Judge Moseneke: Gauteng Health triumvirate ‘must testify’

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Judge Dikgang Moseneke said the Life Esidimeni hearings into the deaths of more than 140 state psychiatric patients would not be completed until the three senior people behind the closures testified.

Former Gauteng health MEC Qedani Mahlangu has told a lawyer she will voluntarily testify at the arbitration hearing probing the deaths of more than 100 state psychiatric patients, reports Business Day. State advocate Tebogo Hutamo told the hearing that the state had made contact with Mahlangu and she could not attend now as she was writing exams‚ but would come in November or December.

The report says Mahlangu was the leader behind the project to close Life Esidimeni homes and move 1‚712 psychiatric patients into ill-equipped non-governmental organisations (NGOs) or their family homes. By February this year‚ 118 mentally ill people had died in NGOs and 141 had died in total by September.

Families have called on Mahlangu to be subpoenaed from London‚ where she is studying‚ to explain why the Life Esidimeni homes were shut.

The report says the hearings wrap up on Friday‚ but will resume at a later date. The new dates for the hearing will be announced this week.

Hearing Judge Dikgang Moseneke said if he did not have written confirmation that Mahlangu would attend and on what date she would appear‚ she must be subpoenaed by all lawyers involved in the hearing. According to the report, he said the hearings would not be completed until the three senior people behind the Esidimeni closures testified. They are Mahlangu‚ former head of department Barney Selebano and former director of mental health Dr Makgoba Manamela.

Moseneke said he had told lawyers repeatedly in his chambers to ensure those witnesses attended. “I have continually directed that steps must be taken so we have them here. We are not going to run out of time … unless I die‚” he said in a joking manner.
“It is in the public interest to make it known that it is my position that those three witnesses come before us ahead of and above the national minister of health‚ the premier of Gauteng province and the current Gauteng MEC for health.”

The report says Moseneke asked for a special report last Thursday from all lawyers involved about all steps taken to ensure Mahlangu‚ Selebano and Manamela’s attendance. Manamela was sent a subpoena on Friday to attend‚ Section 27 advocate Adila Hassim told the hearing.

Witnesses testified that Manamela knew the NGOs did not have adequate food‚ money or staff to look after sick people. It also emerged she may have given a contract to another Gauteng health department staff member to transport bodies of deceased NGO patients‚ Moseneke and Section 27 lawyers told the hearing in its first week.

 

The ANC in Gauteng says it’s been in discussion with Mahlangu about her appearing before the hearing, reports Eyewitness News. It says Mahlangu has indicated that she doesn’t have a problem testifying but she’s pointed out her name does not appear on the list of witnesses.

ANC spokesperson Motalatale Modiba said: “She’s taken the initiative to also be in touch with the office of the former deputy chief justice to ensure that she’s also given a chance to tell her side of the story.” Modiba says Mahlangu did request leave of absence from her provincial executive committee responsibilities to travel overseas for the purposes of pursuing her post-graduate studies. He says suggestions that she went AWOL are wrong.

Meanwhile, the report says, a civil rights group called “Act-Up London” has handed over a memorandum to the London School of Economics where the former health MEC is believed to be studying. The group of about 12 says they’re demanding that Mahlangu take the first flight home to South Africa to testify at the Life Esidimeni hearing.

Member of the civil rights group Dermud Macdonald says they are outraged that she’s studying in London while families continue to relate horror stories of how their loved ones died in the tragedy. “We demand that she does the right thing and also demand that she takes responsibility. There are very grave accusations levelled against her. They should encourage and ensure that she does the right thing and gets on the first plane to South Africa.

 

Moseneke had earlier made it clear that the ongoing hearing would not conclude without Mahlangu’s appearance to give her side of the story. “Let me make it clear that these proceedings will not end until the three witnesses the (former health) MEC, and doctors (suspended HOD Barney) Selebano and (director of mental health) Makgabo] Manamela, who took decisions on this mental health marathon project appear before this hearing … this hearing will not conclude until all three of them appear here,” Polity quotes Moseneke as saying.

‘We have talked about this in chambers and as far as I know, there are no differences between the parties specifically regarding these three witnesses for this hearing. We agreed that the parties will take necessary steps to subpoena the witnesses under the arbitration act, and that any impediments would be brought before me.”

Advocate Hassim, who represents more than 50 families of the Esidimeni victims, said her clients were concerned that there was no sign of provincial health top bosses, three weeks into the hearing.

The report says the beleaguered Mahlangu is widely blamed for the botched relocation of more than 3,000 former Life Esidimeni mental patients to unlicensed NGOs, where 141 of them died due to starvation and neglect – 59 the patients are still unaccounted for.

The report says that former Life Esidimeni manager Dr Morgan Mkhatshwa had earlier told the arbitration that he was left shocked when Mahlangu told him in one of the meetings that mental patients can “sleep under stoves as she did when she was growing up.” “I got the shock of my life in one meeting when she told me there were no mental institutions in Brazil … and that she slept under a stove and so can the patients. I asked her what happened when the patients got aggressive … she said they got chained,” Mkhatshwa said.

In February, Gauteng Premier David Makhura suspended Selebano in the wake of recommendations by Health Ombudsman Malegapuru Makgoba. Mahlangu tendered her resignation as the saga unfolded.

Moseneke said Health Minister Aaron Motsoaledi and Makhura would also testify at the hearing.

 

Government officials and NGOs were seemingly protecting themselves in order to stay out of jail. Polity reports that this is according to Christine Nxumalo, whose sister Virginia Machapela died at the NGO, Precious Angels. The report says Nxumalo is one of the victims’ family members testifying on the third week of the arbitration hearing.

“Our understanding when we got onto the arbitration was that we would get answers, but all officials have not offered any answers…and that makes me angry. What they did rather was to protect themselves, we’re in the third week now and we are exactly where we were when this arbitration started,” she said.

“I was hoping that Ethel Ncube (owner of Precious Angels) would not come here and cry her crocodile tears but offer the truth on what happened to my sister…and why she lied about the date of death…not to come here and cry feeling sorry for herself. (Gauteng Health Department’s chief director of planning Levy) Mosenogi did not say anything either, he was project leader but said nothing.”

Nxumalo said the arbitration was supposed to start the healing process, but the fact that there were no answers as to what happened to her sister and no pathological report, meant the hearing was not helping. She said the heads of NGOs such as Ncube should “stop telling us what they think we need to hear” but admit that they did not have the expertise, were not able to care for or feed the patients.

Advocate Hassim asked her if she wanted to hear from any other government official. “I want to hear from Manamela, Mahlangu, she needs to come testify and tell us what happened, she signed off all of these as MEC, and the former HOD (Selebano)… even with us protesting they went ahead and moved the patients,” Nxumalo said.

Nxumalo said it seemed the officials and NGO heads opted to protect themselves and avoid going to jail.

Moseneke asked her if she could suggest any method for the arbitration to get to the truth regarding the patients’ deaths. “None of us here knows how they died. I suppose the only way would be to offer them amnesty, I think that is the only way to get them to say something… Judge, I think it’s a natural reaction to not tell the truth if doing so would get you into jail, that is their reaction.”

The report says Machapela had been an Alzheimer patient at Life Esidimeni. Nxumalo, who was part of the family committee formed to argue against the deadly transfers, said she received an SMS in June last year, informing her that Machapela was being moved to Cullinan, Pretoria and that Life Esidimeni was closing down. She was later informed that Machapela was at Precious Angels in Atteridgeville, west of Pretoria.

“My sister was happy and joyful at Life Esidimeni…she was gaining weight and even remembered our old jokes,” Nxumalo said.

Machapela died at Precious Angels. Nxumalo said she struggled to get her sister’s body and had to open a police case to try get her body. The funeral parlour where her body was, refused to release the body and demanded that she use their services to bury Machapela.

 

The first relative to testify at the Life Esidimeni hearings said her father’s last wish before he died was that someone look after her mentally ill brother. According to a News24 report, an emotional Sandra de Villiers testified how her brother, Jaco Stols, who was a patient at the Cullinan Care and Rehabilitation Centre (CCRC) for more than 18 years, was one of the patients moved to one of the unlicensed NGOs. He was moved to Siyabadinga, where de Villiers felt the staff weren’t properly trained to look after mental health patients.

De Villiers told the alternative dispute resolution hearings that after visiting her brother she felt disappointed and powerless in the way her brother and other patients were treated. “If you look after those sorts of patients, you need to have a passion for your work,” she said. ”They need lots of care and attention.”

De Villiers said she often arrived in the winter at Siyabadinga, also in Cullinan, to visit her brother, only to find some of the patients walking around naked. “He was very scared… Jaco was always hungry when I went to visit him. I would take him a pair of slippers, and the next time I went to visit him, they would be gone,” she said. “He wore thin clothes. It made me think; was he sleeping on the floor? Was he sleeping only on a mattress? Did he have a blanket over him? All these thoughts crossed my mind when I went to visit him,” de Villiers said.

The report says she testified that during one visit she questioned the staff about his condition and was told not to get emotional. “I was very upset. He was my brother. How can I not get emotional?” she said.

Stols was eventually placed back at CCRC, but when his sister went to visit him, she found him in a deteriorating condition. She found him hungry and dehydrated to the extent where he nearly ate the napkin she brought him with his food.

She said a few days later, she phoned the facility and at first, staff said there was no patient by his name. De Villiers said she thought the staff could sense she was getting upset. Someone then phoned her back telling her that Stols was walking around and no longer in a wheelchair, and that he was eating. “I was very relieved,” she said. “A couple of hours later, they phoned me and said they were taking him to Mamelodi Hospital, (because) he was very sick.” “When I got there, he was very dehydrated. He was badly underfed,” she said.

She was told her brother should actually be in ICU, but there was no space. Less than two weeks later, she got a phone call from one of the nurses who told her Stols passed away.

Moseneke told de Villiers that he was “quite saddened” to hear her story, as he worked most of his life helping those who wanted a just and fair society. He said her story didn’t reflect the constitutional ideals he worked for.

 

The father of Hendrick Maboe, who died after he was transferred from Life Esidimeni to an NGO in Hammanskraal, lashed out at government’s fatal decision to relocate mentally ill patients, adding that all the 141 who died would still be alive if they were left at Esidimeni. “We could not be sitting here if these people were left at Esidimeni…they could all still be alive. It was not God’s will that they died… God is not evil,” IoL reports he told the hearing.

“The officials say ‘Batho Pele’ (people first) but they themselves do not care. As you can see what is happening in the country, they (government) do not know what they are doing…and I am telling you the worst is still to come for this government, I am sorry to say that.”

The report says Maboe’s son, affectionately known as Billy, had been at many psychiatric institutions from a young age. He was at Esidimeni for 20 years, the longest compared to the other institutions. Maboe said Billy was epileptic, a condition he suffered from from his teenage years. He was transferred to Bophelong, an NGO in Hammanskraal, north of Pretoria, without his father’s knowledge.

“Billy loved being at Esidimeni, he was nearer to home, and had adapted to the environment at Esidimeni. He was happy to be there also because he could see his cousin, who is a nurse there.”

According to the report, during one of his visits in May 2016, Maboe said he noticed two trucks at Esidimeni and saw patients taken from the wards to the trucks, led by nurses. “They looked so confused, some of them were crying, they did not know what was happening at that moment. They each held plastic bags, they were like sheep going to an auction…I was so hurt to witness the forced removal initiated by government.” When he returned to Esidimeni to check when his son would be moved, he found builders renovating the premises. He was not allowed in, and was told no one else was in the premises, the place would house a rehabilitation centre. Maboe said he spent months not knowing where his son was until he called him to wish him a good birthday, and was able to locate him in Hammanskraal.

Maboe said he found Billy looking disorientated, hungry and dirty. The premises housed 40 men who slept in a garage at the back of the house. He was not allowed to drink water because he wet himself, Maboe was told.

“I asked a woman there about the diet and whether they received medication…she said there was no medication and that the patients were taken to a local clinic whenever they were ill. Most did not have (identity documents) IDs or (South African Social Security Agency) Sassa cards,” Maboe said.

“I found him to be very quiet at that place of death…he was not talking and said he was thirsty and hungry. ”

He said the NGO refused to allow him to take his son home. He later received a phone call in July informing him of his son’s death.

 

Lesiba Legwabe‚ who lost his brother in the Life Esidimeni saga‚ says he believes the tragedy led to his wife’s death. After his brother’s death last August‚ she was running around “like a hapless chicken”. Legwabe’s brother‚ Mothofela‚ was a patient at a Life Esidimeni home for almost 33 years and was then moved to an NGO.

The Times reports that Legwabe, speaking at the hearing, said his wife asked him if he ever found out why Mothofela died in the NGO. He never found out. If he gets answers he will have a ceremony at his wife’s grave and she “will rest peacefully”‚ he told the hearing.

State advocate Hutamo said the government was sorry for what had happened. Legwabe responded saying that when 16 children were moved from a Life Esidimeni children’s home into an NGO in 2007 and some died‚ the government should have learned from that mistake.

According to the report, he told the state advocate: “Your apology doesn’t augur well. You knew. You should have learned. Those children were dying in NGOs.”

Legwabe later said: “We elect people to be in government in order to lead us‚ not to kill us.” He said government officials didn’t do their jobs. “They are always in a meeting. I don’t know which meeting.”

He also said he would have no closure if the Hawks and NPA didn’t “address the situation” suggesting that criminal charges needed to be laid against the officials who made the decision to close down Life Esidimeni homes.

 

A tearful Ntombifuthi Dladla gave a heart wrenching account of how she had to identify his brother’s badly decomposed body, after the family was only notified by the state months after he had died. According to an eNCA report, Dladla said her brother Joseph Gumede, who she was very close to, died at Anchor Centre, an NGO in Cullinan, Pretoria. She was only informed this year by social worker Daphney Ndhlovu about her brother’s death that took place in July 2016.

“I asked her ‘do you hear what you are saying? Why are you telling me only now?,” she said, before she asked Ndhlovu where the corpse had been stored for over six months. Ndhlovu told her Gumede’s body was at a government mortuary in Mamelodi. She said she forced Ndhlovu to break the news herself to their mother, who had suffered a stroke due to Gumede’s illness. Her mother did not take the news well and had to be taken to a doctor, she added.

According to the report, Ndhlovu said she took her brother to Esidimeni because he had become aggressive and had broken windows at her mother’s home. He would sometimes disappear from home and roamed the streets for some time, she added.

Dladla said Ndhlovu told her they had to travel to Mamelodi together so that she could identify Gumede’s body. “It hurt me the way my brother’s body looked like…his body was decomposed and had a bad smell. The morgue was hot, we were requested to wear masks because of the bad smell in there,” Dladla said as she broke down in tears. She then had to return to the mortuary to take Gumede’s body home. The undertaker did not bring a hearse for the corpse, instead he arrived with his two assistants in a minibus taxi, she added.

“We travelled with my sister, and drove back all the way from Mamelodi to Soweto with my brother’s decomposed body…I wished that the driver would not stop at traffic lights because every time he stopped, flies would pour into the taxi because of the bad smell.”

The report says the worst was not over for the family as they prepared to bury Gumede. “We left him at the undertaker on Monday. I received a call from the owner on Tuesday requesting me to come to his office. I told her I couldn’t because I was preparing for the burial,” said Dladla. “He told me it was difficult to clothe my brother’s body as there were maggots coming out of his body. He suggested that we buy blankets so he can wrap his body instead.”

She said regretted taking her brother to Esidimeni after she survived the streets without him being discovered dead by strangers. “I tried to give my brother a place of safety so that he would not end up dead by the side of the road, but it seemed I signed up death for him. I am even afraid to look my family in the eye because I am the one who took him to Life Esidimeni…it seems I sent him to his death. My brother would disappear but survived the streets as we were able to find him,” she said, sobbing uncontrollably.

When she asked for her brother’s medical file, Ndhlovu told her Gumede was transferred to Pretoria without his medical records.

The arbitration, resumes on Thursday. Moseneke is unavailable on Wednesday.

 

Relatives, last week, broke down and sobbed as they heard how the former MD of Life Esidimeni begged the Gauteng Department of Health for information about where patients were being moved to. News24 reports that Dr Morgan Mkhatshwa told the hearings that it was “a command” to move patients to various NGOs, despite his repeated pleas for information about the names, addresses and contact details for these NGOs.

Mkhatshwa said he failed to understand how department officials, some of them trained medical officials, didn’t stand up and speak out. “It was sad for me to see how clinicians could succumb to what I’d call political pressure. I said it’s bad if you forget the oath you took (as a medical practitioner),” he said. “How could they not stand up and say ‘over my dead body, I will not do that’,” Mkhatshwa said.

He said he warned officials about the plans to transfer patients from Life Esidimeni to a number of unlicensed NGOs, some of which he had known nothing about. This was following an incident in 2007 where 17 children were taken from Life Esidimeni and placed in an NGO. Mkhatshwa said they later died because they had been severely dehydrated and malnourished.

“Why couldn’t we have learned from the 2007 incident? Did we just choose to be oblivious to it, or did we just ignore it?” he asked. “Expert advice was ignored”.

The report says during his testimony, Mkhatshwa recalled how representatives from the various NGOs just started arriving at Life Esidimeni to collect patients. Some even hand-picked patients. “They said they were coming to pick their patients and I said ‘get the hell out of here, this is not an auction’. These are people,” he said.

Responding to a question about patients being collected on the back of bakkies, Mkhatshwa said he told the official to “take that damned thing out of our facilities”.

Mkhatshwa said the decision to move patients from Life Esidimeni to the various NGOs wasn’t “rationally clinically” or “rationally business-wise”, with Mahlangu telling him there wasn’t a budget to pay for the Life Esidimeni contract. “We were ensured that the users would leave Esidimeni for equal or better facilities,” he said.

According to the report, Mkhatshwa said he resigned from his position at Life Esidimeni because he too was traumatised by the way it turned out. “I ask myself if there is anything I could’ve done. I don’t know,” he said. “I think the families did more. They went and toyi toyi’ed at the department… they demanded an apology… they demanded to know where their loved ones were”.

 

Mkhatshwa testified that the department rejected offers to send out its (Life Esidimeni’s) own clinical staff to ensure that the NGOs were adequate and safe for patients, says a Polity report. The department further refused to disclose where the patients were being taken to. His institution asked for the department’s plan and offered to help identify suitable NGOs for patients. The report says a contract termination notice from the department was received in September 2015.

“We were told commissioned research showed that our facilities were too expensive…we asked for the cost study but the department told us they were not obliged to share that with us,” he said. “These patients were not your average mentally ill patients, they were always assessed by experts and were not the kind of patients that one could send to communities. We wanted to know where they were to be taken to, we offered teams of experts to go evaluate the NGO facilities…that was declined.”

He said the department was told discharging over 2,000 patients within a month was not going to be possible or safe for the patients. “These were psychiatric patients…they needed professional clinical staff in order to be evaluated. You need to also trial the place before you send them there permanently…when the department said they would send its own clinical experts, we rejected that.”

The report says so angry were clinical staff at Esidimeni that most threatened to resign amidst the department’s disastrous plan. “Our clinicians wanted to stage a walkout because they could not take that anymore…we begged them to stay and ensure that the patients were seen off to NGOs.”

The Esidimeni staff was very close with the many patients who had subsequently died, knew and understood them in a professional environment, he added.

 

Dianne Noyile‚ who ran the Siyabadinga NGO and looked after 73-mentally disabled and physically disabled patients‚ has admitted she still has the Sassa grant cards of 14 vulnerable patients‚ who are no longer in her care, reports The Times. Her NGO‚ set up in May 2016‚ was without money‚ used two junior nurses and relied on food donations‚ she admitted.

After only being open for two months‚ Noyile’s NGO was shut down last July by the Gauteng Health Department.

The report says Noyile‚ who is a pastor‚ admitted under cross examination that still has the Sassa grant cards of 14 patients who are alive. This means they can’t get their disability grants. She claims she doesn’t draw the money. She has held the cards due to a dispute with the Cullinan Care and Rehabilitation Centre‚ because it took patients’ clothing donations from her NGO‚ when it was shut down.

In total‚ nine patients who had stayed with her died‚ although some passed away a few months after leaving Siyabadinga.

Moseneke‚ told her that patients died in her care under “very clearly negligent and unlawful circumstances” hinting she could be charged with murder.

The report says Moseneke has spoken about criminal consequences “with a bee in his bonnet ” to each Esidimeni witness. No one has yet been criminally charged in the tragedy. Noyile admitted she was operating under an incorrect licence for her NGO and none of her staff were trained to deal with mentally ill or disabled people. Moseneke told her: “You didn’t have anything that patients needed‚ except you and your love‚ as you say.” Moseneke added: “And now people have died in negligent circumstances‚ where you were in charge.”

 

Determining the costs incurred by families of the victims of the Gauteng Mental Health Marathon Project is proving to be a slippery aspect of the arbitration dispute resolution (ADR) process, according to a Business Day report. The hearings are designed to provide information, redress and closure to the affected mental healthcare users and their families.

The report says the parties chose arbitration as the method of resolving the dispute, seeking equitable redress – one term of reference is to provide financial compensation to the families affected but the amount to be paid out per patient remains undetermined.

Each testifying family member has been asked about the emotional and financial damage incurred as part of revealing the extent of the tragedy in which 141 mental health patients died. The report says witnesses have testified about the horrific conditions that their family members had been subjected to but many have been unable to recall how much was spent as a result of the tragedy.

Anna Masombuka, whose daughter Maswidi had been living at a Life Esidimeni Randfontein facility for more than 20 years, told the tribunal that she was unable to give a figure of how much was spent because she was illiterate. Another witness said the emotional trauma she experienced did not allow her to stay abreast of the financial costs related to her husband’s funeral. Phumzile Motshegwa was able to cite R72,000 for funeral costs after her brother Solly Mashego died in the care of illegal NGO Precious Angels.

The report says the state, represented by  Motsoaledi and Makhura, has conceded unconditionally that the conduct of its employees and functionaries had unlawfully and negligently caused the 141 deaths, but it is unclear where the funds for compensation will come from. The Gauteng Department of Health remains cash-strapped, with a R10bn funding gap.

“South Africans have to work hard to find out what equitable redress would mean,” Moseneke said.

 

Western Cape health authorities have, meanwhile, extended a contract with the Life Esidimeni medical group to avoid a repeat of the Gauteng tragedy. A Cape Argus report quotes DA Western Cape spokesperson on health Lorraine Botha as saying that she has called on the provincial department to ensure that Life Esidimeni Mitchells Plain Intermediate Facility conduct a smooth and careful transition to its new, contracted, service provider.

The contract of Life Esidimeni, which provides care for approximately 200 psychiatric patients, ended in August, but was extended until the end of December. Botha said the move would give the new service’s personnel an opportunity to familiarise themselves with both the patients and the facility.

Provincial Health Department head Dr Beth Engelbrecht said in the report: “To ensure the well-being of our patients is prioritised, we started well in advance with the procurement process of a new contract for a new service provider. This process is prescribed, since the current five-year contract with service provider Life Esidimeni expires at the end of December. The procurement process was fair and transparent.

“The department’s pro-activeness in establishing the new contract so early allows for continuous care to patients without interruptions, whether with current or new contract. As is the current practice, we will continue with regular monitoring.”
Botha said she was pleased that none of the patients would be moved from the facility during the transition period, and that patients would remain in care until ready to be discharged.

“This smooth transition is vital, as the Western Cape department should ensure the entire process is handled with the greatest caution and clarity, and  the mental health care provided to patients is sustained and uninterrupted,” Botha said.

“To date, this led to the unfortunate and tragic death of more than 100 patients when their transfer from the Life Esidimeni facility was not handled with the necessary care and due process. I do hope the inquiry currently under way in Gauteng will bring some form of closure to all the families affected by this terribly unfortunate incident,” she said.

The report said emails sent to Life Esidimeni were not replied to and phone calls to its Johannesburg head office went unanswered.

Business Day report
Eyewitness News report
Polity report
Polity report
News24 report
IoL report
The Times report
eNCA report
News24 report
Polity report
The Times report
Business Day report
Cape Argus report


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