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Loughner will stay there for up to four months, and doctors will seek to medicate him to see if he improves, Kleindienst said. He added he didn’t know if Loughner would agree to be medicated.

If Loughner is later determined to be competent enough to understand the case against him, the court proceedings will resume.

If he isn’t deemed competent at the end of his treatment, Loughner’s stay at the facility can be extended. There are no limits on the number of times such extensions can be granted.

If doctors conclude they can’t restore Loughner’s mental competency, the judge must make another decision. If he finds there’s no likelihood of Loughner being restored to competency, he can dismiss the charges.

In that case, state and federal authorities can petition to have Loughner civilly committed and could seek to extend that commitment repeatedly, said Heather Williams, a federal public defender in Tucson who isn’t involved in the Loughner case.

Loughner’s lawyers haven’t said whether they intend to present an insanity defense. But they noted in court filings that his mental condition will likely be a central issue at trial and described him as a “gravely mentally ill man.”

Giffords spokesman C.J. Karamargin declined to comment on Wednesday’s ruling and wasn’t sure if Giffords would be notified. “We’ve never commented on Loughner’s legal case,” he said. “There’s no reason to start now.”

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Associated Press writer Mark Carlson in Phoenix contributed to this report.