Reported / Citable
Background
Bilal Adom, an incarcerated person at Salinas Valley State Prison, has spinal pain and incontinence. Prison staff supplied adult diapers for nearly a year through California’s durable-medical-equipment program. After a housing transfer, staff ended that access. Adom repeatedly sought restoration but went almost five months without the supplies, which he said he needed to use prison toileting and hygiene services safely and with dignity.
Adom sued the California Department of Corrections and Rehabilitation under Title II of the Americans with Disabilities Act (ADA), which prohibits public entities from excluding qualified people with disabilities from their services. The district court granted CDCR summary judgment, largely accepting the view that supplies were not medically necessary. Adom sought damages, declaratory relief, and an injunction requiring a permanent accommodation.
The Court’s Holding
The Ninth Circuit reversed in a divided published opinion. A reasonable jury could find that Adom was disabled through his spinal condition, incontinence, or both; that diapers were necessary for meaningful access to prison toileting and hygiene; and that the denial occurred by reason of disability because his conditions made those services harder to use. Title II’s access inquiry is not identical to a clinician’s medical-necessity determination.
The record also permitted a jury to find deliberate indifference, the heightened showing required for damages. Officials allegedly knew about his symptoms and accommodation requests yet repeatedly ended or denied supplies without an adequate investigation. The court held expressly that a public entity is not excused from its ADA accommodation obligation solely because it decides an accommodation is not medically necessary or indicated. The panel remanded the injunction issue for a first-instance standing analysis. Judge Bea dissented, reasoning that medical necessity defined qualification for the relevant service and that the record did not show deliberate indifference.
Key Takeaways
- Title II focuses on meaningful access to a public service, not only whether a requested item satisfies an agency’s medical-necessity criteria.
- A disability may qualify under the ADA when it substantially limits basic bodily functions or activities such as toileting.
- An accommodation that allows hygienic and dignified use of existing services can be reasonable even when officials dispute its clinical indication.
- Damages require proof of deliberate indifference, but repeated denials after notice and an inadequate investigation may create a jury issue.
- Prospective injunctive relief separately requires Article III standing based on a real ongoing or future injury.
Why It Matters
California public agencies should not let internal benefit or medical-equipment rules substitute for an ADA analysis. Decisionmakers must identify the underlying service, assess how disability impedes meaningful access, and consider reasonable modifications on their own terms.
For practitioners, the decision offers a useful framework for separating three questions that are often blurred together: disability and qualification, denial of meaningful access, and the deliberate-indifference showing needed for money damages.
The decision arose at summary judgment, so the panel did not finally decide that Adom was disabled, entitled to diapers, or owed damages. It decided that a jury could resolve those disputed points in his favor. Agencies defending similar cases should therefore preserve contemporaneous evidence showing who considered the request, what access problem was evaluated, what alternatives were offered, and why the response was reasonable—not rely after the fact on the label “not medically necessary.”