Health MEC breaks her silence on psychiatric patients

In June 2015, Gauteng health MEC, Qedani Mahlangu, announced that the department would terminate its contract with private hospital group, Life Healthcare.
The private healthcare provider had housed almost 2,000 long-term, state-funded psychiatric patients at its Life Esidimeni facilities in Johannesburg.

Patients would either be sent home or transferred into the care of community–based nongovernmental organisations, said Mahlangu. At least 36 patients have died following the move.

Source: M&G/Felix Dlangamandla
Source: M&G/Felix Dlangamandla

Last week, dozens of activists from organisations such as the Treatment Action Campaign (TAC) and public-interest law organisation Section27 joined affected families in a protest outside the Gauteng health department and handed over a list of demands.

This week, Mahlangu discussed the department’s response to the deaths and why the matter may prompt court cases on both sides.

Can you explain the rationale behind the move?

We’ve been through that. I should start by saying we have met with a lot of people and the majority of them were at the march.

When people take things to the street as if there is no engagement with the department, it worries me as to what exactly is the intention of this.

A number of patients … because their psych conditions could not be managed at NGOs (nongovernmental organisations), those [patients] were sent to Sterkfontein [psychiatric hospital], to Weskoppies [psychiatric hospital] and some to the Cullinan [care and rehabilitation] Centre.

We’ve employed additional nurses … and we are also reviewing the amount of money we spend on patient care.

How were NGOs identified and vetted?

From September, I started visiting the NGOs. Before that … I would not have visited NGOs and I don’t think it would be my responsibility as an MEC.

The mental health team would have decided [on] these NGOs. The report we received would say something like: “This NGO qualifies.”

How will the department improve the monitoring of mental health facilities?

These scheduled weekly visits by our team are important but [we will be doing] more unannounced visits. I have said to some of the NGOs like the TAC that I am going to invite you to the NGOs when I go there. We’ve also said to our hospitals that where they have a [nearby NGO operating], medical doctors, not only psychologists, must … visit those places to medically assess patients.

A memo delivered to the department asked for a list of the NGOs housing former Life Esidimeni patients and the number of patients who have died. Will you be responding to the demands?

We will respond to the issues that are practical to respond to. One thing that is impossible to do is to share details of family members without their consent — that we can’t do. Section27 has asked us for the list [of NGOs and patients].

Section27 wants to sue the department, so they want the list for that purpose. They’ve said it in our formal meeting with them. They came with their lawyers; we came with ours.

How many NGOs still house former Life Esidimeni patients?

Sho, I wouldn’t know off the top of my head … Probably more than 10.

You’ve mentioned possibly taking legal action yourself. Why?

Where my name has been used inappropriately in certain things, I will definitely be able to do so. I am working with lots of people who work exceptionally hard and sometimes they will make mistakes. Things go wrong sometimes, [but] the question is how do you learn from the mistake?

Prasa maladministration ‘a very serious matter’

The maladministration that occurred at the Passenger Rail Agency of SA (Prasa) is a “very serious matter”, according to its chairperson.
Prasa maladministration ‘a very serious matter’Popo Molefe told parliament’s Standing Committee on Public Accounts (Scopa) on Wednesday that the board was “rigorously going through the issues raised by Public Protector” Thuli Madonsela, after her investigation into Prasa three months ago revealed large-scale maladministration and targeted former CEO Lucky Montana.

“It is complex,” he said. “We can’t give timeframes. It is unfortunate that we cannot disclose details of what is emerging, because it needs follow-up investigations.

“We have National Treasury working with us and a team of forensic and IT experts as well as criminal lawyers and police working with us.”

“It is a multi-disciplinary committee led by very senior police officer,” he said.

Molefe said he would make announcements regarding the investigation as soon as the board has all the facts. “I accept we are the successor and, therefore, assume assets and liabilities of our processors,” he said. “We don’t want to be absolved. We have to deal with this problem.”

Many of the issues raised by the parliamentarians were subject to the investigation and so Molefe could not answer them. This resulted in the meeting being cut short. Ending the meeting short, Scopa chairperson Themba Godi instructed Prasa officials to compile a list of the various investigations that are underway, and to include how long each probe is likely to take, EWN reported.

Pistorius trial tells us a lot about our society

We have seen one style of cross-examination at the Oscar Pistorius trial: the pit-bull approach. It is tough and brutal…
The target is trapped in the witness box – not unlike a dog thrown into a fighting pit – and the lawyer for the other side sets out to tear apart every aspect of their life and their history, slowly and relentlessly.

It is as if we cross-examine in the same way we play rugby: we are bigger, tougher and more brutal than anyone else and we can wear you down over time through relentless pressure. Who needs brains when we have enough brawn?

Certainly, this approach often works, and prosecution bulldog-in-chief Gerrie Nel has shown that with Pistorius.

Then there’s the other approach

But what happened to what I call the Sydney Kentridge approach: using wit and gentle but sharp skill to nudge the witness into a corner and get them to admit things they do not even realising they are admitting?

One recalls Kentridge outsmarting the Steve Biko killers in that most famous inquest so that – even as he knew he could not win the case under an apartheid-era magistrate – he showed the police to be cruel, dishonest and foolish.

His agile tongue and timely use of irony and sarcasm became the subject of plays and films and are still held up to show how you can score points by being cleverer than your opponents, even when they have all the muscle. This is the work of a terrier rather than a boerboel.

I am not saying that the pit-bull approach is inappropriate, only that one expects some light and shade, some variation in the approach.

Setting the trap

When we want to show that an expert is not up to scratch or sow some doubt on an eyewitness version of events, why do we need always to leave them in a heap on the floor, bruised and beaten?

There are some members of the Bar who still work in the Kentridge tradition.

I once made the mistake of agreeing to be an expert witness in a dispute that went to court and was caught off-guard when the advocate for the other side spent the first few minutes of his cross-examination telling me how smart, expert and skilled I was.

He laid out my experience and achievements better than I could have done it myself. He flattered and cajoled me.

And then he caught me.

He did not need to humiliate me, he just needed me to concede one point, and he led me slowly into that trap. And when he did, it counted that much more because I was all puffed up.

Then there’s this trial

Of course, it is different in a criminal trial like the Pistorius case.

Criminal lawyers are tough players in a rough game, and Nel’s technique was forged in the daily battles of criminal prosecution rather than the more lofty debates of civil dispute.

But I raise the point because I think it tells us a lot about our society and our culture.

In all the coverage of the trial, I am struck that we seem to be avoiding some of the hard issues it has thrown up.

What does the trial tell us about our gun culture? It is not just that a large part of our society has an undue affection for these weapons of individual destruction, but that they are careless and showy about it.

Pistorius did not have a gun; he had an arsenal. Nothing was more telling than the description of his indignation at a policeman who once touched his gun, as if he was fondling parts more private.

What has it told us about the fear that lurks behind our gated communities and how people seek refuge in cars and weaponry?

What does it tell us about the seemingly unchanged lifestyle of many of those in these communities, who seem to be as separate from the rest of society as they were under apartheid?

It is a story of masculinity and muscularity and it is a truly South African story, pause for thought during an election campaign that sometimes seems to be more about brawn than brain.