OP-ED | Life Esidimeni: The NPA has the evidence, now it must do its job

On August 15 2016, Virginia Machpelah died. She was 50 years old. She was 1.5m tall and at the time of her death she weighed 35kg. Her body was emaciated and dehydrated, with gangrene on both feet. 

The details of Machpelah’s death have been known since 2016. She was one of the 144 people who died after being moved out of Life Esidimeni. She was sent to an NGO that was never going to be able to care for her needs. She had Alzheimer’s disease and was on no medication. She used a wheelchair. Her psychiatric needs were not complex; she just needed physical care.

Just three months before Machpelah was transferred out of Life Esidimeni, the annual periodical report conducted at the facility by its doctors specifically indicated that she was unsuitable for placement in an NGO.

The report details her physical and mental state, along with her physical and mental health-care needs. It made no mention of emaciation or the need for care for gangrene. A note in her file provides for her move to a rehabilitation hospital, following a physical assessment by a doctor at Life Esidimeni, because she needed assistance with activities of daily living. It specified that all skin was intact, and no injuries were noted. Again, there was no mention of emaciation. 

The forensic pathologist who conducted her postmortem said: “I have no doubt whatsoever that severe malnutrition, dehydration and gangrene were definitely major contributors in the demise of the patient. This should be considered within a context of neglect.” 

In just 47 days between her move out of Life Esidimeni into an NGO (contrary to the recommendation of her doctors), she became emaciated, dehydrated, developed gangrene in both her feet and died.

Machpelah’s death is but one of the 144 deaths that resulted from the transfer of mental health-care users out of Life Esidimeni. The details of each of these deaths are excruciating and have been carefully investigated and canvassed. Each family, each set of medical records and each postmortem has its own tragic story to tell. Combined, they point to only one conclusion. 

The National Prosecuting Authority (NPA) is considering whether to prosecute the former MEC for health in Gauteng, Qedani Mahlangu, and the former director of mental health, Dr Makgabo Manamela, for causing Machpelah’s death, among others. It has a constitutional obligation to consider and carry out prosecutions without fear, favour or prejudice. Its independence is legally protected and is vital.

In considering a prosecution in this case, the NPA has the benefit of evidence and findings from the 2017-2018 arbitration, a police investigation and the 2021-2023 inquest, in which judge Mmonoa Teffo found that, on the face of it, Mahlangu and Manamela caused the deaths of Machpelah and eight others. It also has a legal opinion from a senior counsel that recommends the prosecution of Mahlangu and Manamela for the culpable homicide of Machpelah and Terrence Chaba, another of the 144 deceased.

Mahlangu and Manamela knew that the NGOs into which they were busing mental health-care users could not provide the necessary care, because we told them.

Over months, families attended meetings, held protests and sued the department of health to stop or slow down this dangerous plan. The heads of psychiatric hospitals across Gauteng wrote a letter to Manamela to warn her about the risks. The clinical head of Tara hospital met with Mahlangu and wrote a memo to Manamela reflecting these concerns. The South African Society of Psychiatrists met with and wrote to Mahlangu and Manamela multiple times about their concerns. The South African Depression and Anxiety Group met with and wrote to Mahlangu and Manamela repeatedly. Ones of these letters, which asked about the processes for identification and assessment of NGOs and assessment of mental health-care users, is dated November 2015, long before the deaths and when 144 lives could have been saved if they had listened. Mahlangu forwarded the letter and ordered the head of department to get their lawyers involved.

Inside the department of health, some officials also raised concerns with Mahlangu and Manamela. When they did so, they were shut down with ridicule. Mahlangu chaired project team meetings every two weeks. There are minutes of or presentations from meetings held in January, February, April and May 2016, all of which were chaired by Mahlangu. She heard about challenges that had been identified, including the concerns of families, the unreadiness of NGOs and the need for doctors to follow mental health-care users to NGOs to assess suitability. Manamela not only managed the project from afar but got her hands dirty, attending at NGOs and even reportedly moving beds to fit more people into wards.

Before, during and after the moves — and before and after the deaths began — Mahlangu and Manamela knew what was happening. 

All of this evidence is in the record, to which the NPA has had access since 2020. 

Bringing a culpable homicide prosecution would be an important step towards justice. To secure a conviction, the onus is on the NPA is to show, beyond reasonable doubt, that Mahlangu and Manamela caused deaths. This onus is greater than that required in the arbitration or the inquest. The families and their lawyers understand this.

But the evidence is there. It has been gathered and compiled and analysed over the almost 10 years since Machpelah and 143 other people died. The police, the pathologists, the families and their lawyers have done their jobs. It is now for the NPA to do the same.

Stevenson is an attorney and the executive director of SECTION27. She has represented the Life Esidimeni families since 2015.