# United States Court of Appeals

For the Seventh Circuit

Chicago, Illinois 60604

Submitted May 11, 2018 *

Decided May 11, 2018

Before

DIANE P. WOOD, Chief Judge

DANIEL A. MANION, Circuit Judge

ILANA DIAMOND ROVNER, Circuit Judge

No. 17

‐ 1660

MARSHAUN LAWS,

Plaintiff

‐ Appellant

,

v

.

WEXFORD HEALTH SOURCES INC., et

al., Defendants

‐ Appellees

. Appeal from the United States District

Court for the Northern District of Illinois,

Eastern Division.

No. 15 CV 1671

Manish S. Shah,

J udge

.

O R D E R

Marshaun Laws, an inmate at Stateville Correctional Center, suffers from back

pain. As relevant on appeal, he sued Stateville’s health

‐ services contractor (Wexford

Health Sources, Inc.) and Dr. Saleh Obaisi (the prison’s medical director and a Wexford

employee). Laws accuses them of violating the Eighth Amendment by waiting too long

to get magnetic resonance imaging (an MRI) and a specialist for his back. The district

* We have agreed to decide this case without oral argument because the briefs

and record adequately present the facts and legal arguments, and oral argument would

not significantly aid the court. 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 NONPRECEDENTIAL DISPOSITION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. 17

‐ 1660 Page 2

court entered summary judgment for the defendants. Because the defendants exercised

reasonable professional judgment in timing this treatment, we affirm.

Laws received attention from Stateville for his back pain soon after he arrived

there in 2013. A physician assistant evaluated him in January and determined that his

back had a full range of motion with no signs of trauma or deformity. Medical staff

advised Laws to apply heat to his back to ease his episodic pain. A radiologist and

Dr. Obaisi both reviewed X

‐ rays of his back and saw no physical injury. Based on the

X

‐ ray results, the episodic nature of the pain, and Laws’s otherwise good health,

Dr. Obaisi believed that Laws had a muscle strain that was best treated as pain arose; he

thought that an MRI was not warranted at that time.

Dr. Obaisi personally examined Laws in November 2013. By then, members of

the medical staff had seen Laws several times, had prescribed pain relievers, and had

instructed him to apply an analgesic balm to his back and to exercise his core. During

Dr. Obaisi’s evaluation, Laws bent over, flexed his legs normally, and displayed healthy

reflexes. Following the assessment, Dr. Obaisi recommended that Laws take Motrin to

manage his pain. Dr. Obaisi next saw Laws in February 2014, at which time Laws said

that his back pain was gone. At a follow

‐ up appointment in May, Laws reported that

his back pain was now “on and off.” Based on this development, Dr. Obaisi decided

that Laws suffered from chronic back pain. He advised Laws to use a back brace and to

apply ice to his back twice per day. Laws continued to see other medical staff for his

pain periodically throughout the fall.

Laws wanted an MRI and an outside specialist to examine his back, so in 2015 he

sued Dr. Obaisi and Wexford under the Eighth Amendment. He asserted that

Dr. Obaisi should have already ordered an MRI and a specialist to examine his back,

and that Wexford had a policy to contain costs by avoiding MRIs and consultants for

back pain. Within three months of filing the suit, Dr. Obaisi requested an MRI for Laws,

and Wexford approved the request.

Laws had his MRI exam in August 2015. Dr. Obaisi reviewed the results in

October, after Laws signed the requisite release form. Dr. Obaisi saw no nerve damage,

so he tested Laws to see if arthritis or lupus was causing his pain. Those tests were

negative, too. The following week Dr. Obaisi and others ordered that Laws receive a

consulting evaluation by an off

‐ site orthopedic surgeon. The following month, before

that evaluation took place, Laws told Dr. Obaisi that Motrin no longer provided

sufficient relief. As a result, Dr. Obaisi suspected that Laws suffered from diffuse

osteoarthritis, and so he prescribed a nonsteroidal anti

‐ inflammatory drug and a muscleNo. 17

‐ 1660 Page 3

relaxant for the pain. A consulting specialist reviewed the MRI results and examined

Laws a few months later. The specialist suggested that Laws try a stronger nonsteroidal

anti

‐ inflammatory drug and begin physical therapy. Dr. Obaisi entered an order for

physical therapy that day.

Based on this record, the district judge granted the defendants’ motion for

summary judgment. The judge concluded that a reasonable jury could not find that

Dr. Obaisi or Wexford was deliberately indifferent to Laws’s pain.

We review the grant of summary judgement de novo and evaluate the record in

the light most favorable to Laws. See Estate of Simpson v. Gorbett

, 863 F.3d 740, 745

(7th Cir. 2017). A health care provider violates the Eighth Amendment if it is

deliberately indifferent to an inmate’s serious medical needs. Estelle v. Gamble

, 429 U.S.

97, 104–05 (1976). To survive summary judgment, Laws must present evidence

suggesting that he suffered from an objectively serious medical condition and that the

defendants knew about the condition but disregarded it. See Farmer v. Brennan

, 511 U.S.

825, 834, 837, (1994); Pyles v. Fahim

, 771 F.3d 403, 409 (7th Cir. 2014). The parties do not

dispute that Laws’s back pain is an objectively serious medical condition. So we focus

on whether a reasonable jury could find that the defendants knew of Laws’s back pain

but did not properly treat it. Pyles

, 771 F.3d at 411.

The uncontested record does not permit a conclusion that Dr. Obaisi recklessly

ignored Laws’s back pain. He reviewed the X

‐ rays of Laws’s back in 2013 and, like the

radiologist, concurred that Laws’s spine was intact. Later he examined Laws and saw

that Laws showed normal movement and flexibility. He prescribed Motrin for Laws’s

episodic pain, and Laws reported in early 2014 that his pain had resolved. When Laws

complained of renewed pain a few months later, Dr. Obaisi prescribed a brace, heat, ice,

core

‐ strengthening exercises, pain medication, and analgesic balm. When the pain

continued, Dr. Obaisi ordered the MRI, and after he reviewed the results, ordered

further diagnostic tests. When the tests returned negative and Laws said that Motrin

was no longer providing relief, Dr. Obaisi prescribed other anti

‐ inflammatory drugs

and muscle relaxants and ordered that Laws see a specialist. At the specialist’s

recommendation, Dr. Obaisi ordered that Laws begin physical therapy.

This treatment was consistent with standard practice for treating back pain.

See Proctor v. Sood

, 863 F.3d 563, 568 (7th Cir. 2017). Laws attached to his complaint

medical articles reporting that back pain is often effectively treated with conservative

efforts like hot or cold compresses, exercises, and pain medication. See id. That is

precisely the course of treatment that Laws received until Dr. Obaisi learned that it wasNo. 17

‐ 1660 Page 4

no longer effective. At that point, he altered the treatment to include an MRI, stronger

nonsteroidal anti

‐ inflammatory drugs, an outside evaluation, and physical therapy.

Laws insists that a jury could find Dr. Obaisi liable under the Eighth Amendment

for not ordering the MRI sooner, but we disagree with him. “[T]he question whether an

X

‐ ray—or additional diagnostic techniques or forms of treatment—is indicated is a

classic example of a matter for medical judgment.” Estelle

, 429 U.S. at 107. As we have

observed, no evidence suggests that the treatment that Dr. Obaisi’s provided in the year

before he ordered the MRI (brace, heat, ice, core exercises, and pain relievers) fell

outside the scope of ordinary professional judgment. Pyles

, 771 F.3d at 411. Laws replies

that he supplied such evidence: Dr. Obaisi ordered the MRI only after Laws sued him.

But the pendency of the lawsuit is at most evidence that Laws disagreed with his

doctor’s medical judgment, and that disagreement alone does not show deliberate

indifference to his needs. See id. at 409. Besides, evidence of “subsequent remedial

measures”—the MRI exam—is not admissible to prove prior culpability. See F ED

.

R. E VID

. 407.

Laws also unpersuasively argues that Dr. Obaisi was deliberately indifferent by

waiting for over a year to consult a specialist. A jury may infer deliberate indifference

when a healthcare provider refuses to seek a specialist if the need for one “either was

known by the treating physicians or would have been obvious to a lay person.” Pyles

,

771 F.3d at 412. The need for a specialist was not apparent until conventional treatment

failed and diagnostic tests ruled out what Dr. Obaisi thought could be sources of Law’s

pain. Once that happened, Dr. Obaisi requested a specialist. It is true that the specialist

did not see Laws until several months later. But the record does not suggest that

Dr. Obaisi was responsible for that delay. See Garvin v. Armstrong

, 236 F.3d 896, 898

(7th Cir. 2001). Based on the history of treatment that Dr. Obaisi provided, a jury could

not conclude that he was deliberately indifferent to Laws. See id.

Finally, a jury could not find that Wexford was deliberately indifferent. Laws

contends that Wexford has an unconstitutional cost

‐ saving policy of delaying MRIs and

avoiding outside specialists. But because Dr. Obaisi exercised his judgment acceptably

in deciding when to order an MRI and seek a specialist, Wexford is not liable for any

delays. See City of Los Angeles v. Heller

, 475 U.S. 796, 799 (1986).

Accordingly, the judgment of the district court is AFFIRMED.