In 2016, South Africa witnessed one of its worst tragedies - 141 people with mental illness lost their lives. They died from neglect and starvation - allegedly in the hands of those who were supposed to protect them in the public health system.
Nearly eight years later and following an inquest into the deaths during the tragedy which began virtually on July 18, 2021, Gauteng High Court, Pretoria, Judge Mmonoa Teffo is due to recommend to the National prosecuting Authority whether anyone should be held criminally liable for the death.
She is expected to deliver her judgment early next year.
Two health officials and the owner of an NGO will especially await the verdict, as Section27, which represented 44 of the victims’ families, called on the court to recommend that they be charged with culpable homicide.
They argued that former Gauteng Health MEC Qedani Mahlangu, former director of the Mental Health Directorate, Dr Makgabo Manamela, and the owner of Precious Angels NGO should face prosecution for their alleged involvement in the deaths.
In terms of the Inquests Act, the judge must determine the cause of the deaths of the 141 mental healthcare users who died after they were moved from Life Esidimeni into unlicensed and unprepared NGOs.
Section27 will present its argument (based on the evidence already before the court) that the deaths of at least 10 of the mental health-care users were caused by the conduct of Mahlangu, Manamela and the owner of Precious Angels.
The arguments before the court included that Mahlangu made the initial decision to terminate the Life Esidimeni contract. She then continued to make a series of reckless decisions in relation to the project for months while chairing project team meetings.
Section27 said this included putting pressure on the Gauteng Department of Health officials to implement the termination (of the) project over an extremely short period of time.
“Mahlangu made these decisions having been warned of the risks of termination, the impracticalities of continuing with the implementation of the project and the insufficiency of measures in place to mitigate the risks and impracticalities,” Section27 submitted.
It also argued that Manamela was the de facto project leader and directly involved in implementation of the termination project.
“She signed licences for NGOs that she knew had not been properly assessed and then failed to ensure that they were paid timeously. She was warned both before and during the implementation of the project about risks and failed to mitigate these risks sufficiently,” Section27 said.
Ethel Ncube, who was the owner of Precious Angels, should also be held accountable, the court was told.
This institution saw the deaths of 20 mental health-care users, the first of whom died less than two weeks after being moved into her care.
“As the owner of the NGO Precious Angels, Ms Ncube housed mental healthcare users in the most deplorable conditions. She knowingly operated an unlicensed NGO, continued to accept patients even after it was clear that she had neither the staff, the resources, nor the facilities to care for them and that taking additional people would compromise their health.”
Section27 added that she employed unskilled workers to take care of patients who required specialised care and allowed them to be housed in conditions that were squalid and inhumane.
“The conduct of Ms Mahlangu, Dr Manamela and Ms Ncube each caused the deaths of the mental health-care users in the Life Esidimeni tragedy,” Section27 argued.
While counsel for the officials asked the court to find that they had nothing to do with the deaths of the patients, evidence led before the court this year by them was mostly a case of passing the buck and pointing fingers at others.
In outlining the events that unfolded, Section27 emphasised that the Gauteng Department of Health's ‘cruel and inhumane decisions’ were responsible for the undignified deaths of 141 patients with mental health problems. Additionally, over 1400 surviving patients experienced torture, trauma, and severe violations of their human rights.
It all started in October 2015, when Mahlangu announced the end of a contract between the Gauteng Department of Health and Life Esidimeni.
The latter is a long-term psychiatric care hospital, which provided highly-specialised chronic care to approximately 2000 mental health-care users. The department planned to move these mental health-care users to NGOs and other psychiatric hospitals in an attempt to save costs.
However, right from the start, civil society expressed apprehension regarding the safety, health, and dignity of the mental health-care users slated for transfer. In June 2015, the South African Society of Psychiatrists penned a letter to the MEC, outlining significant concerns about the untimely cancellation of the agreement with Life Esidimeni facilities.
Section27 said the department ignored these warnings and went ahead, without consulting the families of mental health-care users or following due procedure.
In November of that year, the South African Depression and Anxiety Group, South African Society of Psychiatrists, the SA Federation for Mental Health, and families of Life Esidimeni residents met with the department, asking it to slow down and follow fair processes to ensure comprehensive care for their loved ones.
Section27 began representing the families of mental health-care patients and the patient advocacy organisations then and have continued to work alongside family members since that time.
“Despite settling the litigation that we launched on behalf of the families and patient groups, requiring that the department provide a safe plan for the transfer, the authorities failed to comply with the agreement or consult with stakeholders meaningfully, and instead pressed on.”
“Three times, we marched with family members of mental health-care users to the department to protest the transfer of patients. No plan ever emerged. Information provided by the department was woefully inadequate,” Section27 said.
On February 18 2016, the department extended the contract with Life Esidimeni for another three months but stated that all patients would be transferred out of the facilities by the end of June that year.
Between March and August 2016, patients with varying diagnoses and needs were discharged from Life Esidimeni and transferred to NGOs and hospitals around the province.
Section27 said the process was completely haphazard, with patients being loaded onto the back of trucks, confidential patient records being lost and chaos characterising the process.
The families of patients were not informed where their loved ones were being sent. Some patients were moved multiple times before their families found them. NGOs were not licensed properly, and lacked the facilities to take proper care of patients.
In August 2016, Christine Nxumalo discovered that her sister Virginia had died after being transferred without her knowledge to Precious Angels NGO. After learning that a further eight other patients had died at the same NGO, Christine demanded an inquest into her sister’s death.
“Mental health-care users were tortured, abused, punished and in some cases deprived of food, water and adequate shelter and sanitation at the (often overcrowded) unlicensed NGOs.”
“ They were not provided with the medicine or treatments that they needed for their mental health. In dire and squalid conditions, many developed dehydration, secondary infections like pneumonia or had uncontrolled seizures,” Section27 said.
Meanwhile NGOs were not staffed with trained health-care professionals, they lacked appropriate medicine and equipment, and in some cases even basic infrastructure like beds, bedding and sanitation.
Against all expert advice, and contrary to their constitutional obligations, the department went ahead with a plan that resulted in the deaths, trauma and torture of some of the most vulnerable members of society, the court was later told.
By September 2016, the MEC, in answering parliamentary questions, said that 36 former residents of Life Esidimeni had died since the transfer out of the facility. Evidence later showed that, at the time, more than double that number of patients had died because of the rushed and inhuman move from Life Esidimeni to other NGOs.
By September 15, the Health Ombud Professor. Malegapuru Makgoba was requested by the Minister of Health to investigate the deaths of patients, and the following day family members asked the police to launch inquests into all of the deaths of deceased mental healthcare users.
The Ombud’s report entitled: “No Guns: 94+ Silennt Deaths and Still Counting” was published on February 1, 2017. It detailed the 94 known deaths of mental health-care users and inhumane treatment of others, stating that there is prima facie evidence that certain officials and certain NGOs have shown a total disregard of the rights of the patients and their families.
It found that several deceased had died from illnesses that questioned the conditions/circumstances under which and the quality of care the patients received at the NGO’s.
In June 2017, in line with recommendations made by the Ombud’s report, former Deputy Chief Justice Dikgang Moseneke was appointed to arbitrate an Alternative Dispute Resolution between the government and the families of the Life Esidimeni deceased (legally represented by Section27) and survivors (represented by Legal Aid South Africa).
The arbitration spanned 45 days, with 60 witnesses testifying. Justice Moseneke read out a searing indictment of the government where he ordered that the state pay various costs and damages to the families of deceased mental health-care users.
He condemned senior state officials for the “wanton, arbitrary and unaccounted decision” to discharge patients from Life Esidimeni into the care of unlicensed NGOS.
He also ordered government to pay damages to the families.
Section27 said the arbitration award went beyond common law damages orders alone. Justice Moseneke also ordered the state to pay R1 million in constitutional damages to each claimant for the gross violation of various rights enshrined in the Constitution.
In April 2018, the SAPS officially opened 46 inquest dockets into the Life Esidimeni tragedy. Pieter Luyt from the National Prosecuting Authority acted as the evidence leader at the inquest hearing in which judgment is now awaited.