Retired Deputy Chief Justice Dikgang Moseneke is heading the arbitration hearings between the State and the families of victims in the Life Esidimeni tragedy. Picture: Nokuthula Mbatha/ANA

Johannesburg - A senior nurse has told the Life Esidimeni arbitration she feared she would be charged with insubordination if she didn't follow orders even though she was aware that the quality care of patients was compromised.

Dikeledi Manaka was employed as a quality assurance assessor at Cullinan Care and Rehabilitation Centre (CCRC) at the time. Cullinan is one of the NGOs which admitted patients from Gauteng's Life Esidimeni.

As many as 143 of the patients who were caught up in the chaotic Esidimeni transfers to unlicensed NGO facilities have died, some of them from starvation and neglect. Fifty-nine of the patients are still unaccounted for.

On Monday, Manaka told the hearing that their facility was given more patients than they could handle and the selection process was overlooked.

Their facility was meant to handle 3-21-year-old patients with severe and profound intellectual disability, but they even took in patients who did not fit the the criteria.

She said patients didn't have name tags and they relied on pictures to identify them.

"I was able to catch a few, I was told their names as we got into the bus."

To control overcrowding, Manaka said they transferred some of the patients to Anchor House and Siyabadinga NGOs which were on the same premises.

She conceded that even the transferring process wasn't properly administered, as nurses were tasked with discharging patients without assistance from doctors or psychiatrists.

Manaka said the Siyabadinga facility wasn't well kept and had a foul smell.

"Some beds were not good and didn't have mattresses," she explained.

Advocate Adila Hassim from Section 27 questioned Manana's duty as a quality assurance officer and why she allowed patients to be kept in a facility where she knew they would not receive quality care.

Manaka emphasised that she was caught in the middle and was not able to conduct her duties adequately.

"Secondly, all NGO's are their own entities and I can't be responsible for what happens in other facilities."

Retired deputy Chief Justice Dikgang Moseneke asked Manaka whether it wasn't her duty to make sure that patients were transferred to facilities which would be able to take care of them.

"It wasn't my duty to make sure that NGOs were up to standard....I took it as the NGOs duties, mine was to check if they are being given the services they need."

Hassim took Manaka back to an incident which occurred in July 2016 when Busisiwe Tshabalala died of hypothermia and severe dehydration after a month of being at the CCRC facility.

"How do you explain this, someone died under your care. Why was she deprived of food and water for so long?" asked Hassim.

Manaka distanced herself from Tshabalala's death and said she was not in charge of a ward and wasn't directly involved with patients.

However, she explained that she enquired from nursers about Tshabalala's death and she never got a clear answer.

It was heard that Tshabalala was bedridden and couldn't even speak.

The hearing continues.