Life Esidimeni scandal

Last updated

Life Esidimeni scandal
South Africa adm location map.svg
Red pog.svg
Gauteng
Gauteng (South Africa)
Time2016
LocationLife Esidimeni and various unlicensed suburban residences
CauseStarvation, neglect, scandal. Mentally health patients moved from a state psychiatric care to unlicensed arrangements
Casualties
144 people died
1500+ state patients were affected

The Life Esidimeni tragedy involved the deaths of 144 people [1] [2] at psychiatric facilities in the Gauteng province of South Africa from causes including starvation and neglect. The tragedy takes its name from Life Esidimeni, a subsidiary of Life Healthcare, the private healthcare provider from which some 1 500 state patients were removed in the first half of 2016. The patients were relocated to cheaper care centres, many of which were later found to be unlicensed and grossly under-resourced. The incident has been called "the greatest cause of human rights violation" in democratic South Africa, [3] and stimulated discussion about the care of psychiatric and other state patients. [4] [5] [6] As of 2021, no criminal charges had been laid against any individuals involved, but a judicial inquest into the deaths was ongoing.

Contents

The "Mental Health Marathon Project"

In October 2015, the provincial Department of Health in Gauteng announced the termination of its outsourced care contract with a private health care provider, Life Esidimeni, which had been providing specialised psychiatric care to state patients. According to the Gauteng Member of the Executive Council (MEC) for Health, Qedani Mahlangu, the political head of the Department, the Department terminated the contract to save money and enact a policy of "deinstitutionalising" psychiatric patients. [7] Between March and June 2016, about 1 500 psychiatric patients (up to 1 700 on some accounts) [8] were moved out of Life Esidimeni and into the care of over 100 [9] different NGOs, psychiatric hospitals, and community care facilities. [10] [11] This mass transfer of patients was known in the Department as the "Gauteng Mental Health Marathon Project." [7] [12] [13] Later investigation revealed many attempts to warn the Department of the consequences of transferring patients to NGOs incapable of providing the specialised care they required, including court actions by civil society organisations and patients' families to interdict the transfers. [2] In one instance, the Department avoided an interdict by coming to a court settlement it was later found to have dishonoured. [14]

It later transpired that many of the centres which received patients were unlicensed or fraudulently licensed, while others transparently lacked the skills, resources, and patient records to provide adequate care. [2] [10] [12] Family members of deceased patients reported that they had seen patients walking around naked, [15] that one NGO gave the set of medications to every patient, [16] and that bodies were badly decomposed. [17] The 2018 arbitration report found that 144 people had died, and that many others had been exposed to trauma. [11] According to death certificates, patients died of causes including hypothermia and dehydration, although many certificates listed natural causes. [18]

Health ombud's report

In September 2016, in the Gauteng legislature, Mahlangu first reported that 36 of the transferred patients had died, [9] although it later emerged that there had been at least 77 deaths by then. [14] In late 2016, the Health Ombud, Malegapuru Makgoba, was appointed by the national Minister of Health, Aaron Motsoaledi, to investigate the deaths. [19] The report was released on 1 February 2017, after its publication had been delayed by Mahlangu, who wanted time to peruse the document before providing feedback. [20] It was based on investigation, interviews, and inspections by the Ombud and a panel of experts, as well as on inspections by the Office of Health Standards Compliance and further investigations by the Ministerial Advisory Committee on Mental Health. [14]

Findings

The Health Ombud's report detailed the 94 known cases in which mental healthcare patients had died in Gauteng between 23 March and 19 December 2016. It found that 81 of those deaths had been related to the termination of the Life Esidimeni contract. The Ombud took issue with some of the government's reporting on the deaths, and argued that, even when deaths had been recorded as arising from natural causes, "the conditions and circumstances at NGOs made these deaths other than 'natural.'" Moreover, the report found "prima facie evidence" that the department, its officials, and certain NGOs had violated the Constitution, the National Mental Health Act, and the Mental Health Care Act; and that some government actions showed "a total disregard of the rights of the patients and their families." The decision to terminate the Life Esidimeni contract had been "unwise and flawed," and the Mental Health Marathon Project's inadequate planning and "chaotic" execution was described as "most negligent and reckless" and showing "a total lack of respect for human dignity, care and human life."

According to the report, most violations and deaths occurred among patients transferred to NGOs. There were 27 such NGOs, all of which were found to be operating unlawfully, under invalid licenses. The NGOs lacked "basic competence and experience," "leadership/managerial capacity," and sufficient resources, all of which precipitated or was otherwise linked with the high number of deaths in those facilities. 75 of the 94 confirmed deaths occurred at only five NGO complexes:

Recommendations

The report singled out three officials as "key players" in the Mental Health Marathon Project: the head of the provincial Department of Health, Tiego "Barney" Selebano; the provincial head of mental health services, Makgabo Manamela; and Mahlangu. Amongst other things, it recommended that the Premier should "consider the suitability" of Mahlangu to continue in her role as MEC, and should institute disciplinary proceedings against Selebano, Manamela, and other department officials. Makgoba recommended that the Mental Health Marathon Project should cease to exist, that all patients should urgently be relocated to appropriate care facilities, and that certain facilities should be reviewed or immediately closed. Finally, he recommended that an alternative dispute resolution process should be instituted, and the families of the victims compensated. [14] [21]

Aftermath

Implicated officials

In February 2017, Mahlangu resigned from the Executive Council, following the release of the Health Ombud's report. [2] The Premier suspended Selebano and Manamela, [22] and several medical practitioners employed by the provincial government were referred to professional bodies on misconduct charges, including Selebano to the Health Professions Council of South Africa and others to the South African Nursing Council. [2]

Arbitration report and award

In March 2018, arbitrator Dikgang Moseneke found that the decision to move the patients had been "irrational and in blatant breach of the law and the Constitution," an "irrational and arrogant use of public power." [11] He ruled that families of the affected patients should each be paid around R1.2 million, [2] made up of R180,000 for shock and psychological trauma, R1 million in constitutional damages, and, in cases where the family member had died, R20,000 for funeral expenses. [23] [7] The constitutional damages, Moseneke said, were to compensate "for the government's unjustifiable and reckless breaches" of the Constitution. [7] The Gauteng government reportedly paid R159 million in compensation in June 2018, [8] but in December several hundred families said they had not yet received any payments. [24] Moseneke also directed the government to erect a monument in memorial, but, as of July 2021, this had not been done. [19]

Criminal investigations and inquest

The South African Police Service and the Special Investigating Unit investigated. [25] In April 2017, all 144 dockets were referred to the National Prosecuting Authority, which announced in September 2019 that it had not found sufficient evidence to bring charges. [26] On 19 July 2021, a judicial inquest commenced in the Pretoria High Court to determine the legal cause of each patient's death, with a view towards establishing criminal liability. [1] [12] It is ongoing.

Related Research Articles

<span class="mw-page-title-main">Psychiatric hospital</span> Hospital specializing in the treatment of serious mental disorders

Psychiatric hospitals, also known as mental health hospitals or behavioral health hospitals, are hospitals or wards specializing in the treatment of severe mental disorders, such as schizophrenia, bipolar disorder, eating disorders, dissociative identity disorder, major depressive disorder and many others. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialize only in short-term or outpatient therapy for low-risk patients. Others may specialize in the temporary or permanent confinement of patients who need routine assistance, treatment, or a specialized and controlled environment due to a psychiatric disorder. Patients often choose voluntary commitment, but those who psychiatrists believe pose significant danger to themselves or others may be subject to involuntary commitment and involuntary treatment. Psychiatric hospitals are sometimes referred to as psychiatric wards/units, psych, or wards/units when they are located as a unit within a hospital.

<span class="mw-page-title-main">Advance healthcare directive</span> Legal document

An advance healthcare directive, also known as living will, personal directive, advance directive, medical directive or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity. In the U.S. it has a legal status in itself, whereas in some countries it is legally persuasive without being a legal document.

<span class="mw-page-title-main">Ashworth Hospital</span> Hospital in Maghull, England

Ashworth Hospital is a high-security psychiatric hospital in Maghull, 10 miles (16 km) northeast of Liverpool. It is a part of Mersey Care NHS Foundation Trust, catering to patients with psychiatric health needs that require treatment in conditions of high security.

<span class="mw-page-title-main">Deinstitutionalisation</span> Replacement of psychiatric hospitals

Deinstitutionalisation is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability. In the late 20th century, it led to the closure of many psychiatric hospitals, as patients were increasingly cared for at home, in halfway houses and clinics, in regular hospitals, or not at all.

Gwen Malegwale Ramokgopa is a South African politician who was elected the Treasurer-General of the governing African National Congress (ANC) in December 2022. She was formerly the Deputy Minister of Health under President Jacob Zuma from October 2010 to May 2014.

<span class="mw-page-title-main">South London and Maudsley NHS Foundation Trust</span> NHS foundation trust based in London, England

South London and Maudsley NHS Foundation Trust, also known as SLaM, is an NHS foundation trust based in London, England, which specialises in mental health. It comprises four psychiatric hospitals, the Ladywell Unit based at University Hospital Lewisham, and over 100 community sites and 300 clinical teams. SLaM forms part of the institutions that make up King's Health Partners, an academic health science centre.

The Nic Diederichs Technical High School slashing was an incident on 17 August 2008 at the Nic Diederichs Technical High School in Krugersdorp, South Africa in which 18-year-old matric student Morné Harmse attacked four people with a samurai sword. Sixteen-year-old grade 9 pupil Jacques Pretorius was killed and two campus gardeners and a second pupil were seriously injured. Harmse later pleaded guilty to a charge of murder and three charges of attempted murder, and was sentenced to twenty years' imprisonment.

<span class="mw-page-title-main">Paul Mashatile</span> Deputy President of South Africa since 2023

Paul Shipokosa Mashatile is a South African politician who is the 9th and current deputy president of South Africa. He became deputy president of the governing African National Congress (ANC) in December 2022. Before his election to that position, he was ANC treasurer-general from December 2017 and acting ANC secretary-general from January 2022.

<span class="mw-page-title-main">Charlotte Maxeke Johannesburg Academic Hospital</span> Hospital in Gauteng, South Africa

The Charlotte Maxeke Johannesburg Academic Hospital is an accredited general hospital in Parktown, Johannesburg, Gauteng, South Africa.

<span class="mw-page-title-main">Central Institute of Psychiatry Ranchi</span>

Central institute of Psychiatry Ranchi is an institute that is directly governed by the Government of India. It is situated in Kanke, Ranchi in Jharkhand state of India.

North East London NHS Foundation Trust (NELFT) is an NHS foundation trust which provides mental and community health services. It runs Foxglove Ward, Goodmayes Hospital and Sunflowers Court in Ilford, Phoenix House in Basildon, Heronwood & Galleon Inpatient Facility in Wanstead, Grays Court Community Hospital in Dagenham, and Hawkwell Court in Chingford. Altogether it operates from more than 150 sites.

<span class="mw-page-title-main">Qedani Mahlangu</span> South African politician

Qedani Dorothy Mahlangu is a South African politician who served continuously in the Gauteng Executive Council from 2004 to 2017. She is best known for her tenure as Gauteng's Member of the Executive Council (MEC) for Health from 2014 to 2017, when she presided over the Life Esidimeni scandal. In February 2017, she resigned from the Executive Council and from the Gauteng Provincial Legislature after the Health Ombud, Malegapuru Makgoba, released a report which implicated her in the scandal.

Essex Partnership University NHS Foundation Trust (EPUT) is an NHS foundation trust which provides community health, mental health and learning disability services to approximately 1.3 million people throughout Bedfordshire, Essex, Suffolk and Luton.

<span class="mw-page-title-main">Department of Social Development (South Africa)</span>

The Department of Social Development (DSD) of South Africa is a government department responsible for providing social development, protection, and welfare services to the public. Previously called the Department of Welfare, it was renamed in July 2000. The current Minister of Social Development is Lindiwe Zulu.

<span class="mw-page-title-main">Nightingale Hospital (Marylebone)</span> English mental hospital

The Nightingale Hospital is a private mental health facility in Lisson Grove, Marylebone, London. It is owned by Groupe Sinoue-Sarl, which is based in Garches.

The 2019 Johannesburg riots occurred in the South African city of Johannesburg from 1–5 September 2019, leading to the deaths of at least seven people. The riots were xenophobic in nature, targeting foreign nationals from other African countries. Retaliatory actions by rioters in other African nations was taken against South African brands. The South African Institute of Race Relations stated that the riots were similar in nature and origin to the 2008 xenophobic riots that also occurred in Johannesburg.

<span class="mw-page-title-main">Death of Olaseni Lewis</span> Policing incident in the United Kingdom

Olaseni Lewis, a 23-year-old British man, died on 3 September 2010 at Bethlem Royal Hospital in London, United Kingdom, after police subjected him to prolonged physical restraint. Lewis had voluntarily sought care following the onset of acute mental health issues and died from cerebral hypoxia soon after, following actions that involved eleven officers of London's Metropolitan Police. After seven years of campaigning by Lewis' family and two inquiries by the Independent Police Complaints Commission (IPCC), a second coroners' inquiry was raised.

Babita Deokaran was a South African whistleblower murdered for reporting corruption at the Gauteng Department of Health where she was working as the acting chief director financial accounting officer.

Nomvuyo Memory Mhlakaza-Manamela is a South African politician who has served as Deputy Speaker of the Gauteng Provincial Legislature since May 2019. A human resources practitioner by training, she is a member of the African National Congress (ANC).

References

  1. 1 2 Mahlati, Zinhle (13 September 2021). "Life Esidimeni Inquest - September 13, 2021". IOL. Retrieved 17 November 2021.
  2. 1 2 3 4 5 6 Nicolson, Greg (3 April 2021). "Five years on, the pain of Life Esidimeni continues". Daily Maverick. Retrieved 17 November 2021.
  3. ↑ Bornman, Jan (9 October 2017). "Life Esidimeni: The greatest cause of human right violations since democracy". News24. Retrieved 22 October 2017.
  4. ↑ Ferlito, B A; Dhai, A (27 February 2018). "The Life Esidimeni tragedy: Some ethical transgressions". South African Medical Journal. 108 (3): 157. doi: 10.7196/SAMJ.2018.v108i3.13012 . ISSN   2078-5135. PMID   30004355.
  5. ↑ Durojaye, Ebenezer; Agaba, Daphine Kabagambe (16 November 2018). "Contribution of the Health Ombud to Accountability: The Life Esidimeni Tragedy in South Africa". Health and Human Rights. 20 (2): 161–168. PMC   6293341 . PMID   30568410 . Retrieved 17 November 2021.
  6. ↑ Ornellas, Abigail (2018). "The Life Esidimeni crisis: why a neoliberal agenda leaves no room for the mentally ill". Social Work. 54 (3): 296–308. doi: 10.15270/54-3-650 . S2CID   59386600.
  7. 1 2 3 4 Nicolson, Greg (19 March 2018). "Life Esidimeni families awarded R1.2-million compensation each". Daily Maverick. Retrieved 17 November 2021.
  8. 1 2 Nicolson, Greg (18 July 2018). "Life Esidimeni: Compensation paid, but justice delayed". Daily Maverick. Retrieved 17 November 2021.
  9. 1 2 "36 transferred psychiatric patients have died in Gauteng". Sunday Times. 13 September 2016. Retrieved 17 November 2021.
  10. 1 2 Thamm, Marianne (2 September 2021). "The Wretched of Life Esidimeni: Inquest reveals necrotic underbelly of an abusive and broken public service". Daily Maverick. Retrieved 17 November 2021.
  11. 1 2 3 Moseneke, Dikgang (2018). Arbitration report (PDF). SAFLII.
  12. 1 2 3 Chaskalson, Julia (6 October 2021). "Life Esidimeni inquest: A recap on its progress and what to expect". Daily Maverick. Retrieved 17 November 2021.
  13. ↑ Pikoli, Zukiswa (15 November 2021). "Life Esidimeni inquest resumes after a month's delay, GDOH planning director Levy Mosenogi testifies". Daily Maverick. Retrieved 17 November 2021.
  14. 1 2 3 4 5 Office of the Health Ombud. "Report into the circumstances surrounding the deaths of mentally ill patients: Gauteng Province" (PDF).
  15. ↑ Bornman, Jan (18 October 2017). "Life Esidimeni: Some patients were walking around naked". News24. Retrieved 23 October 2017.
  16. ↑ Bornman, Jan (20 October 2017). "I've been having nightmares - daughter of Life Esidimeni patient". News24. Retrieved 23 October 2017.
  17. ↑ Bornman, Jan (20 October 2017). "Life Esidimeni victim's sister: 'I cried. I did not believe what I saw'". News24. Retrieved 23 October 2017.
  18. ↑ Wild, Sarah (4 September 2017). "Esidimeni: Doctors erase 'unnatural' deaths". Health-e. Retrieved 22 October 2017.
  19. 1 2 Chakalson, Julia; Mafuma, Tendai; Baduza, Mbali (18 July 2021). "The long and painful road to the start of the Life Esidimeni inquest". Daily Maverick. Retrieved 21 November 2021.
  20. ↑ Singh, Kaveel (1 February 2017). "Report into death of mentally ill patients to be released". News24. Retrieved 24 April 2017.
  21. 1 2 "The Life Esidimeni disaster: The Makgoba report". Politicsweb. 1 February 2017. Retrieved 24 April 2017.
  22. ↑ Nicolson, Greg (13 February 2017). "Life Esidimeni: Makhura's administration will continue to face blame". Daily Maverick. Retrieved 21 November 2021.
  23. ↑ "Government must pay R1.2-million to Life Esidimeni families". www.timeslive.co.za. Retrieved 7 January 2019.
  24. ↑ Lindeque, Mia. "Families of Life Esidimeni victims seek legal advice over govt payouts". ewn.co.za. Retrieved 7 January 2019.
  25. ↑ Nicolson, Greg (2 February 2018). "Life Esidimeni: Arbitration – painful, flawed, full of lies – still honoured the victims". Daily Maverick. Retrieved 17 November 2021.
  26. ↑ Jordaan, Nomahlubi (17 September 2019). "'Not enough evidence' to prosecute Life Esidimeni deaths: NPA". Sunday Times. Retrieved 21 November 2021.

Mahlati, Zinhle (13 September 2021). "Life Esidimeni Inquest - September 13, 2021". IOL. Retrieved 17 November 2021.

[2] Nicolson, Greg (3 April 2021). "Five years on, the pain of Life Esidimeni continues". Daily Maverick. Retrieved 17 November 2021. [3] Bornman, Jan (9 October 2017). "Life Esidimeni: The greatest cause of human right violations since democracy". News24. Retrieved 22 October 2017. [4] Ferlito, B A; Dhai, A (27 February 2018). "The Life Esidimeni tragedy: Some ethical transgressions". South African Medical Journal. 108 (3): 157.

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.