Malegapuru Makgoba. Picture: SUPPLIED
Malegapuru Makgoba. Picture: SUPPLIED

The fear of challenging authority coupled with the reluctance to be accountable led to the deaths of 118 mentally ill patients under the care of the Gauteng provincial government.

This is according to Health ombudsman Malegapuru Makgoba who on Monday was the first witness to present evidence to an arbitration committee set up to probe the deaths of the patients.

The committee is chaired by retired Chief Justice Dikgang Moseneke.

Arbitration is an alternative dispute resolution process method prescribed in Makgoba’s report titled "94 deaths and still counting". It comes amid demands by the affected families for financial compensation and closure.

In June 2015, the Gauteng department of health moved more than 1‚400 patients from Life Esidimeni psychiatric homes to NGOs and 108 died‚ it emerged on Monday. Another 10 died as they were moved from Cullinan Care Centre‚ where they had lived for years‚ and placed in unlicensed NGOs to make space for Life Esidimeni patients. At least 118 therefore died.

The number of deceased patients increased from 94 as reported in February to 118 following clarity provided by the ombudsman’s verification team which began its work in March after the release of the report.

Makgoba said during his investigation, employees in the Gauteng health department had admitted knowing that the deinstitutionalisation process and cost-cutting operation that has become known as the Life Esidimeni tragedy was defective but were too afraid to speak out.

The former head of department had told the ombudsman that the culture in the department was one of fear with everyone referring to their seniors as "chief" and never by name because of the pervasive anxiety experienced by all.

Former Gauteng Health MEC Qedani Mahlangu, who resigned the day before the report was made public, was seemingly aloof to the significance of the fear in her department. She told Makgoba that she had assumed everyone had agreed with her on the matter as no one had raised issues about it in meetings.

"My sense is that when you run a department with the culture of fear, you think you are in control" Makgoba said.

Moseneke was astounded that those charged with responsibility did not step up to say they would not participate in the unlawful act.

All of the warnings were ignored, rubbished or sidelined
Malegapuru Makgob

The decision to terminate the contract with private healthcare provider Life Healthcare was announced in October 2015, but Adila Hassim, an advocate with lobby group Section 27 and a representative of 55 families contended that this information had been known internally six months before. Experts had written to the department warning of possible deadly implications of the move but it fell on deaf ears.

Hassim said the state had received numerous warnings against moving the patients from experts at the South African Society of Psychiatrists and the South African Depression and Anxiety Group.

Makgoba testified that the executives had been sufficiently warned by various experts and civil society groups on how to handle the transfer of this vulnerable group.

"All of the warnings were ignored, rubbished or sidelined," said Makgoba adding that the head of department had also felt sidelined with his juniors being instructed from the top, leaving him feeling alienated. Mahlangu even asked the head of department if he worked as a spokesman for Life Esidimeni when he made suggestions.

It also emerged as the arbitration hearings started that Mahlangu is not on the state witness list. None of the state witnesses include people involved in the decisions to end the Life Esidimeni contracts.

The arbitration hearings are expected to continue over the next three weeks.

With Katharine Child

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