United States District Court, M.D. North Carolina
MEMORANDUM OPINION AND ORDER
Catherine C. Eagles, District Judge.
M. Beck is a federal prisoner serving a sentence for drug and
firearms offenses. She has cancer in her left breast and the
Bureau of Prisons has not provided appropriate medical care
for her disease, with repeated delays that have prevented her
from timely obtaining urgent tests and treatment. In the
meantime, her cancer spread to her lymph nodes and possibly
to her right breast. Ms. Beck has filed a motion under the
First Step Act of 2018 seeking immediate compassionate
release. Because Ms. Beck's invasive cancer and BoP's
history of indifference to her treatment constitute
extraordinary and compelling reasons, and because the §
3553(a) factors support a sentence reduction to time served,
the motion for compassionate release will be granted.
Facts and Procedural History
Court has considered the record evidence in this criminal
case, where Ms. Beck submitted her motion for compassionate
release. The Court has also considered the documentary
evidence submitted in Ms. Beck's civil case against BoP
officials for inadequate medical care in violation of her
constitutional rights. See Beck v. Hurwitz, No.
1:19-cv-00488 (M.D. N.C. May 10, 2019). Unless otherwise
specified, docket citations are to the criminal
sometime in 2012, Angela Beck and her husband began operating
a methamphetamine lab in their home in Surry County, North
Carolina. See Doc. 192 at 12-13. They participated
in a conspiracy to distribute methamphetamine that included
many other participants, see Doc. 73 (identifying 20
defendants), and other labs. See Doc. 192 at 1-20.
During a search of the Beck home on January 4, 2013, law
enforcement located items consistent with the manufacture of
methamphetamine, 12 firearms, and drug paraphernalia.
Id. at 12-13. Several persons on the premises
possessed methamphetamine, including Ms. Beck. Id.
at 13. In the preceding months, Ms. Beck had purchased over
42 grams of pseudoephedrine, one of the precursor chemicals
that can be used to manufacture methamphetamine. Id.
Ms. Beck was arrested on state charges and released on bond,
see Doc. 429-1 at 1, she and her husband continued
to manufacture and sell meth out of their home. Doc. 192 at
16. During a search on February 18, 2013, law enforcement
located items consistent with the manufacture of
methamphetamine, a revolver and ammunition, drug
paraphernalia, and numerous cell phones. Id.
months after her second arrest, Ms. Beck pleaded guilty in
this Court to conspiracy to distribute 500 grams or more of
methamphetamine (Count 1, object 1) and possession of a
firearm in furtherance of a drug trafficking crime (Count
12). Doc. 201 at ¶¶ 1-2; Minute Entry 09/06/2013.
The Court granted the Government's motion under U.S.S.G.
§ 5K1.1 to depart from the guidelines, Doc. 249; Minute
Entry 12/12/2013, and sentenced her to 129 months of
imprisonment as to Count 1 and, as required by law, to a
consecutive term of 60 months as to Count 12, for a total
sentence of 189 months. Doc. 277 at 2. The Fourth Circuit
dismissed her appeal. Doc. 363. The Court later reduced her
sentence on Count 1 to 105 months based on a retroactive
sentencing guideline amendment, making her total sentence 165
months. Doc. 442.
Beck is in the custody of the United States Bureau of Prisons
and is assigned to the Federal Correctional Institute in
Aliceville, Alabama. Civil Doc. 3-3 at ¶ 1; Civil Doc.
12 at ¶ 3. She has served approximately 76 months of her
165-month sentence. See Doc. 429-1 at 1. There is
nothing in the record to indicate that she has incurred any
disciplinary violations or infractions while in BoP's
Beck is 47-years old, Doc. 429-1 at 3, and has a family
history of breast cancer. Civil Doc. 3-3 at ¶ 3. In the
fall of 2017, she discovered lumps in her left breast and
promptly sought medical attention. Id. at
¶¶ 2, 4-5. When she first saw the prison doctor to
report the masses, see Id. at ¶ 6, he
recommended imaging and consultation with a surgeon,
10/16/2017--Griffin [BoP 22], but almost two months passed
before BoP took Ms. Beck to see a surgeon. Civil Doc. 3-1 at
¶ 19. Imaging results obtained two weeks later
were “highly suggestive” of cancer, id.
at ¶ 19; 12/22/2017--DeVenny [BoP 36], and in the
ensuing days, weeks, and months, Ms. Beck's doctors
repeatedly said she needed a biopsy to test for cancer.
See, e.g., 12/22/2017--DeVenny [BoP 36];
12/29/2017--Griffin [BoP 39]; 01/08/2018--Griffin [BoP 65];
05/11/2018--Griffin [BoP 96]; 08/07/2018--Bilton [BoP 110]. A
biopsy should be performed no more than two months after the
detection of an abnormality, Civil Doc. 3-1 at ¶ 11, but
BoP waited eight months after imaging before taking her for a
biopsy. Id. at ¶ 20.
the biopsy was finally performed, the surgeon observed
“extensive breast disease that extended
laterally.” 08/28/2018--Bilton [BoP 115]. The biopsy
confirmed invasive cancer in her left breast and the surgeon
recommended additional surgery, but another two months passed
before BoP took her for surgery. Civil Doc. 3-1 at
¶¶ 20-21. In November 2018, over a year after Ms.
Beck first noticed the lumps, the surgeon removed her entire
left breast and part of her pectoral muscle and confirmed a
diagnosis of metastatic breast cancer. 11/01/2018--Bilton
[BoP 252]; 11/02/2018--Bilton [Page 18, Doc. #10]
(“Post op diagnosis: Left breast cancer.”);
see also Civil Doc. 3-1 at ¶ 21 (declaration of
Dr. Winkfield, reviewing records and noting a
“diagnosis of stage IIB (T2N1) breast cancer”).
During surgery, doctors discovered the cancer had spread to
Ms. Beck's lymph nodes, 11/06/18--Bilton [Page 34, Doc.
#12] (noting “metastatic carcinoma” in two
nodes), and removed several nodes. Civil Doc. 3-1 at ¶
the fact that she had a drain and despite her surgeon's
direction that she needed to see him about a week or less
after surgery, 11/03/2018--Bilton [Page 10, Doc. #6], BoP did
not return her for a post-operative visit until six weeks had
passed. Civil Doc. 3-1 at ¶ 22. When she finally saw the
surgeon again, he told her that she needed an oncology
appointment for potential chemotherapy, id., but
five months elapsed after her surgery and over three months
passed after her surgeon advised her to see an oncologist
before BoP took Ms. Beck to a medical oncologist to determine
appropriate treatment and therapy. Id. at
total, some seventeen months passed between the time medical
care providers at the prison learned about the lumps in Ms.
Beck's left breast, see Id. at ¶ 18; Civil
Doc. 3-3 at ¶¶ 5-6, and the time BoP allowed her to
consult with a medical oncologist. Civil Doc. 3-1 at ¶
23; see also Id. at ¶ 15 (noting chemotherapy
is sometimes implemented before surgery to help shrink
“invasive” and “extensive” tumors).
When BoP finally took her to see a medical oncologist on
April 3, 2019, the oncologist determined that it was too late
to begin chemotherapy, which must be instituted soon after
surgery to be effective. See 04/03/2019--Evans [BoP
311]; see also Civil Doc. 3-1 at ¶ 23. When BoP
took her to a radiation oncologist in May 2019, he similarly
determined that it was too late to begin radiation therapy.
05/03/2019--Crew [BoP 318].
Karen Winkfield, an experienced oncologist at Wake Forest
Baptist Comprehensive Cancer Center who reviewed Ms.
Beck's medical records, has testified that “with
respect to timing of systemic therapy following definitive
surgery, delays beyond 12 weeks (3 months) compromise both
recurrence free survival and overall survival.” Civil
Doc. 3-1 at ¶ 26. BoP waited well over three months
before taking Ms. Beck to see physicians who could order such
treatment. Id. at ¶ 23.
January 2019, Ms. Beck reported new lumps in her right breast
to prison medical officials, who confirmed the lumps. Civil
Doc. 3-3 at ¶ 15; 01/30/2019--Nikki [BoP 259] (noting
“firm nodule approximately golf ball size[d]” in
her right breast); 02/12/2019--Hunter-Buskey [BoP 276]
(noting “multiple lumps [in her] right breast; . . .
the first is walnut size[d] and the second is a small peach
size”). Nearly six weeks later, BoP took Ms. Beck for a
PET scan, which suggested the new lumps may be benign.
03/11/2019--Guarisco [BoP 287]. About two weeks after that,
BoP took her to see a surgeon, who noted a “solid
mass” and cyst in her right breast, observed that the
new masses “appear benign, ” and ordered a
puncture aspiration and ultrasound guidance.
03/27/2019--Bilton [USA Bilton 3-4]. BoP did not schedule a
further consultation with the surgeon until mid-June, nearly
three months after the initial surgical
evaluation.Civil Doc. 29 at ¶ 8; Civil Doc. 44 at
¶ 9. It appears Ms. Beck has received the tests and
procedures the surgeon ordered in March, Civil Doc. 45 at 4;
Civil Doc. 44 at ¶ 9, but there are still
“multiple nodularities” in her right breast and
the surgeon has ordered another ultrasound, noting the
potential need for a biopsy. Civil Doc. 45 at 5. Pursuant to
a court order to schedule recommended treatments, see
infra, BoP has scheduled the ultrasound and other
appointments. Civil Doc. 47 at ¶¶ 1-4.
noted supra, Dr. Winkfield, an experienced
oncologist, reviewed Ms. Beck's medical records. While
she was unable to determine from BoP's records
“whether the above delays in care . . . have resulted
in progression of [Ms. Beck's] cancer, ” Civil Doc.
3-1 at ¶ 27, Dr. Winkfield testified without dispute
that “[p]rompt evaluation is particularly important in
patients who have a family history of breast cancer”
and that the “delays in time to surgery and subsequent
delays in adjuvant therapy clearly raise a significant risk
of relapse and irreparable harm to Ms. Beck.”
Id. at ¶¶ 11, 27.
early December 2018, Ms. Beck through counsel asked the
Warden of FCI Aliceville to file a compassionate release
motion to reduce her sentence based on her medical condition
and the poor medical care she was receiving. Doc. 522-1 at 6.
On December 17, the Warden acknowledged receipt of the
request and explained BoP's general criteria for
evaluating such requests. Id. at 5. After over a
month of no action on the request, Ms. Beck submitted a
second request to BoP to file a compassionate release motion
on her behalf. Doc. 521-1 at ¶ 3. A week later, with no
BoP action on either request, Ms. Beck filed her motion for
compassionate release with this Court on January 24, 2019.
two months later, on the day the Government's response
was due, see Text Order 02/27/19, the Government
sought a stay so that BoP could finish its administrative
review of Ms. Beck's request. Doc. 510. Ms. Beck did not
object, id, and the Court granted the stay. Doc.
511. Another six weeks passed with no action by BoP on the
request, and on May 10, 2019, Ms. Beck initiated a civil suit
against several BoP officials and a private contractor,
alleging violations of her Eighth Amendment rights against
cruel and unusual punishment. Civil Doc. 1. She sought a
temporary restraining order and preliminary injunction. Civil
Doc. 3. BoP denied her request for a compassionate release
motion almost immediately thereafter. Doc. 521-1 at 8. The
same day, the Court lifted the stay and directed the
Government to file a response to her compassionate release
motion. See Text Order 05/13/2019; Doc. 521
(Government's response in opposition).
Court held a hearing on Ms. Beck's motion for a TRO in
her civil case on May 17, 2019. Civil Minute Entry
05/17/2019. On May 20, the Court entered a TRO compelling
three BoP officials in their official capacities to take
specific steps to provide urgent medical treatment to Ms.
Beck for her cancer. Civil Doc. 15; see also Civil
Doc. 16 (Amended TRO). The Court found that Ms. Beck had
shown a likelihood of success on the merits of her claim that
BoP officials' indifference to her life-threatening
medical condition and treatment violated her Eighth Amendment
rights. Civil Doc. 16. After another hearing, see
Minute Entry 06/05/2019, the Court extended the Amended TRO
while considering this motion and a motion for preliminary
injunction. Civil Doc. 40.
Court will address additional facts as needed in the context
of the issues presented.
law has long authorized courts to reduce the sentences of
federal prisoners facing extraordinary health conditions and
other serious hardships, but only under very limited
circumstances. Before passage of the First Step Act of 2018,
district courts could grant compassionate release sentence
reductions only upon a motion by the BoP
Director. See Pub. L. No. 98-473, ch. II(D)
§ 3582(c)(1)(A), 98 Stat. 1837 (1984); see also
Green v. Apker, No. 5:13-HC-2159-FL, 2014 WL 3487247, at
*2 (E.D. N.C. July 11, 2014) (collecting cases and noting
that “BOP's decision regarding whether or not to
file a motion for compassionate release is judicially
unreviewable”). Then as now, a defendant must satisfy
one of two statutory conditions before a court can grant a
BoP compassionate release motion: (i) the defendant
has to be at least 70 years old, have served at least 30
years in prison, and the BoP Director must have determined
the defendant was not a danger to the public; or
(ii) “extraordinary and compelling
reasons” warrant the reduction. 18 U.S.C. §
3582(c)(1)(A). When BoP files such motions, reviewing courts
also must consider the sentencing factors set forth in 18
U.S.C. § 3553(a) and can only grant reductions to
defendants who met the statutory requirements if the
reduction was “consistent with applicable policy
statements issued by the Sentencing Commission.” 18
U.S.C. § 3582(c)(1).
assist courts, the Sentencing Commission adopted U.S.S.G.
§ 1B1.13 as the applicable policy statement for motions
filed by the BoP Director under § 3582(c)(1)(A). The
guideline essentially repeats the statutory prerequisites and
adds only a requirement that the defendant must not be
“a danger to the safety of any other person or to the
community.” U.S.S.G. § 1B1.13(2).
application notes to § 1B1.13 are more specific. The
notes list three specific categories and examples of
“extraordinary and compelling reasons, ” along
with a fourth catch-all provision.
the notes discuss when a defendant's medical condition
(subdivision A), health and age together (subdivision B), or
family circumstances (subdivision C) will qualify. U.S.S.G.
§ 1B1.13, application note 1. Subdivision A provides
that a “medical condition of the defendant” may
qualify as an “extraordinary and compelling
reason” justifying a sentence reduction in several
different circumstances, such as when, inter alia,
the defendant has a “terminal illness.”
Id. at note 1(A)(i). Subdivision D acknowledges that
there may be other situations which constitute extraordinary
and compelling reasons and provides a non-specific blanket
authorization for early release, labeled “Other
Reasons.” Id. at note 1(D). That provision
allows compassionate release if, “[a]s determined by
the Director of the Bureau of Prisons, there exists in the
defendant's case an extraordinary and compelling reason
other than, or in combination with, the reasons described in
subdivisions (A) through (C).” Id.
2018, Congress passed the First Step Act. Pub. L. 115-391,
132 Stat. 5194. Among other things, it amended §
3582(c)(1)(A) to add a provision allowing courts to consider
motions by defendants for compassionate release without a
motion by the BoP Director so long as the defendant has asked
the Director to bring such a motion and the Director fails or
refuses. The First Step Act applies the same
statutory requirements to a defendant's motion for
compassionate release as previously applied, and still apply,
to motions by the Director: “extraordinary and
compelling reasons” must warrant the reduction,
court must consider the § 3553(a) ...