Johannesburg -  The suspended director of mental health in Gauteng, Dr Makgabo Manamela, will be issued with a warrant of arrest should she fail to avail herself on Thursday to testify about the deaths of over 140 patients from the Life Esidimeni psychiatric facility, the dispute resolution committee set up to probe the tragedy ruled on Tuesday.

Manamela was implicated after the Health Ombudsman, Professor Malegapuru Makgoba, released a report in February this year into the deaths which he ruled was as a result of the botched transfers of patients from Life Esidimeni to unregistered NGOs in Gauteng.

Manamela failed to show up at the arbitration hearings on Tuesday morning, claiming through her lawyer that she was too sick to testify.

Earlier, Manamela's representative Lerato Mashilane asked for a short adjournment telling the hearing that his client was consulting a doctor and was not feeling well.

"My instructions is that my client will be here on Thursday and a medical certificate with that regard will be given before this arbitration."

Mashilane said the medical certificate will be provided before the end of business on Tuesday.

It was unclear what caused Manamela's sudden illness.

Advocate Adila Hassim, acting for Section 27, expressed her dissatisfaction with the lack of a medical certificate and having to rely on Mashilane's word.

"We have some difficulty with that, but if the witness is unavailable to testify due to illness, there's nothing we can do."

Advocate Dirk Groenewald, representing the families of the deceased, insisted that a warrant of arrest should be issued as Manamela had failed to show up or provide a medical certificate.

Justice Dikgang Moseneke, who is chairing the arbitration hearing, told Groenewald that the move might be premature because chances are Manamela's reasons might be genuine and if that was the case, it would be a waste of the court's time to immediately issue a warrant of arrest.