United States v. Patel: Jointly Proposed Jury Instructions as Invited Error; No Double Counting When §2H1.1(b)(1) Adds Unaccounted “Color of Law” Harm to a §2A3.4-Derived Base Level

1. Introduction

Case: United States v. Rajesh Patel (11th Cir. Dec. 29, 2025) (per curiam) (not for publication).
Parties: United States (Plaintiff-Appellee) v. Dr. Rajesh Motibhai Patel (Defendant-Appellant).
Background: A patient, A.H., attended a veterans’ hospital appointment in 2020 for a pelvic examination and birth-control consultation. She reported that Dr. Patel turned off the lights, closed blinds, and engaged in contact with her genitalia (including “massag[ing] her clitoris” and inserting fingers multiple times) in a manner she perceived as non-medical and abusive. She promptly reported the incident.

Charges and convictions:

18 U.S.C. § 242 (deprivation of rights under color of law): depriving A.H. of her right to bodily integrity.
18 U.S.C. § 2244(b) (abusive sexual contact).

Appeal issues: Patel challenged (i) “fair warning”/notice under § 242; (ii) sufficiency of evidence on “legitimate medical purpose” and sexual intent; (iii) the jury instruction on bodily integrity; (iv) alleged Guidelines double counting in applying U.S.S.G. § 2H1.1(b)(1); and (v) substantive reasonableness of a 15-year supervised release term.

2. Summary of the Opinion

The Eleventh Circuit affirmed across the board. It held:

No plain-error basis to invalidate the § 242 count on “fair warning” grounds because Patel identified no statute, rule, or on-point precedent making the district court’s approach plainly erroneous.
Sufficient evidence supported both convictions that the genital contact lacked a legitimate medical purpose and was accompanied by the requisite sexual/abusive intent.
Jury-instruction challenge was unreviewable under invited-error doctrine because Patel proposed (jointly with the government) the instruction he later attacked.
No impermissible double counting in using § 2H1.1(a)(1) (borrowing a base offense level from § 2A3.4) and then enhancing under § 2H1.1(b)(1) for acting “under color of law,” because the base calculation did not fully account for that distinct harm.
No plain error in the 15-year supervised release term because Patel cited no controlling authority showing the district court’s weighing of public-protection considerations was plainly unreasonable on these facts.

3. Analysis

3.1. Precedents Cited

A. Plain error and “fair warning” in § 242 prosecutions

United States v. Innocent and United States v. Reed: The panel used these to set the review framework—because Patel did not move to dismiss in the district court, the appellate court applied plain-error review.
United States v. Laines, United States v. Moore, and United States v. Madden: These decisions supplied the familiar four-part plain-error architecture and emphasized that the appellant bears the burden to prove each element, including prejudice to substantial rights.
United States v. Sanchez and United States v. Hesser: These were decisive to the panel’s disposition: an error is not “plain” absent explicit statutory/rule language or “on point precedent from the Supreme Court or this Court.” Because Patel did not identify such authority resolving his notice/fair-warning claim, he could not satisfy the “plain” prong.
United States v. Hill (citing United States v. Lanier): These framed the substantive standard for § 242: criminal liability requires “fair warning” that the charged conduct violates a constitutional right. Lanier supplies the cross-doctrinal principle that due process notice is satisfied where the unlawfulness is made clear by constitutional text, statute, or precedent.
Conner v. Sticher: Cited for recognition of the bodily integrity right in this circuit’s Fourteenth Amendment jurisprudence.
Nix v. Franklin Cnty. Sch. Dist., County of Sacramento v. Lewis, T.W. ex rel. Wilson v. Sch. Bd. of Seminole Cnty., Fennell v. Gilstrap (and its “abrogated on other grounds by” note to Kingsley v. Hendrickson): Patel relied on these “shock the conscience”/Due Process cases to argue a lack of fair warning. The panel used them against him: each is fact-specific and not about sexual contact in medical care; none addressed fair warning; and Nix’s negligence limitation was irrelevant because Patel was indicted for willful conduct.

B. Sufficiency of evidence

United States v. Williams (citing United States v. Walker and United States v. Haile): These supplied the de novo sufficiency standard—view evidence and credibility choices in the government’s favor, reversing only if no reasonable factfinder could convict beyond a reasonable doubt.
United States v. Thompson: Used to reject Patel’s attack on A.H.’s testimony based on the passage of time; eyewitness testimony about observed facts can be credited by the jury.

C. Jury instructions and invited error

United States v. McLellan: Establishes that unpreserved jury-instruction challenges are normally reviewed for plain error.
United States v. Maradiaga (citing United States v. Harris): Controls here. If a defendant proposes the instruction, then challenges it on appeal, that is “a textbook case of invited error,” which forecloses review.
United States v. Bird: Closes Patel’s attempted escape hatch—jointly proposed instructions still constitute invited error by the defendant.

D. Guidelines “double counting”

United States v. Little (citing United States v. Dudley): Provides de novo review and the general definition of impermissible double counting.
United States v. Deleon (quoting Dudley): Supplies the key limitation: double counting is impermissible only when the same kind of harm has already been “fully accounted for” by another Guidelines provision.

E. Supervised release and substantive reasonableness (unpreserved)

United States v. Etienne (citing United States v. Moran): Provides that unraised substantive-reasonableness objections are reviewed for plain error, making controlling authority critical to obtaining relief.

3.2. Legal Reasoning

A. § 242 “fair warning” rejected under plain-error constraints

The panel’s reasoning is best understood as procedural and methodological rather than an affirmative “medical sexual misconduct always clearly violates due process” holding. Patel’s failure to litigate dismissal in the district court shifted the case into a demanding posture: plain error requires an appellant to point to controlling, on-point authority making the error obvious.

On the merits, the court emphasized that Patel’s relied-on Fourteenth Amendment cases were (i) fact-bound, (ii) not about sexual contact or medical examinations, and (iii) did not speak to fair warning. The opinion also undercut Patel’s attempt to analogize by noting Nix v. Franklin Cnty. Sch. Dist. addressed negligence, while the indictment alleged willfulness.

B. Sufficiency of evidence: “legitimate medical purpose” and intent inferred from context

The panel treated the case as a classic “competing narratives” trial: the jury had direct victim testimony plus expert evidence about medical norms.

Legitimate medical purpose: A.H.’s testimony described clitoral “massage” and repeated penetration. Experts testified clitoral rubbing is not part of a pelvic exam and that multiple insertions are unusual (typically once; twice only on rare occasions). From that, a reasonable jury could find the touching medically unnecessary.
Intent: The court accepted that intent could be inferred circumstantially: lights turned off, blinds closed, the nurse’s limited vantage point, Patel’s non-response to A.H.’s distress, and the nature/duration of the contact. That combination permitted an inference of intent “to abuse” or “arouse or gratify” sexual desire.

Importantly, the panel rejected Patel’s “time lapse” credibility attack as one for the jury, not appellate reweighing.

C. Invited error: proposing (even jointly) the instruction bars appellate review

The opinion applies an unforgiving but well-established doctrine: when the defendant affirmatively participates in the alleged instructional error—by proposing the language—appellate courts will not review the claim at all. The court emphasized that “jointly proposed” does not soften the doctrine; the defendant’s endorsement is enough.

D. No Guidelines double counting: § 2H1.1(a)(1) borrowing from § 2A3.4 does not “fully account for” color-of-law harm

Patel’s sentencing argument was that “under color of law” was used twice: once in the base offense level and again in the enhancement under U.S.S.G. § 2H1.1(b)(1). The panel’s answer turns on how the base level was actually computed.

The district court used U.S.S.G. § 2H1.1(a)(1), which instructs courts to borrow the offense level from the guideline applicable to the “underlying offense.” Here, the “underlying offense” guideline was U.S.S.G. § 2A3.4(a)(3) (abusive sexual contact), producing base level 12. The panel reasoned that neither § 2H1.1(a)(1) (as a borrowing mechanism) nor § 2A3.4 (as a sexual-contact guideline) “fully accounts for” the distinct harm of abusing official authority. Therefore, adding § 2H1.1(b)(1) was additive rather than duplicative under United States v. Deleon/United States v. Dudley.

E. Supervised release: no plain error without on-point authority

Patel argued the 15-year term was too long given age and the medical setting. The panel did not decide whether those facts would justify a different balance under abuse-of-discretion review; instead, it held Patel could not satisfy the “plain” prong because he offered no controlling authority showing the district court’s public-protection weighting was plainly unreasonable on these facts.

3.3. Impact

Appellate posture matters profoundly: The decision illustrates how plain-error review can be dispositive, particularly for § 242 “fair warning” theories and substantive-reasonableness challenges to supervised release.
Medical-setting sexual misconduct under § 242: Although unpublished, the case signals that attempts to defeat § 242 notice using generalized “shock the conscience” cases outside the medical/sexual context may fail—especially where the indictment alleges willfulness.
Instructional strategy risk: The invited-error holding reinforces a practical rule for trial counsel: jointly proposing (or accepting) an instruction may forfeit appellate review even if the language later appears vulnerable.
Guidelines clarity for civil-rights offenses with sexual misconduct: The double-counting analysis supports the view that a § 2A3.4-derived base level does not inherently capture the institutional/authority-abuse harm that § 2H1.1(b)(1) targets—making the enhancement comparatively resilient on appeal.

4. Complex Concepts Simplified

18 U.S.C. § 242 (“under color of law”): A federal crime when an official (or someone using official power) willfully violates a person’s constitutional rights. “Under color of law” means using authority derived from government position—here, the doctor’s authority in a federal/veterans’ hospital setting.
“Right to bodily integrity” (Due Process): A protected interest in freedom from unwanted physical intrusions, especially invasive contact. The opinion treats it as a Fourteenth Amendment due process right (as referenced via Conner v. Sticher).
“Fair warning”: Due process requires that a criminal defendant have adequate notice that conduct is criminal—usually shown through clear statutory language or precedent applying the law to similar conduct (United States v. Lanier).
Plain-error review: A narrow appellate safety valve used when an issue was not preserved below. Relief typically requires showing an obvious legal mistake under controlling authority plus prejudice.
Invited error: If you ask the court to do something (like give a particular instruction), you generally cannot later claim on appeal that the court erred by doing it.
Impermissible double counting (Sentencing Guidelines): Increasing punishment twice for the same harm. It is permissible to increase punishment for distinct harms even if they arise from the same episode (e.g., sexual contact harm versus abuse-of-authority harm).
Sufficiency of evidence: The appellate court does not re-try the case; it asks only whether a reasonable jury could convict, viewing evidence in the prosecution’s favor.

5. Conclusion

United States v. Patel is a procedurally driven affirmance that nonetheless delivers concrete doctrinal lessons: unpreserved challenges are hard to win without on-point authority; a defendant who proposes an instruction invites any error and forfeits review; and, in civil-rights sentencing, a § 2A3.4-based offense level does not necessarily “fully account for” the distinct harm of acting under color of law, permitting an additional § 2H1.1(b)(1) enhancement without impermissible double counting. In practical terms, the opinion underscores that trial-level preservation and careful instructional positions can be outcome-determinative on appeal, while also reinforcing the evidentiary sufficiency of combining victim testimony, expert medical norms, and circumstantial indicators of intent in medical sexual-contact prosecutions.