Military Police Complaints Commission

1 Military Police Complaints Commission 2 3 FYNES PUBLIC INTEREST HEARINGS 4 held pursuant to section 250.38(1) of the National Defence 5 Act, in the matter of file 2011-004 6 7 LES AUDIENCES D'INTÉRÊT PUBLIQUE SUR FYNES 8 tenues en vertu du paragraphe 250.38(1) de la Loi sur la 9 défense nationale pour le dossier 2011-004 10 11 TRANSCRIPT OF PROCEEDINGS 12 held at 270 Albert St., Ottawa, Ontario 13 on Wednesday, April 4, 2012 14 mercredi, le 4 avril 2012 15 16 VOLUME 5 17 18BEFORE: 19 20Mr. Glenn Stannard Chairperson 21 22Ms. Raymonde Cléroux Registrar 23 24APPEARANCES: 25 26Mr. Mark Freiman Commission counsel 27Ms. Genevieve Coutlée 28Ms. Beth Alexander 29 30Ms. Elizabeth Richards For Sgt Jon Bigelow, MWO Ross Tourout, 31Ms. Korinda McLaine LCol Gilles Sansterre, WO Blair Hart, PO 2 Eric McLaughlin, 32 Sgt David Mitchell, Sgt Matthew Alan Ritco, Maj Daniel Dandurand, 33 Sgt Scott Shannon, LCol Brian Frei, LCol (ret’d) William H. Garrick, 34 WO (ret’d) Sean Der Bonneteau, CWO (ret’d) Barry Watson 35 36Mr. Lorne Ptack For Leo Etienne 37 38Col (ret’d) Michel W. Drapeau For Mr. Shaun Fynes 39Mr. Joshua Juneau and Mrs. Sheila Fynes 40 41Mr. James Heelan For witnesses, Dr. Sowa, Dr. Chu, 42 Dr. Yaltho and Dr. Elwell 43 44 A.S.A.P. Reporting Services Inc. © 2012 45 46 200 Elgin Street, Suite 1105 333 Bay Street, Suite 900 47 Ottawa, Ontario K2P 1L5 Toronto, Ontario M5H 2T4 48 (613) 564-2727 (416) 861-8720 1 (ii) 2 3 4 INDEX 5 6 7 PAGE 8 9SWORN: DR. MATTHEW YALTHO 6 10 Examination In-Chief by Mr. Freiman 6 11 Cross-Examination by Colonel Drapeau 33 12 Cross-Examination by Ms. Richards 37 13 14 15AFFIRMED: LEO ETIENNE 45 16 Examination In-Chief by Ms. Coutlée 46 17 Cross-Examination by Colonel Drapeau 56 18 Cross-Examination by Ms. Richards 59 19 Re-Examination by Ms. Coutlée 62 20 21 22PREVIOUSLY SWORN: DR. LEO ELWELL 70 23 Examination In-Chief by Mr. Freiman 70 24 Cross-Examination by Colonel Drapeau 171 25 Cross-Examination by Ms. Richards 181 26 Re-Examination by Mr. Freiman 196 27 1 (iii) 2 3 LIST OF EXHIBITS 4 5NO. DESCRIPTION PAGE 6 7P-12 Witness book index for Dr. Yaltho. 1 8 9P-13 Witness book index for Mr. Leo Etienne. 1 10 11P-14 Witness book index for Dr. Elwell. 1 12 13P-15 CANFORGEN. 2 14 15P-16 Enrolment and reengagement, QR&0 Chapter 15 Release and QR&O 16 Chapter 16 Leave packages. 2 17 18 19 20 21 22 23 24 1 1 2 3 4 5 1 Ottawa, Ontario 2--- Upon resuming on Wednesday, April 4, 2012, 3 at 9:35 a.m. 4 MS. COUTLÉE: Mr. Chairman, before 5we begin, we will just be entering the exhibits for 6today. 7 So we have the witness book index 8for Dr. Yaltho. 9 THE REGISTRAR: Exhibit P-12. 10 EXHIBIT NO. P-12: Witness 11 book index for Dr. Yaltho. 12 MS. COUTLÉE: The witness book 13index for Mr. Leo Etienne. 14 THE REGISTRAR: Exhibit P-13. 15 EXHIBIT NO. P-13: Witness 16 book index for Mr. Leo 17 Etienne. 18 MS. COUTLÉE: And the witness book 19index for Dr. Elwell. 20 THE REGISTRAR: Exhibit P-14. 21 EXHIBIT NO. P-14: Witness 22 book index for Dr. Elwell. 23 MS. COUTLÉE: There is also two 24additional exhibits that Ms. Richards wants to 25enter. Copies are being made right now and the

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 2 2 3 4 5 1exhibits will be entered for Dr. Elwell. 2 I think they are made, so, we have 3two additional exhibits. 4 MS. RICHARDS: Yes, Mr. Chairman, 5as you may have noticed, we have been having a lot 6of back-and-forth about release and voluntary 7release and medical release issues, so we have for 8you copies of the Queen's Regulations and Orders as 9they relate to issues of service in the Canadian 10Forces, as well as release authority. 11 And there was also an issue raised 12yesterday regarding the provision of sick leave and 13whether there was a requirement for sick leave to 14be approved by the chain of command or the unit, 15and so we have produced as the second document a 16copy of the CANFORGEN dealing with the issue of 17medical employment limitations and sick leave. 18 THE CHAIRPERSON: Will they be 19under the same number? 20 THE REGISTRAR: No, the CANFORGEN 21will be Exhibit P-15. And the enrolment and 22reengagement, Exhibit P-16. 23 EXHIBIT NO. P-15: CANFORGEN. 24 EXHIBIT NO. P-16: Enrolment 25 and reengagement, QR&0

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 3 2 3 4 5 1 Chapter 15 Release and QR&O 2 Chapter 16 Leave packages. 3 MS. RICHARDS: And for the 4description of P-16, perhaps so the record is 5clear, it is, in fact, a bundle of QR&Os, so it's 6enrolment and reengagement but it's also QR&O 7Chapter 15 Release and QR&O Chapter 16 -- let me 8make sure I have the right name -- Leave. 9 I just specify that for the 10record, because I know we have another version of 11QR&O enrolment and reengagement that has been 12produced, but these bundles includes both the 13release and the leave packages. 14 THE CHAIRPERSON: Okay, thank you 15very much. 16 In terms of witnesses for today, 17Mr. Freiman? 18 MR. FREIMAN: We have three, two 19live, Dr. Matthew Yaltho, who will begin the 20morning, and then Dr. Leo Elwell, who will follow. 21We may be interrupting Dr. Elwell's testimony at 2211:30. We have a teleconference scheduled with Mr. 23Leo Etienne who, for medical reasons, is unable to 24travel. 25 THE CHAIRPERSON: My understanding

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 4 2 3 4 5 1is that in order to prepare for that telephone 2testimony, we will need a break at 11:30 so that 3that can be arranged -- I am sorry, 11:15 so that 4can be arranged and swearing of the witness will 5take place. 6 MR. FREIMAN: That's fine. It may 7well be, then, that we will simply take a break 8after Dr. Yaltho's evidence. And I anticipate Mr. 9Etienne's -- I had hoped to start Dr. Elwell, but I 10don't think it makes much sense to start him for 15 11minutes. 12 THE CHAIRPERSON: Are you 13anticipating to finish the first doctor before 1411:15? 15 MR. FREIMAN: I am notoriously bad 16in my estimates, but, yes, we will see. I hate to 17make a promise I can't keep because I always do. 18 THE CHAIRPERSON: I do not want to 19break in the middle of individual's examinations, 20so we will play that by ear. 21 MR. FREIMAN: Thank you. 22 MR. HEELAN: How long do we expect 23we will be with Mr. Etienne? 24 MR. FREIMAN: I suspect less than 25a half hour.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 5 2 3 4 5 1 MR. HEELAN: I just want to make 2sure I arrange for Dr. Elwell to be here ready to 3go. So do we have any suggestions on that? 4 THE CHAIRPERSON: Obviously, the 5best hope would be that we finish the first witness 6and we do Dr. Etienne at 11:30, and we could start 7with, why don't we say 1:30. 8 MR. HEELAN: That would be one -- 9 MR. FREIMAN: One o'clock would be 10preferable, Mr. Chairman. I am not certain how 11long Dr. Elwell's testimony will take, but he is 12quite an important witness. 13 THE CHAIRPERSON: Okay, why don't 14we say one o'clock, then. 15 MR. HEELAN: I will advise him, 16one o'clock. 17 THE CHAIRPERSON: That would be 18our best plan. 19 MR. HEELAN: Okay, thank you. 20 THE CHAIRPERSON: They don't 21always work out, but... 22 So are you ready to call the first 23witness? 24 MR. FREIMAN: Yes. 25 Thank you, Mr. Chairman, the next

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 6 2 3 4 5 1witness is Dr. Matthew Yaltho. 2SWORN: DR. MATTHEW YALTHO 3 THE CHAIRPERSON: Good morning, 4doctor. 5 THE WITNESS: Good morning, sir. 6 THE CHAIRPERSON: If you could 7just, once you are situated, there is a button in 8the middle, if you could push for your microphone. 9And you have already been sworn, as I understand. 10Oh, it's on, you are all set. Thank you. 11EXAMINATION IN-CHIEF BY MR. FREIMAN: 12 Q. Good morning, Dr. Yaltho. 13 I understand, sir, that you are a 14physician licensed to practice in the province of 15Alberta, and you are currently employed -- or you 16were employed in 2008 at the Royal Alexandra 17Hospital; is that correct? 18 A. Yes. 19 Q. Can you help us just by 20filling in your medical background and training up 21to today? 22 A. I was trained in Britain and 23also in Ottawa, Canada, so I did my MRCP from 24England and FRCP from Ottawa. 25 Q. Yes, and following your

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 7 2 3 4 5 1accreditation, do I understand you accredited as a 2psychiatrist? 3 A. Yes, sir. 4 Q. Can you just give us briefly 5a history of your employment from the time of your 6certification? 7 A. After training here, I worked 8in Saskatchewan for two years, then moved to 9Edmonton, Alberta, in 1980. And I have been 10working there since. I am a clinical professor in 11with the University of Alberta. 12 Q. Thank you very much, sir. 13 Now, we are going to discuss this 14morning with you a relatively brief experience you 15had and professional encounter you had with 16Corporal Stuart Langridge. 17 In order to set the scene, I would 18like to ask you to describe what your duties were 19in March of 2008 in terms of whom you would see in 20the hospital for psychiatric consultations. 21 A. I was the doctor on call for 22psychiatry on March 11, 2008, and this patient was 23brought to the emergency department by the military 24police, I believe. 25 Q. I'd like to ask you to look

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 8 2 3 4 5 1at the book that is at your left-hand side. There 2is a number of documents in there. And if you 3could open the document book to Tab 16, you will 4see a clinical consultation report, it's more by 5way of a request to see a soldier. 6 Is this a document that would have 7been brought to your attention when you were called 8to see Corporal Langridge? 9 A. Yes. 10 Q. Okay, so let me just read 11what the note says: 12 "Please see this 13 28-year-old-male who has a 14 history of alcohol and drug 15 abuse and depression. 16 Multiple attempts for 17 substance abuse treatment 18 attempted; i.e., Edgewood, 19 and patient was 20 non-compliant. Discharged 21 from Alberta Hospital on 3/08 22 --"[as read] 23 It looks like -- 24 A. March 3. 25 Q. "-- March 3, under care of

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 9 2 3 4 5 1 Dr. Sowa. Now is heavily 2 under restrictions imposed 3 and stay in his military unit 4 and monitor his actions for 5 next couple of weeks. Is not 6 coping well with this 7 anxiety, poor sleep, and 8 trying to deal his way out of 9 the circumstance. 10 "This member was informed 11 today that he must return to 12 his unit and continue to work 13 and see how he does, and if 14 is doing okay, return to his 15 unit and abstaining, the 16 consideration of a treatment 17 program in Guelph, Ontario, 18 Homewood, would be 19 considered. 20 "Upon realizing he would be 21 forced to return to his unit 22 today, he states he is 23 suicidal and would rather 24 kill himself than return to 25 his unit."[as read]

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 10 2 3 4 5 1 Now, Dr. Yaltho, when you see a 2note like this, does that inform what you do next, 3or is this simply background that you need to 4verify with the soldier, or with the patient, 5rather? 6 Your own admission note is at Tab 71, or consultation report is at Tab 1. 8 A. He did not like to go back to 9the military. I think I put it down in his own 10words in my consultation report. 11 Q. Yes. 12 A. Can't take army stuff 13anymore, quote and unquote. 14 Q. Yes. 15 A. And towards the end, I 16thought maybe he should be released from the 17military on medical grounds, but I don't know how 18the military works. 19 Q. Undoubtedly. 20 So I think what we will do today 21is discuss with you a little bit the medical 22dimension rather than the military dimension. 23 But your recommendation at the 24end, and we will get to that in a second, that it 25would be suitable to have him released on medical

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 11 2 3 4 5 1grounds, was that a medical assessment in light of 2his presentation, or was that simply a pragmatic 3suggestion? 4 A. Looking at the history, I 5think he had at least three or four admissions, 6brief admissions to the Royal Alexandra Hospital 7crisis unit from 2007, I believe. 8 Q. Yes. Yes. 9 A. Plus, I think he was 10discharged from the Alberta Hospital Edmonton by 11Dr. Sowa -- 12 Q. Yes. 13 A. -- just one week before. 14 Q. Correct. 15 A. And I think he spent almost a 16month there. And this man is coming back to the 17hospital within a week's time saying that 'I don't 18want to go back to the military', so I thought that 19it was medical grounds. 20 Q. I'd like to ask you to look 21at one more document, just to see if you would have 22seen this, as well as a background. This is Tab 2317, and it is a psychiatric assessment but, 24obviously, not compiled by you. I assume this was 25compiled by a psychiatric nurse.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 12 2 3 4 5 1 Am I correct that the signature is 2of a psychiatric nurse? 3 A. Yes. 4 Q. And do I understand correctly 5that this would be a sort of intake before you 6would see the patient? 7 A. I believe so, because time is 81050. 9 Q. Right. And I note at the 10end, it's Dr. Yaltho for possible admission -- "to 11Dr. Yaltho for possible admission". 12 To me, that suggests that the 13nurse would have seen him first, would have taken 14the history, and then would have referred Corporal 15Langridge to you for a decision about admission? 16 A. Yes. 17 Q. Okay, and is this a document 18that you would have seen, then, as you were 19interviewing Corporal Langridge? 20 A. Possible, but I don't exactly 21remember because this happened four years ago. 22 Q. Of course, of course. I would 23just like to read this note to you and then ask you 24a couple of questions about it. 25 It says:

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 13 2 3 4 5 1 "Patient presented from CFB 2 Edmonton, escorted by two 3 military members, with 4 complaint of suicidal 5 ideation and anxiety/panic 6 attacks. Patient has several 7 recent admissions (3) in past 8 eight months to --"[as read] 9 I take it that's Royal Alexandra 10crisis unit? 11 A. Yes. 12 Q. "-- and has just released 13 --"[as read] 14 I think. Anyway: 15 "-- from AHE under Dr. Sowa 16 March 5, '08, after 30-day 17 admission."[as read] 18 A. He has a past. 19 Q. "He has a past -- something 20 -- of alcohol and drug abuse 21 and has been told to follow 22 up --"[as read] 23 That's it: 24 "-- follow up with Alcoholics 25 Anonymous. He has sabotaged

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 14 2 3 4 5 1 this plan by not attending, 2 or drinking before the 3 meetings. The military have 4 put constraints on his 5 duties, on his 6 accommodations, and have told 7 him -- and sorry -- and have 8 had him check in every two 9 hours. This has provoked 10 further panic, anxiety and 11 intensified his suicidal 12 ideation. He has a past 13 history of PTSD --"[as read] 14Or past diagnosis, I guess it is. No. 15 "-- past history of PTSD 16 following tours in 17 Afghanistan and Bosnia. Dr. 18 Sowa made -- something -- 19 adjustments to his 20 medications but with little 21 effect. He is actively 22 suicidal presently and will 23 be referred to Dr. Yaltho for 24 possible admission."[as read] 25 Does this add anything to the

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 15 2 3 4 5 1information that you would have already have had 2available to you? 3 A. Yes. 4 Q. Tell me, what does it add for 5you? 6 A. So I get a bit more 7information about the previous assessments. 8 Q. Right. All right, so, with 9all of that in mind, let's look at the note that 10you compiled. And can you tell me, the note itself 11sets out history of past -- 12 THE CHAIRPERSON: Which tab are we 13at? 14 MR. FREIMAN: Tab 1, sorry. 15 BY MR. FREIMAN: 16 Q. Can we start, would the 17narrative in here be what Corporal Langridge would 18have told you on his interview with you in 19hospital, or would you have gotten this information 20from some other source? 21 A. Usually how the doctor on 22call operates, he looks at the information in the 23file before or after he sees the patient. 24 Q. And would this note have been 25compiled when you were doing the initial

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 16 2 3 4 5 1assessment, or would it have been done sometime 2thereafter? 3 A. I think, as I said, the 4nurse's note was done in the morning, and I believe 5I saw him in the evening, afternoon. 6 Q. Okay, so -- 7 THE CHAIRPERSON: Just so I 8understand this note, who has written this note? 9Was this written by you? 10 THE WITNESS: Yes, sir, number 11one, my name is there, Matthew Yaltho, on top. 12 BY MR. FREIMAN: 13 Q. Now, can you read to us the 14"on examination", which is your impressions after 15you've compiled the history -- maybe it would be 16helpful if you just read us the note because it's a 17little hard to read the handwriting. 18 A. So you are talking about the 19middle section? 20 Q. Let's do the whole note. 21It's only a page, so we can afford to do that. 22 A. Dated March 11, '08: 23 "28-year-old military 24 serviceman recently separated 25 from his wife, brought to the

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 17 2 3 4 5 1 emergency for depression, 2 anxiety, PTSD and suicidal 3 thoughts. 'Can't take Army 4 stuff anymore'. He 5 complained of crying spells, 6 chest pain, nightmares, 7 sweating, decreased sleep and 8 memory and decreased energy. 9 Although he was a heavy 10 alcoholic, he drinks seldom 11 now. But indulges in 12 cocaine, last time yesterday, 13 and cannabis. He had a 14 previous admission --"[as 15 read] 16 Q. I think that says two or 17three. 18 A. "-- he had previous 19 admissions in RAH and was 20 discharged from the Alberta 21 Hospital last Friday by Dr. 22 Sowa. He did not attend the 23 AA meeting and had two drinks 24 yesterday. His medications 25 are: Venlafaxine, 225

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 18 2 3 4 5 1 milligrams; gabapentin, 600 2 milligrams at bedtime; 3 Quetiapine, 50 milligrams at 4 bedtime; Zopiclone, 7.5 5 milligrams at bedtime; 6 olanzapine, 2.5 milligrams in 7 the morning and 5 milligrams 8 at bedtime. Says gabapentin 9 helps him with sweating, and 10 he has been complying with 11 the medications. 12 "His common-law wife, a 13 secretary, left him when he 14 was hospitalized in February. 15 He was in Afghanistan for six 16 months in 2004 and in Bosnia 17 in 2001. His elder brother 18 is handicapped. Mom is on 19 gabapentin. 20 "On examination, a young 21 Caucasian male in Army 22 uniform being watched by a 23 serviceman. Depressed, 24 anxious and suicidal. 25 Frustrated that the Army will

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 19 2 3 4 5 1 not release him after eight 2 years and three years 3 previously in the reserve. 4 No psychotic thought nor 5 perception disorder. 6 "Opinion and recommendation: 7 He suffers from, Number 1, 8 mental depression, probably 9 substance-induced, anxiety 10 and PTSD. Number 2, cocaine, 11 alcohol and cannabis abuse. 12 He would require 13 hospitalization, he prefers 14 Alberta Hospital where he 15 felt more secure. No beds in 16 the system. I will check 17 again. AA/AADAC recommended. 18 I believe release from the 19 Army on medical grounds is 20 appropriate."[as read] 21 Q. So having taken the history, 22having come to a provisional diagnosis based on the 23history, you come to the conclusion that 24hospitalization is necessary. 25 Can you help us to understand what

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 20 2 3 4 5 1the plan was that you had for this particular 2hospitalization or what you conceive Corporal 3Langridge might need by way of medical treatment at 4this point? 5 A. As the doctor on call, my job 6is to decide first to admit or not to admit, so I 7decided to admit. And if you look at my notes, I 8think I filled out a mental health admission 9certificate, is what is called Form 1. 10 Q. Yes, I think it's at Tab 4 of 11the document book. 12 A. So that is Number 4. 13 Q. Yes. And on that you noted 14-- now, first, to set the scene, this is a form 15that allows the hospital to detain Corporal 16Langridge, with or without his consent, on the 17grounds that he is potentially a danger to himself 18or others; is that correct? 19 A. Yes. I can detain him for a 20period of 24 hours from 5:30 p.m. 21 Q. Right. 22 A. That is the right bottom. So 23the second doctor has to see him and do a second 24certificate, then it only is enforceable for a 25period of 30 days.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 21 2 3 4 5 1 Q. Now, under your observations 2where it says "I have formed my opinion on the 3following facts observed by me", you put 4"depressed, anxious and suicidal, wanting to be 5released". 6 Can you help us with the 7importance of the second sentence, "wanting to be 8released"? What part did that play in your 9assessment? 10 A. I think I meant wanting to be 11released from the Royal Alexandra Hospital at that 12point, not the Army. 13 Q. So that would mean that he 14had changed his mind and no longer wanted to stay 15in the hospital, but you thought he needed to stay 16in the hospital? 17 A. I think he didn't want to 18come to the hospital, as I said earlier, he wanted 19to go to Alberta Hospital instead. 20 Q. Yes, right. Okay. So he is 21admitted to the hospital, he is certified for a 22period of 24 hours. 23 In your mind, what would his 24course in the hospital have been when you were 25putting all this together?

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 22 2 3 4 5 1 A. I am responsible until he is 2taken over by the other doctor in the ward. And I 3put an order -- there are two doctors working in 4the unit, Dr. Chu and Dr. Block, so I put an order 5he could be transferred to either Dr. Chu or Dr. 6Block. 7 Q. And does that mean that they 8would then be in charge of his subsequent course? 9 A. Yes. 10 Q. I would just like to review 11with you some of the nurse's progress notes during 12this particular admission and see if you have any 13comments either as to his course of -- in the 14hospital, if he was getting better or worse or 15whether you see anything that confirms some of your 16diagnosis. 17 The first note that I would like 18to look at with you is at Tab 11. It's dated 11 19March '08, 2015. 20 Now, do I understand this would be 21more or less after the note that we just saw 22dictated -- sorry, that we just read with you, your 23admission note? Because it says "admitted to 3608 24at 1930". So that would seem to indicate that 25after you saw him, Corporal Langridge was admitted

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 23 2 3 4 5 1around 7:30 p.m., and this nurse appears to be 2compiling a record at 2015 p.m.; do I have that 3right? 4 A. Yes. 5 Q. Okay, so I would just like to 6start with the sentence saying "was": 7 "Was at AHE under Dr. Sowa 8 for one month, was discharged 9 on 5 March '08. Has been 10 working at military base 11 since discharge. States was 12 doing three shifts per week 13 prior to admission to AHE, 14 however, after discharge, has 15 been working full time. 16 States anxiety has been 17 raised since discharge and 18 mood has been low. 19 "Drank a couple of beers last 20 Thursday, no other alcohol 21 use for past week. Has been 22 using cocaine more frequently 23 on and off since last 24 Wednesday. Also has been 25 something more -- smoking

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 24 2 3 4 5 1 more. Did not want to work 2 anymore, states it was too 3 much. Was told to go to work 4 or go to the hospital. 5 "Denies suicidal ideation 6 currently, contracts for 7 safety. Has not slept since 8 Sunday. Last used cocaine 9 yesterday. Reports problems 10 with concentration and with 11 short-term and long-term 12 memory. Describes 13 hypervigilance, always being 14 always paranoid and on edge. 15 Denies auditory or visual 16 hallucinations and delusions. 17 Oriented times 3."[as read] 18 That's time -- well, anyways. 19 "Oriented logical in --"[as 20 read] 21 And I can't read the next word. I 22can't read that next sentence at all. Oh: 23 "-- denies auditory or visual 24 hallucinations."[as read] 25 I have got:

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 25 2 3 4 5 1 "States has never actually 2 been --"[as read] 3 A. You want a better copy, sir? 4 Q. Yes. 5 THE CHAIRPERSON: Maybe you could 6read it, doctor. 7 BY MR. FREIMAN: 8 Q. Perhaps you could just pick 9up where I finished, where I couldn't read, and 10just to the bottom of the page. 11 A. "Contracted for safety, has 12 not slept since Sunday, last 13 used cocaine yesterday, 14 reports --"[as read] 15 Q. I think that's "problems". I 16think that says "problems with concentration". 17 A. "-- concentration and with 18 short-term and long-term 19 memory."[as read] 20 Q. Right. 21 A. Problems, report problems. 22 "Reports problems with 23 concentration and with 24 short-term and long-term 25 memory. Describes

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 26 2 3 4 5 1 hypervigilance, being always 2 paranoid and on edge. Denies 3 auditory and visual 4 hallucinations or delusions. 5 Oriented 3 -- in 6 conversation, speech normal 7 -- speech: Normal rate, 8 rhythm and volume. 9 "States he has never actually 10 been told what diagnosis he 11 has. States military wants 12 to send him to treatment in 13 Ontario for PTSD and alcohol 14 and drug abuse problems. 15 States he feels he may have 16 bipolar disorder. States he 17 has a lot of up and downs, 18 describes very energetic 19 happy periods. States saying 20 last a couple of hours. 21 "Would like to go back to 22 Alberta Hospital Edmonton. 23 States, for the first couple 24 of weeks, he abused his 25 admission, not going to

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 27 2 3 4 5 1 programs, et cetera. 2 However, for the last two 3 weeks of admission, he went 4 to groups, attended AA, went 5 to gym, et cetera. He found 6 this to be beneficial. 7 Cooperating with admission 8 procedures."[as read] 9 Q. Now, having read that, Dr. 10Yaltho, does that change any of your previous 11conclusions? 12 I assume you wouldn't have seen 13this because it happened after your admission. 14 Does this change anything or does 15it confirm your impressions on your own 16examination? 17 A. Possible, but, basically, I 18knew, you know, what they were talking about. 19 Q. Yes, all right. 20 I'd just like to continue to 21Corporal Langridge's course in the hospital. I 22know that you had passed over responsibility, but 23just very briefly, I'd like to look, as I say, at 24just a couple of the progress notes. 25 If we look at March 12th, '08,

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 28 2 3 4 5 10715 hours, we see: 2 "Patient received on his 3 formal status with one --"[as 4 read] 5 A. Certificate. 6 Q. "-- one certificate, and on 7 close observation."[as read] 8 What does that mean, practically? 9Do I understand that "received on formal 10certificate" means that he was still under Form 1 11and, therefore, was an involuntary patient? 12 A. Yes, I think, as I explained 13to you before, his certificate is good until 5:30 14p.m. the next day. 15 Q. Right. 16 A. So this note was made at 175:15, so he had another 15 minutes under one 18certificate. 19 Q. And it also says "and on 20close observation". What's meant by "close 21observation"? 22 A. Maybe I should explain the 23observation levels. 24 Q. Yes. 25 A. There are three observation

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 29 2 3 4 5 1levels in our hospital. One is constant, that's 2one-to-one. 3 Q. Yes. 4 A. The second is close. That 5means the nursing staff have to check the patient 6every 15 minutes. 7 Q. Yes. 8 A. And the third one is general 9observation, where they have more freedom. 10 But in this particular ward, this 11is a crisis unit, we don't have the third level, so 12it is either constant or close. 13 Q. I understand. 14 And can you explain the rationale 15for maintaining either constant or close 16observation? 17 A. It depends on the clinical 18situation and, to some extent, the availability of 19the supporting staff, like security guards, 20available at that point in time. 21 So usually when they are a danger 22to themselves or others, we place them on constant 23observation. So if they are not in immediate or 24imminent danger, we place them on close. 25 Q. I understand.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 30 2 3 4 5 1 We see, then, in the notes, and 2maybe we can go to the last page of the notes, by 31800 -- or sorry, second last page of the note, 4"received patient on voluntary status, close 5observation". 6 So by 1530 of the following day, 7the certificate had expired and now he is on a 8voluntary basis. And I just want to look at the 9last sentence in that first paragraph: 10 "Patient is -- " 11 Either wanting or waiting, I can't 12tell which. 13 " -- to get in a program for 14 his drug addictions and is 15 just waiting for the military 16 to decide what they are going 17 to do. Patient states they 18 will probably send -- 19 possibly send him to 20 Ontario."[as read] 21 So he is now a voluntary patient 22and he is talking about future plans to go to 23Ontario. And then finally -- 24 A. Which section is it, sir? 25 Q. If you look, it's -- sorry, I

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 31 2 3 4 5 1misled you, it's the third last page, March 12, 2'08, 1530 and 800, it looks like. 3 A. Yes. Yes, I found it. 4 Q. Yes. Now, the final page is, 5I take it, done by Dr. Block, who is discharging 6him, and she makes note of his condition and his 7disposition, and what he states. 8 Since she is not here today, I am 9just going to ask if you could read her last note 10for us so we can get an idea of what was happening 11toward the end of the admission, keeping in mind 12he's now a voluntary patient, the certificate has 13expired. And what does Dr. Block tell us? 14 A. You are referring to March 1513, '08? 16 Q. Yes. 17 A. Dr. Block wrote down: 18 "Not interested in talking to 19 me. Does not want anything 20 from anybody here in 21 hospital. Does not want to 22 remain in hospital, denies 23 suicidal or homicidal 24 ideations or intent. I am not 25 prepared to discharge him,

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 32 2 3 4 5 1 but he is voluntary and can 2 sign himself out of the 3 hospital, which he says he 4 will do."[as read] 5 Q. So do I understand correctly 6that at this point, Corporal Langridge is no longer 7under certificate, so there is no power of 8compulsion, he wants to leave, Dr. Block believes 9it would be better not to discharge him, but he 10insists and, therefore, he's discharged against 11medical advice. Is that the sequence? 12 A. I have come across these type 13of situations many times. So Dr. Block or, you 14know, the doctor in charge may have two options, 15either discharge him against medical advice or put 16him on certificate. 17 Q. Yes. 18 And, of course, we don't have Dr. 19Block here, so we don't know what was going through 20her mind, but it appears that she chose the second, 21to allow him to be discharged against medical 22advice. 23 A. That is his right to do that. 24 Q. Yes. 25 Just to round out our discussion

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 33 2 3 4 5 1this morning, Dr. Yaltho, were you ever interviewed 2by the military police in connection with any of 3their investigations? 4 A. I went to meet with the Board 5of Inquiry. 6 Q. Yes. 7 A. In the Garrison in Edmonton 8in 2009. 9 Q. Thank you, thank you very 10much. You did, but other than that, you did not 11speak to the military with respect to this? 12 A. No. 13 MR. FREIMAN: Thank you very much. 14Those are my questions. 15 THE WITNESS: Thank you. 16 MR. FREIMAN: I expect my friends 17may have a few questions for you. 18 THE CHAIRPERSON: Colonel Drapeau. 19 COLONEL DRAPEAU: Mr. Chair, good 20morning. 21CROSS-EXAMINATION BY COLONEL DRAPEAU: 22 Q. Doctor, my name is Michel 23Drapeau. 24 In Tab 1 that we have just seen, 25you wrote or it was written that Stuart did not

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 34 2 3 4 5 1like to go back to the military, that he would 2rather kill himself than to return to his unit. 3 Did you, in your consultation with 4him, discuss a reason why he would feel so 5strongly? 6 A. I, as I told you before, I 7was the doctor on call. I have so many patients to 8see, so I think usually we don't take more than an 9hour to discuss all the issues. 10 But, as I explained to you before, 11he told me he hates the military, I didn't go into 12the details why he hates the military. But he told 13me that he was in the military for about eight 14years and about three or four years service in the 15reserve, so I think about 11 to 12 years, ^ that's 16my understanding. And he served in Bosnia and 17Afghanistan. 18 Q. And that's the extent of your 19knowledge, what discussion you would have had with 20him about the recent -- 21 A. Yes, I didn't go into that 22because I didn't have the time. 23 Q. Doctor, on Tab 1 in your 24notes, about three-quarters down the page, there is 25a listing of all the prescribed drugs that Stuart

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 35 2 3 4 5 1-- about the first paragraph, about seven, eighth 2lines down, there is a listing of all of the 3various drugs that Stuart would have been 4prescribed; you see that? 5 A. Yes. 6 Q. Now, we know that the report 7also says that he had abused alcohol and, at times, 8even cocaine or marijuana. 9 Is there any impact, would it 10dilute the impact of these drugs by doing so or 11enhance the impact? What would be the impact, if 12any, of somebody having alcohol or cocaine with 13these drugs? 14 A. Sir, my recommendation to all 15my patients is that not to mix street drugs with 16the medications because there could be 17interactions, and alcohol included. 18 So he was on an antidepressant 19called venlafaxine. Gabapentin is an antianxiety 20drug, and he told me that it helps him with the 21sweating too. Quetiapine is what we call 22tranquillizing medication or, you know, sometime we 23call it antipsychotic too, but in this particular 24case, to calm down his anxiety level and sleep, 25help him with the sleep. Zopiclone is sleep

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 36 2 3 4 5 1medicine. Olanzapine is an antianxiety and 2tranquillizing medication. 3 So, you know, I wouldn't recommend 4mixing any drugs with any of these medications. 5 Q. I accept that. So it's quite 6a cocktail of medicine that he would have, and he 7did take alcohol. But what's the worse impact of 8such combination? Which is, obviously, not 9recommended. 10 A. Usually what will the outcome 11may be, one, the medications may not work well. 12Sometimes it can complicate the drug level within 13the system. Most of the time, the medications can 14cause other problems, along with the intake of 15alcohol or drugs. 16 The other issue to think about is 17if the drug, street drugs or the alcohol he is 18consuming is causing the anxiety or depression. So 19it could be a chicken or egg type of situation. 20 Q. So it could dilute the 21desired impact of the drugs he is being prescribed? 22 A. It is possible. 23 Q. Possible. 24 COLONEL DRAPEAU: Thank you, 25doctor, that's all my questions.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 37 2 3 4 5 1 THE CHAIRPERSON: Ms. Richards. 2CROSS-EXAMINATION BY MS. RICHARDS: 3 Q. Thank you. 4 Doctor, I just have a couple of 5questions, and I want to follow up on the point 6that you just made that you'd have to consider 7whether or not street drugs or alcohol could be 8causing the depression. 9 A. Yes, ma'am. 10 Q. Okay, I -- from your intake 11notes, I take it that Corporal Langridge disclosed 12to you that he had been indulging in cocaine more 13frequently since the previous Wednesday; you recall 14that in your notes? 15 A. I believe I mentioned that he 16did cocaine the day before. 17 Q. Okay. And if we look, I 18think you had been taken by Commission counsel to 19some of the nursing notes where he said he had been 20using cocaine more frequently since the previous 21Wednesday? 22 A. I don't know. 23 Q. Okay, if you can look at Tab 2411, just at the first page. 25 A. You're talking about the

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 38 2 3 4 5 1nurse's notes? 2 Q. The nurse's notes, that's 3correct. 4 A. Yes. 5 Q. Yes, okay. So it's partway 6down that first note, and I think it's part of the 7portion that you read out for us where it states: 8 "Drank a couple of beers last 9 Thursday. No other alcohol 10 used for past week. Has been 11 using cocaine more frequently 12 on and off since last 13 Wednesday."[as read] 14 A. Which section is that? 15 Q. Sorry, it's -- 16 A. What sentence number? 17 Q. Twelve lines down, and it 18starts at the end of that line. 19 A. Yes, I see that. 20 Q. You see that, okay. 21 So just putting those two pieces 22together in terms of your statement that you'd have 23to consider how drug use and alcohol use could be 24affecting his mood, we know that he has disclosed 25that he has been using it more frequently since the

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 39 2 3 4 5 1previous Wednesday. I just looked up on a calendar 2the day that you saw him. March 11th was a 3Tuesday. So within that week, less than a week, he 4has been using cocaine more frequently, and you 5have been told by him that he, in fact, used it the 6night before he was admitted to the Royal Alex? 7 A. I didn't have that 8information at that point in time because the 9nursing notes was written in the evening. 10 Q. Right, but you knew he had 11used it the night before when you admitted him 12because he disclosed that to you? 13 A. Yes, yes. 14 Q. We have heard some evidence 15from other doctors who have been here that cocaine 16can cause depression or depressed moods. 17 A. Yes, it is possible. 18 Q. And in particular, I believe 19it was Dr. Sowa who talked about the fact that 20there is a greet euphoria from taking cocaine, but 21when the cocaine begins to wear off, there is a 22converse depression and severe depression, that 23depressed mood that can come from that? 24 A. That often happens. 25 Q. Okay. So when Corporal

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 40 2 3 4 5 1Langridge disclosed to you that he had used it the 2night before, is that something that you 3considered, whether or not the cocaine use the 4previous evening and the possibility that it was 5wearing off at that point in time was causing his 6depressed mood? 7 A. It's, again, possible, but 8the history is multi practitions for depression, 9multiple suicide items, and he was just released 10from hospital. 11 But I agree with your point, I 12think substance abuse can cause depression. 13 Q. And were you also aware when 14you reviewed the record that he had actually been 15using cocaine when he was admitted to the Alberta 16Hospital and the severity of the drug use was 17something that Dr. Sowa had commented on and looked 18at? 19 A. I don't remember seeing that 20occur, you know, but it is possible. Because I 21sometimes work in the Alberta Hospital too, they 22have big grounds, and the patients are known to 23indulge in drugs and alcohol when they are out. 24 Q. And I believe it was your 25testimony that you only spent an hour or less with

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 41 2 3 4 5 1Corporal Langridge? 2 A. Yes, ma'am. 3 Q. And so it's fair to say that 4you weren't performing a full diagnosis in that 5amount of time about his conditions, you wouldn't 6have had enough time to formally diagnose what 7Corporal Langridge was suffering from in an hour? 8 A. Not exactly, because, you 9know, I may have looked at the reports from 10previous admissions that would be in the computer, 11plus I may have more information from the other 12sources like the mental health nurse, you know, or 13read the notes before. So I gather a bit of 14information before I see the patient. So had I 15made up my mind what the diagnosis was. 16 Q. Right. So you had looked at 17his file from previous admissions, and I take it 18you had access to the Alberta Hospital and the 19Royal Alex? 20 A. It's possible. 21 Q. So you were aware from 22reviewing that, that no previous psychiatrist had 23diagnosed him with post-traumatic stress disorder? 24 A. My impression was, you know, 25we read it earlier, you know, there is suspected

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 42 2 3 4 5 1possible PTSD. 2 Q. There was a -- as I have seen 3in the medical nomenclature, there is a question 4mark, query PTSD. 5 A. Possible, I said. 6 Q. Yes. And you would agree 7with me that that is different than a firm 8diagnosis of PTSD? 9 A. He had at least two or three 10symptoms when I saw him, you know, he mentioned 11nightmares, which is a very common thing. He 12worked, you know, he was in Bosnia and Afghanistan 13where he witnessed traumatic events quite a bit. 14The nursing notes on March 11, too, describes 15hypervigilance. That's a symptom. So there a few 16symptoms to suggest PTSD. 17 Q. Right, but you mentioned that 18he had been overseas and may have seen traumatic 19events. 20 You'd agree with me that a 21critical incident is one of the required elements 22for diagnosing post-traumatic stress disorder? 23 A. Yes. 24 Q. And no critical incident had 25been disclosed to you in your --

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 43 2 3 4 5 1 A. He didn't tell me that. 2 Q. So I guess to be clear, I 3think all of the doctors have said it was a 4possibility that was in their mind. 5 And my question to you is, would 6you agree with me that at that point in time, 7nobody had formally diagnosed him with 8post-traumatic stress disorder? 9 A. I think, as I said, everybody 10suspected maybe there is possible PTSD. 11 MS. RICHARDS: Thank you very 12much, those are all my questions. 13 THE WITNESS: Thank you. 14 MR. FREIMAN: No re-examination. 15 THE CHAIRPERSON: After that brief 16examination, nothing further, Colonel Drapeau? 17 COLONEL DRAPEAU: Nothing further, 18Mr. Chair. 19 THE CHAIRPERSON: Just one 20question. When you said he had been to Bosnia and 21Afghanistan and witnessed traumatic events, did he 22tell you that or is that, like, did you have that 23discussion? 24 THE WITNESS: He didn't tell me 25specifically that he witnessed or he was involved

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 44 2 3 4 5 1in any serious trauma, but, you know, my impression 2was most of the soldiers who go to Bosnia and 3Afghanistan, they may have experienced some kind of 4traumatic events. But he didn't tell me. 5 THE CHAIRPERSON: So that's just 6an assumption that -- 7 THE WITNESS: An assumption, yes. 8 THE CHAIRPERSON: -- that you read 9from previous -- 10 THE WITNESS: That's true. 11 THE CHAIRPERSON: Did you have any 12discussion with him about Afghanistan or Bosnia at 13all? 14 THE WITNESS: No, I did not. 15 THE CHAIRPERSON: So there was no 16discussion about Afghanistan or Bosnia or anything 17at all to do with that? 18 THE WITNESS: No, sir. 19 THE CHAIRPERSON: Okay. 20 Is there anything further for this 21witness? If not, I want to thank you doctor for 22your attendance today. It's brief, but thank you 23very much for your attendance. 24 In terms of, we have 45 minutes, 25and I would like to start the next witness. Do we

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 45 2 3 4 5 1need five minutes for a health break? 2 MR. FREIMAN: I think there was 3probably a misunderstanding. Both Mr. Heelan and I 4understood that you said you didn't want to start 5and stop a witness. And so I think Mr. Heelan has 6released Dr. Elwell, and he won't be here until 7about one o'clock. 8 THE CHAIRPERSON: Oh, okay that's 9fine. I thought we were going to go a little bit 10longer, but, so we will have a recess, I guess, 11until -- is there any way of advancing the call? 12No? Yes? 13 MS. RICHARDS: No, I believe he is 14in Victoria; isn't he? Yeah, so I think with the 15time difference, it would be difficult. 16 THE CHAIRPERSON: Okay, that's 17fine, we will give everybody a chance to have a new 18coffee, and we will come back probably a few 19minutes before and be ready for the phone call, 20maybe about 25 after. Thank you. 21--- Upon recess at 10:34 a.m. 22--- Upon resuming at 11:26 a.m. 23--- Leo Etienne appearing via teleconference 24AFFIRMED: LEO ETIENNE 25 THE CHAIRPERSON: So if our

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 46 2 3 4 5 1technician has got it all working, I guess we are 2going to be all set. 3 THE WITNESS: I can hear you fine. 4 THE CHAIRPERSON: Mr. Leo Etienne? 5 THE WITNESS: Yes. 6 THE CHAIRPERSON: Okay. I 7understand you have been sworn. My name is 8Commissioner, I am the chair, Glenn Stannard. 9 And Mr. Freiman or Ms. Coutlée. 10EXAMINATION IN-CHIEF BY MS. COUTLÉE: 11 Q. Good morning, Mr. Etienne. 12My name a Genevieve Coutlée. I am counsel with the 13Commission. 14 A. Hi. How are you doing? 15 Q. Good. Thank you. 16 I would like to ask a few 17questions from you. I understand that you have 18before you the three documents that we have 19included in the book of documents? 20 A. Yes, yes. 21 Q. First off, I would like to 22ask what your position was in 2008 at the Edmonton 23base clinic. 24 A. Base addictions counselor. 25 Q. Can you repeat?

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 47 2 3 4 5 1 A. Base addictions counselor, 2BAC. 3 Q. Thank you. 4 And do you recall receiving phone 5calls from Corporal Langridge in late February or 6early March 2008? 7 A. Yes, yes, I do. 8 Q. And can you tell me what you 9recall about these conversations? 10 A. He was wanting to arrange to 11go to treatment, and I told him I would have to 12take it before our medical team, his medical team, 13for approval, for first approval. And then I would 14have to go to either the base surgeon or the deputy 15base surgeon for approval for those funds. 16 Q. Thank you. 17 And specifically, if you can turn 18to the document that should be called Tab 2 -- 19sorry, Tab 1 in your collection. 20 A. Yes. 21 Q. And that would be the note 22dated March 2nd. 23 A. Yes. 24 Q. So it states here: 25 "Wanting to confirm that he

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 48 2 3 4 5 1 can go from the Alberta 2 Hospital to an addictions 3 treatment program. He is 4 committed until March 6th but 5 states he will remain in 6 hospital voluntarily until he 7 can go to treatment."[as 8 read] 9 A. Yes. 10 Q. Now, does that reflect your 11recollection of your conversation with Corporal 12Langridge? 13 A. Yes, it does. 14 Q. So his request was to remain 15in hospital until he could go to treatment? 16 A. Correct. And that's -- I had 17taken that to the treatment team, and the answer 18was, is he needed to be stabilized so... 19 Q. And can you explain what you 20mean by that, he needs to be stabilized? 21 A. Well, when someone is in a 22psychiatric ward, it would be pretty easy to assume 23that he wasn't very stable at the moment, and one 24of the requirements to be able to accept treatment 25would be to be able to be mentally stable to accept

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 49 2 3 4 5 1it. 2 Q. And do you recall 3specifically what measures were being discussed in 4order to stabilize Corporal Langridge? 5 A. I can't recall exactly 6because -- I vaguely recall, and I recall that the 7team's answer was that he had to be stabilized, you 8know, before we could look at treatment. 9 Q. And do you recall, Mr. 10Etienne, who was on the treatment team at that 11meeting where that decision was made? 12 A. I am just about positive 13Robin Lamoureux was the, you know, chairing that 14meeting as the deputy base surgeon. 15 Q. Do you recall who else was 16there? 17 A. I really don't. I can 18speculate, but that's all it would be. 19 Q. Now, without recalling the 20identity of individuals, can you tell us generally 21at those types of meeting what positions would be 22there? Would be there, for example, nurses, 23medical doctors, psychiatrists? 24 A. Yes, to all of the above, and 25probably whoever his social worker was as well, and

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 50 2 3 4 5 1the head nurse for the unit would have been there 2as well -- 3 Q. Do you recall -- 4 A. -- for, you know, like the 5medical unit, A, B, C. 6 Q. I understand that Robin 7Lamoureux was a medical doctor? 8 A. Yes, he is. And normally, 9his unit doctor would also be involved but not 10always. 11 Q. And do you recall whether 12there was also anybody from the mental health 13clinic? 14 A. I can't, but that's what I 15say, is normally there would be somebody there if 16there was a psychiatrist involved or another 17therapist from the other clinic, yes. 18 Q. And as far as base 19addictions, aside from yourself, was there anyone 20else from base addictions? 21 A. I am not sure, but I would 22both -- he wasn't my patient. He was Dennis 23Strilchuk's patient and, before that, Don Perkins' 24patient, so I don't know whether Dennis was there 25or not. Honestly, I couldn't tell you. I would --

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 51 2 3 4 5 1you know, I would assume, unless he was away for 2something or other. 3 Q. After that decision was made, 4do you recall having any other contact with 5Corporal Langridge? 6 A. No, I don't. 7 Q. Do you recall having any 8other contact with anybody else about this case? 9 A. No, no. 10 Q. And if you can turn to Tab 3, 11these are the handwritten notes. 12 A. Yes. 13 Q. All right. On the first 14page, if I can direct your attention to the bottom 15of the page, there is a note dated March 4th. 16 A. Yes. 17 Q. It starts with "med". And the 18last three lines read as follows: 19 "Military want him back for 20 two weeks prior to attend 21 drug rehab. I have verified 22 this in TC -- " 23 Which I take to mean telephone 24conversation. 25 " -- with Leo at the

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 52 2 3 4 5 1 Garrison."[as read] 2 Do you have any recollection of 3that conversation? 4 A. I really don't. There is 5more than one Leo, obviously, involved. 6 Q. But do you recall one way or 7the other whether you had the conversation? 8 A. I have no recall of that 9conversation. 10 Q. And on the following page, 11the one that starts with "4 March 2008 at 15 hours" 12-- 13 A. Yes. 14 Q. -- there is a mention, 15beginning at the second line: 16 "Transportation booked to 17 escort client to the Garrison 18 base to be there for 9:30 to 19 meet with Leo from the base 20 prior to 10-hour drug rehab 21 meeting."[as read] 22 Do you have any recollection of 23having had a meeting scheduled with Corporal 24Langridge? 25 A. No, I don't. And the drug

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 53 2 3 4 5 1rehab meeting at ten o'clock, that would be the 2normal group meeting and, normally, Dennis 3Strilchuk would look after that. 4 Q. Can you explain what the 5"normal group meeting" was? 6 A. All the members who have 7sought help or been to treatment and that, it's a 8regular group therapy meeting for those people to 9attend and, you know, just do a group meeting, a 10group therapy meeting. It was an ongoing group 11that was always held. 12 Q. Thank you. 13 And if you can turn to the next 14page, I am going to read in two extracts just to 15give you a bit of context. 16 So the first one is 5 March '08 at 177:25, beginning at the second line of that note: 18 "Client anxious reworking at 19 the Garrison base full-time 20 directly following discharge. 21 Stated he is unsure what he 22 will be asked to do in the 23 two weeks at the base. 24 Writer encouraged client to 25 shower and get packed, then

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 54 2 3 4 5 1 to call Leo at the base when 2 he arrives there at 8 hours 3 and find out what he will be 4 doing in an attempt to reduce 5 anxiety."[as read] 6 If you go to the next page, I will 7just finish giving you the full context, Mr. 8Etienne. If you go to the next page, there is 9another note that says 5 March '08, 11:45. And 10there, we read: 11 "Able to reach Leo. Client 12 stated that he will attend 13 substance abuse groups and 14 that he will not start work 15 immediately. Also stated 16 that Leo suggested that he 17 attend drug rehab in Ontario. 18 And client stated, 'I will 19 fight that'."[as read] 20 Do you have any recollection of 21that conversation? 22 A. No. 23 You missed a word. At the start 24of that, I think, is "client reported". 25 Q. Yes, yes. Sorry, it is,

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 55 2 3 4 5 1indeed. 2 Now, do you have any recollection 3of any discussions about whether or not Corporal 4Langridge would be working during that period of 5stabilization? 6 A. I wouldn't have said a word 7about such a thing because I can't. I couldn't do 8it in my position. It would have to either come 9from a doctor to be excused from work or his unit 10in conjunction with the doctors. 11 Q. And do you have any 12recollection of that being discussed with either 13the doctors or your other colleagues as to whether 14Corporal Langridge would be working? 15 A. No. I wouldn't be involved 16in anything like that. 17 Q. And do you recall any 18discussions about where he would be sent to rehab? 19 A. No, I don't, because it never 20got that far. 21 MS. COUTLÉE: Thank you, Mr. 22Etienne. Those are my questions. And some of the 23other counsel might have questions for you, so just 24stay on the line, please. 25 THE WITNESS: Okay. Thank you,

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 56 2 3 4 5 1Genevieve. 2 THE CHAIRPERSON: The next 3questioner will be Colonel Drapeau, representing 4the plaintiffs. 5CROSS-EXAMINATION BY COLONEL DRAPEAU: 6 Q. Good day, Mr. Etienne. I only 7have a few questions. 8 A. Yes. 9 Q. Who did you report to in your 10job as addiction counselor? 11 A. Both, I had -- hello? 12 Q. Yes. 13 A. Yes, I had actually two 14reporting people. Anything to do with any kind of 15-- the main part of my job were to the base or 16deputy surgeons, who I would answer to or go to for 17any help or suggestion. And then there was also a 18mental health manager, Kelly Leddicote, as well, 19and she sort of was also my head. So it was 20confusing that way. 21 Q. Thank you. 22 Can you recollect how many times 23you might have met with Corporal Langridge? Can you 24give me an estimate that your intervention with him 25would have covered, an hour or two or four or five?

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 57 2 3 4 5 1I would just like to get a sense of the familiarity 2you would have had with him and his file. 3 A. No, I don't recall meeting 4him. And looking at his file, you know, sort of 5afterwards, that was it. 6 Q. Okay. 7 A. And you know -- 8 Q. Could you repeat? 9 A. I wouldn't be meeting with 10him because he wasn't my patient. 11 Q. Okay. 12 A. So it would be Dennis 13Strilchuk's patient, and I guess Dennis wasn't 14available or something that they put the call 15through to me. 16 Q. So would I be right that you 17would know of him -- 18 A. Yes. 19 Q. -- and you would read 20reports, but you did not have any face-to-face 21contact with him? 22 A. That would be right. 23 Q. When in answer to Madam 24Coutlée's questions you said, you talked about the 25medical team and you were on the team and you

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 58 2 3 4 5 1alluded to a unit doctor, could you explain what 2that is, who that is? 3 A. Certainly. It is -- every 4unit, you know, he was LdSH, I believe. So 5everybody gets assigned a medical unit and, in the 6medical units, there would be doctors, nurses, 7PRNs. And all of those things for the members 8would be there, and they were divided, A, B, C, D. 9 Q. And would you know who that 10doctor was at that time? 11 A. Well, I don't even know for 12sure which unit he was on, so... 13 Q. And would the unit doctor, 14then, be in a position to report back to the unit, 15and do you know if this actually happens? 16 A. It is -- yes, he would be, or 17the charge nurse would be the ones in contact with 18the unit. I would not be. 19 Q. No. And he or she would be 20the person to go to at the unit if they wanted to 21find out anything in order to be of some 22assistance? 23 A. Correct. 24 COLONEL DRAPEAU: That's all my 25question, Mr. Etienne. Merci beaucoup.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 59 2 3 4 5 1 THE WITNESS: Thank you. 2 THE CHAIRPERSON: Ms. Richards, 3representing the subjects. 4CROSS-EXAMINATION BY MS. RICHARDS: 5 Q. Good morning, Mr. Etienne. 6 A. Good morning. 7 Q. I just have a couple of 8questions. You had been asked about these notes 9that you have in front of you at Tab 3, which refer 10to conversations with somebody called Leo. 11 A. Um-hmm. 12 Q. I am wondering, have you had 13a chance to refer to those notes, and do you have 14any view on whether or not it was likely that the 15various references in the notes refer to 16conversations or things that you said? 17 A. It is, first off, is I don't 18recall anything like that and, you know, other than 19what is in my notes. And really, that's it, is I 20have concerns where it says the client reported 21back to the nurse and the nurse made a note, you 22know. And I have, as I said before, many of these 23things I wouldn't be involved in. So I also know 24that there is a psychiatrist named Leo too, so we 25used to differentiate that he was Dr. Leo, and I

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 60 2 3 4 5 1was the good looking one, so... 2 Q. When you looked at the 3various references, have you compared it to your 4normal workday, and does that help you at all in 5terms of assessing -- 6 A. Yes. Normally, on a 7Wednesday, I was heavily involved in meetings, so I 8can only call this a typical Wednesday. I can't 9specifically say that Wednesday. But normally, I 10would have been at the St. Albert clinic at about 117:30 or by 7:30 and for case conferencing over 12there, and very seldom did that end by 10, and then 13I would have to drive back to the base. And then 14normally, I would leave at about 11:30 with the 15mental health manager, Kelly Leddicote, and we 16would stop back -- drive back to St. Albert, stop 17and have some lunch and have a managers meeting at 18one o'clock. 19 Q. Okay. 20 A. And that's, that would be, 21you know, my afternoon gone. 22 Q. So I take it from your normal 23schedule that it would be very unlikely that these 24references to conversations with a Leo would be 25conversations with you because you would not have

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 61 2 3 4 5 1been at the base at that time? 2 A. On the 5th, very, very 3unlikely that I would have had anything to do with, 4because as I say, the most I would be there, for 5just an hour or something. 6 Q. And similarly, there is a 7reference, just to sort of close the loop, to 8Corporal Langridge having been delivered directly 9into the care of Leo on March 5th. I take it that 10you don't recall that either? 11 A. No, I don't. And if somebody 12had called me to the front desk for something like 13that, the only thing -- you know, our standard 14procedure would be, is to take him through to the 15medical unit because we don't have authority to do 16anything. 17 Q. And just one final question. 18In terms of the issue of whether or not the 19military required Corporal Langridge to return from 20the Alberta Hospital, did you have authority as a 21base addiction counselor to refuse Corporal 22Langridge's further care at the Alberta Hospital? 23 A. Oh, absolutely not. I 24wouldn't have -- basically, I had no authority over 25anybody.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 62 2 3 4 5 1 Q. Thank you very much. 2 A. None of the patients I had 3authority over for anything. 4 MS. RICHARDS: Thank you very 5much. Those all are my questions. 6 THE CHAIRPERSON: Any 7clarification questions? 8RE-EXAMINATION BY MS. COUTLÉE: 9 Q. Hello, Mr. Etienne. This is 10Genevieve Coutlée again. Just one or two questions 11to close the loop. You just said that you wouldn't 12have authority to decide whether Corporal Langridge 13would be discharged from the Alberta Hospital and 14be brought back to the base. Can you tell us who 15would have that authority? 16 A. It would be, you know, people 17in the medical chain, you know, above me, such as 18his health unit, the doctors in this health unit, 19the base surge, the deputy base surge, of course, 20and perhaps, you know, one of the psychiatrists or 21something. I think they would still yield to the 22case doctor or whatever. 23 But, no, I have -- there is no way 24I could or would say that somebody should be or 25shouldn't be or sent out of the hospital. And the

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 63 2 3 4 5 1other thing is, is I couldn't and wouldn't say he 2shouldn't go to work for two weeks, you know. I 3have no authorities whatsoever, so I wouldn't even 4venture there. 5 Q. Thank you, Mr. Etienne. 6 And the other decision you 7mentioned is that when Corporal Langridge initially 8requested treatment, you mentioned you had to take 9this to the treatment team, and then I believe you 10said to the base surgeon. Can you clarify that, 11that approval process for us, and who would have 12that authority? 13 A. Sure. If he was not in a 14position like the psychiatric hospital, et cetera, 15I would normally go through things with the 16patient. Then I would have to check with his 17doctors and the unit, the medical unit, and the 18base surge or deputy base surge for approval. And 19once I had those approvals, then I could, you know, 20book in a bedtime at a treatment centre, whichever 21one would be most appropriate. 22 Q. Thank you. 23 And you discussed your normal 24schedule on a Wednesday. I believe you stated very 25early in the morning you would attend a separate

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 64 2 3 4 5 1clinic? 2 A. No. That would be at the 3mental health clinic in St. Albert. 4 Q. Okay. 5 A. I would -- there would be a 6meeting in the morning for, you know, case 7conferencing, which would be booked in advance. And 8then I would come back to the base for a short 9period, and then usually about 12:30ish -- or not 1012:30, 11:30, I would be with the clinic manager, 11Kelly Leddicote, mental health clinic manager. And 12on my way to St. Albert, we would have lunch at a 13restaurant with some of our co-workers and then 14start our meeting at the office there. 15 Q. "At the office", at the 16mental health clinic? 17 A. Yes, in St. Albert. 18 Q. And can you assist us with 19how far away is that clinic from the base? 20 A. I would say driving, 15/20 21minutes, something like that. 22 Q. And -- 23 A. That's why we would usually 24leave, you know, as close as we could to 11:30. 25 Q. Is that also the mental

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 65 2 3 4 5 1health clinic where Corporal Langridge received 2treatment? 3 A. I am not 100 per cent sure 4because I wouldn't have been involved with him on 5that side of things. Well, I wasn't involved with 6him but, even any other patient, I wouldn't be. 7But that's where, the off base was where the 8psychiatrist, psychologist and a couple of social 9workers were stationed, so that's where they would 10go for those services. 11 Q. Thank you. 12 And are you aware if this was the 13clinic where Dr. Elwell was working? 14 A. Yes, yes, that's where he 15worked out of when he was still working with us. 16 Q. Now, when you had the meeting 17with the treatment team about Corporal Langridge's 18request, where was that meeting held? 19 A. That was held at the base. 20 Q. And do you recall what a 21typical Tuesday was like for you back then? 22 A. Umm, let's see... I may or 23may not have been in a social work meeting. We sort 24of alternated that, but that would be at 7:30 in 25the morning until, I don't know, 9, say.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 66 2 3 4 5 1 Q. And after that -- 2 A. That would be off the base. 3After that, I normally would just go on a Tuesday 4into my regular schedule. 5 Q. And what was your regular 6schedule? 7 A. Appointments, appointments 8with patients. 9 Q. And that was at the base? 10 A. Yes. 11 MS. COUTLÉE: Thank you very much. 12Those are my questions. 13 THE WITNESS: I never saw patients 14off the base clinic. 15 MS. COUTLÉE: Thank you. 16 THE CHAIRPERSON: Yes, sir, this 17is the chair speaking. I just want to make sure, 18you said you had never met the corporal before? 19 THE WITNESS: No, that's not true. 20I knew him, you know, by sight sort of thing, but 21he was not my patient, so I never saw him in that 22capacity. 23 THE CHAIRPERSON: Did you ever 24meet him in any capacity? 25 THE WITNESS: Oh, yes, yes. I knew

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 67 2 3 4 5 1who he was. 2 THE CHAIRPERSON: Well, there is a 3difference between knowing who he was and meeting 4him. 5 THE WITNESS: Umm, I am sure I -- 6 THE CHAIRPERSON: By "meeting", I 7mean sitting down with him. 8 Did you ever sit down and meet 9with him? 10 THE WITNESS: No. 11 THE CHAIRPERSON: You were 12introduced to him, but you never sat down and spoke 13with him regarding any -- 14 THE WITNESS: Services at the 15base, sir? 16 THE CHAIRPERSON: -- services or 17anything? 18 THE WITNESS: No. 19 THE CHAIRPERSON: You said you 20don't recall having the conversations. I was a 21little troubled with not -- recollection, that 22could mean several different things to me. 23 Did you ever speak with the 24corporal over the telephone? 25 THE WITNESS: Yes.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 68 2 3 4 5 1 THE CHAIRPERSON: Around these 2dates? 3 THE WITNESS: The last being, I 4believe, the 2nd of March. I can tell you in a 5second here as soon as I get to my notes here. 6 Yes, the 2nd of March, and the 7previous one, I believe, was February the 25th. 8 THE CHAIRPERSON: So you have 9notes that you spoke with him February -- or March 102nd and February 25th? 11 THE WITNESS: Yes. 12 THE CHAIRPERSON: And those 13conversations were about? 14 THE WITNESS: Him wanting to 15arrange to be able to go to treatment, and he was 16to get back to me after I had the team meeting. And 17that was it for me, as far as I recall. I didn't 18speak to him again. 19 THE CHAIRPERSON: And you didn't 20speak with him -- you did or did not speak to him 21on the 5th of March? 22 THE WITNESS: I did not speak to 23him on the 5th of March. There is no recall. I 24have no memory of such a thing. And by my normal 25schedule, I would have very little time in the

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 69 2 3 4 5 1Garrison clinic. 2 THE CHAIRPERSON: Okay. Thank you. 3 Ms. Coutlée, any questions from 4that? 5 Colonel Drapeau? 6 COLONEL DRAPEAU: Not for me, Mr. 7Chair. 8 MS. RICHARDS: No. 9 THE CHAIRPERSON: I want to thank 10you for your time, for the telephone interview, 11sir. And thank you very much, and that concludes 12the required testimony from yourself. 13 THE WITNESS: Thank you. 14 THE CHAIRPERSON: So we will end 15the call. 16 THE WITNESS: Okay. Thank you. 17Bye. 18 THE CHAIRPERSON: Our next witness 19will be ready for one, I believe. 20 MS. RICHARDS: Yes. 21 THE CHAIRPERSON: For one? 22 MR. FREIMAN: That was the plan 23with Mr. Heelan. 24 THE CHAIRPERSON: We will break 25until one o'clock for lunch.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 70 2 3 4 5 1--- Upon luncheon recess at 11:53 a.m. 2--- Upon resuming at 1:08 p.m. 3 MR. FREIMAN: Good afternoon, Mr. 4Chairman, our witness for this afternoon is Dr. Leo 5Elwell. 6PREVIOUSLY SWORN: DR. LEO ELWELL 7EXAMINATION IN-CHIEF BY MR. FREIMAN: 8 Q. Dr. Elwell, you have been 9sworn previously; correct? 10 A. Yes. 11 Q. I understand, sir, that you 12are a physician licensed to practice in the 13province of Alberta? 14 A. That is correct. 15 Q. And that you are certified as 16a psychiatrist? 17 A. Yes, sir. 18 Q. For the benefit of the Chair, 19could you just briefly go over your qualifications 20and training including your employment up to today? 21 A. Okay. For ten years, I was 22in the Air Force Reserve, from 1982 to 1992. I 23then went into medical school after completing a 24bachelor of science. I got my MD from the 25University of Alberta, then finished the psychiatry

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 71 2 3 4 5 1residency at the University of Alberta. Then I was 2with the base as a civilian consultant psychiatrist 3from, pardon my nerves, '99 till 2009; right? Yes, 4yes. And since then, I have been most recently in 5private practice as well as a consultant with the 6Primary Care Network in Sherwood Park. I also 7teach at the U of A in psychiatry. 8 Q. And we heard the other day 9from Dr. Sowa that, in fact, your residency was 10under his supervision? 11 A. Yes. 12 Q. We have heard a good deal, 13Dr. Elwell, about the base clinic and military 14arrangements for medical care. And it's sometimes 15a little confusing because we have the base clinic, 16we have the mental health unit and we have outside 17providers. 18 I think it would be helpful to all 19of us if you could just briefly take us through a 20tour of that maze so we understand who does what, 21especially with regard to the mental health unit, 22where it is physically located vis-à-vis the other 23facilities. 24 A. Okay, the military health 25system has a component that's staffed by military

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 72 2 3 4 5 1doctors as well as by civilian doctors because they 2can't keep enough doctors in uniform. And we come 3in and we assist primarily on an out-patient basis. 4So these are people being treated in the community. 5 Then, when people require more 6intensive care, for example, if they come back with 7IED damage from Afghanistan, they would be treated 8in the civilian hospital system with follow-up 9provided by the military medical system. But 10primarily, they would be treated by the surgeons 11and that at the hospital. 12 So in addition, we have the main 13medical clinic, which is located right next to the 14guard shack at the main entrance of the base 15itself. And then we also had the mental health 16clinic, which was a subsidiary of the main medical 17clinic, and we were located in a separate building, 18and then we moved the mental health clinic out to 19St. Albert for reasons of space and also for 20reasons of comfort on the part of people that were 21seeing us. 22 Then within the main medical 23clinic, we have the different care delivery units, 24or CDUs, and the one that was responsible for Lord 25Strathcona's Horse (Royal Canadians) was CU Charlie

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 73 2 3 4 5 1or C. And within CUC, we would have a unit clerk 2responsible for paperwork. We would have at least 3one, anywhere up to a couple of military doctors, 4depending upon their availability and that, and 5then a number of civilian general practitioners. 6And they were primarily seen as being the 7quarterback, if you will, of attempting to provide 8care for a person. So all the documentation, all 9the information would flow into them. 10 And I'm, as a consultant, I am 11advising to them, but I am not primarily 12responsible for their medical care; right, and I 13would be providing them with what I felt was 14reasonable suggestions, and then they could 15formulate their management plan accordingly. 16 The CDUs provided for continuity 17of care so that usually you saw the same doctor. 18And if the one doctor was away, they would brief 19another doctor, particularly if the person was 20having a lot of problems like a respiratory tract 21infection or whatever, and that way that we could 22make sure that the person got continuity of care. 23 Because what happened with just 24military doctors is that you could be away, posted 25on a course or on a deployment or out in Wainwright

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 74 2 3 4 5 1on exercise or whatever, and you would never really 2see the same doctor. So one of the things that we 3tried to do with having civilians there was that 4they would be providing continuity of care. 5 And they would also know a lot of 6the medical employment limitations and various 7administrative functions that we would have to 8provide to the member. 9 Q. Okay, I'd like to get back to 10some of those questions in a minute, but I want to 11talk about one other aspect of treatment, I won't 12say medical care because I know that's 13controversial. 14 We have also heard a good deal 15about base addictions counselors and the base 16addiction clinic. What was it's relationship to 17the medical community? 18 A. The base drug and alcohol 19counselors, base addiction clinic, was staffed by 20addiction counselors who were certified by their 21independent professional body. And they had a bit 22of a tough row to hoe because on the one hand, they 23were to help under the auspices of some of the 24CFAOs. 25 So let's say somebody has a

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 75 2 3 4 5 1positive urine test for marijuana or some other 2banned substance, right, they would be helping 3treat them with their addiction, okay, and they 4would be advising the GDMO about, look, we need to 5send this person off to -- 6 Q. For the civilians in the 7room, GDMO? 8 A. Is general duty medical 9officer. Interrupt me at any time, I am sorry. 10 Q. That would be the military 11doctor normally in charge of a clinic? 12 A. Normally, in charge of the 13CDU, yes. 14 Q. Okay. 15 A. But it could be a civilian, 16as long as the base surgeon had said, yes, I give 17you the blessing to be able to do, fulfill this 18role. 19 Q. Okay. 20 So, sorry, I interrupted you. 21They would liaise with the GDMO? 22 A. Yes, and they would liaise 23with me. They came to case conference every 24Thursday and, frequently, we would talk about it 25when our paths crossed, when we were close to one

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 76 2 3 4 5 1another in the same building. Once we were out in 2St. Albert, it was a little bit harder because of 3just, you know, being 7 or 10 kilometres away, 4okay. But otherwise, there was a lot of 5conferencing going on. 6 Q. I would like just to get you 7to explain to us a little bit the issues and 8challenges of maintaining confidentiality, 9especially -- we will do it seriatim, but I am 10interested in confidentiality as between the 11medical health unit and the mental health unit and 12also confidentiality as between the base addictions 13counselors and whoever they needed to maintain 14confidentiality for. 15 A. Yes. 16 Q. So let's start first with 17mental health versus medical unit. 18 A. We did it to the same 19standard. The medical employment limitations where 20we say something like the person can't run because 21their knee is hurt, right, what we say to the unit 22is, you know, unfit for running for so many weeks 23or so many months, right. 24 And not any information per se 25about what's causing it, okay, but just to say

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 77 2 3 4 5 1that, look, you cannot employ this person in the 2following manner because of a medical concern. 3 Q. Right. 4 A. And then that way it allows 5the unit to have the person do appropriate physical 6training, and it also allows us to preserve the 7person's right to privacy, because the unit is the 8employer, as it were. 9 Q. Yes, okay. 10 Now, was there any issue of 11confidentiality about mental health records even 12vis-à-vis the physicians who would be in the CDUs? 13 A. We, if something came out 14that was very, very private, so say, for example, 15somebody had been sexually abused as a child, then 16usually we edit that really heavy so that not a lot 17of it goes outside the room where myself and the 18patient is in, okay. 19 So I am not going to write 20gruesome details to go back into the main medical 21file, okay. But the main medical file itself is 22supposedly only accessible by health professionals 23who are guided by a code of ethics, a code of 24conduct, professional standards, so that they are 25not going to go blabbing about that to anybody.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 78 2 3 4 5 1 Then what happens is that a chit 2goes out to the unit that says that this person 3can't do PT for the next two weeks. And that's 4basically it, that's a medical employment 5limitation, you can't have him do PT, for example. 6 Q. Okay, now, what about the 7base addictions counselors? What constraints of 8confidentiality, if any, were they functioning 9under? 10 A. Well, there is -- when the 11unit would get a phone call from the base 12addictions counselor, they knew who they were and 13they knew what they did, so that it shouldn't come 14as a surprise to them, right, and, 'oh, okay, so 15so-and-so has a bit of an addiction problem'. 16 Then what happens is that the 17Forces had a -- and still has -- a system whereby 18if the person starts going for treatment and 19complies with the requirements and the applicable 20Canadian Forces Administrative Order, CFAO, that 21then they can be welcomed back once they have come 22back from treatment and they are provided with 23follow-up so that they don't relapse to their 24addiction; right, and then if they do that and they 25follow the planned course of treatment, that it's

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 79 2 3 4 5 1not a black mark against them. And it's a very, 2very good employer trying to be supportive and 3trying to help people with this problem. And it's 4a good system. 5 Q. I didn't include these 6documents in the collection before you because 7until you started talking about it, it hadn't 8occurred to me that I might want to ask you about 9it, but let me ask you, then. 10 In Corporal Langridge's file, we 11find documents that record a failed drug screening 12preliminary to deployment, and there is in the 13documents, an indication by the base commander that 14he intends to order counseling and probation. And 15then we see an indication that Corporal Langridge 16wanted to challenge the accuracy of the initial 17test, and we then see a document suspending the 18counseling and probation until that process has run 19its course. And we see another administrative step 20where he asks for yet another independent test, so 21we never get to the counseling and probation, but 22throughout, there are periodic references to an 23intention, once this is over, to look at counseling 24and probation. 25 Now, is counseling and probation

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 80 2 3 4 5 1that system that you are talking about, or is there 2something else going on? 3 A. C&P, counseling and 4probation, would be a general term, it's not 100 5per cent properly applied here, okay. 6 Normally, let's say a person is 7always coming into work late, let's say, and then 8you say to him, 'look, you have got to be here on 9time'. Then they keep on doing it and then they 10say, 'okay, fine, I am going to give you a warning, 11a verbal warning, then a recorded warning, now it's 12on paper, and if you keep doing this, I am going to 13put you on counseling and probation. And if after 14six months of C&P, you haven't smartened up, I am 15going to release you administratively', okay. 16 So that's a disciplinary form of 17C&P. 18 The C&P that I am -- I haven't 19seen these documents, so I can't, but I am 20speculating, and, I think, reasonably accurately, 21is what it refers to is the addictions treatment. 22So that you enter into the contract with the base 23addiction counselor, and then they do whatever they 24recommend, okay, so that might be in-patient 25treatment or it might be just intervention at the

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 81 2 3 4 5 1base level and regular attendance at AA or some 2kind of a group therapy thing. 3 And then if you follow that and 4you continue to have clean urine tests or, you 5know, as far as where you are not drinking, okay, 6then you have fulfilled that and it's a good thing, 7okay. 8 So there is two types of pee tests 9that I would like to clarify on. There is the type 10that's going to be done through the medical system, 11and the results of that stay within the medical 12system. And, basically, it's monitoring that, yes, 13you haven't been smoking marijuana, okay, for 14example. That's just one of the substances we can 15test for. 16 On the other hand, there is within 17the Forces, if you are in what's deemed a 18safety-sensitive position, so, for example, driving 19airplanes or stuff like that, that then you have to 20be able to pee clean and not come up with anything 21on the banned list of substances, and that is an 22administrative kind of pee test. 23 So prior to going on deployment, 24that would have been, most likely, an 25administrative pee test.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 82 2 3 4 5 1 Q. That's what it was. 2 A. And done by the unit. 3 Q. That's what it was, and he 4failed. And, again, we are at a bit of a handicap 5because we don't have the documents in front of us, 6but the documents seemed to indicate that the 7counseling and probation that is contemplated is an 8administrative step rather than a therapeutic step. 9If you can't comment on that, that's fine. 10 A. Sorry. 11 Q. Okay. So let's start now to 12talk about the specifics of Corporal Langridge. 13Before I do that, let me just follow up on 14something that you said. 15 If we are looking at the 16therapeutic side, to your knowledge, does entering 17into the therapeutic contract or the therapeutic 18stream in any way depend on exhausting your appeal 19of the original negative finding or negative test? 20 A. No, we are happy to exist 21side by side with the administrative side, and we 22don't share our results with them. 23 Now, if they came up on the 24administrative side with a positive one, that means 25an automatic referral to base drug and alcohol.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 83 2 3 4 5 1 Q. Right. 2 A. Because they want the person 3to get the treatment. 4 Q. Right. But that referral, is 5it administered through the medical stream or is it 6administered through the disciplinary stream? 7 A. Through the medical stream. 8 Q. So you said if the member is 9compliant and demonstrates that he is not using for 10a period of time, that's a good thing? 11 A. Yes. 12 Q. Now, when you say "that's a 13good thing", how is that good thing recorded or how 14is it conveyed to anyone? 15 A. What goes back to the unit is 16a note from the base alcohol counselor and a note 17is also made in the main medical file that the 182034, that's the number of the file, saying that 19this person did the six months of addictions 20treatment, completed satisfactory, no further 21action required by us. 22 And then the unit says, okay, 23good, the problem has been dealt with. 24 Q. All right. So let's look at 25the contrary case. If the member is not compliant,

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 84 2 3 4 5 1if his urine tests and drug screening tests are not 2negative, in fact they are positive, if he does not 3fulfill his undertaking to attend AA meetings, what 4happens with that information? 5 A. Well, typically, we have a 6lot of toing and froing in the first part of 7addictions treatment, they are very unstable. So 8that everybody relapses, and it's just a matter of 9when, okay, and how bad it's going to be. And, 10hopefully, you can get them through that and then 11get on to more successful treatment. 12 If you expect them right off the 13bat to listen to what you are saying and stop 14drinking, that isn't going to happen. 15 So that, typically, there is a 16process there of months, okay, and, you know, even 17if the person is "misbehaving", as it were, in 18other words, they are using their addiction -- 19addictive substance, right, we can continue to try, 20we continue to try, we continue to try and we poke 21away at it and, eventually, we are successful with 22a lot of people. 23 Now, with some people, we are not 24successful, and what happens then is a note goes 25back to the unit that says the member has not

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 85 2 3 4 5 1complied with treatment, as far as we know they are 2still having their ongoing addiction problem. And 3then it's up to the unit, then, to typically 4initiate the release proceedings. And then that 5goes out underneath what we usually call is a 5-F, 6or an administrative unfavourable release. So it's 7not one that you want to leave the job with. It's 8like a bad reference in the civilian world. 9 Q. And did I understand 10correctly that that sort of bad report, let's say, 11report of misbehaviour, would not necessarily be 12sent to the unit until some conclusion had been 13come to that it just wasn't working? 14 A. It's way down the road. It 15doesn't happen in the first two weeks, we are 16talking minimum six months, really. Minimum. 17 Q. So let's change gears just a 18little and start talking about Corporal Langridge 19himself. And my understanding, sir, is that you 20first, in fact for the only time, saw Corporal 21Langridge in November of 2007. 22 Do you have a recollection, or 23having looked at your records, were you able to 24refresh your recollection as to the circumstances 25under which he was referred to you?

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 86 2 3 4 5 1 A. Yes. 2 Q. Can you help us with that? 3 A. Certainly. I saw him the one 4time. From what I recall, he did come late to the 5appointment. 6 Q. Yes. 7 A. And within a couple of 8minutes, he started talking about applying for VAC 9benefits, Veterans Affairs Canada. 10 Q. Yes. 11 A. And what happens as a 12standard of care for myself when somebody asks me 13about that, because that is a relatively common 14question, is I say, 'I have to know you first for a 15good couple of months, it takes me a while to write 16the report, so don't count on anything going to 17Veteran Affairs Canada for at least six months 18coming from me. Somebody else can do it quicker, 19but that's them, that's not me'. And I would have 20told him that. 21 Q. Okay. Just so that everyone 22understands, what would the consequences be of a 23favourable assessment, or favourable in Corporal 24Langridge's sense, that you would send to Veterans 25Affairs Canada?

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 87 2 3 4 5 1 A. What happens out of the VAC 2favourable decision is if they feel that there is 3any part of the person's medical condition, no 4matter what it is, that's attributable to service, 5that then they would receive some form of a pension 6at the time or some form of lump settlement, 7lump-sum settlement, which is what happens now. 8 Q. So would that be accompanied 9by a release from the military? 10 A. No. The two are different 11decisions. You can have people who have lost a 12finger, let's say, in an accident in the military 13and that they are still able to do their job, they 14are still in, servicing in uniform, but they would 15be receiving some form of an award from VAC for the 16loss of the finger. 17 Q. So your role, then, is purely 18advisory in terms of putting VAC into the picture 19as to what the soldier's situation is? 20 A. Yes, I have a 14-page report 21to fill out for them, which is why it takes a 22while. 23 Q. Now, you -- we recently have 24been given Corporal Langridge's mental health file, 25and so I apologize that it's in a separate

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 88 2 3 4 5 1document, but you will see it in that stack to your 2left. There is a big book and there is a small 3book. The small book is mental health records. 4 I believe in there, I think I have 5probably lost the page, but I believe in there, 6there are some notes that you compiled when you 7actually had the interview with Corporal Langridge. 8I believe they begin at page 31, they are, 9unfortunately, not numbered, but for your 10reference, there is a sheet in between that says 11"Leo Elwell, psychiatrist notes". 12 A. This one? 13 Q. Yes, that's it. 14 A. Okay, I am on the right page. 15 Q. If you want to take a minute 16to review, I am glad to wait. 17 What I am going to ask you to do 18is, to the best of your ability, to reconstruct 19what went on in your interview, what your 20impressions were and what your suggested treatment, 21what your plan for treatment was as a result of 22this interview. 23 A. Okay. 24 Q. Okay, now, let me just set 25the stage.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 89 2 3 4 5 1 You have told us that it wasn't 2very long into the session that Corporal Langridge 3started talking about VAC benefits. 4 A. Yes. 5 Q. So we know what, how his 6focus for the appointment was. 7 From your perspective and your 8understanding, what was the reason for the referral 9to you? 10 A. The recent difficulties with 11anxiety and chest pains on the leadership course, 12the LQ. 13 Q. Looking at your notes, does 14it leap out at you that there may have been any 15suicide attempts? 16 A. Yeah, on my page 3, past 17psychiatric history, it looks like the number 4 but 18it's the psych sign: 19 "Tried to kill myself times 20 2. Last time, two, three 21 weeks ago. Short-term 22 crisis, bad, work sucks, 23 spouse left, felt like, 24 expletive deleted, overdose 25 on the Seroquel."[as read]

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 90 2 3 4 5 1 And ETOH means alcohol, it's 2ethanol, that's my shorthand for that. 3 Q. Yours and all your colleagues 4as well. 5 A. Okay. 6 Q. The reason I am asking, 7doctor, is that it appears as though the suicide 8was not very prom -- or the suicide attempt was not 9very prominent in Corporal Langridge's 10presentation. We get to it by the third page -- 11 A. Right. 12 Q. -- and it doesn't seem to 13have been the motivating, from what you tell me, 14the most motivating factor in his getting a 15referral to you; is that your understanding as 16well? 17 A. That would be my 18understanding. 19 Q. All right, so, a soldier 20comes to see you complaining of chest pains, 21anxiety, sweating, nightmares, saying give me a 22letter to VAC? 23 A. Yes. 24 Q. So -- 25 A. And for treatment too, he did

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 91 2 3 4 5 1ask for treatment as well. 2 Q. So what happens in the 3interview? 4 A. At the end of the interview, 5I come up with an idea of how I am going to treat 6it. Again, when VAC is concerned, I try not to go 7really wild on a diagnosis right off the bat. The 8problem with that is, is that it's not fair to me, 9it's not fair to the soldier, it's not fair to VAC, 10right. If I, you know, zoom in on one particular 11aspect of their symptomatology and say, oh, that's 12it, then I have ruled everything else out, right, 13and I don't think that's particularly the way to do 14it. And especially when somebody asks me right off 15the bat in the first couple of minutes about VAC 16benefits, then I am usually wondering, is there a 17bit of a game afoot. 18 Now, everybody likes their VAC 19benefits and I am not in a position to deny them 20and I don't, okay, that's up to VAC, but, you know, 21certainly, a person gets a little bit suspicious 22when they hear that. 23 Q. Did you come to any sort of a 24tentative diagnosis or a provisional diagnosis of 25what was going on here?

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 92 2 3 4 5 1 A. Yeah, a couple of nights ago 2when you forwarded this to me, kindly, thank you, I 3went through it, and what comes out at me is still 4generalized anxiety disorder and alcohol problems. 5 Q. So in light of that 6provisional diagnosis, what was the treatment plan 7that you formulated? 8 A. Well, on one hand, you know, 9he said that Effexor wasn't working for him, okay. 10And if you look at page 5, my handwritten 5, that 11Effexor 300 milligrams KG, so that's 300 milligrams 12once a day, "I hate it, don't notice a difference". 13And then, you know 30 seconds later, "Oh, it keeps 14the chest pains away and I am not as anxious 15anymore". 16 So if I didn't like what the 17Effexor was doing for him, I would have tapered it 18and started him on something else. And instead, 19what I did was I left him at the same dose but 20because of the sweating, which can happen with 21Effexor at nighttime, I put 262 in the morning and 22thirty-seven and a half at bedtime to see if that 23could help him with nighttime sweating. 24 The other thing that I did here 25was that because one of his other complaints was

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 93 2 3 4 5 1regarding the nightmares, and he had had those for 2a number of years by that time, and as well on page 35 there, he says, "I can't say when they started". 4When people develop nightmares after a particular 5Criterion A type of event, okay, they can tell you 6when they started. It's not vague. Okay. It may 7be a week after, it may be a month after, and 8delayed onset, it can be six months after, but they 9can tell you when it started. 10 Q. Did, we are getting into the 11criterion, Criterion A, we are getting into the 12murky world of PTSD, I understand. 13 A. Yes. 14 Q. From Corporal Langridge's 15point of view, did he bring up the issue of PTSD 16with you? 17 A. I would have written it down 18in there. And usually when you are going through 19and doing the occupational history, which, if you 20notice, is on the first page of my handwritten 21notes, okay, you don't have to ask about it, it 22comes out at you, it comes across the room at you. 23It's not -- it's freely volunteered. And the person 24says, okay, when this happened, I was present at 25this or that event, okay. And that's why I ask the

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 94 2 3 4 5 1occupational history first because you don't even 2have to ask, 'hey, have you had any Criterion A 3events happen', okay. 4 And, in fact, in the -- as part of 5the research for this that I was -- for this 6hearing today, that I was looking at was the 7malingering of PTSD. And through the miracle of 8the internet, a lot of people can find out all the 9symptoms of this condition before they go in to see 10their doctor, and that this is commonly done in the 11military, and it's commonly done in other settings 12as well. And as a result of that, by doing the 13occupational history, you can get a sense of 14whether the person is genuine or not with respect 15to that claim. 16 The other thing that I wound up 17doing for him with respect to the nightmares was 18that I prescribed the Neurontin, which is on the 19next pages of the prescription. 20 Q. Let me just get back a little 21bit to the PTSD. 22 A. Sure. 23 Q. We have established that 24Corporal Langridge didn't volunteer either the 25topic or the proper Criterion A event that would

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 95 2 3 4 5 1have led you down that path. 2 But do I understand that PTSD was 3in the air in terms of what you were looking at and 4what you were considering, even without it being 5brought up? 6 A. Yes. 7 Q. And why would that have been? 8 A. Because of the conditions of 9service and what a lot of these guys had been 10through. The stress of just doing the job. You 11don't have to go to Afghanistan to die or see 12people die. That happens here at home, in 13training. He can see people maimed. You can see 14tonnes of stuff that is pretty traumatic, right, 15and stressful. And just the fact of postings and 16training and this and that and just the regular 17routine of life in the military is stressful. 18 Q. Let me ask this a different 19way, then. From the point of view of your 20assessment for VAC, and from the point of view of 21your understanding at the time of that process, 22would it have made a difference if the origin of 23the anxiety were something that Corporal Langridge 24encountered as part of his military service and, 25therefore, causing perhaps PTSD, or whether the

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 96 2 3 4 5 1origin of the anxiety was more prosaic and in his 2personal life or simply in his chemistry? 3 A. Right, and to my mind, at the 4end of this assessment, I thought that the anxiety 5predated everything. So predated deployment to 6Bosnia, predated deployment to Afghanistan. 7 Q. But from the point of view of 8the VAC process first, would that have made any 9difference, in your understanding? 10 A. You see, like, one of the 11reasons why I take six months on these is that I 12want to present to VAC a very convincing argument, 13okay. And certainly we see people who have some 14amount of symptoms before any deployment and then 15an exacerbation afterwards, and I want to be able 16to show VAC that, look, these are the facts of the 17matter, and that make it relatively clearcut for 18them to make a decision. And at this point in 19time, I thought that it predated it. 20 Q. Right. No, I guess what I am 21asking is, is it necessary for there to be a 22connection to the military and to military service 23in order for your assessment to be influential or 24for Corporal Langridge's point of view helpful in 25the VAC process?

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 97 2 3 4 5 1 A. Yes. 2 Q. Okay. So throughout this 3process, there would be an important issue as to 4whether his condition was generated by the 5circumstances of his personal life or whether it 6was generated or exacerbated or reawakened by the 7conditions of his military life? 8 A. Yes, you need to have some 9sense of causality or exacerbation. 10 Q. Was there any component in 11your plan vis-à-vis Corporal Langridge for further 12treatment, perhaps psychotherapy or whatever or 13maybe simply drug therapy, to deal with his 14symptoms rather than the causation for those 15symptoms or rather than isolating the causation? 16 A. Yeah, what I normally would 17do was to treat what I have right here in front of 18me, to ease the suffering as much as I can right 19off the bat. And then in the fullness of time, get 20to really know the person and then be able to say, 21okay, you know, this is the part that came before, 22this is the part that came after. 23 Q. From your notes, can you 24locate any indication as to further booking, 25further appointment or any plans to see him again?

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 98 2 3 4 5 1 A. I wouldn't have written that 2in the rough notes for the initial visit, but I 3would have walked down with him to where the 4bookings secretary is and we would have booked a 5follow-up appointment. 6 Q. And where -- if we were 7looking to locate Corporal Langridge's suite of 8appointments with various practitioners, where 9would that scheduling data be found? 10 A. We had what was called the 11scheduler, the electronic scheduler, and it's 12supposed to have a record of all the appointments 13made, appointments where there were no-shows, 14appointments where there were cancellations, that 15sort of thing. And I believe that you guys did get 16access to that. 17 Q. Okay, have you seen it 18somewhere in the records? Because I have to admit 19that I have not yet memorized the entire record. 20 MS. RICHARDS: Tab 1. 21 MR. FREIMAN: Tab 1, excellent. 22 BY MR. FREIMAN: 23 Q. So Tab 1. 24 A. In the big book, or? 25 MS. RICHARDS: Yes.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 99 2 3 4 5 1 BY MR. FREIMAN: 2 Q. Let's have a look. I was 3with you, I was looking at the little book. 4 Okay, so looking at all of this, 5can you locate where your scheduling would be 6found? 7 A. It's on page 2, and it's -- 8 Q. It should be 1115. 9 A. Five down. 10 Q. So that tells us the 11appointment was 1330 or, and -- 12 A. Oh, he did arrive on time. 13 Q. Yes, he arrived early. 14 A. Oh, good, all right. 15 Q. And if there was a follow-up 16appointment made, would that also be in this book, 17or do they only appear when the person comes for 18the follow-up? 19 A. I am not an expert on the 20scheduler but -- 21 Q. I see something for you that 22may be helpful. 23 If you look under "resource and 24location", the first page, one, two, three, four, I 25think five.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 100 2 3 4 5 1 A. 19 February, yes. 2 Q. That's it, 19 February. Now, 3we know the 19 February was a day in which Corporal 4Langridge was an involuntary guest of the Alberta 5Hospital at Edmonton. 6 A. Okay. 7 Q. So in the ordinary course, 8would somebody have to do something about 9rescheduling that? 10 A. Yes. 11 Q. Okay. And would that person 12be you or would that person be the patient? 13 A. Umm, it would have been, 14normally, the patient, but because this person was 15on everybody's radar, we were talking about him a 16lot, and I had left it up to BAC and to the CDU to 17make sure to book him in. 18 Q. Okay. When you say that this 19person was on everyone's radar, can you give me a 20better idea of what that meant as a practical 21matter? 22 A. He had a lot of difficult 23behaviours as part of what I came to appreciate in 24the Axis 2 diagnosis. And so on the one hand, he 25was --

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 101 2 3 4 5 1 Q. Just to set the stage, many 2people have heard, but the record will not have 3heard, Axis 2 is the behavioural personality axis; 4is that correct? 5 A. Yes. 6 Q. Okay. 7 A. And on the one hand, people 8with Axis 2 diagnosis wind up, especially in 9Cluster B, which is antisocial, borderline conduct 10disorder kind of people, they, on one hand, want 11help, and then on the other hand, reject help. And, 12you know, you can see this as evidenced elsewhere 13in the documents that I have reviewed, where on the 14one hand, he wanted to be a good soldier, he wanted 15to be part of the unit again, he rejoined Recke(ph) 16squadron because that was going to fix everything, 17and then that fell apart in very short order. 18 And then he would want to go in 19and get base drug and alcohol treatment, and then 20he would not show up for appointments or not follow 21what was recommended of him. 22 He went to Edgewood, four days 23later discharged himself against medical advice. 24And the program at Edgewood, I have seen firsthand, 25there is a lot of people that kind of get cold feet

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 102 2 3 4 5 1when they are getting treatment for their addiction 2and they want to check themselves out early before 3completing the program. And the treatment facility 4has an excellent system of talking them down, 5talking with loved ones, talking with other people 6in the group and supporting them through that 7really difficult time. He wasn't able to do that. 8 And that's, again, an example of 9help-seeking, help-rejecting; so, yes, on the one 10hand, I want to go to Edgewood and get treatment 11and on the other hand, I don't. And that's just 12part of the beast, that's part of the nature of the 13illness. 14 Q. Now, you were citing that in 15terms of him being on everyone's radar. 16 A. Yes. 17 Q. So do I understand, then, 18that a number of members of the medical community, 19at least, were discussing these behaviours and 20these issues? 21 A. Yup. 22 Q. Would that discussion, not by 23the doctors necessarily, but the discussion itself 24have extended beyond the medical community and 25reached the general population of soldiers?

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 103 2 3 4 5 1 A. Not by us trying to do that. 2Like, we keep that kind of talk in the shop, you 3know. It's nobody else's business. 4 Q. Okay. So let's talk about 5what the general view was. 6 You have told us that people knew 7who he was and he was a topic of conversation so 8that as, I understand it, even if he wasn't seeing 9a physician on a regular basis the, physician might 10very well be aware -- 11 A. Yup. 12 Q. -- of what was going on? 13 A. And was talking with Shannon 14Newing, because her office was right across the 15hallway from me. 16 Q. Before we go any further, 17would that community who was talking and being 18aware of Corporal Langridge also have included the 19acting base surgeon, captain -- now Major Hannah? 20 A. Yes. 21 Q. Is there any way that members 22of the medical community, either the mental health 23wing or CDU Charlie, would have been unaware of 24Corporal Langridge and his problems? 25 A. I suppose it's possible, but

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 104 2 3 4 5 1not probable. 2 Q. All right, so there was a 3consciousness of what was -- of the issues raised 4by Corporal Langridge and his conduct. Was there 5also a consensus or a sense, a shared sense of what 6to do about that and what the future would hold for 7him? 8 A. Yeah, I think the first thing 9to try and do here is when you are dealing with 10what we call a co-morbid condition, that means that 11you have a mental-health diagnosable condition, and 12you also have some sort of an addiction disorder. 13When you have got both of those together, you have 14got to treat both of them at the same time. And 15what you need to do and what we were trying to do 16with either anxiety or depression, it really 17doesn't matter which label you want to apply, or 18even, for that matter, PTSD, okay, you treat it 19with the antidepressant Effexor at high doses, and 20300 is a high dose. You treat it with something 21like Neurontin for nightmares. You treat it with 22Seroquel, which helps the person go to sleep and 23helps stabilize their mood. 24 So regardless of what the 25diagnosis on Axis 1 is, we pretty well got it

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 105 2 3 4 5 1covered just with those three medications right 2there, any which one. 3 Then the big issue once you got 4the person, let's say, 90 per cent compliant on 5Effexor, then you let that soak in for a bit of 6time and hopefully within a couple of weeks, you 7start seeing treatment results. 8 Now, if the person is drinking and 9drugging and especially cocaine or lots of 10marijuana, whatever you're prescribing becomes an 11experiment, okay. You don't know how it's going to 12work. 13 If the person misses a dose of 14Effexor, they start feeling really weird, 15especially at high doses. And this can happen 16about four hours after missing a dose. That's one 17of its downfalls. But we kept reiterating, though, 18you got to take it, you got to take it regularly, 19okay, and if you take it regularly, it's a very 20good antidepressant, very good antianxiety agent. 21 If you are not taking it regularly 22and if you are mixing it with other stuff, then all 23sorts of weird stuff can happen. 24 And I know that as a standard of 25care, this would have been reiterated to him or

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 106 2 3 4 5 1anybody else like him more than once, because 2sometimes you have to repeat yourself because they 3don't get it the first time. 4 And I know it would have been 5repeated to him by Ms. Newing, and I know it would 6have been repeated to him by either Don Perkins or 7Dennis Strilchuk, either one, because both of them 8were well aware of that. 9 So then we treat both. If the 10person isn't settling down with their addiction, 11then we need to send them to an addiction treatment 12facility. 13 A hospital here like in Alberta 14like U of A or the Alex or Alberta Hospital 15Edmonton, even if you got them in there for like 30 16days, still doesn't really start addressing the 17addiction issues. The illness of addiction, you 18need to go to a specialized care facility, so 19Edgewood, Homewood, Bellwood, some place like that, 20at this level of severity. 21 Q. And was the general sense 22within the community that Corporal Langridge, and 23this is before the final events, that Corporal 24Langridge had a hopeful prognosis? 25 A. Yeah, yeah. We have seen

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 107 2 3 4 5 1lots of people when they are actively abusing 2substances to be all over the place, missing 3appointments, not taking the pills, right, checking 4themselves in and out of hospital for various 5issues including suicidality, and then once they 6get some sobriety, it is amazing the transformation 7that can happen in less than two weeks. I have 8seen it myself when I have taken a course out at 9Edgewood, it's amazing what happens in less than 10two weeks. 11 Q. Now, aside from the obvious 12goal of restoring Corporal Langridge to better 13health by treating, as you described it, both the 14co-morbid conditions, both the anxiety, depression, 15PTSD, whatever we want to call it, and the 16addictions and dependence, was there thought given 17as a separate matter to the issue of suicide? 18 A. You have to keep assessing 19for that all the time. And there is basically, 20there is a bunch of different subtypes of suicide 21or suicidal behaviour, and I think a useful way of 22looking at it here would be the notion of chronic 23suicidality and then acute suicidality. 24 Okay, so the chronic part is over 25the long term, where a person makes repeated

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 108 2 3 4 5 1gestures, okay. And something happens, some kind 2of crisis, and they go into the hospital or they 3come in to see me or somebody else in mental health 4and, 'help me, I am suicidal'. You sit down and 5talk with them a bit if it is really serious, and 6if I think the person is certifiable or if I am 7scared for them, I will send them off to the 8tertiary centre, to the Royal Alex or Alberta 9Hospital or U of A or Mis or Grey Nuns, those are 10all the main mental health hospitals in Edmonton. 11Because I can't really deal with that on an 12out-patient basis, so I send them there. Sometimes 13they go into hospital, sometimes they don't. Even 14though they are identified to me that they are 15suicidal, right, and sometimes the suicidality 16passes in a matter of a couple of hours or 17overnight and they say, oh, okay, I am fine, I am 18fine, I'm okay again. 19 And particularly when you are 20dealing with an Axis 2 or a personality disorder, 21okay, it becomes very difficult to deal with these 22people because there is a fair amount of chronic 23suicidality on their part, okay. 24 When it's acute suicidality, so a 25clearcut example is a person with schizophrenia

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 109 2 3 4 5 1where the voices are telling them to do themselves 2in, okay, that person goes to hospital, gets 3admitted 99 per cent of the time, we deal with it, 4we settle down the voices medically, life is good 5again. Okay. 6 And in that sense, an acute 7suicidality and acute admission, okay, we can deal 8with that in hospital, settle them down, and 9everything is good again. 10 But the chronic ones are very 11difficult because you have to continue to reassess, 12reassess, reassess, reassess, and if you look at 13the notes that Ms. Newing put in there, that was 14done every time, "SI", "HI", suicidal ideation and 15homicidal ideation, and assessing for that. And if 16at any point in time it exceeds a certain comfort 17level, then we wind up referring them into 18hospital. 19 Q. Is there any accepted 20practice, just think about the base, for 21individuals who -- use a term that's probably not 22applicable, who yo-yo in and out of this state, 23admit themselves, get discharged, admit themselves, 24get discharged, is there any larger plan to deal 25with that, or do you simply have to go with that

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 110 2 3 4 5 1sequence? 2 A. Again, you try to get to 3what's the underlying problem, and on at least a 4couple of those suicidality episodes, some form of 5substance was involved, whether it was alcohol or 6something else. And in that context, then if you 7are seeing the suicidality increase when the person 8has been drinking, then you say, look, you know, we 9have to treat this alcohol problem here; right. And 10by treating the addiction, then the suicidality 11retreats. 12 And I think that our hope was 13that, okay, he has had 30 days of depression, 14anxiety, PTSD stabilization, however you want to 15call it, at Alberta Hospital, now we need to get 16him into a treatment facility. And that was 17certainly the plan. 18 Q. Do you know whether the plan 19ever got beyond the hypothetical stage and actually 20crystallized into an appointment at a facility? 21 A. I think that was up to the 22base surgeon, but I thought we had a date, and I 23thought it was in the month of March of '08. 24 Q. If that were the case, would 25there be a record in the ordinary course of the

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 111 2 3 4 5 1booking and, I imagine, the financial approval, 2because it's a hefty down payment; isn't it? 3 A. Yes, yeah. As you probably 4have been able to access, I am not sure because I 5didn't see it in the documents that were forwarded 6to me, but there is a document that says, you know, 7approval for so-and-so to go to Edgewood, here is 8the leave pass, here is this, and then signed off, 9right. And that would have been the same thing 10that was being done for Homewood. 11 Q. Would that be the primary 12document that we should be looking for? We found a 13number of those documents, but they are mostly 14associated with referrals to emergency departments 15in large metropolitan hospitals when Corporal 16Langridge was seen and assessed and eventually -- 17we haven't seen an approval as yet for a course of 18treatment in March of 2008. 19 A. I know that there were 20conversations with Captain Hannah and Homewood 21because we had entertained the idea of going back 22to Edgewood again and that was, you know, certainly 23also by Mr. Langridge's choice, he didn't want to 24go back there; right, so I said, okay, we will try 25one of these other two which are very good as well.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 112 2 3 4 5 1And I know it was in the works, and the matter of 2filling out that form and signing it is less than a 3couple of hours' work and walking it around in the 4base clinic to a couple of different signing 5authorities, but... 6 Q. In terms of pragmatics, 7though, would -- I don't know how better to put it, 8would you have to wait for a bed to become 9available at this facility? 10 A. Yes, yes. 11 Q. Or for a treatment cycle? 12 A. You have to wait for a bed. 13 Q. So would there be any 14correspondence or any other documentary paperwork 15related to trying to secure a bed in one of these 16facilities? 17 A. Usually it was just done by 18phone. 19 Q. Okay, and who would be the 20person who would do that? 21 A. Either the base surgeon or 22his or her designate or the base drug and alcohol 23counselor. 24 Q. Just before we move away, for 25at least for the time being, from the thin book,

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 113 2 3 4 5 1you will be aware from having looked at these notes 2the other day that there are a number of tests, 3some of them complete, some of them incomplete, 4that were -- that involved Corporal Langridge 5filling out questionnaires and forms, 6multiple-choice tests. 7 Do you know what the occasion was 8for having him do those tests? 9 A. My understanding of that was 10that he had seen the psychologist, Dr. William Li, 11prior to my seeing him, and that he had done the 12psychometric battery on him, which is what we did 13as standard care. And unfortunately, I never got 14to see that until after the fact, but I did see 15that. 16 Q. In the ordinary course, what 17would be the reason for doing that and what would 18be the consequence of filling it out and being 19graded and scored? 20 A. It gives us a fuller picture 21of the person. It also aids us with possible 22different diagnoses, it also aids us with whenever 23we do have to fill out something for VAC. VAC likes 24it if the psychiatrist is saying the one thing, the 25psychology work, the psych test results are saying

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 114 2 3 4 5 1the same, and that, then, it's a coherent case for 2the person. 3 Q. Would it have been necessary 4or useful for you to have the results of those 5tests? 6 A. Not necessary. Again, there 7is two functions with what I was trying to do 8there. The first one was trying to treat the 9person for their mental health problems, okay, and 10what I saw was anxiety and addiction. And that's 11where the treatment was headed. So that's the 12first goal. And then the second goal is that in 13the fullness of time, if there is a compensable 14component to the symptoms, okay, then I want to 15fill out the VAC for the person. 16 Q. And just, again, there is one 17more document, and it's a bureaucratic document 18that I wasn't totally sure that I understood. It's 19addressed to you. It's near the beginning of the 20material in the small book, one, two, three, fourth 21page. It's a fax to you -- 22 A. It was to Karen. 23 Q. To Karen, I'm sorry. And I 24take it Karen is the receptionist or a scheduler 25for you?

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 115 2 3 4 5 1 A. Yes, she is a file clerk, 2receptionist, transcriptionist, does a bunch of 3things. 4 Q. Everything. 5 A. Yeah. 6 Q. Do you know what this is 7about? Because it's coming from Veterans Affairs. 8 A. Yes, so they are asking for 9documentation to aid with completing a VAC file on 10him. 11 Q. So would there still have 12been an outstanding question as to entitlement to 13benefits or compensation even after his death? 14 A. Possible, yeah. 15 Q. And where would this come 16from? Does this get generated internally, or is it 17generated as a result of something that's been 18initiated by somebody in the medical community? 19 A. I didn't have the VAC forms 20for him. Normally, I do fill them out. VAC, if 21they have an open dossier, will occasionally remind 22us. 23 Q. You can see the line says: 24 "Also, Dr. Elwell was 25 supposed to write something

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 116 2 3 4 5 1 up for his file."[as read] 2 A. Yes. 3 Q. And I am trying to understand 4where that information would have come from to VAC. 5 A. That would have been probably 6when Mr. Langridge talked to VAC himself. 7 Q. I see. 8 Give me a moment, please. 9 If you look at Tab 39 in the big 10book, this is a discharge summary written by Dr. 11Sowa at the end of the 30-day certificate under 12which Corporal Langridge was staying at the Alberta 13Hospital. 14 First I would like to just ask you 15about the diagnosis on discharge, whether you agree 16with that diagnosis based on the work that you 17yourself independently did or whether you have 18reason to disagree with any of this? 19 A. I think based upon what I saw 20in November, I was comfortable with alcohol for 21sure, okay, alcohol abuse and dependence. 22 And what came about later on 23through reading the documents was that also there 24would be cocaine in there -- 25 Q. When you say "reading the

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 117 2 3 4 5 1documents", you mean? 2 A. This stuff. 3 Q. Is that after his death? 4 A. Yes, after his death. 5 Q. So do I understand that at 6the time of your intake analysis or your interview 7with him, the drug dependency was not high on 8anything that he had discussed with you? 9 A. I don't believe it was 10disclosed to me. 11 Q. The reason I ask is, as we 12discussed earlier, he had clearly failed a drug 13screening test, not in the therapeutic but in the 14administrative stream, and would have been under 15some cloud, in any event, associated with that. 16 A. Yeah, well, I was not briefed 17on that when I saw him on that day. Because, 18otherwise, I certainly would have pushed him harder 19on that. 20 Q. Okay, so we have dealt with 21the first line, the polysubstance dependency, so 22it's not limited to alcohol, and there is also 23cocaine in issue. 24 What about the other parts of the 25diagnosis?

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 118 2 3 4 5 1 A. Well, I would also think I 2would throw in there marijuana as well. 3 In terms of grief reaction, you 4see, that's where Dr. Sowa had more time with him 5and was able to talk with him a bit more about how 6things were like for him growing up and how he felt 7about, for example, his attachment with his father, 8okay. 9 So that Dr. Sowa would be in a 10better place to comment on that than I would. To 11my mind, what I saw was generalized anxiety 12disorder. You know, and this is where he had more 13time with him with the PTSD, so the query, that 14doesn't mean that he has it, but it's asking the 15question, okay. 16 Q. Yes. 17 A. And, again, if we would have 18had possibly more time with him, it might have come 19out, I don't know, okay. What I saw was 20generalized anxiety disorder, I did not see PTSD. 21 Q. Right. 22 A. And the other thing about 23this is that on the civilian side, they 24automatically think that everything that you have 25done in the military has exposed you to dead babies

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 119 2 3 4 5 1and horrors unimaginable, okay. And the reality 2is, is, no, all right. 3 Yes, it's potentially traumatic. 4Yes, lousy things can happen while you are serving, 5okay, but that doesn't mean that everybody gets 6traumatized, in the first place. And in the second 7place, not everybody goes on, even if they are 8traumatized, goes on to have PTSD. 9 Okay, and so there is a bit of a 10disconnect. And by that point in time, I had been 11working at the base for a while, and we were 12cognizant of people for secondary gain for making 13the money out of VAC would tend to play things up a 14bit, okay, and so we were careful about that so 15that when we said, yes, these are our diagnoses, 16they were that, and we had lots of evidence to back 17it up. Okay. 18 Q. Just before I leave this, 19something you said just twigged for me. 20 As we discussed earlier, Corporal 21Langridge didn't, to your recollection, raise PTSD 22in his discussions with you. But the fact that he 23raised VAC, wouldn't that inferentially raise PTSD, 24even if he doesn't say the magic letters? 25 A. That's right, yes.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 120 2 3 4 5 1 MR. FREIMAN: Now, Mr. Chairman, I 2am not finished with this document, but I actually 3want to get to a different topic based on this 4document. And we have detained Dr. Elwell for 5almost an hour and a half already. Perhaps this is 6a good time for a kind of brief break? 7 THE CHAIRPERSON: Why don't we 8break for ten minutes, if that's fine. 9--- Upon recess at 2:22 p.m. 10--- Upon resuming at 2:34 p.m. 11 MR. FREIMAN: Thank you, Mr. 12Chairman 13 BY MR. FREIMAN: 14 Q. Dr. Elwell, during the break 15we have located, through the good offices of Ms. 16Richards for the Department of Justice, the medical 17referral and certification form. For the record, 18this is Document 1143, Collection E, Volume 2, Tab 1910, page 171. I don't have it's postal code, but I 20am sure that's somewhere as well. 21 Just looking at this document, 22Point 2 says: 23 "I understand that 24 administrative or 25 disciplinary action or both

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 121 2 3 4 5 1 may be taken regardless of 2 whether I am found to be 3 dependent on drugs or I 4 accept or refuse 5 treatment."[as read] 6 I appreciate this is outside of 7your normal area of competence, but from your 8understanding of the process, what I gleaned from 9your explanation, is regardless of what that says, 10as a practical matter, if a person were compliant 11with treatment it is unlikely that administrative 12action would be taken? 13 A. That's correct. 14 Q. Now, Dr. Elwell, we were 15looking at the document at Tab 30[sic], and we 16talked a little bit about the diagnosis. 17 What I would like to turn to now 18is the events that took place at or around the time 19of the planned discharge of Corporal Langridge or, 20sorry, the expiry of the certificate. And I would 21like to draw your attention to the second page of 22the discharge summary offered by Dr. Sowa and the 23last two paragraphs. 24 I am just going to read them so 25that we know who we are talking about.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 122 2 3 4 5 1 MS. RICHARDS: Sorry, Mark, I 2think you have the witness on the wrong tab. You 3said Tab 30, and I think it's Tab 39. 4 MR. FREIMAN: No, no, it's 39, I 5am very sorry. 6 BY MR. FREIMAN: 7 Q. So we are at the second page. 8And this is what Dr. Sowa writes: 9 "In the last week of his stay 10 in hospital, we kept him 11 under close observation 12 because of his continued drug 13 abuse. He remained euthymic 14 and without any psychotic 15 symptoms but displayed 16 intermittent irritability and 17 those periods were quite 18 noticeable and indicated 19 illicit drug use. Our plan 20 was to keep him in the 21 hospital until he could be 22 discharged directly to the 23 military. He certainly was 24 not certifiable at the end of 25 the first certificates. He

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 123 2 3 4 5 1 agreed to stay in the 2 hospital as a voluntary 3 patient until arrangements 4 could be made for him to 5 return to a drug 6 rehabilitation program. 7 "Unfortunately the military 8 called us to inform us that 9 they actually did not want 10 him back -- did want him back 11 at the Garrison and that they 12 would make their own 13 arrangements for him to be 14 referred to a drug rehab 15 program. We were rather 16 surprised by this as Stuart 17 had indicated his willingness 18 to stay with us in hospital 19 so that that could be done. 20 However, based on that 21 request, he was escorted the 22 day after his certificates 23 expired directly to the 24 military Garrison and handed 25 over to his sergeant and this

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 124 2 3 4 5 1 was done on the 5 of March, 2 2008."[as read] 3 Were you aware of any discussions 4that were going on about Corporal Langridge and 5what was to be done at the expiry of his 6certificate? 7 A. Well the -- I had talked with 8then Captain Hannah regarding what we should do 9with him once he got out of Alberta Hospital 10because then he came back to our care, right. When 11he is in hospital, he is under Dr. Sowa's care, he 12is in the civilian system. 13 And one of the concerns that had 14come up was that while he was at Alberta Hospital 15was that he was continuing to access cocaine and 16the problem with that being is that you want to 17have this person a little bit stable. And if Dr. 18Sowa is already noticing that he is irritable, what 19addict in their right mind, when they are actively 20using, would want to get out of a situation like 21this because they can continue to access their 22drugs. So, of course, he is going to love to stay 23there, right. At some point in time he needed to 24come back to us. 25 About a year or so prior to this,

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 125 2 3 4 5 1we had an unfortunate situation where we had a 2person with an addiction and PTSD and a major 3depressive disorder and all those things, who had 4gone to Edgewood and in the first week had tried to 5hang himself, and they caught him by accident in 6his room just as he was putting the rope around his 7neck. And as a result of that, we were all very 8sensitized to this potential issue and given Mr. 9Langridge's past track record here of attempts in 10the last number of months, we were very concerned 11for him. 12 We know that if a person is 13actively using the substances that makes them more 14suicidal. We know that if they are drinking 15alcohol, that makes them more suicidal. We know 16that these are factors in completed suicide. 17 We were worried about how do we 18get this guy a little bit clean to start off with, 19get him off into a rehab program, considering that 20we had sent him to Edgewood a mere three months 21earlier and that had lasted a grand total of four 22days, okay. 23 So we were really concerned about 24getting him into a treatment program and getting 25him to stay there.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 126 2 3 4 5 1 One of the other risk factors for 2suicide is when a person is away from their normal 3social network, and whether that's at work or 4whether that's family, if we are sending him here 5to Ontario, okay, from Edmonton, we were concerned 6about what might happen to him there before he gets 7going in treatment at Homewood. 8 The other thing that Homewood, 9Bellwood and Edgewood like to see is that the 10person is at least sober coming in. They don't 11like having to detoxify them. If we recall before 12he had gone to Edgewood, I believe, he had I think 13it was alcohol, he had consumed alcohol before 14going away on the rehab program in January, right, 15January 4th. 16 Q. Yes. 17 A. Okay, so we were worried 18about that happening. And seeing as how he was 19accessing drugs relatively easily, that was our 20understanding of it at Alberta Hospital, then it 21was like, 'okay, where can we get him to a point 22where he is not accessing the cocaine, where he is 23still taking his medications on a regular basis and 24where we can keep a very close eye on him'? 25 Now part of the plan was also that

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 127 2 3 4 5 1if he became acutely suicidal, remember 2chronic/acute, right. If he became acutely 3suicidal, we would, of course, immediately send him 4back to hospital. And that was our understanding 5of why we were trying to do this stabilization, is 6that he wasn't any longer acutely suicidal. Yes, 7he remained a chronic risk; yes, he was partly 8stabilized. Let's get him stable for two weeks 9before we potentially send him away here and have 10bad things happen in Homewood. 11 Q. So when did these 12conversations take place and who are the 13participants in the conversation? 14 A. Base drug and alcohol, and I 15am thinking that it was Dennis by that point, 16Dennis Strilchuk, and -- because Mr. Perkins had 17already discharged him from his care because of 18continued non-compliance, help seeking/help 19rejecting, and Captain Hannah and myself and Rajoo, 20Dr. Rajoo would have been involved too. 21 Q. I think Dr. Rajoo would have 22been on vacation at this point? 23 A. At that point, okay. Then 24Hannah was acting as the person covering for that 25CDU, because normally Rajoo would have been

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 128 2 3 4 5 1involved or whoever was the CDU GDMO. 2 Q. We heard this morning from 3Mr. Etienne, who seemed to have been a courier for 4information, that his plan when Corporal Langridge 5called him proposing to go to Edgewood and to stay 6in hospital until then -- or at one point he had 7another plan -- that he would take the proposal to 8a conference. 9 Is the meeting we are talking 10about, the discussion, the conference that Mr. 11Etienne would have been talking about? 12 A. Yes. 13 Q. Was that a physical 14conference or was it a virtual conference by 15telephone? 16 A. I can't recall. 17 Q. Okay. Let me just then refer 18you to a document in the thin collection. The tenth 19page in. It's, I believe, in your handwriting and 20it's dated 4 March? 21 A. Yes. 22 Q. Now, what is this document 23that we are looking at? 24 A. This is either a 25teleconference or a case conference. Normally I

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 129 2 3 4 5 1write down "teleconference" or "tel con", but I 2didn't in this case. If it's case conference, 3normally we have a form for that and you have seen 4other ones in here. 5 Q. Yes. 6 A. So I am going to guess that 7it was a telephone conversation then. It was 8regarding Mr. Langridge and if he wants to stay in 9Alberta Hospital it was okay with me. It was also 10okay if he leave there, okay. That, you know, if 11he is acutely ill, acutely suicidal, then obviously 12that's the person on the ground in AHE. In this 13case Dr. Sowa or one of the other doctors there 14would have said, 'no, no he is acutely suicidal, we 15can't send him home'. And if he wants to go then 16he would be recertified, right. And it's not our 17place to tell them that decision, that would have 18been their's. 19 So our understanding would be that 20he remains having problems with addiction, the 21anxiety/depression/acute suicidality has been 22mostly dealt with, but this is somebody that we 23have to keep very close tabs on based upon what he 24has done in the last number of months. 25 And again, as part of our concern

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 130 2 3 4 5 1about that previous service member at Edgewood, we 2thought that it would be best to have two weeks 3worth of stability, two weeks away from drugging, 4in this case the cocaine, before going to Edgewood, 5Bellwood or Homewood or any kind of rehab kind of 6place. 7 Q. Let me just stop there and 8ask you a couple of questions. 9 First of all, just looking at that 10second line: 11 "Two weeks stability in 12 community before Edgewood, 13 Bellwood, Homewood."[as read] 14 To me that appears to indicate 15that as of the 4th of March, no specific decision 16had been taken about which, if any, of these three 17facilities would be the ones that he would be 18attending? 19 A. Yes. And then the next 20sentence down, "Homewood" was underlined with a 21question mark. So that indicated that that was 22probably the frontrunner, and that's my 23recollection and my memory, and that it was okay 24with me if he went there. 25 Q. All right. And in the last

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 131 2 3 4 5 1line says: 2 "Urine testing/close 3 follow-up until Homewood? 4 okay, with me."[as read] 5 A. Yes. 6 Q. Can you explain what that 7means? 8 A. So that what we need to do is 9to be able to help the person stay clean, and one 10of the tools that we use is that we get the person 11to do the medical pee test repeatedly. And 12basically it's, you are giving the person a sense 13of containment, okay, so that if they think about 14using the drug that then 'oh, geez, you know, I am 15going to pee positive or Dr. Rajoo or for Leo 16Etienne or whoever', right. And then there is a 17bit of a personal bond there with that person 18treating you and then the person is less likely to 19consume. 20 Q. So when we say "frequent 21urine testing", what's the frequency that you would 22have expected? 23 A. Umm, I have really 24flip-flopped on that throughout my career. It 25depends where they are. I could see doing it

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 132 2 3 4 5 1daily. I could see doing it randomly because then 2there is not that element of predictability. But 3certainly once a week anyway, in this kind of a 4setting. 5 Q. I think we have seen, now 6bearing in mind that Corporal Langridge was in 7hospital for two-and-a-half days of this time, but 8we have only seen record of one urine test from the 9time of his discharge until the time of his 10unfortunate death; is that a surprising fact? 11 A. Not necessarily. I didn't do 12the urine testing myself, like, I do them in my 13civilian practice and I order them. But typically 14what was done at the base was that the BAC people 15would be doing that and then they would report to 16me. 17 Q. Okay. And would there be a 18standing order? Would there be something addressed 19to them to let them know that urine testing was 20required? 21 A. I believe that it was -- the 22policy directive on that would be found in the CFAO 23on drug rehabilitation, which you alluded to with 24this latest submission. There are specifications 25in there, I am not exactly sure as to how often you

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 133 2 3 4 5 1need to do it, but it is mentioned that you do have 2to do it. 3 Q. I am thinking in terms of 4when you are doing it for therapeutic rather than 5legal reasons. Because this, I take it, was 6therapeutic, not legal? 7 A. Yes, this would have been 8therapeutic. I would have expected it, you know, 9once a week. And I am at a loss to explain why it 10wasn't documented. 11 Q. Okay. Now, we heard from -- 12was it your expectation that there would be some 13manner of drug rehabilitation program on behalf of 14Corporal Langridge during his time when he was 15trying to be stabilized in the community? 16 A. Yup. 17 Q. And what would that have 18consisted of? 19 A. Typically what we like to do 20is to have some amount of one-on-one contact with 21the therapist. So Leo Etienne, Dennis Strilchuk, 22Don Perkins, and also to have the person 23participate in groups. And the reason why we love 24the group component in addictions work is that 25frequently people with addictions don't tell the

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 134 2 3 4 5 1truth and there is nobody who is quite as able to 2sniff that out as a fellow addict in rehab. And it 3is amazing how powerful a therapeutic tool that is 4if the person goes to the groups. 5 And we had a group on Thursdays of 6serving members plus some people that were in the 7release proceedings who also had addiction problems 8plus or minus some degree of mental health, other 9issues. And we repeatedly asked him to go to those 10ones and he didn't, wasn't able to do so. 11 Q. Wasn't able to or was not 12willing to? 13 A. Either one. I can't speak to 14his motivation. 15 Q. I would like to refer you to 16a loose sheet of paper that I hope is on your desk, 17if not I will provide them to you. It is a 18one-page note, handwritten, looks something like 19this. 20 A. Yes, okay. 21 Q. That's the one, okay. And for 22the record, this is Document 1128, page 52. I 23regret that I didn't put it in your book of 24documents. 25 This is a page from, I take it,

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 135 2 3 4 5 1the base medical record. The top one records the 2beginning of Corporal Langridge's stay at the 3Alberta Hospital, recorded by nurse Charlene 4Ferdinand, and the bottom reports on arrangements 5on his discharge. It's not dated, but we have 6reason to believe that it would have been either 7the 4th or probably the 5th, which was the date of 8the discharge. 9 I am going to start just by asking 10you whether you recognize the squiggle at the 11bottom? 12 A. No. 13 Q. Nor do we. 14 Let me just read this to you and 15then I have a couple questions about it. 16 "Discharge from Alberta 17 Hospital today for a 'trial 18 of good behaviour' to see if 19 capable of going to addiction 20 treatment centre. Very 21 agitated for group sessions 22 and zero suicidality, settled 23 now, willing to give plan a 24 try. Wants Seroquel for 25 --"[as read]

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 136 2 3 4 5 1 I guess it's "panic" -- 2 A. "2 PRN", so that's two 3tablets as needed. 4 Q. "2 tablets as needed and 25 5 milligrams -- " 6 A. "For agitation". 7 Q. "For agitation". 8 A. "Has worked well in past." 9 Q. And the plan was to give him 10the Seroquel that he asked for. 11 But my question really has to do 12with the first paragraph. 13 The notion of a trial of good 14behaviour; does that correspond to your 15understanding of the plan that would have been put 16in place as a result of the conference we were 17talking about? 18 A. Yeah, umm, basically it was 19not intended to be any kind of judicion, punishment 20or anything like that. It was to be supportive and 21basically it was to try and get this guy clean and 22sober for at least a little bit of time before we 23ship him off to Homewood. 24 And, you know, when we had sent 25him to Edgewood, which is a very fine treatment

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 137 2 3 4 5 1facility and very experienced with dealing with 2people with anxiety disorders, PTSD, major 3depression, addiction, right, he only lasted four 4days. So we didn't want to have that happen again. 5We wanted to have him as stable as we could and 6then send him there. 7 And he was fully part of that kind 8of a plan where you have to behave in the sense of 9no drinking or drugging. 10 Q. Now you say he was fully part 11of, what do you base that understanding on? 12 A. My -- I was not party to that 13discussion, but my understanding was that he sat 14down with a representative from the BAC as well as 15the base surgeon and we said, 'look, we want you to 16stop drinking and drugging, we want you to be 17taking your medications as prescribed, as what we 18have told you to. If you are suicidal, tell us, we 19will send you back to hospital to get it 20reassessed. Otherwise what we need to have you 21doing here, because you are abusing drugs while you 22are at Alberta Hospital, is to have you clean so 23that we can send you off to Homewood and you can 24get the treatment you need for your addiction'. 25 Q. So, but, is the notion of a

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 138 2 3 4 5 1trial of good behaviour accurate in the sense that 2if he was able to demonstrate good behaviour, 3however we define that, he would go to Homewood? 4 A. Absolutely. 5 Q. And if he was not able to 6demonstrate good behaviour? 7 A. Then we keep on trying and at 8some point in time he would have gone off to rehab. 9 Q. So under that scenario, it 10seems to me -- and maybe I am wrong -- unlikely 11that an actual appointment would have been made for 12him because you wouldn't know whether he had been 13successful? 14 A. That's possible, you know. 15And certainly the other thing is that we had really 16good relationships with all of the addiction 17treatment facilities because we sent them lots of 18customers. And, you know, if you look back in 19January when he went, he was supposed to go 20originally on the 9th, and we phoned them and got 21him in even earlier because he was indicating he 22really needed to go. So we were trying to work 23with him, recognizing the instability of people 24when they are actively addicting. 25 Q. Okay, now, the goal was to do

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 139 2 3 4 5 1better than the Alberta Hospital has proved its 2capable of doing in terms of restricting the supply 3or his access to drugs and alcohol. 4 We know that in the past it is 5apparent that Corporal Langridge had no difficulty 6at all obtaining drugs and alcohol while he was 7living on the base. 8 What was it about the new approach 9that would make you or your colleagues optimistic 10that you could control his access better than the 11Alberta Hospital was able to? 12 A. Dr. Hannah had spoken with 13the Strathcona Regiment about trying to set 14something up here, indicating, without of course 15spilling all the medical confidentiality, to say 16that 'look this is a person we are worried about, 17we need to try and get him clean and sober before 18we send him off for rehab', okay. And what was 19happening during the day was that he needed to be 20part of the duty centre, so it wasn't that he was 21on defaulter's parade or that he was in trouble, it 22was just that he had to be there and be present in 23the work place during the day. So signing in every 24couple of hours, I believe, something like that. 25 And then I believe that the

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 140 2 3 4 5 1arrangement was that he slept there at night. But, 2again, this was not out of punishment, it is just 3that it's very difficult to deal drugs at the 4regiment. I am not saying that it's completely 5impossible, but I am saying it is very, very 6difficult and that's what we were trying to do for 7him. 8 Q. So let's look at Tab 40, I 9believe, and this is a note by Mr. Strilchuk, whom, 10as you have noted, was Corporal Langridge's base 11addictions counselor, at least up to the time that 12this note was written. 13 A. Um-hmm. 14 Q. And what -- and this is dated 15the 7th of March 2008. Mr. Strilchuk think's it's 16five days, but it's actually two days after 17Corporal Langridge's discharge. 18 Now was it your understanding that 19the measures designed to make it more difficult for 20Corporal Langridge to obtain drugs and alcohol were 21put in place immediately upon his discharge from 22the hospital? 23 A. That was my thought. 24 Q. Okay, so here is what Mr. 25Strilchuk says:

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 141 2 3 4 5 1 "Member was seeing this 2 writer for approximately five 3 days as he had just returned 4 from a 30-day stay in Alberta 5 Hospital for serious 6 psychiatric issue. Had the 7 member contract many 8 restrictions, however he was 9 totally non-compliant. He 10 became so non-compliant he 11 had to be sent to his unit 12 for close supervision. As a 13 result of these issues, this 14 writer will no longer working 15 with this patient."[as read] 16 So either Mr. Strilchuk is firing 17Corporal Langridge or, in a very genteel way, he is 18reporting that Corporal Langridge has fired him. 19 A. Right. 20 Q. Does this indicate to you 21that there was any success whatsoever in 22restricting drugs or alcohol to Corporal Langridge? 23 A. Well it's not just the active 24drinking or drugging, like the active addictive 25behaviour that we are concerned about. It's also,

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 142 2 3 4 5 1you know, is the person at least making an honest 2attempt in therapy to start talking about addiction 3issues? Is the person willing to submit to the 4treatment? And that's one of the key parts. Like, 5if you look at Step 1 of Alcoholics Anonymous, 6right, it's admitting that you are powerless over 7your addiction. And that is a key tenet that 8people have to kind of say 'look, I am having a 9problem with this drug or this alcohol, I need 10help'. 11 And I think it speaks volumes that 12both Don Perkins, who has been treating addicts 13for, what, 25/35 years, plus Dennis Strilchuk who 14had been treating addicts by that point in time for 15at least three years, he had previously also been 16in recovery himself, okay, that both of these 17people weren't able to work with him. So that is 18help seeking/help rejecting in a huge way. Right. 19 Q. Yes, and we also know that 20Corporal Langridge missed two AA meetings, which 21probably is the total number of AA meetings he was 22supposed to attend since being discharged from the 23clinic -- or from the hospital. 24 So the second element that you 25were talking about, the utility of peer counseling

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 143 2 3 4 5 1or group dynamics where you are confronted with 2your behaviour was also not working? 3 A. Right. 4 Q. So by the second day, am I 5right that it was certainly obvious there would be 6a challenge in terms of either part of the drug 7treatment program that the base had contemplated as 8a bridge to Homewood? 9 A. Yes. 10 Q. Okay. So let's then look at 11-- oh, can I ask you whether, in your view, part of 12the plan on discharge was to have Corporal 13Langridge resume work duties? 14 A. In the sense of reporting to 15work so that we can keep an eye on him and keep him 16clean and sober, yes. But in terms of actually 17doing any like real infantry or crewman work, no. 18 Q. Well we know he was no longer 19doing any of that work anyway. 20 A. Yes, yes, but in the sense of 21him wearing a uniform, coming into work at a 22certain time, staying there, and then sleeping the 23night there. Yes, those were his duties. 24 Q. So let me have a look with 25you at, I think it's Tab 41.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 144 2 3 4 5 1 This is then Captain Hannah's 2note. I can tell you that the 7th of March meeting 3would have occurred immediately after or very 4shortly after the meeting with Mr. Strilchuk that 5caused the letter of resignation as it were. 6 And here is what Captain Hannah 7records: 8 "Member in today because he 9 is upset and not following 10 the BAC plan. Released from 11 Alberta Hospital 3 March, 12 '08."[as read] 13 That's a mistake, it was 5. 14 "Since then has been using 15 alcohol and other drugs. 16 Also has been reported to 17 have been harassing 18 girlfriend. Known 19 polysubstance abuse. 20 Question occupational stress 21 injury, depression. Member 22 directed by unit to live in 23 company lines to enhance 24 supervision. Member upset 25 with this plan, requested

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 145 2 3 4 5 1 consult with Alberta 2 Hospital. Called Alberta 3 Hospital stated they are full 4 and all referrals are to be 5 sent to the Royal Alex 6 Hospital. Member refused to 7 go to Royal Alex and agreed 8 to go to LdSH and be 9 supervised. Denies 10 suicidality. Denies 11 homicidality. Committed to 12 sobriety. Member released to 13 LdSH and MELS."[as read] 14 Which are medical employment 15limitations. 16 A. Yes. 17 Q. So the situation appears to 18be that Corporal Langridge has not complied with 19what he has been asked to do? 20 A. I agree. 21 Q. And so far he hasn't 22demonstrated stability? 23 A. No. 24 Q. And he hasn't demonstrated an 25ability to abstain, and he hasn't demonstrated a

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 146 2 3 4 5 1commitment to group therapy? 2 A. Correct. 3 Q. Now, at this point, Captain 4Hannah says that the member is going to be referred 5to the unit in order to be supervised. 6 Did anyone talk to you about this 7or are these the conditions that you were -- you 8thought about in the March 4th meeting? 9 A. That would be my 10understanding. 11 Q. Okay. So let's look at what 12Captain Hannah says. He has attached his medical 13employment limitations on Corporal Langridge: 14 "1) Abstain from alcohol and 15 non-prescription drugs. 16 "2) Comply with supervised 17 treatment plan. 18 "3) Attend all scheduled 19 appointments."[as read] 20 Then adds a plan. He adds 21supervised at LdSH, times three days; follow-up 22with base addictions counselor, 10 March '08; 23continue with current medications. 24 My first question is: Those three 25conditions don't look like employment limitations

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 147 2 3 4 5 1of the sort that I have seen in the past. 2 A. I agree. 3 Q. Are they, in fact, employment 4limitations? 5 A. No. They are more of the 6medical management of a condition. 7 Q. To your mind, is there any 8benefit in categorizing these medical management 9steps as employment limitations? 10 A. No. 11 Q. Now, let me have a look with 12you at the actual conditions as they were enacted 13for Captain -- sorry, for Corporal Langridge. 14 Now they come in two forms. We 15have the conditions themselves at Tab 43, and I 16understand that this was a document that was 17prepared for submission to the BOI. 18 But there is also, at Tab 42, an 19e-mail chain that may assist us more. 20 Now if we start, as we always have 21to, at the end, which will be the second page at 22the bottom. And it's an e-mail from Captain Hannah 23to Chief Warrant Officer Ross, who was the 24regimental sergeant major for the unit. And Captain 25Hannah writes:

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 148 2 3 4 5 1 "RSM, 2 "With respect to Corporal 3 Langridge, please be advised 4 I would like to impose the 5 following medical 6 occupational employment 7 limitations. 8 "1) Member is to abstain 9 absolutely from alcohol and 10 drugs, unless prescribed by a 11 physician. 12 "2) Member is to comply with 13 treatment plan, which 14 includes him remaining under 15 the supervision of LdSH(RC.) 16 "3) Member is to attend all 17 scheduled appointments as 18 directed by medical services. 19 "I hope this is helpful. If 20 further clarity is required, 21 please call. The same 22 limitations will be faxed to 23 the regiment on CF 2018 later 24 this afternoon."[as read] 25 A. One of the employment

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 149 2 3 4 5 1limitations can be the appointment one. I have 2seen that. But the other two are, you know, 3technically not an occupational employment 4limitation. 5 Q. And my first question really 6is: In directing this to regimental Sergeant Major 7Ross, who, as I understand it, is in charge of 8discipline for the unit, there appears to be 9something that Captain Hannah thinks the RSM can or 10should be doing with regard to these medical 11occupational limitations? 12 A. Yeah, the RSM or regimental 13sergeant major is really kind of like a Janus, it's 14got two faces. So, on the one hand, if you are 15constantly late for work, the RSM will make your 16life miserable; that's the disciplinary aspect. 17But the other aspect of it is, is that the RSM is 18there for the well-being of the enlisted members, 19ie., not officers. And they are to look out to try 20and help them. If somebody's parents pass away 21suddenly or whatever, it's the RSM that typically 22gets the ball rolling to get the person some leave 23and get them out of town to go home. 24 Other supportive stuff, if they 25have girlfriend problems or whatever, they might

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 150 2 3 4 5 1give them a couple days off. Stuff like that. 2 So the RSM is both the stick but 3also kind of like a den mother too, it's both 4roles. 5 Q. Do you have any understanding 6of what role, if any, the regimental sergeant major 7could have in terms of these, what are labelled 8"occupational limitations"? 9 A. He helps to make sure that 10they happen. Because it's one thing if we send a 11chit back with the person saying, you know, 'can't 12do physical training', right. It's another thing 13that then the unit says 'oh, okay, yeah, we got to 14let him heal', right. 15 And usually the RSM likes to know 16about these things so then they don't schedule the 17person to go away to Wainwright for a month to the 18bush, right. 19 Q. I can understand, I think, 20how the -- which you pointed out -- that attending 21all meetings might impinge on something that the 22RSM could do, that is to ensure that he was let off 23of his employment or other duties in order to allow 24him to make those meetings. 25 A. Yes.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 151 2 3 4 5 1 Q. Although, let me just ask 2you: My impression has always been that if a 3soldier has a medical appointment, that takes 4precedence over his normal duties? 5 A. Yes. 6 Q. Okay, so, then the other two 7limitations, I can understand how the regimental 8sergeant major might think that he could enforce 9them with respect to the soldier, but again, and I 10may be wrong, my understanding of an occupational 11limitation was that it was enforceable against the 12employer and it was designed to tailor the 13employment to this -- 14 A. Yes. 15 Q. -- but there is nothing along 16those lines the RSM could do vis-à-vis the unit, 17because the unit would have no interest in him 18drinking or taking drugs and the unit would have no 19interest in him missing any appointments? 20 A. Yes. In addition to that, I 21think that he was already under a medical category 22prior to this. 23 Q. Yes, yes. 24 A. So that Warrant Ross would 25have known about that. They have, usually, a file

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 152 2 3 4 5 1that says 'okay, these are the following people on 2medical category'. 3 Q. All right, well let's read 4the rest of this important e-mail. 5 On that same day, not too much 6later than Captain Hannah's e-mail, Regimental 7Sergeant Major Ross sends an e-mail to Major Jared, 8who was, as I understand it, high up in the chain 9of command for the Strathcona's, and Captain 10Lubiniecki, who I understand was the adjutant here. 11 He says: 12 From your records from the base 13surgeon. Along with this are my directions and 14restrictions."[as read] 15 And, as I understand it, the 16communication from the base surgeon is the first 17e-mail and the directions and restrictions are the 18three points. 19 And here the regimental sergeant 20major writes: 21 "Corporate Langridge will 22 wear a uniform during normal 23 duty hours and perform duties 24 as directed by the RSM. 25 "2) A normal work day will be

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 153 2 3 4 5 1 Monday through Friday, 8 to 2 1630 daily, weekends will be 3 free unless otherwise 4 directed by the RSM. 5 "3) He will have freedom of 6 movement with the following 7 restrictions: 8 "a. He will live in the 9 regiment duty centre, bedded 10 in the defaulter's room. 11 "b. At no time will his door 12 be closed. 13 "c. He will have a curfew of 14 2100 hours daily. 15 "d. He will report to the 16 duty officer every 2 hours on 17 the hour daily. 18 "e. There will be no escorts 19 required except under the 20 following conditions: 2, he 21 will, when required to attend 22 any and all appointments 23 given to him by his 24 healthcare providers, do so 25 under escort; 2, if he

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 154 2 3 4 5 1 chooses to attend AA 2 meetings, he will be escorted 3 to and from the meeting area. 4 The escorts will not attend 5 the meetings with him. 6 "f. All prescribed 7 medication will be held by 8 the duty officer. It is 9 still the member's 10 responsibility to take the 11 prescribed dosage at the 12 appropriate times. 13 "g. When he leaves the 14 confines of the Harvey 15 building, he will inform the 16 duty officer of where he is 17 going and a contact phone 18 number. Paragraph C and D 19 still apply."[as read] 20 And those refer to the curfew and, 21somewhat redundantly, to reporting to the duty 22officer? 23 A. Yes. 24 Q. First of all, this e-mail is 25dated on the 7th of March.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 155 2 3 4 5 1 My understanding, from your 2accounts earlier, was that, in fact, it was as 3early as the 4th of March that there was a plan 4formulated that would have included all of these 5conditions or most of these conditions? 6 A. Yes. 7 Q. So in effect, is the 8regimental sergeant major merely recording what had 9already been in place? 10 A. I don't know if it was 11already in place by that point in time. Certainly 12this was what our thought was in terms of 'let's 13try and do close supervision of this person and get 14him away from the drugs and the alcohol'. 15 And that this was the matter in 16which the regiment said 'look, this is what we can 17do to help out'. 18 Q. All right. Because it seems 19to me there is one of two possibilities, one is 20that this is recording what was already in place 21and the other is this is putting into place 22something that was contemplated to have been in 23place for two days and that for two days Corporal 24Langridge would have been on his own to try to 25maintain sobriety?

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 156 2 3 4 5 1 A. That could have been 2possible. 3 Q. Okay. Now the rest of the 4e-mail is simply record -- it's. The earlier 5e-mail is forwarded to Captain Hannah three days 6hence, because we are looking at a weekend to 7inform him. And his comment is "outstanding, 8thanks". 9 I take it that that indicates that 10this is something with which Captain Hannah not 11only agrees but agrees enthusiastically? 12 A. Yes. 13 Q. Now let's look at this. We 14know that the 7 of June was a Friday of -- of 15March, rather, was a Friday? 16 A. Yes. 17 Q. And these restrictions, then, 18if they are put in place on the Friday will involve 19Corporal Langridge living in a certain place, 20having his door open, having a curfew, but it will 21not involve him being -- having any occupational 22duties because it's the weekend, and we already see 23weekends will be free unless directed by the -- 24otherwise directed by the RSM. 25 We also know that there maintains

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 157 2 3 4 5 1-- or there is maintained a reporting requirement 2which involves reporting every two hours. 3 Now, could I ask whether this 4looks reasonable as a means of preventing a person 5interested in getting drugs from getting drugs? 6 A. I would say yes. Because, 7again, it's very hard to deal drugs, right, at the 8work place, not -- 9 Q. I am talking about the 10weekend. 11 A. The duty centre is still open 12on the weekend. So the e-mail is a little bit 13unclear in that sense as to what happens on the 14weekends; right. 15 Q. I can tell you, and if 16someone thinks that the evidence is otherwise I 17invite them to, in their questions to you, to 18indicate to the contrary. Our understanding is 19that Corporal Langridge was required to report, but 20he could report by telephone and leave a phone 21number where he could be reached for his location 22and that he was able to leave his cellphone number 23as a location at which he could be reached. 24 With that added information, does 25it seem reasonable to you that these measures would

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 158 2 3 4 5 1have been effective in preventing access to drugs 2or alcohol, especially drugs, on a weekend? 3 A. No. I would have preferred 4to physically being in the duty centre on weekends 5as well. 6 Q. Okay. 7 Now I would also like you to have 8a look at Tab 46, please. This is a -- the 9referral note by Captain -- or sorry Dr. Turner. My 10understanding is Dr. Turner may have been subbing 11in for Dr. Rajoo. It is a somewhat difficult 12document to read, so we have prepared a short 13transcription for you. 14 A. It's doctor writing. 15 Q. Pardon? 16 A. It's doctor writing. 17 Q. It's doctor writing, so you 18can probably read it perfectly well, but let me 19read what I understand this says. 20 "Please see this 28-year-old 21 male who has a history of 22 alcohol and drug abuse and 23 depression. Multiple 24 attempts for substance abuse 25 treatment attempted ie.,

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 159 2 3 4 5 1 Edgewood and patient was 2 non-compliant. Discharged 3 from Alberta Hospital on 4 March 3, 2008, under care of 5 Dr. Sowa. Now is basically 6 under restrictions, imposed 7 to stay in his military unit 8 and monitor his actions for 9 the next couple of weeks. He 10 is not coping well with this. 11 Anxiety, poor sleep and 12 trying to deal his way out of 13 the circumstance. This 14 member was informed today 15 that he must return to his 16 unit and continue to work and 17 see how he does and if doing 18 okay and abstaining, the 19 consideration of a treatment 20 program in Guelph, Ontario, 21 Homewood, would be 22 considered. Upon realizing 23 that he would be forced to 24 return to his unit today, he 25 states he is suicidal and

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 160 2 3 4 5 1 would rather kill himself 2 rather than return to his 3 unit."[as read] 4 And that gives his medications. 5 I have not given you -- or it's 6not in the collection, but in the notes before you 7is the chart note by Dr. Turner and it's probably 8relevant as well. 9 This is Document 1302. It states: 10 "Released from Alberta 11 Hospital not long ago. 12 Missed two appointments with 13 AA. Things are in storage. 14 Living at regiment. Hasn't 15 slept in two nights. Working 16 during the day and must 17 report every two hours after 18 work. Things are in storage. 19 Was on half days in past. 20 States not suicidal or 21 homicidal. Feels like is 22 thrown back in deep end. No 23 idea where life is going at 24 present. Scared to go to AA 25 meeting. Discussed with BS

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 161 2 3 4 5 1 -- which we believe is base 2 surgeon and addictions -- no 3 change in management 4 warranted/agree. Unit will 5 continue to administrate and 6 if can show that is ready to 7 consider treatment, will 8 consider Homewood. After, 9 states would rather kill 10 himself than go back to work. 11 Tearful, anxious. Asked if 12 he had a plan 'you know 13 I...'"[as read] 14 And we couldn't make out the next 15word. 16 "...discussed with Alberta 17 Hospital, no beds. A) 18 substance abuse, depression, 19 question PTSD to go to RAH 20 ER, aware will be coming."[as 21 read] 22 And then it says: 23 "Escorted by members to 24 evaluate in ER. If not 25 admitted to RTU -- "[as read]

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 162 2 3 4 5 1 It is return to unit. 2 " -- as per previous 3 arrangements."[as read] 4 Seeing those two notes, do you 5have any views as to the effectiveness of the 6behaviour management that was undertaken by the 7unit? 8 A. First of all, there is an 9increase in acute suicidality, and so the plan is 10that if we are worried -- and we have a very low 11threshold for being worried, okay -- off he goes to 12get assessed again. All right. 13 And each time it's like it's the 14first time. You get reassessed, relooked at by a 15fresh set of eyes in case we are missing something. 16Right, okay. 17 One of the things I'd like to run 18over here at this point is the notion of borderline 19personality traits, borderline personality 20disorder, okay. 21 And what we can see with that is 22that it can present a challenge to even experienced 23clinicians and it can elicit a lot of feelings in 24the clinician as well, including things like 25anxiety, anger, a sense of empathy, frustration;

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 163 2 3 4 5 1very difficult people to deal with. 2 And, for example, when we look at 3the criteria for borderline behaviour, and this, to 4me, reads classic borderline, okay. We have 5problems with abandonment, either perceived or 6real. So if the boyfriend or the girlfriend broke 7up with the person at that time, okay, boom, they 8become suicidal, all right. 9 Mood instability. So he was -- he 10went to the AA group meeting -- or to the Phase 3 11AA group meeting, couldn't handle it, became very 12agitated, anxious, came back, talked to the people 13at the CDU for a bit, calmed down and then, okay 14again, right. 15 Suicidality. Unstable 16relationships with people, okay. And that goes 17back to who you are dating and that sort of thing. 18 Impulsivity where you go out and 19reach for drugs because that helps calm things 20down. 21 Plus, on top of that, before he 22had mentioned that he wanted to be a good soldier, 23so then he wanted to go and join Recke(ph) 24squadron, and then that didn't work out after, 25what, a couple of weeks.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 164 2 3 4 5 1 Anger control difficulties. 2 Identity disturbance, they don't 3know really who they are. So on one hand he wanted 4to be out of the military and he hated it, on the 5other hand he wanted to be a good soldier, which is 6in keeping with everything that he had done up to 7that point, right. 8 And then you can have transient or 9stress related problems with dissociation or 10feeling kind of out of it as well as a feeling of 11emptiness. 12 And when you look at that, and you 13look at what Dr. Turner did here, okay, there is a 14flair up in his condition. We don't know exactly 15why, okay. It doesn't say, you know, anything in 16here specifically about, you know -- 17 Q. His narrative is that it was 18the work, that he was being thrown in the deep end 19and that he wasn't ready to work. 20 A. Right, yeah, but we also know 21from other sources, right, that it was about this 22time where the girlfriend was saying 'I am done', 23right. So. 24 Q. I don't think so. 25 A. No? Okay.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 165 2 3 4 5 1 Q. She had said that on a number 2of previous occasions. 3 A. Okay. Okay. So what we do 4know about parasuicidal or suicidal behaviour in 5this context is that frequently we see it 6associated with acute intoxication or substance 7use. We also see it with relationship issues with 8people, okay -- 9 Q. Let me just interrupt you 10because I don't want to mislead you. 11 There is a note in Captain 12Hannah's note that several days previous on the 13Friday, the girlfriend had been complaining that he 14was harassing her. We do have that note on the 15Friday, but that's the last that I am aware of a 16mention of the girlfriend. 17 A. Okay. 18 In any case, the problem when you 19are dealing with a person with this constellation 20of difficulties, okay, is, again, what's real, 21what's going on, what's the agenda, okay. And, for 22example, he would love to go back to Alberta 23Hospital because Alberta Hospital was, by 24comparison, a bit of a picnic for him, right, and 25he was able to access drugs way easier there than

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 166 2 3 4 5 1presumably at what he got at the Strathcona's. 2 So, you know, when you don't know 3exactly what's going on with respect to an 4exacerbation of acute suicidality, what Rob did 5here, Dr. Turner, sending him to get assessed again 6is the way to handle it because there has been some 7kind of an interval change. 8 Q. Did the course of Corporal 9Langridge's conduct following discharge from the 10Alberta Hospital up to this point where he was 11readmitted to the Royal Alex, does that surprise 12you? 13 A. No, no. With this difficulty 14with the mental health problems, plus a personally 15disorder, plus active addiction going on, the rule 16is chaos, not the exception. 17 Q. I haven't asked you to turn 18to your own final note dated April 8, 2008. I have 19got it in the small book at page 8. I don't think 20I have marked the page in the large book but it's 21there as well. Page 47 in the large book. 22 One reason I haven't referred you 23to it is because I think you have covered most of 24the discussion and the conclusions. 25 The only question I'd ask you is

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 167 2 3 4 5 1about the diagnosis, and I understand you also 2testified at the BOI, the Board of Inquiry that was 3called? 4 A. Yes. 5 Q. And I think this may have 6come up there as well. 7 Under your diagnosis, generalized 8anxiety disorder, major depressive disorder, most 9likely not PTSD although there did seem to be an 10increase in substance abuse pattern following his 11return from Afghanistan. 12 Now the issue of PTSD is raised 13here. Is that because of the original purpose of 14the note for Veterans Affairs or because that was 15an important part of your diagnosis? 16 A. It had implications for VAC, 17but I don't go around doing my stuff trying to 18please them, you know what I mean. Like, it would 19have been part of the decision-making process, and 20certainly it had potential implications for 21dealings with VAC. But I went back and I even went 22to the point afterwards, a lot of the other -- not 23a lot, but numerous other people who were in the AA 24Phase 3 group also came to see me, okay, and they 25were all affected by this. They were mad, they

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 168 2 3 4 5 1were upset, they were sad, they were flared up for 2weeks if not a couple of months after this all went 3down, and I asked them, 'look, you know, like is 4there something that I might have missed here? 5Okay, did you guys see a really good change with 6him?' Because these people live together, sleep 7together. They are closer in many instances like 8husband and spouse, husband and wife. And they 9said, 'no, there were problems before going 10overseas'. 11 Q. How would they know that? 12 A. Because they are close, and 13it doesn't necessarily have to go up the chain of 14command or turn into a disciplinary problem. And in 15terms of the credibility of some of these people, a 16number of them have PTSD, all of them do have 17addiction difficulties as well. And I asked them, 18'was there anything that you guys saw?'. And I was 19going above and beyond what I would normally do 20just in case I had missed something. And, yes, 21there was some degree of increased drinking and 22drugging after he came back from Afghanistan but it 23was also there before Afghanistan. 24 Q. That's what I am struggling 25with, because he would not have been going to AA

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 169 2 3 4 5 1meetings before he went to Afghanistan? 2 A. No. But some of the soldiers 3in the AA meetings were from the Strathcona's and 4knew him from work. 5 Q. Okay. One of the other 6reasons that I was struggling with this particular 7part of your report was that we have seen in other 8parts of the medical record, Corporal Langridge, if 9he is to be believed, saying that he found it 10impossible to open up at the AA meetings, that he 11was being asked to talk about things that he was 12unwilling to talk about? 13 A. Yes. He did not participate 14fully, I agree with that. 15 Q. Now we have in the small book 16a -- I think it's the last tab, questions that were 17asked of you at the BOI. 18 Small book, Tab 2. Now we are not 19supposed to talk about the actual testimony of the 20BOI, so I can only ask you: Were there other 21topics that you discussed other than the ones that 22are mentioned in these questions that you were 23given before the BOI? 24 A. No. 25 Q. And did you have an occasion

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 170 2 3 4 5 1to discuss the BOI or the issues that the BOI was 2concerned about with Major Parley(ph) or any other 3person in charge of the BOI? 4 A. At the BOI, yes. 5 Q. No, before the BOI. 6 A. Before the BOI... I had 7spoken with the major conducting it to see if I 8could find an e-mail trail, because we had talked 9about him on the phone. But I went looking for 10that and wasn't able to find it. 11 So it had been phone 12conversations. 13 Q. But there was some 14conversation where you helped the major to 15understand certain things that he would need at the 16BOI? 17 A. Yes. 18 MR. FREIMAN: Okay. I think you 19have been very patient with me, and I think I have 20probably exhausted my meager store of understanding 21about this matter. So thank you very much for 22assisting us, I expect that my friends will have 23some questions for you as well. 24 THE CHAIRPERSON: Colonel Drapeau. 25 COLONEL DRAPEAU: Mr. Chair.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 171 2 3 4 5 1CROSS-EXAMINATION BY COLONEL DRAPEAU: 2 Q. Good afternoon, Dr. Elwell. 3I have a few questions for you. 4 When Stuart came to see you on the 515th of November, came to see you, according to 6your testimony, for VAC benefits or Veterans 7Affairs Canada benefits, and the treatment? 8 A. Yes. 9 Q. That's your understanding of 10it. 11 But in, and we can go back to Tab 121, but throughout the notes that you took of that 13meeting particular meeting, I note, and I don't 14think this was covered by my friend, but Stuart 15raised the issue of nightmares not only once but he 16raised it on three separate occasions. I am is 17trying just to locate you here. 18 A. Yes. 19 Q. Not only did he raise the 20issue of nightmares, but he raised the issue of 21nightmares that, I think you used this word, it 22happened, it has been happening for years, and he 23has them on a regular basis. 24 Were you able to determine what 25the cause of these nightmares or what the subject

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 172 2 3 4 5 1matters of these nightmares were? If you turn to 2page 5, you see "still nightmares" "every night" he 3says. 4 A. And the content of the 5nightmares, right, underneath that on page 5 was 6some of this is work, no particular incidents, and 7normal life stuff in the nightmares. 8 And typically with military 9induced post-traumatic stress disorder the 10nightmare is the same one or variations on a theme, 11and it is usually very intimately associated with a 12particular Criterion A traumatic type incident. 13 Q. And if you turn to the next 14two pages, page 7, he comes back to that again. 15And if I am reading this correctly, you prescribe 16him some Seroquel; is that right? 17 A. No. He had been on Seroquel 18already, and I went with Neurontin because it works 19for erasing the nightmares. 20 Q. And he comes back again to 21the issue of nightmares, or at least in your notes. 22I have difficulty reading it, but maybe could you 23help me here? 24 A. Sure. 25 Q. The first word starts with

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 173 2 3 4 5 1"maybe" -- 2 THE CHAIRPERSON: What page are 3you on, Colonel? 4 COLONEL DRAPEAU; I am on page 7, 5they are not numbered. The second last page of the 6notes. 7 THE WITNESS: "Maybe more vivid 8now nightmares". 9 BY COLONEL DRAPEAU: 10 Q. Nightmares. So clearly that 11was an issue with him. 12 Have you formed an opinion then or 13now as to what the cause or what the symptoms, in 14fact, mean something? Is that related say to PTSD 15or a form of it? 16 A. Nightmares are associated 17with PTSD. Nightmares are associated with sleep 18disorders. Nightmares are associated with 19intermittent alcohol abuse. Nightmares are 20associated with cocaine. Nightmares are associated 21with, unfortunately, Effexor and other medications 22sometimes. Nightmares are associated with a bunch 23more medical conditions. They don't, in and of 24themselves mean, you know, one particular 25diagnosis.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 174 2 3 4 5 1 Q. And even if they go back, as 2he says here, for years? 3 A. Yes, even if they go back for 4years. 5 Q. Okay, later on you mentioned 6about everybody -- this patient was on everybody's 7radar? 8 A. Yes. 9 Q. And I think you opine in 10there that you don't believe that people within his 11circle of care would have transmitted to disclose 12or discuss that with anybody outside the healthcare 13establishment? 14 A. We are not supposed to, okay. 15You know sometimes things slip out, okay, but for 16the most part, everybody I dealt with at the base 17was pretty tight-lipped about stuff, we kept it 18within the house. 19 Q. But you cannot vouch for it, 20the fact nobody has spoken? 21 A. No, I can't vouch for other 22people. I know about me, I am really careful about 23that. 24 Q. And they would have been 25contact of various sort with unit personnel, all

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 175 2 3 4 5 1for a good reason, but -- 2 A. Typically, the people who 3talked to the unit are the base surgeon, and the 4base drug and alcohol people, the rest of -- and 5then the GDMO, when they are setting out a new 6medical employment limitation. And then the rest 7of the time, we try not to even talk to them just 8by virtue of inadvertently slipping up, right. 9 So there is not a whole lot of 10interaction that way. I certainly didn't phone the 11Strathcona's, and the only person I eventually 12talked to was at the BOI. Major Parley(ph), I 13believe, is his name. 14 Q. Is it possible that, in fact, 15Stuart would not only be on the radar of personnel 16responsible for his care, but on the radar of 17almost anyone on the base and more particularly his 18unit? 19 A. My knowledge was that they 20were aware of the early June suicide attempt at the 21Strathcona's. But after that, as far as I know, I 22mean, I can't speak for them, right, but as far as 23I know, that is what they were aware of, and that's 24it. 25 Q. Well, they would have been

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 176 2 3 4 5 1aware of his various absences and admission to the 2Alberta Hospital? 3 A. Usually, what we say when a 4person goes away to Alberta Hospital is that they 5are going into the hospital. We just leave out the 6fact of which one it is. 7 Now, if they are smart enough to 8phone around, they can find that out where he is 9at, and if they are doing any kind of unit visits, 10which people appreciate because it's supportive, 11they might find out about it that way. But, 12otherwise, when we are sending someone away to 13Edgewood, they would know about that because it 14says it right on the leave pass. 15 Q. But you took word out of my 16mouth. Is it not a regimental practice for a unit 17when one of its members is in hospital to have 18personnel designated to pay a visit, to bring 19whatever, chocolates or cigarettes, to maintain 20this contact? 21 A. Typically, yes, that is done, 22yes. 23 Q. As far as you know, was this 24done in his unit? 25 A. No, I am not sure.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 177 2 3 4 5 1 Q. You met and you knew of a 2file of Stuart, and given his temperament, which I 3presume you made a professional judgment as to the 4type of stress he was under and temperament, were 5you able to apply this to sending him to his unit 6in close supervision under the order, same as 7directions, the anticipated reaction this fellow 8would have, knowing that he was suicidal, knowing 9that he was not exactly a model of discipline at 10that time? 11 A. The intent of the 12restrictions was not disciplinary. He was not in 13the RSM's bad books. He was in the RSM's good 14books, if you will, right, where he is trying to 15help us stabilize this guy for X amount of time, 16right. 17 With respect to how he felt about 18his unit, again, I refer you to my earlier comments 19on borderline personality traits or borderline 20personality disorder, where, on the one hand, he 21wanted to be a good soldier, on the other hand, he 22wanted to get out. So I think that there is a bit 23of that tension in him all the time. 24 And certainly if a person is not 25getting -- an addict is not getting their desired

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 178 2 3 4 5 1substance at that point in time, they are going to 2start really getting upset with you. 3 Q. But would you agree with me 4that Stuart did not look at this as a beneficial 5and something that he wanted to. His frame of mind 6at that time going to the unit, he said, 'I would 7rather kill myself', was not what we expected 8despite all of the good intention of the RSM and 9yourself. 10 So in that position, what you 11would as a professional anticipate that is possible 12action/reaction condition would be? 13 A. Send him to the Royal Alex or 14to Alberta Hospital for an acute assessment, okay, 15and say, okay, is this, you know, something that 16needs hospitalization right at the moment or not? 17Then if the person's hospitalized, well, then he is 18in hospital. Then if they come back to us, what we 19had seen before was that he came out of the AA 20group, and he was really upset. Sat down, talked to 21him for a bit. Ms. Shannon Newing did a lot of 22that as well where sat down and talked to him, 23worked his way through it, worked through the 24difficult emotions, and then he was fine again. 25 Q. But you would not have him --

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 179 2 3 4 5 1I am trying to put words in your mouth for a 2second. You would not have anticipated him to be 3doing something to be disciplined and to be 4observant of the condition, or did you? 5 A. I was hoping that he would, 6you know. But when a person is actively having 7problems, there is a lot of what we call acting out 8behaviour where they are upset, they are tearful, 9they are feeling abandoned, they are feeling empty, 10they are feeling suicidal. It comes and it goes. 11It's very transient, and that doesn't mean when a 12person is in crisis, that right away you put them 13in the hospital. A lot of times, what you can do 14is just sit down with them and talk with them, talk 15them through the feelings, and then the feeling 16passes. 17 Q. One last question for you, 18given your experience, and I could draw your 19attention to a tab, if I need to. What does the 20word "sick parade" mean to you; what is it? 21 A. Sick parade? 22 Q. Sick parade. 23 A. It is a thing that happens 24every morning, and the people who have got a cold 25or a sprained ankle or whatever kind of health

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 180 2 3 4 5 1problem come in to see the care delivery unit. It 2doesn't necessarily have to be your care delivery 3unit. And they take a look at you, figure out, 4okay, what are, what's needed to treat you acutely 5and then if there are any sick leave or days off as 6a result of that. 7 Q. It's at Tab 22. Am I right 8to suggest that sick parade is where an individual 9having had a requirement to access to healthcare 10are basically required to show up at that 11particular time at the health clinic? 12 A. Yes. 13 Q. They don't show up at any 14time during the day as and when they see fit, 15unless emergency? 16 A. Yeah. If it's an emergency 17or even if it's semiurgent, you know, we are not 18going to turn people away. But what we try to do 19is say, 'Look, if you have this health problem and 20you need to go home because you are sick, you come 21in, you see us at MIR, medical inspection room, or 22sick parade first thing in the morning at eight 23o'clock or wherever'. 24 COLONEL DRAPEAU: That's all the 25questions. Thank you.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 181 2 3 4 5 1 THE CHAIRPERSON: Ms. Richards. 2CROSS-EXAMINATION BY MS. RICHARDS: 3 Q. Dr. Elwell, I just have a 4couple of issues I wanted to go back and clear up 5for the record. 6 And one that you haven't spoken 7much about is the issue of medical release from the 8military. Am I correct that when you saw Corporal 9Langridge, that that would have been another use 10that could have been made of your eventual report, 11and that was considering his request for a medical 12release? 13 A. Yes. 14 Q. And can you just discuss from 15your perspective as a healthcare practitioner how 16the medical release process worked in the military 17and what role you played? 18 A. Okay. What happens is that I 19see a person for whatever condition, and if it's a 20short-term condition that's going to get resolved 21pretty quickly, I write back to the CDU that, you 22know, 'We should be able to fix this up quick. 23This is my diagnosis. This is my treatment'. Then 24the CDU makes employment limitation recommendations 25or restrictions, and then the person is monitored

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 182 2 3 4 5 1by myself and by the CDU, the care delivery unit, 2to see how they are progressing with this. 3 A number of months pass, and it's 4looking now like the condition is more permanent, 5okay, at which point in time I pass that along in 6one of my letter, written correspondence to CDU to 7say that this is looking like it needs to be a 8temporary medical category, which is what we 9normally do for six months. So that then goes to 10the unit, and it also goes to Directorate -- 11DMCARM, which is Directorate Military Careers 12something. Sorry, I can't remember. I just always 13called it DMCARM. Anyway, a place in Ottawa where 14they review the temporary category and they say, 15'Okay, yeah, this person can't do what he is 16supposed to do as a result of his military 17occupation for the next six months'. Fine, they 18approve it, and we continue to treat the person, 19hoping that they are going to get better and return 20to full duties, right. 21 So then we have, the person 22doesn't get better. We then have a second 23temporary category of another six months. Again, 24it goes off to DMCARM, and then it also goes to D 25Med Pol, which is another place in Ottawa. And at

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 183 2 3 4 5 1this point in time, it's looking like the person 2won't be coming back to their full duties. And 3then it's a determination of, can we put them into 4another job in the military somewhere, or do they 5fail what we call the universality of service? 6 So universality of service is a 7notion that you can step in and do your job in the 8Canadian Forces and be deployed overseas or go to 9fight the forest fires in BC or whatever as related 10to your occupation or any other occupation, and can 11you physically and mentally handle that. 12 And by the time the second 13temporary category comes around and this question 14starts coming up, and if the person has such an 15aversive psychological reaction to any kind of a 16uniform, then at that point in time, it's like, 17look, he can't even stand being around people in 18uniform, so realistically the chances of him 19continuing in the forces are very slim. And then 20we make a recommendation of a permanent medical 21category, and they fail universality of service, 22and then they get released medically. So this has 23nothing to do with the VAC or VAC benefits. This 24has to do with the Canadian Forces, and it's known 25as a paragraph 3 release. And then you get

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 184 2 3 4 5 1different benefits than if it's an administrative 2or disciplinary release. 3 Q. And so is it fair to say that 4if you get a medical release, the benefits are 5increased? 6 A. Yes. 7 Q. And so we have heard 8testimony from Dr. Hannah that this -- pardon, 9Major Hannah, that this process could take upwards 10of two years or more? 11 A. Yes. 12 Q. In the record, we see 13repeated references to Corporal Langridge asking 14for a medical discharge. And I just want it to be 15clear, can a member of the Canadian Forces get a 16medical discharge just by asking for it? 17 A. Typically, if all they ask 18for it, eventually they would get an administrative 19one or, at the end of their contract, they would be 20released, right. 21 But if they have some degree of 22medical symptomatology, then yes, in due course, 23you would eventually wind up being medically 24released. 25 Q. With a medical opinion to

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 185 2 3 4 5 1back it up? 2 A. Yes. 3 Q. And do you recall, had you 4discussed with Corporal Langridge the length of 5time that the medical release process would take? 6 A. I know for sure we talked 7about the VAC one because that came up really early 8and, ordinarily, I would also indicate that medical 9releases take time as well. 10 But I checked through my 11handwritten notes of that meeting, and I did not 12specifically say anything in it about T Cat or P 13Cat, which are, you know, the kind of conversation 14that we would have had about that. 15 But surely, along the way, that 16would have come up at some conversation with 17somebody because he was seeing lots of medical 18appointments, right, and that's usually one of the 19prerequisites towards heading down that road. 20 Q. Okay. And I see in your 21notes you do have a reference. You don't need to 22turn it up, but you have a reference "get out of 23the forces", and then he says "unsure". 24 Do you recall whether or not 25Corporal Langridge was aware or discussed with you

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 186 2 3 4 5 1the ability for him to get out voluntarily other 2than through a medical release? 3 A. I can't see how anybody would 4be unaware of that, okay. Yes, you have signed a 5contract, but it's very much a voluntary outfit. 6You haven't been drafted. It's not, you know, the 7Russians-coming-over-the-Pole kind of a war. We 8don't want people who don't want to be there. And 9eventually, he would have gotten out of the forces. 10It may have taken some time, but he would have 11gotten out. 12 Q. One of the other just 13administrative issues I wanted to go back to was 14the issue of an SPHL, which I understand is a 15special patients holding list? 16 A. Yes. 17 Q. And Ms. Newing referred to 18that yesterday, but she wasn't able to give us much 19information about what that was or how that process 20worked. 21 A. So when a person's employed 22at the Strathcona's, they have an establishment 23number so that they are slotted into a particular 24pigeon hole at the regiment. And they are supposed 25to be employed as whatever that pigeon hole says

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 187 2 3 4 5 1they are employed at, okay. Now, if you have 20 2corporals and you are supposed to be able to do all 3this operational stuff with those 20 corporals, if 4you have 3 of them out because of mental health 5problems, 2 of them out because of a broken leg or 6whatever, all of a sudden you don't have 20 7corporals anymore. You have got 10 or 15, okay. 8And the unit doesn't want that, right, because that 9constrains their ability to do what they are 10supposed to do, okay, so that they will keep the 11person on their unit in their establishment for at 12least the first two temporary categories, so six 13months each, right, at which point in time, it's 14like, 'Okay. Is this guy coming back to work or 15not? If they are not, okay, we need to put them 16into a different part of the establishment so we 17can get some fresh bodies posted in'. So the 18holding area for a person who is not completely out 19of the forces but no longer is able to do their job 20at the Strathcona's is the SPHL, which is a base 21mailroom, if you will, that the person's 22establishment goes into there, and that is where 23they are attached to. And they have a warrant 24officer to report to a captain, some clerks to help 25them with administration and to help them with the

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 188 2 3 4 5 1release proceeding, retraining, blah, blah, blah, 2blah, that the unit isn't necessarily able to do. 3 Q. And do you know, was that an 4option for Corporal Langridge or anything that was 5discussed with the treating team? 6 A. He was only at the first 7temporary category stage, so it would have probably 8come up during the T Cat interview because the 9doctor doing the temporary category interview is 10supposed to sit down with the person and tell them 11all of the career implications at that point in 12time. 13 Certainly I think it was common 14knowledge amongst people who have been in for a 15while, a brand-new recruit or a brand-new private, 16probably not, but somebody that's been in for a 17while, should have at least heard about it, and he 18should have been told about it at that time when he 19signed the temporary category. 20 Q. And just one in the area of 21general questions, you have spoken a little bit 22about post-traumatic stress disorder. I am just 23wondering if you can tell us, what was your 24experience in that ten years that you were in the 25military with treating post-traumatic stress, and

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 189 2 3 4 5 1how would that compare to psychiatrists in the 2civilian world? 3 A. I have seen too much for a 4lifetime, so it's -- I am glad I am out of it. 5It's awful, you know. And, you know, umm, we 6treated hundreds of people and, unfortunately, in 7the business that we are in, we get to hear a lot 8of nasty stuff. And I have done lots. I have done 9enough. 10 Q. And in your experience in 11those years, was the military open to treating PTSD 12and open to diagnosing PTSD? 13 A. Yes. We had a very steep 14learning curve coming out of the African campaigns, 15so Rwanda, Somalia, and certainly the first couple 16of tours into the former Yugoslavia republic. But 17after that, you know, what we were doing was for 18certainly cutting edge kind of stuff. 19 Excuse me a second. 20 And, you know, certainly we were 21attempting to follow all of the best practices, not 22just within Canada but worldwide. A number of the 23people there in Edmonton had gone to a lot of the 24ISSIS meetings, which is a specialty society for 25the treatment of trauma.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 190 2 3 4 5 1 We were certainly cutting edge in 2Edmonton at the time and, you know, there is a lot 3of, a lot of people that came through, and we 4treated a lot of them. And recognizing that large 5bureaucratic organizations don't always move the 6best way and that there were some frustrations in 7the job, I still think that we did a pretty darn 8good job. 9 Q. Now, if I could take you back 10to March 4th, March 5th, 2008, the issue about when 11Corporal Langridge left the Alberta Hospital and 12came back to the base. 13 A. Yes. 14 Q. We have heard language or 15seen language that Corporal Langridge was ordered 16out of the hospital by the Canadian Forces. I 17wonder if you have any view on that. 18 A. I wouldn't use the term 19"ordered". If -- the term I would use is that he 20no longer met the requirements to be in hospital, 21okay, so that he was suitable for outpatient 22management and, at that point in time, then came 23back on to our radar as part of the outpatient 24management. 25 You know, and then in terms of

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 191 2 3 4 5 1being ordered to report to be assessed for 2outpatient treatment, well, we were technically on 3the hook to watch after him, right. So I think 4saying you will come in and see Dr. Rajoo and/or 5his designate, right, or Dr. Hannah, I think that's 6reasonable to say, yes, you are going to come to a 7doctor's appointment because it's necessary. 8 You know, if he "ordered", I think 9that's too strong a word. 10 Q. And you were asked some 11questions by Commission counsel about the drug 12testing after he was released on March 5th -- 13 A. Yes. 14 Q. -- and whether there had been 15follow-up drug testing? 16 And you were taken to the note on 17March 7th, where Dennis Strilchuk said, basically 18threw up his hands and said he is completely 19non-compliant with the restrictions that are being 20imposed by BAC? 21 A. Right. 22 Q. Is it possible that the P 23testing was part of those restrictions that he was 24not compliant with? 25 A. Yes, that's possible.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 192 2 3 4 5 1 Q. And is it fair to say, it may 2be obvious, pardon me, but you can't force 3somebody, you couldn't force somebody to give a 4urine test? 5 A. No, you can't. 6 Q. One of the questions that 7Commission counsel was asking you towards the end 8was whether or not you felt the restrictions that 9were put in place or the plan that had been set up 10was effective in stopping Corporal Langridge from 11accessing drugs. And I am just wondering from your 12perspective as the -- working in the base in the 13medical community, what options did you have at 14that time in terms of restricting Corporal 15Langridge's access to drugs? 16 A. Well, part of the problem was 17that Alberta Hospital, he was getting ready access 18to it. That was our understanding. Basically, we 19wanted to make it very inconvenient for him to 20access drugs or to go out and get drugs. So by 21showing up to work all the time, having to sign in, 22having to be in the duty centre, having to sleep 23there, we were doing what we could in the civilian 24world after a person had been released from Alberta 25Hospital. They would be either sent home or sent

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 193 2 3 4 5 1-- well, sent home to wherever they lived, right, 2and then whenever their slot in the addiction 3treatment place came open, then they would go 4there. And then in between leaving Alberta 5Hospital and going to Homewood or Edgewood or 6wherever, they would be left to their own devices. 7And, you know, who knows what kind of consequences; 8right? So what we were trying to do there was give 9him every opportunity to try and stay away from the 10drugs and the alcohol and then get him into the 11treatment program. 12 Q. And is it fair to say that 13there still had to be an element of cooperation on 14his part to effect that; you couldn't force it on 15him? 16 A. Yes. And I think it speaks 17volumes that both Don Perkins and Dennis Strilchuk 18wound up firing him, or he fired them. They have 19been involved with addictions treatment for years, 20Donny decades, and they are used to those kinds of 21games going on when a person is actively still 22drugging or drinking. And, you know, for him to 23have been fired by both, that says the amount of 24help seeking, help rejecting. 25 Q. And another question that

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 194 2 3 4 5 1Commission counsel had asked you, if you could just 2turn up Tab 1, in the big book. And this is the 3issue of what was going on between March 5th and 4March 7th, 2008, and Commission counsel put to you 5that Corporal Langridge could have been on his own 6between March 5th and March 7th to try to maintain 7his own sobriety without any assistance, is what I 8understood his question to you to be. 9 If I could just get you to look at 10the first page, it appears to me that Corporal 11Langridge actually had scheduled appointments with 12BAC or with the mental health unit on March 5th, 13March 6th and two on March 7th? 14 A. Yes, yes. 15 Q. So am I correct that part of 16the plan that you had contemplated and discussed 17with the base surgeon included Corporal Langridge 18attending these various addiction programs that 19were available to him at the base? 20 A. Yes. 21 Q. And it was your hope that 22that would help him in maintaining his sobriety -- 23 A. Yes. 24 Q. -- after his release? 25 And, finally, and I think you have

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 195 2 3 4 5 1probably answered this, but I just wanted to ask 2you more directly. You have looked back over it 3now: Do you have any concerns about the medical 4treatment that was offered to Corporal Langridge? 5 A. The problem with looking back 6in medicine is that, you know, you can always go 7what if, what if, what if, and then you can drive 8yourself crazy thinking about it. 9 And at the end of the day, it's 10supposed to be, okay, is this of an acceptable 11community standard? Like not just, you know, and 12using retrospection, it's, you know, your vision is 13always 20/20, right, like I could have done this 14differently or that different. And, believe me, as 15I have been preparing for this thing, you know, I 16have asked myself that question. 17 And I really don't think so. I 18think we went to the wall for him. We did what we 19could. And just, the unfortunate fact of the 20matter is, is that people with mental health 21conditions sometimes kill themselves, and people 22with addictions sometimes kill themselves, and 23that's the reality of the beast. 24 MS. RICHARDS: Thank you very 25much. Those are all my questions.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 196 2 3 4 5 1 THE CHAIRPERSON: Clarification 2questions? 3 MR. FREIMAN: Just a couple of 4very brief ones. 5RE-EXAMINATION BY MR. FREIMAN: 6 Q. When my colleague asked you 7about medical release, I think I heard you say that 8one potential consequence of a repeated request for 9medical release would be to speed up the 10administrative release process. Did I hear that 11correctly? 12 A. No, because the 13administrative process is usually followed through 14staff through the unit, okay. The medical release 15is partially staffed through the unit but mostly 16staffed through medical side and -- sorry, I lost 17my train of thought there. 18 It doesn't necessarily follow that 19and, typically, what happens is that if we are 20already part of the way through a medical process, 21we will let the unit know that. And if there is a 22pending 5, a disciplinary one, they will say, 'Oh, 23okay. The guy is wounded, or he is hurt medically. 24Okay. We will back off', and that the 5 one will 25be cast into the wastepaper basket, and that we

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 197 2 3 4 5 1will pursue the 3, paragraph 31. 2 Q. Just then to ask the question 3directly, to your understanding, was the issue of 4an administrative release in the air or in the 5cards about the same time in the winter and spring 6of 2008? 7 A. When they do this, this kind 8of a referral over to BAC, okay, BAC would sit down 9with the person and say, 'Hey, listen, if you work 10with us, and we are pretty patient people, then 11you'll go out, worst-case scenario through the 12medical route, okay. If you are non-compliant and 13repeatedly non-compliant with treatment, then there 14is the potential that you will get fired or a 15paragraph-5 type of release'. 16 Q. I guess what I am asking is 17not just hypothetical situation, but were you aware 18of any, let's call it chatter, about an 19administrative process with respect to Corporal 20Langridge? 21 A. No. 22 Q. Thank you. 23 Now, one of the other things you 24have told my friend was that at the end of Corporal 25Langridge's stay at the Alberta Hospital, he no

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 198 2 3 4 5 1longer met the criteria for a hospital stay. Now -- 2 A. For certification. 3 Q. For certification, oh, yes. 4 But because I was going to ask 5you, Dr. Sowa expressed the view that he would like 6him to stay? 7 A. Yes. 8 Q. So someone was overruling Dr. 9Sowa's opinion of what would be best for Corporal 10Langridge? 11 A. Certainly when the person 12first comes into hospital and is really mentally 13ill and is certified, okay, we are not going to let 14them go out of hospital even if everything is 15supposedly hunky-dory, right. 16 Q. You don't have a choice; do 17you? 18 A. Sorry? 19 Q. You don't have a choice; do 20you? 21 A. Right, right. 22 And then we have the two 23certificates. So two independent psychiatrists 24have come in and seen this person and said, 'Yes, 25there is a mental health problem here. Yes, he is

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 199 2 3 4 5 1a reasonable danger to himself or to others by 2virtue of his mental health condition and, as a 3result, he gets to stay as a guest at a hospital, 4Alberta Hospital typically'. 5 Now, there is a lot of pressure on 6the psychiatrists there to keep people moving 7through, okay. And towards the end of a stay, so 8you can let the certificate lapse at the end of the 930 days. You can discharge them before the end of 10the 30 days. And as the attending physician, i.e., 11Dr. Sowa, okay, it's their call. So if they have a 12worry about it, and they can even go and recertify 13him two hours before he is due to go out if they 14are really worried about him, right, and let's say 15he is lying potentially about not being suicidal, 16and they can recertify him and then keep him in. 17 The -- when we are talking about 18the last couple of days in psychiatry ward, the 19majority of the treatment has been done, and if you 20keep them in there too long, you can make things 21worse, okay. 22 And so you are always wanting to 23be kind and compassionate, and Dr. Sowa is very 24compassionate. So it would be nice to keep them in 25a couple of days longer because you are getting

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 200 2 3 4 5 1fed, you don't have any responsibilities, you know, 2you get to go to groups and do kind of fun stuff or 3work on projects or whatever. It's pretty low 4stress in a psychiatric ward for obvious reasons, 5and so it's nice, then, sometimes to keep people in 6for, let's say, one more weekend or whatever, 7right. 8 Where -- 9 Q. But just to be clear, Dr. 10Sowa was saying that he was willing to keep 11Corporal Langridge in until a bed was available for 12him at Edgewood or Homewood? 13 A. And on top of that, the 14person was actively still misusing drugs, right. 15 Q. There is, I am just -- in 16fairness, there were suspicions in the notes, but 17the last drug test that Corporal Langridge gave 18under supervision came back clean. 19 MS. RICHARDS: Sorry, that's not 20what the records show. There is one test that said 21clean and one that said positive for cocaine. 22 THE CHAIRPERSON: That's the one 23for March 4th? 24 MS. RICHARDS: Yes. 25 THE CHAIRPERSON: I am unclear as

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 201 2 3 4 5 1to what that says. It does say -- 2 MS. RICHARDS: It says both. 3 THE WITNESS: It says both. 4 MS. RICHARDS: Yes, yes. 5 MR. HEELAN: Can I just interrupt 6for a moment. I hate to interrupt, but we are sort 7of jumping into having Dr. Elwell comment on what 8Dr. Sowa said. The Commission heard what Dr. Sowa 9said, and I just really wonder about the utility of 10this line of questioning and whether it's really 11useful for the Commission. 12 MR. FREIMAN: The fact I am trying 13to establish, Mr. Chairman, is one that I started 14with as to whether there was an overruling as it 15were of Dr. Sowa's suggested treatment. 16 MR. HEELAN: Well, I think, in 17fairness, Dr. Sowa indicated a willingness to keep 18the corporal in, but he also expressed an 19acceptance that he had struggled with dealing with 20the control of the drugs, and he also indicated 21that he was comfortable with the transfer to the 22Garrison. So I don't think that this has been 23fairly put to Dr. Elwell, so if we are going to go 24further with this, I think it should be more 25contextualized.

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 202 2 3 4 5 1 MR. FREIMAN: That's not my 2recollection of what Dr. Sowa said, but I will let 3it drop because there really is no purpose. At the 4end of the day, the facts will be what the facts 5are, and the record will be what the record says. 6 THE CHAIRPERSON: I think Dr. Sowa 7did make some indication that if they could handle 8him better than we have, then basically good for 9them. That's kind of what I drew out of it, and I 10think Dr. Sowa did say that. 11 BY MR. FREIMAN: 12 Q. So I just wanted to ask one 13last question, then, in terms of what was available 14to you as a control measure versus what was 15available at the Alberta Hospital. Is it true that 16the Alberta Hospital had the added resource that 17you didn't of a locked ward? 18 A. I don't know what unit he was 19on. Do you know the number? Like -- 20 Q. How would we find it? I don't 21see that. I think it was 64. I know a 64, but 22that may have been the Royal Alex. 23 A. That would have been 54, and 24that is the Royal Alex. Umm... 54 is locked. 25Depending on where you are in Alberta Hospital, it

6 7 ASAP Reporting Services Inc. 8(613) 564-2727 (416) 861-8720 1 203 2 3 4 5 1could be locked or unlocked. 2 Q. Okay. I will let that go, 3then. 4 THE CHAIRPERSON: Okay. Thank you. 5 Colonel Drapeau, you okay? 6 Ms. Richards? 7 THE CHAIRPERSON: Doctor, that 8concludes the questions for today, and my 9understanding is you won't be required for further, 10at this stage anyways. I want to thank you for 11your testimony. Your experiences are quite 12apparent. You know, when you see the kind of 13emotion, we don't -- I don't take that as a, how 14can I put it, as a sign of weakness but one of 15experience and knowledge, so thank you. 16 I believe that concludes for 17today. There is nothing further. Then we will 18adjourn until 9:30 tomorrow morning. Thank you. 19--- Whereupon proceedings adjourned at 4:26 p.m., 20 to be resumed on Thursday, April 5, 2012, 21 at 9:30 a.m.

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7 I HEREBY CERTIFY THAT the foregoing is an accurate 8 transcription of my stenographic notes made herein, 9 to the best of my skill and ability. 10 11 12 13 14 15

16 Lisa Lamberti, CSR, RPR 17

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