Johannesburg – A quality assurance assessor and deputy nursing manager at an NGO has admitted that she, along with others, compromised the quality of the healthcare provided to mentally ill patients by taking on more patients than they could handle.Dikeledi Jenny Manaka was cross-examined on Wednesday at the Life Esidimeni arbitration hearing in Parktown, Johannesburg.During cross-examination, Manaka told the panel that the work of the facility where she is employed – Cullinan Care and Rehabilitation Centre – (CCRC) centres around taking "care of those with severe and profoundly intellectual disabilities between three and 21 years old" and not mentally ill patients. The facility had a bed capacity of 150 at the time but took on more than it could handle.The panel heard that when Manaka and her team arrived in Randfontein to pick up 10 patients, they were suddenly instructed by the centre's suspended CEO, Matshidiso Nyatlo, who was pressurised by officials at the Gauteng department of health, to take as many patients as possible, resulting in them leaving with 26 patients.The patients did not have identification as the transfers did not take place procedurally. Patients were then rotated between Siyabadinga, CCRC and Anchor House facilities to accommodate more patients until Siyabadinga and Anchor House closed down in July 2016.Section 27 lawyer Advocate Adila Hassim pressed Manaka when she said she knew what was happening at CCRC was wrong.Patients discharged without doctor's approval"You knew that taking on more patients than you could handle was something that would compromise the quality of care provided to patients. You were already overcrowded, this impacted the service you provided," Hassim said.Manaka agreed.Manaka had previously said that nurses discharged patients – without any doctor's approval – to various NGOs that she had not inspected in order to make space for more mentally ill patients.Manaka said that some of the beds at the facilities did not have mattresses, were not clean and had a stench that made her uncomfortable. Solidarity's Advocate Dirk Groenewald challenged Manaka on the fact that patients were discharged from CCRC to other NGOs which were also ill-equipped to take care of the patients, grilling her on who gave the authority for the patients to be discharged to NGOs that were unfit to take on these patients.ALSO READ: Taking in more patients 'was an order and there is nothing we can do'Manaka said that sometimes Daphney Ndlovu – a social worker – would be asked by her CEO, Nyatlo, to draw up a list of names of people who can be discharged and moved to another facility."How could you displace 38 patients who are the core target of mental healthcare without a doctor's assessment?" asked Justice Dikgang Moseneke, noting that she had treated the vulnerable unfairly and unprofessionally by not consulting with their families before their discharge.'It was an order, we had to do it'Manaka said it wasn't her decision to transfer or discharge patients, but that there was a Dr Kenoshi Makoma who assessed some patients and discharged them, a statement which contradicted her testimony on Tuesday that nurses had taken on this responsibility.She said it was difficult for staff at the facility because in the absence of doctors and psychiatrists they did not have the capacity to deal with the patients."Our job was just to act after being notified that they were on their way. We had no permission from their families or from the patients to move them. I am not the only one who raised with the CEO that this NGO move is not good. But it was an order, we had to do it," she said, adding that some of the staff cried while doing so. More than 140 mentally ill patients died after being moved to various NGOs across Gauteng during cost-cutting measures that came as a result of the Gauteng health department ending their contract with Life Esidimeni. The panel heard of patients dying from dehydration, emaciation, and hyperthermia as a result of deteriorating health despite being taken care of at these facilities.Manaka, however, defended herself."I won't take responsibility because some were taken over in a not good condition. The repercussions of prolonged hunger take long to correct," she said about a blind patient who died.