The opinion
FOR THE SOUTHERN DISTRICT OF ILLINOIS
FIRAS M. AYOUBI,
Plaintiff,
v. Case No. 18-cv-1689-NJR-GCS
WEXFORD HEALTH SOURCES, INC.,
CHRISTINE BROWN, SCOTT
THOMPSON, ALBERTO BUTALID,
PERCY MEYERS, STEPHEN RITZ and
ALISA DEARMOND,
Defendants.
MEMORANDUM AND ORDER
ROSENSTENGEL, Chief Judge:
This matter is before the Court on the Report and Recommendation of United States
Magistrate Judge Gilbert C. Sison (Doc. 99), which recommends denying the Motion for Preliminary
Injunction filed by Plaintiff Firas Ayoubi (“Ayoubi”) (Docs. 2 and 23-1). The Report and
Recommendation was entered on July 19, 2019 (Doc. 99), and Ayoubi filed a timely objection (Doc.
103). For the following reasons, the Court adopts the Report and Recommendation and denies the
Motion for Preliminary Injunction.
BACKGROUND
On September 6, 2018, Ayoubi, a former inmate at Pinckneyville Correctional Center, filed a
pro se Complaint alleging that Defendants have been deliberately indifferent to a serious medical
condition (Doc. 1). Ayoubi alleges that he suffers from a “nervous tic” which causes involuntary
twitching and jerking, and places him in “constant” pain and “severe discomfort.” (Doc. 1). The
following claim survived threshold review:
Count 1: Eighth Amendment claim against Wexford Health Sources, Inc.,
Christine Brown, Scott Thompson, Dr. Alberto Butalid, Dr. Percy
Meyers, Dr. Stephen Ritz, and Alisa Dearmond for exhibiting
deliberate indifference to Ayoubi’s serious medical needs (worsening
On September 6, 2018, Ayoubi filed a motion for preliminary injunction, requesting a referral
to a neurologist (Doc. 2). He also requests specialized housing until treated by the neurologist (Id.).
On November 2, 2018, Ayoubi requested to supplement his motion for preliminary injunction, and
Judge Sison granted that request (See Docs. 23 and 24). Judge Sison held a hearing on this motion on
June 21, 2019, and heard testimony from Ayoubi, Defendant Butalid, Defendant Myers and Defendant
Ritz.2
In Judge Sison’s Report and Recommendation currently before the Court (Doc. 99), he
recommends that the request for a preliminary injunction be denied. Judge Sison reasoned that
Ayoubi has not provided the Court with verifiable evidence that his condition presents a serious
medical need requiring immediate attention. He noted that, although Ayoubi believes he suffers from
Huntington’s Disease or Parkinson’s Disease, both of which would satisfy the first prong, the record
is not clear that Ayoubi actually suffers from either of these conditions. Judge Sison further found that
the record does not reveal that Defendants knew of and disregarded an excessive risk to his health. In
light of the fact that Ayoubi had not made a showing that examination by an outside neurologist is
necessary, Judge Sison did not feel it appropriate to “interfere with the internal administration of state
prisons.” (Doc. 99, p. 7).
DISCUSSION
Where timely objections are filed, this Court must undertake a de novo review of the Report
and Recommendation. 28 U.S.C. § 636(b)(1)(B), (C); FED. R. CIV. P. 72(b); SDIL-LR 73.1(b); Harper v.
City of Chicago Heights, 824 F. Supp. 786, 788 (N.D. Ill. 1993); see also Govas v. Chalmers, 965 F.2d 298,
301 (7th Cir. 1992). The Court may accept, reject, or modify the magistrate judge’s recommended
1 Dr. Stephen Ritz was substituted for Unknown Party Dr. A. and Alisa Dearmond was substituted for Unknown
party Dr. B (See Docs. 26 and 83).
2 Subsequent to the filing of the motion for preliminary injunction, Ayoubi was transferred to Dixon Correctional
Center. The parties agreed during the hearing that the motion for preliminary injunction applies only to Wexford
in light of Ayoubi’s transfer (Doc. 99, n. 2).
evidence contained in the record and give fresh consideration to those issues to which specific
objections have been made. Id., quoting 12 Charles Alan Wright et al., Federal Practice and Procedure
§ 3076.8, at p. 55 (1st ed. 1973) (1992 Pocket Part).
As noted above, Ayoubi has filed an objection to the Report and Recommendation (Doc. 103).
This timely objection requires the Court to undertake a de novo review of the Report and
Recommendation. Ayoubi argues that the Report and Recommendation fails to adequately state the
facts and apply the applicable law to the facts and circumstances of this case.
A preliminary injunction is “an extraordinary and drastic remedy, one that should not be
granted unless the movant, by a clear showing, carries the burden of persuasion.” Mazurek v.
Armstrong, 520 U.S. 968, 972 (1997). The purpose of a preliminary injunction is “to minimize the
hardship to the parties pending the ultimate resolution of the lawsuit.” Faheem-El v. Klincar, 841 F.2d
712, 717 (7th Cir. 1988). To obtain a preliminary injunction, a plaintiff has the burden of establishing
that: (1) he is likely to succeed on the merits of his claim; (2) he has no adequate remedy at law; and
(3) he is likely to suffer irreparable harm without the injunction. Planned Parenthood of Indiana, Inc. v.
Comm’r of Indiana State Dep’t Health, 699 F.3d 962, 972 (7th Cir. 2012), citing Am. Civil Liberties Union of
Ill. v. Alvarez, 679 F.3d 583, 589–90 (7th Cir. 2012).
Once the plaintiff has met his burden, the Court must weigh “the balance of harm to the parties
if the injunction is granted or denied and also evaluate the effect of an injunction on the public
interest.” Roland Mach. Co. v. Dresser Indus., Inc., 749 F.2d 380, 386 (7th Cir. 1984); Korte v. Sebelius, 735
F.3d 654, 665 (7th Cir. 2013). “This equitable balancing proceeds on a sliding-scale analysis; the greater
the likelihood of success on the merits, the less heavily the balance of harms must tip in the moving
party’s favor.” Korte, 735 F.3d at 665.
In the context of prisoner litigation, the scope of the Court’s authority to enter an injunction is
circumscribed by the Prison Litigation Reform Act (“PLRA”). Westefer v. Neal, 682 F.3d 679, 683 (7th
Cir. 2012). Under the PLRA, preliminary injunctive relief “must be narrowly drawn, extend no further
means necessary to correct that harm.” 18 U.S.C. § 3626(a)(2).
Ayoubi argues that the Report and Recommendation fails to adequately state the facts and
apply the applicable law to the facts and circumstances of this case. The Court has considered all of
Ayoubi’s arguments and finds the Report and Recommendation to be sound.
For instance, Ayoubi argues that Judge Sison’s conclusion that he did not see any evidence
from Ayoubi’s face that he was in pain at the preliminary injunction hearing is in contravention of
Seventh Circuit law, citing Ayoubi v. Dart, 729 F. App’x 455 (7th Cir. 2018) and Greeno v. Daley, 414 F.3d
645, 655 (7th Cir. 2005). But Judge Sison merely noted his own observations, along with considering
the observations of others, such as Dr. Meyers and a nurse who treated Ayoubi on November 2, 2018,
to conclude that Ayoubi did not provide the Court with verifiable evidence that his condition presents
a serious medical need.
Even if Ayoubi can establish that his condition presents a serious medical need, he has not
established that he is likely to succeed on the merits of the second element. The second element a
plaintiff must establish for a deliberate indifference claim is that a state official acted with the requisite
culpable state of mind. Dunigan ex rel. Nyman v. Winnebago Cnty., 165 F.3d 587, 590 (7th Cir. 1999).
Federal courts will not interfere with a physician’s decision to pursue a particular course of treatment
unless that decision represents so significant a departure from accepted professional standards or
practices that it calls into question whether the physician was actually exercising professional
judgment. Pyles v. Fahim, 711 F.3d 403, 409 (7th Cir. 2014).
As Judge Sison recognized, the records show that Defendants treated Ayoubi based on their
objective findings after evaluating him. In response to Ayoubi’s complaints, he was placed in the
infirmary and monitored for three days in June 2019. Ayoubi was referred to behavioral health,
prescribed Motrin for pain, and had a panel of tests performed. At this point in time, the doctors
believe the appropriate treatment plan is to monitor Ayoubi, rather than refer him to a neurologist.
Ayoubi has not shown that a fact finder would conclude that this treatment was “’so blatantly
inappropriate as to evidence intentional mistreatment likely to seriously aggravate’ a medical
condition.” Edwards v. Snyder, 478 F.3d 827, 831 (7th Cir. 2007).
Ayoubi also argues that there is evidence of progression or deterioration of his medical
condition in the record, as set forth in his sworn affidavit and corroborated by Dr. Kohn. Ayoubi
mentions in his affidavit that, in the last eight months, laying down, running, or walking does not
help to slow down the frequency or brevity of the symptoms. Dr. Kohn wrote in his report that, based
on the record, Ayoubi’s movements, as described, have become more frequent, more readily seen on
routine observation and more bothersome. But this does not give the Court reason to believe that
Ayoubi’s symptoms have escalated to a point or his health has deteriorated to a point that such drastic
relief is necessary.
In sum, the Court finds no justification for the “extraordinary and drastic remedy” of
injunctive relief. Mazurek, 520 U.S. at 972. Ayoubi has failed to reach the threshold burden for
injunctive relief, and the Court finds no reason to reject Judge Sison’s recommendation.
CONCLUSION
For the reasons set forth above, the Court OVERRULES the Objection to Judge Sison’s Report
and Recommendation (Doc. 103), ADOPTS Judge Sison’s Report and Recommendation (Doc. 99), and
DENIES the Motion for Preliminary Injunction (Docs. 2 and 23-1).
IT IS SO ORDERED.
DATED: September 5, 2019
7 wus locating J
NANCY J. ROSENSTENGEL
Chief U.S. District Judge
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