Paul A. Smith v. PAMELA E. HART as Administrator of the Estate of Andrew H. Tilden

United States Court of Appeals
For the Seventh Circuit
Chicago, Illinois 60604
Submitted April 28, 2026*
Decided April 29, 2026
Amended April 30, 2026
Before
THOMAS L. KIRSCH II, Circuit Judge
JOSHUA P. KOLAR, Circuit Judge
REBECCA TAIBLESON, Circuit Judge
No. 25-1631
PAUL A. SMITH,
Plaintiff-Appellant,
v.
PAMELA E. HART as Administrator of
the Estate of Andrew H. Tilden, et al.,
Defendants-Appellees.
Appeal from the United States District
Court for the Central District of Illinois.
No. 21-1236
Colleen R. Lawless,
Judge.
O R D E R
* We have agreed to decide the 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. A PP. P. 34(a)(2)(C).
NONPRECEDENTIAL DISPOSITION
To be cited only in accordance with FED. R. A PP. P. 32.1

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No. 25-1631 Page 2
Paul Smith, an Illinois prisoner, sued Dr. Andrew Tilden,1 the former Medical
Director at Pontiac Correctional Center, along with nurse practitioners Alison
Burchardt, Cheryl Hansen, and Sheila Mara, alleging that they were deliberately
indifferent to his serious medical needs in violation of the Eighth Amendment.2
See 42 U.S.C. § 1983. The district court entered summary judgment for all defendants.
We affirm.
We recount the facts in the light most favorable to Smith and draw all reasonable
inferences in his favor. See Riley v. Waterman, 126 F.4th 1287, 1295 (7th Cir. 2025). Smith
was incarcerated at Pontiac Correctional Center from March 2013 until June 2014, and
again from June 2015 until June 2023. Dr. Tilden was the Medical Director at Pontiac
when Smith was incarcerated there. During his time at Pontiac, Smith suffered from
various medical conditions, including eczema, acid reflux, headaches, and swelling in
his legs and feet. To treat Smith’s eczema, prison medical staff administered numerous
creams and topical ointments, but when those treatments proved ineffective, they
referred him to a dermatologist at the University of Illinois Chicago (UIC). The
dermatologist evaluated Smith for eczema and elephantiasis. Dr. Tilden reviewed the
dermatologist’s report and implemented all but one of the recommendations—
including use of compression stockings, prescriptions for Allegra and Zyrtec, and
referring Smith to a cardiologist for an echocardiogram to rule out congestive heart
failure.
To treat Smith’s acid reflux (and associated symptoms of heartburn), medical
staff prescribed various medications, including Zantac, which effectively relieved his
symptoms. After the Food and Drug Administration determined Zantac contained
unsafe levels of a cancer-causing chemical, Dr. Tilden discontinued Smith’s prescription
and instead prescribed Pepcid and Prilosec. These proved less effective than Zantac at
controlling Smith’s acid reflux.
Smith also suffered from severe headaches and a painful cyst on his left temple.
To treat the headaches, medical staff progressed through seven different medications,
but none provided relief for Smith’s symptoms. Dr. Tilden eventually prescribed an
1 Dr. Tilden died during the litigation and the court granted Smith’s unopposed
motion to substitute Pamela Hart as the administrator of Dr. Tilden’s estate.
2 Smith also sued physician assistants James Caruso and Riliwan Ojelade. The
district court concluded those claims were time-barred, and Smith does not pursue
them on appeal.

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No. 25-1631 Page 3
eighth medication, Ultram, which did help relieve Smith’s headaches. To treat the cyst,
medical staff referred Smith to a dermatologist at UIC who surgically removed it. Smith
did not suffer further pain after the operation and his headaches ceased.
Finally, Smith, who in 2021 weighed 367 pounds, experienced significant
swelling in his legs and feet. Prison medical staff referred Smith to an outside facility for
an ultrasound, which confirmed that Smith did not have a blood clot or deep vein
thrombosis. Dr. Tilden, suspecting that the swelling might have been caused by water
retention, prescribed a diuretic and other medication to control Smith’s heart rhythm.
Later, Dr. Tilden sent Smith to a cardiologist at UIC who, after an echocardiogram,
ruled out the possibility of congestive heart failure. After seeing additional specialists,
Smith was diagnosed with lymphedema (tissue swelling caused by fluid buildup in the
lymphatic system). Smith received multiple medications for his condition, none of
which was effective in reducing his swelling.
Smith filed this lawsuit in July 2021, alleging that the defendants violated his
rights under the Eighth Amendment by acting with deliberate indifference toward the
treatment of his various medical conditions. See 42 U.S.C. § 1983. He asserted that, for
each of his conditions, they persisted in providing courses of treatment that they knew
were ineffective. In the district court, Smith twice moved for recruitment of counsel. The
court denied both motions, concluding that he appeared competent to represent
himself.
After the close of discovery, the parties cross-moved for summary judgment. The
district court denied Smith’s motion as untimely (it was filed two months after the
deadline) and granted summary judgment to the defendants. First, the court accepted
the defendants’ facts as undisputed because Smith had failed to respond to the
defendants’ undisputed material facts in the manner required by local rules. See C.D.
ILL . R. 7.1(D)(2)(b). The court then concluded, based on those facts and its own review of
the record, that no reasonable jury could find that the defendants violated Smith’s
rights. Undisputed medical records and Smith’s own sworn testimony at a deposition
showed that his providers were highly responsive to his complaints about each of his
conditions, routinely provided and changed his medications when they were not
effective, and followed the recommendations of the several specialists who examined
Smith.
On appeal, Smith first asserts that the court abused its discretion by accepting the
defendants’ proposed facts as undisputed. He contends that his pro se status obligated
the court to either overlook his noncompliance with the local rule requiring a

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No. 25-1631 Page 4
paragraph-by-paragraph response, see C.D. ILL . R. 7.1(D)(2)(b), or allow him to amend
his response. But we have repeatedly explained that district courts may “strictly
enforce” their local rules, even with respect to self-represented litigants. See McCurry v.
Kenco Logistics Servs., LLC, 942 F.3d 783, 787 & n.2 (7th Cir. 2019). And although district
courts may allow a litigant to fix a defective statement of facts, FED. R. C IV. P. 56(e)(1),
Smith did not request the opportunity to do so here. Even if he had, the district court
was under no obligation to permit it. See Robinson v. Waterman, 1 F.4th 480, 483 (7th Cir.
2021).
Accepting the defendants’ facts as undisputed, the record does not support
Smith’s claim that the defendants’ treatment decisions amounted to deliberate
indifference. When a prisoner believes he has received inadequate medical care in
violation of the Eighth Amendment, he must show that he “suffered from an objectively
serious medical condition” and that the “individual defendant[s] w[ere] deliberately
indifferent to that condition.” Petties v. Carter, 836 F.3d 722, 728 (7th Cir. 2016) (en banc)
(citing Farmer v. Brennan, 511 U.S. 825, 834 (1994)).
Like the district court, we assume that each of Smith’s medical conditions was
serious, but the medical records and his own testimony at his deposition suggest that
the defendants were attentive—not indifferent—to his ailments. Smith’s testimony
shows that the defendants evaluated him repeatedly, sent him to outside specialists for
testing and procedures, and prescribed and adjusted the dosage of different drugs
when he complained that some were not effective. Cf. Arce v. Wexford Health Sources Inc.,
75 F.4th 673, 681 (7th Cir. 2023). For example, after Smith complained that the
medications he received for his headaches were ineffective, Dr. Tilden prescribed him
Ultram, which Smith confirmed was effective during his deposition. For his cyst, Dr.
Tilden referred Smith to UIC for an excision, which Smith confirmed was successful and
relieved his pain. For his eczema and swelling, Smith’s medical records show—and he
did not dispute—that prison medical staff prescribed him new medications after he
complained, referred him to outside specialists, and implemented nearly all of the
specialists’ recommendations. Smith may have wanted different treatments, or hoped
for more complete or speedier relief, but a prisoner’s mere disagreement with the
course of treatment is not evidence of deliberate indifference. See Lewis v. Sood, 126 F.4th
525, 531–32 (7th Cir. 2025). On these facts, no reasonable jury could conclude that any of
the defendants were deliberately indifferent to any of Smith’s medical conditions.
Smith also argues that the district court abused its discretion by striking his
cross-motion for summary judgment. He relies on an outdated version of Federal Rule

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of Civil Procedure 56, which provided summary judgment could be sought “at any
time.” The rule now provides that the district court may set its own deadlines. See FED.
R. C IV. P. 56(b). Smith had already filed a response to the defendants’ motion for
summary judgment, and his own cross-motion was untimely by nearly two months.
Finally, Smith argues that the district court violated his right to due process, or at
least abused its discretion, in denying his motions to recruit counsel. We disagree. For
each motion, a magistrate judge applied the correct legal standard, see Pruitt v. Mote,
503 F.3d 647, 658 (7th Cir. 2007) (en banc), and reasonably concluded that counsel was
not necessary. The court considered Smith’s unsuccessful efforts to recruit counsel on
his own but concluded that he appeared capable of litigating on his own, pointing to
Smith’s successes in requesting and obtaining discovery. Smith provides no specific
reason to question these determinations. See McCaa v. Hamilton, 959 F.3d 842, 846–47
(7th Cir. 2020).
We have considered Smith’s other arguments, and none merits discussion. The
judgment of the district court is AFFIRMED. Smith’s motion to stay the district court’s
award of costs is DENIED as moot.

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