Doctor who signed off on Lionel Desmond's firearms licence says he didn't pose risk

The doctor who signed off on Lionel Desmond's firearms licence review did so in the same visit the Afghanistan veteran told him he'd been referred to an in-patient program to treat his complex post-traumatic stress disorder.

On day 15 of the inquiry looking into the circumstances leading up to the Jan. 3, 2017, tragedy that saw Desmond shoot dead his wife Shanna, his daughter Aaliyah, his mother Brenda and then himself, Dr. Paul Smith said he hadn't thought his medical opinion would be the only one the firearms office would consider in its review.

He also noted that all he had to do was put a check mark in a box that said he didn't consider his patient a risk to himself or to the public by owning a firearm.

"I was only a link in the chain of decision-making," he testified at the inquiry in Guysborough, N.S. "I didn't think I was the final decision-maker here."

But his note proved to be the key factor in influencing New Brunswick's acting chief firearms officer to reinstate Desmond's licence, according to her testimony last week.

Lysa Rossignol testified that even as she learned of another police call connected to Desmond during the review, she felt Smith's medical note vouched for the veteran's mental well-being.

However, she also said if she'd known Desmond would soon undergo in-patient treatment for what his military psychiatrist described as severe PTSD symptoms, she would not have reinstated the licence.

As the number of witnesses at the inquiry grows, it's become apparent that many had information that others say they would have liked to know, but with various public institutions using different online databases, there was no easy way to share it.

Smith not only knew that Desmond was going to get that in-patient treatment, he testified Monday it would have been a great opportunity for the veteran.

When asked by inquiry counsel why he still filled out the medical form for the firearms licence, the doctor said that Desmond had never seemed suicidal when they met, and that he appeared to be stabilizing since Smith started him on medical cannabis in July 2015.

"What I knew Lionel to be was anything [but] someone [who was] unstable or unsafe to himself or others," Smith said.

But he also noted he told Desmond not to expect to get his guns or licence back, given his arrest under New Brunswick's Mental Health Protection Act in November 2015 following a suicide attempt.

Smith said Desmond described that incident as "embarrassing" and overblown.

Changes to medical form

Smith noted several times that the form he filled out only included a check box and room for a one-line notation, something he testified he thought was a flaw.

"The new forms that they developed are wonderful," he said. "They ask questions that should be asked that were not asked here."

The revised medical questionnaire issued for a firearms licence review collects a more detailed history to create a better picture of the applicant's well-being.

The New Brunswick firearms office started using it in February 2017, a month after the deaths of the Desmond family, and it was created largely in response to the tragedy, the office's former director testified last week.

Cannabis and PTSD

The Afghanistan veteran first met Smith in July 2015 when he decided to stop using his pharmaceutical medication and wanted to try medical cannabis.

Smith testified that between 85 and 90 per cent of the veterans he treats respond to cannabis, both for pain relief and in managing anxiety, insomnia and other symptoms of trauma.

He authored a study in 2015 involving 100 veterans, which "found it was very effective in symptom relief; our numbers were probably in the 50 to 60 per cent range of improvement," he said. He agreed with inquiry counsel that he would like to see those results reproduced with a larger sample size.

Smith felt that Desmond might respond to cannabis and put him on a trial treatment. He prescribed up to 10 grams — or the equivalent of 20 joints — per day, although he noted that his practice was to encourage his patients to use oils.

Smith said his patients start with a much smaller dose and slowly work up to a maximum of 10 grams, but would take less if their symptoms responded to a lower dose.

After three months, Desmond returned and reported that his anxiety, poor sleeping, anger, agitation and chronic pain had significantly diminished since using cannabis, Smith testified.

During that time, the veteran wasn't using any other prescription drugs, according to what he'd told Smith.

There are questions, however, about the efficacy of the treatment as Desmond later told another psychiatrist that he felt the medical marijuana increased paranoid thoughts about his wife being unfaithful.

In preparation for starting his in-patient program in Montreal, Desmond stopped taking cannabis in February 2016.

Smith will face cross-examination Tuesday morning.