Opinion ID: 1194191
Heading Depth: 2
Heading Rank: 2

Heading: The district court properly terminated eleven of the fourteen Stewart Orders under review.

Text: For nine of the Stewart orders, the County's showing of compliance was not contested. We briefly discuss these in subsection V.B.1, below, and affirm the district court's termination of these orders. Gilmore, 220 F.3d at 1008. We address two additional Stewart orders (related to seating in holding cells and adequate meal times) for which the parties did present conflicting evidence, in subsection V.B.2. Because our review of these two orders overlaps considerably with our review of the claims brought by the plaintiffs in Pierce under 42 U.S.C. § 1983 and California state law, we address plaintiffs' claims as part of our review of the termination of the orders themselves. 1. Termination of Stewart Orders related to reading materials, mattresses and beds, law books, population caps, sleep, blankets, telephone access, and communication with jailhouse lawyers. The district court found that the Stewart order regarding the availability of reading materials by mail, as well as the order regarding the availability of mattresses and beds, properly sought to enforce detainees' federal rights. The district court also acknowledged that the Stewart order regarding law-book access merely required that the County's policy be applied to each of its jail facilities. The district court went on to conclude, however, that these orders were not needed to correct current and ongoing violations. We agree. The County presented evidence tending to show its compliance with these Stewart orders, [17] and the plaintiffs did not present any contrary evidence related to these orders to contest the County's showing. The district court also acknowledged that population caps may be an appropriate remedy when overcrowding rises to the level of constitutional violation, but found no ongoing violation here. On the record presented we agree. Finally, the district court terminated the Stewart orders pertaining to sleeptimes, blanket use, telephone access, communications with jailhouse lawyers, and visitation for inmates in administrative segregation. In light of the County's presentation of evidence and the plaintiffs' failure to contest the County's showing, we affirm the district court on the ground that these orders are not necessary to correct current and ongoing violations. We therefore do not reach the question of whether these orders extend no further than necessary and are narrowly drawn and the least intrusive means to correct the violation. See § 3626(b)(3). 2. Termination of Stewart Orders related to seating and meal times.
The Stewart order requires that inmates be provided with seating while detained in holding cells, or elsewhere, awaiting transport to or from court. We affirm the district court's termination of the order, as we conclude that the evidence presented does not suggest that the continuation of prospective relief was necessary to correct a current and ongoing constitutional violation. The record shows that the County actively seeks to avoid overcrowding of holding cells; maximum capacities are posted in the cells, and deputies monitor the cells to ensure compliance. Deputies testified that, on occasion, overcrowding of a particular holding cell may be necessary for logistical and security reasons, butas the district court foundthese instances occur infrequently. Moreover, the record here shows that the hardship associated with the County's occasional overcrowding of the holding cells does not rise to the level of constitutional violation, given the relatively short periods (i.e., matters of hours) detainees spend in the holding cells. There is no evidence of unsanitary conditions or other concerns that would elevate such overcrowding to a constitutional violation. See, e.g., Bell, 441 U.S. at 542, 99 S.Ct. 1861; Lareau v. Manson, 651 F.2d 96, 103 (2d Cir.1981). For these reasons, we also affirm the district court's conclusion that plaintiffs failed to establish that the treatment of detainees in the County's holding cells constituted a violation of 42 U.S.C. § 1983.
The Stewart order requires that inmates be given not less than fifteen minutes within which to complete each meal. The district court terminated this Stewart order and rejected plaintiffs' § 1983 claim that they had been denied adequate meal times in violation of a federally protected right. Turning to plaintiffs' § 1983 claim, we conclude that they have not established that the mealtimes allowed by the County amounted to punishment in the constitutional sense and thus a deprivation of substantive due process. The only potential ground for constitutional relief suggested by the record would be a liberty interest created by a state regulation, in this case Cal.Code. Regs. Tit. 15, § 1240. See Kentucky Dep't of Corr. v. Thompson, 490 U.S. 454, 462, 109 S.Ct. 1904, 104 L.Ed.2d 506 (1989). However, the plaintiffs have not appealed the district court's pretrial ruling that this was not adequately pled as a basis for § 1983 relief. Finally, plaintiffs brought a state law claim for relief based on California Code of Regulations § 1240. Even assuming, without deciding, that § 1240 is sufficient to create an actionable duty under California law, see Cal. Govt.Code § 815.6; Haggis v. City of Los Angeles, 22 Cal.4th 490, 498-99, 93 Cal.Rptr.2d 327, 993 P.2d 983 (2000) (to be actionable under § 815.6, the enactment at issue must: (1) be obligatory, rather than discretionary or permissive; (2) must require that a particular action be taken or not taken, and (3) require that the mandatory duty be designed to prevent the kind of injury suffered by the plaintiff), in light of the policies and procedures implemented by the County to facilitate compliance with the Stewart order, we affirm the district court's conclusion that the County exercised reasonable diligence. [18] C. The district court erred by terminating two Stewart orders mandating minimal access to religious services and exercise for inmates housed in administrative segregation. Three of the remaining fourteen Stewart orders under review concern conditions for inmates in administrative segregation. As mentioned above, see n. 3, supra, administrative segregation is a classification for inmates with violent tendencies that have been deemed a threat to the jail's staff or to other inmates. The Stewart orders provide that inmates classified as administrative segregation must nonetheless be provided with limited access to religious services, limited access to exercise, and limited access to use of a day room. The district court terminated all three Stewart orders ensuring such access, and likewise found that plaintiffs had not proved any actionable § 1983 claim based on a deprivation of those rights. As explained below, we conclude that the district court's finding that inmates in administrative segregation were only sporadically denied access to religious services is clearly erroneous. The denials were systematic, and sufficiently so to constitute a violation of § 1983. Likewise, the record also demonstrates that detainees in administrative segregation were not provided with even the two hours per week of exercise required under the Stewart order. We are satisfied that providing inmates only ninety minutes of exercise per weekless than thirteen minutes per daydoes not comport with constitutional standards, and that such a severe curtailment of the detainees' ability to exercise evidences its punitive intent and necessitates reinstatement of the Stewart order.
The Stewart order requires that inmates in administrative segregation be allowed one of the following opportunities for religious worship: attending regularly scheduled religious services once a week, making short individual visits to the chapel once each week, or meeting with a bona fide religious adviser upon request of the inmate or adviser. The order also provides for the curtailment or elimination of the right if, in the course of exercising it, the inmate is disruptive or violent. Under the Constitution, reasonable opportunities must be afforded to all prisoners to exercise the religious freedom guaranteed by the First and Fourteenth Amendments. Cruz v. Beto, 405 U.S. 319, 322 n. 2, 92 S.Ct. 1079, 31 L.Ed.2d 263 (1972) (addressing the rights of convicted prisoners). However, as with other First Amendment rights in the inmate context, detainees' rights may be limited or retracted if required to maintain[ ] institutional security and preserv[e] internal order and discipline. Bell, 441 U.S. at 549, 99 S.Ct. 1861; see, e.g., Freeman v. Arpaio, 125 F.3d 732, 737 (9th Cir.1997). Restrictions on access to religious opportunities  whether group services, chapel visits, or meetings with religious advisers  must be found reasonable in light of four factors: (1) whether there is a valid, rational connection between the regulation and a legitimate government interest put forward to justify it; (2) whether there are alternative means of exercising the right that remain open to prison inmates; (3) whether accommodation of the asserted constitutional right would have a significant impact on guards and other inmates; and (4) whether ready alternatives are absent (bearing on the reasonableness of the regulation). Turner v. Safley, 482 U.S. 78, 89-90, 107 S.Ct. 2254, 96 L.Ed.2d 64 (1987); see also Beard v. Banks, 548 U.S. 521, 126 S.Ct. 2572, 165 L.Ed.2d 697 (2006); Mauro v. Arpaio, 188 F.3d 1054, 1058-59 (9th Cir.1999) (en banc). Further, because we are dealing with pretrial detainees, to satisfy substantive due process requirements the restriction or regulation cannot be intended to serve a punitive interest. Bell, 441 U.S. at 535, 99 S.Ct. 1861. [19] As the district court observed, under this standard some courts have allowed restrictions on worship for security purposes. Pedraza v. Meyer, 919 F.2d 317, 320(5th Cir.1990) (restriction on type of service inmate may attend permissible where inmate still provided with reasonable opportunities to worship). Denying inmates access to all outlets for religious worship, however, offers no alternative means of exercising the right, as called for by the second prong of Turner. Cf. O'Lone v. Estate of Shabazz, 482 U.S. 342, 107 S.Ct. 2400, 96 L.Ed.2d 282 (1987) (concluding that prison rules which prohibited Muslim inmates from engaging in Friday afternoon prayer services were reasonable, and relying in part on the fact that the inmates were allowed to participate in other weekly religious services and to have free access to the prison's imam). Accordingly, a detainee's placement in administrative segregation does not, standing alone, justify a complete denial of opportunities to practice religion. See Alston v. DeBruyn, 13 F.3d 1036, 1040 (7th Cir.1994) (holding that it was improper for the district court to assume that limits on an inmate's access to religious services were justified based on the inmate's placement in administrative segregation); Mawhinney v. Henderson, 542 F.2d 1, 3 (2d Cir.1976) (holding that inmates in punitive segregation and keeplock could not be denied participation in chapel services simply on the basis of their classification; individualized determinations of the necessity of their exclusion were required). The district court's final order in Stewart states that there was no indication of punishment or any ongoing violation of detainees' rights with respect to access to religious services. Although the court's final order in Pierce acknowledges evidence of at least [o]ccasional instances of impediments to participation, the court characterized these denials as merely sporadic. But the record evidences consistent denial of access to the chapel (whether for group services or individual visits) and to religious advisers to those in administrative segregation. Both of the plaintiffs' witnesses that were housed in administrative segregation, Fermin Valenzuela and Keith Hawkins, testified that they were routinely denied access to any kind of religious worship. Valenzuela testified that none of his requests to meet with his chaplain were granted, and testified that the verbal explanation he received for the denial was that inmates in administrative segregation . . . don't have it coming. Likewise, Hawkins testified that when he was classified in administrative segregation between March 2003 and June 2003, he was never allowed to attend chapel. Even the County's own witness, Deputy Brian Nissen, testified that he had never seen one of our Ad Seg inmates in chapel. The County's evidence was not to the contrary. Although the County argues on appeal that testimony from three detainee plaintiffs (detainees Conn, Palmitessa and Robledo) supported its contention that it provided regular access to religious services and clergy at every opportunity, the record does not bear out the County's characterization. Connwho was not an administrative segregation inmatemerely testified that he was permitted to attend chapel and that no Deputy ever told him that administrative segregation inmates had limited access to religious services. We are not persuaded that an inmate's failure to obtain a voluntary admission of non-compliance from his jailer somehow constitutes proof of compliance. Similarly, Palmitessaalso not an administrative segregation detaineetestified that he went to chapel whenever it was offered, but that it had not, in fact, been offered to him for several weeks. Finally, Robledo another non-administrative segregation witnesstestified on cross-examination that she was allowed access to religious services, but as she made clear on re-direct, she had difficulties getting access to chapel. [20] Nor did the County's affirmative evidence support the district court's factual finding that the County provides opportunities for inmates to participate in religious services and counseling, at least not as to administrative segregation detainees. The County relied primarily on the testimony of two jail personnel  Sergeant Dubsky and Deputy McCulloch  to support its contention that inmates were provided regular access to religious services and clergy at every opportunity. Sergeant Dubsky testified that administrative segregation detainees must fill out a message slip to obtain access to a chaplain, and that there is no limitation on the number of visits available. But Sergeant Dubsky did not testify that administrative segregation detainees were actually given such access. Likewise, Deputy McCulloch merely testified as to the manner in which chapel is called for non-administrative segregation detainees. He did not establish that chapel was called weekly, bi-weekly or with any other pattern of regularity. A custom can be shown or a policy can be inferred from widespread practices or evidence of repeated constitutional violations for which the errant municipal officers were not discharged or reprimanded. Gillette v. Delmore, 979 F.2d 1342, 1349 (9th Cir.1992); see also Nadell v. Las Vegas Metro. Police Dep't, 268 F.3d 924, 929 (9th Cir.2001). Plaintiffs' counsel asked the Sheriffs' department officials who testified whether deputies were ever disciplined or reprimanded for Stewart violations. No witness was able to identify any instance in which disciplinary steps were taken or a reprimand was issued. Moreover, the County's witnesses did not contend, and its brief on appeal does not suggest, that detainees in administrative segregation are denied worship opportunities because of security concerns, or for other legitimate non-punitive reasons. The district court should not have blindly deferred to the County's bare invocation of security concerns, when the County has failed to even establish that there is regular access to religious services for administrative segregation detainees, much less that interruptions in such access are on account of security. Walker v. Sumner, 917 F.2d 382, 386 (9th Cir.1990) (Without requiring some evidence that prison policies are based on legitimate penological justifications . . . `judicial review of prison policies would not be meaningful.') (citation omitted). In sum, the district court erred in denying declaratory or injunctive relief under § 1983. Similarly, the Stewart order remains necessary to ensure that detainees in administrative segregation are not denied access based on their classification alone. We therefore reverse the judgment of the district court with regard to this component of the Stewart injunction, as the record demonstrates that its enforcement remains necessary to correct a current and ongoing violation of [a] Federal right. 18 U.S.C. § 3626(b)(3). We also conclude that the Stewart order, as presently constituted, extends no further than is necessary and is the least intrusive means to correct the violation. Id. The terms of the Stewart injunction require that detainees in administrative segregation be afforded opportunities for worship, provided the detainees have not become disruptive or violent, implicating legitimate security concerns, even though the injunction does not require that detainees be afforded access to group religious services. The jail may instead satisfy the order by allowing individual chapel visits or meetings with religious advisers. In sum, the orderwith its provision for the curtailment or elimination of detainees' rights based on security concernsprovides for no more than a minimum level of ongoing participation in religious activities. Accordingly, we conclude that the injunction is narrowly drawn and extends no further than necessary to correct the violation of a Federal right. 18 U.S.C. § 3626(b)(3).
Exercise is one of the basic human necessities protected by the Eighth Amendment. See LeMaire v. Maass, 12 F.3d 1444, 1457 (9th Cir.1993) (as amended). Moreover, the Fourteenth Amendment requires that pretrial detainees not be denied adequate opportunities for exercise without legitimate governmental objective. See Bell, 441 U.S. at 538, 99 S.Ct. 1861. Determining what constitutes adequate exercise requires consideration of the physical characteristics of the cell and jail and the average length of stay of the inmates. Housley v. Dodson, 41 F.3d 597, 599 (10th Cir.1994). In the Orange County jails, the average period of pretrial detention is 110 days, with those accused of being third strike offenders spending an average of 312 days. Even by conservative estimates, detainees in administrative segregation and protective custody [21] spend twenty-two hours or more in their cells each day. As the district court noted, other courts have held that detainees who are held for more than a short time and spend the bulk of their time inside their cells are ordinarily entitled to daily exercise, or five to seven hours of exercise per week, outside their cells. See Campbell v. Cauthron, 623 F.2d 503, 507 (8th Cir.1980) (holding that pretrial detainees are generally entitled to one hour of exercise outside their cells daily if they spend more than sixteen hours in their cells); see also Housley, 41 F.3d at 599(`a failure to provide inmates (confined for more than a very short period . . .) with the opportunity for at least five hours a week of exercise outside the cell raises serious constitutional questions') (quoting Davenport v. DeRobertis, 844 F.2d 1310, 1315 (7th Cir.1988)). And at least one district court, in a class action brought pursuant to § 1983 challenging pre-trial conditions of confinement, has held that defendants' failure to provide each inmate one hour per day of exercise outside the cells is a constitutionally intolerable condition. Hutchings v. Corum, 501 F.Supp. 1276, 1294 (W.D.Mo.1980). The record shows that pretrial detainees in administrative segregation and other restrictive classifications, such as protective custody, are typically afforded, at best, only ninety minutes weekly in a space equipped for exercise. [22] Although we need not hold that there is a specific minimum amount of weekly exercise that must be afforded to detainees who spend the bulk of their time inside their cells, we hold that providing the equivalent of slightly less than thirteen minutes of exercise a day does not give meaningful protection to this basic human necessity. See LeMaire, 12 F.3d at 1457; Housley, 41 F.3d at 599. We therefore conclude that plaintiffs have established a violation of § 1983. In finding no punitive intent, the district court relied exclusively on the fact that a group of detainees congregating in an open area containing weights and other equipment raises security concerns. We agree that the County has considerable discretion to curtail access to exercise based on security concerns. Bell, 441 U.S. at 539 n. 23, 99 S.Ct. 1861. Here, however, the curtailment to ninety minutes weekly for inmates who otherwise spend the bulk of their time inside their cells reduces the amount of exercise to a point at which there is no meaningful vindication of the constitutional right to exercise for this entire category of detainees. The County has provided nothing more to justify this almost complete denial of exercise than a generalized reference to institutional security concerns. It has made no showing that such a severe restriction is reasonably related to satisfying those concerns. Compare Spain v. Procunier, 600 F.2d 189, 192, 199-200(9th Cir.1979) (impermissible to completely deny access to outdoor exercise for a particular category of inmates, even when inmates within that category were being disciplined for committing violent acts while in prison) with LeMaire, 12 F.3d at 1458 (upholding denial of exercise privileges for a particular inmate deemed a grave security risk who had previously attacked corrections officers). Given the severity of the current restrictions and their application across an entire category of detainees, we conclude that ninety minutes of exercise per week constitutes punishment for purposes of § 1983. Accordingly, we also determine that the Stewart order, which requires that inmates in administrative segregation be permitted exercise at least twice each week for a total of not less than 2 hours per week, is necessary to correct a current and ongoing violation of [a] Federal right. 18 U.S.C. § 3626(b)(3). We likewise conclude that the Stewart order, as it is currently constituted, is narrowly drawn and is the least intrusive means to correct the violation. Id. The Stewart order requires considerably less exercisejust two hours a weekthan the one hour a day recognized elsewhere as a constitutional floor. More importantly, the Stewart order contains a safety-valve that permits the County, in its discretion, to curtail or eliminate exercise rights in the event such inmate becomes violent or disruptive in the course of exercising such rights. Thus, the existing Stewart order accords the County sufficient deference in determining whether a particular inmate poses a risk to security requiring limitations on or revocation of the right. On remand, the district court must reinstate the Stewart order and enjoin violation under § 1983.
The Stewart order requires that inmates be given access to the day room for two hours daily, but provides for curtailment or elimination of the right to day room access for security or disciplinary reasons. Confinement necessarily imposes restraints on detainees' freedom of movement and access to recreation. Nonetheless, such restrictions may constitute punishment in the constitutional sense, and thus violate the Fourteenth Amendment, if they are not rationally related to a legitimate nonpunitive governmental purpose and . . . appear excessive in relation to that purpose. Bell, 441 U.S. at 561, 99 S.Ct. 1861. Given the conditions and average duration of confinement in administrative segregation and similarly restrictive classifications, failure to provide detainees with the opportunity for some daily out-of-cell movement raises serious constitutional questions. See Bell, 441 U.S. at 543, 99 S.Ct. 1861(considering day room access as a factor that mitigates overcrowding); Lock v. Jenkins, 641 F.2d 488, 493-94 (7th Cir.1981) (finding that the importance of day room access increases as the length of time the detainee spends in the cell increases and the size of the cell decreases). The record evidence demonstrated that administrative segregation detainees, were, in fact, given access to the day room. The restrictions placed on use of the day room  limiting administrative segregation detainees' use of the room to one or two inmates at a timeare reasonably related to institutional security concerns. For these reasons, we affirm the district court's denial of plaintiffs' claim under 42 U.S.C. § 1983, because in this instance the County's restrictions still permit access to the day rooms and do not evince any punitive intent. Accordingly, there is no evidence of a current and ongoing violation of a Federal right, and we therefore also affirm the district court's termination of this Stewart order. 18 U.S.C. § 3626(b)(3). [23] D. The district court erred by finding that the County was not in violation of the ADA. Having addressed the portions of this appeal relating to the Stewart injunction and the claims of the overall Pierce class, we turn our attention to the rights of the Pierce sub-class of mobility- and dexterity-impaired pretrial detainees. Plaintiffs argued at trial that the County was not in compliance with the ADA or California's co-extensive access requirements at § 54.1 of the California Civil Code. Plaintiffs maintained that the County failed to address numerous structural barriers and, as a result, denied mobility- and dexterity-impaired detainees access to various features and elements of their cells and common spaces. They also argued that, because of their disabilities, they were segregated and denied access to a variety of the County's educational, rehabilitative, and recreation programs, services, and activities for pretrial detainees. Despite finding that the County was not in full ADA compliance, the district court decline[d] to declare an ADA or California Civil Code violation, or order injunctive relief. This decision cannot stand. As we explain below, we reverse in part and remand for further proceedings consistent with this opinion. 1. Standards for evaluation of the ADA claims. Pursuant to Title II of the ADA, a qualified individual with a disability cannot, 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. [24] It is undisputed that Title II applies to the Orange County jails' services, programs, and activities for detainees. See Pa. Dep't of Corr. v. Yeskey, 524 U.S. 206, 209-10, 118 S.Ct. 1952, 141 L.Ed.2d 215 (1998); Lee v. City of Los Angeles, 250 F.3d 668, 691 (9th Cir.2001). The regulations promulgated under Title II spell out the obligations of public entities. [25] Under the regulations, a qualified individual with a disability (an individual for whom reasonable modifications may be required, 42 U.S.C. § 12131(2)) must not be excluded from or denied the benefits of a public entity's services, programs, or activities because the entity's facilities are inaccessible or unusable. See 28 C.F.R. § 35.149. Generally, public entities must make reasonable modifications in policies, practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program, or activity. Id. § 35.130(b)(7); see McGary v. City of Portland, 386 F.3d 1259, 1265-67(9th Cir.2004). In a subsection titled existing facilities, the regulations provide that a public entity must operate each service, program, and activity so that the service, program, or activity, when viewed in its entirety, is readily accessible to and usable by individuals with disabilities. 28 C.F.R. § 35.150(a). The regulations, however, note in relevant part that: (1) a public entity is not necessarily required to make each of its existing facilities accessible to and usable by individuals with disabilities, id. § 35.150(a)(1); and (2) a public entity is not required to take any action that it can demonstrate would result in a fundamental alteration in the nature of a service, program, or activity or in undue financial and administrative burdens, id. § 35.150(a)(3). [26] The regulations allow public entities to use a variety of methods to make existing facilities readily accessible, including the reassignment of services to accessible buildings and the alteration of existing facilities and construction of new facilities. Id. § 35.150(b)(1). Section 35.150(b)(1) provides: A public entity is not required to make structural changes in existing facilities where other methods are effective in achieving compliance with this section. . . . In choosing among available methods for meeting the requirements of this section, a public entity shall give priority to those methods that offer services, programs, and activities to qualified individuals with disabilities in the most integrated setting appropriate. Id.; see also 28 C.F.R. Pt. 35, App. A(stating that under Title II the concept of program access will continue to apply with respect to facilities now in existence, because the cost of retrofitting existing facilities is often prohibitive). To the extent that structural changes are to be made to an existing facility, the accessibility requirements that apply to new construction and alterations, set out in 28 C.F.R. § 35.151, must be met. 28 C.F.R. § 35.150(b)(1). In addition, the regulations require that an entity with more than fifty employees, such as Orange County, develop a transition plan setting forth the steps that must be taken to complete any planned structural changes. Id. § 35.150(d)(1). Finally, January 26, 1995, was the deadline for making structural changes under the regulations. Id. § 35.150(c). While § 35.150 addresses itself to existing facilities, § 35.151 concerns new construction and alterations. The regulatory requirements in this section are somewhat more straightforward. See Parker v. Universidad de Puerto Rico, 225 F.3d 1, 6 & n. 7 (1st Cir.2000) (comparing Title II's regulations governing existing facilities and new construction and alterations). Section 35.151 requires that any part of a public entity's facility constructed after January 26, 1992 must be designed and constructed in conformance with the Uniform Federal Accessibility Standards (`UFAS') (41 C.F.R. Pt. 101-19.6, App. A) or with the Americans with Disabilities Act Accessibility Guidelines for Buildings and Facilities ('ADAAG') (28 C.F.R. Pt. 36, App. A). Id. § 35.151(a), (c) (allowing departures from these standards when it is clearly evident that equivalent access is afforded). And, to the maximum extent possible, any part of a public entity's facility altered after January 26, 1992 in a manner that affects or could affect [its] usability must also be altered in conformance with one of these accessibility standards. Id. § 35.151(b), (c). 2. ADA standards in the context of prison administration. While the regulations promulgated under Title II provide a framework for analyzing ADA claims generally, we have held that inmates' rights must be analyzed in light of effective prison administration. Gates v. Rowland, 39 F.3d 1439, 1446 (9th Cir.1994). As the district court observed, we held in Gates, 39 F.3d at 1447, that inmates' claims that their rights under the Rehabilitation Act had been violated were subject to the so-called reasonable relation standard articulated in Turner, 482 U.S. at 89, 107 S.Ct. 2254. [27] Under Turner, a regulation that would impinge on inmates' constitutional rights is nevertheless valid if it is reasonably related to the prison's legitimate interests. [28] Id. We concluded in Gates that to prevail on a claim that their statutory rights have been violated, inmates must show that the challenged prison policy or regulation is unreasonable. Gates, 39 F.3d at 1447. [29] In ADA cases, the plaintiff bears the burden of establishing the elements of the prima facie case, including  if needed  the existence of a reasonable accommodation that would enable him to participate in the program, service, or activity at issue. Zukle, 166 F.3d at 1046. The public entity may then rebut this by showing that the requested accommodation would require a fundamental alteration or would produce an undue burden. See 28 C.F.R. § 35.150(a)(3). As we explained in Zukle, determining whether a modification or accommodation is reasonable always requires a fact-specific, context-specific inquiry. 166 F.3d at 1048. This analysis permits a court to consider, with deference to the expert views of facility administrators, a detention or correctional facility's legitimate interests (namely, in maintaining security and order and operating [an] institution in a manageable fashion, Bell, 441 U.S. at 540 n. 23, 99 S.Ct. 1861) when determining whether a given accommodation is reasonable. Cf. Crawford v. Indiana Dep't of Corr., 115 F.3d 481, 487 (7th Cir.1997). 3. The County has failed to reasonably accommodate mobility-impaired and dexterity-impaired inmates in violation of the ADA. The plaintiff class of mobility- and dexterity-impaired pretrial detainees contends that the County's failure to accommodate their disabilities has prevented them from enjoying a number of the County's services, programs, and activities. They argue that the County has not reasonably addressed various structural barriers, and maintains unreasonable policies and practices in violation of the ADA. a. Physical barriers. With regard to barriers, the district court found the evidence to show that the Orange County jails have not yet been brought into full ADA compliance. In 2000, Orange County adopted a Transition Plan to move existing facilities toward ADA compliance. That plan was directed more toward structural modifications of public and visitor areas than toward compliance in inmate areas. The district court went on to state that inmate witnesses and plaintiff's expert, Mr. Robertson, identified various specific architectural barriers and features that are out of compliance with the ADA. These findings are clearly supported by the record. As of 2004, when the case went to trial, the County housed mobility- and dexterity-impaired pretrial detainees in two of its five facilitiesthe Men's and Women's Central Jails. Male inmates with such disabilities were placed in one of three parts of Module O in the Men's Jail: Sheltered Living, Ward C, or Ward D. Female inmates with such disabilities were housed in either Sheltered Living in Module P of the Women's Jail or the infirmary. Plaintiffs' expert witness Peter Robertson was permitted to tour these areas, and to take photographs and measurements of the structures and fixtures. He testified at length regarding his measurements, observations, and conclusions. Robertson maintained that a host of features and fixturesincluding toilets, sinks, showers, hot water dispensers, telephones, and water fountainsin cells or common spaces the County referred to as accessible did not comply with federal accessibility standards. [30] Since the district court's order fails to specify which architectural barriers and features [were] out of compliance with the ADA, we limit ourselves to noting  in support of the court's proper, but vague, finding  that a number of the deficiencies reported by Robertson were conceded by Ron Bihner, the project manager charged with supervising structural modifications at the County jails pursuant to the Transition Plan, and many others were not explicitly disputed. Notably, Bihner agreed that the showers in Wards C and D were not accessible to the mobility-impaired, conceded that the toilet and sink in the women's infirmary day room were inaccessible to individuals in wheelchairs, and acknowledged that the rooftop exercise and recreation areas afforded to male and female disabled detainees did not offer accessible bathroom facilities. [31] The County presented no evidence to dispute Robertson's assertions that rooftop telephones and water fountains were inaccessible to those in wheelchairs and that the sinks and toilets serving the Women's Central Jail classroom were inaccessible, as well as facilities in other areas. [32] While it is evident that the district court was well-supported by the record when it observed (albeit without specificity) that the existence of barriers had been shown, the district court inexplicably made further findings which are unsupported by and contrary to the record: The court concluded that the plaintiffs were not entitled to relief because they had not shown that effective modifications could be made, or that where an architectural shortcoming existed, it was not made accessible by other appropriate action taken by a jail employee. The district court asserted broadly that where structural corrections had not been made, the County had shown that other effective remedies [were] in use. To begin, we agree that plaintiffs were required to show `the existence of . . . reasonable accommodation[s]' that would enable them to make use of the facilities. Zukle, 166 F.3d at 1046(quoting Barnett v. U.S. Air, Inc., 157 F.3d 744, 749 (9th Cir. 1998)). Any finding that they did not do so is legal error. Robertson's testimony included site-specific suggestions of structural, as well as non-structural, accommodations. He drew upon the minimum standards set out in the UFAS or the ADAAG for proposed structural changes, such as the repositioning of a sink or the replacement of controls. See 28 C.F.R. § 35.150(b)(1)(requiring that structural modifications be made in accord with the guidelines for new construction, UFAS or ADAAG). Alternative solutions to remedy some access problems were also offered. For example, Robertson noted in one instance that an inaccessible water fountain could be remedied by adding a cup dispenser rather than changing the position of the fountain. The district court found further that the County was not required to remedy structural deficiencies because other curative methods provided disabled individuals with the requisite access. We agree, as a matter of law, that where reasonable alternative methods achieve compliance, structural changes to existing facilities need not be made. 28 C.F.R. § 35.150(b)(1). However, there is no support for the court's conclusion that such methods were shown to cure the many structural deficiencies in this case. The only deficiencies that were shown to be addressed by alternate methods were small surface-elevation changesi.e., ridges or curbsthat otherwise posed obstacles to movement between locations. Robertson observed, for example, that a five-inch curb obstructed access to the women's rooftop recreation area. He testified that this could be overcome by having a trained deputy guide a wheelchair over the curb. The record supports the conclusion that deputies, in fact, do this, and plaintiffs are not denied access to the rooftop or other locations because of these surface irregularities. [33] The County did not present evidence, as the district court's broad finding asserts, that other deficiencies were remedied through the assistance of deputies or by other curative methods. Plaintiffs, on the other hand, presented evidence to show that deficiencies were not remedied. Robertson testified, for example, that he observed detaineesnot deputiesstruggling to lift a fellow wheelchair-bound detainee over a foot-high retention wall in one of Ward C's inaccessible showers. Conn also testified that he was forced to rely on fellow inmates for assistance when faced with inaccessible bathroom facilities. [34] The impediment posed by such a barrier highlights the inadequacy of deputy or other inmate assistance. The County maintained throughout the trial that the deputies have their hands full given the ratio of deputies to inmates and the various duties incumbent upon the former. Staffing limits make it unreasonable to expect to address all structural deficiencies through deputy assistance. The County argues that the district court's holding should, in any event, be affirmed because plaintiffs failed to satisfy their burden under Turner. We disagree. Even under Turner, the County was required to proffer some reason for its policy or practice. See Armstrong '01, 275 F.3d at 874. The County did not posit any legitimate rationale for maintaining inaccessible bathrooms, sinks, showers, and other fixtures in the housing areas and commons spaces assigned to mobilityand dexterity impaired detainees. [35] The vague assertion by the County's counsel that some accommodations might be costly cannot be construed as a legitimate basis for failing to comply with the ADA (whether through structural modifications or other reasonable methods). See id.; Walker, 917 F.2d at 386. We conclude that the district court erred in denying relief because it based its conclusion on clearly erroneous factual findings. Accordingly, we remand for further proceedings. b. Integration and access to programs and services. Plaintiffs also argued that, by virtue of being housed exclusively in the Men's and Women's Central Jails, they were denied access to a variety of programs, activities, and services for which they would otherwise be eligible. Plaintiffs essentially advanced two arguments: First, they challenged the County's policy of segregating disabled detainees, rather than allowing them to reside, recreate, and consume meals in integrated settings. Second, they argued that, regardless of where they are housed, the County had not operate[d] each service, program, or activity so that the service, program, or activity, when viewed in its entirety, [was] readily accessible to and usable by individuals with disabilities, as required by 28 C.F.R. § 35.150(a). The district court rejected plaintiffs' claims. First, the court concluded that the segregation of disabled detainees was reasonably related to legitimate interests, and therefore declined to order mainstreaming. Second, the court found that the evidence shows that, except for the `Best Choice' Program, the various inmate programs are also available to disabled inmates, and concluded that this was reasonable. The exclusion of disabled inmates from the Best Choice Program, a drug rehabilitation program, was deemed reasonable in light of security concerns. We do not find error in the district court's ruling regarding mainstreaming. Sheriff's Department officials testified at some length regarding the security concerns related to housing mobility- and dexterity-impaired detainees with non-disabled detainees. The district court's finding that plaintiffs did not refute this evidence is not clearly erroneous. The district court's finding that disabled inmates had access to all programs, save the Best Choice program, cannot, however, be squared with the record. [36] As we mentioned earlier, as of 2004, disabled detainees with mobility and dexterity impairments were not housed in the County's James A. Musick Facility or Theo Lacy Facility. [37] The testimony of Sheriff's Department officials revealed that Theo Lacy and Musick offered a variety of programs, services, and activities which were not available to inmates of the Men's and Women's Central Jails. For example, programs in agriculture, woodworking, and welding were among the vocational opportunities available at Musick or Theo Lacy, but not available at the Central Jail Complex. In addition, detainees at Musick and Theo Lacy were afforded opportunities to participate in off-site or community work projects. The recreational opportunities available at Musick or Theo Lacywhere inmates had access to a softball field, volleyball courts, pool tables, and other indoor and outdoor facilitiesalso exceeded those provided at the Central Jail Complex. The Central Jail Complex houses both disabled and non-disabled detainees. However, non-disabled detainees retain at least the possibility of access to the programs offered at Musick and Theo Lacy, while disabled detaineessolely by virtue of their status as disabledhave no possibility of access to the superior services offered outside of the Central Jail Complex. The ADA does not require perfect parity among programs offered by various facilities that are operated by the same umbrella institution. But an inmate cannot be categorically excluded from a beneficial prison program based on his or her disability alone. Yeskey, 524 U.S. at 210, 118 S.Ct. 1952(Modern prisons provide inmates with many recreational `activities,' medical `services,' and educational and vocational `programs,' all of which at least theoretically `benefit' the prisoners (and any of which disabled prisoners could be `excluded from participation in').). Moreover, ADA regulations contemplate reassignment of services to accessible buildings, as a permissible means of accommodation. 28 C.F.R. § 35.150(b)(1). The County would not have to make Musick and Theo Lacy physically or structurally ADA compliant. It might consider, for example, redistributing some programs available at those two facilities to make them available at the Central Jail so that when viewed in [their] entirety the County's programs are readily accessible to and usable by individuals with disabilities. 28 C.F.R. § 35.150(a). But the County may not shunt the disabled into facilities where there is no possibility of access to those programs. [38] While the County need not make all of its existing facilities accessible to individuals with or without disabilities, it is expected to provide program access. 28 C.F.R. Pt. 35, App. A. Any type of educational, vocational, rehabilitative, or recreational program, service, or activity offered to nondisabled detainees should, when viewed in its entirety, be similarly available to disabled detainees who, with or without reasonable accommodations, meet the essential eligibility requirements to participate. The County has offered no explanation or justification, either in district court or on appeal, for the significant differences between the vocational and recreational activities available at Theo Lacy and Musick, and those available to either able or disabled detainees at the Central Jail. As such, the County has not raised the defense that a policy of restricting access to these programs, services, or activities is reasonably related to a legitimate government objective. See Armstrong '01, 275 F.3d at 874. We conclude that the district court erred when it concluded that disabled inmates had access to the various inmate programs, and we must remand as further fact-finding is required to determine what relief is appropriate. [39] In particular, the district court should examine the extent to which the programs offered at Theo Lacy and Musick are capable of reassignment to the Central Jail without eliminating those programs at Theo Lacy or Musick. c. The district court's unsupported assumption that the County would move toward full compliance was clearly erroneous. The district court determined that the County was not in compliance with the ADA, but took it on faith that the County would move toward full compliance. This conclusion is unwarranted given the County's track record. The County adopted its Transition Plan for structural changes in August 2000eight years after the deadline set by the regulations for such plans, and five and a half years after the regulations' deadline for the completion of structural modifications. [40] Furthermore, when ultimately adopted, the Plan failed to address many architectural barriers in common spaces used by disabled detainees (for example, those on the rooftop of the Men's and Women's Jails). Diane DeHaas, the Orange County ADA Title II Coordinator, testified that the work under the Transition Plan had been completed, and spoke of no particular plans to remedy any of the glaring deficiencies. The County has done even less to ensure that disabled detainees are given opportunities to benefit from the various programs, activities, and services offered by the jails. While Title II regulations require that the County complete a self-evaluation regarding the availability of programs, activities, and services, see 28 C.F.R § 35.105(a), DeHaas conceded that she did not know whether it had been done for the County jails. Moreover, she admitted that she had no information about whether disabled detainees could have access to educational programs or a variety of other services. In any event, neither the fact that Orange County might move toward compliance nor the district court's belief that it would do so eventually constituted a proper basis for denying plaintiffs relief. We must remand so that the district court can engage in further fact-finding, consistent with our opinion, to determine what relief should be granted. We note that several years have passed since the trial was held, and, as a result, determining what prospective relief is warranted may require consideration of any significantly changed facts. [41] Finally, the district court's Final Pierce Order did not address plaintiffs' claims that they were denied adequate notice of their rights under the ADA and an appropriate grievance procedure, as required by the regulations. See 28 C.F.R. §§ 35.106, 35.107. On remand, the district court also should make findings on these issues. d. Claims for mental and emotional harms. Prior to trial the district court granted summary judgment to Orange County on plaintiffs' claims for mental and emotional harms. We conclude that decision was in error as it related to two specific allegations advanced by plaintiff Timothy Conn. According to plaintiffs' complaint, Conn alleged that the County failed to adequately accommodate his disability in violation of the ADA, and that he suffered physical injuries, as well as mental and emotional distress, as a result. The district court's March 1, 2004 order held that these alleged injuries were merely de minimis, and therefore precluded by the PLRA, 42 U.S.C. § 1997e(e), from giving rise to any cognizable claim under the ADA for compensatory damages. The PLRA, 42 U.S.C. § 1997e(e), states, No Federal civil action may be brought by a prisoner confined in a jail, prison, or other correctional facility, for mental or emotional injury suffered while in custody without a prior showing of physical injury. See Oliver, 289 F.3d at 626-27(concluding that § 1997e(e) requires a showing of physical injury that need not be significant but must be more than de minimis. ). Conn challenges the district court's determination, arguing that § 1997e(e) does not apply to claims under the ADA and that his injuries were in any case more than de minimis. While the former argument is unpersuasive in light of the plain language of § 1997e(e), [42] the latter argument compels our reversal of the district court's decision with regard to two of Conn's allegations. Conn alleged that during his detention in 2000-2001 he was denied an adequate supply of catheters, and as a result suffered recurrent bladder infections. He also alleged that he was not provided a proper mattress given his disability, and as a result developed bed sores. Neither of these injuries is de minimis. Both bladder infections and bed sores pose significant pain and health risks to paraplegics like Conn. [43] Our court has rejected as overly restrictive the standard for de minimis injuries espoused by the Northern District of Texas in Luong v. Hatt, 979 F.Supp. 481 (N.D.Tex.1997), which requires `an observable or diagnosable medical condition requiring treatment by a medical care professional,' which would cause a `free world person' to seek such treatment. Oliver, 289 F.3d at 628. We have maintained that if allowing claims for de minimis injuries requires too little of plaintiffs, this standard requires too much. Id. Yet notably, Conn's alleged bed sores and bladder infections clear even that stringent standard. Both constitute `observable or diagnosable medical conditions' that would lead a person to seek treatment. See id. [44] In sum, these claims were improperly dismissed, and we remand to the district court for further proceedings consistent with this opinion. E. The district court did not err in rejecting plaintiffs' equal protection claims. Finally, the disabled plaintiffs argue that the district court improperly rejected the equal protection claim brought by the sub-class of mobility- and dexterity-impaired detainees. After reviewing the district court's November 2004 ruling de novo, see Buono v. Norton, 371 F.3d 543, 545 (9th Cir.2004), we affirm the grant of summary judgment. The district court considered whether plaintiffs could establish that they were treated differently from how similarly situated prisoners are treated. This is the first step in a successful equal protection claim based on disability. See McGowan v. Maryland, 366 U.S. 420, 425, 81 S.Ct. 1101, 6 L.Ed.2d 393 (1961); Williamson v. Lee Optical of Oklahoma, Inc., 348 U.S. 483, 490, 75 S.Ct. 461, 99 L.Ed. 563 (1955). Because `the disabled do not constitute a suspect class' for equal protection purposes, a governmental policy that purposefully treats the disabled differently from the non-disabled need only be `rationally related to legitimate legislative goals' to pass constitutional muster. Lee, 250 F.3d at 687(quoting Does 1-5 v. Chandler, 83 F.3d 1150, 1155 (9th Cir.1996)). However, the court's assertion that disabled and nondisabled detainees are not similarly situated for equal-protection purposes is an overstatement. Disabled and nondisabled detainees may be similarly situated in some instances. See, e.g., More v. Farrier, 984 F.2d 269, 270-71 (8th Cir.1993) (finding that wheelchair-bound inmates and nondisabled inmates were equally capable of watching television without assistance, and therefore were similarly situated with regard to the installation of cable television); see also City of Cleburne v. Cleburne Living Ctr., 473 U.S. 432, 446, 105 S.Ct. 3249, 87 L.Ed.2d 313 (1985) (The State may not rely on a classification whose relationship to an asserted goal is so attenuated as to render the distinction arbitrary or irrational.). Nonetheless, we conclude that the district court's holding was proper, given the case presented by the plaintiffs. Plaintiffs' allegations in support of their equal protection claim did not show that they were treated differently from similarly situated prisoners. For example, although plaintiffs alleged that paraplegic and quadriplegic detainees were kept in holding cells without accessible toilets and sinks, they did not allege that the County accommodated the special needs of any other group with regard to toilet or sink access. While these allegations implicate the County's ADA obligations, they do not, without more, implicate equal protection concerns.