SECTION27 prepares to press for culpable homicide charges against key Life Esidimeni figures

Many bereaved family members attended the arbitration hearings. (Photo: Joyrene Kramer)

By Tamsin Metelerkamp

24 Oct 2023

When the Life Esidimeni inquest resumes on Thursday, public interest law centre SECTION27 intends to press for culpable homicide charges to be filed against two former Gauteng health department officials and one NGO owner for their roles in the deaths of mental healthcare users.

The Life Esidimeni inquest is set to resume on Thursday 26 October at the Pretoria division of the Gauteng High Court. In the lead-up, public interest law centre SECTION27 has indicated its intention to argue for culpable homicide charges against three witnesses for their roles in the deaths of mental healthcare users in 2016.

These figures are former Gauteng Health MEC Qedani Mahlangu, former Gauteng mental health head Dr Makgabo Manamela and the owner of Precious Angels NGO, Ethel Ncube.

Some of those who died in the Life Esidimeni tragedy. Photo: A photographic collage was presented at the hearings by Section27 in memory of the mentally ill patients who died in the Esidimeni Life tragedy. The number of patients who died now stands at 144. (Image: Section27)

“SECTION27 represents 44 mental healthcare users who died in the most inhuman, cruel and degrading circumstances while under the care of the state. Many of the people who died suffered starvation, dehydration, neglect and severe violations of their human rights,” stated the law centre.

“We will present our argument (based on the evidence already before the court) that the deaths of at least 10 of the mental healthcare users were caused by the conduct of Ms Mahlangu, Dr Manamela and Ms Ncube.”

The Life Esidimeni inquest, presided over by Judge Mmonoa Teffo, began in July 2021. The court has since heard from 40 witnesses, including health department officials, NGO owners and experts in nursing and mental healthcare. Witness testimonies were wrapped up in May 2023.

Read more in Daily Maverick: Psychiatrist testifies on failed efforts to avoid the Life Esidimeni horror and how her pleas fell on deaf ears

The purpose of the proceedings is to determine the cause of death for 141 mental healthcare users who were moved from the Life Esidimeni health facility to various non-government 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.

A 2017 report by then Health Ombud, Prof Malegapuru Makgoba, found that 27 of the NGOs to which patients were transferred were operating with invalid licences. It further stated that the facilities where the majority of patients died lacked the competence, management and resources to provide for the specialised needs of mental healthcare users.

Former Deputy Chief Justice Dikgang Moseneke at the Life Esidimeni hearings. (Photo: Joyrene Kramer)

‘Culpable homicide’

From Thursday, there will be two weeks in which SECTION27 and 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 patient deaths, after which the National Prosecuting Authority will decide whether to prosecute.

According to SECTION27’s heads of argument, the conduct of Mahlangu, Manamela and Ncube caused the deaths of several mental healthcare users.

“Mahlangu made the initial decision to terminate the Life Esidimeni contract. She then continued to make a series of reckless decisions in relation to the project for months while chairing project team meetings.

“This included putting pressure on the Gauteng Department of Health officials to implement the termination project over an extremely short period of time,” stated SECTION27.

“Mahlangu made these decisions having been warned of the risks of termination, the impracticalities of continuing with the implementation of the project, and the insufficiency of measures in place to mitigate the risks and impracticalities.”

In her testimony at the inquest in May 2023, Mahlangu claimed that the decision to transfer patients out of Life Esidimeni was made by the budget committee led by then Gauteng premier David Makhura, of which she was a member.

She further claimed ignorance of the fact that unsuitable NGOs had acquired licences from the Gauteng Department of Health.

Read more in Daily Maverick: Former Gauteng Health MEC Qedani Mahlangu: Moving 2,000 mental health patients was not my decision

In the case of Manamela, SECTION27 argued that she was the “de facto project leader” for the termination of the Life Esidimeni contract and was directly involved in the project’s implementation.

“She signed licences for NGOs that she knew had not been properly assessed and then failed to ensure that they were paid timeously. She was warned both before and during the implementation of the project about risks and failed to mitigate these risks sufficiently,” it stated.

Many bereaved family members attended the arbitration hearings. (Photo: Joyrene Kramer)

Manamela testified before the inquest in October 2022, claiming that while she signed the licences for NGOs, selecting and vetting them was not her responsibility, but that of her team.

She said that the decision to terminate the Life Esidimeni contract was made by more senior officials and she “did not have the power to stop it”.

Read more in Daily Maverick: Former head of Gauteng mental health Makgabo Manamela denies responsibility for vetting NGOs where patients died

Ncube was the owner of Precious Angels NGO, where 20 mental healthcare users died during the Life Esidimeni tragedy, according to SECTION27. The first of these deaths happened within two weeks of the patient being transferred to her care.

“... Ncube housed mental healthcare users in the most deplorable conditions. She knowingly operated an unlicenced NGO [and] continued to accept patients even after it was clear that she had neither the staff, the resources, nor the facilities to care for them and that taking additional people would compromise their health.

“She employed unskilled workers to take care of patients who required specialised care and allowed them to be housed in conditions that were squalid and inhumane,” stated SECTION27.

In the upcoming proceedings, Ncube is expected to argue that she was not personally responsible for the physical care of mental healthcare users at Precious Angels and that the Gauteng Department of Health was responsible for the circumstances that led to patient deaths.

SECTION27 stated that all three witnesses – Mahlangu, Manamela and Ncube – will argue against its submission that Teffo should recommend their prosecution.

“We hope that the inquest will serve its purpose to promote public confidence in the criminal justice system and reassure the public that unnatural deaths will receive proper attention and investigation.

“In a country starved of accountability, the Life Esidimeni inquest has the potential to further accountability and justice following a disaster of previously unimaginable proportions,” said Section 27. DM

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‘Culpable homicide’