GUYSBOROUGH – Physicians from St. Martha's Regional Hospital in Antigonish started giving testimony in the Desmond Fatality Inquiry this week, shedding light on Lionel Desmond's overnight visit to the hospital on Jan. 1, 2017.
Desmond spent that night in observation in the emergency dept. and was seen by ER physician Dr. Justin Clark before being referred to the psychiatrist on duty. The Inquiry has heard evidence suggesting that he told some family members, after he left St. Martha's on Jan. 2, that he had not been able to stay overnight in the mental health unit because it was full. Dr. Clark was asked if there were in fact beds available in the mental health ward on the night Desmond presented at St. Martha’s.
“The only knowledge I have is based off of my conversation with (psychiatrist) Dr. (Faisal) Rahman, who told me that the patient preferred not to go to the ward. So presumably there were (beds available). That was a possibility.”
When asked if this case points to any improvements that can be made to assist ER doctors in such scenarios, in his view, Dr. Clark said it would be beneficial to have access to social workers or a crisis worker outside of daytime hours.
“I think that would be a benefit in this particular case,” he told the Inquiry on Monday, Feb. 3. “I believe the patient presented just before 7 p.m. and he saw a psychiatrist at 8 p.m. So that's very fast. I would say that's not typically what would happen. Typically, patients will wait hours. And usually they wouldn't be seen by a crisis worker or a psychiatrist until the following day if they presented in the evening.
"But generally speaking, I think having more resources outside daytime hours with a crisis team and social workers would be beneficial.”
Dr. Faisal Rahman testified on Tuesday about the 40-minute conversation he had with Cpl. Lionel Desmond after his involvement was requested by Dr. Clark. Dr. Rahman is the NSHA Chief of Psychiatry serving Antigonish, Guysborough and Cape Breton counties. He described Desmond as calm, attentive and forthcoming during their meeting.
Dr. Rahman described his impression of Desmond as a “mixed picture,” and that his state at the time reflected a relationship in turmoil, rather than symptoms of PTSD.
Dr. Rahman said Desmond told him about conflicts between him and his wife, Shanna, including an incident that occurred on New Year’s Eve, following a vehicle accident.
Desmond conveyed to Dr. Rahman that he was a proud father and supported his family financially. According to the psychiatrist's testimony, Desmond said he had paid for Shanna’s tuition for her degree in Nursing, had kept receipts of payment and wasn’t “seeing any money” now that Shanna was an employed nurse.
Desmond declined Dr. Rahman’s request to call Shanna, saying that his wife had asked him to leave and come back the next day. Dr. Rahman said he learned that it was typical in past conflicts between the couple that RCMP would be called, at which point Desmond would leave and stay with a family member.
During his examination on Tuesday morning, Inquiry counsel Allen Murray asked Dr. Rahman about the circumstances surrounding Desmond’s overnight stay at the hospital. Dr. Rahman said that although there were beds available in the mental health unit that night, Lionel expressed his preference to stay out of that particular section of the hospital.
Dr. Rahman then coordinated with the emergency room nurses and Dr. Clark to establish a place for Desmond to stay overnight there. “They were gracious enough to have Lionel stay in the ER,” for observation, he said.
“There were available beds in the observation area on this evening, and they are not stretchers,” Dr. Rahman emphasized, “they are proper medical beds; they are very comfortable.”
On the morning of Jan. 2, Dr. Rahman was still on call in the hospital. He told the Inquiry he got a call from a female staff person at the hospital telling him that Desmond was requesting to be discharged. Dr. Rahman said he asked if there were any concerns and was told by the caller there were none, so he approved the discharge. Dr. Rahman said he thought the caller was emergency room physician Dr. Jane Anne Howard. But it was not.
“Now there's a little bit of an issue here because I thought (it was) the physician Dr. Jane Anne Howard calling me,” he said. “It sounded like Dr. Jane Anne Howard.”
Dr. Rahman said he went down to the emergency department about a half hour after getting the call and then realized it was not Dr. Howard who had called, but rather a nurse in the department.
The psychiatrist then saw Desmond for “not more than five minutes, and he was ready to leave,” he said. Dr. Rahman said he asked Desmond how he was doing and asked him about his medications.
“I reiterated to him to make sure that he makes an appointment with (psychiatrist) Dr. Slayter.” Desmond did return to St. Martha’s the next day, Jan. 3, to make that appointment.
At the hospital on the morning of Jan. 2, Dr. Rahman said he offered to Desmond that he could stay another night if he wanted, noting that staying upstairs in the mental health unit was still an option. “But he did not want to stay,” he told the Inquiry.
Dr. Rahman said he told Desmond “if he wanted to stay and doesn't want to stay in this hospital, we can always transfer him to somewhere else if he wishes.”
“He was not too interested in that,” he said.
Dr. Rahman said he asked Desmond questions that he would ask anyone being discharged from a mental health stay, including: “Do you feel safe to go home? You don't have any thoughts of hurting yourself, hurting anybody else?
“And he said, ‘No, I'm fine to go.’”
Desmond shot and killed his wife Shanna, daughter Aaliyah and mother Brenda the next day, Jan. 3, at a home in Upper Big Tracadie.
The Inquiry continues hearing evidence this week in Guysborough. Video recordings of the proceedings are available on the Desmond Fatality Inquiry website.