The opinion
IN THE SUPREME COURT OF NORTH CAROLINA
No. 400A19
18 December 2020
STATE OF NORTH CAROLINA
v.
CAROLYN D. “BONNIE” SIDES
Appeal pursuant to N.C.G.S. § 7A-30(2) from the decision of a divided panel of
the Court of Appeals, 267 N.C. App. 653 (2019), finding no error after appeal from
judgments entered on 16 November 2017 by Judge Beecher R. Gray in Superior
Court, Cabarrus County. Heard in the Supreme Court on 31 August 2020.
Joshua H. Stein, Attorney General, by Keith Clayton, Special Deputy Attorney
General, for the State-appellee.
Glenn Gerding, Appellate Defender, by Wyatt Orsbon, Assistant Appellate
Defender, for defendant-appellant.
Disability Rights North Carolina, by Susan H. Pollitt, Lisa Grafstein, and Luke
Woollard, for Disability Rights North Carolina, North Carolina Psychiatric
Association, and North Carolina Chapter of the National Alliance on Mental
Illness, amici curiae.
DAVIS, Justice.
The defendant in this case attempted suicide one evening after her trial had
recessed for the day and was thereafter involuntarily committed. The trial court
declined to hold a competency hearing and determined that she had voluntarily
waived her constitutional right to be present at her trial as a result of the suicide
attempt. Because we hold that the trial court erred by failing to conduct a competency
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Opinion of the Court
hearing under these circumstances, we reverse the decision of the Court of Appeals
and remand for a new trial.
Factual and Procedural Background
Defendant was charged with four counts of felony embezzlement.1 A jury trial
began in Superior Court, Cabarrus County, on 6 November 2017. The State presented
its case-in-chief the first three days of trial, during which time defendant was present
in the courtroom. On the evening of 8 November 2017, defendant intentionally
ingested 60 one-milligram Xanax tablets—thirty times her prescribed daily dose—in
a suicide attempt at her home. She was found unresponsive and was taken to
Carolinas HealthCare System NorthEast for treatment.
Defendant underwent medical evaluation that night by Dr. Kimberly Stover.
Dr. Stover found that defendant “ha[d] been experiencing worsening depression and
increased thoughts of self-harm” and sought defendant’s immediate involuntary
commitment, checking the box on the petition form stating that defendant was
“mentally ill and dangerous to self or others or mentally ill and in need of treatment
in order to prevent further disability or deterioration that would predictably result in
dangerousness.” Dr. Stover also wrote that defendant “is not stable and for her safety
will need further evaluation.”
1 Prior to trial, one of the counts was dismissed by the State.
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A magistrate found reasonable grounds to believe defendant required
involuntary commitment and signed a commitment order, which provided for an
initial period of commitment of twenty-four hours beginning on the morning of
9 November 2017. A separate evaluation was conducted later that day by a
psychiatrist, Dr. Rebecca Silver, after which Dr. Silver noted that defendant “remains
suicidal even today. She is not safe for treatment in the community and requires
inpatient stabilization.”
That morning, the trial court was informed of defendant’s suicide attempt and
hospitalization. The trial court told the attorneys that it would try to “salvage” the
day “without committing an error that’d be reversible.” Defense counsel responded
that a decision to proceed without defendant could not be made “without more
information.” The following exchange then transpired:
THE COURT: It might be useful to have her record for the
last two years or something from the hospital if she has a
record of depression and treatment and all that, but that
would probably—we’d get to some point where we start to
need a medical expert to interpret—
[DEFENSE COUNSEL]: Yeah.
THE COURT: —what all that means.
Defense counsel informed the trial court that he had “been advised that
[defendant] ha[d] a number of medical conditions by her and her family” and offered
to attempt to obtain more information from her doctors. The trial court asked the
State whether it was “aware of any case law that would give us some guidance on
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whether this constitutes a voluntary absence or an involuntary [absence].” After the
State responded that it had not looked into the issue, the trial court stated as follows:
But I think we plan to be back here Monday depending on
what her situation is maybe and whether this—this
absence, if we find out that this would constitute a
voluntary absence, we’d probably go right on through
Monday if it’s clear.
....
. . . If it’s questionable, that would be something
else, and we don’t know if she could show up here Monday
or not at this point.
Defense counsel once again offered to seek additional information about her
medical status and to conduct research on the issue of whether her absence should be
deemed voluntary. The trial court characterized the information received up to that
point—which was limited to the involuntary commitment documents—as “a bare-
bones examination, clear description of findings about two sentences, and that’s it.”
The trial court added that “[i]t takes more in depth when you get into the mental
aspect, a lot more in depth.” The State had prepared a draft order compelling
production of certain portions of defendant’s medical records to assist the trial court
in determining how to proceed. Referencing that draft order, the State stated the
following:
But I’d assume, if that order were signed by the Court, that
we could find out some information as to how she got there,
you know, what she presented with, what, you know, past
symptoms, medications that she could have been on. I
think it would really open up a wealth of information that
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this Court could use in being well-informed to make a
decision in this case.
A discussion ensued concerning the fact that the proposed order only sought
information regarding defendant’s condition on 8 and 9 November 2017. Defense
counsel stated as follows:
[Y]ou may want to expand the order a little bit, but I
believe that what the order says is all information,
complete documentation, complaint, diagnosis, treatment,
prognosis, discharge and any other information that would
assist the Court. I think that’s rather complete, but it’s the
Court’s order. But I think, you know, if you want to—if you
want to put in including current updates to the date and
time of the release or current updates through her
discharge—
The trial court agreed, deciding that the order should be “comprehensive.” The
trial court then recessed the proceedings while the State drafted a revised order for
the release of defendant’s medical records and conducted research on whether the
trial should continue.
When the proceedings resumed that afternoon, the State informed the trial
court of its position that defendant had voluntarily waived her right to be present by
choosing to ingest the excessive number of pills. Defense counsel expressed his belief
that there was a need for more information regarding defendant’s mental health
status, noting that it was not clear whether “her intent was to end her life or to
impede these proceedings.” The trial court agreed to recess further trial proceedings
until the following Monday, at which time defendant would either be released from
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treatment or the trial court would have received the requested medical records. The
trial court then stated the following:
We don’t know what her situation is going to be, but I want
to take the position, unless something happens that shoots
it down, that she voluntarily made herself absent from the
trial and continue on Monday.
The trial court proceeded to release the jury until the following Monday and
issued an order for defendant’s arrest upon the expiration of her period of
commitment. Later that afternoon, the trial court also entered an order for the release
of defendant’s medical records. The trial court mandated the production of “complete
documentation of the Defendant’s complaint, diagnosis, treatment, prognosis,
discharge, and any other information that would assist the court in making a
determination regarding how to proceed,” but limited the temporal scope of the
records to the “admittance date of November 8, 2017, and any days following this date
for the continued treatment of [defendant].”
The proceedings resumed on 13 November 2017 at which time defendant
remained in the hospital under the terms of the involuntary commitment order. The
trial court informed counsel that it had received 89 pages of defendant’s recent
medical records over the weekend, which included reports containing the medical
opinions of Dr. Silver and Dr. Stover, which both stated that defendant required
further immediate inpatient psychiatric stabilization and that she remained suicidal.
The records also noted that defendant had been assessed at a “high” risk level on the
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Columbia Suicide Severity Rating Scale. An evaluation by Dr. Silver stated, in part,
that
[s]he has been on trial for embezzlement . . . .
....
The patient reported that the verdict for her trial
was to be read out this morning, November 9. She states
that last night she wrote goodbye letters to her
grandchildren, and overdosed on 60 tablets of Xanax. She
had stated “I’m not going to go to jail”.
....
. . . She states she continues to think about wishing
she were dead reporting “I don’t really have a will to
live”. . . .
....
. . . She denies any history of suicide attempts before
last nights overdose on Xanax.
The medical records also reflected defendant’s “history of a mood disorder” that
she managed with daily medication but noted that she had “never been
psychiatrically hospitalized.” In addition, the medical records stated that defendant
had been prescribed Haldol for agitation, as well as Vistaril for anxiety and
Trazodone to help her sleep. She was ordered to continue her prescription of 100
milligrams of Zoloft daily.
The following exchange between the trial court and defense counsel then
ensued:
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THE COURT: Up till the time that this matter occurred,
[defense counsel], you have not observed anything of her
that would indicate she lacked competency to proceed in
this trial, would that be a fair statement?
[DEFENSE COUNSEL]: That would be a fair statement.
THE COURT: Okay. And then this intervention came
along Wednesday?
[DEFENSE COUNSEL]: Yes, sir.
THE COURT: And we are where we are now—
[DEFENSE COUNSEL]: Yes.
THE COURT: —she’s being further evaluated?
[DEFENSE COUNSEL]: That’s correct, yes.
THE COURT: All right. It’s my intention this morning as I
stated I think Thursday to proceed with the trial under the
ruling that she has voluntarily by her own actions made
herself absent from the trial at this point. How it may be
in the future I’m not sure, depends on her situation how it
all turns out, but I’m taking the position that she has by
her voluntary actions and by implication made her
presence unavailable for court.
Defense counsel then stated the following:
Your Honor, I would indicate that we did review on
Thursday an involuntary commitment document
indicating that the doctor put on the record that she had
voluntarily overdosed on Xanax by taking 60 milligrams. I
contend that it is somewhat of a leap for us as lay people
and not doctors to consider that her actions are for the
purposes of avoiding jurisdiction of the court or avoiding
trial. Ms. Sides has quite a number of other factors in her
life that are very pressing and from which certain
personalities may find overwhelming. I would just contend,
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Your Honor, that this may be the straw that broke the
camel’s back, but I don’t know that her efforts—I think her
efforts were to end her life, not to end her trial.
And I would contend that we don’t have evidence
regarding whether or not she voluntarily absented herself
from the trial. We know that she attempted to absent
herself from life itself, but I would contend that there is
some distinction of that, that she is in custody in a medical
facility, and we have not investigated whether or not she
chooses or would like to be here. And so we’re making a
leap by saying that she voluntarily absented herself from
the trial, and we’d like to note our objection to that.
Over defense counsel’s objection, the trial court ruled that the trial would
proceed on the basis that defendant’s absence was voluntary. The trial court admitted
into evidence defendant’s medical records and the involuntary commitment
documents, noting that it had considered those documents. The trial then resumed
without defendant being present, and the jury was instructed not to consider
defendant’s absence in weighing the evidence or determining the issue of guilt. At the
close of the State’s case-in-chief, defense counsel moved to dismiss the charges against
her, and the trial court denied the motion. No evidence was offered on defendant’s
behalf. The trial court subsequently denied defense counsel’s renewed motion to
dismiss. That afternoon, the jury reached a verdict finding defendant guilty of all
charges.
On 16 November 2017, defendant appeared in the courtroom for sentencing.
The trial court sentenced her to consecutive sentences of 60 to 84 months
imprisonment for the two Class C felonies and 6 to 17 months imprisonment for the
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Class H felony. The trial court suspended the latter sentence and imposed 60 months
supervised probation. Finally, the trial court ordered defendant to pay $364,194.43
in restitution. On 28 November 2017, defendant gave notice of appeal.
Before the Court of Appeals, defendant argued that the trial court was required
to conduct a competency hearing prior to proceeding with the trial in her absence.
Relying on its prior decision in State v. Minyard, 231 N.C. App. 605 (2014), the
majority at the Court of Appeals rejected this contention, holding that when a
defendant voluntarily absents herself from trial, she waives her constitutional right
to be present and is not entitled to a competency hearing. State v. Sides, 267 N.C.
App. 653, 658 (2019). The majority concluded that defendant’s overdose was a
voluntary act and that no competency hearing was required under the circumstances.
Id. at 661.2
In a dissenting opinion, Judge Stroud stated her belief that a defendant must
be found to be competent before she can be deemed to have voluntarily absented
herself from trial and that substantial evidence had existed before the trial court
casting doubt on defendant’s competence. Id. at 664 (Stroud, J., dissenting). As a
result, Judge Stroud expressed her view that the trial court was required to sua
2 The Court of Appeals also rejected defendant’s additional argument that the trial
court had erred by amending the judgments entered against her in her absence in order to
reflect corrected offense dates. See State v. Sides, 267 N.C. App. 653, 663 (2019). That issue,
however, is not before us in this appeal.
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sponte conduct a competency hearing in this case. Id. at 666. On 18 October 2019,
defendant appealed as of right to this Court based upon the dissent.
Analysis
This case requires us to reconcile the following four principles based on the
facts of this case: (1) a criminal defendant cannot be tried unless she is competent to
stand trial; (2) a defendant has a constitutional right to be present during her entire
trial; (3) a defendant may voluntarily waive her constitutional right to be present;
and (4) such a waiver is only valid if the defendant is competent. Stated succinctly,
in this appeal we must resolve a classic “chicken and egg” dilemma regarding how a
trial court must proceed when faced with a situation where a defendant intentionally
engages in conduct harmful to herself that has the effect of absenting her from trial
under circumstances that raise bona fide concerns about her capacity. In such cases,
the issue is whether the trial court is required to conduct a competency hearing before
proceeding to determine whether the defendant made a voluntary waiver of her right
to be present, or, alternatively, whether it is permissible for the trial court to forego
a competency hearing and instead assume a voluntary waiver of the right to be
present on the theory that the defendant’s absence was the result of an intentional
act.
We conclude that by essentially skipping over the issue of competency and
simply assuming that defendant’s suicide attempt was a voluntary act that
constituted a waiver of her right to be present during her trial, both the majority at
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the Court of Appeals and the trial court “put the cart before the horse.” Once the trial
court had substantial evidence that defendant may have been incompetent, it should
have sua sponte conducted a competency hearing to determine whether she had the
capacity to voluntarily waive her right to be present during the remainder of her trial.
We first address the State’s contention that defendant failed to preserve her
statutory right to a competency hearing. Subsection 15A-1001(a) of the General
Statutes of North Carolina states that
[n]o person may be tried, convicted, sentenced, or punished
for a crime when by reason of mental illness or defect he is
unable to understand the nature and object of the
proceedings against him, to comprehend his own situation
in reference to the proceedings, or to assist in his defense
in a rational or reasonable manner.
N.C.G.S. § 15A-1001(a) (2019).
The issue of whether a defendant has the capacity to be tried “may be raised
at any time on motion by the prosecutor, the defendant, the defense counsel, or the
court.” N.C.G.S. § 15A-1002(a) (2019). Our General Statutes provide that once a
question is raised as to a defendant’s capacity, “the court shall hold a hearing to
determine the defendant’s capacity to proceed.” N.C.G.S. § 15A-1002(b)(1). Defendant
contends that a competency hearing was required under this statute because both
defense counsel and the trial court raised the issue of defendant’s competency and
defense counsel objected to the trial court’s ultimate decision to allow the trial to
proceed.
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The State, conversely, argues that defendant’s statutory right to a competency
hearing pursuant to N.C.G.S. § 15A-1002(b) was waived because defense counsel
neither actually requested such a hearing nor properly objected to the trial court’s
decision to proceed without one. In support of its argument, the State cites several
decisions from this Court in which we held that a defendant’s statutory right to a
competency hearing was not properly preserved. See State v. Badgett, 361 N.C. 234
(2007); State v. King, 353 N.C. 457 (2001); State v. Young, 291 N.C. 562 (1977).
However, we need not resolve the parties’ dispute regarding the preservation
issue. Even assuming arguendo that the State is correct that defendant failed to
preserve her statutory right to a competency hearing as required under our prior
decisions, we hold that defendant possessed a constitutional due process right to such
a hearing.
The United States Supreme Court has held that a defendant is competent to
stand trial if he “has sufficient present ability to consult with his lawyer with a
reasonable degree of rational understanding and a rational as well as factual
understanding of the proceedings against him.” Ryan v. Gonzales, 568 U.S. 57,
66 (2013) (cleaned up). In situations where a trial court possesses information
regarding a defendant that creates “sufficient doubt of his competence to stand trial
to require further inquiry on the question,” it must investigate the competency issue.
Drope v. Missouri, 420 U.S. 162, 180 (1975). This Court has likewise recognized that
“[a] trial court has a constitutional duty to institute, sua sponte, a competency hearing
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if there is substantial evidence before the court indicating that the accused may be
mentally incompetent.” Young, 291 N.C. at 568 (emphasis omitted) (citation omitted).
Because questions of competency can arise for the first time during trial, “[e]ven when
a defendant is competent at the commencement of his trial, a trial court must always
be alert to circumstances suggesting a change that would render the accused unable
to meet the standards of competence to stand trial.” Drope, 420 U.S. at 181.
In addition, although a criminal defendant possesses a constitutional right to
be present at all stages of her trial, see Kentucky v. Stincer, 482 U.S. 730, 745 (1987),
the United States Supreme Court has also recognized the potential for a defendant
in a non-capital case to waive that right.
[W]here the offense is not capital and the accused is not in
custody, the prevailing rule has been, that if, after the trial
has begun in his presence, he voluntarily absents himself,
this does not nullify what has been done or prevent the
completion of the trial, but, on the contrary, operates as a
waiver of his right to be present and leaves the court free
to proceed with the trial in like manner and with like effect
as if he were present.
Taylor v. United States, 414 U.S. 17, 19 (1973) (alteration in original) (citation
omitted).
The Supreme Court has made clear that in order to waive the right to be
present, however, the defendant “must be aware of the processes taking place, of his
right and of his obligation to be present, and he must have no sound reason for
remaining away.” Id. at 19 n.3 (citation omitted). In other words, in order to waive
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the right to be present, there must be “an intentional relinquishment or
abandonment” of that right. Id. at 19 (citation omitted). The Supreme Court has
recognized that “it is contradictory to argue that a defendant may be incompetent,
and yet knowingly or intelligently ‘waive’ his right to have the court determine his
capacity to stand trial.” Pate v. Robinson, 383 U.S. 375, 384 (1966).
Here, the majority at the Court of Appeals reasoned that defendant waived her
right to be present by voluntarily absenting herself from trial. Sides, 267 N.C. App.
at 661. Specifically, the majority held that the trial court was not required to conduct
a competency hearing because defendant waived her right to be present at trial by
intentionally overdosing on medication, thereby resulting in her absence through her
own willful conduct. Id. at 659–60.
We believe that the Court of Appeals erred by making that determination
without first deciding whether there was substantial evidence before the trial court
as to her lack of capacity to truly make such a voluntary decision. As the case law
discussed above makes clear, a defendant cannot be deemed to have voluntarily
waived her constitutional right to be present at her own trial unless she was mentally
competent to make such a decision in the first place. Logically, competency is a
necessary predicate to voluntariness. Accordingly, if there is substantial evidence
suggesting that a defendant may lack the capacity to stand trial, then a sufficient
inquiry into her competency is required before the trial court is able to conclude that
she made a voluntary decision to waive her right to be present at the trial through
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her own conduct. Thus, the majority at the Court of Appeals erred by simply
assuming that defendant’s suicide attempt was necessarily a voluntary act.
Although the majority’s analysis was flawed in this respect, the question
remains whether it nevertheless ultimately reached the correct result. In order to
answer that question, we must determine whether a bona fide doubt actually existed
as to defendant’s lack of competency that required the trial court to sua sponte
conduct a competency hearing before allowing the trial to resume in her absence.
In addressing this issue, we deem it instructive to review prior decisions of this
Court that address the question of whether the trial court was constitutionally
required to initiate a competency hearing sua sponte. In Young, the defendant was
convicted of first-degree murder and sentenced to death. Young, 291 N.C. at 565.
Before trial, defense counsel raised concerns about the defendant’s competency. Id.
at 566. The trial court ordered that the defendant be committed to Dorothea Dix
Hospital to undergo psychiatric examination. Id. at 566. The resulting diagnostic
report and psychiatric opinions identified no evidence of incompetency. Id. at 566–67.
On appeal to this Court, the defendant contended that the trial court had erred by
not holding a competency hearing, citing both his statutory and due process rights.
We concluded that the defendant waived his statutory right to such a hearing as there
was “no indication that the failure to hold a hearing under G.S. 15A-1002(b)(3) . . .
was considered or passed upon by the trial judge.” Id. at 567–68. We further held that
defendant was not constitutionally entitled to such a hearing because where “the
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defendant has been committed and examined relevant to his capacity to proceed, and
all evidence before the court indicates that he has that capacity, he is not denied due
process by the failure of the trial judge to hold a hearing subsequent to the
commitment proceedings.” Id. at 568.
The defendant in State v. Heptinstall, 309 N.C. 231 (1983), was convicted of
first-degree murder. Prior to trial, the trial court conducted an inquiry into his
competency and reviewed evidence of his “significant history of mental illness,”
including a diagnosis of paranoid schizophrenia. Heptinstall, 309 N.C. at 233. Family
members and a forensic psychiatrist testified to the defendant’s bizarre behavior, but
the trial court found him competent and proceeded with trial. Id. at 233–34. The
defendant contended on appeal that the trial court should have conducted another
competency hearing after his “bizarre and incoherent” testimony. Id. at 235.
We rejected this argument, stating that the defendant’s testimony “became
nonsensical and bizarre when the subject turned to matters of morality and religion”
but that otherwise “[a]lmost all of his testimony during the guilt phase indicates that
defendant was accurately oriented regarding his present circumstances.” Id. at 236.
We concluded that “the testimony would not have suggested to the trial court that
defendant then lacked capacity to proceed. There was, therefore, no duty of the trial
court on its own motion to reopen this question.” Id. at 237.
In King, the defendant was convicted of first-degree murder for killing his
estranged wife, and he was sentenced to death. King, 353 N.C. at 461. He argued on
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appeal that the trial court erred by not conducting a competency hearing prior to trial.
Id. at 465. This Court held that the defendant waived his statutory right to a
competency hearing and was not constitutionally entitled to such a hearing because
there was not substantial evidence suggesting that he may have been incompetent.
Id. at 466–67. We noted that the record did “not indicate that either defendant or
defense counsel raised any questions about defendant’s capacity to proceed at any
time during defendant’s trial and capital sentencing proceeding.” Id. at 467. Although
the defendant offered some evidence of past “precautionary treatment for depression
and suicidal tendencies,” we concluded that this alone did not constitute substantial
evidence that the defendant lacked the capacity to proceed and that, as a result, the
trial court did not have a duty to sua sponte conduct a competency hearing. Id.
The defendant in Badgett was sentenced to death for first-degree murder.
Badgett, 361 N.C. at 239. On appeal to this Court, he argued that the trial court erred
by not sua sponte conducting a competency hearing in light of doubts as to his
competency. Id. at 258. After being charged with first-degree murder, the defendant
had sought counseling and was found by psychiatrists to suffer from irritability,
anger management problems, and depression. Id. at 241–42. On appeal, the
defendant attempted to rely on evidence that he had written letters to the trial court
asking for a speedy trial resulting in a death sentence, impliedly asked the jury to
sentence him to death, and engaged in an emotional outburst during sentencing. Id.
at 259–60.
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This Court rejected the defendant’s argument that he was statutorily entitled
to a competency hearing because nothing in the record indicated that questions of
competency were raised at any point during trial. Id. at 259. With regard to the
question of whether he had a constitutional right to a competency hearing, we noted
that he had “interact[ed] appropriately with his attorneys during the trial. . . .
conferred with them . . . . followed their advice . . . . [and] responded directly and
appropriately to questioning.” Id. at 260. Furthermore, the transcript revealed that
the defendant “demonstrated a strong understanding of the proceedings against him”
and treated the trial court with deference. Id. at 260. Moreover, although he did, in
fact, have an “outburst during the state’s closing arguments,” he apologized afterward
and “calmly and rationally” explained why he was upset. Id. at 260–61. Finally, we
recognized that three experts testified about defendant’s psychological history and
none of them suggested that his mental status rendered him incompetent to stand
trial. Id. at 261. For these reasons, we concluded that no competency hearing was
required. Id. at 260.
While our holdings in Young, Heptinstall, King, and Badgett provide useful
guidance on the basic legal principles that govern the present case, we believe several
decisions of the federal courts—including two from the United States Supreme
Court—are more directly relevant to our analysis. In Drope, on the second morning
of trial for a rape charge, the defendant shot himself in the stomach in an attempt to
commit suicide and was hospitalized. Drope, 420 U.S. at 166–67. The remainder of
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the trial proceeded in his absence with the trial court ruling that his absence was
voluntary in light of evidence that he had stated he would “rather be . . . dead than
to go to trial for something he didn’t do.” Id. at 167. The jury found the defendant
guilty, and the trial court sentenced him—after he finally appeared in court after a
three-week hospital stay—to life in prison. Id.
The defendant argued on appeal that the trial court denied him his right to
due process by failing to conduct a competency hearing in light of the circumstances
surrounding his absence from trial. Id. at 163–64. The Supreme Court noted that the
defendant “was absent for a crucial portion of his trial,” which prevented the trial
court from observing his behavior, id. at 180–81, and that “the record reveal[ed] a
failure to give proper weight to the information suggesting incompetence which came
to light during trial.” Id. at 179. The defendant’s wife had testified to her “belief that
her husband was sick and needed psychiatric care” and that he tried to choke and kill
her the night before trial. Id. at 166.
The Supreme Court recognized that “evidence of a defendant’s irrational
behavior, his demeanor at trial, and any prior medical opinion on competence to stand
trial are all relevant in determining whether further inquiry is required” but noted
there are “no fixed or immutable signs which invariably indicate the need for further
inquiry to determine fitness to proceed.” Id. at 180. The Supreme Court determined
that it “was sufficiently likely that, in light of the evidence of [the defendant’s]
behavior including his suicide attempt, and there being no opportunity without his
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presence to evaluate that bearing in fact, the correct course was to suspend the trial
until such an evaluation could be made.” Id. at 181. The Supreme Court concluded
that “when considered together with the information available prior to trial and the
testimony of [the defendant’s] wife at trial, the information concerning [the
defendant’s] suicide attempt created a sufficient doubt of his competence to stand
trial to require further inquiry on the question.” Id. at 180. The Supreme Court
therefore reversed the judgment and remanded the case for a new trial. Id. at 183.
In Pate, the defendant was convicted of murdering his wife and was sentenced
to life imprisonment. Pate, 383 U.S. at 376. At trial, defense counsel asserted the
defense of insanity and contended that the defendant was incompetent to stand trial,
but the trial court did not conduct a competency hearing. Id. The United States
Supreme Court held that the defendant “was constitutionally entitled to a hearing on
the issue of his competence to stand trial.” Id. at 377. The Supreme Court cited
testimony from four witnesses regarding the defendant’s “history of disturbed
behavior,” including instances of erratic conduct and paranoia. Id. at 378–79. In
addition, the Supreme Court noted that the trial court had heard evidence of the
defendant’s prior psychiatric hospitalizations and a hospitalization resulting from an
attempted suicide by gunshot to the head. Id. at 380–81. The Supreme Court
acknowledged evidence that the defendant had exhibited “mental alertness and
understanding” in his exchanges with the trial court, but it observed that even though
the defendant’s “demeanor at trial might be relevant to the ultimate decision as to
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Opinion of the Court
his sanity, it cannot be relied upon to dispense with a hearing on that very issue.” Id.
at 385–86. The Supreme Court ultimately concluded that based on the record, the
defendant’s “present sanity was very much in issue” during the proceedings, thereby
raising a “ ‘bona fide doubt’ as to [the] defendant’s competence to stand trial” such
that he was entitled to a competency hearing. Id. at 384–85.
The United States Court of Appeals for the Ninth Circuit addressed a similar
issue in United States v. Loyola-Dominguez, 125 F.3d 1315 (9th Cir. 1997). In that
case, the defendant attempted suicide in his jail cell the night before trial. Id. at 1316.
The next morning, defense counsel requested that the defendant undergo a
psychiatric evaluation and a competency hearing, citing some additional mental
health difficulties that the defendant had experienced during his incarceration. Id.
The trial court briefly questioned the defendant, asking him whether he would like
to undergo psychiatric evaluation or continue with trial. Id. At one point, the trial
court asked the defendant the following: “Well, do you feel—do you know what’s going
on? Do you know what’s going on at the trial?” The defendant replied: “I don’t know.
I’ve never been here like this, so I don’t know.” Id. at 1317. The trial court then
inquired as to whether the defendant felt that he was “competent to understand
what’s going on,” and the defendant asked: “How long would it take? Because I just
can’t stand anymore, the way they have me there. I feel desperate.” Id. The trial court
ultimately ordered that the trial proceed without a competency hearing. Id.
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In holding that the trial court had erred by failing to hold a competency
hearing, the Ninth Circuit stated that “[w]hile we do not believe that every suicide
attempt inevitably creates a doubt concerning the defendant’s competency, we are
persuaded that, under the circumstances of this case, such a doubt existed.” Id.
at 1318–19. The Ninth Circuit determined that the trial court’s inquiry was
insufficient to assess the defendant’s competency, particularly “the fact that the trial
court did not elicit adequate information, from either defense counsel or [the
defendant], that would have dispelled the concerns that would ordinarily arise
regarding competency.” Id. at 1319. The Ninth Circuit further explained that the
defendant’s responses to the trial court’s questions suggested that he did not fully
understand the nature and consequences of the proceedings. Id. Although the trial
court noted that the defendant “had always seemed fine in the past,” the Ninth
Circuit concluded that the defendant’s recent suicide attempt along with the
surrounding circumstances “raised significant doubts regarding his competency to
stand trial” such that a competency hearing was constitutionally required. Id.
Based on our thorough review of the record in the present case, we believe the
trial court was presented with substantial information that cast doubt on defendant’s
competency. To be sure, defendant’s suicide attempt itself “suggests a rather
substantial degree of mental instability contemporaneous with the trial.” Drope,
420 U.S. at 181. But her suicide attempt does not stand alone in our assessment. See
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Opinion of the Court
id. In our view, the facts before the trial court—when taken as a whole—were clearly
sufficient to trigger the need for a competency hearing.
On the morning of 9 November 2017, the trial court was made aware that
defendant had been hospitalized after a suicide attempt and that a magistrate had
determined that grounds existed to issue an order for her involuntary commitment.
The trial court reviewed two psychiatric opinions regarding defendant’s mental
health issues. Dr. Stover, the doctor who sought defendant’s immediate involuntary
commitment, found that defendant “ha[d] been experiencing worsening depression
and increased thoughts of self-harm” and checked the box on the form stating that
defendant was “mentally ill and dangerous to self or others or mentally ill and in need
of treatment in order to prevent further disability or deterioration that would
predictably result in dangerousness.” Dr. Stover wrote that defendant “is not stable
and for her safety will need further evaluation.” Dr. Silver conducted another
evaluation of defendant later that day and noted that defendant “remains suicidal
even today. She is not safe for treatment in the community and requires inpatient
stabilization.”
Upon receiving this information, the trial court issued an order for the release
of additional medical records—albeit only those records from 8 November 2017
onward. These records, which were reviewed by the trial court, shed additional light
on defendant’s mental health issues, showing that defendant had a “history of a mood
disorder” that she managed with daily medication. In the meantime, defendant
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remained suicidal and was assessed at a “high” risk level on the Columbia Suicide
Severity Rating Scale, and she told Dr. Silver that she did not “really have a will to
live.” As part of her inpatient treatment, she was prescribed Haldol along with
Vistaril and Trazodone. Defendant was also instructed to continue her daily dose of
100 milligrams of Zoloft.
It is clear that the trial court recognized the existence of an issue as to
defendant’s competency. For this reason, the trial court took the initial steps of
recessing trial proceedings, conferring with counsel, and ordering the production of
defendant’s most recent medical records. But instead of ordering a hearing on
defendant’s competency, the trial court at that point abruptly ended further
consideration of the issue, simply assuming—like the Court of Appeals majority—
that her overdose was a voluntary action and that no further competency analysis
was required. Simply put, the trial court started down the road of addressing
defendant’s competency but abandoned the journey midway.
In arguing that no competency hearing was required, the State points to
evidence in the record suggesting that defendant’s ingestion of pills was a voluntary
attempt by her to avoid incarceration upon being convicted. The State supports this
argument, for example, by citing a statement she made to medical providers during
her hospitalization that she is “not going to go to jail.”
By making this argument, however, the State is conflating the separate issues
of (1) whether substantial evidence existed as to defendant’s lack of competency so as
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Opinion of the Court
to require a sua sponte competency hearing, and (2) what the ultimate result of such
a competency hearing would be. But the latter issue is not before us. Rather, the sole
question that we must decide is whether there was substantial evidence before the
trial court to trigger the need for a sua sponte competency hearing in the first place.
After hearing all of the relevant evidence as to defendant’s competency at such a
hearing, the trial court would then have been tasked with weighing the respective
evidence—including those facts that the State highlights in its brief before this
Court—and making a competency determination. Assuming defendant was found to
be competent, then—and only then—would the trial court have been able to make a
determination as to whether defendant’s absence from the trial proceedings was the
result of a voluntary act on her part.3
We wish to emphasize that the issue of whether substantial evidence of a
defendant’s lack of capacity exists so as to require a sua sponte competency hearing
requires a fact-intensive inquiry that will hinge on the unique circumstances
presented in each case. Our holding should not be interpreted as a bright-line rule
that a defendant’s suicide attempt automatically triggers the need for a competency
3 In its analysis, the Court of Appeals majority relied largely on that court’s prior
decision in State v. Minyard, 231 N.C. App. 605 (2014). In Minyard, the Court of Appeals
held, in part, that a defendant who had ingested a large quantity of intoxicating substances
at the end of his trial had voluntarily waived his right to be present during the jury’s
deliberations. Id. at 626–27. To the extent the Court of Appeals’ analysis on that issue is
inconsistent with our holding today, that portion of Minyard is overruled.
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Opinion of the Court
hearing in every instance. Rather, our decision is based on our consideration of all
the evidence in the record when viewed in its totality.
***
The only remaining issue before us is to determine the appropriate remedy on
remand. The two potential remedies are for the trial court to conduct either a new
trial or a retrospective competency hearing.
The United States Supreme Court has recognized “the difficulty of
retrospectively determining an accused’s competence to stand trial.” Pate, 383 U.S.
at 387. Where a retrospective hearing would require the trial court to assess the
defendant’s competency “as of more than a year ago,” the Supreme Court has
suggested that such a hearing is not an appropriate remedy. Dusky v. United States,
362 U.S. 402, 403 (1960).
Here, a retrospective hearing would require an evaluation of defendant’s
competency more than three years ago. Because of the “inherent difficulties of such a
nunc pro tunc determination under the most favorable circumstances,” Drope,
420 U.S. at 183, we do not believe such an undertaking would be feasible. We conclude
that defendant is entitled to a new trial—“assuming, of course, that at the time of
such trial [defendant] is competent to be tried.” Id.
Conclusion
For the reasons stated above, we reverse the decision of the Court of Appeals
and remand for a new trial.
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Opinion of the Court
REVERSED AND REMANDED.
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Justice MORGAN dissenting.
While I agree with my learned colleagues in the majority that “the sole
question that we must decide is whether there was substantial evidence before the
trial court to trigger the need for a sua sponte competency hearing,” I disagree with
their evaluation of defendant’s mental health history as constituting a determination
that “the trial court had substantial evidence that defendant may have been
incompetent.” I am also in accord with the majority’s approach in a case such as the
current one that “the issue of whether substantial evidence of a defendant’s lack of
capacity exists so as to require a sua sponte competency hearing requires a fact-
intensive inquiry that will hinge on the unique circumstances presented in each case,”
although I do not consider the particular features of this case to compel the need for
the trial court to hold a competency hearing. The majority’s tendency here to
embellish aspects of defendant’s mental history and capacity, plus its tendency to
diminish aspects of defendant’s pre-trial and trial behavior, artificially create a
specter of substantial evidence which I do not perceive in this case. As a result, I
dissent.
The Due Process Clause of the United States Constitution protects criminal
defendants who are incompetent to stand trial for charges levied against them by the
State from being compelled to stand trial while they remain incompetent. Cooper v.
Oklahoma, 517 U.S. 348, 354 (1996). In order to possess the competence necessary to
STATE V. SIDES
Morgan, J., dissenting
stand trial, a defendant must have the “capacity to understand the nature and object
of the proceedings against him, to consult with counsel, and to assist in preparing his
defense.” Drope v. Missouri, 420 U.S. 162, 171 (1975). While “a competency
determination is necessary only when a court has reason to doubt the defendant’s
competency,” Godinez v. Moran, 509 U.S. 389, 401 n.13 (1993), North Carolina
criminal courts have a “constitutional duty to institute, sua sponte, a competency
hearing if there is substantial evidence before the court indicating that the accused
may be mentally incompetent.” State v. Badgett, 361 N.C. 234, 259, 644 S.E.2d 206,
221 (2007) (quoting State v. King, 353 N.C. 457, 467, 546 S.E.2d 575, 585 (2001)).
Substantial evidence which establishes a bona fide doubt as to a defendant’s
competency may be established by considering “a defendant’s irrational behavior, his
demeanor at trial, and any prior medical opinion on competence to stand trial.” Drope,
420 U.S. at 180. Indeed, as the majority quotes from Drope, a suicide attempt
“suggests a rather substantial degree of mental instability contemporaneous with
trial.” Id. at 181.
The majority in the present case recounts defendant’s mental health history
prior to trial and delineates her unfortunate and sobering background of agitation,
anxiety, and depression, and her “history of mood disorder.” In its analysis, the
majority sees fit to equate such circumstances as those which existed in Drope, in
which the majority here cites the Supreme Court of the United States’ emphasis on
the testimony of the defendant’s wife that she believed that defendant “ ‘was sick and
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Morgan, J., dissenting
needed psychiatric care’ and that he tried to choke and kill her the night before trial,”
as well as those in Pate v. Robinson, 383 U.S. 375 (1966), wherein the majority here
cites the Supreme Court of the United States’ emphasis on the defendant’s “ ‘history
of disturbed behavior,’ including instances of erratic conduct and paranoia . . . [and]
defendant’s prior psychiatric hospitalizations and a hospitalization resulting from an
attempted suicide by gunshot to the head,” with defendant’s circumstances in the
case sub judice in order to substantiate the majority’s conclusion here that there was
a bona fide doubt about defendant’s competency to stand trial so as to require the
trial court to conduct a sua sponte competency hearing. The breadth and depth of the
mental health challenges experienced by defendants in Drope and Pate were at a
more extreme level than those mental health challenges experienced by defendant in
the present case, although the majority stretches the magnitude of defendant’s
circumstances to qualify for the application of the competency hearing requirement
articulated by the nation’s highest court.
As my distinguished colleagues in the majority magnify the significance of
defendant’s mental health history to elevate it to the reaches of the Drope and Pate
principles governing the existence of substantial evidence to require a trial court’s
sua sponte competency hearing to be conducted, they simultaneously bolster the
perception of the presence of substantial evidence that defendant may have been
incompetent by providing scant recognition of defendant’s behavior that detracts from
a determination of substantial evidence. The information gathered by the trial court
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Morgan, J., dissenting
in conjunction with defendant’s apparent drug overdose showed that defendant had
“never been psychiatrically hospitalized,” that defendant herself denied any history
of suicide attempts prior to her apparent drug overdose, and that defendant reported
that she took the drugs in an effort to kill herself following the end of the third day of
her trial because defendant was aware that “the verdict for her trial was to be read
out this morning” and defendant had stated “I’m not going to jail.” The majority’s
expansive reading of defendant’s limited mental health history, combined with her
singular suicide attempt brought on by a professed desire to avoid incarceration, does
not appear to sufficiently demonstrate, in my view, defendant’s inability “to
understand the nature and object of the proceedings against [her], to consult with
counsel, and to assist in preparing [her own] defense,” which is the standard for
competency as instructed by the Supreme Court in Drope. Drope, 420 U.S. at 171.
Substantial evidence of a defendant’s incapacity to stand trial is inadequately shown
where generalized mental health issues, rather than the Drope delineation of factors,
is shown to exist. I do not consider the standard articulated by Drope to have been
met in the present case.
With the dearth of any information to signify that defendant was incompetent
and defendant’s unequivocal statement that her apparent drug overdose was a
singular suicidal event to avoid the prospect of incarceration, the trial court
determined that defendant’s absence from trial was accomplished by her voluntary
actions which constituted a waiver of defendant’s constitutional right to be present
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Morgan, J., dissenting
at her criminal trial. The modest attention which the majority has given to these core
considerations of the trial court and the Court of Appeals in those forums’ respective
and compatible determinations that defendant was not entitled to a competency
hearing under the totality of these circumstances, while bolstering the specter of the
existence of substantial evidence to require the trial court to conduct a sua sponte
competency hearing, unfortunately decreases the standard for establishment of such
substantial evidence and increases the myriad of situations in which a trial court
must interrupt a criminal trial to conduct a sua sponte competency hearing when a
defendant creates a voluntary absence from trial.
The majority mistakenly conflates defendant’s willingness to participate in her
criminal trial with her ability to do so. In light of this and the additional
aforementioned reasons, I respectfully dissent.
Justice NEWBY and Justice ERVIN join in this dissenting opinion.
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