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Negligence exposed after the tragic death of a mental health patient at Pretoria hospital

By Mapaballo Borotho

Negligence exposed after the tragic death of a mental health patient at Pretoria hospital
Image @Dreamstime
  • Health care workers at Dr George Mukhari Academic Hospital have been found guilty of negligence following the death of mental health patient Lerato Mohlamme.
  • An Ombud report revealed multiple failures, including ignoring safety risks, withholding food, and inadequate medical care.
  • Disciplinary action has been recommended as broader concerns about Gauteng’s mental health system are raised.

Health care workers at Dr George Mukhari Academic Hospital in the City of Tshwane have been found guilty of negligence following the tragic death of a mental health patient who sustained severe burns within the hospital premises.

According to a report released by the Health Ombud on Monday, 23 March 2026, workers failed to comply with legally prescribed seclusion procedures, ignored safety concerns such as a reported burning smell, did not administer prescribed sedative medication, and inadequately monitored the patient’s diabetic condition.

History of the patient

35-year-old Lerato Mohlamme was admitted to George Mukhari Hospital in June 2024, with a long history of mental illness dating back to her teenage years. She reportedly had an aggressive and threatening behaviour.

She had previously been treated at several psychiatric facilities, including Weskoppies Psychiatric Hospital, Kalafong Provincial Tertiary Hospital, Tshwane District Hospital, and Louis Pasteur Private Hospital.

While in casualty on 20 June 2024, Mohlamme reported vaginal pain, discharge, and a bruise on her back, and informed the nursing staff that she had been sexually assaulted before admission.

Despite this disclosure, healthcare workers reportedly failed to conduct a mandatory physical examination, collect forensic evidence, or report the allegation to the relevant authorities as required under the Sexual Offences and Related Matters Amendment Act 32 of 2007

Her burnt body was discovered after a fire broke out in the hospital’s psychiatric ward while other patients were being evacuated.

Her case was brought forward by the Human Rights Commission, citing serious concerns about patient safety in Gauteng hospitals.

Ombud’s findings in Lerato’s death

In its findings, the Ombud said the failures by health care workers amounted to neglect and degrading treatment, in violation of the Mental Health Care Act, and compromised Mohlamme’s safety and dignity.

“The allegation that the healthcare practitioners involved in Ms. L. Mohlamme’s care were negligent is substantiated,” the Ombud said.

The report also revealed that Mohlamme was denied food as a form of punishment. Her blood glucose reportedly dropped to a critically low level without intervention, while evidence suggested meals were not properly offered or documented.

These failures point to broader systemic issues, including understaffing, poor infrastructure, and inadequate training in handling mental health patients.

The Ombud has recommended disciplinary action against the doctors, nurses, and security personnel responsible for Mohlamme’s care during her stay at the hospital.

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