Competency to Stand Trial Turns on Present Functional Understanding—not Etiology (TBI vs. Mental Illness)—and Retroactive Reevaluation Requires Preservation and Changed Circumstances

1. Introduction

In State of West Virginia v. Alex Hunter Mills (W. Va. July 28, 2026) (memorandum decision), the Supreme Court of Appeals of West Virginia affirmed Alex Hunter Mills’s convictions for two counts of third-degree sexual assault. The case arose from allegations that, in June 2020, Mills (age 18) engaged in sexual intercourse with T.D.L. (age 12). The appeal did not contest the jury’s factual findings; instead, it challenged the due-process adequacy of the competency-to-stand-trial process.

Mills argued that evaluators and the circuit court improperly framed competency around “mental health issues,” while the “pertinent issue” was an intellectual disability allegedly caused by a traumatic brain injury (TBI). The State responded that West Virginia’s statutory competency framework adequately tests competency regardless of whether the source is mental illness, cognitive disability, or an alleged TBI.

The key issues were:

  • Whether the circuit court abused its discretion in finding Mills competent to stand trial after restoration treatment.
  • Whether due process required an additional (fourth) and “retroactive” competency evaluation based on an alleged TBI.
  • Whether the request for any additional evaluation was preserved for appellate review.

2. Summary of the Opinion

The Court affirmed. It held that the circuit court did not abuse its discretion in finding Mills competent because multiple evaluators testified he could consult with counsel and understand the proceedings, and because the testing occurred after the period in which the alleged childhood TBI would have occurred—meaning the evaluations were capable of capturing any current cognitive deficits regardless of their cause.

The Court also declined to reach the argument that due process entitled Mills to a fourth—and retroactive—competency evaluation. That claim was not preserved because defense counsel expressly represented at the competency hearing that Mills was not seeking a fourth evaluation, and the portion of trial transcript relied upon on appeal did not actually contain a request.

3. Analysis

3.1. Precedents Cited

State v. Sanders, 209 W. Va. 367, 549 S.E.2d 40 (2001)

Sanders supplied the doctrinal backbone for competency determinations in two ways.

  • Due process principle: The opinion reiterated Sanders syllabus point language that “a defendant cannot be tried or convicted for a crime while he or she is mentally incompetent.” The Court treated this as the governing constitutional baseline.
  • Competency test: The Court quoted Sanders for the “minimal threshold” requiring “a sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding” and both “a rational as well as a factual understanding of the proceedings.” This functional standard, not diagnostic labels, framed the Court’s analysis of Mills’s TBI-focused argument.
  • Retroactive competency evaluation: The opinion distinguished Sanders’ remand for a retroactive evaluation. In Sanders, the competency determination was partly contingent on an immediate trial that did not occur, and later circumstances (including a subsequent psychiatric report and aberrant behavior at the delayed trial) created a “change of circumstance” casting doubt on trial competency. By contrast, Mills’s alleged TBI was known to evaluators during the evaluations and thus was not a “change of circumstance” in the sense described by Sanders.

State v. Rodoussakis, 204 W. Va. 58, 511 S.E.2d 469 (1998) (quoting State ex rel. Cooper v. Caperton, 196 W. Va. 208, 470 S.E.2d 162 (1996))

These cases were used to enforce issue preservation. The Court invoked the rule that, to preserve an issue for appeal, a party must articulate it “with such sufficient distinctiveness to alert a circuit court to the nature of the claimed defect.” Applying that standard, the Court declined to consider Mills’s claimed entitlement to an additional retroactive evaluation because counsel expressly disavowed seeking a fourth evaluation at the competency hearing.

State v. Doom, 237 W. Va. 754, 791 S.E.2d 384 (2016)

Doom appeared in a procedural footnote regarding post-trial motions and appellate jurisdiction. While not central to the competency holding, it underscored that the appeal proceeded despite unresolved post-trial motions, and it framed the Court’s handling of the record without changing the outcome on competency.

3.2. Legal Reasoning

The Court’s reasoning proceeds in two disciplined steps: (1) applying the competency standard to the evidentiary record and deferential standard of review; and (2) applying preservation rules to the attempted expansion of the due-process claim.

(A) Competency is assessed by present functional capacity, not by pinning down the precise cause of impairment

Mills’s appellate theory sought to shift the inquiry from whether he was competent to why he had cognitive limitations. The Court rejected that reframing by returning to the Sanders competency test—present ability to consult with counsel and rational/factual understanding of proceedings—and by emphasizing the evaluators’ testimony that Mills met that threshold after restoration at Sharpe Hospital.

Critically, the Court accepted Ms. Nelson’s explanation that because testing occurred after the alleged childhood TBI would have occurred, the evaluations were suited to measure current cognitive functioning. The Court treated this as a direct answer to Mills’s claim that the process “improperly focused” on mental health: whatever the label, the competency tools used were capable of detecting whether Mills had sufficient cognitive capacity at the time of trial.

(B) Deference to the circuit court under “abuse of discretion” review

The Court reviewed the competency determination for abuse of discretion (citing State v. Sanders). It then anchored affirmance in the circuit court’s explicit reliance on live testimony from Dr. Hasan, Ms. Nelson, and Mr. Lawson. Because two evaluators testified to competency after restoration, and the circuit court credited that testimony, the Court found no abuse of discretion and no due-process violation.

(C) No merits review of a “fourth/retroactive” competency evaluation without preservation

Mills attempted to press a more specific due-process demand: a fourth and retroactive evaluation tied to the alleged TBI. The Court refused to reach it for a straightforward reason—counsel told the circuit court that no fourth evaluation was being sought. Under State v. Rodoussakis (quoting State ex rel. Cooper v. Caperton), that foreclosed appellate review.

The opinion further protected the integrity of the trial record: it rejected Mills’s characterization of a trial-transcript excerpt as a request, stating that no request was actually made.

3.3. Impact

  • Etiology-neutral competency practice: The decision reinforces that competency litigation should focus on present functional capacity (understanding and ability to assist counsel), not on whether limitations are attributed to mental illness, intellectual disability, or an alleged TBI. Future defendants arguing “wrong diagnostic lens” will likely need to show not merely mislabeling, but that the process failed to measure functional abilities relevant to competency.
  • Retroactive competency evaluations remain exceptional: By distinguishing Sanders, the Court signals that retroactive reevaluations are tied to concrete changed circumstances that cast doubt on trial competency—not simply to preexisting conditions that were already known.
  • Preservation is decisive in competency procedure: The opinion warns defense counsel that strategic decisions at competency hearings (including expressly declining further evaluation) can bar later appellate arguments seeking additional examinations.
  • Practical record-building: Competency challenges will likely turn on evaluator testimony and timing of testing. Here, testimony that testing occurred after the alleged TBI became a key factual predicate supporting affirmance.

4. Complex Concepts Simplified

  • “Competency to stand trial”: A defendant is competent if, at the time of trial, he can (1) work with his lawyer in a rational way and (2) understand what the case is about and how the court process works (both factually and rationally). It is about present ability, not moral blame.
  • “Restoration of competency”: If a defendant is initially found incompetent but potentially educable, the court can order treatment/education (here, at Sharpe Hospital) aimed at bringing the person to a level where he can participate meaningfully in the case.
  • “Abuse of discretion” review: On appeal, the question is not whether appellate judges would have decided differently, but whether the trial judge’s decision was outside reasonable bounds given the evidence.
  • “Retroactive competency evaluation”: An after-the-fact attempt to determine whether the defendant was competent at the time of trial. Courts treat this as unusual and typically require a strong reason—such as later developments that undermine confidence in the earlier competency finding.
  • “Issue preservation”: Appellate courts generally will not decide issues unless they were clearly raised in the trial court, giving the judge a fair chance to address them. Saying “we are not seeking” a remedy at a hearing usually prevents arguing on appeal that it was required.

5. Conclusion

State of West Virginia v. Alex Hunter Mills affirms two interlocking principles. First, competency determinations are fundamentally function-based: the Constitution demands a present ability to understand proceedings and assist counsel, and West Virginia’s competency process may satisfy due process regardless of whether cognitive limitations are attributed to mental illness, intellectual disability, or an alleged TBI. Second, attempts to obtain additional or retroactive competency evaluations will fail absent preservation and circumstances akin to the “change of circumstance” concerns described in State v. Sanders. The decision thus strengthens trial-court discretion when supported by evaluator testimony and underscores that competency litigation is won or lost on the evidentiary record and the issues clearly presented to the circuit court.