Janene Devine was only 48 years old when she died and had to suffer years of neglect at the hands of her full-time carer and husband Andrew, a trained nurse. She was a tall woman, 170 centimetres (or 5ft 7in), yet only weighed 30 kilos when she died in March 2007. Her body was covered in bed sores and faeces when she was found in the filthy house she shared with her husband in Perth.
Coroner Dominic Mulligan has to determine whether her husband Andrew Devine's neglect contributed to her death.
Police took a video of her skeletal body and it was shown at the inquest this week. The smell in the bedroom was described as being so bad, those present could hardly breathe.
But everyone is running for cover - the husband, medical staff, the police, her two sons, her mother and other family members.
Psychiatrist Dr Hans Stampfer said the last occasion he saw Mrs Devine in 2005, he believed she was going into a group care home in Maylands. "I thought Janene's safety was assured....that all fell through at the eleventh hour" he said. He also said that her husband had been showing signs of not coping for two years.
Fremantle Hospital occupational therapist Kate Ballard said Mr Devine refused her offer of a referral to an incontinence adviser and to the MS Society. He also rejected an offer of a home visit and a free ramp at the front of their home. But in hindsight, Ms Ballard admitted she might have pushed for a home visit "in stronger terms."
Police said they didn't look into why she was so thin because the pathologist told them that Multiple Sclerosis was responsible for her body wasting away. But that wasn't true, the reason she was so pitifully thin was because she wasn't getting enough liquid food through a tube into her stomach. The inquest heard that she needed 532 cans of nourishment during the last few months of her life but only received 288 cans.
Janene's 88 year old mother Margaret Cannard said she visited her daughter at her home in April 2007. She and her husband were not invited into the home and had to visit with her in the front yard. Her husband wheeled her out in a "lazy boy" and it soon became clear that her daughter could not see, hear or move. Four days later she was dead.
Margaret Cannard said she thought her daughter should have been in a home or at least registered with a care service but she didn't raise the issue with her husband because "I couldn't have told him anything" she said "He knew everything."
Mrs Cannard received a note from Andrew Devine two years before she died which said he was going to kill them both. A few days later she got another note telling her to ignore the first one, which she did. But it was enough for her sister to act and she contacted police.
Janene then spent the next seven months being treated at Sir Charles Gairdner Hospital but instead of going into group housing, which she was offered, her husband said staff weren't skilled enough to look after her properly so she was discharged into his care.
A year later, Janene was admitted to Fremantle Hospital in a "state of decreased consciousness" and weighed 40 kilos. Again she was discharged into her husband's care after he explained that as a registered nurse, he was trained to administer food via a tube into her stomach. But reports show that the "number of cans ordered through the hospital could not possibly sustain her through until the day she died."
Andrew Devine's evidence was suppressed when his lawyer argued that the testimony was so incriminating, it could prejudice a future jury. The case will be referred to the Director of Public Prosecutions if evidence of a crime is found.
This case brings home the dilemma faced by family members who object to their loved one's choice of partners, but are loathe to intervene. It reminds us that we must.
The inquest continues.
Edit December 2012: A forensic report found her death was consistent with late stage Multiple Sclerosis in association with underlying Sepsis. Sepsis is an illness in which the body has a severe response to bacteria or other germs. This response may be called Systemic Inflammatory Response Syndrome (SIRS). Because of an already weakened immune system, those with MS must be extra careful in avoiding germs.
Forensic pathologist Jodie White said she could not rule out malnutrition had contributed to the death, or positional asphyxia, where breathing is interrupted by an item such as a pillow. The court heard Janene Devine's husband Andrew told police at the time he suspected his wife had suffocted but he did not want to make a statement because he thought he would be blamed.
Outside court, Mr Devine said he was glad the matter was finally being heard. "I'm very pleased that my family can move on from this" he said. "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." Mr Devine says he would leave it to the courts to decide whether his name would be cleared.