Prisons – Compassionate release denied despite end-stage renal disease

Where an inmate argued he was entitled to compassionate release due to his end-stage renal disease, the district court did not abuse its discretion in denying his motion. Although terminal illness can be an extraordinary and compelling reason for granting a sentence reduction, his medical records showed he was responding well to treatment.

Background

Brad Acy Holley moved for compassionate release due to his end-stage renal disease. The district court denied his motion, finding that the particular circumstances of his medical condition did not constitute an extraordinary and compelling reason for a sentence reduction.

Terminal illness

The district court did not question that terminal illness can be an extraordinary and compelling reason for granting a sentence reduction. However, it found that Holley was not suffering from a terminal illness. Terminal illness refers to “a serious and advanced illness with an end-of-life trajectory.” The district court found that medical records indicated “that he [was] responding well to treatment.”

Holley does not contend on appeal that the district court misinterpreted his medical records. Instead, he cites statistics showing that the average life expectancy for patients on dialysis is only five to ten years. But generalized statistics tell little about Holley’s particular condition. Both Holley and the government agree that patients can live for 20 or even 30 years on dialysis. The district court was therefore justified in focusing on Holley’s specific medical records rather than statistical probabilities about a broader patient population.

Holley disagrees with this individualized approach. In his view, end-stage renal disease is categorically a terminal illness. Aside from the statistical evidence, he points out that end-stage renal disease is irreversible and fatal if left untreated. He also makes much of the fact that the Sentencing Commission’s applicable policy statement expressly lists “end-stage organ disease” as an example of a terminal illness.

This court cannot accept Holley’s categorical view. While end-stage organ disease can be a terminal illness, nothing in the Commission’s policy statement indicates that it should be regarded as one in every instance. Such a per se rule would needlessly distort the meaning of the term “terminal illness” and undermine the discretion that district courts are generally afforded in this context.

If treatment is effective in stabilizing the disease, then a district court could reasonably find that it does not currently have an end-of-life trajectory. That is the case here.

Care

Holley alternatively claims that his end-stage renal disease warrants compassionate release because it “requires long-term or specialized medical care that is not being provided and without which [he] is at risk of serious deterioration in health or death.”

The district court found that the Bureau of Prisons, or BOP, is providing him with “regular, thorough care.” Indeed, Holley himself acknowledged in his motion that he is being provided with several daily medications, dialysis three times a week, monthly consultation with a kidney specialist and regular monitoring by a physician assistant.

Holley instead, he claims the medical care he requires to preserve his health is a kidney transplant, which he is “highly unlikely to receive . . . in prison.” For support, Holley again cites generalized statistics rather than the record in this case.
There is good reason for Holley to ignore the record. Nothing in it suggests that he cannot receive a kidney transplant while incarcerated. In fact, when Holley mentioned his desire for a kidney transplant in his application for a sentence reduction, the BOP told him to speak with his doctor about the possibility. Holley’s briefs do not point to anything in the record that suggests he ever did so.

The government adds that BOP policy allows inmates to receive transplants. And even the statistics Holley cites indicate that transplant centers are willing to provide organ transplants to prisoners. In any event, the likelihood that Holley will receive a kidney transplant once he is released from prison is similarly speculative.

Assistance

Holley next claims that the district court erred in denying Holley’s request for the appointment of counsel and an expert witness. This court has previously concluded that a motion for a reduction in sentence does not require appointment of counsel. And Holley’s motion ably articulated the relevant legal and factual bases for his claim. Finally, after reviewing Holley’s medical records, the district court reasonably determined that it did not require the aid of a medical expert to understand the issues presented.

Affirmed.

United States v. Holley, Case No. 25-6765, July 1, 2026. 4th Cir. (Wilkinson), from SDWVA at Huntington (Chambers). Zachary Ryan Rohrbaugh for Appellant. Gabriel Caleb Price for Appellee. VLW 026-2-233. 10 pp.

Full-Text Opinion