TORONTO -- Prescribing medication for an agitated inmate by phone was a perfectly normal practice that relied heavily on the prison nurse to convey accurate information, a psychiatrist testified Tuesday.

Dr. Michelle Roy also told the Ashley Smith inquest that she expected the injected tranquilizers she prescribed for Smith to be offered to, not forced on, the disturbed teen.

"The nurse would give me the clinical picture of a patient who would need emergency treatment," Roy said.

"The nurse is on site. She has to assess the patient. It's the nurse's job to do that."

CAUTION: THIS STORY HAS GRAPHIC CONTENT.

Roy testified about a particularly harrowing day in July 2007, when the prison nurse at Joliette Institution for Women in Montreal called to describe "a very problematic situation."

The teenager, who had a propensity to self-harm and whose mental health had been deteriorating after years in segregation and multiple prison transfers, was in a severely agitated state.

"It was a very dramatic situation," Roy testified.

"She had objects in her vagina. She was bleeding. There was a possibility of electrocution."

Roy advised the nurse to put Smith in four-point restraints, prescribed a powerful tranquilizer, and recommended a transfer to the general hospital for an internal exam.

"My expectation when I gave those orders was to inform security that this patient must be put on restraints immediately, and then offer her medication," Roy said.

"The most important thing was to calm her down."

Roy said no one ever informed her in subsequent calls that Smith had been injected over her objections. The drugs did not seem to be effective in calming her down anyway.

The nurse would call to say Smith was still extremely agitated, and was trying to overturn the gurney to which she was strapped.

"The description at that time was very dramatic," Roy said. "I was assuming that she was out of control."

Over a period of about 10 hours, the psychiatrist ended up prescribing five sets of injections for the physically restrained teen -- believing the inmate was accepting them voluntarily.

Roy also told the inquest that the emergency room doctor at the nearby hospital said he would refuse to do an internal examination without consent, so Smith was not transferred.

In addition, a doctor at the Philippe Pinel Institute, a nearby psychiatric hospital from which Smith had been transferred, refused the following day to admit her on an emergency basis.

"Her opinion was Ashley had a very severe behavioural problem and that we would be able to manage her in a penitentiary," Roy said.

Roy said she never met Smith, who was moved to Joliette in July 2007. All she received was a small medical file that contained "very little information."

"There was absolutely no information from psychiatrists in the file," Roy testified.

She also believed Smith would only be there for a few days before being moved yet again to her "home" prison in Nova Scotia. In fact, Smith spent a month at Joliette.

Smith, of Moncton, N.B., was 19 when she choked herself to death in her segregation cell in Kitchener, Ont., in October 2007.