IN THE UNITED STATES COURT OF APPEALS

FOR THE FIFTH CIRCUIT

No. 07-10433

UNITED STATES OF AMERICA

Plaintiff - Appellee

v.

LESTER JON RUSTON

Defendant - Appellant

Appeal from the United States District Court 

for the Northern District of Texas

Before DAVIS, STEWART, and DENNIS, Circuit Judges.

CARL E. STEWART, Circuit Judge:

 Lester Jon Ruston was charged with threatening to assault and murder

a federal magistrate judge with intent to intimidate and retaliate against the

judge in violation of 18 U.S.C. § 115 and was found not guilty by reason of

insanity. The district court committed Ruston to the custody of the Attorney

General under 18 U.S.C. § 4243(a). Prior to a § 4243(c) hearing to determine

whether Ruston could establish that his release would not create a substantial

risk of bodily injury to another due to a present mental disease or illness,

Ruston’s counsel filed a request for the court to hold a hearing to determine if

Ruston was competent to waive his right to counsel. After holding a hearing, a

United States Court of Appeals

Fifth Circuit

F I L E D

April 15, 2009

Charles R. Fulbruge III

Clerk
No. 07-10433

2

magistrate judge found Ruston competent to waive counsel. The district court

then conducted a two-day § 4243(c) hearing where Ruston proceeded pro se. The

district court found that Ruston failed to prove that he did not pose a substantial

risk of bodily injury to others, and ordered that he remain in the custody of the

Attorney General until he could be safely released to the community. Ruston

appeals the district court’s failure to sua sponte hold a competency hearing after

observing Ruston’s behavior at the § 4243(c) hearing and the court’s

determination that Ruston was competent to waive his right to counsel. For

reasons discussed below, we REVERSE and REMAND.

I. FACTUAL AND PROCEDURAL BACKGROUND

On May 21, 2004, Ruston called the chambers of the Honorable Irma

Ramirez, United States Magistrate Judge for the Northern District of Texas.

Ruston left a threatening and profanity-ridden message on Judge Ramirez’s

answering machine. Ruston was arrested the following day and charged with

threatening a federal official in violation of 18 U.S.C. § 115. Ruston then began

filing erratic pro se motions in the district court. 

On August 20, 2004, the Federal Public Defenders office was appointed to

represent Ruston. Subsequently, the district court granted an unopposed Motion

for Psychiatric and Psychological Consultation. Ruston, however, continued to

engage in erratic pro se filings that contained allegations similar to the

following: “[n]othing alleged in [the] indictment has anything to do with Irma

Ramirez’s capacity as a Federal Official. It has to do with a murder for hire plot,

which the Northern District Court is attempting to cover up.” 

On May 4, 2005, the court held a competency hearing where a forensic

psychologist with the U.S. Bureau of Prisons testified that Ruston suffered from

a mental disorder, specifically delusional disorder prosecutorial type, that

impaired his ability to assist counsel. The district court found Ruston suffering

from a mental disease or defect rendering him mentally incompetent to assist
No. 07-10433

3

properly in his defense. Ruston was remanded to the custody of the Attorney

General for purposes of attempting to restore Ruston to competency. Despite

being represented by court-appointed counsel, Ruston continued to file

nonsensical pro se motions with the court. 

On September 13, 2006, Ruston’s attorney submitted a motion entitled

“Memorandum of Competency and Opposition to Involuntary Medication.” On

September 19, 2006, the district court held a competency hearing and found

Ruston competent to stand trial. Dr. James Wolfson testified at the hearing and

stated that Ruston had “present capacity to proceed to adjudication,” but that

“delusional material continue[d] to be present in Ruston’s thinking and could

impair his future capacity for entirely independent strategic legal decision

making.” Dr. Wolfson urged the district court to “prosecute [the] case quickly

because [he] could give no assurance that [Ruston’s] level of remission or at least

rational strategizing might continue.” On September 25, 2006, Ruston’s

attorney provided a Notice of Insanity Defense. On October 2, 2006, a Joint

Stipulation of Fact was submitted where all parties agreed that Ruston was not

guilty by reason of insanity. On October 12, 2006, the district court found

Ruston not guilty by reason of insanity and ordered Ruston committed to the

custody of the Attorney General. However, at the hearing his attorney stated:

Mr. Ruston . . . seems to many times be competent and rationally

interact with me, but there are other times where he seems to act

irrationally. So I realize we are on - I’m trying to find the right

words. Sort of the knife’s edge of competency I guess on a day-today basis which makes things very difficult. So at this point in time

this morning I feel he is interacting with me on a rational basis and

making rational decisions, and I must say that he is rational. But

since the [c]ourt found him competent and today[,] I think there are

moments that he has become so irrational that he cannot be

considered competent.
No. 07-10433

4

On February 13, 2007, Ruston’s attorney filed a motion requesting that the

Court hold a hearing to determine if Ruston waived his right to counsel, because

Ruston wished to proceed pro se in a scheduled § 4243(c) hearing. On March 7,

2007, a magistrate judge held a hearing to determine whether Ruston was

competent to waive counsel. The magistrate judge concluded that Ruston had

“the ability to understand the nature and object of the proceedings to determine

if he is a danger to society and underst[ood] the significance and consequences

of his decision to waive counsel.” Ruston, however, made the following telling

statement at the hearing:

I’ve been competent since the day I was arrested. I have a stack of

medical records that have been suppressed this entire case that

show no mental illness and complete competence. Every document

filed by the government in this case has been a fraud. I’ve been

denied a suppression hearing, I’ve been denied all my constitutional

rights for almost three years and I’m tired of it. 

The court granted Ruston’s motion to proceed pro se, stating that the court

would not force counsel on Ruston. Ruston, pro se, then filed additional

nonsensical motions with the court.

On March 27-28, 2007, Ruston represented himself pro se in an 18 U.S.C.

§ 4243(c) hearing. A § 4243(c) hearing is held to determine whether the

individual is a danger to himself or others. Ruston had the burden of proving by

clear and convincing evidence that his release would not pose a substantial risk

of bodily injury to others or damage to property. At the hearing, Ruston’s

demeanor demonstrated a lack of understanding regarding the nature of the

proceedings against him. 

Dr. Wolfson’s Testimony

 Dr. Wolfson testified that Ruston was unwilling to accept a diagnosis of

mental illness and refused treatment. Dr. Wolfson also testified to reviewing a

report of a forensic evaluation completed by Dr. Maureen Burris, and stated that
No. 07-10433

5

he disagreed with Dr. Burris’s diagnosis that Ruston suffered from delusional

disorder and instead diagnosed Ruston with paranoid schizophrenia. Dr.

Wolfson also testified that it was possible that Ruston was bipolar or suffered

from a personality disorder. Dr. Wolfson explained that regardless of whether

Ruston suffered from paranoid schizophrenia or delusional disorder, both could

be treated with medication, which Ruston was currently refusing. 

The Government then asked Dr. Wolfson to testify regarding his review

of letters and filings Ruston made over the few weeks and months preceding the

§ 4243(c) hearing. Dr. Wolfson testified that the recent filings were “getting a

little stranger than what Ruston had been filing before” and that they were

consistent with a diagnosis of Ruston suffering from paranoid schizophrenia.

For example, the material included a filing where Ruston alleged that Katie

Couric tampered with Dr. Wolfson. Dr. Wolfson stated that while previous

filings were irrational, one could follow Ruston’s reasoning. Dr. Wolfson found

the more recent filings to appear “to be an expansion of [Ruston’s] delusional

system.” Finally, Dr. Wolfson testified that he believed that without treatment

Ruston posed a risk of dangers to others, and that Dr. Wolfson was less

concerned about the risk to others’ property.

During the course of Dr. Wolfson’s testimony, Ruston objected repeatedly

to properly given testimony on the grounds that (1) Dr. Wolfson was not a

qualified expert under Federal Rule of Civil Procedure (“Rule”) 702 (at least

eight objections), (2) a previously filed motion to suppress should have be

granted (at least six objections), (3) District Court Judge Fish should be

disqualified (at least six objections), (4) he was denied his rights to confront

witnesses, (5) the United States Attorney suppressed evidence from expert

witnesses who would testify that Ruston did not suffer from mental illness, and

(6) he had the right to speak his mind under the First Amendment. 
No. 07-10433

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Ruston then began his cross-examination of Dr. Wolfson. Ruston’s

questioning did not relate to whether he would pose a substantial risk of harm

to others or property. Instead, Ruston asked Dr. Wolfson if: 

• Dr. Wolfson’s testimony was tampered with by the Washington, D.C.

Capital Police; 

• complaints Ruston filed with the Attorney General in Washington, D.C.

were sent to Dr. Wolfson;

• Dr. Wolfson failed to respond in writing to “cop-outs” Ruston sent to Dr.

Wolfson;

• Dr. Wolfson was aware of an alleged case between Ruston and Plano

Independent School District;

• Dr. Wilson was familiar with an individual, undergoing care at the facility

Dr. Wolfson worked, who murdered another patient;

• Dr. Wolfson was aware if the duties of a United States Magistrate Judge

include conspiracy to commit murder;

• Dr. Wolfson was aware that Ruston accused Judge Ramirez of being

involved in an attempt to murder him, and accused her of that in the

message he left;

• Dr. Wolfson reviewed handwritten notes sent to the Federal Bureau of

Investigation (“FBI”) as part of an investigation about an attempted

murder plot against Ruston, as well as handwritten notes of a United

States Marshal and member of the United States Secret Service;

• Dr. Wolfson had contact with a Secret Service agent;

• Dr. Wolfson reviewed records connected to an individual allegedly

discharged from the Central Intelligence Agency (“CIA”) for

embezzlement, explaining that:

Jeffrey Don Elmore was discharged from the Central

Intelligence Agency for embezzlement, and I have the right to

United States 4247(d), and I have been denied that right. I
No. 07-10433

7

have the right to confront James Ellis, who conspired to

arrest me. I believe under the Sixth Amendment I have the

right to confront him, and I have subpoenaed him, and he’s

not in the courtroom as far as I can see;

• Dr. Wolfson was testifying that the Government suppressed medical

records from Dr. Wolfson (Dr. Wolfson explained that he was not stating

that); 

• Dr. Wolfson reviewed a FBI report that referenced a black, former marine,

hit man who was hired to murder Ruston, and any 911 records from the

Carrollton Police Department on or about May 18, 2004, responding to a

stalking and murder threat by the alleged hit man; and

• Dr. Wolfson “investigated Mr. Ruston’s family lineage or looked at any of

his family charts to determine whether he is descended from” Scottish

royalty. 

None of these questions involved the potential risk of danger Ruston posed

to individuals or property if released. Ruston did ask at least two questions that

were relevant. First, Ruston asked Dr. Wolfson if he was aware of an improper

2001 hospitalization that resulted in Ruston’s release after a doctor in Plano

diagnosed Ruston with no mental illness and without providing treatment or

medication. Second, Ruston questioned Dr. Wolfson about his testimony at the

earlier competency hearing, and asked how Ruston could have been miraculously

restored to competence without medication or treatment. Dr. Wolfson stated

that those spontaneous remissions are rare, but they occur, based

upon my fairly lengthy interview at Seagoville the day before [the

competency hearing you] appeared more rational. And you were not

free of persecutorial delusions, but you were able to strategize and

rationalize about your case . . . and you appeared to be able to do

that. . . . [A]s I explained at length during that prior hearing, and I

voiced a concern that since I hadn’t done anything to make it

happen – that it hadn’t happened through treatment but

spontaneously – the Court would be advised to prosecute your case
No. 07-10433

8

quickly because I could give them no assurance that level of

remission or at least of rational strategizing might continue.

During the course of the cross-examination, Dr. Wolfson also testified

regarding letters Ruston sent to Katie Couric, but stated that he was more

concerned with letters written “under a Secret Service letterhead or some law

enforcement agency, a fictitious letterhead.” In response, Ruston asked whether

Dr. Wolfson had ever been in contact with Katie Couric or NBC Television

Networks. Dr. Wolfson answered in the negative. Ruston also asked whether

Ruston ever claimed to know Katie Couric. Dr. Wolfson testified that Ruston

never told Dr. Wolfson that Ruston knew her, and that Ruston indicated that his

writings to Katie Couric were “comedy.” Ruston then asked Dr. Wolfson if he

was aware that Ruston was a comedy writer and appeared on local stations as

a comedy character and professional actor, specifically on CBS television. Dr.

Wolfson testified that he had heard Ruston state this before, but had no

independent verification of Ruston’s claims. Ruston concluded his questioning

of Dr. Wolfson.

Testimony of Dr. Lisa Clayton

Ruston then called Dr. Clayton to testify. Dr. Clayton evaluated Ruston

for competency to stand trial and met with Ruston on August 14, 2004, and

September 23, 2004, as required in a court order issued by Judge Mary Miller.

Ruston’s examination of Dr. Clayton was also unrelated to the issue of whether

Ruston’s release would pose a substantial risk of harm to others and property.

As he did with Dr. Wolfson, Ruston consistently asked questions in an

effort to demonstrate that law enforcement organizations and others were

involved in an attempt to murder Ruston. Specifically, Ruston

• filed a motion to recuse Judge Miller; 
No. 07-10433

9

• asserted that he was barred from attending the October 2004 competency

hearing despite the fact that he never gets agitated and had no problem

maintaining court decorum; 

• questioned why Dr. Clayton’s notes from her evaluations of him had been

“suppressed”;

• continued to make references regarding Katie Couric, and asserted that

Dr. Clayton was lying when she testified that during the August 2004

evaluation Ruston told her that Katie Couric came to Dallas to meet

Ruston and that Couric rented an apartment to be in the Dallas area to

meet Ruston;

• asserted, contrary to Dr. Clayton’s testimony, that he told her that a white

female who appeared to be Katie Couric lured Ruston to meet him in

person in July 2002 at an apartment; 

• asked Dr. Clayton if she had been in contact with the United States

Attorney’s office in Plano, Texas;

• asked Dr. Clayton if he told her that he was assaulted and attacked by a

black, male ex-marine and she testified that he did not;

• asked Dr. Clayton if she was aware that a judge conspired to have three

inmates attack Ruston; and

• stated that Dr. Clayton was tampered with and ordered to perjure herself

at the § 4243(c) hearing. 

Ruston also asked whether Dr. Clayton testified at the October 2004

competency hearing that Ruston was filthy, dirty, and the most insane human

being Dr. Clayton ever evaluated. Dr. Clayton stated that she did not know if

she said that, but that when she saw Ruston he was very disheveled, agitated,

started beating on a glass wall, and was “very psychotic” in her opinion. Ruston

then asked if Dr. Clayton had evidence of his alleged beating on the glass wall.
No. 07-10433

10

When Dr. Clayton testified that others did not witness Ruston’s behavior, he

announced that he “didn’t beat on any wall.” 

The Government then cross-examined Dr. Clayton. The Government

asked Dr. Clayton to state her qualifications for the record, and Ruston objected

stating “[s]tand on our motion to suppress, our Daubert better motion, 702 and

our motion to disqualify Judge Fish.” The court overruled the objection. Dr.

Clayton testified that Ruston suffered from a severe mental illness. Ruston

objected, stating “[w]e will stand on our motion to suppress, our Daubert motion

under 702 and our motion to disqualify A. Joe Fish.” The court again overruled

the objection. Dr. Clayton continued testifying, and stated that Ruston suffered

from a combination of schizophrenia and bipolar which is called schizo-effective

disorder. The Government asked whether Ruston sounded agitated when he left

Judge Ramirez the threatening voice mail, and she stated that he did. This

concluded the Government’s cross-examination.

Ruston conducted redirect. Ruston asked Dr. Clayton if she considered it

mental illness to be agitated when someone attempts to murder you. She stated

that she did not. Ruston then asked whether Dr. Clayton considered “it

mentally ill to be agitated when you are kidnaped on fraudulent paperwork and

denied all of your Constitutional rights.” Dr. Clayton stated that she did not.

This concluded Ruston’s redirect. 

Testimony of Dr. George Trapp

Ruston then called Dr. Trapp, a physician and psychiatrist. Dr. Trapp

testified that he conducted a series of interviews of Ruston in August 2006 and

prepared a forensic report for the court. Trapp testified that Ruston never

appeared agitated during the examination, that Ruston never referred to Katie

Couric as his fiancee, and that Dr. Trapp confirmed that Ruston was cast in an

episode of Walker Texas Ranger to drive Senator Kay Bailey Hutchinson who

made a guest appearance. Ruston then asked whether Dr. Trapp thought
No. 07-10433

11

Walker Texas Ranger would cast a “crazy maniac to drive Senator Hutchinson

on a national program.” Dr. Trapp stated that he did not know. 

Dr. Trapp further testified that after his interviews with Ruston he

concluded that Ruston was competent to stand trial. Dr. Trapp testified that he

believed Ruston suffered from a diagnosable mental illness, but that it was in

remission at the time sufficient to provide for competence for trial.

Ruston then asked whether he told Dr. Trapp that Ruston requested

political asylum in Scotland and expressed a desire to leave the country. Dr.

Trapp stated that Ruston had in fact told him this. Ruston then stated “[s]o is

it your testimony that the defendant would not prevent any danger to this

society since he has no intention of living in this society.” Dr. Trapp agreed that

if Ruston was living outside of the United States, he would not be a danger to

those living in the United States. This concluded Dr. Trapp’s testimony. 

Remainder of § 4243(c) Hearing Proceedings

The court then inquired as to other witnesses Ruston wanted to present.

Ruston stated that he subpoenaed Katie Couric, who was not in the courtroom,

in an effort to question her about a July 2006 incident which “they continue to

call a delusion.” The court informed Ruston that only three subpoenas had been

authorized, and continued the hearing until the next morning. 

When court resumed the next morning, March 28, 2007, Ruston informed

the court that he had additional evidence to present, but that he did not have an

additional witness. Ruston then asked the court to take judicial notice of

Ruston’s application for asylum in Scotland and his intention to leave America.

The Government stated that it had no additional evidence, and argued

that Ruston failed to prove by clear and convincing evidence that his release

would not create a substantial risk to others. Ruston objected to all the

“testimony just presented,” stating that he stood on his motion to disqualify,

motion to suppress, and Rule 702 motion. Ruston also stated that he had
No. 07-10433

12

additional evidence that the United States Attorney suppressed, and that the

evidence consisted of doctors’ reports that demonstrated that Ruston suffered

from no mental illness and that it was all fabricated by a FBI agent. The court

overruled the objection. Ruston then submitted what he referred to as “medical

records” to the court. The court accepted the documents and described each

document. The court then asked Ruston if he had any argument he wished to

present, and Ruston stated that he wanted to call himself as a witness. 

Ruston testified to a January 2001 arrest that took place in a bank lobby.

Ruston stated that he did not have a hand-held crossbow at the time of his

arrest, and that he did not attempt to shoot any Secret Service agents. He

stated that the video from multiple security cameras would verify his testimony.

Ruston then testified that he was denied all rights to present this evidence up

to this point, and he wanted to state it for the record. Ruston continued to

testify about other arrests, reports, and records he wanted to present, and again

referenced a hit man who attempted to murder Ruston on three separate

occasions and provided the court with the hit man’s address. Ruston stated that

he suspected the Carrollton Police and Plano Police of hiring the hit man.

Ruston then testified that two judges committed judicial misconduct against

him, and that he was a witness against one of those judges.

Ruston then testified that he never stated to Dr. Clayton that Katie Couric

moved into an apartment to meet him. He testified that he was lured to the

apartment where he viewed a female who appeared to be Katie Couric. Ruston

stated that he felt uncomfortable with the situation and left the scene. Ruston

explained that he was not aware if Katie Couric was the person at the

apartment, but that he did not tell Dr. Clayton that he was engaged to Katie

Couric or knew her because he had never met her. Ruston testified that he and

Katie Couric communicated with each other through the mail. Ruston then

testified to being the victim of an assault while in Dallas County Jail.
No. 07-10433

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Ruston then alleged that he was kidnaped by a Secret Service Agent in

conspiracy with two judges, taken to Parkland Hospital, and injected with

medication without a warrant or court order. Ruston testified that they sent

him to Terrell State Hospital, and that the agent told the hospital that Ruston

was noncompliant with medication and out-patient treatment. Ruston continued

testifying about records he requested and did not receive, and a tort suit he filed

with the Deputy Director of the Secret Service. Ruston also testified that it was

his belief that the FBI continued “to engage in witness tampering and

obstruction of justice.” Ruston went on to testify that he did not believe he

suffered from a mental illness or needed medication.

Ruston maintained that he was not a danger or threat to anyone, but

recognized that he had used bad judgment. Ruston stated that he was an

alcoholic, and testified that he was “in remission.” Ruston also stated that he

said things in anger that he should not have said “because of the criminal act

perpetrated against him.” 

Ruston then testified that he had no intention to continue living in the

United States. Ruston explained that he applied for asylum in Canada and

Scotland, and intended to leave the United States immediately upon release.

Ruston stated that he would not be providing a forwarding address because he

was “tired of the government stalking [him] and trying to murder [him].” 

The Government cross-examined Ruston. Ruston testified that he left the

threatening message for Judge Ramirez. The Government asked Ruston to

verify that he signed a statement verifying that he said the words left on Judge

Ramirez’s answering machine. Ruston admitted that he signed it, but contended

that he was blackmailed into signing the document as a result of the malpractice

of his attorney. The Government then questioned Ruston about the various

persons Ruston testified were conspiring to hurt Ruston. These persons included

several judges and the “criminal element” of the FBI and Secret Service. 
No. 07-10433

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The Government asked Ruston if he believed the doctors who testified that

he suffered from mental illness were a part of the conspiracy against Ruston.

Ruston testified that he believed they were tampered with. Specifically, Ruston

stated that one doctor was “a lesbian who was raped . . . and hates all males.”

The Government asked a few more questions and concluded its crossexamination. 

The district court found that Ruston failed to prove by clear and

convincing evidence that his release would not create a substantial risk of bodily

injury to a person or property damage to another due to a present mental disease

or defect. The district court ordered that Ruston continue to remain in the

custody of the Attorney General until such time that he could be safely released

to the community. 

Ruston appeals from the failure of the district court to conduct a sua

sponte competency hearing and appoint counsel based on Ruston’s conduct

during the § 4243(c) hearing. 

II. DISCUSSION

A. Competency Hearing

We have not located controlling precedent as to what a district court must

do when encountered with a defendant of questionable competency during a §

4243(c) hearing; however, “we find that jurisprudence developed . . . and related

[to] competency questions in criminal trial proceedings [to be] instructive.” 

Mata v. Johnson, 210 F.3d 324, 329 (5th Cir. 2000). 

1. Standard of Review

Whether the district court erred in not sua sponte holding a competency

hearing is reviewed for abuse of discretion. See, e.g., United States v. Messervey,

317 F.3d 457, 463 (5th Cir. 2002). “Whether ‘a reasonable cause’ exists to put

the court on notice that the defendant might be mentally incompetent is left to

the sound discretion of the district court.” United States v. Davis, 61 F.3d 291,
No. 07-10433

15

304 (5th Cir. 1995) (citation omitted); see also United States v. Alden, 527 F.3d

653, 659 (7th Cir. 2008). “The district court is in the best position to determine

the need for a competency hearing.” Alden, 527 F.3d at 659 (citation omitted).

But “[i]f the trial court received evidence, viewed objectively, that should have

raised a reasonable doubt as to competency, yet failed to make further inquiry,

the defendant has been denied a fair” proceeding. Mata, 210 F.3d at 329; see

also Alden, 527 F.3d at 659 (explaining that a district court may sua sponte order

a competency hearing “if there is reasonable cause to believe that the defendant

may presently be suffering from a mental disease or defect rendering him

mentally incompetent to the extent that he is unable to understand the nature

and consequences of the proceedings against him or to assist properly in his

defense.”) (citation omitted); United States v. Marks, 530 F.3d 799, 814 (9th Cir.

2008) (holding that the appropriate inquiry “is not whether the trial court could

have found the defendant either competent or incompetent, nor whether the

reviewing court would find the defendant incompetent” but instead “the record

is reviewed to see if the evidence of incompetence was such that a reasonable

judge would be expected to experience a genuine doubt respecting the

defendant’s competence.”) (quotations omitted). 

2. Analysis

The statutory requirements for a district court to sua sponte hold a

competency hearing are set out in 18 U.S.C. § 4241(a), entitled “[d]etermination

of mental competency to stand trial or to undergo postrelease proceedings.”

Section 4241(a) states that 

[t]he court shall . . . order [ ] a [competency] hearing on its own

motion, if there is reasonable cause to believe that the defendant

may presently be suffering from a mental disease or defect

rendering him mentally incompetent to the extent that he is unable

to understand the nature and consequences of the proceedings

against him or to assist properly in his defense. 
No. 07-10433

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In determining whether the court should order a § 4241(a) hearing, the court

must consider three factors: (1) the existence of a history of irrational behavior,

(2) the defendant’s demeanor at trial, and (3) prior medical opinion on

competency. See Messervey, 317 F.3d at 463. All three factors are “relevant in

determining whether further inquiry is required, but . . . even one of these

factors standing alone may, in some circumstances, be sufficient. There are, of

course, no fixed or immutable signs which invariably indicate the need for

further inquiry to determine fitness to proceed; the question is often a difficult

one in which a wide range of manifestations and subtle nuances are implicated.”

Taylor v. Horn, 504 F.3d 416, 433 (3d Cir. 2007) (citing Drope v. Missouri, 20

U.S. 162, 172, 180 (1975)). The record reflects that Ruston meets the three

factors as set out in Messervey. 

Ruston has an extensive history of irrational behavior paired with multiple

diagnoses documenting his mental illness. It is important to note that the

psychiatrists who examined Ruston found that he suffered from either a

delusional disorder or paranoid schizophrenia. After examining Ruston’s

history, it is apparent to the Court that he has an extensive history of irrational

behavior as a direct result of delusions. Specifically, Ruston believes that

various law enforcement agencies, members of the judiciary, and possibly Katie

Couric are engaged in a plot to murder him. 

The instant case arose out of a threat Ruston issued against Judge

Ramirez. In the threatening message, Ruston specifically alleged that Judge

Ramirez was engaged in an attempted murder plot against Ruston. After arrest,

Ruston filed documents with the court asserting that he was indicted not

because he threatened a federal official, but because the United States District

Court for the Northern District of Texas was attempting to cover up a murder

to hire plot that Judge Ramirez was involved in planning. The Government was

unable to proceed against Ruston because the doctors who examined him found
No. 07-10433

17

him to be incompetent. When assessing competency, the court must “ascertain

whether a criminal defendant ‘has sufficient present ability to consult with his

lawyer with a reasonable degree of rational understanding – and whether he has

a rational as well as factual understanding of the proceedings against him.’”

Drope, 420 U.S. at 172 (citing Dusky v. United States, 362 U.S. 402 (1960)).

Specifically, Ruston was diagnosed with a delusional disorder of a prosecutorial

type, which impaired Ruston’s ability to properly assist counsel. 

When Ruston was eventually found competent to stand trial, Dr. Wolfson

made it clear to the district court that Ruston was far from cured. Dr. Wolfson

testified that while Ruston was presently capable of proceeding to adjudication,

he still suffered from delusions that could impair his ability to make legal

decisions in the future. After Ruston and the Government agreed that Ruston

was not guilty by reason of insanity, his own attorney explained to the district

court that he did not believe Ruston maintained competency between the time

Ruston was found competent and the date the district court entered judgment.

At the § 4243(c) hearing, Dr. Wolfson testified that he reviewed Ruston’s

filings with the district court from the time the district court entered judgment

and the § 4243(c) hearing. Dr. Wolfson specifically testified that Ruston’s ability

to make cogent arguments deteriorated during this time. Further, Dr. Wolfson

explained that the most recent filings appeared to demonstrate “an expansion

of [Ruston’s] delusional system.” Dr. Wolfson’s testimony at Ruston’s

competency hearing warned that Ruston’s level of competency was likely to wane

and based on Ruston’s filings, Dr. Wolfson found that Ruston was suffering just

that sort of deterioration. This testimony, in conjunction with Ruston’s history

of irrational behavior, might have provided a reasonable cause to believe that

Ruston was presently suffering from a mental disease or defect. 

This, however, was not the only evidence before the district court of

Ruston’s questionable competency. Ruston’s demeanor and questioning during
No. 07-10433

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the § 4243(c) hearing provided additional reason to believe that Ruston may

have been suffering from a mental disease or defect. 

 During the magistrate judge’s hearing to determine if Ruston was

competent to waive counsel, Ruston was generally able to answer the magistrate

judge’s questions, although the language quoted above indicated that Ruston

may have still been suffering from “delusional material.” But Ruston’s perceived

level of competency at the magistrate judge’s hearing does not abrogate the duty

of a judge to “always be alert to circumstances suggesting a change that would

render the accused unable to meet the standards of competence to” proceed with

the § 4243(c) hearing. See, e.g., Drope, 420 U.S. at 181. 

At the § 4243(c) hearing, Ruston did not demonstrate a “rational as well

as factual understanding of the proceedings against him.” See Drope, 20 U.S. at

172 (citation omitted). Instead, Ruston’s questioning, objections, and behavior

at the hearing provided reasonable cause to believe that Ruston was presently

suffering from a mental disease or defect, specifically a mental disease that

exhibits itself through delusions, rendering Ruston mentally incompetent. See,

e.g., Alden, 527 F.3d at 659. Ruston continued to assert that the government

was engaged in a plot to kill him and that Katie Couric may have been involved

in the plot. He actively insinuated that law enforcement agents tampered with

witnesses. He also alleged that he was attacked by fellow inmates. During the

§ 4243(c) hearing, Ruston largely failed to ask relevant and pertinent questions

regarding the substantive issue of the hearing–whether Ruston’s release posed

a significant risk of bodily injury to others. Ruston’s delusions were readily

apparent throughout the § 4243(c) hearing. 

While Ruston was found competent at his most recent competency hearing,

that competency hearing was conducted six months prior to the § 4243(c)

hearing. Dr. Wolfson made it clear at the competency hearing that he did not

believe Ruston’s current competency to be permanent, urging the court to
No. 07-10433

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proceed with prosecution immediately while Ruston could still be considered

competent. Once the § 4243(c) hearing began, it is apparent from the record and

transcripts that Ruston had again descended into irrational behavior. 

We hold that the district court abused its discretion when it did not sua

sponte hold a competency hearing upon observing the erratic behavior of Ruston

at his § 4243(c) hearing. The district court was on notice of Ruston’s troubled

history and had a duty to ensure that Ruston was competent before allowing the

§ 4243(c) proceeding to continue. 

B. Waiver of Counsel

We decline to reach the issue of whether the district court erred in

allowing Ruston to waive his right to counsel before proceeding with the §

4243(c) hearing in light of the Supreme Court’s recent decision in Indiana v.

Edwards, 128 S. Ct. 2379 (2008). 

In Edwards, the Supreme Court held that the Constitution does not forbid

states from insisting upon representation by counsel for those competent enough

to stand trial but who suffer from severe mental illness to the point where they

are not competent to conduct trial proceedings by themselves. Id. at 2387-88.

We note that Edwards involves representation within the context of a criminal

trial, and Ruston’s appeal involves a commitment proceeding. Nonetheless,

Edwards appears directly applicable to the issues presented in this case.

Edwards contemplates a scenario where a criminal defendant is conclusively

competent to stand trial, but may not be competent to conduct trial proceedings

by his or herself. Because this Court has determined that a question remains

as to whether Ruston was competent to proceed with the § 4243(c) hearing, it is

inappropriate to move to the next step outlined in Edwards and make a

determination as to whether Ruston was competent to represent himself at the

§ 4243(c) hearing. 
No. 07-10433

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III. CONCLUSION

For the foregoing reasons, we REVERSE and REMAND to the district

court for proceedings consistent with this opinion.