HomeArticlesOne year on: Relive SA's historic Life Esidimeni arbitration

One year on: Relive SA’s historic Life Esidimeni arbitration

The deaths of at least 144 mental health patients shook SA to its core and led to a historic arbitration that lasted more than 40 days.

By the time it was done, the Life Esidimeni tragedy had claimed four times the number that died in the first massacre in the new democratic South Africa.

In 2015, Gauteng health MEC Qedani Mahlangu announced the province would terminate a decades-old contact with the private hospital group Life Esidimeni to provide state-subsidised care for about 1 700 mental health patients. Many of these patients had spent most of their lives in institutions, their families unable to manage the high level of care they needed at home.

But the contract, Mahlangu argued, had become too expensive.

Gauteng health officials decided these patients could now be sent home, to other state facilities or community-based NGOs. Patient families, civil society and professional bodies cautioned that patients were not well enough to go home and NGOs were ill-equipped.

The transfers went ahead anyway, and ultimately at least 144 mental health patients lost their lives after being placed in state facilities and NGOs that were eventually found to be unlicensed.

In the aftermath of a damning ombud report, 134 patient families agreed to take part in a historic arbitration to allow the Gauteng health department to avoid litigation and to promote healing. Former Deputy Chief Justice Dikgang Moseneke presided over the 44 days of hearings during which officials, families, NGO owners and experts testified as to what led to the fatal decision to relocate patients and what happened after.

To mark the one-year anniversary of the start of the Life Esidimeni arbitration, Bhekisisa has obtained the full official transcripts of the hearings, which are available for download below.

44 days of testimonies, dozens of witnesses and more than one hundred deaths. Read our summaries and download the transcripts. (Jabu Kumalo, Gallo)

Day 1 — 9 October

Health Ombud Malegapuru Makgoba goes into detail about his investigation and report into the 144 deaths.

Day 2 — 10 October

Project manager Levy Mosenogi reveals what happened when he tried to stop the removals and how former Gauteng health MEC Qedani Mahlangu accused him of being a spokesperson for the Life Esidimeni hospital group.

Day 3 — 11 October

National health department director general Precious Matsoso testifies that the Gauteng health department did not inform the national government of its plans to relocate patients.

Day 4 — 12 October

Director general in the Office of the Gauteng Premier, Phindile Baleni tells the arbitration that the Human Rights Commission is also investigating the Life Esidimeni deaths.

Day 5 — 13 October

Former acting head of the Gauteng health department Ernest Kenoshi reveals all the officials facing disciplinary action for their role in the project.

Day 6 — 16 October

Social worker at the Cullinan Care Rehabilitation Centre outside Pretoria Daphne Ndhlovu at discloses that the facility took in patients that it was not typically mandated to care for. The facility not only took in Life Esidimeni patients but transferred some of its own patients to unlicensed facilities operating on its grounds to accommodate them.

It’s been a year since the Life Esidimeni arbitration. (Andronica Nedzamba)

Day 7 — 17 October

Owner of the deadly  Precious Angels NGO Ethel Ncube admits that she was not qualified to look after mental health patients and blames the department of health for not supporting her when she needed funds to buy patients food.

Day 8 — 18 October

Life Esidimeni managing director Morgan Mkhatshwa reveals that in 2007 young children were removed from the private healthcare facility and were sent to NGOs. Some of the children died of hunger, malnutrition and dehydration. These were also causes of death among some of the 144 Life Esidimeni patients who later died between 2015 and 2016.

He also disclosed that Life Esidimeni offered the Gauteng department of health the option to buy their facilities, but the department did not consider the offer.

Day 9 — 19 October

Father of deceased mental health patient  Billy Maboe, Joseph Maboe, tells the arbitration that patients were transported in trucks like cattle from Life Esidimeni facilities to NGOs.

Day 10 — 20 October

When Boitumelo Magena’s family visited her mother at the Soweto-based NGO Takalani, she describes how it was impossible to recognise her because she had lost so much weight.

Day 11 — 23 October

Life Esidimeni family committee member Christine Nxumalo voices the pain she and other family members went through as they tried to trace Life Esidimeni patients after they were removed from private facilities. Some families spent months trying to locate loved ones because the move was poorly organised.

Day 12 — 24 October

Ntombifuthi Dhladhla describes the gruesome details of finding her brother’s gravely decomposed body at a mortuary. Some families were only notified of patient deaths weeks after they had passed. Dhladhla was unable to wash or dress her brother’s body before burial because of the state of his body.

Then, Lucas Mogwerane goes into details of how his brother died within two weeks of being discharged from Life Esidimeni and placed in the care of the Rebafeni NGO. The organisation later confessed to Mogwerane that there was no food for patients.

Lucas Mogwerane’s brother died shortly after being transferred to an NGO that had no food for patients. (Andronica Nedzamba)

Day 13 — 26 October

South African Police Services major general Charles Johnson headed up the special task team inquiry into the deaths. He tells the arbitration that the Gauteng department of health’s delay in supplying the police with documents delayed the investigation. The task team subsequently resorted to court action to get necessary documents.

Day 14 — 27 October

Chairperson of the Gauteng Mental Health Review Board Dumi Masondo admits she didn’t understand her duties as part of her role on the legally-mandated oversight body meant to protect patient rights. She also didn’t know she had the power to veto the MEC of health and director of mental health on issues about mental health patients.

Day 15 — 30 October

Anchor Life NGO owner Dorothy Franks admits using patient grants to run the organisation. She also says she collected these grants for four months after the government shut down her NGO. Anchor Life never had a license to house mental health patients on the ground of the Cullinan Care and Rehabilitation Centre.

Day 16 — 8 November

Details of the first mental health patient who died are revealed. Deborah Petla’s post-mortem found that she had died with brown paper and plastic bags in her stomach. Her mother, Maria, says this is evidence of how hungry her daughter was. She says that her daughter was locked in a room where files were kept.

Day 17 — 9 November

Jabulile Hlatswayo testifies that former head of Gauteng mental health services Makgabo Manamela came to her home on the eve of her stepson Sizwe’s funeral and asked her for a post-mortem. Jabulile was notified of SIzwe’s death weeks after it happened and was never contacted by the Cullinan Care Rehabilitation Centre whose staff said they never had a listed next of kin for Sizwe.

Day 18 — 10 November

The health ombud reveals newly discovered deaths.

At least 144 mental health users died after being transferred from Life Esidimeni.

Day 19 — 13 November

Clinical psychologist Coralie Trotter says that it is her professional opinion that mental health patients were tortured in NGOs. She says conditions in NGOs were similar to those associated with concentration camps.

Day 20 — 14 November

Nursing manager at Cullinan Care and Rehabilitation Centre, Dikeledi Manaka says only 10 patients were supposed to be relocated to the facility, but they were forced to take 26.

Day 21 — 15 November

Manaka, admits that the facility was forced to take in more patients than it could safely house.

Day 22 — 16 November

Patient family member Lillian Mpofu says she witnessed patients being served small portions of plain rice.

Day 23— 20 November

The former head of Gauteng mental health services Makgabo Manamela tells of how several Life Esidimeni patients died at one NGO before the government gave them money to feed and cloth patients.

Day 24 — 21 November

Patient family member Andrew Peterson explains how he was blindsided by the announcement of Life Esidimeni’s closure — at an annual Christmas party over a loudspeaker.

Day 25 — 22 November

Patient family member Moelo Mofokeng says she thinks the Gauteng health department knew that NGOs were not ready to receive patients and that they might die as a result before the moved patients.

Cullinan Care and Rehabilitation Centre unit manager, Alfred Rasidzoge, is questioned about why a Life Esidimeni patient’s body decomposed while in the facility’s mortuary.

Day 26 — 23 November

The former head of Gauteng mental health services Makgabo Manamela continues with her testimony and sheds new light on internal discussions around the removal of Life Esidimeni patients.

Day 27 — 24 November

Manamela recounts how she was aware that there were NGOs patients were moved to organisations had never cared for mental health care users.

Head of Gauteng mental health services Makgabo Manamela was aware some NGOs had no experience caring for mental health patients. (Andronica Nedzamba)

Day 28 — 27 November

In day three of her testimony, Manamela reads an autopsy report that indicates a former Life Esidimeni patient died of severe dehydration. Evidence was found that patients did not receive proper care at NGOs. Some were not given food and water.

Day 29 — 30 November

Mamelodi Regional Hospital mortuary service manager Daniel Buda testifies that the body of former Life Esidimeni patient Joseph Gemede came in smelling and in an advanced state of decomposition from Cullinan Care and Rehabilitation Centre.

Longiswa Victoria Nomzibanzi family member of mental healthcare user, Mkanyisele, explains that her brother was operated on without her consent.

Day 30 — 1 December

Nompilo Nkosi whose brother Sizwe is autistic said she was told by Manamela that her brother would be moving to Cullinan Care and Rehabilitation Centre and that the facility was like a “5-star hotel”.

Joseph Ngwenya’s son, also a mental health patient, was moved without him knowing to an unknown location. When Ngwenya found him at a mental healthcare facility, he didn’t recognise his son who was thinner than before and smelled like he had soiled himself.

Day 31 — 4 December

Lesego Baloyi talks of her sister Julia Malinzwi Hlatle who survived a typhoid outbreak at Takalani, a Soweto NGO.

Nomsa Radebe testifies about her brother Mandla David Radebe who was transferred to Bophelong without her knowledge. When she eventually found him, he pleaded with her to take him with her.

Modianeane Abraham Maditsi’s niece, Kgotso Maditsi, is a mental health patient. When Maditsi visited her at the Takalani NGO, he took her home for fear that she would die there.

Day 32 — 5 December

The former head of Gauteng health department Barney Selebano says Mahlangu was responsible for pressurising NGOs to take more patients than they should, resulting in the department contracting unequipped organisations.

Day 33 — 6 December

Selebano testifies saying he was scared of Mahlangu.

Day 34 — 7 December

On the third day of his testimony, Selebano talks about what he thinks should have happened in hindsight. “I wish I could have stopped this project [in its] tracks,” he says.

Day 35 — 8 December

Nomvula Nonjabe describes how her sister Kajakazi Nonjabe was moved from a Life Esidimeni facility to the NGO Goetsi Modimo where the walls were made of concrete slabs normally used for fences.

Day 36 —18 January

Gauteng health deputy director of mental health Hanna Jakobus says she raised concerns about the NGOs not being ready for patients but participated in the Life Esidimeni transfer nonetheless.

Day 37 — 19 January

Jakobus testifies once again, this time taking responsibility as the person in charge of coordinating mental health NGOs.

University of the Witwatersrand head of bioethics and health law Ames Dhai talks on healthcare professionals’ oaths and ethical obligations.

Day 38 — 22 January

Former Gauteng health MEC Mahlangu says she did not participate in the arbitration in November and December because she was studying at the London School of Business and Finance. After a public outcry over Mahlangu’s absence, the school subsequently suspends her.

Day 39 — 24 January

When asked whether she agrees that the decision to terminate the Life Esidimeni contract resulted in the deaths of 143 patients, Mahlangu said, “I am not a medical doctor or forensic expert, so I don’t know who died of what.”

Day 40 — 25 January

Mahlangu says she cannot carry the personal blame for Life Esidimeni as she is just an elected official.

Day 41 — 26 January

Psychiatrist Chris Grobler is a professor at Walter Sisulu University and a member of the South African Society of Psychiatrists (SASOP), which tried to stop the relocation of Life Esidimeni patients. He testifies that if those involved in the Life Esidimeni transfer asked logical questions about the level of care people needed, death would have been foreseen.

Day 42 — 30 January

Gauteng MEC for finance Barbara Creecy argues there is no evidence to support that the Life Esidimeni contract was terminated to save money despite three officials stating it as a cause for the termination.

Gauteng premier David Makhura explains that he did not know Life Esidimeni patients were transferred to NGOs.

Day 43 — 31 January

Makhura argues that he was not shown a plan that stated that patients would be discharged to NGOs.

Gauteng Health MEC Gwen Ramkgopa, who took over for Mahlangu following her resignation, speaks of the lessons she has learned from Mahlangu’s time in office.

Minister of health Aaron Motsoaledi breaks down in tears while testifying and explains that under the law, he has limited authority over MECs.

Day 44 — 7 February

Closing arguments are heard from advocates representing families and patients, namely the public interest law organisations Section27 and Legal Aid as well as trade union Solidarity’s social assistance arm Helping Hands. The trio request about R1.7-million per family — or R1.5-million in compensation for Constitutional damages and an additional 200 000 for trauma counselling.

People can claim Constitutional damages when a government official has violated their Constitutional rights such as the right to health, life or equality. To successfully claim for such damages advocates must show that there is no alternative way to obtain redress for human right violations under common law.

Day 45 — 9 February

In closing arguments, state advocate Tebogo Hutamo argues that families of the deceased family members are not entitled to Constitutional compensation. The state believes that they did not breach any rights of family members.

Day 46 — 19 March

The Gauteng government is ordered to pay each of the 135 Life Esidimeni claimants involved in the arbitration R1-million in Constitutional damages as “appropriate relief and compensation for the government’s unjustifiable and reckless breaches” of six sections of the Constitution and “multiple contraventions” of the National Health Act and Mental Health Care Act.

It also has to pay the families of patients who died R20 000 to cover funeral costs of loved ones and R180 000 for shock and psychological trauma.

Nelisiwe Msomi was a health reporter at Bhekisisa.

Roxy de Villiers was Bhekisisa's social media content producer and engagement officer from 2018 to 2019.