Emergency room doctor didn’t see recent medical history, may have impacted assessment

GUYSBOROUGH: The emergency room doctor who assessed retired Cpl. Lionel Desmond two days before he purchased a military-style carbine and killed his mother, wife, and 10-year-old daughter before turning the gun on himself, testified on Monday that the veteran wasn’t considering suicide and not thinking about harming his family.

Dr. Justin Clark told the fatality inquiry he met with Lionel on December 1, 2017 after he was initially assessed by a triage nurse at St. Martha’s Regional Hospital in Antigonish – Lionel received a score of 2, which on a scale of 1 to 5, indicated he required treatment as soon as possible.

Inside the emergency room, Lionel told the physician, who at the time had only six-months experience in emergency rooms, that he was struggling with his post-traumatic stress disorder (PTSD) and that he had an argument with his wife that resulted in broken furniture when he checked himself into the hospital at 6:51 p.m.

“Patient had a bad day today. Argued with partner, walked a lot to try and calm down, feels as not coping well, is looking for admission, calm and speaking quietly,” Dr. Clark’s notes read. “At some point, you do an assessment for risk; you look at risk factors, and protective factors.”

Weeks prior, in October 2016, Lionel had checked himself into St. Martha’s during a crisis situation – he had an appointment with Dr. Ian Slayter, who indicated his experience with nightmares and flashbacks since returning home from Afghanistan in 2007.

Dr. Clark testified he never saw Slayter’s notes from the psychiatric assessment, in which Dr. Slayter suggested the former rifleman seemed aggressive and paranoid about his wife. He had been able to see a record of Lionel’s previous emergency room visit, but the database didn’t include the meeting with Dr. Slayter, nor an instance in New Brunswick where he was suicidal.

Dr. Slayter also found Lionel suffered from thoughts of jealousy that bordered on delusions.

Dr. Clark also indicated he was aware Lionel had been prescribed several medications, including an anti-psychotic drug, but he couldn’t recall noticing Dr. Slayter’s files in the province’s Meditech system.

The inquiry counsel questioned whether a more fulsome electronic medical database would help emergency rooms doctors and pressed on information not included in Dr. Clark’s medical report – previous psychological assessments, private health clinic information, and medical records from the Canadian Forces.

“Having the more information that you can have, especially recent information is much better in terms of getting an overall assessment.”

Dr. Clark said if he had known there were past reports and emergency room visits it may have helped his assessment of Lionel.

He also testified after spending 21-minutes with Lionel and concluded he was stable and didn’t believe he had any suicidal or homicidal thoughts, he contacted a psychiatrist for consultation because he was uncomfortable managing the situation on his own – that assessment happened shortly after 7:30 p.m. by Dr. Faisal Rahman.

Dr. Clark indicated such an immediate response was impressive, as the majority of patients seeking mental health care after 5 p.m., usually have to wait until the following day to see a psychiatrist.

Dr. Rahman also determined Lionel showed no signs of suicidal or homicidal thoughts.

As to what happens next – there are conflicting accounts.

Dr. Clark testified Lionel was kept for observation in the emergency room for the night, because his wife worked on the psychiatric ward – something Dr. Rahman agreed to – however, the inquiry heard from police Lionel had told his aunt he begged to be admitted to the third floor but was told there were no beds – an allegation the hospital continuously has denied.

After being discharged on January 2, the following afternoon Lionel purchased a Remington Model 760 from Leaves and Limbs Sports in Antigonish at 4:15 p.m., changed into full camouflage, parked on a remote logging road behind his wife’s house, slashed the tires on her truck, and entered the Upper Big Tracadie house with a rifle and a box of ammunition.

Within minutes, 52-year-old Brenda, 31-year-old Shanna, and 10-year-old Aaliyah would become victims of homicide, before the 33-year-old Afghanistan war veteran took his own life.

The inquiry’s mandate is to determine the circumstances under which these deaths occurred, as well as some specific issues, including; whether Lionel and his family had access to the appropriate mental health and domestic violence intervention services; whether healthcare and social services providers who interacted with Lionel were trained to recognize the symptoms of occupational stress injuries or domestic violent; and whether Lionel should have been able to retain, or obtain a license enabling him to obtain or purchase a firearm.

At the conclusion of the proceedings, Judge Warren Zimmer will file a written report with the Provincial Court containing his findings and recommendations, but his report will not contain any findings of legal responsibility.

For more on this case, go to: https://porthawkesburyreporter.com/insurance-benefit-ruling-sheds-light-on-desmond-tragedy/.