Johannesburg - Disgraced Gauteng MEC for health Qedani Mahlangu’s senior staff knew as far back as July 2016 that mentally ill patients were dying in their dozens at the care centres in which they had been dumped.But Mahlangu herself only knew about the crisis a month later – because she had been busy campaigning for the local government elections from ANC provincial headquarters Walter Sisulu House, situated 400m from her Sauer Street office.And when the bodies started piling up, Mahlangu and Dr Makgabo Manamela, her director of mental health, accused Life Esidimeni of “sabotage”.“When Dr Manamela was told that patients were dying every day in some of the NGOs, she said: ‘Leave it, we know what to do’,” said a senior official attached to the Gauteng Mental Health Marathon Project responsible for transferring the patients to the non-governmental organisations where they died. On Saturday, it became apparent that the death toll of 94 patients calculated by health ombud Professor Malegapuru Makgoba would rise by at least 22 patients who remain unidentified at mortuaries in Tshwane for months.Batala Ketole of Ketole Funeral Undertakers in Soshanguve, north of Pretoria, confirmed yesterday to City Press’ sister newspaper, Rapport, that about 14 unidentified bodies had been lying in storage at his facility for months.He confirmed the bodies came from the Precious Angels home in Atteridgeville, where 20 patients out of the 57 who had been transferred there were confirmed to have died.The bodies were brought to him by another undertaker, Put u 2 Rest, also in Atteridgeville.This information was given to Makgoba, who yesterday said: “Yes, here it begins. I predicted in my report that many more bodies would be discovered. I know there are also nine more in a mortuary in Mamelodi.WHEN MAHLANGU RETURNED TO WORKWhen Mahlangu returned to the office the Monday after the August 3 election, she visited the Precious Angels NGO, where 11 patients had already died. Instead of removing the remaining patients, she instructed Dr Richard Lebethe, her acting director of forensic pathology, to conduct postmortems on the bodies.The rest of the patients were left at the NGO, where nine more subsequently died.Mahlangu declined to comment on the allegations.However, a close confidante confirmed she only found out about the deaths in August 2016.“She was on the campaign trail from May to July. She only attended one meeting in July where she was informed that all patients had been placed in NGOs,” the confidante said.She said Mahlangu “suspected sabotage” because Life Esidimeni had refused to hand over patients’ medical records when they were transferred.“She felt that the decision by Life Esidimeni was intentional and meant to cause confusion,” the confidante said.Most of the 1 180 patients transferred from Life Esidimeni to the 27 NGOs left without the files containing their medical history.Gauteng’s department of health alleged during Makgoba’s probe that Life Esidimeni refused to hand over files, saying it might need the information should it ever be sued.Health Minister Aaron Motsoaledi told City Press on Friday that he also initially believed the private healthcare group was deliberately sabotaging the state.“No doctor can transfer a patient without medical records,” he said.“Doctors are supposed to do a proper handover to each other, and in this particular case, these files were vital because sick and vulnerable patients were being transferred into the care of other people.“So, when I learnt about this I thought Life Esidimeni was angry because the department terminated a long-standing contract with it, and therefore, it wanted to sabotage the state.”But Motsoaledi changed his mind when he read Makgoba’s findings that the transfer of patients was chaotic and rushed, and that some severely disabled patients were herded on to bakkies or strapped down with bed sheets during transit.Makgoba also found that all 27 of the NGOs the patients were transferred to were operating illegally, and were not ready or prepared to care for them.However, Dr Nilesh Patel, healthcare services operations executive at Life Esidimeni, denied the patients were discharged without records, saying staff “ensured every patient was transferred with sufficient information to provide for their continued care, treatment and rehabilitation”.He said although rules of the Health Professions Council of SA prescribed that the original medical records “reside at Life Esidimeni for the duration of each patient’s life”, officials had “full and unrestricted access” to them.He added that “transfer notes recording the latest on the patients’ diagnosis, condition, medication history, risk profile and any recent acute illness and investigation results” were given to officials, together with a list of patients’ special dietary requirements, their prescriptions – “up to 28 days of medication” – personal items, a set of clothing, and their family contact details. HOW MANY PATIENTS DIED BEFORECity Press has learnt that hundreds of patients died at Life Esidimeni before the remaining ones were transferred away from its centres in May 2016.Figures of patients who died between September 2011 and May 2016, which City Press obtained, show that 462 patients died of “natural causes” in five care centres run by Life Esidimeni.Almost a quarter – or 109 patients – died in 2012 alone. In 2011, 130 people died there.Mahlangu’s supporters are using these figures to explain the importance of terminating the Life Esidimeni contract and moving the patients elsewhere.Mahlangu’s confidante said they had expected Makgoba to consider these figures during his investigation.“But he chose to ignore this and only look at what led to the deaths of the patients."While there were some errors made by [provincial government] departments, Professor Makgoba should have taken into consideration that this project was in the best interest of the patients and the state,” the confidante said.“The former MEC was also under pressure from the Auditor-General to review indefinite or long-standing contracts with service providers.“The Office of the Auditor-General highlighted that a review of various contracts, including that of Life Esidimeni, could result in cost savings.”However, Makgoba told City Press on Friday that the patient death rate at Life Esidimeni – between three and four for every 100 patients – was significantly lower than those of the NGOs, where at least seven out of every 100 patients died.Patel said patients with severe mental health disorders lived 10 to 25 fewer years than the general population, and that “almost all deaths occurring between 2011 and 2016 ... at Life Esidimeni were due to chronic physical medical conditions such as cardiovascular, respiratory and infectious diseases, diabetes and hypertension”.WHY THE NATIONAL DEPARTMENT DID NOT INTERVENECity Press has learnt that the national health department tried to intervene in 2015, when Mahlangu initiated the Gauteng Mental Health Marathon Project.But the provincial department allegedly told senior national officials – including director-general of health Dr Precious Matsoso – to butt out because it was responsible for implementing policies in the province.A senior national official told City Press this week:“Dr Matsoso and noncommunicable diseases cluster manager Professor Melvyn Freeman tried in vain to get the plan detailing how mentally ill patients were going to be moved from centres owned by Life Esidimeni to various NGOs.“Matsoso was told by Gauteng’s health department head not to worry because ‘we have a plan and that plan was approved by the court’.“When she requested to see the plan, it was never sent to her. The same situation was experienced by Freeman. Both were simply reminded that it was the MEC’s competency to implement any plan.”The senior official said the “concurrent competencies” of national and provincial departments were a major problem.“Some provinces in this country do what they like. They never listen to national government because the National Health Act gives powers to MECs to run health,” said the senior national official.“Each time they will remind you that it is their competence to implement policies developed by [the] national [department], and how they do it does not really concern the national government.“We saw this in Gauteng and we were about to see it in the Eastern Cape as well. MECs do what they like; the minister or the director-general has no say.”Motsoaledi agreed.“I am the minister of health, responsible for the lives of South Africans, but I do not have authority over how provinces implement policies,” he said.Motsoaledi said he would investigate changing the National Health Act and the Mental Health Act, as Makgoba had recommended in his report.“What I need to do now is send a message to all the MECs and premiers to tell them: ‘Do not embark on any decisions, even though you think you have authority, until I give an express approval,’” he said.