The blame for some of the deaths in the Life Esidimeni tragedy – one of the worst human rights infringements in democratic South Africa – has been laid squarely at the feet of former Gauteng MEC Qedani Mahlangu and Gauteng mental health head Dr Makgabo Manamela.
Delivering the long-awaited ruling yesterday, Judge Mmonoa Teffo found that the deaths of some of the mental health patients transferred to ill-prepared NGOs from Life Esidimeni were a result of the negligence of Mahlangu.
BusinessLIVE reports that Teffo said in her judgment that Mahlangu ignored expert advice.
“Having heard all the evidence in this inquest, I have come to the conclusion that the death of the deceased where due to negligence caused by the conduct of Miss Mahlangu and Manamela.
"Mahlangu proceeded to terminate the contract between the Life Esidimeni care centre and the department despite the warnings from experts,” she said.
The deaths of 144 people with mental health problems, after their removal from highly specialised, long-term psychiatric care hospital Life Esidimeni to ill-equipped and unlicensed NGOs and community care facilities, sparked a long, very public fight for justice for the patients, who died from gross neglect and starvation.
“The patients were moved to NGOs that were not equipped to give proper and adequate care …the conduct of the two led to these unfortunate deaths that could have been avoided.
“In respect of Manemela, she hastily facilitated the implementation of the termination plan against expert advice from stakeholders and professionals. She could have saved their lives if she had visited the NGOs and seen they were not adequately equipped and personnel not capable of caring for the patients.
“Effectively, Mahlangu and Manamela agreed to the circumstances … where the deaths were inevitable,” the judge said.
The Citizen says the judge emphasised that the deaths could have been avoided.
“In respect of Dr Makgabo Manamela, … She could have saved many lives as she visited the NGOs and could see that they were not adequately equipped and some of the personnel were not adequately qualified to care for the mental health care users.”
She noted that some of the NGOs were tasked with caring for patients despite not following the prescribed protocols.
“Effectively, Ms Qedani Mahlangu and Dr Makgabo Manamela created the circumstances in which the deaths were inevitable.”
Regarding the deaths for which no autopsy was performed, Teffo was unable to make a determination.
The judge detailed how one of a 50-year-old woman suffered from malnutrition, dehydration and gangrene, which contributed to her death.
The judgment has opened the way for criminal charges to be laid against the key players in the catastrophic transfer by the National Prosecuting Authority.
While news of the first deaths sparked widespread outrage, nationally and internationally, the fight for the right to dignity began long before the avoidable tragedy, when rumours started circulating in June 2015 that the Gauteng Department of Health’s (GDoH) planned to end a decades-long contract with Life Esidimeni and close the facility, writes Daily Maverick.
Civil society organisations, including SECTION27 and South African Depression and Anxiety Group (Sadag) as well as patients’ families, sounded the alarm that patients with mental illness would be at risk if they were moved to places without specialised care.
Their pleas and ensuing litigation were brushed aside, and in October 2015 then MEC for health in Gauteng, Qedani Mahlangu, decided to terminate the contract with Life Esidimeni.
This sparked a three-month scramble, between April and June, to move 1 700 mental health patients from the hospital to 27 unlicensed NGOs that were ill-equipped to care for them.
Daily Maverick reports that some were loaded en masse into the buses without their belongings, shoes or medical records. Others were tied to bakkies with rope. They were moved without their families’ knowledge.
The decision thrust the patients into cruel and inhumane conditions, which ultimately resulted in 144 people dying in undignified conditions, and from causes including malnutrition, gangrene and dehydration.
Cassey Chambers, operations director at Sadag, who has been fighting for justice alongside the victims’ families, told Daily Maverick she recalled the day news of the first death broke on 26 March 2016.
“The first death that happened at Takalani… I remember feeling so devastated because it’s exactly what we hoped to prevent.”
After that death, desperate family spent months searching for their loved ones, mobilising and protesting in a bid to get answers. More deaths were uncovered as the months passed.
It soon emerged that many of the patients at the unlicensed NGOs had been tortured, abused, punished and in some cases deprived of food, water and adequate shelter and sanitation.
They were not given the medicine or treatment they needed. Many developed dehydration, secondary infections like pneumonia and uncontrolled seizures.
The NGOs were not staffed with trained healthcare professionals, lacked appropriate medicine and equipment and in some cases even basic infrastructure such as beds, bedding and sanitation.
Ombud report
On 15 September 2016, the then Health Minister Aaron Motsoaledi requested that the Health Ombud, Professor Malegapuru Makgoba, investigate the deaths in the aftermath of the Esidimeni closure.
After months of investigation and delays, his report was finally released on 1 February 2017, detailing the inhumane conditions and deplorable treatment patients endured at NGOs such as Ubuhle Benkosi, Mosego Home and Takalani Home.
Makgoba’s report, titled “94+ silent deaths and still counting”, found that there were 94 unlawful deaths, which had not been caused by conditions other than mental health.
Another major finding was that all 27 NGOs were operating with invalid licences. Makgoba also found that the Department of Health had been negligent in moving 1 900 patients from Life Esidimeni.
“There is prima facie evidence that certain officials and certain NGOs and some activities within the Gauteng Marathon Project violated the Constitution… [and] have shown a total disregard of the rights of the patients and their families, including but not limited to the right to human dignity; right to life; right to freedom and security of person; right to privacy; right to protection from an environment that is not harmful to their health or well-being; right to access to quality healthcare services, sufficient food and water; and right to an administrative action that is lawful, reasonable and procedurally fair,” the report read.
MEC Mahlangu resigned the night before the ombud’s report was released.
Nine months after its release it emerged that the death toll stood at 144.
While the ombud’s findings were shocking, they were the first sign that the families’ pleas for justice had been finally heard. This paved the way for a historic arbitration which will see the families compensated for the injustice they suffered at the hands of the GDoH.
Watershed arbitration
In June 2017, former Deputy Chief Justice Dikgang Moseneke was appointed to arbitrate an alternative dispute resolution between the government and the families of the deceased (legally represented by SECTION27) and survivors in line with the recommendations of the ombud’s report.
For 45 gruelling days, 60 witnesses testified, finally peeling back the curtain to reveal the inhumane conditions and sheer scope of negligence that characterised the tragedy.
The arbitration not only uncovered evidence that could lead to criminal charges against top health officials and exposed attempts to cover up their culpability, but it finally allowed families and victims to express their anguish.
In a watershed moment, Moseneke found in favour of the families and ordered the state to pay R1m in damages to each claimant for the gross violation of various rights enshrined in the Constitution.
In terms of common law damages, he ordered the state to:
Pay claimants R180 000 for psychological injury and trauma;
Pay claimants R20 000 towards funeral costs;
Erect a memorial for the victims of the Life Esidimeni Marathon Project; and
Pay for counselling for up to three relatives of the deceased.
Chambers described this as a true moment of vindication in the fight for justice.
“For 40-plus days, families were being bussed in, and many of them had lost jobs. They sacrificed so much to be there… they stood in this hall, in this room, when Judge Moseneke read out his closing judgment with such care and compassion. It was so emotional and heavy, but it was the first time I felt that we had been heard. Like someone had said, ‘Yes, this was wrong, and we were right in bringing this up’. I think, for me, in that moment, there was a lot of vindication for what we had been pushing for so long.”
The inquest
During the inquest, which began in July 2021, SECTION27 argued for culpable homicide charges to be brought against Mahlangu, former Gauteng mental health head Dr Makgabo Manamela, and the owner of the Precious Angels NGO, Ethel Ncube.
The inquest was inundated with blame-shifting and finger-pointing. Mahlangu testified that the premier’s budget committee, chaired by former Premier David Makhura, had decided to terminate the contract.
Manamela’s lawyer argued that the district and not the Gauteng health department was responsible for identifying and licensing NGOs, adding that it would have been impossible for her to inspect all NGOs tasked with taking in the Life Esidimeni patients.
The lawyer for Ncube – at whose Precious Angels NGO 20 patients died – said she should bear no responsibility for the department’s inability to do due diligence.
Activist and SECTION27 co-founder Mark Heywood said, on Wednesday morning, that while he hoped the inquiry would find criminal liability for the tragedy, he was cautiously optimistic about the judgment.
“I know in my mind that people like Qedani Mahlangu and some of her officials have criminal culpability for their conduct and the consequences of their conduct. I hope that the inquest will find the same. I’m not a praying man, but I hope the judge comes to the same conclusion because there needs to be criminal prosecution for there to be ultimate justice and for there not to be impunity for the loss of so many lives,” he said.
The Citizen – Former Health MEC Qedani Mahlangu responsible for Life Esidimeni, court rules
BusinessLIVE – Court rules Life Esidimeni deaths were due to former health MEC’s negligence
See more from MedicalBrief archives:
Life Esidimeni judgment next week
SECTION27 seeks culpable homicide charges against Life Esidimeni trio
Former MEC claims she was unaware of risks of Life Esidimeni transfers
Life Esidimeni inquest: MEC dodges blame for ending contracts
Life Esidimeni inquest: ‘He vomited for four weeks and then he starved to death’
Life Esidimeni inquiry: NGO had grown men sleeping in baby cots