One of the questions at the heart of the Desmond fatality inquiry is why a veteran with post-traumatic stress disorder was released from hospital just a day before he shot his family and himself.
The emergency room doctor who assessed Lionel Desmond in Antigonish, N.S., testified Monday that the veteran showed no signs that he planned to harm himself or anyone else. He described him as calm and quiet.
Dr. Justin Clark met Desmond on Jan. 1, 2017, two days before the former soldier killed his wife Shanna, his daughter Aaliyah, 10, and his mother Brenda at a mobile home in Upper Big Tracadie, a rural community in eastern Nova Scotia.
In the emergency room, he told the doctor that he had PTSD and that he was struggling. He said he'd had a fight with his wife that ended with broken furniture and her asking him to leave, Dr. Clark testified.
Testimony last week suggested that a minor truck crash set Desmond off on New Year's Eve, something RCMP Cpl. Jerry Rose-Berthiaume described as the catalyst that set the tragedy in motion.
The CBC's Laura Fraser is liveblogged from the courtroom in Guysborough, N.S.
This was not the first time Desmond showed up at St. Martha's Regional Hospital in crisis.
Weeks before, he'd had an appointment with Dr. Ian Slayter, who noted the veteran's experience with nightmares and flashbacks dating back to soon after his tour of Afghanistan in 2007. But the emergency room doctor testified that he never saw Slayter's notes from that psychiatric assessment, in which Slayter noted that the former soldier seemed aggressive and paranoid about his wife.
As the inquiry investigates whether changes can be made to prevent similar deaths, counsel questioned whether a more fulsome electronic medical database would help emergency room doctors.
Clark had been able to see a record of Desmond's previous emergency room visit, but the patient database didn't show the meeting with Slayter, or an instance in New Brunswick where he was suicidal, he testified.
'No harm to family'
Although Clark's notes and his testimony said he didn't believe Desmond was suicidal or homicidal, he called his colleague for a psychiatric consultation.
Clark testified he did that because he didn't have much experience treating veterans with PTSD.
There are differing accounts about what happened next.
Dr. Clark testified that Desmond was kept for observation in the emergency room for the night, because the veteran's wife worked on the psychiatric ward — and that the treating psychiatrist agreed to Desmond's request. But last week, police say that Desmond told his aunt that he'd begged to be admitted to the ward and was told there were no beds.
He was discharged Jan. 2.
The next afternoon, he parked on a remote logging road behind Shanna's family home, dressed in camouflage, carrying a hunting knife, a rifle and a box of ammunition. Within minutes, four people would be dead.
As other health-care workers are called to testify this week, the judge will look at whether they were trained to recognize the effects of PTSD.
Another critical question the judge will be looking to answer is whether those same health-care workers, or anyone else Desmond saw in the days and months leading up to the shooting, were trained to recognize signs of domestic violence.
That's because in the months leading up to her death, Shanna Desmond attended several appointments with her husband. During one of those appointments, a psychiatrist noted that Lionel seemed aggressive toward her and was having paranoid thoughts about her, according to evidence already presented at the inquiry.
The province's chief medical examiner, who called for the inquiry, believes that staff missed signs that Shanna and her family could be at risk.