The Fifth Circuit affirmed the district court’s denial of Jason Keller’s federal habeas corpus petition, ruling that the Mississippi Supreme Court did not unreasonably apply clearly established federal law or make unreasonable factual determinations regarding the admissibility of a confession Keller made while in an intensive care unit (ICU). Under the Antiterrorism and Effective Death Penalty Act (AEDPA), 28 U.S.C. § 2254(d), the court applied a highly deferential standard, requiring that relief be granted only if the state court’s decision was contrary to Supreme Court precedent or involved an unreasonable application of such law, or was based on an unreasonable determination of facts. The court addressed four specific arguments raised by Keller regarding the ICU statement: 1. **Fruit of the Poisonous Tree:** The court held that the doctrine did not require suppression because the prior Emergency Room (ER) statements were excluded only for *Miranda* violations, not due to actual police coercion violating the Due Process Clause. Under *Oregon v. Elstad*, a subsequent confession is admissible if it is voluntary and not the product of actual compulsion, which was absent here as the trial court found no coercive police activity during the ER interrogations. 2. **Deliberate Exploitation of Miranda (*Missouri v. Seibert*):** The court ruled that *Seibert*, which prohibits a “question-first” interrogation strategy designed to undermine *Miranda* warnings, was inapplicable. The Fifth Circuit found no evidence of the two-step technique contemplated by *Seibert*, noting significant differences in timing (11 hours elapsed), setting (ER vs. ICU), and police conduct, as officers approached the ICU interview anew without relying on prior confessions. 3. **Voluntariness:** Applying the totality of circumstances test from *Colorado v. Connelly* and *Schneckloth v. Bustamonte*, the court affirmed that coercive police activity is a necessary predicate for finding a confession involuntary. The court found it reasonable for the state court to conclude that Keller’s mental state, influenced by morphine and cocaine, did not render his statement involuntary in the absence of specific police overreaching or psychological pressure. 4. **Valid *Miranda* Waiver:** Relying on *Berghuis v. Thompkins*, the court agreed with the state court that Keller’s waiver was valid even if implied rather than express. The record supported a finding that Keller understood his rights, appeared coherent and alert, and voluntarily engaged in a detailed narrative confession. As a practical consequence of this affirmation, the judgment of the district court denying habeas relief stands, and the Mississippi Supreme Court’s decision upholding Keller’s conviction and death sentence remains in effect. No further federal relief is available on the certified issue regarding the ICU statement.