United States Court of Appeals

For the Seventh Circuit

Chicago, Illinois 60604

Submitted December 19, 2019*

Decided December 19, 2019

Before

JOEL M. FLAUM, Circuit Judge

MICHAEL Y. SCUDDER, Circuit Judge

AMY J. ST. EVE, Circuit Judge

No. 19-1351

ALFREDO GARCIA,

Plaintiff-Appellant,

v.

ARMOR CORRECTIONAL HEALTH 

SERVICE, INC., et al.,

Defendants-Appellees.

Appeal from the United States District 

Court for the Eastern District of Wisconsin.

No. 17-C-1075

Lynn Adelman,

Judge.

O R D E R

While held in the Milwaukee County Jail, Alfredo Garcia slipped on water 

overflowing from his toilet and was knocked unconscious. He regarded the care that he 

received for his injuries to be insufficient, and so he brought this deliberate-indifference 

suit against various jail employees; the Milwaukee County Sheriff; and Armor 

Correctional Health Service, Inc., the private entity contracted to provide medical care 

 

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

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

not significantly aid the court. FED. R. APP. P. 34(a)(2)(C).

NONPRECEDENTIAL DISPOSITION

To be cited only in accordance with Fed. R. App. P. 32.1
No. 19-1351 Page 2

at the jail. Both sides moved for summary judgment, and the district court entered

judgment for the defendants. We affirm.

At the time that Garcia entered confinement at the Milwaukee County Jail in late 

2016, he was recovering from a recent surgery on his lower back. He had suffered a long 

history of back problems stemming from an industrial accident in the 1970s. He used a 

walker, a back brace, and two knee braces.

Five days after his arrival at the jail, on a Saturday evening, he noticed water 

flowing out of his toilet. He notified a correctional officer, who called the control center 

to request that the water be cleaned up. At some point between 8:15 and 8:40 p.m., 

Garcia slipped, fell, hit his head, and lost consciousness. 

Around 8:40, Latisha Aikens, a correctional officer, noticed Garcia on the floor of 

his cell and immediately called for assistance. Within minutes, three other officers and 

Cary Adriano, a registered nurse, rushed to the cell. Garcia says that they left him 

“laying in urine and poop filled water before ... attend[ing] to him.” Adriano examined 

Garcia and saw a “small goose egg” sized bump on the back of his head, but noted that 

he was alert, his pupils looked normal, and he could move his arms and legs. After 

determining that Garcia was stable, Adriano called the jail’s advanced registered nurse

practitioner, who provided several instructions: give Garcia antihypertension 

medication, check his blood pressure, schedule an appointment with an outside 

provider for further evaluation on Monday, conduct neurological checks twice daily for 

three days, and provide Tylenol as needed for three days. Garcia asked to go to the 

hospital but was told he could not because the jail was understaffed.

The next day, Garcia filed a grievance, complaining that the medical staff had not 

taken him to the hospital after his fall. He also submitted a non-emergency healthcare 

request form, stating that his fall necessitated medical attention—“maybe x-rays.” 

Around this time, a notation was made in his medical file indicating that an 

appointment needed to be scheduled so that he could be seen by an outside provider. 

Three days later he was transferred to a Wisconsin state prison, without any 

appointment made or his grievance addressed.

Eight months later he was diagnosed with “severe disk disease” in his cervical 

spine—the direct result, he contends, of the defendants’ failure to provide him adequate 

medical care after his fall. 
No. 19-1351 Page 3

Garcia then filed this Eighth Amendment suit against the defendants for not 

sending him to the hospital. He also brought a Monell claim against Armor Correctional 

Health Service, the jail’s private medical provider, and David Clarke, the Milwaukee 

County Sheriff, for maintaining a policy or widespread custom of understaffing the jail.

See Monell v. Dep’t of Soc. Servs., 436 U.S. 658, 694 (1978). 

The parties cross-moved for summary judgment, and the district court entered 

judgment in favor of the defendants. Regarding Garcia’s claims against the correctional 

officers, the court determined that they were entitled to reasonably rely on the 

treatment decisions of the jail’s healthcare professionals. Concerning Garcia’s claims 

against Nurse Adriano, the court concluded that Garcia’s mere disagreement with his

treatment was insufficient to establish that Adriano was deliberately indifferent. Finally, 

as to Garcia’s Monell claims against Armor and Clarke, the court determined that Garcia 

failed to produce any evidence showing that the jail was understaffed as a matter of 

custom or policy. Even if he had, the court continued, Garcia had no evidence that 

Clarke or Armor knew about the understaffing and failed to act. 

On appeal, Garcia first challenges the entry of summary judgment on his Eighth 

Amendment claim that the non-medical officers and Nurse Adriano delayed treating 

him and provided inadequate care. The treatment must have been deficient, he 

maintains, because he was later diagnosed with severe disk disease. 

Prison officials are deliberately indifferent if they know of and disregard an 

excessive risk to an inmate’s health or safety, Farmer v. Brennan, 511 U.S. 825, 837 (1994), 

but Garcia presented no evidence that the defendants responded to his injury with 

indifference. When Aikens noticed Garcia lying on the cell floor, she called for 

assistance, and other officers and Nurse Adriano rushed to the scene, examined Garcia,

and deemed him stable. Garcia may have disagreed with Adriano’s decision (made in 

consultation with the advanced nurse practitioner) not to send him to the emergency 

room, but mere disagreement with a medical provider’s course of treatment is generally 

insufficient to show deliberate indifference. See Lockett v. Bonson, 937 F.3d 1016, 1024

(7th Cir. 2019). Adriano followed up her initial evaluation of Garcia with a treatment 

plan over the next three days that included neurological checks and pain medication, as 

well as an appointment to be scheduled for Garcia to be seen by an outside provider

(the appointment never took place because Garcia was promptly transferred to a state 

prison). These actions do not reflect that Adriano departed substantially from accepted 

professional judgment, see Wilson v. Adams, 901 F.3d 816, 822 (7th Cir. 2018); and the 
No. 19-1351 Page 4

other officers—who are not medical professionals—were entitled to reasonably rely on 

Adriano’s medical judgment. See Giles v. Godinez, 914 F.3d 1040, 1049 (7th Cir. 2019). 

Next, Garcia contends that summary judgment on his Monell claims was 

improper because a factual dispute exists over whether Armor or Clarke knew about 

the jail being understaffed and failed to fill vacant positions. Under Monell, however, 

Garcia needed to present evidence sufficient for a jury to find that the company had 

systemic staffing deficiencies that policymakers knew about but failed to correct. 

See Dixon v. Cook Cty., 819 F.3d 343, 348 (7th Cir. 2016). (This circuit’s case law extends 

Monell from municipalities to private corporations. See Shields v. Ill. Dept. of Corrs., 

746 F.3d 782, 796 (7th Cir. 2014).) Although Garcia reports being told that the jail was 

understaffed on the night he fell, he failed to adduce evidence to suggest that any 

understaffing was systemic. Even if he had, he has not demonstrated that Armor or 

Clarke knew about the problem. Summary judgment was therefore warranted for 

Clarke and Armor. 

 

Finally, Garcia argues that the district court erred by not admitting into evidence 

security camera footage from inside the jail that, he says, shows that the defendants left 

him lying in wastewater until they retrieved towels before providing him any 

treatment. The district court deemed the video inadmissible because neither party 

submitted an affidavit identifying it. “A party seeking to admit evidence must first 

establish a foundation for its authenticity.” United States v. Brewer, 915 F.3d 408, 416 

(7th Cir. 2019); FED. R. EVID. 901. Although Garcia alluded to a video in his declaration, 

he did not explain how he obtained it, when he obtained it, or how he knew that it 

contained what he purported it did. It appears that he mailed a USB drive containing 

the video to the district court without explanation. Under these circumstances, the court

properly declined to admit the video into evidence. 

We have considered Garcia’s remaining arguments (including his

unsubstantiated claim that the defendants forged his medical records), and none has 

merit.

AFFIRMED