Former Gauteng Health MEC Qedani Mahlangu and mental health director Makgabo Manemela have been blamed for the tragic deaths of nine mental health patients in 2016.

Judge Mmonoa Teffo found that Mahlangu terminated the Life Esidimeni contract despite warnings by experts, and “created the circumstances in which the deaths were inevitable”.

The inquest probed the deaths of 141 patients, who were moved to non-governmental facilities after the Life Esidimeni contract was ended by the Gauteng health department.

The Democratic Alliance welcomed the findings and said it was a severe indictment that should lead to culpable homicide charges being filed.

“It is a pity that the lack of autopsies for the other Esidimeni deaths precluded a firm negligence finding for the other deaths. Other charges should also be laid against all those who can be identified in causing the suffering of the Esidimeni patients,” the party said.