Life Esidimeni Arbitration: 143+ and counting?

Monomong Welheminah Thejane told the arbitration that she firmly believes that her brother Daniel Charles Josiah died as a result of negligence. She stated that he had not been moved with his medical file or his identity document.

By Ngqabutho Nceku Mpofu, SECTION27

After two years, and countless attempts at compelling the Gauteng Department of Health (GDoH) to act in the best interests of Mental Health Care Users (MCHUs), significant headway is finally being made in the ‘Marathon Project’ saga, which saw 1 441 MCHUs rapidly moved from Life Esidimeni – to their detriment. It is an indictment of the GDoH and other powers that be that this is happening a little too late for at least 143 mental

health patients, reliant on the public health system, who lost their lives; for their bereaved families; and quite possibly for the 59 patients whose whereabouts are still unknown.

On 9 October 2017, the Life Esidimeni arbitration began. This dispute resolution process, led by former Deputy Chief Justice Dikgang Moseneke, has been geared towards considering adequate compensation, further alternative redress, appropriate psycho-social support, the provision of essential information, and – importantly – closure, where necessary, for families of deceased or affected MCHUs as well as surviving MCHUs.

This process is occurring almost two years after the GDoH announced that it was terminating its long-standing relationship with Life Esidimeni. The need to deinstitutionalise (which is cautiously highlighted in the National Mental Health Policy) and a lack of adequate resources were cited as the primary reasons for the Project. During the arbitration process, both of these reasons have since been debunked.

Life Esidimeni, a private health institution with multiple facilities in Gauteng, had a relationship with the State dating back three decades – to before the dawn of democracy – providing it with services for MCHUs.

The arbitration process has been undertaken as per the recommendations of the Health Ombud, Professor Malegapuru Makgoba, in his report, titled ‘The Response into the Circumstances Surrounding the Deaths of Mentally Ill Patients- NO GUNS: 94+ SILENT DEATHS AND STILL COUNTING[1]’. Prof Makgoba found that despite multiple attempts – by experts, civil society, family members and other concerned community members – to dissuade the GDoH from conducting the Marathon Project, the Department proceeded; resulting in the deaths of MCHUs, which may partly be attributed to the abysmal conditions at the Non-Governmental Organisations (NGOs) to which most of the MCHUs were moved. Parties that attempted to ensure that this did not occur include SECTION27, the South African Depression and Anxiety Group (SADAG), the South African Society of Psychiatrists (SASOP), and the Life Esidimeni Family Committee.

The Ombudsman

According to Prof Makgoba, Life Esidimeni was responsible for 1 711 MCHUs. Of those, 270 were discharged to their homes, in line with the policy of deinstitutionalisation; leaving 1 441 MCHUs, most of whom were transferred

to 27 NGOs. During the arbitration, the Health Ombud revised his initial provisional number of 94 deaths as a result of the Marathon Project, bringing the total to 143 deaths (139 of which took place during the arbitration’s Terms of Reference). Of these, 29 occurred at Cullinan Care and Rehabilitation Centre (CCRC) facilities (Anchor Ward and Siyabadinga), 38 at Takalani (both complexes), 20 at Precious Angels, and 12 at Tshepong. This translates to a ratio of eight times more than the national average.

Family members and expert witnesses

SECTION27 is representing 66 families whose loved ones passed away as a result of the Marathon Project. The arbitration heard heartbreaking testimony from family members – represented separately by SECTION27, The Legal Aid Clinic and Solidarity – about the state in which they found their loved ones. Rev. Joseph Maboe (80) highlighted the nature of the suffering by relating the story of his son Billy, who was so emaciated when found that he ate the plastic packet from the chips they brought him[2]. Billy passed away days later. Ntombifuthi Dladla related the harrowing story of finding her brother’s body in a decomposed state, several months later[3]. In both instances, the families – like many others – had been looking for their loved ones for months, as a result of bureaucratic bungling and lack of rational processes.

Further evidence was provided by Dr Mvuyiso Talatala, a psychiatrist and former President of the South African Society of Psychiatrists (SASOP), an umbrella body representing psychiatrists in South Africa; and Caroline Trotter, a clinical psychologist and psychoanalyst. The former spoke of numerous attempts undertaken to persuade the Department to rethink its approach, while the latter spoke of the inimical effect of the move – mainly on the families of the deceased MCHUs, but to some extent on the surviving MCHUs and their families.

The NGO representatives

The arbitration also heard from Daphney Ndhlovu, a social worker from CCRC; Dikeledi Manaka, a psychiatric nurse from CCRC; Precious Angels owner Ethel Ncube; Anchor Ward owner Dorothy Franks; and former Siyabadinga CEO Dianne Noyile. While their stories varied, marked inexperience, greed, gross neglect and ill-treatment, and lack of the requisite skills were the leitmotifs of their testimony. For instance, Ethel Ncube, whose Precious Angels facility was particularly notorious – 23 out of the 58 patients she received perished – conceded that she only had a certificate in Early Childhood Development, which is an insufficient qualification for looking after adult long-term mentally ill patients. Dorothy Franks admitted during her testimony to receiving R1 500 in monthly SASSA grant payments for each of the 27 patients. These included patients in her NGO who had long since perished there[4]. She also received R600 000, which she accepted, after her NGO was forced to close[5]. Stories abound of patients arriving with limited medicines, no medical records, in buses and cars, occupying overcrowded premises, and having to endure sharing their abode with people of the opposite sex – accentuated by the disparity between able-bodied and non-able-bodied MCHUs, a situation ripe for sexual violence in a country that already has high rates of sexual violence in general.

Gauteng Health Officials

Mr Mosenogi, Project Manager of the Marathon Project and the Director of Planning, Policy and Research at the GDoH, acknowledged his and the Department’s shortcomings, apologising profusely and admitting that they had “made mistakes[6]”.

At the time of writing, Dr. Manamela – the first of the three senior Department officials identified by the Ombud as having “their fingerprints peppered throughout the project[7]” – was due to testify. The arbitration also looked forward to hearing from other key actors. The former provincial Member of the Executive Council (MEC) for Health, Dr. Qedani Mahlangu; the suspended Head of Department, Dr. Selebano; the Minister of Health, Dr. Aaron Motsoaledi; the Premier of Gauteng province, Mr. David Makhura; and family members representing the surviving MCHUs are expected to testify before the end of the arbitration process on 26 January 2018.

In the final analysis, as powerful an individual story as Life Esidimeni is, it is indicative of a broader malaise affecting the provincial healthcare system. The Gauteng Department of Health has a massive budget deficit, and has not been able to pay major service providers. Nothing short of a full-scale turnaround strategy, in partnership with other stakeholders, is required to ensure the right to health care of public healthcare users in Gauteng.

[1] Prof. Malegapuru Makgoba (2017), ‘The Report into the Circumstances Surrounding the Deaths of Mentally Ill Patients: Gauteng Province. No Guns: 94+ Deaths and Still Counting’, Office of the Health Ombud, https://www.sahrc.org.za/home/21/files/Esidimeni%20full%20report.pdf.

[2] Jan Willem Bornman, ‘”He was hungry” – Dad’s desperate search for Life Esidimeni patient ends in tragedy’, News24, https://www.news24.com/SouthAfrica/News/he-was-hungry-dads-desperate-search-for-life-esidimeni-patient-ends-in-tragedy-20171011, 11 October 2017.

[3] Eye Witness News (EWN), ‘Esidimeni: “My brother’s body was found in advanced stage of decomposition”’, http://ewn.co.za/2017/10/24/esidimeni-my-brother-s-body-was-found-in-advanced-stage-of-decomposition, 24 October 2017.

[4] Eye Witness News (EWN), ‘NGO founder admits to using SASSA money of dead Esidimeni patients’, http://ewn.co.za/2017/10/30/ngo-founder-admits-to-using-sassa-money-of-dead-esidimeni-patients, 30 October 2017.

[5] Katherine Child, ‘”I did it for the money”, says NGO owner who raided dead patients’ accounts’, https://www.timeslive.co.za/news/south-africa/2017-10-31-i-did-it-for-money-says-ngo-owner–who-raided-dead-patients-accounts/, Times Live, 31 October 2017.

[6] Jan Willem Bornman, ‘”We made mistakes” – Life Esidimeni Project Head’, https://www.news24.com/SouthAfrica/News/we-made-mistakes-life-esidimeni-project-head-20171010, 10 October 2017.

[7] Prof. Malegapuru Makgoba (2017), ‘The Report into the Circumstances Surrounding the Deaths of Mentally Ill Patients: Gauteng Province. No Guns: 94+ Deaths and Still Counting’, Office of the Health Ombud, https://www.sahrc.org.za/home/21/files/Esidimeni%20full%20report.pdf, page 1.