Statement made in Parliament on the Life Esidimeni mental health patients tragedy by Minister of Health, Dr Aaron Motsoaledi at the National Assembly
Honourable Speaker
Colleagues, Ministers and Deputy Ministers
Honourable Members of the House
Honourable Speaker, let me start by acknowledging the presence in the Gallery, of representatives of members of the families affected by this tragedy. They are:
1. Mr Andrew Pietersen;
2. Ms Nomvula Nonjabe; and
3. Ms Agnes Mlotshwa
Needless to say, we are deeply distressed and angered by the death of mentally ill patients that were transferred from Life Esidimeni Mental Health facilitiy in Gauteng Province. This constitutes one of the periods of darkness in the history of our country but dare I say, it was also a moment of madness in the Provincial Health Department.
Our anguish is exercebated by the very fact that the deceased constitute some of the most vulnerable members of society who are in need of even more protection than the rest of society.
That the idea behind the Gauteng Mental Health Marathon Project, as it came to be known, was to safe money, adds another dimension to our disappointment and pain.
I wish to put it on record that at no stage did it emerge, directly or indirectly, implicitly or explicitly, that the Department of Health nationally or in any province has run out of money to take care of mentally ill patients.
There was hence no reason for so many vulnerable people to perish on account of money. I interrogated this issue with the Premier of Gauteng Province because I wanted to understand what actually the Executive Council in the Province discussed and approved. He told me that the issue never featured on any agenda of the Executive Council but that he as the Premier was told by the Department of Health that they have 4 000 beds in public health institutions which they would like to use and that there is absolutely no reason to continue contracting services of private companies when the public sector is able to provide that number of beds.
This August House must please note that Esidimeni contract is for 2 000 patients and hence this statement meant that they could be accommodated twice.
The Premier assures me that at no time was the issue of NGOs ever raised until that fateful day in September when the MEC made an announcement of 36 deaths in the Provincial Legislature.
At the National level, we have a MINMEC which in the case of health is called the National Health Council (NHC). Like all the MINMECS, it consists of the Minister as the Chairperson, all MECs and HODs (Heads of Departments).
But in addition and different from other MINMECS, it also has the Surgeon General of the South African Military Health Service (SAMHS) and representatives of SALGA (South African Local Government Association). It is therefore a Statutory body. When there are huge undertakings in health, or elsewhere that may affect health, the NHC sits and even go into a recess to interrogate issues - it did so with the 2010 FIFA World Cup, it did so before the President launched the huge HCT Campaign to test 15 million South Africans in 2010. It did so in the advent of Ebola in 2014.
I want to state here today, that the issue of moving mental health patients in Gauteng which clearly falls within the categories I have mentioned above, never came to the National Health Council to be dealt with like all other major events.
We take the death of so many citizens in a very serious light and would therefore like justice not only to prevail but also be seen to be done.
I believe by now, Parliament more or less knows what has happened. Hence I wish to spend more time to outline what is being done about the matter but let me first summarise.
As we come to understand it, the Department of Health wanted to move mentally ill patients out of Life Esidimeni. When families were informed of this they objected because they were satisfied about Life Esidimeni.
Together with SADAG (South African Depression and Anxiety Group) and the South African Federation of Mental Health, they approached Section 27 to take up the matter for them with the Provincial Health Department.
When Section 27 realised that they are going nowhere with the Provincial Health Department, they prepared papers to go court.
While the court date was set, they then contacted the Director-General in the National Health Department and informed her of this problem and the court case and that the Minister and the Premier of Gauteng will be cited even though no relief is sought against them.
The matter was set for court on 22 December 2015. However on 21 December 2015 - a day before the court case, the parties decided to enter into a settlement agreement and not go to court.
The settlement agreement simply stated, among others:
- The parties shall forthwith engage in discussions aimed at resolving the dispute between them by no later than 31 January 2016;
- For avoidance of doubt, the Gauteng Department of Health shall maintain the status quo by not placing users from Life Esidimeni facilities in any other facility pending the conclusion of the settlement discussions.
- The outcome of the settlement discussions is intended to inter alia address the plan for the placement of users following the termination of the contract between the Gauteng Department of Health and Life Esidimeni.
- All stakeholders shall endeavour to reach an agreed plan by no later than 31 January 2016 guided by the constitutional imperative on the Gauteng Department of Health and shall at the very least endeavour that users receive health and other services of no lesser quality to the services that they currently receive of Life Esidimeni in order to protect, promote and fullfil their constitutional rights.
This Honourable Members, is what the parties signed for and agreed upon, that there was no need to make it an order of court because they are all in full agreement as it is.
This Honourable House may please note that the agreement says nothing about NGOs. It just emphasises that wherever they are taken to, it must be a place of no lesser quality than Life Esidimeni.
I later interrogated Section 27 on this matter and they said that they had no reason to suspect that anybody was planning any foul play and hence did not insist on the agreement being an order of court and they had informed the Director-General Health to this effect immediately after signing.
Unfortunately as it is Gauteng Department of Health did not honour the agreement at all and in March 2016 Section 27 rushed to court when they heard that they are about to move patients contrary to the agreement. This time they did not inform the National Director-General of Health of this development, but they wanted an urgent court to interdict.
Unfortunately the Gauteng Department of Health was able to convince the court that they are honouring the Plan, that they will not deviate from the agreement and that wherever they move people to, it will be in line with the agreement, i.e. that the services will be of no lesser quality that it will be at Life Esidimeni.
The court hence dismissed Section 27's interdict.
Armed with this court outcome, the Gauteng Department of Health then fobbed off any attemps by the National Health Director-General and the National Chief Director of Mental Health, who was supposed to have been invited to all meetings in Gauteng where the Plan was to be tabled and executed. They said that they had a court of law agreeing with them on every issue.
But what happend next is completely against what they told the court.
Firstly, NGOs were issued invalid licences as the Health Ombud discovered later during his investigations. The licences were issued by the Director of Mental Health who is not empowered to do so. Only the HOD can issue licences.
Secondly the NGOs went to Life Esidimeni to pick up patients on their own and brought them to their homes without files, without diagnosis and all the necessary ingredients that would bring quality healthcare.
It was difficult for relatives to know where their loved ones were.
It was in September 2016 when the MEC announced in the Provincial Legislature that we realised that something has gone dangerously wrong and hence I appointed the Health Ombud to investigate what actually happened and who did what.
The Health Ombud made a finding that this project was not only neglected, chaotic and hurried, but also violated the rights of the mentally ill patients and went totally against the principle of health, i.e the preservation of life and not the opposite.
The Health Ombud then made 18 recommendations to the State as a whole and another 6 specifically for Gauteng Province.
In religiously carrying out the recommendations we will highlight and reverse all anomalies that were pointed out and became apparent in the Gauteng Department of Health.
The serious anomalies were easily picked up because at the national level, working with all provinces and stakeholders in mental health, we did develop what we call National Mental Health Policy Framework and Strategci Plan 2013-2020.
This Plan was developed along the lines of Mental Health Action Plan 2013-2020 developed by the World Health Organisation.
However, one of the findings of the Health Ombud was that this National Plan was selectively interpreted, misinterpreted and contravened in the Gauteng Mental Health Marathon Project in the same way that the signed agreement was contravened.
All the checks and balances strenously cobbled together in this Plan and the Mental Health Act, 2002 (Act No. 17 of 2002) were contravened in one way or the other especially by the Gauteng Director of Mental Healthcare who is cited in the Health Ombud's Report as one of those whose fingerprints are peppered all over the ill-fated project.
To protect mental health users and ensure their safety and security, the Mental Health Act provides for the formation of Mental Health Review Boards in each and every province. This Review Boards are supported to work as oversight structures and in a way, the last line of defence in protecting mental health users. By law, the Gauteng Mental Health Review Board was supposed to sign off any movement of patients from Life Esidimeni or move or more appropriately refused to sign off and therefore stop it.
It is common knowledge that the Health Ombud arrived at a finding that this Mental Health Review Board in Gauteng was actually moribund, ineffective and without authority and without independence. This is because the Director of Mental Health, same person who issued invalid licences to NGOs, issued invalid appointments to the Mental Health Review Board and subjected them to fall under her Unit. That is why they did not exercise their authority to challenge the Gauteng Mental Health Marathon Project as empowered by the Act.
In de-establishing the Gauteng Mental Health Marathon Project and restore legality to all the violations that have taken place, we did the following:
- On the 4th of January 2017, I appointed a team of 60 professionals and experts in six professional categories - viz, Psychiatry, Psychology, Social Work, Psychiatric Nursing, Occupational Therapy and Environmental Care.
Over a period of 3 days from the 6th to the 9th of February 2017, they visited all 27 NGOs where mental health patients were dispatched to.
- As we speak, 7 of the NGOs have been totally closed and all the mentaly ill patients taken to the State's mental health facilities. The patients are plus minus 600 in number.
The remaining patients plus minus 700 are to be removed and placed in appropriate Health establishments within the Province where competencies to take care of their specialised needs are constantly available as directed by the Health Ombud.
- However this time around, the professional team warned that the relocation process has to be done meticulously, with special care not to cause more damage while trying to reverse the damage already done. For this to be achieved, we have as of yesterday established a special operation center at the National Institute for Communicable Diseases (NICD) in Sandringham in Johannesburg.
We chose this venue because it has an emergency response centre established after the Ebola Epidemic, to make us combat-ready in case of any disease outbreak. While the relocation is not a disease outbreak, it is appropriately placed here to ensure that there is absolute capacity for major logistical operations.
The Operation Centre will manage the planning, logistics, coordination of 5 teams that will assess each and every patient to ensure that they are placed in an appropriate facility that has got the competencies to provide services. The teams will accompany each patient to their eventual destinations.
The teams will first visit the prospective facility to which each patient will be moved with a representative of the families.
There is a core team of 27 members that has reported to the Centre as from today and it has lawyers, Psychiatrists, Psychologists, Social Workers, Dieticians, Environmental Health Practitioners, Emergency Medical Service personnel and a representative of the families.
When the process of relocation starts most probably next week after all assessments would have been done, it is meant that the Centre will operate on a 24-hour basis until the completion of the project - which is relocating 700 mental health patients.
Over the weekend, the Premier of Gauteng and I shall meet with the family representatives to agree on the implementation of recommendation 17 whereby a credible prominent South African with an established track record will be appointed to lead a process of mechanism of redress and compensation as a way of alternative dispute resolution mechanism.
No stone will be remain unturned in making sure that a full account is given of each and every death and that where prosecutions need to be undertaken by the relevant prosecuting authority, this be done without fear or favour.
Legal proceedings and appropriate administrative action will also be instituted against operating NGOs that were found tob e unlawfully and where the mental health patients died.
There has been an assertion made that the NGOs are being used as scapegoats for the blunders of the State. I beg to differ.
The State employees who were fingered by the Health Ombud and who shall also be fingered by law enforcement agencies and the courts of law will have their date with the justice system. They will not be left off the hook, whoever they are.
But the NGOs would also not be left off the hook. How do we accept a situation where an adult South African takes a licence, valid or invalid, to a well established mental care centre, collect a patient there who they do not even know, do not know their diagnosis, their treatment and health needs, and put them in their house to care for them with no training whatsoever? Only a reckless citizen will do so. On top of that, gives them no food nor water because they were not paid for period of 3 months.
It needs some form of misplaced courage and special recklessness towards a fellow human being for anybody, rich or poor, to act in this manner.
This is never ever to be repeated in our beloved country.
Before I sit down, I wish to report to this House that Section 88A of the Act that established the Office of the Health Ombud provides for anybody who is aggrieved or wish to challenge the findings of the Health Ombud, to do so within a period of 30 days of the Ombud's report being released. Once this lapsed the Minister of Health must appoint a special 3 person tribunal chaired by a retired judge, assisted by 2 people with expertise in the field of health, to hear the challenge.
The tribunal is empowered by the Act to confirm, set aside or vary the decision of the Ombud.
I can confirm that we have already received correspondence from lawyers acting on behalf of the suspended Gauteng Department of Health's HOD and al the officials fingered in the Ombud's report, that they are intending to appeal. We shall awaite their move.
For now, let us declare for all to hear, that this tragic and unnecessary incident shall never be repeated within the borders of this country.
I thank you
