The man who said he gunned down three people to "save the babies" at Colorado Springs' lone Planned Parenthood clinic is too delusional to stand trial, according to a ruling Wednesday that left his case at a standstill with no end in sight.
Robert Lewis Dear Jr. sat in stoic silence while being ordered to a state hospital in Pueblo for treatment of a delusional disorder.
He could remain there for weeks, months or even years for therapy to address his unrealistic fears that FBI agents are following and persecuting him as part of a nationwide conspiracy.
He erupted while being led from the courtroom in a final act of defiance to 4th Judicial District Chief Judge Gilbert Martinez.
"That's called prejudiced. Prejudiced!" Dear yelled at the judge. "Filthy animal!"
The order brought added clarity to months of questions about Dear's mental fitness, but also uncertainty about when prosecutors could resume their case against Dear.
"Any case like this is not a quick time line," 4th Judicial District Attorney Dan May said.
The case will resume when Martinez finds that Dear, 58, can understand court proceedings and assist in his own defense.
Until then, the 179 counts Dear faces in the Nov. 27 attack at the Planned Parenthood clinic, including murder and attempted murder, will hang in limbo.
Ke'Arre Stewart, Jennifer Markovsky and University of Colorado at Colorado Springs police officer Garrett Swasey died in the attack, and nine others were wounded.
Martinez rattled off roughly two dozen ways Dear's mental illness has colored his world view, including how Dear believes the judge was being controlled by a higher power.
Martinez recalled how Dear claimed President Barack Obama is trying to take people's guns and that the president created the Islamic State terrorist group.
Dear even incorporated his public defenders into those fears - claiming they were working for the federal government, Martinez noted. Testimony also revealed that Dear was mistrustful of his attorneys because they wanted to mount an insanity defense.
"The defendant's perceptions and understanding are not rational and not grounded in reality," Martinez said.
The two state psychologists who testified to Dear's mental illness included no prognosis for Dear in a report they issued to the court in March, Martinez said.
The Colorado Mental Health Institute at Pueblo can hold defendants as long as the sentence for their most serious charge - in Dear's case, first-degree murder.
As a result, he could spend the rest of his life at the facility.
Experts said lifetime hospital commitments are rare.
Two local defense attorneys said some clients have spent six to 18 months at the Pueblo hospital before a judge ruled them competent for trial. Others appear unlikely ever to leave.
Martinez will receive reports of Dear's psychological state every three months.
The judge plans to issue his next written review Aug. 11, updating the case.
Once in Pueblo, Dear's treatment could include group therapy sessions with other defendants from across the state.
The hospital has a mock courtroom, used to help patients better understand the players at court hearings and how judicial proceedings work.
Treating delusional disorder can be difficult - especially if those delusions have persisted for years or decades, said Nicole Schneider, a forensic psychologist who owns Colorado Clinical and Forensic Psychology in Greenwood Village.
"It's asking you to give up your entire world," Schneider said. "Your reality is as real to you as his is."
The condition is characterized by a firmly held belief that is unchangeable - even in the presence of evidence to refute it. The condition is separate from schizophrenia because symptoms for delusional disorder do not include hallucinations.
One complicating factor: Medications usually prove less effective for delusional disorder than other conditions, such as bipolar disorder, she said.
Should Dear refuse medication, psychologists would have a long and difficult path to forcibly medicate him, defense attorneys said.
Doctors can forcibly medicate patients at the hospital who try to hurt themselves or others, said Joshua Tolini, a defense attorney not connected to Dear's case.
Imposing medication on other patients requires a court ruling. The hospital must convince a judge that the decision is medically appropriate, that it won't undermine the patient's right to a fair trial and that no other, less intrusive treatments exist.
Even if Dear is returned to competency, his mental fitness may not last, experts said.
Medication regimens may stop once a patient leaves the state hospital, and defendants might regress once being moved back to a county jail.
"It's completely fluid," Phil Dubois, a local defense attorney not connected to Dear's case, said of a defendant's competency. "People just don't stay the same day to day, never mind months or years on end."
Mental competency challenges pit the decaying ability for prosecutors to bring a case as time passes against the importance of ensuring defendants are mentally fit to appear at trial, experts said.
Already, little has happened in Dear's case beyond months of hearings focusing on Dear's mental fitness.
He has yet to enter a formal plea, and a decision by prosecutors on whether to seek the death penalty would not be due for months, should proceedings resume.
Other questions went unanswered Wednesday.
Waiting for Martinez's ruling, Dear turned to the gallery.
"Anybody want to know why I did it?" Dear asked, reciting a Bible verse from Psalms.
He paused - speaking up only to lament not being able to take the stand.
"Justice delayed is justice denied," Dear said.