QEDANI DOROTHY MAHLANGU
hereby states that:
1. The loss of life, our country experienced following the termination of the Life Esidimeni Service Level Agreement is certainly one of the most painful ever incident in the history of the South African health care.
2. The deaths of approximately 140 mental health users are indeed painful and regrettable. I want to upfront express my deepest condolences to the families who lost their loved ones following the termination of the Life Esidemeni Service Level Agreement (including the removal of the mental health patients from the Life Esidemeni health-care facilities).
3. Our healthcare system is meant to preserve and where humanly possible, to prolong human life. In this regard, our primary role as the department in the transfer of patients from Life Esidemeni was to ensure that we deliver service to all the people of Gauteng. Clearly, this did not go according to plan and it is indeed unfortunate and deeply regrettable that the implementation of this project ended up with the tragic loss of life and I am sorry that the innocent and vulnerable members of our society lost their lives in the process.
4. I hope that my testimony at these hearings will help families to find closure and also explore consequences to be faced by all who were involved and or played various roles that led to the system failing the deceased, their families and the public.
5. It is important to state that the “Life Esidimeni Project” had good intentions of:
5.1. Firstly – de-institutionalization of mental health users. In other words, the reason for the project was to integrate mental health patients into the communities instead of keeping them permanently institutionalized in hospitals. For far too long mental health users have been treated as social outcasts and this took place against the accepted international practice which seeks to ensure that mental health users are integrated within and/or amongst society.
5.2. Secondly – the project was responding to the various previous negative audit findings/queries by the Office of the Auditor General on the Life Esidemeni Service Level Agreement. In simple terms, Life Esidemeni enjoyed the benefits out of a contract which existed since 1979 without it being subjected to tender in line the provisions of Section 217 of the Constitution of the Republic of South Africa, the PFMA and the Preferential Procurement Policy Framework Act.
5.3. Section 217 of the Constitution, requires all organs of State to procure goods and services through a system which is fair, equitable, competitive, transparent and cost-effective. In other words, the fact that Life Esidemeni enjoyed the benefits of a Contract which did not comply with the provisions of the Constitution.
6. I have taken the liberty to appear in these proceedings, to share with this Commission, information relating to the Life Esidimeni, which information is within my personal knowledge.
7. I prepared a written statement providing a chronological sequence of events relating to the Life Esidemeni Project from the MEC’ point of view.
To members of the families gathered here, the families who lost their loved ones during the implementation of this Project – I am deeply sorry that for your lose. May their souls rest in peace.
8. Justice Moseneke, I now wish to give an account of my involvement as the then MEC for Health in relation to the implementation of the Life Esidemeni Project.
9. In 2014, shortly after the general elections, I was duly appointed as a Member of the Executive Council (“MEC”) of the Department of Health (hereinafter referred to as “the department”), Gauteng Province.
10. By virtue of appointment, I became the Executive Authority of the department, and my duties were largely prescribed, by the Constitution, the Public Finance Management Act (PFMA) and other supporting the legislation. I also had the responsibility to oversee the implementation of government policies in line with the mandate of the department.
11. During and around that time, the department had financial constraints and was under administration in terms of section 18 of the Public Financial Management Act, No. 1 of 1999 (“PFMA”). The cost of healthcare continued to escalate leading to more budgetary constraints.
12. At the Premier Budget Committee (“PBC”) meeting held in November 2014, after the departmental presentation which I annex hereto marked “QM”. Life Esidimeni did not form part of the presentation. During this meeting, the department was requested to develop a plan to reduce costs to ensure that the departmental over expenditure was reduced. A similar instruction was given to other departments as well.
13. In response to the PBC instruction referred to in the above paragraph, the HOD assisted by other officials engaged in a process to develop a plan to cut costs. I later received a costs presentation from the Head of the Department (“HOD”) Doctor Barney Selebano which I annex hereto marked “A”.
14. Dr Selebano also shared the contents of Annexure “A” with the Gauteng Provincial Treasury.
15. The Plan inter alia included but not limited to the termination and or revision of the following services:
15.1 Alex Health Care Centre;
15.2 Selby Park Clinic;
15.3 Life Esidimeni;
15.6 Security Services;
15.7 Long Incapacity Leave for 12 months onward;
15.8 NHLS Laboratory;
15.9 Laundry Services;
15.10 Road Accident Fund; and
16. One of the first cost-cutting exercises to be implemented and or terminated was Selby Park Clinic. The department through its officials implemented this proposal and finalized it in May 2015.
17. Selby Park Clinic – attracted, like Life Esidimeni had attracted negative comments from the auditor general in that, the contract had been renewed without the department following the supply chain processes.
18. For the sake of completeness, I wish to state that the Life Esidimeni contract had continuously created an audit query due to its perpetual nature. This Life Esidimeni contract can be traced back to 01 August 1979 according to the documents at the disposal of the department. Furthermore, the department had been unable to maintain the cost related to the Life Esidimeni agreement for a considerable time.
19. The HOD assisted by other departmental officials developed the Life Esidimeni Implementation Plan.
20. In addition to the Implementation Plan referred to above, the officials in the department led by the HOD developed and presented to me, a template against which the NGOs which were to take over from Life Esidimeni would be assessed. A copy of the template is annexed hereto marked “B”.
21. The department also established the Life Esidimeni Implementation Committee.
22. I was advised by Dr Selebano (which advice I accepted and relied on) that prior to the termination of the Life Esidimeni contract, he sourced and obtained a legal opinion which advised the department to terminate the Life Esidimeni Service Level Agreement. I do not have a copy of the legal opinion with me but I have reason to believe that the department has a copy of the Opinion.
23. Inline with the PFMA and other legislation, I provided guidance when I was required to do informal meetings held with officials in line with the role of the Executive Authority where necessary.
24. In order to ensure the implementation of the project, the Project Committee was required to meet on a weekly basis and I attended several meetings (whenever I was available) where I provided guidance when called upon to do so.
25. During the initial phase of the Project, I was given assurance by the Project Committee through the HOD that the implementation of the project was on track despite a few teething problems.
26. Issues of concern such as shortage of food, blankets were not presented informal meetings with the exception of supply of medicines.
27. When all the Operational Plans which included the template had been presented to me including the briefing by the HOD on the legal opinion, I did not have any reason to doubt information I received constantly from the officials.
28. I never received information that the Project was at risk or that the implementation of the Project would threaten the lives of the patients. In general, I received constant positive reports regarding the implementation of the project.
29. I had full confidence in the managers as well as the professional expertise of the HOD and his team.
30. During or about November 2015, I received an invitation from the office of the Premier to attend a meeting.
31. The purpose of the meeting was to discuss the letter by NEHAWU, wherein NEHAWU requested the department to absorb the Selby Park Clinic and Life Esidimeni staff as part of the exit strategy out of the two contracts.
32. The staff to be absorbed included the nurses, the cleaners and all people who met the government employment requirements.
33. I requested the HOD together with other members of staff to accompany me to the meeting with the Premier.
34. During the said meeting, it was agreed that the Selby Park Clinic and Life Esidimeni staff would be absorbed in the department in line applicable policies and where the Public Service regulations. We agreed also that and some of them would be placed at the various NGO’s which would be appointed to take over from Life Esidimeni.
35. Subsequent to the meeting with NEHAWU, I was informed that Section 27 organization took the department to Court challenging the implementation of the termination of the Life Esidemeni contract.
36. I state that the court application was never brought to my attention. To be precise, I was informed of the application only after the matter had been finalized at Court. Thus I did not oppose the court application although I was cited in my official capacity in the said papers. I understand that the said application was dismissed.
37. In January 2016, the Department was ready to meet with the families of the patients to be affected by the move from Life Esidimeni.
38. In this regard, we agreed with the HOD that, I would visit Waverly to meet with the families whereas the HOD visited Randfontein to have a meeting with the families.
39. During my meeting with the family members at Waverly, we discussed various aspects related to the move and we suggested to form a family committee. I shared my personal mobile number with the families so that they could ask clarity and/or discuss other matters relating to the move thereafter or to report officials if they were not listening to their concerns.
40. Once again, I wish to state for the record that, I was never informed of any major problems (other than teething problems relating to patient files) with the implementation of the termination of the Life Esidimeni contract.
41. During of the meetings it was reported that some patients had arrived at Wiskoppies and Sterkfontein with single clothing, some with one pair of shoes and others with one shoe. I was informed that some on arrival were weak and malnourished and immediately they were taken to Kalafong Hospital.
42. In one of interviews I had with radio 702 wherein I made a plea for members of the public to assist with donations on items such as clothing, pyjamas, tracksuits and shoes for the benefit of the patients.
43. After the Project Team had completed the scoping of the Project and entering the implementation phase of the Project, the process of moving patients to the various facilities was commenced with.
44. I must add, that when the Life Esidimeni released the patients to the various NGOs, it did so without releasing the patient files. I had to intervene by writing a letter to the Life Esidimeni requesting the release of the patient files. The Life Esidimeni was uncooperative with regard to the release of the files. The problem persisted until the period of my resignation.
45. The first key challenge to be brought to my attention was food shortages at an NGO in Cullinan. I took upon myself to visit the Cullinan facility to find out for myself what the cause of the problem was.
46. During that time, I was totally unaware that the patients were dying at the various NGOs or centers.
47. During or about September 2016, I received questions through Legislature on the Life Esidimeni project.
48. When questions are posed in the Legislature, the procedure is that such questions are sent to the MEC’s Parliamentary Officer, who in turn sends the list of such questions to the HOD of the department for assistance with answers to the questions posed. He may in turn source responses from the relevant sources.
49. Once the HOD receives the information required, he sends same to the MEC’s office. Thereafter the MEC will then proceed to respond at the Legislature.
50. I first became aware that 36 patients had passed away at the various NGO’s on the evening of 12 September 2016. This happened during my preparation for the question and answer session at the Legislature on or about 13 September 2016. The information was received from the office of the HOD as well as other officials who might have assisted the HOD through the provision of information requested.
51. On the following day, I proceeded to provide responses to the questions posed in the Legislature.
52. Less than 24 hours after providing the answers in the Legislature, I contacted Prof. Makgoba (the Health Ombudsman) requesting him to assist the department with the investigation of the causes of the 36 deaths. I annex hereto the transcript of my SMS communication with Prof. Makgoba, marked annexure “E”.
53. On the same day in the afternoon I had a meeting with the Minister to discuss Nelson Mandela Children Hospital Budget. I approached Dr. Aaron Motsoaledi, National Minister of Health requesting him to me because I had spoken to the Prof Makgoba and he was not keen and the Minister indicated that he will engage the professor to assist the department and the office of the OMBUDSMAN to set up an investigation into the causes of the 36 deaths.
54. I together with the members of staff held planning meetings with a view to constitute various teams for the purposes of visiting the various NGOs.
55. In Pretoria, I visited an NGO called Precious Angel. I had a conversation with the owner of the NGO who informed me that her NGO had received no payments from the Department. Upon probing, I discovered that the NGO was not registered with the with the Provincial Treasury. I immediately requested the HOD and CFO to assist the NGO with the necessary registration process and or documentation so that it could receive payment. All these happened during the month of September 2016.
56. I need to mention that around the same period of September 2016, I received several media queries regarding the exact number of deaths which had occurred on the Life Esidimeni Project.
57. I continued to receive more questions from the media who informed me amongst the others that the number had increased to 68. I had no full information regarding the questions posed.
58. I requested Dr. Lebethe to facilitate the performance and finalization of autopsies and to register the cases with case numbers relating to same.
59. Throughout the time, I was unaware of the causes of deaths and I believed that the whole matter required full investigation.
60. I proceeded to convene the departmental team for planning and visitation to various NGOs, we spread ourselves into different teams and we were joined by the Ministerial team. We then undertook visits to various NGOs to inspect the infrastructure and to ascertain whether or not there were adequate sleeping arrangements, availability of medication, food, first aid kits and to assess all the matters which needed verification in terms of the template the department had developed earlier.
61. The Mental Review Board was invited as well during the visitation.
62. I visited an NGO in Suurman, Haarmanskraal. I was accompanied by Prof. Freedman from the National Department of Health, Jeanette Hunter, Mental Health Review Board members, GDoH employees.
63. Amongst the items, we paid attention to in line with the template designed earlier were the availability of the nursing staff, security, the toilet facilities, bathrooms, dining places, food, medication and the general conditions of the NGOs.
64. I then gave a directive to the HOD and the team to continue to visit the NGOs, particularly where there were challenges to ensure that the patients were taken care of as well as ensuring general compliance with legislation.
65. Thereafter, I compiled a report for submission to Prof. Makgoba for the purposes of the investigation. During the compilation of the report I discovered a number of documents which I was seeing for the first time. Such information includes but is not limited to the following; the Life Esidimeni death statistics covering the period before the termination of the Life Esidimeni contract which is from 2010, 2011, 2012 and 2013 and, the report on the “Evaluation of Compliance to Health Service Standards and Financial Analysis Report 2014/15”.
66. I annex hereto, the copies relating to the records of deaths at the Life Esidimeni for the period immediately prior to the termination of the Esidimeni Service Level Agreement marked annexures; “D1”, “D2”, “D3”, “D4”, “D5”, “D6”, “D7”, “D8” and “D9”.
67. I beg leave to take this Commission through the statistics of the deaths at the Life Esidimeni for the period 2010 to 2013.
68. Later, I testified during the proceedings before Prof. Makgoba, to this extent, I refer this Commission to the findings of the OMBUDSMAN.
69. In conclusion, I submit that the Life Esidimeni Project could have been handled better and in a manner which promotes human dignity, the right to healthcare including but not limited to the right to life. I once again apologise for the loss of life during the implementation of the Life Esidimeni project.
QEDANI DOROTHY MAHLANGU