BOULDER COUNTY, Colo. — The families and loved ones of the 10 people killed in the Boulder King Soopers shooting will learn early next week if the suspect has been restored to competency and can proceed in the case.

Ahmad Al Aliwi Alissa was found mentally competent by experts in late August, but his defense attorney asked for the determination to be debated in court. The defense claims the last eight evaluations, where Alissa was deemed incompetent, should be key in the decision-making process.

He is accused of killing 10 people at a Boulder King Soopers supermarket in March 2021. He faces a total of 115 criminal counts, including 10 counts of first-degree murder. In May 2021, eight additional counts of attempted murder were filed in the case.

A judge will need to accept the state’s conclusion on the suspect’s competency for the court proceedings against the suspect to continue.

The restoration hearing for the defendant began on Wednesday morning. The suspect appeared dressed in an orange and white striped jumpsuit, and glanced around the courtroom consistently throughout the day.

The first witness that the prosecution called was Dr. Julie Gallagher, who has worked in correctional and state hospital settings and is currently the president of the American Academy of Forensic Psychology. Much of her expertise has involved legal questions about competency to proceed in court and a person’s mental state during a crime.

The Boulder County District Attorney’s Office contacted her after the defendant was found incompetent to stand trial, when he had been in the Colorado Mental Health Hospital in Pueblo for more than a year.

Gallagher looked at all prior competency evaluations and thousands of pages of medical records and found support for the conclusion from the initial evaluations, which determined the defendant had schizophrenia. She said early reports indicated that he “could not or would not” share information, though this could be for a myriad of reasons, ranging from severe mental health challenges to anxiety to being directed by counsel not to talk about the case. “All of those things could be true at the same time,” Gallagher said from the witness stand.

His initial medications at the state hospital caused side effects and medical experts backed away from them in September and October 2022. This process resulted in the defendant isolating himself more, she said. A nurse recommended a new medication in October 2022.

While the defendant was on medication, he showed signs of getting better, though still not enough to be considered competent. He began refusing medication in early 2023, and his mental health declined. In March of this year, a court order for involuntary medication allowed the state hospital to administer a new medication to the defendant and his condition began to improve significantly, Gallagher said.

She added this was a “significant turning point” in the defendant’s treatment.

She said it seemed like the defendant started to communicate more after individual evaluations were offered to him. He did not partake in any group evaluations.

According to the final evaluation before her involvement, Gallagher said evaluators were able to talk with the defendant better. He identified the charges he was facing and some elements of evidence. He also confirmed that he understood the advantages and disadvantages of testifying in court. That report concluded that he had an “adequate, rational knowledge” of the situation.

Gallagher said if the defendant goes back to jail, research shows his mental state will likely decline.

In court, Gallagher mentioned most people are restored to competency within a year, and it’s unusual for the process to last longer than that. During her cross-examination, Gallagher added that the severity of the suspect’s illness could impact their ability to proceed in the case.

The second witness called in front of the court was Dr. Loandra Torres, who is employed by the Court Services Department. She works in the Office of Civil and Forensic Mental Health at the Colorado Mental Health Hospital in Pueblo. She has conducted between 700 and 800 competency evaluations and is an expert in forensic psychology.

Torres became involved in the case after initial competency concerns became apparent. She said she completes evaluations of people related to their competency and is not involved with their treatment.

In January, her evaluation found the defendant was not competent to proceed. That changed about seven months later, when she concluded the defendant was restored to competency. He was aware of the charges against him, provided a brief account of that day and understood he could be sentenced at trial. He understood the meanings of the pleas and roles of courtroom personnel.

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Torres said the defendant’s factual understanding was never an issue, but there were difficulties with the rational component. He often gave vague responses, she said. This was her greatest concern in January — his ability to communicate and make rational decisions in relation to his case. He started to refuse some doses of medication after that evaluation, she said, adding that medication is the main way to treat many psychiatric conditions, including schizophrenia.

Torres said in April 2023, the defendant went through multiple psychological tests, which did not show that he feigned any of his symptoms. The tests found he had an average ability to learn and recall information, but slower processing speeds. He also recognized he had schizophrenia, whereas he had previously negated that he had any mental illnesses. He was found incompetent again in April.

She noted the improvements in the defendant’s August evaluation, which included improved hygiene and reasonable, logical thinking, and no symptoms of depression or mania, or perceptual disturbances. He also did not refuse to answer direct questions about the day of the shooting and days leading up to it, she said.

During that evaluation, the defendant noted that pleading not guilty by reason of insanity was his preferred legal strategy, though he knew there was a lot of evidence against him, including guns with his fingerprints on them, Torres said.

She said the defendant told her he bought the guns to “commit a mass shooting” and indicated he may have wanted to kill himself by cop.

After looking at all of the available information, Torres said she came to the conclusion that the defendant was competent to proceed. She also stressed the importance of keeping him in a “structured” and “therapeutic” environment like the state hospital rather than the jail, even though most people who are restored to competency are returned to jail.

The third witness called was Dr. Hareesh Pillai, a psychiatrist at the state mental health hospital in Pueblo. He was the primary psychiatrist for the defendant until the summer of 2022, when Pillai left for training. He returned to the hospital in July of 2023. Pillai was the one who wrote the affidavit for the court-ordered medication.

In conversations with Pillai, the suspect apparently made comments about feeling like “there’s a fire in my head.”

Pillai spoke about an incident from September 4, where the suspect apparently punched another patient in the face several times unprovoked. The defendant would not discuss the incident with the doctor, but Pillai believes it was related to schizophrenia and underlying psychotic symptoms. The defense took this instance, and others, to show the defendant has not made the necessary improvements to move forward in the case.

On Tuesday night, the defendant evidently refused to take his required medication while he was being held at the Boulder County Jail. Pillai received a call from the jail on Wednesday morning alerting him to the issue. Pillai said if the suspect stops taking his medication, he will regress.

The last witness of the hearing was Dr. Scott Bender, who is an expert in neuropsychology. After reviewing the reports, he said it was unclear if the defendant’s schizophrenia was the cause of the symptoms, or if it was deliberate avoidance. Bender said, in many cases, there are genuine symptoms, but for whatever reason, the patient will either falsely attribute those symptoms or embellish them.

The defense was quick to point out that Bender has never met the suspect in person, and was being paid $400 an hour to appear.

In closing arguments, District Attorney Michael Dougherty said the medications administered in 2023 have shown significant improvements within the suspect, and believes “he has been restored to competency and this case should move forward.”

Defense attorneys said their client has a fundamental right not to stand trial while incompetent, and insisted that a “little improvement” when on medication is not the same as competency.

The suspect will be taken back to the state mental health hospital in Pueblo on Wednesday night. Both prosecutors and defense attorneys do not want the defendant to be held in jail, even if found competent by the court, saying that will cause any progress in his mental state to deteriorate.

The judge is expected to make a decision “early next week” regarding competency restoration. A preliminary hearing is still scheduled for November 14.