South Africa

Life Esidimeni: Former MEC Qedani Mahlangu needs to be put on the stand to tell us why

The Life Esidimeni arbitration, aimed at promoting restorative justice for relatives of the 141 mentally ill patients who died, entered its second week on Monday. Families have had to relive the gruesome details of how their loved ones died, but if former Deputy Chief Justice is to get to the bottom of what happened, former MEC Qedani Mahlangu must be found and put on the stand. By GREG NICOLSON.

In 2014, only one patient died at the Cullinan Care and Rehabilitation Centre. In 2015, two patients died. “What had gone so wrong,” asked former Deputy Chief Justice Dikgang Moseneke on Monday, that “tens and tens” of patients died at the psychiatric care facility in 2016.

Daphney Ndhlovu, a social worker at Cullinan Care who appeared in front of the Life Esidimeni arbitration hearing, couldn’t answer. “I can’t say. Maybe the moving of many patients at the same time…”

You mean people died only because they were moved in large numbers?”

That is my perception,” she replied to Moseneke, who is chairing the arbitration that moved into its second of three weeks on Monday. Were they fed? Were they given their medication? Did they have facilities to bathe? Ndhlovu said they did. “Why? How do you think they died? What is your explanation?” he asked.

Last week it was revealed that a total of 141 acute psychiatric patients died as a result of the Gauteng Mental Health Marathon Project, which saw the provincial health department cut its decades-long partnership with Life Esidimeni and move patients to NGOs and some state-run facilities such as Cullinan Care.

A week into the arbitration, established due to a recommendation in Health Ombudsman Professor Malegapuru Makgoba’s Life Esidimeni report, Moseneke and the various legal teams involved have continued to ask: why? Why was the project implemented despite repeated warnings? Why did so many patients die?

I want to understand the puzzle,” the former deputy chief justice said on Monday. Ndhlovu offered little help. Cullinan Care took in 163 patients from Life Esidimeni, meaning it had almost twice as many patients than its capacity. In minutes of meetings, healthcare professions said the facility couldn’t provide adequate care, but Ndhlovu claimed patient needs were being met. She offered one plausible reason for so many patients dying at Cullinan: many of them had been sent to NGOs because her facility was overcrowded and then they were haphazardly readmitted to Cullinan.

A handful of NGOs are responsible for a majority of the Life Esidimeni deaths. None of them was properly licensed and many patients died of neglect, particularly of hypothermia and starvation, after reporting no such symptoms at Life Esidimeni. Cullinan took in a number of patients once the NGOs were eventually closed down, but it had also sent some of its own patients to the NGOs to make room for the incoming Esidimeni patients.

Two NGOs were actually established within Cullinan’s facility – Siyabadinga and Anchor. Ndhlovu was part of a team that inspected the facilities and said they were suitable, although she only cited the number of grocery items they had available rather than ability to care for patients. She said there were no nurses at Siyabadinga and a caregiver she spoke to had no knowledge of the medications she would have to dispense.

The arbitration has heard a number of horror stories in its first week. Joseph Gumede died at Anchor in July 2016. Over six months later, Ndhlovu, who had to take up patients’ issues after the NGOs were closed, visited his mother to inform her of Gumede’s death. “I could kill you right now,” his mother said on finding out about the death. “Please don’t kill the messenger,” she replied. “I was sent to deliver the message.” Gumede’s mother walked out of the arbitration on Monday, crying, as the story was retold.

When Life Esidimeni patients were moved from the facility like cattle, some tied down in bakkies, they left with either partial or no identity and medical records, without anyone informing their relatives as to where they were being sent. The NGOs they went to had neither the experience nor the resources to care for them (the Gauteng department of health was paying the NGOs a pittance of what they spent on patients at their own facilities and even then didn’t pay the NGOs for months).

NGO leaders will be called to testify at the arbitration and explain why so many patients died under their watch, but ultimately the former Gauteng health leaders must be held accountable. Levy Mosenogi, the department’s chief director for planning, policy and research, last week said the project was irrational and rushed. Asked who pressured him, he said, “The executive, Dr Selebano and Ms Qedani Mahlangu.”

Barney Selebano is the suspended former head of the Gauteng health department. Mahlangu is the former MEC. Along with the suspended director of mental health, Dr Makgabo Manamela, the three were the architects of the deadly project and there have been repeated suggestions that they ploughed ahead with their plans, ignoring warnings and intimidating critical staff.

Ndhlovu is steps removed away from the top officials, but her testimony showed how decisions by the province’s leaders filter down to healthcare providers. Cullinan Care’s former CEO was suspended for refusing to accommodate the Siyabadinga and Anchor NGOs on the facility’s site. “This is an instruction. Let’s do it the way we were instructed,” she was told when she questioned other aspects of the move. Patients’ relatives were barred from visiting wards because pictures were being shared on social media and in newspapers.

The questions remain: why were the patients moved out of Life Esidimeni and why did they die? Moseneke has been able to gather more pieces of the puzzle and the argument previously offered by Mahlangu have been debunked. She claimed the department was spending too much money on Esidimeni and needed to follow national guidelines that promoted community care for mental health patients. Yet Esidimeni cost a fraction of what the government spent per patient in its own facilities and the new policy direction was only planned to be implemented years after the Esidimeni move.

Was there an ulterior motive? We won’t know until Moseneke and the various legal teams are able to cross-examine Mahlangu and the members of her team in public. The decision to move patients out of Life Esidimeni caused at least 141 deaths. There is suspicion among family members that corruption was involved. Lawyers want to subpoena Mahlangu but ridiculously say she can’t be found. If Moseneke wants to know why this happened, our first task must be to find the former MEC and put her on the stand. DM

Photo: A photographic collage was presented at the hearings by Section27 in memory of the mentally ill patients who died in the Esidimeni Life tragedy. The number of patients who died now stands at 141. Photo: Section27.

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