JAUNDICED EYE
It’s the old and tested South African recipe on how to minimise accountability or, with luck, to avoid it completely.
Cover dish with loads of bureaucratic manure. Apply plenty of well-intentioned hot air from ombuds, mediators, and arbitrators. Saturate with platitudes from African National Congress politicians. Leave to simmer for as long as possible. Lift lid. Voilà!
An unappetising, undigestible mush. Nothing substantial to gnaw on.
It is now eight years since the Life Esidimeni tragedy in which at least 144 psychiatric patients died under unimaginably cruel circumstances. Previously healthy, they succumbed, according to the official investigations, to prolonged starvation, malnutrition and dehydration, as well as untreated critical medical conditions
This week, after three years of desultorily paced proceedings, Judge Mmonoa Teffo delivered her inquest findings. She ruled that two government officials — the ANC’s Gauteng Health MEC Qedani Mahlangu and Dr Makgabo Manamela, former head of mental health in Gauteng Health — were legally liable for the deaths of at least nine patients.___STEADY_PAYWALL___
Mahlangu and Manamela were negligent in that they knew the care facilities to which they sent these poor people were inadequately equipped and staffed, and they did so in the face of numerous experts’ advice and warnings. “Effectively, [they] created the circumstances in which the deaths were inevitable,” said Teffo.
The judicial inquest finding is by no means the end of a saga that started in 2016. As a cost-saving measure, Gauteng Health Department had early that year decided to move 1,606 mental patients from private health facilities into “community care”.
Until then, healthcare provider Life Esidimeni had for 30 years provided a competitively priced — about a fifth of the cost of State psychiatric facilities — a regulated and medically sound care package. But rather than pay R320 per patient per day to blood-sucking capitalists, argued Gauteng Health’s executive team, it would be much better to pay community organisations to perform the same service at a mere R112 a throw.
Through a process that has never been convincingly explained or adequately investigated, 27 NGOs were chosen to receive 1,039 patients. To call the entities NGOs (non-governmental organisations), as do all the subsequent investigations, is a misnomer. They were all illegal entities: unregistered, uninspected prior to the patients being moved and unmonitored afterwards, and many had been hastily set up by shysters spotting the opportunity to make a fast buck.
The other 350-plus patients were sent to state-run institutions. However, according to an analysis by the health journalism NGO, Bhekisisa, which has covered the tragedy with admirable tenacity and to the highest standards of reporting, 95% of the deaths occurred at the NGOs.
Within three months, there were murmurs of an unfolding human disaster that Gauteng Health deflected with mockery. It was only after public, media and opposition party pressure became unbearable that Mahlangu was in September 2016 admitted that 36 patients had died. She may have been misinformed or, more likely, lying. Evidence has since emerged that by then at least 77 patients were dead, exponentially higher than could be explained by natural deaths.
Health Ombud Dr Malegapuru Makgoba launched an independent investigation and released a report in February 2017 that fixed the death toll at 94. Over the following months, it became apparent that this, too, was an underestimate. The death toll has since been established to be at least 144 patients, but the true figure will never be known.
Keen to deflect blame and minimise political fallout, the government appointed former Deputy Chief Justice Dikgang Moseneke to arbitrate an alternative dispute resolution between the Gauteng government and the victims and their families. At the end of it, the State paid R450 million in compensation and damages.
Meanwhile, the law enforcement agencies, prosecuting authorities, and medical oversight bodies all promised vigorous action. Unsurprisingly, very little meaningful happened. The inquest, for example, has dragged on for three years.
So, on the face of it, the Teffo judgment is good news. It forces the National Prosecuting Authority (NPA), which in 2019 reported that it did not have enough evidence to bring charges against anyone, to at least pretend to think again.
But whether there is any likelihood of getting a conviction after so many years, is another matter. Also, at the time of writing, the full Teffo judgment had not yet been released, so the basis on which the judge reached her findings cannot be assessed.
One must hope that her reasoning, once released, will prove to be more robust and coherent than her delivery of the headline findings hinted at. Teffo delivered her judgment on Zoom, in a rambling, shambolic discourse that makes Joe Biden look like a master of clarity and executive decisiveness.
From her presentation, which can be viewed on YouTube if you’re a masochist in need of some flagellation, it’s not even clear how many deaths Teffo is holding Mahlangu and Manamela responsible for. The confusion at the end of the judge’s meandering, paper-shuffling performance was such that even the advocates involved were unsure and seeking a definitive answer from Teffo that never came. Some media reports say nine deaths, others 10. Other reports just fudged it.
Whatever the number eventually settled on, it’s the obverse of that number that matters more — no one has been found accountable for the deaths of at least 134 victims of what clearly was gross neglect by their government and “carers”. Because no autopsies were performed on these victims, it was impossible for Teffo to attribute any blame for these deaths to Mahlangu and Manamela.
One can potentially add to the total another 44 patients who simply disappeared, fate unknown.
These patients are unlikely to be alive. They may simply lie unclaimed among the approximately 2,500 unidentified corpses stored in Gauteng mortuaries. Or conceivably, they died and their bodies were unlawfully disposed of by NGOs.
Mahlangu and Manamela are unlikely to be losing sleep over the Teffo judgment. They know from experience that the NPA is unwilling to act against them and, if it were pressured to do so would likely screw up the prosecution. The two would, in any case, be well-defended. The State has already spent around R80 million defending Gauteng Health employees accused of wrongdoing in the Life Esidimeni matter.
Especially fortunate is Dr Tiego Selebano, former head of Gauteng Health, who with Mahlangu and Manamela approved and oversaw the plan. The Makgoba report describes the triumvirate as the ones whose “fingerprints peppered the project”. Inexplicably, he has totally avoided Teffo’s censure.
The Health Professions Council (HPCSA) and the Nursing Council (SANC) medical and nursing oversight bodies, have also failed the victims. Despite recommendations from Makgoba and Moseneke, separately, that several Gauteng Health nurses and doctors should be disciplined, nothing much has happened.
Selebano’s HPCSA disciplinary hearing has been an on-off matter for seven years and while he has been suspended from the medical register during the process, no finding has yet been made. Not that it really matters. He has since retired on a full pension.
Manamela and her deputy, Hannah Jacobus, as well as the chair of the Gauteng Health Review Board, Dumi Masondo, were supposed to be investigated by SANC. As late as 2021, City Press reported that SANC had taken no steps against any of the three. Jacobus, too, has retired and receives her full pension.
In 2021, the Democratic Alliance flushed out, via questions tabled in the provincial legislative assembly, that seven middle-management Gauteng Health officials received final warnings and counselling for their actions. At that stage, the outcome of “an independent process” was still awaited with regard to the fates of Gauteng Health’s Chief Planning Director Levy Mosenogi and its Deputy Director-General of Clinical Services Dr Richard Lebethe.
Despite 144 dockets being referred to the NPA by the police and the Special Investigations Unit (SIU), not a single prosecution was brought. The SIU did, however, reportedly claw back R5 million of State payments made to the NGOs.
There has been no political accountability either. The ANC’s Gauteng Premier at the time, David Makhura, was implicated by witness testimony in the decision to cancel the Life Esidimeni contract. Consequently, there was talk that he would be subpoenaed to give evidence before the Teffo inquest. This did not happen.
Instead, Makhura cruised along in the premiership through to 2022, completely unaffected. His beautifully laudatory Wikipedia biography makes not a word of mention of Life Esidimeni, the single biggest thing that happened on his watch.
Follow WSM on X @TheJaundicedEye
