Justice delayed — a year after inquest ruling, NPA yet to pursue Life Esidimeni case prosecutions

Nine years ago, at least 144 mental healthcare users died when the termination of the Gauteng Department of Health’s contract with long-term psychiatric care hospital Life Esidimeni resulted in more than 1,400 patients being moved to ill-equipped and unlicensed non-government organisations.

A year ago, on 10 July 2024, Judge Mmonoa Teffo issued a ruling in the Life Esidimeni inquest, stating that former Gauteng health MEC Qedani Mahlangu and former director of mental health in Gauteng Dr Makgabo Manamela could be found criminally responsible for the deaths of nine Life Esidimeni patients.

The case was handed over to the National Prosecuting Authority (NPA), with the expectation that the body would consider Teffo’s ruling and decide if the pair would be criminally charged.

However, the NPA has yet to decide on whether Mahlangu and Manamela will face prosecution, leaving the families of the deceased victims to wonder, how much longer will justice for their loved ones be delayed?

Read more: Judge rules former health MEC Qedani Mahlangu can be held criminally liable for 9 Life Esidimeni deaths

Read more: Life Esidimeni families urge NPA to prioritise prosecutions of Mahlangu and Manamela

Frustrated families

In Teffo’s ruling, the nine Life Esidimeni patients whose deaths were found to be caused by Mahlangu and Manamela’s negligence were: Matlakala Motsoahae, Virginia Machpelah, Terrence Chaba, Frans Dekker, Charity Ratsotso, Deborah Phehla, Lucky Maseko, Daniel Josiah and Koketso Mogoerane.

Speaking to Daily Maverick, Christine Nxumalo reflected on the loss of her sister, Virginia Machpelah, during the tragedy, saying, “When you think of how she died and how the others died… you can’t just say, ‘We’re never going to find the person, we’re never going to prosecute.’ It doesn’t sound right.

“To leave somebody unattended, knowing the person is incapable of looking after themselves, rather than returning that person to the family… To leave her in the cold, in a strange environment – no food, no water, no nothing, until she dies – if that’s not cruelty, then I don’t know what is. That is torture.”

Machpelah suffered from early-onset Alzheimer’s and had lived at Life Esidimeni Randfontein Care Centre for two years before being moved to Precious Angels NGO. 

According to Nxumalo, for two months after Machpelah was moved, her family was unable to confirm where she had been placed. The search came to an end on 25 August 2016, when Nxumalo received a call from Ethel Ncube, owner of Precious Angels NGO, to tell her that Machpelah had died eight days earlier.

Machpelah was one of 20 mental healthcare users to die at the Precious Angels NGO in a seven-month period. The NGO was unlicensed, and patients were housed in conditions that public interest law centre Section27 would later describe as “squalid and inhumane”. Many of those who lost their lives showed signs of emaciation, dehydration and pneumonia.

Nxumalo said that the long wait for the NPA’s decision on whether to pursue criminal charges was “very frustrating”.

“We’ve been trying to follow up… and the responses that we got from NPA initially were that they... had looked into the matter. They had put down a document, submitted it for senior [individuals] to approve, and we’ve been waiting for a while for these seniors to actually sign and approve,” she said.

The families of the Life Esidimeni victims would not allow the NPA to give up or walk away from the situation, said Nxumalo. However, she said that “it’s not like… we are getting anywhere, and it’s sad”.

“This is the problem with South African law – for as long as anything political or someone political is involved, prosecution is not an easy thing… because they have ways of delaying, and they’re hoping it will go away,” she said.

Almost a decade after the tragedy, Nxumalo emphasised that the families of Life Esidimeni victims and survivors continued to stand together in the pursuit of justice.

“This tragedy has woken up the activist in me, but the families standing together has also fueled the fire. I think if I was on my own, I probably would have lost the resources, access, will to fight… but because we are together and because amazing stakeholders are supporting us, that’s what’s keeping us going,” she said.

NPA spokesperson Mthunzi Mhaga told Daily Maverick that the prosecuting authority appreciated “the seriousness of the Life Esidimeni case and the importance of accountability for the tragedy, and closure for the families”. 

“Upon receipt of the findings of the inquest by Judge Teffo, the Acting Director of Public Prosecutions (DPP), North Gauteng Division, considered the findings together with the transcript of the inquest proceedings and assembled a team of experienced prosecutors to carefully consider the matter and possible options for prosecution,” said Mhaga.

“In view of the tragic implications for victims and their families, and the complexity of the issues involved, the NPA leadership, including the Acting DPP, commissioned an independent legal opinion from Senior Counsel on the matter. This opinion will be finalised by mid-July, and it will be considered, and guide the decision-making process of the DPP and her team of experienced NPA prosecutors.”

Mhaga said the NPA was engaging with the victims’ families on the matter.

Long wait for justice

During the Life Esidimeni inquest, which ran between July 2021 and November 2023, Section27 represented mental healthcare users who lost their lives in the tragedy. 

The proceedings included almost 150 days of court hearings and 60,000 pages of evidence, according to Sasha Stevenson, executive director of Section27.

“This latest one-year delay in hearing from the NPA about prosecution adds to the many delays that families have experienced in this case, and it’s particularly frustrating given the finding of inquest judge that on the face of it, prima facie, the conduct of Ms Mahlangu and Dr Manamela caused the deaths of nine mental healthcare users,” Stevenson told Daily Maverick.

“That finding was made after an exhaustive consideration of a huge amount of evidence, and really laid the groundwork for the NPA to make the decision to prosecute.”

Stevenson mentioned a picket that family members of Life Esidimeni victims and survivors held outside the NPA’s offices in Pretoria in October 2024, three months after Teffo’s ruling. The protesters called on the NPA to prioritise the prosecution of those implicated in the case.

“The families have had to wait far too long to get justice. It’s important for the families, but it’s also important because there is so little accountability within a health system that continues to fail vulnerable people, and this would be a really important and valuable signal to everyone within that system that you cannot treat vulnerable people’s lives with such disregard,” said Stevenson.

Cassey Chambers, operations director at the South African Depression and Anxiety Group (Sadag), said it was difficult to “trust the system” in the Life Esidimeni case, due to previous instances where victims, families and other stakeholders had been let down by authorities.

Both Section27 and Sadag were among the organisations that took the Gauteng Department of Health to court before the Life Esidimeni tragedy took place, in an effort to prevent the rapid and poorly planned relocation of patients.

“We have to keep pushing, we can’t forget, because we still have those 144-plus people on whose behalf we need to advocate,” said Chambers.

“It’s also for those surviving patients who are left behind. We’re trying to make the system better for them and the future patients who are going to use it, because if we let this disappear, we’re saying that it’s okay to treat mentally ill patients like this.”

Read more: Life Esidimeni: Arbitration – painful, flawed, full of lies – still honoured the victims

Activist and Section27 co-founder Mark Heywood told Daily Maverick that various processes leading up to this point, including the Life Esidimeni arbitration and inquest, had raised expectations about the potential prosecution of those responsible.

“In the case of the inquest, actually pinpointing two people... who are held as considered criminally negligent... has dangled out the prospect of justice and then pulled it away again. And I do think, knowing some of the families, that ultimate closure will come with accountability and punishment of those people who closed Life Esidimeni, having been fully forewarned that it would cause loss of life and harm,” he said.

The prosecution of Mahlangu and Manamela would mark the first time senior political officials were held criminally responsible for loss of life and harm incurred as a result of their actions while they were in office, said Heywood.

“That’s symbolic, legally, morally, publicly – it’s hugely important, and it really would send a signal to a lot of other people,” he said. DM