A federal appeals court just rejected a defense institutions have used for years to deny disabled people accommodations: that their own medical process gets the final word.
By Michael Phillips | Father & Co.
For nearly five months, Bilal Adom lived without adult diapers.
Adom is incarcerated at Salinas Valley State Prison in California. He has a degenerative spinal condition that confines him to a wheelchair, and since 2020 he has suffered from incontinence — periods where he cannot control his bladder or bowels. For almost a year, the prison issued him a weekly supply of diapers without incident. Then, after a routine housing transfer in August 2021, prison staff reviewed his file, decided there was no documented proof his incontinence was “medically necessary” to accommodate, and cut him off.
What followed was five months of Adom soiling himself, his bedding, and his wheelchair — then twisting and bending through the resulting cleanup in a way that aggravated his spinal pain. He filed written request after written request. He told a nurse, mid-appointment, that he had just involuntarily urinated in his chair in front of her. He described being “humiliated and dehumanized.” Each time, the answer came back the same way: no proof of medical necessity, no accommodation.
The prison wasn’t lying about its own rule. California’s Department of Corrections and Rehabilitation really does require an “underlying medical condition” finding before it will issue incontinence supplies through its Durable Medical Equipment program, and for months, no doctor who examined Adom made that finding. When the prison’s Reasonable Accommodation Panel formally denied his request in October 2021, its entire written explanation was one sentence: “there was no indication found for incontinence supplies.” A doctor eventually diagnosed an enlarged prostate that December, and supplies resumed in January 2022 — nearly five months after they were cut off.
That single sentence is the reason this case matters to anyone who has ever been told, by a court, an agency, or an institution, that they don’t qualify for an accommodation because nobody has “indicated” they need it.
The defense institutions rely on
“Treating a disabled person exactly like everyone else can itself deny meaningful access.”
Adom sued under Title II of the Americans with Disabilities Act, which bars public entities — prisons, courts, agencies, school systems — from denying disabled people the benefit of their services because of that disability. A federal district court threw his case out. Its reasoning: CDCR didn’t discriminate against Adom because of his incontinence; it simply followed a neutral policy that requires proof of medical necessity before issuing supplies, and Adom didn’t have that proof. Multiple doctors said so. The institution followed its own rule. Case closed.
It’s a familiar shape. Substitute “family court” for “prison” and “no medical documentation on file” for “no indication found,” and the reasoning is identical to what disabled parents and litigants report hearing when they ask courts or other government programs for accommodations tied to a disability. The institution doesn’t have to admit it’s discriminating. It just has to point to its own paperwork requirement and say the person didn’t meet it.
On September 8, 2026, the Ninth Circuit Court of Appeals rejected that defense — and two others CDCR raised alongside it. The court didn’t rule that CDCR violated the ADA; it ruled that the district court was wrong to take the question away from a jury. But in reversing, the panel laid out legal rules that reach well past this one case.
CDCR’s first defense was the medical-necessity point already described. Its second was that its rule was neutral — every prisoner had to meet the same standard, disabled or not, so nobody was singled out. The Ninth Circuit said that wasn’t enough either. Treating a disabled person exactly like everyone else can itself deny meaningful access when the disability is the reason the ordinary rule doesn’t work for them. As the court put it, the ADA’s reasonable-accommodation requirement exists to guard against the “façade of ‘equal treatment'” when different treatment is what it actually takes to level the playing field.
CDCR’s third defense was that it hadn’t left Adom with nothing — it gave him a commode, priority shower access, and extra linens. The court rejected that too. An alternative accommodation doesn’t satisfy the ADA just because it’s something — it has to actually provide meaningful access to the benefit in question. And when an institution turns down the accommodation someone actually asked for, the court held, it has to show it looked into whether that request was feasible and explain why it wasn’t — not simply hand over something easier for the institution and call the matter resolved.
“An alternative accommodation doesn’t satisfy the ADA just because it’s something.”
What the court actually said
Writing for the panel, Judge Richard Paez held that a jury could find Adom disabled under the ADA regardless of whether any doctor had pinpointed the medical cause of his incontinence. The statute’s definition of disability, he wrote, doesn’t run through a diagnosis — it asks whether a physical or mental impairment substantially limits a major life activity, and loss of bladder or bowel control plainly qualifies whether or not a physician has explained why it’s happening.
That part isn’t especially controversial. The sharper holding is what the court did with CDCR’s central defense: that it couldn’t have discriminated against Adom because its own medical staff determined the accommodation wasn’t indicated. The panel rejected that argument outright. A public entity, Paez wrote, “is not excused from its obligation to provide a reasonable accommodation solely because it determined the accommodation is not medically necessary or indicated.”
“A public entity is not excused from its obligation to provide a reasonable accommodation solely because it determined the accommodation is not medically necessary or indicated.”
The court went further, calling out the danger in letting an institution’s own internal medical determination double as its ADA defense: allowing that would give “an institutional actor… total control over the realization of the protections afforded by the ADA.” If a prison, a court, or an agency can immunize itself from an accommodation claim simply by having its own staff conclude the accommodation isn’t warranted, the ADA stops functioning as an external check and becomes whatever the institution says it is.
“The ADA stops functioning as an external check and becomes whatever the institution says it is.”
The panel also found there was enough evidence for a jury — not a final ruling, but enough to let the question go to trial — that CDCR acted with deliberate indifference, the standard Adom needs to meet to seek damages rather than just a court order. It pointed to the abrupt termination of a working accommodation without any new evaluation, weeks of ignored written requests, and a prison doctor who told Adom that “prisoners were malingering their incontinence conditions” before declining to look further into his medical history at all.
None of this means public entities can never ask for medical documentation or set eligibility rules — the ADA doesn’t say that, and the Ninth Circuit didn’t hold that. What it held is narrower and, for this purpose, more useful: an institution’s own medical-necessity determination can’t substitute for the ADA analysis itself. Requiring documentation is one thing. Treating a lack of it as the end of the discrimination inquiry is another.
The dissent, and why it matters
Judge Carlos Bea dissented, and his disagreement is worth taking seriously — not because it’s right, but because it’s the version of this argument institutions will keep making.
Bea’s position: Adom wasn’t denied anything “by reason of his disability.” He was denied supplies because he failed to meet a neutral, generally applicable eligibility rule that applies to every prisoner alike. The prison didn’t discriminate against him for being incontinent — it declined to give him diapers because his file lacked medical proof, and it would have declined the same request from anyone else in the same paperwork position. Bea leaned hard on Olmstead v. L.C., the 1999 Supreme Court case holding that states may generally rely on “the reasonable assessments of its own professionals” in determining ADA eligibility, and on the well-established line of cases holding that the ADA prohibits discrimination because of disability, not inadequate medical treatment for disability.
That distinction — discrimination versus treatment — is the exact fault line disabled litigants hit when accommodation requests get labeled a “medical” or “clinical” matter for evaluators to sort out, rather than a legal accommodation question the institution is obligated to answer. Bea’s dissent captures the doctrinal logic behind that response. The majority’s answer supplies a powerful argument against it: an institution’s medical gatekeeping and its ADA obligations are not the same inquiry, and passing one doesn’t excuse failing the other.
Why this reaches beyond a prison cell
Title II of the ADA doesn’t only bind prisons. It binds every state and local government entity — courts, clerks’ offices, child-welfare agencies, and other state or local government programs involved in family cases. The reasoning the Ninth Circuit applied to CDCR’s diaper policy applies with equal force anywhere a government body denies an accommodation and then points to its own internal determination that the accommodation “wasn’t indicated” as the end of the analysis.
The court was explicit that this isn’t a narrow, prison-specific carve-out. It rejected CDCR’s argument that classifying something as “medical equipment,” reviewed by doctors, moves it outside the ADA’s reach — because, as the panel noted, “the record suggests that most, if not all, disability accommodations” in the relevant system are reviewed against a medical-necessity standard. If that kind of internal medical review were enough to insulate an agency from Title II, the ADA would offer disabled people almost no protection anywhere government runs a credentialing or eligibility process — which, in family court, is most of it.
One limit is worth naming plainly. Adom is binding precedent within the Ninth Circuit — California, Arizona, Nevada, Oregon, Washington, Idaho, Montana, Alaska, and Hawaii, plus several Pacific territories. It doesn’t automatically control in the other eleven federal circuits. Courts elsewhere can find its reasoning persuasive, and often do look to sister circuits when the law is unsettled, but a judge outside the Ninth Circuit isn’t required to follow it unless their own circuit or the Supreme Court adopts the same rule.
“Requiring documentation is one thing. Treating a lack of it as the end of the discrimination inquiry is another.”
Adom v. CDCR isn’t a family court case, and it won’t decide one. But it takes direct aim at three defenses institutions have leaned on for years to make an accommodation denial look like paperwork instead of what it is: that their own medical review settles the question, that treating everyone the same is enough, and that offering some alternative closes the matter. Whether that reasoning holds up in courts nationwide remains to be seen — but for now, in a circuit covering nearly a fifth of the U.S. population, a federal appeals court has said no to all three, even if, as Judge Bea’s dissent shows, not everyone on that court agrees.
This piece is based on the Ninth Circuit’s published opinion in Adom v. California Department of Corrections and Rehabilitation, No. 24-4756 (9th Cir. Sept. 8, 2026), including the majority opinion by Judge Paez and the dissent by Judge Bea.
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