Alvin Ford was convicted of murder and sentenced to death in Florida in 1974. Eight years later, he began to exhibit symptoms of mental illness. Florida law prohibited the execution of an incompetent prisoner, and Ford's attorneys sought a determination of Ford's competency under procedures provided by statute. The Governor of Florida appointed a panel of three psychiatrists who interviewed Ford to determine competency. The Ford case represents the first U.S. Supreme Court decision in nearly 30 years to examine competency determination procedures for death row inmates. Prior decisions held that, because an incompetent prisoner's interest in freedom from execution is a privilege granted by the State rather than a right, procedures established by States to determine competency are not required to meet the demands of due process. The Supreme Court has abandoned the right/privilege distinction as determinative of due process requirements and has replaced it with a more flexible test that provides due process protection whenever government action threatens a substantial interest in life, liberty, or property. Because condemned prisoners have both life and liberty interests in avoiding execution while incompetent, procedures to determine competency to be executed must meet due process demands. Existing State procedures for determining competency vary widely with regard to the extent of mental health evaluations and the identity of examiners, but most statutes require or permit mental health professionals or other medical experts to examine prisoners. The most effective way to develop adequate protections is to balance prisoner interests against those of the State and to incorporate determinations of competency to be executed into a comprehensive system of mental health care for death row inmates. 226 references.