For the second time this year, New Haven Superior Court Judge Thomas O’Keefe Jr. has ruled that alleged murderer Lishan Wang is incompetent to stand trial.

Wang, who has been charged with the fatal 2010 shooting of former Yale-New Haven Hospital postgraduate fellow Vajinder Toor and the attempted murder of Toor’s wife, was first deemed not competent to stand trial by O’Keefe in April. Since that ruling, Wang has been receiving treatment at the Connecticut Valley Hospital, where doctors have been working to restore his competency. But based on a psychiatric evaluation of Wang conducted by Mark Cotterell and Lori Hauser of the Whiting Forensic Division at Connecticut Valley Hospital, O’Keefe ruled on Monday that Wang is still not competent to stand trial.

In addition, O’Keefe appointed Gail Sicilia of the Connecticut Mental Health Center as Wang’s health care guardian. According to O’Keefe’s ruling, Sicilia has 30 days to evaluate Wang and file a report with the court detailing whether or not she suggests prescribing medication in order to help him regain competency. Within 10 days of the filing, O’Keefe will hold another hearing to decide whether or not the recommended drugs should be administered.

“We oppose the appointment of a health care guardian, and we oppose any court-ordered forced medication,” said New Haven Chief Public Defender Thomas Ullmann — Wang’s defense attorney.

Ullmann added that the probable outcome of Sicilia’s appointment is a court order for Wang to take medication to improve his psychiatric condition, an action that both Ullmann and his client oppose. Sicilia did not respond to multiple requests for comment.

The defendant’s opposition to take medication is likely motivated by a desire to continue avoiding trial, said Kate Stith, criminal law professor at the Yale Law School who was familiar with the case. Stith added that, just as force-feeding defendants on suicide watch has been upheld in federal court, forced administration of medication is not unconstitutional. However, the court will only force medication in extreme cases and only in cases in which the judge is certain that the recommended medication will treat the defendant and make the defendant competent to stand trial, Stith said.

“But it’s not clear to me whether psychosis can be treated with medication,” she said. “Or whether the defendant will be competent or seem competent in court.”

According to The New Haven Register, Cotterell testified that Wang meets some criteria of paranoid personality disorder, but that there is a 50 to 70 percent chance that he can be restored to competency if he takes the appropriate medication.

Cotterell declined to comment on Monday’s ruling. He and Hauser have each been issued a gag order regarding Wang’s case.

State law mandates that a defendant must be able to understand the proceedings of the case against him or her and must be able to assist in his or her own defense in order to stand trial. When O’Keefe deemed Wang unable to stand trial in April, Wang was also no longer allowed to defend himself in court, as he had been doing since the case was first brought to court.

Wang is charged with murdering Toor outside his Branford home on April 26, 2010; he is also charged with firing at Toor’s wife, who was pregnant at the time. Wang and Toor were acquainted before the fatal shooting. Wang worked as a resident under Toor at Kingsbrook Jewish Medical Center in Brooklyn; in 2008, the defendant was fired from his job there.

Wang’s bond is currently set at $900,000.