Rosemary MacDonald Houston was convicted of distributing methadone to Trina Bradford which resulted in Bradford’s death. 21 U.S.C. § 841(a)(1), (b)(1)(C). 1 Houston challenges the sufficiency of the evidence supporting her conviction, and particularly protests being held responsible for a death that she claims was an unforeseeable suicide. We conclude that the plain language of the statute establishes that although cause-in-fact must be proven, foreseeability is not an element of the crime, and that sufficient evidence supports the jury’s verdict as to the remaining elements. We have jurisdiction over this federal crime and affirm.
I
On October 15, 2001, Trina Bradford was found dead in her home on the Blackfeet Indian Reservation in Browning, Montana. Subsequent forensic investigation revealed that Bradford had numerous controlled substances in her blood and mine, including a lethal concentration of methadone. The methadone was determined to have come from a prescription bottle bearing the defendant’s name that was found at the scene of Bradford’s death.
Houston was indicted for distribution of a controlled substance resulting in death under § 841(a)(1) and (b)(1)(C). She was convicted after a jury trial and sentenced to 276 months imprisonment and five years of supervised release.
II
The Government was not required to prove that Bradford’s death was reasonably foreseeable by Houston in order to obtain the heightened minimum sentence authorized by § 841(b)(1)(C). The statute under which Houston was convicted makes it unlawful to “knowingly or intentionally ... distribute ... a controlled substance” and provides a heightened sentence “if death or serious bodily injury results from the use of such substance[.]” § 841(a)(1), (b)(1)(C). To obtain a conviction under § 841(a)(1), the Government was required to prove that 1) Houston knowingly delivered methadone to Trina Bradford and 2) Houston knew it was methadone or some other prohibited drug. To obtain the heightened minimum sentence described in § 841(b)(1)(C), the Government also had to prove that the methadone Houston delivered to Bradford actually caused Bradford’s death. The Government was not required to prove foreseeability as an element of the drug distribution crime.
The district court correctly instructed the jury as to the requirements for conviction under § 841(a)(1),
2
but its instruction regarding § 841(b)(1)(C) was in error.
3
A
Proximate cause is not a necessary element of every crime. Although we noted in
United States v. Main,
B
The addition of proximate cause as an element necessary for invoking the twenty-year minimum sentence described in § 841(b)(1)(C) is inconsistent with the statutory language, our circuit’s related precedent, and the conclusions of every other federal court of appeals to consider the issue.
We have previously considered whether foreseeability is required under another subsection, § 841(b)(l)(A)(ii), which imposes a twenty-year statutory minimum for possession of five kilograms or more of certain controlled substances. ,
United States v. Mesa-Farias,
Other circuits that have considered the question have reached the same conclusion.
See Soler, 275
F.3d at 152-53;
United States v. McIntosh,
The statute puts drug dealers and users on clear notice that their sentences will be enhanced if people die from using the drugs they distribute.... Where serious bodily injury or death results from the distribution of certain drugs, Congress has elected to enhance a defendant’s sentence regardless of whether the defendant knew or should have known that death would result.
C
Requiring that the death have been foreseeable before imposing the enhancement described in § 841(b)(1)(C) is inconsistent with the plain language of the statute and with our circuit’s prior treatment of § 841(b)(1). We therefore join our sister circuits in holding that proximate cause is
We find that the district court erred in instructing the jury otherwise. We nevertheless affirm Houston’s conviction because the district court’s error was harmless. It inured to the benefit of the defendant because it placed a higher burden of proof on the Government than is required by law. The error was without question harmless beyond a reasonable doubt on these facts; it did not affect Houston’s substantial rights. 28 U.S.C. § 2111; Fed.R.Crim.P. 52(a);
see Killian v. United States,
Ill
Houston challenges the sufficiency of the evidence supporting her conviction. We evaluate the sufficiency of the evidence supporting this conviction
de novo. United States v. Bucher,
In this case, the jury—through its guilty verdict—found that the Government proved all of the essential elements of the crime, and more, beyond a reasonable doubt. Although the district court incorrectly instructed the jury that it needed to find proximate cause, and not simply cause-in-fact, the jury necessarily reached the cause-in-fact inquiry in the course of concluding beyond a reasonable doubt that Houston’s actions were the proximate cause of Bradford’s death. Consequently, because the jury found all of the essential elements of the crime—1) that Houston sold methadone to Bradford, 2) that Houston knew that the substance she was selling was methadone (or some other controlled substance), and 3) that the methadone was the cause-in-fact of Bradford’s death—we can evaluate the sufficiency of the evidence without remanding to require that this case be retried with the correct instructions.
We find ample evidence to support the jury’s verdict. Several witnesses provided evidence in support of the first two elements. Bradford’s mother testified that Houston admitted to her that Houston sold methadone to Bradford for $2 per pill. Bradford’s sister testified that Houston confessed to selling forty methadone pills to Bradford shortly before Bradford’s death. Another witness testified that she saw Bradford and Houston together in the bathroom of Houston’s sister’s house; Houston had a bottle of prescription medication' and Bradford had “a bunch of money!.]” An emergency medical technician dispatched to Bradford’s home after Bradford’s body was discovered testified that she observed a bottle of prescription methadone bearing Houston’s name next to Bradford’s bed. From this evidence, a reasonable trier of fact could conclude that Houston knowingly delivered what she knew to be methadone to Bradford.
IV
Although the district court erred in requiring the jury to find proximate cause, the error favored the defendant by imposing additional burdens on the Government beyond what the statute requires. We find that sufficient evidence supported Houston’s conviction. The district court’s judgment is AFFIRMED.
Notes
. In the remainder of this Opinion, " § 841” refers to Title 21 of the United States Code, section 841.
. The district court properly instructed that:
In order for the defendant to be found guilty of this charge, the government must prove each of the following elements beyond a reasonable doubt: First, the defendant knowingly delivered methadone to Trina Bradford. Second, the defendant knew it was methadone or some other prohibited drug.
.Although the Government did not object to the district court's jury instruction below, we exercise our discretion to consider whether
. It is not completely clear that in instructing the jury that proximate cause was a necessary element, the district court was requiring the jury to determine that Bradford's death have been foreseeable to Houston. This is largely because the term proximate cause is not well defined.
See Blue Shield of Va. v. McCready,
. Because we recognize there may be some fact scenarios in which the distribution of a controlled substance is so removed and attenuated from the resulting death that criminal liability could not be imposed within the bounds of due process, we stop short of ascribing to the First Circuit’s "strict liability” language. Proof that the resulting death was actually caused by ingestion of the controlled substance knowingly distributed by the defendant is sufficient to increase the punishment for the unlawful distribution.
