No Outsourcing Escape Hatch: States Remain Liable Under ADA Title II and the Rehabilitation Act for Prison Services Run by Private Contractors

Introduction

In a precedential opinion with sweeping implications for prison litigation and disability rights, the Third Circuit in Jose Montanez v. Paula Price (No. 23-2669, Oct. 8, 2025) revives a state prisoner’s Eighth Amendment and disability law claims arising from catastrophic spinal injuries and alleged denials of basic accommodations. The decision squarely holds that a state cannot evade its obligations under Title II of the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act (RA) by contracting prison services to private vendors, and clarifies that health care, hygiene (toilets/showers), and beds/bedding are “services, programs, or activities” within the statutes’ coverage. The Court also reiterates core Eighth Amendment principles governing deliberate indifference to serious medical needs, recognizes a conditions-of-confinement theory rooted in unsanitary confinement, and rebukes undue restrictions on pro se prisoner pleadings by requiring a meaningful opportunity to amend.

The parties span Pennsylvania corrections officials (“Commonwealth Defendants”) and Wellpath Care LLC and its clinicians (“Medical Defendants”), the latter being the private contractor providing medical care in state facilities. After the district court dismissed all claims with prejudice— relying only on a short, court-restricted pro se form complaint— the Third Circuit affirms in part, reverses in part, and remands with instructions to allow amendment.

Executive takeaways

• States remain responsible for ADA Title II and RA compliance “directly or through contractual arrangements.” Contracting out prison services does not insulate a state from liability.
• Prison health care, hygiene (toilets, showers, sinks), and beds/bedding are “services” within Title II/RA. Denial of meaningful access or refusal to reasonably accommodate can violate both statutes.
• Private prison medical contractors are not “public entities” under Title II, but they may face RA liability if they directly or indirectly receive federal financial assistance; the “all operations” clause applies.
• On the Eighth Amendment, the complaint states deliberate indifference and unsanitary conditions claims against specific individuals (a doctor, a nurse, and a non-medical administrator who allegedly misrepresented test results), but not against other clinicians as pled—though leave to amend must be granted.
• Denial of leave to amend was an abuse of discretion, especially where a mandatory court form capped pro se factual allegations to a few pages.

Summary of the Opinion

The Third Circuit, per Judge Krause, holds:

• Eighth Amendment
  • Reversal: Claims against Dr. Rajinder Mahli (Wellpath physician), Nurse Melanie Wagman (Commonwealth nurse), and Administrator Richard Ellers (Commonwealth healthcare administrator) are sufficiently pleaded. Allegations include abandoning a suddenly paralyzed inmate without care for days, forcing him to crawl, laughing at his request for hospital transport, and misrepresenting x-ray results to delay care. The Court also recognizes an unsanitary conditions-of-confinement claim (urine-soaked cell).
  • Affirmance (but with leave to amend on remand): Dismissal of Eighth Amendment claims against other medical personnel (Dr. Preston, Dr. Edwards, PA Nalley) and against Wellpath as a Monell-type entity was correct on the sparse pleading, but amendment should have been allowed to attempt to link Wellpath policy/custom to the alleged violations.
  • Affirmance: Official-capacity damages claims against the Commonwealth and its officials are barred (Will/Edelman).
• ADA Title II / Rehabilitation Act
  • Reversal: The complaint plausibly alleges that the Commonwealth denied Montanez meaningful access to prison health care, hygiene facilities, and beds/bedding “by reason of” his disability by failing to provide reasonable accommodations; compensatory damages are plausibly pleaded via deliberate indifference.
  • Reversal: Section 504 claim against Wellpath survives because the complaint plausibly alleges Wellpath is an indirect recipient of federal financial assistance; discovery will resolve funding facts. Title II claim against Wellpath remains dismissed because Wellpath is not a “public entity.”
  • Affirmance: No individual-capacity ADA/RA claims against state employees or contractors; such claims lie against entities.
• Leave to Amend
  • Reversal: Denying leave to amend was an abuse of discretion. The district’s rigid pro se form (then limiting factual allegations to ~3.5 pages) hamstrung pleading. Pro se opposition briefs previewed additional facts showing amendment would not be futile. Remand directs allowance of amendment.

Analysis

Precedents Cited and How They Shaped the Decision

The opinion weaves together foundational Eighth Amendment and disability law precedents, plus Third Circuit doctrine on corporate liability and non-medical official responsibility.

• Eighth Amendment medical care and conditions
  • Estelle v. Gamble and Farmer v. Brennan: Deliberate indifference requires knowledge and unreasonable disregard of a serious medical need; negligence and treatment disagreements are insufficient.
  • Monmouth County Corr. Institutional Inmates v. Lanzaro: Defines serious medical needs and examples of deliberate indifference (intentional refusal to treat, nonmedical delay, prevention of recommended care).
  • Spruill v. Gillis and Pearson v. Prison Health Services: Elaborate standards for non-medical officials (liability only where they have reason to believe medical staff are mistreating/not treating); crawling a non-ambulatory inmate can reflect deliberate indifference.
  • Taylor v. Riojas and Young v. Quinlan: Confinement in one’s excreta for days violates the Eighth Amendment—supporting the unsanitary conditions claim here.
• Section 1983 corporate liability and state action
  • West v. Atkins: Private prison medical providers act under color of state law for § 1983.
  • Monell and Natale v. Camden County: No respondeat superior for private contractors; liability requires a policy or custom causing the constitutional violation.
• ADA Title II and Rehabilitation Act scope
  • Pennsylvania Dep’t of Corr. v. Yeskey and Furgess v. Pa. DOC: State prisons are public entities; “services, programs, activities” is capacious.
  • Alexander v. Choate and Tennessee v. Lane: Require reasonable accommodations to provide meaningful access.
  • Blunt v. Lower Merion and S.H. ex rel. Durrell: Same substantive standards under ADA/RA (save causation); compensatory damages require intentional discrimination satisfied by deliberate indifference.
  • Regulatory anchors: 28 C.F.R. § 35.130(b)(1) and § 35.152 (Title II) and 28 C.F.R. §§ 41.51(b)(1), 42.503(b)(1) (RA) explicitly forbid disability discrimination “directly or through contractual, licensing, or other arrangements.”
  • United States v. Georgia: Conditions of confinement and access to toilets/hygiene implicate ADA/RA in prisons.
  • Hall v. Higgins, Shaw v. Kemper, McDaniel v. Syed, Pierce v. County of Orange: Recognize toilets, showers, beds, and medical care as covered “services,” with accommodations required.
• Who can be sued under ADA/RA and funding rules
  • Emerson v. Thiel College and sister-circuit authority: No individual-capacity liability under Title II/RA; Title II targets “public entities.”
  • U.S. Dep’t of Transp. v. Paralyzed Veterans, Cummings v. Premier Rehab, and the Civil Rights Restoration Act: RA liability attaches to direct or indirect recipients of federal financial assistance and covers “all operations.”
• Leave to amend and pro se pleading
  • Erickson v. Pardus, Phillips v. County of Allegheny, Garrett v. Wexford Health, and Roman v. Jeffes: Liberal construction of pro se complaints and liberal amendment policy; deny leave only if futile or inequitable.

Legal Reasoning

Eighth Amendment

The Court applies the two-part test: (1) serious medical need and (2) deliberate indifference. Montanez’s paralysis, incontinence, stenosis/edema requiring surgery, and post-surgical herniated disc are plainly serious medical needs. The question is subjective deliberate indifference.

• Against Dr. Mahli (Wellpath physician): The complaint alleges he knew Montanez could neither stand nor walk and was urinating on himself, yet did not examine or treat him and left him for three days. That is not a mere treatment dispute; it plausibly alleges intentional refusal to treat and unjustified delay risking further harm—classic deliberate indifference. It also supports a separate conditions-of-confinement claim given the unsanitary confinement.
• Against Nurse Wagman (Commonwealth): Allegations that she laughed at hospital transport, failed to provide meaningful assessment, and “dumped” a paralyzed inmate at his cell door—forcing him to crawl inside—plausibly allege obdurate disregard of obvious medical needs and unnecessary exposure to risk of serious injury.
• Against Administrator Ellers (Commonwealth, non-medical): While non-medical staff are usually insulated when a prisoner is “under the care of medical experts,” liability attaches if they know or have reason to know of mistreatment or non-treatment. Allegations that Ellers “lied” to providers about a positive x-ray (herniated disc) to delay care plausibly show actual knowledge and interference—sufficient for deliberate indifference.
• Against other clinicians (Dr. Preston, Dr. Edwards, PA Nalley): As pleaded, allegations amount to disagreements about pain medication strength, denial of a double mattress, and imaging choices—insufficient for deliberate indifference absent more facts. However, the Court orders leave to amend.
• Against Wellpath (entity liability): The complaint did not tie the alleged violations to a Wellpath policy or custom as Monell/Natale require; dismissal was correct, but amendment should be allowed to attempt to plead an actionable policy/custom.
• Official-capacity damages: Barred against the Commonwealth and its officials (Will; Edelman).

ADA Title II and Rehabilitation Act

The Court first clarifies who may be sued, then applies the elements. Title II reaches “public entities,” including state prisons; Section 504 reaches recipients of federal financial assistance and, by statute, covers “all operations” of a covered organization.

• Proper defendants
  • Commonwealth of Pennsylvania: Proper defendant under both Title II and RA.
  • Individual state employees/contractors: No individual-capacity liability under Title II/RA. Official-capacity ADA/RA claims are effectively against the entity.
  • Wellpath: Not a Title II “public entity,” so the ADA claim is dismissed. But the RA claim survives because the complaint plausibly alleges Wellpath is an indirect recipient of federal funds; discovery will resolve funding facts. The Court notes public materials suggesting direct federal grants to Wellpath, underscoring that this is not resolvable at the pleading stage.
• Covered “services, programs, or activities”
  • The Court emphasizes the “all-encompassing” breadth of Title II/RA. It identifies three covered areas that Montanez plausibly could not access “on the same basis as other inmates” because of disability:
    • Health care: Not merely a challenge to the adequacy of treatment, but a denial of meaningful access to the medical unit and to clinical evaluation because he was made to crawl and clinicians refused to enter his cell.
    • Hygiene (toilets/showers/sinks): Being left paralyzed and incontinent for days without access or alternative accommodations plausibly alleges denial of a basic prison service.
    • Beds/bedding (sleep): Being forced to crawl into bed and later denied a reasonable bedding accommodation (e.g., a double mattress) to sleep without severe pain plausibly alleges denial of an accessible sleeping service.
• Causation and intent for damages
  • Causation: The Court notes RA uses a “sole cause” standard and ADA a “but-for” standard, but finds the distinction immaterial here on the pleadings.
  • Compensatory damages: Require “intentional” discrimination, satisfied by deliberate indifference to federally protected ADA/RA rights. Allegations that staff knew of disability-driven needs (obvious paralysis/incontinence; repeated requests for canes/physical therapy/double mattress) and refused accommodations suffice to plead deliberate indifference by the Commonwealth and, for RA purposes, by Wellpath.

No Outsourcing Exception to ADA/RA

The opinion’s most consequential doctrinal move is its express holding that states remain responsible for ADA/RA compliance even when they deliver services “through” private contractors. The Court anchors this holding in:

• Text: Title II and RA are written in the passive voice and focus on the discriminatory event (exclusion/denial), not a particular actor, signaling congressional agnosticism about whether a state employee or a contractor effectuates the discrimination. The regulations likewise forbid discrimination “directly or through contractual, licensing, or other arrangements.”
• Structure and purpose: As remedial statutes intended to eliminate disability discrimination, Title II/RA cannot be nullified in prison settings—where states often outsource core functions—by strategic contracting. Letting states “bury their heads in the sand” would eviscerate the statutes’ guarantees for those wholly dependent on the carceral system.
• Alignment with sister circuits: The Third Circuit joins the Second, Ninth, Tenth, and others in recognizing that public entities must ensure compliance by those to whom they delegate program operations.

Leave to Amend and Pro Se Pleading

The Court finds an abuse of discretion in denying leave to amend. Two aspects drive the result:

• The district’s own mandatory form capped a pro se prisoner’s “statement of claim” to twelve lines plus at most three pages—an ill-suited constraint for complex, multi-defendant civil rights claims. The Middle District has since removed this page limit, which the panel notes may recognize due process concerns.
• Pro se briefing opposing dismissal included over 50 pages of additional facts. While a brief cannot amend a complaint, it serves as a proffer showing amendment would not be futile—especially where the truncated complaint already states some claims.

Impact

For prisons and state defendants

• Compliance responsibility: States must actively ensure ADA/RA compliance by contractors. Contracts, monitoring, training, and grievance systems should be designed to detect and cure accessibility failures.
• Scope of “services”: Health care delivery, hygiene fixtures and access, and beds/bedding are squarely within ADA/RA. Policies must ensure reasonable accommodations—mobility aids, accessible clinical contacts (e.g., staff entering cells when inmates cannot ambulate), accessible toilets/showers, and medically necessary bedding adjustments.
• Damages exposure: Compensatory damages are available upon proof of deliberate indifference to ADA/RA rights. Systemic failures to respond to obvious accommodation needs can create substantial liability.

For private medical contractors

• RA exposure: Contractors may face Section 504 liability if they directly or indirectly receive federal funds (including Medicare/Medicaid or other federal grants). The “all operations” clause broadens exposure beyond the specific program receiving funds.
• Qualified immunity: In a notable statement aligning with other circuits, the panel states that private Wellpath clinicians “cannot assert qualified immunity.” Contractors should assume personal-capacity defenses are limited in § 1983 suits, increasing the importance of robust training and supervision.
• Discovery posture: Whether a contractor is a federal-funds “recipient” is fact-intensive; public grants, reimbursement streams, or pass-through funding can suffice.

For prisoner-plaintiffs and counsel

• Pleading strategies: Frame disability claims as denial of meaningful access and failure to accommodate—distinct from medical negligence theories. Identify specific accommodations requested or obvious needs.
• Entity targeting: Title II/RA claims should be directed at the public entity (state/department); RA also may be directed at private contractors receiving federal funds. Title II claims cannot proceed against private contractors.
• Monell theories: For § 1983 claims against private medical entities, plead policies, customs, or practices (e.g., cost-driven delays, denial of mobility aids, refusal to examine non-ambulatory patients in-cell) that caused the violation.
• Amendment rights: Courts must liberally allow amendment, especially for pro se litigants. If a complaint was filed using a restrictive form, seek leave to file a full amended complaint detailing each defendant’s acts.

Systemic and doctrinal significance

• Clarification of “services”: By expressly naming health care, hygiene facilities, and beds/bedding, the opinion provides clear guardrails for prison accessibility obligations.
• No outsourcing defense: The Third Circuit’s holding forecloses a recurring defense that states can sidestep ADA/RA via contractors—expect more entity-level ADA/RA claims to proceed to discovery and trial.
• Conditions-of-confinement cross-over: The same facts supporting ADA/RA failures (e.g., leaving a paralyzed person in urine) can also sustain Eighth Amendment conditions claims, increasing risk profiles.
• Pro se access to courts: The critique of restrictive complaint forms signals heightened vigilance against procedural barriers that prematurely snuff out potentially meritorious civil rights claims.

Complex Concepts Simplified

• Deliberate indifference (Eighth Amendment): More than negligence. The official knows of a serious medical need and unreasonably ignores it—e.g., refusing to treat obvious paralysis or deliberately delaying care for nonmedical reasons.
• Conditions-of-confinement vs. medical-care claim: The former challenges the overall conditions (e.g., forced to live in excreta); the latter challenges the denial of medical treatment. The same facts can support both.
• Title II vs. RA
  • Title II applies to “public entities” (states, agencies). RA applies to entities receiving federal financial assistance (public or private), directly or indirectly, and covers “all operations.”
  • Both require reasonable accommodations to give disabled persons meaningful access to services, programs, and activities. Compensatory damages require deliberate indifference to ADA/RA rights.
• Meaningful access vs. quality of care: ADA/RA do not federalize medical malpractice. The statutes require equal access and reasonable accommodations; they do not guarantee a particular medical outcome.
• Monell liability: An entity (municipality or private contractor) isn’t vicariously liable for staff acts under § 1983. Liability attaches only if a policy/custom caused the constitutional violation.
• Individual vs. official capacity: ADA/RA damages claims typically run against entities, not individuals personally. Eighth Amendment claims under § 1983 can run against individuals in their personal capacity.

Conclusion

Montanez v. Price is a blueprint for prison disability and medical-care litigation in the Third Circuit. It confirms that states cannot contract around ADA/RA duties; that health care, hygiene, and bedding are covered prison “services”; that private contractors face RA exposure when federally funded; and that deliberate indifference can support both Eighth Amendment and ADA/RA damages claims. Equally important, the decision enforces meaningful access to the courts for pro se prisoners by requiring liberal leave to amend, especially where court-imposed pleading constraints hampered factual development.

On remand, Montanez may pursue Eighth Amendment claims against specific individuals and ADA/RA claims against the Commonwealth (and RA against Wellpath), and he must be allowed to amend to attempt to plead additional viable theories—particularly Monell claims against Wellpath and more detailed deliberate indifference allegations against clinicians. Going forward, carceral systems and their contractors must ensure accessible delivery of core services and document responsive accommodation processes, recognizing that outsourcing is no defense to statutory obligations designed to guarantee disabled prisoners equal access and dignity.