GUYSBOROUGH, N.S. -- Two days before former soldier Lionel Desmond used a rifle to fatally shoot three members of his family and then kill himself, his wife Shanna told him to leave their home in rural Nova Scotia after a heated argument, a fatality inquiry heard Monday.

On its first full day of hearings, the inquiry heard that Desmond, an Afghan war veteran diagnosed with PTSD, followed his wife's advice and presented himself at the emergency room at St. Martha's Regional Hospital in Antigonish, N.S., on Jan. 1, 2017.

Lawyer Stewart Hayne, who represents doctors who tried to help Desmond, said the evidence will show the 33-year-old former infantryman first met with Dr. Justin Clark, who noted Desmond was not in distress and did not have any suicidal or homicidal thoughts.

Hayne, in his opening statement to the inquiry, said Desmond later met with a psychiatrist, Dr. Faisal Rahman, who noted Desmond was "pleasant, forthcoming, engaging, respectful and a proud father."

The lawyer said Rahman will tell the inquiry that Desmond confirmed he had an altercation with his wife earlier in the evening, and he asked Rahman if he could spend the night in the hospital to "reflect and regroup."

Desmond told the doctor that he had hit or punched a table during the argument, and he said he felt badly about frightening his 10-year-old daughter Aaliyah, Hayne said.

Hayne said Rahman, the chief of psychiatry with the provincial health authority's eastern zone, will testify that Desmond "was not agitated," and his reactions were appropriate.

As well, Hayne said the doctor will tell the inquiry that Desmond insisted he did not physically abuse his wife.

Rahman, who has experience working with veterans with post-traumatic stress disorder, told Desmond he could spend the night in the hospital's emergency observation room.

Hayne said Desmond was released the next day after Rahman determined the former infantryman was "coherent and logical."

"Dr. Rahman did not believe that Mr. Desmond required hospitalization," Hayne said, adding that Rahman concluded: "Patient feeling better. Requesting discharge. Will be discharged to home."

Rahman again noted that Desmond did not display any suicidal or homicidal tendencies.

The recollections of the doctors are important because some of Desmond's friends and relatives have long complained he was turned away from the hospital before the killings.

On Jan. 3, 2017, Desmond bought a rifle and shot his wife, daughter and his 52-year-old mother Brenda before turning the gun on himself in their modest home in Upper Big Tracadie.

Desmond, a retired corporal who served with the 2nd Battalion, Royal Canadian Regiment, had been diagnosed with PTSD after two particularly violent tours in Afghanistan in 2007.

The inquiry will examine whether Desmond had access to mental health and domestic violence services -- and whether he should have been able to buy a rifle.

Nova Scotia's chief medical examiner, Dr. Matthew Bowes, told the inquiry that communication snafus between government agencies may constitute a systemic failure in this tragic case.

"The transfer of information seemed to be too complicated and may have been a barrier to Mr. Desmond's care," said Bowes, the provincial official whose investigation of the Desmond case led to the establishment of the inquiry.

"The fact that our system placed a gun in this man's hands, for me, is problematic," he added. "Most reasonable people would (conclude) that someone who's acutely mentally ill should not have access to a gun."

Hayne said Dr. Paul Smith, a family physician who worked at Canadian Forces Base Gagetown in New Brunswick, was the man responsible for granting Desmond approval for a firearms licence, even though he was aware of his PTSD diagnosis.

The inquiry heard that Smith had prescribed medical marijuana for Desmond in July 2015 to help him cope with a major depressive disorder and PTSD. Three months later, Desmond told Smith the drug had helped reduce his anxiety and depression, while virtually eliminating his suicidal thoughts.

However, Hayne said Desmond had stopped using medical marijuana by February 2016, which is when Desmond asked Smith to sign off on a medical assessment form for a firearms licence.

Though Smith was aware that Desmond was experiencing marital problems, he "felt comfortable completing the form indicating that he had no concerns that Mr. Desmond posed a safety risk to himself or others," Hayne said.

"Since learning of the (killings), Dr. Smith has had feelings of sadness that his assessment may have enabled Mr. Desmond to purchase and obtain a gun."

This report by The Canadian Press was first published Jan. 27, 2020.