United States Court of Appeals

for the Fifth Circuit

No. 21-20163

United States of America, 

Plaintiff—Appellee,

versus

Bithomas Ceasar, Jr., 

Defendant—Appellant.

Appeal from the United States District Court

for the Southern District of Texas

No. 4:18-CR-458-1

Before Stewart, Clement, and Elrod, Circuit Judges.

Jennifer Walker Elrod, Circuit Judge:

Bithomas Ceasar, Jr., was charged with receipt, distribution, and 

possession of child pornography. The district court found him incompetent 

to stand trial, and he was committed for evaluation and treatment. Towards 

the end of the commitment period, Ceasar was released on bond to live with 

his mother, and shortly after that the warden of the medical facility issued a 

certificate declaring that he had recovered sufficiently to be competent to 

stand trial. But several months later, all parties, and ultimately the court, 

agreed that he was again incompetent. The question this case presents is 

whether at that time the district court was permitted to return Ceasar to 

United States Court of Appeals

Fifth Circuit

FILED

April 6, 2022

Lyle W. Cayce

Clerk

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custody for an additional period of competency restoration treatment, or 

whether civil commitment proceedings were the only option. Because the 

district court retained the authority to commit Ceasar to a second period of 

competency restoration treatment, we AFFIRM its order doing so and 

REMAND for further proceedings consistent with this opinion. 

I.

In August 2018, Ceasar was indicted for receipt, distribution, and 

possession of child pornography. In October 2019, the district court found 

Ceasar mentally incompetent to stand trial and ordered him to be 

hospitalized at a federal medical facility for competency restoration and 

evaluation. He arrived at the facility on December 10, 2019 and, in 

accordance with federal law, was to remain there for no more than four 

months. See 18 U.S.C. § 4241(d)(1). Shortly before that four-month period 

ended, the Government moved to extend the treatment period for an 

additional four months under 18 U.S.C. § 4241(d)(2). Dr. Ashley 

Christiansen, the doctor in charge of evaluating Ceasar, advised that with the 

additional time his competency could be restored. Ceasar opposed the 

extension and asked for compassionate release because of COVID-19, and he 

also requested that his competency proceedings be stayed. 

With the agreement of both parties, the district court ordered the 

competency proceedings to be stayed because of the pandemic and ordered 

Ceasar to be released on bond from the medical center to live with his mother. 

It also directed Dr. Christiansen to submit an updated report of Ceasar’s

condition within a few weeks. In that report, Dr. Christiansen concluded that 

Ceasar was “likely competent to proceed in his case,” but explained that her 

conclusion was based on very limited data and that “an additional period of 

competency restoration and evaluation may be prudent.” A few weeks after 

the proceedings were stayed and Ceasar was released on bond, the hospital 

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warden issued a certificate of competency based on Dr. Christiansen’s 

report. About two months later, however, the defense’s expert psychologist 

submitted a report concluding that Ceasar was at that time incompetent, but 

that his competency could be restored with treatment. 

In March 2021, the district court held a new competency hearing. 

Both the Government and the defense agreed that at that time Ceasar was 

incompetent but that his competency could be restored with additional 

treatment. The Government requested that he be committed for restoration 

treatment once again. Ceasar argued that because the warden had certified 

him competent the year before, the only option for the court to commit him 

for additional treatment was to do so through civil commitment proceedings 

under 18 U.S.C. §§ 4246 and 4248. 

The district court agreed with the Government and ordered Ceasar to 

undergo additional treatment at another federal medical facility either for 

four months or until his competency was restored, whichever came earlier. 

The court explained that because an additional commitment period would 

likely enable Ceasar to gain competency, it was authorized to commit him for 

an additional reasonable period of time under 18 U.S.C. § 4241(d)(2). Ceasar 

appealed that decision to this court. We have jurisdiction under the collateral 

order doctrine. See United States v. McKown, 930 F.3d 721, 725–26 (5th Cir. 

2019), cert. denied, 140 S. Ct. 2518 (2020).

II.

After a defendant’s initial period of commitment for treatment to 

evaluate or restore competency, the district court has the authority to order 

an additional commitment period if it concludes that there is a substantial 

probability that the defendant will regain competency within that period. 

There is no statutory basis to conclude that the court loses that authority 

simply because when the proceedings were stayed the medical facility 

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certified that the defendant was competent at a particular moment. We 

therefore affirm the decision of the district court.

A.

Ceasar argues that the district court misinterpreted 18 U.S.C. § 4241 

and violated his substantive due process rights by committing him to 

additional restoration treatment after the warden had issued a competency 

certificate. These are legal issues, so we review them de novo. See United 

States v. Jackson, 945 F.3d 315, 319 (5th Cir. 2019), cert. denied, 140 S. Ct. 

2699 (2020); McKown, 930 F.3d at 726.

B.

It is a denial of due process to try a defendant for a crime if the 

defendant is incompetent to stand trial. United States v. Flores-Martinez, 677 

F.3d 699, 705–06 (5th Cir. 2012). Congress has enacted provisions designed 

to safeguard that due process right. Under 18 U.S.C. § 4241(a), both the 

Government and the defendant may move for a hearing to determine the 

defendant’s mental competency before continuing criminal proceedings. If 

the district court finds that the defendant is incompetent, it must commit him 

to the custody of the Attorney General for hospitalization “for such a 

reasonable period of time, not to exceed four months, as is necessary to 

determine whether there is a substantial probability that in the foreseeable 

future he will attain the capacity to permit the proceedings to go forward.” 

18 U.S.C. § 4241(d)(1). The defendant may be committed for one 

“additional reasonable period of time” “if the court finds that there is a 

substantial probability that within such additional period of time he will attain 

the capacity to permit the proceedings to go forward.” Id. § 4241(d)(2)(A). 

At the end of the commitment period, if the defendant has not sufficiently 

improved, he is not subject to any additional commitment except by way of

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the civil commitment procedures described in 18 U.S.C. §§ 4246 and 4248. 

Id.

At any point while the defendant is committed for competency 

restoration treatment and evaluation, the medical facility may certify that the 

defendant has regained competence. Id. § 4241(e). If the facility does so, the 

district court must hold a competency hearing. Id. And if the court concludes 

that the defendant’s competency has indeed been restored, “the court shall 

order his immediate discharge” from treatment and schedule either the trial 

or other related proceedings. Id.

Ceasar served the large majority of his initial four-month

commitment, but before that period concluded, the commitment 

proceedings were stayed and Ceasar was ordered to live with his mother. 

During that time, the warden of the hospital certified that Ceasar was 

competent, but by the time a subsequent competency hearing was held, 

Ceasar was again incompetent. Thus, the district court ordered an additional 

period of commitment for restoration treatment.

Ceasar argues that once the medical facility certified him competent, 

the only way he could be committed again was through civil commitment 

procedures. In his view, once a certificate of competence was issued under 

18 U.S.C. § 4241(e), that ended the “reasonable period of time” for which 

he could be hospitalized for competency restoration. The Government 

responds that the district court properly ordered an additional period of 

treatment for a reasonable period of time under § 4241(d)(2). We agree with 

the Government and thus affirm the district court’s order.

The relevant statutory provisions allow for up to two periods of 

commitment. A district court may order the first period of commitment “to 

determine whether there is a substantial probability that” the defendant will 

become competent “in the foreseeable future.” 18 U.S.C. § 4241(d)(1). It 

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can order the additional period of commitment if “there is a substantial 

probability that within such additional period of time he will attain the 

capacity to permit the proceedings to go forward.” Id. § 4241(d)(2)(A). The 

district court acted in accordance with each of these provisions when it 

committed Ceasar to treatment on two separate occasions. It thus acted 

within its authority, unless its authority was somehow hamstrung by the 

warden’s certification of competency which came while the commitment 

proceedings were stayed and Ceasar was released on bail.

On that issue, we find no statutory basis to conclude that the warden’s 

certification foreclosed the district court’s authority to order an additional 

commitment period under § 4241(d)(2). Again, when a medical facility in 

which a defendant is being treated for competency restoration certifies that 

the defendant has regained competency, § 4241(e) requires the court to hold 

a competency hearing. 18 U.S.C. § 4241(e). Under that subsection, if the 

court concludes that the defendant has indeed regained competency, the 

proceedings move forward. Id. It does not address when the court concludes 

that the defendant is not in fact competent. See id. Thus, there is no reason 

from the text of that provision to conclude that it controls here.

The only other statutory basis which could potentially affect the 

district court’s authority to order an additional period of commitment for 

competency restoration is § 4241(d) itself. That provision explains that “[i]f, 

at the end of the time period specified, it is determined that the defendant’s 

mental condition has not so improved as to permit the proceedings to go 

forward, the defendant is subject to [the civil commitment provisions].” 18 

U.S.C. § 4241(d). 

But that statement does not constrain the district court’s ability to 

order a second period of competency restoration treatment. Section 4241(d)

provides for up to two commitment periods—the first to determine whether 

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the defendant will likely gain competency in the near future, and the second 

if it is likely that the defendant will regain competency during that additional

commitment period. 18 U.S.C. § 4241(d)(1), (2). Subsection (d) goes on to 

explain that the civil commitment proceedings apply when, “at the end of the 

time period specified,” the defendant’s mental condition has not sufficiently 

improved for the proceedings to move forward. Id. § 4241(d). That 

provision must apply to situations in which the court has not concluded under 

subsection (d)(2)(A) that the defendant would likely regain competency with 

a second period of commitment. 

Otherwise, it is hard to imagine when the second period of 

commitment could ever be allowed: If a court concludes that an additional 

commitment period would likely allow for the defendant to regain 

competency (under subsection (d)(2)(A)), it necessarily concludes, albeit 

implicitly, that the defendant’s mental condition has not yet improved to 

permit the proceedings to go forward. We will not read one part of subsection 

(d) in a way that renders another part of that same subsection essentially 

ineffective. See Woodfork v. Marine Cooks & Stewards Union, 642 F.2d 966, 

970–71 (5th Cir. Apr. 1981) (“A basic principle of statutory construction is 

that ‘a statute should not be construed in such a way as to render certain 

provisions superfluous or insignificant.’” (quoting Zeigler Coal Co. v. Kleppe, 

536 F.2d 398, 406 (D.C. Cir. 1976))); Antonin Scalia & Brian A. Garner, 

Reading Law: The Interpretation of Legal Texts 174 (2012) (“If possible, every 

word and every provision is to be given effect . . . . None should be ignored. 

None should needlessly be given an interpretation that causes it to duplicate 

another provision or to have no consequence.”).

Instead, the natural reading of the provision referencing the civil 

commitment procedures is that it applies when, “at the end of the time

period specified” by any orders under subsections (d)(1) or (d)(2), a 

defendant remains incompetent. After all, that phrase sits at the end of 

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subsection (d) generally and not within subpart (d)(1).1 In other words, the 

civil commitment provisions take effect only after the court has ordered all 

commitment periods that it might order under those provisions.2

Thus, the hospital warden’s certification of competency did not 

undermine the district court’s ability to order an additional period of 

commitment when the court—and all the parties, for that matter—

concluded that Ceasar had again become incompetent.3

1 The parties disagree about whether the initial commitment period had ended 

when the additional commitment was ordered. If it had expired, Ceasar says, then in his 

view the commitment could not be extended under subsection (d)(2). 

But we agree with the Second Circuit that the statutory provisions do not require

the additional period of commitment to be ordered before the first period is complete, and 

that ordering the additional commitment period later does not offend due process 

requirements. See United States v. Magassouba, 544 F.3d 387, 406–08 (2d Cir. 2008).

2 That is not to say that a district court must always order both an initial and an 

additional period of commitment. If, for example, the court orders the initial period of 

commitment, and at the end of that period concludes that an additional period of 

commitment would not likely allow the defendant to regain competency, there would be no 

statutory justification to order the second period of commitment. See 18 U.S.C. 

§ 4241(d)(2)(A).

3 We also conclude that the district court did not violate Ceasar’s due process 

rights. The Fifth Amendment Due Process Clause allows the government to involuntarily 

commit incompetent defendants for treatment for a reasonable period of time to the extent 

necessary to determine whether the defendant will attain competency in the near future. 

Jackson v. Indiana, 406 U.S. 715, 738 (1972). The Due Process Clause also allows for an 

additional period of commitment for a reasonable period of time in pursuit of that goal of 

restoring competency. Id. Section 4241(d) by its text closely traces those constitutional 

constraints. See 18 U.S.C. § 4241(d). We have specifically held that § 4241(d) does not 

violate due process. McKown, 930 F.3d at 728. Because the district court complied with 

the requirements of § 4241(d) and ordered commitment periods of a length contemplated 

by that provision, it did not violate Ceasar’s due process rights.

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* * *

For these reasons, we AFFIRM the order of the district court and 

REMAND for further proceedings consistent with this opinion.

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