RIP Jan Macdonald
Ubuntu has through the years had many cases of neglect, cruel treatment and even suspicious deaths of people in mental health institutions. In June of 2012, the Ubuntu Centre received notice of an unusual death at Esidimeni.
The sister of Jan Macdonald wrote: " My brother Jan Mc Donald recently passed away at the Life Esidemeni complex for the mentally ill in Randfontein, Johannesburg, South Africa, he had just turned 50. He passed away on the 27th of May 2012, I believe to neglect, malnutrition and possibly assault (currently under investigation). Jan was transferred to the Lifecare Esidemeni complex for the mentally ill approximately 3 years ago when the government institution Weskoppies closed their doors for permanent patients. This government institution being the National and Provincial department of Health and Social development contracted the Lifecare private group of hospitals to run these mental facilities and hundred of patients were then transferred from Weskoppies in Pretoria to these facilities run by the Lifecare private group. (www.lifehealthcare.co.za)
The conditions at the establishment are shocking and inhumane. Patients have no entertainment and I believe that only recently repaired a TV in this unit that was broken for months on end. They are only let out into a enclosed cement courtyard for a very short period every day. They do not have any reading material available to them. They are expected to remain in their rooms that they share with many other patients or they can walk between the corridors. They are clearly not fed well and as you can see from the picture below taken of my brother in Dec 2011 before he passed away was clearly malnourished.
Since about 26th of March this year up to when he passed away on the 27th of May, Jan was sent to a government hospital three times for injuries (Laratong hospital). The staff at Lifecare Esidimeni claim that he fell. I do not believe them and I believe that he was assaulted. Jan mention to myself when speaking to him in Laratong hospital 6 day before his death that on the third falling that he in fact threw himself on the floor when he saw one of the staff members approaching him he said he was scared of this staff member who apparently dishes up the food as this staff member often threatened to kick him, he did not mention a name.
I believe that Jan was kicked when on the floor as he had a broken hip bone and that takes tremendous force to break. The findings of the autopsy according to Dr Tailor of Roodepoort Forensic Pathology Services show that he also had cracked ribs and bruising. I think Jan was simply too afraid to speak up. Jan was extremely malnourished and I did bring this to the attention of the Lifecare Esidemeni home for the mentally ill in December 2011 by means of an email. The picture below shows him before being admitted to the Lifecare home in Randfontein, and the picture above show how his weight dropped and he looks like he has come out of an concentration camp.
I live in Cape Town however when my brother or sister visited Jan at the Lifecare home he was always accompanied by one of the staff members at the Lifecare hospital. The patient and visitor were never left along to speak. The same when I called him from Cape Town the staff were always in the room when he took the call. I feel there is something very strange about this and shows they were hiding something. The visitors were only allowed to meet the patient in a visiting room with a staff member present.
I have also been in contact with another lady who currently has her ex-husband in the same facility also in Hope ward. She mentioned to me that she noticed his rapid decline of health. Her husband is called Bruce and he is currently still in this home. She mentioned that she noticed his teeth are decaying and also that he smelt like he had not taken a bath for days and that he too had lost a tremendous amount of weight. What scares me the most is that The Lifecare group runs six mental healthcare facilities for adults and three mental healthcare facilities for children in Gauteng.
For my brother Jan it is too late however for the rest of these patients in these facilities SOMETHING HAS TO BE DONE. In South Africa in our culture there is very little regard for the people with psychosocial disabilities/ "mentally ill". SA needs to be educated on human rights. This group are the most neglected group of people in South Africa with no protecting thus making them the most vulnerable. The Lifecare group is a private public listed company showing great profits. They are been paid I would think a vast amount of money to run these facilities for however clearly the benefits are not being passed on to the patients. I hope that all that read this page can help with this huge problem we have in South Africa. I would like to see these facilities improve drastically and to know at least that my brother Jan died with a cause and that being so that others could be helped."
As this was a Gauteng based case, it was referred to the South African Mental Health Federation immediately and we followed up with Jan's sister who wrote back saying: "I have spent the past two weeks on the internet trying to find organisations to help me and it is so important to have this monitoring body to protect the most vulnerable of all in society. The SA Federation for Mental Health invited me to join this discussion. I have also emailed the MEC for the National Department of Health and Social development ,Ncombi Mekgwe. Her PA mentioned that she she has referred this to another department for investigation. I have been in contact with the Review board that represents Life Esidimeni in Randfontein and completed the MHCA02 form.
I am a bit concerned as they mentioned that they only have an preliminary board and they are still busy appointing the board members(011 – 3553903) What I find so strange is that the two members of management from the Lifecare group called me yesterday and when speaking to me they mentioned to me that they were very concerned about the happenings at Life Esidimeni and asked me a couple of questions. Why does Management not know what is happening in their own facilities that they run!!! The home itself did not even know that my brother passed away in Laratong hospital. I informed one of the staff members the next day and they just said “oh okay yes I knew Jan”. After that I did not get one call from Life Esidemeni expressing their condolences it was as if my brother Jan never stayed there for over three years and as if no one cared that he died! I only got response when I emailed the hospital Manager a week after he passed away."
Ubuntu responded to Nikki: "I did forward your initial email to our Board members which lead to it being forwarded to Bharti Patel at South African Mental Health Federation. Ubuntu was asked to forward our contacts at the South African Human Rights Commission - which we did do.
I SAMHF the Commissioner in charge of disability as well as the facilitators of the Section 5 Committee as well as the email of Commissioner Lawrence Mushwana - the chairperson. I was told that they were preparing documentation and reporting to the relevant authorities.I also said in the email to SAMHF that the case you refer to of the person in Hope Ward may be of great importance. If an urgent complaint can be lodged that is supported by your documentation of your brother's treatment and suspicious death - it could be grounds to argue for urgent immediate action.
It must be remembered that the SAHRC can only act on complaints and this can be a simple email, phone call or fax.As for the Mental Health Review Board - if it is not yet legally constituted - it will have limited powers.They report to the Department of Health. I suspect that any action from them will depend on who has been appointed and if they take their responsibilities seriously. Essentially they are not an independent authority.
Management of Lifecare must have got wind of any action that has been taken and of course they will want to do everything to "cover up" or defuse a situation - which will include trying to find out what you know or planning to do. South Africa has ratified the Convention on the Rights of People with Disabilities and this obligates our government to implement the treaty. There is an article that refers to the right of "freedom from exploitation, violence and abuse" - it goes further to put in safeguards by saying that "State Parties shall ensure that all facilities and programmes designed to serve people with disabilities are effectively monitored by independent authorities" The South African Human Rights Commission is mandated to ensure that SA complies with it's international obligations - the above being something that would contribute towards preventing further abuse in institutions in this country. I have raised this at Section 5 meeting, but your brother's case could bolster a really strong argument."
His sister had previously sent this mail asking a manager to give give a full report into Jan's death: "The events around about the end of March we were told he was in sick bay at Lifecare hospital in Randfontein complaining about a painful back. One staff member told me he had fallen the other lady in sick bay told me he had gone into relapse and Malemela told me he had an epileptic fit however the nurse on duty according to Malemela failed to tell Dr Khota regarding the epileptic attack so Dr Khota assumed that he had only fallen.
I did speak to Dr Khota about this confusion afterwards to get some clarity. On the 25/04 we were told that Jan fell again in the shower and had to go to Laratong hospital for stitches in his head. On the 04/05 the sister called again to say that Jan had thrown himself on the floor and they had taken him to Laratong hospital for X-rays. Jan told us he was in great pain but he was ordered to stand up. He was then taken to Laratong hospital to ward 21 and we were told he had broken his lower leg in two places.
He was there till his passing on Sunday the 27th of May. I spoke to the a Dr Anim(spelling could be incorrect) today at Laratong hospital and he said that Jan had blood in his urine on Sunday and also had a distended bladder. They have decided to do a full autopsy to determine the cause of his death as obviously it is not the norm for a patient to pass away from a broken leg.
I have questions regarding how do you break a lower leg in two places when falling. Was he maybe kicked or bullied? I find the re-occuring "fallings" in Hope ward unexplained and Jan also did mentioned to us that he did not want to go back to Hope ward and asked if he could go back to ward Tembani. Jan mentioned that the person who hands out the food often threatened to kick him and when he saw him approaching he threw himself on the floor as he was scared of him and thus broke his lower leg.
I ask the question was it possible he was kicked when on the floor resulting in the broken shin bone in two places? Jan often spoke the truth despite his condition. My sister and I have asked the staff some questions on numerous occasions but always get defensive answers . I have mentioned to them that we need to ask these questions as they are the ones working at the hospital and they would have the answers and we need clarity. I have a lot of questions and would appreciate a full report regarding the above events at the Life Heath care hospital in Randfontein prior to his death".
Shortly afterwards Jan's sister updated Ubuntu on a report back from the autopsy: "I have just spoken to Dr Tailor at Roodepoort Forensic Pathology Services in Roodeport. She will provide the investigating officer with a full histology report in two weeks regarding the cause of his death. She mentioned that she has found that he was severely malnourished and had cracked ribs and bruising under his ribs. She also mentioned that there was a kidney infection. The blood is his urine and thus the distended bladder according to Dr Tailor was as a result of the him not been able to move his left side as he was in traction"
In June, soon after being notified, the Interim Gauteng Mental Health Review Board responded: "Good afternoon We acknowledge receipt of your correspondence dated 12 June 2012, with reference to the above mentioned subject. The interim board has thus far conducted an in-depth review of the file. We will be investigating further with Life Esidiemeni Randfontein Complex. You will receive further feedback on completion of our investigation. Thank you (Ms R Sukhlal Interim Mental Health Review Board Chairperson Gauteng Province)
In July we were alarmed to be informed of the following: "When chatting to you yesterday it only dawned on me afterwards that you may not know that Life Esidimeni has been contracted by the Provincial Government to run the 6 mental health facilities for adults and 3 children mental facilities. The Lifecare group are paid by the government to look after these patients. It is a public-private partnership and I think it may be of great interest to you organisation to refer to the following recent info(dated May 2012) that I found on the internet that refers to a report from the CEO of Lifecare group Mr Mike Flemming. In this report it clearly states the groups concern that the Provincial government has not been paying the bills for Life Esidimeni and that they would need to cut down on costs. This could explain the poor state of these facilities and neglect of these patients. Should you wish to read the report directly from the internet google Mike Flemming CEO lifehealthcare and then refer to BHF article written on the 14.05.2012. I have however copied this article below:
But the hospital group joined a growing list of medical firm complaining that provincial health departments' failure to pay bills on time was adversely affecting their businesses. Last week the National Health Laboratory Service said it was owed almost R2bn by provinces, with KwaZulu-Natal and Gauteng the worst offenders. Gauteng's medical device suppliers have also publicised their difficulties in getting paid, saying delayed payments put small firms at risk of closure. Life Healthcare CEO Michael Flemming said Esidimeni Health, a public-private partnership that provides care for state patients in the provinces, was not turning patients away, but conceded that it had been forced 'to scale back the services it provided to the state in five provinces. He said the only negative on the group's horizon for the past six months had been a disappointing cash collection. Weak collection of government debt contributed to a.6,2 percent decrease in cash generated from operations. Flemming declined to disclose the size of the outstanding provincial debt, but said although the provincial authorities had recently begun to pay their bills again, it appeared they were paying off last year's expenses with this year's budget. Gauteng, the Eastern Cape, and Limpopo were the most problematic provinces, he said, adding that Life Healthcare also had problems with some medical schemes. Flemming said Life Healthcare had taken steps to cut costs, for example, replacing individual counselling services with group therapy. Despite its billing problems, Mr Flemming described Life Healthcare's interim results as "robust".
On the 3 July, Jan's sister was provided with all the information and contact details to go ahead with a formal complaint to the SAHRC. His sister was an adept activist by this stage and was fighting for answers.
On the 5 July, his sister pressed for a response from the SAHRC and sent this email to Commissioner Malatji - " I wish to confirm that SAHRC has received the complaint that I, Nikki de Lange, lodged on the 3rd of July 2012. I believe that my complaint of the unexplained death of my brother and the circumstances detailed are adequate grounds to demonstrate that the human rights of patients in the Hope Ward at the Randfontein Care Centre of Life Care Group are at risk. People that live with mental disabilities in residential facilities are a vulnerable and ignored
group people in SA with little or no access to the public and community . Please indicate to me what actions you are taking to ensure the prevention of further possible neglect and abuse."
Eventually a report was sent to his sister on 28 November 2013 was issued.(can be down loaded by clicking "a report above)
It was found that Jan's rights had not been violated. Despite doing an onsite inspection, there is no record of any other residents being interviewed, if it was an unannounced visit but rather appeared to rely on the finding of the Mental Health Review Board - a Government structure reporting to the Department of Health.
Both Jan's sister and the Ubuntu clan reacted privately is shock. Jan's sister wrote:
"The more I think about this report the more I think it is so unfair to base the report on “after the fact” inspection visit that took place well after a year. What about a report on the conditions at the time when Jan was in the establishment? Also to base their findings on that of the Review Board that did not even wait for the autopsy report before delivering their report. Plus I seem to remember that the Review Board is made up of government workers the very people who granted the Life Care group the contract in the first place. The act as judge and jury? Also interesting to see that a report on each patient must be done very second month now and sent to the Review Board, this was never the case when my brother was in the establishment. None of these forms of entertainment were available at the time. There was one TV that I was told by my brother that was broken for months on end. There was only one doctor Dr Khota who even mentioned to me himself he was overworked had to attend to all the patients on his own. Do they ignore the fact that a Whistle blower within the Lifecare group reported to them that conditions within this establishment were bad. Do they ignore the fact that another family complained about the conditions. No this is not fair I am going to appeal the outcome of this report. Any thought on this from your side?
Ubuntu responded thus: "Lodge an And so the appeal was lo
appeal - this is all just unacceptable!!!!"
And so the appeal was lodged to the SAHRC together with the MHRB Report and the Autopsy Report.
Finally, the appeal outcome was released on 11 April 2014 and Jan's sister was advised to go find a private attorney.
Ubuntu responded: "This is all so disappointing - and especially as it all happened in JB. The thing we note is that at no stage are any of Jan's fellow "patients" interviewed! The words of staff have been believed and whistleblowers ignored. Why would anyone bother to take the time and visit the SAHRC if there were not real concerns???? Did the SAHRC even bother to request his medical file to find out what his weight was when he entered the home? Interview the part time psychologist that saw Jan - if this ever actually happened - But hopefully the word is out that SAHRC could come knocking at any stage and they better shape up I do not know what to say - the "system" is so powerful to cover up abuse"
And so all domestic legal remedies were exhausted for Jan until now. His sister has lodged a formal complaint with the Health Ombudsman that Jans death be investigated along with the "current" reported deaths of 30 people. Senzeni na?
