The psychiatrist who oversaw Steven Rigby's release from a mental health facility two days before he was fatally shot by Saskatoon police officers says she tried to convince Rigby to remain in care at a mental health facility.
"I strongly encouraged him to stay in hospital," said Dr. Monika Hooper, the final witness in a coroner's inquest into Rigby's death.
Rigby, 27, died in an altercation with Saskatoon police officers on the outskirts of the city on Dec. 22, 2018, two days after he left the facility.
The inquest has heard from police witnesses who testified they were acting on information that Rigby was suicidal and that he wanted to get in a police shootout or provoke officers to shoot him. Three local officers who shot Rigby testified that he pointed his gun at or toward other police members.
The week-long inquest is not a criminal process. Its six jurors are tasked with coming up with practical recommendations to prevent deaths like Rigby's in the future.
Rigby's final 3 days
Saskatoon police officers brought Rigby to the emergency room at Royal University Hospital on Dec. 19, 2018, after he went on a bender. Rigby was an alcoholic who suffered from anxiety and depression, according to his family.
The inquest heard Thursday afternoon and Friday morning from the two psychiatrists who treated Rigby after he was brought to the E.R.
Dr. John Wagner, a crisis intervention psychiatrist at the hospital, committed Rigby to the nearby Irene and Les Dubé Centre for Mental Health.
Wagner didn't have a distinct memory of his psychiatric assessment interview with Rigby and relied on his notes during his testimony. But he did remember Rigby's mother, Carey Rigby-Wilcox.
Rigby was ambivalent about treatment and resistant to being involuntarily admitted to the Dubé centre. His mother was worried about him — and specifically concerned "that he would die by suicide by cop or police-involved shooting," Wagner said.
Wagner concluded Rigby was at acute risk of suicide and might have an alcohol-induced depressive disorder, an alcohol abuse disorder and narcissistic personality traits. He also made note of a suicide attempt Rigby made in August 2018 and ultimately committed him to the Dubé centre.
"I don't think he appreciated some of the concerns about the risk to self," said Wagner, who was early in his career as a licensed psychiatrist in 2018. "I erred on the side of caution."
Such calls often cause a rift in the "therapeutic alliance" he's trying to build with a patient, he said.
"People get really mad at me, and I go from being their favourite psychiatrist to their worst sometimes."
A 2nd opinion
When one psychiatrist commits a person in Saskatchewan, a second must reassess the patient within 72 hours to determine whether they still meet the criteria for involuntary admission.
In Rigby's case, that was Dr. Monika Hooper, the final witness to testify during the inquest. Hooper said she reviewed Wagner's notes and then met Rigby on Dec. 20.
People who are committed need to meet three criteria for remaining in care against their will, including lacking the capacity to make decisions about their treatment.
Hooper said Rigby was discharged because she found he had that ability. She also noted he was not expressing suicidal thoughts or plans when she saw him and did not wish to remain at the Dubé centre on a voluntary basis.
As Wagner explained in his own testimony, "If someone has capacity to decide whether they want to remain in hospital, [we] can't keep them there."
Hooper said a person can have capacity and be suicidal at the same time.
"I still felt that he was at risk of deterioration. I accepted that he was at risk of self-harm," she said of Rigby. "But I also knew that he didn't meet criteria under the Mental Health Act to be forced to stay in hospital."
Rigby said he was only suicidal when he drank, she said.
According to Hooper's progress notes about Rigby, which she read out during the inquest, Rigby seemed "calm, coherent, organized" and there was "no indication that he lacks capacity to make treatment decisions."
Rigby was offered ongoing hospitalization to monitor for seizures and delirium tremens, a severe form of alcohol withdrawal that causes confusion and can be associated with death.
"He was advised of risks and advised to go to E.R. in the event of tremors, sweating and hallucinations."
A suicide assessment risk was not conducted on Rigby, Hooper said.
"Maybe I should have," she said under questioning by coroner's counsel Robin Ritter. "I do want to say that wouldn't have changed my ruling that he had capacity to make his own decisions."
Hooper did not think Rigby was an imminent threat and so did not break patient confidentiality and reach out to any police authorities, she said.
She said she had a lengthy discussion in which she encouraged him to stay.
If Rigby had been able to connect with more outpatient resources in the past, his trajectory might have been different, she said.
Discharging doctor 'clearly upset' about death
Brian Pfefferle, the lawyer for Rigby's family, asked Wagner, the doctor who committed Rigby, if, knowing what happened to Rigby, he was surprised that Rigby was discharged so quickly from the Dubé centre.
Wagner said he does not recall being particularly surprised and that he's been in Hooper's shoes himself.
"I have admitted people involuntarily and then discharged them the next day because things have evolved very quickly," he said.
"It really depends on each patient, each encounter."
Suicide risk can fluctuate over time, he added.
It's harder for a person to recover if they're drinking and have a psychiatric disorder, Wagner said.
"My understanding is that the risk of serious consequences and deaths is higher."
Wagner said that when Hooper learned of Rigby's death, "she was clearly upset. As was I.
"We did our best to console each other."
If you're experiencing suicidal thoughts or having a mental health crisis, help is available. For an emergency or crisis situation, call 911. You can also contact the Saskatchewan suicide prevention line toll-free, 24/7 by calling 1-833-456-4566, texting 45645, or chatting online.
You can contact the Regina mobile crisis services suicide line at 306-525-5333 or Saskatoon mobile crisis line at 306-933-6200.
You can also text CONNECT to 686868 and get immediate support from a crisis responder through the Crisis Text Line, powered by Kids Help Phone.
Kids Help Phone can also be reached at 1-800-668-6868, or you can access live chat counselling at www.kidshelpphone.ca.