The former director of Gauteng’s Mental Health Services, Dr Makgabo Manamela, has denied a claim by former Gauteng Health MEC Qedani Mahlangu that she withheld information on the deaths of 144 mental healthcare users in 2016, telling the inquest this week that she had provided monthly updates on the number of deaths.
An affidavit submitted to the Life Esidimeni inquest by Mahlangu had accused Manamela of deliberately concealing information about patients’ deaths, reports Daily Maverick.
Manamela continued her cross-examination on Monday and Tuesday before the inquest was adjourned to 21 November.
“Things go according to levels within the department,” Manamela said. “I couldn’t just go and tell the MEC there were deaths before the contract was terminated, but there were reports… I wasn’t reporting to her, so it won’t be truthful (to say) I misled her.”
Manamela told the inquest Mahlangu gave instructions to move patients from the Life Esidimeni facilities, despite the NGOs to which they were being sent being ill-equipped to take them.
Asked by Advocate Ndivhoniswani Makhani why most patients were transferred to the Tshwane district, she said it was because the department had earmarked hospitals in Pretoria as suitable.
Manamela said that “for chronic healthcare users, there is a hospital in Tshwane called Cullinan catering for severely mentally disabled patients”.
“We renovated that hospital and readied 100 beds. Another reason was because Weskoppies (hospital) is in Tshwane, and was also renovated to accommodate patients.” She said most of the NGOs willing to assist with patients were based in Tshwane.
According to Manamela, during the process of patient placements, meetings were held between the MEC, the hospitals and the programme managers for mental health and TB, who would be called when necessary. Manamela said she would meet the CEOs of the hospitals whenever they had mental health matters to discuss.
Manamela denied threatening to fire the former CEO of the Cullinan Care and Rehabilitation Centre, Matshidiso Nyatlo, saying: “I do not have authority to fire a person. If the people I worked with did not like anything, I would advise them to write a letter giving reasons for why they did not want to do certain tasks and I would escalate it to HR.
“When the placing team encountered difficulties, they could phone me. If the problem needed me to involve myself, I would then talk to them and we would end up agreeing.
“The Cullinan staff, and the placing team, were the ones who decided on which patients would be taken by Cullinan.”
Manamela told the inquest the placement team was well aware of the qualification criteria, but denied giving instructions for the discharge of patients from Cullinan, saying Cullinan staff knew the patients best and the criteria for discharge.
On Monday, Manamela testified that meetings with Mahlangu were “hostile” because the ex-MEC threatened to fire officials who disagreed with her. The former director also revealed that Mahlangu ordered the relocation of the patients even though some NGOs were not ready to accommodate them.
The NGOs had just more than 100 beds, while there were more than 1 000 patients at Life Esidimeni hospitals. Precious Angels, in Pretoria, was one of the NGOs that experienced overcrowding, reports The Citizen.
Manamela had told the inquest that she – with Mahlangu and former Gauteng Health official Richard Lebethe – visited Precious Angels when patients started dying at the NGO. She said the provincial department implemented an “adopt an NGO plan” as part of monitoring and evaluation to prevent more deaths.
Manamela said Precious Angels, among other NGOs, was not registered as a vendor with the provincial Treasury.
The registration process, she said, was the responsibility of the five district offices – including Tshwane and Ekurhuleni – that ran the NGOs. “It was reported to me that they did not register,” she said.
Manamela previously testified that NGOs did not have food and, in some cases, linen and clothes, as the department did not pay them in the first few months they took in patients.
In efforts to deal with this, Manamela said she had made attempts to find out from Gauteng Health’s finance department on what hindered the process.
She was then given the contact details of a treasury official.
“I don’t remember the name of this person, but I sent an email asking them that they fast track this process. The finance department went ahead and checked with treasury because issues relating to payments was not one of my functions,” she continued.
‘Political pressure’
She said there was much dissatisfaction on the termination of the Life Esidimeni project, with some community members submitting a memorandum in the presence of politicians and officials from the South African Depression and Anxiety Group (Sadag).
This was echoed by former managing director of the Life Esidimeni Group, Dr Morgan Mkhatshwa, who testified in July 2021 that various Gauteng Health officials were frustrated by the political pressure to move patients to NGOs.
Mkhatshwa told the court at the time that the officials had expressed unhappiness about the decision to end the Life Esidimeni project.
The inquest is to determine if anyone should be held criminally liable for the deaths of the 144 mentally ill patients relocated from Life Esidimeni facilities to the various NGOs six years ago.
The patients died from severe neglect, hunger and dehydration.
See more from MedicalBrief archives:
Life Esidimeni transfers not practical, but officials forced to comply, inquest hears
Health managers point fingers at politicians in Life Esidimeni inquest
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