Dr Makgoba Manamela‚ who was one of three leaders who ran the project to shut down Life Esidimeni Homes‚ has lost her appeal against the health ombudsman’s report.

When Life Esidimeni homes were shut down‚ Manamela was involved in moving patients from homes into ill-equipped NGOs and 141 later died.

Health ombudsman Malegapuru Makgoba said in a report that Manamela must be suspended from the Gauteng health department "for gross misconduct and or incompetence". Manamela appealed the ombudsman report and her disciplinary proceedings in the Gauteng department of health were postponed due to her appeal.

She lost her appeal‚ the ombudsman's office said on Thursday.

Manamela remains suspended on full pay until her disciplinary action is now completed.

In the arbitration hearings that have sought to understand what happened‚ it emerged Manamela was at the forefront of the project.

On Monday evidence leader Patrick Ngutshana said Manamela had rejected the subpoena to attend the arbitration hearings because her lawyers said she was appealing the ombudsman's report.

However‚ the appeal process is now complete.

Hearing Judge Dikgang Moseneke has said he will not end the Esidimeni hearings until Manamela testifies. Moseneke said he had told lawyers repeatedly in his chambers to ensure she and the former MEC attend. "I have continually directed steps must be taken so we have them here. We are not going to run out of time …unless I die‚" he said in a joking manner.

In other testimony at the hearings‚ Manamela's involvement in the deadly move has been made clear. Dorothy Franks‚ who ran Anchor NGO‚ where five people died‚ testified she was "pressured" by Manamela to take patients.

Dianne Noyile‚ who ran Siyabadinga NGO where patients died‚ testified Manamela physically moved beds into two NGOs operating on the Cullinan Care and Rehabilitation Centre's premises in order to squeeze more patients into a small space.

The premises of the two NGOs became overcrowded and patients died in both. In the hearings‚ witnesses testified Manamela knew that NGOs such as Precious Angels that took patients did not have adequate food‚ money or staff to look after sick people.

Manamela knew that Siyabadinga NGO didn’t have enough food‚ money or space for patients but Noyile testified Manamela asked her to look after a few extra patients over the weekend and promised she would fetch the extra patients in a few days‚ but never did.

When the head of the Mental Health Review board‚ Dumi Masondo‚ whose job was to oversee Manamela‚ enquired about the move - which later led to 141 deaths - Manamela also told Masondo "everything was fine". When Masondo answered the ombudsman's emails enquiring about the tragedy‚ Manamela illegally checked them first.

Manamela gave an instruction to Masondo to transport a body of the deceased NGO patients‚ an outraged Moseneke and Section 27 lawyers told the hearing in its first week.

The ombudsman found that Manamela had issued illegal licences to ill-equipped NGOs to take patients.