With eyes closed tightly, Brian David Mitchell was led Tuesday into a courtroom, where he shouted scriptural references to repentance and destruction.
''Ye shall be smitten and destroyed, both root and branch!'' Mitchell shouted to no one in particular. ''Ye shall be swept off the face of this Earth by a broom . . . Quake and fear and tremble before your Lord.''
As they have done in several previous hearings, bailiffs then led Mitchell out of 3rd District Judge Judith Atherton's courtroom to prevent further disruption.
After Mitchell's outburst and ejection, prosecutors called a Utah State Hospital psychiatrist to the stand to begin an expected three days of clinical expert testimony about whether the self-proclaimed prophet can be forcibly medicated to make him mentally competent to stand trial in the kidnapping of Elizabeth Smart.
At the end of the hearing, Atherton will rule on whether Mitchell, 53, meets new federal standards for forced medication, including whether there is "a substantial likelihood" that drugs would make him competent.
In a similar hearing last year, Atherton ruled Mitchell's wife and co-defendant, Wanda Barzee, 61, could be forcibly medicated. That decision is currently under review by the Utah Supreme Court.
Mitchell and Barzee are charged with aggravated kidnapping and sexual assault in the kidnapping of then-14-year-old Elizabeth, who disappeared from her Federal Heights home during the night of June 5, 2002. After a nine-month odyssey that took them to California and back, Mitchell, Barzee and Smart were taken into custody on a Sandy street on March 12, 2003.
Police say Mitchell and Barzee apparently wanted to make Elizabeth a plural wife.
Mitchell has been at the Utah State Hospital since August 2005, Barzee since March 2004.
Elizabeth's father, Ed Smart, was present at Tuesday's hearing, the first time in several years he had seen Mitchell in person and the first time he had witnessed a Mitchell rant.
During a break in the hearing, Smart told reporters he came to court to find out why Mitchell is considered incompetent.
"He's crazy like a fox," Smart said. "But he has this delusional idea that he is going to change the world and, from that standpoint, I believe he is sick."
Utah State Hospital psychiatrist Paul D. Whitehead - who has been Mitchell's attending physician for the past two years - testified Mitchell has not participated in a single group session aimed at the restoration of competency.
Mitchell also has refused all medical treatment and drugs, except for medicine to relieve his constipation, Whitehead said.
Mitchell also accepted pain medication after another patient, who apparently does not like child sex-offenders, punched and kicked Mitchell, knocking out a tooth and chipping another.
Whitehead said that until December, Mitchell did interact about half the time during informal weekly meetings, although Mitchell did most of the talking.
Since December, Mitchell has ceased to speak to hospital staff, but still communicates with facial expressions, by nodding and writing notes, Whitehead said. Apparently as part of a covenant with God, Mitchell refuses to participate with anything government-sanctioned, Whitehead said.
Defense attorney Heidi Buchi told the court Mitchell has refused visits from his own attorneys since February.
Despite Mitchell's lack of cooperation, Whitehead said he diagnosed him with a delusional disorder, characterized by grandiose, persecutory and narcissistic features.
Whitehead said the hospital has an 80 percent success rate with restoring patients to competency using drugs.
He put Mitchell's chances at restoration between 60 and 80 percent. Without drugs, he said he doubted Mitchell would ever be well enough to stand trial.
About half the patients at the hospital voluntarily take their medications, while the other half are forced, following a so-called Harper hearing, where a hospital panel decides whether certain criteria have been met. Mitchell has never undergone a Harper hearing because he meets all the criteria but one: He has never been a danger to himself or others in the jail or hospital, Whitehead said.
The hearing this week before Atherton is a so-called Sell hearing, after a 2003 U.S. Supreme Court decision that set new federal standards for forced medication.
To order Mitchell forcibly medicated, Atherton must find "a substantial likelihood" of restoring competency, that important governmental interests are at stake, that there are no less-intrusive treatments that would achieve the same results and that giving the drugs would be medically appropriate.
Whitehead said Mitchell was a good candidate for restoration through drugs, in part because he has only a ''moderate'' attachment to his delusion that he is a prophet of God.
As an example, Whitehead said Mitchell's rhetoric changed after a Utah State Prison inmate with fundamentalist beliefs was sent to the hospital. Mitchell began using Greek names for God, and even made changes to his book of prophecy, Whitehead said.
Whitehead said factors weighing against Mitchell's restoration were the duration of his psychosis, estimated at from seven to 13 years; the grandiose nature of his delusion; and his hepatitis C.
