Prisons across the U.S. routinely flout the Americans With Disabilities Act, subjecting thousands of inmates with physical and mental health problems to painful and sometimes humiliating conditions, according to watchdog groups, inmates, corrections officials, and a former Justice Department official in charge of enforcing the law.

The alleged violations include a case in Washington state where an inmate with neuropathy, a nerve condition that can cause numbness in the hands and feet, ended up living on the floor of his cell in solitary confinement. The prisoner, 50-year-old Curtis Graham, claims he was forced to urinate in cups because he was unable to stand after prison staff changed his medication and confiscated his orthopedic shoes and cane.

“They took everything like there wasn’t nothing wrong with me,” Graham told VICE News by phone from the Clallam Bay Corrections Center, a remote facility about a three-and-a-half-hour drive from Seattle. “I’ve been pretty much abused due to my disability, for a really long time,” he added.

Passed by Congress in 1990, the Americans with Disabilities Act requires that prisons provide “reasonable accommodations” for disabled people, such as grab bars, wheelchair ramps, and special adaptations in educational or treatment-related programs for inmates who are deaf or have a cognitive disability. Inmates aren’t supposed to be put in solitary confinement simply because there are no accessible cells available.

For the 31 percent of inmates in state prisons nationwide who report having a physical or cognitive disability, abuse and neglect can be common features of prison life, according to a recent report by Disability Rights Washington. And the situation is only expected to get worse as the U.S. prison population ages. Incarcerated people are three or four times more likely to report having a disability than the rest of the U.S. population.

“Additional forms of punishment are exacted upon inmates with disabilities across the country on a daily basis solely by virtue of their disability,” said Rachael Seevers, a staff attorney at Disability Rights Washington, which called attention to Graham’s case over the summer. “People are sent to prison as punishment, not for punishment.”

Disabled prisoners also have less access to educational and other programming, and they are disproportionately subjected to violence and sexual assault, according to a recent report by the Center for American Progress.

These conditions arise because many state prisons don’t take the ADA seriously, according to Elizabeth Stanoscheck, a former ADA coordinator for the Nebraska Department of Corrections who currently works as an ADA consultant, visiting state prisons around the country to evaluate compliance with the law. In 1998, the Supreme Court ruled that the ADA applies to prisons and jails.

“From that point on, corrections [facilities] should have gotten on board,” Stanoscheck said. “But not all of them did.”

More than 2,000 lawsuits involving the ADA and prisons have been filed in state and federal courts since 1990, but inmates rarely prevail in these cases. Inmates can file complaints through their prison’s internal grievance process, but these are often reviewed by the very staff members who are the subjects of the complaint. A recent lawsuit filed over civil rights abuses of disabled inmates in Shasta County Jail in California alleges that prison officials told inmates that grievance forms were better used to “wipe their ass.”

John Wodatch, who headed the disability rights section of the Department of Justice’s civil rights division from its inception in 1995 until 2011, said most of the thousands of annual complaints the office received were from prisoners and that nearly all of them were substantiated.

“Every complaint we got from those people were legitimate complaints,” he said. “It was a litany of discrimination against people with disabilities.” One common complaint Wodatch encountered was inmates with disabilities missing out on employment programs and vocational trainings in prison because those programs were not accessible.

The DOJ does take steps to enforce the ADA: The department recently released guidance to prisons about placing disabled inmates in solitary confinement, and it has issued a memo concerning the application of the ADA in juvenile detention centers. It has also offered instructions for correctional facilities on designing accessible cells. The feds occasionally investigate ADA violations and have forced some prisons to create alternative oversight mechanisms as part of recent settlements. But that’s not enough for advocates, who want federal funding to be contingent on ADA compliance.

Wodatch said there “just isn’t the capacity” within the DOJ’s civil rights division to address all violations, but there’s also the issue of cost. Retrofitting all prisons and jails across the country would cost hundreds of millions of dollars, according to an estimate by Paul Bishop, an ADA consultant with the Seattle law firm Endelman and Associates.

Some advocates are also concerned that the DOJ under President-elect Donald Trump and Alabama Sen. Jeff Sessions, his nominee to lead the department, will be even less concerned with enforcing the ADA than previous administrations were.

“I worry that if we return to command-and-control corrections that we’ll forget about the harms that these systems inflict on these human beings,” said Jamelia Morgan, a fellow with the ACLU’s National Prison Project. “I’d assume that people with disabilities will slip through the cracks.”

The American Correctional Association declined to comment for this story and the Association of State Correctional Administrators did not respond to a request for comment. A spokesman for the federal Bureau of Prisons said that “accommodations [for disabled prisoners] can be expensive and staff-intensive.”

Without adequate oversight, prisoners with intellectual disabilities, cognitive disorders, and mental illness have been disciplined for failing to follow written rules that they cannot read or understand, according to the Disability Rights Washington report. Many have been unable to complete programs required to move out of solitary, forcing them to remain in isolation for years — and sometimes decades.

Records obtained by VICE News show that Graham, the disabled Washington state inmate who ended up living on the floor of his solitary cell, filed a grievance after doctors at the Clallam Bay Corrections Center discontinued his neuropathy medication. In response to a grievance form Graham submitted, a prison official said that by discontinuing this medication, “your provider was aligning your therapy with the DOC formulary,” meaning Graham was placed on medications the prison was allowed to prescribe.

A Clallam Bay spokesperson said the prison could not comment on the case due to privacy concerns, but pointed to prison policies specifying that medical equipment is allowed in solitary cells if approved by health staff and the unit supervisor. Medical records show that the prison had previously approved special shoes and a cane for Graham, but they were taken from him, according to records. Medical records also indicate that prison staffers reported seeing Graham walk or stand at times, but he says there were days when he couldn’t even crawl to the cell door to get his meals.

“[Corrections staff] came along … and they started throwing cups of water and stuff on me,” Graham said.

Graham has been incarcerated since 2003, after he was convicted on assault and gun charges. Since he first spoke with me earlier this year he was transferred to another Washington state prison. He says he still doesn’t have his orthopedic shoes or cane or an accessible cell. He says he’s still in pain and that guards still harass him about his condition.