Dr Makgabo Manamela testified that she was “surprised” by media reports saying the Life Esidimeni contract had been terminated.

Manamela told the inquest of a few initial meetings she attended with former Gauteng health MEC Qedani Mahlangu and the families of mental healthcare users where two options were proposed: Transfer the patients to other mental healthcare facilities or discharge them into the care of their families.

She said families objected from the first meeting about the proposals. However, Mahlangu told them “there is nothing more we can do”.

Despite the families’ objections, Manamela told the inquest that project teams were convened and instructed to source NGOs that would house the mental healthcare users.

Manamela said that while she had signed for the licences of the NGOs to which the patients would be taken, choosing them and ensuring they were of an appropriate standard was not her responsibility, but rather that of her team.

‘Support role’

She testified that her role was merely one of “support” and profiling which patients were to go to NGOs and which would be released into their families’ care.

Manamela was asked about the case of the Precious Angels NGO which had been expecting to receive child patients and had prepared cots accordingly, but had instead been sent adult patients.

Manamela responded: “The identification of mental health users is not going according to age… most of the time it goes according to the disability they have. The NGOs had the latitude to take patients according to their capabilities. 

“I don’t know about it, and it was not reported to me that she was given patients she does not have the skill to take care of.”

Testifying on Tuesday, Manamela said the department did not have the capacity to take on the more than 1,700 mental healthcare users who were to be transferred from Life Esidimeni. She said that at the time, the department only had a capacity of 116 beds. 

“It was not going to be possible to admit the number of patients we had at the time of termination.” 

Transfer of patients ‘impractical’

Asked by advocate Russell Sibara whether she then thought the transfer was practical, she conceded that “it was impractical, actually”.

Asked whether she had raised her concerns with the executive, Manamela said: “We first discussed it in our meeting with our project manager and advised that he write a letter to our MEC advising that the time is very short… to ask for extension… so that we can see if we can find other NGOs and finish renovations of our hospitals.”  

Follow-up and progress meetings, she said, were chaired by either the then MEC or the head of department (HOD): “I don’t know how to put it… [they were] forceful or hostile, in fact. One may think it’s the management style of the MEC, because she would say, ‘We want it! There is no turning back!’ We saw that in this environment, you have to do it whether it’s possible [or not]… you have to find a way.”

Sibara asked her to explain what she meant by “forceful”, and she said that when she and her team attended the meetings with the MEC and the head of department, they felt like they were working under a lot of pressure and were told that if they didn’t [cooperate] they would be fired. 

She said this pressure came from then Health MEC, Qedani Mahlangu. 

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Sibara asked Manamela if she had the power to stop the termination of the Life Esidimeni contract when the South African Society of Psychiatrists (Sasop) raised concerns over the poorly thought-out transfer of patients. 

“I did not have the power to stop it. The termination was made by the HOD,” said Manamela. As director, she had more senior people to go through, like the chief director, deputy director general and HOD, then the MEC. 

“But I didn’t just keep quiet. I advised Sasop that this is above my level.” She said she asked them to direct their letter to the HOD or MEC.

Manamela went on to say that if she or any member of her team had believed the project would put people in danger, she would have refused to continue.

She also said that while the department did not have access to enough NGOs, they made the decision to go ahead with the project based on plans to renovate hospitals that could later be used for patients

The inquest continues on Wednesday. DM/MC