Former director of mental health services in Gauteng, Dr Makgabo Manamela, has delayed proceedings at the Esidimeni arbitration hearings after calling in ill. A warrant of arrest – suspended until Thursday – has been granted.
Manamela’s lawyer Lerato Mashilane said that his client is ill and has gone to see a doctor. “We’ve got instructions that my client is actually not feeling well today. In fact what I’ve got is that yesterday she thought that maybe she might have been tired and it will be better by this morning but things got worse.”
The report says family members, who are dressed in black in remembrance of their loved ones, started to heckle, calling her a liar.
Solidarity’s Dirk Groenewald, who represents the families of three people who died, says Manamela simply has no respect for the hearings. “Justice, we take issue with the manner in which Dr Manamela treats these arbitration proceedings. It's 10am, she’s now only at the doctor’s.”
The report says Manamela began testifying at the arbitration hearings on Monday after a three-hour attempt to have her testimony postponed, but retired deputy Chief Justice Dikgang Moseneke, who is leading the arbitration hearings, dismissed the application.
She’s been implicated by several witnesses who said that she pushed illegal activity during the execution of the disastrous marathon project that left at least 143 patients dead.
After her reluctance to testify on the previous day, her failure to appear was not taken well by Moseneke as well as by those in attendance. Moseneke questioned why she had not seen a doctor on the previous day, and why she had called in ill at such a late hour, says an eNCA report.
On Monday Manamela, who is one of the key figures in the tragedy, told the hearings that she had not failed in her role. In his report, the Health Ombudsman described how Manamela's fingers were peppered throughout the marathon project. And witness after witness at the arbitration hearings have testified about her involvement. But, the report says, when it was her turn to take the stand, Manamela fought for three hours to delay her testimony, much to the families' frustration. She claimed she needed additional time in order to gather more information about the deaths, but Moseneke dismissed her request.
The report says earlier, the oversight body, the Gauteng Mental Health Review Board testified that Manamela had insisted that everything was above board with the transfers. She said: “After the inspection they (NGOs) submit, we have assessed that NGO. I also saw the NGO leader in my office. I also assess them. The report was sent and the license and budget prepared. I cannot issue any license without assessment.”
But some NGOs accused her of issuing illegal licenses, while others accused her of bringing new patients to their facilities despite their challenges in caring for patients.
When queried by Moseneke as to how she could "allow a person to issue a licence for a non-existent location?", Manamela replied that “it was a human error.”
As to requesting NGOs to take on more patients, she said, “It was on their will.”
A medical certificate is being sought after Manamela, failed to appear on Tuesday, reports Business Day.c
The tribunal heard that Manamela took ill on Monday evening. "At first she thought she was just tired. They say joy comes in the morning. She thought she would feel better in the morning‚" said Manamela’s lawyer‚ Lerato Mashilane. He said Manamela would be able to continue with her testimony on Thursday.
"Is it the doctor’s recommendation that she can only testify on Thursday?" asked Moseneke. Mashilane said that was the case. He said a medical certificate would be presented to the arbitration tribunal before the end of business on Tuesday.
The report says lawyers representing the families of the victims demanded that a warrant of arrest be issued because they were not presented with proof that she was sick. Advocate Adila Hassim‚ who represents families on behalf of Section27‚ said the families were taking strain due to Manamela’s failure to attend the proceedings. "It is causing distress. They feel disrespected‚" she said.
Moseneke ordered that a warrant of arrest – suspended until Thursday – be granted. Lawyers who represented section 27 are expected to secure the warrant.
Families of the Esidimeni victims say they hope the arbitration process will not only help improve services at mentally ill facilities but across the entire health sector, says an Eyewitness News rpeort.
Sarah Mhlongo-Noko who lost her son in the project, says the Esidimeni tragedy has highlighted for her how some officials in the health sector don't take the lives of patients seriously. “They don’t take the lives of people as important.”
Sibusiso Skhakhane, whose brother survived the tragedy has called on the government to improve services at health facilities across the board. “I would also like to makes a humble plea to all those who work in the health sector to have patience when they deal with patients.” Skhakhane says he lives with the constant worry that he may get a call informing him that his brother is dead.
His brother, Mduduzi, suffers from bipolar disorder. He was moved to the Rebafenyi Centre in Atteridgeville, where his condition started to deteriorate. Skhakhane says his brother's transfer to the Rebafenyi Centre affected his health. “We observed that he was losing weight. When we asked, they said he did not like to take his medication.” He says when he visited the NGO near Pretoria to see his brother, he found sheep and goats at the facility.
Skhakhane adds that his brother's health has never been the same as he has become more violent.
A deputy managing nurse admitted processes were flouted when the charity she worked at accepted mentally ill patients in 2016 in the Life Esidimeni tragedy. eNCA reports that Dikeledi Manaka – who was employed as a quality assurance assessor at an NGO in Cullinan, east of Pretoria – struggled to maintain consistency during her testimony.
Manaka told the hearing earlier that the Cullinan Care and Rehabilitation Centre (CCRC) was given more patients than it could handle, and as a result some patients were transferred to Anchor House and Siyabadinga NGO. She explained that as a nurse they were tasked with transferring patients without doctors or psychiatrists assessing the patients. They did this under the directive of former CEO Matshidiso Nyatlo.
During cross-examination, however, Manaka changed her tune and said some patients were actually assessed by Dr Kenoshi Makoma before being transferred.
Advocate Groenewald wanted clarity from Manaka on why she recorded that some deaths occurred at Siyabadinga whereas the patients were at CCRC. Manaka said it was because the patients were still registered under Siyabadinga. Siyabadinga and Anchor House were closed in July 2016, and the patients had to be transferred back to CCRC. Manaka registered three deaths under the closed facilities even though they had not been operating for months.
The report says Moseneke appeared bewildered with Manaka’s response and asked her the patients were not registered in CCRC. She responded saying: “It was a long process and it wasn’t followed”. Moseneke asked Manaka how it was possible that they had patients floating for two months without being registered. Manaka responded: “We were still in a process to readmit them, we were working on a crisis mode”.
She said that when the two NGOs closed, there was overcrowding and CCRC needed assistance to take care of patients who did not fall under the criteria of the facility. Some patients came back without their medical files and some did not have their hand-band identification.
CCRC was meant to handle three to 21-year-old patients with severe and profoundly intellectual disability, but because of the botched marathon project, the facility even took patients who did not fit the criteria.
Manaka said former Gauteng Health MEC Qedani Mahlangu came to the facility and promised to send trained stuff from Weskoppies Psychiatric Hospital to assist them.
Eleven patients died at CCRC while another five people died in Anchor House and four people died in Siyabadinga. It was revealed that most of the deaths occurred due to dehydration, hunger and hypothermia. Some patients were in and out of hospital before they died.
Moseneke asked Manaka what made it so difficult to keep the patients alive. She responded saying: “It is difficult to reverse effects of someone with prolonged hunger. Those who survived, took us time to get them there. Precautions of prolonged hunger take long to correct.” Whenever asked a challenging question, Manaka would pause for a while and said: “I don’t know”.
Groenewald enquired from Manaka if she took responsibility for the deaths that occurred at her facility, but she refused.
The report says Manaka asked Moseneke: “Justice what would you have done if you were in my situation?” Moseneke replied saying: “You could have screamed louder, asked for more doctors and emphasised the weakening conditions of patients.”
[link url="http://ewn.co.za/2017/11/21/watch-live-esidimeni-hearing-delayed-as-manamela-calls-in-ill"]Eyewitness News report[/link]
[link url="https://www.enca.com/south-africa/catch-it-live-life-esidimeni-testimony-continues"]eNCA report[/link]
[link url="https://www.businesslive.co.za/bd/national/health/2017-11-21-medical-certificate-called-for-after-makgabo-manamela-fails-to-appear-before-hearing/"]Business Day report[/link]
[link url="http://ewn.co.za/2017/11/17/families-of-victims-hope-esidimeni-arbitration-will-improve-entire-health-sector"]Eyewitness News report[/link]
[link url="https://www.enca.com/south-africa/esidimeni_you_could_have_asked_for_help"]eNCA report[/link]