigned, hereby accept full and personal liability for all medical services rendered to the above patient by this practice, whether or not I am the patient, and whether or not the patient is covered by medical aid or another third party. I confirm that I sign as debtor and, where applicable, as co-debtor and surety.”

This shifts the burden of enforcement back to a clear and documented commitment.

In sum, South African law recognises four distinct pathways to enforce liability for medical treatment:

Anything beyond these is legally uncertain—and often unenforceable.

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