Gauteng health MEC Qedani Mahlangu resigned this week after the health ombudsman uncovered that her negligence led to the deaths of 94 state mental health patients in 2016 — almost three times more than the previous tally of 36.

The ombudsman’s report, which was released on Wednesday, found that the MEC had deliberately understated the number of deaths that resulted from her decision to remove the patients from long-term private hospital care, for which the state had paid, to unlicensed community-based organisations. Mahlangu submitted her resignation on Tuesday.

In 2015, Mahlangu announced her department’s decision to terminate its contract with private hospital group Life Healthcare and its Life Esidimeni psychiatric facilities to save money. The bulk of state-subsidised patients would be moved to the care of cheaper community-based organisations. Mahlangu encountered huge public opposition, but went ahead with her decision. Experts, families and activists warned that the organisations could not provide the high-level care most Life Esidimeni patients needed.

Health Ombudsman, Malegapuru Makgoba’s report reveals that Mahlangu aimed to save the province R320 a patient a day by terminating the Life Esidimeni contract. She wanted to find high-level in-patient care at nongovernmental organisations for R100 a patient a day. None of the 27 organisations to which patients had been transferred had valid licenses.

According to the report the Gauteng health department encouraged small, ill-equipped organisations to expand patient numbers to get licences. These licences were later fraudulently doled out by Gauteng health employees in a move that would be covered up. The Gauteng head of health now stands accused of tampering with evidence.

Four of the organisations and one government facility were responsible for almost 80% of patient deaths. All but one of the patient deaths were attributed to preventable conditions — suggesting poor care. Several bodies had bruises or abrasions that may indicate abuse.

Makgoba’s report paints a picture of a culture of deceit, negligence and intimidation within the Gauteng health department.

The ombudsman and his team interviewed more than 70 people, including Life Esidimeni and health department staff who had opposed the move but felt powerless to stop it.

“NGOs rocked up to Life Esidimeni [with] open bakkies. Patients were transported ‘without wheelchairs but tied with bed sheets’ to support them. Some [NGOs] chose [patients] like an ‘auction cattle market’,” Makgoba writes.

Joseph Maboe’s son Billy (52) had been in and out of long-term psychiatric institutions since he was a young man. Together with other family members, Maboe tried to fight the relocations — what he eventually came to call “the Great Trek”. Maboe was never told where his son would go. They lost touch for weeks.

“I became worried, I said I don’t know where my son is. Then I got a phone call, I picked it up and someone said: ‘Hello, Papa?’,” he says.

Billy was at Bophelong, a Hammanskraal nongovernmental organisation, which Maboe says was staffed by one retired nurse and was home to 40 patients. Billy had been relocated but his patient file had been left behind at Life Esidimeni.

The ombudsman report shows that many patients were transferred without their files and identity documents. This meant organisations didn’t have details about some patients’ treatment or who to call in case of an emergency or death.

Maboe buried Billy on July 29 after he died of a respiratory infection. Patients were eventually removed from Bophelong and placed at psychiatric hospitals.

Former deputy minister of health Gwen Ramokgopa will replace Mahlangu and oversee the Gauteng department of health’s effort to move all former Life Esidimeni patients out of community-based care as part of the report’s recommendations. Patients will be placed at state psychiatric hospitals where care will cost the state three times what it paid at Life Esidimeni.

The number of dead is likely to climb as more bodies are claimed from state mortuaries.