Cpl. Desmond’s case manager frustrated over delays caused by bureaucratic barriers

PORT HAWKESBURY: Lionel Desmond’s Veterans Affairs-appointed case manager became frustrated, and says the interruption she faced in the retried corporal’s rehabilitation was caused by “significant bureaucratic barriers,” resulting in a four month delay in receiving any clinical services.

Marie-Paule Doucette began her long-awaited testimony on June 22, as she was the 59th and last anticipated witness to be called before the provincial fatality inquiry.

Her role as Desmond’s case manager included assisting him in overcoming barriers to reintegrating into civilian life, which included providing guidance on obtaining treatment, and dealing with other life challenges.

“He felt he needed more support from professionals,” Doucette testified.

She indicated after Desmond was admitted into a rehabilitation program in May 2015, suffering from severe Post-Traumatic Stress Disorder (PTSD), it took six months for her to connect with him, blaming a lack of resources and a backlog of cases caused by cutbacks within the former Conservative government.

“I personally, not as Veterans Affairs but as an individual working there, thought that the delays were a bit much,” Doucette told the inquiry. “There were significant bureaucratic barriers and it complicated the process.”

Despite speaking with Helen Luedee, the clinical care manager on Aug. 16, 2016, just one day after the former infantryman was discharged from an in-patient psychiatric facility where he made “minimal progress,” there was a delay in finding someone to help with his transition to life after the military and in-patient care.

As Desmond was attending the Ste. Anne’s Hospital for in-patient psychiatric treatment, his house in Oromocto, N.B., was sold and he made the decision to return to Nova Scotia immediately after his discharge from the facility, to be with his family.

“It’s out of the ordinary to release someone from in-patient treatment to no resources,” Doucette testified.

She testified that she made the decision to remain Desmond’s case manager, on a provisional basis, following his move, which usually would result in a transfer of case managers, to allow for some continuity of care – which never actually happened.

As for what she could have done differently, Doucette suggested from her interactions with Desmond as his case manager, there was no way for her to predict what would eventually occur on Jan. 3, 2017.

“This was not done out of neglect,” Doucette said as she became emotional.

An internal review conducted four-years-ago by Veterans Affairs following the triple murder-suicide in Upper Big Tracadie established none of their employees made “any procedural errors,” but found 12 areas where the department could increase assisting veterans with complex needs make their transition back into civilian life.

Originally, Veterans Affairs declined to disclose details of the review to the fatality inquiry, claiming that it fell outside the mandate’s scope, but have since changed their minds and the review was made public and released to the inquiry counsel last week.

Among the dozen barriers it identified; case managers were in high demand during the time Desmond was medically-discharged from the military in 2015.

Doucette testified that while on paper, case managers were only supposed to take on 25 veterans at any given time; within a year of being hired she was already working with a caseload of 35-40 clients.

The overwhelming caseload for one individual resulted in her prioritizing her cases and also putting some responsibility on the veteran, who was expected to take some accountability in managing their personal recovery.

“I have to pick and choose what I’m going to sit down with them to help them fill out, because the time that I have to dedicate is already quite limited,” Doucette testified. “So I’m not saying I don’t care, I’m saying that I have to be realistic about what I have to prioritize.”

According to a Veterans Affairs spokesperson, the department has adopted the internal review’s recommendations in at least five of the areas identified.

Of the recommendations identified, adopted or addressed in policy since 2017 have been: the ongoing recruitment of more case managers; connecting veterans to their local Veterans Affairs office before they relocate to another province; better consultation around health-related travel; holding interdisciplinary team meetings to “discuss and take action on” medical recommendations from an occupational stress injury clinic; and a new suicide prevention program.

“The length of time to have a case manager in place is a factor to success and rehabilitation of the client,” the review read. “It is noted that the hiring and retention process is now underway, which could improve the turnaround times noted in the file.”

During her second day of testimony, Doucette suggested she may have benefitted from some form of training in identifying family violence.

“And if there was training specific to detecting risks to homicidal behaviour, that perhaps could have been helpful too,” she explained. “At the time, he was clear that his relationship was difficult.”

Earlier in the week, Shonda Borden, the younger sister of Desmond’s wife, Shanna, testified he underwent a dramatic decline after his medical discharge in 2015. While in the military, he complained about being a victim of anti-Black racism.

She indicated Desmond became more controlling after leaving the military ,and the smallest thing could set him off.

“We used to call it his switch,” Borden said. “It was like walking on egg shells.”

The inquiry has taken a long look at its mandate whether Desmond and his family had access to the appropriate mental health and domestic violence intervention services, whether health care and social services providers who interacted with Desmond were trained to recognize the symptoms of occupational stress injuries or domestic violent, and whether Desmond should have been able to retain, or obtain a license enabling him to possess or purchase a firearm.

As Doucette wrapped up testimony, the provincial inquiry is now expected to meet in September, allowing for all representatives to submit their recommendations to Judge Warren Zimmer for consideration.