Compassionate Release for Terminal Illness & Serious Medical Conditions

By Elizabeth Franklin-Best, Esq., and Christopher Zoukis, JD, MBA

Can a federal inmate get compassionate release for a serious medical condition?

Yes, in defined circumstances. 18 U.S.C. § 3582(c)(1)(A) lets a federal judge reduce a sentence for “extraordinary and compelling reasons,” and USSG § 1B1.13(b)(1) recognizes four medical paths: terminal illness; a condition that substantially diminishes self-care in prison; long-term or specialized care not being provided; and an infectious-disease outbreak or declared public health emergency. A diagnosis alone is not enough.

Key takeaways on the medical-condition ground

• No specific life-expectancy prognosis is required for a terminal-illness claim. USSG § 1B1.13(b)(1)(A) says so in terms: “A specific prognosis of life expectancy … is not required.” If a facility tells your family otherwise, it is describing BOP’s internal referral screen, not the standard the judge applies.
• The BOP’s policy wording now tracks the guideline, but its screen is still its own. PS 5050.51 (September 3, 2026) dropped PS 5050.50’s 18-month life-expectancy test and its bed-or-chair tests and now uses the guideline’s end-of-life and self-care language. The Bureau applies that language through its own Compassionate Release Clinical Guidance, which it does not publish, and its care-not-provided category asks what the Bureau can provide “without undue hardship, prohibitive costs, or significant disruption.” A warden’s denial is not a legal verdict on the motion.
• Self-care is where these motions are won and lost. In fiscal year 2025, courts cited insufficient proof of a serious medical condition 352 times and “able to provide self-care in prison” 260 times as reasons for denial (USSC FY2025 Compassionate Release Data Report, Table 11).
• Medical grounds carry more of these motions than any other category. Among the 631 reasons courts gave for the 394 grants in FY2025, serious physical or medical condition was cited 71 times and terminal illness 28 times (USSC FY2025 Data Report, Table 10).
• COVID-19 as a stand-alone theory is finished. It was cited 1,304 times as a granting rationale in FY2020 and 3 times in FY2025. The infectious-disease provision survives, but it now requires an ongoing outbreak or declared emergency and three conjunctive elements.
• A family member can submit the BOP request, but cannot file the court motion. 28 C.F.R. § 571.61(b) requires the Bureau to process a request made by another person “in the same manner as an inmate’s request,” and 18 U.S.C. § 3582(d)(2) requires the BOP to tell the attorney, partner, and family that they may do so after a terminal diagnosis.
• The 2026 Supreme Court decisions left the medical grounds intact. Fernandez describes “age, illness, a child left with no guardian” as the statute’s heartland.

Medical Conditions That May Support Federal Compassionate Release

This matrix maps each recognized medical category to the guideline provision that governs it, the records that usually carry it, and the caveat that most often defeats it. No category is automatic. Every one requires an individualized showing, and every one requires the request to the warden first.

Condition category	Governing provision and what it requires	Typical supporting records	Key caveat
Terminal illness	§ 1B1.13(b)(1)(A) — “a serious and advanced illness with an end-of-life trajectory.” The guideline’s own examples are metastatic solid-tumor cancer, ALS, end-stage organ disease, and advanced dementia. “A specific prognosis of life expectancy … is not required.”	BOP oncology or specialty consultation reports; staging and imaging in the electronic health record; the Clinical Director’s terminal diagnosis (which starts the § 3582(d)(2)(A) clocks); any hospice or end-of-life care authorization; outside specialist notes obtained on a signed BP-A0621 release	Not automatic. The court still makes a separate danger finding under § 1B1.13(a)(2) and still weighs the § 3553(a) factors. Terminal illness was cited in only 28 of the 631 reasons given for FY2025 grants
Advanced serious disease (non-terminal)	§ 1B1.13(b)(1)(B)(i) — “a serious physical or medical condition” that “substantially diminishes the ability of the defendant to provide self-care within the environment of a correctional facility and from which he or she is not expected to recover”	Chronic care clinic (CCC) encounter notes, which PS 6031.06 requires at least every six months at Care Level 3 and every three months at Care Level 4; medication administration records; labs and diagnostics; the BOP Care Level assignment and every revision of it	Severity alone is not the test — non-recovery plus diminished self-care is. This was the most-cited medical ground in FY2025 (71 citations) and also the most-cited failure: 352 denials for insufficient proof of a serious condition
Severe functional impairment	§ 1B1.13(b)(1)(B)(ii) — “a serious functional … impairment,” measured against self-care in a correctional facility	Activities of Daily Living assessments; the Medical Duty Status (MDS) form in the electronic health record, with work restrictions and any medical hold; assistive-device authorizations; lower-bunk, lower-tier, and ADA housing accommodations; inmate-companion assignments	Only 4 of the 631 FY2025 granting reasons cited serious functional or cognitive impairment, and 15 denials cited insufficient proof of it. BOP’s own guidance states that “[t]he need for a wheelchair or assistance in pushing a wheelchair are not care level criteria” — so a wheelchair, standing alone, proves little
Cognitive decline	§ 1B1.13(b)(1)(B)(ii) — “a serious … cognitive impairment”; advanced dementia is also named as a terminal-illness example under (b)(1)(A)	Neuropsychological or cognitive testing in the record; Psychology Services encounters; documented disorientation, wandering, or medication non-compliance in unit or Health Services notes; a Care Level change tied to cognition; declarations from family describing calls and visits over time	Cognitive claims are the hardest to document from inside, because the institution rarely tests for what the guideline asks about. Assume the record does not yet contain the proof and that an independent evaluation will be needed
Inability to provide self-care	The operative element of all of § 1B1.13(b)(1)(B), and the element courts actually rule on. BOP defines Activities of Daily Living as “eating, urinating, defecating, bathing, and dressing/undressing”	The BOP Care Level Classification guidance functional criteria — independent, needs assistance from an inmate companion, or needs assistance from a health care staff member; nursing notes; the Care Level 4 / Medical Referral Center designation if one exists	“Able to provide self-care in prison” was cited 260 times as a denial reason in FY2025. Write the motion in the institution’s own functional vocabulary, ADL by ADL, or the court will find self-care intact
Other extraordinary medical conditions	§ 1B1.13(b)(1)(C) — care “that is not being provided and without which the defendant is at risk of serious deterioration in health or death”; § 1B1.13(b)(1)(D) — outbreak or declared emergency; § 1B1.13(b)(5) — other circumstances “similar in gravity”	The gap itself: the approved consultation never scheduled, the surgery approved and never performed, the CCC visit missed against the interval PS 6031.06 requires, the referral canceled on transfer; every Inmate Request to Staff and administrative remedy asking for the care; an independent physician’s opinion tying the gap to risk	(C) does not require the condition to be terminal or disabling — but delay alone is not enough. Rodriguez-Mendez (8th Cir. 2026) affirmed a denial where care was being provided, pain was medication-managed, and surgery was not currently needed. Only 12 of the 631 FY2025 granting reasons cited BOP’s failure to treat

What USSG § 1B1.13(b)(1) Actually Says, Subsection by Subsection

The Sentencing Commission’s policy statement is the operative text. It lists four medical circumstances, and the preamble to § 1B1.13(b) says extraordinary and compelling reasons exist “under any of the following circumstances or a combination thereof.” That last clause matters: a case that is thin under one subsection can be built from two.

(A) Terminal illness — and the six-month myth

§ 1B1.13(b)(1)(A) covers a defendant “suffering from a terminal illness (i.e., a serious and advanced illness with an end-of-life trajectory).” The next sentence is the one families need: “A specific prognosis of life expectancy (i.e., a probability of death within a specific time period) is not required.” The guideline then gives examples — “metastatic solid-tumor cancer, amyotrophic lateral sclerosis (ALS), end-stage organ disease, and advanced dementia.”

That definition tracks the statute. 18 U.S.C. § 3582(d)(1) defines “terminal illness” for First Step Act purposes as “a disease or condition with an end-of-life trajectory” — no number attached.

So where does the six-month figure families keep hearing come from? Not from federal compassionate release law — it appears nowhere in § 3582, in § 1B1.13, or in BOP’s compassionate release policy. It is the certification threshold for the Medicare hospice benefit, which requires a physician to certify “a life expectancy of 6 months or less if the terminal illness runs its normal course” (42 C.F.R. § 418.22(b)(1)). It is a familiar number inside a correctional health setting, and it gets repeated as though it governed here. It does not. The number that does appear in BOP policy is 18 months, and that figure lives in the Bureau’s internal referral screen, not in the guideline the judge applies. Both are addressed below.

One more point on (A). The guideline gives examples, not a closed list. Nothing in the text limits terminal illness to the four named categories, and the operative phrase is “end-of-life trajectory.”

(B) Serious condition, impairment, or aging-related decline that diminishes self-care

This is the workhorse provision and the one most medical motions actually run on. § 1B1.13(b)(1)(B) reaches a defendant who is:

• “(i) suffering from a serious physical or medical condition,”
• “(ii) suffering from a serious functional or cognitive impairment, or”
• “(iii) experiencing deteriorating physical or mental health because of the aging process,”

“that substantially diminishes the ability of the defendant to provide self-care within the environment of a correctional facility and from which he or she is not expected to recover.”

Read that closing clause twice, because it contains two independent requirements and both must be met. First, the condition must substantially diminish the ability to provide self-care in a correctional setting — not at home, not in the abstract, but inside the facility where this person actually lives, with its stairs, its distances, its pill lines, and its meal schedule. Second, recovery must not be expected. A serious condition that is expected to resolve does not fit here, however frightening it is right now.

The self-care element is not a formality. It is the specific finding courts make against movants 260 times a year. A motion that proves a severe diagnosis and stops has answered the wrong question.

Aging-related decline under (iii) overlaps with the separate age category at § 1B1.13(b)(2), which requires age 65 or older plus serious deterioration from aging plus at least 10 years or 75% of the sentence served, whichever is less. The difference is important: (b)(1)(B)(iii) has no age floor and no time-served requirement. Someone who fails the age category on time served may still qualify under the medical category. For the age route in full, see age-based compassionate release.

(C) Long-term or specialized care that is not being provided

§ 1B1.13(b)(1)(C) reaches a defendant “suffering from a medical condition that requires long-term or specialized medical care that is not being provided and without which the defendant is at risk of serious deterioration in health or death.”

This provision is aimed at the Bureau’s failure to treat, and it is structurally different from (A) and (B): it does not require the condition to be terminal, and it does not require diminished self-care. A person who is functioning fine today but is not getting the care that keeps them functioning can fit here.

It is also harder than it looks. The Eighth Circuit’s published decision in United States v. Rodriguez-Mendez, No. 24-2854 (8th Cir. Mar. 9, 2026), is the clearest recent illustration and it is worth stating candidly. The record there included severe spinal stenosis, two ineffective injections, wheelchair use, an almost five-month wait for a neurosurgery consultation after a transfer, MRIs that went stale before a follow-up, and months of delay in seeing a physical therapist. The court still affirmed the denial, on both halves of the provision. On the first half, the prison had provided injections and physical therapy, the medication managed the pain, and surgery was not currently required — and the movant’s own expert had said the care received was appropriate. On the second half, that same expert would not opine that the delays had caused harm.

The lesson is not that (C) is hopeless. It is that (C) has two elements, and the second one — risk of serious deterioration or death without the missing care — has to be proved by someone qualified to say it. The panel also noted that courts applying the amended policy statement have not treated “mere delay” as a denial of care.

Applied Insight — Elizabeth Franklin-Best, Esq., Principal Attorney: A (C) claim is not a complaint about the prison. It is a two-part evidentiary showing, and most filings prove only the first part. The first part is documentary and it is the easier one: the order entered, the referral approved, the appointment date that came and went, the transfer that reset the queue. The second part is the one that decides the motion — what happens to this person if the missing care keeps not arriving. No BOP record answers that question, because the Bureau has no reason to write it down. That answer has to come from a physician who has reviewed the whole chart and is willing to say, in writing, what the untreated condition does over the next twelve months. If the reviewing physician will not say it, the motion is not ready, and the honest thing is to say so before it is filed rather than after it is denied.

(D) Infectious-disease outbreak or declared public health emergency

§ 1B1.13(b)(1)(D) sets out three requirements, joined by “and,” so all three must be met:

1. The defendant “is housed at a correctional facility affected or at imminent risk of being affected by (I) an ongoing outbreak of infectious disease, or (II) an ongoing public health emergency declared by the appropriate federal, state, or local authority”;
2. “due to personal health risk factors and custodial status, the defendant is at increased risk of suffering severe medical complications or death as a result of exposure” to that outbreak or emergency; and
3. “such risk cannot be adequately mitigated in a timely manner.”

The practical state of this provision is that it is nearly dormant. COVID-19 was cited as a reason for granting relief 1,304 times in FY2020 and 3 times in FY2025 (USSC Compassionate Release Data Reports, Table 10 of each). “Not at risk from COVID” was still cited 191 times as a denial reason in FY2025.

Two Seventh Circuit decisions explain why the third element usually fails. In United States v. Broadfield, 5 F.4th 801 (7th Cir. 2021), the court held that “for the vast majority of prisoners, the availability of a vaccine makes it impossible to conclude that the risk of COVID-19 is an ‘extraordinary and compelling’ reason for immediate release,” while preserving the case of “[a] prisoner who can show that he is unable to receive or benefit from a vaccine.” United States v. Kurzynowski, 17 F.4th 756 (7th Cir. 2021), applied that rule to hold a vaccinated movant ineligible on a COVID theory. Both predate the November 1, 2023 rewrite of § 1B1.13, and the guideline text above is now what governs — but the mitigation point they make is exactly what element three asks.

If an outbreak is the reason for a motion today, the ordinary path is to plead it alongside (b)(1)(B) or (C) rather than on its own.

Why BOP Says No and the Court Still Says Yes

This is the divergence that costs families the most, and almost no page on the internet states it plainly.

When you submit a request to the warden, the Bureau evaluates it against its own internal policy. Since September 3, 2026 that is Program Statement 5050.51, which lists five medical situations in § 4: terminal illness, debilitation, elderly people with medical conditions, infectious disease, and other extraordinary medical circumstances. The two used most read:

• Terminal medical condition. Inmates “diagnosed with a terminal, incurable disease (i.e., a serious and advanced illness with an end-of-life trajectory) as determined pursuant to the Compassionate Release Clinical Guidance issued by the Medical Director” (§ 4.a, p. 4).
• Debilitated medical condition. An inmate suffering from “(i) a serious physical or medical condition; or (ii) a serious functional or cognitive impairment; from which the inmate is not expected to recover, and which substantially diminishes the inmate’s ability to provide self-care within the correctional environment” (§ 4.b, p. 5).

Now compare that with § 1B1.13(b)(1). The words now largely match. The policy PS 5050.51 replaced, PS 5050.50, screened terminal cases at a life expectancy of “eighteen (18) months or less” and debilitated cases by whether the person was “totally confined to a bed or chair” or confined to one “more than 50% of waking hours”; those tests are gone. What still differs is who applies the words and by what yardstick: the Bureau decides terminal and debilitated status under its own Clinical Guidance, and the Director may decline to file even when a category is met. The guideline asks whether the illness has an end-of-life trajectory, or whether the condition substantially diminishes self-care and is one from which recovery is not expected, or whether needed care is not being provided.

The question	BOP’s internal screen (PS 5050.51)	The court’s test (USSG § 1B1.13(b)(1))
Terminal illness	“A terminal, incurable disease (i.e., a serious and advanced illness with an end-of-life trajectory),” judged under the Bureau’s unpublished Compassionate Release Clinical Guidance (§ 4.a). The former 18-month figure is gone	“A serious and advanced illness with an end-of-life trajectory.” “A specific prognosis of life expectancy … is not required”
Debilitation	A serious physical or medical condition, or a serious functional or cognitive impairment, that “substantially diminishes the inmate’s ability to provide self-care within the correctional environment,” with no recovery expected (§ 4.b). The bed-or-chair tests are gone	A condition that “substantially diminishes the ability … to provide self-care within the environment of a correctional facility” and from which recovery is not expected
Care not being provided	Care that “cannot be provided in the Bureau without undue hardship, prohibitive costs, or significant disruption to the safe and orderly running of the institution,” without which the person is at risk of serious deterioration or death (§ 4.e)	An independent ground under (b)(1)(C) — no terminal illness and no disability required
Who decides	Warden → Office of General Counsel → Medical Director → Director (28 C.F.R. § 571.62(a))	The federal district judge who imposed the sentence
What the outcome means	Whether the BOP Director will file a motion. A General Counsel or Director denial “constitutes a final administrative decision” (28 C.F.R. § 571.63(b)–(c))	Whether the sentence is reduced

The Fourth Circuit put the relationship correctly in United States v. Hargrove, 30 F.4th 189 (4th Cir. 2022), describing PS 5050.50 as “the BOP’s internal guidance” and holding that the extraordinary-and-compelling inquiry “is multifaceted and must take into account the totality of the relevant circumstances.” Hargrove affirmed a denial, but the framing is what matters: courts weigh an array of factors, “not just to the single question of whether a medical condition or a group of medical conditions ‘might increase [an inmate’s] risk.'” A single condition considered in isolation is not the analysis. Hargrove was decided in March 2022, before the November 2023 rewrite of § 1B1.13 made the policy statement applicable to defendant-filed motions, so read its discussion of the guideline’s status with that date in mind — the totality-of-circumstances holding is what survives and what courts apply.

The First Circuit added a related limit in United States v. Quirós-Morales, 83 F.4th 79 (1st Cir. 2023), vacating a denial of a compassionate release motion and holding, in footnote 4, that “no such categorical bar currently exists” tied to the seriousness of the offense of conviction — though the gravity of the offense remains relevant to the judge’s discretion. The same decision addresses a second error that medical movants encounter, discussed below: treating a thin medical showing as ending the case as a matter of law.

Applied Insight — Christopher Zoukis, JD, MBA, Managing Director: The most common thing I hear from a family is that the counselor said their person “doesn’t meet the criteria.” That sentence is usually accurate and almost always misunderstood. The criteria the counselor is applying are the ones in the Bureau’s own policy — until September 2026, 18 months, bed or chair, 50% of waking hours; now PS 5050.51 and the Medical Director’s clinical guidance — because that is the screen staff are trained on and the one that governs whether the Director files. Those criteria are not what the judge applies, and a warden’s denial does not decide the motion. What the warden’s denial actually does is far more useful than most families realize: it satisfies the request requirement and opens the courthouse door. Treat the request to the warden as the first draft of the motion, submit it with the complete records attached, and read a denial as the start of the case rather than the end of it.

How the Bureau of Prisons Handles a Medical Compassionate Release Request

Understanding the internal process tells you what to submit and what to expect back.

Where the request goes. 28 C.F.R. § 571.61(a) requires the request to be submitted to the warden, ordinarily in writing, and to contain at minimum (1) the extraordinary or compelling circumstances relied on and (2) “[p]roposed release plans, including where the inmate will reside, how the inmate will support himself/herself, and, if the basis for the request involves the inmate’s health, information on where the inmate will receive medical treatment, and how the inmate will pay for such treatment.” For a medical request, the treatment plan is not optional detail — the regulation names it. Someone in a residential reentry center or on home confinement sends the request to the Residential Reentry Manager, who counts as the warden for this purpose (PS 5050.51 § 3, p. 3).

Who can submit it. 28 C.F.R. § 571.61(b) provides that the Bureau “processes a request made by another person on behalf of an inmate in the same manner as an inmate’s request,” and directs that a request received at Central Office be referred to the warden of the institution where the person is confined. So a spouse, a parent, an adult child, or an attorney may submit the BOP request. Only the defendant or the BOP Director may file the motion in court.

Who reviews it. 28 C.F.R. § 571.62(a) sets the chain: the warden, then the Office of General Counsel, then the Medical Director for medical referrals, then the Director of the Bureau of Prisons. PS 5050.51 § 9 lists the factors staff must consider at every level — offense conduct, criminal history, victim comments, unresolved detainers and pending charges, supervised release or probation violations, institutional adjustment, disciplinary infractions, personal history from the presentence report, length of sentence and time served, current age, age and health at the time of the offense and sentencing, release plans, any pertinent statement or ruling by the sentencing court (including how far it accounted for age or health), and “[w]hether release would minimize the severity of the offense.”

How fast it is supposed to move. 28 C.F.R. § 571.62(c) provides that “[i]n the event the basis of the request is the medical condition of the inmate, staff shall expedite the request at all levels.” That is a real directive and worth quoting in the request itself. But note what is missing: no regulation sets a deadline for the warden’s decision or for General Counsel review. The only enforceable clock in the entire process is the statutory 30 days in 18 U.S.C. § 3582(c)(1)(A).

What a denial opens. Only a warden’s denial routes into the administrative remedy process — 28 C.F.R. § 571.63(a) directs the person to appeal through 28 C.F.R. part 542, subpart B (informal resolution, commonly called the BP-8, then the BP-9, BP-10, and BP-11). A denial by the General Counsel or by the Director “constitutes a final administrative decision” and is not appealable that way. For the full mechanics, see compassionate release request to warden.

What Evidence Proves a Medical Compassionate Release Case

The two largest medical denial lines describe evidentiary failures, not legal ones. Build the record against those two findings specifically. Medical continuity is the part of the plan that most often decides a medical motion — see the compassionate release plan.

The clinical record, complete rather than summarized

Request the entire BOP health record, not the printout a unit team will hand over. That means:

• Chronic care clinic (CCC) encounter notes. PS 6031.06 § 12 requires that a physician evaluate every CCC-enrolled inmate at least once every 12 months, that Care Level 4 inmates be seen by a physician or advanced practice provider every three months, and that Care Level 3 inmates be seen every six months. Those intervals are a measuring stick: a gap wider than the policy requires is documentary evidence, and it is evidence the institution created itself.
• Comprehensive medical evaluations. PS 6031.06 § 4.e defines a comprehensive medical evaluation as “a thorough history, physical examination, review of diagnostic reports, formulation of an active problem list, and development of a treatment plan,” captured through a History & Physical, a 14- or 30-day encounter, or a CCC encounter. The “active problem list” is the single most useful page in the chart.
• Consultation reports. Specialist consultations are scanned into the electronic health record; the referral, the approval, the appointment, and the report are separate artifacts and you want all four.
• Imaging and laboratory results, with dates, so that staleness is visible.
• Medication administration records, which show both what was prescribed and whether it was actually delivered.
• Health Services clinical encounters and sick call, which show what the person reported and when.

The institutional documents that describe function, not diagnosis

Diagnosis proves the condition. Function proves the self-care element, and function is what § 1B1.13(b)(1)(B) actually asks about. These BOP documents speak that language:

• Care Level assignment. BOP’s Care Level Classification guidance sorts inmates into four levels. Care Level 3 covers people with “complex, and usually chronic” conditions who “may require assistance with some activities of daily living (ADLs) that can be accomplished by inmate companions.” Care Level 4 covers people who need a Medical Referral Center, where “[f]unctioning may be so severely impaired as to require 24-hour skilled nursing care or nursing assistance.” A Care Level change over time is a functional trend line drawn by the Bureau’s own clinicians. PS 6031.06 requires institutions to review and update care levels “at every comprehensive medical evaluation encounter.” For background on what the levels mean and which institutions hold them, see medical care levels in federal prison and federal medical centers.
• Activities of Daily Living. BOP defines ADLs as “eating, urinating, defecating, bathing, and dressing/undressing,” and classifies functional ability into three groups: “[i]ndependent, no assistance is required”; “[a]ssistance from an inmate companion is required”; and “[a]ssistance from a health care staff member is required.” Those three tiers are the vocabulary to write the motion in. Note the same guidance’s warning that “[t]he need for a wheelchair or assistance in pushing a wheelchair are not care level criteria” — so a wheelchair alone does not carry the showing, and a motion that leans on it will not persuade.
• Medical duty status and work restrictions. The Medical Duty Status (MDS) form lives in the electronic health record and is where restrictions and medical holds are recorded. PS 6031.06 § 6.f describes when a medical hold is placed — including approval for surgery within 60 days, recent surgery requiring follow-up, and treatment that must be completed before transfer to a residential reentry center or home confinement.
• Assistive devices and housing accommodations. Lower bunk and lower tier passes, wheelchair or walker authorizations, shower chairs, and ADA housing assignments are each an institutional admission about function.
• Inmate companion assignments. If the Bureau has assigned someone to help this person with ADLs, that is the institution telling the court that self-care is diminished.

For a (C) claim, the gap in care is the evidence

Where the theory is that needed care is not being provided, build a dated timeline and let it do the arguing:

• the order or referral that was entered, and by whom;
• the approval, if there was one;
• every appointment scheduled, canceled, rescheduled, or never set;
• the transfer that reset the queue;
• diagnostics that expired before a follow-up;
• the CCC interval PS 6031.06 required, alongside the interval that actually occurred;
• every Inmate Request to Staff and every administrative remedy asking for the care, with dates and responses.

Then close it with the element Rodriguez-Mendez found missing: what happens to this person if the care keeps not arriving. That is the physician’s job, not the timeline’s.

The independent physician’s review

An outside physician’s review of the complete record does work no BOP document does. Ask it to address, in writing: the diagnosis and stage; whether recovery is expected; the specific ADLs the person cannot perform without assistance in a correctional environment; what care the condition requires; whether that care is being provided; and what the consequences are if it is not. Where cognition is at issue, formal testing usually has to be arranged, because the institution rarely runs it on its own.

A note on the record you build: PS 6031.06 provides that when an inmate is alert and oriented, they have the right to decide with whom to share medical information, and “may elect to request copies of portions or the entire medical record to be sent to the next of kin or other outside entity provided there is a signed release of medical information completed on BP-A0621, Authorization for Release of Medical Records.” That form is how the chart reaches the outside physician. It also provides that a visiting outside provider will execute the same form and that “[t]he Bureau physician should freely” share the record.

How to actually get the records

• While incarcerated: the person completes an Inmate Request to Staff (BP-A0148) addressed to the Health Services Administrator to review or receive copies of the health record (PS 6090.04, Health Information Management § 3.a). Health Services reviews first for security concerns and logs what was released and what was withheld.
• Fees: $0.10 per page for duplication; no charge for reviewing the record; and no fee is collected at all if the total is $14.00 or less (PS 6090.04 § 3.c).
• If records are withheld: the person is given the administrative note denying release and may file a Freedom of Information Act request with the Office of General Counsel’s FOI Section at Central Office, which the Regional Counsel’s office then processes (PS 6090.04 § 3.a).
• After release or in a residential reentry center: the request goes to Central Office in writing, with a signature that is notarized or made under penalty of perjury, and is routed back through the Regional Office to the last institution (PS 6090.04 § 3.b).
• To send records to family or counsel: BP-A0621, above.

Start this early. The records arrive slower than the illness moves.

Applied Insight — Christopher Zoukis, JD, MBA, Managing Director: Write the motion in the institution’s vocabulary, not the family’s. A family will say “he can’t take care of himself anymore,” which is true and proves nothing. The Bureau’s own classification guidance sorts people into three functional tiers — independent, needs help from an inmate companion, needs help from health care staff — and defines the activities of daily living as eating, urinating, defecating, bathing, and dressing. Go through that list one item at a time and say, for each, what this person can still do alone, what they need help with, and who provides the help today. Then attach the Care Level assignment, the duty status restrictions, and the housing accommodation. When the Bureau’s own paperwork already says a person needs assistance with ADLs, the court is not being asked to take the family’s word for anything. That is a different filing from one built on outside letters.

What the Data Shows About Medical Compassionate Release

Numbers, not adjectives. All figures below come from the U.S. Sentencing Commission’s fiscal year 2025 Compassionate Release Data Report, published May 2026.

Reasons courts gave for granting. Courts granted 394 motions in FY2025 and gave 631 reasons for those grants, because a court may cite more than one (Table 10):

Medical rationale cited by the court	Guideline provision	Citations in FY2025	Share of all 631 reasons
Serious physical or medical condition	§ 1B1.13(b)(1)(B)	71	11.3%
Terminal illness	§ 1B1.13(b)(1)(A)	28	4.4%
BOP failure to provide treatment	§ 1B1.13(b)(1)(C)	12	1.9%
Deteriorating health due to aging	§ 1B1.13(b)(1)(B)(iii)	11	1.7%
Serious functional or cognitive impairment	§ 1B1.13(b)(1)(B)(ii)	4	0.6%
COVID-19	§ 1B1.13(b)(1)(D)	3	0.5%

Add those and the medical family accounts for 129 of the 631 reasons courts gave — more than any other single category of ground. The first half of fiscal year 2026 looks similar: serious physical or medical condition was cited 27 times among 199 reasons given for 125 grants, and BOP’s failure to provide treatment 9 times (FY2026 Q1–Q2 Report, Table 10).

Reasons courts gave for denying. Courts denied 2,401 motions in FY2025 and gave 5,067 reasons (Table 11):

Medical reason cited for denial	Citations in FY2025
Insufficient proof of a serious physical or medical condition	352
Able to provide self-care in prison	260
Not at risk from COVID-19	191
Insufficient proof of deteriorating health	66
Insufficient proof of functional or cognitive impairment	15

Those first two lines are the entire medical fight. They are not findings that the law is unfavorable — they are findings that the record was thin. That is why the evidence section above is the longest one on this page.

For context, the largest denial category overall is not medical at all: the § 3553(a) sentencing factors, cited 1,260 times. And failure to exhaust administrative remedies was cited 447 times, which is a paperwork failure that a request to the warden prevents.

The COVID collapse. As a share of all granting rationales, COVID-19 fell from 61.6% in FY2020 (1,304 citations) to 52.4% in FY2021, 20.7% in FY2022, 7.8% in FY2023, 3.3% in FY2024, and 0.5% in FY2025 (3 citations). Any page still framing medical compassionate release as a pandemic remedy is five years out of date.

Where the motion is filed still matters more than most families expect. In FY2025 the national grant rate was 14.1% (394 of 2,795), but it ranged from 31.0% in the Ninth Circuit to 4.9% in the Eighth (Table 3). The motion goes to the court that imposed the sentence, so this is fixed by where the case was prosecuted, not by where the person is imprisoned now. For one of the tougher regions, see compassionate release texas.

Diagnosis Is Not Eligibility: Where Medical Motions Fail

A serious diagnosis is the beginning of the analysis, not the end of it. Five gaps account for most medical denials. A documented illness still has to survive the sentencing factors — see the 3553(a) factors.

The self-care gap. The motion proves the condition and never addresses whether the person can still bathe, dress, eat, and move through the facility. Two hundred sixty denials a year turn on exactly this.

The recovery gap. § 1B1.13(b)(1)(B) requires a condition “from which he or she is not expected to recover.” A severe but treatable condition does not fit, and the motion has to say why this one is different.

The causation gap in (C) claims. Delay is documented; consequence is not. That is precisely the hole Rodriguez-Mendez identified.

The furlough answer. Application Note 1 to § 1B1.13 provides that a reduction “is not appropriate when releasing the defendant under 18 U.S.C. § 3622 for a limited time adequately addresses the defendant’s circumstances.” A motion built entirely around a single procedure or a single family visit invites the government to propose a furlough instead. See temporary release: furlough requests.

The half-finished motion. Even a clean medical showing leaves two findings unmade. USSG § 1B1.13(a)(2) requires the court to find the defendant “is not a danger to the safety of any other person or to the community, as provided in 18 U.S.C. § 3142(g),” and § 3582(c)(1)(A) requires consideration of the § 3553(a) factors. Medical decline often helps on both — a person who needs help bathing is a different risk profile than the one the judge sentenced — but only if the motion makes the argument. How individual judges weigh those factors is its own subject: see what do judges consider when sentencing.

One thing that is not a barrier: the fact that the sentencing judge already knew about the illness. USSG § 1B1.13(e) provides that an extraordinary and compelling reason “need not have been unforeseen at the time of sentencing,” and that the fact a reason “reasonably could have been known or anticipated by the sentencing court does not preclude consideration.” Note that the older BOP regulation at 28 C.F.R. § 571.61(a) still contains the pre-First Step Act language limiting inmate requests to circumstances “which could not reasonably have been foreseen by the court at the time of sentencing.” The guideline governs the judicial motion.

What If the Judge Denies Without Engaging the Medical Record?

Denials of compassionate release are reviewed on appeal for abuse of discretion, which is a deferential standard — but it is not an empty one, and a court that rules without explaining itself can be reversed. That matters in medical cases specifically, because medical motions arrive with hundreds of pages of exhibits and a short docket order cannot show whether anyone read them.

Two decisions make the point. In United States v. Traumann, No. 23-2985 (3d Cir. Oct. 1, 2024) (not precedential), the movant filed 166 pages of medical records on the same day his motion was denied. The Third Circuit could not tell from the order whether the district court had considered them, and vacated: “absent this reasoning, the District Court’s order is essentially unreviewable.” In United States v. Handlon, 53 F.4th 348 (5th Cir. 2022) — a decision that predates the November 2023 rewrite of § 1B1.13, though its explanation holding is unaffected by it — the district court denied a documented, unopposed motion in a one-sentence text order incorporating “the same reasons stated in” a two-year-old ruling on an earlier motion. The Fifth Circuit vacated, holding that a court “cannot deny a second or subsequent motion for compassionate release ‘for the reasons stated’ in a prior denial where the subsequent motion presents changed factual circumstances and it is not possible to discern from the earlier order what the district court thought about the relevant facts,” and adding that “judges have an obligation to say enough that the public can be confident that cases are decided in a reasoned way.”

A third variety of error is deciding the motion on a legal shortcut. That is what happened in Quirós-Morales, where the district court treated the absence of a serious medical condition as ending the case “as a matter of law.” The First Circuit vacated, because a court “by definition abuses its discretion when it makes an error of law.”

None of this means an appeal is easy or that a vacatur produces release — each of these cases went back to the district court for a fresh decision, not to freedom. But if a motion supported by a real medical record was denied in a sentence, the explanation itself may be the issue. See compassionate release denial.

Terminal Illness: What the Bureau Owes the Family, and the 14-Day Clock

If the Clinical Director makes a terminal diagnosis, a set of statutory duties attaches immediately. 18 U.S.C. § 3582(d)(2)(A) requires the Bureau of Prisons to meet the duties below. (The rest of the clock — and the stages that have no deadline at all — is covered on our page on how long does compassionate release take.) The Bureau must:

1. Within 72 hours of the diagnosis, notify the defendant’s attorney, partner, and family members of the condition and inform them “that they may prepare and submit on the defendant’s behalf a request for a sentence reduction.”
2. Within 7 days of the diagnosis, provide the partner and family members, “including extended family,” with an opportunity to visit in person.
3. On request from the defendant, attorney, partner, or family member, ensure that BOP employees “assist the defendant in the preparation, drafting, and submission” of the request.
4. Within 14 days of receiving a request submitted on the defendant’s behalf, process the request.

PS 5050.51 § 4.a confirms that “[t]he statutory time frames of section 3582(d)(2)(A) begin once the Clinical Director of an institution makes a terminal diagnosis,” and that the Clinical Director must then inform the warden and the unit manager “within 24 hours of the diagnosis.” It also directs the warden to forward the referral information to the Office of General Counsel within 14 days, and provides that written authorization for the notifications “will be documented on the BP-A0192, Release of Information Consent form, or equivalent written authorization” (pp. 4–5).

A parallel provision, § 3582(d)(2)(B), applies when a defendant “is physically or mentally unable to submit a request”: the Bureau must tell the attorney, partner, and family that they may submit one, must “accept and process” what they submit, and must have staff assist on request.

Two further points a family should know. § 3582(d)(2)(C) requires every BOP facility to “regularly and visibly post” notice of these rights — in inmate handbooks, staff training materials, law libraries, and medical and hospice facilities — and to make it available on demand. And § 3582(d)(3) requires an annual report to the House and Senate Judiciary Committees that must include, at subsection (G), the time elapsed between the warden’s receipt of each request and the final decision, and at subsection (H), “the number of prisoners who died while their request was pending.” Congress wrote that reporting requirement because people die waiting. If the 72-hour, 7-day, or 14-day duties are not being honored, say so in writing, to the warden, with dates.

None of this changes who files in court. Family members can prepare and submit the BOP request. The motion under § 3582(c)(1)(A) is filed by the defendant or by the BOP Director.

Exhaustion: The Warden Comes First

Before a defendant-filed motion can be heard, 18 U.S.C. § 3582(c)(1)(A) requires that the defendant have “fully exhausted all administrative rights to appeal a failure of the Bureau of Prisons to bring a motion on the defendant’s behalf or the lapse of 30 days from the receipt of such a request by the warden of the defendant’s facility, whichever is earlier.”

Two routes, and the 30-day route is the one most people use: submit the written request to the warden, count 30 days from receipt, file. Failure to exhaust was cited 447 times as a denial reason in FY2025 — an avoidable loss in every instance.

Two medical-specific cautions. First, put every ground in the warden request, including each medical subsection you might rely on, because the circuits disagree about whether the grounds raised with the warden must match the grounds raised in court. Second, do not wait for the warden’s answer if the person’s condition is deteriorating. No regulation gives the warden a deadline; the statutory 30 days is the only enforceable clock in the process, and day 31 is a filing date. The mechanics of the request, the routing, and the BP-8 through BP-11 sequence are covered in full at compassionate release request to warden.

Where Medical Grounds Sit Among the Others

Medical claims are one of six categories in USSG § 1B1.13(b), and the guideline permits any of them “or a combination thereof.” Two neighbors come up constantly in medical cases:

Age. § 1B1.13(b)(2) requires all three of: at least 65 years old, serious deterioration in physical or mental health because of aging, and at least 10 years or 75% of the sentence served, whichever is less. Where the time-served element fails, the aging-decline path at § 1B1.13(b)(1)(B)(iii) may still be open, because it carries no time requirement. The full treatment is at age-based compassionate release.

Family caregiving. § 1B1.13(b)(3) covers the death or incapacitation of the caregiver of a minor child or a disabled adult child, and the incapacitation of a spouse, registered partner, parent, or other immediate family member where the defendant would be the only available caregiver. These claims are often filed alongside a medical claim and turn on a different contested element — whether anyone else is available. See compassionate release family circumstances.

For how the First Step Act opened the courthouse door in 2018 and what the Bureau’s role is now, see bop compassionate release. For the statute’s history and terminology, see compassionate release definition and, in plain language for families, what is a compassionate release. The full overview of every ground and the whole procedure sits on our federal compassionate release attorney page.

What the 2026 Supreme Court Decisions Did and Did Not Change

On May 28, 2026 the Supreme Court decided two compassionate release cases. Neither touched the medical grounds, and one of them says so almost in terms. The two decisions are covered in detail on our page on rutherford v united states.

In Fernandez v. United States, No. 24-556, the Court held that a prisoner attacking the validity of a conviction must proceed under 28 U.S.C. § 2255, not § 3582. In drawing that line, it described “age, illness, a child left with no guardian” as “[t]he heartland ‘extraordinary and compelling reasons’ that might warrant an early release from prison” (slip op. at 13). It then used a medical motion as its example of a filing that stays inside the statute: “When a prisoner moves for compassionate release based on a terminal illness, his motion does not suggest that his conviction is invalid. But if a prisoner moves for relief because of alleged problems with the underlying criminal investigation or trial, his motion suggests that his conviction is flawed” (slip op. at 14–15).

In Rutherford v. United States, Nos. 24-820 and 24-860, decided with Carter v. United States, the Court held that a sentencing disparity created by a change in law Congress declined to make retroactive cannot be an extraordinary and compelling reason, “considered by itself or in combination with other factors,” and that § 1B1.13(b)(6) is invalid to the extent it says otherwise (slip op. at 16). That closes the sentence-length theory. It does not touch § 1B1.13(b)(1).

Get one nuance right, because it is widely misreported: Rutherford did not hold that only “personal circumstances” can qualify. It expressly reserved the question — “We need not decide whether there are reasons beyond personal circumstances that could qualify as ‘extraordinary and compelling'” (slip op. at 10–11) — and added that it need not “nail down the precise boundaries of the phrase” (slip op. at 16).

The practical consequence for a family facing a medical crisis is straightforward. For several years a large share of compassionate release filings led with the length of the sentence and treated health as supporting detail. That ordering is no longer available. The medical route is now a larger share of what remains, and the motions that succeed are the ones built on the person’s present condition and documented from the institution’s own file.

How a Federal Criminal Defense Lawyer Builds a Medical Compassionate Release Case

Most of the work is not legal argument. It is assembling a record that does not yet exist, from an institution with no obligation to help assemble it, for someone who cannot make the calls.

That work includes obtaining the complete BOP health record rather than the summary a family can request; reading it against all four subsections of § 1B1.13(b)(1) rather than the one the family assumed; pulling the institutional documents that speak to function — Care Level, ADL assessments, duty status, accommodations, companion assignments; building a dated care-gap timeline where the theory is (C); retaining an independent physician to address prognosis, self-care capacity in a correctional environment, and the consequences of care not provided; drafting a warden request that satisfies 28 C.F.R. § 571.61, preserves every ground, and reads like the motion it will become; building a release plan naming a specific residence, a specific provider, a confirmed intake appointment, and documented coverage; and briefing the danger finding and the § 3553(a) factors affirmatively rather than defensively, since those are what defeat most motions that clear the medical gate.

It also means saying no when the answer is no, and saying it early. Where the record will not support a motion, other routes exist — a § 2255 motion where the issue is the conviction or sentence itself, federal clemency where the issue is equity rather than law, or home confinement placement work where the release date is close enough to matter. If the immediate problem is getting care rather than getting out, the fight is inside the institution, and that is federal prison consulting work.

Christopher Zoukis leads the firm’s federal prison consulting work — designation, sentence computation, medical-care advocacy, First Step Act credits, RDAP, and reentry planning. The legal work on any compassionate release motion, including the filing, the briefing, and any appeal, is handled by Elizabeth Franklin-Best and the firm’s attorneys.

Why work with Elizabeth Franklin-Best, P.C.

Elizabeth Franklin-Best is the founder and Principal Attorney of Elizabeth Franklin-Best, P.C., a boutique firm devoted to federal criminal appeals and post-conviction relief. Over more than 20 years she has handled more than 330 federal proceedings, over 100 of them appeals, with sixteen published decisions as counsel of record. She is admitted to the U.S. Supreme Court and twelve of the thirteen U.S. Courts of Appeals — every regional circuit (1st–11th) plus the D.C. Circuit — and has appeared pro hac vice in federal courts from Montana to Florida. She is recognized by Best Lawyers in America 2026 for Appellate Practice and by Chambers USA 2026 for Litigation: White-Collar Crime & Government Investigations, and was named South Carolina Public Defender of the Year in 2010. She is the author of Reversing Your Criminal Conviction: Develop Your Winning Strategy (2023) and serves as Board Chair of Justice 360.

Christopher Zoukis, JD, MBA, is the firm’s Managing Director and a nationally recognized federal prison expert. He is the author of the Federal Prison Handbook, Directory of Federal Prisons, Prison Education Guide, and College for Convicts, and serves as Chairman of the Board of the Human Rights Defense Center. He has been quoted as a federal prison expert by outlets including CNN, the Associated Press, and The Washington Post. He earned his J.D. at the University of California, Davis School of Law after serving roughly a decade in the federal Bureau of Prisons, where he became an award-winning incarcerated journalist — a combination of formal training and firsthand knowledge of how BOP health services actually operate that few in federal defense can offer.

The firm runs a national federal practice on an intentionally small caseload, from offices in Columbia and Mount Pleasant, South Carolina. A compassionate release motion is filed in the district that imposed the sentence, wherever in the country that is.

Talk to a Federal Compassionate Release Lawyer About an Urgent Medical Case

Medical cases are time cases. The 30-day clock in 18 U.S.C. § 3582(c)(1)(A) does not start until the warden receives the request, BOP records take weeks to arrive, and an independent physician’s review takes longer still. If someone in your family has received a serious diagnosis in federal custody, the first useful step is a look at the actual record — the health file, the Care Level assignment, the sentence, the sentencing district, and the judge.

It helps to have four things ready when you call: the person’s full name and register number, the institution where they are held, the judgment or the docket number of the case that produced the sentence, and whatever you already know about the diagnosis and who is treating it. If a request has already gone to the warden, bring the date it was submitted and any written response. If it has not, that is usually the first thing to fix.

Call (843) 620-1100 or schedule an urgent case review. We handle these motions in federal district courts nationwide.

Frequently Asked Questions About Medical Compassionate Release

Reviewed for legal accuracy by Elizabeth Franklin-Best, Esq., Principal Attorney·September 2026