## Facts

- April Cadena was arrested on June 23, 2014, and booked into the El Paso County Detention Facility shortly after right-leg surgery with medical instructions for “no weight bearing” and wheelchair use.
- During medical intake, Cadena stated she could not walk and used a wheelchair; an intake form noted recent knee surgery but recorded she could “stand independently” because she stood when asked.
- A jail physician ordered pain medication, follow-up orthopedic care, crutches, a lower bunk, and wound care.
- Cadena testified her wheelchair was taken after intake and she overheard staff state there was no space for a wheelchair user.
- Cadena repeatedly requested a wheelchair and other adjustments; she told officers she could not safely use crutches, stumbled while attempting to do so, and was caught before falling.
- A nurse practitioner allegedly ordered a wheelchair, but it was not provided.
- The facility required inmates to walk in line to receive meals and carry trays back; Cadena requested a modified meal procedure due to her mobility limits, and officers refused.
- While using crutches to carry a meal tray, Cadena fell and alleged severe pain and nerve damage, along with denial or delay of additional medical evaluation.
- Cadena sued the County under Title II of the ADA and under 42 U.S.C. § 1983 for unconstitutional conditions and deliberate indifference to medical needs; the district court granted summary judgment to the County on both claims.

## Issues

1. Whether evidence could permit a reasonable jury to find that the County, a public entity, intentionally denied Cadena reasonable accommodations for a disability in violation of Title II of the ADA, permitting compensatory damages.
2. Whether the County’s actions regarding mobility-related conditions and medical care amounted to unconstitutional conditions of confinement or deliberate indifference to serious medical needs under the Fourteenth Amendment, actionable under § 1983.

## Decision

- The Fifth Circuit affirmed in part, reversed in part, and remanded.
- The court reversed summary judgment on the Title II ADA claim, holding a jury could find Cadena was denied effective, reasonable accommodations and that the denial was intentional (deliberate indifference).
- The court affirmed summary judgment on the § 1983 claim, holding the record did not show an unconstitutional condition of confinement or medical care so deficient as to constitute deliberate indifference.

## Legal Principles

- Title II ADA liability requires a qualified individual with a disability, denial of benefits or discrimination in a public entity’s services/programs/activities, and causation by reason of disability.
- Compensatory damages under Title II in the Fifth Circuit require intentional discrimination, commonly shown by deliberate indifference (actual knowledge of a substantial likelihood of a rights violation and failure to act).
- In custodial settings, “services, programs, or activities” include core jail operations such as movement within the facility and meal distribution; accommodation must be effective in light of known limitations.
- For pretrial detainees, unconstitutional conditions require a deprivation sufficiently serious to deny the minimal measure of life’s necessities plus deliberate indifference by officials.
- Deliberate indifference to medical needs requires knowledge and disregard of an excessive risk; negligence, misjudgment, or disagreement over treatment does not satisfy the constitutional standard.

## Conclusion

The Fifth Circuit held that evidence of repeated requests, medical directives against crutch use, an unimplemented wheelchair order, and refusal to adjust meal procedures could support an ADA finding of intentional failure to accommodate, but that the same record did not meet the higher constitutional threshold for § 1983 liability for conditions of confinement or medical care.


Cadena v. El Paso County, 946 F.3d 717 (5th Cir. 2020)