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 who sued prison doctors for deliberate 

indifference to his painful neurological condition, 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 district court denied Ayoubi’s request, 

*

 We have agreed to decide the case without oral argument because the brief and 

record adequately present the facts and legal arguments, and oral argument would not 

significantly aid the court. See FED. R. APP. P. 34(a)(2)(C). 

NONPRECEDENTIAL DISPOSITION 

To be cited only in accordance with Fed. R. App. P. 32.1 
No. 19-2794 Page 2 

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

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

Upon his arrival at Pinckneyville Correctional Center in early 2018, Ayoubi did 

not identify any current medical needs. But several weeks later, he told a nurse that he 

was experiencing involuntary movement in his 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 during normal activities, the doctor saw no 

abnormal body movements so he backed off his prior recommendation for an outside 

consultation. The prison’s collegial review board, which included Wexford’s regional 

medical director and Pinckneyville’s medical director, agreed on an alternative 

treatment plan that encompassed an onsite neurology examination. 

Under the alternative treatment plan, Ayoubi was admitted to the infirmary for 

three days in mid-2018 and monitored closely. According to the nurses’ notes, he 

twitched or shrugged his right shoulder during two assessments, but otherwise they 

saw no outward signs of uncontrollable muscle movement. In a second collegial review, 

the doctors found Ayoubi’s subjective complaints unsupported by objective findings, 

and thus they decided to continue to monitor and treat him at the prison. 

Ayoubi submitted a grievance to Pinckneyville officials requesting a transfer to 

an outside medical facility for a neurology consultation. That grievance was denied. 

Ayoubi then sued Wexford and three doctors for deliberate indifference to his 

serious medical needs by failing to authorize 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 recommendation 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 failed to make the requisite showing for such 

extraordinary and drastic relief. Ayoubi failed not only to demonstrate a reasonable 

1 After requesting an injunction, Ayoubi transferred from Pinckneyville to Dixon 

Correctional Center. Given this transfer, the 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 standards), but also to show he would suffer 

irreparable harm if the relief were not granted (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 disregarded 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 presented enough evidence to allow a 

reasonable factfinder to infer that his medical providers acted with deliberate 

indifference. We understand him to argue that the cumulative medical record compels 

the conclusion that the refusal of his request for an outside specialist could have been 

made only with malice. 

The record does not support this contention. 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 observation 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 records, 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 “so blatantly inappropriate as to evidence 

intentional mistreatment likely to seriously 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