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A Perth health worker revealed to WA Today and 9News that Mark Bombara had a cyst on his brain when he drove to Floreat a week ago and murdered a mother and daughter.
While looking for his ex-wife, he shot dead her friend Jennifer Petelczyc and her daughter, Gretl, before turning the gun on himself.
"Ultimately, this man from looking at his current health condition had a very compromised and vulnerable brain," the health worker said.
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Speaking on the condition of anonymity, the health professional says Mark Bombara's family had raised concerns about his behaviour escalating.
"Hospital staff had also noticed in the ward, him being irritated and agitated and not displaying the normal behaviour you would see on a ward," they said.
They also revealed medical staff recommended the 63-year-old's driving licence be suspended on medical grounds.
The health worker also called for better information sharing between government agencies about gun ownership, saying health professionals should also be able to make recommendations to suspend a person's firearm licence where they hold concerns.
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"We don't know if someone's got 13 guns at home, no one tells us that," they said.
"It's only if someone offers that information that we can actually then take that into our assessment.
"If we can get back to mandatory reporting about driving a car, we should include mandatory reporting regarding medical clearance for a gun licence and gun posession.
"That is absolutely common sense."
WA's deputy premier said the government is working on building systems to make this possible.
"Our gun reform is very much looking forward to how we can better share information across health and police agencies so we are building systems to get much better information sharing," Rita Saffioti said.
The North Metropolitan Health Service confirmed they treated Bombara just weeks before the shooting.
"Sir Charles Gairdner Hospital treated Mr Bombara in early May for a series of small strokes," they said in a statement.
"While he was in our care … there were no signs of reduced mental capacity, aggression or suicide risk."
The health care worker said it's not just mental health that affects decision making or risk.
"It's our actual health that can actually affect risk as well," they said.
Bombara's daughter Ariel raised her own concerns with police about her father's weapons less than two months before the murders as she and her mum fled the family home.
"The gun reforms being discussed currently are an important step, but it is my unwavering belief that even without his guns, my father would have committed a horrific act of violence which likely would have claimed lives," she said on Tuesday.
All who have spoken out are doing so in the hope of helping change the system.
