The former Gauteng Health Department deputy DG Dr Richard Lebethe says it would have been hard for officials to foresee that patients would pick up infections and ultimately die after they were moved from Life Esidimeni facilities, notes a News24 report.
Lebethe is being cross-examined at the Life Esidimeni inquest, which is investigating whether anyone can be criminally charged for the deaths of 144 mental healthcare users who were moved from Life Esidimeni facilities to ill-equipped NGOs. Patients died of malnutrition and neglect.
Lebethe told the inquest on Monday that it would have been hard to foresee what would happen when patients were moved. “Not in absolute terms you could say there is a probability that it could have been seen… You can't be absolute.” He said medical conditions are not absolute, so there was no way clinicians would know what would happen to patients. He continued: “Infections don't depend on movement or lack of it. I can get an infection at home. Attributing the cause of deaths to the moves plainly like that becomes difficult. Especially if it happens a long time after the movements.”
Lebethe, who was part of the project team leading the moves, continued to minimise his involvement, notes the report. Since last Thursday, he has repeatedly said that his role was minimal because of his busy schedule, and he only started playing an active role when patients started dying.
Asked whether he was in favour of the department terminating the contract with Life Esidimeni, Lebethe said he could not say because he wasn't active in the project team.
However, in cross-examination on Tuesday, he conceded that he was part of the decision-making process that approved the termination of the group contract, despite having spent much of his testimony distancing himself from the decision to move more than 1000 patients into NGOs.
According to IOL, he said he was often busy when meetings took place to discuss the patient removal project, but statements presented by witnesses appear to show otherwise. Levy Mosenogi, a former Health Department official, provided an affidavit that places Lebethe in charge of the project. Mosenogi’s lawyer, Advocate Benedict Maphahle, read a letter written by former Gauteng health MEC Qedani Mahlangu in which she urged officials to implement the project.
Lebethe was also shown a statement in which Mosenogi stated that Lebethe was present when the decision to terminate the Life Esidimeni contract was decided. Lebethe conceded he was part of that meeting. On Mahlangu’s letter, Lebethe also conceded that he was “in charge” of the project because he was head of clinical services. Despite this, he repeated earlier statements that he had been busy, and that mental health officials were in charge while he was busy. He confirmed that he was present when complaints were made about the process used to move patients.
He also admitted that some of the NGOs to which the mental health patients were moved lacked food, and that another "was built on an elevated area, making it unsuitable for patients", according to News24.
He said he had visited the Precious Angels NGO in Atteridgeville, Pretoria, with former health MEC Qedani Mahlangu, and found it unsuitable. Twenty-three mental health patients died there. “The area was in a mountainous area and had a lot of stairs if you needed to get into the house.” He visited the NGO three weeks after the first death was reported.
He said that in December 2016, he visited Rebafenye NGO, which has two branches in Pretoria. The Amandasig branch threatened to shut its doors because it had no food and had not received payment for taking care of the patients, he added. “I begged … (them) to continue operating. I told them it was the December holidays, and it would be difficult to find another place for the patients.” Lebethe said he had to organise food for the patients.
He denied being intimately involved in the moving of patients from Life Esidimeni to NGOs.
Meanwhile, reports News24, Dr Tiego “Barney” Selebano has been called to appear before the HPCSA in October. Selebano was the former head of the Gauteng health department at the time of the tragedy.
COVID-19 restrictions as well as the unavailability of witnesses and documents are some of the excuses used by professional health bodies for why disciplinary hearings against officials like Selebano, who have been implicated in the scandal, have still not been initiated.
In 2018, Health Ombudsman Professor Malegapuru Makgoba recommended Selebano and Makgabo Manamela, a nurse by profession, be investigated for their roles in the Life Esidimeni debacle, calling them “the architects of the project”. Both resigned in 2017.
The Health Professions Council of South Africa (HPCSA) was supposed to look into Selebano's conduct, while the SA Nursing Council (SANC) was supposed to investigate Manamela who at the time, was head of mental health services. The HPCSA said Selebano had objected to a virtual hearing. The case will now be heard from 13 to 15 October.
News24 article – Life Esidimeni: Dr Tiego Selebano to appear before HPCSA in October (Open access)
IOL article – Former GP health official quizzed on Life Esidimeni patient removal (Open access)
See more from MedicalBrief archives:
Life Esidimeni deaths: ‘Not the fault of Health MEC’
Life Esidimeni inquest: one nurse to 40 patients
Life Esidimeni Memorial Portal goes live ahead of inquest