An Adelaide disability support worker has been jailed for more than six years for committing one of the most serious examples of manslaughter by criminal neglect South Australia has ever seen that killed NDIS client Ann Marie Smith.
Warning: This story contains details that will be distressing to some readers.
While Rosa Marie Maione, 70, will be eligible for parole in five years and three months, she is expected to be deported to Italy upon her release from prison where she will be an "elderly woman" and "alone in a foreign country".
Ms Smith lived a quiet, isolated life before she became the victim of Maione's gross criminal neglect.
During sentencing, Justice Anne Bampton said her death was preventable.
"It is clear the care of Ann Smith was compromised from the time you became her sole support worker," Justice Bampton said.
"Whilst Ms Smith's autonomous position has to be respected, she required the involvement of her service provider Integrity Care and health providers.
"You had absolutely no insight into Ms Smith's physical condition leading up to her death — your incompetence, lack of training, lack of assertiveness … produced an environment where you failed to provide appropriate care.
"The tragedy is that if you had acknowledged your limitations and sought professional assistance … and if you and Integrity Care had provided that support in a safe and competent manner with skill and care, her death could have been prevented."
Ms Smith's mother was her primary carer until her death some years before her daughter's.
Her brother had become estranged, he told the Supreme Court, after voicing his concerns about "how her support workers were taking advantage of her".
The Supreme Court heard Ms Smith initially had "no issues with decision making" but her mobility declined to the point she was "essentially bed ridden" and lived and slept in a cane chair.
The 54-year-old had become "totally dependent" on Maione, who was paid under the National Disability Insurance Scheme (NDIS) to provide six hours care per day to Ms Smith, seven days a week, plus an additional two hours for cleaning and shopping.
The prosecution said that was not enough as Ms Smith required two carers per day to help with her general care and routine – including washing, toileting, preparing food, feeding and dressing her.
Maione could not lift Ms Smith alone, calling in a gardener to help on at least two occasions.
In 2014 she sustained a shoulder injury, which rendered her unable to continue to care for high needs patients.
Maione knew she was "incapable" of caring for Ms Smith, but she never sought help, prosecutor Lucy Boord SC told the court during sentencing submissions.
Ms Smith slept and went to the toilet in a cane chair that was so badly soiled it was starting to decompose.
"The question has to be asked, what did she do for all of that time at Ann Marie Smith's house?" Ms Boord previously told the court.
"She didn't seek assistance … from either her supervisors or medical professionals before it was too late.
"There is very little of her daily care that was attended to at all."
When Maione eventually rang an ambulance for Ms Smith in April 2020, the NDIS client had a 15-centimetre-deep bed sore that was gangrenous to the point her hip bone was visible.
Ms Smith died from multiple organ failure from the untreated pressure sore.
The court heard a treating doctor described it as one of the worst pressure wounds he had seen in his professional career.
Ms Smith was also dehydrated and malnourished and her skin had significantly broken down on her body's left side.
Her toenails had not been cut in months, she had no bottom teeth and was suffering from advanced gum disease.
Prosecutor Lucy Boord SC previously told the court Maione's "gross neglect" of Ms Smith had spanned several months, but she was never going to be able to pinpoint the exact moment when it started.
Maione apologised to the court for her crime, which she also acknowledged had "caused so much distress in the disability community and people who rely on carers".
Her lawyer, Stephen Ey, said Ann Marie Smith could be a stubborn and difficult person who often refused Maione's offers of medical help because she did not want to go into a nursing home.
Ms Boord said Maione was distancing herself from full responsibility with her explanations ranging from "complete apathy to victim-blaming to blaming Integrity Care".
"This was the defendant's job … she was paid to take care of Ann Marie Smith and she didn't," she previously told the court.
"This is one of the most serious … examples of manslaughter by criminal neglect."
