Gauteng Health Department ignored report that could have saved Esidimeni patients

16 March 2017

A report commissioned by the Gauteng Health Department in May 2015 found that the service provided by Life Esidimeni (LE) for psychiatric patients was "good value for money" and made recommendations that were ignored concerning the monitoring of patients transferred to NGOs.

According to a written reply by Gauteng Health MEC Gwen Ramokgopa to my questions in the Gauteng Legislature, the report was done by the Health Advance Institute (HAI) which was asked to evaluate the cost of LE's services and to evaluate the appropriate daily tariff per patient.

The report cost R410 500 and was sent to the department on 22 May 2015.

HAI found that the profit over all LE's facilities in 2014/15 was R29.85 million (13.8%) on a turnover of R215.74 million, which was considerably lower than the 28% average profit by health companies on the JSE at that time.

Instead of a predicted average cost of R320 per patient per day in the five LE facilities for 2260 patients, the actual cost was R262 per patient, which was 22.6% lower than expected.

The report says that "LE low costing is probably due to a combination of low infrastructure costs, large number of patients per unit, patients treated in groups rather than individually, below expected staffing levels and efficient management."

According to HAI "there is generally substantial compliance with the terms of the Service Level Agreement (SLA) within the following areas: patient cleanliness, nourishment of patients, good relation between patient and staff, treatment and care."

They did note, however, some areas for review, including:

- a dischargeable status within one year was not met that was a requirement of the SLA and may not be achievable

- no record of milestone observed in the patients file

- limited explanations on the management of treatment to the patients and family

- upholding the responsibility to try to find alternative accommodation for all the patients

- setting up an appropriate M & E system

The report concludes as follows:

"In general the service provided by LE is good value for money. HAI believes that sufficient and relevant information has been obtained to enable the Gauteng Department of Health to make sound and evidence-based decisions with regards to the future financial planning and management of this SLA."

Suggestions were also made, including the following:

- establish task team to define the minimum standards required ... in selection of the new places or alternative accommodation

- urgent inspections and reporting on each of the facilities to which patients were distributed after termination of the LE contract in relation to the norms and standards as defined by the task team

- to withdraw and re-accommodate any patients who are in sub-optimal conditions

- establish regular monitoring inspections at all facilities where patients are to be managed.

On the basis of the report, the department granted a tariff increase as requested by LE.

This report undermines the claim by former Gauteng Health MEC Qedani Mahlangu that LE was overcharging and that the contract was terminated because of high cost.

Furthermore, the recommendations concerning monitoring of patients sent to other facilities were ignored, which led to the tragedy of more than 100 deaths as found by the Health Ombudsman.

It is further evidence of gross negligence by Mahlangu and senior officials that should lead to a conviction of culpable homicide in a court of law.

Issued by Jack Bloom, DA Gauteng Shadow Health MEC, 16 March 2017