Former Gauteng Director of Mental Health Dr Makgabo Manamela gives testimony at the Life Esidimeni Arbitration hearings in Parktown, Johannesburg. Manamela was responsible for this issuing of licenses to the NGO’s where 143 mentally ill patients died. Picture: ALAISTER RUSSELL/THE TIMES
Former Gauteng Director of Mental Health Dr Makgabo Manamela gives testimony at the Life Esidimeni Arbitration hearings in Parktown, Johannesburg. Manamela was responsible for this issuing of licenses to the NGO’s where 143 mentally ill patients died. Picture: ALAISTER RUSSELL/THE TIMES

Makgabo Manamela‚ one of the three officials behind the deaths of narly 150 mentally ill patients after being moved from the care of Life Esidimeni‚ returned to the stand on Thursday‚ thus avoiding an arrest warrant being issued for her.

She spent the morning giving reasons for her actions.

Manamela‚ then-director of the Gauteng mental health directorate‚ signed licences for ill-equipped non-governmental organisations (NGOs) to take in profoundly mentally ill patients because the Esidimeni homes were being shut down. This led to 143 mentally ill people dying‚ most of them at five badly run‚ inexperienced‚ over-crowded NGOs.

After refusing to take responsibility for her role in approving these NGOs‚ hearing Judge Dikgang Moseneke said to her: "Maybe you didn’t care‚ you signed whatever you signed‚ you forget it was about people who [are] flesh and blood."

Manamela replied: "I cannot accept when you say [that] I just don’t care."

Manamela was forced to admit, after detailed evidence was put to her‚ that when the Life Esidimeni contract was ended in September 2015‚ there were not enough NGO or hospital beds for the 1,712 patients in the Esidimeni homes.

"It was a process … we didn’t have enough beds," she said. Even as the move from Esidimeni homes began, in March 2016‚ there was a shortage of places for patients to go.

"Why [then], did you chuck them out?" asked Moseneke.

"We didn’t chuck anyone out‚" Manamela said.

"You did‚" shouted family members at the hearing. Moseneke instructed angry relatives who lost loved ones not to heckle her.

Manamela’s licences allowed unqualified people, such as Ethel Ncube‚ owner of a day-care for disabled children‚ to look after 150 severely mentally ill adult patients. Moseneke wanted Manamela to own up to the consequences of her actions, asking, "How many people died at Precious Angels after you issued a licence and permitted [Ethel Ncube] to take 150 patients?"

She hesitated: "I might not arrive at the right number."

Moseneke told her 20 people died. The judge said angrily: "You issued a licence to Ethel Ncube‚ who has no skill for looking after people like this. She had no beds for them. What do you have to say about the consequences of you permitting her to look after people and now people [have] died?"

Manamela was unapologetic: "The consequences must be assessed. I don’t have the post-mortems. People died. It was heartbreaking. When my team assessed the place‚ it was suitable."

She then blamed officials under her for deciding which NGOs were suitable after inspections. "That is what my team did. At my level‚ I cannot go to each and every NGO [for an inspection]."

Moseneke asked her why NGOs were given no money to care for patients. "For four months‚ Ethel didn’t get a penny from you for her operations."

Manamela replied: "I am not the one who is giving money‚" explaining that payment was the finance team’s responsibility.

When asked about why she gave NGOs that looked after children licences to look after adults‚ she said three times that mentally ill adult patients have the mind of a child‚ so they could be classified as children.

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