Health professionals who treated a woman with multiple sclerosis – who died at home weighing just 30kg – have told a coronial inquest her carer husband repeatedly refused help for respite, alternative accommodation and support services.
Coroner Dominic Mulligan is examining whether neglect caused or contributed to Janene Devine’s death in March 2007.
The inquest has heard evidence that the 48-year-old mother of two’s husband, Andrew Devine, was struggling to cope caring for his wife in their Bull Creek home.
At the time of her death, Mrs Devine, who was uncommunicative and immobile, was grossly emaciated, had multiple infected bed sores and was covered in her own faeces.
Psychiatrist Dr Hans Stampfer said the last occasion he saw Mrs Devine in 2005 he believed she was going to be moving into a group care home in Maylands.
“I thought Janene’s safety was assured … that all fell through at the eleventh hour,” he said.
The inquest has been told Mr Devine rejected the alternative accommodation because he believed the staff were not skilled enough to care for his wife.
Dr Stampfer said no one made him aware of the last-minute change and believed it would have been obvious to most people that Mr and Mrs Devine were making a bad choice in sticking with at-home care.
“The problem I saw with Andrew and Janene … was you couldn’t use the Mental Health Act without breaking the law,” he said.
Dr Stampfer said medicos were limited in what they could do because the Mental Health Act, which gave powers to doctors and even nurses to enforce decisions against the wishes of at-risk patients if it was in their best interests, could not be applied in this case.
The inquest has heard other avenues of alternative accommodation were explored but Mrs Devine was ineligible for various reasons, including her age, the fact she did not have an acquired brain injury and was not wheelchair-bound at the time.
Dr Stampfer said Mr Devine, who had been showing signs of not coping for two years previously, should have had the “wherewithal” to ask for and accept help and believed they could have done “reasonably well” if they had adopted a more co-operative attitude with health services.
Fremantle Hospital occupational therapist Kate Ballard, who had contact with the Devines in late 2006, said Mr Devine refused her offer of a referral to an incontinence adviser and to the MS Society, telling her they had received little help from that support service in the past.
She said Mr Devine also rejected an offer of a free ramp to be installed at the front of their home, because of the length of the ramp needed and time involved, and for her to do a home visit after Mrs Devine’s discharge.
Ms Ballard said if Mrs Devine was being discharged today the process would be handled differently and in hindsight she might have been inclined to push for a home visit in stronger terms, but noted the limitations she was faced with when help was refused.
The inquest was told Mr Devine believed a single-run ramp would have been too steep for his wheelchair-bound wife and that on the rare occasions she left the house he carried her to and from the car.
The court has heard that it appeared Mrs Devine was not receiving enough nourishment through her stomach feeding tube, inserted during her stay in Fremantle Hospital in October 2006.
The inquest has been told if the evidence indicates an indictable offence or offences had been committed then the case will be referred to the Office of the Director of Public Prosecutions.
The inquest continues.