Title: State v. Sides
Citation: N/A
Docket Number: 400A19
State: north-carolina
Issuer: north-carolina Supreme Court
Date: December 18, 2020

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 
STATE V. SIDES 
 
Opinion of the Court 
 
 
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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. 
STATE V. SIDES 
 
Opinion of the Court 
 
 
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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 
STATE V. SIDES 
 
Opinion of the Court 
 
 
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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 
STATE V. SIDES 
 
Opinion of the Court 
 
 
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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 
STATE V. SIDES 
 
Opinion of the Court 
 
 
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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 
STATE V. SIDES 
 
Opinion of the Court 
 
 
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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: 
STATE V. SIDES 
 
Opinion of the Court 
 
 
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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, 
STATE V. SIDES 
 
Opinion of the Court 
 
 
-9- 
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 
STATE V. SIDES 
 
Opinion of the Court 
 
 
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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. 
STATE V. SIDES 
 
Opinion of the Court 
 
 
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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 
STATE V. SIDES 
 
Opinion of the Court 
 
 
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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. 
STATE V. SIDES 
 
Opinion of the Court 
 
 
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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 
STATE V. SIDES 
 
Opinion of the Court 
 
 
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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 
STATE V. SIDES 
 
Opinion of the Court 
 
 
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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 
STATE V. SIDES 
 
Opinion of the Court 
 
 
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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 
STATE V. SIDES 
 
Opinion of the Court 
 
 
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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 
STATE V. SIDES 
 
Opinion of the Court 
 
 
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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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Opinion of the Court 
 
 
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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 
STATE V. SIDES 
 
Opinion of the Court 
 
 
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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 
STATE V. SIDES 
 
Opinion of the Court 
 
 
-22- 
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. 
STATE V. SIDES 
 
Opinion of the Court 
 
 
-23- 
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 
STATE V. SIDES 
 
Opinion of the Court 
 
 
-24- 
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 
STATE V. SIDES 
 
Opinion of the Court 
 
 
-25- 
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 
STATE V. SIDES 
 
Opinion of the Court 
 
 
-26- 
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. 
STATE V. SIDES 
 
Opinion of the Court 
 
 
-27- 
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. 
STATE V. SIDES 
 
Opinion of the Court 
 
 
-28- 
REVERSED AND REMANDED. 
 
 
 
 
 
 
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 
 
 
-2- 
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 
STATE V. SIDES 
 
Morgan, J., dissenting 
 
 
-3- 
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 
STATE V. SIDES 
 
Morgan, J., dissenting 
 
 
-4- 
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 
STATE V. SIDES 
 
Morgan, J., dissenting 
 
 
-5- 
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.