John Ferguson v. Secretary, Florida Department of Corrections ( 2013 )


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  •               Case: 12-15422    Date Filed: 05/21/2013    Page: 1 of 65
    [PUBLISH]
    IN THE UNITED STATES COURT OF APPEALS
    FOR THE ELEVENTH CIRCUIT
    ________________________
    No. 12-15422
    ________________________
    D.C. Docket No. 1:12-cv-23817-DTKH
    JOHN FERGUSON,
    Petitioner-Appellant,
    versus
    SECRETARY, FLORIDA DEPARTMENT OF CORRECTIONS,
    Respondent-Appellee.
    ________________________
    Appeal from the United States District Court
    for the Southern District of Florida
    ________________________
    (May 21, 2013)
    Before CARNES, WILSON and PRYOR, Circuit Judges.
    CARNES, Circuit Judge:
    The Supreme Court has decided that a convicted murderer cannot be
    executed unless he has a rational understanding of the fact that he is going to be
    put to death and of the reason for his execution. Panetti v. Quarterman, 
    551 U.S. 930
    , 954–60, 
    127 S. Ct. 2842
    , 2859–62 (2007). In announcing that rule, however,
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    the Court did not decide what rational understanding means in this context. It
    acknowledged that “a concept like rational understanding is difficult to define” and
    cautioned that “normal” or “rational” in this context does not mean what a
    layperson understands those terms to mean. 
    Id. at 959–60,
    127 S.Ct. at 2862. The
    Court did reject the standard the court of appeals had applied in the Panetti case
    because that standard disregarded or did not give sufficient consideration to
    evidence of “psychological dysfunction” and “delusional beliefs.” 
    Id. at 960,
    127
    S.Ct. at 2862. But the Court emphasized that it deliberately was not being more
    specific and cautioned that it was “not attempt[ing] to set down a rule governing all
    competency determinations.” 
    Id. at 960–61,
    127 S.Ct. at 2862. “[W]e find it
    difficult,” the Court confessed, “to amplify our conclusions or to make them more
    precise.” 
    Id. at 961,
    127 S.Ct. at 2863.
    The bottom line of the Panetti decision is that there is not yet a well-defined
    bottom line in this area of the law. Instead of attempting to answer more
    specifically the question of what is required for a rational understanding of death
    by execution and the reason for it, the Supreme Court preferred to leave “a
    question of this complexity” to be addressed in a fuller manner and on a better
    record by the district court and the court of appeals in that case. 
    Id. The decision
    not to decide more is, unfortunately, the last word from the Supreme Court on the
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    “question of this complexity,” one variation of which is presented by the facts in
    our case.
    The habeas petitioner in our case, John Ferguson, contends that under the
    Panetti decision he is mentally incompetent to be executed. As the facts come to
    us, Ferguson has a mental illness but he does understand that he is going to die by
    execution, and he understands that it is going to happen because he committed
    eight murders. Ferguson also believes, as tens of millions if not hundreds of
    millions of other people do, that there is life after death. Countless people also
    believe, as he does, that they are among God’s chosen people. But Ferguson’s
    religious belief is more grandiose than that because he believes that he is the Prince
    of God. The Florida courts rejected Ferguson’s Panetti claim, and we must decide
    whether their decision to do so “was based on an unreasonable determination of the
    facts in light of the evidence presented in the State court proceeding” or was
    “contrary to, or involved an unreasonable application of, clearly established
    Federal law, as determined by the Supreme Court of the United States.” 28 U.S.C.
    § 2254(d). The key words being “clearly established law.” Or the lack of it.
    I. BACKGROUND
    A. The Crimes
    Part of the analysis of Ferguson’s mental competency to be executed
    involves his understanding of the connection between his execution and the crimes
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    for which he is going to be executed, which makes the nature of those crimes
    relevant.
    1. The Carol City Murders
    On the night of July 27, 1977, Ferguson, posing as a Florida Power and
    Light employee who needed to check some electrical outlets, persuaded Miss
    Margaret Wooden to let him enter her home. Ferguson v. State, 
    417 So. 2d 639
    ,
    640, 643 (Fla. 1982). After pretending to check the outlets in several rooms,
    Ferguson drew a gun on Wooden and bound and blindfolded her. 
    Id. at 640.
    He
    then let two of his criminal cohorts into the house so that they could search it for
    drugs and valuables. 
    Id. About two
    hours later the owner of the house and five of
    his friends arrived. 
    Id. Wielding guns,
    Ferguson and his accomplices bound and
    blindfolded and searched the six men. Shortly thereafter, Wooden’s boyfriend,
    Michael Miller, arrived. He, too, was bound and blindfolded and searched at
    gunpoint. 
    Id. While six
    of the robbery victims were forced to kneel in the living
    room, Miller and Wooden were taken into her bedroom. 
    Id. There they
    were put
    with their knees on the floor and their upper bodies lying across the bed. 
    Id. at 641.
    Then the killing began. Ferguson and his partners in crime methodically
    murdered five of the six men who were kneeling in the living room by shooting
    each one in the back of the head while his hands were tied behind him. 
    Id. One of
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    the six men somehow survived the shot to the back of his head, living to tell about
    the methodical murders of the other men in the living room. 
    Id. While Miller
    and Wooden were kneeling in the bedroom, Wooden heard the
    gunshots in the living room. 
    Id. She saw
    her boyfriend shot to death beside her.
    
    Id. She saw
    a pillow coming toward her before she was shot in the head. 
    Id. And she
    heard Ferguson running out of the bedroom after the shootings. 
    Id. Despite her
    head wound, Wooden managed to make it to a neighbor’s house. 
    Id. When the
    police arrived at Wooden’s house, they found six dead victims, all of whom had
    been shot in the back of the head while their hands were bound behind their backs,
    and they found the two intended murder victims who had been shot in that same
    manner but had somehow survived. 
    Id. 2. The
    Hialeah Murders
    Ferguson had two accomplices when he committed the six Carol City
    murders, but less than six months later he committed two more murders all by
    himself. Ferguson v. State, 
    417 So. 2d 631
    , 633 (Fla. 1982). On the evening of
    January 8, 1978, Brian Glenfeld and Belinda Worley, both of whom were
    seventeen years old, left a Youth for Christ meeting in Hialeah. 
    Id. They were
    supposed to meet some friends at a local ice cream parlor, but they never arrived.
    
    Id. Apparently on
    the way to meeting their friends, the young couple pulled off the
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    road. See 
    id. at 636.
    What Ferguson did to the two teenagers when he chanced
    upon them was recounted by the trial court judge:
    The facts reveal that the two victims were seated in an automobile and
    while seated therein a gunshot was fired through the window striking
    Brian Glenfeld in the arm and chest area. A significant amount of
    bleeding followed and this victim’s blood was found throughout many
    areas of the front of the automobile as well as on the clothing of
    Belinda Worley. Following the shooting, the female victim ran many
    hundreds of feet from the car in an attempt to [elude] the defendant
    and was finally overtaken in some rather dense overgrowth and trees.
    She was subjected to many physical abuses by this defendant,
    including but not limited to, sexual penetration of her vagina and
    anus. The discovery of embedded dirt in her fingers, on her torso both
    front and back and in many areas within her mouth and the findings of
    hemorrhaging around her vagina and anal cavity would indicate that
    she put up a significant struggle and suffered substantially during the
    perpetration of these indignities upon her body. Expert testimony
    indicates that she was a virgin at the time of the occur[r]ence of this
    crime. The position of her body and the location of the wounds on her
    head would indicate that she was in a kneeling position at the time she
    was shot through the top of the head. She was left in a partially nude
    condition in the area where the crime was committed to be thereafter
    fed upon by insects and other predators. Physical evidence would
    substantiate that following the attack upon Belinda Worley the
    defendant went back to the car and shot Brian Glenfeld through the
    head.
    
    Id. Ferguson stole
    cash from Brian Glenfeld’s wallet. 
    Id. at 633.
    Among the
    items he took from Belinda Worley, or her body, were two rings, a gold bracelet,
    and a pair of earrings. 
    Id. When he
    ripped one of those earrings from Worley’s
    ear, he tore her ear lobe. 
    Id. 6 Case:
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    To murder the two young victims Ferguson used a .357 magnum pistol that
    had been stolen from a victim of the Carol City murders nearly six months earlier.
    
    Id. He confessed
    to killing the “two kids.” 
    Id. B. The
    Trials, Appeals, and Collateral Attacks
    Following separate trials, Ferguson was convicted of murdering the six
    Carol City victims and the two Hialeah victims. See Ferguson v. Sec’y for Dep’t
    of Corr., 
    580 F.3d 1183
    , 1190 (11th Cir. 2009). The Florida Supreme Court
    affirmed all eight murder convictions on direct appeal, but remanded for
    resentencing due to the trial court’s reliance on invalid aggravating factors and its
    failure to properly consider certain mitigating factors. Ferguson v. State, 
    417 So. 2d
    639 (Fla. 1982); Ferguson v. State, 
    417 So. 2d 631
    (Fla. 1982). On remand, the
    trial court reimposed the death penalty in each case and the Florida Supreme Court
    affirmed in a consolidated appeal. Ferguson v. State, 
    474 So. 2d 208
    (Fla. 1985).
    Ferguson filed a motion under Florida Rule of Criminal Procedure 3.850
    seeking relief from his convictions and sentences, but that motion was denied and
    the denial was affirmed on appeal. Ferguson v. State, 
    593 So. 2d 508
    (Fla. 1992).
    He filed a federal habeas petition attacking his convictions and sentences, but it too
    was denied, and the denial was affirmed on appeal. 
    Ferguson, 580 F.3d at 1222
    .
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    C. Ferguson’s Mental Health History and the Pre-2000
    State Court Mental Competency Hearings
    Throughout the first half of the 1970s, Ferguson was consistently diagnosed
    by mental health professionals with paranoid schizophrenia, which resulted in
    commitments to a state psychiatric facility and a prescribed regimen of potent
    antipsychotic medications. In 1976 he was deemed mentally competent and
    discharged from a mental hospital.
    In the three and a half decades since that discharge Ferguson’s attorneys
    have exhaustively litigated his mental competency. Although experts have differed
    in their opinions about his mental state during that time, every state and federal
    court to decide the issue has decided that Ferguson is not mentally incompetent.
    Earlier determinations of competency, whether addressed to a prisoner’s
    responsibility for committing a crime or to his ability to stand trial, “do not
    foreclose a prisoner from proving he is incompetent to be executed because of his
    present mental condition.” 
    Panetti, 551 U.S. at 934
    , 127 S.Ct. at 2848. Still, the
    history of Ferguson’s mental condition, the opinions of experts regarding it, and
    judicial decisions about it over the years are all relevant to a discussion of his
    present mental condition.
    In connection with his two 1978 murder trials, the state court held separate
    hearings, one before each trial, to determine whether Ferguson was competent to
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    stand trial. See Ferguson v. Singletary, 
    632 So. 2d 53
    , 58 (Fla. 1994). Four court-
    appointed experts filed reports before the Carol City trial (the one with eight
    shooting victims), unanimously concluding that Ferguson was mentally competent.
    See 
    id. Some of
    the four experts were even of the opinion that Ferguson was
    malingering and not actually schizophrenic, but instead likely was sociopathic.
    See 
    Ferguson, 593 So. 2d at 510
    . Notably, two of those four court-appointed
    experts, Drs. Charles Mutter and Albert Jaslow, receded from the diagnoses that
    they had reached in the early to mid-1970s that Ferguson was actively psychotic.
    Based on the four experts’ opinions, the trial court found Ferguson mentally
    competent to stand trial. See Ferguson, 
    417 So. 2d
    at 645.
    Following his convictions in the Carol City trial, Ferguson obtained several
    mental health experts and entered a plea of not guilty by reason of insanity in the
    Hialeah trial (the one with two murder victims). See Ferguson, 
    417 So. 2d
    at 637.
    The trial court held a pretrial competency hearing and considered conflicting
    testimony from at least seven expert witnesses, three of whom had also filed
    reports in connection with the earlier murder trial. See 
    id. The experts
    were, by
    and large, evenly split on the question of Ferguson’s competency to stand trial:
    three found Ferguson incompetent while another three found him competent.
    Although it is unclear from the record what the seventh expert concluded, it is clear
    that the trial court again found that Ferguson was competent to stand trial. See 
    id. 9 Case:
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    The Florida Supreme Court affirmed, concluding that there was adequate medical
    testimony to support the trial judge’s finding that Ferguson was mentally
    competent to stand trial. 
    Id. at 634.
    When Ferguson filed his initial state post-conviction motion in 1987, he also
    filed a motion to stay the proceedings based on his alleged incompetence to assist
    counsel. See Ferguson v. State, 
    789 So. 2d 306
    , 308 (Fla. 2001). The trial court
    appointed three experts to assess Ferguson’s mental health at the time, ordered
    numerous neurological examinations, and held a three-day evidentiary hearing in
    August 1998, at which a total of six expert witnesses testified on the issue of
    mental competence. 
    Id. at 313–14.
    While the experts offered conflicting
    testimony about the genuineness and severity of Ferguson’s psychological
    symptoms, the trial court found that the credible evidence demonstrated that
    Ferguson did not suffer from a major mental disorder, found that he was
    malingering, and found that he was mentally competent to understand the
    proceedings and assist his counsel. See 
    id. at 313–15.
    The Florida Supreme Court
    upheld the trial court’s findings and determination on those issues, concluding that
    they were adequately supported by the evidence presented at the hearing. 
    Id. at 315.
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    D. The First Federal Habeas Proceeding
    In March of 1995 Ferguson filed his first federal habeas petition, which
    raised numerous constitutional claims about various aspects of his trial, sentencing,
    and state post-conviction proceedings, including a claim that his due process rights
    had been violated because the state post-conviction proceedings were conducted
    while he was mentally incompetent. See 
    Ferguson, 580 F.3d at 1192
    –93, 1220.
    He also filed a motion to stay the federal habeas proceedings on the ground that he
    was mentally incompetent to proceed with it.
    In December 2004, the district court held a five-day evidentiary hearing on
    the motion to stay the habeas proceedings at which it heard conflicting testimony
    from six expert witnesses about Ferguson’s mental state at that time. See 
    id. at 1192,
    1221–22. After considering the evidence, the district court denied the
    motion to stay because it found that Ferguson was mentally competent to proceed
    with the habeas proceeding. See 
    id. On appeal,
    we summarized the district court’s
    findings on the issue:
    After holding a competency hearing, the district court found that there
    was credible evidence to show that Ferguson at one time suffered
    from a mental disorder that had symptoms associated with paranoid
    schizophrenia and that, since 1994, his mental health has improved so
    as to make him “no longer a disruptive member of his prison
    environment.” R4-107 at 15. It also found that his disorder was in
    remission and that he was malingering or exaggerating his symptoms.
    See 
    id. The court
    further found that Ferguson had the “mental
    competency, clarity of thought, directness of speech, and motivation
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    to advance his interests and objectives when faced with a variety of
    adverse circumstances.” 
    Id. at 15,
    17. The court made a number of
    other factual findings including that the totality of his test results
    supported the conclusion that he was “consciously reporting
    symptoms of mental illness that he [was] not presently experiencing”
    and that his unwillingness to cooperate with his counsel was based on
    a desire to avoid punishment. 
    Id. at 17,
    20. Based on all of this, the
    court concluded that Ferguson “ha[d] sufficient present ability to
    consult with counsel with a reasonable degree of rational
    understanding-and ha[d] a rational as well as factual understanding of
    the proceedings against him.” 
    Id. at 21-23.
    Ferguson, 580 F.3d at 1221
    –22. We found ample evidence to support all of
    the district court’s findings on the competency issue. 
    Id. at 1222.
    Assuming
    that a petitioner had a right to have his federal habeas proceeding stayed
    during a period of mental incompetency, we held that the district court had
    not erred in denying Ferguson a stay. 1 
    Id. We also
    affirmed the district court’s denial of all of Ferguson’s
    constitutional claims, including his claim that the state post-conviction court
    had violated his due process rights by adjudicating his claims while he was
    mentally incompetent to proceed. As to that claim, we explained that:
    “After carefully examining the record from the [state collateral court’s]
    1
    The Supreme Court later held that federal habeas petitioners have no right to stay the
    adjudication of their petitions on grounds of mental incompetence. Ryan v. Gonzales, — U.S.
    —, 
    133 S. Ct. 696
    , 700 (2013).
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    competency hearing, we find that the evidence fairly supported the finding
    that Ferguson was competent to proceed with his 3.850 claim.” 
    Id. at 1221.
    E. The 2012 State Commission Competency Proceedings
    On September 5, 2012, the Governor of Florida signed a warrant for
    Ferguson’s execution and prison officials scheduled the execution for October 16,
    2012. Ferguson requested a hearing on his competency to be executed, and, as
    required by Fla. Stat. § 922.07, the Governor temporarily stayed the execution and
    appointed a commission of three psychiatrists. Drs. Wade Myers, Alan Waldman,
    and Tonia Werner were to determine whether Ferguson “understands the nature
    and effect of the death penalty and why it is to be imposed upon him.” The
    Governor directed the commission to conduct its evaluation on October 1, 2012,
    and submit a written report by the following day.
    As instructed, the commissioners met on October 1, 2012, jointly
    interviewed Ferguson for roughly 90 minutes, reviewed his mental health records
    from 1978 to the present, and interviewed three correctional officers who had
    regular contact with Ferguson over the years. The commissioners issued their
    report later that same day, finding that Ferguson “understands the nature and effect
    of the death penalty and why it was imposed on him,” and finding that he was not
    then suffering from mental illness. In support of its findings, the commission
    noted that Ferguson’s mental health records showed that, while he was once
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    diagnosed with paranoid schizophrenia, he had been free of signs and symptoms of
    mental illness for a number of years, had not been treated with antipsychotic
    medications since 2000, and since August 2001 had been classified as an S-1
    inmate, which is a psychiatric grade given to state prisoners who have no
    identifiable mental health problems impairing their functioning in the prison
    setting.
    The commission’s report further noted that, during the interview, Ferguson
    was calm, cooperative, and responsive; he exhibited average intelligence; he
    denied any cognitive disturbances; and he demonstrated linear and goal-directed
    thought processes. While Ferguson told the commissioners that he had been
    anointed the “Prince of God” and would arise following his death to be at the
    “right hand of God,” the commissioners concluded that even if these were genuine
    delusions, they did not affect Ferguson’s “factual and rational understanding of his
    impending execution.” The report specifically mentioned that Ferguson
    acknowledged that he was going to be executed because of the murders he had
    committed and acknowledged that he would die as a result of the execution.
    Finally, the report recounted that the three correctional officers, who had known
    Ferguson for a period of time ranging from nine months to ten years, all described
    him as polite and rational, and none of them had observed any abnormalities in his
    thinking, communication, or behavior.
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    After receiving the competency commission’s report, the Governor
    determined that Ferguson had the mental capacity to understand both the nature of
    the death penalty that was to be inflicted on him and the reasons it would be, and
    on that basis the Governor lifted the stay of execution. On October 3, 2012,
    Ferguson petitioned the state trial court to review the Governor’s competency
    determination, contending that executing him would violate the Eighth
    Amendment, as interpreted in Ford v. Wainwright, 
    477 U.S. 399
    , 
    106 S. Ct. 2595
    (1986), and Panetti, 
    511 U.S. 930
    , 
    127 S. Ct. 2842
    , because he lacked a rational
    understanding of the reasons for, and the consequences of, the punishment.
    Ferguson also argued that Florida’s existing standard for assessing competency to
    be executed, codified in Florida Rules of Criminal Procedure 3.811(b) and
    3.812(b), was inconsistent with the standard announced in Panetti.
    F. The 2012 State Court Evidentiary Hearing
    On October 8, 2012, the trial court issued a stay of execution. Thereafter,
    the court held a two-day evidentiary hearing. During that hearing Ferguson
    presented the testimony of two expert witnesses, Drs. George Woods and Richard
    Rogers, as well as the testimony of one of his attorneys, Patricia Brannan, who had
    been present during the competency commission’s evaluation of Ferguson. The
    State, in turn, called three expert witnesses, Drs. Wade Myers, Tonia Werner, and
    Enrique Suarez; five prison officials who had recent contact with Ferguson; and
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    Jennifer Sagle, a mental health counselor who had worked on death row until July
    2012.
    1. Ferguson’s Witnesses
    i. Dr. Woods
    Dr. George Woods, a psychiatric expert who has testified throughout the
    country on behalf of capital inmates, reviewed Ferguson’s mental health records,
    interviewed him on three separate occasions from October 2011 to September
    2012, and administered several neurological tests. He prepared a written report on
    Ferguson’s behalf, which was admitted into evidence during the evidentiary
    hearing. In his report, Dr. Woods recounted Ferguson’s documented history of
    paranoid schizophrenia, including his belief that he is the Prince of God. The
    report stated that Ferguson exhibited delusional beliefs and reported experiencing
    visual, auditory, and olfactory hallucinations throughout the years. According to
    Dr. Woods’ report, Ferguson said that his long-deceased father was still alive and
    protecting him, that he is the Prince of God, that he will be resurrected at some
    point after his execution “to sit at the right hand of God,” and that he is destined to
    ascend to his rightful throne and ultimately “save the world.” Ferguson also told
    Dr. Woods about visual and auditory hallucinations of seeing and communicating
    with his dead father, as well as olfactory hallucinations of an inexplicable “sweet
    smell.” Ferguson recounted earlier experiences of seeing snakes and vicious dogs
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    coming out of the walls of his cell, although he acknowledged that his visual and
    auditory hallucinations had diminished over the past decade.
    Dr. Woods’ report concluded that, although Ferguson understands that he is
    facing execution and that the State of Florida intends to execute him for the crimes
    for which he was convicted, he lacks a rational understanding of the reason for the
    execution and its consequences. The report said that Ferguson believes his
    convictions and continued incarceration on death row are “not based upon the
    law,” but are part of a plot by the State of Florida “to prevent him from ascending
    to his rightful throne as the Prince of God,” as well as a “conspiracy of corrupt
    policemen” to retaliate against him “for being acquitted in a prior case.” The
    report said that Ferguson believes he will not die as a result of his execution due to
    “his father’s powers” and his eventual resurrection.
    In his hearing testimony, Dr. Woods reiterated his opinion that Ferguson is a
    paranoid schizophrenic and lacks a rational understanding of the reason for his
    execution and its consequences. He testified that Ferguson has grandiose delusions
    that he is the Prince of God, that there is a Communist plot to take over the United
    States, that he will play a divine role in driving away the Communist threat, and
    that the State cannot kill him because he possesses “special powers.” Dr. Woods
    also recounted Ferguson’s reports of visual hallucinations of seeing “shadow
    people” since a very young age, auditory hallucinations of hearing the voice of his
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    dead father, and olfactory hallucinations of a “sweet smell” that would persist even
    after he cleaned his cell. In contrast to his written report, however, Dr. Woods
    testified at the evidentiary hearing that Ferguson believes that, through his trial and
    incarceration, the State of Florida has been preparing him for his “ascension” to his
    rightful throne as the Prince of God, not preventing him from doing so. And, also
    unlike his report, Dr. Woods did not testify that Ferguson believed that his
    convictions, incarceration, and impending execution were the product of a
    conspiracy among state officials or were the result of anything other than the
    murders he had committed.
    In his testimony, Dr. Woods conceded that Ferguson had not taken any
    antipsychotic drugs since 2000, had not exhibited any unusual behaviors to prison
    staff since that time, and since 2001 had maintained an S-1 classification (the
    designation for prisoners with no identifiable mental health concerns that might
    impair their functioning in prison). He also conceded that Ferguson had filed a
    number of prison grievances over the years that were “fairly goal-directed toward
    his daily life” and made no reference at all to believing that he is the Prince of
    God. Dr. Woods described Ferguson as a “geriatric” or “late-life” schizophrenic
    who, despite his psychosis, did not necessarily require medication and would not
    necessarily exhibit any outward manifestations of his illness because the “positive
    symptoms” of paranoid schizophrenia diminish with age. He stated that paranoid
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    schizophrenics are the highest functioning types of schizophrenics and can perform
    ordinary tasks in structured environments.
    In further support of his diagnosis, Dr. Woods opined that Ferguson suffers
    from cavum septum pellucidum, a fissure between the two hemispheres of the
    brain indicative of schizophrenia. Although Dr. Woods initially testified that the
    fissure was “very deep,” he later retreated from that description, conceding on
    cross-examination that the 2004 radiology report upon which he had relied actually
    stated that Ferguson’s brain was intact except for a “very small” cavum septum
    pellucidum. Dr. Woods also conceded that a 2001 article from the American
    Journal of Psychiatry concluded that a small cavum septum pellucidum is a normal
    anatomical variant that appears in virtually equal numbers of schizophrenic and
    non-schizophrenic people.
    ii. Dr. Rogers
    Dr. Richard Rogers, an expert in forensic psychology and malingering, also
    testified as an expert witness for Ferguson. He evaluated Ferguson on September
    20 and 21, 2012, for the limited purpose of determining whether he was currently
    malingering or feigning psychotic symptoms. In addition to interviewing
    Ferguson, Dr. Rogers administered a battery of malingering tests. He
    acknowledged that two of the test scores were elevated and did suggest that
    Ferguson was malingering. However, based on the totality of the results of the
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    administered tests, Dr. Rogers was of the opinion that Ferguson was not currently
    malingering, even if he had done so in the past. On the core question of mental
    competency, however, Dr. Rogers conceded that Ferguson did not exhibit any
    obvious signs of cognitive impairment in his writings or verbal communications
    and appeared to be of average intelligence.
    2. The State’s Witnesses
    At the evidentiary hearing, the State first presented the testimony of two of
    the psychiatrists who had served on the Governor’s competency commission, Drs.
    Myers and Werner.
    i. Dr. Myers
    Dr. Wade Myers, a board certified psychiatrist and professor of psychiatry at
    Brown University, testified that he had evaluated and diagnosed thousands of
    schizophrenic people during his professional career. Dr. Myers described how he
    and his fellow commissioners had conducted their competency evaluation of
    Ferguson. They began by reviewing two file boxes of medical, psychiatric, and
    correctional records dating back to 1978. Each of the three commissioners had
    taken a portion of the records, reviewed them for information about Ferguson’s
    mental health, and then discussed with the other two commissioners the records
    they found significant. Among other things, the records established that Ferguson
    had been classified as an S-1 inmate since 2001, he had not taken any psychotropic
    20
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    medications since 2000, and his prison mental-health evaluations did not indicate
    he had shown any symptoms of mental illness since at least 2001.
    Dr. Myers testified that, after reviewing the medical records for 90 minutes,
    the commission interviewed Ferguson for an additional 90 minutes in the presence
    of attorneys from both sides. During the interview, Ferguson was polite, calm,
    cooperative, and did not exhibit any signs of distress or of any thought disorder.
    Ferguson informed the commissioners that he was not taking any psychiatric
    medications, did not feel like he needed psychiatric treatment, and told them that
    he did not suffer from any mental problems. When one of the commissioners, Dr.
    Waldman, mentioned that Ferguson had been convicted of six homicides, Ferguson
    corrected him and said that it was eight.
    Dr. Myers further testified that Ferguson discussed his religious beliefs,
    stating that he was a Christian, believed in God, read the Bible regularly, and liked
    to visit the prison chaplain. Ferguson said that he hears the voice of God with his
    “inner ears,” but only when he prays. Ferguson also informed the commissioners
    that he was anointed the Prince of God many years ago, and that he would be
    resurrected following his execution to sit “at the right hand of God.” According to
    Dr. Myers, Ferguson only mentioned two current hallucinations: seeing dark
    shadow people, which no longer bothered him, and experiencing an inexplicable
    “sweet smell,” which he actually enjoyed. Ferguson told them that, in the distant
    21
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    past, he had witnessed vicious dogs coming out of his cell walls and “snakes
    coming out of his leg,” though those particular hallucinations had stopped decades
    ago.
    Dr. Myers also testified that, following their interview of Ferguson, the
    commissioners interviewed three correctional officers who had daily interactions
    with Ferguson for time periods ranging from almost a year to nine years. Those
    officers reported that Ferguson communicated normally, was coherent, and never
    exhibited any bizarre behavior.
    After reviewing some additional records and conferring with one another,
    the three commissioners unanimously concluded that Ferguson had the mental
    capacity to understand the nature and effect of the death penalty and the reason it
    was being imposed on him. Dr. Myers explained that, although he and Dr.
    Waldman brought a number of psychological tests to the evaluation, the
    commission members found no reason to administer the tests given the lack of
    evidence that Ferguson suffered from any significant mental illness. Dr. Myers
    emphasized that Ferguson displayed lucid thinking and average intelligence
    throughout the interview, that the correctional records showed that he was
    functioning well in his day-to-day life, and that the correctional officers
    interviewed by the commission had witnessed no bizarre behaviors by him. Dr.
    Myers also testified that he believed that Ferguson was fabricating his reported
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    delusions and, even if they were genuine, he would still not meet the diagnostic
    criteria for schizophrenia because the delusions were not disrupting his daily life.
    Dr. Myers testified that Ferguson had a “rational understanding of the nature of the
    death penalty and the reason it is to be inflicted upon him.”
    ii. Dr. Werner
    Dr. Tonia Werner, a board certified psychiatrist and professor of forensic
    psychiatry at the University of Florida, who had served as one of the competency
    commissioners, also testified at the evidentiary hearing. She corroborated Dr.
    Myers’ account of the commission’s evaluation process and agreed with his
    opinion that Ferguson does possess a rational understanding of the fact of his
    impending execution and of the reason for it. Dr. Werner confirmed that Ferguson
    informed the commissioners that he had been anointed the Prince of God, would be
    resurrected after his death to “sit at the right hand of God,” and would eventually
    return to Earth. She testified, however, that Ferguson had indicated that he was
    going to be executed and stated that he would be the first state inmate to receive
    Florida’s new lethal-injection protocol. She recounted that Dr. Waldman had
    specifically asked Ferguson whether he would physically die and be buried after
    his execution, and Ferguson answered that he would.
    Finally, Dr. Werner testified that she did not believe that Ferguson was
    currently suffering from a major mental illness because his reported hallucinations,
    23
    Case: 12-15422     Date Filed: 05/21/2013    Page: 24 of 65
    particularly those of seeing shadow people, were inconsistent with schizophrenia,
    and there were no signs of dysfunction in his daily activities. She explained that,
    even if Ferguson were suffering from mental illness, he did not demonstrate any
    difficulties in his mental capacity or cognition that would suggest that he did not
    fully understand the reasons for and the consequences of his impending execution.
    iii. Dr. Suarez
    Dr. Enrique Suarez, a neuropsychologist, also testified for the State at the
    evidentiary hearing. He had examined Ferguson in 2004 during the federal habeas
    proceedings and had concluded that Ferguson was not exhibiting any behavioral
    symptoms of psychosis and was malingering. Dr. Suarez testified that he had
    reviewed Ferguson’s records from the 2004 proceeding and from that time to the
    present, had reviewed the reports of Ferguson’s expert witnesses, and had listened
    to the testimony of all of the experts who had testified at the present hearing (he
    was the last expert witness to testify before Dr. Woods was recalled as a rebuttal
    witness). After considering all of those records and testimony, Dr. Suarez was still
    of the opinion that Ferguson was not schizophrenic.
    Dr. Suarez emphasized that it is highly unlikely for a schizophrenic not to
    suffer a relapse after being unmedicated for more than a decade, and that
    Ferguson’s various inmate requests and prison grievances showed “no bleed-
    through” of his professed delusions and hallucinations. He specifically identified
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    an inmate request form dated July 25, 2011, in which Ferguson requested 256
    pages of legal materials for a pro se appeal that he was pursuing. According to Dr.
    Suarez, the request was perfectly coherent, “[q]uite sophisticated,” and
    demonstrated that “delusional contamination” did not hinder Ferguson from being
    “able to work through the system that’s set up to get his needs met.”
    iv. Prison Officials and Employees
    The State also called as witnesses a number of prison officials who had
    regular contact with Ferguson around the time his death warrant was signed on
    September 5, 2012. They uniformly testified that Ferguson did not exhibit any
    abnormal behaviors or make any unusual requests that suggested he was mentally
    unstable. Officer Jay Taylor, who spoke to Ferguson on the day his death warrant
    was signed, testified that Ferguson stated that he had not had a warrant signed on
    him in 35 years.
    Brad Whitehead, the assistant warden at Florida State Prison, testified that
    he spoke to Ferguson about his wishes for a last meal, the disposition of his
    remains, and who should be contacted. Ferguson provided Whitehead with the
    names of his mother, his attorneys’ law firm, and his spiritual advisor, and he also
    expressed concern about his mother’s wellbeing due to her medical conditions.
    When asked what he wanted done with his remains after his execution, Ferguson
    responded that he needed to consult with his attorneys about that. At no point did
    25
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    he indicate or imply that he was unconcerned about the disposition of his remains
    because his status as the Prince of God would render that matter moot.
    Jennifer Sagle, a mental health counselor who worked on death row from
    December 2005 until July 2012, testified that during the time she worked there
    Ferguson maintained an S-1 psychiatric classification, the lowest level recognized
    by the Florida Department of Corrections. Sagle further testified that she never
    received any complaints or referrals from other inmates or prison guards regarding
    Ferguson’s mental health, and that she had not personally observed any unusual
    behavior or symptoms of schizophrenia during her weekly rounds. Although Sagle
    acknowledged that paranoid schizophrenics might not outwardly manifest
    “positive symptoms” of their disease, such as hallucinations, she testified that they
    would exhibit “negative symptoms” such as a flattened affect and lack of
    motivation, which Ferguson had not shown.
    3. Ferguson’s Rebuttal Witnesses
    Ferguson called two witnesses in rebuttal. The first was Patricia Brannan,
    one of his attorneys who had attended the evaluation by the mental competency
    commission. She testified that Ferguson was calm, placid, focused, and
    cooperative while the commissioners interviewed him, though he became agitated
    a few times in response to particular questions. She indicated that, contrary to Dr.
    Myers’ testimony, it was one of the commissioners who had corrected the
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    Case: 12-15422     Date Filed: 05/21/2013    Page: 27 of 65
    misstatement that Ferguson had been convicted of six murders. She further stated
    that, when asked about his impending execution, Ferguson responded “they’re
    gonna kill me, like Jesus” and that “God told me lethal injection, and they have
    some new stuff just for me.” Moreover, when asked by a commissioner about
    what would happen after he was buried, Ferguson responded that he would ascend
    to “sit at the right hand of God” and would eventually return to his “rightful place
    in the world.”
    Dr. Woods was the other rebuttal witness. He testified that the relapse rate
    for geriatric (or late-life) schizophrenics is only about four percent even among
    those not taking antipsychotic medication. He also stated that the fact that
    Ferguson had not exhibited any symptoms to prison officials and employees after
    being off medication for more than a decade was not inconsistent with his
    diagnosis of late-life schizophrenia. He stuck to his diagnosis of Ferguson and the
    opinion that he was not mentally competent to be executed.
    4. The 2012 State Trial Court Decision on Ferguson’s Competency
    After the evidentiary hearing on the competency issue, the state trial court
    issued an order finding that Ferguson had failed to meet his burden of proving that
    he was mentally incompetent to be executed. State v. Ferguson, No. 04-2012-CA-
    507, op. at 1, 17 (Fla. Cir. Ct. Oct. 12, 2012). The court, partially crediting the
    testimony of Dr. Woods and Dr. Rogers “as it relates to Ferguson’s documented
    27
    Case: 12-15422      Date Filed: 05/21/2013   Page: 28 of 65
    history of paranoid schizophrenia,” found that Ferguson suffers from paranoid
    schizophrenia, that there was not “sufficient evidence [he was] malingering during
    the interview with the Commission,” and that he harbors a genuine delusional
    belief that he is the Prince of God. 
    Id. at 17.
    However, the court specifically found
    “the testimony and opinions of Dr. Myers and Dr. Werner to be credible as to the
    limited question of Ferguson’s competency to be executed” and found their
    testimony on those issues to be supported by both the record and the testimony of
    the prison officials and employees. 
    Id. at 17–18.
    The court concluded that, although Ferguson suffers from paranoid
    schizophrenia, “there is no evidence that he does not understand what is taking
    place and why it is taking place” or that his “mental illness interferes, in any way,
    with his ‘rational understanding’ of the fact of his pending execution and the
    reason for it.” 
    Id. at 18.
    In support of its conclusion, the court emphasized that
    “Ferguson is aware that the State is executing him for the murders he committed
    and that he will physically die as a result of the execution,” and that “[t]here is no
    evidence that in his current mental state Ferguson believes himself unable to die or
    that he is being executed for any reason other than the murders he was convicted of
    in 1978.” 
    Id. The court
    also remarked that, “[i]n some sense, Ferguson appears to
    have fit his grandiose [Prince-of-God] delusion into a traditional religious
    worldview” and that his “belief as to his role in the world and what may happen to
    28
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    him in the afterlife is [not] so significantly different from beliefs other Christians
    may hold so as to consider it a sign of insanity.” 
    Id. The state
    trial court rejected Ferguson’s contention that Panetti displaced or
    added anything to the existing state standard for assessing mental competency to
    be executed, which asks whether a prisoner “lacks the mental capacity to
    understand the fact of the impending execution and the reason for it.” 
    Id. at 4.
    The
    court noted that, in Provenzano v. State, 
    760 So. 2d 137
    (Fla. 2000), which was
    decided before Panetti, the Florida Supreme Court had “considered the difficulties
    of persons who have mental illnesses and delusions” and held that they could still
    be found mentally competent to be executed if they possessed “a factual and
    rational understanding” of their execution and the reasons for it. 
    Id. at 4–5.
    5. The 2012 Florida Supreme Court Decision on Ferguson’s Competency
    Ferguson appealed that decision to the Florida Supreme Court, contending
    that the state trial court had failed to apply the mental competency standard
    announced in Panetti and that the Florida Supreme Court’s Provenzano decision
    was no longer good law. He contended in the alternative that, even if the trial
    court had applied the correct legal standard, its finding that he was mentally
    competent to be executed was not supported by the record, particularly given the
    subsidiary findings that he is a paranoid schizophrenic who believes that he is the
    Prince of God. Ferguson also claimed that he had not been afforded a full and fair
    29
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    evidentiary hearing before the state trial court, in contravention of his due process
    rights.
    The Florida Supreme Court affirmed the trial court’s decision. It found that
    there was “competent, substantial evidence” to support the trial court’s finding that
    Ferguson’s mental illness and Prince-of-God delusion did not interfere with his
    “rational understanding” of the fact of his pending execution and the reason for it,
    and that the record supported the finding that he “understands what is taking place
    and why.” Ferguson v. State, No. SC12-2115, op. at 4, 7 (Fla. Oct. 17, 2012). The
    Court did not adopt the state trial court’s view that Ferguson’s delusions were a
    grandiose manifestation of otherwise normal Christian beliefs. It stated that
    “[w]hether Ferguson’s convictions are representative of mainstream Christian
    principles or delusions that derive from his mental illness does not affect our
    inquiry.” 
    Id. at 4.
    Either way, he understood that he was going to be executed and
    why. The Florida Supreme Court also rejected Ferguson’s contention that Panetti
    imposed a stricter standard for mental competency to be executed than the one it
    had adopted in its Provenzano decision. 
    Id. at 6–8.
    In doing so, the Court
    acknowledged Panetti’s statement that a “prisoner’s awareness of the State’s
    rationale for an execution is not the same as a rational understanding of it,” but
    explained that Panetti was a “narrowly tailored decision” and that Provenzano
    30
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    itself had required that a prisoner “understand the connection between his crime
    and the punishment he is to receive for it.” 
    Id. at 7–8.
    G. This Federal Habeas Proceeding
    On October 19, 2012, Ferguson filed a federal habeas petition under 28
    U.S.C. § 2254, along with an emergency motion for a stay of execution until there
    was a ruling on the merits of that petition. His petition claimed that he is mentally
    incompetent to be executed under the Eighth Amendment, as interpreted in Ford
    and Panetti, because he lacks a rational understanding of the consequences of, and
    reasons for, his impending execution. Ferguson contended that the decisions of the
    state courts were contrary to clearly established federal law because they relied on
    the factual-awareness standard rejected by Panetti and were otherwise based on an
    unreasonable determination of the facts in light of the evidence presented.
    On October 20, 2012, the district court granted a temporary stay of
    execution to permit a “fair hearing” on Ferguson’s habeas claim. Two days later
    we granted the State’s emergency motion to vacate that stay of execution,
    concluding that the district court had applied the wrong legal standard for granting
    a stay and that Ferguson had failed to demonstrate that he had a substantial
    likelihood of success on the merits of his claim. We specifically determined that
    Ferguson did not show that the Florida Supreme Court either unreasonably applied
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    clearly established federal law or made an unreasonable determination of the facts
    when it found him competent to be executed.
    Thereafter, and less than an hour before Ferguson’s scheduled execution on
    October 23, 2012, the district court issued a summary order denying the habeas
    petition, but granting Ferguson a certificate of appealability (COA) on the
    following issues:
    A. Whether the decision of the Florida Supreme Court involved an
    unreasonable application of the Un[ited] States Supreme Court’s decision[s]
    in Ford and Panetti.
    B. Whether the Florida Supreme Court’s affirmance of the state trial court
    was based on an unreasonable determination of the facts in light of the
    evidence presented in the state court proceeding, viz, that (a) the petitioner
    has a documented history of paranoid schizophrenia[,] (b) he is not
    malingering, and (c) he has a fixed grandiose delusion that he is the “Prince
    of God.”
    We granted a temporary stay of execution under Eleventh Circuit Rule 22-
    4(a)(7). The State moved to vacate the stay of execution and dismiss Ferguson’s
    appeal on the ground that the district court had improperly granted a COA,
    particularly in light of our earlier determination that Ferguson did not have a
    substantial likelihood of success on the merits of his competency claim. We
    denied the State’s motion to vacate the stay of execution.
    II. DISCUSSION
    “We review de novo the denial of a petition for a writ of habeas corpus.”
    Jamerson v. Sec’y for Dep’t of Corr., 
    410 F.3d 682
    , 687 (11th Cir. 2005). The
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    Antiterrorism and Effective Death Penalty Act of 1996 (AEDPA) precludes federal
    courts from granting habeas relief on a claim already 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,” 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). A state court decision is “contrary to” clearly established federal law if it
    applies a rule that contradicts the governing law set forth by the United States
    Supreme Court, or arrives at a result that differs from Supreme Court precedent
    when faced with materially indistinguishable facts. Bell v. Cone, 
    535 U.S. 685
    ,
    694, 
    122 S. Ct. 1843
    , 1850 (2002). A state court decision involves an
    “unreasonable application” of clearly established federal law if “the state court
    correctly identifies the governing legal principle” from the relevant Supreme Court
    decisions “but unreasonably applies it to the facts of the particular case.” 
    Id. The key
    question is whether the state court’s application of Supreme Court precedent is
    “objectively unreasonable,” not simply whether a federal court “concludes in its
    independent judgment that the . . . state-court decision applied clearly established
    federal law erroneously or incorrectly.” Renico v. Lett, — U.S. —, 
    130 S. Ct. 1855
    , 1862 (2010) (quotation marks omitted).
    33
    Case: 12-15422     Date Filed: 05/21/2013    Page: 34 of 65
    As the Supreme Court has explained, there is a critical difference between
    the question of whether to reverse for a claimed constitutional error on direct
    appeal and the question of whether to grant habeas relief after the state courts have
    rejected the claim of constitutional error. “Under AEDPA . . . it is a necessary
    premise that the two questions are different.” Harrington v. Richter, — U.S. —,
    
    131 S. Ct. 770
    , 785 (2011); see also 
    Renico, 130 S. Ct. at 1862
    (“This distinction
    creates ‘a substantially higher threshold’ for obtaining relief than de novo
    review.”). The distinction between those two questions is critical to the proper
    functioning of the federal writ of habeas corpus in the post-AEDPA age. See
    
    Harrington, 131 S. Ct. at 780
    (explaining that habeas “resources are diminished and
    misspent . . . and confidence in the writ and the law it vindicates undermined, if
    there is judicial disregard for the sound and established principles that inform its
    proper issuance”).
    The Supreme Court has not hesitated to reverse grants of habeas relief
    ordered by courts of appeals that ignore the distinction between direct appeal type
    de novo review and the more restrictive, highly deferential review mandated by 28
    U.S.C. § 2254(d)(1). See, e.g., Felkner v. Jackson, — U.S. —, 
    131 S. Ct. 1305
    ,
    1307 (2011) (reversing a decision ordering habeas relief, which apparently had
    applied the standard of review applicable on direct appeal instead of AEDPA’s
    “highly deferential standard for evaluating state-court rulings”); Premo v. Moore,
    34
    Case: 12-15422      Date Filed: 05/21/2013    Page: 35 of 65
    — U.S. —, 
    131 S. Ct. 733
    , 740 (2011) (reversing a decision ordering relief and
    cautioning that “[f]ederal habeas courts must guard against the danger of equating
    unreasonableness under Strickland with unreasonableness under § 2254(d)”);
    
    Harrington, 131 S. Ct. at 786
    (reversing a decision ordering habeas relief based on a
    de novo review standard, and commenting that “[i]t bears repeating that even a
    strong case for relief does not mean the state court’s contrary conclusion was
    unreasonable”); Smith v. Spisak, 
    558 U.S. 139
    , 149, 
    130 S. Ct. 676
    , 684 (2010)
    (reversing a decision ordering habeas relief because “[w]hatever the legal merits of
    the rule or the underlying verdict forms in this case were we to consider them on
    direct appeal, the jury instructions at Spisak’s trial were not contrary to ‘clearly
    established Federal law’”).
    The point, which the Supreme Court has repeatedly emphasized, is that
    AEDPA imposes a “highly deferential standard for evaluating state-court rulings”
    and “demands that state-court decisions be given the benefit of the doubt.” 
    Renico, 130 S. Ct. at 1862
    (quotation marks omitted). “A state court’s application of
    clearly established federal law or its determination of the facts is unreasonable only
    if no ‘fairminded jurist’ could agree with the state court’s determination or
    conclusion.” Holsey v. Warden, Ga. Diagnostic Prison, 
    694 F.3d 1230
    , 1257 (11th
    Cir. 2012) (quoting 
    Harrington, 131 S. Ct. at 786
    ). To warrant federal habeas relief
    under the deferential standards prescribed by § 2254(d), a petitioner must show
    35
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    that the state court’s ruling was “so lacking in justification that there was an error
    well understood and comprehended in existing law beyond any possibility for
    fairminded disagreement.” 
    Harrington, 131 S. Ct. at 786
    –77.
    A.
    Ferguson first argues that the Florida Supreme Court’s decision involved an
    unreasonable application of clearly established federal law because, in adhering to
    the competency standard laid down in Provenzano, the court purportedly relied on
    the bare factual-awareness standard that the United States Supreme Court rejected
    in Panetti, instead of the applicable “rational understanding” inquiry. 2 Ferguson
    contends that in light of Panetti the competency standard announced by the Florida
    Supreme Court in Provenzano, which adopted the test articulated by Justice Powell
    in his concurring opinion in Ford, is constitutionally deficient because it merely
    asks whether a prisoner is aware of the punishment that will be imposed and the
    reason for imposing it.
    Our analysis of Ferguson’s contention begins with a look at how the
    substantive standard for competency to be executed has evolved in both Florida
    and the United States Supreme Court. Before the Supreme Court ever recognized
    2
    Technically speaking, Ferguson’s contention that the Florida Supreme Court failed to
    apply the competency standard set forth in Panetti would, if believed, render the court’s decision
    “contrary to” clearly established federal law, not merely an “unreasonable application” of
    Supreme Court precedent. See 
    Bell, 535 U.S. at 694
    , 122 S.Ct. at 1850. Nonetheless, because
    the distinction does not impact our analysis or conclusions, we will address the issue in the terms
    set forth in the district court’s COA and employed by Ferguson on appeal.
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    a constitutional bar on executing the mentally incompetent, Florida had a statutory
    bar on putting to death an inmate who lacked the “mental capacity to understand
    the nature of the death penalty and the reasons why it was imposed upon him.”
    Fla. Stat. Ann. § 922.07(2) (1985). Later, in Ford, the Supreme Court held for the
    first time that the “Eighth Amendment prohibits a State from carrying out a
    sentence of death upon a prisoner who is 
    insane,” 477 U.S. at 409
    –10, 106 S.Ct. at
    2602, and it outlined procedural safeguards to enforce that constitutional
    prohibition, see 
    id. at 411–17,
    106 S.Ct. at 2602–06. Justice Marshall’s majority
    opinion in Ford did not, however, specify in any detail the substantive standard to
    be applied in assessing whether a prisoner is competent to be executed. It did note
    that “we may seriously question the retributive value of executing a person who
    has no comprehension of why he has been singled out and stripped of his
    fundamental right to life,” 
    id. at 409,
    106 S.Ct. at 2601, which seemed to imply a
    simple comprehension standard.
    In his concurring opinion, however, Justice Powell articulated a more
    specific standard for competency, explaining that the “Eighth Amendment forbids
    the execution only of those who are unaware of the punishment they are about to
    suffer and why they are to suffer it” and that it is constitutionally sufficient if
    “those who are executed know the fact of their impending execution and the reason
    for it.” 
    Id. at 422,
    106 S.Ct. at 2608 (Powell, J., concurring). Justice Powell
    37
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    explained that “the retributive goal of the criminal law is satisfied” if a prisoner
    “perceives the connection between his crime and his punishment,” and that a
    prisoner can “prepare himself for his passing” only if he is “aware that his death is
    approaching.” 
    Id. Justice Powell
    expressly found that Florida’s statutory
    definition of competency to be executed was constitutionally adequate. 
    Id. at 423,
    106 S.Ct. at 2608.
    While the Ford decision left Florida’s competency standard standing, it did
    find fault with the procedures that were then in effect for determining whether that
    standard was met. 
    Id. at 412–17,
    106 S.Ct. at 2603–05. Thereafter, Florida
    adopted new procedures for assessing a prisoner’s competency to be executed,
    which were codified in Florida Rules of Criminal Procedure 3.811 and 3.812. See
    In re Emergency Amendment to Florida Rules of Criminal Procedure (Rule 3.811,
    Competency to be Executed), 
    497 So. 2d 643
    (Fla. 1986); Fla. R. Crim. P. 3.811;
    Fla. R. Crim. P. 3.812. Rule 3.811 also set forth a substantive competency
    standard, which was virtually identical to Florida’s statutory definition, and which
    provided that “[a] person under sentence of death is insane for purposes of
    execution if the person lacks the mental capacity to understand the fact of the
    impending execution and the reason for it.” Fla. R. Crim. P. 3.811(b).
    After the Ford decision, the Florida Supreme Court had occasion to
    elaborate on the meaning of the State’s competency to be executed standard in two
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    decisions involving the impending execution of Thomas Provenzano. In the first
    of those decisions, Provenzano v. State, 
    750 So. 2d 597
    , 602 (Fla. 1999)
    (Provenzano I), the Court rejected a claim that the standard articulated in Rule
    3.811 was unconstitutional because it did not require a “rational appreciation of the
    connection between the crime and the punishment.” The Court explained that the
    competency standard did, in fact, include a “rationality element” that required a
    prisoner to possess a “rational appreciation of the connection between his crime
    and the punishment he is to receive.” 
    Id. at 602–03.
    It then remanded the case for
    further proceedings to assess Provenzano’s competency to be executed under that
    rational appreciation standard. 
    Id. at 601–03.
    When the case returned to it the following year, the Florida Supreme Court
    affirmed the trial court’s determination that Provenzano, despite harboring a
    delusional belief that he was Jesus Christ, was competent to be executed because
    he had “a factual and rational understanding” that he had been sentenced to death
    for murdering a woman and that he would die when he was executed. Provenzano
    v. State, 
    760 So. 2d 137
    , 140 (Fla. 2000) (Provenzano II). The Court explained
    that “Florida ha[d] adopted the Eighth Amendment standard announced by Justice
    Powell in Ford,” and that Provenzano met this standard because he possessed “the
    39
    Case: 12-15422       Date Filed: 05/21/2013      Page: 40 of 65
    mental capacity to understand the fact of his pending execution and the reason for
    it.”3 
    Id. Seven years
    after the Florida Supreme Court issued its decision in
    Provenzano II, and just over two decades after Ford, the United States Supreme
    Court revisited the substantive standard for competency in Panetti. Panetti, a
    Texas prisoner sentenced to death for murdering his in-laws, claimed that his
    schizo-affective disorder and accompanying delusions, which “recast [his]
    execution as part of spiritual warfare” between “the forces of [] darkness” and “the
    forces of light,” rendered him mentally incompetent to be executed. 
    Panetti, 551 U.S. at 935
    –36, 
    954–56, 127 S. Ct. at 2848
    , 2859–60 (quotation marks omitted).
    Although he was aware that the State of Texas claimed that it intended to execute
    him because of the murders he had committed, Panetti was convinced that the
    stated reason was a “sham” and that the real reason the State sought his execution
    was “to stop him from preaching.” 
    Id. at 954–55,
    127 S.Ct. at 2859 (quotation
    marks omitted). The Fifth Circuit affirmed the denial of federal habeas relief
    because Panetti was aware that he would be executed and “aware that the reason
    the State [had] given for the execution” was the murders he had committed. 
    Id. at 3
             The Florida Supreme Court issued several other decisions in Provenzano’s challenge to
    his impending execution, but those decisions did not specifically address the competency
    standard for execution. See Provenzano v. State, 
    751 So. 2d 37
    (Fla. 1999) (remanding for an
    evidentiary hearing on Provenzano’s claim of incompetency); Provenzano v. Moore, 
    744 So. 2d 413
    (Fla. 1999) (rejecting Provenzano’s challenge to Florida’s method of execution).
    40
    Case: 12-15422      Date Filed: 05/21/2013    Page: 41 of 65
    
    956, 127 S. Ct. at 2860
    . Under its interpretation of the competency standard
    articulated by Justice Powell in Ford, the Fifth Circuit concluded that Panetti’s
    delusions were largely irrelevant to the competency inquiry because it did not
    matter if Panetti’s mental illness prevented him from having a rational
    understanding of the State’s reason for his execution. 
    Id. The Supreme
    Court reversed, holding that the Fifth Circuit’s approach to
    assessing competency was “too restrictive” and was inconsistent with Ford insofar
    as it treated “a prisoner’s delusional belief system as irrelevant if the prisoner
    knows that the State has identified his crimes as the reason for his execution.” 
    Id. at 956–59,
    127 S.Ct. at 2860–61. The Court explained that, whether Ford’s
    competency inquiry is cast in terms of “comprehension” or “awareness” of the
    reasons for a prisoner’s execution, Ford did not support “a strict test for
    competency that treats delusional beliefs as irrelevant once the prisoner is aware
    the State has identified the link between his crime and the punishment to be
    inflicted.” 
    Id. at 959–60,
    127 S.Ct. at 2861–62. The Court concluded that “[a]
    prisoner’s awareness of the State’s rationale for an execution is not the same as a
    rational understanding of it,” and that “Ford does not foreclose inquiry into the
    latter.” 
    Id. at 959,
    127 S.Ct. at 2862.
    While the Supreme Court in Panetti rejected an approach foreclosing an
    inquiry into the rationality of a petitioner’s understanding, it expressly declined to
    41
    Case: 12-15422     Date Filed: 05/21/2013    Page: 42 of 65
    “set down a rule governing all competency determinations” and it acknowledged
    that “a concept like rational understanding is difficult to define.” 
    Id. at 959–61,
    127 S.Ct. at 2862. The Court stressed that “[t]he mental state requisite for
    competence to suffer capital punishment neither presumes nor requires a person
    who would be considered ‘normal,’ or even ‘rational,’ in a layperson’s
    understanding of those terms.” 
    Id. at 959,
    127 S.Ct. at 2862. Because of the
    limited record and the absence of definitive findings in that case concerning “the
    nature and severity of [Panetti’s] alleged mental problems,” the Supreme Court
    was hesitant to “amplify [its] conclusions or to make them more precise” and
    declined to apply them to that case itself. 
    Id. at 961–62,
    127 S.Ct. at 2863.
    Instead, the Court remanded the case to the district court to analyze and resolve in
    the first instance the issue of Panetti’s competency to be executed. 
    Id. at 962,
    127
    S.Ct. at 2863.
    By way of guidance, the Supreme Court noted that “[g]ross delusions
    stemming from 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.” 
    Id. at 960,
    127 S.Ct. at 2862. The
    Court also observed that “[e]xpert evidence may clarify the extent to which severe
    delusions may render a subject’s perception of reality so distorted that he should be
    deemed incompetent.” 
    Id. at 962,
    127 S.Ct. at 2863. On remand, the district court
    42
    Case: 12-15422     Date Filed: 05/21/2013    Page: 43 of 65
    found that Panetti suffered from “severe mental illness” and “paranoid delusions of
    some type,” but that he was nonetheless competent to be executed because he
    possessed a rational understanding of his impending death and the “causal
    connection between [his crimes] and his death sentence.” Panetti v. Quarterman,
    
    2008 WL 2338498
    , at *36–37 (W.D. Tex. Mar. 26, 2008).
    In the present case, the Florida Supreme Court did not apply the bare and
    narrow factual-awareness standard that the United States Supreme Court rejected
    in Panetti. Instead, in reviewing the state trial court’s ruling against Ferguson, the
    Florida Supreme Court framed the question as whether there was substantial
    evidence to support the trial court’s determination that Ferguson’s paranoid
    schizophrenia and Prince-of-God delusion did not interfere “with his ‘rational
    understanding’ of the fact of his pending execution and the reason for it.”
    Ferguson, No. SC12-2115, op. at 4. Citing its decision in Provenzano II and
    Justice Powell’s concurring opinion in Ford, the court variously articulated the
    competency standard as whether an inmate lacks “the capacity to understand the
    nature of the death penalty and why it was imposed,” whether he is “aware of the
    punishment [he is] about to receive and the reason [he is] to receive it,” and
    whether he “understand[s] the connection between his crime and the punishment
    he is to receive for it.” 
    Id. at 4,
    8. The Florida Supreme Court concluded that,
    despite Ferguson’s documented history of paranoid schizophrenia and genuine
    43
    Case: 12-15422     Date Filed: 05/21/2013    Page: 44 of 65
    delusional belief that he is the Prince of God, the record nonetheless shows that he
    “understands what is taking place and why.” 
    Id. at 7.
    In particular, the Court
    noted that Ferguson is “aware that he has never before had a death warrant signed
    on his behalf and that he would be the first person to receive Florida’s current
    protocol of medications for lethal injection,” and it found sufficient evidence to
    support the trial court’s findings that Ferguson is “aware that the State is executing
    him for the murders he committed and that he will physically die as a result of the
    execution.” 
    Id. at 7–8.
    The competency standard articulated and applied by the Florida Supreme
    Court is not inconsistent with clearly established federal law, as set forth in Ford
    and Panetti. The court correctly found that Panetti did not materially alter the
    competency standard that it had announced in Provenzano II, which itself adopted
    the formulation endorsed by Justice Powell in Ford. Contrary to Ferguson’s
    contention, the Supreme Court’s decision in Panetti did not abrogate or otherwise
    reject the awareness standard articulated by Justice Powell, nor did it impose a
    new, more rigorous standard for assessing competency to be executed. 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
    44
    Case: 12-15422        Date Filed: 05/21/2013       Page: 45 of 65
    execution. 
    Panetti, 551 U.S. at 935
    , 
    958–59, 127 S. Ct. at 2848
    , 2861–62. 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 959–61,
    127 S.Ct. at 2861–62 (rejecting “a strict test for competency that treats
    delusional beliefs as irrelevant”). The Court explained that the understanding
    required by Ford is a rational understanding, even though it declined to define
    “rational” in this context. See 
    id. at 959–62,
    2862–63.
    Unlike the Fifth Circuit approach rejected in Panetti, the Florida Supreme
    Court neither suggested that Ferguson is competent to be executed merely because
    he can identify the State’s articulated rationale for his punishment, nor did it deem
    his paranoid schizophrenia and delusional belief that he is the Prince of God to be
    irrelevant to the issue of competency. 4 See Ferguson, No. SC12-2115, op. at 4–8.
    To the contrary, the Florida Supreme Court concluded that, despite Ferguson’s
    4
    Read out of context, the Florida Supreme Court’s statement that “[w]hether Ferguson’s
    convictions are representative of mainstream Christian principles or delusions that derive from
    his mental illness does not affect our inquiry” might be interpreted as indicating that the court
    refused to consider Ferguson’s delusions or their source. See Ferguson, No. SC12-2115, op. at
    4. It is evident from the context, however, that the quoted statement was instead a decision not
    to adopt the state trial court’s characterization of Ferguson’s delusions as a manifestation of
    traditional Christian beliefs, albeit on a grandiose scale. As the remainder of the Florida
    Supreme Court’s opinion makes clear, it did consider Ferguson’s paranoid schizophrenia and
    Prince-of-God delusion as they relate to the issue of rational understanding, and it concluded that
    he nevertheless has a rational understanding that the reason he is going to be executed is the
    murders he committed and that when executed he will die. Just as Panetti’s “severe mental
    illness” and “paranoid delusions” did not, in the final analysis, render him incompetent to be
    executed, see Panetti, 
    2008 WL 2338498
    , at *36–37, the Florida Supreme Court found that
    Ferguson’s delusions did not render him incompetent to be executed either.
    45
    Case: 12-15422     Date Filed: 05/21/2013    Page: 46 of 65
    mental illness and delusional belief, he nonetheless “understands” the connection
    between his impending execution and the murders he had committed and
    understands that he will die when executed. 
    Id. at 7–8.
    Although the Florida Supreme Court’s decisions in Provenzano I and
    Provenzano II predated Panetti, they make clear that Florida’s awareness standard
    for judging competency to be executed includes an inquiry into rationality and
    amounts to an awareness-plus-rational-understanding test. See Provenzano 
    I, 750 So. 2d at 602
    –03 (rejecting the argument that the Florida standard “does not allow
    for the rational appreciation of the connection between the crime and the
    punishment” and holding that Provenzano should be afforded “the opportunity to
    cross-examine [the State’s expert witness concerning] Provenzano’s rational
    appreciation of the connection between his crime and the punishment he is to
    receive”) (emphasis added); Provenzano 
    II, 760 So. 2d at 140
    (citing with approval
    and affirming the trial court’s findings that “Provenzano has a factual and rational
    understanding of . . . ‘the fact that in accordance with the jury’s recommendation,
    he was sentenced to death for the murder of Bailiff Arnie Wilkerson, and that he
    will die once he is executed’”) (emphasis added).
    That the Florida Supreme Court’s opinion in this case used the terms
    “awareness” and “understanding” interchangeably, and often used both terms
    without the modifier “rational,” does not mean that it failed to heed the holding of
    46
    Case: 12-15422     Date Filed: 05/21/2013    Page: 47 of 65
    Panetti or rendered a decision inconsistent with that precedent (or with its own
    Provenzano precedent). We have stressed that, under § 2254(d), “we review the
    state court’s ‘decision’ and not necessarily its rationale,” and that “overemphasis
    on the language of a state court’s rationale would lead to a ‘grading papers’
    approach that is outmoded in the post-AEDPA era.” Parker v. Sec’y for Dep’t of
    Corr., 
    331 F.3d 764
    , 785 (11th Cir. 2003) (quotation marks omitted). Absent a
    “conspicuous misapplication of Supreme Court precedent . . ., we will not presume
    that a state court misapplied federal law” or failed to properly comprehend
    Supreme Court precedent. 
    Id. at 785–86
    (quotation marks and alterations omitted).
    The Supreme Court has held that some use of imprecise language does not
    render a state court decision inconsistent with clearly established federal law. It
    does not, the Court has explained, because “readiness to attribute error” is
    incompatible with both “the presumption that state courts know and follow the
    law” and with AEDPA’s “demand[] that state-court decisions be given the benefit
    of the doubt.” Woodford v. Visciotti, 
    537 U.S. 19
    , 23–24, 
    123 S. Ct. 357
    , 359–60
    (2002). It bears noting that, on at least one occasion, the Supreme Court in Panetti
    equated the requisite “rational understanding” with a certain type or degree of
    “awareness.” See 551 U.S. at 
    960, 127 S. Ct. at 2862
    (referring to “[g]ross
    delusions stemming from a severe mental disorder [that] may put an awareness of a
    47
    Case: 12-15422      Date Filed: 05/21/2013    Page: 48 of 65
    link between a crime and its punishment in a context so far removed from reality”)
    (emphasis added). Imprecision in language is not confined to state court opinions.
    The AEDPA principles of deference have special force here given the
    Supreme Court’s recognition in Panetti that the Court itself did not know exactly
    what a “rational” understanding requires. The Court admitted that “a concept like
    rational understanding is difficult to define,” id. at 
    959, 127 S. Ct. at 2862
    , and it
    proceeded to prove that by not even attempting a definition. The Court did say that
    “normal” or “rational” in this context does not mean what a layperson understands
    those terms to mean, id. at 
    959–60, 127 S. Ct. at 2862
    , but that only underscores the
    absence of a definition. And so does the Court’s concession that “we find it
    difficult to amplify our conclusions or to make them more precise.” 
    Id. at 961,
    127
    S.Ct. at 2863; see also id. at 
    960–61, 127 S. Ct. at 2862
    –63 (emphasizing that it was
    not being more specific); 
    id. at 978,
    127 S.Ct. at 2873 (Thomas, J., dissenting)
    (characterizing the majority opinion’s rational understanding standard as a “half-
    baked holding that leaves the details of the insanity standard for the District Court
    to work out”).
    Given the deference that AEDPA mandates, the “contrary to” issue is
    whether the standard that the Florida Supreme Court applied in determining
    Ferguson’s competency to be executed was “contrary to . . . clearly established
    Federal law, as determined by the Supreme Court” in Panetti. See 28 U.S.C. §
    48
    Case: 12-15422     Date Filed: 05/21/2013    Page: 49 of 65
    2254(d)(1). Because the Supreme Court refrained from clearly establishing in
    Panetti any definition of rational understanding, state courts can hardly be faulted
    for not clearly defining it themselves. The Supreme Court did, however, hold that
    whatever “rational” means in the context of competency to be executed, a court
    may not “treat[] delusional beliefs as irrelevant once the prisoner is aware the State
    has identified the link between his crime and the punishment to be inflicted.”
    Panetti, 551 U.S. at 
    959–61, 127 S. Ct. at 2861
    –62. That, and pretty much that
    alone, is what Panetti held and clearly establishes.
    The standard of rational understanding that the Florida Supreme Court
    applied was not contrary to that holding of Panetti. It did not treat Ferguson’s
    paranoid schizophrenia and his belief that he is the Prince of God as irrelevant to
    whether he has a rational understanding of why he is going to be executed and of
    the fact that when executed he will die. Instead, the Florida Supreme Court
    affirmed the trial court’s finding that notwithstanding his mental condition and
    singular religious belief about his life after death, Ferguson has the requisite
    rational understanding and is competent to be executed. See pp. 
    29–30, supra
    .
    The state court decision about the applicable standard did not involve a
    “conspicuous misapplication of Supreme Court precedent,” 
    Parker, 331 F.3d at 785
    , or an “error well understood and comprehended in existing law beyond any
    possibility for fairminded disagreement,” 
    Harrington, 131 S. Ct. at 786
    –87. For
    49
    Case: 12-15422        Date Filed: 05/21/2013       Page: 50 of 65
    these reasons, we conclude that the rational understanding standard applied by the
    Florida Supreme Court to assess Ferguson’s competency to be executed is not
    inconsistent with clearly established federal law.
    B.
    Ferguson maintains that even if the Florida Supreme Court did apply the
    Panetti competency standard, we should nonetheless hold that it unreasonably
    applied that standard, either as a matter of law or as an ultimate finding of fact, by
    finding that he has a rational understanding of his impending execution and the
    reasons for it. Although Ferguson alternatively invokes § 2254(d)(1) and (d)(2),
    his underlying argument is the same with respect to both AEDPA provisions. 5 We
    will therefore treat the issue as a single inquiry for purposes of this appeal.
    Ferguson specifically contends that the state courts could not reasonably
    conclude that he is competent to be executed given their underlying factual
    findings that he suffers from paranoid schizophrenia, is not currently malingering,
    and harbors a genuine belief that he is the Prince of God. Ferguson asserts that his
    5
    Ferguson takes the position that, whether the Florida Supreme Court’s decision is
    viewed under § 2254(d)(1) or (d)(2), the analysis in this case is virtually the same: whether “the
    underlying facts as found by the State courts” preclude a determination that he has a rational
    understanding of his execution. While § 2254(d)(2) specifically asks whether a state court’s
    decision “was based on an unreasonable determination of the facts in light of the evidence
    presented,” Ferguson would recast the inquiry to be whether the ultimate determination of
    competency constitutes an unreasonable determination of fact in light of the “subsidiary findings
    of fact [the state] courts made.” While we do not agree that the inquiries called for under §
    2254(d)(1) and (d)(2) are identical, we accept Ferguson’s invitation, solely for purposes of this
    appeal, to regard them as two different methods of analyzing the same underlying question.
    50
    Case: 12-15422        Date Filed: 05/21/2013       Page: 51 of 65
    Prince-of-God belief, which the state trial court credited as genuine, encompasses
    beliefs that he cannot be executed due to his “special powers,” that his convictions
    and incarceration are really the result of both a conspiracy of corrupt policemen
    and the State’s attempt to prevent his ascension, and that he is destined to ascend to
    the right hand of God and eventually return to Earth to wage war against
    Communism. Ferguson argues that the state trial court’s conclusion that there is
    “no evidence that . . . [he] believes himself unable to die or that he is being
    executed for any reason other than the murders he was convicted of in 1978” fails
    to account for that court’s own finding that Dr. Woods credibly testified about the
    extent and gravity of Ferguson’s delusions. He contends that the state courts’
    underlying findings about his mental illness and delusional beliefs inevitably lead
    to only one conclusion: that he does not have a rational understanding of his
    impending execution and the reasons for it. 6
    6
    Ferguson also maintains that the Florida Supreme Court unreasonably applied the
    procedural requirements laid down in Ford and Panetti when it concluded that he was afforded a
    fair hearing to determine his competency. Ferguson, however, did not fairly present this
    argument to the district court in his habeas petition. See Smith v. Sec’y, Dep’t of Corr., 
    572 F.3d 1327
    , 1352 (11th Cir. 2009) (noting that an argument that is not fairly presented to the district
    court will not be considered on appeal); Hill v. Jones, 
    81 F.3d 1015
    , 1020 (11th Cir. 1996)
    (same). In his 30-page counseled habeas petition, Ferguson included only two conclusory
    sentences asserting that he “never received [a] fair hearing” due to “incalculable due process
    abuses,” and that the record before the district court was “severely limited by the due process
    abuses visited upon [him] by persons eager to rush to impose the ‘ultimate penalty without the
    full measure of the deliberative process.’” In addition to the conclusory nature of these
    contentions, Ferguson’s attorneys did not expressly designate the issue as a distinct claim for
    relief, nor did they specifically argue that the Florida Supreme Court unreasonably applied the
    procedural requirements of Ford and Panetti.
    51
    Case: 12-15422       Date Filed: 05/21/2013      Page: 52 of 65
    Ferguson’s contentions and arguments rest, in large part, on a misconception
    about the state trial court’s underlying factual findings. A close reading of the trial
    court’s opinion reveals that it did not credit all of Dr. Woods’ statements about
    Ferguson’s delusions. For example, the trial court did not credit Dr. Woods’
    statements or opinion that Ferguson believes he cannot die because he possesses
    “special powers” or that his convictions, incarceration, and impending execution
    are the result of a conspiratorial plot to prevent (or prepare, depending on whether
    one examines Dr. Woods’ report or hearing testimony) Ferguson’s post-death
    ascension to his rightful throne as the Prince of God. The only part of Dr. Woods’
    testimony that the state trial court credited was, as the court described it, the part
    about “Ferguson’s documented history of paranoid schizophrenia.” Ferguson, No.
    04-2012-CA-507, op. at 17. In all other respects, it credited the testimony and
    opinions of Drs. Myers and Werner on the question of “Ferguson’s competency to
    be executed.” 
    Id. And their
    testimony was that Ferguson has a rational
    understanding of his impending execution, of the fact that he will be put to death,
    and of the reasons for his execution.
    In any event, Ferguson’s competency hearing did satisfy the minimum due process
    requirements identified in Ford and Panetti because he was given an “opportunity to submit
    evidence and argument from [his] counsel, including expert psychiatric evidence that may [have]
    differ[ed] from the State’s own psychiatric examination.” See 
    Panetti, 551 U.S. at 949
    –50, 127
    S.Ct. at 2856 (quotation marks omitted). Thus, even if a due process claim had been fairly
    presented, it would fail on the merits.
    52
    Case: 12-15422     Date Filed: 05/21/2013    Page: 53 of 65
    Moreover, the state trial court’s finding that Ferguson was not malingering
    was limited to his not “malingering during the interview with the Commission.”
    
    Id. at 17
    (emphasis added). The court did not find that Ferguson was not
    malingering, or that he was telling the truth, about the alleged beliefs that he did
    not tell the commission about and mentioned only to Dr. Woods. Ferguson did not
    tell the commission anything indicating that he did not think he could die or that he
    possesses “special powers,” or that his planned execution is the result of a
    conspiracy among state officials instead of the penalty for the murders he
    committed. Ferguson mentioned those alleged beliefs only to defense expert Dr.
    Woods. And Dr. Woods did not testify at the evidentiary hearing held by the state
    trial court about any purported belief of Ferguson that his convictions and
    punishment are based on any alleged conspiracy.
    Viewed in this light, there is no contradiction between the state trial court’s
    findings that Ferguson believes he is the Prince of God and that he was not
    malingering during his appearance before the commission, and its finding that
    there was “no evidence that in his current mental state Ferguson believes himself
    unable to die or that he is being executed for any reason other than the murders he
    was convicted of in 1978.” 
    Id. at 18
    (emphasis added). There was of course some
    evidence, derived from Dr. Woods’ report and his trial court hearing testimony,
    that Ferguson believes that he will not die as an immediate result of his execution
    53
    Case: 12-15422        Date Filed: 05/21/2013       Page: 54 of 65
    and that he is being punished for reasons other than the murders he had committed.
    However, the trial court was not required to find that evidence credible when it was
    contradicted by the testimony of the State’s expert witnesses.
    AEDPA’s command that we give state courts “the benefit of the doubt” and
    refrain from readily “attribut[ing] error” means, at the least, that we should avoid
    finding internal inconsistencies and contradictions in the decisions of state courts
    where they do not necessarily exist. See 
    Woodford, 537 U.S. at 23
    –24, 123 S.Ct.
    at 359–60. While the state trial court’s choice of words (“no evidence”) could
    have been more precise and technically correct (“no credible evidence”), giving its
    opinion the benefit of the doubt, as we are required to do by AEDPA, it is clear to
    us that the trial court meant that it found no credible evidence that Ferguson
    genuinely believes that he will not die as a result of his execution or that his
    execution is unrelated to the crimes for which he was convicted. 7 The court
    credited the testimony of Drs. Myers and Werner that Ferguson rationally
    understands that he is going to die and why.
    The question then, as Ferguson presents it, is whether “some fairminded
    jurists could agree” with the state courts’ ultimate conclusion that he is competent
    to be executed given the underlying factual findings that he suffers from paranoid
    schizophrenia, was not malingering during the commission’s evaluation, and
    7
    There is nothing to suggest that the state trial court simply ignored facets of Dr. Woods’
    testimony, instead of deeming them not credible. Ferguson, No. 04-2012-CA-507, op. at 6.
    54
    Case: 12-15422     Date Filed: 05/21/2013    Page: 55 of 65
    genuinely believes that he is the Prince of God. See 
    Holsey, 694 F.3d at 1257
    .
    The answer is yes –– fair-minded jurists could agree with that conclusion. During
    the commission’s evaluation, Ferguson informed the State’s psychiatric experts
    that he had been anointed the Prince of God, that he would be resurrected at some
    point after his execution to sit at “the right hand of God,” and that he would
    eventually return to Earth. Nevertheless, the State’s experts, whose testimony the
    state trial court credited on the question of Ferguson’s competency, noted that
    Ferguson acknowledged that he was going to be executed because of the eight
    murders he committed, acknowledged that he would be the first inmate to receive
    Florida’s new lethal-injection protocol, and acknowledged that he would
    physically die as an immediate result of being executed. Based on those facts, as
    well as the absence of any outward signs that Ferguson was suffering from
    cognitive disturbance or impairment, Drs. Myers and Werner were of the opinion
    that Ferguson’s delusions, even if genuine, did not prevent him from having a
    rational understanding of the nature of the death penalty and a rational
    understanding of the reasons that it was going to be imposed on him.
    While Ferguson’s expert, Dr. Woods, offered a contrary opinion, it was not
    objectively unreasonable for the state trial court to credit the expert opinions of
    Drs. Myers and Werner, particularly in light of the undisputed evidence that
    Ferguson has, for over a decade, adequately functioned in his day-to-day life
    55
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    without the need for antipsychotic medications and without exhibiting any outward
    manifestations of mental illness or instability to prison officials. Moreover, two of
    the prison officers who appeared at the competency hearing testified that Ferguson,
    after pointing out that he had not had a warrant signed on his behalf in 35 years,
    discussed with them the disposition of his remains, without any indication that he
    believed that he would not physically perish. The combined testimony of all of the
    State’s witnesses supports the conclusion that the nature and severity of Ferguson’s
    mental illness do not render his “perception of reality so distorted” that he cannot
    adequately appreciate the connection between his crimes and impending execution.
    See 
    Panetti, 551 U.S. at 960
    , 
    962, 127 S. Ct. at 2862
    –63. At the very least, a fair-
    minded jurist could so find, as the state trial court judge and the Florida Supreme
    Court did find.
    This is not the first time that a court has found someone suffering from
    schizophrenia is mentally competent for one purpose or another. See Wright v.
    Sec’y for Dep’t of Corr., 
    278 F.3d 1245
    , 1259 (11th Cir. 2002) (holding that, even
    under the stricter competency-to-stand-trial standard, “[t]he fact that [the
    petitioner] suffers from chronic schizophrenia the effects of which have come and
    gone over the years is not enough to create a real, substantial, and legitimate
    doubt” about his competency); Lawrence v. Sec’y, Fla. Dep’t of Corr., 
    700 F.3d 464
    , 482 (11th Cir. 2012) (affirming the district court’s finding that a diagnosis of
    56
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    schizophrenia is not enough to show that a defendant was incompetent to enter a
    guilty plea or stand trial). After all, the Supreme Court in Panetti stated that the
    requisite mental state for competency “neither presumes nor requires a person who
    would be considered ‘normal,’ or even ‘rational,’ in a layperson’s understanding of
    those terms.” Panetti, 551 U.S. at 
    959, 127 S. Ct. at 2862
    .
    It is also significant that the Supreme Court did not actually rule that Panetti
    himself was incompetent to be executed as a result of his schizo-affective disorder
    and accompanying delusions. Instead, it remanded the case to the district court to
    make a decision about that in the first instance.8 
    Panetti, 551 U.S. at 956
    –62, 127
    S.Ct. at 2860–63. As we have mentioned, on remand the district court concluded
    that Panetti was competent to be executed despite his “severe mental illness” and
    “paranoid delusions” because he nevertheless possessed a “rational understanding
    of the causal connection between [his crimes] and his death sentence.” Panetti,
    
    2008 WL 2338498
    , at *36–37.
    Both the reasoning and outcome of the Supreme Court’s decision in Panetti
    leave ample room for fair-minded jurists to conclude, as the state courts did here,
    that Ferguson is mentally competent to be executed despite his mental illness and
    8
    Even if we were to assume that the facts of this case are materially indistinguishable
    from those in Panetti, that would not render the Florida Supreme Court’s decision inconsistent
    with clearly established federal law because Panetti did not reach a contrary result –– the
    Supreme Court did not conclude that Panetti was incompetent to be executed. See 
    Bell, 535 U.S. at 694
    , 122 S.Ct. at 1850 (explaining that a state court decision is inconsistent with clearly
    established federal law if it arrives at a different or contrary result in the face of materially
    indistinguishable facts).
    57
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    the presence of a delusional belief. See 
    Renico, 130 S. Ct. at 1864
    (explaining that,
    under AEDPA, “the more general the rule at issue—and thus the greater the
    potential for reasoned disagreement among fair-minded judges—the more leeway
    state courts have in reaching outcomes in case-by-case determinations) (quotation
    marks and alteration omitted); see also Hill v. Humphrey, 
    662 F.3d 1335
    , 1348
    (11th Cir. 2011) (en banc) (concluding that the Supreme Court’s decision to leave
    it to the states to develop specific standards for determining whether an inmate is
    “mentally retarded” for purposes of the Eighth Amendment “makes it wholly
    inappropriate for this court, by judicial fiat, to tell the States how to conduct an
    inquiry into a defendant’s mental retardation”) (quotation marks omitted).
    C.
    We offer some closing thoughts about what has been consistently referred to
    throughout this litigation, and in this opinion, as Ferguson’s delusion that he is the
    Prince of God and that after he dies he will be resurrected in that capacity. The
    state trial court was right about this being a “grandiose” belief. And it is not a
    commonplace belief or one that most people would consider normal in the
    colloquial sense. As we have pointed out several times, however, the Supreme
    Court stressed in Panetti that rational for purposes of competency to be executed
    does not mean “‘normal,’ or even ‘rational,’ in a layperson’s understanding of
    those terms.” Panetti, 551 U.S. at 
    959–61, 127 S. Ct. at 2862
    . That most people
    58
    Case: 12-15422     Date Filed: 05/21/2013   Page: 59 of 65
    would characterize Ferguson’s Prince-of-God belief, in the vernacular, as “crazy”
    does not mean that someone who holds that belief is not competent to be executed.
    It does not mean that, because competence to be executed is a specific inquiry into
    whether the petitioner has a rational understanding –– in the specialized Panetti
    sense –– of two things. One is that he is going to be executed because of the
    murders he committed. Ferguson’s Prince-of-God delusion is not necessarily
    inconsistent with a rational belief that he is going to be executed because of the
    murders he committed.
    The second part of the Panetti standard requires a rational understanding by
    Ferguson that he will die when he is executed. Ferguson’s Prince-of-God delusion,
    as the state courts found it to exist (as distinguished from Dr. Woods’ belief about
    it), does not rule out Ferguson having a rational understanding that he will die
    when he is executed. That much is shown by the fact that the state courts found
    that Ferguson, despite that delusion, knows that the execution will result in his
    death.
    One could argue, as Ferguson’s attorneys do, that his belief that he will be
    resurrected as the Prince of God negates a rational understanding that he will be
    killed and thereby establishes that he is not mentally competent to be executed.
    That cannot be correct. Panetti cannot mean that a belief in resurrection or other
    forms of life after death is inconsistent with the rational understanding of death that
    59
    Case: 12-15422     Date Filed: 05/21/2013    Page: 60 of 65
    is required for mental competence to be executed. If it did mean that, most
    Americans would be mentally incompetent to be executed.
    While Ferguson’s thoughts about what happens after death may seem
    extreme to many people, nearly every major world religion — from Christianity to
    Zoroastrianism — envisions some kind of continuation of life after death, often
    including resurrection. Ferguson’s belief in his ultimate corporeal resurrection
    may differ in degree, but it does not necessarily differ in kind, from the beliefs of
    millions of Americans. According to a 2006 survey conducted by the AARP about
    views of the afterlife held by Americans over the age of fifty, 23% of respondents
    stated that they believed in reincarnation while an additional 50% believed in
    another form of life after death. Jean Koppen & Gretchen Anderson, AARP,
    Thoughts on the Afterlife Among U.S. Adults 50+ 4 (June 2007), available at
    assets.aarp.org/rgcenter/general/afterlife.pdf (last visited April 26, 2013). A more
    recent study of national surveys similarly shows that 75% of American adults
    believe in some form of life after death. Andrew Singleton, Beyond Heaven?
    Young People and the Afterlife, 27 J. Contemp. Religion 453, 453 (2012). Are the
    courts to say that three-fourths of Americans are delusional and mentally
    incompetent?
    Passages in the Old Testament speak of God resurrecting bones, see Ezekial
    37:13–14, while resurrection and eternal life are fundamental tenets of the New
    60
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    Testament, see, e.g., 1 Corinthians 15:12; John 6:40; John 3:16. Hundreds of
    millions of people worldwide share those beliefs. Zoroastrian tradition teaches
    that, after a great struggle between God and the power of evil, there will be a
    general resurrection of humanity, and the resurrected will pass through molten
    metal to be purged of sin. Farnaz Ma’sumian, Life After Death: A Study of the
    Afterlife in World Religions 24 (Oneworld Publications 1995). The Qur’an
    teaches that eternal paradise awaits believers who do righteous deeds and eternal
    punishment awaits those who do evil deeds. Qur’an 2:81–82. Observers of Shinto
    believe that after death every person becomes a kami, a supernatural being who
    continues to have a part in the life of the community, nation, and family. “Saints”
    in Encyclopedia Britannica Online Academic Edition, available at
    http://www.britannica.com/EBchecked/topic/516666/saint (last visited April 26,
    2013).
    Tibetan Buddhists believe that the first Dalai Lama is reborn through each
    successive one. “Dalai Lama,” in Encyclopedia of World Religions 275, 275
    (Wendy Doniger et al. eds., Merriam-Webster 1999). Hindu sacred texts include
    the story of a mortal who overcame the fear of death and became a god himself.
    Christopher Moreman, Beyond the Threshold: Afterlife Beliefs and Experiences in
    World Religions 249 (Rowman & Littlefield Publishers 2008). Ancient Egyptians
    believed that after death their pharaohs would become stars in the sky. 
    Id. And 61
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    the list goes on and on. Which of the myriad beliefs about what happens on the
    other side of death are irrational, delusional, or symptoms of mental illness?
    A conclusion that a particular belief about the afterlife and one’s role in it is
    extreme enough to be irrational, delusional, and indicative of incompetence to be
    executed is only a few steps away from the same conclusion about any person who
    believes in resurrection, in heaven or hell, or in any variation of life after death.
    Courts should be reluctant to treat as a symptom of mental illness anyone’s belief
    about what will happen to him after he dies. It is beyond the ken of courts to
    measure the rationality of religious beliefs –– what will happen to us after we pass
    through the dark curtain of death is the ultimate non-justiciable question.
    Because the state courts’ determination that Ferguson possesses a rational
    understanding of his execution and the reason for it is not “so lacking in
    justification that there was an error well understood and comprehended in existing
    law beyond any possibility for fairminded disagreement,” AEDPA precludes us
    from disturbing their judgment. See 
    Harrington, 131 S. Ct. at 786
    –87.
    III. CONCLUSION
    AEDPA “reflects the view that habeas corpus is a guard against extreme
    malfunctions in the state criminal justice systems, not a substitute for ordinary
    error correction through appeal.” 
    Id. at 786
    (quotation marks omitted) (emphasis
    added). There was no extreme malfunction in his case. The Florida Supreme
    62
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    Court properly applied Panetti’s “rational understanding” standard, considered
    conflicting expert testimony about the nature and severity of Ferguson’s mental
    illness, and made a determination about his competency to be executed that is by
    no means beyond any possibility for fair-minded disagreement. AEDPA requires
    that federal habeas relief be denied and that we affirm that denial.
    AFFIRMED.
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    WILSON, Circuit Judge, concurring in the result:
    I write separately to address the Florida Supreme Court’s statement that
    Panetti v. Quarterman, 
    551 U.S. 930
    , 
    127 S. Ct. 2842
    (2007), “does not alter [its]
    decision in Provenzano [v. State, 
    760 So. 2d 137
    (Fla. 2000)].” Ferguson v. State,
    Fla. 2012, __ So. 2d. __, (No. SC12-2115, Oct. 17, 2012).
    Repeating the standard from Provenzano, the Florida Supreme Court in
    Ferguson declared that “the Eighth Amendment requires only that defendants be
    aware of the punishment they are about to receive and the reason they are to
    receive it.” 
    Id. (citing Ford
    v. Wainwright, 
    477 U.S. 399
    , 422 (1986) (Powell, J.,
    concurring)); see 
    Provenzano, 760 So. 2d at 140
    . That statement of the law is
    patently incorrect in the wake of Panetti, which explicitly held that “[a] prisoner’s
    awareness of the State’s rationale for an execution is not the same as a rational
    understanding of 
    it.” 551 U.S. at 959
    , 127 S. Ct. at 2862 (emphasis added).
    While I acknowledge that the Florida Supreme Court was on the right track
    when it stated that “Ferguson [must] understand the connection between his crime
    and the punishment he is to receive for it,” Ferguson v. State, Fla. 2012, __ So. 2d.
    __, (No. SC12-2115, Oct. 17, 2012) (emphasis added), its assertion that
    Provenzano remains unchanged by Panetti suggests that a naked awareness
    standard is sufficient. That is not so—once again, I emphasize that Panetti
    requires more than just a prisoner’s ability to regurgitate the State’s announced
    64
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    reason for his punishment or to recite the facts attendant to his execution. Panetti
    requires “a rational understanding of the reason for [that] 
    execution.” 551 U.S. at 958
    , 127 S. Ct. at 2861. Therefore, insofar as the Florida Supreme Court continues
    to believe that “the Eighth Amendment requires only that defendants be aware of
    the punishment they are about to receive and the reason they are to receive it,”
    Ferguson v. State, Fla. 2012, __ So. 2d. __, (No. SC12-2115, Oct. 17, 2012), it is
    not correct; Panetti requires more.
    Having stated my concerns, and despite the Florida Supreme Court’s
    acknowledgement that Ferguson is not malingering and that he suffers from mental
    illness, I agree that we must defer to the Florida Supreme Court’s finding that
    “[t]here is no evidence that in his current mental state Ferguson believes himself
    unable to die or that he is being executed for any reason other than the murders he
    was convicted of in 1978.” 
    Id. (internal quotation
    marks omitted). I am therefore
    obliged to concur in the result.
    65