The death of Ann Marie Smith: a shocking case of neglect, or a failure of the system?
The police say when Ann Marie Smith was finally taken to hospital, her flesh was rotting. She was also malnourished.
Doctors at the Royal Adelaide Hospital sought to treat the severe pressure sores on her body. According to detectives, Smith had been sitting in the same woven cane chair for more than a year.
When the surgery was finished, Smith, who had cerebral palsy, was immediately taken into palliative care.
A day later, on 6 April, Ann Marie Smith died. She was 54.
Smith’s case is now the subject of a police major crime investigation, and has prompted a state audit of carer screening processes. This week, the NDIS watchdog launched a independent probe into her death amid growing public outrage.
Her tragic death has again placed an intense spotlight on the treatment of people with disabilities in Australia. It is notable given there is already an ongoing royal commission into their abuse, neglect and exploitation.
Federal Greens senator Jordon Steele-John, a disability rights advocate who lives with cerebral palsy, called it a “wake-up call”.
“It is time now to end the blame game, it is time now to end the endless conversation about whose responsibility it is to deal with these issues,” he told the Guardian.
“We need to take it on as a whole of society responsibility and work together so we don’t lose people in these circumstances.”
Federal Labor’s NDIS spokesman, Bill Shorten, said the independent investigation the opposition had campaigned for into Smith’s death should also examine the case of David Harris. Harris was an NDIS participant who was last year found dead in his house after his supports had been cut off, although the agency denies any wrongdoing.
More cases have emerged in recent days. Police in Queensland laid murder charges against the father of fouryear-old Willow Dunn, who lived with Down’s syndrome and allegedly starved to death.
Also this week, two autistic teenage boys were found by Brisbane paramedics living in squalid conditions. It is alleged they were locked in a room wearing only nappies.
On Friday, the Queensland government announced both cases will now be investigated by the state’s Child and Family Commission.
Smith was receiving full-time care
Ann Marie Smith had been receiving full-time care, six hours a day, seven days a week since 2013. She had been supported by the state-based Disability SA until 2018, when the introduction of the NDIS meant she moved to Integrity Care.
She had a sole carer, according to police, who has been identified as Hectorville woman Rosa Maione.
Smith had lived alone in Kensington Gardens in Adelaide’s eastern suburbs since 2009, when her parents died. It is alleged she may not have left the house in some time.
“The outside of the house gives no indication into the horrors that were perhaps occurring within it,” the SA police Detective Superintendent Des Bray said as he launched a public appeal for information earlier this month.
The police investigation is expected to be “protracted and complex” and will rely on medical experts. There would be a “significant focus” on Smith’s financial affairs.
No charges have been laid.
An old photo distributed to the media showed Smith healthy and smiling. But Bray said in recent years Smith had been completely unable to bathe or feed herself. She could no longer use a wheelchair.
On 5 April Smith’s carer became concerned about her condition, detectives say.
Paramedics came to the house, but a day later she died in hospital of profound septic shock and multiple organ failure from severe pressure sores and issues connected with her cerebral palsy. She was also found to be suffering from malnutrition.
Shocked by her condition, the doctors who treated Smith contacted the Health and Community Services Complaints Commissioner.
Bray alleged Smith had lived in the same woven cane chair in the lounge room for over a year.
“That chair had also become her toilet,” he said. “There was no fridge in the house and investigators were unable to locate any nutritional food in the house.”
Asked how it was that police believed Smith had not been found, Bray said: “It’s not so much a matter of not being found.
“Every day, she has a carer come in. The question for us is how did Ann become so unwell when she has a fulltime carer and people … entrusted with her care.”
At the press conference launching a public call for information, Bray noted the plan Smith was receiving was called a “person-centered support plan”.
He said there would be two concurrent investigations: a coronial probe and a manslaughter investigation conducted by police. They had already seized records from Integrity Care, and interviewed Maoine.
NDIS watchdog accused of inaction
On 17 May, Smith’s carer was sacked by NDIS provider Integrity Care. On Monday, a SA Parliamentary Committee heard neither the carer nor the providers had applied for a disability employee screening until after Smith’s death.
Last week, amid growing public anger, the NDIS Quality and Safeguards Commission, which regulates NDIS providers, announced a $12,600 fine against Integrity Care for failing to report her death within the required 24 hours.
In fact, the commission only learned of Smith’s death from the South Australian Health and Community Service Complaints Commissioner two weeks later.
Shorten described the penalty as the “equivalent of a speeding fine” while Steele-John said it was less than 5% of the potential penalty available to the commission.
“They can fine somebody $250,000,” Steele-John said. “Yet somebody in the commission decided $12,600 was enough. That to me speaks to a cultural problem within the commission.”
The commission maintained it was only an initial action. On Wednesday, it went on to announce former federal court judge Alan Robertson SC would investigate the regulation of the provider that was responsible for supporting Smith.
It means Robertson will be tasked with investigating the commission, whose role is to keep NDIS providers accountable within a $22bn scheme that covers 360,000 people.
There is now growing frustration with the watchdog, which was widely welcomed when established by the Coalition in 2018.
Steele-John said he raised with a “heavy heart” the question of whether the commission was doing its job properly.
Guardian Australia this week reported that the watchdog had taken action against only 17 individuals and seven providers over an 18-month period in which it received 74,000 incident reports.
Shorten also said the commission had questions to answer. “The paid support worker, they’ll investigate their role, they’ll investigate Integrity Care, but I want to know, what was the NDIA doing just paying out the money and not checking if the person was getting value?
“What was the watchdog [doing]? I mean, it’s got teeth, but I don’t know if there’s any evidence that it actually bites anything.”
The federal NDIS minister, Stuart Robert, who has faced criticism over the government’s response to the Smith case, said the law prevented him from directing the commission to open an independent inquiry.
But he welcomed the inquiry, saying Smith’s death was “absolutely shocking” and the circumstances that led to it “must never be allowed to happen again”.
On Adelaide radio this week, Robert was repeatedly pressed on how many times Smith had been checked before her death.
He said he was aware of the figure, but declined to reveal it.
“I’m going to wait until the inquiry produces all the information so all Australians can make proper judgments and we can get to the bottom of it,” he said.
Robertson will hand his report into Smith’s death to the NDIS commissioner, Graeme Head, on 31 August.
Crisis support services can be reached 24 hours a day: Lifeline 13 11 14; Suicide Call Back Service 1300 659 467; Kids Helpline 1800 55 1800; MensLine Australia 1300 78 99 78; Beyond Blue 1300 22 463
Anyone with information should call Crime Stoppers on 1800 333 000 or report online at www.crimestopperssa.com.au – information can be provided anonymously.
Do you know more? luke.henriquesgomes@theguardian.com