United States Court of Appeals

For the Eighth Circuit 

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No. 22-2582

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Carlos Hall, Sr.

 Plaintiff - Appellant

v.

Eric Higgins

 Defendant - Appellee

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Appeal from United States District Court 

for the Eastern District of Arkansas - Central

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Submitted: June 14, 2023

Filed: August 15, 2023

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Before GRUENDER, KELLY, and GRASZ, Circuit Judges. 

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KELLY, Circuit Judge.

Carlos Hall, Sr., was held in pretrial custody at the Pulaski County Regional 

Detention Facility (the Jail) in Little Rock, Arkansas, for five weeks. After he was 

released, Hall filed a suit for damages against a Pulaski County official, alleging 

deliberate indifference to his medical needs, unconstitutional conditions of 

confinement, and disability discrimination. The district court granted summary 
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judgment to the defendant on all of Hall’s claims. We affirm in part and reverse in 

part. 

I. 

For summary judgment purposes, we view the evidence in the light most 

favorable to the nonmoving party—here, Hall—and draw all reasonable inferences 

in his favor. See Triple H Debris Removal, Inc. v. Companion Prop. & Cas. Ins. 

Co., 560 F.3d 881, 882 (8th Cir. 2009). 

Hall has been paralyzed from the waist down since 2012, and he requires a 

wheelchair for mobility. On April 11, 2019, Hall was arrested and booked into the 

Jail, where he remained in pretrial detention until he was released on May 20, 2019. 

Upon arriving at the Jail, Hall underwent a medical screening, during which the Jail

noted that he was paralyzed and required a wheelchair, that he suffered from bowel 

incontinence, and that he utilized a catheter and ostomy bag. Because Hall used a 

wheelchair, the Jail assigned him to a lower bunk and placed him in lower-level 

housing. 

During his detention, Hall experienced daily difficulties with accessing his 

bed and the Jail’s showers. Hall testified in a deposition that his living units1 had 

“no arm rails” to allow him to enter his bed from his wheelchair. He also testified 

that the Jail’s showers either had a “little step” that prevented him from entering the 

shower while seated in his wheelchair or had “shower chair[s]” that were difficult 

for him to “maneuver . . . on [his] own.” Hall said that he repeatedly asked the Jail’s

staff to lift him in and out of his wheelchair and into the shower or his bed, but they

either refused or told him that they were prohibited from doing so under “protocol.” 

Because Hall lacked assistance getting in and out of his wheelchair, he fell “hard” 

in his living unit and in the shower.

1

Hall stayed in three different units during his detention. Hall’s first living

unit was a single-occupancy cell in the Jail’s administrative segregation wing, while 

his other two units were “open bunk beds” or “open barracks.”
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Hall also faced difficulties accessing the toilet in his living units and cleansing 

himself after bladder or bowel movements. For example, Hall testified that one of 

the Jail’s toilets was “useless” to him and that he could not “get on [it].” Hall said 

he once spent three days in “the same diaper” because he was unable to transfer from 

his wheelchair to the toilet. And the Jail’s nurses documented on at least one 

occasion that Hall was observed with “soiled” clothing.

 Because the Jail’s staff refused to physically assist Hall, he says that he was 

forced to ask other inmates to provide him with assistance getting out of his 

wheelchair and into his bed or the shower, and that he had to pay inmates to “wip[e] 

[his] backside” after his bowel movements. When Hall “ran out of commissary to 

pay people to help [him],” he remained bedbound. Hall described this experience as

“humiliating.”

Additionally, Hall felt that the medical care he received in the Jail was 

inadequate. During his weeks-long detention, Hall was assessed by the Jail’s 

medical professionals multiple times a week, and those professionals also attended 

to Hall whenever he complained of pain, discomfort, or other health issues. And 

Hall regularly received his prescription medications from Jail staff during what the 

Jail called “pill call.” But he testified that his lack of mobility caused him to miss 

two mental health appointments and one pill call.

Hall also felt that the Jail did not care for his catheter during his detention. 

Hall was assessed by the Jail’s medical staff and received treatment shortly after he 

reported that his catheter was leaking. Likewise, Hall was assessed by the Jail’s staff 

when they suspected an infection at his catheter site, and the Jail later transported 

Hall to University of Arkansas for Medical Services (UAMS)—Hall’s longtime 

source of medical care—to receive treatment for this infection.

Hall further testified he developed bedsores at the Jail. But he received 

multiple physical examinations during his detention that revealed no abscesses, 
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rashes, pressure sores, or ulcers. And Hall’s medical records from the Jail and from 

UAMS show no diagnosis of bedsores.

On October 11, 2019, Hall sued Pulaski County Sheriff Eric Higgins in his 

official capacity, and Higgins later removed the case to federal court. Hall asserted 

42 U.S.C. § 1983 claims for deliberate indifference to his medical needs and 

unconstitutional conditions of confinement, in violation of the Fourteenth 

Amendment,

2 as well as a claim of disability discrimination, in violation of the 

Arkansas Civil Rights Act (ACRA) and Title II of the Americans with Disabilities 

Act (ADA). Hall sought compensatory and punitive damages for his physical, 

mental, and emotional distress, as well as his medical expenses.

On May 5, 2022, Sheriff Higgins moved for summary judgment on all claims, 

which the district court granted. The district court found that Hall could not show 

the Jail was deliberately indifferent to any serious medical need because Hall was 

assessed “no fewer than eighteen times during his 39-day detention,” and medical 

records did not support Hall’s arguments that the Jail ignored his medical issues. In 

considering Hall’s conditions-of-confinement claim, the court ultimately granted 

summary judgment because Hall failed to show that any constitutional violation was 

the result of a Jail “custom, policy, or practice.” As for Hall’s disability 

discrimination claim, the district court concluded that no evidence in the record 

supported Hall’s assertions that he was denied access to a handicap-accessible living

unit or that he was denied access to medical services because he was disabled. Hall 

now appeals.

2

Hall brought his deliberate indifference and conditions-of-confinement 

claims under the Eighth and Fourteenth Amendments. But because Hall was 

detained at the Jail pretrial, these constitutional claims are properly asserted under 

only the Fourteenth Amendment. Accord Stearns v. Inmate Servs. Corp., 957 F.3d 

902, 906 (8th Cir. 2020) (analyzing the plaintiff’s conditions-of-confinement claim 

“under the Fourteenth Amendment’s Due Process Clause rather than the Eighth 

Amendment” because the plaintiff was “a pretrial detainee”); Johnson v. Leonard, 

929 F.3d 569, 575 (8th Cir. 2019) (analyzing the pretrial detainee plaintiff’s medical 

care claim under the Fourteenth Amendment).
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II. 

We review a district court’s grant of summary judgment de novo. Martinez 

v. W.W. Grainger, Inc., 664 F.3d 225, 229 (8th Cir. 2011). Summary judgment is 

appropriate if “there is no genuine dispute as to any material fact and the moving 

party is entitled to judgment as a matter of law.” Meyer v. McKenzie Elec. Coop., 

Inc., 947 F.3d 506, 508 (8th Cir. 2020); Fed. R. Civ. P. 56(a). We “may affirm the 

judgment on any basis supported by the record.” Hohn v. BNSF Ry. Co., 707 F.3d 

995, 1000 (8th Cir. 2013).

A.

We begin with Hall’s § 1983 deliberate indifference and conditions-ofconfinement claims. Hall’s claims against Sheriff Higgins in his official capacity 

are equivalent to claims against Pulaski County. See Veatch v. Bartels Lutheran 

Home, 627 F.3d 1254, 1257 (8th Cir. 2010) (“A suit against a government officer in 

his official capacity is functionally equivalent to a suit against the employing 

governmental entity.”); Liebe v. Norton, 157 F.3d 574, 578 (8th Cir. 1998)

(“Because Appellant’s suit against [the sheriff] is against [him] in his official 

capacity, it must be treated as a suit against the County.”). “[I]t is well established 

‘that a municipality cannot be held liable on a respondeat superior theory, that is, 

solely because it employs a tortfeasor.’” Atkinson v. City of Mountain View, 709 

F.3d 1201, 1214 (8th Cir. 2013) (quoting Szabla v. City of Brooklyn Park, 486 F.3d 

385, 389 (8th Cir. 2007) (en banc)). “A municipality can be liable under § 1983 only 

if a municipal policy or custom caused a plaintiff to be deprived of a federal right or 

if the municipality failed to adequately train its employees.” Snider v. City of Cape 

Girardeau, 752 F.3d 1149, 1160 (8th Cir. 2014); see also Ware v. Jackson County, 

150 F.3d 873, 880 (8th Cir. 1998). 
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1.

We turn first to Hall’s deliberate indifference claim. The Fourteenth 

Amendment protects pretrial detainees from officials’ “deliberate indifference” to 

their “serious medical needs.” Estelle v. Gamble, 429 U.S. 97, 104 (1976). As a 

pretrial detainee, Hall “is entitled to at least as much protection under the Fourteenth 

Amendment as under the Eighth Amendment.” Johnson, 929 F.3d at 575 (cleaned 

up); see Hartsfield v. Colburn, 491 F.3d 394, 396 (8th Cir. 2007) (noting that 

deliberate indifference is “the appropriate standard of culpability for all claims that 

prison officials failed to provide pretrial detainees with adequate . . . medical care”). 

To prove his deliberate indifference claim, Hall must show: “(1) he suffered from an 

objectively serious medical need, and (2) defendants knew of the need yet 

deliberately disregarded it.” Johnson, 929 F.3d at 575 (quoting Hartsfield v. 

Colburn, 371 F.3d 454, 457 (8th Cir. 2004)). 

An objectively serious medical need is one that “has been diagnosed by a 

physician as requiring treatment or if it is so obvious that even a layperson would 

easily recognize the necessity for a doctor’s attention.” Barton v. Taber, 908 F.3d 

1119, 1124 (8th Cir. 2018) (cleaned up). Deliberate disregard requires “more than 

negligence, more even than gross negligence,” but less than “purposefully causing 

or knowingly bringing about a substantial risk of serious harm to the inmate.” 

Thompson v. King, 730 F.3d 742, 747 (8th Cir. 2013) (citations omitted). Thus, to 

be liable for deliberate indifference, a defendant “must both be aware of facts from 

which the inference could be drawn that a substantial risk of serious harm exists, and 

he must also draw the inference.” Farmer v. Brennan, 511 U.S. 825, 837 (1994). 

“Deliberate indifference may be demonstrated by prison guards who intentionally 

deny or delay access to medical care or intentionally interfere with prescribed 

treatment, or by prison doctors who fail to respond to prisoner’s serious medical 

needs.” Dulany v. Carnahan, 132 F.3d 1234, 1239 (8th Cir. 1997). However, a 

detainee’s mere disagreement with a medical professional’s treatment decisions, 

alone, is insufficient. See Barr v. Pearson, 909 F.3d 919, 921–22 (8th Cir. 2018). 
-7- 

Here, Hall contends that the Jail knew that his paraplegia could lead to the 

development of bedsores but deliberately disregarded that concern. Hall also 

contends that the Jail knew that he suffered from bladder incontinence but 

deliberately failed to adequately maintain his catheter. The evidence shows that the 

Jail provided Hall with regular and frequent medical attention to address his medical 

issues, including his concerns about bedsores and his catheter. Each time Hall 

requested medical treatment, he was seen by the Jail’s medical professionals. Hall’s 

lengthy medical records do not reveal any diagnosis of bedsores during his time at 

the Jail. And while Hall was diagnosed with a catheter infection, his catheter site 

was examined by the Jail’s nurses when he complained of leakage, and when the 

nurses later observed signs of an infection at Hall’s catheter site, he was transported 

to UAMS for treatment the same day. On this record, no reasonable jury could 

conclude that the Jail deliberately disregarded Hall’s serious medical needs. Without 

a constitutional violation, Hall’s deliberate indifference claim fails. See Morris v. 

Cradduck, 954 F.3d 1055, 1060 (8th Cir. 2020). 

2. 

Next, we turn to Hall’s conditions-of-confinement claim. Pretrial detainees 

are presumed innocent and cannot be punished before they have been convicted of 

a crime. See Bell v. Wolfish, 441 U.S. 520, 535–37 (1979); see also Stearns, 957 

F.3d at 906–08. But “not every disability imposed during pretrial detention amounts 

to ‘punishment’ in the constitutional sense.” Smith v. Copeland, 87 F.3d 265, 268 

(8th Cir. 1996) (quoting Bell, 441 U.S. at 537). The “proper inquiry” is whether the 

conditions complained of by a pretrial detainee “amount to punishment.” Bell, 441 

U.S. at 535. Here, Hall must demonstrate that the conditions of his confinement at 

the Jail amounted to unconstitutional punishment by showing that the conditions 

were intended to be punitive, or that they “were not reasonably related to a legitimate 

governmental purpose or were excessive in relation to that purpose.” Stearns, 957 

F.3d at 907.
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Hall argues the Jail allowed him to remain in his soiled waste for days, failed 

to provide him “necessary assistance” with “toileting and bathing,” and failed to

assist with transferring him from his wheelchair, all of which exposed him to 

dangerous falls and unsanitary living conditions during his confinement. However, 

even if we assume that Hall has shown he was subjected to conditions of 

confinement that amounted to punishment, we agree with the district court that this 

claim fails. 

Hall attempts to establish municipal liability based upon what he alleges are 

“numerous policies” of Pulaski County that “restricted the medical staff’s ability to 

assist him in the [J]ail.” “To prove the existence of a policy” for municipal liability 

purposes, Hall may point to “an official policy” or “a deliberate choice of a guiding 

principle or procedure made by the municipal official who has final authority 

regarding such matters.” Schaffer v. Beringer, 842 F.3d 585, 596 (8th Cir. 2016)

(quoting Mettler v. Whitledge, 165 F.3d 1197, 1204 (8th Cir. 1999)). Hall has not 

presented evidence of the existence of any official policy that “restrict[s]” care to 

disabled inmates. Indeed, Pulaski County’s official written policies provide for the 

“proper housing and handling” of detainees at the Jail “who have a disability or 

impairment,” and for the provision of medical care by the Jail’s medical 

professionals for “individuals with special needs.” And Hall does not identify any 

evidence that evinces a deliberate choice of a guiding principle or procedure made 

by Pulaski County restricting the ability of the Jail’s staff to assist disabled inmates. 

See Marsh v. Phelps County, 902 F.3d 745, 752–53 (8th Cir. 2018). 

A plaintiff may also establish municipal liability by way of an unofficial 

custom if he establishes: 

(1) the existence of a continuing, widespread, persistent pattern of 

unconstitutional misconduct by the governmental entity’s employees; 

(2) deliberate indifference to or tacit authorization of such conduct by 

the governmental entity’s policymaking officials after notice to the 

officials of that misconduct; and 
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(3) that plaintiff was injured by acts pursuant to the governmental 

entity’s custom, i.e., that the custom was a moving force behind the 

constitutional violation. 

Brewington v. Keener, 902 F.3d 796, 801 (8th Cir. 2018) (quoting Corwin v. City 

of Independence, 829 F.3d 695, 700 (8th Cir. 2016)). “The pattern of 

unconstitutional conduct must be so pervasive and widespread so ‘as to have the 

effect and force of law.’” Id. (quoting Andrews v. Fowler, 98 F.3d 1069, 1075 (8th 

Cir. 1996)). Hall argues that his experience at the Jail was not the result of “isolated 

acts of employee negligence,” but rather was the product of a Jail custom of 

“refus[ing] to help him on a daily basis.” The evidence supports a finding that Hall

struggled with daily-living activities while detained at the Jail. But there is nothing 

in the record that indicates Hall’s experience was the consequence of a “pervasive 

and widespread” custom or practice at the Jail, and his bare assertions of such a 

custom are insufficient to impose municipal liability on Pulaski County. The district 

court appropriately granted summary judgment on Hall’s conditions-of-confinement 

claim.

B.

Hall contends that the district court erroneously granted summary judgment 

on his disability discrimination claim under the ADA and ACRA, which we consider 

together. See Duty v. Norton-Alcoa Proppants, 293 F.3d 481, 490 (8th Cir. 2002)

(analyzing ADA and ACRA claims using the same standards).

Title II of the ADA provides that “no qualified individual with a disability 

shall, by reason of such disability, be excluded from participation in or be denied the 

benefits of the services, programs, or activities of a public entity, or be subjected to 

discrimination by any such entity.” 42 U.S.C. § 12132; see also Mason v. Corr. 

Med. Servs., Inc., 559 F.3d 880, 886 (8th Cir. 2009). To prove his ADA claim, Hall 

must demonstrate that he is a qualified individual with a disability and that because 

of his disability, he was excluded from participation in or denied benefits of the Jail’s 

services, programs, or activities. See Baribeau v. City of Minneapolis, 596 F.3d 465, 
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484 (8th Cir. 2010). Furthermore, to recover compensatory damages, Hall must 

prove discriminatory intent, which can be shown by proffering evidence of the Jail’s 

“deliberate indifference to the strong likelihood that pursuit of its questioned policies 

will likely result in a violation of federally protected rights.” Meagley, 639 F.3d at

389 (citation omitted). 

Hall argues that the Jail discriminated against him because it failed to provide 

accommodations that would enable him to use or access the Jail’s toilets,

3 beds, and

certain medical care services, namely, two of his mental health appointments and 

one pill call.

4

 The failure to make reasonable accommodations “is a separate form 

of prohibited discrimination.” Peebles v. Potter, 354 F.3d 761, 766 (8th Cir. 2004); 

see also Withers v. Johnson, 763 F.3d 998, 1003 (8th Cir. 2014) (“Discrimination 

under the ADA . . . encompasses both disparate treatment because of a disability and 

failure to provide reasonable accommodations to a qualified individual’s known 

disability.”). Thus, a public entity must make reasonable accommodations where 

necessary to give “meaningful access” to programs or benefits; mere “limited 

participation” by persons with disabilities is not equivalent to “meaningful access.” 

See Randolph v. Rodgers, 170 F.3d 850, 858 (8th Cir. 1999). However, under Title 

3

Although Hall wore a diaper and may not have used or needed a toilet for his 

bowel movements, Hall clarified at oral argument that the toilet is “a platform by 

which he can clean his soiled diaper” and cleanse himself. 

4

As to Hall’s argument that the Jail discriminated against him because it failed 

to accommodate his need for handicap-accessible showers, Hall did not raise a 

disability discrimination claim regarding access to showers in his complaint, see N. 

States Power Co. v. Fed. Transit Admin., 358 F.3d 1050, 1057 (8th Cir. 2004) 

(explaining that parties are not “entitle[d] . . . to manufacture claims, which were not 

pled, late into the litigation for the purpose of avoiding summary judgment”), nor 

did he develop such an argument under the ADA before the district court at summary 

judgment. See Cole v. Int’l Union, United Auto., Aerospace & Agric. Implement 

Workers of Am., 533 F.3d 932, 936 (8th Cir. 2008) (“[A] party cannot assert 

arguments that were not presented to the district court in opposing summary 

judgment in an appeal contesting an adverse grant of summary judgment.”). As a 

result, the accessibility of the Jail’s showers is not properly before us.
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II, a public entity may demonstrate as an affirmative defense that “the requested 

accommodation of the plaintiff’s disability would constitute an undue burden.” 

Gorman v. Bartch, 152 F.3d 907, 912 (8th Cir. 1998). 

The parties here agree that Hall is a qualified individual with a disability. See

42 U.S.C. § 12102(1)(A) (defining a disability as “a physical or mental impairment 

that substantially limits one or more major life activities”). And they agree that the 

Jail’s toilets, beds, and medical care are a “service” under the ADA. See Mason, 

559 F.3d at 886 (noting that “[r]ecreational activities, medical services, and 

educational and vocational programs” are “benefits” under the ADA (citation 

omitted)); Bahl v. County of Ramsey, 695 F.3d 778, 787 (8th Cir. 2012) (reading 

the ADA’s “services, programs, or activities” language to encompass “anything a 

public entity does” (citation omitted)). The central question, then, is whether Hall 

was excluded from participation in, or denied the benefits of, these services because 

he is disabled.

Sheriff Higgins proffered evidence that Hall’s living units complied with 

ADA design standards, and that Hall missed the identified medical care 

appointments not because he was disabled, but because he refused to go to the 

appointments. But Hall testified that he was unable to enter his bed or use the toilet

in his living units because he lacked assistive devices or any aid getting in and out 

of his wheelchair, and he testified that he could not attend the medical appointments 

for the same reason. Based on this evidence, Hall has raised a genuine issue of fact 

with respect to whether the Jail accommodated his access to these services—that is, 

whether the Jail afforded him the same benefits as non-disabled detainees.

But only a “known disability triggers the duty to reasonably accommodate,” 

Peebles, 354 F.3d at 767, and Sheriff Higgins contends that the Jail was unaware of 

Hall’s need for certain accommodations. Specifically, Sheriff Higgins notes that 

Hall “never complained about toilet access during his detention” nor did Hall say 

that “he needed a cell with grab bars.” Yet, Hall testified that he repeatedly informed

the Jail’s guards and nurses of his need for assistance transferring in and out of his 
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wheelchair. And the record shows that Hall indeed submitted “grievances” to the 

Jail complaining, for example, that he could not “stand up,” that he lacked help 

“changing or cleaning” himself, and that he could not “transfer to a toilet [and] back 

to the chair.” Moreover, at least one of Hall’s disabilities—his paraplegia and the 

concomitant need for accommodations—was “obvious.” See, e.g., Robertson v. Las 

Animas Cnty. Sheriff’s Dep’t, 500 F.3d 1185, 1197 (10th Cir. 2007) (noting that in 

“certain instances” a public entity “will know of the individual’s need for an 

accommodation because it is ‘obvious’”); Windham v. Harris County, 875 F.3d 229, 

237 (5th Cir. 2017) (explaining that a plaintiff who fails to request an 

accommodation can still prevail if “the disability, resulting limitation, and necessary 

reasonable accommodation were open, obvious, and apparent to the entity’s relevant 

agents” (cleaned up)). Thus, here too, a genuine issue of fact exists regarding 

whether the Jail was on notice that Hall needed accommodations. 

Sheriff Higgins nonetheless downplays Hall’s testimony, asserting that Hall’s 

“own statements” or self-serving allegations are insufficient to permit his claims to 

survive summary judgment. But a “party’s own testimony is often self-serving,” 

and that alone is not grounds for disregarding it entirely. See Argenyi v. Creighton 

Univ., 703 F.3d 441, 446 (8th Cir. 2013) (quoting C.R. Pittman Constr. Co. v. Nat’l 

Fire Ins. Co. of Hartford, 453 F. App’x 439, 443 (5th Cir. 2011)). Here, Hall testified 

in detail about his personal experience at the Jail, and at summary judgment, it is not 

the role of the district court to weigh competing evidence or “attempt to discern the 

truth of any factual issue.” Morris v. City of Chillicothe, 512 F.3d 1013, 1018 (8th 

Cir. 2008). Accordingly, Hall’s testimony is sufficient to survive summary 

judgment. See Argenyi, 703 F.3d at 446 (“In [an ADA] case such as this it is 

especially important to consider the complainant’s testimony carefully because ‘the 

individual with a disability is most familiar with his or her disability and is in the 

best position to determine what type of aid or service will be effective.’” (citation 

omitted)). And viewing the evidence in the light most favorable to Hall, a reasonable 

factfinder could conclude that the Jail failed to provide him with meaningful access 
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to beds, toilets, and the identified medical care services. We reverse and remand on 

Hall’s disability discrimination claim.

5

III. 

We affirm summary judgment on Hall’s § 1983 deliberate indifference and 

conditions-of-confinement claims. But because triable issues remain on Hall’s 

disability discrimination claim under the ADA and ACRA, we reverse and remand 

for further proceedings consistent with this opinion.

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5

We express no opinion on whether the accommodations sought by Hall were 

reasonable or even available. These are questions that the district court may evaluate 

on remand.