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Military Police Complaints CommissionFYNES PUBLIC INTEREST HEARINGS

held pursuant to section 250.38(1) of the National DefenceAct, in the matter of file 2011-004

LES AUDIENCES D'INTÉRÊT PUBLIQUE SUR FYNEStenues en vertu du paragraphe 250.38(1) de la Loi sur la

défense nationale pour le dossier 2011-004

TRANSCRIPT OF PROCEEDINGSheld at 270 Albert St., Ottawa, Ontario

on Wednesday, April 4, 2012mercredi, le 4 avril 2012

VOLUME 5

BEFORE:

Mr. Glenn Stannard Chairperson

Ms. Raymonde Cléroux Registrar

APPEARANCES:

Mr. Mark Freiman Commission counselMs. Genevieve CoutléeMs. Beth Alexander

Ms. Elizabeth Richards For Sgt Jon Bigelow, MWO Ross Tourout,Ms. Korinda McLaine LCol Gilles Sansterre, WO Blair Hart, PO 2 Eric McLaughlin,

Sgt David Mitchell, Sgt Matthew Alan Ritco, Maj Daniel Dandurand,Sgt Scott Shannon, LCol Brian Frei, LCol (ret’d) William H. Garrick,

WO (ret’d) Sean Der Bonneteau, CWO (ret’d) Barry Watson

Mr. Lorne Ptack For Leo Etienne

Col (ret’d) Michel W. Drapeau For Mr. Shaun FynesMr. Joshua Juneau and Mrs. Sheila Fynes

Mr. James Heelan For witnesses, Dr. Sowa, Dr. Chu,Dr. Yaltho and Dr. Elwell

A.S.A.P. Reporting Services Inc. © 2012

200 Elgin Street, Suite 1105 333 Bay Street, Suite 900Ottawa, Ontario K2P 1L5 Toronto, Ontario M5H 2T4(613) 564-2727 (416) 861-8720

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(ii)

INDEX

PAGE

SWORN: DR. MATTHEW YALTHO 6Examination In-Chief by Mr. Freiman 6Cross-Examination by Colonel Drapeau 33Cross-Examination by Ms. Richards 37

AFFIRMED: LEO ETIENNE 45Examination In-Chief by Ms. Coutlée 46Cross-Examination by Colonel Drapeau 56Cross-Examination by Ms. Richards 59Re-Examination by Ms. Coutlée 62

PREVIOUSLY SWORN: DR. LEO ELWELL 70Examination In-Chief by Mr. Freiman 70Cross-Examination by Colonel Drapeau 171Cross-Examination by Ms. Richards 181Re-Examination by Mr. Freiman 196

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(iii)

LIST OF EXHIBITS

NO. DESCRIPTION PAGE

P-12 Witness book index for Dr. Yaltho. 1

P-13 Witness book index for Mr. Leo Etienne. 1

P-14 Witness book index for Dr. Elwell. 1

P-15 CANFORGEN. 2

P-16 Enrolment and reengagement, QR&0 Chapter 15 Release and QR&O Chapter 16 Leave packages. 2

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Ottawa, Ontario

--- Upon resuming on Wednesday, April 4, 2012,

at 9:35 a.m.

MS. COUTLÉE: Mr. Chairman, before

we begin, we will just be entering the exhibits for

today.

So we have the witness book index

for Dr. Yaltho.

THE REGISTRAR: Exhibit P-12.

EXHIBIT NO. P-12: Witness

book index for Dr. Yaltho.

MS. COUTLÉE: The witness book

index for Mr. Leo Etienne.



book index for Mr. Leo

Etienne.

MS. COUTLÉE: And the witness book

index for Dr. Elwell.



book index for Dr. Elwell.

MS. COUTLÉE: There is also two

additional exhibits that Ms. Richards wants to

enter. Copies are being made right now and the

ASAP Reporting Services Inc.(613) 564-2727 (416) 861-8720

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exhibits will be entered for Dr. Elwell.

I think they are made, so, we have

two additional exhibits.

MS. RICHARDS: Yes, Mr. Chairman,

as you may have noticed, we have been having a lot

of back-and-forth about release and voluntary

release and medical release issues, so we have for

you copies of the Queen's Regulations and Orders as

they relate to issues of service in the Canadian

Forces, as well as release authority.

And there was also an issue raised

yesterday regarding the provision of sick leave and

whether there was a requirement for sick leave to

be approved by the chain of command or the unit,

and so we have produced as the second document a

copy of the CANFORGEN dealing with the issue of

medical employment limitations and sick leave.

THE CHAIRPERSON: Will they be

under the same number?

THE REGISTRAR: No, the CANFORGEN

will be Exhibit P-15. And the enrolment and

reengagement, Exhibit P-16.

EXHIBIT NO. P-15: CANFORGEN.

EXHIBIT NO. P-16: Enrolment

and reengagement, QR&0


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Chapter 15 Release and QR&O

Chapter 16 Leave packages.

MS. RICHARDS: And for the

description of P-16, perhaps so the record is

clear, it is, in fact, a bundle of QR&Os, so it's

enrolment and reengagement but it's also QR&O

Chapter 15 Release and QR&O Chapter 16 -- let me

make sure I have the right name -- Leave.

I just specify that for the

record, because I know we have another version of

QR&O enrolment and reengagement that has been

produced, but these bundles includes both the

release and the leave packages.

THE CHAIRPERSON: Okay, thank you

very much.

In terms of witnesses for today,

Mr. Freiman?

MR. FREIMAN: We have three, two

live, Dr. Matthew Yaltho, who will begin the

morning, and then Dr. Leo Elwell, who will follow.

We may be interrupting Dr. Elwell's testimony at

11:30. We have a teleconference scheduled with Mr.

Leo Etienne who, for medical reasons, is unable to

travel.

THE CHAIRPERSON: My understanding


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is that in order to prepare for that telephone

testimony, we will need a break at 11:30 so that

that can be arranged -- I am sorry, 11:15 so that

can be arranged and swearing of the witness will

take place.

MR. FREIMAN: That's fine. It may

well be, then, that we will simply take a break

after Dr. Yaltho's evidence. And I anticipate Mr.

Etienne's -- I had hoped to start Dr. Elwell, but I

don't think it makes much sense to start him for 15

minutes.

THE CHAIRPERSON: Are you

anticipating to finish the first doctor before

11:15?

MR. FREIMAN: I am notoriously bad

in my estimates, but, yes, we will see. I hate to

make a promise I can't keep because I always do.

THE CHAIRPERSON: I do not want to

break in the middle of individual's examinations,

so we will play that by ear.

MR. FREIMAN: Thank you.

MR. HEELAN: How long do we expect

we will be with Mr. Etienne?

MR. FREIMAN: I suspect less than

a half hour.


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MR. HEELAN: I just want to make

sure I arrange for Dr. Elwell to be here ready to

go. So do we have any suggestions on that?

THE CHAIRPERSON: Obviously, the

best hope would be that we finish the first witness

and we do Dr. Etienne at 11:30, and we could start

with, why don't we say 1:30.

MR. HEELAN: That would be one --

MR. FREIMAN: One o'clock would be

preferable, Mr. Chairman. I am not certain how

long Dr. Elwell's testimony will take, but he is

quite an important witness.

THE CHAIRPERSON: Okay, why don't

we say one o'clock, then.

MR. HEELAN: I will advise him,

one o'clock.

THE CHAIRPERSON: That would be

our best plan.

MR. HEELAN: Okay, thank you.

THE CHAIRPERSON: They don't

always work out, but...

So are you ready to call the first

witness?

MR. FREIMAN: Yes.

Thank you, Mr. Chairman, the next


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witness is Dr. Matthew Yaltho.

SWORN: DR. MATTHEW YALTHO

THE CHAIRPERSON: Good morning,

doctor.

THE WITNESS: Good morning, sir.

THE CHAIRPERSON: If you could

just, once you are situated, there is a button in

the middle, if you could push for your microphone.

And you have already been sworn, as I understand.

Oh, it's on, you are all set. Thank you.

EXAMINATION IN-CHIEF BY MR. FREIMAN:

Q. Good morning, Dr. Yaltho.

I understand, sir, that you are a

physician licensed to practice in the province of

Alberta, and you are currently employed -- or you

were employed in 2008 at the Royal Alexandra

Hospital; is that correct?

A. Yes.

Q. Can you help us just by

filling in your medical background and training up

to today?

A. I was trained in Britain and

also in Ottawa, Canada, so I did my MRCP from

England and FRCP from Ottawa.


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Q. Yes, and following your

accreditation, do I understand you accredited as a

psychiatrist?

A. Yes, sir.

Q. Can you just give us briefly

a history of your employment from the time of your

certification?

A. After training here, I worked

in Saskatchewan for two years, then moved to

Edmonton, Alberta, in 1980. And I have been

working there since. I am a clinical professor in

with the University of Alberta.

Q. Thank you very much, sir.

Now, we are going to discuss this

morning with you a relatively brief experience you

had and professional encounter you had with

Corporal Stuart Langridge.

In order to set the scene, I would

like to ask you to describe what your duties were

in March of 2008 in terms of whom you would see in

the hospital for psychiatric consultations.

A. I was the doctor on call for

psychiatry on March 11, 2008, and this patient was

brought to the emergency department by the military

police, I believe.


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Q. I'd like to ask you to look

at the book that is at your left-hand side. There

is a number of documents in there. And if you

could open the document book to Tab 16, you will

see a clinical consultation report, it's more by

way of a request to see a soldier.

Is this a document that would have

been brought to your attention when you were called

to see Corporal Langridge?

A. Yes.

Q. Okay, so let me just read

what the note says:

"Please see this

28-year-old-male who has a

history of alcohol and drug

abuse and depression.

Multiple attempts for

substance abuse treatment

attempted; i.e., Edgewood,

and patient was

non-compliant. Discharged

from Alberta Hospital on 3/08

--"[as read]

It looks like --

A. March 3.


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Q. "-- March 3, under care of

Dr. Sowa. Now is heavily

under restrictions imposed

and stay in his military unit

and monitor his actions for

next couple of weeks. Is not

coping well with this

anxiety, poor sleep, and

trying to deal his way out of

the circumstance.

"This member was informed

today that he must return to

his unit and continue to work

and see how he does, and if

is doing okay, return to his

unit and abstaining, the

consideration of a treatment

program in Guelph, Ontario,

Homewood, would be

considered.

"Upon realizing he would be

forced to return to his unit

today, he states he is

suicidal and would rather

kill himself than return to


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his unit."[as read]

Now, Dr. Yaltho, when you see a

note like this, does that inform what you do next,

or is this simply background that you need to

verify with the soldier, or with the patient,

rather?

Your own admission note is at Tab

1, or consultation report is at Tab 1.

A. He did not like to go back to

the military. I think I put it down in his own

words in my consultation report.

Q. Yes.

A. Can't take army stuff

anymore, quote and unquote.

Q. Yes.

A. And towards the end, I

thought maybe he should be released from the

military on medical grounds, but I don't know how

the military works.

Q. Undoubtedly.

So I think what we will do today

is discuss with you a little bit the medical

dimension rather than the military dimension.

But your recommendation at the

end, and we will get to that in a second, that it


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would be suitable to have him released on medical

grounds, was that a medical assessment in light of

his presentation, or was that simply a pragmatic

suggestion?

A. Looking at the history, I

think he had at least three or four admissions,

brief admissions to the Royal Alexandra Hospital

crisis unit from 2007, I believe.

Q. Yes. Yes.

A. Plus, I think he was

discharged from the Alberta Hospital Edmonton by

Dr. Sowa --

Q. Yes.

A. -- just one week before.

Q. Correct.

A. And I think he spent almost a

month there. And this man is coming back to the

hospital within a week's time saying that 'I don't

want to go back to the military', so I thought that

it was medical grounds.

Q. I'd like to ask you to look

at one more document, just to see if you would have

seen this, as well as a background. This is Tab

17, and it is a psychiatric assessment but,

obviously, not compiled by you. I assume this was


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compiled by a psychiatric nurse.

Am I correct that the signature is

of a psychiatric nurse?

A. Yes.

Q. And do I understand correctly

that this would be a sort of intake before you

would see the patient?

A. I believe so, because time is

1050.

Q. Right. And I note at the

end, it's Dr. Yaltho for possible admission -- "to

Dr. Yaltho for possible admission".

To me, that suggests that the

nurse would have seen him first, would have taken

the history, and then would have referred Corporal

Langridge to you for a decision about admission?

A. Yes.

Q. Okay, and is this a document

that you would have seen, then, as you were

interviewing Corporal Langridge?

A. Possible, but I don't exactly

remember because this happened four years ago.

Q. Of course, of course. I would

just like to read this note to you and then ask you

a couple of questions about it.


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It says:

"Patient presented from CFB

Edmonton, escorted by two

military members, with

complaint of suicidal

ideation and anxiety/panic

attacks. Patient has several

recent admissions (3) in past

eight months to --"[as read]

I take it that's Royal Alexandra

crisis unit?

A. Yes.

Q. "-- and has just released

--"[as read]

I think. Anyway:

"-- from AHE under Dr. Sowa

March 5, '08, after 30-day

admission."[as read]

A. He has a past.

Q. "He has a past -- something

-- of alcohol and drug abuse

and has been told to follow

up --"[as read]

That's it:

"-- follow up with Alcoholics


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Anonymous. He has sabotaged

this plan by not attending,

or drinking before the

meetings. The military have

put constraints on his

duties, on his

accommodations, and have told

him -- and sorry -- and have

had him check in every two

hours. This has provoked

further panic, anxiety and

intensified his suicidal

ideation. He has a past

history of PTSD --"[as read]

Or past diagnosis, I guess it is. No.

"-- past history of PTSD

following tours in

Afghanistan and Bosnia. Dr.

Sowa made -- something --

adjustments to his

medications but with little

effect. He is actively

suicidal presently and will

be referred to Dr. Yaltho for

possible admission."[as read]


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Does this add anything to the

information that you would have already have had

available to you?

A. Yes.

Q. Tell me, what does it add for

you?

A. So I get a bit more

information about the previous assessments.

Q. Right. All right, so, with

all of that in mind, let's look at the note that

you compiled. And can you tell me, the note itself

sets out history of past --

THE CHAIRPERSON: Which tab are we

at?

MR. FREIMAN: Tab 1, sorry.

BY MR. FREIMAN:

Q. Can we start, would the

narrative in here be what Corporal Langridge would

have told you on his interview with you in

hospital, or would you have gotten this information

from some other source?

A. Usually how the doctor on

call operates, he looks at the information in the

file before or after he sees the patient.

Q. And would this note have been


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compiled when you were doing the initial

assessment, or would it have been done sometime

thereafter?

A. I think, as I said, the

nurse's note was done in the morning, and I believe

I saw him in the evening, afternoon.

Q. Okay, so --

THE CHAIRPERSON: Just so I

understand this note, who has written this note?

Was this written by you?

THE WITNESS: Yes, sir, number

one, my name is there, Matthew Yaltho, on top.

BY MR. FREIMAN:

Q. Now, can you read to us the

"on examination", which is your impressions after

you've compiled the history -- maybe it would be

helpful if you just read us the note because it's a

little hard to read the handwriting.

A. So you are talking about the

middle section?

Q. Let's do the whole note.

It's only a page, so we can afford to do that.

A. Dated March 11, '08:

"28-year-old military

serviceman recently separated


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from his wife, brought to the

emergency for depression,

anxiety, PTSD and suicidal

thoughts. 'Can't take Army

stuff anymore'. He

complained of crying spells,

chest pain, nightmares,

sweating, decreased sleep and

memory and decreased energy.

Although he was a heavy

alcoholic, he drinks seldom

now. But indulges in

cocaine, last time yesterday,

and cannabis. He had a

previous admission --"[as

read]

Q. I think that says two or

three.

A. "-- he had previous

admissions in RAH and was

discharged from the Alberta

Hospital last Friday by Dr.

Sowa. He did not attend the

AA meeting and had two drinks

yesterday. His medications


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are: Venlafaxine, 225

milligrams; gabapentin, 600

milligrams at bedtime;

Quetiapine, 50 milligrams at

bedtime; Zopiclone, 7.5

milligrams at bedtime;

olanzapine, 2.5 milligrams in

the morning and 5 milligrams

at bedtime. Says gabapentin

helps him with sweating, and

he has been complying with

the medications.

"His common-law wife, a

secretary, left him when he

was hospitalized in February.

He was in Afghanistan for six

months in 2004 and in Bosnia

in 2001. His elder brother

is handicapped. Mom is on

gabapentin.

"On examination, a young

Caucasian male in Army

uniform being watched by a

serviceman. Depressed,

anxious and suicidal.


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Frustrated that the Army will

not release him after eight

years and three years

previously in the reserve.

No psychotic thought nor

perception disorder.

"Opinion and recommendation:

He suffers from, Number 1,

mental depression, probably

substance-induced, anxiety

and PTSD. Number 2, cocaine,

alcohol and cannabis abuse.

He would require

hospitalization, he prefers

Alberta Hospital where he

felt more secure. No beds in

the system. I will check

again. AA/AADAC recommended.

I believe release from the

Army on medical grounds is

appropriate."[as read]

Q. So having taken the history,

having come to a provisional diagnosis based on the

history, you come to the conclusion that

hospitalization is necessary.


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Can you help us to understand what

the plan was that you had for this particular

hospitalization or what you conceive Corporal

Langridge might need by way of medical treatment at

this point?

A. As the doctor on call, my job

is to decide first to admit or not to admit, so I

decided to admit. And if you look at my notes, I

think I filled out a mental health admission

certificate, is what is called Form 1.

Q. Yes, I think it's at Tab 4 of

the document book.

A. So that is Number 4.

Q. Yes. And on that you noted

-- now, first, to set the scene, this is a form

that allows the hospital to detain Corporal

Langridge, with or without his consent, on the

grounds that he is potentially a danger to himself

or others; is that correct?

A. Yes. I can detain him for a

period of 24 hours from 5:30 p.m.

Q. Right.

A. That is the right bottom. So

the second doctor has to see him and do a second

certificate, then it only is enforceable for a


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period of 30 days.

Q. Now, under your observations

where it says "I have formed my opinion on the

following facts observed by me", you put

"depressed, anxious and suicidal, wanting to be

released".

Can you help us with the

importance of the second sentence, "wanting to be

released"? What part did that play in your

assessment?

A. I think I meant wanting to be

released from the Royal Alexandra Hospital at that

point, not the Army.

Q. So that would mean that he

had changed his mind and no longer wanted to stay

in the hospital, but you thought he needed to stay

in the hospital?

A. I think he didn't want to

come to the hospital, as I said earlier, he wanted

to go to Alberta Hospital instead.

Q. Yes, right. Okay. So he is

admitted to the hospital, he is certified for a

period of 24 hours.

In your mind, what would his

course in the hospital have been when you were


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putting all this together?

A. I am responsible until he is

taken over by the other doctor in the ward. And I

put an order -- there are two doctors working in

the unit, Dr. Chu and Dr. Block, so I put an order

he could be transferred to either Dr. Chu or Dr.

Block.

Q. And does that mean that they

would then be in charge of his subsequent course?

A. Yes.

Q. I would just like to review

with you some of the nurse's progress notes during

this particular admission and see if you have any

comments either as to his course of -- in the

hospital, if he was getting better or worse or

whether you see anything that confirms some of your

diagnosis.

The first note that I would like

to look at with you is at Tab 11. It's dated 11

March '08, 2015.

Now, do I understand this would be

more or less after the note that we just saw

dictated -- sorry, that we just read with you, your

admission note? Because it says "admitted to 3608

at 1930". So that would seem to indicate that


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after you saw him, Corporal Langridge was admitted

around 7:30 p.m., and this nurse appears to be

compiling a record at 2015 p.m.; do I have that

right?

A. Yes.

Q. Okay, so I would just like to

start with the sentence saying "was":

"Was at AHE under Dr. Sowa

for one month, was discharged

on 5 March '08. Has been

working at military base

since discharge. States was

doing three shifts per week

prior to admission to AHE,

however, after discharge, has

been working full time.

States anxiety has been

raised since discharge and

mood has been low.

"Drank a couple of beers last

Thursday, no other alcohol

use for past week. Has been

using cocaine more frequently

on and off since last

Wednesday. Also has been


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something more -- smoking

more. Did not want to work

anymore, states it was too

much. Was told to go to work

or go to the hospital.

"Denies suicidal ideation

currently, contracts for

safety. Has not slept since

Sunday. Last used cocaine

yesterday. Reports problems

with concentration and with

short-term and long-term

memory. Describes

hypervigilance, always being

always paranoid and on edge.

Denies auditory or visual

hallucinations and delusions.

Oriented times 3."[as read]

That's time -- well, anyways.

"Oriented logical in --"[as

read]

And I can't read the next word. I

can't read that next sentence at all. Oh:

"-- denies auditory or visual

hallucinations."[as read]


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I have got:

"States has never actually

been --"[as read]

A. You want a better copy, sir?

Q. Yes.

THE CHAIRPERSON: Maybe you could

read it, doctor.

BY MR. FREIMAN:

Q. Perhaps you could just pick

up where I finished, where I couldn't read, and

just to the bottom of the page.

A. "Contracted for safety, has

not slept since Sunday, last

used cocaine yesterday,

reports --"[as read]

Q. I think that's "problems". I

think that says "problems with concentration".

A. "-- concentration and with


memory."[as read]

Q. Right.

A. Problems, report problems.

"Reports problems with

concentration and with



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memory. Describes

hypervigilance, being always

paranoid and on edge. Denies

auditory and visual

hallucinations or delusions.

Oriented 3 -- in

conversation, speech normal

-- speech: Normal rate,

rhythm and volume.

"States he has never actually

been told what diagnosis he

has. States military wants

to send him to treatment in

Ontario for PTSD and alcohol

and drug abuse problems.

States he feels he may have

bipolar disorder. States he

has a lot of up and downs,

describes very energetic

happy periods. States saying

last a couple of hours.

"Would like to go back to

Alberta Hospital Edmonton.

States, for the first couple

of weeks, he abused his


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admission, not going to

programs, et cetera.

However, for the last two

weeks of admission, he went

to groups, attended AA, went

to gym, et cetera. He found

this to be beneficial.

Cooperating with admission

procedures."[as read]

Q. Now, having read that, Dr.

Yaltho, does that change any of your previous

conclusions?

I assume you wouldn't have seen

this because it happened after your admission.

Does this change anything or does

it confirm your impressions on your own

examination?

A. Possible, but, basically, I

knew, you know, what they were talking about.

Q. Yes, all right.

I'd just like to continue to

Corporal Langridge's course in the hospital. I

know that you had passed over responsibility, but

just very briefly, I'd like to look, as I say, at

just a couple of the progress notes.


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If we look at March 12th, '08,

0715 hours, we see:

"Patient received on his

formal status with one --"[as

read]

A. Certificate.

Q. "-- one certificate, and on

close observation."[as read]

What does that mean, practically?

Do I understand that "received on formal

certificate" means that he was still under Form 1

and, therefore, was an involuntary patient?

A. Yes, I think, as I explained

to you before, his certificate is good until 5:30

p.m. the next day.

Q. Right.

A. So this note was made at

5:15, so he had another 15 minutes under one

certificate.

Q. And it also says "and on

close observation". What's meant by "close

observation"?

A. Maybe I should explain the

observation levels.

Q. Yes.


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A. There are three observation

levels in our hospital. One is constant, that's

one-to-one.

Q. Yes.

A. The second is close. That

means the nursing staff have to check the patient

every 15 minutes.

Q. Yes.

A. And the third one is general

observation, where they have more freedom.

But in this particular ward, this

is a crisis unit, we don't have the third level, so

it is either constant or close.

Q. I understand.

And can you explain the rationale

for maintaining either constant or close

observation?

A. It depends on the clinical

situation and, to some extent, the availability of

the supporting staff, like security guards,

available at that point in time.

So usually when they are a danger

to themselves or others, we place them on constant

observation. So if they are not in immediate or

imminent danger, we place them on close.


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Q. I understand.

We see, then, in the notes, and

maybe we can go to the last page of the notes, by

1800 -- or sorry, second last page of the note,

"received patient on voluntary status, close

observation".

So by 1530 of the following day,

the certificate had expired and now he is on a

voluntary basis. And I just want to look at the

last sentence in that first paragraph:

"Patient is -- "

Either wanting or waiting, I can't

tell which.

" -- to get in a program for

his drug addictions and is

just waiting for the military

to decide what they are going

to do. Patient states they

will probably send --

possibly send him to

Ontario."[as read]

So he is now a voluntary patient

and he is talking about future plans to go to

Ontario. And then finally --

A. Which section is it, sir?


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Q. If you look, it's -- sorry, I

misled you, it's the third last page, March 12,

'08, 1530 and 800, it looks like.

A. Yes. Yes, I found it.

Q. Yes. Now, the final page is,

I take it, done by Dr. Block, who is discharging

him, and she makes note of his condition and his

disposition, and what he states.

Since she is not here today, I am

just going to ask if you could read her last note

for us so we can get an idea of what was happening

toward the end of the admission, keeping in mind

he's now a voluntary patient, the certificate has

expired. And what does Dr. Block tell us?

A. You are referring to March

13, '08?

Q. Yes.

A. Dr. Block wrote down:

"Not interested in talking to

me. Does not want anything

from anybody here in

hospital. Does not want to

remain in hospital, denies

suicidal or homicidal

ideations or intent. I am not


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prepared to discharge him,

but he is voluntary and can

sign himself out of the

hospital, which he says he

will do."[as read]

Q. So do I understand correctly

that at this point, Corporal Langridge is no longer

under certificate, so there is no power of

compulsion, he wants to leave, Dr. Block believes

it would be better not to discharge him, but he

insists and, therefore, he's discharged against

medical advice. Is that the sequence?

A. I have come across these type

of situations many times. So Dr. Block or, you

know, the doctor in charge may have two options,

either discharge him against medical advice or put

him on certificate.

Q. Yes.

And, of course, we don't have Dr.

Block here, so we don't know what was going through

her mind, but it appears that she chose the second,

to allow him to be discharged against medical

advice.

A. That is his right to do that.

Q. Yes.


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Just to round out our discussion

this morning, Dr. Yaltho, were you ever interviewed

by the military police in connection with any of

their investigations?

A. I went to meet with the Board

of Inquiry.

Q. Yes.

A. In the Garrison in Edmonton

in 2009.

Q. Thank you, thank you very

much. You did, but other than that, you did not

speak to the military with respect to this?

A. No.

MR. FREIMAN: Thank you very much.

Those are my questions.

THE WITNESS: Thank you.

MR. FREIMAN: I expect my friends

may have a few questions for you.

THE CHAIRPERSON: Colonel Drapeau.

COLONEL DRAPEAU: Mr. Chair, good

morning.

CROSS-EXAMINATION BY COLONEL DRAPEAU:

Q. Doctor, my name is Michel

Drapeau.

In Tab 1 that we have just seen,


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you wrote or it was written that Stuart did not

like to go back to the military, that he would

rather kill himself than to return to his unit.

Did you, in your consultation with

him, discuss a reason why he would feel so

strongly?

A. I, as I told you before, I

was the doctor on call. I have so many patients to

see, so I think usually we don't take more than an

hour to discuss all the issues.

But, as I explained to you before,

he told me he hates the military, I didn't go into

the details why he hates the military. But he told

me that he was in the military for about eight

years and about three or four years service in the

reserve, so I think about 11 to 12 years, ^ that's

my understanding. And he served in Bosnia and

Afghanistan.

Q. And that's the extent of your

knowledge, what discussion you would have had with

him about the recent --

A. Yes, I didn't go into that

because I didn't have the time.

Q. Doctor, on Tab 1 in your

notes, about three-quarters down the page, there is


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a listing of all the prescribed drugs that Stuart

-- about the first paragraph, about seven, eighth

lines down, there is a listing of all of the

various drugs that Stuart would have been

prescribed; you see that?

A. Yes.

Q. Now, we know that the report

also says that he had abused alcohol and, at times,

even cocaine or marijuana.

Is there any impact, would it

dilute the impact of these drugs by doing so or

enhance the impact? What would be the impact, if

any, of somebody having alcohol or cocaine with

these drugs?

A. Sir, my recommendation to all

my patients is that not to mix street drugs with

the medications because there could be

interactions, and alcohol included.

So he was on an antidepressant

called venlafaxine. Gabapentin is an antianxiety

drug, and he told me that it helps him with the

sweating too. Quetiapine is what we call

tranquillizing medication or, you know, sometime we

call it antipsychotic too, but in this particular

case, to calm down his anxiety level and sleep,


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help him with the sleep. Zopiclone is sleep

medicine. Olanzapine is an antianxiety and

tranquillizing medication.

So, you know, I wouldn't recommend

mixing any drugs with any of these medications.

Q. I accept that. So it's quite

a cocktail of medicine that he would have, and he

did take alcohol. But what's the worse impact of

such combination? Which is, obviously, not

recommended.

A. Usually what will the outcome

may be, one, the medications may not work well.

Sometimes it can complicate the drug level within

the system. Most of the time, the medications can

cause other problems, along with the intake of

alcohol or drugs.

The other issue to think about is

if the drug, street drugs or the alcohol he is

consuming is causing the anxiety or depression. So

it could be a chicken or egg type of situation.

Q. So it could dilute the

desired impact of the drugs he is being prescribed?

A. It is possible.

Q. Possible.

COLONEL DRAPEAU: Thank you,


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doctor, that's all my questions.

THE CHAIRPERSON: Ms. Richards.

CROSS-EXAMINATION BY MS. RICHARDS:

Q. Thank you.

Doctor, I just have a couple of

questions, and I want to follow up on the point

that you just made that you'd have to consider

whether or not street drugs or alcohol could be

causing the depression.

A. Yes, ma'am.

Q. Okay, I -- from your intake

notes, I take it that Corporal Langridge disclosed

to you that he had been indulging in cocaine more

frequently since the previous Wednesday; you recall

that in your notes?

A. I believe I mentioned that he

did cocaine the day before.

Q. Okay. And if we look, I

think you had been taken by Commission counsel to

some of the nursing notes where he said he had been

using cocaine more frequently since the previous

Wednesday?

A. I don't know.

Q. Okay, if you can look at Tab

11, just at the first page.


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A. You're talking about the

nurse's notes?

Q. The nurse's notes, that's

correct.

A. Yes.

Q. Yes, okay. So it's partway

down that first note, and I think it's part of the

portion that you read out for us where it states:

"Drank a couple of beers last

Thursday. No other alcohol

used for past week. Has been

using cocaine more frequently

on and off since last

Wednesday."[as read]

A. Which section is that?

Q. Sorry, it's --

A. What sentence number?

Q. Twelve lines down, and it

starts at the end of that line.

A. Yes, I see that.

Q. You see that, okay.

So just putting those two pieces

together in terms of your statement that you'd have

to consider how drug use and alcohol use could be

affecting his mood, we know that he has disclosed


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that he has been using it more frequently since the

previous Wednesday. I just looked up on a calendar

the day that you saw him. March 11th was a

Tuesday. So within that week, less than a week, he

has been using cocaine more frequently, and you

have been told by him that he, in fact, used it the

night before he was admitted to the Royal Alex?

A. I didn't have that

information at that point in time because the

nursing notes was written in the evening.

Q. Right, but you knew he had

used it the night before when you admitted him

because he disclosed that to you?

A. Yes, yes.

Q. We have heard some evidence

from other doctors who have been here that cocaine

can cause depression or depressed moods.

A. Yes, it is possible.

Q. And in particular, I believe

it was Dr. Sowa who talked about the fact that

there is a greet euphoria from taking cocaine, but

when the cocaine begins to wear off, there is a

converse depression and severe depression, that

depressed mood that can come from that?

A. That often happens.


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Q. Okay. So when Corporal

Langridge disclosed to you that he had used it the

night before, is that something that you

considered, whether or not the cocaine use the

previous evening and the possibility that it was

wearing off at that point in time was causing his

depressed mood?

A. It's, again, possible, but

the history is multi practitions for depression,

multiple suicide items, and he was just released

from hospital.

But I agree with your point, I

think substance abuse can cause depression.

Q. And were you also aware when

you reviewed the record that he had actually been

using cocaine when he was admitted to the Alberta

Hospital and the severity of the drug use was

something that Dr. Sowa had commented on and looked

at?

A. I don't remember seeing that

occur, you know, but it is possible. Because I

sometimes work in the Alberta Hospital too, they

have big grounds, and the patients are known to

indulge in drugs and alcohol when they are out.

Q. And I believe it was your


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testimony that you only spent an hour or less with

Corporal Langridge?

A. Yes, ma'am.

Q. And so it's fair to say that

you weren't performing a full diagnosis in that

amount of time about his conditions, you wouldn't

have had enough time to formally diagnose what

Corporal Langridge was suffering from in an hour?

A. Not exactly, because, you

know, I may have looked at the reports from

previous admissions that would be in the computer,

plus I may have more information from the other

sources like the mental health nurse, you know, or

read the notes before. So I gather a bit of

information before I see the patient. So had I

made up my mind what the diagnosis was.

Q. Right. So you had looked at

his file from previous admissions, and I take it

you had access to the Alberta Hospital and the

Royal Alex?

A. It's possible.

Q. So you were aware from

reviewing that, that no previous psychiatrist had

diagnosed him with post-traumatic stress disorder?

A. My impression was, you know,


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we read it earlier, you know, there is suspected

possible PTSD.

Q. There was a -- as I have seen

in the medical nomenclature, there is a question

mark, query PTSD.

A. Possible, I said.

Q. Yes. And you would agree

with me that that is different than a firm

diagnosis of PTSD?

A. He had at least two or three

symptoms when I saw him, you know, he mentioned

nightmares, which is a very common thing. He

worked, you know, he was in Bosnia and Afghanistan

where he witnessed traumatic events quite a bit.

The nursing notes on March 11, too, describes

hypervigilance. That's a symptom. So there a few

symptoms to suggest PTSD.

Q. Right, but you mentioned that

he had been overseas and may have seen traumatic

events.

You'd agree with me that a

critical incident is one of the required elements

for diagnosing post-traumatic stress disorder?

A. Yes.

Q. And no critical incident had


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been disclosed to you in your --

A. He didn't tell me that.

Q. So I guess to be clear, I

think all of the doctors have said it was a

possibility that was in their mind.

And my question to you is, would

you agree with me that at that point in time,

nobody had formally diagnosed him with

post-traumatic stress disorder?

A. I think, as I said, everybody

suspected maybe there is possible PTSD.

MS. RICHARDS: Thank you very

much, those are all my questions.


MR. FREIMAN: No re-examination.

THE CHAIRPERSON: After that brief

examination, nothing further, Colonel Drapeau?

COLONEL DRAPEAU: Nothing further,

Mr. Chair.

THE CHAIRPERSON: Just one

question. When you said he had been to Bosnia and

Afghanistan and witnessed traumatic events, did he

tell you that or is that, like, did you have that

discussion?

THE WITNESS: He didn't tell me


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specifically that he witnessed or he was involved

in any serious trauma, but, you know, my impression

was most of the soldiers who go to Bosnia and

Afghanistan, they may have experienced some kind of

traumatic events. But he didn't tell me.

THE CHAIRPERSON: So that's just

an assumption that --

THE WITNESS: An assumption, yes.

THE CHAIRPERSON: -- that you read

from previous --

THE WITNESS: That's true.

THE CHAIRPERSON: Did you have any

discussion with him about Afghanistan or Bosnia at

all?

THE WITNESS: No, I did not.

THE CHAIRPERSON: So there was no

discussion about Afghanistan or Bosnia or anything

at all to do with that?

THE WITNESS: No, sir.

THE CHAIRPERSON: Okay.

Is there anything further for this

witness? If not, I want to thank you doctor for

your attendance today. It's brief, but thank you

very much for your attendance.

In terms of, we have 45 minutes,


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and I would like to start the next witness. Do we

need five minutes for a health break?

MR. FREIMAN: I think there was

probably a misunderstanding. Both Mr. Heelan and I

understood that you said you didn't want to start

and stop a witness. And so I think Mr. Heelan has

released Dr. Elwell, and he won't be here until

about one o'clock.

THE CHAIRPERSON: Oh, okay that's

fine. I thought we were going to go a little bit

longer, but, so we will have a recess, I guess,

until -- is there any way of advancing the call?

No? Yes?

MS. RICHARDS: No, I believe he is

in Victoria; isn't he? Yeah, so I think with the

time difference, it would be difficult.

THE CHAIRPERSON: Okay, that's

fine, we will give everybody a chance to have a new

coffee, and we will come back probably a few

minutes before and be ready for the phone call,

maybe about 25 after. Thank you.

--- Upon recess at 10:34 a.m.

--- Upon resuming at 11:26 a.m.

--- Leo Etienne appearing via teleconference

AFFIRMED: LEO ETIENNE


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THE CHAIRPERSON: So if our

technician has got it all working, I guess we are

going to be all set.

THE WITNESS: I can hear you fine.

THE CHAIRPERSON: Mr. Leo Etienne?

THE WITNESS: Yes.

THE CHAIRPERSON: Okay. I

understand you have been sworn. My name is

Commissioner, I am the chair, Glenn Stannard.

And Mr. Freiman or Ms. Coutlée.

EXAMINATION IN-CHIEF BY MS. COUTLÉE:

Q. Good morning, Mr. Etienne.

My name a Genevieve Coutlée. I am counsel with the

Commission.

A. Hi. How are you doing?

Q. Good. Thank you.

I would like to ask a few

questions from you. I understand that you have

before you the three documents that we have

included in the book of documents?

A. Yes, yes.

Q. First off, I would like to

ask what your position was in 2008 at the Edmonton

base clinic.

A. Base addictions counselor.


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Q. Can you repeat?

A. Base addictions counselor,

BAC.

Q. Thank you.

And do you recall receiving phone

calls from Corporal Langridge in late February or

early March 2008?

A. Yes, yes, I do.

Q. And can you tell me what you

recall about these conversations?

A. He was wanting to arrange to

go to treatment, and I told him I would have to

take it before our medical team, his medical team,

for approval, for first approval. And then I would

have to go to either the base surgeon or the deputy

base surgeon for approval for those funds.

Q. Thank you.

And specifically, if you can turn

to the document that should be called Tab 2 --

sorry, Tab 1 in your collection.

A. Yes.

Q. And that would be the note

dated March 2nd.

A. Yes.

Q. So it states here:


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"Wanting to confirm that he

can go from the Alberta

Hospital to an addictions

treatment program. He is

committed until March 6th but

states he will remain in

hospital voluntarily until he

can go to treatment."[as

read]

A. Yes.

Q. Now, does that reflect your

recollection of your conversation with Corporal

Langridge?

A. Yes, it does.

Q. So his request was to remain

in hospital until he could go to treatment?

A. Correct. And that's -- I had

taken that to the treatment team, and the answer

was, is he needed to be stabilized so...

Q. And can you explain what you

mean by that, he needs to be stabilized?

A. Well, when someone is in a

psychiatric ward, it would be pretty easy to assume

that he wasn't very stable at the moment, and one

of the requirements to be able to accept treatment


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would be to be able to be mentally stable to accept

it.

Q. And do you recall

specifically what measures were being discussed in

order to stabilize Corporal Langridge?

A. I can't recall exactly

because -- I vaguely recall, and I recall that the

team's answer was that he had to be stabilized, you

know, before we could look at treatment.

Q. And do you recall, Mr.

Etienne, who was on the treatment team at that

meeting where that decision was made?

A. I am just about positive

Robin Lamoureux was the, you know, chairing that

meeting as the deputy base surgeon.

Q. Do you recall who else was

there?

A. I really don't. I can

speculate, but that's all it would be.

Q. Now, without recalling the

identity of individuals, can you tell us generally

at those types of meeting what positions would be

there? Would be there, for example, nurses,

medical doctors, psychiatrists?

A. Yes, to all of the above, and


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probably whoever his social worker was as well, and

the head nurse for the unit would have been there

as well --

Q. Do you recall --

A. -- for, you know, like the

medical unit, A, B, C.

Q. I understand that Robin

Lamoureux was a medical doctor?

A. Yes, he is. And normally,

his unit doctor would also be involved but not

always.

Q. And do you recall whether

there was also anybody from the mental health

clinic?

A. I can't, but that's what I

say, is normally there would be somebody there if

there was a psychiatrist involved or another

therapist from the other clinic, yes.

Q. And as far as base

addictions, aside from yourself, was there anyone

else from base addictions?

A. I am not sure, but I would

both -- he wasn't my patient. He was Dennis

Strilchuk's patient and, before that, Don Perkins'

patient, so I don't know whether Dennis was there


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or not. Honestly, I couldn't tell you. I would --

you know, I would assume, unless he was away for

something or other.

Q. After that decision was made,

do you recall having any other contact with

Corporal Langridge?

A. No, I don't.

Q. Do you recall having any

other contact with anybody else about this case?

A. No, no.

Q. And if you can turn to Tab 3,

these are the handwritten notes.

A. Yes.

Q. All right. On the first

page, if I can direct your attention to the bottom

of the page, there is a note dated March 4th.

A. Yes.

Q. It starts with "med". And the

last three lines read as follows:

"Military want him back for

two weeks prior to attend

drug rehab. I have verified

this in TC -- "

Which I take to mean telephone

conversation.


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" -- with Leo at the

Garrison."[as read]

Do you have any recollection of

that conversation?

A. I really don't. There is

more than one Leo, obviously, involved.

Q. But do you recall one way or

the other whether you had the conversation?

A. I have no recall of that

conversation.

Q. And on the following page,

the one that starts with "4 March 2008 at 15 hours"

--

A. Yes.

Q. -- there is a mention,

beginning at the second line:

"Transportation booked to

escort client to the Garrison

base to be there for 9:30 to

meet with Leo from the base

prior to 10-hour drug rehab

meeting."[as read]


having had a meeting scheduled with Corporal

Langridge?


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A. No, I don't. And the drug

rehab meeting at ten o'clock, that would be the

normal group meeting and, normally, Dennis

Strilchuk would look after that.

Q. Can you explain what the

"normal group meeting" was?

A. All the members who have

sought help or been to treatment and that, it's a

regular group therapy meeting for those people to

attend and, you know, just do a group meeting, a

group therapy meeting. It was an ongoing group

that was always held.

Q. Thank you.

And if you can turn to the next

page, I am going to read in two extracts just to

give you a bit of context.

So the first one is 5 March '08 at

7:25, beginning at the second line of that note:

"Client anxious reworking at

the Garrison base full-time

directly following discharge.

Stated he is unsure what he

will be asked to do in the

two weeks at the base.

Writer encouraged client to


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shower and get packed, then

to call Leo at the base when

he arrives there at 8 hours

and find out what he will be

doing in an attempt to reduce

anxiety."[as read]

If you go to the next page, I will

just finish giving you the full context, Mr.

Etienne. If you go to the next page, there is

another note that says 5 March '08, 11:45. And

there, we read:

"Able to reach Leo. Client

stated that he will attend

substance abuse groups and

that he will not start work

immediately. Also stated

that Leo suggested that he

attend drug rehab in Ontario.

And client stated, 'I will

fight that'."[as read]


that conversation?

A. No.

You missed a word. At the start

of that, I think, is "client reported".


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Q. Yes, yes. Sorry, it is,

indeed.

Now, do you have any recollection

of any discussions about whether or not Corporal

Langridge would be working during that period of

stabilization?

A. I wouldn't have said a word

about such a thing because I can't. I couldn't do

it in my position. It would have to either come

from a doctor to be excused from work or his unit

in conjunction with the doctors.

Q. And do you have any

recollection of that being discussed with either

the doctors or your other colleagues as to whether

Corporal Langridge would be working?

A. No. I wouldn't be involved

in anything like that.

Q. And do you recall any

discussions about where he would be sent to rehab?

A. No, I don't, because it never

got that far.

MS. COUTLÉE: Thank you, Mr.

Etienne. Those are my questions. And some of the

other counsel might have questions for you, so just

stay on the line, please.


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THE WITNESS: Okay. Thank you,

Genevieve.

THE CHAIRPERSON: The next

questioner will be Colonel Drapeau, representing

the plaintiffs.


Q. Good day, Mr. Etienne. I only

have a few questions.

A. Yes.

Q. Who did you report to in your

job as addiction counselor?

A. Both, I had -- hello?

Q. Yes.

A. Yes, I had actually two

reporting people. Anything to do with any kind of

-- the main part of my job were to the base or

deputy surgeons, who I would answer to or go to for

any help or suggestion. And then there was also a

mental health manager, Kelly Leddicote, as well,

and she sort of was also my head. So it was

confusing that way.

Q. Thank you.

Can you recollect how many times

you might have met with Corporal Langridge? Can you

give me an estimate that your intervention with him


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would have covered, an hour or two or four or five?

I would just like to get a sense of the familiarity

you would have had with him and his file.

A. No, I don't recall meeting

him. And looking at his file, you know, sort of

afterwards, that was it.

Q. Okay.

A. And you know --

Q. Could you repeat?

A. I wouldn't be meeting with

him because he wasn't my patient.

Q. Okay.

A. So it would be Dennis

Strilchuk's patient, and I guess Dennis wasn't

available or something that they put the call

through to me.

Q. So would I be right that you

would know of him --

A. Yes.

Q. -- and you would read

reports, but you did not have any face-to-face

contact with him?

A. That would be right.

Q. When in answer to Madam

Coutlée's questions you said, you talked about the


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medical team and you were on the team and you

alluded to a unit doctor, could you explain what

that is, who that is?

A. Certainly. It is -- every

unit, you know, he was LdSH, I believe. So

everybody gets assigned a medical unit and, in the

medical units, there would be doctors, nurses,

PRNs. And all of those things for the members

would be there, and they were divided, A, B, C, D.

Q. And would you know who that

doctor was at that time?

A. Well, I don't even know for

sure which unit he was on, so...

Q. And would the unit doctor,

then, be in a position to report back to the unit,

and do you know if this actually happens?

A. It is -- yes, he would be, or

the charge nurse would be the ones in contact with

the unit. I would not be.

Q. No. And he or she would be

the person to go to at the unit if they wanted to

find out anything in order to be of some

assistance?

A. Correct.

COLONEL DRAPEAU: That's all my


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question, Mr. Etienne. Merci beaucoup.


THE CHAIRPERSON: Ms. Richards,

representing the subjects.


Q. Good morning, Mr. Etienne.

A. Good morning.

Q. I just have a couple of

questions. You had been asked about these notes

that you have in front of you at Tab 3, which refer

to conversations with somebody called Leo.

A. Um-hmm.

Q. I am wondering, have you had

a chance to refer to those notes, and do you have

any view on whether or not it was likely that the

various references in the notes refer to

conversations or things that you said?

A. It is, first off, is I don't

recall anything like that and, you know, other than

what is in my notes. And really, that's it, is I

have concerns where it says the client reported

back to the nurse and the nurse made a note, you

know. And I have, as I said before, many of these

things I wouldn't be involved in. So I also know

that there is a psychiatrist named Leo too, so we


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used to differentiate that he was Dr. Leo, and I

was the good looking one, so...

Q. When you looked at the

various references, have you compared it to your

normal workday, and does that help you at all in

terms of assessing --

A. Yes. Normally, on a

Wednesday, I was heavily involved in meetings, so I

can only call this a typical Wednesday. I can't

specifically say that Wednesday. But normally, I

would have been at the St. Albert clinic at about

7:30 or by 7:30 and for case conferencing over

there, and very seldom did that end by 10, and then

I would have to drive back to the base. And then

normally, I would leave at about 11:30 with the

mental health manager, Kelly Leddicote, and we

would stop back -- drive back to St. Albert, stop

and have some lunch and have a managers meeting at

one o'clock.

Q. Okay.

A. And that's, that would be,

you know, my afternoon gone.

Q. So I take it from your normal

schedule that it would be very unlikely that these

references to conversations with a Leo would be


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conversations with you because you would not have

been at the base at that time?

A. On the 5th, very, very

unlikely that I would have had anything to do with,

because as I say, the most I would be there, for

just an hour or something.

Q. And similarly, there is a

reference, just to sort of close the loop, to

Corporal Langridge having been delivered directly

into the care of Leo on March 5th. I take it that

you don't recall that either?

A. No, I don't. And if somebody

had called me to the front desk for something like

that, the only thing -- you know, our standard

procedure would be, is to take him through to the

medical unit because we don't have authority to do

anything.

Q. And just one final question.

In terms of the issue of whether or not the

military required Corporal Langridge to return from

the Alberta Hospital, did you have authority as a

base addiction counselor to refuse Corporal

Langridge's further care at the Alberta Hospital?

A. Oh, absolutely not. I

wouldn't have -- basically, I had no authority over


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anybody.

Q. Thank you very much.

A. None of the patients I had

authority over for anything.


much. Those all are my questions.

THE CHAIRPERSON: Any

clarification questions?

RE-EXAMINATION BY MS. COUTLÉE:

Q. Hello, Mr. Etienne. This is

Genevieve Coutlée again. Just one or two questions

to close the loop. You just said that you wouldn't

have authority to decide whether Corporal Langridge

would be discharged from the Alberta Hospital and

be brought back to the base. Can you tell us who

would have that authority?

A. It would be, you know, people

in the medical chain, you know, above me, such as

his health unit, the doctors in this health unit,

the base surge, the deputy base surge, of course,

and perhaps, you know, one of the psychiatrists or

something. I think they would still yield to the

case doctor or whatever.

But, no, I have -- there is no way

I could or would say that somebody should be or


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shouldn't be or sent out of the hospital. And the

other thing is, is I couldn't and wouldn't say he

shouldn't go to work for two weeks, you know. I

have no authorities whatsoever, so I wouldn't even

venture there.

Q. Thank you, Mr. Etienne.

And the other decision you

mentioned is that when Corporal Langridge initially

requested treatment, you mentioned you had to take

this to the treatment team, and then I believe you

said to the base surgeon. Can you clarify that,

that approval process for us, and who would have

that authority?

A. Sure. If he was not in a

position like the psychiatric hospital, et cetera,

I would normally go through things with the

patient. Then I would have to check with his

doctors and the unit, the medical unit, and the

base surge or deputy base surge for approval. And

once I had those approvals, then I could, you know,

book in a bedtime at a treatment centre, whichever

one would be most appropriate.

Q. Thank you.

And you discussed your normal

schedule on a Wednesday. I believe you stated very


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early in the morning you would attend a separate

clinic?

A. No. That would be at the

mental health clinic in St. Albert.

Q. Okay.

A. I would -- there would be a

meeting in the morning for, you know, case

conferencing, which would be booked in advance. And

then I would come back to the base for a short

period, and then usually about 12:30ish -- or not

12:30, 11:30, I would be with the clinic manager,

Kelly Leddicote, mental health clinic manager. And

on my way to St. Albert, we would have lunch at a

restaurant with some of our co-workers and then

start our meeting at the office there.

Q. "At the office", at the

mental health clinic?

A. Yes, in St. Albert.

Q. And can you assist us with

how far away is that clinic from the base?

A. I would say driving, 15/20

minutes, something like that.

Q. And --

A. That's why we would usually

leave, you know, as close as we could to 11:30.


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Q. Is that also the mental

health clinic where Corporal Langridge received

treatment?

A. I am not 100 per cent sure

because I wouldn't have been involved with him on

that side of things. Well, I wasn't involved with

him but, even any other patient, I wouldn't be.

But that's where, the off base was where the

psychiatrist, psychologist and a couple of social

workers were stationed, so that's where they would

go for those services.

Q. Thank you.

And are you aware if this was the

clinic where Dr. Elwell was working?

A. Yes, yes, that's where he

worked out of when he was still working with us.

Q. Now, when you had the meeting

with the treatment team about Corporal Langridge's

request, where was that meeting held?

A. That was held at the base.

Q. And do you recall what a

typical Tuesday was like for you back then?

A. Umm, let's see... I may or

may not have been in a social work meeting. We sort

of alternated that, but that would be at 7:30 in


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the morning until, I don't know, 9, say.

Q. And after that --

A. That would be off the base.

After that, I normally would just go on a Tuesday

into my regular schedule.

Q. And what was your regular

schedule?

A. Appointments, appointments

with patients.

Q. And that was at the base?

A. Yes.

MS. COUTLÉE: Thank you very much.

Those are my questions.

THE WITNESS: I never saw patients

off the base clinic.

MS. COUTLÉE: Thank you.

THE CHAIRPERSON: Yes, sir, this

is the chair speaking. I just want to make sure,

you said you had never met the corporal before?

THE WITNESS: No, that's not true.

I knew him, you know, by sight sort of thing, but

he was not my patient, so I never saw him in that

capacity.

THE CHAIRPERSON: Did you ever

meet him in any capacity?


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THE WITNESS: Oh, yes, yes. I knew

who he was.

THE CHAIRPERSON: Well, there is a

difference between knowing who he was and meeting

him.

THE WITNESS: Umm, I am sure I --

THE CHAIRPERSON: By "meeting", I

mean sitting down with him.

Did you ever sit down and meet

with him?

THE WITNESS: No.

THE CHAIRPERSON: You were

introduced to him, but you never sat down and spoke

with him regarding any --

THE WITNESS: Services at the

base, sir?

THE CHAIRPERSON: -- services or

anything?

THE WITNESS: No.

THE CHAIRPERSON: You said you

don't recall having the conversations. I was a

little troubled with not -- recollection, that

could mean several different things to me.

Did you ever speak with the

corporal over the telephone?


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THE WITNESS: Yes.

THE CHAIRPERSON: Around these

dates?

THE WITNESS: The last being, I

believe, the 2nd of March. I can tell you in a

second here as soon as I get to my notes here.

Yes, the 2nd of March, and the

previous one, I believe, was February the 25th.

THE CHAIRPERSON: So you have

notes that you spoke with him February -- or March

2nd and February 25th?

THE WITNESS: Yes.

THE CHAIRPERSON: And those

conversations were about?

THE WITNESS: Him wanting to

arrange to be able to go to treatment, and he was

to get back to me after I had the team meeting. And

that was it for me, as far as I recall. I didn't

speak to him again.

THE CHAIRPERSON: And you didn't

speak with him -- you did or did not speak to him

on the 5th of March?

THE WITNESS: I did not speak to

him on the 5th of March. There is no recall. I

have no memory of such a thing. And by my normal


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schedule, I would have very little time in the

Garrison clinic.

THE CHAIRPERSON: Okay. Thank you.

Ms. Coutlée, any questions from

that?

Colonel Drapeau?

COLONEL DRAPEAU: Not for me, Mr.

Chair.

MS. RICHARDS: No.

THE CHAIRPERSON: I want to thank

you for your time, for the telephone interview,

sir. And thank you very much, and that concludes

the required testimony from yourself.


THE CHAIRPERSON: So we will end

the call.

THE WITNESS: Okay. Thank you.

Bye.

THE CHAIRPERSON: Our next witness

will be ready for one, I believe.

MS. RICHARDS: Yes.

THE CHAIRPERSON: For one?

MR. FREIMAN: That was the plan

with Mr. Heelan.

THE CHAIRPERSON: We will break


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until one o'clock for lunch.

--- Upon luncheon recess at 11:53 a.m.

--- Upon resuming at 1:08 p.m.

MR. FREIMAN: Good afternoon, Mr.

Chairman, our witness for this afternoon is Dr. Leo

Elwell.

PREVIOUSLY SWORN: DR. LEO ELWELL

EXAMINATION IN-CHIEF BY MR. FREIMAN:

Q. Dr. Elwell, you have been

sworn previously; correct?

A. Yes.

Q. I understand, sir, that you

are a physician licensed to practice in the

province of Alberta?

A. That is correct.

Q. And that you are certified as

a psychiatrist?

A. Yes, sir.

Q. For the benefit of the Chair,

could you just briefly go over your qualifications

and training including your employment up to today?

A. Okay. For ten years, I was

in the Air Force Reserve, from 1982 to 1992. I

then went into medical school after completing a

bachelor of science. I got my MD from the


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University of Alberta, then finished the psychiatry

residency at the University of Alberta. Then I was

with the base as a civilian consultant psychiatrist

from, pardon my nerves, '99 till 2009; right? Yes,

yes. And since then, I have been most recently in

private practice as well as a consultant with the

Primary Care Network in Sherwood Park. I also

teach at the U of A in psychiatry.

Q. And we heard the other day

from Dr. Sowa that, in fact, your residency was

under his supervision?

A. Yes.

Q. We have heard a good deal,

Dr. Elwell, about the base clinic and military

arrangements for medical care. And it's sometimes

a little confusing because we have the base clinic,

we have the mental health unit and we have outside

providers.

I think it would be helpful to all

of us if you could just briefly take us through a

tour of that maze so we understand who does what,

especially with regard to the mental health unit,

where it is physically located vis-à-vis the other

facilities.

A. Okay, the military health


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system has a component that's staffed by military

doctors as well as by civilian doctors because they

can't keep enough doctors in uniform. And we come

in and we assist primarily on an out-patient basis.

So these are people being treated in the community.

Then, when people require more

intensive care, for example, if they come back with

IED damage from Afghanistan, they would be treated

in the civilian hospital system with follow-up

provided by the military medical system. But

primarily, they would be treated by the surgeons

and that at the hospital.

So in addition, we have the main

medical clinic, which is located right next to the

guard shack at the main entrance of the base

itself. And then we also had the mental health

clinic, which was a subsidiary of the main medical

clinic, and we were located in a separate building,

and then we moved the mental health clinic out to

St. Albert for reasons of space and also for

reasons of comfort on the part of people that were

seeing us.

Then within the main medical

clinic, we have the different care delivery units,

or CDUs, and the one that was responsible for Lord


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Strathcona's Horse (Royal Canadians) was CU Charlie

or C. And within CUC, we would have a unit clerk

responsible for paperwork. We would have at least

one, anywhere up to a couple of military doctors,

depending upon their availability and that, and

then a number of civilian general practitioners.

And they were primarily seen as being the

quarterback, if you will, of attempting to provide

care for a person. So all the documentation, all

the information would flow into them.

And I'm, as a consultant, I am

advising to them, but I am not primarily

responsible for their medical care; right, and I

would be providing them with what I felt was

reasonable suggestions, and then they could

formulate their management plan accordingly.

The CDUs provided for continuity

of care so that usually you saw the same doctor.

And if the one doctor was away, they would brief

another doctor, particularly if the person was

having a lot of problems like a respiratory tract

infection or whatever, and that way that we could

make sure that the person got continuity of care.

Because what happened with just

military doctors is that you could be away, posted


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on a course or on a deployment or out in Wainwright

on exercise or whatever, and you would never really

see the same doctor. So one of the things that we

tried to do with having civilians there was that

they would be providing continuity of care.

And they would also know a lot of

the medical employment limitations and various

administrative functions that we would have to

provide to the member.

Q. Okay, I'd like to get back to

some of those questions in a minute, but I want to

talk about one other aspect of treatment, I won't

say medical care because I know that's

controversial.

We have also heard a good deal

about base addictions counselors and the base

addiction clinic. What was it's relationship to

the medical community?

A. The base drug and alcohol

counselors, base addiction clinic, was staffed by

addiction counselors who were certified by their

independent professional body. And they had a bit

of a tough row to hoe because on the one hand, they

were to help under the auspices of some of the

CFAOs.


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So let's say somebody has a

positive urine test for marijuana or some other

banned substance, right, they would be helping

treat them with their addiction, okay, and they

would be advising the GDMO about, look, we need to

send this person off to --

Q. For the civilians in the

room, GDMO?

A. Is general duty medical

officer. Interrupt me at any time, I am sorry.

Q. That would be the military

doctor normally in charge of a clinic?

A. Normally, in charge of the

CDU, yes.

Q. Okay.

A. But it could be a civilian,

as long as the base surgeon had said, yes, I give

you the blessing to be able to do, fulfill this

role.

Q. Okay.

So, sorry, I interrupted you.

They would liaise with the GDMO?

A. Yes, and they would liaise

with me. They came to case conference every

Thursday and, frequently, we would talk about it


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when our paths crossed, when we were close to one

another in the same building. Once we were out in

St. Albert, it was a little bit harder because of

just, you know, being 7 or 10 kilometres away,

okay. But otherwise, there was a lot of

conferencing going on.

Q. I would like just to get you

to explain to us a little bit the issues and

challenges of maintaining confidentiality,

especially -- we will do it seriatim, but I am

interested in confidentiality as between the

medical health unit and the mental health unit and

also confidentiality as between the base addictions

counselors and whoever they needed to maintain

confidentiality for.

A. Yes.

Q. So let's start first with

mental health versus medical unit.

A. We did it to the same

standard. The medical employment limitations where

we say something like the person can't run because

their knee is hurt, right, what we say to the unit

is, you know, unfit for running for so many weeks

or so many months, right.

And not any information per se


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about what's causing it, okay, but just to say

that, look, you cannot employ this person in the

following manner because of a medical concern.

Q. Right.

A. And then that way it allows

the unit to have the person do appropriate physical

training, and it also allows us to preserve the

person's right to privacy, because the unit is the

employer, as it were.

Q. Yes, okay.

Now, was there any issue of

confidentiality about mental health records even

vis-à-vis the physicians who would be in the CDUs?

A. We, if something came out

that was very, very private, so say, for example,

somebody had been sexually abused as a child, then

usually we edit that really heavy so that not a lot

of it goes outside the room where myself and the

patient is in, okay.

So I am not going to write

gruesome details to go back into the main medical

file, okay. But the main medical file itself is

supposedly only accessible by health professionals

who are guided by a code of ethics, a code of

conduct, professional standards, so that they are


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not going to go blabbing about that to anybody.

Then what happens is that a chit

goes out to the unit that says that this person

can't do PT for the next two weeks. And that's

basically it, that's a medical employment

limitation, you can't have him do PT, for example.

Q. Okay, now, what about the

base addictions counselors? What constraints of

confidentiality, if any, were they functioning

under?

A. Well, there is -- when the

unit would get a phone call from the base

addictions counselor, they knew who they were and

they knew what they did, so that it shouldn't come

as a surprise to them, right, and, 'oh, okay, so

so-and-so has a bit of an addiction problem'.

Then what happens is that the

Forces had a -- and still has -- a system whereby

if the person starts going for treatment and

complies with the requirements and the applicable

Canadian Forces Administrative Order, CFAO, that

then they can be welcomed back once they have come

back from treatment and they are provided with

follow-up so that they don't relapse to their

addiction; right, and then if they do that and they


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follow the planned course of treatment, that it's

not a black mark against them. And it's a very,

very good employer trying to be supportive and

trying to help people with this problem. And it's

a good system.

Q. I didn't include these

documents in the collection before you because

until you started talking about it, it hadn't

occurred to me that I might want to ask you about

it, but let me ask you, then.

In Corporal Langridge's file, we

find documents that record a failed drug screening

preliminary to deployment, and there is in the

documents, an indication by the base commander that

he intends to order counseling and probation. And

then we see an indication that Corporal Langridge

wanted to challenge the accuracy of the initial

test, and we then see a document suspending the

counseling and probation until that process has run

its course. And we see another administrative step

where he asks for yet another independent test, so

we never get to the counseling and probation, but

throughout, there are periodic references to an

intention, once this is over, to look at counseling

and probation.


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Now, is counseling and probation

that system that you are talking about, or is there

something else going on?

A. C&P, counseling and

probation, would be a general term, it's not 100

per cent properly applied here, okay.

Normally, let's say a person is

always coming into work late, let's say, and then

you say to him, 'look, you have got to be here on

time'. Then they keep on doing it and then they

say, 'okay, fine, I am going to give you a warning,

a verbal warning, then a recorded warning, now it's

on paper, and if you keep doing this, I am going to

put you on counseling and probation. And if after

six months of C&P, you haven't smartened up, I am

going to release you administratively', okay.

So that's a disciplinary form of

C&P.

The C&P that I am -- I haven't

seen these documents, so I can't, but I am

speculating, and, I think, reasonably accurately,

is what it refers to is the addictions treatment.

So that you enter into the contract with the base

addiction counselor, and then they do whatever they

recommend, okay, so that might be in-patient


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treatment or it might be just intervention at the

base level and regular attendance at AA or some

kind of a group therapy thing.

And then if you follow that and

you continue to have clean urine tests or, you

know, as far as where you are not drinking, okay,

then you have fulfilled that and it's a good thing,

okay.

So there is two types of pee tests

that I would like to clarify on. There is the type

that's going to be done through the medical system,

and the results of that stay within the medical

system. And, basically, it's monitoring that, yes,

you haven't been smoking marijuana, okay, for

example. That's just one of the substances we can

test for.

On the other hand, there is within

the Forces, if you are in what's deemed a

safety-sensitive position, so, for example, driving

airplanes or stuff like that, that then you have to

be able to pee clean and not come up with anything

on the banned list of substances, and that is an

administrative kind of pee test.

So prior to going on deployment,

that would have been, most likely, an


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administrative pee test.

Q. That's what it was.

A. And done by the unit.

Q. That's what it was, and he

failed. And, again, we are at a bit of a handicap

because we don't have the documents in front of us,

but the documents seemed to indicate that the

counseling and probation that is contemplated is an

administrative step rather than a therapeutic step.

If you can't comment on that, that's fine.

A. Sorry.

Q. Okay. So let's start now to

talk about the specifics of Corporal Langridge.

Before I do that, let me just follow up on

something that you said.

If we are looking at the

therapeutic side, to your knowledge, does entering

into the therapeutic contract or the therapeutic

stream in any way depend on exhausting your appeal

of the original negative finding or negative test?

A. No, we are happy to exist

side by side with the administrative side, and we

don't share our results with them.

Now, if they came up on the

administrative side with a positive one, that means


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an automatic referral to base drug and alcohol.

Q. Right.

A. Because they want the person

to get the treatment.

Q. Right. But that referral, is

it administered through the medical stream or is it

administered through the disciplinary stream?

A. Through the medical stream.

Q. So you said if the member is

compliant and demonstrates that he is not using for

a period of time, that's a good thing?

A. Yes.

Q. Now, when you say "that's a

good thing", how is that good thing recorded or how

is it conveyed to anyone?

A. What goes back to the unit is

a note from the base alcohol counselor and a note

is also made in the main medical file that the

2034, that's the number of the file, saying that

this person did the six months of addictions

treatment, completed satisfactory, no further

action required by us.

And then the unit says, okay,

good, the problem has been dealt with.

Q. All right. So let's look at


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the contrary case. If the member is not compliant,

if his urine tests and drug screening tests are not

negative, in fact they are positive, if he does not

fulfill his undertaking to attend AA meetings, what

happens with that information?

A. Well, typically, we have a

lot of toing and froing in the first part of

addictions treatment, they are very unstable. So

that everybody relapses, and it's just a matter of

when, okay, and how bad it's going to be. And,

hopefully, you can get them through that and then

get on to more successful treatment.

If you expect them right off the

bat to listen to what you are saying and stop

drinking, that isn't going to happen.

So that, typically, there is a

process there of months, okay, and, you know, even

if the person is "misbehaving", as it were, in

other words, they are using their addiction --

addictive substance, right, we can continue to try,

we continue to try, we continue to try and we poke

away at it and, eventually, we are successful with

a lot of people.

Now, with some people, we are not

successful, and what happens then is a note goes


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back to the unit that says the member has not

complied with treatment, as far as we know they are

still having their ongoing addiction problem. And

then it's up to the unit, then, to typically

initiate the release proceedings. And then that

goes out underneath what we usually call is a 5-F,

or an administrative unfavourable release. So it's

not one that you want to leave the job with. It's

like a bad reference in the civilian world.

Q. And did I understand

correctly that that sort of bad report, let's say,

report of misbehaviour, would not necessarily be

sent to the unit until some conclusion had been

come to that it just wasn't working?

A. It's way down the road. It

doesn't happen in the first two weeks, we are

talking minimum six months, really. Minimum.

Q. So let's change gears just a

little and start talking about Corporal Langridge

himself. And my understanding, sir, is that you

first, in fact for the only time, saw Corporal

Langridge in November of 2007.

Do you have a recollection, or

having looked at your records, were you able to

refresh your recollection as to the circumstances


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under which he was referred to you?

A. Yes.

Q. Can you help us with that?

A. Certainly. I saw him the one

time. From what I recall, he did come late to the

appointment.

Q. Yes.

A. And within a couple of

minutes, he started talking about applying for VAC

benefits, Veterans Affairs Canada.

Q. Yes.

A. And what happens as a

standard of care for myself when somebody asks me

about that, because that is a relatively common

question, is I say, 'I have to know you first for a

good couple of months, it takes me a while to write

the report, so don't count on anything going to

Veteran Affairs Canada for at least six months

coming from me. Somebody else can do it quicker,

but that's them, that's not me'. And I would have

told him that.

Q. Okay. Just so that everyone

understands, what would the consequences be of a

favourable assessment, or favourable in Corporal

Langridge's sense, that you would send to Veterans


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Affairs Canada?

A. What happens out of the VAC

favourable decision is if they feel that there is

any part of the person's medical condition, no

matter what it is, that's attributable to service,

that then they would receive some form of a pension

at the time or some form of lump settlement,

lump-sum settlement, which is what happens now.

Q. So would that be accompanied

by a release from the military?

A. No. The two are different

decisions. You can have people who have lost a

finger, let's say, in an accident in the military

and that they are still able to do their job, they

are still in, servicing in uniform, but they would

be receiving some form of an award from VAC for the

loss of the finger.

Q. So your role, then, is purely

advisory in terms of putting VAC into the picture

as to what the soldier's situation is?

A. Yes, I have a 14-page report

to fill out for them, which is why it takes a

while.

Q. Now, you -- we recently have

been given Corporal Langridge's mental health file,


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and so I apologize that it's in a separate

document, but you will see it in that stack to your

left. There is a big book and there is a small

book. The small book is mental health records.

I believe in there, I think I have

probably lost the page, but I believe in there,

there are some notes that you compiled when you

actually had the interview with Corporal Langridge.

I believe they begin at page 31, they are,

unfortunately, not numbered, but for your

reference, there is a sheet in between that says

"Leo Elwell, psychiatrist notes".

A. This one?

Q. Yes, that's it.

A. Okay, I am on the right page.

Q. If you want to take a minute

to review, I am glad to wait.

What I am going to ask you to do

is, to the best of your ability, to reconstruct

what went on in your interview, what your

impressions were and what your suggested treatment,

what your plan for treatment was as a result of

this interview.

A. Okay.

Q. Okay, now, let me just set


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the stage.

You have told us that it wasn't

very long into the session that Corporal Langridge

started talking about VAC benefits.

A. Yes.

Q. So we know what, how his

focus for the appointment was.

From your perspective and your

understanding, what was the reason for the referral

to you?

A. The recent difficulties with

anxiety and chest pains on the leadership course,

the LQ.

Q. Looking at your notes, does

it leap out at you that there may have been any

suicide attempts?

A. Yeah, on my page 3, past

psychiatric history, it looks like the number 4 but

it's the psych sign:

"Tried to kill myself times

2. Last time, two, three

weeks ago. Short-term

crisis, bad, work sucks,

spouse left, felt like,

expletive deleted, overdose


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on the Seroquel."[as read]

And ETOH means alcohol, it's

ethanol, that's my shorthand for that.

Q. Yours and all your colleagues

as well.

A. Okay.

Q. The reason I am asking,

doctor, is that it appears as though the suicide

was not very prom -- or the suicide attempt was not

very prominent in Corporal Langridge's

presentation. We get to it by the third page --

A. Right.

Q. -- and it doesn't seem to

have been the motivating, from what you tell me,

the most motivating factor in his getting a

referral to you; is that your understanding as

well?

A. That would be my

understanding.

Q. All right, so, a soldier

comes to see you complaining of chest pains,

anxiety, sweating, nightmares, saying give me a

letter to VAC?

A. Yes.

Q. So --


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A. And for treatment too, he did

ask for treatment as well.

Q. So what happens in the

interview?

A. At the end of the interview,

I come up with an idea of how I am going to treat

it. Again, when VAC is concerned, I try not to go

really wild on a diagnosis right off the bat. The

problem with that is, is that it's not fair to me,

it's not fair to the soldier, it's not fair to VAC,

right. If I, you know, zoom in on one particular

aspect of their symptomatology and say, oh, that's

it, then I have ruled everything else out, right,

and I don't think that's particularly the way to do

it. And especially when somebody asks me right off

the bat in the first couple of minutes about VAC

benefits, then I am usually wondering, is there a

bit of a game afoot.

Now, everybody likes their VAC

benefits and I am not in a position to deny them

and I don't, okay, that's up to VAC, but, you know,

certainly, a person gets a little bit suspicious

when they hear that.

Q. Did you come to any sort of a

tentative diagnosis or a provisional diagnosis of


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what was going on here?

A. Yeah, a couple of nights ago

when you forwarded this to me, kindly, thank you, I

went through it, and what comes out at me is still

generalized anxiety disorder and alcohol problems.

Q. So in light of that

provisional diagnosis, what was the treatment plan

that you formulated?

A. Well, on one hand, you know,

he said that Effexor wasn't working for him, okay.

And if you look at page 5, my handwritten 5, that

Effexor 300 milligrams KG, so that's 300 milligrams

once a day, "I hate it, don't notice a difference".

And then, you know 30 seconds later, "Oh, it keeps

the chest pains away and I am not as anxious

anymore".

So if I didn't like what the

Effexor was doing for him, I would have tapered it

and started him on something else. And instead,

what I did was I left him at the same dose but

because of the sweating, which can happen with

Effexor at nighttime, I put 262 in the morning and

thirty-seven and a half at bedtime to see if that

could help him with nighttime sweating.

The other thing that I did here


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was that because one of his other complaints was

regarding the nightmares, and he had had those for

a number of years by that time, and as well on page

5 there, he says, "I can't say when they started".

When people develop nightmares after a particular

Criterion A type of event, okay, they can tell you

when they started. It's not vague. Okay. It may

be a week after, it may be a month after, and

delayed onset, it can be six months after, but they

can tell you when it started.

Q. Did, we are getting into the

criterion, Criterion A, we are getting into the

murky world of PTSD, I understand.

A. Yes.

Q. From Corporal Langridge's

point of view, did he bring up the issue of PTSD

with you?

A. I would have written it down

in there. And usually when you are going through

and doing the occupational history, which, if you

notice, is on the first page of my handwritten

notes, okay, you don't have to ask about it, it

comes out at you, it comes across the room at you.

It's not -- it's freely volunteered. And the person

says, okay, when this happened, I was present at


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this or that event, okay. And that's why I ask the

occupational history first because you don't even

have to ask, 'hey, have you had any Criterion A

events happen', okay.

And, in fact, in the -- as part of

the research for this that I was -- for this

hearing today, that I was looking at was the

malingering of PTSD. And through the miracle of

the internet, a lot of people can find out all the

symptoms of this condition before they go in to see

their doctor, and that this is commonly done in the

military, and it's commonly done in other settings

as well. And as a result of that, by doing the

occupational history, you can get a sense of

whether the person is genuine or not with respect

to that claim.

The other thing that I wound up

doing for him with respect to the nightmares was

that I prescribed the Neurontin, which is on the

next pages of the prescription.

Q. Let me just get back a little

bit to the PTSD.

A. Sure.

Q. We have established that

Corporal Langridge didn't volunteer either the


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topic or the proper Criterion A event that would

have led you down that path.

But do I understand that PTSD was

in the air in terms of what you were looking at and

what you were considering, even without it being

brought up?

A. Yes.

Q. And why would that have been?

A. Because of the conditions of

service and what a lot of these guys had been

through. The stress of just doing the job. You

don't have to go to Afghanistan to die or see

people die. That happens here at home, in

training. He can see people maimed. You can see

tonnes of stuff that is pretty traumatic, right,

and stressful. And just the fact of postings and

training and this and that and just the regular

routine of life in the military is stressful.

Q. Let me ask this a different

way, then. From the point of view of your

assessment for VAC, and from the point of view of

your understanding at the time of that process,

would it have made a difference if the origin of

the anxiety were something that Corporal Langridge

encountered as part of his military service and,


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therefore, causing perhaps PTSD, or whether the

origin of the anxiety was more prosaic and in his

personal life or simply in his chemistry?

A. Right, and to my mind, at the

end of this assessment, I thought that the anxiety

predated everything. So predated deployment to

Bosnia, predated deployment to Afghanistan.

Q. But from the point of view of

the VAC process first, would that have made any

difference, in your understanding?

A. You see, like, one of the

reasons why I take six months on these is that I

want to present to VAC a very convincing argument,

okay. And certainly we see people who have some

amount of symptoms before any deployment and then

an exacerbation afterwards, and I want to be able

to show VAC that, look, these are the facts of the

matter, and that make it relatively clearcut for

them to make a decision. And at this point in

time, I thought that it predated it.

Q. Right. No, I guess what I am

asking is, is it necessary for there to be a

connection to the military and to military service

in order for your assessment to be influential or

for Corporal Langridge's point of view helpful in


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the VAC process?

A. Yes.

Q. Okay. So throughout this

process, there would be an important issue as to

whether his condition was generated by the

circumstances of his personal life or whether it

was generated or exacerbated or reawakened by the

conditions of his military life?

A. Yes, you need to have some

sense of causality or exacerbation.

Q. Was there any component in

your plan vis-à-vis Corporal Langridge for further

treatment, perhaps psychotherapy or whatever or

maybe simply drug therapy, to deal with his

symptoms rather than the causation for those

symptoms or rather than isolating the causation?

A. Yeah, what I normally would

do was to treat what I have right here in front of

me, to ease the suffering as much as I can right

off the bat. And then in the fullness of time, get

to really know the person and then be able to say,

okay, you know, this is the part that came before,

this is the part that came after.

Q. From your notes, can you

locate any indication as to further booking,


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further appointment or any plans to see him again?

A. I wouldn't have written that

in the rough notes for the initial visit, but I

would have walked down with him to where the

bookings secretary is and we would have booked a

follow-up appointment.

Q. And where -- if we were

looking to locate Corporal Langridge's suite of

appointments with various practitioners, where

would that scheduling data be found?

A. We had what was called the

scheduler, the electronic scheduler, and it's

supposed to have a record of all the appointments

made, appointments where there were no-shows,

appointments where there were cancellations, that

sort of thing. And I believe that you guys did get

access to that.

Q. Okay, have you seen it

somewhere in the records? Because I have to admit

that I have not yet memorized the entire record.

MS. RICHARDS: Tab 1.

MR. FREIMAN: Tab 1, excellent.

BY MR. FREIMAN:

Q. So Tab 1.

A. In the big book, or?


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MS. RICHARDS: Yes.

BY MR. FREIMAN:

Q. Let's have a look. I was

with you, I was looking at the little book.

Okay, so looking at all of this,

can you locate where your scheduling would be

found?

A. It's on page 2, and it's --

Q. It should be 1115.

A. Five down.

Q. So that tells us the

appointment was 1330 or, and --

A. Oh, he did arrive on time.

Q. Yes, he arrived early.

A. Oh, good, all right.

Q. And if there was a follow-up

appointment made, would that also be in this book,

or do they only appear when the person comes for

the follow-up?

A. I am not an expert on the

scheduler but --

Q. I see something for you that

may be helpful.

If you look under "resource and

location", the first page, one, two, three, four, I


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think five.

A. 19 February, yes.

Q. That's it, 19 February. Now,

we know the 19 February was a day in which Corporal

Langridge was an involuntary guest of the Alberta

Hospital at Edmonton.

A. Okay.

Q. So in the ordinary course,

would somebody have to do something about

rescheduling that?

A. Yes.

Q. Okay. And would that person

be you or would that person be the patient?

A. Umm, it would have been,

normally, the patient, but because this person was

on everybody's radar, we were talking about him a

lot, and I had left it up to BAC and to the CDU to

make sure to book him in.

Q. Okay. When you say that this

person was on everyone's radar, can you give me a

better idea of what that meant as a practical

matter?

A. He had a lot of difficult

behaviours as part of what I came to appreciate in

the Axis 2 diagnosis. And so on the one hand, he


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was --

Q. Just to set the stage, many

people have heard, but the record will not have

heard, Axis 2 is the behavioural personality axis;

is that correct?

A. Yes.

Q. Okay.

A. And on the one hand, people

with Axis 2 diagnosis wind up, especially in

Cluster B, which is antisocial, borderline conduct

disorder kind of people, they, on one hand, want

help, and then on the other hand, reject help. And,

you know, you can see this as evidenced elsewhere

in the documents that I have reviewed, where on the

one hand, he wanted to be a good soldier, he wanted

to be part of the unit again, he rejoined Recke(ph)

squadron because that was going to fix everything,

and then that fell apart in very short order.

And then he would want to go in

and get base drug and alcohol treatment, and then

he would not show up for appointments or not follow

what was recommended of him.

He went to Edgewood, four days

later discharged himself against medical advice.

And the program at Edgewood, I have seen firsthand,


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there is a lot of people that kind of get cold feet

when they are getting treatment for their addiction

and they want to check themselves out early before

completing the program. And the treatment facility

has an excellent system of talking them down,

talking with loved ones, talking with other people

in the group and supporting them through that

really difficult time. He wasn't able to do that.

And that's, again, an example of

help-seeking, help-rejecting; so, yes, on the one

hand, I want to go to Edgewood and get treatment

and on the other hand, I don't. And that's just

part of the beast, that's part of the nature of the

illness.

Q. Now, you were citing that in

terms of him being on everyone's radar.

A. Yes.

Q. So do I understand, then,

that a number of members of the medical community,

at least, were discussing these behaviours and

these issues?

A. Yup.

Q. Would that discussion, not by

the doctors necessarily, but the discussion itself

have extended beyond the medical community and


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reached the general population of soldiers?

A. Not by us trying to do that.

Like, we keep that kind of talk in the shop, you

know. It's nobody else's business.

Q. Okay. So let's talk about

what the general view was.

You have told us that people knew

who he was and he was a topic of conversation so

that as, I understand it, even if he wasn't seeing

a physician on a regular basis the, physician might

very well be aware --

A. Yup.

Q. -- of what was going on?

A. And was talking with Shannon

Newing, because her office was right across the

hallway from me.

Q. Before we go any further,

would that community who was talking and being

aware of Corporal Langridge also have included the

acting base surgeon, captain -- now Major Hannah?

A. Yes.

Q. Is there any way that members

of the medical community, either the mental health

wing or CDU Charlie, would have been unaware of

Corporal Langridge and his problems?


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A. I suppose it's possible, but

not probable.

Q. All right, so there was a

consciousness of what was -- of the issues raised

by Corporal Langridge and his conduct. Was there

also a consensus or a sense, a shared sense of what

to do about that and what the future would hold for

him?

A. Yeah, I think the first thing

to try and do here is when you are dealing with

what we call a co-morbid condition, that means that

you have a mental-health diagnosable condition, and

you also have some sort of an addiction disorder.

When you have got both of those together, you have

got to treat both of them at the same time. And

what you need to do and what we were trying to do

with either anxiety or depression, it really

doesn't matter which label you want to apply, or

even, for that matter, PTSD, okay, you treat it

with the antidepressant Effexor at high doses, and

300 is a high dose. You treat it with something

like Neurontin for nightmares. You treat it with

Seroquel, which helps the person go to sleep and

helps stabilize their mood.

So regardless of what the


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diagnosis on Axis 1 is, we pretty well got it

covered just with those three medications right

there, any which one.

Then the big issue once you got

the person, let's say, 90 per cent compliant on

Effexor, then you let that soak in for a bit of

time and hopefully within a couple of weeks, you

start seeing treatment results.

Now, if the person is drinking and

drugging and especially cocaine or lots of

marijuana, whatever you're prescribing becomes an

experiment, okay. You don't know how it's going to

work.

If the person misses a dose of

Effexor, they start feeling really weird,

especially at high doses. And this can happen

about four hours after missing a dose. That's one

of its downfalls. But we kept reiterating, though,

you got to take it, you got to take it regularly,

okay, and if you take it regularly, it's a very

good antidepressant, very good antianxiety agent.

If you are not taking it regularly

and if you are mixing it with other stuff, then all

sorts of weird stuff can happen.

And I know that as a standard of


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care, this would have been reiterated to him or

anybody else like him more than once, because

sometimes you have to repeat yourself because they

don't get it the first time.

And I know it would have been

repeated to him by Ms. Newing, and I know it would

have been repeated to him by either Don Perkins or

Dennis Strilchuk, either one, because both of them

were well aware of that.

So then we treat both. If the

person isn't settling down with their addiction,

then we need to send them to an addiction treatment

facility.

A hospital here like in Alberta

like U of A or the Alex or Alberta Hospital

Edmonton, even if you got them in there for like 30

days, still doesn't really start addressing the

addiction issues. The illness of addiction, you

need to go to a specialized care facility, so

Edgewood, Homewood, Bellwood, some place like that,

at this level of severity.

Q. And was the general sense

within the community that Corporal Langridge, and

this is before the final events, that Corporal

Langridge had a hopeful prognosis?


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A. Yeah, yeah. We have seen

lots of people when they are actively abusing

substances to be all over the place, missing

appointments, not taking the pills, right, checking

themselves in and out of hospital for various

issues including suicidality, and then once they

get some sobriety, it is amazing the transformation

that can happen in less than two weeks. I have

seen it myself when I have taken a course out at

Edgewood, it's amazing what happens in less than

two weeks.

Q. Now, aside from the obvious

goal of restoring Corporal Langridge to better

health by treating, as you described it, both the

co-morbid conditions, both the anxiety, depression,

PTSD, whatever we want to call it, and the

addictions and dependence, was there thought given

as a separate matter to the issue of suicide?

A. You have to keep assessing

for that all the time. And there is basically,

there is a bunch of different subtypes of suicide

or suicidal behaviour, and I think a useful way of

looking at it here would be the notion of chronic

suicidality and then acute suicidality.

Okay, so the chronic part is over


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the long term, where a person makes repeated

gestures, okay. And something happens, some kind

of crisis, and they go into the hospital or they

come in to see me or somebody else in mental health

and, 'help me, I am suicidal'. You sit down and

talk with them a bit if it is really serious, and

if I think the person is certifiable or if I am

scared for them, I will send them off to the

tertiary centre, to the Royal Alex or Alberta

Hospital or U of A or Mis or Grey Nuns, those are

all the main mental health hospitals in Edmonton.

Because I can't really deal with that on an

out-patient basis, so I send them there. Sometimes

they go into hospital, sometimes they don't. Even

though they are identified to me that they are

suicidal, right, and sometimes the suicidality

passes in a matter of a couple of hours or

overnight and they say, oh, okay, I am fine, I am

fine, I'm okay again.

And particularly when you are

dealing with an Axis 2 or a personality disorder,

okay, it becomes very difficult to deal with these

people because there is a fair amount of chronic

suicidality on their part, okay.

When it's acute suicidality, so a


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clearcut example is a person with schizophrenia

where the voices are telling them to do themselves

in, okay, that person goes to hospital, gets

admitted 99 per cent of the time, we deal with it,

we settle down the voices medically, life is good

again. Okay.

And in that sense, an acute

suicidality and acute admission, okay, we can deal

with that in hospital, settle them down, and

everything is good again.

But the chronic ones are very

difficult because you have to continue to reassess,

reassess, reassess, reassess, and if you look at

the notes that Ms. Newing put in there, that was

done every time, "SI", "HI", suicidal ideation and

homicidal ideation, and assessing for that. And if

at any point in time it exceeds a certain comfort

level, then we wind up referring them into

hospital.

Q. Is there any accepted

practice, just think about the base, for

individuals who -- use a term that's probably not

applicable, who yo-yo in and out of this state,

admit themselves, get discharged, admit themselves,

get discharged, is there any larger plan to deal


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with that, or do you simply have to go with that

sequence?

A. Again, you try to get to

what's the underlying problem, and on at least a

couple of those suicidality episodes, some form of

substance was involved, whether it was alcohol or

something else. And in that context, then if you

are seeing the suicidality increase when the person

has been drinking, then you say, look, you know, we

have to treat this alcohol problem here; right. And

by treating the addiction, then the suicidality

retreats.

And I think that our hope was

that, okay, he has had 30 days of depression,

anxiety, PTSD stabilization, however you want to

call it, at Alberta Hospital, now we need to get

him into a treatment facility. And that was

certainly the plan.

Q. Do you know whether the plan

ever got beyond the hypothetical stage and actually

crystallized into an appointment at a facility?

A. I think that was up to the

base surgeon, but I thought we had a date, and I

thought it was in the month of March of '08.

Q. If that were the case, would


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there be a record in the ordinary course of the

booking and, I imagine, the financial approval,

because it's a hefty down payment; isn't it?

A. Yes, yeah. As you probably

have been able to access, I am not sure because I

didn't see it in the documents that were forwarded

to me, but there is a document that says, you know,

approval for so-and-so to go to Edgewood, here is

the leave pass, here is this, and then signed off,

right. And that would have been the same thing

that was being done for Homewood.

Q. Would that be the primary

document that we should be looking for? We found a

number of those documents, but they are mostly

associated with referrals to emergency departments

in large metropolitan hospitals when Corporal

Langridge was seen and assessed and eventually --

we haven't seen an approval as yet for a course of

treatment in March of 2008.

A. I know that there were

conversations with Captain Hannah and Homewood

because we had entertained the idea of going back

to Edgewood again and that was, you know, certainly

also by Mr. Langridge's choice, he didn't want to

go back there; right, so I said, okay, we will try


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one of these other two which are very good as well.

And I know it was in the works, and the matter of

filling out that form and signing it is less than a

couple of hours' work and walking it around in the

base clinic to a couple of different signing

authorities, but...

Q. In terms of pragmatics,

though, would -- I don't know how better to put it,

would you have to wait for a bed to become

available at this facility?

A. Yes, yes.

Q. Or for a treatment cycle?

A. You have to wait for a bed.

Q. So would there be any

correspondence or any other documentary paperwork

related to trying to secure a bed in one of these

facilities?

A. Usually it was just done by

phone.

Q. Okay, and who would be the

person who would do that?

A. Either the base surgeon or

his or her designate or the base drug and alcohol

counselor.

Q. Just before we move away, for


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at least for the time being, from the thin book,

you will be aware from having looked at these notes

the other day that there are a number of tests,

some of them complete, some of them incomplete,

that were -- that involved Corporal Langridge

filling out questionnaires and forms,

multiple-choice tests.

Do you know what the occasion was

for having him do those tests?

A. My understanding of that was

that he had seen the psychologist, Dr. William Li,

prior to my seeing him, and that he had done the

psychometric battery on him, which is what we did

as standard care. And unfortunately, I never got

to see that until after the fact, but I did see

that.

Q. In the ordinary course, what

would be the reason for doing that and what would

be the consequence of filling it out and being

graded and scored?

A. It gives us a fuller picture

of the person. It also aids us with possible

different diagnoses, it also aids us with whenever

we do have to fill out something for VAC. VAC likes

it if the psychiatrist is saying the one thing, the


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psychology work, the psych test results are saying

the same, and that, then, it's a coherent case for

the person.

Q. Would it have been necessary

or useful for you to have the results of those

tests?

A. Not necessary. Again, there

is two functions with what I was trying to do

there. The first one was trying to treat the

person for their mental health problems, okay, and

what I saw was anxiety and addiction. And that's

where the treatment was headed. So that's the

first goal. And then the second goal is that in

the fullness of time, if there is a compensable

component to the symptoms, okay, then I want to

fill out the VAC for the person.

Q. And just, again, there is one

more document, and it's a bureaucratic document

that I wasn't totally sure that I understood. It's

addressed to you. It's near the beginning of the

material in the small book, one, two, three, fourth

page. It's a fax to you --

A. It was to Karen.

Q. To Karen, I'm sorry. And I

take it Karen is the receptionist or a scheduler


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for you?

A. Yes, she is a file clerk,

receptionist, transcriptionist, does a bunch of

things.

Q. Everything.

A. Yeah.

Q. Do you know what this is

about? Because it's coming from Veterans Affairs.

A. Yes, so they are asking for

documentation to aid with completing a VAC file on

him.

Q. So would there still have

been an outstanding question as to entitlement to

benefits or compensation even after his death?

A. Possible, yeah.

Q. And where would this come

from? Does this get generated internally, or is it

generated as a result of something that's been

initiated by somebody in the medical community?

A. I didn't have the VAC forms

for him. Normally, I do fill them out. VAC, if

they have an open dossier, will occasionally remind

us.

Q. You can see the line says:

"Also, Dr. Elwell was


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supposed to write something

up for his file."[as read]

A. Yes.

Q. And I am trying to understand

where that information would have come from to VAC.

A. That would have been probably

when Mr. Langridge talked to VAC himself.

Q. I see.

Give me a moment, please.

If you look at Tab 39 in the big

book, this is a discharge summary written by Dr.

Sowa at the end of the 30-day certificate under

which Corporal Langridge was staying at the Alberta

Hospital.

First I would like to just ask you

about the diagnosis on discharge, whether you agree

with that diagnosis based on the work that you

yourself independently did or whether you have

reason to disagree with any of this?

A. I think based upon what I saw

in November, I was comfortable with alcohol for

sure, okay, alcohol abuse and dependence.

And what came about later on

through reading the documents was that also there

would be cocaine in there --


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Q. When you say "reading the

documents", you mean?

A. This stuff.

Q. Is that after his death?

A. Yes, after his death.

Q. So do I understand that at

the time of your intake analysis or your interview

with him, the drug dependency was not high on

anything that he had discussed with you?

A. I don't believe it was

disclosed to me.

Q. The reason I ask is, as we

discussed earlier, he had clearly failed a drug

screening test, not in the therapeutic but in the

administrative stream, and would have been under

some cloud, in any event, associated with that.

A. Yeah, well, I was not briefed

on that when I saw him on that day. Because,

otherwise, I certainly would have pushed him harder

on that.

Q. Okay, so we have dealt with

the first line, the polysubstance dependency, so

it's not limited to alcohol, and there is also

cocaine in issue.

What about the other parts of the


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diagnosis?

A. Well, I would also think I

would throw in there marijuana as well.

In terms of grief reaction, you

see, that's where Dr. Sowa had more time with him

and was able to talk with him a bit more about how

things were like for him growing up and how he felt

about, for example, his attachment with his father,

okay.

So that Dr. Sowa would be in a

better place to comment on that than I would. To

my mind, what I saw was generalized anxiety

disorder. You know, and this is where he had more

time with him with the PTSD, so the query, that

doesn't mean that he has it, but it's asking the

question, okay.

Q. Yes.

A. And, again, if we would have

had possibly more time with him, it might have come

out, I don't know, okay. What I saw was

generalized anxiety disorder, I did not see PTSD.

Q. Right.

A. And the other thing about

this is that on the civilian side, they

automatically think that everything that you have


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done in the military has exposed you to dead babies

and horrors unimaginable, okay. And the reality

is, is, no, all right.

Yes, it's potentially traumatic.

Yes, lousy things can happen while you are serving,

okay, but that doesn't mean that everybody gets

traumatized, in the first place. And in the second

place, not everybody goes on, even if they are

traumatized, goes on to have PTSD.

Okay, and so there is a bit of a

disconnect. And by that point in time, I had been

working at the base for a while, and we were

cognizant of people for secondary gain for making

the money out of VAC would tend to play things up a

bit, okay, and so we were careful about that so

that when we said, yes, these are our diagnoses,

they were that, and we had lots of evidence to back

it up. Okay.

Q. Just before I leave this,

something you said just twigged for me.

As we discussed earlier, Corporal

Langridge didn't, to your recollection, raise PTSD

in his discussions with you. But the fact that he

raised VAC, wouldn't that inferentially raise PTSD,

even if he doesn't say the magic letters?


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A. That's right, yes.

MR. FREIMAN: Now, Mr. Chairman, I

am not finished with this document, but I actually

want to get to a different topic based on this

document. And we have detained Dr. Elwell for

almost an hour and a half already. Perhaps this is

a good time for a kind of brief break?

THE CHAIRPERSON: Why don't we

break for ten minutes, if that's fine.

--- Upon recess at 2:22 p.m.

--- Upon resuming at 2:34 p.m.

MR. FREIMAN: Thank you, Mr.

Chairman

BY MR. FREIMAN:

Q. Dr. Elwell, during the break

we have located, through the good offices of Ms.

Richards for the Department of Justice, the medical

referral and certification form. For the record,

this is Document 1143, Collection E, Volume 2, Tab

10, page 171. I don't have it's postal code, but I

am sure that's somewhere as well.

Just looking at this document,

Point 2 says:

"I understand that

administrative or


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disciplinary action or both

may be taken regardless of

whether I am found to be

dependent on drugs or I

accept or refuse

treatment."[as read]

I appreciate this is outside of

your normal area of competence, but from your

understanding of the process, what I gleaned from

your explanation, is regardless of what that says,

as a practical matter, if a person were compliant

with treatment it is unlikely that administrative

action would be taken?

A. That's correct.

Q. Now, Dr. Elwell, we were

looking at the document at Tab 30[sic], and we

talked a little bit about the diagnosis.

What I would like to turn to now

is the events that took place at or around the time

of the planned discharge of Corporal Langridge or,

sorry, the expiry of the certificate. And I would

like to draw your attention to the second page of

the discharge summary offered by Dr. Sowa and the

last two paragraphs.

I am just going to read them so


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that we know who we are talking about.

MS. RICHARDS: Sorry, Mark, I

think you have the witness on the wrong tab. You

said Tab 30, and I think it's Tab 39.

MR. FREIMAN: No, no, it's 39, I

am very sorry.

BY MR. FREIMAN:

Q. So we are at the second page.

And this is what Dr. Sowa writes:

"In the last week of his stay

in hospital, we kept him

under close observation

because of his continued drug

abuse. He remained euthymic

and without any psychotic

symptoms but displayed

intermittent irritability and

those periods were quite

noticeable and indicated

illicit drug use. Our plan

was to keep him in the

hospital until he could be

discharged directly to the

military. He certainly was

not certifiable at the end of


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the first certificates. He

agreed to stay in the

hospital as a voluntary

patient until arrangements

could be made for him to

return to a drug

rehabilitation program.

"Unfortunately the military

called us to inform us that

they actually did not want

him back -- did want him back

at the Garrison and that they

would make their own

arrangements for him to be

referred to a drug rehab

program. We were rather

surprised by this as Stuart

had indicated his willingness

to stay with us in hospital

so that that could be done.

However, based on that

request, he was escorted the

day after his certificates

expired directly to the

military Garrison and handed


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over to his sergeant and this

was done on the 5 of March,

2008."[as read]

Were you aware of any discussions

that were going on about Corporal Langridge and

what was to be done at the expiry of his

certificate?

A. Well the -- I had talked with

then Captain Hannah regarding what we should do

with him once he got out of Alberta Hospital

because then he came back to our care, right. When

he is in hospital, he is under Dr. Sowa's care, he

is in the civilian system.

And one of the concerns that had

come up was that while he was at Alberta Hospital

was that he was continuing to access cocaine and

the problem with that being is that you want to

have this person a little bit stable. And if Dr.

Sowa is already noticing that he is irritable, what

addict in their right mind, when they are actively

using, would want to get out of a situation like

this because they can continue to access their

drugs. So, of course, he is going to love to stay

there, right. At some point in time he needed to

come back to us.


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About a year or so prior to this,

we had an unfortunate situation where we had a

person with an addiction and PTSD and a major

depressive disorder and all those things, who had

gone to Edgewood and in the first week had tried to

hang himself, and they caught him by accident in

his room just as he was putting the rope around his

neck. And as a result of that, we were all very

sensitized to this potential issue and given Mr.

Langridge's past track record here of attempts in

the last number of months, we were very concerned

for him.

We know that if a person is

actively using the substances that makes them more

suicidal. We know that if they are drinking

alcohol, that makes them more suicidal. We know

that these are factors in completed suicide.

We were worried about how do we

get this guy a little bit clean to start off with,

get him off into a rehab program, considering that

we had sent him to Edgewood a mere three months

earlier and that had lasted a grand total of four

days, okay.

So we were really concerned about

getting him into a treatment program and getting


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him to stay there.

One of the other risk factors for

suicide is when a person is away from their normal

social network, and whether that's at work or

whether that's family, if we are sending him here

to Ontario, okay, from Edmonton, we were concerned

about what might happen to him there before he gets

going in treatment at Homewood.

The other thing that Homewood,

Bellwood and Edgewood like to see is that the

person is at least sober coming in. They don't

like having to detoxify them. If we recall before

he had gone to Edgewood, I believe, he had I think

it was alcohol, he had consumed alcohol before

going away on the rehab program in January, right,

January 4th.

Q. Yes.

A. Okay, so we were worried

about that happening. And seeing as how he was

accessing drugs relatively easily, that was our

understanding of it at Alberta Hospital, then it

was like, 'okay, where can we get him to a point

where he is not accessing the cocaine, where he is

still taking his medications on a regular basis and

where we can keep a very close eye on him'?


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Now part of the plan was also that

if he became acutely suicidal, remember

chronic/acute, right. If he became acutely

suicidal, we would, of course, immediately send him

back to hospital. And that was our understanding

of why we were trying to do this stabilization, is

that he wasn't any longer acutely suicidal. Yes,

he remained a chronic risk; yes, he was partly

stabilized. Let's get him stable for two weeks

before we potentially send him away here and have

bad things happen in Homewood.

Q. So when did these

conversations take place and who are the

participants in the conversation?

A. Base drug and alcohol, and I

am thinking that it was Dennis by that point,

Dennis Strilchuk, and -- because Mr. Perkins had

already discharged him from his care because of

continued non-compliance, help seeking/help

rejecting, and Captain Hannah and myself and Rajoo,

Dr. Rajoo would have been involved too.

Q. I think Dr. Rajoo would have

been on vacation at this point?

A. At that point, okay. Then

Hannah was acting as the person covering for that


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CDU, because normally Rajoo would have been

involved or whoever was the CDU GDMO.

Q. We heard this morning from

Mr. Etienne, who seemed to have been a courier for

information, that his plan when Corporal Langridge

called him proposing to go to Edgewood and to stay

in hospital until then -- or at one point he had

another plan -- that he would take the proposal to

a conference.

Is the meeting we are talking

about, the discussion, the conference that Mr.

Etienne would have been talking about?

A. Yes.

Q. Was that a physical

conference or was it a virtual conference by

telephone?

A. I can't recall.

Q. Okay. Let me just then refer

you to a document in the thin collection. The tenth

page in. It's, I believe, in your handwriting and

it's dated 4 March?

A. Yes.

Q. Now, what is this document

that we are looking at?

A. This is either a


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teleconference or a case conference. Normally I

write down "teleconference" or "tel con", but I

didn't in this case. If it's case conference,

normally we have a form for that and you have seen

other ones in here.

Q. Yes.

A. So I am going to guess that

it was a telephone conversation then. It was

regarding Mr. Langridge and if he wants to stay in

Alberta Hospital it was okay with me. It was also

okay if he leave there, okay. That, you know, if

he is acutely ill, acutely suicidal, then obviously

that's the person on the ground in AHE. In this

case Dr. Sowa or one of the other doctors there

would have said, 'no, no he is acutely suicidal, we

can't send him home'. And if he wants to go then

he would be recertified, right. And it's not our

place to tell them that decision, that would have

been their's.

So our understanding would be that

he remains having problems with addiction, the

anxiety/depression/acute suicidality has been

mostly dealt with, but this is somebody that we

have to keep very close tabs on based upon what he

has done in the last number of months.


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And again, as part of our concern

about that previous service member at Edgewood, we

thought that it would be best to have two weeks

worth of stability, two weeks away from drugging,

in this case the cocaine, before going to Edgewood,

Bellwood or Homewood or any kind of rehab kind of

place.

Q. Let me just stop there and

ask you a couple of questions.

First of all, just looking at that

second line:

"Two weeks stability in

community before Edgewood,

Bellwood, Homewood."[as read]

To me that appears to indicate

that as of the 4th of March, no specific decision

had been taken about which, if any, of these three

facilities would be the ones that he would be

attending?

A. Yes. And then the next

sentence down, "Homewood" was underlined with a

question mark. So that indicated that that was

probably the frontrunner, and that's my

recollection and my memory, and that it was okay

with me if he went there.


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Q. All right. And in the last

line says:

"Urine testing/close

follow-up until Homewood?

okay, with me."[as read]

A. Yes.

Q. Can you explain what that

means?

A. So that what we need to do is

to be able to help the person stay clean, and one

of the tools that we use is that we get the person

to do the medical pee test repeatedly. And

basically it's, you are giving the person a sense

of containment, okay, so that if they think about

using the drug that then 'oh, geez, you know, I am

going to pee positive or Dr. Rajoo or for Leo

Etienne or whoever', right. And then there is a

bit of a personal bond there with that person

treating you and then the person is less likely to

consume.

Q. So when we say "frequent

urine testing", what's the frequency that you would

have expected?

A. Umm, I have really

flip-flopped on that throughout my career. It


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depends where they are. I could see doing it

daily. I could see doing it randomly because then

there is not that element of predictability. But

certainly once a week anyway, in this kind of a

setting.

Q. I think we have seen, now

bearing in mind that Corporal Langridge was in

hospital for two-and-a-half days of this time, but

we have only seen record of one urine test from the

time of his discharge until the time of his

unfortunate death; is that a surprising fact?

A. Not necessarily. I didn't do

the urine testing myself, like, I do them in my

civilian practice and I order them. But typically

what was done at the base was that the BAC people

would be doing that and then they would report to

me.

Q. Okay. And would there be a

standing order? Would there be something addressed

to them to let them know that urine testing was

required?

A. I believe that it was -- the

policy directive on that would be found in the CFAO

on drug rehabilitation, which you alluded to with

this latest submission. There are specifications


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in there, I am not exactly sure as to how often you

need to do it, but it is mentioned that you do have

to do it.

Q. I am thinking in terms of

when you are doing it for therapeutic rather than

legal reasons. Because this, I take it, was

therapeutic, not legal?

A. Yes, this would have been

therapeutic. I would have expected it, you know,

once a week. And I am at a loss to explain why it

wasn't documented.

Q. Okay. Now, we heard from --

was it your expectation that there would be some

manner of drug rehabilitation program on behalf of

Corporal Langridge during his time when he was

trying to be stabilized in the community?

A. Yup.

Q. And what would that have

consisted of?

A. Typically what we like to do

is to have some amount of one-on-one contact with

the therapist. So Leo Etienne, Dennis Strilchuk,

Don Perkins, and also to have the person

participate in groups. And the reason why we love

the group component in addictions work is that


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frequently people with addictions don't tell the

truth and there is nobody who is quite as able to

sniff that out as a fellow addict in rehab. And it

is amazing how powerful a therapeutic tool that is

if the person goes to the groups.

And we had a group on Thursdays of

serving members plus some people that were in the

release proceedings who also had addiction problems

plus or minus some degree of mental health, other

issues. And we repeatedly asked him to go to those

ones and he didn't, wasn't able to do so.

Q. Wasn't able to or was not

willing to?

A. Either one. I can't speak to

his motivation.

Q. I would like to refer you to

a loose sheet of paper that I hope is on your desk,

if not I will provide them to you. It is a

one-page note, handwritten, looks something like

this.

A. Yes, okay.

Q. That's the one, okay. And for

the record, this is Document 1128, page 52. I

regret that I didn't put it in your book of

documents.


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This is a page from, I take it,

the base medical record. The top one records the

beginning of Corporal Langridge's stay at the

Alberta Hospital, recorded by nurse Charlene

Ferdinand, and the bottom reports on arrangements

on his discharge. It's not dated, but we have

reason to believe that it would have been either

the 4th or probably the 5th, which was the date of

the discharge.

I am going to start just by asking

you whether you recognize the squiggle at the

bottom?

A. No.

Q. Nor do we.

Let me just read this to you and

then I have a couple questions about it.

"Discharge from Alberta

Hospital today for a 'trial

of good behaviour' to see if

capable of going to addiction

treatment centre. Very

agitated for group sessions

and zero suicidality, settled

now, willing to give plan a

try. Wants Seroquel for


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--"[as read]

I guess it's "panic" --

A. "2 PRN", so that's two

tablets as needed.

Q. "2 tablets as needed and 25

milligrams -- "

A. "For agitation".

Q. "For agitation".

A. "Has worked well in past."

Q. And the plan was to give him

the Seroquel that he asked for.

But my question really has to do

with the first paragraph.

The notion of a trial of good

behaviour; does that correspond to your

understanding of the plan that would have been put

in place as a result of the conference we were

talking about?

A. Yeah, umm, basically it was

not intended to be any kind of judicion, punishment

or anything like that. It was to be supportive and

basically it was to try and get this guy clean and

sober for at least a little bit of time before we

ship him off to Homewood.

And, you know, when we had sent


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him to Edgewood, which is a very fine treatment

facility and very experienced with dealing with

people with anxiety disorders, PTSD, major

depression, addiction, right, he only lasted four

days. So we didn't want to have that happen again.

We wanted to have him as stable as we could and

then send him there.

And he was fully part of that kind

of a plan where you have to behave in the sense of

no drinking or drugging.

Q. Now you say he was fully part

of, what do you base that understanding on?

A. My -- I was not party to that

discussion, but my understanding was that he sat

down with a representative from the BAC as well as

the base surgeon and we said, 'look, we want you to

stop drinking and drugging, we want you to be

taking your medications as prescribed, as what we

have told you to. If you are suicidal, tell us, we

will send you back to hospital to get it

reassessed. Otherwise what we need to have you

doing here, because you are abusing drugs while you

are at Alberta Hospital, is to have you clean so

that we can send you off to Homewood and you can

get the treatment you need for your addiction'.


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Q. So, but, is the notion of a

trial of good behaviour accurate in the sense that

if he was able to demonstrate good behaviour,

however we define that, he would go to Homewood?

A. Absolutely.

Q. And if he was not able to

demonstrate good behaviour?

A. Then we keep on trying and at

some point in time he would have gone off to rehab.

Q. So under that scenario, it

seems to me -- and maybe I am wrong -- unlikely

that an actual appointment would have been made for

him because you wouldn't know whether he had been

successful?

A. That's possible, you know.

And certainly the other thing is that we had really

good relationships with all of the addiction

treatment facilities because we sent them lots of

customers. And, you know, if you look back in

January when he went, he was supposed to go

originally on the 9th, and we phoned them and got

him in even earlier because he was indicating he

really needed to go. So we were trying to work

with him, recognizing the instability of people

when they are actively addicting.


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Q. Okay, now, the goal was to do

better than the Alberta Hospital has proved its

capable of doing in terms of restricting the supply

or his access to drugs and alcohol.

We know that in the past it is

apparent that Corporal Langridge had no difficulty

at all obtaining drugs and alcohol while he was

living on the base.

What was it about the new approach

that would make you or your colleagues optimistic

that you could control his access better than the

Alberta Hospital was able to?

A. Dr. Hannah had spoken with

the Strathcona Regiment about trying to set

something up here, indicating, without of course

spilling all the medical confidentiality, to say

that 'look this is a person we are worried about,

we need to try and get him clean and sober before

we send him off for rehab', okay. And what was

happening during the day was that he needed to be

part of the duty centre, so it wasn't that he was

on defaulter's parade or that he was in trouble, it

was just that he had to be there and be present in

the work place during the day. So signing in every

couple of hours, I believe, something like that.


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And then I believe that the

arrangement was that he slept there at night. But,

again, this was not out of punishment, it is just

that it's very difficult to deal drugs at the

regiment. I am not saying that it's completely

impossible, but I am saying it is very, very

difficult and that's what we were trying to do for

him.

Q. So let's look at Tab 40, I

believe, and this is a note by Mr. Strilchuk, whom,

as you have noted, was Corporal Langridge's base

addictions counselor, at least up to the time that

this note was written.

A. Um-hmm.

Q. And what -- and this is dated

the 7th of March 2008. Mr. Strilchuk think's it's

five days, but it's actually two days after

Corporal Langridge's discharge.

Now was it your understanding that

the measures designed to make it more difficult for

Corporal Langridge to obtain drugs and alcohol were

put in place immediately upon his discharge from

the hospital?

A. That was my thought.

Q. Okay, so here is what Mr.


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Strilchuk says:

"Member was seeing this

writer for approximately five

days as he had just returned

from a 30-day stay in Alberta

Hospital for serious

psychiatric issue. Had the

member contract many

restrictions, however he was

totally non-compliant. He

became so non-compliant he

had to be sent to his unit

for close supervision. As a

result of these issues, this

writer will no longer working

with this patient."[as read]

So either Mr. Strilchuk is firing

Corporal Langridge or, in a very genteel way, he is

reporting that Corporal Langridge has fired him.

A. Right.

Q. Does this indicate to you

that there was any success whatsoever in

restricting drugs or alcohol to Corporal Langridge?

A. Well it's not just the active

drinking or drugging, like the active addictive


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behaviour that we are concerned about. It's also,

you know, is the person at least making an honest

attempt in therapy to start talking about addiction

issues? Is the person willing to submit to the

treatment? And that's one of the key parts. Like,

if you look at Step 1 of Alcoholics Anonymous,

right, it's admitting that you are powerless over

your addiction. And that is a key tenet that

people have to kind of say 'look, I am having a

problem with this drug or this alcohol, I need

help'.

And I think it speaks volumes that

both Don Perkins, who has been treating addicts

for, what, 25/35 years, plus Dennis Strilchuk who

had been treating addicts by that point in time for

at least three years, he had previously also been

in recovery himself, okay, that both of these

people weren't able to work with him. So that is

help seeking/help rejecting in a huge way. Right.

Q. Yes, and we also know that

Corporal Langridge missed two AA meetings, which

probably is the total number of AA meetings he was

supposed to attend since being discharged from the

clinic -- or from the hospital.

So the second element that you


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were talking about, the utility of peer counseling

or group dynamics where you are confronted with

your behaviour was also not working?

A. Right.

Q. So by the second day, am I

right that it was certainly obvious there would be

a challenge in terms of either part of the drug

treatment program that the base had contemplated as

a bridge to Homewood?

A. Yes.

Q. Okay. So let's then look at

-- oh, can I ask you whether, in your view, part of

the plan on discharge was to have Corporal

Langridge resume work duties?

A. In the sense of reporting to

work so that we can keep an eye on him and keep him

clean and sober, yes. But in terms of actually

doing any like real infantry or crewman work, no.

Q. Well we know he was no longer

doing any of that work anyway.

A. Yes, yes, but in the sense of

him wearing a uniform, coming into work at a

certain time, staying there, and then sleeping the

night there. Yes, those were his duties.

Q. So let me have a look with


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you at, I think it's Tab 41.

This is then Captain Hannah's

note. I can tell you that the 7th of March meeting

would have occurred immediately after or very

shortly after the meeting with Mr. Strilchuk that

caused the letter of resignation as it were.

And here is what Captain Hannah

records:

"Member in today because he

is upset and not following

the BAC plan. Released from

Alberta Hospital 3 March,

'08."[as read]

That's a mistake, it was 5.

"Since then has been using

alcohol and other drugs.

Also has been reported to

have been harassing

girlfriend. Known

polysubstance abuse.

Question occupational stress

injury, depression. Member

directed by unit to live in

company lines to enhance

supervision. Member upset


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with this plan, requested

consult with Alberta

Hospital. Called Alberta

Hospital stated they are full

and all referrals are to be

sent to the Royal Alex

Hospital. Member refused to

go to Royal Alex and agreed

to go to LdSH and be

supervised. Denies

suicidality. Denies

homicidality. Committed to

sobriety. Member released to

LdSH and MELS."[as read]

Which are medical employment

limitations.

A. Yes.

Q. So the situation appears to

be that Corporal Langridge has not complied with

what he has been asked to do?

A. I agree.

Q. And so far he hasn't

demonstrated stability?

A. No.

Q. And he hasn't demonstrated an


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ability to abstain, and he hasn't demonstrated a

commitment to group therapy?

A. Correct.

Q. Now, at this point, Captain

Hannah says that the member is going to be referred

to the unit in order to be supervised.

Did anyone talk to you about this

or are these the conditions that you were -- you

thought about in the March 4th meeting?

A. That would be my

understanding.

Q. Okay. So let's look at what

Captain Hannah says. He has attached his medical

employment limitations on Corporal Langridge:

"1) Abstain from alcohol and

non-prescription drugs.

"2) Comply with supervised

treatment plan.

"3) Attend all scheduled

appointments."[as read]

Then adds a plan. He adds

supervised at LdSH, times three days; follow-up

with base addictions counselor, 10 March '08;

continue with current medications.

My first question is: Those three


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conditions don't look like employment limitations

of the sort that I have seen in the past.

A. I agree.

Q. Are they, in fact, employment

limitations?

A. No. They are more of the

medical management of a condition.

Q. To your mind, is there any

benefit in categorizing these medical management

steps as employment limitations?

A. No.

Q. Now, let me have a look with

you at the actual conditions as they were enacted

for Captain -- sorry, for Corporal Langridge.

Now they come in two forms. We

have the conditions themselves at Tab 43, and I

understand that this was a document that was

prepared for submission to the BOI.

But there is also, at Tab 42, an

e-mail chain that may assist us more.

Now if we start, as we always have

to, at the end, which will be the second page at

the bottom. And it's an e-mail from Captain Hannah

to Chief Warrant Officer Ross, who was the

regimental sergeant major for the unit. And Captain


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Hannah writes:

"RSM,

"With respect to Corporal

Langridge, please be advised

I would like to impose the

following medical

occupational employment

limitations.

"1) Member is to abstain

absolutely from alcohol and

drugs, unless prescribed by a

physician.

"2) Member is to comply with

treatment plan, which

includes him remaining under

the supervision of LdSH(RC.)

"3) Member is to attend all

scheduled appointments as

directed by medical services.

"I hope this is helpful. If

further clarity is required,

please call. The same

limitations will be faxed to

the regiment on CF 2018 later

this afternoon."[as read]


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A. One of the employment

limitations can be the appointment one. I have

seen that. But the other two are, you know,

technically not an occupational employment

limitation.

Q. And my first question really

is: In directing this to regimental Sergeant Major

Ross, who, as I understand it, is in charge of

discipline for the unit, there appears to be

something that Captain Hannah thinks the RSM can or

should be doing with regard to these medical

occupational limitations?

A. Yeah, the RSM or regimental

sergeant major is really kind of like a Janus, it's

got two faces. So, on the one hand, if you are

constantly late for work, the RSM will make your

life miserable; that's the disciplinary aspect.

But the other aspect of it is, is that the RSM is

there for the well-being of the enlisted members,

ie., not officers. And they are to look out to try

and help them. If somebody's parents pass away

suddenly or whatever, it's the RSM that typically

gets the ball rolling to get the person some leave

and get them out of town to go home.

Other supportive stuff, if they


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have girlfriend problems or whatever, they might

give them a couple days off. Stuff like that.

So the RSM is both the stick but

also kind of like a den mother too, it's both

roles.

Q. Do you have any understanding

of what role, if any, the regimental sergeant major

could have in terms of these, what are labelled

"occupational limitations"?

A. He helps to make sure that

they happen. Because it's one thing if we send a

chit back with the person saying, you know, 'can't

do physical training', right. It's another thing

that then the unit says 'oh, okay, yeah, we got to

let him heal', right.

And usually the RSM likes to know

about these things so then they don't schedule the

person to go away to Wainwright for a month to the

bush, right.

Q. I can understand, I think,

how the -- which you pointed out -- that attending

all meetings might impinge on something that the

RSM could do, that is to ensure that he was let off

of his employment or other duties in order to allow

him to make those meetings.


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A. Yes.

Q. Although, let me just ask

you: My impression has always been that if a

soldier has a medical appointment, that takes

precedence over his normal duties?

A. Yes.

Q. Okay, so, then the other two

limitations, I can understand how the regimental

sergeant major might think that he could enforce

them with respect to the soldier, but again, and I

may be wrong, my understanding of an occupational

limitation was that it was enforceable against the

employer and it was designed to tailor the

employment to this --

A. Yes.

Q. -- but there is nothing along

those lines the RSM could do vis-à-vis the unit,

because the unit would have no interest in him

drinking or taking drugs and the unit would have no

interest in him missing any appointments?

A. Yes. In addition to that, I

think that he was already under a medical category

prior to this.

Q. Yes, yes.

A. So that Warrant Ross would


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have known about that. They have, usually, a file

that says 'okay, these are the following people on

medical category'.

Q. All right, well let's read

the rest of this important e-mail.

On that same day, not too much

later than Captain Hannah's e-mail, Regimental

Sergeant Major Ross sends an e-mail to Major Jared,

who was, as I understand it, high up in the chain

of command for the Strathcona's, and Captain

Lubiniecki, who I understand was the adjutant here.

He says:

From your records from the base

surgeon. Along with this are my directions and

restrictions."[as read]

And, as I understand it, the

communication from the base surgeon is the first

e-mail and the directions and restrictions are the

three points.

And here the regimental sergeant

major writes:

"Corporate Langridge will

wear a uniform during normal

duty hours and perform duties

as directed by the RSM.


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"2) A normal work day will be

Monday through Friday, 8 to

1630 daily, weekends will be

free unless otherwise

directed by the RSM.

"3) He will have freedom of

movement with the following

restrictions:

"a. He will live in the

regiment duty centre, bedded

in the defaulter's room.

"b. At no time will his door

be closed.

"c. He will have a curfew of

2100 hours daily.

"d. He will report to the

duty officer every 2 hours on

the hour daily.

"e. There will be no escorts

required except under the

following conditions: 2, he

will, when required to attend

any and all appointments

given to him by his

healthcare providers, do so


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under escort; 2, if he

chooses to attend AA

meetings, he will be escorted

to and from the meeting area.

The escorts will not attend

the meetings with him.

"f. All prescribed

medication will be held by

the duty officer. It is

still the member's

responsibility to take the

prescribed dosage at the

appropriate times.

"g. When he leaves the

confines of the Harvey

building, he will inform the

duty officer of where he is

going and a contact phone

number. Paragraph C and D

still apply."[as read]

And those refer to the curfew and,

somewhat redundantly, to reporting to the duty

officer?

A. Yes.

Q. First of all, this e-mail is


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dated on the 7th of March.

My understanding, from your

accounts earlier, was that, in fact, it was as

early as the 4th of March that there was a plan

formulated that would have included all of these

conditions or most of these conditions?

A. Yes.

Q. So in effect, is the

regimental sergeant major merely recording what had

already been in place?

A. I don't know if it was

already in place by that point in time. Certainly

this was what our thought was in terms of 'let's

try and do close supervision of this person and get

him away from the drugs and the alcohol'.

And that this was the matter in

which the regiment said 'look, this is what we can

do to help out'.

Q. All right. Because it seems

to me there is one of two possibilities, one is

that this is recording what was already in place

and the other is this is putting into place

something that was contemplated to have been in

place for two days and that for two days Corporal

Langridge would have been on his own to try to


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maintain sobriety?

A. That could have been

possible.

Q. Okay. Now the rest of the

e-mail is simply record -- it's. The earlier

e-mail is forwarded to Captain Hannah three days

hence, because we are looking at a weekend to

inform him. And his comment is "outstanding,

thanks".

I take it that that indicates that

this is something with which Captain Hannah not

only agrees but agrees enthusiastically?

A. Yes.

Q. Now let's look at this. We

know that the 7 of June was a Friday of -- of

March, rather, was a Friday?

A. Yes.

Q. And these restrictions, then,

if they are put in place on the Friday will involve

Corporal Langridge living in a certain place,

having his door open, having a curfew, but it will

not involve him being -- having any occupational

duties because it's the weekend, and we already see

weekends will be free unless directed by the --

otherwise directed by the RSM.


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We also know that there maintains

-- or there is maintained a reporting requirement

which involves reporting every two hours.

Now, could I ask whether this

looks reasonable as a means of preventing a person

interested in getting drugs from getting drugs?

A. I would say yes. Because,

again, it's very hard to deal drugs, right, at the

work place, not --

Q. I am talking about the

weekend.

A. The duty centre is still open

on the weekend. So the e-mail is a little bit

unclear in that sense as to what happens on the

weekends; right.

Q. I can tell you, and if

someone thinks that the evidence is otherwise I

invite them to, in their questions to you, to

indicate to the contrary. Our understanding is

that Corporal Langridge was required to report, but

he could report by telephone and leave a phone

number where he could be reached for his location

and that he was able to leave his cellphone number

as a location at which he could be reached.

With that added information, does


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it seem reasonable to you that these measures would

have been effective in preventing access to drugs

or alcohol, especially drugs, on a weekend?

A. No. I would have preferred

to physically being in the duty centre on weekends

as well.

Q. Okay.

Now I would also like you to have

a look at Tab 46, please. This is a -- the

referral note by Captain -- or sorry Dr. Turner. My

understanding is Dr. Turner may have been subbing

in for Dr. Rajoo. It is a somewhat difficult

document to read, so we have prepared a short

transcription for you.

A. It's doctor writing.

Q. Pardon?

A. It's doctor writing.

Q. It's doctor writing, so you

can probably read it perfectly well, but let me

read what I understand this says.

"Please see this 28-year-old

male who has a history of

alcohol and drug abuse and

depression. Multiple

attempts for substance abuse


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treatment attempted ie.,

Edgewood and patient was

non-compliant. Discharged

from Alberta Hospital on

March 3, 2008, under care of

Dr. Sowa. Now is basically

under restrictions, imposed

to stay in his military unit

and monitor his actions for

the next couple of weeks. He

is not coping well with this.

Anxiety, poor sleep and

trying to deal his way out of

the circumstance. This

member was informed today

that he must return to his

unit and continue to work and

see how he does and if doing

okay and abstaining, the

consideration of a treatment

program in Guelph, Ontario,

Homewood, would be

considered. Upon realizing

that he would be forced to

return to his unit today, he


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states he is suicidal and

would rather kill himself

rather than return to his

unit."[as read]

And that gives his medications.

I have not given you -- or it's

not in the collection, but in the notes before you

is the chart note by Dr. Turner and it's probably

relevant as well.

This is Document 1302. It states:

"Released from Alberta

Hospital not long ago.

Missed two appointments with

AA. Things are in storage.

Living at regiment. Hasn't

slept in two nights. Working

during the day and must

report every two hours after

work. Things are in storage.

Was on half days in past.

States not suicidal or

homicidal. Feels like is

thrown back in deep end. No

idea where life is going at

present. Scared to go to AA


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meeting. Discussed with BS

-- which we believe is base

surgeon and addictions -- no

change in management

warranted/agree. Unit will

continue to administrate and

if can show that is ready to

consider treatment, will

consider Homewood. After,

states would rather kill

himself than go back to work.

Tearful, anxious. Asked if

he had a plan 'you know

I...'"[as read]

And we couldn't make out the next

word.

"...discussed with Alberta

Hospital, no beds. A)

substance abuse, depression,

question PTSD to go to RAH

ER, aware will be coming."[as

read]

And then it says:

"Escorted by members to

evaluate in ER. If not


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admitted to RTU -- "[as read]

It is return to unit.

" -- as per previous

arrangements."[as read]

Seeing those two notes, do you

have any views as to the effectiveness of the

behaviour management that was undertaken by the

unit?

A. First of all, there is an

increase in acute suicidality, and so the plan is

that if we are worried -- and we have a very low

threshold for being worried, okay -- off he goes to

get assessed again. All right.

And each time it's like it's the

first time. You get reassessed, relooked at by a

fresh set of eyes in case we are missing something.

Right, okay.

One of the things I'd like to run

over here at this point is the notion of borderline

personality traits, borderline personality

disorder, okay.

And what we can see with that is

that it can present a challenge to even experienced

clinicians and it can elicit a lot of feelings in

the clinician as well, including things like


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anxiety, anger, a sense of empathy, frustration;

very difficult people to deal with.

And, for example, when we look at

the criteria for borderline behaviour, and this, to

me, reads classic borderline, okay. We have

problems with abandonment, either perceived or

real. So if the boyfriend or the girlfriend broke

up with the person at that time, okay, boom, they

become suicidal, all right.

Mood instability. So he was -- he

went to the AA group meeting -- or to the Phase 3

AA group meeting, couldn't handle it, became very

agitated, anxious, came back, talked to the people

at the CDU for a bit, calmed down and then, okay

again, right.

Suicidality. Unstable

relationships with people, okay. And that goes

back to who you are dating and that sort of thing.

Impulsivity where you go out and

reach for drugs because that helps calm things

down.

Plus, on top of that, before he

had mentioned that he wanted to be a good soldier,

so then he wanted to go and join Recke(ph)

squadron, and then that didn't work out after,


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what, a couple of weeks.

Anger control difficulties.

Identity disturbance, they don't

know really who they are. So on one hand he wanted

to be out of the military and he hated it, on the

other hand he wanted to be a good soldier, which is

in keeping with everything that he had done up to

that point, right.

And then you can have transient or

stress related problems with dissociation or

feeling kind of out of it as well as a feeling of

emptiness.

And when you look at that, and you

look at what Dr. Turner did here, okay, there is a

flair up in his condition. We don't know exactly

why, okay. It doesn't say, you know, anything in

here specifically about, you know --

Q. His narrative is that it was

the work, that he was being thrown in the deep end

and that he wasn't ready to work.

A. Right, yeah, but we also know

from other sources, right, that it was about this

time where the girlfriend was saying 'I am done',

right. So.

Q. I don't think so.


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A. No? Okay.

Q. She had said that on a number

of previous occasions.

A. Okay. Okay. So what we do

know about parasuicidal or suicidal behaviour in

this context is that frequently we see it

associated with acute intoxication or substance

use. We also see it with relationship issues with

people, okay --

Q. Let me just interrupt you

because I don't want to mislead you.

There is a note in Captain

Hannah's note that several days previous on the

Friday, the girlfriend had been complaining that he

was harassing her. We do have that note on the

Friday, but that's the last that I am aware of a

mention of the girlfriend.

A. Okay.

In any case, the problem when you

are dealing with a person with this constellation

of difficulties, okay, is, again, what's real,

what's going on, what's the agenda, okay. And, for

example, he would love to go back to Alberta

Hospital because Alberta Hospital was, by

comparison, a bit of a picnic for him, right, and


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he was able to access drugs way easier there than

presumably at what he got at the Strathcona's.

So, you know, when you don't know

exactly what's going on with respect to an

exacerbation of acute suicidality, what Rob did

here, Dr. Turner, sending him to get assessed again

is the way to handle it because there has been some

kind of an interval change.

Q. Did the course of Corporal

Langridge's conduct following discharge from the

Alberta Hospital up to this point where he was

readmitted to the Royal Alex, does that surprise

you?

A. No, no. With this difficulty

with the mental health problems, plus a personally

disorder, plus active addiction going on, the rule

is chaos, not the exception.

Q. I haven't asked you to turn

to your own final note dated April 8, 2008. I have

got it in the small book at page 8. I don't think

I have marked the page in the large book but it's

there as well. Page 47 in the large book.

One reason I haven't referred you

to it is because I think you have covered most of

the discussion and the conclusions.


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The only question I'd ask you is

about the diagnosis, and I understand you also

testified at the BOI, the Board of Inquiry that was

called?

A. Yes.

Q. And I think this may have

come up there as well.

Under your diagnosis, generalized

anxiety disorder, major depressive disorder, most

likely not PTSD although there did seem to be an

increase in substance abuse pattern following his

return from Afghanistan.

Now the issue of PTSD is raised

here. Is that because of the original purpose of

the note for Veterans Affairs or because that was

an important part of your diagnosis?

A. It had implications for VAC,

but I don't go around doing my stuff trying to

please them, you know what I mean. Like, it would

have been part of the decision-making process, and

certainly it had potential implications for

dealings with VAC. But I went back and I even went

to the point afterwards, a lot of the other -- not

a lot, but numerous other people who were in the AA

Phase 3 group also came to see me, okay, and they


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were all affected by this. They were mad, they

were upset, they were sad, they were flared up for

weeks if not a couple of months after this all went

down, and I asked them, 'look, you know, like is

there something that I might have missed here?

Okay, did you guys see a really good change with

him?' Because these people live together, sleep

together. They are closer in many instances like

husband and spouse, husband and wife. And they

said, 'no, there were problems before going

overseas'.

Q. How would they know that?

A. Because they are close, and

it doesn't necessarily have to go up the chain of

command or turn into a disciplinary problem. And in

terms of the credibility of some of these people, a

number of them have PTSD, all of them do have

addiction difficulties as well. And I asked them,

'was there anything that you guys saw?'. And I was

going above and beyond what I would normally do

just in case I had missed something. And, yes,

there was some degree of increased drinking and

drugging after he came back from Afghanistan but it

was also there before Afghanistan.

Q. That's what I am struggling


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with, because he would not have been going to AA

meetings before he went to Afghanistan?

A. No. But some of the soldiers

in the AA meetings were from the Strathcona's and

knew him from work.

Q. Okay. One of the other

reasons that I was struggling with this particular

part of your report was that we have seen in other

parts of the medical record, Corporal Langridge, if

he is to be believed, saying that he found it

impossible to open up at the AA meetings, that he

was being asked to talk about things that he was

unwilling to talk about?

A. Yes. He did not participate

fully, I agree with that.

Q. Now we have in the small book

a -- I think it's the last tab, questions that were

asked of you at the BOI.

Small book, Tab 2. Now we are not

supposed to talk about the actual testimony of the

BOI, so I can only ask you: Were there other

topics that you discussed other than the ones that

are mentioned in these questions that you were

given before the BOI?

A. No.


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Q. And did you have an occasion

to discuss the BOI or the issues that the BOI was

concerned about with Major Parley(ph) or any other

person in charge of the BOI?

A. At the BOI, yes.

Q. No, before the BOI.

A. Before the BOI... I had

spoken with the major conducting it to see if I

could find an e-mail trail, because we had talked

about him on the phone. But I went looking for

that and wasn't able to find it.

So it had been phone

conversations.

Q. But there was some

conversation where you helped the major to

understand certain things that he would need at the

BOI?

A. Yes.

MR. FREIMAN: Okay. I think you

have been very patient with me, and I think I have

probably exhausted my meager store of understanding

about this matter. So thank you very much for

assisting us, I expect that my friends will have

some questions for you as well.

THE CHAIRPERSON: Colonel Drapeau.


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COLONEL DRAPEAU: Mr. Chair.


Q. Good afternoon, Dr. Elwell.

I have a few questions for you.

When Stuart came to see you on the

15th of November, came to see you, according to

your testimony, for VAC benefits or Veterans

Affairs Canada benefits, and the treatment?

A. Yes.

Q. That's your understanding of

it.

But in, and we can go back to Tab

1, but throughout the notes that you took of that

meeting particular meeting, I note, and I don't

think this was covered by my friend, but Stuart

raised the issue of nightmares not only once but he

raised it on three separate occasions. I am is

trying just to locate you here.

A. Yes.

Q. Not only did he raise the

issue of nightmares, but he raised the issue of

nightmares that, I think you used this word, it

happened, it has been happening for years, and he

has them on a regular basis.

Were you able to determine what


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the cause of these nightmares or what the subject

matters of these nightmares were? If you turn to

page 5, you see "still nightmares" "every night" he

says.

A. And the content of the

nightmares, right, underneath that on page 5 was

some of this is work, no particular incidents, and

normal life stuff in the nightmares.

And typically with military

induced post-traumatic stress disorder the

nightmare is the same one or variations on a theme,

and it is usually very intimately associated with a

particular Criterion A traumatic type incident.

Q. And if you turn to the next

two pages, page 7, he comes back to that again.

And if I am reading this correctly, you prescribe

him some Seroquel; is that right?

A. No. He had been on Seroquel

already, and I went with Neurontin because it works

for erasing the nightmares.

Q. And he comes back again to

the issue of nightmares, or at least in your notes.

I have difficulty reading it, but maybe could you

help me here?

A. Sure.


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Q. The first word starts with

"maybe" --

THE CHAIRPERSON: What page are

you on, Colonel?

COLONEL DRAPEAU; I am on page 7,

they are not numbered. The second last page of the

notes.

THE WITNESS: "Maybe more vivid

now nightmares".

BY COLONEL DRAPEAU:

Q. Nightmares. So clearly that

was an issue with him.

Have you formed an opinion then or

now as to what the cause or what the symptoms, in

fact, mean something? Is that related say to PTSD

or a form of it?

A. Nightmares are associated

with PTSD. Nightmares are associated with sleep

disorders. Nightmares are associated with

intermittent alcohol abuse. Nightmares are

associated with cocaine. Nightmares are associated

with, unfortunately, Effexor and other medications

sometimes. Nightmares are associated with a bunch

more medical conditions. They don't, in and of

themselves mean, you know, one particular


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diagnosis.

Q. And even if they go back, as

he says here, for years?

A. Yes, even if they go back for

years.

Q. Okay, later on you mentioned

about everybody -- this patient was on everybody's

radar?

A. Yes.

Q. And I think you opine in

there that you don't believe that people within his

circle of care would have transmitted to disclose

or discuss that with anybody outside the healthcare

establishment?

A. We are not supposed to, okay.

You know sometimes things slip out, okay, but for

the most part, everybody I dealt with at the base

was pretty tight-lipped about stuff, we kept it

within the house.

Q. But you cannot vouch for it,

the fact nobody has spoken?

A. No, I can't vouch for other

people. I know about me, I am really careful about

that.

Q. And they would have been


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contact of various sort with unit personnel, all

for a good reason, but --

A. Typically, the people who

talked to the unit are the base surgeon, and the

base drug and alcohol people, the rest of -- and

then the GDMO, when they are setting out a new

medical employment limitation. And then the rest

of the time, we try not to even talk to them just

by virtue of inadvertently slipping up, right.

So there is not a whole lot of

interaction that way. I certainly didn't phone the

Strathcona's, and the only person I eventually

talked to was at the BOI. Major Parley(ph), I

believe, is his name.

Q. Is it possible that, in fact,

Stuart would not only be on the radar of personnel

responsible for his care, but on the radar of

almost anyone on the base and more particularly his

unit?

A. My knowledge was that they

were aware of the early June suicide attempt at the

Strathcona's. But after that, as far as I know, I

mean, I can't speak for them, right, but as far as

I know, that is what they were aware of, and that's

it.


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Q. Well, they would have been

aware of his various absences and admission to the

Alberta Hospital?

A. Usually, what we say when a

person goes away to Alberta Hospital is that they

are going into the hospital. We just leave out the

fact of which one it is.

Now, if they are smart enough to

phone around, they can find that out where he is

at, and if they are doing any kind of unit visits,

which people appreciate because it's supportive,

they might find out about it that way. But,

otherwise, when we are sending someone away to

Edgewood, they would know about that because it

says it right on the leave pass.

Q. But you took word out of my

mouth. Is it not a regimental practice for a unit

when one of its members is in hospital to have

personnel designated to pay a visit, to bring

whatever, chocolates or cigarettes, to maintain

this contact?

A. Typically, yes, that is done,

yes.

Q. As far as you know, was this

done in his unit?


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A. No, I am not sure.

Q. You met and you knew of a

file of Stuart, and given his temperament, which I

presume you made a professional judgment as to the

type of stress he was under and temperament, were

you able to apply this to sending him to his unit

in close supervision under the order, same as

directions, the anticipated reaction this fellow

would have, knowing that he was suicidal, knowing

that he was not exactly a model of discipline at

that time?

A. The intent of the

restrictions was not disciplinary. He was not in

the RSM's bad books. He was in the RSM's good

books, if you will, right, where he is trying to

help us stabilize this guy for X amount of time,

right.

With respect to how he felt about

his unit, again, I refer you to my earlier comments

on borderline personality traits or borderline

personality disorder, where, on the one hand, he

wanted to be a good soldier, on the other hand, he

wanted to get out. So I think that there is a bit

of that tension in him all the time.

And certainly if a person is not


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getting -- an addict is not getting their desired

substance at that point in time, they are going to

start really getting upset with you.

Q. But would you agree with me

that Stuart did not look at this as a beneficial

and something that he wanted to. His frame of mind

at that time going to the unit, he said, 'I would

rather kill myself', was not what we expected

despite all of the good intention of the RSM and

yourself.

So in that position, what you

would as a professional anticipate that is possible

action/reaction condition would be?

A. Send him to the Royal Alex or

to Alberta Hospital for an acute assessment, okay,

and say, okay, is this, you know, something that

needs hospitalization right at the moment or not?

Then if the person's hospitalized, well, then he is

in hospital. Then if they come back to us, what we

had seen before was that he came out of the AA

group, and he was really upset. Sat down, talked to

him for a bit. Ms. Shannon Newing did a lot of

that as well where sat down and talked to him,

worked his way through it, worked through the

difficult emotions, and then he was fine again.


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Q. But you would not have him --

I am trying to put words in your mouth for a

second. You would not have anticipated him to be

doing something to be disciplined and to be

observant of the condition, or did you?

A. I was hoping that he would,

you know. But when a person is actively having

problems, there is a lot of what we call acting out

behaviour where they are upset, they are tearful,

they are feeling abandoned, they are feeling empty,

they are feeling suicidal. It comes and it goes.

It's very transient, and that doesn't mean when a

person is in crisis, that right away you put them

in the hospital. A lot of times, what you can do

is just sit down with them and talk with them, talk

them through the feelings, and then the feeling

passes.

Q. One last question for you,

given your experience, and I could draw your

attention to a tab, if I need to. What does the

word "sick parade" mean to you; what is it?

A. Sick parade?

Q. Sick parade.

A. It is a thing that happens

every morning, and the people who have got a cold


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or a sprained ankle or whatever kind of health

problem come in to see the care delivery unit. It

doesn't necessarily have to be your care delivery

unit. And they take a look at you, figure out,

okay, what are, what's needed to treat you acutely

and then if there are any sick leave or days off as

a result of that.

Q. It's at Tab 22. Am I right

to suggest that sick parade is where an individual

having had a requirement to access to healthcare

are basically required to show up at that

particular time at the health clinic?

A. Yes.

Q. They don't show up at any

time during the day as and when they see fit,

unless emergency?

A. Yeah. If it's an emergency

or even if it's semiurgent, you know, we are not

going to turn people away. But what we try to do

is say, 'Look, if you have this health problem and

you need to go home because you are sick, you come

in, you see us at MIR, medical inspection room, or

sick parade first thing in the morning at eight

o'clock or wherever'.

COLONEL DRAPEAU: That's all the


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questions. Thank you.

THE CHAIRPERSON: Ms. Richards.


Q. Dr. Elwell, I just have a

couple of issues I wanted to go back and clear up

for the record.

And one that you haven't spoken

much about is the issue of medical release from the

military. Am I correct that when you saw Corporal

Langridge, that that would have been another use

that could have been made of your eventual report,

and that was considering his request for a medical

release?

A. Yes.

Q. And can you just discuss from

your perspective as a healthcare practitioner how

the medical release process worked in the military

and what role you played?

A. Okay. What happens is that I

see a person for whatever condition, and if it's a

short-term condition that's going to get resolved

pretty quickly, I write back to the CDU that, you

know, 'We should be able to fix this up quick.

This is my diagnosis. This is my treatment'. Then

the CDU makes employment limitation recommendations


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or restrictions, and then the person is monitored

by myself and by the CDU, the care delivery unit,

to see how they are progressing with this.

A number of months pass, and it's

looking now like the condition is more permanent,

okay, at which point in time I pass that along in

one of my letter, written correspondence to CDU to

say that this is looking like it needs to be a

temporary medical category, which is what we

normally do for six months. So that then goes to

the unit, and it also goes to Directorate --

DMCARM, which is Directorate Military Careers

something. Sorry, I can't remember. I just always

called it DMCARM. Anyway, a place in Ottawa where

they review the temporary category and they say,

'Okay, yeah, this person can't do what he is

supposed to do as a result of his military

occupation for the next six months'. Fine, they

approve it, and we continue to treat the person,

hoping that they are going to get better and return

to full duties, right.

So then we have, the person

doesn't get better. We then have a second

temporary category of another six months. Again,

it goes off to DMCARM, and then it also goes to D


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Med Pol, which is another place in Ottawa. And at

this point in time, it's looking like the person

won't be coming back to their full duties. And

then it's a determination of, can we put them into

another job in the military somewhere, or do they

fail what we call the universality of service?

So universality of service is a

notion that you can step in and do your job in the

Canadian Forces and be deployed overseas or go to

fight the forest fires in BC or whatever as related

to your occupation or any other occupation, and can

you physically and mentally handle that.

And by the time the second

temporary category comes around and this question

starts coming up, and if the person has such an

aversive psychological reaction to any kind of a

uniform, then at that point in time, it's like,

look, he can't even stand being around people in

uniform, so realistically the chances of him

continuing in the forces are very slim. And then

we make a recommendation of a permanent medical

category, and they fail universality of service,

and then they get released medically. So this has

nothing to do with the VAC or VAC benefits. This

has to do with the Canadian Forces, and it's known


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as a paragraph 3 release. And then you get

different benefits than if it's an administrative

or disciplinary release.

Q. And so is it fair to say that

if you get a medical release, the benefits are

increased?

A. Yes.

Q. And so we have heard

testimony from Dr. Hannah that this -- pardon,

Major Hannah, that this process could take upwards

of two years or more?

A. Yes.

Q. In the record, we see

repeated references to Corporal Langridge asking

for a medical discharge. And I just want it to be

clear, can a member of the Canadian Forces get a

medical discharge just by asking for it?

A. Typically, if all they ask

for it, eventually they would get an administrative

one or, at the end of their contract, they would be

released, right.

But if they have some degree of

medical symptomatology, then yes, in due course,

you would eventually wind up being medically

released.


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Q. With a medical opinion to

back it up?

A. Yes.

Q. And do you recall, had you

discussed with Corporal Langridge the length of

time that the medical release process would take?

A. I know for sure we talked

about the VAC one because that came up really early

and, ordinarily, I would also indicate that medical

releases take time as well.

But I checked through my

handwritten notes of that meeting, and I did not

specifically say anything in it about T Cat or P

Cat, which are, you know, the kind of conversation

that we would have had about that.

But surely, along the way, that

would have come up at some conversation with

somebody because he was seeing lots of medical

appointments, right, and that's usually one of the

prerequisites towards heading down that road.

Q. Okay. And I see in your

notes you do have a reference. You don't need to

turn it up, but you have a reference "get out of

the forces", and then he says "unsure".

Do you recall whether or not


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Corporal Langridge was aware or discussed with you

the ability for him to get out voluntarily other

than through a medical release?

A. I can't see how anybody would

be unaware of that, okay. Yes, you have signed a

contract, but it's very much a voluntary outfit.

You haven't been drafted. It's not, you know, the

Russians-coming-over-the-Pole kind of a war. We

don't want people who don't want to be there. And

eventually, he would have gotten out of the forces.

It may have taken some time, but he would have

gotten out.

Q. One of the other just

administrative issues I wanted to go back to was

the issue of an SPHL, which I understand is a

special patients holding list?

A. Yes.

Q. And Ms. Newing referred to

that yesterday, but she wasn't able to give us much

information about what that was or how that process

worked.

A. So when a person's employed

at the Strathcona's, they have an establishment

number so that they are slotted into a particular

pigeon hole at the regiment. And they are supposed


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to be employed as whatever that pigeon hole says

they are employed at, okay. Now, if you have 20

corporals and you are supposed to be able to do all

this operational stuff with those 20 corporals, if

you have 3 of them out because of mental health

problems, 2 of them out because of a broken leg or

whatever, all of a sudden you don't have 20

corporals anymore. You have got 10 or 15, okay.

And the unit doesn't want that, right, because that

constrains their ability to do what they are

supposed to do, okay, so that they will keep the

person on their unit in their establishment for at

least the first two temporary categories, so six

months each, right, at which point in time, it's

like, 'Okay. Is this guy coming back to work or

not? If they are not, okay, we need to put them

into a different part of the establishment so we

can get some fresh bodies posted in'. So the

holding area for a person who is not completely out

of the forces but no longer is able to do their job

at the Strathcona's is the SPHL, which is a base

mailroom, if you will, that the person's

establishment goes into there, and that is where

they are attached to. And they have a warrant

officer to report to a captain, some clerks to help


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them with administration and to help them with the

release proceeding, retraining, blah, blah, blah,

blah, that the unit isn't necessarily able to do.

Q. And do you know, was that an

option for Corporal Langridge or anything that was

discussed with the treating team?

A. He was only at the first

temporary category stage, so it would have probably

come up during the T Cat interview because the

doctor doing the temporary category interview is

supposed to sit down with the person and tell them

all of the career implications at that point in

time.

Certainly I think it was common

knowledge amongst people who have been in for a

while, a brand-new recruit or a brand-new private,

probably not, but somebody that's been in for a

while, should have at least heard about it, and he

should have been told about it at that time when he

signed the temporary category.

Q. And just one in the area of

general questions, you have spoken a little bit

about post-traumatic stress disorder. I am just

wondering if you can tell us, what was your

experience in that ten years that you were in the


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military with treating post-traumatic stress, and

how would that compare to psychiatrists in the

civilian world?

A. I have seen too much for a

lifetime, so it's -- I am glad I am out of it.

It's awful, you know. And, you know, umm, we

treated hundreds of people and, unfortunately, in

the business that we are in, we get to hear a lot

of nasty stuff. And I have done lots. I have done

enough.

Q. And in your experience in

those years, was the military open to treating PTSD

and open to diagnosing PTSD?

A. Yes. We had a very steep

learning curve coming out of the African campaigns,

so Rwanda, Somalia, and certainly the first couple

of tours into the former Yugoslavia republic. But

after that, you know, what we were doing was for

certainly cutting edge kind of stuff.

Excuse me a second.

And, you know, certainly we were

attempting to follow all of the best practices, not

just within Canada but worldwide. A number of the

people there in Edmonton had gone to a lot of the

ISSIS meetings, which is a specialty society for


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the treatment of trauma.

We were certainly cutting edge in

Edmonton at the time and, you know, there is a lot

of, a lot of people that came through, and we

treated a lot of them. And recognizing that large

bureaucratic organizations don't always move the

best way and that there were some frustrations in

the job, I still think that we did a pretty darn

good job.

Q. Now, if I could take you back

to March 4th, March 5th, 2008, the issue about when

Corporal Langridge left the Alberta Hospital and

came back to the base.

A. Yes.

Q. We have heard language or

seen language that Corporal Langridge was ordered

out of the hospital by the Canadian Forces. I

wonder if you have any view on that.

A. I wouldn't use the term

"ordered". If -- the term I would use is that he

no longer met the requirements to be in hospital,

okay, so that he was suitable for outpatient

management and, at that point in time, then came

back on to our radar as part of the outpatient

management.


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You know, and then in terms of

being ordered to report to be assessed for

outpatient treatment, well, we were technically on

the hook to watch after him, right. So I think

saying you will come in and see Dr. Rajoo and/or

his designate, right, or Dr. Hannah, I think that's

reasonable to say, yes, you are going to come to a

doctor's appointment because it's necessary.

You know, if he "ordered", I think

that's too strong a word.

Q. And you were asked some

questions by Commission counsel about the drug

testing after he was released on March 5th --

A. Yes.

Q. -- and whether there had been

follow-up drug testing?

And you were taken to the note on

March 7th, where Dennis Strilchuk said, basically

threw up his hands and said he is completely

non-compliant with the restrictions that are being

imposed by BAC?

A. Right.

Q. Is it possible that the P

testing was part of those restrictions that he was

not compliant with?


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A. Yes, that's possible.

Q. And is it fair to say, it may

be obvious, pardon me, but you can't force

somebody, you couldn't force somebody to give a

urine test?

A. No, you can't.

Q. One of the questions that

Commission counsel was asking you towards the end

was whether or not you felt the restrictions that

were put in place or the plan that had been set up

was effective in stopping Corporal Langridge from

accessing drugs. And I am just wondering from your

perspective as the -- working in the base in the

medical community, what options did you have at

that time in terms of restricting Corporal

Langridge's access to drugs?

A. Well, part of the problem was

that Alberta Hospital, he was getting ready access

to it. That was our understanding. Basically, we

wanted to make it very inconvenient for him to

access drugs or to go out and get drugs. So by

showing up to work all the time, having to sign in,

having to be in the duty centre, having to sleep

there, we were doing what we could in the civilian

world after a person had been released from Alberta


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Hospital. They would be either sent home or sent

-- well, sent home to wherever they lived, right,

and then whenever their slot in the addiction

treatment place came open, then they would go

there. And then in between leaving Alberta

Hospital and going to Homewood or Edgewood or

wherever, they would be left to their own devices.

And, you know, who knows what kind of consequences;

right? So what we were trying to do there was give

him every opportunity to try and stay away from the

drugs and the alcohol and then get him into the

treatment program.

Q. And is it fair to say that

there still had to be an element of cooperation on

his part to effect that; you couldn't force it on

him?

A. Yes. And I think it speaks

volumes that both Don Perkins and Dennis Strilchuk

wound up firing him, or he fired them. They have

been involved with addictions treatment for years,

Donny decades, and they are used to those kinds of

games going on when a person is actively still

drugging or drinking. And, you know, for him to

have been fired by both, that says the amount of

help seeking, help rejecting.


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Q. And another question that

Commission counsel had asked you, if you could just

turn up Tab 1, in the big book. And this is the

issue of what was going on between March 5th and

March 7th, 2008, and Commission counsel put to you

that Corporal Langridge could have been on his own

between March 5th and March 7th to try to maintain

his own sobriety without any assistance, is what I

understood his question to you to be.

If I could just get you to look at

the first page, it appears to me that Corporal

Langridge actually had scheduled appointments with

BAC or with the mental health unit on March 5th,

March 6th and two on March 7th?

A. Yes, yes.

Q. So am I correct that part of

the plan that you had contemplated and discussed

with the base surgeon included Corporal Langridge

attending these various addiction programs that

were available to him at the base?

A. Yes.

Q. And it was your hope that

that would help him in maintaining his sobriety --

A. Yes.

Q. -- after his release?


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And, finally, and I think you have

probably answered this, but I just wanted to ask

you more directly. You have looked back over it

now: Do you have any concerns about the medical

treatment that was offered to Corporal Langridge?

A. The problem with looking back

in medicine is that, you know, you can always go

what if, what if, what if, and then you can drive

yourself crazy thinking about it.

And at the end of the day, it's

supposed to be, okay, is this of an acceptable

community standard? Like not just, you know, and

using retrospection, it's, you know, your vision is

always 20/20, right, like I could have done this

differently or that different. And, believe me, as

I have been preparing for this thing, you know, I

have asked myself that question.

And I really don't think so. I

think we went to the wall for him. We did what we

could. And just, the unfortunate fact of the

matter is, is that people with mental health

conditions sometimes kill themselves, and people

with addictions sometimes kill themselves, and

that's the reality of the beast.



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much. Those are all my questions.

THE CHAIRPERSON: Clarification

questions?

MR. FREIMAN: Just a couple of

very brief ones.

RE-EXAMINATION BY MR. FREIMAN:

Q. When my colleague asked you

about medical release, I think I heard you say that

one potential consequence of a repeated request for

medical release would be to speed up the

administrative release process. Did I hear that

correctly?

A. No, because the

administrative process is usually followed through

staff through the unit, okay. The medical release

is partially staffed through the unit but mostly

staffed through medical side and -- sorry, I lost

my train of thought there.

It doesn't necessarily follow that

and, typically, what happens is that if we are

already part of the way through a medical process,

we will let the unit know that. And if there is a

pending 5, a disciplinary one, they will say, 'Oh,

okay. The guy is wounded, or he is hurt medically.

Okay. We will back off', and that the 5 one will


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be cast into the wastepaper basket, and that we

will pursue the 3, paragraph 31.

Q. Just then to ask the question

directly, to your understanding, was the issue of

an administrative release in the air or in the

cards about the same time in the winter and spring

of 2008?

A. When they do this, this kind

of a referral over to BAC, okay, BAC would sit down

with the person and say, 'Hey, listen, if you work

with us, and we are pretty patient people, then

you'll go out, worst-case scenario through the

medical route, okay. If you are non-compliant and

repeatedly non-compliant with treatment, then there

is the potential that you will get fired or a

paragraph-5 type of release'.

Q. I guess what I am asking is

not just hypothetical situation, but were you aware

of any, let's call it chatter, about an

administrative process with respect to Corporal

Langridge?

A. No.

Q. Thank you.

Now, one of the other things you

have told my friend was that at the end of Corporal


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Langridge's stay at the Alberta Hospital, he no

longer met the criteria for a hospital stay. Now --

A. For certification.

Q. For certification, oh, yes.

But because I was going to ask

you, Dr. Sowa expressed the view that he would like

him to stay?

A. Yes.

Q. So someone was overruling Dr.

Sowa's opinion of what would be best for Corporal

Langridge?

A. Certainly when the person

first comes into hospital and is really mentally

ill and is certified, okay, we are not going to let

them go out of hospital even if everything is

supposedly hunky-dory, right.

Q. You don't have a choice; do

you?

A. Sorry?

Q. You don't have a choice; do

you?

A. Right, right.

And then we have the two

certificates. So two independent psychiatrists

have come in and seen this person and said, 'Yes,


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there is a mental health problem here. Yes, he is

a reasonable danger to himself or to others by

virtue of his mental health condition and, as a

result, he gets to stay as a guest at a hospital,

Alberta Hospital typically'.

Now, there is a lot of pressure on

the psychiatrists there to keep people moving

through, okay. And towards the end of a stay, so

you can let the certificate lapse at the end of the

30 days. You can discharge them before the end of

the 30 days. And as the attending physician, i.e.,

Dr. Sowa, okay, it's their call. So if they have a

worry about it, and they can even go and recertify

him two hours before he is due to go out if they

are really worried about him, right, and let's say

he is lying potentially about not being suicidal,

and they can recertify him and then keep him in.

The -- when we are talking about

the last couple of days in psychiatry ward, the

majority of the treatment has been done, and if you

keep them in there too long, you can make things

worse, okay.

And so you are always wanting to

be kind and compassionate, and Dr. Sowa is very

compassionate. So it would be nice to keep them in


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a couple of days longer because you are getting

fed, you don't have any responsibilities, you know,

you get to go to groups and do kind of fun stuff or

work on projects or whatever. It's pretty low

stress in a psychiatric ward for obvious reasons,

and so it's nice, then, sometimes to keep people in

for, let's say, one more weekend or whatever,

right.

Where --

Q. But just to be clear, Dr.

Sowa was saying that he was willing to keep

Corporal Langridge in until a bed was available for

him at Edgewood or Homewood?

A. And on top of that, the

person was actively still misusing drugs, right.

Q. There is, I am just -- in

fairness, there were suspicions in the notes, but

the last drug test that Corporal Langridge gave

under supervision came back clean.

MS. RICHARDS: Sorry, that's not

what the records show. There is one test that said

clean and one that said positive for cocaine.

THE CHAIRPERSON: That's the one

for March 4th?

MS. RICHARDS: Yes.


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THE CHAIRPERSON: I am unclear as

to what that says. It does say --

MS. RICHARDS: It says both.

THE WITNESS: It says both.

MS. RICHARDS: Yes, yes.

MR. HEELAN: Can I just interrupt

for a moment. I hate to interrupt, but we are sort

of jumping into having Dr. Elwell comment on what

Dr. Sowa said. The Commission heard what Dr. Sowa

said, and I just really wonder about the utility of

this line of questioning and whether it's really

useful for the Commission.

MR. FREIMAN: The fact I am trying

to establish, Mr. Chairman, is one that I started

with as to whether there was an overruling as it

were of Dr. Sowa's suggested treatment.

MR. HEELAN: Well, I think, in

fairness, Dr. Sowa indicated a willingness to keep

the corporal in, but he also expressed an

acceptance that he had struggled with dealing with

the control of the drugs, and he also indicated

that he was comfortable with the transfer to the

Garrison. So I don't think that this has been

fairly put to Dr. Elwell, so if we are going to go

further with this, I think it should be more


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contextualized.

MR. FREIMAN: That's not my

recollection of what Dr. Sowa said, but I will let

it drop because there really is no purpose. At the

end of the day, the facts will be what the facts

are, and the record will be what the record says.

THE CHAIRPERSON: I think Dr. Sowa

did make some indication that if they could handle

him better than we have, then basically good for

them. That's kind of what I drew out of it, and I

think Dr. Sowa did say that.

BY MR. FREIMAN:

Q. So I just wanted to ask one

last question, then, in terms of what was available

to you as a control measure versus what was

available at the Alberta Hospital. Is it true that

the Alberta Hospital had the added resource that

you didn't of a locked ward?

A. I don't know what unit he was

on. Do you know the number? Like --

Q. How would we find it? I don't

see that. I think it was 64. I know a 64, but

that may have been the Royal Alex.

A. That would have been 54, and

that is the Royal Alex. Umm... 54 is locked.


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Depending on where you are in Alberta Hospital, it

could be locked or unlocked.

Q. Okay. I will let that go,

then.

THE CHAIRPERSON: Okay. Thank you.

Colonel Drapeau, you okay?

Ms. Richards?

THE CHAIRPERSON: Doctor, that

concludes the questions for today, and my

understanding is you won't be required for further,

at this stage anyways. I want to thank you for

your testimony. Your experiences are quite

apparent. You know, when you see the kind of

emotion, we don't -- I don't take that as a, how

can I put it, as a sign of weakness but one of

experience and knowledge, so thank you.

I believe that concludes for

today. There is nothing further. Then we will

adjourn until 9:30 tomorrow morning. Thank you.

--- Whereupon proceedings adjourned at 4:26 p.m.,

to be resumed on Thursday, April 5, 2012,

at 9:30 a.m.


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I HEREBY CERTIFY THAT the foregoing is an accurate

transcription of my stenographic notes made herein,

to the best of my skill and ability.

Lisa Lamberti, CSR, RPR


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