Cruz was arrested for assaulting, resisting, or impeding Social Security Administration employees and two counts of threatening a federal law enforcement officer. The district court granted a judgment of acquittal on Count I, and a jury returned guilty verdicts on Count II and Count III. After the court received the pre-sentence investigation report, the prosecution successfully moved for a determination of competency. A Federal Bureau of Prisons forensic psychologist concluded that Cruz was mentally incompetent and suffered from schizophrenic disorder, bipolar type. After a hearing, the court concluded that Cruz was incompetent and found that he could not proceed with sentencing. A second report concurred with the diagnosis, noted Cruz’s ongoing refusal to take anti-psychotic medication recommended by BOP personnel, concluded that without medication Cruz would remain incompetent, and stated that “there is a substantial probability that [his] competency can be restored with a period of” forced medication. The prosecution obtained an order authorizing the BOP to medicate Cruz against his will. The Third Circuit affirmed, citing the Supreme Court decision, United States v. Sell (2003), and reasoning that the government can have a sufficiently important interest in forcibly medicating a defendant to restore his mental competency and render him fit to proceed with sentencing.

