by Matt Clarke

On July 7, 2026, District Judge David Ezra of the United States District Court for the Western District of Texas in Austin issued a permanent injunction ordering Stephanie Muth, the Executive Commissioner of the Texas Health and Human Services Commission (HHSC) to admit incompetent defendants detained in a Texas jail to one of HHSC’s mental health facilities for restoration of competence within 21 days of a state court committing them to HHSC for restoration of competency. Muth was given four years to fully comply with the permanent injunction.

Numerous defendants who had been detained in Texas jails for long periods of time while awaiting competency restoration filed this class-action federal civil rights lawsuit alleging the lengthy detention violated their federal due process rights. They were aided by attorneys from Edwards Law in Austin, Disabilities Rights Texas in Houston and Austin, and Winston Taylor LLP in D.C., including Lisa A. Snead, Peter Hoffer, Michael Singley, Beth L. Mitchell, Brittany BreAnn Norman, Jeffery S. Edwards and Kristin Leigh McGough.

Following a six-day bench trial in December 2025, Texas Governor Greg Abbott (R) filed an amicus brief maintaining that the lawsuit should be dismissed because it was unclear whether plaintiffs had exhausted administrative remedies, as required by the Prison Litigation Reform Act (PLRA), 42 U.S.C. § 1997e(a). As a threshold matter, the court held that the PLRA did not apply because plaintiffs were not challenging the conditions of their confinement but rather a decision made by another agency outside of the facility. See: Almahdi v. Ridge, 201 F. App’x 865 (3d Cir. 2006).

Evidence showed that, as of August 2025, the average wait time for Maximum Security Units (MSUs) at a hospital was 202 days after commitment. For non-MSUs, it was 178 days. The problem, the court held, was that lengthy confinement in a county jail, often in solitary confinement, and without the option of bail, was inconsistent with the purpose of the confinement—the restoration of competency to stand trial.

In fact, the harsh jail conditions often caused people to decompensate, making restoration of competence more difficult and increasing the amount of time required for restoration. HHSC had attempted to reduce wait times by instituting jail-based competency-restoration programs at a few jails and diversion initiatives, but these had little influence on wait times.

Tellingly, 292 of HHSC’s 2,770 beds were offline due to construction, maintenance or staff shortages. HHSC is plagued with staff shortages but has not requested additional funding to increase staff salary or construct new bed. Instead, it contracted for an average of 747.2 beds in private facilities each day.

As of June 2025, HHSC reserved 73% of its beds for forensic cases and discharged over 1,500 incompetency detainees annually with more than 90% of them restored to competency. More than 98% of the detainees who were restored to competency on their first commitment had an average restoration time of 100 days.

The trial evidence had shown that, when notified of a commitment, HHSC places the committed defendant on a waiting list for a bed in one of the agency’s mental health facilities. As bed space becomes available, it is allocated largely on a first-come, first-served basis. HHSC determines whether the defendant requires an MSU and keeps a separate MSU list. In May 2025, the 482 detainees on the MSU wait list had an average wait time of 241 days while the 1,205 on the non-MSU list waited an average of 182 days.

The court noted that, despite having 10% of its beds offline due to staff shortage, HHSC had not requested additional funding for additional staffing. Further, in 2012, when a Texas court had briefly set a 21-day jail stay limit for detainees awaiting transfer to HHSC, the agency had managed to meet the limit.

The court noted that CannonDesign published a 2014 report under contract with HHSC. It found that state hospital compensation lagged behind community and was largely responsible for the high (33%) turnover rate among direct care staff. The report projected that HHSC would need 4,768 beds by 2024. It only had 2,958 in June 2024.

The court also noted that HHSC’s chief medical officer and plaintiffs’ experts agreed that delaying competency restoration services risked clinical harm. It held that the prolonged incompetency detention also caused legal harm, preventing detainees from assisting their attorneys in investigating and identifying witnesses, causing misdemeanor defendants to spend much more time in jail, often as much as the maximum possible sentence, and making them ineligible for bail.

The court held that HHSC’s future plans were unlikely to reduce the wait list time and additional funds would not help. It noted that “[m]any other states have deadlines of 30 days or less in their similar competency restoration service systems, and most achieve timelines under 21 days—including California which, despite a population and prior history of a wait list larger than Texas, now begins competency restoration services within about five days.” Other deadline examples include: Alabama (30 days), Oregon (7 days), California (28 days) and (Colorado, 7 days for a subset of detainees, 28 days for all others).

The class is all persons who are or will be charged with a crime in Texas and committed by a Texas court to a HHSC facility for competency restoration services but, due to insufficient HHSC forensic capacity, remain jailed more than 21 days from HHSC’s receipt of the commitment order until HHSC makes a bed available.

The court noted that, with respect to the class, “the nature and duration of the commitment [must] bear some reasonable relation to the purpose for which the individual is committed,” per Jackson v. Indiana, 406 U.S. 715 (1972). The Jackson Court held that “an incompetent detainee’s commitment can last only for the ‘reasonable period of time necessary to determine whether there is a substantial probability that he will attain that capacity in the foreseeable future’” and that the “‘commitment must be justified by progress toward that goal.’”

Applying the Jackson standard, the court found that the purpose of the commitment is “to obtain competency restoration services” so as to “be restored to proceed to trial,” Tex. Code of Crim. Pro., Art. 46B.073(b), and lengthy confinement in jail, often under solitary confinement and without mental health treatment, did not serve that purpose.

The court held that “the only constitutionally permissible period of jail confinement after HHSC receives an incompetency detainee’s commitment order is the brief window to collect paperwork, identify the appropriate facility, coordinate with sheriffs, effect the transfer, and admit the detainee. Any materially longer period of jail confinement is impermissible under Jackson.” It found that 21 days after HHSC receives the commitment order “is the outer constitutional limit for pre-hospitalization detention” and keeping them in jail confinement beyond that limit violates their due process rights and is not rationally related to any legitimate state interest. The court found plaintiffs are entitled to attorney fees and costs and allowed them 75 days to file a motion seeking attorney fees and costs.

The court issued a declaratory judgment in plaintiffs’ favor and a permanent injunction ordering Muth to place incompetency detainees in Texas jails in a HHSC mental health facility for competency restoration services within 21 days after receiving the commitment order. The court allowed four years for full compliance and instructed Muth work with plaintiffs to establish appropriate phase-in benchmarks and monitoring. See: Ward v. Muth, 2026 U.S. Dist. LEXIS 150411 (W.D. Tex.). 

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