The Shield Summary Newsletter — September, 2026
Two federal appeals courts answered that question in the same week this month. On September 8, the Ninth Circuit held in Adom v. California Department of Corrections and Rehabilitation that a prison could not defend the abrupt cutoff of a wheelchair user’s incontinence supplies by pointing to a “no medical necessity” determination. Two days later, the Fourth Circuit held in Edwards v. Witherspoon that opioid use disorder is a disability and revived ADA and Section 504 claims arising from the denial of medication after childbirth. Neither case involves an exotic fact pattern. Both arise from routine operational decisions: a housing transfer, a supply order, a blanket medication policy.
That is why we built ADA Behind Bars: Legal Obligations, Operational Solutions & Risk Management, our national correctional ADA symposium, October 26–28 at the Horry County Sheriff’s Office J. Reuben Long Detention Center in Conway, South Carolina, which sits inside the Fourth Circuit. Seven faculty members will work through the legal obligations and, just as important, the operational fixes that keep a facility out of the cases described in this issue.
Every attendee receives an individualized correctional ADA self-assessment, valued at $750, covering jail operations, with Shield’s written analysis and a 30-minute telephone consultation to review the findings and next steps. Attendees also gain access to Shield’s correctional ADA resource library of checklists, templates, sample documents, and practical compliance tools that stays with you after the live program ends. The self-assessment alone is valued at more than the $595 regular registration fee, and the agency rate is $425 per person for three or more attendees. Seating is limited to 50.
You will find the verified case law, settlement data, and a practical framework for a defensible jail ADA program in the pages that follow.
Two September 2026 Decisions Every Jail Administrator Needs to Know
Within three days of each other, two federal circuits issued published decisions that revive disability claims by incarcerated plaintiffs. One holds that a medical-necessity determination does not end the ADA inquiry. The other recognizes opioid use disorder as a disability and reaches a blanket medication policy. Both are directly relevant to how jails handle accommodation requests.
Bilal Adom, incarcerated at Salinas Valley State Prison, has a chronic spinal condition that requires a wheelchair and causes urinary and fecal incontinence. From December 2020, the prison supplied him weekly incontinence supplies through its Durable Medical Equipment program, and a permanent order was entered in May 2021. After he transferred to a new yard in August 2021, the order was terminated in mid-September without any medical consultation. Adom made repeated written and verbal requests over the following days and was refused. A Reasonable Accommodation Panel formally denied the request on October 14, offering priority showers and extra linens instead, and a physician later determined the supplies were not medically necessary. Supplies were not restored until January 2022, roughly five months after the cutoff, during which Adom alleged he lived in his own waste and suffered severe spinal pain from nighttime cleanup. The Ninth Circuit reversed summary judgment for the defendants on the ADA claim. A reasonable jury could find that he was a qualified individual with a disability, that he was denied meaningful access to toileting and hygiene services, that the denial was by reason of his disability, and that the department acted with deliberate indifference, the standard required for damages. The court held that a public entity is not excused from providing a reasonable accommodation solely because it determined the accommodation was not medically necessary. The case was remanded for trial on damages, and the district court must first address standing for the requested injunction. Judge Bea dissented, reasoning that Adom failed to show medical necessity and that the denial rested on neutral eligibility criteria.
Practical Impact: Adom removes the most common institutional defense to an accommodation claim. Agencies frequently treat a clinician’s “not medically necessary” finding as the end of the analysis. The Ninth Circuit rejected that approach: medical judgment is reviewable, and decisions by doctors can themselves evidence deliberate indifference. The court also set out the practical test for damages: notice of the need for accommodation, followed by a failure to act adequately on that notice. Denying a request with only conclusory statements, and without a fact-specific inquiry into whether the accommodation is reasonable and feasible, is the pattern the court found a jury could treat as deliberate. Note that the case is not a final merits ruling and was decided over a dissent, so agencies should expect continued litigation over its scope.
Tracey Edwards was incarcerated at the North Carolina Correctional Institution for Women. She alleged that officials abruptly discontinued her medication for opioid use disorder after she gave birth, causing severe withdrawal, and that she was shackled shortly before, during, and after childbirth in violation of the prison’s own policy. The district court dismissed her claims. The Fourth Circuit reversed and remanded for trial. On the Eighth Amendment claims, the court held that shackling a pregnant woman during labor and immediately postpartum poses an objectively serious risk of harm, denied qualified immunity to the warden and the officers involved in the shackling, and concluded that a jury could find deliberate indifference where officials enforced a policy denying medication for opioid use disorder to all non-pregnant individuals. On the disability claims, the court held that the district court had wrongly treated them as pregnancy-related rather than disability-related, and it recognized opioid use disorder as a disability qualifying for protection under Title II of the ADA and Section 504 of the Rehabilitation Act, noting a growing recognition that substance use and opioid use disorder are disabilities.
Practical Impact: Edwards arose in a prison, but its reasoning applies with equal force to jails, where booking and detox decisions are made every day. Two points matter most. First, a categorical policy that withholds medication for opioid use disorder from a class of detainees is exposed under both the Eighth Amendment and the ADA, and individualized assessment cannot be replaced by a blanket rule. Second, once opioid use disorder is treated as a disability, requests for continued medication are accommodation questions and should be run through the agency’s ADA process, not only its medical formulary. Agencies in the Fourth Circuit, which includes South Carolina, Maryland, North Carolina, Virginia, and West Virginia, are directly bound.
Adom & Edwards: Four Rules for the Jail ADA Program
Read together, Adom and Edwards say the same thing from different directions: a correctional agency’s ADA obligations are not displaced by its medical system, and they are not satisfied by a policy that never asks the individual question.
The ADA’s accommodation framework is not linked to, or limited by, the medical system. In Adom, the Ninth Circuit held that a public entity may be obligated to provide a reasonable accommodation even when the accommodation has not been prescribed by a medical professional, and that a decision grounded in medical judgment remains reviewable. Adult diapers were not treated as medical treatment of the underlying condition; they were an accommodation that enabled access to toileting and hygiene services. Agencies should separate two questions that are often merged in practice: whether care is medically indicated, and whether an accommodation is needed for meaningful access.
The court described deliberate indifference under Title II as knowledge that harm to a federally protected right is substantially likely, followed by a failure to act on that likelihood, and said it may be inferred when an entity ignores or denies requested accommodations without sufficient inquiry. The facts a jury could rely on were ordinary: a supply order terminated without examining the detainee, four written requests in ten days with no accommodation for over a month, and denials supported by conclusory statements. A documented, individualized inquiry into what the person needs and whether the accommodation is reasonable and feasible is the best evidence against a deliberate-indifference finding.
The Ninth Circuit put the standard plainly: when a person with a disability can access a public entity’s services only by experiencing pain and humiliation, that access is likely not meaningful. Offering extra towels, priority showers, and a commode did not satisfy the obligation when the detainee still lived in his own waste. Substitute accommodations should be tested against the access the detainee actually receives, not against the agency’s view that something was offered.
Edwards pairs the Eighth Amendment and the ADA on this point. A policy that denies opioid use disorder medication to an entire category of detainees invites both a deliberate-indifference claim and a disability-discrimination claim, and the Fourth Circuit rejected the effort to recast the disability claims as something else. For jails, the operational lesson is that intake screening, medication continuity, and accommodation review must be capable of reaching the individual, including detainees in withdrawal.
A Note on Weight: Adom was decided 2–1, remanded for trial rather than resolved on the merits, and the Ninth Circuit has left standing for injunctive relief for the district court. Edwards was likewise remanded for trial. Agencies should treat these decisions as clear signals of how courts will frame the questions, not as final determinations of liability. Shield PST offers policy review and constitutional and ADA compliance assessment services. Contact us at staff@shieldpst.org or shieldpst.org.
Sixteen Million Dollars, Two Detainees, One Common Failure
Both of these matters involved a detainee whose serious condition was visible to staff, was explained away, and was not escalated to appropriate care in time. The pattern is the same one Adom describes: notice, followed by a failure to act.
Daniel Foard, 32, was booked into the La Plata County jail in Durango on August 11, 2023, on a failure-to-appear charge. After detoxification from fentanyl, jail medical staff cleared him for general population despite repeated collapses. When he later complained of severe abdominal pain and vomited repeatedly, nurses failed to recognize the symptoms of a perforated duodenal ulcer. He was placed in holding cells where he deteriorated, and staff dismissed his condition as fake or drug-related. An autopsy found a liter of cloudy brown fluid in his abdominal cavity. The suit, Foard v. Southern Health Partners, No. 1:25-cv-02223 (D. Colo.), alleged deliberate indifference to serious medical needs in violation of the Eighth and Fourteenth Amendments, systemic understaffing of the jail medical unit to reduce costs, and failure to train and supervise medical and custody staff. The county settled for $5 million, paid by its insurer. Claims against Southern Health Partners and its staff remain pending.
Agency Lesson: Attributing a detainee’s symptoms to drug use or malingering is the kind of conclusory dismissal that courts, including the Ninth Circuit in Adom, treat as evidence of deliberate indifference. Agencies should require escalation to a higher level of care when a detainee coming out of detox continues to collapse or reports severe pain, and should audit contractor staffing levels rather than assume the vendor contract transfers the risk.
Reneyda Aguilar-Hurtado, 50, died on June 12, 2023, after 85 days in the DuPage County Jail awaiting transfer to a state mental health facility. She had been ordered unfit to stand trial on a misdemeanor battery charge. A deputy found her unresponsive on her mattress; she suffered cardiac arrest at the hospital and could not be revived. She had lost approximately 60 pounds in custody. The pathologist attributed her death to multisystem organ failure caused by failure to thrive due to psychotic disorder, and noted that self-neglect and medical neglect contributed significantly. The federal lawsuit alleged deliberate indifference to health and safety and a widespread practice and policy of failing to protect critically ill detainees, citing approximately a dozen other detainees’ complaints of inadequate care. A judge approved an $11 million settlement in February 2025. The family’s attorney stated that the county made real and substantial changes, including revised training, administrative oversight, and procedures for urgent hospital transfers of detainees with mental illness.
Agency Lesson: Detainees found unfit to stand trial are among the most vulnerable people in a jail, and long waits for a state hospital bed do not suspend the county’s duty of care. A written protocol for weight loss, refusal of food or medication, and urgent transfer, together with documented supervisory review, is the type of measure the county adopted after the fact. This settlement predates 2026 and is included here because it is a leading example of the exposure attached to serious mental illness in custody.
Building a Defensible Jail ADA Program
The ADA has applied to jails for more than a quarter century. What has changed is how consistently courts, the Department of Justice, and class-action counsel now test what agencies actually do, rather than what their policies say.
The Supreme Court held unanimously in Pennsylvania Department of Corrections v. Yeskey, 524 U.S. 206 (1998), that Title II unambiguously extends to state prisons and their inmates. The decisions in this issue build on that foundation. In Weldeyohannes v. State of Washington (9th Cir. Dec. 19, 2025) (published), the Ninth Circuit reinstated ADA, Rehabilitation Act, and Eighth Amendment claims by a wheelchair-using prisoner who was moved to a standard bus after a records error understated his transport needs, reasoning that officials must conduct a fact-specific investigation when an accommodation is requested. That is the same duty Adom describes less than nine months later.
On September 5, 2025, the Department of Justice’s Civil Rights Division and the Arkansas Division of Correction entered an agreement under Title II covering the Ouachita River Unit in Malvern, which has a capacity of 1,782 and includes a special needs unit. The agreement requires barrier removal in cells, restrooms, showers, medical areas, and dining facilities for people with mobility disabilities; regulation of shower water temperature to prevent scalding injuries to paralyzed inmates who lack sensation; provision of medically necessary durable equipment such as trapeze bars, transfer boards, and patient lifts; and appropriate wound care and catheter maintenance. The agreement is a useful checklist of the physical and medical access items federal investigators examine in a correctional setting.
In Westmoreland v. Dart (N.D. Ill.), a polio survivor who used a cane was assigned a top bunk despite medical directives requiring a lower bunk, fell, and was left permanently in a wheelchair; the Cook County Jail resolved that injury claim for $1.85 million, approved in January 2024. A separate ADA challenge to the lack of compliant ramps in the jail’s Residential Treatment Unit was certified as a class action on September 2, 2025, on behalf of detainees who use wheelchairs to traverse those ramps. Both matters turn on the same operational link: information about a disability must reach the people who assign housing and manage physical access.
ADA Behind Bars · October 26–28, 2026 · Conway, South Carolina. Every attendee receives an individualized correctional ADA self-assessment, valued at $750, covering jail operations, with Shield’s written analysis and a 30-minute telephone consultation to discuss the findings, answer questions, and review next steps. Attendees also access Shield’s correctional ADA resource library: checklists, templates, sample documents, practical compliance tools, and other materials intended to serve as a continuing resource after the live program concludes. Held at the Horry County Sheriff’s Office J. Reuben Long Detention Center. Seating is limited to 50. Regular registration is $595; the agency rate is $425 per person for three or more attendees from the same agency.
Three steps close much of the exposure the cases above describe. First, make sure disability information captured at intake and classification actually reaches housing, medical, and disciplinary decision-makers. Second, replace any blanket rule that decides an accommodation or medication question for a whole category of detainees with an individualized review. Third, document the inquiry: who asked, what was asked, what alternatives were considered, and why the final decision was reasonable. The ADA Behind Bars self-assessment is designed to test exactly these points against your own facility.
Compliance Begins at Intake
ADA Behind Bars is organized around the decision points below, because that is where jail ADA exposure is created and where it can be controlled.
ADA issues in correctional settings often begin as routine operational decisions involving housing, mobility, communication, medical needs, discipline, or access to programs. The framework below follows those decision points.
Title II prohibits a public entity from excluding a qualified individual with a disability from, or denying the benefits of, its services, programs, and activities, or otherwise subjecting the person to discrimination. Yeskey confirmed that this reaches state correctional facilities, and the same logic applies to county jails and detention centers. Section 504 of the Rehabilitation Act imposes parallel obligations on programs that receive federal funds. A jail’s “services, programs, and activities” include housing, classification, medical and mental health care, communication, recreation, visitation, work and education programs, and discipline. Nothing in the jail environment is outside the statute by default.
A disability that is not identified at booking cannot be accommodated in housing, discipline, or programs. The Westmoreland and Weldeyohannes facts both turn on information that existed on paper but did not reach the person making the decision. Intake screening should capture mobility, communication, sensory, chronic medical, and behavioral health needs, and the results should travel with the detainee to classification, housing, medical, and the shift supervisor. Under Edwards, screening should also identify detainees who are on, or in need of, medication for opioid use disorder.
A public entity must make reasonable modifications to policies, practices, and procedures when necessary to avoid discrimination on the basis of disability, unless the modification would fundamentally alter the nature of the service. The regulation is at 28 C.F.R. § 35.130(b)(7). Adom gives the standard practical meaning: the question is whether the person has meaningful access, not whether the same rule was applied to everyone, and a “not medically necessary” determination does not answer it. Common operational gaps include mobility barriers, communication access for deaf and hard-of-hearing detainees, chronic conditions that require supplies or equipment, and behavioral health needs.
Disciplinary decisions involving people with disabilities increase ADA exposure because rule violations can arise from an unmet disability-related need, such as a detainee who cannot hear or understand a command, or one whose serious mental illness affects behavior. Before imposing discipline, restrictive housing, or force, staff should ask whether a modification or accommodation was needed and whether it was provided. The same inquiry belongs in the file when the answer is no.
Injunctive relief under Title II does not depend on intent, but damages generally require deliberate indifference, which Adom frames as notice of the need for accommodation followed by a failure to act adequately. That makes process records the central defense: the request, the inquiry, the alternatives considered, the decision, and the reasons. Public entities with 50 or more employees must designate an ADA coordinator and adopt a grievance procedure under 28 C.F.R. § 35.107, and a functioning coordinator role is often the difference between a request that is resolved and one that becomes a lawsuit.
Test these five points against your own facility. The ADA Behind Bars correctional ADA self-assessment, valued at $750 and included with every registration, applies this framework to your jail operations and comes with Shield’s written analysis and a 30-minute consultation. Register at shieldpst.org.
2026 Shield PST Training Calendar
| Date | Event | Location | Type |
|---|---|---|---|
| Sept16 / 23 / 30, 2026 |
AI-Assisted Police Reports: The Emerging Legal Landscape
Three-session live virtual program, 9:00 AM–1:00 PM PDT each day · Jeb Brown, John G. Peters Jr., Neil Okazaki, Rodney Hill, Jay Stanley, Chief Jay Hart (Ret.) · $495 standard; agency rates at shieldpst.org · Register at shieldpst.org
|
Online | Virtual Program |
| October26–28, 2026 |
ADA Behind Bars: Legal Obligations, Operational Solutions & Risk Management
National Correctional ADA Symposium · Jeb Brown, John G. Peters Jr., Mitch Lucas, Kathleen Totemoff, Donald Leach, Jerry Gutierrez, Marcus Rhodes · $595 regular / $425 agency (3+) · 50 seats only · Every attendee receives a $750-value correctional ADA self-assessment (written analysis plus a 30-minute consultation) and access to Shield’s resource library of checklists, templates, sample documents, and compliance tools · Register at shieldpst.org
|
Conway, SC J. Reuben Long Detention Center |
Symposium |
| Nov 30–Dec 2, 2026 |
Advanced Internal Affairs Seminar
In-person seminar · Mon/Tue 9:00 AM–5:00 PM, Wed 9:00 AM–12:00 PM · Program details at shieldpst.org
|
TBD | Live Program |
AI Police Reports: $495 standard · ADA Behind Bars: $595 regular / $425 agency (3+), includes $750-value self-assessment and resource library access · Registration and program details at shieldpst.org
