As a weeping Mr. Chau was removed from a Toronto courtroom to begin an indefinite stay in Whitby Mental Health Centre, hard questions about the medical system's failure to prevent the tragedy took centre stage.

Crown and defence lawyers pointed straight at Mr. Chau's family doctor - Edmond Lo - who kept his patient on a low dosage of his monthly medication, and said after the killings that he cannot, as part of his job, be expected to keep tabs on even seriously ill mental patients.

"He never followed up to see if Mr. Chau was taking his medication," defence lawyer Peter Lindsay said in an interview. "He never booked another appointment."

Mr. Lindsay said that Mr. Chau apparently failed to show up for his regular monthly injection in January, 2006, weeks before the killings. The tragedy might have been averted had there been a mechanism in place in Dr. Lo's office to follow up on him - and had Dr. Lo probed the paranoid hallucinations his patient was experiencing, Mr. Lindsay said.

"There were clear warning signs that something was wrong," he said.

In a joint submission yesterday to Ontario Superior Court Judge David McCombs, Mr. Lindsay, and prosecutors Phil Kotanen and Kim Motyl said that Mr. Chau's 18-year history of hallucinations, paranoia and bizarre behaviour worsened considerably in late 2005.

His monthly injections of Piportil were losing their effectiveness, they added.

"Mr. Chau saw his family doctor, Dr. Edmond Lo, several times in the fall of 2005, reporting symptoms consistent with a breakthrough of his schizophrenia," the statement said. "These could have been addressed by increasing his dosage, administering it more frequently, or changing medications. None of these steps were taken, however."

Cogent and occasionally animated in the interview yesterday, Mr. Chau - a native of Vietnam who immigrated to Canada in 1981 - repeatedly referred to the attack on his family as "the accident." He said that he had depended on doctors to keep his symptoms under control, and they failed him.

"It was because of my medication," Mr. Chau said. "I lost my control."

He added that he looks forward to being released in the near future: "Now, I am very well," he said. "I am getting injections."

By the terms of an order issued by Judge McCombs, Mr. Chau - who was deemed not criminally responsible - will be assessed by the Ontario Review Board within 45 days and every year thereafter. He can be released only if the board determines that he no longer presents a threat to the community.

At the time of the tragedy, the Chau family was subsisting mainly on donations from relatives. Ms. Liang, who was working in a dim sum restaurant when she met Mr. Chau five years ago, had become primarily a dedicated stay-at-home mother.

Jenny Chu, one of Mr. Chau's eight siblings, said in an interview yesterday that she lodged a complaint soon after the killings against Dr. Lo with the Ontario College of Physicians and Surgeons. She said that she intends to file a second complaint against Mr. Chau's long-time psychiatrist.

Ms. Chu said that her brother showed unmistakable signs of growing problems in late 2006. Family members soon became "100 per cent" certain that Mr. Chau would end up going berserk, she said.

He refused to go near his son and began to irrationally boil water, Ms. Chu said. Mr. Chau also shaved his hair as a form of spiritual cleansing, destroyed Buddhist shrines at his sister's home and his own, cut up his children's clothes and photographs of them, and repeatedly threw the contents of his home outside.

At the same time, Mr. Chau also appeared to have periods in which he recognized that he was ill and might even present a danger. A sense of this came across when he placed a 911 call to police after the killings, describing himself as "crazy."

In a psychiatric report filed with the court yesterday, Ms. Chu said that she had accompanied her brother on Jan. 6, 2006, to visit a psychiatrist who was treating him, Dr. Hung Tat Lo.

Even though Mr. Chau was saying that "the devil was telling him to kill the family," she said that the psychiatrist was unwilling to try to have him committed to a hospital: "He told me to stop talking," she added. "He was rude."

According to transcripts from Mr. Chau's preliminary inquiry, Dr. Lo, the family doctor, said that during the final appointments, he failed to ask Mr. Chau whether he was suffering from delusions.

Dr. Lo conceded that he ought to have sought more information from Mr. Chau's psychiatrist.

"Do you have any excuse why you didn't?" Mr. Lindsay asked in cross-examination.

"No," Dr. Lo replied.

Chi-Kun Shi, a lawyer who is helping the family, said that Ms. Liang had another young son from a previous relationship who was not at home on the day of the killings.

She said that soon after the tragedy the boy and his grandmother disappeared. Relatives have been unable to locate them to give the boy $40,000 donated by the Chinese community.

Ms. Chu said that her extended family has been in shock since the killings. "My hands shake," she said. "I can't sleep. I'm still under care by a psychiatrist."

She said that her children have never been told the truth about what happened; they believe that their cousins died in an accident.

In light of her family's tragedy, Ms. Chu said that health authorities should carefully reconsider how potentially dangerous patients are assessed and handled.

Source