Court Opinion

ID: 9390801
Source: CourtListenerOpinion
Date Created: 2023-04-28 17:06:30.441308+00
Date Added: 2024-06-11T17:18:37.269995
License: Public Domain

IN THE SUPREME COURT OF NORTH CAROLINA

                                    No. 202PA21

                                 Filed 28 April 2023

STATE OF NORTH CAROLINA

              v.
SCOTT WARREN FLOW

      On discretionary review pursuant to N.C.G.S. § 7A-31 of a unanimous decision

of the Court of Appeals, 277 N.C. App. 289 (2021), affirming the judgments entered

on 20 December 2019 by Judge Nathan H. Gwyn, III in Superior Court, Gaston

County. This matter was calendared for argument in the Supreme Court on 9

February 2023 but determined on the record and briefs without oral argument

pursuant to Rule 30(f) of the North Carolina Rules of Appellate Procedure.

      Joshua H. Stein, Attorney General, by Rebecca E. Lem, Assistant Attorney
      General, for the State-appellee.

      Mark Montgomery for defendant-appellant.

      MORGAN, Justice.

      Defendant’s appeal in this criminal case raises the issue of whether the trial

court erred in declining to conduct further inquiry into defendant’s capacity to

proceed following his apparent suicide attempt on the morning of the sixth day of

trial before the jury was given its instructions, but after the jury had heard closing

arguments from both sides. We hold that, within the particular facts and overall
                                      STATE V. FLOW

                                    Opinion of the Court

context of this case, the trial court acted in accordance with the Constitution of the

United States and the North Carolina General Statutes by receiving evidence

concerning defendant’s medical history and defendant’s state of mind at the time of

his apparent suicide attempt and by determining that defendant’s actions voluntarily

absented him from further court proceedings. Accordingly, we affirm the decision of

the Court of Appeals, which found no error in the judgments entered by the trial

court.

                     I.   Procedural and Factual Background

         Defendant was indicted by a grand jury for the criminal offenses of first-degree

rape, first-degree burglary, first-degree kidnapping, first-degree sexual offense,

possession of a firearm by a convicted felon, and violation of a protective order in

connection with events occurring between 26 May 2018 and 27 May 2018 in Dallas,

North Carolina. Defendant’s charges were joined for trial. His trial began on 9

December 2019. Defendant stipulated to the existence of his prior felony conviction

and pleaded not guilty to the charges lodged against him. The trial court conducted

the following colloquy with defendant to ensure that defendant was entering this

stipulation freely, voluntarily, and intelligently:

               THE COURT: All right. For the record, Mr. Flow, among
               the charges you face is one that’s called felony possession
               of a firearm while being a convicted felon. The State, by
               this piece of paper, has handed up something that says, on
               February 3rd, 2003, in Lancaster County, South Carolina,
               under File Number 02GS29-862, the defendant – that’s you
               – was convicted of a felony that was committed on May 1st,
               2002.

                                            -2-
                      STATE V. FLOW

                     Opinion of the Court

I am told that you and your attorney and the State have
considered whether or not to go along with that stipulation.
This is a decision that is yours and yours alone. It’s not up
to your attorney, it’s not up to anyone in your family, it’s
not up to the DA, it’s not up to me, it is yours and yours
alone.

Do you understand everything I have said so far?

THE DEFENDANT: Yes, sir.

THE COURT: So knowing that, you are – if you sign off on
this stipulation, knowing that you would be admitting to
something that the State has got the burden of proving by
proof beyond a reasonable doubt, and that you don’t have
to enter into that stipulation if you don’t want to, is this
what you’re asking to do?

Are you so stipulating and are you comfortable with doing
that?

Do you want to talk to your attorney a little bit more?

You can. Just do it privately so I don’t hear you.

THE DEFENDANT: Yes, sir.

(Discussion off record)

THE DEFENDANT: Yes, I – yes, sir.

THE COURT: Okay. Now, before I write this up, are you
fully aware of what you’re doing?

THE DEFENDANT: Yes, sir.

THE COURT: You’re not taking any mind-altering
medications or substances are you?

THE DEFENDANT: No, sir.

                             -3-
                      STATE V. FLOW

                     Opinion of the Court

THE COURT: Do you have any questions of me about what
this might mean for you —

THE DEFENDANT: No, sir.

THE COURT: — that haven’t already been answered by
your attorney?

THE DEFENDANT: No, sir.

THE COURT: So you make this decision to make this
stipulation freely and voluntarily and of your own free will?

THE DEFENDANT: Yes.

THE COURT: And you know what the legal consequences
might be for you?

THE DEFENDANT: Yes, sir.

THE COURT: Do you want any additional time to talk to
your attorney?

If you want additional time we can take this up later.

THE DEFENDANT: No, sir.

THE COURT: You’re good to make the call now?

THE DEFENDANT: Yes, sir.

THE COURT: Does that satisfy you, Mr. Higdon, and, Ms.
Monteleone?

MR. HIGDON: Yes, Your Honor.

MS. MONTELEONE: Yes, Your Honor.

THE COURT: Okay. Well, I’ll hand it back to both of you
for signing.

It still needs to be signed by Mr. Flow, and you, Mr. Higdon.

                             -4-
                                     STATE V. FLOW

                                   Opinion of the Court

             And the stipulation as to that will be accepted by the Court.

      Throughout the course of the trial, the State elicited evidence through the

testimony of thirteen witnesses. The evidence presented at trial tended to show the

following: in the early morning hours of 27 May 2018, law enforcement officers of the

Gaston County Police Department’s Emergency Response Team entered the home of

defendant’s ex-girlfriend, Hannah,1 where she was being held at gunpoint by

defendant. Sergeants Anderson Holder and Matthew Hensley testified at trial that

the Emergency Response Team had to initiate an emergency rescue of Hannah after

three and a half hours of negotiations with defendant failed to secure her release.

Holder testified that the police team placed an explosive charge on the front door of

Hannah’s home to gain entry to the residence and that he subsequently ran inside,

kicked open the door to the master bedroom, and made his way into a small bathroom

where defendant had his legs around Hannah and was holding a pistol to her head.

Sergeant Holder then engaged in a physical confrontation with defendant in order to

disarm and detain him while Sergeant Hensley removed Hannah from the bathroom.

      Hannah and her teenage daughter, Brooklin, provided testimony regarding the

relationship between Hannah and defendant leading up to 26 May 2018. Hannah

testified that she met defendant in the spring of 2017. At first, Hannah and defendant

were just friends, but later they began dating while refraining from engaging in

      1  The pseudonym “Hannah” is used throughout this opinion to protect the identity of
the victim.

                                           -5-
                                  STATE V. FLOW

                                 Opinion of the Court

sexual relations with one another. Both Hannah and Brooklin testified about an

argument that took place between Hannah and defendant around Thanksgiving of

2017 during which defendant began “cussing and raging” at Hannah after defendant

had taken a wrong turn while driving with her and Brooklin in the car. Afterward,

Hannah chose to end her relationship with defendant and, in response, defendant

told Hannah that she would come to “regret the day [that she] ever met [him].”

Around Christmas of 2017, Hannah and Brooklin discovered that someone had

damaged Hannah’s vehicle by puncturing the tires on the right side of the vehicle;

after that incident, Hannah sought and was granted a domestic violence protective

order (DVPO) against defendant in February 2018 pursuant to N.C.G.S. § 50B-

1(b)(6).

       Hannah further testified that she resumed contact with defendant after he

came to visit Hannah’s mother in the hospital after the mother had fallen and had

developed double pneumonia. Defendant apologized to Hannah for puncturing

Hannah’s tires, and they soon resumed seeing each other. Hannah testified that she

was afraid to stop speaking with defendant because he told Hannah that he would

never leave her alone and that the protective order would not prevent defendant from

contacting her. Hannah stated that she never contacted law enforcement about

defendant’s violation of the protective order because Hannah did not want to get

defendant into trouble. Instead, Hannah tried to get defendant “on the right path”

and to get him involved with “some good men at church” for support. Although they

                                         -6-
                                     STATE V. FLOW

                                    Opinion of the Court

renewed their dating relationship and would hug and kiss each other, Hannah and

defendant never had consensual sex.

       On 26 May 2018, Hannah testified that she picked up Brooklin to go shopping

in Lincolnton, North Carolina. While the two were on their way to Lincolnton,

defendant called Hannah and screamed about driving down the road while being the

target of gunshots. After defendant ended the telephone call, Hannah called him back

to ask about the situation. Defendant responded that his friend’s father or father-in-

law had started shooting at him and that he did not know why, but that he was going

to go home and would call Hannah back later. While Hannah and Brooklin were in

the Walmart store in Lincolnton, defendant called Hannah back on FaceTime2 and

asked her if she knew where he was. Hannah recognized defendant’s location as her

niece’s house. Hannah asked defendant what he was doing at her niece’s house and

defendant responded that he was “hiding out from the law.” Hannah tried to call

defendant again after she and Brooklin left Walmart, but he did not answer Hannah’s

call. Later that day, after Hannah had returned home, defendant called her again

and told Hannah that he was “going to kill a ni**er.” Hannah was concerned that

defendant was referring to the Black boyfriend of Hannah’s older daughter Brittany,

about whom defendant had spoken in the past. Hannah then left her residence to

drive to Brittany’s house to make sure that defendant was not there; after verifying

       2A communication method available to specified cellular telephone users which allows
them to see one another while they talk to each other.

                                            -7-
                                   STATE V. FLOW

                                  Opinion of the Court

that he was not, Hannah turned around to return home. During Hannah’s return trip

to her residence, she called defendant’s father by telephone; defendant’s father

commented that defendant was “not his normal self.” While talking to defendant’s

father, Hannah missed several telephone calls and text messages from both Brooklin

and defendant.

      Brooklin testified that she had been left at Hannah’s house with Brooklin’s two

young nieces, Armoni and Daeja, while Hannah went to determine whether

defendant was at Brittany’s house. Brooklin put Daeja in the youngster’s crib and

was in the kitchen with Armoni when defendant pulled his vehicle into the driveway

of Hannah’s residence. Brooklin told Armoni to run upstairs; Brooklin locked the door

of the home and proceeded to go upstairs with Armoni. Brooklin told Armoni to hide

in the bed in Brooklin’s bedroom and turned off the light; Brooklin then went into the

laundry room, where Daeja’s crib had been placed, to check on Daeja. From the

laundry room, Brooklin looked through the window and saw defendant exit his car,

approach the residence, bang on the back door of the home, and subsequently kick in

the back door in order to enter the house.

      Brooklin watched as defendant walked toward her mother Hannah’s bedroom

and heard defendant as he rummaged through Hannah’s dresser drawers. When

defendant left the bedroom, Brooklin saw one of Hannah’s guns in his hand. Brooklin

asked defendant for what purpose he had acquired her mother’s gun, and he started

to walk towards her. Brooklin then retreated into her room as defendant yelled at

                                          -8-
                                  STATE V. FLOW

                                 Opinion of the Court

her, asking Brooklin why her mother Hannah was ignoring him and demanding that

Brooklin call Hannah. Brooklin told defendant to stop because he was scaring her

and because her young nieces were in the house. Nonetheless, defendant continued

to yell and “lunged” at Brooklin with the gun behind his back. Brooklin attempted to

reach Hannah via text messages and telephone calls throughout this encounter, but

Hannah did not answer; as an alternative, Brooklin texted and then called her

neighbor, Brittany Brady, to tell Brady that defendant had broken into the house and

that Brooklin needed help to remove the children from the residence. Defendant then

exited the house and stood outside.

      When Hannah returned home, she saw defendant’s vehicle in her driveway.

After Hannah parked her vehicle in the driveway, defendant attempted to get into

Hannah’s vehicle. Hannah then exited her vehicle and walked into the house with

defendant following her. Hannah asked defendant for the reason that both of the

doors to Hannah’s home were open and for the reason that his glasses were in a

broken condition outside of the carport. Defendant shrugged in response. Brooklin

informed her mother Hannah that defendant had retrieved both of Hannah’s guns

after kicking in the doors to the house and that defendant was going to try to kill

them. Their neighbor Brady then pulled her own vehicle into Hannah’s driveway as

Brady and Brooklin endeavored to remove the children, Armoni and Daeja, from the

house while defendant and Hannah went upstairs. Brooklin noticed that defendant

was holding Hannah by the arm. Brooklin told her mother that Brooklin was going

                                         -9-
                                    STATE V. FLOW

                                   Opinion of the Court

to call the police. Defendant continued to hold Hannah by the arm so that Hannah

was unable to leave after Hannah escorted Armoni and Daeja down the stairs in order

to exit the house with Brooklin and Brady.

      After Brooklin, Brady, Armoni, and Daeja departed from Hannah’s house,

defendant removed the wristwatch from his arm and threw it onto the ground,

causing the wristwatch to break and scatter into pieces. Defendant then grabbed

Hannah and began dragging her upstairs. He pushed Hannah into her bedroom and

then cocked her gun and made sure that it was loaded. Defendant locked the door,

put the gun to the back of Hannah’s head, and threatened to “blow [her] brains out.”

Hannah began praying, at which point defendant pulled her up from the floor and

pushed her into the small bathroom attached to her bedroom. Defendant then shut

the bathroom door and locked it behind him, confining the two of them to the

bathroom. Defendant grabbed Hannah by the neck, placed the gun against her

temple, and began to tell her that she had “used” him. He pushed the gun into

Hannah’s eye socket and continued to threaten her. Hannah begged for her life.

Defendant then ordered Hannah to sit on the floor and to keep her hands flat on the

floor while he began to empty his pockets and to throw the contents into the sink in

search of cigarettes and a lighter. When defendant found his cigarettes and lighter,

he sat on the edge of the shower and began to smoke a cigarette. Defendant blew

smoke from the cigarette into Hannah’s face. Defendant talked about how “it wasn’t

supposed to end like this” and that he had intended to kill himself, defendant’s father,

                                          -10-
                                   STATE V. FLOW

                                 Opinion of the Court

and Hannah when they were all in South Carolina to visit defendant’s father for the

elder’s birthday. Defendant then spoke of getting into a confrontation with a man

with whom he formerly worked and wanting to “kill that ni**er.”

      Defendant continued to blow smoke from his cigarette into Hannah’s face while

they were locked in the small bathroom adjacent to Hannah’s bedroom. Hannah

asked defendant to turn on the ceiling fan or to crack the bathroom door because the

temperature inside the bathroom was hot. Defendant refused Hannah’s request and

then he stood up, stating that he had heard something. Defendant cracked the

bathroom door and noticed that blue lights were flashing from a law enforcement

vehicle across the street. Defendant instructed Hannah to call the emergency

telephone number 911 and to tell emergency personnel to “cut those blue lights off”

or he would “blow [her] brains out.” After Hannah satisfied defendant’s commands so

that defendant would not kill her, defendant directed Hannah to sit back down in the

bathroom with her hands on the floor. When Hannah moved her hand to redirect

some of her hair that had fallen across her face, defendant struck Hannah with the

butt of the firearm. Later, defendant told Hannah that he needed to use the bathroom.

Defendant forced Hannah to straddle the commode and to unzip his pants for him.

Defendant then ordered Hannah to pull out his penis and to aim it toward the toilet

bowl. Defendant continued to hold Hannah’s gun while he urinated. Hannah was

unable to direct defendant’s urine into the toilet bowl and the urine went

“everywhere” while he “just stood there.”

                                        -11-
                                   STATE V. FLOW

                                 Opinion of the Court

      Defendant allowed Hannah to wipe some of his urine from her legs and feet

with a towel. He then instructed her to get off of the commode. Defendant began to

jerk at Hannah’s pants and told her to remove them. Hannah said no. In response,

defendant threatened to “blow [off her] kneecaps.” Defendant pointed the gun at

Hannah and she removed her pants. Defendant then directed Hannah to remove her

shirt; Hannah complied. Defendant pushed Hannah toward the commode, removed

his own pants, and unsuccessfully attempted to put his penis into Hannah’s rectum.

Defendant next tried to put his penis into Hannah’s vagina, also without success.

      Defendant unlocked the bathroom door and pulled Hannah out of the bathroom

and into her bedroom. He pushed Hannah toward the bed and ordered her to get onto

her knees. Defendant then got behind Hannah, put the gun to her back, and stuck

his penis into her vagina and began to have intercourse with her. Defendant made

Hannah turn over as he continued to have intercourse with her. At this point,

Hannah’s telephone was ringing as law enforcement was attempting to get into

contact with her. Defendant then compelled Hannah to lie across the bed and forced

her to put his penis into her mouth to perform fellatio. Subsequently, defendant

allowed Hannah to put her clothing back on. Defendant stated that he was thirsty

and that he wanted a bottle of water. Hannah offered to obtain a bottle of water from

the kitchen for defendant, but he would not allow her to leave the bedroom without

him. Instead, defendant put his arm around Hannah’s neck and placed the gun at her

temple before leaving the bedroom with her.

                                        -12-
                                   STATE V. FLOW

                                 Opinion of the Court

      When defendant and Hannah entered the living room, defendant attempted to

turn on the light, but mistakenly flipped the switch for the ceiling fan instead.

Defendant then began to holler that “they’ve cut the lights off” and pulled Hannah

backwards into another bathroom. Hannah’s telephone rang and defendant answered

it; he began speaking to law enforcement about his desire for some water. Hannah

used the bathroom and both she and defendant drank some water from the faucet of

the bathroom sink before he pulled her back into the bedroom. Defendant then ended

the telephone call with law enforcement and instructed Hannah to take off her clothes

again. He directed Hannah to lie on the bed and defendant inserted his penis into her

vagina. Defendant then rolled onto his back and told Hannah to get on top of him.

Defendant continued to hold the firearm throughout these occurrences. After

defendant allowed Hannah to get off of him, defendant positioned himself behind her

and again inserted his penis into her. When defendant had finished, he allowed

Hannah to put back on her shirt and pants.

      Throughout the night, defendant periodically allowed Hannah to answer

telephone calls from law enforcement officers. He also directed Hannah to call her

pastor, the pastor’s wife, and Hannah’s friend Laurie Parker. Neither Hannah’s

pastor nor the pastor’s wife answered Hannah’s calls, but Parker called Hannah back.

Defendant told Hannah that Hannah “better talk to [Parker] now while [she could].”

At one point, defendant permitted Hannah to answer a telephone call from law

enforcement while defendant attempted to contact his uncle on his own telephone.

                                        -13-
                                    STATE V. FLOW

                                   Opinion of the Court

Defendant’s uncle did not answer defendant’s calls, and defendant then attempted to

reach his uncle’s daughter, Jennifer. When Jennifer answered defendant’s telephone

call, he told Jennifer that he needed to speak with her father and that he had done

something “really bad.” Defendant’s telephone subsequently lost power to operate.

Defendant then looked over at Hannah and said “it’s time.” Defendant told Hannah

that he was going to kill her and then himself. Hannah began to scream and to

attempt to get away from defendant. Hannah then heard a “big boom,” which was the

explosion that the Gaston County Police Department’s Emergency Response Team

had initiated in order to make entry into the house.

      After the Emergency Response Team successfully removed Hannah from the

house, Hannah was reunited with her daughters. Hannah told law enforcement that

defendant had raped her twice. Hannah’s older daughter Brittany then transported

Hannah to the local hospital, where medical professionals recorded Hannah’s medical

history and Hannah’s description of defendant’s assault on her. Hospital staff took

photographs of Hannah’s injuries; conducted a physical examination of Hannah; and

took swabs of Hannah’s fingernails, breast, mouth, vaginal, and external genital

areas. The anal, vaginal, and external genital swabs all tested positive for defendant’s

DNA3 profile. Hannah’s injuries included bald patches on her scalp where defendant

had pulled at her hair, bruises on her arms and the back of her head, abrasions to her

leg and knee, a broken toe, and both internal and external lacerations to her vagina.

      3   Deoxyribonucleic acid.

                                          -14-
                                      STATE V. FLOW

                                    Opinion of the Court

      After the State had rested its case on Friday, 13 December 2019, defense

counsel made a motion to dismiss each charged offense and all lesser-included

offenses against defendant on the grounds that the State’s evidence was insufficient

as a matter of law. The trial court granted defendant’s motions to dismiss both of the

first-degree kidnapping charges and allowed the first-degree burglary charge to go

forward as second-degree but denied the remainder of defendant’s motions to dismiss.

Upon defendant’s election not to testify or to present evidence on his own behalf, the

trial court conducted the following colloquies to ensure that defendant was making

these choices freely, voluntarily, and intelligently. The first colloquy occurred on 13

December 2019 in the following manner:

             [DEFENSE COUNSEL]: I just want for Your Honor to
             inquire with my client regarding he understands he has the
             right to testify. It’s my belief he’s going to elect not to testify
             at this time. I just wanted to get that on the record.

             THE COURT: I will put that on the record now. And I will
             also re-address it Monday, and give him an opportunity to
             think about it over the weekend.

             Mr. Flow, have you been able to go over with your attorneys
             your choice of whether or not you want to testify?

             THE DEFENDANT: Yes, Your Honor.

             THE COURT: Just answer yes or no.

             You have?

             THE DEFENDANT: Yes.

             THE COURT: And have they answered all of your
             questions about that?

                                            -15-
                       STATE V. FLOW

                      Opinion of the Court

THE DEFENDANT: Yes, sir.

THE COURT: And how are you feeling today?

Is your mind clear?

THE DEFENDANT: Yes.

THE COURT: Are you taking any kind of medicines or any
kind of substances at all that would affect how you think
or feel?

THE DEFENDANT: No, sir.

THE COURT: So your mind is clear as we have this
conversation?

THE DEFENDANT: Correct, yes, sir.

THE COURT: And you realize you have the right not to
testify?

THE DEFENDANT: Yes, sir.

THE COURT: Do you also realize, as a result of your
conversation with the attorneys, that you have the right to
testify?

THE DEFENDANT: Yes, sir.

THE COURT: You have both of those rights.

THE DEFENDANT: Right.

THE COURT: And you understand that at this juncture, at
this point in the trial, it is your decision entirely as to
whether or not you decide to testify or not.

Do you understand that?

THE DEFENDANT: Yes.

                             -16-
                         STATE V. FLOW

                        Opinion of the Court

THE COURT: It is not your lawyer’s decision, it’s not the
DA’s decision, it’s not my decision, it’s your decision and
your decision alone.

So have you been able to think some this afternoon about
whether or not you want to testify?

THE DEFENDANT: Yes, sir, I have.

THE COURT: And what is your decision?

THE DEFENDANT: I’m not going to testify.

THE COURT: Okay. Well, that is certainly your right.

Let the record reflect the Court has had the colloquy with
Mr. Flow outside the presence of the jury, at the request of
his counsel. And the decision at this point, 10 till 4 on
December 13th, is not to testify.

Is that correct, sir?

THE DEFENDANT: Correct, sir.

THE COURT: Do you have any questions about your
decision to testify or not?

THE DEFENDANT: No, sir.

THE COURT: How far did you go in school?

THE DEFENDANT: I have a GED, and I had some
technical college.

THE COURT: And some technical beyond a GED?

THE DEFENDANT: Yes, sir.

THE COURT: So then you can read and write?

THE DEFENDANT: Yes, sir.

                               -17-
                                    STATE V. FLOW

                                   Opinion of the Court

             THE COURT: Okay. Does that satisfy —

             [DEFENSE COUNSEL]: Yes, Your Honor.

             THE COURT: — you, Mr. Higdon, about the colloquy the
             Court is required to have?

             [DEFENSE COUNSEL]: Yes, Your Honor.

On Monday, 16 December 2019, the trial court conducted the following additional

colloquy to ensure that it was defendant’s legally acceptable choice not to present

evidence or to testify on his own behalf:

             [DEFENSE COUNSEL]: The defendant will not be putting
             on any evidence.

             THE COURT: Okay. If you would please stand.

             (The defendant complied)

             THE COURT: You’ve been over that choice of yours with
             both Ms. Monteleone and you[r] attorney Mr. Higdon?

             THE DEFENDANT: Yes, yes, Your Honor.

             THE COURT: Do you have any questions about that?

             THE DEFENDANT: No, sir.

             THE COURT: Do you realize it’s your choice and your
             choice alone as to whether or not you put on evidence or
             not?

             THE DEFENDANT: Yes, Your Honor.

             THE COURT: That you have the constitutional right to
             present evidence?

             THE DEFENDANT: Yes.

                                            -18-
                        STATE V. FLOW

                      Opinion of the Court

THE COURT: To offer witnesses on your behalf?

THE DEFENDANT: Yes.

THE COURT: And also you have the constitutional right
not to.

THE DEFENDANT: Yes, Your Honor.

THE COURT: It is not your lawyer’s decision, it is not your
family’s decision, it’s not mine, or the assistant DA’s, it is
yours and yours alone.

Do you have any questions about that?

THE DEFENDANT: No, sir.

THE COURT: Have all of your questions about that issue
been satisfactorily answered by your attorneys, Ms.
Monteleone and Mr. Higdon?

THE DEFENDANT: Yes, Your Honor.

THE COURT: Okay. You may have a seat.

(The defendant complied)

THE COURT: I am finding that that choice, like his choice
not to testify, is made freely, voluntarily, and intelligently,
and that he has had the opportunity to confer with counsel
about that.

....

THE COURT: Have you thought anymore about your
decision not to testify?

I take it that by you not presenting any evidence you also
mean for that to mean you’re not going to testify?

(The defendant stood)

                             -19-
                                     STATE V. FLOW

                                   Opinion of the Court

             THE DEFENDANT: Yes, Your Honor.

Following this exchange, defense counsel renewed the motion, on defendant’s behalf,

to dismiss all of the charges against defendant. The trial court denied the motion and

the jury charge conference took place. The jury was then brought into the courtroom

and it heard closing arguments from both sides before trial proceedings concluded for

the day.

      On the next day of Tuesday, 17 December 2019—the sixth day of trial and the

day that the jury was scheduled to receive its instructions prior to the start of its

deliberations in this case—defendant jumped off of the second-story mezzanine of the

Gaston County Jail by first hanging onto a balcony railing before jumping a distance

of sixteen feet onto the floor below and striking a steel table feet-first. Defendant was

subsequently taken to the CaroMont Regional Medical Center via emergency

transport, where he received surgery for his injuries which resulted from his actions.

Defense counsel challenged defendant’s competency under N.C.G.S. § 15A-1002 to

continue with the trial proceedings and asked the trial court to delay any further

proceedings until such a time as the court was satisfied that it had made an inquiry

as to whether defendant had the capacity to proceed. In response, the State argued

that defendant’s apparent suicide attempt did not implicate his capacity to proceed,

but instead represented a voluntary absence and therefore constituted a waiver of his

constitutional right to be present at every stage of his trial. The trial court instructed

defense counsel to acquire information on defendant’s condition and on the events

                                          -20-
                                   STATE V. FLOW

                                  Opinion of the Court

leading to his absence.

      Following a recess from trial proceedings during which both defense counsel

and the State gathered evidence regarding the events being explored and defendant’s

circumstances, defense counsel called an investigator with the public defender’s

office, Shana Withers, to testify as to defendant’s condition at CaroMont. Withers

testified that defendant was “clearly medicated” and had been fitted with a neck brace

as well as an immobilizing device on his left leg. Withers also testified that

defendant’s trauma surgeon spoke to defendant regarding a surgery that defendant

needed in order to repair the upper femur of defendant’s left leg; the doctor also

reported that defendant had broken two ribs. Withers noted that defendant’s

responses to the doctor were “[r]elatively inaudible” and that defendant appeared to

be having a “hard time responding.” According to Withers, the hospital’s legal counsel

was unable to release defendant’s medical records without a court order, and Withers

further testified that sheriff’s deputies had informed her that no one from the

psychological department of the hospital had examined defendant. Defense counsel

asserted that this testimony met the “textbook definition of incapable of proceeding,”

given that defendant was heavily medicated and was unable to provide intelligible

responses.

      In order to determine whether defendant had forfeited his right to be present

for the trial’s ongoing proceedings by his own actions, the trial court also received

testimony from Assistant Chief Deputy of the Gaston County Sheriff’s Office Darrell

                                         -21-
                                       STATE V. FLOW

                                   Opinion of the Court

Griffin and reviewed camera footage of the incident. Griffin testified that nothing in

his investigation suggested that any other parties were involved in defendant’s

actions. Griffin related that this event occurred when defendant told jail officials that

defendant wanted to return to his jail cell to retrieve his glasses before being brought

to court. The trial court asked Griffin whether defendant had demonstrated any

instances of mental or emotional disturbance during the time that defendant had

been at the jail; Griffin testified that Griffin was not aware of any such occasion. No

other witnesses were called forward to testify by either the State or the defense. The

State argued that defendant had voluntarily absented himself from the trial

proceedings due to defendant’s actions, whereas defense counsel contended that the

resumption of trial proceedings in defendant’s absence “would violate his due process

rights, his right to a jury trial, under the Federal Constitution, the State

Constitution, and the applicable statutes under North Carolina law.” The State also

submitted that defendant’s actions may not have been suicidal in nature at all in light

of the specific aspects of his jump.

      The trial court observed that its inquiry was “limited to a very narrow issue”

of whether defendant’s actions were voluntary, rather than the question of whether

his actions amounted to a suicidal gesture. Upon concluding that defendant’s injuries

were entirely caused by defendant’s own voluntary actions, the trial court determined

that defendant had voluntarily absented himself from the trial proceedings and that

the trial could go forward properly in his absence. Neither the defense nor the State

                                           -22-
                                    STATE V. FLOW

                                  Opinion of the Court

requested any additional findings from the trial court; however, defense counsel

objected to the trial court’s determination on the record before the parties

participated in the remainder of the jury charge conference.

      After deliberating for the remainder of the afternoon of Tuesday, 17 December

2019 and the beginning of the following morning of Wednesday, 18 December 2019,

the jury returned a verdict of guilty on each of the charges against defendant while

he was absent from the trial proceedings. For sentencing purposes, the trial court

submitted for the jury’s consideration the State’s only requested aggravating factor,

to wit: defendant knowingly violated a valid protective order in the course of

constituting the second-degree burglary and first-degree kidnapping. The jury found

the existence of this aggravating factor for purposes of sentencing defendant for his

commission of these two particular crimes. Defense counsel repeatedly made motions

to strike the jury verdicts as violations of defendant’s rights to due process and to a

jury trial under the Constitution of the United States and the Constitution of North

Carolina. The trial court denied these motions and entered judgments against

defendant. On Friday, 20 December 2019, after defendant had returned to court and

in accordance with the jury’s verdicts, the trial court sentenced defendant to

consecutive sentences of incarceration of 276 to 392 months each for the commission

of the crime of first-degree forcible sexual offense and both commissions of the crime

of first-degree forcible rape. Defendant’s convictions for first-degree kidnapping,

second-degree burglary, DVPO violation with a deadly weapon, possession of a

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                                    STATE V. FLOW

                                   Opinion of the Court

firearm by a felon, and false imprisonment were consolidated for judgment with

defendant being sentenced to 180 to 228 months of incarceration to run consecutively

to his three other consecutive sentences. Lastly, defendant was ordered to register as

a sex offender for the remainder of his natural life.

      Defendant appealed to the Court of Appeals, arguing that the trial court erred

in denying defense counsel’s motion to conduct an inquiry into defendant’s capacity

to proceed. Defendant also contended before the lower appellate court that the trial

court’s instructions on first-degree sexual offense deprived defendant of his right to a

unanimous jury verdict; however, this issue is not the subject of the present appeal.

In an opinion filed on 4 May 2021, State v. Flow, 277 N.C. App. 289 (2021), a

unanimous Court of Appeals panel found no error in the judgments entered by the

trial court. The lower appellate court acknowledged this Court’s holding in State v.

Sides, 376 N.C. 449, 450 (2020), in which we determined that the trial court in that

case had erred in concluding that the defendant Sides had waived her constitutional

right to be present at her trial as the result of her suicide attempt and by the trial

court’s subsequent failure to conduct a competency hearing sua sponte to determine

whether the defendant had possessed the capacity to waive her right to be present

where substantial evidence was presented to show that the defendant may have been

incompetent at the time of her suicide attempt. Flow, 277 N.C. App. at 296–97, 299.

In Sides, we concluded that “[o]nce the trial court had substantial evidence that

defendant may have been incompetent, it should have sua sponte conducted a

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                                    STATE V. FLOW

                                  Opinion of the Court

competency hearing to determine whether she had the capacity to voluntarily waive

her right to be present during the remainder of her trial.” 376 N.C. at 457. This Court

observed:

             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.

Id. at 456. We further opined, however, 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 hearing in every
             instance. Rather, our decision is based on our consideration
             of all the evidence in the record when viewed in its totality.

Id. at 466. The Court of Appeals in the present case noted that, unlike in Sides,

nothing in defendant’s prior record, conduct, or actions provided the trial court with

notice or evidence that defendant may have been incompetent. Flow, 277 N.C. App at

299. Furthermore, the trial court here had the opportunity to personally observe

defendant’s conduct and demeanor at the time of his apparent suicide attempt, to

hear arguments from both the State and the defense, and to receive evidence

concerning defendant’s competency before concluding that defendant had voluntarily

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                                    Opinion of the Court

absented himself from the trial proceedings. Id. Finally, unlike the defendant in

Sides, defendant in this case engaged in multiple lengthy colloquies with the trial

court and waived his right to testify or to present evidence on his own behalf. Id. at

300.

       Here, the Court of Appeals decided that there was no substantial evidence

which tended to show, or to support a finding, that defendant may have been

incompetent apart from his apparent suicide attempt; consequently, the trial court

was not required to preside over an additional sua sponte hearing regarding

defendant’s competency after having already conducted an appropriate fact-intensive

inquiry into whether defendant had voluntarily waived his right to be present for the

rest of the trial proceedings due to his intentional actions. Id. at 302. After further

holding that the trial court did not deprive defendant of his right to a unanimous jury

verdict with the trial court’s jury instruction on first-degree sexual offense, the lower

appellate court concluded that defendant had received a fair trial, free from

prejudicial errors, and therefore affirmed the jury’s verdicts and judgments

thereupon entered. Id. at 303–04.

       Defendant petitioned this Court for discretionary review pursuant to N.C.G.S.

§ 7A-31(c) to consider: (1) whether the trial court erred by failing to conduct further

inquiry into defendant’s capacity to proceed, and (2) whether the trial court’s

instruction on sexual offense deprived defendant of his right to a unanimous jury

verdict. This Court allowed review as to the first issue and denied review as to the

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                                   Opinion of the Court

second issue by way of a special order issued on 17 August 2022. As such, our review

in this matter is limited to whether the trial court erred by failing to conduct further

inquiry into defendant’s continued capacity to proceed following defendant’s apparent

suicide attempt on 17 December 2019 after the trial court had determined that

defendant had voluntarily absented himself from the court proceedings as the result

of his actions.

                                  II.    Analysis

       Defendant depicts his appeal as presenting two interrelated arguments in his

claim that the trial court erred in declining to conduct further inquiry into

defendant’s capacity to proceed—one statutory claim arising out of the North

Carolina General Statutes and one constitutional claim arising out of the Due Process

Clause of the Fourteenth Amendment. Because defendant’s claims present questions

of law concerning the trial court’s alleged nonconformance with statutory

requirements and alleged violations of defendant’s constitutional rights, our review

is de novo. State v. Watlington, 216 N.C. App. 388, 394 (2011); State v. Ortiz-Zape,

367 N.C. 1, 10 (2013). In evaluating defendant’s contentions, we hold that the trial

court did not err in declining to make further inquiry into defendant’s capacity to

proceed during the trial proceedings because the trial court received all of the

evidence which the defense was prepared to present at the original hearing and there

was not substantial evidence to indicate that defendant may have lacked capacity at

the time of his apparent suicide attempt.

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                                   Opinion of the Court

   A. Defendant’s Statutory Claim

      First, defendant asserts that the trial court acted in violation of the North

Carolina General Statutes by allowing criminal proceedings to continue against

defendant while he was incompetent to stand trial. The pertinent statutory law

states:

             No 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) (2021). Relevant statutory provisions further provide that a

question regarding a defendant’s capacity to proceed “may be raised at any time on

motion by the prosecutor, the defendant, the defense counsel, or the court” and that,

once a defendant’s capacity to stand trial is called into question, the trial court is

required to “hold a hearing to determine the defendant’s capacity to proceed.”

N.C.G.S. § 15A-1002(a)–(b) (2021). When a competency hearing is conducted,

“[r]easonable notice shall be given to the defendant and prosecutor, and the State and

the defendant may introduce evidence.” N.C.G.S. § 15A-1002(b)(1). “A defendant has

the burden of proof to show incapacity or that he is not competent to stand trial.”

State v. O’Neal, 116 N.C. App. 390, 395 (1994) (citing State v. Gates, 65 N.C. App. 277,

283 (1983)). At the conclusion of such a competency hearing, “[t]he order of the court

shall contain findings of fact to support its determination of the defendant’s capacity

to proceed.” N.C.G.S. § 15A-1002(b1) (2021). “Where the procedural requirement of a

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                                    Opinion of the Court

hearing has been met, defendant must show that the trial court abused its discretion

in denying the motion [for an evaluation of defendant’s capacity to stand trial] before

reversal is required.” Gates, 65 N.C. App. at 284 (citing State v. McGuire, 297 N.C. 69

(1979), cert. denied sub nom McGuire v. State, 444 U.S. 943 (1979)).

      Defendant calls our attention to a definitive request that his counsel made for

a competency hearing after defendant injured himself on 17 December 2019.

Specifically, the attorney stated to the trial court:

             [DEFENSE COUNSEL]: Your Honor, at this time the
             defense makes a motion, based on the best available
             information that I have, that this may be a suicide attempt,
             and I’m going to challenge my client’s competency under
             15A-1002, and the Court should delay any further
             proceedings until the Court is satisfied that it has made an
             inquiry as to whether or not the defendant has the capacity
             to proceed at trial.

We agree that this motion was plainly sufficient to trigger the statutory requirement

that the court “hold a hearing to determine the defendant’s capacity to proceed.”

N.C.G.S. § 15A-1002(b)(1). However, the relevant queries then become (1) whether

the inquiry subsequently conducted by the trial court sufficed to meet the statutory

requirements provided by N.C.G.S. § 15A-1002 and (2) if not, whether defendant has

demonstrated that he was prejudiced by the trial court’s failure to conduct a

statutorily sufficient hearing. See N.C.G.S. § 15A-1443(a) (2021).

      Section 15A-1002 provides sparse guidance regarding the procedural and

substantive requirements of the competency hearing mandated by the statutory

enactment. “Although the present statute requires the court to conduct a hearing

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                                   Opinion of the Court

when a question is raised as to a defendant’s capacity to stand trial, no particular

procedure is mandated. The method of inquiry is still largely within the discretion of

the trial judge.” Gates, 65 N.C. App. at 282. Indeed, this area of the General Statutes

is largely characterized by permissive language delineating what the trial court may

do when conducting a competency hearing, including, but not limited to, the court’s

issuance of an order for a medical examination of the defendant. On the other hand,

there is correspondingly little reference in the statutes to what the trial court shall

do. See, e.g., N.C.G.S. § 15A-1002(b)(1a) and (2). As a result, our appellate courts have

ascertained that “[t]he hearing requirement . . . appears to be satisfied as long as it

appears from the record that the defendant, upon making the motion, is provided an

opportunity to present any and all evidence he or she is prepared to present.” Gates,

65 N.C. App. at 283.

      Consistent with this appropriate construction of the applicable statutory

provisions and applying it to the instant case, we therefore hold that the inquiry

conducted by the trial court following defense counsel’s motion in this case was

statutorily sufficient because defendant was provided an opportunity to present any

and all evidence relating to his competency that he was prepared to present.

Specifically, the trial court released defense counsel to visit defendant in the hospital

and to gather any evidence pertaining to defendant’s absence from court that the

defense saw fit to present. When the parties reconvened and proceedings resumed,

the trial court solicited evidence regarding whether defendant had a history of mental

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                                   Opinion of the Court

illness, evidence regarding whether anyone had witnessed previous instances of

mental or emotional disturbance from defendant, and evidence regarding defendant’s

behavior leading up to, and at the time of, his apparent suicide attempt. In accordance

with N.C.G.S. § 15A-1002(b)(1), both the State and the defense were permitted to

introduce evidence for the trial court’s consideration. The trial court was even able to

review videographic evidence which showed defendant as he jumped from the jail’s

second-story mezzanine. At the conclusion of this hearing, the trial court determined

that defendant had voluntarily absented himself from further proceedings.

      Although the trial court declined to specifically consider whether defendant

had manifested a “suicidal gesture” at the time of his jump, we do not deem the trial

court’s approach to connote inadequate contemplation by the tribunal of the evidence

presented on defendant’s capacity. Suicidality does not automatically render one

incompetent; conversely, a defendant may be found incompetent by way of mental

illness without being determined to be suicidal. However, a defendant cannot be

found to have acted voluntarily if he lacked capacity at the time of his conduct in

question. See Sides, 376 N.C. at 459 (“Logically, competency is a necessary predicate

to voluntariness.”). By receiving evidence concerning defendant’s state of mind

leading up to, and at the time of, his apparent suicide attempt, the trial court was

able to determine whether defendant had acted voluntarily and had thereby waived

his right to be present at all stages of his trial. See State v. Woods, 293 N.C. 58, 64

(1977) (“Clearly, the trial court considered all information relative to defendant’s

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                                   Opinion of the Court

capacity which was presented to it and found, implicitly at least, that defendant was

competent to proceed to trial.”). Therefore, the trial court was not required to make a

specific determination regarding whether defendant’s acts amounted to a suicidal

gesture.

      Because we hold that the trial court’s inquiry into defendant’s capacity to

proceed at the time of his apparent suicide attempt was statutorily sufficient, we

therefore do not need to reach the issue of whether defendant has demonstrated

prejudice. We do note, however, that defendant has made no showing that he was

prejudiced by any failure on the part of the trial court to conduct any further inquiry.

In order to demonstrate prejudicial statutory error in accordance with N.C.G.S. §

15A-1443(a), defendant would have to prove that there was a reasonable possibility

that, had the trial court conducted further inquiry into his capacity to proceed, a

different outcome would have resulted at his trial. Defendant was only absent from

trial for the trial court’s rendition of the charge to the jury and the announcement of

the jury verdicts. Defendant himself expressly waived his right to present evidence

and to testify on his own behalf after two lengthy colloquies with the trial court prior

to his apparent suicide attempt. The trial court instructed the jury that it was not to

speculate about the reason for defendant’s absence or to infer anything from the fact

that defendant was not physically present in court prior to the jury’s deliberations.

Defendant returned to court in person for sentencing on 20 December 2019.

Therefore, assuming arguendo that there was any error in the trial court’s execution

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                                   Opinion of the Court

of defendant’s N.C.G.S. § 15A-1002 hearing, there are no grounds existent to vacate

the trial court’s judgment because it did not prejudice defendant.

   B. Defendant’s Constitutional Due Process Claim

      Second, defendant contends that the trial court violated his constitutional

rights because the Due Process Clause of the Fourteenth Amendment provides that

(1) a criminal defendant has the right to be present at all stages of his own trial

“whenever his presence has a relation, reasonably substantial, to the fulness of his

opportunity to defend against the charge,” Snyder v. Massachusetts, 291 U.S. 97, 105–

06 (1934), and (2) a criminal defendant cannot be tried unless he is competent to

stand trial, Medina v. California, 505 U.S. 437, 439 (1992). Although competency

hearings mandated by state statute are largely within the discretion of the trial

judge, do not confer onto defendants the right to a medical examination, and merely

require that both sides be afforded an opportunity to present evidence bearing on the

issue of competence, hearings arising under the Due Process Clause require trial

judges to actively “elicit adequate information” to “dispel[] the concerns that would

ordinarily arise regarding competency.” United States v. Loyola-Dominguez, 125 F.3d

1315, 1319 (9th Cir. 1997); see also State v. Whitted, 209 N.C. App. 522, 529 (2011).

Under some circumstances, a trial court may even be constitutionally required to

order a psychiatric examination to determine a defendant’s ongoing capacity to stand

trial. State v. Rich, 346 N.C. 50, 61 (1997); State v. Heptinstall, 309 N.C. 231, 235–36

(1983). However, a defendant is not entitled to a competency hearing under the Due

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                                   Opinion of the Court

Process Clause unless substantial evidence is presented which tends to demonstrate

his or her incompetence.

      “[T]he standard for competence to stand trial is whether the defendant has

sufficient present ability to consult with his lawyer with a reasonable degree of

rational understanding and has a rational as well as factual understanding of the

proceedings against him.” Godinez v. Moran, 509 U.S. 389, 396 (1993) (extraneity

omitted). “Even 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

v. Missouri, 420 U.S. 162, 181 (1975). Specifically, a trial court may be required to

investigate a defendant’s competency when presented with evidence which “create[s]

a sufficient doubt of his competence to stand trial.” Id. at 180; see also State v. Young,

291 N.C. 562, 568 (1977) (“A trial court has 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.” (extraneity omitted)).

Generally, this right cannot be waived. See Pate v. Robinson, 383 U.S. 375, 384 (1966)

(“[I]t 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.”). However, a defendant who voluntarily induces his own inability to

proceed may nonetheless be required to stand trial. See, e.g., United States v. Crites,

176 F.3d 1096, 1097–98 (8th Cir. 1999) (holding that trial court did not err in finding

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                                    Opinion of the Court

that defendant was voluntarily absent after a suicide attempt left him unconscious

and hospitalized); Moore v. Campbell, 344 F.3d 1313, 1324 (11th Cir. 2003) (denying

defendant’s petition for habeas corpus after state court found that defendant forfeited

the right to be present by refusing to eat or drink, resulting in his incapacity).

       On the other hand, a defendant in a non-capital case may ordinarily waive his

right to be present at all stages of his trial:

              Where 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) (extraneity omitted). Moreover, “a

defendant may waive the benefit of statutory or constitutional provisions by conduct

inconsistent with a purpose to insist upon it.” Young, 291 N.C. at 567. However, the

Supreme Court of the United States has cautioned that, in order to voluntarily waive

his or her right to be present at trial, a 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.” Taylor, 414 U.S. at 19–20 n.3 (quoting Cureton v.

United States, 396 F.2d 671, 676 (D.C. Cir. 1968)). In other words, a defendant’s

voluntary waiver must be “an intentional relinquishment or abandonment” of his

right to be present. Id. at 19 (quoting Johnson v. Zerbst, 304 U.S. 458, 464 (1938)).

Consequently, this Court has held that a trial court, whenever presented with

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                                    Opinion of the Court

substantial evidence of a defendant’s incompetence, must first determine whether a

defendant possessed the capacity to voluntarily waive his constitutional right to be

present at trial before determining that he or she had voluntarily absented himself

or herself from the proceedings. Sides, 376 N.C. at 459 (“[I]f 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 . . . .”).

         As in Sides, this case raises 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 [himself] that has the effect of absenting

[him] from trial” and potentially causing his present incompetence. Id. at 456. As in

Sides, the determinative issue will be whether the trial court in the instant case had

substantial evidence that defendant may have lacked capacity at the time of his

apparent suicide attempt which resulted in his subsequent incompetence and

inability to be present for the remainder of his trial. Id. at 457. Finally, like in Sides,

the resolution of this issue “requires a fact-intensive inquiry that will hinge on the

unique circumstances presented in [this] case.” Id. at 466. Notably, this Court has

previously established the legal principle, which we have already applied here, that

an apparent suicide attempt does not, standing alone, “automatically trigger[ ] the

need for a competency hearing in every instance.” Id. at 466. Because a suicide

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                                  Opinion of the Court

attempt does not inherently constitute sufficient evidence that a defendant may be

incompetent so as to require a court to conduct further inquiry into his or her ongoing

competence to stand trial prior to making a determination that the defendant had

voluntarily absented himself or herself, we must therefore consider what, if any,

additional evidence existed to support the conclusion that defendant lacked capacity

at the time of his apparent suicide attempt in order to ascertain whether the trial

court was required to conduct further inquiry into defendant’s competence before

concluding that defendant had voluntarily absented himself from further

proceedings.

      “Substantial evidence is such relevant evidence as a reasonable mind might

accept as adequate to support a conclusion.” State v. Bowman, 193 N.C. App. 104, 112

(2008) (quoting State v. Denny, 361 N.C. 662, 664–65 (2007)), cert. denied, 363 N.C.

657 (2009). “[E]vidence 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 there are “no fixed or

immutable signs which invariably indicate the need for further inquiry to determine

fitness to proceed.” Drope, 420 U.S. at 180. Furthermore, the trial court “may have

insights” into a defendant’s competency that are “not conveyed by the record”

available to an appellate court. Pierce v. Underwood, 487 U.S. 552, 560 (1988); see

also Miller v. Fenton, 474 U.S. 104, 116–17 (1985).

      Defendant argues that defense counsel presented the trial court with

                                         -37-
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                                  Opinion of the Court

substantial evidence in the form of three broad categories which called into question

defendant’s ongoing competence to stand trial. First, defendant underscores his

behavior in the events leading up to his arrest, noting that several trial witnesses

testified to his excessive acts on 26 May 2018, including, inter alia, his rants to

Hannah on the telephone about being the target of gunshots and later being pursued

by police while Hannah was driving in her car with her daughter Brooklin, his

repeated and allegedly uncharacteristic use of a racial slur, his claimed inability to

control his own urination, his threats of suicide, and his action of smashing his own

wristwatch with no apparent purpose. Defendant emphasizes that both Hannah and

defendant’s father observed that defendant was “not himself” that day, thus leading

Hannah to wonder if defendant was operating under the influence of mind-altering

substances. Second, defendant points to his apparent suicide attempt on the sixth

day of his trial, which he contends “suggests a rather substantial degree of mental

instability” standing on its own. Drope, 420 U.S. at 181. Lastly, defendant references

Public Defender Investigator Withers’ testimony that defendant was “clearly

medicated” and had trouble communicating when she went to visit him in the hospital

following defendant’s apparent suicide attempt.

      At the outset of our analysis of defendant’s assertions as to the existence of

substantial evidence of his ongoing incapacity to proceed in his trial, we view Ms.

Withers’ testimony as failing to provide any insight into the salient question of

whether there was substantial evidence before the trial court that defendant may

                                         -38-
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                                   Opinion of the Court

have lacked capacity at the time of his apparent suicide attempt. The fact that there

was evidence indicating that defendant might have been incompetent to stand trial

due to the influence of medication prescribed to him as a result of his self-inflicted

injuries is irrelevant, because the evidence is not substantial that defendant lacked

capacity independent of the administration of medication to him after the time of his

apparent suicide attempt. Furthermore, as related above, while a defendant’s attempt

to commit suicide is “an act which suggests a rather substantial degree of mental

instability” by itself, id., it does not automatically trigger the need for a competency

hearing in every case. Sides, 376 N.C. at 466. This Court is, therefore, left to consider

whether any additional indicia of defendant’s incompetence can be combined with his

apparent suicide attempt to support the conclusion that he may have lacked the

capacity on 17 December 2019 to voluntarily absent himself from court proceedings,

thereby necessitating further inquiry into his competence under the Due Process

Clause. See Bowman, 193 N.C. App. at 112.

      Aside from Ms. Withers’ testimony and his self-injurious act on 17 December

2019, the only indicia that defendant offers to support his assertion that the trial

court was presented with substantial evidence which tended to show that he might

have lacked capacity on the date at issue were the oddities of his behavior in the

events leading up to his arrest in 2018. As a preliminary matter, although the nature

of defendant’s crimes and his key behaviors during the scrutinized events may be of

some probative value in determining whether the trial court was presented with

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                                   Opinion of the Court

substantial evidence of defendant’s incompetence, they too “cannot be equated with

mental incompetence to stand trial.” Nguyen v. Reynolds, 131 F.3d 1340, 1346 (10th

Cir. 1997) (“Although the crime itself was horrific and irrational, that alone cannot

be equated with mental incompetence to stand trial.”). Indeed, even if defendant’s

offenses and behavioral absurdities may have been indicative of genuine mental

disturbance, they do not necessarily bear on the issue of competency to stand trial

because “[n]ot every manifestation of mental illness demonstrates incompetence to

stand trial.” United States ex rel. Foster v. De Robertis, 741 F.2d 1007, 1012 (7th Cir.

1984). “Similarly, neither low intelligence, mental deficiency, nor bizarre, volatile,

and irrational behavior can be equated with mental incompetence to stand trial.”

Medina v. Singletary, 59 F.3d 1095, 1107 (11th Cir. 1995). “[R]ather, the evidence

must indicate a present inability to assist counsel or understand the charges.” De

Robertis, 741 F.2d at 1012.

      Although characterizable as bizarre, defendant’s behavior in the events

leading up to his arrest in May 2018, combined with his later apparent suicide

attempt, is inadequate to support the conclusion that defendant may have lacked the

ability to understand the proceedings against him or to assist counsel in preparing

defendant’s defense in December 2019. Unlike in Sides, the trial court in the instant

case was not presented with any evidence tending to indicate that defendant

experienced a prolonged history of severe mental illness that could have hindered his

ability to make a voluntary decision to absent himself from further proceedings. 376

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                                  Opinion of the Court

N.C. at 464–65; see also Pate, 383 U.S. at 378–85. Nor, as in cases such as Loyola-

Dominguez, did defendant give any indication in his interactions with the trial court

or with defense counsel that defendant either failed to understand the nature and

consequences of the proceedings against him or that he was unable to assist properly

in his own defense prior to, or at the time of, his apparent suicide attempt. 125 F.3d

at 1319. With these uncommon circumstances of a criminal defendant’s apparent

suicide attempt which was made during the course of trial proceedings, the trial court

here was uniquely equipped to receive not only oral testimony which detailed

defendant’s behaviors leading up to his injurious act, but also videographic evidence

which showed defendant at the exact time of his apparent suicide attempt. The trial

court was, therefore, in an unusually enabled position to evaluate whether

defendant’s apparent suicide attempt evidenced such a sudden and severe decline in

his mental health that defendant had lost the capacity to voluntarily absent himself

from further proceedings without the trial court’s need to conduct any further inquiry

into defendant’s capacity at that time. See id.

      Moreover, the trial court in this case had ample opportunity to evaluate

defendant’s interactions with counsel and to conduct multiple lengthy colloquies with

defendant throughout the course of trial, including such a conversational engagement

between the trial court and defendant as recently as a single day prior to defendant’s

apparent suicide attempt. During the three separate colloquies that the trial court

conducted with defendant in the week leading up to defendant’s apparent suicide

                                         -41-
                                    STATE V. FLOW

                                  Opinion of the Court

attempt, defendant was lucid and appropriate in his responses. In open court,

defendant confirmed that his head was “clear,” that he wasn’t under the influence of

any mind-altering medications or substances, and that he had conferred with his

attorney in electing to stipulate to his prior felony offense and to decline to testify

and/or present evidence on his own behalf. In addition to his appropriate “yes, sir”

and “no, sir” responses to the trial court’s narrowly designed questions, defendant

capably provided coherent details about his attained level of education and literacy

when prompted. As a result, the trial court was able to conclude that defendant was

entering into these strategic legal decisions “freely, voluntarily, and intelligently”

with the assistance of counsel.

      This form of evidence is especially pertinent because it directly relates to the

crux of competency—whether a defendant, regardless of any mental or emotional

disturbance, has the present ability to understand and to engage meaningfully with

his trial counsel and with the legal proceedings brought against him. See Heptinstall,

309 N.C. at 236 (crediting the fact that, although the defendant provided testimony

that was “bizarre and nonsensical” in response to inquiries about morality or religion,

he was “accurately oriented” to his present circumstances, including the charges

against him); State v. Badgett, 361 N.C. 234, 260 (2007) (stating that “[t]he record

shows that defendant was able to interact appropriately with his attorneys during

the trial[,]” that he “followed their advice by declining to testify during the guilt-

innocence phase[,]” and that he “also responded directly and appropriately to

                                         -42-
                                    STATE V. FLOW

                                   Opinion of the Court

questioning during the capital sentencing proceeding as well as to the trial court’s

inquiries throughout the trial”). Cf. Drope, 420 U.S. at 180–81 (stating that “as a

result of petitioner’s absence” during a “crucial portion” of his trial, “the trial judge

and defense counsel were no longer able to observe him in the context of the trial and

to gauge from his demeanor whether he was able to cooperate with his attorney and

to understand the nature and object of the proceedings against him”). In addition,

unlike in Heptinstall and Badgett, defendant’s interactions with the trial court in this

case were exclusively lucid and provided no indication of incompetency or even any

degree of mental disturbance.

      Based upon our review of the record, we conclude that, taking the facts on the

whole which were before the trial court in the present case, there was not substantial

evidence here which tended to cast doubt on defendant’s competency at the time of

his apparent suicide attempt. The trial court was able to directly observe defendant

over the course of the trial; to conduct multiple lengthy colloquies with defendant in

the days of the trial which immediately preceded defendant’s absence; and to receive

and review evidence, including surveillance footage, detailing defendant’s actual

demeanor at the time of his apparent suicide attempt. Unlike other cases in which

this Court has held that sufficient evidence existed to warrant additional inquiry into

a defendant’s capacity under the Due Process Clause, the trial court in this case was

not presented with any evidence which tended to indicate that defendant had a

history of mental illness; likewise, none of defendant’s interactions with the trial

                                          -43-
                                       STATE V. FLOW

                                   Opinion of the Court

court tended to cast doubt upon his ability to appropriately participate in and to

understand the legal proceedings against him. Rather, the only evidence which

tended to indicate defendant’s incompetence on the morning of 17 December 2019

was: (1) his apparent suicide attempt itself, and (2) the nature of defendant’s crimes

and his behaviors at the time that his criminal offenses were committed in May 2018.

We hold that these indicia, standing alone or in combination with each other, were

not adequate to support the conclusion that defendant may have lacked competency

at the time of his apparent suicide attempt. Therefore, the trial court was not

constitutionally required to conduct any further inquiry into defendant’s competency

prior to making its determination that defendant had voluntarily absented himself

from the trial proceedings.

                                III.     Conclusion

      In light of our determination that the trial court was not required to conduct

further inquiry into defendant’s continued capacity to proceed following the trial

court’s hearing concerning defendant’s apparent suicide attempt, we affirm the

decision of the Court of Appeals, thereby affirming the jury’s verdicts at trial and the

trial court’s judgments which were entered against defendant.

      AFFIRMED.

                                           -44-
                                    STATE V. FLOW

                                   Earls, J., dissenting

      Justice EARLS dissenting.

      A criminal defendant’s right not to stand trial unless competent to do so is a

vital part of American jurisprudence, with its origin tracing back to the common law.

See, e.g., Medina v. California, 505 U.S. 437, 446 (1992); see also Youtsey v. United

States, 97 F. 937, 940 (6th Cir. 1899) (collecting cases). This right is enshrined in our

federal Constitution under the Due Process Clause of the Fifth and Fourteenth

Amendments. U.S. Const. amend. V; U.S. Const. amend. XIV; see also Pate v.

Robinson, 383 U.S. 375 (1966) (holding that when a defendant is not provided with

procedures adequate to protect their right not to be tried or convicted while

incompetent, their due process right to a fair trial is violated). Importantly, our

federal Constitution guarantees every criminal defendant due process protection, no

matter how heinous their crime. See U.S. Const. amend. V (“No person shall be . . .

deprived of life, liberty, or property, without due process of law[.]”); see U.S. Const.

amend. XIV (“[N]or shall any state deprive any person of life, liberty, or property,

without due process of law[.]”); see also Drope v. Missouri, 420 U.S. 164, 180 (1975)

(finding a due process, competency to stand trial violation, for a defendant who was

charged along with two others in the forcible rape of his wife); see also Pate, 383 U.S.

at 376, 385–86 (finding that a defendant who murdered his common-law wife had his

due process rights “abridged” because he did not “receive an adequate hearing on his

competence to stand trial”).

                                           -45-
                                    STATE V. FLOW

                                   Earls, J., dissenting

      As early as 1899, the Sixth Circuit explained that “[i]t is fundamental that an

insane person can neither plead to an arraignment, be subjected to a trial, or after

trial, receive judgment, or, after judgment, undergo punishment.” Youtsey, 97 F. at

940. The United States Supreme Court has since explained that “a person whose

mental condition is such that he lacks the capacity to understand the nature and

object of the proceedings against him, to consult with counsel, and to assist in

preparing his defense may not be subjected to trial.” Drope v. Missouri, 420 U.S. at

171. This Court has held that “a trial court has 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. Young, 291 N.C

562, 568 (1977) (cleaned up) (quoting Crenshaw v. Wolff, 504 F.2d 377 (8th Cir. 1974)).

Furthermore, because a defendant’s competency status can change over time, “a trial

court must always be alert to circumstances” that may signal a change in a

defendant’s competency. State v. Sides, 376 N.C. 449, 458 (2020) (quoting Drope, 420

U.S. at 181). Indeed, questions of competency can arise at any time, even for the first

time during trial. Id.

      In like manner, North Carolina also affords defendants a statutory protection

against being subjected to trial when they are not competent. See N.C.G.S. § 15A-

1001(a) (2021); see also N.C.G.S. § 15A-1002(a) & (b)(1) (2021). Thus, at the time of

Mr. Flow’s proceeding, the trial court had at least two reasons to conduct a

competency hearing: one based on North Carolina’s statutory protections, and

                                           -46-
                                    STATE V. FLOW

                                   Earls, J., dissenting

another based on Mr. Flow’s federal constitutional rights.

      As the majority carefully documents, the crime in this case was undoubtedly

beyond horrific for the victims. Without question, “[t]he Government’s interest in

bringing to trial an individual accused of a serious crime is important.” Sell v. United

States, 539 U.S. 166, 180 (2003). “[T]he Government seeks to protect through

application of the criminal law the basic human need for security.” Id. (citing Riggins

v. Nevada, 504 U.S. 127 at 135–136 (1992) (“[P]ower to bring an accused to trial is

fundamental to a scheme of ‘ordered liberty’ and prerequisite to social justice and

peace.” (alteration in original) (quoting Illinois v. Allen, 397 U.S. 337, 347 (1970)

(Brennan, J., concurring)))). However, at the same time, “the Government has a

concomitant, constitutionally essential interest in assuring that the defendant’s trial

is a fair one.” Id. To be fair, the trial must comport with statutory and constitutional

guarantees. “If a defendant is incompetent, due process considerations require

suspension of the criminal trial until such time, if any, that the defendant regains

the capacity to participate in his defense and understand the proceedings against

him.” Medina, 505 U.S. at 448 (citing Dusky v. United States, 362 U.S. 402 (1960) (per

curiam)). If we decide that defendants who commit especially heinous crimes do not

need to be afforded due process rights, we undermine the very foundation of the rule

of law. Furthermore, to be clear, as we said in Sides, a retrospective competency

hearing rather than a new trial is a possible remedy in these circumstances. See

Sides, 376 N.C. at 466.

                                           -47-
                                    STATE V. FLOW

                                  Earls, J., dissenting

   A. Statutory Protections

   In North Carolina a defendant has a statutory right not to 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). When a defendant meets the above criteria, they are said to

have “incapacity to proceed.” Id. A court must “hold a hearing to determine the

defendant’s capacity to proceed” if a question is raised regarding the defendant’s

capacity. N.C.G.S. § 15A-1002(b)(1). A defendant’s capacity to proceed “may be raised

at any time on a motion by the prosecutor, the defendant, the defense counsel, or the

court.” N.C.G.S. § 15A-1002(a). Under this framework, once the question of capacity

is raised, the defendant is not required to show evidence of incapacity to trigger a

hearing. N.C.G.S. §§ 15A-1001(a) & 15A-1002(a). This is a significant distinction. The

issue here is not whether the evidence demonstrates that Mr. Flow was, at the time

of his attempted suicide, not competent to stand trial. Rather it is simply whether the

evidence was substantial enough to trigger the right to a hearing on that question.

      In this case, as he was being brought to court for trial proceedings, Mr. Flow

jumped off the second story of the Gaston County Jail and was seriously injured,

requiring surgery. Mr. Flow’s counsel subsequently raised the issue of competency

and asked that the court make an inquiry into Mr. Flow’s capacity to proceed. Defense

counsel specifically noted, that “based on the best available information” Mr. Flow’s

                                          -48-
                                   STATE V. FLOW

                                  Earls, J., dissenting

actions may have been “a suicide attempt” and counsel thus raised a challenge to Mr.

Flow’s competency pursuant to N.C.G.S. § 15A-1002. Accordingly, defense counsel

asked the court to delay proceedings until a hearing addressing Mr. Flow’s capacity

to proceed had been conducted. The trial court took the matter under advisement and

asked defense counsel to obtain additional information on the length of Mr. Flow’s

unavailability. While the trial court ultimately held a hearing, this hearing did not

meet the requirements delineated in N.C.G.S. § 15A-1002. Under that statute, Mr.

Flow was entitled to a hearing to determine whether he had the “capacity to proceed”

with trial. N.C.G.S. § 15A-1002(b)(1). However, rather than considering whether Mr.

Flow was competent to proceed, the trial court examined whether his jump from the

second story of the Gaston County Jail was a voluntary action absenting him from

court. Those are two different questions. Compare Ryan v. Gonzales, 568 U.S. 57, 66

(2013) (holding 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” (cleaned up)) with Taylor v. United States, 414 U.S. 17, 19 & n.3 (1973)

(holding that a defendant in a non-capital case waives his right to be present if he

voluntarily absents himself while being aware of the processes taking place, of his

right and obligation to be present and having no sound reason for remaining away).

      The majority contends that because N.C.G.S. § 15A-1002 provides little

guidance on the appropriate procedural and substantive requirements for a

                                          -49-
                                    STATE V. FLOW

                                   Earls, J., dissenting

competency hearing, any hearing that allows a defendant to present “any and all

evidence [they] are prepared to present” is sufficient to satisfy the statutory

requirement. State v. Gates, 65 N.C. App. 277, 283 (1983). In the first instance, the

problem with this approach is that what matters is not simply whether the defendant

can present evidence but what question the hearing is intended to resolve, what facts

are relevant to that question, and what legal standard applies. Moreover, contrary to

the majority’s assertion, N.C.G.S. § 15A-1002’s language does provide the trial court

with important guidance. Namely, that a court must “hold a hearing to determine the

defendant’s capacity to proceed” if a question is raised as to defendant’s capacity.

N.C.G.S. § 15A-1002(b)(1). This means that Mr. Flow was entitled to a hearing to

determine whether he had the “capacity to proceed” with trial and not a hearing to

determine whether his absence from the courtroom was the result of a voluntary

action. See N.C.G.S. § 15A-1002. This is precisely what we held in Sides, 376 N.C. at

456.

       Crucially, a court cannot consider if a defendant’s actions were taken

voluntarily without first determining if the defendant had the capacity to take a

voluntary action. Sides, 376 N.C. at 457. When a defendant voluntarily absents

themselves from trial, they make an “intentional relinquishment or abandonment of

a known right or privilege.” Taylor, 414 U.S. at 19 (quoting Johnson v. Zerbst, 304

U.S. 458, 464 (1938)); see also Sides, 376 N.C at 458–59 (“[I]n order to waive the right

to be present [at trial], there must be an intentional relinquishment or abandonment

                                           -50-
                                   STATE V. FLOW

                                  Earls, J., dissenting

of that right.” (cleaned up)). Thus, it follows that assessing the voluntariness of a

defendant’s actions without first determining their competency “put[s] the cart before

the horse,” as a defendant cannot engage in a voluntary action unless they are

competent to do so. Sides, 376 N.C. at 457. Accordingly, because the trial court’s

hearing addressed whether Mr. Flow acted voluntarily when he jumped from the

second story of the Gaston County Jail, and not whether he had the competency to

proceed with trial, the hearing pursuant to N.C.G.S. § 15A-1002 was inadequate to

satisfy the statutory mandate.

   B. Constitutional Protections

      Mr. Flow also has a constitutional due process right not to be tried unless he

is competent to stand trial. U.S. Const. amend. V; U.S. Const. amend. XIV; see also

Pate v. Robinson, 383 U.S. 375 (1966). This constitutional right establishes a trial

court’s duty to hold a competency hearing sua sponte if the court is presented with

substantial evidence calling a defendant’s competence into question. Young, 291 N.C.

at 568; Sides, 376 N.C. at 458. Adherence to this requirement ensures that only

competent defendants are subjected to trial.

      While it is true that a non-capital defendant can waive their right to be present

at trial by voluntarily absenting themselves, Taylor, 414 U.S. at 19, it is also true

that a defendant must be competent to take a voluntary action. Pate, 383 U.S. at 384.

This means that, as with the statutory right, under the constitutional analysis a court

cannot determine the voluntariness of a defendant’s actions or whether they waived

                                          -51-
                                     STATE V. FLOW

                                    Earls, J., dissenting

their right to be present at trial through those actions, without first determining their

competency. Sides, 376 N.C. at 457, 459. Indeed, as this Court explained in Sides, “[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.” Id.

at 459.

      State v. Sides is directly on point and controlling here. A court cannot

“essentially skip[ ] over the issue of competency and simply assum[e] that [a]

defendant’s suicide attempt was a voluntary act that constituted a waiver of [their]

right to be present during . . . [their] trial .” Id. at 456–57. Instead, in circumstances

where a trial court has “substantial evidence that [a] defendant may have been

incompetent,” it is required to conduct a competency hearing “to determine whether

[the defendant] had the capacity to voluntarily waive [their] right to be present” at

trial. Id. at 457 Following United States Supreme Court precedent, Sides articulated

a standard, which provides 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.” Id. at 462 (quoting

Drope, 420 U.S. at 180).

      Although in Sides this Court stated “that a defendant’s suicide attempt [does

not] automatically trigger[ ] the need for a competency hearing in every instance,” id.

at 466, Sides also explained that a “defendant’s suicide attempt itself ‘suggests a

                                            -52-
                                      STATE V. FLOW

                                     Earls, J., dissenting

rather substantial degree of mental instability.’ ” Id. at 464 (quoting Drope, 420 U.S.

at 181). The United States Supreme Court and some federal circuit courts have also

indicated the same. Drope, 420 U.S. at 181 (stating that suicide “suggests a rather

substantial degree of mental instability”); see also United States v. Loyola-

Dominguez, 125 F.3d 1315, 1319 (9th Cir. 1997) (“[Defendant]’s suicide attempt on

the eve of trial raised significant doubts regarding his competency to stand trial. In

these circumstances, due process required a hearing to ascertain whether or not he

was competent.”); Maxwell v. Roe, 606 F.3d 561, 570–71 (9th Cir. 2010) (holding that

defendant’s attempted suicide “in the midst of trial” was a significant factor

warranting a competency inquiry); United States v. Mason, 52 F.3d. 1286, 1287, 1293

(4th Cir. 1995) (determining that the district court should have granted a

retrospective competency hearing after defendant attempted suicide following his

conviction on federal drug charges); Estock v. Lane, 842 F.2d 184, 186, 189 (7th Cir.

1988) (per curiam) (concluding that at a retrospective competency hearing, the federal

district court properly concluded that petitioner had not been competent at his plea

hearing, in part, because he had attempted suicide six days prior)1; Saddler v. United

States, 531 F.2d 83, 86 (2nd Cir. 1976) (per curiam) (holding that when evidence of

defendant’s history of mental illness, including a suicide attempt, became known to

1 The standard for competence to stand trial is the same as the standard for competence to
plead guilty and to waive the right to the assistance of counsel. Godinez v. Moran, 509 U.S.
389, 398 (1993) (“[W]e reject the notion that competence to plead guilty or to waive the right
to counsel must be measured by a standard that is higher than (or even different from) the
Dusky standard.”).

                                             -53-
                                    STATE V. FLOW

                                   Earls, J., dissenting

the trial court, it was error for the court not to order an evaluation into defendant’s

competency). Thus, even though a suicide attempt standing alone may not

automatically trigger the need for a competency hearing in every instance, Sides 376

N.C. at 466, evidence of a suicide attempt must be analyzed alongside other evidence

in the record of a “defendant’s irrational behavior, [their] demeanor at trial, and any

prior medical opinion on competence to stand trial.” Sides, 376 N.C. at 462 (quoting

Drope, 420 U.S. at 180–81).

      In Drope, the United States Supreme Court noted that it “was sufficiently

likely that in light of the evidence of [defendant’s] behavior including his suicide

attempt . . . [that] the correct course was to suspend the trial until such an evaluation

could be made.” Drope, 420 U.S. at 181. There, the additional evidence in the record

included, inter alia, testimony from defendant’s wife that she believed “her husband

was sick and needed psychiatric care” and that he had tried to choke and kill her the

night before. Id. at 165–66. Furthermore, in Pate v. Robinson, the Court reviewed

testimony in the record detailing the defendant’s history of disturbed behavior,

including instances of erratic conduct and paranoia. 383 U.S. 375, 378–79 (1966). In

both cases, the Court determined that the defendant was entitled to a competency

hearing and the trial court’s failure to provide such a hearing was a violation of the

defendant’s constitutional rights. Id. at 386; Drope, 420 U.S. at 172, 180.

      Similarly, in Mr. Flow’s case, Hannah testified that on the day of the incident

Mr. Flow was talking in a way “[she] had never heard him talk before,” and that when

                                           -54-
                                    STATE V. FLOW

                                  Earls, J., dissenting

she called Mr. Flow’s father to ask what was “going on with [him],” his father stated

that Mr. Flow was “not his normal self.” Hannah further testified that Mr. Flow had

acted strangely by “grabb[ing] his watch and jerk[ing] it off his arm” and for no

apparent reason “sl[inging]” it onto the floor where it broke into pieces. When Hannah

and Mr. Flow entered Hannah’s living room, and reached a tall lamp that Hannah

owned, “[Mr. Flow] stopped and slammed [the lamp] on the ground and stepped over

it.” Hannah responded by asking “what are you doing, why are you acting like this,

what’s going on.” She later said to him “what are you talking about, you’re talking

crazy, I don’t understand anything you are saying.” Furthermore, Hannah testified

that during the commission of Mr. Flow’s crime, while the police were attempting to

speak with him, rather than engage in conversation with them, Mr. Flow “was saying

something about water.” Mr. Flow had experienced suicidal ideation on at least two

prior occasions, both of which he shared with Hannah during the incident that led to

his arrest. The first was when Mr. Flow told Hannah “it wasn’t supposed to be this

way” because she was “supposed to [have gone] to South Carolina” with him where

he was “gonna kill [his] daddy and then [Hannah] and then [himself].” The second

time was while Hannah was on the phone with the police, and Mr. Flow stated “[I]t’s

time . . . I’m gonna kill you and I’m gonna kill myself.” This evidence was relevant to

whether Mr. Flow was competent at the time of his suicide attempt during trial. As

in Pate and Drope, Mr. Flow was entitled to a hearing to determine whether he was

competent to stand trial. Pate, 383 U.S. at 386; Drope, 420 U.S. at 180. The trial

                                          -55-
                                    STATE V. FLOW

                                   Earls, J., dissenting

court’s failure to examine the issue of his competency was a violation of Mr. Flow’s

constitutional right to a fair trial. See Pate, 383 U.S. at 385; see Drope, 420 U.S. at

172, 180.

      The State argues and the majority agrees that the trial court’s colloquies with

Mr. Flow refute the presence of substantial evidence sufficient to raise doubt as to

Mr. Flow’s competency. In Pate, the United States Supreme Court explained the role

that colloquies between the court and the defendant might have in determining

competency to stand trial. 383 U.S. at 386. There, despite having information

suggesting the defendant was incompetent, the Illinois Supreme Court ultimately

determined this evidence was not sufficient to warrant a competency hearing because

the defendant had displayed “mental alertness and understanding . . . in [his]

colloquies with the trial judge.” Id. at 385 (cleaned up). Nevertheless, the United

States Supreme Court concluded that even though the defendant had exhibited

“mental alertness and understanding” in his exchanges with the trial court, this

information while relevant, could not be used to dispense with a competency hearing.

Id. at 385–86.

      In this case the trial court engaged in three relevant colloquies with Mr. Flow.

The first colloquy took place on 9 December 2019 when the court asked Mr. Flow

whether he was willing to stipulate to his prior felony conviction, and after consulting

with defense counsel, Mr. Flow replied “Yes, I - - yes, sir.” The court subsequently

asked Mr. Flow if he was making this decision “freely and voluntarily and of [his] own

                                           -56-
                                    STATE V. FLOW

                                  Earls, J., dissenting

free will.” Mr. Flow stated that he was. During the second colloquy on 13 December

2019, the Court asked Mr. Flow if his “mind was clear,” and Mr. Flow answered “Yes.”

In the third colloquy on 16 December 2019, the court asked Mr. Flow if he had

discussed his choice not to present evidence with defense counsel, whether he had

any questions about this, and whether he understood that it was his choice and only

his choice to decide whether he wanted to present evidence. Mr. Flow responded “Yes,

Your Honor,” indicating his understanding. Mr. Flow also acknowledged his

constitutional right and indicated he did not want to testify on his own behalf.

      The majority finds these colloquies to be “especially pertinent” in determining

whether substantial evidence of Mr. Flow’s incompetence to stand trial was presented

to the trial court. Namely, the majority states that these colloquies speak to whether

Mr. Flow had the ability to understand the legal proceedings against him, and

meaningfully consult with his attorney. The majority believes that because Mr. Flow

was “lucid and appropriate in his responses” the trial court was not required to hold

a competency hearing; however, this cannot be true. For “[e]ven when a defendant is

competent at the commencement of his trial,” this can change, and “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.” Sides, 376 N.C. at 458

(alteration in original) (quoting Drope, 420 U.S. at 181). Thus, while these colloquies

may be relevant in ascertaining Mr. Flow’s competency at the time they occurred,

they are not instructive as to Mr. Flow’s competency on the day of his suicide attempt,

                                          -57-
                                    STATE V. FLOW

                                   Earls, J., dissenting

the days following his suicide attempt, or at the time defense counsel raised the issue

of competency. Accordingly, these colloquies are relevant to but not sufficient to

“dispense with a hearing” to determine Mr. Flow’s competency. See Sides, 376 N.C.

at 463 (quoting Pate, 383 U.S. at 385–86).

      In addition, the State argues that Mr. Flow’s actions leading up to his suicide

attempt showed that he was competent at the time he jumped from the Gaston

County Jail’s second story, and thus that action was taken voluntarily. On the day

Mr. Flow attempted suicide, the officer removed him from his cell for court. Mr. Flow

asked the officer if he could return to his cell to retrieve his glasses and the officer

allowed him to do so. Shortly thereafter a radio call went out stating that Mr. Flow

was hanging off the second floor of the Gaston County Jail. The State suggests that

Mr. Flow’s actions leading up to his suicide attempt imply that he acted voluntarily

in absenting himself from court. Specifically, the State contends that because Mr.

Flow jumped off the jail mezzanine instead of retrieving his glasses from his cell, and

attempted suicide by hanging off the second story of the jail before landing on a table

sixteen feet below, this guarantees that Mr. Flow was “lucid” when he jumped.

      However, the proper analysis in this case requires a trial court to consider Mr.

Flow’s evidence of incompetency in the aggregate, including his previous suicidal

ideation and erratic behavior on the day of his arrest. Drope, 420 U.S. at 180 (stating

the defendant’s “attempt to commit suicide ‘did not stand alone’ ” (quoting Moore v.

United States, 464 F.2d 663, 666 (9th Cir. 1972))). In the end, “[w]hatever the

                                           -58-
                                      STATE V. FLOW

                                     Earls, J., dissenting

relationship between mental illness and incompetence to stand trial, in this case the

bearing of the former on the latter was sufficiently likely that, in light of the evidence

of petitioner’s behavior including his suicide attempt . . . the correct course was to

suspend the trial until” an evaluation into his competency was made. Id. at 181.

       The competency to stand trial standard requires that a defendant have

“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.” Dusky v. United States, 362 U.S. 402, 402 (1960) (per

curiam). While it is true that competency to stand trial must be determined by an

analysis of the relevant evidence in the record, and that a suicide attempt is but one

piece of that evidence, a defendant whose suicide attempt is the result of psychotic

symptoms may not be competent to stand trial.2 Defendants who experience psychotic

symptoms may exhibit “cognitive or perceptual dysfunction, mainly delusions or

hallucinations.” Jeffrey A. Lieberman & Michael B. First, Psychotic Disorders, 379

New England J. of Med. 270, 270 (2018). In many cases, people experiencing these

symptoms do not possess the ability to have a “rational understanding of the

proceedings against [them].”3 See Dusky, 362 U.S. 402 (1960). Only a trained mental

2 Psychotic symptoms can be present in several psychiatric conditions. For example, a person
suffering from schizophrenia, bipolar disorder, or depression with psychotic features can
experience symptoms of psychosis. Jeffrey A. Lieberman & Michael B. First, Psychotic
Disorders, 379 New England J. of Med. 270, 271 (2018).
3 Studies investigating the relationship between mental illness and competency to stand trial

have “generally found that a large portion . . . of defendants [experiencing psychosis] are
judged incompetent.” Jodi Viljoen, Ronald Roesch, and Patricia A. Zapf, An Examination of

                                             -59-
                                      STATE V. FLOW

                                     Earls, J., dissenting

health professional can determine whether Mr. Flow’s behavior is consistent with

psychosis. Ultimately, because the trial court did not hold a hearing assessing Mr.

Flow’s competency, we cannot yet know whether Mr. Flow’s suicide attempt during

trial was indicative of, or resulted from, a mental condition that would render him

incompetent to stand trial.

   C. Adequacy of the Trial Court’s Hearing

       The hearing conducted by the trial court was inadequate for at least three

reasons. As previously stated, N.C.G.S. § 15A-1002(b)(1) does not contemplate a

hearing to determine the voluntariness of a defendant’s actions; instead, it mandates

that a hearing be held to determine a “defendant’s capacity to proceed.” N.C.G.S. 15A-

1002(b)(1). Thus, when defense counsel raised the question of Mr. Flow’s competency,

the trial court was required to hold a hearing addressing Mr. Flow’s competency, not

the voluntariness of his actions. See N.C.G.S. 15A-1002(b)(1). Additionally, our

decision in Sides, as well as United States Supreme Court precedent, requires a trial

court to first determine whether a defendant is competent prior to determining

whether their suicide attempt was the result of a voluntary action. Sides, 376 N.C. at

the Relationship Between Competency to Stand Trial, Competency to Waive Interrogation
Rights, and Psychopathology, 26 Law and Hum. Behav. 481, 484 (2002). Furthermore, in one
study, defendants with primary psychotic disorders were found to have performed
significantly worse on tests measuring three factors: (1) their understanding of the nature
and object of their legal proceedings, including arrest, the charges against them, the role of
key participants, the legal process itself, pleas and courtroom procedures; (2) their
understanding of the potential consequences of the legal proceedings; and (3) their ability to
communicate with counsel. Id. at 488, 493–494.

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                                        STATE V. FLOW

                                      Earls, J., dissenting

459; Pate, 383 U.S. at 384. However, the trial court acted in a manner contrary to

Sides by only considering whether Mr. Flow acted voluntarily when he jumped from

the second story of the Gaston County Jail. See Sides, 376 N.C. at 459 (“[I]f 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

trial through her own conduct.”).

       Lastly, in the hearing it did hold, the trial court failed to take into account all

the evidence before it. Specifically, it declined to consider whether Mr. Flow’s actions

were the result of “suicidal gesture.” This was despite defense counsel having noted

Mr. Flow’s absence from court was “surrounded by mental health issues and a suicide

attempt.”4 The trial court incorrectly reasoned that its task to determine whether the

trial should proceed in Mr. Flow’s absence was divorced from whether Mr. Flow’s

actions had been caused by suicidal behavior. Instead, the court made findings of fact

related to whether the defendant had taken a voluntary action or if “perhaps [he] had

[been] pushed” or may have “slipped.” Ultimately, the trial court decided Mr. Flow

had acted voluntarily when he jumped off the second story of the jail building and

4The Court of Appeals has previously stated that “[b]ecause defense counsel is usually in the
best position to determine that the defendant is able to understand the proceedings and assist
in his defense, it is well established that significant weight is afforded to a defense counsel’s
representation that his client is competent.” State v. McRae, 163 N.C. App. 359, 369 (2004).
Thus, it follows that “significant weight” should also be afforded to defense counsel’s
representation that their client may not be competent. See id.

                                              -61-
                                    STATE V. FLOW

                                   Earls, J., dissenting

“that the trial [would] in fact go forward.” However, whether a defendant’s actions

are suicidal in nature speaks directly to the issue of competency, and although it is

true that a suicide attempt in and of itself does not automatically determine the need

for a competency hearing, it suggests the presence of mental instability and should

be analyzed alongside other evidence in the record. Sides, 376 N.C. at 464 (citing

Drope, 420 U.S. at 181).

      Accordingly, the trial court’s hearing was inadequate because it not only side

stepped the issue of competency by only addressing the voluntariness of Mr. Flow’s

actions, but also because in doing so, the court failed to properly consider all the

evidence relevant to whether Mr. Flow was competent at that point to stand trial.

   D. State v. Sides

      This Court decided Sides a little over two years ago. The majority attempts to

distinguish Sides from the instant case on the grounds that, because a defendant’s

suicide attempt does not automatically trigger the need for a competency hearing in

every case, “[t]his Court is, therefore, left to consider whether any additional indicia

of defendant’s incompetence can be combined with his apparent suicide attempt to

support that he may have lacked the capacity to . . . voluntarily absent himself from

the court proceedings.”    The majority suggests that Mr. Flow’s crimes and his

behavior during those crimes are not relevant to whether the trial court was

presented with substantial evidence of Mr. Flow’s incapacity to proceed, and thus the

trial court was not required to hold a competency hearing. However, our opinion in

                                           -62-
                                    STATE V. FLOW

                                   Earls, J., dissenting

Sides is not this narrow. Instead, whether there is substantial evidence of a

defendant’s incompetence to stand trial is a “fact intensive inquiry” into “evidence of

a defendant’s irrational behavior, his demeanor at trial and any prior medical opinion

on competence to stand trial.” Sides, 376 N.C. at 462, 466. Moreover, a defendant’s

“history of disturbed behavior, including instances of erratic conduct” are also

relevant in determining whether substantial evidence existed to warrant a

competency hearing. Id. at 462–63 (citing Pate, 383 U.S. at 378–79).

      There was substantial evidence before the trial court to trigger the need for a

competency hearing and defense counsel explicitly requested one. The majority fails

to properly apply Sides and concludes that it was not error in these circumstances to

deny counsel’s request for a competency hearing. I would remand the case to the trial

court for a retrospective hearing based on all the evidence in the record relevant to

Mr. Flow’s mental state at the time the competency hearing was requested by

counsel. Therefore, I respectfully dissent.

                                           -63-