# United States Court of Appeals

For the Seventh Circuit Chicago, Illinois 60604

Submitted September 2, 2020 *

Decided September 3, 2020

Before

DAVID F. HAMILTON, Circuit Judge

MICHAEL B. BRENNAN, Circuit Judge

AMY J. ST. EVE, Circuit Judge

No. 19-2794

FIRAS M. AYOUBI, Plaintiff-Appellant

,

v

.

WEXFORD HEALTH SOURCES, INC.,
et al., Defendants-Appellees

. Appeal from the United States District

Court for the Southern District of Illinois.

No. 18-cv-1689-NJR-GCS

Nancy J. Rosenstengel, Chief Judge

.

O R D E R

Firas Ayoubi, an Illinois inmate wh o sued prison doctors for deliberate indifference to his painful neurological condit ion, appeals the denial of his request for a preliminary injunction. Ayoubi believes that Wexford Health Sources, Inc., and two of its doctors have ignored his condition—which he describes as a “nervous tick” that causes involuntary twitching and jerking— and sought an injunction compelling his treatment by an outside specialist. The di strict court denied Ayoubi’s request,

* We have agreed to decide the case wi thout oral argument because the brief and record adequately present the facts and le gal arguments, and oral argument would not significantly aid the court. See F ED

. R. A PP

. P. 34(a)(2)(C). NONPRECEDENTIAL DISPOSITION

To be cited onl y in accordance with Fed. R. A pp . P. 32.1No. 19-2794 Page 2

concluding that he had not demonstrated a reasonable likelihood of success on the

merits. We see no error in the dist rict court’s decision and affirm.

Upon his arrival at Pinckneyville Corre ctional Center in early 2018, Ayoubi did not identify any current medical needs. But se veral weeks later, he told a nurse that he was experiencing involuntary movement in hi s torso and left leg—a condition that he said had persisted for a year and a half. He later was seen by Dr. Percy Meyers, a Wexford physician, who noted some involuntary movement in Ayoubi’s upper body, opined that he may have a movement disorder, and recommended a neurology consultation. But when he observed Ayoubi du ring normal activities, the doctor saw no abnormal body movements so he backed of f his prior recommendation for an outside consultation. The prison’s collegial review board, which included Wexford’s regional medical director and Pinckneyville’s medi cal director, agreed on an alternative treatment plan that encompassed an onsite neurology examination.

Under the alternative treatment plan, Ay oubi was admitted to the infirmary for three days in mid-2018 and monitored closel y. According to the nurses’ notes, he twitched or shrugged his right shoulder du ring two assessments, but otherwise they saw no outward signs of uncontrollable muscle movement. In a second collegial review, the doctors found Ayoubi’s subjective comp laints unsupported by objective findings, and thus they decided to continue to monitor and treat him at the prison.

Ayoubi submitted a grievance to Pinckneyvi lle officials requesting a transfer to an outside medical facility for a neurology consultation. That grievance was denied.

Ayoubi then sued Wexford and three do ctors for deliberate indifference to his serious medical needs by failing to authoriz e a neurology consultation. He principally sought a preliminary injunction compelling an outside neurology consultation, as well as an adjustment in housing conditions (either a single cell or a bottom bunk).

The district judge, adopting the reco mmendation of a magistrate judge who had conducted a hearing on the matter, denied Ayoubi’s request for an injunction. 1 The district judge determined that Ayoubi faile d to make the requisite showing for such extraordinary and drastic relief. Ayoubi fail ed not only to demonstrate a reasonable

1 After requesting an injunction, Ayoubi transferred from Pinckneyville to Dixon
Correctional Center. Given this transfer, th e parties agreed that the motion for a preliminary injunction applied only to Wexford.No. 19-2794 Page 3

likelihood of success on the merits (because he had not shown that his treatment plan departed significantly from professional st andards), but also to show he would suffer irreparable harm if the relief were not grante d (because his symptoms had not escalated to a point where drastic intervention was necessary).

In this interlocutory appeal, Ayoubi first challenges the conclusion that he failed

to demonstrate a reasonable likelihood of success on the merits—one of the requirements for obtaining a preliminary injunction. See Courthouse News Serv. v. Brown

, 908 F.3d 1063, 1068 (7th Cir. 2018). To succeed on a deliberate-indifference claim, Ayoubi had to show that he suffered from an objectively serious medical condition and that prison officials knew of and disreg arded an excessive risk to his health. Farmer v.
Brennan, 511 U.S. 825, 834 (1994); Petties v. Carter , 836 F.3d 722, 728 (7th Cir. 2016) (en banc). Although the parties dispute whether Ayoubi has supplied evidence of a serious
medical condition, we assume for the sake of discussion that his neurological condition poses a substantial risk to his health.

We turn, then, to whether Ayoubi pr esented enough evidence to allow a

reasonable factfinder to infer that hi s medical providers acted with deliberate indifference. We understand him to argue th at the cumulative medical record compels the conclusion that the refusal of his reques t for an outside specialist could have been made only with malice.

The record does not support this contenti on. As the district court determined, no factfinder could conclude the defendants deliberately ignored or seriously aggravated Ayoubi’s condition. The record reflects that, in response to his complaints of pain, the defendants placed him under close observatio n for several days in the infirmary, where he was given laboratory tests and prescribed Motrin for pain relief. Based on the

assessments from that time and other re cords, the doctors concluded that the appropriate treatment plan was to continue to monitor his condition rather than refer him to an outside specialist. Ayoubi has not countered this by pointing to anything in the record to suggest that his care was “s o blatantly inappropriate as to evidence intentional mistreatment likely to seri ously aggravate a medical condition.” See Edwards v. Snyder , 478 F.3d 827, 831 (7th Cir. 2007).

Because Ayoubi cannot show a likelihood of success on the merits, we need not address the other prerequisites to obtain a preliminary injunction. See Girl Scouts of Manitou Council, Inc. v. Girl Scouts of U.S. of Am., Inc. , 549 F.3d 1079, 1086 (7th Cir. 2008).No. 19-2794 Page 4

We have considered his remaining arguments, and none has merit.

AFFIRMED