Wasteful expenditure on emergency ambulance transport is on the rise, and the university is now drawing a financial line in the sand.
- Wits University attempts to manage the high cost of emergency services for residence students who refuse ambulance transport.
- Almost R300 000 is spent annually on ambulance services.
- The trend of transport refusals has been happening for years.
The frantic dance of red and blue lights shatters the silence of a Wits residence hall, pulsing through the window blinds. For a student without medical aid, this sudden flashing arrival is reassuring; a lifeline of professional care provided by the university.
But what happens when the student’s condition improves, or they have a change of heart and the ambulance leaves without a patient?
This frequent scenario is what the university views as a financially wasteful trend, prompting it to inform students they could be liable for a minimum of R3,000 for refusing transport for medical emergencies.
The communication, forwarded via email by the respective wardens to students living in Wits residences, begs the question of what exactly constitutes a “wasted call,” and how does this apparent misuse of emergency services translate into a significant financial burden for the university?
The financial burden and wasted calls
The Wits Campus Housing and Residence Life (CHRL) department has been absorbing costs related to student medical emergencies.
ER24, the private emergency service provider for students not on medical aid, expressed its concern to the university about students’ refusal to be transported.
Basil Mugwena, CHRL director, explained that if a student is not on medical aid, the university calls ER24 and covers the cost, opting for private services like ER24 over slower government ambulances.
The CHRL financial manager, Tabrez Jooman, stated, “Contractually, if a student refuses to be further assisted, the University still pays for the ambulance service.”
The university’s annual contract with private ambulance provider, ER24 amounts to approximately R300,000.
Mugwena notes that a single ambulance that is dispatched and leaves without a patient can cost the university almost R1,000.
It’s important to note that the R300,000 contract with ER24 does not cover the most severe cases. Mugwena, talking about the intensive care unit (ICU), clarified, “There are cases that we’ve had where we’ve had students in ICU.”
He emphasised that for these serious incidents, the university often has to cover much larger expenses. For example, he recounted one incident where a student was in the ICU for an extended period: “The default position is if you are not on medical aid after 72 hours, if you are still sick, you must be transferred to government [hospital]. Which will not happen. [So], we paid.”
These more critical situations fall outside the scope of the regular ambulance contract, placing a greater financial strain on the university.
The frustration, Mugwena noted, stems from situations where an ambulance is called, but the student either no longer needs or refuses the transport or those who call to “see whether these fellows will respond”.
“This [transport refusals] has been going on for the past few years,” he said.
A paramedic’s perspective on refusals
Campus Health paramedic, Tebogo Sibilanga, whose team works closely with ER24 to provide rapid emergency care for students, confirmed that they have seen numerous cases of refusals for hospital transportation (RHT).
When asked how they determine if a student is fit to refuse transport, Sibilanga explained, “We’ve got what we call a Glasgow Coma Score. It has a score out of 15 which we use to determine your level of consciousness. And also, your body coordination.”
Sibilanga explained that they are legally prohibited from forcing a patient into an ambulance unless a mental health professional determines the student is a danger to themselves or others.
A common scene is set by Sibilanga: an asthmatic student who, after being found and stabilised by the team, refuses transport upon feeling better because they found their pump.
While the patient may have the resources to manage their condition, the paramedic’s protocol requires them to assess the situation thoroughly before leaving a patient to their own devices.
“We’ve had cases… when the paramedics arrived, they found that no, this particular student simply did not take their own medication,” Mugwena stated.
If the student is stable, they may be encouraged to use Campus Health services instead.
Sibilanga also shed light on the reason for the reliance on private services. “Due to delays with provincial ambulances—which can sometimes take hours—the university outsources the service to ER24 to ensure a rapid response time, ideally within a six-minute window.”
This partnership, alongside a deal with Milpark Hospital, Charlotte Maxeke and Hillbrow Hospital, is designed to bridge the gap in emergency care for students, particularly those who do not have medical aid.
“Actually, there are two paramedics on campus for the whole university, which is very disturbing. But we are working on hiring more people,” he said.
The challenge of mental health crises
A portion of the “wasted” calls stems from students experiencing anxiety attacks, particularly those who are directed to Akeso, a private psychiatric hospital.
Mugwena described this arrangement as a “headache,” noting a frustrating trend where students will often refuse to go to the on-campus Counselling and Careers Development Unit (CCDU), but then insist on being taken to Akeso. However, according to protocol, a student must first be seen by CCDU to get a referral.
Mugwena pointed to stigmatisation as a major reason for students’ hesitation to be taken by an Akeso vehicle, fearing they will be perceived as “mad.”
While the university does have the authority to authorise an “involuntary admission” if a psychiatrist determines a student is a danger to themselves, Mugwena believes the issue is more complex than simple abuse of the system.
He stated, “I will not say this person is doing this deliberately… I’m saying something may be underlying.” He added that he would not penalise a student for refusing transport due to a mental health issue, calling it “inhumane.”
So, are students actually liable for payment?
The short answer is no.
Contrary to the email, both Mugwena and Jooman indicated that the R3,000 charge mentioned in the email is a deterrent, not a rigid fee that has been implemented.
Jooman said, “I am not aware of any minimum charge of R3000 being set and none has been levied to any student to date.” Mugwena confirmed, “We have never done any penalty on any student.”
Despite the threat, it was revealed that their main strategy is education.
“The best thing that we can do is to educate because time and again we say to wardens, talk to students, particularly about calling ambulance services,” clarified Mugwena.
When asked if there is ongoing communication with students about emergency procedures, Zethu Lubisi, warden for the all-female residence, Sunnyside Hall of Residence, said, “Yes, during quarterly PGM meetings, wardens share information and encourage students to use university health services like Campus Health to get timely assistance and reduce reliance on ambulance services.”
For now, Wits is walking a fine line, using a financial threat to manage a behavioural trend, while internally acknowledging the ethical and human complexities of the situation.
The central message to students is clear: “Stop abusing this,” while the internal conversation among staff is focused on the best way to educate students and reduce financial waste without compromising their wellbeing.
FEATURED IMAGE: ER24 ambulance vehicle parked outside on the piazza at the Great Hall at Wits University. Photo: Lukholo Mazibuko
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