Vernon Madison v. Commissioner, Alabama Department of Corrections ( 2017 )


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  •            Case: 16-12279    Date Filed: 03/15/2017   Page: 1 of 39
    [PUBLISH]
    IN THE UNITED STATES COURT OF APPEALS
    FOR THE ELEVENTH CIRCUIT
    ________________________
    No. 16-12279
    ________________________
    D.C. Docket No. 1:16-cv-00191-KD-M
    VERNON MADISON,
    Petitioner–Appellant,
    versus
    COMMISSIONER, ALABAMA DEPARTMENT OF CORRECTIONS,
    Respondent–Appellee.
    ________________________
    Appeal from the United States District Court
    for the Southern District of Alabama
    ________________________
    (March 15, 2017)
    Before WILSON, MARTIN, and JORDAN, Circuit Judges.
    MARTIN, Circuit Judge:
    Case: 16-12279       Date Filed: 03/15/2017       Page: 2 of 39
    Thirty years ago, the Supreme Court held that the Eighth Amendment
    prohibits the execution of a person who is incompetent. 1 Ford v. Wainwright, 
    477 U.S. 399
    , 409–10, 
    106 S. Ct. 2595
    , 2602 (1986). The Court has since clarified that
    a person cannot be executed if he lacks a “rational understanding” of the reason for
    his execution. Panetti v. Quarterman, 
    551 U.S. 930
    , 954–60, 
    127 S. Ct. 2842
    ,
    2859–62 (2007). This standard requires the prisoner to be able to rationally
    understand the connection between the crime he committed and the punishment he
    is to receive. See Ferguson v. Sec’y, Florida Dep’t of Corr., 
    716 F.3d 1315
    , 1336
    (11th Cir. 2013). The Supreme Court told us that if the prisoner does not
    understand this connection, “the punishment can serve no proper purpose” and
    cannot be carried out. 
    Panetti, 551 U.S. at 960
    , 127 S. Ct. at 2862.
    This habeas petitioner, Vernon Madison, is a 66-year-old man on death row
    for the murder of a police officer over three decades ago. In recent years, Mr.
    Madison has suffered strokes resulting in significant cognitive and physical
    decline. His lawyers argue here that he is mentally incompetent to be executed
    under Ford and Panetti. Finding that Mr. Madison had made a substantial
    threshold showing of incompetency, an Alabama trial court held a competency
    hearing. At the hearing, Mr. Madison presented unrebutted testimony from Dr.
    1
    While the Court used the term “insane” in Ford, post-Ford decisions identify the issue
    as “competency to be executed.” E.g., Herrera v. Collins, 
    506 U.S. 390
    , 439, 
    113 S. Ct. 853
    , 881
    (1993).
    2
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    John Goff that his strokes caused major vascular disorder (also known as vascular
    dementia) and related memory impairments and that, as a result, he has no memory
    of committing the murder—the very act that is the reason for his execution. To the
    contrary, Mr. Madison does not believe he ever killed anyone. Dr. Goff testified
    that due to his memory impairments, Mr. Madison does not have a rational
    understanding of why the state is seeking to execute him. The State presented
    expert testimony from Dr. Karl Kirkland. Dr. Kirkland testified that Mr. Madison
    was able to accurately discuss his legal appeals and legal theories with his
    attorneys and—on pretty much this basis alone—concluded that Mr. Madison has
    “a rational understanding of [his] sentence.” Accepting the testimony of Dr.
    Kirkland, the Alabama trial court decided that Mr. Madison is competent to be
    executed. Mr. Madison argues that the trial court’s decision relied on an
    unreasonable determination of the facts and involved an unreasonable application
    of the law. We agree.
    In so holding, we are mindful of the great deference due to state court
    decisions on federal habeas review, particularly when the state court is applying a
    general standard like the one in Panetti. See Harrington v. Richter, 
    562 U.S. 86
    ,
    101, 
    131 S. Ct. 770
    , 786 (2011) (“The more general the rule, the more leeway
    courts have in reaching outcomes in case-by-case determinations.” (quotation
    omitted)). But “even a general standard may be applied in an unreasonable
    3
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    manner.” 
    Panetti, 551 U.S. at 953
    , 127 S. Ct. at 2858. Panetti may set out a
    general standard for competency, but the focus of the inquiry is clear. Panetti
    doesn’t ask whether the prisoner can talk about the history of his case or legal
    theories with his attorneys. Instead, Panetti requires courts to look at whether the
    prisoner is able to rationally understand the connection between the crime he
    committed and the punishment he is to receive. See 
    Panetti, 551 U.S. at 960
    , 127
    S. Ct. at 2862. One of the experts testified that due to a mental disorder, Mr.
    Madison was not able to make this connection. The other expert never addressed
    this question at all. This record is therefore wholly insufficient to support the trial
    court’s decision. We conclude that the state court’s decision that Mr. Madison is
    competent to be executed rested on an unreasonable determination of the facts and
    involved an unreasonable application of Panetti. We therefore reverse the District
    Court’s denial of habeas relief.
    I. BACKGROUND AND PROCEDURAL HISTORY
    Mr. Madison has been tried three times for killing a police officer in 1985.
    Madison v. State, 
    718 So. 2d 90
    , 94 (Ala. Crim. App. 1997). His first two
    convictions were reversed. At his third trial, the jury found Mr. Madison guilty of
    capital murder and recommended a life sentence by an 8-4 vote. See 
    id. The trial
    judge overrode the jury’s recommendation and sentenced Mr. Madison to death.
    
    Id. His conviction
    and sentence were affirmed by the Alabama Court of Criminal
    4
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    Appeals, 
    id. at 104,
    and the Alabama Supreme Court. Ex parte Madison, 
    718 So. 2d
    104, 108 (Ala. 1998).
    In February 2016, following the denial of state and federal habeas relief, Mr.
    Madison filed a petition for suspension of his death sentence in the Circuit Court of
    Mobile County, Alabama, arguing that he was incompetent to be executed under
    Ford and Alabama law. See Ala. Code § 15-16-23 (providing that the trial court
    shall suspend the execution of a death sentence if “it is made to appear to the
    satisfaction of the trial court that the [prisoner] is then insane”). The Alabama trial
    court found that Mr. Madison had made a preliminary showing of incompetency,
    ordered that Mr. Madison be evaluated by a court-appointed expert, and scheduled
    a competency hearing. At the competency hearing, the court heard testimony from
    the court-appointed expert as well as Mr. Madison’s expert. The court issued an
    order on April 29, 2016, finding that Mr. Madison was competent to be executed.
    Under state law, this ruling is not subject to review by any other Alabama court.
    See Ala. Code § 15-16-23.
    Mr. Madison then filed a motion for a stay of execution and a petition for
    federal habeas relief in the U.S. District Court. The District Court found that Mr.
    Madison had exhausted his Ford claim, but it denied relief on the merits.2 Mr.
    2
    Although this is Mr. Madison’s second federal habeas petition, it is not barred as
    “second or successive” under 28 U.S.C. § 2244(b) because his Ford claim did not become ripe
    until his execution was imminent. See 
    Panetti, 551 U.S. at 945
    –47, 127 S. Ct. at 2853–55.
    5
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    Madison appealed, and we granted Mr. Madison’s motion for a certificate of
    appealability, stayed his execution, and ordered expedited briefing on the merits of
    his Ford claim.
    II. FACTS
    A. MR. MADISON’S CURRENT MEDICAL CONDITION
    Mr. Madison, who is 66 years old, has a history of physical and mental
    impairments. He is legally blind, cannot walk independently, is incontinent, and
    has slurred speech. He has also suffered at least two recent strokes—one in May
    2015 and another in January 2016.3 The May 2015 stroke was severe, and affected
    Mr. Madison’s vision while also causing a substantial deficit in motor
    coordination. After this stroke, he showed signs of memory loss, repeatedly asking
    that his mother be informed that he had a stroke despite the fact that she had passed
    away several years earlier. On January 4, 2016, Mr. Madison had another stroke.
    He was found in his prison cell, unresponsive and incontinent. Medical records
    document that Mr. Madison was in an altered mental status after the January 2016
    stroke. He appeared “very confused” and disoriented, and he exhibited signs of
    memory loss.
    Following these strokes, Mr. Madison’s legal team noticed a significant
    decline in his mental status, including memory loss, difficulty communicating, and
    3
    The record indicates that Mr. Madison likely suffered other strokes before May 2015.
    6
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    profound disorientation and confusion. Mr. Madison reported frequently urinating
    on himself because “no one will let me out to use the bathroom,” although he has a
    toilet in his cell. And Mr. Madison told his attorney during a visit in February
    2016 that he planned to move to Florida after his release from prison. As a result,
    Mr. Madison’s attorneys requested—and the Alabama trial court granted—a
    hearing to determine whether Mr. Madison is competent to be executed.
    B. THE STATE COURT COMPETENCY HEARING
    Before the hearing, Mr. Madison was evaluated by Dr. Kirkland, the court-
    appointed psychologist, and Dr. Goff, a neuropsychologist retained by Mr.
    Madison’s counsel. Both experts reviewed Mr. Madison’s medical records and
    examined him. Both experts testified at the hearing and prepared written reports
    that were admitted into evidence.
    1. The Expert Reports
    In his report, Dr. Kirkland acknowledged that Mr. Madison’s strokes had
    caused significant physical and cognitive decline and found no indication of
    malingering. Despite this decline, Dr. Kirkland found that Mr. Madison was able
    to accurately describe the history of his case regarding his appeals and was aware
    that the trial judge had overridden the jury’s life sentence. Dr. Kirkland also noted
    that Mr. Madison could discuss details from his youth, such as where he attended
    elementary and high school. The report concluded that “Mr. Madison appears to
    7
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    be able to have a rational understanding of the sentence, the results or effects of the
    sentence, and to still be able to discuss defense and legal theories with his
    attorneys.”
    Dr. Goff’s report also concluded that Mr. Madison had suffered “significant
    cognitive decline” due to his strokes and that there was no clinical indication of
    malingering. He administered the fourth edition of the Weschsler Adult
    Intelligence Scale (WAIS-IV) and calculated a General Ability Index of 72, which
    falls within the borderline range of intelligence.4 According to Dr. Goff’s report,
    this score marked a very significant decline from Mr. Madison’s previous levels of
    function. The report explained that Mr. Madison’s Working Memory Index of 58
    reflected “a very substantial deficit” in regard to working memory and that Mr.
    Madison had “a significant cognitive deficit.” 5
    Dr. Goff diagnosed Mr. Madison with major vascular neurological disorder
    (vascular dementia) and reported that Madison suffered from retrograde amnesia.
    As a result, Mr. Madison could not recall certain past events that happened before
    his January 2016 stroke. Dr. Goff’s report explained that if Mr. Madison was told
    a fact or a series of facts he might be able to recall this new information, but he
    would not be able to recall any memories affected by the retrograde amnesia.
    4
    A full scale IQ score could not be calculated because Dr. Goff was unable to administer
    two subscales of the WAIS-IV due to Mr. Madison’s vision problems.
    5
    The Working Memory Index is scored on a scale like an IQ test, where the mean is 100
    and the standardization is 15.
    8
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    According to Dr. Goff, Mr. Madison didn’t have an independent recollection of his
    crime or the identity of the victim. Dr. Goff reported:
    When [I] asked [Mr. Madison] where he was convicted from he said,
    “It must have been Mobile” although he seemed unsure. Again he
    was able to tell me that the crime “must have been a murder.” He
    could not identify the name of the victim. . . . [H]e indicates that he
    does not believe that he ever killed anybody because, “I never went
    around killing folks.”
    The report noted that Mr. Madison was not able to tell Dr. Goff the sequence of
    events from the offense to his arrest to the trial or any related details. During the
    interview, Mr. Madison said that he had been told by others that he had three trials
    and that the judge had overridden the jury’s life sentence.
    Dr. Goff reported that Mr. Madison understood the meaning of “execution”
    and “the idea of being dead.” Dr. Goff concluded that Mr. Madison understood
    what he had been tried for but—because he could not remember the underlying
    crime and didn’t believe he had ever killed anyone—“[h]e does not seem to
    understand the reasoning behind the current proceeding [his execution] as it applies
    to him.”
    2. The Evidentiary Hearing
    Dr. Kirkland, Dr. Goff, and Mr. Madison’s prison warden testified at the
    competency hearing. Dr. Kirkland emphasized Mr. Madison’s ability to discuss
    the details of his legal appeals and the current status of his case. Dr. Kirkland also
    testified that Mr. Madison was aware of his execution. On redirect examination,
    9
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    Dr. Kirkland acknowledged that Mr. Madison’s mental condition had significantly
    deteriorated, but he testified that Mr. Madison was able to talk “about very specific
    things that would indicate that he could remember specific things about the time of
    the offense.” In response to the court’s question of whether Mr. Madison
    understood that the state was seeking retribution for an act that he had committed,
    Dr. Kirkland replied: “Certainly. [Mr. Madison] talked specifically about [a] death
    sentence versus life without [parole] in the original trial and the first retrial and in
    the second.”
    Dr. Goff’s testimony at the evidentiary hearing largely followed his report.
    Dr. Goff testified that the stroke Mr. Madison suffered in January 2016 likely
    caused his memory problems. Dr. Goff described this event as a thalamic stroke—
    a type of stroke that commonly results in memory problems as well as other
    difficulties—and this conclusion was in keeping with an MRI report showing a
    “[t]iny focal acute to subacute infarct in the right thalamus.” According to Dr.
    Goff, areas of Mr. Madison’s brain have essentially died as a result of his strokes,
    and this is consistent with Mr. Madison’s medical records.6 It appeared to Dr.
    6
    The State suggests that Mr. Madison didn’t really have a thalamic stroke, pointing to
    medical records indicating that Mr. Madison’s January 2016 event was caused by drug use.
    While it’s true there was some evidence of drug use, both experts agreed that Mr. Madison’s
    cognitive decline resulted from strokes. And MRI imaging confirms that Mr. Madison had a
    “very small acute CVA” and a “new small right thalamic infarct.” “CVA” stands for
    “cerebrovascular accident,” which is also referred to as a stroke. See Medline Plus Medical
    Dictionary, http://c.merriam-webster.com/medlineplus/stroke (last visited October 13, 2016). An
    “infarct” refers to an area of dead tissue caused by a restriction in blood flow. See 
    id., 10 Case:
    16-12279       Date Filed: 03/15/2017       Page: 11 of 39
    Goff that the basis of Mr. Madison’s knowledge about his case was information he
    learned from his attorneys. Dr. Goff testified that Mr. Madison understood that the
    State was seeking retribution but didn’t understand the past act for which he was
    being punished. Dr. Goff concluded that Mr. Madison understood he was being
    executed but—because he lacked memories of his past—didn’t understand why.
    3. Warden Davenport
    The state called as a witness Warden Davenport, who had served the death
    warrant on Mr. Madison. Mr. Davenport testified that he read the court order
    setting the execution date to Mr. Madison and that Mr. Madison said “my lawyers
    are supposed to be handling that.” The Warden also testified that prisoners are
    assigned mental health codes if they receive mental health care. According to Mr.
    Davenport, Mr. Madison’s mental health code was zero, which indicates that
    Madison was not receiving treatment for a mental health condition.
    C. THE ALABAMA COURT’S COMPETENCY DECISION
    The Alabama trial court issued a written order in which it held that Mr.
    Madison was competent to be executed. The court identified Ford and Panetti as
    the relevant standards. It stated that the burden of proof was on Mr. Madison to
    http://c.merriam-webster.com/medlineplus/infarct (last visited October 13, 2016). As Dr. Goff
    explained, an “infarct” is, in lay terms, a stroke. Mr. Madison’s medical records also show that
    he has encephalomalacia, which refers to “softening of the brain due to degenerative changes in
    nervous tissue.” See 
    id., http://c.merriam-webster.com/medlineplus/encephalomalacia (last
    visited October 28, 2016). The medical records clearly establish that Mr. Madison had a stroke
    that affected his thalamus and that parts of his brain have died.
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    show, by a preponderance of the evidence, “that [he] suffers from a mental illness
    which deprives [him] of the capacity to rationally understand that he is being
    executed as a punishment for a crime.” The court’s order summarized the
    evidence from the competency hearing, including the testimony of Dr. Kirkland
    and Dr. Goff. It then found that Mr. Madison had failed to prove his incompetence
    by a preponderance of the evidence. The court “accept[ed]” the testimony of Dr.
    Kirkland regarding Mr. Madison’s understanding of his execution. It found that
    Mr. Madison “has a rational[] understanding, as required by Panetti, that he is
    going to be executed because of the murder he committed and a rational[]
    understanding that the State is seeking retribution and that he will die when he is
    executed.”
    III. STANDARD OF REVIEW
    This appeal is governed by 28 U.S.C. § 2254, as amended by the
    Antiterrorism and Effective Death Penalty Act of 1996 (AEDPA). 7 AEDPA
    7
    Mr. Madison argues that the lack of appellate review in Alabama state court for Ford
    claims precludes the application of AEDPA to his federal habeas petition. See Ala. Code § 15-
    16-23 (prohibiting appellate review of trial court’s competency finding). Mr. Madison has good
    reason to be concerned about this. AEDPA severely limits the ability of federal courts to review
    state court decisions for constitutional error. As a result, state courts are the primary guardians
    of the constitutional rights of state prisoners. See Burt v. Titlow, 
    134 S. Ct. 10
    , 15–16 (2013)
    (“Recognizing the duty and ability of our state-court colleagues to adjudicate claims of
    constitutional wrong, AEDPA erects a formidable barrier to federal habeas relief for prisoners
    whose claims have been adjudicated in state court.”). Alabama’s statutory scheme relegates an
    important question—whether a person’s impending execution is prohibited by the Constitution—
    to a single judge and makes that judge’s determination unreviewable by the state’s appellate
    courts. While we have concerns about a scheme that singles out one type of constitutional claim
    12
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    imposes a “highly deferential standard for evaluating state-court rulings.” Renico
    v. Lett, 
    559 U.S. 766
    , 773, 
    130 S. Ct. 1855
    , 1862 (2010) (quotation omitted). It
    bars federal courts from granting habeas relief on a claim that was adjudicated on
    the merits in state court unless the state court’s decision (1) “was contrary to, or
    involved an unreasonable application of, clearly established Federal law, as
    determined by the Supreme Court of the United States,” or (2) “was based on an
    unreasonable determination of the facts in light of the evidence presented in the
    State court proceeding.” 28 U.S.C. § 2254(d).
    Under § 2254(d)(1), “clearly established Federal law” means “the governing
    legal principle or principles set forth by the Supreme Court at the time the state
    court renders its decision.” Lockyer v. Andrade, 
    538 U.S. 63
    , 71–72, 
    123 S. Ct. 1166
    , 1172 (2003). It “refers to the holdings, as opposed to the dicta, of [the
    Supreme] Court’s decisions.” Williams v. Taylor, 
    529 U.S. 362
    , 412, 
    120 S. Ct. 1495
    , 1523 (2000).
    A state court decision is “contrary to” clearly established federal law if the
    state court applied “a rule different from the governing law set forth in [Supreme
    Court] cases, or if it decide[d] a case differently than [the Supreme Court] ha[s]
    done on a set of materially indistinguishable facts.” Bell v. Cone, 
    535 U.S. 685
    ,
    for less review (and consequently less protection) than other types of constitutional claims, we
    need not reach this issue because we conclude Mr. Madison is entitled to relief even under
    AEDPA’s deferential standard of review.
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    694, 
    122 S. Ct. 1843
    , 1850 (2002). A state court decision involves an
    “unreasonable application” of clearly established federal law if the state court (1)
    “identifies the correct governing legal rule from [the Supreme] Court’s cases but
    unreasonably applies it to the facts of the particular state prisoner’s case,” or (2)
    “either unreasonably extends a legal principle from [Supreme Court] precedent to a
    new context where it should not apply or unreasonably refuses to extend that
    principle to a new context where it should apply.” 
    Williams, 529 U.S. at 407
    , 120
    S. Ct. at 1520. The “unreasonable application” inquiry focuses on whether the
    state court’s application of Supreme Court precedent was “objectively
    unreasonable,” 
    id. at 409,
    120 S. Ct. at 1521, which “requires the state court
    decision to be more than incorrect or erroneous.” 
    Lockyer, 538 U.S. at 75
    , 123 S.
    Ct. at 1174.
    We afford state court findings of fact “substantial deference.” Brumfield v.
    Cain, 576 U.S. ___, 
    135 S. Ct. 2269
    , 2277 (2015). “[A] decision adjudicated on
    the merits in a state court and based on a factual determination will not be
    overturned on factual grounds unless objectively unreasonable in light of the
    evidence presented in the state-court proceeding.” Miller-El v. Cockrell, 
    537 U.S. 322
    , 340, 
    123 S. Ct. 1029
    , 1041 (2003). A finding of fact is not unreasonable
    “merely because the federal habeas court would have reached a different
    conclusion in the first instance.” Wood v. Allen, 
    558 U.S. 290
    , 301, 
    130 S. Ct. 14
                 Case: 16-12279     Date Filed: 03/15/2017   Page: 15 of 39
    841, 849 (2010). Indeed, we presume that a state court’s findings of fact are
    correct unless rebutted by “clear and convincing evidence.” 28 U.S.C.
    § 2254(e)(1). But
    when a state court’s adjudication of a habeas claim results in a
    decision that is based on an unreasonable determination of the facts in
    light of the evidence presented in the State court proceeding, this
    Court is not bound to defer to unreasonably-found facts or to the legal
    conclusions that flow from them.
    Jones v. Walker, 
    540 F.3d 1277
    , 1288 n.5 (11th Cir. 2008) (en banc) (quotation
    omitted and alterations adopted). And we bear in mind that “[d]eference does not
    by definition preclude relief. A federal court can disagree with a state court’s
    credibility determination and, when guided by AEDPA, conclude the decision was
    unreasonable or that the factual premise was incorrect by clear and convincing
    evidence.” 
    Miller-El, 537 U.S. at 340
    , 123 S. Ct. at 1041.
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    IV. DISCUSSION8
    A. THE COMPETENCY STANDARD
    We begin our analysis with the Supreme Court precedent on the competency
    standard. In Ford, the Court held that the Eighth Amendment prohibits the state
    from executing a person who is incompetent. The plurality opinion reasoned that
    the Eighth Amendment prohibits execution of “one whose mental illness prevents
    him from comprehending the reasons for the penalty or its implications.” 
    Ford, 477 U.S. at 417
    , 106 S. Ct at 2606. In a concurring opinion, Justice Powell
    concluded that the Eighth Amendment forbids the execution of “those who are
    unaware of the punishment they are about to suffer and why they are to suffer it”
    8
    In the District Court proceedings, the parties disputed whether Mr. Madison exhausted
    his Ford claim in state court. There, the State argued that Mr. Madison failed to exhaust because
    he did not appeal the trial court’s decision to the Alabama Court of Criminal Appeals. The
    District Court found to the contrary that Mr. Madison had exhausted his claim. Although the
    State did not renew this exhaustion argument on appeal, and conceded at oral argument that it
    wasn’t sure whether its position was even correct, we write to explain that the District Court got
    this right.
    Section 15-16-23, which grants an Alabama trial court the authority to suspend a death
    sentence if the petitioner is incompetent to be executed, explicitly precludes review by any other
    judge or court. See Ala. Code § 15-16-23 (“This mode of suspending the execution of sentence
    after conviction on account of the insanity of the convict shall be exclusive and final and shall
    not be reviewed or revised by or renewed before any other court or judge.”). The Alabama Court
    of Criminal Appeals has twice held that § 15-16-23 precludes appellate review of the trial court’s
    competency determination, and these decisions have not been overruled. See Weeks v. State,
    
    663 So. 2d 1045
    , 1046 (Ala. Crim. App. 1995) (granting state’s motion to dismiss appeal
    because Ala. Code § 15-16-23 “clearly states that a finding by the trial court on the issue of
    insanity, as it relates to this statute, is not reviewable by any other court”); Magwood v. State,
    
    449 So. 2d 1267
    , 1268 (Ala. Crim. App. 1984) (concluding that it did not have jurisdiction over
    appeal under § 15-16-23 and declining to “creat[e] a right of appellate review contrary to the
    explicit language of the statute”). On this basis, we conclude that Mr. Madison properly
    exhausted the available state court remedies. See 28 U.S.C. § 2254(b)(1).
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    and requires that prisoners “know the fact of their impending execution and the
    reason for it.” 
    Id. at 422,
    106 S. Ct. at 2608 (Powell, J., concurring). In Panetti,
    the Supreme Court revisited the competency standard and “clarified that the
    requisite ‘awareness’ or ‘comprehension’ required by Ford was tantamount to a
    ‘rational understanding’ of the connection between a prisoner’s crimes and his
    execution.” 
    Ferguson, 716 F.3d at 1336
    (citing 
    Panetti, 551 U.S. at 935
    , 
    958–59, 127 S. Ct. at 2848
    , 2861–62). In sum, under Panetti and Ford the prisoner must
    rationally understand that he is going to be put to death and the reason why. See
    
    Ferguson, 716 F.3d at 1318
    .
    In Panetti, the Supreme Court rejected the “improperly restrictive”
    competency test articulated by the Fifth Circuit and held that a prisoner must
    rationally, as well as factually, understand the reasons for his execution. 
    Panetti, 551 U.S. at 935
    , 
    959, 127 S. Ct. at 2848
    , 2862. The Fifth Circuit identified the
    relevant inquiry as whether a prisoner “is aware that he is going to be executed and
    why he is going to be executed.” 
    Id. at 956,
    127 S. Ct. at 2860 (quotation omitted
    and alteration adopted). The Fifth Circuit concluded that a prisoner is competent if
    he is aware he committed a crime, that he will be executed, and that his crime is
    the stated reason for the execution. See 
    id. The Supreme
    Court rejected this
    standard as inconsistent with Ford because it treated “a prisoner’s delusional belief
    system as irrelevant if the prisoner knows that the State has identified his crimes as
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    the reason for his execution.” 
    Id. at 958,
    127 S. Ct. at 2861. The Court explained
    that a prisoner’s mental condition is relevant to the requisite “comprehension” or
    “awareness” if it “so impair[s] the prisoner’s concept of reality that he cannot reach
    a rational understanding of the reason for the execution.” 
    Id. (alterations adopted).
    Although Panetti identifies the concept of “rational understanding” as the
    focus of the competency inquiry, the Court’s opinion does not define the term. See
    
    id. at 959,
    127 S. Ct. at 2862. But while Panetti declined “to set down a rule
    governing all competency determinations,” 
    id. at 960–61,
    127 S. Ct. at 2862, it did
    plainly tell us what is insufficient. Panetti explicitly rejected a bare factual-
    awareness standard, holding that “[a] prisoner’s awareness of the State’s rationale
    for an execution is not the same as a rational understanding of it.” Id. at 
    959, 127 S. Ct. at 2862
    . In other words, it’s not enough for the prisoner to merely recite the
    proffered reason for his execution. Instead, Panetti tells us we must look at the
    prisoner’s own “concept of reality,” id. at 
    958, 127 S. Ct. at 2861
    —particularly as
    it relates to the relationship between his crime and his execution. See id. at 
    960, 127 S. Ct. at 2862
    (“[A] severe mental disorder may put an awareness of a link
    between a crime and its punishment in a context so far removed from reality that
    the punishment can serve no proper purpose.”). After Panetti, it’s therefore clear
    that in order to determine competency, a court must examine whether a prisoner’s
    mental condition prevents him from appreciating the link between his crime and
    18
    Case: 16-12279        Date Filed: 03/15/2017        Page: 19 of 39
    his punishment.9 See 
    Panetti, 551 U.S. at 960
    –62, 127 S. Ct. at 2862–63;
    
    Ferguson, 716 F.3d at 1318
    (stating that the analysis of “mental competency to be
    executed involves [the prisoner’s] understanding of the connection between his
    execution and the crimes for which he is going to be executed”).
    B. THE ALABAMA COURT UNREASONABLY DETERMINED THE FACTS
    Mr. Madison argues that the state trial court’s decision was based on an
    unreasonable determination of the facts because the court refused to consider
    undisputed evidence of his diagnosed dementia and corresponding memory
    deficits. Mr. Madison points out that the trial court’s order never mentions his
    dementia diagnosis or engages in any analysis about how that diagnosis or his
    memory impairment impacts his ability to rationally understand the reason for his
    execution. The State responds that the trial court considered all of the evidence
    and simply relied on Dr. Kirkland’s testimony to determine that Mr. Madison is
    competent. But our review of Dr. Kirkland’s testimony leads us to conclude that it
    is insufficient to support the trial court’s competency determination. Indeed, Dr.
    9
    The rationales supporting the prohibition on the execution of people who are not
    competent underscore that the relevant inquiry focuses on the prisoner’s subjective
    understanding of the reason for his execution. Justice Powell’s opinion in Ford was concerned
    with the prisoner’s capacity to experience retribution, 477 U.S. at 
    422, 106 S. Ct. at 2608
    (Powell, J., concurring) (“If the [prisoner] perceives the connection between his crime and his
    punishment, the retributive goal of the criminal law is satisfied.”), and the prisoner’s ability “to
    prepare, mentally and spiritually, for [] death,” 
    id. at 421,
    106 S. Ct. at 2607. The Ford majority
    spoke of the “fear and pain” that people who do not understand the reason for their execution
    face. 
    Id. at 410,
    106 S. Ct. at 2602. The Court explained that “civilized societies” feel “natural
    abhorrence” at killing people like this because they lack the “capacity to come to grips with
    [their] own conscience or deity.” 
    Id. at 409,
    106 S. Ct. at 2601.
    19
    Case: 16-12279    Date Filed: 03/15/2017   Page: 20 of 39
    Kirkland’s testimony is not relevant to the competency inquiry called for by the
    Supreme Court.
    As we have discussed, Panetti requires a court to examine whether the
    prisoner, due to a mental disorder, lacks a rational understanding of the connection
    between his crime and his execution. The only evidence presented to the state
    court on this question was the testimony and reports of Dr. Kirkland and Dr. Goff.
    That evidence shows that Mr. Madison suffers from a serious mental disorder that
    has left him unable to recall his capital offense and that Mr. Madison believes, to
    the best of his ability, he didn’t kill anyone.
    First, it is clear that Mr. Madison has a serious mental condition. The
    experts agreed that Mr. Madison’s strokes have impaired his cognitive functioning.
    Dr. Goff diagnosed Mr. Madison with a vascular neurological disorder (vascular
    dementia) characterized by retrograde amnesia. Dr. Kirkland did not dispute that
    diagnosis. The experts agreed there was no indication that Mr. Madison was
    malingering.
    Second, on the record before us it is uncontroverted that, due to his mental
    condition, Mr. Madison has no memory of his capital offense. Dr. Goff
    specifically evaluated Mr. Madison’s cognitive abilities, including his memory,
    and found that while Mr. Madison is able to remember certain things from his past,
    he has no memory of the murder. The State presented no evidence to rebut this
    20
    Case: 16-12279       Date Filed: 03/15/2017      Page: 21 of 39
    finding. Indeed, the record includes no indication that Dr. Kirkland assessed
    whether Mr. Madison could remember the crime, and the State concedes that Dr.
    Kirkland never testified on this particular point. Rather, Dr. Kirkland testified that
    Mr. Madison “was able to talk with me about very specific things that would
    indicate that he could remember specific things about the time of the offense.”
    (Emphasis added.) Dr. Kirkland’s report reflected only that Mr. Madison was able
    to discuss certain details about his youth, such as where he attended elementary
    and high school, and the history of the litigation challenging his conviction and
    sentence. These statements do not show that Mr. Madison can remember the event
    that matters here—his capital offense. Dr. Goff’s testimony that Mr. Madison does
    not remember committing the murder is therefore unrefuted. 10
    Third, the record shows that, as a result of his mental disorder, Mr. Madison
    does not rationally understand the connection between his crime and his execution.
    Dr. Goff’s evaluation focused on Mr. Madison’s understanding of the reason for
    his execution, and Dr. Goff used a checklist of interview questions specifically
    designed to assess a prisoner’s competency to be executed.11 On the basis of this
    10
    The state trial court made no explicit finding as to whether Mr. Madison could
    remember his offense. In any event, such a finding would not have been reasonable in light of
    the evidence presented at the state court proceeding because there was no testimony or evidence
    to support it.
    11
    Dr. Goff used an interview checklist published in the Journal of Behavioral Sciences
    and the Law. See Zapf, P.A., Boccaccini, M.T., & Brodsky, S. L., Assessment of Competency
    for Execution: Professional Guidelines and an Evaluation Checklist, 21 Behav. Sci. & L. 103
    21
    Case: 16-12279        Date Filed: 03/15/2017        Page: 22 of 39
    evaluation, Dr. Goff testified that Mr. Madison cannot remember the crime and
    doesn’t believe he has killed anyone. Dr. Goff therefore concluded that Mr.
    Madison doesn’t understand why he is going to be punished or the act for which he
    is to be punished. Dr. Goff’s testimony addressed the core question posed by
    Panetti—whether Mr. Madison rationally understands that his crime is the reason
    for his execution. In stark contrast, Dr. Kirkland’s report and testimony include no
    indication that he evaluated whether Mr. Madison understood this connection at
    all.12 Dr. Kirkland didn’t refute any of Dr. Goff’s conclusions. Instead, the
    conclusions in Dr. Kirkland’s report appear to rely exclusively on Mr. Madison’s
    ability to discuss the history of his case.
    Dr. Kirkland’s testimony at the competency hearing demonstrates that he
    simply wasn’t looking at the right issues. Dr. Kirkland summarized his relevant
    findings as follows: First, “[Mr. Madison] was able to discuss his case with me in
    detail, in particular, each returned trip to [the sentencing] court”; and, second, “he
    was able to discuss the posture of the case at this point in an accurate fashion, and
    (2003). The checklist is divided into four sections: (1) understanding the reasons for
    punishment, (2) understanding the punishment, (3) appreciation and reasoning (in addition to
    simple factual understanding), and (4) ability to assist the attorney. 
    Id. at 114.
    In his report, Dr.
    Goff noted that he attempted to complete the first section of the checklist, which focuses on the
    individual’s understanding of the crime and other conviction-related information. Id.; see also
    
    id. at 117–18.
    Dr. Goff was not able to follow the suggested outline because of Mr. Madison’s
    “tendency to repeat himself and his tendency to go off on tangents and start talking about other
    issues.”
    12
    Although Dr. Kirkland has performed a significant number of competency evaluations
    in other contexts (e.g., competency to stand trial), Mr. Madison was the first prisoner he
    evaluated for his competency to be executed.
    22
    Case: 16-12279       Date Filed: 03/15/2017       Page: 23 of 39
    indicated that he knew what the original sentence was as well as why the case has
    been tried three times.” But this evidence shows only that Mr. Madison
    understands the procedural history of his case and is aware that he has been
    sentenced to death. Demonstrating this distinction, when the trial court asked Dr.
    Kirkland whether Mr. Madison understood that the State was seeking retribution
    for an act Madison had committed in the past, Dr. Kirkland replied, “Certainly.
    [Mr. Madison] talked specifically about [a] death sentence versus life without
    [parole] in the original trial and the first retrial and in the second.” That’s all Dr.
    Kirkland said. Mr. Madison’s ability to distinguish between a death sentence and a
    life sentence does not show—or even suggest—that he understands that his death
    sentence means he will be put to death because of the crime he committed.
    The critical fact underlying the state court’s competency decision was that
    Mr. Madison rationally understands “that he is going to be executed because of the
    murder he committed.” (Emphasis added.) But nothing in the record supports this
    finding.13 Dr. Kirkland never testified that Mr. Madison understands that his
    13
    The dissent says that Dr. Kirkland’s testimony supports the state court’s competency
    finding. We respectfully disagree. No testimony from Dr. Kirkland bears on Mr. Madison’s
    ability to understand the connection between the murder he committed in 1985 and his
    execution. Dr. Kirkland’s testimony that Mr. Madison understands his legal appeals and can
    discuss legal theories with his attorneys could perhaps demonstrate that Mr. Madison is
    competent to stand trial. See Drope v. Missouri, 
    420 U.S. 162
    , 171, 
    95 S. Ct. 896
    , 903 (1975)
    (competency to stand trial requires that the defendant have “the capacity to understand the nature
    and object of the proceedings against him, to consult with counsel, and to assist in preparing his
    defense”). But, as we’ve explained, it does not show that he is competent to be executed.
    23
    Case: 16-12279         Date Filed: 03/15/2017       Page: 24 of 39
    execution is connected to the murder he committed. And none of Dr. Kirkland’s
    testimony otherwise bears on Mr. Madison’s ability to understand the connection
    between his past crime and his execution. The only evidence in the record that
    does address this issue demonstrates that, due to his serious mental disorder, Mr.
    Madison does not understand the connection between his crime and his execution.
    Dr. Goff’s testimony showed that Mr. Madison cannot remember his crime,
    doesn’t believe he committed murder, and therefore cannot rationally connect his
    crime to his execution. Dr. Kirkland didn’t talk about Mr. Madison’s ability to
    make this connection at all. As a result, the state court’s finding that Mr. Madison
    “has a rational[] understanding . . . that he is going to be executed because of the
    murder he committed” is not supported by the record and is therefore plainly
    unreasonable.14 See Burgess v. Comm’r, Ala. Dep’t of Corr., 
    723 F.3d 1308
    , 1319
    Although the dissent portrays the state court as reasonably choosing between two experts,
    this record does not contain conflicting expert testimony on the critical issue of whether Mr.
    Madison rationally understands the connection between the murder he committed and his
    execution. As a result, this is not a situation in which the state court simply credited one expert
    over another. Cf. 
    Ferguson, 716 F.3d at 1339
    –40 (concluding that petitioner was not entitled to
    relief under § 2254(d), in part because the state court merely credited the testimony of some
    experts over others).
    14
    Although the Supreme Court has “not yet defined the precise relationship between
    § 2254(d)(2) and § 2254(e)(1),” 
    Brumfield, 135 S. Ct. at 2282
    (quotation omitted), and neither
    has this Court, Landers v. Warden, Atty. Gen. of Ala., 
    776 F.3d 1288
    , 1293 n.4 (11th Cir. 2015)
    (“The interaction between [§ 2254](d)(2) and (e)(1) . . . is an open question in this circuit.”), Mr.
    Madison has met his burden under either standard. Nothing in the record supports the state
    court’s factual determination. And the unrebutted expert testimony on this point shows the exact
    opposite. We therefore conclude Mr. Madison has produced clear and convincing evidence that
    he does not rationally understand the connection between his past crime and his execution. See
    Ward v. Hall, 
    592 F.3d 1144
    , 1178 (11th Cir. 2010) (concluding habeas petitioner had rebutted
    24
    Case: 16-12279       Date Filed: 03/15/2017       Page: 25 of 39
    (11th Cir. 2013) (holding state court’s ruling was an unreasonable determination of
    the facts because the record was “insufficient to support its conclusions”); Green v.
    Nelson, 
    595 F.3d 1245
    , 1251 (11th Cir. 2010) (concluding the state court’s
    determination had “no basis in th[e] record” and was therefore unreasonable under
    § 2254(d)(2)). We therefore conclude that the state court’s decision that Mr.
    Madison is competent to be executed rests on an unreasonable determination of the
    facts.
    C. THE ALABAMA COURT UNREASONABLY APPLIED THE LAW
    This record also leads us to conclude that the state court’s decision involved
    an unreasonable application of clearly established federal law. The state court
    cited Panetti in support of its finding that Mr. Madison was competent to be
    executed. But, considering the evidence presented at the competency hearing, this
    finding “cannot be reconciled” with any reasonable application of Panetti. 551
    U.S. at 
    953, 127 S. Ct. at 2858
    .
    The State argues that Mr. Madison cannot succeed under AEDPA because
    Ford and Panetti didn’t hold that the specific mental conditions relevant here,
    dementia and related memory loss, “definitively preclude rational understanding.”
    Rather, the State suggests that only a prisoner suffering from gross delusions can
    the presumed correctness of the state court’s factual finding when “there [was] no contrary
    evidence in the record to refute” the petitioner’s evidence).
    25
    Case: 16-12279       Date Filed: 03/15/2017       Page: 26 of 39
    show incompetency under Panetti.15 This is not consistent with our reading of
    Ford and Panetti. Neither case says a prisoner must suffer from delusions in order
    to be deemed incompetent. Indeed, such a narrow and rigid rule would be
    inconsistent with the principles underlying those decisions. The Supreme Court
    was concerned with a much broader question. That is, whether a prisoner’s
    “current mental state [] bar[s] his execution” under the Eighth Amendment,
    
    Panetti, 551 U.S. at 934
    , 127 S. Ct. at 2848, by preventing him from
    “comprehending the meaning and purpose of the punishment,” 
    id. at 960,
    127 S.
    Ct. at 2862.
    Panetti requires a court making a competency determination to analyze the
    prisoner’s understanding of the connection between his crime and his execution.
    See 
    Panetti, 551 U.S. at 960
    , 127 S. Ct. at 2862 (focusing on the prisoner’s
    “awareness of a link between [his] crime and [his] punishment”); see also
    
    Ferguson, 716 F.3d at 1336
    . And the Supreme Court has told us that the prisoner’s
    own “concept of reality” is relevant to this determination. See 
    Panetti, 551 U.S. at 958
    –60, 127 S. Ct. at 2861–62. Courts may not conflate a prisoner’s mere
    awareness of the stated reason for his execution with a rational understanding of
    15
    At oral argument, the State argued that a prisoner who has severe dementia that doesn’t
    result in delusions but has completely obliterated his memory would be competent to be executed
    because the mere fact that a prisoner doesn’t suffer from delusions means that he can form the
    rational understanding required by Panetti.
    26
    Case: 16-12279     Date Filed: 03/15/2017    Page: 27 of 39
    that reason—“[a] prisoner’s awareness of the State’s rationale for an execution is
    not the same as a rational understanding of it.” Id. at 
    959, 127 S. Ct. at 2862
    .
    In short, the Supreme Court has made it clear that to determine competency,
    a court must examine the prisoner’s understanding of the connection between his
    crime and his execution, taking into account any impairments resulting from a
    mental disorder. See 
    Panetti, 551 U.S. at 958
    –60, 127 S. Ct. at 2861–62. The state
    court didn’t do that here. The court never considered the impact of Mr. Madison’s
    memory loss or his belief that he never killed anyone on his ability to make the
    required connection between his crime and his execution. And the evidence the
    trial court did consider—namely, Dr. Kirkland’s testimony—did not address Mr.
    Madison’s understanding of this connection at all. Therefore, under any
    reasonable interpretation of Panetti, this record cannot support the trial court’s
    finding that Mr. Madison is competent to be executed.
    A closer look at the competency standard rejected by the Supreme Court in
    Panetti as “too restrictive” makes this obvious. 
    Id. at 956,
    127 S. Ct. at 2860. The
    Fifth Circuit’s test before the Court in Panetti considered a prisoner competent if
    he was aware of committing the underlying crime, aware that he will be executed,
    and aware that the reason the state has given for his execution is the underlying
    crime. See 
    id. But, even
    under this standard, Mr. Madison cannot be deemed
    competent. The record shows that, due to his dementia, he isn’t aware that he
    27
    Case: 16-12279     Date Filed: 03/15/2017    Page: 28 of 39
    committed the underlying crime—he doesn’t remember the crime and he believes,
    to the best of his ability, he has never killed anyone. Panetti clearly established
    that the Fifth Circuit’s “bare and narrow factual-awareness” test was too
    restrictive, see 
    Ferguson, 716 F.3d at 1335
    , so this trial court’s determination that
    Mr. Madison is competent is wholly inconsistent with Panetti.
    We are aware that the Supreme Court recognized “a concept like rational
    understanding is difficult to define.” Panetti, 551 U.S. at 
    959, 127 S. Ct. at 2862
    .
    But Panetti plainly requires courts making competency determinations to analyze
    whether the prisoner understands “the connection between his execution and the
    crimes for which he is going to be executed.” 
    Ferguson, 716 F.3d at 1318
    . The
    state court failed to do that here. If a court can find a prisoner competent to be
    executed without evidence that he understands why he is being punished, Panetti
    doesn’t stand for much.
    AEDPA requires us to ask whether “some fairminded jurists could agree,”
    with the state court’s competency determination in light of the Panetti standard and
    the evidence presented to the state court. See 
    Ferguson, 716 F.3d at 1340
    (quotation omitted). Given the unrebutted evidence that Mr. Madison suffers from
    vascular dementia, has no memory of his capital crime, was not malingering during
    the experts’ evaluations, and believes that he has not killed anyone—as well as the
    utter lack of any testimony that Mr. Madison understands the connection between
    28
    Case: 16-12279    Date Filed: 03/15/2017   Page: 29 of 39
    the murder he committed and his impending execution—the answer here is no. A
    person cannot rationally understand why he is being killed if, according to his
    “concept of reality,” he never committed a crime. 
    Panetti, 551 U.S. at 958
    , 127 S.
    Ct. at 2861. A finding that a man with no memory of what he did wrong has a
    rational understanding of why he is being put to death is patently unreasonable.
    V. CONCLUSION
    Because the Alabama trial court unreasonably determined the facts relevant
    to Mr. Madison’s claim and unreasonably applied controlling federal law, we do
    not owe the state court’s finding that Mr. Madison is competent to be executed
    deference under AEDPA. We therefore review the merits of Mr. Madison’s claim
    de novo. See Adkins v. Warden, Holman CF, 
    710 F.3d 1241
    , 1255 (11th Cir.
    2013); Cooper v. Sec’y, Dep’t of Corr., 
    646 F.3d 1328
    , 1353 (11th Cir. 2011) .
    Under Panetti there are two relevant questions. First, whether Mr. Madison
    rationally understands the connection between his crime and his execution—that is,
    whether he understands that he is going to be executed because of the murder he
    committed. 
    Ferguson, 716 F.3d at 1342
    . And second, whether Mr. Madison
    understands that he will die when he is executed. 
    Id. It is
    undisputed that Mr.
    Madison understands that his execution will result in his death. But for the second
    question, the evidence shows that, due to his dementia and related memory
    impairments, Mr. Madison lacks a rational understanding of the link between his
    29
    Case: 16-12279     Date Filed: 03/15/2017    Page: 30 of 39
    crime and his execution. Mr. Madison may have been told that he is being
    executed because of the murder he committed, but he doesn’t remember his capital
    offense, and according to his perception of reality he never committed murder.
    This record is without evidence that Mr. Madison is malingering, and there is no
    finding by the trial court to that effect. A person does not rationally understand his
    punishment if he is simply blindly accepting what he has been told. See Panetti,
    551 U.S. at 
    959, 127 S. Ct. at 2862
    (“A prisoner’s awareness of the State’s
    rationale for an execution is not the same as a rational understanding of it.”); see
    also 
    Ferguson, 716 F.3d at 1344
    (Wilson, J., concurring) (“Panetti requires more
    than just a prisoner’s ability to regurgitate the State’s announced reason for his
    punishment or to recite the facts attendant to his execution.”). Dr. Goff testified
    that Mr. Madison does not understand why he is being executed or the act for
    which he is being punished. None of the evidence at the competency hearing
    belies Dr. Goff’s testimony. We therefore conclude that Mr. Madison is
    incompetent to be executed.
    REVERSED.
    30
    Case: 16-12279   Date Filed: 03/15/2017   Page: 31 of 39
    JORDAN, Circuit Judge, dissenting.
    After reviewing the record, I believe that Vernon Madison is currently
    incompetent.     I therefore do not think that Alabama can, consistent with the
    Constitution, execute him at this time for his murder of a police officer three
    decades ago. See generally Panetti v. Quarterman, 
    551 U.S. 930
    , 958 (2007)
    (explaining that a state cannot put to death a prisoner who “cannot reach a rational
    understanding of the reason for the execution”). But Congress has chosen to
    generally prohibit federal courts from adjudicating constitutional claims anew on
    habeas review, so Mr. Madison’s competency (or lack thereof) is not our initial call
    to make. Under the restrictive standards we are required to apply, see 28 U.S.C.
    § 2254(d), and given the way we interpreted Panetti in Ferguson v. Secretary, 
    716 F.3d 1315
    (11th Cir. 2013), I do not think Mr. Madison can obtain habeas relief.
    I
    Mr. Madison asserts that the state trial court’s decision is not entitled to
    AEDPA deference because Alabama law does not provide for any appellate
    review. See Br. for Appellant at 20–26. But he did not present this theory to the
    district court, and normally we do not entertain arguments raised for the first time
    on appeal. See, e.g., Landers v. Warden, 
    776 F.3d 1288
    , 1296–97 (11th Cir. 2015).
    I understand that we have discretion to address an unpreserved claim, see, e.g.,
    Burns v. Secretary, 
    720 F.3d 1296
    , 1303 n.2 (11th Cir. 2013) (citing cases), but I
    31
    Case: 16-12279     Date Filed: 03/15/2017   Page: 32 of 39
    would not exercise such discretion here because Mr. Madison never sought a
    certificate of appealability on this issue.
    II
    Mr. Madison argues that the state trial court improperly applied a
    competency standard which required him to show that he suffered from a mental
    illness, and refused to consider his dementia and corresponding memory deficits.
    As a result, he says, the state trial court’s decision was contrary to, and an
    unreasonable application of, Ford v. Wainwright, 
    477 U.S. 399
    (1986), and
    Panetti. See Br. for Appellant at 26–31. I am not convinced by this argument.
    First, the state trial court cited both Ford and Panetti in its order. And it
    correctly quoted Panetti for the proposition that “[a] prisoner’s awareness of the
    [s]tate’s rationale for an execution is not the same as a rational understanding of it.
    Ford does not foreclose inquiry into the latter.” D.E. 8-2 at 4 (quoting 
    Panetti, 551 U.S. at 959
    ) (internal quotation marks omitted).
    Second, although I strongly disagree with Alabama’s contention that mental
    illness is a necessary (though not sufficient) prerequisite for a finding of
    incompetency under Ford and Panetti—I can imagine a number of scenarios where
    lack of competency is not due to mental illness—Mr. Madison told the state trial
    court at the evidentiary hearing that the applicable competency standard was the
    one approved in Weeks v. Jones, 
    52 F.3d 1559
    , 1568 (11th Cir. 1995), i.e., the
    32
    Case: 16-12279    Date Filed: 03/15/2017    Page: 33 of 39
    standard found in Standard 7-5.6(b) of the American Bar Association’s Criminal
    Justice Mental Health Standards (which itself refers to “mental illness”), as
    modified by Panetti. Mr. Madison explained the standard as follows:
    [T]his [c]ourt would have the obligation of determining whether Mr.
    Madison, as a result of mental illness or mental retardation, cannot
    understand the nature of the pending proceeding, what he . . . was
    tried for, the reason for the punishment, or the nature of the
    punishment. And I’m reading from Weeks. . . . The convict is also
    incompetent if, as a result of mental illness or retardation, the convict
    lacks sufficient capacity to recognize or understand any fact which
    may exist which would make the punishment unjust or lawful, or
    lacks the ability to convey such information to counsel or the [c]ourt.
    Obviously, there’s the United States Supreme Court decision in
    P[a]netti as well, which describes the standard as one of having a
    rational understanding of the proceedings and not just a factual
    understanding of what’s happening.
    D.E. 8-1 at 7–8 (emphasis added). Because Mr. Madison urged the state trial court
    to use the Weeks standard, which referred to mental illness, he cannot now
    complain that it did as he asked. See, e.g., F.T.C. v. AbbVie Prod. LLC, 
    713 F.3d 54
    , 65–66 (11th Cir. 2013) (concluding that party which argued for a certain
    standard in the district court invited error and could not request a different standard
    on appeal).
    III
    Mr. Madison contends that the state trial court erred in finding him
    competent to be executed. This claim is a difficult one, but at the end of the day I
    33
    Case: 16-12279       Date Filed: 03/15/2017      Page: 34 of 39
    do not believe that Mr. Madison can overcome the presumption of correctness
    afforded to the state trial court’s factual finding by clear and convincing evidence.
    A
    A state can, consistent with the Due Process Clause of the Fourteenth
    Amendment, presume that a defendant is competent, and place the burden on him
    to show otherwise by a preponderance of the evidence. See Medina v. California,
    
    505 U.S. 437
    , 446–53 (1992); Cooper v. Oklahoma, 
    517 U.S. 348
    , 355–56 (1996).
    Unfortunately, the Alabama statute at issue here, Ala. Code § 15-16-23, is silent on
    who has the burden of proof as to competency, and because the statute does not
    allow for appellate review of a trial court’s competency ruling, see, e.g., Weeks v.
    State, 
    663 So. 2d 1045
    , 1046 (Ala. Crim. App. 1995), there are no reported
    decisions in Alabama which address the burden of proof. Our cases involving
    § 15-16-23 are also silent on that issue. See, e.g., Magwood v. Smith, 
    791 F.2d 1438
    , 1445–47 (11th Cir. 1986).1
    In its order, the state trial court explained that the parties had agreed that Mr.
    Madison had the burden of showing, by a preponderance of the evidence, that he is
    incompetent and cannot be executed. See D.E. 8-2 at 4. When he filed his habeas
    1
    One of our opinions, James v. Singletary, 
    957 F.2d 1562
    , 1571 (11th Cir. 1992), says—
    without citing any authority—that a “petitioner raising a substantive claim of incompetency is
    entitled to no presumption of incompetency and must demonstrate his or incompetency by a
    preponderance of the evidence.” This language, however, is dicta because the James panel only
    addressed whether the Florida petitioner in that case had done enough to obtain an evidentiary
    hearing in the district court.
    34
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    corpus petition, Mr. Madison did not take issue with the state trial court’s
    statement. See D.E. 1 at 15–16. And in his brief here Mr. Madison does not
    quarrel with the state trial court’s allocation of the burden of proof. It seems to me,
    therefore, that our § 2254(d)(2) analysis must proceed with the understanding that
    in the state trial court Mr. Madison bore the burden of establishing that he is
    incompetent. That necessarily means, of course, that Alabama did not have to
    establish that Mr. Madison is competent.2
    B
    The state trial court’s determination that Mr. Madison is competent under
    Panetti constitutes a finding of fact. See, e.g., Demosthenes v. Baal, 
    495 U.S. 731
    ,
    735 (1990) (pre-AEDPA); Lawrence v. Secretary, 
    700 F.3d 464
    , 476–77 (11th Cir.
    2012) (post-AEDPA).          Under AEDPA that finding of fact is “presumed to be
    correct,” and Mr. Madison shoulders the burden of rebutting that “presumption of
    correctness by clear and convincing evidence.” 28 U.S.C. § 2254(e)(1). Clear and
    convincing evidence, as we have explained, is “an intermediate standard of proof
    2
    Some Alabama cases, in addressing competency to stand trial under Ala. Code § 15-16-
    22, have explained that the defendant bears an initial burden of producing evidence that he is
    incompetent, but once he does so the state “must then prove that [he] is competent.” Lackey v.
    State, 
    615 So. 2d 145
    , 152 (Ala. Crim. App. 1992). Mr. Madison has not tried to place the
    burden on Alabama even though dicta in Magwood v. State, 
    689 So. 2d 959
    , 973 (Ala. Crim.
    App. 1996), suggests that “[t]he standards and guidelines concerning [§ 15-16-23] are analogous
    to those concerning the determination of competence to stand trial established in § 15-16-22[.]”
    35
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    that lies between proof by a preponderance of the evidence and proof beyond a
    reasonable doubt.” Fults v. GDCP Warden, 
    764 F.3d 1311
    , 1314 (11th Cir. 2014).
    Significantly, we do not apply Panetti and Ford in a vaccum. In Ferguson,
    we explained that Panetti, though rejecting a “bare and narrow factual-awareness
    standard[,] . . . did not abrogate or otherwise reject the awareness standard
    articulated by Justice Powell [in Ford], nor did it impose a new, more rigorous
    standard for assessing competency to be 
    executed.” 716 F.3d at 1335
    . “Instead,
    the Supreme Court in Panetti generally accepted the proposition that Ford had laid
    down the ‘substantive federal baseline for competency,’ and it clarified that the
    requisite ‘awareness’ or ‘comprehension’ required by Ford was tantamount to a
    ‘rational understanding’ of the connection between a prisoner’s crimes and his
    execution.” 
    Id. at 1335–36
    (citation omitted). “What the Supreme Court rejected
    in Panetti was an overly narrow interpretation of Ford that deems a prisoner’s
    mental illness and delusional beliefs irrelevant to whether he can understand the
    fact of his pending execution and the reason for it.” 
    Id. at 1336.
    In Ferguson we also pointed out that Panetti declined to provide a definition
    of the phrase “rational understanding,” except to say that “‘normal’ or ‘rational’ in
    this context does not mean what a layperson understands those terms to mean.” 
    Id. at 1337
    (citation omitted). And “[b]ecause the Supreme Court refrained from
    36
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    clearly establishing in Panetti any definition of rational understanding,” we said
    that “state courts can hardly be faulted for not clearly defining it themselves.” 
    Id. There is,
    undoubtedly, evidence in the record which shows that
    Mr. Madison—given his thalamic stroke, ensuing vascular dementia, and
    numerous other significant medical problems—is incompetent. Dr. John Goff, for
    example, concluded that Mr. Madison is not competent. Mr. Madison, according
    to Dr. Goff, does not remember who his victim was. See D.E. 8-1 at 59. And
    although Mr. Madison realizes that he is going to be executed, Dr. Goff believes
    that he does not understand why due to the loss of episodic (i.e., event-specific)
    memory. See 
    id. at 48,
    55. Dr. Goff reached his conclusion after examining
    Mr. Madison, administering a number of tests to him, interviewing other
    individuals who interacted with him, and reviewing his medical history. See 
    id. at 40–53.
    I personally find Dr. Goff’s opinion persuasive and would credit it if I
    were the factfinder, but that is not my role. See Burt v. Titlow, 
    134 S. Ct. 10
    , 15
    (2013) (“[A] state-court factual determination is not unreasonable merely because
    the federal habeas court would have reached a different conclusion in the first
    instance.”). 3
    3
    I do note, however, that Dr. Goff was not aware that Mr. Madison had never admitted
    that he was guilty of murder, and had tried to establish that he acted in self-defense. See D.E. 8-
    1 at 65; Madison v. State, 
    718 So. 2d 90
    , 97 (Ala. Crim. App. 1997).
    37
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    What matters here is that there is evidence in the record which supports a
    finding that Mr. Madison is competent.           Dr. Karl Kirkland, following an
    examination of Mr. Madison and a review of his medical records, concluded that
    he is competent despite a decline in cognitive functioning. See D.E. 8-1 at 17. As
    set forth in his report, which was admitted as Court Exhibit 1 at the state court
    evidentiary hearing, Dr. Kirkland reached his conclusion based on findings that
    Mr. Madison (a) does not have “psychosis, paranoia, or delusion;” (b) remembers
    his appeals and has a strong belief that his state trial judge should have recused
    himself; (c) understands the “exact posture of his case at this point;” (d) is “able to
    accurately discuss many aspects of his case;” and (e) “appears to be able to have a
    rational understanding of the sentence, the results or effects of the sentence, and to
    still be able to discuss defense and legal theories with his attorneys.” D.E. 8-3 at
    9–11. At the evidentiary hearing, Dr. Kirkland testified that Mr. Madison is “able
    to discuss the posture of the case at this point in an accurate fashion,” and is “able
    to be cognizant, aware . . . where he is with the case.” D.E. 8-1 at 16–17. He also
    explained that Mr. Madison knows about his pending execution, and realizes that
    he has two possible sentences: execution and life without parole. 
    Id. at 23,
    25–26.
    The state trial court found, after considering the conflicting evidence, that
    Mr. Madison failed to prove by a preponderance of the evidence that he is
    incompetent. See D.E. 8-2 at 10. The state trial court accepted the testimony of
    38
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    Dr. Kirkland as to Mr. Madison’s understanding of the situation, and specifically
    found that Mr. Madison “has a rational[ ] understanding, as required by Panetti,
    that he is going to be executed because of the murder he committed and a
    rational[ ] understanding that the [s]tate is seeking retribution and that he will die
    when he is executed.” 
    Id. I acknowledge
    that Dr. Kirkland may not have performed the most
    exhaustive of examinations, may not have asked the best questions, and may not
    have provided the most pristine opinion.          But that is not dispositive because
    Alabama did not have the burden of proof. Given that Mr. Madison bore the
    burden of establishing his incompetency, and that the state trial court considered
    but implicitly rejected Dr. Goff’s opinion, see Hodges v. Attorney General, 
    506 F.3d 1337
    , 1347 n.2 (11th Cir. 2007), I do not believe Mr. Madison can overcome
    the presumption of correctness given to that court’s competency finding by clear
    and convincing evidence. See 
    Ferguson, 716 F.3d at 1339
    –42; 
    Fults, 764 F.3d at 1314
    , 1319–21.      Stated differently, the state trial court’s finding was not
    “objectively unreasonable in light of the evidence presented in the state-court
    proceeding.” Miller-El v. Cockrell, 
    537 U.S. 322
    , 340 (2003).4
    IV
    Respectfully, and reluctantly, I dissent.
    4
    Things might be different if Alabama had the burden of demonstrating that Mr.
    Madison is competent. But, as the case was litigated in the state court, it did not.
    39