A Tasmanian woman weighed just 19.1 kilograms and had no subcutaneous body fat stores when she died of starvation, an inquest has heard.
Patricia Iliev, 57, died in March 2021 at her home in Sheffield after being immobile on the couch for about eight weeks and having ceased eating during that time.
Ms Iliev had received no medical attention since 1988 but had been cared for by her partner Philip Adams since 2020 after a back injury restricted her mobility.
Over the last decades of her life, Ms Iliev suffered multiple painful back injuries which ultimately led to her buying mobility aids and no longer leaving her home from late 2020.
Ms Iliev was living in the northern Tasmanian town of Sheffield at the time of her death. (ABC News: Piia Wirsu)
A coronial inquest was held across multiple hearings at Devonport and Launceston between May 2022 and September 2024, with findings handed down in August 2025.
It explored the circumstances of Ms Iliev’s death and if any aspects of Mr Adams’ care may have contributed to her passing.
The coroner found Mr Adams could have done more, but ultimately did not do any act to maliciously cause her death.
Partner tried to dodge questioning
In the pre-inquest process, Mr Adams was told he had been identified as an interested party and adverse findings might be made against him.
Mr Adams attempted to refuse to answer questions, claiming privilege against self-incrimination — but coroner Olivia McTaggart said he was not entitled to invoke the claim.
In March 2024, Mr Adams appeared at the inquest in Devonport, but refused to go into the witness box or answer questions from lawyers.
He was charged with one count of contempt of court and, after initially pleading not guilty, entered a guilty plea and apologised to the coroner.
Mr Adams gave evidence that he found Ms Iliev deceased on the couch after coming in from spending a couple of hours in the garden.
The inquest heard he spent several hours mourning, cleaning and dressing her before contacting a telephone health service.
Paramedics and police who attended the scene described Ms Iliev as having a severely emaciated and pallid appearance.
The inquest heard Ms Iliev did not leave her Sheffield home in the months leading up to her death. (ABC News: Luke Bowden)
Starvation was identified as the primary cause of death, in an autopsy conducted by Dr Donald Ritchey.
Dr Ritchey wrote that Ms Iliev had less than half the normal body mass index and that she “weighed only 19.1kg and had no subcutaneous body fat stores”.
A gastrointestinal stromal tumour of the stomach — a type of cancer — and advanced lung disease caused by smoking were listed as secondary causes of death.
The pathology report said it was likely the tumour caused Ms Iliev to have a depressed appetite, and that individuals with advanced emphysema are also at risk of wasting syndrome — which can lead to severe weight loss.
Shopkeeper remembered ‘bird-like’ person
Among the witnesses to appear before the coronial inquest was Jennifer Sargeant, a local shopkeeper who would occasionally chat with Ms Iliev.
The shopkeeper described Ms Iliev as a “tiny and bird-like” person who was “frail”, “always stooped to her shoulders” and who refused to see doctors for her back injury.
In June 2018, Ms Sargeant spoke to another business owner, discussing that they had not seen Ms Iliev for well over six months.
They asked police to conduct a welfare check on her at that time.
A second welfare check was then conducted on Ms Iliev in August 2019 — which was the last time anyone other than Mr Adams saw her alive.
The inquest also heard a neighbour who lived next door to the couple for more than 14 years had very little to do with them and did not know their names.
Inquest considered partner’s role in death
The inquest considered whether Ms Iliev was reliant on Mr Adams for her basic needs, including food, water and health care, and the adequacy of care he provided.
It looked at whether any aspects of the care contributed to her death, to what extent Mr Adams was following Ms Iliev’s directions and whether she had any capacity to make decisions about her medical care.
Mr Adams gave evidence Ms Iliev was a very light eater and had never weighed more than 35 kilograms in the time he had known her.
He said she became “pretty much confined to the couch” as it was more comfortable and she found it easier to use a bedpan and bottle in the lounge room instead of the toilet.
The inquiry heard in the six months leading up to her death, Ms Iliev gradually decreased her food intake to one meal a day to reduce the amount she had to use the bedpan or plastic bag.
Mr Adams said that in her final week, Ms Iliev told him: “Philip, I’ve decided to stop eating.”
He said they did not specify a time when she would resume eating, but she said: “I’ll let you know.”
In written evidence, Mr Adams said it was not Ms Iliev’s intention to die and that she had successfully used diet restriction throughout her life to achieve her desired health outcomes — including once completing a 15-day fast.
The inquiry heard she slipped into a deep sleep two to three days before her death and was not responsive, was not talking properly and confused about the time of day.
Mr Adams said he considered seeking medical treatment for his partner, but chose not to because he was aware she did not want any medical intervention.
Partner did not act maliciously, coroner finds
In handing down her findings, Ms McTaggart described the circumstances as a “sad and confronting case”.
She said it was clear from the evidence that Ms Iliev’s back pain and other conditions could have been effectively treated through conventional medical treatment.
Ms McTaggart said medical treatment could have saved Ms Iliev’s life, even in the later stages.
Coroner Olivia McTaggart described Ms Iliev’s death as a “sad and confronting case”. (ABC News: Luke Bowden)
The coroner said if Ms Iliev had prepared an Advanced Care Directive which stated she did not wish to receive medical assistance, it would have greatly helped authorities and may have eliminated the need for a protracted public inquest.
“As it stood, the only evidence available was from Mr Adams, and his evidence that her death was unexpected and unintentional is not credible,” Ms McTaggart said.
The coroner found it was implausible that Mr Adams was not aware of the severity of Ms Iliev’s condition.
“I do not accept to the requisite standard his evidence that, in her last days, Ms Iliev was able to express coherently or had decision-making capacity,” Ms McTaggart said.
“I also do not accept his evidence that he was unaware of her dangerously low body weight, that her death was unintended, and that he did not expect Ms Iliev to die.”
Ms McTaggart was also critical of the way Mr Adams handled Ms Iliev’s final week, suggesting he should have intervened to offer her food or get her help.
But the coroner found Mr Adams did not act maliciously or deliberately allow her to die for financial gain.
“Despite the difficulty in determining the facts surrounding Ms Iliev’s death, I am satisfied that Mr Adams did not do any act to maliciously cause her death,” Ms McTaggart said.
“He clearly had affection for her, respected her wishes — or what he believed to be her wishes — and provided her food, water and assistance on the occasions she made requests.”
The coroner said it was possible mental illness played a part in Ms Iliev’s fasting.
Ms Iliev’s brother Kim Iliev was in Coroners Court as the findings were handed down.
He said his sister and Mr Adams had lived a simple life.
“They had an alternative lifestyle, ate wholefoods, vegetarian and regularly fasted, that was all part of their beliefs,” he said.
“They had a long and happy relationship.”