Medication Conditions Are Ripe When Tethered to an Unsupported Mandatory Treatment Condition: Fifth Circuit Vacates Mental-Health Special Conditions for Lack of Record Support

Introduction

In United States v. Dubuisson (5th Cir. Sept. 9, 2025), a per curiam panel of the Fifth Circuit vacated two special conditions of supervised release—mandatory mental-health treatment and compliance with any prescribed mental-health medications—because the district court imposed them without record support and without articulating factual findings. The decision both reaffirms existing Fifth Circuit requirements for imposing special conditions under 18 U.S.C. § 3583(d) and clarifies ripeness doctrine for appellate review of medication conditions when they are functionally tethered to a mandatory, but unsupported, treatment requirement. Although the opinion is unpublished and therefore not precedential under Fifth Circuit Rule 47.5, it provides practical guidance that will influence sentencing practice throughout the circuit.

Case Background and Parties

Defendant–Appellant Pierrer Andre Dubuisson was stopped while driving a vehicle with seven passengers unlawfully present in the United States. He was convicted by a jury of knowingly transporting an alien within the United States, but the jury rejected the alleged purpose of commercial advantage or private financial gain, capping the statutory maximum at five years. The district court sentenced him to 57 months’ imprisonment and three years of supervised release, and—without making findings—imposed special conditions requiring (1) participation in mental-health treatment and (2) compliance with any mental-health medications prescribed by a treating physician.

The Presentence Report (PSR) described Dubuisson as uncooperative and agitated, noted his statements accusing law enforcement, the probation office, the court, and his counsel of bias or corruption, and recounted that he yelled in a holding cell that agents wanted him to kill himself. Critically, however, the PSR also recorded that Dubuisson reported no mental-health issues and that no information indicated he had ever experienced mental or emotional problems.

Key Issues

Whether the district court plainly erred by imposing mental-health treatment and medication conditions without record support or on-the-record findings, as required under § 3583(d) and relevant policy statements (U.S.S.G. § 5D1.3(d)(5)).
Whether Dubuisson’s challenge to the medication condition was ripe for appellate review before supervised release began, particularly where the medication requirement was closely linked to the (unsupported) mandatory treatment condition.

Summary of the Opinion

Applying plain-error review (no objection was lodged below), the Fifth Circuit vacated both the treatment and medication special conditions and remanded. The court held:

The district court’s imposition of a mental-health treatment condition was unsupported by the record and inconsistent with U.S.S.G. § 5D1.3(d)(5), which recommends such a condition only if the court has reason to believe the defendant needs psychological or psychiatric treatment. The PSR expressly stated the opposite, and the court made no findings tying Dubuisson’s conduct to a mental-health need.
The failure to provide findings was clear and obvious error, affected substantial rights (autonomy, time demands, stigma), and warranted correction on appeal.
The challenge to the separate medication condition was ripe because, on these facts, it was inextricably linked to the unsupported mandatory treatment condition. The court vacated the medication condition on the same rationale as the treatment condition.

Judge Jones dissented, indicating she would apply a clear-error standard to the district court’s imposition of mental-health conditions.

Analysis

Precedents Cited and Their Influence

18 U.S.C. § 3583(d) and § 3553(a)(2)(D): Conditions of supervised release must be reasonably related to specified sentencing factors, impose no greater deprivation of liberty than necessary, and be consistent with Sentencing Commission policy statements. The opinion grounds its analysis in these statutory limits.
U.S.S.G. § 5D1.3(d)(5): The Sentencing Commission recommends a mental-health treatment condition only if the court has reason to believe the defendant needs psychological or psychiatric treatment. The panel found the record lacked any such reason, directly contravening this policy statement and thus § 3583(d)(3).
United States v. Paul, 274 F.3d 155 (5th Cir. 2001) and United States v. Vigil, 989 F.3d 406 (5th Cir. 2021): Both emphasize that special conditions must be reasonably related to § 3553(a) factors and not impose undue liberty deprivations. The court uses these as the doctrinal framework for scrutinizing the conditions here.
United States v. Salazar, 743 F.3d 445 (5th Cir. 2014) and United States v. Caravayo, 809 F.3d 269 (5th Cir. 2015): Salazar requires factual findings to justify special conditions; Caravayo allows appellate affirmation if reasoning can be inferred from the record. In Dubuisson, the PSR undercut any inference: it affirmatively stated there were no mental-health issues, and the court made no findings.
United States v. Alvarez, 880 F.3d 236 (5th Cir. 2018) and United States v. Gordon, 838 F.3d 597 (5th Cir. 2016): Alvarez holds that imposing a mental-health treatment condition without record support is clear and obvious error; both recognize the autonomy and stigma concerns that affect substantial rights and justify relief. These cases provide the template for vacatur here.
United States v. Prieto, 801 F.3d 547 (5th Cir. 2015): Supports the finding that unwarranted special conditions affect substantial rights because, but for the error, the defendant would not be subjected to them.
Puckett v. United States, 556 U.S. 129 (2009): Supplies the four-prong plain error test used to evaluate unpreserved claims; the court walks through these prongs in vacating the conditions.
Ripeness authorities—United States v. Magana, 837 F.3d 457 (5th Cir. 2016) and United States v. Isgar, 739 F.3d 829 (5th Cir. 2014): Establish that ripeness is jurisdictional and is reviewed de novo. A condition is ripe when its imposition is not contingent on future events.
United States v. Ellis, 720 F.3d 220 (5th Cir. 2013): Held that challenges to potential future medication/testing embedded within treatment conditions may be unripe if speculative. The panel distinguishes Ellis by the concrete imposition here of both treatment and a separate medication mandate.
United States v. Bree, 927 F.3d 856 (5th Cir. 2019): Notes that treatment and medication requirements are often bundled; the court vacated a bundled mental-health condition for lack of support. Dubuisson leverages this structural link to find the medication condition ripe.
United States v. Hall, No. 23-50082, 2023 WL 8184818 (5th Cir. Nov. 27, 2023) (unpublished): Found a standalone medication-condition challenge unripe when it was uncertain whether medication would ever be prescribed. The Dubuisson panel distinguishes Hall because here the medication mandate is “inextricably linked” to an improperly imposed mandatory treatment condition.

Legal Reasoning

The court proceeds in two stages—first addressing the substance of the treatment condition and then jurisdiction (ripeness) and merits of the medication condition.

1) Mental-health treatment condition (plain-error vacatur)

Failure to explain and lack of record support: The district court adopted the PSR wholesale but made no findings supporting a need for mental-health treatment. The PSR expressly recorded no mental or emotional problems. Although it recounted argumentative and accusatory behavior, the panel found that such “recalcitrance” does not, without more, justify a mental-health condition.
Policy-statement inconsistency: Because U.S.S.G. § 5D1.3(d)(5) recommends mental-health treatment only when the court has reason to believe the defendant needs it, imposing the condition notwithstanding a record that affirmatively denies such need violates § 3583(d)(3)’s requirement of consistency with Sentencing Commission policy statements.
Reasonable-relatedness and minimal-deprivation limits: Without evidence linking the condition to the nature of the offense, the defendant’s characteristics, deterrence, protection of the public, or effective provision of needed care (§ 3583(d)(1)), the condition cannot stand; moreover, the liberty intrusions (time, autonomy, stigma) are “greater than necessary” (§ 3583(d)(2); § 3553(a)(2)(D)).
Plain error satisfied: Under Puckett’s four-prong test:
- Clear or obvious error: Alvarez and related cases make clear that imposing treatment without explanation or support is error.
- Substantial rights: Prieto and Alvarez recognize that unwarranted treatment affects liberty and autonomy and would not have been imposed but for the error.
- Fourth prong (fairness/integrity): The stigma and autonomy concerns warrant correction, consistent with Gordon and Alvarez.

2) Medication condition (ripeness and merits)

Ripeness: Unlike in Hall or Ellis, where the possibility of future medication was speculative, Dubuisson’s case involved a mandatory treatment condition and a separate, contemporaneously imposed requirement to take all prescribed mental-health medications. The panel reasons that medication is functionally tethered to treatment: although treatment can occur without medication, medication typically cannot occur without treatment or physician involvement. Because the treatment condition is mandatory (and here unsupported), the linked medication mandate presents a sufficiently concrete risk of application to be ripe.
Merits: For the same reasons the treatment condition lacked record support and contravened § 5D1.3(d)(5) and § 3583(d), the medication condition—derivative of the unsupported treatment premise—also fails and is vacated.

3) Standard-of-review note

A footnote indicates Judge Jones would apply a clear-error standard to review the imposition of mental-health conditions. The per curiam, however, applies plain-error review because no objection was preserved at sentencing. The nuance underscores an ongoing debate about the degree of deference to district courts when factual predicates for special conditions are contested or undeveloped, especially where the PSR itself undercuts the predicate.

Impact

The opinion, while unpublished, materially clarifies Fifth Circuit practice in several ways:

Record-based justification is essential: District courts must ground mental-health special conditions in concrete, articulable findings supported by the record. Hostility, uncooperativeness, or accusatory statements—standing alone—do not equate to evidence of a mental-health need.
Policy-statement compliance is enforceable on appeal: The court operationalizes § 3583(d)(3) and U.S.S.G. § 5D1.3(d)(5) as meaningful constraints. PSR statements disclaiming mental-health issues weigh heavily against imposing treatment absent contrary evidence.
Ripeness for medication conditions: When a medication mandate is issued alongside a mandatory treatment condition that itself lacks record support, appellate ripeness is satisfied, and the medication condition rises or falls with the treatment condition. This distinguishes cases where medication is only a speculative possibility.
Autonomy and stigma matter: Echoing Alvarez and Gordon, the court emphasizes liberty and dignity interests implicated by compelled treatment/medication, reinforcing the “no greater than necessary” requirement.
Practical sentencing guidance:
- Probation officers should document concrete indicators of mental-health need (diagnoses, treatment history, expert evaluations) if recommending treatment or medication conditions.
- District courts should either make express findings or adopt specific PSR findings that actually support the condition; a blanket PSR adoption that disavows mental-health issues will not suffice.
- Defense counsel should preserve objections; even if not preserved, Dubuisson demonstrates that unsubstantiated mental-health conditions can be vacated on plain-error review.
- Government advocates should be prepared to link behavior to clinically relevant indicators or risk reversal.
Potential doctrinal friction: The dissent’s reference to a clear-error standard hints at possible future disputes about deferential review of factual predicates for special conditions, especially when the record is thin or equivocal.

Complex Concepts Simplified

Special conditions of supervised release: Tailored rules a defendant must follow after prison. They must relate to sentencing goals, be no more restrictive than necessary, and conform to Sentencing Commission policies.
“Reasonably related”: There must be a logical, evidence-based connection between the condition and statutory purposes like deterrence, public protection, or providing needed treatment.
U.S.S.G. § 5D1.3(d)(5): The Guidelines recommend imposing a mental-health treatment condition only if the court has reason to believe the defendant needs psychological or psychiatric care. Absent that, the condition is inconsistent with policy.
Plain error review: When a party fails to object at sentencing, the appellate court can still correct an error if it is obvious, affects the outcome, and seriously undermines the fairness or integrity of proceedings.
Ripeness: Courts decide only real, not hypothetical, disputes. A challenge is ripe if the condition is mandatory or the injury is sufficiently likely—not merely conjectural. When medication is mandated alongside required treatment, the risk of being medicated is concrete enough.

Conclusion

United States v. Dubuisson reinforces a clear message: mental-health special conditions of supervised release are not placeholders for judicial unease with a defendant’s demeanor. They require record-based justification, on-the-record findings, and adherence to Sentencing Commission policy statements. The opinion also clarifies that when a medication condition is bound up with an unsupported mandatory treatment requirement, the medication challenge is ripe and fails for the same reasons. Even as an unpublished disposition, Dubuisson offers a detailed roadmap for district courts, probation officers, and litigants: document need, explain the nexus to statutory goals, and tailor conditions to impose no greater deprivation than necessary. Failure to do so invites vacatur on appeal.