Former Gauteng Health MEC Qedani Mahlangu may have withheld information from provincial politicians, including mounting complaints about conditions at the deadly NGOs that housed state mental health patients, according to evidence presented at the Life Esidimeni arbitration hearings Monday.

After months of delay, Mahlangu finally testified at the hearings into the department’s decision to remove about 1 700 mental health patients from government-subsidised private healthcare facilities of the Life Healthcare Group. Many were later placed with community nongovernmental organisations and 143 ultimately died.

Mahlangu maintained that she was unaware of how unequipped these organisations were to house phychiatric patients. But on Monday advocate Adila Hassan, who is is representing more than 50 patient families on behalf of the public interest law organisation Section27, read out an email from Mahlangu to her staff in response to a complaint from South African Depression and Anxiety Group (SADAG) about the death of Virginia Machpelah at the Precious Angels NGO and related mounting bodies in a local mortuary.

Mahlangu was the MEC at the time. She accidentally hit “reply all” and as a result also included SADAG in her response. “Get our legal team involved in this process. These NGOs are dishonest. Please treat this as urgent,” her response read.

Precious Angels would become one of the deadliest NGO to house Life Esidimeni patients and saw at least 20 deaths, according to health ombudsman Malegapuru Makgoba’s report on the tragedy that was released in February last year.

After filing past heightened security, including metal detectors, families of the deceased patients erupted into choruses of “Senzeni Na? [What have we done?]” as Mahlangu entered, with some breaking into sobs. The embattled politician was accompanied by a new set of lawyers in a last-minute change of counsel on Friday night that her advocates say left them scrambling to review mountains of evidence.

Mahlangu’s long-awaited public apology to families shortly after she took the stand was met with sniggers.

Listen to Mahlangu’s opening remarks

While cross-examining Mahlangu, Hassan questioned why Mahlangu had not disclosed the the Section27 and SADAG complaint to the provincial legislature.

Hassan read aloud from an official reply in which Mahlangu claimed that “out of the all the 122 NGOs that have been providing care and mental health to patients, we have only received one complaint about one NGO that was not registered properly”.

Mahlangu also told members of the provincial legislature that hundreds of beds to accommodate former Life Esidimeni patients were available at public facilities, said Hassan, who again cited replies made to questions before the body that clearly stated no immediate beds were available.

Hassan read aloud several responses from hospital heads to the Gauteng health department’s request to accommodate patients.

Mahlangu had said that 416 beds were available at the Weskoppies Psychiatric Hospital to which management replied: “The hospital is currently full and has a waiting list. There is one empty ward that may accommodate 80 people but requires significant renovation. Management was not made aware of patient transfers.”

When Gauteng health officials came looking for dozens of beds that were supposedly available at the Cullinan Care and Rehabilitation Centre, senior staff explained that there were none. The government facility also reminded the department that it had previously closed several wards because of health and safety concerns and that these wards, as at Weskoppies, would need considerable revamping before they could be used.

In Germiston, the public hospital responded that it didn’t house psychiatric patients at all but instead provided out-patient care.

On Twitter, the DA’s shadow health MEC for Gauteng and MPL Jack Bloom said this information could have saved lives.

If only she hadn’t lied to me in the Legislature this could have all been avoided!

— Jack Bloom (@JackBloomDA) January 22, 2018

Mahlangu claims that at the time that the department was in negotiations to cancel the long-standing contract with Life Esidimeni, there were open beds at two new district hospitals constructed in Soweto and Vosloorus east of Johannesburg.

Nationally, few if any district hospitals provide the kind of long-term psychiatric care that Life Esidimeni offered state patients, some of whom had been residents for years.

Busloads of activists protested at Monday’s hearing as heightened security kept many outside the gates of the Emoyeni Conference Centre in Johannesburg. (Oupa Nkosi)

Monday’s revelation of a shortage of psychiatric beds in the country is likely not news to mental healthcare workers but could shed light on how even senior Gauteng officials may have been misled.

Mahlangu had repeatedly told senior provincial figures, including Premier David Makhura, that Life Esidimeni patients would be accommodated by public facilities.

Makhura maintains that although he and provincial budget committee members knew that the state was to terminate its Life Esidimeni contract, he did not know of plans to relocate patients to NGOs in what became known as the Gauteng Mental Health Marathon Project.

“The testimony of [former Gauteng head of health Barney] Selebano confirmed that the premier was not aware of the Marathon project and that he only knew about the termination of the contract, not the move to the NGOs,” Gauteng provincial spokesperson Thabo Masebe told Bhekisisa after Selebano appeared before the tribunal in December. Selebano and the province’s former director of mental health Makgabo Manamela resigned last week within days of one another.

“[Makhura] was told that the department had enough capacity in public institutions to accommodate all the mental healthcare users,” Masebe explained.

In his state of the province address, Makhura stuck to this story saying: “The provincial health department repeatedly reported that, as a result of the new hospitals and community health centres, they had enough beds in public health facilities that could accommodate public patients from private health facilities such as Selby Hospital and Life Esidimeni centres.”

Makhura and Health Minister Aaron Motsoaledi are expected to appear before the tribunal before it concludes.

But Mahlangu says Manamela and Selebano deceived her. She claims Manamela concealed reports about food shortages at NGOs. Later, patient autopsies would reveal people were so hungry that they had eaten plastic packets before their deaths.

“No one alleged to me that patients did not have food. We got to know about those reports through the media,” Mahlangu says.

“I got to know, only in the past few days, that information was being brought to Manamela.”

Mahlangu now blames the duo for feeding her incorrect figures on the patient beds at government hospitals that never materialised.

“They lied to me.”

Mahlangu’s testimony is expected to continue on Wednesday.

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mental healthLife EsidimeniQedani Mahlangu