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Former Gauteng health MEC Qedani Mahlangu. Picture: ALON SKUY
Former Gauteng health MEC Qedani Mahlangu. Picture: ALON SKUY

The Life Esidimeni inquest has concluded that former Gauteng MEC for health Qedani Mahlangu and the former head of Gauteng’s mental health services, Makgabo Manamela, were responsible for the deaths of some of the patients transferred from private facilities to ill-equipped NGOs eight years ago.

“Effectively Ms Qedani Mahlangu and Dr Manamela created the circumstances in which the deaths were inevitable,” said judge Mmonoa Teffo, as she read a summary of her judgment on Wednesday afternoon.

The National Prosecuting Authority (NPA) is expected to decide whether to prosecute after it has studied her judgment, a full version of which has yet to be released.

Despite many warnings from healthcare professionals and civil society organisations, the Gauteng health department moved more than 1,700 stable state mental patients from private healthcare facilities managed by hospital group Life Healthcare to unlicensed and underresourced NGOs in 2015 and 2016.

At least 141 patients died after the transfer, according to an investigation by the health ombud, who described their neglect in harrowing detail in a report released in 2017. Patients were deprived of food, heating and medical care. Many of the those who died were emaciated and dehydrated.

The health ombud’s probe was followed by an arbitration hearing, which concluded that the rights of the patients and their families were disregarded. It directed the Gauteng provincial government to pay each family R1.2m in damages.

The NPA then launched an inquest into the Life Esidimeni tragedy in July 2021, seeking to determine whether anyone should be held criminally liable for the deaths.


The judge found Mahlangu terminated the contract between the Life Esidimeni Care Centre and the Gauteng department of health “despite numerous expert advice and warnings from professionals and stakeholders”.

As a result, patients were moved to NGOs with neither the equipment nor the experience to provide the requisite mental health care. “Her conduct led to regrettable and unfortunate deaths — some of which could have been avoided.”

Manamela facilitated plans hastily for the transfer of patients, against expert and stakeholder advice, and could have saved many lives had she acted differently, concluded Teffo. “She visited the NGOs and could see they were not adequately equipped, and some personnel were not adequately qualified to care for mental healthcare users.”

The court was unable to make findings on patients who had not had autopsies but determined that the deaths of nine patients were brought about by the negligent conduct of Mahlangu and Manamela, she said. The judge did not comment on the owners of the NGOs contracted to provide services to the Gauteng health department.

Section27, which represented the families of 44 of the patients who died, argued during the inquest that Ethel Ncube, the owner of the Precious Angels NGO, should be charged with culpable homicide, along with Mahlangu and Manamela. It said at the time that Ncube knowingly operated an unlicensed NGO, housed patients in squalid and inhumane conditions and continued to accept patients without adequate staff, facilities or the resources to care for them.

Section27 CEO Sasha Stevenson welcomed the inquest findings, saying they were a bold statement in favour of accountability.

“For the families of mental healthcare users who died after being transferred from Life Esidimeni, and indeed for the many people who have watched as the different legal processes relating to this case have unfolded over the past nine years, it has been a long wait for justice, and this outcome is an end in itself and a vital step on the path towards criminal accountability,” said the judge.

The DA’s Gauteng shadow health MEC, Jack Bloom, said the judgment was a severe indictment that should lead to culpable homicide charges against Mahlangu and Manamela.

“Other charges should also be laid against all those who can be identified in causing the suffering of the Esidimeni patients. These include contraventions of the Mental Health Care Act and the National Health Act, as well as fraud in licensing the NGOs and other matters.”

Bloom urged the NPA to formulate criminal charges as soon as possible so that justice was seen to be done.

Update: July 10 2024
This story contains additional comment from the Section 27 NGO

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