While Pretoria high court judge Mmonoa Teffo has found that 10 Life Esidimeni patient deaths were, until proven otherwise, caused by former Gauteng health MEC Qedani Mahlangu and former head of mental health services Dr Makgabo Manamela, the third “perpetrator” has been let off the hook.
Delivering judgment in the Life Esidimeni inquest, Teffo did not hold Ethel Ncube, owner of the Precious Angels NGO where the most deaths happened, accountable for any of the 20 deaths of patients in her care.
This brings finality to the hearings that started in July 2021 and concluded at the end of October last year. Its crucial purpose was to determine any criminal accountability for the deaths of over 140 patients who were transferred from Life Esidimeni facilities to unlicensed NGOs during the 2015/16 Gauteng Mental Health Marathon Project.
Public interest law centre Section 27 spearheaded the case for the families of the deceased. In their argument, Section 27 set out clear cases against the three main alleged perpetrators, asking the court to find them prima facie guilty of culpable homicide in relation to the deaths of 10 patients.
These are patients whose families managed to get independent postmortems carried out on their loved ones. These were the only cases that had clear and accurate reports on the actual cause of death — unlike many of the autopsy reports carried out by the Gauteng health department, which determined that the deaths were due to natural causes.
The three identified by Section 27 as the people who needed to be held criminally liable for their actions were Mahlangu, Manamela and Ncube, owner of the irregularly registered Precious Angels NGO.
Mahlangu resigned from her post on February 1 2017, the day the damning heath ombudsman’s report findings were released.
Section 27 argued that it was Mahlangu who made the initial decision to terminate the outsourced care contract with private healthcare provider Life Esidimeni, which had been providing specialised psychiatric care to state patients.
While Mahlangu disputes having made the decision alone, Section 27 argued that it was ultimately her decision that led to 144 deaths. Mahlangu claimed that Life Esidimeni had received negative audit findings by the auditor-general, that a process of ‘de-institutionalising’ patients was needed and that this was necessary for cost-cutting purposes.
She was warned by many people and organisations of the risks of the move, but decided to go ahead with it. She had the power to reverse her decision and stop more deaths once it became known that patients were dying — but failed to do so. And, Section 27 argued, it was ultimately only Mahlangu and Manamela who had the power to continue driving the crisis forward.
Section 27 argued that the reasons she gave for her decision were not valid — that the alleged policy to de-institutionalise mental health patients did not stand; that there was no evidence of any auditor-general concerns with the Life Esidimeni contract; and there were no real budgetary constraints. This was because the Health Advanced Institute commissioned to produce a report on cost containment for the Gauteng health department found that the Life Esidimeni contract provided good value for money.
Manamela made several admissions that demonstrated her culpability, Section 27 argued.
She knew that NGOs such as Precious Angels were not equipped to care for mental health patients and still allowed some frail users to be transferred there. This resulted in 20 hastened deaths, five of which she was said to be criminally liable for.
“It was her team that was responsible for recommending improvements to facilities before the transfer and only audited them long after the deaths happened. She signed the licences for the NGOs to operate, declaring that she was satisfied that they met the requirements. She admitted to signing the licences without having sight of the facilities. She admitted that the transfer plan was poorly executed and led to the deaths of 144 patients,” Section 27 said.
Manamela had visited Kalafong Hospital, where wards had been declared unfit for human habitation. She devised a plan to renovate them to be used by the NGOs to house 150 patient beds. But the wards were earmarked for demolition and could not be used, leaving the NGOs with no premises with just two months to go before the planned patient discharge.
“She had the requisite information to determine whether the transfer would be a success or failure. She was a reasonable person and an expert in her field. She knew the dangers and threats of the termination project and proceeded to implement her poor plans regardless,” Section 27 said.
She approved the NGO licences without following proper process. The licences reflected incorrect addresses, incorrect mental healthcare user classifications, and all were backdated to April 1 2016 regardless of the date of the signature. Anchor House was licensed for 150 beds when it had no premises. Precious Angels was licensed to operate from Kalafong Hospital with no ward allocated.
The required service-level agreements with the NGOs were signed only after patients were moved, meaning the department was not able to pay them. And she knew this.
Like Mahlangu, Manamela was repeatedly warned that the plan would fail. She was presented with other options, and her own department experts raised concerns and alarm over the NGOs, but she ignored them.
Instead, she ordered that the process be speeded up. She ignored warnings from psychiatrists in the field and continued to implement the project plan.
When presented with a list of demands by patient families, she responded with false statements, claiming that the NGOs had been properly assessed and accredited. She then devised “Adopt an NGO” strategy as “a mechanism of damage control”. This was formally initiated only after 17 deaths at Precious Angels in four months and 47 deaths in total.
The third person that Section 27 had asked to be held criminally responsible was Ncube, where the first of 20 patients died within two weeks of being moved into her care.
Ncube told the hearing that neither she nor her staff had the relevant experience or training to care for mental health patients, that the facilities she had procured were inadequate and that she had gone ahead with the project despite all the promised assistance not materialising. She operated her NGO without a proper licence.
When facilities promised by government didn’t come to pass, Ncube borrowed a house in Danville and another in Atteridgeville from her uncles. When promised food and blankets also did not arrive, and she had run out of medication she continued to accept more patients.
Patients died of malnutrition, pneumonia, asphyxiation due to food aspiration and other medical causes. Many died emaciated.
She had no experience running a 24-hour facility. She accepted patients with Alzheimer's, epilepsy and cerebral palsy. She hired cleaners as care workers — only two or three on each shift, with no security. She claimed that Precious Angels was assessed two weeks after taking in patients, but there is no evidence of this having happened.
Patients were left without blankets — seven of the deaths were from pneumonia and four of the patients were significantly underweight when they died.
At the time Ncube was allocated 150 patients, she had no beds or staff. A report on the Danville house found that 39 patients were accommodated in the house and it was suggested that the garage be converted into a ward to accommodate 36 patients. A report on the Atteridgeville house found that there were 15 female patients — three in one room, 12 in another in cot beds placed close together. Patients were put in nappies and staff used the one toilet in the house.
An inspection found no emergency equipment and patients were watched by only three untrained staffers. Some patients were left on plastic mattresses on the floor with no blankets in winter, and all the food in the house amounted to two cabbages.
This was reported to Manamela, who said she had nowhere else to send the patients and sent other staffers to double-check the report findings. Another two patients died before the second opinion could be determined.
Department staff found the facilities woefully inadequate and recommended the immediate relocation of the patients — but Precious Angels was not shut down for months.
Ncube herself collected patients from Life Esidimeni, knowing that she was not licensed for the locations she took them to. She accommodated bedridden adult patients in cot beds for children.
“She knowingly took in patients she was not qualified to care for with insufficient food, medicine and blankets, without a licence,” said Section 27.
Patient beds were placed so close together that cupboards and doors could not be opened. There was no hot water, and three of the patients who died in her care had gangrene and bed sores — indicating inadequate care.
But Teffo did not find Ncube criminally responsible for any of the deaths. The devastated families, who have already been waiting for eight years, now start the wait to see if arrests will be made.
Would you like to comment on this article?
Sign up (it's quick and free) or sign in now.
Please read our Comment Policy before commenting.