Health Ombudsman Malegapuru Makgoba who along with Motsoaledi briefed Parliament's portfolio and select committees on Health, said the law governing mental healthcare patients should be changed to give power back to the national ministry, to prevent provincial officials from deliberating hiding critical information.
"The minister has no authority, but when it goes wrong, he takes responsibility," said Makgoba.
MPs heard how the national health department head of non-communicable diseases, Melvyn Freeman, knocked on closed doors when he tried to get information when there were signs that something was amiss following the transfer of patients.
"According to me there was a deliberate attempt not to allow him in any of the meeting," Motsoaledi later told MPs.
Motsoaledi said as soon as he learnt people were dying, he put an advisory team in place who within 48 hours closed some of the NGOs, while the Ombudsman started his investigation.
The minister explained how the transfer of patients to the unlicensed facilities was so badly managed and chaotic that NGOs arrived with vans to pick up patients without their medical records.
Motsoaledi said even if the NGOs did not know they were not transgressing the law, this was no excuse for the deaths. "Ignorance is punishable by law," he said.
"How do I take human being..I don't have records of what they sick with, what they should be treated with, what is the diagnosis?"
Those NGOs that have been closed due to negligence and deaths reported to the ombudsman that they were not prepared to receive patients, were not trained to treat the mentally ill, did not have the proper infrastructure, and their facilities were overcrowded.
Many only realised they needed professional staff when people started dying, said Makgoba.
"They saw it as a business as opposed to a service."
The NGOs, according to the ombudsman, did not have valid licences. When the licences were inspected, they were signed by a director of the Gauteng health department, Dr Makgabo Manamela, who later admitted she was not qualified to do so.
After both Manamela and head of department Barney Selebano admitted they knew the licences were not correctly approved, Selebano then went to the NGOs and signed new licences, backdating them, Makgabo said, later adding this was akin to "tampering with evidence".
"When the HOD [head of department] comes and give you evidence under oath, under affirmation, goes around to NGOs signing licences. That is an example of tampering with licenses."
The ombudsman recommended disciplinary hearings against implicated officials, while the matter has also been referred to the police for investigation.
Motsoaledi said the police forensic investigation started in September last year, with officers also helping with the identification of bodies.
The minister expressed concern that "some people were already buried", with no indication of how many post mortems were done.
The department would leave it up to the National Prosecuting Authority to decide on whether anyone could be held responsible.
MPs like the Economic Freedom Fighters' Delisile Ngwenya said the resignation of Health MEC Qedani Mahlangu "was not enough".
"I think she should also [be] criminally charged for what she has done."
It also came to light that Selebano and other officials, through a firm of attorneys, have given notice that they intended challenging the Ombudsman's findings and recommendations.
Makgoba confirmed that the death toll was "well above" 100 and climbing,and also outlined to MPs how difficult his job was due to anomalies and lack of information.
"We are above 100. I can't say that is the end. From data that is coming one is quite confident that figure has gone above 100," he said. He said 26 of the patients "had two dates of death". "It just tells you how difficult the data was." Five of the NGOs accounted for 80 of the deaths.
Of the 1300 patients transferred from Esidimeni, around 600 patients have been transferred to psychiatric centres like Weskoppies and Sterkfontein, among others.
The other 700 remain at NGOs where no deaths have been reported.
It also came to light that while the treatment of one mentally ill patient cost the state R320 a day at Esidimeni, while Weskoppies charged R1 960 per day, per patient.
Motsoaledi said the management of Esidimeni, while closed at the moment, has indicated once they reorganise, rehire staff and stock up with the necessities, they would be able to receive several hundred patients back in eight weeks.