United States v. Abraham Cruz, 757 F.3d 372

Cruz was convicted on two counts of threatening federal law-enforcement officers (18 U.S.C. §115) and found mentally incompetent to proceed to sentencing after BOP psychological evaluations diagnosing schizophrenia/bipolar disorder and recommending antipsychotic medication.
Government moved under Sell v. United States to authorize involuntary medication to restore competency for sentencing; BOP clinicians testified it was substantially likely medication would restore competency and Cruz refused medication.
District Court held a Sell hearing, applied the four Sell factors, and ordered forcible medication, finding the Government’s interest sufficiently important (relying on statutory maximums and the PSR’s Guidelines range) and that the other Sell factors were met by clear and convincing evidence.
Cruz did not meaningfully oppose at the hearing or file opposition to the motion per local rules; he later sought a stay and appealed, arguing the Government’s interest was not sufficiently important and raising preservation and PSR-related objections.
The Third Circuit reviewed for plain error (finding Cruz forfeited arguments by failing to timely oppose), adopted a mixed standard for Sell’s first factor (de novo legal review but clear-error for any underlying facts), and affirmed the District Court’s Sell order.

Issue	Plaintiff's Argument (Cruz)	Defendant's Argument (Govt.)	Held
Whether Sell permits involuntary medication to restore competency for sentencing	Sell applies only pre-trial; sentencing interest is weaker and cannot justify forcible medication	Government has an important interest in accurate, participatory sentencing (Booker/Guidelines); Sell principles extend to sentencing	Government can have an important interest in restoring competency for sentencing; affirmed
Seriousness of the offense for Sell first factor	§115 threats here are less serious than cases like Sell/Grape; Guidelines/PSR unreliable	Crimes carry 10-year max and PSR Guidelines range supports seriousness	Offenses are "serious" (statutory max and Guidelines both support)
Use of the PSR/Guidelines range to assess seriousness	PSR range premature/doesn’t account for mental-health departures; reliance was improper	PSR is a reasonable source; court may consider Guidelines range as part of seriousness analysis	Consideration of PSR/Guidelines was not reversible plain error; alternative statutory-max analysis independently supported result
Effect of potential future civil commitment on Government interest	Likely civil commitment would lessen Govt. interest (a Sell special circumstance)	Civil-commitment likelihood was unclear and did not undermine the Government’s interest	District Court’s finding of uncertainty about civil commitment was not clearly erroneous and did not materially diminish the Govt. interest

Sell v. United States, 539 U.S. 166 (2003) (sets four-factor test for involuntary medication to restore competency)
United States v. Grape, 549 F.3d 591 (3d Cir. 2008) (interprets Sell; assigns plenary review to first factor and clear-error to factual factors)
United States v. Dillon, 738 F.3d 284 (D.C. Cir. 2013) (applies mixed review to Sell’s first prong and reviews underlying facts for clear error)
United States v. Mikulich, 732 F.3d 692 (6th Cir. 2013) (adopts burden-shifting for defendant to show special circumstances undermining Government’s interest)
United States v. Wood, 459 F. Supp. 2d 451 (E.D. Va. 2006) (holds Government may seek involuntary medication to restore competency for sentencing under Booker-based sentencing interests)
United States v. Booker, 543 U.S. 220 (2005) (explains federal sentencing objectives and role of presentence information)
Washington v. Harper, 494 U.S. 210 (1990) (recognizes liberty interests implicated by involuntary medication)