Christopher Pyles v. Magid Fahim

In the

United States Court of Appeals

For the Seventh Circuit

No. 14-1752

CHRISTOPHER PYLES,

Plaintiff-Appellant,

v.

MAGID FAHIM, Doctor, Medical Direc-

tor, Menard CC, et al.,

Defendants-Appellees.

Appeal from the United States District Court

for the Southern District of Illinois.

No. 3:11-cv-000378-SCW — Stephen C. Williams, Magistrate Judge.

SUBMITTED AUGUST 28, 2014 — DECIDED NOVEMBER 13, 2014

Before WOOD, Chief Judge, and EASTERBROOK and RIPPLE,

Circuit Judges.

RIPPLE, Circuit Judge. Christopher Pyles, an Illinois prisoner,

injured his back when he slipped on wet stairs at Menard

Correctional Center. Mr. Pyles sometimes used those stairs

when showering, and a month before his fall he had alerted the

warden, Donald Gaetz, that this stairway can be treacherous

because of the water tracked from the nearby showers.

2 No. 14-1752

Mr. Pyles contends, in this action under 42 U.S.C. § 1983, that

Warden Gaetz was deliberately indifferent to the hazard, and

that Wexford Health Sources (“Wexford”), which provides

contract medical care to Menard inmates, and a Wexford

physician, Magid Fahim, were deliberately indifferent to his

back injury. Mr. Pyles alleged that, after initially being treated

for his fall, he suffered ongoing, significant pain, yet Dr. Fahim

refused to investigate its cause.

At screening, see 28 U.S.C. § 1915A, the district court

dismissed Mr. Pyles’s claim against the warden. A magistrate

judge (presiding by consent) later granted summary judgment

for Wexford and Dr. Fahim on the medical claim. On appeal,

Mr. Pyles challenges the adverse rulings on both of his Eighth

Amendment claims.

Although we do not fully agree with the district court’s

analysis, we conclude that the court correctly reasoned that the

slipping hazard about which Mr. Pyles complained was not

sufficiently dangerous to support an Eighth Amendment claim.

We also agree with the district court that, from the evidence

submitted at summary judgment, a finder of fact could not

reasonably conclude that Mr. Pyles’s medical claim rests on

more than a disagreement with Dr. Fahim about the

appropriate course of treatment. We therefore affirm the

judgment of the district court.

No. 14-1752 3

I

Background

A.

In late June 2009, Mr. Pyles addressed and sent to

Warden Gaetz an emergency grievance in which he

complained that the stairs that he and others in the cell block

use to access the “six gallery” showers become dangerously

slick from water tracked by the inmates’ shower shoes.1 This

footwear was required, but the inmates had no means of

drying the soles before accessing the stairs, and the stairs

themselves lacked measures to reduce the slipping hazard

caused by accumulated water. In his grievance, Mr. Pyles

recounted his own difficulties with safely traversing the stairs

and requested that additional precautions be taken to address

the issue.2 As far as the record shows, no one replied to

Mr. Pyles’s grievance.

Then, on July 25, 2009, roughly five weeks after he

submitted his emergency grievance, Mr. Pyles fell on the wet

stairs while returning from the “six gallery” showers.3 He

struck his head on a step and then injured his lower back as he

1

R.13 at 3, 8.

2

Twice in recent weeks, Mr. Pyles recounted, he had slipped on these wet

stairs but avoided falling. He sometimes could not “make it to” the showers

on his own floor, he explained, and he urged that “some preventative

measures” be taken to reduce the “risk of injury or physical harm”

presented by these stairs. Id at 8.

3

Id. at 11; R.117-2 at 5.

4 No. 14-1752

tumbled down the stairs. He lost consciousness and was

temporarily paralyzed from the waist down. He first was taken

to a local hospital. CT scans did not reveal spinal damage, but

a radiologist recommended an MRI “[i]f there remains a

clinical concern for injury.”4 An MRI, the radiologist explained,

“is more sensitive in evaluating the soft tissues.”5 Before the

day ended, Mr. Pyles was airlifted from the local hospital to a

hospital in St. Louis, Missouri. During his stay at that facility,

doctors obtained MRI views of Mr. Pyles’s head, neck, and

spine. His treating physicians also ordered additional CT

scans. The attending radiologists reported that none of these

diagnostic procedures showed abnormal results.6 The doctors

in St. Louis diagnosed Mr. Pyles with a spinal contusion.

Mr. Pyles was seen by both a physical therapist and an

occupational therapist in St. Louis. After observing Mr. Pyles’s

unsteady gait and lingering mobility problems, each prescribed

some therapy to improve Mr. Pyles’s functional mobility.

Mr. Pyles returned to Menard after five days in St. Louis.

He remained in the prison infirmary for another four days,

where he was seen daily by staff. Afterward, he was released

to the general population, but continued to complain about

extreme pain in his lower back. Doctors examined him six

times in the next two months. Each time, the treating physician

concluded that only a painkiller, usually nonprescription

4

R.117-2 at 3.

5

Id.

6

Doctors did worry that one of the MRI views showed hemorrhaging in

the spinal canal, but a spinal angiogram revealed no bleeding.

No. 14-1752 5

ibuprofen, was warranted.7 Two back X-rays revealed “[p]ost

[t]raumatic [a]rthritic changes” in Mr. Pyles’s spine, but no

fracture or other abnormality.8

In late September 2009, two months after Mr. Pyles’s injury,

Dr. Fahim joined Wexford as the medical director at Menard.

When Dr. Fahim first examined Mr. Pyles in January 2010, he

wrote in the medical file that he had not detected any

abnormality. He substituted, nevertheless, a muscle relaxer

and a prescription painkiller for the nonprescription ibuprofen

that Mr. Pyles previously had been receiving. Dr. Fahim also

instructed Mr. Pyles on the “proper exercise [and] stretching of

[b]ack mus[c]les” that could alleviate his back pain.9 Mr. Pyles

informed the Doctor that his back pain had been worsening

and requested another MRI, but Dr. Fahim said he did not see

the need.

Dr. Fahim examined Mr. Pyles twice more, in May and

October 2010. Both times he wrote in the medical notes that

Mr. Pyles reported low back pain but that the examination

revealed no problems. During the May visit, however,

Dr. Fahim increased the dosages of Mr. Pyles’s medications,

and then in October he prescribed a corticosteroid, an

7

One doctor prescribed a prescription painkiller, but the medical director

who preceded Dr. Fahim discontinued it after one week. Mr. Pyles testified

at his deposition that he never received anything other than nonprescrip-

tion ibuprofen during that two-month period.

8

R.117-3 at 8.

9

Id. at 9.

6 No. 14-1752

anticonvulsant, and a drug commonly used in treating

osteoarthritis.

During the period that Dr. Fahim was treating him,

Mr. Pyles also was being seen by other medical personnel at

Menard. None reported a need for additional medical care. A

new X-ray was taken in May of that year, but it showed only

“minimal” or “mild” degenerative changes to Mr. Pyles’s

spine.10

Dr. Fahim did not examine Mr. Pyles again after October

2010, and in August 2011 he left Wexford’s employ. During

this period Mr. Pyles continued seeing other physicians and

medical staff nearly once per month. On one occasion

Dr. Fahim did review Mr. Pyles’s medical file after another

physician forwarded a request from Mr. Pyles for an MRI.

Dr. Fahim again refused to order the test, explaining that no

physician at Menard had recommended an MRI after

examining Mr. Pyles.

Near the time of Dr. Fahim’s resignation, however,

Mr. Pyles’s family physician provided a letter stating that, if

she were treating Mr. Pyles, she would have ordered an MRI

and “referred him to a specialist if needed.”11 It is unclear from

this correspondence, however, whether Mr. Pyles’s personal

physician knew that he had been hospitalized after his fall.

Nevertheless, notes written in Mr. Pyles’s file by doctors who

10

Id. at 33.

11

R.129-4 at 17.

No. 14-1752 7

succeeded Dr. Fahim as medical director endorse Dr. Fahim’s

view that another MRI was unnecessary.

Mr. Pyles maintained, in grievances to prison officials and

in his declaration to the district court, that Dr. Fahim had

refused to record the true nature and substance of his

complaints. Mr. Pyles maintained that he has suffered

constant, excruciating pain in his lower back, radiating into his

legs; this pain, he said, was more intense when he was sitting

or reclining and caused numbness when he stood. He did not

experience pain in his neck or thoracic region, but the pain in

his lower back had grown increasingly worse since his return

from the St. Louis hospital. He did not contest, however, that

Dr. Fahim had changed the medication that he prescribed to

treat the back pain or that Dr. Fahim and other medical staff

regularly had instructed him about stretching exercises that

could help alleviate his back pain. Mr. Pyles also

acknowledged that physical activity partly relieved his pain.

Mr. Pyles further testified at his deposition that Dr. Fahim

had once said that a new treatment (a cortisone shot) might be

attempted and that a visit to a specialist might be warranted.

These plans were scrapped, however, after Mr. Pyles visited

with another doctor. Mr. Pyles contended that an appointment

with the specialist never was scheduled for the same reason

that he never received an additional MRI: Wexford has a policy

of limiting the medical care it provides in order to cut costs,

and the company effectuates this policy by rewarding

employees who successfully control costs.

Mr. Pyles bases this belief on conversations that he had

with unnamed medical staff at the jail, who told him that a

8 No. 14-1752

visit to a specialist or an MRI would not happen “because it

costs too much money.”12 Because of this alleged policy,

Mr. Pyles seeks to hold Wexford responsible for what he

characterizes as deliberate indifference to his back pain.

Dr. Fahim, for his part, maintains that he never received

incentives to cut costs by providing less expensive treatment,

and an affidavit submitted by a Wexford manager further

attests that the company does not offer rewards or bonuses to

physicians who minimize costs by withholding necessary

medical care.

B.

Mr. Pyles brought this action in May 2011, nearly two years

after his injury and before Dr. Fahim’s departure. In addition

to claiming that Warden Gaetz had been deliberately

indifferent to the risk of injury from the slippery stairs,

Mr. Pyles alleged that Dr. Fahim and Wexford deliberately had

ignored his back pain. Mr. Pyles alleges that, instead of

addressing the underlying cause of his pain, Dr. Fahim merely

continued to prescribe ineffective drugs, while ignoring

Mr. Pyles’s complaints of continuous and worsening back pain.

The need for “a change in treatment,” Mr. Pyles alleged,

“would have been obvious” to a layman, and the failure to

change course renders the treatment constitutionally

12

R.13 at 23.

No. 14-1752 9

deficient.13 Mr. Pyles demanded damages as well as injunctive

relief, in particular that he be scheduled for another MRI and

a consultation with a specialist.

In dismissing, at screening, the claim against Warden

Gaetz, the district court reasoned that Mr. Pyles had “not pled

sufficient facts to state a claim that Defendant Gaetz was

deliberately indifferent” to the conditions “that made a

particular flight of stairs unsafe.”14 Mr. Pyles’s claim is

groundless, the court continued, because “the same wet

staircase would also be used by guards and other officials,”

and a failure to maintain dry stairs “cannot be considered cruel

and unusual.”15

The parties then consented to proceed before a magistrate

judge sitting as the district court. See 28 U.S.C. § 636(c). In

granting summary judgment for Wexford and Dr. Fahim, the

district court concluded that Mr. Pyles lacks evidence of

deliberate indifference during the time that Dr. Fahim was

treating Mr. Pyles.16 The court reasoned that undisputed

13

R.13 at 4. Mr. Pyles also brought a state-law negligence claim against

Warden Gaetz and a medical malpractice claim against Dr. Fahim, but he

has abandoned these supplemental claims on appeal, and we do not

mention them further.

14

R.14 at 6.

15

Id.

16

The court limited its analysis to this period because Mr. Pyles filed a

separate lawsuit against the physicians at Menard who have treated his

back since Dr. Fahim’s departure. See Pyles v. Nwaobasi, et al., No. 13-cv-0770

(continued...)

10 No. 14-1752

evidence establishes that Dr. Fahim was attentive to

Mr. Pyles’s complaints, actively looked for back problems on

the occasions he examined Mr. Pyles, and continually changed

his prescribed course of medication in order to relieve

Mr. Pyles’s pain. And the court concluded that Mr. Pyles’s

quarrel with Dr. Fahim about scheduling an MRI was a

disagreement about the proper exercise of medical discretion,

not a constitutional violation. Wexford, the court continued,

could not be held liable because no company policy was the

“moving force” behind any constitutional violation.17

II

Discussion

A.

We review both the decision to dismiss a prisoner’s

complaint at screening and a grant of summary judgment de

novo. See Holloway v. Del. Cnty. Sheriff, 700 F.3d 1063, 1068 (7th

Cir. 2012); Smith v. Knox Cnty. Jail, 666 F.3d 1037, 1039 (7th Cir.

2012) (per curiam).

16

(...continued)

(S.D. Ill. filed July 30, 2013). In that action, the defendants filed a motion for

summary judgment for failure to exhaust administrative remedies, which

the district court granted on September 30, 2014, thereby dismissing the

action, see Pyles v. Nwaobasi, et al., No. 13-cv-0770, slip op. at 14 (S.D. Ill.

Sept. 30, 2014).

17

R.136 at 12 (quoting Minix v. Canarecci, 597 F.3d 824, 832 (7th Cir. 2010)).

No. 14-1752 11

The Eighth Amendment, applicable to the states through

the Due Process Clause of the Fourteenth Amendment,

protects prisoners from prison conditions that cause “the

wanton and unnecessary infliction of pain,” Rhodes v. Chapman,

452 U.S. 337, 347 (1981), including both hazardous prison

conditions, see Farmer v. Brennan, 511 U.S. 825, 832 (1994), and

grossly inadequate medical care, see Estelle v. Gamble, 429 U.S.

97, 103–04 (1976). The burden is on the prisoner to demonstrate

that prison officials violated the Eighth Amendment, and that

burden is a heavy one. See Whitley v. Albers, 475 U.S. 312, 325

(1986).

In order to state a claim under the Eighth Amendment for

deliberate indifference to a hazardous condition of

confinement, Mr. Pyles needed only to allege that

Warden Gaetz deliberately ignored a prison condition that

presented an objectively, sufficiently serious risk of harm.

See Townsend v. Fuchs, 522 F.3d 765, 773 (7th Cir. 2008).18

Although Mr. Pyles was required to allege that Warden Gaetz

acted with a sufficiently culpable state of mind, he could meet

this burden by asserting that the warden knew about the

hazardous condition and “turned a blind eye to it.” Vance v.

Peters, 97 F.3d 987, 994 (7th Cir. 1996).

Similarly, to prevail on his medical claim, Mr. Pyles was

required to make two showings. First, he needed to

demonstrate that he suffers from an objectively serious medical

18

See also Delaney v. DeTella, 256 F.3d 679, 683 (7th Cir. 2001).

12 No. 14-1752

condition. Arnett v. Webster, 658 F.3d 742, 750 (7th Cir. 2011).19

A medical condition is objectively serious if a physician has

diagnosed it as requiring treatment, or the need for treatment

would be obvious to a layperson. Knight v. Wiseman, 590 F.3d

458, 463 (7th Cir. 2009).20 Second, Mr. Pyles had to demonstrate

that Dr. Fahim knew about his condition and the risk it posed,

but disregarded that risk. Arnett, 658 F.3d at 751.21 Something

more than negligence or even malpractice is required.

Duckworth v. Ahmad, 532 F.3d 675, 679 (7th Cir. 2008).

A prisoner may establish deliberate indifference by

demonstrating that the treatment he received was “blatantly

inappropriate.” Greeno v. Daley, 414 F.3d 645, 654 (7th Cir. 2005)

(quoting Snipes v. DeTella, 95 F.3d 586, 592 (7th Cir. 1996)).

Making that showing is not easy: “A medical professional is

entitled to deference in treatment decisions unless ‘no

minimally competent professional would have so responded

under those circumstances.’” Sain v. Wood, 512 F.3d 886, 894–95

(7th Cir. 2008) (quoting Collignon v. Milwaukee Cnty., 163 F.3d

982, 988 (7th Cir. 1998)). Disagreement between a prisoner and

his doctor, or even between two medical professionals, about

the proper course of treatment generally is insufficient, by

itself, to establish an Eighth Amendment violation. Johnson v.

19

See also Knight v. Wiseman, 590 F.3d 458, 463 (7th Cir. 2009).

20

See also Edwards v. Snyder, 478 F.3d 827, 830–31 (7th Cir. 2007).

21

See also Greeno v. Daley, 414 F.3d 645, 653 (7th Cir. 2005).

No. 14-1752 13

Doughty, 433 F.3d 1001, 1013 (7th Cir. 2006).22 The federal courts

will not interfere with a doctor’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 doctor

actually was exercising his professional judgment. Roe v. Elyea,

631 F.3d 843, 857 (7th Cir. 2011); Sain, 512 F.3d at 895.

Finally, with regard to Mr. Pyles’s claim against Wexford,

because § 1983 does not permit liability to rest on the doctrine

of respondeat superior, Maniscalco v. Simon, 712 F.3d 1139, 1145–

46 (7th Cir. 2013), Mr. Pyles was required to show that a

Wexford policy was the “direct cause” of or “moving force”

behind his constitutional injury. Minix v. Canarecci, 597 F.3d

824, 832 (7th Cir. 2010).23

B.

With those standards in mind, we turn first to Mr. Pyles’s

conditions-of-confinement claim against Warden Gaetz.

Mr. Pyles’s complaint alleges that Warden Gaetz consciously

ignored a safety hazard after being told about that hazard. The

accident and the severity of Mr. Pyles’s injuries raise an

inference that the stairway used to access the “six gallery”

showers was unsafe for that purpose. Before he was injured,

22

See also Snipes v. DeTella, 95 F.3d 586, 592 (7th Cir. 1996).

23

Although Wexford is a private corporation, we analyze claims against the

company as we would a claim of municipal liability. Minix, 597 F.3d at 834;

Woodward v. Corr. Med. Servs. of Ill., Inc., 368 F.3d 917, 927 n.1 (7th Cir. 2004).

14 No. 14-1752

Mr. Pyles had addressed and sent his “emergency grievance”

directly to Warden Gaetz, see Ill. Admin. Code tit. 20, § 504.840.

Yet according to Mr. Pyles, his grievance was not

acknowledged in the following weeks before his fall, and

neither was any change made to lessen the hazard presented

by the wet stairs. These allegations make out, at this stage of

the proceedings, a plausible claim that Warden Gaetz

knowingly turned a blind eye to the hazard which led to

Mr. Pyles’s injury.

The district court’s analysis of the complaint gives us pause.

Instead of asking whether Mr. Pyles’s complaint states a

plausible claim of deliberate indifference, the district court

required that Mr. Pyles plead facts and, even before discovery,

“show that Defendant Gaetz acted with a sufficiently culpable

state of mind.”24 But proof comes later, not at the complaint

stage. See Smith, 666 F.3d at 1039; Bennett v. Schmidt, 153 F.3d

516, 518–19 (7th Cir. 1998).

The district court also concluded that Mr. Pyles’s claims

failed because the staircase is not a condition “unique to

confinement” because that same staircase would be used by

guards and other prison employees. Yet that is too restrictive

a view of the Eighth Amendment. Prison life cannot so easily

be equated to life on the outside. See DeShaney v. Winnebago

Cnty. Dep’t of Soc. Servs., 489 U.S. 189, 199–200 (1989) (“[W]hen

the State takes a person into its custody and holds him there

against his will, the Constitution imposes upon it a

corresponding duty to assume some responsibility for his

24

R.14 at 6.

No. 14-1752 15

safety and general well-being.”); Estelle, 429 U.S. at 103–04. The

simple fact that persons other than prisoners made use of this

stairwell, however, does not automatically render Mr. Pyles’s

claim meritless.

Nevertheless, we agree with the central point of the district

court’s analysis: The hazard about which Mr. Pyles complains

is not sufficiently serious to invoke the Eighth Amendment.

Federal courts consistently have adopted the view that slippery

surfaces and shower floors in prisons, without more, cannot

constitute a hazardous condition of confinement.25

Accordingly, despite incorrectly holding Mr. Pyles’s complaint

to a heightened pleading standard, the district court correctly

dismissed this claim at screening.

C.

We turn next to Mr. Pyles’s claims against Dr. Fahim and

Wexford. Mr. Pyles contends that the district court erred in

25

See Coleman v. Sweetin, 745 F.3d 756, 764 (5th Cir. 2014) (per curiam)

(agreeing with district court that, as a matter of law, “prisoner slip-and-fall

claims almost never serve as the predicate for constitutional violations,”

thus upholding sua sponte dismissal of deliberate-indifference claim brought

by inmate who slipped and fell in shower); Reynolds v. Powell, 370 F.3d 1028,

1031 (10th Cir. 2004) (upholding dismissal at summary judgment of Eighth

Amendment claim brought by inmate who attributed slip-and-fall to

standing water in shower, since “slippery floors constitute a daily risk faced

by members of the public at large”); LeMaire v. Maass, 12 F.3d 1444, 1457

(9th Cir. 1993) (reasoning that, even if shackled inmate might fall on wet

floor while showering, allegations of “slippery prison floors” do not state

“even an arguable claim for cruel and unusual punishment”(quoting Jackson

v. Arizona, 885 F.2d 639, 641 (9th Cir. 1989)).

16 No. 14-1752

granting summary judgment for Dr. Fahim and Wexford

because Dr. Fahim had persisted in a course of treatment

known to be ineffective and refused to schedule an MRI or

refer him to a specialist in order to avoid diagnosing the real

injury to Mr. Pyles’s back.

The parties do not quarrel over whether Mr. Pyles suffers

from a serious medical condition, so we will assume, for the

purpose of our analysis, that Mr. Pyles’s back pain is an

objectively serious medical condition. See Jackson v. Kotter, 541

F.3d 688, 698 (7th Cir. 2008). The dispute instead concerns

whether Dr. Fahim’s refusal to schedule Mr. Pyles for an MRI

or to authorize a visit to a specialist permits an inference that

he possessed the mental culpability required to hold him liable

under the Eighth Amendment.

An MRI is simply a diagnostic tool, and the decision to

forego diagnostic tests is “a classic example of a matter for

medical judgment.” Estelle, 429 U.S. at 107.26 Mr. Pyles did not

submit evidence from which a jury reasonably could find that

Dr. Fahim’s exercise of medical judgment departed

significantly from accepted professional norms. See Roe, 631

F.3d at 857–58; Jackson, 541 F.3d at 697–98. Rather, Dr. Fahim’s

decision to forego an MRI was implicitly endorsed by every

other doctor who examined Mr. Pyles.

26

See also Ray v. Wexford Health Sources, Inc., 706 F.3d 864, 866 (7th Cir. 2013)

(per curiam); Jackson v. Kotter, 541 F.3d 688, 698 (7th Cir. 2008); Norton v.

Dimazana, 122 F.3d 286, 292 (5th Cir. 1997); Adams v. Poag, 61 F.3d 1537, 1545

(11th Cir. 1995).

No. 14-1752 17

Mr. Pyles’s assertion regarding Dr. Fahim’s decision to

forego a specialist’s opinion presents a somewhat closer

question. A prison physician is not required to authorize a visit

to a specialist in order to render constitutionally acceptable

medical care. Like other medical decisions, the choice whether

to refer a prisoner to a specialist involves the exercise of

medical discretion, Self v. Crum, 439 F.3d 1227, 1232 (10th Cir.

2006), and so refusal to refer supports a claim of deliberate

indifference only if that choice is “blatantly inappropriate,”

see Roe, 631 F.3d at 858.

On occasion, we have noted that failure to authorize such

a visit permits an inference of deliberate indifference. For

instance, in Berry v. Peterman, 604 F.3d 435 (7th Cir. 2010), we

concluded that summary judgment in favor of a jail physician

was unwarranted because the physician, in response to

complaints of severe unremitting and unexplained tooth pain,

had “rejected the obvious alternative of referring [the prisoner]

to a dentist.” Id. at 441. In Hayes v. Snyder, 546 F.3d 516 (7th Cir.

2008), a prison physician’s refusal to authorize a visit to a

urologist to treat a prisoner’s painful scrotal cysts and spasms,

in the face of increasing pain and after a previous physician

had spoken to a urologist about the prisoner’s condition, was

sufficient to create a triable issue of fact. Id. at 524–26. In Greeno

v. Daley, we likewise concluded that summary judgment for

prison medical staff was inappropriate. 414 F.3d at 655. The

prisoner there suffered from severe intestinal distress over a

period of years, and was ultimately diagnosed by a specialist

as having an esophageal ulcer. Id. at 648–51. We concluded that

the prison doctor’s refusal to send the inmate to a specialist

would allow a jury to find for the prisoner because the

18 No. 14-1752

possibility of an ulcer had been noted in the prisoner’s medical

file two years before the diagnosis, and the prisoner had been

made to suffer in the meantime. Id. at 655. Similarly, in Jones v.

Simek, 193 F.3d 485 (7th Cir. 1999), a prison physician was not

entitled to summary judgment because the evidence supported

an inference that the physician had recognized that an inmate

suffered from a “nerve problem” but then for six months

refused to authorize a consultation with a neurologist. Id. at

491.

Animating our rulings in these cases is the principle that if

the need for specialized expertise either was known by the

treating physicians or would have been obvious to a lay

person, then the “obdurate refusal” to engage specialists

permits an inference that a medical provider was deliberately

indifferent to the inmate’s condition. See Greeno, 414 F.3d at

654. We conclude that this principle does not foreclose

summary judgment in favor of Dr. Fahim. Here, unlike the

situations in Greeno and Jones, there was no prior indication of

a potentially serious long-term medical issue, nor was the need

for a specialist obvious, such as in Berry or Hayes. Rather, there

is nothing in this record that suggests that Dr. Fahim’s choice

was “blatantly inappropriate.” Roe, 631 F.3d at 858.

Mr. Pyles suffers from back pain, a common ailment. On

this record a jury could not conclude that Dr. Fahim inflicted

cruel and unusual punishment on Mr. Pyles by refusing to

refer him to a specialist. We do not mean to suggest that back

pain never requires treatment by a specialist, but only that it is

not warranted under these circumstances.

No. 14-1752 19

We agree with the district court that the undisputed

evidence establishes that Dr. Fahim was not deliberately

indifferent to Mr. Pyles’s pain. When Mr. Pyles complained

that his medications were not helping, Dr. Fahim responded by

prescribing new medications or changing the dosages.

Mr. Pyles may have wanted different treatment, but his

disagreement with Dr. Fahim does not allow him to prevail on

his Eighth Amendment claim. As far as this record shows,

Dr. Fahim’s choice of treatment was not blatantly inappropri-

ate.

Finally, Wexford cannot be held liable for damages because

there is no underlying constitutional violation. See City of

Los Angeles v. Heller, 475 U.S. 796, 799 (1986) (per curiam).

Moreover, even if a violation did occur, Mr. Pyles’s only

evidence of a Wexford policy is an unsubstantiated, hearsay

assertion, which is insufficient to defeat summary judgment.

See, e.g., Boyce v. Moore, 314 F.3d 884, 889–90 (7th Cir. 2002).

Conclusion

For the foregoing reasons, we uphold both the decision to

dismiss Mr. Pyles’s conditions-of-confinement claim at

screening and the grant of summary judgment on Mr. Pyles’s

medical claims. The defendants’ actions did not create the kind

of extreme deprivations that merit relief under the Eighth

Amendment. The judgment of the district court is affirmed.

AFFIRMED