PORT HAWKESBURY, N.S. -- The manager of a Halifax-area mental health clinic for military veterans testified Thursday that the facility doesn't require patients to have a family physician before accessing its services, but such a rule may have previously existed.

The issue of whether a family doctor is required surfaced this week during the fataility inquiry, which is trying to determine why Afghanistan war veteran Lionel Desmond fatally shot his wife, daughter and mother in Upper Big Tracadie, N.S., on Jan. 3, 2017.

In testimony Tuesday, the inquiry was told by a former intake nurse at the clinic, Natasha Tofflemire, that a case manager told her Veterans Affairs couldn't refer Desmond to the clinic for psychiatric treatment until it was confirmed he had a family doctor.

Patrick Daigle, the current manager for the Operational Stress Injury Clinic for veterans in Dartmouth, N.S.. was questioned on the issue Thursday by fatality inquiry counsel Shane Russell. Daigle said there is no current requirement for someone to have a family physician, but there may have been previously.

"It wasn't a rule when I came to the clinic in February of 2018" he said. "I think there may have been something in place prior to that."

Tofflemire had testified that her conversation with the case manager took place on Oct. 6, 2016 -- two months after Desmond moved back to Nova Scotia after receiving counselling and therapy at Ste. Anne's Hospital in Montreal.

She said that at that point the clinic placed Desmond's file "on hold,"' which meant nothing would happen until Veterans Affairs asked for more help. She said the federal department never called back, adding that she left her position about a week later.

Daigle told the commissioner of the inquiry, Warren Zimmer, that he recently talked to the clinic's former manager and though he's not sure of the details, he believes guidelines around the need for a family doctor were in place but have since changed.

The clinic has since added a family physician to its staff. Daigle said the former manager told him the idea of adding a family physician predated "the tragic events" of January 2017.

In other testimony Thursday, clinic director Dr. Abraham Rudnick confirmed the family doctor was part of an expansion of staff that occurred after he took over in the fall of 2018.

Rudnick also told the inquiry that better national data is needed about how to properly treat veterans for conditions such as post-traumatic stress disorder.

He said "robust and systematically collected data" could help with better treatment planning.

"We need statistics for that to know what works and what doesn't work at all those levels of the (system) journey by a soldier and then a veteran," said Rudnick.

He said otherwise, there may be instances where health providers are "spinning our wheels" and providing treatment options that are not effective.

"We may have gaps that are not identified," he said.

Rudnick said research from the Veterans Administration in the United States indicates about 50 per cent of people with military PTSD respond well to current treatments, showing that more research and development is needed.

The inquiry has heard that Desmond struggled to find help for his worsening PTSD symptoms after he left Ste. Anne's Hospital in Montreal on Aug. 15, 2016.

This report by The Canadian Press was first published March 11, 2021.