For those into baseball, the last week of the season is going to be pretty wild with several wildcard teams trying to figure out positioning and some even trying to figure out if they are going to make the playoffs at all. Good luck to your teams. Also, I was honored to receive the Federal Bar Association Sarah T. Hughes Civil Rights Award over the weekend in Richmond, Virginia. I have never given a speech before where I had to read my remarks. Fortunately, it went well. It was also great to attend the convention and meet everyone, including many that I consider good friends.
Turning to the blog entry for the week, it is a published decision of the Ninth Circuit decided on September 8, 2026. The case, Adom v. California Department of Corrections and Rehabilitation, here, which runs 134 pages, involves a lawsuit alleging that the prison did not provide medical care for a prisoner with a disability in accordance with its Title II obligations. What makes this case unusual, is the court’s in-depth analysis on why a Title II claim survives summary judgment. In an unpublished memorandum decision, the Ninth Circuit allows an Eighth Amendment claim, with a dissent, to go forward against one of the defendants. I am not going to focus on the memorandum decision, but rather just on the published decision discussing Title II of the ADA. For that matter, I am not going to focus on the dissent to the published opinion either, as I had real trouble following it. As usual, the blog entry is divided into categories, and they are: facts; why plaintiff is a qualified individual with a disability; why plaintiff was denied services by reason of his disability; why plaintiff’s damages claims can go forward; why the injunctive relief claim needs to be remanded for further consideration by the trial court; and thoughts/takeaways (there are lots of them). Of course, the reader is free to focus on any or all of the categories.
I
Facts
Adom has a spinal condition that causes him chronic, severe pain and significantly limits his mobility. He underwent spinal surgery in 2008 and has an active recommendation for a second surgery. He is also a stroke survivor. Adom uses a wheelchair to get around and wears a prison-issued vest that signals he is mobility impaired. Since 2020, Adom has suffered incontinence. He is unable to control his urinary evacuations, particularly at night, and sometimes also involuntarily evacuates stool. For nearly a year after Adom’s incontinence symptoms emerged, prison staff provided him with incontinence supplies, adult diapers, through CDCR’s Durable Medical Equipment and Medical Supply program. After Adom was transferred to a different housing unit, prison staff terminated his access to these supplies. Adom repeatedly requested restored access, but his requests were denied for nearly five months. The trial court granted summary judgment to the defendant and Adom (plaintiff), appealed to the Ninth Circuit.
II
Why Plaintiff Is a Qualified Individual with a Disability
- A qualified individual under Title II of the ADA is a person who with or without reasonable modifications meets the essential eligibility requirements for the receipt of services or the participation in programs or activities provided by a public entity.
- The services plaintiff seeks are available to those, like the plaintiff, who are incarcerated. Plaintiff is therefore qualified to receive all relevant services.
- Plaintiff is also a person with a disability as he has a spinal condition and incontinence, which are physical impairments. He also is substantially limited in the major life activities of bowel and bladder functions.
- After the amendments to the ADA, the question of whether an individual’s impairment is a disability under the ADA should not demand an extensive analysis.
- Plaintiff’s incontinence qualifies as a disability even though his doctor did not initially understand its medical basis or believe that diapers were medically necessary.
- Neither the statute, regulation, nor case law require a medical diagnosis or a doctor’s determination of a medical need in order for a condition to qualify as a disability under the ADA.
- The ADA does not require a one-to-one analysis of impairments and substantial limitations. That is, construing the meaning of disability broadly, multiple intersecting impairments may contribute to the same substantial limitations on a major life activity.
- The ADA entitles inmates to receive the benefits of an incarcerating institution’s programs and services without facing discrimination on account of a disability.
- California Department of Corrections and Rehabilitation provides services of toileting and hygiene, i.e. providing the means for inmate to urinate and defecate, as well with the means to keep themselves clean.
- California regulations demand that the California Department of Corrections and Rehabilitation must provide the means for all incarcerated person to keep themselves and their living quarters clean and to practice good health habits.
- The broad language of Title II brings within its scope anything a public entity does.
- California Department of Corrections and Rehabilitation has an affirmative obligation to provide the plaintiff with meaningful access to the benefits of its services.
- A reasonable jury could find that plaintiff was denied meaningful access to the benefit of the California Department of Corrections and Rehabilitation’s toileting and hygienic services because he needed the accommodation of adult diapers to enjoy those benefits on par with the rest of the prison population.
- When a person with disability can access a public entity’s services only by experiencing pain and humiliation, that access is likely not meaningful.
- For a person with disabilities, meaningful access to the benefits of toileting and hygiene services may require more than physical access to a toilet, sink, and shower.
- Title II instructs that the requisite access for a person with a disability may be achieved through reasonable modification to rules, policy, or practices or the provision of auxiliary aids and services. Since plaintiff urinates involuntarily, without notice, and often in the middle the night, structurally accessible facilities fall short of providing the plaintiff a dignified and hygienic way to manage his bodily functions. Accordingly, a jury could find that the California Department of Corrections and Rehabilitation alternative accommodation did not suffice to ensure plaintiff meaningful (emphasis in opinion),
- The California Department of Corrections and Rehabilitation treated the plaintiff the same (emphasis in opinion), as inmate without disabilities when the ADA required it to treat the plaintiff differently (emphasis in opinion).
- The purpose of the ADA’s reasonable accommodation requirement is to guard against the façade of equal treatment when particular accommodations are necessary to level the playing field.
- Plaintiff sufficiently alleged the general theory of his ADA claim (denial of services by reason of disability), and the nucleus of facts entitling him to relief (the denial of incontinence supplies and the ways in which that denial left him unable to cleanly and humanely relieve himself).
III
Why Plaintiff Was Denied Services by Reason of His Disability
- The phrase “by reason of such disability,” does only a modest work of requiring a connection between the alleged disability and the alleged denial of benefits.
- Plaintiff’s incontinence and spinal condition made it harder for him to enjoy the benefits of toileting and hygiene services without diapers. Therefore, a clear basis in fact exists for a jury to conclude that there is a connection (the legal term is “nexus,” which is the one the court uses), between plaintiff’s disabilities and a benefit that he was denied.
IV
Why Plaintiff Damages Claims Can Go Forward
- To establish deliberate indifference under the ADA, a plaintiff has to show that the public entity: 1) was on notice as to the need for accommodation; and 2) failed to adequately act on that notice.
- When a plaintiff has alerted the public entity to his need for an accommodation (or where the need for accommodation is obvious, or required by statute or regulation), the public entity is on notice that an accommodation is required, and the plaintiff has satisfied the first element of the deliberate indifference test.
- As to the requirement of failing to adequately act on the notice, an adequate response requires at a minimum, that the public entity undertake a fact specific investigation to determine what constitutes a reasonable accommodation. Such investigation must gather sufficient information from the individual with the disability and, where necessary, qualified experts, to understand the individual’s needs.
- An alternative accommodation is not an adequate response if it fails to provide meaningful access to the benefits of the service at issue.
- If a public entity denies a request for specific accommodation, it must demonstrate that it inquired as to the feasibility of the request and why it would be unreasonable or could not be accommodated.
- Providing one accommodation does not necessarily defeat the argument that the public entity was deliberately indifferent to the need for different accommodations.
- Deliberateness may be inferred when the public entity ignores or denies requested accommodations without sufficient inquiry.
- In a footnote, the court noted that deliberate indifference under Title II of the ADA is a different standard than the deliberate indifference standard under the Eighth Amendment.
- It is unlikely that an investigation is adequate when a public entity fails to gather new information before terminating a prior accommodation.
- California Department of Corrections and Rehabilitation abruptly terminated plaintiff’s order for weekly incontinence supplies, which he was previously receiving without issue. The abrupt termination could amount to a rejection of a plaintiff’s prior express request for accommodation and is an affirmative act from which a jury could infer deliberateness.
- California Department of Corrections and Rehabilitation only had access to the same medical records on which prior staff relied upon to conclude that plaintiff needed a permanent supplies order, and that no medical or custodial staff examined or interviewed the plaintiff to understand whether he no longer needed diapers. It is unlikely that an investigation is adequate when a public entity fails to gather new information before terminating a prior accommodation.
- A reasonable factfinder could conclude that the California Department of Corrections and Rehabilitation failed to conduct an adequate investigation before terminating the supplies order.
- A rational factfinder could also conclude that the California Department of Corrections and Rehabilitation acted with deliberate indifference when it ignored and summarily rejected plaintiff’s repeated pleas to reinstate his supplies order.
- A jury could conclude that the California Department of Corrections and Rehabilitation acted with deliberate indifference when it repeatedly rejected plaintiff’s requested accommodation without investigating whether it was reasonable and feasible.
- Viewing the facts in plaintiff’s favor, accommodations given by the California Department of Corrections and Rehabilitation did not provide the plaintiff with meaningful access to the benefits of its services. That is, half-solutions rather than granting the plaintiff the accommodation he requested that he had been previously provided could be found to be deliberate indifference.
- Disabilities within the meaning of the ADA are not limited to conditions with clear diagnoses or medical indications.
- The ADA creates a framework of disability and accommodation that is not directly linked to the medical system or limited to medical accommodation programs.
- A public entity may be obligated to provide a reasonable accommodation even when the accommodation has not been prescribed by a medical professional and even when state policy requires the prior identification of the medical condition before issuing supplies through a medical equipment program.
- It cannot be the case that an individual with a disability has no recourse under the ADA when he is left to live and sleep in his own waste, simply because the precise medical cause of his incontinence is elusive or because the existing accommodation programs are inadequate. Any other result would give an institutional actor that controls the relevant medical staff total control over the realization of the protections afforded by the ADA, which simply cannot be the case. Such an approach would undermine the Supreme Court’s holding, here, that Title II of the ADA applies with full force to State prisons.
- The denial of a disability accommodation is reviewable even when it is grounded in medical judgment, and decisions by doctors can evince deliberate indifference.
- The cases cited by the dissent do not stand for the proposition that medical judgments insulate public entities from ADA liability.
- Public entities are vicariously liable for the acts of their employees in violation of Title II of the ADA.
V
Why the Injunctive Relief Claim Needs to Be Remanded for Further Consideration by the Trial Court
- Plaintiff must demonstrate that at the beginning of the litigation, he had a reasonable fear that his access to incontinence supplies would again be abruptly terminated. That is, he must show there is at least a substantial risk that the harm will occur.
- An insufficient record exists to assess the likelihood of whether the harm will occur again.
- While the parties agree that plaintiff has been receiving incontinence supplies since the commencement of the litigation, it is not clear whether he has received those supplies pursuant to a formal order or by the mere good graces of the California Department of Corrections and Rehabilitation. The record doesn’t show when plaintiff’s last temporary order was set to expire, how temporary orders are set up to renew, or whether at the time of filing, there was a risk that the latest temporary order would expire before new temporary order could be approved.
- On remand, the district court should clarify the nature and duration of the accommodation order in place at the time the action was filed, whether there is a substantial risk that plaintiff will experience another abrupt termination of incontinence supplies when they are indicated by his status, and whether a permanent order or other injunctive relief would remedy that risk.
VI
Thoughts/Takeaways
- This case does an amazing job of drilling into the essence of the ADA and those thoughts can be applied on a preventive law level to many different contexts.
- I have seen cases of late talking about medical necessity for a reasonable accommodation. This case directly, correctly so in my opinion, contradicts those cases.
- A variety of impairments may operate together in order to form a substantial limitation on a major life activity.
- Title II covers anything a public entity does.
- Meaningful access is the standard for Title II cases, particularly when it comes to failure to make reasonable modifications.
- Experiencing pain and humiliation is not meaningful access if that is what is necessary to benefit from a public entity’s services.
- Structural accessibility may not be enough for certain disabilities, and is not a get out of jail free card for all disabilities.
- The ADA requires persons with disability to be treated differently and not the same as everyone else.
- The ADA reasonable accommodation requirements exist for the purpose of leveling the playing field (I have referred to this concept for over 25 years now, as getting the person with a disability to the same starting line as a person without a disability).
- Causation (“by reason of such disability”), is not a high requirement. That said, readers are also encouraged to check out this blog entry, here, discussing the Supreme Court’s Bostock decision.
- Deliberate indifference under the ADA has a different meaning despite the terminology being the same, from deliberate indifference in Eighth Amendment jurisprudence.
- Check out your jurisdiction as to how it deals with deliberate indifference under the ADA. While the leading case is the one we discussed here, not all jurisdiction go about it the same way.
- Magic words are not required to put an entity on notice that an accommodation is required. If the disability is obvious or required by statute or regulation, notice is presumed.
- An adequate response to a request for a reasonable modification, requires a public entity to undertake a fact specific investigation to determine what constitutes a reasonable accommodation. Preventive law would suggest an interactive process. Regardless, a thorough individualized analysis is most certainly required.
- Any accommodation must provide meaningful access to the benefits or service at issue.
- Where a public entity denies a request for an accommodation, then it is up to the public entity to show it inquired as to the feasibility of the request and why it was unreasonable or cannot be accommodated. Keep in mind, Title II of the ADA’s final implementing regulations, here, require the head of a public entity to certify that the reasonable accommodation request would lead to a fundamental alteration or an undue burden.
- An investigation is not adequate when the public entity failed to gather new information before terminating a prior accommodation. Employers would also do well to keep this statement of the court in mind. I have seen too many cases where an employee’s accommodation is terminated without gathering new information prior to the termination, particularly upon a change in supervisors. Definitely look for plaintiff employment lawyers to seize on this particular language of the opinion in cases where there was a termination of an existing accommodation without any inquiry into whether a change in circumstances warranted such a termination.
- A clear medical diagnosis is not necessary to establish a disability under the ADA.
- The ADA framework of disability and accommodation is not directly linked to the medical system.
- A public entity may be required to provide a reasonable accommodation even when the accommodation has not been prescribed by a medical professional and even when state policy requires prior identification of the medical condition before issuing supplies through a medical equipment program.
- The denial of a disability accommodation request is reviewable even when it is grounded in medical judgment.
- Jurisdictions are definitely split on the vicarious liability for the acts of public entity employees. In the Ninth Circuit, there is vicarious liability. Other circuits use a different standard. Also, in the 11th Circuit, an individual employed by a public entity can be individually liable for any retaliation per this case (I know of no other U.S. Court of Appeals that has remotely approached Shotz). Eventually, the Supreme Court is going to have to figure vicarious liability for public entities for the discriminatory actions of their employees.