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Cadena v. El Paso County

United States Court of Appeals, Fifth Circuit

January 3, 2020

APRIL CADENA, Plaintiff - Appellant
EL PASO COUNTY, Defendant-Appellee

          Appeal from the United States District Court for the Western District of Texas

          Before DAVIS, GRAVES, and HIGGINSON, Circuit Judges.

          STEPHEN A. HIGGINSON, Circuit Judge

         April Cadena seeks review of the district court's dismissal of her claim against El Paso County under the Americans with Disabilities Act (ADA) and 42 U.S.C. § 1983. We reverse the district court's summary judgment dismissal of Cadena's ADA claim because a reasonable jury could find that the County intentionally denied Cadena reasonable accommodations. However, we affirm summary judgment dismissal of Cadena's § 1983 claim because Cadena cannot show that she was subjected to an unconstitutional condition of confinement, or that the medical treatment that she received was so deficient that it amounted to deliberate indifference to a serious medical need.


         The El Paso police arrested Cadena on June 23, 2014 on an outstanding warrant for failure to appear. At the time of her arrest, Cadena was in a wheelchair because she had undergone surgery on her right leg to repair a broken tibia three days earlier. She was discharged from the hospital only 24 hours before her arrest with instructions stating "no weight bearing" for her right leg and notes from a physical therapist explaining that she "will not be a candidate for crutches . . . and will have to be discharged with a wheelchair."

         Cadena was then taken to the El Paso County Detention Facility, where a licensed vocational nurse (LVN) conducted a medical intake procedure. Viewing the facts in the light most favorable to Cadena, she told the LVN that she could not walk, which was why she had a wheelchair. The intake form filled out by the LVN indicated that Cadena "had knee surgery yesterday" but determined that she was "able to stand independently" because Cadena stood during the intake when asked to do so. Based on the intake procedure, the County's physician, Dr. Salazar, gave telephonic orders that Cadena be given pain medication, that she follow up with an orthopedic physician in two weeks, that she be given crutches, that she be assigned to a lower bunk, and that she be given wound care on her right leg. Cadena testified that after intake, her wheelchair was taken away. She also testified that as she was being led to her cell, she overheard staff saying "that there was no space in the county for a person in a wheelchair."

         A few hours later, Cadena visited the medical clinic and requested a wheelchair. Cadena told the two officers escorting her to the clinic that she could not walk with crutches and needed a wheelchair. On the way to the clinic, she stumbled while attempting to move using crutches, and the officers had to catch her before she hit the floor. After this, Officer Davila, one of the officers escorting her, obtained a wheelchair and wheeled Cadena the rest of the way to the clinic. At the clinic, Cadena testified that Nurse Fuentes told her that there was no space on the floor for a wheelchair. Cadena testified that she was left in her cell with only crutches after the clinic visit.

         On June 25, 2014 at 10:30 a.m., two days after her arrival, the medical staff entered an order allowing Cadena to keep her wheelchair. At about 4:30 p.m. that day, however, Cadena did yet not have a wheelchair at mealtime and fell in her cell while trying to carry a tray with food on crutches. In Cadena's unit, patients were required to walk to the end of the cellblock to retrieve trays of food and to carry the trays back to their cells to eat. Cadena testified that Officer Davila, the same officer who had escorted her to the clinic, was overseeing this process. Cadena testified that she asked Officer Davila to deviate from this procedure-either by bringing Cadena's tray to her cell or by allowing Cadena to eat in the area where the trays were being handed out-so that Cadena would not have to carry a tray while using crutches. Cadena testified that Officer Davila refused these requests. Cadena fell while trying to carry both her tray and her crutches back to her cell.

         Cadena was taken to the jail's medical clinic, and then to the emergency room. The emergency room physician recommended a boot, non-weight bearing status, and a follow up appointment with Cadena's orthopedic surgeon the next day. After her fall, Cadena reported pain in her leg as a 7 out of 10. Cadena testified that her leg was twisted with her foot facing the middle of her body, and her medical records confirm that her tibia was "malaligned." The County made a follow-up appointment for Cadena to see an orthopedic surgeon at Texas Tech Orthopedic Clinic on July 14, 2014, which was the earliest appointment available at that clinic. Cadena was also transferred to the housing unit adjacent to the medical clinic.

         On July 14, Cadena went to an appointment at the Texas Tech Orthopedic Clinic. On July 18, 2014, Cadena attended a court hearing, after which she was discharged from custody into a Women's Substance Abuse Treatment Facility (WSAT). On July 22, 2014, while residing at WSAT, Cadena underwent a second surgery. Cadena's medical records from her surgery at Texas Tech state that Cadena was "in extreme varus" and "in extreme pain" before corrective surgery. Even after the second surgery, Cadena alleges that she has continuing nerve damage in her right leg and that she cannot engage in recreational activities or ambulate normally.

         On June 21, 2016, Cadena filed a complaint in the Western District of Texas against El Paso County, Corizon Health Inc., and Dr. Salazar. Cadena claims that El Paso County violated Title II of the ADA and Section 504 of the Rehabilitation Act by failing to provide her with reasonable accommodations. Cadena also claims that the County was deliberately indifferent to her serious medical needs in violation of the Fourteenth Amendment. Cadena alleges that these constitutional violations were the result of the County's unlawful policies, procedures, and customs.

         On August 25, 2017, Corizon Health and Dr. Salazar filed a motion for summary judgment on Cadena's claims against them. On October 13, 2017, El Paso County filed a separate motion for summary judgment on Cadena's claims against it. On March 26, 2018, the district court adopted the Magistrate's report and recommendation granting Corizon Health and Dr. Salazar's motion for summary judgment and dismissing Cadena's claims against those defendants. The district court then adopted in part and reversed in part the Magistrate's report and recommendation regarding El Paso County's motion, dismissing the remainder of Cadena's claims.

         On August 30, 2018, Cadena appealed the district court's order granting the ...

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