Robert Card’s Army Reserve superiors did not necessarily have to follow the same protocol for follow-up care as those who supervise active-duty military personnel, a U.S. Army mental health expert told the Lewiston shooting commission on Thursday.

But Col. Mark Ochoa, a doctor stationed at Fort Liberty in North Carolina (formerly Fort Bragg) involved in the Army’s psychological health program, also acknowledged under questioning that Card’s commanders ultimately had the responsibility for ensuring that he was being treated properly.

The commission investigating the Lewiston mass shooting, listens to testimony from Cara Cookson, a victim witness advocate from the attorney general’s office, on the six month anniversary of the killings. Derek Davis/Staff Photographer

“We are there to help commanders the best we can,” he said. “I don’t like to think they are on their own.”

Card, who shot and killed 18 people at two locations in Lewiston on Oct. 25, had been struggling with his mental health for many months. In July, he was admitted to a psychiatric hospital in New York at the urging of his Army Reserve officers, but he was discharged after two weeks and his own supervisor, Capt. Jeremy Reamer, acknowledged to commission members in April that not enough was done to ensure Card was getting follow-up care.

Ochoa was the only participant in Thursday’s commission meeting, the latest in a series of public sessions with the goal of investigating the deadliest shooting in state history.

Prior commission meetings have featured testimony from police officers involved in investigating Card’s behavior before the shooting, fellow members of Card’s Saco-based Army Reserve unit, family members of victims and, more recently, members of Card’s family.

Some of the testimony, from those who watched Card’s mental health deteriorate leading up to Maine’s worst mass shooting, has been heart-wrenching.

Ochoa was not directly involved in Card’s care, and he was not asked questions about Card. Instead, he was asked to explain more broadly how the Army provides mental health resources and referrals for its members. He acknowledged there can be gaps in communication between the Army’s psychological health program and specific units and members.

“We only know what we know,” he said on more than one occasion.

Ochoa also explained that there are differences in how active-duty members and reservists are treated. The biggest challenge, he said, in bringing mental health care to reservists is that they are mostly part-time volunteer soldiers who scatter when not training together.

Commission member Debra Baeder, former chief forensic psychologist for the state of Maine, asked Ochoa if the army’s psychological program had any ability to mandate that a reservist get treatment.

“No, not for reservists,” he said. That would have to come from commanders.

Baeder also asked Ochoa if there are concerns among reserve officers and their supervisors about making mental health referrals because it might create a negative profile for specific members.

“Of course, that hinders people,” he said, before adding, “but a medical condition should be treated as such.”

Member Paula Silsby, a former federal prosecutor, tried to get Ochoa to say what should be done in various situations where Army members need mental health care, but Ochoa said each situation is different.

“Right, but (a supervisor’s) responsibility is to manage an issue involving those under his or her command,” Silsby said.

“Yes, commanders are the authority,” Ochoa replied.

An interim report issued in March concluded that law enforcement failed to take Card into protective custody and seize his firearms in the weeks before the mass shooting.

The 30-page report called a Sagadahoc County Sheriff’s Office deputy’s failure to take Card into custody in mid-September “an abdication of law enforcement’s responsibility.”

One officer who was singled out, Sagadahoc Sheriff’s Sgt. Aaron Skolfield, has since disputed aspects of that interim report as “inaccurate and extremely misleading,” and attempted to shift responsibility to Card’s Army colleagues. Skolfield is now running for sheriff this year.

Commission members have not spared Army officials from blame, though, and Thursday’s meeting hinted at some of that.

Ochoa repeatedly responded to questions that reservists simply don’t have the same access to services, and if or when they receive care in a civilian setting, that’s not always communicated back to military personnel.

Reamer, Card’s supervisor, already has acknowledged that he could have done more to ensure Card was getting help following his release from the hospital last summer.

But Reamer still shifted blame elsewhere.

“You can lead a horse to water, but you can’t make him drink it,” he said during an April meeting. “Ultimately, his mental health comes down to him.”

Commission members are expected to keep meeting and have yet to set a firm deadline for completing their work.