Carter v. City of Shreveport: Fifth Circuit Re-Affirms that the ADA Does Not Create a Medical Standard of Care

1. Introduction

In Carter v. City of Shreveport, No. 23-30848 (5th Cir. July 21, 2025), the United States Court of Appeals for the Fifth Circuit was asked to decide whether jail officials’ alleged failure to change a paraplegic inmate’s bandages could support liability under Title II of the Americans with Disabilities Act (ADA) and § 504 of the Rehabilitation Act (RA). Plaintiff Jacqueline Carter, acting as next friend for her son William Carter, asserted three causes of action: (i) § 1983 deliberate-indifference to medical needs, (ii) disability discrimination under the ADA/RA, and (iii) Louisiana negligence. After the district court granted judgment as a matter of law (Rule 50) on the ADA/RA claim and excluded the plaintiff’s medical-policy expert, a jury returned defense verdicts on the remaining claims. The plaintiff appealed only the ADA/RA ruling and the expert exclusion.

The Fifth Circuit affirmed, holding that:

1. Failing to provide a specific medical treatment—here, wet-to-dry dressing changes—constitutes medical negligence at most, not disability discrimination or a failure to accommodate under the ADA/RA; and
2. The district court’s exclusion of the proffered expert was immaterial in light of the dispositive ruling on the ADA/RA theory.

Taken together with earlier Fifth Circuit precedent, Carter cements the principle that the ADA and RA do not supply a medical standard of care for prisoners or detainees; instead, a plaintiff must show intentional discrimination or the denial of an aid or service that is separate from, and in addition to, routine medical treatment.

2. Summary of the Judgment

The court (Judge Richman, joined by Judges Willett and Douglas) reviewed the district court’s Rule 50 dismissal de novo. It concluded:

• The plaintiff’s allegations center on a medical treatment decision—how often and by whom Carter’s bandages should have been changed. Under established Fifth Circuit precedent, negligent or even grossly negligent medical care is not actionable under the ADA/RA.
• Neither of the two recognized ADA theories—failure to accommodate or disparate treatment—was satisfied:
  • No accommodation was requested beyond the medical treatment itself.
  • Placement in a segregated cell for Carter’s safety was not shown to be intentional discrimination; at most it was a misguided but non-discriminatory decision.
• Because the ADA/RA claim failed as a matter of law, the exclusion of expert testimony relating solely to that claim could not have affected the judgment.

3. Analysis

3.1 Precedents Cited and Their Influence

• Cadena v. El Paso County, 946 F.3d 717 (5th Cir. 2020)
  Held that negligent medical care cannot be re-packaged as an ADA claim. Carter relies heavily on Cadena to characterize dressing changes as purely medical, not accommodations.
• Valentine v. Collier, 993 F.3d 270 (5th Cir. 2021) & Windham v. Harris County, 875 F.3d 229 (5th Cir. 2017)
  Provide the open–obvious–apparent and specific-request tests for knowledge in failure-to-accommodate claims. The panel notes that it need not reach those tests because the plaintiff alleged no legally cognizable accommodation.
• J.W. v. Paley, 81 F.4th 440 (5th Cir. 2023)
  Reaffirmed that even ill-conceived actions intended for a disabled person’s safety do not equal intentional discrimination absent animus. The court analogizes Carter’s segregated housing to the school-resource-officer scenario in Paley.
• Bryant v. Madigan, 84 F.3d 246 (7th Cir. 1996) (cited)
  Warned against using the ADA as an end-run around the deliberate-indifference standard. The Fifth Circuit adopts that rationale.
• Other supportive precedents: Nottingham v. Richardson; Hale v. Harrison County; Olmstead v. L.C.; and Pennsylvania Dep’t of Corrections v. Yeskey.

3.2 The Court’s Legal Reasoning

1. Framing the right question. The panel distinguishes between access to medical services (potentially an ADA issue) and the adequacy or correctness of a particular medical treatment (a medical-negligence or § 1983 issue). Wet-to-dry dressing changes fall squarely in the latter category.
2. Failure-to-accommodate theory rejected.
   • The claimed accommodation (bandage changes) is the disputed medical care itself.
   • The ADA does not federalize medical malpractice; it imposes a nondiscrimination duty only with respect to services actually offered. Because the jail did provide medical services, albeit allegedly poorly, no accommodation was withheld.
3. Disparate-treatment theory rejected.
   • Segregating Carter for his safety was disability-related, but not disability-based animus.
   • No evidence showed that Dr. Dixon’s cell-bar examination was motivated by discrimination rather than logistical choices.
4. Expert testimony immaterial. Since the ADA claim fails as a matter of law, whether Dr. Nitzkin’s opinions were admissible is moot.

3.3 Potential Impact on Future Litigation

The decision fortifies a bright line in the Fifth Circuit (and offers persuasive authority elsewhere):

• Medical negligence ≠ ADA violation. Litigants must pursue medical malpractice or § 1983 deliberate-indifference theories, not ADA/RA theories, when contesting the adequacy of treatment.
• Intentional discrimination remains the touchstone. Plaintiffs must present evidence of discriminatory motive or a denied accommodation separate from medical care. Routine safety measures—even if ill-conceived—will not alone satisfy that burden.
• Correctional facilities receive clearer guidance. Jails and prisons need not fear that everyday medical decisions automatically invite ADA liability, though they must still provide equal access to whatever medical services exist.
• Strategic pleading will shift. Counsel likely will emphasize § 1983 and state-law negligence claims rather than attempt to shoehorn treatment disputes into ADA/RA frameworks.

4. Complex Concepts Simplified

• Title II ADA vs. § 504 RA: Both prohibit disability-based discrimination by public entities. The RA applies only if federal funds are involved, but in practice the two statutes are construed identically.
• Failure to Accommodate: Claim that the defendant did not modify its policies or procedures to allow a disabled person equal participation (e.g., providing a sign-language interpreter). Requires either a direct request or an obvious need.
• Disparate Treatment: Classic intentional discrimination—treating someone worse because of disability.
• Rule 50 Judgment as a Matter of Law: After evidence closes, a court may take an issue away from the jury if no reasonable juror could find for the opponent on that issue.
• Monell Claim: A § 1983 theory against a municipality, requiring proof that an official policy or custom caused the constitutional violation.
• Wet-to-Dry Dressing: A wound-care method where moist gauze is applied, allowed to dry, and then removed to debride tissue. Requires skilled, regular changes to avoid infection.

5. Conclusion

Carter v. City of Shreveport reiterates a critical boundary: the ADA and RA guarantee equal access to governmental services, but they do not prescribe how those services must be performed. Allegations that jail staff botched medical treatment—even if true—belong in the domains of medical malpractice or Eighth/Fourteenth Amendment deliberate-indifference claims, not in disability-discrimination law. By drawing a clear demarcation between services and standards of care, the Fifth Circuit provides essential guidance to litigants, trial courts, and correctional institutions alike, ensuring that disability statutes remain focused on eliminating discrimination rather than policing professional judgment.