Gauteng Department of Healths Chief Director of Planning Levy Mosenogi takes an oath before testifying in the Esidimeni HealthCare Centre arbitration hearing held in Johannesburg. Photo: Supplied by Gauteng Department of Health

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Esidimeni project ‘too costly’

JOHANNESBURG, October 11 – In the wake of the deaths of mentally ill patients at ill-equipped NGOs, the Gauteng government decided to return patients to Life HealthCare Esidimeni centres, costing it more money than it originally paid, provincial health’s chief director of planning Levy Mosenogi said on Tuesday.
“The project turned out to be costly because we went back to Esidimeni, and they’re now charging us more than before. So not only did the project cost lives, it was not feasible….it was very costly,” Mosenogi told the arbitration hearing chaired by retired Justice Dikgang Moseneke.
Mosenogi was being cross examined by Section27’s  Advocate Adila Hassim.
Apart from the loss of 118 lives, more than 1,000 staffers at Esidimeni centres lost their jobs as the provincial Department of Health terminated the contract, citing costs. Mosenogi’s human resources task team had to look for jobs for staffers, especially nurses, at psychiatric hospitals, he added.
Moseneke asked him why people’s lives were sacrificed in order to save money as well job losses.
“Why was there no deep concern in a country with such a high level of unemployment? Was the head of department (HOD) and MEC not concerned about this near calamity? What is the justification in law, let alone in human dignity for doing that?” he asked.
Mosenogi responded: “I do not know Sir, that is why I tried my best to ensure that staffers were absorbed by other institutions. That pained me, it gave me sleepless nights, more so for unqualified care givers. I tried my best but what I did was not enough”.
The mental health act was breached in many ways as cited by in Health Ombudsman Malegapuru Makgoba’s report on the Esidimeni saga, said Moseneke.
”I know what our Constitution says… what the law says. the act has been breached…and to boot it all, more than a 1000 jobs were lost only for people to die and for the department to go straight back to Esidimeni and ask that the patients be taken back. Is there an acceptable explanation to our nation as to why this happened?” he asked Mosenogi.
Mosenogi responded: “In my opinion, there is no suitable explanation…I cannot justify that. There was no urgent need to move patients from Esidimeni”.
Earlier, he told the arbitration that he was placed in charge of the Esidimeni project by former MEC Qedani Mahlangu in November 2015. That time, a contract termination notice had already been sent to Esidimeni a month earlier.
The department had until March 2016, to find adequate care centres for the mostly chronically ill patients in a short space, leading to bungling of the project.
Releasing his report earlier this year, Makgoba found that as many as 94 mentally ill patients who were transferred from Esidimeni to unlicensed care centres died of causes that included neglect and starvation. The death toll figure rose over time as more information was discovered by Makgoba, bringing the number of deaths to 118.
Mosenogi told the arbitration hearing that the reasons behind the termination of the Esidimeni contract was to cut costs and put the contract out to tender, in order allow other service providers to come in.
The hearings continue on Wednesday.

Levy Mosenogi, chief director of planning at the Gauteng Department of Health, who was in charge of the transfer of mentally ill patients from Life HealthCare Esidimeni, told a hearing how he had to halt the transfer of minors to avoid putting their lives in danger.
The arbitration hearing into the death of more than 100 people that had been transferred from Life Esidimeni to unlicensed NGO’s is being chaired by retired Justice Dikgang Moseneke.
Mosenogi told the hearing that when he was appointed by former Health MEC Qedani Mahlangu in November 2015 to oversee the transfers, a contract termination notice had already been sent to Life HealthCare Esidimeni a month earlier.
The department had until March 2016 to find care centres for the mostly chronically ill patients.
At a first meeting with stakeholder organisations such as Section27, concerns were raised about the seemingly hasty process, said Mosenogi.
”The meeting was chaired by HOD [head of department] Dr Barney Selebano, the MEC and family members were there as well in Germiston. The stakeholders raised the concern that moving the patients was going to be problematic,” he said.
Mosenogi said another Esidimeni centre called Baneng, which cared for minors only, left him concerned after a visit there. He did everything he could to make sure the vulnerable children were not transferred, he said.
Moseneke asked why there was a need to also transfer the 295 children being cared for at Baneng.
”Takalani in Soweto was identified as a suitable place for Baneng. Baneng was part of Esidimeni, whose contract had to be terminated. After my visit to Baneng, I decided to not move them. It hit me after that visit as to how vulnerable the children were,” Mosenogi said.
Upon realising that there was not enough time to find suitable centres for the province’s mentally ill patients by March, Mosenogi said he asked for more time from the department.
Moseneke asked him: ”Tell me, what was behind the urgency to transfer people? Why did you not ask for more time?” asked Moseneke.
”I asked for at least 6 months to a year to successfully complete the transfer, I was given three months. I further proposed, as I submitted to the Ombudsman, that the department purchase Baneng…I did not want the children moved because I really feared for the worst. I did raise issues, expected senior managers to assist me, but I was the lone voice…at some point I was asked if I was the spokesman for Esidimeni,” Mosenogi said to Moseneke.
He said he was ultimately defeated by the”system”.
The department finally agreed with Mosenogi to not transfer the children from Baneng.
Mosenogi said he was appointed chief director in 2012 and had previously completed the transfer of patients from Selby Park, a private hospital.
In February, Gauteng Premier David Makhura suspended Selebano in the wake of recommendations by Health Ombudsman Malegapuru Makgoba, following the death of 118 psychiatric patients at ill-equipped facilities of various NGOs.
At the time, Makgoba’s report found that as many as 94 mentally ill patients who were transferred from Life Healthcare Esidimeni to unlicensed care centres died of causes that included neglect and starvation. The death toll figure rose over time as more information was discovered by Makgoba, bringing the number of deaths to 118.
Mosenogi told the arbitration hearing that the reasons behind the termination of the Esidimeni contract was to cut costs and put the contract out to tender, in order allow other service providers to come in.

Former South African MEC Qedani Mahlangu failed to share information about three NGOs that were being used as “fronts” to illegitimately claim funds, the country’s health ombudsman on Tuesday told a hearing into a probe of organisations used to loot state coffers.

Gauteng Health MEC Mahlangu, who resigned amid a scandal in which more than 100 mentally ill patients died when they were tragically transferred into the care of unlicensed NGOs, has been brought before the Esidemini arbitration hearings.

Health Ombudsman Malegapuru Makgoba told the hearing that Mahlangu only gave him information on 27 out of 30 NGOs.

”When I first requested documents from the MEC to help me in my investigation, I requested her to give me necessary information of NGOs that were used, she gave me 27. Later on, I discovered that there were 30…so there were three NGOs I was not informed about, and I tried to find out why,” Makgoba said.

”I found out that one was fronting for another one. I was not given this NGO to investigate because it was a front for a registered NGO. That means they were accepting patients on behalf of another registered NGO and they were obviously sharing whatever they received between them. The registered one would claim for the number of patients it accepted and also claim for the unregistered one.”


The death of 118 mental patients was as a result of gross incompetence coupled with former Gauteng health MEC Qedani Mahlangu “being clueless” about what she was doing, Ombudsman Malegapuru Makgoba  told the arbitrary hearing on Tuesday.



In May 2016 Mahlangu ordered the transfer of the patients from Life Esidimeni to 27 other non-government organisations,

”I think there was just general incompetence across the system. Warning signals were there, but the department was not ready in a proper way,” said Makgoba.

The health ombudsman was under cross examination from lawyer Dirk Groenewald, who represented three families who’s relatives died in the Esidimeni saga.



Retired Justice Dikgang Moseneke asked Makgoba what could have driven Mahlangu to go ahead with moving patients that led to to deaths of so many patients, while she was warned of dangers of her actions.

”What was she doing? What drove her in the face of all warnings by experts, clinical departments, families, even by project managers she appointed … and she still pushed through when the risks appeared so ominous. What was it? Did she tell you what drove her so hard to want to do this that turned out so fatal?” asked Moseneke.


Makgoba said MahIangu never understood the magnitude of the problem.

”I do not think she knew how big this matter was, I do not think she understood either, I tried to find out from her what actually happened and controls she set up, all I could gather was that this whole thing was not planned properly. There were no proper processes,” said Makgoba.



Makgoba testified about how families went for months without knowing where their relatives were.

The department never bothered to inform families where patients were being transferred to. Those who found out about the transfers and requested information about the whereabouts of their loved ones were ignored.



One parent, a reverend, found out a year later about his son’s location only because the patient called him to wish him a happy birthday, he said.

“For over a year Reverend Mabuya did not know where his son was transferred to, until, by coincidence, Billy called him on his birthday, and that was when he knew where he was. He then went to see him and bought him KFC, and as I testified yesterday, Billy was so much hungry he ate the KFC and the paper bag covering it. This was a serious human rights violation.”



One patient died and his sister did not know for three weeks until she received a call from the NGO.

”They asked her if they should bury the brother or whether the family would come collect his body … from this you can see that the families were not treated with common courtesy, human dignity and respect.

“Importantly, these are embedded in our Constitution – to treat people with respect, it is one of the pillars of our Constitution, and that did not occur in relation to the relatives and families.”



The health ombudsman described as “horror” the stories that emanated from the Esidimeni saga.

”One heard stories about how patients were transported in inappropriate transport where some of them had to be tied to the vehicles because the transportation was not appropriate. Some patients were transferred, for example, from Cullinan, and then to somewhere else almost against the decision of the team that assessed them as to where they fit,” said Makgoba.



”It is a requirement in mental health that assessment on capability of patient, intellectually and physically, be done before the transfer. Then you identify a suitable place that would befit their requirements. The opposite was done, which went against what is required in mental heal.”



Some patients were transferred several times from one NGO to another.


Makgoba said every time a mental patient is transferred, they are affected by that process and take a long time to recover from the experience.



”Some of them are not even aware as to where they were going, they do not protest….occassionally they do but generally they do not protest. You are basicaly doing something against people who are vulnerable and quite, and I just thought that that was cruelty,” he said.



Groenewald asked Makgoba if the government had lied to patients’ relatives when the department said the patients would be looked after properly when they were transferred from Esidimeni.



Makgoba said: ”I am not a lawyer and I find  usage of that word very difficult and complex there’s big difference between lying.incompetence is a often subconscious and not deliberate, lying is deliberate intentional process, I do not think there could have been such intention…to say they lied is too strong a word.”



He said he could use a friendly term and say the state was  ”were economical with the truth.”



Moseneke earlier started the proceedings by reminding everyone that Tuesday was World Mental Health Day, adding that it was important to protect the rights of mentally ill patients.



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