Esidimeni made fruitless attempts to halt ex-MEC’s ‘Brazilian’ solution: MD
Managing director testifies how Qedani Mahlangu justified decision to transfer patients as a cost-cutting measure
When former Gauteng health MEC Qedani Mahlangu informed Life Esidimeni management of her intention to end her department’s contract with them for the care of 1,300 psychiatric patients, she was adamant.
Speaking at day two of the Pretoria high court inquest into the tragedy, Life Esidimeni MD Dr Basuku Mkhatshwa said he was in charge of the service-level agreement the group had with the Gauteng department of health (GDOH) at the time. He testified about his involvement in the transfers that led to the deaths of 144 patients and his efforts to halt the process.
He said Mahlangu had met with Life Esidimeni management in February 2015 to inform them that their contract was to be terminated within a month.
“She said in Brazil they did not have any psychiatric patients in care. She said even those who are aggressive are looked after by their families who walk with them chained in the streets. She said her own brother has mental health issues and her family looks after them and that she can remember once having to sleep under a stove at home because of space problems and that the CMHUs (chronic mental health users) can do the same,” Mkhatshwa said.
Those NGOs that came said the project had been posed to them as a business opportunity. They had no qualifications or experience.
According to Mkhatshwa, Life Esidimeni was contracted by the GDOH to provide 2,260 beds for what he termed chronic mental health users. In 2014 they were informed that their contract was to be terminated over a few years in a process aimed at deinstitutionalising patients, moving them closer to their homes and cutting costs.
“We were told that we were to reduce beds by 200 per year from 2014 to 2020. We agreed, but then we realised the need for beds was exceeding the reduction,” he said, adding that they communicated this to the Gauteng health department.
The department then ordered a cost and needs analysis to determine the need for Life Esidimeni’s services. And in the meantime they were instructed to step up the process of discharging patients and reducing beds.
Life Esidimeni asked for a copy of the final report but was refused. It declared a dispute with the GDOH, which placed a moratorium on state hospitals and institutions referring psychiatric patients to Life Esidimeni for care.
Mkhatshwa said they requested an urgent meeting with health officials, but by October 2015 they started being approached by NGOs wanting to take patients away. They refused to hand over patients in situations where the transport was a bakkie with no canopy.
“Those NGOs that came said the project had been posed to them as a business opportunity. They had no qualifications or experience. The GDOH refused to give us the NGOs’ addresses, and our impression was that this was because some of them had not yet been established and they were not yet licensed,” he said.
In November Dr Makgabo Manamela, then the director of mental health in the provincial health department, visited Life Esidimeni’s Randfontein facility with a colleague to see for herself the facility and the care being given.
“The other official was unable to conclude the visit. She said it was just ‘too much’,” he said, explaining that the woman had been incredibly distressed by the state of the patients and their need for care.
Mkhatshwa said patients’ families were in conflict with health officials over the transfer plans, but that the GDOH remained adamant that the Life Esidimeni contract was to be terminated.
Under cross-examination by adv Adila Hassim of Section27, he reiterated his belief that the contract termination was predominantly done as a cost-saving exercise.
“We were already operating on as low costs as possible, also because of the economies of scale. It was just not possible to cut those costs any further without compromising the levels of care. There were times when we did not get paid, but we never compromised on care. We were able to get by with the support of the mother company,” he said, explaining how the GDOH would fall into arrears amounting to millions.
“When you describe a disastrous situation do you mean it in the sense of ‘death’ as such, or just physical degradation?” Hassim asked.
“I mean actual death and physical degradation that could lead to death,” Mkhatshwa responded.
He said Life Esidimeni’s efforts to help the Gauteng mental health directorate and offers to train NGO staff had been ignored and later blatantly refused.
The hearing continues on Wednesday.
The Inquest Inquiry is open to the public to watch online via live streaming by the Judiciary RSA youtube channel or on the Facebook page @TheSouthAfricanJudiciary.