Former Gauteng Health MEC Qedani Mahlangu testifies during the Life Esidimeni arbitration hearings on January 22, 2018 in Johannesburg. , South Africa. (Photo by Alet Pretorius/Gallo Images/Getty Images)
The Life Esidimeni inquest found this week that the death of 141 mental health patients in 2016 was caused by the negligence of former Gauteng health MEC Qedani Mahlangu and former Gauteng director of the mental health directorate, Makgabo Manamela.
In 2015 and 2016, more than 2 000 patients were moved to ill-equipped, unlicensed NGOs after the Gauteng health department terminated its contract with Life Esidimeni.
Handing down her ruling in the Pretoria high court on Wednesday, Judge Mmonoa Teffo said Mahlangu had terminated the contract between Life Esidimeni and the Gauteng department of health despite the objections of numerous mental health experts.
“Having heard all the evidence in this inquest, I have come to the conclusion the death of the deceased was due to negligence caused by the conduct of Miss Mahlangu and Dr Manamela,” said Teffo.
The inquest found that Manamela failed to report that the NGOs to which the patients were transferred were ill-equipped.
“She could have saved many lives as she visited NGOs and could see that they were not adequately equipped and some of the personnel were not adequately qualified to care for the mental healthcare users,” the judge said.
She added the deaths of nine of the patients — Virginia Machpelah, Deborah Phehla, Frans Dekker, Charity Ratsotso, Koketso Mogoerane, Terrence Chaba, Daniel Josiah, Matlakala Motsoahae, and Lucky Maseko — were caused by starvation, malnutrition or pneumonia.
According to records read out by Teffo, many of the patients’ bodies were not sent for autopsies.
Public interest law centre Section27, representing 44 of the bereaved families, has called for those responsible to be charged with culpable homicide for their involvement in the deaths.
“We trust that … Ms Mahlangu and Dr Manamela will be prosecuted for culpable homicide,” said Section27 chief executive Sasha Stevenson in a statement after the proceedings.
Following Teffo’s decision, the National Prosecuting Authority will decide whether to pursue criminal prosecution against Mahlangu, Manamela and the NGOs that failed to provide adequate services for the patients.
The inquest ran from 19 July 2021 until 8 November.
It started after the South African Police Service officially opened 46 inquest dockets in April 2018 at the request of family members of patients who died as a result of the closure of Life Esidimeni. In July 2021, Teffo was appointed to preside over the inquest.
Testifying at the inquest, Mahlangu said former Gauteng premier David Makhura had signed off on the transfer of the patients from Life Esidimeni facilities to cut costs.
“The ultimate decision to transfer the mental health patients was taken by the premier,” Mahlangu said.
During Makhura’s testimony in the Pretoria high court in May last year, he said he had called a meeting with Mahlangu after hearing about the deaths.
But, he said, the MEC assured him that the deaths of the mental health patients was “normal” and compared the number of deaths to past cases.
“I was shocked that in some years we would have 30 [deaths] and other years close to 40 but, according to them [the Gauteng health department], the passing of mental health patients in the NGOs was not unusual, it was normal,” said Makhura.
The former Gauteng premier was testifying on allegations that the premier’s budget committee had instructed the provincial health department to cut costs.
He admitted that steps were taken to bring the department’s finances under control but said the decision was not at the discretion of the premier’s budget committee (PBC).
“Outside implementing those cost-containment measures by everybody, there was no PBC decision to deal with cutting costs from any department.
“The PBC would be in no position to make a decision on a contract or procurement. It would completely be unlawful,” said Makhura.
But the former MEC for finance Barbara Creecy, during her testimony, denied that the health department was under pressure to cut the costs allocated to psychiatric or mental hospitals.
Creecy added that the health department was instead underspending its allocated budget.
“In 2015 to 2016 we recognised the overspending and allocated R1.26 billion to the department — the spending was R1.22 billion, an underspending.
The budget increased to R1.35 billion, the actual spending was R1.27 billion,” she said.
The Life Esidimeni saga began in October 2015 when Mahlangu announced the termination of the contract between the Gauteng health department and Life Esidimeni. The long-term psychiatric care facility provided highly specialised chronic care to about 2 000 patients.
The health department said it planned to move the patients to NGOs, and other psychiatric hospitals in Gauteng, in an attempt to “deinstitutionalise” mental healthcare and to cut spending.
Civil society had raised concerns about the safety, health and dignity of the mental healthcare patients who would be transferred to newly established NGOs.
In June 2015, the South African Society of Psychiatrists wrote to the MEC detailing the serious risks of the department’s premature decision to cancel the agreement with Life Esidimeni facilities.
In February 2016, the Gauteng health department extended the contract with Life Esidimeni for an extra three months but said that all patients would be transferred out of the facilities by the end of June 2016.
From March to August 2016, patients with varying diagnoses and needs were discharged from Life Esidimeni and transferred to 27 NGOs and hospitals around the province.
“The process was completely haphazard, with patients being loaded onto the back of trucks, confidential patient records being lost and chaos characterising the process,” said Section27 in the court proceedings.
The father of one patient, Billy Maboe, described seeing the “lost souls” herded onto buses, some with their belongings in a single plastic packet, to make what he called “the Great Trek”. Billy didn’t survive.
Soon after the move, the family members of some of the transferred patients raised the alarm about the “torture”, declining health and deaths of their loved ones.
According to court papers, in August 2016, Christine Nxumalo discovered that her sister Virginia had died after being transferred to the Precious Angels NGO. Her family was not notified.
Nxumalo later learned that eight other patients had died at the same NGO and demanded an inquest.
Answering questions in parliament in September that year, the MEC said that 36 former Life Esidimeni patients had died since their transfer from the facility.
Evidence later showed that, at the time of the MEC’s revelation, more than double the number of patients had died.
After the MEC’s revelations, then minister of health Aaron Motsoaledi requested an investigation into the deaths of the patients.
The health ombud Malegapuru Makgoba was appointed in September 2016 to investigate the transfer of the patients in more detail and invited the MEC, civil society organisations and patients’ family members to make submissions to its report.
The ombud’s report, titled No Guns: 94+ Silent Deaths and Still Counting, was published on 1 February 2017. It detailed the deaths of 94 patients and the “inhumane treatment” of others.
“Several deceased had died from illnesses that questioned the conditions/circumstances under which and the quality of care patients received at NGOs, eg, fits, dehydration, aspiration pneumonia, acquired pneumonia, cardiac arrest, ‘being found dead in the morning without night observations’, etc,” the ombud’s report stated.
According to interviews conducted by the ombud, two hours before patient Freddie Collitz, 61, died in the care of the Mosego Home in Krugersdorp — an old-age facility for psychiatric patients — he had a wound to the head, blisters around his ankles and a sore on his nose. Collitz, who suffered from depression, had been moved by the Gauteng health department from the Randfontein LE Institution to the Krugersdorp NGO.
In June 2017, in line with recommendations made by the ombud report, former deputy chief justice Dikgang Moseneke was appointed to arbitrate an alternative dispute resolution between the government and the families of the Life Esidimeni deceased, represented by Section27 and survivors, who were represented by Legal Aid South Africa.
It was estimated that the arbitration, which began on 9 October 2017, would take three days. It ended up taking 45 days, with 60 witnesses testifying and two days of legal arguments before the arbitration adjourned.
Of the 60 witnesses, 12 were senior government officials including the minister of health, the Gauteng premier and members of the executive council for finance and health.
Cullinan Care and Rehabilitation Centre social worker Daphne Ndhlovu testified that she did not speak up when she witnessed the centre’s patients begin to die because she was threatened and accused of insubordination.
“We knew we were not giving justice to our patients but it was instructions from above,” Ndhlovu said.
Manamela and her deputy, Hannah Jacobus, as well as the chairperson of the Gauteng Mental Health Review Board, Dumi Masondo, were implicated in the arbitrator’s indictment.
In March 2018, Moseneke ordered that the state pay the costs and damages for the families of the deceased mental healthcare users.
In his indictment, Moseneke condemned senior state officials for the “wanton, arbitrary and unaccounted decision” to discharge patients from Life Esidimeni into the care of unlicensed NGOs, which he said “caused so much pain and suffering, stress, trauma and morbidity, and in my view, is a very serious breach of the constitutional obligations by the state and its servants”.