Galveston County’s interim District Attorney, Kenneth Cusick, defense attorney Nick Poehl and Judge Lonnie Cox recently visited the state hospital where doctors are working to restore the competency of the charged Santa Fe High School gunman.
The visit comes as Judge Cox is poised to signed an order recommitting Dimitrios Pagourtzis to North Texas State Hospital for another up to one year period.
Pagourtzis is charged with murdering students Chris Stone, Aaron McLeod, Angelique Ramirez, Jared Black, Kimberly Vaughan, Sabika Sheikh, Christian Garcia, Shana Fisher, and educators Cynthia Tisdale and Ann Perkins.
He’s also charged with wounding more than a dozen others during the May 18, 2018 mass shooting at Santa Fe High School.
Pagourtzis was first declared incompetent to stand trial in 2019. Until his competency is restored, the criminal case cannot move forward.
“I’m just resolved to do what I need to do to make the effort to have his competency restored to face trial,” said Cusick.
Cusick, Poehl and Cox spoke with doctors at North Texas State Hospital’s Vernon campus about Pagourtzis’ treatment. Cusick said based on that meeting he will not challenge the judge’s order recommitting Pagourtzis.
However, Cusick said if, at the end of the next two-to-three month treatment cycle, doctors have not restored Pagourtzis’ competency, he may seek an independent assessment of his mental state.
“Do you think he’s faking it?” asked 2 Investigates Robert Arnold.
“Based on my observations, I’m not a medical expert, and so the experts say they do not believe that’s occurring. But I’m not so sure,” said Cusick “I’ll have to rely on mental health experts to back that up.”
Cusick said he has not yet determined which expert he would use to independently evaluate Pagourtzis’ competency. Cusick said doctors told him they are making progress.
“Based on what I saw and what I heard from the staff about his progress, my opinion, my lay opinion, is I think we’re close and so I want this to happen sooner than later," said Cusick. “I’ll see what this other treatment does, but then if I need to enlist other professionals to evaluate, to get second and third opinions, I’m gonna do it."
Poehl was with Cusick during the visit to North Texas State Hospital.
“They called him the sickest individual in Vernon. Of all the 217 they house right now, he is the most ill, the most mentally ill,” Poehl said state doctors told Cusick, Judge Cox and him.
“Did doctors say, ‘yes or no,’ as to whether they felt his competency could be restored?” asked Arnold.
“The odds are low. That’s what they told us,” said Poehl. “The evidence is clear, he’s not competent, he hasn’t been competent for a very long time.”
Poehl said he is not opposed to an independent evaluation of Pagourtzis, but points out more than a dozen medical experts have evaluated him over the years and all maintain he is incompetent.
Cusick would not discuss his observations of Pagourtzis, but Poehl shared they spoke with him briefly. Poehl said Pagourtzis has a job in the hospital’s library.
“Some people may hear that and go, ‘well, that sounds competent to me,’” said Arnold.
"That’s not what competency is about. Competency is about rationally understanding what’s going on around you, rationally understand what you’re charged with, being able to communicate rationally with your attorney, assist in your own defense, participate in your defense. You can be trained to do a lot of rote tasks, particularly while heavily medicated, and still not be competent," said Poehl.
Pagourtzis has now been at North Texas State Hospital for 2,234 days, which is well beyond the average 158 days doctors in the North Texas system took to restore patients’ competency during 2025.
Records from the State Health and Human Services Commission show Pagourtzis is one of 11 patients who has been at the facility for five years or longer. HHSC reports the average daily cost to treat a patient at NTSH was $949 in 2025.
State doctors have to inform the court every year whether they believe competency restoration is imminent or if more treatment is needed.
Cusick also said if Pagourtzis’ competency is restored, he will then seek to have the trial moved back to Galveston County. Before he was declared incompetent, the previous judge presiding over the case granted the defense a change of venue to have the trial held in Fort Bend County.