In the

United States Court of Appeals

For the Seventh Circuit ____________________ 

No. 19-1767 

MICHAEL THOMAS, 

Plaintiff-Appellant, 

v.

ALINE MARTIJA, et al., 

Defendants-Appellees. 

____________________ 

Appeal from the United States District Court for the

Northern District of Illinois, Eastern Division.

No. 15 C 7187 — Rebecca R. Pallmeyer, Chief Judge. 

____________________ 

ARGUED OCTOBER 28, 2020 — DECIDED MARCH 16, 2021 

____________________ 

Before RIPPLE, WOOD, and BRENNAN, Circuit Judges. 

WOOD, Circuit Judge. In 1976, the Supreme Court 

recognized that the government has an “obligation to provide 

medical care for those whom it is punishing by incarceration.” 

Estelle v. Gamble, 429 U.S. 97, 103 (1976). And the state may not 

punish someone by withholding necessary care. As this court 

has recognized, the Eighth Amendment “safeguards the 

prisoner against a lack of medical care that ‘may result in pain 
2 No. 19-1767 

and suffering which no one suggests would serve any 

penological purpose.’” Petties v. Carter, 836 F.3d 722, 727 (7th 

Cir. 2016) (en banc) (quoting Gamble, 429 U.S. at 103). The 

question in this case is whether Michael Thomas, who has 

been incarcerated in Illinois for over a decade, suffered from 

deliberately indifferent medical care in violation of his Eighth 

Amendment rights with respect to the care his prison 

furnished (or failed to furnish) for his broken hand and his 

enlarged prostate. 

In this suit, which Thomas brought under 42 U.S.C. § 1983, 

he seeks recovery from three sources: Dr. Saleh Obaisi; Dr. 

Aline Martija; and the company that Illinois uses to provide 

prison health care, Wexford Health Sources. The district court 

granted summary judgment to all defendants on all claims.

We agree with the dispositions in favor of Dr. Martija and 

Wexford. We conclude, however, that triable issues of fact 

remain with respect to Dr. Obaisi (who appears here through 

his Estate, since he died several years ago). We thus reverse 

and remand that part of the judgment. 

I 

Thomas broke his hand in the midst of a fight at the Hill 

Correctional Center on March 23, 2011. He sought and 

received medical care from the Hill staff, who put a cast on 

his hand and prescribed a low-bunk permit to avoid 

subjecting him to severe pain and potential further injury 

from the need to use his broken hand to reach the upper bunk. 

X-rays from May 9, 2011, showed that Thomas’s hand had 

begun to heal but was still fractured. 

On May 11, 2011, Thomas was transferred to Illinois’s

Stateville Correctional Center, where he remains today. 
No. 19-1767 3

Before he left Hill, the prison officials there told him that his 

cast needed to be removed for the transfer, but that he would 

receive a new cast upon his arrival at Stateville. Thomas 

agreed to have the cast taken off. Upon his arrival at Stateville, 

however, no one recasted him. A Stateville doctor reviewed 

Thomas’s May 9, 2011, x-ray (taken at Hill) on June 19, 2011, 

and concluded that the fracture remained “unresolved.” That 

observation went unnoted. A physician’s assistant looked at

the same x-ray on June 30, 2011, and determined that Thomas 

required no further treatment. Yet a doctor’s note from 

August 2011 described the injured hand as “still healing,” and 

apparently things were still unresolved as of December 2011, 

when a doctor referred Thomas to physical therapy for his 

hand. Thomas received that therapy ten months later, from 

October to December of 2012. 

Our story picks up a year later, when in November 2013 

Dr. Obaisi became the medical director at Stateville; Dr. 

Martija joined its staff in July 2014. Thomas began seeing both 

Dr. Obaisi and Dr. Martija when he sought treatment and 

accommodations for lingering complications from his hand 

injury. Up until August 2014, he had kept his low-bunk 

permit, but it expired at that time. Asserting that he was still 

unable to navigate the top bunk, in October 2014 Thomas met 

with Stateville medical staff and asked them to renew the lowbunk permit. He also submitted formal requests through the 

prison’s grievance system for a referral to an orthopedic 

specialist for lingering complications from the same hand 

injury. Thomas met with Dr. Obaisi on January 15, 2015, at 

which time he repeated his requests for the low-bunk permit 

and for additional treatment for his hand (even though the 

appointment was for his prostate condition). Thomas

submitted a grievance reiterating those requests the same day.
4 No. 19-1767 

Five months later, on June 25, 2015, Dr. Obaisi responded. He 

renewed Thomas’s low-bunk permit in the course of another

visit related to Thomas’s enlarged prostate, and he agreed to 

refer Thomas to an orthopedic specialist. That appointment 

was scheduled for four months later, on October 29, 2015. 

After the orthopedists at the University of Illinois at 

Chicago (UIC) delayed Thomas’s appointment for an 

additional month, Thomas finally was seen there. The UIC 

specialist reported on November 12, 2015, that Thomas had 

suffered some nerve damage in his hand, with consequent 

diminished sensation. The specialist told Thomas that he 

would not have suffered such significant complications if his 

hand had been properly treated. 

As we indicated, Thomas also suffers from an enlarged 

prostate—a condition he has had since at least 1996. The 

record shows that from 2011 to 2016 he received regular 

treatment from medical staff in the prison system for his 

prostate. He has received the drug Flomax for this condition 

for many years, although Thomas does not believe that the 

Flomax has helped much. Thomas also saw Dr. Obaisi on 

January 15, 2015, for a residual urine test (a procedure that 

reveals blockage from an enlarged prostate), but he declined 

the opportunity to undergo the same procedure a week later. 

II

The account of the facts we have just provided presents 

them in the light most favorable to Thomas, the party 

opposing summary judgment. The only question before us is 

whether these facts require judgment for the defendants, even 

when viewed in that favorable light, or if there is some work 

for the trier of fact to perform. Weighing evidence is for the 
No. 19-1767 5

factfinder, not the court. Anderson v. Liberty Lobby, Inc., 477 

U.S. 242, 255 (1986); Kodish v. Oakbrook Terrace Fire Protection 

Dist., 604 F.3d 490, 505 (7th Cir. 2010). On the other hand, if 

there are no genuine disputes of fact and the record shows 

that the movant is entitled to judgment as a matter of law, no 

trial is needed. Thomas challenges the district court’s grant of 

summary judgment in favor of all three defendants. We first 

consider the individual defendants, and then turn to 

Wexford.

A. Individual Defendants

A prison official—including someone in the position of the 

doctors here—violates the Eighth Amendment “only when 

two requirements are met. First, the deprivation alleged must 

be, objectively, sufficiently serious,” and second, “[the] prison 

official must have a sufficiently culpable state of mind.” 

Farmer v. Brennan, 511 U.S. 825, 834 (1994) (internal quotation 

marks omitted). Farmer defined that state of mind as 

“deliberate indifference,” which exists when “the official 

knows of and disregards an excessive risk to inmate health or 

safety; the 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.” Id. at 837. 

In Davis v. Kayira, we elaborated on this standard, as it applies 

to an Eighth-Amendment claim based on inadequate medical 

care: 

[A] plaintiff might point to a number of things, 

including the obviousness of the risk, the defendant’s 

persistence in a course of treatment known to be 

ineffective, or proof that the defendant’s treatment 

decision departed so radically from accepted 

professional judgment, practice, or standards that a 
6 No. 19-1767 

jury may reasonably infer that the decision was not 

based on professional judgment. 

938 F.3d 910, 915 (7th Cir. 2019) (cleaned up). In addition, 

“inexplicable delay in treatment which serves no penological 

interest” can support a finding of deliberate indifference in 

this context. Petties v. Carter, 836 F.3d at 730; Grievson v. 

Anderson, 538 F.3d 763, 779 (7th Cir. 2008). 

The district court accepted for purposes of the defendants’ 

summary-judgment motion that Thomas’s two medical 

conditions were objectively serious, but it concluded that 

Thomas had failed to present any evidence that would permit 

the trier of fact to conclude that either doctor acted with 

deliberate indifference. We too confine our attention to the 

latter issue. 

1. Dr. Obaisi

Before reaching Thomas’s substantive claims against Dr. 

Obaisi, we must clear away a procedural obstacle: what effect, 

if any, does the fact that Thomas is now proceeding only 

against Dr. Obaisi’s Estate have on this case? Thomas argues 

that the Estate has waived any substantive defenses to his 

section 1983 claim on appeal because in the trial court the

Estate raised only the Illinois dead man’s statute in defense. 

That statute, Thomas contends, creates a state-law defense 

that applies in federal court only to matters for which state 

law provides the rule of decision. See Fed. R. Evid. 601; 

Lovejoy Electronics, Inc. v. O’Berto, 873 F.2d 1001, 1005 (7th Cir. 

1989). Since federal law provides the rule of decision in a case 

under section 1983, federal law governs privilege here. 

Thomas is overstating the matter a bit: the Supreme Court 

has instructed that state law provides the federal rule of 
No. 19-1767 7

decision in cases under section 1983 for some issues that the 

statute does not address, including survivorship. See 42 

U.S.C. § 1988; Robertson v. Wegmann, 436 U.S. 584 (1978). The 

parties did not mention this wrinkle, but this case is not 

affected by it. Thomas thoroughly briefed his substantive 

claims against Dr. Obaisi before both the district court and 

this court, and the Estate has had ample opportunity to 

respond. We are therefore free to proceed to the merits. 

a. Hand Injury

Thomas focuses on Dr. Obaisi’s long, and in Thomas’s 

view needless, delay both in renewing his low-bunk permit 

and in referring him to a specialist in response to his constant

complaints of pain. It is not enough, however, simply to point 

to a delay, which may or may not reflect deliberate 

indifference. Instead, we ask how serious the condition in 

question was, how easy it would have been to treat it, and 

whether it exacerbated an injury or unnecessarily prolonged 

pain. Petties, 836 F.3d at 730–31. Delay need not be extreme; 

failing to provide a very easy treatment or accommodation 

can suffice, if unnecessary suffering resulted. See Gil v. Reed, 

381 F.3d 649, 662 (7th Cir. 2004). 

Failure to grant a low-bunk permit can support a finding 

of deliberate indifference. See, e.g., Palmer v. Franz, 928 F.3d 

560 (7th Cir. 2019); Withers v. Wexford Health Sources, Inc., 710 

F.3d 688 (7th Cir. 2013). Similarly, a physician’s delay, even if 

brief, in referring an inmate to a specialist in the face of a 

known need for specialist treatment may also reflect 

deliberate indifference. See Goodloe v. Sood, 947 F.3d 1026 (7th 

Cir. 2020); Petties, 836 F.3d at 726. Even a delay of less than a 

week may be the result of deliberate indifference. See Conley
8 No. 19-1767 

v. Birch, 796 F.3d 742, 749 (7th Cir. 2015) (five days attributable 

to defendant). 

As our earlier account of the facts shows, Dr. Obaisi did 

not respond for six and ten months to Thomas’s requests for 

the renewal of his low-bunk permit and a referral to an 

orthopedic specialist. This timing would allow a factfinder to 

conclude that Dr. Obaisi was aware of Thomas’s continuing 

pain from the hand and consciously and needlessly delayed 

both measures. Thomas filed a grievance in October 2014 after 

meeting with prison medical professionals; that grievance 

covered his request for the renewal of the low-bunk permit, 

which had expired in August 2014, as well as his petition to 

see a specialist. Nothing came of it. Thomas then had an 

appointment with Dr. Obaisi on January 15, 2015, during 

which Thomas informed the doctor that he still needed a new 

low-bunk permit. Thomas codified this request in a formal 

grievance filed the same day. Dr. Obaisi finally began 

processing this request five months later, on June 25, 2015, 

after an appointment for Thomas’s prostate problems, 

without any explanation for his earlier inaction. 

Dr. Obaisi now offers several responses, but none in our 

view suffices to support summary judgment in his favor. 

First, he suggests that the evidence does not actually support 

a finding of when he knew about the permit request because

his own notes from the January 2015 appointment do not 

mention it. But Thomas’s first-hand account of that 

conversation is competent evidence, even if one alternatively 

could infer from the lack of mention in the note that the issue 

was not raised. A jury reasonably could conclude that Dr. 

Obaisi simply did notrecord this detail. Indeed, failing to note 

a request is consistent with deliberate indifference toward 
No. 19-1767 9

that concern. Thomas’s concurrent grievance immediately 

after the appointment also supports a finding that he did, in 

fact, mention his request. Again, the fact that a jury might 

instead conclude that Dr. Obaisi learned about the request 

only on June 25, 2015, during the prostate exam, just shows 

that there is a dispute of fact that must be resolved. Dr.

Obaisi’s notes from the June appointment indicate only “pain 

r[ight] hand post metacarpal fracture,” with no mention of a 

request for a permit. Yet in June Dr. Obaisi did take action on 

Thomas’s persistent request for a renewal of the low-bunk 

permit. A jury reasonably could conclude that Dr. Obaisi had 

known about the permit request for some time and, for no 

reason that appears in the record, simply delayed acting on it. 

Dr. Obaisi also contends that Thomas failed to present 

concrete evidence that would permit a finding that he was 

forced to use an upper bunk during the period of delay. We 

do not read the record this way. After Thomas’s low-bunk 

permit expired in August 2014, he made a request for its

renewal in October. Thomas reiterated his plea in January

2015, both during his appointment with Dr. Obaisi and 

through the formal grievance channels. A jury could 

reasonably conclude either that Thomas had to use an upper 

bunk between August 2014 and January 2015, and that this is 

what prompted his repeated requests for the accommodation, 

or at a minimum that he feared an imminent loss of his nowunprotected low-bunk privilege. Or the jury might see 

Thomas’s behavior as bad-faith pestering; we have no way of 

knowing without a trial. It is enough for present purposes to 

say that a reasonable jury could conclude that Thomas would 

not have persisted in his request unless he actually needed the 

accommodation. 
10 No. 19-1767 

But, Dr. Obaisi suggests, perhaps Thomas did not actually 

need the permit after January 2015, when the doctor may have 

first known about Thomas’s request, because Thomas did not 

renew his request before June. That is just one possible 

inference from the five-month hiatus; another is that Thomas 

was discouraged or that he was trying to advance his request 

in other ways. A reasonable jury could conclude that a person 

who already had asked twice for a renewed permit and had 

submitted grievances formalizing that request still needed the 

permit. It could also find, on this record, that the delay would 

expose him to pain by forcing him to use his poorly healed 

broken hand to climb to an upper bunk. 

b. Specialist Referral

The evidence would also permit a jury to conclude that Dr. 

Obaisi acted with deliberate indifference by unnecessarily 

delaying referring Thomas to an orthopedic specialist. Recall 

that Thomas asked for this referral in October 2014 and 

January 2015 when he saw Dr. Obaisi, and that he

documented those requests through the formal grievance 

process. Dr. Obaisi finally began the referral process on June 

25, 2015. A jury could conclude that Dr. Obaisi learned about 

this request as early as the January appointment or through 

Thomas’s grievance filed immediately after that appointment, 

yet inexplicably failed to act for many months. 

Dr. Obaisi contends that he was not responsible for the 

delay; instead, he says, it was the fault of the UIC orthopedist. 

He suggests that the orthopedist may not have had an 

opening before October 2015, and that it was UIC, not himself, 

that rescheduled the appointment for November. All this is to 

say that there are facts that need to be resolved. It is enough 

for now that there is evidence supporting two possibilities: 
No. 19-1767 11

either that Dr. Obaisi was deliberately indifferent to Thomas’s 

needs and caused this delay, or that administrative issues 

beyond his control were to blame. Moreover, one cannot 

blame the orthopedists for delays before June 2015, when Dr. 

Obaisi initiated the referral process. 

Although Farmer requires only a showing of a substantial 

risk of harm to an inmate, it is still necessary to link that harm 

or the risk thereof to the defendant. Thomas has done so in 

two ways. First, he relies on the rule that a cognizable injury 

exists where an inmate presents “independent evidence that 

the delay exacerbated the injury or unnecessarily prolonged 

pain.” Petties, 836 F.3d at 730–31 (citing Williams v. Liefer, 491 

F.3d 710, 716 (7th Cir. 2007)) (emphasis added). Dr. Obaisi’s 

delay, he contends, unnecessarily prolonged his pain while he 

was waiting for the orthopedist’s treatment plan, which

ultimately included splinting his hand and pursuing physical 

therapy. Second, Thomas points to medical reports from his 

visit with the orthopedist. Those reports indicate that Thomas 

suffered from diminished sensation in his fingers and healing 

abnormalities, and they note that Thomas’s fracture had “not 

completely healed.” A jury could conclude that the delay in 

adequately treating Thomas’s hand injury led to nerve 

damage and improper healing. Failure to provide necessary 

relief and delaying access to a qualified specialist can lead to

prolongation of pain. See Goodloe, 947 F.3d at 1032; Petties, 836 

F.3d at 731–32; Conley, 796 F.3d at 749. 

Dr. Obaisi pushes back against the proposition that the 

injuries the orthopedist documented are fairly traceable to 

anything he did or failed to do. When asked whether the 

damage “was due to the original breaking or due to the 

recovery after that,” the orthopedist told Thomas that his 
12 No. 19-1767 

nerve damage resulted from “the original breaking.” But a 

jury reasonably could conclude that this meant only that the

recovery process did not cause additional damage. That

possibility is consistent with the theory that the original break

caused the nerve damage because it was ignored for too long. 

Thomas’s case is also not undermined by the fact that he 

did not complain about his hand for two years and then again 

noted significant pain in October 2014 and January 2015. A 

jury could conclude that he suffered a setback caused by 

imperfect healing and that Dr. Obaisi’s failure to act with any 

sense of urgency exacerbated the injury. 

Taking another tack, Dr. Obaisi suggests that Thomas was 

responsible for his problems in 2015 because he got into a 

fight in March of that year and punched another inmate. 

Thomas may have used his formerly broken hand and caused 

all the damage the orthopedist documented in November 

2015. But Thomas complained of significant pain in his hand 

in October 2014, well before the new fight, and he formally 

asked to be seen by a specialist then and again in January 

2015. No fight two months after the later date could have 

affected that course of events. It is also worth noting that 

nothing in the record reveals which hand Thomas used 

during the March 2015 incident. 

Dr. Obaisi calls our attention to a potential typographical 

error in the medical report from the orthopedist and asks us 

to draw an inference favorable to him from that supposed 

glitch. On November 12, 2015, the orthopedist indicated that 

the fracture “has now completely healed.” But notes from 

Thomas’s next appointment with the same doctor on 

September 1, 2016, indicate that new x-rays showed that the 

fractures in his hand “[were] not completely healed, but are 
No. 19-1767 13

shortened.” The defendants want us to read the “not” in the 

second note as a typo and to instead insert “now,” which 

would be consistent with the earlier note. (One could also 

change the first note’s “now” to a “not,” for that matter.) But 

we must take all inferences in the light most favorable to 

Thomas, and from that perspective, the later note just 

indicates that the new x-rays furnished additional 

information about his condition. Support for the latter view 

also comes from a radiology report from a September 1, 2016, 

appointment; that record indicates that the x-rays from 

November 12, 2015, and September 1, 2016, revealed 

“redemonstrations” of the bone injury. With this before it, a

jury could conclude that the hand had never fully healed (and 

so was susceptible to repeated re-injury), and thus that Dr. 

Obaisi’s delay referring Thomas to a specialist unnecessarily 

prolonged his pain. 

Dr. Obaisi argues finally that he cannot be held 

responsible for any additional suffering because the 

orthopedist’s treatment plan mirrored the one the prisons 

initially followed in 2011 and 2012—that is, the use of a splint 

and occupational therapy. But if anything, a reasonable jury 

could conclude that a person who broke his hand in 2011 

would not normally need to be splinted in 2015 or to receive 

additional physical therapy in 2016. From this, a jury might 

conclude that Dr. Obaisi acted with deliberate indifference by 

delaying his referral of Thomas to someone qualified to 

address the new pain in 2014 and 2015 from this old injury. 

c. Prostate

Thomas’s last complaint against Dr. Obaisi concerns the 

doctor’s response to his enlarged prostate. He had been 

getting Flomax from various doctors since as early as January 
14 No. 19-1767 

2012. Dr. Obaisi, and later Dr. Martija, continued that 

prescription, but Thomas complained that it was ineffective

and that the doctors knew this. He supports his allegation of 

knowledge with several medical records. First, a Wexford 

medical professional’s ultrasound referral for his prostate on 

January 5, 2012, indicated that Thomas “failed initial 

medication trials with ... Flomax.” This note suggests, 

according to Thomas, that doctors in the Wexford system had 

known since at least January 2012 that Flomax was ineffective

for him. Second, Dr. Obaisi noted during an appointment on 

June 25, 2015, that Thomas “ha[d] been off Flomax which 

reduced nocturia.” Nocturia is a condition that causes the 

person to wake up frequently during the night to urinate; it is 

associated with an enlarged prostate (among other things). 

Thomas contends that a reasonable jury could find that Dr. 

Obaisi concluded that Thomas would suffer less from 

nocturia if he was taken off Flomax. Nonetheless, Dr. Obaisi 

(and later, Dr. Martija) continued to prescribe Flomax rather 

than explore alternative treatment plans. 

Persisting in treatment known to be ineffective can 

constitute deliberate medical indifference, provided that the 

doctor was subjectively aware that the treatment plan was 

ineffective. Petties, 836 F.3d at 729–30; Goodloe, 947 F.3d at 

1031. It is not enough that the plaintiff simply believes the 

treatment was ineffective or disagrees with the doctor’s 

chosen course of treatment. Johnson v. Doughty, 433 F.3d 1001, 

1013 (7th Cir. 2006); Estelle v. Gamble, 429 U.S. 97, 107 (1976). 

The challenged plan must deviate so substantially from 

accepted professional judgment that no reasonable physician

would reach the same judgment. Arnett v. Webster, 658 F.3d 

742, 751 (7th Cir. 2011). 
No. 19-1767 15

For this part of the case, we agree with the district court 

that no jury could conclude that Dr. Obaisi acted with 

deliberate indifference when he chose to continue the Flomax 

prescription. Dr. Obaisi was not alone in his judgment that 

this was the proper drug. Dr. Martija came to the same 

conclusion, as did Thomas’s earlier doctors. The one note to 

which Thomas points is not enough to create a jury issue. 

Even if Thomas’s nocturia was temporarily reduced while he 

was not taking Flomax, trade-offs are common in medicine, 

and the evidence in this record indicates that Flomax is a 

widely accepted treatment for an enlarged prostate. Indeed, 

Thomas asked for additional Flomax prescriptions when his 

prescription ran out in May and June of 2015. 

2. Dr. Martija

We can be briefer with Thomas’s claims against Dr. 

Martija, because she was not as involved in his treatment. We 

begin, as before, with the hand injury and the associated 

complaints about the low-bunk permit and the specialist 

referral. The extension of the low-bunk permit that Dr. Obaisi 

granted expired on December 26, 2015. Shortly thereafter, 

Thomas asked Dr. Martija to renew it. Dr. Martija’s notes from 

Thomas’s appointment with her on January 22, 2016, reveal 

that she renewed the permit. Nothing in the record would 

permit a finding that Dr. Martija learned of Thomas’s renewal 

request any earlier than January 22, 2016, and so no jury could 

conclude that she acted with deliberate indifference during 

the one-month period between the expiration of the permit 

and her renewal. Similarly, by November 2015 Thomas had 

seen the UIC orthopedist; Dr. Martija had nothing to do with 

any delays in that process. 
16 No. 19-1767 

Finally, with respect to the enlarged prostate, all that Dr. 

Martija did was to continue the prescriptions of Flomax. 

Thomas alleges that she ignored the presence of records 

dating as far back as 1996 reporting that he suffered from an 

enlarged prostate. Those records show that he had benign 

prostatic hyperplasia (BPH) (i.e. an enlarged prostate), and a 

January 2012 ultrasound confirmed this diagnosis. Dr. Martija 

seems to have had some reservations about this assessment, 

because she wrote after Thomas’s appointment in May 2015 

that she saw “no basis for BPH.” But she did not act on that

skepticism. Instead, she prescribed Flomax and offered to 

conduct standard tests to determine the seriousness of his 

condition. She also reviewed Thomas’s medical records and

determined that nothing required more aggressive action. She 

ordered a follow-up residual urine test in June 2015 with Dr. 

Obaisi. Neither doctor thought that the results of this test 

required a change in Thomas’s treatment. 

This course of events, even construed favorably to 

Thomas, does not reflect deliberate indifference. The district 

court thus correctly granted summary judgment in favor of 

Dr. Martija. 

B. Wexford

We turn finally to Thomas’s claims against Wexford. The 

critical question for finding a corporation liable under Monell

v. Dep’t of Social Servs., 436 U.S. 658 (1978), “is whether a 

municipal (or corporate) policy or custom gave rise to the 

harm (that is, caused it), or if instead the harm resulted from 

the acts of the entity’s agents.” Glisson v. Indiana Dep’t of Corr., 

849 F.3d 372, 379 (7th Cir. 2017) (en banc). Monell recognizes 

three primary ways in which one might prove that the 

corporation or municipality itself inflicted the harm. First, the
No. 19-1767 17

plaintiff may show that the alleged unconstitutional conduct 

implements or executes an official policy adopted by the 

entity’s officers. Monell, 436 U.S. at 690; see also Glisson, 849 

F.3d at 379 (quoting Los Angeles Cnty. v. Humphries, 562 U.S. 

29, 35 (2010)). Second, the plaintiff may show that the 

unconstitutional action was done pursuant to a custom—even 

one that is not formally codified. Monell, 436 U.S. at 690–91. 

Finally, the plaintiff may prove that an actor with final 

decision-making authority within the entity adopted the 

relevant policy or custom. Id. at 694; see also Vodak v. City of 

Chicago, 639 F.3d 738, 747 (7th Cir. 2011). 

The district court found that Thomas could not satisfy any 

of these approaches and thus could not proceed on his claim 

against Wexford. It added that Monell liability is unavailing 

because, as it saw things, none of the individual defendants

was liable, and municipal liability requires an underlying 

constitutional violation. Petty v. City of Chicago, 754 F.3d 416, 

424–25 (7th Cir. 2014). 

We find no merit in Thomas’s arguments to the contrary. 

He contends that the failure of the doctors at Stateville to 

provide the treatment of his hand that the Hill staff promised 

as a condition for his transfer reveals a custom of deliberate 

indifference. We have described that transfer earlier and see 

no need to repeat the details. It is enough to say that this single 

incident of a lapse in follow-up medical care is not enough to 

show either a formal policy on Wexford’s part or an informal 

custom. 

Thomas also urges that Dr. Obaisi was the final 

policymaker for Stateville. He reads our holding in Petties as 

confirming that the medical director of a particular facility is 

a final decisionmaker for Monell purposes. Petties held that the 
18 No. 19-1767 

plaintiff had alleged enough to proceed in an individual suit 

against Dr. Imhotep Carter, who was then serving as 

Stateville’s medical director. But the defendant in Petties was 

Dr. Carter, individually; it was not Wexford, his employer. 

The fact that Dr. Carter was following (or not) certain 

procedures prescribed by Wexford was pertinent to the 

deliberate indifference analysis, but it did not sweep Wexford 

in as a defendant. There is no evidence supporting the 

counter-intuitive idea that Wexford, the corporation, has as 

many “final” decisionmakers as it has prisons. Nothing in the 

record supports a finding that an institution-level medical 

director sat at “the apex of authority” for Wexford’s transfer 

policies. See Vodak, 639 F.3d at 748. 

Finally, Thomas alleges that Wexford’s failure to establish 

a policy designed to coordinate treatment between facilities 

when an inmate is transferred constitutes deliberate medical 

indifference. It is true, as we held in Glisson, that the decision 

not to have a policy can itself be a policy for Monell purposes.

849 F.3d at 379. But here Thomas has not presented any 

evidence that would permit a jury to find that Wexford had a 

policy not to provide coordinated care. All we know is that in 

Thomas’s case, after he arrived at Stateville the transferee 

doctors said that they did not know that the transferor

personnel had promised Thomas that he would receive a new 

splint. But the Stateville staff did not ignore Thomas; they 

performed their own medical assessment and concluded that 

he did not need a new splint. That may have been good 

medical care, or not, but it does not support a finding that an 

overriding policy was driving their decisions. 
No. 19-1767 19

III

We REVERSE the district court’s grant of summary 

judgment in favor of Dr. Obaisi and REMAND the case against 

his Estate for further proceedings consistent with this 

opinion. We AFFIRM the district court’s judgment in favor of 

Dr. Martija and Wexford Health Sources.