Loughner, dressed in a khaki prison suit and sporting bushy, reddish sideburns, was removed from the hearing after an outburst and had to watch part of the proceeding on a TV screen in another room. Burns had Loughner escorted from the courtroom after Loughner lowered his head and said what sounded like: "Thank you for the freak show. She died in front of me." His head was inches from the table in front of him.
Loughner was later brought back into the courtroom, and the judged told him he had a right to watch the hearing. Burns asked Loughner if he wanted to stay in the courtroom and behave or view the proceeding on a screen in another room.
Loughner responded: "I want to watch the TV screen."
At least two survivors of the Jan. 8 attack looked on: Giffords aide Pam Simon, who was shot in the chest and right wrist; and retired Army Col. Bill Badger, who is credited with helping subdue Loughner after a bullet grazed the back of Badger's head.
The ruling came after Loughner spent five weeks in March and April at a federal facility in Springfield, Mo., where he was examined by two court-appointed mental health professionals. The two were asked to determine whether Loughner understands the consequences of the case against him.
The competency reports by psychologist Christina Pietz and psychiatrist Matthew Carroll haven't been publicly released.
Loughner has pleaded not guilty to 49 federal charges stemming from the Jan. 8 shooting at a meet-and-greet event that wounded Giffords and 12 others and killed six people, including a 9-year-old girl and a federal judge.
Prosecutors had asked for the mental exam, citing a YouTube video in which they believe a hooded Loughner wore garbage bags and burned an American flag.
The judge gave the two mental health professionals access to Loughner's health records from his pediatrician, a behavioral health hospital that treated him for extreme intoxication in May 2006 and an urgent care center where he was treated in 2004 for unknown reasons.
Loughner will be sent to a federal facility for a maximum of four months to see if his competency can be restored. If he's later determined to be competent, the case against him will resume.
If he isn't deemed competent at the end of his treatment, his stay at the facility can be extended. There are no limits on the number of times such extensions can be granted.
If doctors conclude they can't restore his mental competency, the judge would have to decide whether the suspect can be restored. If the judge decides there's no likelihood of restoration, the judge can dismiss the charges against him. In that case, state and federal authorities can petition to have him civilly committed and could seek to extend that commitment repeatedly, said Heather Williams, a federal public defender in Tucson who isn't involved in the Loughner case.
The doctors who examined Loughner were ordered not to focus on his sanity at the time of the shooting.
Loughner's lawyers haven't said whether they intend to present an insanity defense. But they noted in court filings that his mental condition will likely be a central issue at trial and described him as a "gravely mentally ill man."