IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF INDIANA

SOUTH BEND DIVISION

FREDERICK C. CASHNER, )

)

Plaintiff, )

)

vs. ) CAUSE NO. 3:14-CV-1641

)

JOHN J. WIDUP, et al., )

)

Defendants. )

OPINION AND ORDER

This matter is before the Court on: (1) Defendant John

Widup’s Motion for Summary Judgment (DE #64); and (2) Defendants

Dr. Al-Shami and Kimberly White’s Motion for Summary Judgment (DE

#66), both filed on March 28, 2016. For these reasons the Court:

(1) GRANTS the defendants’ motions for summary judgment (DE 

 ##64, 66);

(2) DISMISSES with prejudice Plaintiff’s federal claims;

(3) DISMISSES without prejudice Plaintiff’s state law 

 claims; and

(4) ORDERS the clerk to enter judgment in favor of the 

 defendants consistent with this order and close this 

 case.

BACKGROUND

Frederick C. Cashner, a pro se prisoner, is proceeding in

this case against Dr. Nadir Al-Shami, Nurse Kimberly White, and

Warden John J. Widup1 for denying him proper medical treatment

1 In their individual capacities for monetary damages. (DE #1 at 5.)
for chronic headaches while he was a pretrial detainee at the

Porter County Jail between March 2011 to February 2013. He

concedes that he received treatment for chronic headaches, but

complains that the treatment provided was not effective. 

In his motion for summary judgment, Warden Widup argues that

he had no personal involvement in Cashner’s medical care and,

therefore, the claims against him must be dismissed. In the

medical defendants’ motion for summary judgment, Dr. Al-Shami and

Nurse White argue that the medical care rendered to Cashner was

adequate and within the applicable standard of care. Cashner was

provided with a “Notice of Summary Judgment Motion” as required

by N.D. Ind. L.R. 56-1 and a copy of both Federal Rule of Civil

Procedure 56 and Local Rule 56-1. (DE ##63, 69.) That notice

clearly informed him that unless he disputed the facts presented

by the defendant, the court could accept those facts as true. 

Fed. R. Civ. P. 56(e) (“If a party . . . fails to properly

address another party’s assertion of fact . . . the court may . .

. consider the fact undisputed for purposes of the motion.”). It

also told him that unless he submitted evidence creating a

factual dispute, he could lose this case. Fed. R. Civ. P. 56(a)

(“The court shall grant summary judgment if the movant shows that

there is no genuine dispute as to any material fact and the

movant is entitled to judgment as a matter of law.”). Cashner has

filed his response.

2
DISCUSSION

Summary Judgment Standard

Summary judgment must be granted when “there is no genuine

dispute as to any material fact and the movant is entitled to

judgment as a matter of law.” FED. R. CIV. P. 56(a). A genuine

dispute of material fact exists when “the evidence is such that a

reasonable jury could return a verdict for the nonmoving party.”

Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). Not

every dispute between the parties makes summary judgment

inappropriate; “[o]nly disputes over facts that might affect the

outcome of the suit under the governing law will properly

preclude the entry of summary judgment.” Id. In determining

whether summary judgment is appropriate, the deciding court must

construe all facts in the light most favorable to the non-moving

party and draw all reasonable inferences in that party’s favor.

Ogden v. Atterholt, 606 F.3d 355, 358 (7th Cir. 2010). “However,

our favor toward the nonmoving party does not extend to drawing

inferences that are supported by only speculation or conjecture.” 

Fitzgerald v. Santoro, 707 F.3d 725, 730 (7th Cir. 2013) (citing

Harper v. C.R. Eng., Inc., 687 F.3d 297, 306 (7th Cir. 2012)).

Facts

On April 25, 2011, Cashner was booked into the Porter County

Jail. (DE #68-2 at 3.) At this time, Advance Correctional

3
Healthcare (“ACH”) provided inmate medical services at the jail.

(DE #65-1.) Between April 2011 and December 31, 2012, Registered

Nurse Kimberly White and several other nurses were assigned to

work at the jail. (DE #65-2 ¶ 4; DE #68-1 ¶ 2.) In addition, Dr.

Nadir Al-Shami and two other physicians were assigned to work

there. (Id.) During his incarceration, John Widup was the Warden

of the Porter County Jail. (DE #65-2 ¶ 3.) He was charged with

overseeing general day-to-day operations. (Id.) He typically

deferred to the jail’s medical staff for all inmate medical

matters. (Id. at ¶ 6.)

Cashner’s medical history at the jail is lengthy, welldocumented and largely undisputed. On August 13, 2011, Cashner

submitted a Medical Request Form, complaining that he had been

having headaches every day. (DE #68-4 at 174.) Cashner reported

that the headaches began after he was taken off his blood

pressure medication and that Ibuprofen was not relieving the

headaches. (Id.) Dr. John Collier examined Cashner on August 16,

2011, and diagnosed him with headaches with hypertension and

prescribed Tylenol. (DE #68-2 at 17.) Dr. Collier also ordered

medical staff to monitor Cashner’s blood pressure and headache

patterns. (Id.) On August 23, 2011, Dr. Wes Harmston examined

Cashner. (Ex. #68-2 at 18.) Cashner reported migraines that

occurred first thing in the morning. (Id.) Dr. Harmston continued

4
the Tylenol prescription and ordered Cashner to avoid caffeine

and carefully observe his head position. (Id.)

 On September 2, 2011, Cashner submitted a Medical Request

Form indicating that his headaches were continuing. (DE #68-4 at

173.) Cashner requested a re-examination of his headaches, which

had worsened since his Tylenol had been reduced to once daily.

(Id.) On September 6, 2011, Dr. Harmston reviewed Cashner’s

medical chart and prescribed Tylenol twice daily. (Id. at 141.)

On September 7, 2011, Cashner submitted a Medical Request Form

indicating that he would like to speak with Kimberly House about

his ongoing medical problems. (Id. at 172; DE 68-1 ¶ 7.) On

September 8, 2011, Nurse White responded that she would place

Cashner on the list to see the doctor, and she also offered daily

nursing services by the nurse on duty. (Id.) On September 13,

2011, Dr. Harmston examined Cashner, where he reported persistent

headaches, unchanged on his prescribed regimen of Tylenol. (DE

#68-2 at 19.) Dr. Harmston indicated that he would refer Cashner

to a neurologist for his migraine headaches. (Id.) Dr. Harmston

also prescribed a stronger dose of Tylenol as needed and Naprosyn

as needed. (Id.) On September 14, 2011, Nurse White spoke with

Dr. Harmston, and Dr. Harmston indicated that Cashner’s neurology

consultation would be discontinued and that Dr. Harmston would

re-evaluate Cashner on September 20, 2011. (DE #68-1 ¶ 8.) On

September 16, 2011, Nurse White spoke with Cashner and informed

5
him of Dr. Harmston’s decision to discontinue Cashner’s neurology

consult and to instead re-evaluate Cashner on September 20, 2011.

(DE #68-3 at 140; DE #68-1 ¶ 9.) During this conversation,

Cashner indicated that his new medication was helping with his

headaches. (Id.) Cashner also indicated that he had experienced

chronic headaches approximately 10 years prior due to a problem

with his cervical spine. (Id.)

On September 20, 2011, Dr. Harmston re-evaluated Cashner.

(DE #68-2 at 20.) Cashner reported chronic headaches for the past

month. (Id.) Cashner also reported a photophobia caused by a pain

in his neck that radiated to the back of his head. (Id.) Dr.

Harmston diagnosed migraine headaches versus tension-related

headaches. (Id.) Dr. Harmston prescribed Fioricet as needed for

14 days and Flexeril 10 mg for 14 days. (Id.) On September 21,

2011, Nurse White spoke with Cashner to inform him that, because

Dr. Harmston had prescribed certain medications (Flexeril and

Fioricet), Warden John Widup wanted Cashner moved to medical

isolation. (DE #68-3 at 139; DE #68-1 ¶ 10.) Cashner refused to

be moved to medical isolation and stated, “I’m not going to move

where there is no TV.” (Id.) Nurse White educated Cashner

regarding his recurrent headaches and the need to take his

medications as prescribed. (Id.) On September 25, 2011, Cashner

submitted a Medical Request Form asking to speak to the doctor

about his ongoing headaches and his treatments and prescriptions.

6
(DE #68-4 at 171.) On September 27, 2011, Dr. Harmston examined

Cashner, where he reported headaches, which had improved. (DE

#68-2 at 21.) Cashner also indicated that he did not want to be

confined to medical isolation, as he was claustrophobic. (Id.)

Cashner inquired whether Imitrex would be allowed in general

population. (Id.) On September 28, 2011, Nurse White responded

that Imitrex would be allowed if Cashner moved to medical

isolation for close observation, per Warden Widup. (DE #68-1 ¶

11.)

On October 2, 2011, Cashner submitted a Medical Request Form

asking to speak with the doctor about the change in his

prescription for his headaches. (DE #68-4 at 170.) October 10,

2011, Dawn Martin, L.P.N. examined Cashner. (DE #68-3 at 138.)

Cashner indicated that he was doing okay and had no complaints.

(Id.) Dr. Harmston examined Cashner later that day, where he

reported headaches, but indicated that his Imitrex prescription

had been helping. (DE #68-2 at 22.) Dr. Harmston prescribed

another round of the Butalbital and Flexeril regimen and

discontinued Tylenol. (Id.) On October 11, 2011, Nurse Martin

examined Cashner. (DE #68-3 at 138.) Cashner complained of not

receiving his medications 4 times daily, and Nurse Martin

explained the as-needed nature of his medications, i.e., if

Cashner did not complain of or have a headache, he would not

receive his medication. (Id.) On the morning of October 12, 2011,

7
Cashner again expressed his frustration over not receiving his

Fioricet every six 6 hours. (Id.) Nurse Walker informed Cashner

that his as-needed medications were only to be administered for

complaints of a significant headache. (Id.) Cashner continued to

insist that he should receive his medications on a set schedule,

and Nurse Walker again educated him on the parameters of his asneeded medications. (Id.) That night, Nurse Martin examined

Cashner, where he complained of headaches that were constant and

not relieved by his medications. (Id.) Nurse Martin administered

Cashner’s medications and discharged him to his housing unit.

(Id.) 

On the morning of October 13, 2011, Cashner reported to

nursing staff that his headache was worse than what it had been

previously. (DE #68-3 at 137.) Nursing staff administered

Cashner’s medications as prescribed. (Id.) That evening, Cashner

again reported to nursing staff that his headache had returned.

(Id.) Cashner indicated that he took Motrin in addition to his

prescription medications that morning. (Id.) Nurse Walker

explained to Cashner that his prescription medications were to be

administered on an as-needed basis and sent Cashner back to his

housing unit. (Id.) On the morning of October 14, 2011, Cashner

took his medications as prescribed, but indicated that his

medications were not working to relieve his headaches. (Id.)

Cashner requested to see a specialist and signed a Refusal Form

8
for his Flexeril and Fioricet. (Id.; DE #68-2 at 23.) Cashner

submitted a Medical Request Form indicating that the medication

prescribed by Dr. Harmston was not working and that his headaches

continued. (DE #68-4 at 169.) Cashner expressed that he would

like testing or treatment to determine the cause of his

headaches. (Id.) Nursing staff advised Cashner that he was

scheduled to see Dr. Harmston and returned Cashner to general

population. (DE #68-3 at 137.) 

On October 16, 2011, Cashner indicated to nursing staff that

he would like to restart his Flexeril and Fioricet. (DE #68-3 at

136.) Dr. Harmston prescribed Flexeril and Fioricet. (Id.)

Cashner later reported to nursing staff that he had a headache,

and nursing staff administered his medications. (Id.) On October

17, 2011, Nurse White and Warden Widup met with Cashner to

educate him on the meaning and purpose of his medications being

prescribed “as needed,” since he had previously complained that

his medications were not delivered on a set schedule. (DE #68-1 ¶

12; DE #65-2 ¶¶ 5, 9.) Cashner verbalized his understanding, and

Nurse White informed Dr. Harmston of the conversation and

education provided. (Id.) Dr. Harmston examined Cashner later

that day, where he reported continued headaches and expressed

concerns about his medications being administered as needed. (DE

#68-2 at 24.) Cashner told Dr. Harmston that he thought that he

needed his medications on a set schedule. (Id.) Dr. Harmston

9
altered Cashner’s medication regimen as follows: Butalbital twice

daily (instead of as needed); and Flexeril once daily for one 1

week. (Id.) Dr. Harmston also prescribed Naprosyn twice daily as

needed. (Id.) On October 18, 2011, Nurse Martin observed Cashner

in his cell listening to music on his headphones very loudly. (DE

#68-3 at 136.) Nurse Martin indicated that she could hear the

music while checking on other inmates in medical isolation. (Id.)

Cashner later reported to nursing staff that he had a headache.

(Id.) After examination, Cashner indicated that his headache was

much improved. (Id.) That same day, Dr. Harmston changed

Cashner’s Naprosyn prescription from 325 mg to 375 mg. (DE #68-3

at 134.) On October 19, 2011, Nurse Martin examined Cashner,

where he complained of a headache, but that it was much better

than before. (Id.) Nurse Martin administered Cashner’s

medications. (Id.) On October 20, 2011, Cashner told nursing

staff that his medication was working to alleviate his headaches.

Id. Cashner did express, however, that he wanted to discuss a

change of his medications and that he wanted out of medical

isolation. (Id.) On October 21, 2011, Nurse Martin examined

Cashner, where he reported a headache, but that it was much

better than before. (Id.)

On October 22, 2011, Cashner denied any headaches and told

nursing staff that his headache medications were working. (DE

#68-3 at 134.) On the morning of October 23, 2011, Cashner denied

10
any headaches and again indicated that his headaches had

dissipated since Dr. Harmston prescribed his most recent regimen

of medications. (Id.) Later that day, however, Cashner reported

to nursing staff that he had a headache and had taken Motrin to

try to ease his pain. (DE #68-3 at 133.) Cashner indicated that

the Motrin helped and that his headache went away. (Id.) Nurse

Walker observed Cashner listening to his headphones loudly. (Id.)

On October 24, 2011, Dr. Harmston examined Cashner. (DE #68-2 at

25.) Cashner indicated that he would like to take NSAIDs for his

headaches. (Id.) Dr. Harmston ordered continuous monitoring of

Cashner’s blood pressure and prescribed Naprosyn 875 mg twice

daily for 14 days. (Id.) Dr. Harmston discontinued Cashner’s

Ibuprofen and Flexeril and instructed Cashner to follow up in 2

weeks. (Id.) On October 31, 2011, Dr. Harmston again examined

Cashner and prescribed Propranolol and ordered Cashner’s Naprosyn

continued. (Id. at 26.) Dr. Harmston also ordered continuous

monitoring of Cashner’s blood pressure and instructed him to

return if his symptoms worsened. (Id.)

On November 14, 2011, Dr. Harmston examined Cashner. (Id. at

27.) Dr. Harmston found Cashner to have elevated blood pressure

and headaches. (Id.) Dr. Harmston also noted that Cashner had

been tolerating his Propranolol well. (Id.) Dr. Harmston

increased Cashner’s Propranolol to 80 mg twice daily to lower his

blood pressure. (Id.) Dr. Harmston also ordered Cashner’s

11
Naprosyn continued and that nursing staff monitor Cashner’s blood

pressure daily for 14 days. (Id.)

On December 1, 2011, Cashner submitted a Medical Request

Form requesting follow up regarding the recent change in his

blood pressure medication and to discuss his headaches that had

returned. (DE #68-4 at 168.) On December 5, 2011, Dr. Harmston

examined Cashner, where he complained of adverse side-effects to

his Propranolol. (DE #68-2 at 28.) Dr. Harmston prescribed

Metoprolol and discontinued Propranolol. (Id.) Dr. Harmston also

ordered that nursing staff monitor Cashner’s blood pressure daily

for 2 weeks. (Id.) On December 10, 2011, Cashner submitted a

Medical Request Form indicating that he was experiencing

headaches and other adverse side-effects to his Metoprolol and

requesting to speak with the doctor about changing his blood

pressure medication. (DE #68-4 at 167.) On December 19, 2011, Dr.

Harmston examined Cashner and noted that Cashner attributed his

headaches to his beta blocker blood pressure medication. (DE #68-

2 at 29.) Dr. Harmston discontinued Cashner’s Metoprolol and

prescribed Norvasc. (Id.)

On February 7, 2012, Cashner signed a Refusal Form for his

Norvasc. (Id. at 30.) On February 14, 2012, Cashner submitted a

Medical Request Form asking that the doctor extend his Naprosyn

prescription for his headaches. (DE #68-4 at 166.) Cashner

indicated that the Naprosyn had been working to relieve his

12
headaches. (Id.) Nurse Walker responded to Cashner’s request the

next day and indicated that the doctor would renew his Naprosyn

prescription. (Id.)

On May 6, 2012, Cashner submitted a Medical Request Form

asking to speak with the doctor about further testing or

treatment related to his headaches. (Id. at 164.) Cashner

indicated that his Naprosyn, which he had been taking for 7

months, was providing at least some relief, but that he still

experienced headaches. (Id.) On May 8, 2012, Nurse Martin

examined Cashner. (DE #68-3 at 133.) Nurse Martin noted that

Cashner was doing well on his medications, and Dr. Harmston

submitted a telephone order to continue them. (Id.) On May 14,

2012, Dr. Harmston examined Mr. Cashner, where he reported

elevated blood pressure and off-and-on headaches. (DE #68-2 at

33.) Cashner also indicated that he was taking his Naprosyn as

prescribed for his headaches. (Id.) Cashner told Dr. Harmston

that he had been headache-free on Naprosyn, but that he recently

had been experiencing headaches more frequently. (Id.) Dr.

Harmston ordered that nursing staff monitor Cashner’s blood

pressure weekly and prescribed Fioricet, but Cashner declined

this medication. (Id.) Dr. Harmston alternatively ordered that

Cashner continue on his Naprosyn and also referred him for an

13
outside consultation for a neurology evaluation.2 (Id.) Pursuant

to Dr. Harmston’s orders, Nurse Kim White scheduled Cashner for a

neurology consultation with Dr. Vyas. (DE #68-1 ¶ 13.)

On May 23, 2012, Cashner submitted a Medical Request Form

indicating that his headaches were still frequently occurring.

(DE #68-4 at 163; DE #68-1 ¶ 14.) Cashner inquired as to whether

he was scheduled to see a specialist for further treatment of his

headaches. (Id.) Nurse White responded that Cashner had been

scheduled for a neurology evaluation. (Id.) Nurse White also

inquired as to whether Cashner wanted to reconsider his having

declined Fioricet at his May 14, 2012 visit with Dr. Harmston.

(Id.)

On June 14, 2012, Cashner submitted a Medical Request Form

indicating that his headaches were occurring more frequently and

more painfully than previous headaches. (DE #68-4 at 162; DE #68-

1 ¶ 15.) Cashner expressed interest in interim treatment until he

could consult with a specialist. (Id.) Nurse White responded and

informed Cashner that medical staff had scheduled an appointment

with a specialist and that Cashner had declined Fioricet, which

2

 Cashner attempts to embellish this by claiming that Dr. Harmston

“announced that he had done all he could do to control my headaches and stated

that it was his recommendation that I see a specialist.” (DE #70-2 ¶ 5.) This

evidence, if admissible, would have nominal value in this case. But,

nevertheless, as the defendants correctly point out, this purported statement

made by non-party is inadmissible hearsay, FED. R. EVID. 802, not subject to any

hearsay exception. FED. R. EVID. 803, 807. As a result, it cannot be used as

evidence to defeat a motion for summary judgment. Smith v. Dunn, 368 F.3d 705,

709 (7th Cir. 2004).

14
Dr. Harmston had attempted to prescribe on May 14, 2012. (Id.)

Nurse White again offered Cashner Fiorcet. (Id.) Nurse Martin

examined Cashner later that day. (DE #68-3 at 132.) Nurse Martin

noted that Cashner was doing well on his medications and that he

was not experiencing any adverse side-effects. (Id.) Dr. Collier

submitted a telephone order for Diltiazem and Naprosyn. (Id.) On

June 18, 2012, Cashner submitted a Medical Request Form denying

that he ever declined Fioricet and that he instead declined to be

placed in medical isolation in order to take Fioricet. (DE #68-4

at 161; DE #68-1 ¶ 16.) Cashner requested Flexeril and Naprosyn

until he could be seen by a specialist. (Id.) Nurse White

responded the following day that Cashner had been offered

appropriate medical treatment, but that he had refused and denied

himself such treatment. (Id.) Nurse White also indicated that the

medical provider dictates treatment options. (Id.) On June 20,

2012, Cashner submitted a Medical Request Form asking for an

explanation as to the appropriate medical treatment that he had

refused. (DE #68-4 at 160; DE #68-1 ¶ 17.) Cashner again asserted

that he had not refused to take Fioricet, but had refused to be

placed in medical isolation to take Fioricet. (Id.) Nurse White

responded that Cashner had refused Fioricet and also indicated

that medical staff had scheduled Cashner for an outside neurology

evaluation. (Id.) On June 25, 2012, Cashner submitted a Medical

Request Form asking to speak to “a different doctor” than whom

15
Cashner had seen previously and whom “may have some knowledge”

that “the other doctor doesn’t.” (DE #68-4 at 159.) Nurse Walker

responded the following day that every doctor at the Porter

County Jail follows the same protocols and procedures and that

Cashner would be able to discuss his headaches with the

neurologist in several days. (Id.) Cashner had an appointment to

see Dr. Vyas, the neurologist, on June 28, 2012. (DE #68-1 ¶ 32.)

However, officers were not able to transport him to that

appointment due to a staff shortage and an emergency in the jail

that day. (Id.; DE #65-2 ¶ 13) Nurse Kim White was not

responsible for transporting Cashner to this appointment. (Id.)

Cashner’s appointment with Dr. Vyas was re-scheduled for the next

available date. (DE #65-2 ¶ 13.)

On July 1, 2012, Cashner submitted a Medical Request Form

asking to see the doctor. (DE #68-4 at 158.) Nurse White

responded the following day that she had referred Cashner’s

request to the doctor. (Id.) On July 2, 2012, after being gone

from the jail for several days, Nurse White was advised that

Porter County Jail security staff could not transport Cashner to

his outside neurologist consultation on June 28, 2012 due to an

emergency in the jail. (DE #68-3 at 132; DE #68-1 ¶¶ 18, 32.) As

soon as she was made aware of this, Nurse White rescheduled

Cashner’s appointment with Dr. Vyas for August 30, 2012 and

informed security staff of the scheduling change. (Id.) On July

16
3, 2012, Dr. Collier examined Cashner, where Cashner reported

headaches and issues with his blood pressure. (DE #68-2 at 33.)

Dr. Collier discontinued Cashner’s Naprosyn and prescribed

Meloxicam. (Id.) On July 6, 2012, Cashner reported to nursing

staff that Meloxicam was not relieving his headaches. (DE #68-3

at 131.) Cashner indicated that Naprosyn provided greater relief

of his headaches than Meloxicam. (Id.) Dr. Collier submitted a

telephone order to reinstate Cashner’s Naprosyn and to

discontinue Meloxicam. (Id.)

On July 13, 2012, Cashner submitted a Medical Request Form

asking to see the doctor. (DE #68-4 at 157; DE #68-1 ¶ 19.) Nurse

White responded by scheduling Cashner with the doctor. (Id.)

Later that evening, Cashner reported to custody officers during

medication distribution with chest pain, a rapid heart rate, a

headache, and ringing in his ears. (DE #68-2 at 34-36.) At

approximately 7:00 p.m., Officer Brian Lambka checked Cashner’s

blood pressure with a wrist monitor, which returned a reading of

230/142. (Id. at 34.) Officer Lambka instructed Officer June

Taylor to contact the shift supervisor, Lieutenant Hunter McKee,

to inform Lt. McKee of Cashner’s condition. (Id.) Officer Taylor

contacted Lt. McKee at approximately 8:05 p.m., and Lt. McKee

evaluated Cashner. (Id. at 35.) Lt. McKee checked Cashner’s

vitals and noted that his blood pressure had lowered to 194/118.

(Id.) Cashner informed Lt. McKee that his chest pain was on the

17
left side of his chest and felt as if his heart was “going to

beat out of (his) chest.” (Id.) Lt. McKee contacted Dr. Nadir AlShami to inform him of Cashner’s condition. (Id.; DE #68-8 ¶ 7.)

Dr. Al-Shami was not present at the Porter County Jail on July

13, 2012, but submitted telephone orders for one Nitroglycerin

tablet for Cashner’s chest pain and continued monitoring of

Cashner’s condition. (Id.) Dr. Al-Shami also instructed the

custody officers to contact him if Cashner’s condition did not

improve. (Id.) Lt. McKee again contacted Dr. Al-Shami and

informed him that Cashner’s pain had not improved. (Id.) Dr. AlShami submitted telephone orders to administer 325 mg of Aspirin

and move Cashner to medical isolation for better observation.

(Id.) Officer Lambka placed Cashner in medical isolation and told

him to inform the custody officers if his pain levels increased.

(DE #68-2 at 34-35.)

At approximately 3:30 a.m. on July 14, 2012, Cashner

reported chest pain and a rapid heart rate to Corporal Nathan

Graf, the custody officer working in Main Control at that time.

(Id. at 37.) Officer Ramus reported Cashner’s elevated blood

pressure to Corporal Melana Florer, who contacted Dr. Townsend,

another on-call physician. (Id.) Dr. Al-Shami was unavailable

when custody officers called, and Dr. Townsend was likely the

second doctor on the on-call list. (DE #68-6 ¶ 7.) Dr. Townsend

submitted a telephone order to transfer Cashner to the Porter

18
Regional Hospital. (DE #68-2 at 37.) At approximately 4:30 a.m.

on July 14, 2012, custody officers transferred Cashner to Porter

Regional Hospital for his unimproved chest pain. (Id.; DE #68-8.)

Porter Regional Hospital medical staff performed a coronary CT

angiogram, which revealed right coronary artery dominance and

normal coronary anatomy without anomaly. (Id.) Porter Regional

Hospital medical staff interpreted the coronary CT angiogram as

normal and ordered a stress test for Cashner in the next 30 days.

(Id.) Porter Regional Hospital medical staff prescribed

Clonidine, Aspirin, and Metoprolol and discharged Cashner to the

Porter County Jail. (Id.) Upon return from Porter Regional

Hospital on July 14, 2012, Nurse Walker examined Cashner, where

he denied headaches or problems with his blood pressure. (DE #68-

3 at 130.) Nurse Walker indicated that Cashner took his

medications and ensured that he remained in medical isolation for

observation, per the doctor’s orders. (Id.) That evening, Cashner

reported “bad” headaches. (Id.) Nursing staff indicated that

Cashner took his medications, but was very upset. (Id.) Nursing

staff observed no signs or symptoms of acute distress. (Id.)

On July 15, 2012, Nurse Walker assessed Cashner in the

morning medication pass line. (Id.) Cashner voiced no new

complaints or complaints of a headache. (Id.) Nurse Walker

indicated that Cashner took all of his medications and was to

remain in medical isolation for monitoring. (Id.) At

19
approximately 5:45 p.m., nursing staff reviewed Cashner’s blood

pressure reading from that evening (172/108) with Dr. Al-Shami.

(DE #68-3 at 129; DE #68-6 ¶ 8.) Based upon Cashner’s elevated

blood pressure reading, Dr. Al-Shami submitted a telephone order

for a trial dose of Lisinopril 40 mg to be administered at the

evening medication pass and to re-check Cashner’s blood pressure

by the end of the evening shift. (Id.) That evening, nursing

staff examined Cashner, who complained of a “bad” headache. (DE

#68-3 at 130.) Cashner’s blood pressure was 192/117. (Id.)

Nursing staff called Dr. Al-Shami regarding Cashner’s blood

pressure, and Dr. Al-Shami ordered an increase in Diltiazem (for

high blood pressure) to 120 mg twice daily, and nursing staff

administered the increased dosage immediately thereafter. (Id.)

Nursing staff also administered the trial dosage of Lisinopril 40

mg during the evening medication pass. (DE #68-3 at 129; DE #68-6

¶ 8.) Cashner’s blood pressure decreased to 153/104 after nursing

staff administered the trial dosage of Lisinopril. (DE #68-3 at

130; DE #68-6 ¶ 8.)

On the morning of July 16, 2012, Cashner took his

medications and made no complaints of a headache. (DE #68-3 at

128.) That evening, Nurse Martin examined Cashner, who reported a

headache. (Id.) On July 17, 2012, Dr. Al-Shami examined Cashner,

who reported headaches. (DE #68-2 45; DE #68-6 ¶ 9.) Dr. Al-Shami

discontinued Cashner’s Naprosyn and prescribed Tylenol. (Id.) Dr.

20
Al-Shami also determined that an outside neurology consultation

was not medically necessary because Dr. Al-Shami had diagnosed

Cashner with tension-related headaches (versus migraine

headaches), which were manageable on Cashner’s current pain

medication regimen without the need for a neurology consultation.

(Id.) In Dr. Al-Shami’s medical opinion, Cashner’s chronic

headaches were related to his uncontrolled high blood pressure.

(DE #68-6 ¶ 9.) The priority then was to get Cashner’s blood

pressure under better control to see if his headaches improved,

before sending him for further testing and evaluation with a

neurologist. (Id.) On July 18, 2012, Cashner reported to Nurse

Walker requesting another dose of Tylenol for his headaches. (DE

#68-3 at 127.) Nursing staff contacted Dr. Al-Shami, who ordered

one dose of Tylenol. (Id.; DE 68-6 ¶ 10.) On July 19, 2012, Dr.

Al-Shami ordered Atenolol to treat Cashner’s high blood pressure.

(DE #68-3 at 126; DE #68-6 ¶ 11.)

On July 23, 2012, Cashner submitted a Medical Request Form

asking to see the doctor. (DE #68-4 at 156; DE #68-1 ¶ 20.) Nurse

White responded the following day and indicated that Cashner had

seen Dr. Al-Shami last week and she instructed Cashner to set

forth any specific questions that he had so that Nurse White

could pass those on to Dr. Al-Shami for response. (Id.) Nurse

White later contacted Dr. Al-Shami with Cashner’s complaints and

Dr. Al-Shami discontinued Cashner’s evening dose of Tylenol and

21
prescribed Tylenol once daily for 30 days because Cashner’s

tension headaches could be effectively managed on a single daily

dose of Tylenol. (DE #68-3 at 127; DE #68-1 ¶ 20; DE #68-6 ¶ 12.)

On July 29, 2012, Cashner submitted a Medical Request Form asking

to see the doctor and indicating that he was still experiencing

headaches. (DE #68-4 at 155; DE #68-1 ¶ 21.) Nurse White

responded the following day that she would schedule a visit with

Dr. Al-Shami as soon as practicable, and that Cashner had an

upcoming appointment with an outside neurologist related to his

headaches. (Id.) On July 30, 2012, Cashner submitted a Medical

Request Form asking to see the doctor for his headaches and high

blood pressure. (DE #68-4 at 154; DE #68-1 ¶ 22.) Nurse White

responded the following day that Cashner was on the list to see

the doctor and had an upcoming appointment with an outside

neurologist. (Id.)

On August 5, 2012, Cashner submitted a Medical Request Form

indicating that he was still experiencing daily headaches. (DE

#68-4 at 153.) Cashner reported that his Tylenol helped to dull

his headache pain in the mornings, but that his headaches

worsened in the afternoon. (Id.) Cashner asked to see the doctor.

(Id.) Nurse Walker responded the following day that Cashner was

on the list to see the doctor and had an upcoming appointment

with an outside neurologist. (Id.) On August 7, 2012, Dr. AlShami examined Cashner, where Cashner continued to report

22
headaches. (DE #68-2 at 53; DE #68-6 ¶ 13.) Dr. Al-Shami again

diagnosed tension-related headaches, as Cashner reported daily

headaches, whereas migraine headaches would only occur

intermittently, not daily. (Id.) Dr. Al-Shami felt that Cashner’s

tension headaches were manageable on his current pain medication

regimen. (Id.) On August 13, 2012, Cashner submitted a Medical

Request Form asking to see the doctor and indicating that he was

still experiencing headaches. (DE #68-4 at 152; DE #68-1 ¶ 23.)

Cashner asserted that his medications were not controlling his

headaches. (Id.) Nurse White responded that day that she would

schedule Cashner for a visit with Dr. Al-Shami as soon as

practicable and she inquired as to whether Cashner’s prescribed

medications worked better than Meloxicam, which had been

previously prescribed and discontinued. (Id.)

On August 14, 2012, Dr. Al-Shami examined Cashner, where

Cashner reported headaches and uncontrolled blood pressure. (DE

#68-2 at 54; DE #68-6 ¶ 14.) Dr. Al-Shami added Hydralazine to

Cashner’s medication regimen to treat his high blood pressure.

(Id.) On August 17, 2012, Cashner was apparently involved in an

altercation with another inmate. (DE #68-2 at 55-61; DE #68-6 ¶

15.) Nursing staff contacted Dr. Al-Shami regarding Cashner’s

condition and Dr. Al-Shami ordered an x-ray of Cashner’s facial

bones, including nasal and mandible, an x-ray of his left

shoulder, an x-ray of his left hand, and Ibuprofen. (Id.) Dr. Al23
Shami determined that, based on the injuries reported by nursing

staff to him, there was no need to send Cashner to the emergency

room on that date. (DE #68-6 ¶ 15.) Cashner’s x-rays were normal

and showed no injuries. (Id.)

On August 19, 2012, Cashner indicated to Nurse Walker that

he would not take his new prescription medication (Hydralazine

100 mg) because the medication gave him a headache. (DE #68-3 at

126.) On August 20, 2012, Cashner submitted a Medical Request

Form indicating that he had an adverse reaction to his

Hydralazine and that he could not take the medication any longer.

(DE #68-4 at 151.) Cashner also indicated that his blood pressure

remained high and that he still experienced headaches. (Id.)

Cashner requested to see a provider who could control his blood

pressure and headaches. (Id.) Nurse Walker assessed Cashner that

morning in the medication pass line. (DE #68-3 at 125.) Cashner

complained that his new medication (Hydralazine) caused

headaches. (Id.) Cashner took his Hydralazine as prescribed and

voiced no complaints of headaches thereafter. (Id.) That evening,

nursing staff indicated that Cashner refused his Hydralazine, but

took all other prescribed medications. (Id.) Cashner voiced no

new complaints at that time. (Id.) On August 21, 2012, Nurse

Martin examined Cashner and he refused his Hydralazine, but took

all other prescribed medications. (Id.) Cashner voiced no

complaints. (Id.) Dr. Al-Shami examined Cashner later that day,

24
where he reported headaches and adverse side-effects from his

Hydralazine. (DE #68-2 at 69; DE #68-6 ¶ 16.) Dr. Al-Shami

increased Cashner’s Diltiazem to 240 mg to control his blood

pressure and ordered nursing staff to check Cashner’s blood

pressure. (Id.) On August 22 and August 23, 2012, Cashner took

his medications and voiced no complaints. (DE #68-3 at 125.) On

August 24, 2012, Nurse Walker examined Cashner. (Id.) Cashner

took his medications and voiced no complaints. (Id.) Nurse Walker

indicated that Cashner would be transferred out of medical

isolation that day. (Id.) On August 26, 2012, Cashner took his

medications and voiced no complaints. (Id.) On August 27, 2012,

nursing staff examined Cashner. (Id.) Cashner took his

medications and reported continual headaches (Id.) Cashner also

expressed that he enjoyed his new housing pod. (Id.) That

evening, Nurse Martin examined Cashner. (Id.) Cashner took his

medications and voiced no complaints. (Id.) On August 28, 2012,

Nurse Martin examined Cashner. (Id.) Cashner took his medications

and voiced no complaints. (Id.)

On August 30, 2012, jail staff was able to transport Cashner

to Dr. Vyas’ office. (DE #65-2 ¶13.) Neurologist Daksha Vyas,

M.D. evaluated Cashner during this outside consultation. (DE #68-

7.) This appointment had been previously scheduled by Nurse White

and ordered by Dr. Harmston, Dr. Al-Shami’s predecessor at the

Porter County Jail, prior to Dr. Al-Shami’s involvement in

25
Cashner’s medical care. (DE #68-6 ¶ 17.) Even though Dr. Al-Shami

did not think this evaluation was necessary, Dr. Al-Shami saw no

harm in permitting Cashner to go to a previously-scheduled

appointment. (Id.) At the consultation, Cashner reported that his

headaches started approximately 1 year prior and that he

experienced them daily since that time. (DE #68-7 at 1-5.)

Cashner also indicated that his headaches were located behind his

eyes and in the back of his head and that he had blurred vision

during his headache episodes. (Id.) Cashner conveyed that medical

staff at the Porter County Jail had prescribed Naprosyn, but that

this medication raised his blood pressure. (Id.) Cashner also

expressed that Fioricet and Flexeril had provided headache relief

in the past. (Id.) Cashner indicated that he was currently taking

Tylenol, which only provided minimal relief. (Id.) Dr. Vyas

conducted a neurological exam and physical exam, which were both

completely normal. (DE #68-7 at 2-4; DE #68-6 ¶ 17.) Dr. Vyas did

note tenderness in Cashner’s cervical para-spinal muscles and

documented Cashner’s previous cervical spine fusion surgery. (DE

#68-7 at 1, 3.) Dr. Vyas ordered labs (Free T4, TSH, ANA Titer,

Sed Rate), an MRI of Cashner’s brain, an x-ray of his cervical

spine, and an EEG. (DE #68-7 at 4.) Dr. Vyas prescribed Ultram 50

mg 3 times daily for 30 days. (Id.) The following day, Dr. AlShami prescribed Ultram 50 mg three times daily for 30 days and

discontinued Cashner’s Tylenol and/or Ibuprofen orders, as those

26
medications were no longer necessary to treat Cashner’s pain

given his prescription for Ultram. (DE #68-2 at 73, 76; DE #68-6

¶ 18.)

On September 3, 2012, Cashner submitted a Medical Request

Form inquiring as to why he had not received his prescription for

Flexeril twice daily as ordered by Dr. Vyas on August 30, 2012.

(DE #68-3 at 150.) Nurse Walker responded the following day and

indicated that no such prescription had been written by Dr. Vyas,

other than what had already been ordered by Dr. Al-Shami. (Id.)

On September 4, 2012, Dr. Al-Shami ordered all labs for Mr.

Cashner, as recommended by Dr. Vyas. (DE #68-3 at 81; DE #68-6 ¶

19.) 

Cashner alleges that while Nurse White was drawing blood for

his lab work on September 4, 2012, Dr. Al-Shami entered the room.

(DE #70-2 ¶ 13.) Dr. Al-Shami grabbed Cashner’s chart and stated

that “he had traveled the world treating patients,” and “he was a

better doctor than any neurologist,” and “he wasn’t going to let

any other doctor tell him how to treat a patient of his.” (Id. at

¶ 13.) Cashner says that Dr. Al-Shami informed him that he would

not be going back to see Dr. Vyas. (Id.) According to Cashner,

Dr. Al-Shami continued by saying that “his headaches were all in

my head,” and stated that he would no longer treat Cashner for

his chronic headaches. (Id. at ¶¶ 15, 16.) On that same date, Dr.

Al-Shami informed Cashner that “an MRI was a very expensive

27
procedure and was too expensive for me to have at the Jail’s

expense.” (Id. at ¶ 17.) Later that same day, Cashner claims he

was called into Warden Widup’s office and was again told that an

MRI was too expensive. (Id. at ¶ 18.) 

On September 5, 2012, Dr. Al-Shami reviewed Cashner’s lab

results, all of which were normal. (DE #68-6 ¶ 20.) Cashner’s

normal lab results solidified Dr. Al-Shami’s opinion that his

headaches were related to high blood pressure and Dr. Al-Shami

did not think an MRI or neurology follow-up were necessary. (Id.)

Cashner submitted a Medical Request Form inquiring as to who had

cancelled his prescription for Ultram and the reason for the

cancellation. (DE #68-3 at 149; DE #68-1 ¶ 24.) Nurse White

responded the following day and indicated that the jail doctor

had deemed Cashner’s prescription for Ultram unnecessary based

upon Cashner’s normal lab results and normal physical and

neurological exams. (Id.) On September 7, 2012, Nurse Walker

spoke with Cashner regarding medication renewal. (DE #68-3 at

124.) Cashner indicated that he was stable and wished to continue

his medications as prescribed. (Id.) Dr. Al-Shami renewed

Cashner’s Lisinopril. (DE #68-3 at 124; DE #68-6 ¶ 21.) By way of

a note dated September 7, 2012, Nurse White informed Cashner that

Dr. Al-Shami had deemed his appointment with Dr. Vyas on

September 13, 2012 unnecessary because of his normal lab work and

physical exam. (DE #68-3 at 82; DE #68-1 ¶ 25.) Dr. Al-Shami had

28
reviewed all of Cashner’s labs (as recommended by Dr. Vyas) on

September 5, 2012, and all labs were normal, thus negating the

need for an MRI of Cashner’s brain and/or follow up with Dr.

Vyas. (DE #68-3 at 81.) Cashner’s normal lab results solidified

Dr. Al-Shami’s opinion that his headaches were related to his

high blood pressure. (DE #68-6 ¶ 34.) Dr. Al-Shami, therefore,

did not think that an MRI of Mr. Cashner’s brain or a neurology

follow-up consultation was necessary. (Id.)

On September 13, 2012, Nurse White and Warden Widup met with

Cashner to discuss his chronic headaches and available treatments

and medications. (DE #68-3 at 123; DE #68-1 ¶ 26; DE #68-6 ¶ 22;

DE #65-2 ¶ 10.) Cashner indicated that Tylenol and Ibuprofen

provided no relief for his headaches. (Id.) Nurse White and

Warden Widup consulted with Dr. Al-Shami, who ordered a trial

prescription of Topamax, as well as daily blood pressure checks.

(Id.; DE #65-2 ¶ 10) Topamax is used to treat severe headaches.

(DE #68-6 ¶ 22.) On September 25, 2012, Dr. Al-Shami examined

Cashner. (DE #68-3 at 83; DE #68-6 ¶ 23.) Dr. Al-Shami noted no

neurological deficits, but observed that Cashner’s blood pressure

was still too high and explained and discussed his concerns with

Cashner. (Id.)

On October 11, 2012, Cashner filed a Motion to Compel

Medical Records and Medical Treatment in the Porter County

Superior Court as part of his criminal case. (DE #68-3 at 84-87.)

29
Cashner requested an order from the Porter County Superior Court

directing medical staff at the Porter County Jail to schedule an

MRI of Cashner’s brain; schedule a follow-up visit with Dr. Vyas;

provide the medications prescribed by Dr. Vyas; and to provide a

copy of all of Cashner’s medical records to his attorney. (Id.)

On October 16, 2012, Dr. Al-Shami ordered Topamax for Cashner’s

headaches. (DE #68-3 at 122; DE #68-6 ¶ 24.) On October 20, 2012,

Cashner complained to Nurse Walker of a headache during the

medication pass line. (DE #68-3 at 122; DE #68-6 ¶ 25.) Nurse

Walker notified Dr. Al-Shami, who ordered nursing staff to start

Cashner’s Topamax prescription for his headaches. (Id.) On

October 27, 2012, Nurse Martin examined Cashner. (Id.) Cashner

voiced no complaints of a headache. (Id.) On October 29, 2012,

Nurse Walker examined Cashner in the morning while Nurse Martin

did so in the evening. (Id.) Cashner voiced no complaints during

either visit and took his medications as prescribed. (Id.) Also

on October 29, 2012, the Porter County Superior Court issued an

Order granting Cashner’s Motion to Compel, which directed the

Porter County Jail to schedule a follow-up appointment with Dr.

Vyas within 15 days of the date of the Order, but that the

appointment date did not have to be within 15 days. (DE #68-3 at

88; DE #68-1, Ex. 1.) On October 30, 2012, nursing staff examined

Cashner. (DE #68-3 at 122.) Cashner voiced no complaints, but

stated, “I have a surprise for the medical department.” (Id.)

30
Cashner took his medications as prescribed. (Id.) That evening,

Nurse Martin assessed Cashner. (Id.) Cashner voiced no complaints

and took his medications as prescribed. (Id.) On October 31,

2012, Cashner voiced no complaints to either the morning shift or

evening shift nurses. (DE #68-3 at 121, 122.)

On November 2, 2012, Nurse White scheduled Cashner for a

follow-up appointment with Dr. Vyas on December 6, 2012 at 3:15

p.m., in compliance with the criminal court’s order. (DE #68-3 at

88; DE #68-1 ¶¶ 27, 32.) From November 2, 2012 to November 4,

2012, Cashner voiced no complaints of headaches and took his

medications as prescribed. (DE #68-3 at 121.) On the morning of

November 6, 2012, Nurse Walker assessed Cashner, who reported a

headache. (Id.) Cashner took his medications as prescribed,

including his Topamax. (Id.) That evening, Nurse Martin assessed

Cashner, who voiced no complaints and took his medications as

prescribed. (Id.) On November 7 and November 8, 2012, Cashner

voiced no complaints of headaches. (Id.) On the morning of

November 9, 2012, Nurse Walker assessed Cashner. (Id.) Cashner

indicated that he had been awakened in the middle of the night

with a headache, but that he did not have a headache at that

time. (Id.) That evening, nursing staff assessed Cashner, who

voiced no complaints. (DE #68-3 at 120.) From November 10, 2012

to November 18, 2012, Cashner voiced no complaints of headaches.

(DE #68-3 at 119-121.) On November 18, 2012, Cashner reported to

31
nursing staff that he felt “much better” than he did the prior

Thursday. (DE #68-3 at 119.) On the morning of November 19, 2012,

nursing staff assessed Cashner, who reported a “bad” headache.

(Id.) Cashner also indicated that he had taken pain medications

he had purchased from the commissary prior to evaluation.(Id.)

Nursing staff administered Cashner’s prescribed medications and

returned him to his housing unit. (Id.) On the morning of

November 20, 2012, Nurse Walker assessed Cashner. (Id.) Cashner

took his medications as prescribed and voiced no complaints.

(Id.) That evening, nursing staff assessed Cashner. (Id.) Cashner

reported that he was still experiencing the same headache from

the day before, but that its severity had subsided. (Id.) Nursing

staff advised Cashner to continue taking pain relievers purchased

from the commissary and to take a hot shower and meditate to try

to relax and relieve any possible stress. (Id.) On the morning of

November 21, 2012, Nurse Walker assessed Cashner. (Id.) Cashner

voiced no complaints. (Id.) That evening, Nurse Martin assessed

Cashner. (Id.) Nurse Martin offered to request a renewal of

Cashner’s Topamax, but Cashner declined. (Id.) Cashner indicated

that he wanted Toradol, which he alleged was Court-ordered. (Id.)

Cashner voiced no other complaints and took his medications as

prescribed. (Id.)

On November 22, 2012, Cashner submitted a Medical Request

Form asking for a prescription for Ultram, which he alleged was

32
Court-ordered. (DE #68-3 at 147; DE #68-1 ¶ 28.) Nurse White

responded on November 26, 2012 and placed Cashner on the list to

see Dr. Al-Shami. (Id.) From November 23, 2012 to November 25,

2012, Cashner voiced no complaints. (DE #68-3 at 118-119.) On

November 25, 2012, Nurse Walker administered Cashner’s

medications prior to his going to Court that day. (DE #68-3 at

118.) Cashner voiced no complaints. (Id.) Upon his return from

Court, nursing staff assessed Cashner and noted that his blood

pressure was elevated. (Id.) Cashner indicated that his elevated

blood pressure was likely due to his stressful day in Court.

(Id.) Cashner voiced no complaints of a headache. (Id.) On

November 27, 2012, Cashner voiced no complaints of headaches.

(Id.) On November 28, 2012, Dr. Al-Shami examined Cashner and

Cashner reported headaches. (DE #68-3 at 90; DE #68-6 ¶ 26.) Dr.

Al-Shami advised Cashner to continue purchasing Tylenol from the

commissary for his headaches. (Id.) Dr. Al-Shami also prescribed

Ultram 50 mg twice daily. (Id.) Dr. Al-Shami requested a

consultation with an outside neurologist regarding Cashner’s

headaches, pursuant to a Court Order dated October 29, 2012.

(Id.) He and Nurse White then discussed the Court Order and that

they were in compliance with it, because Cashner was already

scheduled on November 2, 2012, for an appointment on December 6,

2012, which was within 15 days of the court order. (DE #68-1 ¶

29, Ex. 1.) On November 29, 2012, Cashner voiced no complaints of

33
a headache. (DE #68-3 at 118.) On November 30, 2012, Dr. Al-Shami

reviewed Cashner’s blood pressure records and ordered weekly

blood pressure checks. (Id.; DE #68-6 ¶ 27.)

On December 1, 2012, Mr. Cashner voiced no complaints of a

headache.(DE #68-3 at 118.) On December 2, 2012, nursing staff

assessed Cashner, who indicated that he was still having

headaches. (Id.) On the morning of December 3, 2012, nursing

staff assessed Cashner. (Id.) Cashner inquired as to why he had

not yet received his Ultram prescription. (Id.) That evening,

Cashner again inquired as to why he had not yet received his

Ultram prescription. (Id.) Cashner voiced no other complaints.

(Id.) On the evening of December 4, 2012, nursing staff assessed

Cashner. (DE #68-3 at 117.) Cashner again inquired as to why he

had not yet received his Ultram prescription. (Id.) Cashner

voiced no other complaints. (Id.) On December 5, 2012, Cashner

voiced no complaints of a headache. (Id.)

On December 6, 2012, Dr. Vyas examined Cashner during his

second outside neurology consultation. (DE #68-7 at 6-10.) Dr.

Vyas indicated that Cashner took Tylenol and Motrin for his

headaches, which provided inconsistent relief. (Id. at 6.) Dr.

Vyas also noted that Cashner’s Topamax prescription had at least

partially alleviated his headaches. (Id.) Dr. Vyas noted that

Cashner had chronic headaches since June of 2011. (Id.) Dr. Vyas

performed a physical exam and neurological exam, which were both

34
normal. (Id. at 7-9.) Dr. Vyas ordered an MRI of Cashner’s brain

and prescribed Ultram 50 mg three 3 times daily and Flexeril 10

mg at bedtime. (Id. at 9.) Dr. Vyas instructed Cashner to follow

up in six weeks. (Id.) That evening, Dr. Al-Shami ordered Ultram

50 mg once daily for 60 days and Flexeril 10 mg once daily for 60

days. (DE #68-3 at 93, 117; DE #68-6 ¶ 28.) Nursing staff

informed Dr. Al-Shami that the medications were not in stock at

the Porter County Jail, and Dr. Al-Shami submitted an emergency

order through Diamond Pharmacy for the medications. (Id.) 

On December 8, 2012, Nurse Martin assessed Cashner. (DE #68-

3 at 117.) Nurse Martin explained to Cashner that, due to the

nature of his newly-ordered medications (Ultram and Flexeril), he

would need to be moved to medical isolation to take these

medications. (Id.) Cashner expressed his understanding and

refused to move to medical isolation. (Id.; DE #68-6 ¶ 29.)

Cashner indicated that he would discuss the issue with his

attorney, the Medical Director and Warden Widup. (Id.) Cashner

voiced no other complaints. (Id.) On December 9, 2012, Cashner

submitted a Medical Request Form asking to speak with Nurse White

regarding his newly-prescribed medications and why the

medications could only be taken in medical isolation. (DE #68-3

at 146.) Nurse Walker responded the following day that Warden

Widup was in charge of this decision and that medical staff

played no role in the decision. (Id.) On the evening of December

35
9, 2012, Cashner refused to move to medical isolation to take his

Ultram and Flexeril. (Id. at 116; DE #68-6 ¶ 30.) Medical and

administrative staff at the Porter County Jail preferred that

inmates on medications such as Ultram and Flexeril were housed in

medical isolation, rather than general population, to reduce the

risk of medication hoarding and trafficking, which is common in

the jail setting. (DE #68-6 ¶ 30.)

On December 10, 2012, Cashner took his medications as

prescribed, including his Ultram and Flexeril. (DE #68-3 at 116.)

That same day, Nurse White and Warden Widup met with Cashner

pursuant to his December 9th request. (Id. at 115; DE #68-1 ¶ 30;

DE #65-2 ¶ 11.) Cashner agreed to take his medications as

ordered, so long as the medications were crushed. (Id.) Nurse

White and Warden Widup agreed and indicated that Cashner could

remain in general population at that time. (Id.) Dr. Al-Shami

indicated by telephone order that nursing staff could crush

Cashner’s Ultram and Flexeril to be administered in general

population. (DE #68-3 at 115; DE #68-6 ¶ 31.) After December 10,

2012, Cashner took his medications and made few complaints of

headaches. (DE #68-6 ¶ 32.) Nursing staff did not contact Dr. AlShami again regarding Cashner. (Id.) On the evening of December

11, 2012, nursing staff assessed Cashner, who indicated that he

was doing much better. (Id.) From December 12, 2012 to December

23, 2012, Cashner voiced no complaints of headaches. (DE #68-3 at

36
114-15.) On the morning of December 24, 2012, nursing staff

assessed Cashner. (Id. at 114.) Cashner indicated that he was

still experiencing headaches, but that his headaches were shorter

in duration and less intense with his new medications. (Id.)

Nurse Kim White stopped working for ACH on December 31,

2012, and also stopped working at the Porter County Jail at that

time. (DE #68-1 ¶ 5.) She had no further involvement with

Cashner’s medical care after this date. (Id.) From December 25,

2012 to January 23, 2013, Cashner voiced no complaints of

headaches. (DE #68-3 at 110-114.) On January 24, 2013, Cashner

transferred to the Indiana Department of Correction. (Id. at

110.)

Dr. Al-Shami has over 35 years of experience treating

patients in both the private practice and the correctional

settings. (DE #68-6 ¶ 34.) He has training and professional

experience treating various chronic conditions, including chronic

headaches such as those experienced by Cashner. (Id.) In his

treatment of Cashner, Dr. Al-Shami based his diagnoses and

treatment decisions on Cashner’s subjective complaints, objective

conditions, and his medical judgment. (Id.) Cashner reported

daily headaches, which led Dr. Al-Shami to conclude that he was

experiencing tension-related headaches, which could be treated

and/or managed with over-the-counter pain medications. (Id.)

Cashner also had significantly elevated blood pressures, which

37
Dr. Al-Shami believed was likely causing his headaches. (Id.) In

Dr. Al-Shami’s opinion, if Cashner had been experiencing migraine

headaches, he would not experience the daily, mild headaches that

he in fact reported, but would rather experience more severe

headaches of lesser frequency. (Id.) Dr. Al-Shami only prescribed

pain medications that he believed would best treat Mr. Cashner’s

headaches and pain. (Id.)

Dr. Al-Shami believes that the medical care rendered to Mr.

Cashner by the medical staff at the Porter County Jail, including

Dr. Al-Shami and the nurses, was reasonable, appropriate, and

within the applicable standard of care. (Id. at ¶ 37.) Dr. AlShami’s treatment decisions regarding Cashner were not based on

any policy, practice, procedure or custom of ACH or the Porter

County Jail. (Id. at ¶ 38.) Dr. Al-Shami states that his

treatment decisions regarding Cashner had nothing to do with cost

or monetary concerns; he prescribes whatever medication or

treatment he thinks is appropriate, regardless of cost. (Id.) Dr.

Al-Shami does not even know whether the Porter County Jail or ACH

paid for inmates’ medical care, because cost was never a concern

to him. (Id.) Likewise, Nurse White states that The medical care

rendered by her and the nursing staff at the jail was reasonable,

appropriate, and within the applicable standard of nursing care.

(Id. at ¶ 38.)

38
While Warden Widup only had three in-person meetings with

Cashner, he still remained informed on his medical condition. (DE

#65-2 ¶¶ 16, 17, 23.) Warden Widup knew that Dr. Al-Shami had

diagnosed Cashner with having tension headaches that were brought

on by high blood pressure. (Id. at ¶¶ 17, 18.) Warden Widup was

kept informed on Cashner’s medical issues, including his

diagnoses, courses of medication, and Cashner’s hesitance to take

certain medications that would require him to be housed in

medical isolation due to jail policy. (Id. at ¶¶ 18, 20, 23.)

DISCUSSION

A. Federal Deliberate Indifference Claims

As a preliminary matter, because Cashner was a pretrial

detainee when these events occurred, the Fourteenth rather than

the Eighth Amendment applies. Lewis v. Downey, 581 F.3d 467, 473

(7th Cir. 2009). The governing standards are functionally

equivalent, however, and “anything that would violate the Eighth

Amendment would also violate the Fourteenth Amendment.” Id.

To establish liability under the Eighth Amendment, a

prisoner must show: (1) his medical need was objectively serious;

and (2) the defendant acted with deliberate indifference to his

medical need. Farmer v. Brennan, 511 U.S. 825, 834 (1994.) A

medical need is “serious” if it is one that a physician has

diagnosed as mandating treatment, or one that is so obvious that

39
even a lay person would easily recognize the necessity for a

doctor’s attention, and if untreated could result in further

significant injury or unnecessary pain, and that significantly

affects the person’s daily activities or features chronic and

substantial pain. Greeno v. Daley, 414 F.3d 645, 653 (7th Cir.

2005). Deliberate indifference is a high standard, and is

“something approaching a total unconcern for a prisoner’s welfare

in the face of serious risks,” or a “conscious, culpable refusal”

to prevent harm. Duane v. Lane, 959 F.2d 673, 677 (7th Cir.

1992). As the Seventh Circuit has explained:

[C]onduct is deliberately indifferent when the official

has acted in an intentional or criminally reckless

manner, i.e., the defendant must have known that the

plaintiff was at serious risk of being harmed and

decided not to do anything to prevent that harm from

occurring even though he could have easily done so.

Board v. Farnham, 394 F.3d 469, 478 (7th Cir. 2005).

For a medical professional to be held liable for deliberate

indifference to an inmate’s medical needs, he must make a

decision that represents “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.” Jackson v. Kotter, 541 F.3d 688,

697 (7th Cir. 2008). As the Seventh Circuit has explained:

[M]edical professionals are not required to provide

proper medical treatment to prisoners, but rather they

must provide medical treatment that reflects

professional judgment, practice, or standards. There is

not one proper way to practice medicine in a prison,

40
but rather a range of acceptable courses based on

prevailing standards in the field. A medical

professional’s treatment decisions will be accorded

deference unless no minimally competent professional

would have so responded under those circumstances.

Id. at 697-698. Negligence, incompetence, or even medical

malpractice do not amount to deliberate indifference. Pierson v.

Hartley, 391 F.3d 898, 902 (7th Cir. 2004); Walker v. Peters, 233

F.3d 494, 499 (7th Cir. 2000). 

Furthermore, a prisoner is not entitled to demand specific

care, nor is he entitled to the “best care possible.” Forbes v.

Edgar, 112 F.3d 262, 267 (7th Cir.1997). Where the defendants

have provided some level of care for a prisoner’s medical

condition, in order to establish deliberate indifference the

prisoner must show that “the defendants’ responses to [his

condition] were so plainly inappropriate as to permit the

inference that the defendants intentionally or recklessly

disregarded his needs.” Hayes v. Synder, 546 F.3d 516, 524 (7th

Cir. 2008). A mere disagreement with medical professionals about

the appropriate treatment does not amount to an Eighth Amendment

violation. Ciarpaglini v. Saini, 352 F.3d 328, 331 (7th Cir.

2003). 

1. Dr. Al-Shami was not deliberately

indifferent to Cashner’s medical condition

Cashner was granted leave to proceed on his allegations that

Dr. Al-Shami was dismissive of his chronic headaches and refused

to provide him with effective medical treatment and testing. To

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survive summary judgment on his theory that Dr. Al-Shami denied

him constitutionally adequate treatment, Cashner needed to

present evidence that “no minimally competent” doctor would have

chosen that course of treatment. Sain v. Wood, 512 F.3d 886,

894-95 (7th Cir. 2008). This he has not done. 

Cashner argues that Dr. Al-Shami’s decision not to follow

Dr. Vyas’ recommendation to get an MRI constituted deliberate

indifference. As a threshold matter, the mere fact that Dr. AlShami had a difference of opinion with Dr. Vyas’s recommendation

does not give rise to deliberate indifference. Indeed, questions

of whether certain diagnostic tests are warranted are “a classic

example of a matter for medical judgment.” Estate of Cole ex.

rel. Pardue v. Fromm, 94 F.3d 254, 261 (7th Cir. 1996) (quotation

omitted). Similarly, Cashner’s desire for an MRI does not

establish an Eighth Amendment violation, as a prisoner "is not

entitled to demand specific care." Forbes v. Edgar, 112 F.3d 262,

267 (7th Cir. 1997) (stating that a prisoner "is not entitled to

the best care possible"); see also Kendrick v. Frank, 310 F.

App'x 34, 38 (7th Cir. 2009) (stating that there is not "a

constitutional right to demand either a particular type of

medical treatment or a certain specialist" (citing Forbes, 112

F.3d at 267)).

Certainly, though, a decision to ignore a specialist’s

orders can raise an inference of deliberate indifference. Gil v.

42
Reed, 381 F.3d 649, 662-64 (7th Cir. 2004). To do this, a

plaintiff must present sufficient facts to create a genuine issue

about the doctor’s state of mind in refusing to follow the

specialist’s advice. Id. at 663. Cashner has presented no

evidence to raise such an inference here. Cashner attempts to

argue that Dr. Al-Shami refused to have him undergo an MRI out of

cost containment concerns. Considering the extensive medical

treatment the jail provided to Cashner during 2011 and 2012, it

is hard to fathom that he would be denied one diagnostic test

based on cost. Indeed, none of the defendants testified that

money was ever an issue in treating Cashner. Notably, Dr. AlShami stated that he did not even know whether his employer or

the Porter County Sheriff’s Department paid for inmates’ medical

care. 

Nevertheless, Cashner believes that his September 4, 2012

conversation with Dr. Al-Shami shows that he was denied an MRI

because of cost. The Court disagrees. On this day, Cashner says

Dr. Al-Shami told him that there was nothing wrong with him and

his “headaches were all in his head.” (DE #70-2 ¶ 15.) Dr. AlShami went on to say that “he wasn’t going to let any other

doctor tell him how to treat a patient of his,” and explained

that Cashner “would not be going back to see Dr. Vyas. . . ..”

(Id. at ¶¶ 13, 14.) Dr. Al-Shami further stated “that an MRI was

43
a very expensive procedure and was too expensive for me to have

at the Jail’s expense.” (Id. at ¶ 17.) 

It would be unreasonable for the court to consider Dr. AlShami’s last comment in isolation to infer that Dr. Al-Shami was

denying a medically necessary diagnostic test in order to save

money. Indeed, Dr. Al-Shami never says that he is refusing to

order a necessary MRI based on cost. To the contrary, the

conversation reveals that Dr. Al-Shami did not believe Cashner

needed an MRI and was not going to order one just because Dr.

Vyas recommended it. There is nothing wrong with Dr. Al-Shami

telling Cashner that an MRI is too expensive of a procedure for

the jail to pay for since it was unnecessary.

The undisputed facts are that Dr. Al-Shami did not believe

that either a follow-up appointment with Dr. Vyas or an MRI was

medically necessary. Again, the September 4, 2012, conversation

illustrates that Dr. Al-Shami did not believe an MRI was

necessary and would not order one just because Dr. Vyas

recommended it. This is reinforced in Dr. Al-Shami’s affidavit,

where he explained that his decision to forego the recommended

MRI was based on his conclusion that Cashner’s condition and test

results did not warrant an MRI. He decided not to order the

testing after lab results confirmed his belief that Cashner was

suffering from tension related headaches caused by uncontrolled

blood pressure. Ultimately, there is no evidence that would allow

44
a reasonable fact-finder to infer that Dr. Al-Shami’s decisions

were based on anything other than medical judgment. See e.g.

Zackery v. Mesrobian, 299 Fed. Appx. 598, 601, 602 (7th Cir.

2008) (finding no deliberate indifference and granting summary

judgment in favor of jail doctor who used his own medical

judgment in rejecting specialist’s recommendations).

Next, Cashner complains that on September 4, 2012, Dr. AlShami told him that he would no longer treat Cashner’s headaches.

Even if Dr. Al-Shami made such a statement, that statement itself

while unprofessional, would not violate the constitution. DeWalt

v. Carter, 224 F.3d 607, 612 (7th Cir. 2000). And, whether Dr.

Al-Shami made those statements is immaterial. The undisputed

facts and medical records show that Dr. Al-Shami continued to

treat Cashner on numerous occasions beyond September 4, 2012.

Upon review, Dr. Al-Shami was Cashner’s primary care

provider from June 2012 to December 2012. In those six months,

the medical records show that Dr. Al-Shami personally met with

and examined Cashner six times. In addition, Dr. Al-Shami issued

telephone orders on 17 different occasions to assist Cashner with

his health concerns. The records reflect Dr. Al-Shami met

regularly with Cashner, prescribed him various medications, and

monitored his condition in an effort to get his headaches and

blood pressure under control. The records also establish that Dr.

Al-Shami would change medications and treatments when they proved

45
ineffective. It is clear that Dr. Al-Shami diligently worked with

Cashner to alleviate his headache problems. While Cashner

apparently may not have agreed with all aspects of Dr. Al-Shami’s

treatment, dissatisfaction with a doctor’s chosen course of

treatment - even when it is negligent - is insufficient to

establish deliberate indifference. Estelle, 429 U.S. at 107. In

light of the totality of care Dr. Al-Shami provided, a reasonable

fact-finder could not construe his actions as deliberate

indifference. Walker, 233 F.3d at 501. The Court recognizes there

is not one appropriate way to practice medicine in a prison, but

rather a range of acceptable courses of action based on

prevailing standards in the field. See Snipes v. DeTella, 95 F.3d

586, 592 (7th Cir. 1996) ("[T]he Constitution is not a medical

code that mandates specific medical treatment."); see also

Estelle v. Gamble, 429 U.S. 97, 107 (1976). Because the record is

devoid of any evidence that Dr. Al-Shami acted deliberately

indifferent to Cashner’s medical condition, summary judgment on

his behalf is appropriate.

2. Nurse White was not deliberately

indifferent to Cashner’s medical condition

Cashner was granted leave to proceed on his allegations that

Nurse White delayed him being treated by a neurologist by failing

to arrange for him to be transported to his June 28 and September

13, 2012, appointments with Dr. Vyas. (DE ##1, 5.) However, the

46
undisputed facts show that Nurse White did not cause any delays.

Cashner was not transported to an appointment with Dr. Vyas on

June 28, 2012, due to a worker shortage at the jail along with an

emergency situation that arose on that day. And, Cashner’s

September 13, 2012, appointment was cancelled by Dr. Al-Shami

because he did not find it medically necessary. Thus, Nurse White

was not involved in delaying Cashner’s neurologist appointments.

The reasons why Cashner was not transported those two

appointments with Dr. Vyas were beyond her control and there is

no evidence that she was deliberately indifferent to Cashner’s

condition. In his response, Cashner does not argue to the

contrary. (See DE 70.) Thus, Nurse White is entitled to summary

judgment as well.

3. Warden Widup was not deliberately

indifferent to Cashner’s medical condition

Cashner was granted leave to proceed on his allegations that

Warden Widup delayed him being treated by a neurologist by

failing to arrange for him to be transported to his June 28 and

September 13, 2012, appointments with Dr. Vyas. (DE ##1, 5.)

However, as explained above, Warden Widup played no role in

Cashner not being transported to Dr. Vyas’ office on those dates.

Thus, he cannot be held liable. Burks v. Raemisch, 555 F.3d 592,

596 (7th Cir. 2009).

47
Cashner was also granted leave to proceed on his allegations

that Warden Widup cancelled the treatment and procedures ordered

by Dr. Harmston due to monetary concerns. Cashner claims that on

September 4, 2012, Warden Widup stated that “an MRI was too

expensive for the jail to pay for.” (DE #70-2 at 3.) However, the

undisputed evidence reveals that Warden Widup had no personal

involvement in the decisions involving Cashner’s medical care.

Though Cashner does not like it, the law encourages non-medical

staff to defer to the judgment of medical personnel. See Berry v.

Peterman, 604 F.3d 435, 440 (7th Cir. 2010). Thus, regardless of

Warden Widup’s opinion of how costly an MRI was, it was entirely

reasonable and proper for Warden Widup to defer to the medical

personnel’s decision regarding Cashner’s health care in this

case. Vance v. Peters, 97 F.3d 987 (7th Cir. 1996). There is no

evidence that Warden Widup instructed any jail staff to deny

Cashner any necessary medical treatment. Nor is there any

evidence that Warden Widup knew Cashner was being denied any

necessary medical treatment. Consequently, Warden Widup is

entitled to summary judgment. 

B. State Medical Malpractice Claims

Finally, as all of his federal claims have been dismissed,

this Court declines supplemental jurisdiction over Cashner’s

remaining state law claims. Cady v. South Suburban College, 152

48
Fed. Appx. 531, 534 (7th Cir. 2005); Groce v. Eli Lilly & Co.,

193 F.3d 496, 501 (7th Cir. 1999). Accordingly, Cashner’s state

law claims are dismissed without prejudice.

CONCLUSION

For these reasons, the Court:

(1) GRANTS the defendants’ motions for summary judgment (DE 

 ##64, 66);

(2) DISMISSES with prejudice Plaintiff’s federal claims;

(3) DISMISSES without prejudice Plaintiff’s state law 

 claims; and

(4) ORDERS the clerk to enter judgment in favor of the 

 defendants consistent with this order and close this 

 case.

DATED: December 21, 2016 /s/ RUDY LOZANO, Judge

United States District Court

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