The medical director of Cape Medical Response has been told his ambulances must stop and pay the toll fee if they use Chapman's Peak drive, irrespective of whether it is an emergency

Alan Walters told the Cape Times newspaper he was "absolutely gobsmacked" when he learnt the ambulances were not exempt.

"It's just amazing, really nonsense," he said.

"I'm not talking about going to a meeting in a response car, I'm talking about an ambulance with lights flashing with a critically ill patient in the back.

"It happened when the guys were on call and they got a call to go to Hout Bay to transfer a patient to Constantiaberg as an emergency.

"They were stopped at the toll and had to scrabble around collecting money to pay the toll," Walters said.

The incident happened last month.

Walters wrote to Rob Pomario, a director of Entilini Concession, asking that ambulances be granted exemption from toll fees when attending to a medical emergency "so that valuable seconds can be saved".

"All our response vehicles are immediately identifiable as such, with signage and emergency lights," he wrote.

Pomario wrote back to say he could not grant the ambulances exemption from the toll fees.

He suggested that the ambulances "carry a float at all times to avoid any delays in finding toll fees".

"Alternatively, we suggest that you discuss our frequent user facility with our operator.

"The gazette is very clear as to which vehicles are to be regarded as emergency vehicles," Pomario wrote.

Walters wrote to Western Cape premier Helen Zille, to say his ambulance service was not granted toll-fee exemption when responding to emergency calls.

"And that means life and death calls. Your opinion would be appreciated."

Walters said the premier's office wrote back to say the office would be closed until mid-January. He had not heard anything since then.