The Desmond Fatality Inquiry is being held at the Guysborough Municipal building in Guysborough, N.S. on November 18, 2019. An inquiry investigating why a mentally ill Afghanistan war veteran fatally shot three members of this family before killing himself enters its second week of hearings today. Lionel Desmond, a 33-year-old former infantryman from rural Nova Scotia, killed his mother, wife and 10-year-old daughter before turning a military-style rifle on himself in January 2017. THE CANADIAN PRESS/Andrew Vaughan

GUYSBOROUGH, N.S. - A Nova Scotia doctor who saw Lionel Desmond two days before he killed his family and took his own life told a fatality inquiry Monday the mentally ill former soldier received exceptionally swift care at the local hospital.

Dr. Justin Clark testified that Desmond was initially assessed by a triage nurse at St. Martha's Regional Hospital in Antigonish, N.S., when he sought help following a heated argument with his wife Shanna on the night of Jan. 1, 2017.

Clark told the inquiry Desmond received a score of 2, which on a scale of 1 to 5 indicated he required treatment as soon as possible, given the fact that a score of 1 is regarded as a full-blown emergency.

"You want to see them as soon as possible," said Clark, an emergency room doctor who had only six months experience at the time. "It does suggest urgency."

Desmond's chart indicated he had complained he was suffering from the symptoms of post-traumatic stress disorder and a post-concussion disorder when he entered the hospital just before 7 p.m.

The inquiry has heard that Desmond was diagnosed with PTSD in 2011 after he took part in two particularly violent tours in Afghanistan in 2007. Family and friends have long complained he did not get the help he needed when he returned home to Upper Big Tracadie, N.S., in 2015.

Clark said Desmond's chart indicated he was "not coping well" because he had damaged a piece of furniture in his home while arguing with his wife Shanna earlier in the evening. The chart also indicated Shanna had told him to leave their home for the night.

Desmond told the triage nurse he had not hurt anyone, Clark said.

Last week, the inquiry heard from a senior RCMP investigator, who said an argument over a minor auto accident on New Year's Eve appeared to be the trigger for Desmond's decision to fatally shoot his 31-year-old wife, their 10-year-daughter Aaliyah and his 52-year-old mother Brenda before turning the gun on himself in the family's rural home.

However, Clark said when he met with Desmond shortly after 7 p.m., he found the 33-year-old former infantryman to be "calm, polite and co-operative."

He said Desmond did not appear to have any suicidal or homicidal thoughts during a 21-minute interview in the hospital. Clark said such interviews typically include questions about access to firearms and whether the subject has considered hurting or killing anyone.

On the chart, Clark noted Desmond showed no acute distress and no evidence of psychosis.

Inquiry counsel Shane Russell asked Clark if Desmond appeared nervous, unable to maintain eye contact or had a "flat affect" while speaking.

"Not that I recall," Clark said.

Russell also asked if Clark had seen electronic medical records showing Desmond had two appointments with psychiatrist Ian Slayter in 2016 — on Oct. 24 and Dec. 2.

The inquiry has heard that Desmond complained to Slayter about anxiety, nightmares, depression, angry outbursts and paranoia toward his wife. Slayter also found Desmond suffered from thoughts of jealousy that bordered on delusions.

Clark said he was aware Desmond had been prescribed several medications, including an anti-psychotic drug, but he said he couldn't recall seeing Slayter's files in the province's Meditech system.

Russell asked the doctor several times if that kind of information would have been useful.

"The more information you get about a person, the better," Clark said, noting that he did not have much experience dealing with veterans with PTSD.

The lawyer also asked Clark if he used a checklist to gauge Desmond's suicide risk.

"I suppose you could have a checklist as part of the charts," Clark said. "But those risk factors are something we are expected to know."

Despite Desmond's stable demeanour, Clark said he decided to call on a psychiatrist for a further assessment, which happened shortly after 7:30 p.m. when Dr. Faisal Rahman took over.

Clark said that kind of immediate response was impressive, given the fact that most patients seeking mental health care after 5 p.m. usually have to wait until the next day to see a psychiatrist.

The inquiry has heard that Rahman also found Desmond showed no signs of suicidal or homicidal thoughts, but the psychiatrist decided it would be prudent for Desmond to spend the night in the hospital's emergency observation room.

The recollections of the doctors are important because some of Desmond's friends and relatives had complained he was turned away from the hospital before the killings — an allegation the hospital has denied.

Rahman, who is expected to testify Tuesday, released Desmond from the hospital the next day, Jan. 2, 2017.

On Jan 3, 2017, Desmond fatally shot his family with a military style carbine he had legally purchased earlier in the day.

This report by The Canadian Press was first published Feb. 3, 2020.

— By Michael MacDonald in Halifax.

News from © The Canadian Press, 2020