If the defendant's condition does not improve in the prescribed time, his/her continued commitment must be based either on State civil commitment procedures or on the commitment provision for dangerous persons under 18 U.S.C. § 4246. The Federal procedures comport with the Supreme Court's views on incompetency expressed in Jackson v. Indiana, 406 U.S. 715 (1972), and have been upheld against a variety of constitutional challenges. See, e.g., United States v. Sahhar, 917 F.2d 1197 (9th Cir. 1990).
Upon appropriate certification from the director of the facility in which the defendant is hospitalized, a commitment hearing under Section 4246 will be held. This hearing is ordinarily held in the district in which the defendant is confined, rather than in the district of the trial court which originally ordered the evaluation. See 18 U.S.C. § 4246(a). But see United States v. Wheeler, 744 F. Supp. 633 (E.D. Pa. 1990), for a discussion of the trial court's authority to conduct such a hearing, where the director's certification was never made.