“It’s a huge relief,” said Marc Kotze on Friday. His-brother-in-law is a patient at Lorraine Frail Care Centre in Port Elizabeth, one of the two state-funded centres run by Life Esidimeni in Port Elizabeth. They care for the severely mentally and physically disabled patients. Eastern Cape Social Development MEC Nancy Sihlwayi has ignored relatives’ attempts to challenge the decision to move patients from Esidimeni to NGOs, but on Thursday the plan was postponed. Kotze, who is part of the Frail Care Crisis Collective, said he is still weary of the MEC but excited by the victory.

The reversing of the move was a direct response to the release of the health ombudsman’s Life Esidimeni report, which this week found at least 94 chronic mental illness patients had died since being moved from Esidimeni’s facilities in Gauteng to NGOs. It looked like the tragedy would be repeated in the Eastern Cape, with Sihlwayi’s arrogance matching that of Gauteng MEC Qedani Mahlangu. But Health Minister Aaron Motsoaledi and Eastern Cape Premier Phumulo Masualle intervened, leading to the extension of Esidimeni’s contract by a year to find a solution for both patients and the state.

As criminal charges have been laid against Gauteng health officials this week, the Eastern Cape intervention raises the question: How much did Premier David Makhura and Motsoaledi know before bodies in Gauteng started stacking up in morgues? Could they have done more to prevent almost 100 deaths?

Gauteng Health head of department Dr Barney Selebano, in his testimony to Health Ombudsman Malegapuru Makgoba, said the “decision to start deinstitutionalisation of mental health care users from [Life Esidimeni] was undertaken in the office of the premier of Gauteng, the Honourable David Makhura, together with the HoD”. Policies to push community-based support were taken nationally long before Gauteng implemented its rushed and fatal plan, so it is likely the premier’s office was involved in some policy issues. But Makgoba emphasises that while the decision was said to be made in the premier’s office it was not by Makhura (his emphasis). Charges have been laid against Selebano for his role in the tragedy.

Makgoba found the premier had not committed any wrongdoing nor was he aware of the disastrous plan until the MEC announced in September that 36 people had died in the months since they were moved.

The DA’s Jack Bloom said Makhura should resign. He said the premier was implicated in the decision to transfer patients out of Life Esidimeni, should have known about the issue, and intervened after numerous media reports were published with warnings the plan would end in disaster. Once it was announced in September that 36 people had already died, he should have done more to prevent further deaths, said Bloom. The Economic Freedom Fighters (EFF) have laid charges against the premier and the Gauteng ANC Youth League (ANCYL)also said it planned to lay charges and called for the premier to resign.

On Friday, the ANC spokesperson Zizi Kodwa slammed the provincial Youth League. “No person should ever grand stand on anyone’s pain. It is for this reason that the ANC finds the statements of the ANCYL in Gauteng atrocious, despicable and unbefitting not only members of the ANC but humanity at large.”

Makhura has denied he knew of the warnings published in the media before the move, despite a number of publications, including Daily Maverick, noting the concerns. Makhura’s spokesperson Thabo Masebe said the premier first knew about the patient transfers around July or August as they began. The suggestion Makhura may have been a part of the decision was “very strange”, said Masebe. Makhura could have only known if the issue was raised in the executive council.

“That was not the case,” he said.

Mahlangu is on record saying the decision was not that of the national health department or premier, but Gauteng department of health. She has subsequently resigned and in Makgoba’s report distanced herself from the matter, suggesting staffers rather than the MEC were responsible.

Makhura was also named as a respondent in court papers in December 2015 as families and NGOs challenged the move from Life Esidimeni. Masebe said Makhura is often called as a respondent in court matters relating to the provincial government and not necessarily made aware of the claims. On whether the premier might have seen warnings in the media prior to the Life Esidimeni patients’ move, Masebe said the issue only gained public prominence after the fatalities were first announced and then he took action. Masebe dismissed calls for the premier to resign or face criminal charges. Relatives and civil society groups welcomed his interventions, but the issue had now become politicised, he said.

Minister Motsoaledi is also mentioned in the ombudsman’s report, cited as urgently requesting an update on the move from Life Esidimeni – before the patients were moved. Makgoba found the minister should shoulder no blame for the disaster, but correspondence from the minister’s cluster manager for non-communicable diseases, Professsor Melvyn Freeman, in May last year suggested Motsoaledi might have been concerned about the Gauteng department’s plans. In the May email, Freeman told Gauteng mental health director Makgabo Manamela the minister required “an URGENT reply” from the province on its plans.

Motsoaledi dismissed the claim he knew about or could have prevented the disaster before it happened:

“My involvement came in when I then heard that there was an announcement in the legislature that 36 people had died,” Motsoaledi told Daily Maverick on Friday. That was in September. He then dispatched a team within 48 hours to inspect 17 of the NGOs patients had been sent to, which led to some of them being closed.

On Freeman’s claims, Motsoaledi said he was surprised to read of them and contacted Freeman to ask why he said the minister had made a request he said he’d never made.

“He was trying to use my name to push them as people must know the matter is serious,” the minister said he was told. “Like you I was surprised when I saw those emails.”

What could have been done differently? Motsoaledi said if the provincial department approached his office before the process started, national officials would have intervened. The problem is that provincial departments don’t have to take such issues to national level because many health competencies fall under provinces. The minister supported the ombudsman’s call for mental health policy to be reviewed and for a national department mental health expert to, in the future, review such plans.

“Enough measures to ensure something like this never happens again,” said Motsoaledi.

While multiple charges have been laid, with the EFF leading the charge against a number of Gauteng health department officials, the NGOs, and service providers involved, the minister and the premier now say their concern is ensuring the safety of patients who remain in care of the dodgy NGOs and preventing the disaster from occurring again. A statement from the Gauteng government on Friday said a task team was visiting NGOs, working with patients’ relatives, to prepare patients for relocation.

As the national and provincial health departments implement plans to prevent any loss of life and further disasters, and the premier and minister deny they were responsible, questions will remain: Could they have done more? Could they have intervened as they now have in Eastern Cape? Or does it take a massacre to change the system? DM