NGOs where Life Esidimeni patients were placed did not have service-level agreements: ex-Gauteng health official

There was not enough time allocated for Life Esidimeni’s “Marathon Project” and this resulted in the death of 144 mental healthcare users, former deputy director of the Gauteng Health Department’s mental health directorate, Hendricka Jacobus, has told the inquest into the tragedy.

Jacobus was back on the witness stand on Tuesday, 18 January and began her testimony with the extent to which she had engaged with former Gauteng health MEC Qedani Mahlangu while the project to move them from Life Esidimeni health facilities into NGOs was being implemented. 

Under cross-examination by legal counsel for Mahlangu, advocate Teneille Govender, Jacobus told the inquest: “I had no contact or involvement with Mrs Mahlangu during the project except we were called to one meeting, it was almost at the end of the project.” 

Jacobus said she couldn’t remember the full details of the meeting but that afterwards Mahlangu had wanted to visit Precious Angels and Suurman NGOs in Hammanskraal, and that had been her only engagement with Mahlangu.

Asked by Govender about Mahlangu’s intervention at the Siyabandinga and Anchor House NGOs, Jacobus said: “What I observed with the Siyabadinga administration and handling of patients, I was worried. So I discussed that with Dr Manamela and [said] that she should really come and assist me… Dr Manamela came after an hour and said they will come and support me the following morning, then they’ll come for a meeting. Then the following morning, Dr Manamela, Mrs Mahlangu and quite a number of senior chief directors came to Cullinan Care and Rehabilitation Centre (CCRC), to Siyabandinga and Anchor House.”

Dr Makgabo Manamela is the former head of Gauteng Mental Health.

Judge Mmonoa Teffo pressed Jacobus to speak directly to whether or not she had any direct involvement with Mahlangu when she visited the CCRC, to which Jacobus replied: “Not directly because they were in a group.”

Turning to the matter of insufficient time allocated for the transfer of patients, Govender put it to Jacobus that, based on her previous testimony, three to six months was the standard time to process NGO contracts and grant licences, the nine months proposed for the Marathon Project should have been enough. Jacobus replied that it could take longer depending on what district officials’ findings were in terms of readiness at identified NGOs when initiating contracts. 

Govender further contested the Jacobus’s claim of insufficient time, saying the Gauteng Department of Health was forewarned about the closure of Life Esidimeni as far back as July 2013, during which time “capacity could have been built”.

Jacobus replied that they were informed but no specific timeframes were given and that the department did start “identifying” the existing NGOs with which they worked, as well as new ones, for readiness. She further testified that Manamela had the final say over which NGOs would be contracted. 

Representing Life Esidimeni, advocate Harry van Bergen put it to Jacobus that the process of transferring patients from Life Esidimeni to NGOs had been “derailed” because of the department’s failure to secure contracts with “functioning and competent” NGOs. He said there were NGOs who were not fully or properly licensed which were contracted to the department and had mental healthcare users allocated to them. 

Jacobus replied that “the finalisation of NGOs that was given through, the number of bed spaces was satisfactory, the staffing of these NGOs was satisfactory in terms of linen, in terms of food was satisfactory. The derailing of the process was with the implementation of the project that wasn’t followed according to the numbers stipulated.”

Jacobus testified that she submitted a report to Manamela stating that three years were needed to transfer the patients from Life Esidimeni to NGOs. Asked by Van Bergen how she had arrived at three years, Jacobus said this was based on her knowledge of the capacity of existing NGOs, and that there were some that needed to have their capacity “strengthened” in order to be able to take on patients. Jacobus told the inquest that it was only in January 2016 that formal inspections with engineers were conducted to ascertain the suitability of NGOs to take on patients.

Jacobus testified that she was involved in the placement of patients during the Marathon Project and that there were patients allocated to the incorrect NGOs as well as instances where patients ran out of medication where she had to intervene. 

Asked by Judge Teffo what the reason would be for patients to run short of medication, Jacobus said she had received reports from NGO managers that patients had been sent from Life Esidimeni with insufficient medication. “When we went to Weskoppies for replenishing of the medication, some of the scripts were expired.” 

Legal counsel for families of the 144 deceased patients, advocate Adila Hassim, asked Jacobus to confirm whether the NGOs where the patients were placed during the Marathon Project had service-level agreements as well as food and menu specifications with the department, as per the requirements for licensing. “Not at the time of placements,” replied Jacobus, adding that she had informed Manamela about this.

The inquest continues throughout the week. DM/MC