Psychiatric referral for veteran who killed family, himself, delayed over lack of family doctor, inquiry hears

At the time Lionel Desmond was referred to the Occupational Stress Injury Clinic in Halifax, the new facility was turning away veterans who didn't have family doctors, a fatality inquiry into the Afghanistan veteran's fatal shooting of his family and himself heard Thursday. 

Numerous witnesses have testified at the inquiry in Port Hawkesbury, N.S., about the care Desmond received from the time he was released from the military in June 2015 to the evening of Jan. 3, 2017, when he shot his wife, Shanna, his daughter, Aaliyah, his mother, Brenda, and finally himself at his in-laws' home in Upper Big Tracadie, N.S. The purpose of the inquiry is to consider how to prevent future deaths.

After Desmond's military release, he had been a patient at the Occupational Stress Injury (OSI) Clinic in Fredericton, N.B., a Veterans Affairs-funded outpatient facility that treats former soldiers who develop mental illness as a result of their service. Desmond himself had been diagnosed with severe post-traumatic stress disorder. 

He was sent to take part in an inpatient psychiatric facility at Ste. Anne's hospital in Montreal. When Desmond left that facility in August 2016, he moved home to Nova Scotia to be with his family. His care team back in New Brunswick wanted their counterparts in Nova Scotia to follow up with him. But their referral was unsuccessful. 

Derek Leduc, the former operations manager at the Nova Scotia OSI Clinic, told the inquiry on Thursday that the clinic would only accept referrals from a client's Veterans Affairs case manager. 

But when Desmond's case manager connected with the clinic, a nursing note from October 2016 suggested that she was unable to complete the referral. Instead, the note said that she would follow-up with her client to see whether he had a family doctor and would then send along his file for psychiatry services. 

The note also stated that Desmond would seek therapy in his home community of Guysborough, N.S., roughly 260 kilometres away from the clinic.

Gaps in Desmond's follow-up care

One of the inquiry's mandates is whether the veteran had appropriate access to mental health care. That's also expected to be a focal point for the judge's recommendations.

Shane Russell, inquiry counsel, suggested to Leduc that the Nova Scotia OSI Clinic was admitting patients in 2016 in a way that was inequitable. 

"It sounds like you drew a very hard line in the sand, that you were shutting one of the doors to access OSI services," Russell said. "Did you contemplate what was on the other side for those who were trying to seek it in the community?"

Leduc said that access would have been part of their discussion but, at the time, they had one psychiatrist and that person was working just four days a week.

The inquiry has already heard from a nurse at the Nova Scotia OSI Clinic that there was a wait of about two months to see a psychiatrist. 

Leduc said that the psychiatrist would primarily do disability assessments and medication management — and relied on a family doctor to do follow-up care. 

Many former soldiers, however, did not have a civilian family doctor if they had only recently left the military, Leduc acknowledged.

And it would likely take some time for them to get one — in the fall of 2016, about 40,000 people were on a provincial waitlist for a family physician, according to provincial data.

That prompted the clinic to make a change: Leduc said he asked Veterans Affairs to fund an in-house physician, a recommendation that was approved on Dec. 13, 2016.