By David Schwartz
PHOENIX (Reuters) - A year after a deadly shooting spree that left Representative Gabrielle Giffords battling for her life, the accused gunman remains shut up in a prison hospital amid wrangling over his fitness to stand trial.
College dropout Jared Loughner is charged with murdering six people and wounding 13 others, including Giffords, who was shot through the head and is recovering.
Loughner was found by two medical experts to have schizophrenia, disordered thinking and delusions, and the 23-year-old was declared mentally incompetent to stand trial at a May hearing.
With Loughner consigned to treatment at a federal prison hospital in Springfield, Missouri, the trial proceedings are in limbo.
A appellate court is currently weighing whether to uphold or reverse federal judge Larry Burns' decision giving doctors four more months to restore him to competency.
Also at issue is whether the doctors can continue to force antipsychotic medication on Loughner, who was found to be unable to comprehend the proceedings against him and to assist in his own defense -- the twin legal tests of competency.
Since the ruling, defense attorneys have repeatedly sought an immediate stop to the drug regime, arguing that Loughner's constitutional due-process rights were being violated and there was no legal basis to continue the forced medication.
They have also fought efforts to extend his stay in the Missouri facility.
But legal experts say precedent suggests the 9th Circuit Court of Appeals, which is weighing the arguments, is likely to allow Loughner to continue treatment.
"I would just be amazed if they overturned the trial judge," said Stephen J. Morse, a professor of law and psychology at the University of Pennsylvania.
IMPROVING IN HOSPITAL
As the legal battle goes on, federal prosecutors said that Loughner appears to be improving from the out-of-control man evicted from the competency hearing in May by Burns for a confused verbal outburst.
Marshals dragged him from the room after he interrupted proceedings, shouting "she died in front of me," perhaps a reference to a deluded belief that he had killed Giffords. Watching the outburst, Loughner's mother wept inconsolably.
Since then, prosecutors credit treatment and use of anti-psychotic drugs. Christina Pietz, the primary psychologist treating Loughner, has said he is not the same individual that she encountered at the prison's mental health unit.
At that time Loughner threw a chair and lunged and spat at his attorneys, believing they were conspiring against him, "blackmailing and extorting him for money," Pietz testified.
During a spate without medication, she said Loughner went for 50 hours without sleep and that a blister caused by pacing subsequently infected his foot and leg. He would sob uncontrollably and throw his feces on his clothes and bed.
Pietz said Loughner still shows signs of being delusional, but no longer reports hearing voices or expresses the desire to kill himself. Conversations are easier. The smirk captured in a haunting booking photograph taken after his arrest is gone.
She said Loughner now makes eye contact with her during her sessions that range from 10 minutes to an hour each weekday.
Pietz said Loughner now realizes that Giffords is alive, and he is sorry for the killings.
"He understands that he's murdered people," she told the court in late September. "He talks about that. He talks about how remorseful he is for that.
"He understands the implications of what he did, the impact of what he did."
Roxanna and John Green, the parents of the youngest shooting victim, nine year old Christina Taylor Green, told ABC News they had no plans to attend Loughner's court proceedings.
"I don't think about him," Roxanna Green told "Nightline" anchor Cynthia McFadden. "I think of, that she was, like, in a car accident."
Asked what their reaction would be if the incompetent-to-stand-trial ruling stood and Loughner simply remained incarcerated, the Greens said they could accept it.
"As long as he never hurts anyone ever again, and is never able to get out ... I would be O.K. with that," said Roxanna Green.
If Loughner did end up convicted of murder and executed, would the Greens take some comfort from his death?
"Not really," said John Green, who is a supporter of the death penalty, according to Roxanna Green's new book. "It's not going to bring my girl back."
LOW THRESHOLD FOR COMPETENCY
Legal experts say it is quite common for defendants suffering from schizophrenia to be restored to competency and proceed to trial. That is just a matter of time.
"The level of competency is not very high," said Lynda Frost, planning and programs director for the Hogg Foundation for Mental Health at the University of Texas-Austin. "It's a minimal level of functioning and most people can be restored."
Experts say that the Loughner's stay can continue to be extended for a "reasonable period of time" to make him mentally fit. But the time is not open-ended.
If he proceeds to trial, experts say Loughner's attorneys likely will use an insanity defense. His attorneys could not be reached for comment.
If not, he is likely to spend his life confined to a hospital.
"If he can't be restored, then eventually prosecutors are going to have to bite the bullet and then have a judge commit him," said Roy Spece, a law professor at the University of Arizona in Tucson, who has followed the case. "My best guess is that he will end up civilly committed until he dies," he said.
Shooting victim Eric Fuller, a Navy veteran who was struck in the back and knee in the shooting spree, is against the death penalty and sees Loughner as a sick man. He's not seeking vengeance or punishment for Loughner.
"I might feel differently if the bullets had hit me in the spine, say, and I were paralyzed," Fuller told Reuters. "I would be out for his scalp."
(Editing by Tim Gaynor, Greg McCune and Peter Bohan)