In the

United States Court of Appeals

For the Seventh Circuit ____________________ 

No. 20-2946 

ROBERT MCDANIEL, as Executor of

the Estate of Carl Joseph McDaniel, 

Plaintiff-Appellant, 

v.

SALAM SYED, et al., 

Defendants-Appellees. 

____________________ 

Appeal from the United States District Court for the

Eastern District of Wisconsin. 

No. 1:17-cv-01493-WCG — William C. Griesbach, Judge. 

____________________ 

ARGUED JANUARY 13, 2022 — DECIDED SEPTEMBER 16, 2024 

____________________ 

Before HAMILTON, BRENNAN, and JACKSON-AKIWUMI,

Circuit Judges. 

HAMILTON, Circuit Judge. Carl McDaniel was a Wisconsin 

prisoner for more than fourteen years. He had many serious 

medical conditions, including some that caused problems 

with mobility and incontinence. McDaniel sued the Wisconsin Department of Corrections under Title II of the Americans 

with Disabilities Act (ADA), 42 U.S.C. § 12131, and Section 504 
2 No. 20-2946 

of the Rehabilitation Act, 29 U.S.C. § 794. He asserted that the 

Department violated his rights under both statutes by denying him a cell (a) in a no-stairs unit, (b) that was single-occupancy, and (c) with a bed without a top bunk above it. 

McDaniel also brought an Eighth Amendment claim against 

a prison physician, Dr. Salam Syed, alleging he was deliberately indifferent to McDaniel’s medical needs. The district 

court granted summary judgment for the Department on all 

claims and for Dr. Syed on the Eighth Amendment claim. 

McDaniel appealed.1 

After we heard oral argument, McDaniel was released 

from prison, but he later died, in February 2024. His son Robert McDaniel represents his father’s estate and is now the 

plaintiff. 

We affirm in part and reverse in part. We affirm summary 

judgment for defendants on the claims for a single-occupancy 

cell and no top bunk, as well as on the Eighth Amendment 

claim against Dr. Syed. We reverse on the refusal to assign 

McDaniel to a no-stairs unit. McDaniel presented evidence 

that having to make his way up and down stairs to get to 

meals, the infirmary, and other prison programs effectively 

denied him access to those programs, and that the Department knew its refusal to place McDaniel in a no-stairs unit 

was having that effect. In particular, McDaniel presented evidence that denial of a no-stairs unit caused him to miss about 

600 meals in just the one year he was in the Columbia 

1 After plaintiff McDaniel appealed the grant of summary judgment, 

we recruited counsel for him. Attorneys Thomas G. Hungar and Andrew 

G.I. Kilberg and the firm of Gibson, Dunn & Crutcher LLP have ably 

represented plaintiff McDaniel before the panel. They have the thanks of 

the court.
No. 20-2946 3

Correctional Institution, and that prison staff knew he was 

missing meals and medication because of his pain and difficulty in getting up and down stairs. He presented this evidence with sufficient clarity to the district court so that the 

district court and we are required to treat those facts as true.

On these facts, which we hope are unusual, a reasonable jury 

could find that the denial of a no-stairs unit amounted to an 

intentional violation of rights under the ADA and the Rehabilitation Act. 

McDaniel’s release from prison rendered moot his request 

for injunctive relief, but his ADA and Rehabilitation Act 

claims for compensatory damages survive his release from 

prison and his death and are still available. A jury could find 

prison officials were deliberately indifferent to McDaniel’s 

lack of access to various prison programs. Because a jury 

could also find this same conduct—deliberate indifference to 

McDaniel’s inability to access, in particular, regular meals—

violated the Eighth Amendment, the Department is not entitled to sovereign immunity, and compensatory damages may 

be available under the ADA for failure to accommodate his 

disabilities.

I. Procedural Issue

Before turning to the merits, we first address a key procedural issue in the district court’s handling of the facts on summary judgment. The district court declined to treat as true 

McDaniel’s evidence that the defendants’ refusal to assign 

him to a no-stairs cell caused him to miss roughly 600 meals 

in one year and that defendants were aware of this consequence. The district court’s refusal was an error.
4 No. 20-2946 

McDaniel litigated in the district court pro se, including 

the summary judgment motions. (There was a brief exception; 

court-recruited counsel drafted his amended complaints and 

then withdrew.) As part of the summary judgment proceedings, the defendants filed their proposed findings of fact subject to Civil Local Rule 56 of the Eastern District of Wisconsin. 

In the absence of an agreed statement of undisputed facts, the 

rule requires the moving party to file a statement of proposed 

material facts. See E.D. Wis. Civ. Local Rule 56(b)(1). These 

statements must contain numbered paragraphs and specific 

citations to support the factual assertions. Local Rule 

56(b)(1)(c)(i). The opposing party is then required to respond 

to the moving party’s statement of material facts by identifying which facts, if any, are in dispute, and citing record evidence to support the party’s assertions. Local Rule 56(b)(2). 

The rule says the record citations must be “specific” but does 

not specify a particular form for those record citations.

Consistent with our decision in Lewis v. Faulkner, 689 F.2d 

100, 102 (7th Cir. 1982), the district court promptly issued a 

notice to McDaniel advising him as follows:

Plaintiff Carl Joseph McDaniel, who is representing himself, filed a complaint under 42 

U.S.C. § 1983. On June 29, 2020, the defendants 

filed a motion for summary judgment. (ECF No. 

159.) Under Civil L. R. 56(b)(2), McDaniel’s response materials are due within thirty days of 

service of the motion, or by Wednesday, July 29, 

2020. In responding to the defendants’ motion 

for summary judgment, McDaniel must respond to each of the defendants’ proposed findings of fact by agreeing with each proposed fact 
No. 20-2946 5

or explaining why he disagrees with a particular proposed fact. If he does not indicate one 

way or the other, the court will assume that he 

agrees with the proposed fact. McDaniel must 

support every disagreement with a proposed 

fact by citing to evidence. He can do that by relying on documents that he attaches to his response or by telling the court his version of what 

happened in an affidavit or an unsworn declaration under 28 U.S.C. § 1746.1 An unsworn declaration is a way for a party to tell his side of the 

story while declaring to the court that everything in the declaration is true and correct. 

McDaniel must also respond to the legal arguments in the defendants’ brief.

_______________ 

1 At the bottom of his declaration he should 

state: “I declare under penalty of perjury that 

the foregoing is true and correct. Executed on 

[date]. [Signature].” 28 U.S.C. § 1746(2). 

Dkt. No. 169. 

McDaniel took the court’s notice to heart. On August 14, 

2020, he filed seven documents (docket entries 176–82), including a response to the defendants’ proposed findings of 

fact, a brief, a separate “reply to defense argument,” and responses to four affidavits submitted by the defendants. The 

documents totaled 33 pages.

Plaintiffs’ documents responded paragraph by paragraph 

to the defendants’ proposed statements of fact, and even paragraph by paragraph to each affidavit the defendants 
6 No. 20-2946 

submitted and paragraph by paragraph to the defendants’ 

brief. He also submitted his own statements of undisputed 

and disputed facts. 

In most of his response paragraphs, however, McDaniel 

did not provide specific docket number citations to the record. 

Still, he did in places refer by name to various documents in 

the record when directly responding to paragraphs in the defendants’ summary judgment briefing that included such record citations. For example, he referred to “the ‘Initial’ Dr. Paul 

Order” for the proposition that his surgeon recommended he 

not lift more than five to ten pounds. This was in his numbered response to paragraph 11 of defendants’ proposed 

statement of facts, which included a record citation to the 

same doctor’s report that McDaniel cited by name.

Most important, though, and consistent with the district 

court’s directions, McDaniel signed all of those documents 

under penalty of perjury under 28 U.S.C. § 1746. That meant 

that all of those documents had the legal effect of affidavits. 

They provided evidence that could be considered on summary judgment to the extent that McDaniel’s factual assertions were within his personal knowledge and were otherwise 

admissible. See Owens v. Hinsley, 635 F.3d 950, 955 (7th Cir. 

2011) (“[A] declaration under § 1746 is equivalent to an affidavit for purposes of summary judgment.”); Ford v. Wilson, 90 

F.3d 245, 246–47 (7th Cir. 1996) (complaint verified under penalty of perjury amounted to affidavit that could be relied upon 

to oppose summary judgment).

In its summary judgment ruling, however, the district 

court wrote that “not all of his responses or his own proposed 

findings of fact cite to an affidavit, declaration, or specific part 

of the record to support them.” SA 4. The court added that it 
No. 20-2946 7

would consider plaintiff’s proposed facts and responses to defendants’ proposed facts only “to the extent they comply with 

the local rules,” without specifying further the failures or the 

affected portions of plaintiff’s submissions. Id. The court relied primarily on the defendants’ version of the facts in deciding the summary judgment motions.2

McDaniel contends this decision was an abuse of discretion. An appellate court reviews the decision of a district court 

to enforce its local rules for an abuse of discretion. Hinterberger 

v. City of Indianapolis, 966 F.3d 523, 528 (7th Cir. 2020). District 

courts “may require strict compliance with their local rules,” 

id., and we have held that enforcing such rules in the event of 

non-compliance is generally not an abuse of discretion. See 

Cichon v. Exelon Generation Co., 401 F.3d 803, 809–10 (7th Cir. 

2005) (“A district court does not abuse its discretion when, in 

imposing a penalty for a litigant’s non-compliance with Local 

Rule 56.1, the court chooses to ignore and not consider the additional facts that a litigant has proposed.”); see also Ammons 

v. Aramark Uniform Services, Inc., 368 F.3d 809, 817 (7th Cir. 

2004) (“Substantial compliance is not strict compliance.”). A 

district court is not authorized, however, to reject a party’s 

summary judgment submissions for failure to comply with 

unwritten requirements.

2 McDaniel did not, as Local Rule 56.1(b)(2)(B)(i) requires, reproduce 

each numbered paragraph in the defendants’ statement of facts. That requirement would be onerous as applied to a prisoner who has only limited 

access to a defective typewriter, and the district court does not appear to 

have relied on that failing. See also Fed. R. Civ. P. 83 (a)(2) (“A local rule 

imposing a requirement of form must not be enforced in a way that causes 

a party to lose any right because of a nonwillful failure to comply.”).
8 No. 20-2946 

This is one of the rare cases in which the district court went 

a step too far, at least with respect to one key fact. In his response to the defendants’ proposed findings of fact, McDaniel 

testified that he was “missing [h]undreds of state meals” at 

the Columbia Correctional Institution. In his response to defendant Dr. Syed’s affidavit, McDaniel said the prison “denied [me] over 600 state meals.” His brief echoed these points, 

saying that he “missed over 600 state meals in less than a year 

because of severe pain,” and “Defendants were all aware of 

the ongoing constitutional violations of the [o]ver 600 ... state 

meals.” Defendants’ own summary judgment submissions 

also show that they were aware of plaintiff’s complaints that 

he was missing many meals and medications because of pain 

and difficulty getting up and down stairs. See Def. Proposed 

Findings of Fact ¶¶ 30 36, 38, 39, Dkt. No. 167. 

Local Rule 56.1 did not require plaintiff to cite other affidavits in his affidavits. This seems to be the principal point of 

our disagreement with the district court and with our dissenting colleague. Where the moving party asserts as an undisputed fact “X is the case,” and plaintiff responds in the corresponding paragraph “X is not the case,” and where the plaintiff’s response is attested under § 1746 and within his personal 

knowledge, that is enough to dispute whether X is true or 

false. See Owens, 635 F.3d at 955; Ford, 90 F.3d at 246–47 (7th 

Cir. 1996). Moreover, defendants’ summary judgment papers 

did not even try to contradict directly plaintiff’s complaints 

about missing meals and medications because of his pain and 

difficulty with stairs. We are required to treat as true 
No. 20-2946 9

plaintiff’s factual assertions that were supported with evidence, including his own affidavits.3

It is evident that McDaniel, a pro se litigant, tried to comply with the district court’s instructions. See Nichols v. Michigan City Plant Planning Dep’t, 755 F.3d 594, 600 (7th Cir. 2014) 

(“[A] trial court is obligated to give a liberal construction to a 

pro se plaintiff’s filings.”). We know well that rules like Local 

Rule 56 are intended “to make the summary judgment process less burdensome on district courts, by requiring the parties to nail down the relevant facts and the way they propose 

to support them.” Sojka v. Bovis Lend Lease, Inc., 686 F.3d 394, 

398 (7th Cir. 2012) (evaluating parallel local rule from another 

district). That process can help a busy district court determine 

which facts are supported by the record and which are not. It 

also gives the court and the opposing party notice of which 

legal and factual issues are up for debate. At the same time, 

we have also explained that local rules—and instructions on 

how to comply with them—are “not intended to provide a 

maze of technical traps to complicate and delay litigation 

without advancing the merits.” Stevo v. Frasor, 662 F.3d 880, 

887 (7th Cir. 2011) (district court did not abuse discretion by 

overlooking moving parties’ technical failures to comply with 

local rule on summary judgment materials). Unfortunately, 

3 McDaniel was not consistent about how many hundreds of meals he 

missed. In the amended complaint, he said the number was approximately 500. In his testimony submitted on summary judgment, that number was over 600. In one place in his brief in opposition to summary judgment, he said an individual employee knew he missed over 450 meals, 

again citing by name exhibits attached to that official’s declaration in the 

record. The difference between 450 and 600 meals was not the basis for the 

district court’s rejection of evidence that McDaniel missed hundreds of 

meals.
10 No. 20-2946 

that is what occurred here, primarily because the district court 

may not have appreciated that plaintiff could rely on his own 

factual assertions in his own declarations without citing any 

other documents.

One could criticize plaintiff for not having organized his 

summary judgment submissions as coherently and persuasively as an experienced lawyer might have. That does not 

justify overlooking, however, plaintiff’s specific factual assertions made under penalty of perjury. Even for excellent lawyers, it can be difficult to provide a clearly organized response 

to a motion for summary judgment. Local rules like this one 

allow the moving party to organize the facts and the narrative. The non-moving party is required to follow that organization, at least with respect to proposed facts. That can make 

it difficult for a non-moving party with a solid case to weave 

the evidence into a coherent narrative and to show how different facts and theories are related. For pro se parties, the 

challenge can be especially daunting. In this case, however, 

we conclude that McDaniel’s 33 pages of summary judgment 

submissions told the district court with sufficient clarity that 

he was relying on his own testimony about missing hundreds 

of meals and medications, and about defendants’ awareness 

of that consequence of his pain and mobility limits. And he 

made that point in the portion of his brief addressing his ADA 

and Rehabilitation Act claims. See Dkt. No. 177 at 10. 

To be sure, McDaniel’s submissions were not “by any 

measure ideal.” Sojka, 686 F.3d at 398. Many of his supposed 

facts were conclusory and argumentative. That is also often 

true of submissions by counsel, of course, and a district court 

is entitled to disregard such conclusory assertions even if a 

party tries to ground them in record citations. Cichon, 401 F.3d 
No. 20-2946 11

at 808, 809–10 (no abuse of discretion in disregarding conclusory submissions that lacked factual support). But the fact 

that some proposed facts are conclusory or argumentative 

does not mean a court is free to disregard the ones that are 

factual and specific. See Fed. R. Civ. P. 56(e) advisory committee’s note to 2010 amendment (“If there is a proper response 

or reply as to some facts, the court cannot grant summary 

judgment without determining whether those facts can be 

genuinely disputed.”). 

We conclude the district court abused its discretion in disregarding McDaniel’s factual assertion sworn under penalty 

of perjury that he had missed approximately 600 meals in one 

year at Columbia and that prison staff knew he was regularly 

missing meals due to his pain and difficulty in moving up and 

down stairs. McDaniel was entitled to have the court assume 

those facts in his favor in deciding the defendants’ motions 

for summary judgment.

In the following portions of this opinion, we first summarize the material facts, filtering the evidence through the lens 

of summary judgment procedure. Next, we turn to McDaniel’s ADA and Rehabilitation Act claims. We explain why disputes of material fact remain related to the failure of the Department of Corrections to accommodate McDaniel by refusing him a no-stairs unit and why Eleventh Amendment sovereign immunity does not bar his request for money damages 

for this claim. We then explain why summary judgment for 

defendants was proper on McDaniel’s two other failure-to-accommodate claims. Finally, we explain why we affirm summary judgment for Dr. Syed on McDaniel’s separate Eighth 

Amendment claim for deliberate indifference. 
12 No. 20-2946 

II. Factual and Procedural History

We set forth the facts in the light most favorable to McDaniel and give him the benefit of all reasonable inferences in his 

favor, as required on summary judgment. E.g., Navratil v. City 

of Racine, 101 F.4th 511, 516 (7th Cir. 2024). For more than fourteen years, Carl McDaniel was a prisoner in the custody of the 

Wisconsin Department of Corrections. When he filed this appeal, McDaniel was in his early sixties and had extensive medical problems, including hypertension, hyperthyroidism, 

chronic obstructive pulmonary disease, stage 3 chronic kidney disease, bladder tumors, type 2 diabetes complicated by 

neuropathy, gout, fibromyalgia, anxiety, post-traumatic 

stress disorder, bipolar disorder, chronic pain, peptic ulcer 

disease, asthma, and degenerative joint disease in his spine 

with spinal stenosis. McDaniel had developed some of these 

ailments before his incarceration and others during. 

While incarcerated, McDaniel received medical treatment 

for those ailments, including spinal surgery in the summer of 

2017. Before that surgery, McDaniel used a wheelchair. Afterward, he could move using a four-wheel walker. But McDaniel continued to experience other medical problems, including 

degenerative joint disease of the spine and incontinence issues, resulting in significant back pain and difficulty controlling urination and defecation. Following his spinal surgery, 

the treating physician gave McDaniel several post-operative 

instructions: he was to avoid “strenuous exercising,” “lift[ing] 

more than 5–10 pounds,” and “bending, lifting, carrying, 

twisting,” but the physician said he could “climb stairs.”
No. 20-2946 13

A. Problems at the Columbia Correctional Institution

A few months after the spinal surgery, the Department of 

Corrections transferred McDaniel to the Columbia Correctional Institution. Before the transfer, McDaniel had restrictions in his file for a low-tier floor, no-stairs unit, low 

bunk, and walker. At the new facility, however, a physical 

therapist evaluated McDaniel and recommended changing 

those restrictions. As part of the evaluation, McDaniel had 

successfully walked up and down just six stairs. The therapist 

concluded the no-stairs and low-tier restrictions were no 

longer necessary. McDaniel’s eventual cell assignment, he 

said, required him to walk up and down the stairs at least sixteen times each day to access prison programs and activities, 

including meals and the infirmary. Defendant Dr. Syed, one 

of the facility’s treating physicians, approved discontinuing 

those restrictions. McDaniel then received a walker, a cane, 

and a double-occupancy cell with a low bunk, but in a unit 

that was accessible only by stairs.4

The cell assignment created problems for McDaniel almost 

immediately. For one, the stairs impeded his access to meals 

and medications since the cafeteria and infirmary were on another floor. McDaniel complained from the start that he was 

not able to get out of his cell to eat or to retrieve his pain medication. He eventually stopped attending most meals and taking his medications because of the pain from going up and 

down the stairs to access those services. In the end, McDaniel 

4 At some point during McDaniel’s time at Columbia, he was moved 

to a different double-occupancy cell. There were no relevant differences 

between these two cells. Both required using stairs to attend meals and 

retrieve medications.
14 No. 20-2946 

testified, he missed some 600 meals during his year at Columbia.

When McDaniel was able to navigate the stairs, he did so 

with help. For instance, McDaniel would often purchase food 

from the prison commissary. To pick up his orders, McDaniel 

would use the goods he brought from the commissary to 

“pay” other prisoners to help him up and down the stairs. 

Other prisoners carried McDaniel’s walker for him while he 

used the railing to move or sat and scooted down the stairs. 

Sometimes other prisoners would even put their arms around 

him and walk McDaniel up the stairs. But prison staff eventually forbade McDaniel from asking prisoners, guards, or anyone else for help. Staff also told McDaniel he had to stop scooting down the stairs on his buttocks or he would get a “conduct 

report.”5

McDaniel also had difficulty navigating his cell. In doubleoccupancy cells that contain a toilet, people sometimes use socalled “courtesy screens” to create some privacy. Most of the 

time, McDaniel could use his walker to access the toilet. When 

a courtesy screen was up, however, there was simply not 

enough room to hold onto the walker when using the toilet. 

5 In McDaniel’s version of events, the walker did little to solve the 

stairs problem: “It’s made out of steel and it’s got a chair on it.... I couldn’t 

hold it with one hand.... But I couldn’t hold that and hold the rail and get 

up and down the stairs....” McDaniel asserted under penalty of perjury 

that his walker weighed about twenty-five pounds, well over the five-toten-pound lifting restriction he was prescribed after his surgery. McDaniel

likewise contends that the cane did not help. To use the cane, McDaniel 

also had to carry his walker since the walker was necessary to move once 

he made his way up or down the stairs. Carrying both a walker and a cane, 

he said, was too much for him to handle.
No. 20-2946 15

As a result, McDaniel emphasizes, he had multiple falls moving around his cell and when using the toilet, which lacked 

railings and support to hold.

Toilet access was especially important for McDaniel. Since 

he had difficulty controlling his bladder and bowels, at least 

one doctor told McDaniel to practice timed voiding (going to 

the bathroom in fixed time intervals, rather than by demand).

Without his own toilet and the ability to practice timed voiding, he would often soil himself. His cellmates, McDaniel 

says, had difficulty with his timed voiding and accidents. He 

contends that animosity contributed to a difficult living environment that caused him significant stress and led to an altercation with one cellmate.

In addition, McDaniel’s bed also had a top bunk where a 

cellmate slept. Due to what McDaniel described as a “lack of 

flexibility in my entire spine,” he often hit his head and neck 

on that bunk, contributing further to his pain. His cellmate 

would also often hit McDaniel when climbing into the top 

bunk.

B. Requests for Accommodations

McDaniel submitted several requests for accommodations 

of his disabilities at Columbia. All were denied. A few days 

after receiving his cell assignment, McDaniel asked for a “feed 

in cell” restriction. His request was denied after a staff member saw McDaniel walking around the unit. McDaniel later 

sent two accommodation requests to the facility’s ADA coordinator because of his “Fibromyalgia, Diabetes, (painful) 

Neuropathy, [arthritis] of my Spinal Cord/Knees, need for 

Mobility Impairment Device (walker).” The requests documented his falls trying to “access[] [the] unsafe toilet;” 
16 No. 20-2946 

instances where he struck his “Head/Neck on bunk;” and a 

general “inability to access meds, food, services, programs, 

and benefits from exacerbated pain [from] transitioning [the] 

stairwell.” McDaniel also submitted a “Health Service Request” for a “handicap accessible cell.” The ADA Coordinator 

responded to these submissions by explaining that McDaniel’s low-tier and no-stairs restrictions had been removed, so 

he did not qualify for a “handicap cell.” No other actions were 

taken. 

At an appointment with the facility’s Health Services 

Unit—where Dr. Syed worked—McDaniel again asked for a 

single-occupancy, wheelchair-accessible cell. He explained 

that he “has pains and has no medication,” and “cannot go up 

or down stairs.” Health Services staff told him that he did not 

meet the criteria for a single-occupancy or wheelchair-accessible cell and that “many/most ppl live w/ pain and he will 

endure if he wants to do the activity.”

McDaniel had more appointments with the Health Services Unit. His complaints continued. McDaniel told the staff 

about his chronic pain, lack of access to meals, and incontinence issues. Despite these consistent complaints, Dr. Syed 

and others did not modify McDaniel’s restrictions and continued to refuse him a cell on a floor where he would not need 

to use stairs to access services, including meals. When 

McDaniel again told Health Services staff that he was not taking his medications because it was too painful to go up and 

down the stairs to retrieve them, staff members instructed 

him to “take your medication as prescribed.” Others told him 

to try physical therapy. Staff members told McDaniel that 

movement would help him to avoid developing muscle atrophy. In the end, Health Services staff evaluated McDaniel at 
No. 20-2946 17

least forty-nine times during his year in the Columbia Correctional Institution.

While prison staff members, including Dr. Syed, continued to deny McDaniel any new accommodations or significant changes in medical treatment, various doctors outside of 

the facility assessed McDaniel. Those doctors came to different conclusions about McDaniel’s care. 

To start, a nephrologist who treated McDaniel’s kidney 

conditions visited him in his cell to conduct an exam. At that 

time, McDaniel did not have a cellmate. The nephrologist 

wrote that the “current singled cell is providing him this option [to do timed voiding] and I would recommend this to 

continue as to avoid further complications and stress associated with” incontinence. Shortly after the nephrologist’s visit, 

however, the facility gave McDaniel a cellmate and continued 

to offer him diapers to help with his accidents. When the 

nephrologist followed up with McDaniel a few months later, 

she noted a significant decline in his condition. She wrote in 

his chart that the “single cell status was previously significantly helpful in minimizing issues and stress surrounding 

bowel and bladder concerns,” and that timed voiding was 

critical for treating his chronic kidney disease. McDaniel continued to live in a double-occupancy cell with a cellmate.

Other doctors expressed similar opinions that contradicted Health Services staff. A pain specialist, for instance, assessed McDaniel and recommended that he be “put in [a] cell 

with no top bunk,” which would help mitigate instances 
18 No. 20-2946 

where he would hit his head and neck. McDaniel’s sleeping 

arrangements did not change.6

C. Procedural History

McDaniel filed this lawsuit against the Wisconsin Department of Corrections, Dr. Syed, and others seeking both injunctive and monetary relief. He alleged that the Department violated his rights under the ADA and the Rehabilitation Act by 

refusing to accommodate his disabilities. McDaniel also alleged that Dr. Syed and others violated the Eighth Amendment in various ways.7

6 After McDaniel had been at Columbia for just over a year, the Department transferred him to the New Lisbon Correctional Institution. 

Here, the facility shuffled McDaniel between no-stairs cells, normal double-occupancy cells, and even a so-called “dry cell” (lacking a toilet). After 

McDaniel filed this lawsuit, the facility changed course. It gave him a single-occupancy cell with a toilet and a medical mattress. The staff lowered 

the bottom bunk and raised the top bunk so McDaniel would not hit his 

head getting in and out of bed. The facility also instituted a wheelchair 

restriction for long distances, a shower chair restriction, and gave McDaniel diapers to help with his incontinence issues. While the vast majority of 

McDaniel’s arguments concern the accommodations he was denied at Columbia, he also contends that New Lisbon’s accommodations were not 

reasonable. The evidence underlying those claims is lacking by comparison and underdeveloped. We agree with the district court that no reasonable jury could find for McDaniel on those claims, and we focus our discussion on Columbia.

7 McDaniel initially brought claims against other prison officials at 

Columbia and New Lisbon but did not pursue those claims on appeal. He 

had also sought a preliminary injunction demanding accommodations of 

his disabilities. The district court denied the injunction after the Department assured the court it would keep McDaniel in a single-occupancy wet 

cell for the length of the case. After the district court granted summary 

judgment, the Department moved McDaniel to yet another facility where 
No. 20-2946 19

McDaniel litigated in the district court pro se, with one exception. The district court appointed counsel for the limited 

purpose of helping McDaniel file an amended complaint. The 

appointed counsel then withdrew with court approval. Upon 

the close of discovery, the defendants moved for summary 

judgment. As discussed above, the district court granted the 

defendants’ motion after largely discounting McDaniel’s factual statements.

After we heard oral argument in this appeal, McDaniel 

was released from prison, which rendered moot his requests 

for injunctive relief. In February 2024, McDaniel died. We 

granted his son’s motion to be substituted as the plaintiff in 

this case, acting as executor of McDaniel’s estate. See Fed. R. 

App. P. 43(a)(1); Smith v. First Hospital Laboratories, Inc., 77 

F.4th 603, 607 (7th Cir. 2023) (proceeding with appeal after 

substituting executor of plaintiff’s estate as plaintiff).8

III. Eleventh Amendment Sovereign Immunity

Sovereign immunity bears on whether a federal court may 

hear a case, so we address it before reaching the merits. See 

Seminole Tribe of Florida v. Florida, 517 U.S. 44, 64–65 (1996). 

The district court quite reasonably chose to avoid “thorny 

questions of sovereign immunity” under the ADA by 

he claimed he faced challenges similar to those complained of here. See 

McDaniel v. Wisconsin Dep’t of Corrections, No. 21-3048, 2022 WL 1965902 

(7th Cir. June 6, 2022) (vacating denial of preliminary injunction).

8 Wisconsin law provides for survival of a plaintiff’s claims for personal injuries like McDaniel’s. Wis. Stat. § 895.01(1)(am)(7) (causes of action for “other damage to the person” survive death of plaintiff); see, e.g., 

Sawyer v. Midelfort, 227 Wis. 2d 124, 151–54, 595 N.W.2d 423, 436–38 (1999) 

(claim for psychological damage caused by medical malpractice survived 

death of plaintiff).
20 No. 20-2946 

analyzing McDaniel’s reasonable accommodation claims under the Rehabilitation Act. See McDaniel v. Syed, No. 17-cv01493, 2020 WL 5570401, at *7 (E.D. Wis. Sept. 17, 2020), citing 

Jaros v. Illinois Dep’t of Corrections, 684 F.3d 667, 671–72 (7th 

Cir. 2012). Because of McDaniel’s release from prison and 

later death, however, the only remedy available if McDaniel 

succeeds on his reasonable accommodation claim is money 

damages. This makes the issue of Eleventh Amendment state 

sovereign immunity more critical. Relief available under Title 

II of the ADA and the Rehabilitation Act is “coextensive,” Jaros, 684 F.3d at 671, and Wisconsin has waived its immunity 

from suits for damages under the Rehabilitation Act as a condition of its receipt of federal funds. See Stanley v. Litscher, 213 

F.3d 340, 344 (7th Cir. 2000). We do not think this ends our 

inquiry, though. We think it prudent to address whether sovereign immunity would bar McDaniel from seeking money 

damages under Title II of the ADA.

Congress may abrogate state sovereign immunity when 

exercising its enforcement power conferred by section 5 of the 

Fourteenth Amendment. College Savings Bank v. Florida Prepaid 

Postsecondary Education Expense Bd., 527 U.S. 666, 670 (1999). 

The ADA provides: “A State shall not be immune under the 

eleventh amendment to the Constitution of the United States 

from an action in Federal or State court of competent jurisdiction for a violation of this chapter.” 42 U.S.C. § 12202. The Supreme Court has recognized this statement as an unequivocal 

expression of Congress’s intent to abrogate state sovereign 

immunity. See United States v. Georgia, 546 U.S. 151, 154 (2006); 

Board of Trustees of Univ. of Alabama v. Garrett, 531 U.S. 356, 

363–64 (2001); see also Seminole Tribe, 517 U.S. at 55 (“In order 

to determine whether Congress has abrogated the States’ sovereign immunity, we ask two questions: first, whether 
No. 20-2946 21

Congress has ‘unequivocally expresse[d] its intent to abrogate 

the immunity,’ and second, whether Congress has acted ‘pursuant to a valid exercise of power.’” (alteration in original) 

(quoting Green v. Mansour, 474 U.S. 64, 68 (1985))). 

Whether Congress validly exercised its section 5 enforcement power in the ADA is a separate question. The Supreme 

Court explored this question in United States v. Georgia, 546 

U.S. 151 (2006), and explained that there are two paths by 

which Congress could have validly abrogated state sovereign 

immunity under Title II of the ADA. 

First, a plaintiff can show that his claim falls into the category of valid prophylactic legislation Congress enacted under 

section 5 following the three-step inquiry articulated in Tennessee v. Lane: (1) identify the rights at issue, (2) identify the 

pattern of violations the legislation is designed to remedy and 

prevent, and (3) determine whether the legislation is congruent with and proportional to the pattern of violations. 541 U.S. 

509, 522–34 (2004); see also City of Boerne v. Flores, 521 U.S. 507, 

520 (1997) (holding that Congress may enact prophylactic legislation to remedy or prevent unconstitutional discrimination 

under section 5 of the Fourteenth Amendment if the legislation exhibits “a congruence and proportionality between the 

injury to be prevented or remedied and the means adopted to 

that end”). 

Alternatively, as in Georgia, Title II of the ADA validly abrogates state sovereign immunity for conduct that also represents a violation of the Fourteenth Amendment. A plaintiff 

taking this route need not satisfy the congruence and proportionality inquiry under Lane and Boerne because the plaintiff 

does not seek to hold a state liable for damages for conduct 

that is constitutional. In these cases, ADA Title II liability acts 
22 No. 20-2946 

not as “prophylactic” legislation but as a remedy for an actual 

constitutional violation.

We explain below that the deprivation of food that 

McDaniel argues violates Title II of the ADA would also violate the Eighth Amendment’s prohibition on cruel and unusual punishment, as incorporated against the states through 

the Fourteenth Amendment (or at least a reasonable jury 

could find as much). Therefore, regardless of whether relief is 

granted under the Rehabilitation Act or Title II of the ADA, 

the Wisconsin Department of Corrections is not immune from 

liability for money damages under the Eleventh Amendment.9 We return to this issue in more detail below, after addressing the merits of McDaniel’s ADA and Rehabilitation 

Act claims, including the availability of money damages. 

IV. ADA and Rehabilitation Act Claims

We review de novo the district court’s grant of summary 

judgment, giving the non-moving party the benefit of 

9 McDaniel could recover damages under either the ADA or the Rehabilitation Act but not both. He could have only one recovery for the 

same injury. See Duran v. Town of Cicero, 653 F.3d 632, 639 (7th Cir. 2011)

(a plaintiff may have but one recovery); Calero–Cerezo v. United States Dep't 

of Justice, 355 F.3d 6, 11 n. 1 (1st Cir. 2004) (dismissal of ADA claim had no 

effect on scope of remedy because Rehabilitation Act claim remained). Despite this, some recent court decisions have still considered the issue of 

sovereign immunity under both statutes before resolving plaintiffs’ claims 

on the merits, as we have done here. See, e.g., Durham v. Kelley, 82 F.4th 

217, 227–29 (3d Cir. 2023); but see Bennett-Nelson v. Louisiana Bd. of Regents, 

431 F.3d 448, 455 (5th Cir. 2005) (explaining that “having already held that 

sovereign immunity does not bar the appellants’ claim under [the Rehabilitation Act], we need not address at this juncture the issue of abrogation 

under Title II of the ADA, because the rights and remedies under either 

are the same for purposes of this case”).
No. 20-2946 23

conflicts in the evidence and all reasonable inferences in his 

favor. Navratil, 101 F.4th at 518. Summary judgment is appropriate when the moving party shows there is no genuine dispute as to any material fact and it is entitled to judgment as a 

matter of law. Fed. R. Civ. P. 56(a). “A dispute of material fact 

is genuine ‘if the evidence is such that a reasonable jury could 

return a verdict for the nonmoving party.’” Johnson v. 

Dominguez, 5 F.4th 818, 824 (7th Cir. 2021), quoting Zaya v. 

Sood, 836 F.3d 800, 804 (7th Cir. 2016).

A. Legal Standard

McDaniel contends that the Wisconsin Department of 

Corrections violated the ADA and the Rehabilitation Act by 

refusing to accommodate his physical impairments, resulting 

in the denial of access to programs and services. Title II of the 

ADA provides that “no qualified individual with a disability 

shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, 

or activities of a public entity, or be subjected to discrimination by any such entity.” 42 U.S.C. § 12132. Section 504 of the 

Rehabilitation Act provides: “No otherwise qualified individual with a disability ... shall, solely by reason of her or his 

disability, be excluded from the participation in, be denied the 

benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.” 29 

U.S.C. § 794(a). The relief available under the ADA and the 

Rehabilitation Act is “coextensive.” Jaros, 684 F.3d at 671. 

“‘[C]ourts construe and apply [the statutes] in a consistent 

manner,’ and our evaluation of [a plaintiff’s] claims under 

both [requires] the same analysis.” A.H. ex rel. Holzmueller v. 

Illinois High School Ass’n, 881 F.3d 587, 592 (7th Cir. 2018), 
24 No. 20-2946 

quoting Radaszewski ex rel. Radaszewski v. Maram, 383 F.3d 599, 

607 (7th Cir. 2004).10

To avoid summary judgment under the ADA and the Rehabilitation Act, McDaniel must offer evidence that “(1) he is 

a qualified person (2) with a disability and (3) the Department 

of Corrections denied him access to a program or activity because of his disability.” Jaros, 684 F.3d at 672. The Department 

disputes only the third element. If McDaniel offers evidence 

that could support a jury finding in his favor on that element, 

“the burden shifts to the [Department] to prove that the requested accommodation would impose an undue hardship.” 

Conners v. Wilkie, 984 F.3d 1255, 1261 (7th Cir. 2021); see also 

Oconomowoc Residential Programs, Inc. v. City of Milwaukee, 300 

F.3d 775, 784 (7th Cir. 2002) (“An accommodation is unreasonable if it imposes undue financial or administrative burdens 

or requires a fundamental alteration in the nature of the program.”).11

10 There are a few differences between the ADA and the Rehabilitation 

Act, but they do not affect the merits of McDaniel’s claims at summary 

judgment. See Jaros, 684 F.3d at 671 (Rehabilitation Act claim requires as 

additional element the receipt of federal funds, which all states accept for 

their prisons); see also, e.g., Reed v. Columbia St. Mary’s Hospital, 915 F.3d 

473, 484 (7th Cir. 2019) (noting key difference between ADA and Rehabilitation Act regarding defendant’s intent).

11 Reasonable accommodation claims under Title II of the ADA and 

Section 504 of the Rehabilitation Act are firmly part of both statutes, even 

though they do not contain specific language on point. See A.H., 881 F.3d 

at 592 (“While Title II and Section 504 of the Rehabilitation Act lack such 

specific reasonable accommodation language, their corresponding regulations employ language indicating that entities must provide reasonable 

accommodations to the disabled.”); see also Reed, 915 F.3d at 484 (“The 

Rehabilitation Act does not contain an explicit accommodation 
No. 20-2946 25

It is well established that “[r]efusing to make reasonable 

accommodations is tantamount to denying access.” Jaros, 684 

F.3d at 672. Just as an employer is not obliged to provide an 

employee with a disability the particular accommodation he 

requests or prefers, Mobley v. Allstate Insurance Co., 531 F.3d 

539, 546 (7th Cir. 2008), prison officials are not required to provide a prisoner with disabilities the particular accommodations he requests or prefers. Rather, “the [defendant] need 

only provide some reasonable accommodation,” id. (internal 

quotation omitted), that ensures that the person with disabilities has “equal access to the benefits of” programs or activities. See Wisconsin Community Services, Inc. v. City of Milwaukee, 465 F.3d 737, 748 (7th Cir. 2006) (en banc) (zoning restrictions affecting health care for persons with disabilities, 

addressed under Rehabilitation Act and Title II of ADA). 

In a prison, qualifying programs and activities include 

meals, medical care, showers, toilets, and the like. See Georgia, 

546 U.S. at 157; Jaros, 684 F.3d at 672. Whether an accommodation satisfies these requirements is a “highly fact-specific 

inquiry,” whether in employment or in prison. See McAllister 

v. Innovation Ventures, LLC, 983 F.3d 963, 968 (7th Cir. 2020) 

(internal quotation omitted).

To win compensatory damages under the statutes, 

McDaniel must also offer evidence that the Department of 

Corrections was intentionally discriminatory or at least deliberately indifferent to its violation. Lacy v. Cook County, 897 

F.3d 847, 862–63 (7th Cir. 2018) (agreeing with most circuits 

that deliberate indifference is sufficient to prove intentional 

requirement, but the Supreme Court has located a duty to accommodate 

in the statute generally.”).
26 No. 20-2946 

discrimination under failure-to-accommodate claims). That 

requires “both (1) knowledge that a harm to a federally protected right is substantially likely, and (2) a failure to act upon 

that likelihood.” Id. at 863, quoting S.H. ex rel. Durrell v. Lower 

Merion School District, 729 F.3d 248, 263 (3d Cir. 2013) (internal 

quotation omitted).12

B. Reasonable Accommodations

McDaniel asserts that the Department of Corrections 

failed to provide reasonable accommodations by denying him 

(1) a no-stairs unit, (2) a single-occupancy wet cell, and (3) a 

cell without a top bunk. We take these issues in turn.

1. No-Stairs Unit

After McDaniel was transferred to Columbia, Dr. Syed removed his low-tier, no-stairs restriction upon a recommendation by the physical therapist who evaluated McDaniel. He 

was then placed in a cell in a unit that would require him to 

go up and down stairs in his daily activities. We assume that 

the initial cell assignment was reasonable at first. The healthcare professionals at the facility believed McDaniel needed to 

use stairs to improve mobility and to avoid atrophy after his 

recent spinal surgery. That accommodation was also in line 

with the spinal surgeon’s post-operative instructions. The 

question for us, however, is whether the denial of a no-stairs 

unit became unreasonable after McDaniel’s problems accessing services became evident and the Department still refused 

his repeated requests for a no-stairs unit.

12 A plaintiff can win compensatory damages under the Rehabilitation 

Act but not damages for emotional distress. Cummings v. Premier Rehab 

Keller, P.L.L.C., 596 U.S. 212, 230 (2022).
No. 20-2946 27

On this record, the evidence on denial of access is sufficient to defeat summary judgment for the Department. 

McDaniel needed to make his way up and down stairs to participate in various prison programs and activities, including 

ones as basic as meals and medical care. McDaniel offered evidence that, during his year at Columbia, he missed some 600 

meals and many doses of his medications because the stairs—

which he often could not climb or descend due to the pain of 

doing so—impeded his access. Accommodations must give 

“meaningful access to the benefit that the grantee offers.” Alexander v. Choate, 469 U.S. 287, 301 (1985). A reasonable jury 

could find that missing nearly two meals a day on average 

meant McDaniel did not have “meaningful access” to meals. 

The same is true of his access to medications. On this record, 

a reasonable jury could find that requiring McDaniel to walk 

up and down stairs for meals and medications was not reasonable.

The district court, however, found that McDaniel’s cell assignment was reasonable because he was physically able to 

walk up and down stairs to access prison programs, even if it 

was more painful to do so. The court pointed to the fact that 

some prison officials had observed McDaniel managing to go 

up or down stairs a few times. That reasoning may or may not 

be persuasive at trial, but it is not consistent with the summary judgment standard. McDaniel presented evidence that 

he could not navigate the stairs often enough to meet his basic 

needs on a daily basis. He also explained that the occasions 

when prison officials had observed him navigate the stairs 

were the rare times that he tried the stairs to request accommodations or to avoid starvation.
28 No. 20-2946 

Giving McDaniel the benefit of conflicting evidence, we 

cannot say beyond reasonable dispute that the Department 

was reasonable in choosing to keep housing him in a unit requiring him to go up and down stairs many times each day to 

gain access to prison programs, benefits, and services, including meals and medications. Ample evidence could support a 

jury finding of the exact opposite—that it was unreasonable 

to refuse McDaniel’s requests to be placed in a no-stairs unit. 

That holds true even if McDaniel could and did manage to go 

up and down stairs occasionally, and often with help.13

The district court also suggested that McDaniel’s walker 

was an adequate accommodation for the stair problem, so that 

McDaniel was not denied access to programs or services by 

living in a unit with stairs. Applying the summary judgment 

standard, we again must disagree. McDaniel offered evidence 

that his walker weighed about twenty-five pounds, and he 

was directed not to lift more than ten pounds. He also provided evidence that he could not use the walker to move up 

and down stairs and often relied on other prisoners to carry 

his walker for him so he could hold onto the railing. If a prisoner needs help from other prisoners to access programs, 

however, the general rule is that the accommodation is ineffective and inadequate. Wright v. New York State Dep’t of Corrections, 831 F.3d 64, 74, 79 (2d Cir. 2016) (reversing summary 

judgment for defense); see also American Council of the Blind v. 

13 The evidence McDaniel offered that he had access on average to 

only one meal per day is consistent with prison officials noting they sometimes saw McDaniel using the stairs successfully. The issue is whether a 

reasonable jury would be required to find that McDaniel’s access to only 

one meal per day constituted “meaningful access” to the relevant prison 

program, meals. See Alexander, 469 U.S. at 301.
No. 20-2946 29

Paulson, 525 F.3d 1256, 1269, 1274 (D.C. Cir. 2008) (affirming 

summary judgment for plaintiff; Rehabilitation Act’s emphasis on self-sufficiency should ensure that “enjoyment of a public benefit is not contingent upon the cooperation of third persons”). The walker aided McDaniel in attending meals only if 

a friend carried the walker up the stairs, which then allowed 

him to use the walker to move freely around the cafeteria. A 

reasonable accommodation cannot be one that requires the 

aid of other prisoners.14

a. Medical Judgment? 

The Department contends that the decision to house 

McDaniel in a unit with stairs was a form of medical treatment, which it says dooms his claim. As a general matter, the 

ADA and the Rehabilitation Act do not apply to issues of allegedly inadequate medical treatment. See Reed, 915 F.3d at 

486 n.6 (“The Rehabilitation Act and the Americans with Disabilities Act do not create a remedy for medical malpractice.”); Bryant v. Madigan, 84 F.3d 246, 249 (7th Cir. 1996) (explaining that ADA is not violated by “a prison’s simply failing 

to attend to the medical needs of its disabled prisoners”). 

As the Department sees the issue, McDaniel must prove 

that medical decisions had no bearing on the denials of his 

accommodation requests for a no-stairs unit because otherwise he cannot show that he was denied access to programs 

or services because of his disability. A contrary rule, the Department says, “would lead to the absurd result of creating 

litigation risk whenever medical staff deny [a prisoner’s] 

14 The cane likewise failed to solve the problem. It required McDaniel 

to walk with a cane while also carrying his walker. McDaniel contends 

that he could not use or carry both simultaneously.
30 No. 20-2946 

requested treatment based on their medical judgments and 

observations.” In this case, the Department contends, it denied McDaniel a no-stairs unit because it was deferring to the 

reasoned medical judgment of the facility’s staff that he did 

not need such a restriction.

The Department’s general point is correct. When prisoners 

are unhappy with the medical care they have received, legal 

redress may be available through medical malpractice suits or 

Eighth Amendment suits, not under the ADA or the Rehabilitation Act. But when it comes to issues of mobility affecting 

access to programs (here, principally meals and medical care), 

that argument runs against the weight of recent authority, at 

least as applied to McDaniel’s evidence. 

Starting with the Supreme Court, in Georgia, the Court addressed whether a prisoner with a disability in state prison 

could sue the state for damages under Title II of the ADA. 546 

U.S. at 153. When discussing whether the conduct at issue violated the Act in the first place, the Court explained that an 

“alleged deliberate refusal of prison officials to accommodate 

[a plaintiff’s] disability-related needs in such fundamentals as

mobility” could constitute an ADA violation because those decisions could lead to the “‘exclu[sion] from participation in or 

... deni[al of] the benefits of’ the prison’s ‘services, programs, 

or activities.’” Id. at 157 (alterations and omission in original; 

emphasis added), quoting 42 U.S.C. § 12132. That statement 

clearly assumes that the ADA and the Rehabilitation Act address mobility issues that affect a prisoner’s ability to participate equally in programs and services, even if they might also 

relate to medical decisions. At the very least, those decisions 

are not entirely off-limits from scrutiny under the ADA and 

Rehabilitation Act.
No. 20-2946 31

Since Georgia, other circuits have treated decisions related 

to a prisoner’s mobility as disability accommodation issues, 

not just as issues of allegedly inadequate medical treatment, 

even when medical staff were directly involved in denying a 

prisoner a claimed reasonable accommodation. 

For example, in Wright, the Second Circuit treated the decision to deny a prisoner a motorized wheelchair as an accommodation issue. 831 F.3d at 69, 74. Wright had received a 

“quad cane, a manual wheelchair, use of his customized cushion, knee pads, wheelchair accessible living space, and access 

to mobility aides from the mobility assistance program.” Id. at 

73. But he testified that even with those accommodations, he 

was “unable to visit the law library,” “missed multiple morning sick calls, doctor appointments, and meals,” and “defecated or urinated on himself on more than one occasion” because he could not reach the bathroom quickly enough. Id. 

The court found it obvious that these shortcomings were 

“examples of Wright being denied meaningful access to 

prison services, programs, and activities.” Id. The court also 

took particular issue with Wright’s forced reliance on other 

prisoners to navigate prison programs, which was “fundamentally in tension with the ADA and [the Rehabilitation 

Act’s] emphasis on independent living and self-sufficiency.” 

Id. at 74–75 (internal quotation omitted). The Second Circuit 

reversed summary judgment for the defendants, concluding 

that a reasonable jury could find that a motorized wheelchair 

was a reasonable accommodation.15

15 The Department of Corrections tries to distinguish Wright because 

the prison there failed to engage in an individual assessment of the prisoner’s needs when it denied him a wheelchair. In Wright the prison had
32 No. 20-2946 

In another similar case, the Fifth Circuit recognized the 

ADA could offer relief for a denial of accommodations the 

plaintiff needed to move within a jail. In Cadena v. El Paso 

County, 946 F.3d 717 (5th Cir. 2020), Cadena was incarcerated 

for failing to appear in court. Three days before her arrest, she 

had undergone surgery on her right leg. She used a wheelchair as she recovered. Upon arrival at the jail, a nurse conducted an intake evaluation. The nurse determined that Cadena could stand “independently” because she had “stood 

during the intake when asked to do so.” Id. at 721. Cadena, 

however, told the nurse that she could not walk, given her recent surgery. The facility physician decided that Cadena 

needed crutches but not a wheelchair. The facility also denied 

her requests for “a modified food delivery procedure, and 

various forms of medical care.” Id. at 725. At least one person, 

but not the treating physician, told Cadena that the facility 

could not accommodate a wheelchair.

The crutches, like the stairs for McDaniel, created problems for Cadena from the start. She could not safely navigate 

the facility on crutches and told staff members at least three 

times that she needed a wheelchair. One officer testified that 

she saw Cadena fall as she tried to use the crutches. The 

crutches also impeded her ability to access meals. She could 

maintained a blanket policy banning motorized wheelchairs. Here, by 

contrast, McDaniel was evaluated many times by prison staff, and they 

determined his requested accommodations were not medically necessary. 

Whether individualized assessments occurred, however, does not resolve 

the issue of whether the accommodations resulting from such assessments 

were reasonable. Defendants cannot avoid liability under the statutes by 

conducting individualized assessments if the result is a failure to provide 

reasonable accommodations ensuring meaningful access to programs or 

activities. This is an issue for trial.
No. 20-2946 33

not carry her food tray and use the crutches at the same time. 

But jail officials “continued to refuse the requested accommodation despite indications that further accommodation was 

necessary.” Id. at 726. 

In reversing summary judgment for the defense on the 

reasonable accommodation issue, the Fifth Circuit rejected 

the defendant’s argument that it properly deferred to the physician’s “medical judgment that Cadena did not need a wheelchair.” Id. The court first explained that the Supreme Court 

and the Second Circuit had treated “mobility aids” as “disability accommodations.” Id., citing Georgia, 546 U.S. at 157, 

and Wright, 831 F.3d at 73. In addition, there were reasons to 

doubt whether the physician actually intended for Cadena 

not to have access to a wheelchair, and other staff had explicitly recommended that she receive one. Thus, “the [defendant’s] characterization that it was merely deferring to a reasoned medical judgment [was] inaccurate.” Id. at 727. 

These cases indicate a general principle that decisions impeding a prisoner’s ability to move freely throughout a facility 

and discouraging his participation in prison activities can be 

addressed under the ADA and the Rehabilitation Act. See also 

Koon v. North Carolina, 50 F.4th 398, 401–02, 405–06 (4th Cir. 

2022) (treating medical professionals denying prisoner a 

handicap pass to use library without climbing stairs as an accommodation issue under the ADA); Brooks v. Colorado Dep’t 

of Corrections, 12 F.4th 1160, 1164–65, 1172 (10th Cir. 2021) (reversing summary judgment for defendants under ADA; trial 

required to decide whether provision of adult diapers was a 

reasonable accommodation for prisoner with ulcerative colitis 

that caused him to miss hundreds of meals per year after 

prison’s clinical services denied prisoner a movement pass 
34 No. 20-2946 

that would have allowed him to access meals more flexibly); 

see also Furgess v. Pennsylvania Dep't of Corrections, 933 F.3d 

285, 291 (3d Cir. 2019) (explaining “complaints about not being provided an accessible shower are not allegations of medical malpractice or disagreements about medical treatment. 

They are requests for reasonable accommodations so that inmates with disabilities can take a shower—just like able-bodied inmates”). Such claims are not barred as a matter of law 

even if the denial of an accommodation can be described in 

some respects as a “medical decision.” 

Our decision in Bryant, 84 F.3d at 246, does not conflict 

with this view; the case is readily distinguishable from this 

situation. Bryant was a prisoner with paraplegia. He sued a 

prison after it had refused his request for guardrails for his 

bed and as a result, he fell out of his bed and broke his leg. 

Bryant also complained that he was denied medication after 

surgery to fix his broken leg. Bryant argued these actions violated, in part, the ADA. We rejected his claim.

We emphasized two important points. First, Bryant had 

not complained “of being excluded from some prison service, 

program, or activity.” Id. at 249. Instead, he took issue with 

“incompetent treatment of his paraplegia,” which the ADA 

does not address. Id. Second, we emphasized that 

“[s]tandards of medical care are not irrelevant to the [ADA]. 

Disabled people often cannot participate in programs and activities unless special attention is given to their medical 

needs.” Id. That was not Bryant’s case because he did not 

claim he was denied access to a program or activity. McDaniel, by contrast, has offered evidence that he was in fact denied 
No. 20-2946 35

access to qualifying programs and services because the Department refused to assign him to a no-stairs unit.16

We read these cases, taken together, as establishing a few 

general principles. First, the ADA and the Rehabilitation Act 

do not apply when a prisoner simply disagrees with his 

course of medical treatment. Second, simple disagreement 

with treatment is different from cases where, as here, a plaintiff offers evidence that the choice to reject his accommodation 

requests directly affected his mobility, preventing him from 

moving freely throughout the facility and impairing or preventing his participation in prison activities. “Disabled people 

often cannot participate in programs and activities unless special attention is given to their medical needs.” Bryant, 84 F.3d 

at 249. Consistent with Georgia and the later circuit cases cited 

above, the evidence here raises issues under the ADA and the 

16 The Department also relies on Fitzgerald v. Corrections Corp. of America, 403 F.3d 1134 (10th Cir. 2005), but the situation there is also readily 

distinguishable from McDaniel’s mobility issues. Fitzgerald broke his hip 

while incarcerated. The treating physician advised the prison that a surgical procedure was the best form of treatment, but that another acceptable 

course of treatment was to do nothing. The facility chose to do nothing. 

Fitzgerald sued, asserting that the physician’s recommendation that the 

facility may “do nothing” violated his rights under the ADA and the Rehabilitation Act. The Tenth Circuit rejected his claim, explaining that a surgery is something that Fitzgerald “would not have been ‘otherwise qualified’ for ... in the absence of his alleged disability.” Id. at 1144. Whether to 

have surgery or not was “the sort of purely medical decision[] that we 

have held [does] not ordinarily fall within the scope of the ADA or the 

Rehabilitation Act.” Id. Fitzgerald did not argue that he was denied access 

to a program or service because of his disability. The sole issue was his 

disagreement with the treatment he received.
36 No. 20-2946 

Rehabilitation Act, not just medical malpractice or Eighth 

Amendment health-care claims. 

Whether to house McDaniel in a unit with stairs presented 

an accommodation issue since it directly related to his mobility. If McDaniel could not access the cafeteria if he lived in a 

unit with stairs but could if he lived in a unit without them, 

then a no-stairs restriction could qualify as a mobility aid. The 

choice to assign him to a unit with stairs affected his ability to 

move freely around the prison, and, according to McDaniel’s 

evidence, resulted in his missing 600 meals in one year, as well 

as many doses of medications.

McDaniel has shown a material dispute as to whether 

housing him in a unit with stairs was a reasonable accommodation. McDaniel never claimed he was incapable of ever 

making his way up and down stairs. His case has always been 

that stairs were too difficult and painful for him to access 

meals and medications on a regular basis. The Department’s 

justification that the cell assignment was necessary because 

movement, like walking up and down stairs, could help 

McDaniel avoid developing muscle atrophy does not compel 

summary judgment in its favor. Even if the decision was reasonable when McDaniel was first transferred and was recovering from his spinal surgery, McDaniel’s evidence shows 

that as time went on, he struggled to the point that he was 

missing medications and an average of two meals a day. 

Faced with that evidence, a jury could find that it eventually 

became unreasonable for the prison to deny a non-stairs assignment. We recognize, of course, that doctors often give 

treatment instructions that patients do not agree with and 

may even find painful, such as stressing movement after surgery. But our task is assessing whether McDaniel received 
No. 20-2946 37

meaningful access to prison programs, and to make that assessment by giving McDaniel the benefit of conflicts in the evidence. As months went by and he was relegated to asking 

other prisoners for assistance or even scooting up and down 

stairs on his buttocks for meals, medications, and other services, there is a genuine factual dispute over whether the cell 

assignment continued to be reasonable.

McDaniel has offered evidence to establish a prima facie 

case that denying him a no-stairs unit amounted to a failure 

to accommodate his disabilities. The Department has not argued that McDaniel’s requested accommodation—a no-stairs 

unit—would have imposed an undue hardship on prison officials. McDaniel’s evidence thus supports a triable claim that 

the Department violated his rights under the ADA and the 

Rehabilitation Act during his time at Columbia. 

b. Compensatory Damages

The next issue is whether a reasonable jury could award 

McDaniel compensatory damages, which, under the ADA 

and Rehabilitation Act, would require a finding that the Department was at least deliberately indifferent to his lack of access. Lacy, 897 F.3d at 863. Deliberate indifference, again, requires that “the defendant knew that harm to a federally protected right was substantially likely and ... failed to act on that 

likelihood.” Id. at 862 (omission and emphases in original; internal quotation omitted).

As explained, McDaniel offered evidence that the stairs 

prevented his access to meals and medication. He and the defendants also offered evidence that he conveyed that fact repeatedly to various facility staff members during his year at 

Columbia. All his requests for a no-stairs unit were denied, 
38 No. 20-2946 

and his cell assignment went unchanged. A reasonable jury 

could find that the Department, by refusing to change 

McDaniel’s disability-related restrictions and to place him in 

a no-stairs unit, even after knowing he was missing meals and 

medication dosages, was deliberately indifferent to violations 

of McDaniel’s “federally protected right[s]” under the ADA 

and the Rehabilitation Act. Id. (internal quotation omitted). At 

bottom, McDaniel has offered enough evidence to defeat summary judgment on this failure-to-accommodate claim for 

money damages. We reverse the district court’s decision to the 

contrary.

c. Eleventh Amendment Sovereign Immunity and the 

Eighth Amendment’s Prohibition on Cruel and Unusual Punishment

Having set out the merits of McDaniel’s reasonable-accommodation claim regarding the denial of a no-stairs unit, 

we return to the issue of sovereign immunity. If a reasonable 

jury could conclude that one or more responsible prison officials were deliberately indifferent to McDaniel’s federally 

protected rights under the ADA, then a reasonable jury could 

also find that same conduct violated the Eighth Amendment. 

This point is important, because it means that, for purposes of 

McDaniel’s ADA Title II claim for money damages, Congress 

could validly abrogate state sovereign immunity under the 

Eleventh Amendment. See Georgia, 546 U.S. at 159 (“[I]nsofar 

as Title II creates a private cause of action for damages against 

the States for conduct that actually violates the Fourteenth 

Amendment, Title II validly abrogates state sovereign immunity.” (emphasis original)). 

We discuss below McDaniel’s Eighth Amendment claim 

against Dr. Syed for deliberate indifference to medical needs. 
No. 20-2946 39

McDaniel’s Title II ADA claim is comparable to a “conditions 

of confinement” claim under the Eighth Amendment. See 

Farmer v. Brennan, 511 U.S. 825, 832 (1994) (explaining that 

Eighth Amendment imposes duties on prison officials to 

“provide humane conditions of confinement”).

“Adequate food and facilities to wash and use the toilet are 

among the ‘minimal civilized measure of life’s necessities’ 

that must be afforded prisoners.” Jaros, 684 F.3d at 670, quoting Rhodes v. Chapman, 452 U.S. 337, 347 (1981), and citing Wilson v. Seiter, 501 U.S. 294, 304 (1991). The Supreme Court has 

recognized that the food prisoners are fed is a “condition” of 

confinement. Wilson, 501 U.S. at 303. Prison officials are liable 

under the Eighth Amendment for depriving an inmate of humane conditions of confinement if the official is deliberately 

indifferent to a substantial risk of harm from that deprivation. 

See Farmer, 511 U.S. at 837. 

We explained above why a reasonable jury could conclude 

that prison officials were deliberately indifferent to McDaniel’s lack of access to prison programs, including meals. We 

also think it obvious that depriving a prisoner of nearly two 

meals a day for an entire year can amount to a substantial risk 

of harm. See Reed v. McBride, 178 F.3d 849, 853–54 (7th Cir. 

1999) (reversing summary judgment; prisoner missing meals 

three to five days at a time was a “sufficiently serious” deprivation to constitute an Eighth Amendment violation); accord, 

Foster v. Runnels, 554 F.3d 807, 812–13 (9th Cir. 2009) (reversing summary judgment; depriving prisoner of sixteen meals 

in twenty-three days was sufficiently serious deprivation of a 

life necessity to establish Eighth Amendment violation); Simmons v. Cook, 154 F.3d 805, 807–09 (8th Cir. 1998) (upholding 

damage award for Eighth Amendment violation where 
40 No. 20-2946 

paraplegic prisoners missed four consecutive meals because 

their wheelchairs could not access food tray slots, depriving 

them of “the minimal civilized measure of life’s necessities,” 

quoting Farmer, 511 U.S. at 834); Cooper v. Sheriff, Lubbock 

County, 929 F.2d 1078, 1083 (5th Cir. 1991) (deprivation of adequate food for significant periods of time is a “form of corporal punishment” forbidden by the Eighth Amendment). Because the conduct that supports McDaniel’s Title II ADA 

claim would also amount to a violation of the Eighth Amendment, the Eleventh Amendment does not bar him from seeking money damages against the Wisconsin Department of 

Corrections. He is seeking recompense for an actual constitutional violation.

2. Single-Occupancy Wet Cell

We turn now to McDaniel’s assertion that placing him in a 

double-occupancy cell failed to accommodate his disabilities. 

Again, to survive summary judgment on this issue, McDaniel 

needed to offer evidence that the Department of Corrections 

denied him access to a program or activity because of his disability. Unlike his claim for a no-stairs unit, this claim presented a medical treatment dispute. Relief is not available under the ADA and the Rehabilitation Act, and the district court 

properly granted summary judgment on the claim.

McDaniel contended that the double-occupancy wet cell 

was not a reasonable accommodation for his incontinence and 

therefore impeded his access to the toilet. Staff at Columbia 

denied McDaniel’s request for a single-occupancy cell because they did not believe one was medically necessary. These 

conflicting positions indicate the core dispute was and continues to be over the best treatment of incontinence, not McDaniel’s access to a toilet. 
No. 20-2946 41

We draw our understanding from the nephrologist herself, whose recommendations McDaniel relies upon here. She 

said that the “current single[] cell is providing him this option 

[to do timed voiding] and I would recommend this to continue as to avoid further complications and stress associated 

with” incontinence; and in a follow-up, “single cell status was 

previously significantly helpful in minimizing issues and 

stress surrounding bowel and bladder concerns.” Her recommendations for a single-occupancy cell were based on what 

she believed McDaniel needed to treat his incontinence issues 

and to practice timed voiding. The Department denied 

McDaniel a single-occupancy cell because it disagreed with 

the nephrologist and McDaniel that one was medically necessary. These disagreements are more akin to Bryant and that 

plaintiff’s concerns with the prison’s alleged “incompetent 

treatment of his paraplegia.” 84 F.3d at 249. In this case, 

McDaniel took issue with what he saw as incompetent treatment of his incontinence. This seems more like a treatment issue, not an accommodation issue. 

McDaniel tried to present this issue as one regarding toilet 

access, but we are not convinced. McDaniel testified that he 

would often fall off the toilet because he could not access it 

with his walker, which he needed for balance, when the courtesy screen was up in his cell. If a prisoner could not access a 

toilet because the bathroom could not accommodate a wheelchair, for instance, that could present potential issues under 

the ADA and the Rehabilitation Act. See Georgia, 546 U.S. at 

155, 157 (ADA violation was “quite plausible” since bathroom 

was not equipped for wheelchair access). If the concern were 

simply the courtesy screen blocking his ability to access the 

toilet, that would be one thing. But McDaniel went a step further: he contended the only way to remedy this situation was 
42 No. 20-2946 

to give him his own cell with his own toilet, not just so that he 

could use his walker while using the toilet, but so that he 

could practice timed voiding. McDaniel’s proposed solution 

constitutes a form of medical treatment for his incontinence. 

This reasoning undermines McDaniel’s attempt to characterize this claim as an access issue.

3. No Top Bunk

McDaniel contended further that having a bed with a top 

bunk failed to accommodate his disabilities. McDaniel had a 

lower bunk. While he hit his head on the top bunk a few times 

when getting into his bed, he has not offered evidence that the 

top bunk prevented him from accessing programs or services. 

To the extent the pain specialists believed McDaniel should 

have had a bed without a top bunk, that decision was related 

to decreasing the number of opportunities where McDaniel 

might aggravate his pain. That rationale does not show a denial of access to programs or services. A reasonable jury could 

not find that the top bunk prevented or discouraged his participation in prison activities.

To summarize our conclusions under the Rehabilitation 

Act and the ADA, McDaniel met his burden to defeat summary judgment on the theory that the Department of Corrections failed to accommodate and was deliberately indifferent 

to his disability-related needs when it denied him a cell in a 

unit that would not require him to go up or down stairs for 

routine activities. We reverse the district court’s grant of summary judgment on that claim. We affirm the court’s grant of 

summary judgment on the other claims under those statutes.
No. 20-2946 43

V. Eighth Amendment Claim Against Dr. Syed

We turn now to McDaniel’s Eighth Amendment claim 

against Dr. Syed, a physician at the Columbia Correctional Institution. According to McDaniel, Dr. Syed expressed skepticism toward him in their first interaction, saying he could not 

“possibly have” all his diagnosed medical issues. Later, however, Dr. Syed referred McDaniel to the Waupun Memorial 

Hospital pain clinic in response to his complaints. Dr. Syed 

continued to treat McDaniel, prescribing new medications 

when necessary and refusing others after concluding that 

McDaniel was likely engaging in “attention-seeking and 

drug-seeking behavior.” Dr. Syed did not alter the disability 

restrictions in McDaniel’s file at any point. 

McDaniel contended that Dr. Syed was deliberately indifferent to his medical needs in two ways: first, by failing to follow medical recommendations of outside specialists, and second, by failing to change his course of treatment when it was 

not adequately treating McDaniel’s pain. Given the demanding standard under the Eighth Amendment, a reasonable jury 

could not find for McDaniel on either theory.

A. Legal Standard

The Eighth Amendment prohibits “cruel and unusual 

punishment” of a prisoner. It is well established that a prison 

official’s “deliberate indifference” to a prisoner’s “serious 

medical needs” violates that mandate. Farmer, 511 U.S. at 835 

(internal quotation omitted); Perez v. Fenoglio, 792 F.3d 768, 

776 (7th Cir. 2015). To support a claim of deliberate indifference, McDaniel needed to offer evidence that (1) he had an 

objectively serious medical condition, and (2) Dr. Syed acted 

with deliberate indifference to that condition. See Petties v. 
44 No. 20-2946 

Carter, 836 F.3d 722, 728 (7th Cir. 2016) (en banc). Dr. Syed 

disputes only the second element.

Deliberate indifference depends on the defendant’s “subjective state of mind.” Id. The question is whether McDaniel 

provided evidence to support a finding that Dr. Syed “actually

knew of and disregarded a substantial risk of harm.” Id. (emphasis in original); see also Farmer, 511 U.S. at 837 (“[T]he official must both be aware of facts from which the inference 

could be drawn that a substantial risk of serious harm exists, 

and he must also draw the inference.”). Negligence or even 

objective recklessness—the “fail[ure] to act in the face of an 

unjustifiably high risk that is so obvious that it should be 

known”—is not enough to satisfy that standard. Petties, 836 

F.3d at 728 (emphasis in original). 

Under the Eighth Amendment, a medical professional 

who has treated a prisoner “is entitled to deference in treatment decisions unless no minimally competent professional 

would have so responded under those circumstances.” Campbell v. Kallas, 936 F.3d 536, 545 (7th Cir. 2019), quoting Sain v. 

Wood, 512 F.3d 886, 894–95 (7th Cir. 2008) (internal quotation 

omitted). To violate the Eighth Amendment, a treatment decision must be “such a substantial departure from accepted 

professional judgment, practice, or standards, as to demonstrate that the person responsible actually did not base the decision on such a judgment.” Sain, 512 F.3d at 895, quoting Collignon v. Milwaukee County, 163 F.3d 982, 988 (7th Cir. 1998). 

Equally important, however, the “receipt of some medical care 

does not automatically defeat a claim of deliberate indifference if a fact finder could infer the treatment was ‘so blatantly 

inappropriate as to evidence intentional mistreatment likely 

to seriously aggravate’ a medical condition.” Edwards v. 
No. 20-2946 45

Snyder, 478 F.3d 827, 831 (7th Cir. 2007), quoting Snipes v. DeTella, 95 F.3d 586, 592 (7th Cir. 1996); see also Arnett v. Webster, 

658 F.3d 742, 751 (7th Cir. 2011) (“a prisoner [does not] need 

to show that he was literally ignored”). 

B. Disagreement with Specialists

McDaniel first asserts that Dr. Syed was deliberately indifferent to his serious medical needs by acting contrary to the 

recommendations of outside specialists. Deliberate indifference can occur when a prison official acts contrary to the recommendations of specialists for non-medical reasons. See Perez, 792 F.3d at 778 (collecting cases). That is not what occurred here. The undisputed evidence shows that Dr. Syed’s 

actions were based on “his own legitimate medical judgment[s].” Id. at 779; see Estate of Cole v. Fromm, 94 F.3d 254, 261 

(7th Cir. 1996) (“Mere differences of opinion among medical 

personnel regarding a patient’s appropriate treatment do not 

give rise to deliberate indifference.”). McDaniel has not offered evidence that the care he received was “blatantly inappropriate” or that Dr. Syed’s decisions were “substantial departures from accepted professional judgment, practice, or 

standards.”

Take the no-stairs issue first. Dr. Syed agreed to discontinue McDaniel’s no-stairs restriction after a physical therapist made that recommendation shortly after McDaniel arrived at Columbia. McDaniel argues that by including certain 

restrictions in the post-operative instructions (which preceded his transfer), the spinal surgeon effectively recommended that he live in a unit that would not require him to 

go up and down stairs routinely. McDaniel contended that a 

reasonable jury could find that Dr. Syed was deliberately 
46 No. 20-2946 

indifferent to his medical needs by acting against that supposed recommendation.

There are several problems with this argument. First, it is 

not clear that the post-operative instructions support McDaniel’s position. He points to the instruction that said he should 

lift no more than five to ten pounds. McDaniel asserted under 

penalty of perjury that his walker weighed twenty-five 

pounds (recall it had four wheels and an attached chair). But 

for this argument to have traction, Dr. Syed would have 

needed to have been aware of that weight and to have understood that McDaniel needed to use the walker to go up and 

down stairs, requiring him to lift more than ten pounds each 

time. (Recall that as part of the evaluation, the physical therapist had McDaniel walk up and down six stairs without the 

aid of a walker, which he did successfully. Dr. Syed consulted 

these notes in changing McDaniel’s restrictions.) Putting 

those evidentiary holes aside, the post-operative instructions 

also said that McDaniel may “climb stairs.” A reasonable jury 

could not find that Dr. Syed acted with deliberate indifference 

to McDaniel’s serious medical needs by agreeing with the spinal surgeon’s suggestion that McDaniel could “climb stairs.” 

Next, consider the recommendation by the outside pain 

specialist that McDaniel live in a cell without a top bunk. 

McDaniel contends that the top bunk exacerbated his pain because he would often hit his head on the bunk due to his limited mobility in his back and that his cellmate would sometimes hit him getting in and out of bed. When McDaniel complained of these issues to the Health Services Unit, staff members were not able to corroborate his complaints. Dr. Syed assessed McDaniel’s condition and did not believe that a notop-bunk restriction was medically necessary. McDaniel has 
No. 20-2946 47

not offered evidence that Dr. Syed’s conclusion was a substantial departure from acceptable professional standards, even if 

it did conflict with the outside pain specialist’s recommendation. Holloway v. Delaware County Sheriff, 700 F.3d 1063, 1074 

(7th Cir. 2012) (“[T]he prison physician, as the [prisoner’s] acting primary care doctor, is free to make his own, independent 

medical determination as to the necessity of certain treatments or medications, so long as the determination is based 

on the physician’s professional judgment and does not go 

against accepted professional standards.”).

Finally, McDaniel points to the recommendation by the 

nephrologist that he live in a single-occupancy wet cell to aid 

in his timed voiding. At an appointment a few months into his 

stay at Columbia, McDaniel told Dr. Syed that he had issues 

with “fecal incontinence” and that he had “problems [with] 

cell[mate] when defecating.” Dr. Syed did not change McDaniel’s cell assignment. Then, a nephrologist visited McDaniel 

twice and concluded that a single-occupancy wet cell would 

help treat his incontinence issues. Dr. Syed, however, continued the same course of treatment: diapers and a double-occupancy cell with a toilet. Other Health Services staff agreed 

with Dr. Syed that McDaniel’s cell assignment did not need to 

change. 

McDaniel has again failed to introduce a disputed fact that 

Dr. Syed’s decision was devoid of medical judgment or to 

show that the prison was required to adopt the nephrologist’s 

recommendation. Deliberate indifference is a demanding 

standard, and McDaniel did not offer evidence that Dr. Syed’s 

decision to keep his treatment the same was a substantial departure from acceptable professional standards. Snipes, 95 

F.3d at 592 (“[T]he Constitution is not a medical code that 
48 No. 20-2946 

mandates specific medical treatment.”). The recommendations by the nephrologist do not support such a conclusion on 

their own. See Reck v. Wexford Health Sources, Inc., 27 F.4th 473, 

484–85 (7th Cir. 2022) (disagreement among physicians did 

not, without more, establish reckless disregard for patient 

harm and pain required for constitutional violation).

C. Pain Treatment

McDaniel also asserted that a reasonable jury could find 

that Dr. Syed was deliberately indifferent to his pain. We disagree. “[T]he Eighth Amendment does not entitle incarcerated patients to their preferred pain medication, nor does it 

impose the unrealistic requirement that doctors keep patients 

completely pain-free.” Arce v. Wexford Health Sources Inc., 75 

F.4th 673, 681 (7th Cir. 2023) (internal citations omitted).

In response to McDaniel’s complaints of pain early in his 

stay at the Columbia Correctional Institution, Dr. Syed referred him to the Waupun Memorial Hospital pain clinic. He 

also prescribed McDaniel new medications to help address 

his pain. Later, Dr. Syed assessed McDaniel, concluded that 

he was likely engaging in “attention-seeking and drug-seeking behavior,” and refused to change his medications. Dr. 

Syed said that his conclusion was based on his medical assessment, a past cardiac work-up, and how McDaniel presented 

himself during their interaction. “The administration of pain 

killers requires medical expertise and judgment. Using them 

entails risks that doctors must consider in light of the benefits.” Snipes, 95 F.3d at 591. 

McDaniel has again not offered evidence that Dr. Syed’s 

decision constituted a substantial departure from acceptable 

professional standards or that the treatment he did receive 
No. 20-2946 49

was “‘so blatantly inappropriate as to evidence intentional 

mistreatment likely to seriously aggravate’ his condition.” 

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

Snipes, 95 F.3d at 592; see also Lee v. Young, 533 F.3d 505, 511 

(7th Cir. 2008) (“Prison officials are expected to act responsibly under the circumstances that confront them but are not 

required to act flawlessly.” (internal quotation omitted)). That 

strikes us as especially true when other staff members in the 

Health Services Unit came to similar conclusions regarding 

McDaniel’s care. Cf. Pyles v. Fahim, 771 F.3d 403, 411 (7th Cir. 

2014) (doctor not deliberately indifferent when decision to 

forgo MRI was “implicitly endorsed by every other doctor 

who examined [the plaintiff]”).

* * * 

The district court’s grant of summary judgment for the Department on McDaniel’s ADA and Rehabilitation Act failureto-accommodate claim based on the denial of a no-stairs unit 

at the Columbia Correctional Institution is REVERSED. In all 

other respects the judgment of the district court is 

AFFIRMED, and the case is REMANDED for proceedings 

consistent with this opinion. 
50 No. 20-2946 

BRENNAN, Circuit Judge, concurring in part and dissenting 

in part. My colleagues and I agree that the defendants are entitled to summary judgment on most of Carl McDaniel’s case. 

We part ways on his claim under Section 504 of the Rehabilitation Act, as applied to the denial of his placement in a nostair unit during his incarceration at Columbia Correctional 

Institution. Because review is limited to the evidence that was 

properly before the district court, I would affirm the district 

court’s grant of summary judgment to the defendants in full.

The district court correctly concluded that McDaniel’s 

submissions disregarded the local rules. McDaniel did not 

even try to identify the evidence on which he now relies for

his claim to be housed in a no-stair unit. The district court declined to scour the record. Instead, it considered McDaniel’s 

responses to the defendants’ proposed facts and his own proposed facts only when they complied with the local rules. 

That decision was a matter within the district court’s sound

discretion.

I 

A. Civil Local Rule 56 – Summary Judgment

Under our case law, district courts have broad discretion 

to compel compliance with their local rules governing summary judgment proceedings. These rules serve a crucial function for district judges, who face the difficult task of managing 

and prioritizing hundreds of cases and thousands of motions. 

In particular, the local rules on summary judgment require a 

party to direct the judge to the portions of the record that support the party’s factual assertions or its opposition to those of 

its counterparty. Hinterberger v. City of Indianapolis, 966 F.3d 

523, 529 (7th Cir. 2020). “The rules of each district court 
No. 20-2946 51

structuring the summary-judgment process cannot serve their 

function if parties can later go to the court of appeals and secure a reversal based on evidence the district judge may not 

have known was present.” Johnson v. Cambridge Indus., Inc., 

325 F.3d 892, 898 (7th Cir. 2003). 

In the Eastern District of Wisconsin, a party moving for 

summary judgment must file a statement of proposed material facts. Civil Local Rule 56(b)(1)(C). Each fact must be contained within its own separate, numbered paragraph. Id. The 

party opposing summary judgment must reproduce each 

numbered paragraph in the moving party’s statement. Civil 

Local Rule 56(b)(2)(B). For any disagreement, the nonmovant 

must submit “specific references to the affidavits, declarations, parts of the record, and other supporting materials relied upon.” Id. The nonmoving party also must file “a statement, consisting of short numbered paragraphs, of any additional facts that require the denial of summary judgment, including references to the affidavits, declarations, parts of the 

record, and other supporting materials relied upon to support 

the facts described in that paragraph.” Civil Local Rule 

56(b)(2)(B).1 

Time and again, we have recognized that district courts 

“may require strict compliance with their local rules.” Hinterberger, 966 F.3d at 528; see also Ammons v. Aramark Unif. Servs., 

1 The current iteration of Civil Local Rule 56 has been in effect since 

2010. This court has upheld the enforcement of earlier versions of the rule, 

which date back decades. See Huey v. United Parcel Serv., Inc., 165 F.3d 1084, 

1085 (7th Cir. 1999) (upholding then-Civil Local Rule 6.05, which required 

the submission of specific evidentiary materials to dispute particular facts 

at summary judgment); Kunik v. Racine Cnty., Wis., 106 F.3d 168, 171, 174 

(7th Cir. 1997) (same).
52 No. 20-2946

Inc., 368 F.3d 809, 817 (7th Cir. 2004). When a district court 

decides that a litigant has violated those rules, we review that 

decision solely for abuse of discretion. Cichon v. Exelon Generation Co., 401 F.3d 803, 808–09 (7th Cir. 2005) (considering 

Northern District of Illinois Local Rule 56.1, closely analogous 

to the Eastern District of Wisconsin local rule here). And we 

have repeatedly stressed that district courts may decline to 

consider the noncompliant portions of submissions. “[A] 

court does not abuse its discretion when it opts to disregard 

facts presented in a manner inconsistent with the rules.” Fabriko Acquisition Corp. v. Prokos, 536 F.3d 605, 607–08 (7th Cir. 

2008) (upholding district court decision under predecessor 

E.D. of Wis. Civil Local Rule 56.2(b) to limit factual record 

when litigant failed to specify citations to evidentiary materials). 

Contrary to McDaniel’s arguments, requiring adherence 

to local rules is not empty formalism. Rather, it is essential to 

the proper functioning of the district courts. Johnson, 325 F.3d 

at 898. In our adversarial system of litigation, the parties have 

the duty to identify “what facts are truly disputed and may 

require resolution at a trial.” Hinterberger, 966 F.3d at 529. A 

district court has no such duty. Id. 

B. McDaniel’s Noncompliance

The defendants followed the local rule by submitting a 93-

paragraph statement of proposed material facts. McDaniel’s

responses to those proposed facts failed to comply with the 

local rule. Few, if any, of McDaniel’s responses cited affidavits, declarations, or specific portions of the record. Many responses contain no citation, while some list a vague authority 

such as “policy.” That falls short under our case law. See 

McKinney v. Off. of Sheriff of Whitley Cnty., 866 F.3d 803, 808–
No. 20-2946 53

09 (7th Cir. 2017); Ammons, 368 F.3d at 817–18 (stating that a

denial “must include a specific reference to the affidavit or 

other part of the record. ... Citations to an entire transcript of 

a deposition or to a lengthy exhibit are not specific and are, 

accordingly, inappropriate.”). 

Even in the few places where McDaniel’s responses appear to reference specific documents, the responses do not tell 

the district court where to find those documents. Several of 

McDaniel’s responses also improperly contain legal arguments. Many times, we have held that such responses violate 

local rules on summary judgment. See Hinterberger, 966 F.3d 

at 528–29; Curtis v. Costco Wholesale Corp., 807 F.3d 215, 219 

(7th Cir. 2015); FTC v. Bay Area Bus. Council, Inc., 423 F.3d 627, 

634 (7th Cir. 2005); Smith v. Lamz, 321 F.3d 680, 683 (7th Cir. 

2003); Bordelon v. Chicago Sch. Reform Bd. of Trs., 233 F.3d 524, 

528–29 (7th Cir. 2000). 

McDaniel’s statement of additional material facts was also 

deficient. His submission includes some citations to documents in the record, but for the most part it does not contain 

facts, and instead quotes legal arguments made in the parties’ 

briefs. 

McDaniel points to two cases to argue that the district 

court should excuse his noncompliance, but neither is analogous. In Sojka v. Bovis Lend Lease, Inc., 686 F.3d 394 (7th Cir. 

2012), it was an abuse of discretion for the district court to refuse to consider evidence just because it was included in the

nonmovant’s statement of material facts but not in his accompanying memorandum of law. 686 F.3d at 397. There, the nonmovant “did not make the district court scour the record; he 

followed [the local rule] ... and brought to the district court’s 

attention the evidence in the record supporting his opposition 
54 No. 20-2946

to summary judgment.” Id. at 398. Here, though, McDaniel 

would have the district court search the record, and he did not 

follow Civil Local Rule 56(b)(2)(B). Sojka therefore does not 

help McDaniel.

Likewise, in McKinney, this court ruled that a district court 

abused its discretion by disregarding the “specific guidance” 

as to pertinent record evidence that the nonmovant provided 

at summary judgment. 866 F.3d at 808. There, the nonmovant 

provided the district court with “a detailed and organized 

guide to [the] evidence supporting his assertions of disputed 

facts and his legal arguments.” Id. at 809. McDaniel provided 

no such detailed and organized guide, so the district court 

was within its discretion to disregard evidence that was not 

identified in compliance with the local rule.

Per McDaniel, the district court lacked discretion to enforce the local rule against him for two other reasons. The first 

is that McDaniel represented himself before the district court. 

The second concerns the district court permitting him to respond to the defendants’ statement of material facts by submitting an affidavit or unsworn declaration. 

Neither reason is persuasive. First, given the procedural 

history here, McDaniel was not entitled to special solicitude 

because he litigated pro se. The district court recruited an experienced, knowledgeable attorney to assist McDaniel with 

prosecuting his claims. But McDaniel became dissatisfied 

with his attorney’s legal strategy, and he asked the court to 

terminate his services. The attorney therefore withdrew. 

McDaniel chose to litigate pro se, so he cannot use that status 

to claim an entitlement to disregard the district court’s local 

rules. In any event, pro se litigants are not excused from complying with procedural rules, Pearle Vision, Inc. v. Romm, 541 
No. 20-2946 55

F.3d 751, 758 (7th Cir. 2008), or court orders. DJM Logistics, 

Inc. v. FedEx Ground Package Sys., Inc., 39 F.4th 408, 415 (7th 

Cir. 2022). That principle applies to rules governing summary 

judgment. Zoretic v. Darge, 832 F.3d 639, 641 (7th Cir. 2016)

(citing Greer v. Bd. of Educ., 267 F.3d 723, 727 (7th Cir. 2001)). 

Second, the district court did not coax McDaniel into noncompliance with Civil Local Rule 56. To the contrary, the

court advised him in a plain language Notice and Order that 

he “must support every disagreement with a proposed fact by 

citing to evidence.” As McDaniel notes, the court allowed him 

to do so “by relying on documents that he attaches to his response or by telling the court his version of what happened in 

an affidavit or an unsworn declaration under 28 U.S.C. 

§ 1746.” But nothing in the court’s Notice and Order excused 

McDaniel from providing “a detailed and organized guide to 

[the] evidence supporting his assertions of disputed facts and 

his legal arguments.” McKinney, 866 F.3d at 809. McDaniel did 

not meet that standard. So, the district court was within its 

discretion to decide the summary judgment motion without 

first sifting through this case’s extensive record to try to locate

and examine evidence that McDaniel failed to identify or respond to. 

C. The Majority Opinion’s View of the Facts

My colleagues conclude that the district court went too far 

with respect to one fact—that McDaniel missed meals because 

he was not assigned to a no-stairs unit. Because McDaniel

signed all his summary judgment submissions under penalty 

of perjury, the majority opinion concludes that they provide 

a factual record that satisfies the applicable federal and local 

rules. Then the majority opinion pulls statements about the 
56 No. 20-2946

meals missed from McDaniel’s submissions, citing them as 

the evidence that survives summary judgment.

On review, though, the selected quotes from McDaniel’s 

filings repeated in the majority opinion do not qualify as facts 

defeating summary judgment. All but one relate to claims different than his placement in a no-stairs unit.2 The only statement the majority opinion cites that is connected to McDaniel’s Rehabilitation Act claim3 still violates Civil Local Rule 

56(b)(2)(B) by failing to be a concise response to the movant’s 

statement of facts that specifies references to the record relied 

upon.

2 McDaniel’s statement that he was “missing [h]undreds of state 

meals” is in R. 178 ¶ 46, his response to defendants’ proposed findings of 

fact concerning his claim not to have a top bunk. 

McDaniel’s statement that the prison “denied [me] over 600 state 

meals” is in R. 179, his response to the declaration of Dr. Salam Syed, who 

played no role in McDaniel’s ADA/Rehabilitation Act claim. This statement was in response to ¶ 26 of Dr. Syed’s declaration about McDaniel’s 

medications, not his request to be assigned to a no-stairs unit. 

And McDaniel’s statements that he “missed over 600 state meals in 

less than a year because of severe pain” and “Defendants were all aware 

of the ongoing constitutional violations of the [o]ver 600 ... state meals” 

are from R. 177, his “Reply to Defense Argument,” at pp. 10 and 12 of that 

filing, in its section concerning his conditions of confinement claim, not 

his Rehabilitation Act claim.

3 McDaniel’s statement that “[m]issing over 600 state meals because 

of severe unrelenting pain and being fed by modifying a program, which 

defendants never did, is not a comfort consideration, it is a “Life-Giving” 

requirement of the defendants” is from R. 177, his “Reply to Defense Argument,” at p. 10 of that filing, in its section concerning his Rehabilitation 

Act claim.
No. 20-2946 57

The irony, of course, is that by not upholding the local 

rule, we are left performing the very task that rule is supposed 

to preclude—combing the record for statements and considering them as evidence on a dispositive motion.

A district court cannot ignore facts brought to its attention. 

But under the federal and local rules, parties must properly 

present the factual record for the court to resolve a summary 

judgment motion. This sorting function of parties identifying 

evidence for the court on a dispositive motion is critical. It 

forms the backbone of all the case law discussed above. It is 

not overly formalistic to ask that this requirement be complied with, something McDaniel failed to do. He certainly did 

not provide “a detailed and organized guide to [the] evidence 

supporting his assertions of disputed facts and his legal arguments,” McKinney, 866 F.3d at 809, as this court requires. 

My colleagues conclude that the declarations McDaniel 

added to each of his submissions rendered his missing-meals 

statement admissible evidence that precludes summary judgment on his no-stairs claim. Yet that conclusion fails to recognize the sorting function of the local rule. That rule’s point is 

to focus the district court and the litigants on admissible evidence pertinent to the dispositive motion. If declarations can 

bootstrap into evidence all of a pro se litigant’s submissions, 

the local rule is undermined. 

Unlike my colleagues, I do not see the district court misapprehending that his declaration must itself incorporate affidavits, or that court failing to appreciate that McDaniel 

could rely on his own declaration. If the court did believe either of those things, it would not have worded the Notice and 

Order in the disjunctive: 
58 No. 20-2946

McDaniel must support every disagreement 

with a proposed fact by citing to evidence. He 

can do that by relying on documents that he attaches to his response or by telling the court his 

version of what happened in an affidavit or an 

unsworn declaration ... .

(emphasis supplied).

The majority opinion also criticizes the district court for 

holding McDaniel to an “unwritten requirement” by considering his submissions only to the extent they complied with 

the local rule. But this critique shifts from the litigant to the 

court the local rule’s requirement to enumerate the applicable 

evidence. To demand more from the district court—per the 

majority, to “specify[] further the failures or the affected portions of plaintiff’s submissions”—reads into the local rule an 

obligation that is not there. Failing to take a step that the local 

rule does not call for is not an abuse of discretion.

Beyond McDaniel’s failure to affirmatively offer evidence 

to defeat summary judgment, he also failed to adequately 

contest several proposed factual findings which doom the nostair-unit theory of his Rehabilitation Act claim. Most pertinent are three findings proposed by the defendants: 

• A physical therapist at Columbia evaluated 

McDaniel’s mobility in January 2018. During 

that assessment, McDaniel managed to ascend and descend six stairs, and the physical 

therapist decided he was safe to ambulate 

stairs. McDaniel agreed with that finding, 

though he argued that the physical therapist 

did not sufficiently account for safety. 
No. 20-2946 59

• Michael Fink, a Corrections Unit Supervisor 

at Columbia, observed McDaniel successfully climbing the stairs more than once to 

report concerns. Again, McDaniel agreed

this was true. His response referenced “the 

multiple times [he] did have to use stairs.” 

• McDaniel was “encouraged to get out of his 

cell for meals and use his cane for the stairs 

because muscle atrophy from lack of movement could result in the inability to walk in 

the future.” For support, the defendants 

cited the declaration of Dr. Syed, a physician 

at Columbia who oversaw McDaniel’s treatment and evaluated him several times.

McDaniel failed to even acknowledge this 

proposed finding, declining to offer any response. 

Because McDaniel did not competently dispute any of these 

facts, the district court was within its discretion to treat them

as admitted. See Fabriko Acquisition Corp., 536 F.3d at 607–08; 

Cichon, 401 F.3d at 809–10. 

II

I turn now to the substance of McDaniel’s claim under Section 504 of the Rehabilitation Act. By the statute’s terms, “[n]o 

otherwise qualified individual with a disability ... shall, 

solely by reason of her or his disability, be excluded from the 

participation in, be denied the benefits of, or be subjected to 

discrimination under any program or activity receiving Federal financial assistance.” 29 U.S.C. § 794(a). The analysis is 

the same that applies to a claim under the Americans with 
60 No. 20-2946

Disabilities Act (“ADA”). Jaros v. Ill. Dep’t of Corr., 684 F.3d 

667, 671 (7th Cir. 2012). To recover, McDaniel must prove that 

“(1) he is a qualified person (2) with a disability and (3) the 

Department of Corrections denied him access to a program or 

activity because of his disability.” Id. at 672. 

The dispute here is over the third element—whether 

McDaniel was denied access to a program or activity because 

of his disability. The meals that prisons make available to inmates qualify as programs or activities under the statute. Id. 

So, the question is whether a reasonable jury could find that 

McDaniel was denied access to meals. Under Section 504, refusing to make reasonable accommodations amounts to denying access, id., but only when the result is that the qualified 

person cannot access programs or activities at all. Wagoner v. 

Lemmon, 778 F.3d 586, 593 (7th Cir. 2015); see also Hildreth v. 

Butler, 960 F.3d 420, 431 (7th Cir. 2020) (applying this principle 

in the identical ADA context). A prison’s institutional prerogatives factor into whether an accommodation is considered 

reasonable. Hildreth, 960 F.3d at 431 (citing Love v. Westville 

Corr. Ctr., 103 F.3d 558, 560 (7th Cir. 1996)). 

Considering only the facts properly before the district 

court, it knew that both the physical therapist and Fink observed McDaniel safely ambulate stairs. The court also knew 

that McDaniel was given a rationale, which was based on 

medical judgment, for why his placement in a no-stair unit 

would not have been benefited his long-term health. Taken 

together, these facts show the absence of a genuine dispute of 

material fact as to whether McDaniel required a no-stair unit

to access meals. The burden therefore shifts to McDaniel, the 

nonmoving party, to provide evidence of specific facts creating a genuine dispute of material fact and thus precluding 
No. 20-2946 61

summary judgment. See Cincinnati Life Ins. Co. v. Beyrer, 722 

F.3d 939, 951 (7th Cir. 2013); Carroll v. Lynch, 698 F.3d 561, 564 

(7th Cir. 2012). 

Under the facts as described supra section I, McDaniel did 

not cite any such evidence to the district court. On appeal, he 

relies on two portions of his deposition testimony. In the first, 

McDaniel testified he did not attend programs and activities 

at Columbia because it was “too painful” for him to walk up 

the stairs. And in the second, McDaniel stated he could not 

get up and down the stairs without assistance from other inmates. 

Before the district court, though, McDaniel did not identify these passages. They are not mentioned in his responses 

to the defendants’ proposed findings of fact, his own statement of undisputed facts, or his summary judgment brief. 

McDaniel did not even cite his deposition more generally, 

though that would have been insufficient. See McKinney, 866 

F.3d at 808–09; Ammons, 368 F.3d at 817–18. Only by 

“scour[ing] the record,” Sojka, 686 F.3d at 398, and “doing the 

work for” McDaniel by “identifying what facts [were] truly 

disputed,” Hinterberger, 966 F.3d at 529, could the district 

court have located these portions of his deposition and analyzed their import. As noted earlier, that goes beyond what is 

required of district courts and of this court on appeal. 

As discussed above, McDaniel was observed successfully 

using the stairs at Columbia more than once. Placement in a 

no-stair unit also would have been contrary to the medical 

judgment of trained professionals. The other accommodations McDaniel was given, including the cane that he was directed to use when climbing stairs, were reasonable because 

they permitted him to access meals and activities while also 
62 No. 20-2946

accounting for other considerations. See Hildreth, 960 F.3d at 

431 (reaching this conclusion about a different accommodation in the prison context). 

These facts make the disposition of the no-stair theory of 

McDaniel’s Rehabilitation Act claim straightforward. Recall 

that to recover, McDaniel has to prove that a no-stair unit was 

a reasonable accommodation, the absence of which denied 

him access to programs or activities. Jaros, 684 F.3d at 672. The 

refusal to adopt a specific accommodation requested by a 

prisoner is not a denial of access unless the prisoner cannot 

use the program or participate in the activity. Wagoner, 778 

F.3d at 593. This is so even if the requested accommodation 

would significantly ease the inconvenience to the prisoner. Id. 

* * *

Based on the facts properly before the district court, placement in a no-stair unit would not have been necessary for 

McDaniel to get his meals because he could safely use the 

stairs. No reasonable jury could conclude that the Wisconsin 

Department of Corrections violated the Rehabilitation Act 

when it declined to place McDaniel in a no-stair unit. I therefore respectfully concur in part and dissent in part.