One thing Abdi's last psychiatrist says he could have done differently
Coroner's inquest focuses on Abdi's final time in hospital
The Abdirahman Abdi inquest is being livestreamed during the day here.
The last psychiatrist to treat Abdirahman Abdi says he could have suggested a different method for Abdi to inject his anti-psychotic drugs, in light of periods when Abdi didn't take his medication due in part to his religious practices.
Dr. Ramprasad Bismil, who was a staff psychiatrist at The Ottawa Hospital in 2016, is the latest witness to testify at the ongoing coroner's inquest into Abdi's death.
Abdi, a 38-year-old Somali-Canadian, struggled for months with mental illness before becoming involved in a violent altercation with two Ottawa police officers and dying in hospital the next day, on July 25, 2016.
The inquest has heard that Abdi was in and out of hospital from February 2016 to July 7 of that year — two weeks before his death.
His mental condition would improve when he took his meds, but he didn't always do that because as a Muslim, he tried to observe religious fasting, the inquest has heard.
Still had 'residual' hallucinations
When Bismil first saw Abdi on July 4, after he'd been admitted involuntarily by another doctor two days earlier, things had taken a turn for the worse.
Abdi was unable to cope in the community and showed a lack of awareness of his own symptoms, including hallucinations, Bismil said.
He had stopped taking medication in early June "to see if he actually required it," and also due to "an attempt to observe religious fasting," according to an agreed statement of facts. He was now speaking to himself, hearing voices and not sleeping. He showed, in sum, signs of "a schizophrenia spectrum illness."
Bismil said once Abdi went back on his meds while in hospital, his condition improved rapidly. Though he still had some "residual" hallucinations, they weren't bothering him and they don't generally mean a person is a danger to the public, Bismil said.
"He was compliant with the treatment. There was no physical aggression.... He also appears to have had a very supportive family who was quite involved in his care."
Bismil said that on July 7, 2016, he offered to keep Abdi at the hospital on a voluntary basis for further observation, as there were still beds available, but the family decided it was not necessary and Abdi himself didn't want to stay there.
Bismil discharged him. Ramadan had finished and "my impression at that point of time was that adherence [for taking his pills] going forward would not be a factor."
Abdi missed a followup appointment on July 19, five days before the arrest that left him hospitalized.
Abdi's postmortem showed no drugs or alcohol in his system, including the anti-psychotic medication he had been prescribed, the trial against one of the arresting police officers heard.
Bismil said he had no information about whether Abdi stuck to his medication after July 7.
No sexually inappropriate behaviour in hospital
Inquest lawyer Maria Stevens asked Bismil if, when he discharged Abdi, he discussed the possibility of injectable medications in order to navigate the conflict between "an ability to fast and take oral medication."
He did not. "That seems to be possibly related to my confidence in the adherence to treatment going forward based on my interactions with Mr. Abdi," Bismil said.
"Knowing what you know now, that he has passed away, that he was still having symptoms, was there anything systemically that you might see as an area for improvement?" Stevens asked.
"In retrospect," Bismil replied, "if the reason for this is for compliance with oral medication, I think injectable medication could have been considered at that point of time, should have been offered to Mr. Abdi."
Patient preference for injectables needs to be considered, Bismil added — a point hammered home by a lawyer for a group that advocates for people living with serious mental health issues.
Injectables are painful and remain in the system for a long time, said Anita Szigeti of the Empowerment Council.
And as Bismil pointed out during Szigeti's cross-examination of him, Abdi would have had to continue taking pills for two weeks after being started on injectables.
Inquests are not legal proceedings but are instead free-ranging fact-finding missions meant to empower jurors to suggest ways deaths like Abdi's can be avoided in the future.
WATCH / The death of Abdirahman Abdi: Here's what you need to know:
Abdi was arrested in a violent altercation on July 24, 2016 because he had groped women in his Hintonburg neighbourhood that morning.
The inquest heard that no sexually inappropriate behaviour was noted during Abdi's hospital stay in early July.
"That would have been flagged very quickly and brought to my attention," Bismil said.
Abdi's patient information indicated he had been aggressive with family members before his admission in early July, but it did not specify whether it was physical or verbal.
"On a balance of probabilities," Bismil said, "it is not likely to be physical aggression because if it was physical aggression I would have probably documented it."
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