United States Court of Appeals For the First Circuit
No. 22-1714
UNITED STATES,
Appellee,
v.
EDISON BURGOS-MONTES,
Defendant, Appellant.
APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF PUERTO RICO
[Hon. Jay A. García-Gregory, U.S. District Judge]
Before
Barron, Chief Judge, Thompson and Rikelman, Circuit Judges.
Alejandra Bird-López, Assistant Federal Public Defender, with whom Héctor L. Ramos-Vega, Interim Federal Public Defender, District of Puerto Rico, Franco L. Pérez-Redondo, Assistant Federal Public Defender, Supervisor, Appeals Section, and Rachel Brill, Federal Public Defender, District of Puerto Rico, were on brief, for appellant.
Sean P. Murphy, with whom W. Stephen Muldrow, United States Attorney, Mariana E. Bauzá-Almonte, Assistant United States Attorney, Chief, Appellate Division, and David C. Bornstein, Assistant United States Attorney, were on brief, for appellee. June 30, 2025 RIKELMAN, Circuit Judge. Edison Burgos-Montes, who is
in his mid-fifties and serving a life sentence, seeks compassionate
release based on his serious medical conditions. In late 2021,
Burgos filed a motion with the district court requesting his
release, arguing primarily that the Bureau of Prisons' (BOP)
ongoing failure to provide adequate treatment for his severe
hypertension and obstructive sleep apnea was an "extraordinary and
compelling reason[]" to reduce his sentence. 18 U.S.C. § 3582(c).
The district court found that Burgos was receiving "adequate
medical, dental and psychological care" and denied his motion
without prejudice. Burgos contends that this finding was clearly
erroneous, and we agree in part. We conclude that the district
court overlooked the undisputed evidence demonstrating that,
almost one year after Burgos's sleep apnea diagnosis and despite
his ongoing severe hypertension, the BOP had yet to provide Burgos
with the established treatment for sleep apnea. Thus, we vacate
the district court's order and remand for further proceedings
consistent with this opinion.
- 3 - I. BACKGROUND
A. Relevant Facts
Burgos began serving his prison sentence at USP Pollock,
a BOP Care Level 1 medical facility.1 During his time at Pollock,
he suffered from uncontrolled hypertension, which places an
individual at risk of congestive heart failure, heart attack, and
death. Obstructive sleep apnea can cause or exacerbate
hypertension.
Burgos's medical records from Pollock are replete with
evidence of his chronically high blood pressure. The records
include regular blood pressure readings ranging from 164/94 on the
low end to 201/117 on the high end, indicating a hypertensive
crisis. Indeed, in 2021, medical records show Burgos with only
one normal blood pressure reading.
Even though Pollock medical staff prescribed Burgos six
different antihypertensive medications, his high blood pressure
persisted. The staff's attempts to adjust the combination and
dosage of Burgos's medications did not improve his condition. On
According to the BOP's Care Level Classification Guide, Care 1
Level 1 inmates "are less than 70 years of age," "are generally healthy," and may have "limited medical needs that can be easily managed by clinician evaluations every 6-12 months." Fed. Bureau of Prisons, Clinical Guidance: Care Level Classification for Medical and Mental Health Conditions or Disabilities 2 (2019), https://www.bop.gov/resources/pdfs/care_level_classification_gui de.pdf [https://perma.cc/3P9N-UAK2] [hereinafter "BOP Clinical Guidance"].
- 4 - top of his hypertension, Burgos also reported experiencing
headaches and chest pains so severe that they caused him to vomit.
As a result, the Pollock medical staff prescribed a new medication
specifically to manage his chest pain.
Burgos's high blood pressure readings continued even
after the BOP transferred him to FCC Coleman, a Care Level 3
medical facility, in September 2021.2 For example, Burgos was
hospitalized for three days in June 2022, after multiple elevated
blood pressure readings on a single day (175/104, 193/133, and
204/129), two of which reached crisis levels. And earlier that
year, Burgos ran out of his antihypertensive medications for five
days and his blood pressure required him to reschedule a dental
procedure.
Coleman medical staff also tried to adjust Burgos's
medication regimen and took him off one medication, furosemide.
After his hospitalization, however, the medical staff
re-prescribed furosemide.
The parties point to conflicting evidence in the record
regarding whether and to what extent Burgos contributed to his
medication regimen disruptions. The government highlights
2Care Level 3 inmates "have complex, and usually chronic" conditions that require "frequent clinical contacts to maintain control or stability of their condition." They also may "require periodic hospitalization." BOP Clinical Guidance, supra note 1, at 3.
- 5 - statements in Burgos's medical records that furosemide was
discontinued "due to misuse/diversion by the inmate." But a
contemporaneous evaluation from a Coleman staff member states that
Burgos was "taking [his] medication in correct dosages at [the]
correct time" in a "responsible" manner. Relatedly, the parties
also dispute whether the five-day lapse in medication that
postponed Burgos's dental procedure was the result of him "not
taking his medications due to side effects," or the result of
medical staff negligence.
Both before and after his transfer to Coleman, Burgos
also complained of problems sleeping: He regularly woke up "gasping
for air," snored loudly during the night, and experienced fatigue
and trouble concentrating during the day. After scoring poorly on
a sleep questionnaire, he received a provisional sleep apnea
diagnosis in October 2020, while he was still at Pollock.
Burgos was scheduled for a "specialty procedure" related
to his difficulty breathing, presumably a sleep study, by the
"target date" of December 31, 2020. According to his medical
records, however, he did not undergo a sleep study at Pollock until
six months later, on June 30, 2021. Following that sleep study,
Burgos received a confirmatory diagnosis of sleep apnea in October
2021, soon after his transfer to Coleman. For unexplained reasons,
this diagnosis was not contemporaneously recorded in Burgos's
medical file.
- 6 - Even after undergoing the June 2021 sleep study and
receiving a sleep apnea diagnosis in October 2021, Burgos did not
receive the standard treatment for sleep apnea: a Continuous
Positive Airway Pressure (CPAP) machine.3 In April 2022, Burgos
met with an outside cardiologist, who recommended that Burgos
receive a CPAP machine "ASAP, as this will improve blood pressure
values and energy." Still, Burgos was not provided with a CPAP
machine.
In May 2022, nearly a year after his first sleep study,
Burgos completed another sleep questionnaire at Coleman, which
again indicated that he suffered from obstructive sleep apnea.
Coleman medical staff recommended that Burgos undergo a second
sleep study but did not indicate in his file why another study was
necessary to diagnose him. Indeed, at the time, sleep apnea was
already listed in Burgos's medical records as a "current" "health
problem[]."
As of July 2022, almost one year after his sleep apnea
diagnosis, Burgos had yet to undergo the second sleep study or
receive a CPAP machine. He remains incarcerated at Coleman.
3 A standard CPAP machine is a mask that helps treat sleep apnea by delivering continuous air through a patient's mouth and/or nose while they sleep. The continuous flow of air keeps the tongue, uvula, and soft palate from obstructing the patient's airway. See CPAP Machine, Cleveland Clinic, https://my.clevelandclinic.org/health/treatments/22043-cpap- machine [https://perma.cc/NXU5-2DBV] (last visited June 4, 2025).
- 7 - B. Procedural History
After exhausting his administrative remedies with the
BOP, Burgos filed a motion for compassionate release with the
district court in late November 2021, two months after he was
transferred to Coleman. In his motion, Burgos contended that he
was suffering from multiple "serious medical conditions" that
warranted a sentence reduction, including hypertension, sleep
apnea, and high risk of COVID-19 infection.4
Burgos attached a letter from Dr. George Bren, a
board-certified cardiologist, in support of his motion. In his
letter, Dr. Bren stated that he had evaluated Burgos's medical
records from July 2019 to September 2021 and concluded that Burgos
suffered from multiple medical conditions for which the BOP was
providing inadequate care.
In particular, Dr. Bren offered his medical opinion that
Burgos suffered from "poorly controlled" hypertension, as
evidenced by his elevated blood pressure and a September 2020
electrocardiogram showing changes to Burgos's heart structure. He
concluded that "[a]djustment of antihypertensive medications has
been slow and without a logical basis," highlighting the BOP's
decision to switch Burgos "off a 'stronger' medication and [onto]
a 'weaker' medication."
4 Burgos does not raise his COVID-related arguments on appeal.
- 8 - Dr. Bren also explained that Burgos suffered from
"[p]robable obstructive sleep apnea," and that the
"well-documented consequences" of untreated sleep apnea included
"heart failure and pulmonary hypertension." Dr. Bren recommended
that the BOP provide Burgos with a CPAP machine. He also noted
that Burgos suffered from chest pain, esophageal spasm, obesity,
elevated cholesterol, and possible long COVID.
The government filed its initial opposition to Burgos's
compassionate release motion in January 2022 and focused primarily
on Burgos's COVID-related arguments. Burgos replied that the
government had ignored most of Dr. Bren's medical findings, and he
provided evidence of his additional elevated blood pressure
readings from October 2021 and January 2022.
The district court determined that the government "ha[d]
not adequately responded to [Burgos]'s argument and Dr. Bren's
Report regarding [Burgos']s deteriorated and deteriorating health
and BOP's inability to provide him with adequate care." It ordered
the government to do so promptly.
To comply with the district court's order, in May 2022,
the government submitted a letter from Dr. Gary Venuto, the
Clinical Director at Coleman (the "May letter"). In the May
letter, Dr. Venuto briefly summarized Burgos's medical care,
confirmed that Burgos was scheduled for another sleep study "to
rule out the possibility of obstructive sleep apnea as a root cause
- 9 - of his hypertension," and explained that the health services team
was conducting further review of "[t]he medical information
provided by Dr. George Bren." Burgos replied, pointing out that
Dr. Venuto's letter confirmed that he "ha[d] not been given a CPAP
machine," despite his October 2021 sleep apnea diagnosis and the
contemporaneous notation in his medical record that sleep apnea
was a "current" health condition. The district court ordered the
government to produce by early July the results of the further
review by the Coleman medical team that Dr. Venuto had promised.
The government then submitted a second letter from Dr.
Venuto (the "July letter"), as well as Burgos's updated medical
records. In the July letter, Dr. Venuto chronicled Burgos's
medical care since his arrival at Coleman ten months earlier. He
explained that the Coleman medical staff had adjusted Burgos's
antihypertensive medication regimen but also informed Burgos that
his lifestyle was contributing to his hypertension and that
"medication alone w[ould] not alleviate" his condition. According
to Dr. Venuto, some of the changes or interruptions in medication
that Burgos had raised to the district court were the result of
Burgos's failure to alert medical staff that his medications had
run out, as well as Burgos's noncompliance with medication
procedures. Dr. Venuto again noted that a second sleep study was
"pending," but did not elaborate on why a second study had not
- 10 - been conducted in the time between his May and July letters.5
Nevertheless, Dr. Venuto concluded that Burgos "has received
timely and appropriate medical, dental and psychological care."
The district court denied Burgos's motion for
compassionate release on August 25, 2022. The order stated in
full:
At this time, Defendant has failed to establish extraordinary and compelling reasons justifying a reduction in sentence. Dr. George Bren's report regarding Defendant's deteriorated and deteriorating health and his assessment regarding BOP's inadequate care are based on his review of medical records and other legal documents spanning the period of 7/19/2019 to 9/24/2021. In the period covered by those records, Defendant was primarily housed at a Care Level 1 medical facility. Defendant is now being housed at FCC Coleman, a Care Level 3 medical facility. The Court credits Dr. Gary Venuto's assessment that Defendant is receiving adequate medical, dental, and psychological care since arriving at FCC Coleman. As such, the Court is not deciding at this time whether (i) Defendant poses a danger to the safety of any other person or the community, as provided by 18 U.S.C. § 3142(g); or (ii) a reduction is consistent with policy statement issued by the Sentencing Commission at U.S.S.G. 1B1.13. Defendant may refile the present motion provided he submits evidence to satisfy the requirements of 18 U.S.C. [§] 3582(c)(1)(A).
(Citations omitted.)
5 Burgos's medical records state that the second sleep study was to be conducted on July 6, 2022. Dr. Venuto's letter was dated July 7.
- 11 - Burgos appealed. We noted that the district court's
order allowed Burgos to "refile the present motion," raising the
question of whether it was an appealable "final decision" under 28
U.S.C § 1291, and we issued an order to show cause why the appeal
should be allowed to proceed. Ultimately, we reserved decision on
the jurisdictional question to the merits panel.
II. STANDARD OF REVIEW
We review the district court's denial of Burgos's
compassionate release motion for abuse of discretion. See United
States v. Saccoccia, 10 F.4th 1, 4-5 (1st Cir. 2021). Under this
umbrella standard, we review questions of law de novo and the
district court's factual findings for clear error. See United
States v. Cruz-Rivera, 137 F.4th 25, 30 (1st Cir. 2025) (citing
United States v. Ruvalcaba, 26 F.4th 14, 19 (1st Cir. 2022)). "A
district court's finding is clearly erroneous when although there
is evidence to support it, the reviewing court on the entire record
is left with the definite and firm conviction that a mistake has
been committed." United States v. Benito Lara, 56 F.4th 222, 226
(1st Cir. 2022) (cleaned up) (quoting United States v. U.S. Gypsum
Co., 333 U.S. 364, 395 (1948)).
The district court found that Burgos was receiving
adequate medical care and, based on that finding, determined that
Burgos had not demonstrated an "extraordinary and compelling"
reason to support his sentence reduction request. Because it
- 12 - concluded that Burgos failed the first prong of the compassionate
release test, the court explicitly stated that it did not reach
the remaining parts of the test. Accordingly, our analysis also
focuses only on the first prong of the compassionate release test.
III. DISCUSSION
We begin by addressing whether we have jurisdiction over
the district court's order denying Burgos's motion for
compassionate release. Concluding that we do, we turn to the
merits and agree with Burgos that the district court clearly erred
in finding that he was receiving "adequate" medical care at
Coleman, at least as to his hypertension and sleep apnea.
A. Jurisdiction
At the outset, we must consider whether the district
court's order denying Burgos's motion without prejudice and
permitting him to "refile the present motion" was a final judgment
that we have jurisdiction to review. See García-Goyco v. L. Env't.
Consultants, Inc., 428 F.3d 14, 18-19 (1st Cir. 2005) (noting the
"scant authority" concerning whether denials "without prejudice
and with leave to resubmit" are final orders). Despite the
parties' agreement that we do have jurisdiction, "we have some
independent responsibility to examine" the issue "before
proceeding to the merits." Caribbean Mgmt. Grp., Inc. v. Erikon
LLC, 966 F.3d 35, 40 (1st Cir. 2020).
- 13 - When "evaluating the finality of an order entered after
judgment," we "generally treat the post-judgment proceeding as if
it were a lawsuit distinct from the [case] that generated the
underlying judgment." Id. Here, Burgos's criminal case generated
the underlying judgment and the compassionate release motion
constitutes the post-judgment proceeding. See United States v.
Rivera-Rodríguez, 75 F.4th 1, 16 (1st Cir. 2023) (recognizing that
compassionate release motions are post-judgment proceedings and
stating that "compassionate release appealability, 'like
appealability with respect to the disposition of virtually all
other post-judgment motions, is governed by 28 U.S.C. § 1291'"
(quoting United States v. McAndrews, 12 F.3d 273, 277 (1st Cir.
1993))).
Under our precedent, "an order entered after judgment is
final if it leaves the district court with no further work to
resolve the post-judgment dispute and, thus, ends the
post-judgment proceeding." Caribbean Mgmt., 966 F.3d at 40.
Applying that reasoning, we have held that "[o]rders resolving
compassionate release motions amount to final judgments" because
they "satisf[y] the preconditions established by [§] 1291, for
entry of the order leaves nothing further to be done."
Rivera-Rodríguez, 75 F.4th at 16 (second alteration in original)
(quoting McAndrews, 12 F.3d at 277).
- 14 - The question is whether the district court's order here
amounts to an exception to that general rule. As both parties
acknowledge, the district court ruled on the merits of Burgos's
compassionate release motion based on the evidence they had
presented up to that point, including Burgos's medical records
from July 2019 through June 2022. As a result, there was no
"further work" for the district court to do to resolve Burgos's
2021 motion. Even if Burgos "refile[d]" a motion for compassionate
release, that subsequent filing would not resuscitate his earlier
2021 motion. Instead, it would present a new request for
compassionate release based on additional evidence about Burgos's
health that would post-date the order on appeal. Thus, we conclude
that the district court's order was a final judgment.6
We note one additional jurisdictional wrinkle that the 6
parties did not raise. On the same day that Burgos filed his notice of appeal, he also filed a motion for reconsideration (which the district court later denied "in light of the pending appeal"). We conclude that the motion for reconsideration did not undermine the finality of the district court's order on the facts here. As it turned out, Burgos filed both the notice of appeal and the motion for reconsideration one day after the 14-day deadline for appealing the district court's order. Although Burgos later filed a request for a retroactive extension of his appeal deadline, which the district court granted, he did not reference his motion for reconsideration in that filing. Because Burgos's time to appeal had already run at the time that he filed his motion for reconsideration, that motion did not disturb the finality of the district court's order. See United States v. Healy, 376 U.S. 75, 78 (1964) (ruling that a motion to reconsider in criminal case filed before the deadline to appeal stopped the appeal clock and stating that "criminal judgments are nonfinal for purposes of appeal so long as timely rehearing petitions [or motions to
- 15 - B. The Compassionate Release Motion
Assured of our jurisdiction, we turn to the merits.
Under the compassionate release statute, a court may reduce a term
of imprisonment if certain criteria are met and if the defendant
has exhausted administrative remedies at the BOP. See 18 U.S.C.
§ 3582(c)(1)(A); see also Cruz-Rivera, 137 F.4th at 28.
In evaluating a compassionate release motion, the
district court engages in a multi-step inquiry. Initially, it
determines if the defendant is eligible for compassionate release
by assessing (1) if the defendant has presented "extraordinary and
compelling reasons warrant[ing] such a [sentence] reduction," and
(2) whether the sentence reduction is "consistent with applicable
policy statements issued by the Sentencing Commission." 18 U.S.C.
§ 3582(c)(1)(A). If the defendant is eligible for compassionate
release under these two criteria, the district court then considers
the relevant § 3553(a) sentencing factors and "determine[s]
whether, in its discretion, the [sentence] reduction . . . is
warranted in whole or in part under the particular circumstances
of the case." Saccoccia, 10 F.4th at 4 (quoting Dillon v. United
States, 560 U.S. 817, 827 (2010)).
reconsider] are pending" (emphasis added)); see also United States v. Rollins, 607 F.3d 500, 502 (7th Cir. 2010) (a motion for reconsideration in a criminal case cannot "rejuvenate an extinguished right to appeal" (quoting Healy, 376 U.S. at 77)). To rule otherwise would improperly restart the appeal clock.
- 16 - As Burgos explains, the district court's finding that he
was receiving adequate medical care was essential to its conclusion
that he had failed to meet the first prong of the compassionate
release test: the demonstration of an "extraordinary and
compelling" reason for a sentence reduction. Thus, Burgos argues,
because this adequate-care finding was clearly erroneous, we
should vacate the district court's decision so that it can
re-evaluate if he meets the criteria for compassionate release.
The government does not dispute that untreated medical
conditions like severe hypertension and obstructive sleep apnea
can constitute "extraordinary and compelling reasons" for a
reduced sentence under § 3582.7 Rather, the dispute here focuses
on whether the district court clearly erred in concluding as a
factual matter that Burgos was receiving "adequate" medical care
for these conditions at Coleman.
Burgos argues that the district court made two clearly
erroneous factual findings in resolving this critical question.8
7At oral argument, the government argued that, properly managed, sleep apnea that exacerbates hypertension does not meet the statutory standard. But Burgos's challenge centers on his claim that the BOP was not properly managing his sleep apnea. 8Burgos also suggests that the district court should not have relied on Dr. Venuto's July letter at all. Our review of his arguments, however, makes clear that Burgos does not lodge a legal challenge to Dr. Venuto's qualifications as an expert or otherwise challenge the admissibility of Dr. Venuto's opinion that Burgos was receiving adequate treatment. Rather, Burgos points out that Dr. Venuto's opinion was conclusory and failed to grapple with the
- 17 - First, he asserts that the BOP was not adequately treating his
sleep apnea, which likely contributed to his severe hypertension.
In particular, he points to the evidence demonstrating the BOP's
ongoing failure to provide him with a CPAP machine. Second, he
contends that BOP was illogically and ineffectively adjusting his
antihypertensive medication regimen.9
To set the stage for our analysis of Burgos's primary
claim of error, related to the BOP's failure to treat his sleep
apnea, we briefly review the key undisputed facts. First, while
at Pollock, Burgos suffered from uncontrolled hypertension and
"probable" obstructive sleep apnea. Second, untreated obstructive
sleep apnea can be a "root cause" of hypertension. Third, the
standard of care for obstructive sleep apnea is typically a CPAP
machine, but the BOP had not provided Burgos with a CPAP machine
by the time of the district court's order. And fourth, as the
government conceded at oral argument, the district court had found
details of his medical record as to each of his medical conditions, including his sleep apnea. Thus, we treat Burgos's challenge to Dr. Venuto's July letter as part of his overarching claim that the record as a whole demonstrates that the district court's adequate-treatment finding was clearly erroneous. 9 In a single sentence in his opening brief, Burgos also raises concerns about the BOP's response to his high cholesterol and chest pain but does not point us to any particular failures on the BOP's part in its treatment of these conditions. Thus, we deem any claims related to those aspects of the BOP's medical treatment to be waived. See United States v. Zannino, 895 F.2d 1, 17 (1st Cir. 1990).
- 18 - in an earlier text order that Burgos was receiving inadequate
medical care at Pollock.10
Given these undisputed facts, we focus on whether the
district court clearly erred in finding that Burgos was receiving
adequate treatment for obstructive sleep apnea after his transfer
to Coleman. The district court's order references only one piece
of evidence on this issue: Dr. Venuto's statement in his July
letter that Burgos was receiving "timely and appropriate medical,
dental, and psychological care" at that facility. But that
statement must be evaluated "given other, undisputed evidence in
the record." United States v. Espinoza-Roque, 26 F.4th 32, 37
(1st Cir. 2022).
Our review of the record indicates that Burgos did not
receive any sleep apnea treatment at Coleman.11 Burgos did attend
10 The government argues that Dr. Bren's opinion, which supported the district court's conclusion on this point, should not be credited because he was not Burgos's treating physician and had not personally observed Burgos. That argument is unpersuasive. Medical experts often are not treating physicians. Further, as Burgos points out, the government's own expert, Dr. Venuto, never claimed to have personally observed Burgos. Nevertheless, the government urges us to rely on Dr. Venuto's assessment. 11The government contends that Burgos has waived any argument relying upon the updated medical records it provided for the period from July 2021 to June 2022. We disagree. Burgos's citations to the relevant record excerpts in his briefs to the district court and to us, and his assertions that his health conditions had not improved even after his transfer to Coleman, sufficiently preserved the argument that he was continuing to receive inadequate care.
- 19 - an appointment with an outside cardiologist who confirmed that he
needed a CPAP machine as soon as possible, and Coleman medical
staff discussed a second sleep study for Burgos. But Burgos never
received any treatment for this condition, and the record
contradicts the inference that a second sleep study was needed to
provide such treatment, given the cardiologist's instruction that
Burgos receive the CPAP machine immediately.
The government's responses to Burgos's arguments -- that
Burgos lacked an official diagnosis of sleep apnea and that the
promised second sleep study amounted to treatment -- are
unpersuasive. To begin, the government insists that Burgos's
medical records did not contain a "formal[] diagnos[is]" of sleep
apnea, which, in its view, indicates that Burgos did not require
any additional treatment for the condition. But the government
has no explanation for why the notes in Burgos's medical file do
not amount to such a diagnosis, at least as of July 2022. See
United States v. Oquendo-Rivera, 586 F.3d 63, 68 (1st Cir. 2009)
(holding that a failure to discuss "points that seem relevant" and
"other points that gave at least some indirect support" to the
defendant's position was clear error).
To recap: Burgos received his first provisional sleep
apnea diagnosis in October 2020, after reporting to BOP medical
staff that he was "gasping for air" at night and was unable to
sleep. He then underwent a sleep study in June 2021. To be sure,
- 20 - the results of the study are not included in his medical records.
Nonetheless, those same records list sleep apnea as a "current"
health condition, with a diagnosis date of October 2021. Further,
there is no evidence in the record to contradict the opinion of
the outside cardiologist that Burgos's sleep apnea likely
contributed to his uncontrolled hypertension, for which Burgos was
hospitalized while at Coleman.12 Thus, the record leaves us with
a "definite and firm conviction" that Burgos suffered from
obstructive sleep apnea, which likely contributed to his
Next, the government points out that Burgos's second
sleep study was listed as an "urgent" priority and suggests that
this is sufficient evidence that the BOP was adequately treating
Burgos for sleep apnea. Even if we overlook that the "urgent"
sleep study had yet to be conducted as of Dr. Venuto's second
letter to the court, however, a sleep study is a diagnostic tool:
The only treatment for sleep apnea discussed in Burgos's medical
records is a CPAP machine. See Aponte-Dávila v. Mun. of Caguas,
828 F.3d 40, 48 (1st Cir. 2016) (holding that it was clear error
to "plac[e] altogether too much emphasis on [a] factor" that
12Dr. Venuto did opine that Burgos's blood pressure was an ongoing issue in part because Burgos was refusing to make necessary changes to his diet and exercise regimen. But he never suggested that Burgos's sleep apnea did not contribute to his hypertension; instead, Dr. Venuto confirmed in his May letter that could be the case.
- 21 - "do[es] not [itself] result in a change" in the critical
circumstance at issue). Indeed, as we have explained, in April
2022, an outside cardiologist recommended that Burgos receive a
CPAP machine "ASAP" to treat his sleep apnea, without suggesting
that additional diagnostic testing was needed. And Dr. Venuto
acknowledged that as of July 2022, Burgos had still not received
a CPAP machine. Further, there is no medical evidence in the
record suggesting that a confirmatory sleep study is required for
a CPAP machine to be prescribed when, as is the case here, the
patient has already received a sleep apnea diagnosis. Thus, the
evidence provides no support for the government's position that
simply scheduling a second sleep study amounts to adequate
treatment on these facts. Accordingly, we agree with Burgos that
the district court clearly erred in finding that the BOP was
providing adequate treatment for his sleep apnea.
Burgos next challenges the district court's finding that
the BOP's antihypertensive medication regimen was adequate, but on
this point, we disagree with him. Burgos's medical file indicates
that on some occasions, he was not taking his medications, which
Dr. Venuto noted could have contributed to any perceived
inefficacy. And, as Dr. Venuto also explained, BOP staff at
Coleman changed Burgos's medication regimen immediately in
response to his hospitalization in June 2022, re-prescribing
furosemide after it had been discontinued. Thus, the record
- 22 - contains evidence to contradict Burgos's contention that
alterations to his "flawed pharmaceutical regimen" were "slow and
haphazard." So, we see no basis for disturbing the district
court's factual finding on this issue.
To wrap up, we conclude that the district court's
"critical finding" that Burgos was receiving adequate treatment
for his sleep apnea was clearly erroneous. United States v.
Henderson, 463 F.3d 27, 47 (1st Cir. 2006). That is because, as
we have explained, the record is clear that nearly a year after
Burgos received a sleep apnea diagnosis, months after a consulting
cardiologist recommended that he receive a CPAP machine "ASAP,"
and even after his transfer to a higher-level care facility, the
BOP had yet to provide Burgos with a CPAP machine or any other
sleep apnea treatment. And there is no dispute that untreated
sleep apnea for a patient like Burgos, who also suffers from severe
hypertension, could amount to an "extraordinary and compelling"
reason to grant compassionate release. See United States v.
Trenkler, 47 F.4th 42, 50 (1st Cir. 2022) ("[T]he 'extraordinary
and compelling' standard . . . contemplates that any number of
reasons may suffice on a case-by-case basis, whether it's one,
two, or ten."). So, we must vacate the district court's order
denying Burgos's compassionate release motion and remand for it to
consider whether Burgos has made a showing of an "extraordinary
and compelling" reason under § 3582. We express no opinion on
- 23 - whether Burgos can satisfy the remaining prongs of the
compassionate release test.
IV. CONCLUSION
For all these reasons, we vacate the district court's
denial of Burgos's motion for compassionate release and remand for
proceedings consistent with this opinion.
- 24 -