A South African policeman provides security outside parliament in Cape Town, South Africa, Thursday, Feb. 9, 2017.The Associated Press
More than 100 people have died and the death toll is still rising after a chaotic and disastrous government decision to transfer psychiatric patients from hospitals to unlicensed private care homes in South Africa.
The growing scandal has rocked South Africa, with fresh revelations of more deaths on Wednesday as investigators pursue the case. Senior officials were repeatedly warned of the risk of the patient-transfer scheme, yet they pushed ahead with it anyway.
"I am quite confident that the figure is now above 100 deaths as we speak," South African health ombudsman Malegapuru Makgoba told a parliamentary committee on Wednesday.
"I can say to this committee that we are still collating more data that is coming in of deaths," he said.
His preliminary report, earlier this month, said at least 94 patients had died unlawfully as a result of the transfer, but police are still trying to identify a further 19 bodies from the private homes, believed to be transferred patients.
Dr. Makgoba's investigation found a range of troubling factors in the scandal: a government cost-cutting campaign that went wrong, private homes that saw the psychiatric patients as a business opportunity, appalling living conditions that sometimes resembled those of a concentration camp and senior officials who ignored all warnings of looming disaster.
Some of the patients were transferred to the private homes in the back of pickup trucks or were tied with bedsheets during their transfer, the report found.
They had been receiving specialized care at their hospitals before the transfer, but they were sent to homes without doctors, nurses or other qualified staff. Some of the homes lacked proper food, water, medicine and even heating in the winter. Many patients died of dehydration, heart attacks, diarrhea and pneumonia. Some had become emaciated from hunger. In many cases, the causes of death are still unknown.
The scandal took place in Gauteng, the country's most populous province, where Johannesburg and Pretoria are located. The head of the provincial health ministry, Qedani Mahlangu, resigned just hours before the ombudsman released his preliminary report this month. Opposition parties are pursuing criminal charges against her.
Two other senior officials, Barney Selebano and Makgabo Manamela, have been suspended. The investigation named the three officials as "key players" in the disaster and blamed them for a "reckless" and "negligent" decision with "inadequate planning and a chaotic and rushed implementation process."
The government had wanted to deinstitutionalize the patients from hospitals, a widely supported goal. But it rushed into a shambolic transfer process in early 2016 after announcing that 2,000 patients from the Life Esidimeni hospital group would be sent to 27 private-care homes and other facilities run by charities.
Some of the facilities were just double-storey houses, and some were run as a business venture, the ombudsman said. None of the homes had valid licences, and many were overcrowded and lacked the resources to care for the influx of psychiatric patients, he said.
Families, professional organizations, opposition politicians and civil-society groups had been warning against the transfers since 2015 and had even gone to court to seek safeguards. But the transfers went ahead last year anyway.
South African Health Minister Aaron Motsoaledi said the private homes chose the patients "like a cattle auction," without regard to the specialized care that the patients would need. "How could they take patients without medical records into their care?" he asked in his appearance at the parliamentary committee on Wednesday.
Last September, the government acknowledged that 36 patients had died after the transfer. But in reality, 77 patients had already died by then, the investigation found.
Seven of the 27 homes have now been closed, and officials are planning to close the remaining homes as a result of the ombudsman's report. Some patients could return to the hospitals where they began.
The senior officials who pushed for the patient transfers "knew of the risks before embarking on this project and watched as the tragedy unfolded," said Section27, a public-interest law centre in South Africa.
"They did nothing to stop it. They should be held to account to the fullest extent of the law."
Another civil-society group, the Treatment Action Campaign, said it was shocked by the "inhumanity and callous disregard for the lives of others" that the ombudsman's report revealed.
The report "paints a picture of a government with no regard for the lives of some of the most marginalized people in our society – people with severe mental-health problems," it said.
"The report also paints a picture of a health-care system that is grossly mismanaged and has been entrusted to people incapable of effectively serving the public interest."
Geoffrey York