Justice Dikgang Moseneke spent Makgabo Manamela’s fourth day on the stand trying to get her to realise the fatal consequences of her actions‚ eventually telling her she didn’t “get it”.

Dr Manamela‚ who has a PhD in psychiatric nursing‚ signed licences giving underfunded‚ inexperienced‚ badly equipped NGOs permission to look after severely mentally ill patients and as a result‚ 143 people died‚ most of them in those NGOs.

NGOs were used to care for patients because 1‚712 patients were moved out of Life Esidimeni homes when the Gauteng Department of Health terminated the contract with Life Esidimeni.

Manamela was challenged by Solidarity advocate Dirk Groenewald for reporting the date on which she signed the NGO licences incorrectly. She called this a “procedural error”.

She and the advocate then debated back and forth about why she had “misrepresented” the date that she signed licences as April 1‚ 2015‚ when she had earlier admitted under oath that she hadn’t signed all of them that day. Groenewald told her she was guilty of fraud.

Eventually‚ Moseneke reminded her that her decision to allow NGOs to care for these people had affected human lives.

“You were making a decision about other people’s lives... people whose lives may be enhanced or lost. I am not asking questions about the date and the error. I want you to appreciate that you were given power by a law… to make... certain decisions that would affect the lives of mental healthcare patients.”

“You exercised that power‚ and the result is that the patients died. Can you see that connection?”

He continued: “It is not how clever[ly] you explain something – just understand. You made a decision. You granted licences to people who were incompetent to do their job‚ and some people lost their lives.”

Manamela responded: “My response is that even though there is a procedural error‚ the NGO was assessed.”

She said she gave NGOs licences based on her team’s favourable assessment of them after an inspection.

“The procedural error I am not disputing‚” she said‚ admitting the dates recorded on the licences were fraudulent.

Then Justice Moseneke‚ who had often made his point about human lives in her four days on the stand‚ responded: “You do not get it.” Manamela nevertheless disputed this‚ saying: “I get it.”

Moseneke was incredulous: “It still goes over your head what a big omission it is – [one] that led to... deaths.”

She countered that there may have been other reasons for some of the deaths: “Justice‚ if I [may] say something on that. It might be that the NGOs were not as qualified‚ as [the report given to me by my team] was saying. There are other variables that might have led to the deaths of other users [patients] – the illnesses they may be having... medication‚ blood levels‚ and maybe stuff they lacked because NGOs weren’t paid.”

She said she had not intended that licences would allow “anyone” to take care of patients.

Evidence has been led showing that NGOs did not get funding from the department for four months‚ had no food‚ no blankets‚ no access to doctors‚ no medical records of patients‚ and no financial means to hire skilled staff.

Patients discovered by families‚ dead or alive‚ were often emaciated – and it is believed some starved to death‚ died as a result of dehydration‚ or succumbed to pneumonia in the winter cold.