The camera panned to Gauteng Premier David Makhura during last week’s State of the Nation Address (SONA). Democratic Alliance (DA) leaders had arrived at SONA with a banner reading “Remember the Esidimeni 94”. As the party’s request for a moment of silence was denied by Speaker Baleka Mbete, Makhura appeared solemn on TV, tarnished by his comrade’s lack of sensitivity.

The premier, along with Health Minister Aaron Motsoaledi, responded swiftly to Health Ombudsman Professor Malegapuru Makgoba’s recent report, which detailed how the provincial health department’s transferring of mentally ill patients from Life Esidimeni into NGOs led to at least 94 deaths.

Makhura has so far avoided culpability for the disastrous decision and implementation of the Gauteng department’s plan, but the DA continues to apply pressure.

Makhura’s office has denied the latest claims that he was warned and failed to act. The premier’s spokesperson, Thabo Masebe, on Sunday said, “Nobody met with the premier to discuss this issue and I don’t think it’s wise to deliberate on the matter, which should not have happened.” He continued, “What is important right now is to implement the recommendations set out by the ombudsman to alleviate the wrongs highlighted in the report and safeguard lives.”

Masebe was responding to claims from Gauteng DA MPL Jack Bloom. This weekend he released excerpts of a January 2016 letter from Wits occupational therapy students who spent time at Life Esidimeni’s Waverley facility. “We are concerned that these patients, who are already vulnerable, will be at risk of abuse and injury should they be discharged from Waverley,” the students warned.

Bloom claimed the letter was evidence that Makhura “ignored explicit warnings that the transfer of mental health patients from Life Healthcare Esidimeni would be a disaster that could result in deaths”. He added, “We need to know – what did he know, and when did he know it?”

Makhura has said he only knew of the plan to transfer patients out of Life Esidimeni when the process began mid-2016 and was not notified that his office was named as a respondent in court attempts to prevent the transfer. He has claimed not to have seen earlier media reports on the plan’s potentially dire consequences and only knew of its fatal implementation when Health MEC Qedani Mahlangu announced 36 deaths in September. The letter from the Wits students was forwarded to the health department, without the premier seeing it.

“Responsibility radiates wider than Gauteng health,” said DA MP Wilmot James in a statement. He called on Motsoaledi to investigate why the tragedy occurred despite top officials being warned long in advance. The Wits letter was also sent to the former director-general of the national health department. Makgoba’s report found neither Makhura nor Motsoaledi culpable, but an oversight committee in the Gauteng Legislature will probe the role of the office of the premier.

Health MEC Mahlangu resigned on the eve of the release of the ombudsman’s report and Makhura has suspended Gauteng department of health boss Dr Tiego Selebano and the provincial head of mental health services, Dr Makgabo Manamela. The report found all three shared significant responsibility for the disaster.

“The ANC-led government is committed to ensuring that not only are the [health ombudsman’s] recommendations implemented, but that the most vulnerable in society feel taken care of by the health department,” said an update from the Gauteng ANC recently. It said new health MEC Gwen Ramokgopa spent her first days in office meeting stakeholders and had visited one of the affected NGOs. A team of experts appointed to facilitate the shift of patients from NGOs to state facilities, and prevent further deaths, had managed to visit all affected NGOs as it works with patients’ relatives before the move.

In his SONA address on Thursday, President Jacob Zuma said, “We need to be distressed by the death of so many psychiatric patients in Gauteng. I’ve instructed the minister of health to ensure that the health ombudsman’s recommendations are wholly and speedily implemented without any hesitations.”

He supported a review of health legislation to return certain mental health responsibilities back to the national department. Motsoaledi, and the ombudsman, have said the legislation must be revised to avoid a provincial department acting independently and irresponsibly.

The DA continues to target those who might be implicated in the tragedy. Last week, the South African Human Rights Commission (SAHRC) responded to the party’s claims that the commission could have responded earlier to a request for “urgent attention” in March by suggesting the DA did not have all the facts.

On Monday, Bloom claimed a Tshwane ANC councillor and police major-general were linked to an unlicensed NGO which took Life Esidimeni patients, and where one person died. “There should be an investigation into the money flows and who personally benefitted at all the NGOs where Esidimeni patients were placed,” said Bloom.

He and DA Federal Executive chair James Selfe will continue to pressure the ANC government. The provincial premier and health minister appear to be doing everything right since the release of the health ombudsman’s report. They are taking the issue seriously, holding those responsible to account, are working with patients’ families to ensure no one else dies in the dodgy NGOs, and have committed to implementing the ombudsman’s recommendations to avoid a repeat of the disaster.

But the issue will continue to tarnish the premier’s term in the lead-up to the 2019 elections. Even if it’s true that Makhura had no opportunity to intervene and prevent the deaths, the blame lies with the Gauteng health department, shown to have been incompetent, arrogant, misleading, and ultimately responsible for the brutal conditions under which some of the province’s most vulnerable died.

The MEC was from the ANC, in an ANC government, in a province where the party has lost significant support. Even if it does everything right, it could be too late. Makhura’s administration will not be able to erase the stain of at least 94 deaths under its watch. DM

Read more:

• Life Esidimeni 94: Makhura and Motsoaledi – what did they know and when did they know it? in Daily Maverick
• 94 deaths later: Life Esidimeni report brings light, but only justice awaits Daily Maverick
• Life Esidimeni 94: Solidarity brings class action, to surprise of many in Daily Maverick

Photo: Edward Munch: The Scream – SA style