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A district judge has a statutory duty to order a competency hearing sua sponte if evidence of incompetency causes a reasonable judge to experience a genuine doubt regarding the defendant’s competence.

Defendant Joel Dreyer, a practicing psychiatrist, was convicted of conspiracy to distribute controlled substances for providing prescriptions of oxycodone and hydrocodone to patients outside the ordinary course of his practice. Dreyer was diagnosed with frontotemporal dementia three years before participating in the conspiracy. Defense counsel did not request a competency hearing during the trial and the district court did not order a hearing sua sponte. Dreyer appealed, claiming that the district court erred in failing to order a competency hearing sua sponte. The district court must order a competency hearing if “the evidence of incompetence was such that a reasonable judge would be expected to experience a genuine doubt respecting the defendant’s competence.” See 18 U.S.C. § 4241(a). Competency questions arise if the defendant is either unable to (1) understand the nature and consequence of the proceedings, or (2) assist counsel in preparing a defense.” Three experts testified in the case. Each expert diagnosed Dreyer with frontotemporal dementia and noted Dreyer’s “inability to regulate his behavior and speech.” Dreyer’s counsel also informed the district judge that Dreyer would not speak on his own behalf during his sentencing hearing as a result of his medical condition. The experts and defense counsel raised genuine doubt regarding Dreyer’s competence. The case was remanded to a different judge because the original judge would have difficulty setting aside her previously expressed views as to Dreyer's competency. Reassignment was necessary to preserve the appearance of justice. VACATED and REMANDED.