United States v. McKiver, 704 F. App'x 29

Defendant Jeffrey McKiver was arrested after NYPD officers found over 100 grams of heroin packaged for resale in his backpack following a stop on August 22, 2014.
McKiver pleaded guilty to distributing and possessing with intent to distribute over 100 grams of heroin in violation of 21 U.S.C. § 841(a)(1), (b)(1)(B), which carries a five‑year mandatory minimum.
The Probation Office and district court calculated a Guidelines range of 70–87 months (Offense Level 23, Criminal History IV).
At sentencing the district court imposed a below‑Guidelines sentence of 68 months’ imprisonment and five years’ supervised release.
McKiver appealed, arguing his sentence was substantively unreasonable because of inadequate medical care (fractured hand, sleep apnea, other conditions) and that supervised release should be four years as recommended by probation.
The Second Circuit affirmed, concluding the district court adequately weighed McKiver’s medical issues and 18 U.S.C. § 3553(a) factors and that the sentence was not shockingly high or otherwise unreasonable.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Substantive reasonableness of sentence	Government: district court properly exercised discretion and accounted for § 3553(a) factors	McKiver: sentence substantively unreasonable because his medical conditions received inadequate treatment and warranted a lower or non‑custodial sentence	Affirmed — sentence (68 months) is a permissible, individualized below‑Guidelines term; not the rare case warranting vacatur
Length of supervised release	Government: five years is within court’s discretion	McKiver: probation recommended four years; five years is excessive	Affirmed — McKiver failed to show five years is "shockingly high," so district court discretion stands

United States v. Cavera, 550 F.3d 180 (2d Cir. 2008) (establishes deferential abuse‑of‑discretion review for substantive reasonableness)
Gall v. United States, 552 U.S. 38 (2007) (standard for procedural and substantive reasonableness of sentences)
United States v. Rigas, 583 F.3d 108 (2d Cir. 2009) (vacatur of sentence only in rare cases: shockingly high/low or legally unsupportable)
United States v. McFarlin, 535 F.3d 808 (8th Cir. 2008) (district court may impose non‑custodial sentence for defendants with serious medical conditions)
Smith v. Carpenter, 316 F.3d 178 (2d Cir. 2003) (discussing remedies for inadequate medical care under 42 U.S.C. § 1983)
Jiminian v. Nash, 245 F.3d 144 (2d Cir. 2001) (discussing habeas relief under 28 U.S.C. § 2241)