By Garret DeReus

A recent Fifth Circuit decision from July of 2025 highlights the limits of the Americans with Disabilities Act (ADA) in jails and prisons. While the ADA prohibits discrimination based on disability, in Carter v. City of Shreveport, No. 23-30848, 2025 WL 2025596 (5th Cir. July 21, 2025), the Fifth Circuit court ruled that inadequate medical care—even when it leads to serious harm—doesn’t violate the ADA if it amounts to medical negligence rather than intentional discrimination. This ruling did not evaluate federal regulations related to program access or regulatory guidance for the ADA that specifically states that jails should “proper medication and medical treatment” to prisoners with disabilities.

The Facts: An Inmate with Bedsores Who Was Allegedly Ignored 

William Carter’s case presents a scenario that many inmates with disabilities face. As the Fifth Circuit explained, Carter, who is paraplegic and uses a wheelchair for mobility, had several bedsores on his buttocks and hip before he spent eight days at the Shreveport City Jail for unauthorized use of 911. Carter’s mother, suing as his “next friend,” claims the jail did not provide care for these wounds, resulting in their infection and Carter’s hospitalization weeks after release.

The jail’s response—or lack thereof—to Carter’s medical needs was alleged to be inadequate. When the jail doctor examined Carter and noted he needed “wet to dry” bandage changes, jail staff testified they didn’t understand this as an instruction to provide care. One jailer didn’t know what “wet-to-dry dressing” meant, while another didn’t interpret the doctor’s notes as requiring any action. Five days later, when the doctor determined Carter “needs more assistance than the jail can provide,” the jail released him rather than sending him to the hospital. Carter’s wounds had allegedly become infected during his stay, and he was later hospitalized with infected bedsores and other serious conditions.

The Court’s Ruling: Drawing a Line Between Discrimination and Negligence

The Fifth Circuit affirmed the district court’s judgment against Carter, ruling that his ADA claims failed as a matter of law. The court’s reasoning centered on a crucial distinction: the ADA does not typically provide a remedy for negligent medical treatment. In this regard, the Fifth Circuit didn’t exactly break new ground as it has long held that “the ADA does not typically provide a remedy for negligent medical treatment.” Cadena v. El Paso Cnty., 946 F.3d 717, 726 (5th Cir. 2020)

In Carter, the Court held that bandage changes are a medical treatment and thus are not covered by the ADA. No further analysis was provided on this issue. The Fifth Circuit then stated that the most Carter could possibly complain about under the ADA is (1) the decision to release him instead of sending him to the hospital or (2) the delay from October 12 to October 17 in realizing Carter needed more care than the jail could provide. Nonetheless, after evaluating these claims, the Court held that these claims were also “no more than medical negligence” and thus weren’t actionable under the ADA. 

In sum, the court held that while the ADA requires reasonable accommodations for disabled individuals, the jail’s alleged failure to provide care, as pursued by the plaintiff, was not actionable under ADA for failure to accommodate, as the claim allegedly was nothing more than a claim of medical negligence.

Overlooked Law: The Program Access Regulation and Applicable DOJ Guidance 

While at first blush this opinion may appear simple, the issue is what was not evaluated. Nowhere in its decision did the Fifth Circuit evaluate the “program access” regulation of Title II of the ADA, which states “A public entity shall operate each service, program, or activity so that the service, program, or activity, when viewed in its entirety, is readily accessible to and usable by individuals with disabilities.” 28 C.F.R. § 35.150(a)

Indeed, in the guidance interpreting its own regulations, the Department of Justice has explained:

“Detention and correctional facilities are unique facilities under Title II. Inmates cannot leave the facilities and must have their needs met by the corrections system, including needs relating to a disability. If the detention and correctional facilities fail to accommodate prisoners with disabilities, these individuals have little recourse, particularly when the need is great (e.g., an accessible toilet; adequate catheters; or a shower chair). It is essential that corrections systems fulfill their nondiscrimination and program access obligations by adequately addressing the needs of prisoners with disabilities, which include, but are not limited to, proper medication and medical treatment, accessible toilet and shower facilities, devices such as a bed transfer or a shower chair, and assistance with hygiene methods for prisoners with physical disabilities.” (28 C.F.R. Pt. 35, App. A, Title II Regulations 2010 Guidance, emphasis added)

This guidance explicitly references “proper medication and medical treatment” as part of a jail’s obligation to accommodate prisoners with disabilities. This obligation make sense given the program access obligation of an entity to ensure that a program is “usable by” persons with disabilities, without limitation. The regulatory scheme recognizes that inmates “cannot leave the facilities and must have their needs met by the corrections system”—a reality that makes inadequate medical care particularly devastating for disabled prisoners.

Why Wasn’t The DOJ’s ADA Guidance Considered?

Notably, the Fifth Circuit’s opinion in Carter never cited or addressed this federal guidance requiring “proper medication and medical treatment” for disabled inmates. This omission is striking given how directly the regulation appears to apply to Carter’s situation. That said, it is not particularly surprising. This ADA guidance has rarely been invoked in the Fifth Circuit—appearing in only three district court cases within the circuit’s jurisdiction.

That said, it is unclear how this argument would fare at the Fifth Circuit if it were raised. The answer has become uncertain following the Supreme Court’s recent decision in Loper Bright Enterprises v. Raimondo, which overturned the longstanding Chevron doctrine that required courts to defer to reasonable agency interpretations of ambiguous statutes. Under the new framework, courts must exercise their independent judgment in interpreting statutes, potentially giving less weight to agency guidance like the ADA regulations quoted above.

Without Chevron deference, it’s unclear whether the Fifth Circuit would view the regulatory guidance requiring “proper medication and medical treatment” as persuasive, noteworthy, or simply irrelevant. The court might determine that the statute itself doesn’t explicitly require medical treatment as an accommodation, regardless of what the implementing regulations say. This uncertainty makes it even more challenging for inmates with disabilities and their advocates to predict how courts will rule on this issue. 

The Segregation Issue: Failure to Request an Accommodation

Another concerning aspect of Carter’s case involved his placement in a segregated cell. The jail placed Carter in a segregated cell on account of his disability, which caused the doctor to examine him through the bars and forego a hands-on exam, allegedly leading to insufficient medical treatment for his bedsores.

The court found this didn’t constitute intentional discrimination, but the Court’s limited analysis failed to look at what constitutes intentional indiscrimination. Under the ADA, “intentional discrimination” can mean two different things: it can mean discrimination based on animus or ill-will toward people with disabilities, or it can mean that a defendant has received notice that it is not adequately accommodating a person’s disability-related needs but fails to act. 

As the Fifth Circuit noted in Carter, the knowledge requirement is satisfied when either the plaintiff “specifically identifies the disability and resulting limitations and requests an accommodation in direct and specific terms,” or the disability and necessary accommodations are “open, obvious, and apparent” to the entity’s relevant agents. Here, it does not appear that there was evidence that the plaintiff made an explicit request for accommodation that the physician come into the cell. And the Fifth Circuit described the physician not going into the inmate’s cell as allegedly occurring “out of consideration for his disability, not from animus against it.” This emphasizes the critical importance of people with disabilities explicitly communicating to public entities when their needs are not being met, creating a clear record that can establish the “intentional” element of discrimination if problems persist.