Compassionate Release Is Not a Backdoor § 2255: Third Circuit Clarifies Limits on Ruan-Based Trial Error, Parental Caregiving, and Medical Hardship

Case: United States v. William O’Brien, III, No. 25-1729 (3d Cir. Oct. 28, 2025) — Nonprecedential summary affirmance (L.A.R. 27.4; I.O.P. 10.6). Panel: Krause, Phipps, Scirica, JJ.

Introduction

In this nonprecedential per curiam disposition, the Third Circuit summarily affirmed the denial of a second motion for compassionate release filed by a physician convicted of dispensing controlled substances outside the usual course of professional practice, among other offenses. The court holds that:

Legal challenges to a conviction—here, a Ruan-based jury-instruction claim—do not supply “extraordinary and compelling reasons” under 18 U.S.C. § 3582(c)(1)(A)(i), reaffirming that § 3582 is not a substitute for 28 U.S.C. § 2255.
Family circumstances premised on caring for an ailing parent require proof that the defendant is the only available caregiver under U.S.S.G. § 1B1.13(b)(3)(C)—a demanding standard not met here.
Minor or managed medical issues (e.g., eye ailments, dietary complaints) do not meet the medical criteria for “extraordinary and compelling reasons” under U.S.S.G. § 1B1.13(b)(1).

The court also denied a motion to stay pending the Supreme Court’s forthcoming decision in Fernandez v. United States, which will address whether reasons cognizable under § 2255 can be considered within § 3582(c)(1)(A). Even if such reasons could be considered, the panel concluded, the record here would not justify relief.

Summary of the Opinion

William O’Brien, III, a physician sentenced to 30 years after a jury convicted him of narcotics offenses and money laundering, appealed the denial of his second compassionate release motion. He invoked three grounds: (1) alleged instructional error under Ruan v. United States, 597 U.S. 450 (2022); (2) the need to care for an elderly, ill mother; and (3) his own medical care while incarcerated. The district court denied relief solely because O’Brien failed to demonstrate “extraordinary and compelling reasons,” without reaching the § 3553(a) factors.

The Third Circuit affirmed. Applying abuse-of-discretion review, it held:

Ruan claim: A § 3582 motion is not a vehicle to attack the validity of a conviction (citing Okereke; agreeing with the cross-circuit consensus summarized in Fernandez). Moreover, the record from O’Brien’s direct appeal—including extensive evidence of unlawful prescribing and a willful-blindness instruction keyed to O’Brien’s subjective belief—would defeat any claim that Ruan furnishes an extraordinary and compelling reason.
Caregiving for a parent: U.S.S.G. § 1B1.13(b)(3)(C) requires proof that the defendant is the only available caregiver. The record showed other adult children exist; the standard was not met.
Medical conditions: O’Brien’s reported ailments and intermittent issues with snacks or vitamins did not rise to the level of “extraordinary and compelling” medical circumstances contemplated by § 1B1.13(b)(1).

The court granted the government’s motion for summary affirmance and to be excused from filing a brief, finding no substantial question presented. It denied the motion to stay pending Fernandez.

Analysis

Precedents and Authorities Cited

United States v. Pawlowski, 967 F.3d 327 (3d Cir. 2020): Establishes the two-step framework for compassionate release—(1) extraordinary and compelling reasons; and (2) a favorable § 3553(a) analysis (with relevant policy statements). Also confirms abuse-of-discretion review.
Hope v. Warden York County Prison, 972 F.3d 310 (3d Cir. 2020): Articulates abuse-of-discretion standard—reversal is warranted only for errors of law or clearly erroneous factual assessments.
Ruan v. United States, 597 U.S. 450 (2022): In prosecutions of licensed physicians for unlawful prescribing under the Controlled Substances Act, once authorization is raised, the Government must prove beyond a reasonable doubt that the defendant knew or intended to act without authorization.
Okereke v. United States, 307 F.3d 117 (3d Cir. 2002): § 2255 is the presumptive means to challenge convictions and sentences, not other procedural vehicles (reaffirmed here in the compassionate-release context).
United States v. Von Vader, 58 F.4th 369 (7th Cir. 2023): “Extraordinary and compelling” reasons do not include purely legal contentions that have dedicated statutory avenues (e.g., § 2255).
United States v. Fernandez, 104 F.4th 420 (2d Cir. 2024), cert. granted in part, No. 24-556: Addresses whether courts may consider § 2255-type reasons within § 3582(c)(1)(A); the Second Circuit cataloged a cross-circuit consensus declining to do so, with the First Circuit’s Trenkler as an outlier.
United States v. Trenkler, 47 F.4th 42 (1st Cir. 2022): Recognizes a broader reading of compassionate release that can, in limited circumstances, encompass legal-error considerations—distinct from the approach followed by most circuits.
U.S.S.G. § 1B1.13 (2023 amendments): Provides the authoritative policy statement for courts adjudicating defendant-filed compassionate release motions, including enumerated grounds for medical conditions (§ 1B1.13(b)(1)) and family circumstances, including caregiving for an incapacitated parent when the defendant is the only available caregiver (§ 1B1.13(b)(3)(C)).
United States v. O’Brien, 738 F. App’x 38 (3d Cir.), cert. denied, 586 U.S. 905 (2018): O’Brien’s direct appeal, describing extensive evidence of unlawful prescribing and referencing the willful-blindness instruction.

Legal Reasoning

The panel proceeded issue-by-issue under the “extraordinary and compelling” threshold, declining to reach § 3553(a) because the record did not satisfy the first requirement. That sequencing is consistent with Pawlowski.

1) Ruan-based trial error is not an “extraordinary and compelling” reason

O’Brien argued that the district court’s jury instructions were defective under Ruan, which requires the Government to prove the physician knew or intended to act without authorization. The panel held this type of argument is categorically improper in a § 3582 motion: trial-error or conviction-validity claims must be brought, if at all, under § 2255 (Okereke). This aligns with the dominant appellate view (as canvassed by the Second Circuit in Fernandez) that compassionate release is not a collateral-attack proxy. The Seventh Circuit’s reasoning in Von Vader supplies a clear formulation: purely legal contentions with their own statutory pathway are not “extraordinary and compelling.”

The panel added an alternative holding: even if § 3582 permitted consideration of such legal arguments, O’Brien’s record would not justify relief. On direct appeal, the Third Circuit had described a “parade of witnesses, a confidential informant, videotape evidence, and expert testimony” showing prescribing “outside the usual course of professional practice and for no medical purpose.” Additionally, the trial court’s willful-blindness instruction required jurors to find that O’Brien subjectively believed he was acting outside the usual course—tracking Ruan’s mens rea requirement. Thus, even on the merits-adjacent plane, the alleged instructional error did not rise to the level of an extraordinary and compelling circumstance.

2) Parental caregiving requires proof that the defendant is the only available caregiver

O’Brien offered his mother’s affidavit describing advanced age and significant health issues. The policy statement at § 1B1.13(b)(3)(C), however, authorizes compassionate release for a parent’s incapacitation only when the defendant is the only available caregiver. The record acknowledged other adult children (despite living in other states), which defeats the exclusivity requirement. The panel recognized the mother’s circumstances but concluded the stringent text of § 1B1.13(b)(3)(C) was not satisfied.

3) Medical-need claims must meet the policy statement’s high threshold

O’Brien cited eye ailments and intermittent issues with receiving snack bags and vitamins. Section 1B1.13(b)(1) contemplates grave medical conditions—terminal illness; serious conditions that substantially diminish the ability to provide self-care within a correctional setting; or conditions requiring specialized care that the facility cannot provide. The panel agreed with the district court that O’Brien’s submissions did not meet this standard.

4) Summary disposition and denial of stay

Concluding that no substantial question existed, the court granted the government’s request for summary affirmance and excused briefing. It also denied O’Brien’s motion to stay pending the Supreme Court’s decision in Fernandez, noting both the prevailing circuit consensus against using § 3582 to consider § 2255-type claims and, independently, the weakness of O’Brien’s Ruan theory on these facts.

Impact and Implications

Although nonprecedential, this decision is a clear signal about how the Third Circuit is approaching three recurring compassionate release themes:

No collateral-attack end-run via § 3582: Defendants cannot use compassionate release to litigate trial errors or conviction validity. That route remains § 2255, absent an extraordinary outlier like the First Circuit’s Trenkler approach. Unless the Supreme Court disapproves the consensus in Fernandez, courts in the Third Circuit will continue to refuse framing legal innocence or instructional error as “extraordinary and compelling.”
Strict caregiving standard for parents: The 2023 policy statement explicitly recognizes caregiving for incapacitated parents—but only when the defendant is the sole available caregiver. Geographic distance of siblings, without more, will not suffice to prove exclusivity. Practitioners should assemble comprehensive evidence of unavailability (e.g., medical, work, disability, caregiving burdens of others) if seeking relief on this ground.
Medical conditions must be severe and inadequately managed: Intermittent or minor care issues generally fall short. Successful medical-based motions typically demonstrate a serious condition that substantially diminishes the ability to self-care in custody or requires treatment unavailable in the facility.
Sequencing of analysis: District courts may deny at step one (no extraordinary and compelling reasons) without reaching § 3553(a), and such denials are reviewed deferentially for abuse of discretion.

The panel’s alternative analysis of the Ruan issue also matters practically: even if the Supreme Court in Fernandez permits some consideration of legal-change arguments within § 3582, defendants will still need a powerful factual showing that the change matters in their case. Evidence and instructions already satisfying Ruan’s mens rea requirement will undercut such claims.

Complex Concepts Simplified

“Extraordinary and Compelling Reasons”: A statutory threshold for compassionate release. The Sentencing Commission’s policy statement (§ 1B1.13) now governs defendant-filed motions and lists qualifying categories (medical, age, family circumstances, and certain other reasons). The bar is high.
§ 2255 vs. § 3582(c)(1)(A): Section 2255 is the primary post-conviction route to challenge the legality of a conviction or sentence (e.g., errors at trial). Section 3582(c)(1)(A) allows sentence reductions for exceptional post-sentencing developments; it is not designed for relitigating guilt or trial errors.
Willful Blindness: A jury may be instructed that a defendant cannot avoid liability by deliberately ignoring what is obvious. In this case, the instruction required a finding that O’Brien subjectively believed he was acting outside legitimate medical practice—tracking the knowledge/intent element emphasized in Ruan.
“Only Available Caregiver” (Parent): Under § 1B1.13(b)(3)(C), compassionate release may be considered if a defendant is the sole available caregiver for an incapacitated parent. The existence of other adult children or caregivers typically defeats this ground unless the movant shows they are truly unavailable.
Summary Affirmance (3d Cir. L.A.R. 27.4; I.O.P. 10.6): A procedural mechanism allowing the court to affirm without full briefing where the appeal presents no substantial question.
Abuse of Discretion: A deferential appellate standard. The denial is upheld unless it rests on a legal error or a clearly erroneous view of the evidence.

Conclusion

United States v. O’Brien, III reinforces several important constraints on compassionate release:

Section 3582(c)(1)(A) is not a vehicle for correcting asserted trial errors like those alleged under Ruan; such claims belong in § 2255 proceedings.
Family-based relief for parental care is narrowly circumscribed by § 1B1.13’s “only available caregiver” requirement, which demands concrete proof of exclusivity.
Medical complaints must meet the stringent standards in § 1B1.13(b)(1), typically involving serious, inadequately manageable conditions.

Even as the Supreme Court considers in Fernandez whether legal-change arguments may ever factor into the § 3582 analysis, this decision shows that, in the Third Circuit, the threshold remains high and fact-intensive. Where the trial record already reflects a mens rea finding consistent with Ruan, and where family or medical circumstances do not meet the policy statement’s exacting terms, compassionate release will be denied without reaching the § 3553(a) factors. While nonprecedential, O’Brien provides a clear, practical roadmap for litigants and courts navigating the evolving boundaries of compassionate release after the Sentencing Commission’s 2023 policy-statement amendments.

Note: The panel expressly states the disposition is nonprecedential under I.O.P. 5.7. Its analysis nonetheless reflects the Third Circuit’s current approach to § 3582(c)(1)(A) issues pending further guidance from the Supreme Court in Fernandez.