When RCMP officers were called for a second time in less than an hour last October to the hospital in Middleton, N.S., they donned body armour in the parking lot and armed themselves with a C8 carbine assault rifle and a Taser.

Inside, patients had fled the emergency room waiting area. It was empty, except for one person: a 60-year-old mentally ill man named Mark Baltzer who had left a .22-calibre rifle stashed in a camouflage case at the door.

The Oct. 3 gun incident and Baltzer's arrest at Soldiers' Memorial Hospital prompted Premier Stephen McNeil to strike a working group on health-care facility safety, which is expected to release a report today.

Report calls for lockdown policies

Through court hearings, records and interviews, CBC News has learned more details of what happened that day.

They include how Baltzer had earlier that evening walked into the same hospital with an arrow and large hunting knife on his belt — but had been deemed psychiatrically fit by an emergency doctor after refusing treatment for an injured foot. He was then escorted out and handed back his weapons.

Nova Scotia Nurses' Union president Janet Hazelton, a member of the safety working group, said in an interview Thursday the group did not delve into the details of the Middleton incident. But she said one of the 12 recommendations to be made Friday is to draw up lockdown policies for health-care facilities.

"They may be able to lock the doors or lock the building, but there's no policies," Hazelton said.

"When to do it, how to do it, who makes the decisions, when is the decision made, what do we do with visitors."

Mark Baltzer twice entered the hospital in Middleton last October with weapons. (Halifax Regional Police)

She said police, for example, have detailed information on the locations of entrances and exits at schools, but know nothing about hospitals.

Not criminally responsible

Baltzer, who has bipolar disorder, has since been declared not criminally responsible for the gun incident. It's at least the third time the courts have made that finding in relation to crimes he's committed.

In fact, he had been granted an absolute discharge from under the authority of the East Coast Forensic Hospital just three weeks before his arrest, following a year living in the community under certain conditions.

He's now back at the forensic hospital, but is allowed out in the community for several hours a day. The Criminal Code Review Board will decide whether he should be released on conditions at a hearing Feb. 7.

Review board chair Peter Lederman said Baltzer is a "highly intelligent person" who successfully runs businesses in the Annapolis Valley, including a Christmas tree farm, when he is well. The issue, he said, is he deteriorates quickly when he stops taking his lithium medication.

The concern of the review board, Lederman said, is Baltzer harbours paranoid delusions of being unjustly treated by police. He has a history of possessing guns and has repeatedly in the past threatened to kill officers, although he's never tried to follow through.

Given the Middleton hospital incident, it may mean the review board will place Baltzer under long-term conditions to ensure he continues with his medication.

The incident last October at Soldiers' Memorial Hospital in Middleton prompted the premier to call for a review of health-care facility security. (Google Maps)

"The last time we gave him an absolute discharge he assured us that he would keep taking it. And he didn't. It's difficult to accept his word on that," Lederman said.

Two visits in one day

Officers who dealt with Baltzer on Oct. 3 were well aware of his history. And police had already received several calls related to him that day. Officers spoke with him, worried he was deteriorating mentally, but noted his disposition at that point was positive.

Police were first called to Soldiers' Memorial around 6:30 p.m. by staff who said Baltzer had entered the hospital with a knife and arrow and was refusing to let security search his duffel bag.

Officers arrived to find Baltzer limping across the parking lot, blood from an injured foot soaking through a hospital slipper. He told police he was in a rush to get to Newfoundland.

ER doctor cleared Baltzer

Baltzer was handed back his knife and arrow. Police spoke with him for about half an hour, found him irrational and talking nonsensically. Officers briefly considered detaining him under the Involuntary Psychiatric Treatment Act, according to a warrant related to the case.

But they balked at the idea because an emergency room doctor at Soldiers' Memorial had just deemed Baltzer mentally fit after he refused treatment for his hurt foot.

Police left, but were called back within minutes. Baltzer was back inside, creating a disturbance. Police found a gun at the entrance in a case meant for a bow. Officers ultimately threatened Baltzer with a Taser and he was arrested.

Officers used 'tremendous restraint'

Dr. Risk Kronfli, a forensic psychiatrist who later assessed Baltzer, credited officers with exercising "tremendous restraint."

Lederman of the review board is more blunt.

"He could have ended up getting shot or something by the police. We had to look out for his own welfare in cases like this."