“There is a trail of events in this situation that defies comprehension. Vulnerable, dependent, poor people were virtually tortured to death. And if that did not matter to the officials of the department, they compounded the matter by treating the victims of their decisions – the families – with the utmost contempt and disregard for their pain, dignity, and humanity.”
Daily Maverick reports that so reads the affidavit that psychoanalyst and clinical psychologist Coralie Trotter submitted to the health ombudsman after working with a team of 19 other clinicians to assess the impact of the Gauteng Health Department’s fatal decision to move 1,700 patients out of Life Esidimeni.
The report says lawyers for the provincial government tried to bar Trotter’s damning testimony at the Life Esidimeni arbitration hearings, where it was revealed a total of 143 patients have died as a result of the department’s Gauteng Mental Health Marathon Project, but she was allowed to proceed.
The report says as the arbitration continues and more evidence emerges that could lead to decent compensation for the families, the state’s counsel appears to be under mounting pressure to limit government responsibility. The arbitration, however, appears to promise more hope in finding the truth and holding officials accountable.
In her testimony, Trotter reiterated how patients’ inhumane treatment by the department and the NGOs they were transferred to could amount to torture. Citing clinical Professor Ira Brenner, she said dehumanisation is a two-step process. “Step one is identifying undesirable humans. Step two is turning them into non-humans.” That’s what the department did and it had a devastating effect on families, who she said suffered from continuous traumatic stress disorder (CTSD).
The report says that could have implications for compensation paid to both the families of the 143 patients who died and those of around 1,600 others who survived the move from Life Esidimeni.
The state’s lawyer Advocate Tebogo Hutamo refused to accede to Trotter’s testimony being heard, questioned her expertise, and argued that her testimony was irrelevant. Former deputy chief justice Dikgang Moseneke, who is presiding over the Life Esidimeni arbitration, allowed Trotter to proceed but will only decide later whether to include her evidence. Although the state said Trotter’s findings were based on hearsay, she interviewed 11 families.
The report says the state’s lawyer also attacked the testimony of Dr Mvuyiso Talatala, saying Section27, which represents the relatives of many patients who died, had brought doctors as “hired guns”. Talatala, the former president of the South African Society of Psychiatrists, was one of the many mental health professionals who warned the department about its planned move. His testimony could also lead to increased compensation pay-outs and further shame upon the Gauteng government for ignoring repeated warnings.
Relatives of those who died after being moved from Life Esidimeni have demanded to hear the three most implicated officials testify, the report says. Former provincial health MEC Qedani Mahlangu, suspended head of department Dr Barney Selebano, and suspended director of mental health Dr Makgabo Manamela have repeatedly come up in the hearings and the health ombudsman’s report as the primary culprits, pushing the disastrous plan through and creating a climate of fear preventing dissenters from taking a stance against them.
Mahlangu disappeared into obscurity after she resigned on the morning Health Ombudsman Professor Malegapuru Makgoba released his report. The report says after a sustained campaign to have her testify at the arbitration, it was revealed she is studying in the UK at the Global Banking School. She claimed in a statement released last week that “it is completely false that I refuse or ran away or disappeared from the Esidimeni arbitration. From the beginning, in line with my conscience, I have made it clear to all authorities involved that I'm available to appear before the arbitration.”
It’s unclear as to whom she expressed her desire to participate in the arbitration, the report says. She only spoke out last week. Lawyers trying to get her to appear said they didn’t know where she was. And despite her professed availability, Mahlangu is only willing to appear on her terms. Moseneke wanted to complete the arbitration this year, but after a break, it will have to resume in January to hear her testimony.
It was announced last week that Selebano’s appeal against the ombudsman’s findings and the disciplinary action taken against him was dismissed. Manamela’s appeal has also been dismissed, meaning the pair must finally face disciplinary action for their role in the cause of the 143 deaths. “This paves the way for them to be charged in a disciplinary process that will probably lead to their dismissal,” said the DA Gauteng’s Jack Bloom.
Mahlangu, Manamela and Selebano are described as the key architects behind the Esidimeni move and despite the state’s latest attempts to have incriminating evidence barred will be grilled on the information that has been gathered in their absence.
“Closure requires truth. The fact that the deaths are still under investigation and that there has been no explanation forthcoming from the Gauteng Department of Health regarding the set of aversive events the families have experienced, means that these families are living in a state of uncertainty,” said Trotter in her affidavit.
The report says the Life Esidimeni arbitration is set to close this year on 8 December and then reopen late January to finally hear Mahlangu’s testimony. In the coming weeks, we’ll hear testimony from the relatives of those who survived the move, to add to the horrific testimonies of relatives of the deceased patients. The truth about what happened, however, can only be revealed by Mahlangu, Manamela and Selebano.
State attorney Tebogo Hutamo had requested that Trotter’s evidence describing trauma and anxiety experienced by former Life Esidimeni patients should be ruled inadmissible as she did not personally interview victims’ families, says a Polity report. The documents she based her evidence on were provided by public interest law centre Section 27, pointing to possible influence, he added.
Moseneke replied: “An expert opinion can formulate an opinion based on facts. She does not have to produce the facts…the facts are placed before the expert, and she is entitled to provide an opinion. Are you saying there are no underlying facts?”
“Yes, we say the opinion is based on hearsay evidence, her opinion will be flawed if it is not based on facts before the arbitration,” Hutamo replied.
The report says Adilla Hassim, for Section27, dismissed Hutamo’s argument. “The methodology was to work together with the (psychiatric team) and gather the facts and expert reports, not just from an ordinary person but from experts. Miss Trotter, and her team did this work pro bono, further told us that so concerned was she by the process that she had it independently peer reviewed by an attorney and an expert professor in psycho analysis to provide oversight for her and her team,” Hassim said.
Based on facts presented to Trotter, she put forward an expert opinion to assist this process, she added.
Trotter says she strongly believes some patients were tortured until their deaths. Eyewitness News reports that Trotter is a seasoned clinical psychologist who has worked in the healthcare fraternity for several years.
Trotter says the victims of the Esidimeni tragedy were definitely tortured. “This is not saying ‘okay you’re going to move but we’re going to do it in the most humane way possible’. This was done inhumanely, and so now we’re in the terrain of torture. And then that doesn’t stop because the patients are moved into these filthy, dangerous environments as if they’re not people.
“You’ve now got something that is a basic human right, which is water and food have become complex. That is torture.
She says in the years she has worked, even in trauma crisis situations, Esidimeni has to be the worst she’s ever seen. “I was working with clinicians who were coming out of the prisons, coming back from Rwanda. So my exposure to trauma is pervasive and vast, and I have never seen levels of trauma like this – ever.”
The state has also objected to the South African Depression and Anxiety Group (SADAG) manager Cassey Chambers testifying at the arbitration hearings, reports The Times.
SADAG met with Mahlangu and Selebano and asked them to stop the move in 2015. The group was involved with 2015 and 2016 litigation with the department‚ trying to prevent Esidimeni homes from being shut.
The report says the organisation has been supporting families since before the move took place‚ holding meetings with them and participating on a WhatsApp group with concerned relatives. SADAG even helped families trace loved ones‚ after patients went missing or were moved to undisclosed locations. Cassey Chambers has been quoted in the media on the issue since before the deaths started.
The report says her boss Zane Wilson‚ director of SADAG is furious about the attempted gag. Wilson said: "Despite SADAG working on this issue‚ raising concerns‚ holding countless meetings‚ three public marches‚ being involved in two court cases‚ receiving hundreds of calls from family members concerned about loved ones‚ reporting concerns‚ and making hundreds of thousands of calls to track and find patients‚ the state doesn’t want us to share our testimony or evidence. SADAG has helped‚ and will continue to help all Esidimeni families and patients."
Manamela has agreed to testify at the arbitration hearings, reports The Times. Evidence leader Patrick Ngutshana told the hearings that Manamela has agreed to testify‚ as long as her legal costs are covered by the state.
The report says she challenged the first subpoena summoning her to testify on the grounds that there was an error in the date of the subpoena‚ and that she was appealing the health ombudsman's report into her culpability. She has not challenged the second subpoena sent to her by Section 27‚ compelling her to testify at the hearings.
The ombudsman’s report‚ released on 1 February‚ suggested that Manamela be suspended by the Gauteng Health Department and investigated for "negligence and/or gross incompetence". She has since lost her appeal against the report.
The report says Manamela remains on full salary‚ the health department confirmed at the hearings‚ and she is facing a disciplinary hearing.
In the hearings‚ much of the testimony has focused on Manamela's role in the move. Dianne Noyile‚ who ran one of the NGOs at which patients died‚ testified that Manamela physically moved beds into the two NGOs operating on the Cullinan Care and Rehabilitation Centre's premises in order to squeeze more patients into small spaces. The premises of the two NGOs became overcrowded‚ and patients died in both. In the hearings‚ witnesses testified that Manamela knew NGOs such as Precious Angels‚ at which 20 patients died‚ did not have adequate food‚ money or staff to look after sick people.
According to the report, the ombudsman found that Manamela had issued illegal licences to ill-equipped NGOs to take patients. It has also been alleged during the hearings that she knew that a staff member in the health department profited from transporting the deceased body of an Esidimeni patient.
Talatala has told the hearings that the Gauteng Health Department lied to the courts when the group tried to urgently interdict the transfer of psychological patients.
Eyewitness News reports that Talatala, who was the head of Sasop until December last year, said that the organisation he led, which represents dozens of psychiatrists across the country, was completely against the Esidimeni marathon project and even took the Gauteng Health Department to court twice on an urgent basis.
Talatala says they took the department to court because officials would not listen to its warnings. He says they lost both court cases because the department fabricated the truth.
“Because the department lied to the court and they convinced the judge and they argued that those patients were being discharged by doctors, (that) it was not them who ordered the patients to be discharged and the patients were well enough to be at home which was untrue.”
Talatala told the hearings that he believed the Gauteng Department of Health wanted to create an "infrastructure crisis". News24 reports that when rumours started going around that the Gauteng Department of Health wanted to end its contract with Life Esidimeni, he had written to a number of officials, including Manamela, warning them about the potential consequences of their plan. "In my view, they wanted to do away with Life Esidimeni and… they wanted to create an infrastructure crisis," he said.
Talatala said moving patients out of Life Esidimeni would have created the crisis and he believed it would have allowed the health department to spend money on other projects, to play catch up and create space for all the de-institutionalised patients. Talatala said the letters raising various concerns went unanswered.
The report says these concerns included a failure to properly consider the severity of the illness of the patients at Life Esidimeni and what care they received, the level of care at Life Esidimeni versus what they were likely to get at the NGOs, and the fact that there was already a shortage of beds for patients.
"We never got a letter back from any of the people we wrote to,” he said. "The department had already made up its mind that it was going to close those facilities… and we were being a nuisance. Our idea was to look after the interests of the patients and their mental health," he said.
Earlier, before Talatala was allowed to be sworn in and give his evidence, the report said counsel for the state opposed to him being a witness. Their objection was based on Talatala already forming part of court action against the Gauteng Health Department.
Talatala said that the arbitration process must help ensure all those working in the mental health sector treat psychiatric patients with respect. Eyewitness News reports that he said in his closing remarks: “I’m also hopeful that this process, while it has been difficult, especially for our society, will result in better care for our patients and our communities.”
The report says Moseneke then applauded Talatala and his colleagues for fighting the department in court and doing what they could to protect the rights of vulnerable patients. “So, you’ve intervened in a way that is remarkable. And that is really what I’m saying and without any immediate benefit and just extend that I think also to all your colleagues who were part of this and who blew the whistle and who refused to be cowed down and who did what had to be done.”
The report says families gathered chanting as the specialist psychiatrist was released from his oath.
The deputy manager in the nursing department at the Cullinan Care and Rehabilitation Centre (CCRC) testified how they were forced to obey orders from top officials and take in more patients from Life Esidimeni than they initially agreed to.
News24 reports that Dikeledi Jenny Manaka, the acting deputy manager in the nursing department, said she and other junior managers tried to raise warnings about the number of patients they were taking in, but they were told it was orders (received).
"You know, to be honest, I don’t want to talk about my thoughts, but I will relate to my feelings… We tried as the lower level managers (to tell them) that this was not going to be right," she said. "We complained that we were not happy with the situation, but the CEO said it was an order and there’s nothing she can do (about it)."
Manaka said the orders came from senior departmental officials including Manamela, the suspended head of the mental health review board. Manamela is expected to testify at the hearings on Monday next week.
Manaka said it would have been more "manageable" to take in fewer patients at a time. "If we took those patients in a small group, it would have been manageable. But the way it was done was like a bomb for us. We did not even have time to create rapport with the patients," she said.
In March 2016, she and other staff from CCRC went to the Life Esidimeni facility in Randfontein to collect 10 patients, but they ended up leaving with 26. "When we got to Life Esidimeni, we found them (the patients) already put aside. Every group was prepared for where they were going," she said. Manaka said they were told that they were "supposed to take as many (patients) as they can carry".
The number of former Life Esidimeni patients who died during and after the Gauteng mental marathon project has risen to 143. News 24 reports that this emerged after the Health Ombudsman was asked to review the number of patients who passed away after discrepancies emerged during the arbitration hearings.
Earlier during the hearings, the figure was updated to 141 patients who had died and another 59 who were still unaccounted for.
Makgoba’s initial number was 118 patients, but taking into account the number of patients who had died until the end of September 2017, that number had increased to 143. According to Makgoba’s figures, 29 patients had died at the Cullinan Care and Rehabilitation Centre, Anchor and Siyabadinga, which all share the same premises, 38 patients had died at Mosego and Takalani in Soweto, 20 died at Precious Angels and another 13 at Tshepong.
These four facilities accounted for nearly 80% of the patients who passed away during the transfer of Life Esidimeni patients, according to Makgoba. "Those were the high-density places where people died," he said.
[link url="https://www.dailymaverick.co.za/article/2017-11-15-esidimeni-arbitration-finally-putting-pressure-on-state-culprits/#.WgvOLTCxXIU"]Daily Maverick report[/link]
[link url="https://www.polity.org.za/article/life-esidimeni-state-dismisses-expert-opinion-as-hearsay-2017-11-13"]Polity report[/link]
[link url="http://ewn.co.za/2017/11/10/psychologist-believes-esidimeni-patients-were-tortured"]Eyewitness News report[/link]
[link url="https://www.timeslive.co.za/news/south-africa/2017-11-13-state-objects-to-key-esidimeni-witness/"]The Times report[/link]
[link url="https://www.timeslive.co.za/news/south-africa/2017-11-14-justice-for-esidimeni-families-manamela-will-testify/"]The Times report[/link]
[link url="http://ewn.co.za/2017/11/14/gauteng-health-dept-lied-to-courts-esidimeni-panel-told"]Eyewitness News report[/link]
[link url="https://www.news24.com/SouthAfrica/News/gauteng-health-department-wanted-to-create-a-crisis-20171113"]News24 report[/link]
[link url="http://ewn.co.za/2017/11/14/arbitration-process-must-ensure-psychiatric-patients-are-treated-with-respect"]Eyewitness News report[/link]
[link url="https://www.news24.com/SouthAfrica/News/taking-in-more-patients-was-an-order-and-there-is-nothing-we-can-do-20171114"]News24 report[/link]
[link url="https://www.news24.com/SouthAfrica/News/life-esidimeni-death-toll-rises-to-143-20171110"]News24 report[/link]