Advocates argue for culpable homicide charges against top health officials for 2015 tragedy

With the resumption of the Life Esidimeni inquest at the Gauteng Division of the High Court in Pretoria on Thursday, advocates from public interest law centre SECTION27 and AfriForum’s private prosecution unit asked the court to recommend criminal charges against key witnesses.

SECTION27 argued for culpable homicide charges to be instituted against Gauteng Health MEC, Qedani Mahlangu, former Gauteng mental health head, Dr Makgabo Manamela, and the owner of Precious Angels NGO, Ethel Ncube.

“[There are] 141 deaths that are on the docket in this inquest. In other words, what we were talking about is a mass atrocity, and we submit that it would not have occurred if it were not for the conduct of Ms Mahlangu, Dr Manamela and … Ms Ncube,” said Advocate Adila Hassim representing SECTION27.

The purpose of the inquest, which began in July 2021, is to determine liability and cause of the deaths of 141 mental healthcare users who were moved from the Life Esidimeni health facility to non-governmental organisations in 2016. 

They were part of a group of more than 1,500 patients who were transferred out of Life Esidimeni when the Gauteng Department of Health terminated its long-standing contract with the service provider.

Hassim told the court, presided over by Judge Mmonoa Teffo, that the deaths of at least 10 mental healthcare users in the tragedy were closely connected to the conduct of Mahlangu, Manamela and Ncube.

“The first point to make is that Mahlangu made the decision [to terminate the Life Esidimeni contract]. Although she tries to characterise this as a collective decision of the [Gauteng] premier’s budget council, the evidence is to the contrary,” she said.

Mahlangu had oversight of the Life Esidimeni project, said Hassim. 

Other Gauteng health department officials testified to regular meetings with her throughout the process, and she chaired at least five meetings related to the transfer efforts between January and May 2016.

“Mahlangu knew the risks. She knew what was going wrong. She was involved in meetings and discussions and correspondence at all the critical and material times [during] the transfer of the user and after,” said Hassim.

“We say that she’s criminally responsible for the death of the mental healthcare users … because she took the decision to terminate; she insisted on its urgent implementation [and] she failed to stop implementation when she was warned [of the risks] on many occasions, by her own officials and specialists… 

“She had the power and the knowledge to prevent the deaths, but she did not do so.”

Read more in Daily Maverick: Life Esidimeni: Welcome to ‘know nothing’ Qedani Mahlangu’s forgetful world

In the case of Manamela, Hassim argued that she was the “de facto” leader of the project. 

Despite having a PhD in psychiatric nursing, she signed licences for NGOs that had no prior experience in caring for mental healthcare users. Many had not met the basic requirements for licensing, such as having a current service level agreement.

“At least four witnesses who have testified in the inquest … testified that Dr Manamela told them to place the [mental healthcare] users even though the audit [of NGOs] hadn’t been done … because the problems would be dealt with later,” said Hassim.

“This court should not shrink from finding that Manamela has a criminal case to answer.”

Read more in Daily Maverick: ‘I did not withhold information,’ says former Gauteng mental health official implicated in patient deaths

Ncube registered Precious Angels NGO in June 2016, and that same month took on 56 adult mental healthcare users and started operating a 24-hour facility, according to advocate Nasreen Rajab-Budlender, also representing SECTION27.

“Within two weeks of receiving those mental healthcare users, the first person in [Ncube’s] care would die,” she said.

“Another unknown mental healthcare user would die three days after that … and what followed was a fairly consistent stream of deaths until January 2017. 

“So, what we see is a seven-month period where 20 mental healthcare users would die. That is approximately a third of all the mental healthcare users housed in Precious Angels under the care of Ncube.

“Virtually all of those mental healthcare users were emaciated, dehydrated [and] many of them had pneumonia when they died.”

Rajab-Budlender argued that Ncube continued to take on more patients even after it became clear that the Gauteng Department of Health was not delivering the promised resources and training. 

The patients, who had conditions including cerebral palsy, dementia and psychosis, were kept in houses that were not licenced.

“[Ncube] had agency; she was responsible for Precious Angels … at the end of the day, she was the one who made the decision to keep accepting more mental healthcare users,” said Rajab-Budlender.

Read more in Daily Maverick: Portraits of lives lost: Left lying on the floor 

Representing families of four Life Esidimeni victims, advocate Phyllis Vorster of AfriForum’s private prosecution unit argued for murder charges against four former Gauteng Department of Health officials and one NGO owner. 

The four ex-officials were Mahlangu, Manamela, former head of the Gauteng Department of Health, Dr Barney Selebano, and former Deputy Director-General for Mental Health Services, Hannah Jacobus. Dianne Noyile, the NGO owner, ran the Siyabadinga facility where several mental healthcare users died.

Over the next two weeks, other parties will present oral arguments before the court. 

Teffo is expected to rule on whether the conduct of any person contributed to any of the deaths, after which the National Prosecuting Authority will decide whether to prosecute. 

The inquest continues. DM