The care a Perth man provided to his wife who had multiple sclerosis and was malnourished and had infected bed sores when she died five years ago is being investigated by the coroner with a suggestion the case involved "likley neglect".
Janene Devine, 48, weighed just 30kg - despite being 170cm tall - had multiple bed sores on her body and was covered in faeces when she was found dead in her bed in a dirty and disorganised house on March 16, 2007.
Coroner Dominic Mulligan is examining the circumstances surrounding Mrs Devine's death, particularly the quality of care provided by her husband Andrew Devine.
Mrs Devine was diagnosed with MS in 1999 and both she and her husband were registered nurses.
Counsel assisting the coroner Melanie Smith told the inquest this case involved "likely neglect".
Ms Smith told the court Mrs Devine was only hospitalised twice in the last two years of her life and questions would also be raised about her treatment by health professionals.
She said she wanted to make it plain that the case could be referred to the Office of the Director of Public Prosecutions if the evidence heard at the inquest indicated an indictable offence or offences had been committed in connection with Mrs Devine's death.
"The cause of death is in issue in this matter, in particular whether Mrs Devine's MS or the consequences of her likely neglect were the cause," Ms Smith said.
Forensic pathologist Dr Jodie White, who performed the autopsy on Mrs Devine, said she believed the cause of death was consistent with end-stage MS in association with sepsis. However, she told the court Mrs Devine's sepsis was the most important contributing factor in her death and concluded that she was "grossly emaciated".
In her evidence to the court, Dr White agreed with Mr Mulligan that a more appropriate cause of death could be malnourishment in association with sepsis against a background of end-stage MS.
Mr Mulligan said he was concerned that Mrs Devine's weight had dropped by 25 per cent from her last stint in hospital in October 2006 when she weighed just over 40kg.
Ms Smith told the inquest Mr Devine had rejected certain medical help, support services and an offer of alternative accommodation in a care home, deeming staff were not skilled enough to look after his wife.
In October 2006, Mrs Devine was admitted to Fremantle Hospital where she had a feeding tube inserted. The inquest was told if fed adequately via the tube that Mrs Devine should not have lost weight.
"Mr Devine was trained in how to feed Mrs Devine using the PEG tube and how to order the cans of food used. It appears that the number of cans ordered through the hospital could not have possibly have been enough to sustain Mrs Devine through to the day she died," Ms Smith said.
Ms Smith said when Mr Devine rang 000 to report his wife's death he told police he suspected his wife had suffocated but did not want to make a statement because he thought he would be blamed.
The inquest was told that in 2005 Mr Devine threatened to kill Mrs Devine then himself, resulting in Mrs Devine spending seven months at Sir Charles Gairdner Hospital.
Mr Devine, who is being represented by lawyer Johnson Kitto, is due to give evidence at the inquest later in the week. Mrs Devine's two adult sons will also give evidence later in the week as to what they were doing while their mother was dying.
The inquest was told without any complications Mrs Devine, who weighed 60kg in 2003, could have lived for longer, with one doctor estimating she could have had another 15 years.
Ms Smith said further issues to be explored at the week-long inquest include a lack of communication between the two hospitals, a lack of follow-up by health care professionals after her discharge, no referral to a palliative care service which may have include an assessment of the home and quality of care issues and why hospital staff seemed to accept the family's word that Mrs Devine did not want aggressive treatment, but treated palliatively instead.
Ms Smith also said there were no investigations as to Mrs Devine's ability to make decisions towards the end of her stay at Fremantle Hospital.
In questioning Dr White, Mr Devine's lawyer Johnson Kitto talked generally of patients refusing nourishment and that being within their rights.
Mr Kitto put it to Dr White that due to her MS Mrs Devine may not have been aware of her bed sores and that the risk of complications increase in a home care environment.
Dr White said she could not rule out suffocation as contributing to Mrs Devine's death.
Mr Mulligan said medical opinion was that MS was not a fatal condition in itself, and given modern medicine a sufferer could expect to have a 90 to 95 per cent normal life expectancy.
Outside court, Mr Devine said he was glad his wife's death was being investigated by the Coroner. He said he hoped this process could help him and his family move on.
"We've been held in limbo for five years too long, and I'm just so happy and I think Janene herself would be happy," he said.
When asked if he hoped his name would be in the clear at the end of the inquest, Mr Devine replied: "We'll see, we'll leave it for the court to decide."
The inquest continues.